Friday, September 10, 2004

The Dementia Wrench

Mari and I were discussing dementia and dying. How can one believe in a soul when they watch their loved one fade away over a period of years due to dementia? My experience with dementia is somewhat limited. My great-grandmother developed dementia and I witnessed her living with it over years, however I was so young, that I don't recall what she was like before the onset of dementia. I also have worked with numerous patients in the hospital whom have had dementia, however, once again, I didn't know them before they became demented.

I don't claim to truly know the answers. But these are the thoughts I've been playing around with...

Can the soul (if there is one) really be lingering so long after one loses one's mind? Though that could be asked of anyone suffering from any illness - physical as well as mental. People in comas, people who lose their ability to communicate for whatever reason. But I believe yes. There is a wiser presence within us - that we access whenever we have the courage and/or ability to - that exists for all. I believe that our brains both make life meaningful as well as hinder us. Our lives are spent trying to overcome our own thoughts in a way - through meditation, yoga, psychotherapy, prayer, addictions, whathaveyou.

JennyNYC wrote in my comments section of my Is There Life After Death? posting:

"Psychology comes into it too. Someone in a coma might exert energy not to "let go" until comfortable. People in comas function at some level; otherwise, they'd be dead."

Yes, I will definitely - without a doubt - acknowledge there is a very strong component to the dying experience that is a psychological process of letting go of this life. However, through watching so many people die, I still think there is more to it. Again, back to the dementia - or in the case of brain death this might apply. These patients don't necessarily have the brain physiology to understand on a psychological level what is happening - they can't even tell you where they are, let alone why they are in the hospital. Yet there is a part of them, a wiser self, that seems to reside beyond the limits of their physical brain power that responds to the experience of dying (as I described in the last post - i.e. waiting for people to arrive before dying - people that in their dementia they may not even be able to identify if looked at).

So I say all this for the sake of exploring the subject. I'm still not sure what I believe. But dementia certainly complicates the beliefs that I've had in place until now and still provides ample food for thought.

JennyNYC: "What do you make of all the people who deserve to have closure but die without it? All the people who die with unresolved circumstances, with unfinished business? What accounts for the difference?"

Luck. lol. Though, really that may be a big part of it. Of course, this is complicated by several factors - some people don't want to deal with their death consciously enough to face their unfinished business. Others may cling to life, even after horrible accidents, desperate to resolve conflicts from this life. I think 1) some of these conflicts are then resolved internally without the people involved needing to be present - just as they are in our lives, in general. The cliche of our life passing before our eyes could be a quick attempt to find resolution from within. 2) We die as we live. If we've lived in denial much of our lives, we may be willing to die with that same denial. I think reincarnation is possible. That might explain these unresolved issues then needing to be resolved in a next life. Who knows? But accidents happe: plane crashes, murder, drowning. We are not all given the luxury of time at the end of our life. That said. I think it's important to contemplate our death in this life. Not to be morbid and morose. But I believe it is important not to wait until our time is up to find those resolutions. Make ammends today. One can never know what tomorrow will bring.


big seester said...

What a creepy thought, but what if dementia didn't always necessarily remove a person's ability to identify the present, only removed their ability to act upon their inclinations? Okay, that's a stretch, but I'd love it if someone would prove to me why that can't be true.

Admittedly, I haven't been around many people who suffered from this. My grandmother, who recently passed away, suffered from Alzheimer's. As it crept upon her, many years ago, she told me she could feel her memories slipping away, and that made her sad. Eventually, a lot of memories seemed to leave her, except possibly memories from her childhood.

The last time I saw her, although her body was there, the woman I knew was somewhere else. It wasn't as if she were gone, she had just become so internal (I can't think of another way to say it) that the external world didn't seem to matter any more. It was as if she were dreaming. She spoke quietly and mostly incoherently of things and people who weren't there, but I'm guessing that they had been, once upon a time. It's like her mind had traveled back in time, but her body was left in the present.

I'd like to think that she's somewhere still, but the thought that she's been released is equally as comforting. About a decade ago I also recall her talking about death and how it had become less frightening as she entered old age. She spoke of it wistfully, as if she were waiting for it. It saddens me that she had to wait so long for the release, that she had to go through so much suffering. Not physical suffering, but the feelings she undoubtedly had of uselessness, of wanting to go back home from where she was being "cared" for, of being a burden to those she loved. She was in her nineties when she passed away.

Anonymous said...

This is really interesting. I also have limited experience in this area. Both of my grandmothers died of Alzheimer's. Most recently my mother's mother, and I was very close to her, and so it really brought all of these issues of death and the dying process right into my consciousness. I didn't, however, really think of it in terms of the loss of one's mind and how it affects their experience with death, but more in terms of the family.

I tend to think about things in terms of feeling. So, often it's about sensation, intuition, etc, which makes me very inarticulate at times, but I will try to explain my thoughts on this. I am not sure what I belive about spirituality, about the afterlife, about the soul. I do believe that people have an energy that is beyond any capacity that we have as humans for explaining. I believe that this energy is still there when someone has a markedly decreased cognitive capacity, which is not the same as being in a coma. But maybe that is because I have always associated "coma" with death.... the person is essentially dead even though they may be breathing. But in terms of mental capacity, even if the person is not capable of understanding their situation, the physical processes that happen to them, I believe they "know" something. Just like they can still feel, cry, be happy or angry. There is a sense of something happening, even if the words cannot be used to describe it or if they forget whatever a few minutes after they remember. When I was with my grandmother, I knew that she was still there somewhere, maybe not the same person she had always been, but because she would smile or laugh. Small things, but things indicating life... whatever that means... even without cognition.

Dementia also poses a number of other issues for the family.... That gaping sense of loss and grief is there long before the body actually dies. I think, more than dealing with terminal illness in general, being with someone who is dying and in the throes of dementia does not allow for the family to put closure on the experience in the same way as they could if their loved one was still "mentally" present. Although, memories of that person as their whole person can help put things into perspective once they have died, and true closure and acceptance can begin then. When everyone's suffering through the process has stopped.

And who knows. Maybe the person with dementia has put closure on their dying experience (or their life) in a different way. Maybe it's something that we can't understand or explain, or maybe it's a different experience because they aren't cognitively aware of what is going on... They can just slip away more peacefully based on those -- feelings -- that I was describing before. Maybe it's just something we don't know because it's beyond what we can understand in our own experience and beyond what science can explain right now.

Those are my thoughts -- I hope they make sense.