Rabbi Sandra Katz on spiritual dimensions of dementia

Spirituality and Dementia

“Rabbi, I feel so frustrated when she tells me she wants to go home. What am I supposed to tell her? I can’t take care of her at home or I would still be doing it.” Of course. That’s why she’s here. It is our privilege to take care of her. I think, yes, and being away from the family enables her to explore her identity in new ways now. She can let go of being who others always thought she was. She can have the disarray she needs to feel the nearness of the Holy One.

When I work with people who have begun to let loose of former roles and strictures, I find that they sometimes have a new freedom to explore emotional issues that were previously off limits. I believe that is a gift that dementia can offer: it enables the individual to do emotional and spiritual work in a new way.

I love the sacred dimension of working with a resident who tells me, “I want to go home.” As an interpreter of sacred text, I hear the statement on its face value, and in deeper ways. [1] I can validate the person’s concern, and walk with him or her in the longing to go home. Sometimes it is very satisfying to talk about what is meaningful and memorable about home. It’s natural to think of those things.

On a deeper level, the individual may be speaking in metaphor. Is there a place I belong? When will I die? What will death be like? Is it okay to want to die?

Then I see our human condition reflected in these words. My partner in this encounter is speaking for me, too, and for humanity. What does home mean? How welcome it sounds to have a place of just being, a place of acceptance, and a place where we belong. Especially for those who have suffered since childhood, the longing for a real home, maybe one with our eternal loving Parent, sounds deeply authentic.

Could this resident talk about death before the dementia began? In many cases, no. Letting go of parts of the identity, especially the parts that blocked free expression of feelings, can give individuals new access to feelings and to the language of exploring them. There is a holiness in the present that people focused on the past, the future, or what others think might miss. [2] My friends with dementia apprehend it – and they have the gumption to share it.

If we are not going to live this way forever – no matter what medicine promises – we may as well accomplish our life goals. Some people we meet have very thick shells. Dementia allows a not-so-gentle opening of the veneer coating these individuals. It hurts to see them change. We grieve for their losses – and they do, too, when we give them room to do so.

“Where are my schoolbooks?” “I know I put my wallet in this purse.” “Can you give me a dime for the streetcar?” I hear these on their face value, but also as invitations to walk together a little in a new place. [3]

As a corollary, I would also add that perhaps those of us who have had the liberty and/or the courage to do the emotional/spiritual work of our lives may not have to worry about NEEDING dementia to free us. Well, we can hope…

[1] I am indebted to Rabbi Dayle Friedman for this notion.
[2] Thanks to Rabbi Sam Seicol for this idea.
[3] Naomi Feil’s work, Validation, also informs this article. Her original book seems to be out of print, but she has a recent publication called Validation Breakthrough: Simple Techniques for Communicating with People with Alzheimer’s-Type Dementia.

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