Do not cast me off in the time of old age; forsake me not when my strength fails me. (Psalm 71:9)
I often think of this verse whenever I look into the eyes of first-time visitors to our Jewish nursing home and see the fear of growing old, of becoming frail, of being in the “valley of the shadow of death” (Psalm 23:4). So stark is the “otherness” of this place, often the proverbial comfort of “Your rod and Your staff” eludes.
And no place here seems to broadcast the message more clearly than the dementia-designated floor. Language, rules for communication and socialization, reference points of “reality” are utterly different in this alien world.
The outsiders view the inhabitants as pitifully less than human. Some even classify them as falling outside the definition of “personhood,” and thereby no longer entitled to the moral and legal protection of being a full “person.” And, when they become virtually inanimate, unable to do anything on their own, they are defined by the word “vegetable”—depriving them of any vestige of their humanity.
This is not a Jewish point of view. Judaism (as well as Christianity and Islam) affirms that every human being, no matter how capable or compromised, is created in the Divine image and therefore possesses infinite, unconditional worth. Indeed, our tradition teaches that even a goseis— a person who is in the process of dying—is still fully human and may not even be touched, lest death be hastened (Semachot 1:1–3; Shabbat 151b). And we learn in Midrash Song of Songs Rabbah (5:16) that every person present at Sinai heard God’s Voice uniquely, perhaps because the Voice was heard not only by the mind, but also by the soul. For Jews to say the “v” word (“vegetable”) is not only politically incorrect, it is a sacrilege. A human being can never be less than “fully human,” much less a “vegetable.”
In my role as a rabbi and a chaplain, I have spent countless hours helping residents with advanced dementia stay spiritually and culturally connected to God, Torah, and the Jewish people. In playing to their strengths, to whatever capacities they still retain, I’ve come to realize that many cognitively impaired residents seem more spiritually attuned than other residents who are more cognitively intact.
One individual, whom I will call Joe, coped with advanced Alzheimer’s disease. As his cognitive abilities waned, he forgot the words to the blessing over the wine, and his responses didn’t always fit the question he was asked. But I could always count on him to help set the atmosphere for our weekly Kabbalat Shabbat (welcoming the Sabbath). He would greet me with a warm handshake, a smile, and a reminder: “Rabbi, it’s time to talk to the Boss!” Then he would pray and sing with joyful enthusiasm and heartfelt spontaneity. Despite loss of memory, executive function, and bowel and bladder control, he was one of the most spiritually attuned people I’ve ever met.
Interestingly, in Joe’s case and other instances, Alzheimer’s disease can actually be a boon to someone’s “personhood,” precisely, and ironically, because it is a boon to his or her spirituality. I have witnessed heightened feelings of joy, spontaneity, enthusiasm, and gratitude in people with dementia, because these feelings no longer pass through the cognitive filter of the rational mind. Sometimes I marvel that folks like Joe seem more fortunate spiritually than those of us who have that filter. With the loss of cognition and memory, they no longer worry about the past or the future. And because they live only in the present, they are usually more at ease. When offered love, compassion, and physical contact, they tend to respond with more intuitive, primal, and pure feelings of affection. Indeed, when they are no longer aware that they are no longer aware, but have not yet lost their operative capacity to speak and communicate cogently, they faithfully entrust their care to others, human or Divine—sometimes quite enthusiastically.
In a curious way, I have come to view persons with advanced dementia as assuming the role of “angels.” As foreign as this may sound and contrary to what many of us may have been taught, Judaism has a long, rich tradition of angelology, which does not necessarily subscribe to the popular notion of angels as having wings, halos, and flowing robes. Jewish tradition teaches that angels are spiritual entities created by God to perform a single task. Some serve God by conveying information to mortals (the Hebrew word for angel— mal’akh —means “messenger”); others may be assigned to protect, fight for, or rescue them.
Still other angels are given special assignments. For example, in Jewish tradition Satan is not “the devil,” but rather an angel assigned the task of tempting human beings and then holding them accountable for their misdeeds. Other angels are created to perpetually sing God’s praises. We read of them in the traditional Shacharit (morning) service: “They (the Heavenly Beings) all perform with awe and reverence the will of their Creator; they all open their mouths with holiness and purity…with pure speech and sacred melody, they all exclaim in unison and with reverence: Holy, holy, holy is Adonai Tsevaot; the whole world is full of God’s glory.”
Yet, no matter their assignment, in Jewish tradition angels do not have free will or free choice. Unlike human beings, they are “pre-programmed” to serve God through specific assigned tasks.
From my experience, when persons with dementia lose their ability to make choices, they become like angels. Their behavior is no longer a function of what they choose to say or do, but rather of circumstances beyond their control. And, like many of their Heavenly counterparts, their task (whether they are aware of it or not) is now to sing praises to God.
Our Sages teach that, in the Shacharit service, when we recite the Kedushah prayer proclaiming God’s sanctity in the world—just as the seraphim (angels) did in Isaiah’s vision (Isaiah 6:2–3)—we create a “symmetry of sanctity” with these Heavenly Beings: humans praising God on Earth just as the angelic singers do on high. However, while we—with our free will intact—may choose to sing, those with advanced dementia cannot help but sing. What comes out of their mouths may sound to us like gibberish and nonsense, but in fact it may be a faithful replication of what is offered on high—with purity of the soul.
Persons with dementia are like angels in another important way. They are, albeit unwittingly, “messengers from God,” daily delivering a standing invitation from the Creator to reflect on what it means to be human. They beckon us to be grateful for our God-given gifts and abilities, and also to know our limitations; to discern when we must take responsibility for our lives, and when we must “let go” and put our trust in another—whether that “other” is human or Divine.
I am aware that many people will be unconvinced by my likening persons with dementia to angels. While they may concede that these individuals are not “vegetables,” some readers may consider them more “in between.” Even if this is so, all of us would do well to remember Martin Buber’s observation: It is the spaces “in between” where one encounters holiness.
Our perspective on persons with dementia ultimately depends on how we choose to see them. We can choose to hear the grunts, shrieks, and bleating as cacophonies of suffering and abandonment in seemingly “God-forsaken places.” Or we can choose to understand these human beings as unwitting messengers of God, their sounds the pure lyrics of this testimony. For if the whole world truly isfull of God’s glory, then God does not forsake places where even helplessness and death seem to hold sway.
In Judaism, we experience the sacred not only with awe and reverence, but also with fear. Significantly, the Hebrew word yirah denotes both meanings—“fear” and “reverence”—simultaneously. As author and philosopher Sam Keen has observed, “In the life of the spirit, paradox is the rule…the opposites coincide, the diseased parts form a graceful whole….In considering the whole and holiness of life, we must at once hold before our eyes visions of horror and wonder, cruelty and kindness….Both/and, not either/or” (Fire In the Belly: On Being a Man).
I pray that when we are in the presence of people with advanced dementia, we will come to open ourselves, on a deeper level, to the possibility of having angels in our midst. And may we come to understand and accept the natural, abiding tension of “fear” and “reverence” in these scary but sacred moments.Then, may we affirm anew that, however broken our world may be, “the whole world is full of God’s glory.” For if we merit the ability to glue the broken fragments back together, we may ultimately redeem them.