Dementia, Faith, and Friendship with Christ

In a Facebook response to a recent homily, a friend posted:

People with dementia forget the relationships they have with people, eventually even close family members they have known for decades and meet regularly. Presumably a relationship with God is not exempt from this? What does this mean? I know that God will never blame me for something that is not my fault, and dementia isn’t anyone’s fault. How does faith fit into it all?

The short answer is that a person in friendship with Christ before the onset of dementia will not lose that friendship because of dementia, and a person who never knew Christ while they were of sound mind is in a similar category to an infant.

The long answer goes like this:

The importance of living in friendship with Christ, is that it is the key to spending eternity in happiness with God (a.k.a. “Going to Heaven”). We can’t earn heaven (Jesus did that on the Cross) and we can’t even make the first step towards accepting the offer of heaven (this needs God’s grace, though Pelagius didn’t think so). Yet some response on our part is needed when we are prompted. So what do we have to do to accept God’s offer of heaven? Different texts in the Bible point to different answers.

Matthew 25:31-46 (“The Sheep and the Goats”) implies that it all depends on whether or not you helped your neighbour when they were in need.

John 6:53-58 (“The Bread of Life”) suggests that only those who take Holy Communion will attain heaven.

John 3:3-5 (“Be Born Again”) says we must be “born again” of water and the Spirit. Some interpret this to mean baptism, though the Catholic tradition allows for the “baptism of desire” of anyone who had planned to receive water baptism but died before it was possible. Others interpret it as experiencing a personal infilling with the Holy Spirit (a.k.a. Baptism in the Holy Spirit).

Romans 10:9-13 (“Speak and Be Saved”) says that you must believe in your heart and profess with your lips that Jesus is Lord.

It would be wrong to rest everything on one passage alone, for God has given us the whole of the Bible that we may know His message. The Romans passage is key, for if we believe and profess that Jesus is Lord, we will become his disciples, and keep all the commands he has given us. We will seek water baptism, if we are not already baptised. We will receive Holy Communion regularly, because he commanded us to do so in memory of him. We will do our utmost to help our needy neighbours. If we fail to do this things, we will not be professing Jesus as Lord.

But two things are necessary foundations for any of this to take place. One is that the person hears the message of Jesus. The other is that they are of sound mind, at least sound enough to understand and respond.

Concerning those who never heard the message, St Paul says they can be saved by doing good according to their own conscience – “the law in their hearts”. This is why the Catholic Church has never said that all human beings automatically go to heaven (those who knowingly turn away from God’s law or who are of persistent ill-will may not), nor that only baptised Catholics go to heaven.

Concerning those who died before ever attaining the use of reason, the Catholic church is confident that baptised infants go to heaven and cautiously optimistic that all who die in childhood are welcomed by Christ, who affirmed children on earth.

What of those who, having lived an adult life, lose their use of reason? Here I am not aware of any formal doctrinal statements, so I will do my best to extrapolate what the Church does teach to cover this situation.

We understand that a person, of sound mind, cannot repent and choose Christ after bodily death. If a sudden and unexpected death befalls a thinking adult – as could happen to any one of us at any time – we receive a particular judgement based on our earthly decisions up to that point. It seems reasonable to say that we also lose our ability to repent and choose Christ if dementia reaches a severe degree, and this is no more unfair than the consequences of sudden death.

If a practicing Catholic is afflicted with dementia, they are only morally responsible for their personal actions to the extent that they understand what they are doing. Once extreme dementia totally removes personal responsibility, it is no longer possible for that person to sin. And since a practicing Catholic can receive the Sacrament of Anointing even though they have lost the use of reason, those sins can be forgiven. Canon Law also requires the priest to give the benefit of the doubt to an unconscious Catholic, so unless it is fairly certain that Catholic would have refused anointing, they must be given the Sacrament. This sacrament forgives sins. It is not uncommon for a priest to be called to the deathbed of a long-lapsed Catholic, and to confer Anointing, even if the person cannot communicate; the lapsed Catholic therefore receives God’s forgiveness before death. This echoes the paralysed man having his sins forgiven on the strength of the faith of the friends who brought him to Jesus (Mark 2:3-5).

I was once called to the bedside of a woman on a life-support machine and was asked, by her teenage children, to baptise her. They insisted that she had never been baptised but was a Christian, watched religious TV programmes with them, sang along with the hymns, and had had her daughters baptised. Now it looked like she would never regain consciousness before the life-support machine was turned off. Nothing in the Catholic rulebook for baptism explicitly covered this scenario. I could only baptise an adult if they explicitly professed faith, but this woman was now in the state of a disabled person who might permanently lack capacity to profess faith – and if she had been a child, could have been baptised on the say-so of her parents. I decided to go ahead with the baptism, giving strict instructions that were she to recover, religious instruction would be needed on how to live as a Catholic.

Coming back to my friend’s original question, how does faith fit into it all? In the Gospels, healing comes by faith. Often it is the faith of the sick person who approaches Jesus. Sometimes it is the faith of another – the friends of the paralytic, or a parent whose child is dying. Sometimes the Lord himself takes the initiative, raising a dead child or casting out a demon.

During our earthly life, that faith can only be expressed within the limitations of our flesh. Clearly, our immortal soul’s capacity to communicate is limited by being in flesh, and more so when there is some illness or deformity affecting the brain. When we die, our soul will meet Christ without the fetters of this earthly life. We can trust that God will be a just judge and will not expect more of any soul than was possible for its own individual circumstances. And yet in some way we will receive the reward of our faithful actions; there will be a greater kind of happiness for those who walked in obedient friendship with Christ, praying and receiving the sacraments, than for those who simply followed their conscience.

It is possible for God to overcome mental illness and brain damage, and communicate Himself to a soul in any way he chooses. But experience tells us that God will not often do this (at least in a way with external consequences), and so people of faith have the painful experience of seeing their loved one with dementia lose touch with their religious identity.

Ultimately, a key mystery of the Christian faith is that Jesus asks us to make disciples of all nations, scattering our seed on the thorny, stony, and barren soil. Only a few seeds bear fruit in abundance; yet the Lord’s work for us is to sow anyway. God chooses which souls are born in places and times which can hear the Gospel proclaimed. God chooses which souls should receive extraordinary calls to conversion (such as St Paul on the road to Damascus). Even those of sound mind can experience a ‘long dark night of the soul’ when God withdraws a conscious sense of his presence – this happened to Blessed Teresa of Calcutta. God’s plan also allows those cases where the good soil loses its fertility through dementia, and personal awareness of God is lost until the soul awakens into eternity. This may seem like a very unsatisfactory state of affairs, but if God is the kind of God proclaimed by the Catholic faith, it is the only one consistent with the reality of the world around us.