“She was a wonderful mother and a devoted wife”, he said, holding her hand. She sadly didn’t meet his gaze but rather looked past him, glassy-eyed and unseeing. As her speech pathologist I was sitting by her bedside, watching her not recognise her husband of 41 years. She was in the final stages of Alzheimer’s disease and we were discussing the very few medical intervention options left for her—she was no longer eating as she’d forgotten the purpose and function of food. After careful and sorrowful reflection, her husband decided against further intervention and therefore against invasively inserting a tube in her stomach via surgery.
Dementia, including Alzheimer’s disease, is a brain disease that gradually erodes a person’s mental capacities. The prevalence of dementia is increasing with the ageing population in Australia: as of 2018, three in 10 people over 85 are affected, and one in 10 people over 65 are affected. With our identity often bound by our memories, those with advanced dementia are often described as “the living dead”—the body is alive but the person isn’t. A question that arises for followers of Jesus is this: is a Christian still a Christian if they’ve forgotten Jesus?
Salvation and dementia
The Bible holds two seemingly contradictory ideas:
- Justification. Salvation is a gift from God to which believers contribute nothing (Ephesians 2:8)
- Regeneration. Believers who fail to obey the word of God will be denied his kingdom (Hebrews 4:6)
Dementia touches the regeneration aspect of salvation. Sufferers often can no longer process long dialogues (such as sermons) and they struggle to discuss abstract ideas that are often brought up in Bible study. They may not seem to be living out their faith: dementia symptoms such as aggression, depression, suspicion and paranoia contribute to this dilemma. In effect, a Christian person can become indistinguishable from a non-believer in their conduct.
So… what do we do?
Step 1: Distinguish the illness from the person
Dementia can make Christians appear as though they have forgotten God, which is very often very distressing for families and carers. But this is not necessarily the case. A sinful and deliberate failure to rebel against God is not the same as the symptoms of dementia. The two things must be distinguished.
When a Christian with dementia displays anger or suspicion, God sees into their hearts (Jer 17:10) and knows if the person has abandoned him or is succumbing to illness. He will know which aspects of the behaviour are a result of the disease or of sinfulness.
Step 2: Don’t abandon God
A diagnosis of dementia is not an excuse to abandon God. A person may appear to abandon him as the disease progresses, but this is not a permission to do so prematurely.
Calvin maintained that eternal life does not depend upon “perfect knowledge of God” and that God has been known to call people “by the illumination of the Spirit apart from the medium of preaching” (Calvin, Inst. IV. XVI.19). Even if a person is unable to give outward signs of their faith such as attending church or reading the Bible, we must not underestimate the work of the Holy Spirit to bring and sustain faith apart from these things.
Step 3: Depend on God’s memory
Although human memory is frail, God’s memory is not. The fulfillment of God’s promise to Abraham in Genesis 12, culminating in the coming of Jesus, spans thousands of years. God’s memory never faltered. Furthermore, God’s memory brings salvation independent of human memory. God can, has, and does, save those who forget him. Speaking of the Israelites rescued from Egypt in the Exodus, the psalmist writes:
They did not remember the abundance of [God’s] steadfast love…
Yet he saved them for his name’s sake,
that he might make known his mighty power. (Ps 106:7, 8)
The psalmist uses this to support his encouragement to ask God to remember to save us:
help me when you save them. (Ps 106:4)
Even if a Christian no longer resembles what they once were (or who they are in their hearts), God’s immutability and omniscience means that he will not judge a person upon their last moments. A Christian can be confident that God will know their heart.
Dementia is not a unique condition that can remove a Christian from God. Once a Christian commits to God, they are etched forever into God’s memory. If their intention is not to fall away, regardless of their capacity to display faith, then “neither death nor life, nor angels nor rulers, nor things present nor things to come, nor powers, nor height nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord” (Rom 8:38-9).