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Senile Dementia and A Resurrection Theology
By Glenn D. Weaver

"Slow physical deterioration and loosened social relationships have profound spiritual significance, for they can separate a person from God. It is remarkable that the laments which so vividly portray this human despair should dominate the Psalter-Israel's book of praise. Their presence must be taken to reflect complex struggles to understand a God who could only be the just, loving, sovereign Lord, yet who stood witness to such violation of God's purposes for human beings."

DIAGNOSIS of senile dementia, Alzheimer's disease, has recently increased to the point that it is now considered the fourth leading cause of death in adults. Since Alzheimer's disease does not respond to any known form of treatment, it presents an increasing threat to the health of the aging and an increasing dilemma for mental health professionals. When Christians consider this disorder, which seems so clearly the product of a simple deterioration of the brain, they often tend to think of it primarily as a "health" problem which has little spiritual significance. That is, the disorganization of psychological processes in dementia does not really affect one's relationship with God for this relationship extends through channels that transcend the experience of the body. We frequently say something like this to demented patients when they feel guilty about their loss of behavioral control.

Such a medical compartmentalization of senile dementia neither fits the understanding of persons presented in the Bible nor the experience that most demented patients know firsthand. A more biblically based theology concerning this type of suffering should help us to understand better the spiritual journeys of many of these patients and to realize our collective relationship to the single great hope for them-the hope of resurrection in Jesus Christ.

I

The Psalter contains some of the most lyrically comforting passages in the Bible. It is poetry that catches us up from the trials of everyday

Glenn D. Weaver is Visiting Professor of Psychology at Calvin College. He is a graduate of Wheaton College, Princeton Theological Seminary, and Princeton University where he received his Ph.D. in psychology. His teaching and research interests are in the areas of psychopathology, motivation, and relationships between psychology and religion.

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existence into the "shalom" of God. In many Christian traditions, the Psalms occupy a central place in liturgies which draw believers away from the pains of life to contemplate God. When we construe the Psalms primarily in this fashion, we tend to read them very selectively. We select for frequent reading only those passages that fit our preconceptions about worthy praise, for example, creation psalms (8, 19, 139), liturgical psalms (24, 46, l22), songs of thanksgiving (34, 40, 116), hymns of praise (100, l03, 107), songs of trust (23, 91, 121), and wisdom psalms (1, 37, 73). In so doing, we comfortably assign the Psalms a liturgical and didactic function in the sanctuary, but overlook their potential for providing a practical theology to deal with some of the most devastating problems in counseling and mental health care.

By far the most frequent type of psalm in the Scriptures is the individual lament. It is probably fair to suggest that this type is also the most neglected by Christians today. The individual laments carry us from our baseline sense of security downward to the nadir of a person's anguish and misery. And this descent is ordinarily no mere device to set in motion a more triumphant divine ascent. The psalms of lament can take up residence in the depths and, by turning over the many sides of suffering in a poetic parallelism, encourage us to think and feel our way into the potential ruin of our own condition. Engaging in that sort of lament seems wrong to our Christian sensibilities. It runs over into harsh complaining and lack of charity toward our enemies. Psalm 88 illustrates this movement of thought and emotion:

O Lord, the God who saves me,
day and night I cry out before you.
May my prayer come before you;
turn your ear to my cry.

For my soul is full of trouble
and my life draws near the grave.
I am counted among those who go down to the pit;
I am like a man without strength.
I am set apart with the dead,
like the slain who lie in the grave,
whom you remember no more,
who are cut off from your care.

You have put me in the lowest pit,
in the darkest depths.
Your wrath lies heavily upon me;
you have overwhelmed me with all your waves.
You have taken me from my closest friends
and have made me repulsive to them.
I am confined and cannot escape;
my eyes are dim with grief.

I call to you, O Lord, every day;
I spread out my hands to you.
Do you show your wonders to the dead?
Do those who are dead rise up and praise you?

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Is your love declared in the grave,
your faithfulness in destruction?
Are your wonders known in the place of darkness,
or your righteous deeds in the land of oblivion?

But I cry to you for help, O Lord;
in the morning my prayer comes before you.
Why, O Lord, do you reject me
and hide your face from me?

From my youth I have been afflicted and close to death;
I have suffered your terrors and am in despair.
Your wrath has swept over me;
your terrors have destroyed me.
All day long they surround me like a flood;
they have completely engulfed me.
You have taken my companions and loved ones from me;
the darkness is my closest friend (NIV).

What can a passage which apparently communicates so little hope teach us about persons and their relationship with God?

There are several important confessional meanings. To begin with, the psalmist affirms an understanding of human personhood that appears throughout the Old Testament. Humans were created unified beings. The Hebrew text of Genesis 2:7 states that when God breathed the breath of life into the dust of the earth, the human being became "nephesh." This Hebrew word is translated "soul" in the King James Version, but is given a variety of translations in more recent versions: "being," "creature," and "man began to live." In other Old Testament passages, this term is used to refer variously to a person's throat, neck, desire, and the vital processes that uphold physical life. When all of these references are considered, it becomes clear that although a person's identity may be spoken of as manifesting different aspects, that identity may nevertheless be spoken of singly, as one creature, rooted in the processes of the physical body. "Nephesh" is not separate from the body, but includes the body and expresses the vitality of experience that it allows.

The human "nephesh" also refers to the continuing relationship of our identity to God, God's act did not plant some divine entity in a body which then gave persons a generic claim to eternal existence. "Nephesh" is not a divine form or force that humans have within. "Nephesh" is what happened when God brought into existence the whole of a specific person, Adam. Adam's existence, and the existence of any other specific person whom he represents, remains completely dependent on the moment by moment breath of God that upholds that life. As long as the breath is in us, we may live in responsibility and love with God. The description of Adam's walking before God in the Garden of Eden immediately follows the record of Adam's creation. It is likewise our "being" to walk with and to praise God.

But the breath of life may be removed. When it is, the person's praise of God falls silent. At that moment, the person's whole life passes into

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death. Since one's identity is fully engaged in the body (there is no separate entity called "soul"), the physical death of the body suggests the end of personal identity and falling out of relationship with God. The context of Psalm 88 was most likely an extended period of serious illness during which the writer was forced by the slow ebb of his physical powers to realize the loss of his relationship with God, the loss of his very being. The psalmist anguishes without relief precisely because of his belief in this view of human identity.

This picture of death should be viewed against the background of God's larger work in the creation. The Genesis accounts assume an original creation of earth which was formless and empty. Its condition was one of chaos, conveyed to us in the images of darkness and the watery deep. When God intervened, God brought order and pattern where chaos had been before. Divine institutions of order reflected God's purposes and allowed the creation to glorify God. At the end of this process came that unique ordering of the dust which was human "nephesh." In this final pattern, God brought about the new reality in which God's very life and person would be imaged on the earth.

Then sin entered the world, and with it forces which were opposed to the creation plan. Both in the Old and New Testaments, Jewish writers connect sin with the reversal of the ordering process of creation and a return to the chaos of the deep. In that most Jewish of the New Testament writings, the book of Revelation, John envisions Satan rising from the abyss of chaos-the pit of disorder and non-existence--into which Satan will again be cast at his final defeat. Any process which threatens the created order must reflect sinful forces which separate us from God.

The psalmist perceives just this return to chaos in the physical death of the body. It is a return to the pit and the darkest depths in which the upholding, ordering power of God is not known. The product of death-the return to original dust--cannot sustain the image of God.

There is another aspect of the movement toward non-existence which is death. The psalmist mentions it in close association with the descent into the pit.

You have taken me from my closest friends
and have made me repulsive to them.

Psalm 88 closes with a repetition of this despairing cry.

You have taken my companions and loved ones from me;
the darkness is my closest friend.

Hebrew men and women experienced personal identity as they lived in community with other persons. God was revealed through historical events which established covenant with a people. The worship acceptable in God's sight was worship which emanated from the collective life of the people. They expressed their obedience in working the fields when they left a measure of grain to be gleaned by the poor, in tithing when

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they gathered one tenth of their goods for support of the priesthood, and in rituals of family life (circumcision, marriage, passing blessings from one generation to another). All of these experiences were offered up to God in the formal liturgy of the temple, and here God's presence was made known in God's acceptance of the blood sacrifice for the sins of the nation. As Psalm 42 puts it, to be separated from this experience of collective worship was to be separated from God and to sense one's identity slipping away.

Slow physical deterioration and loosened social relationships have profound spiritual significance, for they can separate a person from God. It is remarkable that the laments which so vividly portray this human despair should dominate the Psalter--Israel's book of praise. Their presence must be taken to reflect complex struggles to understand a God who could only be the just, loving, sovereign Lord, yet who stood witness to such violation of God's purposes for human beings.

If the individual who faced death were held responsible for unleashing the chaos of the deep, the lament would have a different form. It would then be a prayer of repentance. Such is not the case. The psalmists struggle with the apparent evidence, manifested by God's wrath, that the petitioner has sinned, but they do not accept the conclusion. In fact, many of the laments locate the forces of chaos in an unspecified group of enemies who assail one's person. We hear echoes of Job's message that the mystery of suffering cannot be equated simply with personal sin.

Furthermore, if "nephesh" passes out of communion with God at death, one's case for justice assumes the greatest urgency. It is only appropriate that the case be offered as part of one's worship of the God of justice. Although psalms of lament sometimes strain our Christian beliefs about grace and love, for Israelites in peril of their very existence these psalms were critical opportunities to work through their situations and recover the love of a distant God.

II

Dementia is the diagnostic label for the condition that most people call senility. The major symptom is memory loss resulting in eventual confusion of language, thinking, and abilities of perceptual recognition; but various other upsets of perception, emotion, and motor response may be evident. When these symptoms have their onset after age 65, the condition is referred to as senile dementia. The most common cause of this condition is Alzheimer's disease. In this disease, the symptoms typically follow an insidious course. Patients and relatives may not be able to determine just when the symptoms first appeared, but once the condition has been recognized, it can be observed to progress steadily toward severe disorganization and death.

Attempts have been made to identify three stages in the progression of Alzheimer's dementia. There is, typically, a first stage of "forgetfulness" during which deficiencies begin to be recognized by the victim and the spouse or close friends. The victim continually misplaces needed

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items, fails to remember the names of persons recently introduced, is quickly confused when driving on unfamiliar roads, has difficulty concentrating on reading or following television plots, and shows increasing lack of care in personal appearance and work. Persons may develop strategies for covering these deficiencies rather well, and this frequently leads to denial. In moments of solitude, however, the victim usually senses that something is wrong-matters are slipping out of control. This realization often provokes considerable anxiety and depression.

The second stage may be called a "confused phase." After stage one has advanced to the point at which the victim usually has recognized his or her difficulties, the condition may result in disorganization which is too painful to recognize and increasingly difficult to reflect upon. Major new upsets are noticeable in concentration and recent memory. Persons may no sooner finish reading an article than they have forgotten what they read. Appointments or agreements just reached are soon forgotten, so that it quickly becomes a struggle and eventually impossible to function on a job. Difficulties are experienced when recalling even familiar information, such as the names of one's grandchildren or one's address. There are problems with time and space orientation. Often patients who travel on their own to medical appointments will be delayed because they get off the bus at the wrong time or walk in the wrong direction after leaving their houses. Speech may be affected, since it is increasingly difficult to retrieve the next word in any intended sentence that has been prefashioned in the mind. The severe deterioration of short-term memory makes it increasingly difficult for patients even to think about errors that they have just made. So baseline emotional experience changes from anxiety and depression to a rather flattened affect. People increasingly withdraw from social contacts and may find it comfortable to spend most of their time at home, perseverating very familiar activities.

The third and final phase is that of true "dementia." In this stage, patients typically can no longer be left alone. They may wander away from caretakers if not continually watched. They may no longer be capable of initiating even basic self-care on their own. Thus, they need to be guided in dressing, washing themselves, feeding, and bowel functions. Much of the person's thinking centers on memories of the distant past which remain more complete and accessible than memories of more recent events. As behavioral control is surrendered to caretakers, patients may evidence paranoid suspicions about assaults on their person-suspicions that can result in psychotic-like delusions and hallucinations. If the victim survives, the final stages of dementia will move toward increasing loss of control over physical functions and verbal processes. The patient may experience seizures, and eventually coma and death.

The symptoms of Alzheimer's dementia are largely caused by damages in the nerve cells of the brain. The fluid inside of these cells

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develops neurofibrillary tangles, or fiber-like structures wrapped around one another in a helical fashion. The brain tissue also is marked by senile plaques-groupings of antibody material surrounded by the fragments of destroyed nerve cells. Finally, many of the nerve cells evidence granulovacular deterioration-the appearance of bubble-like areas within each cell filled with granular material. These structural changes are accompanied by neurochemical changes, the most consistent of which is a deficiency of the neurotransmitter acetylcholine that transmits nerve impulses from one nerve cell to another. The result is that previously patterned circuits of nerve signals are scrambled and the brain can no longer uphold major psychological functions.

It seems a warranted hermeneutic step to suggest that these descriptions of senile dementia illustrate the return to chaos which the author of Psalm 88 associated with his relentless progression toward death. Alzheimer's disease produces chaos in the part of the body that is most central to our imaging God in this life. It is a loss of physical organization that has the significance of a movement back to the original dust of human creation. So, on the basis of the psalmist's vision, it should involve a progressive falling of an individual "nephesh" from relationship with God.

Certainly, the loss of identity which accompanies movement toward the pit of chaos would seem to be confirmed in the demented patient's experience of life. William James proposed long ago that a person's sense of identity that gives moment by moment meaning to use of the pronoun "I" is dependent upon the flow of consciousness of the present into memories of the past. It is this experience that gives each of us a sense of being the same person now that we were five hours, five days and five years ago, despite all of the changes that have occurred around us during that time. Memory locates one's sense of self in a personal history and allows a person to project self forward to an anticipation of the future. Memory is the storehouse of emotion and value interpretations that allows one to inhibit impulses of the moment, to accept responsibility for moral decisions and to live in love and trust with other persons. When memory functions are destroyed, we lose touch with our personal reality and increasingly mirror the demands of our momentary environments and biological drives. The God of our own salvation histories, who called us to live as disciples and led us into the life of the church, must then seem very distant indeed.

So far we have discussed experience in the abstract. But these concepts do apply to real persons. Janet is a seventy-five year old woman who has had Alzheimer's dementia for two years. She has been a Christian most of her life.

Janet had always regularly attended church services. Members of the congregation knew her as a gentle, concerned friend. After services, she would always take time to seek out neglected persons on the fringe of the congregation's life. She called them on the telephone during the week,

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and when they moved far away faithfully wrote long, personal letters expressing encouragement and love. She upheld her friends in prayer.

When her symptoms of forgetfulness first became evident, Janet struggled to compensate. She wrote lists of names and addresses to cue her recognition of faces and to guide her memory of people's needs. She spent hours more at her typewriter trying to recall information for her letters and to find the right words to communicate her feelings. Yet the battle was being lost. Her lists filled shoeboxes in her closets, from which it was impossible to locate a desired name. Her letters became more verbose as they lost more and more of their content.

Janet became quite anxious about her condition. Her anxiety about not remembering names and not being able to follow sermons led her to stay away from church. She eventually stopped writing letters and no longer talked on the telephone. She became depressed. Her pattern fit the classical textbook description. But there was more to her experience than the textbooks convey.

Janet was deeply troubled about her relationship with God. She was convinced that she had fallen from her walk of discipleship by deserting her friends. The small disagreements that she had experienced with other Christians and the several times that she had failed their expectations assumed major importance in her self-understanding. She began to imagine acute physical disorders, such as intestinal cancer, to explain the changes in her actions; but when none were diagnosed after extensive physical examinations, she concluded that because of her lack of faithfulness she was no longer fit for the Lord's service and God was placing her aside.

As the disease progressed through the "confused stage," Janet began to lose her ability to control impulse. Her lack of control was most aggravated when she was admitted to the hospital for a further series of tests. Away from the security provided by her husband and home, she wandered about during the night in violation of the nurses' commands. She described past sexual disturbances in an explicit manner. When a male patient entered her room by mistake at night, she was certain that she had enticed him there and had then been raped. These experiences devastated her self-concept. She now came to believe that she had committed sins which surely provoked God's wrath. The continual deterioration of her condition and the doctors' inability to help seemed evidence that God's presence had been withdrawn from her.

When her orientation to space and time began to diminish, Janet lost interest in daily devotions and prayer. Her previously strong sense of meeting with the Lord at a place and time each day of her life to bring her cares before God began to slip away. With this lapse, she began to talk less about the Lord, yet on occasion grieved that life was not now as it had been and wished, at least for the moment, to return to church to worship once again.

The experience that I have just described could be brought before

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God in a psalm of lament. It would be a most appropriate liturgical act for Janet to have worshiped God in this fashion. Surely she needed the experience that even her cries from the depths were praise of the living God and that the suffering of the fall toward chaos, while an expression of sin in the creation, need not represent the sins of the victim who may plead her case before the Lord. But both the psalms of lament and Janet's experienced loss of identity pose questions about the direction in which the creation is headed and the triumph of the grace of God. The writer of Ecclesiastes expresses it well:

Remember him [your creator] before the silver cord is severed,
or the golden bowl is broken;
before the pitcher is shattered at the spring,
or the wheel broken at the well,
and the dust returns to the ground it came from,
and the breath returns to God who gave it.
"Meaningless! Meaningless!" says the Teacher.
"Everything is meaningless!" (12:6-7).

III

The previous discussion helps to explain why the resurrection of Jesus Christ must be the centerpiece of our Christian faith. For if Christ's sacrifice on the cross is understood exclusively as substitutionary atonement for the sins of a multitude of "souls," some now disembodied in heaven and some yet residing in bodies upon the earth, then it should have been sufficient for the sweet fragrance of his sacrifice to reach the presence of God when Christ's soul returned to the Father's side. If, on the other hand, as the Scriptures suggest, Christ's death involved a struggle with and victory over all of the powers of chaos seeking to undo the order of God's creation, including human "nephesh," then the resurrection must be part of the result. In Ephesians 1, Paul pictures this victory as a coming together of all things in the creation, a placing in order under the headship of the Christ. The direction of earth's history was reversed from movement toward dissolution to the final fulfillment of the purposes of God. The key to this reversal was the renewal of the image of God in this world in the pattern originally intended--a new person fully engaged in a body which chaos cannot overcome. In I Corinthians l5, Paul applied this message of cosmic victory to the lives of believers. In keeping with the Old Testament's theology of persons, he argues that "if there is a natural body, there must also be a spiritual body." Human "nephesh" finally cannot be anything but embodied existence. However, this body will be "spiritual." At this point, I believe, the apostle does not mean that it will be insubstantial, but rather that it will be controlled in harmony with the Spirit, or the breath of God's sustaining power. It will identify us with the new Adam, the renewed human person who is Jesus Christ. If this is our hope, then we too can expect to follow Christ's path toward this end-the way through the dissolution and death of this present life.

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This perspective triumphantly answers the prior questions posed by the writer of Ecclesiastes. The slow suffering which Janet experienced as her life descended into the pit identifies her with the suffering of Jesus Christ, whose sacrifice of self to the powers of chaos on a cosmic level separated him from the presence of God. Moreover, the book of Revelation (chap. 5) suggests that the present suffering of the saints brought about through the powers of chaos, and the prayers which express that suffering (expressions of lament), further the plan of Christ's redemption and will at the end of time lead to the unleashing of divine judgment and full revelation of God's renewed creation. Although the immediate reference in Revelation 5 is to powers of chaos in their political manifestations, the Roman governments which made martyrs of first century Christians, the vision is further developed to include the four horsemen (invasion, rebellion, famine, pestilence) representing chaos in nature as well. The lament of Psalm 88 has been heard. There can be few clearer experiences of engaging in this battle with the forces of the abyss of chaos than the long pilgrimage experienced in Alzheimer's disease. Perhaps this fortells an even more intimate identification with the victorious suffering Lord at life's end.

Thus far, we have spoken of the resurrection of believers very much as an eschatological event-an event at the end of this present time. The Scriptures strongly affirm that it is a present reality as well. When Christ died, descended into the pit, and rose again, creation was changed forever. As T. F. Torrance puts it:

The resurrection of the believer is regarded primarily as the transforming effect of the resurrection of Christ, yet not effect in the sense of some new and subsequent event, but effect as something that is already implicated in the resurrection of Christ. Our resurrection has already taken place and is fully tied up with the resurrection of Christ, and therefore proceeds from it more by way of what has already taken place, than as new effect proceeding from it. That is why the New Testament speaks so astonishingly of our having already tasted the powers of the age to come (Heb. 6:5), for in Christ we already live in the end of time! Through Christ the very fullness (pleroma) of God, which resides in Him, already overflows to us (Col. 2:9-10).¹

In application to the present discussion, I take this to mean that the upholding and renewing power of God is active in this present space and time. There is a reality in life which serves to uphold human identity even as this present "nephesh" (because of deterioration of the brain) moves toward chaos. In one sense, this power is the work of the Holy Spirit in all believers which mysteriously keeps them in the life of Christ even when their experience seems very distant from God. Even the psalmists had an unclear anticipation of this truth when they confessed paradoxically that God was present even in the pit of darkness.

But in another sense, this upholding, transforming power of the Spirit is revealed and exercised in the reality which now is the presence of the

¹ T. F. Torrance, Space, Time and Resurrection (Grand Rapids: Eerdmans, 1976), p. 36.

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resurrected Christ-his body, the church. The church has the mission and the power to renew the creation. It accomplishes this in many ways: by working for change in governments which perpetuate injustice, by caring for the natural environment in a manner which allows it to sustain life, by encouraging the development of medicine to heal the ravages of disease, by healing broken interpersonal relationships in families, and by calling all men and women to faith in Jesus Christ. The church should accomplish this mission also by doing all that it can to uphold the identities, the "nephesh," of persons experiencing the ravages of Alzheimer's dementia. In so doing, the church may bring to fulfillment the Old Testament vision that one's identity is established, redeemed, and maintained in the collective experience of a people living in covenant with their God.

IV

It remains for us to consider practical ways in which the church can provide this upholding function for people suffering Alzheimer's disease. These remarks must remain open-ended. Although I will mention several suggestions regarding how persons may be upheld, there is a challenge for all of us to accept the mission of thinking creatively about methods of therapy and care.

We often think of memory as a process contained entirely within the individual person. Perhaps we are encouraged to do this by lingering psychoanalytic ideas about the personal unconscious. More often than not, however, memory is a social experience. In conversation, we negotiate our understanding of the past. For example, a father says, "I remember how mother kept us waiting so long before we were able to leave the restaurant last night." Mother responds, "Oh, that's not how it was at all. It was father who arrived home from work late and threw our schedule off course." So the negotiations begin.

We all employ unique strategies for storing our impressions of the present for later recall. And we must rely on the strategies of others to complement our own recollections. After a couple live together for a time, they can begin to anticipate how the other one will organize events for memory, and what cues that person will need to retrieve those events on a later occasion. In many respects, memory is an art form in which we each develop our own style. A sensitive partner who shares our experience of the past may come to understand our style and learn how to support that style in conversation through providing the missing links in thought and the needed retrieval cues.

Those who care for Alzheimer's patients should take time to learn as much as possible about the form of a specific patient's memory processes in the past. What sorts of cues were most valuable in organizing material for memory storage-faces, voices, colors, etc.? When experiencing a new event with the patient, draw special attention to those cues and, when negotiating a recollection later on, introduce those cues in a

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systematic way into the conversation. In the earlier stages of the disease, this technique can be helpful in keeping the patient involved in present experiences. It may also prepare the patient to accept this process of negotiation more easily when most of it must be initiated by the caretaker later on.

Later in the stages of the disease, cues to a basic memory of space and time may be made continually available in a "reality center" at some central location in the house. This arrangement may include a large clock with small cardboard clock faces beneath on which the hands can be set to represent different points throughout the day. Next to each clock may be placed small pictures of different rooms in the house and an activity in that room appropriate to that time of day-for example, eating in the kitchen at noon, picking up the mail on the porch at 2 p.m., sleeping in the bedroom at 9 p.m. This will not only provide patients with some sense of personal control over their activities, but also "embody" for them a visual sense of the immediate past and anticipation of the near future.

As short-term memory further deteriorates, there will come a time at which patients spend much of the day living in events of the past. Our first response may be to discourage this regression and repeatedly draw them back to the present. This reaction may not be wise; for the distant past may be recalled in a coherent form that supports a continuing identity and an involvement with other persons when those experiences have slipped out of the present. Patients may be very concerned about getting the facts of childhood, adolescence, and young adulthood right-for this is the remaining evidence of their identity and, for Christians, the confirmation of their walk with God.

Those who care for Alzheimer's patients should do everything possible to help them make judgments about recollections of the past. An album may be created in which old photographs are organized into family groups. One may investigate the dates on which particular personal photographs were taken and then talk with the patient about national events and experiences in church which occurred at that same time. Identify articles of clothing that the patient favored and try to retrieve them from the person's wardrobe. Purchase small gifts that the person mentions in connection with past birthdays or anniversaries. In other words, do whatever can be done to embody a representation of this individual's life that will continue even when the brain's embodiment of that record begins to falter.

When cognitive processes are fragmented, individuals may still meaningfully experience personal identity in relationship with others through other modalities of experience. In Janet's case, music apparently provided this tie. Long after she could no longer find the words to express herself in writing, she was still able to sit down at the piano and recognizably play familiar gospel songs and hymns. I believe that she felt closest to the sustaining power of the risen Christ when she hummed

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a portion of a favorite hymn during the day. Her sense of being related to others increased when persons around her joined in singing the whole song.

When the Alzheimer's patient has become immobile and silent in the later stages of the disease, the modalities of touch and voice discrimination may continue to serve as important avenues for upholding a person's experience of identity. Feeling the contours of a face and the warmth of a hand conveys the sense of extending oneself to others, and in the hugs, kisses, and familiar low-pitched tones of a loved one security is given in return.

Throughout the stages of dementia, patients should be assured that they remain one with the whole body of Jesus Christ. Churches should make provisions for patients to attend services as long as they possibly can. When patients can no longer attend, they should be visited in their homes by a core group of familiar members who are well-versed in the strategies already mentioned and who have taken the time to know each patient's identity well. As I understand it, this is uniquely the calling of the diaconal office in the New Testament.

Unfortunately, churches too seldom provide this most basic witness to the resurrection in a sacrificial way. Frequently, a patient's last clear grasp of personal security is lost when the burden of care becomes overwhelming for her family and she is sent to live in the strange, frightening environment of a nursing home. In many cases, this move would not be necessary or might be considerably delayed if a sufficient number of trained, committed volunteers were available to help with providing care in the person's home. The potential for such a volunteer force is present in the church. But in order for this potential to be realized, church members would have to take seriously the call to tithe their talents and time as well as their material goods. Perhaps it is not too much to suggest that this reordering of priorities may be one of the most important ways in which Christians will be called to respond to the changes which will occur in an aging population in the decades just ahead.