Redeeming Dementia: Spirituality, Theology, and Science
160
Redeeming Dementia: Spirituality, Theology, and Science
160eBook
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Overview
Dementia: a specter that haunts many, either as a fear for the future or as lived reality with a loved one. It has been called the “theological disease” because it affects so much of how we define our humanity: language, long-term memory, and ability to plan the future. The church has a role in bringing hope and shepherding the spiritual journeys of people with dementia and their families. Beginning with current theological models of personhood, concepts about the self and spirituality are explored through the latest research in medicine and neuroscience as well as from work on spirituality and aging. The final chapter focuses on narratives of successful programs in churches and retirement communities designed to minister to people with dementia alongside their families and caregivers.
Product Details
| ISBN-13: | 9781640650572 |
|---|---|
| Publisher: | Church Publishing |
| Publication date: | 11/17/2018 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 160 |
| File size: | 501 KB |
About the Author
Janice Hicks, is a chaplain and recently ordained deacon from the Episcopal Diocese of Washington. She received a PhD in chemistry from Columbia University and worked as a professor of chemistry at Georgetown University and then at the National Science Foundation. Her career change starting with an MDiv from Virginia Theological Seminary was due in part to the caregiving she gave to her mother who lived with dementia for over twenty years. She lives in Maryland.
Read an Excerpt
CHAPTER 1
The Healthy Brain
The body is very important in our story. Christians believe in the Incarnation, that the second person of the Trinity assumed human form in the person of Jesus Christ. We are embodied, too. This chapter begins our discussion about the physical body, and in particular, the healthy brain.
Brain and Mind
Many today believe that it is the human brain that makes us different from other forms of life. It is immense and more complex in comparison to that of other species, giving rise to an unprecedented human consciousness with abilities such as self-awareness, intelligence, language, self-control, extensive planning, emotion, the ability to cooperate, and other attributes observed only to a lesser degree, if at all, in the species closest to us. Rather than believing in the traditional concept of the soul, some theologians believe that it is consciousness, or the "information pattern," that survives after death. (See chapter 3 for more information on this topic.)
Those holding to the scientific-secular model for what makes us human would say that it was the surging size of the brain about two hundred thousand years ago that marked the transition from human ancestors to human beings that were largely like us. Because the brain is affected by dementia, those characteristics that some believe make us human can also be affected. This is why theologian David Keck referred to Alzheimer's disease as the "theological disease," because it calls into question beliefs about what makes us human.
Another layer of the theological and scientific discussion is about the subtle differences between brain and mind. For the purposes of our discussion, brain is the physical organ made of brain cells (neurons), fed by circulating fluids and chemicals, full of energy, which as a system generates electrochemical signals. The brain is an object you could hold in your hand. The mind includes intangibles such as thoughts, processing, perceptions, emotions, spirituality, and even relationships. The mind is like the software, yielding laws and theories, yes, but also changing in time and difficult to categorize.
Jeannette Norden articulates the common belief among neuroscientists that "the brain is the biological substrate [substance] of the mind." To complicate matters, it has been discovered that the human heart has forty thousand neurons, and the gut has a billion neurons, so even the physical organ "brain" may not be as contained (just in our heads) as we once thought.
Basics about the Brain and Neurons
The 3-pound human brain is much more complex than previously thought. It consists of 100 billion neurons — brain cells — packed together in a consistency like that of firm tofu. The human brain uses a very large amount (20 percent) of your body's energy when you are at rest. The brain has two hemispheres and all but one of the substructures are paired left and right. The figure on the next page shows a slice through the brain from the forehead to the back of the head, revealing one hemisphere.
There are three major parts of the brain. The brain stem includes the spinal cord, cerebellum (which controls balance and rote motions), and medulla oblongata (which controls heart rate, blood pressure, and breathing, among other activities). It is called the stem because it connects to the rest of our body, as if the brain were the fruit. The brain stem is evolutionarily the oldest part that we share in common with animals. In addition to the functions already named, it is also responsible for digestion, reflexes, sleeping, and arousal. It is the first to develop in a fetus, and the last to be affected by Alzheimer's.
The second part, the midbrain, is the emotional brain, regulating sex hormones, sleep cycle, hunger, emotions, and addictions. The midbrain also contains the pleasure center that makes us feel good, and the amygdala, which is responsible for the fight-or-flight impulse, anger, and fear. The hippocampus — the name in Greek means "seahorse" because it was imagined to resemble such an animal — is thought to consolidate short-term memory into long-term memory and enable spatial memory. The hippocampus is the first place that is affected by Alzheimer's, which is why the first symptoms of this disease are usually loss of short-term memory, difficulty forming new memories, and disorientation in space.
The third part of the brain is the wrinkly, folded exterior, the cerebral cortex (or cerebrum), which is the thinking brain. It is evolutionarily the newest part, and in humans its size is massive compared to in other animals. Whereas a mouse brain is 40 percent cerebral cortex, a human brain is 80 percent. Here is the seat of our thoughts, reasoning, language, planning, and imagination. Parts of the cerebral cortex also process our senses, temperature, movement, reading, music, and mathematics. It is affected in the middle and late stages of dementia.
The cerebral cortex is divided into four lobes. The frontal lobe is responsible for executive functions such as concentration, planning, and problem-solving. The parietal lobe is associated with understanding speech and using words. The temporal lobe interprets sensory stimuli and contains memory of visual and auditory patterns. The occipital lobe interprets visual information and recognizes visual images.
Of the 100 billion neurons making up the brain, there are thousands of different kinds: multipolar, unipolar, bipolar, pyramidal, and so on. Most have a microscopic cell body, a long projection (or fiber) called the axon, and dendritic terminals, like tree branches, that connect with nearby neurons. Axons are usually microscopic but can be as long as several feet, reaching down the spinal cord to activate muscles, for example.
The cell bodies gather to form substructures, called gray matter because of their gray coloring. The axons join to form adjoining layers called white matter, so named because the axons are coated with a waxy protective substance called myelin, which appears white. There are an astounding 100,000 miles of axonal fibers in one human brain, enough to circle the Earth four times.
A method called diffusion spectrum imaging, invented only in the past few years, produced the image shown in the figure below, which reveals a grid-like order of the fibers that astounded even most neuroscientists. Most expected a more tangled anatomy.
In addition to neurons, the brain also has as many glial cells that provide support for neurons, such as cleaning their environments. We will see later on how this is an important process during sleep and is possibly a point of deficiency in illnesses causing dementia.
Drawing of the fiber pathways of a living female human brain, mapped noninvasively with diffusion spectrum imaging. The image shows a view from above (front of the brain is at the top of the picture). The fibers of white matter (axons of brain cells) are arranged in major grid-like pathways.
The Brain as an Electrochemical System
Feelings, thoughts, sensations, and muscle actions all are thought to result from particular neural pathways involving neurons and chemical changes. Neurons communicate by sending electrical pulses that travel down their axons. The rate of the pulses — faster or slower — and the intensity of the pulses — strong or weak — contain the information the brain is trying to transfer. The pulses stimulate the release of chemicals (neurotransmitters), which travel a short distance from one cell to the next across synapses, passing the signal and wiring the two cells together. It's been said that "neurons that fire together, wire together." This concept of networking among cells is thought to be important in memory as well as in many other brain processes.
The neurotransmitters released at the synapses have various effects. Some, for example, are excitatory — triggering wakefulness, attentiveness, anger, aggression, etc. — while others are inhibitory — calming anxiety, inducing sleep, etc.
Diagram of a neuronal synapse showing neurotransmitters (dots) leaving the end of the neuron on the left as the result of an electrical pulse that came down the axon, and becoming attached to receptors on the dendrite of the neuron on the right, creating the pulses in that neuron to pass on the information.
With electrical signals traveling all of the possible synapses in the many neurons and the many chemicals involved, the agility of the brain is enormous. The brain has potentially forty quadrillion synaptic connections, making one human brain potentially more powerful than the entire Internet (that is, a storage potential of one petabyte.)
Neurotransmitter receptors are not just restricted to the brain, but rather are found throughout the body. Neuropsycho-immunologists Candace Pert and Michael Ruff termed this "a network of communication between brain and body" or, colloquially, "liquid brain." This fact, together with the knowledge that the heart and gut have neurons of their own, shows that the information system in our body extends beyond the boundaries of what we traditionally call the brain.
A few of the major types of neurotransmitters in the brain and their functions.
The interaction of the mind and body has been a philosophical quandary at least since Ancient Greece. Pert's contemporary neuroscientific description of "liquid brain" recalls Gregory of Nyssa's description in 300 CE: "the mind approaching our nature in some inexplicable and incomprehensible way, and coming into contact with it, is to be regarded as both in it and around it, neither implanted in it nor enfolded with it, but in a way which we cannot speak or think."
It is natural that some of the first therapies for dementia focus on the brain chemicals that can affect brain activity. One common Alzheimer's medication, Aricept (donepezil), increases acetylcholine in the brain to increase activity. Namenda (memantine) is thought to block excess glutamate that can kill neurons.
Long ago we were taught in school that once the brain reaches maturity, it no longer makes new neurons, but in 1998 Peter Eriksson showed this is wrong: the brain does make new neurons in some areas. A chemical named brain-derived neurotrophic factor (BDNF) causes brain cells to grow. How do we increase BDNF? Arthur Kramer and Kirk Erickson demonstrated in 2011 that physical exercise increases the size of the hippocampus and improves memory.
Other studies also indicate the brain can be altered even into adulthood in a process termed neuroplasticity. This includes forming new substructures on the neurons (e.g., spines), new connections between neurons (synapses), and new receptors on neuron surfaces. For example, researchers believe that the brain can remap and rewire in response to injury and training. Yet the assignment of brain regions to functions is thought to be fairly stable. Rodrigo Quian Quiroga found that one particular neuron fired when a patient was shown different photographs of television actress Jennifer Aniston, but not for photographs of others. Quiroga suggests that it is the abstract identity that is stored and that there may be an "invariant, sparse and explicit code." He suggests the situation is likely more complicated than a one-to-one correspondence between a face and a neuron, but the result indicates certain stability between function and structure. It is still the early days of research in understanding structure, function, and memory in the brain.
The Senses
The five senses of vision, hearing, smell, taste, and touch increase the richness of our interaction with the world. Each is an immeasurable gift not only helping our survival but also yielding sensual pleasures like the appreciation of beauty. As inputs to the brain, the senses are vital for communication. To communicate most effectively with a person with dementia, it is helpful to understand what is happening with each of the senses, as they might be altered with the illness.
Touch is the first sense in a newborn, and often the last to be lost to dementia. Our bodies are covered with a network of six to ten million sensors; more than half of those sensors are located on our hands, feet, and faces. Where possible and with permission, touch is an important, pastoral way to communicate. A light touch on the shoulder or holding hands can be very effective. If a person is lying down, touching the feet can also be effective. Passive touch, like the sun or breeze on bodies and faces, is also a pleasure that is not to be underestimated.
With the sense of smell, the signal pathway is a direct line to the brain, separated by just two or three synapses to the hippocampus. This is why smells can be quickly and strongly associated with memories and emotions. We can harness the power of smell in liturgies through the use of incense, for example, or use specific smells through aromatherapy to benefit particular symptoms. A 2002 study showed that the scent of lemon balm significantly decreased agitation in people with severe dementia. In some cases, however, dementia sufferers may experience a loss of smell.
Through the sense of vision, retinal cells transmit one billion pieces of information to the brain every second. The brain then has to sort through this astounding amount of information to decide what to pay attention to. People tend to pay more attention to changes in their visual field. Because people with Alzheimer's often lose peripheral vision, it is important to approach a person from the front rather than the side. Getting eye contact before speaking is also important. People with Alzheimer's may lose contrast between colors and cannot see blue and purple tones. Using red, orange, and yellow will enhance contrast for clearer vision.
The ear has the fewest sensory cells of any sensory organ, only about 3,500. People with dementia may have hearing loss, similarly to any person who is aging. If a person's response is lagging, however, it may not be a hearing issue, but rather a longer processing time. Shouting at people with dementia won't shorten that processing time. Professionals suggest that directions or questions be as short and simple as possible, followed by thirty seconds of waiting. By waiting, an answer may come.
Memory and Forgetting
Memory is everywhere. We are often asked, "Do you remember this?" When we are with family or old friends, we hear ourselves say, "Remember when ... ?" Even in church we are told, "Do this in remembrance of me."
Memory is required for our identities, learning, relationships, and decision-making. Photographs and souvenirs memorialize holidays, vacations, and special celebrations. National observances and monuments help us remember critical events in our history. Forgetfulness is also everywhere. In our busy lives, we cling to calendars to boost our memories. We want to remember the intense feelings from joyous moments of our lives — falling in love, recovering from a serious illness, the birth of a child. We tend to think deeply about memory only when it lapses and serious problems start to infringe on our everyday lives. These lapses could be due to medication, stress, or illness, but we most fear an irreversible degenerative brain disease such as Alzheimer's disease.
While not completely understood, the resulting neural pathways consisting of hundreds of neurons may be the basis of long-term memory. When cells fire together, there is a chemical trace left behind called "long- term potentiation." The repetition of information during study, for example, strengthens these pathways, resulting in easier recall.
There is more than one kind of memory. Memory begins when our senses feed stimuli to our brains, many of which are ignored. When we pay attention, sensory memory is retained almost automatically, taking less than a second. The information goes into short-term memory, which is like a temporary scratch pad. Short-term memory is a nerve impulse, not a well-worn track, and can hold about seven items for ten to fifteen seconds or sometimes up to one minute. The information can be quickly lost if more information comes in. The hippocampus (located in the figure on page 3) coordinates the conversion of short-term memory to long-term memory, functioning like a memory control center. For example, a childhood memory of a worship service might have sounds, smells, and emotions stored in their respective parts of the brain. The hippocampus ties these together from various parts of the brain (auditory, olfactory, emotional) to form a single episode.
(Continues…)
Excerpted from "Redeeming Dementia"
by .
Copyright © 2018 Dorothy Linthicum and Janice Hicks.
Excerpted by permission of Church Publishing Incorporated.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Preface
Introduction
Chapter 1 The Healthy Brain
Chapter 2 The Brain Affected by Dementia
Chapter 3 Theology of the Human Person
Chapter 4 Theology of Dementia
Chapter 5 Aging and Spirituality
Chapter 6 Embracing People Who Have Dementia
Chapter 7 Serving with People Who Have Dementia
Conclusion Finding God in the Midst of Dementia
Further Reading
What People are Saying About This
"A profound and powerful re-framing, re-educating, and re-minding that the disease called dementia does not literally un-mind people or make them anything other than human beings with whom God remains in relationship. It is the supposedly healthy who do the un-minding, when we assume those with dementia have nothing to share or teach. This book is a labor of love and a deeply important pastoral and theological gift to all God's people. Don't read it and weep––read it and learn to see the loving possibilities of dementia."
––The Rt. Rev. Katharine Jefferts Schori, Assisting Bishop of the Episcopal Diocese of San Diego and former Presiding Bishop of the Episcopal Church
"Hicks and Linthicum go to the heart of the theological question of paradox that is dementia. Drawing on modern scholarship, lived experience, and contemporary best practice, they challenge the church to reflect afresh on the nature of personhood. They rightly conclude, 'by understanding and embracing the redemptive qualities of dementia, we can begin to see God's redeeming power in our own lives.'"
––The Rev. Dr. David Primrose, Director of Transforming Communities, Diocese of Lichfield, The Church of England
"Redeeming Dementia is personal, practical, and profound. Linthicum and Hicks masterfully share wisdom from dementia care experts and theologians to provide deeper understanding of God's all-encompassing love. Their practical ideas demonstrate how to better support and nurture relationships with people experiencing dementia and their care partners. Personal stories of journeying with their own parents personalize and validate the book's insights. An excellent read!"
––Kathy Berry, chaplain at Westminster Canterbury Richmond and author of When Words Fail