This was written in February 2018.  I have made minor edits.

Last year my mum was diagnosed with dementia.  I am currently trying to process the grief that goes along with this.  As part of that process, I decided to do some theological reflection on dementia.  I am working through this so perhaps I will change my mind on some things later.  But here is the first reflection.  More to come I expect.

Dementia is quite common in people over 65; one in ten people over 65 have dementia and one in three people over 85 have dementia.  It is the second-highest cause of death in Australia.[1]  This means that most people in Australia will either experience dementia themselves or have a relative or friend with dementia at some time in life.  As we tend to live in denial about getting old and eventually dying, we each ignore the likelihood that the person with dementia might one day be ourselves.

In reflecting on dementia it seemed like a good idea to begin at the beginning.  Very early in the Bible we are told that God made humans in his image (Gen 1:26-27).  This is a wonderful thing that is unique to humans.  No other creature, not even angels, is designated as the image of God.  But what does that mean?

The idea of a soul as the image of God is not biblical, but it does have a long Christian history.  According to this tradition, the soul is something internal and can be separated from the body.  As the body decays the soul remains.  But what does the soul look like?  Augustine spoke of the three powers of the soul – intellect, memory and will.  All three are diminished in dementia.  Alzheimer’s disease irrevocably destroys brain cells in the parts of the brain that hold memories and affects the ability to learn new things.  It also causes the person to lose some language skills.  Of course, it affects different people to different degrees and at different rates.  Short term memory loss is the thing people most associate with dementia, but it is not the only issue.  Memories fade; short term memory is the worst affected, but even long term memory can be gone.  The will is another matter.  People with dementia still exercise the will and get frustrated by this and by what other people do and don’t do.  But if this is the image of God, then people with dementia would seem to be a diminished version of the image.

The second idea about the image of God is functional.  God told Adam and Eve to fill the earth and subdue it (Gen 1:28).  This is about what we do.  But when you get older and need to be cared for because you cannot care for yourself anymore, then productivity goes away.  Since our culture measures worth by productivity (and also by spending capacity), older people begin to fall outside the sphere of worth.  In fact, the logical conclusion of this understanding of life is what happened under the Nazi regime in the 1930s and 40s.  Old people were not considered worthwhile and were abused or killed[2] (along with people with disabilities – physical and intellectual).[3]  Does the Bible assign worth to people depending on how productive they are?  No.  Our existence is purely by the grace of God.  He gives us life and breath and everything else.  In him we live and move and have our being (Acts 17:25, 28).  We are familiar with the idea that salvation is by grace.  But grace is the basis of every aspect of our existence.  To be human is to be the product of God’s grace.  So I do not believe that function is the image of God.

The image of God is not some human capacity or characteristic that is like God.  God is far above us and self-existent.  Humans are creatures and cannot create themselves or exist apart from God.  Instead, the image of God is a relationship.  It is first of all a relationship of grace in which we stand as creatures of God.  God loves us and sustains us.  As we stand in this relationship of grace, fully dependent on the God who made us, trusting him completely, we reflect God.  We are his image.  When we try to live apart from that relationship, we no longer reflect God properly.  The image is broken.

But later chapters in Genesis (5:1-3; 9:6), along with some allusions to the image in the New Testament (James 3:9), imply that the image of God cannot be removed from human beings, even if it is marred.  We are still God’s creatures.  Effectively, this implies an unbreakable dignity for humans.  In the case of people with dementia, the lack of capacity, lack of productivity and failing memory cannot take away that relationship of grace, because it is always upheld in Christ, who is the perfect image of God (Col 1:15).  He is the foundation in which the image of God resides.  Since Jesus is the man who represents all human beings, because he came and took on our humanity for our sake and for our salvation (Nicene Creed), the image of God in Christ is enough to guarantee that the image of God cannot be removed from any human being.

So people with dementia cannot be ignored or discounted or abused.  They remain God’s beloved creatures, made in his image.  This value must translate into the way people are treated if we are to be consistent in applying this doctrine.  Although many people with dementia are incapable of making decisions about many aspects of their lives, the way in which those decisions are made on their behalf must be respectful of the person.  In addition, the person is still able to decide some things, even if this is limited, and thus should be allowed to decide for his or herself.  Maintaining a degree of autonomy is fitting for creatures made in God’s image.