Dementia and Depression

אלקי נשמה שנתת בי טהורה הוא

God, the soul that you have implanted in me is pure

- Jewish morning liturgy

I have spent quite a bit of the past year doing per-diem chaplaincy in hospice. A significant percentage of my patients suffer from some form of dementia or mental deterioration.

Dementia is a catch-all category which includes a lot of behaviors: Some patients can carry on perfectly “normal” conversations that are very out of touch with reality; others say nonsensical words; yet others are withdrawn or angry and do not speak at all.

What is common with all of my patients who suffer from the various forms of dementia is that they are still fully human beings. Our liturgy, which includes the above quote as part of the morning blessings upon waking, makes it clear that despite what physical and mental deterioration we all experience, the soul that God has given each of us is pure and undiminished at all stages of our lives.

Those of us who minister to dementia patients ought to have this part of the Jewish liturgy first and foremost in our minds every time we enter a patient’s room. Chaplains, who deal with matters spiritual, must be aware that in each and every dementia patient we serve, there is an undiminished spirit, and conduct ourselves accordingly.

Additionally, clinicians must be careful not to write off all patient behaviors as symptoms of dementia. Since an undiminished spirit still resides in each patient, they are subject to illnesses such as depression, which in at least some cases has a strong spiritual component. Clinicians ought to do a better job screening even dementia patients for mental illness including depression, which is sometimes treatable with medication. This can significantly improve quality of life for some patients and help to make the other symptoms of dementia much more tolerable.