Alzheimer’s & Grace

Thu, 01 Apr 2004 00:00:00 -0500

The author of Psalm 71 begs the Lord, “Cast me not off in the time of old age; forsake me not when my strength fails me.” And in the Decalogue we hear this precept of the Lord: “Honor thy father and thy mother.” Both the ancient prayer and the ancient command have been given a modern edge of urgency by the current increase in our life expectancy and the special illnesses that age brings with it. Among the most challenging of these illnesses is dementia.

A conservative estimate is that at least 30 percent of people over age eighty-five have Alzheimer’s disease, the major cause of the dementia syndrome. The leading symptoms of dementia are, frankly, terrifying: loss of memory, of language, and of reasoning ability. We all feel at least a slight anxiety about dementia because these dreaded symptoms seem to assault our very identities, to dissolve the autobiographical narratives that constitute the very story of our lives. But are there hints of a deeper purpose underlying the universe even in the deep forgetfulness of dementia, hints for both those afflicted and those who care for them?

One lesson, for me, is that people with dementia remind us that we are all deficient in spiritual memory, that we are largely forgetful of the Creative Presence that set up a universe to give rise to creatures like ourselves. Religion is in large part an effort at memory enhancement through speech, symbol, and ritual. The Prophets were sent to remind Israel of its covenants with the Lord; Christians celebrate the Eucharist with the words of Jesus, “Do this in remembrance of me” (Luke 22:19). The Book of Common Prayer contains these eloquent words: “Heavenly Father, in whom we live and move and have our being; we do humbly pray you so to guide and govern us by your holy spirit, that in all the cares and occupations of our daily life we might not forget you, but remember that we are always walking in your sight.”

St. Augustine is the great theologian of memory. His awe at human memory is clear in the tenth book of his Confessions : “All this goes on inside me, in the vast cloisters of my memory. In it are the sky, the earth, and the sea, ready at my summons, together with everything that I have ever perceived in them by my senses, except the things which I have forgotten. In it I meet myself as well. I remember myself and what I have done, when and where I did it, and the state of my mind at the time.”

Augustine saw memory as an aid to our salvation. Despite all our false pursuits of happiness in possessions or accomplishments, our hearts remain restless, seeking true happiness in God, and to aid that search there is within us a “still faint glow of light” that is nothing other than a memory, however dim, of a blessed state of true happiness that preceded the fall.

Those whom severe dementia has made deeply forgetful do forget much that is crucial to life as ordinarily lived: they may even forget those who love them most, and this is terribly painful to the forgotten ones. Yet they may have fleeting moments of a “still faint glow of light” when they recall vague traces of those who love them. We, who love them and are forgotten, may have by analogy some deeper apprehension of the life of the loving but unremembered God who, if religious thinkers such as Abraham Heschel or the “process” theologians are correct, calls out to each one of us, “Forget me not.”

Observers estimate, and my personal experience confirms, that 90 percent of Americans who are diagnosed with dementia pray. They are, it seems, thrown back onto whatever faith they have in the loving and beneficent purposes underlying the universe. They are shaken existentially, and many begin this final phase of their lives with a profound recovery of spirituality.

I think of Peter, a member of a focus group in a project about coping with a diagnosis of Alzheimer’s, who said, “Oh, I was devastated that I lost the technical ability to do my job and the sense of pride that comes into play. And I think pride sometimes is an evil factor because it weighs on your mind and it tells you that you are worthless and it kind of destroys your self-worth.” Peter goes to his Roman Catholic church every Sunday, and every day he reads from a prayer book:

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Sacred Pain: Hurting the Body for the Sake of the Soul

Fri, 01 Mar 2002 00:00:00 -0500

In the current literature on the connections between science and religion, it is rare to find a discussion of pain. Cosmology, mathematical chaos theory, the anthropic principle, neurotheology, and love are among topics commonly treated. Ariel Glucklich has thus broken fresh ground in Sacred Pain: Hurting the Body for the Sake of the Soul , which examines the positive role of pain across religious traditions.

But Glucklich, who teaches in the Theology Department at Georgetown, is much more than a deeply thoughtful student of world religions; he is equally fluent in the myriad scientific concepts and theories of pain prevalent today, most of which engage the neurosciences and psychiatry. Above all, he forces the reader to set aside the too easy assumption that pain is always a problem, and that it has no respectable place in the spiritual life. As he acknowledges, his book “is an unusual work in assuming that pain has served humanity in a variety of constructive religious and social ways.”

Who has not at some point asked why it is that innumerable religious rituals involve inflicting intentional pain through forms of self“flagellation, barefoot pilgrimages, extreme fasting, sleepless nights in prayer vigils, piercing the body, wearing coarse and irritating garments, and the like? Witnesses from St. Anthony of the Desert to St. Francis of Assisi testify that intense spiritual and religious life may conflict with contemporary ideals of good health, comfort, and prosperity.

In a remarkably lucid opening chapter on “Religious Ways of Hurting,” Glucklich subjects the concept of theodicy”the attempt to explain how a good and all“powerful God could allow pain to occur in human experience”to scrutiny. The author explains how various religious “models” of pain typically treat it less as a problem than as a solution”especially when it is intentional”and rarely equate it with suffering in any simple way. In the juridical model, for example, the martyr and ascetic may regard their painful experience as serving a divine purpose, giving rise to a “strange insensitivity to pain” as a means to divine insight and hidden truth. In this view, pain is less punishment than a test that leads to gnosis or wisdom. In the medical model, pain is “true medicine for the soul” while the military outlook treats it as “a weapon by means of which the body is subdued.” In other words, bodily pain can be viewed as a force that purifies the soul.

After presenting an array of such interpretive models of pain, Glucklich turns to the domain of neuroscience, which teaches that “certain levels of pain possess analgesic qualities and can even induce euphoric states of mind.” These states of mind are associated with the release of endogenous opioids (the endorphins) in the brain, as well as with other biochemical events that provide a firm scientific basis for religious rituals that require a painful rite of passage to a new self. Avoiding any single and inevitably reductive analysis, Glucklich explains why it is that pain is used and even welcomed in the history of religions. There are, it seems, empirical grounds for the classically religious assertion that pain”and perhaps especially self“inflicted pain”“fails to alienate the true lovers of God,” and can even be a direct path to knowledge or experience of God.

The author fully realizes that self“inflicted pain is today usually interpreted as a form of psychopathology. But within the mystical context, “pain unmakes the profane world with its corporeal attachments and leads the mystics away from the body to self“transcendence.” Glucklich contends that such meaningful pain and discipline elevates the individual into a world of deeper human community. Here pain is even blotted out”for example, via a process in the brain known as “gate“control” that profoundly alters biochemistry and consciousness. In an erudite scientific overview, the author shows how “ intentionally painful manipulations of the body could lead to states of self“transcendence or effacement.”

Later chapters take up psychological models of sacred pain and self“transformation, and even the tortures of the Inquisition, in which forced pain was, regrettably, viewed as redemptive. Glucklich is especially adept at handling the modern era of anesthetics, when pain came to be seen strictly as a medical problem to be overcome by the application of chemicals such as ether and chloroform. While this nineteenth“century application was heralded by many, it was also an issue of intense ethical debate among doctors, primarily because the wider culture still held pain to be beneficial in certain respects. As the author laments, “We have lost our capacity to understand why and how pain would be valuable for mystics, members of religious communities, and perhaps humanity as a whole. The role of pain, before it was displaced, was rich and nuanced, and ultimately situated persons within broader social and religious contexts.” Glucklich hopes that his work “may help explain how a life can be painful and meaningful at the same time. Perhaps, in a minor way, understanding can then filter downward and help separate pain from suffering.”

Sacred Pain will undoubtedly be a jolting and discomforting book for anyone who assumes that spirituality and religion are entirely consistent with modern medical values. Historians of religion have long taken note of the ubiquitous presence of intentionally painful rituals and practices, and even made this a central heuristic key to understanding religious experiences. Whether we are considering some of the excruciating rites of passage among Native Americans, or the Muslim who walks for weeks on pilgrimage to Mecca with bloodied bare feet, something here runs against the grain of what we normally consider to be normal and healthy. The tendency to pathologize such actions is well documented, and as Glucklich acknowledges, the line between religious experience and psychopathology can be fuzzy. Yet in light of the time“honored place of sacred pain in the religions of the world, as well as the insights of neuroscientific approaches to understanding pain, he urges us not to be dismissive.

The book is not without flaws. For one thing, Glucklich might have made some important theological distinctions. In Christianity, for example, the redemptive pain that sets the cosmos in balance is uniquely the province of Christ, who alone was perfect and who alone could indemnify or atone for the sins of the world. Moreover, Glucklich could have offered some insights into the complex balance between sacred pain and the stewardship responsibilities that religious traditions assert with respect to the gift of the body. Duties of self“care mitigate the extent of self“inflicted pain. What is the relationship, for instance, between the proscription against suicide and the phenomenon of sacred pain? Where do various traditions draw the line on self“inflicted pain, and why?

Yet overall the book succeeds in making a new place in our consciousness for sacred pain. I once encountered a devout Catholic woman who refused all pain medication despite her painful tumor. The health care professionals frantically called in a psychiatrist to declare her mentally incompetent”at which point pain care could be imposed. Fortunately, the psychiatrist involved respected the woman’s faith, and, after a careful interview, concluded that she was in her right mind. The woman died after a long and painful battle with cancer, yet she remained prayerful and spiritually focused throughout her ordeal. Indeed, she seemed remarkably placid and peaceful. She did not cry, and she remained kind and generous until the end. Glucklich helps us to appreciate the legitimacy of such experiences. Pain cannot necessarily be equated with suffering, and for some it can even have redemptive value.

Sacred Pain also underscores how the ability to control pain medically has created a culture in which the experience of pain is judged to be unacceptable and, when completely unavoidable, unambiguously tragic. Our pursuit of sensate pleasure and our utilitarian demand for comfort have become quite absolute, removing us far from the values of an earlier time, when divine hopes helped people to navigate the experience of pain. The idea that freedom from all pain and discomfort is the only acceptable way to live has made us less sensitive to the realities of chronic pain in the lives of many, and less able to accept the fact that painful lives can also be good ones. We have, apparently, become less able to deal creatively with the physical and psychological experiences of pain that are coeval with the frailties of human existence.

Thus it is that suicide becomes an easy alternative to a life that falls short of the ideal of complete sensate comfort. It is now judged by many to be “merciful” to assist a person in pain to end his own life. Human dignity thus comes to be contingent on being pain free. Certainly where pain leads to suffering, the advent of modern pain medications is to be welcomed wholeheartedly. Yet Glucklich helps us to see what we have lost through all of our substantial gains.

Sacred Pain succeeds not only because of the immense and careful scholarship it displays, but also because it establishes a creative dialogue between science and religion on a question of enduring, and today largely forgotten, importance. Most of all, the book invites its readers to appreciate that pain need not be meaningless.

Stephen G. Post teaches in the School of Medicine at Case Western Reserve University.

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Alzheimer’s & Grace

Sacred Pain: Hurting the Body for the Sake of the Soul