Originally I was going to write about dementia, aging, and physical dependence all together, and while these topics have interrelated aspects, I do not think that my approach to them all would be the same. I had written several paragraphs on these topics; however, I deleted them and decided to start again. I was discussing them in a mostly “symptomatic” way, rather than trying to get to the root issues—not to say a symptomatic approach is wrong. Because of this difficulty in trying to cover so much at once, this will cover just dementia for now. And maybe this will be only the first post on dementia, we will see. Why is it so tragic and painful to see dementia or Alzheimer’s affecting someone? I think this comes primarily from two different things: personality and free will. I’m not saying that these all the only two things that play into this, these are simply the two that have stuck out most to me.
To begin, personality is a complex topic that I will not pretend to be an expert on. That said, I think that we as humans have a good general understanding of what personality is. According to Merriam-Webster, personality can be defined as:
“3 a : the complex of characteristics that distinguishes an individual or a nation or group; especially: the totality of an individual’s behavioral and emotional characteristics
b : a set of distinctive traits and characteristics • the energetic personality of the city” (“Personality.”)
So, looking at personality like is why dementia is so tragic. Having seen my grandfather suffer from Alzheimer’s and my grandmother at the time of writing this suffering from dementia, there are certainly notable changes in personality. This can be stark too, not just subtle differences. When someone you love is suddenly…not the same person as they were, that is impactful. Such changes in personality can make them seem like they are not who they were, despite all your memories of them as they were.
Something that I hope to never know from first-hand experience is what that process is like for the person suffering from dementia. Do they notice changes in themselves? If so, what would that be like? To know that you are becoming someone different, perhaps almost like slowly becoming a spectator to your own life. And if they do not notice it, either because of a lack of insight or how pervasively it changes them, do they instead see the change in interpersonal dynamics as a change in the personalities of those around them? Perhaps if this is the case—and I do not have any data on hand to support or deny this idea—then maybe that explains some of the negative reactions that people with dementia often have towards loved ones trying to help them. As they start losing physical control and become physically dependent, those around them then start changing and becoming others as well?
This leads into the second topic that I wanted to address: free will. According to Merriam-Webster, free will is:
“1 : voluntary choice or decision • I do this of my own free will
2 : freedom of humans to make choices that are not determined by prior causes or divine intervention” (“Free Will.”)
Free will is a basic element of being human; however, there are circumstances that can limit this. I think the combination of physical dependence and the altered interpersonal dynamic that can arise from dementia creates a strange situation. While these individuals can make voluntary decisions, some of these decisions can lead to injury or death. As such, a responsible caretaker must judge the efficacy of these decisions, and sometimes that means not allowing the patient to do those things that they decide to do.
So yes, they have free will, but it might seem to them like they only have some of the same level of free will as an incarcerated individual. A prisoner does have the ability to make a voluntary decision; however, they do not always have the ability to carry out that decision, due to their imprisonment and the guards. And while the caretaker-patient relationship is nothing like a guard-inmate relationship, the patient might feel that it is more like that due to the caretaker limiting what the patient is allowed to do. Based on observation of this sort of thing unfortunately having to happen, there are so many times where I have seen the frustration and powerlessness on their face. It’s heartbreaking to watch, especially since it is for their safety, but the disconnect in communication and understanding from the dementia ravaging their mental functions creates such a sad situation.
The tragic dimensions of dementia are abundant, but I feel that focusing on these aspects are helpful—at least to me—in trying to understand the pain of the patient. I certainly am not able to help in the research of the medical and physiological aspects of dementia, so instead I can try to understand this sort of thing a little bit better.
“Free Will.” Merriam-Webster.com. Merriam-Webster, n.d. Web. 29 May 2017.
“Personality.” Merriam-Webster.com. Merriam-Webster, n.d. Web. 29 May 2017.