{"id":3781,"date":"2024-01-24T09:11:36","date_gmt":"2024-01-24T14:11:36","guid":{"rendered":"https:\/\/sites.une.edu\/gwep\/?page_id=3781"},"modified":"2024-01-24T09:26:30","modified_gmt":"2024-01-24T14:26:30","slug":"speak-memory","status":"publish","type":"page","link":"https:\/\/sites.une.edu\/gwep\/speak-memory\/","title":{"rendered":"Speak, Memory"},"content":{"rendered":"\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"783\" height=\"789\" src=\"https:\/\/sites.une.edu\/gwep\/wp-content\/uploads\/sites\/23\/2024\/01\/Speak-Memory-3-783x789.jpg\" alt=\"\" class=\"wp-image-3754\" srcset=\"https:\/\/sites.une.edu\/gwep\/wp-content\/uploads\/sites\/23\/2024\/01\/Speak-Memory-3-783x789.jpg 783w, https:\/\/sites.une.edu\/gwep\/wp-content\/uploads\/sites\/23\/2024\/01\/Speak-Memory-3-298x300.jpg 298w, https:\/\/sites.une.edu\/gwep\/wp-content\/uploads\/sites\/23\/2024\/01\/Speak-Memory-3-150x150.jpg 150w, https:\/\/sites.une.edu\/gwep\/wp-content\/uploads\/sites\/23\/2024\/01\/Speak-Memory-3-768x774.jpg 768w, https:\/\/sites.une.edu\/gwep\/wp-content\/uploads\/sites\/23\/2024\/01\/Speak-Memory-3-1523x1536.jpg 1523w, https:\/\/sites.une.edu\/gwep\/wp-content\/uploads\/sites\/23\/2024\/01\/Speak-Memory-3.jpg 1944w\" sizes=\"auto, (max-width: 783px) 100vw, 783px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Lynn Casteel Harper On New Ways Of Understanding Dementia<\/h2>\n\n\n\n<p>BY\u00a0DEREK ASKEY &#8212; DECEMBER 2023<\/p>\n\n\n\n<p>N<em>early 7 million Americans have Alzheimer\u2019s disease, most of them elderly, with 10 percent of people over the age of sixty-five affected. But as prevalent as it is, the condition is still widely misunderstood and stigmatized.<\/em><\/p>\n\n\n\n<p><em>You may know someone with dementia: a parent, a grandparent, a spouse, a colleague. For me it was my gran, my beloved maternal grandmother, who lived next door when I was growing up. She had Alzheimer\u2019s, the brain disease that accounts for the majority of dementia cases. She died in 2012, her symptoms having steadily intensified in her final years, a progression familiar to many: first she forgot words, then names, then how to drive her car. I remember visiting her on sunny afternoons after I had moved away from home, when she was no longer able to converse. We sat in her living room in companionable silence, the wall clock ticking louder than I remembered it ever having done before. I\u2019d think of sentiments I wanted to express but couldn\u2019t. Somehow it seemed enough for her that I was there.<\/em><\/p>\n\n\n\n<p><em>Baptist minister, nursing-home chaplain, and writer Lynn Casteel Harper has been working with the elderly for years, particularly those affected by dementia. She, too, has a familial connection with Alzheimer\u2019s: her grandfather and other family members have died with it, and she\u2019s at high risk of developing it herself. Her 2020 book,&nbsp;<\/em><a href=\"https:\/\/books.catapult.co\/books\/on-vanishing\">On Vanishing: Mortality, Dementia, and What It Means to Disappear<\/a><em>, takes an unconventional approach to the subject, exploring how our culture ostracizes those it no longer sees as valuable members of society \u2014 not just people with dementia but anyone who isn\u2019t \u201ccontributing.\u201d The book is as much about literature, philosophy, and theology as it is about cognitive decline. Harper explores how Western culture overvalues self-sufficiency, and she argues for a more humane way of treating those who have dementia \u2014 by better integrating them into society, acknowledging their contributions, and recognizing that any of us may develop cognitive symptoms at some point in our lives.<\/em><\/p>\n\n\n\n<p><em>Originally from southeastern Missouri, Harper earned her master of divinity at Wake Forest University in Winston-Salem, North Carolina, and completed her chaplaincy residency at Robert Wood Johnson University Hospital in New Brunswick, New Jersey. Her book, with its striking title, came to my attention shortly after I\u2019d learned that&nbsp;<\/em>The Sun<em>\u2019s founder and editor,&nbsp;<a href=\"https:\/\/www.thesunmagazine.org\/contributors\/sy-safransky\">Sy Safransky<\/a>, was developing dementia [<\/em>see&nbsp;<a href=\"https:\/\/www.thesunmagazine.org\/article\/443d0773-dfc7-47b5-9c04-1d329062e2d8\">Sy\u2019s essay in this issue<\/a>&nbsp;\u2014 Ed.<em>]. True to the magazine\u2019s spirit of candor and vulnerability, he encouraged me to speak with her.<\/em><\/p>\n\n\n\n<p><em>I visited Harper at the Riverside Church in Manhattan, where she serves as Minister of Older Adults. As she showed me around the historic building, we were frequently interrupted by churchgoers and members of her community \u2014 most of them elderly \u2014 who wanted to say hello. We spoke at length in her cozy office on one of the church\u2019s upper floors. A few weeks earlier, she said, an injured pigeon had mysteriously walked in, as if seeking her spiritual counsel.<\/em><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/planksun.blob.core.windows.net\/sun-site-files\/8833\/576-8-harper.jpg\" alt=\"Lynn Casteel Harper stands outside in a parklike setting wearing a winter coat and scarf.\" \/><figcaption class=\"wp-element-caption\"><em>Lynn Casteel Harper<\/em><br>\u00a9 Travis Tanay<\/figcaption><\/figure>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;You\u2019ve written about your mother giving you your childhood papers \u2014 drawings and schoolwork and even the meeting minutes for a club you\u2019d formed with your friends. You say the&nbsp;<em>you<\/em>&nbsp;who\u2019d made the materials was so unfamiliar that the papers felt \u201cforeign.\u201d How does this type of routine memory loss, which everyone experiences, relate to dementia?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;Though the losses with dementia are more startling, even upsetting, they are still part of the continuum of human experience. We\u2019re always negotiating our personalities, which are not static. When I saw those childhood papers and remembered the secret club I had formed with friends in middle school, there was a sense of rediscovering that little girl who was writing and who craved community and friendship, but who also had some guardedness about the treasures she kept. Looking back, I can say, \u201cI honor that self, even though I\u2019ve outgrown it, and there are still gifts there to receive.\u201d<\/p>\n\n\n\n<p>We experience multiple selves throughout our lives. It is actually a gift to forget some of them. If we remembered everything, it would be a burden. When people have conditions where they can\u2019t easily forget, it can be a problem for them. There is something to be said for&nbsp;<em>not<\/em>&nbsp;having to carry around everything we\u2019ve encountered in a given day, week, year, or phase of life. And there\u2019s something magical about rediscovering something you did at a different time that surprises you. It may not always be a happy surprise. There may be shame associated with whatever your previous self did or didn\u2019t do. I think it requires some compassion for yourself, some gentleness, to hold the multiple selves that you have been.<\/p>\n\n\n\n<p>We shouldn\u2019t be so tied to the idea that the predementia self was the most pristine or pure or true version of yourself, and the one with dementia is somehow less valid. That creates stigma and gives others permission to distance themselves:&nbsp;<em>This isn\u2019t the person I know<\/em>. My sixth-grade self was still the real me, and she was connected to and involved with her world. She\u2019s still a part of me, even if I\u2019m not living that experience any longer.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;Surveys consistently show that Alzheimer\u2019s is the most feared disease in the U.S. What does that say about us?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;I\u2019ve read that people worry more about other conditions \u2014 cancer is always high on the list \u2014 but people&nbsp;<em>fear<\/em>&nbsp;Alzheimer\u2019s. Over the course of working with people with dementia, encountering it in my family, and writing a book, I\u2019ve seen how overwhelming the fear around cognitive decline can be. People have knee-jerk reactions that I don\u2019t think they would with other diseases: \u201cIf I get a diagnosis, I\u2019m going straight to the gun shop,\u201d or \u201cJust wheel me out in a lightning storm holding a golf club.\u201d Sometimes the fear shuts down conversation. People don\u2019t even want to talk about this. Or they make statements like \u201cThat is the worst thing that could ever happen to a person; hard stop.\u201d I sometimes hear, \u201cYou must be a really special person to work with those people\u201d \u2014 which I\u2019m not. I\u2019m a normal person who has the same fears as everyone else. I\u2019ve experienced the fear of dependency, of not having any way to control a situation, of helplessness:&nbsp;<em>What if I have to rely on other people?<\/em>&nbsp;That fear is cultural.<\/p>\n\n\n\n<p>So what do we do with it? Fear itself isn\u2019t the problem. It\u2019s just a feeling. But fear leads to stigma. People with dementia report losing friendships at a much higher rate than their peers, and they\u2019re under greater threat of elder abuse. A lot of that has to do with unexamined fear. To be alive is to be fragile, and it\u2019s natural to be afraid. But if we\u2019re unwilling or unable to work with our fears \u2014 naming them, taking some of the air out of them \u2014 they grow.<\/p>\n\n\n\n<p>For me, the fear was reduced when I got to know people living with dementia and realized they are not defined by their disability. They are not lost. They are not empty shells, even though they are often treated that way. They wish for the same things I wish for, which are to love and be loved, to be treated as a whole person with a history.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;You write that our cultural values \u201coften define a person\u2019s worth in terms of financial, physical, and intellectual power,\u201d and this makes us devalue those with dementia. How do we address that, short of changing our culture?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;I don\u2019t know if there is an answer. Tom Kitwood was a social psychologist in Britain who did a lot of research on people living with dementia. He was going into care homes in the 1980s and 1990s, and he came to realize that the environments in which these people lived were profoundly stigmatizing and might actually have accelerated their decline. He noted the interactions they experienced throughout a day, and he labeled seventeen malignant things that happened to them, such as infantilization, being ignored, being banished. He said it wasn\u2019t about the malice or ill will of individual caregivers. It was part of the air we breathe.<\/p>\n\n\n\n<p>I think the first step is to build communities where an alternate value system is articulated. Here at the Riverside Church we try to keep an eye on the people who are often last in line for services, for attention, for respect. When people living with dementia are being dismissed, what does it say about those of us who are doing the dismissing? And how do we create communities where people are valued beyond what the dominant culture says makes a person valuable? What we try to do here is lift up the sacred value of all people, so that there\u2019s nothing you can do or not do that makes you less worthy of attention and resources and respect.<\/p>\n\n\n\n<p>That\u2019s not easy. It\u2019s not like you set your mission statement and it just happens. But I think it\u2019s hard to do apart from community. And it doesn\u2019t have to happen only in faith communities. It can also happen in artistic communities, intentional communities. The problem is individualism \u2014 this idea that we can go it alone. The solution cannot be lovely, kind individuals working in isolation. It takes a group effort.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;Is dementia viewed differently in cultures where multiple generations of a family tend to live in the same house or area and caring for elders at home is more commonplace?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;I hesitate to paint with a broad brush, but I will say communities that don\u2019t prize independence above all else fare better. Successful aging isn\u2019t about remaining disease-free, which is our dominant narrative in the U.S.: you age successfully because you remain \u201csharp as a tack,\u201d \u201cfit as a fiddle,\u201d or whatever we want to call it. But when cultures are able to frame aging in a larger sense of being part of community, of being a bearer of wisdom and deserving of honor, it removes some of the stigma. The reaction isn\u2019t \u201cOh, now Dad needs help. This is completely devastating.\u201d Rather this is part of what it means to be in a loving relationship, and this person is still highly valued within our family or community.<\/p>\n\n\n\n<p>The fear of dementia gets wrapped up in our view of aging in general. Not all people who live into old age necessarily experience cognitive diminishment, but dementia is often age-related. So how we approach any number of issues related to old age often affects how we think about cognitive change.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;Do you see those attitudes changing as baby boomers \u2014 who until very recently were the largest generation in the U.S. \u2014 become elderly?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;I hope so. What I\u2019m seeing with some boomers who are newly initiated into old age is that they\u2019re taking that same approach they\u2019ve taken toward other social-justice struggles they\u2019ve engaged with in their lifetimes, such as civil rights and women\u2019s rights, and are applying it to the limits and stereotypes placed on old age. Environmentalist&nbsp;<a href=\"https:\/\/www.thesunmagazine.org\/contributors\/bill-mckibben\">Bill McKibben<\/a>, now in his sixties, founded a group called Third Act to try to harness older people\u2019s wisdom and experience in organizing to address climate change. This kind of recognition of older adults\u2019 positive potential and power gives me hope. The flip side is that boomers can also have that sense of \u201cWe will extend youth forever, and that will be the model of what it means to age successfully.\u201d This idea of so-called super seniors is stigmatizing to those people who&nbsp;<em>do<\/em>&nbsp;experience limitations and challenges. They\u2019re not in the \u201csuccessful-aging club.\u201d<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;They\u2019re not riding a bicycle in a drug commercial.<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;And some people were&nbsp;<em>never<\/em>&nbsp;on the bicycle \u2014 people who were never part of white, middle-class, well-heeled, well-resourced America.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;Black Americans develop Alzheimer\u2019s and other dementias at nearly twice the rate of whites, and women make up almost two-thirds of Alzheimer\u2019s cases. How do you understand those imbalances?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;Those questions are being explored by experts in a lot of disciplines right now. I will say that health is not just a matter of the genetics you inherit. It has to do with your whole social-cultural environment: of being held or not held dear, being honored or not. And the place where people have been forced to live affects their well-being, especially if there are environmental toxins in the air or the water, like in Flint, Michigan. A whole network of things that disenfranchise people affect brain health as well. Do they have access to fresh vegetables in grocery stores?<\/p>\n\n\n\n<p>Of course, Alzheimer\u2019s also cuts across culture and class. People from all backgrounds are vulnerable to this disease. But we can\u2019t live in a bubble and say that our social environment has no effect. We know that brain trauma increases your chances of getting dementia later. So it has to do with the levels of trauma people are experiencing. It has to do with how women\u2019s health \u2014 and especially what it means to age as a woman \u00ad\u2014 is often understudied. The same populations in this country who are under threat for any number of health disparities are also under threat for this particular disease.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;Jack Kevorkian\u2019s first assisted-suicide patient, Janet Adkins, killed herself after she found out she had Alzheimer\u2019s. You write, \u201cIs this not the fascist impulse, the imperialist compulsion? Or might it be the compassionate impulse, the yearning to be free of unnecessary affliction? How blurry the distinction between exterminating weakness and alleviating suffering.\u201d Where do you see it transitioning from one to the other?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;The dominant culture often sees Janet Adkins, or any number of people who end their lives after getting an Alzheimer\u2019s diagnosis, as heroic. I want us to step back from that and think about what we\u2019re really saying, which is \u201cMy strong self will not permit weakness.\u201d That\u2019s a scary way for a society to operate, which is why I use language like \u201cfascist impulse.\u201d What does this attitude say, not only about our relationship to ourselves but to others in our country who don\u2019t fit our definition of&nbsp;<em>strong<\/em>?<\/p>\n\n\n\n<p>I\u2019m not a masochist. I don\u2019t believe that suffering is necessarily efficacious or that people should have to endure unnecessary suffering for some moralistic reason. But I want to question the assumption that dementia brings only unrelenting suffering. \u201cThere\u2019s no life there,\u201d we\u2019re told. \u201cThere\u2019s no joy. There\u2019s only diminishing relationship and disappearing love.\u201d But how much suffering is created because we withdraw our best care and respect and love and public resources from these people?<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;You describe your grandfather, who had severe dementia, leaning into his wife\u2019s coffin and saying, \u201cI don\u2019t want to join you yet, babe!\u201d It\u2019s grim but also sort of funny. I was wondering where humor figures into the \u201cvanishing\u201d of someone with dementia.<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;I\u2019ve experienced plenty of joy and humor in people living with dementia \u2014 just laughing at the human condition or loosening up a little bit. Like my grandfather leaning into my grandmother\u2019s coffin. There was something very true in what he said. I had never known him not to drink from the cup of life, whether he was flying airplanes or serving as a physician or on the Rotary Club. That was&nbsp;<em>him<\/em>&nbsp;talking, not the dementia.<\/p>\n\n\n\n<p>As a chaplain on a dementia unit, I met a man I\u2019ll call Tom. To get to know him, I asked him a lot of questions about his life. The next day, when I walked onto the unit, Tom put his head in his hands and said, \u201cOh, no, not you. Are you here to ask me a million questions again?\u201d In the moment it felt bad, like a little dagger to my ego. [<em>Laughs.<\/em>] But he was right! I had peppered him with questions and probably exhausted his limited capacities. That was a truth that I needed to see, and he showed it to me. Those of us who don\u2019t have dementia too often fail to recognize how we can learn from people who do. We\u2019re not just bringing them our enlightened selves:&nbsp;<em>Isn\u2019t it wonderful that we\u2019re so caring toward these folks?<\/em>&nbsp;No! What are we learning?<\/p>\n\n\n\n<p>I remember a woman, Bernice, pointing to my gray hair and saying, \u201cOh, you\u2019re aging, too \u2014 just like us.\u201d I had to laugh. She included me in their boat:&nbsp;<em>We\u2019re human in this<\/em>.&nbsp;<em>Welcome aboard.<\/em>&nbsp;I love those touch points of honesty and humor. It takes me out of my need to always have it together, to always have an answer, to always be the one who\u2019s bringing aid to someone else.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;Those who are \u201cmad\u201d are often seen as insightful precisely because they\u2019re mad. We believe there\u2019s a relationship between genius and madness. But I don\u2019t think we extend that to people with dementia, because they \u201caren\u2019t themselves.\u201d Does the intent of the speaker determine the value of the insight?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;I get what you\u2019re saying: with madness, the person\u2019s almost too much themselves. [<em>Laughs.<\/em>] And we do have a view of madness around artistic creation that isn\u2019t entirely negative. It can be brilliant or eye-opening. I just saw a van Gogh exhibit at the Met. We don\u2019t say, \u201cThis painter had some mental problems, so let\u2019s not pay attention to his work.\u201d<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;If anything, it\u2019s the opposite, right?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;Right! We\u2019re leaning in, like: \u201cTell us what we can learn.\u201d Why don\u2019t we do that with people who are experiencing cognitive change or impairment? Why aren\u2019t those of us who are \u201ctemporarily able-brained\u201d \u2014 to use the phrase from [sociologist] Morris Friedell \u2014 leaning in to pay closer attention?<\/p>\n\n\n\n<p>I think of Willem de Kooning, the abstract-expressionist painter who likely lived his final years with dementia. Some of his earlier paintings have this \u201cmad\u201d quality to them \u2014 the tortured artist struggling to get something on the canvas. And then, as his dementia progressed, it seemed things came easier to him. Some of his paintings late in life are much more spacious and airy. For a while the value of those paintings wasn\u2019t recognized \u2014 maybe because he was no longer the \u201cmad genius\u201d who\u2019d created the earlier ones, and work created by a person with dementia isn\u2019t as valued. Why is that?<\/p>\n\n\n\n<p>I don\u2019t want people with dementia to be seen as mad or lunatics. And yet the frame that\u2019s often put around them instead is one of vacancy: They\u2019re leaving their body. They\u2019re a husk or a shell. The light\u2019s on, but nobody\u2019s home. There\u2019s this sense that their essential self is progressively vanishing, which reinforces the idea that what they do or say or create isn\u2019t worthy of our careful attention.<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p>\u201cThere\u2019s no life there,\u201d we\u2019re told. \u201cThere\u2019s no joy. There\u2019s only diminishing relationship and disappearing love.\u201d But how much suffering is created because we withdraw our best care and respect and love and public resources from these people?<\/p>\n<\/blockquote>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;No one has come back from Alzheimer\u2019s and reported to us what that was like, so we have a limited ability to imagine it. You\u2019ve talked about how, as someone who sleepwalks, you know something happened but can\u2019t quite recall it. Do you think dementia is like that?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;I have used my sleepwalking experiences as a learning opportunity \u2014 not that people with dementia are asleep or in any way sleepwalking. But if, for instance, I start to clean the kitchen counter while I\u2019m sleepwalking, it doesn\u2019t help for my husband to try to stop me or to argue or rationalize. The best he can do is just let me do my thing or simply offer reassurance, like \u201cThings are&nbsp;OK. You can come back to bed. I\u2019ll take care of it in the morning.\u201d I think those experiences give me a window into what it\u2019s like for people with dementia who want to communicate. To have people negate your efforts is painful and embarrassing. The right thing to do is to provide reassurance and presence as opposed to correction.<\/p>\n\n\n\n<p>I\u2019ve also gravitated toward the Christian mystics, who move past the cognitive and into a deeper level of connection \u2014 with the self, with the universe, with the divine \u2014 that transcends words. I belong to a tradition that values words: studying the Bible, preaching erudite sermons. But the mystics say that silence is supreme, that the divine is actually met in silence \u2014&nbsp;<em>is<\/em>&nbsp;silence. If we can become more comfortable with absence, and even see it as sacred, then I think we can become more comfortable with gaps and absences and loss within ourselves \u2014 and not see that as a diminished capacity to relate to the divine.<\/p>\n\n\n\n<p><em>The Cloud of Unknowing<\/em>&nbsp;is a mystic text from the fourteenth century, author unknown, that talks about darkness and going into these foggy realms where we meet God in a pure form, beyond our concepts, beyond our capacity for abstract thought, beyond language. That is among the holiest experiences, and leads us to see ourselves as more than just a set of narrowly defined mental abilities.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;Were the mystics achieving that foggy state through deprivation and isolation? How did they get there?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;Practices varied. Some of it was ascetic \u2014 like you say, deprivation, whether that\u2019s fasting or long periods of solitude. But many of the mystics lived and worked among others, often in a religious community. A lot of them would have used contemplative prayer. A practice that\u2019s regained some popularity now in Christian life is called \u201ccentering prayer\u201d: periods of silent meditation where, if thoughts start to enter, you bring your mind back to a sacred word. The idea is not to ruminate on that word or make it the prayer, but to use the word when the mind becomes distracted, to invite the self back to silence.<\/p>\n\n\n\n<p>In Protestant life \u2014 at least, in my strand of it \u2014 the balance is often tipped toward intellectualism and activism and doctrine: What are you doing? How are you active? What are you learning? I think this bent can help frame the care of people with dementia in terms of social justice, but it can also stigmatize those who have trouble doing or thinking as they used to. I hope that contemplation and action can complement each other and coexist.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;You write of your grandfather: \u201cHe had touched a new place within himself, meek and mild, free from what is assertive, controlled, and strong.\u201d Similarly you describe&nbsp;<a href=\"https:\/\/www.thesunmagazine.org\/contributors\/ralph-waldo-emerson\">Ralph Waldo Emerson<\/a>\u2019s dementia as a state where he was constantly in the moment, a condition for which he\u2019d previously expressed admiration.<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;At the end of Emerson\u2019s life, his friends would come and just look at him. They said his head was \u201cin the empyrean\u201d \u2014 the heavens. The idea was that Emerson had come to some kind of peak, as opposed to a valley, and his friends enjoyed his presence. That viewpoint is within the realm of possibility for us, if we can wrap our minds around the idea that dementia has a positive side. The same is true of many relationships throughout our lives. For my friends who have young children, it\u2019s both beautiful&nbsp;<em>and<\/em>&nbsp;hard. We shouldn\u2019t consign people to one category or the other: either you\u2019re sick or you\u2019re well; you\u2019re here or you\u2019re gone. It would be dishonest to say dementia is without hardship or suffering, but it\u2019s also true that people can live a long time with dementia, and live well; that people with dementia experience love and joy and relationship.<\/p>\n\n\n\n<p>When I worked as a chaplain, there was a son who had a strained relationship with his mother, who was on the dementia unit. He said she had never been affectionate with him. But now, when he came to see her, she hugged and kissed him. For the first time in his life he was experiencing warmth and acceptance from her. But those stories are not the ones that make headlines. What dominates newspaper coverage is the suffering, the tragedy narrative. Shedding some aspects of the past in dementia might be a relief to the family or even to the person themselves. I\u2019ve seen people with severe mental illness enter into dementia, and some of the more distressing manifestations of their illness soften or fall away. That\u2019s not always the case, but it\u2019s worrisome when just one story captures the public\u2019s imagination: that it\u2019s tragic, that it\u2019s suffering. Then that\u2019s all we can see.<\/p>\n\n\n\n<p>Over the past several years people living with dementia have formed groups and are speaking for themselves and pushing back against the idea that they\u2019re not \u201chere\u201d: \u201cCome talk to us,\u201d they are saying. \u201cWe have something to share.\u201d I remember speaking with Jim, an activist who had a dementia diagnosis. He knew I was writing about dementia, and he told me, \u201cTell them we\u2019re not suffering.\u201d I think about that a lot. I have taken it as my marching orders.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;You refer to the \u201cabiding self\u201d of those with Alzheimer\u2019s: retired teachers continuing to teach kids in their imagination, people singing songs from their youth, and so on. I remember my gran, even when she was deep into her Alzheimer\u2019s, recalling songs she liked and also worrying about two little girls who were playing outside \u2014 clearly a memory of my mom and my aunt when they were little. What have you observed of the self that abides?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;I love how you framed that story about your grandmother. You could have just said, \u201cShe saw people who weren\u2019t there. That was the dementia.\u201d And there\u2019s some truth to that. But there\u2019s also something real underneath \u2014 something firmly intact within her. As a mother, she still cared.<\/p>\n\n\n\n<p>My grandfather was a physician, and one day when he was in assisted living, someone fell, and he went to try to pick the person up. The aides didn\u2019t understand that his behavior was not aggressive. It was a care impulse. Once my mother had explained his past to them, they started calling him \u201cDr. Jack\u201d and let him push wheelchairs or guide walkers.<\/p>\n\n\n\n<p>What often happens with dementia is people are given one role to play: a sick person. And everything is siphoned into that one role. Anything they try to do outside of it is viewed through the dementia narrative. But people want to have different roles. I don\u2019t want to be defined by my most \u201cdiminished\u201d self.<\/p>\n\n\n\n<p>It\u2019s a common trope that dementia is like a second childhood: they\u2019re regressing. But no child has had the experiences these people have had or lives in an adult body and carries within them a lifetime of memories, including memories that cannot be spoken or accessed easily.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;It\u2019s hard for loved ones when someone with Alzheimer\u2019s forgets them. How do we recalibrate our expectations in these relationships?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;I certainly remember when my grandfather stopped saying my name, and the pain of that:&nbsp;<em>If you don\u2019t remember me, how can you love me?<\/em>&nbsp;But love can persist beyond the ability to recall.<\/p>\n\n\n\n<p>What does it mean to remember love? We don\u2019t say that, because young children won\u2019t remember experiencing love, we\u2019re not going to give it to them. We have a sense that they will remember, even if they won\u2019t be able to recall the experience once they\u2019re grown. They somehow carry in their body the impression of being loved and cared for, of being in beautiful places. So why, when someone is at the other end of life, do we think it\u2019s not equally important for them to experience love and care? Doesn\u2019t that say more about those of us who don\u2019t have dementia, and our ego needs, than it does about the people living with dementia? Memory is more than simply pulling files from our brains. Memory isn\u2019t just a private affair of an individual\u2019s brain. It involves the whole body and other people.<\/p>\n\n\n\n<p>What does it mean for us as a larger community to hold memories for someone, as opposed to one person having to do all the work? Maybe it\u2019s more important for me to remember my grandfather and who he is than it is for him to be able to recall a certain memory about me.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;Were you able to reach that conclusion while he was living?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;There were moments. My family and I did the best we could to share who he was with caregivers who hadn\u2019t known him as long. If we could do that throughout the life-span, I think that\u2019s better than waiting.<\/p>\n\n\n\n<p>If we can find communities of trust \u2014 communities that aren\u2019t based just on shared interest or shared ability, but that move into what Aristotle calls \u201cvirtue friendship\u201d \u2014 that would go a long way toward creating a counterculture that says, \u201cYou\u2019re experiencing dementia, but you\u2019re not discarded. We\u2019re going to hold for you the memories that you can\u2019t hold.\u201d<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;You decided not to get tested for a gene that indicates an increased risk of developing dementia, including Alzheimer\u2019s disease, and you vowed to speak of \u201c<em>when<\/em>&nbsp;I get dementia\u201d as opposed to \u201cif.\u201d Have you stayed true to that decision? Has your resolve been challenged?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;Yes and yes. I have not gotten tested. My dad\u2019s last surviving sibling died with Alzheimer\u2019s this year, and my father entered an Alzheimer\u2019s drug study. Though he does not have Alzheimer\u2019s yet, he has the gene variant&nbsp;APOE4, areas of concern on his brain scans, and a strong family history of the disease. He doesn\u2019t have symptoms, but because of his risk factors, he enrolled in the AHEAD Study at Washington University Medical Center in St. Louis. It\u2019s partially funded by some drug company, of course. The idea is that the drug will head off symptoms before they emerge.<\/p>\n\n\n\n<p>Alzheimer\u2019s is a part of my lineage, and I am at a high risk. So I do try to say, \u201c<em>When<\/em>&nbsp;I have dementia,\u201d or, \u201cAs someone who doesn\u2019t have dementia&nbsp;<em>yet<\/em>.\u201d A woman in a workshop I led was very upset with me for saying that. She told me I was inviting the disease, but I don\u2019t see it that way at all. I see it as a way to normalize the discussion of dementia.<\/p>\n\n\n\n<p>If I begin to talk openly about the possibility of dementia in my future, perhaps it can lower the barrier for other people to talk about it, and to name their fears and hopes around it. Though some have received my efforts negatively, for the most part I think people find my choice of language intriguing. It\u2019s not meant to be glib. It\u2019s just better than thinking,&nbsp;<em>That won\u2019t be me<\/em>.&nbsp;<em>I\u2019m healthy; I walk every day; I take my vitamins and eat right.<\/em><\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;We\u2019ve all seen the ways in which aging and cognitive decline can be politicized. There\u2019s no shortage of headlines about President Biden\u2019s fitness for office.<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;Using&nbsp;<em>dementia<\/em>&nbsp;as a nasty term that automatically discounts anyone who has a slip of the tongue or struggles to find a word \u2014 that\u2019s totally untenable and has nothing to do with the journey of dementia. Frankly, Donald Trump received that label, too, from the Left. Anytime we do that to undercut an older politician\u2019s authority, it\u2019s stigmatizing to people living with dementia. It\u2019s using their condition to make fun of or discount someone else. That\u2019s not fair to people with dementia. And it\u2019s not fair to older people like Biden, who are hyperscrutinized. If a middle-aged politician forgot a word, would we blame their age? I forget things all the time, and no one blames my age yet.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;Yet.<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;Yet. If we live long enough, blame for the normal things we forget, the gaffes, will eventually be assigned to our age. And a narrative of negativity spins out from there. The use of that narrative in politics holds a mirror up to the broader culture. What does it say about our values? What does it say about us?<\/p>\n\n\n\n<p>Knowing and being connected to people living with dementia is important, but you might still come away with a stigmatizing narrative. Listening to those who are advocating for less stigma helps. It has been revolutionizing for me. There\u2019s an international group called Reimagining Dementia that\u2019s composed of people living with dementia, and also activists and advocates. The group doesn\u2019t dwell on who has a diagnosis or not. Some people want to share that information, but others say that\u2019s not how they want to be viewed, or that\u2019s not their experience. It\u2019s one of the most joyous, hopeful groups I\u2019m a part of.<\/p>\n\n\n\n<p>It all comes back to community: How do we shift the culture? We press forward and try to find others who want to be a part of what we\u2019re doing. Reimagining Dementia recorded a song recently, sung by people living with dementia and those who care about them. They are using music, using art, using dance to get outside of the strictures we put on ourselves. The meetings are some of the highlights of my month.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/planksun.blob.core.windows.net\/sun-site-files\/8834\/576-13-vugteveen.jpg\" alt=\"Blurry photo of a man led away by the hand by a woman. Only his forearm and hand are visible while she is in silhouette.\" \/><\/figure>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;Your friend Janet\u2019s mother had Alzheimer\u2019s, and she asked Janet a question that has stuck with me since I read it: \u201cAre you me?\u201d There\u2019s a permeability of the self implied in that question.<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;Where do I stop and you start? We work hard to maintain a sense of individual self when, in truth, we are connected in a lot of ways. Janet\u2019s mother\u2019s question gets at that in a philosophical way, but also a concrete way. Her daughter is in some ways concretely&nbsp;<em>her<\/em>, through&nbsp;DNA, and in other ways not.<\/p>\n\n\n\n<p>I think one of our greatest tools in dealing with dementia is the arts. Yes, we value medicine\u2019s contribution, but the arts allow us to enter into dementia experiences, to express something beyond the self. We\u2019re not the first to confront these questions. While writing&nbsp;<em>On Vanishing<\/em>, I was drawn to Shakespeare, especially&nbsp;<em>King Lear<\/em>: \u201cAnd, to deal plainly, I fear I am not in my perfect mind.\u201d The old monarch is slipping a little, losing some of his power, and feeling that slip. I keep going back to Whitman, whose \u201cSong of Myself\u201d expresses it so loosely and so expansively: \u201cI too am not a bit tamed, I too am untranslatable.\u201d We don\u2019t have to present a self to the world that\u2019s consistent and constant across time and space. We\u2019re untamed.<\/p>\n\n\n\n<p>I found myself going to the Bible as well and looking back at Hebrew poetry. The ancient Hebrews did not view the brain\u2019s executive function as the apex of what it means to be human. It was always about community and their relationship with the divine and how that was, and is, a dialogue. I turned to the New Testament and Jesus\u2019s teachings: \u201cBlessed are the meek, for they shall inherit the earth.\u201d Empowering the meek and humble is a very different approach than the one we take today. I was also drawn to the parables in the gospels, especially the teachings around the lost and found: the woman who loses the coin and sweeps the entire house to try to find it; the shepherd who leaves the ninety-nine sheep to go in search of the lost one. The message to those who are lost is: \u201cWe\u2019re only whole if you\u2019re with us.\u201d<\/p>\n\n\n\n<p>Some of my most profound experiences of faith have occurred in the presence of people living with dementia: the quiet and peaceful moments of being together and feeling held in a kind of transcendent love. What people with dementia experience is in some ways a holy mystery. They don\u2019t become irreligious. They don\u2019t forget their faith. When they are fully supported and offered ways to connect with their faith \u2014 whether through ritual or music or prayers or scripture or objects from nature \u2014 they remember their faith in a full-bodied way. I\u2019ve seen people who could no longer speak or walk or talk recite a prayer or sing together. It goes back to the mystics, who say religion is an experience of the divine even deeper than what we often call faith.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;Could we think of that as a faith felt in the body?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;In Christian life we say a community of believers is the body of Christ, and we are each members of the body. We are only whole as a body of Christ when the weakest member is fully attended to. There\u2019s really no&nbsp;<em>I<\/em>. Now, whether we live up to that is another story.<\/p>\n\n\n\n<p>Remembrance is the act of repairing the body to wholeness. So if people who live on the margins \u2014 immigrants, asylum seekers, our&nbsp;LGBTQ&nbsp;neighbors, older adults, people living with dementia \u2014 if these people have been severed from the community, it\u2019s our duty to&nbsp;<em>re<\/em>member them, and not because we\u2019re doing a nice thing, but because the body, our church, suffers when we don\u2019t include them.<\/p>\n\n\n\n<p>When we see people with dementia as fundamentally defective, our default is the charity model. We\u2019re giving, but there\u2019s no reciprocity or mutuality. We don\u2019t ask, \u201cWhat is the gift this person is bringing to this community, and how can we receive that gift?\u201d<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;Our founder and editor, Sy Safransky, titled one of his books&nbsp;<em>Many Alarm Clocks<\/em>, based on a quote from the Russian mystic Gurdjieff: \u201cA man may be awakened by an alarm clock. But the trouble is that a man gets accustomed to the alarm clock far too quickly. He ceases to hear it. Many alarm clocks are necessary and always new ones.\u201d It\u2019s so easy to slip into that day-to-day assumption of permanence, when we are at all times defined by impermanence.<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;Some people try to avoid this by using an app that makes their phone ding a few times a day to remind them they\u2019re going to die. It\u2019s a spiritual practice for them to face life in the light of their own finitude.<\/p>\n\n\n\n<p>We cling to the illusion that tomorrow will be like today. We have to plan as if that\u2019s the case, but we also have to reckon with the reality of impermanence. When we tell ourselves, \u201cBecause of these resources I have, because of these things I do, I will be buffered from that fate,\u201d that\u2019s an illusion \u2014 one that creates distance between us and people who are experiencing disability or illness. It reinforces a hierarchy.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;The elderly are probably the most aware of impermanence, and they are precisely the people we\u2019re choosing not to listen to.<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;To grow older isn\u2019t necessarily to grow wiser, but it gives us that opportunity. We have a lot of experience at our back. How do we translate our experience into wisdom and then create a culture that is welcoming of that wisdom? There are some groups \u2014 Sage-ing International, Gray Panthers \u2014 trying to promote older people as wisdom keepers and leaders.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;What have you observed about the way those with Alzheimer\u2019s communicate with each other?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;When I worked at a nursing home, I ran a small group for people living with deep dementia, and some profound relationships developed among the members \u2014 often out of my view, since I wasn\u2019t there all the time. There was a sense of companionship, of holding one another. People wanted to hold hands or offer each other a comforting touch. Of course, there were also people who didn\u2019t get along. Personalities persisted, as did personality clashes. But that\u2019s true in every community. It\u2019s not that everyone gets dementia, and suddenly they all appreciate each other\u2019s quirks. But I\u2019ve seen care and compassion and mutual support develop between them as well.<\/p>\n\n\n\n<p>When my grandfather had dementia, my mom hired a woman who just hung out and had coffee with him several mornings a week. Something beautiful developed between this woman and my grandfather. She had a lightness and looseness around him that we didn\u2019t. She didn\u2019t have dementia, of course, but she could reflect him back to us in a different light when we were seeing something heavier.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;Historically treatment of dementia has often been inhumane: deprivation, spinning patients in a chair, and on and on. How do you think we will look back on our current treatment of people with dementia?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;I think we will see how incomplete our approach was: The obsession with a cure. The overuse of psychotropic medications to \u201cmanage distressing behaviors.\u201d Only something like 10 percent of that is necessary, research shows. A lot of those psychotropic medications are dangerous for people living with dementia. Although medication has its place, creating supportive care environments and properly paying and respecting direct-care workers allows us to handle distress without automatically resorting to a pill. We have a tremendously stressed healthcare system that relies too much on pharmaceutical interventions. I hope we\u2019ll see this as a time when progress was being made on the edges, when expressions of distress came to be seen for what they are: communication.<\/p>\n\n\n\n<p><strong>Askey:<\/strong>&nbsp;Obviously&nbsp;COVID&nbsp;isolated elders even more. What lessons can we take from that?<\/p>\n\n\n\n<p><strong>Harper:<\/strong>&nbsp;Well, everybody got a dose of isolation, but people in nursing homes were absolutely devastated, and more than half of people in nursing homes live with some form of dementia. The slowness with which we responded to nursing-home deaths during&nbsp;COVID&nbsp;reflects how we view them. The lieutenant governor of Texas said, basically, that old people should take the hit on this one so we could keep the economy open. That was, like, day ten of the pandemic. And Trump, in the fall of 2020, after we\u2019d all seen devastation in nursing homes, said&nbsp;COVID&nbsp;\u201caffects virtually nobody,\u201d just elderly people. So \u201cnobody\u201d and \u201celderly people\u201d are essentially the same. But this rhetoric came from the Left, too.&nbsp;<a href=\"https:\/\/www.thesunmagazine.org\/contributors\/peter-singer\">Peter Singer<\/a>, a well-known ethicist from Princeton, said although we lost a lot of lives to&nbsp;COVID, we didn\u2019t lose that many&nbsp;<em>years<\/em>. How do you place a value on a year of life for someone you love?<\/p>\n\n\n\n<p>I hope&nbsp;COVID&nbsp;can help us reexamine the segregation that we\u2019ve normalized for older people and people with dementia, who live in nursing homes separated from the wider community. Their care workers were also devastated by the pandemic; hospitals were prioritized over nursing homes, even though people were dying at a much faster rate in nursing homes.<\/p>\n\n\n\n<p>We need to ask ourselves: How do we want to age? How do we want to live when we have dementia or need help? How do we create communities that don\u2019t just segregate people? How do we pay people well for doing the care work that\u2019s so valuable? If my grandfather\u2019s caregivers had left overnight and not come back, he would have been a wreck. Our lives would have been turned upside down. That to me says their work is valuable. But because the people doing this work are primarily women, and disproportionately women of color, we fall back on the long-standing practice of devaluing their labor. I hope, as part of changing how we treat people with dementia, we can reevaluate the racism and sexism embedded in our economy, especially our care economy. I hope we can keep lifting people up.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Lynn Casteel Harper On New Ways Of Understanding Dementia BY\u00a0DEREK ASKEY &#8212; DECEMBER 2023 Nearly 7 &hellip;<\/p>\n","protected":false},"author":88,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"folder":[],"class_list":["post-3781","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Speak, Memory - AgingME: Geriatrics Workforce Enhancement Program (GWEP)<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/sites.une.edu\/gwep\/speak-memory\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Speak, Memory - AgingME: Geriatrics Workforce Enhancement Program (GWEP)\" \/>\n<meta property=\"og:description\" content=\"Lynn Casteel Harper On New Ways Of Understanding Dementia BY\u00a0DEREK ASKEY &#8212; 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