Editor’s Note: Rabbi Cary Kozberg has been Director of Spiritual Life at Wexner Heritage Village in Columbus, OH, since 1989.
His responsibilities include overseeing the religious and spiritual nurturing of residents, family members and staff throughout Wexner Heritage Village. He believes that spirituality is the base that supports our ability to serve others and states that “spirituality gives meaning and purpose to our mission to honor the elderly, affirm the dignity of every person and bring healing to those who need it.”
A nationally-recognized resource on spirituality and dementia, Rabbi Kozberg is the author of Honoring Broken Tablets: A Jewish Response to Dementia and co-editor (with Rabbi James Michaels) of Flourishing in the Later Years: Jewish Pastoral Insights On Senior Residential Care.
He delivered this sermon on Rosh Hashanah 2014.
One day, a 75 year-old man hears a voice telling him to leave his family and his community, and go to a place that he will be shown. In return for his obeying this command, the man is promised fame, countless descendants, land, and the blessing of being held in high esteem.
The voice addresses this man alone, and only the man himself hears the voice. The man has never heard the voice before, but still he obeys: he takes his wife and orphaned nephew and leaves for this as-yet-unknown destination.
Because the man is obedient, the voice continues to address him. The man and his wife are elderly, and childless. The voice continues to tell him that all the promises made to him will be fulfilled, including (absurd as it sounds) the one about having children! When the man is 99 years old, the voice tells him to affirm this budding relationship by circumcising himself and every male in his household, and he is told that this practice is to continue forever.
The man and his wife finally do have a child of their own when he is 100 and she is 90. Then one day, the voice calls to the man once again and requests that he give the child back. Without hesitation—and with some haste—the man makes preparations to obey. But at the last moment, the voice stops him and proclaims him a most worthy, most faithful man.
The story, of course, is that of Abraham and Sarah. One part of the story we just read a few minutes ago, and another part—the Binding of Isaac—we will read tomorrow. Our Sages chose these stories as the Torah readings for Rosh Hashanah probably because Abraham and Sarah are, in our Tradition, the exemplars par excellence, of sustaining hope in the face of an uncertain future. It is a hope based on trusting G-d—even when what
G-d is communicating doesn’t “make sense”.
Whenever I read the Abraham narratives, I often ask myself: if these events were to occur today—if Abraham and Sarah were contemporaries of ours—how would we respond to them? How would we react to their words and their actions? What would we say? Given the fact that we live in a culture which perceives “truth” and “reality” very differently from how our ancestors did, it is safe bet that most of us would pity this poor couple as having lost touch with reality, probably due to some form of dementia brought on by their advanced age. After all, what other LOGICAL reason could there be to explain why a 75 year old man would obey a voice telling him to pack up everything and leave for an unknown destination? What other LOGICAL reason could there be to explain why a 99-year old man would obey a command to mutilate himself and others as well? Today, based on what we judge to be real or not real, sane or insane, we would put such a person in a place where he could pose no threat to himself or others. As for his wife, our hearts would go out to her, as we lamented her gullibility and possibly her own onset of dementia.
Yes, many of us would conclude that Abe probably was “not in his right mind”. That certainly would seem to be the conclusion of Dr. Ezekiel Emanuel, who is quoted in an op-ed piece by Victor David Hanson, which appeared in this morning’s Columbus Dispatch (“Doctor’s Essay on Aging Was Troubling”, Sept. 25, 2014) . Mr. Hanson writes:
Normally, no one would care that in a recent Atlantic essay, “Why I hope to die at 75,” 57-year-old Dr. Ezekiel Emanuel argued that living to be 75 years old was long enough. After 75, Emanuel suggests, “we are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic…
“I think this manic desperation to endlessly extend life is misguided and potentially destructive,” Emanuel writes. “For many reasons, 75 is a pretty good age to aim to stop.”
Dr. Emanuel, you may remember, was one of the architects of the Affordable Healthcare Act. Apparently, he believes that when a person reaches the age of 75, it’s time to die, because after 75, a person is no longer as vibrant and engaged, but becomes feeble, ineffectual and pathetic.
Dr. Emanuel is Jewish, but it seems that he never learned about Abraham when he went to Hebrew school. According to Scripture, Abraham was just getting started at the age of 75. Precisely because Abraham responded the way he did when he was as old as he was— and despite what logic may have dictated—not only is he not dismissed as being “out of his mind”, ineffectual or feeble; on the contrary—he is revered as the spiritual ancestor and role model of the world’s three monotheistic religions.
But, for a moment, let’s give a wink to Dr. Emanuel; let’s ask this hard question: What if Abraham really did have…dementia? Would it matter? Would he be less of a role model for us? The answer is: for some like Dr. Emanuel—yes, he would be less of a role model. Or more correctly, he wouldn’t be a role model at all because, “being pathetic” and “not in his right mind” , nothing he said or did would be taken that seriously.
But for those of us who believe that human beings are not just logical minds housed in physical bodies, but are created with souls that somehow, someway always respond to G-d’s call– no matter what other parts of us are compromised or fail—we might entertain the possibility that not only would dementia not detract from Abraham’s spiritual greatness; it actually might have enhanced it.
How so? Because, as those of us who spend time around people with dementia see time and again: when our cognitive abilities diminish, our inner spiritual longings begin to express themselves more strongly and with more energy and passion. In other words, when we no longer have the filter of “logic” holding us back, our inner selves often become more animated and alive. When dementia takes away our ability to think clearly, we are often able to feel matters related to the spirit more authentically and more spontaneously.
I imagine that this might have been the way it was with Abraham. I imagine that this is what our Sages may have had in mind when they taught that at Sinai, everyone there experienced the voice of G-d, each in his/her own way, and according to his/her own abilities: men heard it one way, women heard it another way; the young heard it in their way, and the elderly heard it in their way. Everyone’s experience was unique because when G-d speaks, it’s not just the Mind that is listening; it’s the heart and the soul that are listening. And, again as we see daily around here at Wexner Heritage House, even though dementia may ravage the mind, it most certainly does not diminish the soul.
Let me tell you my favorite story about how spiritual passion and spontaneity comes to the fore when cognitive abilities diminish. I didn’t witness this personally, but it was told to me by a most reliable source:
Several years ago, the family of a certain woman noticed that her cognitive abilities were significantly declining. So they decided to make sure that the upcoming Christmas holiday would be as wonderful and as uplifting for her as they could make it. A year or so before, she had moved to a senior residential care center. For a while, she flourished in her new home.
But then, her family began to notice her decline. Wondering if this was a sign that her days on earth might be numbered, they all agreed that if this Christmas was going to be her last one, it would be an inspiring experience for her—and a memorable one for them.
They decided to take her to their church’s annual Christmas Eve program—the church where she had been a faithful and active member for most of her 85+ years. Shepherding her through the crowded sanctuary, her family gently helped her put names to the vaguely familiar faces she saw. Wanting her to focus solely on the program without distractions from the sights and around her, they made sure to sit on the first row.
The program was a re-enactment of the Nativity—and when it began, the transformation in her was immediate. To their great joy and satisfaction, she was mesmerized by the play–her eyes sparkling, her face aglow in anticipation, as she connected with countless memories of similar scenes over the years.
Then it happened.
During one scene, one of the shepherds approached the manger and exclaimed with great emotion, “Is this baby the one we have waited for? Is this infant the Promised One? Is he really the true Messiah?”
In the blink of an eye—and to the astonishment of all around her—the woman leapt out of her seat , shook her fist, and, in a loud voice filled with passionate affirmation and annoyance, shouted back:
“OF COURSE HE IS! ANY DUMB S.O.B. KNOWS THAT!!”
(I apologize for the “salty” language, but you see how it makes the point)
The “salty language” notwithstanding, we must ask: in the face of such spontaneity and passion, how can one maintain that people with dementia are not (to reference the title of the recent film) still “ALIVE INSIDE”? I would offer another, less “salty”, example:
During the High Holiday season, one of the programs that we have done here with some of our residents who have dementia is to ask them open-ended questions that focus on their feelings and long time memories. We do this in order to help them better connect with this sacred time of the year. Here are some of the questions we ask, along with some of their responses. Mind you: all of these answers are from people who were assumed to be “no longer ‘with it’ ”:
Before you leave this world what do you want others to know?
“Live life as if today was your last day”.
“Be kind and considerate and help others even in a small way.”
What do you hope for?
“That I will have the strength to better bear the burdens I have.”
“That I will be remembered by those I love.”
“That my children will understand me better, and I will understand them better.”
What do you wish you could change?
“I’d like my memory to be better.”
“I wish I would not have spent so much time dwelling on disappointments and would have been able to let go of things that upset me.”
“I wish I could have been able to accept what came with more grace and have no regrets.”
When one listens to these answers, one wonders if these people who are supposed to be “not with it anymore” actually “get it” better than the rest of us! And listening to these answers, the words of Rabbi Abraham Heschel, come to mind: what matters is not what’s inside a person’s head, but what is inside his heart.
And yet, even with such powerful anecdotal testimonies –and there are hundreds of them occurring everywhere, everyday! –somehow we “normal” folks still don’t seem to be hearing what these folks are telling us. We don’t seem to be getting the message, and this is because we live in what Dr. Stephen Post calls a “hypercognitive culture”—a culture in which the value of human beings is determined by their cognitive and intellectual abilities–how smart/shrewd/sharp/mentally productive they are.
And when these abilities are diminished or lost, so is the person’s worth and dignity. It’s as if we have attached a caveat to the famous statement by the philosopher Descartes, “I think, therefore I am”. We’ve added: “But when I no longer can think, then I no longer AM”.
Indeed, it is out of this mindset that people like Dr. Emanuel and others will say–and I’ve heard it said too many times in my career– “If I ever get that way, shoot me!”.
It is out of this mindset that a recent Dispatch editorial, while praising efforts to help those with dementia, actually presented a lot of “doom and gloom” by declaring that dementia “masks personality and steals enjoyment, turning the golden years to rust” (“Music helps ease dementia’s grip”, Columbus Dispatch, August 23, 2014)
And it is out of this mindset that even the Alzheimer’s Association itself—THE advocacy group for people with dementia and their families– proclaimed in some of its promotional materials, that the disease “takes everything away from you…it means the loss of anything and everything you’ve ever known…it robs people of all bodily functions and eventually their humanity.”
“TAKES EVERYTHING AWAY FROM YOU”? Yes, Alzheimer’s does rob people of their ability to remember, to think clearly, and do even the simplest tasks. But it does not rob them of their spirit. It does not rob them of the ability to continue to enjoy those things that most of us take for granted: sunshine, listening to birds, sitting and holding hands with a loved one. It doesn’t rob them of the ability to love, and be loved in return.
Yet we somehow don’t acknowledge this. Somehow we keep holding on to this mindset. And that is a shame.
It is a shame because ultimately such a mindset will not help us to respond effectively to the challenge of dementia which is only going to increase, as these statistics bear out:
–Here in Ohio, by 2020, the population of those 60 and over will increase by 20%, and will double by 2040.
–At age 65—1 in 7 persons has Alzheimer’s (usually undiagnosed)
–By age 72, one in 3 experiences some sort of cognitive decline.
–At age 85, up to half of all persons will have some sort of dementia.
–In the coming years, there will be a critical shortage of geriatricians and geriatric psychiatrists, and right now there is a dirth of effective medications to stop or effectively slow down cognitive decline.
Given these statistics, it would certainly behoove us to pay attention to what experts are telling us: when it comes to responding to the expanding challenge of dementia: we need a new perspective, we need a new narrative.
To quote John and Susan McFadden, we need a new narrative that doesn’t talk about dementia as “attacking the brain”; a new narrative that doesn’t refer to people as “victims” who will ultimately become “vegetables” (to be sure, a person never becomes a carrot or a broccoli or a turnip); a new narrative that doesn’t focus on—and promote– FEAR.
Instead, we need is a narrative that focuses on nurturing and nourishing the soul and the spirit; a narrative that focuses on a person’s abiding ability and desire to still relate to others, in whatever ways they are able.
We need to broadcast what the late Rev. Elbert Cole taught throughout his career: that people with dementia, despite their losses are still people, and they have the same needs as other people. They need:
–to love and be loved, to be respected and appreciated.
–to express compassion and share of themselves,however they are able to do this.
–to feel productive, stimulated and secure.
–to celebrate the joy of living by feeling “connected” to those around them, to their environment, and to G-d.
And certainly one of the most powerful ways to nurture and stimulate the spirit and to keep it energized and alive is music. We here at Heritage House know that to be true, pretty much on a daily basis.
But fortunately, in large part due to the film “ALIVE INSIDE” which was recently screened here in Columbus at the Drexel Theater and sold out its first night, so many more people are also beginning to understand that people with dementia need this kind of nurturing and nourishing. And they’re beginning to appreciate how music is one of the best ways to make this happen. Seeing how people with dementia literally CHANGE and are transformed, we’re learning that our narrative about dementia also can–and needs—to change.
This film, “ALIVE INSIDE” documents a project called “Music and Memory”, which is the brainchild of Dan Cohen, who is a social worker by profession. The film dramatically shows how the most cognitively-compromised, disconnected and hard-to-reach people can be transformed, simply by having them listen to music that they grew up with—be it blues, big band, or rock and roll. Whatever type of music the person enjoyed—it brought forth memories long buried, and dramatically the person’s behavior. Take a look:
It’s amazing what they’ve done! You can see how these individuals were practically resurrected—and all without medication! But even more noteworthy has been the film’s impact the film on audiences; folks are seeing for themselves that these people really are still “alive inside. We’re learning that we can still reach them, relate to them, and even learn from them: how to live dignity and even purpose, instead of just waiting to die.
I’m happy to say that we are planning to start a Music and Memory program here at Heritage House. We have secured funding to train our staff, purchase the i-pods and download the music to create personalized playlists for those who will benefit from this program.
One last comment: today is Rosh Hashanah, the beginning of a new year. This holiday isalso called Yom Hazikaron, the day of remembering. At this time of the year, when we affirm that G-d remembers and never forget us, we are called to be His partners to remember those who routinely forget—to help them to remember and to help them stay connected to usand to Him.
For some of us, this may indeed be a somewhat formidable challenge. But it is one that is much less formidable when we remember that:
TO LOVE SOMEONE IS TO LEARN THE SONG
THAT IS IN THEIR HEART, AND TO SING TO THEM
WHEN THEY HAVE FORGOTTEN IT.
Today, as we ask G-d to remember and reconnect with us, may we renew our commitment to remember and reconnect with our loved ones, friends and neighbors who can no longer remember or reconnect on their own. As we continue to face the challenges that Alzheimer’s disease and other forms of dementia will put in our path, may we work to create that new narrative—which celebrates being “alive inside”, which celebrates and nurtures those parts of our being human which dementia cannot destroy.
When Moses broke the first set of tablets, he put the shattered pieces in the Holy Ark because, even thought they were broken, they were still sacred. So may we affirm the sanctity of those who others see as having little value because they are broken.
As we begin this new year, may our efforts serve to help each of us mend our own brokenness.