From the Archives: Hugo Petzsch on Dementia

After a brief hiatus, Public Faith resumes with a new series drawing from its extensive archive of publications. The Centre for Theology and Public Issues was founded 27 years ago in order to place theological wisdom into conversation with public policy makers, service providers, and service recipients. During CTPI’s initial year, founder Duncan Forrester launched a series of Occasional Papers that lasted until 2003. Most of these papers are now available in their entirety on Google Books.

The first of the Occasional Papers is, in many ways, exemplary of CTPI’s mission as an institution of public theology. The paper, “‘Does he know how frightening he is in his strangeness’: A Study of Attitudes to Dementing People,” was written by Hugo M. D. Petzsch as a dissertation in fulfilment of requirements for the Bachelor of Divinity degree. Petzsch explores both NHS and church responsesĀ  to demented persons, and argues passionately for a response that imitates Jesus’ welcoming of outcasts. After summarizing the paper, we consider the questions it continues to raise nearly 30 years later.

I. Petzsch initially considered looking solely at the care structure for the demented, but realized this took the focus off the demented themselves. On the other extreme, he began a kind of systematic theology of dementia, only to see that this perpetuated a view of the demented as “objects” of study. Instead, he chooses to examine our understanding of relationships as these are challenged by the demented. This examination is carried out in light of medical and theological investigations.

II. Petzsch reviews clinical definitions of dementia and concludes that the various forms involve changes to the person’s memory, emotions, behavior, and rational and sensory capacities. For current discussion of clinical definitions, see the NHS page on dementia.

III. He goes on to evaluate the various care facilities available for demented persons, as well as the assumptions underlying care. Some of his criticisms, unfortunately, continue to be valid. Dementia care is chronically underfunded, and social and medical services are not well integrated. Petzsch suggests that the reason for these problems is that chronic illnesses like dementia challenge our view of the world as easily managed by science and medicine. Because there is no “cure” for dementia, we prefer to push the demented and, too often, their carers, out of sight and mind.

IV. Petzsch turns to theological and church resources for addressing dementia, and does not find them to be much of an improvement over the NHS. Theologians tend to define human persons as rational beings. But how then are Christians to conceive of persons who “lose” their rationality, such as in cases of dementia. Petzsch looks at Barth and Brunner’s classic modern attempts to overcome this rationalism, but concludes they too define humans by their rationality. Christian medical ethicists, such as Paul Ramsey and Joseph Fletcher, are even worse. In their discussions of neo-nates, they continue to restrict the definition of personhood to rational and even aesthetic categories. These discussions have grave implications when transferred to demented persons. Given the state of theology, Petzsch is not surprised to find that Christian pastoral care for the demented is lacking. He wonders why churches prioritize children’s ministry, when children too tend to be loud, unruly and incontinent–do the churches hold a materialist anthropology, he provocatively asks, in which a person’s potential social contribution is all that matters?

There have certainly been important changes since Petzsch wrote, both to academic theology and to church provision of care. The Centre for Spirituality, Health and Disability, at the University of Aberdeen, carries out theological research on dementia and other chronic disabilities. There are resources for local churches on caring for the demented. The churches are beginning to prioritize dementia in prayer and action. Yet Christians know that, all too often, we are keen to usher the demented out of our churches and social lives. Petzsch’s probing question still resonates.

V. Petzsch then offers four biblical models as metaphorical responses to the demented. The first is drawn from the Old Testament ritual in which a goat is symbolically laden with the community’s sins and led out into the wilderness. In a similar manner, we tend to treat the demented and their carers as “unclean” and incapable of being related to. Petzsch acknowledges the difficulties of relating to the demented, but does not accept scapegoating them and removing them from polite society as an option. The second model is that of Isaiah’s suffering servant. Putting the messianic overtones to one side, Petzsch describes how Isaiah not only looks upon the servant’s suffering, but admits complicity in causing the suffering. Admission of guilt is important, but it too is not enough–“informed inertia” is not yet a renewed relationship with the demented. Petzsch therefore turns to Jesus’ interactions with outcasts, such as the Gedarene demoniac. Jesus engages the outcast, healing and restoring him to community. Jesus’ response must be our response.

VI. Petzsch concludes the paper with a few practical recommendations: we need to visit and sit with the demented; we need to have better support groups for carers and family of the demented; we need an organized society for the demented, better publicity, and more funding. To be sure, many of these recommendations are being carried out. As of 2010, there is now a Dementia Centre. The Alzheimer’s Society and the NHS have readily available resources and support networks. We have already mentioned how churches and theology departments are responding. At the same time, the NHS estimates that the number of demented persons in England alone, already 570,000, is expected to double in the next 30 years. The coming health care crisis caused by ageing baby boomers is much discussed, and at a time when governments are looking to reduce their health care expenditures. The questions Petzsch raises about how and why we care for the demented have never been more pressing.

How do you think Christians should respond to demented persons? What do you think churches can do to welcome and care for the demented? What place do you think the church has in lobbying for better national health care? Do you know any good stories about caring for the demented? Please share your thoughts in the comments.

Image Credit: Nonno by Agostino. L

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