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A caller to Pat Robertson's "700 Club" broadcast on September 13th posed a challenging question. A friend of the caller has become bitter at God because his wife is suffering from Alzheimer's disease. Was it acceptable, the caller wondered, that the friend started seeing another woman since his wife "as he knows her is gone." In response, Pat Robertson described Alzheimer's disease as a "walking death," and suggested that the man divorce his afflicted wife but also set up custodial care for her. Robertson's comments have been lambasted by many who suggest that he misunderstands the course of Alzheimer's disease and that his views go against his own theological values. So is Alzheimer's disease really a "walking death?" And how can marriage vows weather the inevitable loss of persona that Alzheimer's disease and other forms of dementia bring?
In my clinical practice as a geriatric psychiatrist at a busy memory center, I often hear similar concerns from spouses who struggle with the loss of communication, intimacy and companionship and the growing burden of caregiving as Alzheimer's disease progresses. I have heard many spouses and other caregivers refer to their afflicted loved ones as suffering a form of living death. As Alzheimer' disease progresses into moderate and severe stages, individuals lose much of their identities, and eventually do not remember or even recognize spouses, children and lifelong friends. Their abilities to engage in previous interests diminish as they become increasingly dependent on others for care. Against this background, Pat Robertson was only voicing what many caregivers sometimes think about their loved ones with dementia. For example, one middle-aged husband told me that he was overwhelmed with caring for his wife who has suffered from Alzheimer's disease since the age of 60. "She is no longer the woman I married," he stated, and lamented how he struggles with comments from friends that he should take a lover. When I informed another man that his wife's course would likely last for years, he replied, "That's a long time dead."
From one perspective, then, Robertson's description of Alzheimer's disease is not uncommon and does capture a blunt --and some would say honest-- perspective. But it is also a limited view of Alzheimer's disease that dehumanizes the very sufferers who Robertson and others would certainly agree were created "in the image of God." Alzheimer's disease typically runs an 8 to 10 year course from the start of symptoms, and during most of this time individuals retain the power to recognize others and engage in loving and meaningful relationships. Even in later stages of disease individuals retain the ability to enjoy sensory experiences, humor and affection. To label someone with Alzheimer's disease as demonstrating a "walking death" is to completely ignore the humanity which remains until the very end. Spend time with the vast majority of caregivers for Alzheimer's patients and you will see holiness in action - individuals who are able to see beyond tragic changes in their loved ones and provide not simply custodial care but loving care.
One important issue raised by Robertson's comments concerns the burden that Alzheimer's disease imposes on a marriage. As the disease progresses the afflicted spouse is less able to fulfill the expected role of a marital partner. The non-afflicted spouse goes from being a partner to being a caregiver, eventually having to provide or pay for daily supervision and assistance with dressing, hygiene, transportation and a host of other daily needs. It can be an exhausting, lonely and depressing experience, and no doubt accounts for the elevated rates of major depressive disorder, medical illnesses and even mortality in caregivers. Some spouses yearn for or even seek out new relationships to provide companionship and intimacy when they no longer can find it with their partner. One might even argue, as perhaps Robertson does, that religious law from a variety of traditions would sanction divorce in such circumstances. As a clinician, it is not my role to judge others for these desires or behaviors. By the same token, I do not encourage them either. In my experience, very few spouses end up seeking new relationships. But I do encourage active discussion about these issues either individually or in a group in order to provide caregivers with support to cope with the changes in their relationships. In the case called into Pat Robertson, it might be best to first encourage the man who is bitter and angry with God to seek counseling with a trusted clergy or a therapist, and to explore his feelings about how his marriage has changed. Seeking out a new relationship might be a legitimate impulse on his part, but it also may represent action based on confusion and unresolved anger that will cause more heartache in the end.
Robertson is quite aware of the tragedy and suffering of Alzheimer's disease. But his suggestion for the man to seek a divorce is putting the cart before the horse. Divorce may be an option for the man, but it's a rare choice. In my entire career I've never seen it happen. My response, instead, would be to empathize with the man's feelings, acknowledge the struggle that he and so many other spouses of Alzheimer's patients face, remind him of the still present humanity and sacredness in his wife and the potential for a loving and meaningful relationship despite the illness, and refer him to the many wonderful support services for Alzheimer's disease. In the end, let us respond positively and collectively to the cry of the Psalmist: "Do not cast me off in old age; when my strength fails, do not forsake me" (Psalm 71:9). Regardless of our religious traditions, it's a sentiment we all can share.
