My mother is 83 and has had dementia for about five years. When I saw her four years ago, the door of her apartment was open and she had just gone wandering off. The onset was so rapid that she quickly got to the point where she cannot remember anyone.

When I saw her again two years ago, she didn’t recognise me at all. She doesn’t recognize my brother either. While I was with her, out of the blue, she mentioned a strange word: monastery. There was this spark of recognition there but that was the only recognition.

I visit her at the nursing home once every two years. I don’t feel that I need to be close to my mother because I am trained as a monk to let go. If I didn’t have a brother who is looking after her, I would be a bit more concerned. So I am very grateful to my brother for looking after her. In a sense, my brother is doing my duties for me. I have great respect for him.

When a person has dementia, they may not recognise you. They may not know who you are when you visit them, but you know who they are. And so it’s worthwhile visiting them. Just because they don’t recognise you is no reason not to go and see them because you still know who they are. And that’s why it’s important to go and say hello.

Understanding the fears of people with dementia

My mother’s dementia is quite benign. She was always peaceful and kind. But in a dementia care facility I visited in the north of London, there were people who showed every sign of being terrified. For the two hours I was there, they were in constant fear.

There have been times when I was travelling and I wake up in a hotel room or temple without knowing where I am. It takes a while to get my bearings. But it’s disturbing for the first couple of seconds.

For people with dementia, it is every second of their lives: being in an unfamiliar place filled with unfamiliar people.

A moment of clarity in the mist that is dementia

What happens to a person with dementia in the last moments of life? For people who are not under medication, in the last moments, the last few minutes of their lives, there is often a sense of clarity and calm. Sometimes people emerge from a coma.

One of my disciples was with her sister in a hospice at the bedside of their dying father. They were holding their father’s hand and, without any warning, he opened his eyes. He looked around and his two daughters said: “I love you, Dad” and then he closed his eyes and died.

It is one of those occasions when the last few moments of life are very clear and lucid and this is what often happens to someone with dementia.

Dementia is a brain disorder and Buddhists believe that the mind disengages from the brain in the last few moments of life so the lack of clarity, the mist that is dementia, clears. And in the last few moments before death and after death, you are clear again and you have the ability to remember to think, to know like you were before you had dementia. The blockage on your consciousness¹
known as dementia is lifted.

As for my mother, I am not bothered by her dementia because I accept it as part of nature. She doesn’t have any suffering; she is not constantly terrified. She doesn’t know where she is but she is happy and that happiness makes me feel quite content.

And I am happy because I know that this is a temporary condition and at the moment of her death, clarity will return to her.²

For the Buddhist reader:

Kamma and dementia

Kamma (Pali; Sankrit: karma) is certainly why people get dementia.³ But you have two kinds of people with dementia: my mother who is very well, hardly any suffering at all, and those who have the same disease⁴ and are being tortured by it.

Just like any other thing that happens in life, it’s not whether you are rich or poor, healthy or sick or gifted with some talent, it’s how you use those talents and even how you use your sickness.

My mother has some form of innate wisdom, which stems from a servile attitude that she has all her life, so she finds it easier to accept whatever happens, compared to people you might call control freak types. They feel powerless when they cannot control and with dementia, you obviously cannot control very much at all. This gives them a huge amount of fear.

Do remember that who they are is a result of kamma. My mother had a good attitude to life and, because of that good kamma, is very happy even though she has dementia. Other people may not deal with the same disease in a good way. This is also a result of kamma.

This is not kamma generated by going to a temple and giving donations; this is a kamma that comes by developing a good attitude to life.

The old kamma gives you your ingredients, but the most important thing about kamma is what you’re doing with those ingredients.

Sometimes you get much better food from a hawker in Singapore than an expensive five-star restaurant because even though the hawker may not have good ingredients, he puts in so much effort into his cooking.

So the ingredients you have is the old kamma and what you do with it is the kamma of now. That is the most important thing in life.

Dementia is like a sleep that lasts for many years. It’s like a waking coma. The work in their lives are not undone by dementia. It’s like a break. It’s like a time lapse. Hence, people with dementia do not make kamma during that period of their lives.

Footnotes
¹ The Buddhist concept of consciousness is different from thecommon definition of awareness.
² Ajahn Brahm perceives dementia as temporary because he believes in rebirth; clarity returns to his mother when she dies and reborn.
³ At least one other monk has taken a different stance. Shravasti Dhammika, spiritual advisor of Buddha Dhamma Mandala Society, Singapore, believes that events out of reasonable control, like natural disasters and illnesses, are not caused by kamma.
⁴ Dementia is not a disease per se. The Alzheimer’s Society describes dementia as “a set of symptoms which include loss of memory, mood changes, and problems with communication and reasoning.” There are various types of dementia. The two commonest types, according to the Alzheimer’s Association, are Alzheimer’s Disease and vascular dementia. Read more dementia FAQs here.

Ajahn Brahmavamso Mahathera is the abbot of Bodhinyana Monastery, Serpentine, Western Australia, and spiritual patron ofBuddhist Fellowship, Singapore. Before he was ordained, he readtheoretical physics in Cambridge University.

As told to Jeremy Boo.

Update: Ajahn Brahm’s mother, Mrs Hazel Betts, passed away on 16 February 2012.