With a firm grasp of the literature in theology and related disciplines engaging dementia, especially Alzheimer's disease, John Swinton proposes that most theological engagements with dementia are not sufficiently theological. They speak the language of the DSM-IV and other diagnostic tools, along with psychology and medicine. The language of diagnosis sets the stage and scope for how the condition is explored. Swinton does not take issue with medical research using the language of medicine to explore dementia-shaped personhood. His issue is with theology abandoning its rich traditions for the language of psychology and medical care to explore the religious dimensions of dementia. Dementia: Living the Memories of God offers a counter proposal, with a rich critique of other approaches in theology that lead to different conclusions than his approach.
The ten chapter book originated as a response to a 2009 program on BBC Radio discussing the theological issues of dementia. The program ended with a question posed to Swinton and the other guests, "If you ended up having dementia, how would you like to be treated?" Swinton's answer—"I hope that I will be loved and cared for just for who I am"—led him to further post show reflections on the nature of "who I am." The question of the identity of a person with dementia is a critical one with different answers. Biological and psychological responses, with their categories and classifications, abound, but theological responses to identity in the face of dementia are fewer.
Those few responses, according to Swinton, are largely inadequate and misguided, either because they are too shaped by non-theological categories or because of deficiencies in their theology. For example, David Keck's important study, Forgetting Whose We Are: Alzheimer's Disease and the Love of God (Abingdon Press, 1996), contends that human selfhood fundamentally changes in the face of the type of dementia his study explores. Selfhood and identity require "cognitively aware subjective self" (14), something that cannot be present with diminishing mental faculties. However, Keck's assumption undergirding his theology is something that Swinton takes to task in the entirety of his book.
Swinton's thesis responds directly to that contention. A theology that states personhood and the self dissolve as memory fades is a theology controlled by biological and neurological categories, not merely informed by them. Keck's thesis, expressed negatively, is that human beings do not cease being fully human selves as their memories and mental faculties end. Instead, "these people remain tightly held within the memories of God." (15). A theological response to dementia, Swinton argues, requires a theological definition of personhood. While memory, intellect, and cognition are neurological markers of humanness, the theological marker, [End Page 296] according to Swinton, is grounded in God's knowledge of the subject. The book keeps this thesis present throughout all of its chapters.
Chapter Seven, "Personhood and Humanness," provides extensive details of a theological definition of human identity. That definition has five elements: dependency, embodiment, relationality, woundedness, and love. All five of these categories do not require memory or cognition. Moreover, they may be enhanced by the diminishment of cognition. In fact, human identity is so dependent on relationality that dementia provides a tragic but valuable example of what existing is. To be human is to be in relationship with another person in a type of community. The awareness that one is in relationship is not the determining factor that a human with value is present. Swinton cites the story of John Goldingay's relationship with his wife, Ann, recounted in Walk On: Life, Loss, Trust, and Other Realities (Baker Academic Books, 2002). Succumbing to multiple sclerosis, Ann reached a point where she could not respond to anyone. Expressing the thought that his wife was unable to exercise her gifts, John was positively challenged by a caregiver who said, "Ann's spirit ministers to my spirit" (236). That encounter, cited in a chapter on human identity being centered in the sacredness of the present moment, defines self-identity as profoundly relational.