When the Mind Goes

This letter is for people watching someone disappear, and quietly frightened by what they are seeing. Two questions get asked in that room, usually not out loud. Is this a judgment? And is this the truth coming out?

This is one of a pair. It is about dementia, and it is written for the family, because the person it concerns can no longer read it. Its companion, The Noonday Demon, is about melancholy and mania, and is written for the person themselves.

The question is not foolish

Start by granting what is real in it, because the people who wonder are usually not being cruel. They are watching something they cannot explain.

A woman lives a decent life for eighty years. She raises children, keeps her word, sits in a pew. Then she goes into a nursing home with Alzheimer’s and begins to curse, to accuse, to say things nobody ever heard from her. Someone who loves her watches this and thinks: was that in her the whole time? That is not a wicked thought. It is a person trying to make sense of a stranger wearing a face they know.

And Scripture does not pretend that how a person lives has no bodily consequences. Paul tells the Corinthians that their abuse of the Lord’s table had physical results: “For this cause many are weak and sickly among you, and many sleep” (1 Corinthians 11:30). Medicine agrees in its own register. Heavy drinking and repeated head injury really do raise the risk of dementia. Sometimes an illness does trace back to how a man lived, and saying so is not slander.

So the wondering has something behind it. The question is what may be concluded from it.

What “gave them over” actually describes

The phrase people reach for is Romans 1, a reprobate mind. It is worth reading the sequence, because Paul gives it step by step and every step is something a person does:

Romans 1:21, 25, 28 · KJV

Because that, when they knew God, they glorified him not as God, neither were thankful; but became vain in their imaginations, and their foolish heart was darkened… Who changed the truth of God into a lie, and worshipped and served the creature more than the Creator… And even as they did not like to retain God in their knowledge, God gave them over to a reprobate mind, to do those things which are not convenient.

They knew. They were not thankful. They changed the truth into a lie. They did not like to retain God in their knowledge, and then He gave them over. It is a judicial answer to a will that kept pushing, while knowing better. Nothing in it describes tissue dying.

A person with dementia is not suppressing anything. The instrument is failing; the will is not turning. Nobody says a stroke reveals a man’s unwillingness to walk.

The inference Jesus forbids

The disciples once asked exactly the question this letter is about, and got a one-word answer:

John 9:2-3 · KJV

And his disciples asked him, saying, Master, who did sin, this man, or his parents, that he was born blind? Jesus answered, Neither hath this man sinned, nor his parents: but that the works of God should be made manifest in him.

Augustine, reading that answer, is careful not to make it say more than it does. He does not claim the man was sinless, or his parents were:

That is the whole distinction this letter turns on. Not that nobody had sinned, which would be a strange thing to claim of anyone. That the sin was not the reason. Chrysostom puts the principle underneath it in one line, and it is the one Ezekiel had already fought for: “one man cannot be punished for the sin of another.”

He says it again, twice in four verses, about two disasters everyone in Jerusalem was discussing: the Galileans Pilate killed, and the eighteen crushed when the tower in Siloam fell. “Suppose ye that these Galilaeans were sinners above all the Galilaeans, because they suffered such things? I tell you, Nay” (Luke 13:2-5). What He puts in place of the diagnosis is not a verdict on the dead but a warning to the people asking.

And God says it Himself about the men who built a whole theology on hidden sin. Job’s friends were sincere, careful, and orthodox-sounding, and their case was precisely that undisclosed sin explained his suffering:

Job 42:7 · KJV

My wrath is kindled against thee, and against thy two friends: for ye have not spoken of me the thing that is right, as my servant Job hath.

Ecclesiastes puts the limit plainest of all, and it is stronger than saying we cannot be sure: “no man knoweth either love or hatred by all that is before them… All things come alike to all” (Ecclesiastes 9:1-2). You cannot read God’s disposition off a person’s circumstances. That is not agnosticism. It is a prohibition on the reading.

Jerome had to say it not as a doctrine but as a letter, to a friend who had fallen ill and was doing to himself what the disciples did to the blind man:

Is it a truth serum?

The second question is different from the first, and it deserves its own answer. Not is this judgment, but is this revelation. Drink loosens the tongue, and everyone knows it; does dementia do the same thing, only permanently?

Here the details matter, and they cut against the idea in a way that is worth knowing.

Cursing is the worst possible evidence. Profanity is not stored with ordinary speech. It belongs to automatic, formulaic language, handled largely by deeper structures and the right side of the brain rather than the left-hemisphere language areas that build sentences. It sits alongside song lyrics, counting, and memorised prayer. That is why people who have lost nearly all ordinary speech can still swear fluently, and why the same people can often still say the Lord’s Prayer or sing a hymn word-perfect when they can no longer name their own children. What survives is what was automatic, not what was true. A woman who spent eighty years among people who swore has that vocabulary stored whether or not she ever used it. When the brakes fail, the automatic material comes out first. It is the shelf nearest the door, not the confession at the back of the cupboard.

And dementia does not only remove; it invents. Drink lowers a guard on something already there. Dementia manufactures content that was never there: confabulated memories, and fixed accusations of theft or infidelity in people who were never suspicious a day in their lives. A husband of fifty faithful years becomes, in his wife’s settled belief, a thief. Nothing is being revealed. Something is being generated.

The test also runs the other way, which is how you know it is not a test. Some people with dementia become gentler, stop old habits, and show nothing ugly at all. If the disease were a truth serum, that would be proof of a clean inner life, and no one should want to claim it as proof, because it is not. A test that returns a verdict in both directions, and can never be checked, is not telling you anything about the soul. It is telling you which parts of a brain went first.

What cannot be ruled out

Everything above says the inference is not allowed. It does not say the thing never happens, and that distinction has to be kept or this letter overreaches in the other direction.

God does give people over. Paul says so, and he is describing something real, not a figure of speech. It is possible that a man somewhere is both hardened in that way and also ill, and no one watching could tell which they were looking at. Nothing here rules that out. What is ruled out is concluding it from the outside, which is a different claim, and it is the claim Job’s friends made.

There is a second possibility people raise, usually quietly, because it sounds unhinged in a modern room: that new thinking, ideas and speech that were never in a person, might be a spirit rather than a disease. Scripture does not treat that as absurd. It describes a spirit that made a boy mute (Mark 9:17, 25), a spirit of divination that spoke through a girl (Acts 16:16), and a woman bent double for eighteen years whom Jesus describes as one “whom Satan hath bound” (Luke 13:16). That last one matters, because it is a physical condition with a spirit behind it, which is exactly the overlap people are asking about.

But the Gospels keep the categories apart while allowing that overlap. Matthew lists them side by side rather than as one thing: they brought Him “all sick people that were taken with divers diseases and torments, and those which were possessed with devils, and those which were lunatick, and those that had the palsy” (Matthew 4:24). Mark does the same: “he healed many that were sick of divers diseases, and cast out many devils” (Mark 1:34). Scripture knows the difference between an illness and a spirit, names both, and does not collapse one into the other.

So the honest position is narrow. A spirit is possible; Scripture says so plainly. A disease is possible, and in the great majority of cases is what the evidence shows. We are not given a way to tell from the outside, and John’s instruction when spirits are in question is to test rather than to assume: “believe not every spirit, but try the spirits whether they are of God” (1 John 4:1).

The cost of guessing wrong runs one way more than the other. Treat a spirit as an illness and you have missed something, and prayer was going to be offered anyway. Treat an illness as a spirit, or as judgment, and you have told a family that their mother is under the wrath of God on evidence that cannot carry it, and you cannot take that back.

Who is allowed to say

Scripture does not leave the heart unreadable because nobody is reading it. It reserves the reading.

1 Samuel 16:7 · KJV

…for the LORD seeth not as man seeth; for man looketh on the outward appearance, but the LORD looketh on the heart.

Jeremiah asks the question and answers it in the next breath: “The heart is deceitful above all things, and desperately wicked: who can know it? I the LORD search the heart” (Jeremiah 17:9-10). The answer to who can know it is given, and it is not us. Paul is explicit about the timing:

1 Corinthians 4:5 · KJV

Therefore judge nothing before the time, until the Lord come, who both will bring to light the hidden things of darkness, and will make manifest the counsels of the hearts: and then shall every man have praise of God.

There is a revealing coming. It is not this one, and it is not administered by a disease.

What holds when the mind does not

The fear underneath both questions is usually not theological at all. It is this: if she cannot remember Him, is she still His?

Scripture puts the weight on the other side of that relationship, deliberately:

2 Timothy 2:19 · KJV

Nevertheless the foundation of God standeth sure, having this seal, The Lord knoweth them that are his.

Not they know Him. Not they can still say so. The seal is His knowledge of them. Six verses earlier: “If we believe not, yet he abideth faithful: he cannot deny himself” (2 Timothy 2:13).

And the promise made for exactly these years is a promise about carrying:

Isaiah 46:4 · KJV

And even to your old age I am he; and even to hoar hairs will I carry you: I have made, and I will bear; even I will carry, and will deliver you.

An old man prays the same thing in the Psalms, and he prays it because he can feel it coming: “Cast me not off in the time of old age; forsake me not when my strength faileth” (Psalm 71:9).

Where this lands

A specific sin can have a specific physical consequence, and that is ordinary cause and effect, not a verdict. But an unnamed hidden sin, inferred backwards from an illness, is exactly what Job’s friends were rebuked for, and the inference from suffering to guilt is the one Jesus answered with a flat Neither.

So wonder, if you are watching it. Wondering is not wicked, and pretending you never wondered helps no one, and no one here is claiming to know what is not happening in a room he has never stood in. But do not let the wondering harden into a finding, because the evidence cannot bear it and Scripture will not license it. The person in that bed is not being exposed. She is being carried, by Someone who has not forgotten her name even on the days she cannot remember His.

Study the passages

• Romans 1:21-28: what being given over actually follows
• John 9:1-3: who did sin? Neither
• Luke 13:1-5: I tell you, Nay
• Job 42:7: the friends who explained suffering by sin
• Ecclesiastes 9:1-2: no man knoweth love or hatred by what is before him
• 1 Samuel 16:7; Jeremiah 17:9-10; 1 Corinthians 4:5: who reads the heart, and when
• 2 Timothy 2:13, 19; Isaiah 46:4; Psalm 71:9: what holds when we do not

Companion page: The Noonday Demon, on melancholy and mania, where the same question is asked of an illness the sufferer can still speak about. See also Faith & Psychology, on the soul before God, and Take Not Thy Holy Spirit From Me, on what it does and does not mean to fall. Scripture quotations from the King James Version. The account of preserved automatic speech and of confabulation in dementia is the standard clinical picture rather than a claim of this site. The observation that people who have lost ordinary speech keep oaths, counting and song goes back to John Hughlings Jackson in the 1870s; the modern review is Diane Van Lancker and Jeffrey L. Cummings, “Expletives: neurolinguistic and neurobehavioral perspectives on swearing,” Brain Research Reviews 31 (1999), 83–104, which surveys preserved, impaired and augmented swearing in aphasia, hemispherectomy and Tourette’s and places it with the right hemisphere and the deeper structures rather than the left-hemisphere language areas. A reader who wants the research should start there and weigh it.