Alzheimer’s: A Stoic Take
What Stoicism can do, with practice and dedication, is to make the whole situation more bearable.
J. writes: I have recently learned that my father has moderate Alzheimer’s dementia. Having watched multiple family members die from this, I know there is the potential for a long, difficult road ahead. Do you have any writings related to this, or can you point me in the direction of some Stoic literature related to the topic? I am doing alright with the news, but I would like to prepare myself for what is to come so that I can be maximally useful to my family and incur the least amount of suffering on myself with my thoughts around the situation.
First of all, I’m sorry to hear about your father’s condition. As you say on the basis of your previous experiences, there is a long and hard road ahead for both of you. Can Stoicism be useful in these situations? It depends on what one means by that word. You might have seen recent research claiming that stoicism (note the small-s) is actually detrimental for the elderly. That’s because what many researchers study is “stoicism” as in the stiff upper lip / suppress your emotions attitude, which is, indeed detrimental. But if we are talking about Stoicism (capital-S) as in the philosophy, then I can’t think of any situation in life in which it cannot be helpful.
But of course, being helpful is not the same as being a panacea. Stoicism will not only not make your father’s Alzheimer’s go away, obviously, but it will not make it possible for either you or him to go through it without emotional pain. What it can do, with practice and dedication, is to make the whole situation more bearable, and to help you cultivate equanimity and compassion. That, I think, is all a philosophy of life can reasonably be expected to accomplish. And it’s a lot.
I’m going to start in what may seem like an odd place: Stoic physics. The word does not refer to the study of subatomic particles, but rather to physis, i.e., nature. The Stoics thought that to live a eudaimonic life, that is, a life worth living, we need to understand how nature works. If we don’t, we are bound to make mistakes that are going to make our life more difficult, or less well lived.
In the present case, this means spending some time understanding the nature of the disease that is affecting your father, which you have probably already done. I don’t mean that you should start reading the latest technical literature on Alzheimer’s, as that is for specialists. But you want to both arrive at a a basic grasp of the condition and keep up with potentially useful new developments as they come along.
For instance, it is good to know that typically the life expectancy for an Alzheimer’s patient is three to nine years. This gives you the likely time horizon within which you can be of help to your father and the rest of your family, and during which you will have to prepare yourself for one day letting go of him. I have lost both my parents already, both to cancer, and I can say that it is easy to overestimate how much time we have left with them. Do not make that mistake.
Another thing that the physis of Alzheimer’s tells you is that there are neither medications nor supplements that have been scientifically shown to change things significantly. Available treatments are palliative and offer little in the way of improving symptoms. It’s unfortunate, but that’s the way it is. I am pointing this out because the second thing the Stoics told us we need to practice in order to live a good life is logic, in the expansive sense of sound reasoning. I know that it will be tempting — if not for you, possibly for your father or for another relative — to try out “alternative” medicines. It would be a waste of time and resources, and it would only cruelly encourage unfounded hopes, not to mention fuel an industry based on pseudoscience. Of course, this could change tomorrow, if researchers will suddenly come up with an effective treatment, and that is why you need to keep up with scientific developments, largely by having serious conversations with your father’s doctors.
What does seem to have a positive effect not just on Alzheimer’s but on other types of dementia is a standard combination of physical activity, healthy nutrition, and social engagement. You can be directly helpful to your father in all three areas, especially the latter. Make sure he eats well and gets physical exercise, but more importantly spend time with him and make sure that others do as well.
The next item to bring up is, of course, the so-called dichotomy of control:
Some things are up to us, while others are not. Up to us are opinion, motivation, desire, aversion, and, in a word, whatever is of our own doing; not up to us are our body, our property, reputation, office, and, in a word, whatever is not of our own doing. (Enchiridion 1.1)
What is and is not under your control here? Obviously, you don’t control the disease. But you also don’t control either your father’s or your other relatives’ reactions to it. You don’t even control the majority of your thoughts, which originate subconsciously, or your initial feelings about any given situation, which tend to be automatic (what the Stoics call “impressions”). You do control your own considered, explicit judgments about the situation, and your decisions to act or not to act in certain ways.
I find that it helps practicing the dichotomy of control to sit down, from time to time, and actually write down a list of things you do / do not control concerning whatever it is that you are dealing with. That’s the approach Greg Lopez and I advise in A Handbook for New Stoics. Writing things down will achieve two important goals: it will make the dichotomy explicit to you, and it will help internalize the notion, which is easy to grasp but somewhat difficult to practice.
An additional consideration is that you need to remember that while Stoicism will help you, not everyone is on board with the philosophy. Which means you should not expect others to behave Stoically. Indeed, sometimes you may not want to behave Stoically, outwardly. Epictetus explains:
When you see anyone weeping for grief, either that his son has gone abroad or that he has suffered in his affairs, take care not to be overcome by the apparent evil, but discriminate and be ready to say, “What hurts this man is not this occurrence itself — for another man might not be hurt by it — but the view he chooses to take of it.” As far as conversation goes, however, do not disdain to accommodate yourself to him and, if need be, to groan with him. Take heed, however, not to groan inwardly, too. (Enchiridion 16)
The point is that Stoic values are quite different from standard societal ones, and that you may end up being very unhelpful if you try to act outwardly as a Stoic. You may have accepted, for instance, that your father has a terminal illness, and you may be preparing yourself mentally to the inevitable outcome. Indeed, I hope you will. But do not assume that others will act accordingly, nor that they would benefit from being told that they should. The path toward self-help may be very different from the path toward other-help, and you need to practice both.
There is one more very important and very delicate issue to consider. Even though you do not mention it, I’m sure it has occurred to you that there is a chance, though not a certainty, that you will one day find yourself in your father’s current situation. What I wrote above, of course, would still apply. But something else from the Stoic arsenal applies as well. Something I have been pondering myself from time to time, in case I should at some point down the road suffer of progressive dementia. My advice, therefore, to myself as much as to you, is to read and carefully ponder the 70th letter from Seneca to Lucilius, particularly sections 14 and 15.
I wish you and your father best luck, and to you in particular best practice, which ideally will make you immune from luck:
Gird yourself about with philosophy, an impregnable wall. Though it be assaulted by many engines, Fortune can find no passage into it. The soul stands on unassailable ground, if it has abandoned external things; it is independent in its own fortress; and every weapon that is hurled falls short of the mark. Fortune has not the long reach with which we credit her; she can seize none except him that clings to her. (Seneca, Letter LXXXII.5)