Map of life expectancy at birth from Global Education Project.

Wednesday, June 05, 2013

Oh yeah, about dementia

I'm going to interrupt the walk through the DSM to pick up on the extensive comment from KwC, on the previous post. It so happens that my father also suffered from fronto-temporal dementia, although fortunately, the personality changes he manifested were much easier for others to deal with. He did go through a stage where he was a bit stubborn about his obsessions, but quickly became sort of sweetly apathetic. His helplessness was certainly very frustrating to my mother and other caregivers, but at least he wasn't proactively obnoxious.

Unfortunately, KwC's experiences are not uncommon. Dementia can cause people to become argumentative, resentful of loved ones, paranoid, amoral, irresponsible, accusatory, even violent. Nursing home staff will often drug such people into a stupor, for their benefit rather than the patient's. It's presumably unethical, but physical restraint doesn't seem a much better option. There is no cognitive behavioral therapy or other counseling approach to such people, they are completely impervious to reason. That's the very nature of the disease.

I wish I had an answer for folks but what I do want us to consider here is the fundamental undermining of our notions of accountability and free will. However terrible it feels to see a loved one's personality so horribly transformed, few of us will say that we blame the person or believe they should be punished for their behavior. It's an organic disease of the brain, not their intention to be hurtful.

Uh oh. Dementia or not, the brain is always a physical organ which produces behavior. I can't find any defensible reason why we excuse people if we can find a brain tumor, or a traumatic brain injury, or some neurodegenerative process that shows up on a CT scan or an MRI; but otherwise put all the blame for evil on the evildoer. None of us created our self, our brains got to the state which generates our current behavior through the unfolding of genetic potential in whatever environment we happened to find ourselves, and so we became what we are at this moment.

The illusion of free will may be necessary, but that's all it is. At the extreme, that people can be spared the death penalty if they can convince a judge that they lacked the capacity to conform their conduct to the requirements of the law is nonsensical. If a person does not conform his or her conduct to the requirements of the law, a fortiori, he or she lacked the capacity to do so. We are what we are.

1 comment:

kathy a. said...

Thanks for these observations. Free will has more meaning in ordinary contexts -- where someone is capable of rational decisionmaking, they can modify their behavior. All of us will still make mistakes, but the erosion from relatively normal brain functioning -- for whatever reason -- makes expectations about behavior less and less realistic.

With serious mental illnesses that are not so easily identified, criminal law and public policy have not caught up. It is very difficult to prove an insanity defense, for example -- in the absence of something like a brain scan showing huge damage (and sometimes even then), the prosecution will always argue evil. Media reports about severely mentally ill people will usually be sensationalized, with the emphasis on evil.