The Wisdom of Forgetting: The Childlike Faith of the Demented

When Jesus said, “Assuredly, I say to you, unless you are converted and become as little children, you will by no means enter the kingdom of heaven” (Matthew 18:3), He spoke of a conversion (literally: change/turn) that’s not about regression, but restoration. It’s a return to trust, not a loss of wisdom. For those who watch a loved one lose their memory, language, and reasoning through Alzheimer’s or some other form of senile degeneration (aka, dementia), these words can sound almost cruel at first glance. “Become like a child.” How could that be a comfort when we’re watching someone we love become as helpless as a child again? Yet Christ’s words aren’t about the tragedy of helplessness; they’re about the beauty of dependence. In the Kingdom of God, dependence is not weakness but the posture of faith.

Families who watch their loved one drift into cognitive darkness often wrestle with questions such as: Does my mother still believe? Does my husband still know the Lord? Does my father still have faith if he can no longer say he believes in Jesus? In these moments, Jesus’ words become an anchor. When He placed a child before the disciples and said, “Whoever humbles himself as this little child is the greatest in the kingdom of heaven” (v. 4), He was redefining greatness as helplessness that trusts. A child—a child of God—doesn’t achieve faith; they receive it. Likewise, the demented patient doesn’t “hold on” to Christ with intellectual strength. Rather, Christ holds on to them.

When I enter a room where a patient no longer knows the names of their children or even their own name, I often begin with the singing of a hymn as the start of a condensed church service for them, and something remarkable happens. Lips that moments before were mumbling nonsense become still, basking in the Word of the Lord—a corporeal moment of, “Be still and know that I am God” (Psalm 46:10). And their wandering eyes suddenly focus on me (and they don’t fall asleep like so many of you do in church!). Sometimes, even tears form. This is the mystery of the Spirit’s work. The faith given in Baptism is not stored in the intellect like information; it’s inscribed on their heart, where the Spirit Himself intercedes “with groanings which cannot be uttered” (Romans 8:26).

To the world, dementia is a cruel thief—indeed, even the word “demented” has become derogatorily synonymous with “crazy” or “insane” or “wild.” And it is cruel. It’s a terrible disease. To faith, however, dementia can be a revealing fire. It strips away all self-assurance and self-sufficiency, leaving only what God has given. The childlike faith of the demented isn’t something new created in their last days; it’s the same faith they’ve always had, now purified of pretensions. They no longer argue or analyze. They no longer try to “understand” God’s ways. They simply are, like the little ones to whom Jesus said, “of such is the kingdom of heaven” (Matthew 19:14). The rest of us, still clinging to our stiff-necked intellect and pride, might envy such simplicity; for in their forgetfulness, they remember the one thing needful: that they are loved, held, and known.

The Efficacy of the Word: Beyond Rational Faith

Among many well-meaning Christians, there persists the assumption that saving faith must be expressed consciously and rationally—that one must “accept Jesus as their Lord and Savior” through a deliberate act of the will. After all, “if you confess with your mouth the Lord Jesus and believe in your heart that God has raised Him from the dead, you will be saved” right? (Romans 10:9). But most of the demented can’t do this. They often can’t confess with their mouth that Jesus is Lord. And the chaplain, pastor, or loved one can’t peer into their mind or heart to know what they believe. So, what of their faith?

Thus, such decision theology quickly collapses. The patient can no longer comprehend, decide, or respond. If salvation depends on an intellectual response, then dementia would sever a soul from grace. But Lutheran theology, rooted in Scripture and the Confessions, confesses a more beautiful truth: salvation depends not on the work of man, but on the means through which God Himself works—the Word and Sacraments.

As both a parish pastor and hospice chaplain, when I visit a demented patient, I don’t rely on persuasion or understanding. I rely on the same creative Word that spoke light into the darkness. The Word of God that said “Let there be light” and immediately, light came into being, is the same Word of God that both speaks faith where none exists and sustains it where it was first given. The Lord Himself speaks on the efficacy of His Word, “For as the rain comes down, and the snow from heaven, and do not return there, but water the earth, and make it bring forth and bud, that it may give seed to the sower and bread to the eater, so shall My Word be that goes forth from My mouth; it shall not return to Me void, but it shall accomplish what I please, and it shall prosper in the thing for which I sent it” (Isaiah 55:10-11).

The Gospel doesn’t need a functioning intellect to take root; it carries its own efficacy. God’s Word does what He says it will do because the power lies in the Speaker’s authority, not in the hearer’s comprehension. In other words, grace is not a concept to be grasped but a gift to be received. Even Paul says this within the same context as Romans 10 above, “How then shall they call on Him in whom they have not believed? And how shall they believe in Him of whom they have not heard? And how shall they hear without a preacher? …So then faith comes by hearing, and hearing by the Word of God” (vv. 14, 17). Faith comes by hearing, not by comprehension.

This same truth extends to the Sacraments. In the Lord’s Supper, the Lord binds His promises to visible means. He doesn’t command us to climb up to Him through faith that understands. Instead, He comes down to us in water, bread, and wine joined to His Word. Luther called the Sacraments “the visible Word,” for in them God acts concretely to deliver what He promises. The baptized dementia patient carries that seal upon their body and soul forever. The Supper—whether remembered or forgotten—remains Christ’s Body and Blood for the forgiveness of sins. The Lord’s presence in the Sacrament is not diminished by the communicant’s confusion, for it depends not on mental clarity but on divine constancy.

That being said, in ministering to an LCMS Lutheran suffering from dementia, I often assure them of their Baptism rather than administering the Lord’s Supper and Absolution (unless they happen to be lucid), and this distinction arises from pastoral care shaped by Scripture. Paul warns in 1 Corinthians 11:27-29 that “whoever eats this bread or drinks this cup of the Lord in an unworthy manner will be guilty o the body and blood of the Lord,” and therefore urges that “a man examine himself” before partaking. The Supper, being the visible Gospel for those who can discern the Body and Blood of Christ, requires a measure of self-awareness and repentance that dementia often renders impossible.

Baptism, however, requires no such examination, for it is wholly God’s act and promise—an identity bestowed, not a meal received. To remind a demented saint of their Baptism is to anchor them in the one Sacrament that depends not on present cognition but on God’s unbreakable Word: “You are Mine” (Isaiah 43:1). In their confusion, that assurance remains the surest proclamation of grace, declaring that the faith once given still endures, not by their remembering Him, but by His remembering them. (I also only assure non-Lutheran demented patients of their Baptism, if I happen to know if they’re baptized, rather than giving them the Lord’s Supper since, as a Lutheran pastor, I confess closed communion, which is a topic that is beyond the scope of this article.)

This is the crucial distinction between ex opere operato and the efficacy of the Word and Sacraments. The former—a medieval error meaning “from the work performed”—imagines grace is automatically dispensed by the mere performance of the rite, regardless of faith. As Lutherans, we reject this mechanical notion. Yet we also reject the opposite error—that the Sacraments are mere symbols that require human understanding to be effective. The truth lies in between: the Sacraments are efficacious because the living Christ acts through them by His Word. Their power rests not in ritual or human comprehension, but in divine promise. When I administer the rite of the Commendation of the Dying, I do so not in superstition but in faith that Christ Himself is present through the litany of prayer and His Word, for just as He said, “For where two or three are gathered together in My name, I am there in the midst of them” (Matthew 18:20).

This is why Lutheran theology has such a profound pastoral advantage in dementia care. We don’t look for evidence of belief in the patient’s cognizance or decision-making abilities; we look to where Christ has promised to be and administer His grace. The same Spirit who once called them by name in Baptism still intercedes for them with “groanings which cannot be uttered” through His Holy Spirit. The efficacy of the Word and Sacraments ensures that the Gospel continues its work even when every other human faculty fails. Salvation does not hang by the thin thread of reason but by the unbreakable promise of God. The patient’s silence—or nonsensical muttering—is not unbelief. It is rest.

Thus, when I perform the Commendation of the Dying or read Scripture at a bedside where words no longer find response, I do so in faith that God’s Word still delivers what He Himself proclaims. At the end of the rite, I say, “Go in peace,” not because the patient can hear me with comprehension, but because Christ’s Word still accomplishes what it declares. Just as the Spirit hovered over the waters at creation, His Spirit now hovers over the baptized in their dying, keeping them in the grace no disease can destroy.

God Knows the Heart

There’s a deep comfort in remembering that the Lord doesn’t measure faith by intellect but by childlike trust. Repeatedly, Scripture shows Jesus responds not to eloquent prayers or theological precision, but to the cry of the heart. The paralytic lowered through the roof didn’t speak; his friends did all the talking. Yet when Jesus “saw their faith,” He forgave the paralytic and healed him (Mark 2:1-5). The woman with the issue of blood didn’t make a rational profession of faith; she simply reached out in desperate belief, and Jesus called her “daughter” (Matthew 9:18-22). The centurion who begged for his servant’s healing didn’t belong to Israel, yet Jesus marveled, “I have not found such great faith, not even in Israel,” because the centurion knew by faith that Jesus didn’t need to be physically present to heal his servant, only that His Word was enough (Luke 7:1-10). In each case, Christ’s response transcended rational comprehension. He saw trust, not logic. Is this not the same Word of Christ we believe, teach, and confess?

This truth speaks volumes to the care of those who can no longer express themselves, at least in ways deemed rational. The demented Christian who can no longer recite their children’s names or the Creed or the Lord’s Prayer or even “I accept Jesus as my Lord and Savior” (as theologically problematic as that statement is), is not beyond Christ’s compassion. God knows their heart. He sees the spark of faith that reason is fundamentally incapable of articulating. In dementia, the outer faculties may crumble, but the inner person remains—known and loved by God. The Shepherd does not lose His sheep simply because the sheep forgets the Shepherd’s name. He calls them by name, and they know His voice, even when their minds cannot form the words (John 10:3-4).

There are moments in hospice care when this truth becomes visible. One day, I was doing the Commendation of the Dying for a woman deep in the throes of Alzheimer’s. She had never said a word during any of my previous visits with her. As I ended the Litany of the Dying section (“Lord, have mercy. Christ, have mercy. Lord, have mercy.”), suddenly she started to say, “Have mercy… Have mercy… Have mercy…” I didn’t prompt her.

You can choose to believe that instead of faith, this is just her weak mind grabbing on to something that was repeated a lot, like a child repeats anything a parent says, and, well… exactly. Children learn a lot from what their parents say. As her spiritual father in that moment, she latched onto the Word of the Lord spoken over her. And I choose to err on the side of grace—that the Word of God was doing its efficacious work by sustaining her faith.

That’s what the Spirit does—He keeps alive what no disease can kill. And don’t just take it from me. Take it from the Apostle Paul: “For I am persuaded that neither death nor life, nor angels nor principalities nor powers, nor things present nor things to come, nor height nor depth, nor any other created thing [not even dementia], shall be able to separate us from the love of God which is in Christ Jesus our Lord” (Romans 8:38-39). The mind may fail, but the love of God does not. The heart of faith continues to beat beneath the brokenness of the brain.

When Jesus told His disciples that the Kingdom belongs to “such as these,” He included not only children but all who trust without understanding. Dementia, for all its sorrow, strips away pretense. It leaves a person as they truly are before God: utterly dependent, and totally loved. We see this dependence as weakness, but Jesus calls it greatness. We see confusion, but Jesus sees trust—faith.

In the end, dementia reveals the mystery of faith. Faith is not an intellectual exercise but the work of God. Faith depends not on remembering every doctrine but on the object to which is clings, which is Christ the Lord.