The following is an AI-generated rough transcript of the Equipping Hour. It may contain inaccuracies. 

Opening and Introduction

Smedly Yates: Well, good morning. Happy Sunday. Welcome to Grace Bible Church this morning and to Equipping Hour. This morning, we’re going to be doing a follow-up from an equipping hour that Jake taught on January 11th on dementia. And that was, Jake, that was riveting and encouraging. And I thought you taught us everything we needed to know, but apparently you didn’t. Because the numbers of follow-up questions from that equipping hour broke all records. So we’ve sort of accumulated those questions. And let me just encourage you, if you didn’t get a chance to listen to that equipping hour from January 11th, pull it up on the website, go back and listen to that. And this morning, what we’re going to do is just put the questions that many of you asked in person and submitted. Or just get to ask those of Jake in front of all of us. And so Jake really is going to give most of the answers here. I don’t know if I have a whole lot to say. Other than these are the questions we got, Jake, help us. So with that, let me open us in a word of prayer and we’ll get started.

Heavenly Father, thank you so much for your kindness to us. We don’t deserve to have physical ability endure in this life. We don’t deserve to have mental capacity sustained in this life. We truly only deserve condemnation under your wrath for our sins. And so anything that you give to us, we pray to use as a gift, as a stewardship, to use well and for your glory, and to be content and to trust you as things diminish. And we thank you for the preparation, for mental decline. You’ve already given us from principles from your word. We pray even now as we discuss caring for one another and seeking to glorify you in personal worship in our physical existence that you would be honored as we listen and apply and are strengthened and sharpened to help others. We ask all this in Jesus’ name. Amen.

I’m going to start with kind of a personal question that came in, Jake, and it goes like this. If I try not to get dementia, you gave us a lot of helps, dietary exercise, sleep, some of those things that were really helpful, practical things. So if I’m doing those things, if I’m trying not to get dementia, am I expressing distrust and dissatisfaction in God and his sovereignty?

Stewardship, Planning, and God’s Sovereignty

Jacob Hantla: Maybe. So, yeah, we spend a lot of time talking about the practical ways that you might want to steward this life and this body that God’s given you. The big hitters were exercise, right? We said if there’s one that you can do, it’s that. But there’s a lot more. There’s a, but if you’re doing those things, is that sinful? It might be. There’s a way to do the right thing for the wrong reasons. Planning, though, is not unbelief. Planning like God doesn’t exist is unbelief. or planning like God’s way isn’t best in your selfishly, arrogantly grabbing after your own desires. That’s unbelief. That’s sin. So the issue isn’t whether you should steward, but it’s whether an action that you’re saying is stewardship is actually a mask for control, pride, and fear. Proverbs 27:12 says the prudent sees danger and hides himself. There’s a way to see that. Where you see danger, you hide yourself from it. You take planned steps in order to avoid it that actually roots itself from fear of the Lord. And that would be right. And in contrast, it says the simple go on as if that danger isn’t there and they suffer for it. So there’s nothing inherently righteous or right and just saying, I’m going to trust the Lord and use that as a mask for just lazy thoughtlessness. Similarly, there’s nothing righteous at all in saying, I don’t want what I fear is coming and I’m going to grasp after what I want. But James 4, you guys might want to open there. This is, a really, really helpful section of scripture for planning. And it reveals why we actually have to, at the heart of all of this, guard our hearts, not merely do the right thing. James Chapter 4. And this is in the context of the warning, or the command to humble yourself from verse 10, humble yourselves before the Lord because God resists the proud and gives grace to the humble. And now, he says, come now, verse 13, you who say today or tomorrow, we’re going to go into such and such a town, spend a year there trade, and make a profit. Yet you do not know what tomorrow will bring. What is your life? You’re a mist that appears for a little time and then vanishes. Instead, you ought to say, if the Lord wills, we will do this or that. So the take home from that is not don’t plan, don’t run a business, but rather as you run it, run it as one who actually embraces and recognizes your temporalness, your weakness, your dependence, and God’s sovereignty.

Smedly Yates: If we zoom out from the topic of dementia, and we just think about the principle underlying that, we’re dealing with the realities of God using human means in his sovereign plans. If we rephrase the question, we might say, is it sin and distrust of the Lord to study for your chemistry exam? No, of course not. Can you sin by studying for your chemistry exam without thought toward God and exalt your own pride and intellect and your hard work? Yeah, that’d be wrong. A godless, practical, atheistic approach to effort would be sin. But a laziness that says, well, I’m just trusting in the Lord, but I’m not going to go apply for a job, study from my exam, practice for the athletic endeavor, or whatever is sin the other way. And I love the example of evangelism. We know that God will save people, but we know that God uses means to do it. So is it a failure to trust God when I go out and share the gospel with people? No, it’s actually the obedience that God uses as a means to accomplish his ends. Now, I can’t control the results. So you can be faithful, worshiping the Lord, telling others how great Jesus is all day long and nobody gets saved and God is honored and we trust him.

Jacob Hantla: Yeah. There’s two biblical, I love the illustration. It’s throughout the Bible of horses and chariots. You can write down Proverbs 21:31 and Psalm 20:7. In Proverbs 21:31, it says, the horse is made ready for the day of battle. Who does that? We do that. The people do that, and they go, battle, but it says, but victory belongs to Yahweh. And similarly, in Psalm 20:7, this, this was actually one of my favorite passages in fighting cancer. I stole it from Piper in his book, Don’t Waste Your Cancer. He says, some trust in chariots, and some in horses, but we trust in the name of Yahweh our God, which doesn’t mean go to battle with slow horses and broken down chariots, it’s wise to get the best you can. If you know that you might be facing a future with dementia or anything else you might face, chemistry test or other health problem, be diligent to plan, but do it in a way that when you don’t get dementia, it wasn’t your effort that gets the glory. It was Yahweh’s. And if you get dementia anyway, you say, it was the Lord’s will. It’s best, I trust.

Reverse Sanctification and Dementia

Smedly Yates: A question came through, and really there were several facets that sort of get at the same kind of question. But people wondered, and this comes obviously from people who have worked hard to care for people with various forms of dementia. But it seems like Christians at times can experience what looks like reverse sanctification. Is that what’s going on there? Have people been abandoned by the Holy Spirit when behaviors change in mental decline.

Jacob Hantla: Yeah, I think probably about five, six of you asked that question with very particular circumstances in mind. And the question doesn’t overstate the reality of what occurs. So reverse sanctification. Sanctification is the process of progressively being conformed to the image of Christ from the point of salvation, usually, and normally for a Christian, until the point when they finish well, die, and are taken home, and then glory. But that doesn’t always happen for Christians. The reality is sometimes in dementia, some Christians become more childlike in their faith. It’s not inevitable that your sanctification will reverse. And I don’t think that’s the right term. It’s the observed reality that we see. But sometimes their faith becomes more simple, but not less godly. They might tell the same stories over and over again. Or if you imagine sometimes what happens in dementia, your existence in the moment is separated from what’s gone before it. So you’re always disoriented. That’s terrifying. And so you see the Christian in those moments having a childlike trust questions that you feel bad for them, but they are trusting the Lord in a real way. But sometimes, and this is the words of Dr. John Dunlop, wrote a book on the Christian and dementia. He goes, dementia can indeed change personalities. It has transformed wonderful, loving, godly people into tyrants. And that happens. I’ve seen, you see somebody who was self-controlled loving. and as they progress into dementia, they curse. They use language that’s not befitting a Christian at all. There’s inappropriateness in all kinds of ways. And so what’s going on there? I think it’s helpful. I’m going to do another physiology lesson. Bear with me, I promise it’s worth it. It helps me. So there’s some types of dementia, especially that there’s one we talked about called frontotemporal. What does that mean? It’s the area of the brain in which it happens. And it changes the way that your brain physically works. So there’s an, I’m going to oversimplify a little bit. So, but this is, this is helpful. If you think of your prefrontal cortex, you might have heard that word because we joke. Teenagers, their prefrontal cortex isn’t fully developed. And that’s true. It’s why you don’t trust your kids to make life-altering decisions. But the prefrontal cortex is, you could think of it as the executive control center of your brain. It houses the part of your brain for abstract thought, concentration, working memory, and most critically, inhibition of inappropriate thoughts and actions. You and I do it all the time you think it’s like the breaks. There’s a filter on, thank God there’s a filter, right? Something comes to your mind and it doesn’t come out your mouth. Because of the prefrontal cortex, it overrides automatic impulsive thoughts. It helps you consider the consequences in the future before acting. It connects your current behaviors to the past experiences and your goals. And when that area is damaged, somebody has a really hard time choosing the appropriate behavior for the situation. The damage, it sort of removes the filter. There’s another thing, orbital frontal cortex. It’s just another area of your brain. You don’t need to know the big word. But what that is is that’s particularly critical for regulating social behavior. When that area of the brain gets damaged, like if you get a cancer to that area or a surgery that affects, that area instantly, that person can explain what appropriate social behavior is, but they don’t recognize when their behavior violates that. So it’s manifested by like just a list from a textbook that I looked up on this. It’s greeting strangers in an overly familiar manner, standing too close to others, inappropriate touching, being aware of social norms, like I said, but unaware that your behavior violates that, and that can go to extremes, sexual inappropriateness, language inappropriateness, and they’re just unaware. You and I, if we were to be saying that, it would be sin. In this case, it actually may represent a physical inability. So what’s going on there? I want to think about the brain and the believer. When the Holy Spirit expresses self-control in a believer. So, right, the fruit of the spirit is self-control. And I just said, well, self-control comes from the prefrontal cortex. So are we just our brains? No. When the Holy Spirit makes a believer new. And when the Holy Spirit controls that believer, he does it in a way through the working of our physiologic brain that enables us to submit to him, which means that he’s actually using our prefrontal cortex in a renewed way. I think it’s helpful. Open your Bible’s to Ephesians 5:18. I think this is really helpful. And there is an inner working between the way our brains and our most inner us, your soul, your mind, you’re who you are. There’s a working there that we, don’t truly understand, but that we can get glimpses into here. And I think that that, if we think of the way our brains in the working of the Holy Spirit to accomplish things like self-control, I think this is a helpful verse. Ephesians 5:18, do not get drunk with wine, for that is debauchery. And what’s that contrasted with? But be filled with the Holy Spirit, with the Spirit. So what does alcohol physically do? Alcohol in a person, it actually, you’re going to now see why I did this physiology lesson, it actually dramatically reduces prefrontal cortex activity. It takes the break off. It takes the filter off. You may still have the Holy Spirit, but the physiologic means that he uses to exercise control of, you would use to minimize your expressions of sin while in this body that’s falling apart, you’ve now chemically altered that. And so you have a lack of self-control, an impaired moral reasoning, increased risk-taking. Similarly, your orbital frontal cortex goes dysfunctional. That’s why I mentioned those two things. That happens with alcohol and anything that stimulates GABA receptors. That would be like benzodiazepines, some sleeping pills, some anti-enactylase, some anti-enactylase. anxiety meds, it can lead to social inappropriateness for those same reasons. Opioids. Research shows that chronic amphetamine and opioid use alters decision-making by ways that are very similar to focal damage to that orbital frontal cortex. You can see now chemicals interacting with your brain in a way that we’re used to seeing those people don’t act right. THC from marijuana, same thing, decreased brain volumes in chronic use, especially in the orbital frontal cortex. Sleep deprivation. Tons of breakdown, temporary, and the connection between amygdala, which is like your fighter flight, your stress area, and your prefrontal cortex connectivity. So sleep deprivation triggers this. You basically don’t have a brain. on your emotional regulation. So why am I going through all that? If we have the ability, it’s right for us to keep ourselves from breaking our brain intentionally. Don’t be drunk. Avoid chemicals that would alter those areas and make the expression of self-control more difficult or less likely. and you can actually, you see it in your kids when they’re unslept, more prone to sin. You see it in yourself. So imagine yourself with 48 hours without sleep, then drink a little bit of alcohol. You will become disinhibited, irritable, and be much more prone to sin. Don’t do that to yourself. But now what happens if that’s actually happening physically because areas of your brain are dying, they’re tangled up with proteins, or they’re otherwise that they can’t access the energy stores to function? That’s effectively what they’re, but they can’t sleep it off or sober up. It helps you be probably a little more understanding and maybe see that it’s not actually a reversing of sanctification, but rather, I think it’s a, well, let’s just turn to 2 Corinthians 4, and I think we’ll see what it is. You see that dementia can change behavior by damaging the brain’s physiologic instruments of restraint and judgment, but it’s not the same thing as the Holy Spirit moving out. sanctification isn’t stored in a lobe of the brain. You are more than your brain. It’s actually our brain is that part of us that’s wasting away. It’s not our inner man. So 2nd Corinthians 4:16, we do not lose heart. Though our outer self is wasting away, our inner self is being renewed day by day. day. This is helpful to remember in somebody whose outer self is falling apart, not just physically their body doesn’t work anymore, but their brain’s not working. This light momentary affliction is preparing for us an eternal weight of glory beyond all comparison. As we look not to the things that are seen, but the things that are unseen, the things that are seen are transient, but the things that are unseen are eternal. It’s really helpful. when we look at somebody with dementia and it looks like they’re becoming less and less Christian. I love the way John Piper says it. He has a helpful ask Pastor John on dementia. And he says, Paul’s telling us that weak, in glorious, demented shadow of a once strong Christian in front of us is on the brink of glory and power. You need to go into nursing homes and think that way. These people are on the brink of glory and power. We must keep this continuity in mind between diminished powers of human beings here and the spectacular powers that they’re going to have in the resurrection. It’s so important if we lose a sense of that continuity for the Christian, will assume that we are becoming less human rather than being on the brink of gloriously superhuman. So it’s helpful to see that your brain is the outer person that’s wasting away. And that isn’t necessarily connected to the what God has done in the most inner you.

Confrontation, Rebuke, and Care for the Weak

Smedly Yates: Given that reality, Jake, we think about somebody whose inhibitions are broken down. The manifest ability for self-control allows things in the heart to make their way out. Is there ever a place for confrontation, rebuke, encouragement, help for somebody who’s still living the Christian life, still susceptible to sin? At what level is it appropriate? How should we think about, you know, helping behavior and rotten speech and things like that?

Jacob Hantla: Yeah, absolutely. There is. You have to recognize that the purpose of rebuke would be repentance, right? And just like with children and with all Christians, it’s really wise and necessary to discern when possible between sin and inability. The reality is that we can’t always do that. But before I go there, I want to get back to this question. Let’s think about ourselves and what we’re going to be prone to do with what I just said. I’m going to be prone, you might be prone, to say, well, I didn’t sin. It’s just my physiology that made me do it. You don’t get off the hook ever in the Bible because your physiology had a weakness.

God uses our weakness and our physiology as the platform in which he demonstrates his power, and particularly his power over sin. Our brains, actually a significant part of why they’re weak and why they break like this, is because it’s a part of God’s judgment for us. Romans 1, right? We became futile in our thinking, and our minds were darkened as a result of our unwillingness to acknowledge God as God. We are not merely our brains, and yet the dysfunction of our brains is actually a significant part of the fall. God renews that. He changes that in the believer.

And if you as a Christian say, I know where I am particularly vulnerable, maybe I’m heading down a path towards dementia, or maybe I have some particular weaknesses where I haven’t slept much this week. I just had back surgery. I know I’m going to be on an opioid for pain, and I know that I’m going to have a particular—even if you can’t say the area of your brain that’s going to not function right—you’re going to say, all right, Jake taught me that I’m going to tend to act inappropriately towards people. I’m not going to view myself rightly. I’m going to have a lack of self-control. I better ask for help. I’m not going to justify sin, but I’m actually going to be more vigilant for it. Fight it more diligently and get people around me to help me fight it.

So now let’s go to the question of, is it ever appropriate to rebuke a dementia patient? Let’s assume that person is a Christian. Go to 1 Thessalonians 5:14. If that person is a Christian and they are sinning, even if they’re not even aware of it, they’re going to say, will you please come to me and help me? I’m going to need help. We need to, as best we can, use the right tool for the situation. Discern weakness, faint-heartedness, and still don’t hesitate to admonish unruliness or idleness.

So 1 Thessalonians 5:14: “We urge you, brothers, admonish the idle or the unruly, encourage the fainthearted, help the weak.” Do you see those three different instructions? Somebody might be expressing sin. All three of these might be evidences of—in all of these three cases—there might be somebody evidencing unbelief or something that needs turning, changing. And in one case, the tool is admonishment. In another, it’s actually help. And in the other, it’s encouragement.

Now consider the person with dementia. Their brain is not functioning the way that yours is. They can’t connect their actions to what’s socially appropriate. They can’t connect their actions with the goals they’re aiming at. They might be unclear as to even the situation that they find themselves in, the context of their life. That’s a pitiable—in all the right ways—pitiable circumstance. That would tend to make that person fainthearted, very weak. What they probably need more than admonishment is help and encouragement.

I love Poithress. This is from Piper and Grudem’s book, Recovering Biblical Manhood and Womanhood. He says, “Our privilege as Christ’s children altogether should stimulate rather than destroy our concern to treat each person in the church with the sensitivity and respect due to that person by reason of his age, gift, sex, leadership status, personality,” and I would add mental status.

So how should you do this? With mild impairment, let’s just go down a category. If you had somebody with mild impairment—not all dementias, it’s not this catch-all where everybody’s all the same—you can have a mild impairment. Probably normal accountability. They’re going to tend to need more admonishment and help and encouragement, but be slower, be gentle, be more concrete. You’re probably not going to be able to string together three or four if-then statements to logically get them there. Make it simple.

Sort of like when you’re admonishing your three-year-old, maybe your five-year-old, your seven-year-old. You still do it, but not in the same way that you would a 25-year-old or a 35-year-old. But then with moderate impairment, your correction probably becomes more redirection. Just simple statements of, “That’s not okay. Let’s go over here.” Change the environment. And then severe impairment, probably treat it more as symptom management, prioritizing safety, comfort. Simple statements still: “That’s not okay.” Like you would use for your one-year-old: “Use your hands for gentleness. We don’t speak like that. That doesn’t honor the Lord.”

Normal Aging, Forgetfulness, and Dementia

Smedly Yates: Statements like that. This is so helpful, Jake. I think partly because we don’t want to be in a position where we’re shocked and our black-and-white categories of sanctification, justification, get in the way of compassionate care and love for someone who is in a weakened state that needs help. It’s not dismissing sin, but just really helpful, compassionate care. I have a more personal question for you. Last evening, we had a number of friends in our home, and I got confused and thought that a dear sweet friend was somebody else altogether. And it occurred to me later, I asked a really strange question that didn’t make any sense to her at all. Do I have dementia?

Jacob Hantla: I don’t think so. But you are getting older. There’s a forgetfulness that’s just a part of being human. And there is a forgetfulness that’s increasingly normal with age.

Smedly Yates: You’re right behind me. You’re catching up. No, you’re not catching up, but you’re behind me.

Jacob Hantla: Percentage-wise, I’m catching up, and I will never in an absolute, absolute way. So there’s normal aging, and some normal cognitive decline with aging is very different than actual dementia. So if you do have questions about that, it’s helpful. Regardless, if you just say, hey, I’m getting old. I’m not sleeping as well. Just as a result of not sleeping as well, as a result of just being weaker, maybe having more history behind you, some more stuff to forget, or whatever, you realize, hey, I don’t have dementia, but I’m not who I once was. That’s not a bad place to be.

There’s a weakness there that’s helpful to get people around you to augment your weaknesses. How much more, if you were heading toward dementia. I promise I’ll tell you if I see it. You do the same for me. But regardless, you might or you might not. I don’t think you do. But let’s say that you’re saying, I forget stuff, do I have dementia? The second that you start thinking that, you’re probably not the right person to be making that call. It’s wise to get family members, elders, even medical professionals, doctors to assess: is this dementia? Is it a reversible cause? What’s the probability it’s going to accelerate?

And then as you start seeing more and more likelihood that, yeah, this is progressing, start getting people around you to start relinquishing intentionally controls that you might have on your life. Can you double-check me on any purchases greater than X amount of money? Let’s go update the will. Let’s get you on a power of attorney. Invite them to take away the keys at the appropriate time. Even if you say that’s a long way from now, that’s a really humble way to invite, in a godly way, people who love you to be enabled to help you.

Forgetting the Gospel and Childlike Faith

Smedly Yates: Jake, can a believer forget the gospel in a mentally diminished state or not have the ability to articulate the gospel?

Jacob Hantla: Yeah. They can. Memories are stored in our brain. And you might not have access to those memories even while you are saved. Right? That unbreakable chain of salvation will end in glorification from Romans chapter 8: all those whom he foreknew, and it gets all the way to glorification. And in the midst of that may be a trial like your memories are disconnected from you in a way that you can’t explain concepts like substitutionary atonement, you might not even remember that Jesus is your Savior, though he is.

And so if somebody has forgotten those things, don’t tire of reminding them of those things. Because even if that memory can only stay with them for that one moment, it’s real. And it might help them endure that moment. It’s a really complex, I can’t say that we understand it at all. But God does. There’s a complex relationship between our thoughts, our memories, how those connect to our actions, and what our ultimate status before God that’s normally expressed through faith. And you can’t have faith without trusting in Jesus. So how can somebody who doesn’t even know who Jesus is trust in him? I’m just going to say I’m not God. God knows. And when you are in your right mind, if you do, that’s evidence of God’s work in you. Because nobody can say Jesus is Lord apart from, in me, and being it, apart from God changing them, saving them, making them new. And so if their brain breaks, and they no longer are able to say that in the same way, I don’t think that’s going to be devastating because they weren’t saved on the merit of faith, but they were saved by grace through the exercise of faith. That faith may look different now. But it’s helpful to think of what kind of people go into the kingdom. Like the disciples, when the children were coming, and they said, no, don’t let them near. And Jesus says, no, it’s, it’s that kind of person who gets into the kingdom. Don’t think that those, faith doesn’t have to be complex. Faith doesn’t have to be well reasoned out. That doesn’t mean that you have an excuse not to think. Peter says, add to your faith knowledge, right? We are expected to grow in faith. I’d love to hear you expound on this, Smed. But there’s a childlikeness of faith that actually in your dementia, you might be able to express that. In your arrogance, maybe in your self-trusting when your faculties are working, it may actually be God’s means of separating you from your strength, because when we’re weak, we’re strong in him, that we don’t get to see all the interplay of that, but we may be a means moment by moment of reminding the Christian who forgot who Jesus was of who he is.

Smedly Yates: I think that’s so helpful. The weakest place you will ever be in life are at your last moments on the earth. No matter how it is you go out of this life. Just last night I was working through the details of the resurrection in 1 Corinthians 15. And listen to this, Paul is comparing the resurrection to a seed sown into the ground and then what comes out afterwards. And there are different levels of glory from sun, moon to stars, different kinds of bodies, fish, and other things. But not everybody’s the same. But every human being who faces physical mortality ends life here and then experiences resurrection, every one of us will experience the most profound weaknesses in the last moments. And here’s how Paul describes it. The body is sown, placed into the ground like a seed, corruptible. Subject to absolute humiliating corruption, raised incorruptible. No longer ever subject to corruption. And when we think about brain deterioration, that word corruption is weighty. Sown in dishonor. The last moments of anyone’s physicality are the most dishonorable. Stripped of power, stripped of strength, stripped of dignity, but raised in glory. And Jake, what you shared earlier about somebody being on the brink of the kind of glory that C.S. Lewis described—if we were to see a resurrected saint now we’d be tempted to fall down and worship them or run away in abject terror. We just have no idea what this glory is like on this side of it. But we go from the lowest, most undignified, most powerless spot in our earthly existence in those last moments. And he goes on and says, put in the ground in weakness, raised in power, put in the ground natural, raised supernatural. And so the earthy is first and then the spiritual. And so it’s just helpful to think about not being surprised when someone is at their most profoundly weak, not just physically but mentally, end-of-life scenarios.

Jacob Hantla: Yeah, it’s profoundly humbling. And it makes us want to say, I don’t want to be there. Can I avoid that? Okay. I mean, do your best. And ultimately God may bring us there in a way that all of us, sometimes our last moments are momentary, sometimes our last moments of that corruptible humiliation last a really long time. In this tent we groan, longing to put on our heavenly dwelling, if indeed by putting it on, we may not be found naked. For while we are still in this tent, this physical body that’s falling apart, we groan, being burdened. Not that we would be unclothed. It’s not merely saying, hey, let’s take this thing off, but that we would be further clothed so that what is mortal may be swallowed up by life. It’s not even worth comparing. And so if that’s the way that God has to be glorified in us—to go back to that first question—okay, I’ll do that. It’s light and momentary, even if it lasts a long time. And even if I’m not even able in the moment to contemplate what time is, it’s humiliating. And you know what? I’m going to ask the Lord to take that from me. I’m going to say, God, please don’t. That’s an okay prayer. That’s similar to what Paul prayed and said in 2 Corinthians 12. And Jesus says, no, my grace is sufficient for you, for my power is made perfect in weakness. And if Jesus says that to you, Christian, you can say, okay, I’m going to be content with weaknesses. And man, if you get to care for somebody in their weak moments there, it’s helpful to have these things in mind to know they’re on the brink of glory.

Marriage, Roles, and Dementia

Smedly Yates: I want to move to a practical and theological question related to roles, thinking particularly about husbands and wives honoring biblical roles in marriage, particularly when a husband is experiencing mental decline and dementia. How does a wife caring for a husband honor those roles with a diminished ability?

Jacob Hantla: Yeah, that’s a really helpful question. I loved thinking through this.

Smedly Yates: I came up with it myself. No. Several people asked. I just wrote it down.

Jacob Hantla: You did. I think we want to avoid two opposite errors. One is a view of submission and leadership as a rigid subservience. If a husband can’t lead, the wife can’t act. Or on the other side, a role evaporation. That illness or inability cancels biblical patterns. Both of those would be absolutely wrong. Did you get that? One would be if the husband can’t lead, then the wife shouldn’t be able to act. And if the husband can’t lead because of inability, role distinction, that God set out that is grounded in creation order, not in ability, right? Men aren’t pastors because we’re better at it or smarter at all or better teachers. That’s not where God grounds it. But in his purposes. And so it’s helpful. If we think about what femininity is, so we’re helping a wife whose husband is just incapable of leading in the ways that she wishes he could, a heart that longs to follow. You think of 1 Peter 3:4. The adorning for the woman is in the imperishable beauty of a gentle and quiet spirit, which in God’s sight is very precious. Normally, that’s going to be expressed through submitting to husbands, to their leadership, even in ways, as long as their leadership—for unbelievers, as long as their leadership doesn’t lead them to go against the Lord—even submitting to that with a gentle and quiet spirit. That’s going to play itself out differently for a husband who can’t lead through inability or poor decision-making due to brain decline.

You go to Proverbs 31. This breaks the category of a submissive wife as one who’s subservient and just says, “Tell me exactly what to do, so I only do that thing.” No, an excellent wife who can find, she’s far more precious than jewels. The heart of her husband trusts in her. He will have no lack of gain. She does him good and not harm all the days of her life. You see right there a husband who can trust his wife, whose wife is working for his good and not harm, that’s a wife who’s embraced godly roles. It’s not a wife, it’s not neediness that she expresses, but productivity and care. Jump forward to verse 15 of Proverbs 31. She rises while it is yet night, provides food for her household, portions for her maidens, she considers a field and buys it, the fruit of her hand, she plants a vineyard, she dresses herself with strength and makes her arms strong. She perceives that her merchandise is profitable, her lamp does not go out at night. This is a woman who can work, who can work hard, but very different from that which feminists would say, hey, a woman who doesn’t need a man, a woman who functions for her own good, depart from him, but this is a woman who’s functioning strong for the good of her husband. And her husband trusts, she, verse 27, looks to the ways of her household. She doesn’t eat the bread of idleness. Children and her husband call her blessed and praise her. Charm is deceitful, beauty is vain, but a woman who fears the Lord is to be praised. This biblical femininity is rooted in fear of the Lord, love of her husband, not a desire to dominate over the husband, but to come alongside as a God-given helper to build him up, that can be demonstrated in very unique, very God-glorifying ways with a husband whose mind is increasingly not working.

It’s fundamentally a disposition to honor and support the husband voluntarily and gladly. Leadership often involves delegation. So, husbands: if you’re heading that way, plan in advance for the kinds of ways so that your wife, even when you can no longer give your preferences, she knows, and it seems like in the moment, she’s actually working against it when you no longer understand what’s going on. She’s actually able to follow. So it’s good and right for the wife to be productive, capable, in a way that might look independent, but with a hard attitude that supports. So anticipate that.

I want to give a personal example. This is actually hard and a little bit embarrassing. So dementia is different than delirium. Delirium is something that’s short-term, usually from a cause. You see it in elderly when they get like UTIs. You can see it from medications. Post-surgery, I see it all the time with anesthesia. As many of you guys know, I spent a long time in the hospital with Burkitt lymphoma. I was getting a lot of chemo. They stick a needle in my spine, give me chemo directly into my cerebral spinal fluid around my brain. I was on tons of pain medication and all kinds of other medications that did weird things to my brain. I don’t remember this time, but there was apparently a few days—I remember bits and pieces of it—where I was out of my mind. I at one point apparently tried to hit Kiki. I took all my clothes off and tried to go in the hall at the hospital. Kiki was a loving, submissive, supportive wife by helping me not do that. I am very grateful for her tearfully persevering, guarding me from myself as my brain was failing me. At that point, thankfully, in a reversible way. But she was not stepping out of her God-ordained role by saying, “No, Jake, you cannot go in the hall naked. No, Jake, you cannot hit me. Jake, get in bed,” and even physically and chemically restraining me for a time. That was a gracious expression of role differentiation that I think honored the Lord and honored me.

I remember also, just husbands to wives, me at the—I was reading my vows this morning from almost 25 years ago. I wrote in those vows. And I’d encourage you guys to think through that now. And singles, as you’re thinking through marriage, think through what it might mean in all the different stages. I said, “I pray that as we grow old together, our love will grow stronger because we are together growing as one closer to Christ. I commit myself to loving you, even when your beautiful body is gone, even when your mind is not sharp, even when you do not recognize who I am. No matter what the cost to me, I will be married to you until God takes you.” And that’s what it means. That love isn’t in it for what the other one can give. It’s not self-seeking. It actually seeks the good of the other. So have this mind in you, which is yours in Christ Jesus, who though he was in the form of God, did not count equality with God a thing to be grasped after, but he emptied himself, taking the form of a slave, being found in human form. He did that all the way to the point of death, death on the cross. That’s what husbands are called to. That’s what all of us are called to. So thinking, I am above changing this diaper or correcting my spouse for the thousand and seventy-second time this week. Stooping that low is nothing compared to our Savior’s humble condescension to us. And so you actually are embracing God-given roles as a Christian when we help and endure and love our spouse to the very end.

Honoring Parents and End-of-Life Care

Smedly Yates: And that’s a great segue, Jake. When I think about what you just described, our parents did those very things for us when we were helpless. There may come a time where those roles are reversed and we’re helping our parents in their end-of-life situations. I’m going to ask you a series of questions that came in and you can answer whichever ones you want. I’ll try to go faster so we get through them. Maybe. Maybe we do a part 17 of this series, whatever. But I’m thinking about the command, the prohibition, do not sharply rebuke an older man. And the positive commands honor your father and mother. Those commands don’t expire. And when I think about don’t sharply rebuke an older man, there ought to be an elevated view of those who have walked this life longer than we have. We’ve lost that in an American culture, right? Tribal cultures have kept that in some ways. Other places, other cultures have kept that. We just sort of disregard the elderly as a new cultural phenomenon. And, you know, the word euthanasia, the beginning of the word is, is eu or good and thanasia, thanos, death. Good death. It’s not good. And we don’t discard people when they’re no longer of utilitarian purpose. But that is where our culture is going. And Christians must look very different. So when we think about how do we gently, compassionately, lovingly honor God, honor our parents, loving them through end-of-life scenarios. Here’s a series of questions. How do I honor those relationships when compassionate care, sometimes correction, help the 1,077th time. Dad, use your words. Don’t use your hand. You know, whatever it is. Give me the keys. How do we do that and honor them in our disposition? Number two, is it sin to employ the resources of home health care or a live-in situation, a retirement community, etc.? And then what do we need to think about with end-of-life scenarios? Yeah. That’s a lot of questions. Let’s go.

Jacob Hantla: Let’s go. So I think honoring your parents means, first off, it’s a disposition of the heart, but it’s a disposition of the heart that is connected to meeting their physical needs. You went to 1 Timothy 5. Do not sharply rebuke an older man, but encourage him as you would a father. And then dot that dot, second, verse 2, older women as mothers. And then it rolls into, let’s think of widows who are truly widows. Open to 1 Timothy 5. This is maybe a section that you’re like, you might not read this honor widows who are truly widows section, thinking it applies to you. It does. And I think in it is the answer to this question, or at least a significant part of it. Verse four, the thought here is the church needs to take care of widows, but don’t do so in a way that robs a family of the responsibility and need to take care of their own parents. So look at verse four. If a widow has children or even grandchildren, let them first learn to show godliness to their own household. And now look at this three part: make some return to their parents. So rooted in just a mom, dad, thank you for however many years of my life. You changed my diapers and fed me and looked after every need. It’s okay if my career is messed up because I have to have you in my home and I have to go take care of you. That is, do you see what it says? That is actual showing of godliness. I love what you just said. It’s so different than the culture. The culture might do this in a way that Christians have to be sharply different than. It is godliness to make return for the way that your parents cared for you. Number two, this is pleasing in the sight of God. You don’t do it out of social obligation—well, who else is going to do it? They don’t have enough insurance. Or even if they do have insurance and you do get the privilege of having live-in help. No, you are seeking to please the Lord as you make return to them. This is pleasing. Yeah, and then the third was, yeah, so godliness, make return to their parents. It’s please the Lord. Take care of your parents. Meet the needs. And if you don’t, verse 8, do you see what it says? If anyone does not provide for relatives, especially members of his household, do you see what you’re saying? You have denied the faith and you are worse than an unbeliever. This is what James is referring to in chapter 2. That’s a faith that’s dead being by itself. The religion, end of James 1, the true religion, takes care of orphans and widows in their distress. How much more are your parents? So, yes, take care of your parents. You have to. It’s a great privilege. It’s actually God’s ordained means of living out godliness.

So can you send your parents to a care home? Does that mean you have to maximally sacrifice? Not necessarily. It doesn’t mean that you have to perform every task. Neglect is sin, but using help may be wisdom. The reality is dementia needs are often 24-7. They involve skilled needs at times. They may wander, fall, be incontinent, unsafe swallowing. Care at home at all costs—that may be rooted in love. It may also be rooted in pride or even foolishness. Honor can actually look like choosing a good facility, visiting often, advocating, overseeing care. Encourage the church to be involved, but don’t demand the church do the work at you avoiding it. I don’t remember what the other questions were.

Smedly Yates: That’s all right. We got one minute left, Jake. Would you close our time in prayer?

Closing Prayer

Jacob Hantla: God, thank you for your word and just how replete it is with wisdom and principles and instruction and most of all revelation of who you are and what pleases you. God, I pray from this and just from this lesson and all the trials that you bring us through related to dementia and so many others that you would increasingly form us each individually and then corporately as your body. Form us into your image. Increase our godliness and then, God, bring us safely home. We love you. Be glorified in our lives and in our church. In Jesus’ name we pray. Amen.