Hans Siepel. Voices of the Soul: The Forgotten Truth about Dementia. Soesterberg: Aspekt Publishers, 2022. 194 pages (Paperback). ISBN: 9789464626896. German edition. Hanau: AMRA Verlag, 2013. €16.95 (hardcover). Dutch edition. Leeuwarden: Elikser, 2016. (currently not available).

Hans Siepel, a former senior official of the Dutch Ministry of Internal Affairs, describes in “Voices of the Soul”, the dementia process of his mother. When the diagnosis has been made, she is admitted to a nursing home, but it immediately becomes clear that she absolutely does not want that. She wants to stay at home and asks her family to stay with her no matter what. Hans Siepel decides, together with his brother and their wives, to move into the parental home and to support their father and mother.

Siepel is a gifted writer and he takes us into the decline process of his mother. Gradually, things get worse but there are also many beautiful, good and special moments. His mother comes in a state of resistance and rebellion against everything that is related with “having to”. She opposes anything that does not please her. Siepel suspects, and is increasingly more convinced, that his mother still wants to share important matters with her family, things that she could not express in the years before. She goes her own way with determination and shows what she wants.

Hans Siepel does not want to use medicines, as it is his conviction that they will only harm their mother. In fact, they may further disadvantage the little contact that is still possible. He is confirmed in this belief by his mother’s actions.

Hans believes from the vague and unclear signals that his mother gives that he should continue to ask questions and also involve other family members in what is happening in her life. These are going to be tough and emotionally difficult times. Mutual relationships are strengthened; the pieces of the puzzle of his mother’s story become increasingly clear. Hans interprets the signals and memories of his mother in his own way. In the end, his mother reveals a secret that she has carried with her from early childhood and that has everything to do with her resistance to ”having to”. After sharing this with all her family members, she can say goodbye to life.

Voices of the Soul shows us how to deal with family members with dementia. It was a conscious choice to deviate from the prescribed path. It is, for people who have the time and/or financial possibilities, a positive alternative to hiding the elderly in nursing homes where they are gradually languishing. I remembered the last year of my medical study when I was doing an internship in a nursing home in the Netherlands. We went on a home visit to a farmer’s wife who was eligible for admission to the home. She disagreed with that decision and lamented: “… why is that necessary? In the past, people just stayed at home.”

I can endorse the choice of Siepel and his family not to use sedative drugs and drugs for dementia. Drugs of the last group do not work and do not help and they only give false hope. In France, the expenditure on such drugs is no longer reimbursed, for this reason. In hospitals and nursing homes they are given, but that is mainly to give the nursing staff a rest. The doctors and nurses do not have much more than pills and more pills to offer. That is sad and gives us a lot of food for thought.

The book also gives plenty of reasons for interesting philosophical reflections such as on the relationship between body and mind, Cartesian dualism, or the Spinozist image of God. The 17th-century French philosopher Rene Descartes created a philosophy in which the body and the soul were separated, the Cartesian dualism. He visited the Republic of the Seven United Netherlands where he was opposed by the Portuguese-Jewish philosopher Baruch De Spinoza. Spinoza contested the view of Descartes. In Spinoza’s philosophy body and soul were two aspects of the same substance, called God or Nature. There was no place for dualism in Spinoza’s philosophy (Ethics chapter 1: God).

Unfortunately, the dualistic view of Descartes was accepted by the medical guild and it can be doubted whether this was in the best interests of patients. Cartesian dualism is regarded as one of the main causes of a reductionist or mechanistic treatment of patients. By separating the mind from the body, the importance of mental states in the maintenance of health is denied. This leads to the biological reductionism of disease. Cartesian dualism is especially troublesome in the artificial separation of physical and mental disorders in psychiatry. Distinctions between pure somatic and pure mental complaints or diseases might not be the best way to treat patients. Doctors, and especially general practitioners, should pay attention to all aspects of their patients, to the whole human being they are dealing with. Nowadays we see that less and less attention is being paid to this topic.

This book should be compulsory literature in the medical curriculum.