Adversity, Dementia, and the Purpose Hidden in a Diagnosis

The most important phone call of Barry Michels’s life was one he was never meant to hear. He was sitting in a hospital cafeteria while his wife, Judy, underwent a procedure. She called to say she was finished and he could come collect her, and then, by accident, the line stayed open. He heard her talking to her nurse. “He doesn’t know it,” she said, “but he also has Alzheimer’s.” In the conversation Michels later described to Oprah on her podcast, the moment felt physical: “It’s like my blood just ran cold.” That scene opens this conversation, and it sets up everything that follows. In a long, unhurried exchange, Oprah talks with the psychotherapist and co-author of The Tools about his diagnosis with Lewy body dementia, his memoir Ahead of All Parting, and the stubborn question at the center of both: can the worst thing that happens to a person also become the material of a fuller life?

Why does a dementia diagnosis frighten people more than most illnesses?

Oprah opens by citing a statistic she had read in preparation: dementia ranks with cancer among the medical conditions people fear most. Her reasoning is specific. Cancer, even at its most frightening, may come with a treatment or a clinical trial, a glimmer that something might work. Dementia, as she and Michels discuss it, attacks the one thing a person most identifies with. “This is the thing I think most people fear,” Oprah says, “is the loss of your very self.”

Michels draws the same line from the clinical side. With cancer, he points out, consciousness remains intact; you are still yourself while you fight the disease. With Lewy body dementia, he says, “you begin to lose what defines you as you.” He then adds a refinement that gives the conversation its emotional gravity: what defines a person may be less their faculties than what they believed about themselves. “Or what you thought of yourself defines you,” he says. The fear, in other words, is not only about memory. It is about identity coming unmoored.

Oprah’s intro also names the progression the disease is known for: the loss of independence, the loss of memory, and, in Lewy body dementia specifically, the possibility of hallucinations and changes in behavior. She is candid that she had never heard of the disease before reading Michels’s book. Michels is equally direct about its mechanics. It is, he says, “a gradual wasting away of the personality,” and the person “really loses themselves.” He lost his father to it, and he has come to understand his own condition as what he calls mixed dementia, a combination of Alzheimer’s and Lewy body dementia. “That’s what I have,” he says.

What does living with Lewy body dementia look like day to day?

The most useful thing about this conversation is how plainly Michels describes the variability of his days. Oprah asks how he is, and he offers a grade: “a sort of a medium day.” A medium day means his brain is not as sharp as he is used to it being. He may fumble for answers. He may not remember parts of his own book that he ought to. What it does not mean is complete fog or disorientation. A bad day, by his account, is one where he feels he should not be doing psychotherapy at all, because he will not be helpful to the person in front of him.

That detail matters because Michels is still seeing patients. He describes mornings when his head feels filled with fog, and a routine that works against it: a run or some exercise, a little poetry, then back to the office. Once the first session begins, something shifts. “The moment I see them on the Zoom screen or they’re in person, I’m there,” he says. He attributes this to a principle he has built his practice around. “I recognize that when I’m forced to, I show up. And I show up really well.”

Then he makes the claim that turns the interview into a case for how people should meet illness. When Oprah asks whether he would have declined faster without the obligation to work, he answers without hedging: “I think if people had coddled me or if I had coddled myself, I would have deteriorated a lot more quickly.” It is a hard sentence to hear from someone who is ill, and Michels is not offering it as a rule for everyone. He is describing his own experience, and his own sense that structure, responsibility, and being needed kept him in the world.

What is The Tools, and how does it relate to this diagnosis?

Michels is a Los Angeles-based psychotherapist. He and his longtime collaborator Phil Stutz co-wrote the New York Times bestseller The Tools. Their work relies on mental exercises with names like active love, grateful flow, and loss processing. The aim, as Oprah summarizes it, is to help people confront psychological obstacles and transform them into opportunities for growth. That framework is the thread linking the therapist’s practice to the patient in the diagnosis chair. The question he has to answer for himself is the same one he helps his clients answer: what do you do when the obstacle cannot be removed?

Michels says the diagnosis changed him as a therapist, and the conversation returns to that change more than once. The shift is less about technique than about what he knows now from the inside. Many patients come to him carrying something they cannot fix, and he now understands that condition more intimately than he did. He is also clear that the tools are not a shield. They are a way of meeting what is happening, which is why he keeps returning to the act of showing up.

Can a terrible diagnosis become a blessing?

This is the question the whole video is built around, and Oprah does not pretend it is easy. Early on she admits she could not imagine anyone seeing a Lewy body diagnosis as a blessing, and she says she wanted to find someone who could. The framing she offers is that Michels now sees his illness as “the path he was meant to walk,” one that has opened him in ways he never expected, through vulnerability, love, prayer, and the written word.

The opening montage makes the stakes plain with a single line that stands on its own: everything that happens to you, especially the worst things, is there for a reason, and you can use those things to transform yourself. That is a strong claim, and the conversation earns it only partly. What the interview does show convincingly is the difference between a reason and a lesson. Michels does not say his disease is good. He says that living through it has taught him things he would not otherwise have learned, and that he is willing to put that learning to work for other people.

The conversation also widens to other voices. Drew Barrymore, a longtime client of Michels, joins to talk about what his work has meant to her and about watching him navigate his illness. The video also introduces a guest named Alex, who was diagnosed with kidney failure, extending the discussion beyond neurology into other serious diagnoses. Religion, guilt, writing, and mortality take up the later stretches of the hour, and each one returns to the same tension: how a person holds grief and meaning at once.

What role does writing play for someone losing his memory?

The memoir is itself the answer to that question. Michels writes poetry on the days when his brain can manage it, and the book is an act of composition at the moment composition is hardest. Oprah’s framing of the book as one to keep by the bedside suggests why it resonates: it is not a clinical account but a record of a mind deciding how to spend what remains of its clarity. Writing becomes a way of continuing to be the person his diagnosis says he is losing.

Where to go from here

If this conversation stays with you, start with the book it grew out of. Ahead of All Parting by Barry Michels is the fullest account of the diagnosis, the grief, and the acceptance that Oprah’s interview only touches. Then return to The Tools, written with Phil Stutz, to see the exercises that shaped Michels’s approach before his illness changed what he understood about them. Watch the full episode for the sections on guilt, faith, and mortality, which are where the emotional argument is most personal. And if you are living with a diagnosis of your own or caring for someone who is, consider the question Michels keeps answering in different ways: not whether you will be tested, but what you choose to show up for when the test arrives.

Attribution note: quotations are drawn from Oprah Winfrey’s podcast conversation with Barry Michels, published on her channel in October 2026. Timestamps refer to that episode.