Dementia, Music, Identity and Memory

 

Lantana and Friends

Lantana and Friends

 

Recently my colleague Kristin D. mentioned an NPR story about the Sundance award-winning documentary film “Alive Inside” – she knew I would be interested in it and I did get a chance to see the film at Chez Artiste.  I enjoyed this movie about music that transforms persons with dementia on several different levels.  If you’re curious about it, take a look at the video clip on YouTube that features Henry.  Henry is a resident at a skilled nursing facility (SNF) a/k/a “nursing home” who was, before getting headphones and an iPod loaded with some of his favorite music, mostly withdrawn and typically lost inside himself.

One of the music excerpts featured in the film is a song by Cab Calloway. This clip is a fave of mine (it’s got some pretty tight dance moves by the Nicholas brothers) and the song was covered by Joe Jackson in the 1980’s.  I grew up listening to my parents’ favorites: Ella Fitzgerald (who sang some scat from time to time), Duke Ellington and Oscar Peterson.

This film resonated with me on several different levels.  First, I have personal experience with the sort of “time travel” that music can perform for someone with dementia.  In a post I published about sixteen months ago, I recounted an experience I had while working as a volunteer “para-chaplain” in a SNF.  I had traveled to a local SNF to lead a holiday service for some residents and because I was lucky enough to be accompanied by a guitarist, at the end of the service I sang an old Yiddish song called Oif’n Prippitchik.  About midway into the song something very interesting happened.  One of the residents who attended was a woman with very advanced dementia who, it was reported to me later, had not spoken in over a year.  She started first to hum and then sing along with the song.  She spoke about her grandmother.  The song had transported her right back to a happy memory of childhood, when her grandmother had sung that song to her.  By the means of music, hearing that melody – she was moved in a sort of time travel.  I was most certainly moved witnessing that event.  Another story of music as a means of transport for the spirit comes to mind, it is from Megory Anderson’s book Sacred Dying.

A basic premise of the film is that people are not human machines.  Often what we see on the outside – when someone is old and frail and seems to have lost so much capacity to be the person they once were – is not the real picture or a complete picture.   Even when we see a loved one or a stranger in such a situation, we might shrug and say to ourselves “he’s not the same person anymore” or we may grieve for what that person was and doesn’t appear to be any longer.  We focus on the losses and often ignore what is left, however difficult or challenging it is to recognize.  It is often difficult to see a person there, who remains – despite the label of a diagnosis or condition that changes them.  Doesn’t all of life change all of us?  It made me think of Tom Kitwood and his legacy of person-centered care, based on the idea that people with dementia have much to teach us.  Yes, there’s a blog post I’ve written about that as well.

Whatever it is, it is the being, the timeless in us (identified generally by the neurologist Dr. Oliver Sacks as a part of the brain that is often left intact by dementia’s onslaught and ravages elsewhere)) – that is the place where music reaches through, past all the mechanical breakdowns and plaques and tangles of dementia, of Alzheimer’s or some other variety of dementia.  In the film, it is apparent that the music’s effect on the residents is to re-animate them.  The music gets through in a way that other communication cannot and the music helps the residents re-member, to inhabit their bodies and lives in ways that are astonishing.  Our basic human need to help others who are suffering and withdrawn is met by the residents’ responses.

After I saw the movie I wondered – should our end-of-life preferences, as stated in an advance directive or other documents, list our favorite music choice?  Perhaps a line on the form would ask: what music would you like to hear if/when you get dementia and become remote?  I know the music preference is sometimes done for memorial services . . .  but why wait?!

Perhaps I will write more in the coming months about the wisdom of aging, aging is what we are designed to do as adults – so why is it that our death-denying and youth-glorifying culture diminishes this process and its mysteries, this important stage in life that many of us hope we are lucky enough to encounter, enjoy and pass through?  Does our American culture’s emphasis on individuality and the capacity-focused, independence of the “rugged individualist” sometimes hamper our acquisition of wisdom or does or culture simply place a lower value on it . . .  because wisdom often comes with age and experience?  Here’s an interesting article in The Economist from a couple years back with some insights about culture and wisdom.  Yes, this post has many rhetorical questions!

 ©Barbara Cashman  2014   www.DenverElderLaw.org

Conscious Aging, Memory and Longing

Tex and Barb at Medicine Bow  Lodge & Guest Ranch

Tex and Barb at Medicine Bow Lodge & Guest Ranch

The theme of this post is about remembering and forgetting, for a number of reasons I suppose.  I didn’t forget to publish a post last week, but was absent, away from my everyday for several days, remembering how to ride a horse (hence the picture of me and my trusty mount Tex, a slightly cantankerous nine-year-old gelding who loved to snack on the abundant flowers).  Forgetting often overtakes us on many different levels.

Plato’s fascination with theory was an early way out of the direct experience of being human. Thinking about our human experience is a well-recognized way of distancing ourselves from that experience (even if we don’t think about it in those terms) and is itself a form of forgetting.   Recent works in neuroscience continue to wrestle with the theory of what it is to be conscious.  A recent favorite of mine is Phi: A Voyage From the Brain to the Soul (2012), by professor of psychiatry Giulio Tononi.  His work is well-written and artfully illustrated and I liked especially his chapter 17 entitled “Galileo and the Bat: In which it is feared that the quality of experience cannot be derived from matter.”    In the nine page chapter, Tononi tells the story of the cave (hey, doesn’t that sound like Plato?) and the demise of the bat who was one of its inhabitants.  It is a beautiful illustration that questions how science can describe consciousness – either as a measure or a quality. And further – what can determine it (consciousness) when we humans share the same basic infrastructure or what would seem to be the physical architecture of awareness but that gives rise to so much variation.  Where I part ways with this is in the search for the piece of the brain that contains consciousness, the idea that the quality of consciousness is still determined by some quantity or configuration.  I think this has been previously attempted . . . !

So, if I might suggest an antidote to all these measurable, reducible, objectified search tools, try The Reign of Quantity and Signs of the Times, by Rene Guenon.  I don’t pretend to understand or agree with much of what he had to say, but I do think his point that the immeasurable quality of space is the real space (not the quantifiable space) is refreshing to read and offers much hope for finding a way out of our collective forgetting that plagues so many of us on an individual and collective level.

Another type of forgetting is dis-integration.  This is the reverse of what memory has been described as by Daniel Siegel in Mindsight: Memory is a layering of our experiences which have been processed and encoded, and the integration he describes occurs at a horizontal (left and right brain), vertical (from the lower limbic region up to the cortex), and more subjective integration that includes our personal story, present state of mind, time and the interpersonal element of integration.  The last part – interpersonal integration – Siegel describes as “the ‘we’ of well-being.”  Mindsight, passim at 71-76.

What do we remember and what do we forget? So I return again to the New Yorker article “This Old Man.” In that article, nonagenarian Roger Angell writes beautifully from the heart about being surprised by getting to such an old age, but notes his biggest surprise (#1) is the unceasing need for deep attachment and intimate love.  Based on my reading of his article, I would say the secret to his happiness is longing.  Longing is searching.  As Ravi Ravindra wrote in Pilgrim Without Boundaries:

In being alive to the search, we are alive.

I think this longing, this search is a form of remembering, a remembering of something that is elusive, a connection and not really a memory at all, by the measurement of neuroscience.  Where does it come from?

Another scientist has a different take on why we search and strive to bond with others, particularly in intimate relationships.  In Our Drive to Bond, Bruce Lipton writes about the “fundamental biological imperative that propels you and every organism on this planet to be in a community, to be in relationship with other organisms.”  This type of remembrance is undoubtedly awareness, but obviously on a broad scale indeed, even if it is felt in an acutely personal way.

There are so many ways to address this longing, this remembrance of connection that drives us forward and toward it.  I will close this post with an excerpt from a poem, about our life – looked at as experience that is the long forgetting: This is from William Blake’s Ode (Number 563, Intimations of Immortality from Recollections of Early Childhood, ll. 59-65);

Our birth is but a sleep and a forgetting:

The Soul that rises with us, our life’s Star,

        Hath had elsewhere its setting,

          And cometh from afar:

        Not in entire forgetfulness,

        And not in utter nakedness,

But trailing clouds of glory do we come . . .

You can read the entire Ode here. I’m sure I’ll be back to writing about more practical topics soon, but as the summer blossoms fade and the harvest arrives, I couldn’t pass up this contemplative topic!

 ©Barbara Cashman  2014   www.DenverElderLaw.org