The umbrella term of ‘the arts’ comprises of a wide range of activities and outcomes, and art may be interpreted differently by people. Art may be passive or participatory. For example, passive forms of art may include listening to music, or looking at, and appreciating, a piece of art. Participatory forms of art can include visual based arts, theatre, music, dance, poetry and time slips. Time slips are a form of storytelling art, in which the person literally imagines the story. The aim is to alleviate the pressure of remembering a story, enabling a person to use their imagination. Different versions of time slips have developed over time. At Alzheimer’s Europe 2015, I heard about a project in Switzerland that used time slips to ‘awaken the story within’; during this project people living with dementia were given an image and asked to tell the story, or rather to ‘awaken the story within’ – a delightful, imaginative and accessible project, enjoyed by many. Time slips, like other tangible art activities have a legacy, as they can be enjoyed by others within the community, providing a lasting sense of collaboration, integration and interconnection within communities, as we move from individual support planning to true citizenship for individuals living with dementia with our society.
Visual based arts may be used therapeutically for people with dementia, but the term ‘Art Therapy’ could be off-putting; some may not consider themselves good at art; others may comment that they don’t need therapy. Therefore, recognising, and supporting, personal expectations and objectives is key to the success of any art group. Individuals may join art groups for various reasons; to make friends; to develop new skills; perhaps in pursuit of the satisfaction of producing a piece of art. The self-perceived outcomes will influence individual benefits gained from the sessions.
There is potential for art groups to deliver benefits across several domains; to alleviate some of the symptoms caused by dementia (medical); to provide people an opportunity to meaningfully participate (human rights); to provide the opportunity to develop new relationships (social); and to work collaboratively in communities, developing and contributing to community artwork (arts).
Art appreciation encompasses emotional and visual skills, most of which are preserved, to a degree, in people with dementia. At later stages in some types of dementia such as PCA, a variant of AD, the individual with dementia can experience some difficulties with visual spatial function. However, in the world of art some of these difficulties can be attributes, as abstract pieces can be highly regarded, both individually and collectively. Disordered and distinctive art can be appealing to many.
As the dementia progresses an individual may lose certain skills; for example, memory, language, judgement and planning. What art activities seeks to do is overcome these difficulties by utilising the preserved capacities of the person. Preserved motor and sensory skills enables a person to engage with art, and for many, art can become a powerful form of expression where language skills are lost.
Some of the more abstract pieces of art could be expression of the person’s tethering from the concrete world, which may be illustrated within William Utermohlen’s series of drawings over the period of his progressive disease. In his works can be seen visual representation of the organic challenges the brain encounters; difficulties with memory, recognition and distinction of colours and recognition of faces, or the experience of having a symmetrical view, possibly caused by visual field loss. There is also evidence that relational shapes and sizes are disordered as perceptions becomes more obscure, and where there is a loss of definition related to depth perception and colour contrast; there is a distortion in spatial awareness and a flattening of perspective. As the pieces here progress we see there may also have been a loss in motor skills, evidenced in the brush stroke and depth of application.
When I first glanced at these drawings, however, it was not the organic challenges that struck me, nor did I dwell unnecessarily on the difference between the reality and the abstract as evidence of cognitive decline; I felt an emotional connection to this man’s experience through the lens of dementia, his experiences communicated through metaphor and colour. To me the work of art had become a very powerful means by which William Utermohlen communicated his inner feelings and subjective experience, and a means through which one hopes he achieved some sense of release or relief. In his pictures I see a slow, evolving disconnection with a sense of self, an erosion of sense of identity, linked possibly to a loss of life role or sense of autonomy. I see a struggle to connect meaningfully with the environment, and to maintain an ‘attachment’ to the world, and to one’s own identity within. In the middle pictures I see a fluctuating sense of being, between an inner and outer world. The pictures highlight to me how important it is to foster meaningful connections, to create a physical and social environment which supports, reaffirms and reminds the person of who they are.
Often, when a person with dementia experiences a strong feeling, such as anger, frustration and/or embarrassment, complex cognitive skills are required to work through and resolve those emotions. For example, if a person loses their keys, which may lead to feelings of frustration and anger, one way to resolve this might be to draw upon memory, or language skills. If, as a result of damage to the brain these skills are not available, then the person may be left with negative and strong emotions. One way of externalising strong emotions may be to tell someone, however difficulties with language may hinder this, and instead the communication may be achieved physically or aggressively; this may then be unhelpfully labelled ‘challenging behaviour’, and in some cases may lead to exclusion or the inappropriate use of sedative drugs. Visual based arts may, in part, prevent inappropriate interventions by offering an alternative means of expressing these emotions that others can comprehend more deeply, and with which others can engage. Art need not be a detailed replication of what the eye can actually see, but can be abstract and symbolic, highlighting deeper meaning or altered perspective.
The aim of my training work is get people to recognise the emotional struggle experienced by some people living with dementia. In doing so, we can aim to identify the right interventions that create a safe space in which to support a person to remember who they are, to feel again connected, and to retain a sense of ‘attachment’. Art activities not only provide a mechanism for expressing one’s emotion, but also provide a platform for community engagement and citizenship, for giving and doing together. In art activities there is a potential for a sense of achievement, ownership, belonging and connection to a community.
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