by Daniel George, PhD, assistant professor, Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania
Storytelling is central to the human experience. In fact, it is quite likely that our human ancestors survived, in part, because they became adept at telling stories to convey complex information about environmental threats, the status of food and water sources, social group dynamics, and to transmit crucial information and practices across generations.
The urge to engage in storytelling is so irrepressible that it is almost a reflex. Try looking at any given painting involving human (or other) subjects and see if you can suppress the instinctive desire to project an explanatory story. This narrative instinct is present even in persons with dementia, a vulnerable population too often defined in our society by their deficits rather than by their remaining strengths.
Anne Basting, a theater professor from the University of Wisconsin-Milwaukee, tapped into the primordial power of storytelling in the mid-‘90s. Working in an assisted living home as a graduate student, she became frustrated by the lack of engaging activities. She tore a picture of the Marlboro Man out of a magazine and simply asked residents to tell a story about the cowboy in the picture. The residents — all of whom were affected by advanced memory loss – sprung to life, issuing forth with insightful, witty, and imaginative observations that Anne recorded in a free-form poem.
Anne went on to develop this process into TimeSlips, a group-based storytelling activity for persons with dementia that is increasingly used in caregiving settings worldwide. TimeSlips involves giving persons with dementia a visual prompt (generally a staged and surreal image with no recognizable subjects, see photo above) and encouraging participants to collectively tell a story about the subjects of a given picture.
What unfolds is commonly a whimsical stitching-together of spontaneous observations, repartee, biographical memories, and even garbled sounds into a meandering prose poem that frequently unravels into incoherence and absurd contradiction, but also often maintains some semblance of internal logic and cohesiveness.
Unlike traditional reminiscence therapy, which places some pressure on persons with dementia to remember in linear, chronological fashion (i.e. “when did you meet the friends in this picture?”), TimeSlips invites participants into the frenzy of collective storytelling and dramatic performance. Anne’s motto, “Forget Memory, Try Imagination” emphasizes the thrust of the process to foster storytelling rather than the recovery of details or facts.
A small base of research on TimeSlips has found that it improves communication skills, affect, and alertness in participants, while also enhancing caregiver-patient relationships. During my first two years teaching at Penn State College of Medicine, I have trained classes of 4th-year medical students to facilitate TimeSlips sessions, and each has made four 1.5-hour visits to a local assisted living home to work with several dozen residents living on the locked unit. (Click here to see the resulting TimeSlips narratives.)Previous to the class, the only interactions students had with such folks was on clinical rotations, where elderly patients presented with complicated chronic deficits requiring medical attention. In short, the visits have been a resounding success.
As reported in the June 2013 issue of Academic Medicine, we have found significant improvements in the perceptions and attitudes of the medical students towards residents with dementia. In our classroom conversations, students have spoken of developing greater empathy and patience; needing to see the person not the disease; the importance of validating rather than reality-orienting; the need to help patients and families not feel suffocated by the stigma of “AD”; the potential for creativity and imagination – even in those more severely affected by brain aging; meeting people in the moment instead of demanding that they occupy our reality.
But improving attitudes and deepening humanism are only a part of the story. I have also challenged my students to develop creative final projects based on the narratives that have emerged from TimeSlips sessions. In turn, they have produced an astounding array of creative projects, ranging from dramatic dialogues to paintings and sketches to stop-animation films:
All of this has burgeoned out of the simple act of creating a space for intergenerational storytelling. With drugs to effectively and safely treat the cognitive and behavioral symptoms of dementia severely lacking, non-pharmacological like TimeSlips offer safe, cost-effective, and humanizing alternatives that remind us of the simple, protective fabric of human relationships and the enduring value of the arts.