Keeping up Pretences

There is often a discrepancy between the in-tact social behavior of Alzheimer’s patients and the more hidden cognitive changes that are taking place, and this can be deeply confusing.  My mother remained wonderfully warm and hospitable and friendly almost to the end of her illness, offering to make a cup of tea, or a plate of chicken soup, to whoever she spoke to, even when she was living in a small room of a geriatric facility, with no ability to manage her own life.  Those aspects of her nature were barely damaged by the illness, though she had no idea to whom she was being so loving.  This “confabulation”, i.e. talking as though one is keeping up with the conversation, is an often heartbreaking display of the effort to maintain pretenses.

Interestingly, art productions of patients can be useful indicators of underlying decline in mental functioning.  As an art therapist in a unit, I could often point out basic changes in graphic abilities, such as confusion on the page, uncontrolled and wild composition, simplification of images, distortions and fragmentation of images.  This insight through the artwork was helpful to the rest of the therapeutic team who might be missing fundamental and hidden difficulties the patient was experiencing.  When the changes were pointed out to the staff, they were able to understand and make adaptations to changes in their functioning.

Ruth Abraham – When Words Have Lost Their Meaning: Alzheimer’s Patients Communicate Through Art.

 

When Patients say “No”

Max Wallack pointed out a problem of patients saying “No” to caretakers, refusing to carry out basic life activities such as bathing.  It is interesting how Alzheimer’s patients seem to be more courageous, or upfront, or aggressive as the disease progresses.  One of the explanations that I present in my book “When Words Have Lost Their Meaning; Alzheimer’s Patient’s Communicate Through Art” is a phenomenon call disinhibition.  This refers to the fact that the strong socializing influences that have been absorbed and learned throughout one’s life i.e. normal inhibitions that we all have, are slowly eroded.  It can make patients behave more like children, who express more openly than adults, exactly what they feel.  They are less willing to please others, and more connected with   their feelings in the here and now.  That’s why sometimes a woman or man with dementia will say quite insulting things that they wouldn’t have said in the past.  We all have hidden feelings like this, but we have learned to hide them, to be appropriate.  But Alzheimer’s patients increasingly forget how to hide them.

 

Art Reproductions Stimulate Artwork

Take a look at yet another project based on the understanding of the contribution of art to Alzheimer’s patients.  http://www.capecodonline.com/apps/pbcs.dll/article?AID=/20100318/LIFE/3180301/-1/NEWS

Deprived of language skills, patients observe paintings by artists and respond to them.  The visual image stimulates emotions, memories, stories, responses.  Generally, increased liveliness is observed.

I have worked with patients who find it hard to begin to take pencil to page.  Showing them reproductions – well chosen, of course – often helps them to get going on their own work.  I would recommend an addition to this project in Cape Cod, and anyone else who is working with small groups of dementia patients that observe art.  After the group has looked at a few pictures and discussed them, each could be given a board, with a piece of paper and a pencil.  They could be asked to make a drawing of any one, or any part of the picture before them.  Each will naturally respond to what is significant emotionally for them.  This can be enormously cathartic and communicative at the same time.  Quite significant verbal responses may ensue.

I once showed the members of the art therapy participants some reproductions of mother and child paintings.   Then I asked each one to say something about what it meant to be a mother.  These were people with very diminished language skills.  Yet here are some line from the lovely group-poem that they produced.

The Love of  Child (the name chosen by the group for the poem)

Mother and child – it is the whole world

To be happy, to see the mother hug the child

From joy, tears come to her eyes

Let the child drink from her breast or her body

Maybe they went out to dance from joy

Devotion and unending love

They loved to hear this poem read out again and again and I’m sure it wouldn’t have come about without the presence of the pictures in front of them.

 

Good Idea for Stimulating Conversation

The current museum projects for Alzheimer’s sufferers are a brilliant way to both entertain and encourage communication.  Conversation can be more problematic with AD people as they tend to lose track of the links and the subject.  But if they have a stimulus in front of them, if there is a picture to look at, they can constantly refer to it.  They don’t have to depend on their mind to hold them in one place.  The visual stimulus is there to do it for them.  In Chapter 3  of “When Words Have Lost Their Meaning: Alzheimer’s Patients Communicate Through Art,” Greenwood Press 2005, I suggest ideas for art activities with dementia patients.  Some people have very little feel for color or lines and are too passive or restless to take paint to paper.  A good option is to find reproductions of paintings that one can look at and talk about.  Chagall’s wedding pictures, so whimsical, but so full of love, often result in dialogue about long marriages, loyalty, past and present happiness and love.  On the other hand, try showing some pictures of lonely fingers in diners, by Edward Hopper.  These give patients the opportunity to talk about their loneliness, share their longing for connection and companionship.  Patients need not only to be cheered up, but should have their sadness and concerns voiced and listened to with compassion.  The trick of course, is to choose the right picture for the particular person, matching it to his/her personality or current mood.

Ruth Abraham

 

Meditation and Art

An interesting study of the cognitive benefits of meditation  is worth considering.   I found that when Alzheimer’s patients became involved in an art activity, their breathing became much quieter, they are less agitated, and patients who need to talk all the time, became more silent. All of these seem similar to the meditative state. For me it was no more than anecdotal observation, but I often thought it would be worth putting this to some objective scientific study. John Varghese, author of BACE, suggests that “in the patient’s struggle to communicate through these images, new neuronal connections may be formed and could be therapeutic – stimulating greater retrieval capability in the brain.” Definitely worth investigation.

Ruth Abraham: When Words Have Lost Their Meaning: Alzheimer’s Patients Communicate Through Art, Greenwood Press 2005

 

Hope

A few weeks ago, a member of  a geriatric facility who had heard of the work I do, having read my book “When Words have Lost Their Meaning: Alzheimer’s Patients Communicate Through Art,” contacted me for some advice and to share an exciting moment.  A ninety plus old lady with medium dementia had been in the facility for some months, behaving with extreme passivity, total lack of interest in activities, and obvious depression.  Then someone brought a catalogue of famous people, containing brightly colored photographs.  The old lady found a pencil and began to draw one of these faces with great skill, concentration and determination.  Thus started a series of pictures to which she devotes herself three times a week.  She is enormously proud and while she has little  language capacity, her pleasure and engagement in the process is palpable.  Who would have thought that this sad lady, given pencils and paper, would reveal  skills and capacities that no one had dreamed of.  And how many more of them are there.  With therapeutic and artistic skills, one can open up hours of pleasure and confirmation of continuing humanity.  And if not hours, maybe half hours, or quarter hours.  We owe it to them to find a way, and art and expression through art, is one of the ways.

Ruth Abraham

 

A Valuable Endorsement of Art Therapy for Alzheimer’s

A valuable affirmation of art therapy as a contribution to Alzheimer’s patients has come from John Varghese.  Varghese is the editor of BACE, published by John Wiley and Sons, which provides global understanding essential for a future drug discovery for the treatment of Alzheimer’s.   The importance for me, for us, for everyone, is that he found it important to include an Afterward to the purely scientific book, relating to the significance of art therapy in the treatment of Alzheimer’s patients.  This reflects the seriousness with which Varghese views the humanistic approach to Alzheimer’s patients.  I was glad to be the contributor to his book.

Art therapists relate to the continuing human qualities of Alzheimer’s patients in spite of the illness.  We attend with the utmost seriousness to his personal longings, aesthetic preferences, social style, and emotions such as anger, sadness and aggression.  As language skills deteriorate, the patient can use painting and sculpting, symbols and images, color and lines, as alternative ways to communicate and express their inner world.

In the book “ When Words Have Lost Their Meaning: Alzheimer’s Patients Communicate Through Art,” Greenwood Press, 2005, a chapter is dedicated to show the ways in which art materials can be chosen and presented to loved ones and patients.  Many caregivers, though not therapists, have found this practical chapter very useful.

 

Back in the blogging world

A long time has passed since I wrote my last blog.  I will now write more frequently because of what I see as a growing interest in the contribution of art to the well being of Alzheimer’s patients.  One of the signs of this is that my book  “When Words Have Lost Their Meaning: Alzheimer’s Patients Communicate Through Art” (Greenwood Publication 2005) is in greater demand now than it ever was.   The aging population of the world is growing and with it an ever increasing number of people are being diagnosed with Alzheimer’s.  More resources are needed and being sought by the medical world and by the ordinary family who has to cope with a loved one who has the condition.   One of the resources of value is art therapy – not to cure but to provide consolation, means of communication, self worth, and an activity that confirms the patients continuing humanity in spite of dementia.

 

FACING ACCUSATIONS

Friends and colleagues often seek my advice about ageing parents who are increasingly confused and behave in bizarre, unrecognizable ways. They know that I have traveled that long hard road with my mother who suffered from Alzheimer’s, as well as gaining experience through my work of many years in a geriatric facility.

Recently, Rose (we’ll call her that), told me that her mother has begun to accuse her of taking her money, of cheating her and leaving her destitute. Rose is an intelligent woman and knows something about Alzheimer’s, but in spite of it, she is angry. She can’t help it. Of all people, she says, how can my mother accuse me. Me, her daughter. I spend so much time, thought and effort to make her life easier. I am a devoted daughter, and always have been. The thought of stealing from her is so abhorrent. It’s too objectionable an accusation for me to abide.

But of course, she loses sight of the fact that it is the dementia that is talking, not her beloved mother. The accusation comes from the brain of a person suffering from a progressive and cruel illness. I tried, with some success to paraphrase this accusation of Rose’s mother. What she was saying is, “Rose, I am so muddled up. I cannot keep control of the thoughts in my head. I know I had some money somewhere, but I don’t know where it is or how much it is. Maybe I mislaid it somewhere. I just can’t keep track of things. I think the people around me must be taking my money away from me. You might well be one of them.”

The thing is it is easier for Rose’s mom to think someone is stealing from her, rather than to face the hideous reality that she is losing her mental faculties. In a moment of anger and insult, Rose fails to understand that her mother’s perceptions and judgments are increasingly faulty, that she no longer perceives the world in a reliable manner, as she used to, or as the rest of the world does. Things don’t connect, because the brain cannot interpret what it sees. Have any of you been accused in such a way? Is it hard to control the natural sense of insult? I’d love to know. It’s an important subject.

 

Sharing Art Images with Alzheimer’s Patients

Recently there has been a wealth of interesting information about the important value of creative activity for Alzheimer’s sufferers.  One of the finest projects was conceived by John Zeisel , President of Hearthstone Geriatric Facilities, with Francesca Rosenberg.  Groups of men and women are taken to see art collections at the MOMA in New York and the Fine Arts Museum in Boston.  The paintings, says Randy Kennedy, of the New York Times, (The Pablo Picasso Alzheimer’s Therapy) “sometimes spark interpretive and expressive powers” that had previously been hidden.  And care officials say that “at the very least, they see temporary but palpable and moving, improvement in the small group of people who have participated in the tours.”

Through my experience as an art therapist with Alzheimer’s patients, I can confirm the value of this passive art activity, of the stimulating effects of observing powerful, beautiful, colorful images.  Sometimes, when working with patients who were simply too confused, too depressed, and too tired to take crayon to paper, I would bring an art book and direct their gaze to paintings that, with experience, I had learned would elicit alert interest.  For instance, the pictures of Edward Hopper, with their scenes
of isolation and loneliness could result in a conversation about their own loneliness.  Chagall’s colorful images of men and women, marriage, and intimacy could lead to memories of past, youthful love and their own romances. 

Try this:  Collect some of these images, sit close to your loved one, and begin to talk about the picture.  Ask them if they like the picture and why.  Ask which colors they like, what feeling the picture gives them.  Share your own feelings, which will then stimulate them to agree or disagree.  Ask them what they think is happening in the picture.  Maybe what will happen later to any one of the characters in the picture.  Help them to focus on what they see and relate to it.  If it is a portrait, focus on the features, what they say about the person.  Ask if they would like to get to know that person.  Have a laugh about the name that you might give to him or her.

There are a few “dont’s.”

Don’t choose very frightening images (Goya’s “black Paintings” for instance.  Confused people are essentially emotionally vulnerable.)

Don’t choose very abstract pictures.  They are harder to talk about.

Don’t choose pictures with many small details that confuse the eye.  Old people often have eyesight difficulties and the image can appear to them as a muddle of shapes that they cannot interpret.

Good luck.  Let me know how it went.  If there were difficulties, share them with me.  Maybe I can help.