Her work filming patients with dementia responding to music has convinced Sitar Rose that 'however masked they may be by their illness, the personalities are still there'. Her video may herald a breakthrough in the treatment of dementia, writes Sylvia Thompson.
Good conversation is a fine art at the best of times. To succeed, it requires a careful, uncalculated sharing of interest, emotion and empathy.
But to partake in a meaningful exchange with someone who has limited means of expression through diminished physical and/or mental health requires further special talent and inclination.
In her work with old people suffering from dementia, Maria Mullan, music programme co-ordinator with Age Concern in Northern Ireland uses music as a means of communication. Responding to Music is a video made by Scottish film-maker Sitar Rose which sensitively records the creative exchange of feelings and thoughts between Maria Mullan and patients in day care and residential settings in Northern Ireland.
"It was very exciting to make the video. I hope it will be beneficial to care staff who can use music as a creative experience," says Mullan, who combines counselling techniques such as active listening and mirroring (repeating phrases back to the patient and copying his or her physical gestures) alongside creative use of musical instruments, voice and recordings.
Responding to Music shows excerpts from one-to-one music sessions between Mullan and nine old people suffering from dementia. The familiarity with musical instruments varies between individuals yet the experience of participating through playing, singing, dancing or simply listening is intense and meaningful for each one.
"You touch the very, the little strings as I think in the centre of my heart," one of the participants, Bob tells Mullan during the session.
"I do. I like it everywhere. I love music. Music is school. And music is home. And music in the house. And Irish music," replies Winifred to a question from Mullan on whether she likes music at church.
Seen out of the context of their illness and their often confused and disoriented everyday realities, the verbal expression of these people seems almost poetic. Mullan says that the musical instruments create an informality which frees the individuals from the normal constraints of conversation. The pauses between playing, the silences and spontaneous reminiscence are all valuable parts of the exchange.
One participant, John Pat, plays the balaphone (a wooden instrument from West Africa which is played like a xylophone) with gusto before moving on to play a piece on the mouth organ and then quote song lyrics which unlock memories of a disagreement he had with his mother. The idea that music offers us the opportunity to unlock feelings and uncover old emotions is not new but in such a setting, the poignancy of the moment is keen.
Edinburgh-based film-maker Sitar Rose has 20 years experience as a documentary film-maker. This experience shows in the sensitive way she focuses on the wave of a hand, the tap of a foot or the glint in the eye of participants in Responding to Music.
"It was interesting for me to make a video which was observing someone doing this kind of work because I have done some experimental work myself using video with people with dementia. So I am used to picking up on non-verbal communication and seeing the whole person.
"In my work, I have used video cameras with individuals to enable them to create a portrait of themselves. Sometimes, we filmed the individuals making their videos and played it back to them." As part of this work, Rose has filmed places where individuals are from and edited the footage in computerised digital editing suites which she brought into the residential care settings.
"I've worked with people who haven't got very much verbal communication and this type of work definitely brings people out of themselves even if they are at a very internal stage of their illness." While the use of the arts in such settings is not new, its value is still under-recognised, according to Rose. "In the past, there was an assumption that if people lose their rationality, the disease has taken over. My belief is that however masked they may be by their illness, their personalities are still there." Co-author of the booklet which accompanies the Responding to Music video John Killick puts his finger on the core issue in all of this.
"When you look at Sitar Rose's video portraits of these people, you wonder whether the individuals have dementia at all, yet when you meet them on the ward or in the lounge room, you have no doubt whatsoever," he says.
"The opportunity presented by these projects - and there are others using visual art and photography - is that they maximise the potential of these people," says Killick. As research fellow into Communication through the Arts at the Dementia Services Development Centre, Department of Applied Social Sciences, University of Stirling, Scotland, Killick is involved in research which further explores a key study by Bruce L. Miller from the University of California.
Miller studied 12 patients who developed musical or painting abilities despite serious progression of their condition. He concluded that the emergence of new skills in the setting of dementia suggests that loss of function in one brain area can release new functions elsewhere.
Jane Edwards, course director of the MA in Music Therapy at the Irish World Music Centre, University of Limerick says "Research has shown that for people with dementia, music therapy can assist in decreasing the agitation that can result when people are confused and disoriented. Music therapy has been shown to reduce aggression during bathing and other activities of daily life where the person might be dependent on the help of others." Edwards adds, "While it must be recognised that dementia is a progressive deteriorating condition, music participation can promote well being and quality of life throughout the progression of the disease. For a person who has dementia, participating in a music therapy session can be the one moment of the week where they are oriented, involved, responding and interacting with others. Carers in particular can find the opportunity to join their spouse or relative singing and playing instruments a moving and welcomed experience."
To order a copy of the video and booklet, Responding to Music, contact Linda Robinson on 048-90245729 or e-mail lrobinson@ageconcernni.org
For more information on the Masters in Music Therapy at the World Music Centre, University of Limerick, phone 061-213122 or e-mail jane.edwards@ul.ie
