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Filmmaker Michelle Memran became interested in therapeutic filmmaking after spending much of her twenties making a collaborative documentary with the visionary Cuban American playwright María Irene Fornés, who wrote more than three dozen plays and was the recipient of numerous prestigious grants and awards (https://fornesinstitute.com/about/biography). The documentary, entitled The Rest I Make Up (2018), chronicles Ms. Memran’s artistic collaboration with Ms. Fornés during the early stages of the playwright’s dementia and is a testament to the resilience of the creative spirit and the enduring pleasures of friendship, even — and especially — during cognitive change. (The full documentary is available on Amazon at https://amzn.to/3adPuDl.)
Since finishing the film, Ms. Memran has become interested in filmmaking as a therapeutic practice for people in the early stages of Alzheimer’s disease and other types of dementia. “We spend so much of our lives in our minds,” she explained, “and when you start having neurocognitive change, you’re often forced to change the ways you live, and create.” She believes that being in a collaborative process with someone you know and trust not only can ease that transition but also build self-esteem during an incredibly uncertain time. “The camera literally sees you,” she said. “And I think it can help us see and appreciate ourselves in moments when we can’t.”
Consent is, of course, a sensitive topic with this type of work and one Ms. Memran has thought about extensively. In working with those living with dementia, she feels consent must be an ongoing process of building trust and checking in with your collaborator. It’s important to note that Ms. Memran and Irene (Ms. Fornés’s nickname) became friends long before the filming began. It was only when Irene had stopped writing, likely due to the onset of Alzheimer’s, that the two discovered a camera could become a kind of dictation tool. “I had an old camcorder, and when I turned to Irene, she began writing in a different way,” she said. “I would say to her, ‘The lens is your pen.’”
In addition to being an expressive tool, Ms. Memran believes the camera can help people with short-term memory loss revisit events they may have recently forgotten. For example, as seen in their film, after Irene had forgotten a recent trip to her home country of Cuba, Ms. Memran was able to rewind the tape and replay it for her.
The process of making a film together can also provide a meaningful sense of connection and a way to continue one’s life’s work. She noted, “The first thing Irene would say to me was, ‘Are we going to work today?’ And so that sense of purpose and working on something — I think there is nothing like it. For anyone! And particularly for those in the midst of an invisibilizing, isolating illness.”
Research and Practice: From Therapeutic Filmmaking to “Multisensory” Expression
There has been limited research on the use of film therapy with patients with dementia or in long-term care. However, researchers have explored the therapeutic use of filmmaking in those suffering from trauma or posttraumatic stress disorder (PTSD). For instance, one qualitative study found that collaborative filmmaking with veterans suffering from PTSD helped the participants in “gaining a new sense of agency, regaining a sense of affiliation, and processing the trauma” (Front Psychol 2018;9:1954). The researchers recognize that for illness experiences that cannot be expressed in words, such as PTSD, filmmaking can offer a multisensory mode of expression, supplementing more traditional narrative approaches to care. Further, they write, “video production is inherently collaborative” and thus can become a way for the participants to experience human connection around what might otherwise be an isolating experience.
Therapeutic filmmaking can be situated among the growing collection of arts-based therapies (including visual arts, theater, writing, and music therapy) used in clinical settings. In the long-term care setting, art therapies are recognized to facilitate self-exploration, communication, emotional relief, and adjustment to age-related changes (Int J Nurs Sci 2021;8:102–119). The World Health Organization has also highlighted the link between the arts and overall health, particularly when it comes to “reducing the risk of age-related mental and physical decline” and providing “social and emotional support in palliative care and bereavement” (“Intersectional Action: The Arts, Health, and Well-Being,” World Health Organization, 2019: https://bit.ly/34zrFTe).
For patients with dementia or Alzheimer’s disease, visual art therapy does not necessarily have a greater benefit than other nonpharmacological interventions, but the evidence is lacking and inconclusive (Cochrane Database Syst Rev 2018;9:CD011073). However, a 2020 review found moderate evidence for the effectiveness of “occupational and environmentally based multisensory activities,” including music, dance, and combined visual and auditory interventions (Occup Ther Health Care 2020;34:171–201). Outside of long-term care, some researchers have argued that, as a multisensory and “multiply therapeutic” technique, therapeutic filmmaking may have more benefits than traditional art therapies (Front Psychol 2018; 9:1954).
Of course, there are obvious constraints to using therapeutic filmmaking in long-term care, including funding for art therapists and cameras, and questions of consent. But with proper resources and scaffolding to ensure care, Ms. Memran said she would love to do a pilot program in a memory care unit to see how people respond to the camera and whether the process alters the mood and energy in the same way music has been shown to stir interest and memories in residents.
But before that can happen, Ms. Memran explained, the mediums of film and video will need to be acknowledged as having therapeutic value and must be added to art therapy programs and curriculums. As far as she can tell, currently no art therapy programs include these modalities.
Ms. Memran’s current collaborator, Gus Rogerson, is a former actor and artistic director in New York City whom she reconnected with at an event. Recently diagnosed with young-onset Alzheimer’s and aphasia, Mr. Rogerson knew that he wanted to share his story in some way. Ms. Memran and Mr. Rogerson began meeting regularly via Zoom to discuss different approaches. First, they began filming, each with their own camera, but they quickly realized that Mr. Rogerson really wanted to write poetry. “The magic moment,” she said, “was when he started reading his work aloud to me on Zoom.”
This shift later made sense to Ms. Memran because Mr. Rogerson’s Alzheimer’s disease was diagnosed as the logopenic variant, which affects the language center of the brain. “Gus loves words, and he wants to hold onto them for as long as he can,” she said. “Our artistic practice is to conserve and encourage his voice.” Finding the “magic moment” is key, Ms. Memran emphasized, and it’s going to be different for each person: “It’s not what you want to do, it’s what they want to do, and being flexible enough to make that happen, because otherwise it’s not a collaboration.”
Of her work with Mr. Rogerson, Ms. Memran says, “I’m learning a new language — which is his language. You can’t jump ahead. You have to be right there with him. It’s an important reminder to just be in this moment.” That’s what the collaborative creative process is ultimately about: being present with someone through the telling of their own unfolding life.
Ms. Fornés passed away in 2018, but her artistic legacy remains (https://www.fornesinstitute.com/). Mr. Rogerson and his wife reviewed a draft of this article and gave their permission to print his name and story.
Dr. Bird is the managing editor of Caring for the Ages.