The Past in the Present Using Reminiscence in Health and Social Care By Faith Gibson, M.A., O.B.E. Foreword by Barbara K. Haight, Dr.P.H., R.N., FAAN

Excerpted from the Foreword by Barbara Haight and the Introduction for The Past in the Present: Using Reminiscence in Health and Social Care, by Faith Gibson, M.A., O.B.E.

Copyright © 2004 by Health Professions Press. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Foreword

This is a great book, and I am honored to write this foreword at a time when telling one’s story is the linchpin not only for conducting reminiscing and life review sessions but for using many varied therapies and oral history techniques. Accounts of the use of reminiscence have been ongoing since the times of Aristotle and Socrates, but today the method has come into its own as an important and self-preserving process. Once the domain of older people, reminiscing and life review are now seen as important developmental tools used throughout a lifetime, starting in childhood when one is old enough to have memories. We are at the threshold of an interesting renaissance in the decade of the brain, and the use of memory plays an important part in that renaissance. Reminiscence and life review may surface as the most important pathways to a peaceful existence with our past and thus a hopeful future.

Since the 1990s, there have been many literary contributions to the field of reminiscence but never one that explains the processes so clearly and definitively as this book does. This book is truly the work of an expert practitioner who can share her knowledge in helpful format for all to use the modalities in practice. A practitioner, who is also a gifted writer, Faith Gibson has added to our expertise in this field of storytelling. Starting with her beliefs in the processes after decades of personal use for her clients, Gibson discusses the interactive process of memory, open to constant editing and based on life experiences, as a pathway to deriving comfort and self-knowledge as one grows older. She defines reminiscence, recall, review, and partial reconstruction as the building blocks of memory work and simplifies the work of the brain to be more understandable to readers of every level.

In Chapter 3 she explores reminiscence as a tool for staff development, something not done in other books, and uses her extensive teaching experience to lay out a format for the reader. Particularly helpful are the figures that summarize and explain the content. These figures can help administrators incorporate reminiscing modalities into their institutions — something needed to humanize what is often a sterile environment.

Parts II and III offer practical guidance to those who wish to follow in Gibson’s footsteps. Gibson shines in her discussion of reminiscing with people who have dementia. She generously shares her lifetime experiences and knowledge base with clarity and conciseness. Gibson continues to take giant steps in her discussion of the promotion of social inclusion through reminiscence, using the Troubles in Belfast as one of several examples. These examples can easily be translated to the southern United States where many have undergone similar injustices due to segregation, or they can be translated to Europe to the Jews who suffered during the Holocaust. Perhaps these memories can also be used to teach the rest of us that we are not unique but a part of the injustice that pervades the world and thereby endowed with a responsibility to challenge it.

"Thank you" is the only way to end this foreword. Thank you, Faith Gibson, for sharing a lifetime of insightful thinking that will serve the younger generations as they carry the old knowledge forward and meld it with new discoveries. This book is truly a gift to the reminiscers of the future.

Barbara K. Haight, Dr.P.H., R.N., FAAN
Professor Emeritus
College of Nursing
Medical University of South Carolina

Introduction

The Past in the Present is based on the conviction that although each of us is unique, our singular identity and personhood can only be fully experienced in loving relationship and communication with other people. Whatever the present holds for each of us we can only live comfortably with it — and dare to be hopeful about the future — if we have come to understand and accept our personal past. If we are to reach such understanding we need to dare to tell our stories, first to ourselves and then to others. It is through this process of storytelling and being assured that our stories have been heard that we come to understand who we are and what our lives might mean.

When thinking about the modern reminiscence and life review movement, several characteristics are apparent. The theory and practice of reminiscence and life review straddle many boundaries. Although multidimensional, multiprofessional, multidisciplinary, and multicultural, reminiscence is also intergenerational and international. It embraces a range of approaches and activities with individuals, couples, small groups, and communities both of interest and of place. It embraces intellectual, emotional, physical, creative, and spiritual aspects of life. Paradoxically reminiscence is both intrapersonal and interpersonal; it encourages introspection and private reflection yet promotes sociability and engagement with others. Much reminiscing takes place in the company of others and may be purposely organized; it also occurs in private, with or without special preparation. Although not regarded as entertainment, reminiscence is frequently lighthearted and entertaining; it can also be sad and distressing. Although not a therapy, it is usually therapeutic.

Although reminiscence is not restricted to old age, the growing number of people living to advanced old age means that interest in reminiscence and life review is increasing. More and more people are using reminiscence to assist them to reflect upon their past lives, now largely lost except to memory or preserved in more tangible reminders of the times through which they have lived. A growing interest in spirituality or a search for meaning in late life parallels this considerable interest in reminiscence. Psychology, philosophy, history, religion, and the creative arts intersect in the experience of many older people who pursue their quest for meaning making down many and varied paths, including reminiscence and life review.

Reminiscence can be thought of as re-membering again what has been forgotten without needing to relearn it (Erdelyi, 1996). The past that was can never be recaptured except through the processes of remembering, recall, review and partial reconstruction in the imagination. Each subsequent re-visiting or recalling of the past inevitably involves reconstructing it, and in this process we reconstruct ourselves. All re-membering seems to involve a process of over-writing rather than obliterating the previously remembered version. In our imaginations we construct our stories, and by telling our stories to other people we consolidate our sense of personal identity. The recall and recording in one form or another of past memories and the stories that they nourish has become for many people an important part of making sense of their life’s journey. The stories told about that journey are not assets to be stripped or plundered; they are a gift, and those to whom they are entrusted should guard them well.

Butler, whose 1963 article is widely regarded as the inspirational foundation of the contemporary reminiscence movement, more recently suggested,

While it is useful to develop objective, quantitative, psychological, and psychosocial measures of reminiscence and life review, perhaps their strength lies ultimately in the qualitative realm—reflecting a kind of meditation on an individual’s vanished world, that is, one’s own life and the anticipated loss of self as one grows older and experiences the rising expectation of death. The life review may help guide individuals during the final stage and help organize a sense of one’s own life purpose. (Butler, 1999, p. 36)

Reminiscence and life review serve many different functions for diverse people and different functions for the same person at different times. Reminiscence does not have a discrete body of theory but draws from many disciplines and is nurtured by many sources. Reflecting this diversity, many professions use it in many varied contexts. In some ways reminiscence is regarded as a normal, everyday, straightforward part of life, something that we all know about and most of us engage in from time to time. Yet its complexity and diversity has attracted the interest and attention of researchers and practitioners from many different academic and professional backgrounds. Reminiscence work is still evolving and developing. As it simultaneously draws ideas from autobiographical memory, oral history, and the creative arts, it deepens its theoretical and therapeutic base while extending and broadening its myriad applications; herein lies its attractiveness, dynamic strength, rewards, and challenges.

Memory plays a central part in forming our subjective understanding of our individual selves throughout our lives and our collective identities as citizens of nation states and increasingly of the world at large, for we are all captives of our personal and collective memories. Because memory is a dynamic, not a static, source of ideas and imagination whose meanings are open to change, interpretation, and to some extent reconstruction, each time we recall them, we all retain an ability to re-make our lives and contribute toward the re-making of our fractured communities.

In reminiscence work we are seeking to explore where we started and where we have arrived, and through the partial reconstruction of our memories, to paraphrase T.S. Eliot, we come to know the place as if for the first time or in a different way. Understanding these processes of how memories are acquired, recovered, and reconstructed challenges the most learned brain scientists. Yet these same processes bring immense pleasure to people of all ages who meanwhile understand almost nothing of the neuroscience, biochemistry, and physiology of the complex neural processes involved. Nonetheless we all have available to us almost limitless possibilities for enlarging our understanding of the past and using this understanding for enriching our lives in the present.

Increasingly reminiscence is being used in conjunction with other therapies and artistic activities or as a bridge or pathway into them. Reminiscence is particularly valuable if used in this way because reminiscence is usually an acceptable and easy way to establish initial contact and to convey genuine interest in and empathy for others. Consequently reminiscence deepens relationships and demonstrates respect for and appreciation of other people and the life each has lived. It can be used on its own or in association with other approaches with individuals, couples, or small groups. It fits well with multidisciplinary and multiprofessional approaches based on mutual respect and under circumstances in which knowledge, skills, and experience complement each other and are grounded in a common value base.

Although the scope of this book goes beyond the realm of older people, its major emphasis is on older people. The values, knowledge, and skills that it seeks to explain are founded on the conviction that whatever we do, we need to do something in terms of making an effort to communicate with and relate to other people, regardless of age. The worst mistake we can make as members of families and communities—and whether we are artists, teachers, health and welfare professionals, museum and library staff, or community workers—is to assume that we and those who we encounter day-by-day are self-sufficient and independent. Because each one of us is bound together with others in inter-dependent relationships, we all have a responsibility to attempt to reach out to others, for none of us is self-sufficient. As the capacity and opportunity for people to make this effort diminishes for whatever personal or contextual reason, our responsibility to reach out becomes all the greater.

Controversy often erupts over who should be doing group work with older people. Professionals tend to guard their territory zealously and to feel that nonprofessionals doing group work will unleash strong feelings and emotions with which they cannot deal. This attitude sells older individuals short: They are a tough lot. The danger is not in the practice of group work with older adults: the real danger is in not conducting groups and thereby fostering the still-prevalent attitude of "therapeutic nihilism." It is better to take a risk than to sit by and watch apathy, fear, sensory deprivation, loneliness, and helplessness continue in older adults. (Burnside, 1984, p. iv)

Burnside’s position, although especially applicable to older people, is equally relevant to many other people contending with diminished life chances, poverty, disabilities, and problems in living. Her focus on group work also embraces individuals and her call to responsible, concerned action, even in the face of incomplete knowledge and rudimentary skills, is as relevant to this century as to the last. Despite much progress, too little has changed in the human service professions; much still remains to be done.

A life span developmental perspective informs this book, and I hope that professional people from many different backgrounds will find it relevant. Regardless of particular professional allegiances, we all need to take responsibility for making it possible for any person who wants to tell his or her life story to have access to a person who is willing, able, and prepared to listen. It has been said that we lose our souls when someone else takes it upon him- or herself to tell our story. This reaction is not inevitable, and there will be some people who, because of disabilities or special circumstances, may need assistance in telling their story and being heard. It is important that skilled help is available to those who need it so that they can tell their own story, in their own way, and in doing so feel enriched rather than diminished.

Much reminiscence and life review work has traditionally taken place in health and welfare facilities, but increasingly it is also occurring in many different community settings. Whatever the context and whatever sponsoring agency is involved, if high standards are to be achieved senior staff must endorse and support the process. It is essential that all reminiscence facilitators — whether they are staff members, volunteers, or independent practitioners — be interested in reminiscence, equipped to undertake it, and supported in their efforts. Good practice requires that all reminiscence sessions whether with individuals, couples, or small groups are well planned, well resourced, and regularly evaluated.

There are both technical and artistic aspects to reminiscence work. “If technique without feeling is ineffectual, feeling without technique is inefficient. If technical competence without compassion is sterile, compassion without competence is an exercise in futility” (Kadushin, 1978, p. 4). For reminiscence work is still both art and science, a confluence of the imaginative and the therapeutic, requiring both feeling responses and technical skill. One without the other, or concentration on one at the expense of the other, will fail to achieve the varied possibilities for people of all ages inherent in using recall of the past to enrich the present and give courage for the future. The justification for using art, if justification is needed in this increasingly technology-ridden world, is well summed up by an unknown author:

Art gives hope — a hope that transcends the immediate world of experience. Creative activity provides a counterbalance to all that is restrictive, pedestrian, ordinary, and limiting in our lives as we age, becoming almost imperceptibly but inevitably the captives of diminishing physical health, reduced energy, and shrinking social circles. Feeding the world of the imagination is as essential as nourishing the physical body. And if we attend to one and not the other, we hasten dreariness and death.

The term reminiscence therapy is commonly but inaccurately used regardless of who is undertaking it, for what purpose, and within what service context. Bluck and Levine (1998) preferred the term technique. I prefer the term reminiscence work. Only when professionals who hold a recognized therapy qualification use particular types of reminiscence for specific purposes in clinical settings might the term reminiscence therapy sometimes be appropriate. Therapy suggests illness or malfunction with intervention by an expert who is employed to assess, diagnose, and treat in order to remedy a disease, defect, or malfunction. People alone can be regarded as experts in terms of recalling and recounting their own personal life experience, and they need to be affirmed as such. They are not necessarily ill or suffering from an identified condition (although some may be) that can be cured by prescribed reminiscence therapy.

The term therapy also conveys a misleading precision, a spurious exactness, and sits uncomfortably with the free flowing creativity and diversity so characteristic of most reminiscence exchanges. The term work on the other hand suggests serious mutual engagement in a shared enterprise. Therapy suggests an imbalance of power, status, knowledge, and authority. It elevates the professional healer or superior leader and conflicts with the egalitarian mutuality of most reminiscence work. Many reminiscence workers or facilitators may not hold recognized health qualifications and there is no widely recognized specific qualification in reminiscence and life review work, as far as I am aware. Although training and preparation are necessary and supervision highly desirable, to use the terms therapy and therapist in this connection is misleading and may create false expectations.

The term work, rather than therapy, reflects a strengths perspective and a person-centered approach. It stresses the importance of interpersonal relationships, mutual interdependency, and active participation. It rejects negative stereotyping and emphasizes empowerment, citizenship, and development throughout the entire life course. It recognizes each person as the authority on his or her own life. Much reminiscence practice occurs in contexts unrelated to health and social welfare. It is well established in schools, colleges, museums, libraries, arts organizations, community clubs, and groups of many kinds. Such organizations would describe their mission more in educational, artistic, citizenship, recreational, or community service terms. The idea of these organizations delivering therapy would be inappropriate, misleading, and probably unacceptable. They are likely to have other objectives and legitimately seek other outcomes from reminiscence work.

Discussion about the meaning of memory, remembering, imagination, and creativity is found in the literature of many disciplines, including neuroscience, biology, physiology, psychology, artificial intelligence, philosophy, history, literature, art, and many clinical or therapeutic human service professions. This book does not attempt to encompass this vast range of learning and practice expertise yet in many different direct and indirect ways it draws from all of these rich streams. I hope that it will inform the practice of professionals and also encourage volunteers and family caregivers to use reminiscence and to reminisce themselves. I have tried to provide sufficient relevant background theory to interest, inform, and justify the practical applied suggestions that are aimed at contributing to the well being and life satisfaction of people of diverse ages and varied life circumstances.

To do this is a tall order, and where my understanding of the theoretical ideas is incomplete or fails adequately to represent their complexity, or where the practice interventions appear to be confused, simplistic, or irrelevant, I alone must bear responsibility. It would be easy to ignore the literature of contributing disciplines and to write a simple how-to-do-it kind of reminiscence cookbook. Alternately, it would be easy to become so overwhelmed by the extent and erudition of writing about memory that stretches back over many centuries to decide the task is impossible and should be abandoned. It seems to me, having spent many years researching, practicing, teaching, and thinking about memory and reminiscence work, that either response is inadequate. So despite my acute awareness of all the pitfalls, I hope that readers will be intrigued about memory and will explore for themselves some of the implications of remembering in order to nourish their own and other people’s lives. For although I have made strenuous efforts not to over-state the case for reminiscing, I hope that its exciting possibilities and numerous benefits are made clear so that we come to appreciate how reminiscence helps us to enjoy life but even more profoundly to endure it with hope.

The book has three parts. Part I considers memory, aging, and values, the why and what of reminiscence and the ways in which staff who use reminiscence may benefit. Part II gives guidance about planned reminiscence and life review with individuals, couples, and small groups, shows how to capture personal and collective memories in tangible ways, and shows how it might assist marginalized communities. These chapters seek to answer the how-to-do-it questions. Part III considers aspects of memory, dementia, and creativity and concentrates specifically on adapting reminiscence practice for people who have dementia and involving families, volunteers, adult day services, and residential staff in using it to encourage communication and preserve relationships.