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I may as well make my full disclosure at the outset of this review: I am getting old, I am a depressive, I am worried about getting Alzheimer's, I love reading and writing autobiography, I also love reading and writing about reading and writing autobiography, and I have always been a sucker for the meaning of life. So this book, a collection of articles mostly by and for clinicians about the use of reminiscence and life stories as therapy, was a big hit with me. It's based on what is now over five decades' worth of practice and research in "reminiscence work", pioneered by a seminal 1963 article in the journal Psychiatry by psychiatrist and gerontologist Robert N. Butler, titled "The Life Review: An Interpretation of Reminiscence in the Aged". Out of Butler's research came a new field of elder care, along with its official organ, The International Institute of Reminiscence and Life Review, founded in 1999 and headquartered at the University of Wisconsin-Superior.
The purpose of "reminiscence work", in the words of the book's Foreword, is to use "a wide variety of creative arts to stimulate recall of the past as a means of enriching the present, decreasing isolation, increasing self-understanding and sustaining relationships." The clinicians who are the book's primary authors and audience serve a population that divides roughly into three groups: people with dementia, people with a mental illness (most often depression), and people suffering from a traumatic life event. As the IIRLR's full title suggests, researchers in the field differentiate between two different processes and styles of memory: "reminiscence", which tends to be episodic, relatively superficial, and focused on specific life events, and "life review", which is more evaluative, and concerned with deeper meaning and significance. In life review, "the aim is to achieve a sense of self-worth, coherence, and reconciliation with regard to one's past". One of the most informative chapters on life review (Chapter 17, "Life Review: Lifespan Development, Meaning Processes and Interventions", by Gerben J. Westerhof) refers to this kind of memory as "semantic", and distinguishes between "redemptive" and "contaminative" meaning: the former entails "an initially negative experience [that] is salvaged by the good that follows it", and the latter
a plot where an emotionally positive experience becomes negative, as it is ruined or spoiled: a marriage is followed by divorce, success in one's work by failure. These negative consequences often come to dominate the life story.
One of the results of such "contamination" would be what is called "narrative foreclosure" -- a term of art for what otherwise might simply be called despair: "the conviction that no new experiences and commitments from both the past and future are possible that can substantially change the meaning of one's life as it is told now."
It is this kind of "narrative foreclosure" that is explicitly – and one is tempted to say heroically – rejected in the centerpiece essay of the collection, "The Narrative Self in the Lived Experience of Dementia", by Christine Bryden, who herself suffers from the disease. Bryden's essay (Chapter 11) exemplifies what many of her co-authors emphasize: it is the search for meaning that characterizes the work of life review. (Here the classic work of Viktor Frankl, Man's Search for Meaning, is recognized as central.) But because her recall is severely compromised by her dementia, Bryden notes that "narrative for me is a search for meaning in the present moment". She argues that recall is not essential to having a narrative, and that "being able to sequence events accurately over time is not essential to creating meaning." I was a little puzzled by her assertion that "my experience of each moment [is] a continuous narrative". What exactly makes for the "continuity" ascribed here to narrative, if not the connection of its separate "moments" in time? Bryden seems to be saying that a temporal sequencing of events is not the only way to make a narrative, since "people with dementia have and are a story". In other words, identity supersedes chronology, and we don't need to be able to remember the events that made us who we are in order to still know who we are. Bryden's concept of what constitutes narrative for someone suffering from dementia is perhaps best expressed in her reflections on parable, which seems especially appropriate given that she mentions her Christian faith several times in the essay:
My narrative quest can be regarded as a parable…. Parables have a context, plot, beginning, middle and end, but the end is unexpected and redirects us to reflect further to discover a sense of meaning beyond what would be found in the straightforward narrative of experience. Similarly, narratives need not be linear, consistent, coherent and realistic, and can be more like a patchwork allowing for "transcendence, mystery, and surprise".
(Here she is quoting a 2015 journal article by C. Baldwin and J. Estey, "The Self and Spirituality: Overcoming Narrative Loss in Aging".)
Bryden takes up the aforementioned idea of "narrative foreclosure", "where we believe that our story is now finished", to argue in fact for the contrary: that narrative for those who can't remember their past still exists, but it is oriented towards the future, not the past:
…We still have an evolving story, and our narrative is being formed and reformed within a larger set of narratives, which are like the threads of a tapestry being interwoven to create a picture within our sociocultural milieu.
Bryden repeats the weaving metaphor when she rightly credits the role of "care-partners" (the people to whom the life-stories are told) in narrative therapy: "In these relationships of listening and telling, care-partners are like weavers who help us to reweave 'a poorly woven portion of the tapestry into the new weaving'."
The quote this time is from a 2014 book by S.M. Coyle on "spiritual narrative", which is also the focus of the other standout chapter in the collection, Elizabeth MacKinlay's "Spiritual Reminiscence in Later Life" (Chapter 7). Like Bryden, MacKinlay is interested in the relationship between tellers and listeners, and in the crucial role of listening:
As I listened to the words of those who agreed to participate in my initial study…I found it a privilege to be the listener, and I realized that my listening was often being worked out in what could be best described as sacred space.
Teller and listener are engaged in a symbiotic relationship, and here MacKinlay aptly quotes a 2003 article by G.M. Kenyon: "The desire of the story listener calls forth the words of the storyteller."
But though MacKinlay's primary message, like that of many of her peers, is about the need to find meaning and hope in old age, she is also well aware of the presence of despair. Here is Yvonne, one of the frail elders she worked with:
The hardest thing for me now is being in the position I'm in with the sickness, I know it's not going to get any better, which I accept, but to be honest I wish to goodness I could just go like that, go to sleep and finish it because I'm fed up of being the way I am…. I've always been a hard worker and full of life but now, life it means nothing to me now, I've got nothing really. I mean I'll be in a nursing home for the rest of my life so that's not living….
Yvonne's honest and truthful assessment is a reminder that "gerotranscendence, where being rather than doing come to dominate the daily life", is a challenge that not everyone is equal to.
In an early chapter, one of the contributors remarks, "We believe it is fair and accurate to describe reminiscence and life review as primarily a data-driven rather than a theory-driven discipline." Those readers averse to theory may be thankful for this – but not so fast. A few of the chapters are so heavily data-driven that they end up mired in figures and charts – not to mention the scientistic verbiage that seems to be an occupational hazard of the field. Phrases such as "a lingering death trajectory" and "maladaptive post-loss attachment" only add insult to injury, and remind us that narrative is not only therapy, but art as well, and despite the very best of intentions, not all of its workers are equally endowed.
But intentions count for a lot, and despite a few passages of rough prose-sledding, I finished reading this book with the uplifting sense that the practitioners of "reminiscence work" – both tellers and listeners – are engaged in a group endeavor of the utmost value and importance: the work of giving hope and meaning to those who might otherwise have neither. Elizabeth MacKinlay, in "Spiritual Reminiscence in Later Life", perhaps puts it best:
Ultimately, finding meaning brings the ability to transcend and find transformation in life, moving from self-centeredness to other centeredness. It is through working with reminiscence that story can be articulated, refined and re-storied, particularly when facing the challenges of later life. This process enables the person to actually transcend and find hope and joy at the depths of their being, even when all outward signs seem to point otherwise.
© 2019 Josh Gidding
Josh Gidding, PhD, Seattle