The Memory Ensemble: improvising connections among performance, disability, and ageing

Abstract

There is a recognised need for research that illuminates mutually beneficial connections among performance, ageing, disability theory, and praxis. One such project is the Memory Ensemble^™, an improvisational theatre intervention for persons with early stage Alzheimer’s disease and related dementias (ADRD). This case study explores how the programme productively disrupts and expands notions of all three: performance, disability, and ageing. The mission of the Memory Ensemble is to improve the quality of life for persons living with ADRD through the intervention of improvisational performance; to investigate the benefits of this non-pharmacological intervention; and to translate these benefits to other communities.

Introduction

There is a recognised need for research that illuminates mutually beneficial connections among performance, ageing, and disability theory and practice. While connections between performance and disability have a developing history (Conroy 2009; Kuppers 2003, 2011; Lord 1981; Masefield 2007; Sandahl 2005; Sandahl and Auslander 2005; Sinclair 1995; Tomlinson 1982), less work has been done to consider connections between performance and ageing (Basting 2009) and between disability and ageing (Gibbons 2016a; Priestley 2003); and little work has been done to consider intersections among the three fields (Basting 2009; Conroy 2009; Sandahl 2005). Finally, there is a specific need for ‘academic work about disability to benefit disabled people directly and in a way that can be measured by social science methodologies’ (Conroy 2009, 4).

Such complex work begs questions: How do evolving conceptions of disability locate themselves in performance practice? How does the meeting of performance and disability demonstrate itself in the work of applied theatre educators and learners? And, how are local performing arts practices expanding, interrupting, or affecting notions of disability? To address these questions, this essay provides a case study of the Memory Ensemble^™ – an improvisational performance intervention for persons with early stage Alzheimer’s disease and related dementias (ADRD) – and explores how the programme is in conversation with performance, disability, and ageing research, theory, and practice.

The Memory Ensemble

The Memory Ensemble – an improvisational theatre experience for persons with dementia – was founded by Darby Morhardt and Mary O’Hara with the Cognitive Neurology and Alzheimer’s Disease Center (CNADC), Northwestern University Feinberg School of Medicine, and Christine Mary Dunford with the Lookingglass Theatre Company (LTC). Since the CNADC’s inception, there has been a growing need for challenging and supportive learning opportunities for persons in the early stages of ADRD. This realisation led to the creation of programming specifically for those newly diagnosed to provide empowering and supportive experiences amidst cognitive loss (Morhardt 2006; Morhardt and Skoglund 2005). In 2010, clinical social workers (Morhardt and O’Hara) engaged in dialogue with teaching and performance artist (Dunford), which led to the creation of the Memory Ensemble. Soon thereafter a growing team of teaching artists, social workers, and other researchers (including Yoshizaki-Gibbons) came together to further enrich the Memory Ensemble conceptually and practically.

The Memory Ensemble aims to: (a) improve quality of life for persons living with ADRD through the intervention of improvisational performance; (b) investigate the benefits of this non-pharmacological intervention; and (c) translate these benefits to other communities. Since 2010, one to three Memory Ensemble workshops, consisting of six to nine 90-minute sessions, have been offered to persons with early stage ADRD annually. The Memory Ensemble’s methods (e.g. pre-test/post-test mood assessments, focus groups, and field notes) and results have been disseminated in other outlets (O’Hara, Dunford, and Morhardt 2013; Morhardt, Dunford, O’Hara, Grimm, & Dowden, Forthcoming). Accordingly, in this article, we discuss the ways the Memory Ensemble engages in praxis; that is, how the Memory Ensemble’s curriculum and methods are interwoven with theoretical perspectives from performance studies, ageing studies, and disability studies. Three interrelated perspectives are discussed: (1) disability, ageing, and performance are political, (2) disability, ageing, and performance are relational, and (3) considering intersections of ageing and disability challenge dominant notions of time and memory in performance and in everyday life. Ways in which each perspective is embodied in the practice of the Memory Ensemble are explained.

Performance and dementia

In theatrical terms, ‘performances’ are often understood as public enactments by actors of texts in a performance area, or a stage, for an audience. Performance studies scholar Margaret Thompson Drewal expands ideas of all four – actor, text, performance area, and audience – to theorise performance as ‘the practical application of embodied skill and knowledge to the task of taking action’ (1991, 1). Additionally, anthropologist Victor Turner suggests that human beings are ‘homo performans’, or ‘culture-inventing, social-performing, self-making and self-transforming creature(s)’ (Conquergood 1991, 187).

However, people with dementia are often incorrectly assumed to be incapable of engaging in creative or performative pursuits, developing skills, forming community, or enjoying life (Basting 2009). The Memory Ensemble challenges these dominant cultural discourses. Memory Ensemble participants rely on embodied knowledge of the world and/or improvisation, rather than memory, to engage in improvised or spontaneous acts of creativity to successfully perform, or participate, in activities in a room for an audience of fellow ensemble members, and, thus, remake or reinforce ideas of themselves as self-making and self-transforming individuals.

Disability, ageing, and performance are political

The Memory Ensemble reflects the ways in which disability, ageing, and performance are political. As Conory (2009, 2) notes, ‘For disability to be political there must be a conceptual shifting of the world, a persistent re-imagining of the way that humans relate to each other across differences of corporeal form and function.’ The Memory Ensemble envisions ways of engaging in performance and being in community with others that do not rely on memory, but rather emphasise creativity. Rather than treat disability accommodations as a ‘special’ request made by individuals, the Memory Ensemble creates an environment that is welcoming and structured, yet still flexible, to support people with varying memory impairments.

For example, we established a routine that helps participants remain oriented. Sessions take place each week on the same day and time, in the same room, with the same 6–14 participants and the same 2–4 facilitators. Likewise, the same ‘welcome’ sign always greets participants at the door; chairs always begin (and end) in a circle; a Memory Ensemble mantra is always written on a board on the wall. In addition, each Memory Ensemble session follows a similar sequence of events. Each week, facilitators ask participants to put on a name tag, which ensures people do not have to memorise and recall names. Then, participants complete a pre-session mood assessment tool, and ‘check-in’ by narrating their emotional state through a structured metaphor-based activity (e.g. ‘If my feelings were a color, I would be feeling _______, because_______.’). This is followed by a warm-up activity that uses imagination while breathing deeply and stretching gently (e.g. ‘Let’s all take a deep breath and use our breath to blow up a balloon that we have in front of us in our hands. Now, let’s pretend the wind blows our balloon high above our head; then, it blows our balloon down to the ground’). The warm-up is followed by a simple activity that introduces or reinforces fundamental performance/improvisation skills (e.g. listening closely to a partner, observing someone or something in detail, and saying ‘yes’ to ideas);¹ and/or to improvisation concepts (like activity, location, or character). Facilitators use these activities – which require participants to follow only one- or two-steps of direction – as a foundation for more complex activities that require application of combinations of skills and that are often implemented with little direction from facilitators (e.g. pretending to meet a person at a bus stop and engaging in an action that leads to characters in conversation). Finally, participants end sessions by narrating and analysing their emotional state with a ‘check-out’ which mirrors the metaphor-based check-in. Lastly, participants complete a post-session mood assessment. By using the same general routine each week, participants with memory impairments are supported in their ability to participate fully and feel successful.

While following a routine is important, increasing amounts of flexibility are also built into the curriculum. By allowing for adaptation as the programme progresses, we seek to establish a foundation of skills from which participants can draw, and then use flexibility later in the curriculum to ensure individuals’ needs are met, even as those needs fluctuate or change. Consequently, the curriculum for the first three Memory Ensemble sessions is set. The first session is dedicated to introducing activities that require participants to embody guiding principles (like saying ‘yes’ to each other), and building a performance community and vocabulary. During the second session, participants and facilitators get to know each other as individuals – and recognise that all members bring expertise to the room – by briefly sharing areas of personal and professional experience. Then, participants continue work that encourages affirmation of ideas both physically (e.g. through ‘mirror’ activities) and verbally (e.g. through variations of ‘Yes …, and … ‘). During the third session, activities are introduced that allow participants to identify and explore issues of common concern on global, community, and personal levels. If it has not happened already, this is a time for participants to recognise that memory loss is a shared concern. After the first three sessions, objectives/activities for the remaining sessions are determined by facilitators depending on the skill levels and needs of participants.

As the curriculum illustrates, the Memory Ensemble occurs in an accessible environment and draws on lesson plans that are routinised yet flexible to meet the needs of people with ADRD and ensure they can fully participate. In doing so, the programme demonstrates that the environment and curriculum within performance education can be designed, and redesigned as needed, to be inclusive of diverse people with various embodiments and unique lived experiences.

Disability, ageing, and performance are relational

The Memory Ensemble also demonstrates the ways in which disability, ageing, and performance are relational. Kafer (2013, 8) highlights the relational nature of disability in her conception of the political/relational model of disability, writing, ‘Disability is experienced in and through relationships.’ When one understands disabilities such as dementia as relational, then one can consider the ‘social patterns that exclude or stigmatize particular kinds of bodies, minds, and ways of being’ (Kafer 2013, 5), and then, relatedly, how to overcome that exclusion and stigmatisation.

The Memory Ensemble embodies relationality. Memory Ensemble participants become an ‘ensemble’ – or a group of people who work together toward a common goal – as they develop close, collaborative relationships with each other, and with facilitators. The same facilitators, including at least one master teaching artist and one clinical social worker familiar with ADRD, lead each series of sessions. Master teaching artists are committed to an ensemble ethic, engage in objective-based teaching and learning, and have enough knowledge of a wide range of theatre and improvisation practices to be able to comfortably switch activities, adapt activities, and/or improvise completely new activities in an instant depending on the needs in the room.² Clinicians in the room participate in all activities as full members of the ensemble. They serve as a bridge between the work in the room and participants’ lives outside the Memory Ensemble. They often provide teaching artists with insight into how ADRD might be impacting participants’ work in the Memory Ensemble. After each Memory Ensemble session, teaching artists and the clinician meet briefly to discuss and assess activities and member participation. This follow-up meeting allows teaching artists to intentionally plan activities for the next session based on ensemble members’ abilities and interests, and the clinician to plan to follow up with individual members as necessary around issues that may have surfaced during the session; both of which model and support the relational aspects of care integrated into the principles and practices of the Memory Ensemble.

Given the stigma of ADRD in our society, varying levels of comfort with a diagnosis often exist among participants new to the Memory Ensemble. To foster a desire to develop and maintain a sense of common experience and purpose, guests are invited to attend only a first orientation session and/or a final celebration at the end of a workshop series. New Memory Ensemble members are often asked to begin with a new cohort, rather than join a cohort once a series of sessions have begun. This structure allows Memory Ensemble participants to develop a sense of ensemble, or a community connected by common purpose, as they share the experience of learning or developing improvisation skills, and engaging in collaborative creative work. By emphasising this connectedness – or harmony, as one Memory Ensemble participant put it – the Memory Ensemble works to support people with ADRD in developing a sense of community and de-stigmatising the experience of memory loss.

Considering intersections of ageing and disability challenges dominant notions of time and memory in performance and everyday life

Furthermore, the Memory Ensemble illustrates and reinforces the disability studies and ageing studies theories of crip time (Kafer 2013) and demented time (Gibbons 2016b) due to its emphasis on focusing on the present moment and remaining flexible as moments pass and needs change. Facilitators adapt many Memory Ensemble activities from ‘games’ developed by theatre artists that encourage participants to be ‘in the moment’ and to work with whatever information is in front of them in the room, rather than solely from memory. Activities are followed by group discussion in response to prompts such as, ‘While doing that activity what did you notice? What did you experience?’ This structure allows participants to engage in analysis and assessment of session activities, and of their own participation and learning, with an emphasis on creativity, connectivity, and reflection rather than memory.

Hence, Memory Ensemble participants participate in creative activities that do not require the ability to bring the past into the present, but rather ask individuals to work together in relationship. Memory Ensemble participants develop a significant sense of accomplishment by successfully creating a series of ‘now’ narratives, or improvised moments of interaction, with others in the room. These moments are often informed by the details, fears, and hopes of participants’ day-to-day lives, but just as often go beyond these realities to explore new possibilities of relationship and response. Memory Ensemble participants experience themselves as people who are capable of learning new skills (improvisation, and of creating narrative ‘now’ moments) in their day-to-day lives inside, and outside, of the Memory Ensemble.

Conclusion

In summary, the theoretical core of the Memory Ensemble is based on the assumptions that people with ADRD have a disability; that all people, all selves, with or without disabilities, are inherently relational; and that people with ADRD can think creatively and spontaneously, strengths that are preserved in the early stages of dementia (Basting 2009). While a detailed examination of relevant questions in performance, disability, and ageing studies about representation, performance, personhood, and identity are beyond the scope of this article, the Memory Ensemble serves as a starting point for exploration of these complex issues by disrupting normative ideas that disability and ageing are characterised by incompetence and decline and that only able-bodied/able-minded people can engage in performance. Repeatedly, Memory Ensemble members engage in improvisation activities that provoke low levels of anxiety; and then respond by stopping, taking a breath, observing what is happening in the room, and relying on their imagination to come up with an answer that allows them to move forward, with their activity partner, in the moment. In addition, over time, facilitators learned that Memory Ensemble members are translating skills learned to their day-to-day lives to successfully navigate moments of uncertainty or anxiety. This flips the notion that people with ADRD experience only loss of memory and relational capacity by demonstrating that participants can, and do, develop expertise as improvisers; and as improvisational partners in life.