Shadow of the past

Reminiscence work is widely used to alleviate
the symptoms of memory loss in older people, but talking about the
past can trigger recollections of events that people would prefer
to forget, such as wartime experiences, death and abuse. Natalie
Valios reports.

Reminiscing is usually associated with a
pleasant trawl through memories of childhood, loved ones and happy
occasions. Reminiscence work is now widely used with older people,
particularly those with dementia, as a way of helping to alleviate
the symptoms of memory loss. Benefits include improving confidence
and self-esteem, and group reminiscence work can provide a
stimulating forum for discussion.

However, reminiscence workers are increasingly
recognising that, for some older people, reminiscing may have a
darker edge to it. Talking about the past could trigger
recollections of events they would prefer to forget, such as
wartime experiences, bereavement and abuse.

Reminiscence work is not psychotherapy, says
Bernie Arigho, reminiscence co-ordinator for Age Exchange, a
voluntary organisation in south east London specialising in all
aspects of reminiscence work.

“Clarity about the aims and methods of
reminiscence work is essential,” he says. “Confusion about rules
can lead to anxiety, tension, disappointment and embarrassment. We
are not offering a treatment for any identified mental health
problems. Instead we are offering people the opportunity to take
part and make their contribution to a cultural, educational and
creative activity in which they and their memories and life
experiences will be valued, respected and cared for. This in itself
can have therapeutic effects.”

Sometimes people may need support, sympathy
and understanding for memories that are difficult to come to terms
with and feelings that are difficult to bear, he adds. Almost all
Age Exchange’s projects are delivered in care settings, and Arigho
believes that people should be offered this support as a standard
part of care when needed.

A distinction must be made as to when
someone’s trauma goes beyond the scope of a reminiscence group and
calls for a trained counsellor. An Age Concern England resource
pack on reminiscence schemes warns that, while people should be
allowed to recount painful or unpleasant experiences if they want,
should these become expressions of grief or trauma, then
facilitators should follow up after the session or refer the person
to an appropriate source of help. The report also argues that no
one should be forced to take part in reminiscence work and there
should be no obligation to stay in the group. No one should have to
continue a discussion if they don’t want to.

People respond differently to the idea of
reminiscence work, says Lindsay Royan, consultant clinical
psychologist for the North East London Mental Health Trust. While
some are happy to reminisce freely, others don’t wish to.

The reasons for this are twofold, says Royan:
either they don’t see the point, the past is the past and they find
the idea quite patronising; or their memories are too painful and
they want to avoid dwelling on them.

Nevertheless, she believes it would be a huge
shame if reminiscence work stopped for fear that it uncovers
trauma. “The process should be about inviting people to talk,
rather than confronting them with the past.”

And there is a distinction to be made between
nostalgia and reminiscence, she says. “Nostalgia screens out
anything negative and in their enthusiasm to present a positive
picture of the past a reminiscence group facilitator can overlook
the fact that their clients might not have that.”

Reminiscence work must be entered sensitively.
It’s all very well talking about the good old days when you sat
round the piano singing Roll Out the Barrel, but if you
were bombed out of your house and were the only survivor, talking
about the war will trigger unhappy memories, she says.

Facilitators of a reminiscence group need to
be good listeners, because what is emphasised and what is left out
when an older person recounts a story gives a clue as to whether
there is a traumatic memory.

If someone is going to disclose trauma, it may
be the result of their relationship with the listener as much as
their need to tell it, says Royan. If something is disclosed, it’s
important that the listener reacts with acceptance, not
disapproval, shock or disbelief.

Traumatic events are symbolised by loss of
control and power, so it is easy for a facilitator to overstep the
mark and unwittingly recreate the feelings of original trauma by
asking someone to tell them what is on their mind.

“Respect for personal choice about which
memories to share and how to share them is a fundamental principle
of good practice, along with support for any painful emotions that
arise, an individualised approach, and evaluation and monitoring
throughout the project,” says Arigho.

Some people have coped through their lives by
not disclosing – and that needs to be respected. “We only need to
intervene when this method is no longer working,” says Royan.
“Maybe they start becoming distressed and depressed because what
has been helping them cope – such as family, partners or career –
has gone from their life. Then there’s a legitimacy in trying to
gently help them talk about the trauma.”

A report for the Otto Schiff Housing
Association highlighted the situation in one residential care home
for Jewish people with dementia who came to England as refugees
from Nazi Europe.¹ Here there seemed to be an unwritten
rule that any form of reminiscence should be avoided because it
might force people to relive traumatic experiences they had locked
away.

The report says: “This one approach for all
contradicts the crux of person-centred care, which should allow
those individuals who wish to leave the past undisturbed to do so,
but should recognise the need of others to connect with those past
events and to enable them to do so in a safe manner.”

The report also highlights the fact that
dementia results in older people remembering the distant past
better than the recent past. “People who may have locked away
traumatic events earlier in their lives are now locked in with
these surfacing memories, but with no means of dealing with them,”
it says.

In Royan’s experience, completely forgetting
or completely remembering the past seem to be the best coping
strategies – those who want to remember but cannot and those who
want to forget but are unable to have the most difficulty.

For example, some people have coped with the
Holocaust best by completely blocking it out, she says. Jeanie
Rosefield, a psychologist who co-ordinates reminiscence work at
Jewish Care, agrees: “We do have Holocaust survivors [in
reminiscence groups] but they might not want to say anything.

“When I do a reminiscence group, I don’t go in
and say ‘Let’s talk about death today or the Nazis’, but we might
be talking about train journeys and some people will have sad
associations with this. One person said ‘I had to say goodbye to my
parents when I was 12, I was put on a train to come to England
while they went to a concentration camp – I never saw them
again’.”

In another group, the topic of conversation
was nursery rhymes and one woman said she still remembers hearing
Nazi soldiers whistling Silent Night as they marched
past.

If something sad or traumatic does crop up,
Rosefield will go to them after the group and ask whether they
would like to talk more. Usually they don’t want to – it has helped
just to say it. “Trauma slips out by mistake, because they feel
comfortable and the topic lends itself to a person revealing their
story,” she adds.

Rosefield runs reminiscence groups at the
Michael Sobell community centre, a Jewish Care-run day centre in
Golders Green, London. Up to 30 people congregate in the
reminiscence room, which is decorated in a style that would not be
out of place in the 1930s. It has velvet drapes, a wind-up
gramophone and a fireplace to create a warm, family atmosphere.

“For me, the purpose of reminiscence is to
make individuals recall the vibrancy of youth, to talk, listen and
be the centre of attention,” says Rosefield.

– For more information go to www.age-exchange.org.uk
 

¹ G Wills, R Feldman, K
Robinson, Dementia and Past Trauma, Otto Schiff Housing
Association, 2001