Over the last 40 years, the widespread acceptance of the biomedical model of dementia has countered the suggestion that senility was an inevitable consequence of old age (Lyman, 1989). Advances in the understanding of the pathology and genetics of dementias such as Alzheimer’s disease, and the search for a biological cause and a biological treatment mean that research in the psychosocial aspects of dementia has been somewhat neglected. More recently, the psychosocial processes affecting the individual with dementia have been better understood Beattie 1984, Kitwood 1990, Kitwood 1993 and Lyman 1989. Beattie (1984) notes that retirement is accompanied by a “loss of mastery over self and environment” as the individual begins to feel less empowered and more dependent and this problem is accentuated by dementia. In addition, disabilities and sensory impairments such as deafness and visual deterioration serve to further disempower the individual and make them feel isolated from what is happening around them. Kitwood 1990 and Kitwood 1993 elegantly describes the “malignant social psychology” affecting people with dementia, whereby others no longer treat them as full individuals. For example, in “outpacing,” others may communicate too fast for the dementia sufferer leaving them feeling perplexed and excluded from the discussion. This leads to loss of self-esteem, a cycle of discouragement and failure and an eroding of the sense of self.
A variety of psychological therapies have been used and evaluated with dementia sufferers (Woods, 1994). Most of these have focused on improving the patient’s cognition or reducing psychiatric symptoms rather than the patient’s subjective experience of dementia. In contrast, creative arts therapies (drama, movement, dance, art and music) aim to help preserve and maximise the dementia patient’s eroding sense of self. These modalities draw on the sensory, affective experiences of their participants and encourage reminiscence, self-expression and socialisation. Despite the presence of waning cognition, affective responsiveness can remain relatively intact and therefore people with dementia often experience periods of extreme frustration, anxiety, sadness, anger and irritability. Most poignantly, they lose the ability to express their feelings coherently. Creative arts therapies such as drama and movement therapies provide opportunities for more organised self-expression through the use of metaphor (Johnson, et al. 1992). As Laffoon, et al. (1985) note, drama therapy can address key issues for elderly people such as stress, loneliness, lack of assertiveness, pain, changing family roles and death. In their book Waiting at the Gate: Creativity and Hope in the Nursing Home, Sandel and Johnson (1987) noted that life in a nursing home is characterised by waiting for various things and suggest creative arts therapies as an antidote “to the dependency, passivity and death that waiting expresses.” They describe five ways in which drama and movement therapy may benefit the health and well-being of the elderly: increasing orientation and activation, facilitating reminiscence, increasing self-understanding and acceptance, developing meaningful personal relationships and building communal spirit. Drama and movement therapies have been increasingly used with the cognitively impaired elderly (Sandel and Johnson, 1987), however, there has been little formal research. Drama and movement therapies can add meaning and value to the dementia sufferer’s life experience. However, further research is needed to explore and justify the use of these therapies in the treatment of dementia not only to understand the subjective experience of the dementia sufferer, but also to ascertain improvements which may be attributable to the therapy. The aim of this study was to investigate the effects of drama therapy in a group of elderly people with dementia.
