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By Mark Butler

July 21st, 2014

Photography in Care; Care in Photography

Photographs, never straightforward, take on all sorts of different roles in care settings. Photographs of family and events are often literally part of the furniture – essential to the care home’s recreation of a reassuring domestic existence and a routine reminder of a past life. 

But in the context of care photographs assume much more complex and perplexing identities.  Photographs become a stimulant of memory as well as a comforter - used (and arguably abused) in the name of reminiscence therapy as objects which serve a clinical purpose.  They become props to frame and recycle the past to create a present. They are there to define a personal past (“this is you during the war, remember?”) and also a mythical collective past (“this is what we/you did back then, remember?”).  Both pasts, although largely unreal, seem to be given an undisputed status by photographs which are assumed to capture unquestioningly how it all was.

Remember what it was like?  Remember what it was like. Remember and keep remembering.

As objects seen as deeply personal to the person with dementia,  photographs become solid reference points for apparently making memories open and accessible to others –a record of a past existence as well as a jumping off point for an assessment of how tuned in to the present people with dementia are today.  Sadly photographs become less a source of routine comfort and more of a personal challenge – a set of historical, insistent images, nagging at memory.  They become records which acquire a status as beyond dispute.  They become an entry point for care professionals to get at the person with dementia.  They stimulate communication, keep the dialogue going and help people hold onto their identity.  Surely there can be no problem here? 

Photographs, alongside all their other roles, can of course act as a healthy stimulus of some sort.  But they can also become a way of capturing an illusory past which nevertheless acts almost as an official memory, an undisputed set of reference points that should be remembered.  That is how it was. This is who you were. A test of memory and an insistent challenge which has to be met on a daily basis or conclusions will be drawn. 

Remember what it was like?  Remember what it was like. Remember and keep remembering.

I do wonder whether certain forms of reminiscence practice can run counter to what is actually most helpful, ethical and appropriate around people with dementia, especially in care settings.  Is photography (amongst other props) being used in an unthinking, oversimplified or unimaginative way to create a false past, rather than encouraging a meaningful engagement by the person with dementia with their present and future? 

Is there not greater benefit in supporting the person with dementia in going with the flow, in exploring the fragmentation of their present through “riskier” creative processes?  Connecting to current feelings, although a greater challenge in many ways than looking safely backwards, must be of more value than gathering around a comforting past which must be remembered, even if it did not exactly exist like that.

Are there not dangers of planting false memory and even a risk of adding to frustration, anxiety and the symptoms of dementia by not making the necessary effort to connect with the messy reality of now?  Isn’t there a possibility that photographs, and other props designed to stimulate memory actually get in the way of the genuine connection, support, deep listening, love and care which people with dementia need?

These questions of course relate to more than any specific role assumed by photographs.  Maybe what I am really engaging with is the unsophisticated, faux creative, care and therapy which I have seen over the years, and which remains all too evident today.  But perhaps it actually goes deeper than that. 

Photographs are inherently powerful, complex and multidimensional.  They are not a neutral record. In a care setting where photographs assume deeper roles they, like so much else, must be approached with care and with eyes wide open.