AFTERWORD Ruth Abraham

Israel

A lifetime of memories exists in constellation all through the brain, but without a reliable system of retrieval, they ’ ll sit dormant forever

— David Shenk

INTRODUCTION

Observed from the outside, Alzheimer ’ s disease (AD) patients drawing on paper or shaping clay into pots or fi gures, might appear to be involved in nothing more than pleasant busy - time activity. However, when taking part in an art therapy session, the patient is exposed to more than that, the very least of which is an opportunity to express bottled - up feelings such as anger and sadness. As the disease progresses, there is a large loss of neuronal connections, and what is demonstrated through artwork is the activation of existing, dormant connections, compensating for the loss of language, logical and sequential thought processes.

AD patients are increasingly isolated, lonely, and marginalized, in many ways rendered invisible. The confi rmation that they continue to exist in a social fabric is enhanced by attentive listening, understanding, and feedback from the therapist. Sharing memories and feelings through the language of art compensates for the diminishing capacity to communicate through words.

AD patients tend to suffer from lack of initiative, are often listless, and lack confi dence. As they lose their language skills, they are assailed by the anxiety of not being able to communicate and of not being understood. When he sits in the large common rooms of facilities, the AD patient can often be seen dozing, staring into space, or fi ddling purposelessly with objects. In the art room, that same patient becomes fully engaged, touching upon early memories, making color choices spe-cifi cally to their taste, making signifi cant marks on the page. Creative acts such as these are a source of rich pleasure, something that AD patients progressively lack in their lives. I have witnessed noticeable physiological changes during the sessions; there is often a marked decrease in agitation and breathing becomes deeper and calmer. Valuable research could be done taking objective measures of general health both before and after the session, such as blood pressure levels, heart rate, and respiratory rate, in an attempt to ascertain physiological changes occurring as a result of the creative involvement.

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One of the defi ning criteria of any therapy is that it results in sustained improvement beyond the actual therapy session. This necessitates insight, memory, and subsequent internalization. Since AD patients are considered unable to learn, in the sense of absorbing and retaining new information, the question arises whether art therapy could be defi ned as a therapy for them. In my book, When Words Have Lost Their Meaning: Alzheimer ’ s Patients Communicate Through Art (Greenwood Publication, 2005), I have shown that the art productions of many of the patients, even in the advanced stages of dementia, did improve over time, meaning there was a learning and internalization process. The participants acquired greater skill, used the materials more effi ciently, made more considered choices, and their use of color became richer.

ARTWORK AS A MEASURE OF THE PROGRESSION OF AD

Pictures painted by AD patients have been thought of as X - rays of the declining mind. For instance, the portraits of Utermohlen, http://www.37signals.com/svn/posts/81-william-utermohlens-self-portraits , are a documentation of the way AD impacted on the painterly skills of this talented artist. As the dementia progressed, the images lost their complexity, clarity, and depth, an indication of cortical deterio-ration. On the other hand, the art of many AD patients, who had not painted in the past, displayed minor but defi nitive improvements over time. As these patients attempted to recollect memories and struggled to communicate through images, color, design, and patterning, it is possible to assume that new neuronal transmis-sions were being activated; new connections, absent at the start of the process, were being rewired. The investigation of these subtle changes occurring in the art of AD patients might shine light on the power of art activity to stimulate greater retrieval capability in the brain.

In this section, there are a number of artworks by AD patients at differing stages of the disease. While the details of the images may have some correlation to the declining state of the mind, each of the pictures below served differing needs of the individual patient. The use of specifi c art material helped them express current emotions. In all of these cases, their work improved during the period they took part in the art therapy sessions.

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Image 1 Sheila used sharp pointed pencil crayons to create many pictures of women. The small repetitive hatched lines with which she painstakingly fi lled areas of the dress, skin, and hair, were a means to calm her compulsive tendencies and agitated state (mild cognitive impairment). (See color insert.)

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Image 2 Bella fi lled pages with colorful patterns, many of them taking on the form of fl owers which she so loved. Continuing to draw even in her home where her caregivers provided her with pages and crayons, the art became a signifi cant consolation in her more isolated condition. The art helped her focus and quieted her obsessional questions and wandering (moderate stage dementia).

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Image 3 Joe was struggling with severe paranoia which he portrayed in the glaring eyes of this portrait. A mild mannered man, he repeatedly used the art to express anger and fear that lay hidden behind his unemotional facade. The rich layering of liquid paint (gouache) and dramatic use of color lends expressive power to the work (moderate stage dementia). (See color insert.)

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Image 4 Myron chose oil pastel, drawing repeated parallel lines to create this bird, an image of fl ight and movement. The work was done with energy and determination, surprising in a man who was almost mute, and for many of the initial sessions, had been a passive observer (late stage dementia).

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Image 5 This is Alice ’ s attempt to copy a still life. It was a great achievement, given that her perception of fi gure and ground was already seriously impaired. She made joyful use of oil pastel to create many colorful works (late stage dementia). (See color insert.)