My last post explored what we gain when we stop trying to correct our loved ones with dementia who say things that contradict what we know to be true. (“To Live Truthfully Under Imaginary Circumstances,” Blogpost January 17, 2016). In a nutshell, I noted that ‘playing along’ with dementia’s ‘untruths’ can reduce tensions, strengthen communication, and increase emotional honesty. This month let me introduce you to someone who takes ‘playing along’ a step further. Karen Stobbe founded In The Moment, an organization using theater arts to strengthen communication and emotional bonds between the two parties of the dementia care partnership. Here’s Karen’s story.

Karen and her husband Mondy Carterare actors and acting teachers specializing in improvisational techniques. If you’re unfamiliar with ‘improv,’ ask someone in college; pretty much every campus has at least one improv club. Here are the basics: Spontaneity is the essence of improv, which uses no scripts. Instead, everything depends entirely on the rules of a given exercise. For example, in the exercise called “Yes, and,” an actor must reply with “Yes, and – ” to whatever his or her fellow actor or audience member has just said. And then he must add something. Such an exchange might go like this:

Audience member: Your hair is on fire!
Actor 1: Yes, and …someone’s using my hair to roast marshmallows.
Actor 2: Yes, we’re roasting marshmallows, …and I need you to hold still so I can get mine perfectly golden brown.

And so forth. The exercise can go on from there in in countless directions.

Karen’s father died after having Alzheimers. Several years ago, when her mother Virginia also started showing signs of dementia, Karen decided to surf the internet for guidelines for good communication with people with dementia. She found such a list and quickly realized that it looked familiar. “Are you teaching a new class on improv?” Mondy asked when he glanced at the printout she had downloaded. And a friend who also was caring for a loved one with dementia happened to see a list of instructions Karen had intended for a beginning improv class. The friend asked, “What’s this, do’s and don’ts for dementia?”

In a flash, Karen recognized the convergence of her professional life as an actor and her personal life as the daughter of a demented mother. The rules for getting along in both worlds were one and the same: “Be in the moment.” “Step into their world.” “Instead of ‘No, that’s wrong,’ say “Yes, and…’.”

A recent segment of the radio show “This American Life” captured a conversation between Virginia and Mondy. One morning, Virginia turns from looking out the window and says she sees a monkey outside:
Mondy: It’s pretty early in the season for monkeys. Didn’t even know, actually, that they were here in North Carolina.
Virginia: Oh, there’s not a lot of them. But they’re pretty busy now.
Mondy: Well, if you see one again, we should try and capture it. Because that would be a blast to have in the house.
Virginia: You can’t keep monkeys in the house.
Mondy: Well, you just have to train them right and give them pants. Because if they don’t have pants, that’s just a barbarian’s monkey.
Virginia: We can’t have monkeys in the house.
Mondy: All right, all right. So I guess you’re making up a rule that we can’t have monkeys in the house.
Virginia: Yes, I am.

By stepping into her world, to use the improv term of art, Mondy does much more than merely keeping a conversation going for its own sake or humoring Virginia. If you listen or read carefully, you get a strong sense of Virginia’s personality. When Mondy suggests having one of the monkeys live in the house, she objects. Irrespective of whether she’s the one doing the mopping these days, Virginia likes to run a tight ship. No wildness, and mess allowed indoors.

Mondy’s ‘playing along,’ with his gentle requests to bring chaos into the house, helps Virginia define herself as the captain of the ship on matters of domestic cleanliness, order, and decorum. The dialogue is unscripted, but it helps Virginia to continue writing her long-held life-script as mother, homemaker, and person of good sense. At this stage in her life, Virginia may no longer be able to recall specific memories or the language to prove to herself or to Mondy that, when it comes to the home, she knows best. But by being part of her improv sketch, Mondy invites her to continue being exactly who she has been for much of her life.

And what about those monkeys? Are they the products of a disordered mind? Karen Stobbe insists that they are not. I recently spoke with her about the radio broadcast and her work. She said, “The thing is, my mother spent most of her life in the upper midwest, where there’s practically no bamboo, which is what my mother sees now outside her living room window in North Carolina, where we moved her. For her, the bamboo looks pretty tropical. So it’s an easy mental jump from a bamboo thicket to monkeys. Her associations aren’t simply random. They actually follow a certain logic.” The mind works–continues to work, and to create–with what’s at hand.

More than just a hallucination, the monkeys in Virginia’s front yard testify to the urgency of our need—and the strength of our ability—to make sense of our world through storytelling. Just as two improv actors can make a whole hilarious scene from a wisp of a plot thrown at them by an audience member, so too does a person with little or no recall of his or her personal history nevertheless persevere through storytelling. Virginia’s monkey story may be based less on fact than a story you or I might tell. But it’s doing the same job: it helps Virginia make sense of her experience.

After our conversation Karen Stobbe left me with many profound insights. One was a renewed appreciation for the ways that creativity can help make up for some of what we lose when we lose our hold on the facts. If you tell me that there are no monkeys outside the window, then fine. We’ll end the conversation there, and neither of us will gain anything. If you respond instead: “Yes, there are monkeys, and –” then maybe we can have a conversation about something real.

To hear the podcast On this American Life, go to “Act Two” on this link: http://www.thisamericanlife.org/radio-archives/episode/532/magic-words

To learn more about Karen Stobbe’s work using improv techniques to reach people with dementia, go to: http://www.in-themoment.com/index.asp