Abstract: In our research, two groups of people living with memory loss due to mid-stage dementia were invited to view a film installation, centred on the experience of a woman with a brain lesion and dense amnesia. The groups, recruited from day-care and support settings, were living at home. One included informal care-givers. After the film, each participated in a visual matrix: A group-based method of eliciting image-led and affective associations in response to aesthetic stimuli to support shared and distributed memory. We hypothesised that the associative process of the visual matrix would support meaningful engagement for participants with dementia.

We discuss the participation and self-reflection facilitated through the method in terms of social scaffolding, attending to differences between the groups, presence of care-givers and visual matrix setting. We consider the conditions in which scenic experience, replete with embodied memory traces is expressed in a visual matrix by people with impaired recall, enabling them to engage with a complex artwork. This provides insight into how the embodied, subjective experience of people living with memory loss can be communicated. Implications for enrichment programmes, social activities and communication in group care settings are considered.

Key words: art; affect; social scaffolding; memory loss; dementia; reverie; visual matrix; scenic experience

In 2015, "Lesions in the Landscape", a multimedia art exhibition, premiered at FACT (Foundation for Art and Technology), a Media Arts Centre in Liverpool, UK. Focusing on memory loss as an individual and cultural phenomenon, the centre piece was a 30 minute three-screen video and sound installation that examined the experience of Claire, a British woman living with amnesia, whose voice is heard on the soundtrack along with that of the cognitive neuropsychologist, Martin CONWAY. These sequences are interwoven with the landscape of St Kilda, a remote archipelago 40 miles west of the Outer Hebrides, which was evacuated in 1930. [1]

The outcome of an art-science project led by artist Shona Illingworth in collaboration with Claire, Martin CONWAY and neuropsychologist Catherine LOVEDAY, the installation presents St Kilda as a visual metaphor for the experience of memory loss, with the island's sudden abandonment evoking loss of connection to a past that is still materially evident, and an incapacity to produce new memories.

Figure 1: Shona Illingworth, Lesions in the Landscape, 2015. Installation view, FACT (supported by the Wellcome Trust, Photograph: Jon BARRACLOUGH) [2]

In the study reported here¹⁾ we investigated how "Lesions in the Landscape" was encountered by two groups of people living with mid-stage dementia who were themselves affected by memory loss. It is the experience of memory loss and the circumstances that enable people with impaired memory to respond to a complex visual artwork that is our focus of interest and not the formal diagnosis. The method used in the study—the visual matrix²⁾—is described below (FROGGETT, MANLEY & ROY, 2015). It involves a free associative process in which a visual stimulus (in this case the film) is used to elicit thoughts, feelings and further visual imagery in a group setting where people respond first to the stimulus and then to one another, building up a pattern of shared responses. The use of this group-based method means that our findings have implications for supporting people living with memory loss in social settings such as care homes and day-centres, or participating in enrichment programmes, where a key purpose of organised activities and leisure is to support social interaction and connection. [3]

The visual matrix allows for the expression of images and thoughts as they arise in the moment, rather than through prompting or demanding that participants follow a line of argument or reflection on past experiences. Since the method is led by imagery, visualisation and other modes of sensory experience (acoustic, haptic, kinaesthetic) the "scenic" character of the memories evoked in a visual matrix is strongly evident. We hypothesised that the associative process of the visual matrix would work well with participants who had difficulties with recall but were able to connect to previous experience through implicit memory (SABAT, 2006). The study afforded an opportunity to understand how interacting with an artwork in a social setting can activate a visual and aesthetic response among people living with memory loss, whose ability to express themselves verbally might otherwise be impaired. Most importantly, the visual matrix maximises the potential for complex engagement entailing self-reflection. The researchers who developed the method (FROGGETT et al., 2015) drew on the work of cultural analyst Alfred LORENZER (1986), both in understanding how units of lived experience present themselves as scenes (KRUEGER, 2017), and in the depth of hermeneutic modes of data interpretation (LEITHÄUSER, 2001; SALLING OLESEN, 2012)³⁾. Donald WINNICOTT's (1971) characterisation of transitional phenomena and potential space was an important influence, as was DELEUZE and GUATTARI's (1988) understanding of how imagistic and affect-laden thinking develops rhizomatically. Two of the authors of this article (FROGGETT and MANLEY), had previously used the visual matrix with professionals and advocates for people living with dementia, but not with informal care-givers, nor with those living with dementia or other forms of memory loss (CLARKE, 2017; LIVENG et al., 2017). [4]

Arts engagement for people living with memory loss, often but not exclusively due to dementia, is a growing area of interest in professional practice and research (KENNING, 2016). Many arts engagement programs are designed by their leaders to focus on the impact of art on the individual. There is still relatively little research on social impact and the social implications of arts engagement, or on the possibilities offered by exploring group contexts. The authors used the visual matrix method to examine group responses—and to offer people living with dementia the chance to engage with a complex media art work, focused specifically on the experience of memory loss. By contrast, the focus in dementia arts programs has often been "in the moment" pleasure rather than self-reflection. The complex visual and auditory layers of "Lesions in the Landscape", with its metaphorical play on landscape and forgetting and many entry-points into its narrative, offered groups of people with varied life histories the opportunity to find personal points of identification and, as we shall see, to find common ground in relation to experiences of memory loss that they hold in common. [5]

Dementia is a clinical term for a syndrome consisting of a wide range of symptoms. It is primarily age-related with an estimated one in five people over the age of 85 having some form of dementia. However, dementia can occur in younger people or result from brain trauma. It is neurodegenerative and affects cognitive and physical functioning, personality and behaviour. The most common form of dementia is Alzheimer's disease which presents with memory impairment (CHERTKOW, FELDMAN, JACOVA & MASSOUD, 2013; SCOTT & BARRETT, 2007). In this study, we did not request details about types of dementia, diagnoses, symptoms, or period since diagnosis, and participants simply presented as attendees from memory loss or memory support programs. [6]

We initiated our research after undertaking an exploratory pilot study of the visual matrix method in Liverpool with a mixed group of care-givers and people living with dementia. The researchers and the accompanying clinical psychologist were struck by the animation and ease of emotional and aesthetic engagement among members of the group. Members with dementia appeared to be fully participant to a degree that had not been anticipated, and although the presence of care-givers clearly facilitated the associative process, they did not dominate or lead the proceedings. Rather, the group quickly manifested as an interconnected whole developing a distinctive aesthetic and affective environment in which all could participate. As a research team, we were aware that a likely explanation for this, aside from the facilitative nature of the associative process itself, was the "social scaffolding" offered by the presence and participation of care-givers. This social support structure has the effect of "expanding" or "distributing" memory among a group (BROWN & REAVEY, 2015). We took the opportunity when the installation toured in Sydney to set up another visual matrix with people living with memory loss due to dementia, this time without the presence of informal carer-givers⁴⁾. [8]

The Liverpool group SURF (Service User Reference Forum) was accessed through Mersey Care post-diagnostic support program where informal care-givers (family or friends) are integrated into "relationship centred care". It included three participants with memory loss due to dementia, two former carer-givers, one accompanying partner, and the partner of a man who was too unwell to attend. The psychologist/group leader also participated. Besides being known to each other participants belonged to a larger support group, which focused on living well with memory loss and dementia. [9]

The Sydney group was made-up of nine people attending the Bonzer Tuesday Group—a social programme for people living with memory loss and dementia. The community centre where it was held reported that all members had dementia, and all presented with signs of memory loss. Participants jointly made decisions on group activities where they travelled, ate, and talked together. However, some members did not appear to remember others. They were accompanied by a student supervisor (not yet qualified) who took part in the matrix and the bus driver who was not seated as part of the matrix and did not contribute verbally. [10]

What the two groups had in common were that they were "ready-made" groups and people who were reportedly living with mid-stage dementia, and whose members appeared to interact freely; both groups were roughly evenly divided between genders. Our focus was on the possibility of shared aesthetic engagement in a social setting and our objectives were to understand:

Since the associative process of the visual matrix is facilitated by sensory stimuli we also hoped that the study would offer insights into the embodied experience of living with dementia. [12]

The visual matrix is a group-based qualitative psychosocial method designed to capture shared responses to an aesthetic or affective stimulus (FROGGETT et al., 2015; MULLER, BENNETT, FROGGETT, & BARTLETT, 2015). It is led by imagery and visualization that promote associations, initially to the stimulus then to other's associations. These take the form of images, thoughts, and feelings derived from participants' affective and sensory experiences within the "here-and-now" of the group but may also draw on personal memories. Associations produced by individual participants intertwine, diverge, and overlay each other rhizomatically⁵⁾ resulting a "collage" rather than a linear narrative or argument. Unlike a focus group, participants are not required to formulate individual viewpoints or position themselves in a discussion. Instead, their experience felt in the moment is prioritised and, by virtue of the associative process of the matrix, this has a shared character. The unit of analysis for a visual matrix is the group rather than the individual, and hence the method is suited to understanding responses among collectivities (such as audiences in the case of artworks) rather than individuals. The method is also "group-sensitive" in the sense that it is designed to be responsive to the particularities of groups and how they function. Although, it often draws on participants' biographical memories in the production of imagery, it is not designed to assess either the experience or functional capacity of individuals. [13]

The developers of the visual matrix built it on three theoretical pillars⁶⁾ that have been explored in detail elsewhere (FROGGETT et al., 2015). For present purposes we focus on the importance for the process of Donald WINNICOTT's (1971) and Alfred LORENZER's (1986) theories of symbolisation. From a Winnicottian perspective the visual matrix method creates a set of conditions which participants may use as a "potential space" (WINNICOTT, 1971, p.41)—a space of emergence, conducive to creative thinking, where "transitional phenomena" arise, in this case through visualisation and its associated affects. Transitional phenomena are so called because they occur in interaction with objects that are perceived as transitional between experience that may appear to the subject be "internal", and that which has a quality of "externality". Hence, they incite curiosity and reality-testing. They are precursors to symbolisation, whereby both visual and verbal forms are found for an expression of embodied experience. LORENZER concurs with the emphasis on interaction (rather than objects) in elaborating his theory of memory traces.

"In a word, memory-traces are representatives not of things, but of situations; they are traces of past interactions and prototypes of future interacting, scenic models, or formulas of interaction (i.e. 'forms of interaction'). Moreover, just as the objects of our everyday experience are encountered never in isolation, but always within the panorama of a life-world, so all individual memory-traces are elements of complex situational scenarios—and not isolated 'reproductions of things' or denotations" (LORENZER, 2016 [1983], p.1402). [14]

For LORENZER the subject is always experientially implicated in these scenarios via interaction forms or patterns which have been moulded by socialisation and have become routinised. This scenic material remains as residues of past unconsciously held experiences and is replete with sensuously embodied memory traces. The visual matrix setting facilitates shared visualisation and an accumulation of imagined scenes which are affectively and aesthetically experienced in the here-and-now of the matrix, and which find symbolic expression in its image work through the visual and verbal forms of a shared culture. The emergent expressions of a visual matrix are thus neither "internal" to participants (though they are rooted in biographical experiences) nor "external" in the sense of being purely socio-cultural in origin. They are "in-between" (transitional) occurring in interaction between participant individuals, the group, and the material and cultural world. Like WINNICOTT, LORENZER is concerned with the symbolisation of sensory experience and how it occurs. Indeed, LORENZER and ORBAN (1978) acknowledge an affinity between their theory of scenic experience and WINNICOTT's view of transitional phenomena. [15]

In using the visual matrix, the researchers aimed to create conditions in which the production of scenic experience and transitional phenomena were activated among participants. Personal impressions and memories, many of which were forgotten or "beneath" awareness emerged into consciousness in the shared associative process of the group—retaining their in-between quality as belonging neither exclusively to the individual nor wholly to the collectivity. They helped to establish an inter-connectivity which impelled the process of the group through the rhizomatically interconnected images, affects, and ideas of the emergent matrixial collage. We first describe how the visual matrix can facilitate a shared art experience for people living with memory loss due to dementia and in our discussion return to the importance of scenic experience where functional memory is impaired. [16]

People living with dementia, particularly Alzheimer's, undergo explicit memory loss; that is, conscious recollection, as in recall or recognition. However, implicit memory, relating to the ability to encode and retrieve information without conscious awareness, but "reflect[s] the unconscious effects of previous experiences" (HARRISON, SON, KIM & WHALL, 2007, p.286), is preserved into later stages of disease; emotions and traces of experiences persist after explicit memory has faded (GUZMÁN-VÉLEZ, FEINSTEIN & TRANEL, 2014; SABAT 2006). Research across a range of disciplines is increasingly focusing on the importance of being "in the moment", primed by earlier experiences that are not explicitly recalled (CLARKE & WOLVERSON, 2016; GUZMÁN-VÉLEZ et al., 2014; HARRISON et al., 2007; KITWOOD, 1997; TREADAWAY, PRYTHERCH, KENNING & FENNELL, 2016). Furthermore, SABAT (2006) differentiates, in relation to memory loss, the difference between recall and reflection. Being unable to consciously recollect an experience or image does not negate selfhood or the experience in total. A memory of the experience may be reflected in actions and behaviours regardless of the ability to recall it (SABAT, 2005). The visual matrix is designed to facilitate being in the moment and creates a setting where implicit memory or memory traces can find expression through a process of shared (socially scaffolded) symbolisation. Following LANGER (1948 [1942]) this takes the form first of presentational symbolisation (in the form of shared imagery and associated affect) and only then discursive symbolisation (in the form of the verbal articulation of the imagery and associated thoughts). In a visual matrix presentational symbolisation, which is associated with art and music and the language of poetry and literature takes priority over the discursive, resulting in expressions which are rich in figurative and metaphorical content. [17]

We thought that the visual matrix would work well with our groups because participants are not pressured to speak—thoughts may be expressed or dropped at any point—and associations are not interpreted in the matrix itself. This mitigates the risk that individuals may forget what they saw or felt—the shared associations themselves function as ongoing stimuli. It also alleviates any anxiety that may accompany an individual's difficulty in holding onto and articulating a thought with linear rationality. The visual matrix generates data which is a re-enactment in-the-moment of lived experience—in this case the experience of an artwork—which incidentally arouses other fragments of biographical lived experience. It is therefore concerned with what the stimulus produces in participants, rather than asking for judgements or opinions about it. It is also designed to facilitate engagement, bypassing any need for specialist knowledge or discourse. [18]

In the potential space of the visual matrix there are therefore three distinct aspects that, separately or in combination, can in principle support the participation of people with dementia:

The two groups used the imagery and sound of the film installation to very different effect. Because the group processes produce a distinctive affective "climate" as well as clusters and intensities of imagery we first present them separately. We selectively present material which is emblematic as well as illustrative, while our commentary is derived from the panel interpretations undertaken according to the hermeneutic principles and protocol described above. We then discuss the two groups in relation to each other. [21]

The Liverpool group engaged easily with the matrix and from the outset generated affect-laden imagery. Associations resonated through the group with fluent connections to memory loss. [22]

The request from a facilitator for a first image elicits "desolation". Immediately, the landscape of St Kilda with its abandoned settlement is re-created in the mind's eye and recognized as a metaphor for loss of a future:

"desolate wasn't it? Really, it was totally desolate and that could be oppressive really because there's no ... light, there's no future."

"And I think that perhaps is the oppressive part of it, that everything was finished, you know?" [23]

An image of Claire follows in what for the group is a particularly moving scene where she is standing in a room in her own house

"looking at the photograph, sort of touching it as though she was trying to make it real to her ... trying to remember who it was on the photograph." [24]

Claire's amnesiac experience is taken to be emblematic of memory loss (it appears irrelevant that this arose from amnesia rather than dementia). She also represents the possibility of living and creating connections in the context of desolation:

"Maybe that picture of Claire in her room resonates so much because whereas those houses [on St Kilda] were all derelict or abandoned, right? Hers was still her home, even though she was—you know ..." [25]

The participants readily insert themselves into the scene. As in the film itself, their biographical memory loss intertwines with their historical awareness of a place that has lost its living link to a past that people once provided. Participants associate to scenes where forgetting appears to diminish the store of life experience. A cupboard with drawers in Claire's room is re-envisaged as a container for memories that are there but inaccessible (echoing CONWAY's narration in the voice-over about loss of connection rather than complete loss of memory). A participant's husband (not present) is mentioned. He cannot remember last weekend's trip, even though he was "good at the time" and could retrieve older memories. In the same vein, the film's evocation of events "frozen in time" prompts association with inaccessible memories. [26]

Images of hand-held torch lights, in the film, which sweep across the land as if searching for something unknown among the ruins, are also linked to vanishing memory, described as "very moving"; but also disturbing:

"And that was a little bit of a frightening feeling of—I didn't really want them to go out and then they started to dim and fade."

"I thought, as you lose that person ... It's hard to explain it here, but that's how I felt." [27]

Participants find in these visual metaphors an analogue for their own fear and sadness for what the future may hold. However, other emotions are also engaged, alongside intellectual appreciation ("It was incredible, I thought. I really enjoyed it"). While mourning and loss pervade the matrix, hopeful sentiments emerge—a feeling of impending loss is followed by emotional uplift: "I found it absolutely amazing and exhilarating". [28]

The group continue to re-experience fluctuations of mood as they respond to the imagery and sound-track:

"The first part was quite impressive ... when the music seemed to lift out of her."

"The music reminded me of ... some of ... childhood and church and sort of being in ... maybe something like the cathedral and listening to the music of the past ..."

"I felt like the birds were a bit more hopeful and free. That kind of broke it a little bit for me. But then I could see that that was quite dark as well."

"I think I felt as though all that was left of the whole island, was the birds. And I think we've gone—that was like a sad part for me." [29]

Kinetic imagery in the film of rocks and water in motion promote a sense of rising and falling and characterizes the experience of the whole film, which is likened to an "emotional rollercoaster" that "emphasizes the down and the up":

"I can close my eyes and see a part of it and you get another memory from it, you know. And I think oh that's good because—okay, there's something wrong, but it's going to get easier—and then the music came, and I thought now does this mean it's the end? And it wasn't, because then it got more...it was incredible, I really enjoyed it." [30]

The participants' self-reflexive use of the artwork extends in places to a meta-commentary on the experience of living with memory loss and the fallibility of what is remembered:

"Memory and reality aren't necessarily the same. I don't think they go hand in hand." [31]

There is perceptive commentary in which motifs in the film are understood as an aesthetic representation of neurological characteristics of dementia.

"The landscape and the lights that made me think actually of impulses rather than memories."

The artwork was considered by the participants to be an "incredible production", gratefully perceived as made "for us":

The Sydney group also engaged well, but differently, with the film. Some were vocal and others made only brief interjections, but nevertheless appeared to have followed the proceedings. The one care-giver present was a trainee who sat at the back of the room looking and listening (not in the "snowflake" seating arrangement). The bus driver appeared to exclude himself from any engagement by noisily moving around and clearing away tea cups, and a rainstorm rattled the windows and threatened to interrupt the flow as a window had to be closed. However, participants appeared unperturbed by the potential distractions—possibly because they were used to the erratic noise of the community centres they attended. They mostly stayed with the process, although sometimes veering off-track, and then spontaneously returning to the topic. [34]

It was less clear in Sydney that the group had a shared experience, but they engaged animatedly with the film, asking questions and fact-checking:

"Which side was it on? On the right hand or the left-hand side, if you're looking at Scotland?"

"Well, it's off to the left, if you're looking—that's north. Scotland and then St Kilda."

They liked "the sounds", and asked questions about the stone houses, inhospitable terrain, birds, ancient goats, and growing food. Concrete thinking was interspersed with personal narrative where the relationship between their story and the film at first seemed oblique. Participants recounted episodes of travel, leisure, and military service usually prompted by the film. War-time memories were stimulated by military installations on the island, and perception of conflict among the birds. There appeared to be an unrecognised sensory/affective process whereby participants inserted themselves into the scenes of the film without being aware they were doing so. There was no identification with Claire. [36]

The first association was "escape"—noteworthy given that evacuation is not synonymous with escape (people of St Kilda "consented" to compulsory evacuation). The group wondered whether apparent panic in the film was because of leaving their homes and all that was familiar, commenting on how few possessions they took with them.

"Those evacuation scenes, I found myself wondering why they were running. Why did they need to run to the boat? Because they were all running as if in a state of panic."

"Why should they panic? They had a boat there to—there was a boat there to pick them up. It was because they were originally born on that island or have never been off it, sort of thing."

"Yeah, I wondered about that feeling of panic and the same feeling of panic and claustrophobia when the family group hid behind the boat." [37]

The discomfort at leaving one's home for the unknown occupies quite an extended passage and can be interpreted as an allusion to participants' own circumstances. Many were undergoing changes in their home life as family dynamics and hierarchies shifted; heads of the families were being supplanted by grown-up children or caring partners. Those living alone would soon have to leave their homes (perhaps taking few belongings) for assisted care. Yet, the group showed no awareness of using the film's visual narrative as a metaphor for their own experiences. [38]

They pass from the trauma of evacuation to the harshness of the environment and then to the birds:

"Yeah. And that together with the flight of the people, some still retaining freedom as a certain ..."

"Yeah, but that island would've been—what would you call it—where birds flock every season."

Here participants are relating to two scenes in the film, which are separated in sequence and demand a recall that spans narrative to connect the ideas. The "eternal" circling of seabirds contrasts with the panic-stricken flight of the population, but is given a twist—from freedom the birds become prey and then food. An unconsciously self-referential metaphor appears to be "eat or be eaten"—a motto for survival at a time of increasing dependency and decreasing agency. With a flash of humour one participant states "I found myself wondering what those birds taste like!" Another, perhaps alluding to bland community centre lunches, comments on the need for curry powder. The participants speak of the hostile environment again in desolate tones and continue to refer to it throughout the matrix:

"And the intense cold ... And someone said something about the sense of freedom and I don't get a sense of freedom when I see the scrabbling for a bit of touch on rock. It's a competition like any other animals or birds do. They fight for a spot on the rock and they fight over it and they expel other birds so that they can get a bit of it... and the sunshine is weak." [40]

Neither the "cold" nor the "weak sunshine" are directly represented by the maker of this monochrome film, but the sensations are "felt" and present to the speaker, amplifying a sense of impending loss of control over personal comfort. [41]

This interpretation is supported by the insistence with which the speaker returns to the idea of defending one's place, finding one's purchase in a new place, and fighting for recognition of the person that they are and have been. This fight for the survival of selfhood and self-respect is reflected in other clusters of associations—relating to war, and also to hygiene (with references to the smell of other people, toilets, and perhaps anxiety about lack of privacy). By virtue of the generalization in "... competition, like any other animals do", we, the research team, infer an extension of a presumed state of conflict in the animal world to human situations where people struggle to live together. There is no evidence that the speaker is intentionally relating this to a life of increasing dependency, but once uttered she recognizes the feeling the scene has produced in her and she continues on and off to loop back to it unreflectively. [42]

These matrix participants do not explicitly comment on living with memory loss and why they have watched the film together. They make very little reference to Claire nor do they show curiosity about her, seeing the film's story as wholly external to their own situation. Even though powerful analogies are continuously produced, they do not lead to insightful connections. [43]

About half way through, the student care-giver tries to make links between the film and participants' experience. She implicitly invites the participants to consider their own experience, but this is not followed up

"So you feel like you can only connect with the world, a little bit. You're very isolated. You're alone. You're stuck in the maze. You don't know where to go. You don't know what to do, but you're really, extremely isolated, kind of feeling. It's like a war. You're in the war. You are disconnected outside; different part of war, but you're just stuck there." [44]

At this point a succession of scenes have provided metaphors for the circumstances of the group. However, no meta-commentary develops, and this is a key difference from the Liverpool group. [45]

Clearly, our two groups in no sense offered an experimental situation. Nevertheless, the differences are striking, and we here link them tentatively to social scaffolding and collaborative memory. [46]

The Sydney group, who shared more organised leisure time, worked less well together. They participated with vivacity and continued to return to the film imagery and narrative. There were some conversational sequences, superficial curiosity and fact-checking. Their easy humour suggested that they were relaxed in one another's company. Yet they gave no evidence of having an experience in common. Their preoccupations and personal narratives were largely self-referential, focusing on the retelling and looping of autobiographical stories that were about the teller's identity rather than group sensitive—a noted characteristic of dementia (HYDÉN & ÖRULV, 2009). [47]

There was no shared reflection that all were living with memory loss. When the student/care-giver spoke of being "lost in a maze" (referring to a visual cue in the film in lines of broken walls) they did not use it, and instead returned to a very concrete, factual mode of thought. The metaphorical resonance for them of the harshness of life on the island for humans and birds remained unacknowledged. Much of the content of the film was remembered, as they provided scaffolding for one another, with utterances acting as prompts, but the memories were never linked to their own experiences of living with memory loss. It is telling that this visual matrix process began with "escape" and "panic". [48]

By contrast, the Liverpool group met less frequently, and with discontinuities. They, however, used the visual matrix to express a profound appreciation for the film, a shared sense that it was "for us", and an affective group resonance which transcended individual moments of confusion and forgetting. They took it for granted that they had an object in common. Instead of rehearsing details of the film to check their understanding, they operated metaphorically, and at a higher level of abstraction, accommodating the grief and loss of forgetting and inescapable "desolation"—a mourning of memory itself. Their struggle was living well with what remained ("there are times that are all right"). The Liverpool group acknowledged living with memory loss and saw that their experiences echoed Claire's—"It made me think". In short, they made insightful and self-reflexive use of the film. "Using the matrix" appeared almost second nature to them. Without hesitation they entered into to its associative flow and aesthetic space, linking to the film, and "being in the moment". [49]

In the community centre in Sydney that the participants attended, we understand that in contrast to the Liverpool group, memory loss and dementia are not commonly mentioned let alone openly discussed among the Sydney group. This is a key difference. A clear difference between the matrices was in the role of the care-givers. In Liverpool the presence of the care-givers enhanced the reverie. Connections to the film and to one another were readily made. Aesthetic responses came in a flow of inter-connecting associations. The matrix quickly took on an organically interwoven quality in which abstracting the utterances of particular speakers made little analytical sense. In the Sydney matrix, by contrast, the reverie never fully developed, and the process was vulnerable to paired conversations and interjections. While participants' associations were prompted by the film, there was a bias towards the retelling of stories—a process for making sense of identity and the world used by people living with dementia and discussed by HYDÉN and ÖRULV (2009). [50]

In Liverpool the psychologist and care-givers helped to consolidate the self-reflexivity which led to consideration on how the film illuminates experience of memory loss in general, and its emotional and practical consequences. The reflection was on living with dementia from both "inside" and "outside", while the imagistic collage the group produced together offered a third "transitional object"—through the connectivity of the "in-between". In other words, the participants used the matrix creatively as a potential space to produce imaginative ideas that were also grounded in the everyday lives of the group. [51]

In Liverpool, Steve⁸⁾ had not been well enough to attend on the day of the matrix. However, his wife maintained a reflective commentary, relating scenes from the film to their everyday problems in living with memory loss. In doing so, she ensured that Steve was held in the mind of the group and the day-to-day practicalities she referred to were recognised by all. [52]

The matrix was prompted by scenes of desolate landscape and military installations to consider whether life is worth living after "Armageddon", the voices of people with and without dementia seamlessly inter-mingled. However, Steve's wife was identifiable because she continuously referred to their relationship and referenced Steve by name.

"I'd rather have a bomb land right there than be one of the few left behind ..."

"It's going to happen. As long as Steve's with me and we'll both go together because he always promised me we've got to stay together ... when the children ... they were running, and they head down the ... but I thought they were going in the boats. And I thought well you know ... is there hiding things. Sometimes Steve just looks down quiet and I say, 'what's wrong with you'? 'Nothing', and he just comes up talking and he's fine with me ... we saw the helicopter going over. I thought he's checking everything and no one's there. And then it just seemed—I think when that music came, that was sort of the best thing. I thought maybe it's to say, 'well you can have times that are alright'."

"But I wondered as well if maybe we don't need to understand the whole story, because actually we can just appreciate the different elements of it, and that relates to just living in the here and now, doesn't it ..."

"But Steve can't remember that we went away. And going away this weekend, so when we were there he was brilliant, so that was part of things I think. He'll see something happening there, but he'd look at it and he's forgetting next day. He wouldn't know anything about the film. That was the thing, where we all remember parts of it in our ..." [53]

The presence of care-givers in Liverpool effectively provides a cognitive and affective scaffold in this conversation linking the practical and relational realities of memory loss, with Steve's predicament and Claire's story. The Sydney group, in the absence of an affective basis for scaffolding, or the reality testing that the Liverpool carers afforded, appeared to lack the relational bearings to think about living with memory loss or dementia. In its absence they focused largely on St Kilda. [54]

We converge here, albeit from an arts perspective and with an arts-based method, with the (Bergsonian) view expressed by BROWN and REAVEY that treats memory as emerging through the ongoing flow of experience, across time, space and narrative: "what we are is the endless activity of scaffolding, rather than some structure buried underneath. The challenge is to produce a psychology that can engage with this proposition" (2015, p.147). We offer not a psychology, but an empirical method. In so doing, we also propose that the concept of scaffolding must be understood in an expansive and multi-dimensional way—not simply as a compensatory mechanism for impaired cognitive function. Specifically, use of the visual matrix has enabled us to highlight the affective dimensions of the scaffolding that support social engagement. [55]

The Liverpool and Sydney groups provide contrasting manifestations of communication among people with dementia. In the former we witness the effects of social scaffolding, which enabled full participation by the whole group in a flow of experience in all its psychosocial and scenic complexity. The group attuned to the sensory, affective and aesthetic experience of the film—through its rising and falling sound-track, desolate landscape, monochrome palette, brooding menace of military installations and spectral presence of an ancient Soay sheep, condemned to drag its pelt uselessly like the bedraggled remnants of an extinguished life⁹⁾. There was also empathic curiosity for Claire's predicament and resonance with the visually and narratively anchored idea of being "frozen in time". Through a complex set of overlapping registers, the group apprehended the aesthetic "density" of the film. In this sense, we see in action "the endless activity of scaffolding" but would resist the notion that in the matrix the carers "compensated" for the deficits of those with dementia or that any participant with memory loss was represented in proxy. [56]

The Liverpool group were self-reflexively prompted to consider two hopeful propositions in the face of the desolation of memory loss: firstly, the idea that when memory fades "the emotional life goes on" and secondly, using the visual metaphor provided by Claire searching among the drawers in a cupboard, the idea that although conscious memory falls away, it still remains biographically inscribed in the body. Similarly, the memory of the film was inscribed in the group so that its imprint remained to be appreciated by all, even though the details proved elusive for some. In the matrix, the participants with dementia were in no way exposed as lacking memory; at one point a participant says, "for example, I've forgotten most of the film", but this is met with a recognising ripple of laughter and has the effect of affirming her participation in a moment of solidarity, rather than exposing a deficiency in relation to other participants. This points to a form of collaborative memory that is not simply task-oriented but affect-oriented and that in the presence of the care-givers and the containing environment they helped to establish, was further supported by the conditions established by the visual matrix itself. [57]

In support of our claims regarding the fullness of participation in a complex psychosocial experience we can refer not only to the imagistic and affective content, but the richly figurative quality of the language used to convey associations. As researchers we have witnessed time and again in visual matrices the freshness and authenticity of expression that at times verges on poetic, the avoidance of stereotypical thinking and the "embodied" quality of the utterances. LORENZER (1986) sustains that scenic experience is inscribed as sensuous memory traces that may find expression in the "sensual symbolic" forms to be found in art, music, and the figurative language of poetry and literature, where they become fully symbolized in verbal language. When language loses its scenic character (as in scientific discourse) it is de-sensualised taking on a clichéd and stereotypical form. When the scenic is fully present in language, so is the embodied memory trace, which infuses verbalisation with the vitality of an experiential link. In the Liverpool matrix absence of cliché and the full sensory and affective engagement of matrix participants were generative, enabling participants to take in, think about and express their responses to a complex artwork with linguistic creativity. We posit that the absence of clichés meant that the sensuously grounded scenic memory remained active throughout the group nourishing its capacity for visual and verbal symbolisation. In turn we suggest that where there is memory loss in dementia this creativity may remain active long after conventional linguistic expression falls away. [58]

In the realm of dementia arts there is a strong impetus to strategically "forget memory" (BASTING, 2009) since its pursuit is often fruitless and frustrating. The Liverpool visual matrix indicates a possibility of maintaining agency through insight into dementia, supported by a particular kind of social scaffolding. This form of scaffolding, here fostered through the matrix, is perhaps best thought of in terms of a total sensory, affective, and social environment, which sustains the distribution of experiencing subjects into the world and their ongoing intermingling with other distributed subjects. This is very different to HYDEN's (2014) account of collaborative preparation of food by a mixed group of people with dementia and carers. Through careful planning and communication designed to explain, remind and instruct, people living with dementia, primarily moderate, were helped to participate in making meals. The care-givers compensated for loss of cognitive and executive function through meticulous and carefully graded tasks. Affect is not discussed in the article, so we must assume that it was not regarded as material to successful performance. We are not told whether the people with dementia were stressed, calmed, excited or bored by the jobs that were assigned to them, nor whether they found meaning or satisfaction through their completion. There is no suggestion that they might have actively contributed to defining the task or stamping their own idiomatic way of doing things upon it. Whether or not they had any thoughts about it, or wanted to repeat the experience, is not known. It is useful to see that in a collaborative situation people with dementia were enabled to carry out a practical task that they would otherwise have struggled with. However, if the activity prompted any form of self-expression, this has not been recorded, and, given its compensatory character, it might reasonably be described as proceeding from and reinforcing a deficit model of functional ability. [59]

Where memory loss is due to dementia the visual matrix may also open up interesting questions regarding confabulation—given that the method could be argued to activate/stimulate confabulating. Confabulation, as it occurs in dementia, refers to the tendency to sense-making through co-opting memories and stories (ÖRULV & HYDÉN, 2006). It is an important concept since autobiographical memory specialists contend that certain dementia effects may be less about forgetting than a failure of executive functions. There is often capacity for abundant long-term memory retrieval, but not for reality-checking of memories that come to mind; hence "true" memory narratives get spliced into incorrect explanations of present situations. CONWAY and TACCHI (1996) suggest executive function is at stake in confabulation and we infer that social scaffolding, as in a close care-giver relationship, can curtail excesses of confabulation because the care-giver/scaffolder specifically compensates for dysfunctional "internal" connections, taking up the "executive" capacity externally. While the visual matrix does not support investigation of individual cognitive function, it does open up consideration of social scaffolding in a group setting. [60]

People living with memory loss and dementia are yet to be offered the richly expressive and in depth, self-reflective experiences that are facilitated for other audiences through arts engagement. The unintended effect of this is to limit the opportunity for people to use artworks to reflect upon and express their own insight, born of lived experience. All too often, access to stimuli that elicit the full gamut of human emotions, including negativity, is limited by professionals with welfare concerns who inadvertently restrict potentially transformative experiences. Our focus in the visual matrices was not on the artwork, as happens in arts access programs, but on responses and associations arising from engagement with the artwork and on exploring the experience through the expressions of the group. We have shown through the visual matrices in Liverpool, and to some extent in Sydney, how under the right conditions insight into sophisticated artworks can be achieved, affording people living with dementia pleasurable and emotionally complex and communicable aesthetic experiences. [61]

In both visual matrices we witnessed the full affective participation of people with dementia, with and without care-givers in a scaffolding capacity. This was evidenced in their use of visual metaphor, figurative language, cultural references, communicative reciprocity, sense of humour, emotional range, and manifest enjoyment. The difference between them, as we have explained, is that the Liverpool matrix immediately cohered around a shared object of attention and a shared experience. We attribute this not only to the containment and scaffolding provided by the care-givers and the matrix, but also the fact that these conditions enable the reverie to develop to its fullest extent. We are inclined, therefore to ask whether a focus on compensating for limitations in cognitive and executive function might not be misplaced. It may well be that there are features of the visual matrix, yet to be fully explored, which are particularly helpful in establishing a setting in which people with dementia can participate to their fullest capacity, and where their contribution, whether voluble or subdued, resonates with the group and leaves an imprint on the interwoven and shared production, which would have been different had they not been there. [62]

Of course, elaborating a metaphor and chopping a vegetable are not commensurate, since having an idea does not in and of itself enable fine motor skills. We are not claiming that functioning well in a visual matrix translates directly to functioning well in a kitchen. However, having thoughts and feelings about what one is doing is clearly connected to motivation, agency, resilience, and the ability to evaluate and gain satisfaction from a task and be present in the moment. It is also connected to a person's ability to struggle with a task and his or her sense of why it is being done, and for whom. Most significantly, it is implicated in the existential signature people leave on the tasks they perform and the settings and relationships within which they carry them out (BOLLAS, 1993)—in short, in the sense of selves as social beings and the recognition this accrues from others. [63]

What then are the distinctive features of a well-functioning visual matrix that might enhance collaboration among people with dementia and the broader population, and what are the implications for social care settings? By well-functioning we mean that the matrix develops as a potential space, capable of supporting reverie. As we have shown, this may well depend on the presence of sympathetic care-givers to develop social scaffolding, but presence alone is not enough. There are features of the conditions that a visual matrix provides that could well be reproduced in everyday group care as well as collective enrichment programmes. The visual matrix is clearly a shared activity in which the outcome is that of the group as a whole, rather than a didactic process aimed at improving individual functioning, or one that is led by people assumed to have greater competence. Because it makes no division or distinction according to capacity, it tends to elicit a high degree of participation from people who would be at a disadvantage in discursive contexts. The associative process is not prescriptive and does not favour the dominance of authoritative voices or expert opinion. It does not proceed according to a linear rationality but accumulates and makes use of interlinked imagery as it arises. With practice visual matrix principles can be used to facilitate group engagement and communication in conjunction with number of creative contexts such as excursions, story-telling or art-making. [64]

Critical to communication in dementia groups may be stress-free conditions in which stimuli are provided but anxiety is forestalled, so that it is easy to speak or not to speak, according to inclination. In the visual matrix thinking is scenic and, according to LORENZER, the scene is the primary mode of perception, so no one has a particular advantage. Explicit individual memory is not required because imagery unfolds in the moment in response to other people's associations; and the matrix itself holds the collective expressed memory of the group. Affective expression is privileged and is not subordinated to linguistic facility. The key point—and indication of a need for further research into the implications for social care practice—may well be that the capacity for discursive symbolization is impaired in certain forms of memory loss while the sensual symbolic remains intact for much longer, and when this is disrupted there are still the specific interaction forms laid down as embodied memory traces which express themselves in a person's distinctive presence in a social world. Providing opportunities for a range of sensory and imaginative engagements with the material and cultural world should be seen, therefore, not as an optional addition in social care, but as an existential necessity, that enables people living with dementia to fully apprehend and express their own humanity and live in community. [65]

In conclusion, although the visual matrix was initially developed as a research method which can be used for understanding the lived experiences of people who might struggle to articulate them, it can also be used as a tool of engagement. Moreover, it has features that can be used in group care to promote self-expression, reflection and communication. Its principles of operation—associative, scenic, imagistic, affect-laden, aesthetically attuned, contained and socially scaffolded—all have implications for the design of both day-to-day social interactions and enrichment programmes, which can lack ambition in terms of the complexity of experiences that they offer. Furthermore, in our study, we tentatively suggest that it is not only memory that should be forgotten but an insistence on modes of rational discourse or cognition that disregard, for example, the expressive ingenuity of confabulation. The implications are that there are that social care settings should encourage modes of thinking and speaking that can work with, rather than against, the grain of experience of people with dementia and other forms of memory loss and that the conditions of artistic engagement explored here could inform new strategies of communicative activity in group situations. [66]

Research for this article was supported by the Australian Research Council under a Linkage Project (Curating Third Space) in partnership with the University of New South Wales and University of Central Lancashire. Thanks are due to Sarah BUTCHARD, clinical psychologist working with the SURF group in Liverpool both for her help in facilitating the participation of the group and her feedback on our early findings, also to FACT where the Lesions in the Landscape was shown and who provided facilities for the Liverpool visual matrix on site.

1) This research was funded by the Australian Government through the Australian Research Council. ARC Linkage Project, LP150100481, Curating Third Space: The value of art-science collaboration. It was submitted for review and approved by Human Ethics, UNSW, Sydney. <back>

2) Although we henceforth refer to it as a group method, the term matrix denotes a whole from which something emerges (from Latin, where matrix means "womb"). <back>

3) This article includes a condensed account of the method and its protocol and discusses its application in facilitating self-expression among people living with memory loss and dementia. A full methodological and theoretical elaboration of the method is to be found in a previous issue of FQS (FROGGETT et al., 2015). <back>

4) This was not intended to be a controlled experiment, rather it was to provide a contrast whereby inferences could be drawn inductively about the conditions in which aesthetic experience could be enjoyed and communicated among groups of people living with memory loss. <back>

5) Associations spark each other, giving rise to new sequences and clusters of imagery, and nodes of ideas or affective intensities. Thus, the Deleuzian metaphor of the rhizome (DELEUZE & GUATTARI, 1988) captures the formation of images, affects, and ideas and non-linear thought processes of the visual matrix. <back>

6) The third pillar, not discussed here, from the work of Gilles DELEUZE and Felix GUATTARI (1988) (see FROGGETT et al., 2015 for further discussion) has been important in accounting for how the fragments of experience, expressed as images and affects in the matrix, take on de-centred aspect with respect to the participating subjectivities of the matrix members, accumulating rhizomatically into clusters and intensities of imagery and thought rather than linear thematic organisation. This supports the sense that the expressions of the group are shared rather than individual productions. <back>

7) For a full discussion of the interpretive protocols and theoretical underpinnings see FROGGETT et al. (2015). <back>

9) This image made a great impression on participants, judging by their remarks on it at the time. Sarah BUTCHARD, accompanying clinical psychologist reported that at the time of writing (two years after the visual matrix) it is still remembered and discussed among the group for whom it has become a signature image of the artwork, most likely because of its metaphorical and scenic resonance. <back>

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Jill BENNETT is an Australian Research Council laureate fellow at the University of New South Wales (UNSW), where she is also director of the National Institute for Experimental Arts and founding director of The Big Anxiety—festival of arts + science + people. Her Laureate Research Lab advances the study of the subjective experience of ageing, mental health, marginalisation and stigma, combining psycho-social approaches with the use of immersive environments and virtual reality to enable perspective sharing, and the development of effective methods for cultivating empathy. Jill is a visual media theorist, curator and immersive media producer, whose research focuses on trauma, emotional experience, memory and mental health. Her research includes arts-science collaborations at the intersection of trauma studies, psychology and mental health. Her books, include "Empathic Vision" (2005, Stanford University Press) and "Practical Aesthetics" (2012, I.B.Taruis), as well as monographs on media arts, curating and its social impact. She has produced and curated many exhibitions and events, encompassing visual, media and performing arts, interactive workshops and experimental discussion forums, designed to promote new forms of engagement.

Lynn FROGGETT has a cross-disciplinary academic background in humanities and social sciences and is professor and co-director of Psychosocial Research at the University of Central Lancashire and co-director of the trans-disciplinary Lancashire Institute for Citizenship, Society and Change. She is also chair of The Association for Psychosocial Studies in the UK. Her research focus includes psychosocial wellbeing, public mental health and the arts. She has led research projects in digital, clinical, cultural and community settings as diverse as youth justice, public mental health, museums, hospitals, new model arts institutions, primary care, regeneration contexts, schools and festivals. Current projects are concerned with the role of the arts in health and well-being civic action, cultural renewal and local democracy. The theoretical and conceptual development from these projects is cumulative, trans-disciplinary and rests on in-depth, hermeneutic, ethnographic, narrative and visual methodologies. She is also visiting research professor at The University of Stavanger, Norway, and collaborating visiting professor at the University of Roskilde, Denmark.

University of Central Lancashire
The Psychosocial Research Unit
Preston PR1 2HE, UK

Gail KENNING is an artist and researcher. She uses ethnographic methodologies to explore social and cultural approaches to health with a particular focus on ageing, dementia and wellbeing and the evaluation of arts engagement projects. Gail is senior researcher at University of Technology Sydney (UTS), honorary reader in design for ageing and dementia at Cardiff Metropolitan University, Wales, UK and Design United visiting fellow at Eindhoven University of Technology, Netherlands. Gail is also chief investigator on funded design for dementia projects in Australia, and co-investigator on AHRC and NWO projects in UK and Netherlands respectively.

Julian MANLEY works at the University of Central Lancashire. He graduated at Cambridge University and holds a master in group relations and society and a PhD in social dreaming from the University of the West of England, Bristol. His research is centred around visual methods evolving from and including social dreaming and the visual matrix. He researches psychosocial and group relational approaches to knowledge and includes a Deleuzian perspective to this work. His book "Social Dreaming, Associative Thinking and Intensities of Affect" was published in 2018 (Palgrave).

Lizzie MULLER is a curator specialising in interaction, audience experience and interdisciplinary collaboration. Her current research explores the relationship between curatorial practice and shifts in contemporary knowledge formations. Lizzie's recent exhibitions include "Human Non Human" (with Katie DYER) at the Museum of Applied Arts and Sciences, Sydney and "A Working Model of the World" (with Holly WILLIAMS), which has been staged in Australia, USA and Scotland.

Bennett, Jill; Froggett, Lynn; Kenning, Gail; Manley Julian & Muller, Lizzie (2019). Memory Loss and Scenic Experience: An Arts Based Investigation [66 paragraphs]. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 20(1), Art. 13, http://dx.doi.org/10.17169/fqs-20.1.3126.

Forum Qualitative Sozialforschung / Forum: Qualitative Social Research (FQS)

ISSN 1438-5627

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