For the last 18 months, I have been fortunate enough to be part of Created Out of Mind, an interdisciplinary research project based at the Wellcome Collection in London. The project, funded by Wellcome, has brought together artists, clinicians, broadcasters, musicians, scientists and people living with dementias, with the aim of exploring, challenging and shaping perceptions and understanding of dementias. Previously to this, I have been (and continue to be) involved as a lead musician with Music for Life, a programme of creative music workshops that bring together professional musicians, people living with dementias and those that care for them, to create music together through improvisation. It was therefore with great excitement that I received the invitation from the British Council in Japan to take part in a study tour, Arts for an Ageing Society. What a wonderful opportunity to step outside the environment that I am familiar with, and discover how issues of ageing, inclusion, creativity and the arts are being explored somewhere else.
I had become aware through various articles in the news that Japan was beginning to face some of the issues associated with longer life expectancy, but it wasn’t until I arrived that the full picture became clear to me. Japan is termed a ‘super-ageing society’, with the national census in 2015 reporting that 26.7% of the population were aged 65 or older – a situation which is expected to be mirrored in the UK in about 30 years. Of this proportion, about 16% are living with a dementia. As life expectancy increases, so too will the number of people living with dementias. Japan is finding itself in the situation of having to become a world leader in creating a society that includes older people, one where they can continue to participate, contribute and feel valued. This presents many exciting opportunities, and of course challenges. With the eyes of the world on Japan for the Tokyo Olympics in 2020, there was definitely a sense of excitement and urgency amongst those we met and spoke with, as they expressed a desire to ensure that the opportunities were grasped so that Japan has the possibility of taking a lead in changing perceptions of older people on a global stage.
The British Council set up a wonderful range of meetings, public forums and discussions over a whistle-stop four days, and I found much to consider and reflect upon with new colleagues in Japan, as well as with the other tour delegates:
- Abid Hussain – Director of Diversity, Arts Council England
- Catherine Cassidy – Director of Engagement at Scottish Ballet
- Jane Findlay – Head of Learning, Dulwich Picture Gallery
- Andrew Barry – Elders Programme Manager, The Royal Exchange Theatre
Hope and Dignity
The first person that we met during the tour was Dr Shuichi Awata, of the Tokyo Metropolitan Institute of Gerontology. He spoke passionately and eloquently about the need to create a society where people living with dementias can live well, ‘with hope and dignity.’ For this to be achieved, it would be essential for the voices of those living with dementias to be heard. He spoke inspiringly of his desire for people with dementias to continue to feel comfortable and fulfilled in environments they are familiar with, and that they should continue to experience choice and agency. Key to achieving this will be the integration of health and social care in community based integrated care systems and dementia friendly communities, as set out in Japan’s New Orange Plan(2015).[1]Dr Awata also spoke of the need to uphold the human rights of those of us who are living with dementias. If we consider that people living with dementias are disabled, and we are informed by the social model of disability, then the need for changes in approaches and attitudes is clear. I had read an article published in the UK that set out the arguments for this approach[2], and it was exciting to meet someone in Japan who was looking at how to bring it into being.
This conversation with Dr Awata was especially interesting in the light of one of the research projects that I have been co-leading with Dr Hannah Zeilig, as part of Created Out of Mind. With All is a project which aims to explore the possibilities and challenges of working co-creatively using the arts with people living with dementias. Professional musicians and dancers work alongside people living with dementias, their family members and friends, using only improvisation. This approach aims to use the arts to engage with people’s innate creativity with the intention of bringing them more equally into relationship with others. There is a focus on the creative process and spontaneity, as well as the value of ‘in the moment’ shared experiences and relationships. As a way for people living dementias to be able to experience their continuing identity and agency, there appears to be much potential in this approach.
There was further opportunity to reflect on this in the afternoon of the same day. We were privileged to be able to observe musicians from the Tokyo Metropolitan Concert Hall as they lead a session at a day centre. Towards the end of the session, they playfully passed a selection of percussion instruments around the group. The ensuing interactions were fascinating, as the people living with dementias interacted with the musicians and each other spontaneously and creatively. The whole atmosphere became noticeably more enlivened as the professional musicians were led into improvised pieces by the clients of the day centre. In discussion with the musicians after the session, I shared with them the similarity of this approach to the practice of Music for Life, and the research I am undertaking in With All. All were agreed that there is much still to be explored, and that the potential for people with dementias and musicians alike is exciting.
A Sandbox for Music
After two days in Tokyo, and a very exciting journey on Japan’s legendary Shinkansen, or ‘bullet train’, we arrived in Kyoto. A further two days of discussions and public forums produced further opportunities for reflection and exchange of ideas. Again, we met musicians who were working with improvisation, and exploring the possibilities of this approach. Jun Suzuki told us about his ‘sandbox for music’ approach – where the emphasis is placed upon play and creativity. We also shared some thoughts about the intrinsic value of the arts for all of us as a means of exploring our experiences, both individually and communally, as we have done for millennia. The arts in their use with older people, and in particular those living with dementias, are so often viewed as therapy or ‘medicine’, rather than as something expressive, creative or exploratory. I was particularly moved by a presentation given by the manager of one of the care homes in Kyoto, who said that the arts could be a way for people to continue to live, and to continue to be creative. She spoke of the ways that the creative arts projects that were happening in the home she managed were enabling people to ‘continue to evolve and to express potential’. This brought me back to some lines from T.S Eliot’s poem East Coker, that seem to sum up so much of my thoughts and feelings:
…Old men ought to be explorers
Here or there does not matter
We must be still and still moving
Into another intensity…
Julian West (Head of Open Academy, Royal Academy of Music)
[1]An outline of the Orange Plan can be downloaded from the following web page: https://www.alz.co.uk/dementia-plans(accessed 22 April 2018)
[2]Shakespeare T, Zeilig H, Mittler P, 2017, ‘Rights in Mind: Thinking differently about dementia and disability’, Dementia DOI: 10.1177/1471301217701506