In 2020, there were over 7,0000 people in Malta living with dementia, according to statistics released by the National Audit Office. This figure is projected to almost double by the year 2050.
These are sobering numbers that highlight the need for a conversation about the quality of life of a significant percentage of the Maltese population. Which is exactly what In Other Words, a play that is being produced by The Shrinking Violets, sets out to do. The production takes playwright Matthew Seager’s script and – via music, dramaturgy and a collaboration with the Malta Dementia Society – bursts the box wide open to not only create good theatre and stop there, but also to instigate continued awareness and discussions about the topic.
I meet up with Chiara Hyzler, who is directing the production and who explains that the focus of the script is the power of music as therapy, and how it provides comfort to those living with dementia or Alzheimer’s.
“Since we started working on the production I have found myself constantly reading articles, watching documentaries and trying to learn as much as I can about dementia. Through my research, I am discovering that more and more care homes are taking up music as a means to provide comfort and to supplement medication,” Chiara tells me.
She adds that case studies have shown that music therapy is an effective way to ignite memories and many times, we see even non-verbal people respond physically or verbally in some way.
This is precisely the crux of In Other Words, a poignant love story that tackles the impact of Alzheimer’s (a form of dementia) on one couple. Jane’s (Denise Mulholland) and Arthur’s (Jes Camilleri) relationship is portrayed through the years, jumping across time frames and giving us their individual perspective. Bringing it all together is the music that Arthur so loves, specifically Frank Sinatra’s Fly Me To The Moon, their ‘couple’ song.
Music, however, plays a much deeper role than that of the one song in this play, enforcing the realisation that many who care for those living with dementia already know – music, and art therapy in general, can work wonders in terms of life quality.
“Throughout the play you can see the effect Fly Me To The Moon has on Arthur. It keeps him grounded. They play the song whenever either of them is upset, or when Arthur is getting too frustrated. It’s a way to bring him back” Chiara explains. “You can see the transformation it brings forth in him, he starts singing and dancing. The music brings him back to a certain degree. And it’s just amazing.”
Music plays a strong role throughout the entire play, with composer Matteo Depares creating soundscapes that shift with the protagonists’ mood, and complement the passage of time. Chiara describes these soundscapes, which make up about 70% of the show, as almost becoming “a third character” in the show.
“ You can’t have a piece like this without giving focus to the music. I wanted to create an uncomfortable feeling that reflects Arthur’s state of mind, so there’s a huge difference between these soundscapes and their song. One is comforting, while the other reflects the sounds in Arthur’s head, becoming an audio journey of the frustrations he feels,” Chiara continues.
Unlike with other productions, where the music score is created very much separately, their composition was a continuing process that complements the narrative and direction. Or, as Chiara puts it, it wasn’t a case of creating a score and walking away. Matteo himself describes the process as aiming to capture a nearly cinematic view into Arthur’s head as he experiences the decline and fights to hold a grip on reality.
“Arthur’s reality becomes blurred and distorted, so this is mirrored in the sound we hear while this is happening. In contrast, Frank Sinatra’s music creates a valuable point of clarity and connection with his wife Jane,” Matteo explains, adding that his own grandmother lived with dementia in the last decade of her life, and that as a child he witnessed the harsh reality of the decline first-hand.
I return to Chiara, to find out about more about the challenges of directing such a complex play. She tells me that with such a tough topic she is constantly reminded not to overplay the physicality, and that it’s all about the subtlety. Not overusing the music or over-choreographing, as well as creating a harmony between all the elements in the room.
Chiara’s words are echoed by Anne Cuschieri, who works with the Malta Dementia Society, which supports individuals living with dementia and their families. She tells me about DancingtoDementia, a programme being offered to those who are living in care homes.
“We currently have two dance facilitators giving the sessions. It’s not something that a dancer can do without the right training, so right now we are a bit limited as to the number of homes where we can offer it. But we’re in process of training another eight dancers as we’ve seen first-hand the beneficial effect these sessions are having,” Anne tells me.
The NGO is also running Kuluri u Tifkiriet, a visual arts programme that is supported by the Arts Council Malta Programme Support Scheme that runs across the course of 10 weeks. The programme, which is being run by therapists and involves six people living with dementia, not just about the end result but more about the journey and how the participants react.
“We have seen that music, art, dance… these all bring out the best in people with dementia.
For those hours, they are living in their old world. Even if they forget an hour later, it doesn’t matter because for that hour they are living. There are many who either have no family or visitors, and who depend on any activities that the homes organise. Without those, they will simply be left staring at a wall all day,” Anne says.
This is precisely why the Society makes it a point to offer these events for free, even though they do come at an expense for the organisation itself.
“Our goal is to reach more people in homes. Funding is always an issue, naturally. As is awareness, even on the part of those who are caring for someone who has dementia. We hope that endeavours such as this one will help spread the word, and hopefully lead to more people benefitting from these forms of therapy,” Anne concludes.
Dementia and the local landscape
Prof Charles Scerri, chair of the Malta Dementia Society shares some facts.
Dementia is a clinical term referring to a group of brain diseases that result in progressive deterioration of cognitive functions. Approximately 70 per cent of all dementia cases are of the Alzheimer type. Symptoms include memory impairment, difficulties in spatial orientation, changes in mood and personality, communication deficiencies and functional losses in activities of daily living.
“Dementia doesn’t only affect the person living with it – for every individual with dementia, there are at least three or four others who are indirectly affected,” Prof Scerri says. “What causes the onset is unknown; it can strike at any age, but the older the individual gets, the greater the risk.”
As an example, Prof Scerri states that one per cent of 65-year-olds have dementia. At age 80, this increases to 30 per cent. At present there is no cure, and the treatment that is available only aims to slow down the decline. How many people manage to live independently after onset?
“While there are no official figures for independent living, it is calculated that approximately 80-85% of people living with dementia in the Maltese islands do so in their communities and are cared for by family members,” Prof Scerri says.
The good news is that Malta offers some of the best care services across Europe in respect to community-dwelling individuals living with dementia. These include a dedicated 24/7 Helpline, a number of Day/Night Dementia Activity Centres, Respite services and a Dementia Intervention Team.
And, Prof Scerri says that the argument for music, dancing and such forms of therapy is backed by science. Activities like dancing and music improve the overall quality of life and helps those living with dementia to express themselves.
“Such therapies also reduce challenging behaviours such as anxiety and agitation. Listening to music and singing has been found to help memory recollection and enhances social engagement, especially with caregivers,” he concludes.
The Malta Dementia Society can be reached at www.maltadementiasociety.org.mt /. The National Dementia Helpline is 1771. For other theatre-related pieces, check out this Holy Week production by Dwall Ġodda. Other Sunday Circle features can be accessed on the main page.