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Discussion & Study Guide

In and Out of Time

 

In and Out of Time has been used for a variety of classes and exhibitions, from sociology and psychology courses to private psychology practices and Alzheimer's Disease support groups. The film's lyrical style, however, has given it a much broader audience on television and at film festivals. This study guide is designed primarily for students of the psychology and care of people with Alzheimer's Disease and for caregivers.

About Alzheimer's Disease

An estimated 2.5 million Americans are currently suffering from Alzheimer's Disease. Although the disease was first described 90 years ago, it has only become a common diagnosis in the last fifteen years.

Alzheimer's is a progressive disease that affects both cognitive and physical abilities. The disease manifests itself by a distinct order of diminishing capabilities, with short term memory and cognitive functions suffering first. The result is that many Alzheimer's sufferers are initially frustrated by an inability to remember recent events or follow simple instructions.

It has been noted by neurologists, however, that there is a distinction between factual and procedural memory. The Alzheimer's patient may lose her capacity for factual memory, for remembering where she is or what she was just told, but retain for a much longer period of time her ability to do non-cognitive tasks, tasks that have become what one might call "second nature." A person suffering from Alzheimer's Disease typically might have difficulty processing new ideas or forming the appropriate words in a conversation, but will somehow be able to sing songs from childhood without missing a verse.

Understanding the distinction between factual and procedural memory is invaluable in dealing with those suffering from Alzheimer's Disease (or any other form of dementia). Knowing what the patient is still capable of doing procedurally at any given moment can make the difference between frustration and relative ease. Rather than focusing on the patient's inability to remember or to follow instructions, the caregiver can direct activities towards the patient's remaining abilities. These abilities are often simple but enjoyable ones--singing (or just listening ) to music, drawing, looking through picture books, or gardening. A calm environment simply structured around such activities makes life much easier for both patient and caregiver.

Discussion Questions

1. Discuss the kinds of situations that seemed particularly difficult for the grandmother in In and Out of Time.
   
   
2. Discuss the situations that appeared to be generally easier for her.
   
   
3. Physical exercise and social activity are important for a person with Alzheimer's Disease. Discuss appropriate activities.
   
   
4. What can caregivers do to simplify daily routines for a person with Alzheimer's Disease?
   
   
5. If you were to discover that your parent was developing Alzheimer's Disease today, how would you steer your relationship to adapt to the inevitable changes ahead?
   
   
6. How does one's assumptions about aging influence the way one might view a person with Alzheimer's Disease?
   
   
7. Discuss the idea that, "if this moment will mean nothing later, in a sense it means everything now."

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Some excerpts from T.S. Eliot's "Four Quartets " (parts of which are read at the end of the film):

Time present and time past
Are both perhaps present in time future,
And time future contained in time past.
If all time is eternally present
All time is unredeemable.
What might have been is an abstraction
Remaining a perpetual possibility
Only in a world of speculation.
What might have been and what has been
Point to one end, which is always present.

For most of us there is only the unattended
Moment, the moment in and out of time,
The distraction fit, lost in a shaft of sunlight,
The wild thyme unseen, or the winter lightning
Or the waterfall, or music heard so deeply
That it is not heard at all, but you are the music
While the music lasts.