Alive Inside opens on a ninety-year-old woman, sitting in a chair set against a black background, explaining that she can’t remember anything. The setting is very deliberate: she suffers from dementia, and as the film will argue repeatedly throughout, people with dementia in nursing homes live in a world devoid of meaning. We watch her start listening to Louis Armstrong’s “When the Saints Go Marching In,” and she lights up, telling us it reminds her of her school days. Then, the film cuts to an old black-and-white film strip, a stand-in for the kinds of memories the music must be evoking. The stories of her life start pouring out. What the social worker Dan Cohen discovered is that music seems to unlock a previously inaccessible world of memories for people with dementia, and Alive Inside follows his journey to bring this joy to more people.
The parts of the brain involved in remembering music are the last ones to be affected by dementia, and music can activate more parts of the brain than any other stimulus. So when we meet Henry, a ninety-year-old man suffering with dementia, who’s been in a nursing home for 10 years, it’s music that wakes him up. Before the music, he spent most of his time with his head down, his eyes closed, barely able to string together a few words or remember anything. When Henry is given headphones and music, everything changes. In closeup, we watch his eyes open wide, a smile appear, and the wheels of his brain start turning. Rossato-Bennet has slowed down the footage to magnify the changes. Henry starts singing, remembering stories of his past, and he brings joy to everyone in the room: he was thought to be lost to the world, out of his mind, but the music brought him back.
Director Michael Rossato-Bennett met Henry on his first day of shooting, which was meant to be a one-time thing where he would follow Cohen for a day. But he was so moved by Henry’s awakening, that he ended up following Cohen for three years. In that time, Cohen singlehandedly worked to get music into nursing homes, and get the people there access to the specific music from their past. Any old music won’t work. It has to be something that’s associated with your specific memories. Rossato-Bennett presents Cohen as a lone crusader, driving alone, carrying large boxes of iPods into a nursing home. And initially, he was met with much resistance: we have no problem medicating our elders with thousands of dollars of pharmaceuticals each month, but supplying them each with a $60 personal music system was unthinkable.
The film starts by showing us just how powerful music can be for people with dementia, and then goes on to tackle the whole system of nursing homes and elder care in the United States. There are five million people with dementia in the US, and within the next ten years, this number will at least double. The nursing home, the film explains, was born out of a marriage between the hospital and the poorhouse in the 20th century as a way to manage aging urbanites.
When people move into nursing homes, they lose their autonomy and much of their identity all in one day. Rossato-Bennett always emphasizes the institutional nature of the nursing homes, whether it’s showing us the cookie cutter identical meals being prepared for the residents or filming a nurse bringing medication from the perspective of the “patient.” The problem, Rossato-Bennet and Cohen argue, is that we’re treating our elders like patients and not people.
While Cohen’s goal started out as bringing personal music to as many nursing homes as he could personally managed, he soon realised this wasn’t enough: he’d reached a few dozen homes, but there are 650 in the country. Instead, the film searches for an entirely new way to manage people with dementia. The first sign of promise appears when they meet dementia patient Nell, who continues to live at home with her husband Norman, having avoided long-term care and drugs for ten years. The secret: music. Her husband has kept her constantly stimulated with music. It suggests there may be a different way forward for people with families, willing to do this kind of work, although it’s a more complicated one for those without.
Before completing the movie, Rosatto-Bennet posted a clip of Henry “waking up” with music to YouTube, and it went viral. Suddenly, Cohen’s mission transformed from something nobody was interested in hearing about to one that had more demand than he could meet on his own. The chief pleasure of the film is watching these various people with dementia listening to music, which causes them to wake up, become alert, and regain their identity. One participant hadn’t moved or responded to any stimulus in several years, but once she had her music, she started dancing in her bed. Although the film provides some interesting information about how music works its magic and the state of nursing homes today, it’s a little light on scientific information. It goes for the visceral instead of the intellectual, and in that it’s a success. But it’s such a fascinating idea that I wish they had dived deeper into why it works, instead of just what can be done with this discovery.
Alive Inside is now streaming on Netflix.