Let's Get Away from It All

Patient Proposal: Stream-of-Consciousness Filmmaking via Social Media for Older Adults with Dementia and Psychosis

Project Title

MemoryFlow: A Social Media-Based Filmmaking Intervention for Dementia Patients Experiencing Psychosis

Background and Rationale

Older adults with dementia often experience psychosis, including thought insertion, auditory hallucinations, and paranoia (e.g., beliefs that nurses are “one of them” or that they are being poisoned). These symptoms can be particularly distressing for patients who cannot tolerate neuroleptic medications due to side effects or medical contraindications. The reality of living on a fixed income while managing cognitive decline and psychosis exacerbates feelings of isolation, loss of agency, and disconnection from reality. Creative interventions, such as expressive writing and storytelling, have been shown to improve emotional regulation, cognitive organization, and social connection in patients with mental health challenges (Pennebaker & Smyth, 2016). Social media platforms like Twitter (X) and Facebook, with their accessibility and interactive features, offer a novel medium for patients to externalize their thoughts, create structured narratives, and communicate with trained geriatric psychiatrists.

This project proposes a no-budget, social media-driven filmmaking initiative where patients with dementia and psychosis collaboratively create a stream-of-consciousness film. The film will reflect their inner experiences—fragmented thoughts, memories, and emotions—while progressing forward to emphasize the present moment and foster a sense of agency. By using Twitter and Facebook as an “editing board,” patients can post thoughts, images, or short videos that trained clinicians help shape into a cohesive narrative, providing a therapeutic outlet and a means to connect with others.

Objectives

1. Therapeutic Expression: Enable patients to externalize and organize fragmented thoughts and experiences, reducing distress from thought insertion and paranoia.
2. Cognitive Support: Teach patients to use social media as a tool for structuring thoughts, akin to a digital journal, to maintain cognitive coherence.
3. Social Connection: Facilitate communication between patients and geriatric psychiatrists via social media, fostering trust and reducing paranoia (e.g., countering beliefs like “the nurse is one of them”).
4. Creative Empowerment: Create a collaborative, forward-moving stream-of-consciousness film that captures patients’ lived experiences, offering an escape from the challenges of aging and cognitive decline.
5. Accessibility: Ensure the intervention is feasible for patients on fixed incomes by using free platforms (Twitter/X and Facebook) and requiring no financial resources.

Target Population

• Older adults (aged 65+) diagnosed with dementia experiencing psychosis (e.g., thought insertion, auditory hallucinations, paranoia).
• Patients who cannot tolerate neuroleptic medications due to side effects or medical contraindications.
• Individuals with access to a smartphone, tablet, or computer and basic internet connectivity (or access to shared devices at a care facility).
• Patients capable of engaging in guided creative activities with support from clinicians or caregivers.

Methodology

The project will be implemented in a structured, clinician-guided process using Twitter (X) and Facebook to create a stream-of-consciousness film. Each step leverages social media’s accessibility and interactivity to support patients’ cognitive and emotional needs.

1. Recruitment and Training:
   • Participants: Recruit patients through geriatric psychiatry clinics, community centers, or care facilities. Ensure informed consent, emphasizing the therapeutic and creative nature of the project.
   • Technology Training: Provide simple tutorials (via caregivers or clinicians) on using Twitter (X) and Facebook to post text, images, or short videos. For patients with limited tech skills, caregivers or volunteers can assist with posting.
   • Clinician Involvement: Train geriatric psychiatrists to moderate social media interactions, interpret posts, and guide narrative development while addressing paranoia and thought insertion.
2. Content Creation:
   • Posting Thoughts: Patients post short text updates, photos, or 10-15 second videos on a private Twitter (X) or Facebook group, reflecting their thoughts, memories, or sensory experiences. Examples: “I hear the birds today, like when I was a child,” or “The nurse smiled, but I’m not sure why.”
   • Stream-of-Consciousness Style: Encourage patients to post spontaneously, capturing the fluid, non-linear nature of their thoughts. The forward-moving narrative avoids backward-looking flashbacks, focusing on present experiences or future hopes to align with the therapeutic goal of grounding patients in the moment.
   • Prompts: Clinicians provide gentle prompts (e.g., “What’s a memory that makes you smile?” or “What do you see around you right now?”) to stimulate posts and reduce anxiety about sharing.
3. Narrative Development:
   • Editing Board Concept: Use the social media feed as a digital editing board. Clinicians and volunteers (e.g., film students or community members recruited via social media) organize posts into a loose narrative, grouping them by themes (e.g., childhood memories, sensory experiences, emotions).
   • Collaborative Filmmaking: Convert posts into film elements:
     • Text posts become subtitles or voiceovers (recorded by volunteers or patients, if able).
     • Photos or videos are edited into short sequences using free software like DaVinci Resolve or iMovie.
     • Audio elements (e.g., patient-recorded thoughts or ambient sounds) are added to enhance the stream-of-consciousness feel.
   • Forward Progression: Arrange content chronologically or thematically to create a sense of moving forward, reflecting patients’ ongoing experiences rather than dwelling on past losses.
4. Therapeutic Moderation:
   • Geriatric Psychiatrist Role: Clinicians monitor posts for signs of distress, paranoia, or thought insertion (e.g., “Everyone is poisoning me”). They respond with validating comments (e.g., “It sounds really hard to feel that way. Can you share what you saw today that felt safe?”) to build trust and reframe paranoid thoughts.
   • Cognitive Support: Clinicians help patients recognize their posts as part of a creative process, reinforcing a sense of agency and reducing the impact of intrusive thoughts.
   • Group Interaction: Encourage patients to comment on each other’s posts in the private group, fostering a sense of community and reducing isolation.
5. Film Assembly and Sharing:
   • No-Budget Tools: Use free editing software and open-source music (e.g., from Free Music Archive) to compile the film. Volunteers can donate time for editing and production.
   • Distribution: Share the final film on the project’s public Twitter (X) or Facebook page to raise awareness about dementia and psychosis. Alternatively, screen it at care facilities or community centers for patients and families.
   • Therapeutic Feedback: Show patients their contributions in the film to reinforce their sense of accomplishment and validate their experiences.

Social Media Strategy

• Twitter (X):
  • Use hashtags (e.g., #MemoryFlowFilm, #DementiaStories) to organize posts and attract volunteers or community support.
  • Post short updates or polls to engage the broader community (e.g., “What’s a memory that makes you feel alive?”) to normalize patients’ contributions and reduce stigma.
  • Leverage Twitter’s real-time nature for quick clinician-patient interactions.
• Facebook:
  • Create a private group for patients and clinicians to ensure privacy and safety.
  • Use Facebook Live for group discussions or storytelling sessions, allowing patients to participate in real time or watch later.
  • Post behind-the-scenes updates to attract volunteer editors or supporters from local film communities.
• Crowdsourcing Support:
  • Post calls for volunteers (e.g., film students, retired editors) on both platforms, emphasizing the project’s social impact.
  • Request donated resources (e.g., old smartphones, tripods) via local Facebook groups or Twitter threads.

Expected Outcomes

• Therapeutic Benefits:
  • Reduced distress from thought insertion and paranoia by externalizing thoughts in a structured, creative format.
  • Improved cognitive organization through the act of posting and seeing thoughts reflected in the film.
  • Enhanced emotional connection through clinician feedback and peer interactions, countering feelings of isolation.
• Creative Output: A stream-of-consciousness film that captures the lived experiences of dementia patients, raising awareness and fostering empathy in the community.
• Feasibility: The no-budget approach ensures accessibility for patients on fixed incomes, relying solely on free platforms and volunteer support.

Challenges and Mitigations

• Technology Barriers: Some patients may struggle with social media. Mitigation: Provide hands-on support from caregivers or volunteers, or allow verbal contributions recorded by others.
• Privacy Concerns: Patients may fear surveillance or judgment. Mitigation: Use private groups, anonymize contributions in the final film, and ensure clinicians address paranoia sensitively.
• Paranoia Management: Beliefs like “the nurse is one of them” may persist. Mitigation: Clinicians use posts to explore these feelings, redirecting focus to safe, positive themes.
• Variable Participation: Patients’ cognitive abilities may fluctuate. Mitigation: Allow flexible participation (e.g., one post per week) and use clinician prompts to sustain engagement.

Evaluation

• Patient Outcomes: Assess changes in distress, cognitive coherence, and social engagement using validated scales (e.g., Neuropsychiatric Inventory for psychosis symptoms) and qualitative feedback from patients and clinicians.
• Film Impact: Gather feedback from viewers (caregivers, families, community members) on the film’s emotional resonance and awareness-raising potential.
• Feasibility: Track participation rates, volunteer involvement, and ease of social media use to refine the approach.

Budget and Resources

• No-Cost Approach: The project requires no financial investment, using:
  • Free social media platforms (Twitter/X, Facebook).
  • Free editing software (e.g., DaVinci Resolve, iMovie).
  • Volunteer time from clinicians, caregivers, and community members.
  • Donated or shared devices (e.g., smartphones at care facilities).
• Community Support: Leverage Twitter and Facebook to recruit volunteers and resources, ensuring sustainability.

Conclusion

MemoryFlow uses Twitter and Facebook as therapeutic and creative tools to empower older adults with dementia and psychosis to express their inner worlds, maintain cognitive coherence, and connect with others. By transforming fragmented thoughts into a forward-moving, stream-of-consciousness film, the project offers an escape from the challenges of aging and cognitive decline while fostering hope and agency. With the guidance of trained geriatric psychiatrists, this no-budget initiative harnesses the power of social media to create a meaningful, accessible intervention for a vulnerable population.

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Implementation Tips for No-Budget Filmmaking

• Engage Local Communities: Post on Twitter (X) and local Facebook groups to recruit film students, retirees, or hobbyists willing to donate editing skills or equipment.
• Simplify Production: Focus on raw, authentic content (e.g., shaky smartphone videos) to reflect the stream-of-consciousness style, reducing the need for polished production.
• Clinician Training: Ensure geriatric psychiatrists are trained in social media moderation and narrative therapy to guide patients effectively.
• Patient Safety: Use private groups and anonymized posts to protect patient privacy and address paranoia about being monitored.

Connection to Your Previous Conversations

Your interest in thought insertion, paranoia, and therapeutic interventions for mental health challenges (e.g., self-monitoring strategies, expressive writing) informs this proposal. The stream-of-consciousness approach aligns with your prior discussions of fragmented narratives and the need to structure chaotic thoughts into coherent stories, while the focus on non-pharmacological support reflects your awareness of the limitations of neuroleptics for some patients.