Friendship,curiosity and the city: Dementia friends and memory walks in Liverpool

Introduction: Walking, remembering, connecting

Two men are walking up an icy, cobbled street in Liverpool. Their conversation stops and starts as they move, noticing and being distracted by things along the way. Dave, in his fifties, is the chattier of the two. He is leading the conversation and seems to be enjoying the morning. Things along the way remind him of others – a cathedral sparks recollections of his daughter, who works in churches as a signer for people with hearing difficulties. Dog poo on the street starts a conversation about people who don’t pick up after their pets. Dave tells a story about a ghost, seen in a church in Birmingham; he repeats this story several times. When they come across a patch of snow on the ground, Dave stumbles and needs some help. Sean, his younger companion, steps in to guide him around the obstacle. Later, when they are in the cathedral, Dave needs help again. He has forgotten how to unbutton his coat.

Dave is living with dementia, and Sean is a volunteer with a charity, participating in a befriending scheme which supports people with this illness and their carers, friends and families. This morning, as they have done many times before, they are walking together. They are visiting one of Dave’s favourite places – the Anglican Cathedral – and the café there. On other occasions they have been on the ferry across the Mersey, and to the Museum of Liverpool. They find that the city, as well as representations of it and objects from it, both of which are found in the Museum, spark memories in Dave and conversations with his volunteer-befriender. Walking together gives shape to these memories and interactions.

Sue, a staff member at the charity, helped put this walk in context. She explained that Dave ‘likes the old Liverpool part because that’s where his memories are when he was a young lad’. ¹ These memories also draw together Dave and Sean, at least during the time they spend together, when they find a mutual interest in the city and in each other. This curiosity forms a catalyst for connection and a kind of friendship. This friendship has a special value, which another staff member at the charity, Paula, alluded to:

The benefit is for the person with dementia is to have a free-flowing conversation with a person who is willing to listen and is interested and who is not your family member, who is not your carer, who is a friend, he’s there to befriend you.

These observations highlight the potential for places – cities in particular – as objects of and contexts for shared and mutual curiosity, to be catalysts for relationships, including forms of friendship, which in turn can be beneficial to wellbeing. In this paper, we examine relationships between cities, curiosities and friendships through the lens of befriending practices, directed at people with dementia and those who support them. This discussion brings new meanings to terms that have been coined by the Alzheimer’s Society in the UK: Dementia Friends and Dementia Walks.

We argue that the city is not just a vessel for friendships or a problem to be solved or mitigated through them. Georg Simmel presented such a case in his influential essay, ‘The Metropolis and Mental Life’, which identified metropolitan relationships with reserve, distance and distrust (Simmel, 1980 [1903]; see also Giddens, 1992). According to Simmel, urban dwellers compartmentalise their lives and relationships, making it difficult to relate to others in a ‘holistic way’ (Pahl, 2000: 36). This analysis of fragmented and alienated metropolitan, modern life has since been interrogated and largely refuted (Spencer and Pahl, 2006), but relationships between cities and friendships remain poorly understood – a gap in knowledge and understanding that this special issue is designed to address, and to which we seek to contribute. We do so by exploring how urban encounters – with things, places and others – can draw people together in ways that can be beneficial for wellbeing.

Of course, urban encounters do not always draw people together; for this to happen, they must be experienced in particular ways (Thrift, 2004). In this paper, we identify one catalyst that can draw people together in such contexts: relational curiosity. Curiosity has been defined as ‘a strong desire to know or learn something’ (Pearsall, 2002: 351). Relational curiosity – being curious about others, and being curious with them – challenges commonplace assumptions that curiosity is an essentially private drive, motivation, desire or state of mind (Phillips, 2015). The concept of relational curiosity develops Rachel Smith’s (2008: 159) assertion that curiosity has the potential to ‘link people together and offer new modes of engagement with the world’. It also fleshes out Mark Zuss’s (2012: 88) assertion that ‘critical curiosity is manifest in acts of intervention into daily life in the interest of transforming it’. Relational curiosity can take the form of shared interest in things and places – illustrated by Dave and Sean’s interest in the streets they walked through – as well as mutual curiosity – Dave’s interest in Sean and vice versa.

When we go on to speak of the relationship between Dave and Sean as a friendship, we are using a term that means different things to different people. An influential, foundational thinker in this context, Aristotle (1968) distinguished three overlapping types of friendship – the good (who know who we really are), the pleasant (with whom we share activities and enjoy company) and the useful (who help and support each other) (Barkas, 1985). This typology has been elaborated (Spencer and Pahl, 2006), updated and debated (Kathiravelu, 2013). Relationships experienced through dementia befriending schemes take different forms, some of which can be understood on these terms as forms of friendship (Ward et al., 2012). As such, they also build upon the differentiated, critical, sometimes counter-intuitive approaches to friendship advanced by political theorist and classicist Danielle Allen (2004), the Christian-identified scholar John Swinton (2000) and dementia worker Gaynor Hammond (2002), all of whom are considered below. These scholars argue, in different ways, that friendships can be important both for those who experience or are affected by them and also for society more widely. As Liz Spencer and Ray Pahl (2006: 1) put it, friendships can be a form of ‘hidden solidarities’ and a kind of ‘social glue’, as well as a source of self-esteem, personal happiness and hope.

This paper examines relationships between friendship, curiosity and the city through the findings of a research project, which investigated the Liverpool Decade of Health and Wellbeing (LDHW) and its promotion of ‘five ways to wellbeing’. We focus upon two of the five ways – known as Take Notice and Connect – and examine their translation and dissemination through health and wellbeing advice and through specific schemes such as dementia befriending. To investigate this, we conducted participant observation, taking part in sessions involving befrienders and people living with dementia. We also conducted 27 interviews with people who were involved in the design and/or delivery of LDHW, focusing upon understandings of and reflections on the projects in which they were involved. Interviewees included staff members at the charity introduced above (Mary, Jenny and Paula) and two volunteer-befrienders (Sean and John) who were accompanied by one of their client-friends ² (Dave). We also interviewed participants in a scheme called the House of Memories, which took place at the Museum of Liverpool, and a number of health and wellbeing professionals, some of whom are quoted below. This research took place between June 2012 and May 2013 and was carried out by Richard Phillips, Bethan Evans and Joanna Long, who joined this project as a Research Assistant. Informed consent was sought from all interviewees and all names (of individuals and organisations) here are pseudonyms except where anonymity would not be possible or where explicitly agreed.

Take notice and connect – in the city

The dementia befriending scheme introduced above and some of the venues visited and activities pursued by befrienders and their client-friends were allied to and/or supported financially by the LDHW. These schemes, venues and activities were selected on the basis of their relevance to one or more of the five ways to wellbeing. The five ways were identified and endorsed within a review of evidence-based health and wellbeing interventions, which was commissioned by the UK government and published in 2008 by the New Economics Foundation (NEF, 2008). Two of the five ways – Connect and Take Notice – are particularly relevant to this study and are therefore most prominent in this paper. The others, less directly relevant, are Be Active, Keep Learning and Give. ³ The LDHW was an early and influential adopter of the five ways (http://liverpool.gov.uk/leisure-parks-and-events/Events/healthandwellbeing/). The health authority (Primary Care Trust or PCT) allocated a budget to support schemes designed to promote one or more of the five ways (£300,000 was awarded through grants of £2000 to £7000) (source: Interview with Mersey Forest Partnerships, which administered some of this funding).

Liverpool – the city in which these initiatives are situated – has a population of just under half a million, within the Merseyside metropolitan area which is home to around 1.4 million, and includes the Wirral peninsula (http://worldpopulationreview.com/world-cities/liverpool-population/, accessed 1 July 2015). Other points to note, which become relevant to this research, are the city’s history as a port, with dockside work and industry, some of which survives and is represented in the Museum of Liverpool, situated in the regenerated Albert Dock (Haggerty et al., 2008). Following years of postwar, post-imperial economic decline, the city has experienced high levels of deprivation, reflected in both socio-economic indicators and also in measures of health and wellbeing (Belchem, 2006). Recent economic renaissance has been driven, in part, by cultural projects such as the European Capital of Culture festival, 2008 (Haggerty et al., 2008). Synergies between efforts to improve health and wellbeing and a wide range of artistic and creative work have been reflected in some innovative projects and networks (Sixsmith and Gibson, 2007), and this defines an interface in which the LDHW, the five ways and the research described in this paper are located.

The five ways overlap and interconnect. Chris Price, Health and Wellbeing Partnership Manager at Liverpool PCT, stressed that ‘it’s the balance of the five together which people need to make it most effective’. He explained that, while connections with ‘family, friends, colleagues and neighbours’ are crucial for wellbeing, Connect should not be seen in isolation, but in relation to the other ways to wellbeing, which involve giving, being active, learning and taking notice. Intersections between the five ways are recognised in many of the schemes that have been allied to and funded through the LDHW. These include a community garden in suburban Liverpool, which is designed to build connections between neighbours, peers and generations, while also encouraging participants to take notice of the garden, in each case with positive implications for their wellbeing (Phillips et al., 2015). These two ways to wellbeing are conceived as follows (NEF, 2008: 3):

Take Notice: Be curious. Catch sight of the beautiful. Remark on the unusual. Notice the changing seasons. Savour the moment, whether you are walking to work, eating lunch or talking to friends. Be aware of the world around you and what you are feeling. Reflecting on your experiences will help you appreciate what matters.

Connect: Connect with the people around you. With family, friends, colleagues and neighbours. At home, work, school or in your local community. Think of these as the cornerstones of your life and invest time in developing them. Building these connections will support and enrich you every day.

Synergies between connecting and taking notice in ordinary urban settings speak to broader questions about how places can be used to benefit wellbeing. Such places – conceived as therapeutic landscapes – are said to promote the physical, mental and spiritual wellbeing of those who spend time there. Traditionally, therapeutic landscape research and practice have tended to privilege ‘exceptional’, out-of-the-ordinary spaces such as forests and beaches (Conradson, 2005). This tendency has been challenged through recognition of ‘localized and ordinary spaces of care and wellbeing’ (Little, 2012: 218) including ‘urban, domestic and everyday places’ (Milligan et al., 2004: 1785).

David Conradson’s observation that nowhere is ‘intrinsically therapeutic’ (Conradson, 2005: 338) and conversely that everywhere is potentially therapeutic raises questions about how to engage with ordinary places in beneficial ways. Take Notice – attending to ‘the world around you’ – presents one possible answer to this question. The evidence base for this way to wellbeing was derived primarily from research on mindfulness practices as a treatment for depression and anxiety (NEF, 2008). Sam Thompson, a co-author of the NEF report that coined this phrase, told us that mindfulness practices and philosophies such as meditation and yoga can be difficult to communicate, and that it was necessary to ‘give some examples that would feel quite normal in real life to people’. Merseycare’s Mandy Chivers added that some might see mindfulness as ‘new age or weird’. When she set up a working group to explore ways of implementing this way to wellbeing, Chivers emphasised its concern with ordinary, everyday urban settings, calling this the ‘Take Notice in the City working group or action set’. This group focused upon what it might mean in practice to explore the ‘beautiful’ and the ‘unusual’ within ordinary, everyday settings such as ‘walking to work, eating lunch or talking to friends’.

The city plays an important, though not unique, part in this story. The Liverpool area is the locus of health care providers and projects including the PCT, the LDHW and Merseycare. It also forms the setting for the activities described in this paper – including museum visits and urban walks. Many of these spaces and activities are funded and maintained by and through Liverpool institutions and bodies including Liverpool City Council and National Museums Liverpool. These public and third sector organisations play an important part in shaping accessible and walkable environments, which researchers elsewhere have linked to the wellbeing of older people (Clarke et al., 2010). The city and particularly the city centre is also a space in which people are thrown together with others and/or have the chance to encounter them (Phillips, 2015). It is also a site of shared memories, such as those gathered together in museum collections. That said, the activities described here are not uniquely urban. ‘Taking notice’ is possible in rural settings too, of course. It is beyond the scope of this paper to comment on the ways in which the issues discussed here – health and wellbeing provisions, dementia support charities, public space and museum resources, and so on – vary between rural and urban areas. Still, the experiences described in this paper are at least contingently urban.

Dementia friendship

Projects that engage with friendship within the ways to wellbeing include the befriending scheme introduced above. Befriending refers to support and encouragement provided by a trained volunteer to another person and tends to involve ‘informal and supportive’ rather than goal-oriented relationships (Mulvihill, 2011: 180). Befriending is typically used to support people experiencing life transitions such as adolescence and ageing or health and/or relationship challenges, and those caring for or supporting these individuals (Andrews et al., 2003; Stevens, 2001). Charlesworth et al. (2008: 13) define befriending as ‘a form of social support where a supportive other is introduced to, or matched with an individual who would otherwise be socially isolated’ and in which support is provided through ‘a range of interventions from emotional support to tangible assistance’, and through practices including ‘companionship and conversation’.

Befriending schemes typically foster sustained relationships, which can sometimes be understood as kinds of friendship. In the context of dementia befriending – directed at people with dementia and/or those who care for or live with them – these might be termed dementia friendships. Such relationships must be distinguished from the scheme known as Dementia Friends, which now claims over one million participants in the UK and is run by the Alzheimer’s Society. Somewhat confusingly, given its title, this scheme does not arrange or encourage befriending. Rather, participants learn more about dementia and ‘some of the ways they can help people living with the condition’. This ranges from ‘being more patient in shop queues, to volunteering, to campaigning for change’ (https://www.dementiafriends.org.uk/WEBArticle?page=how-to-get-involved, accessed 15 May 2015). In contrast, the dementia befriending schemes considered in this paper and the practices with which they are associated are given to depth rather than breadth, and they conform more closely to friendships.

An expanded understanding of ‘dementia friendship’ may depart from commonplace assumptions that friendship is a private, reciprocal and sentimental bond between individuals (Allan, 1979). This has been expressed variously as ‘an intimate relationship that is based on relatively free association’ (Descharmes et al., 2011: 13) and as ‘a voluntary caring relationship between two or more persons having no kinship or legal bonds’ (Barkas, 1985: ix). As a ‘social construction involving specifiable principles of organisation’ (Allan, 1979: 7), friendship is understood differently in different times and places, and ideas about friendship can be challenged and reimagined (Descharmes et al., 2011). Received and popular ideas about friendship tend to be idealised, reflecting stereotypes rather than ‘actual flesh-and-blood relationships’ (Spencer and Pahl, 2006: 4). In practice, friendships are more eclectic and elastic than is sometimes assumed. Spencer and Pahl (2006: 33) argue that ‘there is no agreement about precisely what is meant or how the term should be used’, some people referring to their ‘spouse or partner as a friend’, some reserving this word for ‘a select group of individuals’ and others for ‘all those whom they know well enough to call by their first name’ (see also Pahl, 2000). These observations echo Aristotle, one of a number of key thinkers including Cicero (1967) and Plato (1928) to have problematised this term, who distinguished the three types of friendship, introduced above: good, pleasant and useful friendships (Barkas, 1985). The multiple forms and parameters of friendship have more recently been the subject of a wide range of theoretical and empirical work, with contributions by Michel Foucault (1997), Jacques Derrida (2006), Anthony Giddens (1992), Danielle Allen (2004), Laavanya Kathriavelu (2013) and Tim Bunnell (Bunnell et al., 2012). Aristotle’s typology has been elaborated and updated through distinctions between ‘simpler’ and more ‘complex’ relationships (Spencer and Pahl, 2006: 60); friendships with more and less contact, and with stronger and weaker ‘sense of presence’ (Spencer and Pahl, 2006: 74); and between those with higher and lower levels of commitment, which can also be contrasted between ‘chosen’ and ‘given’ bonds (Spencer and Pahl, 2006: 198). The fluidity and multivalence of this term makes it necessary to specify and negotiate its meanings, as they are and as they might be, and also makes it possible to contest some variously cherished and unthinking assumptions about these relationships, such as the assumptions that they are necessarily private, reciprocal, sentimental and permanent bonds.

Dementia befriending practices resonate with a number of theoretical and practical interventions that seek to reconfigure friendship and mobilise it as a vehicle for social change. Danielle Allen advances an understanding of ‘political friendship’ that is not necessarily sentimental or based on intimacy or ‘closeness’ (Allen, 2004: 119), but is practice-based and socially engaged (Allen, 2004: 127–129). Envisaging ‘acts of care’ (Allen, 2004: 119) in ‘interactions with strangers’ (Allen, 2004: 138), she repositions friendship from the private to the public sphere, where it can be a cohesive force within divided societies and fractured communities. Others more explicitly jettison assumptions or ideals of reciprocity and equality within friendships (Allan, 1979). John Swinton (2000) advocates ‘radical friendship’ organised around empathy and social justice, in which communities reach out to people with dementia and mental illness. Drawing upon research and practice in nursing and mental health care, he seeks to learn from ‘the friendships of Jesus’, envisaging ‘radical friendship’ that reaches out to ‘the poor, the outcast, and the stranger’ (Swinton, 2000: 9). This approach speaks directly to friendships involving carer-befrienders and people with dementia. In The Friendship Club (2002), Gaynor Hammond describes her experience of founding and running a centre for people with dementia, ‘a place where friendship would flourish’ (Hammond, 2002: 3). This anticipates the observations, introduced above, about the relationship between Sean and Dave in Liverpool, which can be understood not simply as formal befriending, but as a form of friendship (see Ward et al., 2012).

Though some befriending practices usefully question ‘taken-for-granted assumptions about what makes a friend a friend’ (Pahl, 2000: 1), it does not follow that every assumption about friendship should be jettisoned. Empirical studies of friendship tend to concur that all relationships worthy of this name must have certain core qualities, one of which is a sense of connection. As Spencer and Pahl argue, friendship ‘can take many forms but, at its strongest, it is based on trust, commitment and loyalty’ (Spencer and Pahl, 2006: 210). This is echoed in studies of befriending schemes. The voluntary arrangements, which these schemes almost always follow, fit comfortably with understandings that ‘friendship is a relationship of choice’ (Andrews et al., 2003: 350). And, though befriending may be asymmetric in that one person or group sets out to help another, a degree of reciprocity is important to most participants. A study of befriending services for older people in the UK found that many participants attached importance to ‘friendly reciprocity, which they recognised as an ingredient of “real” friendship’ (Andrews et al., 2003: 349). Some form of reciprocity is also crucial in negotiating the power relations of friendship. Though dementia befriending is inherently asymmetric, since people with dementia are often forced to depend upon others for permission to do ordinary things like walking, participants’ freedom to opt in and out of these relationships is important in ensuring that both maintain some agency and that neither feels nor is powerless.

For most participants, befriending felt contrived at first, but at its best it developed into ‘a reciprocal and mutually reinforcing relationship that provides both parties with non-financial rewards’ (Andrews et al., 2003: 351). By recognising that ‘friends are people who like each other’ (Spencer and Pahl, 2006: 59), it is possible to avoid diluting this term or confusing it with other positive or beneficial relationships. And, by recognising that friendships may take different forms, beyond their common core, it is possible to see that the friendships advanced through some dementia befriending schemes do not displace or threaten other understandings of friendship, which they sit alongside and potentially complement.

Befriending schemes advance an understanding of friendship that pays particular attention to the practices through which friendships are formed and performed, and through which their potential benefits are explored and in some cases realised. This borrows Danielle Allen’s argument that ‘friendship is not an emotion, but a practice’. It adapts Allen’s argument, drawn from the specific context of political friendships combatting racism (Allen, 2004: xxi), that: ‘Friendship begins in the recognition that friends have a shared life—not a common, nor an identical life—only one with common events, climates, built-environments, fixations of the imagination, and social structures’. A focus on practice also resonates with Thrift’s (2004: 62) discussion of the affective life of cities where affects ‘occur in an encounter between manifold beings, and the outcome of each encounter depends upon what forms of composition these beings are able to enter into’. Thus, it is not just the relationship between the person living with dementia and their befriender that matters, but also their encounter with the city and material objects therein (Phillips et al., 2015).

Friendship and curiosity

The connection between two people, which Ray Pahl identified as the heart of friendship, depends upon getting to know each other and finding ways to spend time together happily or beneficially. In this context of befriending, this means moving beyond the initial sense that this may be ‘contrived’ and pursuing a deeper connection and ‘real’ friendship (Andrews et al., 2003: 349). Curiosity in the other person – mutual or empathetic curiosity – is crucial to this development (McAvoy, 2014). Like friendship, curiosity can be seen as a disposition – in this case, ‘a strong desire to know or learn something’ (Pearsall, 2002: 351) – and/or as the practices through which this desire is expressed. Curiosity is not necessarily a catalyst for friendship – it can express a desire to know about people rather than to know them – though curiosity can sometimes be a vehicle for forming, performing and mobilising relationships including friendships.

Empathetic curiosity can be expressed through a variety of means – from asking others direct questions to finding out about them through less direct approaches. Richard Sennett (2012) argues that ‘getting along with those who are different’ begins with finding out about them, which depends upon communication skills (Sennett, 2012: 230). These skills range from direct questions to non-verbal communications including ‘listening well’ and ‘behaving tactfully’ (Sennett, 2012: 6). Sennett argues that ‘the listener’s empathy can be expressed by maintaining eye-contact even while keeping silent, conveying “I am attending intently to you” rather than “I know just what you feel”’ (Sennett 2012: 21). These insights are particularly relevant to dementia support. Phil McAvoy (2014) stresses the importance of practical skills and dispositions including eye contact, attentiveness to differences in needs, picking up on emotional cues and being sensitive to pacing issues in the course of conversations.

These indirect approaches may be particularly helpful where certain dementia-related experiences are present – where people may not be able to recall or articulate answers to direct factual questions, remember what they are told and/or demonstrate certain conversational competencies. ⁴ John, a befriending volunteer, illustrated how it is possible to express curiosity without asking too many direct questions. He tries to find out about a person by asking their relatives and working up a ‘background story’ which might contain clues about what they like and have liked when they were a child or younger adult (John, Dementia Support Charity). Finding out about a person with dementia can also involve broader enquiries. The Alzheimer Society’s website explains that ‘a Dementia Friend learns a little bit more about what it’s like to live with dementia and then turns that understanding into action’ by bringing additional insights to his or her existing networks and relationships including with people who are living with dementia, and others too (www.dementiafriends.org.uk/WEBArticle?page=what-is-a-friend, accessed 15 May 2015). In more immediate encounters, indirect and unchallenging conversational styles are recommended by experienced befrienders. John contrasted the way we were interviewing him with his own interactions with two men he befriends: ‘You’re asking direct questions. But if you knew that you were seeing me for a year, every week, them questions come out in different ways’ (John, Dementia Support Charity). Conversations between befrienders and people with dementia can also use things as prompts. Gaynor Hammond (2002: 14) suggests how this can be done:

Avoid asking questions; rather, use things around you as a talking point. ‘What a lovely picture on the wall!’‘Isn’t this a pretty room!’‘What a lovely view!’ A question requires a correct answer. For example, the question ‘What did you have for dinner?’ could cause distress because they cannot remember. Whereas ‘What a nice picture!’ requires only a comment or opinion – they might say they hate the picture! That’s ok.

This approach might easily come across as patronising and indifferent – showing little genuine interest in a person as an individual – but it is evidently well meaning and it does hint at something useful, in the form of indirect and undemanding conversation. Cues such as the picture in this example variously spark memories (in the case of familiar objects) and prompt curiosity (about the unfamiliar), in each case sidestepping short-term memory problems (affecting some but not all people with dementia) that can make conversation difficult, and also providing common ground for interaction and relationship building (Manchester, 2015).

Indirect conversational approaches can work with cues that either happen to be present or are brought in deliberately for this purpose. It is common for family and friends of people living with dementia to compile memory books and collections of objects, which can later be used in conversations with them (Leanne, Dementia Services, Liverpool City Council), sometimes at the suggestion of medical professionals (Varley, 2008) or with the assistance of volunteers through charities (Paula, Dementia Support Charity). These principles and practices have been formalised through a scheme, known as the House of Memories, which compiles and lends out boxes of objects that can trigger memories that may be shared by members of a generation and geographical area. This is one of a range of schemes that the Museum of Liverpool promotes for people with dementia and their carers and family members, others including ‘life story work’ and ‘talking mats’ (www.liverpoolmuseums.org.uk/learning/projects/house-of-memories/; Varley, 2008). These schemes are explained in training days, demonstrating and exploring how friends and carers of people with dementia might use memory boxes and Museum displays (www.liverpoolmuseums.org.uk/learning/projects/house-of-memories/buddy-days.aspx). Mary explained how Dave benefits from this:

He loves museums, the art galleries, anything like that he really enjoys. And he’s just able to talk, because his short-term memory is so poor, when he goes to the museum and he sees all the old things, it really does stimulate good conversation. And he really gets a lot out of going there. (Mary, Dementia Support Charity)

Mary’s colleague, Paula, echoed these points and also mentioned the Liverpool Football Club Gallery:

we took loads of people there, men mostly, and they wanted to go there more and more. We encouraged befrienders to take people to the Liverpool Museum, to the new one because it’s free and there are quite a few objects and things all about Liverpool and we hope that triggers memories as well. (Paula, Dementia Support Charity)

More-than-visual cues are important in this context, both in sparking memories and also in arousing curiosity. Paula remembers how a ‘stinky’ orange soap opened up a conversation between herself and a woman with dementia. It reminded Paula of ‘the soap [her] mum used in Russia to wash clothes’, while the woman spoke about memories of soap making on the Wirral. Throwing some light upon the power of sensory objects to stimulate curiosity, philosopher Mark Zuss traces curiosity to the ‘immersion of bodies in the world’ (Zuss, 2012: 128), arguing that sensory experiences awaken the desire to know: ‘like small flames, questions arise from the filaments of our senses’ (Zuss, 2012: 122).

As Paula’s references to soap and the Wirral indicate, objects can be historically and geographically situated. Depictions of times and places, such as photographs of places, work in similar ways. Mary observed that Dave liked the objects and displays in the Museum of Liverpool because they reminded him of ‘when he was a young lad’ (Mary, Dementia Support Charity). Though this takes him back to particular moments in his own life, it also takes him back to a shared past, a city he inhabited with others of his generation. Fleshing out this point, Leanne (Dementia Services, Liverpool City Council) explained the salience of everyday places and objects in retrieving personal and collective memories:

Things like a docker’s hook would be good if you’d worked on the docks, you might have some residual memory of that … the cigarettes that you used to smoke perhaps you know, I think … and pictures, you know, sort of pictures of the city or places in the city that have now been demolished and everything else, you know.

She added that a similar approach had been adopted in her father’s care home, which had recreated important places and landmarks in Liverpool to enable residents to access place-based memories:

It’s a corridor. One side it’s Goodison Park with the street sign from Goodison Road and a picture of Goodison Park and the crest and various other things. And on the other side it’s Anfield Road and it’s got … yeah, so you’ve got Anfield and Goodison. Which of course is very specific to this city but … I mean … because every time he sees it, it’s like the first time he’s seen it (laughs) and ‘Oh look at this, this is good’…. I will sort of say to him because we were Everton fans and I’d say to him ‘Oh Dad, here’s Goodison Park, do you remember when we used to go?’ and you know, you try …‘Oh yeah, we used to sit down there’ and you know, that sort of thing. And every time we go past it, I will talk about it to him.

The objects and themes illustrated here – dockers’ hooks, bars of soap and football teams – illustrate a tendency to gravitate towards uncontroversial and impersonal themes, and away from others that might spark difficult memories or re-open old wounds. This indicates that in re-awakening memories, even those that seem safe, there is an element of risk. This risk is inherent in the variable affective responses to spaces (Thrift, 2004). We return to this point below.

In these examples, objects drawn from particular times and places and more direct depictions of those contexts are used to establish connections between individuals, including people with dementia and their carers, befrienders and other friends. This was apparent when Richard (one of the authors of this paper) joined Dave and Sean on the walk through Liverpool, described above. He writes:

When we had coffee at the Cathedral, I talked about my favourite coffee in Liverpool (at Bold Street Coffee) and Dave talked about his (Costa lattes). Walking with Dave and Sean, I attempted to practice the non-interrogative, non-intrusive conversational style recommended by others (including John). So I talked a bit about myself and my interests, around objects that sparked conversations such as the coffee we were drinking at the Anglican Cathedral, but I did also slip up a bit, including when I followed up some of Dave’s chat about his son who lives in a village, by asking which village (he didn’t know). (Field Diary, April 2013)

The reference points for these conversations are the relatively neutral ground of public spaces, which can be distinguished from the emotional intensity of home where other befriending activities typically take place but which may be seen as more personal and private, as Ann Varley (2008) has shown in her moving account of her father’s attachment to home. Understanding the importance of home to her father with dementia, Varley describes how she resisted advice she frequently received to send him into care. Home, she felt, was central to his sense of self. In contrast, experiences of public spaces such as churches, coffee shops and city streets such as those described within this paper tend to be less challenging, with more potential for encountering strangers and for finding common ground through which to form friendships, or at least to negotiate befriending situations.

Memory walks

In addition to their associational and representational references, places – cities in particular – can also stimulate memory and curiosity more directly. For people with dementia, particularly those who have greater mobility, it is possible and desirable to explore and visit actual places, as the vignette of Sean and Dave’s walk in Liverpool illustrated. Paula explained:

If there are no mobility issues and if the family members are agreed, we do encourage going out as much as possible because for quite a few people with dementia not getting out there and not seeing … not being in their community, not being able to go to the shops and pick up a newspaper, as they have been doing over the past … well all their lives, it’s a problem. So yes we encourage going out to places. (Paula, Dementia Support Charity)

This rationale for activities such as these was echoed by the director of an organisation that works to promote the mental health and wellbeing of older people in Liverpool. His organisation regards ‘memory walks’ as a way of ‘getting people socially active’ and ‘to get them walking’, a way of ‘promoting wellbeing and mental health’ (Director, Health Promotion Company).

These ‘memory walks’ must be distinguished from the Memory Walks convened by the Alzheimer’s Society, which are simply short sponsored walks, which raise money for research into dementia and offer a public show of solidarity with people affected by the disease (https://www.memorywalk.org.uk/find-a-walk/london/, accessed 15 May 2015). The common terminology is suggestive, however, envisioning the possibility of a deeper kind of walking, which may directly involve people with dementia and be incorporated within befriending practices.

These activities can be beneficial to those involved, according to Leanne, Commissioner for Dementia Services at Liverpool City Council, who goes so far as to suggest that the stimulation of encountering objects and places can slow the course of dementia. She stresses that ‘it’s a progressive disease’ but ‘you would try and slow the progress as much as you can. Anything that helps to keep people engaged and active really [is worthwhile]’.

Walking together can be a way of meeting a person with dementia on their own terms, mirroring their conversational competences and helping to recall and reignite exchanges when memory fails. Dave and Sean’s walk in Liverpool facilitated a non-linear, flowing conversation, with pauses and silences, changes of direction, repetition, gaps and fractures. All this could start and end quite easily, without the awkwardness that might accompany some other broken exchanges. As Rebecca Solnit (2001: 8) writes, walking ‘inevitably leads into other subjects. Walking is a subject that is always straying’. And, while walking facilitated this encounter between Sean and Dave, it facilitated the development or continuation of their relationship. As mentioned above, things along the way reminded Dave of others – the Cathedral prompting recollections of his daughter and of a church, said to be haunted – and this also took place through a shared, slow-paced walk. Revisiting these memories also drew Dave together with Sean, at least during the afternoon they spent together.

Walking can also have special significance for people with dementia, many of whom lose or are denied the freedom to walk on their own. People with dementia are often characterised through terms such as ‘challenging’ or ‘problem behaviours’ or the ‘behavioural and psychological symptoms of dementia (BPSD)’. ⁵ Walking is identified as problematic and referred to as wandering, over-activity, pacing, agitation or following or trailing others (Dewing, 2005). It is portrayed as a problem to be managed, particularly through surveillance and restraint, both physical and chemical, within hospitals and residential care settings (http://www.alzheimer-europe.org/Ethics/Ethical-issues-in-practice/The-ethical-issues-linked-to-restrictions-of-freedom-of-people-with-dementia). In this context, regardless of how his own mobility may have been managed, Dave’s walk was not simply a banal, taken for granted, everyday event. Moreover, Dave was not only a participant in the walk with Sean and Richard; he also suggested the route and negotiated the pace, and he showed that he enjoyed the activity. Enabling walks, whether in city streets or within buildings such as museums, dementia befriending schemes can therefore enable people to participate in activities that may otherwise be difficult for them. These walks provide opportunities to be reminded of the past and to encounter the new, both in the form of new relationships and experiences. For Dave, the cathedral was a familiar place, encountered earlier in life, but the Costa coffees were a relatively new find and also a catalyst for a new relationship.

Relationships such as these do not necessarily have a linear trajectory. Since some people with dementia can forget what has just been said, and even who they are with, building a relationship can be stop-start and one-sided. Still, the charity behind this befriending scheme recognises the importance of building relationships to the extent that this is possible and seeks to maintain stability in pairings between volunteers and clients (Mary and Jenny, Dementia Support Charity). These relationships have more scope to grow when the person with dementia takes real interest in the befriender, and vice versa. Like other forms of friendship, this is not always easy. Paula describes ‘tricky situations’ in which befrienders are drawn into talking about their lives and then feeling judged, such as the lone parent volunteer whose client with dementia advised her to ‘give your child up for adoption and go and get married’. Paula, telling the story, explained that ‘he was very curious’ and appears to have enjoyed passing judgement on his young befriender, even though this left her distressed. A number of others, experienced in dementia support, told us that it can be painful to follow people with dementia into their worlds, and painful for the latter to revisit difficult times in their own lives such as memories of wartime bombing (Leanne, Dementia Services, Liverpool City Council). Even when overtly difficult subjects are avoided, remembering is fraught with risk. But, for people living with dementia, many areas of everyday life bring heightened risks, which cannot simply be avoided (Clarke et al., 2010). If they come with risk, this is what makes dementia friendships ‘real’ friendships.

Conclusions

Befriending schemes in Liverpool and the practices they entail, including time spent walking together in the city, bring a new meaning to established terms such as dementia friends and memory walks. Encounters between befrienders and their client-friends, which make use of objects and museum displays and involve walking together in the city, rekindle memories and spark curiosity, which can act as a catalyst for connection. This can cultivate a range of relationships, some of which conform to or extend notions of friendship, within the expansive and critical understandings of friendship considered in this paper. Dementia friends, as we have used this term, depart from some commonplace assumptions about friendship, which revolve around sentimental bonds between individuals, but find agreement with some critical (but not always new) approaches to friendship, which focus upon practical rather than purely emotional relationships, and acknowledge the value of useful, altruistic, situational and ephemeral friendships. These relationships bring some of the benefits of other friendships (Andrews et al., 2003: 349) including enhanced ‘wellbeing’. This is why friends and friendships are specifically mentioned within the five ways to wellbeing, particularly Take Notice and Connect. Memory Walks, as have used this term, use the rhythms of walking to engage with the conversational competences of people with dementia, working the stop-start, interrupted, repetitive form of a walk. They also work with the settings of such walks, the relatively neutral common ground of the city, which can bring two near-strangers a little closer together, without touching upon the more deeply personal issues that can be associated with some other settings such as the home (Varley, 2008).

But where do these practices take those who participate in them? Though sometimes described as a bond, friendship does not always last. It is sometimes said that modern relationships ‘have become fleeting and transient’ (Spencer and Pahl, 2006: 1) and, though this may be true, this does not necessarily mean that these are not friendships, nor that they are bad friendships, nor any worse than the friendships of earlier generations. Friendships – including those cultivated through dementia befriending schemes – can run their course. Paula explained that ‘some befrienders … develop these lasting friendships but I wouldn’t say many do because once they move on, they move on and they don’t come back’. But the charity is happy for relationships to continue, once voluntary befriending activities have ceased, and some relationships do continue in this way. In one case, even after the person with dementia died, ‘the friendship is still there … with the family member’. But the majority of these relationships do come to an end: ‘usually it’s shortish-term; if someone’s with us for a year, that’s a great achievement but then they move on because they either find employment or there are other things they’re interested in’ (Paula, Dementia Support Charity). Not all such relationships are ended by the volunteers. Their client-friends also back out in some cases or lose the ability to practice friendship, for example through the skills of recognising and conversing with volunteers. Paula has witnessed ‘really lasting and meaningful friendships [between befrienders and] people with dementia’ (Paula, Dementia Support Charity) but says these relationships are harder and rarer in later stages of the illness.

The risks of dementia friendships need to be taken seriously by both parties, but to some extent these are the risks of any friendship: risks of rejection, loss and misunderstanding. But the potential rewards of such friendships are very real too, and these include the self-esteem that comes with a ‘feeling of being liked and needed’ (Barkas, 1985: ix) and reduced isolation (Interview, Mary and Jenny, Dementia Support Charity). However, we have not tried to formally assess the consequences of these practices for those who take part. Others have attempted more systematic evaluation of particular practices and schemes through quantitative and qualitative evaluations of volunteer friendship programmes, assessing the impacts of friendship upon ‘physical or mental wellbeing’ (Andrews et al., 2003: 352). But, while any assessment of the friendship practices discussed here should be measured and not idealised or exaggerated, the research presented here suggests (but does not of course prove) that such practices, including taking notice and connecting with others, can be beneficial.

Through the dementia befriending practices examined in this paper, we have also ventured a broader argument, concerned with cities and friendships. We have argued that the city is not just a vessel for friendships or a problem to be solved or mitigated through them. The ordinary places and everyday encounters, encompassed in the physical fabric and fundamental sociality of the city, can be catalysts for relational curiosity, directed at things, places and others, which in turn can draw people together in ways that can be risky and imperfect, but also stand to be positive and beneficial.