Brain dump – knowing and sharing

I tried to sit down and read a paper but I’m still banging my head against this idea of different ways of knowing and I couldn’t settle down so I’m going to off-load onto text.

Skinner (him of behaviourism, pigeons, boxes and food pellets) wrote in a paper back in the 60s that you didn’t need statistics. The need for statistics, he argued, was a side-effect of working with the construct of ‘mind’, which was a bad idea from start to finish as far as he was concerned. Skinner didn’t need statistics because he didn’t try to investigate mind. Instead, Skinner researched behaviour. Skinner went on to argue that he knew he was right because he could predictably control behaviour. The proof was in the eating of the pudding rather than in an analysis of the ingredients.

Now,  Skinner’s rants against mind and his expectation of the dawning day when we all gave up on mind and just studied behaviour sound like the ravings of an ill-fated prophet for a doomed ideology. But I like this essay because there is an important idea lurking within it (apart from dismissing statistics): What constitutes valid forms of knowing? And, who are we knowing at?

Deciding who gets to define what is a valid form of knowledge is a form of politics, an exercise in power and in determining which voices are allowed to be heard. I know… this is nothing new. But how do you go about negotiating places at the table? And how do you get people go value and accept other forms of knowledge.

Much of the work on using the arts as a form of creative engagement with older people posits that the arts are an alternative way of communicating and (implicitly) of knowing. Hope’s paper ( which I discussed in the previous blog post) posits practice as a form of tacit knowledge. How do we put these on a par (equal in status but different in other ways) to the ways of knowing that are so familiar and comfortable to those that often have the purse strings (statistical and biological ways of knowing, for instance). How do we de-familiarise those ways of knowing to those knowers so that they become more aware of their own assumptions?

The other question that is bugging me comes back to this idea of sharing practice. If practice is a form of tacit knowledge and if (as according to Collins) tacit knowledge arises as practices are shared in social settings. Then surely the way to share practice is actually through some form of public rehearsal of that practice. Isn’t it?

This brain-dump was prompted by a workshop that I attended yesterday. Before it began I had a lovely chat with a pair of artists about how we went about thinking through stuff. We contrasted my academic scaffold of knowledge with their, more practice based, ways of knowing. The workshop itself included 3sessions that tried very different approaches.

The first, led by the took a much more experiential approach. It was a creative or, at least, meditative session. We were , led to reflect on our experience and you got a sense of how the facilitators go about their practice. It was lovely and insightful. I don’t think we could all go away afterwards and do the same but we might know which direction we needed to head in.

The second took a traditional approach, sharing about their practice but not really conveying any sense of how they do what they do. At the end of it we had a sense of outcomes but you’d have no inkling of how to go about it. (Maybe that was the intention.) Actually, I ended up grinding my teeth as the presenter rolled out the old left brain, right brain, analytical, creative nonsense – I was the epitome of restraint. Mostly.

The third opted for a ‘middle way’ of opening with some experiential work, with us as participants rather than facilitators, followed by some academic scaffolding.

I think that there might be a another option,  which might involve reviewing videos of good practice and thinking together about what works and why. But there are a host of practical issues and ethical hurdles to make that work.

(And breathe…) There, now that’s done I can go back to reading papers rather than staring at them furiously.

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Is this me (us)?

I feel that I ought to open with a disclaimer. I am sometimes an educator and sometimes a researcher. One of the things I like about being an educator is the balance of control and improvisation. I am a bodger of makeshift solutions to immediate and temporary problems; an improviser of responses to unforeseen questions. I shy away from the term, ‘creative’. I am not an artist.

So, I was slightly bewildered to experience a sense of recognition when reading a paper on arts practice as research. ‘Bursting paradigms: a colour wheel of practice-research’ (Hope, 2016) looks at the different ways that arts practice and research intersect. She expands the (apparently) traditional distinctions of research into, through and as (for) arts practice into a six-fold spectrum of possibilities.

Hope is looking at arts practices as a research paradigm in the UK and the issues that people have been wrestling with over the last couple of decades. “When framing practice as research there is a tendency to foreground the process. How and why am I going about this and how does it relate to other processes of trying things out in a similar way?” One of the challenges with this is that it foregrounds certain ways of knowing and of communicating that knowledge that don’t necessarily fit well with the academic focus on the written word.

The point where I started to recognise myself, and the work of other museums staff, was where Hope starts to talk about the way that artist-researchers work. “A common thread that perhaps [runs] through practice-research is one where methodologies emerge because of the practice, rather than prior to it. […] [When research starts with practice] questions and methodology emerge through making, doing, and testing things out. Searching might therefore be iterative, improvised, and intuitive resulting in cyclical or reciprocal research dynamics rather than always focusing on searching for the answers to a predefined question.” Later, Hope notes that “practitioner-researchers “do not merely ‘think’ their way through or out of a problem, but rather they ‘practice’ to a resolution””. This last bit feels like a lot of education work – iterating round to a working solution when faced with new challenges or new audiences.

Doesn’t this describe the work that museums’ staff are engaged in as they explore how to work with people with dementia?

I’ve had a couple of lovely conversations with staff at the Royal Albert Memorial Museum in Exeter about their on-going work in this area. This feels like a good description of what they are doing. And the Active Ageing Officers at Beamish. And, almost certainly, others.

Hope goes on to discuss research paradigms. A research paradigm underlies the ontology, epistemology, and methodology that a researcher might sign up to. It gives clues as to where, philosophically, the researcher is coming from, defined as a shared set of “beliefs and values, laws, and practices which govern a community of practitioners”. […]  “Existing research paradigms include a positivist worldview, which implies research is scientifically verifiable and can be proved or disproved, [and] a non-positivist understanding, implying situated knowledge that acknowledges subjectivity of the researcher and the significance of context. […] How a researcher relates to these different ways of viewing the world will depend on the discipline they are coming from and the focus of their research. Practice-research is often aligned to a non-positivist tradition that uses a qualitative methodology.”

It has to be said that communities of researchers and communities of educators are perhaps less reflexive of their own ontologies and epistemologies than they might be. (Though, to be fair, I usually have to get my dictionary out to make sure I understand what epistemologies are, before I work up to reflecting on my own.) I also find this personally challenging as I was initially trained in a positivist worldview and am trying to cross-over into a non-positivist tradition. (Painful!) However, as Hope notes, while “ontologies might be distinct, approaches, discoveries, and research questions might overlap and interweave.”

It seems that arts-based research paradigms still face various challenges. One is how to establish validity. Another is that, in some cases, “the practice becomes the research itself, rather than a description or illustration of the research”, which means that interested others must engage “with the practice not just a writing-up of the practice.” This is something else I’m trying to get my head around at the moment – how do you effectively share good, creative practice when so much of that practice is based on tacit knowledge? Finally, Hope finds that “practice is not trusted [within academia] […] the dominant paradigms remain intact with a polite nod to alternative ways of working.” I suspect that the same could be true of the various funding and political agencies that museums work with in order to support their work.

On the whole though, it strikes me that this idea of the practitioner-researcher is something that I can usefully appropriate for my own work and one which helpfully re-frames a lot of the work that I see going on in the museums sector, nationally & internationally.

Reference

Hope, S. (2016) Bursting paradigms: a colour-wheel of practice-research. Cultural Trends, 25(2), 74 – 86

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The end of a conversation?

I’ve had a couple of conversations which went along the lines of “Have you read the REMCARE report? It shows that reminiscence work has negative effects on participants.” It seemed as though these colleagues felt that this was the end of the conversation. It’s taken a while to getting round to reading the report (and it’s taken even longer to writing this post) but I wanted to summarise some of what it said but also challenge the idea that the REMCARE report is the definitive statement that some people seem to want it to be.

The Executive Summary of the REMCARE study is readily available on-line (Woods et al., 2012a). The full-report (Woods et al., 2012b) is worth reading – there’s a lot of information in the details.

It’s probably worth stating, up front, that I am not committed to the idea that reminiscing is necessarily good for you. The evidence up to this point has generally been ambivalent, at best, and based on small studies. It doesn’t help that there isn’t a single or definitive way of doing reminiscence. Nor am I persuaded by the view that reminiscence is intrinsically bad and we should all just go and do creative work. Even if this conversation did decide against reminiscence, it would still be a fascinating process and it’s the process that interests me.

Secondly, the REMCARE study is an unquestionably impressive piece of work. Bob Woods, one of the lead researchers, had previous published a protocol for how you might go about doing a randomly controlled trial for cultural interventions (Woods et al., 2009) and REMCARE is a fine example of what this looks like: control groups, quantitative measures, careful statistics. The study involved a large number of participants (N = 488) with a mean age of 77.5 years, whose dementia was assessed as part of the research, although they were not able to control for the type of dementia and research has indicated that this is significant (Woods et al., 2012b). The primary outcome measures were self-reported quality of life for the person with dementia and psychological distress for the carer. Secondary outcome measures for the person with dementia included autobiographical memory, depression, anxiety and activities of daily living. The carer reported their stress related to care-giving and their levels of anxiety and depression. Both the carer and the person with dementia rated the quality of the relationship between them. (Woods et al., 2012a)

The study is grounded in an earlier qualitative piece of work evaluating the ‘Remember Yesterday, Caring Today’ (RYCT) reminiscence protocol. (If you want to find an example of a good piece of international, multi-partner work – this is it.) The study found positive impacts for that approach to reminiscence and the leader of that project (Pam Schweitzer) was persuaded to become involved in this quantitative assessment of the approach (Schweitzer, 2013). The intervention consisted of joint reminiscence groups held weekly for 12 consecutive weeks, followed by monthly maintenance sessions for a further 7 months. Each session lasted 2 hours and focused on a different theme, including: childhood, schooldays, working life, marriage, and holidays and journeys. Participants were encouraged to contribute with materials brought from home. Each session blended work in large and small groups, and a range of activities including art, cooking, physical re-enactment of memories, singing and oral reminiscence. The inclusion of the person with dementia is considered paramount. In the joint reminiscence groups facilitators and volunteers guided carers to allow the person with dementia to respond and to value their contribution (Woods et al, 2012a).

The headline findings: The intention-to-treat analysis indicated there were no differences in outcome between the intervention and control conditions on primary or secondary outcomes at the 10-month end point or at the assessment carried out at 3 months. Carers of people with dementia allocated to the reminiscence intervention reported a significant increase in anxiety at the 10-month end point. People with dementia in the intervention group made more use of local authority and NHS day care than those in the treatment as usual group. Economic analyses from a public sector, multiagency perspective indicated that joint reminiscence groups are unlikely to be cost-effective.

In short – not good. As Schweitzer (2013) acknowledges, she and many of her colleagues were hopeful that this study would support the qualitative findings of the earlier study and were deeply disappointed when they did not.

You could end the conversation there but it hasn’t and it probably shouldn’t.

It is worth considering what is included in the reminiscence sessions – “art, cooking, physical re-enactment of memories, singing and oral reminiscence”. This isn’t just sitting around with an object asking people what they remember – this is a broad engagement of the person through the use of personally meaningful objects. I would argue that if the study undermines the value of reminiscence, it also undermines the value of creative work. I don’t think that the people who want to use it to promote creativity, at the expense of reminiscence, can use the REMCARE findings in quite that way.

One of the important negative findings is that the carers reported significantly increased anxiety as a result of participating. I understand (second-hand from a colleague who listened to a talk by Paul Camic) that the increased anxiety was linked to the burden of having to get their partners to the sessions and the tension between the positive behaviours expressed during the session and their ‘normal’ behaviour. (I need to chase this up to be more certain.) There are procedural issues here, the carers actively take part in the sessions and not all reminiscence work is structured that way. So there is a question about the impact on carers where transport is provided and they don’t attend. Based on my own work, I’d argue that this leads to very different carer responses. There is also tension with earlier work, involving sessions with professional carers, which implied that the experience of sharing reminiscence with a person with dementia re-instantiated their personhood, in the eyes of the carer, and positively changes the way that the carer cares for the person with dementia (Zeisel, 2009). The tensions need exploring. The REMCARE study also looked at long-term benefits, rather than proximal and short-term benefits (which many studies focus on). In the full REMCARE report, the authors point to both of these areas in their recommendations for future work (Woods et al, 2012b).

One of the points of the discussion in the full-report is that the data was analysed by allocation only (i.e. was someone in the intervention group or the control) rather than by how many times the person actually attended. Re-analysing the data according to whether people actually attended indicated that there were more positive outcomes for those that attended more weekly sessions (in terms of autobiographical memory, quality of life and quality of relationship with carer). All this suggests that the sessions had some real benefit. However, the carers who accompanied their partners to more sessions reported higher levels of stress, which is consistent with the headline findings.

Schweitzer has written about the findings of the REMCARE study (2013) in which she was open about her responses to the findings. Schweitzer noted how she struggled to reconcile the negative quantitative results with the positive qualitative findings and on-going feedback that she receives from participants (both participants with dementia and carers). She ultimately questioned whether quantitative measures are appropriate to this type of work – which is a huge and on-going debate.

I honestly don’t think that the REMCARE study can be used the way that some of my colleagues appear to want to use it. It clearly problematises any simplistic attempt to laud the therapeutic value of reminiscence (and, I think, creative interventions) but, at the same time, it isn’t a definitive end point to the conversation. Indeed, Schweitzer (amongst other) seem determined to keep the conversation going.

References

Schwietzer, P. (2013). ‘Reminiscence in Dementia Care’. The International Journal of Reminiscence and Life Review, 1 (1), pp. 42-47. http://www.ijrlr.org/ojs/index.php/IJRLR

Woods, R. T., et al. (2009) Reminiscence groups for people with dementia and their family carers: pragmatic eight-centre randomised trial of joint reminiscence and maintenance versus usual treatment: a protocol. Trials, 10:64. Available at  http://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-10-64

Woods, R. T., et al. (2012a). REMCARE: reminiscence groups for people with dementia and their family caregivers – effectiveness and cost-effectiveness pragmatic multicentre randomised trial (Executive Summary). Health Technology Assessment, 16 (48). Available at http://www.journalslibrary.nihr.ac.uk/__data/assets/pdf_file/0008/63953/ExecutiveSummary-hta16480.pdf

Woods, R. T., et al. (2012a). REMCARE: reminiscence groups for people with dementia and their family caregivers – effectiveness and cost-effectiveness pragmatic multicentre randomised trial (Full report). Health Technology Assessment, 16 (48). Available at http://www.journalslibrary.nihr.ac.uk/__data/assets/pdf_file/0006/64716/FullReport-hta16480.pdf

Zeisel, J. (2009) I’m Still Here: A New Philosophy of Alzheimer’s Care Avery: New York

 

Posted in dementia, measurement of impact, qualitative methods, reminiscence, research methodology, Uncategorized | Leave a comment

Fluid thinking and creativity: constructs and tasks

I recently read an interesting paper which reported a pilot study on the effects of creative reminiscence on people with dementia and their carers (Fletcher & Eckberg, 2014). The paper is helpful in a variety of ways, not least for the ways in which they seek to assess the impact the sessions. One sentence caught my eye and has provoked a bit of ruminating. The sentence was, “Flood and Scharer (2006) proposed that promoting creativity in elders could help them make better adjustments to the challenges of aging, and because it is associated with fluid thinking, may help them remain more self-reliant.”

I confess that, a few months ago, I would have read this and not given it a great deal of thought and I’m left with the impression that the authors also felt that the link between creativity and fluid thinking was fairly unproblematic. I want to make it a bit more problematic.

I have to admit that I’ve not read the Flood & Scharer reference but it is on my list of papers to read. (That list rarely gets shorter!) So, I am going to make some assumptions about what the authors intend, starting with the notion of ‘fluid thinking’.

I’m assuming that the term ‘fluid thinking’ refers to basically the same concept as ‘fluid intelligence’. Fluid intelligence is “a complex human ability that allows us to adapt our thinking to a new cognitive problem or situation” (Jaeggi et al., 2008). It is a construct that emerges out of psychometric intelligence testing. Test scores from across a population are subjected to a statistical technique known as factor analysis, which looks for common sources of variance within the data and then ascribes names and meanings to the different sources of variance. This is not to say that the constructs lack psychological reality: general intelligence scores predict behaviour in domains far removed from the tests themselves whilst crystalline intelligence reflects the episodic knowledge that we accumulate over time. However, the constructs are not predicated on any understanding of how the brain works.

One really contentious issue is whether we can deliberately improve these forms of intelligence. I recently had to hand-write at speed an essay on this topic and I’m not going to regurgitate it here. The short version is that whilst it is obvious that crystalline intelligence grows over our lifetime, the question of how amenable fluid intelligence is to intervention is a source of on-going academic debate.

To be clear: we have this construct, ‘fluid intelligence’ and we have tasks that test or assess (aspects of) that construct. Experimental work has shown that training on a task can improve performance on that task but it is less than clear whether those improvements can transfer over to other tasks which also draw on aspects of fluid intelligence (“far transfer”). The paper by Jaeggi et al. (2008) was one of the first papers to apparently demonstrate far transfer. But a later attempt at repeating the study, with a more rigorous procedure, failed to replicate the findings (Redick et al., 2013) (To add further complexity to the situation both of these papers are looking at both fluid intelligence and working memory. Working memory is a different psychological construct with a different academic lineage which, everyone seems to agree, ought to have something to do with fluid intelligence even if everyone can’t agree what that relationship might be!) Subsequent reviews of studies (e.g. Shinvaer, 2014) have similarly failed to agree on whether far transfer has been achieved.

I haven’t even factored aspects of cognitive ageing into this and, alas, they are relevant. Nevertheless, the upshot of this is that the claim that creativity can promote fluid thinking needs to be treated with a lot more caution.

Furthermore, having wrestled with these various constructs and the problematic links between construct and task-demand… I’ve begun to question the construct of ‘creativity’. There have been various attempts to define creativity (e.g., Ken Robinson’s definition which underpinned the Creative Partnerships programme) but without a great deal of consensus. Without a clear construct it is difficult to set it up as a causal or explanatory factor. Without a clear construct the relationship between creativity and other constructs is equally problematic.

In the Fletcher and Eckberg paper, the participants were also given ‘attention control’ activities. This seems to suggest that attention control has some sort of relationship to creativity..? It certainly features in some models of working memory.

I acquired a new motto last term: “It’s not a mess, it’s complicated.” The caveat to the motto being: “(if it can be disaggregated)”. If creativity can be disaggregated then there is a better chance that we could demonstrate clearer links to other psychological constructs and perhaps tease apart what goes on in rich (if not messy) therapeutic encounters.
References

Fletcher, T.S. & Eckberg, J.D. (2014). The Effects of Creative Reminiscing on Individuals with Dementia and Their Caregivers: A Pilot Study. Physical & Occupational Therapy In Geriatrics, 32(1), 68-84

Flood M, Scharer K. (2006). Creativity enhancement: Possibilities for successful aging. Issues in Mental Health Nursing, 27, 939–959

Jaeggi, S.M., Buschkuehl, M., Jonides, J. & Perrig, W.J. (2008). Improving fluid intelligence with training on working memory. PNAS, 105 (19), 6829–6833

Redick, T.S., et al. (2013). No Evidence of Intelligence Improvement After Working Memory Training: A Randomized, Placebo-Controlled Study. Journal of Experimental Psychology: General, 142 (2), 359–379

Shinaver III, C.S., Entwistle, P.C. & Söderqvist, S. (2014). Cogmed WM Training: Reviewing the Reviews. Applied Neuropsychology: Child, 3:3, 163-172

Posted in Cognition, measurement of impact | 2 Comments

2015 in review

The WordPress.com stats helper monkeys prepared a 2015 annual report for this blog.

Here’s an excerpt:

A San Francisco cable car holds 60 people. This blog was viewed about 1,900 times in 2015. If it were a cable car, it would take about 32 trips to carry that many people.

Click here to see the complete report.

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ICCHS and Beamish Museum projects

I’ve been quite quiet on this blog for a while. Life/work/study has gotten the better of writing. So, here’s some news about a couple of interesting projects that I’m working on.

Each project takes a different approach to looking at the ways that open air museums interacts with older people – one is more quantitative and focused on object-based reminiscence; the other is more qualitative and looks at holistic engagement through meaningful activities in the museum setting. Both have distinct strengths and challenges but I hope that, in combination, we’ll gain some valuable insights.

ICCHS Research

ICCHS staff are working with colleagues at Beamish Museum to investigate the impact of the museum’s work with older people in two, separate projects.

Beamish Museum is an open air museum which tells the story of life in the north east of England in at different moments in the 18th, 19th and 20th centuries. They use buildings moved from across the region to create period settings. The museum’s staff have been working with older audiences for several years. Originally the sessions took place in one of the 19th Century ‘Pit Cottages’ but recently moved into ‘Orchard Cottage’ which is a 1940s set out as a 1940s farm-worker’s cottage. The sessions have also evolved from conventional reminiscence sessions, making use of handling collections and the immersive setting, into broader sessions, involving sensory stimuli and meaningful physical activity. The aim of the sessions is to…

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Memories and stories

In recent months, I’ve become a big fan of Mixcloud. A recent mix of ambient music, included a piece of music from the soundtrack (including dialogue) of Blade Runner, the moment where the replicant Roy Batty (played by Rutger Hauer) knows he is about to die and in a monologue he recounts the things he has seen. Famously, he describes the events/memories as “lost to me now, like tears in rain“. The mix caught me unawares and it prompted me to think about my dad, who died a few years ago…

My dad died shortly before his 90th birthday and, in one of my last visits to him, I managed to prompt him into reminiscing about his life. In the post-WW2 period and up to the 1960s, my dad was an electrician (technically, an electrical fitter) in the RAF and, when I was young, he was wont to tell me stories of his time serving at the RAF base in Hong Kong, so those were the ones I winkled out of him. All his memories are lost to me now, apart from the few I gleaned out of him…

My colleague, Rhiannon Mason, is interested in the cultural aspects of memory. One aspect of this is the way that me memories have an extended life in a family. My dad tells me his memories and, in turn, I might recount them to my children. Thus a memory might have a lifetime of 80 years or more. Or, I can write them here, where they have an uncertain future. So here are two…

My dad worked in Hong Kong at the time the squadrons were in transition from Spitfires to the jet-powered, de Havilland Vampires. When they’re on the runway, Spitfires sit pointing slightly upward because of arrangement of their landing gear. One day, when no-one was anywhere near them, one of the Spitfires fired off the rocket-packs slung under its wings. The rockets slammed into the hillside above the officers’ mess. Thankfully, the heads of the rockets were solid and not explosive so the incident just scared the officers rather than killing them. As an electrician, it was my dad’s job to find the problem and fix it. It turned out that the hot, humid climate was playing havoc with the wiring and the rocket firing switch had shorted. Having claimed to have fix it, dad had to prove it. So the Spitfire was rolled out to the end of the runway where the Spitfire could fire out into sea. [From what my dad said, it seems that there was some concern that the trial might go catastrophically wrong, so his colleagues stood at some distance and my dad rigged a trigger that he could use from outside of the plane. With no little trepidation, Dad set up the trial and fired the rockets… All was well.

Later, the first Vampire arrived. It was the first jet fighter in a squadron in East Asia and it arrived in a series of crates. (Think of a flat-packed aeroplane.) Dad was one of a group of technicians who were told, by a Warrant Officer, to gather in a hangar. There they were told, “Here are the crates with all the parts, there are the instructions, go and build the plane.” Dad and his work-mates had different areas of expertise which complemented each other (though apparently one of them was an alcoholic, so they tucked him away in a corner and got on without him). After some time, they assembled the plane. The Warrant Office congratulated them and then escorted them away; at the same time the officers gathered in front of the plane for the formal photograph commemorating the arrival of the first Meteor. Thus my dad and his colleagues were obliterated from the official memory.

Now… there were other stories too and I have no way of ascertaining the veracity of them, at least not without a lot of time and effort. And even, if I did that, what would I gain? The stories were part of his account of his life and part of my idea of my dad. Perhaps it is better to accept them as such and take them at face value.

Also… memories are pliable, both in their external form and their neural encoding. When we reconstruct a memory and recount it for others, we shape the memory to make it more tell-able, more story-like. We fit it into socially acceptable forms that work in the moment. In re-telling the memory, we also change the way that it is encoded in the neural structures of our brains. So the events, even if they actually happened, probably didn’t happen quite the way I have recounted them – they were probably more haphazard and less story-like.

But, apart from the structure, what is the difference between a memory and a story? The recounts above were memories for my dad and they are part of my memory of my dad but for anyone who reads them they are just stories. When trying to decide between possible accounts of psychological phenomena, one question that is often asked is – is this account parsimonious? A parsimonious account of memories and stories might well be that, neurologically, they are dealt with in the same way. A memory might well just be a story that sits in a particular network of associated ideas. So we share our stories/memories so that they won’t be lost in the rain just yet.

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