Not long after the start of  my fieldwork in a town in Northeast Italy, I was invited for pizza by members of an association formed by professional dementia care workers, families, and people living with dementia. The association runs a respite center for individuals with cognitive impairment. It also organizes public meetings and offers professional training to promote a person-centered model of dementia care (i.e., one which treats persons with dementia as individuals and equal partners in caring relations). The association’s work was part of a nation-wide effort to reimagine aging futures, life with dementia, and intergenerational relations in a time when drops in fertility rates, increased longevity, and multimorbidity at old age (as well as a limited welfare system) was not only reinforcing the social stigmatization of dementia, but was also creating what is usually framed in Italy, as elsewhere, as “a care deficit.”

The pizza was served at the private home of a family to which 85-year-old Paolo, living with Alzheimer’s disease at an advanced stage, belonged. At the end of the evening, the host, Elena, Paolo’s wife, put on some music and her husband then started dancing with one of the guests, Agnese, who was also living with advanced dementia and who was accompanied by her daughter, Sara. Suddenly, Paolo stopped dancing and started to laugh very intensely. Agnese responded with a similar type of laughter, which very soon morphed into singing and screaming at high frequency and decibel levels. It was the first time I had witnessed such a scene (although I was to witness many more in the months of fieldwork that lay ahead). It certainly made an impression on me. However, I did not know how to define this impression, let alone what to do with it and how to express it to those around me. While I did initially appreciate the delight emanating from the dancers, I struggled to decipher whether Agnese’s tones were  ludic expressions of joy or uncontrolled screams of panic. Were they a consequence of hallucination (as the biomedical discourse would have it) or an expression of emotions that I could not immediately name and embrace? At that moment, I thought that a wise thing to do would be to try to understand how others witnessing this scene were reacting. Very conveniently, Irene, the president of the association, standing next to me, said in a voice loud enough for me to hear clearly despite the hubbub around: “What a wonderful voice she has, look! This is so powerful! What a couple! And what a dance!” Raising her hand to her face, her eyes and body now turned towards the dancing couple; she was visibly moved by the scene and enjoying what she called the beauty of the sound and movements, especially the interaction between the two dancers. She stood in silence for a while, listening to the raised voices and swaying to the rhythm of the sounds Paolo was making.

At first, I was unable to tune myself into the notion of beauty (bellezza) that Irene (and the rest of the crowd, who were following her lead) were appreciating and to focus my eyes and ears on this fragment of the visual field around me. My eyes were still chaotically scanning the scene: Paolo’s legs tapping the floor in a marching rhythm, Agnese’s high-pitched vocal utterances, Paolo’s wife trying to position her body between that of her husband and the sharp edges of the table. In other words, my eyes and ears failed to focus on the elements that Irene had identified as beautiful. Although I was relieved that Irene was offering bodily cues as to where our sensory attention should be directed, my looking and listening remained anchored in my habituated type of aesthetics when we started to dance. Even though—taking seriously Irene’s call to admire the vocalization and dancing—I tried to focus on listening to Agnese’s high-pitched voice, I still could not help but think what my friends at home would say could they see us reacting to this dance in the way we did (i.e., dancing along, joining in with the song). Only after a while, I finally managed to really focus on– and aesthetically appreciate–the song and dance of Paolo and Agnese, letting the others be in charge of protecting the dancers from potential bruises. In contrast, for the people at the pizza party, bellezza seemed to be found not in the idyllic scenes but something that emerges when they become the carers they want to become (Mattingly 2014). By highlighting certain features of the visual and audio landscape (the gestures, the bodily movements, the tone and rhythm of the voice rather than how it might be categorized medically) and tuning in her sensory attention accordingly, Irene had turned what might otherwise be classified as ambiguous vocal utterances by hallucinating, screaming dementia patients into the beautiful song of beautiful singers—for herself, for others, and eventually also for me. 

This was, in retrospect, a pivotal moment in a social process that  Cristina Grasseni has called “skilling the vision:” a process through which a novice receives hints–from expert practitioners and from a structured environment more broadly–as to how to look in a proper way; that is, how to discern from the multitude of items in the field of one’s vision those elements that are relevant to the context, and that require further attention (Grasseni 2004b). Vision here is understood as not only optical but grounded in multisensory experience: the auditory and kinesthetic both mobilized to reconfigure perception (Grasseni 2022; Ingold 2000; Howes 1991). As I have argued elsewhere, skilling the vision constitutes and is constituted by acts of care (Pieta 2021). That is, in skilling the vision, what matters is not establishing the correctness of evidence per se (in this case, determining what dementia is). Rather, what matters is the relevance of evidence in the context and, specifically, what type of relationships–and thus what kind of life with dementia–can be generated through a particular type of looking. Here I want to extend this argument to suggest that skilling the vision is also a way of enacting caring futures. Once we agree that a caregiver’s ability to reconfigure their perceptual field in order to relate to an other with dementia is a skill, we can also attune to what Grasseni calls the “futuring” dimension of the skilled practices of looking (Grasseni 2023). Specifically, we are better positioned to interrogate what futures of care relations are enacted and expressed through these skilled practices of looking, and how exactly this future-making of care relations is sustained through visual apprenticeship. 

As Roger Canals argues, images are images insomuch as they help in imagining what has been and what may become (Canals 2024). In this way, Canals echoes other visual scholars who insist that images be theorized not as documents of “what has been” but as signposts directing our senses and attention to “what could be;” not mirrors of the present but “beacon(s) for the future” (Kandinsky paraphrased in Favero 2021; see also Ingold 2010). Rather than merely representing, images generate and participate in social relations (Favero 2023). And yet, as highlighted below, seeing is not a matter of personal invention but is to a large extent a matter of social enskillment. It is set in an ecology of practice and requires “educating and training in a relationship of apprenticeship” (Grasseni 2004a, 41). It is this embeddedness in social relations that makes the process of skilling the vision a future-making practice that is not only technical and functional but also intrinsically political and moral.  

Both caregiving and ethnographic fieldwork often entail learning from others how to look in a “proper” way.  What I find particularly fascinating is that ethnographers working with individuals with dementia in cultural settings different to my own, when faced with visual fields that are similarly opaque and overcrowded to those that I encounter, have directed their attention in a manner and direction other than I might in a similar situation and, as a result, have seen things that I might not have observed. I suggest that this might be because their “strategic looking” at dementia was oriented towards a different goal than mine and embedded within different ecologies of practice. Indeed, such ethnographers seem to have received a different type of training for the direction and management of their attention than that within which my own looking has been embedded. The ethnographic story offered by Rasmus Dyring from his fieldwork in a dementia ward in Denmark, as well as the subsequent commentary by Lisa Stevenson on Dyring’s way of looking, should illustrate my point:

In his 2022 chapter that appeared in Imagistic Care: Growing Old in a Precarious World (edited by Mattingly and Grøn), Dyring reports on his encounter with a man, Keld, in a dementia ward in Denmark (Dyring 2022). During their meeting, Keld was very slowly turning the pages of a tabloid magazine. He then stopped to study a picture of  a young couple in a romantic embrace. Dyring (2022, 109) reports on what he himself saw:

Then, very slowly, but with great determination, (Keld) extends his index finger and begins to scratch the surface of the page with his fingernail. Resolutely, he scratches. Perhaps there is a stain of some sort. Perhaps the words on the pages are mere stains. Perhaps he is scratching the words– scratching the word-stains. He scratches. The clouds drift. Light supplants shade. Scratching.

Lisa Stevenson (2022, xii) then comments on Dyring’s way of looking in the field:

Keld scratching away the words is an image. His scratching occurs at the intersection of perception and expression. The point for Dyring is not to decode the image so that it may hang limply on the wall of his essay, but to stay with the image. What happens when words (with all their semantic and propositional content) become, or are revealed as, word stains? When scratching is a beginning?

The model of looking which Stevenson–via Dyring–is proposing here is what she has elsewhere called the imagistic mode of attention (Mattingly and Grøn 2022, 6; Stevenson 2014). That is, the focusing of our attention on the phenomenological aspects of the image (the surfaces of the words, the gestures and sounds the movement generates) but crucially, without attempting to codify the image into semantic significance. Indeed, it seems that Dyring discerns from the multitude of visual elements within his reach ambiguous elements that grab his attention. By juxtaposing my type of looking with that of Dyring (and with the “imagistic type of looking,” in general) I do not mean to suggest that we have, merely, interpreted differently equally opaque phenomena. Rather, it seems that during fieldwork, we have become part of two different ecologies of practice. My attention has operated as a form of locally-trained “coherence work” (Grøn 2022, 88; Kontos 2006): my eyes, ears, and body were educated by experts like Irene to search for something that could fit within local semantic categories (e.g., that of beauty). The overall objective of this training was to teach me how to avoid epistemological tensions and to evoke positive emotions by identifying and highlighting specific visual and aural elements. As I later realized, Dyring’s and Stevenson’s looking seems to have been shaped by another type of community of practice, the objective of which is to perceptually embrace rather than overcome epistemological tensions. I posit that the reason why we as ethnographers may have ultimately observed different things is not because we have entered in the field with different presupposed mental schemes and moral dispositions which allowed us to notice and interpret visible elements in distinct ways. As I mentioned above, I did not know how to organize my visual field until Irene eventually offered me clues (and, in the absence of a detailed ethnographic description, I can only speculate about Dyring’s visual apprenticeship process). Rather–and this is the hypothesis I want to probe in the remaining parts of this essay–Drying’s seeing and my own (and our individual enactings of desired futures) were shaped by different types of training of perceptual bodily attention and by different techniques of visual and sensory discernment.

Felicity Aulino has already convincingly argued that morality and care are not the outcome of inner mental dispositions but rather a function of culturally-shaped perception, i.e. of habituated ways of bodily perceiving (Aulino 2016; see also Kontos 2006). My point here is not to rehearse this argument but to highlight that anthropological reports on culturally-embedded habituated bodily routines through which people in different places in the world provide for each other have so far failed to sufficiently explain the practices, materialities and actors that participate in this social training of perception. That is, we miss a consolidated corpus of thick phenomenological description that would allow us–through case comparison–to understand how in particular settings the visual and, more broadly, sensory attention of caregivers and of ethnographers working with them is trained and negotiated by the structured environment. If care is a visual matter (Pieta 2021) and the task of visual anthropology is to interrogate visual culture as the intersection of biology, culture and politics (Favero 2021), then one of the tasks of what I propose calling visual anthropology of care (Pieta, forthcoming) should not only be to explicate the embodied knowledge in which the relations of care are embedded in various cultural settings. Rather, we should also seek to understand how it is thanks to social apprenticeship and techniques of visual discernment that this embodied knowledge emerges. I will now introduce another example from the field to demonstrate that not only research participants but also image-making technologies can play an important role in the training of sensory attention. 

A “thank you” gift. Video courtesy of Barbara Pieta.

The video presented above was produced by Barbara Beltramello, a cameraperson whom I hired using my generous PhD grant to help me produce a film intended to be a “thank you” gift to the respite center community in which I carried out my  fieldwork. It was made during an interview with the respite center manager and shows one of several items that were hanging in the center– specifically, a stripe of cloth holding cards with the names of the week (these cards were used for cognitive exercises).  This filmmaker’s decision to “touch” with the camera-eye the patters on the cloth rather than to use the cards as a requisite in a scene demonstrating the card’s daily function (i.e. as a device in cognitive therapy) was yet another cue that contributed to the skilling of my vision during fieldwork. Indeed, the camera was a “focusing media” (Grasseni and Gieser 2019): it helped the cameraperson, and subsequently also me, to direct our bodies, the camera lens, and thus also our (and the viewers’) eyes to  specific aspects of the “reality” around us–the beauty of the cloth. Through this visual discernment the  camera became more than  a device structuring our visual expression (Grasseni and Gieser 2019). By focusing on the beauty of the card-holder rather than on the way the cards are used during therapeutic practices, the camera, and the skilled vision, also contributed to our re-imagining of local relations of care. Furthermore, certain politically and morally invested claims made by the center’s manager—like the assertions made during the video-recorded interview that good life with dementia is possible (see image below) served as important verbal hints—another element of the apprenticeship offered to help us grasp what the goal of our visual discernment should be, what we are expected to see and—by implication—to show.

In my doctoral thesis (Pieta, forthcoming), I hope to illuminate how social actors (their bodily patterns, sometimes intertwined with language), technological devices (e.g. the video camera) as well as material visual products (e.g., photographs, posters and films)shaped my way of orienting myself in the sensory field. As I demonstrate, the effect of this training of the gaze is not a total adherence to the worldview (understood literally, as a way of seeing and as a metaphor for knowledge) of more senior experts. Rather it constitutes the background that has structured my improvisational skills and against which I can orient myself within a field “overcrowded” with manifold sensory elements. 

References

Aulino, Felicity. 2016. “Rituals of Care for the Elderly in Northern Thailand: Merit, Morality, and the Everyday of Long-Term Care.” American Ethnologist 43 (1): 91–102.

Dyring, Rasmus. 2022. “On the Silent Anarchy of Intimacy: Images of Alterity, Openness, and Sociality in Life with Dementia.” In Imagistic Care. Growing Old in a Precarious World, edited by Cheryl Mattingly and Lone Grøn, 109–36. Fordham University Press.

Favero, Paolo S.H. 2023. “The Image Is a Cure.” Visual Studies 38 (2): 196–98. 

Favero, Paolo S. H. 2021. Image-Making-India Visual Culture, Technology, Politics. London and New York: Routledge.

Grasseni, Cristina. 2004a. “Skilled Vision. An Apprenticeship in Breeding Aesthetics.” Social Anthropology 12 (1): 41–55.

———. 2004b. “Skilled Vision. An Apprenticeship in Breeding Aesthetics.” Social Anthropology 12 (1): 41–55.

———. 2022. “More than Visual: The Apprenticeship of Skilled Visions.” Ethos, 1-19, December. 

———. 2023. “Skill, Craft, and Poiesis-Intensive Innovation.” FormAkademisk 16 (4). 

Grasseni, Cristina, and Thorsten Gieser. 2019. “Introduction: Skilled Mediations.” Social Anthropology 27 (1): 6–16. 

Grøn, Lone. 2022. “‘Yeah . . . Yeah’: Imagistic Signatures and Responsive Events in a Danish Dementia Ward.” In Imagistic Care: Growing Old in a Precarious World, edited by Cheryl Mattingly and Grøn Lone. New York: Fordham University Press.

Howes, David. 1991. Varieties of Sensory Experience. Toronto: University of Toronto Press.

Ingold, Tim. 2000. The Perception of the Environment: Essays on Livelihood, Dwelling, and Skill. London: Routledge.

———. 2010. “Ways of Mind-Walking: Reading, Writing, Painting.” Visual Studies 25 (1): 15–23. 

Kontos, Pia C. 2006. “Embodied Selfhood: An Ethnographic Exploration of Alzheimer’s Disease.” In Thinking about Dementia: Culture, Loss, and the Anthropology of Senility, edited by Annette Leibing and Lawrence Cohen. New Brunswick and London: Rutgers University Press.

Mattingly, Cheryl. 2014. Moral Laboratories. Berkeley: University of California Press. 

Mattingly, Cheryl, and Lone Grøn. 2022. Imagistic Care. Growing Old in a Precarious World. New York: Fordham University Press.

Pieta, Barbara. 2021. “Carescopes: On Caring, Looking at and Becoming.” Anthrovision, no. 9.2 (December).

Stevenson, Lisa. 2014. Life Beside Itself. Oakland, California: University of California Press.

——— . 2022. “Foreword.” In Imagistic Care: Growing Old in a Precarious World. New York: Fordham University Press.

Barbara Pieta is a PhD-candidate at the Max Planck Institute for Social Anthropology. In her doctoral dissertation, she explores the intermingling of visuality and care, drawing on the ethnographic research in Italy which involved families living with the experience of dementia. Barbara is also, together with Paolo Favero, a co-founder of Images of Care Collective. She was also the co-editor (with Jay Sokolovsky) of the Special Issue of the Anthrovision Journal entitled “Towards Visual and Multimodal Anthropology of Care, Ageing and the Life Course” and the coordinator of the inaugural edition of Aging and Visual Anthropology Award (AVA).

Cite as: Pieta, Barbara. 2024. “Skilling the Vision as Envisioning Aging Futures: On Visual Apprenticeship in the Anthropology of Aging and Care.” In “Aging Globally: Challenges and Possibilities of Growing Old in an Unsettling Era,” edited by Magdalena Zegarra Chiappori, American Ethnologist website, 7 August 2024. [https://americanethnologist.org/online-content/collections/aging-globally/skilling-the-vision-as-envisioning-aging-futures-on-visual-apprenticeship-in-the-anthropology-of-aging-and-careby-barbara-pieta/]