Sooner or later we shall have to get down to the humble task of exploring the depths of our consciousness and dragging to light what sincere bits of reflected experience we can find. These bits will not always be beautiful, they will not always be pleasant, but they will be genuine. And then we can build. . . . In time . . . a genuine culture — better yet, a series of linked autonomous cultures — will grace our lives.

In his classic study, The Puritan Family: Religion and Domestic Relations in Seventeenth-Century New England, Edmund Morgan revives the term "visible saints" to describe elders who appeared to be chosen for salvation. Morgan notes that many of these deeply religious folk experienced intense anxiety as they grew older. Despite their best efforts to live according to God's will, aging believers — accepting the Calvinist doctrines of predestination and divine inscrutability — could never be assured of their eternal fate. Hence, they looked for some reassurance that God had chosen them to rise among the just. This search for visible signs of "election" came to focus on longevity and wealth: older Puritans hoped that signs of physical and material success in this world would predict spiritual success in the next.

Older people who enter American nursing homes also experience existential uncertainty. Today, however, old age and financial security offer scant solace to the nursing home resident. Profoundly disconnected from their new environment, rarely sharing a common vision with care providers, residents may wonder if their lives have any meaning. Alienated and frightened by the rigid routines that control their daily lives, residents often feel invisible — to themselves as well as to others.

The Visible Lives project described here does not aim to transform nursing home residents into "visible saints." But it does aim, in Edward Sapir's words, "to get down to the humble task of exploring the depths of our consciousness and dragging to light what sincere bits of reflected experience we can find." Our project takes what is invisible — an elder's life story — and renders it visible to the nursing home community of care providers, caregivers, staff, residents, and volunteers. Through life-story interviews, we collect significant images (i.e., family photographs, personal documents, certificates, etc.) and texts (i.e., narrative — life-story experiences, religious passages, poems, adages, etc.) from a resident's life; we then craft these into a montage, which is attached to a colored "storyboard," representing the elder's life story in tangible form. We plan to develop a series of ceremonies in which a resident's storyboard is presented to the nursing home community; displayed on the resident's door or in some prominent place in the nursing home; later re-created to reflect changes in the resident's life; and, after the resident's death, re-presented to the nursing home community as a memorial and a public acknowledgment of their loss.

Mrs. Theresa Jackson of Galveston, Texas, a participant in the Visible Lives project.

For each resident who participates, the project begins with the taping of several in-depth, life-story interviews. Questions and follow-up probes include: "Tell me about your childhood. Describe your most vivid memories of your parents. Who are you most like? How are you most like that person? What is your most memorable adult life experience? Tell me about that. What would you most like people to know about you?"

Our life-story interview questions are designed to allow and evoke idiosyncratic responses. After the interviews are transcribed, the resident chooses themes to use in constructing the storyboard. Along with life-story narrative, old photographs, and documents, an animated contemporary image of the resident is placed on the storyboard. If old photographs and documents are unavailable, clip art or other images relevant to the elder's story are substituted. After all the artifacts are collected, we work with the resident in arranging visual images and enlarged pieces of narrative on the storyboard. Visible Lives builds on a resident's current interests, abilities and strengths and on learning more about his or her past. We hope to increase individualized care for nursing home residents by using elders' life stories to build and strengthen meaningful relationships between care providers and residents.

Without genuine collaboration with the elderly resident, biographical narrative and images alone would be subject to the same limitations as the medical chart — information may actually obscure knowledge. Collaborating on the storyboard focuses on what the resident finds significant about his or her life; it also facilitates creativity and control in a setting with few opportunities for individual decision making. We have begun working with residents of Texas nursing homes to craft personal storyboards, providing occasions for residents to "re-member" themselves in preparation for a "definitional ceremony" in which they present their storyboards to the nursing home community.

The terms "re-membering" and "definitional ceremony" are taken from the work of Barbara Myerhoff, who developed them while studying the culture of elderly Jewish immigrants at a senior center in Venice, California, in the 1970s. Myerhoff observed that these people (who originally emigrated from Eastern Europe and whose culture of origin had been destroyed by the Holocaust) felt unseen. She also noticed that her listening presence gave people an opportunity to "become visible — [and to] exercise power over their images."

"Sometimes the image is the only part of their lives subject to control," writes Myerhoff in her 1992 book, Remembered Lives: The Work of Ritual, Storytelling, and Growing Older, "but this is not a small thing to control. It may lead to realization of personal power and serve as a source of pleasure and understanding . . . Heightened . . . self-awareness . . . does not always come with age and is probably not critical to well-being. But when it does occur, it may bring one into a greater fullness of being; one may become a more fully realized example of the possibilities of being human."

Mrs. Jackson prays in the community chapel.

As the title of her book suggests, Myerhoff also observed the creative work of ritual at the Aliyah Center. Since these people had moved to California in later life, they were cut off from their children and from their culture of origin. At the Aliyah Center, they carried on various traditional celebrations, festivals, religious services, and other communal events that allowed them to re-member themselves. Meyerhoff coined this term to capture the creative process of selecting, arranging, and connecting that characterizes life-story work.

In a talk on survivors' stories given in 1983, Myerhoff poignantly described both an elder's isolation and the empowering quality of storytelling: "[W]hen a person steps into a group of strangers and says, 'I was that,' who is there to believe it? And when the person says, 'I was that, and you have no way of knowing what that was, you will never understand, you will never know my language, you will never know what it felt like to live there, you will never know how we talked, you will never know what we ate, you will never know what my grandmother sang' — then what? Then that whole invisible world somehow has to be remade, presented, made tangible, performed, enacted. The storytelling has to become a very persuasive and dramatized affair. All stories are rhetorical, or rather persuasive, but here the need to persuade is even more important. Storytellers must become, visibly, before the audience, some remnant of the vanished world, so that this — the world-in-the-story made visible in the teller — conveys some shred or some hope of hinting or giving a taste of what they are worth as human beings and why they should be seen and heard."

The Visible Lives project helps elders reconfigure the experiences, values, and choices of a lifetime. In the process of creating a storyboard, we collaborate with residents in two ways: in actually creating the storyboard (the first occasion for listening and telling stories) and later in the presentation — definitional ceremony — of the shaped life story (the second, more public, occasion for listening and telling). These repeated life-story tellings reclaim and define life before nursing home placement — a reality not clearly seen by care providers.

We first met Mrs. Theresa Jackson in the summer of 1996, after she moved to a Galveston nursing home with her husband, who had been paralyzed by a stroke. Shortly after their arrival, Mrs. Jackson's husband died. She made use of the life-story interviews to mourn her husband's death — to remember his life and to re-member her own.

"He wasn't just a man," she said, "He was a provider, he was a husband. . . . Roy was very religious, very dutiful to the usher board. Not a Sunday came that he didn't go to church. He was always at his post at Jerusalem Baptist Church. . . . I sat next to Roy in my recliner after he got sick and held his hand. That was all that I could do. It was very hard after he died. But as I sit and talk it eases my mind quite a bit. Sometimes I talk to his picture. And I ask God to let me be with my husband forever in Heaven, and I believe he will do that."

Mrs. Jackson's storyboard — which contained the themes she selected — presented her life as a whole. We see her partly as an old woman who talks to the picture of her dead husband on the wall. She is a grieving widow, self-conscious about her missing teeth but proud of her still-thick gray hair, which an attendant braids and arranges in different styles. She is also a little girl in Arcadia, Louisiana, picking cotton alongside her four brothers; a young woman working at her first job in a meat-packing plant in Galveston; a young bride; a mother, grandmother, and great-grandmother. The storyboard, in other words, allows others to see Mrs. Jackson as she sees herself.

The Visible Lives project then, attempts to blend meaning and experience — to express the rich variety and emotional possibilities of aging and the human spirit. The storyboard and its ritual presentation are intended to move and persuade the nursing home community — to see not only the wrinkled skin and white-haired head but also the little girl picking cotton (Mrs. Jackson's storyboard), the young man playing the "mouth harp," and the young nurse who hosted the neighborhood children. We want to help build a culture in the nursing home in which lives are linked — where resident storytellers are heard and seen and where care providers listen to the stories and see bits of themselves reflected in the lives of their charges.

Thomas R. Cole, Ph.D. is a professor and the graduate program director at the Institute for the Medical Humanities, University of Texas Medical Branch, Galveston, Texas. He is the author of The Journey of Life: A Cultural History of Aging in America (Cambridge University Press, 1992) and Senior Editor of The Oxford Book of Aging (Oxford University Press, 1995). Thu Tram T. Nguyen is the Humanities and Aging fellow supported by the Sealy Center on Aging and a Ph.D. student in the Medical Humanities at the University of Texas Medical Branch in Galveston.