Music therapy eases suffering for patients

Monday, May 1, 2000 | 9:42 a.m.

The young woman sits quietly and expressionless at a long table, staring at a tattered photograph of herself and a boy, perhaps 4 years old.

The bottom of the wallet-sized picture is folded so that it stands up in front of her, becoming a sort of nameplate -- a source of self-identification, reminding her of who she is: mother with child.

Dressed casually in jeans and a shirt, hair unkempt, she stares intently at the picture, focusing on it rather than her surroundings, seemingly unaware of the bars on the hospital's windows, the series of locked doors that lead to the outside world, and the music playing in the background.

There are others at the table: a man in his 20s who fantasizes about killing animals ; a businessman whose sneakers don't have laces because he might use them to kill himself; a woman with a master's degree who believes a man, whom she met only once, married her and has entered her body.

One man in his 40s was chained to a radiator in front of a television set for several years in a New York City apartment by his parents when he was a child in the 1970s and now relates to the world through the eyes of "The Munsters." He speaks in a code that you must understand in order to understand him.

A woman frequently leaves the table to go to the restroom. It is later learned that she hears voices and goes to the restroom to argue with them.

They are all listening to music.

It has been said that music sooths the savage breast. Increasingly, it also is being used to treat manic-depressive, bipolar and schizophrenic personalities, as well as Alzheimer's patients, stroke victims and people with physical and learning disabilities.

"Music is a tool, a bridge to healing," said Steve Robinson, one of two musical therapists employed by the state of Nevada.

Robinson works at Southern Nevada Adult Mental Health Services, where he uses music as part of the therapy for most of the 83 patients who have been committed to the hospital either by the state or by their families.

Music therapists work toward a number of nonmusical goals, including improving communication skills, decreasing inappropriate behavior, improving academic and motor skills, increasing attention span, strengthening social and leisure skills, pain management and stress reduction.

Therapists have a variety of music activities and interventions at their disposal. For example: The therapist and patient might compose songs to express feelings; a patient might learn to play the piano to improve fine motor skills; a variety of instruments may be used to stimulate unspoken emotions.

"Music helps them to begin to think in abstract terms," Robinson said. "In psychosis, one of the first things to leave is the ability to think abstractly, and (it's) the last thing to return.

"They lose sight of the larger picture and can't visualize what will happen tomorrow. They can't visualize feeling any different than they do now. If you can't think abstractly you can't think that your feeling of depression is ever going to go away and so you might as well kill yourself."

Robinson said that music has certain universal effects on people. "Everybody is plugged into, keyed into some musical experience that is familiar to them," he said. "It's a facilitator. It creates the atmosphere, the environment.

"If I play a song that is associated with the time of life when you were happy, feeling love, times were good, you tend to get a bit of that feeling while you are listening to that song. I try to capitalize on that. If I play something that is important or meaningful to you, if you can remember how you felt when you were functioning better, it aids in the overall treatment."

Robinson's medicine cabinet includes thousands of recordings covering more than five decades -- tapes, vinyl, CDs, even eight-track tapes. He has every genre and type of music, including bluegrass, zydeco, country, classical, rock and Hawaiian.

One moment you might hear Elton John, the next the Andrews Sisters or Simon and Garfunkel.

He rarely plays an entire song; mostly it is a piece, a few chords or a bar that jolts an emotion, a memory.

Robinson usually holds two group sessions per day, one in the morning and one in the afternoon. The groups are divided according to the severity of the patients' problems.

On Thursday evenings about 45 patients, and many staff members, participate in their own version of "Name That Tune," dividing into two groups that compete against each other trying to be the first to name the song and artist after hearing a snippet of a tune.

"Once, during one of the games, there was a woman in the back of the room who had not spoken, who was emotionally flat and didn't respond or communicate. No one recognized a Spike Jones song I played, from the '40s. This woman is back there, no rapport, no self-esteem, she mumbles the answer and everyone applauds," Robinson said.

"Everyone pats her on the back and she comes alive. Music therapy puts people back in touch with themselves. They function better."

Music therapy an old song

Music therapy, in one form another, has been around for hundreds of years, if not thousands. It has been an organized system of treatment in this country since 1950 and in use in Nevada since 1989 when Robinson was hired by the state.

"During the Greek, Roman and biblical times there were references to using music as medicine," noted William Davis, coordinator of undergraduate studies in music therapy at Colorado State University, in Fort Collins, Colo.

Benjamin Rush, considered to be the father of psychiatry and a signer of the Declaration of Independence, promoted the use of music in the late 1700s and early 1800s. However, until the end of World War II, it had little widespread acceptance.

"It was a hit-and-miss thing. No one was formally trained in music therapy," Davis said.

After World War II doctors noticed that many veterans who were hospitalized for psychiatric and other problems responded to music when they didn't respond to other stimuli.

The University of Kansas, in Lawrence, Kan., and Michigan State University, in East Lansing, Mich., started the first undergraduate programs in musical therapy in the late 1940s. Today more than 70 colleges and universities offer degrees in the subject, and 17 of those have graduate programs.

"When I enrolled in the University of Kansas in 1971 I only had a choice of 16 schools for music therapy," Davis said. "In the last 30 years we have seen an explosion in this type of therapy."

There are more than 4,000 licensed musical therapists in this country. Davis attributes the growth to the mid-1960s when federal laws mandated more and better treatment for institutionalized patients.

"States were required to kick in more money for the treatment of these individuals," Davis said. "Social consciousness of the '60s helped propel music therapy."

It was the era of rock 'n' roll, which many conservatives blamed for most of the ills in the country. But now it is a medical treatment.

Therapy's use expands

Researchers, many of them at Colorado State University, also are discovering that music therapy helps a wider variety of problems than just mental illness: It also is becoming more popular in the treatment of people who have had strokes or have Parkinson's disease or are suffering from traumatic brain injuries, Davis noted.

"Based on research in the lab, music influences not only the body consciously but also in a nonconcsious way," he said.

The American Musical Therapy Association (AMTA), the professional organization of music therapists, defines music therapy as "the prescribed use of music and musical interventions in order to restore, maintain and improve emotional, physical, physiological and spiritual health and well-being."

It is prescribed by members of the client's treatment team, which may include doctors, social workers, psychologists, teachers, case workers and parents. "With any medical treatment, most of it is done in a team treatment approach," Davis said. "That's just the nature of health care in this country today."

The AMTA has a laundry list of uses for musical therapy:

Tests have revealed, Davis said, that people who have had strokes can walk more easily when listening to the strong rhythm of music. "The rhythmic pulse forces the body into better neurological organization," he said.

"The exciting work is being done in the lab here (at CSU), using different populations (of people with a variety of ailments), to improve basic functioning skills."

Davis said that music therapy will be a growth industry for America's aging population.

"So many people are living longer. The elderly is such a huge segment of our society we are going to see a demand for (music therapy) services." Davis said. "We can see music benefiting the elderly in terms of relaxation and reminisence (which is clinically called 'life review').

"Music is very potent! Late-stage Alzheimer's patients, who have lost the ability to speak and have behavioral problems and do a lot of wandering and pacing and have to have help bathing and dressing, music seems to calm them down. It triggers a memory."

Music as a tool

Music as therapeutic tool attempts to establish a trusting relationship between the patient and therapist, who then is better able to work toward improving the patient's physical and mental functioning through structured activities such as singing, listening, playing instruments, composition, moving to music and music and imagery exercises.

In Las Vegas, Robinson uses records in conjunction with worksheets to connect with his patients.

During the group sessions, in which a dozen or so people sit around a table, Robinson uses a lot of handouts: sheets of paper containing groups of pictures that patients refer to when answering questions Robinson poses after playing a piece of music.

In one recent session his musical exercise emphasized the abstract and concrete.

"I do a lot of movement from the concrete to abstract, subjective to the objective," he said. "It not only helps to assess when they are showing improvement, but it helps them with the act of making abstract choices. A certain music sound will remind you of this kind of tree or this kind of weather or helps you to visualize this kind of situation."

Not everyone at the table will participate in a session.

"Someone very paranoid might not complete (the handout). He might just sit in the corner and stare at it. But sometimes just getting them off a hospital unit (and into the therapy session) is helpful," Robinson said.

Some of the patients are potentially violent, which is why the doors are locked and windows secured. One patient is more of a danger to himself than anyone else.

"He doesn't respond socially. He will eat anything. He's very self-destructive," Robinson said. The patient has been institutionalized most of his 35 years. His parents abandoned him in a Las Vegas motel when he was 13.

"I bring him up here to listen to music," he said. "He has a self-control problem. But he loves this setting so he controls himself to attend. He likes going to the group, so he can remember just far enough ahead to control himself -- he wants to control himself."

Still, this patient probably won't be healed, Robinson said. "But I try to increase the quality of his life by a degree or two," he explained.

He said he doesn't set goals that are too high for the patients. "You burn out quickly if you think you are going to cure people in a day. I try to get them back to a functioning level," he said.

Not everyone will be cured by music, or any other type of therapy.

"Even when they come back again and again, I believe they are entitled to the best quality of life they can get," Robinson said. "When they walk out feeling a little happier, when they remember what it feels to be happy and they can say, 'Oh, yeah, life was good then,' I am satisfied," Robinson said.

At the end of a recent session the young woman who had been staring for an hour at a picture of herself and her son rose and joined a single-file procession out of the room, leaving behind a worksheet that was almost blank.

When Robinson finally gets through to her, it will be music to his ears.

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