Music, drugs, and rock n’ roll

c70f72d2f5ec952d0cc995fce1d4536cYou know that feeling when you hear a song and it instantly becomes your new favorite? When you can’t get enough, you put it on repeat, and you find yourself hearing it everywhere? I searched for a long time for a word or phrase that encompassed that feeling. Or more specifically, the feeling when the song finally loses its emotional spark and becomes ordinary again, subtly whisked away into the endless sea of playlists. Well, I found that phrase several years ago, in a play that I wrote some music for. The play was a series of poems, and in one poem, the speaker “wore out the magic” of a Spanish dance. I was struck.

A few years later, I was listening to a very complicated and interesting lecture in one of my music therapy graduate courses. Basically, my professor was discussing how music motivates parts of the brain at the cellular level. He said, “Dopamine gives cells their seeking behavior,” which makes sense. We all know music causes our bodies to release dopamine and endorphins through the chemical reactions that occur in the brain.

I thought back to my idea – wearing out the magic. I asked my professor about this idea and how it related to the discussion – the release of dopamine. What happens when you no longer feel that rush? And also, what is happening when you introduce novelty (like a new song)? He responded with a fascinating answer. He said the only thing he could compare it to was drugs. The more you indulge in a song, the more of a “fix” you need to feel that renewed high. Novelty can bring that. And time. Have you ever noticed how excited you get when you hear a song you used to love (see top) but haven’t heard it in a long time. There’s your fix.

After processing all of this information, it seemed pretty clear to me why so many famous musicians turn to drugs. They write (or are the voice of) a hit song, perform to thousands of fans – they must being riding quite a high. And then it all comes down. Night after night. That’s a lot of up and down, which can create a very unstable feeling, especially if the person is still maturing or insecure. So what else can give them that high? What’s a quick….fix?

I don’t have a solution to this problem, but perhaps a rather unique insight because of my work as a music therapist, and it’s this: Musicians might use drugs to provide that high – to match the benefits they get from their music. I use music to provide the benefits of drugs without using drugs.

Troubled musicians use drugs in place of music. I help the troubled by using music in place of drugs.

My patients are in hospice. They take a lot of medications, mostly for pain and anxiety. Personally, I don’t believe music therapy can completely take the place of drugs, but I believe music therapy can allow for a smaller dosage and lessened frequency of drugs.

Music is supposed to make you feel better, it was designed that way. So are drugs. But the difference between music and drugs is that music has (very little to) no harmful side effects. And that’s what I love about music therapy. It is a positive, enriching way to lift someone from a dark place without any* threat of harm. As a music therapist, it’s my job to pick the right drug (song) in the right dosage (volume, tempo, complexity) to reach the proper outcome (smile, memory, relaxation). I trust the music. I just hope the magic never wears out.

*It doesn’t escape me that some music can bring back painful memories and events, but for the most part, I think people would agree that music is painless.

Devotions for June, Week 2

Sorry this is a little late getting up! Here’s a recap of last week’s posts:

Photo June 9, Listen

If we don’t work on listening, we will become a generation that nobody will come to for help.

 

 

Photo-2June 10, Pride

Those who wear God’s love don’t think of themselves – not because they’re not worth thinking about, but because God has filled them with His love and they have no need to feel insecure.

 

 

DSC_0292June 11, Gift

A reflection on my nephew Haden, on his 3rd birthday

 

 

Photo-3June 12, Diligence

If we put as much work into seeking God as we do other, less important things, what would happen?

 

Photo-4June 13, Aesthetic

Sometimes music is the mechanism we use to tune into the Holy Spirit. But sometimes the music itself is the Holy Spirit encounter.

 

Photo-5June 14, Favor

we should never be ungrateful for the doors He opens or doesn’t open, as He knows us far better than we know ourselves!

 

We’re halfway kids! Happy Sunday and tune in tomorrow!
-Sarah 🙂

Devotions for June, Entry 13 {aesthetic}

You alone are the Lord. You made the heavens, even the highest heavens, and all their starry host, the earth and all that is on it, the seas and all that is in them. You give life to everything, and the multitudes of heaven worship you. Nehemiah 9:6

Photo-4

One thing I love about music is that it is both aesthetic and functional.  Sometimes it’s more important for music to serve a functional purpose (keeping time, providing structure) and other times music serves an aesthetic purpose, to warm or enthrall others with its beauty.

This aspect is used in music therapy. It’s called: music in therapy vs. music as therapy. For music in therapy, the music is used functionally to promote socialization or memory recall or provide an opportunity for self-expression, among countless other outcomes. For music as therapy, the music itself serves as the prime vehicle for improvement. For example, if I sing a song with a patient with Alzheimer’s who tends to be withdrawn and afterwards they smile at me and express an emotion, I’ve used music in therapy for mood enhancement and self-expression. But, if that same patient is restless due to extreme pain and they need distracted until the pain meds kick in, I use music as therapy – the music itself is the aid, not the reaction from the music.

I like that God is artistic. He didn’t just make things functional and leave it at that. He gave us beauty to admire. I was recently at a Gungor concert (my first). Holy cow, it was the most unbelievably talented, creative, innovative group of musicians I’ve heard in a long time. Particularly for being a Christian band (sorry, it’s true.) What struck me was that they didn’t pray during the show or talk about God, they just played their music. And that was worship for me. I stood there in wonder of God because of how amazing the music was.

I think music can be used in worship like it can be used in therapy. It can be music in worship, or music as worship. Sometimes music is the mechanism we use to tune into the Holy Spirit. But sometimes the music itself is the Holy Spirit encounter.

And I would like to emphasize that it doesn’t have to be worship music. Case in point, below is one of the most beautiful things I’ve ever heard:

p.s. there will be a full moon tonight! I love full moons. 

 

Real Musicians

From the Academy Award winning documentary 20 Feet From Stardom, a quote from Sting:

Real musicians – there’s a spiritual component to what they do. It’s got nothing to do with worldly success. The music is much more an inner journey. Any other success is just cream on the cake.

There’s this idea that you can go on American Idol and suddenly become a star, but you may bypass the spiritual work that you have to do to get there. And if you bypass that then your success will be wafer thin.

Songs for the End of Life

Most of my patients like hymns, and I often play what I call the Big 3:  “The Old Rugged Cross,” “In the Garden,” and “How Great Thou Art”. “Amazing Grace” isn’t part of the Big 3 because it’s in a class entirely by itself. It is by far my most requested song. “Jesus Loves Me” gets an honorable mention. There are other hymns I like to incorporate, lesser known than the Big 3, but still familiar: “Softly and Tenderly,” “Just a Closer Walk With Thee,” “What a Friend We Have in Jesus,” and “Sweet Hour of Prayer,” among many others.

When the patient has reached the very end of life, with literally hours or minutes left, and every breath calculated and delicate, these songs take on an almost unfathomable new meaning. Songs that might have been sung hundreds of times in church or at camp or revivals are now so potent when being sung to a loved one taking his or her last breaths. Consider these lyrics:

from The Old Rugged Cross:

To the Old Rugged Cross, I will ever be true
It’s shame and reproach gladly bear
Then He’ll call me someday to my home far away
Where His glory forever I’ll share

from Softly and Tenderly:

Come home, come home
Ye who are weary come home
Earnestly, tenderly, Jesus is calling
Calling, oh sinner, come home

from How Great Thou Art:

When Christ shall come, with shout of acclamation
And take me home, what joy shall fill my heart
Then I will bow with humble adoration
And there proclaim, “My God, how great Thou art.”

Anytime there are lyrics that talk about home it really hits you how relevant the song is. It’s a powerful message, so powerful that I have to be careful with these words. If the family or the patient isn’t ready or hasn’t accepted that death is coming, I could do real damage. I’ve been in situations where I held back from singing songs with these lyrics because I didn’t know what the reaction would be. It’s at times like those I have to rely on my intuition and empathy to make the right choices.

When I can sense that the patient is ready and the family has accepted the circumstances, I feel comfortable and led to sing these songs. I also like to sing a song called “Going Home.” The lyrics are simple, poetic, and usually comforting for the family.

Going Home

Going home, going home
I’m jus’ going home
Quiet like, some still day
I’m jus’ going home

It’s not far, just close by
Through an open door
Work all done, cares laid by
Going to fear no more

Mama’s there ‘specting me
Papa’s waiting, too
Lots of folk gathered there
All the friends I knew

Nothing lost, all’s gain
No more fret nor pain
No more stumbling on the way
No more longing for the day
Going to roam no more

Morning star lights the way
Restless dream all done
Shadows gone, break of day
Real life yes begun

There’s no break, aint no end
Jus’ a livin’ on
Wide awake with a smile
Going on and on
I’m a’goin home.

The other night my boyfriend and I were talking about heaven and all the descriptions it’s been given. I mentioned how I feel heaven is too glorious, too substantial to be up in the clouds like it’s always imagined. He said he likes to think of it how Tolkien described “the West” at the end of the Lord of the Rings trilogy:

“And the ship went out into the High Sea and passed into the West, until at last on a night of rain Frodo smelled a sweet fragrance on the air and heard the sound of singing that came over the water…the grey rain-curtain turned all to silver glass and was rolled back, and he beheld white shores and beyond them a far green country under a swift sunrise.”

I’ve occasionally used the song “Into the West,” from the LOTR movies, in my sessions, when I’ve felt it’s been appropriate. The imagery paints a beautiful picture and can be comforting for the patients.

Into the West

Lay down
Your sweet and weary head
Night is falling
You’ve come to journey’s end
Sleep now
And dream of the ones who came before
They are calling
From across the distant shore

Why do you weep?
What are these tears upon your face?
Soon you will see
All of your fears will pass away
Safe in my arms
You’re only sleeping

What can you see
On the horizon?
Why do the white gulls call?
Across the sea
A pale moon rises
The ships have come to carry you home

And all will turn
To silver glass
A light on the water
All souls pass

Hope fades
Into the world of night
Through shadows falling
Out of memory and time
Don’t say: We have come now to the end
White shores are calling
You and I will meet again

And you’ll be here in my arms
Just sleeping

What can you see
On the horizon?
Why do the white gulls call?
Across the sea
A pale moon rises
The ships have come to carry you home

And all will turn
To silver glass
A light on the water
Grey ships pass
Into the West

Finally, not a song (yet), but I came across a poem that is often used in hospice care and at funerals. I was probably drawn to it because it reminded me of the Tolkien words. The poem is called “Gone From My Sight” by Henry Van Dyke.

Gone From My Sight

I am standing upon the seashore. A ship, at my side,
spreads her white sails to the moving breeze and starts
for the blue ocean. She is an object of beauty and strength.
I stand and watch her until, at length, she hangs like a speck
of white cloud just where the sea and sky come to mingle with each other.

Then, someone at my side says, “There, she is gone”

Gone where?

Gone from my sight. That is all. She is just as large in mast,
hull and spar as she was when she left my side.
And, she is just as able to bear her load of living freight to her destined port.

Her diminished size is in me — not in her.
And, just at the moment when someone says, “There, she is gone,”
there are other eyes watching her coming, and other voices
ready to take up the glad shout, “Here she comes!”

And that is dying…

haven

Anecdotes

A few of the many amazing stories I have found myself in these past 6 weeks of my internship:

Dang my Rowdy Soul

My second week we visited a newly admitted patient in her home. Her quality of life was very low and she was unresponsive to us and our music therapy, but we knew the husband would benefit, which is perfectly appropriate in hospice. After we explained what music therapy was, the husband told us what his wife likes, and also mentioned a song that he was interested in hearing, called “Dang my Rowdy Soul”. He explained how he used to listen to this song on his grandparents’ Victrola but hadn’t heard it after they died. I took it upon myself to find the song, which I did thanks to Youtube, and I wrote it down and learned it.

The next time we visited, I played the song for the husband. He confirmed it was the right song and was a little flabbergasted that I had found it just for him. I asked him when he heard it last and he said 1951, right before he left for Korea. He was very appreciative of our visit and our music.

His wife died the next day. It may seem odd to hear, but sometimes death is a good thing, especially considering her quality of life was so poor and it was very hard on the husband. But what struck me was that we wouldn’t be going back to visit. If I hadn’t learned and sung the song for him on that second visit, he may never have heard it again.

The Old Rugged Cross

We went to do an assessment (first time visit) of a current patient with dementia. My supervisor was familiar with the patient and warned me that she may be agitated. We arrived to her room in the nursing home and looked in. The patient was small, and curled up in her bed. She was in the fetal position and laying sideways. She appeared to be sleeping. My supervisor knelt down next to her, touched her hand over the blanket, and spoke her name. Her immediate response was a jerky motion and “what do you want?” but didn’t open her eyes. When we said we were here to share music with her, she said “alright.” Knowing she was spiritual, we began singing hymns. The patient began singing along but never opened her eyes. After a period of singing, we said good-bye and that we would be back soon. The patient thanked us for coming and was very appreciative. She was pleasantly resting when we left.

Upon writing our note in the patient’s chart, we found several other notes stating that the patient was agitated, mean, and uncooperative, calling people names and telling them to leave her alone. My supervisor and I looked at each other in bewilderment. How interesting we didn’t get that response at all…

Precious and Few

On a Friday afternoon, the last patient of the week, we did an assessment of a gentleman who had been discharged from Hospice and recently re-admitted. Only in his 60s, he was rapidly declining due to Alzheimer’s disease. His wife was present and was coping well with her husband’s condition. Since my supervisor had done music therapy with this patient before he was initially discharged, she knew some of his preferred music, and also that he used to dance. Usually only able to hold attention for five seconds on one thing, the patient kept dancing with help from his wife while my supervisor played a blues progression on the guitar. When the music stopped, my supervisor talked to the wife about her husband’s care, while the husband wandered around the room, not really focusing on anything.

Knowing the song “Precious and Few” was a significant song for the couple, my supervisor pulled it up on her iPad and played the recording while the wife took her husbands hands and moved them in a circular motion while dancing. He complied and moved along with his wife.

As I was watching, I noticed the patient was moving, but not exhibiting any kind of affect (emotional response) and not acknowledging his wife. Then, for a brief moment, the husband put his left arm around his wife’s waist and pulled her in close, resting his chin on her shoulder. She laughed and “awww”ed and said, “See, you’re still in there somewhere.” But before she finished her sentence, he went back to his previous behavior. The moment brought tears to my eyes.

Going Home

I spent most of last week in orientation, so I was in the office and not out on visits. There’s a particular song I’ve introduced to my supervisor, called “Going Home.” It’s poignant and very appropriate for those last days and moments of a patient’s life. Just as my training was getting underway one morning, my supervisor texted me and asked me to call her so I could sing her the melody of the song, as she was about to visit a patient who was impending (very close to death) and she wasn’t completely comfortable with the song yet. I left her a voicemail of me singing the song and she also was aided by a Youtube clip.

She texted me later that the song was perfect for the moment and the family members were able to grieve openly with each other. My supervisor left the patient relaxed, though still showing signs of impending death, and the family, close together.

The patient died that afternoon.

Oh, how much have I seen the effects of music therapy in hospice care. It’s the soft cushion of care and support upon which our patients and families rest and breathe.

cloud

Hospice Music Therapy Goals

The definition of music therapy is to design interventions of benefit to achieve non-musical goals to meet a client’s needs. Determining what the goals should be for the client is a really important part of the music therapy standards of practice, and it takes a lot of practice to know what goals are appropriate for each client. Goals are determined after the client is assessed. Assessment occurs after a client has been referred by someone (doctor, teacher, self). In hospice, music therapy can be referred by the doctor, nurse, or social worker.

In assessment, the music therapist (MT) will engage with the patient and/or the family. She will find out the patient’s preferred music and any significant songs or artists they really love. She may ask what the patient is looking forward to or hopeful for, and what’s most important to them. Usually, the MT will have had an opportunity to look at the patient’s chart to find his/her primary and secondary diagnoses (what the terminal illness is) and from that alone we can get an idea of what goals would be appropriate. For example, if the patient’s diagnosis is dementia, the goals will most likely be decreased isolation and depression (because a lot of times they can’t remember that people visit them) and improving quality of life. Here is a list of the most common goals for hospice music therapy patients:

goals

  • improve quality of life
  • life review
  • decrease isolation
  • decrease loneliness
  • decrease anxiety
  • decrease depression
  • family connection
  • spiritual support
  • emotional support
  • interpersonal support
  • self expression
  • independence
  • anticipatory grief
  • comfort
  • presence

Goals can also be set for the family or caregiver. Sometimes the patient is in a comatose state or unresponsive, but the spouse or other family members are having difficulty with their grief. In those cases, music therapy can still be prescribed to support the family. Goals in these instances are usually family connection, spiritual and emotional support, and anticipatory grief.

So how can music help achieve these goals? Some of them are self-explanatory. The presence of the music therapist and the music itself can be comforting and can also help with goals of decreasing isolation and loneliness. Spiritual and emotional support occurs when music is selected that is meaningful to the patient and/or in which the lyrics have significant meaning to the situation (yesterday the daughters of a patient told us how he remarked he was ready to go home, so I sang the song “Going Home”).

It’s easy to come to the conclusion that anybody with a guitar and a nice singing voice could do this job…and I guess they could pretty well. But music therapists are trained not only to know songs and be able to pick out the right ones, but we’re trained to determine the most effective goals for the patient. We’re also educated in the diseases we come across and how music affects the physiology of the patient (breathing, heart rate, etc.) I compare it to someone who wants physical therapy, so they just hire someone who is athletic and knows how to stretch. Yeah, stretching is good, but there’s more to physical therapy than just moving limbs back and forth. The same is true for music therapy: there’s more to it than just singing pretty songs.

Just look at our documentation!