A Tonic of…

Atonal Medicine

Music As A Melodic Therapy...

It all starts with the beating of a mother’s heart. In the earliest hours of a new dawn, a chroma of rising colour in the sky signals an arriving day. Our mother’s suppressed, soothing voice also rises on the air of our own entering dawn, heard during our earliest days in the womb. Our loving relationship with music starts at the youngest age, even ahead of our arrival; murmurs of vague melody and the harmonies of everyday conversation sink into our fragile ears, as we unconsciously absorb the music of the world before we have even entered into it. The fluctuating heartbeats of our mothers that echo alongside our own inner beats are among the very first rhythms we hear. The first, faint indications of music are among us before our awakening, before the birdsong of the dawn and before the first blush of our origins.

Our auditory sense is fully formed and functional four months before the nativity, so it seems that even with the youngest of ears music is something deeply entombed inside us, at the very outset of existence. A network of circuitry runs throughout our system, and whenever music is heard the cortex can be seen to light up with every passing heartbeat, like Earth’s cities at night. It has been said that we absorb large amounts of what will become our favourite musical preferences whilst in the womb, at the point when we are at the peak of our sensitivity and receptive to everything surrounding us. Aware of it or not, the throbbing pulse of a heartbeat and the reassuring, increasingly familiar voice of a mother conducts our first symphony.

Primal in its origins, music possesses a unique aura. Notes and bars hang in the air without leaving a visible, physical trace. Unlike a painting, there are no prints or any kind of visual residue left behind with music that can be seen with our own eyes. Music may exist in the unseen world, but it still moves us emotionally in euphoric highs and melancholic lows. In this most intimate of relationships, our emotions link together through music and form a toughened, unbreakable chain. Special events may result through this bond. Shockingly or not, the emotional power that music holds over us can transcend itself, and transform into a therapeutic act.

Music can help to shape and mould our behaviours and our personalities, as we, too, help shape bars of music and unite them with their notes. Music can lead us into highly positive mindsets, and in so doing couple this positive mind with the body. An earth-shattering notion rises over the horizon. Maybe, just maybe, a positive mind under the influence of music has the potential to heal an injured body. Eventually, all of the elements add up, and the reality suddenly strikes – music has the very real capacity to change lives.

Any side effects or after effects that are felt during, or after listening to music, manifest themselves in vastly different ways. There is usually a brilliant twinkle or a sparkle in the eyes and an uncontrollable urge, almost subconsciously, to tap that foot as the rhythm progresses, keeping time to the metronomic beat. A song may recycle in the mind for hours at a time, maybe even an entire day if one is unlucky enough, and this either becomes incredibly distracting, or beautifully tuneful medicine for the soul as it revolves in a looping of deja vu. The entirely aesthetic nature of music makes it almost impossible to fully comprehend and dissect, but this only increases a love that was previously already burning with the fires of a cauldron lit with intensity. And all the while, as the music plays on, the sound waves which hang in the air leave cascading lines of vibrations. Just because it is completely unseen in our vision, it doesn’t mean it itsn’t there. Maybe she is just shy, but these vibrations allow us only the faintest hint of music’s physical presence, reserved to the air alone. The only other musical apparition in the physical world is the one reflected through the people affected so by its resonating melodies, the constant progression of a harmony and the pulsing rhythms which beat to the drums of our lives, through dancing and the physical emotion of body language; tears of the eyes and a smile on the lips.

Instruments require a degree of human control in order to call the music out from her rest, as she lays on the ground, silently breathing. She will make no sound until we come forward, pick her up and play. Music is inside us as individuals, not the instrument, and once music arrives, the potential is there to heal people the world over – regardless of nationality, race, geography or gender. Music as a therapeutic practice is a relatively recent addition within the professional world, yet music as a source for healing has been seen throughout history.

Music Therapy is now available on the National Health Service (NHS) in England, and many universities offer music therapy training in three year courses at degree level. Using music and her resonating effects as a means of communication can help people in a way that isn’t possible in any other therapeutic art form. It is able to reach deeply into a person’s heart, mind and soul in a way that no verbal language could ever attain.

Music can be found everywhere; in the morning’s chirping birdsong and even in silence – ‘4:33’ by John Cage is a particularly effective example on the beauty of silent music. The sheet music may read blank lines, but the piece isn’t empty, or even completely silent. It may be that silence is music in itself, and one that, unlike music confined to a recorded moment, changes with every performance in a billion and one possible outcomes.

It could be argued that music is the most powerful of all languages on the planet, or possibly even further out into the vast universe. For every second, music has been broadcast via radio waves, and these waves, now decades old, are at this very moment travelling through the black, advertising our Earth to the silent void. It seems that the pulse of music may beat just as forcefully and passionately as our heartbeat’s devotion to the body.

It has often been affirmed, with the kindest of assurances, that time is and always will be the greatest of healers. This may be true in a romantical sense, but it could also be a truth that music, and her resonating vibrations which beat upon all aspects of life, acts as an even greater potential source of healing. Music is a constant support for many of us, gifting to us all a seemingly never-ending joy and optimism. Music, and her relationship with us, allows us to reflect deeply on anything our heart chooses, to become uplifted in a climaxing chorus and to find inspiration in our day to day lives.

Inside the Cathedrals and places of worship all over the world regardless of faith, music is frequently used to praise the Almighty. In fact, music is a vital element in religion and religious practices. It would be almost impossible to think of Christmas without the angelic carols, or a mosque without its call to prayer, reminding us all of music’s spiritual connection with the mind and the body. Music is highly motivational; from the mental preparation of a sporting showdown, with beats that increase adrenaline and determination, to fitness classes, as the music helps with keeping fit while keeping time and exercising the body. In rocking a crowd to an intense atmosphere, whether it be ice hockey or beach volleyball, the effect is still the same, and music remains a highly motivational art. Although these examples are linked to physical fitness, they reflect the positive effects that music may have on both the mind and the body.

Dance music, be it disco, electronica, funk or house music, seems to aim for around 120 BPM (Beats Per Minute), for a very good reason; when dancing, our heart rates usually fluctuate around this tempo, linking our body to the beat, taking advantage of our synchronised internal rhythms and replacing it with an electronic kind that purposely keeps us dancing (while the higher tempo also influnces the mind to buy drinks and stay hydrated.)

On paper, only a limited number of options exist when it comes to musical note choice in western harmony. Although we are seemingly only allowed the range of notes A-G, including sharps and flats, music completely annihilates any notion that this may be a restriction. Despite the twelve available notes, very rarely does the music sound like the same old song, even though the chord progressions and rhythms used may have been heard a million times before. The way the notes are used really defines who they are and what they have to say, played in revolving sequences and with a wide range of elements present such as tone, timing, note duration, articulation and intensity. Like the painter, utilising a set number of colours and producing a stunningly dynamic painting, the enigmatic elements await a release. Tuning in the radio and hearing that song, the one that sends very real shivers down the neck, becomes the moment when all of these elements coalesce, and transforms a song into a sound that has influence over the physical body. One realises that it is not only these elements that play upon this bond. There is a secretive element that will remain forever cloaked and concealed in the rhythms and melodies, hidden deep inside the essence of music, that affects us in this way, continuing to leave our breath entirely relinquished.

Mental Caverns Without Sunshine

In sickness and in health, the physically and mentally disabled, the imprisoned or those in the unceasing grip of a life-altering disease, music has the ability to heal. It may sound unlikely, but throughout our youth of pre-school, early childhood and teenage kicks, throughout the matured cycle of adulthood and then eventually through to the final path of the elderly, music can transcend, and more importantly unite, people from all ages, ethnicity, social class, gender and nationality. All the while, music spreads its love all over the world like a sonical covering of cloud, and turns non-believers into the most devoted of apostles.

Ascending the spirit in a way similar to that of an out-of-body experience, music has the potential to release anyone from any pain or suffering they may be subjected to, both physical and mental. For one moment, no matter the duration of the piece of music, people from all walks of life appear to be suddenly, and almost miraculously, cured of any limitations that have been placed upon them, as long as the music plays on. Temporary though the effects may be, the results that are seen when music is used as a therapy are truly astonishing. It’s also a reason for a celebration;, as it announces a sweet victory over any and all limitations that wish to keep their prisoner forever caged. Music therapy for people with autism opens the way for any patient to express a true voice, communicating through percussion or the tinkling notes of a piano. As they play, the freedom that music offers creates an unrestricted, flowing expression that may not be otherwise possible, and also releases everyone’s potential.

A fascinating example of the intensity of music arises in patients suffering with the debilitating effects of Parkinson’s Disease. In usual circumstances, patients afflicted with the disease would find any motion extremely limiting, yet it’s often the case that when music starts to play, their eyes suddenly sparkle and take on a new life, or perhaps it is better to say that they revert back to their old life, one that was free before the disease took over. Music seems to transport their minds away from the physical restrictions the disease places upon them, offering sufferers, and even people with no sign of physical or mental illness, a light in their own inner chasms. A heart left broken, or broken bones in a body, music takes all who will listen by the hand, and, no matter the duration, leave behind any frustrations that the physical body had them set in.

Any amount of positivity can be found in the dimmest of recesses. No matter how inconsequential, no matter how tiny the light of belief, it can still be unearthed if there is still a glimmer of faith. A well known case, which recently surfaced on the web called ‘Alive Inside’ (and has, at the time of writing, over six million views) involved the case of an old man named Henry. Henry had been in a nursing home for ten years, mentally trapped in his own, isolated confines, uncommunicative and in a state of desolation. In the days of old, he loved everything related to music, and he loved to sing. His perception of the world around him remained diminished. He was effectively lost in his inner mind, unable to escape and locked inside his condition. Until…

‘Henry, would you like some music?’ He was given an iPod, and some headphones were placed over him. Some of his favourite music began playing, as he had heard in his youth. A staggering change occurred. His eyes came to life and lost their vacant expression, and transformed into dazzlingly bright eyes, with an electrifying intensity. He began to sing, putting so much heart and soul into the music that he even began placing vibrato in his vocalisation. His soulful vocals released Henry’s passion for music that remained, when other characteristics had seemed to be lost, and through the music, the limitations that he had been placed within were crushed. He was alive within himself. It was a truly astonishing transformation to see, and a deeply emotional one. Finally, after the music stopped playing, Henry was studied and asked to respond to his feelings about music in yes or no answers. Instead, he replied with a flurry of intricate details explaining why he loved music so deeply. His answers also revealed thoughts that were deeply spiritual and thankful.

‘It gives me the feeling of love. Romance. I figure right now the world needs to come into music, singing…’

Music was Henry’s outlet to mental freedom, and his true love. It was the memory association that the music possessed, for once again, he was living a moment once ago, expressing himself in his present state, and one which remained even after decades had passed. It is experiences such as this that raise hope, and a smile.

iPods replaced Walkmans, and Walkmans replaced the cassette tape. No matter the format, the devices send a direct musical line to the brain via the earphones. In scientific studies, it is rhythm which seems to offer us the brightest hints of information about music’s relationship with our minds. Shining a focus on the different aspects of motor skills, orientation or relaxation from anxiety or panic, it becomes increasingly clear that music heals. For instance, rhythms present in songs can help to give back a rhythmic ability to one that had been previously lost in time. In the elderly, the element of rhythm offers people their own internal rhythm, and helps to give them some forward momentum in terms of motor skills. The rhythmical patterns and predictability of an advancing beat can even help to organise thoughts that appeared to be forever lost in the mind. Reminiscences can be triggered in the brain at the sound of a favourite piece of music from a person’s past, one which has a special emotional significance to the listener, activating dormant regions of the brain and taking the patient back to their special moment.

Any rhythm, regardless of the time signature or the duration of the notes, quavers or minims, silence or sixteenths, seem to help organize the mind, creating logical paths through a piece of music. Music is very forward thinking in its foundation. Every passing second sees it continually advance forward; there is always an acceleration, even with the slowest of music. A rhythm still likely exists in the person, as in the song, whether prominently or subconsciously. As precise as a stopwatch’s beep, the inevitable metronomic accuracy inside music acts as the vertical spine for all of the skeletal bones of a song to stand tall on, holding everything upright while driving everything forward.

Healing In Harmony

‘He who sings scares away his woes’ – Cervantes

All of the artistic outlets can be used as an effective form of therapy. Painting, writing, drama, dance and the wider arts can all help to heal our wounds that are left so open and raw after coming under any slicing attacks of negativity, so it may not come as a complete shock to discover that music as a therapy is an ever widening area. Through physical stimulation to mental well-being and rehabilitation, music as a therapeutic device is increasingly being used. It’s also a therapy which has been used for a long time, without necessarily having the higher levels of exposure seen today.

Self-expression can be extremely therapeutic, not to mention highly rewarding in satiating artistic desires, and the results of releasing any degree of self expression are largely positive and beneficial. Any possible change in a person’s personality and behaviour, or in their physical well-being, that may occur when music is used as a therapy may be a purely psychological change. Any concrete results of a change as a result of music therapy are difficult to obtain, as experiences will vary wildly in person-to-person, environment, age and mindset. That being said, there must still be a basis for music as a therapy affecting the mind and having some degree of influence upon it. As is so often seen, the mind’s health, in whatever kind of emotional state, can influence the body with staggering levels. There are definitely butterfly effects to the therapy; help to heal one person, and their new reflections on life will impact upon others, and this positivity can spread like a tidal wave of hopeful possibility.

Music therapy is a relatively recent practice in hospitals, care homes, schools and prisons. The discipline aims to primarily help people recover from an illness or an injury, a mental rehabilitation, depression and any physical or mental disability. A musician will play to the patients, building up a positive relationship through an interaction and communication via music. The young and old can speak through a musical instrument without any speech leaving their lips, releasing their thoughts and wishes out into the open. Singing and playing in this way creates a unique bond between the patient and the therapist that cannot be obtained through other practices. Any musical instrument or musical environment can be used, although a guitar, piano and percussion are predominantly featured.

Amazingly, people with no mental or physical problems also use music as a therapy, to discover more about the inner self, or to use it as a relaxant to bring about a sense of calm. Therapy in music can help to relieve anxiety, reach levels of universal escapism and to enter and enhance deep meditation, as well as increase one’s self-awareness. It is almost a promise that, at one point or another in our individual lives, anyone who has fallen completely for a piece of music has used that piece as a therapeutic aid. An emotional release through listening or creating music acts as an outlet for the soul, and music is the medication. The loving caress of steel strings and the ballet of the fingers over the fretboard, the tinkling, resounding notes of a grand piano and its sensitivity, and the intense, rhythmical pounding of drums that may release anger and frustration via the drumsticks dissipates any negativity, and turns a destructive feeling into a positive form of expression.  Regardless of condition, people affected by the music still display a love which still exists, even inside the supposedly darkest, buried depths. Music is able to reach inside and awaken areas of the brain which many thought were lost, and in the process fires new pathways into life through both the left and right hemispheres of the brain.

The brain's fascinating relationship with music doesn't stop at an emotional level, either. It's interesting to note that research taken from image scans such as Functional Magnetic Resonance Imaging (FMRI) shows areas of the brain becoming activated when imagining the sound of a favourite piece of music. The amygdala, an area of the brain's medial temporal lobe containing nuclei, and the area responsible for the processing of emotions, fear responses and pleasure, shows an increase in activity when listening to a favourite piece of music, or even imagining it. Scans such as these reveal flirtatious evidence of music affecting the brain.

Our inner relationship with music dates back to our own dawn. Activation of music has been linked to areas in the brain that are responsible for our primal fight or flight instincts and responses and our evolutionary advances. Present in all mammals, this highlights the depths of our relationship with music, and its intrinsic networking inside the mind.

There are numerous ways for a therapist to communicate with a patient through music therapy. Playing live, in the moment, to the patient may be the most productive method. Familiar and comforting songs, or songs that are affectionately thought of in the mind, may engage the patient more than hearing an unrecognisable piece of music. Recorded music may be used, for nostalgia and remembrance, and although recorded music is relatively recent, spanning roughly one hundred and fifty years to date, an original recording of a piece of music can hold sway over any kind of interpretation. Recorded music does not necessarily offer a link best suited to the patient, or between a patient and a therapist. The personal communication between patient and therapist is the one, true bond, and the gateway to an increased therapeutic value. Recorded music is of cherished importance when it comes to music as a therapeutic tool, but ideally the intimacy and guidance of a music therapist playing to the patient, in the same room, becomes the crucial link which may then lead towards positive change and even a new friendship. Music therapy may even help to deal with depression. Both psychological and physical therapists can refer patients to trained music therapists for any future treatment.

‘Music washes away from the soul the dust of everyday life’ – Berthold Auerbach

Music as a therapy, in one form or another, has existed for thousands of years, either through subconscious use, or used as a practice in a civilisation well aware of its healing capabilities. Often studied by scientists and psychologists with great intrigue, it appears to be the case that music therapy holds substance, and as the years pass and scientific advances come to fruition, the evidence begins to stack up in favour of music being an effective form of treatment. There have been numerous tudies undertaken by scientists and lovers of music the world over, dating back thousands of years. One of the earliest known writings linked to music therapy dates back to the times of Al Farabi (872-950 A.D.) a highly renowned philosopher, musician and cosmologist, who wrote the treatise ‘Meanings of the Intellect’, which discussed the therapeutic effects of music upon the soul. Known to Muslim intellectuals as The Second Teacher, the successor to Aristotle, the great philosopher, it is clear that music’s bond between healing and philosophy stretches back across thousands of years and throughout many cultures. Aristotle himself once declared “Music has a power of forming the character, and should therefore be introduced into the education of the young.” Aristotle also proclaimed that “Music directly represents the passions of the soul. If one listens to the wrong kind of music, he will become the wrong kind of person.”

Stretching even further back to biblical times, it was said that,

“And it came to pass, when the evil spirit from God was upon Saul, that David took an harp, and played with his hand: so Saul was refreshed, and was well, and the evil spirit departed from him” (King James Bible, Cambridge Ed.)

The seeds of music therapy, as we now see it, emerged in the devastation of World War I and World War II, where musicians would play to injured soldiers as an aid to their recovery. Music helped, or at least eased, the afflicted battle-scars left on the terrifying battlefields, calming both their emotional ordeal and mental trauma of war, and their physical pain and injury.

Inner Healing

There is a whole network of activity deep within the brain when a pice of music plays. Not all music that is intended to move us in a specific emotional way may do so, but there are certain traits which appear in the brain depending on the emotional intent of the music. A major key may allow our minds to think of joy and uplifting emotions of happiness and optimism. A minor key may tell us to feel sad or lonely, automatically assuming we should feel the emotional intent that the musician hopes to achieve. Whether or not we connect with the emotional intent is another matter, yet what is certain is the constant level of activity inside the brain when the music plays. Sombre moods are often accompanied by decreased levels of the chemicals Serotonin and Dopamine, which surrounds the brain, and both of these chemicals regulate our moods, keeping them in a state of relative balance. Serotonin is largely responsible for our moods of happiness and general well-being. It becomes deeply intriguing when it was discovered that listening to music actually produces higher levels of Serotonin, and this in turn raises our state of joy. In western music, songs of joy often possess frequent use of higher pitches, a quicker duration between a set of notes and a faster tempo, although tempo is free to vastly change for all possible musical moods.

This can be experimented by playing any musical instrument. For example, if we take a keyboard or a guitar and play any major or minor chord in staccato bursts at a fast tempo, an uplifted mood will be created. However, if we play the same chords slower and hold the notes longer, the effect will seem a little more subdued. Our fingers, part of our motor skills, display an increased speed and activity as they quickly hold and release the chord, and our physical motions are also reflected through musical moods in its own body language of faster tempos and use of major tonalities. Adrenaline kicks in, sending sparks of neurons flying in a way that further raises our mood, and this is reflected in the body – dancing, tapping our fingers and feet, clapping, rocking and moving to the music.

Melancholic songs also affect our moods. When we feel sad, we want to retreat away from the cold world and everyone in it. Sad lyrics of longing and the blues comforts us when we need comforting the most. Have you ever noticed how the saddest songs are sometimes the most beautiful, resonating with our own situations? There is a reason behind this. In our desperate times, the music shines a light for us, the lyrics are a remembrance that we are not alone. We resonate with the songwriter, who is experiencing the same turmoil (and who has turned this turmoil into a positive form of expression). The lyrics tell of any emotion the listener may be feeling at that present moment. Relating to this music is the brain’s own therapy, the mind’s way of consoling as any emotional instability affects our capabilities and ultimately our survival. ‘Love hurts’ is a very real thing – people who are rejected throughout life and never move on have a lower life expectancy than those who stay positive and look to the future, which is further evidence of the body and mind linking in health.

Does the song suggest happiness or sadness, or are we supposed to feel these emotions because that is what is expected of us? Our inability to fully understand the links between music and the brain further adds to the mystique that surrounds it. One gets the feeling that music goes even deeper than chemical reactions in the brain and back to our primal instincts; an unbreakable strand in our DNA, just as the rhythm of the drum enacted a tribal intensity and territory deep in the caves thousands of years ago.

The Therapist

“If you can walk, you can dance. If you can talk, you can sing” – Zimbabwe Proverb

The role of a music therapist requires a patience, understanding and a sensitivity towards each individual patient. They are the figure for the positive efforts that have been realised in a patient, a source of inspiration which, with their guidance, will help to turn tentative steps into a positive, brave stride forward.

Each patient may display unique levels of behaviour, different needs and thoughts that must be taken into consideration, and the patient must always be encouraged. In this aspect, the patient-therapist relationship is completely equal, as it is up to the patient to realise the change and to fully carry it out. The interactions and participations that music therapy creates also makes it highly rewarding, while also allowing the therapist a high level of artistic freedom and creativity. The therapist must choose the direction that will best serve the patient, and the relationship that is forged between patient and therapist acts as the heartbeat of the therapeutic process. Encouragement allows the patient to delve deep and find their own soul which they can then set free into the world, far removed from any struggles they may be experiencing and focusing their energy into a creative outlet of expression.

An ideal environment for a music therapy session would be carried out in a music room, with privacy ensured. The length of each session is agreed before commencing, and the first links between the patient and the therapist are created in a commitment of attendance.

Music therapy can help to overcome mood disorders, help people with learning disabilities, people who may struggle to communicate verbally, people with addiction problems, eating disorders and high stress levels. Children with autism benefit through the playing of musical instruments, while people suffering from alzheimer’s disease are, amazingly, transported back to their youth through a loved song, when all other systems may be shutting down. It can become a communal experience, as people start to sing and hum a once loved melody. It seems that the capacity for musical memory lingers longer than any other form of memory. As Oliver Sacks notes in his fascinating book ‘Musicophilia’, regarding a letter from the Australian music therapist Gretta Sculthorp, who worked in nursing homes and hospitals for ten years, said that,

‘At first I thought I was providing entertainment, but now know that what I do is act as a can-opener for people’s memories…One of the loveliest outcomes of my work is that nursing staff can suddenly see their charges in a whole new light, as people who have had a past, and not only a past but a past with joy and delight in it.

There are listeners who come and stand beside or in front of me, touching me, for the whole time. There are always people who cry. There are people who dance…there are disturbed people who become calm, and silent people who give voice, frozen people who beat time. There are people who don’t know where they are, but who recognise me immediately, as “the Singing Lady”. (Musicophilia, Music and Identity: Dementia and Music Therapy)

Alex Smalley, of Olan Mill and Pausal, worked as a Music Therapist at the high security Broadmoor Mental Hospital for six years, on a pilot initiative that worked with patients who had DSPD (Dangerous and Severe Personality Disorder).

The government’s initiative at the hospital was aimed specifically at prisoners who were coming towards the end of their sentencing, or ones who had recently finished their sentence, but who were still considered a serious threat to the public if they were released. In this situation, music therapy was one link on a chain between the ending of a sentence and the start of a rehabilitation. Alex cited The European Court of Human Rights, stating that ‘you cannot detain a person on a section without offering them a treatment program aimed at rehabilitating the patient’. These were clearly people who displayed extreme anti-social tendencies and behavioural problems, and this is where the musical harmony of hope was introduced.

Music therapy in this instance also raises a very important issue regarding the avoidance of the death penalty, where in many places in the world, with prisoners such as these, the punishment would be enacted without a second thought. This is not only a pro-life initiative, but it isn’t a strictly forgiving process, either. Music offers the possibility of redemption and of therapeutic healing, while also giving the patients a feeling of self-worth and a sense of value and importance, something which can only be seen as a positive stride away from the hardship of their past. A second chance is important. Through music, patients are given the chance of achieving something positive. The rehabilitation process through music therapy is also a metaphorical olive branch in the form of a stave, but, as with everything, it was the pratients who, despite all of their behavioural difficulties, chose to embrace it.

Working with some of the leading psychologists, doctors and security personnel, Alex was directly involved in this radical form of therapy. The therapy is a cycle of learning; the patient learns from the therapist, and the therapist learns new insights into the patient and the practice. One could say that music therapy, in the early phases, is a constant learning curve. It may also be worth noting that a change of environment may place different results on any potential therapeutic outcomes. A few considerations will always come into play, such as the age of the patient, their social and mental state, the kind of therapy and the actual, physical environment itself.

The nature of the patient’s tendencies and anti social personality disorders meant that bringing them all together for one music therapy session was a challenging task in itself. The personality traits revealed hostility towards others. Yet, in the music room, sound became the focal point. The risk to the public was at a dangerously high level. Initially, music was used as an entry point, a starting point to gain trust among the patients and to find out more information about their personalities and their own distinct behaviours. Approaches such as these help to gain a crucial insight into each individual patient, and ultimately, the most effective course of treatment.

The Sanctuary

For the patients of Broodmoor, music offered a comforting presence in the darkest of territory. Anger and bubbling frustration that was close to exploding could be rechanneled into more positive directions through music. The music room at Broadmoor Prison was very well equipt, featuring a wide range of instruments and a recording studio with well-known professional music software such as Logic and Ableton, as well as outboard equipment ready to use if required. These plentiful resources could have the capability to lift a mood into one of opportunity, and to stir an emotional excitement just by looking at the array of instrumentation at hand. Appearances can have an important psychological impact; just looking around at musical possibilities, it may be possible to feel mentally ‘released’, or some partial detachment and escape from the conditions of the inner prison.

A feeling of mental freedom may not always be desired with patients such as these, due to their behavioural difficulties, but under the guidance of a music therapist a creative outlet that was previously dormant may start to burn. Music, in this situation, became a beacon of change, the slow-burning embers flickering a hope that many may have thought was lost forever. For some of the patients, the thought of being inside a real music studio was a whole world away to that of their imprisoned lives. In this respect, just entering the room brought about an increased, positive attitude. As the sessions passed, the presence of each other’s company began to feel easier, and a circle of a bond was gradually created. People who would find difficulty in communicating were engaging in verbal communication, and music, and the therapy, was the reason. Alex was already unlocking doors and easing away any barriers.

Communication was the central aim to the therapy, and the first point of contact. Listening to an album and then discussing it in a group environment, and creating a soundscape made out of film samples were all features to the sessions. Crucially, when the session had ended, and the music studio was left behind, the patients were able to retain some of their musical creations in the form of a CD. Sessions could be recorded by Alex, meaning the patients had a physical representation of their creativity and work. It became a source of delight in knowing they had the capabilities to create music, not to mention a glowing pride in sharing it with friends and relatives. It also built a link between the confines of the prison, and the creativity and free-flowing expression of the music room. Additionally, there may have been a negative psychological effect upon leaving the studio, knowing that they had to return to the hospital; there may also have been a psychological boost knowing that a session was inbound. It seems to work both ways depending on perspective; it could be something to look forward to, but at the same time there may have been disappointment tinged with a sweet sorrow when the time came to finally leave.

A shared goal is vital to the therapeutic process. Through any style of music, people who would under other circumstances retreat into an anti social shell would be instructing and helping other patients to reach a goal; in this case, creating music. A team mentality was formed, maybe one that is not so dissimilar to the team spirit and close bonding found in professional sports teams the world over. This truly staggering change in behaviour was not completely down to music. It’s also caused by being involved in a different situation, with a chance to create something. It may be viewed as a challenge laid down to yourself and your capabilities. Some patients would display violent traits; music may be seen as something of a conquest, and there are many emotions that come with this – pride, a sense of achievement and success. All the while, the music therapist would be gaining invaluable information on each patient and their behaviour in a particular social environment. Alex described the information he received as ‘vital’, to help build up an idea of the patient’s personality. True colours were displayed, whether the patient was aware of it or not.

A lot of options existed in directing a given session. A sharp eye and ear for how each individual was feeling on any given day was an essential social and awareness skill, ensuring that sessions flowed freely, and in the process maximised the potential benefits of any given session. The patient may be put in a scenario that they have never previously experienced. Shared goals removed anti-social tendencies and destroy barriers; it's something to work towards and achieve together. There is also a connection between the instrument and the patient, representing a physical manifestation of the therapeutic process in action, and of the positive change they are working towards.

Musical preference can be a key element towards understanding, and becoming closer to, patients who otherwise would seem unapproachable. For instance, rap, urban and grime music were the stand-out musical preferences among patients in the hospital, possibly linking back to their own culture and origins of society, a street culture reflected in the music. The patients seem to display an attraction with the music and the society they were once a part of. This preference could be taken advantage of in sessions by the therapist. In focusing on this one style of music, it gave the patients an extra incentive to create the music that resonated with them. Rap is a style that acts as a perfect vehicle for lyrical expression and freedom through words, while also further solidifying the relationship between society and music. It may also have been a comforting presence, knowing the music resonated with their past and their youth. Given the opportunity to ‘spit’ over, and create their own hip-hop song inside the music studio at the hospital was not only an expression of the music they loved, but the style, perhaps, could also bring them a little closer to home while confined and hidden away from the world. It gave them a sense of identity and purpose, while artists in the genre could become role models for the patients – another reason to be inspired.

The rap and hip hop style of music focuses on a higher level of production. In a music therapy session, this would be advantageous to both the patient and the therapist. Alex would remain in control of the technical work, while the patient would decide on which sample to insert and how much delay to use. Poetry and lyric writing allowed violent patients to express themselves in a way that appealed to them, expressing feelings through the music that they would otherwise find difficult in a purely verbal situation. The relevance of the lyrics, and their backgrounds, is highlighted through rap, and writing meaningful lyrics that the patient can associate with becomes an essential release, possibly even the ultimate therapeutic act. This is also a case of music being subliminally buried within society, class systems, race and possibly nationality – various musical styles, such as the Samba, or maybe Americana, are proof of music originating in one area of the world and becoming embedded deep within an area’s culture; it’s music’s accent.

As with any therapy, the effects were not always desireable, and, as expected, there were a couple of downfalls to the therapy. Music was the one activity that could transcend the patient-to-staff barrier. Alex stated that, in any one session, there could be a patient playing the guitar and a staff member playing the drums. On the positive side, it was a relationship of high interaction, creating something out of nothing as part of an ensemble. It was a fun experience and it also boosted their self esteem, while gaining the vital element of trust – critical to any relationship. Negatively speaking, the very nature of their personality traits sometimes made it awkward, and even difficult, to ensure a smooth session. Patients in the high security wing were likely to be expert manipulators, and the possibility remained that a patient may try to negatively affect a session without as much as a second thought. Alex stated that the patients would push any and all boundaries between the patient-staff relationship, and this could leave the more inexperienced members of staff vulnerable to breaking codes of practice. Not only could the breaking of boundaries re-enforce a patient’s disorder, it could also possibly make them better psychopaths. This could potentially reverse any and all possible benefits the therapy was likely to attain, and what the service aimed to achieve.

Narcissistic Personality Disorder, with the most noticeable characteristics including a high level of self-importance, a lack of empathy, and an exploitative trait towards others to achieve their own means, are all highly disruptive features that could have a negative influence over anything, let alone a possible therapeutic environment. They are also often envious towards others. This came into its own in the music room, as patients with the disorder brought their behaviour into a session. Due to their inflated belief in themselves over others, problems arose. They had the capability and willingness to bully other patients, which in turn could lower the recipient’s self esteem in the process, and dominating what should be a team goal into an advantageous outcome for their own selfish ways. The patients who displayed narcissistic personality disorder had to be boundaried to ensure that the session remained unaffected and free from disruption, so that any negative effects on the patient’s peers never manifested.  In re-affirming the therapist’s shared goal philosophy with the patient, an insight into teamwork was created, through music, and also restricted their narcissism, at least to some degree. However, these problems are similar to any unwanted side effects of drinking a sour tasting medicine that will eventually make the patient feel better. The notion of teamwork was crucial when patients discussed the nature of a band environment. In a band situation, everybody remains equal as a team, depending on each other with an absolute trust that is hard to break. It also develops a companionship with your bandmates, knowing that you all are creating a musical energy and having fun at the same time. Sharing a bond huddles people together, and the result usually leaves people close together long after the music has returned to silence.

Alex would work one to one with the patients privately, and patients without any past musical knowledge or skills (or an unactivated skill) ensured that music therapy remained interesting and became both a positive focus and a fantastic new opportunity, not only to learn a new skill, but to become a part of a team and create something in unison under the liberty of music.

The absolute stylistic freedom over the spectrum of music ensured there was something for everyone. In Alex's experience, the effects music had on the brain, from a neurological perspective, manifested themselves in very interesting ways, and ranged from hallucinations to extreme euphoria. These results that music had on the patients had to be diluted by the therapist so as not to get too carried away.

Alex stated that ‘ultimately we were seeking to enhance mood, build appropriate therapeutic relationships, gain information on patients, build new skills sets for the patients and educate them’. Of course, these experiences were confined to their environment inside a high security hospital, and dealt with dangerous individuals. In this context, the therapy still produced positive results, despite the behavioural problems inherent with the disorder and the personalities displayed in the patients. Seen in other environments, with other age groups and personality types, the results may change completely.

This is the heart of the therapy as it currently stands. In an era where the government cut the arts, music therapy should not be overlooked, as it has both the power and the capacity to change lives, and the arts, in this respect, are all too often shunned as a secondary substitute, or abandoned altogether. Alex stated that he ‘…never witnessed anyone be cured through music in a way that could be recorded or proven’. It seems to be the case that any changes are difficult to prove, as so much is taking place in the mind, rather than the visual appearance on the physical body. Yet, music as a therapy is still very much in its infancy, in regard to professional practice, as is the case with most therapies. Alex did say, however, that music seemed to act as a power to enhance any significant neurological changes.

The lasting effect that music as a therapy seems to have at this point in time is as a communication device. Just as our earliest ancestors used percussion as warnings to communicate, so too do we speak music with others in the present day. It also highlights the notion that music goes beyond much of reason, and is something locked within our primal code. Alex’s patients felt comfortable with music, and that is another positive stepping stone. The music therapist is then in the right position of trust to oversee and guide the patient towards a neurological healing; in the case of Broadmoor, the healing was largely a mental one.  Interactions with other people are learnt and positive experiences are realised, in some instances a poditive relationship is formed for the very first time.

Does music physically heal the body? If it does, it is likely that the ‘mind over matter’ comes into play. All music is processed through the brain and its many channels and sub-sections. It remains entirely subjective, like music, on whether a healthy mind can heal an injured body.

An Octave Higher

Music induces like-minded reactions regardless of geography. It is truly an international force. No matter where you may be, a smile can conjure another smile, and a sorrowful piece of music can console and help to heal the inner soul in its heartwrenching beauty, where words and actions may fail.

It may not be a coincidence that meditation utilises music as a central element towards hypnosis and inner searching. Music’s ethereal nature does seem to lean towards a spiritual experience. Like faith, we may never see it, but we very much feel it. Music can also manifest itself in the phenomenon of musical synaesthesia, a condition that unites multiple senses, where notes that are played are seen as specific colours in the vision, such as dark blue or mint green.

It may be fair to say that any negativity that may arise from a music therapy session may ultimately arise from emotions such as jealousy or anger, and while music may trigger these specific states in some instances, perhaps a reminiscence of a once-loved song that floods the mind with memories, music leaves us largely with love and positivity, rather than any negative traits. It seems to come down to the individual and the control over all negative reactions.

“Do you know that our soul is composed of harmony?” – Leonardo DaVinci

Coda

In many ways, music is a therapy for us all. People all over the world, regardless of nationality, ethnicity, gender, profession, culture, lovers of music and musicians alike. Everyone who loves music, regardless of genre, has been affected by her presence at one point or another in their life. Music is active in more areas of the brain than any verbal language and dialect we use in the modern world. Music means different things to us all. Everybody experiences it differently over the passage of time, mood, occasion and moment in our life. It can bring into focus our current situations, fill us with an appreciation for life, console us, uplift us in perfect fifths and just rock out for fun. May her ability continue to release us from the constraints of a world that can taste bittersweet, healing lives as she passes on her bravery.

The writer would like to pass on his deep, personal thanks to Alex Smalley for his insight into music therapy and his experiences as a music therapist.

Sources & Recommended Further Reading:

Alex Smalley 
‘Musicophilia’ – Oliver Sacks; ‘This Is Your Brain On Music’ 
Daniel Levitin; NHS Careers
The British Association for Music Therapy (BAMT)
‘The Music Lesson’ – Victor L. Wooten

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