Music, Health and Palliative Care: Through the lens of Music Therapy

Music, Health and Palliative Care: Through the lens of Music Therapy

– Ms Debashree Das Gupta, Mumbai

Each one of us experience music every day in some form or the other. Whether it is physically, psychologically, socially, culturally or spiritually, music has an inexplicable presence in everyone’s life. From an ethnomusicology perspective, the functionality of music is very much related to the “promotion of human well being” through human contact, meaning, and imagination of possibilities which is also connected to one’s social instincts. As we celebrate and rejoice ‘World Music Day’ on 21^st June, 2023, it is important to understand Music from a holistic point of view.

So, let’s begin by understanding What Music Therapy is:

To start, each of us have been benefiting immensely through music, even though we may not be aware of Music as a therapy. The World Federation of Music Therapy, defines Music Therapy as “The professional use of music and its elements as an intervention in medical, educational, and everyday environments with individuals, groups, families, or communities who seek to optimise their quality of life and improve their physical, social, communicative, emotional, intellectual, and spiritual health and wellbeing” (2011). Music, in its therapeutic form with a biopsychosocial approach, can support overall wellness, stress management, pain management, mood regulation, memory function, communication & social skills, physical rehabilitation, and many more.

A range of methods are used in music therapy sessions, based on the specific needs of a patient.

i) In receptive experiences, the client listens to music and responds to the experience verbally or with silence, or in other ways.

ii) The Compositional Method is used when the client and the therapist work together to create an original musical piece through melody, rhythm or lyric. This could include song writing, song transformation, and many more.

iii) In the Recreative Method, the client learns, sings, plays, or performs pre-composed music or reproduces any kind of model musical form.

iv) The Improvisational method is used when a client makes music while playing or singing, promptly creating a melody, rhythm, song, or instrumental piece. For example- Instrumental non referential, song improvisation, body improvisation etc.

Palliative care, challenges and the scope of music therapy:

In life, every individual strives for a better quality of life (QoL) through personal health, relationships, education status, work environment, social status, wealth, a sense of security and safety, freedom, autonomy in decision making, social belonging and their physical surroundings (Teoli D, Bhardwaj A. 2023).

These individuals when receiving palliative care will often have distressing physical, psychosocial, and spiritual needs; while their caregivers experience anticipatory grief and thereafter a sense of bereavement. Under these circumstances, these individuals face coping difficulties, depression, withdrawal, isolation, challenges in communicating and expressing their needs and desires, while also experiencing distressing physical symptoms. 

While Palliative care works towards improving the quality of life of patients and that of their families who are facing challenges associated with life-threatening illness, whether physical, psychological, social or spiritual. (World Health Organisation), Music Therapy adopts a Biopsychosocial approach to use music and its elements to help improve an individual’s wellbeing.

Integrating Music Therapy in palliative care will therefore help improve the quality of life of a patient and their caregiver, as both disciplines focus on a common objective: improving the quality of life of an individual.

What does the available evidence say?

A brief look at the available evidence yielded the following supporting arguments. Using improvisation techniques of music therapy in in-patient hospice clients, led to a reduction in clients discomforting behaviour (Batzner KW. Lawrence,2003). Another thematic analysis denoted that music therapy can help in pain management, relaxation, providing happiness and hope, reducing anxiety and depression, improvement in Spirituality and Quality of Life of those patients receiving palliative care. (Nyashanu M, Ikhile D, Pfende F. 2021), (Kathy Jo Gutgsell et. al 2013). A study by Bailey (1985) also found that patients who received music therapy generally reported a reduction in pain, improvement in mood, and an improvement in communication.

The well-known Music Therapist and Academician, David Aldridge in his book ‘Music Therapy in Palliative Care’, presented to us a collection of case studies, in which various music therapists employed techniques such as melodic improvisation, sing along with one’s favourite music, guided imagery with music, musical drama etc. to improve the quality of life of their patients. One of the Music Therapists from this collection, Trygve Aasgaard, goes on to highlight the effectiveness of adopting a holistic and humanistic approach in improving the life state of a terminally ill patient.

Adopting music therapy is therefore not targeted towards rectifying the past or building the future, but in reality, it tries to make that particular moment and day manageable for both the patient and their caregiver.

At this juncture, I would like to share Mr Kumar’s story which reiterates everything I have said so far.

I had the privilege of working with Kumar, a 42 year old gentleman who was diagnosed with depression and Obsessive Compulsive Disorder (OCD). Kumar’s symptoms from his disorder limited him from living a normal life when compared to others. He was under medication, psychotherapy and had started losing interest in everyday chores. Over time, he was unkempt in comparison to earlier times when he was always presentable and tidy. His condition was negatively affecting his personal, social and also his professional life. He felt that he had become a burden on his family and saw no meaning to life anymore. He also displayed suicidal tendencies.

It was under these circumstances that I began working with Kumar, by adopting a combination of music therapy techniques. I used Music Assisted Relaxation and Imaginal Listening techniques to help reduce the overall severity of his depression. I used Preferred music listening to help deviate him from unwanted intrusive thoughts. His confidence was uplifted with the adoption of Therapeutic Musical Instrument playing. We also used Group Music Therapy (Group Singing, Musical Games, Group Drumming) as a way to work with Kumar and his family as a unit of care. This Family music therapy helped improve Kumar’s trust towards his family.

After 3 months of Music therapy which was an adjunct therapy alongside the standard treatment and care, I am happy to share that Kumar embarked on his small independent business venture with support from his family. Despite having a long way to go, he developed a sense of hope to live and started to rebuild his bond with his family. Over time his suicidal thoughts were reduced significantly.

Finally, where are we now and what is the road ahead?

Music therapy in the West is currently a licensed approach and is practiced widely as a complementary therapy. Though music holds a very central place in Indian culture, it was not widely recognised as a form of therapy in India. It is heartening to observe that this much beneficial therapy is now slowly and steadily being accepted to be included in formal care pathways, even in India. Various musical and music therapy initiatives are now being adopted in medical institutions, care homes and in charitable organisations to provide care and relief for patients of all kinds. The Shankar Mahadevan Academy Nirvana (SMA Nirvana) is one such initiative which works with several organisations across the country to provide free virtual music concerts to those who will benefit from it. The SMA Nirvana and AIIMS, New Delhi, are now collaborating on a research project to study the impact of music therapy among in Indian populations. Having the support of such music groups / bands / institutions / artists will make such initiatives cost effective and sustainable for institutions to render holistic care.

To spread the awareness of these benefits, hospitals, rehabilitation centres, and care facilities must advocate for music therapy to be adopted as a recognised complementary therapy, with ofcourse support and acknowledgement from relevant government and private bodies.

Remember, Illness per se is not the identity of the person, but just a small part of their existence! Hence adopting and integrating natural tools such as music, will certainly improve one’s life state and help one live a fuller life.

---

References:

Schulkin J., Greta B. Front. Neurosci., 17 September 2014 Sec. Social and Evolutionary Neuroscience Volume 8 – 2014 | https://doi.org/10.3389/fnins.2014.00292

India’s Rich Musical Heritage has a lot to offer to modern psychiatry, March 25, 2020, Sravanti L. Sanivarapu Department of Psychiatry, Institute of Mental Health, Hyderabad, Telangana, India

Teoli D, Bhardwaj A. Quality Of Life. [Updated 2023 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.

Batzner KW. Lawrence, KS: University of Kansas; 2003. The effects of therapist vocal improvisation on discomfort behaviors of in-patient hospice clients.

Nyashanu M, Ikhile D, Pfende F. Exploring the efficacy of music in palliative care: A scoping review. Palliat Support Care. 2021 Jun;19(3):355-360.

Kathy Jo Gutgsell, Mark Schluchter, Seunghee Margevicius, Peter A. DeGolia, Beth McLaughlin, Mariel Harris, Janice Mecklenburg, Clareen Wiencek, Music Therapy Reduces Pain in Palliative Care Patients: A Randomized Controlled Trial, Journal of Pain and Symptom Management, Volume 45, Issue 5, 2013

Porter S, McConnell T, Clarke M, Kirkwood J, Hughes N, Graham-Wisener L, Regan J, McKeown M, McGrillen K, Reid J. A critical realist evaluation of a music therapy intervention in palliative care. BMC Palliat Care. 2017 Dec 8

https://www.musictherapy.org/about/musictherapy/

https://www.who.int/news-room/fact-sheets/detail/palliative-care