Copyright, 2004 Amrita Cottrell, All Rights Reserved.
I recently had the great pleasure of working with someone through the last stages of his life and I sat with him as he died. About seven hours before his death his wife, daughter, son, another caregiver and I surrounded his bed and sang songs of love to him. Even though he was in great pain and in respiratory distress he managed to give us a beautiful smile that could be seen around the oxygen mask that covered his face. That was our special way of saying goodbye to him. It was a deeply poignant time for all of us and also for the hospital staff who told me later how moved they were by the event. Music helped to transform a moment of great sadness into a spontaneously healing ritual which assisted him to fall into a deep sleep and awake only long enough to give one last look of love before he drifted off into a peaceful death.
Music has the power to touch the heart and express that which cannot be said in words. Throughout the dying process, music can help a patient to share or express deep feelings and create a sense of calm and serenity not only for him or her but also for the family and the caregivers, sharing all together this ultimate journey.
Music is also a power therapeutic intervention for many of the physiological symptoms of the dying such as alleviating pain, reducing anxiety and nausea and inducing deep relaxation and sleep.
Integrating music with supportive care of the dying is becoming more common in hospice and palliative care programs. The conscious use of music as an adjunct support service is good example of how the multidisciplinary approach to hospice care seeks to address the total person and their family. Because music reaches a deep, non-rational part of the human spirit, it is ideally suited as an adjunct service that can affect feelings such as grief, fear, anxiety, sadness, and anger that stand in the way of a clear passage. Music can release blocked or painful feelings and can stimulate positive ones such as hope, love, and gratitude. Sharing music together can lead to sharing of the emotions that the music brings up. Acknowledging these emotions in a safe and supportive setting can help bring closure to old issues and enable reflection and sometimes reconciliation.
We are rhythmic creatures. Inasmuch as all matter is vibrating, our bodies are a series of overlapping rhythmic patterns: heartbeat, pulse(s), brainwave activity, electrical currents from our muscles, etc. When we speak, the variations of pitch, tone, volume and rhythm, are responsible for 38% of our communication. The remainder of human communication is 55% non-verbal, and 7% actual verbal language. In actuality, we use sound and music as part of our ongoing human experience and communication network, whether we are consciously aware of it or not.
Sound is an extremely powerful tool for healing, personal growth, and spiritual transformation. For centuries, sound has been used successfully to induce states of physical, mental, and emotional relaxation. Ancient esoteric traditions contend that our identity is an interactive vibrational energy system whose patterns of intention, consciousness, and information can be expressed dynamically through the human voice. Sound vibration directly aligns all energy fields; the use of our own voice is the most powerful and potent vehicle to bring about this alignment. Sound allows us to enter into what is the most personal and sacred experience we may ever know. From this place, we can deeply access our own inner resources to retrieve information, energy, renewed vitality, balance, clarity, inspiration, relaxation, creativity, free expression, and transformation.
Don Campbell, in his book The Mozart Effect, notes that places like the University of Massachusetts Medical Center in Worchester are using harp music in lieu of tranquilizers and painkillers for cancer and other seriously ill patients. He also notes that Dr. Paul Robertson, visiting professor at Kingston University in Ontario, Canada, cites studies where patients exposed to fifteen minutes of soothing music require only one half of the recommended doses of anesthetic drugs and sedatives for painful operations. Even former president Bill Clinton, in 1997, chose to forego general anesthesia and chose country-western music to calm him during his extensive tendon surgery.
Sound, in the form of chant, tone, music, and nature sounds is being re-discovered in the healthcare arena for the enhancement of health, vitality, hospice/palliative care, numerous psychological and behavioral conditions, and stress reduction.
Goldman & Gurin’s work on psycho-immunology, which they published in 1993 in their book Mind Body Medicine, revealed that nerve fibers are contained in every organ of the immune system, which provides biological communication between the nerve endings and the immune system. They postulate that there is a direct link between a person’s thoughts, attitudes, perceptions, and emotions, and the health of the immune system. This being the case, we have the ability to be proactive in the health of our body and mind.
One way music affects us is a phenomena called entrainment. Entrainment is linked to Dutch scientist, Christian Huygens. In 1665, while working on the design of the pendulum clock, Huygens found that when he placed two of them on a wall near each other and swung the pendulums at different rates, they would eventually end up swinging in at the same rate. This is due to their mutual influence on one another.
Practically defined, entrainment is the tendency for two oscillating bodies to lock into phase so that they vibrate in harmony. It is also defined as a synchronization of two or more rhythmic cycles. The principle of entrainment is universal, appearing in chemistry, pharmacology, biology, medicine, psychology, sociology, astronomy, architecture and more. A classic example shows individual pulsing heart muscle cells. When they are brought close together, they begin pulsing in synchrony. Another example of the entrainment effect is women who live in the same household often find that their menstrual cycles will coincide.
Entrainment is very evident in music. It is possible to have rhythmic entrainment, melodic entrainment, and dynamic entrainment. Entrainment music has the potential to (1) resonate with the listener’s feelings, (2) transform the negative into the positive, and (3) promote a state of liveliness or serenity. Certain sounds, in specific sequence can help bring the listener from one state of mind to another.
In other words, our bodies automatically adjust to the pace, rhythm, or pulse of the music. How many times have you walked into a room with other things on your mind and heard music playing? You stop to listen for a few minutes and all of the sudden, your foot is tapping to the music or you are swaying your head or body with the beat. Or, a certain piece of music evokes memories of a time when you heard the music before, and the feelings of that time come immediately back into your awareness? In scientific terms, our psyches and bodies become entrained to the sonic environment created by the music.
Entrainment is a powerful tool for behavior modification. In effect, the principle of entrainment directly relates to the Greek word isomorphic (commonly referred to as the iso principle). Isomorphic means same form or appearance. Therefore, musical entrainment is actually a process of joining with feelings conveyed in the music and sensing the feeling of commonality with it. One might almost have an experience of feeling a connection with the composer or performer by sharing emotions and feelings conveyed in the music, either through its creation or through the performance itself. Music in this sense can be a powerful tool in both positive and negative ways to the listener. Music entrainment is more than just a tool to be used for behavior modification, however. Music has the power to integrate the whole person, allowing for profound healing. Music is one of the few experiences that can touch a person on all levels of consciousness. It is a potent sensory stimulus that can work simultaneously on the body, mind, and spirit.
The second way in which sound and music can be used in healing is through diversion. Sound and music are used to take the attention away from an unpleasant or unwanted situation. An example of diversionary music is the playing of bright, happy, energizing music when the listener feels “down in the dumps.” Music, in this sense, can be used in a therapeutic way to reduce anxiety and pain, transporting the listener to another reality temporarily during the healing process. For centuries shamans have used drums and vocal sounds as an integral part of healing practices in indigenous cultures. The shaman uses the sounds as a tool for entering into a trance themselves as well as an actual tool in the healing process.
When music is used “as medicine” in this way, it can directly affect the health of the patient. An example of this is the use of music as “audio-analgesia”. Music can alleviate or lessen pain, or at times, is used in lieu of pain medications. In this way music is seen as a necessary component in affecting the outcome of the treatment. Vibrational therapy sessions can affect physiological changes such as lowering of blood pressure, heart rate, lessening muscle tension, decreasing ACTH (stress hormones), and relieving nausea.
Dr. Walter Quan, Jr., Oncologist-Hematologist of St. Luke’s Medical Center in Cleveland, Ohio, attests that: "The mind/body relationship is particularly important in terms of looking at the immune system to treat cancer. We believe that patients who are under less stress, who are in a brighter mood, appear to do better in terms of their anti-cancer therapy. I think that music therapy and imaging and immune therapy of cancer all tie together…I think it can be helpful in conjunction with biologic therapy for cancer. A study done just relatively recently on cancer patients showed that approximately three quarters of cancer patients that had their usual pain medicines but also had the additional music therapy experienced less pain then previously…Music therapy that helps patients relax could possibly be beneficial in raising their innate immune system which could have obvious therapeutic implications for cancer."
“Without a doubt, music therapy ranks high on the list of modern-day management of critical care patients…Its relaxing properties enable patients to get well faster by allowing them to accept their condition and treatment without excessive anxiety….half an hour of music produces the same effect as ten milligrams of Valium,” says Raymond Bahr, MD, Director of Coronary Care at St. Agnes Hospital in Baltimore, Maryland.
Music is said to soothe the savage beast. Joyce Handler believes it can also calm the personal demons people find within themselves. "My music addresses a persons needs for hope, encouragement, support, and comfort," said Handler, an Upland, California, composer and psychologist who uses music in her private practice. Increasingly, research shows that music can do more than start toes tapping. It produces measurable and sometimes unseen benefits; it energizes, it can lower blood pressure, and it can elicit deep emotional responses and releases.
Handler recently started using her music to treat cancer patients, and says it is beneficial in treatment for a number of problems. She has taught people how to strengthen their self-esteem and develop trust in relationships using music therapy.
Cancer patients specifically started listening to music for emotional and physical healing back in 1985, when a music therapy program started at University Hospitals of Cleveland in the Ireland Cancer Center. The Robert and Beverly Lewis Family Cancer Care Center at Pomona Valley Hospital Medical Center hosted a recent workshop demonstrating music therapy treatment techniques. Handler led the event, using a synthesizer to play floaty New Age-type melodies.
"Music therapy is one of the newest and most encouraging forms of complementary treatment.'' said Martha Osborne, nurse educator at the center.” We all know how powerful, healing, and overwhelming music can be and we hope to help patients and their families get through the challenge of cancer. "Music releases many suppressed emotions that cancer patients have and gives them a chance to work through them,” Osborne said.
Joshua Leeds, author of Sonic Alchemy interviewed Therese Schroeder Shekker, Director of The Chalice of Repose Program in Mt. Angel, Oregon. In the interview Therese shares an amazing story of the power of music. “Pain is described in the medical world on a scale of 1 to 10. One special woman had very advanced MS. She was contracted, not quite in a fetal position, but quite contracted; both legs, arms, face to the chest. She had been described to us as having lived on a pain scale of (45)! Morphine could not reach her. On top of this, there were other family complications. The spouse of this woman had developed a drinking problem and was very abusive, etc. She wanted to die. Her pain had been described as so excruciating that her nurses told me, “Therese, it is as though she has an abcessed tooth everywhere throughout her body.” I had had an abcessed tooth once, and I remember wanting to cut my head off! I couldn’t even imagine what she was going through. I was actually quite worried. I thought, “Surely wouldn’t every kind of music, no matter how gentle and lovingly it was played be stimulating and therefore increase her pain?”
We went and attended to her. That woman received the music so deeply. We thought that she had died. Her respiratory pattern was almost imperceptible…only about 4 breaths per minute. She received at such a deep level. The amazing thing was that after we had been playing for a few minutes the contraction changed one limb at a time. First her jaw fell open and relaxed and then her right hand and arm opened, left arm, and then both legs. We were completely in shock. It was dramatic.
I touched her. She was cold as a refrigerator and I really thought that she had died. We tip-toed out of the room. But she hadn’t died! She slept for seven hours. The nurses said that she hadn’t done that in months, and with no morphine. Before she died, she dictated a letter to one of the nurses thanking us. She said that she had been ashamed that she couldn’t come out of the experience she was in. She went to such a deep place, while we played, that she was walking in heaven. So in her soul, she was already full of movement and free.
The use of music in palliative care can help to lessen feelings of isolation and loneliness by providing opportunities for social interaction and the sharing of personal experiences with others. The use of religious music can provide spiritual comfort, reassurance and support the individual's faith. Music therapy can also be used to help family members throughout the grieving process by providing comfort, continuity and opportunities to express feelings of loss.
Music has been found to have a significant impact on reducing the perception of physical pain and the length and severity of chemotherapy-induced nausea and vomiting. Carefully selected music can facilitate relaxation and alleviate anxiety, agitation and insomnia or it can provide motivation for physical activation and enhance feelings of well-being. Music can also assist the individual in maintaining a sense of independence and in retaining a sense of control of his or her life by providing opportunities for choice and decision-making.
The music that is used depends on the results you intend for the healing setting. Most healing music in the palliative setting is designed for relaxation and meditation, so the best choice is music designed to transport the listener to an altered state of consciousness where they are free from intellectual analysis. It can range from a simple instrumental tune on the piano to Tibetan bowl music or chanting.
The following characteristics should apply to healing music in the palliative care setting.
· Pulse: At or below heart rate (72 per minute) for calming or reducing tension.
· Rhythm: Smooth, steady and flowing at all times for integrating internal body rhythms and energy flows.
· Melody: Slow and sustained without any perceptible or familiar phrasing; pitch sequences primarily by step at pulse rate for relaxing or slightly faster for energizing.
· Duration: Minimum 15-45 minutes of steady music (periods of silence in between sessions are important for integration
· Tone quality: Generally the softer quality instrument like the flute, harp and organ, and soft vocals.
In conclusion, Deforia Lane, Ph.D., music therapist and resident director of music therapy at University Hospitals of Cleveland Ireland Cancer Center says, “Music has the unique power to do what often seems impossible: To open us precisely where we had been shut down; to touch us where nothing had ever moved; to heal us with a blood-red chorus of an approaching dusk; to sear us with a beauty or a longing that runs up and down the spine. This, for me, is certain: music is a window of opportunity, discovery, art, grace, a seamless break in the picture of any world that might have gone wrong.”
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In May, 1999, Amrita was diagnosed with breast cancer for the second time in two years. She knew that "conventional treatment" was not the journey she wanted to take again. Amrita entered a shamanic journey into the spirit realm, trusting her own process as teacher and healer. With no handbook or physician to guide her, she entered an unknown world of intuition and trust. She followed her own spirit essence and inner knowing to an astonishing experience of eradicating the cancer within two months by using sound, music and emotional release.
Amrita uses sound and music in a private and group practice. She is the founder and director of The Healing Music Organization in Santa Cruz, California, and is on the faculty at California Institute of Psychoacoustics in San Francisco. Amrita is a member of the Threshold Choir, a group of women who sing at the bedsides of people in hospices, hospitals, nursing homes, and private homes when we are invited by family or caregivers. Sometimes the family is present when we sing, and we sing as much for them as for the person who is in bed. To find out more information about the Threshold Choir, visit www.thresholdchoir.org
Music without words means leaving behind the mind. And leaving behind the mind is meditation.
Meditation returns you to the source. And the source of all is sound. — Kabir
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