Music as Medicine: How Performing and Listening Treat Trauma

In the summer of 2012, my father passed me a well-worn copy of New York magazine with a provocative cover story by Michael Wolff titled “A Life Worth Ending”. In the story, Wolff chronicles his mother’s steady decline through dementia. I still remember the quote on the cover: “Mom, I Love You. I Also Wish You Were Dead. And I Expect You Do, Too.”

My father and uncle—like many Americans—related to the author’s sentiment, and his dilemma: Modern science allows us to keep our loved ones “alive” far longer than ever before, even while diseases like Alzheimer’s can reduce them to empty vessels, imprisoned in their own flesh. What about the quality of their lives and the quality of the lives of those left to care for them?

When I saw my grandmother in her later years, she often seemed politely embarrassed by her Alzheimer’s, touching her cheek, smiling, shaking her head and apologizing when she couldn’t remember my name or my sister’s. I only saw her become very agitated a few times, closer to the end. She passed––peacefully, thankfully––in Florida at the beginning of last year.

Growing evidence suggests that music can play a significant and positive role in rehabilitation and hospice care.

I thought about her recently as I watched the documentary Alive Inside. It is the story of Dan Cohen, founder of the nonprofit organization Music & Memory, and his quest to bring iPods into nursing homes nationwide as a form of personalized care for patients.

I remembered my grandma belting out golden-age jazz standards at the drop of a hat, and how once, while I was driving her home from dinner with the radio on, she tapped her finger along to the song, then looked me in the eye and said somewhat seriously “that’s what’s called ‘laying down a beat’”. Watching the movie, retroactive regret formed within me: I wish I had bought my grandmother an iPod.

Music & Memory

Dan Cohen has the accent of a New Yorker and the delivery to match: fast, bottom line-oriented, though not unfriendly. I get the sense he’s more pragmatic than overtly sentimental about the work he does.

“In 2006 I heard a journalist say iPods were ubiquitous,” Cohen tells me over the phone. “So I Googled ‘iPods and nursing homes’ and there are 16,000 nursing homes and nobody using iPods. From what I’ve seen of nursing homes in my life, it just doesn’t seem right. If I ever want to listen to my 60s music in a nursing home, will I be able to?”

Dan Cohen’s Music and Memory program is beginning to be used in therapeutic settings in several states.

Cohen is a social worker, but when he first brought personalized iPods into a Long Island nursing home that year, it was as a volunteer, in order to earn trust in his methods. Initially, he set up three residents with iPods full of their favorite music and watched as their suffering from a variety of ailments––depression, diabetes––receded while they listened. He eventually began working with residents suffering from dementia, where he saw the kind of dramatic results on display in the Alive Inside documentary: confused, agitated, and nearly immobile nursing home residents suddenly singing, dancing, smiling and crying to their favorite music.

“I would go to different nursing homes and say ‘Give me your most disruptive resident’. One of them was cursing at nurses all the time, knocking food and drinks out of their hands. He didn’t have any family, but we knew he was a veteran, so we made him a playlist of some patriotic music, and he immediately snapped to attention and started humming to the music, and that was it for his disruptive behavior.”

Dan volunteered for eighteen months before receiving additional funding from the Shelley and Donald Rubin Foundation to build his Music and Memory program. Donald Rubin had seen firsthand the effect music had on his own mother and her mood before she passed from Alzheimer’s. These funds enabled Dan to roll his program out to two hundred nursing home residents in four different New York nursing homes, and to demonstrate that the impact of this was repeatable.

“An initial complaint was: ‘Dan, you can’t do this, you’re going to isolate these residents even more–– with headphones, sitting in a dark corner…’ What we found, though, is that the thirty-three professional staff interviewed said ‘We had no instances of further isolation, but boy were they more social’. People were less agitated, more cooperative, more engaged, and in less pain, because perception of pain is often reduced when you’re engaged with music… Then I thought it was just a matter of getting attention.”

To help ensure the new program would get the right kind of attention, Cohen asked The Donald and Shelley Rubin Foundation for recommendations on a filmmaker.

“When I was trying to tell people about this, my friends said ‘Ah Dan, how nice, you’re bringing old people music’ and I said ‘No no, you don’t get it’. I couldn’t communicate the extraordinary impact. I thought ‘If only I could get someone to film a few minutes of this…’ That turned out to be the Henry clip.”

”The Henry Clip” is a now-viral video captured by filmmaker Michael Rossato-Bennett on his first day following Cohen. (This clip would be included in Rossato-Bennett’s Alive Inside.) “Henry” is the subject: a nearly-catatonic nursing home resident in his 90s, suffering from dementia. When Henry listens to his favorite gospel music, however, he sings, begins to move, and for a period afterward, reflects on the music and his remembered experiences in poignant––even poetic––terms. As neurologist and author Oliver Sacks comments during the video, Henry “has reacquired his identity through the power of music.”

Cohen was right: the power of stories like Henry’s were undeniable. Based on the clip of Henry alone, the Wisconsin State Department of Health called Cohen, asking how they could begin to implement a statewide iPod program for nursing homes.

Today, more than 1,000 nursing homes, assisted living facilities, hospices, hospitals, and home care programs actively participate in Music & Memory’s program to provide personalized music playlists to those they serve. In addition to Wisconsin, Utah and Ohio have made commitments to initiate statewide programs, with more states in the queue. In early 2013, The Alzheimer Society of Toronto began a Music and Memory project with the goal of bringing iPods to over 10,000 patients suffering from Alzheimer’s. Early evaluations of the project note decreased levels of agitation in patients and decreased levels of stress in caregivers.

“That’s still my challenge—just getting adoption,” Cohen says. “It’s going to happen. It’s just a matter of when people want to jump in. Because it works.”

Sounds of Science

iPod Shuffles in nursing homes may provide a new context for music as medicine, but music therapy is not a new idea. It was a popular form of treatment for soldiers returning home from both World Wars, and in fact, as recently as 2010, the U.S. Department of Veterans Affairs created its own music therapy program for veterans, documenting the results in a report titled “Guitars for Vets: Evaluating psychological outcome of a novel music therapy”.

A wounded soldier participates in music therapy (Photo by flickr user Lori Newman)

The Guitars for Vets program recruited forty veterans with significant PTSD symptoms as subjects. Each subject received a guitar and an hour of individual musical training each week, as well as a weekly group instruction session. After the study, they kept their music, supplies and instructions. The study reported significant decreases in prominent PTSD symptoms, as well as overall decreases in symptoms of depression, and increases in health-related quality of life.

Although just listening to music can be therapeutic, a music therapist like Eric Waldon distinguishes between that experience and actual music therapy, as he told PBS Newshour’s Spencer Michels:

“It isn’t ‘Johnny went to choir, and Johnny got better.’ It’s that Johnny has a music therapist, and together with the music therapist he got better… The term ‘therapy’ itself says that there’s a therapeutic relationship and there’s an intentional use of music to address non-musical goals.”

But whether we’re just listening recreationally or performing with an intent to heal ourselves or others, our brains are wired in ways that respond positively to music, even as our other cognitive abilities fail us.

The same areas of the brain that process language and syntax, attention, memory, and motor control also process the music that we hear. And research has shown that music learning can increase cognitive abilities and motor control. Put these two concepts together and––as Michael Thaut, Ph.D., and Gerald McIntosh, M.D. wrote in their article “How Music Helps to Heal the Injured Brain”––“Music can drive general reeducation of cognitive, motor, and speech and language functions via shared brain systems and plasticity. Once used only as a supplementary stimulation to facilitate treatment, music could now be investigated as a potential element of active learning and training.”

In practical terms, this could mean using musical rhythms as way to help facilitate movement in patients with stroke and Parkinson’s. (From Thaut and McIntosh’s article: “…their improvements in certain areas were instantaneous and stunning”.) For Congresswoman Gabby Giffords, who suffered brain injury following a failed assassination attempt, it meant layering words on top of rhythms and melodies in order to learn how to speak again.

Music & Memory’s work may not be strictly considered “therapy” by therapists, but Dan Cohen points to it greatly decreasing the need for antipsychotic medications in Alzheimer’s patients.

“Music reduces agitation. Agitation is the number one reason they are given antipsychotics. To me, that alone is huge. In Canada, I heard it’s something like 30%––in Australia maybe something like 60%––of Alzheimer’s patients have been on an antipsychotic. It’s a really big problem because you’re just sort of deadening people for the convenience of staff. Or, not just them, but families at home––‘Mom hit me last night, doc. Give mom something…’ They feel there’s no other alternative, but we’ve shown that half the time you can just replace the drugs with music.”

I ask Cohen if having plenty of science on his side (in addition to stories like Henry’s) makes his mission any easier. In his answer, I hear the flaw in my own thinking and in our healthcare system: dividing medicine into a zero sum game of what works and what doesn’t, seeing our health as a video game life bar that goes up or down with “good” or “bad” medicine, often ignores the fact that we are human beings.

“It’s just a quality of life thing. Do we need double-blind randomized studies to know why we listen to music? No, we don’t need a study to know why we listen to our music. We know it connects with our emotions, it moves us, and we enjoy it.”

“There’s a study that says residents of nursing homes spend 90% of the time idle. And half the people in a nursing home never get a visitor. If you never get a visitor, and you’re idle 90% of the time, that’s a recipe for decline, even if you’re relatively physically stable.”

Then there’s the music––heard through every car stereo, home phonograph, TV commercial, auditorium PA, and mall speaker from childhood to adulthood––suddenly gone from our lives forever. If Dan Cohen isn’t providing nursing home residents with medicine, he’s at least replenishing their memories of being human.

“It’s called providing ‘person-centered’ or ‘person-directed’ care. It’s not just this person with a health issue in room 202. It’s Mrs. Smith, and she has three kids, and this is her home now… When people go home, they have access to their music. When they go into a long-term care facility, assisted living facility, hospice, or hospital, they should have their music. It will change the nature of their experience.”

Songs from Back Home

After watching Alive Inside, I bought two of the simplest mp3 players I could find.

One was for my Uncle Luke, who is confined to a wheelchair after a stroke paralyzed the left side of his body and decreased his speaking ability a few years ago. I loaded the mp3 player with his favorite classic rock: Hendrix, Santana, The Allman Brothers, ZZ Top. When I first saw Luke at the rehab facility after his stroke, he called me by my brother’s name, but remembered well a story about having sex in a tree at Woodstock during a Santana drum solo. (He referred to his partner in crime as his “Cinnamon Girl” after the Neil Young song). The next day I brought an old guitar of mine back to the rehab center and hacked my way through a version of “Cinnamon Girl” for him. He smiled the whole time, but I couldn’t tell how much he really liked it. Maybe he was still up in that tree at Woodstock.

I loaded the other mp3 player I bought with classic doo-wop for my father—the stuff we used to listen to on “The Doo Wop Shop” FM radio show on long car rides when I was little. Dad is still quite sharp in mind (and tongue), but chronic emphysema leaves him alternately sucking down oxygen from a mask, or bending over, his hands on his knees, cursing his breathing.

This was not true when I played him his new mix over a New Year’s family vacation, however. He sang, he danced, he smiled, he recalled a 1968 concert in Las Vegas where he saw Fats Domino play (complete with a faithful impression), and he was able to hit the high harmony counterpart to my bass voice when we sang along with Curtis Lee’s “Pretty Little Angel Eyes”.

But is music really the panacea we would like it to be? Cohen’s claim that music reduces our perception of pain is backed up by research, but I’m now tempted to fall all the way down the rabbit-hole of fantasy: picturing my grandmother still swaying in her chair thanks to Count Basie tunes, or my mother beating cancer on a steady diet of Sheryl Crow, Deep Forest, and that one Des’ree song she really liked. This admittedly, is probably just wishful thinking.

I ask my friend Jenny George for her unique perspective. Jenny, who is a leukemia survivor, is about to celebrate another birthday with her annual “Dancing on the Valentine” benefit show for the Leukemia & Lymphoma Society. The name comes from a song by Duran Duran, the band Jenny credits with helping her weather the prognosis of certain death she was given in her teen years.

“I really honestly don’t think I’d be alive if I didn’t have Duran Duran,” Jenny tells me. “Every bone marrow procedure, every spinal tap––I only listened to Duran Duran. It gave me something to look forward to and to hold on to. Sure, chemotherapy and modern medicine cured me, but music did, too. It was always the most important thing to me because it was the only thing I had control over.”

It may be that music is less an added benefit to our humanity, and more a part of our humanity itself. There is evidence to suggest that musical communication preceded verbal communication in our evolution, and that the singing and rhythms we created in caves thousands and thousands of years ago actually facilitated our walk into humankind. In this light, it’s fair to wonder if some part of our being really does cease to exist when we live in a place with no music.

“People can help,” Dan Cohen says of Music & Memory and its mission. “They can volunteer in a nursing home and help people get set up. Groups can adopt a nursing home. $2500 will provide a nursing home with training and iPods—it will get them going.” Schools can also host iPod drives and facilitate volunteer groups. Cohen reports that there are over a hundred high schools and colleges signed on with Music & Memory, with younger, tech-savvy students organizing iPod playlists for nursing home residents.

“The number one thing is to make sure everyone in the family has their playlists set up, whether or not they’re in the healthcare system.”

I’ll take Cocteau Twins, The Cardigans’ Life, Hendrix’s Electric Ladyland, everything Miles Davis did, and sure, throw in “Pretty Little Angel Eyes” for good measure, so that long after my dad is gone and my brain has turned to mush, I can still remember us singing that chorus together.

Blake Madden is a musician and author who lives in Seattle.

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