A brief discussion concerning the importance of music in health care, this article shows how Hospice Hawaii's vision puts it in the forefront of service providers using music as one of the healing arts.
by Arthur W. Harvey, D.M.A.
With the expansion of therapeutic music services and training programs by Hospice Hawaii, it seems appropriate to provide a brief discussion concerning the importance of music in health care. There are a number of different therapeutic approaches that use music, including Music Therapy, Sound Therapy, Sound Healing, Healing Music, Arts Medicine, and Music in Medicine.
Of specific interest to Hawaii's physicians and other physicians throughout the world is the emergence of a new cross-disciplinary field of inquiry and application called "MusicMedicine." As the research base for this new discipline is accumulating, efforts to integrate music into health care continue to increase.
Hospice Hawaii is at the threshold of expanding the role of music in both their clinical and service programs. A series of training programs focusing on several approaches for integrating music into medical services have been developed for Hospice Hawaii.
In a recent meeting, Maestro Samuel Wong, M.D., and Hospice Hawaii began plans to provide a collaborative relationship between the Honolulu Symphony and Hospice Hawaii to bring the richness of classical music into health care.
Two international organizations begun by physicians to promote the inclusion of music as a viable component of health care are The International Arts Medicine Association (lAMA) founded by Richard Lippin, M.D., and the International society for Music in medicine (lSIMIM) founded by Roland Droh, M.D. and Ralph Spintge. M.D.
The International Journal of Arts Medicine is a result of their cooperative efforts. Since my years in the late 1980's as Adjunct Professor at the University of Louisville School of Medicine, guiding the development of the program for Arts in Medicine, I have been a member of both organizations and am also on the International Advisory Board of the IJAM.
Ralph Spintge, M.D., Executive Director of the International Society for Music in Medicine, writing in the introduction to a 1996 publication, MusicMedicine Volume 2, stated that:
"MusicMedicine" has " ... penetrated all the broad areas of traditional medical practice, ranging from the well-being of the unborn infant to the needs of the elderly suffering from various forms of dementia and physical frailty. Effects of music on brain function; internal rhythm; connecting mind and body; rehabilitation; pre-, peri- and post-surgery; pain relief; problems associated with repetitive stroke injury; and sound and vibration therapy are examples of the breadth of this new specialty within Medicine."
Ina Ajernian, M.D., Assistant Director of Palliative Care Service for Royal Victoria Hospital (McGill University, Quebec) writing in the introduction to "Music Therapy in Palliative/Hospice Care" by Susan Munro, shared insights gained when a music therapist was added to the multidisciplinary Palliative/Hospice Care Team.
"As a physician I had always enjoyed music; as a celebration of life, as a social event, in the many quiet personal moments. Yet I had never attempted to integrate music in my professional work. Now I saw patients sharing a common heritage drawn together by shared music into a supportive community. I saw taut faces and rigid muscles relax before the strains of calm, reassuring rhythms." "I witnessed patients whose emotions were locked behind controlled exteriors, able to communicate something of their inner being through the symbolism of music. I observed music facilitating the review of a lifetime of memories, affirming that life had had value, bridging the past to the present, and the present to the future for those who would be left behind. No medication or other treatment technique approached the diversity in potential."
In a review of "Music Therapy in Medical Settings" in Advances, Dr. David Aldridge, of the Faculty of Medicine at the University of Witten Herdecke described the use of music in cancer therapy, pain management, and Hospice care.
"In the Supportive Care Program of the Pain Service to the Neurology Department of Sloan-Kettering Cancer Center, New York, a music therapist was part of the supportive team along with the psychiatrist, nurse-clinician, neuro-oncologist, chaplain, and social worker. Music therapy was used to promote relaxation, to reduce anxiety, to supplement other pain control methods, and to enhance communication between patient and family."
In addition to reducing pain, particularly in pain clinics, music has been offered during chemotherapy as a form of relaxation and distraction to bring overall relief and to reduce nausea and vomiting.
An experience I had some years ago with a lady suffering form cancer of the liver and pancreas has served as a motivator for me to encourage the use of music as a viable intervention in hospice care. I was asked to share some music with her and her family who had come to be with her in her final days, as entertainment, possible distraction, and encouragement during the holiday season. She was carried downstairs to the room where the piano was located.
Although taking medication, she was in constant pain and had difficulty sleeping. As I began playing the piano and singing songs for and with her and her family, in addition to the important diversionary and cathartic value of the music making, there was a noticeable change in energy level and pain perception. After over an hour of music making, with its inevitable expression and releasing of emotions, she was taken back to her bed for the night.
In response to the musical experience, I was told at her funeral a few days later that the evening of the music making was the only night she slept throughout the night for the last few months of her life, and that when she woke up the next morning, she did not feel any pain.
There are far too many applications of music in health care to discuss them all in this brief article. One area of specific application for Hospice Care is that described in a study reported in July 1997 in the Journal of Gerontological Nursing on the use of "Quiet Music", selections from Relax with the Classics, as a means of replacing anxiety and agitation with calmness and relaxation in elderly, institutionalized patients with significant dementia. The introduction of relaxing music resulted in a 46% reduction in the incidence of agitated behaviors during the first week of music.
Lind Institute, the producer of the Relax with the Classics recordings used in that study, has just released a set of Music for Health and Wellness CD's that I created for use in health care.
We believe that Hospice Hawaii's vision of including music as a therapeutic intervention, as one of many important and powerful services, represents an awareness of the important role that music can play in medicine, and puts Hospice Hawaii in the forefront of service providers using music as one of the healing arts.
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