There are several reasons for the power of music. Music uplifts the soul and reminds us of happier days gone by, it helps to confront the darker parts of our consciousness. Music can be enjoyed personally, in the confines of one’s room, and can equally be experienced in a joyous or sombre union, say at a music festival or a funeral.
Regardless of those particular reasons that we listen to music in the first place, there is one unifying factor surrounding our persistent return to sonic artistry: evidently, music speaks directly to the people, whether that be as an expression of joy or sorrow. In light of this, music is increasingly being used as a form of psychotherapy.
To many, this makes perfect sense. When we have been experiencing the battle of fighting back the tears, trying to get on with our everyday lives, sometimes, suddenly, as Leonard Cohen’s poetry rings out atop his carefully fingerpicked nylon guitar strings, something moves in us, and our eyes fill up. We quickly realise that we are not alone in our pain and are healed.
The psychiatrist, Dr Segundo Robert-Ibarra, agrees, and notes that music allows us to confront our pain and trauma when we are initially resistant to it. “Music is a way to reach people initially resistant to traditional talk therapy,” he says. “Grief and depression have a way of high-jacking the mind and creating a sense of no longer being yourself. Listening to familiar music that has a personal meaning can be a way for people to remember who they were before experiencing trauma.”
In fact, music therapy (an admittedly non-traditional approach to psychotherapy) has shown excellent results in helping to treat depression, anxiety, trauma, grief and loneliness. The Houston Methodist Research Institute’s Performing Arts Medicine Centre offers music therapy to its participants and examines the effect that music has on the brain.
A 2019 study conducted by the Houston Methodist Research Institute concluded that playing familiar and nostalgic music positively affected those who had recently suffered from a stroke. Music can help to reactivate parts of the brain that have been damaged, improve decision-making and emotions, lower the heart rate, relieve stress and induce calmness.
John Head, a therapist at Houston Methodist, says: “Music is so sticky because it interacts with multiple parts of our brain. It can help normalise an otherwise chaotic space like an unfamiliar hospital or a monster encounter. It won’t cure depression or any other condition, but it is a useful tool to help manage the symptoms.” So while music won’t exactly cure depression, it is nonetheless a vital tool in reducing its intensity and ought to be consulted at every opportunity.
Recently, I was afforded the opportunity to talk with Justin Russo, the Program Director at Music & Memory, a non-profit organisation that helps individuals with a variety of cognitive and physical impairments through the use of personalised music. Justin explained that the organisation began with the “commonly held understanding that the music that we love the most is deeply rooted in our conscious and unconscious brains”, so it can therefore be used to help those who have gone through cognitive loss and “reawaken” parts of the brain that have been damaged.
As to their approach, Justin admitted that it is pretty simple on the surface. He said: “What we do is we train care and community professionals to launch and sustain music programmes that offer personalised music playlists.” Each music playlist is specially catered to the individual, containing “favourites from a person’s formative years, roughly ages 12 to 25. These favourites have deep memories long attached to the brain, and they can actually activate a person’s cognition, essentially bringing the person back to life, enabling them to feel like themselves again, to converse, to socialise and ultimately to be present for their own lives.”
But how do care professionals go about creating that playlist? Well, Justin explained that there is essentially a “getting to know you” process that Music and Memory call “becoming a music detective”. The process involves working with the person in question’s family, asking them questions, finding out which records they listened to when they were younger, or whether they had a specific wedding song, etc.
The reason that Music and Memory go for that “quality over quantity” modus is that the aim is really to trigger the recall of memory rather than to merely provide enjoyment of a particular song, as it can significantly improve the cognitive abilities of a person with dementia or Alzheimer’s. As Justin notes, “It’s really amazing to see people kind of come alive. They can remember family members. They can talk about their own childhoods when they hadn’t been able to. They can answer questions about the music that they love. They can participate in their own life, which is just a wonderful gift.”
Naturally, given the settings in which people with dementia find themselves, in care homes, etc., they can often be faced with several traumatic and distressing instances. Take, for example, mealtimes or receiving medication or treatment. However, Justin notes that using music that has a positive memory attached to it can help to soothe the person during those occasions and make their lives more enjoyable.
Justin added: “It can be helpful for agitation and anxiety. Distress episodes are an important part of everyday life in healthcare because, for people living with dementia, life can often be very overwhelming. […] But when they’re immersed in their favourite music, they’re more alert, they’re better able to follow cues, and they’re better able to ward off distress because they’re tied to those memories. So suddenly, it becomes a very different experience”.
Not only can using music in this light help to repair the cognition of an individual, but it can also strengthen the bond between a person and their caregiver. The caregiver gains a tremendous amount of joy and satisfaction from getting to know their participant better and being able to share in the moving power of music. “It brings people closer together, after all,” as Justin notes.
Justin is keen to stress, though, that Music and Memory are not a team of music therapists as such. He said: “We’re not music therapists, although our organisation was started in part by music therapists who saw the need for a scalable model. They endorsed this programme as a means to reach more people. Because while music can be enormously beneficial in terms of specific therapeutic interventions, many more people can simply benefit just by having access to the music they like. That’s really the basis for the Music and Memory; to be able to just bring those people their favourite music. It’s not a substitute for music therapy for people who need it. But it can be enormously beneficial for a lot of people. And technology has made this possible in residential care where it just wasn’t, just wasn’t possible before.”
As well as talking with Justin, I also discussed music’s role in cognitive therapy with his colleague Concetta Tomaino, the executive director and co-founder of the Institute for Music and Neurological Function. Tomaino thoroughly agrees with Justin that a personalised playlist can greatly benefit those with dementia and other cognitive impairments, as well as noting the importance of the more traditional music therapy route.
As to that traditional music therapy route, Concetta said: “Music can become a catalyst for unleashing and unravelling some of the feelings that are holding people back, and maybe bring up some issues that maybe they haven’t really thought about. Through this expressiveness of music you can start to deal with anger, frustration, sadness, things like that.”
Concetta drummed home the fact that music can also provide healing to those with cognitive problems, adding: “Because they have a sort of loss of connection to the world around them, their personalised playlist becomes a way of keeping a sense of self and a sense of belonging. Some of the depression that you see in dementia is because of this ambiguous loss, like, ‘who am I?’, ‘where am I?’ ‘What’s going on?’ Personalised music actually reduces some of those agitated behaviours and some of the restlessness in people with dementia.”
Crucially, Concetta claims that using music in this form can help delay the progress of cognitive loss in the early stages of diagnosis. This can be achieved by employing word recall (singing lyrics to one another), as well as improving attention through listening to the entirety of a song. If memory and cognition loss has worsened beyond the initial diagnosis, then the aforementioned process of maintaining connections to family members and caregivers becomes imperative.
As to the reason that we form those emotional connections to songs in the first place, Concetta explained: “Emotion is, I think, more essential or more primary than cognition. And so associations connected to strong emotions are better stored and preserved than [merely] identifying something cognitively. Research has shown that the things we remember and hold on to remain with us because of some important emotional connection.”
We finished our conversation with two touching tales of when music had been used to great benefit in the care home setting. The first was of a man whose wife had severe dementia, could not recognise her husband and was almost entirely non-verbal. The man looked after his wife every day and took her to music therapy class, where he would sing to her. He became upset at the fact that his wife didn’t know him any longer. But when the therapist showed him the session video, he noticed that she had been looking and smiling at him all while he had been singing to her, and it became evident that she knew and remembered him.
The other story concerns another elderly couple who had both been musicians. The husband stopped playing the violin when his wife was diagnosed with severe dementia. When he visited her in her home, he was upset that she could not remember him or their life anymore. However, when they listened to some of their favourite music together, the husband noticed that his wife (who had been a pianist) was moving her hands in the correct way to play the piece of music. The next time, he brought his violin along and said, “this was the most transformational thing that happened in the past ten years, to know that she recognised me in the way I played the music.”
These stories go to show the profound effect that music can have on those with dementia and cognitive impairments, which in the eyes of their loved ones, can be as good as verbal recognition. Both Justin Russo and Concetta Tomaino are doing excellent work in providing care for those with mental ailments and their families.
Concetta concluded: “It’s a hard thing to accept when somebody you care about so much doesn’t acknowledge you as somebody important and may be afraid of you because they don’t recognise you, which happens a lot. All I can say is to understand that it’s not directed at you at all, that this is some kind of internal turmoil that the person is dealing with. But be reassured – and I’ve seen it – when music is being played, all of a sudden, there’s this sense of, ‘I know this’, ‘I have a sense of this person’. And in those moments, that could be an incredible opportunity to stay connected.”
Please visit the Music and Memory website to learn more, as well as the Music for Dementia Organisation website. And check out our full interview with Justin Russo below.
