Music Therapy
Singing for self-healing, health and wellbeing PDF Print E-mail

By Jane W. Davidson

Outside of Western practices, group singing is an important social and cultural force. Emergent studies in the area of music therapy and music and health demonstrate that group singing can promote feelings of health and wellbeing. Studies provide evidence of the physiological, cognitive and emotional benefits of group singing for an improved quality of life. Considering the potential for young and old across the lifespan, it is proposed that group singing should be encouraged for all people, without placing demands on music reading skills.

Context

In a music psychology study investigating the key emotional experiences associated with music, Sloboda (1991) noted that members of his own choir reported significant physiological reactions such as shivers down the spine, goose bumps, even tears. Though these were responses to listening to music, it is to be noted that overall the interviewees reported Bach’s Mass in B minor to have the most profound effect on them, and this was a piece they had all recently performed. The idea that group participation leads to stronger emotional experiences is gaining currency in music psychology. For instance, Bailey (2005) investigated 121 members of three different types of choirs considering the effects of (1) group singing, (2) isolated listening and (3) social listening. Participation in the group singing was found to be more beneficial than either isolated or social listening on 73% of the items. These items included: (a) improves concentration, (b) is an exhilarating experience, (c) gives me a kind of high, and (d) improves my mood. Isolated listening was considered most beneficial on the remaining 27% of items including: (a) helps to suppress emotions, (b) helps to reduce stress, and (c) makes me feel mentally rejuvenated. These results indicate that group singing promotes heightened arousal on a variety of behavioural dimensions, and that listening is better for resting/recuperation.

Research and everyday practice using music also shows that in Western culture we listen to music to regulate our mood (e.g., driving to work we pass the time, or we listen to a ‘relaxing’ CD in the bathtub - see DeNora, 2000) Indeed, in Western culture we are exposed to a whole raft of commercial enterprises based around the music we ‘use’ in everyday life, but these are almost exclusively in the domain of music consumption for listeners: eg, music suitable to stimulate certain moods in order to buy specific brands of clothing; music to improve our IQ; music for spiritual healing. At best, many of these more commercial enterprises base their products on folk/popular psychology rather than controlled scientific outcome. But, if the participatory activity of singing - especially group singing - as indicated in Bailey’s systematic research, can have both measurable and positive behavioural impact, it is surely an activity we should encourage. The current paper presents the idea that singing is of significance for us all.

Pursuing the details of Bailey’s work a little more, it is important to note that in the perceptions of choral participants from Australia, Brazil, Canada, Hong Kong and Iceland (n = 224) the holistic health effects of group singing were compared with listening to music, watching television and each participant’s activity of choice. Cognitive, emotional, spiritual, social and physical effects assessed the holistic benefits. The results indicated that group singing was regarded as being significantly more beneficial than the other activity categories. Even when the activity of choice was a physical activity, the participants believed that group singing was more holistically beneficial.

In addition to the compelling results above, Bailey and Davidson (2001, 2002, 2003) emphasized the crucial importance of group singing participation for homeless men. They discovered that singing in a group created a potential for social bonding between the choristers, but more importantly, a social distance seemed to be created from which these otherwise marginalized individuals could begin to develop a relationship with the public and demonstrate that they were much more than their appearance might suggest. Generally, opportunities around performance seemed to promote feelings of pride for social contribution and personal recognition. The recent Australian TV series The Choir of Hard Knocks (ABC TV 2007) provides further, though popular evidence for the social significance of the participatory activity for choristers.

Thus far, we have considered group singing only from the Western tradition. Looking more broadly at music making across human cultures, the social communion of singing with its interaction offering inclusive opportunities can be found in a direct and recognisable way. For example, Blacking (1967, 1971, 1973, 1974, 1977, 1985, 1987, 1988, 1989) who lived with the Venda people of South Africa, wrote enthusiastically about the significance of human musical communication as observed in the singing and the accompanying dancing activities he was able to experience. By investigating a culture different to his own, Blacking was able to reflect upon the fact that musical activity was used not only as a means of emotional regulation, but for educating individuals towards cultural practice and for forging social relationships. His promotion of the concept of ‘human musicality’ being a crucial feature of being human provides support for the notion that singing activity is not only a natural, but also an essential expressive medium for us all.

Examination of Indigenous Australian culture further demonstrates the strength of the link between music, the human voice, the human body, symbolic function, expression, communication and social collaboration. As the oldest living culture, surviving relatively unchanged for over 40,000 years, virtually all aspects of human behaviour are shown to have an intrinsic link with music: eating, hunting, lovemaking, birth, marriage and death are all collaborative music-filled activities. More specifically, songs include many kinds of vocalisations ranging from growling, grunting, and shrieking to bitonal syllabic chanting (c.f., Oxford Companion to the Body, entry on music and the body, written by Davidson in 2001). The music demonstrates how human communication has evolved from survival function through to the engagement in singing for artistic pleasure. With this evidence, we can argue a case that singing is an essential human activity. But, living the contemporary Western experience, most readers will realise that speaking relative to the Venda experience and the Indigenous nomadic bush peoples of Australia, most Westerners have a very limited exposure to singing or any other musical participation.

Opportunities for most Westerners to participate in singing activities might include: natural mother-infant interactions, pre-school, primary or secondary school activity, being with friends in groups and organisations, attending some ceremonies and significant public events, or receiving a specialised training either privately or through an extra-curricular school programme. The last category is of course usually the consequence of a family interest in learning or a very vigorous school or community programme. Even with this sort of family or community support, we know that fewer than 5% Westerners who do begin music learning experiences actually persist to competence – see McPherson & Davidson, 2006. The reality is, of course, that rigorous and lengthy training is required to develop the musical skills required to play with fluency Western classical musical instruments. For example, to play concert violin to a professional standard, approximately 10,000 hours of amassed practice by the age of 21 years of age is required (see Ericsson, 1996; Ericsson, Krampe, & Tesch-Römer, 1993). This is too daunting for most, especially if the music-making is not to be the main focus of the person’s life. Given the highly compartmentalised lifestyles Westerners lead, most give up their efforts completely when competence is so hard to achieve. Though singing can involve a rigorous training and technique, group singing does not require lengthy solitary practice, and whilst many amateur ensembles need members to be able to read music and hold harmony lines, there are equally many singing groups which require enthusiasm not formal musical skills. It is to this latter instance where I see the most potential for the engagement of many as such groups provide each individual participant with an opportunity for group music-making.

It may seem fanciful to those with hectic and compartmentalised lives to conceive of setting aside time to engage in group singing everyday, but given the scientific and cultural evidence, it would be an ideal situation for self-expression, mood regulation, feelings of being in a better holistic state of positive health and wellbeing as well as social connectedness. The following review provides further evidence to support group-singing experiences.

Singing and early life experience

Researchers are increasingly able to argue that musical capacities and behaviours in humans appear to have evolved as abstractions of essential biological function. For example, observing neonate behaviour and development, Trevarthen (2001/2002) shows that complex social life emanates from activities like turn taking in vocalisations (motherese) experienced firstly through nurturance (mother-infant interactions around feeding), and on through rhythmical play leading to turn-taking and more and more complex forms of social awareness and collaboration. He argues that this ‘intrinsic motivic pulse’ is a proto-musical behaviour. This explanation can account for the ubiquity of music as across human cultures.

Trevarthen’s work permits us to theorise that musical behaviours permit a strong base for the construction of selfhood. For example, Trevarthen demonstrates how infants articulate the process of feeding by using their hands to conduct (in terms of musical timing and phrasing) and the vocalisation in their motherese interactions. These behaviours demonstrate sympathy and awareness and sharing with the mother. From these signals (present in all infants, from premature babies as well as congentially blind newborns), it is not hard to imagine how our adult complex repertoire of non-verbal gestures and vocal interactions for subtle social discourse emerge. There is a naturalness to how the voice is used in these pro-musical behaviours, which illustrate the human communicative urge. These ideas are fully supported in other infancy studies by Ayers (1973) and Dissanayake (2000) who underscore that these types of communication enable the infant to engage in practices which allow an emergent sense of self to develop: a sense of ‘me’ in relationship. They are also seen as the pre-cursors so crucial to language development. A reference to the Greek concept of human behaviour of musiké – in which the expressive signals of the whole person are implied – have been incorporated into such understanding of musicality.

Associated evidence arguing a case for the importance of vocalisation as a tool for social communion and the development of self –for confidence, emotional expression is found in Malloch’s (1999/2000) study of motherese. He was able to observe motherese interactions for women with bi-polar disorder experiencing both depressed and hypermanic states and compare these with a control group. He discovered that in the case of the ill mothers, the motherese was not musically timed: the depressed mothers were lethargic; the hyper manic mothers were extremely excited and agitated. At either extreme, infants became distressed when they were not responded to with paced musical phrases with space for response. There was evidence that the infants did not feel ‘understood’ or interacted with. Indeed, the infants were found to initiate vocal play (pro-singing behaviour) and wait for a response of either mirroring or extemporisation behaviour, but these responses did not come where the mothers were ill. Though a lack of timed interactive motherese does not seem to have long-term effects on infants, in the short term, the disturbance to the normal vocalisations upset the development of happy and socially interactive babies.

Toddler observations demonstrate that reciprocated or synchronous imitations of vocal and gestural behaviours as well as pitch, intensity and melodic contour (Papousek & Papousek, 1981) occur spontaneously and appear to be crucial for social sharing with all. Additionally, recent research examining pre-schooler’s collaborative play demonstrates that that the youngsters share vocalised and bodily reactions and experiences, and there is a sympathetic mirroring of types of bodily reactions and responses which are directly connected to the experience of emotion: the enharmonic key changes in tonal music are often associated with ‘shivers down the spine’ or ‘goose bumps’, reflecting psychological states such as excitement, joy sadness etc. (Sloboda, 1991, and Sloboda, O’Neill, & Ivaldi, 2001)). Crucially, the singing/playing that exists is purposeful and intentioned intended? to be communicative and emotionally charged for biological purpose (Bannan, 2003).

So, it seems that from the earliest evidence of human perception and cognition, our responses are rooted in vocalised sensation and an imperative and driven social communication. This is expressed usually by sharing in collaborative goals, and it is a clear means through which the social communication is experienced. Motherese is arguably the most fundamental form of ‘singing’ activity. Though only based in a dyad, it is the root for sharing and social interaction.

We know from the research of Trevarthen and colleagues that motherese is not only significant for the infant, but it is a positive way for caregivers to share emotional and social experiences and so bond with the infant. In all human cultures, motherese and toddler imaginative sing-play is found. Indeed, it seems that in the case of the infant and the toddler, singing-types of activity (motherese/imaginative song) provide a forum for the individual to develop a sense of self in relation to others, and this of course is a potent force for future social life. With such ideas in mind, it is not difficult to understand how and why group singing in a range of groups (adults and children) has been found to have emotional and wellbeing effects.

Singing for quality of life across the lifespan

Linking to the infancy research explored above, Ruud (1997, 1998) writes compellingly about how musical opportunities in Western culture can be crucial for social empowerment, and most specifically for the formation of an identity. He gives examples of how children make their initial step towards selfhood in their peer group imaginative musical play. The development of a specific peer group taste serves as a way of endorsing group identity, as is often shown in relation to musical listening and participation amongst teenagers, with their musical culture representing a separate social world from that of the adult.

Ruud goes on to highlight that music facilitates navigation between a private and public self, whether it is being used for self-regulation reasons (perhaps changing mood) or the presentation of self to a group (e.g., performance). Also, it can be used to reflect internal space – listening to music in the bedroom, or relaxing making music (usually pop and rock) with friends. It can also helps young people to learn to create ‘in’ and ‘out’ social groups (Tarrant, North & Hargreaves, 2002), that is, those with whom to associate and those to avoid.

In the case of singing only, there is sufficient evidence present to show that it can give many opportunities for social empowerment (the homeless men discussed earlier). But, more especially, Faulkner and Davidson (2005, 2006) have shown how singing can form crucial links in the following ways: generational exchange (as a grandfather sings to his granddaughter), communion with nature (singing in spaces and places), testing out of identity (singing in competitions like ‘higher’, ‘longer’ etc.)

Importantly, and from a background of music in therapeutic treatment, Aasgaard (1999) has also proposed the use of music as an inherent component of an institutional or non-institutional setting. He argues that in this empowered position, especially through live performance, music enhances the well being of those inhabiting the space. Aasgaard’s own working space is a hospital. Using a mobile music station he is able to ask patients, visitors, doctors, nurses and administrators to contribute towards creating songs in and around the hospital building. His work offers a sense of community and coherence for all, whether long-stay patients, employees, or day visitors. The songs allow for a shared emotion and understanding, as well as an ownership of the space on which the voice is projected.

At a more intimate level, Aldridge (1999) describes how singing to and with a dying friend heightened intimacy and understanding in a situation where words were too painful, too awkward, or inadequate. The singing by-passed all formal verbal exchanges and enabled emotional intimacy through the harmonic structure of the music. Similarly, Magee & Davidson (2004a & 2004b) describe the use of singing activities with individuals in the late-stages of multiple sclerosis to permit the use the songs for reminiscence value, and to monitor the level of muscle control and strength of the vocal mechanism. Again, the singing enabled expression of emotions around loss and grief which patients had otherwise not been able to express. Also, Clift and colleagues (Clift & Hancox 2001; Hancox 2006; Bamford & Clift 2007) have investigated a choral group within a university context as well as developing a network of ‘Silver Song Clubs’ across the SE of England which are not only becoming increasingly popular, but have also demonstrated positive and stimulated social interaction and increased sense of wellbeing for members (all over 55 years of age). In a related manner, Cohen (2006) has shown that older people who engaged in choral participation for the first time, by contrast to a comparison group who did not sing, had fewer visits to doctors and reported a reduction in the number of over-the-counter medications taken. Relatedly, research with Alzheimer’s disease patients has shown improved cognitive activity with moments of insight and coherence when engaged in singing activities (Bannan & Montgomery-Smith, 2006; Prickett & Moore, 1991).

With findings like those explored above, it is evident that there are many possibilities inside the activity of singing and in the associated social context of the activity. Excitingly, contemporary physiological studies have advanced understanding of the effects of group vocal performance through the measurement of levels of cortisol and secretory immunoglobulin A (sIgA). Cortisol is a measure of stress and sIgA is an endocrine defence against infection in the upper respiratory tract. Generally, decreases in levels of cortisol and increases in levels of sIgA and are considered favourable. The cortisol results were variable and inconclusive, however, increased levels of sIgA suggest that active participation in singing may enhance immune system functioning (Beck et al., 2000). So singing has a real and positive physiological benefit.

Concluding comment

With the evidence presented above, a case has been made for the importance of singing across the lifespan. It is important to note that the recent Australian National Review of School Music Education (Pascoe et al., 2005) demanded that an immediate priority should be to improve and sustain the quality and status of music in Australian schools. Part of this priority must be to make sure we encourage singing and maintain and develop this pattern of behaviour across the lifespan. I have not reported research on the beneficial experiences of singing in school, mainly because I have not been involved in this research area (unlike singing for health or singing with people living with various forms of disability). Undoubtedly, for many, singing experiences in school are already good. Indeed, my excellent primary school experiences of singing began my own life-long love of singing. But, as Pascoe and colleagues report, the types and standards of music on offer in school and in general is very variable. There have been recent initiatives to increase opportunities for singing, for example, the Music. Count Us In project of 2007 was a $300,000 Australian Government initiative for schools to learn and perform the song Life is a Song on 30 August. This is a small, but encouraging move. Without doubt, the musical opportunities created and presented in schools have the potential to endorse the cultural value of musical participation for all, for positive social and physical health and wellbeing.

Singing for holistic health benefit has been recognised the UK for some time (Bannan, 2000), and in March 2007 the current author attended a national meeting entitled Sing for Health at the Sage, Gateshead. In addition, the Department of Education and Science has pledged over 10 million pounds over the course of 2007/2008 to develop a National Singing Programme in the UK, encouraging the use of singing to promote social health and wellbeing for all. I would argue that Australian agencies should also consider such forms of support to initiate and develop opportunities for group singing as extensively as is possible.

References

Aasgaard, T. (1999). Music therapy as milieu in the hospice and paediatric oncology ward. In: D. Aldridge (ed.), Music therapy in palliative care: New voices. London: Jessica Kingsley Publications, pp. 29-42.

ABC TV. (2007). Choir of hard knocks. Australia.

Aldridge, D. (1999). Music therapy and the creative act. In D. Aldridge, (ed.), Music therapy in palliative care: New voices. London: Jessica Kingsley Publishers, pp. 15-28.

Ayers, B. (1973). Effects of infant carrying practices on rhythm in music. Ethos 1: 387-404.

Bailey, B. (2005). Singing out of tune and in tune: An investigation of the effects of amateur group singing from diverse socio-economic and cultural perspectives. Unpublished doctoral dissertation, University of Sheffield.

Bailey, B., & Davidson J. W. (2005). Music as adaptive behaviour, Psychology of Music 33(3): 269-303.

Bailey, B., & Davidson, J. W. (2002). Group singing as adaptive behaviour: Perceptions from members of a choir of homeless men. Musicae Scientiae VI: 221-56.

Bailey, B., & Davidson, J. W. (2003). Amateur group singing as a therapeutic agent. Nordic Journal of Music Therapy 12: 18-32.

Bailey, B., & Davidson, J. W. (2001). Singing as adaptive behaviour. Proceedings of Phenomenon of Singing III, Festival 500: Sharing the Voices. St John’s, Newfoundland, Canada, June, pp. 25-9.

Bamford, A., & Clift, S. M. (2007). Southampton silver song club: Reflections on music making with elderly people facilitated by student volunteers. Sidney De Haan Reports 4. Sidney De Haan Research Centre for Arts and Health, Canterbury.

Bannan, N. (2000) Instinctive singing: Lifelong development of ’the child within’. The British Journal of Music Education 17(3): 295-301.

Bannan, N. (2003). Reverse-engineering the human voice: Examining the adaptive prerequisites for song And language. In R. Kopiez, A. Lehmann & I. Wolther (eds.), Proceedings of the Fifth Triennial Conference of the European Society for the Cognitive Sciences of Music, CD-ROM. Hanover: Hochschule für Musik und Theater.

Bannan, N., & Montgomery-Smith, C. (forthcoming). ‘Singing for the brain’: Reflections on the human capacity for music arising from a pilot study of group singing with Alzheimer’s patients and carers. Journal of Royal Society for the Promotion of Health.

Beck, R., Cesario, T., Yousefi, S. & Enamoto, H. (2000). Choral singing, performance perception and immune system changes in salivary immunoglobulin and cortisol. Music Perception 18(1): 87-106.

Blacking, J. (1967). Venda children’s songs: A study in ethnomusicological analysis. Johannesburg: Witwatersrand University Press.

Blacking, J. (1971). The value of music in human experience. Yearbook of the International Folk Music Council 1: 33-71.

Blacking, J. (1973). How musical is man? Seattle: University of Washington Press.

Blacking, J. (1974). Ethnomusicology as a key subject in the social sciences. In Memorium Antonio Jorge Dias 3: 71-93.

Blacking, J. (1977). The anthropology of the body. ASA Monograph 15. London: Academic Press.

Blacking, J. (1985). A false trail for the arts? Multicultural music education and the denial of individual creativity. In M. Ross (ed.), The aesthetic in education. Oxford: Pergamon Press, pp. 1-27.

Blacking, J. (1987). A commonsense view of all music: Reflections on Percy Grainger’s writings on ethnomusicology and music education. Cambridge: Cambridge University Press.

Blacking, J. (1988). Dance and music in Venda children’s cognitive development. In G. Jahoda & I. M. Lewis (eds.), Acquiring culture: Cross cultural studies in child development, pp. 91-112. London: Croom Helm.

Blacking, J. (1989). The biology of music-making. In H. Myers (ed.), Ethnomusicology: An introduction Vol. 1. London: MacMillan, pp. 301-14.

Clift, S., & Hancox, G. (2001). The perceived benefits of singing: Findings from preliminary surveys of a university college choral society. The Journal of the Royal Society for the Promotion of Health 121(4): 248-56.

Cohen, G. D., Perlstein, S., Chapline, J., Kelly, J., Firth, K.M., Simmens, S. (2006). The impact of professionally conducted cultural programs on the physical health, mental health, and social functioning of older adults. Gerontologist 46(6): 726-34.

Davidson, J. W. (2001). Music and the body, In C. Blakemore & S. Jennett (eds.), Oxford companion to the body. Oxford, Oxford University Press, pp. 465-6.

DeNora, T. (2000). Music in everyday life. Cambridge: Cambridge University Press.

Dissanayake, E. (2000). Antecedents of the temporal arts in early mother-infant interaction. In N.L. Wallin, B. Merker, & S. Brown (eds.), The origins of music. London: MIT Press.

Ericsson, K. A. (1996). The acquisition of expert performance: An introduction to some of the issues. In K. A. Ericsson (ed.), The road to excellence. Mahwah, NJ: Erlbaum, pp. 1-50.

Ericsson, K. A., Krampe, R. T., & Tesch-Römer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review 100: 363-406.

Faulkner, R., & Davidson, J. W. (2006). Men in chorus: collaboration and competition in homo-social vocal behaviour. Psychology of Music 34(2): 219-38.

Faulkner, R., & Davidson, J. W. (2005). Men's vocal behaviour and the construction of self. Musicae Scientiae 8(2): 231-55.

Hancox, G. (2006). Music arts and health at Canterbury Christ Church University. Community music-making for children and older people newsletter. Folkestone, Sing for Your Life Ltd. February 2006.

Kreutz, G., Bongard, S., Rohrmann, S., Hodapp, V., & Grebe, D. (2004). Effects of choir singing or listening on secretory immunoglobulin A, cortisol, and emotional state. Journal of Behavioral Medicine 27(6): 623-35.

Magee, W. L., & Davidson, J. W. (2004a). Singing In therapy: Monitoring disease process in chronic degenerative illness. British Journal of Music Therapy 18(2): 65-77.

Magee, W. L., & Davidson, J. W. (2004b). Music therapy in multiple sclerosis: Results of a systematic qualitative analysis. Music Therapy Perspectives 22(1): 39-51.

Malloch, S. (1999/2000). Mothers and infants and communicative musicality. Musiace Scientiae, Special Issue: 29-58.

McPherson, G. E., & Davidson, J. W. (2006). Playing an instrument. In G. E. McPherson (ed.), The Child as musician. New York: Oxford University Press, pp 331-52

Papousek, M., & Papousek, H. (1981). Musical elements in the infant’s vocalisation: Their significance for communication, cognition and creativity. Advances in infant research 1: 163-224.

Pascoe, R., Leong, S., MacCallum, J., Mackinlay, E., Marsh, K., Smith, B., Church, T., & Winterton, A. (2005). National review of music education: Augmenting the diminished. Canberra: Australian Government Department of Education, Science and Training.

Prickett, C. A., & Moore, R. S. (1991). ‘The use of music to aid memory of Alzheimer’ patients. Journal of Music Therapy 28: 101-10.

Ruud, E. (1997). Music and the quality of life. Sandane: Nordic Journal of Music Therapy. Internet document last accessed 13 March 2005 available at http://www.hisf.no/njmt/selectruud97.html

Ruud, E. (1998). Music therapy, improvisation, communication and culture. Gilsum: Barcelona Publishers.

Sloboda, J. A. (1991). Music structure and emotional response: some empirical findings. Psychology of Music 19: 110-20.

Sloboda, J. A., O’Neill, S. A., & Ivaldi, A. (2001). Functions of music in everyday life: An exploratory study using the experience sampling method. Musicae Scientiae 5(1): 9-32.

Tarrant M., North, A. C., & Hargreaves, D. J. (20002). Youth identity and music. In R. Macdonald, D. J. Hargreaves & D. Miell (eds.), Musical identities. Oxford: Oxford University Press.

Trevarthen, C. (1999/2000). Musicality and the intrinsic motive pulse: Evidence from psychology and infant communication. Musicae Scientiae, Special Issue: 155-215.

Professor Jane W. Davidson is Head of the Department of Music at the University of Western Australia.

 
Hello in There PDF Print E-mail

Hello in There

Kirstin Robertson-Gillam

 

Music therapist, Kirstin Robertson-Gillam, uses "choir therapy" to help older people connect with their past, their future, their breath and the power of silence.

 

Old age represents the last developmental phase of a long life. It should be a time for reflection on one's life achievements. However, the tasks of old age can be complicated by strokes, chronic illnesses and dementia. According to Alzheimer's Australia, 210,000 Australians have dementia and by 2015, it will be the most debilitating and frequently occurring disability in Australia. Research undertaken by Richard Fleming for the Commonwealth Government found that approximately 70% of the nursing home population in Australia has dementia.

There is something spiritually meaningful about singing, especially when it's in a group such as a choir. Singing expresses the transcendent dimension of human life. It gives hope, motivation, meaning and purpose.

Spirituality can be seen as a search for meaning through relationships, nature and the arts. Choir therapy reaches into this spiritual dimension, reflecting the cultural, religious and social background of the community. Songs taken from religious, classical, popular and jazz genres are used.

In his 1999 research, Paul Newham says singing writes and rewrites the past and contains an ‘aesthetic code’ in which the appreciation of the beauty of music can help to transcend the frailties and stresses associated with old age.

Fear of the future ties in with the stereotype of growing old and losing purpose and connection to life. This is so beautifully expressed by Bette Midler in the song, Hello in There. This song is about an elderly couple who don’t talk much anymore and remember how they lost a baby in the Korean war, but ‘it don’t matter anymore’. The song holds the pathos of how they view the futility of their lives and pleads for people to stop and really look into “frail old eyes” to find the real person inside.

Studies indicate that as people approach the end of their lives, their ability to be creative increases. Creativity offers an avenue in which to address and resolve dissatisfactions with life. It optimises a person’s ability to deal with the growing constraints of old age. Choir therapy connects with these creative abilities in old people if they are given a conducive environment. It also helps elderly people to become more socially aware and form meaningful relationships with others. Elderly people are challenged to learn a new skill through an approach in which there is no such thing as a mistake. This is designed to increase their motivation and confidence.

An aged care choir involves moments of silence in which members are encouraged to listen to their breathing patterns and feel the energy of life around them. This silence is important as most elderly people live in noisy environments with little time for quiet reflection. Breathing exercises relax the body and enhance singing abilities.

Researcher Alicia Clair found that elderly people often feel constrained about singing because they believe that their voices are not worthwhile musical products. However, with practice, choir members are able to hear their own voices and build a sense of motivation and achievement. Singing exercises are always practised in order to expand and improve vocal quality. I have found that over time, elderly voices improve and begin to reflect the pure sweet sounds akin to children’s voices.

The song material for the choir is carefully chosen from the cultural, social and religious background of the aged care community. They are set in keys which encompass their vocal ranges and are achievable to sing. Some songs are well-known and bring back memories of past events which help to express positive as well as negative feelings and generate discussions and new friendships.

There are also songs in the repertoire which are unknown to many and can present a challenge. One example is Handel’s aria, Where’er You Walk. This song requires focused attention and musical precision. There is a long pause in the middle and the choir is required to slow down and sing softer or louder on cue. Both aged care choirs that I have formed have mastered this song and performed it as part of their repertoire.

Performance creates a purpose for the choir and the opportunity for community involvement. As with all musical performances, the audience is deeply involved with the music. This is very evident with the performances given by the choir to their fellow residents and families. So much joy is generated by the experiences.

The choir supports religious events and social occasions. The present Blue Mountains choir has performed seven times for its community in the past year. It is indeed a wonderful achievement when many of its members have late-stage dementia. They may not remember the event at a cognitive level, yet they remember the songs and all the musical dynamics required for a good performance. One lady with severe dementia says that she has to sing in order to be understood. Before one practice, she said to me, ‘We’re going to have a good time today’. This comment showed how much she remembered each practice session at an emotional level.

Elizabeth Kubler-Ross once said that people are like stained glass windows. They sparkle and shine when the sun is out but when the darkness sets in, their true beauty is revealed only if there is light from within. This light is representative of the human spirit which never goes out. It can become dim and blurred through illness, trauma and old age. It is important to find ways to keep the flame bright for people who have dementia and other debilitating illnesses.

However it’s not just elderly people with dementia who can benefit from the healing power of choir work.

Sharon was only 54 years old when she found herself living in a Blue Mountains aged care hostel because of a life-threatening mental breakdown. Her flame had become dimmed and obscured by the trauma of her illness. She joined the choir in the facility and also participated in vocal improvisation counselling sessions with me every week. She began to interact socially with others and found her voice for the first time. She learnt to express her emotions which had been locked away for many years and discovered an emptiness inside her which she described as the loss of her ‘selfhood’.

Through voice work and the choir community, Sharon was able to leave the aged care facility after three years of therapy. She now celebrates the joy of life and is no longer depressed. Her psychiatrist has taken her off all her medications. She continues to have private sessions in which she sings about her issues as she walks her path to wholeness. She is waiting to join a community choir in the Blue Mountains for people with chronic illnesses when funding can be obtained.

One gentleman of 95 years was a previously well-known church organist and choir master. He joined the Blue Mountains choir and found enormous purpose and meaning during the last years of his life. He was able to reminisce about his musical career as well as his experiences in the war. The choir sang three of his own compositions at religious events. One such event was the death of his own wife when he asked for the choir to attend the church and sing one of his hymns. The choir felt that they were participating in his loss in the most meaningful way and were able to feel part of their wider community.

People with dementia can become easily distracted, agitated and challenging. Arthur was a very fit man with severe dementia who was prone to becoming agitated in response to certain triggers within his environment. Being a good singer, he was referred to the choir to see if singing would reduce his agitation. After twelve months, Arthur was able to sit through one hour of weekly choir practice with regular reinforcement and encouragement. His wife was very pleased that he found a creative avenue in which to channel his energies. Arthur joined in with all the exercises and coped very well with learning new songs. When he becomes tired of reading the song book, he watches me conducting and lip reads the words. He likes to be helpful. One day he decided to wheel a fellow choir member who is an amputee back to his nursing home instead of getting onto the bus to go home. I walked beside him and gave him encouraging comments about the importance of being helpful.  Once the task was completed, Arthur was quite happy to return and board the bus.

Apart from the choir, other less structured singing sessions include music therapy reminiscence groups. Two out of three weekly groups are dementia-specific. They begin each week with a tea party using a rose teapot, tablecloth and cake. This creates a feeling of familiarity and engenders conversation, humour and camaraderie. Transitional objects such as sea shells, poems and soft toys are used to stimulate the imagination and encourage social interaction.

Percussion instruments are handed around and each person is encouraged to sing and play together. Multi-tasking is difficult for people with dementia. However, if they are given the rhythm to play with their instrument first, they can start to sing the song and continue playing at the same time. Stories are created out of the songs from their younger days and many comments are made. One song, Lily Marlene, was introduced as being a song about a war prostitute who engaged in this activity in order to obtain secret information from the enemy. This caused quite a stir amongst the ladies of the group with much laughter as one lady suggested that I must be one too because I was singing about it! She also told me that she uses the truth loosely! She thoroughly enjoys this weekly repartee between us.

Singing is the best medicine for depression. It takes away the blues and brings about increased motivation and engagement in life. Many adults have told me about their earlier negative experiences when they were stopped from singing because they sounded awful! We all need to express our inner essence and celebrate life every day. Choir therapy gives elderly people meaning and purpose, and helps them to engage in life once more.

In a recent Sun-Herald article, journalist, Claire Scobie wrote of the remarkable transformation that she observed during a choir practice: ‘There is something unbearably poignant about this: a sense of community, of shared experience, is seamlessly created’.

 

References

Killick, J. (2006) ‘Helping the Flame to Stay Bright: Celebrating the Spiritual in Dementia.’ Journal of Religion, Spirituality and Aging. Vol.18, No.2/3. The Howroth Pastoral Press.USA

Newham, P. (1999) Using Voice and Song in Therapy: The practical application of Voice Movement Therapy. London (UK). Jessica Kingsley Press.

Scobie, C. (2006)  ‘Songs to Remember.’ Sun-Herald newspaper, Sunday Life supplement.  Sydney, Australia. pp 25-6.