Music and Food, Dentures and Therapy

Imagine with me for a moment that music is analogous to food. In many ways, this isn't really a stretch.

No human culture exists anywhere, or ever has, to the best of our knowledge, without music.

Music is so important to the human experience on this planet that when it's not provided for us, we seek it out or make it ourselves.

Music sustains and nourishes us on so many levels throughout the lifespan. On some level, we all intuitively understand this. Music is a unique form of nourishment, essential to human striving and thriving.

Now imagine for a moment that I proposed giving a steak to a newborn infant. Or nothing but doughnuts to someone with Type I diabetes. Or perhaps a crunchy salad to someone with poor-fitting dentures.

Just like our intuitive understanding of music as a form of human nourishment, we also understand that one size does not fit all when it comes to providing food to human beings.

We understand that "food" is not a broad, all-encompassing label that means anything we call "food" will be safe for everyone to eat, and nor will any one "food" meet the nutritional needs of every person.

We readily adapt the specific foods we provide across the lifespan to accommodate each person's needs. We feed infants foods they can digest. We accommodate food allergies. When older adults, or anyone, has a high risk for aspiration due to difficulty swallowing, we add thickeners to their liquids. We puree food for those who can't chew. We even have advanced techniques like NG tubes or other feeding tubes. If necessary, nutrients can be supplied via an IV.

Sometimes we can make an intuitive guess on what sorts of foods are both safe and nourishing (effective) for certain individuals. And sometimes we must consult with medical experts who are qualified to advise and make adaptations to meet an individual's needs.

We understand all of the above very well. But, in my experience, that seems to be where the understanding stops.

There are many who assume that music is, in fact, a one size fits all kind of food. As a society, in general, we fail to consider that not all music, in all contexts, for all individuals, will be both safe and beneficial.

"But it's just music!" many protest. Surely, music is always beneficial. How could something so wonderful possibly cause harm? Well, food is just food, right? How could food possibly cause harm?

Music is powerful. We know it impacts human beings deeply on physiological, psychosocial, and spiritual dimensions. Anything that can help can also harm. I'll say it once more. Anything that can help can also harm.  Food. Prescription medications. Stretching. Music.

Just as we must carefully consider and assess the limitations, needs, and preferences of an individual when providing food for them, so does a clinical music therapist carefully assess the limitations, needs, strengths, and preferences of each patient or client before providing them with music-based interventions.

We know that not all music will safe for a premature infant in the NICU, nor will anything under the umbrella term of "music" be effective in meeting their medical goals.

Music therapists also know that not all music experiences will be safe, comfortable, or effective for individuals with dementia or PTSD.

Safe and effective are our watchwords when it comes to involving our patients and clients in something as powerful as music.

I'll tell one story that illustrates my point.

I had just started my internship with a hospice and was completing a day of orientation with a chaplain. We arrived to a nursing home to visit with a woman with advanced Alzheimer's. She was asleep sitting up in a reclining wheelchair, parked near a large speaker. There was a community Southern Gospel band there to provide entertainment.

This group had a lot of things right. They were using music within the preferences of many people in the room. They were providing music that was loud enough to accommodate the many individuals who were hard of hearing.

Our patient, however? They started to play, and she immediately looked highly uncomfortable. The music was far too loud, too fast, and too stimulating for her current state of consciousness. Before the music began, her face appeared calm and peaceful. But with this music, she was grimacing, frowning, moaning and crying out, and beginning to shift restlessly in her chair.

The chaplain and I wheeled her back to her room. In the quiet, she began to calm back down. I very softly started to sing acapella, choosing old hymns that were likely to be familiar from her childhood, based on the background information the chaplain had given me. As she continued to become calm and responsive, the chaplain and I sang together, a little louder. Our shared interaction culminated in her open eyes, smiling brightly, reaching to touch and hug the chaplain and me.

Both instances involved providing this woman with music. One scenario made her feel worse. One scenario brought her into meaningful connection with her fellow human beings.

"Food" isn't just "food," "medicine" isn't  just "medicine," and "music" isn't just "music." Seeking the services of an MT-BC ensures a high standard for safe, clinically effective musical experiences for all patients and clients.

A Q&A with Nancy Leigh

I recently attended a Drury Business Network morning meetup group, where I was so fortunate to connect with Nancy Leigh Crandal, another alumna of Drury.

We struck up conversation about the work she does with interior design, aimed at helping older adults and people with physical limitations to better and more safely occupy their home spaces, which has an enormous impact on overall well-being and quality of life.

As a board-certified music therapist, I also use creative arts mediums to improve the quality of someone's environment as a way to improve their health, feelings of well-being, and quality of life.

I was recharged and inspired by hearing Nancy's perspective on her work as an interior designer, and I am thrilled to have the chance to share some of her thoughts with you. Nancy graciously agreed to let me interview her via email for my music therapy musers.

1. Q: Will you please share with our readers a little about your education, background, and your design experience so far?

A: B.S. from MSU in Residential Planning & Construction. B.A. from Drury University in Art and Bach. Of Architecture. Worked in the building profession designing, project management in residential and commercial area.

2. Q: I was so inspired to meet you recently and learn about your current project of using the elements of design to improve the environments and quality of life for older adults and people with disabilities. What initially inspired you to apply your background in interior design to improving the lives of this group of people? 

A:Universal Design & Aging in Place, to me, is a Holistic approach for the life you live. It encompasses all aspects of a balanced life.  My emphases is the environment you physicality live in connecting it to comfort, health and quality of life for all.

3. Q: When we spoke, you mentioned that even subtle elements of the environment such as the color of household appliances can make a big impact on health, safety, and quality of life. Would you please share a little more about how the environment impacts human health and functioning?

A: Our environment affects all our senses. When it is pleasing to our senses, gives a feeling of safety, and connects with our inner beings, we are just more content.

4. Q: You also mentioned that you are seeking individuals who are willing to help you conduct some field research. Can you explain what it is you are looking for and how people should go about contacting you?

A:I find face to face a great way to connect with people and see and hear how they live in their space and what they would like to improve for ease of comfort. It takes about an hour of me listening to how one functions in their environment. It is not a design session ,it is a listening session. I can be reached at 417-569-9414 or nlcreativedesign@sbcglobal.net.

5. Q: What else would you most like to share with the community about your work?

A:My goal is educating and simplifying the space you occupy.

My thanks go out to Nancy for sharing her passion for her work, and I hope my readers will spread the word so that she can continue to learn about the needs of our community. 

In the Trenches

When will the healthcare we offer be as warm, as human, as authentic as the people to whom we offer it?

Seriously. I'm asking.

I work with and for real, living, loving, breathing, hurting, healing, and dying human beings, each a complex universe of human experience unto him or herself.

One of the reasons I was so drawn to hospice work is because the hospice philosophy of care is acutely aware of this reality, and every policy in place reflects this reality for providing individualized patient care.

But earlier this week, my therapist heart got slammed up against a wall because of someone I wasn't working with. In short, it hurt and it made me intensely frustrated with the big, overall umbrella of providing healthcare to older adults in this country.

I pulled up to outside of an assisted living and skilled nursing facility where one of my patients resides. I was there on my employer's time to see someone on my hospice caseload. This means I don't have the luxury of interacting with every resident in the facility.

That's why my heart sank as I wound my way past the nurse's station, guitar on my back -- I heard a gentleman call out from behind me, "Miss? Miss! Is that a guitar? Are you going to share some good, old music with me today?"

I turned back long enough to wave at him, to give him the warmest, most compassionate smile I could, and said, "I'm so sorry, but I am here to see someone specific."

I tried to ignore the pangs in my heart as his face fell and I kept moving.

After a beautiful, delightful routine visit to my patient, I passed back by this gentleman and several other ladies, all parked in wheelchairs, dozing or making hushed small talk in front of the nursing station.

This time, the gentleman leaned forward and asked me what kind of guitar I owned. I told him, and his eyes lit up. He exclaimed, "That's a great guitar! I used to have one, but with 12 strings. I had to get rid of most of my guitars when I moved here though...not enough room." The lady next to him joined our conversation, asking me if I knew the entertainer that was scheduled to appear later that afternoon. They invited me to join them sometime and said they wished I had been there to see them.

I lingered just a few moments with these people. I had other patients to see that day and paperwork to finish after that. By way of parting, I started singing the old standard, "Show Me the Way to Go Home."

A woman had been sitting silently this entire time, with her head bent way down over her lap and her eyes closed. I started singing this song and she immediately sprang to life. Her posture changed. She made eye contact, and her eyes began to sparkle with the smile that was now illuminating her entire face. She opened her mouth and sang the entire little song in beautiful harmony to my melody. In an instant, she was transformed into a former, vibrant version of herself.

The facility staff that observed this brief interaction remarked that she had a cousin who was a famous singer and that she had occasionally sung duets with him.

This woman said nothing, but continued to smile at me expectantly, as though waiting for her next cue to sing.

That's when my heart slammed into the wall.

I was not there for her. I cannot bill for time spent interacting with her. No one has asked me to assess her needs, limitations, strengths, abilities, and responses for clinical music therapy.

I wanted nothing more than to advocate for her access to a certified music therapist. To speak with the facility staff about the real and significant changes in her when a live person interacted with her using her preferred music. To demonstrate the ways in which I could meet her care plan needs and improve her quality of life.

I wanted to see what other songs she remembered and took joy from. I wanted to provide human touch as I supported her in playing small rhythm instruments with me, if she was willing.

In short, I wanted to serve as music therapist to her -- to use music to bring her out of the world in which she spends her days drooped silently over her knees in a wheelchair.

The gentleman who had to give up his guitar collection, this woman, and every other resident there were warm, human, authentic.

But I had to rush along. That's what it's like to work in the trenches of healthcare in this country.

The trenches are where I meet my fellow human beings and offer them help and therapy through the medium of music.

So the trenches are where I want to stay. I want to change the culture of healthcare from the inside.

And today I am asking...when will he healthcare we offer be as warm, as human, as authentic as the people to whom we offer it?