Monday, August 15, 2016

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.