by Jude Treder-Wolff, LCSW, CGP, MT
As a music and creative arts therapist I worked in nursing homes and psychiatric hospitals using songs to reach beyond a person's deteriorated or diminished thinking minds and into their emotions and essence. Oliver Sacks contributed greatly to the professional standing of music therapy but it is his ability to frame the harsh truths about neurological and other brain disorders that continues to give me personal strength. Because to recognize that my mother, a person who shaped my identity in so many ways, has lost the capacity to remember anything new and lives in a time warp that often does not include me or my siblings' existence is to gradually face painful questions with no easy answers and sad realities about changing relationships. It means creating entirely new roles that we have to define for ourselves without any clear sense we are getting it right. It often means sacrificing the need to be understood, and in the face of being misunderstood, still try to offer emotional presence. As I continue to go through my own experience of the protracted series of losses that dementia imposes on a family, Oliver Sacks empowers me to see that what remains is the "music" of a person, and it is often through music we can directly interact with it. Chapter 39 of Musicophilia deals specifically with dementia and music therapy, and it seems particularly significant that it appears in the section titled "Music and Identity." He writes:
"Shakespeare's Jaques, in As You Like It, considering the 7 ages of man, sees the final one as 'sans everything.' Yet though one may be profoundly reduced and impaired, one is never sans anything, never a tabula rasa. Someone with Alzheimer's may undergo a regression to a 'second childhood,' but aspects of one's essential character, of personality and personhood, of self, survive - along with certain indestructible forms of memory - even in very advanced dementia. It is as if identity has such a robust, widespread neural basis, as if personal style is so deeply ingrained in the nervous system that it is never wholly lost, at least while there is any mental life present at all....In particular, the response to music is preserved, even when dementia is very advanced."
Conversations with my mother and the others at her dinner table in the facility where she lives now are a bit like a tennis game in which everyone has their own ball. All the women are lovely and have something to say, but it has little connection to what anyone else has said, and if it does the conversation has no staying power. This inability to track a conversation or a series of thoughts produces an agonizing isolation for people with dementia, that is greatly reduced by singing songs familiar to a group. "It is astonishing to see mute, isolated, confused individuals warm to music, recognize it as familiar, start to sing and bond with a therapist," Dr. Sacks writes. "It is even more astonishing to see a dozen deeply demented people, all in worlds or nonworlds of their own, seeming incapable of any coherent reactions, let alone interactions, and how they respond to the presence of a music therapist who begins to play music in front of them."
My mother's mental state is one of general confusion, especially about time, and for the last several years she has had no memory that her mother died in 1971, nor her husband in 1983. This failure of mind is a strange comfort to me
when I visit because she is seems, for awhile anyway, to be living in a period when she was happier and very productive. I see no benefit to reminding her of reality, because a more positive mood yields a better day for her than a true accounting of the facts. And when we play the piano, past and present seem to come together. She hums familiar melodies and can sometimes sing lyrics with no hesitation. She smiles and connects at the sound of the piano pieces we practiced and played over and over again when we were growing up. For that time, her enduring self and personal legacy is revealed once more. Because music engages the mind in a way that bypasses the cognitive pathways that dementia attacks. It engages a range of emotions while diminishing activity in the amygdala - the "alarm system" of the brain triggered by the perception of a threat, which is easily and repeatedly cued in people with dementia - so for a time anxiety is replaced with pleasure, cognitive and emotional functions are united, and the present moment is a pretty nice place to be.
When I was active as a music therapy in nursing homes and psychiatric hospitals I felt a kind of desperate desire to convince the rest of the world about what was clear to me, that music is medicine. Oliver Sacks fulfilled this desire by being a fantastic advocate for music therapy and validating it through his research. He was a force behind the remarkable and groundbreaking Institute for Music and Neurological Function in New York that is constantly expanding knowledge through clinical research and treatment through clinical practice. His music goes on and on and we are all better for having heard it.
Jude Treder-Wolff is a writer/performer and trainer/consultant. She is host and creator of (mostly) TRUE THINGS, a show that features true stories, with a twist. The next performance is Sat. Sept. 12 in Port Jefferson, NY. Follow her on Twitter @JuTrWolff