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May 16 2014

Music gives people a voice when words fail them at the end of their lives

by My Inner Space

A music therapist describes how improvising songs can open a vital channel of communication in palliative care.

Many patients talk about feelings of powerlessness and a silence in which they become invisible. Photograph: Rex Features
All that was dear to me, down below the sea
I cannot hold this piece of driftwood
When life abandons me
Liz, a patient at the Sobell House hospice, 2013

In palliative care, when clients and their therapists get to know one another they do so with a shared knowledge, whether voiced or not, that while both of them are going to die eventually, at least one of them is going to be doing it very soon.

The relationship between client and therapist is always unique. And whatever you may think about "therapy", all (or most) of it is based on a fundamental human process. Where there is trust and dialogue, there is an opportunity for creativity and healing. But how do you talk about dying when you know that it's about to happen? Are you frightened, angry, anxious or depressed? Are you full of remorse? Or are you relieved? What will you leave behind? Who will you leave behind?

A few classic movie scenes spring to mind where the hero on the very brink of death sees his life flash before him, a 10-second review of an entire life in colour, and then he's gone. Off to … wherever.

But if, for instance, you are dying of cancer after active, curative treatment has stopped, the 10 seconds can become 10 weeks, or 10 months. And then what do you do? Do you simply wait for the end of the movie, do you try to stop it now and freeze the picture, or do you hit rewind and look at it again, frame by frame? Or do you make a new movie altogether?

Serious illness, pain, exhaustion and the fear of death can contribute to an overwhelming sense of having "lost our voice". Many clients talk about their feelings of powerlessness and a silence in which they become invisible. "How can I tell my daughter how much I love her when we're too frightened to even look at each other most of the time?"

As a music therapist working with people at the end of their lives, I have become familiar with these dilemmas. And over the past 10 years or so I've used therapeutic songwriting as a way to enable clients to be creative when they are trying to say the unsayable or think the unthinkable. I have lost count of the number of times I've heard myself saying, "I don't know the answer to that, but let's put it in the music and see where it takes us." And of course, music and song being what they are, we can be taken to all sorts of places, often surprising and often at great speed.

Sitting in a music room with someone who has been robbed of the mechanics of speech by a brain tumour or a stroke and hearing them reconnect with their language through singing is one of the most inspiring experiences I encounter in my work. I love the way that it still surprises me, every time it happens.

We all reveal ourselves in music. Whether we consider ourselves to be musical or not, human beings have a relationship with music that is as ancient as mankind itself, and yet at the same time is as contemporary and relevant as this very moment in time. Our world is full of songs.

Through improvising in music we can begin to identify some of these feelings and begin to name and describe them. By creating songs in these exchanges, singing the words, clients can experience a new sense of expressive freedom and honesty. The songs they leave behind talk to us of people experiencing themselves in new ways, making surprising discoveries, creating valuable legacies for their families and, at times finding reconciliation and peace.

Medicine Unboxed is a project that connects the public with healthcare professionals in a scientific, political and ethical conversation about medicine, illuminated through the arts. For more information on this year's event in Cheltenham, 23-24 November, visit our Facebook page, follow @medicineunboxed, or visit our Pinterest boards to learn about the conference programme

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