“Music expresses that which cannot be put into words and cannot remain silent.”
Music Professor Ron Borczon works with a client, Andre M., in CSUN’s Music Therapy Wellness Clinic. Photo by Lee Choo
In the 2003 film Cold Mountain, there is a scene in which Oakley, a young soldier, lays dying. He makes a simple request, “I’d like to hear some music while I go.” A man named Stobrod, who owns a fiddle, is found and brought to his bedside. Stobrod becomes flustered when Oakley asks for music that sounds “like when you’re thirsty up at Bishop’s Creek and the water is so cool,” protesting that he only knows a few songs. In the end, though, he picks up his instrument and begins to improvise a beautiful melody, creating peace for the boy’s last moments.
Playwright William Congreve also knew the power of music when he wrote that it “has charms to sooth a savage breast, to soften rocks, or bend a knotted oak.” We use music to mark significant moments and transitions in life – birthdays, weddings, funerals, rites of passage, religious ceremonies – just as our ancestors used music to measure the movements of daily life through work songs, farm calls, and lullabies. Music can engage us in ways that are totally unique from any other activity, and it literally resonates through our bodies, minds, and spirits.
No wonder, then, that the field of music therapy has grown over the last half century to become a valued and significant part of many educational, medical, and rehabilitative services today. Music therapists work with a diverse population, and the programs that are found in hospitals, schools, prisons, and treatment centers are tailored to address both physical and psychological needs. This week, we had the opportunity to speak with John Mondanaro, Clinical Director of The Louis & Lucille Armstrong Music Therapy Program at New York’s Beth Israel Medical Center, about the work of music therapy and the incredible healing power it offers.
BreakThru Radio: Music therapy can be used to address a variety of issues and concerns, and is used within a broad spectrum of populations – in the most basic sense, how would you define music therapy?
John Mondanaro: As a profession, music therapy is evidence-based health care that uses music to address the physical, social, cognitive and emotional needs of individuals of all ages. In a medical setting, we work from a medical music-psychotherapy standpoint. We can address issues of the body, such as respiration complications, heart rate, anxiety, pain, and we can also use music as an expressive modality, psychotherapeutically, through songwriting, improvisation (verbal and non-verbal process), conflict resolution, and emotional catharsis. We assess each person on an individual basis, and we move in either direction, or sometimes both.
It’s an established profession, really, since the 1950’s, though music’s been used in medicine for thousands of years. You can look as far back as Socrates to find references to music healing the spirit and the mind, but it really emerged formally back in WWII when music was being implemented by nursing staff to ease the soldiers’ post-traumatic stress syndrome.
BTR: After reading a little bit about the specific programs you’re involved with in the Louis Armstrong Department – can you talk about some of those? The program mentioned on your website that addresses teen and youth asthma through the use of wind instruments was especially interesting.
JM: We work with premature infants, clear through geriatric and end-of-life, and everything in between. With any population or age group, we look at the effect of the mind on the body, and the body on the mind, and how the use of music can create an integrated treatment in terms of body-mind-spirit. We start with an assessment, where we find out who the person is prior to illness, who they are in coping with illness and treatment, and we learn about the trajectory of what’s happening medically so we can work with them along more existential issues as well.
With the asthma program in particular, that was one of two research studies we looked at, dealing with the use of wind instruments and singing to build pulmonary strength and capacity. We created a program in the boroughs of New York, working with school age children. The work focused primarily on the use of winds and singing, but also introduced music as a form of meditation – a coping strategy for children and adults. As they feel themselves having an asthma episode, they can start doing some mind-body work to calm their breath. So the work occurs both medically and psycho-therapeutically.
We did a similar three-tiered study looking at adults with chronic pulmonary disease. Using winds, improvisational singing and percussion we sought to meet the same needs: physically, to increase pulmonary strength, but also psychologically and emotionally, to use music as a form of socialization and expression.
Those themes emerge throughout the hospital. With Oncology and Palliative end-of-life, sometimes music – having the capacity to work in both verbal and non-verbal realms – can access feelings that are beyond words. It can also bridge family dynamics that might be strained with the stressors that come with illness and treatment. Music can be a bridge to work through some conflicts at a non-verbal level, and we’ve often seen that. Families find a way to be closer through something as non-invasive and innately human as music.
BTR: Do music therapists work alongside other therapists within a comprehensive rehabilitation program?
JM: Absolutely. One of the programs that we’re heavily involved with here is in the department of Orthopedics. There’s a whole integrative movement where they have Reiki, as well as yoga, acupuncture, and music therapy. We’re studying the effects of music on pain in patients undergoing lower back surgery, which is one of the most excruciatingly painful surgeries.
The work is very focused on tension release, and in music there is a cycling of tension resolution chording. We know that that’s also happening in the body when someone is recovering from surgery – the muscles are surging constantly in tension and release. So we mirror that in the music, and the patients can actively participate in that through percussion or drumming, while some prefer to be passively receptive and focus on imagery. In either case, the music is aimed at mirroring what’s happening in the body naturally, while supporting a mindfulness with the breath.
Breath is the one function that we can mindfully control. We can choose to lower or slow down our breathing – we can’t do that with our heart or pulse rate, but with our breath we can. If that process is supported with music, we can really help patients connect with an inner resilience and also optimize their threshold for coping with pain.
We have a lot of different studies going right now, but pain is definitely a theme. I think pain is a really hot topic because it’s something that’s universal – it can be emotional, physical, acute or chronic. It shapes our lives, whether we want it to or not. We look at pain in all of our studies, and we’ll actually be doing a big two-day conference on pain in January, when we’ll be inviting different people to speak on the topic here at Beth Israel.
BTR: Can you describe the specifics of what might happen in a given session?
JM: I just worked with a patient in the hospital, a 29-year-old man with sickle cell, and the work happened in two sessions. The work in the first session was very much what I just described: tension release. He was doing some very slow hand percussion, but primarily focusing on breath and visualization, while I created an improvisation that cycled through tension chording, resolving to harmony. He lowered his pain score from six or seven down to three or four in that session.
In the second session, his pain was at a lower level, around two, and he was quite interactive and wanted to do more participation. So he was drumming, using hand percussion, and we did everything from bossa nova, to a Ray Charles R&B piece, ending with a Nat King Cole song in a marimba kind of rhythm. He was smiling from ear to ear and participating.
BTR: Do you ever work with pre-recorded songs or tracks, or do you as the therapist provide live music?
JM: We rarely use recorded music here. We use it if someone wants a resource available around the clock – we may create a recording for that. In our Radiology/Oncology program, the music therapist there is creating customized 20-minute tracks for people based on what they like, and they listen to that when they’re in radiation. But primarily, here, the program is focused on live music, and on the relationship between the patient and the therapist creating music together. With live music, we can match the music to the heart rate, the respiratory rate, the emotional presentation, and we can change it as those things change.
BTR: As an artist and musician, how would you say the work of music therapy has impacted your own personal work?
JM: You know, when I finished my studies, I thought that I would move back into doing more performance again and I just haven’t. The work is such a profound way to give of yourself musically – I’m writing all the time, with patients, and I’m improvising on a daily basis, spending probably 6 or 7 hours of my work day playing music. It’s been very fulfilling.
The way it’s affected my own songwriting, which I still do on the side, is that it’s reinforced my belief in story and narrative. I think the best songs have a story, the best oral traditions are based on history and what people have done to come to this point. As a therapist, I attend to that with vigilance. I want to know, if someone is willing to tell me, who they are – besides their illness. I may know that they have a certain type of cancer, but they’re a whole person, with a whole life of context, and events, and people, and achievements that should go recognized, even though they’re fighting an illness. Sometimes, the music part of a person, or the stories that they have – those things remain intact and vital, even when the body may be breaking down.