2004 Index of Articles
Listed in alphabetical order
2001 Index of Articles
2002 Index of Articles
2003 Index of Articles
Music Thanatology “The music deeply touches the souls of all who are present. I’ve seen patients who were struggling calm down and families who were feeling exhausted and overwhelmed become more invigorated,” says Alyse A. Rynor, MSW, LCSW, Palliative Care Center & Hospice of the North Shore, Evanston, IL. Rynor refers to an emerging field known as music thanatology. It is defined as “a palliative medical modality employing prescriptive music to tend to the complex physical and spiritual needs of the dying” (Schroeder-Sheker, 1994). Music thanatology is modeled after an 11th century French monastic practice known as infirmary music that focused on the relief of physical, mental, or spiritual pain. Listening to this music helped monks experience a peaceful death. The goal of modern music thanatology is to help people experience a peaceful death through prescriptive music. Music thanatology is not confined to a particular religion (Schroeder-Sheker, 1994). Like the medieval monks, music thanatologists also practice infirmary music when they hold a vigil. “When I go to a vigil, I tailor the music to the patient,” explains Margaret Pasquesi, MA, CM-Th, certified music thanatologist. “What key or mode I play, the complexity, simplicity, or direction of the musical line, is based on vital signs such as pulse rate, breathing, and temperature, along with the rest of the patient’s presenting physiology. The musical prescription changes throughout the course of the vigil as the patient changes. We avoid familiar music, since this can leave patients stuck in their head, when what often needs to happen is a return to the body.” The vigil is primarily nonverbal, alternating suites of music with silence over the course of a half-hour to 11/2 hours. Applause or verbal response is discouraged since a vigil should not be looked at as a performance, but something the patient and loved ones receive. Roots of the Art Schroeder-Sheker was also influenced by an encounter with a man who was dying of emphysema. One evening when she came in his room, it was clear he was nearing death. He had difficulty breathing and could not swallow. The room was filled with fear and agony. She climbed into his hospital bed, propped herself up behind him in midwifery position, and began singing quietly to him and rocking very gently. She thought he might be Russian Orthodox, so she sang some religious songs. Silence replaced the man’s struggle. Even though Schroeder-Sheker didn’t have any medical or philosophical sophistication, she understood that what had happened was a matter of heart (Schroeder-Sheker, 1994). In 1972, Schroeder-Sheker started The Chalice of Repose Project, a two-year clinical practice and graduate-level educational program. At present, no schools certify people as music thanatologists; however, an academic program is in the works. Music thanatologists use harps and voices and generally work in teams of two. “The benefits of having two harps and two voices are numerous, especially the extensive options available to us musically, such as counter-melody, harmony, echo/round, sustain, variation, and textural possibilities, plus having the ability to surround a patient and family with sound,” Pasquesi explains. “Also, it is invaluable to have two sets of hands, eyes, and ears. Often, a patient who is otherwise alone reaches out during the music for a hand to hold. By using the team approach, the music can play without stopping.” The Value of the Vigil Joseph Dunn, MD, a pain management specialist with a practice in Eugene, OR, witnessed a vigil played for a man dying of cancer. He said: “The benefits of the treatment helped control his pain and decreased his anxiety while the music was being played. It also provided an environment for the patient and his family to talk about what was taking place, which is the most important thing” (Taylor). Prescriptive music is effective for patients of any age, whether conscious or comatose, hard of hearing or not. The music is tailored to fit the patient’s physical and spiritual pain, restlessness, labored breathing, anxiety, sleeplessness, and emotional distress. Patients with various types of cancer; respiratory illnesses; cardiac disease; AIDS; and slow degenerative diseases such as ALS, multiple sclerosis, end-stage dementia, and Alzheimer’s can benefit from music vigils. A vigil also offers a transformative and helpful presence during the difficult experience of removing a patient from life support systems. “As a hospice social worker, I often make referrals to music thanatology. I find it not only benefits patients during the end of life, but provides much-needed respite for the family as well,” says Rynor. When making referrals to a music thanatologist, provide the patient’s name, age, diagnosis, location, and reason for the referral. The reasons range from immanency (the person is actively dying) to agitation, terminal restlessness, dyspnea or other difficulty breathing, sleeplessness, pain, need for nonverbal processing, difficult family situation, etc. Thanatologists take their music to patients at home and in hospitals, nursing homes, or long-term care facilities. You can find a music thanatologist on the music-thanatology Web site at www.music-thanatologyassociation.com. — Barb Chandler is a Sacramento, CA-based freelance writer. References |
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