“Do you think they sang at the Last Supper?”

Easter at Hill House

Music Session, Residents & Gary, Hill House

The day I start working at Hill House I ring the bell and to my surprise a priest answers it. She just happens to be near the door, getting ready to do a communion service for a small group of residents in a side room. When I announce myself as the new music therapist, she quickly enlists me to play guitar for the hymns. 

The priest comes only monthly, and the residents at this home are a mix of Christian and Jewish, whilst many of the carers are young Muslim women. I wonder how the spiritual needs of people can be cared for here. 


Just before Easter Ruth, one of the residents, unexpectedly asks at the end of the music therapy group session “Do you think they sang at the Last Supper?”. This is a woman who lives with dementia, says very little, and looks confused if you speak to her. Her question remains in the air, so she answers it herself: “As we’ve been so happy I think we should go and cook a chicken!”. 


Eve comes up to me at the end of the session. She looks into my eyes and struggles to get the words out, but there’s something she needs to say to me: “Thank you for coming here… music… it’s more important than food for us”. 


As a visiting music therapist, and working there as a practitioner prior to Care for Music, I wasn’t at Hill House enough to answer my question about how the care home did or didn’t manage the spiritual needs of its residents (our ‘data collection’ has been conducted online because of the pandemic). But over the years there I’ve had glimpses of how music can be part of what could be thought of as spiritual experience for residents, staff, families. The vignettes I’ve included above were a reminder to listen and look carefully at what residents may not be able say or express anymore in conventional ways, but sometimes convey in poetic forms, images, or gestures. Also, to be conscious of what music ‘points towards’ for some people, which we might call the spiritual, soulful, or transcendent – however variously these terms are understood and ‘performed’. 

But this remains a key issue of course: how is ‘the spiritual’ understood and talked about today, especially in late and end of life care settings, and in a multi-cultural, multi-faith context? So, I’ve been reading around this area again, and thinking back to the history of how music therapy has slowly began to talk about spirituality again. Some readers of this blog may remember the Oxford World Congress in 2002 where Nigel Hartley and colleagues bravely put both community and spirituality back onto the map for serious professional discussion. Both areas had been taboo in music therapy for too long but, we argued, should be talked about again since they were clearly present in clients’ and therapists’ experience. Since 2002 there’s been a gradual development of both practice and serious thinking and research in this area, especially within later or end-of-life care (to mention just the sources I’ve been reading – Hartley 2012; Goodhead & Hartley 2018; Tsiris 2018; Notarangelo 2021).  

In Spirituality in Hospice Care Nigel Hartley is helpfully candid in his chapter about the ‘definition problem’: “…the concept of spirituality, for me, is messy, slippery and confusing, but also intriguing, occasionally inspiring and often totally consuming” (p.24). Nigel probably speaks here for many of us, if we’d admit it! A priest’s chapter in the same book writes wearily about spirituality as a ‘giant conceptual sponge’, soaking up almost anything. Another way we could say this is that words like spirit(ual) or soul(ful) are ‘placeholders’ – they don’t point to anything specific, but are a way of pointing towards the intangible, and possibly unsayable. In contrast to the materialist vocabularies of medicine (‘broken bone’, ‘blood clot’,) they don’t indicate things or even processes. They are “unwords” in Iain McGhilchrist’s (2021) nice term – words that place-hold that which doesn’t have a physical, spatial, or even temporal reality in the usual sense, but still matters, and still has traceable consequences. What a spiritual or religious vocabulary gives is a way of talking and thinking that directs our attention to people and their experiences in a non-ordinary way. Spirit-talk, soul-talk, transcendence-talk affords a particular quality of attention, witness, and care towards whole persons and their relationship with the seen and the unseen, which we might otherwise overlook if we only allow physical, psychological, or social phenomena to be ‘real’. Cicely Saunders, the hospice pioneer famously talked about ‘total pain,’ which included ‘spiritual pain’. But where is this? What vocabulary and practices express and address it? 


In my book How Music Helps the sections work through the various areas where music does just this: helps recognise people fully, build identities, relationships, community. The logical end-point to this sequence emerged as how music often helps with experiences of ‘transcendence’ – with how music can sometimes take us beyond the self, the area of spirituality. I realised that throughout the book I’d assembled a certain spiritual vocabulary because this was the only set of words and ideas that could describe this particular aspect of musical experience that people so regularly tell us about as music therapists.

As we now work through the data of the Care for Music project we’ve allowed ourselves to be attracted to those ‘facets’ that most shine out. Spirituality is one of these, and an initial approach to data analysis has been to trace the vocabulary of the field notes that best describe this facet. In a thousand pages of practice log, the following ‘spiritual’ terms occur (in ascending order of prevalence): Epiphany = 2; Religion/Religious = 3; Faith = 3; Transcendence = 5; Consolation = 5; Suffer(ing) = 7; Pray(er) = 7; Existential = 11; Vitality = 13; Beyond = 19; Purpose = 20; Ritual = 22; Presence = 23; Soul = 24; Meaning = 26; Value = 27; Community/communitas = 36/36; Quickening = 37; Witness = 48; Spirit(ual) = 49; Hope = 58; Beauty = 75; Attention = 92; (En)joy-joyful = 199; Love = 305; Life = 324.

It’s worth looking closer at the incidents and experiences that elicited these ‘tags’. This blog isn’t the place for a long discussion on an elusive subject, but here are some inconclusive notes and questions on aspects of music and spirituality that we’re currently thinking about in relation to Hill House and the people who live and work there:   

  • Non-verbal spirituality: Many of the residents of Hill House are ‘post-verbal’ for various reasons. But they often retain lively embodied and symbolic ways of communicating and creatively expressing themselves. How does music help with this alternative articulation of ‘the spiritual’? The vignettes above from Susannah and Eve show how there’s often a symbolic or poetic allusion that communicates aspects perhaps of their past and present religious or spiritual practice or understanding (for example, music as ‘spiritual food’ for Eve). Other times it’s simply the non-verbal sense of ‘something beyond’ within a fleeting moment of musical connection. 
  • Ritual and communitas – The Christian communion service I helped with during my first day was a conventional religious ritual of great value to those who attended. But are the music therapy sessions themselves a ritual? My logs over the years record many sessions where mood, energy, social relationships and more have been transformed: “Conviviality – helped by the tea coming halfway; warmth and mutual contact and appreciation between residents, between staff and residents. And lastly, hope and fun.” Is this what Victor Turner called ‘communitas’? – a dynamic, liminal, performative state of ‘betweenness’ that groups can experience as transformative; “that sense of union with others which is a large part of the aim of ritual and a major concern of religion” (Edith Turner).
  • Spirit and Soul – A family member once said, “It’s a portal to people’s spirits”, whereas the manager one day said, “Thank you, my soul’s been warmed” after she joined a group. The tendency for spirituality to be a ‘giant conceptual sponge’ indicates there’s room for more phenomenological differentiation. The data depicts manifestations of both ‘spirit’ and ‘soul’; inevitably a subjective and poetic distinction, but interesting. In short: spirit lifts, animates, quickens, whilst soul descends, deepens, colours, connects. How does music work differently with spirit and soul? 
  • Suffering, Beauty, Joy – A spiritual lens can allow seemingly incompatible aspects of experience to relate. Beauty, rather than being sentimental, stands out in relation to that which is fragile, near the end, feeling anything but beautiful. Joy stands out amongst pain, sadness and suffering. In music these opposites and incompatibilities can and do exist. Here’s an excerpt from the current, project, log:
    • “As ever the music’s a vehicle for ‘something else’ happening there: I know this sounds vague, but I mean it’s to do with the dimension of ‘spirituality’, broadly conceived: joy, quickening, connection, appreciation… Life in a word. Perhaps I think this because it’s Ash Wednesday, and I’m just about to sing in the cathedral service… but also earlier I was thinking about the paradox in a place like Hill House between the spiritual aspect of musicking… and the everyday shit of their lives – for residents and carers (quite literally, the work is endless toileting and feeding).”
    • “Yes, there are dark times…  but also light ones too. We need sadness too… It makes it real” (Elinor)
  • Hope: The daughter of a resident once said, “I was getting down about coming here, and how mum is… and then this afternoon’s music has given me hope again…”. As Tia has written about in her recent study of this aspect (DeNora 2021), hope is a dream we carry, often amid situations which are difficult and feeling hopeless. Musicking often generates, carries, and lends hope to people and situations at Hill House.
  • Life – “You bring life to us” Eve says. ‘Life’ comes top of the list of ‘tags’ (324), with the paradox of this being in a situation where people are near the end of their lives. Residents, staff, families point out how music often shows up the life still in people, and the particular quality of life that flares in musical communication, often referred to as ‘quickening’ in the log – which is far more than physical stimulation. That ‘life’ is seen as a spiritual aspect perhaps connects to the growing trend for what the theologian Don Cupitt (1999) calls ‘the new religion of ordinary life’ where “life” itself is celebrated and sacralised. Of all the reports that we witness on how music helps in Hill House it’s perhaps how it ‘brings back the life’ in people that is most notable – and perhaps the most intangible spiritual phenomenon? 


Lastly, a confession: I left out ‘love’ when I first searched for key ‘spiritual terms’ in the data. It turned out to have 305 references! Love is such an everyday word that we may forget (like me!) that it’s at the core of almost all spiritual traditions and endeavour. Along with Hope and Faith there is Love as Caritas – or ‘charity’ in the traditional biblical translation. It’s also increasingly acknowledged in the literature on dementia care (Gerrard 2019). I then remembered the quote that I put at the very end of How Music Helps, when one of my interviewees, Rachel Verney, talks about Nordoff and Robbins’ ‘music child’ concept: 

The idea of the ‘music child’ was an attempt to say how there’s something about people which is whole and healthy and which responds to the call of music. But it’s also hope, and it’s love, and it’s beauty, and it promises the impossible. It’s absolutely a spiritual concept, there’s no question.(p.294)

This kind of love isn’t primarily eros (though that can be there in music too), or philia as close musical companionship and community, or even agape – the unconditional love of the New Testament. Instead it’s perhaps what Mark Vernon (2008) explains as a further form of love characterised by the Greeks – kalos, which he links to wellbeing. Kalos can mean ‘beauty’ but in the sense that it orientates you to what you love, and through this love towards a desire for the good, and to live rightly and happily. Music doesn’t of course make people love, but it helps with this. The anthropologist John Blacking (1973) wrote of his long-term immersion in the musical culture of the Venda of South Africa: “Problems in human societies begin when people learn less about love […] The hard task is to love, and music is a skill that prepares man [sic] for this most difficult task” (p.103). 


I’m about to leave Hill House when Susannah takes both my hands begins a speech to me, says how lovely the music is, how sensitive my touch is… and then she tries to say more and her speech muddles. She stops, pauses, looks me straight in the eye and says “Love… Love… Love…”.


Blacking, J. (1973). How Musical is Man? University of Washington Press. 

Cupitt, D. (1999). The New Religion of Life in Everyday Speech. SCM Press. 

DeNora, T. (2021). Hope: The Dream We Carry. Palgrave Macmillan. 

Hartley, N. (2012). Spirituality and the Arts: Discovering What Really Matters’. In: M.Cobb et al. (eds) The Oxford Textboook of Spirituality in Healthcare. Oxford University Press. 

Gerrard, N. (2019). What Dementia Teaches Us About Love. Penguin. 

Goodhead, A. & Hartley, N. (2018). Spirituality in Hospice Care. London: Jessica Kingsley.

McGilchrist, I. (2021). The Matter with Things. Perspectiva Press. 

Notarangelo, A. (2021). ‘Ecological Awareness in Practice: Spirituality, Community Health, and the Possibilities of Music Therapy’. Health & Social Care Chaplaincy Vol.9, no.2 pp298-314. https://doi.org/10.1558/hscc.41473

Vernon, M. (2008). Wellbeing. Acumen. 

Tsiris, G. (2018). Performing spirituality in music therapy: Towards action, context and the everyday. Unpublished PhD thesis: Nordoff-Robbins/Goldsmiths, University of London. 

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