As part of the Care for Music Festival, held at Mountbatten on the beautiful Isle of Wight, we took part in a ‘knowledge exchange’ event with local musicians.
Originally, and thinking of the very special ‘Moody Blues’ piano that’s available in Mountbatten’s John Cheverton Centre (JCC), we’d intended the event to be for Island-based pianists. We thought they might like to try their hands at playing ‘piano lounge music in a hospice or care setting’. Then we expanded this idea to include any other ‘harmony instruments’. We were thinking of things like classical guitar, or harp… To our surprise, the musicians who expressed interest in the event were, all of them, folkmusicians, in particular musicians with strong interests in Sea Shanties!
Our first thought was, “well, will Sea Shanties ‘fit’ into a care environment? Aren’t they a little – er – boisterous? Will that be too much for a hospice lounge?” We were quickly proved wrong…
So, we met back in March and had a really rich, fruitful discussion. It led to the notion that perhaps the musicians might play (or rehearse) outside in the summer weather on the hospice deck – so as not to be too loud inside the lounge area. Then, one of the musicians, John Bentley, who also organises the monthly folk club at Quay Arts, proposed the idea of a – Mountbatten Folk Club. A group of musicians who would visit the hospice, meet in the JCC, each taking a turn to offer a song and, over time, get to know and be known by the people and the place. John and his colleagues discussed this a bit more, John proposed it to Mountbatten, and met with Matt White, Director of Communications. The idea got the green light from CEO Nigel Hartley, and now the Club has met for the first time, last week, in the JCC. The musicians come to Mountbatten on a voluntary basis, donating their time and art. They offered classic folk songs, sea shanties, and originally composed songs.
The Mountbatten Folk Club is now open to anyone who uses Mountbatten’s services, to staff, family, and Mountbatten volunteers. The hope is that people from Mountbatten might also join in. And indeed, in the first session that already happened. One outpatient, a highly accomplished song writer, has already joined the group and offered his original songs. And – delightful coincidence (or perhaps not, given we are on The Island) – it turned out this man also had a long-standing interest in – Sea Shanties!
In the middle of it all, a senior nurse came in, saw what was happening and immediately went to fetch her camera. A long conversation ensued. Discussions of ukuleles, where to learn how to play them and where to find folk groups on the Island. Tia chatted with some of the day patients and visitors who seemed very clearly to be enjoying the music. CEO Nigel Hartley came out to say hello and invited the group to play in the wards next time they visited. When the musicians turned to the audience to ask if anyone else might care to offer a song, one spritely lady piped up: I can’t sing you a song, but if I had a triangle I’d play along.
And so, Mountbatten has taken to the High Seas with exuberant, lovely, vibrant music. The musicians offered some of their original songs and we all sang along to folk classics such as Cockles and Mussels, Bob Dylan’s Girl from the North Country, Amanda McBroom’s The Rose, Ewan MacColl’s Dirty Old Town, The Isle of Wight for Me, and – it was bound to be sung – umpteen jolly verses (some of them improvised?) of What Can You Do With A Drunken Sailor.
Thank you to the musicians! And looking forward to the next time!
What I learn from people caring for music (by Wolfgang Schmid)
Heavy clouds, drizzle, called yr in Norwegian, and strong winds herald the beginning of spring in Bergen. One of my colleagues at the hospice once explained to me “we have two seasons in Bergen: White winter and green winter. And such weather indicates the green one”. Nevertheless, I am on my way to Grieghallen, Bergen´s big concert venue in the middle of the city, named after one of her famous sons, the musician and composer Edvard Hagerup Grieg.
Inside the Grieghallen, in the foyer on the first level, about 300 people have come together. A friendly, warming atmosphere with the humming sounds of people´s chatting, laughter, and pleasant anticipation fills the hall. On a stage, 60 people from the Bergen Røde Kors kor (Bergen Red Cross choir) have taken their seats. In a semicircle in front of the stage, about 250 people have gathered, most of them sitting around coffee tables with cake and coffee served. I see two TV teams positioning their cameras, and several journalists walking around taking photos. On the lefthand side of the stage, seven musicians from the Bergen Philharmonic Orchestra warm up: Two violin players, a third one with a traditional Hardangerfidel, a trumpetist, a pianist, a percussionist, and a double bass player. The choir are about 35 people living at the Bergen Red Cross home for the elderly, presenting with varied stages of dementia, and around 25 volunteers. Since 2013, the choir has its annual concert at the Grieghallen related to the project “Musikk for minnet” (Music for memory) where people with dementia and volunteers from the Bergen Red Cross sing, play and dance in concert with professional musicians from the Bergen Philharmonic Orchestra and music therapy students and tutors from the Grieg Academy.
Later, I read on the “Musikk for minnet”-website about the project’s intention and philosophy highlighting that “people with dementia are often referred to as a uniform group. Through the project, we hope to be able to contribute to seeing the individual behind the disease.” The melody of the folktune «Å var jeg en sangfugl” (Oh were I a songbird) played on the Hardangerfidel mixes with the people´s chatting. Eventually, the choir joins and sings the tune in unison. Our colleague Fraser and the choir at the Mountbatten hospice on the Isle of Wight comes into my mind. A community of around 70-80 people with both staff, patients, and relatives. Fraser describes in his blog on these pages (“Why do we sing?”) their weekly meetings on Wednesday evening, also throughout the lockdown on zoom. There, choir members emphasize their enjoyment with singing together, lifting each other up, and jointly create an animated atmosphere of pleasure and recreation, that I also sense on this afternoon in the Grieghallen.
One song follows the other. Next one is the waltz “No kjem ein vals, den vil eg ha med deg” (Now comes a waltz, I want to dance it with you). The people on the stage sing, clap, and dance. We, the people around them, sing, clap and dance. We move and are moved by the music and each other´s commitment and enjoyment. I notice others’ emotion. They notice mine. We confirm each other´s sense of this occasion, which is contained and carried on from moment to moment by and in the music.
No kjem ein vals Den vil eg ha med deg Kom lat oss dansa til trekkspelmusikken Til sola går ned
Now comes a waltz
I want to dance it with you
Come let’s dance to the accordion music
Until the sun goes down
I see people filming with their mobile phones. I see people smiling and with tears in their eyes. I see a younger woman approaching an older choir singer right in front of the stage. Is it his daughter or niece? After a sniff, he recognizes her and kisses her on the check. And then they waltz together. I have tears in my eyes and wonder, who is including whom here? What people might care for when they care for music? Questions that we in the C4M-team have discussed throughout the project. Now at the end of the project, as we sum up, these questions come up again. So, not new issues, but on this afternoon in Grieghallen, I understand that this concert tells me something simple but important related to these questions: I do not just listen to a choir performance, but also witness how people living with dementia share and invite me into their lives. Their care for music is a materialization of both agency and community. Their care for music dissolves established roles of caregiver and care recipient, of person with dementia and person without dementia. The people on the stage let us into their world, take care for all of us and make us feel welcome and included. We see, listen, are curious, learn from, and are affected by each other. We embody this in our care for music.
The philosopher Hans-Georg Gadamer suggests a person´s health and their caring for it as an active and rewarding engagement, and an original manifestation of human existence. How this can take place, be perceived and embodied, is discussed by several authors on musicking and health. For example, David Aldridge (2005) suggests that we perform our health through and in dialogue with others within a social and cultural context. We improvise our lives from moment to moment. With living as jazz, he proposes a musical metaphor for understanding human live. Like a piece of jazz, we are constantly improvising our lives to meet internal and external demands of our daily lives. Living as jazz highlights how we are and remain active, dynamic beings throughout our lives. This can continue even when we experience loss of memory, sense of orientation, or the ability to communicate with language. Also, when we are terminally ill and dying.
The word exist originates from the Latin word existō and means to come and stand forth, be who one is, have a perception of oneself, be seen by others and interact with them, inhabit a place in the world, where one experiences meaning with their unfolding lives. On this afternoon in Grieghallen, I witness how people, how I myself, perform and perceive myself in the presence and together with hundreds of other people. We have just met each other. Now, some minutes later, we dance and sing with each other. We share some time of our lives. Freely. Intimately. Joyfully. If once only. To me, this invitation to dance is a deeply devoted and enriching engagement. An acknowledgement and celebration of the experience of being and belonging. Experiences that the philosopher Ola Sigurdson suggests, are core aspects of a person´s existential health. We are healthy, in an existential sense, when we experience that the life we live is ours. Existential health also comprises the experience and awareness for our vulnerability and the way we relate to suffering. It equips us with intentional and reflexive qualities to relate to both our ailment and health.
In my music therapy work at the hospice, people with advanced stages of terminal illness show me photos, share stories and songs from their lives, are curious, humorous, sad, tired, in existential pain. Though they often have limited time, some share their imagination and thoughts, their hope, their despair. Some their struggles and strategies to cope and live their lives at the end of life. I understand this as an enactment of their existential health, a care for their own lives, including both its ailment and health.
Espen, one of the participants in the care for music-project taught me his favorite songs. He was referred to the hospice with advanced stage stomach cancer that had spread throughout his body making it difficult for him to swallow and speak. Espen spends most of the time lying in bed. He loves to sing. In our first encounter, he tells me, with a hoarse voice and many pauses, about his lifelong passion for singing in choirs. As a boy, he had seen a film version of an Italian opera with Enrico Caruso and Kirsten Flagstad at the Bergen cinema. He was thrilled by their voices and the performance. During the interval – the film roles needed to be changed at that time – he run home to his mother to share his excitement. But only to hear from her that the film had not been over yet, and that he had missed the second half. He remembers that this was the time when he decided to sing himself, when he joined a children´s choir. Now, some decades later in the hospice room, he still cares for music and asks me to play the song “Jeg er havren” (I am the oats). I find the text and melody on the internet and take up my accordion. First, he tries to sing himself, but it is difficult, and he lets me know. It makes him sad. I gently continue playing the song in a more improvised manner and at some point, Espen starts to conduct me with his left hand. After some time, I realize that he does not only show me the tempo and dynamic of the music, but its melody with its articulation and rhythm. Lying on his back in the hospice bed, the position that gives him least pain, he draws the words of the song with his left forefinger in the air above him. He sings the song with his hand. He conducts me as precisely as any skilled conductor. His repertoire of caring for music has expanded. He improvises and adapts it according to his very condition and the context. He acknowledges his vulnerability and limitations and at the same time reveals his enormous capacity and will for creativity and ownership. And by teaching me his song in this way, he includes me in his care for music, like the choir singers in Grieghallen did. Espen shares something important from his life with me. And he shows me not only how we can care for music together, care for each other and ourselves, but how care can be done in a broader sense. Based on a theory of selfhood consisting of multiple parts, psychologist Philip Bromberg suggests that health is the ability to stand in the spaces between realities without losing any of them. One can relate to different parts of self while being a whole person at the same time. I understand, that with his care for music, Espen still relates to himself as a singer, without ignoring the limitations set by a terminal illness. I understand that he stands in the space between these realities, performs and improvises his life, his existential health. His care for music might even help him to inhabit this space, keep it open and invite me into it. In our third session he does not want to make music himself nor listen to it. He has become much weaker and even more tired. He says: “What a pity that we do not have more time together. I could have taught you so many songs”. Instead, he asks his wife to bring all his songbooks with her from home and give them to me. This is, in my understanding, how he continues to care for music.
What I learn from encounters with Espen, many other participants, and from the choir singers on the afternoon in Grieghallen is that care for music comes in various forms and variations. It can be done in various places. In a hospice bed and in the foyer of the Grieghallen. Thus, not everybody wants to care for music. Music might not be equally important for all people, but many still care for music at the end of their life, seek and find opportunities to do so, and thus also nurture the experience of existential health, of living and owning their lives with its limitations and possibilities. People´s care for music provides me with some guidance for how I can support them in doing this: How to stand in the spaces between several, sometimes contradictory realities of living and dying. How to value these spaces, keep them alive and open, care for continuity and coherence that can come from them. How to care for and perform existential health. How to continue to write our own life stories.
The “Music for memory” concert is over. I pass the bronze statue of Edvard H. Grieg outside the Grieghallen and wonder, if and how he might have cared for music at the end of his life. Later I read in one of the biographies about him, that from 1903 he had increasing respiratory problems, and during the spring of 1907 his health deteriorated considerably. After an unusually wet summer in Western Norway, his condition became critical, and he died on 4th of September 1907 at Bergen Municipal Hospital. During the autopsy, a pulmonary emphysema was diagnosed as the cause of death. It is not recorded if Grieg had music at the hospital. If somebody has sung or played for him. His wife Nina Grieg later wrote in a letter: “Things went badly for him all summer, ever more badly. He was always freezing and had less and less breath. Energetic as he was up to the end, he practiced the piano and studied his scores in spite of increasing weakness.”
Aldridge, D. (1998). Life as jazz: Hope, meaning, and music therapy in the treatment of life-threatening illness. Advances in Mind-Body Medicine, 14(4), 271–282.
Aldridge, D. (Ed). (2005). Music Therapy and Neurological Rehabilitation: Performing Health. London: Jessica Kingsley.
Bromberg, P. M. (1996). Standing in the spaces: the multiplicity of self and the psychoanalytic relationship. Contemp. Psychoanal. 32, 509–535. doi: 10.1080/ 00107530.1996.10746334
Sigurdson, O. (2016). Existential Health. Philosophical and historical perspectives. LIR J. 6, 8–26.
Sigurdson, O. (2019). “Only vulnerable creatures suffer: on suffering, embodiment and existential health”, in Phenomenology of the Broken Body, eds E. Dahl, C.
The Care for Music team is just back from Newport, Isle of Wight. The Project is now nearly at the end of its formal schedule (though we will continue with writing and outreach and connect to the Island Life and Death project which runs through 2024). We were thrilled that our long-anticipated Festival was finally able to happen at Mountbatten Hospice. There was an intimate seminar around project findings. There were sofa discussions around a wonderful film produced by Wolfgang Schmid and Jill Halstead. There was a tour of the hospice for Wolfgang from CEO Nigel Hartley.
There was a really fruitful meeting with three important folk musicians from the Island where we shared knowledge about playing ‘background’ music in caring settings. We hope that will lead to good things down the line….
And then… there was…. The Cabaret!
The Cabaret evening was hosted by “The Singing CEO” Nigel Hartley. Fittingly, Nigel started off with the song Wilkommen (complete with inspired, improvised, occasion-specific lyrics):
Willkommen! Bienvenue! Welcome! Leave your troubles outside In here at Mountbatten, life is beautiful The ladies are beautiful Even some of the men are beautiful
And I’ll tell you a secret:
Some say that even the CEO is beautiful…
And now presenting the choir! Each and every one so musical– You don’t believe me Well, do not take my word for it Let’s listen!
Taking its cue, the Choir began – with Cabaret! And we were off…
Solos and ensembles from choir members and service users… The choir were ‘on fire’, as Tia said in her poem of thanks to Catering Manager Vera Mircescu, Head of Communications, Matt White, the Choir, and Choir Director Fraser during the interval.
It was heartening to see how many Mountbatten volunteers turned out to help set up for the event. Café manager Jackie Davis, Café volunteer Sean, and many others gave up their time to make this special. And Donna Read, most amazing cake maker, produced this beautiful piano-shaped, delicious, cake….
The soloists and ensembles were amazing. Some were in costume. There were two ‘nuns’ who sang Climb Every Mountain (they had a little trouble getting into their habits but we won’t make a pun about that here…). Outside, in the hospice gardens, the rain was coming down in buckets, so what more appropriate than Singing in the Rain along with a tap-dancer complete with a Mountbatten Sunflower umbrella. Another singer – who claimed to be an octogenarian – showed off legs that a twenty-year-old might envy. She was dripping in, as she put it, ‘my bling’ when she came briskly to centre stage to announce, ‘I’m the tart of the hospice’ and then sang, with relish, I enjoy being a girl.
There was a birthday to be celebrated and a surprise singing by all of ‘Happy Birthday’. There was a medley of concertina tunes. There was an original song that moved us greatly and which continues to play on in our memories (If I could turn the clockback). Two original poems and very funny were read. Another lady sang a personally tailored version of I did it my way (which was about not bothering with the housework any more – she waved a rainbow feather duster about for emphasis).
And Fraser Simpson, beloved by all the choir, played, conducted, and supported the soloists with panache and tender loving care. The Choir sang Beyond the Sea, It ain’t Necessarily So, Downtown and Supercalifragilisticexpialidocious. Gary vamped along from the corner on piano number two. Tia and Wolfgang cheered from the audience.
Once again, Mountbatten has shown how it is possible to be, all at once, a vibrant cultural and community centre, a place where we can be light of heart, and a place of care for people who are dying. For the Care for Music Team, it was wonderful and inspiring. As Gary put it during the speeches, ‘if you care for music, music will care for you’.
The kantele, ‘her’ personality, and a Nordic hospice setting
Last month Tia visited Wolfgang to follow him and his kantele as they made their rounds at the hospice. It is obvious that Wolfgang’s kantele does a lot of beautiful work. Now Wolfgang and Tia (and, in fact, the kantele) are writing an article about that work. What properties for soothing and healing might this type of plucked, very resonant instrument have, for whom, played how and where, by whom, and why?
It is such a beautiful thing, with its lovely trapeze-shaped frame of pale woods (a combination of sycamore an mountain spruce) and row of 15 strings that can be tuned both in pentatonic and diatonic scales. According to the instrument maker in Berlin who made Wolfgang’s kantele, it is the texture of the wood from mountain trees makes the fragile instrument especially sturdy. The instrument comes in different designs (size, register, number of strings from 11-25, with or without bridge). It develops its optimal sound quality over time as the wood ages and as it becomes ‘seasoned’ from being played. So kanteles do not wear out through use, but rather gain in liveliness over the years. Wolfgang’s instrument is now 12 years old. It is a warm, natural, organic object amidst the inevitable (if important) white coats and sterile features of the hospital environment that the hospice is part of…
The kantele is also very well-behaved in a hospital or hospice setting. It, or, as Wolfgang says, ‘she’, sits quietly on his lap like a well-mannered cat. She seems to knows precisely when to be silent and when to sing, and, like a cat, how to make herself very small, or very large…
Culturally, the kantele enjoys a rich, poetic legacy that is familiar to many people in Nordic countries. The Kalevalarecounts how the first kantele was constructed from the bones of a pike and the hair of a horse’s tail:
“All the beasts that haunt the woodlands, On their nimble feet came bounding, Came to listen to his playing, Came to hear his songs of joyance. Leaped the squirrels from the branches, Merrily from birch to aspen; Climbed the ermines on the fences, O’er the plains the elk-deer bounded, And the lynxes purred with pleasure; Wolves awoke in far-off swamp-lands, Bounded o’er the marsh and heather, And the bear his den deserted, Left his lair within the pine-wood, Settled by a fence to listen, Leaned against the listening gate-posts, But the gate-posts yield beneath him; Now he climbs the fir-tree branches That he may enjoy and wonder, Climbs and listens to the music Of the harp of Wainamoinen.”
The Sibelius Academy in Helsinki has its own fields of folk music studies where the kantele is included as an important instrument. The areas around the Baltics have offshoots, or similar instruments in kokles (Latvia), kankles (Lithuania), kannel (Estonia) and gusli (Russia). In Norway, the langeleik (or langleik, langhørpu and langspill), is a famous folk music instrument. In South-Germany and Austria the Zither is the counterpart to the kantele…
When Lotte hears the kantele for the first time at her bedside in the hospice she tells Wolfgang about the Zither she has at home. In her family, the Zither was played and passed along from her great-gandfather to her mother´s father, her mother and finally to her. Lotte says after her experience with the kantele music (end of 5th session): “When it comes down to it, what matters in life, who you are, you get to the core of yourself. Then you are really alone. You are really alone when you are about to die. But you have people around you who can walk the path with you. They walk with you, but they cannot follow you into death. And then to have that kind of music that you have played for me on the kantele and that made me feel so calm. I know I will be ok. I know I will manage because I have music that helps me to feel calm. To me, it is a lot about finding this calmness in myself and the ability to let go. And I believe that when the day comes that I must die, the music will carry me on and help me to find my way into death”.
Wolfgang visits Lotte and her partner two weeks later at their home place, Lotte´s condition has deteriorated and she is unrousable. Her partner tells Wolfgang that Lotte had asked him to show Wolfgang the Zither.
Wolfgang and Tia have been exploring what the kantele can ‘do’ in hospice settings, the very instrument-specific ways in which it can be of help. One of those things involves the kantele’s deceptive simplicity – the fact that it can be played, and produce beautiful sounds, by virtually anyone, anyhow, anywhere: the instrument requires little strength and its strings, once tuned, simply respond. Perhaps for this reason, the kantele is sometimes called a ‘humble’ instrument and for this reason it is often taught in Finnish primary school. Indeed, once and a while, when Wolfgang is called in to a short conference with the medical team, he has entrusted the instrument to Tia who occasionally plucks it in a desultory way (Du spiller musikk, ja? someone passing by on the ward asked her last time – perhaps just being polite…).
So too, the techniques required for making the instrument sound, and produce different pitches and volumes, are clearly visible to an onlooker: the instrument is louder as you near the centre of a string (and the sounding hole), and quieter as you move away from it, and each pitch is produced from a separate string (different lengths – longer for lower pitches, shorter for higher pitches). Playing the kantele is done with the fingertips and produces a softer sound than would playing with a pick. There is (seemingly – but read on) no complicated fingering system or fretboard. So, compared, say, to a valveless trumpet where all is in the lips, and mostly hidden behind a mouthpiece, the internal muscles and the breath, the kantele is a ‘what you see is what you get’ (wysiwyg) instrument: its techniques of operation are not hidden or ‘black-boxed’ but can be seen and at least partially understood (and replicated) by a novice musician, by someone new to the instrument. In this sense, the kantele is an instrument that embodies some of the principles of participatorydesign.
In fact, the story is somewhat more complex…. One of the virtues of the kantele is its tremendous willingness to adapt. It can be played simply, by an untrained player (such as just described when Tia tried it out), and sound nice. Alternately, a more experienced player will know that there is more technique than meets the ear or eye. For example, as with other string instruments, to play each note in tune, Wolfgang is constantly adapting the power of plucking the strings, as a little bit too much or too little affects the tone pitch.
Despite these finer points of playing, the kantele’s apparent simplicity, the ease with which one can play it, means that when Wolfgang plays for and with someone at the hospice, there are few mysteries as to how the sound is produced. That clarity is perhaps especially important because patients in a hospice often face uncertainty – there are many things that are mysterious, and concerning. So, if they are able to see what Wolfgang is doing, they have good access to the processes by which the sounds are produced. And Wolfgang can be looking at them too, if that’s appropriate, without needing to distort his face to produce the sound. Because it is a string instrument, Wolfgang can also speak in between playing if appropriate – and how Wolfgang speaks with the people he visits is a huge part of his music-therapeutic craft (and a topic that we are continuing to explore).
In fact, it might be most accurate to say that Wolfgang and the kantele (‘she’) are both visiting with, ‘speaking with’, the person in the bed or armchair. The kantele has, in other words, a nice, open personality but is not an ego, she does not ‘insist’ on being heard or on being the centre of attention. These traits mean that, if a patient (in a bed) should wish to try playing the instrument for themselves, it is possible, it requires minimal effort and it is pleasing. Low-threshold… Which is not, of course, to say that the kantele will suit everyone – no one size instrument fits all; not everyone will care for music, or care for music at this time, here, now…
On this topic, Wolfgang, Tia, Gary and Fraser have written earlier, describing one patient, Mia, then in the last weeks of her life, who borrowed Wolfgang’s kantele over a weekend, wrote a song and performed that song for her visiting siblings (who made a video recording that they then allowed to be shared with the Care for Music Team).
In addition to that scholarly article, Wolfgang wrote a “very short short story” from the kantele’s perspective, about ‘her’ encounter with Mia. His work is part of our methodological strategy of using poetic and artistic media as a mode of ‘gentle methods’ of research enquiry. Here is an excerpt:
“She lifts me up and sails me through the air above her bed. Her fingers broken through the chemo caress my strings. Her soft, delicate fingertips find a melody. And I feel the vibrant joy in both our bodies…”
There are further and at present, more hypothetical, questions – what, if anything, might be the importance of kinaesthetic hearing + seeing? Watching, as the tense strings are plucked, listening to each tone reverberate, hearing each tone linger and eventually fade back into the silence of a hospital or hospice room… Does the instrument afford a particular set of metaphoric understandings? For example, of how pain might be managed, what pain might be like, how pain might also ‘fade’? A listener might make a connection between the notion of taut nerves or muscles, of those tense things being stretched and allowed to relax, to vibrate, resonate… And perhaps through that to ease, to be more quiet than before… Then there is the sight of that gentle activity – how the instrument is played… Again this might not be a link that all or even many might make, but it might be easier to make this link given the material properties of the kantele, than, for example, the trumpet (absolutely glorious as that instrument is).
On one of the days Tia visited with Wolfgang there was a strong wind blowing outside the hospital. From inside one patient’s room, they could hear the trees at the base of the mountain rustling and see them as they were blown back and forth. The hospital room, therefore, was not as quiet as it usually would have been. It was almost, Tia thought, as if the kantele had become an aeolian harp. Later, when she mentioned this to Wolfgang, she learned that he had taken careful notice of the natural sounds and was working with them, weaving the wind into his playing. As Tia sat in the corner of the room (we do not have permission to discuss the reactions of the person we were with at this time and so will not say anything about him/her), Tia felt completely at peace, attentive to the wind which the almost inaudible kantele served as a counterpoint. She reflected on how, if she were in that hospice bed, it might well be these kinds of sounds that she would most long to hear…
It might seem that we are romanticising the kantele – and perhaps we are. But we hope what we are also doing is enquiring into the manifold, micro-crafted features of how ‘she’ (the instrument) comes to be empowered to act – on each, specific and individual, occasion. So, for example, when Wolfgang introduces the kantele to a person for the first time, he plays some music to let the person hear ´her´ sound; from there, they decide themselves if they want to hear more – or not. (There are only a few do not wish to hear the kantele´s sound at all, and only a very few who do not want Wolfgang to continue after he first plays). Once decided, Wolfgang asks the person to find a comfortable position in their bed or armchair, close their eyes if they want, and then have not more to do. Wolfgang adds that he might adapt the improvised music to the person, relate to their breathing and overall condition. But not necessarily.
After a first improvisation (2-3 minutes), Wolfgang will pause, listen, and give space to the person to respond or remain silent. In this pause some people give feedback about the music and tell that it is comforting, calming, soothing, that they have less pain. Or that the music should be different: Calmer, more lively, softer, louder… Some people just ask for more kantele music. And some have their own ideas and tell Wolfgang how they wish to continue, for example, here, first Daniel and then, Anders:
Daniel: After the first improvisation where Daniel gets to know the sound of the kantele, he suggests that he might conduct Wolfgang´s playing. His wife and son are present in the hospice room. Daniel sits in his bed and initially moves his fingers, subsequently his hands and arms to tell a dramatic story with music. The kantele’s music follows Daniel´s gestures and movements: Single soft tones accumulate and increase, and lead to waves of energetic soundclusters and tremoli that gradually recede again. In this performance, Wolfgang plays the instrument as soft and as loud as he can. To match the dynamic sound qualities of Daniel´s sweeping arm movements, Wolfgang helds the instrument with its back towards his stomach, so that the instrument´s body and his body complement each other resulting in higher volume.
Michaela, Daniel´s nurse on that day, approaches Wolfgang after the session to say, that the atmosphere in the room was quite different after Daniel´s performance. She could sense emotional resolution and belonging, qualities that had not been there before. Wolfgang and Daniel get to see each other a second time at Daniel’s home. Together with Daniel´s son, they choose music for his funeral.
Anders: The third time Anders meets Wolfgang and the kantele he watches them attentively. He recalls his experiences with the kantele music from the week before and tells that he had seen himself as a little boy flying away with the music.
During the first improvisation on the kantele in this session, Anders dreams away and flies again with the music. During the second piece of improvised music, he sees himself above a beach, but is this time distracted by the kantele music. It is too energetic and rhythimcal. So, Wolfgang asks Anders to tell him more about the place (beach) where he wants to be and then adapts the music accordingly, finally plays music that is calmer and more open in it´s melodic structures.
“That wasn’t easy”, Anders says after the music. “I am going to die”.
Anders tells Wolfgang more about the vision he had while the kantele was playing. He was on a sailing boat off to the sea. His family had gathered at the beach, but not all of them were there. So, he turned into an eagle and flew back to them. He wanted to say goodbye to everyone.
Anders pauses for some time. Then asks for some more music and suggests: “Maybe it goes better with more rhythmical music?”
He closes his eyes and again turns into an eagle in his imagination while the music is on, flies back to his family at the beach to make sure that they are all together and ok.
“This is difficult. But I managed to say goodbye this time”.
Some thoughts later, from Wolfgang´s research log: “Anders shares his experiences and needs openly. He employs and accommodates the kantele music to fit with his ideas (a kind of ´flying carpet´, a vehicle for his last journey?). He imagines how it will be, what needs to be in place for him to be able to let go. And seems to prepare himself for ´how´ to do this. The kantele music shelters, contains and expresses his resources and his vulnerability.”
“…Now he climbs the fir-tree branches That he may enjoy and wonder, Climbs and listens to the music Of the harp of Wainamoinen.”
Over the past years, the instrument´s role in interdisciplinary care and pain management at the hospice has become more distinct and recognized. Here at the hospice, music and the administration of analgesics are combined as often as this is possible for practical reasons, acknowledging that a person´s pain experience is individual and complex, and needs to be met in its physical, emotional, social and spiritual dimensions. It is linked to a developing collaboration between physiotherapy and musictherapy and that is contributing to the holistic approach to care at the hospice. As Wolfgang’s medical colleagues see it, the kantele contributes to a balance between providing patients with a fundamental embodied experience of, on the one hand, activation (physiotherapy) and, on the other, rest (music therapy). That balance is often hard to achieve when someone is in immense pain or experiencing side effects of medication. As Sara, a specialized palliative care nurse, put it when speaking to Wolfgang:
“Du spiller på andre strenger” (“you play on different strings”).
Wolfgang, Fraser, Gary and Tia are delighted that our article on ‘late’ learning is now published in a Special Issue of Scuola Democratica, Edited by Anna Lisa Tota and Antonietta De Feo. Other articles in this rich SI address Disability and Arts Education, Prison Theatre, Epistemology, Educational Research Training, Teaching Sociology through social aesthetics, the School as a Temporary Exhibition Space, and two book reviews, one on A. Bayley’s Posthuman Pedagogies in Practice: Arts Based Approaches for Developing Participatory Futures (Palgrave MacMillan 2018)and one on Tia’s book on Hope in the same issue, the latter by Lia Luchetti.)
We were excited to be able to present three detailed, person-centered case studies (one from each of the three research sites – a care home and two hospices), to use some of our Care for Music drawings for the first time in an academic article, and to work with amazingly helpful editors and very helpful critical peer reviewers too. The process was wonderful and we look forward to future dialogue on the topic of who can learn, what is creativity, for whom, when and where, and with what consequences.
The list of references from the article is here:
Ansdell, G. and Pavlicevic, M. (2010), «Practicing ‘Gentle Empiricism’: The Nordoff Rob- bins Research Heritage», Music Therapy Perspectives, 28 (2), 131-9.
Antonovsky, A. (1987), Unraveling the Mystery of Health: How People Manage Stress and Stay Well, San Francisco, Jossey-Bass.
Becker, H.S. (1982), Art Worlds, Berkeley-Los Angeles-London, University of California Press.
Featherstone, K. and Northcote, A. (2020), Wandering the Wards: An Ethnography of Hospi- tal Care and its Consequences for People Living With Dementia. London, Routledge.
Freire, P. (1970), Pedagogy of the Oppressed, London, Continuum Press.
Delamont, S. and Atkinson, P. (2001), «Doctoring Uncertainty: Mastering Craft Knowledge», Social Studies of Science, 31 (1), 87-107.
DeNora, T. (2014), Making Sense of Reality: Culture and Perception in Everyday Life, London, Sage.
Groce, N. (1985), Everyone Here Spoke Sign Language, Cambridge, MA, Harvard Univer- sity Press.
Lave, J. and Wenger, E. (1991), Situated Learning: Legitimate Peripheral Participation, Cambridge, Cambridge University Press.
London, M. (2021), The Oxford Handbook of Lifelong Learning (2nd edition), New York, Oxford University Press.
Mehan, H. (1988), «Educational Handicaps as a Cultural Meaning System», Ethos, 16 (1), 73-91.
Tia DeNora, Wolfgang Schmid, Fraser Simpson and Gary Ansdell
Mukerji, C. (2009), Impossible Engineering: Technology and Territoriality in the Canal du Midi, Princeton, NJ, Princeton University Press.
Schmid, W. (2017), «Being Together – Exploring the Modulation of Affect in Improvisa- tional Music Therapy with a Man in a Persistent Vegetative State – A Qualitative Single Case Study», Health Psychology Report, 2 (5), 186-92.
Schmid, W. (2013), «A Penguin on the Moon: Self-Organisational Processes in Improvi- sational Music Therapy in Neurological Rehabilitation», Nordic Journal of Music Therapy, 23 (2), 152-72.
Suchman, L. (1987), Plans and Situated Actions: The Problem of Human-Machine Commu- nication, Cambridge, Cambridge University Press.
Tota, A.L. and Hagen, T. (2016), Routledge International Handbook of Memory Studies, London, Routledge.
Witkin, R. (1998), Adorno on Music, London, Routledge.
Wood, S. (2020), «Beyond Messians Birds: The Post-Verbal World of Dementia», BMJOpen Medical Humanities, 46, 73-83.
We’ve been meeting with our Project Consultant, Rachel Verney, on and off throughout the analysis stage of Care for Music. Rachel was trained by Paul Nordoff and Clive Robbins and has had vast experience working as a music therapist, and training many, now quite senior and well-known, music therapists. When we meet, we look at data together and test ideas, interpretations, hunches….
Rachel was Gary’s teacher and now she’s Tia’s teacher too. She has an uncanny eye – and ear. Today we looked, repeatedly, at video footage using the stop-and-discuss technique. We were interested in whether, without any prompting or background, Rachel might see and hear what we thought we’d noticed. Or whether she would not! (Which makes it a bit of an adventure, and therefore all-the-more interesting.)
Some people might call this cross-validation, which of course it is, but it is also much more. We have learned and are learning from Rachel how to develop our micro-observation skills, she offers fresh thinking of what might be happening and – equally vital – she has a congenital aversion to jargon which we have found more than once has stopped us in our tracks. Today we spent a lot of time ‘unpacking’ the term, ‘to musicalize care’. We decided it involved a number of different things – an attitude toward possibilities, practices that draw activities into music’s parameters, careful listening (including embodied listening, such as ‘listening with your fingers’) and careful response, and openness to being changed. We also got deep into micro-matters such as ‘was that a fermata or did it simply sound like a held-note because it was being sounded over an inverted chord?’. In the example we were listening to this isn’t just a ‘musicological’ matter as these micro-musical details potentially influence the responses and actions of the people in the scene we’re looking at (or not! This was the nub of our conversation). We also learned more about the benefits of, as Rachel puts it, ‘optimistic listening’, that is listening for the best possible outcomes so that we know, perhaps, how better to produce them musically-socially in real time practice. Thank You Rachel.
The Care for Music Team is very pleased to announce that Care for Music Investigator, Gary Ansdell and his research partner at Nordoff Robbins, Professor Mercedes Pavlicevic have received the European Music Therapy Confederation Award for 2022. The Conference meets every three years.
We are very happy to be able to include Gary’s message of thanks to the conference here:
“My heartfelt thanks to the European Music Therapy Confederation for this honour. Also on behalf of the late Mercedes Pavlicevic and her family, who will be thrilled to hear this news. As most of you know Mercedes died in 2018 – it’s just past the 4th anniversary of her death. We still miss Mercedes the person of course, but her legacy is clear now, and was well celebrated at the World Congress in 2020 in South Africa. Two key qualities came out of us thinking about Mercedes’ professional work: courage and imagination. She was certainly a disrupter of professional holy cows… but she did this with lightness, intelligence, and kindness.
It’s really special that this award is presented here, as Mercedes had important connections with Edinburgh. But of course she also influenced music therapists and other musicians worldwide – in Africa, the Middle East, Europe. She was a real international.
I had the pleasure and privilege of working with Mercedes over more than 20 years. Mercedes as ‘disturber’ had a low tolerance of lazy ideas, practices, and people! A lot of our work together was in the early days of developing the Community Music Therapy as an idea and international movement. I sometimes describe Community Music Therapy as a can-opener rather than a can. Our aim was to open up music therapy again – to help music therapists work best in their local, cultural contexts. Getting beyond ‘one size fits all’ models and practices.
Those qualities that were key to Mercedes and her work – courage and imagination – are also key to Community Music Therapy and its shoogle. I’ll finish with the slogan that we often used: Follow where music and people lead… That usually works!”
Congratulations to Gary and Mercedes, whom we miss dearly. You have inspired us in all we do.
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.
Gary: We’ve both collected so much data from our practical work now, and it’s time for us to start doing something with it. Where I am now is at the stage of reviewing and sorting from my practice in Hill House. How to make sense of it. What to select? Why? How?
Like many aspects of this project, this new stage has seemed more like an artistic idea shaping-up, rather than following a pre-planned sequence of going from ‘data collection’ to ‘data analysis’, and then to ‘findings’. It’s been very much less neat than that! Rather we’ve tried to let the material tell us itself what it needs doing to it (I know that sounds unscientific, but that’s honestly the way it’s felt).
I also realise that finding ways of working with the data have been inspired by chance aspects of my everyday life (again like an artistic process). For example, I was clearing out a cupboard and came across an old leather-bound photograph album of my grandfather’s. In the 1920s he was a professional pilot in the British Royal Air Force, stationed in various places in the Middle East. The album records sights, incidents, people and objects from this time and place. One particular page struck me:
The top row has two photos of a river in Iraq, whilst in the bottom row my grandfather stands next to a bi-plane; then there’s another picture of planes behind sand-bags, and finally a pelican. I asked myself why my grandfather had arranged these pictures in this way on this page. You could think of several answers: rivers and planes are two ways of travelling; planes and pelicans both have wings, and so on. Our minds naturally start comparing, contrasting, and making patterns and explanations out of a variety of ‘things’. If I read the captions below the pelican photo I get a further layer of meaning: “Our mascot”. But of course the mascot has been chosen because of its resemblance to those early flying machines. Patterns emerge as layers of meaning build up and coincide.
I looked up the etymology for ‘album’ and found that it’s Latin for “white”…. So an album is a ‘white space’ for arranging things. I’d never realised that the Beatles’ White Album was perhaps a joke?
I started making my own ‘research albums’ before I came across this family album, but it made me think further about the process and uses of making albums. I was looking for a way of bringing together bits of written text (my research logs of reflective report on sessions and events, and poems about the work), along with video and audio recordings, still photos, and other ephemera that I’d collected. It struck me that the ubiquitous Powerpoint programme is ideal for this. So that’s what I did. Not only for individual cases, but also for some emerging analytic ‘facets’ we were experimenting with. For example, we’ve made the thought experiment of considering everyone in the care home site as a performing musician. To try out this idea I searched through the data for all the examples of care home residents performing within these musician categories: Players, Singers, Dancers, Listeners, Conductors…. and then compiled Powerpoint albums of examples of these categories using text, photos, audio-video clips, poems….
The example in the photo above is the ‘title slide’ of the album of a woman we’ll call Violet. Her album assembles the key material from our music therapy sessions, and through its arrangement shows how her care for music linked with her care for other things and people in her life (china figurines she’d collected with her mother, her cat, plants) – but also musical favourites like the John Wilson orchestra and the singer Jonas Kaufmann.
Making these albums has been a fascinating and moving process of identifying, collecting, arranging, and editing material. I’ve realised just how much every act of selection and arrangement is itself an act of interpretation and proto-analysis. I’ve noticed how this seemingly practical task has simultaneously involved a further layer of the research analytic process: exploring the diachronic narrative of a single case across varying media; juxtaposing and comparing aspects of sameness and difference within a set of similar examples; testing an analytic facet we are experimenting with; thinking-through what variation of aspect means in relation to an element manifested across the data. What, for example, does it mean to find so many residents conducting music when (for most of them) this had been something they’d never done in their lives before? Is there a commonality beneath their different styles of conducting? In this way the gathering and arranging also became simultaneously an analytic process of exploring and reflecting on the richness of data….
I think, Wolfgang, you’ve found yourself doing something quite similar in relation to your own data?
Wolfgang: Yes, I’ve experimented with mosaics, or what I call for ´mosaics in motion´ at the moment, as I use pictures that I take from all sorts of data to flexibly arrange and re-arrange them together with the participants of our project. Initially, this part of the project-work was driven by the question of how I could keep and store data from dying people who will most likely not be with us anymore when we present the research. This is not only a question and concern in the Care for Music Project, but a practical and ethical issue of ´user involvement in research´ that’s discussed in the wider palliative care field. So, I felt a need to experiment with approaches to data collection and arrangement that keep those people this ethnography is about still ´with us´ as participants and researchers and suggests a place for them beyond data collection. I also realize in this project (not the first time, but probably more explicitly) that data collection is a process that is also about me. I am a practitioner-researcher in the project who stores and arranges data material that I am often part of myself. Building a mosaic also documents the selection process of what data I choose to include and when I do this. This work might be initiated and led by me, but is potentially co-constituted by patients, their families, friends, and health care workers. The data does not suddenly ´pop up´ or appear ´at once´ from somewhere out there, but rather accumulates over time – even finds me, as I and the participants engage with each other.Not least, I found that building a mosaic can be a reason for me to contact bereaved relatives of a person who has died, and to look at the mosaic together, re-arrange it, and in this way engage in a process of participatory sense-making. (Which leads to the question of who or what determines when data collection and analysis is completed?).
To give an example for my experiment with ´mosaics in motion´ we can look at Mia´s mosaic, which her parents and I are building together at the moment. Picture 1 shows my first sketch of Mia´s mosaic that I drew on paper on a Friday afternoon as an attempt to get an overview over the various data material I had gathered so far.
Drawing Mia´s mosaic on paper however seemed to be far too static. So, I further developed the mosaic-idea, and eventually took photos of the data, which included people (mostly of their hands to protect their identity), a CD cover, a book, and a newspaper that they talked about or gave me as a gift. I took pictures of a plant in their garden, or their pet or instrument at a home visit. I photographed a page of a person´s favorite sheet music, a song text, an image or signature of an artist. I also took pictures of excerpts from an interview-transcript with a participant, notations of their music, an extract of my research log, a still from a video-recording from a music therapy session. I took pictures of people´s living rooms, the hospice room, a church or concert hall where they had listened to music.
I then printed out these photos and spread them out on my kitchen table to view them. Eventually, I cut out a part of each of the pictures, that for me illustrated a particularity of this piece of data (the head of a pet, a snippet of a piece of sheet music, the keyboard of an instrument), and that could become part of a collage for each of the participants (see pic 2).
In this way, I manufactured the first pieces of a jigsaw. From there, the ´mosaic in motion´ idea evolved, meaning that the composition of the pieces of each mosaic, their specific arrangement and re-arrangement could happen in collaborative, co-creative, participatory processes with the project´s participants (sometimes the patients, but more often their relatives and health care workers). Mia´s mosaic is still under construction and being built by me and her parents. Their involvement does not necessarily stop or become less after she had died. Instead, the involvement of the wider group of participants can continue and prolong into data arrangement and analysis.
While talking about this Gary and hearing about you grandfather, it comes to my mind, that I took a lot of pictures in my parent´s house in southern Germany early this year. Photos that I found there in little frames on the walls or on a bookshelf, or in the many photo albums that my parents had made over the years. As you know, my father died unexpectedly at the hospital in February 2021 during the pandemic. No one of us was present and could be with him due to visiting restrictions. Actually, we got hardly information about what was going on and how my father was doing. At least, I could travel from Norway to Germany and be with my mother and my brothers for the funeral. The special circumstances and restrictions that we had to adapt to gave me the feeling of being distant to all that happened to me and my family. So, before I had to return to Norway, I took pictures from some of the pictures in my parent´s house and the photos in the albums. I was not sure when I could be there again, see my mother and brothers, visit my father´s gravesite. I just took a lot of pictures that I then printed out in Bergen when I was back. They are memoires and representations yes, but most of all served my need to keep things together, to stay in touch with them, and to create some kind of continuation and commonality with my family and the places and summer holidays and Christmas Eves we had together. I think that experience influenced the development of the ‘mosaics in motion’…
Gary: What’s interesting in both of our ‘gentle methods’ is the light is shines on the overlapping layers of the qualitative analysis process – which I think is often obscured by thinking of discrete research stages; the idea that there is a kind of abstract ‘processing’ of data that happens before ‘analysis proper’, which in turn happens before the interpretation of findings.
Secondly, what’s interesting is how much our approach relies on an imaginative process – quite literally working with images – and allowing these images (that may include ‘sound images’ and ‘poetic images’ as well) to speak directly to us, to show us something of the underlying pattern that leads them to connect-up at a higher level, and to show us something more fundamental about the overall phenomenon that we’re researching – the mutual ‘care for music’ that people variously and mutually enact in these settings.
Of course there’s a long tradition in ethnography and other qualitative research approaches of designing and working with ‘facets’ of the core phenomenon through a variety of methods (Mason 2011). In particular I’ve become interested to explore one of the ‘ancestors’ of qualitative research – Goethe’s scientific methodology, which he called ‘gentle empiricism’ and which best illustrates this ‘living’ continuity of working with data material and analytic ideas at the same time (Seamon & Zajonc 1998). There’s a growing literature that shows what a hidden influence Goethe’s perspective has had on philosophers and sociologists in the 20th century (Dodd 2008; Vine 2015), and I’ve been pleased to find a recently-completed doctoral study by a community musician and scholar, Ruby Swift (2020), who uses ‘gentle empiricism’ to guide her study of music with couples at home living with dementia. This also does many of the things we’re describing here, both in terms of treatment of material, and the continuity between data gathering and analysis.
I’m wondering whether the way that we’ve both approached this task has something to do with our own former experiences of ‘delicate empiricism’ in action – those formative experiences we both had in clinical and research epistemology when in the 1990s we both worked as music therapists at the Gemeinschaftskrankenhaus in Herdecke, Germany. There we experienced the Goethean-based method in action when we sat in medical case conferences or talked about research with colleagues. I realise how much I learned from their Goethean phenomenological method of first collecting together examples of the therapeutic work of a patient – their musicking, their art, dancing, sculpture – and then arranging and exploring this diverse material in such a way that it speaks of a larger meaning in relation to their personal style of illness and health. What do you think?
Wolfgang: Yes, I think the time in Herdecke was really defining for me as well, and in particular for the development of a culture of person-centeredness. Just thinking about the time we could spent every week for the interdisciplinary meetings you mention with the idea that every colleague could hear and see what was ´there´, in the music or painting or sculpture of a patient. And always with a focus on the process of formation, on how a person plays, moves, paints. Actually it was also a care for finding words to describe and capture as many details as possible in a dialogue with each other. And with a focus on a person’s resources and how these could become part of their health promotion and coping processes.So, the mosaics probably refer back to this Herdecke-style, collecting and showing parts of a person´s life, so that we than can further engage with within therapy.
I realize that with the mosaics I also experiment with my transition from a music therapy practitioner working in palliative care since 2014, to a practitioner-researcher and ethnographer in the Care for Music project. In this transition process I feel that engaging with mosaics and the process of building them serves several purposes: Firstly, as mentioned earlier, it helps me to gain and keep an overview of the data material that I am myself part of. It confirms how data collection is a process over time and not separate from the events or materials it shows. As a practitioner-researcher I feel I do research from inside the practice. When I meet people, talk and make music together with them I also generate, discover, document and collect research data. To me, the mosaics are a way of ´visual memoing’, as Butler-Kilber (2018) suggested it, that allow me to present and organize data in a kind of visualized case studies, and at the same time show how they are built and change over time.
Secondly, building mosaics is a dialogical and co-creative process, that invites the variety of people involved in a case to engage with each other and with the material. ´Mosaics in motion´ have a low threshold to join in, and a strong performative element that is with people not about them. Like in music therapy improvisation, building mosaics invites people to play around, experiment and try out things. In other words, the qualities and features of the artistic processes generating the material in a music therapy session also informs the arrangement and analysis through the mosaics. The mosaic pieces can easily be moved around by all participants, but probably more important and interesting from a methodological stance, the participants themselves can also physically move them around, and are themselves moved emotionally while engaging with the material and each other. This opens up a discovery of several perspectives on the material, how to re-see and re-model it, providing multiple potential insights. I would say that this haptic, playful, potentially open-ended re-search process invites all people to a participatory sense-making process. It can help bereaved people to find words for what they see and hear in a ´mosaic in motion´, something that might otherwise still be difficult for some to express or talk about.
Back to the ongoing work with Mia´s mosaic. I showed first ideas of her mosaic to her parents when we met at my office, the pieces in front of us on a table. The three of us stood there and looked at them. Eventually Mia´s mother took some pictures of the mosaic with her mobile phone. While looking at the mosaic, we got up from our chairs and moved around the table and changed places from where we look at the mosaic. Mia´s parents started a conversation about single pieces and the stories related to them. They linked some of the pieces together with their own stories and added new information to the existing one. In this building process, more pieces were gradually added to the mosaic. However, this did not just increase the amount of data material, but also initiated dialogue about why and how some of the pieces might belong to each other, revealing the stories ´between them´. While there in my office, the three of us started to re-arrange the pieces, moved them around and grouped them, brought some closer to each other, and some other ones more to the periphery. To me it seemed that we engaged in a process of meaningful arrangement of Mia´s mosaic. This shows a step from data arrangement to analysis with some first assumptions and hypotheses of what and how we made sense of the data (see pic 3).
This collaborative arrangement of data together with Mia´s parents is an example for what Laura Ellingson (2017) calls a ´becoming analysis´ where, from an embodiment perspective, the sensorial, relational and doing of analysis is in the foreground. Mia´s parents and I moved the pieces around, and we also moved ourselves around my office table while doing this. We touched pieces of the mosaic, took some of them up and moved them to explore and show each other meaningful arrangements that sometimes provided us with new insight. We commented, laughed, confirmed, and complemented each other in this ´becoming analysis´ – what I would call a participatory-sense making process. While doing so, Mia´s father told that his daughter had never thought to get to play herself on a Kantele in one of the music therapy sessions at the hospice. Her fingers were damaged by the side effects of the chemotherapy and she was afraid to use them, but had found ways to pluck the strings of the Kantele with the forefinger and thumb of her right hand, and to perform a piece of self-made music. Three weeks before she passed away, Mia became a composer, performer and entertainer, presenting herself with ´multiple bodies´ as Di Paolo, Cuffari and DeJaegher (2018) suggest, yet unfinished and ready to expand and grow, rather than solely the one of a terminal ill patient that needed hospice care.
Gary: I was talking to the music therapist and researcher Cochavit Elefant about this work on albums and she made an interesting comment that as method it sounds like an extension of the Participatory Action Research that she’d worked with in an earlier project. But for us the participatory aspect is also taken explicitly into the analytic stage where we find ways of continuing to participate in the original material and phenomena – not letting this be replaced only by abstract representations that are then analytically ‘processed’. Cochavit’s thought seems true to me. It again links to the Goethean ‘gentle empiricism’ – not ‘letting-go’ of our participation until this is really necessary and prepared – at which point there is indeed often a ‘conceptual leap’ to the level of idea and insight.
Wolfgang: There is one more aspect that the ´mosaics in motion´ provide for me in the transition from a practitioner to practitioner-researcher, in particular with respect to data analysis. Mosaics serve as a kind of ´visual hermeneutics´, meaning that they invite to a back-and-forth movement not within a written text but within visual material, between details and the whole of a mosaic – as a way of conducting analysis and gaining more understanding of the material. A mosaic presents an overview of a person´s music throughout her life, albeit never a complete one. At the same time, it offers possibilities for zooming into a piece to explore what constitutes it. It’s like in Tia’s earlier ´drawing-in´ blog in which she shows how she does this with drawings of details, a hand, a movement, a sight on a nano-level.
Gary: I increasingly find that there’s a rich heritage behind working and thinking in this way; that there’s value in approaching the understanding of a phenomenon in a less linear way; not trying to achieve a full picture, but allowing us to work from fragments, and from various angles in the gradual ‘collating’ of an idea or understanding. Wittgenstein for example wrote of his Philosophical Investigations:
“The philosophical remarks in this book are, as it were, a number of sketches of landscapes which were made in the course of long and meandering journeys […] The same or almost the same points were always being approached from different directions, and new sketches made. So this book is really just an album.”[§3e]
It seems we’re in good company in this project of edging towards understanding through a mode of data presentation that is not abstract and transparent, but rather what Walter Benjamin called a ‘constellation’ of material, from which what matters and what is significant can shine out.
Wolfgang: Well, to me this work appeals to my own creative engagement and curiosity as researcher. I think these features that are core to my therapeutic work can now become more visible and comprehensive in the research as well. Moreover, I see that the mosaic experiment brings a freshness to data collection and analysis that enables the involvement and participation of vulnerable people in a way that I have not expected beforehand. I did not plan this, but rather followed my wish and concern to stay in touch with the people and the vitality and presence of the original material; to discover and understand and to avoid to let go of ‘the phenomenon’ during the process of analysis.
Of course, our experiments with albums and mosaics are in their beginnings, and I think this kind of ´visual inquiry´ does not aim to present a ´truth´, but rather shows ideas of how our data material could be understood and make sense.
When I shared details from the mosaic with Mia´s parents her father commented with the words: “I am still grieving. But I start to feel gratitude for all Mia has given to us. And looking at this mosaic, her music, talking about it, hearing how you describe it, makes me grateful”.
Di Paolo, E.A., Cuffari, E.C., and DeJaegher, H. (2018). Linguistic Bodies – The Continuity between Life and Language. London, Cambridge (US): MIT-Press
Dodd, Nigel (2008). ‘Goethe in Palermo: Urphänomen and Analogical Reasoning in Simmel and Benjamin.’ Journal of Classical Sociology 2008; 8; 411 DOI: 10.1177/1468795X08095206
Ellingson, L. (2017). Embodiment in Qualitative Research. Routledge
Seamon, David & Arthur Zajonc (1998). Goethe’s Way of Science. NY: State University of New York.
Swift, Ruby (2020) Flourishing through Music: Understanding, Promoting and Supporting Shared Musical Activity within the Caring Relationships of People with Dementia Living at Home. PhD thesis, University of Worcester.
Vine, Troy (2015). The philosophical legacy of Goethe’s morphology. inIsis – The Field Centre Research Journal Vol.2 No.2 – 2015
Ludwig Wittgenstein, Philosophical Investigations, trans. G. E. M. Anscombe, P. M. S. Hacker and J. Schulte, revised 4th ed. (Oxford: Blackwell, 2009), p. 3e
“A rainy, dark day… in every sense! We’ve just heard of a new lockdown throughout most of the UK starting on the 26th of December, with a new variant of C19 [delta] rapidly spreading. Happy Christmas!! And, of course, the residents of Hill House won’t be able to see their families over Christmas… everything just feels very dark at the moment. But today we nevertheless… despite… (all those characteristic Covid times words)… manage to have some comfort and joy in the session. As ever, I’m surprised, heartened, thankful that this is possible…” – Gary’s logbook, December 23, 2020.
Special occasions are still important to people at Hill House, ‘despite’ the pandemic, ‘despite’ adversity and the various challenges faced there by all. And everybody pitches in to make a convivial feeling.
Staff enact the carols in pantomime mode, with energy that is contagious. The manager dances in to the room to The Holly and the Ivy, then snaps a photo with her phone.
One resident has a sheaf of carol lyrics in her hand (this causes confusion later as she can’t find the carols Gary’s playing) so in the middle of Silent Night she snaps, “we’ve got different words here” and looks up at the TV screen in something of a huff.
Meanwhile, and as with any group of people, Christmas is not everyone’s cup of tea, even if the complaints are received as if they are in the spirit of British Christmas Panto heckling (“Look behind you,” “Boo!” and “Oh no it’s not”):
Gary: Shall we do this one now?
Roderick: [sotto voce, off stage] If you must!
Gary: That’s a nice song isn’t it?
Roderick: It’s dreadful!
Gary: What shall we do now?”
Roderick: Go to bed!
The occasion of Christmas is however one that most of the members of Hill House recognise and ‘celebrate’ – if not necessarily as a religious occasion. And Christmas at Hill House does not only have to happen in the month of December. For one thing, there is a lot of cultural diversity in the living room of this care home with staff from all over the world (and a multiplicity of religions) and residents with diverse religious and spiritual orientations. For another thing, many of the residents cannot always say when pressed what season they are in, or perhaps it might be more accurate to say that ‘the seasons’ for them are now more flexible and floating occasions:
“At the end of the session as usual we sing Auld lang Syne as a goodbye song. Jane quickly follows this up with Merry Christmas [it’s May!!] – at which point several of the carer staff dissolve in laughter. Jane quickly moves on to calling for a vote of thanks for me, reverting to her ‘hostess’ role again (a sign of her recovery!).” – Gary’s practitioner log, May 2020.
However, simply having things to celebrate is the key thing, and the occasion of Christmas – along with the pictures all festooned with tinsel, and the special things to eat – is an opportunity for festivity, for being together, sharing and enjoying seasonal treats. And in real time, perhaps especially in this situation where language and remembering pose challenges to some, music can support a sense of occasion. It can lend shape to what people do in the name of special occasions.
For example, Gary offers is a very hammed up climax to Mary’s Boy Child, increasingly swinging the rhythm in response to the amount of dancing taking place. Gary’s practitioner log also tells us that he used the famous rhythm in the carol, Drummer Boy (‘Pa rum pum pum pum’) as a ‘hook’ to collect together residents and staff. When we watch the video of this carol, it is clear that music gets latched on to, developed and varied by individuals who, through that process, further distribute the rhythm across the room. And that invites others to join in, in ways that further elaborate the festive scene.
And sure enough (a) care team member Dan sits with May, taps the song’s rhythm on May’s knee and later gives her a hug (b) Tina, a member of the care team, claps the rhythm and bounces on her knees (c) Sandra one of Hill House’s keenest resident dancers, watches the TV screen carefully, clapping in rhythm (d) Joan, who is slightly slumped in an armchair begins to conduct with her right hand (e) Mavis, a care team member, dances across the room close to the camera (f) Brydie gently explores her chair arm and then begins, eventually, to focus on the TV. And (g) even Roderick (“if you must”) taps the rhythm on the arm of his chair with verve. Then Tina and resident Sandra begin to dance.
Seasons’ greetings from us to everyone at Hill House at this challenging time.