Featherstone, K. and A. Northcote. Wandering the Wards: An Ethnography of Hospital Care and its Consequences for People Living With Dementia. London: Routledge. 2020. Xxii + 165pp. £77.38 (cloth) free (ebk) ISBN 978-1-350-07845-1 (cloth) ISBN 978-1-003-08733-5 (ebk)
We recently read this wonderful book. Our review of it will appear soon in Sociology of Health and Illness. It touched on many things, among them (for us) three important, interrelated topics. First, self-preservation: How, within institutions such as care homes and hospitals, do individuals engage in make-do, impromptu and improvised strategies as part of the routine care of self? Second, communication and cognition manifest themselves in multiple formats, extending beyond linguistic matters and yet these skills may not be ‘seen’. Third, there may be vicious circles set in motion when people’s ‘logics’ of practice are rendered invisible.
So maybe walking (‘wandering’) is as an adaptive behaviour, a response to the perceived sense of restriction and loss of control experienced in unfamiliar or unsettling circumstances? Maybe exercising – literally – freedom (of movement) is a means for restoring a sense of embodied agency and empowerment? If so, then maybe it’s not surprising that people living with dementia often feel a powerful need to move?
Perhaps the philosophy of embodied cognition can help us to explore these questions and their connection to our main concerns in Care for Music. The philosopher, and our colleague, Giovanna Colombetti describes how:
“Cognition as sense making does not require a central executive system that represents facts about the world, reasons about them, and generates rules for action. Cognition from an enacted perspective is, rather, the capacity to enact, to bring forth a world of sense, namely an Umwelt that has a special significance for the organism enacting it” (2014: 18).
As with walking, so too music? Which leads us the theme we’re currently exploring. How do, and why is it that, some people living with dementia seem to love to conduct the music therapist’s music making? Using whatever might be available as a ‘baton’ – a hand, a drum stick, a walking stick, a spoon. This conducting seems to be, and all at once, a virtual form of movement, a kind of dancing or rhythmic gesture, physical exercise, a kind of musical composing (choosing what, sound-wise is going to happen next and how – the creative shaping of a musical future in dialogue and collaboration with someone else), a chance to connect in split second time, an opportunity to exercise creative control, a form of pleasure. All adding up to, of course, the care for music.
Colombetti, G. 2014 The Feeling Body. Cambridge, MA: MIT Press.
Keep smiling, keep shining Knowing you can always count on me for sure That’s what friends are for.
In good times, in bad times I’ll be on your side for evermore That’s what friends are for.
Burt Bacharach & Carole Bayer Sager
Every Wednesday evening for three years, around 70-80 people packed themselves into Mountbatten Hospice on the Isle of Wight for a couple of hours. A café and social, day and rehabilitation centre, open seven days a week to the public as well as patients and families sits at the heart of our hospice building and it is into this space that our choir comes together. Staff, patients, relatives – including bereaved people, volunteers as well as members of the wider island community – would all join forces and sing. Some were quite experienced singers whilst others were trying out their voices more or less for the first time. All were welcome.
As the leader of this group, I’ve always been interested in what it is that they come for. We know, of course, that singing is a particularly health-giving activity – ‘body mind and soul’ in the deepest sense: it’s great exercise, it fires the brain, and it gets us in touch with our feeling life, from which we are so often disconnected.
We know that it’s more than this, too. Singing is a social activity and creates community. Many friendships have been forged through the choir. When people sing together, they flourish together. A couple of years ago, Ana Ambrose, who was then a Clinical Psychology doctoral student at the University of Southampton did a study in which she interviewed choir members. Her research highlighted five key types of benefit that members associated with the choir: the sense of being connected, improved physical health, improved mental and emotional wellbeing, a sense of purpose, and a changed perception of the hospice.
Within our Isle of Wight community, the hospice is a focal point. We look after around 2000 people on any one day across our communities and the hospice building provides spaces for inpatient beds, day, self-help and rehabilitation services to support this work. Widely loved and supported, it looks after those affected by death, dying and bereavement, as well as running an innovative programme to change attitudes towards the work that we do. When the choir began in 2017, it quickly found a place at the centre of the hospice community, through a focus on singing songs of hope, uplift, consolation, joy, and mutual support. Bacharach’s classic, That’s what friends are for (originally recorded by Dionne Warwick and friends) is now a kind of choir anthem.
When the country went into lockdown in March 2020, all of this came to a halt. The media began to warn us against singing. In an instant, singing was transformed from being a life-giving practice into a potentially dangerous medium of Covid transmission. For us, and seemingly for the world, singing’s sudden ‘fall from grace’ felt like a peculiarly powerful symbol of the shredding of communities. And then we turned to Zoom…
The key question was –could we sing together online?
The answer came in stages – yes…no…YES!
The choir’s first online meeting in late March was experimental. There were 43 of us – a impressive number given that many members were using Zoom for the first time. People had all kinds of teething problems with cameras, mics and the rest of it. We found out quickly (and hilariously) that there were two big problems. One was the time lag between sounds being made and received by others – the infamous ‘latency’ problem which makes it impossible to sing in time together – and the other was the tendency for the audio to overload with so many channels, all but the loudest sounds cutting out. The upshot was that within seconds of starting a song those at the front would be several bars ahead of the stragglers at the back and the rest somewhere in between. We laughed, but we couldn’t resolve it.
And so, like many other choirs gathering online, we reached for the only realistic solution. Everyone is muted, they hear me and sing along, but they are unable to hear each other (though we can all see each other of course – and the ‘sight of sound’ as Richard Leppert (1995) once called it, has become ever more important). It doesn’t ‘work’ – in the way we might normally think of community singing ‘working’ but something happens that’s satisfying enough to keep a strong core of about 30 people returning each week – and we’ve kept it going for nine months now.
All this activity attracted the interest of the local island media. The Press regularly reports on hospice activities, and within a few days of our first meeting (I think of them as ‘meetings’ rather than rehearsals or practices because it’s difficult to rehearse a choir when you can’t hear it) there was a news piece. The choir members’ comments featured in that story illustrate some of the initial excitement of the experience which was felt very genuinely by many:
“It was very novel to see more than one person at a time, and with me living on my own and also working from home, it gave me immense pleasure seeing you all again!”
“The online meeting is as social as the actual one. Great fun as people get to understand the technology.”
“I found it really moving, and it’s just so lovely to connect with others at the moment – probably even more so for people on their own.”
“I so enjoyed seeing you and other choir friends again. Feel we all lifted one another’s spirits.”
Choir member Sue has described how she joined the choir after the death of her husband who was looked after by the Mountbatten team:
“It is a wonderful thing to be able to look forward to each week. To know that there is no pressure and that I will be with people who have been through or experienced similar situations to myself, with who there is an immediate bond. I have made many friends, which has been invaluable in building my new way of life alone.
Continuing to sing online through ‘Zoom’ has been an exciting new challenge and I am so pleased that I have been able to achieve this, using new skills acquired and being able to continue to enjoy singing at this particularly difficult time of lockdown and the feeling of isolation.”
The online format of the sessions has also enabled us to invite members of the community choir of our sister hospice over in Southampton, Mountbatten Hampshire, to join us, since they also had suspended their regular weekly sessions in the pandemic. This has proved an unexpected pleasure, with several members of the Southampton choir zooming with us each week.
Why does it still work, nine months later?
Although as a community choir we come together to sing and this has always been the central focus, the online sessions have revealed ever-more clearly that the social aspects of this singing are just as important. In the online format, the ‘bits in between’ when I invite choir members to say a brief word about how they are doing (which happens more informally around the edges when we are singing together in the hospice) have become an integral part of the evening, and indeed, maybe the zoom format makes this interchange easier to do. At the same time, we hold in mind those who are not with us, either because they cannot manage the technicalities of Zoom or because they do not find the format a satisfying enough musical experience (and it is important to acknowledge that it does not work for everybody).
Another choir member Alison wrote to me just before Christmas:
“Thank you so much for sustaining our choir throughout lockdown and beyond. It has been such a joy and tonic to positive well-being to sing together on Wednesday evenings and in a strange way I have felt I’ve got to know choir members even better even though we’ve been apart and how lovely to share singing with our Southampton friends.”
What a lovely realisation: that the Zoom choir is not merely a watered-down version of the ‘real thing’, but brings its own unique enrichment.
How long can we keep this going? At the time of writing the vaccine programme is well underway, but a new lockdown has just been imposed by the UK government. There’s new hope with the roll out of vaccines, but we’re still in the thick of it and like everyone, we’re taking every day at a time. But each week when I see the faces of my friends “keep smiling, keep shining” as they sing across our screens, I know our songs will keep our hope, friendship and love alive and well. What are friends for? What is music for?
Leppert, Richard. (1995) The Sight of Sound: Music, Representation and the History of the Body. Berkeley, Los Angeles and London: University of California Press.
“- Say it, no ideas, but in things…” – William Carlos Williams, Paterson
Imaginative engagement of what might, through other methods of investigation, be documented… That is our aim…. Working on a longitudinal (10 year), ethnographic study of community music and mental health some years back, we took inspiration from the work and writings of the American doctor-poet, William Carlos Williams. Williams described how, as a doctor on the daily house-call round, he sought to comprehend the situations of his patients and, “com[e] up with my medical pictures in my mind, like those artists do with their head and heart using the easel, and like photographers do in the same way with their cameras. …trying to figure things out, get the right picture, as do artists, painting or photographing, trying to get their kind of ‘right picture’.” We used this quote as the epigraph to the one of the books associated with our project.
For Williams (as for Goethe, father of ‘delicate empiricism’), the ‘science’ of doctoring was by no means separate from the ‘art’ of writing a poem. What’s in, or out, of a frame, what kind of frame (and therefore claim) makes (or ‘figures out’) experience. (NB the word poet comes from the Greek poiein, or ‘to make’.) For us, this making contributes to the more general project of making sense of things in the research field, albeit for slightly different reasons and we’ve listed those reasons here:
Tia’s poems deal with non-fictional material – the imagined problems, and solutions (?), associated with living ‘in a care facility’. Her poems typically begin with real-life (field) events but then shift into the realm of fiction. Here, after encountering a situation in real life, she tries to imagine a further situation involving a devoted couple who are physically separate due to the exigencies of their conditions and care needs. The poem was concerned with what are sometimes described as ‘coping strategies’:
We are two of the mountains
There’s a valley between our two, twin
beds. We’re far apart up here,
camping past the foothills.
Our tents are staked.
I wave to you. You signal back
with a mirror. Sunlight plays on the eastern wall.
Gary’s poems, by contrast, recall things that happened, sometimes verbatim, and his reactions, in the scenes of care where he works. They come, as he once said, ‘tumbling’ out, composed on his phone after a work session in care facility:
Today there’s only
the rough sound of your
laboured breath left.
A promise of song at the beginning of life,
your lungs work now only to complete
these final beats
of the body’s time.
Keeping vigil in this room
are the icons of your life:
an oil painting of the famous young composer,
a print of two stylised Japanese carp,
two bronze Buddhas –
staying with you as you did them.
On the bookshelf the record
of your scholar’s devotion;
close probings of music and spirit.
But now these images and voices recede,
Leaving your own life’s melody
longing to cadence.
As a research team, we then use these poems to pursue more explicit, ‘research’ questions – for example we use them in interviews with each other to tease out what might be our otherwise-tacit assumptions about people, situation, and place (e.g., ‘what made you think that couple actually wanted to be physically closer?’ or ‘how did you come to think that that person was longing for “cadence”?’). We think poems work well for this purpose because of the way they draw attention to details, often one ‘grain’ at a time. Seeing the world in these grains (and regardless of whether a poem is ‘good’), lingering because this literary format allows for, requires, lingering, permits metonymy, letting the ‘grains’ stand in for wider patterns and matters in the ‘field’ – and letting us test the robustness of these metonymic relationships. So, the poem becomes a lens or way of refracting and magnifying scene, place, history and relationship. And it runs in contrast to our field notes.
In other words, writing a poem is a methodological strategy not a form of ‘outreach’. We are not using poems to communicate our research findings to others, nor to encourage public engagement with our findings. Rather, poetry offers us a springboard for further questioning – questioning the poem in terms of the ‘history’ of how it took shape and questioning whether and how the poetic ‘angle’ does or doesn’t square with what audio-recordings, photos, videos, field notes, or interview transcripts might reveal. This valuing of multiple modes of representation resonates in turn with what we’ve learned about writing and analysis from ‘master’ ethnographers such as Paul Atkinson(2019; 2012). Atkinson describes how all science writing is, inevitably, a literary endeavour, has a poetics. Every literary foray, every format will package/repackage, arrange, highlight, translate, traduce, constitute, and constrain – that’s the social contract we make with words.
And so, we end with the questions we hope to pursue over the next two years (and more) about the relationship between poetic image and research idea. What emerges when we ‘tell’ about the research scene in small, ‘poetic’ bundles of words? How might pursuing this question shine a light on some of the border territories between fiction and non-fiction which Bruno Latour once called, ‘Scienti-fiction’? We are great believers in the adage that truth is stranger than fiction. But we also believe, along with philosopher and novelist Iris Murdoch, in the power of, ‘faint, suggestive imagery’ (Murdoch 2000: 332), that fiction can distil truth and so bring us closer to the realities of lived experience in ways that, as Murdoch says, ‘are often so much less definite than pictures’ (ibid). And so, we will continue to think about how to widen the range of documentary methods in the pursuit of making research more complete, or more whole.
Atkinson, Paul (2019). Writing Ethnographically. London: Sage.
Atkinson Paul (2012 ). The Ethnographic Imagination: Textual Constructions of Reality. New York: Routledge.
Murdoch, Iris (2000 ). The Nice and the Good. London: Vintage Classics.
I take one of the surgical masks out of the box that is placed on a little table in front of Rebecca´s room, put the elastic straps behind my ears and fix the blue-white colored piece of fabric tight on my nasal bridge. During this extraordinary year with the Covid-19 pandemic, I have learned that this helps to prevent my glasses from getting fogged when I breathe, talk or sing. I knock at the door to Rebecca´s room. She was referred to the hospice the day before and my colleagues describe her in the team meeting as being very weak and tired. Rebecca has stopped eating and drinking and seems to having entered the final phase of her life.
Since 2014, I work as a music therapist at the hospice in western Norway. Once a week, I offer to play music for terminally ill people and their families, listen to their preferred music or sing familiar songs together. I work in a multi-disciplinary team with specialized nurses and physicians, a physiotherapist, a priest, a family therapist and a psychologist. People referred to the hospice are often in the final phase of their life and die during their stay. This means that I often see them only once in their dying process. Like in other hospices all over the world, we aim to practice person-centered holistic care here. That means neither hastening nor postponing death and dying, but affirming life. It means recognizing dying as a natural process – a part of life. And the hospice is a lively place; people are welcome 24/7, to gather to eat, celebrate and grieve together, to live their lives as fully as they might wish and with the best possible quality.
All these practices were turned upside down by the sanctions following the Covid 19-pandemic in spring 2020 during the first lockdown. The hospice was completely closed down for ten days. Eventually a few people were admitted to the hospice after this period. But life and care in the hospice was quite different from before. Visitor restrictions were introduced that allowed in exceptional cases that a terminally ill person could have one visitor, a close family member and always the same person, each day for a limited amount of time. When the hospice gradually opened again, we were talking about how to do music therapy – via zoom? With me sitting outside a person’s room? Or, being in the room but wearing a surgical mask, the requisite three meters distant, a maximum of 15 minutes. I decided to try the third option. As a music therapist, I did not necessarily have to be physically close in the way my colleagues from physiotherapy or nursing need to be. Even with the new constraints, being in the same room together felt right.
So, Rebecca and I meet during the second lockdown in winter 2020. My face and hands covered with a mask and gloves, I enter her room, taking with me a kantele, a small string instrument that can be easily sterilized after the session.
When I introduce music therapy to persons and their families at the hospice, the kantele is often my companion. It is both, a door-opener and an opportunity for here-and-now musicking. Once played, people often start to talk about music, and we find a song or piece that is meaningful to them and that we continue with.
Rebecca lies in her bed. A morning show is running on TV. I introduce myself and she looks at me and the instrument. Her reaction comes completely unexpected to me. She rises her body from the bed with such an energy, claps her hands and smiles. With a cheerful voice, she says that this is really a surprise! While I find a chair in three meters distance to her, Rebecca tells me that she has been writing some poems that she always wanted to make songs out of and that she used to play the piano, the trumpet and the guitar. She plays on an air guitar with big movements as if to prove that. She is really excited about the idea of music making, and at the same time expresses that she is quite tired and exhausted. We turn off the TV as Rebecca wants to hear the sound of the Kantele:
I begin with some sequences of arpeggiated tones and eventually find a little melody that I repeat. Rebecca closes her eyes and I can see that her breathing becomes steadier and deeper. She seems to relax and I almost get the sense that she has fallen asleep, but she opens her eyes and says that she likes the soft and delicate sound of the kantele. I ask her to tell me more about her poems and she tries to recall one of them. She smiles and I can hardly believe that this is the same person that has been introduced in the interdisciplinary team meeting earlier that day. She is frail and at the same time enjoys talking about her poems and music and seems to be right in the middle of it again. She asks me where I come from and if I want to sing a song from my home country.
I smile at her energy and her concern for me, weak as she is. I suggest an old song for advent that is known in both Germany and Norway: “Es ist ein Ros´ entsprungen” – “Det hev ei rose sprunga”. During the year I have become used to sing with the surgical mask and sing the first verse of the song in German and then in Norwegian. Rebecca closes her eyes and I see that she taps the rhythm of the melody with her right forefinger on the bed linen. She becomes slower and I adapt the tempo of my singing accordingly. Again, I feel that she has fallen asleep. But she opens her eyes and smiles. I say, that it would be lovely if we could meet again and take one of her poems and find a melody to it. She agrees and says that this needs to happen another day, as she felt quite tired now. Rebecca dies two days later.
I tell her nurse about the music therapy session, Rebecca´s energy, dedication and joy. And my nursing colleague responds: “You play on other strings with the people – both literally and metaphorically”.
I have been working at the hospice in this way now for nearly the entirety of this extraordinary year, and I realize that keeping a distance or a surgical mask are not hindrances for music therapy. To the contrary, we can build sounding bridges and musical bonds between us, keeping distance without being distant at all.
Doing sessions ‘down the line’ really highlights the physical distance between, in our work, the Hill House residents and staff on the one hand and Gary, music therapist, miles away, on the other. But it also reveals what it is that everyone involved – Gary, residents, staff – are doing to care for music in times of social distancing to compensate for the enforced separation…. To think about this, we’ve been rereading Mercédès Pavlicevic – in particular, her abiding concern with what she called, ‘moments’.
Mercédès’ deals with ‘moments’ in several texts. The first might have been a contribution to Voicesin 2001 (Pavlicevic 2001; Pavlicevic 2010; Pavlicevic 2012). Her conception of what makes a moment special (at different times she calls these ‘optimal’, ‘special’, ‘magical) is inclusive. Each time she speaks of moments, though, there is one constant: moments are understood as fulcrums for change. In the moment, after the moment – things are different. And the scenes of action where they occur become charged with new possibilities and potentials. It is perhaps a little bit like after a thunder storm the air is – electric (one of Mercédès’ favourite words by the way).
So, in her publication, ‘Between Beats: Therapy Transforming People and Places’ (Pavlicevic 2012: 202), Mercédès’ considers a day room in a care home and poses the question:
How do the people – who are in disparate and separate intrasubjective orbits, some with reduced and fractured capacities for ‘being social’ – gather into one shared musical moment…?’
She considers how being gathered is produced in ‘moments’. A moment might contain the social and musical practices, one after another, that draw people into a shared situation, an event with some kind of felt, perceived, spoken about, sense of something shared. A jointly owned happening in other words.
Such practices might include a dramatized shift in participants’ roles. For example, Mercédès’ describes how two carers sitting in a corner of the room start clapping in sync, and in a way that quickly transforms them – while still members of the care team they are now also very conspicuous musicians. This identity shift in turn underscores the general, and shared, sense of musical purpose and energy in the room at that time. Here, synchronous demonstrates to others – Something Musical is Happening – and We Are Together!
Not all transitional moments involve synchrony however. They can also be musical, as it were, gear shifts – changes of genre, material (a new song, a different volume level, octave or key, tempo), gesture, energy flow.
Gathering. Reorientation. Happening. Shifting. Transitions… Mercédès’ understanding of musical moments resonates with sociological theorist Emile Durkheim’s notion of, ‘collective effervescence’ – the drawing out, and drawing together of otherwise – Mercédès’ term again – ‘disparate’ individuals – drawing them in or on to something that stands outside of each of them – but is capable of holding all of them, something that generates collective energy.
The word ‘above’ is important – it references what Durkheim spoke of as the ‘supra’ individual. Durkheim understood culture as lifting individuals up and into a realm of forms – cultural patterns and materials that offer shape for experience, that socialise us in present action for future action. It is through participating in this ‘lifting’ process that we become, and learn how to become, a member of a group, a social human being. It is how we find ‘ourselves’:
Society cannot make its influence felt unless it is in action and it is not in action unless the individuals who compose it are assembled together and act in common’ (Durkhiem 2001 : 417-18).
Seen in this context, our human capacity for communicative musicality – and the synchronous activities that constitute live musicking – is a means for human social being. So what does music made during social distancing highlight about social assembly, shared processes of acting and being? In online synchronous music making we are not able to effect split-second precision of musical timing. But can we gather anything new from studying online musicking? In particular does it illuminate new features related to how music can ‘gather’ us?
We put this question to Simon Procter (Director of Music Services, Education, Research and Public Affairs at Nordoff Robbins) because, as it happened (and as you do in Music Therapy PhD Seminars), we (11 of us plus families) had recently produced an online partially improvised Christmas Panto, using Zoom – in costume (part of Gary’s script is reproduced here – we’d love to share the video but people’s kids were also involved and – frankly we all look extremely silly!). The plot was based loosely on Dick Wittington and His Cat, adapted to reflect the joys and sorrows of doing a PhD. Simon was cast as the Fairy of Bowbells, resplendent in gold lamé and baubles, a bearded ‘furry fairy’, complete with magic wand (the flashlight on his phone we think). He led us in a song he had specially composed for this occasion – about the trials and tribulations of finishing a thesis.
WHO DOES WHAT?
Dick is introduced to Barney the cat by the Fairy of Bowbells
Dick is lonely, and needs a research partner to help him. The NR Director of Research Enterprise, Strategy, Quality, Certainty and Paperclips makes an introduction…
Fairy of Bowbells [Simon] – speech/song to introduce Dick to Barney. The value of research partnerships, etc… Dick expresses gratitude
Scene 2: Nordoff Robbins PhD Seminar Christmas Panto, 2020, Script by G Ansdell
Simon’s song had a chorus: ‘We’re all here to help you write/We’re all here to help you write/We’re all here to help you write/Your magnum opus!’ Cue synchrony. Or in this case, not. The voices wafted in and out, some took longer to finish than others. They were – most precisely – out of sync! You can hear most of the final verse, followed by the chorus here:
Tia (Dame Cicely Suet, abusive supervisor) took part heartily. She, barely noticed (or cared?) about latency. ‘Latency? What Latency?’ If anything, the mismatched voices seemed to underscore (that word again) the bizarre sense/fun of what was happening – the fact that we were doing a song together, live, and indeed, in defiance of what the medium could not deliver (sync). You might say that Tia failed to notice zoom’s ‘failing’ here because it was eclipsed by something more important – singing the chorus of this new and very amusing song together. You might even say that this specific context (its haeccceity or unique ‘this-ness’) was as beautiful in its way as any perfect, split-second sync. It was, we think, a ‘moment’, in Mercédès’ term.
We began to think it might be similar to how music works in pain management. If you engage with music, or with the social interaction linked to music, perception of pain can be eclipsed. The fact is the mind can never notice everything at once; it’s selective. Psychologists speak about Inattentional Blindness. That’s when we don’t see one thing because we’re focused on another (DeNora 2014:107-23). Ethnomethodologists (the study of ordinary people’s methods of sense making) speak about how we add things to what we perceive or encounter, ‘filling in’, letting unclear information ‘pass’ and generally colluding to produce the semblance of a sensible, ‘natural, normal’ world (Heritage 1984: 96). We cooperate – and collude. Whether or not we find coherence, beauty, logic, or even a sense of musical togetherness, depends on many factors. It depends upon what we bring to the scene, how cooperative we are in the shared work of producing ‘collective effervescence’ and – of course – these things are linked to how motivated we are to do so.
Meanwhile, Tia was reminded of her involvement in another research project, with Glasgow Improvisers Orchestra. The interdisciplinary team there, led by Raymond MacDonald, has been exploring how online music making is embracing latency as another instrument, playing with zoom’s affordances, and through that finding novel ways to stay together (and care for each other during Lockdown). The team (Rob Burke, Ross Birrell, Maria Sappo Donahue) has just finished its first major article and is hard at work on a second. And GIO have graciously let Tia sit in on their Tuesday night sessions.
Yesterday, while writing up this blog entry, Tia went back to Simon and asked him: had he noticed the latency during his Panto song, and if so, did it bother him? Yes, he did notice it. He thought as he was ‘leading’ the singing that he had to take care to keep moving, not to wait until everyone ‘caught up’ otherwise the music would get progressively slower and grind to a halt. But then, he described how this was by no means his first experience with the ‘latency problem’. Earlier in his career, serving as a church organist, Simon routinely dealt with the ‘latency problem’: ‘ you have to plough on… you’re miles away from the congregation and what you hear back from them is miles too late’ is what he said (on this topic, see Stack Exchange 2015). No doubt there are other forms of latency that we encounter socially – for example at Hill House where many of the residents live with dementia and responses are often, ‘delayed’. No doubt our own responses are sometimes, ‘delayed’ and, indeed, ethnomusicologist Charles Keil argues that, ‘[m]usic to be personally involving and socially valuable must be “out of time” and “out of tune”’ (1987: 275). The question is when this ‘problem’ matters, and to whom, and how, through what cultural means? It is, in Thomas Szasz’s sense, just one more ‘problem in living’ (Szasz 2010 ) which might be over-come.
Maybe the constraints of enforced distanced musicking are helping us notice (and extend) the para-musical features of music. Maybe our already-existing notion of music as Music+ (music is always somewhere, in some context, linked to other things/meanings) is now Music++? In other words, music PLUS all the things that music can be when perfect synchrony is denied are coming to the fore (and this was a key finding in the GIO study): gesture, comportment, words, props, actions, activities, costumes, pictures, people (this list only begins to scratch the surface)… Maybe the ‘latency problem’ will lead to a more fully-fledged (or fully acknowledged) notion – following Cook’s pioneering work on this topic (Cook 1998) – of music as a multi-media modality, even when we might think we’re simply making or listening to ‘sound’? Maybe, this period of enforced latency will help us to see just what music can do includes but also extends beyond the sonic and the sonic-semiotic . For example, sometimes making music, or listening to music, music might be more of a pretext for other forms of meaningful and aesthetic activity – ceremony, sharing, displaying, moving, communicating… (doing the Panto, in spite of ‘the latency problem’ was definitely part of a group consolidation or ‘gathering’). Feminist improvisers have been demonstrating this point for decades in the concepts of social virtuosity and mixed abilities (Nicols).
As long ago as E M Foster’s Howard’s End (‘only connect’) and his dystopian story The Machine Stops, writers have debated technology’s dual-edged quality. These debates underscore how, as with music, technology is always technology+. So, maybe creative ways of addressing ‘the latency problem’ – indeed, of embracing latency and working it into the musical system – underscores some of the themes that disability studies have pursued for some long time (Groce 1988), namely that ‘problems in living’ can be transcended if collaborative practices change.
Cook, N (1998) Analysing Musical Multimedia. Oxford: Oxford University Press.
DeNora, T (2014) Making Sense of Reality: culture and perception in everyday life. London: Sage.
Durkheim, E (2001 ) The Elementary Forms of Religious Life. (Trans. C Cossman). Oxford: Oxford University Press.
Groce, N (1988) Everyone Here Spoke Sign Language: Hereditary Deafness in Martha’s Vineyard. Cambridge, MA: Harvard University Press.
Heritage, J (1984) Garfinkel and Ethnomethodology. Cambridge: Polity.
Keil, C (1987) Participatory Discrepancies and the Power of Music. Cultural Anthropology, Vol. 2, No. 3 (Aug., 1987), pp. 275-283
Pavlicevic, M (2010) Let the music work: Optimal moments of collaborative musicing. In B. Stige, G. Ansdell, C. Elefant, & M. Pavlicevic (Eds.), Where Music Helps. Community Music Therapy in Action and Reflection. Farnham, UK: Ashgate.
Pavlicevic, M (2012) Between Beats:Group Music Therapy Transforming People and Places. Pp. 197-217 in R. MacDonald, G. Kreutz and L. Mitchell (Eds). Oxford Handbook of Music, Health and Wellbeing. Oxford University Press.
As we reported in the last Vignette, the Skype sessions at Hill House in the last six months seem to have been – surprisingly – successful. Surprising, that is, for Gary – who feared that the famous ‘latency effect’ [aka sound delay] would make musical activity just too difficult between him and the residents.
During these Covid times musicians of all types have been talking extensively about the possibilities of playing together ‘synchronously’ on Skype or Zoom. The problem is that split-second timings are disrupted due to latency. So fully synchronous, rhythmically entrained, music making is difficult if not impossible. (Which is why so many web-performances rely on ‘a-synchronous’ re-combinations of music’s individual parts – to bring them into sync.)
The irony is that only by going off-line – and non-live – can synchrony be achieved. And yet, being online is being together in time – if not in sync. Which then to choose? Non-interactive and in sync or interactive and out of sync? For music therapy, and indeed for any situation where music is being used as a medium of emergent, ‘live’ interaction, there is only one option – live. But latency complicates the picture and for us the question arises: what’s lost when we make this compromise – and what, perhaps, is gained?
On long-distance phone calls and over Skype/Zoom we can usually cope with some degree of latency when talk is the expressive modality. But musicking together is a different thing. Latency in online synchronous music making means we see things before we hear them, and for music this can matter. The traditional assumption has been that successful music-making relies on very split-second timing, and often when we’re deprived of being in sync we feel dissatisfied, frustrated. So, when sync isn’t possible people won’t feel they are ‘together’ in the music. Or will they?
There’s a theoretical interest here too. A whole raft of theory from the sociologist Schütz (1964) to the early communication theorists Daniel Stern (2004), Colwyn Trevarthen and Stephen Malloch (2009) have argued that successful non-verbal communication both in and out of therapy is based on precise interactional synchrony, and that disruptions in shared timing have (bad) emotional and relational consequences for the communication partners. There’s a further literature that suggests split-second synchrony gives rise to good emotional consequences – bonding, empathy, even a surge in endorphins (Clarke, DeNora and Vuoskowski 2015).
Music therapists have been particularly concerned about musical latency as they’ve been experimenting with online work. This concern is heightened because many of the people music therapists work with already have problems with conventional verbal communication. For these reasons, we thought that sound delay might be a particular problem in the care home setting: to be sure the residents already encounter too may barriers to communication, such as hearing and sight impairments, or the unknown effects of dementia on participation in music. So adding a further complication initially felt like it would be impossible. Gary experienced this first hand, and at first it’s odd and disconcerting to see someone’s mouth moving and then to hear the sound a split-second later, or to hear an echo of singing in the care home that’s not in synch to the music he was making in his room more than a hundred miles away in Norwich. Our thinking was: if Gary finds that disconcerting what must the residents and carers make of it down there in Hill House?
But it turns out that although the latency problem has featured in every one of the 25 sessions Gary’s done so far, this hasn’t made sessions impossible. To the contrary, it seems that residents and staff at Hill House are finding ways to cope with latency – pointing to the screen, helping each other to take part, conducting the music with a hand or a walking stick, miming gestures or engaging in improvised dance. The visual features of music have, it seems, come to the fore and helped to compensate for what is not so easily achievable online. Gary is now continually working on ways to develop those ways that people are helping to keep the music relevant, and building on the new resources he’s finding week-to-week. And some of these strategies, and the larger questions they’ve raised have been unexpected prompts for our research, and our thinking about ‘care for music’ in these settings – and perhaps others too.
We’ve been looking in some detail at latency effects in the sessions, and how residents, carers, and Gary as the music therapist cope, and possibly ‘repair’ the musical communication in live musical time.
Here are some of the questions that we’re pursuing through what we see as the ‘accidental experiment’ of socially distanced music making:
What are the different experiences of musical latency for ‘each side’ of an online musical encounter within a music therapy scenario? For example, is it worse for someone producing or receiving music (perhaps acutely for a highly trained musician?). Is it less important for people who may experience music making as just a way to be together socially?
What techniques and strategies is each side learning to use to cope with latency, or to compensate for it?
Are these musical ‘repairs and adjustments’ (from both sides) a continuation of the ‘normal life’ repairs and adjustments we all make in communicative interactions – perceptually, cognitively, socially?
How is latency helped by ‘musical intermediaries’ (we have started calling them ‘musical mediums’) such as carers conducting the music, and dancing, singing with the residents? Is this a form of ‘devolving’ the latency into real-time musical synchrony within the room?
We’re interested in probing these questions through further inquiry. It’s an intriguing question: when is disruption not disruptive?
We (Gary and Tia) are exploring the uses of poetry in ethnographic research. This is different from writing, for its own sake, poetry about what happens in, or outside of, the field. This is also different from seeking to share ‘research poems’ with readers or listeners as part of a process of ‘public engagement’. We are – some might say, overly – cautious about writing poems expressly for these purposes. We think that they can become:
….so artificial, Such a deliberate step backwards To create an object…
By contrast, poetry is part of our desire to develop ‘gentle’ research methods and to contribute to conversations around what ‘gentle’ methods might mean and do. ….
We think social research often makes too-hasty a leap to interpretation, to attribution of character and causality. We think, by contrast, there is much to gain and learn by being ‘gentle’, by which we mean taking time with a scene, staying ‘with’ a person or group, and zooming in to examine a moment (perhaps listening repeatedly to the micro-features of a sound recording). We want to slow the research process down. And we think poetry has a role to play in this slowness.
We’re interested in where attempting the poem-writing process takes us, what it might reveal (to us) about our research sites and research relationships, and how poetry might draw out new and potentially important features of what we are seeking to describe and understand. We are equally interested in how writing poems, because of the demands that literary forms make of their makers, might not only draw out, but also potentially traduce or over-write the greater richness of what is otherwise there to be noticed.
Which has led us to ask, to what extent is it possible to harness the dynamics of poetry writing so as to lead to further reflections about a scene or site or set of relationships. If all forms of writing involve compromise, if all of them produce an ‘object’ then writing in any genre –a letter or research report, field notes, novels, and poems – can be dangerous. Dangerous – and also necessary, if we want to place our thoughts in a shared domain, to capture what we want to know about and dwell upon. The question is then how to tell about and how modes of telling all have consequences… How, then, to use the various lenses that writing affords to learn more – in this case about people, music and care.
I started working as a music therapist at Hill House four years ago. Almost every week since there has been live music for a couple of hours on a Thursday afternoon. It involves anyone who’s there at the time: residents, family members, staff coming in for ten minutes, or simply dancing through to the kitchen. The sitting room turns, gradually, from sleepy to lively. There might be unexpected musical participation as people sing, dance, play instruments, or just tap a foot. Sometimes you’ll see people mouthing the words to a song. Residents singing to their next-chair-neighbours. Staff noticing things they’d never seen residents do before. In a rare moment of intimacy the wife of one resident will hold hands and sing with her husband who, once-eloquent, no longer has spoken language. These afternoons are inevitably convivial, joyful. The atmosphere lightens. There is a sense of presence– people coming back, as it were, to themselves, and coming together in a powerful way.
Then the music stopped. Covid-19. In March 2020 almost all care homes in the UK were in crisis. Family visits and social activities ceased immediately as care homes valiantly adapted to the new situation to protect their vulnerable residents. I sat at home feeling helpless – thinking about what was happening at Hill House, worrying about the residents I’d grown so fond of, and wondering if the situation would spell the end of music therapy sessions.
Three weeks later, the manager asked if I would continue the music sessions by Skype. My first thought was ‘this will be impossible!’. In those early days of the pandemic musicians all over the world were rapidly discussing online how to manage music therapy, music teaching, or music performance now. The talk was of synchronous and asynchronous timing – facing the simple fact that on the internet current technological limitations meant that we see quicker than we hear, so there’s a significant time-lapse that makes making music together in real-time challenging, and often unsatisfactory. I wondered how I could possibly manage this when the people I was making music with also had perceptual and cognitive challenges due to their age or disability…
But, of course, I tried. The first week care workers organised some residents in a row in front of the large TV in the living room that was linked-up to Skype, and I sat in front of my laptop miles away, singing and playing guitar and piano. To me, the first session felt chaotic and hopeless: the signal kept dropping out, and I felt I was singing to myself as I watched some of the residents I knew staring at the TV screen in what looked to me like puzzlement. But then a moment… Saul looked up at the TV, moved his arm upwards with the musical phrase, waited, and as I sang a downwards melody he gradually lowered his conducting arm along with my voice. Musical connection!The rest of the session was messy, probably unsatisfactory to everyone, but I’d learned something crucial: it waspossible.
I’ve now done 22 of these Skype sessions. It’s helped me re-think how what it can mean to have a ‘successful session’. Often these sessions are messy, sometimes confused (with all of us equally confused as to what’s going on!). My vision of the room is limited (mostly I see just the front of the room). We see each other in two dimensions. The internet signal is intermittent. Of course, residents are often sleepy or not feeling up for it – though this is no different from when music was live.
Despite the difficulties, there are moments when it clicks. When people seem to look right through the TV, right through the physical distance that separates us. There is mutual learning and support as all of us adapt to the constraints. Residents are singing to each other again. They are pointing to the TV screen, alerting each other to what’s going on. Staff are singing with the residents, dancing with them, dancing with each other. Staff members say that in these tough times when they are stressed and over-worked, just five minutes of doing live music with the residents and with each other makes all the difference. “It’s therapy for us” is what they have said.
For the Care for Music Research Project, dealing with these constraints has led to what we are beginning to realise constitutes a series of ‘accidental experiments’. Facilitating musical connection in extremishas opened up new ways of thinking about what it means to be musically connected. It has put the spotlight on many skills and capabilities we did not know the residents had. It has highlighted their care for music, and their desire to sustain musical encounters. And it’s opened up new questions and topics – specifically how any ‘successful’ musical event is a collaborative, and multi-media, multi-sensory, effort, something immensely richer than an ‘intervention’. So now in our research around this topic we’re asking the question, what might this time of social distancing teach us about musical connection and how can what we learn be feed back into music making once – hopefully – we can be together again in the same room? To be continued…
The theme of this World Federation Congress is Polyrhythms of Music Therapy. Nice. We recorded our contribution for the conference on Friday. None of us are too clued up with zoom so it’s been a learning curve. But in a way, that made it more fun – at least in the recording and we laughed a lot in between trying to get the timings sorted and the key information conveyed. The Congress website is here and will be updated regularly until the actual dates – July 7 & 8 – when the presentations can be viewed (and we’ll be on hand afterward to for discussion). https://www.wfmt.info/resource-centers/events-center/world-congress/
Music is there for us. It keeps us company. It puts us in mind of others. It can help to shift our mood.
So much uncertainty. Inevitable anxiety. Much in upheaval. The NHS enduring tremendous strain. And all of us, if we are lucky, at home (that is, if we have homes). And something new that doesn’t come naturally – social distancing.
This is where music can help. We can’t go to the theatre or sing with our choir or jam with our band. It is not possible to visit museums. To just hang out in parks or on street corners. Or to attend church services. But music is still there for us and it offers consolation.
At this time we’re thinking of our favourite music, registering, savouring and remembering the different times in our lives when we first encountered certain songs or works, the people that music helps us to recall (those who are living but also people from our past who may have died). Even in isolation music can help to kindle connections, memories and moods.