ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Monday, July 1, 1996 TAG: 9607020005
SECTION: EXTRA PAGE: 3 EDITION: METRO
SOURCE: STEVE METCALF The HARTFORD COURANT
An elderly woman in a nursing home, who has not spoken a word in months, sits motionless in her wheelchair, listing heavily to one side. Her eyes are closed, as these days they nearly always are. On a nearby piano, somebody begins to play the old hymn ``I Come to the Garden Alone.'' The woman stirs in her chair and begins humming along. Her eyes open. Minutes later, she is conversing lucidly with astonished relatives.
A severely disturbed young man, confined to a mental hospital for committing a series of serious crimes he was later judged incapable of understanding, learns to play the guitar. Within months he is leading a band and writing his own music. Increasingly socialized, he soon may be discharged to a halfway house.
A dental patient, unable to take standard painkillers like Novocain, dons stereo headphones and listens, rapt, to his favorite Broadway show tunes, barely aware that his dentist is drilling and scraping away, fitting the man with a complicated porcelain crown.
The anecdotal evidence, reported in professional journals as well as the popular media, is compelling: Music heals.
And the field known as music therapy - roughly speaking, the systematic and prescribed use of music to heal - is making strides in learning how and why.
Barely a half-century old, music therapy is increasingly being used to enhance the quality of life for, and in some cases actually help cure, people with a range of psychological and physical afflictions, from brain trauma to Alzheimer's disease, from substance-abuse problems to chronic pain, from the isolation of retardation to the stress and discomfort of childbirth.
The use of music as a healing agent is, in the broadest sense, centuries old.
Plato and Aristotle posited a close relationship between the study and practice of music and a healthy personality.
Pythagoras suggested that music was a crucial ingredient in helping to maintain a balance among the four ``humors'' that the ancients associated with our basic human temperament.
Less formally, music has soothed (though perhaps also roiled) countless individual savage breasts, as the writings of everyone from Luther to Nietszche to Lewis Thomas attest.
But as a modern discipline, music therapy is a recent phenomenon, with its roots in the mid-20th century.
In the aftermath of World War I and especially World War II, many musicians visited veterans' hospitals in an effort to bring a measure of solace and comfort to the wounded. The sometimes profound responses of recovering soldiers, who suffered from a variety of traumas, led to more clinical study of the therapeutic effects of music.
The first accredited music therapy program in the world was established at Michigan State University in 1944.
Today, more than 70 colleges and universities offer programs in music therapy. An estimated 5,000 people are currently active as music therapists.
There are two governing bodies in the field - the National Association of Music Therapy and the smaller American Association of Music Therapy - and both certify and maintain professional standards for members. The groups are scheduled to merge in 1998.
Music therapists are employed in psychiatric hospitals, drug and alcohol recovery centers, nursing homes, hospice programs, prisons, senior centers and schools. In addition, a small but growing number of music therapists work in private practice.
The way music therapy works varies.
It can be as simple, and as passive, as playing music for patients on an instrument or stereo. It can mean more participatory activity, such as having the patient sing or keep time with hand-held drums, or learn an instrument. In a few cases, it can mean the development of more sophisticated musical skills, such as composition or harmony, as a form of communication or self-expression.
The range of possibility is as vast as the range of musical experience available to everyone.
``The therapist is always being called upon to make intuitive choices,'' says Melissa Moon, a music therapist at the Broome Developmental Center in Binghampton, N.Y. ``There is no one right way for it to work.''
``It's not an exact science because everyone responds differently to music. I have to take my cues from whatever the patient is feeling that day,'' she says.
Since most of Moon's patients have profound disabilities, she has to set reasonable, and sometimes distinctly modest goals. ``I pick behaviors that I want to increase or decrease. It can be something as simple as helping someone learn to use a utensil when eating. Then I use music to help reach those goals.''
But sometimes the goals are exceeded in unexpected ways.
``I had a man who was retarded and who was also severely disabled physically. But he learned to play the harmonica wonderfully. He got to the point where he could play any song you asked for, with a real sense of phrasing and feeling. It was not only a wonderful thing for him, it was also great for the other patients to see as well.''
Mark Farrell, director of rehabilitation services at the Whiting Forensic Division of Connecticut Valley Hospital in Middletown, says the ensemble aspect of music-making also can be critical.
``We have, for instance, a jazz band and the more advanced patients do some very good playing. They play some very sophisticated tunes from the so-called real book. Tunes like `Watermelon Man.' The group activity is very important to these patients. Sometimes we talk about the lyrics and their meaning.''
For all its documented success stories, music therapy is still regarded with skepticism, if not hostility, by many in the medical and psychiatric communities.
There are some reasons for this.
For one, the published scientific literature is scant, and much of what does exist is based on single-case studies, or small-group experiences.
For another, the very nature of the discipline - with its somewhat free-form methodology and unpredictable results - has tended to give it a fringy, seat-of-the-pants feel.
But in recent years, the field has grown in acceptance and awareness. Some health maintenance organizations and insurance companies now accept music therapy as a legitimate treatment, and the Health Care Financing Administration recognizes music therapy as a reimbursable service under Medicare and Medicaid.
Still, acceptance varies from institution to institution.
``It's very often an uphill battle to sell the value of music therapy to certain administrators,'' says Farrell. ``In particular, those who themselves have a nonmusical background are apt to undervalue music therapy. But slowly, as the literature grows and the results are better known, we're coming into our own.''
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