In my years as a singer, actress and storyteller, before embarking on this mid-life choice of a career as a music therapist, I was struck, time and again, by the power of both the sung and the spoken word to captivate people-whether in a huge concert hall with over a thousand people enraptured by a chorus, in a small intimate group of children listening to a story with songs, or in the ability of a father (my husband) to soothe the fretful cries of his infant son by holding him up to his chest while singing low, slow tones. The expressive and communicative powers of the voice-through musical or verbal communication-are wide-ranging and, of course, of perpetual interest to music therapists.
In her article "Integrating Music, Language and the Voice in Music Therapy," Joanne Loewy discusses four models of music therapy, each of which incorporates the use of voice, music and language to varying degrees, and she emphasizes the importance for music therapists to integrate these four models. These models are Music Therapy in the Pre-Linguistic Stages, in a Develop-mental Context, in Recovery, and Music Therapy and the Voice in Psycho-therapeutic Function. I would like to discuss Loewy's ideas as represented in the literature on music therapy, as well as in the literature of other tangential but crucially related fields of anthropology, neurology and psychology. I would also like to consider her discussion in terms of clinical situations I have encountered in the past two months of my internship. And I will relate some personal experiences where I have encountered the intersections of music, language and voice that Ms. Loewy speaks of in this article.
As Loewy asserts at the beginning of her article, "speech is both a cognitive and musical process.that humans are engaged in at every juncture.in moment-to-moment communications." She points out that speech and music are vitally related in that during speech we employ dynamics, rhythm, intonation and timbre-all of which are the basic building blocks of music--to more fully express the sentiments of our words. As expressive creatures, we naturally add a composer's elements to our speech to make our meaning better understood.
In the Pre-linguistic Stage, infants rely on the musical elements of communication to establish interpersonal relationships with those around them. These are the first aspects of "language" that a baby acquires. Loewy states that "the musical aspects of language.can be thought of as sonorous units into which phonemes are later placed." Steven Mithen, in his book The Singing Neanderthals (2006), refers to this infant-directed-speech as a " 'multimedia package'.which [includes] facial expression, gesture and body language [as well as the musical elements of] exaggerated vowels, repetition.[and] a greater range of pitch" (p.197). Anybody who has had a baby, or who sits in an airport (as I am now doing) watching a mother cooing and ahh-ing in concert (pun intended) with her infant recognizes those hours of endless transfixed communication with their baby.
Loewy discusses how music can be used in a developmental context to enhance cognitive processes. In these instances, song (often through the use of rhythmic cuing) can enhance non-musical, or verbal, learning. In my life as a mother to two young boys and as a storyteller/singer for children, this technique always prompted enthusiastic verbal responses. This aid to language development is particularly useful in children with learning disabilities and speech disorders, as is evident at my internship site for developmentally delayed students, where this process is employed often with great success.
As a natural extension of infant-directed-speech, a child's natural way of developing language is through constant imitation of the "rhythm and musical contours of discourse prior to.words." A striking example of this that we study as graduate students in music therapy is Nordoff and Robbins's (1977) now-famous case of Edward (in-class listening to recording of sessions, October 15, 1007). Through expertly, patiently and persistently meeting Edward's initial distressed vocal cries with music, Paul Nordoff and Clive Robbins were eventually able to provide Edward with a musical framework for discourse with them. This is evident in the Hello exchange that takes place between Nordoff and Edward in their ninth session. This case is so striking because not only has Edward found language (albeit a modest amount at this point); but most importantly he has discovered that he can participate in a social exchange through his musicalized language. One can actually hear, in the tapes of these sessions, the joy in the young Edward's voice as he exchanges Hello's with Paul Nordoff. His utterance is not just an accurate and comprehensible "hello"; it is filled with a new-found thrill in being part of a human verbal exchange, for possibly one of the first times in his life. In a recent talk (Nov. 5, 2007) about his new book Musicophilia (2007) at Harvard University, Oliver Sacks, the renowned neurologist, referred to music as "social cement"; Edward's exhilaration at his new social intercourse is a perfect example of this.
In a developmental context, music and language in this kind of communication are also serving as aids to the development of one's identity.
Human beings have an inherent urge to communicate; we are social beings. And it is through the reciprocal activity of communication that our identity is first established: we see ourselves in how others respond to us. In the above example, Edward was being "self-actualized" through the interesponsivity of the Hello exchange. Similarly, when a child hears his or her name sung within the context of a Hello Song at a group music circle, their identity is affirmed through hearing their name pronounced through the rhythmic and melodic elements of this group pronouncement.
In her discussion of the use of music therapy in recovery, Loewy points out that, while music and rhythm are often used successfully in gait training, there are surprisingly few reports of it being used in speech recovery. Even Oliver Sacks (2007), points out that while there are cases of aphasic patients who recover the use of language through singing familiar songs, they are not usually able to recover propositional speech, (i.e., self-initiated speech). However, while these patients may not recover full use of social speech, re-gaining the ability to sing reestablishes "a very basic existential communication" (p.215) with others. This ability not only confirms for them " 'I am alive, I am here,' but [it] may express thoughts and feelings that cannot be expressed at that point by speech" (pp.215-216). Their singing re-engages in a social interchange with others which helps to lift them from the isolation in which so many aphasics live.
I found it interesting to learn about one of the forms of therapy which is somewhat effective in helping aphasics recover speech which is called Melodic Intonation Therapy. One would think, from its name, that this would be a form of music therapy; but Loewy explains that because it only employs elements of spoken prosody (melodic line, rhythm and stress points of speech) and not the "auditory aesthetic aural organization" of music, it is not considered music therapy. Instead, it is considered a form of speech therapy.
Loewy also discusses the use of music to retrieve long-term memory. She cites Connie Tomaino's work which uses music to evoke the part of one's identity that are associated with certain songs. Loewy provides an audio link in which a man with Alzheimer's and his wife suddenly relive a time from their past as they sing their Trenton High School song (audio excerpt (f)
[ Loewyexcerpt_f.mp3 (1,90MB) ]). As Loewy says of this case, "Music's ability to lodge and then unlock memories and verses from specific moments in time may be one of its most potent qualities in recovery potential."
Loewy then goes on to discuss the psychotherapeutic function of music therapy, i.e., how "the musical aspects of speech" and the voice itself are crucial factors in the development of the ego. She discusses the Embodied Voice Work model of Lisa Sokolov, which specifically seeks to identify the Self through the improvisational use of the voice. This process, where use of the voice "brings us into contact with many levels of ourselves," seems akin to Mary Priestly's (1994) step of "accessing the unconscious [in search of one's] inner geography" in her Analytical Music Therapy model.
Loewy quotes Sokolov's belief that "singing places us in a 'vital hub of what it is to be human' (Sokolov, in press)". While Sokolov clearly believes that one reaches that "vital hub" through vocal improvisation, I believe that one can also reach it through singing pre-composed music as well: there is an undeniable affirmation of Self in the physical thrill of producing fully embodied vocal tones. Any choral singer or soloist will confirm this as, I'm sure, will any fully involved rock, pop or folk singer as well. The physical act of singing is an undeniable affirmation of identity. The other aspect of Sokolov's work which resonates with me is her emphasis on breath. She insists that awareness of breath and sound in our body brings us in closer touch with our inner processes (Sokolov, in press). I have certainly found this to be true as a singer; but this profound grounding capability of breath has been re-asserted for me through the deep breathing I do in my yoga practice. I am beginning to use breath awareness with some of my clients at my internship site in the hope that this can help them, too, feel more physically and emotionally grounded.
Another analytically-oriented technique that Loewy discusses is Diane Austin's Vocal Holding. Through vocal improvisations, Austin helps her clients explore wounded parts of themselves. Austin's concept of "giv[ing] trauma a voice" brings to mind Carol Gilligan's milestone work In a Different Voice (1982/1993), in which she discussed the urgency to help adolescent girls find their often-quashed "voice" in our society. One of Gilligan's protégés, Annie Rogers (2006), used the concept of voice to help girls and women (including herself) find a way to express the pain and shock of physical and/or sexual abuse by giving "voice" to the "unsayable" (p.44). Wouldn't it be wonderful if Gilligan and Rogers and the many therapists who work with trauma victims, discovered the power of music to help unleash some of their clients' lost voices.
As musicians, as students of the expressive therapies and as clinicians, we know that the links between music and the human psyche are endless and intriguing. On first reading Loewy's article, I was reminded of a fascinating observation by anthropologist Stephen Mithen. In his book The Singing Neanderthals (2006), Mithen discusses some of the primal human calls, i.e., the original ways in which our ancestors used their voices to communicate. Two of these were the laugh and the sob. Then Mithen points out the almost eerie link between such primitive (yet still absolutely current) utterances as these and music, when he reveals that some of these basic calls are clearly articulated in musical terms in some of the iconic pieces of Western music. For instance, the laugh can be heard articulated perfectly in the opening section of Bach's Magnificat, in the rapidly articulated and upward-rising, repeated phrases of "Maa-ah-ah-ah-ah-ah-ag-ni-fi-cat." Even the words here serve to reiterate the joyous laugh being articulated-in any language: you're hearing a repeated "ha-ha-ha-ha"! And then Mithen gives us an instance in which music captures the opposite mood: in Mozart's Requiem the Lacrymosa (meaning "tears") is essentially a weary but insistent and heart-wrenching sob.
As music therapists we should consider it our great good fortune to have the infinite and rich vocabulary of music available to us to treat our clients. And we must consider it our responsibility to use and integrate the many components of music, as well as the various models of music therapy available to us, to help our clients attain their fullest possible expressivity and sense of self.
References
Gilligan, C. (1982/1993). In a different voice: Psychological theory and women's development. Cambridge: Harvard University Press.
Mithen, S. (2006). The singing Neanderthals: The origins of music, language, mind, and body. Cambridge: Harvard University Press.
Nordoff, P. & Robbins, C. (1977). Creative music therapy. New York: John Day Company.
Priestly, M. (1994). Essays on analytical music therapy. Phoenixville, PA: Barcelona Publishers.
Rogers, A. (2006). The Unsayable: The hidden language of trauma. New York: Random House.
Sacks, O. (2007). Musicophilia: Tales of music and the brain. New York: Alfred A. Knopf.