Psycho-social Aims of Music Therapy for Elderly Persons

By Fukumi Kitamoto |Author bio & contact info|

In Japan, the population is rapidly aging. Given this situation, music therapy has proven to be a valuable new psycho-social approach. I have been introducing music therapy into my clinical work as a psychological treatment mediated by music. Here I will examine its meaning, sharing my communication experiences with various clients.

Case 1: The Culture of "Shameful Feeling to Living on", and the Discovery of Oasis

Ms. T is an 84-year-woman who has been hospitalized for more than 10 years due to a chronic internal disease. Her situation is that of the so-called social hospitalization. She had a life history of enjoying Japanese traditional dance as a recreation in the elderly center she used to belong to. In the hospital, she participated in the group music session for the non-demented patients. She was quite active here, sometimes showing the dance she was proud of, or sometimes creating the words for the group song incorporating local specialities. However, one day a television crew brought a camera to report on the hospital, at which time she reacted by hiding herself, saying "if I were seen as an alive person..." This attitude stemmed from her thought that she was no longer a member of her family. In other words, she was a dead person, and so she did not want to expose her figure to the public. This episode showed that she had been carrying a feeling that was unique to Japanese culture. Following the custom of "Ubasute"¹, the elderly abandon their daily lives of their own accord, and contribute to the younger generation by decreasing the perceived burden on their families to take care of their needs or acknowledge their existence. It was the very opposite to the smiling and positive response she had been showing in the session. In a place with musical resources, certainly the healthy and positive sides of the participant tend to be expressed, but at that moment, I witnessed the sorrow alive within the individual at the same time. Still, this client continued to attend the music session after this episode, and made another parody song looking back on her life: "I am tired and sick but together with you all, this may be my oasis...holding on the compassion of people, I am here again, to live the rest of my life..."

I think the truth confessed in song lyrics is common to both East and West. People instinctively know the ways to use songs, sometimes to bare sadness and pain by singing out the feeling "usually hidden in the heart", sometimes getting rid of "what is too dangerous to write down" by expressing it in a song instead, or sometimes tasting the message in a song more deeply than just expressing it in speech. What made this client call the session an "oasis" came from somewhere deep in her heart. The group singing company meant being with friends who share a time being released from tension The session room itself was the resting place to have a breather. Songs are only born from the released body. Ms. T who used to smile merely on the surface, by accumulating the experiences of warming each other by each others' voice, seemed to able to melt the frozen part deeply buried in her heart.

Case 2: The Name Given to the Music Group "Ujo no Mandara" - Reintegration of the Soul -

Mr. W is an 87-year-old man who suffers from chronic heart disease. He is a devout Buddhist, and has offered sutra recitation morning and evening in other patients' rooms as requested. He started to participate in the music therapy of his own will, and displayed the leadership he cultivated since his youth, when for example, he was the leader of the young men's association of his village. Mr. W remarked on this group, "I enjoy it because I don't have to sing well here." He also congratulated the peaceful period of the time, saying "I like Shoka ². These are the songs of a peaceful time."

One day, he heard that his nephew who was younger than he, had passed away. He came to the music group and told me about it. Then he said "Today, by all means I must participate in the session." Although he never referred to the topic during the session, when it was over and the other members left the room, he was quietly joining his hands in prayer.

Mr. W. gave a name to the group, saying "'Ujo no Mandara' is what this group is." In Buddhism "Ujo" means all living creatures including human-beings, the gathering of unenlightened people. "Mandara" is the great cosmos of Buddha. In this session, Mr. W seemed to be simultaneously experiencing limited life and eternal life, the flames of karma and the purification of the soul. Jungian psychology explains that Mandara sometimes plays a role as a defense mechanism for the fragmented personality. Mr. W's soul which was fragmented by the death of his young nephew, seemed to be healed in the Mandara formed by the group members, and reintegrated through singing together with them. It was just like Mantra is chanted when the faithful are enlightened.

Implications

How to live when one gets old is a significant issue for everyone. Needless to say, this process goes on quietly inside the individual. During the process, those who continue to enjoy physical health are rarely cut off from the people's circle, as they live with the family who stands close to them. However, those who suffer from some kind of disease that needs constant medical care have to walk this path on their own. For these people, it is essential to have the presence of somebody to walk with.

In the cases noted above, the communication with the same generation functioned as a psycho-social support. Here the role of the therapist is:

1. to help with opening up the "meeting ground" for them;
2. to produce the music use as a medium to facilitate alive performance developed in the "ground";
3. to function as a successor of their beings, which means to make them believe with deep feeling that they are not forgotten but their beings will live forever in the therapists' heart.

Yes, we therapists are in the position to be able to become storytellers relating how they lived their lives and pass this information down to subsequent generations. This passing down function implies that music therapy can contribute to the spiritual care.

Notes

1. Ubasute: In an old legend of Japan, elderly people were abandoned in a mountain called "Ubasute-yama". The old people were left there for reasons of domestic economy.
2. Shoka: The songs especially composed for children since Japan introduced the elementary school system in 1872. These songs were published on the music textbooks of the school, but have been loved and sung for generations by both young and old. But these songs were not allowed in wartime because the Japanese military considered that such calm and beautiful songs would dampen the people's will to win.

Acknowledgements

I would like to express my gratitude to Rika Ikuno who offered me the opportunity to contribute to the Voices and helped me with the English translation.