Hard and Heavy Music: Can It Make a Difference in the Young Cancer Patients� Life?

By Fereshteh Ahmadi

Music is what I am when I experience it.
(Thomas Clifton)

Introduction

A number of publications have described the specific benefits of music-based therapy interventions for cancer patients. Interactive music interventions such as instrumental improvisation, drumming and singing have shown promise in improving the mood of cancer patients (Burns, Harbuz, Hucklebridge & Bunt, 2001; Cassileth, Vickers & Magill, 2003; Krout, 2001). Some studies (Burns, 2001; Sahler, Hunter & Liesveld, 2003; Tilch et al., 1999; Weber, Nuessler, Wilmanns, 1997) have examined the effects of receptive interventions, such as music listening, music and imagery or a combination of music therapy interventions, on outcomes such as decreased pain and nausea, improved mood, increased family communication and improved quality of life among cancer patients.

Investigations of the role music plays in facing pain and serious illness have tended to focus on stimulating and soothing music, like jazz or classical music, healing or spiritual music, and religious music (see, for instance, Lim & Locsin, 2006; Bernatzky, Bernatzky, Hesse, Staffen & Ladurner, 2004; Lou, 2001; Whipple & Glynn, 1992). The role of so-called hard and heavy music as a coping method has not yet been properly studied. A variety of problems like teenage pregnancy, alcohol and drug use, homicide and suicide are thought to be either directly or indirectly dealt with or strongly implied in hard and heavy music genres, such as heavy metal music. In some cases, the lyrics in this kind of music communicate potentially harmful health messages. But hard and heavy music has another function that has not yet been studied thoroughly. A few studies (for ex. Arnett, 1996; Deyhle, 1998) have shown that hard and heavy music can help young people cope with their personal and social problems by expressing feelings of alienation from family, culture, and society as well as feelings of dissatisfaction and defiance.

The aim of the present article is to discuss the role hard and heavy music plays in coping with cancer. Here, hard and heavy music refers to genres such as heavy metal, hard rock, hard rap, punk rock and aggressive pop music.

As the basis for my discussion on the role of hard and heavy music in coping with cancer among young people, I have chosen to use interviews with two informants whose cases provided striking examples of the role this kind of music can play in coping. The two case studies in focus were singled out from a qualitative study I conducted among 17 cancer patients, in Sweden, who have used music (listened to or played music) as a means of coping with their illness. Proceeding from a qualitative inquiry, my aim is not to generalize the obtained results, but to shed light on how hard and heavy music can play a role in coping with cancer.

The intentions of the present article is to draw attention to the significant role hard and heavy music can play in coping with cancer, and by doing this to contribute to advancing the position of music therapy intervention in psychological treatment of cancer patients, especially in societies like Sweden, where use of music in therapy with cancer patients is rather uncommon. Music therapy, as a complementary treatment, offers important support to individuals undergoing cancer treatment. It is well known that, immediately after medical treatment or even years after it, cancer patients can face different psychological problems like depression and, thus, still need to cope with the problem cancer has caused. In such situations, music therapy based on the patients needs may constitute an outstanding coping method

Hard and Heavy Music and Its Positive Effects

Before discussing the positive effects of hard and heavy music, it is important to shortly explain the social functions of music. In analyzing our two cases studies, these functions will be taken into consideration. As Hargreaves, Miell and MacDonald (2002, p. 5) wrote, "the social functions of music are manifested in three principal ways for the individual, namely in the management of interpersonal relationships, mood and self-identity." Concerning the first way, music is used as a means of developing and negotiating interpersonal relations. Musical preferences can define the social group one belongs to (ibid.). Regarding the second way, some studies (see, for example, Hargreaves & North, 2001; Hargreaves & North, 1999; North, Hargreaves & McKendrick, 2000) have shown that people, especially young people, use music as a means of regulating their mood. With respect to the third way, Hargreaves et al. (2002p. 5) suggested that one of the primary social functions of music lies in establishing and developing an individuals sense of identity. When discussing the role hard and heavy music has played as a coping method for my two interviewees, Helen and Sara, these three ways in which the social functions of music are manifested will be taken into consideration.

Many studies (Knight & Rickard, 2001; Cassileth, 2004; Hussey & Layman, 2003; Ikonomidou, Rehnstrom & Naesh, 2004; Groen, 2007; Marwick, 2000) have shown the positive effects of music and music therapy on ill people. Listening to classical music or soft music from ancient times was regarded as affording harmony and as having a soothing effect on people. But hard and heavy music is not like soft music and has often been thought to cause aggressiveness and violence (Anderson, Nicholas & Eubanks, 1993).

There are few studies which focus on the positive role of hard and heavy music. One of them is the study which Arnett (1996) conducted among 70 boys and 38 girls on their involvement with heavy metal music [1]. This study revealed that this music has helped them deal with their problems in at least two ways. One way is that heavy metal music has soothed their anger and calmed them down, helping them to find an inner tranquility. The other is that these young people have found a source of meaning in their involvement with heavy metal, for instance in their strong relation to the song lyrics (Arnett, 1996, p. 25). As Arnett explains, the interviewees have sought out heavy metal music when they have been in dark moods. Forty-eight percent of the boys answered that they listen to this music especially when they are angry, and an additional seven percent of the boys mentioned emotions such as anxiety or sadness (Arnett, 1996, p. 81). On the basis of his study, Arnett (1996, p. 81) concluded that:

Heavy metal music characteristically has the effect of calming them down, of purging their anger rather than inflaming it. Over half of the metalsheads who said they listen to it when in a negative mood also reported a cathartic effect of this kind, an effect of relieving their anger, unhappiness, or anxiety. Many of them consciously use the music to purge themselves of these negative emotions.

Arnett did not find it strange that heavy metal music was a source of meaning for his informants. He related this to the uniqueness of our time, when many other sources have become "diluted or have dried up" (Arnett, 1996, p. 25). According to him, heavy metal music can be a source of meaning:

demonstrates that human propensity for finding sources of meaning is highly flexible and that there is tremendous variability in the sorts of experiences and ideas and symbols that may serve this yearning" (ibid.).

When I conducted my study on Music and coping, I did not yet have sufficient knowledge of either heavy metal music or Arnetts and others studies on the effects of this music. I was astonished when some of my young interviewees explained how listening to music like heavy metal has helped them cope with cancer. I then began to study this music and its effects. One of the most interesting and comprehensive studies I found on this issue was Arnetts study (1996) on Metal Heads. Arnetts interviewees narratives on the effects of heavy metal music on young people were very similar to my interviewees narratives. Finding a source of meaning and easing their anger, anxiety and sadness were two effects of heavy and hard music that my interviewees also emphasized. However, I have found an additional effect not mentioned in Arnetts study. By creating an imaginary alternative world for young cancer patients, hard and heavy music, like heavy metal music, has provided an alternative way for them to express their alternative selves. In the following, this effect and the two other effects of hard and heavy music mentioned above will be discussed.

Hard and Heavy Music as a Source of Meaning

Meaning in life is a construct with many features. Different studies (Steger & Frazier, 2005; Debats, 1999; King, Hicks, Krull, Del & Amber, 2006) have conceptualized it in diverse ways. Generally it refers to the value and purpose of life and important life goals. As a potentially life-threatening disease, cancer may bring about changes in the individuals view of meaning. It can cause individuals to question their previous beliefs about the meaning of life.

One of the problems young cancer patients may face is losing the dreams they had for their future, dreams about family life, education, occupation, etc. They may suppose that cancer has taken from them their dreams and hence the meaning of their life as they knew it. Some may succeed in again finding a meaning in life and be satisfied with their life; some may not value life as they did before being stricken with cancer, and some may become confused about their own identity and future. Among those who have found a new meaning in life is Helen.

At the time of the interview, Helen was 30 years old. She got breast cancer at 23. She was so depressed after her operation and treatment that she could not continue her education; her boyfriend left her after a while. As she explained, she felt alone and angry; cancer had emptied her of all her dreams and hopes. She had a rather good relationship with her mother, but they did not live in the same city. She no longer cared about her future and was depressed. She had lost the will to live. As a teenager, she had listened to hard and heavy music, but at the time she got cancer, she had not listened to this kind of music for some time. After treatment she began listening to heavy metal music once again.

Helen explained that this music had helped her realize that her dreams about her life and the world were illusory, that life was not just and as sacred as she had once believed that the world was full of injustice and that people everywhere suffered from injustice, prejudice and discrimination. She explained that she began to understand that there was no special meaning of human life. Thinking in this way caused her to relax; this new outlook helped her stop regarding cancer as a "murderer" who had killed her life and her dreams. She explained:

I was very sad, but more than that, I was angry; I went around and asked why this had happen me; everything was ok before cancer, I had a boyfriend, began to study and was having a pretty good time; before cancer, I had many plans. I was so depressed that I couldnt do anything. I bought some CDs and listen to them all the time, they were all heavy metal music, one was "I Hate Therefore I Am", another "Children of Bodom". These helped me see my life and my situation differently. I began to realize that its no problem that I have no dream, no ambition, and no goals any more; that it was even good that I didnt see any especial meaning with my life. Those who have a dream and ambitions and sought a goal in life were the ones who were cheating themselves. I felt enlighten and regarded those who still could not see the dark side of life as ignorant and blind. I felt good about thinking in that way. I owe this to those CDs I listened for a long period after my treatment finished. . This music gave me a new goal: to be goalless, to be different from ordinary people who stress themselves to death in order to reach a goal and again find another one to run after. For some years the meaning of my life was to have no meaning, no goal, no dream, no expectations for my future, only to be. The heavy metal music helped me discover this view of myself and my world, it justified my way of being. I needed this; this was my coping. Besides, I was not alone; I felt that I belonged to a large group of people who shared this view with me, especially young people, teenagers maybe, black people, here in Sweden young immigrants. I was no longer a miserable cancer patient; I belonged to a "wise" group who had the ability to see the real face of our world, you know like those in "matrix". It was released, I no longer felt captured by cancer and people who wanted to help me.

In Helens case, finding a meaning in life meant finding her place in the world. As she explained, before she found it difficult to regulate her relation with others because she saw herself as an alien, a person who differs from people around. Heavy metal music helped her to find herself belonging to a "large group of people". The heavy metal music has then helped her regulate her relationships with the people around her. She understood where she belonged in society. It was no longer difficult to interact with others, as it had been before when she was "captured by cancer and people who wanted to help" her. Here we see the first principal way in which the social functions of music are manifested, namely in the management of interpersonal relationships.

Hard and Heavy Music as a Source of Tranquility

Some of the normal emotions that cancer patients may experience at diagnosis and during treatment are fear, shock, anger, depression, sadness, denial, anxiety, guilt, stress, loneliness and alienation. Dealing with diagnosis and treatment usually causes overall stress, which may bring about problems related to insomnia, headaches, body aches, fatigue, crying, feeling moody, pain, irritability and tension. These emotions can lead to loneliness, frustration, hopelessness, withdrawal from others and feeling out of control. Treatment may have a long-term impact on cancer patients health, which causes emotions such as fear of recurrence, loss of attractiveness, difficulty with sexual function, fear of loss of fertility, especially in cases of breast and prostate cancer.

Saras experiences provide an excellent example of how hard and heavy music can play the role of a positive coping strategy which helps to deal with the negative emotions that cancer gives rise to. It is important that we first get a picture of her situation. This picture is drawn from Saras own understanding of her situation.

At the time of the interview, Sara was 24 years old. She was 8 when she got cancer. At around 9 years of age, the cancer tumor was removed, but this resulted in a visible handicap. During the whole treatment period, and afterwards, she behaved not as a child but as an adult, trying to handle things in a calm and rational manner. Sara hid her sadness, fear and anger during entire her childhood.

Her mother was very active, in her work and in everything that had to do with Saras sickness. But even though she was around a great deal she was not really present mentally. Saras father was an emotional person. Sara was very attached to her father, so she could not understand why he was not around as much as her mother was. Saras father died of cancer when Sara was 20 years old. Sara was treated for serious depression for half a year before the death of her father. At the time she started her medication, her doctor wanted her to be under supervision, so she was placed in a psychiatric clinic. Although she was emotionally unstable starting in her teens, it was not before her fathers death that the emotions she had hidden throughout her childhood resurfaced.

According to Sara, the principal problem she had during and after her cancer period was the lack of conversation about her situation. She did not react to her feelings, as she had lost contact with them while trying to live up to the expectations of others. The result of not "being allowed" to be a child, together with the anger, frustration and fear caused the lack of communication with her family and the other people who cared about her. So she was not surprised that she became psychologically unstable as teenager. It was when she was being treated for depression that music became a way for Sara to cope with her feelings. Sara explains that:

It was during this period that music became very central. I mean, I was in a psychiatric clinic I listened to music a lot during the time my father got ill, music in which my pain could be identified. I bought a CD-walkman and walked around with it and listened to music. You felt very lonely in the clinic and music is company in a way. You get a feeling youre not alone when you hear another person sing about the things you are feeling. In periods I listened a lot to punk rock; it was a way to be angry, to release all the feelings. You make the feeling more intense with the music, it is like it creates a resonance between the feelings and the music you hear, something like an interplay between feelings and the music and it became easier to bear the feeling. Afterwards you feel kind of calm.

The citation above shows, that hard and heavy music can have a harmonizing and relaxing effect despite the fact that it is loud and abrasive and that its lyrics do anything but describe the beautiful side of being human or depict any hope or a positive future for individuals or the world.

Hard and heavy music creates an imaginary world in which the patient can live far from the real one. The case of Helen, described above when discussing the role of heavy music in finding a meaning in life, is interesting in this regard. Helen explained that before "coming out" and being able to show her anger openly, she lived for a long period in two worlds: the real one and the invented one. Living in this invented world became her rescue, her coping method. She stressed that it was partly due to listening to hard and heavy music that she had been able to endure the psychological effects of cancer. As Helen explained, cancer can put you in a hopeless and terrible situation. You have no choice but to accept what others, especially hospital staff and your family, say to you. You should be a tolerant person, particularly when you are young and do not have experience of how to deal with a life crisis. You are afraid and have lost all confidence in yourself. It is not surprising that you can become like a little child again, without any protection of your own, but only the protection that others can give you. She stressed:

I tried to show that I was a strong and brave person who could handle the situation. I did not show any anger or sadness. I played the role of an understanding girl who hoped for a better future. I didnt at all believe in the future, I had no hope; I was angry and very sad. I wanted to leave everyone and fly, but how could I do it? I was a weak and sick girl whose entire existence was in the hands of others. I was frustrated over being so dependent on others. I hated them all. I could express this anger, hate and frustration only when I was alone, when I could be a mean person, a destroyer in a world I had found in heavy metal music. It was enough to put my CD and listen to the heavy metal music I had. It was like using drugs. Music helped me enter a world where I was free to be bad, no rationality, no kindness, no obedience and dependency, free. In this world, my world, I could shout at them, even hurt them. I was strong, healthy and capable of doing what I wanted. I know it is awful to feel like this about people who loved me and took care of me. But I was young and dying, at least I thought I was. When I listen to music I lived in an invented world where I was free to be myself. It was thanks to this invented world that I could come back to the real world again and be that nice understanding sick girl. I was sometimes ashamed of my thoughts, but now I believe this helped me survive, at least mentally.

Here we have the second principal way in which the social functions of music are manifested for young people, i.e. music as a means of regulating mood (Hargreaves et al., 2002). The case of Helen shows that hard and heavy music may not only help a cancer patient to get rid of her/his anger. It may also create an imaginary world in which the patient has a new identity. In such a case, the patient actually lives in two worlds, the real one, where she/he is a humble cancer patient, and an invented one, where she/he is an aggressive person who destroys everything. The calmness comes afterwards.

Both informants, Helen and Sara, explained that they had listened to hard and heavy music when they where in a negative mood and that the music had a purgative effect on them, relieving their anger. The music was used as a tranquilizer and helped them get rid of their anger and gain control. In the present cases, hard and heavy music, contrary to what we might expect, does not lead to wildness and depression, but serves as a source of reflection. For these young cancer patients, this music filled the emotional vacuum they felt in their loneliness, or when they suffered from the effects of treatment and subsequent psychological problems.

Hard and Heavy Music as a Source of Expressing a Sense of Self

Besides being a source of meaning and having a tranquilizing effect, one of the important effects of hard and heavy music seems to be providing an alternative avenue for self-expression for young people facing a life crisis. We will discuss this below. But first some words on the relation between music and self-conception.

Globalization and technological development have brought about a new view of the self as something constantly in a process of change and reconstruction, owing to different experiences, situations and everyday interactions with different people (Featherstone, 1996; Croucher, 2004; Sarup & Raja, 1996; Epstein, 1998). This view has enabled a better understanding of the widespread and varied interactions between music and the individual.

Since the second half of the 1950s, American rock'n'roll began to exercise its hegemony over the music listening habits of young people around the world. Rock 'n' roll began to be regarded chiefly as a youth phenomenon. The youth movement, which developed in many Western countries, expressed itself mainly through certain forms of rock and pop music. One of the reasons for such a concurrence between the youth movement and rock and pop music was that this music provides for the young a sense of identity based on notions of age and generation. Yet the role of music in articulating young peoples sense of identity is not limited to either the 1960s or the youth movement. This role also has an individual feature that stems from young peoples different life situations, no less when facing a life crisis.

According to OCallaghan (2002), when cancer patients are involved in musical re-play, they may have powerful experiences of identity affirmation. The role of music in expressing the sense of self is essential. As Bowman (2003, p. 2) expresses:

Music is what I am... You are the music... Claims like these suggest a profoundly intimate and inherently complex relationship between music and ones sense of self: a relationship that is neither superficial nor casual. Musics role in constructing, negotiating, and maintaining identity (whether individual or collective) is deeper and more urgent than other human engagements or at any rate its quality is markedly different. Music and identity are, one might say, joined at the hip.

According to Roberts (2000, p. 54), one of the sociological concepts currently used in the music education literature is identity. This concept is used by adding in other concepts such as self and role. The most prevalent sociological model in music education research is, according to Roberts (ibid.), symbolic interactionism, based on the work of George Herbert Mead and Charles Horton Cooley. In their view, identity is formed in the interaction between self and society (Mead, 1934; Cooley, 1983). To better understand the role of hard and heavy music in providing an alternative avenue for self-expression in young cancer patients, I use Cooleys concept of the looking-glass self (Cooley, 1983). This concept reflects the idea that a persons self grows out of society's interpersonal interactions and the perceptions of others. In other words, a person views himself/herself through others perceptions in society and in turn gains a sense of self. Our conception of our self is then a result of a process in which we learn to see ourselves as others do. The process of the looking-glass self begins early in life, yet it continues throughout a persons life, because our interaction with others never ceases. According to Cooley, the looking-glass self seems to have three main components.

The imagination of our appearance to other persons
The imagination of their judgment of that appearance
The experience of some sort of feeling, such as satisfaction, pride, embarrassment or humiliation.

The concept of the looking-glass self helps us better understand the impact of social interaction in the construction of individuals' self-conception. Yet as Gracas and Schwalbe (1983, p. 77) pointed out, this concept has contributed "to an overly passive and oversocialized view of human beings." The looking-glass self can well explain the role of others in construction of the self-conception, especially during the initial period of socialization. However, when we enter the social world and get our different social roles, we neither passively accept them nor act on the basis of others images of our self. We compare our own view of our self with others views of it. We reflect upon our own understanding of the roles we have and on others expectations of these roles. We also negotiate between our divergent and sometimes conflicting roles. So we actively and continually examine and re-examine our looking-glass self. The process of self-concept formation is not, therefore, a passive process of the acceptance of others views about the individual. It is a complicated process in which the individuals self-determination plays an import role.

In different situations, this active reflection on others views about us can be strengthened or weakened. In other words, our vulnerability to acceptance of others views about our self varies depending on the circumstances we face. When individuals are hit by cancer, especially as a child or a young person, there is a risk that they will be strongly affected by their role as a sick person and passively accept the looking-glass self as their own perception of their self. Other peoples image of them becomes their own self-image. But the problem does not stop there. An obstruction to this image, i.e. the sick role, can grow a short time or sometimes even years after falling ill. Such an obstruction can give rise to a conflict between the young individuals self-understanding of her-/himself as a strong, independent young person and the role that others had ascribed to her/him at the time of sickness. Here the individual faces a conflict between the self and the looking-glass self.

Both the interviewees, Sara and Helen, expressed facing such a conflict. Concerning the three components of the looking-glass self, we can explain their experience as below. They had an imagination of others image of their self as a sick person. They understood this role as ascribing to them certain characteristics, such as dependency and obligatory acceptance of ones own situation. This understanding and evaluation of others view of their self gave rise to negative feelings such as shame and humiliation, but also anger and resistance. It was in such a situation that hard and heavy music came into the picture.

Both Sara and Helen expressed that hard and heavy music helped them handle a conflict between their self-image as a "normal" person and the looking-glass self, which ascribed to them the sick role. As they explained, they could then, using the imaginary world that this music had created for them, "come out" and express their "ideal self", the self they wanted others to perceive. Sara stressed that:

The aggressiveness was good because everything felt so unfair; children are not supposed to think about death. Music is so alive, and it has so much comfort in it. I listened to different aggressive music during the time I felt angry, and it was good, it was pleasant to show your feelings through the music. I was so pissed off with everything. I got cancer when I was 8 years old and I have a handicap because of it. I showed my self as a good and calm child during the sickness, then as a teenager I tried to be like everyone else, pretended to be strong. But then suddenly it was enough. The music helped me for a while to show my anger and dissatisfaction, my real self.

Helen, the other interviewee, pointed out that the lyrics of the heavy metal music, she listened to, caused her anger, which had been hidden for a long time, to resurface. During her period of illness, and even after it, she was "obliged" to be under the control of physicians, and other healthcare staff and her family. She should be a "rational" patient who understands her situation. She explained:

Many around me cared about my body, but not my soul. I was the centre of attention, but indeed no one could see my real self. I should control my feelings; this was an unacceptable expectation to put on a young person.

The heavy metal music made her strong enough to show her anger. "This made me feel good and relaxed. I felt that at last I was free, I could be myself, I could show how I really feel, who I am", she emphasized. As our two case studies show, hard and heavy music has helped both interviewees see themselves as someone else. This music has produced a new image, a new self for both interviewees, a new image that they use to strengthen their self-esteem and self-determination.

Here it should be mentioned that although these two case studies show the role of self-determination and the individuals ability to take an active position in relation to the looking-glass self with the help of hard and heavy music, our two interviewees do differ regarding their dissociation from the image others ascribed to them.

It is a familiar tendency among the cancer patients to distance themselves from the "image" that others have of them as a cancer patient. They try to deny being a cancer patient; they reject the sick role ascribed to them. Especially young people want to be understood as normal, as strong, healthy, nice, and attractive, just as they were before being stricken with cancer. However, the degree of denial of and distancing from the sick roll varies from individual to individual. One person may entirely accept the sick role others ascribe to her/him, while another may accept it only partially or not all. Different factors can play a role in this context. In our two cases, age can be regarded a possible factor.

Concerning the case of Sara, as a child she totally accepted others view of her self, and therefore the looking-glass self became her own perception of who she was. The reason for this is not so difficult to understand. Sara was only 8 years old when she was stricken with cancer. She was still in the primary socialization process when she was ascribed the sick roll. She had no experience of acquiring different roles and hence no opportunity to learn how to negotiate between different identities. She lacked self-determination. It took several years for her to develop a sense of self-esteem and to realize her self-determination in the social interaction. Hard and heavy music played an important role in this respect. It became her coping method, a resource that helped her become enough strong to act against the sick role that had been ascribed to her for several years. We should remember that, in her case because of her handicap, others view of her as a sick person did not cease even after she had survived the cancer.

Helen, on the other hand, was 23 when she was struck by cancer. She had already passed through the primary socialization process, acquired different roles in social life and learned to negotiate between the different identities ascribed to her by others. She had experienced different social interactions with which she could develop her self-determination. Yet being hit by cancer and being ascribed the role of cancer patient were strong enough to oblige her to accept the sick role and to accept, though partially, others view of her self. When she emphasized that: "I tried to show that I was a strong and brave person who could handle the situation. I did not show any anger or sadness. I played the role of an understanding girl who hoped for a better future. I didnt believe in the future at all, I had no hope; I was angry and very sad", she was actually telling us that she played the role others expected of her, but her view of her self was not totally in accordance with what others perceived. In the case of Helen, resistance to the looking-glass self happened almost early after hitting by cancer. Concerning the difference between Sara and Helen, we may suppose that the age at which one faces a crisis can be an important factor for how actively or passively one is affected by others views and how deeply the looking-glass self becomes ones own self-conception. The role of hard and heavy music may also be impacted by the age factor. Sara as a child had hardly experienced any serious life crisis and had not experienced any coping method. She found hard and heavy music later in life, as a young adult. Helen, on the other, as she explained, had already faced the young hood crisis and used the hard and heavy music from that period. She returned to this method when she was hit by cancer.

Despite the above-mentioned differences between the two case studies, I should emphasize that, in both cases, what made the situation unbearable for the young patients was continuing to play a role they did not want to play. Instead of pretending to be calm and strong, they wished they could cry and show their weakness, anger and sadness. They wished they could say to others that they were afraid, that it is hard to be "rational" in such a situation. They felt the people around them asked too much of them. It was in such a situation that hard and heavy music helped. This music helped these young patients cope with their illness by giving them the opportunity to question everything that was conventionally accepted, and it did this by opening for them the door to a world in which one could be her/his "real" self and express all her/his forbidden feelings.

Here we find the third way in which, according to Hargreaves et al. (2002, p. 5), the social functions of music are manifested, i.e., in establishing and developing an individuals sense of identity.

Discussion

Coping is, among other things, a behavior chosen to face a certain stressful situation. This behavior, like many other behaviors of an individual, is a manifestation of certain attitudes. These attitudes, in turn, express the norms and values that the individual has internalized during her/his socialization in a certain society. Individuals views of and attitudes toward politics, the economy, professional life, sexual and family life, religion and morality play an important role in how they deal with a stressful situation. Culture, as the framework of such views and attitudes, has a determining effect on the choice of coping methods in a stressful situation (Ahmadi, 2006). On of the factors which shapes coping is then culture. Another factor is time, i.e. the historical epoch during which the coping process occurs. The choice of coping methods is then based on, among other things, culture and time (epoch). Given that it is embedded in culture and time, coping takes on different colors. Understanding the role of music in coping demands knowledge of and insight into the cultural setting and the era within which coping occurs. If we are to understand the role of hard and heavy music in coping among young people, we need to comprehend the world in which young boys and girls live in our post-modern era. The choice of coping methods they use in times of crisis is affected by among others, this world. Heavy and hard music is part of the young generations world. This music is a mirror, reflecting the individual and social problems this generation encounters in everyday life. Surely, not every young person listens to this kind of music, but we should be aware of the potential effects of this music, which can attract young people, not least in times of crisis. My study shows that hard and heavy music can be a method of coping with cancer and that it helps in at least three ways: as a source of tranquility, as a source of expressing a sense of self, and as a source of meaning. Hard and heavy music may give young cancer patients the opportunity to gain self-confidence, put away the false mask they are wearing, and be who they really are.

Here it may be asked whether I aim, on the basis of my study, to propose including hard and heavy music in therapy programs for young cancer patients. My answer is that this is more complicated than simply saying yes or no. There are studies showing that aggressive lyrics and music can contribute to violent thoughts and behavior in people experiencing a crisis. It is also true that using hard and heavy music as therapy appeals to some therapists. Buttery (2004) points out two therapists who successfully have applied hard and heavy music in their therapeutic work with young people. One of them is Dr. Don Elligan, who is a clinical psychologist in Chicago, Illinois, and author of the book Rap Therapy: A Practical Guide for Communicating with Youth and Young Adults. He says:

I'm using rap to reach a demographic group that I otherwise may not reach", and adds that "In a lot of ways, the music adolescents and young adults are attracted to is a manifestation of their angst and the developmental challenges they're going through. That's not necessarily a bad thing" Buttery (2004).

Elligan has used rap to make contact with clients in order to promote cognitive and behavioral change. Another therapist is Bob Bruer, a music therapist at the Mental Health Centre Penetanguishene in Penetanguishene, Ontario. He practices rap therapy with forensic clients. Bruer has found ways to put rap to therapeutic use by facing more aggressive lyrics head-on with clients (Buttery, 2004). He says: "Rap being used in therapy just makes sense," and adds, "Clients are trying to be heard, and we need to listen" (Buttery, 2004). In answering the question of whether heavy metal music should be included in therapy with young cancer patients, I would like to repeat what Buttery (2004) maintained:

After all, the goal of therapy is to get clients to honestly express what they feel and think. And given rap's [and I add hard and heavy musics] popularity, some clients may find their voice through the genre.

It is important to consider the role of hard and heavy music as a possible method of coping with cancer. It is even more important to take into consideration the individual, social and cultural context in which this coping method is used. Like other coping methods, heavy metal music may be useful for one individual and harmful for another, depending on the situation. Moreover, coping has an individual character. Owing to the individual character of coping, it is meaningful to study what types of individual characteristics can make heavy metal music a helpful or harmful coping method. As Pargament (1997, p. 89) stressed:

coping involves an encounter between an individual and a situation; it is multidimensional; it is multilayered and contextual; it involves possibilities and choices; and it is diverse.

Finding this diversity requires being open to the possibility of different ways of coping with a difficult crisis, even if certain ways may seem harmful and undesirable at first glance.

Note

[1]The data obtained by using the volunteer/interview method and the classroom survey method. All the interviewees were fans of heavy metal music. 48 boys and 25 girls were interviewed. Information on the other 22 boys and 16 girls were obtained in the course of collecting data for comparison group by questionnaires. The 22 boys and 16 girls were those who had indicated in a questionnaire of musical preferences that they "strongly liked" heavy metal music. The boys were interviewed in suburban Atlanta, Georgia and the girls in Atlanta and in Cambridge (Arnett, 1996 p. ix, p. 171).

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