Musical Pathways in Recovery

Community Music Therapy and Mental Wellbeing

Gary Ansdell, Tia DeNora

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317091417
• Edition: 1
• Topic: Medicina
• Subtopic: Teoria, pratica e riferimenti medici

"Music triggered a healing process from within me. I started singing for the joy of singing myself and it helped me carry my recovery beyond the state I was in before I fell ill nine years ago to a level of well-being that I haven't had perhaps for thirty years."

This book explores the experiences of people who took part in a vibrant musical community for people experiencing mental health difficulties, SMART (St Mary Abbotts Rehabilitation and Training). Ansdell (a music therapist/researcher) and DeNora (a music sociologist) describe their long-term ethnographic work with this group, charting the creation and development of a unique music project that won the 2008 Royal Society for Public Health Arts and Health Award. Ansdell and DeNora track the 'musical pathways' of a series of key people within SMART, focusing on changes in health and social status over time in relation to their musical activity. The book includes the voices and perspectives of project members and develops with them a new understanding of how music promotes their health and wellbeing. A contemporary ecological understanding of 'music and change' is outlined, drawing on and further developing theory from music sociology and Community Music Therapy. This innovative book will be of interest to anyone working in the mental health field, but also music therapists, sociologists, musicologists, music educators and ethnomusicologists. This volume completes a three part 'triptych', alongside the other volumes, Music Asylums: Wellbeing Through Music in Everyday Life, and How Music Helps: In Music Therapy and Everyday Life.

Part I
Musical Pathways

1. Bridget’s Pathway Between …

Gary goes across to the Mental Health Unit to fetch the songbooks from the music therapy room and as he comes out he meets one of the patients, a middle-aged woman. She is slowly shuffling along the corridor towards the doors, which are secured. It’s not someone he knows so he keeps a respectful distance, but the two of them converge at the door. The patient looks tense and anxious, and her body mirrors this state, her shoulders hunched, her movements inhibited and controlled. She pushes a buzzer, talks to the security guard and the door is released. Gary signs out of the building and the security man at the front desk says to this woman ‘You’ve got two hours leave now, but don’t go too far, and make sure you’re back at four!’

Through the doors the woman turns left, and Gary maintains his distance. As they walk, separately, the short distance along a quiet side road towards a building on the periphery of this medical site, Gary realises that they are probably both heading for the same place. He can’t help noticing as he walks behind this woman that she changes slightly as she walks free of the mental health unit. Her pace quickens a little, her shoulders seem to release, and she looks up for the first time, as if she’s heading somewhere rather than just shuffling along a corridor.

The place they are heading towards is an older building with a homemade looking sign directing down to the basement of a two-storey Victorian structure (very different in style and feel from the modern medical facility we’ve just left 100 metres back). The sign says ‘SMART’ and indicates SMART Cafe. They go down the stairs, recently repainted in friendly, non-institutional colours (painted by a group of bankers doing volunteer work as part of a weekend bonding exercise). There is homemade art hung on the walls. At the bottom of the stairs the woman opens the door, holds it open for Gary – and someone calls, ‘Bridget! Come and sit down and have a cuppa! It’s great you managed it again!’. She smiles and sits down next to Lucy, a long-term member of SMART and SMART Music.

SMART, the place where it all happens

SMART’S website describes this organisaton and its purpose simply and imaginatvely:

SMART has 2 doors, one that faces the mental health hospital, and another that backs on to the wider Chelsea community. You are welcome to visit us through either.

SMART was set up as a charity in 1985 by some forward-looking psychiatrists to help form a bridge for patents between a stay in hospital and life back in the community. It has been helping people ever since, in a unique way that combines respect, challenge and opportunity for people treading the often-difficult path to recovery between mental health services and everyday social and cultural life. SMART’S mission states that ‘the founders recognised the importance of meaningful activity and training as a way to rebuild lives, giving people purpose, confidence and skills. As the Charity grew it also recognised the importance of friends, music, laughter and fun’.

Part of this ‘serious fun’ has been the music project that this book follows, is connected to and seeks to celebrate. It started in 2005 after Gary had been working as a music therapist in the adjacent hospital setting for five years. As he handed this work over to another music therapist, Sarah Wilson, he was faced with a new and interesting challenge. One day on the street outside the hospital he met Robert, someone he’d done music therapy with on a one-to-one basis. Asking how Robert was now he got the answer: ‘I’m fairly well now – but there’s no music! That’s one of the things that got me well again – and now I’m discharged from the hospital there’s no music therapy!’ (This disconnect is a common problem with acute services. Enhancing the links between in-hospital provision and supportive services in the community to help people stay well remains an on-going challenge due to funding shortages.) Gary asked Robert where he spent his time now, and he pointed to SMART, but said that there was no music there.¹

Gary investigated and found that although there was no active music-making, there were many musicians – amateur, semi-professional and former professionals whose mental illness had stopped them from playing. There was a lot of talk of music, but no actual music being made. With the help of the Nordoff Robbins music therapy charity and the staff of SMART, Gary set up a weekly music session called simply ‘SMART Music’ in the cafe. Like the cafe, this session was open to anyone – members of the SMART community, members of the public just dropping in for a coffee. Over the next few years it found its shape, and its participants – musicians, music-lovers and those for whom music simply helped, whether they were singing, playing or just witnessing because they happened to be in the cafe that day. SMART’S website currently describes this group:

Every Wednesday from 2pm to 4pm we host a jam session in our cafe that is open to all. Anyone can sing, play an instrument or simply sit and watch. All types of music is played: rock ‘n’ roll, blues, ballads, pop, songs old and new. Come down and enjoy tea, cake and good company.

Overall then, the project established a place outside of hospital where people in hospital and discharged from hospital could make music together:

Figure 1 The site of the Chelsea Community Music Therapy Project

The SMART Music group is facilitated by music therapists, but is not explicitly named or identified as a music therapy session. It is more like a hybrid between a large music therapy group and an open mic session. The event has run from February 2005 to the present. In the summer of 2006 ethnomusicology student Rob Szymanek joined the team as a Research Assistant (he had been in SMART the summer before where he did fieldwork for an MA in Ethnomusicology). Rob produced further field notes and conducted interviews with all the core members at SMART. In 2007, music therapist Sarah Wilson joined SMART to develop and expand the music project, which by then had become a joint practical and research project supported by SMART and Nordoff Robbins, called the Chelsea Community Music Therapy Project (later renamed the SMART Music Project). In the second year of the project 39 members of the SMART community were interviewed by Rob – both those who did and did not take part in the music group. In 2008 Gary did a second round of interviewing, this time with a smaller group of key participants in the project, people who had begun to be thought of as ‘pathway cases’.

Also in the second year, Tia joined the research arm of the project, visiting as and when she could. (An application to the Economic and Social Research Council was rated well but never funded.) Around 2009 Gary and Tia began to conceive of the book project (a ‘triptych’) of which this book is Book Three, the central panel of the triptych.² Tia’s role was occasional (Gary did all the work of setting things up and he did the lion’s share of collecting the data; Sarah took over from Gary as the Music Therapist in 2008).³

In what follows, the main narrative ‘voice’ we use to tell the tale is primarily a mix of Gary, Tia, Sarah and Rob – but it is also supplemented with the voices of SMART members and staff, and other commentators at key moments. We hope to convey the ethnographic feel of SMART and its participants, changing over a long sweep of nearly 10 years. Alongside this we will weave into the mix as appropriate various theoretical and conceptual matters, but through the unfolding of the descriptive narrative, and from the point of view of how people and creative musical practices led to changes – mostly for the better – at SMART between 2005–14.⁴ Our narrative strategy is to refrain from attempting to insert ourselves and our impressions too far forward, but instead to follow the actors as they engage with music, objects, each other and the SMART space to build collective culture and identity and thus to pave pathways away from illness, and its habits and trappings. This type of journey is, we want to emphasise, by no means confined to these people, to people in a hospital or to people living with mental health conditions. The continuum, or the ‘being between’ health and illness is one on which all of us stand as we experience, as Kathy Charmaz (1997) memorably put it, our ‘Good Days/Bad Days’. We hope therefore that there will be relevance for anyone in the stories that follow of SMART and its continually evolving ‘music of changes’.

***

Overall, we found how much a relationship to music was a key resource for many members in their everyday attempts to keep themselves (and each other) well. We also found that this small community needed more than a weekly open music session: it had different sub-groups who needed specific musical resources and musical help. Amelia, a new Director of the charity said that what she wanted was the active nurturing of a musical community at SMART. Sarah worked with great skill and sensitivity in the following years to realise this aim, creating two further musical groups and identities at SMART: SMART Singers – a smaller closed group who work at learning and performing songs, and SMART Band – made up of experienced players who are supported in jamming, rehearsing and doing gigs. The three aspects of the music project have proved to be organically related and self-supporting. SMART has indeed become amongst other things a vibrant musical community since 2005. The two smaller groups have provided music for SMART’S in-house parties and events; and have also performed externally for other audiences.

One key aspect of the project is how it created an informal ‘musical bridge’ between the medical services just up the road in the psychiatric hospital, and SMART. Gary knows many of the people at SMART from his time working at the hospital (1999–2005), and Sarah has worked at the hospital site as well as at SMART since 2007. For ethical reasons, for this study and this book we will follow people in their musical pathways only within and beyond SMART (and where their paths included the medical site, we will only talk about them from the physical and symbolic door of medical services).⁵ It will be increasingly apparent, however, that one of our key discoveries through this long-term engagement with the SMART musical community and particular people from it, is that music accompanies people in their pathways in recovery, between states of illness and health, and between sites of treatment, care and support in unique and valuable ways.

***

When Gary followed Bridget to SMART Music that day it turns out that Bridget is taking part for the second time. She was encouraged by Sarah to use her two hours daily leave from the ward at the psychiatric unit to come down to SMART and join the music group. As Gary sits at the piano that afternoon he occasionally glances towards this woman, and sees her gradually thaw, as she shares a songbook with Lucy, and begins to sing. Once she looks up and shares a wary smile with Gary as he somehow catches and acknowledges her enjoyment in the music. In the tea-break Gary talks with Bridget, and she tells him that she’s recently been overwhelmed with anxiety and agoraphobia, and had to be taken into hospital. Music therapy in the hospital was one of the few things there that had made her feel human again, but she’d been nervous about coming to SMART as any group of people usually terrifies her: ‘What if I burst into tears in Starbucks?’ she says. ‘But here I feel I could, and nobody would mind’. She’d been relieved to find last week how friendly and informal the group was, and she’d come back today. ‘It helps’ she says.

***

Bridget’s story here stands for many similar tales we report in this book, and for an overall pattern that our research has suggested for how music helps many people with mental health problems to start, develop and follow-through musical pathways – in both modest or profound ways. At one level Bridget traced a very simple pathway: from the corridor of the mental health facility to the conviviality and support of SMART Music. But more symbolically she also traced a pathway between being a patient (‘make sure you’re back by 4!’) within a medical-model treatment where her primary identity is an illness identity, to a setting and event where her potential and actual health-identity is recognised, nurtured and celebrated through musicking.

Thus Gary followed Bridget in a real and concrete way that day: over just 20 metres and three minutes – and yet he witnessed modest yet real transformations in her physical, social and psychological being. This tactic of following, witnessing and then engaging-with through listening, attending-to, understanding and making sense of someone’s experience is an exemplar of the larger research enterprise that is presented in this book. We (Gary, Tia, Sarah, Rob) have followed, traced and tried to faithfully represent the varying musical pathways of many individuals, group and occasions in this musical community. Sometimes these pathways extend over many years (up to 10 years to date), and over many different sites and circumstances. Pathways are often complex: they extend and lead onwards, but also sometimes turn back on themselves, get tangled and knotted, and in doing so encompass the full range of life in all of its joy, sorrow, conflict and courage. But whatever scale these musical pathways have covered, there are we think some key understandings that they communicate as a whole about the complex but vital inter-relationships between people, music, places, health states, wellbeing and the potential for ‘musical fourishing’ within challenging times and situations. They help illuminate what mental health can be; and how music can help in cultivating and supporting it.

Our research approach – ‘gentle empiricism’ – and the data⁶

As we write this book, the role of the arts in healthcare is coming under increasing scrutiny. We have described this change, and our responses to it, in other work, and in the two books of the ‘triptych’ that are associated with this one (Ansdell 2014; DeNora 2013a). We have outlined our respective understandings of ‘delicate’ or ‘gentle’ empiricism, an approach first outlined by Goethe in his scientific work (Ansdell and Pavlicivec 2010), and we have engaged in some of the ongoing debates over what counts as ‘evidence’ or ‘efectveness’ of the arts in healthcare situatons. We do not intend to rehearse those arguments all over again here. What we do want to do, however, is to hold our project work up to the mirror of prominent work that has sought to provide standards of ‘rigour’ in qualitative research in healthcare settings. In fact, we believe that qualitative research, and in particular the intimate form of enquiry otherwise known as ethnographic rese...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of Figures
• Preface
• I Musical Pathways
• II Continuous Outcomes
• III Musical Recovery
• Coda
• Appendix A: About Method: How We Wrote This Book
• Appendix B: How We Negotiated the Ethics of this Project
• Bibliography
• Index