Music, Music Therapy and Trauma

International Perspectives

Julie Sutton

• Publisher: Jessica Kingsley Publishers
• Year: 2002
• ISBN:
  9781846423321
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Music communicates where words fail, and music therapy has been proven to connect with those who were thought to be unreachable, making it an ideal medium for working with those who have suffered psychological trauma. Music, Music Therapy and Trauma addresses the need for an exploration of current thinking on music and trauma. With chapters written by many of today's leading specialists in this area, music and trauma is approached from a wide range of perspectives, with contributions on the following:

* neurology of trauma and music;

* music and trauma in general;

* social and cultural perspectives on trauma;

* contextualising contemporary classical music and conflict;

* music and trauma in areas where there is war, community unrest and violence (Northern Ireland, Bosnia-Herzegovina, South Africa);

* music, trauma and early development.

Including specific examples and case studies, this book addresses the growing interest in the effects of trauma and how music therapy can provide a way through this complex process.

Part 1

Trauma Perspectives

CHAPTER 1

Trauma

Trauma in context

Julie P. Sutton

Over the past decade something has happened to our perception of ‘trauma’. We have always reacted with horror to reports of the physical aspect of disasters, but more recently we have become better informed about the psychological shock that takes place. We are now aware not only of the immediate impact of traumatic events, but also of their repercussions. We realise that these repercussions are widespread and affect not only those immediately involved in the event itself. There is a complexity of influences that reaches far beyond the place where the event occurred. As the catastrophic event in New York on 11 September 2001 showed, these influences can reach across community and country boundaries. In today’s society it is very likely that we will all experience the impact of single event trauma at some level.

In this chapter the concept of traumatic experience is placed in a historical context, in order to demonstrate how attitudes to the psychological effect of traumatic events have changed over the centuries. These changes in approach have influenced the provision of support and treatment for those who have experienced events beyond the ordinary. There is a further exploration of traumatic experience through a single music therapy case study. A final perspective is then added, inviting the reader to consider the impact of the work with those traumatised upon the therapist.

Contextualising definitions of trauma

For 30 years or more, dictionary definitions of trauma have mentioned a ‘shock’ (Hornby 1974) or a ‘wound’ (Wingate 1972) that causes lasting effects and/or damage. These three facets – shock, wound and a lasting effect – remain in the literature and are still central to our understanding of trauma. The task of describing how trauma affects people is more complex. In the medical literature, rather than attempt a single definition, the Diagnostic and Statistical Manual of Mental Disorders (DSM) details categories of response and lists of symptoms, including post traumatic stress disorder (PTSD) and related conditions (APA 1994).

The term PTSD was first used in 1980 (APA 1994) and includes three types of symptoms – the re-experiencing of the event, a lack of affect or numbness, and active avoidance of any reminder of what took place. PTSD is a chronic, debilitating condition, with extremely distressing symptoms such as flashbacks, numbing, dissociation and persistent, increased arousal. People who develop PTSD find that these symptoms are present for more than a month and are long lasting and devastating, with impairment in social, occupational and other areas of life. Work with Vietnam veterans, for instance, has shown that all aspects of social functioning were severely impaired and continued so for many years (Goldberg et al. 1990, pp.1227–32; Kaylor, King and King 1987, pp.257–71). Later research into Desert Storm troops’ experiences replicated such findings, demonstrating the life-changing impact of exposure to experiences beyond the norm (Sutker et al. 1994, pp.383–90).

To put this in an overall context, it can be said that for the majority of us encountering trauma, the more acute and distressing symptoms are present during the 48-hour period after the traumatic event itself. We will discover that after two days the effects of our symptoms will lessen. Not every person will develop PTSD, nor will all find that symptoms decrease after the two-day period. Others will develop acute symptoms similar to PTSD (marked anxiety or avoidance, numbing or detachment, derealisation and depersonalisation), lasting between two days and four weeks. With their symptoms beginning to diminish after a month, this group of people will not develop PTSD and, in recognition of this, the term acute stress disorder (ASD) has been added to the DSM. Encompassing the whole range of responses and symptoms, from the relatively short lived (up to two days) to the longer lasting (one month onwards), the term ASD separates the commonly experienced, immediate, overwhelming impact of trauma from the chronic condition of PTSD. ASD can also used as a predictor, revealing a process that potentially could lead to PTSD. Most importantly, ASD can be seen as an attempt to acknowledge how high the level of distress can be in the period immediately after the traumatic event.

With a catalogue of symptoms that can change over time, such post-trauma conditions still do not provide a clear-cut picture of how trauma affects the individual. This is further complicated because of the amount of time involved in the development of symptoms that eventually result in PTSD, including the possibility of a delayed onset, perhaps occurring some months or years after an event. This was seen recently in Northern Ireland, following the first IRA ceasefire. Rather than bringing a greater sense of safety in the community, the beginning of the peace process was linked with evidence of a statistically significant increase in psychiatric admissions (Northern Ireland Association for Mental Health 1995). Therefore, the aftermath of a traumatic event can be thought of as a long echo into the future – an echo that can begin to be heard after rescue services have left the disaster scene.

The change to the DSM view of trauma is significant, because it highlights the increasing complexity of conditions emanating from traumatic events. This not only testifies to the severity of the impact of trauma upon a greater number of people, but also acknowledges that the aftermath of a traumatic event will render any of us vulnerable to serious, prolonged illness. Such vulnerability can remain over a considerable time, held within the long post-trauma echo.

To expand upon the traditional definitions and approaches, we can think of trauma in terms of something so far beyond the ordinary that it will overwhelm one’s resilience and defences. It becomes impossible to feel the full impact of the trauma, or to function as normal. Reports of survivors and witnesses frequently detail a sense of disbelief and numbness in response to what they have seen and experienced. The result is that what one had previously held safe is no longer reliably so. One’s perception of the world changes irrevocably. Garland (1998) has noted that trauma causes a kind of wound, that renders useless the protective filtering processes through which we have come to feel safe in the world. I believe this is a useful context within which to think about trauma, because it links both the inner life and previous life experiences of the individual to the traumatic event. Trauma does not occur due to the external factor of a single event. Trauma is enmeshed in an internal process of an attempt to assimilate how the event has irrevocably affected the individual.

We usually associate the word trauma with single events, such as major accidents, natural disasters and acts of war. While most people said to be ‘traumatised’ have experienced or witnessed a terrible event, it is not necessary to be present at the site of a disaster to be affected. Our vulnerability to the effects of trauma is increased with the speed of satellite communication, where news reports including pictures and footage of disasters can reach across the world in minutes. Trauma is also not only experienced in relation to disaster or war. Sudden or unexpected news of the violent death or injury to a loved one can also cause a severe, traumatic reaction, including PTSD. In today’s society, the impact of trauma is more widespread than ever before.

Contextualising multidisciplinary attitudes to trauma

While contemporary thinking about trauma takes into account the severity of impact upon the population, this has not always been so. A brief overview of the changes in attitude to trauma reveals it was only recently acknowledged that people are indeed acutely affected by exposure to traumatic incidents.

One of the first examples of any mention of trauma is from the 1860s. John Ericson, a British physician, noticed a pattern to the psycho-emotional responses of patients involved in railway accidents. Ericson hypothesised that there was a direct physical cause for this because of the shock to the spine during the accident. This work motivated half a century of further research from authors such as Pavlov, Crile and Cannon (cited in Young 1995, pp.21–6). However, it was the thinking of Freud, Binet, Janet and Breuer that considered the psychological consequences and the idea of a shock or wound to the mind (Leys 2000). This idea was by no means generally accepted. Although during World War I the term ‘shell shock’ was used to describe what we now understand as post-trauma responses, there was very little support or sympathy for those affected. Only relatively recently – during the past four decades – has widespread interest been shown in the effects that traumatic experiences have upon people. From the 1970s onwards, there has been an increase in multidisciplinary perspectives, and with this came an expansion of the concept of trauma. Notable contributions are found from Herman’s 20 years of work on the trauma of abuse and violence (1992), and van der Kolk’s focus on mind–body links rather than the mind or body alone (van der Kolk, McFarlane and Weisaeth 1996).

The field of neurology has had a significant role in current thinking, suggesting that during the traumatic event there is a sensory overload, which can result in lasting damage to brain processes (Sutton 2000). This approach has presented a hypothetical overall process relating to the traumatic experience itself. Damasio, for instance, suggested a distinction between two kinds of brain processes, ‘primary’ and ‘secondary’ emotions, that are implicated during traumatic experiences (Damasio 1994). ‘Primary’ emotions relate to ancestral survival responses that can be said to be ‘wired at birth’, while ‘secondary’ emotions are linked with the patterns of behaviour set down through early life experiences. ‘Primary’ emotions are set in place while living through a potentially life-threatening situation (the familiar ‘fight or flight’ responses), and ‘secondary’ emotions offer opportunities for finding ways of adjusting to having experienced such situations. These processes are inevitably interconnected, in the sense that Damasio says: ‘secondary emotions utilise the machinery of primary emotions’ (Damasio 1994, p.137). Grounded in brain research, the work of neurologists has introduced some new perspectives from which to view the post-trauma process (Swallow 2002).

Experiences of real or perceived threat to survival have roots in our ability as a species to survive. These experiences link with our early perceptions of feeling safe or ‘not safe’. As infants we depend on our primary caregivers for our physical and emotional safety and these first relationships colour all subsequent relationships. The impact of these early experiences of threat to survival – or loss of safety – have been another important perspective from which to think about trauma.

Klein related a sense of loss of safety to the early infant experience of the breast (Klein 1940, pp.311–38). Klein suggested that when the feeding breast was removed there was a feeling of abandonment for the baby. Infant caregiver observations have revealed the overwhelming nature of sensations for the infant in these situations (Marrone 1998; Piontelli 1992). The impact of this experience is at such an early stage that neither resources nor language for processing or assimilating the experience are available, with the repercussions reverberating throughout life. Bowlby considered the earliest relationships from infancy into childhood to have had a central survival function, enabling the developing child to feel safe and protected (Bowlby 1988). It would be impossible for the adults in these relationships to have created a constant state of security for the infant. Nor would this cushioned existence be of use to the infant, who would be without a means of developing any resilience to the stresses of everyday life. Bowlby wrote in detail about the result of developmental changes in infant perception, from feeling safe to feeling unsafe, particularly focusing on the sense of loss of safe attachment and its implications for later life.

Stern (1977) also showed how the two participants in the first relationship brought their individual life experiences to the interaction. Here, for instance, through the mother’s own developed patterns of response, she passed on to her child her experience of her mother. However conscious the adult is of the experience, and however they aim to protect the infant from it, they still have the memory of their own abandonment and losses at the unconscious level. While in altered form, this inherited experience passes through generations.

As shown briefly above, the psychological literature is another area that has informed the work of trauma specialists, based on the realisation that our early experiences are not only carried throughout life but also in some altered form passed on to our children. When faced with perceived or real physical threat to survival during traumatic events later in life, these early survival experiences directly influence the ways in which we respond.

Broadening the perspective further, traumatic events have an impact not only on the individual, but also upon community and society. Northern Irish researchers Dunn (1995) and Smyth (2002) have shown how delicate and complex exposure to such events can be. Taking the example of the New York World Trade Centre collapse on 11 September 2001, the repercussions of a single event can be immense and long lasting. There are many levels at which this occurs and one does not have to be physically close to the event to have become affected. For instance, while those at or near the scene were severely affected, those outside the immediate area and beyond also felt the traumatic shock. The news footage that travelled across the globe rendered countless others vulnerable to the impact of the event. Apart from the observers’ responses to news footage, it is easy to forget that those who brought us reports of the event could be affected. Mark Devenport, the BBC Northern Ireland Political Editor, has written about how his experiences of reporting have stayed with him: ‘I never liked knocking on the door or picking up the phone to talk for the first time to the family of a terrorist victim. Unlike the doctor, the priest, the neighbour or the social worker, I felt I wasn’t offe...

Table of contents

• Cover
• Half Title
• Of Related Interest
• Title Page
• Copyright
• Dedication
• Contents
• Acknowledgements
• Introduction
• Part 1 Trauma Perspectives
• Part 2 Culture, Society and Musical Perspectives
• Part 3 International Clinical Perspectives
• Part 4 The Support Perspective
• Afterword
• List of Contributors
• Subject Index
• Author Index