Oliver Sacks, a doctor and neurologist who has written many books regarding the different effects of brain injury, asks whether people who are living with dementia lose their sense of self as a result of memory loss which can progress to a loss of judgement, planning and self-awareness.
He suggests that ‘..aspects of one’s essential character, of personality and personhood, of self, survive, along with certain, almost indestructible forms of memory-even in very advanced dementia. It is as if identity has such a robust, widespread neural basis, as if personal style is so deeply ingrained in the nervous system, that it is never wholly lost…’ p. 336
And most importantly for our purposes here,
‘In particular, the response to music is preserved, even when the dementia is very advanced…The aim of music therapy in people with dementia…seeks to address the emotions, cognitive powers, thoughts and memories, the surviving ‘self’ of the patient, to stimulate these and bring them to the fore. It aims to enrich and enlarge existence, to give freedom, stability, organisation and focus.’ P336-337
‘…music therapy with such patients is possible because musical perception, musical sensibility, musical emotion, and musical memory can survive long after other forms of memory have disappeared. Music of the right kind can serve to orient and anchor a patient when almost nothing else can.’ P337
He gives examples of a patient who could continue to play the piano to a high standard despite living with Alzheimer’s disease- the type of memory that such a skill requires seems to stay intact for a long time. He also describes how many parts of a person’s character could remain intact e.g. kindness, politeness, as if these behaviours too were long established and less likely to be lost.
Singing
Sacks talks about the significance of singing for people who are living with dementia, how the realisation that people are still able to sing fluently, despite perhaps loss of other language skills feel reassuringly positive. A sense of ‘I can do that!’.
Singing ‘..can stimulate his feelings, his imagination, his sense of humour and creativity, and his sense of identity as nothing else can. It can enliven him, calm him, focus and engage him. It can give him back himself, and not least it can charm others, arouse their amazement and admiration-reactions more and more necessary to someone who, in his lucid moments, is painfully aware of his tragic disease and sometimes says that he feels ‘broken inside’.’ P342
Sacks describes the effects of positively engaging with music in this way ‘The mood engendered by singing can last a while, sometimes even outlasting the memory that he has sung, which may be lost within a couple of minutes.’ P343
Groups
Sacks goes on to talk about similar effects in group context, how people suddenly can focus and pay attention when they hear a familiar song, that ‘…patients become alert and aware; agitated ones grow calmer.’ P. 344
He talks about how remarkable it is that attention can be gained and held for several minutes at a time, how people engage specifically with what is being played- by using old songs that people of similar ages and backgrounds would have known.
Using music that is familiar to people is important as it can help in ‘…eliciting emotions and associations that had been long forgotten, giving the patient access once again to moods and memories, thoughts and worlds that had seemingly been completely lost. Faces assume expression as the old music is recognized and its emotional power felt. ‘ p. 344
It can be powerful to see a whole group, many of whom had been unable to talk before, all singing together as much as they can: ‘…a sense of community takes hold, and these patients who seemed incorrigibly isolated by their disease and dementia are able, at least for a while, to recognise and bond with others.’ P.345
Music can be a ‘…can-opener for people’s memories.’ P.345
Part of the work is finding out what individual people will respond and relate to, sometimes people can still respond to the emotional power of unfamiliar music.
The positive effects and reprieve from symptoms that have been set off by music can be long lasting, persisting for hours or days.
Music is part of being human… to those who are lost in dementia…Music is no luxury to them, but a necessity, and can have a power beyond anything else to restore them to themselves, and to others, at least for a while.’ P.347
Reflective Questions
Q: Why is music is music so effective in supporting people who are living with damage to brain structures as a result of dementia?
This is to do with the way that music is stored across all areas of the brain. This means that people with dementia, even advanced dementia, are often still able to recognise, access and engage with music when other cognitive functions are deteriorating or lost. This can support people with dementia to retain a sense of their identity, and belonging, a sense of being seen and heard. Music can stimulate memories, emotions and language functions, it can support movement and connection with others.
Q: What can some of the aims of music therapy be in supporting someone who is living with dementia?
Supporting a sense of connection with others, strengthening relationships with others, engaging in positive social experiences with others, allowing opportunities to express difficult emotions, supporting a sense of identity, opportunities to express personal preferences, provide opportunities for strengths-based interactions which support and sustain what people are still able to do, to name a few.
Q: Describe the importance of singing when people are living with dementia
Singing can provide a sense of agency and feelings of achievement. Singing can also stimulate emotions, memory, creativity and support a sense of identity for people living with dementia. Singing can support emotional regulation and may improve mood and attention. Singing with others creates a sense of community and connection and can decrease feelings of isolation, allowing people to be seen and heard.
Q: How might you find out what music is important to and connects with someone you work with?
This is a combination of investigation, speaking with friends and family, looking into the music that was popular when the person was between the ages of 10 and 30 years, and trial and error – it may be that music that is not all that well known to a person creates a response. A good place to start is with widely known familiar songs.
Can you describe how someone you know who lives with dementia responds to music or certain songs? What is the song/music? What happens when they hear it or it is sung? Do you use it in certain situations?
It can be helpful to note your thoughts and feelings down for you to reflect on later.
