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Article 1001
Where Words Fail, Music Speaks

            In my home I have a sign over the door that reads, Where Words Fail, Music Speaks.  Never have I experienced this truth more profoundly than while providing music for hospice patients and their caregivers.  The appropriate music played with care and skill can be “medicine for the spirit” – as one patient put it – for both patient and caregivers.  People are often surprised (and usually delighted) to discover that Hospice Partners of the Central Coast offers in-home visits by one of three full-time staff musicians to any hospice patient or family who desires it.  As part of the Spiritual Team, the Hospice Musicians are full members of the Interdisciplinary Team, working with each patient, patient caregiver and fellow hospice team members to provide the most beneficial music possible.    
           
            The use of music as a modality of palliative care is nothing new.  For millennia, music and medicine were intertwined in the imaginations and practices of ancient musicians and physicians alike.  To the ancient Greeks, Apollo was the god of medicine and music.  He was often depicted in art and sculpture holding the stringed lyre on which he played celestial or curative music.  His two most famous sons were Orpheus, the musician who quieted the wrath of the Furies and calmed Death himself with his sublime singing and lyre playing; and Asclepius, the physician to whom the Greeks dedicated their places of healing.  It is said that in ancient Greek healing clinics, music was played regularly to soothe the soul and restore the spirit.Plato, Aristotle, Pythagoras, Boethius and many other Classical Greek and Roman philosophers and poets devoted much attention and numerous pages to music’s powerful capacity to temper the soul (psyche), shape character and foster healing.   
           
            This rich, mutually beneficial marriage between music and medicine was still thriving in the 10th century AD, when the European hospice movement blossomed in a Benedictine monastery in Cluny, France.  The use of music to address or alleviate suffering was central to the monks’ medical practice.  Like the Greeks before them, these musician-physician-priestswerekeenly aware of the intimate relationship between mood and musical mode.  They observed that when we are exposed to music our mood is altered, emulating the emotion, feeling or spirit of the music we are hearing.  The images, rhythms, sensations and fantasies that simultaneously engender and flow from one’s “interior state” change as we are surrounded by and filled with a new “spirit”.         
           
            When you are agitated or tense and listen to soothing music in order to calm down, you are practicing the ancient art of tempering the soul.  As you listen, your thoughts and fantasies unwind themselves from, say, workplace conflicts, and a spirit of spaciousness and ease – conveyed sensually by the music – tempers your psyche.  You relax as your mood is affected and adjusted by the mood of the music you are hearing.  When you are sad, you might temper the sorrow by listening to buoyant music that invites a spirit of joy; or you may listen to music that moves you further into the melancholy, giving it more depth, allowing you to feel into its deeper necessity.  When you hear music of your faith tradition, you are likely filled with a spirit of reverence, gratitude, awe, humility or hope; when you hear songs of unrequited love, you feel yourself “taken over” by that particular inflection of sorrow and longing, along with the images, memories and fantasies that accompany it. 
           
            Music’s ability to influence one’s interior state may seem self evident, but in this highly technological and machine oriented age it is easily overlooked, and it is an important part of what makes music so effective in hospice care.  Many things can temper one’s mood – scent, conversation, a place, drugs, touch, food – but the ancients knew that music is especially powerful in this regard.  Over the hundreds of years the Cluniac monks practiced musical medicine, they became extremely knowledgeable and adept regarding the use of specific musical modes to tend highly differentiated and nuanced expressions of suffering. 
           
            An appreciation of music’s tempering qualities is, of course, not only an ancient western phenomenon.  Throughout history, countless cultures have recognized and utilized this dimension of music in their healing traditions.  One important common denominator among these diverse musical practitioners is the awareness that illness, dying and death are more than medical or physical conditions; they are also profound emotional, psychic and spiritual states.  As Hospice Musicians, the music we provide our patients – while connected to and informed by the rich music/healing traditions that have come before us – is unique to this complex culture at our time in history.  However, the “outcomes” we observe are not unlike those the Monks of Cluny noted and notated in their manuscripts.    
           
            Daily we witness music’s ability to soothe suffering that is unreachable by words (or medication) alone: easing fear, anxiety, distress, anger and depression; fostering comfort and a profound sense of connection and camaraderie among patients and their families; eliciting stories and images of deep meaning and significance.  We watch as “non verbal” Alzheimer’s patients smile, tap their feet and sing along to songs that hold holy memories.  In chaotic, clinical or sterile environments, we see music’s capacity to soften the atmosphere, inviting invisible but tangible qualities such as stillness, reverence, peace, a sense of safety, depth, healing sorrow, joy, and sometimes even laughter, to the bedside of the patient.  In addition, we have repeatedly observed music’s capacity to ease physical symptoms: to quiet labored breathing, restlessness or insomnia, to calm agitation and soothe even severe physical pain.  For families of an actively dying patient, music can help nurture a last and lasting image of their loved one that includes – at its heart – beauty, a deep and abiding sense of intimacy, and an experience of sacred mystery.   
           
            The kind of music provided depends entirely on the situation, circumstances and needs.  Each patient, and each family, is unique.  There is no “one size (or song) fits all”.  The music provided is for this patient and family at this time in these circumstances.  Furthermore, the music provided is adjusted and modified during the course of each specific visit based on the changing moment-by-moment needs of those present.  Like other members of the hospice team, the Hospice Musician’s task is to meet each patient and family “where they are,” while being responsive, compassionateand attentive. 
           
            Whether providing soothing music on harp or flute to support a patient who is actively dying, sacred songs from a patient’s religious tradition on guitar and voice, popular or folk songs a patient has loved all his or her life, lullabies or chants sung a cappella, songs created spontaneously for a particular moment, or some other variation of music, we are grateful to be of service at this most fragile and vulnerable time in a person’s life. 

Chris O’Connell, BA, CHM, has been providing music to hospice patients for over a decade.  He is a regular presenter on the subjects of the Musical Imagination and Music in Hospice Care.  He has performed at retreats, conferences, hospitals and festivals throughout California, Oregon, Massachusetts and New York.