A Healer’s Craft
THE TOOLS OF THE TRADE FOR ART AND MUSIC THERAPISTS ARE IMAGINATION, CREATIVITY AND SONG.The New Physician
At Duke University Medical Center’s oncology unit, a little boy with cancer looks forward to seeing musical therapist Martha Burke, who will come by with her cart of musical instruments, tapes, or sometimes, just her voice, to help him forget his grown-up troubles. Often the boy’s parents join them in singing “Noah’s Ark”—the boy’s favorite song. Eventually, the day arrives when they call Burke to sing the song with them one last time.
“I never knew if he liked it so much because of the animals,” Burke says, “or if it was because the ‘twosies’ part made him feel like he’d never be alone.”
At another hospital in North Carolina, a smaller, long-term care facility, Sammie Goodwyn stands on a chair, creating a bulletin board. A fellow worker helps her as she places letters and figures, just as most of us recall doing as children in grade school. From a small distance away, seated in a mobile recliner, a patient with late-stage Alzheimer’s watches Goodwyn work. When Goodwyn steps down and backs away from her creation, her patient, to her surprise, begins grading her project—just as the patient had done so many years ago when she was a schoolteacher and then a principal.
“She just very coherently examined our work and told us how we had done,” Goodwyn says, chuckling. “Overall, we got a B.”
It was for art therapist Goodwyn the pinnacle in role reversals. And ultimately, a strong selling point for her vocation. Goodwyn and Burke are members of the small army of medical creative therapists working to find their niche in health-care environments nationwide. It’s not an easy task, but it is, they and other practitioners of their craft are finding, more than just worthwhile. Sometimes it’s just plain necessary.
Patients with Alzheimer’s “are like little windows of time that open up occasionally, those times when they are just as coherent as you and I,” Goodwyn says. When those windows open, Goodwyn is there—must be there—with her keen sense and her art activities and her materials. Chalk and paper, ink and paint, canvasses like bandages to the soul.
“The things she creates,” Goodwyn says of the former schoolteacher, “[act as] a barometer for the staff of where she is right now. We did a lighthearted activity the other day, because so many of the patients have the flu right now. I cut out some snowflakes and put them down in front of them. She knew it was a snowflake, so that’s progress. And watercolors—she does these absolutely beautiful pictures, very clean, clear colors. You wouldn’t think someone with the disease could do such things.
“It tells me that that particular part of her brain is still functioning.” But what it does best, it ultimately does for the patient’s physical well-being. That’s the critical distinction between medical art therapy and the traditional form we associate with psychotherapy use—the ink blots, the drawings meant to glean information from a patient whose illness is mental. The links, however fuzzy, between what a patient thinks and what he feels in his body are the focus of Goodwyn’s craft.
Goodwyn says that working here is nothing like she expected. Patients here are dealing with “all the stuff that’s left over, the loose ends they didn’t get to when they were fully functioning, the stuff you wished you’d done differently. These are end-of-life issues. These are folks who are facing a real deterioration of independence, a deterioration of choices.” Art therapy, she says, gives patients a choice, by saying, “What do you want to do today?”
But, this is not an art class. Goodwyn works to help her patients understand each other as a group as well as the memories that have fallen from their mental scrapbooks. Together, they get better. And when one person in a group activity can’t see to draw or to paint or to create because time has taken his once sparkling vision, Goodwyn blindfolds the group. “Here,” she says, as they go about their creations, “now we are all the same.”
The art they create can be as telling a part of patients’ medical records as the diagnoses and prescriptions on a hospital chart. Broken lines, borders undefined, disjointed stick figures with arms poking from a head where ears should be. “It mimics what’s happening to their health exactly,” she says.
Art therapy’s acceptance in a medical setting is a scattered and sometimes tattered proposition. Managed-care cutbacks forced Goodwyn, who had served on staff at a local hospital purely as an art therapist for at-risk patients, to look for work elsewhere. Third-party reimbursement for an art therapist is difficult in many states—most practitioners end up seeking licensure under the title of “counselor” as a result, incorporating their art therapy into a range of other treatments, including traditional psychotherapy. And the national American Art Therapy Association is still pulling together to advocate the practice’s cause, Goodwyn says.
Laura Black Keenan, who’s worked in the field in Pennsylvania since 1991, says some states have it better than others. In fact, medical art therapy is alive and thriving in such metropolitan areas as Philadelphia, where a graduate program at MCP Hahnemann has added two electives in the specialty in recent years. One is directed toward children’s studies and the other, adults. Hahnemann was the first school in the nation to offer art therapy in a medical method—thanks to Keenan, who created the program at the pediatric rehab unit at Children’s Seashore Hospital (now Philadelphia Children’s Hospital) when she was a second-year intern in Hahnemann’s art therapy curriculum.
Keenan pitched her idea to the hospital based on what she’d seen in children. “I went through the different aspects of what art therapy helps children deal with,” she says. “First, there’s just the ‘being in the hospital’ part, being set apart from their friends and their school activities. [And], there’s also the pain they’re feeling from their bodies, from recovering from a serious illness.”
Many children who don’t understand what’s happening to their bodies refuse to cooperate with doctors, tearing out IVs, turning off machines, venting emotions. Keenan’s solution is to turn what scares them into art. So, she gathers tubes, gauze and bandages—just about anything but needles—and from them spring amazing collages and sculptures.
“Art is a child’s language,” she says. “It’s a language for anyone who hasn’t learned to or can’t verbally express what’s wrong.”
Of course, there are those who view Keenan’s work simply as “playing and having fun,” but, for the most part, it’s met with enthusiasm. Now, Hahnemann’s course also is offered to practitioners already in the hospital setting, and many students choose to do their internships in medical art therapy at surrounding health centers.
SOUND OF MUSIC
The driving force behind the creative arts therapy movement is a trend toward holistic healing, the idea that physical well-being cannot be achieved without the senses—something that has evolved over the last five to seven years. But the most widely accepted of these seems to be music therapy. While there are only about 30 graduate programs for what Goodwyn and Keenan do, there are more than 70 such curricula for Burke’s music therapy. And music therapy has a more cohesive national organization, the American Music Therapy Association.
One way music therapy has made inroads to moving out of the “alternative” medicine realm is by finding acceptance at large medical centers of note. Duke University Medical Center opened its music therapy program for patients in 1991 in its oncology unit; now, there are specialized offices for the heart center and at the Durham Veterans Affairs hospital with which it closely works. Likewise, the Ireland Cancer Center in Cleveland includes it as an integral part of patients’ health.
“The larger institutions are more likely to hire a music therapist on staff,” says Burke, citing funding and advanced research as causes.
Burke completed a nationwide study two years ago of hospitals to find out which kinds of creative arts therapy personnel they had on staff. Most had at least one music therapist. But, “in general, it wasn’t as widespread as we’d like it to be,” she says. “It’s going to take finding advocates in the medical field to push its importance to bring [it to] the level where it should be. It’s seen as a luxury, but at the same time, there’s more interest in it than ever. The medical field as a whole is realizing that you have to treat the whole person—you can’t just treat the symptom and let them go.”
But even smaller community hospitals are more likely to have a music therapist than an art therapist, Burke says. People still tend to think of art as a purely psychological remedy, overlooking its medical twist, she says. And most people intuitively grasp the idea that music has an effect on our senses—it keeps us awake on long trips and helps us relax after a hectic day. But music therapy’s real advantage over art therapy may be that medical research has shown it can improve a patient’s physical health and not just brighten the emotions.
Burke cites a study she conducted with knee replacement patients using music. All the participants underwent the same kind of surgery and were given the same kinds of treatment, except for the half who had music therapy incorporated into their postoperative rehabilitation. These patients were overwhelmingly more satisfied with their treatment than the half who didn’t receive the therapy, reporting that their pain was more controlled and that they felt they were treated with more respect. They also thought everyone should be given music.
Colorado State University researchers also have found that using music for people suffering from Parkinson’s disease or for patients who have had strokes helps them strengthen muscle movements.
What explains it? Cheryl Benze, a music therapist at Duke University’s Heart Center, says that listening to music lowers heart rate and blood pressure and increases the production of oxygen because it causes the body to produce higher levels of melatonin, the sleep hormone, and serotonin—a neurotransmitter that carries vital signals between certain brain cells.
“So people rest better when they listen to music,” she says. “It also encourages the immune fighting hormone [IaG], which of course helps the body heal itself.”
BRIDGING THAT GAP
But there may be another powerful force—giving rise to therapies of the senses—managed care.
“Music can fill that gap where everything else is being cut and minimized by managed care,” Burke says. “It alleviates that get-’em-in-get-’em-out feeling.”
Benze agrees. “Nurses don’t have time to give personal attention anymore, to sit with patients like in the past,” she says. “By proxy, I give them that nursing attention that’s lacking.”
And, unlike other hospital personnel, art and music therapists are encouraged to be emotionally involved in their patients’ welfare. But the corporate workings of medicine today even take their toll on Benze, who often must give a crash course in her craft to the treat-’em-and-street-’em set.
“These patients are often in and out in a week,” she says. “It’s a challenge to reach them in that short amount of time. I tell them, ‘Just remember my voice. Remember me singing this song to you, and then sing it to yourself.’ I teach people to understand how their bodies react to music, to peel off all the layers.”
Benze travels the hallways at Duke with her cart of musical instruments. Sometimes, she’ll pull out a harp and begin to play for a patient. Other times, she’ll ask what kinds of music the patient likes—and then create a tape of those songs for him, a “prescription” from the music therapist. And there are patients who prefer to sing along with her—which often ends in a room full of hospital staff, including some nurses and doctors, stopping in to join the music.
Indeed, physicians at Duke have been overwhelmingly positive about the introduction of music therapy since Benze began in 1993. She says physicians on staff are happy to incorporate it into the center. It’s also been popular among medical students, who can take a music therapies course in their third or fourth year.
“It’s particularly important that medical students get introduced to music therapy,” she says. “When they spend the majority of their later years in clinical settings, it can be overwhelmingly technical. The psychosocial part of treating patients gets lost in the nuts and bolts of what they’re learning.”
The greatest testament to creative arts therapies’ value, though, is that patients continue to give them A-pluses for their unconventional healing, Benze says.
“I take people by surprise,” she says. “I’m not going to stick anyone. I don’t wear a white coat. I carry a guitar.”
Elizabeth A. McNichol is a freelance writer based in Chapel Hill, North Carolina.