Devotional Music Therapy,
Music Therapy within the Context of Yoga and Eastern Spirituality
Death is absolute, transforming anyone who is in its presence. During the death process, we – the dying and the caregiver - move beyond the personal sense of self. The essence of who we are naturally reveals itself, and we tap into a collective source of wisdom connected to the impermanence of the body and the strength of the human spirit.
Drawing from indigenous practices as well as Western and Eastern spiritual perspectives on death and dying, this chapter presents a framework within which to consider the subtleties and modalities of implementing the voice, vocal music, and sound to accompany the death process. This approach is based on the premise that music therapy at the end of life can be enhanced by the insights of the philosophy and practice of yoga (first named around 1500 B.C). The word, yoga, denotes union, deriving from the Sanskrit root, yug, meaning to bind or yoke (Eliade, 4). This union refers to the merging of divine consciousness with the human spirit. As an integral science for human development, yoga consists of a system of philosophical, physiological, spiritual and mystical practices (angas) that attempt to move one towards the state of unconditional liberation. Through various techniques and modalities, yoga teaches us to connect with the power and the light at our center, and that the path of enlightenment is a return to that source.
Yoga may facilitate a profoundly supportive presence by the therapist when the idea of ‘liberation from conditions’ is integrated into the process of working with the dying person. Therapists thus may move gently from their strategies of busily doing, prescribing, changing, planning, playing lots of music and making decisions, to the yogic state of just being present, without a musical or therapeutic agenda.
Whereas the word, yoga, in the West is often used to refer to physical exercises involving movement and breath, these practices are more accurately termed, hatha yoga, and they are only one small piece of the yogic path. Hatha yoga focuses on the body, using asana, or specific postures practiced with a meditative mind and an awareness of the breath. Traditionally, a hatha yoga session ends with savasana, or corpse pose, where the practitioner lies in stillness, surrendering the weight of the body as much as possible to the floor. It is a practice of letting go, a rehearsal for the inevitable dying process with its necessary detachment and dissolution. After the body is completely relaxed, silence is invited, and the experience is completed with intonation of the seed syllable, OM. This, as well as other ancient seed sounds and mantras from many cultures are especially effective when intoned while the body and the mind are at ease and relaxed. These sound formulas become the vocal conduits to invoke and manifest the union with the Divine within. Their therapeutic potential is unquestionable and constantly evolving.
In my experience of relating to the dying as a music psychotherapist, training hospice workers, and being in contact with the families of the terminally ill, I have found it helpful to conceptualize death as an asana itself, a posture that involves letting go of controlling the mind and body and being at ease. This is a state that can be shared by both patient and clinician.
The approach I use also draws from the wisdom of indigenous and shamanic traditions that understand the process of dying as a journey. These provide direction in transforming fear and despair into a skillful means of practical support for the journey. These practices involve using evocative voices, simple chants and deep drumbeats to facilitate the transference of energy, while also connecting with the healing power of nature and the spirit world for information and strength. When possible, it is beneficial to offer the sessions outdoors in nature, integrating the smells of flowers and trees, the sound of birds, and to play and share percussion instruments made of natural materials, such us shakers made of tree leaves.
The practices described in this chapter merge these diverse yet universal traditions: yoga systems, shamanism, and world spiritual traditions, such as Buddhism and Hinduism, that emphasize the importance of unifying with the divine at the moment of death, as one moves beyond ordinary consciousness and the material world. This perspective on the death process and the practices related to it can enhance and enrich music therapy at the end of life, a field that is constantly evolving.
It is also my intent to highlight issues involved in the selection of music for end of life care, so that the reader may reach a deeper understanding of the relationship between the architecture of the music and its power to shift emotions and lessen pain. The musical concepts of rasa, spiritual melodicism, mystical minimalism, and changeless harmonies, will be described, with special attention given to the texture of the voice and the quality of the melodic, rhythmic and instrumental arrangement of the music. A closer examination of these structural musical concepts may refine one’s auditory sensitivity, thereby increasing one’s mindfulness and creativity, while also encouraging the use of culturally diverse styles.
Pre-Assessment; Being Rather than Doing
As music therapists we have been trained to explore the integrative experience of sound, emotion, behavior, and consciousness. In caring for the dying, we create a therapeutic container to hold and release emotions, physical pain, and an emergent spiritual inquiry. Finally, we learn to accompany the person by peacefully ‘being there,’ with an unconditional sense of presence, providing our musical energy as needed. In chanting and vocal forms of meditation described later in the chapter, the voice communicates healing and comfort.
This kind of relaxed presence and discreet musical intervention can be a challenge for music therapists whose backgrounds may emphasize making music, assessing, prescribing, treating, and ‘doing’ things for the patient. Alternately, the model presented here encourages pre-assessment of the state of the clinician’s own body/mind/spirit of the, as preparation for being with the patient. We pre-assess ourselves in order to offer a presence that is delicate, intimate, open, and simple. This state is grounded in the observation of one’s own thoughts and emotions before entering the presence of the patient.
During the session itself one also aims for a higher appreciation of the function of breath, sound, touch, body language and culture. We relax our therapeutic expectations and continually reevaluate the impact of our clinical interventions to realize the delicate balance between being and doing.
As music therapists for the terminally ill, we rely on the soothing properties of the music we play and create, concentrating on relaxing the patient’s body and mind, while accommodating feelings of loss, suffering, and forgiveness. My combined and extended experience as a clinical psychologist, music therapist, composer, and practitioner of meditation, has helped me to be mindful of the integration of various clinical strategies during the same session. A regular session starts after my own pre-assessment and meditation session, so I can approach the patient with a serene presence. I softly touch his or her hands, still within the space of non-verbal communication. If the circumstance allows, I will ask the patient if he or she is open to listening to music, and what kind of music they would like me to play. Usually, I play long tones or drones with a small harmonium, and accompany the long tones with a soft voice, humming simple repetitive melodies. Sometimes the patient wishes to accompany, and he/she repeats the same melody, creates harmonies, or creates new melodies. If requested by the patient or somebody in the family, this creative music therapy exchange is followed by a familiar piece of music played live or on a CD album. At the end of the recorded music, I invite meditation, and we share a deep silence for as long as it lasts. Sometimes the patient enters into an expanded state of consciousness, sometimes she/he falls asleep, and other times he/she feels like talking, sharing memories, or expressing previously contained emotions.
There is a gentle quality to our exchange—rather than establishing a relationship to the dying person, with the attachment that this implies, we are relating in the present, continuously opening ourselves to the experience of the moment.
The basic therapeutic attitude of being with the dying also challenges us to move away from our own needs and wants to create an environment for the patient that is inviting but not invasive. Exchanges with the patient are meant to facilitate relaxation, intimacy, wisdom, and spiritual insight, whether these involve music, words, or fertile silence. Thus, the quality of mindfulness becomes a core value in this process.
Mindfulness is the skill and art of living in the present, without judging, reflecting or thinking. It is simply observing, with each breath, the moment in which one finds one’s self. Implicit within the experience of being is the approach of inviting rather than imposing, exchanging rather than changing, and sharing and mirroring instead of advising, judging and expecting. Therapeutic energy is generated by learning how to match and tune in and dwell with the patient in the same emotional frequency. It is a quality of receptiveness that involves surrendering to a force larger than one’s self.
Through attention to breath, tone quality, chanting, singing over a drone, and sometimes using soft pulsing rhythmic accompaniment, one may facilitate what in the Buddhist tradition is the basic technique for relaxation and healing: resting in the nature of mind. This state is one of clarity, radiance and emptiness. The musical exchange facilitates relaxation and spiritual intimacy.
Assessment of the patient involves gathering information related to his or her medical status, mood, coping ability, prior musical experience, especially with regard to singing and chanting; cultural and social background, spiritual orientation, and religious affiliation. It is important to discover how the patient led his or her life to acquire a better understanding of how he or she wants to die. This can be gathered through talking to family members and being in the patient’s home as well as talking to the patient him/herself. It is not necessary to share the same spiritual orientation with the patient, as therapy is based on unconditional compassion that goes beyond spiritual and cultural factors. Therapists may visualize themselves establishing a connection with the patient even before they are in their presence.
Through clinical assessment, we create a singular music therapy approach that is appropriate for the patient’s needs; this is modified according to changes in the patient’s condition. It is important to remain open to the variety of ways that the therapist and patient may engage in the musical experience, for example, actively (through actual co-performance), or passively (through listening).
Breathing and Vocal Practices
During the pre-assessment as well as the assessment stages, one aims to cultivate a devotional attitude of selflessness, and to dissipate tensions in the body and mind. Chanting can be a powerful means for developing a clear state of mind.
“Chanting is a significant and mysterious practice. It is the highest nectar, a tonic that fully nourishes our inner being. Chanting opens the heart and makes love flow within us. It releases such intoxicating inner bliss and enthusiastic splendor, that simply through the nectar it generates, we can enter the abode of the Self” (Muktananda, 7).
The following exercises may be used effectively in the therapist’s pre-assessment as well as during the patient assessment and treatment.
Basic QiGong Breathing; Sensing our body; emptying our mind.
Standing up or sitting, hands are free of tension, the chin is parallel to the floor, and the eyes are soft, not closed and not completely open. Take a deep breath, keeping the shoulders down. Bring the open hands and arms near your belly, while holding the breath in the pelvic cavity for few seconds. Exhale slowly, directing the air upwards towards the crown. Release the hands and arms. Repeat at least 3 times. Variation: include 5 neck rotations in each side (left/right) before exhaling. Duration: 5min
Vocal Release; The Effortless Voice Practice
Allow for sound to follow breath, and voice to follow sound. Release a vocal tone through a relaxed and small lip opening, like humming (sounding like “wuu”). Sustain your focus on that specific tone, toning over a subtle drone played by an external instrument or device. Keep a clear sense of sounding one or two notes, dwelling in that tonal space. We attune ourselves to tone, not yet exploring melody. [The drone is a continuous tone or harmony usually created with the simultaneous sound of the tonic and dominant (Fifth), or the tonic (Fourth). If played on strings, it will involve many other partial harmonies and sonorities. As an essential part of Indian classical music, the drone is sometimes described as “the breath of God,” leading the musician and the listener into a state of contemplation, and slowly clearing the mind to a state beyond thoughts and emotions]. We immerse ourselves deeply into the experience of opening the voice, departing from the root tone, diving into subtle undulations of the same tone, wandering through transformations of timbre and texture. Sounding into the realm of somatic and emotional resonance, the phrasing is simple, calm, and knowing. The tone always returns “home,” to the infinite tonal ground offered by the drone. Variation: use a variety of seed-sounds such as: Ah, Eh, Om, Ram, Bam, Yam, Lam, Tam. These sacred syllables are related to the embodiment of the qualities of the elements of nature. Duration: 5 to 10 min. This toning practice is recommended to enhance deep listening and concentration; the effect of relaxing the mind through this vocal meditation is enhanced creativity.
The therapist may also engage in other preliminary practices, such as listening to a piece of music that brings immediate inner serenity, chanting a personal mantra, reading poetry, creating visualizations, meditating, Yoga exercises, swimming, sand tray design, offering objects to create a simple shrine, arranging the space, and taking a short walk in nature.
The Role of the Music
When working with patients at end of life, we use music in the following ways:
To accompany and offer comfort
The Therapeutic Power of the Music: An Eastern Context
“Our available links with the visible and the invisible worlds are the organs of perception and feelings, which lends sharpness and color to our experience. It is possible that the gaining of this conscious participation - with and through music - will lead to the refinement of the quality of our musical life, enhancing the competence of our service.” (quote from Roland Steckel, 87, from Through Music To The Self, Peter Michael Hamel)
As therapists, it is essential to consider how best to structure the music offered to patients at the end of their lives. To this end, one may question: What are the musical and non-musical elements that contribute to music’s emotional impact? How is effective music structured? How do musical parameters such as density of notes, pace, volume, and timbre, relate to the various uses of music throughout the treatment process?
There is an inherent benefit in combining and integrating sonorities from non-Western musical traditions and ancient systems of music, including Indian scales and ragas, as well as Middle Eastern, Tibetan, Chinese, and Japanese melodies. In these traditions, the boundaries of music, religion and cosmology become permeable, and music becomes yoga, a noble vehicle for the process of detachment and liberation. This perhaps is the fundamental function of music during the final passage.
In the Western tradition, the main components of music are considered to be melody, harmony and rhythm. In the music of India, however, harmony is not part of the musical structure, rather is conceived of as the relation between the performer and the music. Thus, great importance is placed on melody and rhythm, with rasa as the third essential element of musical structure. Understanding the ancient concept of rasa may shed new light on the therapeutic significance of musical structure.
The theory of rasa comes from texts written before the fifth century AD and is an essential part of the formal theory of art in India. It refers to the pure delight that a work of art can elicit, a thrill that comes from sharing the mood and suddenly understanding the true essence of one’s own emotions through the art. “Rasa is variously defined as: savor, taste, mood, sentiment, and relish. It describes a state of heightened emotional perception triggered by the presence of musical energy or a work of art. It appears in the mind as an awareness of a sentiment, such as love, pathos, devotion, fear, joy, heroism, aversion, awe, or tranquility, in which the self becomes immersed to the exclusion of all else.” (Nakkach, 442)
The appreciation of the mood felt through each rasa is a basic component of therapeutic music and a vital part of the methodologies used for healing. It involves the rigorous work of listening to the tonal quality of the scales and melodies that comprise the music offered.
In the author’s approach, the appropriate mood (rasa) combined with the soft tone of voice, a drone or minimal instrumental accompaniment, and specific visualization exercises, are the main clinical tools for facilitating the conveyance of emotion to the patient and, in some cases, for the expression of feeling by the patient. Mindful attention to mood in the music that is offered can evoke powerful emotional reactions, including the release of repressed pain and fear, and subsequently move these in the direction of inner serenity. The sharing of the emotional experience of rasa between patient and therapist also helps to solidify their relationship. At the end of life, the basic rasas or sentiments conveyed by the music the therapist offers most often include inner serenity (shanti), devotion (bhakti), spiritual love (karuna), joy (hasya) and detachment.
This Eastern approach to emotional aesthetics challenges therapists to consider in a new way the transformational power of music in psychotherapy and end of life care. Rather than selecting music based on preference or to produce a specific effect, in this approach, melodies and the pace of the music are chosen to trigger an enduring aesthetic/emotional reaction that can be relived and recalled at will by the patient. In the music of India, powerful melodies are rendered by the combination of rasa and raga. The ragas are considered vibrant musical energies that when played at the right time and season can be profoundly transforming and healing.
An understanding of the basic principles of raga and rasa offers clinicians opportunities to better grasp the connection between music and emotion. It leads us to explore the nature of what we embody as feeling. The appreciation of rasa and the moods evoked by the structure of a song provides a valuable way to access the spiritual or transpersonal nature of fear, pain and release.
In the practice of music therapy, I use a thoughtful combination of vocal and instrumental music, including familiar and original songs and chants, and create a delicate balance between improvisation and the use of compositions. I find it particularly effective to start with familiar songs and images suggested by the patient, and then to use the melodic structure of these songs to vocalize gently, and sometimes create spontaneous chants in the same key and scale as the familiar piece. Some non-musical elements that inspire and add to the clinical container created with music are poems and other suitable readings, including an examination of the lyrics that are part of the songs we share. In addition, making sounds with instruments that contain elements reflecting water, leaves, and air, provides a sense of fluidity and lightness in the communication.
Vocal Music and the Passage: Sounding, Toning and Chanting
“The embodiment of the vocal technique is based on the cultivation of a clear presence and the skillful alignment between the three basic components of the vocal instrument: Respiration, Phonation, and Resonance”(Sundberg, Johan, 25)
The voice as a fabric of breath, tone and expression has the capacity to convey and release emotions like no other instrument. In music therapy at the end of life, one may discover the use of working with the range of breath to tone, using humming as a preliminary practice, to generate an atmosphere of calm receptiveness for both clinician and patient. Before entering into the dimension of melody, one may slowly chant ascending and descending notes over a drone, using sensitive pitch bending. The interval, or space between the notes, is used as a metaphor for the spiritual journey. Of relevance here is the Eastern concept of microtonal intervals, divisions of semi-tones, as well as the practice of meending or portmento, i.e., the slow sliding up and down within the space between two notes. This gentle microtonal movement has the capacity to expand the senses and proves to be naturally entrancing, reaffirming the intimacy in the therapeutic relationship. It also creates a sense of ‘journeying,’ while allowing enough time to connect with the emotion that needs to be released.
Sonorous Yogas: Pre-Melodic Vocal Practices
Sonorous yogas are invocatory words and ancient universal seed-sounds, intoned in particular frequencies that deliver explicit spiritual information. They have the capacity to transform consciousness through sound, sometimes combining the quality of the voice with subtle movement and particular gestures of the hands known as mudras. These practices consist of the use of one tone or a few notes with sacred syllables such as Ah, Ham, Om, Aim, Ram, and Hum, or sometimes with syllables that we create intuitively on the spot with the patient. Musically, the focus is on the production of tone rather than melodic phrasing. One slides and bends the few tones used, like the slow glissando of a cello string.
Sonorous yogas are an ancient form of chanting or toning, and are effective practices to concentrate in the aspects of the sound produced; these facilitate deep listening while also relaxing the body and the mind, improving physiological functioning (heart and heart rates). They also provide a valuable means of inducing a contemplative and sacred atmosphere. The clinician may start the sounding with a call and response technique with a patient, or the patient may simply listen and relax.
Other sonorous yoga exercises include:1) Humming – sounding with the lips closed like the sound of “Mmm;” 2) Toning – chanting one specific frequency with attention to the embouchure used and duration of the sound; 3) Droning – dwelling in one or no more than three different tones over a drone; 4) Meending – microtonal movement of tone up and down over a drone, pausing in between, known in the Western tradition as glissando for strings, and portamento for other instruments 5) Toning with Seed-Sounds – the use of long tones in chanting a meaningful seed syllable; 6) Toning over a Pulse – short tones accompanied with a soft and deep drum pulse; 7) Sonic Meditation – contemplative attention strategies that use sound to sharpen auditory awareness; and 8) Vocal Meditation – toning, droning, and microtonal movement over a chosen scale or raga (the focus is on the movement of tone within a scale, not on creating melody).
Tone, Toning and Transformation of Consciousness
The embouchure, the shape of the lips when we sing, is the seat of tone, with the focal point on the lower lip where the inner air meets the outer. According to Garcia Ricardo, a devoted student of Rudolph Steiner, the tone has its place of origin in the pineal gland. It is the combination of ear, pineal gland, and embouchure that creates tone. The magic of tone is enhanced by emotion, mood, and awareness of the sound. (Garcia Ricardo, 26)
Toning may benefit the individual in a number of ways. A breathy texture fosters a greater appreciation of the function of breath and also auditory sensitivity. The use of long tones engenders a sense of spaciousness that transforms consciousness. During sessions I use toning very softly in a lower register first, producing a sound like Humming but with the lips a bit more open, more like intoning an Uhhhhh sound. I usually use this form of soft toning early in the session to assess the patient’s actual sensibility to music, chanting, or singing a song during the session. While toning, I leave mindful pauses and space for silence during the toning to facilitate soothing and relaxed states, according to the mood and the condition of the patient I may include inspiring words chanted at the appropriate pace to create meaning and intimacy. If appropriate, I invite the patient to harmonize and tone with me. The effectiveness of toning depends upon the quality of the intoning, the attack, the timbre or texture of the voice, the volume, and in particular on the clarity of the intent behind it.
Conscious Musical Structure
In exploring how the music that seems to resonate best is constructed, the significance of the conscious use of melody, rhythm, harmony and mood cannot be underestimated. The modality (tonal arrangement) of a melody, the pace of the rhythmic structure, and the harmonic movement determine whether or not the music and the therapist can meet the complex needs of the patient. For example, music or songs that have dense intricate melodies with many notes and dense harmonies, unless requested by the patient, may overwhelm the vulnerable state of the patient and not have therapeutic value. In my approach, the musical elements that I see as more appropriate are vocal music that is more melodic than rhythmical, consciously alternating minor and major scales, with a slow pace, simple rhythmic patterns, clear and evocative harmonies, I explore chanting and improvising songs over a drone (a long tone). Working with different cultures, we learn that some people prefer Gregorian chants and others like to hear Gospel or classical music; some patients like to hear music they never heard before and others always request the same song in every session. The music of both Hildegaard von Bingen (1050-1111) and the contemporary composer Arvo Part is welcome by the terminally ill.
Some of the psycho-spiritual qualities that may be conveyed or accessed when selecting music for end of life care include inner wisdom, serenity, open mindedness, selflessness, compassion, devotion, calm acceptance, wonder, detachment, inner joy and self-love, radiance, and relaxation. These psycho-spiritual qualities are best manifested within the structure of the music through the use of simple chanting and the practice of simple melodies over a drone, like Pre-Baroque and Gregorian chant, Medieval music and lullabies from many different cultures.I find Spanish Early Music specially powerful in its delicate treatment of melodies in Dorian and Phrygian modes.
The French word for drone is bourdon or seam, meaning that which weaves together and holds together. The drone comprises a delicate combination of fundamental, partial and overtones. Acoustic drones are more effective than synthesized ones, as they provide more resonance. The key or tonic is quite important, and keys from A- flat to D seem to be suitable for both female and male voices. Drones have a paradoxical transporting and grounding quality that carries the voice, the music and the mind into synergy and wholeness. I treat the drone as a throne for the voice, as it is the most effective accompaniment for vocal improvisation. Arpeggio-like drones can be created with a harp, a dulcimer, a guitar or a piano; they can also be created by sustaining one or two notes on stringed instruments, accordions, harmoniums, or good quality portable keyboards. Acoustic pianos (using one or two sustained notes within the chosen tonality) are ideal but not always accessible in clinical settings.
Droning, the Practice of Singing with a Drone
We called this practice droning, it involves slow singing over a sustained pitch, slowly connecting micro-tonally with neighboring notes. Singing with a drone is an ancient practice that helps to precisely tune the voice as a musical instrument, while relaxing the mind. Droning can change one’s affect immediately by releasing tensions and helping the mind to focus on sound instead of fear or pain. Droning is an easy practice to share with the patient.
Melody Carries the Emotions
“When you listen, you exist” (Baschet, 4).
Melody is defined as a tonal configuration with movement that unfolds in relation to time, in accordance with given cultural conventions and constraints. In early Western music, the treatment of melody was organized around modes, and it has always been a means to express meaning and feeling. The term mode and modal music has been used to define classes of scales and melodies, Modes involve the internal relationship of notes within a scale and the predominance of one of them over the others as a tonic or resting point. Modes and modality are intrinsic to the structure of many musical cultures, such as the Chinese tyao, the Arabian and Turkish maqam, the ancient Greek, Gregorian and Medieval chant, and the Indian raga mentioned earlier.
For vocal improvisations constructed over a drone, the Greek modes, in particular, the Dorian, Mixolydian, Phrygian and Aeolian are recommended. These modes have a strong correspondence with ancient Indian ragas used specifically for healing. The practice of vocal meditation (slow tonal and microtonal ascending and descending melodic patterns) is a good way to become familiar with the flavor of each of these modes. Melodies constructed with simplicity and minimalism, and involving a great deal of repetition most effectively convey the “rasa,” the emotional taste of the music. It is helpful as one begins to create chant-like songs with these modes, and to recognize the modes used in familiar songs and to vocalize with these as well.
In music therapy end of life work, chants that are in pentatonic scales have strong healing qualities in both major and minor keys. Nearly 70 percent of the healing chants, mourning songs and prayers from many parts of the world are constructed in minor modes and pentatonic scales.
Mindfulness as Clinical Intuition
A therapist must rely on his or her clinical intuition, selecting the modality that is appropriate for each situation and setting, and this influences the patient’s emotional and consciousness states. I refer to this treatment of melody as spiritual melodicism - the mindful use of melody in perfect synergy with ethereal harmonies and textural rhythms. The melody leads the emotion and becomes a metaphor to evoke meaning, aid memory, hold, embrace, and comfort, improving the ability to cope with stress and fear.
Chanting as Meditation: A Contemplative Vocal Practice to Assist the Passage
The following are general guidelines for therapists interested in the practice of vocal meditation leading to chanting. Before starting, find a comfortable space where