Tia DeNora (2013) Music Asylums - Wellbeing Through Music in Everyday Life, Ashgate
The musical asylum
Sociologist Tia DeNora brought the book Music Asylums - Wellbeing Through Music in Everyday Life into the field of 'music and health'. Not surprisingly, already with the book Music in Everyday Life she invited herself into music therapy - and therefore became one of the first significant sociological theorists to take the practice of music therapy seriously. We quickly discovered this in Norway, we have invited her here several times, for which she also generously thanks us in the foreword. Now we can be happy that she makes a significant theoretical contribution to the understanding of how and why music can contribute to health and increased well-being. Because there is a lot of research that confirms that music works, less that tries to explain the mechanisms of action.
A free space
The title of the book is inspired by Erwin Goffman's book Asylum, which was published fifty years ago, and which cast a critical eye on the totalizing psychiatric institution and the negative effect it could have on the patients. "Asylum" can be a place of refuge (church asylum, political asylum): "I use the term 'asylum' to denote respite from distress and a place and time in which it is possible to flourish", writes DeNora. The purpose of the book is therefore to show that through music we can reach a state where we thrive, feel at one with and are in flux with our surroundings, engage in creative activity, experience being valued in interactions with others, feel desire and perhaps also forgets pain or whatever bothers us. The asylum is a space for play, rest, and creative activity.
DeNora draws from, among other things, music therapy and music and health research. But also an introductory quote from a letter the composer Mendelssohn wrote to his sister casts a historical glance at the notion of music's instrumental functions. The letter refers to a female acquaintance of Beethoven who has lost her child. Beethoven is reluctant to seek her out, but in the end, he invites her to his home. When she arrives, she finds Beethoven at the piano and he says, "Let's talk to each other through music". He then played for her for more than an hour and the woman was then able to relate, according to Mendelssohn, that "Beethoven had said a lot to her and finally had given her comfort".
Biomarkers and social reductionism
We who work with music and health find ourselves within a medical sphere that sets certain frameworks and conditions for how we are accepted, how we can legitimize ourselves. We feel the pressure from the evidence-based thinking, from a medical culture where genetic testing, "personalized medicine" and the search for biomarkers are connected to the offers from a pharmaceutical industry that hunts for new products and new profits. DeNora outlines this larger context, where the production of new diagnoses also constantly opens up new markets.
In DSM-5, for example, "shyness" has become a diagnosis to be treated with drugs such as paxil or serosat, DeNora refers. Smokers are now diagnosed with "Nicotine use disorder" - maybe it's a good thing I managed to quit in time. I recognize myself well in this criticism of psychiatry from my own student days in the seventies. It was the heyday of anti-psychiatry, with names like Ronald Laing and Thomas Szaz. These came with me in my luggage when I traveled to the USA to study music therapy in the early seventies. One of the first books I bought in an antiquarian in Tallahassee was an old textbook on psychiatry - there I could read that "left-handedness" was a diagnosis - which not least sharpened my skepticism about diagnoses - left-handed as I have always been (proud of).
Sociology of deviance
One of the most important courses I took at Florida State University was in the sociology of deviance. The essay I wrote there formed the basis for the first chapter of my master's thesis and later the book Music Therapy and its Relationship to Current Treatment Theories. When I also got an internship at a very backward psychiatric institution just over the border in Georgia, where the clients were mainly black poor, and where I read Erwin Goffman's Asylum at the same time, I asked my internship teacher if we shouldn't close our music therapy practice and instead offer legal aid to help the ‘imprisoned’ return to society.
Later, I followed the discussion about psychiatry, I understood that you don't throw patients into the street because the institutions are total. Nor does one stop giving antipsychotic medication to people in acute need. Rather, we have probably learned (if not fully realized everywhere) that good institutions can be created, that talk therapy and medication should go hand in hand. I saw this up close in my own practice when, late in life, I studied psychology and worked with young schizophrenics under the guidance of an experienced clinical psychologist. This institution actually also offered music lessons, photography, dance and painting.
Enough about that. Thomas Szasz, who wrote The Myth of Mental Illness, gets his two sides in DeNora's book, but at the same time he receives criticism for his "libertarian" reductionism – he reduces mental health to individual choices. As a counterpart to a biological reductionism, DeNora wants to develop a reasoning about mental health and well-being that steers clear of this polarization between body and culture as explanatory factors.
The neuropsychological reductionism
Another well-known form of reductionism – also referred to as neuro-imperialism – is found where the brain is used to explain all the effects of music. DeNora refers to how neurological discourses are remnants of 19th-century phrenological thinking where all psychological states were equated with physical functions. But now, very different cognitive and perceptual functions take place in the same area of the brain, which makes it difficult to reduce such processes to a specific region. Brain research has now progressed with regard to mapping where in the brain different forms of musical processing take place, which is of course useful for music therapists to know. The problem is that the experience of meaning transcends the physical processes in the brain.
When neuroscientists describe their mapping work, it can sound as if it is the brain that is "talking". When the neuroscientist himself tells about his experiences, he uses first-person language: "I experienced that", so of course they do not say that it was their brain that experienced it. This philosophical question of consciousness is on the agenda in the discussion between brain researchers and philosophers.
Or as DeNora writes: "We are not, in other words, mere brain. (…) The brain is, as I shall describe, connected also to the person, to other people and their history, to language and learning, memory and association, habit, culturally constructed values, convention, physical interaction, occasions, situations, shared experience, custom, climate, diet, air quality, electro-magnetic current and many other things that linguistically we deem to be 'outside' of individuals. It is this totality of connections that we should include in our attempts to understand what music is and how it works.”
From placebo to nocebo
In the discourse on illness - where DeNora moves from schizophrenia, through depression, to high blood pressure and stress - the purpose is to circle an understanding of illness that is ecological and holistic. DeNora will avoid reducing disease to genetic defects or making health an individual responsibility. It is disturbing to read about the increase in the use of antidepressants, at the same time that the research so strongly questions the effect of the drugs. Research on placebo effects (which is sometimes not published because it does not support the effects of new drugs) provides strong support for the connection between our beliefs and bodily reactions.
Placebo's dark twin - nocebo - tells us about the negative effects of our own thoughts and attitudes: We also get sick from our own negative expectations. DeNora uses the sociologist Peter Freund as a source (The Civilized Body: Social Domination, Control, and Health) to capture the entire complex reality – social structures, cultural practices, working life – which also affects the interaction between body and psyche, and which can deregulate the body's ability to cope with stress. It is the interaction between the forms of life we live under and the small daily micro-adjustments in body dispositions that in the long run can develop or intensify body conditions we classify as illness.
A critical theory of health
DeNora outlines a complex and multifaceted concept of health, where health is an identity, a condition that is ecologically constituted as an "open system". She first describes three dimensions of health. (a) Health consists of inscriptions, i.e. we are 'marked' both by ourselves and others as our condition is given a name. (b) This state of health is about what we are able to perform, and (c) it consists of and has meaning as 'lived experience'. For example, we can imagine a situation where we have problems climbing stairs, the doctor tells us that we have a heart-lung disease, or gout etc. The doctor's diagnosis can cause me to become more aware of my own condition, and this the inscription makes me stop climbing stairs (nocebo) and thus get in increasingly poor shape. But I can also not listen to the doctor, tell myself that I was just 'temporarily in bad shape'. It could also lead to me always taking the lift, and thus never noticing the problem. What DeNora wants to tell us is that behavior (performance) affects inscription, inscription affects behavior, inscription affects experience, experience affects inscription and experience affects behavior, or how I act will affect the experience of how I feel.
A health sociological perspective will try to say something about how these inscriptions, experiences and performances are constituted. Central is the understanding of how they appear within social ecologies, worlds, material cultures and spaces – including discourses, values, ideas, objects, techniques, institutions and social practices. As we saw in the example of taking the lift, the person would never experience having a disability – in other words, experience, performance and inscription depend on what my social world offers or cannot offer (affordance). In other words, health/illness is also about ethics and social arrangements.
To avoid a purely individualistic position, we must take into account how culture and surroundings mediate illness/health. Within "disability studies", anthropology or constructivist studies of culture, one is precisely concerned with how health conditions are mediated by particular institutional configurations or cultural practices.
A final dimension in DeNora's understanding of health/disease is about temporality – about how symptoms and our ability to act can vary from day to day, from moment to moment. This can be due to biological functions in the body, the effects of the medicine, psycho-social conditions such as motivation, distraction, desire, commitment, or entirely external conditions which, for example, the degree of air pollution will affect disease related to the respiratory tract.
The variations can be great in the experience of health-illness: there is both health experienced through illness and illness that manifests itself while experiencing health. When DeNora characterizes health and illness as an 'open system', it is because the system takes shape in relation to conditions outside the individual and outside the individual's internal physiological and biological composition. Since the system is also figured in relation to various external factors, it is inevitably also temporary, in flux, potentially variable.
Withdrawal or rearranging?
DeNora devotes two entire chapters to the sociologist Erwin Goffman when she introduces a concept of asylum that will give explanatory power to the nourishing power of music. The refuge, the asylum, which Goffman outlines in his book of the same name, is about a retreat: Even inside the total institution, the patients could find places, activities and fantasies that provided protection from reality. But this actual asylum cut off the patients' opportunities to unfold. The self's opportunities to get involved, to create freedom, to act based on its own interests were destroyed by the hierarchies and structures of the total institution.
Now, however, DeNora outlines two forms of asylum – two strategies for obtaining asylum: removal and refurnishing. Both are defined with the following content or state achieved as: "room, ontological security, control and creativity, pleasure, validation of self, sense of fit, flow, comfort, ease, house, temporal fit".
It is such conditions, processes or experiences that are sought either via withdrawal (removal) or a refurnishing of existence (refurnishing). When we withdraw and protect ourselves from the outside world (listening to music, going to the theater, reading a book, sleeping, traveling, eating and drinking, playing poker, watching TV, etc.) we can experience a respite, that we are restored. The same can be experienced when we engage more actively in our hobbies and interests (write a blog, play in a band, engage in religion or are active in church work, sing in a choir, attend language courses, etc.). The difference, however, is that when we actively refurnish or redecorate our lives through such free spaces, we build up new resources that can be invested in new shared social experiences with others.
The Asylum-Pod
The iPod becomes the very illustration of how music can be used to create, strengthen, signal or expand the space we travel in. Mobile and private music listening, as particularly described by Michael Bull (and which Marie Skånland contextualizes in her doctoral dissertation in a health context), can be about how music is used to regulate emotions, recharge batteries, create well-being or is used as a response to the polyrhythmic noise that meets us in modern city life.
The iPod listening is the starting point for DeNora's description of the connection between "removal" strategies and the regulation of stress. But at the same time, we know how listening via iPod is also a "social statement" ('I want to be at peace'), or a shared social activity (through sharing headphones) that intervenes in the outside world and helps to rearrange the surroundings so that we get new resources and shopping opportunities. The music creates moods and colors the situation, and is thus seen as helping to create a road map that gives direction to choices and priorities.
It is interesting when DeNora highlights the research on how a new rising generation classifies and categorizes music largely according to the situations and events they associate the music with (music that suits a sunny afternoon, good for cycling, etc.). Perhaps this technology heralds new musical listening practices that strongly influence and reshape how we talk about, categorize and interact with music's functions and aesthetic potentials.
Performance of self and identity
To illustrate how music can be used to reframe our place in the world, DeNora draws on examples from a music therapy project she has followed with music therapist Gary Ansdell. Here it can be mentioned that DeNora's book was the first part of a triptych in the series Music and Change: Ecological Perspectives - where Gary Ansdell's book, How Music Helps, was published in 2014 and where the third publication is a collaboration between DeNora and Ansdell based on a community music therapy project - BRIGHT).
In this project they have a music cafe where the participants did solo performances. DeNora theorizes these performances as aesthetic and simultaneously functional performances, and where it is not just music that is performed, but also identities. The song offers cultural material through which people express themselves. Different musical styles and forms model conditions and offer an authority in which the performer can invest himself, and thus build resources to rearrange his world.
Through music, a stance is taken, one takes a position and creates a space for oneself to try out ways of being, acting and experiencing. The way in which the music is performed can appear as a proxy for an identity that one wants to project onto the outside world, try out and participate in the community through. Performing music becomes a way of generating resources, materials that can be used to preserve and develop the self. This is where music's potential for change lies. This is where music therapy offers a musical asylum, a haven to rearrange, try out and consolidate a different identity.
Musicalization of consciousness
DeNora makes an excursion into the philosophy of consciousness, philosophy of mind, to establish a theory of how consciousness can be musicalized. She argues for how a musical consciousness is a medium for social relations, which regulates consciousness and becomes a form of self-representation. Music, as a socially organized phenomenon, is imported from the outside world, it structures consciousness and creates an alloy of "orientation, mind, action, emotion and sensory experience".
DeNora concludes that aesthetic modalities and materials can structure, refine and channel experience. We become more sensitive to being in the world (cf. the aesthetic's original meaning). Art enriches our ability to narrate and formulate experiences as a conscious "I". It adds flexibility, new experience categories and new affective content. These modulations (inflections), categories and affects are/become part of the assumptions with which we encounter the world. The forms they take have a structuring effect on consciousness, on our selective sensitivity to our surroundings.
Consciousness is hot or cold, writes DeNora. It is warm when it is pre-reflexive, corporeal and immediate. We can experience music in this way, for example when we move to music without thinking about it further. But we can of course change the mode, to a kind of 'second order' of consciousness, where we put language on experiences and feelings, associate the music with events or reflect on the musical material.
The examples DeNora use to illustrate this she takes from the "rubber hand" experiment in psychology, the magician's ways of manipulating our perceptions, and not least the work of music therapists with pain relief. DeNora provides an analysis of music therapist Jane Edwards' work with pain relief in a boy who has to undergo a very demanding treatment when changing bandages. She shows how the music, in interaction with the situation, reshaping of roles, therapeutic relationships, neuropsychological changes, and not least the boy's identification with the aesthetic material of the music itself, helps to alleviate the pain experience.
The purpose of the analysis is to show how a "warm musical awareness" can transform bodily states and perceptions, create some new prerequisites for redefining one's expectations of treatment and thus provide resources for change in the boy. DeNora also uses the example from the film and how American soldiers in Iraq use heavy metal to "warm the consciousness" so that they can carry out their operations from inside the tanks in an emotional state compatible with the demands of the "job"...
Sonic performances
DeNora uses the music therapy method (The Bonny Method of) Guided Imagery and Music to illustrate how music offers material (and metaphors) that enable non-musical conditions to come to consciousness, be examined and eventually find a solution. As a GIM therapist myself, I tend to say that music is a metaphor producer, it creates images, body experiences, associations that provide a rich reflection of what moves within us, what we may not have fully focused on before we laid down on the bench, but which became conscious to us while listening to music, possibly with help from the therapist. It is through this awareness that consciousness becomes "cold". This means that we reflect on our own reactions and experiences, on the situation or the music. We translate the musical experience (and consciousness) into language by using some of the metaphors that appear, metaphors with links to the body, thoughts.
Where is the good music?
DeNora uses an episode from a situation in a hospital, where the members of the BRIGHT project, i.e. all amateurs with a past in mental health care, make a concert. After the concert, they go around the wards. Here lies an elderly dying man who asks if they can sing "Swing low, Sweet chariot" for him. It will be a gripping performance that touches everyone, transforms the situation, and connects participants and listeners. "There could have been no better music anywhere", writes DeNora, and starts the discussion about whether music that does good is the same as good music. But first she clears away simple notions of musical quality as something that is predefined and locked to certain works/performances. Secondly, she writes off a relativism that makes all value judgments of music and performance relative, i.e. completely dependent on subjective interpretations.
DeNora sets up a table where she distinguishes in the grid fields between a) music that is good and that does good (has good effects, for example on health and well-being which is the issue here), b) music that is good, but does not have good effects, c) music if not good, but which has good effects, and d) music which is neither good nor has good effects. Vivaldi's Four Seasons, used at the airport in New York is used as an example that this is (good) music that has good effects for the authorities who have installed the music to keep the homeless away from this public space (to the extent that it works). However, the music is a great annoyance to anyone who does not like Vivaldi, to those who are opposed to background music, to the hearing impaired who are further hampered in their communication, etc.
For DeNora, an important question is "how people do things with aesthetics". She wants a more flexible understanding of aesthetic taxonomies and classifications, she wants to arrive at a form of "goodness in" and "goodness from" music that is locally situated and grounded, and that emerges relationally in the same way as the phenomena health and illness.
It is impossible to classify "good music" in a decontextualized way. At the same time, context is not something fixed, but something that is selectively mobilized and produced in the situation. Different forms of goodness find their form in relation to a number of conditions such as special features of the situation, ways of seeing, goals, beliefs, preferences, conditions of perception, discourses, etc. There are different forms of difference, and aesthetic frameworks that are used to define quality and value is institutionalized by various user groups and communities of practice. Aesthetic choices are ethical choices. What is 'good' about the music is not about identity, but about identification, writes DeNora, and thereby wants to dissolve the distinction between "goodness in" and "goodness from" music. In this deregulated and contextualized aesthetic, this musical good appears to be closely linked to forms of life, to collective action, something that is produced and institutionalized through a collaboration. What is good appears to us through identifying the right set of aesthetic criteria. That there should be many such forms of good music is in itself no problem, as long as we understand that our socio-musical forms of creating social order are not linked to the music itself, but to our attempts to constitute ourselves and our relationships with each other.
Medical humanities
Such an ecological and context-sensitive understanding of how music and health are open and fluid phenomena requires an approach that puts the study of the "here-and-now" in musical processes on the agenda. When I studied music therapy in the USA in the seventies - under a behavioral therapy regime, I reacted that people were only concerned with the effect, the usefulness, of measuring that the music worked. We find the same ideology today, where RCTs apply and where there are fully structured interviews, Likert scales, tests and surveys that are to lend evidence to the therapy. Why, how and when the music works are probably equally important questions, and which will require an ethnomethodological approach in that we are present in the processes and gain access to the participants' life world.
DeNora opens up such studies, she gives us a new language in her synthesis of sociology, (musical) aesthetics and health science. She opens the black box and shows us that musical transformations happen through our involvement in music, as performers and listeners. The music is not a means in this process. The musicalization of consciousness that is created changes our mental state, it gives the opportunity to rearrange and create a new space for action.
Comments