Response to Addressing Issues of Ethnicity and Identity in Palliative Care Through Music Therapy Practice

By Kristen D. Macleod, student, Lesley University Email: kmacleo2@lesley.edu

Lucy Forests article Addressing Issues of Ethnicity and Identity in Palliative Care Through Music Therapy Practice is an important insight for any music therapist or music therapy student who wishes to work within this population in the future. As the number of immigrants is increasing the world over the implications for music therapists are vast in this subject area. This is especially so for future hospice and palliative care music therapists where exploring a patients past through music may be a vital tool in providing comfort and exerting identity in end of life care. I feel there needs to be more research presented, and classes available for students on ethnic identity issues within this population in order for future productive clinical practice to take place.

As a Scottish International student completing my first semester of music therapy study in the USA, I feel strongly regarding the importance of maintaining my minority cultural influences within such a dominant majority culture as it defines who I am and how I got here. Beginning my internship training within the Hospice population has made me realise how identity, whether it is culturally different from the majority or not, plays a large part in addressing many of the psychosocial issues surrounding terminal diagnosis and prognosis. I agree with the author when she says that the identity of patients with terminal illness may in ways be challenged and controlled and at times defined by illness (Forest, 2000). For the terminally ill patient coming to terms with a terminal diagnosis must be difficult enough, but for many to lose their identity to the control of this illness is depressing. To work with this population, I feel it is so important to see past the diagnosed illness and to see the person as a whole being. As hospice music therapists we are treating the person behind the illness and the impact their symptoms may have, not specifically the illness itself. The illness does not define the patients identity, however having said that I feel that part of our job as music therapists may be to help the patient come to terms with the acceptance of the illness as a part of their current identity within the world.

As many hospice patients are coming to terms with the implications of their illness I think the influence of ones culture can become more apparent. I think that looking back over ones life in musical life reviews, as the author described, can help give life significance to the patient thus helping them give meaning to end of life. According to Dileo & Starr, culture can also provide a lens for understanding the illness and the patient’s inherent reactions to it (Dileo & Starr 2005, P.85). I feel that this is an important aspect for Music Therapists and students to be aware of, as it is likely that the cultural impact of the patient’s response to their illness will be important in facilitating appropriate therapeutic interventions.

From my internship observations I have seen that patients can explore and resolve the issues and conflicts they are facing through musical experiences, while re-establishing their identity. Music can act as a container enabling patients to explore and express their being in the world through a creative medium that is not restricted or impeded by illness (Forest, 2000). This of course is also the case in music therapy interventions in the treatment of other populations. However, hospice patients will be undergoing irreversible and sometimes exceedingly progressive changes to their health, psychologically altering their own perception of who they are at a more complex level. Therefore, I strongly agree with the author in that music therapy interventions implemented with each individual patient, whether they be improvisation, life-review, song writing or listening, are expressive of their identity. Through these interventions the patient is announcing to the world ‘this is me, this is who I was, this is where I came from, and this is who I am now!’

I think that music therapy is important in reaffirming identity in that it gives the hospice patient the power of choice. Patients are left with little independence at the end of life, therefore music can offer the opportunity for decision making on the patients terms, giving them a chance to fully assert their identity and indeed their ethnicity. The familiarity of choosing songs can help memories become more vivid. Therefore the music therapist can give some power back to the patent, in order for them to feel their place in the world. In Lessons Learned from the Dying: Stories from the therapist, Zabin believes that the presence of power is essential when working with those who have had so much power removed from their lives (Zabin, 2005).

These implications of identity construction and especially cultural identity reaffirmation are relevant to the training of the music therapist. Coming into a new culture I am having to constantly familiarise myself with music of older generations of this country and in some respects leave a lot of my own musical roots behind me. However, I feel that training as a music therapist in a culture different to where I come from is important for my own musical and therapeutic development. I think that there should be a lot more encouragement within this field of training for students to assimilate with other cultures other than the dominant, such as familiarising oneself with the popular repertoire of Eastern cultures, Latin cultures , African cultures etc. As a therapist of the future working with this population is going to mean expanding knowledge and musical vocabulary and broadening cultural awareness. Music therapy interventions will need to be consistent with the culture and how individuals from this broad cultural category may chose to cope when confronting the dying process. I feel in working with the patient as a whole and their individual identity, it is very important that cultural stereotyping and musical generalisations should not occur as they are not always relevant to individual patients. Music therapists will therefore be challenged to grow musically, intellectually and personally. I’m looking forward to the challenges ahead!

References

Dileo, C. & Starr, R. (2005). Cultural issues in music therapy at end of life. In: C. Dileo & J. Loewy (Eds.). Music Therapy at the End of Life. Cherry Hill, NJ: Jeffrey Books.

Forrest, Lucy C. (2001). Addressing Issues of Ethnicity and Identity in Palliative Care Through Music Therapy Practice. Voices: A World Forum for Music Therapy. Retrieved November 20, 2009, from http://www.voices.no/mainissues/Voices1(2)Forrest.html

Zabin, A. (2005). Lessons learned from the Dying: Stories from the Therapist. Music Therapy Perspectives, 23 (1), 70 - 75