Music therapy and spirituality; A transcendental understanding

By David Aldridge (Email: davida@uni-wh.de):

There has indeed been an emerging interest in spirituality in the field of music therapy, particularly for those working in palliative care that predates the Oxford Congress (Aldridge 2000; Aldridge 1995b; Bailey 1997; Lowis and Hughes 1997; Magill 2002; Marr 1999; West 1994). In "Music therapy in palliative care: New voices" (Aldridge 1999), several authors reflect the need for spiritual considerations when working with the dying (Hartley 1999; Hogan 1999). Nigel Hartley has developed this work particularly in hospice settings (Hartley 2001) and with Gary Ansdell ensured that the theme was prominent at the last Music Therapy World Congress in Oxford. In the world of music therapy, the importance of spiritual considerations is evident in the early work of Helen Bonny as a central plank of her approach (Bonny and Pahnke 1972) and Susan Munro's pioneering work in palliative care (Munro and Mount 1978).

Lucanne Magill responded to Michael Mayne at the World Congress in Oxford, July 26, 2002. She reflected on what she believes is really the heart of what we do, music therapy in spirituality. As she says, "So much of what we do is beyond words and it is really because of this transcendental nature of music that important healing in music therapy can and does occur". Her response, in full, can be found at http://www.musictherapyworld.net online.

These considerations of spirituality are not unique to music therapy, there is, and has been, over the last decade, an increasing vigorous debate over the need for spiritual considerations in health care delivery (Aldridge 1987a; Aldridge 1987c; Aldridge 1988; Aldridge 1996; Bailey 1997). There is an overlap between music therapy and several other integrative medicine approaches particularly in the use of breath and how this is applied in altering consciousness (Aldridge 2002). Based on this published work, Nigel Hartley asked me to speak at a series of symposia held at the hospice where he works in Oxford, and we have presented together at various venues. Our intention has been to sponsor the discussion of spirituality as a legitimate topic in music therapy, just as I have tried to do in the field of medicine (Aldridge 1987a,b and c; 1991a and b) and healing in religion (Aldridge 1986) over the last fifteen years.

My thesis is that health, like music (Aldridge 2002), is performed. Indeed, the process of "healthing" can be understood as an improvised process of "musicking". How health is performed depends upon a variety of negotiated meanings, and how those meanings are transcended. As human beings we continue to develop. Body and self are narrative constructions, stories that are related to intimates at chosen moments. These meanings are concerned with body, mind and spirit. My intention is to set about the task of reviving a set of meanings given to the understanding of human behaviour that is termed spiritual. It is legitimate to talk about spirituality in a culture of health care delivery. Human beings perform their lives together in meaningful contexts of significant others that are nested within broader social contexts. The difference contexts of performance are related to an ecological understanding of what it is to be a human being amongst other human beings and will argue for a return to a sacred understanding of human beings and nature. In these instances, "God", "the divine", "the cosmos" or "nature" may be the name given to a meaningful immanent context in which life is performed.

Spiritual meanings are linked to actions, and those actions have consequences that are performed as prayer, meditation, worship, healing and in our approaches, music healing. What patients think about the causes of their illnesses influences what they do in terms of health care treatment and to whom they turn for the resolution of distress. For some people, rather than consider illness alone, they relate their personal identities to being healthy, one factor of which is spirituality. The maintenance and promotion of health, or becoming healthy, is an activity. As such it will be expressed bodily, a praxis aesthetic. Thus we would expect to see people not only having sets of beliefs about health but also actions related to those beliefs. Some of these may be dietary, some involve exercise and some prayer or meditation. Some will be musical. In more formal terms they may wish to engage in spiritual healing and contact a spiritual healer amongst the health care practitioners that they consult. Indeed, some medical practitioners refer patients to spiritual healers (Aldridge 1986; Aldridge 1987b) or develop holistic concepts of health care (Aldridge 1988).

There is a link between religion and spirituality, that I argue extensively in my book Spirituality, healing and medicine (Aldridge 2000) although the two are often confused. The same difficulty has prevailed in the medical and nursing literature where spiritulaity and religion are confounded.

All major religions recognise a spiritual dimension and that is the relationship between the human being and the divine. We see this reflected in the Yin and Yang symbol of Traditional Chinese Medicine that emphasises the vertical relationship between the human and the divine, each in their manifestation containing a seed of the other and uniting together to form a whole. Similarly, the Christian cross reflects both the realms of horizontal earthly existence and vertical divine relationship. The difficulty lies in the explanations that are used for understanding when either a sacred ecology or the divine relationship is used, one is assumed to supersede the other according to the interpreter of events. Both are partial. Indeed, what many spiritual authors seek is to take us beyond the dualisms of material and spiritual, beyond body and mind, to realise that in understanding the relations between the two then we leap to another realm of knowledge. Indeed, the Buddhist concept of the "Middle way" is not to find some mid-point between the two, but to transcend the two ideas unifying them in a balanced understanding. This leap that goes beyond dualism is the process of transcendence. In its simplest form, there is a change of consciousness to another level of knowledge; in short, the purpose of spirituality is achieved.

Spirituality in a late modern sense is used consistently throughout the literature related to medical practice as an ineffable dimension that is separate from religion itself. A person may regard herself as having a spiritual dimension but this may not be explored in any religious practice. Central to these arguments is the concept that spirituality lends a unity and purpose to life.

My position is that if spirituality is about the individual, ineffable and implicit, religion is about the social, spoken and explicit. Such definitions are an attempt to explicate the practices whereby spirituality is achieved. Spirituality lends meaning and purpose to our lives, these purposes help us transcend what we are. We are processes of individual development in relational contexts, that are embedded within a cultural matrix. We are also developing understandings of truth, indeed, each one of us is an aspect of truth. These understandings are predicated on changes in consciousness achieved through transcending one state of consciousness to another. This dynamic process of transcendence is animated by forces or subtle energies, and music is a primary example, in some contexts, of such subtlety.

To remain authentic to both traditional texts and to the earlier part of this commentary, I would suggest the use of truthing rather than truth, in the way that I have used healthing rather than health. Truth(ing) being a cosmic activity related to the breathing out and breathing in of the creator, thus my previous remarks about life being analagous to music; "living as jazz" where we are constantly being performed as living beings (Aldridge 2000). Thus, truth is an activity; truthing constantly being performed, and we are its examples.

"Religious" is used as an operationalization, or outward manifestation of "spirituality". There are spiritual practices that people engage in, these often take place in groups and are guided by culture. As a cultural system, religion is a meaning-seeking activity that offers the individual and others both purpose and an ability to perceive meaning. We have not only a set of offered meanings but also the resources and practices by which meanings can be realised. However, as Idries Shah reminds us that we must be wary of confusing "spirituality" with what is manifested outwardly.

"The poetry and the teaching to which you have referred is an outward manifestation. You feed on outward manifestation. Do not, please, give that the name of spirituality" quoted in the story of "The Cook's Assistant" Idries Shah (1969), p. 115.

The social is what is common to all religions, it offers forms for experiencing nature and the divine; for transforming the self that is the goal of human development. Consciousness, achieving truth, is a social activity dependent upon its embodiment in individuals. Culture is the specific manifestation of such social forms in symbols, language and ritual localised for temporal and geographical contexts, thus specific cults and cultures. In globalization, we have the dissemination of culture but without social forms related to human contact. Therefore we may spread the idea of spirituality but offer no forms for the achievement of spiritual understandings, which is the traditional role of religious forms in everyday life. The same goes for the idea of music therapy, the idea of musicking as a performative health practice is useless unless we find cultural forms (as in perFORMance) such that healthing may be achieved. This may be at the heart of the current Community Music Therapy debate where music therapy has become a globalized activity and there is a need for negotiation of what forms it will take. (No doubt the mullahs, ayatollahs, bishops, high-priestesses of music therapy will all have their say about what form is has to have). The process of truthing behind the spirit of music therapy will be expressed socially in its religious forms. These forms will be inevitably corrupted, like all religions, as they appear at specific times, in specific places for particular peoples (even though the time may be centruies, the places inter-continental and the peoples varied). Only spirit remains.

Beyond meaning - Transcendence

Medicine, from the Latin root medicus is the measure of illness and injury, and shares the Latin metiri, to measure. Yet this measurement was based on natural cycles and measures. To attend medically, Latin mederi, also supports the Latin word meditari from which we have the modern meditation, which is the measuring of an idea in thought. The task of the healer in this sense is to direct the attention of the patient through the value of suffering to a solution which is beyond the problem itself. In this sense, the healer encourages a change in the sign of the patient's suffering from negative to positive. We are encouraged to see the benefit of suffering in bringing us beyond our present understandings, which is also an understanding of the transcendental. This, I argue, is what happens in music therapy, particularly in the context of palliative care.

Transcendence is a "going beyond" a current awareness to another level of understanding. This does not necessarily imply a conventional set of beliefs, it is based upon an innate capacity that we have as human beings to rise above the situation. Boyd (Boyd 1995) makes his argument for a consideration of the term "soul" as separate from "spirit". "Soul" is the subjective or inner person as a whole in the natural state, including the body as an inseparable part, and relates to the word "psyche" (p151). "Spirit" however refers to that which could be both inside and outside a person. Soul focuses on the secular self, spirit refers to that which brings the soul to transcend itself, from without or within.

The process of spiritual development can be seen as a "quest" or a journey, In medieval times, the quest for the Holy Grail was not for a material chalice but symbolised the search for knowledge as a vessel in which the divine may be contained. However, what confounds this issue today is that we equate questioning as an activity rather like the chatter of infants. Many spiritual traditions emphasise the importance of silence and non-activity where the appropriate question may be framed, an as importantly, the answer may be heard. Meditation, prayer and music have both been used to fulfil these functions.

Techniques of questioning, as embarking upon a quest, are a the heart of both science and spirituality in the search for knowledge. However, both demand a discipline if answers are to be found. These appropriate methods of questioning have to be learned and the approaches taught. The answers however cannot be learned for they appear new to each generation and to the appropriate contexts.

While the spiritual dimension may be separate from the religious, religious practices are said to provide a bridge to the spiritual, thus assuming that the spiritual is a realm beyond the religious (Lukoff, Provenzano, Lu et al. 1999). This spiritual dimension is seen as a relationship with a higher power experienced as internal and intensely personal that need not be associated with the formal external aspects of religion; transcending sense phenomena, rationality and feelings leading to a heightened state of consciousness or awareness. The danger is that what may be seen as "spiritual illuminations" in the raw condition of altered states of consciousness are imagined to be spiritual experiences . These can become addictive (Shah 1983; Shah 1990) preventing any developmental change. Thus the need for a spiritual guide, emphasised in the great traditions, and reflected too in secular psychotherapy as a wise counsellor, to prevent the interpretation of emotions as spirituality. the same confounding of emotion and spirituality may also occur in the use of music, hence the prohibition of musical experiences in some religions and at some stages of spiritual teaching.

The ability to rise above suffering, to go beyond the present situation to a realm where life takes on another, perhaps deeper, significance is an important factor in palliative care , in the long term management of chronic illness and as central plank of psychotherapy. In the treatment of alcoholism, it is the recognition of personal suffering and the need to transcend the limitations of the self, to understand that we are "Not-God"(Kurtz 1979), as a process of spiritual awakening that brings about one of the vital steps in recovery. Deborah Salmon (Salmon 2001) refers to music therapy as a containing or sacred space that facilitates the process of connecting to that which is psychologically and spiritually significant for the patient, thereby transforming experiences of suffering into those of meaning.

Transcending the current situation

From the literature it is possible to piece together a process of spiritual change where there is a need to transcend the current situation. To achieve this there has to be a change both in thought and feeling accompanied by appropriate actions. This is expressed as a process of questioning, as a search for meaning. Such meanings take the searcher beyond what she is to a higher consciousness, or state of awareness, that is connected to the truth, which people refer to as "god", "the divine", "the supreme power", "that". This is a circular process of development based on revealed personal understandings achieved through transcendence, which lead to other understandings. Idries Shah refers to this process as a removal of veils to the Truth (Shah 1978). These veils that obscure the truth are formed either through indoctrination, that blinds us, or through the base aspirations of our subjective selves preventing subtle perceptions and higher visions. Religion itself may be a veil that hides the truth, although it offers a public perspective into the truth. The task we face is how to make those veils transparent , or remove them. A further task is how to cope with the truth thus revealed.

The whole concept of pluralism, often invoked for justifying differing positions within the world of music therapy, is itself a term borrowed from theology. The basis of the understanding is that no one of us as human beings can begin to claim a full understanding of the divine (or what ever you may choose to call him or her), thus in all modest we have to recognise that we have only parts of the picture. A challenge is for us all to come together and merge those various understandings. This is recognised in the Christian perspective of 2Though we are many, we are one body".

Central to this process of transcendence is the recognition of a higher power. The argument surrounding powers, forces and energies appears to be a common denominator in varying explanations of spiritual healing (sometimes expressed as vibrations). Even where spiritual energies are not mentioned directly in term so healing, they are described as the driving force behind the specific search for meaning (Aldridge 1995a). So when we want to understand the process of healing, then perhaps we can use a coarse metaphor and ask how this process is fuelled. As we saw earlier, the whole person as "soul" is transformed from within or without by "spirit". My suggestion is that what is sometimes called "mind-body" medicine may be more accurate in referring to "soul" medicine leaving room for an invigorated concept of spiritual healing.

In the same manner, what may be termed the spiritual in music therapy, may be better referred to as "soul music", which is only an excuse for me to get out my Otis Redding song book. And heaven forbid a new movement "Spiritual Music Therapy".

References

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Aldridge, D (1987a) Families, cancer and dying. Family Practice 4, 212-218.

Aldridge, D. (1987b) One body: a guide to healing in the Church. London: S.P.C.K.

Aldridge, D (1987c) A team approach to terminal care: personal implications for patients and practitioners. Journal of the Royal College of General Practitioners 37, 364.

Aldridge, D (1988) Families, cancer and dying. Journal of the Institute of Religion and Medicine 3, 312-322.

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Marr, J (1999) GIM at the End of Life: Case Studies in Palliative Care. Journal of The Association for Music and Imagery 6, 1998-99, 34-54.

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