The Soul Is a Song

Do you take the time to make musical playlists? Maybe there are songs you enjoy listening to when you’re exercising or full of high energy, whereas there are different songs that you would choose to play in the background at your cocktail party or for a romantic evening.

Music is powerful; it invokes or reinforces strong emotion. It “sets a mood.”

Retailers even begin to play Christmas songs well before Thanksgiving because it reminds shoppers that the holiday is coming. When you think of your childhood, certain music may come to mind- music that was popular during those times or music that your parents played. Hearing these old songs can summon a wave of nostalgia. We associate the melody and the way it makes us feel with memories of long ago. Sometimes a song is so ingrained in our emotional memory that we simply cannot listen to it without being transported to a specific time in our past.

Now it is being shown that this unusual relationship between music and memory can do much more than bring us joy- it can actually slow down and temporarily reverse the memory impairment that occurs in dementia. Specifically, this works the best if we use songs that a person used to be very fond of. In cases where dementia is very advanced a patient cannot always tell you themselves what their favorite songs are, so family, friends, and caregivers can often be of assistance.

What would your “memory playlist” include? Are there certain songs that remind you of pivotal or emotional moments in your life? Perhaps there was a song that you sang every year in church for Christmas, or a love song from your own wedding. Maybe there is a song that reminds you of how much it hurt the very first time you had your heart broken.

Do you think you ought to create a playlist for your future self, just in case? That playlist could be your sort of musical autobiography, serving to remind you of the significant events in your life and how they all came together to lead up to this present moment. While memory loss can be caused by head trauma and other circumstances, dementia is the most common and progressively devastating of all causes, and it can be brought on by both genetic and environmental factors.

Due to the fact that we institutionalize our elderly in today’s society, not everyone has a true understanding of what dementia is like, nor how much of a serious problem it is. Some people do not realize that dementia is more of a blanket term for different diseases that share similar characteristics. All forms of dementia are in essence caused by cell death in the brain.

The most common of these is Alzheimer’s Disease, accounting for anywhere from sixty to eighty percent of all cases.

Parkinson’s Disease, which is marked by loss of motor function and oftentimes visible tremor as well as by memory loss, is a fairly common variant of dementia.

Some of these diseases have a genetic basis, as is the case in Huntington’s Disease or “familial” (early onset) Alzheimer’s.

Dementia is the single most expensive disease in the United States today, and the expense is not strictly measured in dollars and cents. It causes enormous suffering in both patients and caregivers and puts strain on families and communities who lack the resources to provide optimal care. The National Institute on Aging estimated in 2010 that it cost $215 billion per year to accommodate members of the population with dementia, which is more than the cost for both heart disease and cancer combined for that same year.

In 2013, there were 35 million people struggling to live with dementia. That number is expected to triple by 2050. If you think that dementia is not within the domain of your concerns, perhaps think again, especially if you have a genetic predisposition for it. Luckily, medicine is improving and there are many ways to identify the environmental factors that lead up to or hasten the onset of symptoms.

People with advanced stage dementia have often undergone a complete change in personality and are seldom, if ever, able to express their internal thoughts and feelings once they enter into its later stages. Eventually, dementia leads to death when cellular death becomes extensive enough.

People with dementia often do not recognize friends or family members. Sometimes they will eat lunch and immediately afterwards say to their caregivers: “When is lunch? I've been waiting for hours!” In some cases if you ask them they will not even know their own names. For this reason it is understandable why many cannot bear it when their loved ones deteriorate in this way. Their chief complaint is that the person they once knew and cherished is “gone,” that they don’t even recognize the ones they used to love the very most.

But now it is becoming clear that this may not be entirely the case- the person is not gone but, rather, who they are as a human being happens to be obscured by the disease. They may seem lifeless externally, sitting quietly and without expression for hours and hours, often unable to speak or to comprehend speech. But then when they are given music, something incredible happens.

In 2014 a beautiful and independently created film was released, called “Alive Inside.” An emotionally evocative documentary and winner of the Sundance Film Festival, it centers on the amazing response that nursing home residents with dementia have when they are given personalized iPods with their favorite music from the past. The documentary was intended to show the incredible and immediate effects of music on these patients’ mood, memory, and ability to hold a conversation even where there was no such ability before. It takes the viewer inside of the first nursing homes in which the program was piloted, offering a little-known glimpse into the facilities where we send our elderly when we can no longer care for them. “Alive Inside” is the first documentary of its kind, created by the same man who founded the Music and Memory Foundation, Dan Cohen. While ample research previously existed supporting the hypothesis that music therapy improves memory and cognitive function, “Alive Inside” demonstrates on a human level how it actually works.

As a Recreational Activity Coordinator in 2015 I was present when the nursing home that I worked for signed up for the Music and Memory program, making our facility in Florida eligible to receive free iPods for their residents. Unfortunately I was unable to remain in my position long enough to witness the long-term effects of the program. However, the exposure of the program through the film has undoubtedly resulted in a greater awareness of it within the public sphere- among caregivers and among the administrative departments of nursing homes and assisted living facilities, most importantly. Nonetheless, while there I was able to witness the great success of other musical programs, such as when musicians came to play at the nursing home or when we had sing-a-longs with our residents as a planned activity.

On one occasion, I was sitting with a very lovely resident with advanced dementia, a sweet woman who always wanted to sit next to me and hold my hand even though she was never capable of carrying out a sensible conversation. When the visiting musician suddenly began to play “I will always love you,” by Whitney Houston, she began to sing along word for word, squeezing my hand more tightly as her eyes became glassy with tears. It was clear that this song had great emotional significance. And while afterwards she was only slightly more coherent than usual, she seemed to be possessed by a peacefulness and presence that wasn't there before. She didn't wander about or babble, but she did tell me she loved me quite a few times, and even remembered my name. It was enough for me to begin to understand the relationship between music and the mind- or should one call it music and the soul?- long before I saw the documentary or found the research supporting it. Sadly, that resident passed away not too long afterward, but I am grateful to possess that poignant and beautiful memory of the time we shared.

The very well-known author and neurologist Dr. Oliver Sacks is interviewed in “Alive Inside,” and he acknowledges the music’s therapeutic benefit, testifying that dementia patients do indeed “come alive” and become “animated” from the experience of music. Dr. Sacks is arguably an authority on music and the brain, and he wrote a book called “Musicophila: Tales of Music and the Brain,” which discusses why we get music stuck in our heads, why we tend to seek to impose order upon random sounds in the identification of melody, and even the fascinating phenomenon of a man becoming a musical genius after being struck by lightning.

Dr. Sacks acknowledges that any neurologist would be hard-pressed to fail to identify the brain of a musician, whereas in the case of other kinds of artists, this is not so. The brain of a musician lights up like no other when they are experiencing or playing music, a neuronal network consisting of branches upon branches of complex circuitry that extends through multiple regions of the brain. Perhaps this is why the emotional experience and recollection of music is so easily preserved in those with memory loss. Because there is no specific locality of function involved in experiencing and recalling music, cellular death is not as quick to impair the larger network of neuronal connections involved in the perception of sounds and their integration into music. The brains of musicians are also known to house more gray matter, which is vital to working memory.

In a word, it is the limbic system that is activated when a person listens to music that has past significance or is simply emotional and profound in and of itself. Music does not necessarily have to be from one’s childhood or past to have an immediate effect on the listener, but it was shown that a study group of dementia patients who were able to recognize songs played for them rated their experience as a more pleasurable one than it was for those which they did not recognize. The limbic system has been referred to as the paleomammalian cortex, it being on either side of the thalamus immediately below the cerebrum; its functions are essentially an interplay between both consciousness and unconscious processes, the complex mire from which memory, emotion, and the experience of music arise.

Isn’t it amazing to think that something separate from our conscious thoughts- our emotions- hold our memories and our sense of self together as a coherent whole?- and that the key to using our own emotion to recover our very souls lies within melody and song?

The connection between music and verbal memory is a very intimate one; this much becomes clear when we try to recite the alphabet in a monotone, without singing it in the familiar tune that most of us are taught growing up. Music helps us to remember song lyrics, and in turn lyrics can also help us to remember music. Interestingly, perfect pitch, or the ability to identify or to play a note in isolation, is not an ability that is as unique as previously believed, and it is certainly not only found among musicians. In fact, perfect pitch can be acquired through musical practice, and it can also be induced temporarily by electrical stimulation of Heschel’s gyrus within the auditory complex of the brain (Mathys, Loui, Zheng & Schlaug; 2010). Stefan Koelesch and colleagues demonstrated faster recognition of certain words when study subjects are primed with “short musical pieces with particular characteristics" (Koelsch, Kasper, Sammler, Schulze, Gunter & Friederici; 2004). The inevitable conclusion is that there is some connection between what is going on when we memorize words and sentences and what occurs when we remember notes and melodies.

There is a wealth of evidence that shows that music therapy is advantageous in more ways than one. In addition to helping those who have memory loss due to stroke, music therapy helps children with autism and other mental or emotional problems. Binaural beats, which are presented as slightly different frequencies to either ear, overlap to correspond with the “alpha” wave range (7.5-12.5 Hz) which has been associated with vigilance, inhibitory processes, attention, working memory, perceptual abilities and information processing speed (Braboszcz a Delorme; 2011; Clark et al., 2004; Freunberger et al., 2011; Lachat et al., 2012; Oprisan, 2004; Palva & Palva, 2007; VanRullen & Kotch, 2003).

Currently the impact of variables such as timbre and tempo are also being considered, with changes in either having been shown to be associated with both conscious (explicit) and subconscious (implicit) musical memory when study subjects were asked to identify songs before and after these slight changes were applied. (Halpern and Mullensiefen, 2008).

The potential for study of these processes is seemingly endless, but what we can be certain of right now is that music that figures prominently in a person’s past can be of great assistance when it comes to bringing their memory, ability to carry a conversation, and their personhood back, even if only for a short duration of time. What remains to be seen are the longitudinal and preventative effects of such therapy, especially when it is used before a person enters the advanced stages of dementia. Family members who care for dementia sufferers at home may find some hope and even some reprieve with the assistance of music, finding that their loved ones are calmer, happier, and easier to communicate with after a few minutes spent listening to their favorite songs.

Even for those for whom permanent improvement is a lost hope, there is no doubt that regular exposure to music can drastically improve one’s quality of life in circumstances where that quality is generally very low. At least momentarily, they are calmed and centered, and they are able to communicate with those around them. Many people with dementia tend to deteriorate at an accelerated rate when they enter a nursing home. They feel alone, confused, and afraid, which can result in behavior that is difficult for caregivers to handle. This is perhaps why in the United States 16 percent of all nursing home residents were being prescribed an anti-psychotic intended to treat bipolar disorder or schizophrenia, even though Medicare has rules that forbid this, according to the AARP. These drugs are not intended to be prescribed to elderly persons with dementia, but are often prescribed any way because they make life easier for medical staff members. Unfortunately, such patients are often unable to speak up for themselves. There simply has to be a better way.

If you have a member of the family living with dementia, try it for yourself. Consult with others about what their favorite songs used to be if needed, and sit with them, allowing them to listen on the radio or with a pair of headphones.

If you are a musician with time on your hands, why not volunteer some of it at your local nursing home? Some nursing homes are specifically designed for patients with memory issues, and they are always thrilled to receive volunteers. Any music with a positive sound and message can be beneficial, even if the residents do not recognize the songs.

Perhaps you know someone who is a caretaker of a person with dementia; share this knowledge with them. Let them know that there is a way that they can communicate with their loved ones again, as well as a way to bring joy into their otherwise seemingly bleak lives.

Finally, if you have a used iPod lying around, consider donating it to the Music and Memory Foundation. It is so easy to bring happiness to those who are suffering bearing only the gift of music.