Medical Music: Anthropological Insights into Music Therapy

MEDICAL MUSIC: ANTHROPOLOGICAL INSIGHTS INTO MUSIC THERAPY

INTRODUCTION

I began my day at the George Center for Music Therapy in Roswell, Georgia, a suburban

town north of Atlanta within the Atlanta Metro area. Roswell has a population of approximately

90,000, but the clinic serves clients from across the Greater Atlanta area, home to about 5.5

million people. Located in Sweet Apple Village, directly across from Sweet Apple Elementary

School, the center is situated in an upper-middle-class area with well-maintained lawns and

modern buildings. Driving through the office complex, I passed restaurants, shops, and other

offices before arriving at The George Center.

Upon entering, I was greeted by Jordan, a recent graduate of the University of Georgia

with a degree in Music Therapy. The center felt quiet, which I later learned was due to many of

its clients being children and teenagers who had returned to school for the new academic year.

Jordan explained that I would accompany her to a group music therapy session at the Academy in

North Fulton for children with disabilities. While the session was insightful, the details will not

be included here as this study focuses solely on music therapists rather than their patients.

When I returned to the center, I met Jamie, the owner and director of The George Center

for Music Therapy. Jamie, in her mid-30s, wore glasses and radiated the warm, upbeat demeanor

I had come to associate with music therapists. We resumed an interview we had started a month

earlier in July. The clinic itself boasts state-of-the-art facilities, including specialized rooms with

noise-absorbing panels and lighting designed to minimize stimuli for patients with epilepsy.

There are five individual therapy rooms equipped with pianos, drums, and guitars mounted on

the walls. The center also features a large group therapy room, a conference room, a break room,

and a reception area filled with games, toys, and magazines for waiting clients and their families.

Walking through the center, it was remarkable to think that Music Therapy has only been

an established professional discipline in the U.S. since the late 20th century. After the interview, I

observed Lana, an experienced music therapist, working with an autistic patient, followed by

Madison, another therapist, conducting a session with a teenager experiencing severe depression

and anxiety. Madison’s session stood out to me, as I had initially assumed most clients would be

dealing with depression and anxiety, but I soon realized that this was not the norm.

Intention

The aim of this thesis is to explore music therapy as a cultural practice, utilizing the

theoretical frameworks of medical pluralism and embodiment to examine its positioning on the

periphery of biomedicine. The analysis draws upon previously published research and

ethnographic fieldwork conducted with music therapists. Initially, the study sought to investigate

the application of music therapy for mental health conditions such as stress and depression,

informed by statistics from the National Institute of Mental Health (NIMH, 2010), which report

that 9.5% of the U.S. population experiences depression. This assumption shaped the early

direction of the research.

However, through interviews with music therapists, it became clear that music therapy

addresses a wide array of mental and physical conditions, ranging from Autism and Alzheimer's

to Cerebral Palsy. While stress and depression remain central to the study, the focus has

expanded to consider broader themes, including American perceptions of illness, the role of

music in healing, the impact of clinical discourse on access to alternative treatments, and music

therapists' efforts to integrate mind-body healing into biomedical frameworks.

The therapeutic use of music and ritual performance has been a cornerstone of healing

practices in various cultural contexts globally (Koen, 2008). This thesis situates music therapy as

a professional discipline in the U.S., connecting it to medical ethnomusicology research that

examines healing rituals across cultures (Roseman, 2008). Additionally, it explores how

globalization—particularly neoliberalism—has contributed to rising inequality, poverty, stress,

and disease (Farmer, 1997; 1999). Neoliberal policies, such as deinstitutionalization, have shifted

the responsibility for mental health care from state institutions to individuals, creating access

barriers for many (Desjarlais, 1997).

Drawing on Foucault’s (1973) analysis of clinical discourse, this thesis examines the

marginalization of music therapy within biomedical practices and the strategies practitioners

employ to legitimize and integrate it as an alternative form of mind-body healing. While

biomedicine traditionally prioritizes the visible body, music therapy focuses on holistic care,

thriving in the U.S. among those seeking alternatives to conventional psychotherapy despite

challenges posed by biomedical norms and neoliberal policies.

The fieldwork for this study was conducted in the Metro Atlanta area from June to

October 2015. Semi-structured interviews with ten music therapists served as the primary

anthropological method, complemented by interview data analysis. These interviews, conducted

both in person and via email, focused exclusively on therapists rather than patients. A full day

was spent at The George Center for Music Therapy, as detailed in the opening ethnographic

account.

The research addresses key questions:

What motivated Atlanta music therapists to enter this profession?

What mental and physical conditions do music therapists treat, and what methods and

techniques do they employ?

What role does music play in healing?

Who has access to music therapy, and how do historical and cultural factors shape this

access?

How does scientific medical discourse influence access to music therapy?

The subsequent chapters of this thesis provide a comprehensive exploration of these

questions and the broader implications of music therapy as a cultural and professional practic

Chapter Summary

Chapter 2 examines theoretical principles in medical anthropology and medical

ethnomusicology. Medical pluralism provides the basic theory for this research in recognizing

the alternative frameworks of disease and cure seen in cultural systems around the world

(Johannessen & Lázár 2006). Medical ethnomusicology adheres to this theory in analyzing the

power of sound and music in cross-cultural healing rituals (Koen 2008; Roseman 2008). This

chapter discusses the development of the clinic as a cultural and historical framework of Music

Therapy as a professional discipline within and on the periphery of this framework (Foucault

1973; Peters 2000). Western discourse on biomedicine has implications for access to music

therapy in the US. Embodiment, or culturally described way of experiencing the world with the

body (Desjarlais 1992; Howard 2000), rejecting the mind-body dichotomy in healing rituals

(Csordas 1993; Fassin 2007), and this theory helps explain music therapy as a valid cultural

healing system, but on the periphery of biomedicine (Foucault 1973). This chapter then explores

the use of narrative and music that are central to healing for many cultures around the world

(Barz 2008; Black 2013; Hinton 2008; Olsen 2008). Finally, it examines structural violence,

which involves large-scale forces such as racism, poverty, and inequality (Farmer 1997, 1999;

Hunter 2007; Briggs et al 2003). It is strongly correlated with the diseases and diseases that

music therapy often treats.

Chapter 3 discusses background information and research methods. It outlines the

research's objectives and questions to understand the different ways music therapists in Atlanta

treat mental and physical illnesses contained in individuals, often through structural violence and

inequality. Research methods and ethnographic methodologies are discussed, including

interviews and participant observations. Background information puts myself in research. It

provides an understanding of my interest in music, disease, and healing, and why my research is

focused on ethnomusicology, medical anthropology, and psychological anthropology. My early

relationship with music, music, and experiences with family illness laid the foundation for my

interest in this study.

Field research takes place in the Metro Atlanta area, and chapter 4 outlines this. It

describes the details of the study, including the music therapy clinic where the interview took

place, the interview process, and background information of the music therapist interviewed.

Having a background in music, most therapists know early on that they want a career in music,

and many are exposed to music therapy through personal experience of illness. This personal

experience makes practitioners and adherents of music healing powerful. However, the study

participants felt they had to constantly legitimize music therapy to skeptics. Music therapy

focuses on mind-body healing in cultures fixated on biomedical models, and music therapists

struggle to reconcile this perspective. Finally, this chapter reviews methods and techniques.

Chapter 5 begins with a broad overview of disease and intervention. It analyzes the

theoretical principles of use and the role of music in therapy and healing as perceived by Atlanta

music therapists. Music's role includes treating the mind and body as one, creating community,

connecting with memories, and acting as a medium and facilitator. Then this chapter explores

music therapy interventions for stress, depression, and anxiety with patients, families, and in the

context of mourning and birth (Hanser 1999; 1999). Finally, it explains the use of music therapy

in treating Alzheimer's disease and various physical disabilities due to traumatic injuries and

deadly diseases (Brummel-Smith 2008; Clair 2008).

Chapter 6 explores the recent growth of music therapy in Metro Atlanta, including the

socioeconomic and demographic makeup of patient samples in the area. It discusses the

politicization of medical knowledge and its institutionalization, followed by the subsequent

deinstitutionalization, i.e., the way in which neoliberal and capitalist policies and agendas shift

the responsibility of psychological care from the state to the individual (Foucault 1973;

Desjarlais 1997). This has created problems in funding and access to music therapy. Then the

various avenues and barriers to accessing music therapy are described, including insurance,

waivers, grants, and nonprofits. Study participants had to include mind-body connectivity and

spiritual healing in music therapy in a biomedical model that focuses on body care in order to be

eligible for insurance and receive accreditation for state licensing, and this has changed practices

in terms of documenting results and changing clinical terminology. Finally, this chapter explores

praxis solutions to create more access to music therapy for low-income populations, which

includes following the University of Kentucky model and state regulations.

Chapter 7 summarizes the thesis, presents theoretical conclusions, and evaluates the

significance of the research. Music Therapy is marginalized in terms of biomedicine, gender of

work, and socioeconomic status. It emphasizes music therapy as a viable method of healing in a

culture where access has been restricted due to its marginalization through Western discourse on

biomedicine and the deinstitutionalization of mental health care through neoliberal policies.

1 MEDICAL, MUSIC, AND CLINICAL ANTHROPOLOGY

This thesis synthesizes ideas from a number of topics and theories in medical

anthropology, cultural anthropology, and medical ethnomusicology. It brings together work with

scholarship on medical pluralism and embodiment in recognizing and understanding the use of

narrative and music in health and healing. This chapter first examines medical pluralism as an

overarching theory that recognizes the alternative framework of disease and cure seen in cultural

systems around the world (Johannessen & Lázár 2006). Medical ethnomusicology, which studies

the use of cross-cultural sounds and music in healing rituals, adheres to the theory of medical

pluralism in understanding this phenomenon (Koen 2008; Roseman 2008). Furthermore, the

development of the clinic and the history of Music Therapy in the U.S. are discussed (Foucault

1973; Peters 2000). Medical discourse, which is central in the creation of modern biomedical

models, has implications for music therapy in the U.S. in terms of which populations have access

to treatment and how that treatment occurs.

This chapter analyzes the theory of embodiment, an idea that transcends the mind-body

dichotomy in healing rituals (Csordas 1993; Fassin 2007). Embodiment is defined as culturally

described ways of experiencing the world with the body (Desjarlais 1992; Howard 2000), and

this theory helps in explaining music therapy as a cultural healing system that resides on the

periphery of biomedicine (Foucault 1973). While music, and the narratives in music, are healing

centers for many cultures around the world (Barz 2008; Black 2013; Hinton 2008; Olsen 2008),

has recently gained popularity in the mainstream US context. Finally, this chapter relates music

therapy, which is used to treat mental illnesses contained in individuals, to inequality. The global

power of neoliberalism and the resulting inequality shape the way disease is manifested by

individuals around the world. Structural violence involves large-scale forces, such as racism,

poverty, and inequality. This strength is strongly correlated with disease and disease (Farmer

1997, 1999; Hunter 2007; Briggs et al 2003). This thesis is ultimately interested in music therapy

healing methods for treating mental and physical illnesses, and the ways in which neoliberal

policies and medical discourse influence these treatment options.

1.1 Medical Pluralism & Medical Ethnomusicology

The Western biomedical model focuses on biomedicine and caring for the body, the

visible, and the prescribed (Foucault 1973). Medical pluralism, on the other hand, recognizes the

validity of multiple medical frameworks for treating the mind and body, noting that no single

framework is completely consistent, coherent, or complete (Johannessen & Lázár 2006). The

theory of medical pluralism provides a solid foundation for medical anthropology and medical

ethnomusicology in observing and recognizing various disease and health cultural systems taking

into account the importance of context. It not only sheds light on the different ways in which

cultural practices visualize and view disease and healing around the world, but it also aids in

understanding music therapy as a valid alternative method of healing in the U.S.

In studying magic among Azande, Evans-Pritchard (1976) provides an early example of

anthropological research on thinking and motivation for action. Azande uses magic in diagnosing

wounds, illnesses, and healing. This is the medical framework for explaining misfortune.

For example, if a boy pierces his toes, it is because he is blinded by magic (Evans-Pritchard

1976:20). If the barn collapses with the people underneath it, magic is in charge of the time. The

Azande people realized termites caused structures to decay, but the "second spear" of magic was

responsible for the timing of events (Evans-Pritchard 1976:23-25). If a person is sick, he

searches for poison divination and the results are based on taboo and magic (Evans-

Pritchard 1976:28). This belief system is very logical under Azande's rule.

Medical ethnomusicology embraces medical pluralism in evaluating the meaning of

cultural music and understanding cross-cultural musical healing (Koen 2008; Roseman 2008).

Medical ethnomusicology seeks to understand the power and role of music and sound in health

and healing in all cultures, and this requires the understanding and application of medical

pluralism. Examining music, health, and healing through a variety of disciplines offers new

insights into improving quality of life, disease and disease prevention, and even healing (Koen

2008:3). In the 1900s, anthropologists and musicologists embraced medical pluralism as they

became increasingly interested in music and healing diverse cultural practices that resulted in the

field of medical ethnomusicology (Koen 2008:6). The practice includes not only therapy, but also

the actual healing and healing of diseases. It usually involves spiritual and religious rituals or

ceremonies, meditation, and prevention methods (Koen 2008:6). Instead of a rigorous biomedical

model, medical ethnomusicology combines "neurological, psychological, emotional, and

cognitive processes, sociocultural dynamics, spirituality, belief, and metaphysical as central

concerns and modes of action that play an important role in achieving and maintaining health"

(Koen 2008:7). Just like in medical anthropology, cultural context should not be overlooked

when analyzing the role of music in cross-cultural healing (Koen 2008:12).

To understand musical healing in various cultural practices, one must understand the

meaning of cultural music and embrace various belief systems. A four-fold framework for cross-

cultural engagement in research on music and therapy was developed to understand the healing

of music embedded in different cultures and apply that knowledge to other contexts (Roseman

2008:24). The quadruple approach includes musical, socio-cultural, performative, and

biomedical, thus emphasizing various medical frameworks and pluralism. The musical axis is

concerned with the structure of sound (tone, pitch, tempo), the sociocultural axis involves

culturally relevant musical metaphors, the performative axis examines how music healers convey

voices, and the biomedical axis focuses on psychophysiological transformation (Roseman

2008:29). This approach has been used to study music therapy in the US. Music is analogous to

emotions and creates an affective environment of joy or pain through duration, tone, tempo,

rhythm, and melody (Roseman 2008:29). Medical pluralism recognizes music therapy as a valid

method of healing by taking into account the cultural context.

1.2 Discourse & Clinic

While music is commonly used in healing rituals around the world, it is not common in

biomedicine. Many cultures focus on mind-body interconnectedness in healing rituals, while in

A Western cultural practice, medicine places a strong emphasis on the biomedical model.

Foucault (1973) analyzed the development of clinics in Western societies, providing insight into

why this was possible. During the 18th century, the narrative around disease discourse changed

from a fantasy language to a language of visibility, or from using words such as "damp

parchment" to "red membrane" in describing disease (Foucault 1973:xi). The relationship

between the visible and the invisible changes, revealing through observation and language what

was previously beyond perception. A different kind of alliance between words and the objects

they describe is developed, "allowing one to see and to speak" (Foucault 1973:xii). In clinical

experience, the body is confronted with the "language of rationality" (Foucault 1973:xv). In the

18th century, the clinic produced a system of reorganization. "What's wrong with you?" is

replaced with "Where does it hurt?" emphasizing the importance of the physical location of the

disease. The clinic owes its importance not only to the reorganization of medical discourse, but

also to the possibility of a discourse about disease altogether (Foucault 1973:xix).

Diseases become spatial and localized within the body, although the configuration cannot

always be shown geometrically (Foucault 1973:3). Instead, it is described using the relationship

of closure, subordination, division, and similarity (Foucault 1973:5). Endless exchanges between

doctors and patients occur until the disease reveals its true nature

(Foucault 1973:9). Here, tertiary spatialization refers to the ways in which a disease is restricted,

isolated, divided into regions, or distributed in healing facilities by a community in the most

advantageous way to protect itself and build relief. It is on the basis of tertiary spatialization that

"the whole medical experience is canceled and defined for the most concrete perception, a new

dimension, and a new foundation" (Foucault 1973:16). Space medicine disappeared, and was

given legal protection, new status, and medicine became institutionalized (Foucault 1973:20).

This perspective has profound implications for Western discourse around medicine, and by

extension, for alternative healing methods such as music therapy. Music therapy is used to treat

mental and physical illnesses. A relatively new field struggles to justify treating the mind and

body as one in a society that places heavy emphasis on biomedicine and treats only the visible

while giving little weight to the invisible, i.e. the realm of the soul.

1.3 Terapi Musik

This section explores how the origins of the clinic are related to the history of Music

Therapy in the US. According to Foucault (1973), medicine discovered the possibility of origin

in the clinic. Historically, medicine was simply the relationship between a disease and its

mitigation. It is not based on theoretical knowledge like in a hospital. Actions to relieve pain are

not even necessarily conscious; they were carried out "immediately and blindly" (Foucault

1973:55). That knowledge is not recorded and hidden for future use. The decline of clinics begins

when knowledge is no longer available for immediate use. It is secret, politicized, and

concentrated in privileged groups (Foucault 1973:55). Music Therapy is usually given in clinics,

places where people go to seek treatment to feel better. Western clinical discourse influences our

understanding of music therapy in the US.

Peters (2000) is a music therapist who provides an emic perspective on music therapy.

Music therapy has many definitions, but most recognize it as the role of music and sound in

achieving goals in mental and physical health (Peters 2000:2). Peters (2000) provides a

descriptive and in-depth definition of music therapy:

Music therapy can be defined as a process of planned and goal-directed interactions and

interventions, based on an assessment and evaluation of the individual client's specific needs,

strengths, and weaknesses, in which music or music-based experiences (e.g., singing, playing

musical instruments, moving or listening to music, creating or discussing songs and music) are

specifically prescribed for use by specially trained personnel (i.e., music therapists or those

trained and supervised) to influence positive changes in an individual's condition, skills, thoughts,

feelings, or behaviors (Peters 2000:2).

Music therapy is often an individual process between therapist and patient that lasts over a long

period of time; There is no simple or instant cure. It involves careful planning and methodical

steps that include musical, artistic, therapeutic, interpersonal, and behavioral elements. An

atmosphere of trust and care between the therapist, the client, and the music is very important

and necessary because the main interaction is in the musical experience beyond verbal

expression. Musical experiences can be active or passive, and include playing an instrument,

singing, listening to music, feeling musical vibrations, and responding to music emotionally

(Peters 2000:3-5).

Medical and psychiatric journals began publishing articles on the use of music in treating

physical and mental disorders in the early 19th century (Peters 2000:26). Psychiatric

interventions began in the 19th century, when mentally ill patients could be removed from their

environment and placed in "moral prisoners" where they underwent therapeutic programs

involving art, museums, and listening to music (Wigram et al 1999:7). It is believed that listening

to music can calm and calm a suffering and disturbed mind. Harmonious music is considered to

bring chaos of the mind into harmony (Wigram et al 1999:7).

In the early 20th century, research showed the psychological effects and physiological

responses to music, especially its effects on mood and mental health (Peters 2000:29). The

invention of the phonograph allowed the use of music in hospitals during medical surgeries, to

induce sleep, to calm fears, and as an anesthetic aid. During the interwar period, music therapy as

a psychiatric intervention continued to evolve, and music therapy programs were implemented in

psychiatric hospitals and prisons (Peters 2000:29). Early institutions and foundations were

developed to train students in music therapy, and after World War II, music as medicine

skyrocketed in psychiatric and veterans' hospitals (Peters 2000:33). Many music therapists in this

study cite the emergence of PTSD or Post Traumatic Stress Disorder after World War II as the

official beginning of professional music therapy. By the end of the 20th century, music therapy

had become an organized professional discipline with the founding of the American Music

Therapy Association in 1996 (Peters 2000:40). Music therapy is now a recognized profession in

about 50 countries (Wigram 1995).

1.4 Embodiment: Healing

This chapter has so far analyzed the role of medical pluralism in medical anthropology

and medical ethnomusicology in considering cultural contexts and various frameworks for

disease and healing. It examines the development of Western biomedical discourse and the

history of Music Therapy in the US. Now turning to exploring the different ways disease and

healing are embodied cultural experiences. The embodiment is useful for understanding music

therapy and its marginalization in biomedical discourse. Embodiment is a theory that rejects the

biomedical mind-body dichotomy. This perspective is important in understanding how disease is

embedded as an individual experience through history and culture. Embodiment theory describes

the historical, socio-political, and socioeconomic forces that make up diseases and become

embodied in individuals (Fassin 2007).

Embodiment describes the social construction of not only sickness and disease but also

health and healing. Csordas (1993) describes embodiment as a way of experiencing the world

through practice and perception. Practice involves thinking, feeling, and acting with a body that

is ingrained, internalized, and accustomed to it. Here, Csordas (1993) uses embodiment to move

beyond the traditional mind-body dichotomy. Practice shapes our perceptions, which are always

cultural. Attention or the formation of an object is called a somatic mode of attention, which is "a

culturally described way of paying attention to and with one's body to the environment that

includes the presence of another person embodied" (Csordas 1993:138). Embodiment helps

understand how healing practices unfold in a variety of cultural patterns, including Catholic

Charismatic healers, Puerto Rican spiritistic mediums, and nonreligious healing in Siddha

medicine and contemporary psychotherapy.

1.4.1 Shamanism & Possession

Other examples of culturally formed embodiments of healing include shamanism and

trance. Many cultural practices today embody healing in music through shamanic or shamanic

rituals (Howard 2000:354). The word "shamanism" was first applied to the religious activities of

Siberians more than 200 years ago (Howard 2000:354). The definition describes a shaman as a

healer or fortune teller who travels to the spirit realm through a trance and acts out the stages of

the journey (Howard 2000:355). Shamanism, and in particular healing through shamanism, is a

phenomenon seen all over the world. However, practices, concepts, and descriptions vary greatly

among different social groups (Howard 2000:355). Although shamanism is not common in the

U.S., we embody music in healing through music therapy, the focus of this thesis.

Examples of shamanism and musical healing can be seen in Venezuela, Peru, the Middle

East, and Nepal. In South America, shamanism uses musical healing when a shaman enters the

spirit realm. Many Native tribes of South America associate disease with evil spirits, imbalances

with nature, and the supernatural (Olsen 2008:331). The Venezuelan warao and desert peoples of

northern Peru use music in healing rituals. Shamans are spiritual specialists who enter a state of

trance through music to contact or manifest the supernatural (Olsen 2008:332). Both groups have

three types of shamans who perform healing rituals using special toys and songs. This process

requires trust from healers and patients. Music therapy is an important element in Islamic culture

in the Middle East. Research in Iran and Central Asia showed the influence of trance, hypnotic

effects, and the power of music to alter consciousness. Significantly, Westerners cannot manifest

trance unless they understand the cultural context. For example, a Swedish woman can only

experience a trance after marrying a Muslim, following the saying, "He who does not know tarab

(ecstasy of music), he does not belong to the Arabs" (2008:381). Although shamanic practices

vary across cultures, music is an integral part of many different healing traditions.

Possession or ecstasy is a key element of shamanism, and music helps enter into a trance

(Howard 2000). Becker (2000) explains that a certain type of selfishness is necessary to enter a

trance, which may explain why the practice of trance is not common in the US, and is even

looked down upon. The Western perspective has historically emphasized the self as the limited,

innate, and essence of an individual (Lutz 1988:4). This view of the self can influence openness

to the emotional response to musical stimulation that almost always accompanies trance-based

rituals (Becker 2000:26). Participating in a trance ceremony means getting into the community

narrative and becoming a certain type of person who is not one's own (Becker 2000:27). In the

context of the US mainstream, we do not easily accept trance because of our view of ourselves.

To experience trance, there should be no distance between the ritual and the self, and if integrity

is felt challenged, trance cannot occur (Becker 2000:30)

Possessiveness has many different characteristics. The healer and the patient must

manifest a trance to achieve a healing experience. Two different physical states of embodiment

can be distinguished: one characterized by noise, hyperactivity, loss of control, loss of

knowledge, and dissociation, and the other with silence, tranquility, regained control, intuitive

knowledge, and increased consciousness, with many states in between (Howard 2000:363). It is

seen as an expression of hysteria or mental illness, reflexes to cultural stimuli, hyperventilation,

body disorientation, and high consciousness due to drugs, food, music, dance, and repetitive

actions (Howard 2000:363). Music is the most plastic art because it is the most open and requires

interpretation (Howard 2000:364). Music is the trigger for manifesting a state of trance: it

obstructs the environment and mind, regulates or messes with the body, and focuses or inhibits

the senses (Howard 2000:364). Shamans use the rhythm of drums, bells, and sounds during

healing rituals to help manifest trance or altered states of consciousness to facilitate resolution

and healing (Peters 2000:21).

Sound serves as a distraction that allows the mind to enter different states.

An example of the use of drums in trance and healing can be seen in the Yolmo Sherpa of

Tibet. The people of this region practice Buddhism and shamanism and are influenced by Tibet

and Nepal (Desjarlais 1992:7). Shamans perform oracular divination or mo using drums to

induce a state of trance so that the god can enter the body to reveal the patient's illness. During

his ethnographic fieldwork, Desjarlais (1992) tried to manifest trance by participating in drum

beating, body vibrating, and musical crescendo. Music is a stimulus that promotes the

embodiment of a state of trance due to the social coding of meaning (Howard 2000:364). When

Desjarlais took on cultural nuances, he was more able to embody a trance state, even to the point

that he was trusted to play the drums. The rhythm of the drums results in "auditory driving,

matching brain waves, and leading to sensory bombardment and seizures" (Howard 2000:365).

Although his experience of trance was not the same as that of Yolmo, Desjarlais' experience of

being a hybrid,

"between and between" the two worlds, a mixture of shamanic practices and embodied

knowledge (Desjarlais 1992:19). The image of his trance state may be a therapeutic or

transcendent experience resulting from his transformation in the field.

Desjarlais accompanies a shaman on a home visit to perform healing rituals, and he

interviews patients after treatment on the body, pain, and emotions (Desjarlais 1992:13). Music is

very important during this shamanic healing ritual. Pain occurs with "loss of soul" when the soul

leaves the body to roam the country and talk to ghosts and demons resulting in sadness, despair,

and anxiety (Desjarlais 1992:13). Shamans are called to find the soul and bring it back. In Yolmo

wa culture, people usually do not show or express emotions. The loss of the soul is similar to

grief, grief, and anxiety, and shamanic healing rituals "seem to offer an indirect medium through

which this personal suffering is voiced, shaped, and potentially transformed" (Desjarlais

1992:22). For example, a young bride loses her spirit. He was upset, confused, and crying, and

the shaman's diagnosis raised the error that legitimized his feelings (Desjarlais 1992:22). His

feelings, which are described as sadness or malaise, are likely due to cultural tensions in the

home between men and women (Desjarlais 1992:23). The author alludes that "loss of soul"

loosely translates as "depression." Just as disease is culturally shaped and embodied, healing is

culturally shaped and embodied is the key to the healing experience. This demonstrates the

importance of cultural context in medical ethnomusicology (Koen 2008), and the fourfold

usefulness of the framework in understanding medical pluralism and musical healing in cultural

practice (Roseman 2008).

1.4.2 Narrative & Music

Medical pluralism examines alternative healing and disease frameworks in which

biomedical models prove inadequate in explaining cultural practices around health and disease.

Explanatory frameworks for health and disease are often formed in narratives and music.

Narratives help in reframing the past to understand the diseases that disrupt normal life and in

telling fragile stories stigmatized by culture. Music aids in healing experiences through entering

into trance and changing states of mind and self. Both narrative and music, and narrative in

music, help understand illness, facilitate psychological flexibility, and promote healing through

the embodiment of ritual transformation.

The use of narrative and music in healing rituals is present in African songs (Barz 2008;

Black 2013) and cross-cultural music therapy (Hinton 2008). The narrative in the song changes

the cultural memory of HIV/AIDS in Uganda. This explains how Ugandans "live positive" with

HIV, shifting language from the stigma label of "HIV positive" to manipulating cultural memory

(Barz 2008:164). The main method of shifting cultural memory is through the songs of AIDS

support groups. Through the help of health workers, the language of these songs changed from

death and death to hope and empowerment to change memories and change the attitude of AIDS

sufferers from illness and death to positive and lively life (Barz 2008:165). This method actively

seeks to harmonize positive messages from traditional healers, medical doctors, and religious

institutions. Traumatic injuries and serious illnesses turn ordinary experiences into extraordinary

experiences, and people use narratives to understand these disorders of normal life (Ochs

2004:271). "Traumatic re-memory" through music refers to the process by which traumatic

memories are legitimized and incorporated into the narrative to liberate past victims (Barz

2008:167). HIV/AIDS has been ingrained in the African psyche, and songs and narratives are

effective tools in changing the perspective of the disease.

The narrative and music used in HIV/AIDS revelations are evidenced in South Africa

with the Zulu Gospel choir (Black 2013). The choir members reveal status and spread awareness

through the narrative of the performance, which helps in seeking treatment and healing. The

choir provides the basis for narrative events that are embedded in a larger context that results in a

coherent narrative (Black 2013:359). Structural violence and uneven distribution of HIV/AIDS

are manifested in choir members, and narratives allow them to embody positive lives.

Performance and art allow discourse on subjects that are difficult to talk about because of

dominant ideals (Black 2013:363). Through choir and music, they can see the context of their

uprooted positions, understand their illness, and achieve healing.

One way to understand the role of narrative and music in healing is the concept of

flexibility. Hinton (2008) is interested in how rituals, and in particular musical healing rituals,

instill qualities in individuals that are considered valuable by society by presenting a primary of

flexibility that promotes psychological flexibility. Flexibility is both physical and psychological.

In other words, it is embodied. Muscle and joint flexibility is similar to psychological flexibility

in producing a relaxation response. Psychological shifts consist of detaching from emotions and

choosing new emotions or psychological "sets" (Hinton 2008:124). Pathology can be defined as

the inability to change psychological sets and adapt to new mindsets. Psychological and

emotional flexibility is the ability to shift this set and adapt to new situations (Hinton 2008: 125).

Somatic flexibility includes joints, nervous system, and brain. Increasing flexibility in this

system increases psychological flexibility by reducing tension, stress, and anxiety that trigger

psychological flexibility (Hinton 2008: 129). Culture promotes flexibility through simultaneous

patterns and sequential patterns. Music has simultaneous patterns that can be handled

simultaneously or separately, and sequential patterns, including shifts in harmony, melody, and

rhythm, and these patterns promote psychological shifts and flexibility (Hinton 2008:134). The

healing tradition of music is embedded in the cultural context and serves as a primer for healing.

Societies around the world improve social health through a flexibility primary that

facilitates psychological flexibility. Cultural practices teach how to control attention and shift

emotional states. Pathology can be associated with a lack of flexibility, such as an inability to be

flexible resulting in stress and anxiety or an inability to concentrate resulting in ADD (Hinton

2008:143). Psychological illnesses are caused by inflexibility of the mind. The tradition of

musical healing in culture serves as "ritual healing" by instilling techniques of happiness and

adjustment, thus promoting psychological flexibility through music and dance (Hinton

2008:149). In the Isan culture in Thailand, musical healing rituals promote flexibility through a

variety of ways, including pattern shifts in music and kinesthetic dance. Flexibility comes into

being, part of a "flexible memory network" that can be remembered in difficult situations that

require a change in perception (Hinton 2008: 158). Musical healing rituals promote healing

through the primary embodiment of flexibility that changes psychological mindsets. These

musical rituals are embedded in the cultural context and help understand diseases.

1.5 Neoliberalism & Structural Violence

Music therapy is one of a number of options for people struggling with mental or physical

illness. This section discusses neoliberalism and structural violence because disease and

inequality are closely correlated. Structural violence involves large-scale forces, such as racism,

poverty, and inequality, which are strongly correlated with disease and disease (Farmer 1997;

1999). Structural violence is prevalent around the world, from Haiti to South Africa to

Venezuela. In Haiti, for example, economic patterns correlate with disease distribution, structural

inequality, and structural violence (Farmer 1997). Personal distress, poverty, racism, and

suffering manifest as individual experiences (Farmer 1997:262). Structural violence is embedded

in the larger cultural, historical, and political economic matrix (Farmer 1997:273). As the world

becomes increasingly interconnected, globalization is shaping the historical, political, and

economic forces that orchestrate violence and suffering. Structural violence is rampant in Haiti.

Globally, the U.S. government funds the Haitian military that enforces unlimited political

violence. In historical terms, Haitians are descendants of slaves kidnapped from Africa to

produce sugar, coffee, and cotton, and these Haitians suffer a disproportionate share of inequality

(Farmer 1997:274). In countries around the world, global power leads to inequality, poverty, and

higher mortality rates (Farmer 1997:276).

Farmer (1999) examined how these large-scale social forces disproportionately impact

certain populations in spreading and preventing disease. Suffering is often blamed on cultural

differences rather than the result of globalization that facilitates inequality. For example, people

in Haiti often die from tuberculosis, a treatable disease, because of structures that inhibit access

to resources. Three million people die each year from tuberculosis, and infectious diseases are

the most common cause of death in the world (Farmer 1999:3). The uneven distribution of these

infections is due to social inequality (Farmer 1999:4). Instead of blaming AIDS victims and the

poor, poverty structures, social conditions, and access to prevention and treatment require

evaluation (Farmer 1999:9). The standard of care needs to be questioned because all need access

to quality healthcare.

Another example of the link between disease and inequality can be found in South Africa.

The structural violence of colonialism and apartheid has led to racism and a dramatic increase in

AIDS rates in South Africa between 1990 and 2005 from 1% to 29% (Hunter 2007:689). Causes

responsible for the pandemic's massive increase include increased inequality, poverty, and in

particular, the political economy, sex, and money exchange (Hunter 2007:690). The adoption of

neoliberal policies has led to an increase in marginalization of women, declining marriage,

circular migration of women, and the sex economy. Informal settlements known as imijondolos

have HIV rates twice that of rural and urban environments (Hunter 2007:690). The people who

live there are young, unemployed, poor, and have many sex partners (Hunter

The poor are and remain sick in rich and poor countries (Farmer 1999:12). Wealth inequality

equals health inequality and a lack of social cohesion.

Venezuela provides a third example of the impact of structural violence on health and

access to medicines. Briggs and Martini-Briggs (2003), an anthropologist and a physician,

respectively, discuss how structural violence facilitated a cholera outbreak in the Amacuro Delta

region of Venezuela in the nineties. In the most remote areas of the delta, there are no clinics,

schools, or shops, and locals blame the villagers' deaths on witchcraft and try traditional

medicines such as hoarotu and wisidatu (Briggs et al 2003:3). A disproportionate proportion of

those who died were indigenous peoples because they did not have access to government

services, healthcare, clean water, and water treatment. Health officials and authorities use

language to control information and determine the population in Venezuela. A clean citizen is

defined as an individual who has a modern medical understanding of the body, health, hygiene,

and goes to the doctor when sick, and those who are unable to adopt this relationship as an

unhealthy subject (Briggs et al 2003:10). This creates a catalyst for implementing unequal health

policies that cause outbreaks.

During the cholera outbreak in Venezuela, the media tried to link cholera to poverty, the

poor, and indigenous peoples. Media images fortify the dominant narratives of "space versus

race" and "us versus them," with the authority in suits juxtaposed with images of sick bodies

(Briggs et al 2003:104). Stories of indigenous peoples being infected because of their own

agency are presented to the press before fully investigating the situation (Briggs et al 2003:200).

Officials explained how the disease started and spread in racial terms even before the pandemic

began, and it was soon associated with indigenous people's favorite foods (Briggs et al

2003:200). When these are no longer waterproof, the argument shifts to lack of hygiene,

migration habits, healing beliefs, biological vulnerability, and geographic location. If anything,

industrialization brought cholera through transport, colonization, and exploitation, i.e. through

structural violence (Briggs et al 2003:296).

In conclusion, this chapter examines medical pluralism as an overarching theory of

medical anthropology that recognizes alternative frameworks for disease and health. It explores

the ethnomusicology of music in the context of medical pluralism in understanding the use of

narrative and music in cross-cultural healing. It discusses the development of the clinic,

Western discourse on biomedicine, and Music Therapy as a professional discipline in the US.

This chapter then analyzes the theory of embodiment in rejecting the mind-body dichotomy in

healing rituals. This theory is useful in illustrating the reasons why music therapy is on the

periphery of biomedicine. Next, the use of narrative and music in various healing rituals and

cultural practices is examined, and finally, this chapter links disease to inequality. Structural

violence involves forces such as inequality and poverty that are strongly correlated with the

illnesses and illnesses that music therapy often treats. The following chapters explore Music

Therapy in the U.S. by examining music therapists, the role of music in healing, who has access,

and how to make these alternative healing methods more available to populations that can use

them.

2 RESEARCH METHODS AND BACKGROUND

2.1 Research Objectives & Questions

This chapter lays the foundation for the focus of this study and the purpose of this thesis.

It begins by outlining the purpose of the study, which is to explore the anthropological

perspective of music therapy and examine its use in Atlanta as a treatment option for mental and

physical illnesses. This is followed by a discussion of the research, including where the research

took place, who was involved, and which anthropological research methods were used during the

duration of the project. Furthermore, it provides my own experience and background in music

and illness that led me to my interest in ethnomusicology, medical anthropology, and thus, the

subject matter of this thesis, music therapy. Finally, analyze the ethics and potential obstacles

faced in this study.

The main ethnographic goal is to develop an anthropological perspective on music

therapy. This is informed by Foucault's (1973) discourse on the clinic and its development as an

institution in Western medicine. Music therapy underscores mind-body interconnectedness and

holistic healing (Koen, 2008). Clinical discourse was reorganized around treating the visible

(Foucault 1973), placing music therapy on the fringes of Western ideas about biomedicine. I

explore the circumstances surrounding a person's decision to become a music therapist, the

methods and techniques used by music therapists to treat mental and physical disorders, and the

role of music in healing. Methodologically, this study utilizes participant observations and

interviews with music therapists. The study seeks to answer the following questions: What

brought Atlanta music therapists into this profession? What mental and physical disorders do

music therapists treat, and what methods and techniques do they use? What is the role of music

in healing?

Who has access to music therapy, and how do historical and cultural factors affect this access?

How does the discourse around Western medicine affect access to music therapy? Through

interviews with music therapists in Atlanta, this research seeks to understand the local culture of

music therapy, and how we as a society conceptualize the disease and the role of music healing

in the U.S.

The study examines how music therapists in Atlanta treat mental and physical illnesses

that manifest in individuals, often due to inequality and poverty. Although some people are more

susceptible to mental stress than others, mental illness occurs in all types of people regardless of

age, class, or ethnicity, and the effects can be at least frustrating, and debilitating at worst. Some

people turn to healthy exits, such as exercising, meditating, or immersing themselves in hobbies.

Others turn to substance abuse to "self-medicate", using drugs and alcohol to escape reality and

stress that can complicate and worsen life. Still others seek professional help from psychiatrists,

psychologists, counselors, and therapists. A psychiatrist may prescribe antidepressants or other

medications, while a psychologist may examine a person's past in an attempt to dissect what is

bothering the mind. Counselors and therapists help develop activities and goals to cope with

stress and depression, and they can provide a variety of therapies, including psychotherapy,

aromatherapy, dance therapy, art therapy, and music therapy. Music therapy is growing as an

option for those seeking alternatives to pharmaceutical and psychological treatments, although

access is still limited for certain populations.

2.2 Research Methods

Evaluation Research examines the cultural environment of the existing program (Trotter

& Schensul 1998:692). In my case, I examined the music therapy atmosphere of Atlanta through

the perspective of a therapist. The applied setting involves four clinics and offices in Atlanta

administering music therapy, which entails identifying a network of people who regularly use

music therapy. I use social cognitive theory, which focuses on thought processes and cultural

beliefs (Trotter & Schensul 1998:697). These theories stem from the interaction between

cognitive psychology and psychological anthropology. I used ethnographic research methods,

including participant observation, semi-structured interviews, and data analysis.

Participant observation and interviews took place in music therapy offices and clinics in the

Atlanta area with music therapists only. This project does not include patients or clients. With

many private practices in the Greater Atlanta area, it wasn't difficult to find a music therapist in

the community that I could interview. I use targeted sampling in looking for diligent individuals

practitioners (Trotter & Schensul, 1998:707).

Interviews with therapists are conducted in person or online via email if not available or

preferred. The interview begins with an explanation of the approval procedure and the signing of

the consent form. At the beginning of the interview, I read the consent form to the participant and

send a digital copy after the interview. For the online interview, I sent the approval form via

email, and they scanned the signed copy and emailed it back. I received verbal confirmation of

approval on the audio recording for the live interview. The interviews lasted between one and

two hours, and ten therapists were interviewed. Participants are told that they can end the

interview at any time without consequences. First names and contact information are collected

for communication purposes and stored digitally on password-protected computers. Participants

had the option to choose a pseudonym that linked them to their information in this note, but no

one chose to use a pseudonym. Audio recordings are only used after obtaining explicit

permission. Files are also stored on a password-protected computer, and printed versions of the

data are stored in a locked space.

Only the Principal Investigator and myself have access to the data. Upon completion of the study,

all data will be destroyed physically or digitally.

2.3 Background Music

Now that the objectives, questions, and methods of the research have been addressed, my

background with music and the illness that informs the research question will be discussed. My

interest in this research was based on my early relationship with music, music, and experiences

with family illness. Music has always played a big role in my family. My brother has been

playing drums since he was five years old and currently plays in two bands, while my sister and I

started playing the piano at a young age. I mostly learn to play by ear and by watching other

people play. In elementary school, I picked up a band and played many instruments, from clarinet

to trombone to tuba. My first major declared in college was music. I took guitar classes in

addition to piano and music theory classes. I even entertained the idea of applying to Berklee

School of Music. Although I eventually changed my major, I still received an Outside

Concentration in Music, and I am an avid guitar player today. I also had a lot of early experience

with the emotional power of music and dance. After watching a movie in a theater, I would go

think about the score of the movie rather than the movie itself. I remember watching movies and

picking the score with the piano, showing the early ears. I started thinking about a strong musical

role in film, so much so that I thought I might pursue a career in it someday.

I also connected with dance at an early age, and I was interested in different dance styles,

such as hip-hop, salsa, breaking, and krumping. I see dance as one of the most visual expressions

of human emotions, and krumping fully represents and expresses influence through body

movements. I have personally experienced the positive mental benefits of music. If I'm stressed, I

can pick up my guitar and after playing for a while, I "get out of the zone" and feel as if the

weight has been lifted from my chest. Or, if I take the time and listen to music for just thirty

minutes, I see a noticeable improvement in my mood. Although I never went to Berklee School

of Music or became a film score composer, the emotional power of music continues to intrigue

me, and this project focuses that energy on medical ethnomusicology and the role of music in

healing.

2.3.1 Music is "My Jam"

In my interviews with music therapists in the Metro Atlanta area, many of the study

participants pointed out the impact of music on our moods and emotions. Although it is never an

interview question, the topic of personal relationship with music comes up in most interviews.

For example, Sarah at Metro Music Therapy feels music is very personal to people, and she

suggests that, "people identify with the music they choose to listen to." Jamie, owner of The

George Center for Music Therapy, states that we all use music therapeutically every day. When

angry, a song can serve as a mantra, when sad it can calm the soul, or a summer traffic jam can

cause someone to roll down a car window and throw some shades while exclaiming, "that's my

jam!" I often wonder if we as a culture use music more to change our mood or to adjust our

mood. For example, if someone is sad, does he listen to a cheerful song, maybe Michael Jackson

to lift his mood? While music therapists can use music to lift mood, most of us, according to the

study participants in the study, use music to match our mood.

If we go to a wedding, we hear happy music that fits the environment. When we are

depressed, we listen to sad music. If I'm feeling sad, I might listen to someone like

Elliott Smith who uses minor chords and pathetic lyrics in his music. Beth, owner of Music

Greater Atlanta Therapy Services, chooses music based on her mood. He argues he does it

"because sometimes music can be distracting, and sometimes music can be energizing, and

sometimes music can be soothing." Lana of The George Center agrees, stating music that doesn't

match her mood often upsets her, but music that matches her mood helps her feel heard and

understood. Jennifer, the owner of Therabeat, listens to upbeat music when she works out, and

"coffee shop music" when she wants to relax. Like me, all study participants were attuned to

their emotional connection to music and its impact on their mood. But my interest in music

therapy goes beyond the musical element. I became curious about mental illness and the

structures that surround it because of personal family experiences.

2.4 Diseases: Aplastic Anemia & Beyond

In 1997, and again in 2004, my sister was diagnosed with Aplastic Anemia. Aplastic

anemia is a very rare disease in which the bone marrow stops producing red blood cells, white

blood cells, and platelets. Basically, blood dies. The disease is so rare that hospitals see about one

case a year, and the only treatment is a bone marrow transplant. Even with a donor, the chances

of survival are still not 100%. Fortunately, I was a good fit for my sister. During both transplants,

she had to undergo chemotherapy, hospital isolation, and months of recovery before returning to

her normal life. The first transplant was done with baby stem cells, a process in which doctors

drilled into my pelvis through my lower back to extract marrow. However, the first transplant

failed. The second transplant was done through apheresis, a process in which adult stem cells are

filtered out of my blood after my bones are stimulated to produce excess stem cells.

Miraculously, the second transplant was successful and the number remained normal, but she

suffered from graft versus host disease. His body was constantly at war with my bone marrow

causing painful side effects. He was taking cancer-causing immunosuppressant drugs to suppress

his immune system so that his body wouldn't reject my bone marrow, but he could quit the drugs.

This type of disease experience had not only caused great damage to his body, but had also

wreaked havoc on his mind.

For years, my sister felt she would not live past 40 years, and living with a deadly illness

for half her life had resulted in chronic stress, clinical depression, and severe anxiety. As a young

adult, his way of dealing with this condition was neither emotional nor vulnerable, and he

facilitated this process through substance addiction. Despite the obstacles, my sister moved

forward with her life, graduating from law school in the middle of a second transplant,

graduating from cosmetology school, and finally opening her own business. He overcame his

illness by putting it aside and pursuing his academic and career goals. However, his past

continues to haunt him, and his mental illness has manifested into a new diagnosis as he comes to

terms with his past illness experience that he has harbored for so long. This is difficult for him

and our family. Music and dance have played an important role in my sister's illness. She views

dancing as her personal therapy, and she was a research participant in my project in 2014. He

attributes his association to music and dance directly to his medical history. "I think it's because

of [of] everything I've been through, and finally made that connection for myself, for what it did

for me, so I can now recognize it in other people."

Often closing his eyes on the dance floor, he once opened it and his close friends just

looked at him and declared that dancing was indeed his meditation. When I play guitar, I often

close my eyes to hear and connect with music better, so this detail makes a lot of sense to me.

According to Foucault (1973), medical discourse focuses on visible treatment, and perhaps by

closing our eyes, we can experience different types of healing in the invisible mind aided by our

sense of hearing. He summed up what dance did for him:

This is where the problem does not exist. When you don't think about everything that happens in

your life, then your anxiety decreases. Moving and dancing to the music makes you happy. You

don't feel pressured. It was all about the whole thing that was lost at the time. That's a lot of

Buddhist practice, living in the present.

This echoes sentiments expressed by the ancient Chinese philosopher Lao Tzu in the 6th century.

"If you're depressed, you're living in the past. If you're anxious, you're living in the future.

If you are at peace, you are living in the present." My older sister seems to have found

peace in the moments of presence on the dance floor. He also tackles his illness through

narrative. As mentioned earlier, narratives help individuals understand traumatic illnesses,

which interfere with normal life (Ochs 2004). He writes in his journal almost every day

about his life and experiences. I believe that through his writing, he is trying to understand

his past and his experiences with illness.

2.5 Ethics & Barriers

Potential obstacles and ethical issues exist in any project. The American Anthropological

Association's blog on ethics lists seven principles of professional responsibility in anthropology. I

applied these ethical principles to this research. This first is not to do harm, especially important

when working with vulnerable populations. No vulnerable populations were involved in the

study. The second is honesty about work. Open and honest communication regarding the

objectives, methods, and objectives of the study took place with the music therapist in a

transparent atmosphere. The third is to get informed consent. Informed consent was obtained

from all research participants involved in this project. The fourth is to weigh competing ethical

obligations with all parties involved, including the music therapist, the principal study

participant. The fifth is to make the results accessible. The information obtained through this

research will be available to the public or upon request. The sixth is to protect and preserve

records. This principle is followed as described in the research method. Finally, the seventh

principle is to maintain ethical and respectful professional relationships, which this study seeks to

achieve.

The potential obstacle lies in one theoretical underpinning of the study, which looks at

neoliberalism, structural violence, poverty, and inequality. One concern before starting this

project is that those who live in poverty and suffer from stress and related illnesses may have

limited access to alternative and complementary medicine, such as music therapy, let alone

access to medications or support systems due to a lack of insurance or other resources. While the

study implies individuals with higher socioeconomic status have more access to music therapy,

lower socioeconomic populations do have avenues for access as well. The study seeks to gain

insight into the cultural environment of music therapy by understanding what populations in the

area are accepting it and why.

As long as we participate in the social system, we cannot choose whether to engage in the

consequences it produces. We engage only through the fact that we are here. Thus, we can only

choose how to get involved, whether to be just part of the problem or also be part of the solution.

That's where our strengths lie, as well as our responsibilities (Johnson 2005:89, from the AAA

website).

Thinking about my past experiences with music and illness, I believe music has a great capacity

to treat disorders of the mind and body. The study explores praxis solutions with the aim of

contributing to greater access to music therapy for low-income populations.

This chapter discusses background information and research methods. It outlines the

purpose and question of the study, which is to understand the different ways music therapists in

Atlanta use music to treat mental and physical illnesses. It presents research methods and

ethnographic methodologies, including participant interviews and observations, that were used

during the study. Background information puts myself in research. It was done by discussing my

interest in music, disease, and healing, and why my research was focused on ethnomusicology,

medical anthropology, and psychological anthropology. My early relationship with music, music,

and my experience with family illness laid the foundation for my interest in this research. It

concludes with seven ethical principles that guide research.

3 FIELD RESEARCH

3.1 Music Therapy in Atlanta

The study took place in Greater Atlanta, also known as Metro Atlanta, an area with a

population of about 5.5 million people. It seeks to understand the cultural elements surrounding

the field of Music Therapy, including the correlation between inequality, health, and access to

alternative and complementary healing methods such as music therapy. It seeks to understand the

role and utilization of music in healing in the U.S. through interviews with ten music therapists in

the Metro Atlanta area who work in one of the following four music therapy clinics: The George

Center for Music Therapy, Therabeat Inc., Music Therapy Services of Greater Atlanta, and Metro

Music Therapy. All clinics are located north of downtown Atlanta. All of the music therapists

interviewed for the study were women. Music therapy in the U.S. is marginalized in terms of its

relationship to biomedicine (Foucault 1973) and occupational gender (Hochschild 1983). Perhaps

women are predominantly represented by music therapists due to the feminization of the

caregiver role and the emotional work she often needs (Hochschild, 1983). A male therapist was

contacted but eventually became unresponsive. Seven interviews were conducted in person, and

three interviews were conducted via email. The George Center for Music Therapy produced the

most data with five therapists interviewed for the study. George Center's music therapists include

Jamie, Andrea, Jordan, Lana, and Madison. The two therapists interviewed from Therabeat, Inc.

were Jennifer, the owner, and Chelsea. Therapists interviewed from Metro Music Therapy

include Kally and Sarah. Finally, Beth was interviewed, a music therapist and owner of Greater

Atlanta Music Therapy Services. The discussion below is my analysis of the similarities found

throughout the interviews, complemented by my participants' observations and personal

experiences described in chapter 3, and contextualized in the literature discussed in chapter 2.

3.1.1 Atlanta Music Therapist

As stated earlier, a total of ten therapists were interviewed. Jamie is the owner of The

George Center for Music Therapy and is in her mid-thirties. He was born in Chattanooga and

raised in Detroit, graduating from Western Michigan University with a degree in Music Theater.

He moved to Orlando to perform for Disney, then to New York to perform in theaters, and then

earned a Master's degree in Music Therapy in 2004. He worked as an Assistant Director in a

private practice before starting The George Center in 2010. Jamie grew up singing and playing

the piano and violin.

Andrea has been an Assistant Director at The George Center since 2012. He was born in the

North

Carolina and moved to Powder Springs near Atlanta when she was four years old. He graduated

from Georgia College and State University in Milledgeville in 2009 with a degree in Music

Therapy.

Its main instrument is the cello.

Jordan, Lana, and Madison were the other three therapists from The George Center

interviewed. Jordan was born and raised in McDonough near Atlanta and graduated from the

University of Georgia with a degree in Music Therapy. She grew up singing at an early age and

has been practicing for two years. Lana was born in Alabama before moving to Georgia when she

was nine years old, and she received degrees in Music Education and Music Therapy from

Samford University and Appalachian State University, respectively. He has been singing in the

choir since he was three years old, and played a variety of instruments growing up. Finally,

Madison was born and raised in Atlanta and received a degree from Florida State University in

Music Therapy.

He has been at The George Center for less than a year.

Jennifer and Chelsea are music therapists interviewed from Therabeat, and they have

some interesting similarities. They both received degrees in Music Therapy from UGA. Jennifer

was born in Texas and lived there for six months before moving to Canton north of Atlanta, while

Chelsea was instead born in Atlanta lived there for six months before moving to Texas and

eventually returning to Atlanta. Sound is their primary instrument in college, as all Music

Therapy majors must specialize as part of the UGA program. Jennifer started Therabeat in 2006

and opened her current clinic in 2012. He has been training for twelve years while Chelsea has

been training for three years. Beth, owner of Greater Atlanta Music Therapy Services, was born

and raised in Ohio. He earned his Music Therapy degree from Eastern Michigan University and

received his Master's degree in Neurological Music Therapy from Colorado State University.

Moving to Atlanta in 1998, Beth immediately started her company, which is Atlanta's oldest

music therapy clinic. He was an accomplished pianist.

Kally and Sarah were the last two music therapists to be introduced, and both worked for

Metro Music Therapy. Kally was born in Maryland, grew up in Atlanta, and graduated from

Georgia College and State University in Milledgeville with a degree in Music Therapy. He

interned in Dallas before moving back to Atlanta a year and a half ago to start practicing. He

started playing the piano but mostly plays guitar now. Sarah was born in Charlotte, North

Carolina and grew up in Roswell outside of Atlanta. Like Kally, she received a degree in Music

Therapy from Georgia College and State University and has been practicing in Atlanta for three

years. Sarah started playing the piano at a young age, but the voice was her main instrument in

college. She primarily works with substance abuse patients, while Kally primarily works with

hospital patients.

3.1.2 Background Music

Greater Atlanta is made up of people from all over the world. Although none of the music

therapists interviewed were born overseas, they collectively represent different regions in the

Eastern U.S. None of the music therapists were single children growing up, all of whom had at

least one sibling, and two, Andrea and Sarah, homeschooled during high school. All of the

therapists interviewed have a degree in Music Therapy, and most go to one of the two major

schools that offer Music Therapy degrees in the state: Georgia College and State University and

the University of Georgia. Two owners received the title in Michigan. Three of the interviewed

owners either have a Master's degree in Music Therapy or received specialized training in

Neurological Music Therapy. All music therapists are very willing to give interviews, are eager

to spread the word about music therapy, and most of them are young professionals who are eager

to work in a relatively new field. Two things stand out about how they became interested in

music therapy. Having a background in music, most of them know from an early age they want a

career in music, and they come to learn about music therapy through a loved one who is sick or

sick themselves. Perhaps this particular relationship with music and music therapy is related to

the marginalized position of music therapy with respect to biomedicine, as mentioned in chapter

two. Those who do not have such connections may not know about these career options or

understand them in traditional biomedical discourse.

Ask many high school seniors what they want to study in college, and most will give

more than one answer or no answer at all. Indeed, most college students change their major at

least once in college. However, in the case of the participants interviewed for this study, most

knew from the beginning they wanted to do music therapy. One explanation for this is that they

all have a musical background and come from a musical family, so they know that they want to

do something with music. Only Beth, the owner at Music Therapy Services of Greater Atlanta,

comes from a non-music family. Even looking at my own musical background, I have always

wanted to incorporate music into my life, which is why it is the subject of this thesis. All

therapists start singing and playing musical instruments from an early age, from the age of 3 to

10 years. Music therapists play a variety of instruments, including piano, guitar, cello, violin, and

clarinet, with the top two instruments being the piano and guitar. Jamie, owner of The George

Center, says that all certified music therapists must be proficient in piano, guitar, drums, and

voice. All have enjoyed listening to music since childhood, and their tastes include classical rock,

Christian rock, gospel, classical, and popular music from the 60s, 70s, and today.

In addition to having a musical background, many participants were exposed to music

therapy early in life. During her homeschooling years, Andrea met a music therapist who worked

at the Children's Healthcare of Atlanta (CHoA) while performing with a community orchestra.

Her father, who was also in the orchestra, knew this therapist and arranged for Andrea to

accompany him to learn more about music therapy. Chelsea witnessed music therapy while

working at a summer camp in high school and became addicted. Beth wrote a career paper in her

sophomore year of high school, and a teacher who knew she was a school escort suggested music

therapy. Also in high school, Beth observed a music therapist at the city hospital and thought,

"holy cow, this is real, this is cool." She was already interested in becoming a special education

teacher and felt Music Therapy was a good marriage of the two. Jordan also took a career test.

Music Therapy is one of his main career suggestions, and he "never looks back." Kally knew

before college that she wanted to help people, and music has always been a big part of her life.

He stated Music

Therapy as the first and only major in college.

3.1.3 Experience with Music Healing

Another factor that attracted study participants into music therapy was having a close

friend or family member who was suffering from the disease, or having an illness of their own,

and then finding healing in music. As stated in the previous chapter, I became interested in the

role of music in healing because of my own sick family background. It's no surprise that some of

the music therapists in this study found their career paths through disease experiences. Jamie has

a grandfather with Alzheimer's, and he will notice physiological changes in him when he comes

home from school and plays the piano. His movements will calm down and his breathing will

become slower. Jennifer can witness how music helps a close friend with cancer get through

treatment. Andrea has a cousin in Texas with significant medical needs, and music therapy is one

of the best parts of her day. Suffering from Ulcerative Colitis, an inflammatory bowel disease,

Kally says music helps her with pain management. She feels her diagnosis affects her desire to

work with people with chronic or deadly illnesses. The experience of this disease led the research

participants to music therapy.

Although Sarah had no prior experience with music therapy or experience of illness, she

found herself drawn to the field. Sarah, a music therapist with Metro Music Therapy, was one of

two therapists in the study who started college as a Music Education major. She was doing

student observations, and a little girl clung to her hip and wanted her attention whenever Sarah

was in class. One day she tells Sarah that she will never see her again because she and her mother

ran away from her father and uncle. Sarah learns from the teacher that her father and uncle are

drug dealers, and Sarah feels helpless because she can't do anything to help this little girl. Sarah

commented:

So it was really disappointing for me that I would go into a field where I would see a lot of problems and

not really be able to do anything. Especially since the main focus is obviously teaching music.

With music therapy, Sarah feels she can focus more on the person than on the music. More

generally, I learned that for many of the study participants, music was often secondary and acted

as a medium that facilitated interaction rather than healing itself. This will be discussed later in

this chapter. Although Sarah's story is unique among therapists, all have a passion for music, both

inside and outside of work.

Some therapists are active musicians outside the office who perform in choirs, musicals,

and bands. Beth sang with the Atlanta Women's Chorus, Jordan performed professional theater

and musicals in the Atlanta area, and Andrea performed as part of a duo called Corks and

Chords, pointing out that "sometimes you just want to be in it for music." The duo even has a

self-titled YouTube channel. Many therapists occasionally perform in church choirs and bands,

and Jamie used to act and sing with a theater troupe in Lawrenceville, Georgia, which is located

just outside the city. Because therapists play music all day for their work, many "enjoy the

silence," as Andrea puts it. Beth prefers to be quiet when she gets home, and Jamie exclaims that

the last thing she wants to do is listen to music when she gets home from work. Listening to

music all day is likely to be very tiring, and Kally confirms this by stating, "your brain is very

stimulated by music," and she often sits still while driving in her car. Although they enjoy

silence, music still plays an important role outside of work.

When therapists play or listen to music in their free time, it is often to relax. When

discussing the impact of music on mood, Kally stated she plays the guitar in her spare time

because she can control it, which relaxes her.

Kally: I think a lot of my desire to play music and do things related to music is that I can control it.

Especially like if I'm in a stressful situation that I can't control.

Stephen: Okay, yes this is not something I thought before.

Kaally: Oh yes, and I think too, like that's funny, I look back at college. In college I had a lot of

problems related to Ulcerative Colitis. And I struggled through it. I'm proud of the way I fought

my way through it.

Stephen: That's right.

Kally: And I think, that, as a student, I channel my frustration and lack of control to help others,

because it's something I can control. True, just as there are so many aspects of life in general that

you can't, you can't control.

Stephen: That's right.

Kally: You don't have control, you know, if someone in your family dies, or if I don't know, you

know, there are a lot of things that you don't control and it's something that I manipulate, I can

control, and I know that I'm trying to make a difference.

Playing music is something that Kally can control versus many uncontrollable life variables.

Andrea agrees with this sentiment. When he is very stressed and feels that something is out of his

control, he will play the piano until he feels better. Working in a hospital with a dying patient or

working in a substance abuse clinic with a suicidal patient can certainly be stressful, and the

participants used music privately to relieve compression. They feel most of their patients'

suffering is out of their control, and music allows them to regain control. This may also be what

patients gain from music therapy, a sense of control over a large part of their control.

3.2 Skepticism & "Hippy" Treatment

Simply playing or listening to music can help relieve stress, but Music Therapy involves

more than that. It includes many methods and techniques used to treat a myriad of mental and

physical illnesses, but some people are not sure. Opinions on the effectiveness of music therapy

in alleviating the suffering of mental and physical illnesses vary, and most people may believe

that traditional therapies are more effective in treating mental and physical illnesses. Emerging as

a professional field in the U.S. in the late 20th century (Peters 2000), music therapists often find

themselves explaining, justifying, and legitimizing music therapy in relation to biomedical

discourse. One reason for this is because music therapy emphasizes the interconnectedness of

mind and body in healing (Koen 2008), and during the 18th century, clinical discourse was

reorganized around biomedicine, treating only what can be observed and seen inside the body

(Foucault 1973). The disease of the mind is invisible and elusive, and from "absurd psychology

is born" (Foucault 1973:197). However, traditional psychology emphasizes mind-body

differences, focusing on the former at the expense of the latter. Therefore, music therapy is on the

fringes of biomedicine and what many people accept as legitimate treatment in our society

because it focuses on mind-body healing. It's easy to understand why many of the music

therapists I interviewed strongly believe in the healing power of music given their musical

background, early exposure to music therapy, and experiences with illnesses and alternative

healing methods.

The therapists I interviewed argue many people are skeptical of the health benefits of

music therapy, as the profession seems to have taken on the "hokey" quality with some skeptics.

Countering this perception, participants emphasized the importance of interaction and emotional

connection. For example, music therapists Beth and Kally believe that public discourse, as

evidenced in films like Alive Inside, perpetuates misconceptions about Music Therapy. Alive

Inside is a documentary film by social worker and pseudoscientist Dan Cohen. The film shows

the effects of music on memory with Alzheimer's patients. Cohen puts headphones on their heads

and gives them an iPod, and like magic, patients are pulled from the depths of their minds and

come alive, connected to music and family in the process. Beth argues clearly that giving

Alzheimer's patients an iPod is definitely not music therapy, and emphasizes the interactive

nature of music therapy in doing so. She uses music to connect emotionally, visually, and

sometimes spiritually with her patients, stating, "I'm emotionally invested in this session." Jordan

analyzes aspects of music therapy involvement. "This is what makes us completely different

from someone who plays the harp in a nursing home or hospital—the difference is physical,

mental, emotional, and sometimes spiritual involvement." However, music therapists struggle

between supporting spiritual healing in music therapy and needing to gain legitimacy in Western

biomedical culture. Kally agrees that movies like Alive Inside create a false impression of music

therapy, as it's the only thing some people ever go through. He admits that it is even seen as

taboo and feels he should educate, advocate, and justify the benefits and usefulness of music

therapy all the time.

Both Jamie and Andrea from The George Center often find themselves educating people

about music therapy as well. Some people assume a music therapist prescribes listening to music,

but music therapy is all about interaction. Jamie said he would never prescribe a CD for patients

to listen to so they feel better, and it was a ridiculous idea to prescribe Bach, for example. Music

therapy is interactive and involves musical activities, so music therapy does not occur unless

Jamie is present and provides music. Jamie stated:

Music is a universal language, music heals, music educates, music is used in every culture in the

world, in medicine and education. Why do we need to talk about it? I mean, I can show the

research, but why do I need to show the research? Literally every culture since the beginning of

time has used music in medicine and education.

Jamie seems to be exhausted having to explain to people who are skeptical of the benefits of

music therapy. However, while music is often used in healing around the world, it can also be

irritating depending on mood, and has even historically been used as a torture tool.

Study participants showed that in U.S. culture, people have difficulty purchasing

alternative therapies that treat the mind as connected to the body, and this is partly due to the

biomedical view of the clinic. Andrea explained that people have an image in their head of

someone sitting on the pitch playing the guitar and singing hippy songs. Jamie agrees with this

statement about hippies:

We hate the fact that there are people who think music therapists are a bunch of hippies sitting

around a campfire singing kumbaya and that's music therapy, which is not what we do. But I [also]

hate the fact that we lost a bunch of hippies sitting around a campfire singing kumbaya. That's

what is so special about music is that it brings people together.

This is an interesting observation by Jamie. On the one hand, the fact that people immediately get

the image of hippies singing campfire songs when they think of music therapy means that people

cancel it. They do not believe it or see the truth in it, because a hippy may represent a free spirit

who is medically ineligible and may, through the help of illicit substances, come into contact

with a deeper, spiritual, and false realm, a realm that exists outside the realm of biomedical

discourse. On the other hand, Jamie argues that we may have lost something as a society. We

may have lost the ancient tradition of people gathering around fire, food, and music to take part

in communal sharing, friendship, and ultimately, healing. The therapists interviewed for this

study were exposed to Music Therapy early in life, so they never developed the skepticism of

some of their critics. Their musical background and education, combined with musical healing

experiences with close friends, family, or themselves, create a believer and committed music

therapy practitioner.

3.3 Socially Constructed Mental Disorders

Before exploring the methods and techniques of Music Therapy, this section discusses the

process and improvement of socially constructed mental disorders. A number of music therapists

interviewed spoke about the early days of professional music therapy in the context of PTSD, or

Post Traumatic Stress Disorder, a disorder commonly diagnosed in soldiers returning from war.

According to Jamie, music therapy began after World War II when nurses found using music

with soldiers diagnosed with PTSD had positive physiological and psychological effects. Kally

stated that research on the impact of music therapy on PTSD is currently being conducted with

the active-duty military. PTSD is a fairly new mental disorder when compared to other mental

conditions. PTSD and other mental disorders are often constructed socially, just as subjectivity

and emotions are constructed socially, and they are not just the result of biological phenomena.

By changing the socioeconomic, sociopolitical, and historical landscapes, intersubjectivity is

altered, emotions and memories are recreated, and mental disorders are socially constructed

(Kleinman & Fitz-Henry 2007). PTSD as a mental illness is partly a cultural phenomenon.

Anthropologists and social scientists have studied the idea of universal human nature that

is based on neurobiology and has not changed throughout history. The Western perspective has

historically emphasized emotions as the essence of the individual, innate, innate, instinctive, and

universal across cultures (Lutz 1988:4). However, thoughts, feelings, beliefs, conscious

experiences, i.e. subjectivity, are not just individual characteristics (Lutz 1988). This viewpoint

ignores the influence of history, culture, politics, and economics on subjectivity (Kleinman &

Fitz-Henry 2007:53). Collective experience shapes subjectivity, and this idea helps explain

modern mental illnesses such as depression and PTSD as socially constructed. Mental disorders

are not unique individually and need to be analyzed as social experiences in a social context.

Universal neurobiological processes do not cause PTSD and other mental illnesses. Historical

and social processes affect the way people experience their emotions, memories, and subjectivity.

The imaginary line between the self and the social world does not exist. Psychologists and

anthropologists shift their understanding of mental illness from universal and individual

experience to contextual framing of subjective processes (Kleinman & Fitz-Henry 2007:64). It is

important for music therapists to understand the different conditions of patients seeking music

therapy.

Psychologists and psychiatrists diagnose patients with new mental illnesses with such

frequency that the list of mental disorders grows more and more every year. Many of these

distractions are socially constructed. Jamie points to this as a major issue in mental health right

now. By labeling it, it gives it legitimacy, he said. As a child, she thought she would be diagnosed

with a relatively new mental disorder called Sensory Processing Disorder, a type of

OCD or obsessive compulsive disorder. Jamie stated:

I'm telling you now, if I were born today, I would be diagnosed with Sensory Processing Disorder.

Like I couldn't stand the wrinkles in my socks, and I would pull them until they were torn, and

then I threw them in the trash, and my mother said, if you go home without socks again, you will

be grounded for the rest of your life.

Eventually she grew out of it because it no longer worked, but she argues children today are

receiving this new socially constructed diagnosis, and parents then believe their children need

therapy and medication. This behavior serves children because they get a lot of attention for it,

and they can't process the difference between negative and positive attention. As a music

therapist, Jamie feels there are many developmental and cognitive disorders that require music

treatment, but he feels as a society, we have gone too far in labeling every little nuance as

diagnostic. Regarding his own past experiences with OCD, he gets better every year of his life.

Perhaps Jamie's childhood OCD and sensory processing tendencies make him a perfect fit to

empathize with children dealing with the same issues and help them realize that wrinkled socks

are not a big deal. PTSD, OCD, and Sensory Processing Disorder are just a few of the socially

constructed mental disorders treated by music therapy.

3.4 Methods & Techniques

There are six methods and techniques of music therapy, including assessment, goal

setting, music intervention, determination of musical function, and selection of musical material

followed by applying, documenting, and evaluating treatment (Peters 2000). Assessments are

conducted prior to treatment to learn the client's history, strengths, weaknesses, and needs. This

involves reviewing medical records, interviewing clients and family members, discussing client

needs with the care team, and engaging and observing the client's interactions with music (Peters

2000:65). Assessments at Therabeat usually last for three sessions. If a child still doesn't respond

to music by moving or dancing, Jennifer realizes that the child can't process the music and won't

be able to follow the instructions. In the case of patients who are unresponsive with Alzheimer's

or dementia, Kally will interview family members to assess their history and music preferences.

Goal setting creates therapeutic goals and objectives of what the client wants to achieve

by providing direction, goals, and focus on treatment (Peters 2000:66). Jennifer will get

immediate goals from the Occupational Therapy, Physical, and Speech Therapy notes. When

asked what patients want to achieve, Beth stated:

Therapy focuses on goals. So every patient has goals and goals, and that's what we're working on,

right? First, we find out what their goals and objectives are. Either their doctor told me, or I and

the patient decided... So when I finished the session, no matter who, right, I thought, okay, what is

my big goal, and how are they doing with that goal today? And is there anything they can do at

home this week to help us achieve our ultimate goal.

If the client is able to articulate what he wants to achieve, Andrea will choose the goals with the

patient, but sometimes the goals are discussed with the parents and he bases them on school and

other therapeutic needs. Andrea commented:

yes, well [clients] can sometimes say this is what I've been trying to achieve all along. Most of the

time, it will be something that we discuss with parents. What would you like to see your child

achieve during this time period? What are their needs in school? What are their needs in their other

therapies? How can we support it with music therapy?

Music interventions, such as songwriting and lyric analysis, are musical procedures that help

clients achieve therapeutic goals, and procedures include musical function, musical experience,

and musical material (Peters 2000:67). One of the techniques that comes up in almost every

interview is ISO

Principles, which are techniques used to facilitate interventions. Kally explains it this way:

ISO principles, so certain techniques about, basically involve meeting with the people where they

are. So if someone is very agitated, and that in turn causes them to have more pain, um, we with

our voice or our guitar or whatever we use fits where they are musically. So if they breathe very

deeply, we won't choose too slowly. We'll start with a faster tempo and try to slow them down with

breathing and help them take deeper breaths by slowing down our instrument.

The ISO principle involves matching the patient's mood to the rhythm and tempo of the music,

and then bringing them to different circumstances to intervene.

Determining the function of music is another method. There are five determinants of

music's function: music as a carrier of information, reinforcement, learning background, physical

structure, or reflection of the skills to be learned (Peters 2000:67). Finally, selecting musical

material combines musical function with the client's response to musical stimuli to plan the type

of musical experience for therapeutic treatment interventions (Peters 2000:68). Jamie explains

that the choice of music is very important, and they always use music that the patient likes.

Music is always a patient's favorite, so regardless of the therapist's preferences or what the

therapist thinks will help in the situation, it really doesn't matter. What matters is the patient's

preference. So, if the patient really likes death metal, then we need to use death metal in the

session. Now, if we feel like death metal might not fit the situation, or we might want to expand

into a different genre, we'll still include death metal, and we'll try to venture into a different genre

by using it. But we have to use music that the patient likes, because that's the hook. That's how we

get our patients to buy. That's how we get them to participate. That's where they'll have the most

emotional connection with music, and that's where they'll be able to open up and talk about what's

going on, or be motivated to participate in the activity.

This statement implies patients may not be confident in music therapy due to clinical discourse

on biomedicine (Foucault 1973), and by choosing and connecting with their own music, they are

more willing to believe in the power of music in healing.

Giving "music homework" is another technique that some music therapists use. Most of

the study participants gave music assignments to patients, but Jamie did not, emphasizing that

therapy is interactive and only occurs when the music therapist is present. Playing the piano at

home helps with motor skills, reading music, and sequencing, and by practicing you will work

towards those goals, but it is not therapy. Beth has several patients who approve of homework

assignments as part of their goals and objectives, and don't need to be music-oriented. For

example, an OCD patient may complete a reflection task by observing the behavior of others,

and then comparing it to their own. Beth elaborates:

Um, as I don't know, like when I was treating a lot of preteens with OCD, their self-awareness was

a big deal, right? They don't really understand that their OCD is different, do they? You know like

when you were twelve, you were like, I don't know how I'm different, how I'm the same. So I'm

going to ask them to do a little bit of reflection homework. You know, observe a few people, and

then compare them to themselves, or interview five people in their house, you know what I mean?

Self-awareness is the focus of the activity, and he wants them to understand their behavior is

different and not necessarily healthy. Andrea commissioned to train, and Jennifer and Chelsea

did a home program. The only music therapist who doesn't give any homework is Sarah.

This chapter discusses field research, which takes place in Greater Atlanta, including

music therapy clinics where research takes place, the interview process, and introducing music

therapists and providing their background information. All of the therapists interviewed had a

background in music and knew early on that they wanted a career in music, often finding out

about music therapy through personal illness experiences. They are also all women, which may

be related to the history of women's disenfranchisement and the marginalized status of Music

Therapy as a professional discipline in the U.S. As such, they must constantly legitimize and

justify music therapy, which focuses on mind-body interconnectedness in healing in a medical

climate that emphasizes the biomedical model. Again, embodiment theory rejects this dichotomy

and aids in understanding music therapy as a healing method in cultural practice. Also, music

therapists strongly believe in the power of music in healing, likely due to their musical

background and personal illness experiences. In exploring the emergence of PTSD and other

diagnoses in the U.S., the social constructs of mental illness are examined. Finally, this chapter

ends with methods and techniques. The next chapter provides an overview of the disease and

intervention and explores the deeper role and purpose of music in therapy.

4 DISEASES AND INTERVENTIONS

When I started this study, one of its main goals was to examine the use of music therapy

with stress and depression, given that 9.5% of the U.S. population suffers from depression

(NIMH 2010). I was under the erroneous assumption that music therapy mostly treats stress and

depression. Only about 1% of Beth's private practice patients come in for stress-related

depression, while 60 to 70% of Sarah's substance abuse and hospital patients are treated for stress

and depression. Through interviews with study participants, I realized that music therapy is being

used to treat a variety of mental and physical illnesses, from Parkinson's to Autism to Alzheimer's

and ADHD. My own misconceptions about the use of music therapy in treating various diseases

underscore the marginality of music therapy in modern medical discourse. The music therapists

in the study mainly worked in four private practices. While these are private practices, they all

have contracts with a variety of entities in the Atlanta area, including nursing homes, substance

abuse clinics, special education programs, hospitals, and nonprofits, and the arrangements tend to

affect the types of clients that music therapists serve and the specific mental or physical illnesses

they treat.

Kally and Sarah work for Metro Music Therapy, and MMT mostly contracts with hospital

and substance abuse patients who tend to be older. Hospital patients are in the dying process, and

many of them suffer from Alzheimer's and dementia. Sarah works with substance abuse patients,

so she sees more patients with stress and depression than private practice inpatient care. When

discussing Sarah's internship in a psychiatric hospital, she stated private practices don't typically

contract with hospitals or psychic units, which have more stress and depression patients.

But as far as private practice goes about running and working with depression/anxiety, private

practice will not typically contract with hospitals, such as psychiatric units. And there aren't many

stand-alone soul facilities like that, you know? I don't think I know of any place that's like an

inpatient counseling place, you know? As it wouldn't be very realistic, you need more acute

treatment for it.

He explains stress and depression patients should seek private practice care, and that is usually

not the case because these patients often end up in hospitals or psychiatric units only when their

condition becomes critical and debilitating.

The George Center, Therabeat, and MTSofGA all work hard with pediatrics, so they tend

to look at children with Emotional and Behavioral Disorders, or EBD, and developmental

disorders, all subcategories of mental disorders. The list of mental disorders that private practice

treats is too numerous to list here. As Jordan points out, "anything and everything is worthy of

music therapy treatment." The most common treated mental disorders that are consistently

mentioned in all interviews are Autism, ADHD, OCD, Down syndrome, Alzheimer's, and of

course, stress, depression, and anxiety. Some of them will be discussed in the next section in

more detail. Regardless of her condition, Jennifer explains that she treats the symptoms of the

disorder, not the diagnosis.

Like I will treat the symptoms. I don't treat the diagnosis. I will treat the symptoms of autism. I

don't treat autism. I would treat the symptoms of depression, but I don't treat depression itself, sort

of, if it makes sense. I [don't] treat Down syndrome... but I will treat the symptoms of Down

syndrome. I can't change Down syndrome. Does that make sense?

He treats the symptoms of depression, autism, and Down syndrome, emphasizing the point that

he cannot change the fact that a person has a particular disorder.

Therefore, the focus of this thesis, and by extension the purpose of this study in focusing

on the anthropological perspective of music therapy, is not to explain every possible disease that

music therapy treats, nor is it to examine every possible intervention used to treat the condition.

If you want to find a complete list of diseases and interventions, one only needs to read a book on

Music Therapy or search the Internet to learn these facts. Moreover, no two patients are treated

the same way, even if they both suffer from the same condition.

Jennifer elaborated:

Let's say I have two patients with Down syndrome. You will see I facilitate completely different

from one patient to another, because you take into account their personality, you take into account

their age, you take into account their family. I mean, you really take the whole picture into

account.

Specific interventions used by study participants included songwriting, lyric analysis, music

improvisation, therapeutic singing and instrumental playing, musical movements, sensory

integration, melodic intonation, gait training, sequencing, and dance. Some of them will also be

discussed in more detail in the next section.

4.1 The Role of Music in Healing

As previously stated, the study was not interested in any disease treated with music

therapy, nor did it focus on any possible intervention for treatment. The study was interested in a

deeper process and was not immediately proven to occur. It focuses on the theoretical principles

of use, such as its focus on mind-body healing rather than strict biomedical healing. This chapter

explores the role of therapeutic music in mind-body healing, creating community, in connecting

memories, and in acting as a medium and facilitator. It also researches music therapy in treating

depression, anxiety, Alzheimer's, and physical disability (Peters 2000; Brummel-Smith 2008;

Clair 2008). Finally, the chapter concludes by discussing the use of nontraditional music therapy

in birth and grief counseling. Music therapists often use and apply music therapy in dealing with

pain, pregnancy, and loss and mourning (Hanser 1999; 1999).

Peters (2000) is a music therapist who offers his views on the role of music in healing.

Music is made of physical structures and real vibrations in space and time that can be felt and

heard with our senses (Peters 2000:50). The chords and tones of music are connected to natural

and physical structures, so music connects people with the vibrations of the physical realm and

the universe in real time (Peters 2000:51). Music facilitates mind-body connectivity by acting on

both the mind and body, emphasizing holistic healing methods (Peters 2000:53). This overlaps

with elements of the musical healing tradition in other cultures. Instead of dualism, many

cultures view the physical and spiritual realm as a whole (Koen 2008:94). Music expresses this

wholeness, and when combined with prayer, it creates heightened awareness, spirituality, and

transcendence, and facilitates communication with God, a higher power, or spirituality (Koen

2008:97). For example, through the Persian mistress, or devotional music, prayer, and

meditation, "participants can reach certainty that her energy will influence healing changes,

which in turn aids healing or may even cause it to occur" (Koen 2008:95). HCP, or the principle

of human certainty, can influence transformative healing with faith, certainty, and knowledge

(Koen 2008:95).

Music also brings communities together by facilitating interpersonal interaction through

rhythm, organization, and emotional connection. These communities are created in social

gatherings, religious settings, group performances, music concerts, and dance (Peters 2000:54).

They are also set in unconventional settings, such as substance abuse clinics and psychiatric

hospitals. Sarah feels that through music, she gets a different level of relationship very easily, and

patients may not realize that therapy is going on because they are just enjoying the music. It

gives patients a shared experience when they listen to familiar songs together. Sarah stated:

We've all experienced it, we've all listened to it, so it gives us a kind of ground. Then I feel like it's

also developing a relationship, to say okay, you kind of understand where I'm coming from now

because you've experienced this as well.

Patients develop relationships and mutual understanding through shared experiences. Many

people have experienced a conversation with someone and connected through music, or listened

to a song together and experienced together. Perhaps people feel understood through this

relationship, which is important for humans as social beings, that others feel what they feel when

they hear certain music.

The wordless and nonverbal aspects of music help in conveying emotions, which has

therapeutic implications by helping patients who have difficulty expressing emotions verbally,

and thus music presents a non-threatening outlet for sharing emotions (Peters 2000:56). Creating,

performing, and listening to music gives people personal meaning and improves health and life

satisfaction (Peters 2000:57). Music therapy helps individuals who feel alone connect with

society through shared emotions. Sarah gives an example of this connection and unity when

describing a woman who wants to commit suicide during a song rewriting practice.

I don't remember what the woman ended up writing, but I remember, she wanted to kill herself,

well I think she really tried to kill herself. He shared his lyrics that he wrote, and he started crying.

It was very sincere, and everyone in the group had a moment where we all shared an

understanding of how he felt.

Everyone in the group supported him, not trying to fix anything, but letting him share and

experience with him. This is when Sarah feels she is making a real difference in people's lives as

a music therapist.

The third role of music in therapy is the connection to memory. The study participants

discussed the strong relationship between music and memories. Jamie stated:

Music defines the moments in our lives. I mean, I think I said this in our last interview, but um, we

attached great memories in our lives to music. We all remember our summer hours in our last year

of high school. We all remember the first song we made in the car with our boyfriend. We all

remember our wedding songs, or the songs we sang to our children when they were born. I mean,

it's a big memory for us.

We attach important memories in our lives to music. A song might pop up declaring, "that's my

jam!" Jamie goes on to discuss music and memories:

You hear a song you haven't heard in twenty years, and it comes on the radio, and you know every

word. Well, you can't memorize a monologue from twenty years ago, but you know every word for

that music because you attach a melody, you attach a rhythm. All of those are different triggers for

those memories, and how it affects you emotionally can be good, it can be bad, however, it's real,

you know?

Jamie argues that we know every word in music because we attach a melody and rhythm, and

that acts as a different trigger for that memory and how it affects us emotionally, for better or

worse. In my own experience, certain songs will take me to a very specific time and place. It

reminded me of what was really going on in my life, who I was with and where, and what I was

feeling at the time. Jordan agreed, stating:

Music for me holds memories. I always associate certain songs with certain moments in my life,

good or bad. And no matter how many years pass, every time I hear that song, I will be brought

back to the memories I have associated with it.

It is as if music allows travel, both in space and time. This can be very important in healing when

brought to positive memories. Even the negative memories evoked by music can facilitate the

processing of the past and heal the soul.

When working with substance abuse patients, Jamie uses music that patients enjoy. If a

patient has a favorite song, it is because they have memories and meanings attached to it. It

reminds them of certain moments in their lives, making those moments easier to talk about.

Sarah's substance abuse patients listen to music when they are high, so the music reminds them

where they are and who they are with when they are high. He created a safe space so that they

could listen to that music in different conditions, and they would be able to talk about the

emotions of those times more easily. Kally uses "Life Review," a technique in which she plays

one of her patients' favorite songs that evokes strong emotions. The music promotes talking

about their favorite memories and where they were at that moment in their lives. "What one song

means to one person will not mean the same to another." As a music therapist, Kally wants a

response, and music helps her patients draw their own conclusions. Music therapists are able to

exploit the strong connection between music and memories in therapy.

Finally, the role of music in therapy is to function as a motivator, mediator, and facilitator.

As mentioned earlier, music is secondary to the engaged person. That's why Sarah switched her

major from Music Education to Music Therapy, so she could focus on the individual rather than

music. Sarah and I had an interesting discussion about the role of music in therapy and healing:

Stephen: What do you think about the role of music in therapy and healing? I guess what we've

talked about is that it's not about music but about it, well in your particular case, and I don't want

to answer for you, but the role of music is more of a facilitator in terms of getting people to

express things that they don't want. I mean, we've already talked about it, but it's just a general,

what do you think his role is? This will be different for each type of condition that is most likely to

be treated.

Sarah: When I was in school, we learned that music can be a motivator, and music can be a

medium, you know? Like what you say, it is a medium or facilitating something.

This is at school. I tried digging back into the file.

Stephen: Give me a school answer, that's good.

Sarah: That's true, because you know, as music therapists we use music to motivate. For a child

who needs to do some kind of physical exercise, or playing a musical instrument can be a

motivation to do something.

Stephen: That's right.

Sarah: And it's like, we can use music as motivation for ourselves in our daily lives. Like when

you want to exercise, or when you want to clean the house, turn on the music.

Stephen: Right, a lot of times when I'm writing, I like jazz or classical when I'm studying,

something without lyrics. Something like a real repetition, like movie score music that I like to

wear.

Sarah: yes, it sets the mood. It can be set, like you can put it as background music to set the mood

of what you're trying to create. Like, if I want people to come into the room and get excited, I'm

going to wear I'm Walking On Sunshine or something, and they're like, 'Oh my gosh!'

In this discussion, Sarah analyzes the many ways music acts as a medium and motivator in

therapy and in our daily lives. Andrea and Lana also feel that the role of music is motivating.

Andrea noted that music is the driving factor that drives therapy, stating, "So music for me, if I

can do an activity without music and achieve the same results, then I did it wrong. So, music is

the thing that drives change." Music is essential for change. Lana commented that music is a tool

that motivates clients to work to improve their functional skills. Emphasizing that therapy always

comes first, Jordan uses music to facilitate therapy. He sometimes describes his profession as "a

therapist who specializes in music."

Beth argues: "The human factor is very important." As an accompaniment, for example,

he would have the patient play the black keys on the piano and accompany what they were

playing, making it musical. He felt he had to be able to relate to them or he wasn't doing a good

job. Sarah uses music to "fulfill non-musical purposes." He sees music as a medium in the

healing process. Madison also notes that music assists individuals in achieving goals unrelated to

music, stating, "Although music is not a healing mechanism per se, it is an excellent tool for

improving health, well-being, and assisting individuals in achieving goals unrelated to music,

which are therapeutically oriented." According to Jamie, music serves as an excellent medium in

bringing people together.

Like, that's what's so special about music is that it brings people together... And that's what makes

music such an amazing medium, therapeutically, because I can get my guitar, my ukulele, and I

can go straight into you, and we can interact together in a musical way.

Music facilitates interaction. Music as a medium, facilitator, and motivator seems to be the main

role of music in therapy. By connecting to music, patients are motivated to participate and open

themselves to the therapeutic and healing process of music in a way they may not be able to do

in traditional clinics that focus on visual observation (Foucault 1973). The next section will

analyze examples of mental and physical disorders treated with music therapy.

4.2 Stress, Depression, & Anxiety

The World Health Organization (2010) reported depression affects 121 million people,

and by 2020, it is predicted to be the second most disabling disease in the world after heart

disease. The largest cross-sectional study using retrospective data reported a higher risk of mood

disorders in each successive generation, and in particular higher rates of MDD or Major

Depressive Disorder (Hidaka 2012: 206). These statistics fueled my belief that music therapy

mostly treats stress and depression. Although I learned that it treats a myriad of conditions

besides stress and depression, I still ask about what techniques are useful in treating stress and

depression.

Songwriting and lyric analysis are often used.

Beth states songwriting and lyric analysis are some of the most common stress and

depression interventions that increase self-awareness and self-expression. Expressing emotions

through music is seen as "safe" for those who cannot be verbally pronounced, and writing songs

with emotionally laden words provides an avenue for verbal communication (Peters 2000:253).

Kally gives an example of musical healing in songwriting. A teenage girl with a deadly illness

suffers from high levels of anxiety and depression. Whenever he was anxious, he was told to

write down his feelings, and they would turn them into a song. He immediately wrote down

words and lyrics that spoke about his family and his life. He was given two different chord

progressions to choose from, and they made a beautiful song out of it. He now plays it and listens

to it when he's anxious, and it helps him get through those few difficult moments. The following

is a discussion between Jamie and me about the use of songwriting with patients with Cerebral

Palsy.

Jamie: He has Cerebral Palsy, he's still a teenager, and he's just cognitively realized that he's

probably never going to get married or have children or have a normal, you know, normal life.

Stephen: That's right.

Jamie: For a teenager to deal with it a lot, and so, our focus on his therapy shifted from subtle and

motor goals, because he had Cerebral Palsy, we taught him how to do a three-finger chord on the

ukulele, so that he could wash himself and feed himself, and that's how it transferred as a

therapeutic goal, to really work on depression, anxiety. He couldn't process the fact that he wasn't

going to get married, who was going to love me, and I was in a wheelchair.

Stephen: Right, it's like, my sister, something similar. Like, having a deadly illness all her life

affected her feelings like a broken item. She may not be able to have children, my sister, but she

might. But, we are talking about demanding those who do not offer to freeze their eggs when we

do the first treatment, chemo, things like that.

Jamie: Yes.

Stephen: What method, do you think with this girl, is it effective in treating [depression and

anxiety]?

Jamie: yes, so he loves to sing, so we do a lot of singing, lyric analysis, and songwriting with him,

so that he processes his thoughts and feelings that he has.

Her therapy focus shifts from subtle motor goals to overcoming depression and anxiety through

singing, lyric analysis, and songwriting to help her process her thoughts and feelings.

Music facilitates expressing emotions using words to help process the disease.

Traumatic injuries and serious illnesses turn ordinary experiences into extraordinary

experiences. Previous research has focused on how people use narratives to understand this

disorder against normal life (Ochs 2004:271). One very relevant study focused on occupational

therapy. Like music therapists, occupational therapists (OTs) work with patients in different

divisions of the hospital. And like music therapists, occupational therapists are somewhat

marginal to mainstream biomedicine. They teach patients with disabilities to regain their daily

functions by playing games, teaching them crafts, and motivating them (Mattingly 1998:51). OT

uses narrative in therapeutic interactions to help patients imagine the future while remembering

the past through mundane tasks in the present, such as playing chess (Mattingly 1998:65). The

game of chess may not symbolize the end, but the beginning in the larger narrative, a new

trajectory becomes, as the OT patient learns to complete this simple task (Mattingly 1998:69).

Guided by a prospective narrative, the therapist and the patient direct action based on the

envisioned ending. Like narrative stories, songwriting helps patients renegotiate the social world

with their new disability. Music therapists use current tasks such as writing songs and analyzing

lyrics to help patients process the past while hoping for a better tomorrow.

Music therapy can improve the self-esteem of depressed patients in psychiatric hospitals

and substance abuse clinics through music improvisation and songwriting. Sarah and Kally work

with substance abuse and hospital patients, and most of them suffer from high levels of stress,

clinical depression, and anxiety. Taking a slightly different approach, Sarah calls interventions

"experiences", and she breaks them down into four categories: listening, improvisation, creation,

and recreation. Listening is just listening to music, improvisation involves actually playing an

instrument, creations include songwriting, and recreation is rewriting songs or singing karaoke. It

is helpful for depressed patients to express emotions using verbal and nonverbal means (Peters

2000:253). Sarah says one of the big benefits of music therapy is that patients process their

emotions verbally without realizing them compared to daily psychotherapy, which can be

recurrent.

I feel one of the great benefits of music therapy is that we are still doing verbal processing, but

they don't realize that it's happening. And they were able to do a lot of emotional expression,

which was one of the biggest goals for the rest of their group, but they didn't realize it was

happening until they took a step back, and they were like, wow, I did a lot of this good processing

and everything.

They just need to take breaks sometimes, and for Sarah, "music therapy is rest without actual

rest." Also, it is an opportunity for things to get out that may not be the other way around.

In working with stress and depression patients in drug and alcohol rehabilitation clinics,

Sarah works on positive emotional expression and self-image by creating experiences that give

patients the opportunity to become vulnerable. One example is karaoke. Karaoke is usually

associated with karaoke bars, so he creates a safe space for them to be vulnerable in the clinic.

Most of them have intense anxiety and fear of picking up the microphone and singing in front of

their peers, but afterwards they feel amazing and alive. They realize that they are able to become

vulnerable in dealing with their fears, overcome them, and eventually succeed. Through singing

karaoke, they increase their self-esteem, confidence, and self-esteem, reducing symptoms of

stress, depression, and anxiety. Songwriting, lyric analysis, and even karaoke are tools that music

therapists use for patients suffering from stress, clinical depression, and anxiety.

4.2.1 Family

Music therapists affirm that patients are not the only ones who need treatment for stress,

depression, and anxiety. Family members are often and sometimes inevitably affected by the

illness of loved ones, suffering from stress, anxiety, and depression themselves. They are so

caring, and it is painful to see a close family member struggling with a deadly illness or recent

traumatic injury, learning to cope with a debilitating diagnosis. Sometimes a patient has a mental

illness that causes him to be angry and violent, causing the family to worry about his safety and

the safety of others. Jamie gave the following example of an autistic patient.

This child is nonverbal, plays in his own poop, self-harms, is cruel, threatens to kill his family. I

mean, this is a very significant thing that happened. So parents are depressed, and they have a lot

of anxiety, and they are worried about their other children and siblings who are not safe at home

with their beloved child but they hate at that time because their family is so bad, and they are

nonverbal so they can't communicate. So there are all sorts of stress and anxiety going on within

the family unit, and how that affects the way they learn and how they behave, seeking negative

versus positive attention. So stress, anxiety, and depression are present in almost all of our families

in some way, and almost all of our clients in some way, because they're dealing with other issues,

you know.

Parents are worried about their other children whose safety is now compromised. They love the

child, but they are frustrated at the same time because he can't even communicate with them.

This situation is not surprising to cause depression and anxiety in the rest of the family.

Sarah described working with the families of hospital patients suffering from stress,

depression, and anxiety, noting that even though they are not patients themselves, she feels she is

there for them to provide emotional support. Sometimes they are restless or need comfort, and

using ISO Principles, he uses music to match their mood to calm them down and help them

sleep.

Jennifer stated that some families experience periods of denial, sadness, or anger.

But then you get [denial], and you also have the stage with the grief that our family is facing with a

child who may be born with Down syndrome, may be born with Cerebral Palsy. Those families,

although their child may not die, they have stages of grief that they go through. So sometimes you

get angry parents, and you know they're just angry, and they have to deal with knowing that their

son will never run on the football field like they did. Their son will never do some of those things,

so you have to come to them and we do it just for love. I say girls, we have to give them some

sunshine if they're gray, and show them what their son can do!

I can attest to the pain that families experience when a loved one suffers from a mental condition.

My sister's mental illness was emotionally very difficult for my mother and me. I feel like a part

of my sister has been lost, and in a sense, I grieve that loss.

4.2.2 Mourning & Birth

Pain and anxiety are described as largely psychological events, and music alters that

perception (Hanser 1999:160). Music is used in loss and mourning, as death is another event that

can cause anxiety and depression. Fear and anxiety of death and finality led people in Western

societies to erect walls at a psychological cost (Sekeles 1999:186). Jamie's company works with

Kate's Club in Atlanta, which helps children who are grieving the loss of a parent from a sibling

to gang violence, prostitution, or drug trafficking. Sadness causes children to suffer from

depression and anxiety, so Jamie works on the regulation of emotions and processing using

music. Music therapists use music as an alternative to verbal expression in creating personal

rituals to change perceptions, accept all life cycles, reduce feelings of anxiety and helplessness,

and work through death and loss (Sekeles 1999:186). This contrasts with other cultural music's

use of music to cope with death, such as in cremation ceremonies in Bali, where death is

celebrated to promote the memory of the dead and music is used to protect the soul (Bakan

2008:247).

Music therapy applied to women in labor resulted in reduced anxiety and body tension,

smoother labor, and less verbalization of pain and demand for pain medication through altered

pain perception (Hanser 1999: 160). Music therapists and patients listen to music and record

responses and tempes, then create a personally significant "playlist" of music to play during birth

(Hanser 1999:166). Calming music paired with deep relaxation and exercise helps with anxiety

and depression for women in labor as music hints at altered behavior. Pregnant women practice

breathing and relaxation exercises accompanied by selected music in preparation for childbirth

(Hanser 1999:163).

Both Jamie and Jennifer use music during childbirth with mixed results. Jamie created

several "soft playlists" that included Milk Carton Kids, the Punch Brothers, and Nickel Creek. It

was her first child, and she had to have a cesarean section. His son was immediately taken away

without him being able to hug him. Instead of celebrating, she remembers being very upset when

the music was playing in the background, so it wasn't a good experience. Jennifer's experience

with music at birth also did not go as planned. Jennifer called her second child a "very passionate

child," and there was a reason for the joke. The playlist consists of "cold music" such as Nora

Jones and Jack Johnson. He pushed when the song fell to the next track in an alphabetically

sorted playlist, which was a song by Jamie Johnson, a mix of hard country and rock metal that

shouldn't have been on the list. Jennifer stopped the birth demanding that the track be repaired

even though the baby would come out. Both her husband and the doctor thought she was joking,

but she was serious. She will not have children with Jamie Johnson. The joke was that "he must

have heard Jamie Johnson because he was ready to fight the world."

4.3 Alzheimer's disease

Music therapy is also used in treating Alzheimer's disease. Alzheimer's disease is the most

common form of dementia impacting 4.5 million Americans, and this number will grow to 13.5

million by 2030 (Brummel-Smith 2008:185). Characteristics of the disease include wandering,

forgetfulness, verbal attacks, hallucinations, and physical aggression. Medicaid covers most of

the costs of institutional care for long-term care. However, Medicaid and Medicare do not cover

non-institutional costs, thus shifting costs from state to individual (BrummelSmith 2008:187).

Medications are expensive and ineffective, and music therapy has been shown to be effective in

calming patients and recalling memory. Music activates many areas of the brain, improves

function, and relieves stress (Clair 2008: 204). Cognitive function and musical ability deteriorate

as the disease progresses. Close relationships suffer from Alzheimer's, and music therapy can

restore meaningful interactions (Clair 2008:209). Again, music helps families who often suffer

from a loved one's mental illness.

In working with people with Alzheimer's disease, Kally draws on reality orientation, while

Jennifer helps her grandmother recall memories. Kally uses a technique with her Alzheimer's

patients called reality orientation. Basically, if a patient thinks that they live in a different time or

place, he or she will be oriented towards their reality.

So a lot of times with Alzheimer's and dementia, we work to help with reality orientation, so it's

good to help maintain, like if they're time and place-oriented, to help maintain it, but if not, I mean

our approach is that we're not trying to fix it. Like if you sit here and tell me it's 1955 and your

parents are getting ready to buy a house on a ranch in South Carolina, I have a patient, like every

time I see him, my parents will come to pick me up right away, I'm going to get out of here. He

never really [was invited]. His parents have long since left. We went with it. There's no point in

being agitated because we're trying to tell them, well it's not 1955.

Kally says there are times when they are oriented to our time and reality through music. It pulls

them away from where they are and calms them down if they are aggressive or angry. Jennifer

can't change her grandmother's Alzheimer's, but she can, for a moment, bring her back when she

sings for her.

Her grandmother would look into her eyes and start singing, and at that moment, she might

remember a more specific time and place. Music has a powerful effect to bring us to a specific

memory in time. It seems clear that a strong musical association with memories can bring a

person back from the depths of their mind when they hear it, and they overcome the corrosive

effects of

Alzheimer's disease, even if only for a moment.

4.4 Physical Disabilities

The music therapists from this study generally treated the physical disabilities of patients

in the Greater Atlanta area. Physical disorders treated include Cerebral Palsy, Parkinson's

Disease, stroke, gross motor function, and muscular dystrophy. Kally has patients who have

difficulty crossing the midline, or reaching beyond the midline. It's a condition I've never heard

of, but it's something that music therapy treats. During the session, Kally will deliberately place

the instrument the patient wants to play on the left side of her body and investigate it to use her

right arm to reach past the midline of her body and grab the instrument. It was as if he was using

instruments and music as a reward to achieve a goal without the patient realizing it. Jamie has a

patient who suffered a traumatic brain injury in a car accident. He could no longer hold and pull

his bow to play his violin because the right side of his body was weak due to injury. They made

adaptive cuffs so he could hold the bow with his fists and play, and they kept adapting the cuffs

while strengthening his fingers so he could learn to play again. As music therapists, they know

the mechanism of how their hands need to hold the cuff and are able to adjust the cuff to work

for it.

Kally also discusses the use of music in pain management. Kally suffers from ulcerative

colitis and often experiences flares where the symptoms increase and can be very painful. He

listens to music to distract his mind from the pain he is experiencing, but it has to be instrumental

music because he finds music with a disturbing sound. He finds himself analyzing the words and

finally focuses once again on the pain. Instrumental music took his mind away from the pain. It

seemed to take his mind to another place, while the words in the music brought him back to the

place where he was experiencing pain. These are just a few of the uses of music therapy in

treating physical ailments.

The chapter begins with a broad review of the disease and intervention before focusing on

the unclear processing underlying music therapy. It was done by analyzing the role of music in

healing as perceived by music therapists in the Atlanta Metro area. The role of music in therapy

emphasizes holistic healing, community and connection, connection with memory, and mediation

and facilitation of therapist-client interaction. Going beyond minddichotomies and using music to

facilitate the healing process is key to the effectiveness of Music Therapy as practiced in Atlanta.

This chapter explores music therapy interventions for stress, depression, and anxiety with

patients, families, and in the context of mourning and birth. This chapter then explains the use of

music therapy in treating Alzheimer's disease and various physical disabilities, sometimes due to

traumatic injuries or deadly illnesses.

5 ACCESS MUSIC THERAPY

This chapter discusses inequalities in music therapy through the exploration of access to

music therapy. It examines the socioeconomic and demographic makeup of patients in the

Atlanta area, who has access to music therapy, and what factors influence this access, such as

recent changes in the U.S. health care system. This chapter then discusses the

deinstitutionalization of mental health care as a victim of neoliberal and capitalist policies and

agendas. Finally, this chapter will turn its attention to praxis solutions by discussing ways to

make them more available to populations negatively impacted by globalization that can benefit

from integrative, complementary, and alternative medicine. Potential solutions include securing

state regulations, public advocacy and education, restructuring insurance policies, and lobbying

insurance companies to include the use of the University of Kentucky's insurance model.

Atlanta has seen a recent expansion in the growth of Music Therapy, particularly in the

field of pediatrics. As mentioned, Music Therapy is a relatively new field in therapeutic

medicine. Music therapy in the U.S. did not become prominent until after World War II and only

gained legitimacy as a profession in the late 20th century with the development of the American

Music Therapy Association in 1996 (Peters 2000). According to Jamie, Atlanta is a "wood's nest"

for music therapy, with the state's largest music therapy department school system, twelve private

practices, and departments in most hospitals. According to Kally, Music Therapy is growing

every year with more people becoming certified music therapists. Beth, who started the first

music therapy clinic in Atlanta in 1998, agrees that private practice is thriving, and she has "a lot

of patients." There are many ways people come to learn about music therapy and information to

get a population that can benefit from music therapy.

Nowadays, Music Therapy is becoming more common. CNN even made a recent report

on Therabeat. According to study participants, a referral of a doctor or therapist and word of

mouth is a very common way to get information. Other places to find music therapy include

support groups, community groups, and social media, such as Facebook. Jamie states that in the

disability community, the question is not what music therapy is, but "why don't we have it?" It's

not about educating what it is, but advocacy is still useful for disseminating knowledge. Kally

commented that when they do wellness sessions for companies like Children's Healthcare of

Atlanta, part of her mission is to spread music therapy.

Jamie does speaking engagements at community events, assisted living facilities, and other

companies. Through speaking shows, Jamie gets referrals for individual clients. He gets

additional referrals through contracts he has with private schools throughout Roswell, including

Jacob's Ladder, Boarding School, Cumberland Academy, and Academy in North Fulton.

However, many of these new patients at The George Center will have higher socioeconomic

status and pay for themselves.

5.1 Demographic & Socioeconomic Makeup

This section seeks to explore the demographic and socioeconomic makeup of music

therapy patients. Of the four clinics included in the study, I spoke to the owners of three. All of

the clinics in the study were located north of Atlanta, and one clinic, Metro Music Therapy, was

largely mobile. This is the only clinic whose owner I did not interview. Sarah from Metro Music

Therapy said her patients are predominantly white. Beth, owner of Greater Atlanta Music

Therapy Services in Roswell, notes that 75% of her patients are split between Black and White,

with the other 25% being a mix of predominantly Indian, Hispanic, and Portuguese. She said her

patients are mostly representative of the Roswell area, and she feels she would see more Hispanic

patients if she had Spanish-speaking therapists. Jennifer, the owner of Therabeat in Canton, said

most of her patients are white, some Latino, and she currently has only three black patients.

Andrea at The George Center, also at Roswell, stated she sees patients who are predominantly

white, and the rest are a mixture of blacks and Indians. It seems that Therabeat in Canton has the

least diverse patient population according to therapists. Jamie, owner of The George Center, said

the demographics of his patients depend on the environment or setting. If she works with patients

at a nonprofit, she sees more of a racial mix versus her private practice patients. No definitive

conclusions can be drawn from this small sample of data, but it appears that many different

ethnicities are receiving music therapy in Atlanta.

Music therapy is not only marginal in terms of biomedicine (Foucault 1973) and gender

(Hochschild 1983), but also marginal in terms of socioeconomic status. Music Therapy is not

cheap. Jamie feels that unfortunately, the majority of music therapy patients today are paid

privately and have a higher socioeconomic status. Many families cannot afford it. However,

avenues for low-income patients to receive music therapy include nonprofit organizations,

hospitals, and substance abuse clinics. For example, the hospital patients that Kally and Sarah

met were low-income patients, and music therapy was included in the hospital's care. The

situation is complicated at the substance abuse clinic where Sarah works. Patients were divided

into two groups: private paychecks, which were predominantly white, and Medicaid, which was

predominantly black. Music therapy is included as part of a treatment program only for patients

who are paid for personally, and Sarah expresses her irritation by stating:

And it's actually very frustrating, because like, it shouldn't be like that. If it's part of your program,

it's part of your program. And why do people who pay privately need music therapy and people

who can't pay personally don't? So it doesn't make sense, but that's what happened. This is very

expensive, because rehabilitation is expensive.

Jennifer also expressed her sentiments about personal salaries and reaching out to low-income

populations, commenting:

So, then we had a lot of personal salaries, and the frustrating thing for me as a business owner was

the kids that I wanted to reach, I couldn't reach, because I couldn't pay the therapist to go see them

if they couldn't afford them. But it was one of those things that broke my heart.

The majority of his patients are paid personally, and it is frustrating for him as a business owner

that on the one hand, he wants to help people, but on the other hand, he has to run a business.

Beth suspects most music therapy clients have money. But, he believes the next major

recipient is poorer, as the government pays for it through programs like Babies Can't Wait or

government relief. Beth worked with Babies Can't Wait patients for twelve years and saw

"amazing families and amazing patients" who appreciated her services, but the program lost

funding and wasn't what it used to be. Jennifer lives in Babies Can't Wait just to reach families

who can't reach through other means. It seems that unless clients receive treatment in hospitals or

through government programs, more often than not, they have to pay out of pocket, making all

but those at the top of the socioeconomic ladder unable to pay for music therapy. However, this

trend is not new. The deinstitutionalization of psychological care has shifted the responsibility of

costs from the state to the individual for years.

5.2 Neoliberalism & Deinstitutionalization

Neoliberal agendas and policies not only shape poverty, inequality, and mental illness, but

also shift psychological care from the state to the individual. During the reorganization of the

18th-century clinic, the government became acutely aware that the health of the state depended

on the health of the individual (Foucault 1973). Epidemics are collective, and complex methods

of multiple observations and cross-examinations are needed to find the root causes of epidemics,

and this form of investigation is being institutionalized. Medical knowledge became politicized

with the establishment of state health regulations that provided information and surveillance

(Foucault 1973:25). The state is not only concerned with the healing of the sick, but embraces the

knowledge of the "healthy person", and uses this knowledge not only to advise citizens on health,

but also to dictate health policies, standards, and morals to the public (Foucault 1973:34).

Disease history is a necessary medical knowledge in education regarding potential disease

threats. A mutually beneficial relationship develops between the rich and the poor. By helping the

poor, the rich created a larger library of diseases that could affect them (Foucault 1973:84). There

is "a spontaneous and deep-rooted convergence between the requirements of political ideology

and medical technology," (Foucault

1973:38). Medicine became a priority of the state, and all obstacles that stood in the way of the

establishment of centralized medical knowledge were removed. Medicines became free, but only

for a short time.

In recent decades, the country's health care has become deinstitutionalized. Healthcare

has shifted from states to profit-driven industries where individuals are responsible for bearing

costs. Deinstitutionalization began in the 1960s when psychiatric hospitals and psychiatric

hospitals freed patients to community care centers resulting in many problems. Centers are

unable to accommodate the number of patients, states refuse to allocate funds to mental health

centers or provide services for chronically ill people, and patients are unable to navigate

psychological, social, and financial difficulties due to living alone or with groups, leaving former

patients destitute and homeless (Desjarlais 1997:30). In the past, they would be treated in

psychiatric and psychiatric hospitals, but now they are outpatients if they are lucky. People with

mental illness have more difficulty securing low-cost housing, finding work, having poorer

physical health, and fewer friends or family when compared to other homeless people (Desjarlais

1997:31). These centers are temporary and can never implement adequate psychiatric services for

patients (Desjarlais 1997:34). Through deinstitutionalization, mentally ill people have little

access to adequate services such as psychological care, let alone music therapy. In addition, the

marginalization of music therapy from biomedicine is further limiting access to music therapy.

5.3 Insurance, Waiver, & Grants

Insurance, waivers, and grants create avenues and barriers to music therapy. According to

Jamie, only the best insurance plans will pay for music therapy and the benefits for many of his

family are getting worse under the Affordable Care Act. Families who previously had a $2,000

deduction now have it for $10,000. Jamie asked, "what's the point of having insurance, since you

can't afford to pay $10,000 out of pocket?" Patients are forced to pay for a plan they will never

use, and Jamie notes 50 to 60% of his clients have seen a skyrocketing reduction.

When asked if the insurance company covers music therapy, Jennifer explained:

Some insurance companies do, as long as there are no exceptions. Some plans will say we won't

cover it, but thanks to Obamacare, now the insurance deductible is so high that even if the

insurance will cover it, sometimes it's not an option for families because they have a $10,000

deductible, so it's not realistic to meet that deductible to meet your insurance.

It seems that for universal health care, society must bear additional costs, which can be seen as a

further example of deinstitutionalization in shifting those costs. Beth noted music therapy usually

has to be covered under a separate policy, which provides further evidence of the marginalization

of music therapy from biomedicine. Kally and Sarah both commented that Medicaid and

Medicare, insurance for low-income and older individuals, respectively, generally do not cover

music therapy, highlighting the socioeconomic exclusivity of music therapy. Jennifer asserted

that the only way Medicaid would cover music therapy was through waiver. He treats between

eight and ten paying patients using waivers.

During the 18th century, medical knowledge became free in the interest of the state, and

neoliberal policies deinstitutionalized mental health care in the 1960s (Foucault 1973, Desjarlais

1997). Medical discourse changed to focus on the treatment of diseases seen in the body

(Foucault 1973). Insurance does not cover music therapy partly because of deinstitutionalization,

and partly because it is on the periphery of biomedicine. Treating the mind with music is not a

"necessity", and therefore the insurance company does not reimburse the cost. Psychotherapy and

other mental health treatments such as music therapy are given to low-income people only in

certain contexts such as hospitals and substance abuse clinics. But even in Sarah's case, patients

who abuse her substance are divided between those who are paid for privately and can afford it,

and those who have

Medicaid and can't.

Although insurance is limited, music therapy can be made more available to those who

can use it. Various alternatives include waivers, grants, scholarships, and non-profit

organizations. Nonprofits such as Georgia Community Support and Solutions and Alchemy Sky

provide funds for music therapy for low-income people. In discussing access for low-income

populations, Jamie stated, "we would all agree that this profession is the most needy group."

Alchemy Sky pays music therapists to provide care at VA hospitals and homeless shelters. Beth

pointed out that relief is government money. He said many people think

Georgia Community Support and Solutions provides grants, but usually government waivers.

They distribute money to individuals and take small pieces. Kally and Andrea also have clients

who pay for music therapy with funding from Georgia Community and Support Solutions.

Grants and scholarships are private companies or entities that provide money. Grants are

often given to nonprofits, so Beth is unable to take advantage of the grants because she is for

profit. Beth has a contract with a school for the deaf and blind, and she applied for a grant

through a music therapy school. The hospital also receives grant money for music therapy. Kally

interns at a hospital where all music therapy programs are funded by grants donated by the

family. Individuals who see the value of music in healing can give the money earned through

fundraising to the hospital. One of the main problems with grants and scholarships is that those

who can benefit the most from those funds are usually the least likely to seek them out and apply

for them.

Jennifer gives her Babies Can't Wait patients, which are low-income patients who receive

government funding for music therapy, all the grant information they need. They have

worksheets that instruct them on how to apply for grants. However, higher education and higher-

income patients are the people he sees applying for grants, which are not for people who are

"designed for grants." When asked about which patients Jamie sees applying for grants and

scholarships, he explained:

So upper-class, they won't be approved for them, because usually to get a grant or a scholarship for

something like this, you have to prove financial need, and they won't be approved for that because

they're making enough money that they can pay for themselves or their insurance or whatever. We

found that the lower socioeconomic groups did not have the resources or were not educated

enough about the resources to go out and find them. So these families are not online and Googling

to find out what is available to me to get funding sources, even though they are the ones who can

use it the most. And there are many reasons. Sometimes it's education, sometimes it's just access.

Jamie states that this is why his middle-class clients are the ones who receive grants and

scholarships. His upper-class clients cannot prove financial need, and his lower-class clients do

not have the resources to go out and seek grants and scholarships.

Despite little direct access to grants, low-income families still receive music therapy

through services donated to nonprofits. Nonprofits don't just fund music therapy services, they

are also recipients of music therapist-donated services. Jamie has an internship providing music

therapy to Stark House, an after-school nonprofit program for English as a Second Language and

low-income households in Roswell. They also work with a nonprofit organization called Kate's

Club, which helps children who are grieving the loss of a family member to gang violence, drug

trafficking, or prostitution. Although grants and scholarships are typically awarded to middle-

class groups, waivers and nonprofit organizations are available to the lower-class population.

5.4 Lobbying for State Regulations

While music therapy is a growing option for people seeking complementary or alternative

treatments, and there are opportunities for funding for low-income populations such as waivers,

grants, and scholarships, there are still barriers and hurdles that require solutions to make music

therapy more accessible. As Jamie stated, any population "from birth to death" can benefit from

music therapy. While many find out through doctor referrals, Kally noted, "I think other health

professionals are one of our biggest hurdles. It's not that a lot of them disagree with that, but I

just think it takes a lot of convincing." Here is another example of the need for legitimate music

therapy for skeptics. Even doctors need to be convincing in the face of research showing the

benefits of music therapy because it does not fit the mold of mainstream biomedical discourse

(Foucault 1973). Doctors are not the only ones who need reassurance. To influence real change

and create access through private and state insurance, state policymakers and legislators must

also be convinced.

Legitimacy created a double-edged sword for the study participants. On the one hand,

music therapists emphasize mind-body connectivity and spiritual healing in music therapy. On

the other hand, they must present hard data documenting health improvements to participate in a

culture that places premiums on biomedical and visual healing in order to be eligible for

insurance and receive accreditation. In Western capitalist societies, insurance companies and

policymakers typically do not cover or advocate therapies that embrace mind-body or spiritual

healing. In addition, proving psychological improvement can be difficult. As such, practices must

adapt to data-driven models of biomedical medicine. For example, when a patient performs

correctly during a session, the music therapist must calculate, record, and record the results

precisely. Music therapists are even wary of the terminology used to describe music therapy. For

example, Jennifer explains that treatment is called an "intervention" and not an "activity" to

make the terminology more clinical, and therefore, more legitimate. Although music therapists

feel the spiritual healing aspect of music therapy is essential, they need this hard data as evidence

of its effectiveness in order to obtain insurance coverage and accreditation for state licensing in

biomedical culture.

Beth wonders why patients and parents don't have more control over how insurance funds

are allocated for therapy. For example, many insurance plans automatically cover physical

therapy (PT), occupational therapy (OT), and speech therapy, even if the patient does not need

them or is better suited to receive music therapy or horseback riding. Beth speculates these

therapies are covered while others aren't because they have good lobbyists or "play the game

better." If we pay for insurance, we have to decide what is best for us. Jennifer emphasized the

example in Kentucky that other states should follow. The University of Kentucky's programs

include music therapy in addition to PT, OT, and speech therapy. The British recognise the

benefits of music therapy, and they see it as cheaper by reducing the need for therapy or more

expensive drugs. By presenting this data to Blue Cross Blue Shield, the insurance company for

the UK, they wrote music therapy into their plans, while BCBS in Georgia and other state plans

did not cover music therapy. In fact, when the state of Georgia's plan shifted from United

Healthcare to BCBS, there was a major decline in insurance reimbursement for music therapy.

Under the Western biomedical model, access to funds revolves around hard data. Since it is

difficult to show a statistically psychological improvement, following the British model is a good

option. By proving to policymakers that music therapy is effective and cheaper than more

"traditional therapies" using hard data, BCBS is confident and the UK program is rewriting its

plans. Sarah agrees that hard data will help with funding and coverage. They are currently using

data showing the benefits of music therapy to set up programs at NCU hospitals.

Except for the example of the UK, it is almost impossible to mobilize major changes in

insurance companies because they are private and complicated. However, one of the most

effective ways to create more access is to lobby state governments for state regulations, which

will create access to more funding and more quality services. Jamie stated that there is a joint

effort between the American Music Therapy Association and the Certification Council for Music

Therapists to pass legislatures for state licenses in each state. Currently, there are five states that

have state regulations. Jamie is on the task force for the state of Georgia, which is the third state

to pass legislation for state licensure two years ago, and there are grassroots task forces in every

state. This means that in order to practice music therapy, one must not only be certified by the

National Council Certification, he must also be licensed by the state. This has two main

implications for patients: access to quality services and access to state funds and reimbursement

in terms of insurance.

First, when states regulate Music Therapy through state licensing, they ensure those who

practice music therapy are certified music therapists. Without regulation, anyone can claim to be

a music therapist but not actually certified with the proper training, which is necessary to work

with at-risk populations, such as children with emotionally disturbed behavior or those in the

dying process. Foucault (1973) shows how medicine became politicized, which may explain why

today we feel licensing and certification with professional organizations means music therapy is

more valid, legal, and acceptable in the country. Second, state funding and insurance

reimbursement will be available which means access for low-income individuals will increase.

National insurance companies, such as United Healthcare and Aetna, do not require a state

license, so these plans can cover music therapy. However, BCBS is a state plan. To bill for

Medicaid, Medicare, or other state-specific insurance planes, music therapists must be licensed.

Once licensed, music therapists can apply for Medicaid and Medicare coverage. If approved,

low-income individuals with Medicaid and Medicare insurance will have more access to music

therapy. If each state passes legislation for state regulations on state licensing, low-income

populations will have access to integrative, complementary, and alternative medicines such as

music therapy.

Exploring the recent growth of music therapy in Metro Atlanta, this chapter discusses the

socioeconomic and demographic makeup of a limited sample. It examines the creation of "free

medicine" through the politicization of medical knowledge and its institutionalization. This was

followed by the deinstitutionalization of health care, which is the way neoliberal policies and

agendas shift the responsibility of psychological care from the state to individuals creating

problems in funding and access to music therapy. This chapter then discusses the various avenues

and barriers to accessing music therapy, which include insurance, waiver, grants, and nonprofits,

and the ways Music Therapy must align to incorporate biomedical discourse and practice in order

to qualify for insurance coverage and accreditation for state licensing. Finally, this chapter

explores praxis solutions to create more access to music therapy for low-income populations by

following the University of Kentucky model or through state regulations for access to quality

services and more funding.

6 CONCLUSION

This thesis explores music therapy as a cultural practice in the United States. It relies on

previously published research, synthesizing a number of topics in the anthropological literature,

and combining this research with data from ethnographic studies of ten music therapists in the

Greater Atlanta to come to a conclusion. This thesis uses the theory of medical pluralism and

embodiment in examining the way music therapy is on the fringes of the Western biomedical

model in rejecting the mind-body dichotomy. It deals with the way medical discourse and

neoliberal policies affect disease and access to ICAM such as music therapy. The medical

discourse on biomedicine helps in understanding the marginalization of music therapy, the efforts

of music therapists to justify it as a legitimate form of healing, and who has access to these

alternative healing methods. Music therapists are in a difficult position because they seek to

emphasize mind-body interconnectedness and spiritual healing in music therapy in a culture that

places a premium on biomedical to qualify for insurance and accreditation. Despite the barriers

presented by biomedical discourse and neoliberal conditions of structural violence and

deinstitutionalization, music therapy is thriving in the U.S. for those seeking alternatives to

traditional psychotherapeutic treatments. This thesis analyzes the theories underlying the

research, presents the ethnography of music therapists, and offers a praxis solution in seeking

further access for low-income populations.

The thesis begins with medical pluralism as the basic theory that informs this research in

recognizing the various frameworks for disease and cure. Medical ethnomusicology is explored

in the context of medical pluralism in examining the role of narrative and music used in cross-

cultural healing rituals. It examines the development of the clinic and the history of Music

Therapy as a professional discipline in the US. This was followed by a discussion of

embodiment, a theory that rejects the mind-body dichotomy and aids in understanding music

therapy as a healing cultural system outside the Western biomedical realm. It then analyzes

music, including narratives in music, which are common in cultural healing practices around the

world. In linking disease to inequality, this thesis examines the impact of neoliberalism and

structural violence on poverty, disease, and access to music therapy. Ethnography of the thesis

was then interested in music therapy in the U.S. context as a treatment option for mental and

physical illness, often due to structural violence, and the way medical discourse and neoliberal

policies influenced these treatment options.

The next stage of the thesis provides research methods and background information. It

analyzes the questions, methods, and objectives of the research. The study asks the following

questions: What brought Atlanta music therapists into this profession? What mental and physical

disorders do music therapists treat, and what methods and techniques do they use? What is the

role of music in healing? Who has access to music therapy, and how do historical and cultural

factors affect this access? How does the discourse surrounding Western biomedicine affect access

to music therapy? The thesis answers these questions using participant interviews and

observations with music therapists. The purpose of the study was to understand the cultural

practice of music therapy in the U.S. and how music therapists treat mental and physical illnesses

of Atlanta patients using music. The thesis puts myself in the study by providing my background

information. My early connection to the power of music, music, and family experience of illness

laid the foundation for my interest in the fields of ethnomusicology, medical anthropology, and

psychological anthropology.

This thesis discusses field research, which took place in Atlanta from June to October

2015. Semi-structured interviews and analysis of interview data are anthropological methods

used. A total of ten music therapists were interviewed representing four clinics, and patients were

not included in the study. All therapists know that they want a career that incorporates music for

two reasons: they have a background in music and many are exposed to music therapy early in

life through personal illness experiences, which creates a strong belief in the power of music in

healing. However, the study participants felt they had to constantly legitimize music therapy to

skeptics who saw it as a "hippy" drug. Music therapy emphasizes mind-body healing in a culture

fixated on biomedicine, and music therapists grapple with integrating these two perspectives to

legitimize the practice. Further embodiments help in explaining music therapy as a cultural

healing system. This thesis then reviews the social construction of mental illness and the methods

and techniques used for mental and physical illness interventions. The focus of this thesis, and by

extension the purpose of this research, is to examine the anthropological perspective of music

therapy.

This thesis addresses specific diseases and interventions. From the beginning of the study,

I wrongly assumed many patients would seek treatment for depression given that 9.5% of the

U.S. population suffers from depression. However, I learned music therapy is used to treat a

variety of mental and physical ailments, from Autism to Alzheimer's to Cerebral Palsy. However,

the purpose of this study is not to explain every disease treated with music therapy, or any

possible interventions for treatment. The study is interested in the underlying and not

immediately proven processes that occur in music therapy in examining the role of music in

healing. According to music therapists, the role of music in healing focuses on mind-body

connectedness, bringing community together, connecting with memory, and facilitating and

mediating interactions between therapists and patients. Music therapy uses music to transcend

the dichotomy of the body in facilitating the healing process. This thesis then explores music

therapy in treatment interventions for stress, depression, and anxiety with patients, families, and

in mourning and birth. Songwriting and lyric analysis are effective interventions that help

understand traumatic illnesses that interfere with normal life, reducing symptoms of stress,

depression, and anxiety. It also discusses music used to treat Alzheimer's disease and various

physical disabilities due to traumatic injuries or deadly diseases.

Finally, the study analyzed trends in music therapy in addition to the socioeconomic and

demographic makeup of patients in the Metro Atlanta area. It discusses the politicization and

institutionalization of medicine in the 18th century that liberates truth in a medical discourse that

liberates medical knowledge. This was followed by the deinstitutionalization of mental health

care in the 1960s that shifted psychological care from the state to the individual. The

deinstitutionalization of mental health care, in addition to the marginalization of music therapy

due to biomedical discourse, has had an impact on access to music therapy. Deinstitutionalization

continues today with insurance reductions so astronomic that patients have no incentive to seek

alternative treatments, and marginalization exists by the fact that separate policies are necessary

to access music therapy. There are avenues to access music therapy, including waivers, grants,

and scholarships. However, in order to be eligible for insurance coverage and accreditation for

state licensing, music therapists must reconcile mind-body connectivity and spiritual healing in

music therapy with modern medical biomedical models. It has transformed the practice of music

therapy in terms of carefully documenting therapeutic outcomes and changing clinical

terminology from words like "activity" to "intervention." The thesis then explores praxis

solutions to create further access to low-income populations, including more patient agents in

deciding how to allocate insurance funds, public education and advocacy, state regulations, and

lobbying insurance companies to include Music Therapy using the University of Kentucky's

insurance policy as a model.

In conclusion, the clinical discourse on biomedicine and deinstitutionalization both have

implications for access to music therapy today. As the discourse shifts to treat visible diseases,

little weight is given to mind-body healing methods. This partly explains why medicines such as

music therapy are on the periphery of Western biomedicine today, creating barriers to access.

Deinstitutionalization further restricts access in shifting the responsibility of health care choices

from the state to the individual. It's hard to show mental healing or provide "hard data" because

the results are often invisible compared to seeing physical healing from injury. Therefore, music

therapists should constantly justify and justify mind-body healing in music therapy to doctors,

skeptics, and insurance companies who may view music therapy as a "hippie treatment." At the

same time, they must change practices to focus on hard data that shows improved health in order

to participate in a culture that places high value in biomedical models. Insurance companies do

not see validity in mental health care in part because of the history of clinical discourse in

Western biomedicine. However, by following the UK insurance model, insurers can see the

healing value of music through hard data that shows music therapy is effective and cheaper than

many traditional therapies.

Finally, this thesis analyzes the marginalization of Music Therapy in terms of Western

discourse on biomedicine, gender work in the field, and socioeconomic status. In addition, the

various ways in which neoliberal policies facilitate deinstitutionalization and structural violence

are discussed throughout this thesis. One of the concerns of the study is that those most affected

by neoliberalism will have the least access to music therapy, which often treats diseases that are

highly correlated with inequality and poverty due to structural violence. The study concluded that

on the contrary, some opportunities do exist for low-income people to receive these treatment

options. Modelling insurance policies after the UK plan, in addition to lobbying state regulations,

will create further access for low-income populations who can use alternatives and

a complementary form of mind-body healing.

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