Wednesday, January 6, 2016

Positive Difference Making Fundamentals in Focus - An Introduction to Music Therapy

Music Therapy – An Introduction

There are many aspects of how a mental health disorder such as schizophrenia or bipolar or major depressive disorder (among others) changes a person that health care professionals generally don't understand, don't grasp and don't - or can't - deal with. 

Or perhaps even more difficultly, those living with the effects of brain injury or trauma. 

In many ways, we become crushed and broken souls - broken and crushed by the demons that plague our minds, by what life will heap upon us because our minds cannot deal with life like mentally healthy people can or like we used to be able to, by the cruel stigmatization and ostracization that society will beat us down with, by painful isolation from society and meaningful human connections (the subject for a coming post), by being deprived of simple things like love and understanding and acceptance and so on. All of this in itself will alter - quite literally - our brain networks and greatly contribute to how we function or not function - and suffer.

The majority of this blog was written on the assumption of a diagnosis of bipolar disorder, which long made sense because many of the the symptoms are very difficult to read and accurately assess and assign a "diagnosis". Nonetheless, it was the outer world and inner world events of the previous seven years that really began to tear my mind and soul apart and leave me at many times and stages so utterly broken that even another step - literally and figuratively - felt like I was moving fifteen tons. Thirty months of brain damaging and mind altering pharmaceutical chemicals, great pains and losses during the course of the seven years starting at the end of 2007, mind rending psychotic episodes plus all the effects that wildly swinging through periods and episodes of mania, depression, mixed episodes, crippling anxiety and at times yo-yoing through all of those plus the aforementioned effects of what life will heap upon you.

Between societal stigma and ostracizing and being dragged through the mental health care system and psychiatric "care", you will be thoroughly stripped of dignity, esteem, any sense of self, self-care and image - virtually anything and everything to do with being a human being.

And no one - and I do mean NO ONE - will understand what's going on in you nor be able to help you (as much as some may genuinely try). There are many things that will damage the brain and soul in a given psychiatric disorder but perhaps nothing causes more damage than the complete and utter crushing isolation one will ultimately experience.

During the worst years there were times after I came out of the most intense episodes where I'd look around at myself and couldn't for the life of me see who or what I was. I'd look around and all I could make out were broken and shattered pieces of "me" spread all over with so many pieces of who I'd been before out of sight. I wondered many times, "is this what was meant by the nursery rhyme Humpty-Dumpty?". And that "all the king's horses and all the king's men couldn't put Humpty-Dumpty back together again" was a metaphor for how those who have gone through mind and soul destroying experiences end up as - broken minds and souls that cannot be put back together?

Furthermore, one can't even see what should be put back together or even what the "together" would even look like. There were shattered bits of the successful man I'd once been but they were largely no longer recognizable or were literally inaccessible. There were larger bits of what I'd become (some of the monstrous inner demons) and there were bits of what appeared to be some sort of "core me". What was this "me" I was to reassemble to look like?

But I had no "king's men" nor "king's horses" to put me back together again. In fact, after the years of being let down by the various mental health care professions in every way possible (and this is by far not an uncommon experience unique to me) and no one else knowing what to do, all I had was - me. The pieces themselves had to somehow put the pieces back together again and - the hardest part - somehow assemble someone who could get through life again in some sort of meaningful way.

But what is broken? The mind. And what is the mind but something created by the brain? It is all created by the brain.

When I unshackled myself from the care of mainstream psychiatry back on the dawn of 2013 and started looking around for answers, I saw that what we - us psychiatric survivor peeps - needed was a better understanding of the brain and how it works. So I took up neuroscience (the full story of which I really must get to some day). I wanted to know every minute detail of what went on in the brain and why.

And I can tell you that "broken" and "shattered" are not merely feelings. Great and important parts of the brain that create who we are - our minds and souls - really do get broken, things really do get rent apart and shattered (in tiny, microscopic ways). Furthermore, this microscopic damage begins to cascade through our bodies and really begin to break us down.

I had no idea when I originally wrote this piece a little over three years ago and especially the preceding paragraph how literally true the sense of being broken, shattered and rent apart really was for my case. I was referring mostly to some of the worst periods that started in 2008 and persisted through roughly the summer of 2014 and had been assuming that everything I experienced was due to a particularly bad case of bipolar disorder. Recently, however, it has come to light that a great deal of the mental phenomenon and symptoms very likely are more as a result of the long term effects of a long history of concussions and the resultant Chronic Traumatic Encephalothapy, an entirely different and much more serious brain issue altogether.

Nonetheless, the challenge remained the same. [BGE - April 27, 2018]

The question then became how to put it all back together again, or at least reassemble and heal it all in ways that will move us forward in life again in relative peace, with healthier and more balanced states of mind and better contentment and free of the demons that plague us.

And the answer I found was neuroplasticity - the brain's ability to heal itself, to rearrange itself, to recreate and build new networks and circuits. Understanding what neuroplasticity is completely changed my world. It is the foundation and cornerstone of all hope that's given me life over the previous three years. Neuroplasticity is what will put the shattered bits of my Humpty-Dumpty mind back together again.

And it could do the same for yours (for while our brains may be assembled somewhat differently and thus produce two different people, they are made up of the same essential stuff which all functions on the same principles).

I spent a great deal of time studying neuroplasticity and how and why it worked and of course most importantly, how to make it work for you and me. The answers, I found, were not rocket science. The basic answers I outlined in my extremely popular Positive Difference Making Fundamentals. That is only a very rough outline and guide, however, and I've long wanted to get to all the points in there in more detail and I'm finally working my way towards that.

Which - finally - brings us to today's Positive Difference Making Fundamental in Focus -

Music Therapy

Now I originally had in mind a long post outlining the neuroscience of music and its effects on the brain and what positive neuroplastic changes it will enact on the damaged "you" that resides among all that neuro-circuitry and what brain regions would be affected and so on. I get to that in this post on the neuroscience of music therapy so today we'll try to keep it a bit more fun. I'll touch a bit on the science of it but not onerously so.

I have to start, however, by making clear what I mean by "music therapy" and what I don't mean by it. What I do not mean is putting on some chipper feel good music to cheer oneself out of a blue mood. That can be part of it for sure (while not today I'll eventually get to that too) but that's not what I'm talking about.

No, what I'm talking about is rearranging your brain. I'm talking about opening up vast new tracts of neuronal real estate. I'm talking rewiring parts of your brain. I'm talking changing how your very mind and outlook work. I'm talking about improving cognitive functions, creativity, and mental sharpness and thinking speed. But I am also talking about healing your shattered soul.

What I'm hoping to do, with this column (or post or chapter), is begin to teach you how to design your own music therapy program which could greatly aid in healing your brain (and thus you). This is all relative, of course, and I'm not promising that a few hours of listening to music will have you dancing through a meadow like Julie Andrews in The Sound of Music (though I suppose that's not outside the realm of possibility either), but the neuroscience and the real world evidence of what music can do for the brain is so firmly established that if you utilize it well enough, your brain will improve in certain significant ways (which we'll get to in time).

Now, before I begin, I have to offer up a bit of a caveat about myself ; I love music. Oh, I know, most people will say they love music but they generally mean they love a few certain kinds of favourite music that they happen to find uplifting or cheering or perhaps just have a deep nostalgia and fondness for the music they "grew up with". What I mean is that I love the very foundations of music. I love the concept of music. I love the art of music. I love music of all forms, styles, genres, ages, epochs and eras (or at least my love crosses a good deal of it all). Often when I listen to music I am blocking out everything else and focusing on nothing but the notes and melodies and arrangements (or I don't exactly focus, but block out all else and let the music naturally flow over me). I might study the lyrics. I get deeply into it. I am a dedicated music lover (there was a reason I once built a high fidelity stereo worth nearly $10,000). I am passionate about music. Being removed from a broad range of music will have a very detrimental effect on my mind, soul and moods (just like when we are separated from a lover). So it's entirely possible that music therapy works unusually well for me. We shall see, however. Part of my goal here is to get you to be as passionate about music as I am. And if you already share my passion, to better harness it in healing your brain.

Okay, now let's begin with a bit of an introduction to what music does to and for the brain.

In the excellent and best selling book This is Your Brain on Music, we learn that listening to music coordinates more disparate parts of your brain than almost any other mental or physical activity. From the humble cerebellum to the limbic region to all areas of the cerebral cortex, listening to music will stimulate and stir and activate.

The cerebellum is a very old (in evolutionary development terms) piece of our brain. It is located at the lower back part of your head and had long been thought to be largely responsible for muscle memory and coordinating physical planning and movement. But recent research now strongly suggests that the cerebellum is highly involved in and associated with cerebral networks involved in higher cognition and cognitive abilities.

This can at least partially explain why a good walk or other physical activity can "get our brains going" and spark and inspire ideas and so on. But what is more exciting about this discovery for our purpose here today is how much listening to music stimulates the cerebellum and strengthens connections within it and networks connecting it to other regions of the brain. This is very important for many of us mental health peeps because it could well be that part of our suffering is incredible fatigue that prevents us from physically exercising as much as we could. While I do not suggest replacing physical exercise with music, it is the absolute best form of brain exercise in lieu of physical exercise if that is for whatever reason too difficult or impossible (more in a moment).

Before we go on, I need to tell you some bad news about the brain. I get into more detail on this in that post on the neuroscience of music therapy.

The brain - your brain, a young brain, an old brain, any brain - does not like to do nothing. It will (literally) atrophy if it doesn't have "demand loads" put on it. If you recall the post on neuroplasticity, we saw this image there.

Note the differences in brain cell connections between the stimulated and unstimulated brain connections. On the right is what we're talking about with atrophy in the brain. Though there are a few tiny specific regions of the brain that we don't want to look too much like that on the left (more below), in general diminishing synaptic connections is a Very Bad Thing indeed. Connections are what holds memories, thoughts and abilities and virtually everything concerned with higher cognitive abilities.

A problem with all aging brains (and by "aging" I mean all ages above the age of about twenty-five, the age at which most brains reach full adult maturity) is that as we fall into regular routines our "learning curves" drop off steeply. We stop stimulating the brain with new and novel material, ideas, thoughts, knowledge, etc. This will intuitively seem to be Not True to most of you but in fact most of what we "learn" after full brain maturation is fairly day to day bric-a-brac of the routines we need to do to get through life. Important for sure, but not what the brain really craves and not what really builds strong and important "neuronal muscle", staving off brain atrophy.

What really and truly stimulates a brain creating new connections - and even strengthening old ones - and thus building and thickening all important grey matter is new and novel experiences.

There are, of course, many ways to do this but today, of course, we're just focusing on music's remarkable ability to provide your brain with stimulation that is demonstrably superior to almost any other activity you could do.

Now, of particular importance to many of us either in the throes of a severe depressive episode during which one barely has the energy to get out of bed or for those of us with advanced long term conditions (and usually middle-aged and above) for whom a near crippling lack of energy is a daily reality, keeping our brains activated and stimulated is a huge challenge.

And it is here where music therapy truly shines and is critical to employ as a part of your daily life. For when you are glued to the sofa or the bed and can barely move a bodily or neuronal muscle, you can listen to music. Music will give your brain something to do and greatly aid in preventing the cognitive decline and memory difficulties so many people hammered by psychiatric disorders of all kinds experience and become anxious about.

In future posts I'll get into more what exactly music does for the brain but let's now move on to how to do Music Therapy

Designing Music Therapy

I'm hoping to inspire you to take up music therapy as enthusiastically as I did. Many professionals both in private and group therapy practice and in the various research branches of cognitive psychology will recommend to us mental health peeps to take up a hobby and I can think of no better or any more beneficial hobby for us than the study of music.

Of course playing music or taking up an instrument would be a fantastic thing to do, but for those of us not endowed with such talent, that would probably be too ambitious to begin with so we'll just focus for now on listening to music. By thinking of it as studying music, however, we put our brains on a different footing than merely passively listening to whatever music happens to be around.

I'd like to say that "any music will do" but that is simply not true. While we could say that any music is better than none at all, that is not necessarily true either.

As mentioned above, what best stimulates the brain, its connections and neurobiology in positive ways is new and novel experiences so what we want to make a part of our music therapy program is finding and learning new forms of music. Not just new bands or artists in your favourite genres (though I'd encourage that as well), but entirely new and novel (to you) forms and genres of music.

Also, for the most optimal therapeutic benefits musical complexity is very important. Simple pop music arrangements of notes, chords, time signature and beat will not provide the kind of stimulation we need. For that there is little question that certain forms of classical music and classic jazz are among the best forms, both of which often (though not always) are composed in much more complex arrangements of notes, chords and time signatures that best challenge the brain.

What will happen when you listen to novel and complex musical arrangements is that your brain will immediately go racing around all your memory circuits waking them up - "Yo! Have you heard this?!" To which your memory circuits will reply - "Hell no!", to which your brain will reply in turn - "thought so!" and then - and here's the important part - it'll furiously work at trying to figure out all this new stuff, all the while stimulating the hell out of all kinds of far flung regions of your brain. And as it's doing this, all kinds of new connections are being formed in instant and real time.

Fantastique, n'est ce pas?!

But it's more than just that technical stuff, it's about saving your very soul.

For this is what happens or can happen.

In those times when I was hammered by life and struggle and crippled by the fatigue and when my mind would want to plunge into unfathomably dark pits of blackness and despair, I'd put on perhaps Miles Davis's A Kind of Blue or maybe Mozart violin concertos which would connect me to not only some of the world's all time greatest composers but also without question it would connect me to some of the best and most beautiful music ever composed and recorded. And it was in connecting to that beauty, in connecting to those composers and the pinnacles of human achievement and art forms, that my darkened and battered soul would feel buoyed, would feel a healing power, would feel and sense beauty and would be rescued from the pits of darkness and despair.

And more importantly, it was this feeling of being connected to other human souls through music that helped enormously in calming the crushing feelings of isolation and loneliness that I suffered from.

As well, the right kind of beautiful music will help de-stimulate and calm overactive emotional, fear and anxiety regions of the brain like the amygdala and related circuits (there are connections and circuits here that are too stimulated and built up and this is a large reason why "you" are prone to such intense emotions and emotional reactions). So while we're positively stimulating other parts of the brain, music therapy can be working to help dial back the stimulation in emotional circuitry and start to deactivate overly strong connections there.

So, to recap:

- music can stimulate and activate your brain like almost no other activity you could possibly do

- you can do music therapy at any time either with other activities or when you are unable to do anything else physically or mentally

- while I'll get to the benefits of familiar music in a future column, for the best results and higher cognitive and memory circuit stimulation, new and novel forms of music are best

- music can calm overly active emotion processing regions and circuitry

- music can connect you with some of the great beauty of life and salve your soul

For related reading within this blog, please see The Neuroscience of Music Therapy to get a better understanding of how music positively affects the brain and the benefits thereof and Neuroscience in Focus - An Introduction to Neuroplasticity

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