A New Vision for Music in Hospice Care

Categories: Care.

My goal was not to embark on an exploration of the nature of transcendence versus disassociation, the concept of healing versus curing, nor the role of psychosocial wellness in communicative musicianship. Such topics might seem far removed from the arena of music, let alone stage performance, but they constitute some of my most lively seminars. What’s more, these topics seem even further from the culture of a music conservatory, whose assertion is that performance is ultimately an elite spectacle which, while certainly intended for the enjoyment of the listener, is largely centered around the artist. The field of Music Therapy has long understood that while the “stage-performance” approach to music study may well lead to high levels of technical proficiency, it does not even scratch the surface of music’s ability to target pain and anxiety levels in a palliative individual, for example, to say nothing of music’s other well-documented therapeutic benefits.

Music Therapy and Music Performance Study have a great deal to learn from each other, and Hospice has a great deal to teach both disciplines. Music Therapy boldly testifies to the communicative power of the medium, Performance Study explores the endlessly subtle ways music can be made to “speak” to the listener, and Hospice quietly stands as that most exquisite arena of healing, in which the worlds of matter and spirit may be regularly witnessed in complete transparency like nowhere else. What a place to put sensitive, transcendent musicianship. My vision for the future of Music in Hospice Care is one where the synergies between Performance Study, Music Therapy, and Hospice are are fully understood and integrated into services that support the palliative individual’s journey into dying from the standpoint of wholeness and healing. Music Thanatology understands this synergy well thanks to the groundbreaking work of Therese Schroeder-Sheker. I believe the essence of her approach, however, must not be limited to improvised harp and voice, as she has asserted. With sensitive discernment, technical capacity, and wisdom in performance practice, I have found many elements of her approach may be transferred to any instrument, any repertoire, and almost any musician willing to journey into this work.

From a pedagogic standpoint, in hospice care especially I believe that expressivity in musical performance relies primarily on what I refer to as the “rhetorical literacy” of the musician. I like to use this term because of its loose parallel to concepts of philosophical rhetoric, which can be extended to oration/narration, and in condensed form to poetry reading. From the standpoint of poetry, rhetorical literacy in music is easily understood: phrases of spoken poetry may be shaped and contoured in precisely the same ways as music may be nuanced in rhythm, articulation, and tone. When I play the acoustic clavichord for my hospice bedside meditation practice, I use the instrument and repertoire to explore rhetorical literacy in ways that interact with the aural expectations of the palliative individual, both meeting and challenging them. On the basis of patient testimonial I assert that this approach is strongly mitigating for pain and anxiety levels.

Imagine the most exquisite blues singer you can remember hearing: imagine the flexibility with rhythm and attention to detail. Imagine hearing every syllable, every word, and every note as a physical or a spiritual sensation – a feeling. Imagine experiencing all of the subtleties, nuances, hesitations and surprises that unfold from one note to the next, the subtle changes in rhythm, the seemingly arbitrary pairing and grouping of notes, the sense of directing music and lyrics to illustrate and match the contour of a melodic phrase, and the suspension of pulse. That is the essence of rhetorical literacy: it can be made a universal attribute of any musical performance. It is the place where music and healing intersect. It belongs in hospice.

Dr Kevin Komisaruk is a Canadian concert musician and maintains a private bedside practice in hospice palliative care in Greater Toronto. He has taught at the University of Toronto since 2003, where he leads the palliative care performance curriculum at the Faculty of Music. Email: kevin.komisaruk@utoronto.ca.