Psychopathology 1991:24:121-129
© 1991 S. Karger AG, Basel 0254-4962/91/0243-0121 $2.75/0
Music Psychopathology IV. The Course of Musical Expression during Music Therapy with Psychiatric Inpatients' R. Steinberg a . V. Kimm igb, L. Railhb, W. Guntherb , J. Bognerb, T. Tim m erm annb aPfalzklinik Landeck. Klingenmunster: bPsychiatric University Hospital, Munich. FRG
Music therapy is widely used in psychia try as a nonverbal therapeutic means in group activity [6, 15]. Although in many countries music therapy is taught at univer sities and schools, the scientific background to the theory has remained rather small [9], The field is characterized by a large body of casuistic contributions based on psychoana lytic reflections [6, 12, 23]; some experi ments dealing with vegetative reactions also give hints as to the physiological basis of the effects of music [5, 8, 22]. But a systematic examination of the musical ‘language’ in mu sical therapy, what the participants tell one another and how they do it, has never been1 1 Dedicated to H. Hippius on his 65th birthday.
attempted. In a series of experiments Stein berg et at. [18-20] showed that musical ex pression changes in a systematic manner de pending on the kind and the degree of men tal disease, which allows us to speak of music psychopathology. No statistic difference was observed between the quality of musical ex pression of control persons of average musi cal ability and schizophrenic, manic, endog enous- and neurotic-depressed patients, when in a remitted state. When psychotic, the instrumental performances of schizo phrenics were impaired in a dimension of musical logic and order, whereas endoge nous-depressed patients showed a consider ably weakened motoric quality in their play ing. In this respect they could easily be dis
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/29/2018 4:23:45 AM
Abstract. The music therapeutic productions of 67 psychiatric inpatients were analyzed concerning a systematic variation in the course of therapy. The impairment of performance was not as regular as with customary music, nevertheless with growing remission it was reversible in all diagnostic subgroups. The change for the better of rhythmic and motor skills of endogenous-depressed patients was seen to the same extent as with traditional music. The polarity profile developed for the assessment of music proved meaningful in the character ization of music therapeutic utterances.
Steinberg/Kimmig/Raith/Giinther/Bogner/Timmermann
tinguished from ncurolic-dcpressed patients, who showed only few systematic differences in their expressive capacities as did patients with maniform syndromes. It was hypothesized that, depending on psychopathology, also with the elementary musical utterances in active music therapy, some systematic characteristics will be found as with customary music2.
Method The experiment was run with the usual set up of active music therapy in semicloscd groups. Inpatients suffering from schizophrenic, endogenous-depressive and manic psychosis formed one group, a second group consisted mainly of neurotic-depressed pa tients. Patients were classified according to 1CD 9 cri teria [2] at discharge. They were selected for music therapy with regard to their ability to attend a group. Patients with special musical skills were on the whole rejected, since 'musicians' often demand standards of traditional music in music therapy, which prevents them from integrating into those groups. On average each patient took part in 3.5 music therapy lessons within 6 weeks, which corresponds to the average inpatients' stay at the University Hospital. As usual, music therapy began with the singing of familiar folk songs. Then the so-called ‘drums game’ was started. Each patient was supposed to express his feelings on a drum for about 0.5 min. then the group was expected to take over this musical picture by accompanying the soloist with the usual Orff percus sion instruments [12]. A contact microphone was attached to the drum and recorded the playing on one channel of a tape recorder. The second channel con tained the musical production of the group and was recorded with a room microphone. In this way the drumming could also be separated easily during the group improvisation. The latter lasted for about 2 min. then the next patient started as a soloist. With
2 The term 'customary music' is used in contrast to the musical productions in music therapy. The terms 'traditional' as well as 'true' or 'conventional music' cover the meaning as well.
out any exception all patients agreed to the recordings, which lasted through the whole therapeutic lesson. It seemed that the recordings did not change the thera peutic situation by e.g. the induction of stage fright. After the drums game the lessons were confined to the usual elements of music therapy. About I h before and immediately after music therapy patients had to fill in the BfS self-rating scale [24]. A brief questionnaire [21] asked about the patient’s satisfaction with the les son. By means of the Brief Psychiatric Rating Scale (BPRS) [14], the psychopathologic state was assessed by the psychiatrist in attendance, who did not partici pate in music therapy. The recordings of solo parts were selected and rated by means of a semantic differential [13] de scribed in part II [19]. The rating was carried out by 3 musically trained physicians, who did not know about the psychopathologic state of the patients at the re cordings. Metronome tempo (MM) of each sample was determined in beats per minute by adjustment of a mechanical metronome clock to the loudspeaker by independent raters. Average tempo was taken for data processing when the two ratings did not differ more than 10%. Otherwise the sample was rejected from analysis.
Results 30 male (mean age 25.9 ± 6.7 years) and 37 female (32.4 ± 12.1 years) patients were selected for the statistics. Apart from the group of endogenous-depressed patients, the gender relation was balanced, as seen in ta ble 2, which shows follow-up data for 43 patients. Only 6 out of 67 patients had expe rience with musical instruments. Therefore no specific musical skills had to be consid ered. as it was quite important with the patients analyzed for customary musical abilities as described in part 111 [20]. Polarity Profile
With the recordings of each patient’s first therapeutic lesson the interrater reliability and the retest stability in assessing musical
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/29/2018 4:23:45 AM
122
123
Music Psychopathology
Table I. Polarity profile
1 Flowing, spirited. lively 2 Firm, stable. clear, exact 3 Fine, precise, tender, sensitive 4 Rhythmic 5 Peaceful 6 With feeling, intense. full of tension 7 F.xpressive, subtle 8 Professional 9 Logical, orderly. uniform 10 Serious, profound 11 Bold, expressive
A
B
C
D
E
F
G
H
0.93
0.83
0.93
0.85 -0.03
0.90
0.73
0.92
0.83
0.25
© 1991 S. Karger AG, Basel 0254-4962/91/0243-0121 $2.75/0
Music Psychopathology IV. The Course of Musical Expression during Music Therapy with Psychiatric Inpatients' R. Steinberg a . V. Kimm igb, L. Railhb, W. Guntherb , J. Bognerb, T. Tim m erm annb aPfalzklinik Landeck. Klingenmunster: bPsychiatric University Hospital, Munich. FRG
Music therapy is widely used in psychia try as a nonverbal therapeutic means in group activity [6, 15]. Although in many countries music therapy is taught at univer sities and schools, the scientific background to the theory has remained rather small [9], The field is characterized by a large body of casuistic contributions based on psychoana lytic reflections [6, 12, 23]; some experi ments dealing with vegetative reactions also give hints as to the physiological basis of the effects of music [5, 8, 22]. But a systematic examination of the musical ‘language’ in mu sical therapy, what the participants tell one another and how they do it, has never been1 1 Dedicated to H. Hippius on his 65th birthday.
attempted. In a series of experiments Stein berg et at. [18-20] showed that musical ex pression changes in a systematic manner de pending on the kind and the degree of men tal disease, which allows us to speak of music psychopathology. No statistic difference was observed between the quality of musical ex pression of control persons of average musi cal ability and schizophrenic, manic, endog enous- and neurotic-depressed patients, when in a remitted state. When psychotic, the instrumental performances of schizo phrenics were impaired in a dimension of musical logic and order, whereas endoge nous-depressed patients showed a consider ably weakened motoric quality in their play ing. In this respect they could easily be dis
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/29/2018 4:23:45 AM
Abstract. The music therapeutic productions of 67 psychiatric inpatients were analyzed concerning a systematic variation in the course of therapy. The impairment of performance was not as regular as with customary music, nevertheless with growing remission it was reversible in all diagnostic subgroups. The change for the better of rhythmic and motor skills of endogenous-depressed patients was seen to the same extent as with traditional music. The polarity profile developed for the assessment of music proved meaningful in the character ization of music therapeutic utterances.
Steinberg/Kimmig/Raith/Giinther/Bogner/Timmermann
tinguished from ncurolic-dcpressed patients, who showed only few systematic differences in their expressive capacities as did patients with maniform syndromes. It was hypothesized that, depending on psychopathology, also with the elementary musical utterances in active music therapy, some systematic characteristics will be found as with customary music2.
Method The experiment was run with the usual set up of active music therapy in semicloscd groups. Inpatients suffering from schizophrenic, endogenous-depressive and manic psychosis formed one group, a second group consisted mainly of neurotic-depressed pa tients. Patients were classified according to 1CD 9 cri teria [2] at discharge. They were selected for music therapy with regard to their ability to attend a group. Patients with special musical skills were on the whole rejected, since 'musicians' often demand standards of traditional music in music therapy, which prevents them from integrating into those groups. On average each patient took part in 3.5 music therapy lessons within 6 weeks, which corresponds to the average inpatients' stay at the University Hospital. As usual, music therapy began with the singing of familiar folk songs. Then the so-called ‘drums game’ was started. Each patient was supposed to express his feelings on a drum for about 0.5 min. then the group was expected to take over this musical picture by accompanying the soloist with the usual Orff percus sion instruments [12]. A contact microphone was attached to the drum and recorded the playing on one channel of a tape recorder. The second channel con tained the musical production of the group and was recorded with a room microphone. In this way the drumming could also be separated easily during the group improvisation. The latter lasted for about 2 min. then the next patient started as a soloist. With
2 The term 'customary music' is used in contrast to the musical productions in music therapy. The terms 'traditional' as well as 'true' or 'conventional music' cover the meaning as well.
out any exception all patients agreed to the recordings, which lasted through the whole therapeutic lesson. It seemed that the recordings did not change the thera peutic situation by e.g. the induction of stage fright. After the drums game the lessons were confined to the usual elements of music therapy. About I h before and immediately after music therapy patients had to fill in the BfS self-rating scale [24]. A brief questionnaire [21] asked about the patient’s satisfaction with the les son. By means of the Brief Psychiatric Rating Scale (BPRS) [14], the psychopathologic state was assessed by the psychiatrist in attendance, who did not partici pate in music therapy. The recordings of solo parts were selected and rated by means of a semantic differential [13] de scribed in part II [19]. The rating was carried out by 3 musically trained physicians, who did not know about the psychopathologic state of the patients at the re cordings. Metronome tempo (MM) of each sample was determined in beats per minute by adjustment of a mechanical metronome clock to the loudspeaker by independent raters. Average tempo was taken for data processing when the two ratings did not differ more than 10%. Otherwise the sample was rejected from analysis.
Results 30 male (mean age 25.9 ± 6.7 years) and 37 female (32.4 ± 12.1 years) patients were selected for the statistics. Apart from the group of endogenous-depressed patients, the gender relation was balanced, as seen in ta ble 2, which shows follow-up data for 43 patients. Only 6 out of 67 patients had expe rience with musical instruments. Therefore no specific musical skills had to be consid ered. as it was quite important with the patients analyzed for customary musical abilities as described in part 111 [20]. Polarity Profile
With the recordings of each patient’s first therapeutic lesson the interrater reliability and the retest stability in assessing musical
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/29/2018 4:23:45 AM
122
123
Music Psychopathology
Table I. Polarity profile
1 Flowing, spirited. lively 2 Firm, stable. clear, exact 3 Fine, precise, tender, sensitive 4 Rhythmic 5 Peaceful 6 With feeling, intense. full of tension 7 F.xpressive, subtle 8 Professional 9 Logical, orderly. uniform 10 Serious, profound 11 Bold, expressive
A
B
C
D
E
F
G
H
0.93
0.83
0.93
0.85 -0.03
0.90
0.73
0.92
0.83
0.25
