Music & Dementia #2 - on eternity, boundaries, and serving others
In the previous 'Music and Dementia' blog post, I wrote about how doing music with people with dementia gives us a chance to celebrate and enact a Biblical view of what it is to be human. In this blog post, we’re looking at ways in which this 'musicking' can realign our perspectives on eternity, music and serving others, as well as the more nitty-gritty topic of boundaries.
Gift not gain (nor god)
One of the difficulties in this work can be the nagging question ‘does it really make a difference?’, and even if we don’t ask it in our own minds the funders surely will! If it isn’t remembered the next day was it still worth something? The benefits don’t necessarily stop when the music does: people with dementia are often reported to have improved mood or reduced agitation for a few hours after the music has stopped and exercising muscles in music sessions may help people with dementia continue to dress and feed themselves.  But as wonderful as these benefits are, I hesitate to call them really long-term and they certainly are not a cure.
As I talked to other musicians, two ways of approaching the relatively fleeting benefits of music came to light:
1. Music is gift not gain. Having dementia can force us to enjoy music in the present as a gift rather than as something that will add to our overall worth, reputation or even future happiness. Even if the people that I sing with do not remember the happy, sociable, lively moments that we shared, those moments are still valuable and a gift from God at the right time. The book of Ecclesiastes discusses how all wealth, prestige and pleasure is to be enjoyed while it lasts but not held on to – none of it will make an eternal difference but it is to be enjoyed in the present. Often we don’t live like that, particularly with our music making as each lesson, practice hour or performance can feel as if it is adding to our overall importance, our success, our value as a musician and as a person. What if we just enjoyed each moment of music as a good gift in its own time rather than something to be stored up for our bio or our next conversation with prospective patrons or rivals?
2. Music falls short as an ultimate saviour. As one postgraduate violinist said to me, the people she worked with on her community-music placement are ‘still going to die and have dementia’. She went on to say that the music sessions aren’t futile, but they aren’t going to ultimately solve or fix anything – the improvements are fleeting. In the light of eternity, even the ‘long-term’ benefits of music sessions (reduced agitation, improved mood and ability to carry out daily tasks for several hours after each session) seem short-term. This is where I sometimes feel I am at odds with other practitioners who speak as if music, or the arts more widely, are the answer in dementia care. As a Christian I have a greater hope; I am not satisfied with merely making life a bit better now – I am hungry for the new creation where all pain and tears are wiped away. However wonderful the benefits from my music sessions are, however much joy they create, music falls short as an ultimate saviour. As practitioners we must remember this as it can be easy to get a bit of a saviour-complex when care staff or relatives eulogise me because they see their loved ones finally smiling, connecting with other people and acting more like their old selves in my music sessions. It can be so tempting to put our worth in this work and to seek our satisfaction in it, but ultimately music is not a saviour for people with dementia or for us as musicians; in the light of eternity we need Jesus to truly heal and satisfy us.
People with dementia often lose inhibitions they had earlier in their lives and this can encourage an incredibly permissive atmosphere in dementia care such that ‘anything goes’. In the music sessions I have been involved in, this has manifested itself in lewd lyrics and occasional bottom-slapping. Everyone has to follow their own conscience in these areas, but I want to emphasise the difference between loving a person and celebrating their every action. For example, I always invite people to make up their own words to songs, and whilst I usually try to celebrate and sing whatever anyone comes up with, I tend to tailor or edge around particularly lewd or expletive lyrics. A mentor I once had would probably say that I am wrong to censor some lyrics because my job is to celebrate and incorporate anything that a person in my music session offers. This becomes a more difficult line to follow, however, when we start talking about bottom-slapping rather than lyric writing! My challenge is to show that I truly value the person even if I don’t encourage their less inhibited behaviour. I would argue that sometimes it shows that you value a person more by not celebrating behaviours that they would have been embarrassed about doing for most of their life. I can still show love, patience and respect. As one student I spoke to said, ‘It doesn’t matter if you give me a smile or “the finger”, I’m still going to be kind’.
Running amazing music workshops involves taking some creative risks. If you invite someone with dementia to conduct an improvisation, you do not know what you might get, but you do have to follow their lead as closely as you can and play your instrument as well as you possibly can. It teaches us humility; it teaches us to put people first even if that means risking musical perfection and our pride. You are always serving the people in the session rather than just trying to impress them - perhaps that is what our relationship with our audience should always be!
I hope you’ve found these reflections helpful, whether you run dementia-friendly workshops yourself, would like to do so, or if someone you love has dementia. Please feel free to get in touch with any comments or questions, or if you’d like to discuss this more - email firstname.lastname@example.org
 Sung, H.C., Lee, W.L., Chang, S.M. & Smith, G.D. (2011) ‘Exploring nursing staff’s attitudes and use of music for older people with dementia in long-term care facilities’, Journal of Clinical Nursing, 20:11-12, pp. 1776—1783.
Gerdner, L. A. & Swanson, E. A. (1993) ‘Effects of individualized music on elderly patients who are confused and agitated’, Archives of Psychiatric Nursing, vol. 7:5, pp. 282291.
Palmer, M. (2001) ‘Older adults are total people’, in Expressive arts with elders: a resource, Weisberg, N. and Wilder, R. (eds.) 2nd edition, London: Jessica Kingsley Publishers, pp.179-187.
 Gibson, D. (2016) Destiny: Living life by preparing to die, IVP.