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Dan Goldman together with Stefanie Blain-Moraes will serve as plenary speakers for an exciting and innovative session entitled Music and Connection, at the , Oct 15-18, 2024. Dan Goldman works as a music therapist and bereavement support group facilitator at the in Montreal, Quebec. Stefanie Blain-Moraes is a biomedical engineer and associate professor at 9I制作厂免费 in Montreal as well as the Canada Research Chair (Tier 2) in Consciousness and Personhood Technology.

Devon Phillips (DP): We're very fortunate that you will both be presenting at the closing plenary of the 9I制作厂免费 International Palliative Care Congress. You are collaborating in a session called My first question to both of you is, what is the role of music in the context of serious illness?

Dan Goldman (DG):

Whether I'm working with individuals who are at the end of their lives or with those who are in the midst of grief, it's important for me to remember that we can relate in a variety of ways. One way is through dialogue, another is through shared silence, and a third is through music. In fact, these three ways interweave quite naturally in a music therapy session, each offering its own advantages and potential for what can be felt and expressed.

There are so many important emotions that emerge around the end of life and during grief. I think that in a music therapy session, we're trying to hold and we're trying to contain, or at the very least, make space for a broad range of emotions, many of which are paradoxical, are going in a lot of different directions and don't necessarily follow a logical sequence. Having access to the three ways of relating (dialogue, shared silence, and music), helps individuals to navigate complex and challenging emotions.

If we take a song, for instance, there is repetition in the form, and predictability in the rhythms, lyrics, and melodies. At a time when so much is out of a person's control, predictability and repetition are comforting. Music offers people a place where they can land for a certain length of time and rest there. So, we can say that music provides a containing and supportive space for emotions, thoughts, sensations, memories 鈥� the full range of experience. Patients usually prefer songs they resonate with, songs that recall fond memories of places, events, or relationships. People often connect with a refrain or a particular line in the verse. These songs often lead to soulful conversations that can then transition back into further songs, helping to process the topics that emerged. Pauses between dialogue or even within the music can allow for the emergence and expression of emotion, too. At its core, music has the capacity to 鈥渉old,鈥� and when we're going through significant life events, we usually want to be held and comforted. Additionally, music can be seen as a form of touch because we're generating sound vibrations that we feel throughout the body; in this way, we're experiencing a very personalized kind of holding.

Stefanie Blain-Moraes (SBM): Dan, that鈥檚 beautiful. You know, every time Dan and I talk, I feel so lucky to be doing this keynote with him. I'll supplement what he said: so much of the focus at end of life is relational, and music really helps to create a connection between two individuals, which is I think what people crave.

DP: I also wanted to speak to a little bit about personhood and loss of personhood at end of life when people can lose their sense of self, identity, and to varying degrees, their ability to communicate. I would think music can serve a very special role. Stefanie, do you want to perhaps address that given your work with assisted technology in people with a diminished ability to communicate?

SBM: The technology that I'm sharing at the plenary is something called biomusic, and it was designed for people who are unable to move, unable to speak. We find that under those circumstances, personhood tends to slowly deteriorate, and slowly becomes jeopardized. Often the care workers look at the body as something that needs custodial care 鈥� something that needs maintenance; something to be kept clean. But the person gets lost in there because it's a one-way interaction. I'm coming up to you, I'm talking to you but I get no response. It's hard to sustain that for more than 5 minutes, even with the best of intentions, because you鈥檙e getting nothing back in return. The biomusic is a technology that takes someone鈥檚 internal physiological reactions and makes them explicit. People are responding even if you can't see them responding - they can be responding covertly. For example, I might not be able to physically answer you, I might not be able to intentionally move, but my body knows that your body is here. I recognize that there's another presence here and my body is responding to that. Even if I can't show you that you are having an effect, you are having an effect on my body. This technology was designed to make that explicit. The original design was a visual output, and it didn't function in the way that biomusic does. People treated it as an analytic tool - what is this trying to tell me? How do I interpret this graph? We switched over to music, one of the reasons being that music is -- and I loved how Dan put it before -- able to hold a lot more than just the cold, 鈥渄oes this graph go up or down?鈥�. When we are able to convey someone's internal reactions through a medium that is meaningful but still leaves room for interpretation from the listener, we find that people are able to reattribute this personhood to someone who had potentially been losing that.

DP: Dan, as an experienced music therapist, you're dealing with issues of personhood as well as you work with people at the end of life. What has this experience been like?

DG: One of my main roles is to accompany people through the progressive process of loss. It seems like there is an accumulation of grief in terms of losing one's autonomy, one's senses, one's sense of self, and the ability to communicate and relate to loved ones. There are so many things along the way that dying people lose. I am fortunate in that I have the opportunity to witness how music can support individuals to regain and reinforce a sense of who they are as a whole, and not solely defined as a person with an illness. The love of music seems to remain intact so long as a person can still hear well enough, and this helps to carry people through a progression of intense change. Individuals can simply nod or smile or give some kind of signal and we can see that they鈥檙e still engaged, and that they are communicating with us 鈥� that their personhood is still here. This can be very reassuring for family members, too. I'm thinking right now about a gentleman who had lost his ability to verbalize. I knew, based on a conversation with his wife, that he had been a choral director and loved classical music. I remember playing a piece by JS Bach for him and seeing some tears emerge as he nodded 'yes'. And so that love of music remained intact despite the gentleman鈥檚 limited capacities. And even when everything is changing so quickly, when the illness trajectory goes into high gear, there is a potential to engage in music as a stabilizing force.

With regard to the final stages of the illness, if I have come to know the patient well, I will continue to play the patient's favorite songs/pieces while they are actively dying/non-responsive. I'm not always sure that this is the right thing to do, though I usually rely on my intuition, what I know about the patient, and the common notion that 'hearing is the last thing to go' to inspire or at least justify the use of music during this stage. I'm completely fascinated by Stefanie's work and excited to explore and interact with bio music, which will help to engage with a few questions such as: what might be the role of music with a non-responsive patient in palliative care? How might this way of working support my relationship and my engagement with the patient? How might listening and improvising with a patient's nervous system change the way I feel towards them? Could it be that having evidence of another person's inner music increases the potential for empathy? Does hearing another person's inner music preserve a patient's integrity of personhood?

DP: These are fascinating questions Dan. Stefanie, how are you using the biomusic technology at this time?

SBM: We are working with kids who are in palliative care and who are minimally communicative. We are creating memory making experiences with them and their parents by playing the child's biomusic during an experience that we've crafted for that particular couple. We conduct an interview beforehand to figure out what would be meaningful to those parents. The mother will listen to her child's biomusic and talk about these moments afterwards - the moments that stood out, that were meaningful, and sometimes very profound moments where the music changes and emerges and reveals reactions that you had suspected all along were there. I find that people really feel very validated when there is an external representation of 鈥淵es, I knew that he was reacting to this鈥�. We will record a little sound clip of these moments and put it into a music box and then put that in a stuffed animal, or a crafted music box and we鈥檒l give it to the parents. They can play it while the child is alive, but they also keep it after the child has passed. And that association between that musical moment and the child is something that sustains the personhood of that child even after passing because of the meaning associated with that music in that moment.

DP: That's extremely powerful. The music is communication and connection, the music is representing the essence of that child. That's so wonderful. Stefanie, I think you're bringing some biofeedback instrument or tool with you to the plenary to demonstrate this process, is that correct?

SBM: Correct. There will be a live demonstration of biomusic with Dan and I being able to show in real time what someone鈥檚 reaction will be. Then Dan is going to work musically with the biomusic feedback so that you can see what relational interaction with biomusic would look like and we're going to invite the audience to participate in creating this experience too. We are very excited!