Toby Williams is head of the music therapy department at Brooklyn Conservatory of Music, as well as a professor at NYU and a licensed creative arts therapist. In this episode, she talks about her journey from bandleader to therapist, therapy as a conduit to insight, and shares personal stories of how music has helped clients at different stages of their lives.
Find Toby HERE
What we're listening to:
Want to support TSI? Buy me a coffee! It literally fuels my music.
Or RATE AND REVIEW, it's the nice thing to do :)
As mentioned in the episode: Nordic Journal of Music Therapy/Vol. 20, No. 3, October 2011, 225–241
Song lyrics and the alteration of self-image (Excerpts) By Fereshteh Ahmadi*
Music and identity
The relationship between music and identity has been discussed by several researchers (Hall & du Gay, 1996; Ruud, 1997, 1998; Krims, 2000; Daykin, 2007; Bergman, 2009). Ruud’s papers on music and identity have played an import role in the field of music therapy. According to Ruud (1997), music is the starting point for a feeling of belonging to a group and for developing a sense of identity. The meanings in the music are understood by considering the relationship between music and society and hence by studying the contexts in which the music is performed. As Ruud (1998) explained, music plays an important role in the construction of identity within the mediascape that surrounds us from birth to death. Music can serve as raw material for building values and life orientations, as a way to anchor important relationships to other people, as a way of framing our situatedness in a certain time and space, and as a way to position ourselves within our cultures and thus make explicit our ethnicity, gender, and class. It also provides important ‘‘peak’’ or transcendental experiences that may strengthen the formation of identity in the sense that we feel meaning, purpose, and significance in our life. . . . the issue of music and identity is important for the field of music therapy in several ways. (pp. 47–48) . As Ruud pointed out in the above citation, there is a strong relation between cultural identity, gender identity, ethnic identity, and music. Seen in this light, it is not difficult to understand the important role music can play in the construction and reconstruction of self-image. According to Quinn, Ruud makes the relation between music, identity, and the conception of self-concept clearer by discussing that music can be connected to the way we present our identities. What we listen to, perform and how we talk about music are not necessarily a reflection of our identity, but the way in which we present our identities. By being aware of our musical identity and how music helps to construct an individual’s self concept can help us to choose the right music for our clients that are representative of their life and culture. (p. 5) We cannot discuss the concept of identity without taking into consideration the concept of role. The concepts of role and identity are important sociological concepts currently used in the music education literature. The teachings of symbolic interactionists, such as Mead and Cooley, are used in music education research (Roberts, 2000, p. 54). Role is the basic unit of socialization and the roles individuals perform depend on their audience and situation (Goffman, 1959). Goffman defined different terms in this regard; one is embracement, in which the individual disappears totally into the virtual self available in the situation, [being] seen in terms of the image. The other, role distance, is the opposite and expresses a degree of separateness, in order to deny not the role itself but the virtual self implied in the role. An individual exists, according to Goffman (1959), between an actual self and a virtual self. There are divergent understandings of Goffman’s virtual self and actual self (the latter is also called real self or 2 authentic self). As I read Goffman, virtual self means the self-image of an individual that is created when we impute to the individual certain roles and characteristics. In other words, virtual self refers to the expectations the other has about the characteristics possessed by a person in a certain role. The attributes the individual could in fact be shown to possess are called her/his actual self. Identity is a complex, manifold and non-fixed concept that can be discussed from different points of view. Scholars belonging to divergent disciplines have dealt with the concept of identity on several levels and from different perspectives. According to Mead and Cooley (Mead, 1934; Cooley, 1983/1902), identity is formed in the interaction between self and society. In other words, a person’s self grows out of society’s interpersonal interactions and the perceptions of others. Such being the case, a person views him/herself through the perceptions of others in society and in turn gains a sense of self. However, when we enter the social world and acquire our different social roles, we neither passively accept them nor act on the basis of others’ images of our self. We compare our own view of our self with others’ views of it. We reflect upon our own understanding of the roles we have and on others’ expectations of these roles. We also negotiate between our divergent and sometimes conflicting roles. The process of self-concept formation is not, therefore, a passive process of the acceptance of others’ views about the individual. Our vulnerability to acceptance of others’ views about our self varies depending on the circumstances we face (Ahmadi, 2009).
When individuals are diagnosed with cancer, there is a risk that they will be strongly affected by their role as an ailing person and passively accept the views of others – the sick role – as their own perception of their self (Haigh, 1993). As my study shows, for some patients, one important step toward coping with the psychological effects of illness is to replace the attributed sick role with a new image – a new self-understanding as someone other than the role others have ascribed to the individual at the time of illness. Here music can play the role of a coping method that helps individuals overcome others’ view of them as ill and reconstruct their own self-image and self- identity. Several studies have discussed the relation between identity and music (Whiteley, 2000; Krims, 2000; Bennett 2000). The study I conducted among cancer patients shows that song lyrics are important factor in the reconstruction of identity among some informants. As O’Callaghan (2004) wrote, according to the psychoanalytic ‘‘talking therapies’’ model, song lyrics may symbolically represent aspects of one’s self, providing scope for new ways of thinking about life adaptation issues. Identification with lyrics may also support, comfort, help ventilation of feelings, and inspire. (p. 39)
Song lyrics and coping with cancer
Several studies have examined the effects of music lyrics on mental and developmental health (Brown & Hendee, 1989; de l’Etoile, 2002; O’Callaghan, O’Brien, Magill, & Ballinger, 2009). However, only a limited number of studies have looked at the role of song lyrics in the processes of coping with cancer. James Lull (1987), in his book Popular music and communication, discussed how listening to music can enable a person to escape from personal burdens and tensions, stimulate fantasies and feelings of mental and physical ecstasy, and alleviate loneliness.
Music can contribute to establishing, reinforcing, or changing moods, especially among people who are vulnerable owing to a serious illness such as cancer. Aimlessness, self-doubt, irritation, frustration, depression, and restlessness are some of the emotions that cause cancer patients to seek out music in an effort to find relaxation, but especially validation of their identity as a person whose individual as well as social relations, occupation, etc., are threatened by illness.Accordingly, when patients are faced with an emotional conflict due to the new situation the illness has created, song lyrics not only help them avoid negative feelings and stimulate positive feelings, they also serve to assert personalities. For a cancer patient, identifying oneself and one’s situation with these images may be an effective coping strategy. Song lyrics may then provide an alternative avenue for self-expression for people who have been diagnosed with cancer and find themselves in an identity crisis. What the message and image inherent in the music mean to a patient depends as much on what that patient brings to the message as on what the message provides for the patient. Just as other researchers (e.g., McGuire, 1986; Blosser & Roberts, 1985) have done, I assert that individuals’ interpretations of and responses to messages are different and depend on how they understand the goal of the messages. What is interesting here is that there is a rather great chance that a patient will interpret the messages in song lyrics differently from other people in his/her environment. This is due to the special situation that she/he finds her/himself in and that those of us who are not ill do not. The meaning a patient, suffering from the psychological strains brought on by cancer, constructs from songs probably depends on how the patient perceives her/his situation and identifies her/ himself and the situation with the content of the songs. This is the case for some of my informants.
As pointed out by Cassileth et al. (2003), music therapy can be a means of masking or preparing a patient to face certain mental and physical problems. It is, however, not a substitute for conventional cancer treatment. Cassileth et al. maintained that music therapy does not have a direct impact on the biology of the disease. According to them, it is instead a matter of helping patients cope with a difficult situation. As my study shows, song lyrics can function as a means of masking or preparing oneself for problems. I will return to this when discussing my results on the impact of song lyrics on the reconstruction of self-identity among the interviewees.
Case studies and discussion: the role of song lyrics in creating a new self-image
In the present article, only one part of the results from the study ‘‘Music as a coping method: A study of the role of music in coping with cancer from a patient perspective’’ is in focus. The theme self-image and song lyrics was one among several themes found in the study in question. This theme was identified in several interview protocols, but I have chosen to use the interviews with four informants as the basis for my discussion here. In these four interviews, this particular theme could be identified more clearly than in the other cases.
Peter and religious music
At the time of the interview, Peter was 73 years old. He had been newly diagnosed with prostate cancer and was still undergoing treatment. He reported that he was a big fan of Einar Ekberg, who according to him was perhaps the most important cantor of the twentieth century. He emphasized that he was a Christian personality, a very deep and warm one. He died at 50 of cancer. I have read a book on how his belief was impacted by cancer. He has the most fantastic songs with themes like heaven, eternal hope and what belief means. I have listened to such songs a lot especially during the period I used to take Casodex,3 during this time I became more aware of the fact that it was not sure that I was gong to live the year after, that I was maybe at the last stage of my life. In this situation, I have entertained myself with such songs, which gave me new hope and new happiness; songs that have helped me find a new identity, to see myself not as a cancer patient but as a believer. I got two DVDs and a CD from the US with the title ‘‘Billy Gaither Homecoming.’’ When I listen to these songs, I am affirmed. This is exactly what I feel; it is exactly what I experience. These guys, who sing, all suffering from an illness, tell me about their belief and their hope, they look into my eyes directly and say ‘‘it is what you believe and it is the hope you have.’’ So it’s clear that these songs have had a strong effect on me, they create a world where I am a believer, not a patient with the diagnosis, prostate cancer, I am Job and cancer is my test. As we see, Peter identifies himself with singers who have suffered from one or several serious health problems. Their words on how illness has strengthened their identity as believers have helped him see himself as a religious person with strong faith and his illness as a hardship God dealt out to test his virtue, as we read in the Book of Job. The lyrics of the religious songs Peter listened to have, as he maintained, strengthened his faith and affected his self-identity. In this way, the lyrics have functioned as a coping strategy, which has helped him to overcome the stress and fears brought about by cancer. Peter spoke about how the lyrics in the religious music helped him to overcome what he considered as others’ view of him as old and ailing. As it seems, he had difficulty in accepting his role as a sick person and did not wish to be identified as a cancer patient. He explained that, in the world created by religious music, this wish could be fulfilled. While in the real world he was only a cancer patient, a person who he believed others felt pity for, in the world created by religious music he was not ill, but a man whose virtue was being tested by God. He was a lucky man to whom God had drawn attention, and cancer was God’s test. It was no longer important whether he survived. What was important was that he would not lose his faith because of the cancer. I was very sad after being diagnosed with cancer. When my family looked at me I could see in their eyes how they felt sorry for me. I was an old man near death. I had worked and was full of energy all my life and now when I was dying – I believed I was dying – the last image that my family and people around had of me was a sick, old, weak man. This was not what I wished. But Einar Ekberg and the other singers I listened to changed my world. I sat and listened for hours and hours to their music. This gave me hope and strength. Their words gave me a massage ‘‘you are not an old cancer patient, you are a good Christian, a chosen one, the one who can understand Jesus and his suffering, Job’s and his hesitation. You should be proud of yourself and you should see your cancer as a blessing.’’ This made me feel I was being reborn. God was testing me as He did with Job, and I had to pass this test, then the rest was no longer important.
As Peter explained, his thoughts were no longer directed toward his illness, but toward coming out of this test a winner. He stressed that the song lyrics he listened to actually served to reconstruct his view of himself as a unique individual and granted him a new identity, a religious identity. My interpretation is that these song lyrics have become a means of masking a psychological problem that people diagnosed with cancer may face. What I am referring to is the ascription of the sick role by others to cancer patients – a role that is sometimes difficult for patients to accept. Song lyrics helped Peter overcome this problem by providing him with a new self-image as a religious person. This new self-image allowed him to see himself differently from the way in which he believed others saw him.
Sara, Helen, and hard and heavy music
Sara was 24 years old at the time of the interview. She was a child when diagnosed with cancer. At around nine years of age, the cancer tumor was removed, but this resulted in a visible handicap. During the entire treatment period, and afterwards, she behaved not as a child, but as an adult, trying to handle things in a calm and rational manner. During her teenage years when she suffered greatly from the psychological effects of cancer, she began listening intensively to aggressive music. She emphasized that the aggressiveness was good because everything felt so unfair; children are not supposed to think about death. Music is so alive, and it has so much comfort in it. I listened to aggressive music during the time I felt angry, and it was good, it was pleasant to show your feelings through the music. I was so pissed off with everything. I got cancer when I was eight years old and I have got a handicap because of it. I showed myself as a good and calm child during the sickness, then as a teenager I tried to be like everyone else, pretended to be strong. But then suddenly it was enough. The music helped me for a while to show my anger and dissatisfaction, my real self. As Sara’s explanation of her childhood indicates, she had not yet found an opportunity to develop her self-identity, because her role as an ill child took over all other roles and identities she had or could have. She lacked self- determination. It took several years for her to develop a sense of self-esteem and to realize her self-determination in social interaction. According to Sara, the lyrics of hard and heavy music played an important role in this respect. Listening to this music became her coping method; a resource that helped her grow strong enough to act against the sick role, which she felt had been ascribed to her for several years. She stressed that, because of her handicap, others’ view of her as ill did not cease even after she had survived the cancer.
Helen, another interviewee, was 30 years old at the time of the interview. She had been diagnosed with breast cancer at the age of 23. She described herself before the diagnosis as ‘‘a girl friend, student, and a person who enjoyed life.’’ But then she became ‘‘a sad, hopeless person who went around asking ‘why me?’’’ She explained that her image of herself as well as the picture others had of her changed very suddenly. She became a cancer patient – a member of a social group to which others ascribed several negative attributes. Helen stressed that it was difficult to handle this change; the lyrics of the music she listened to became her salvation when she pretended to be the person the songs were addressed to. She had the feeling that a new person was growing inside her. She pointed out that the lyrics of the heavy and hard music she listened to, caused her anger, which had long been hidden, to come to the surface. She explained: Many around me cared about my body, but not my soul. I was the center of attention, but really no one could see my real self. I should control my feelings; this was an unacceptable expectation to put on a young person. She pointed out that the music she listened to made her so aggressive that other people left her alone. She emphasized that ‘‘This made me feel good and relaxed. I felt that at last I was free, I could be myself, I could show how I really feel, who I am.’’ As Helen explained it, she began to realize that her dreams about her life and the world were illusory, that life and the world were not as pleasing and fair as she believed, that the world was full of injustices and that people around the world suffered because of unfairness, prejudice, and discrimina- tion. She explained that she began to understand that there was no special meaning to human life. She felt relaxed by thinking in this way; this new view helped her stop regarding cancer as a murderer who had killed her life and her dreams. She explained: I was very sad, but more than that, I was angry; I went around asking why this had happen to me; everything was fine before the cancer, I had a boyfriend, had started studying and was having a pretty good time; before cancer, I had many plans. I was so depressed that I couldn’t do anything. I bought some CDs and listened to them all the time, they were all heavy metal, one was ‘‘I Hate Therefore I Am,’’ another ‘‘Children of Bodom.’’ These helped me see my life and my situation differently. I began to realize that it’s no problem that I have no dream, no ambition, and no goals any more; that it was even good that I didn’t see any special meaning with my life.
In the case of the above interviewees, we can clearly see the difference between the identities they ascribed themselves and the identities they believed others ascribed to them. Playing a role that was misleading had made the situation unbearable for these young patients. They wanted to cry and show their anger instead of pretending to be calm and strong. This wish was fulfilled by listening to aggressive music and pretending to be the person these songs addressed – an angry, mean person who was strong, healthy, and who dared to protest. The lyrics of hard and heavy music helped these young patients cope with their illness by giving them the opportunity to question everything that was conventionally accepted in the cultural setting – the Swedish one – the framework in which they had been socialized. This culture had taught them to solve their personal problems by relying primarily on themselves, remaining calm and keeping the situation under control. As a Swede, you are expected to be lugn och sansad, i.e. calm and collected. For them, the lyrics of the hard and heavy music opened the door to a world where one could be her/his real self and express all forbidden feelings, and this helped them achieve tranquility. Helen and Sara ascribed to themselves characteristics such as angry, unhappy, weak, ill, without hope and control, while others regarded them as tolerant, strong, brave, calm, and rational. By listening to hard and heavy music, they tried to overcome this discrepancy. The song lyrics they listened to did not become a means of masking their situation, but rather a means of preparing for normal life, especially when they put the treatment period behind them and began their return to everyday life.
Christine and cheerful music
Christine was 62 at the time of the interview and had been diagnosed with breast cancer the year before. She seemed extremely cheerful. She explained that music had always been part of her life because she had been brought up in a family with a strong background in playing music. She emphasized that her voice is not beautiful, but she has always sung for herself; she has done this because music helps her live in a dream world where she can do as she wishes. She explained that she still loved singing the songs of ‘‘Pippi Longstocking.’’4 These songs made her feel like Pippi Longstocking: strong and healthy. Pippi Longstocking (Swedish: Pippi La ̊ ngstrump) is a fictional character in a series of children’s books created by Swedish author Astrid Lindgren. Pippi is very unconventional, assertive, rich, and extraordinarily strong, able to lift her horse with only one arm, without difficulty. She frequently mocks and dupes the adults she encounters, an attitude likely to appeal to young readers. However, Pippi usually reserves her worst behavior for the most pompous and condescending of adults. In her interview, Christine refers to Pippi and the music of the filmatization of the Pippi books in a television series. This music and other cheerful music have made her feel that nothing can stand in the way of her being happy. She said that she did not like roles; she wished she could always reveal her self. She stressed that but I can do this only when singing. I really love to sing. It’s the best thing I can do. This has helped me a lot, especially when I went through chemotropic treatment and felt awful. I sang all the time during this period. It helped me overcome my fear and stop thinking about death. I sang the songs that made me happy. They were joyful; some of them were dance music, like samba. I could see myself on the dance floor, dancing and dancing. You know it’s magic, you put on a CD and it lets you become whoever you wish. The song lyrics Christine listened to or sang created an imaginary world in which she was no longer a middle-aged woman with breast cancer, but a cheerful young girl who had no problems and lived in total happiness.
I was waiting in the hospital for surgery. In my room there were three other women. They were also waiting to be operated on. I felt bored. I began to sing with a low voice a song, a cheerful song that I used to sing when I was teenager. The song was about some girls who were at a party and waiting to be invited for dance. The two other women in the room first looked at me like they thought I was mad, but after a while one of them began to laugh. Then both women began to sing with me. We laughed and sang for almost an hour. We didn’t feel like we were in the hospital. We were somewhere else. We were not three middle-aged women waiting for a serious operation that would change our life. We were three young women who were happy; happy and without any fears. When the nurse came in to take one of the women for surgery, we said good luck to her and continued singing. Even when the other one left and I was alone I continued singing. I really didn’t feel like a sick person, I was a happy girl singing at the beach, in a wood. Music and song lyrics, which have been an integrated part of her life, have functioned as a coping method that has helped her change her situation to the positive. She said: After the operation, I was informed that they had removed more lymphatic glands than they had planned before the operation. I was shocked. How a four centimeter tumor had changed my life. I began to worry, but then I started listening to a song and sing it for myself. This made me feel like I was in a different world, someone other than this poor sick women who was lying alone in a hospital bed. I said to myself ‘‘No I want to live day by day, not lying around and feeling sorry for myself. I will live and I will sing and dance as long as I live’’ . . . There were periods when I was sad, but music can make miracles happen, I used it to take my worries away and hide them somewhere I could not reach them. When I asked Christian exactly what kind of music has helped her feel better, she answered: I was sometimes sad and maybe even depressed. After a while I noticed that people around me treated me like a sick person and they didn’t interact with me like before. This made me sad. You won’t believe me, but one day I put a CD on, Pippi’s song, and began singing along. It was amazing, I felt immediately strong and happy like Pippi, after that I put this CD on everyday for one hour and sang. I was there, in Pippi’s old house, jumping here and there. I believe after that the people around me were normal with me again. I don’t know, maybe I believed or wanted to believe in this way. In the case of Christine, the discrepancy between what she regarded as others’ understanding of her as a middle-aged ailing women and her own understanding of herself as a happy girl, a ‘‘Pippi Longstocking,’’ who was able to do what she wished, was overcome by the world created in the lyrics of the cheerful music. The lyrics became a means of masking a psychological problem such as depression, which cancer patients usually go through. Seeing herself as Pippi Longstocking helped Christine to identify herself with someone who is not only not sick, but who is also stronger than others and who can even help people who are weak. This new image – the exact opposite of the sick role that she believes others attribute to her – made her feel happy and healthy, and helped her overcome the sadness and stress brought about by cancer.
Summary discussion
My study, conducted among cancer patients in Sweden, shows that song lyrics can create an imaginary world in which cancer patients, who are trying to resolve the discrepancy between the image they have of themselves and the image they believe others have of them, develop a new self-image. As the above case studies show, the song lyrics the interviewees listened to created a world different from the real world they lived in. These song lyrics helped them to see their situation from a new angle – different from how others saw them – and helped them overcome the discrepancy between the picture they thought others had of them and the picture they had of themselves or wished others had. It is fairly common for cancer patients to distance themselves from the image they feel others have of them as a cancer patient. They try to deny their virtual self, i.e., the role of being a cancer patient. They want to be understood as normal, as they were before being diagnosed with cancer. For the present informants, song lyrics helped them see themselves as someone else and produced a new image, a new self, into which the individual can disappear, thus creating greater distance to the sick role (Ahmadi, 2009; Ahmadi & Norberg, 2010). The present study indicates that the lyrics of religious and cheerful songs can help patients achieve a balance in their inner feelings by identifying themselves with the person the lyrics address. But it is not only the lyrics of this kind of music that can help cancer patients cope with their illness. The study also shows that the lyrics of hard and heavy music can help young cancer patients get rid of their anger and reconstruct their self-image. In such a case, the patient lives in an imaginary world in which she/he is a mean, aggressive person who destroys everything (Ahmadi, 2009; Ahmadi & Norberg, 2010).
The above case studies illustrate the importance of considering the role different kinds of music, especially hard and heavy music, can play in coping with cancer. Music therapists should consider the role of hard and heavy music as a possible method of coping with cancer. It is obvious that, like other coping methods, heavy metal music may be useful for one individual and harmful for another, depending on the situation. In other words, coping has an individual character. Given this, it is important to study what types of individual characteristics can make heavy metal music a helpful or harmful coping method.
As a coping method, music has served as a means of masking certain problems in some cases and as a means of preparing patients to face problems in other cases. Regardless of what the song lyrics mean to informants and regardless of whether the music is religious, cheerful, or hard and heavy, as the present study shows, music has played an important role as a coping method for informants diagnosed with cancer. Music helped them identify themselves with the situations described in the songs they listened to, and by doing this helped them create a new self-image, a new identity. Given the essential role music has played in coping with cancer in the present cases, it is crucial that cancer therapists turn more of their attention to music and that the importance of song lyrics be recognized and focused on.
Notes on the contributor
Fereshteh Ahmadi is a Professor of Sociology. She concluded her Ph.D. in sociology at Uppsala University in 1995. Her Ph.D. thesis, Iranian Islam and the concept of the individual, deals with the problem of the non-development of the concept of the individual in Iranian ways of thinking. She is now working as a researcher, presently specializing in issues related to religious and spiritual coping. She had conducted a qualitative study among cancer patients in Sweden concerning the religious and spiritual coping methods and written some essays on this issue. She is now responsible for a research project on Music as a coping method which is a study of the role of music in coping with cancer from patients’ perspective. The project is financed by the Swedish Research Council.
Besides, she has done research on gerontology, international migration at the Department of Sociology, Uppsala University and at the Department of Social Work and Psychology (previous Caring Sciences and Sociology), University of Ga ̈vle, where she is a Senior Lecturer. She also does research on Islamic Feminism at the Department of Sociology, Uppsala University.
