Positive Vibrations:
A Feminist Critique of Traditional Western Music Therapy
Music therapy has been around for thousands of years. And yet it was not officially recognized as a medical practice until the second half of the twentieth century when the National Association of Music Therapy was established in 1950 (Tyler). Music therapy is very interdisciplinary. The different approaches to music therapy include those from education, psychology, neuroscience, as well as music therapy itself. The first three have developed on the foundations of their respective disciplines, adopting the existing practices and theories; the latter, being autonomous, implements a wider range of accepted approaches. In psychology, for example, music therapists have taken current psychological theories and used them as a basis for different types of music therapy. Neurological Music Therapy (NMT) is "based on a neuroscience model of music perception and production, and the influence of music on functional changes in non-musical brain and behavior functions" (Davis). Music therapy is practiced in different forms, whether listening to and discussing music, dancing in response, playing musical instruments, or composing and performing songs. There are various purposes for which music therapy is used, such as: to promote wellness, manage stress, alleviate pain, express feelings, enhance memory, improve communication and physical rehabilitation (AMTA website). In addition to these widely recognized and practiced uses, music therapy can be applied to issues specifically related to women, such as overcoming the consequences of domestic violence, rape, sexual abuse in children, drug abuse, postnatal depression and child loss (Adrienne).
The history of music therapy can be traced to ancient Greece, although some scholars argue that allusions to music therapy can be found in Mesopotamian and Ancient Egyptian literary sources or even in proto-historic magical practices (Davis). The four major traditions of learned medicine – Greko-Roman, Arabic, Indian, and Chinese, – as well as local practices, all include the use of music therapy, whether as treatment of psychological or physical ailments. The fact that the practice of music therapy developed independently in many different cultures may serve as evidence of its reliability. In Ancient Greece, Plato laid out the theoretical justification of music therapy by formulating the theory that music therapy works by "tuning" the soul to the cosmos (Horden). Both the Ancient Greeks and Romans prescribed music (along with wine and women) for treatment of melancholy (Kummel in Horden). Because in classical antiquity science was often inseparable from philosophy, it is difficult to determine to what extent these claims were applied in practice. The evidence of practical application of music therapy first appears in medieval Arabic literary sources which mention music therapy being applied in mental hospitals (Dols in Horden). In Ayurvedic medicine music was used for a variety of purposes, among them to counteract snakebite (Katz in Horden). Chinese medicine, which in itself is therapeutic, associated the Five Phases with the five modes of music and advocated the balance between those (Horden).
In the Middle Ages, the healing power of music was, at times, far exaggerated. This could be a result of the fact that people could not explain the nature of disease, such as the bubonic plague, and were willing to do anything to save their lives. In the introduction to The Decameron, a collection of novellas set against the background of the Black Death, the author Giovanni Boccaccio gives an account of people who "formed communities in houses where there were no sick, and lived a separate and secluded life, [...] eating and drinking moderately of the most delicate viands and the finest wines [...] and diverting their minds with music and such other delights as they could devise" [Boccaccio]. With our current knowledge of epidemiology, one can see the rationale behind isolating from the source of contamination and the advantage of having a balanced diet, but listening to pleasant music is not a reliable way of preventing infection. However, people in the Middle Ages did not have the knowledge available to us now and could not separate the real preventive measures from the superficial ones. Similarly, in 1614, a Spanish physician, Rodericus Castro writes: "Throughout Spain whenever anyone falls seriously ill, it is usual to summon musicians" and claims that music can serve as a remedy for phrenitis, mania, melancholia, fever, lethargy, apoplexy, catalepsy, consumption, and epilepsy . A German physician, Ulrich von Hutten, even proposed music as a treatment for syphilis (Kummel in Horden).
During the Enlightenment, in contrast, music therapy was declared pseudo-science (Horden), since anything that could not be proven by the empirical method was discarded as unreliable. It is not in our power, however, to evaluate how much modern science has lost as a consequence of its systematic disregard of alternative methods and sources of learning. In the nineteenth century, music therapy was reintroduced into medical practice largely due to the efforts of Canon Frederick Kill Harford (1832-1906) who conducted experiments and published his findings to show that music can be used to reduce fever and calm hospital patients (Tyler). However, the belief in the healing power of music was restricted to psychological benefits and for the next half a century music therapy was developing in the model of psychotherapy, adopting its therapeutic methods, assessment criteria, research findings, etc. Recently there has been a renewed interest in the possible physiological effects of music. Research has been published which shows a significant decrease in in vitro cancer cell growth in response to certain kinds of music (Sharma et al). In 2009 Cochrane published a review of 23 clinical trials which concludes that some music may reduce heart rate, respiratory rate, and blood pressure in patients with coronary heart disease (Bradt), but this may also be linked to the calming effect of music.
Having examined the history of music therapy, we may conclude that it is quite a controversial practice. First, music therapy was stigmatized because of being used in the treatment of mental illness, thus dealing with the marginalized populations. Second, the abuse of its capabilities during the Middle Ages has led to a perpetual skepticism towards its effectiveness. Third, there is a clear gender bias in music therapy because for a long time music and entertainment (along with wine and women) was regarded as inappropriate for women. The fourth reason for the criticism of music therapy is the fact that its availability was restricted to the upper classes who could afford to have musicians perform for them. Moreover, the traditional practice of music therapy was based on the achievements of "dead European males" and used western musical tradition as the therapeutic vehicle, thus manifesting itself as "elite" (Horden). Finally, music therapy has developed along the lines of psychotherapy and other related fields, which means it did not develop its own methodologies, practices, and objectives targeting specific problems which music therapy works with.
Applying a feminist critique to music therapy may provide significant improvement and expansion of the current capacities of the field. First, it may be beneficial for democratizing the discipline, that is, providing service to disadvantaged populations and addressing a wider range of issues. Second, it may encourage cross-cultural exchange of practices, which will greatly increase the range of its possibilities, given the long and rich traditions of music therapy in non-western medicine. The feminist therapy approach was developed in the 1970s in response to the second wave of feminism (Curtis). Even though music therapy appears to be a very receptive field to which feminist perspective can be easily applied, very few changes have been introduced until recent years (Hadley and Edwards). Furthermore, even when innovations are being applied in practice, few of them are being documented. In part, this is due to the fact that music therapy as a professional field has not had much time to develop and gain authority. As a consequence, few sources of funding are available and few journals are willing to publish the feminist research on the subject. This reflects the tendency in our society to ignore the issues concerning minorities and the unwillingness to change the existing order of things in the scientific sphere. As Sandra L. Curtis explains, "Feminist therapy brings with it an understanding of the silencing of women's voices in the current sociopolitical context" [Curtis]. Let us now examine some of the problems in music therapy which may be solved by applying the feminist approach.
The main problem with social therapy (of which music therapy is a part) is that it is designed to justify and preserve the existing social order. The role of music therapy is to normalize clients to the current social, cultural, or political reality (Adrienne). Unfortunately, what is considered normal in a given social reality is often extremely unjust to minority groups. However, it does not mean that they are wrong simply because they are in conflict with the existing social construct, which satisfies the privileged groups and ignores the interest of the disenfranchised. The recipients of music therapy should not be called patients (which implies sickness), but rather clients. Therapists should be trained in sociological theories of gender and oppression in order to understand the client's social position and try to help. Simply adhering to the professional ethics of music therapy is not making a change in the clients' lives, it is simply "placating, soothing, and softening the edges of overmedication, ritualization, and institutional rules. Music therapy relaxes the urge to question diagnoses and other issues considered not relevant to the defined therapeutic goal" (Adrienne). A feminist approach to music therapy can introduce change in the lives of the client and in the broader society.
The unwillingness to allow music therapy to change the existing social reality is reflected in the attributes of the practice. These are the institutional settings, professional regimen and methods, client-therapist relationships, and the music used in sessions. Institutionalization and professionalization of music therapy creates a whole range of problems. First, making music therapy a professional field with well-defined objectives, strong professional ethics, approved set of procedures, abstract conceptual organization, and a specific body of knowledge limits the possibilities of what it can do,who it works with, and what kinds of issues it addresses (Adrienne). Such over-specialization is prone to missing the big picture, the deep problems in our society. It creates an appearance of neutrality and impersonality that conceals class, gender, and racial subtexts (Smith in Adrienne). It also requires the construction of a body of knowledge that would justify the need for such a profession.
Knowledge as a social construct defines what we label as normal or deviant and what is considered recovery. "Diagnoses, psychiatrically, psychologically, and medically, explain more about our fears as society than about the individuals themselves (Adrienne). It also reflects the hierarchical organization of our society where women "are alienated to a greater degree from power, prestige, and privilege" (Stefan) and thus are prevented from contributing their views to the development of this knowledge. Since a large proportion of music therapy clients are women, would it not make sense to include a feminist perspective in its practice? Moreover, as feminist standpoint theorists advocate, such an approach may prove beneficial for all categories of patients because women's experiences as an oppressed gender enables them to understand the problems of their patients (Harding). An alternative way to justify the demand for a music therapist profession is to maintain a constant supply of clients. By defining the problems that clients face as illness, the therapists earn their money. A feminist linguist, Genevieve Vaughn, argues that the exchange system makes it seem like therapists are helping their clients, while in reality the clients are helping the therapists by providing them their problems (Vaughn).
As can be seen from the previous example, the nature of the client-therapist relationship is mutually dependent. However, the practice of music therapy tends to simplify it to a one-sided power relationship, with the therapist representing authority and the client being a recipient. There are several ways by which the practice of music therapy accomplishes this. First, the clients are seen as needing help managing their social forces (Adrienne). The very fact of starting music therapy stigmatizes them as "patients" and focuses on their disabilities. This cannot be helpful for those who are seeking to restore their wellness, because, according to labeling theory, people tend to become what they are labeled (Becker in Adrienne). Second, the psychoanalytic model used in music therapy creates an environment where the therapist is a powerful authoritative figure. The therapy room is a formal and foreign place for the client and the ruling domain for the therapist. The therapist usually has better training in music and therefore authoritatively influences the client's perception and interpretation. The process of recording and evaluating the client's response, formulating the goals and assessing the progress violates the client's privacy and demeans their freedom, forces them to open their feelings to a stranger who gives nothing in return. Here a radical feminist lens may be applied to encourage more personal involvement, reducing the distance between the client and the therapist and thus establishing a more equal relationship, more like friendship. To take this one step further, radical feminism rejects one-on-one therapeutic relationship as a dualistic and hierarchical relationship and encourages music therapy clients to form non-hierarchical women groups to discuss their experiences. (MacKinnon in Rosser). For clients who are trying to reclaim their sense of worth and power this approach may prove extremely beneficial.
The traditional client-therapist relationship is not the only factor that acts negatively on the clients' self-esteem by reinforcing their powerlessness in the current social reality. The music itself is a powerful tool for such reinforcement. In traditional music therapy the music is being "administered" to the client. The therapist decides what kind of music to apply and it is usually western "art" music (Adrienne). Music therapy is centered around the great western masterpieces, most of which have been composed by privileged white men. For women, this serves as yet another proof of male supremacy. For the majority of the clients, it is difficult to relate to this "elite" kind of music because they come from a different social or ethnic background. The socialist and African-American feminist approach to the problem would significantly improve the diversity and quality of the material and would be especially beneficial since the countless songs generated during the long history of oppression of African-Americans in the United States address the same issues that music therapy clients encounter (Rosser and Merrill). Music reflects the cultural premises of our age, the accepted codes of communication and primarily gives voice to the groups are in the position to create art and the themes they wish to address. As a means of communication, music translates the prevalent cultural beliefs into a different form of expression. Therefore, its social function is to unconsciously perpetuate gender oppression (McClary). The only way to protect the clients from this musical propaganda would be to have them actively make music. Song writing is one of the most beneficial methods in music therapy that helps clients (especially women) to express their voice (Curtis). "It supports participants to objectify the cause of their struggle and to decrease their sense of victimization in responding to it" (O'Grady). Not only is it a powerful tool for clients to regain their power, but it also has a strong communicative intent. Having women and minorities express their views and concerns will bring attention to these issues and instigate change.
There are more ways to improve music therapy using the feminist approach. Simply increasing the number of women working in the field (as a liberal feminist would propose) would not suffice because it is already the case. Essentialists argue that women choose music therapy because of their biologically-determined affinity for the creative arts, particularly music, interest in social issues, a need to care for someone, and ability to sympathize (Curtis, Rosser). However, all women music therapists must go through the formal training process which devalues these biological advantages. Music therapy training is based on the traditional educational system, which values objectivity, distancing oneself from the object, a hierarchical relationship between the teacher and student, and formal classroom setting. Such an approach limits the learning experience of future music therapists. Instead, one could propose a feminist pedagogy which emphasizes the importance of emotion and experience as sources of knowledge, analyzing issues from multiple perspectives, rejecting teacher-student hierarchy, promoting group-based learning, self-reflection, community outreach, and learning from the music therapy clients (Hadley). To take this one step further, a radical feminist would argue that no training is needed in order to become a music therapist. In fact, many people engage in music therapy without acknowledging it, whether by listening to relaxing music to fall asleep or making a cheerful CD for a friend.
Another insightful perspective to be applied to music therapy is that of ecofeminism. Although music therapy is practiced in many different cultures, the western tradition tends to ignore the achievements of those. In many aboriginal cultures, such as the indigenous Taiwanese population, women play a central role in shamanistic medical practices, which utilize religious rituals, music, and dance as musical treatment (Lee). In such cultures there is a strong association of female with the Earth, which is viewed as protecting, nurturing, life- and strength-giving. Unlike in the western culture, where the association of women and nature is used to justify exploitation of both, indigenous societies deeply honor the Earth (Kenny). Thus, for women reconnecting with the Earth and nature through expressive song or dance, similar to shamanistic practices, it is a source of empowerment (Ouellette in Kenny).
The field of music therapy in not strictly scientific and it does not need to be. People have used music as healing for thousands of years, as many of us do every day. As Jennifer Adrienne's professor once pointed out to her: "Isn't that interesting, if I'm normal it's called listening to or engaging in music, if I'm defined by society as not normal, it's called music therapy" (Adrienne). In fact, making music therapy an acclaimed medical practice, having the therapist publish a certain number of papers every five years simply feeds the bureaucratic mechanism; assigning the client a diagnosis for the purpose of insurance reimbursement only increases their sense of alienation from society. "Medical diagnoses often serve to silence explanations that point to social problems" (Adrienne). Instead of helping a human being drowning in a storm, the therapists just gives them a straw and throws them back into the ocean. In addition, people who need help the most often cannot afford to go to an institution, do not know what options are available, do not believe in the possibility of help, or simply do not trust doctors. Music therapy is not a objective practice with clearly defined the goals and guidelines for measuring success. I propose that instead of trying to adhere to the approved norms used in other related practices, music therapists should explore alternative approaches: applying the feminist perspective, learning from experience of other cultures, experimenting with settings, mediums, forms of expression, group composition, and emotional exchange. I Music therapy needs this kind of flexibility in order to be able to help a wider range of problems and clients.
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