Guest Post: "The Loss of a Loved One: Grief vs Depression"

The Loss of a Loved One: Grief vs. Depression

Hello, musers! I'm pleased to bring you this guest post by Jackie Waters. Enjoy!

Photo by Pixabay

Your life's companion is gone; it’s like a part of you is missing. There is so much weight on your heart, and you have every right to mourn in your own way. Your grief is your grief. You may feel confused about how to take charge of your life without this person by your side. When someone you have loved and spent your life with is gone, it’s only natural to feel lost and confused. Grief is the path to moving through your feelings and is a pivotal part of the healing process. Sometimes, however, the grief is so intense that you may begin to feel a deeper, longer depression in your heart and your mind.

Seniors dealing with grief from the loss of a spouse can feel intense moments of sadness, but that doesn’t necessarily constitute depression. That’s why it’s so important to understand the difference between grief and depression. Symptoms of grief include:

• Difficulty concentrating
• Pangs of longing for your deceased loved one
• Anger or guilt that your loved one left you behind
• Lack of energy and bouts of lethargy
• Loss of independence
• Fear of new responsibilities
• Loss of appetite
• Trouble sleeping
• Uncontrollable crying, both in private and public
• Difficulty making decisions

There’s no manual for grief. Everyone mourns the sorrow of loss differently and moves through the healing process at their own pace. Sometimes seniors dealing with the death of a spouse experience symptoms much like depression, such as isolation, withdrawal from social activities and deep, and painful feelings of sadness. However, there are several important distinctions that clue you in to the difference between depression and grief.

• Symptom duration. When it comes to grief and depression, there is a difference between the length of time that people deal with feelings of sadness. Seniors dealing with depression feel this aching sadness frequently, and likely have dealt with it long before their spouse passed away. Those dealing with grief often feel times of depression, but also fluctuate between various other emotions like anger, guilt, cheerfulness, anxiety and numbness.
• Levels of social activity. Seniors with depression will isolate themselves, especially during particularly low periods. Sometimes they avoid, or even shun, family and friends. They may withdraw entirely from even their closest friends. When someone is grieving, they may not want to be around large groups or out in public, but will accept intimate invitations from those they are close and comfortable with. They may also only spend brief periods of time engaged in social functions, leaving early or staying on the fringes.
• Continue daily functions. When a senior is grieving, they may take some time off to themselves, but can still make trips to the grocery store, post office, or work. They may be infrequent or short tips at first, but the main point is that they still make an effort. They may feel anxious about going out, but sometimes look forward to how these activities can occupy their time and mind. Seniors who are clinically depressed, may not be able to perform their daily tasks. They experience symptoms so severe that they miss work or responsibilities. They may even have difficulty with self care, such as showering or eating.

Seniors are at serious risk for depression, especially those who are have recently lost a spouse. Studies show that seniors tend to resist getting help because they don't want to be a burden on their families. Some see depression as a weakness or grieving the loss of a spouse as a sign of death. For these reasons and more - keeping in mind that, for some, depression can lead to other very serious issues such as addiction or suicide - seniors are at risk of developing further complications. It’s so important that seniors dealing with the loss of a spouse reach out for support. It’s not a sign of weakness; it’s a sign of strength.

Are you or a loved one struggling with depression or complicated grief after the loss of a loved one? Music therapy may be helpful to you. Please contact me at 417-569-7144 today to set up a free consultation. 

Decisions, Decisions

Hello! Welcome back!

Imagine for a moment you happen to walk by the room where I am practicing music therapy with a patient or client. You observe me offering a client with dementia song choices, singing the song they choose, and prompting and encouraging them to also sing or play an instrument.

It looks very basic on the surface, right?

But there is so much going on inside the mind of a music therapist in those moments related to the musical decisions we make and how we make them.

In the context of using music for therapy, as opposed to music education, or entertainment, musical decisions are clinical decisions, too.

So before we even get to that basic musical interaction between therapist and client, a music therapist is considering:

• What periods of this person's life does he or she tend to be most responsive to and nostalgic over? What decade in time is most likely to spark a strong emotional response or elicit meaningful engagement with memories?
• What do we know about the limitations imposed by their disease process? Do they need a slower tempo in order to catch their breath to sing?
• What about this particular client's vocal range? Does this song need to be pitched in a key that's not super comfortable for me, but better for the client's voice?
• What portions of the song should I be singing? Should I do the whole thing, or only the chorus several times because they don't remember the verses and I will loose their engagement if we try to sing them?
• How loudly does this person need me to sing in order to hear me, but not get overstimulated?
• Will cuing them with body language, chord structure, and rhythm changes be enough to help them sing along, or does this person need verbal cues, as well?

And prior to those questions, I'll be asking myself about this person's affect, energy level, pain needs, and so many other factors to decide if it's even the right time and place for this person to have a musical interaction.

Contrast that sort of decision-making process with how a performer or entertainer might plan their set list. The motivators are primarily going to be what that performer wants to do, balanced with some consideration about what the audience will enjoy.

But in therapy, every musical choice I make is guided by my clients and their treatment plan. So I may sing something I am 100% burnt-out on, not because I particularly want to, but because I know it will be most likely to help my clients achieve their treatment goals.

These kinds of considerations are critical because music therapists do not throw music at problems and see what sticks. We provide musical therapeutic intervention for the treatment of our clients and patients. We must know we are providing safe and effective treatments. The training and expertise an MT-BC brings to patient care makes us well worth the cost and effort to bring music therapy to every clinical setting.

I hope I live to see the day where every person who could benefit from MT has the chance to receive services. In the meantime, you'll see me out there, singing "You are My Sunshine," for the 12th time this week and loving it.

Thawing Out

Sometimes, the most accurate way for me to reflect on the quality of my day's work is whether or not I made someone cry.

That sounds a bit awful at first glance, doesn't it?

I know.

Maybe it's more accurate for me to say my day was especially successful if I helped someone cry.

Someone who ultimately found it beneficial to cry, to experience an emotional catharsis, but who, for whatever reason(s), was unable to access and express their turbulent emotions prior to the addition of music therapy.

Here's an incredibly common scenario. I often arrive to the bedside of a patient who is in the active dying process. The room is typically full of family members who love this person very much, are feeling all kinds of emotions about the person in the bed and about each other, and who have no idea what to do with themselves as they sit vigil, wanting to be present as their loved one takes their last breath.

I walk into these rooms and it's as if the oxygen has been removed. Everyone is usually standing stiffly, shoulders hunched, head down, not looking at the person in the bed or one another. Conversation is stiff and rare. It's like the whole family has been frozen by their inability to connect with the emotional and sensory elements of this intimate experience of sitting vigil for a loved one.

But something happens when I introduce music. From the very first note, the environment is changed. It's similar to the effect of adding music to a dramatic movie scene - access to emotions is easy. The family begins to thaw out almost immediately. Maybe someone looks up to make eye contact with me and finds themselves smiling because they remember that this was their father's favorite hymn. Maybe this child looks to her brother and says, "Do you remember Daddy singing this to us when we were kids?" And the smiles begin to mix with tears. Siblings reach for one another. The whole family begins to move, to talk, to laugh, to cry. They all move closer to the bed and provide loving touch to their dying loved one and to each other.

As we continue to share music, memories come rushing up to the surface and the family shares stories, laughter, and finds it easier to tell this departing family member that he or she is loved and will be missed. It's safe to look the dying process in the eyes and say goodbye. From frozen to warmth, these people are now more fully able to participate in and experience this pivotal moment in the circle of life. It's like the music weaves a protective container around them and holds a space in which they can be human, vulnerable, and authentic. We have transformed the vigil experience from one of terrible, interminable waiting, to a memory of shared family experience, love, and support.

So when I get home from work and my fiancé asks me how my day went, I can honestly say, "It was wonderful. I got so many people to cry!"

It Doesn't Have to be This Way

Hi, musers, and welcome back!

A few weeks ago, I was visiting one of my patients in a skilled nursing facility. She was in one bed, with her husband of 50+ years beside her, with her roommate over in the next bed.

We all know that live music tends to carry, so even though I wasn't there to see her roommate, I did keep her in my periphery because if she begins to have a distressing response to music I am using with my patient, I am going to need to adapt my approach.

I noticed that she was lying in bed, sort of curled up on one side, not making eye contact with anyone, and very much withdrawn.

So as my patient is getting her need for increased meaningful interactions met via music she and her husband used to dance to, I notice out of the corner of my eye that her roommate has rolled in bed a bit to look more closely at us. She catches my eye and begins mouthing the words to songs that are familiar to her, as well.

A nurse from the facility comes in to ask Ms. Roommate if she will be getting up for lunch today. Ms. Roommate sighs and says she doesn't feel like it, and just doesn't want to.

The nurse leaves.

Ms. Roommate continues to appear more and more interested in the music we are sharing. Within minutes, she has pushed the button to lift the head of her bed and is full-out singing along with me. And nodding her head. And moving her arms and hands in time to the music. And grinning ear to ear. She's engaged in this.

The nurse returns. And begins explaining to my patient that if she doesn't get up and move, if she doesn't find a way to start taking some deeper breaths, she is going to get pneumonia and that will be a quick ticket out. Ms. Roommate listens for a moment, then turns and continues to belt out the big band number I am singing. The nurse gets frustrated that this woman isn't taking this request to get up and breathe seriously.

Did you cringe? Do you see what happened here? Ms. Roommate was already sitting up and breathing more deeply. At this point, she had scooted herself to the edge of the bed and was sitting UP. And singing like she meant it. You can't sing like that without drawing deep, sustained breaths. You can't wave your arms like an enthusiastic band director and not be moving some blood around.

Now, don't get me wrong. I understand how easy it is to develop "tunnel vision" when it comes to making sure your patients get their care plan goals met. I know this nurse just desperately wanted to see this woman get up and around as a way to keep her healthier, longer. I know that this nurse hasn't had the chance to learn about MT applications, and that at she is right there at the top of the list of professionals who are overworked and underappreciated and under supported.

So I don't blame her for not seeing that Ms. Roommate was already well on her way towards getting what she needed that day without any poking or prodding. We have a society and a healthcare system that tends to view anything involving the arts as nice fluff and filler when you have the surplus budget, and not as a serious clinical tool for motivating people towards compliance with their treatment plan.

But it doesn't have to be this way.

Can you imagine a world full of nursing homes with access to group and 1:1 music therapy? Where instead of trying to pester people into engagement with their peers, you could simply allow them access to natural avenues to accomplish that? Instead of begging them to get up and move, you just make sure they have access to their favorite toe-tappers and a music therapist who can use techniques to encourage them to move? What if we had a modality that has care plan goals "baked in" to the experience of something these people already know and love? (Hint: That modality is MT!)

One last word about Ms. Roommate. She grabbed my hand as I was packing up, told me that I had played songs she and her late husband used to dance to, as well, and that now she felt so cheerful and energized that she wanted to get up for lunch and maybe even eat something.

I'm on a mission to change the thinking and culture within healthcare, one interaction at a time, so that one day, other direct care staff will see someone singing along and instead of thinking "entertainment," they will think, "blood oxygenation." Because it just doesn't have to be this way.

The Gift of Intuition

Any clinical professional knows that we study certain rules and guidelines for assessing our patients and clients and then determining appropriate interventions for them.

One such guideline for music therapy for determining appropriate preferred music to use in therapy is that we generally stick to music that was popular when our patients were 15-25 years old. Research shows that this decade of life is when our brains tend to be most susceptible to forming intensely nostalgic, emotional connections with music. The rule tells me I am far more likely to get engagement for therapy when I can find music that likely played on the radio in someone's first car than if I use music their grandparents went out waltzing to.

I have had great clinical success with the process of consciously applying this guideline and sifting through all the available data on each patient to arrive at some great educated guesses to get started. And we know that a responsible MT is going to assess actual responses to music and keep sifting through that data and always take a patient's expressed preferences as the most important information.

And yet...

There are moments when my internal dialogue keeps pestering me with something that falls outside of the rules and guidelines for what "should" be preferred by any given patient. My intuition persistently demands that I ask them, that I offer this music and just see if they even know what I am talking about and if they want to engage with this music. Some of the most powerful clinical responses I have ever gotten have occurred as the result of listening to those intuitive nudges.

And music therapy is not the only area of clinical practice where a departure from the standard procedure occasionally yields a strong result or critical finding. How many physicians can tell stories of that time they ordered a test for a patient for no reason that made logical sense to them, but their gut just insisted? They just "had a feeling" they needed to order the chest x-ray or the bloodwork even though nothing in the presenting symptoms clearly pointed to this?

What exactly is going on with clinical intuition? I want to unpack that a bit. So many of us explicitly trust our logical, linear thinking processes that consciously sift through data and apply theories and guidelines, and thus implicitly remain a little wary of anything intuition tells us.

I recently read The Gift of Fear by Gavin De Becker. This book completely changed the way I view intuition as a subconscious cognitive process (and not as mystical, otherworldly, "hunches.")

Imagine your reflexes for a moment. They operate outside of and faster than conscious awareness. The other morning, I brushed the back of my hand against the slow cooker. My arm flew up and away from it faster than I could realize why. I didn't have to consciously think, "This is hot. I know that this temperature will damage my skin and cause pain. I should move my hand now." It just happens.  Later that morning, I was on a run and happily inside the reverie of my mind, almost in a meditate state. Suddenly, I felt my legs seize up and my body jerk backward, milliseconds before I became aware of my head turning and my eyes and ears consciously registering the oncoming car. My instinctive reflexes operated on behalf of my best interests before my conscious, logical mind had any say whatsoever. And good thing, too.

What does this have to do with intuition as a cognitive process? Imagine it like this: your conscious, logical, linear mind is a bit like a teacher giving a lecture to the rest of your brain. "We are going to take this data today and apply these rules to it and that's how we will know what to do for this patient." Your intuition is all the other unconscious parts of the brain, the room full of students busily gathering sensory and memory data and passing notes to one another in the classroom. By the time these students have generated enough flurry to get your conscious attention and you intercept the note, you can be reasonably sure they have something worth your attention. Yes, intuition is sometimes wrong, but it learns. That error will be stored away for future use and used to inform those busy little students for next time.

This is how the process played out for me in a visit with a patient: By all the "rules," she should like rock and pop music from the 1970s and 1980s, and she does! No problem there. So why, when she mentioned an image from her childhood, did I suddenly feel an overwhelming urge to offer her a cowboy song from 1935? There was no logical reason for my mind to go there, but I had just intercepted a note from my subconscious that said I really must. So, I asked. I said her words had brought some lyrics to mind, and did she know anything about this song? She said it sounded familiar and asked me to please sing it.

She burst into happy, nostalgic tears at hearing this song and told me her grandmother used to walk through the house, singing it all the time, and she had mostly been raised by her grandmother. From there, we discovered many of the other songs she learned at Grandma's piano. The biggest increase in her subjective self-report of her well-being and quality of life happened in that session, using music that I never would have arrived at by only considering the data from my conscious mind.

Somewhere under the surface, my intuition was sifting through everything I had ever learned about this patient, the CDs I had seen in her apartment in passing, statements she had made, and I don't even know what else. But finally, my intuition had something important enough to bother me with, to interrupt the teacher's lesson and get caught passing me that note.

I'm so curious what other clinicians have experienced with the role of intuition in their practice. Drop me a note in the comments and thank you for reading!

Doing With or Doing To?

Happy Friday to you!

Think with me for a moment about the last time you visited your doctor, or underwent any kind of procedure in the hospital or doctor's office.

For me, that was a fairly painful but brief biopsy. Now, a question: was your perception of that visit or procedure one of having the medical professional do something to you or were you perhaps conscious of a relational element, a sense of doing with?

I think these are very important elements of healthcare and therapy to consider. Chances are, when you undergo "standard" medical care, the dynamic is one of doing to. Think about the language we use: provider and patient, procedure, undergo. As critical thinkers in the helping professions, we know that the perception of care provided is nearly as important as the care itself.

That biopsy I mentioned? The longest. five. minutes. of. my. life. We know that learned helplessness and the feeling of powerlessness is one of the most damaging psychological elements of experiencing trauma. When undergoing a painful procedure, it seems as though there are some traumatic elements "baked in," due to the very nature of needing to allow someone to do something painful to you.

I can't even articulate what a difference it would have made for me to have another music therapist there to engage me in some element of choice and control for that five minutes. I could have chosen my favorite, super intense music to provide a clear signal for my brain to focus elsewhere besides the procedure. One enormous swath of the total experience of that exam room environment would have been under my control, determined entirely by my needs and preferences, and not "standard procedure."

I posit that one of the elements of music therapy intervention and process that sets it apart from other modalities that may address the same or similar goals is the degree to which an MT-BC is focused on doing with.

(Even the cats want in on the instruments for doing with!)

Music is an inherently social process and phenomenon. There are so many ways an individual or group can engage with or in music. You can sing with it, move to it, mouth the words, play an instrument, play what's written or improvise around it, think about the lyrics, analyze and talk about the lyrics, experience and share nostalgic memories in response to it, or just be present and mindfully listen to it. In the presence of live music, some part of you (and many parts of your brain) engages WITH what's happening.

In my work with hospice patients and their families, part of my approach is to include them as co-music-makers to whatever extent is comfortable and desirable for them. And there again, their individual needs and preferences are a driving factor in how our musical interaction takes shape. It's part of my initial clinical assessment: What music does this person prefer and relate to, and how do they relate? Are they a toe-tapper, a crier, a lyric-discusser, a belt-it-out-at-the-top-of-their-lungs-er? Some combination of all of the above?

So when I hand someone with Parkinson's an egg shaker, and they experience tremors, I adjust my tempo to include their tremors. It becomes part of the music. There's relational support. We are doing with, together. Or when someone is more fatigued and they decline to make their own song choices, I don't just decide what music I want to use that visit - I remember and consider what they have responded to and preferred and chosen in the past and keep an eye on their affect, breathing, etc. as I incorporate their previously-expressed preferences and autonomy. And even when someone is only capable of lying still and resting while listening to music, I am carefully watching them for responses - a change in facial expression, breathing rate, motor activity, visible muscle tension - to give me direction. They are still co-creators in this musical experience because what they indicate will determine what we do next.

It's important to remember that I am never providing music "at" someone, but always seeking to engage in music with them. This musing raises the broader question for me of how this unique perspective might translate across the other modalities of healthcare. Could we transform someone's experience of having a procedure "done to them" simply by including MT and the elements of doing with?

Please let me know what you think in the comments and thank you for stopping by!

But Not to be Smaller

Happy Monday, my fellow musers!

Yesterday, I noticed my legs seemed more toned and I was way more comfortable in my favorite pair of jeans. That really has nothing much to do with this post, but more about that in a minute.

I have mentioned before how much I loved Brain Rules by John Medina. It's one of those books I keep picking up, and every time I do, it enriches some part of my personal life, my professional life, or the intersection of the two. (Have I mentioned that I am practicing piano better and faster than before with the help these rules?)

Just a few pages into this book and I'd had enough of a nudge to start running regularly again and to recruit my sweetheart to join me. Check this out:

"Just about every mental test possible was tried. No matter how it was measured, the answer was consistently yes: A lifetime of exercise can result in a sometimes astonishing elevation in cognitive performance, compared with those who are sedentary. Exercisers outperform couch potatoes in tests that measure long-term memory, reasoning, attention, problem-solving, even so-called fluid intelligence tasks...Essentially, exercise improves a whole host of abilities prized in the classroom and at work." (Brain Rules, page 14)

An astonishing elevation in cognitive performance? Yes, please! That kind of self-care was the push I needed to start running this time around. I have had an on-again, off-again relationship with running. I think this time it will stick, though. Why? Because this time around, my motives are different.

In the past, running was about being smaller. It was about weight and size and jiggle-reduction and not much else.

My loved ones cannot afford for me to be preoccupied with being smaller. My patients, their families, my co-workers, and everyone else cannot afford for me to bring a version of me that is in any way focused on shrinking. I run for so many reasons now, and a sharper mind is just one of them.

I run to show myself I am fully capable of suiting up and showing up, to get in touch with that inner voice who says, "I can," find her, and turn up her volume, to build my bravery and my self-compassion one step at a time so when I need it, I can confidently call upon that part of myself who must have hard conversations with families facing a death. I run to get bigger in heart, in strength, in confidence, in nurturing self-care, and yes, in improved oxygenation to my brain cells and sharper thinking. But never again simply to be smaller.

So when I glanced in the mirror yesterday and saw some changes, I could think, "Well, cool. But that's not important." How absolutely liberating. I will choose today to grow, but not to be smaller.

PS: If you want to learn some of the best neuroscience out there for taking care of a human brain, you can get a copy of Brain Rules here. I promise this will help you be a better therapist and human being!