On Music Therapy for Veterans

Text and Photography · Date 2/8/2018

How strange to be older than an army specialist. One gray, drizzly day at Fort Campbell, in Kentucky, a 24-year-old firefighter with brown hair, a pale complexion, and a self-deprecating sense of humor was struggling to play a C major scale with both hands on a little keyboard. As I watched her instructor, a blond 101st Airborne Division Band member named Richard, walk her through the underhand motions of her thumbs, I remembered my own early discomfort in piano lessons. “This is gonna look ridiculous,” she said.

The room was white, with fluorescent lights. Tacky motivational posters (“Communication: Build bridges, not walls”) formed a neat horizontal row. In one corner, an older man who asked to be identified by his first name, Jonathan, was hacking softly by himself through a chord progression, fiddling with melodic suspensions over dominant chords. In another corner, Arnaldo, a heavyset man in uniform, worked on an Adele song with his younger teacher. They listened to snatches of it on Spotify, then sung it back. At times Arnaldo took over the words in a clean, thin falsetto that belied his heavy, almost intimidating presence.

“The healing power of music.” “The power of their voice in songs of healing.” “Music’s healing powers may offer hope for a happier life.” Clichés about the ways that music can assuage trauma abound both in the many music therapy programs for veterans, and in the way the media writes about them. As a classical musician, these phrases make me as uncomfortable as claims about music’s alleged status as the “universal language.” Sometimes music can make you feel better; at other times it can make you feel worse. Is it a tool of treatment or an art like any other, with ambiguous and conflicted power? Last week, I drove from Nashville, Tennessee to Fort Campbell, passing gun shops, barbers, and used car dealers offering military discounts, searching, in an unscientific way, to ease my skepticism.

The program I visited was offered as part of Fort Campbell’s Warrior Transition Battalion’s occupational therapy services. The participants were recovering from a variety of physical injuries, not necessarily related to combat. (One soldier I spoke to said he’d injured his leg during a soccer game in Qatar.) They were required to participate in some form of occupational therapy, and had chosen music from a list of electives. Most were beginners; their teachers were all instrumentalists from the 101st Airborne Division band. “The occupational therapists here offer music for post-traumatic growth and mTBI recovery,” said Warren Officer 2 Charles Doswell, the band’s commander. “My soldiers are just giving music lessons, is what it amounts to. The growth and the socialization…is kind of a byproduct of learning how to play music in a group setting.”

Feelings and frustrations came out in small ways during the group session I observed. Arnaldo couldn’t find the sheet music he needed. “I hate it when I can’t find what I’m looking for,” he said. His teacher, a pianist named Walter, reassured him: “Even if you don’t have the music that’s OK.” Arnaldo didn’t seem convinced. Later, I spoke to the firefighter specialist separately. The introductory lesson, which, besides the C major scale, covered chords, arpeggios (misheard as “abrizio”), and clefs, “was good until the end,” she told me. “I have trouble remembering things and concentrating. I had trouble concentrating towards the end. But the instructor was really good, and helped to pull me back in.” The mix of soft keyboard chords and voices bothered her: “having a bunch of noises going at the same time…was stressing me out.” I hovered on the edge of asking about her specific diagnosis. What can a soldier have that music can improve? “I’ve got physical injuries, but I’ve also got mental health stuff that I’m taking care of,” she replied. I asked her to elaborate, and she agreed, as long as I granted her full anonymity. Then the Public Affairs Officer monitoring this story jumped in and and said she didn’t have to.

There was something stoic about the music lessons that afternoon at Fort Campbell. Conversations between teachers and pupils stayed focused on the specifics of music: guitar fingerings, the number of steps in a scale, the way jazz is “like putting together a puzzle in real time.” The polar opposite approach, called Group Analytic Music Therapy, is outlined in the Oxford Handbook of Music Therapy by a researcher and therapist named Heidi Ahonen. Rather than learning music with the aim of being good at it, participants in her sessions improvise, listen, and take part in group therapeutic discussions without regard to quality. It’s a more verbal way of working with music: the music “activates archetypal images” and “allows clients to experience their feelings and to communicate these within a safe symbolic distance.”

Though Ahonen compares music therapy to “a hall of mirrors” which reflects the patient’s emotions and trauma back to himself, she also admits that “the musical process itself is therapeutic.” What, concretely, does musical process mean? When Jonathan, who suffers from depression, PTSD, and anxiety, spoke to me separately, he described the pleasure he derives from music in distinctly physical, tactile terms. He feels better “before, during, and after” the music lessons: “I get here, I get a chance to pull the thing out of the box, right? There’s people standing around, and I get to do something in front of people. But then before I get here, there’s like a preparation to get here. I have to put the thing in the case. I have to practice, get all excited about that. There’s a mental excitement to the buildup to get there. You gotta put it in the car, you gotta drive. People see you walking around with the piano…I put it in the car, and then we get here, and I break it out, and then we start our lesson.”

In her article “Music Therapy in Mental Health Care for Adults,” Triona McCaffery describes the treatment as “a means of ‘working through’ beyond verbal media.” That “beyond” refers to sonic expression, but more immediately, I think, to the concrete physical mechanics and sensations involved in playing music. “You clumped up your fingers,” the teacher Richard told the firefighter, and she agreed, flexing her hand to relax it, present in the corporeal moment. When a solider named Tim, his large uniform engulfing his guitar, tried to find a G major seventh chord, his teacher reached out and lightly touched his finger, and Tim flexed his hand as well. If post-traumatic stress is more physical than emotional, as a neuropathologist has posited according to a 2016 New York Times Magazine article, then there is a pleasing symmetry in the idea that recovery might look somehow physical as well. The soldiers I met at Fort Campbell showed their healthy distraction more in their body language than in words. They exhibited the body language of being fully occupied.

None of which is to say that music lessons should be credited with miraculous—as opposed to incremental—healing powers. Jonathan told me that in addition to music therapy, he is on medication for his PTSD, depression, and anxiety. Music is not enough to maintain his even keel; he stays constantly engaged in various other activities. “As soon as I drop the piano down, I’m off running again,” he said. As a civilian, it can feel impossible to grasp the depth of war-related injury and how that can be eased through small interventions like music therapy. My next-door neighbor growing up, with whom I played Star Wars games as a child, joined the Marines in 2007. He came home deeply traumatized, and was later shot by local police after threatening them with a knife while high on inhalants. (He survived.) Against the realities of post-traumatic stress, platitudes like “music makes us want to live” seem pitifully inadequate, even if they do contain some truth.

The problem with the idea that music has inherent “healing power” is that if you feel anxious or depressed or traumatized, and you try listening to music, and it doesn’t make you feel better, it’s easy to think that nothing will. Music therapy, that afternoon at Fort Campbell convinced me, is most appropriately seen as one element of a broader therapeutic cocktail. Interventions like medication and traditional therapy are the most important components. Then comes the broader social integration: the small talk with your teacher, the anticipation of unpacking your piano case, the light touch of someone else’s hand. Only after that comes the sound itself. This is what McCaffery’s phrase “working through” really means in the context of music therapy, I think. As David Ferry writes, in his poem “Measure 100”:

To someone there in the room behind the music;Someone else working out a problemAt a table under the glowing light of a lamp; Or the moment when the disease has finallyProceeded to its foregone working through, Leaving behind it nothing but the questionOf whether there’s a heaven to sing about. ¶