Wednesday, October 30, 2013

The Ghost in the Machine

Working with music as a transformative modality brings me up smack against the research by neuroscientists. There seems to be a consensus that sound can cause release of, say, serotonin, and that varying amounts of serotonin have varying effects on the human system, ranging from very good to very bad. Anyone who's working through the issue of getting their psych meds "right" can confirm that.

Notable physicians, neuroscientists and surgeons playing around with the effects of music today include Dr Oliver Sacks ("Musicophilia: Tales of Music and the Brain"), Dr Daniel J Levitin ("This is Your Brain on Music") and Dr Claudius Conrad ("A Musician Who Performs With A Scalpel"). Also, if you haven't heard this remarkable segment from on "blame" it is VERY worth an hour of your time, especially because it got me thinking about how little we really know about the human brain.

Like music therapy, neuroscience is still in relative infancy. Both music therapy and neuroscience are making incredible strides forward in research and treatment, but based on the actual science we have for both disciplines, we're a long way from consistent results. That is, the skill of the music therapist or neuroscientist is still the biggest factor in applying research to successful treatment. One neuroscientist, interviewed on the radiolab "blame" segment, compared what we know about the human brain to viewing the Earth from space: we can see a lot of stuff happening, but we are a long way from understanding what's really going on. The analogue to this, from a musical point of view, are last Century's musical over-simplifications: "listening to Mozart makes you smarter" or "listening to rap makes you angry." Hogwash. Sort of.

The real issue is that, thanks in part to the profit-based medical industry, medical research is overly fascinated with quantifiable results. The search for quantifiable results -- the scientific method, if you will -- only leads us down a rabbit hole that keeps getting narrower and narrower until we can reliably make a conclusion that something -- albeit a very small thing -- changed as a result of our intervention (drugs, surgery, music). For music, this is exactly the wrong measurement. Music is too broad to be pigeon-holed so neatly.

I agree that a singular effect of a specific sound can be quantified, but that's not the same thing as understanding how even the simplest melody can create such a huge range of emotion, varying from individual to individual, and it's certainly a long way from being a determining factor in treatment of a particular symptom. Serotonin's effects can range from more peaceful sleep to schizophrenia, depending on the quantity present in the human system, and music-induced riots -- the premiere of Stravisky's "Rite of Spring" is one well-known example -- probably trace their impetus to a measurable overdose of serotonin. I'm not encouraging neuroscientific research in a mosh pit, but it could be instructive....

The big point here is that too narrow a focus on a particular result and connecting it too specifically to music, in my opinion, misses the powerful and holistic nature of "music therapy." What little scientific knowledge we have about the effects of music -- by the very nature of the way in which that knowledge was obtained -- does not give a very big picture of the potential music has for results. Our medical need to quantify a particular effect obscures our view of the hundreds of other effects happening simultaneously.

Music therapy, for example, has been found to be quite beneficial in "treating" autism. That's wonderful, to be sure. But not everyone in the world has autism. On the other hand, a huge majority of people in the world have stress-related issues -- too many of them to quantify, certainly -- and it's well known that music can "help" with distress. Unfortunately for the measurement-based treatment community, nothing is going to be done to advance music as a "cure" for distress, specifically because "stress" is too general and the effects of music are too broad. That's a shame, because nothing works better for self medication in distress than music. Sadly, both the medical and music therapy communities consider themselves successful for alleviating the symptoms of many stress-related illnesses while forgetting that they haven't done a thing about the actual stress-producing causes....

Until we have a better understanding of neuroscience, and of music's ability to trigger predictable responses in the human system, a more holistic approach is needed. The medical research and treatment community is going to have to accept a more qualitative perspective. Patients' response to intervention must be allowed to go outside a multi-point checklist and numerical scale if we are to have any chance at understanding the more complex results of that music-based intervention. This isn't a new idea, but it's use is overdue. How many patients are killed by well-meaning physicians who administer the wrong drug? Our reliance on smaller and smaller slices of understanding is useful, but the interaction of the entire human system with any given intervention is critical. We delve farther and farther into isolated effects at our own peril, and folks who deserve better care ought not pay for it with poorer health.

On the other hand, music is safe, effective and freely available. In addition to mental, emotion and physical benefits, it also has positive social implications. Most importantly, one doesn't need a credentialed therapist to experience and enjoy the effects of music -- even the therapeutic ones! Anyone experiencing distress who is within range of a computer or a smart phone is also within range of treatment for that distress. 

How does this work? You can either wait around for an expert to answer that question with "science" your health insurance might just pay for, or you can begin NOW to use music for your own relief. Ask yourself: would I stop eating because I don't understand the science underlying my digestive system and biology of nutrition? Music and sound have been available for millennia. What are we waiting for? Some doctor to tell us to fire up Spotify or Pandora or Songza? The ghost in your machine is hungry for music! Time to start listening!

Time to start giving ourselves better care. It's not hard -- and it might even "treat" issues we didn't even consider transforming in ways we hadn't thought possible.

Get your music on!

Thursday, October 10, 2013

How to Fill the Biggest Gap in Veterans Services

Recently, I had the opportunity to chat with a professor from San Diego State University School of Public Affairs. This distinguished gentleman has spent a good deal of effort in the area of re-integration of justice-involved individuals to "normal" society. He made the observation that re-integration works best when the receiving social structure is properly prepared.

This means that we have a much better shot at keeping recidivism rates low when "the public" has the skills and knowledge to help provide a smooth ride from prison to life free society.

Do you have those kinds of skills and that knowledge? I'm not sure that I do...but I'm motivated to learn.

This got me thinking about what folks in "Veterans Services" social enterprises like to call "transition" -- the period of time and the associated activities that members of the United States Armed Forces undergo prior to and immediately after "separation" from active duty and integration into life as civilians.

Here in San Diego, Veterans Services organizations of all sizes and kinds have begun to work closely with both government and military command to re-define the process of transition and the continuum of services necessary to help folks in that process be more successful at it. Many other communities around the United States are actively thinking about the same things, developing best practices and dramatically improving their local transition processes to be better than they may ever have been.

I honor that hard work and commitment and want very much to see it succeed. I have no doubt that it can, but the professor's comments about re-integration made me wonder: is the public ready for this? As a civilian in San Diego, am I prepared for this?

Why me? Because after a Service member separates, I'm part of the community he or she lives in. I'm part of the workforce Service members expect to contribute to. I'm part of the social fabric a transitioning Service member hopes to weave their skills and capabilities into. What do I need to do, learn, understand and appreciate to be ready to help transitioning Service members become successful in civilian life?

We have a very progressive Chaplaincy at our local Veterans Administration Healthcare Center. One of the interesting programs these Chaplains launched is a couples retreat called "From Warrior to Soulmate" that seeks to help military members and their significant others become a strong family unit. Warrior to Soulmate was so successful, both with Veterans and with Active Duty Service members, that the program went nationwide less than a year after it was launched.

The VA Chaplains also began a program of education for church leaders and congregations throughout San Diego County. This program helped clergy and regular citizens gain an appreciation for the needs of transitioning Service members beyond housing, employment and physical care. It was useful to the clergy as counselors and mentors, and I hope it was also useful to the members of their churches -- the people in a transitioning Service member's faith-based community.

The gap, however, between what we have today in San Diego County -- as good as we think it is -- and an informed compassionate and effective citizenry able to properly support and mentor Service members in transition is a big one.

Employers need to have understanding and compassion as well as skills and tools to mentor Service-to-Civilian Veterans. School teachers and administrators need the same skills and more to provide compassionate care for the children of ex-military families. Government and civic organizations have awareness but they also need to strengthen their skills.

And regular folks like me, my wife, our kids and our friends need to know what to expect when we encounter a Service member in transition.

So do you, in your community, when newly-minted Veterans transition out of Service to be your community members, friends, co-workers, parishioners, parents of your kids' school get the picture.

And, by the way, Veterans are just one of the very important groups of transitioning folks you might find in your community. Others include formerly-justice-involved individuals, folks moving from homeless to domiciled and large populations of recent immigrants or refugees -- there are most likely others.

To close this gap in services we need a new kind of agency or non-government organization: one that teaches regular folks how to mentor folks in transition.

Mentor? Yes: mentor. We don't need more clinicians, therapists and professionals to fill this gap -- there are plenty of opportunities for those specialties, too, in their own domains. What we need are regular everyday folks who are spooled up on what it takes to be both useful and compassionate resources for transitioning folks. 

Not everyone is going to want to be a mentor of course, but everyone -- yes everyone in a high-transition community -- must be aware of what's happening around them and, most importantly, at the very least must be able to offer someone in transition a word of support. It is critical to transitioning folks that the communities around them don't express ignorance nor ignore their specific needs -- this harms the entire community, not just those in transition.

Will you step up to help? Here's an action plan:
  1. Learn about the transitioning folks in your community and what their specific needs might be.
  2. Teach people close to you what you've learned. 
  3. Volunteer your skills in a way that seems meaningful to you to assist with transitioning folks' integration to your community -- if that's mentoring, that's best!
  4. Interact in some natural way with folks in transition -- just showing up reliably shows your compassion and empathy and this means so much to someone in transition.
If you are a community leader, you can also encourage agencies and organizations around you to bring their energy and resources to this effort. You may find that, even though a specific agency may not be chartered to fill this gap, they will be able to offer some kind of assistance to do so, such as the San Diego VA Chaplains' initiative to educate ministers, preachers, pastors and priests about the needs of Service members returning from deployment or becoming Veterans.

Remember that old World War II poster of Uncle Sam with the tag line "I want you?" It's no longer about a war, it's about an opportunity to change communities at the grass roots. Uncle Sam still wants you, but now it's about what you can do to create a stronger more resilient sustainable community that does more than just assimilate folks in transition. We have a unique opportunity today to create stronger communities, filled with extraordinary potential, provided we are ready and willing to engage those who want very much to belong.

We can do this. We must do this. Every one of us deserves it.