Music Therapy Today a quarterly journal of studies in music and music therapy from the Chair of Qualitative Research in Medicine
Volume VII, Issue 3 (October 2006)
David Aldridge & Jรถrg Fachner (eds.) Chair of Qualitative Research in Medicine Published by MusicTherapyWorld.net UniversityWitten/Herdecke Witten, Germany ISSN 1610-191X
Editor in Chief/Publisher Prof. Dr. phil. David Aldridge Managing Editor Dr. Jörg Fachner, joergf@uni-wh.de Translation and editorial assistance Christina Wagner, cwagner@uni-wh.de Book review editor and dissertations archive Annemiek Vink, a.c.vink@capitolonline.nl “Odds and Ends, Themes and Trends” Tom Doch, t.doch@t-online.de International contacts Dr. Petra Kern, PETRAKERN@prodigy.net Scientific Advisory Board Prof. Dr. Jaakko Erkkilä, University of Jyväskylä, Finland Dr. Hanne Mette Ridder, University of Aalborg, Denmark Dr. Gudrun Aldridge, University Witten/Herdecke, Germany Marcos Vidret, University of Buenos Aires, Argentinia Dr. Cochavit Elefant, Bar-Ilan University, Israel Prof. Dr. Cheryl Dileo. Temple University in Philadelphia, USA Prof. Dr. Marlene Dobkin de Rios, University of California, Irvine, USA Dr. Alenka Barber-Kersovan University of Hamburg, Germany Prof. Dr. Tia DeNora, University of Exeter, UK Dr. Patricia L. Sabbatella, University of Cadiz, Spain
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Table of Contents Music Therapy Today i Table of Contents vii Editorial Music Therapy Today Vol. 7. Issue 3 (online 1st October 2006) 508 David Aldridge and Jörg Fachner 508 Shamanism and biomedical approaches in Nepal –Dualism or synthesis? 514 Carolin Häußermann 514 Traditional oriental music therapy – a regulatory and relational approach 623 Gerhard Tucek 623 Rave, Communitas, and Embodied Idealism 648 Bryan Rill 648 Music therapy in early neurorehabilitation with people who have experienced traumatic brain injury 662 Simon Gilbertson 662 Portrait: WFMT Chair, Commission on Clinical Practice 694 Nobuko Saji 694 Portrait: Music Therapy - “For - Brain, Body & Soul “ - A view on Indian music and music therapy 697 Bhaskar Khandekar 697 vii
Rhythm is the source of all existence - An Interview with Percussionist Greg Ellis 701 by Petra Kern 701 Odds and ends, themes and trends 707 Tom Doch 707
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Music Therapy Today Vol. VII (3) (October) 2006
Editorial Music Therapy Today Vol. 7. Issue 3 (online 1st October 2006) David Aldridge and Jörg Fachner
Welcome to a new issue of Music Therapy Today! The role of the music in traditional healing rituals has been a question that ethnologists and anthropologists have asked and that cannot be easily answered without looking at the context and meaning of music in the process of performed healing rituals. Music has to be understood in the situation in which it is used. In our first article from Carolin Häussermann, you will read about Shamanism and biomedical approaches in Nepal – dualism or synthesis? Carolin explores the question whether such a duality exists in the Nepalese context of healers orientating in a western medicine tradition and the existing traditional healing system or whether a synthesis of both healing systems is possible. This has been a central question of medical anthropologists looking at similar contexts and is relevant to our Western cultures of health care delivery.
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Traditional healers often experience that their healing methods are disregarded as old fashioned and outdated when Western medicine is introduced. Prof. Nepal and Prof. Gartoulla, when the interviewed by Carolin Häussermann, demonstrate that there is an interest for traditional healing rituals in the west. Both have studied the wisdom and knowledge of folk belief and healing systems in the Himalaya and are working on a synthesis of biomedical and traditional healing systems. This article, which is the end term paper of a study course on ethno therapies developed in at the Institute for Ethnomedicine in Munich gives insight into the problems and backgrounds of medical and healing practice in Nepal. Such questions are an integral part of the research approach at the Chair of Qualitative Research in Medicine (see Aldridge, D. (1990). The delivery of health care alternatives. Journal of the Royal Society of Medicine, 83, 179-182., Aldridge, D. (1990). Making and taking health care decisions. Journal of the Royal Society of Medicine, 83, 720-723.). Gerhard Tucek’s paper Traditional oriental music therapy – a regulatory and relational approach continues his thoughts and clinical elaborations of the transference process from a hermetic traditional healing system into a modern open interactive music therapy approach based on the melodies, scales and songs of the traditional oriental music therapy (see Aldridge 2006). In his last article for Music Therapy Today he has shared his observation and thoughts of this transformation process and has discussed results of an EEG exploration. Now he is back with an article which further explores the possibilities of measuring regulatory and relational aspects of the therapeutic process with heart rate variability measurements and measurements possible with a SMART watch (i.e. pulse
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frequency, EMG, skin potential, resistance, etc.). This simple non-invasive apparatus suitable to the demands of music therapy practice have already been successfully explored for music therapy in dementia care shows how we can use compact and mobile Hi-Tec without disturbing the process of our therapy work while recording quantitative data for physiological analysis. „A large number of measured data collected so far confirm the trend found in the examples presented here. We have now started to study long-term therapy effects of traditional oriental music therapy by research into patients’ quality of sleep”. Another sort of healing ritual is most likely associated with loose leisure activity, subcultural hedonism and forbidden drug abuse: the Rave Party! The article Rave, Communitas, and Embodied Idealism by Bryan Rill discusses experiences made in the Rave community “where youth gather to express themselves and enjoy freedom from social structure. This community is tied together by one dominant theme—the Unity and Acceptance of Diversity (UAD).” Rill explores concepts by Turner and Csordas, Merleau-Ponty’s phenomenology of perception and liminal states of consciousness to describe the layers, empowerment and transformation of personal meaning, experience and embodiment in such party events. “Music, complimented by the symbolic content of visual medium, is the rhetoric of the context, and such non-verbalized communication is made equally powerful to spoken sacra by the unique ability of music to both facilitate cognitive flexibility and act as a vehicle for the ideology of this subculture“. Ravers feel that they experienced a physical, emotional or spiritual release or healing as a cyberethnography from Hutson (2000) in the Journal Anthropological Quarterly Vol. 73 has documented. „Rave-parties are grounds for new forms of spiritual healing“. Rill contextualises this observations and impressions with the symbolic Editorial Music Therapy Today Vol. 7. Issue 3 (online 1st October 2006)
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analysis and theoretical framework of cultural anthropology to “recast our understanding of rave as a social movement necessary in the functioning of social systems.” Simon Gilbertson’s article takes us back to the practice of researching Music therapy in early neurorehabilitation with people who have experienced traumatic brain injury. “In the main body of this qualitative study, using therapeutic narrative analysis and musicological analysis, we can follow an emerging analysis of a collection of significant events as interpreted by the therapist. These episodes are joined or distinguished through constructs eliciting the nature of the phenomena. Correlations between the constructs have led to the identification of categories, terms hinting towards the essence of the processes of change in music therapy in neurorehabilitation.” As we are music therapists it is of use to have a clear concept how to look at the objective changes in the music which are taking place in the therapeutic process to document our work and progress with the our main therapeutic medium the music itself. This study, which is a condensed part of Gilbertson’s doctoral thesis, is an excellent example, how we can ground our work on data that evolves out of the practice of doing music therapy and how to reflect our practical work as practitioners. With this issue we start another section of “Music Therapy Today”: Portraits of people in the music therapy world. One portrait features Nobuko Saji. Nobuko holds the WFMT chair of the commission on Clinical Practice. Here she shares her work and visions, ideas and interests in the World Federation for Music Therapy.
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Another portrait is Bhaskar Khandekar, a music therapist in India. In his View on Indian music and music therapy he offers us a short essay reflecting on music therapy practice, which does not claim to be comprehensive. His thoughts on Indian music and therapy continues a train of thoughts already opened up by other Indian music therapist like Sumathy Sundar or T.V. Sairam in contributions to this or other journals. As Indian music has attracted musicians and listeners, with established traditional music healing systems, we are observing with interest how musicians and practitioners use that long and rich tradition of their own music for therapeutic aims in contemporary contexts. Petra Kern presents an interview with the percussionist Greg Ellis who has recorded and played with Mickey Hart, Jeff Beck, Billy Idol and other famous musicians of our time. He has his own ideas on music as a medium for healing. „Gradually understanding the healing aspect of rhythm and the drums, Greg’s primary focus of playing shifted from performing and entertaining to supporting wellbeing. Greg’s intention behind the recorded cycle of music is to revitalize the natural flow of the intuitive mind, to balance spiritual and physical aspects of one’s being, and to facilitate being in the moment“. Grab your headphones and while downloading the mp3 files start listening what he has to tell us about his experiences with music. Tom Doch’s New section Odds and ends, themes and trends reminds us of the rich internet world of information relating to music, music medicine and music therapy. Tom is doing this news section as an idealist and music lover and promotes the scientific work of people that might be of interest for our profession. As this news section of Music Therapy Today aims to give a short cut of information, it is only natural that he uses and
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links short summaries that have been sent out from the press departments of the researchers facilities. The aim of this website is to provide links to information as well as to provide content. Anything under odds and ends, themes and trends is such a link to existing work on the net – we cannot claim responsibility for the content of other websites (it may become outdated quickly). Tom can only quote the material that press departments, including University press departments give him, so if the information is incorrect or as an author you feel misrepresented, then please refer yourselves to the relevant press department (even when it is your own!!!!). The main content of Music Therapy Today is in the articles themselves. We hope that you enjoy reading them.
David Aldridge and JĂśrg Fachner
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Music Therapy Today Vol. VII (3) (October) 2006
Shamanism and biomedical approaches in Nepal –Dualism or synthesis? Carolin Häußermann
FIGURE 1. Jhankris at Gosainkunda; Photo: Mani Lama (postcard)
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Prologue by Florian Rubner Ethnomedicine is an interdisciplinary field of activity and comprises a variety of concepts from natural sciences, social sciences and humanities. Ethnomedicine is concerned with definitions and interpretations of health and illness in different cultures and the resulting culture-specific methods of healing and treatment. The main focus in ethnomedicine is first of all on what is unfamiliar. Other, unfamiliar medical systems are not necessarily structured like our biomedical system. Our concept of anatomy is only one among many other concepts of the human body. The concept of illness is nothing but a culture-specific definition of suffering, so that therapy may take unfamiliar forms as well. The Institute of Ethnomedicine – ETHNOMED – offers further simultaneous training to European students with an interest in such an interdisciplinary and intercultural discourse in theory and practice, and whose future professional activities will take place in therapeutical, ethnological or other scientific/academic contexts. Such a solid body of knowledge, experience and (self-)reflection is the best possible basis for therapeutic and counselling skills to unfold. Objectives of further training for students are to build up sound basic knowledge in ethnomedicine and gain insights into international, ethnomedically relevant fields of discussion. Experienced teachers supervise intercultural encounters and discussions with traditional healers and also convey basic knowledge in other areas of ethnomedicine, for example ethnobotanics, ethnopsychology and ethnotherapy. Practical exercises as well as diagnostic methods and healing procedures are monitored by traditional healers. Competent and experienced scientists provide help in interdisciplinary exchange, interpretation and reflection. Interactive, indepth interviews are intended to improve perception of behaviour pertiPrologue by Florian Rubner
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nent to one’s own and other cultures, reveal cultural and personal patterns and thus make participants aware of socio-cultural aspects in dealing with health, illness and healing. For more information on further simultaneous training for students see www.institut-ethnomed.de or e-mail: studenten(at)institut-ethnomed.de. This paper on „shamanism and biomedical approaches – dualism or synthesis“ was submitted to the Institute of Ethnomedicine – ETHNOMED – as final thesis to conclude the further training programme for students in „ethnomedicine“. Carolin Häußermann explores medical pluralism in Nepal at the Tribhuvan University Teaching Hospital (TUTH) in Kathmandu and the Shamanic Studies and Research Centre in Naikap. She points out the origins of this dualism between both systems and possible ways to overcome this historical separation – through dialogue in mutual respect and active studies of interventions as practised by the other side. Florian Rubner, ethnologist, M.A.
Introduction RESEARCH QUESTION
Shamanism and biomedical approaches in Nepal – dualism or synthesis? I completed the surgery tertial of my practical year as part of my (bio)medical training at the Teaching Hospital of Tribhuvan University, Kathmandu – a unique opportunity to collect a wide range of impressions from health care in Nepal. Stimulated by the student course at the Institute of Ethnomedicine in Munich and contacts with Mohan Rai, director of the Shamanistic Studies and Research Centre, Naikap, I developed the idea of a field research
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project on the co-existence of the biomedical system based on western medical training and traditional shamanistic healing traditions in Nepal. CONCEPT
First I intended to get a more profound understanding of the philosophical principles of shamanistic healing in Nepal and spent a three- week introduction period at the Shamanistic Studies and Research Centre in Naikap. In addition, I had many opportunities to accompany traditional Nepalese healers in their ceremonies throughout my time in Nepal. My main concern was to explore what Western medicine in its definition of illness and health does not consider, or only insufficiently: health and illness in the context of family and village community, and ultimately of cosmology as well. Working at the Teaching Hospital of Tribhuvan University Kathmandu, I also discovered other perspectives: what was the attitude of Nepalese physicians with Western medical training towards the phenomenon of „shamanistic healing“? What decided which system suited which patient? What was the basis for a patient or client’s decision, and which was the role of financial and ideological criteria, or caste? My main focus was on a possible synthesis of traditional procedures and modern Western medicine, on areas where both approaches compete, and where they may complement each other in a way that would make sense for Nepal. I planned to interview physicians and other biomedical health care practitioners on the subject of „shamanistic healing in Nepal“ and to talk with traditional healers about their views on Western medicine, always keeping in mind the limitations of one’s own system and the other, the differences between both approaches, and any similarities as well.
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This research concept is based on the classical ethnomedical triangle described by Kleinman (1981) who differentiates between disease, illness and sickness. This is a tool to approach the disease/health concept of experts (biomedics, traditional healers) and patients as well as their social context. Kleinman’s (1981:104ff) term of EMs (explanatory models) plays an important role in exploring the many healing systems used in Nepal and in clarifying the reasons why patients claim certain types of healing. The various EMs comprise one or all of the following five aspects: etiology, emergence of symptoms, pathophysiology, progress of illness and treatment (Kleinman 1978:87f). Disease is described as a malfunction or maladaption in the biological or psychological sense (for example, an organic change in the patient), i.e. an explanatory model for illness based on complex mechanisms of development. Disease thus comprises the viewpoint of an expert in the field of health and illness (Kleinman 1978:88). In 1978, Kleinman still mentions disease as a viewpoint connected with the EM of „professional practitioners (modern and indigenous)“ (1978:88). In the secondary literature (e.g. Pfleiderer 1985; Kristvik 1999), however, this equivalent mention of professional indigenous healers (e.g. illness models of Ayurveda or Traditional Chinese Medicine) is often left out, thus reducing disease to the perspective of biomedicine and therefore the scientifically based component. This might give the impression that the so-called biomedicine is an objective categorization of illness symptoms; but it must be pointed out in this context that even biomedicine is not free of its own cultural conditioning, and we should keep this thought in mind. „Conversely, biomedicine does not contain culture-free clinical realities and EMs.“ (Kleinman, 1978:91)
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Illness, on the other hand, according to Kleinman expresses the experience of a patient with deviations from a state he himself defines as healthy, and the significance he, his family and his environment give to these deviations, as well as their own personal EM on their generation (ibid 1978:88). „Illness is the shaping of disease into behaviour and experience“, as Kleinman (1981:72) comments on his definition. In addition, illness is sometimes used by therapists concerned with psychosomatic problems. Also healers who work with cosmological causes of illness and being ill, seem to use socialogical and psychicological explanatory models in the sense of the EM illness quite convincingly (ibid 1978:88). Sickness is the term comprising these both components, the entire coin with the two sides called disease and illness, so to speak. Sickness includes technical as well as personal, socialized explanatory models for illness or being ill, in the sense of absence of health. The differentiation between disease and illness demands different approaches. Kleinman says in his concept that disease may be handled by curing, that is a removal of physical symptoms, whereas illness may be handled by healing, i.e. a holistic approach. Kleinman (1981:38) also uses the term clinical reality, which describes the views, attitudes and standards of a social group with regard to illness and healing. This definition does not differentiate between a group with biomedical or traditional shamnistic views. „Health care outcomes (compliance, satisfaction, etc.) are directly related to the degree of cognitive disparity between patient and practitioner EMs and to the effectiveness of clinical communication.“ (Kleinman 1981:114) Only when healer and patient are aware of their different explanatory models, when they try to see the impairment of health at the same level of
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meaning and at least to approximate their explanatory models, can they achieve an increasingly positive, healing effect, but with one qualification: obviously, explanatory models of individual patients cannot be considered as static – they change with time and experience. A patient may also have several EMs at the same time (Kristvik 1999:40). In my opinion the art therefore lies in looking for approximations of changing explanatory models in the healer-patient interview. „Constructing illness from disease is a central function of health care systems (a coping function) and the first stage of healing“ is how Kleinman (1981:72) formulates the objective of a healer’s activities. IMPLEMENTATION
The Kathmandu valley was repeatedly chosen for ethnomedical studies on the medical pluralism existing here. For me, too, this was the place to accompany shamans and biomedical physicians in their work.
METHODS
The methods used in this field research were accompanying observation, experience analysis, interviews and chance talks. Later, after my return, I added literature research and evaluation.
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FIGURE 2. Entrance to Universtiy Hospital
Biomedicine at the Tribhuvan University Teching Hospital, Kathmandu. The Institute of Medicine at Tribhuvan University Kathmandu, founded in 1972, today trains medical staff of various professional fields. „To prepare medical graduates who will have the skill, knowledge and attitude to work in the environment that exists there“, this is how Gartoulla (1998:36) describes the objectives of student training in medicine in the undergraduate programme at Tribhuvan University. Practical and theoretical teaching units in medical sociology, medical anthropology and psychology were introduced in the curriculum. This is where I spent four months in surgery as part of my practical year and where I learned more about projects and research approaches in medical anthropology in Nepal from teachers, physicians and students.
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Download Video (Surround view from the rooftop of the Shamanistic Studies and Research Centre, Naikap) H_video1. mp4 (Quicktime 9,5 MB) H_video1. wmv (9,6 MB) Shamanism: the Shamanistic Studies and Research Centre, Naikap. In 1988 Mohan Rai established the Shamanistic Studies and Research Centre, Naikap, to preserve the knowledge of Nepali shamans and also to acquaint interested foreigners from Europe, U.S., Canada and Australia with shamnistic philosophy and the healing techniques involved (see brochure M. Rai): „Shamans who teach at Shamanistic Studies and Research Centre als carefully selected from Himalayan mountain tribes including Tamang, Rai, Sherpa, Gurung and others, both for their reputations as powerful healers and for their ability to transmit their knowledge to foreign students.“ I spent my first three weeks in Nepal at the Shamanistic Studies and Research Centre, Naikap, to gain insights into the cosmology of Nepali shamans and to learn about their models of illness, their methods of diagnosis and therapy in theory and practice. I attended numerous ceremonies, mainly in the evenings. My closest contacts were with two female shamans, one of the group of Kiranti-Rai1, the other of the Tamang, so that my experience with shaman healing is mainly from the repertoire of the shamans of these ethnic groups, even if some basic procedures in diagnosis and therapy are common to most Nepali shamans.
1. I use this expression „kiranti“ also used by Gartoulla, which is to be found in English-language literature. Another version is „Kirati“, see e.g. Müller-Ebeling 2000. The Rai are part of the tibeto-nepali group.
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Nepal – Research at the foot of the Himalayas GENERAL REGIONAL STUDIES
FIGURE 3. Annapurna- Himalaya
Nepal measures 800 km from northwest to southeast with an average width of only 200 km (Donner 1990:10) and is located between the huge states of China in the north and India in the south. Currently it is subdivided into five development regions, 14 zones and 75 districts (Gartoulla 1998:3). The country comprises highly different zones of vegetation with an unbelievable variety of fauna and flora, starting with the subtropical southern Terai region, branching out from the Ganges plain, to the hills (between 610 m and 4877 m above sea-level) and up to the snow-covered Himalaya peaks in the north (mountain area between 4877 m and 8839 m above sea-level) (ibid:8). Its inhabitants are just as varied: about 75 different ethnic groups speak ca. 50 different languages (ibid:5). Only 58 % Nepal – Research at the foot of the Himalayas
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of the entire population have a command of Nepali as the lingua franca (ibid:5). The caste system in Nepal with a majority of Hindus (90 %) still dominates many areas of daily life. Other significant influences are Buddhism (5 %) (ibid:6) and far older traditions, in part animistic, depending on the respective ethnic group. SOCIAL AND HEALTH CARE SITUATION
According to the WHO Nepal is among the poorest and least developed nations of the world. The economic basis is agriculture, mainly in the form of subsistence economy, comprising over 90 % of the working population (Donner 1990:100). Industrial development is still in its early stages. Tourism was the most important source of foreign exchange before increasing armed riots in recent years resulted in a considerable fall in the number of tourists and income from foreign exchange. More and more workers migrate to the Gulf states or India and support their families back in Nepal (Benedikter 2003:165; Graner 2005). Per capita income in Nepal is among the lowest of all south asian states. UN statistics indicate US $ 235 as annual per capita income, and 42.5 % of the population in Nepal as living in absolute poverty (Gartoulla 1998:12). Education levels are low with a literacy rate of only 54 %. In 2001, about 80 % of boys finished primary school, but only 40 % of girls (Benedikter 2003:209). A look at the health sector reveals why the WHO counts Nepal amongst the least developed nations world-wide: the Nepal Human Development Report 2004 speaks of per capita expenditure for health of US $ 2.0 per year, stagnating at this level for years.
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Live expectancy at birth is currently 62.2 years1. Mother and infant mortality are high in Nepal (Tiwari 2005). Most frequent diseases are skin diseases, acute respiratory infections and diarrhea, followed by intestinal worm infestations. Diarrhea is a tremendous and widely spread problem among infants in Nepal and is reflected in the high mortality rates of children under five (ibid 2005).2 There is no even distribution of medical facilities due to the geography; distant rural areas (see Figure 4 on page 526) are clearly disadvantaged (Haddix McKay 2002). Only 29 % of the poor have access to a health care facility in less than 30 minutes (WHO 2004). Moreover, health care facilities in rural areas are limited in what they can do: lack of medicaltechnical equipment, drugs and personnel are the main problems for inhabitants of rural areas looking for help in medical facilities (Haddix McKay 2002; WHO 2004). Benedikter (2003:160) points out that in the rural areas in Nepal with about 83 % of the population there is only one physician per 57.000 inhabitants.
1. In Germany average life expectancy is now 81.2 years for girls and 75.4 years for boys (ırzte Zeitung, June 3, 2004) 2. For statistical data on the social and health care situation in Nepal see appendix.
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FIGURE 4. Geographical conditions
For more than 10 years now, the so-called Maoists have been waging guerilla warfare against the Nepali army and the king as the representative of monarchy; as a consequence, economic, social and health-related systems have seen a dramatic deterioration: experts believe that about 50 % of all health care facilities in the country have either not enough medical personnel or none at all (WHO 2004). The health workers on site are increasingly threatened or intimidated by Maoists and government troups alike. Bans on driving and road blocks delay or impede delivery of medical supplies and equipment (Benedikter 2003:240). In addition to its traditional problems the country has to cope with a growing number of internal refugees, uncontrolled growth of the capital Kathmandu (ibid:165), organized crime (Dacoits) – mainly in the border Nepal – Research at the foot of the Himalayas
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area with India (CIJ 2004)-, increasing drug problems and domestic violence (Benedikter 2003:200), states of emergency, general strikes, massive violations of human rights, e.g. disappearances, kidnapping, forced recruting of child soldiers, torture and killing between both sides involved in the civil war (Benedikter 2003:239). Last March (2006), the political situation in Nepal took another turn for the worse when the maoists ended their unilateral truce after the king had announced elections for February without consulting the political parties. The major parties boycotted the elections and organized protests in Kathmandu that soon expanded nation-wide, bringing more and more people out into the streets despite curfews who expressed their dissatisfaction with the intolerable situation. After mass demonstrations leaving many dead or injured, and adverse reactions from police and armed forces, the king finally had to submit to pressure and returned the executive powers to the parties. The situation seems clearly improved now, although by no means stable, but some important progress has been achieved: the king's powers are much curtailed, maoists form part fo the government, and constitutional elections have been scheduled for next year. CONCEPT OF ILLNESS IN NEPAL
‚Medical belief systems are sets of premises and ideas which enable people to organize their perceptions and experinces of medical events and to organize their interventions for affecting and controlling these events. In a nutshell, they are ways of defining problems and generating solutions to these problems.’ (Young 1983:1205) There is not one single concept of illness in Nepal. Explanatory models of different individuals and groups on the generation of illness are influenced by a variety of factors like income, caste, age, religion, but mostly by social class, level of education, by life in the city, especially the
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metropolis Kathmandu with its strong western influences, or by life in the country and in remote regions. Advice by family and friends as well as personal experience with illness also play an important role. I found that a biomedical concept of illness, based e.g. on the theory of germs, was spread among the staff of the teaching hospital, but also among a majority of my neighbors in the Baluwatar sector of Kathmandu. Gartoulla (1998), Kristvik (1999) and Subedi (2001) sum up the various traditional explanations for illness in different systems which, however, correspond to each other in principle. In my description of traditional explanatory models for illness I shall follow the system by Subedi who differentiates between individual causes, natural world, social world and supernatural world (Subedi 2001:35). In the time I spent in Nepal I found the following causes for illness within traditional explanatory models: Individual causes. Individual causes cover illnesses which der patient has mainly caused himself. They are seen as the consequence of wrong eating habits or changes in diet, or wrong behavior that impairs health (Subedi 2001:35). „Illness is increasingly blamed on ‚not taking care’ of one’s diet, clothing, hygiene, sexual behavior and physical exercise. Illness is therefore an evidence of such carelessness, and the sufferer feels guilty for causing it. For the prevention and cure of these health problems the victims change their food habits and other behaviors.“ (ibid:35) In my experience this explanatory model for illness also plays an important role with patients at the university hospital. At the out-patient depart-
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ment patients and their relatives very often asked whether wrong or recently changed diet had caused a patient’s illness. Natural world. Unfavorable constellation of planets (Graha bigrayo) This concept ist strongly influenced by hinduism and sees the constellation of planets at an individual’s birth or in certain times of his life as a cause of illness or misfortune in general, e.g. family conflicts or financial problems. From this perspective planets affect the big and small things in man’s life and determine success or failure. Many Nepalis consult astrologers to determine lucky dates for weddings or other important life events. Illness due to planet influences, so-called khadko, must be repaired by shamans, e.g. through the khadco kattne ritual, a cutting of the threads of destiny. This ritual is performed for individuals who have experienced a period of extreme misfortune, loss of property, loss of beloved ones, depression or serious illness. Download ritual video H_video2.mp4 (Quicktime 3,6 MB) H_video2.wmv (Mediaplayer 3,2 MB) Imbalance of hot and cold The concept of hot and cold known to many Europeans from the principles of Traditional Chinese Medicine (TCM) sorts food, but also physical symptoms of illness, times of the day and seasons, climatic influences and human character traits and constitution into the two opposites of hot and cold. The idea is that a balance of hot and cold must be maintained, or recovered in the case of illness, in order to achieve health.
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Therapeutic principles are to cool conditions of too much heat, and to treat illnesses caused by too much cold with warmth, for example with types of food considered hot, whereby the system of hot and cold does not necessarily refer to the temperature of the food. On the other hand Nepalis also know states with too much heat that are cured with hot food. Stone (1976) listed as hot (in Nepalese: gharmi) food meat, eggs, milk and tea. Cold (in Nepalese: chiso) are yoghurt, cucumber or bananas1. The belief is that additional warmth will finally achieve a maximum of warmth in the body as a precondition for a slow reduction of excessive warmth until a balanced state is achieved that means physical well-being. A case in point is that of a Nepali acquaintance of mine. He was in bed with chickenpox, shaking with chills and covered with pustules, and his aunt who fed the family ‚treated’ him with a diet of rice and hot milk. Social world. Bokshi Bokshi or witch is the name given to a woman (less frequently a man) from the patient’s social world who practises magic against harm. The most frequent reasons quoted for harm befalling individuals are envy or some grudge, or the rage of the Boskis and a previous argument. The witches receive their skills from older witches who train them. Childless elderly women are often assumed to practise witchcraft, so that women of this type generally are suspicious.
1. The system to categorize food as either hot or cold – Subedi adds neutral as another category – is by no means consistent, according to studies by Stone (1976), Blustain (1976) and Subedi (2003), in comparison of regions in Nepal and also within ethnic groups (Subedi 2001). But the idea of a hot – cold imbalance as cause of illness is widely held in Nepal.
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Gartoulla (1998) describes how Bokshis may harm people: they produce a small figure representing the victim and pronounce magic spells, or they actively mix bewitched substances into a victim’s food. They keep such substances – human hair, finger and toe nails, animal claws or bone fragments - in small bundles. Bokshis are believed to harm or cause illness through the evil eye. A Bokshi is also believed to be able to induce certain gods (e.g. Devis) or other supernatural powers (Masaans, Bhutas) to harm a victim or to send dangerous animals like snakes or tigers to kill him or her. They say witches can shoot bewitched spiritual arrows that cause illness, or witches come to their victims at night and drink their blood, so that they get weaker and weaker (Gartoulla 1998:131).1 Shamans in Naikap claimed to be able to determine the identity of a witch who had harmed a patient. However they would never mention names. This is also the experience of Peters (1979) and Sidky (2000). Evil Eye The Evil Eye, also known from other cultures like Turkey2, is a common concept according to which illness may be caused by a person’s look. Envy is a frequent reason, and in Nepal the Evil Eye is closely related to the Bokshis’ magic. However, the Evil Eye is rather seen as an unwise
1. The knowledge held by Bokshis and shamans is almost identical; what is different is the way they use it: witches use it as kubidhya or bad knowledge, shamans as subidhya (good knowledge) (Subedi 2001). Mohan Rai told me god Shiva had given one mantra more to shamans than to witches. Thus shamans defeated Bokshis in a fight because Bokshis were unable to take a bite from the Amaliso leaf (lat. Thysanolaena maxima). The leafs of this plant still show the bite of the witches and are seen as symbols of shaman superiority. 2. Another name for the Evil Eye in Turkey is „Nazar“ which may be averted with an eye made of blue glass (Nazar Boncugu) or blue glass perls.
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and unintentional envious reaction and not, as with witches, a deliberate deed in order to make someone ill. Many Nepalis believe that children are highly vulnerable to the Evil Eye, and they paint babies’ and infants’ eyes with kayal to protect them. Supernatural causes. Acute and/or serious health problems in particular are seen as indications of supernatural causes. If diseases take sudden turns for the worse or lead to loss of mental abilities, people also assume supernatural causes, an angry god or a neglected ancestor spirit. Attacks by gods Gods in general, e.g. Jungali, Nagas, Devis Jungali, the goddess of the forest, has a decisive role in the Kiranti-Rai
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concept of illness. She is the mistress of nature, and wrong behavior or lack of respect of nature may cause Jungali to attack. Mohan Rai in Naikap desribed how victims will suffer strong and sudden headaches, get mad or get many further health problems. A cure requires sacrifices to Jungali – monitored by the shaman who speaks a Jungali mantra but performed by the patient himself, his physical condition permitting. This ceremony always takes place in the open. Nagas are snake gods and live in all forms of water. Water contamination makes them angry. Gartoulla (1998) gives an exact description of illnesses that may be caused by Sitalamai, goddess of the pox, and of what must be done to cure such patients.
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Stone (1976) underlines that Devis (goddesses) may also cause illness, e.g. Akash Devi whose shadow may fall upon children and thus harm them. Kuladeva Kuladevas are ancestor spirits and highly significant elements of the
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health concept of the ethnic group of Kiranti-Rai. If these spirits are not sufficiently respected, if rituals for deceased family members are not performed or not with care, an angry Kuladeva may make a family member ill in order to point out any neglect of ancestors. In contrast to evil spirits, the gods and ancestor spirits may cause illness out of anger about neglect, i.e. a failure on the part fo the victim or a relative; but in contrast to Bhutas they do not attack without provocation, nor are they summoned by witches. Attacks by evil spirits All evil spirits have in common that they attack innocent victims or may be summoned by Bokshis to harm someone. These attacks against innocent persons are due to the fact that the evil spirits are hungry and try to still their hunger.They are believed to slowly suck life out their victims. Therefore the harmed individual is a victim of evil spirits and not guilty of his illness, as he would be e.g. in case of taboo violation or neglect of ancestor spirits. The Nepali know many different kinds of evil spirits. The following descriptions of evil spirits come from shamans in Naikap: Bhuta Bhutas1 are divided into subcategories of which I know 26. They are all
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spirits of deceased persons who died an early or unnatural death, through accidents, suicide or at giving birth. At certain times of a day2 the danger
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of Bhuta attacks is higher, and Bhutas always attack the weakest member of a social group, those who had an unfavorable planet constellation at birth or are already weakened by illness. Pret Pret is the invisible spirit of a dead person (Gartoulla 1998:129). Mohan
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Rai sees the Pret as a ghost „who acts evil, restless and who makes others unhappy and unrest. As a matter of fact pret is another word for bhuta“. Masaan Masaans also have several subtypes and stand between men and gods in
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the shaman cosmology. In their lifetime they were respected individuals, e.g. powerful shamans or lamas who died an unnatural death. Powerful as they were in life, they have much influence after death as well. They can do much harm to humans, but some shamans evoke them as helpers in their spiritual journeys and in healing rituals. Masaans1 are believed to prefer to dwell near Ghats or on cemetaries where they are visited by powerful shamans (Müller-Ebeling 2000). Bayu The Bayu is a spirit of wind and air, and capable of triggering big catas-
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trophies like tsunamis if not treated with sufficient respect as I was told in Naikap. Stone (1983:976) describes the Bayu as the spirit of a person after unnatural death who attacks his own relatives and makes them ill. Only after
1. I opt for the form used by Mohan Rai, i.e. Bhuta in singular and Bhutas in plural. Stone (1976), Peters (1979) and Gartoulla (1998) use Bhut. 2. Much feared are Bhuta attacks at night and at road crossings where evil spirits are assumed to gather. 1. I use the version Masaan and the plural Masaans used by Mohan Rai and also by Peters (1979). Stone (1976) writes Masan. Gartoulla (1998) uses Masana and the plural form of Masanas.
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ritual acceptance of the Bayu into the circle of ancestor spirits will he stop molesting his living relatives and causing illness. Lagu Gartoulla (1998), Peters (1979) and Stone (1976) found in their field
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research that the term „Lagu“ is frequently used as a general term for all evil spirits, i.e. Bhuta, Pret, Masaan etc. Mohan Rai comments as follows: „Lagu is a common word in Nepali. For example, if someone is attacked by evil spirits or devis and devas, but mostly evil spirits.(…) Actually, Lagu means to become certainly and immediately sick. This can be mostly in the morning, by midday and evening. (…) This we call Lagu/Lagan.“ Loss of soul. The soul of an individual may be lost in various ways. In several interviews in Naikap I heard that children may lose their soul easily. For example, waking up with a start may cause loss of the soul, since the soul leaves the body in sleep and may not have enough time to return to the body. But shock situations in daily life or attacks e.g. by stray dogs may cause the soul to be lost. On cemetaries1 or near the Ghats, the places where Hindus burn their dead, the soul may also be lost. Some people even told me it might be harmful to be patted on the right shoulder from behind. Signs for loss of soul may be absent look2 and physical weakness, in children watery diarhhea, glassy eyes, restless sleep and continuous weeping. A ceremony to recover the soul is the required therapy to be performed by an experienced shaman. Here I would like to underline again that the above concepts on generation of illness – including the biomedical explanatory model, which was not described in detail – must not be seen as categorically separate. Most
1. The Rai bury their dead whereas Hindus burn them. 2. A particularly distinct sign, as I was told in Naikap
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Nepalese accept a combination of several explanatory models or change their viewpoint on the cause of an illness with time or, independent of their own illness, through new impressions and experiences. So there is no static or systematic basis for these concepts. Medical pluralism in Nepal on the one hand corresponds to an individual pluralism of explanatory models for illness on the other.
III. Healing systems 1.) BIOMEDICINE
„’Medicine’, to the western mind, is based on the notion that science, with its methodology of research and experimentation, is potentially capable of combatting any sickness and curing any disease“, according to Blustain (1976:83). The national health system in Nepal, which developed gradually only after the borders opened in 1951 and only with substantial foreign support, introduced decentralized integrated services in the form of so-called Rural Health Posts in 1960. 5-year plans on national health addressed a variety of prevention areas and diseases, e.g. programmes to fight malaria, pox, tuberculosis and leprosy, birth control projects and motherinfant care, as well as an extended programme of basic immunization (Dixit 1999; Gartoulla 1998). Starting in the 1970s, there was a gradual shift away from curative towards preventive programmes. After the WHO declaration of Alma Ata, Nepal introduces the principle of Primary Health Care (PHC)1.
1. PHC is characterized by the use of local resources, e.g. involvement of locals, and adaptation of intervention to existing socio-cultural and socio-economic conditions in the target group. PHC is seen as a strategy to develop society, to improve living conditions and thereby health of the population. The basic view is that physicians and paramedics can only address symptoms but cannot eliminate the original causes of illness in developing countries, e.g. poverty (Hackenbruch 1998).
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„What has been accepted even by the authorities is that the health services provided by the government reach no more than 10 – 15 % of the population and that even after a great deal of resources put in and effort expended.“ (Dixit 1999:38) FIGURE 5. Directions to University Hospital facilities
In figures: in 2001, there were 1259 physicians in public hospitals and surgeries in the entire country, that is one physician for 19.695 inhabitants. In 2004 the Ministry of Health registered 5 specialized central hospitals, 1 regional hospital, 1 subregional clinic, 11 zonal clinics and 62 district hospitals (Tiwari 2005) plus several small Health Offices and
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health posts or stations, the latter poorly equipped (Haddix McKay 2002). Although jobs in remote areas are better paid, it is hard to find health care employees who are willing to take these jobs. A combination of higher wages and free further education programmes1 had some success (WHO 2004). For a survey of the structure of the health care system in Nepal see Appendix. Medical personnel. Physicians Nepali physicians in their majority are not interested in jobs in rural areas. According to Benedikter (2003:160) 60 % of all physicians in Nepal work in the capital Kathmandu. Consequently, the rural areas have one physician for approximately 57.000 inhabitants (ibid 2003:160)! A surgeon at the TUTH told me that even the offer of double salary for a position in a rural area – a programme of the Nepalese Ministry of Health in order to make rural areas more attractive to physicians – was not successful, so that the programme was stopped. Physicians repeatedly told me that jobs in rural areas are seen as dead end for a medical career. Poor equipment and insufficient supplies of drugs at the health facilities in rural areas are further reasons for physicians to see such positions as unattractive (Gartoulla 1998:57 and 73ff). From discussions with medical students at the TUTH I learned that the most-sought after jobs for graduates of medical schools in Nepal are in the United States or at least in Europe, and that they are making tremen-
1. e.g. a postgraduate university course that is paid in full.
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dous efforts to get them. Among medical graduates in Nepal the brain drain is huge (Dixit 1999:183). Those physicians who work in Nepal in public clinics try to get jobs at private hospitals in addition which creates much additional income. But this requires to find jobs near larger towns or cities where private and public health care facilities are nearby and such double employment is possible. Nurses Training of nurses started in 1987 and follows a so-called „community orientation“ (Dixit 1999:165) in preparation not only for nursing in city clinics and nursing homes but also for positions in rural areas. In 1999 Dixit wrote that 280 nurses finish their training each year (ibid). The situation improved when several other nursing campuses opened, some of them with private teaching. In 2005 Nepal had 6.216 nurses, and a total of 6.654 hospital beds, taking the public and the private sectors together. These figures clearly indicate a drastic lack of health care personnel compared to a population of 23.151.423 (Tiwari 2005). Health assistants /health workers Most of these health workers receive short training programmes. Their tasks at Health Posts are mainly curative, e.g. prescription of drugs, and some preventive aspects, e.g. vaccinations (Gartoulla 1998:57). Some workers at community level have received specific training as Community Health Leaders in order to recognize certain diseases like diarrhea, leprosy or tuberculosis and to prepare oral rehydration solution, nun chini pani.
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The Village Health Workers are mainly employed for prevention, e.g. building latrines etc. (ibid:20). However, in remote regions of Nepal the role of health workers is often comparable to that of physicians. They have to assume many of their responsibilities since physicians are so rare. Peons „This is usually a local person. His training is not from far away, his skills are acquired on the spot. The peon distributes the medicine prescribed by the person in charge, he gives injections and changes dressings.(…) The peon tends to be the one who gives the system stability and the one who does much of the work and has patient contact. He is the one who stays in place.“ (Kristvik 1999:80ff) Peons quite often are the only staff patients will see at Healths Posts or Sub-Health Posts. Although they are only intended to help out, often they hand drugs out to patients, even without checking with those in charge (Haddix McKay 2002). Diagnosis procedures. Biomedicine uses anamnestic, clinical, laboratory-chemical and apparative procedures for diagnosis. Anamnesis is a patient interview on his current health problems, covering pain symptoms, previous illness, allergies or incompatibilities and drug intake. First the patient answers questions on vegetative factors like sleep, appetite, thirst, weight, stool and urination or consumption of drugs (also alcohol and tabacco). A comprehensive anamnesis also addresses aspects of a patient’s social background, i.e. job, marital status, leisure activities, illness and causes of death among near relations, in order to discover heredited problems. Women are asked about menstrual cycle, births and postmenopausal problems where applicable. Clinical aspects comprise physical examination. Body parts where the patient indicates complaints are
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examined in more detail. Medical-therapeutical devices are stethoscope, reflex hammer, light, spatula etc. Laboratory-chemical diagnostics are performed where applicable through analysis of a patient’s blood, urine, stool or sputum samples.1 Apparative examinations comprise non-invasive and invasive interventions. Non-invasive diagnostic interventions are ultra-sound, X-ray, CT and MRT. Endoscopies, punctures or biopsies are invasive. Therapy. Biomedical therapies are divided into causal and symptomatic, but also curative and palliative interventions. Causal therapy covers the elimination of the cause of an illness, e.g. surgical appendix removal in appendicitis. Symptomatic therapies remove only the complaints and effects of an illness as indicated by the patient but not the original cause, e.g. pain killers for toothache. Curative therapy is defined as a complete and frequently surgical removal of the cause of an illness and the return of the patient to a state of health. Palliative therapy is mainly mentioned in the context of oncology with tumor patients with unfavorable prognosis and covers maximum symptom control with the intention to improve patients’ quality of life. In addition, biomedicine differentiates between drug therapies, interventional and surgical therapies. Treatment costs. Costs for treatment in biomedicine vary considerably: they depend on chosen diagnostic and therapeutic procedures, but also on the respective health care system and the underlying health philosophy and in addition on the status of the clinic in question (public, NGO or private).
1. Blood analysis indicates changes in electrolyte metabolism, immune defense, specifics on liver, kidney and pankreas function. Urine may contain microorganisms that indicate kidney damage or diabetes mellitus. Stool may contain bacteria or parasites and indicate digestion anomalies.
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Nepal does not know obligatory health insurance so that patients and their families have to pay for each single (bio)medical service immediately.1 Relatives of a patient even have to buy suture material for wounds, cannula, syringes and sodium chloride solution from a drug store affiliated to the hospital, after the physician has made a list of the required materials and drugs. Even before a patient meets the physician he has to pay for the consultation at the hospital „counter“. Emergencies receive medical treatment while another person accompanying the patient has to handle payments. The Western Regional Hospital (WRH) in Pokhara has a price list for surgical operations as I learned during my stay there in 2003; they differentiate between major (large or long operations), minor (smaller) and foreigners, and these three main groups are subdivided further. Most public hospitals and many of those managed by foreign NGOs have a social fund to cover treatment costs for poor patients in part or entirely. However, this often requires complex petitions in order to substantiate such claims. 2..) SHAMANISM
Maile the shaman sat down in front of the altar while an assistant walked around collecting all necessary utensils. Incense was burning in a bowl of hot coals. The shaman blessed the altar with some rice, her assistant sprinkled rice on the heads of those present. Maile started to drum herself into trance after she pulled her malas – rudraksha, ritha and bell mala – across her shoulders. We sat there for a long time and listened to the drums, Maile’s singing and the words the assistant called out to her. One of those present also went into a trance and also started to shake. At 1. A CT image of the skull e.g. at the Teaching Hospital of Tribhuvan University costs ca. 2000 Nepali rupees (ca. 25 Euro) as per Nov. 2005; compare the annual per capita income of US $ 235; table see appendix).
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one time Maile’s assistant gestured to me to sit down beside the shaman. The questioning of my ancestors was to begin. I received a phurba in my hands and closed my eyes. The helper whispered I should try and sit relaxed although this was not easy in view of my excitement. I tried to imagine my ancestors and started to visualize Jungali and Bhairab. Maile danced around me with her drum, I closed my eyes and soon had a feeling of sitting inside the drum myself. Everything was vibrating, and I started getting goose- pimples. Tremendous warmth rose inside me. Then all of a sudden something humid was sprinkled over me, and the feeling on my skin alternated between hot and cold. Images of respect and trust appeared before my inner eye repeatedly. This was what I wanted to show to the people who had accepted me here. Maile gradually slowed down her drumming and finally stopped. I opened my eyes, got up, threw three hands full of rice towards the altar and again took a seat along the outer wall. The helper gave some chang (rice beer) to all present and told us to sip once and to spread the rest on our heads. Then Maile’s helper translated what the shaman had heard in her trance.
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FIGURE 6. Traditional healer Parvati performing a healing ritual
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„A shaman is a person who at his will can enter into a non-ordinary psychic state (in which he either has his soul undertake a journey to the spirit world or he becomes possessed by a spirit) in order to make contact with the spirit world on behalf of members of his community“, as Reinhard (1976:16) wrote in the introduction to „Spirit Possession in the Nepal Himalaya“, an anthology on the phenomenon of Nepali shamanism. A large variety of subcategories of shamans has been described to exist in Nepal. These are e.g.: Dhami, Jhankri 1976), Yeba, Yema, Samba, Mangba
2
1
(Gartoulla 1998; Hitchcock
(Jones 1976:31ff), Ojha, Fedan-
gwa 3, Bijuwa, Baidang, Jharphukey (Gartoulla 1998:19ff) and Phombo (Sidky 2000:47). In the following I shall mainly refer to Dhami and Jhankri and not go into detail on the other types of shamans in Nepal to avoid confusion. Dhami and Jhankri are the terms I have used for the shamans I accompanied. Dhami or Jhankri. These two terms are not used consistently in literature: Stone (1976) translates Dhami as medium or psychic person while she uses the term Jhankri for shamans of the Tamang or rather unspecifically as a synonym for shamans. Personally she mostly speaks of Janne Manche (people who know), but she underlines that they do not undertake spiritual journeys but are possessed by gods and spirits. Gartoulla (1998:123) describes the Dhamis as shamans from the Brahman caste, Jasi and Chhetri. They evoked their 1. Hitchcock (1976) writes Jhakri instead of Jhankri 2. Mohan Rai writes Mangpa 3. Jones (1976) writes Phedangma instead of Fedangwa
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ancestor spirits (Kuladevas). Jhankris, in contrast, who do not belong to that caste, cooperated with the Masaans or with Shikari, a god described as a hunter. Unlike the Dhamis, they preferred wide white robes for their ceremonies (ibid:19ff). Kristvik (1999) finds in her field research in east Nepal that people in Bhojpur use Dhami as a synonym for Jhankri. Mohan Rai told me: „Dhami Jhankri is general Nepali.“ The Jhankris I met use Jharphuk and trance and contact supernatural powers for diagnosis and healing.1 There is no deliberate decision to become a shaman in most cases. The shamans I asked told me that they had become shamans in different ways: one shaman describes an introduction through Ban-Jhankri, the original shaman, who he said introduced him to all secrets of the shaman cosmos when he was a child. After this shaman died, a ritual revealed that his youngest son who until then had shown no interest in shamanism would continue his father’s healing tradition – even the shamans selected for his training were named in the ceremony. The son was chosen by his father’s spirit in the ritual, which became visible in the son’s shivering and the fact that his father’s ritual objects were used for himself. Another shaman has followed in the family tradition and is part of a long succession of shamans in his clan. All shamans interviewed spoke of initiation experiences that directed them towards shamnistic healing - as adolescents in most cases.
1. A discussion of possession and spiritual journey as part of the shamanism definition and the pertinent problems of differentiation in Nepal in particular would go beyond the scope of this paper. See Johan Reinhard „Shamanism and Spirit Possession: the Definition Problem“ (1976:12ff).
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The work of a Nepali shaman is not a regular job or source of main income. Most shamans are farmers or have other jobs and assume the healing function whenever required by patients or their relatives. Shamans appear to see it as their duty to help those who contact them with a wide range of complaints. They endure all-night healing rituals, accept interruptions of their own work and even personal health risks. Being a shaman means not only to „do one’s job“ but a serious vocation where the knowledge of one’s teachers has to be applied with respect. This is the impression I gathered during my stay with the shamans in Naikap. Other terms for the shamans in Nepal have to be defined: Ojha Ojha is a Jhankri who is an expert for particularly severe or chronic ill-
•
ness. A Jhankri contacted by such a patient asks the Ojha for help if he has failed to heal the patient (Gartoulla 1998:21). Fedangwa, Bijuwa Fedangwa is the name given to their shaman by the ethnic group of
•
Limbu, according to Mohan Rai (see Gartoulla 1998:21). Bijuwa is the Rai name (ibid:21). Mohan Rai added that apart from Bijuwa, the Kiranti-Rai also use the names Noksung and Mangpa. These Fedangwas sometimes use brass bowls instead of drums to reach trance. For their rituals they wear long white robes and malas (chains) across the chest (Gartoulla 1998:21). Baidang or Jharphukey He does not enter the trance state and uses only Jharpuk as a method of
•
diagnosis (Gartoulla 1998:21; Blustain 1976). Mohan Rai told me that the Baidang uses neither drums nor the Phurba (ceremonial or spiritual dagger).
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Diagnostic procedure. „The shaman uses trance and non-trance divination techniques to learn the nature of a patient’s illness and its cause, the whereabouts of lost objects, the identity of a their or source of jealous thoughts“, according to Mohan Rai’s short description of the Nepali shamans’ diagnostic methods in a brochure. The shamans I was allowed to accompany in Nepal employ pulse diagnosis (nadi herne), rice diagnosis (ankat herne), ginger diagnosis, water diagnosis or mala diagnosis. An even or uneven number of pearls being counted in a randomly chosen section of the mala provides the answer to the question asked before on the patient’s illness, i.e. either „yes“ or „no“. The same applies to ginger and rice diagnosis which are also employed like an oracle, or Jokhana. In addition, the shamans in Naikap use bamboo staffs as spiritual binoculars, but also drums and trance journeys to the three worlds of the shamanistic cosmos in order to ask various helpers for indications of the cause of illness and possible therapy.1
1. The distribution of the rice grains or ginger cubes thrown in a Jokhana (oracle) – if e.g. an even number of ginger cubes shows the side of the cut on top - indicates the type of illness and its prognosis. The shaman thus also decides on the most effective cure for a patient.
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FIGURE 7. searching the cause of the patient’s illness
Therapy. A shaman’s healing procedure may last a few minutes only in some cases or comprise extended and costly all-night rituals that may have to be repeated or continued over several days. Jharpuk is the general term for all short healing procedures that are performed with spoken mantras and removal of negative influences immediately after the symptoms occur1.
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Medicinal herbs or certain diets are often prescribed and regularly sought for by patients and families. Amulets are produced by the shaman himself and contain either a powerful object (animal claw, medicinal herb etc.) or a protective mantra written on paper. Accordingly, the amulets carried around the neck protect the bearer from negative influences. An example of a prolonged ritual is the khadco kattne, the cutting of the lines of fate, to be performed in case of negative planet influence and sometimes accompanied by animal sacrifice.1 Download ritual video H_video3 (Quicktime 7,5 MB) H_video3 (Mediaplayer 7,8 MB) Supernatural causes of illness mostly demand appeasement, which the patient may achieve himself in the form of regular pujas for Kuladevas or other deities, if these are angry because of a lack of attention. The shaman on the other hand has to incur the good will of the evil spirits with rituals involving food.2 Eigner sums up her experience with shamanistic healing in Nepal as follows: „The superficial structure of shamanistic healing methods is varied. But deeper down they basically consists of the same elements: connection of therapeutic procedures with cosmic forces, reduction of the damaging burden for the patient, a redefinition of the suffering experienced through a specific symbolic system and 1. e.g. through the Phurba (ceremonial dagger), a ritual broom or a Khukuri (Nepalese knife) that are guided along a patient’s body downwards in order to remove negative energies (see also Okada 1976). 1. In Naikap, shamans do not sacrifice goats but use animal figures made of fruit, e.g. an animal made of cucumber with wooden sticks as legs. 2. The food offered ritually on a plate made of sal leaves is an invitation to the evil spirit to release the patient and accept the ritual food or a sacrificed animal instead.
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a manipulation of symbols through which a transition is made from the state of illness to that of health.“ (Eigner 1998:69) Treatment costs. The costs of consulting a Nepalese shaman are generally lower compared with biomedicine. Small healing procedures are free sometimes. In many cases a patient pays a shaman according to his own judgement or financial possibilities, the gift being either money or natural produce. For larger and more extensive ceremonies the shaman describes to the patient or his family exactly what is required, e.g. a sacrificial animal, chang, rice and so on. In some ceremonies all present are guests of the patient’s family , which may be expensive depending on the length of the ceremony and the number of participants. One of the Phombos, the Jirel shamans in east Nepal, summarizes: „Phombos are like doctors, we treat people who are suffering from spirits, in other words, those who are stricken with illnesses that are of a supernatural origin. We do it with mantras, herbal medicine, and the help of our own spirits.“ (Sidky 2000:46f) 3.) OTHER HEALING TRADITIONS
Religious healers. „A priest is usually part of a larger religious establishment, is more concerned with the conduct of group rituals and derives his relation with supernatural powers by virtue of his office within [an ecclesiastical establishment]. The shaman, to the contrary, is usually an individual practitioner, and his contact to the supernatural world is personal and immediate.“ (Murphy 1989:203, quoted in Sidky 2000:41) Lama, Hindu priest, Jyotishi Lamas, Buddhist scholars, are consulted specifically in Bhuddist communities. They perform prayer ceremonies for sick persons (Haddix McKay 2002), which is called ceremonial healing (Dietrich 1996). Hindu priests and Jyotishi (astrologers) are often asked for a diagnosis. They calculate the influence of planets on a patient. The Hindu priests then perform the Puja required for recovery, and therefore are in close
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contact with the astrologers. Hindu priests are often able to calculate planet influences themselves.
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FIGURE 8. Puja place at a Shiva Lingam
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Unani. Unani medicine has its roots in Galen’s humoral pathology. It developed in the Islamic sphere and reached Nepal via India (traveliteindia). The Unani practitioners are called Hakim in India and Jaanne in Nepal, according to Blustain (Blustain 1976:96). Ayurveda. Ayurveda, the knowledge of long life, is an old Hindu tradition of healing that reached Nepal from India. It is based on the principle of the Tridoshas: Vata Dosha, Pitta Dosha and Kapha Dosha. These Doshas consist of two out of the five elements ether, air, fire, water and earth respectively. One individual composition of these five elements and thus of the Tridoshas is attributed to each human being. Everybody has the duty to keep, or in case of illness to recover, a balance of these elements and Doshas through an adequate life style and diet, which are taught in ayurveda (Ayurvedic Foundation). Ayurveda practitioners who either studied ayurveda or follow a family tradition as Vaidhyas and have been trained by their parents, produce the herb mixtures they prescribe themselves or have them prepared by ayurveda chemists (Gartoulla 1998:81). Apart from herbal mixtures they also use massage (Shankar 2001).1 Traditional Tibetian Medicine. Practitioners
of
Tibetian
medicine
belong to two groups: first the Amchi, the herbal healer of Tibet, and second, some Lamas, Tibetian healers, practice the so-called ceremonial healing, i.e. healing through mantras and meditation (Dietrich 1996)2.
1. An estimated 2000 healers practiced ayurveda in Nepal in 1982; of these, about 500 are said to be ayurveda physicians or have qualified e.g. in ayurveda studies. The largest facility for ayurveda treatment in Nepal is the Ayurveda Hospital in Kathmandu. 2. see also previous page „Lamas as healers“
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The Amchi passes his knowledge along to disciples, in the past often to his own children. The disciples accompany their teacher to gather experience, they learn to recognize and find medicinal plants and to produce herbal remedies. They also learn moxibustion1 and other techniques as well as astrology, which plays an essential role in Tibetian medicine. In 2003 a special clinic for Tibetian medicine was established in Kathmandu, and four small private institutions train Amchis in Nepal (Himalayan Amchi Association). Obviously a strict differentiation between religious beliefs and practices within the wide range of traditional healers in Nepal is impossible. „To solve human needs and problems the gods have several alternatives. One of the most important alternatives is to empower a few chosen persons through dreams to help cure sickness and diseases. So, for example Dhamis and Jhankris (Shaman-healers) are perceived people chosen by the gods to save and nourish their creation.“ (Gartoulla 1998:120)
IV. Results An astonished look from my Nepalese fellow-student while we are sitting in the conference room of the Tribhuvan University Teaching Hospital and waiting for the early surgical meeting to start. I had only asked him a simple question: could he tell me something about the various healing traditions in Nepal? I can almost read his thoughts: this German student, who is lucky to study medicine in Europe and – for unfathomable reasons – spends part of her practical year in such an underdeveloped and insta-
1. a method in Traditional Chinese Medicine (TCM) where moxa or mugwort, e.g. in the form of a moxa cigar, is burnt over the patient’s body. This method serves to warm certain body parts in TCM.
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ble country as Nepal, shows an interest in these unscientific alternative healing traditions and the superstitious beliefs involved. „Are you serious, you are really fascinated about medical anthropology, especially in Nepal? You know, we medical students here, we all hate that subject, it’s the most boring thing we have to study in the first year of our course.“ This was more or less the reactions of most of my Nepali fellow-students whenever I wanted to learn something about traditional healing methods or spoke of my „course in ethnomedicine“. This is why I did not even mention the fact that I had sat together with shamans in the evenings, drumming and learning their mantras, that I had even experienced some Chintas myself. Most of them, the surgeons in particular, but also the medical students I was together with in courses and on the ward, expressed astonishment and incomprehension. Consequently, I led something of a double life: by day I was the German medical student who changed dressings and was allowed to suture skin in the operating theatre, in the evenings I turned into the disciple of a Nepali shaman! „The treatment of a disease depends upon what is held to be the cause of that disease. If an educated man believes that the cause of disease is naturalistic, he contacts empirical medications from various sources such as drug-peddler, drug retailers, grocers, community leaders, doctors etc. In a similar fashion, if a man believes the cause of a disease to be the wrath of god, influence of an evil spirit, sorcery or breach of taboo, he consults/practices appropriate agencies for treatment by witchcraft and magic, charms, amulets, or even sometimes uses ethnomedicine where they are held to possess magical properties“, writes Gartoulla (1998:80) in his analysis on the use of ethnomedicine therapies in Nepal. Patients with a traditional view of illness often find it illogical that the physician with biomedical training only records one pulse while the shaman is able to distinguish between up to three different pulses per wrist (see Gartoulla 1998:166).
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FIGURE 9. Shamanic puls diagnostic
The fact that biomedicine mainly treats patients independent of their family and social environment also contradicts the understanding of many patients in Nepal of disease as a „family and social affair“ (ibid:166). „When used to the intense and elaborate efforts of the dhami, the behaviour of the health post staff can seem unsatisfactory to most people. ‚In the health posts they just give the same pills to everyone’ was a rather common complaint. For a sick person in Bhojpur, going to see a traditional healer implies more than consulting a health specialist. Seeking the help of a dhami means seeking a cause and explanation beyond the
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immediate symptons of an ailment, and requesting assistance from greater healing powers“, writes Kristvik (1999:77) on the basis of her experience in east Nepal. Biomedical physicians often dismiss information given by a patient who from a traditional understanding of illness1 believes this information to be relevant and essential to diagnosis and resulting therapy; this contributes to misunderstandings between physician and patient and makes some patients think they are not understood properly (Gartoulla 1998:166). In addition, patients criticize the chronic lack of time for extensive interviews in biomedicine and likewise examination of a patient, but also long-term and therefore costly therapies with medication. These may be seen as additional obstacles for a stable doctor-patient relationship and subsequent patient compliance. At the Teaching Hospital in Kathmandu, and also at the Western Regional Hospital in Pokhara I found that the simple question of costs for treatment and everything involved - trip to hospital, stay in hospital, food, medication or surgery – will decide whether some patients consult a shaman or other traditional healer first who assesses the complaints and gives an appropriate diagnosis. This tendency is probably stronger in rural areas where medical facilities are scarce. Another important point is that patients do not see biomedical therapies and traditional healing methods as mutually exclusive options but in many cases make use of different therapy approaches consecutively or simultaneously. 2 What we see is therefore a plurality of healing systems on one hand and a pluralistic approach in using them on the other.
1. e.g. hot-cold dichiotomy
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According to Pfleiderer, this „oscillation between different interpretation patterns“ (Pfleiderer 1982, in Böker 1992:46) is a characteristic of changing societies in so-called developing countries – a description that fits Nepal as well. From a perspective not only of patients but also the respective healing systems, the following tendency is obvious: The differentiation and confrontation between biomedicine and traditional healing in Nepal appears to come mainly from representatives of biomedicine with an academic western education, as I found personally and learned from a number of research reports on the subject. While shamans with their holistic approach do not see biomedicine as serious competition1, some biomedical physicians feel shamans are a threat to the population and a nuisance and may undermine patient compliance with scientific therapy approaches of western orientation. Why do biomedical physicians in Nepal have such problems accepting other, more traditional forms of healing? Some diagnostic and therapeutic approaches of Nepali shamans appear „strange“, perhaps even „mystical“ or just like „conjuring tricks“ at first sight. Biomedics object that shamans have no scientific training, that their approaches are based mostly on assumptions that cannot be verified nor repeated, i.e. they criticize the lack of scientific determinism according to which all natural phenomena show a strict causal connection. Sha-
2. Field research by Okada (1976), Blustain (1976), Stone (1976) and others indicates that people in rural areas in Nepal tend to consult a shaman or other traditional healer first since these are locally available. But many patients also visit the Health Posts or hospitals, often in addition to a shaman therapy, afterwards or between two such therapy sessions. Ayurveda, Unani or Tibetian medicine and self-treatment with household remedies or over-the-counter medicine are further alternatives to biomedicine and shamanism (Gartoulla 1998). 1. Shamans treat patients for illness due to supernatural causes.
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mans often prescribe herbal remedies but mostly without a scientific basis in the Western sense (see also Gartoulla 1998).1 The missing scientific foundation and the alleged ignorance of shamans are superficial explanations for a dualism of biomedicine and traditional shamanistic healing in Nepal. The core problem, as Prof. Dr. Nepal confirmed in his interview, is that traditional medicine is seen as a synonym of backwardness and is therefore stigmatised2, while Western biomedicine is a synonym for modernization, education, progress, technology and development. The dualism described has therefore grown and been supported by Western development aid with its mainly ethno-centristic attitude, specifically at the beginning, in Nepal3. Everybody who believes himself to be educated and modern and wants to demonstrate this must therefore oppose traditional medicine! The result
1. Scientific determinism became obsolete a long time ago, and a change in paradigms took place in Western natural science, see research in modern quantum physics. But old patterns with determinism and positivism still seem to dominate biomedical practice in particular. In practice, new findings and concepts, e.g. on mutual influences of body and psyche, gain ground very slowly. 2. Stone (1976:78) says: „Secondly there have been repercussions from the fact that developing agencies explicitly oppose modern and traditional medicine. Educators instruct school children to abandon their „superstitious“ beliefs in illness causation. Doctors deny the validity of local practitioners and encourage patients not to summon them. Local practitioners, in turn, occasionally discourage clients from going to the hospital. With the lines drawn in this fashion, villagers are presented with a new realm of opposing symbols for incorporation into their social life. Of relevance here, villagers in particular contexts seek to be identified with the „modern“ world, which, in this area, is largely defined as the world of education. Symbolic denial of traditional medical practices and confirmation of Western medicine is one of the ways in which such identification is effected.“ 3. Davies (1994/95) quotes Foster (1987): „the developed world possessed both the talent and capital for helping backward countries to develop“! The idea was to help underdeveloped nations to achieve modern, Western-progressive living conditions.
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is a confrontation between Nepali biomedics and traditional healers but also between various ethnic groups1. Prof. Dr. Nepal told me in his interview: „You know, general educated Nepalese nowadays they know these are traditional healers and they represent all the old, primitive things, are uneducated, illiterate people. Medicine is modern now, you must look for the hospital doctors, doctors trained in Germany or in where ever. (…) There’s one question: it’s of stigma. Stigma, you know, these peope [the shamans] are uneducated, illiterate village people and if we [the biomedics] try to relate ourselves with these people then it’s not so good, you are considered again low.“ We may summarize with Kleinman: „As long as biomedically trained experts, influenced by scientism, treat healing as an independent, timeless and culture-free process, they will have difficulty in appreciating the holistic nature of indigenous etiologies and therapies.“ (in Davies 1994/ 95) In contrast, traditional healers do not appear to see biomedics as competition.
1. superstitious rural population versus modern urbane population with academic training
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FIGURE 10. Traditional healer Parvati in front of her ritual objects
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FIGURE 11. Traditional healer Parvati in front of her ritual objects
„(…) If my diagnosis reveals a supernatural cause, then I will proceed with treatment. If not, I will refer the patient to a doctor. Also, if a bodily ailment fails to respond to my repeated attempts to cure it, I will send the patient to a physician. Problems that we cannot cure are those that involve physical damage to the body, such as broken legs, severed limbs and cuts. These patients must seek modern medical treatment.“ This is how a Phombo, Jirel shaman in east Nepal, describes his view of biomedicine. (Sidky 2000:49f)
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Shamans even seem to adapt to modern influences in Nepali society to some extent: „One of the most striking things about the contemporary alternative health care scene is the vitality displayed by traditional systems and their practitioners not in carrying on in an unchanged fashion, but in adapting their etiologies, therapies, and rituals to meet the expectations of their traditional (and new) clients who are also adapting to the modern world and its ways .“ (Gartoulla 1998:164) The danger of too much westernization in therapy approaches must be underlined in this context. Skultans writes (1988 quoted in Böker 1992:47) that in Kathmandu in particular, the practices of some traditional healers are increasingly mechanistic, above all in the speedy treatment and unpersonal atmosphere. I have not seen anything like this myself, but can easily imagine such potential results of a hasty adaptation to modern influences. Kristvik (1999) confirms that shamans are highly flexible, creative and adaptive in reconciling modern Western influences with traditional methods and putting them into practice: „A distinction between diseases needing intervention from a doctor, and others requiring a dhami’s assistance, can hardly be part of a very old tradition in a place which has only had health posts for a generation or so. Rather than being static, rigid ways, the practices of the Dhamis in Bhojpur seemed to be in a constant flux. Their statements and behaviours reveal a tendency towards complementary co-existence with modern health services, sharing patients with the professional health workers. But the possibility of a competitive line is also evident, in which case patients will be warned against going to the health post.“ (Kristvik 1999:98) She addresses the problem of actio and reactio also discussed by Stone (1976:78): if health care practitioners see shamanistic healers stigmatized with backwardness, and if they also stigmatize those patients who come
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to the health care facility after a shamanistic healing attempt, then their attitude must provoke a re-action, i.e. a separation of traditional healers. A possible reaction is that shamans reject biomedicial approaches, and that they pass on this attitude to those who consult them. The patient has to make a clear and definite decision, he is forced to choose between shamanism and biomedicine without the option to use both. This type of action and reaction1 is an additional hurdle on the path to a cooperation between shamans and biomedics, which finally might become impossible. A hardening of the lines, a further separation between both healing systems and even a greater rift in society are possible consequences. Obviously this paper highlights only some tendencies and extremes and cannot assume to give a comprehensive picture of the many assessments and opinions on traditional healing and biomedicine in between.2 Another, and in my opinion most important, aspect of the debate on dualism or a possible synthesis of biomedicine and shamanism is how both systems get on and communicate with each other. Both sides expect respect for their own knowledge, methods and therapy results; but biomedics in particular often have problems recognizing such knowledge and successful outcomes on the other side, since biomedical methods appear incomparable to those of traditional healers. But both approaches are less different than might be assumed at first sight: Peters (1979) in his article „Shamanism and Medicine in Developing Nepal“ illustrates that psychiatry, psychoanalysis and psychotherapy use concepts similar to those of Nepali shamanism. Conflicts in the domestic
1. in addition to the above-mentioned dualism of modern versus backward that dominates society. 2. An extensive discussion of all aspects would go beyond the scope of this paper. Compare Stone (1986): Primary Health Care for whom? Village perspectives from Nepal
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or social context frequently require a shaman’s intervention. Shamans use their healing techniques not to eliminate organic disorders but try to help where emotional balance and human relationships are disturbed. I would not subscribe to this view without reservation. Certainly many problems taken to the shamans are located in the socio-psychological sphere and may be treated in a community-centred approach aimed at social (re-)integration. But in my experience this does not exclude the treatment of organic problems by shamans. The shamans in Naikap I saw in their healing procedures also treat fever, strong headaches, diarrhea and similar disorders, i.e. physical complaints. But keeping the concept of psychosomatic illness in mind I would agree with Peters (1979) to a certain point, since not all physical symptoms have psychosomatic interpretations and explanations. Corresponding to shamanistic methods of healing a patient through a ritual, we see techniques like e.g. NLP and biofeedback in Western medicine, or the much-discussed placebo effect (Kristvik 1999:111ff). „Just by naming the disease there is immediate reduction in the patient’s anxiety. This is because, once the illness is put into a cultural frame, definite expectations are aroused in the patient and his family. (…) It does not matter what the name is; it can be a psychological complex, a biological organism or a masaan. (…) The diagnostic process through which illness is identified enables a transformation from chaos to order in the eyes of the patient and those concerned for him, and this has therapeutic effectiveness.“ (Peters 1979:34) No matter which system is assessed in the light of the above statement: biomedicine as well as shamanistic healing enable a patient to handle his perceived complaints better – depending on his personal interpretation of his symptoms: a biological-scientific, cause-oriented explanatory model, or rather supernatural powers. The important thing in this situation is to offer a supportive structure for the patient, and a conclusive picture of the
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symptoms that confuse and frighten him. Thus the patient is empowered to act1.
V. Summary A wide variety of factors decide which type of healing a patient chooses, as Dr. Gartoulla confirmed in his interview. These are a patient’s income, social status, caste, age, religiosity, education, advice from family and friends, and personal experience with illness, among others. The essential point is how a patient assesses the nature of his illness and its cause, and this depends on the symptoms and his understanding of them. Beine (2001:163) mentions a „symptom based treatment seeking strategy“. „Depending on which healer had been consulted, the cause of the illness could have been attributed to anxiety, an upset in the hotcold balance of the body, witchcraft, intestinal parasites, or a malevolent ghost. The method of diagnosis could have involved the reading of the three different arteries in the wrist, an x-ray machine, or a consultation with the spirits. Cures could have ranged from surgery to exorcism. Not only techniques, but philosophies would have varied; seeing illness as due to the conscious actions of the gods (or, in the case of witchcraft, humans) is vastly different from viewing it as due to impersonal actions of germs.“ (Blustain 1976:84) „(…) medicine is based upon faith – faith in the ability of the healers, faith in the methods of curing, and faith in the philosophy and cosmology upon which the system is built. A westerner unfamiliar with the village curing practices would undoubtedly look upon the trance of the jhankri with amused horror. Similarly, the increase in hospital visits over the past seven years is indicative of the faith the villagers are increasingly placing in the hospital. No system of medicine can guaranteee a one hundred percent rate of cure. A patient in the west whose condition does not improve 1. he may e.g. opt for a nightly healing ceremony with the shaman, or for blood analysis and x-ray and subsequent drug therapy with the physician. There seem to be four core elements that are decisive in both systems: belief, suggestion, group support, and catharsis, according to Peters (1979:35) on Kennedy (1974).
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does not resolve that he will never again enter a hospital. Rather, he might ascribe the failure to the incompetency of the doctor, to a faulty diagnosis, to a malfunction in the testing equipment (…). The villager as well has means for rationalizing medical failures. (…) As with the western patient, faith is never shaken in the basic validity of the system.“ (Blustain 1976:102f) Kristvik (1999) in a study on tuberculosis therapy and prophylaxis between biomedicine and traditional understandings of health underlines the need for incorporating traditional healers and traditional understandings of illness in all efforts to fight illness in Nepal. She sees shamanistic healers in a key position. A Norwegian nurse, she is well aware how difficult dialogue and resulting cooperation between biomedics and shamans really are. Both sides would have to make concessions in order to bridge the historical gap between biomedicine and traditional arts of healing in Nepal: they would have to meet on the same footing, to accept the experience and methods of the other side and to give up artificially maintained competitive attitudes. All this presupposes a willingness to study the medical approaches of the other side and to make a serious attempt at dialogue and understanding. „Understanding seeks an identification with the experience of others without which no true interpretation is possible.“ (Kakar 1982:209, in: Dougherty 1986:35) Efforts must be made to transfer the focus from seemingly insurmountable differences to common elements in both healing systems. As described above, a closer look reveals a host of commonalities. Ultimately, the philosophy underlying both systems may be reduced to the question of existence, of living and dying as such, independent of culture-specific explanatory models:
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„Both medical and indigenous practitioners are involved in attempts to understand more of the mysteries of life and death. Both attempts are necessarily incomplete and undergoing constant change.“ (Kristvik 1999:101)
VI. Discussion Several decades ago, the integration of traditional medicine into, or participation in, a nation’s health care system was a subject of intensive debates on scientific, but also specific development policy related and medical issues. The discussion was mainly triggered by the WHO declaration of Alma Ata in 1978 that defined health for everybody by 2000 as an objective of all national and international health care efforts and gave considerable attention to an integration of traditional healers.1 Research of so-called herbal medicine as part of traditional healing receives much attention in this declaration. What at first sight seems to be an open-minded ethnomedical approach appears rather critical, however, with a closer look at the way in which the WHO intends to integrate traditional healers in the health care system. I agree with Kristvik (1999) who warns against efforts to sell off traditional knowledge, and marketing through multinationals, specifically for vegetable substances. I recall the repeated and on-going legal battles for patents between indigenous groups in the Amazonas region and multinational pharmaceutical companies and efforts to protect millenium-old knowledge of rain forst medical plants.
1. In this context the WHO describes the traditional healer as „a person who is recognized by the community in which he lives as competent to provide health care by using vegetable, animal and mineral substances and certain other methods based on social, cultural and religious background as well as on the knowledge, attitudes and beliefs that are prevalent in the community regarding physical, mental and social well-being and the causation of disease and disability“ (WHO 1978:9; in Kristvik 1999:122).
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The WHO document (1978) also mentions, as pointed out by Kristvik (1999), „radical development and promotion of traditional medicine (…)“. The guidelines are even clearer: 1. Giving recognition to traditional practitioners and incorporating them into community development programmes. 2. Retraining traditional practitioners for appropriate use in primary health care. Davies (1994/95) finds a more drastic way of expressing this attitude: „(…) the PHC planner has a moral obligation to include traditional healers, so as to oversee them and eliminate any possible dangerous practices.“ What the WHO document, point 1, presents as placing traditional healers on the same footing with biomedics, is almost completely reversed in point 21: the guideline plans to train the traditional healer „properly“ – in the biomedical sense, in order to send him back to the village as an (advertizing) expert in biomedical procedures and diagnose patients for biomedical symptoms in order to refer them to biomedical health facilities; this happened e.g. to promulgate oral rehydration solution, nun chini pani, as therapeutic intervention for cholera and other diarrhea-related diseases, but also birth control measures in rural areas. For some time, this was successful and some healers cooperated actively but lost interest quickly (Kristvik 1999). Biomedical training for traditional healers is certainly well-intentioned and may even help to reduce epidemic diarrhea and high death rates as a consequence. However, this perspective neglects the healing knowledge practiced by traditional Nepalese healers for thousands of years, and just dismisses its effectiveness.
1. See Kristvik (1999:124)
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As Prof. Dr. Nepal underlined in his interview, the shaman is not accepted as equal but rather is instrumentalized by the biomedical system on the basis of his influence in rural areas and his close connections to the village community – qualities which biomedical physicians have never developed, specifically in rural areas of Nepal. Jochen Diesfeld (1974) summarized these aspects in a lecture on the integration of traditional healing systems into national health care strategies in developing countries and suggested reasons why biomedicine still has acceptance problems in traditional and above all rural communities. „In this context I do not intend to analyse traditional medicine for effectiveness or harmfulness from a scientific perspective but underline that in a traditional society it achieves what western scientific medicine has not achieved there up to now, that is, to be accepted and to address and meet the felt needs of individuals and the community. Modern medicine operates absolutely outside the social and spiritual context of traditional societies. If in addition we consider that this exported scientific medicine is exclusively informed by the social and spiritual context of its countries of origin, then it is even more obvious that this is not only export of scientific medicine but of medicine formed and developed for the culture it emerged from. We must be aware that western biomedicine, too, gains much of its knowledge on illness and treatment from empirical observation and therefore resembles so-called traditional medicine in this respect. So-called natural-scientific medicine also contains many elements marked by traditional behaviour patterns without scientific validation the scientific analysis of which started only recently. The impact of western civilization and the resulting destruction of traditional social patterns has another consequence for health in the widest meaning of the word. It destroys traditional forms of social security without which there is no health. In this respect we are less able to procure adequate replacment than in the more strictly medical field.“ (Materialien zur Ethnomedizin 1978:93)
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This applies particularly to the situation in Nepal. In the 1970s a large number of anthropologists, sociologists and ethnologists from all over the world started to study the effects of biomedicine in Nepal on the patients’ concept of illness and their selection of a healer – i.e. either traditional healer or biomedic, and the mutual influence of the different medical systems on each other then and today. Blustain (1976) summarizes his observations made during field research in Saano Dumre between 1974 and 1976 as follows: „(…) the Nepali villager’s concepts of medicine are not a tabula rasa upon which westerners can freely impress all sorts of notions about viruses and antibiotics. Nor is the problem one of finding ways of replacing village methods with more „scientific“ ones. While the hospital unquestionably has much to offer in the treatment of diseases, it could never preempt the psychotherapeutic role of the jhankri. If health care in Nepal is to be improved, one must start with the assumption, that the villagers’ faith in their own healing techniques – be they herbal or ritual – is not going to be shaken by the occasional visits of medical teams or even by the building of hospitals. The problem facing the public health workers is one of finding the means of integrating western ideas into the village system. From the villager’s point of view, the process has already begun.“ (Blustain 1976:103) Similar to many parts of Africa1, the majority of biomedical cooperation projects with traditional healers in Nepal are seen as problematic, if not failed (Kristvik 1999). The reason Kristvik gives is the one-sidedness of so-called „training sessions“ where traditional healers were trained in biomedicine but without receiving something in exchange from the health workers, i.e. not so much financial incentives but rather recognition of and respect for their work and traditional skills. These training
1. See also Green, Edward C.;1988; Can collaborative programs between biomedical and african indigenous health practitioners succeed?
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sessions, originally aimed at an exchange of knowledge, normally turned into attempts to break traditional healers of their „bad habits“. Personally I also detected this attitude, often subconscious and widely held among enlightened project initiators and staff with academic training, when I interviewed Prof. Dr. Nepal. He described a cooperation project with shamans on psychiatric care for the population of Kirtipur in the 1980s with the following words: „So, we interacted with them and then we taught them that, if you have patients of this sort, you know, then you send these patients also to the health post, nearby health post, where paramedics have been trained to identify epilepsy, to provide anti-epileptic medicines, identify psychosis, give anti-psychotic medicines …like that. But if you (addressing to the shamans) have hysterical disorders, affective disorders, don’t send these patients here. You just manage on your own. The only thing you do, you don’t extract too much money from the family. Don’t try to make a lot of money out of them and don’t try to abuse the patient. Sometimes, you know, they burned1 the patient, they do all sorts of things, physical damage to the patient’s body. Don’t do that: beating, heating, nailing, burning – these sorts of things don’t do, don’t extract too much money. You just manage on your own. And those patients in which epilepsy is there, send these patients here, anti-epileptic medicines have to be given. And: it worked very well!“ Although the revolutionary character of such a project in Nepal in the 1980s and the enthusiasm with which Prof. Dr. Nepal reports the successful outcome clearly reveal that he seriously wants cooperation with shamans in Kirtipur on the basis of partnership, he is still a victim of his own socialization and western training: certain personal values – not to demand too much money from patients and not to submit patients to drastic interventions – become preconditions for smooth cooperation 1. „Burning“ refers to an intervention where for example burning coals are placed directly on the skin above a point that hurts. Internal pains for example are treated this way (Haddix McKay 2002)
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with shamans. A well-intentioned and often hidden kind of behaviour control – an admonitory finger! Nevertheless, Rätsch (2000) and Kristvik (1999) report a few quite encouraging, albeit small-scale, attempts at cooperation between shamans and biomedics1; even if it was not possible to transfer the results to standardized nation-wide programs nor to analyse long-term tests. The TB program of the British Medical Trust where Kristivik (1999) did her field research served at least to improve communication between healers and biomedical health care staff – surely a step in the right direction. „If the professional health workers were to recognize the dhamis as health workers in their own right, it would be a challenge to the hierarchical order between the high and low castes, the urban and the rural, the educated and the illiterate, which is not a minor thing. Opening up for co-operation with traditional healers would imply that the doctors must let go of some of their control, prestige and power.“ (Kristvik 1999:131) Representatives of western (bio)medicine are still unprepared to do so. But the status quo in health care in Nepal as described above demands a definition of problem areas and pertinent measures that might serve to improve the current desolate situation: „First, the progress of western medical education is a very recent phenomenon in Nepal. Secondly, institutional infrastructure for reaching modern medical treatment for everyone is far from adequate. Thirdly, the spread of general education itself is not yet satisfactory. Due to all these and other causes, ethnomedication and other traditional healing practices have continued to be much relevant in the Nepalese context (…).“ (Gartoulla 1998:78) This means that health care in Nepal, either in project planning or in the implementation of health care strategies, requires studies of traditional
1. see also Poudyal, Bimal (1997): Traditional Healers as Eye Team Members in Nepal
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healing structures and the pertinent understandings of illness and health. But it will be necessary to redefine the type of such studies and the attitude for addressing traditional healing methods, to reconsider approaches that failed in the past, and to ask new questions: It is not enough to find out what the cause of an illness is (as biomedics usually do), but the patient wants answers to the why: why am I the one to be affected, why me, why now? The patient wants explanations that go far beyond the biomedical explanatory model for illness and require profounder exploration of issues concerning human existence, life and death. The patient wants somebody to help him placing his illness into his individual, socio-cultural world view in a way that makes sense to him.1 So much on theoretical background; but a far more difficult question to answer is: how can, should and may all this be embedded into a concept that works and is supported and furthered by all involved, and also integrated in practice? First of all, we see from the above that Nepal as a nation, and therefore the illness concept of its population and the kind of planned diagnosis and therapy, are in a process of change. Beine (2001) has a very graphic way of describing changes in the understandings of illness and treatment options among the people in Saano Dumre who Blustain (1976) had interviewed on the same issues 25 years before. Beine (2001) sees the medical pluralism he finds there as a „hybrid system“, a maximization of therapy offers through a combination of tradi-
1. see also Allan Young (1983): The relevance of traditional medical cultures to modern primary health care
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tional and biomedical approaches, with regard to the explanatory model (EM) of the population but also to the therapists involved. „(…) in one domain (home remedies), products of western development are being applied in an ingeniously indigenous fashion, while in another domain (spiritually perceived sickness) the traditional healer’s practices are being modified to incorporate new beliefs in the efficacy of western medicine. And in another instance the use of traditional healers is being modified to exclusive use in one domain only („shaking“ illness).“ (Beine 2001:164) Beine’s (2001) interviews reveal interesting results: 88 % of people interviewed in Saano Dumre said they go to the hospital if home remedies fail, only 12 % went to the traditional healer. Shamans were consulted mainly in case of suspected „shaking illness“1. Most frequently mentioned groups of important causes of illness were: pathogenic agents (64 %), negative influence of planets (24 %), bad karma (16 %), spirits (3 %), physical weakness (8 %). 76 % of those interviewed said they consulted the dhami-jhankri less frequently than 25 years before.
1. an indication of illness caused by spirits
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FIGURE 12. Traditional healer Maile drumming
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Biomedical explanatory models for illness, in particular the concept of germs and biomedical explanation of contagiosity1 of certain diseases find increasing acceptance among the population. But traditional explanations, for example attacks by evil spirits or witches, are also preserved. Beine (2001) continues to describe a growing awareness among shamans that some types of illness may be cured better by biomedics in hospitals and therefore they send their patients to the biomedical clinic if their shamanistic interventions fail or even immediately after addressing gods and spirits for diagnosis. It remains to be seen whether Beine’s observations also apply to other rural areas in Nepal and what has become of his conclusions today, almost five years after his field research and under the influence of the „People’s War“. To my knowledge many NGOs have withdrawn support and personnel from their hospitals in rural and remote regions in Nepal, or have drastically shortened their health services2, due to continuous harrassment by maoist fighters, for example at the Am Pipal hospital, one of the biomedical health care facilities analysed by Blustain (1976) and Beine (2001)3. Fears among the medical staff and lack of supplies due to road blocks further contribute to endangering health care services. Therefore it would only be logical that shamans and other traditional healers now assume more of their former tasks they had already passed on to the clinics.
1. transmission of a disease through droplet infection, smear infection etc. 2. see also Benedikter (2003:240), Molesworth (2006) 3. Dr.med. Wolfgang Starke wrote in an article published in Deutsches Äırzteblatt, August 8 2005, that the United Mission to Nepal (UMN) who built the hospital in Am Pipal ca. 35 years ago, left „in great haste“ in 2001. The reasons are still unclear. It was only due to the efforts of former personnel who kept the facility going without being paid for long periods that the hospital survived. I heard repeated hints that maoist intimidation was the reason why the NGO left the hospital.
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It must also be noted that Beine (2001), similar to many ethnomedical research reports, analyses the situation on a theoretical level but does not suggest practical ways to implement necessary steps – at least not in his publication, although his discovery of the „hybrid system“ suggests a number of useful approaches. As a consequence of all this, I see the willingness among biomedics in Nepal to get involved in medical projects combining shamanism and biomedicine as rather limited to date. But perhaps western biomedics are able to give some impetus and re-import1 traditional shaman knowledge from Europe to Nepal and thus promote an interest among biomedics in Nepal. My suggestion for testing a „hybrid system“ in practice is based on the concept of a combined, integrative approach involving physicians and traditional healers: if the patient so wishes, biomedics and shamans might try to assume joint responsibility in the care and treatment of this patient2. One field where I imagine this might be feasible is obstetrics. Pregnant women for example might consult shamans to be purified from negative influence or receive amulets and protective mantras, and on the other hand they have the chance of basic check-ups and preventive examinations or of biomedical intervention in case of complications at birth. A real hybridization would also require a midwife to complement the team, to be present at birth and support mother and child after birth. A basic precondition would be the above-mentioned willingness to study the other approaches, to communicate at eye-level, to give mutual support
1. Prof. Dr. Nepal told me in his interview: „But I was surprised, in the western countries like Germany or America, the interest in alternative medicine increased. That again will come back here. That will come back here as well. So there’s a doctor in Germany, he does treatment with both the things, he does modern medical treatment also, he does this shamanism also. So Nepali doctors also will start doing that, start practising that. So in a way, it has gone to the West and come back. And the West again is a kind of leader – role models who’ll show us the path.“ 2. See also Poudyal, Bimal: Traditional Healers as Eye Team Members in Nepal
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and to learn from each other. The overriding intention must be: to treat patients in the best possible way to recover or maintain health on a physical, mental and spiritual level. Applied to Kleinman’s model, this may be seen as an effort to integrate both sides of the coin – disease/curing and illness/healing – in a holistic manner into an approach that aims to remove sickness and thus to address patients’ complaints in a far more comprehensive way. Young (1983:1210) postulates on traditional healing methods complementing biomedicine: „On the other hand, the traditional practitioner’s strength is in healing patients rather than curing them – i.e. giving meaning to biomedical events rather than controlling them. To the extent that this is true, we can conclude that traditional healers (a) provide a legitimate medical service (healing illness) and (b) complement the curative services provided by the official medical sector, reduce patient dissatisfaction, and diminish the causes of maladaptive behavior.“ This integrative therapy approach might find acceptance among patients, as may be seen from Durkin-Longley’s (1984) article „Multiple therapeutic use in urban Nepal“. She reports her observations: „(…) clients resort to different healers simultaneously to manage different aspects of their disorders.“ (ibid:870) Obviously, the integrative approach described above must be seen as simplified and rather sketchy and also incomplete in view of my biographical background; nevertheless I believe it would be worthwile to put it into practice. This would require some preparation: first a team must be organized consisting of shaman, midwife and physician, team members must build trust and have opportunities to be present when the other approaches are practiced, must learn some basic principles themselves or at least receive explanations. Communication in one language – Nepali VI. Discussion
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seems a good suggestion – requires some preparation, too, certainly for the biomeds with western training. Such an experiment may require so much preparation, planning and implementation that it could become a life-time mission for all involved. The intention therefore is not a shortterm research project but rather a continuous and joint effort in the interest of patients. I believe results from such a team approach would be highly interesting: an integrative approach with a focus on commonalities and advantages of the different systems of healing and the intention to put them into practice on the basis of equality. In conclusion I quote once again Prof. Dr. Nepal, head of the psychiatric department at Tribhuvan University Teaching Hospital. Considerable obstacles will have to be overcome in order to achieve real cooperation of both systems – biomedicine on one, and shamanism on the other side; but there are some personalities who are willing to assume this mission and to take possible steps on converging paths to an understanding. „Biomedicine has some advantages, good things. This alternative, complementary medicine has certain advantages, certain good things. And what patients need, what societies will need: best of the two things. You know, if something is working here, if it is better on this side, why not to take it? There is good on this side, why not to take it? Whatever patient care, care of the patient, is, it’s the best of the two worlds what we need. Not thinking of this is, this comes from rural area, this comes from the illiterate part of society, this comes from lower caste group. No! It is working, it’s worth. It has to be blended.“ Let us hope that one day a confession of one’s own weaknesses and an acceptance of the opposite approach will bring us to the decisive point, where a patient’s recovery through an individual, patient-oriented combination of different healing approaches becomes reality.
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„But change is possible – even in Nepal!“ (Prof. Dr. Nepal in the interview)
Appendix INTERVIEWS
1.1. Prof. Dr. Mahendra Nepal, Dep. of Psychiatry, TUTH, Kathmandu Date: 7.11.2005 . Carolin und Marcus (C&M): Maybe you could just introduce yourself and give a brief summary on the topic and the interest you have in medical anthropology. So, we can start with the summary: Prof. Dr. M. Nepal: I’m a psychiatrist and my name is Dr. Mahendra Nepal. I’m a psychiatrist trained more in the western medical way. I was primarily trained in India and then other places. And I’ve been working as psychiatrist in this hospital in Nepal since 1986… and, what else…. I’ve been, in that, I’m also working through the community mental health programmes in the villages through this mental health project. C&M: So that’s the point where you come in contact with the shamans?
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Prof. Dr. M. Nepal: So, there we come in contact - in community mental health programmes in the villages, there we come in contact with traditional healers. And so we’ve already worked on mental health in the villages, so traditional healers are there and you got to interact, you are bound to talk to them, interact with them, take them in your confidence and like that. They have been providing psychological services to the people for a long time, so psychiatrist…Nepal has just a few, less than 45 psychiatrists, counselor psychotherapists very few, 3, 4, 5 such as this. The large number of Nepali people, they are receiving their psychological support, emotional support, counseling from these traditional healers, not from recent times, this is from ancient times, since four thousand, five thousand years. So that tradition is going on. And then when we talk about modern psychiatric care, modern mental health care, so we have to interact with these people also in the village level and my limited interactions are there trying and work with them in that setting. C&M: What are the causes for patients to seek either the shamans or the biomedical doctors? Is it only psychiatry, or also other causes ? Prof. Dr. M. Nepal: In the village setting these traditional healers are very influencial, very powerful. They are called… in many places they are called “jannes”, janne means someone-who-knows. A fountain of knowledge. So, village people, if they have any problem, medical problem, any problem, problems like life problems from birth in the family, death in the family to marriage issues, to fights, quarrels inside the family, to financial crisis problems, fever, diarrhea of the children or psychiatric problems … anything, so these are the first people who are contacted, consulted. So in the village setting, Nepali village setting, educated people like these people will be, will have some knowledge about the outside world. Then usually there is a school nearby, this school teacher will be educated a little bit, he will know, he will have some information, some Appendix
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knowledge about certain things. Then there are health workers, not doctors, because Nepal doesn’t have enough number of doctors to send to each village. So there are non-doctor-, non-physician-health-workers….ehm…or nurses, different kinds of paramedics. Either these people are nearby or school teachers are there, or these traditional healers. So these people are the first ones who are consulted, like “my child has got diarrhea. Now what to do?” So, this person will make a decision: okey, I can give you some herbal medicines. He’ll be alright! Or he’ll decide “No, this I cannot do much; you take him to the health post, nearby health post or take him to the hospital, which is the district health post or to the doctors house which is two days walk or three days walk or whatever”. So this person makes the decision and then for minor ailments, physical ailments he manages with the herbal medicines, and also for the psychiatric things, also he manages. So his method of management is, one has to learn, one has to understand what he does, what he or she, it’s not only he, not really biased towards male, but it could be she also. And they come in a different…. Nepal as you know is divided into three different topographic zones…unlike Germany. Nepal is a smaller country, but lot of variety, because of the topography. Germany you drive from… how many hours you take to drive from Munich to Hamburg? In 8 hours you can reach? But to reach from north to south here, 8 hours is not enough. It’s a problem! Transport communication is a problem and topography is the problem. In the high mountains at least… if the roads are better then within half an hour you can drive from the sea level, 200 feet from the sea level, to four thousand feet within half an hour, if there is a road. If there is no road, then you’ll have to walk for days. So this unique topography Nepal has, has brought a lot of variety. So there are different types of people, ethnic groups, different caste groups, different religions, they are there since centuries for thousands of years living together, but they are so different. And the east part of Nepal is different
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from the west part, southern part is different from the north part…. All variety, languages are different, there’s around 90 different languages in this small country. Can you imagine that variety? And even the flora and fauna, the plants and insects, these animal sorts are different. North side you got Tundra, snow covered mountains almost like your northern european.. north Finnland or north Norway type of things. Go to southern part it’s very tropical, it’s heat and dust, it’s moist, it’s dusty also you get mosquitos…. Within one country, small country lots of variety! So… here also according to the different race groups, different ethnic groups the traditional healing practice has differed, that also is. So among the Brahmins there is different sort of traditional healing, Tamangs different, different, Rais will have different, Magars will have different, Gurung caste will have different. They have their own healing traditions and practices. And…although there are certain commonalities, certain things are common, but again the rituals, the practices, other things are getting differed from place to place and from each region, each caste group to other caste groups….okey? So, there is variety there also, in healing practices also, there are lot’s of reasons: like some will pray to the sun god, some will pray to the goddess of the forest, some will pray to the goddess of the family also something….Some use mixture of ritual, magical treatment as well as herbal medicines, some purely herbal and then there are ayurvedic practitioners - you know ayurvedic practitioners? - who are more university… they are more educated, they have university education and all. So, they are also used, but Ayurveda is one of the ancient Hindu medical treatment methods. C&M: Is this common here in Nepal? Prof. Dr. M. Nepal: It’s common. Like in villages it is quite common, in urban areas a little. It is quite scientific. Ayurveda is the oldest medical system, but is was… it could not grow… it could not develop.., because Appendix
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the Indian subcontinent – it was in this part of the world – was invaded by the Muslims, the Muslims who came from …ahhh….. more from Afghanistan or from that side the invaders came. So they invaded in the th
th
5 century, 6 century, massive …they killed lot of people and in all this schools were distroyed, ayurvedic schools and things were distroyed. So, it could not grow. Some of the concepts of Ayurveda was taken by Arabic Ayurveda people…and then it went to Europe from there, it travelled to Europe from there. But in Europe the Renaissance period came – you th
know Renaissance period? – the period of revival in Europe. When? 14 , th
th
th
15 century? Renaissance? 17 century or 16 century. So when the science started growing, so that time some of this basic medical principals which was taken from … originally from the Ayurveda from here, which travelled to Europe by the land route through Arabic people and then there. There then it developed as a medical science. Whereas here, it remained at the same stage. Okey? So the oldest textbook of medicine, oldest textbooks of surgery, ayurvedic surgery, was written. There was a surgeon Sushruta - do you know that? - there was a physician called Charaka. So Charaka used to be the physician and used to be placed in a university – the first universities of the world were here, not Oxford or Cambridge or Heidelberg or… No, here. So there was a place called Taksashila, sanskrit word is Taksashila, now it’s called Takshila. Now it is in the Pakistani side. Only ruins are there. Everything was destroyed by the invaders from outside. So there this physician Charaka used to practise medicine of that time, ayurvedic medicine of this time. Sushruta used to practise near Benares, in Benares, Varanasi, and near Nalanda. Nalanda is in the Indian State of Bihar. So there was another big university there. That was again, that was destroyed. If you read the Sushrutas they, that time, they describe how to do appendicectomy. They describe how to
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repair fractures, they describe how to remove cataract. Many such things are described. C&M: When was this written? Prof. Dr. M. Nepal: I can’t give exact dates, but around 1500 to 2000 years back. But now what has happened was, it was written in the Sushruta Samhita called (???) …..So the (???) are there, like if your patient has these symptoms, he might be suffering for appendicectomy and this has to be… appendicectomy has to be done, is written. But it was not practised. You know, the actual practice part was not done since that time. At that time how did they practise? We don’t know. That time, since the person who wrote that Sushrutas time, there’s no anesthesia, there’s no xray, there’s no lab-test, but then it was lost in between. But the books are still, such as practical surgery and medicine are still there. So these are ayurvedic practitioners, are traditional medical practitioners and they also exist very much. Especially amongst the Brahmin’s and Kshatriya’s communities. What else you have to ask? C&M: I heard about the PhD work that was done for the university of Tokyo, you talked about it in the annual conference here. The topic was how to implement traditional, trained traditional healers in the Nepalese health system. Maybe you could give a brief summary on this and tell your idea how you think traditional healers could be implemented to guarantee a nationwide health care system in Nepal? Prof. Dr. M. Nepal: I forgot that. Is it a PhD in Tokyo? I’ll have to check that. C&M: You said that in the annual report and I just noted it down. Yes..
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Prof. Dr. M. Nepal: We’ll have to check that again. Exactly… The traditional healers, as I said earlier, they are the ones who are providing the mental health care at the village level. So, when we started working with traditional healers, so we found that they are the ones who are handling everything. All the mental health problems, isn’t it? And so we found them quite useful in many different ways… and we, we thought that we must work in collaboration with these people rather than antagonizing with them. You know, general educated Nepalese nowadays they know these are traditional healers and they represent all the old, primitive things, are uneducated, illiterate people. Medicine is modern now, you must look for the hospital doctors, doctors trained in Germany or in where ever. So they are sort of discriminated in many different ways. But there the kind of services they are providing and …. In the village area – to replace them is not possible. And they will not be replaced for a long time. And so we got to work with them. And we saw their clientel or sort of visitors they have been treating, that we saw, but there was another strategy we have done here in Kathmandu itself in the late 1980s when I had started my out-patient at Teaching Hospital. Teaching was just built when I established my outpatient, so but there was a medical anthropologist from the University of Bristol, an Italian lady working there. So, there was a traditional healer in Kirtipur – I hope he’s still there. In Kirtipur as a traditional healer and he sees lots of mental patients. And that time only two psychiatrists - one was Mental Hospital one was, I had just started Teaching Hospital psychiatry - only two places in the late 1980s, 1987/ 88 that time. And the number of patients used to be seen much more there than what we used to see together, you know in the hospitals. Many of the mental patients used to be taken to these persons and we did compare the patients going to him and coming to us and we saw a similar sort of diagnostic strategies. And sometimes patients that time were seen by us also, seen by him also - our own patients used to be found in his
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place also. Almost 85 – 90% of the patients who came to us, they had a consultation before - from a traditional healer. This sort of things we found. And.. this was in Kathmandu, I’m talking, but in village level much more, much higher, almost everybody. So there, there we categorized illness into two or three different categories, psychiatric categories. One sort of illnesses what we said that’s those where the role of medications is dominant, like epilepsy, like cases of psychosis where anti-psychotic medicines have to be given, like depression with anti-depressions, this sort of things, like brain delirium or this sort of things. So those categories of illnesses where medicine has to be given, one category. Another category where the role of medicine is nil, like most of the stress-related disorders, affective disorders, hysteria, dissociative disorders …. Very common: hysteria is almost managed in Europe, but it is quite common here! C&M: You told us the last time it is very common here… Prof. Dr. M. Nepal: And so, there the role of medicine is minimal, there the role of psychological input is quite high. So, some categorize illnesses in these categories. So there’s categories of illnesses where medicine is the main source of treatment, there’s categories of illnesses where psychological intervention is the means of treatment, not the medicines. So we oriented them, we developed a manual, an orientation programme for them. Many of them were uneducated. Mohan Rai, Mr. Rai speaks English and is literate, many of his colleagues will not be the same… they can’t even read and write, forget about European or English languages. So, we interacted with them and then we taught them that, if you have patients of this sort, you know, then send these patients also to the health post, nearby health post, where paramedics have been trained to identify epilepsy, to provide anti-epileptic medicines, identify psychosis, give anti-psychotic medicines.. like that. But if you have hysterical disorAppendix
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ders, affective disorders, don’t send these patients here. You just manage on your own. The only thing you do, you don’t extract too much money from the family. Don’t try to make a lot of money out of them and don’t try to abuse the patient. Sometimes, you know, they burned the patient, they do all sorts of things, physical damage to the patient’s body. Don’t do that: beating, heating, nailing, burning - these sorts of things don’t do, don’t extract too much money. You just manage on your own. And those patients in which epilepsy is there send these patients here, anti-epileptic medicines have to be given. And: it worked very well! So, in many places like this old, 60 – 70 years old shamans, they don’t know medical signals, but they could differentiate between epileptic features and hysterical features and as medical student – you are medical student or a doctor? – it is so difficult to differentiate for medical students between hysterical features and epileptic features. It is the favourite question I ask to my students in the exam, even to my postgraduates: how do you differentiate between epilepsy and this. And they have difficulties, because they don’t have experience and they haven’t seen many cases, but these shamans in villages, since they have seen many cases by experience, so they could differentiate this is that case. This sort of patients, when we give our treatment, they respond, but patients with a seizure disorder, epilepsy, they don’t respond with our things. They say that. Name they cannot take. You know, this I discovered, it was very surprising to me. And, okey, so these patients should be send to the health post and these patients will be given anti-epileptic medicines, if the patient has hysterical thing only, you just manage on your own….Like, and their management is much better than our management, in medical issue. In our management we do psychotherapy, all kinds of psychotherapy, counseling, takes long time, a lot of money has to be spend, if you take Freudian Psychoanalysis this will take 5 years of treatment. For all that, 2 or 3
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consultations they [shamans] will do, the person becomes alright. They will say, okey, this goddess is unhappy with you, I’ll do this kind of “puja”, and I’ll have to sacrifice this chicken, it costs you around 50 rupees, and this goddess, she will become happy….And after 2 or 3 consultations the person is fine - finish! – and a symptomatic relief is there, the person and the whole family feels better. But if that person comes to our side, then we’ll do all sorts of investigations: CT-scan, EEG, and then psychotherapy counseling takes long time, takes a lot of money. So, if they are doing that kind of job with the same sort of result, why not they should continue doing that? And it worked very well in that way, in epileptic patients refering to this side, they are on anti-epileptic medicines, patients with psychosis, okey, they’ll start with anti-psychotic medicines. In our programme we had 5 basic medicines: phenobarbital tablet only that for epilepsy, chlorbromazine tablet, amitriptylin tablet for depression, chlorbromazine for psychosis…, like the basic medicines used to be given. It was all given free of cost as part of the programme. So, it was working, so this was the experience which I think I was sharing with you the last time also and you know, there is, for many years to come, these villages will not have the services of psychotherapists or psychiatrists. Maybe hundred years, maybe hundred, two hundred years..so by then they will still be providing services, so instead of replacing them, throwing them out or saying them they are useless people and this, we should work in collaboration with them and in that way we can provide better services. That’s what we concluded. C&M: Has there been any attempt to train traditional healers in the line of other departments like obstetrics or internal medicine, like for different kinds of diseases or problems? Prof. Dr. M. Nepal: Not so much, not so much, this is an interesting question… Appendix
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C&M: Mostly psychiatric? Prof. Dr. M. Nepal: Psychiatry we have used them as therapists, but they have been used as, more as a messenger or health education people for this rehydration solution, nun chini pani, that solution, advertisement of that, they have been used as a messenger. In some places for tuberculosis programme, identification of tuberculosis in the villages, they have been used in the eastern part of Nepal, as part of, I think the British-Nepal Medical Trust has used them. In some places maybe for family planning and other programmes they have been used. But our sources that if we, we used them more as a colleague. Other programmes, they use them more as agents of change, you know, because they were so popular, so powerful, so they could just spread the message. But we used them as an equal therapist. Do you see the difference? But this is an interesting question. C&M: What is your opinion on the consciousness of biomedics here in Nepal upon the other alternative healing systems that exist. Is there any attempt to collaborate, e.g. I’m working in surgery here. I don’t think the surgeons are very much interested in collaboration or even conscious about what happens in the village area and how traditional healers try to deal with the problems in village level. Prof. Dr. M. Nepal: It is another interesting question. It depends upon the training and the background of persons involved. That of course is there. So surgeons are more a mechanical kind of speciality as you know. So, for them it will be less. Even in the psychological aspects of the patient care they have a minimum kind of experience or knowledge about that. They are all mechanical: okey, this and that sort of thing is it, this has to be removed, this has to be replaced - that kind of mechanical mind they have. But in general, it’s not there. There’s one question, it’s of stigma.
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Stigma, you know, these people are uneducated, illiterate village people and if we try to relate ourselves with these people then it’s not so good, you are considered again low. C&M: So it’s not considered as a resource or… Prof. Dr. M. Nepal: I’m trained in Germany, and so why should I talk with these illiterate people. That kind of stigma is there quite a lot. Other prejudices not so much. But, you know, biomeds, you know this is an interesting question on other sides, you people are coming all the way from Germany getting interested in this and asking all these questions. Here, you know, this tradition of alternative medicine and complementary care these exist. These are the originators of this system in the world, this part of the world. But it is completely neglected. It is completely banned. These people are more towards the western side, more mechanical, more modern, so-called modern kind of approach they are going on and this part is ignored, overlooked completely. And it’s not considered modern or development, if I start talking about this sort of things my colleagues will think that I’ve gone either crazy, mad myself or they’ll think that I’m talking about non-development, I’m not trying to develop psychiatry myself. But once you come, people from Germany will come and ask me these questions, they’ll say “Oh, this is very important, because people from Germany also are interested in this!”. That kind of attitude. But there is, a good blend has to take place. Biomedicine has some advantages, good things. This alternative, complementary medicine has certain advantages, certain good things. And what patients need, what societies will need: best of the two things. You know, if something is working here, if it is better on this side, why not to take it? There is good on this side, why not to take it? Whatever patient care, care of the patient is, it’s the best of the two worlds what we need, not thinking of this is, this comes from rural area, this comes from the illiterate part of society, Appendix
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this comes from lower caste group. No! It is working, it’s worth. It has to be blended. So that are the rules to be there and I was talking to my colleague, the Dean of the Institute of Medicine, we were talking earlier here, and he was saying that he is reading through all these books on psychology and all he had red when he was student age, and now he is reading again and he is finding it very interesting. He’s a pediatrician. And, we were talking in that way, that in Nepal and in this part of the world nowadays, you know, there is a lot of Yogis, practitioners have become very famous in this. There is one called Ram Deva. Have you heard of him? He gives, in the television he gives programmes. Millions of people in India they are taking this, many in Nepal also, many of my patients, many people I know, not patients, even other persons also. All my days have changed, knowing I’m getting right up, I’ll talk in the morning, and one hour lying in front of television seeing Yoga and I’ll do this.. C&M: I know this… Prof. Dr. M. Nepal: You saw this? C&M: Yes, a friend of mine, actually a German, too, sits in front of the TV in the morning sometimes. Prof. Dr. M. Nepal: Many Nepali people tell me like that, many of my patients. And he teaches this and that, … and I feel much better now and healthy. And he is extreme, Ram Devas views. He says they’d throw off their medicines, blood pressure medicines, depression medicines and other medicines, you don’t need medicines at all. Practically, it’s another extreme. So, and he has become very, very popular, extremely popular in a short span of time: Within the last one year, two years! He’s such a popularity, because of the media also, television, satellite television these days it goes a lot of places and people see it and … So the popularity of
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these people and the effectivity of their methods is an alternative approach. It is primarily stress-related problems, psychological things which he’s handeling, and then he’s providing emotional support. He’s providing counseling through the television channels to a large number of people. And people are getting better, they are feeling better, which was not being provided by these surgeons we were talking about, these physicians we were talking about. You go to cardiology, cardiologist I think are so mechanical, you know they do ECG, Echo, this, that, heart problems, this that, but they’ll not think of the psychological aspect, the mental health aspect of heart problems. They’ll not think. Psychological aspects for them, once they think of mental health, it means only hardcore psychiatric, schizophrenia, manic-depressive or those sorts of things considered psychiatric. The milder form of things is not considered psychologically ill. But it’s widespread, it’s very widespread and people are getting, this sort of people are getting better, they used to be feeling sick, but they are feeling better nowadays. Even in the mental health, in large epidemiological surveys, done in many countries, in our country also it was done. Almost, I remember, 42 or 45 percent of the German population they have identifyable mental health problems; and lots more here. Almost 45% of the German population, this survey was done 2 years or 3 years back, observation in psychological medicine. Okey, that’s a huge number. And this years in the June month, the month of June, in America, a survey of a similar subject was published which said that more than half of the Americans, more than half, they had an identifyable mental health problem. Similar method, the German survey and the American survey was done similar method. They have identifyable mental health problems. So, you know what happened in America? For two days or three days all the major newspapers had headlines that half of the Americans are mentally ill, the large (???). And mentally ill means, again misconception is people think metally ill means people are psychotic, crazy,
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mad – this is not true! There are sort of softer psychological illnesses: stresses, anxiety, depression, this sort of things. And those things are not easily identified also. The person who is suffering, he or she also cannot complain, he also will not know what is happening. There’s no biological test, there’s no x-ray, there is no scan, there is no blood test or there is no blood pressure test, like this. So these people keep on suffering, they keep on going to the doctors, not knowing what is happening. So these are the people who are getting benefits from this – you know alternative methods of treatment. And all of them are checked, as the villagers in my project, all of them will not require medicines. All of them will not require surgery. They will be alright with simple counseling, with emotional support and simple psychological techniques which Ram Deva is providing through the, from the “idiot box”. C&M: Yes, every morning… Prof. Dr. M. Nepal: Every morning. Maybe you ask one question more and then we meet again. C&M: Yes, that’s no problem. Maybe you could give an outlook to the future what you expect like for the situation here in Nepal. Is it possible that more and more biomedical doctors get involved in projects like the one you are doing? With a consciousness of having lots of traditional healers around that could help to establish a nationwide medical health care system. Prof. Dr. M. Nepal: It has to be done. But people recognize the role of psychological factors in the health, that part is being recognized day by day. That is an amazing thing to see. In front of my eyes things are changing. Many things are changing. I had not dreamt when I had come here, as a psychiatrist trained in India, I came here to start a Department in
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Teaching Hospital, in 1986. That time, I had not thought that things will change so rapidly, so fast. But this is happening, this is a very positive, very good thing. In Nepal also this is happening. So change is possible, even in Nepal! That’s what I say. C&M: That’s the quotation we have in the medical library.. C&M: But this only can work after you showed the westerners how this can work, like shamanism, because they came here to learn about shamanism and then do this in Germany and then it’s … people are getting more interested in stuff like this, because they can reach it in Germany also, they don’t have to travel to Nepal. Prof. Dr. M. Nepal: Yes, that is my quotation. I always give that quotation, so when I was the director of the hospital, I was the director earlier, so my quotation was picked up. So in front of my eyes things have changed. So, it is possible to bring in changes, but this actively involving traditional healers in the treatment process, that needs to be done by someone. At the moment not too many people are doing it. So, but at certain points of time, few people will recognize that need. But actively people are not doing it. But I was surprised, in the western countries like Germany or America, the interest in alternative medicine increased. That again will come back here. That will come back here as well. So there«s a doctor in Germany, he does treatment with both the things, he does modern medical treatment also, he does this shamanism also. So Nepali doctors also will start doing that, start practising that. So in a way, it has gone to the West and come back. And the West again is a kind of leader - role models who«ll show us the path. Prof. Dr. M. Nepal: These things were established thousands of years back here. And then in between the importances of these things were lost,
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we lost the contact and touch with these things. And these people have started rushing towards western things, things which were much more materialistic and it«s like that. And now that reconnection has to be made. And you need a strong leader for that, really strong, whether I«ll fit for that I doubt! C&M: And you see the way goes through the western side, so first it goes to the west and then it comes back, like a re-import to Nepal? Even though the source of all of this alternative medicine has originally come from Nepal… Prof. Dr. M. Nepal: Yes, it was for around 2000 years, like Indians say in India. Our Nepal was a small country, so this part of the world remained as ah.. colonized by outside forces. So since the last 2000 years these things happening are happening. And as a result, people have lost their confidence in their ability, their potential that we could also do something new. You know that lack of confidence, that they are completely disempowered, because of they have sort of subdued…. earlier by Muslims, earlier by other sorts of invaders then Muslims, like Hindus, Aryans they call it. You know the Aryans? Hitler used it in a bad way. But they call Aryans, so Hindu Aryans are not that Hitler-way, but in a different way. But they were subdued for the last 2000 years. Then while the British came, and there was lot of in-fighting and the caste system that developed in an upper, higher caste and a lower caste. You know, the Hindu caste system: four caste systems, the Brahmins, the Kshatriyas, the Vajshyas, Shudras and the Untouchables. So, they started fighting amongst each other. Whereas, you know, the Muslim religion came and Christianity came, where everyone is equal, where everyone could go everywhere. So, those were sort of revolutionary ideas, which were picked up very fast. Whereas the old Hindu Aryan tradition, you know, started fighting with each other. So they were subdued, they lost the batAppendix
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tles and they were subdued for 2000 years. And as result of that they have lost that confidence that we could do something on our own and we should work. In my thinking that is the reason. So it has to go to the west and then is has to be re-imported. But change is possible even in Nepal!!!
C&M: Thank you very much. 1.2. Dr. R. P. Gartoulla, Dep. of Public Health, TUTH, Kathmandu . Interview questions for Ass. Prof. Dr. R. P. Gartoulla, answered by email in November 2005: . Q: Could you just introduce yourself and give a brief summary on the topics you are interested in in medical anthropology? A: I have been involved in this field since 1984. First, I started doing research and then teaching to medical, public health and nursing graduates and postgraduates, supervise thesis of bachelor, master and Ph.D. students. Q: What are the causes for patients to seek help either with a shaman or with a biomedical doctor? A: The term “patient” is not suitable everywhere. The term should be used in a hospital after havingproper diagnosis (not symptomatic) with pathological and radiological (where applicable) probing and given treatment with drugs and/or surgical cases.You may use the term as “users/ consumers” visiting either to shaman healers or health professionals. They go to shaman healers because: They have long term relationship • Mostly local • Culturally same group •
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• • • • • • •
Low cost Easily available Meet on time Simple way of curing In the same religious background Kin relationship Faith
No taboos on shamans ingredients (see the book entitled Therapy pattern of conventional medicine…available at TUTH library and also see Quest for Health available at library and in the market) People generally go to health institutions after the advice of shaman healers. Very few directly go to health institutions because of belief, cost and previous experiences. Q: Which role does the income of the family, social status, caste, age, sex and religion play for this decision? A: Generally, culture plays vital role for the decision of consultation and medication. Income, social status and demographic status determine for the decision process. The cost of health institutions is not bearable to the poor is an important phenomenon to push towards shamanism. Gender is another factor for pushing to shamanism because, mostly the male as an active income generator of the family will get proper medication even though that is costly. Q: What are the main questions why people seek help with a shaman? Or any other alternative medical practitioner? (See answer of no 1 question) Cure rate • Availability • Low cost •
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Q: Do you think both approaches on disease (sickness) and health – the biomedical and the shaman’s way - are influencing each other? What could be the synergism coming out of this co-existence? Has there been research on this special question? A: There is very few research which is not sufficient. Only after promulgation of Tenth Five Years Plan it has given priority for coordination of both services. The government level do not have action plan to integrate both fields. Medical practitioners do not wish to be with shaman healers and there is the problem of recognition of shamanism among the medical personnel. I don’t see any co-existence between two practices. Q: Do you think it’s possible to implement traditional healers in the national medical system to guarantee a country wide access to health facilities? (E.g. Mental health in communities managed by Jhankris.) How do you think implementing could be done? Has there been any effort for this so far? A: It would be very nice to integrate THs in National health stream. But, miserably it has not been started yet. THs are the first front line health manpower in all strata of the country, but the government policies are silent on this. The policy makers and NGOs do not understand the truth. THs are the most institutions to provide health care, but are out of training and linkage. Q: Is there consciousness about the existence of alternative healing methods within the biomedical structures in Nepal? Do biomedical doctors take it into account? A: I don’t think it is so.
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Q: Do both, the biomedics and the alternative healers, see the limitation of their own approach to illness/sickness and health? A: Yes absolutely they see, but separately. There is no coordination and networking between them. Q: Overlooking the past 10 years, did you find major changes in the way patients chose their healers or in the consciousness of biomedical doctors and shamans about each other? A: The populations with exposure by the CBOs, NGOs and FCHV, TBA have changed health seeking behaviour. Now a days they contact to biomedical institutions where NGOs are working, but still they go to shaman healers first and only then to health institutions. Q: What is the present situation? What are you expecting for the future? A: Even though the modern health facilities are available, people do not go to health facilities directly. More than 50% of the population do self medication. (see o Google search type “Ritu Prasad Gartoulla” you will get self medication) Q: What about other possibilities for alternative health care like Ayurveda, Unani, etc.? How do they influence both, the biomedical and the shamanic treatment? A: The possibilities for alternative health care like Ayurveda and Unani are like allopathic medicine which has certain standards to follow for receiving and giving treatment/medication. They are the developed form of Ethnomedicine and are common and popular.
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Q: Are there any culture bound syndromes in Nepal? (E.g. Susto in Latin America.) How are they dealt with and how are they described by the anthropologists? A: The feeling of supernatural being (see the book on Medical Anthropology written by …?? Published from UK..) and personalistic and naturalistic etiologies. (see the book on An introduction to Medical Sociology and Medical Anthropology available at TUTH library/Nursing library Maharajgunj). Ethnopsychiatry is the example in Nepal where THs heal/ treat through chanting till the problem is not removed. There are several examples of culture bound syndromes (see Therapy pattern of conventional medicine and also Quest for Health). Q: Further literature …? A: Go through above mentioned three books for literatures and Google search. Q: New edition of an Introduction to Medical Sociology and Anthropology? A: I am going to correct the manuscript to publish the second edition within 6 months probably. Thank you. TABLES
The following figures serve to illustrate the social situation in Nepal (Tiwari 2005) TABLE 1.
population density of population
23.151.423 157 persons per km2
number of households in per cent in
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The following figures serve to illustrate the social situation in Nepal (Tiwari 2005) TABLE 1.
rural areas urban areas population growth rate annual per capita income Literacy rate Men Women Life expectancy at birth Total fertility rate/woman Death rate of mothers at birth/ 100.000 life births (1996) Death rate of children at birth/ 1000 life births Death rate of children under 5/ 1000 life births Access to drinking water High quality drinking water Medium quality drinking water Basic provision with drinking water
TABLE 2.
83.90 % 16.10 % 2.24 % 235.00 US $ 54 % 65 % 43 % 62.2 years 4.1 539 64.2 91 71.6 % 4.4 % 6.4 % 60.8 %
Health Services Coverage Fact Sheet 1
REPORTING STATUS
1999/00
2000/01
2001/02
District to MIS Section
100%
100%
100%
Hospital to DHO
61%
75%
80%
PHCC to district
96%
96%
96%
HP to District
95%
97%
97%
Sub Health Post to HP/PHC
92%
94%
94%
FCHV to SHP/HP/PHC
55%
58%
61%
TBA to SHP/HP/PHC
51%
51%
53%
NGO Private Sectors/Others to DHO
63%
58%
70%
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TABLE 2.
Health Services Coverage Fact Sheet 1
EXPANDED PROGRAMME ON IMMUNISATION 1 BCG Coverage
97%
95%
94%
2 DPT-3 Coverage
80%
80%
80%
3 Polio-3 Coverage
80%
80%
80%
4 Measles Coverage
77%
75%
76%
5. Number of children <5 Years Received Polio (NID-Phase 1)
3,632,031
3,949,54 4
4,116,535
Number of children <5 Years Received Polio (NID-Phase 2)
3,808,542
4,012,55 9
4,126,782
6 Growth Monitoring Coverage as % of <3 Children New Visits
34%
38%
31%
7. Promotion of Malnourished Children (Weight/Age-New Visits)
21%
18%
16%
8 Reported incidence of ARI/1,000 <5 children New Visits
166
210
229
9 Annual Incidence of Pneumonia (Mild+Severe)/1,000 among <5 Children New Visits
72
90
97
10 Proportion of Severe Pneumonia among New Cases
5.3
4.2
3.8
NUTRITION Growth Monitoring
ACUTE RESPIRATORY TRACT INFECTION
TABLE 3.
Health Services Coverage Fact Sheet 2
DIARRHOEAL DISEASES 11 Incidence of Diarrhoea/1,000 <5 Children New Cases
164
177
177
12 % of Some Dehydration among Total New Cases
41.1%
41.7%
41.6%
13 % of Severe dehydration among Total New Cases
5%
4%
4%
14 Diarrhoeal Deaths /1,000
0.7
0.1
0.04
15 Case Fatality Rate/1,000
0.4
0.4
0.22
165 First Antenatal Visits as % of Expected Pregnancies
35%
41%
43%
17 Average No. of ANC Visits per Pregnant Woman
1.7
1.8
1.9
18 Deliveries Conducted by TBA as % of Expected Pregnancies
5.3%
6.5%
7.1%
19 Deliveries conducted by trained person (Including TBA's) as % of expected pregnancies
13.5%
13.8%
15.0%
20 Contraceptive Prevalence Rate (CPR)
34.5%
36.9%
37.4%
21 Condoms
1.9%
2.1%
2.2%
2.3%
3.0%
2.6%
SAFE MOTHERHOOD
FAMILY PLANNING
22 Pills
(CPR Method Mix)
"
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TABLE 3.
Health Services Coverage Fact Sheet 2
23 Depo Provera "
8.7%
9.7%
10.2%
24 IUD "
0.7%
0.8%
0.8%
25 Norplant "
0.8%
0.8%
0.8%
20.0%
20.5%
20.9%
27 Couple Years of Protection (CYP) By Method (% of MWRA) for New Acceptors
32.6%
34.1%
33.6%
28 Condoms
1.9%
2.2%
2.2%
1.2%
1.4%
1.5%
30 Depo "
6.1%
6.8%
7.2%
31 IUD "
1.5%
1.6%
2.1%
32 Norplant "
1.0%
0.9%
0.7%
33 Sterilisation "
20.7%
21.3%
19.8%
34 Blood Slide Examination Rate per 100 Malarious Area Population
0.6
0.7
0.6
35 Slide Positivity Rate (SPR)
8.9
5.4
9.2
* 36 Case Detection Rate
67%
69%
70%
* 37 New Sputum +ve
13,446
13,683
13,714
*38 Treatment Success Rate on DOTS
89%
89%
89%
*39 Sputum Convertion Rate
84%
84%
84%
*40 DOTS Coverage (Population)
75%
84%
89%
** 41 New Case Detection Rate/10,000
3.18
3.44
5.73
** 42 Prevalence Rate/10,000
3.88
3.43
4.41
** 43 Disability Rate Grade 2 Among New Cases
7.18
8.43
4.31
44 Total OPD New Visits
7,036,459
7,846,6 67
8,642,8 52
45 Total OPD New Visits as % of Total Population
30.7%
33.4%
35.8%
265 Sterilisation
29 Pills
"
(CYP Method Mix)
"
MALARIA CONTROL PROGRAMME
TUBERCULOSIS CONTROL PROGRAMME
LEPROSY CONTROL PROGRAMME
CURATIVE SERVICES
Source: FHD, PFAD/DoHS, 2002 * NT, ** NTC, ** LCD, N/A: Not Available Kandel D 2003 10 02 The past and present health system of Nepal; www.asiatraditional-
medicine.it/archivio/file/000/schede/ Kandel_D_2003_10_02_The_past_and_present_health_s ystem_of_Nepal.doc; Retreived 21.02.2006
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FIGURE 13. DoHS Annual Report 2001/2002: Organisational Structure of the Department of Health Services
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FIGURE 14. Information broschure Shamanistic Studies and Research Centre, Naikap Page 1
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FIGURE 15. Information broschure Shamanistic Studies and Research Centre, Naikap Page 2
GLOSSARY OF NEPALESE TERMS
A Amchi: Tibetian herbal healer ankat herne: rice diagnosis Ayurveda: the knowledge of long life, old Hindu tradition of healing B Baidang: shaman who does not enter trance state and only uses Jharpuk for diagnosis Ban-Jhankri: original shaman Appendix
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Bayu: spirit of wind and air demanding to be accepted into the circle of ancestor spirits Bell mala: necklace made of bells, worn by shamans in healing ceremonies Bhairab: deity representing the southern sphere in Nepali shamanistic cosmology Bhuta: spirit of a person who died of unnatural causes Bijuwa: Rai word for shaman Bokshi: witch Brahman: highest caste in Nepalese Hinduism C Chang: rice beer Chhetri: second-highest caste in Nepalese Hinduism Chinta: shamanistic healing ritual chiso: cold D Devi: goddess F Fedangwa: term chosen by the Limbu for a subgroup of their shamans
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G gharmi: hot Ghat: cremation site Graha bigrayo: unfavourable constellation of planets J Janne Manche: „people who know“; these are the „wise“ persons in a (village) community, e.g. elders, but also village teachers or healers Jhankri: shaman Jharphuk: short healing ceremony comprising mantra and removal of negative energies through passing hands over a patient Jharpukey: healer who does not enter trance state and only uses Jharpuk for diagnosis Jokhana: oracle used by shamans for diagnosis Jungali: queen of the forest; she plays a significant role in the cosmology of Nepalese shamanism Jyotishi: Hindu astrologer K khadco kattne: ritual of cutting the lines of fate Khukuri: Nepalese knife kubidhy: bad knowledge, knowledge employed with evil intention
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Kuladeva: ancestor spirit L Lagu: general term for evil spirits Lama: Buddhist scholar Limbu: ethnic group in Nepal M Mala: necklace Mangba: member of a subgroup of Limbu shamans. Specialist for haunted souls of persons who died from violence or at birth Mantra: prayer formula Masaan: certain type of evil spirits N nadi herne: pulse diagnosis Naga: snake, snake god Nun chini pani: oral rehydration solution O Ojha: shaman who is considered an expert for particularly serious acute or chronic disorders P
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Phombo: Jirel word for shaman Phurba: ceremonial dagger, ritual object used by Nepalese shamans Pret: evil spirit Puja: worship Pujari: priest, i.e. person who performs the Puja in a temple R Rai: Tibetian-Nepalese ethnic group in Nepal Rithamala: necklace made from seeds of the soap nut Rudrakshamala: necklace from rudraksha seeds S Saano: small Samba: member of a subgroup of Limbu shamans. He is an expert in Mundhum, the oral traditions and mythologies of the Limbu Shikari: the hunter, plays an important role in shamanistic cosmology in Nepal Subidhy: good knowledge, knowledge employed in a positive sense, e.g. in healing T Tamang: ethnic group in Nepal
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U Unani: Arab healing tradition that reached Nepal via India and is based on the homoral pathology according to Galen V Vaidhya: Ayurveda practitioner Y Yeba: member of a subgroup of Limbu shamans. He is an expert in diseases attributed to supernatural causes Yema: female form of Yeba
4. REFERENCES
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Blustain, Harvey S. (1976) Levels of medicine in a central Nepali village; in: Contributions to Nepalese Studies; Vol. 3; 83 – 105; Kathmandu Böker, Heinz (1992) Concepts of mental illness: an ethnopsychiatric study of the mental hospital«s in- and out-patients in the Kathmandu valley, in: Contributions to Nepalese Studies; Vol. 19, No.1; 27 - 50; Kathmandu CIJ - Centre for Investigative Journalism (2004) People in the ‘People’s War’; Himal Books, Lalitpur, Nepal Davies, Marcus (1994/95) Modern and Traditional Medicine in the Developing World; in: Latitudes – The Mc Gill Journal for Developing Studies; Vol. 4; Mc Gill University Montreal, Quebec, Canada; Retreived 4.02.2006 from www.ssmu.mcgill.ca/journals/latitudes/volumes.htm Dietrich, Angela (1996) Buddhist healers in Nepal – some observations, in: Contributions to Nepalese Studies; Vol. 23, No. 2; 473 - 480; Kathmandu Dixit, Hemang (1999) The Quest for Health; Educational Enterprise (P) Ltd; Kathmandu; Second Edition Donner, Wolf (1990) Nepal. Beck’sche Reihe, Aktuelle Länderkunden; München Dougherty, Linda M. (1986) Sita and the Goddess: A Case Study of a Woman Healer in Nepal; in: Contributions to Nepalese Studies; Vol.14; No.1; 25 – 36; Kathmandu Durkin-Longley, Maureen (1984) Multiple therapeutic use in urban Nepal; in: Social Science and Medicine; Vol. 19; No. 8; 867 - 872
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Eigner, Dagmar (1998) Struktur und Dynamik schamanischer Heilrituale in Nepal; in: C. Gottschalk-Batschkus (ed.) Curare Sonderband 14/98 Ethnotherapien. (p. 66-69) VWB-Verlag für Wissenschaft und Bildung; Berlin Gartoulla, Ritu Prasad (1998) Therapy pattern of Conventional Medicine with other alternative medications – A study in medical anthropology in Nepal; Research Centre for Integrated Development, Kathmandu Graner, Elvira (2005) Kartoffeln und Nepalis - Subsistenz-Ökonomie und internationale Migration; Nepal Information Nr.95; Juli 2005 Green, Edward C. (1988) Can collaborative programs between biomedical and african indigenous health practitioners succeed? In: Social Science and Medicine; Vol. 27; No.11; 1125 - 1130 Hackenbruch, Elgin (Hrsg.) (1998) Going International – Pflegende in der Entwicklungszusammenarbeit und Humanitären Hilfe; Ullstein Medical Haddix McKay, Kimber (2002) Health needs in two ethnic communities of Humla District, Nepal; in: Contributions to Nepalese Studies; Vol.29; No. 2; 241 - 273; Kathmandu Himalayan Amchi Association; Sienna Craig Introduction to traditional amchi medicine. Retreived 16.02.2006 from www.drokpa.org/haa.htm Hitchcock, John T.; Jones, Rex L. (1976) Spirit Possession in the Nepal Himalayas; Vikas Publishing House, Reprint 1996 Jones, Rex L. (1976) Limbu Spirit Possession and Shamanism; in: Hitchcock, John T. & Jones, Rex L.; Spirit Possession in the Nepal Himalayas; 29 – 55; Vikas Publishing House, Reprint 1996 Appendix
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Kleinman, Arthur (1978) Concepts and a model for the comparison of medical systems as cultural systems; in: Social Science and Medicine; Vol. 12; 85 – 93 Kleinman, Arthur (1981) Patients and Healers in the Context of Culture – An Exploration of the Borderland between Anthropology, Medicine and Psychiatry. University of California Press; Berkeley, Los Angeles; London Kristvik, Ellen (1999) Drums and Syringes; Bibliotheca Himalayica; Series III; Vol. 7; Kathmandu Ludwig, Bruni; Pfleiderer-Becker, Beatrix (1978) Materialien zur Ethnomedizin; Spektrum der Dritten Welt 15; Hrsg.: Wilfried Euchner; KübelStiftung gGmbH, Bensheim Molesworth, Kate (2006) Community Action for Health in Conflict; in: Bulletin von Medicus Mundi Schweiz Nr. 99; Januar 2006; Retreived 22.02.2006
from
www.medicusmundi.ch/mms/services/bulletin/
bulletin200601/kap02/Moleswort h.html Müller-Ebeling, Claudia; Rätsch, Christian; Shahi, Surendra Bahadur (2000) Schamanismus und Tantra in Nepal – Heilmethoden, Thankas und Rituale aus dem Himalaya. AT Verlag; Arau, Schweiz Okada, Ferdinand E. (1976) Notes on two shaman-curers in Kathmandu; ; in: Contributions to Nepalese Studies; Vol. 3; 107 - 112; Kathmandu Peters, Larry G. (1979) Shamanism and Medicine in Developing Nepal; in: Contributions to Nepalese Studies; Vol. 6; No. 2; 27 - 43; Kathmandu Pfleiderer, Beatrix; Bichmann, Wolfgang (1985) Krankheit und Kultur – Eine Einführung in die Ethnomedizin; Dietrich Reimer Verlag; Berlin Appendix
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Poudyal, Bimal (1997) Traditional Healers as Eye Team Members in Nepal; in: Community Eye Health Journal; Vol. 10; No. 21; 4 - 5 Rätsch, Christian (2000) Die Zukunft des Schamanismus; in: MüllerEbeling, Claudia; Rätsch, Christian; Shahi, Surendra Bahadur; Schamanismus und Tantra in Nepal – Heilmethoden, Thankas und Rituale aus dem Himalaya; AT Verlag; Arau, Schweiz Reinhard, Johan (1976) Shamanism and Spirit Possession: The Definition Problem; in: Hitchcock , John T. & Jones, Rex L.; Spirit Possession in the Nepal Himalayas; 12 – 20; Vikas Publishing House, Reprint 1996 Shankar, P. Ravi (2001) A study on the use of complementary and alternative medicine therapies in and around Pokhara sub-metropolitan city, western Nepal; Pokhara; Internetrecherche, Retrieved 21.01.2006 fromhttp://clinmed.netprints.org/cgi/content/full/2002050007v1 Sidky, H.; Spielbauer, Ronald H.; Subedi, Janardan; Hamill, James; Singh, Robin; Blangero, J.; Williams-Blangero, S. 2000: Phombos: a look at traditional healers among the Jirels of eastern Nepal; in: Contributions to Nepalese Studies; The Jirel Issue; 39 - 52; Kathmandu Starke, Wolfhard (2005) Eine Alternative zum Vorruhestand – Als Unfallchirurg in Nepal; in: Deutsches Ärzteblatt; Jg. 102; Heft 31 - 32; 8. August 2005 Stone, Linda (1976) Concepts of Illness and Curing in a Central Nepal Village; in: Contributions to Nepalese Studies; Vol. 3; 55 - 80; Kathmandu Stone, Linda (1983): Hierarchy and food in Nepalese healing rituals; in: Social Science and Medicine; Vol. 17; No. 14; 971 - 978
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Stone, Linda (1986) Primary Health Care for whom? Village perspectives from Nepal; in: Social Science and Medicine; Vol. 22; No. 3; 293 - 302 Subedi, Madhusudan Sharma (2001) Medical Anthropology of Nepal; Udaya Books; Kathmandu Tiwari, Dipak Prasad; Kandel, Saroj Prakash (2005) Health Data and Facts Sheet with quick review of health; Institute of Medicine, TUTH; Kathmandu Tiwari, Dipak Prasad; Kandel, Saroj Prakash (2006) Traveliteindia Unani System of Medicine;
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dia.com/healing1.asp United Nations (2004) Nepal Human Development Report 2004 WHO; Maria Paalman (2004) Towards Pro-poor Health Planning – In the Context of Macroeconomics and Health; Country Case Study Nepal; Royal Tropical Institute Amsterdam Young, Allan (1983) The relevance of traditional medical cultures to modern Primary Health Care; in: Social Science and Medicine; Vol. 17; No. 16; 1205 – 1211
Gratitudes I want to express my gratitude to all persons involved immediately in the generation of this publication: to the Ethnomed team for the wonderful time I spent in Munich in further education, for the unusual experiences and encounters. I found the right track in my life, many pieces of the puzzle suddenly fit in – thank you! In particular I wish to mention Florian Rubner who always had valuable suggestions, who endured endless dis-
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cussions and answered all questions with equanimity; Jörg Fachner, Gerhard Tucek and Christian Rätsch who turned my concluding colloquium into a new start with their ideas and comments, and Andreas Reimers, a physician who shares my interest in Nepal and shamanism. I thank Prof. Dr. Aldridge for the opportunity to publish this paper and for the in-depth discussion prior to publication, and Christina Wagner for her translation. I also thank the Evangelisches Studienwerk e.V. Villigst; without their generous support I would never have been able to afford the journey to Nepal nor the Ethnomed course. My heart-felt thanks go to all others whose active and unflagging support helped me to conclude this paper, specifically Prof. Dr. Nepal and Ass. Prof. Dr. Gartoulla whose willingness to be interviewed and whose publications facilitated my approach to the subject. I would also mention Binod Shresta, who is still wondering why I find the subject so exciting but nevertheless provided organizational backing, and Sudeep who introduced me to the mysteries of the Nepalese language. I am grateful to Mohan Rai, Suraj, Marion and Shiva for their lessons in shamanism and for the many clarifications, to the wider Rai family and in particular to Chhema and Raj Kumar for making me feel at home. I thank Markus for sharing ethnographic material. My specific thanks go to the shamans at the Shamanistic Studies and Research Centre in Naikap; their gift to me is more than I can express in words. And finally I would like to thank all those people in Nepal I met who helped me to develop a deeper understanding of the small things in
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every-day life and who permitted me to share their joy and their suffering. They will always have a place in my heart. In addition I thank my parents and friends for their continuous and tremendous support; without them I would not have been able to cope.
Carolin Häußermann
Author details FIGURE 16. Carolin Häußermann
Study of medicine at University Witten/Herdecke, Germany; Scholar of Evangelisches Studienwerk e. V. Villigst, Germany; finished the study course Ethnomedicine at the Institute for Ethnomedicine in Munich, Germany in June 2006; training in Acupuncture (TCM) at University Witten/ Herdecke; medical internships and practice in Portugal, Brasil, Nepal and the UK INTERESTS:
cultural understanding of health and illness; Synthesis of shamanism and biomedicine in Nepal
Author details
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THIS ARTICLE CAN BE CITED AS:
Häußermann, C. (2006) Shamanism and biomedical approaches in Nepal –Dualism or Sythesis? Music Therapy Today (Online 1st October) Vol.VII (3) 514-622. available at http://musictherapyworld.net
Author details
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Music Therapy Today Vol. VII (3) (October)
Traditional oriental music therapy – a regulatory and relational approach Gerhard Tucek
Introduction Traditional oriental music therapy is a system documented over about one thousand years, of therapeutic, prophylactic and rehabilitative relevance, as we see it today, and has proved its worth in practice. In its traditional form it was used in hospitals as a regular paramedical discipline and part of Islamic arts of healing from the 9th century onwards. One theoretical basis was humoral pathology (the theory of four humours), another the religious-philosophical conviction that music – as an audible musical transposition of cosmic sound – nurtures the „spirit soul“ as well as the „material body“. The idea was that a variety of different microtonal scales (Makamat) helped to produce certain desired effects in organic systems and emotions through a regulative effect of music on the „humours“. For further historic details see references1.
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With the replacement of the humoral-pathological treatment model by the concept of biomedicine, this therapy approach disappeared from hospitals in Turkey and the Arab countries. In the middle of the 1980s, Oruc Güvenc returned to the approach in Istambul and tried to re-establish it in the traditional form. His efforts assumed an intercultural dimension through cooperation with this author from 1984 onwards (compare Tucek, 2003). In Austria today, the approach has been adapted to local conditions with regard to clinical needs, is well established and increasingly evaluated according to scientific criteria (see below). A basic difference between the traditional and the current therapy concept may be summed up as follows: in the Middle Ages, music was interpreted as an objective quality of being (in orient and occident alike). The individual was able to make this quality visible, but not capable of producing it himself. Today, in contrast, music is interpreted as a subjective human expression that may find its fulfilment in beauty. For an understanding of traditional oriental music therapy (as it is practiced and taught in Austria today) this change means that the therapeutic effects are no longer based on a ‚cosmic system’ from outside, but rather on a re-structuring of an inner system. This occurs in the work (by those involved in the process) on meaningful musical contents and forms of expression that may be experienced as pertinent. The method used in this context comprises an alternating musical dialogue between patient and therapist (compare Tucek 2005a), the „regulative-medical“ effects of music played live by the therapist, as well as therapeutic movement and dance exercises. 1. Güvenc, (1985); Kümmel, (1977); Neubauer, (1990); Schipperges, (1987); Shiloah, (2002); Tucek, (2003b).
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An essential challenge to traditional oriental music therapy (as part of the cultural transfer) was a scientific analysis of the receptive method in regard of the theory of an organ and emotion specific effect of the Makam structures. Modern findings from brain research describe the human brain as a socio-cultural organ1. Against this background, it must be doubted whether specific emotional contents may be transferred 1:1 to European patients via Arabic or Turkish musical styles. This is due not so much to any cultural prejudices but rather to culturally influenced (sound) preferences and images (on the part of therapist and patient). Nevertheless, clinical practice of traditional oriental music therapy shows clearly documented therapeutic effects. Some remarks in this context from the perspective of cultural and social anthropology: Man is a universal and at the same time a culture-specific being with regard to music perception. A universally human level is the location for the psycho-physiological effects of rhythms (drums, rattles, etc.) and sound spaces (harmonic overtone singing, gong, etc.) • The level of culturally shared experience with pertinent associations may be illustrated with the following example: most people in our culture associate the Christmas carol „Stille Nacht, heilige Nacht / silent night, holy night“ with a festive or joyful mood. • Let us now imagine a family singing this song in front of the illuminated Christmas tree when the father breaks down with a heart attack and dies. We may assume that what this song will evoke in this particular family in future will not be a festive mood but grief (level of subjective experience). •
1. Apart from the genetic basis, human experience is influeced by many ‚epigenetic’ factors (cultural, social, individual setting of experience).
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On the understanding that the therapist has incorporated the oriental musical material thoroughly in the course of his training and supervised practice, then he might be able to transfer basic emotional moods like joy, calm, peace etc. through a loving and joyful therapeutic relationship in support of the music. It is possible to establish new, and for the patient positive, sound experiences in this way (via Makam scales and oriental instruments). In selecting the modes and pieces of music, however, we must ensure that the chosen musical structures are not too remote from what a patient is used to listen to. In simple words, we must find a way between a potential „fascination“ for what is new, and a potential rejection of what is „just too strange“. If the therapist is successful here, he will stimulate therapeutic processes in the patient the physiological correlates of which may be measured and illustrated chronobiologically. A superior objective of the therapy is the intention to support patients during therapy in recovering a harmonic interplay between external cultural life style and internal subjective harmony. In this sense, “… music is not only what it is, it is what it means to the individual, what it can do for him or her … the pursuit of music can show human beings what they have in common.” (Sir Simon Rattle) Hesse demonstrated that a subjective access to various types of music in the course of a human life is not static but changes continuously (2003, p.7).
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In addition, our subjective access to music is determined by external factors. In our clinical practice we frequently observed patients and their families who developed a very positive attitude to musical offers of receptive traditional oriental music therapy; but after release from hospital they did not continue. Only upon re-hospitalization did this type of music regain significance. Therefore, a positive response to traditional oriental music seems to be conntected to the clinical setting. A relative said: “Now that I am back among the group, I know what I have been missing for the last six months.” Music thus serves to recreate the mood, not only as recreation, but as a turn to the innermost core. On this basis, music provides a natural foundation for the recovery of the “entire self”, even if the individual is seen as “sick” or “handicapped” in the medical sense. I believe an important effect of traditional oriental music therapy is that in first contact there are no (previously) established individual associations with known musical styles, since the sound (instruments, Makam structure) is so new and different. This leaves room for new structures and new associations.
Music therapy in medicine / music medicine I want to give a short description of the relationship between “music medicine” and “music therapy in medicine”. The following table by Krautschik (2003) sums up the most important positions which have considerable influence on the respective therapeutic concepts and their research designs. TABLE 1. therapeutic concepts and their research designs Music medicine Positivistic scientific tradition
Music therapy in medicine Hermeneutic scientific tradition
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TABLE 1. therapeutic concepts and their research designs Biomedical concept Music has therapeutic potential by itself Symptom orientation Starting-point: illness Music as medicine = desired biological effects
Relational-medical concept Emphasis on relation: therapist-client; musicclient Health orientation Starting-point: health (resources) Artistic-creative activity Improved quality of life through creative expression of self
From my perspective of a clinical music therapist it does not make sense to neglect the human and social dimension which is so important for the recovery of a patient (music therapy in medicine) in favour of an approach with a focus on the therapeutic potential of music programmes for the only purpose of lowering blood pressure, for example (music medicine). Personally I do not feel comfortable with a perspective that does not consider the traditional intention of music to move humans individually, socially and transcendentially1. I was deeply moved by the self-attribution of a patient with severe traumatic brain damage at the Center of Neurological Rehabilitation of AUVA in Vienna; after a therapy session where he had actively participated in music-making in the common room, he told other patients he was an “artist”. I quote Aldridge in this context: “… health is a performance that can be achieved. Health is not simply a singular performance; it is performed with others.” (2005; p.264) The question is which therapy approach may offer the most effective help to which patient in which situation and stage of therapy. It would be fatal
1. It must be noted, however, that other criteria in handling the therapeutic potential or music are legitimate and valid as well.
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to replace positions of music therapists by musical programmes in future in order to save money.
From empirical experience to scientific foundation: The clinical variety of traditional oriental music therapy of today combines both concepts in its equally “regulatory-medical” and “relationalmedical” approach. In the past, we evaluated clincial therapy processes via empirical observations and documentation (case description, video documentation). In addition we intend to found this approach on physiological “hard facts”. Early clinical studies (Murg, Tucek et al., 2002; Tucek, 2005b; Tucek et al., 2006) represented important steps. Clinical practice, however, was full of organisational hurdles. Selected research methods often limit the freedom of therapists to act. Consequently we continued to look for methods that would not confine a music therapist (in the sense of a best practice model) to a previously determined method of intervention (active versus receptive).
Regulatory-medical concept and receptive traditional oriental music therapy In a receptive therapy approach, precomposed pieces (comparable to the so-called play songs in Nordoff Robbins music therapy) alternate with rhythmically improvised passages. The effects observed were activating and deactivating respectively (sympathicotonic versus parasympathicotonic). Results of a clinical EEG study at the Meidling centre for neurological rehabilitation on patients with severe traumatic brain damage revealed
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that this receptive approach may have relaxing effects (reduced spasms) and at the same time improve vigilance (Murg, Tucek et al., 2002; Tucek et al., 2006). Similar relaxing and anxiolytic effects were reported in a study with 64 patients at the Groß Gerungs centre for cardiological rehabilitation (Tucek, 2005b). A recent clinical study on in-patient treatment for depressive episodes had comparable results (Scharinger, 2006). In summary: Traditional oriental music therapy appears to be a wellestablished means with a regulatory influence on mental-physiological processes. We now look at the question whether in addition to regulation (activating / deactivating effects) it is also possible to influence organs in a more differentiated way. The following – simplified – aspects are taken into consideration: If the therapeutic agent is in the structure of the note scales themselves, then this should have a direct impact on the body in the sense of a physical resonance phenomenon. (Assumption: Makam has (physiological) effects independent of cultural imprint). • If the therapeutic agent is in the mental influence via the associative channel, then music would be connected with previous cultural and individual experience in its predictable effects. (Assumption: All people – even all individuals – have “their own” music) • If the therapeutic agent is in the musical relationship, then music would be a human-relational resonance phenomenon. (Assumption: music functions as a significant field of experience and activity) •
Current research approach The dimension of relational and regulatory medicine will now be illustrated with two examples of measurement and on the basis of different chronobiological methods of data collection:
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Example 1 shows the change in the regulation state in a patient with acute myelotic leukemia (AML)1 through music therapy. • Example 2 illustrates the relational dimension between therapist and patient with acute lymphatic leukemia (ALL)2 in the course of a therapy unit with individual synchronous stages. (compare Tucek et al., 2006) •
EXAMPLE 1
A portable ECG apparatus with a scanner frequency of 4096 Hz, i.e. many times higher than traditional long-term ECG appliances, measures heart rhythms. The resulting so-called “spectrogram” reflects the rhythms of numerous endogenous systems (respiration, peristalsis, hormonal secretion etc.). The differences in the sequence of heart beats show the respective dominance of one of the two branches of the autonomic nervous system on the pacemaker nodes of the heart. (The sympaticus acts as an accelerating part of the autonomous nervous system (ANS) and generates fight, flight, performance etc.) The parasympathicus in contrast supports regeneration and recovery. This is why the parasympathically controlled part of the heart rate variability (HRV) is an indication of the ability to recover, which is an essential precondition for health. The following health parameters may be deduced from HRV measurements:
1. AML is a malignant cancer of myeloblasts. These are the immature preforms of various granulocytes. The immature granulocytes are nonfunctional and divide in uncontrolled fashion. Then they suppress the healthy blood cells from blood and bone mark and often infiltrate spleen, liver and brain. AML is the most frequent form of leukemia in adults. (Reference: www.ArztScout.com, per July 13, 2006) 2. ALL develops like this: Lymphocytes (subtype of white blood cells) that are responsible for immune processes degenerate. Degenerated lymphatic cells collect in the bone mark, destroy growing blood cells and replace them. (Reference: www.ArztScout.com, per July 13, 2006)
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•
•
•
•
•
•
General condition, vitality, “biological age”: the product of constitution and lifestyle. (Even with best genetic preconditions, “wasting illnesses” or unhealthy lifestyle may use up resources.) Regulatory capacity: adaptation and interaction between resonant frequency (day – night, rest – activity) and external influences (appointments, others, sports etc.) Physical resilience: lower pulse in sleep, heart rate under and after stress, range and intensity of frequency analysis of heart rate sequence reflect the potential in this area. Mental resilience: detection at 0.1 Hz. in combination with pulse-respiratory quotient, heart rate and variability in the respiration-modulated high frequency range are indicators of mental resilience. Ability to recover: Recovery is the basis for resilience. Sympathicus reduction and simultaneous increase in high frequency parts of heart rate variability, decrease of pulse and respiration frequency are objective units of measurement. Quality of sleep: qualitative and quantitative aspects of calm and deep sleep phases are evaluated. Extent of vagus activity.
The coordination of respiratory frequency and heart rate sequence produces a restructuring of psycho-physiological processes in the sense of an “economization” of the entire system that is reflected in the “spectrogram”. This comprises the following frequency ranges (Figure 1 on page 633): Very Low Frequency (VLF), a range between 25 sec. and 5 min. with a frequency of 0.04 – 0.0033 Hz., dependent on body position, physical activity and thermoregulation. • Low Frequency (LF), a range between 7 to 25 seconds and a frequency of 0.04 and 0.15 Hz. It is parasympathically and sympathically controlled and corresponds to the blood pressure rhythms. • High Frequency (HF) as presented in the figure moves between 2,5 and 7 seconds in a range of 0.15 to 0.4 Hz. It is parasympathically controlled and modulated via respiration. •
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FIGURE 1. frequency ranges
Another important term in regulation diagnostics is “respiratory sinus arrythmia” (RSA): the coordination of heart and respiratory frequencies, ideally at a ratio of 4:1 (e.g. 60 heart beats with 15 times breathing per minute). In the spectrogram, RSA becomes visible in horizontal lines in a range between 0.2 and 0.4 Hz, mainly in restful sleep. Additional literature: Hildebrandt et al., (1998); Moser et al., (1994); Moser et al., (1999); Moser, in Tucek (eds.), (2005b).
Clinical applications of traditional oriental music therapy – examples CONTROL MEASUREMENT IN A HEALTHY TEST SUBJECT DURING RECEPTIVE MUSIC THERAPY
Figure 2 on page 634 shows the spectrogram of a healthy test subject in the course of a receptive encounter group session as part of the study course in traditional oriental music therapy. The purpose was to stimulate regenerative regulatory mechanisms for a balance of sympathicus and
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parasympathicus activity. The test person was lying on a mat while the training therapist was turned to her and made music on an Arabian/Turkish lute. FIGURE 2. Spectrogram of a healthy test subject
Explanation and interpretation of the figure. The
Figure 2
on
page 634 shows a dinstict reduction in sympathicus activity (no more blue shades in the low frequency range), and most important, the phenomenon of a HRV with six high points as indication of high coordination of respiration and heart beat, suggesting excellent regulatory abilities. In simple words: the test person was conducted to a regeneration-induced state that goes far beyond any regenerative effects to be achieved in everyday life. The occurrence of such a resonance phenomenon – where the heart does not produce a “sound” as in a respiratory sinus arrythmia, but a sound with a total of 5 overtones – may be seen in individual cases, e.g. in specifically trained music therapists while singing mantras or reciting antique verses (compare Moser 1999). The occurrence in a merely pasClinical applications of traditional oriental music therapy – examples
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sively received melody is unusual and not to be expected according to previous experience with perception from audio equipment. The reason of this resonance effect is not quite clear. We assume that the phenomenon is due to two components, the trusting relationship (the training therapist and the student knew each other) and the music (as an agent conveying calm and relaxation)1.
An example of measurement of a healthy test subject in a traditional “healing dance” (Bakse) The following Figure 3 on page 635 and Figure 4 on page 636 show the spectrograms of the same test person during a traditional “Bakse” dance used for activation (for details see Tucek 2003b). FIGURE 3. Begin of dance
1. Further research projects addressing this question are in preparation.
An example of measurement of a healthy test subject in a traditional “healing dance”
Tucek, G. (2006) Traditional oriental music therapy – a regulatory and relational approach. Music Therapy Today (Online 1st October) Vol.VII (3) 623-647. available at http://musictherapyworld.net
FIGURE 4. Middle part of the dance
FIGURE 5. End of dance
EXPLANATION AND INTERPRETATION OF FIGURES ON ACTIVATING DANCE:
The entire variability (performance) at the beginning (Figure 3 on page 635) at 12:45 p.m. has reached 1.500 msec2, at the end (Figure 5 on page 636) at 1.10 p.m. it is 2.300 msec2.
An example of measurement of a healthy test subject in a traditional “healing dance”
Tucek, G. (2006) Traditional oriental music therapy – a regulatory and relational approach. Music Therapy Today (Online 1st October) Vol.VII (3) 623-647. available at http://musictherapyworld.net
Simultaneously, a distinct respiratory sinus arrhythmia is visible at the beginning (Figure 3 on page 635), but no longer in the end (Figure 4 on page 636); on the contrary, the spectrum appears denser here, with a harmonious course ascending from the low frequency range. Another obvious fact is the trough-like harmonious course of HRV, congruent with the process of activation and the progressing dance. In the middle part of the dance (Figure 4 on page 636) there is an unusually high HRV of more than 15.000 msec2, with a heart rate of 130 beats per minute, a phenomenon all the more remarkable since usually HRV decreases with increasing heart frequency, which is due to mathematical and physiological factors exclusively. In simple words, this means that we have an initial state of tiredness, then a doubling of performance (pulse increase from 66 to 125 beats per minute) within 17 minutes and a tenfold increase of the performance potential (from 1500 to 15.000 msec2). Normally we would have expected to seee a decrease in performance potential with increasing heart frequency, whereas in this case we saw a potentiation of performance potential. What appears remarkable in Figure 5 on page 636 is that the performance potential was clearly higher at the end of the dance compared to the start, and was harmonically spread over a wide frequency range; this suggests an auto regulation in the course of the dance in the sense of intensified economization and activation. MEASUREMENT OF A RECEPTIVE MUSIC THERAPY SESSION
Figure 6 on page 638 and Figure 7 on page 639 show an exemplary measurement of a 21-year-old male patient1 (Mr. P.) with myelogenous leu1. At the pediatric oncology station of the children and women’s hospital in Linz (Austria).
An example of measurement of a healthy test subject in a traditional “healing dance”
Tucek, G. (2006) Traditional oriental music therapy – a regulatory and relational approach. Music Therapy Today (Online 1st October) Vol.VII (3) 623-647. available at http://musictherapyworld.net
kemia in the course of a receptive therapy session. The patient was recumbent on a hospital bed, while the therapist was turned to him and played an Arabian/Turkish lute and a harpsichord. At the time of measurement, Mr. P. received a block of chemotherapy. Prior to measurements he complained of weakness, fatigue, diffuse pain and indisposition. FIGURE 6. Measurement of a receptive therapy session 1
An example of measurement of a healthy test subject in a traditional “healing dance”
Tucek, G. (2006) Traditional oriental music therapy – a regulatory and relational approach. Music Therapy Today (Online 1st October) Vol.VII (3) 623-647. available at http://musictherapyworld.net
FIGURE 7. Measurement of a receptive therapy session 2
Explanation and interpretation of figures. The basis is a medium level of activation with simultaneously recognizable signs of fatigue (RSA) (Figure 6 on page 638), which disappear completely after 15 minutes. Towards the end of the session (Figure 7 on page 639) we see a fourfold increase in the heart rate variability (from 100 to 400 msec2) with signs of physical activation (blue colouring in the low frequency spectral range). The patient’s heart rate fell from a mean value of 82 to 58 beats per minute in the course of the session. This indicates that the reduced general state described by the patient prior to therapy, i.e. sensations of weakness, sickness and diffuse pain, was transformed to a vegetative stabilization with reduced pain (heart rate reduction), increased vitality (HRV increase to the fourfold amount) and disappearance of sickness (patient’s spontaneous remark after session). This interpretation was also confirmed in the interview on the patient’s subjective state of health after the session. EXAMPLE 2:
A SMARD watch – another system of non-invasive measurement and analysis for regulatory diagnostics - involves measurements of the An example of measurement of a healthy test subject in a traditional “healing dance”
Tucek, G. (2006) Traditional oriental music therapy – a regulatory and relational approach. Music Therapy Today (Online 1st October) Vol.VII (3) 623-647. available at http://musictherapyworld.net
parameters heart frequency and pulse frequency (HF and PF), muscular activity (EMG), skin potential1 (HP), skin resistance2 (HW), skin temperature (HT) and convection temperature3 (KT)4. Figure 8 on page 640 shows the dynamic functions of measurements in patient A suffering from ALL (above) and therapist (below) in the course of the session at the above-mentioned pediatric oncology unit. For simplification, average measurements were taken across all three physiological parameters, skin resistance (vegetative-emotional processes), skin potential (nervous-cognitive processes) and electromyogram (muscular processes). FIGURE 8. SMARD watch measurement in pediatric oncology
1. 2. 3. 4.
Bures, (1960). Boucsein, (1988). ISF, (2000). References: Balzer, & Hecht, (2000); Boucsein, (1988); Bures, & Petràò, et al. (1960); Ferstl, (2005); Fritz, (2005)
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EXPLANATION AND INTERPRETATION OF THE FIGURE:
The general similarity of the curves in this figure suggests a high degree of synchronisation between therapist and patient A. The shape of the curve may be interpreted as indication that the therapist succeeded in reaching the patient immediately and “carrying her along” in this music therapy session. This underlines the basic significance of the relatory component and also the fact that it is possible to measure and illustrate this component in music therapy. The therapist’s condition and sensibility and the resulting ability to empathize with a patient’s condition (perception and musical implementation of needs) are therefore decisive factors if a music therapy session is to be successful.
Summary & outlook: Experienced music therapy researchers know the difficulties of clinical practice with regard to replicability and standardization (compare: Tucek, in Aldridge (ed.), (2005); Scharinger, (2006). But on the other hand there is a legitimate demand for “hard facts” to verify therapy efficiency. A general discussion of this subject is beyond the scope of this presentation, but I would like to underline the two essential advantages of the approaches described here: Both measurement methods allow a music therapist flexibility in his interventions with individual patients without rendering the measuring procedure worthless. • Both measurement methods produce physiological “hard facts”, e.g. heart and pulse frequency (HF and PF), muscular activity (EMG), skin potential (HP), heart rate variability (HRV) etc. •
The measuring methods described here are an additional tool for therapists to reflect patients’ feedback and their own perceptions and observations of a given situation on the basis of objective measurements. These
Summary & outlook:
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approaches open up new possibilities and perspectives for evaluation of processes in music therapy. A large number of measured data collected so far confirm the trend found in the examples presented here. We have now started to study long-term therapy effects of traditional oriental music therapy by research into patients’ quality of sleep1.
References Aldridge, David (ed.) Music Therapy and Neurological Rehabilitation Performing Health, London: Jessica Kingsley Publishers. Balzer, H.-U. & Hecht, K. (2000) Chrono-Psychobiologische Regulationsdiagnostik (CRD) – Ein neuer Weg zur objektiven Bestimmung von Gesundheit und Krankheit. In K. Hecht & H.-U. Balzer (ed.)
Stressmanagement,
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medizin, Prävention (p. 134-154). Lengerich: Pabst Science Publishers. Boucsein, W. (1988). Elektrodermale Aktivität. Berlin: Springer-Verlag. Bures, J. & Petráò, M. et al. (1960). Electrophysiological Methods in Biological Research. Praha: ÈSAV (Èeskoslovenská Akademie Vìd), Sekce biologicko-lékaøská. Ferstl, E. (2005). Untersuchung von Zusammenhängen zwischen psychophysiologischen Reaktionen und dem Leistungsverhalten von
1. In short: we assume a relation between the quality of an individual’s sleep and his or her regenerative abilities.
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Musikern in Auftrittssituationen. Unveröffentlichte Dissertation, Universität Mozarteum Salzburg. Fritz, F. M. (2005). Eine Methode zur Klassifizierung von Regelvorgängen biologischer und musikalischer Prozesse mit Hilfe eines künstlichen
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phie an der Fakultät für Human- und Sozialwissenschaften der Universität Wien. Tucek, G. (2003b). Altorientalische Musiktherapie im interkulturellen Dialog - Kulturimmanente und kulturtranszendente Aspekte im Menschenbild In: Helga Egner (ed.) Heilung und Heil. Begegnung Verantwortung - Interkultureller Dialog. (p.120-148) Patmos Verlagshaus Düsseldorf & Zürich, . Tucek, G. (2005a). "Traditional Oriental Music Therapy" in neurological rehabilitation. In: Aldridge, David (ed.) Music Therapy and Neurological Rehabilitation Performing Health. (p.211-230). London: Jessica Kingsley Publishers. Tucek, G. (ed.) (2005b) Musik und Medizin - Beiträge zur Musik- und Therapieforschung 1995 -2004 (DVD-ROM). Wien: GAMED. ISBN 3-200-00155-0 . Tucek, G. et al. 2006: The revival of Traditional Oriental Music Therapy discussed by cross cultural reflections and a pilot scheme of a quantitative EEG-analysis for patients in Minimally Responsive State, in: Music Therapy Today (Online) Vol.VII (1), (March) 39-64. available at http://musictherapyworld.net. INTERNET:
www. ArztScout.com (13.7.06).
References
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Author’s details: FIGURE 9. Gerhard Tucek
Music therapist, specific interests: neurological and cardiological rehabilitation, pediatric oncology, work with handicapped persons; clinical therapy research; practice research. University education: studies of applied cultural sciences (Mag.phil.) and ethnology (Dr.phil.); university Author’s details:
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training course in practice research; studies of traditional oriental music therapy with Dr. Oruc Güvenc 1989 – 2000 establishing the „School for traditional oriental music therapy“ in cooperation with Dr. Oruc Güvenc. Since 1997 Director of the course in traditional oriental music therapy. Since 2004 Lecturer at the University for Music and Performing Art, Vienna, since 2005 at the Institute for Culture & Social Anthropology of Vienna University. Since 2002: Director of the seminar and lecture series „Mensch – Kunst – Medizin“ (in cooperation with GAMED and Karajan Centrum Vienna). 2004: Founding member and Director of IMARAA (international music and art research association austria) ADDRESS:
Institute For Ethno-Music-Therapy, Niederneustift 66, A-3924 Schloss Rosenau (Head of the Institute: Mag. Dr. Gerhard Tucek) Tel:0043 / 2822 / 51248 Fax +18 e- mail: info(at)ethnomusik.com
THIS ARTICLE CAN BE CITED AS:
Tucek, G. (2006) Traditional oriental music therapy – a regulatory and relational approach. Music Therapy Today (Online 1st October) Vol.VII (3) 623-647. available at http://musictherapyworld.net
Author’s details:
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Music Therapy Today Vol. VII (3) (October) 2006
Rave, Communitas, and Embodied Idealism Bryan Rill
Introduction Electronic Dance Music Culture, a contemporary subculture centered on raves, is a global phenomenon that has been attracting the interest of
scholars across the globe. Originating from "Acid House" parties in Ibiza and "Techno" dance parties in Goa, raves became the most dynamic digital counterculture of the 1990s. First in Europe, then in the US, and then all over the world, raves have become associated with peace-and-love idealism, community, an embrace of technology, and psychedelic consciousness. The music performed at most events is called electronic dance music, or EDM, which is commonly called “techno” by those not in “the scene.” The central event of this subculture is the rave, an all night dance party hosted in either clubs or more remote warehouses. A rave is an alternate reality of dancing, release, and free expression. From glow sticks to glittered lips, rave is about fascination, youthfulness, and play. The participants are individuals in their style and flavor, but together they are a liquid sea of bodies, all synchronized to the beats around and within them. These beats form soundscapes—each existing as its own special reality characterized by its own particular beat and own particular vibe. 648
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The VIBE - that overwhelming wave of positive energy - dissolves the selves of all the participants into one collective mind, all experiencing the same sensations at peak moments of the night. This trance state is an ephemeral existence wherein participants lose touch with material reality as they drift among the varied soundscapes. Metaphorically the rave world can be viewed as a netherworld, in which participants are walking, or dancing, their way through dark passages guided only by the music. They feel its pulse throughout their bodies entirely, and become slaves to its sounds as it leads them throughout the night.
Rave, Communitas and Unity and Acceptance of Diversity (UAD) These events are an illustration of Victor Turner’s theory of communitas, an anti-structural moment “in and out of time,” where youth gather to express themselves and enjoy freedom from social structure. This community is tied together by one dominant theme—the Unity and Acceptance of Diversity (UAD). This article examines this theme in light of theoretical frameworks posed by Turner (1967, 1969) and Thomas Csordas (2002). Specifically, I shall use Turner’s methods of symbolic analysis to examine this theme as a dominant symbol and discuss the rave as a liminal process wherein this theme acts as sacra. Further, I shall incorporate current theoretical approaches to embodied practices to illustrate how symbols can have lasting effects not only in our minds, but also our bodies. Finally, I aim to stress the importance of such marginal movements as important social processes, an integral part of the reciprocal relationship between society’s structure and the dissolution of such structure. Understood in this context, rave can be reinterpreted as a natural expression of a social cycle rather than the dominant view articulated by Baudrillard, wherein he states
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“Nothing could better signify the complete disappearance of a culture of meaning and aesthetic sensibility than the spinning of strobe lights and gyroscopes streaking the space whose moving pedestal is created by the crowd” (1982: 5). Victor Turner is widely known for his contribution to symbolic anthropology. Turner focused on the symbols in ritual, and his model emphasized the dynamic and changing nature of symbols in practice. He argued that in any ritual context there are certain dominant and instrumental symbols, and that these can be analyzed on three levels: the operational, exegetic, and contextual. In lay terms, these levels are: (1) an etic perspective of the use of symbols in action, (2) the emic understanding (informant testimonies of their meaning), and (3) the cultural structure in which these symbols have meaning. In ‘The Forest of Symbols: Aspects of Ndembu Ritual’ (1967), he laid out a formal framework for symbolic analysis that is still useful today. Central to Turners’ framework is the idea that a dominant symbol must be a visible, known thing. This is not the case at raves. The rave community is tied together by a dominant symbol, but that symbol is a concept rather than a thing. That concept, Unity and Acceptance of Diversity, conforms to Turner’s three properties of a symbol (1967: 27-30). First, multiple meanings are condensed within this symbol including:1 Acceptance of others regardless social class, ethnicity, religious beliefs, or appearance. • Open-mindedness to the beliefs of others, particularly receptiveness to Eastern religious ideas. • Freedom of expression, as seen in both the media at raves and the dress of the participants. •
1. Note that this essay does not allow sufficient space for ethnographic evidence to support these points. This data is extensively discussed in Rill 2003. Rave, Communitas and Unity and Acceptance of Diversity (UAD)
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UAD is also a unification of disparate significata, in that many qualities of the rave atmosphere can be linked to this central concept. This can be seen in: • •
• • • •
The spatial organization of raves, where individual autonomous space gives way to communal space. The social organization of friend groups often composed of people from many different social circles that would not normally interact in society. Clothing styles, for at raves people dress as everything from aliens to fairies. Artistic expression, such as wall murals, candle circles, 4-D modeled graphic animation, religious iconography, etc present at many raves. The principle of egalitarianism. The passive, love everyone theme often reiterated in both musical lyrics and personal communication.
Finally, the UAD does have a polarization of meaning. But here I diverge from Turner’s two poles (ideological and sensory), to articulate the poles of UAD as ideological and sensual. The ideological pole of UAD is identical to Turner’s formulation, the cluster of significata condensed within the ideal. But rave does not have a sensory pole, defined by Turner as a visible, physical property of the symbol (1967). One example of this pole is the white sap of the mudyi tree in Ndembu ritual, wherein the sap actually looks like breast milk or semen. Hence the sensory pole is a tangible property of the symbol that embodies cultural meaning. UAD does not have such a concrete manifestation in the material world,1 but that does not mean that UAD lacks a physiological element. UAD is felt by the participants, hence my term sensual pole. The implication of this sensual pole is that Unity and Acceptance of Diversity is not merely an ideo-
1. The symbols participants incorporate into their appearance (clothing, tattoos, etc.) and dance styles are a form of embodiment of UAD, but these expressions in EDMC differ from Turner’s model in that they are temporal actions that embody the ideal rather than the more permanent physical properties of a symbol that Turner defines as the sensory pole. Rave, Communitas and Unity and Acceptance of Diversity (UAD)
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logical fantasy that exists in the minds of participants. It has a sensual counterpart, and when we humans feel something that touches us deeply, it adds a tremendous meaning to the experience. Hence, it is an embodied ideal. MUSIC AND EMBODIMENT
In Turner’s terms, this meaning is the sacra –the symbolic message-- in the liminal context of raves. Liminality is achieved by separation, and at raves this is easily accomplished in a world full of intense lighting and loud sound; usually in dark warehouses far removed from social centers. In this sense raves are comparable to separation in rites of passage, where the neophyte is physically and psychically removed from social structure.
The liminal state of raves is also comparable to rites of passage in that the individual self dissolves into a collective whole and differentiation ceases to exist. At raves, participants experience a dissolution of self and consciousness, which Des Tramacchi calls “ego-death and experiential transcendence” (2001). Participants let go of conscious reality and experience the event as a pre-objective body. By “pre-objective,” I refer to Merleau-Ponty’s phenomenological argument that perception ends in representations; which is to say that representations are secondary products of reflective thinking; on the level of perception we have no objects, we are simply in the world (Csordas 2002: 61). For the pre-objective body, then, the experience is full of richness and indeterminacy that can be modeled in consciousness as a comprehendible experience only after the night has ended; and while there participants are caught up in a milieu of sensations, symbols, and movements that cannot easily be untangled from one another. It is in this state that UAD as sacra is particularly powerful. At raves, there is no absolute authority or explicit cultural tradition being taught to Rave, Communitas and Unity and Acceptance of Diversity (UAD)
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neophytes. Rather, it is an unstructured environment wherein the sacra are conveyed in the music and visual medium. Music, “with its many symbols and metaphors, encourages a certain cognitive flexibility, engendering an altered state of consciousness”, which is “the ability to spontaneously restructure one’s knowledge” by “criss-crossing conceptual landscapes” (Koen 2005:302; Spiro and Jehng 1990: 165-169). Music, complimented by the symbolic content of visual medium, is the rhetoric of the context, and such non-verbalized communication is made equally powerful to spoken sacra by the unique ability of music to both facilitate cognitive flexibility and act as a vehicle for the ideology of this subculture. This is what Csordas calls the embodied experience, where empowered participants can experience a transformation of the self (2002: 25). While the rhetoric coded within music and visual medium is not the carefully trained performance of a Charismatic or Navajo healer, I believe that it also has the capacity to “redirect the supplicant’s attention to new aspects of his actions and experiences, or persuade him to attend to accustomed features of action and experiences from new perspectives” (2002: 25). The sacra are also embodied thru practice. The deconstruction of autonomous space, as well as the open-armed free love idealism pervasive at raves makes it impossible to maintain separation from the communal ideal.1 “At the heart of the matter is the desire to 'be together', which the dance party - apparently like no other form of popular music gathering in our history - seems to embody. This is the underlying cultural business of EDMC. It is the 'underground sociality' that Maffesoli, who once penned a book subtitled 'Towards a Sociology of the Orgy', speaks of; it is the 1. Although it is common that people retreat into themselves and claim to have a private relationship with the music, these same people acknowledge the sense of unity with other people dancing and their participation in the collective movement of the dance party. Rave, Communitas and Unity and Acceptance of Diversity (UAD)
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social 'effervescence' a la Durkhiem and the social liminality of communitas that Turner made clear is culture's regenerative reservoir - a necessary threshold which is by its nature potent with possibility” (Graham St John- Personal Correspondence). St. John, the editor of the important reader Free NRG: Notes From The Edge of The Dance Floor (2001) shows that that this sense of internal community both attracts people into EDMC in response to their sense of alienation and ennui within society at large and sustains the community of participants. TRANSFORMATION AND HEALING
This embodiment of sacra and the affective experience have the capacity to engender transformation. Websites and e-journals are full testimonies of ravers who feel that they experienced a physical, emotional, or spiritual release, empowerment, or healing. The most commonly referenced of these are www.hyperreral.org and www.ecstasy.org, two websites that archive testimonies of participants’ experiences as members of EDMC. Scott Hutson’s cyberethnography uses these resources extensively to validate his argument that raves are the ground for new forms of spiritual healing (2000). In Csordas’s terms, this potential transformation is a fundamental part of a healing process, and these experiences can be understood in light of his concepts of predisposition, empowerment, and transformation. Predisposition means that participants must come to believe that healing is possible. This is what enables some ravers to interpret the experience as healing while others do not. Many ravers do feel that it is possible because that ideal is expressed in the medium of the event. Empowerment, the persuasion that the therapy is efficacious, is a personal phenomenon and cannot be generalized to all participants. Some participants claim that their sense of freedom and the egalitarian ideal
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inherit within UAD is physically liberating. When musical lyrics of love and unity are present, participants ‘feel the love’ and a sense of mystical bonding with those around them. Others never feel anything they would describe as liberating or mystical. I believe that Timothy Leary’s “Set and Setting” hypothesis serves to explain the difference experiences and mindsets of the participants (Leary, Metzner, & Halpert 1964). Transformation, the cognitive/affective behavioral change, is a process that occurs regularly in rave contexts for those that are empowered. It is the gradual transformation of self, the restructuring of knowledge to incorporate the symbolic and experiential meanings gleaned from experiences in EDMC. Informants have expressed this transformation as becoming more empathetic, understanding diverse perspectives, learning to respect others, and finding a sense of peace in life. This transformation of acceptance/ inner peace is a lasting effect that carries from the rave communitas back into the external social world. From this perspective, Unity and Acceptance of Diversity is not a phenomenon contained within the world of raves; it has the potential to reshape the worldview of participants. Thus, in terms of aggregation, the reintegration of the raver into society is not defined so much by changed social roles, (which is Turner’s view) as it is by a transformation of self and perception (Csordas’s view).
Levels of symbolic analysis Turner’s three levels of symbolic analysis: operational, positional, and exegetical are particularly useful for examining UAD within the rave community and interpreting the larger social implications of this subculture.
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An operational analysis of UAD considers the importance of the ideal as a binding theme in rave subculture. It functions as an appeal to the scene for potential participants, and within it operates to sustain conditions of egalitarianism. Furthermore, it supports free expression in media and self-representation. Hence, UAD is central to the creation of a Temporary Autonomous Zone (TAZ), defined as “fleeting moments where fantasies are made real and freedom of expression rules before external reality intervenes” (Bey 1997: 5). On the exegetical level of analysis, UAD is central to the PLUR (Peace, Love Unity, and Respect) credo of the subculture. This credo is echoed across websites and in participants interview responses, and is the ‘fantasy’ that participants wish the external world could embrace Thus, for the participants, it is not only an ideal for within the context, but also a utopian vision for the future. It means more than acceptance of diversity, also encompassing love, sharing, and unity. The third level of analysis, contextual, places UAD in the larger social context. The importance of this concept is that it “enables a direct and immediate abandonment of socio-culturally mediated divisions; rave provides an alternate co-operative pathway…it is a ‘difference engine’—but the difference sought after is not an essential or fundamental difference, but the freedom to be different, to ‘other’ one’s self in collusion with others, an intimate process forging strong bonds between fellow liminaries” (St. John 2003, personal correspondence). Rave then is an expression of structural resistance, a result of structural anomie expressed in an event that collectively rejects a society that organizes humans as commodities and separates them by social markers to perpetuate difference.
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Unfortunately, the utopian vision of UAD is only completely sustainable in its own state of communitas. While many participants attempt to practice the ideals embodied in UAD, most find it difficult to maintain in the external social world. Complete egalitarianism and freedom of expression are not permissible in the structured society participants return to. Upon returning to this external social world, participants often express disappointment that the ideal cannot be sustained. But this, in turn, creates a desire to return to the state of communitas and live that ideal again; acting to preserve the longetivity of the subculture. In Turner’s terms, rave acts as a revitalization movement, wherein participants immerse themselves in a TAZ and return to structure feeling liberated and refreshed. In Csordas’s terms, this is in effect ritual healing, where the embodied idealism of UAD “amounts to the creation of meaning for supplicants. To the extent that this new meaning encompasses the person’s life experience, healing thus creates for him a new reality or phenomenological world” (2002: 25). In concord with Csordas, the degree to which a participant is ‘healed’ is determined by the extent to which they live the ideal, or practice egalitarianism and acceptance in the external social world.
Conclusion To conclude, Unity and Acceptance of Diversity is the dominant symbol, the embodied ideal of the rave subculture. This ideal is more than just a mental construct. Symbols can and do affect our total beings, because the body is not merely a vessel of culture, it is a product of it. Raves themselves are instances of communitas, emphasizing spontaneity, free expression, immediacy, and the affective experience. They are antistructural, contrasting the values and norms of the external social world.
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Within these contexts participants enter liminal states in which they enact the UAD ideal through practice. For some, this experience can be a form of ritual healing, as the embodiment of the ideal acts to imbue a sense of liberation and unity free from social constraints. Rave, in the larger context, forms part of the “dialectical process that involves successive experience of high and low, communitas and structure, homogeneity and differentiation, equality and inequality” (Turner 1969: 97). Part of its power lies in the perception by some that it is sacred because it transgresses and dissolves the norms that hold structured society together. For others, it is powerful because it is an avenue of free expression wherein participants can find release from social tensions. I hope to have recast your understanding of rave as a social movement necessary in the functioning of social systems. Rather than accepting the negative interpretation of scholars like Baudrillard, raves can be understood as serving an important function in the social process, where people are “released from structure into communitas only to return to structure revitalized by their experience of communitas” (Turner 1969: 129). The need for this release helps explain the longetivity of this subculture and the development of similar movements in the future when rave is long gone.
REFERENCES Baudrillard, Jean (1982) The Beauborg Effect: Implosion and Deterrence. October 20(Spring). As cited in Thornton 1996. Bey, Hakim (1991) TAZ: The Temporary Autonomous Zone - Ontological Anarchy and Poetic Terrorism. New York: Autonomedia.
REFERENCES
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Csordas, Thomas (2002) Body/Meaning/Healing. Contemporary Anthropology of Religion Series. New York: Palgrave MacMillan. Hutson, Scott R. (2000) The Rave: Spiritual Healing in Modern Western Subcultures. Anthropological Quarterly 73(1):35-49. Koen, Ben (2005) Medical Ethnomusicology in the Pamir Mountains: Music and Prayer in Healing. Ethnomusicology 49(2): 287-311. Leary, T., R. Metzner and R. Alpert. (1964) The Psychedelic Experience: A Manual Based on the Tibetan Book of Death. Oxford: Oxford University Press. Merleau-Ponty, M. (1962) Phenomenology of Perception. London: Routledge and Kegan Paul. Rill, Bryan (2003) Teckno Culture: A Context for the Hybridization of Belief Systems. M.A. Thesis: Florida Atlantic University. St John, Graham (ed.) (2001) FreeNRG: Notes From The Edge of The Dance Floor. Australia: Common Ground Publishing. St John, Graham (2002) Personal Correspondence Spiro, R.J. and J. Jehng (1990) Cognitive Flexibility and Hypertext: Theory and Technology for the Non-Linear and Multidimensional Traversal of Complex Subject Matter. In Cognition, Education, and Multimedia. D. Nix and R. Spiro, eds. Pp. 163-205. Hillsdale, NJ: Erlbaum. Thornton, Sarah (1996) Club Cultures: Music, Media, and SubculturalCapital. Hanover: Wesleyan University Press.
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Tramacchi, Des (2001) Chaos Engines: Doofs, Psychedelics, and Religious Experience. In FreeNRg: Notes From The Edge of The Dance Floor. G. St John, ed. pp. 171-187. Australia: Common Ground Publishing. Turner, Victor (1967) The Forest of Symbols: Aspects of Ndembu Ritual. London: Cornell University Press. Turner, Victor (1969) The Ritual Process: Structure and Anti-Structure. Chicago: Aldine Publishing Co. INTERNET RESOURCES
http://www.hyperreal.org http://www.ecstasy.org
Author Details Bryan Rill is currently working towards a PhD in cultural anthropology at Florida State University. His research interests lie in exploring the local model for religious healing among Shugendo practitioners in Japan, a mountain centered ascetic sect. Also serving on the exective board for the Society for the Anthropology of Consciousness, Mr. Rill seeks to expand upon current understandings of consciousness and healing. This article is part of a larger collection that explores the effects of altered states within Electronic Dance Music Culture, which is currently submitted for publication as a manuscript.
Bryan Rill, M.A. Department of Anthropology Author Details
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Florida State University Tallahassee, FL, USA brr04d@fsu.edu 001-850-251-0931 THIS ARTICLE CAN BE CITED AS:
Rill, B. (2006) Rave, Communitas, and Embodied Idealism. Music Therapy Today (Online 1st October) Vol.VII (3) 648-661. available at http:// musictherapyworld.net
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Music Therapy Today Vol. VII (3) (October) 2006
Music therapy in early neurorehabilitation with people who have experienced traumatic brain injury Simon Gilbertson
Abstract This research study (Gilbertson 2005a) investigates what clinical changes can be identified in music improvisation as a part of early neurorehabilitation for people with severe traumatic brain injury and whether these changes can be linked to musical intervention. A significant part of this study is devoted to reviewing the literature (Gilbertson 2005b). This resulted in the creation of the Music Therapy World Journal Index, the first comprehensive music therapy journal database (www.musictherapyworld.net). In the main body of this qualitative study, using therapeutic narrative analysis (Aldridge 1996, Aldridge & Aldridge 2002) and musicological analysis, we can follow an emerging analysis of a collection of significant events as interpreted by the therapist. These episodes are joined or distinguished through constructs eliciting the nature of the phenomena (personal construct theory, Kelly 1955). Correlations between the constructs have led to the identification of categories, terms hinting towards the essence of the processes of change in music therapy in neurorehabilitation. It has been possible to identify clinically significant change in musical expression, communication, agency, emotionality, motility and participa662
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tion and to link these changes to the musical intervention. By doing so, criteria have been identified for the recognition and description of change in processes of rehabilitation. The identified pattern of change from isolated and idiosyncratic behaviour towards more conventional and integrated behaviour led to the recognition of the significance of the concept of relationship in early neurorehabilitation. This study is not a comparison study; it is an inquiry into processes, and investigates the ways change has taken place. By looking at what happens in episodes it is possible to hypothesize about the nature of rehabilitation through music therapy.
Introduction In this paper, I will present my doctoral research study on individual music therapy in early neurorehabilitation with people who have experienced traumatic brain injury (Gilbertson 2005a). To begin, I will introduce you to the topic and state the research questions of this study. Following a concise description of the literature review, I will go on to portray the methods applied in this study. The results of the study will be followed by a short discussion.
The topic and background: Traumatic brain injury, music therapy and rehabiltiation My clinical background is as a music therapist and between 1994 and 2002 I worked in the Klinik Holthausen a clinic for neurosurgical rehabilitation in Hattingen, Germany. More than half of the patients treated in the clinic have suffered traumatic brain injury, and these patients are at the focus of my study. Traumatic brain injury is defined as â&#x20AC;&#x153;damage to living brain tissue caused by an external, mechanical forceâ&#x20AC;? (Lemkuhl, 1992).
Introduction
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The most common sequelae of traumatic brain injury include changes in consciousness and behaviour, disorders of motor function, memory, speech/language, cognition, awareness and perception. The consequences of traumatic brain injury range from, to quote the National Institute of Health, “neurological and psychological impairments, to medical problems and disabilities that affect the individual with TBI, as well as the family, friends, community, and society in general” (NIH Consensus Development Panel, 1999, p.976). When considering traumatic brain injury it is necessary to consider not only the changes to the lives of those injured but also of those affected. The type of music therapy applied in this study is known as “creative music therapy” which is a form of improvised music therapy that stems from the pioneering work of Paul Nordoff and Clive Robbins (1977). This form of music therapy has been applied in rehabilitation since the early 1990’s and can be found in an increasing number of clinics offering rehabilitation following traumatic brain injury. The term “rehabilitation” is commonly used in two different ways. Firstly, the term is used to describe a particular form of health care treatment. Secondly, the term is used to determine specific phases in health care treatment systems. The word, rehabilitation derives from the Latin term, rehabilitare, meaning “to restore to a previous condition; to set up again in proper condition” (Freidrichsen, 1980). Another definition is “to restore to health or normal life by training and therapy after imprisonment, addiction, or illness” (Soanes & Stevenson, 2003). These definitions suggest an expectation that rehabilitation will return an individual to a previous, earlier and normal state. For people being treated in early neurorehabilitation following traumatic brain injury it is misleading to consider rehabilitation only from this restorative perspective or in such
The topic and background: Traumatic brain injury, music therapy and rehabiltiation
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simple terms of reversibility. Definitions of contemporary neurorehabilitation additionally emphasize the need for co-active involvement of the patient and therapist in a process of adaptation to life possibly with disabilities. The English neurorehabilitation specialist, Barbara Wilson (1999) describes rehabilitation as a “two way process”. She states, “Unlike treatment, which is given to a patient, rehabilitation is a process in which the patient, client or disabled person takes an active part. Professional staff work together with the disabled person to achieve the optimum level of physical, social, psychological, and vocational functioning. The ultimate goal of rehabilitation is to enable the person with a disability to function as adequately as possible in his or her most appropriate environment” (ibid., p.13). Welter and Schönle (1997) refer to four central considerations expressed by the World Health Organization about rehabilitation: “Rehabilitation, as a rule, does not lead to a profit • The aims of rehabilitation should not be oriented to economical factors • Rehabilitation is a social strategy, that aims at a fair and equal society • Rehabilitation is a measure of our willingness to cooperate with the poorest, the most dependent and the under-privileged in our society” (p.2). •
As we see, rehabilitation is understood as an element of our society that is based on participation and equality, regardless of health situation. As Aldridge (2001) remarks, “We are challenged as a society that people within our midst are suffering and it is our responsibility within the delivery of health care to meet that challenge with appropriate responses” (p.1). This research study took place in Germany and though music therapy does not yet have State recognition, the German Ministry of Health (Bundesministeriums für Gesundheit) declares, “the term ‘rehabilitation’ encompasses all measures that are focused on helping physically, menThe topic and background: Traumatic brain injury, music therapy and rehabiltiation
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tally or emotionally disabled or those in danger of disablement to unfold their abilities and strengths and to find an appropriate place in society” (own translation, Bundesministeriums für Gesundheit, 1999, p.69). The German Ministry of Health defines rehabilitation as to incude: “Services pertaining: to general social integration, in particular assistance to the development of psychological and physical abilities before the compulsory school begin, to appropriate school education including relevant preparation, for disabled who may only be educated practically, to facilitation of participation in life in the community, to carry out an appropriate job, as far as professional development are not possible, to facilitate communication with the environment, to maintain, improve and restore physical and psychological motility alongside emotional balance, to facilitate household duties, to improve housing, to organize recreation and to otherwise participation in social and cultural life” (own translation, Bundesministeriums für Gesundheit, 1999, p.69). Welter and Schönle (1997), in their extensive portrayal of neurological rehabilitation, emphasize, “Rehabilitation is only successful, if it prohibits loneliness and social isolation, and when it manages a re-integration of the affected into society” (own translation, p.4) and by doing so provide interesting analogies to music therapy.
Literature review At the outset of this study I carried out a comprehensive literature review (Gilbertson 2005a). This review uses a systematic search strategy that is designed to reach a high level of comprehensiveness and differs from a traditional search strategy in that it adheres to strict and explicit inclusion and exclusion criteria. The search string used to search electronic databases (see Table 1 on page 667) was a Boolean combination of the terms ‘music’, together with ‘brain’, or ‘craniocerebral’, or ‘lesion’, or ‘head injury’, or ‘coma’. Only
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material published before December 2003 was included and the inclusion criteria demanded the material must explicitly deal with the treatment of people with traumatic brain injury in music therapy. Hand searches of journals not indexed in databases were completed, as were searches through the reference lists of identified articles. The databases searched were: TABLE 1. Databases searched in the literature review American College of Physicians Club Allied and Complementary Medicine BIOSIS Previews CAIRSS Cochrane Central Register of Controlled Trials Cochrane Database of Systematic Reviews CINAHL Database of Abstracts of Reviews of Effects Dissertation Abstracts EMBASE INGENTA Music Therapy DATA 5 Music Therapy World Journal Index PREMEDLINE PSYCINFO PSYNDEX PubMed/MEDLINE System for Information on Grey Literature SOCSCI Temple University Music Therapy Database
The initial result of the literature review was the finding that the indexing of music therapy journal articles in the existing electronic databases is
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poor and incomprehensive (Gilbertson & Aldridge, 2003). The Journal of Music Therapy for example, is the only music therapy journal accepted for inclusion by the National Library of Medicine in its PubMed/MEDLINE database. Surprisingly not more than 40% of the articles published in the journal are actually included in the database. To resolve this deficit, I comprehensively indexed every article published in 12 international music therapy journals. This data was transformed into a new, freely available electronic bibliographic database known as Music Therapy World Journal Index that can be accessed via CD Rom (Aldridge, Gilbertson & Wentz, 2005) or Internet (www.musictherapyworld.net). In the identified literature, most reports were of an anecdotal nature and suggested that music improvisation may be significant in the rehabilitation of people who have experienced traumatic brain injury. The identified material describes the positive benefit music improvisation in therapy may offer in the areas of initial contact in very early stages after injury, for emotional expression and development of identity, and suggests that music improvisation may positively affect memory, cognition, and mood (Bischof 2001, Emich 1980, Gadomski & Jochims 1986, Gilbertson 1999, Herkenrath 2002, Hiller 1989, Kennely & Edwards 1997, Magee 1999, Oyama et al 2003, Rosenfeld & Dun, Tamplin, 2000, Wheeler et al 2003). However, using this search strategy no formal research on the use of music improvisation in therapy with people who have experienced traumatic brain injury was identified. Wendy Magee, a music therapy researcher stated in 1999 that this may be related to the fact that, â&#x20AC;&#x153;it is often immensely difficult to illustrate the value of this type of contact in a neurorehabilitation setting in any quantifiable way, other than incorporat-
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ing more physical and functional goals within a music therapy program. In doing so, however, we risk neglecting the enormous potential for emotional rehabilitation which music therapy offersâ&#x20AC;? (p.20).
Research questions of this study Based on the findings of the literature review and clinical practice, two research questions were formulated for this study: What clinical changes can be identified in improvised music therapy in early neurorehabilitation with people who have experienced traumatic brain injury? Can this clinical change be linked to musical events occurring in music improvisations in therapy?
Methods The study material consists of audio and video recordings of music therapy that took place between 1994 and 2002 in my own clinical work. A research method was required that remained close to the nature of music therapy and that would facilitate the recognition of areas of change in a retrospective and explorative study. Therapeutic Narrative Analysis was developed by David Aldridge (Aldridge, 1996, Aldridge and Aldridge, 2002) and is a form of qualitative research based on case study design. By incorporating clinical notes, transcriptions of sessions, video and audio recordings and analytic procedures common within music therapy practice, it presented an optimal choice of research design, fitting well to the study material and research questions.
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Therapeutic narrative analysis is based on the Personal Construct Theory developed by George Kelly in 1955 (Kelly, 1955) and structured in five distinct phases. In Phase 1, we are asked to identify the narrative to be researched. The narrative is the story we wish to investigate. In this study, the narrative is about change in music therapy with three individuals who have experienced traumatic brain injury. Phase 2 is concerned with positioning this narrative in the context of the ecology of ideas in existing literature and in the setting in which the narrative occurs. In Phase 3, episodes are selected that illustrate the focus of interest. This means the therapist will be asked to make choices about the significance of events that have taken place in music therapy. Constructs are then elicited from the therapist that portray similarities or differences between the episodes. At a further level of abstraction, categories are then generated from the constructs. In this study, this step has been achieved using the Repertory Grid, a computer software tool based on personal construct theory (Kelly, 1955). Constructs and categories may lead the researcher to identify core-categories at a higher level of abstraction. A core category expresses the main focus of the “story”, relating the constructs and categories to their underlying theory (Strauss & Corbin, 1998). Dey (1999) describes how, “Selecting a core category seems to involve the elimination of alternative accounts - for these are relegated to future reports. It suggests that there is no place for conflicting and contradictory explanations, which may be more or less supported by the available evidence” (p.112). The sources of
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core categories, also referred to as “central categories” (Strauss & Corbin, 1990), are twofold: “A central category may evolve out of the list of existing categories. Or, a researcher may study the categories and determine that, although each category tells part of the story, none captures it completely. Therefore, another more abstract term or phrase is needed, a conceptual idea under which all the other categories can be subsumed” (Strauss & Corbin, 1998, p.146). In Phase 4, the episodes are submitted to analysis. In this case, this includes musicological analysis of music transcriptions and sonograms of the episodes. In Phase 5, the researcher explicates the research narrative, this means the researcher sews the parts of the analysis back together and clarifies the meaning of the narrative.
Example from the study I will now like to present each of the five phases by using an example taken from the study. From the blue squares on the left side of the figures, you will be able to identify which phase I am currently dealing with.
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FIGURE 1. Phase 1 of Therapeutic Narrative Analysis
Phase 1 has been described earlier. The narrative of this study is about music therapy in early neurorehabilitation with people who have experienced traumatic brain injury. FIGURE 2. Phase 2 of Therapeutic Narrative Analysis
Phase 2 â&#x20AC;&#x201C; This is also covered earlier in the literature review and description of the setting.
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FIGURE 3. Phase 3 of Therapeutic Narrative Analysis
Phase 3 For the purposes of this study, 12 episodes have been selected from many hours of recorded clinical material. The selection process has been determined by the representational nature of an episode for events of utmost significance in the process of rehabilitation. The qualitative research methods expert, Robson, defines this form of sampling as “purposive sampling”. Each of the episodes is given a unique name, or label, for example, Episode 1 “first foot forward”, and Episode 11 “steel drum” and Episode 12 “9th September” (see Figure 4 on page 674).
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FIGURE 4. Episode labels
Once the episodes have been selected, constructs are elicited by considering three of the episodes and describing why two of the episodes are similar and how the remaining episode is different (see Figure 5 on page 675). Repertory Grid (RepGrid) software has been used to support this process.
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FIGURE 5. Eliciting constructs
In this example, the therapist has determined that steel drum and 9th of September are similar and represent the quality of “certainty”. As we can see in the figure, the episode “first foot forward” is different to the other two episodes and the therapist describes this using the term “questionable” (see Figure 5 on page 675). The therapist is then required to rank the remaining 9 of the 12 episodes somewhere along the continuum between the constructs in a manner that makes sense for him/her (see Figure 6 on page 676).
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FIGURE 6. Process of ranking
This process is repeated until a clear pattern of similarities and differences becomes apparent in the therapist’s use of the constructs in ranking the episodes. The RepGrid software produces two forms of data analysis and representation. The focus analysis, which is a factor analysis, identifies correlations between the use of the constructs and these are shown in the tree-diagram to the right of the constructs (see Figure 7 on page 677). Here, marked in yellow, is the construct example “questionable and certainty” mentioned earlier. The patterns of correlation suggest groupings of constructs. From these groupings, the following categories have been elicited: musical expression, communication, agency, emotionality, motility, and participation.
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FIGURE 7. Focus Analysis
The principle components analysis shows a spatial representation of the constructs and episodes on two principal axes (see Figure 8 on page 678). This representation shows correlations between episodes marked here with blue dots, and the construct pairs through the position of the episode and constructs.
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FIGURE 8. Principle components analysis
FIGURE 9. Phase 4 of Therapeutic Narrative Analysis
In the fourth phase of therapeutic narrative analysis, the episodes are analysed.
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To demonstrate an example in this phase, I would like to give you an impression of the analysis process of the video recording of Episode 1 with the label “first foot forward”. This is a clinical example and may be disturbing for those of you new to this subject, so please be prepared. The episodes originates from therapy with a nine-year old boy, I call Bert, who was involved in a road traffic accident as a pedestrian. In the video film, Bert is sitting in his wheelchair, you may see signs of the operation scars on his head and his arms are affected with severe level of muscle tone. He does not make any vocal sounds, no conventional communication was being observed, and at this time the doctors, therapists and family members are not able to assess his perception of the environment. In the film, the therapist is sitting hidden behind the piano. To introduce you to the therapist’s narrative, the following passage has been extracted that relates to Episode 1. This is dense narrative and demonstrates the process of construing and the use of constructs and categories. The constructs are highlighted in the text in italics, the categories in bold: “The therapist is being directive and leads the improvisation on the piano; the patient remains still and does not move. It is only at the close of the episode that the patient moves his foot into the wind chimes in a single isolated action. The therapist is unsure whether the patient is making music; it is suggested that he may only be making sounds, not directly aware of the musical implications of his playing. Though the actions of the therapist and patient seem coordinated, the episode is characterised by an uncertainty and the patient’s awareness of the interaction seems questionable. These constructs belong to the category communication; the therapist is focussed on interaction and communication.” As I have mentioned earlier, all episodes have been transcribed into musical notation. Some episodes have also been analysed using a sonogram (see Figure 10 on page 680). A sonogram shows the intensity of
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frequencies on the vertical axis over time along the horizontal axis. The time-code of a sonogram allows the exact description of the relationship of events to each other over time. FIGURE 10. Sonogram of Episode 1
In this episode, we can identify four clear phrases. The individual pitches of the piano melody are marked here with circles, and the two occasions where the patient moves his foot up and down and sounds the windchimes are marked with dotted squares. With this sonogram, the researcher can validate the strength and accuracy of the therapistâ&#x20AC;&#x2122;s descriptions of the events occurring in the episode. You can view the episode here: Download Video Episode EpisodeOne.mp4 (Quicktime 9.2 MB)
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EpdisodeOne.wmv (Mediaplayer 5.2 MB) GENERATING CATEGORIES
The last step of analysis process deals with generating categories. To do this, I have returned to the principal components analysis and reanalysed the relationships between the categories elicited from the constructs and the episodes. On a closer view, patterns of distribution have become apparent (see Figure 11 on page 681). The constructs from which the categories communication, emotionality, and agency have been generated appear near to the horizontal axis. The categories, musical expression, participation, and motility are nearer to the vertical axis. FIGURE 11. Patterns of distribution of categories
With this in mind, superordinate categories at a higher level of abstraction have been generated to describe this pattern (See Figure 12 on page 682): isolated-integrated (x axis)
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and idiosyncratic-conventional (y axis) FIGURE 12. Superordinate categories
The term, isolated, is defined in the New Oxford English Dictionary as “far away from other people, having minimal contact or little contact with others” (Soanes & Stevenson, 2003). It is rooted in the Latin word “insula” meaning “island” (ibid.). Following this, “being isolated” refers to a type of contact and not a situation of no contact. The term, integrated, stems from “integrate”, which is defined as “combine with another to form a whole, bring into equal participation in or membership of a social group” (Soanes & Stevenson, 2003). The term, idiosyncratic, stems from “idiosyncrasy” meaning “a mode of behaviour or way of thought peculiar to an individual” (Soanes & Stevenson, 2003). The term, conventional, is defined as “based on or in accordance with what is generally done or believed” (Soanes & Stevenson, 2003). It Example from the study
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derives from the Latin, “conventio(n)” meaning “meeting, covenant” (ibid.). CHANGE IN THERAPY
If we are thinking about change in therapy, we will need to think about change over time. This means we should consider the original chronological order of the episodes, if we wish to identify patterns of change during process of rehabilitation. If we blend out the lower levels of abstraction to view the episodes in relation to the superordinate categories and then show the original chronological sequence of the episodes, a pattern becomes clear in the therapy process of the three individuals considered in this study (see Figure 13 on page 683). FIGURE 13. Chronology of Episodes
By viewing the patterns of change demonstrated in terms of the superordinate categories, we can see that music therapy has facilitated change in all three patients towards conventional-integrated behaviour (see Figure 14 on page 684).
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FIGURE 14. General pattern of change
FIGURE 15. Phase 5 of Therapeutic Narrative Analysis
I will now move on to the final phase of therapeutic narrative analysis and to explicate the research narrative by drawing together the pieces of this narrative analysis. We have seen in the previous phases that it has been possible to identify change and generate constructs and categories that describe this change. But what is the significance of these changes in terms of the lives of the
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patients? The essence of these categories is their relevance in determining relationship. The term has been generated from the super-ordinate categories of the poles of the RepGrid, isolated and integrated, and idiosyncratic and conventional, and represents the core category of this narrative. The term relationship is defined as, “the way in which two or more people or things are connected” (Soanes & Stevenson, 2003), and describes the relation between them. The term “relation” derives from the Latin “relatio(n)” from “referre” meaning “bring back” (ibid). This perspective is helpful in understanding the changes identified in this study.
Discussion First, I would like to provide responses to the two research questions of this study. The first research question asked: what clinical changes can be identified in improvised music therapy in early neurorehabilitation with people who have experienced traumatic brain injury? This study has identified clinically significant change in improvised music therapy in the areas of musical expression, communication, agency, emotionality, motility, and participation. By doing, criteria have been identified for the recognition and description of change in processes of rehabilitation. The pattern of changes of isolated and idiosyncratic behaviour towards more conventional and integrated behaviour identified in this study have led to the recognition of the significance of the concept of relationship in early neurorehabilitation. Discussion
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The second research question asked whether this change can be linked to musical events occurring in music improvisations in therapy. The conceptual grounding of the analysis of episodes with musicological analysis has provided a firm base for the synthesis of the findings and this study has shown that it has been possible to link clinically significant change to musical events occurring in music improvisation in therapy. The focus of the study has led to an identification of a reduction of isolation and idiosyncratic behaviour and its significance in the setting of neurorehabilitation. Whereby many therapy strategies in neurorehabilitation focus on regaining functional ability, this study has shown that music therapy is not simply an additional therapy that can be added to this list. The application of music therapy can facilitate improvements in both functional and psychological aspects of life. This study demonstrates how music therapy broadens the potential of existing treatment possibilities, in particular in the re-establishment of relationships through a change from isolated and idiosyncratic behaviour towards conventional and integrated behaviour. When considering the role of music therapy in rehabilitation, we may be reminded of the Latin origins of the term “rehabilitat” meaning, “to restore to health or normal life, and former privileges” (Soanes & Stevenson, 2003). Traumatic brain injury influences an individual’s ability to participate in many, if not all relationships. Once lost, this participation may be considered to be a privilege. However, relationships are not privileges regardless of illness or disease, they are the most essential part of human life. Therefore this is part of the true work of rehabilitation, to assist people who have experienced traumatic brain injury to enjoy and develop relationships in their lives.
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Concluding comments This study is not a comparison study and has not answered the question whether other interventions may have been more, or less, or as effective in facilitating the changes identified in this study. This study is an inquiry into processes, and as such, investigates the ways change has taken place, as opposed to asking how much change has taken place. The study is the first to investigate what clinical changes can be identified, can these therapeutic changes be linked to musical events, and whether it is possible to demonstrate these changes to non-music therapists. It is basic qualitative research, and provides criteria and parameters of change that can be used in future studies. Theory is generated from data; by looking at what happens in episodes it is possible to hypothesize about the nature of rehabilitation through music therapy. It is important that changes in communication and relationships are investigated using qualitative techniques. From these qualitative conceptual studies we can generate the criteria for quantitative studies.
Acknowledgements I thank my mentor Professor Dr. David Aldridge for his encouragement and inspiration and for sharing his experience with me.
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Author Information FIGURE 16. Simon Gilbertson
Simon Gilbertson is an active musician and music therapist/supervisor and works at the Nordoff-Robbins Music Therapy Centre, Witten, Germany with both children and adults. He is a tutor in group improvisation at the University Witten/Herdecke and lectures on literature research methods at the doctoral programme at the School of Public Health at the University Bielefeld. His core interests include qualitative research methods incorporating musicological and video analysis and documentary film. His clinical practice has included work with developmentally challenged children, children and adults with cancer, neurological illness and disease and trauma. Simon initially trained in music at the Royal Academy of Music (trumpet and piano/composition) and King's College, London (composition and ethnomusicology). After completing his training in music therapy at the Nordoff-Robbins Centre London, he moved to Germany in 1994 where he took up a post as head of department of a leading music therapy department in early neurosurgical rehabilitation for children and adults. Whilst working as a research assistant to Prof. David Aldridge at the University Witten/Herdecke (2002-2005) on the Structured Review Project, Simon completed his doctorate on music therapy with people who have experienced traumatic brain injury. Simon can be contacted at the Nordoff-Robbins Zentrum Witten:
Author Information
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Nordoff Robbins Zentrum Witten RuhrstraĂ&#x;e 70 58452 Witten 02302 282470 simong(at)nordoff-robbins.org http://web.mac.com/simongilbertson www.simongilbertson.net THIS ARTICLE CAN BE CITED AS:
Gilbertson, S. (2006) Music therapy in early neurorehabilitation with people who have experienced traumatic brain injury. Music Therapy Today (Online 1st October) Vol.VII (3) 662-693. available at http:// musictherapyworld.net
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Music Therapy Today Vol. VII (3) (October) 2006
Portrait: WFMT Chair, Commission on Clinical Practice
Nobuko Saji
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Her works: IN EDUCATION:
I am a professor in the School of Nursing at Miyagi University, Japan. I teach musicology and music therapy to future nurses, counselors, teachers, and music therapists.
IN MUSIC THERAPY:
I have practiced music therapy since 1990 for elderly clients with dementia or Parkinson's disease, • for adult inpatients with mental disorder, • for children with autism or Down's syndrome •
I have a special interest in the physiological and behavioral evaluation of music therapy practice for elderly clients with dementia. IN ADMINISTRATION:
As the chair of the Election Administration Commission of the Japanese Music Therapy Association (JMTA) and a representative of the Tohoku region of JMTA, I have helped the professional association’s administration.
Her vision for the profession: I would like to contribute to advancing clinical practice in Asia and the world in the following ways: 1.
2.
By organizing symposiums and public lectures in Japan with music therapists from all over the world in order to promote the originality and universality of Japanese and Asian music therapy. Because the particular music therapy method used by each therapist must be selected by considering each client’ circumstances. Music therapists in Asia need to establish our original methods on the bases of American and European music therapy practice. By lecturing the importance of music therapy within complementary medicine to future nurses who will work with music therapists in hospitals and other facilities and may engage in research projects with doctors, fellow nurses and other specialists in related disciplines. It
Her works:
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would be beneficial to the patients if all medical practitioners have a better understanding of the clinical practice of music therapy.
Her personal interests: Swimming and Cooking
This article can be cited as: Saji, N. (2006) WFMT Chair, Commission on Clinical Practice. Music Therapy Today (Online 1st October) Vol.VII (3) 694-696. available at http://musictherapyworld.net
Her personal interests:
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Portrait: Music Therapy â&#x20AC;&#x153;For - Brain, Body & Soul â&#x20AC;&#x153; - A view on Indian music and music therapy Bhaskar Khandekar
Music has frequently been used as a therapeutic agent from the ancient times. Music is a kind of yoga system through the medium of sonorous sound, which acts upon the human organism and awakens and develops their proper functions to extent of self-realisation. This is the ultimate goal of Hindu Philosophy and religion. Melody is the keynote of Indian Music. The 'Raga' is the basis of melody. Various 'Ragas', have been found to be very effective in curing many diseases. Music helps in the treatment of actual diseases in the following manners: 1. One obvious use of music is that of a sedative. It can replace the administration of tranquilizers, or at least reduce the dosage of tranquillizers. 2. Music increases the metabolic activities within the human body. It accelerates the respiration, influence the internal secretion, improves the muscular activities and as such affects the Central Nervous System and Circulatory System of the listener and the performer. Music Therapy is not the subject of an article only. The entire subject is Now in the experimental and implementation stage, and data are rapidly
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accumulating. And the ancient system is gradually being transformed in to a modern science. Since -1993, I am a practitioner of Music Therapy. After, more then five thousands patients, I have observed that - Indian classical 'Ragas' have been acclaimed to have healing effects. They stimulate the Brain, ease tension and remove fatigue. The effect of Music Therapy may be immediate or slow, depending upon number of factors like the subject, his mental condition, environment and the type of Music, selected for having the desired effect. Music Therapy largely depends on individual needs and taste. The use of Music as therapy is based on scientific and clinical approach and has to be used with great care and deep study of the nature of illness. We can call it â&#x20AC;&#x153;The study of IndividualModality Theoryâ&#x20AC;?. Before using music as Therapy it must be ascertained which type of music is to be used. The concept of Music Therapy is dependent on correct intonation and right use of the basic elements of music. Such as notes [swara] rhythm, volume, beats, and piece of melody. There are countless 'Ragas' of course with countless characteristic peculiarities of their own. That is why we cannot establish a particular Rag for a particular disease. Different types of Ragas are applied in each different case. When we use term Music Therapy, we think world -wide system of therapy. Literature of Vocal part of Indian Classical Music is not sufficient in that case. We should apply the formula of three ' Ps ' i] Perfect Time, - It includes duration, span, interval and time to play the music. ii] Perfect Direction - It includes posture and conditions to listen the music. iii] Perfect Force - It includes Tone, Timber, sound quality and volume of Meditative Music We should remember the three categories of patients i.e. 698
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i] Music Learned, ii] Music Lovers, iii] Non-Musical. Select the Meditative Music accordingly. Music helps in the treatment of actual diseases in the following manner: One obvious use of music is that of a sedative. It can replace the administration of tranquilizers, or at least reduce the dosage of tranquilizers. Music increases the metabolic activities within the human body. It accelerates the respiration, influences the internal secretion, improves the muscular activities and as such affects the â&#x20AC;&#x153;Central Nervous Systemâ&#x20AC;&#x153; and Circulatory System of the listener and the performer. The modern revival of music therapy has not yet sufficiently progressed to indicate its full utility. Several problems immediately invite further research. Under existing conditions, it would seem advisable to broaden the foundation of musical research. Not only to advance the ethical and moral rights of the human being, but also to prevent, if possible, the negative and destructive influences which may be due to ignorance of the laws governing the effects of sound and rhythm. The Indian would regard it as a sacrilege to profane his magic music, and would further insist that such profanation would destroy the healing power of the rites. It is obvious that the psychological effect of the therapeutic music would be greater if the patient understood that the scientific foundation of the procedure had been thoroughly established. I take a great pleasure in introducing this contribution to the Music lovers of India.
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I am sure this little knowledge will prove a great help in increasing awareness for Music Therapy. Physiological, Psychological, Physical, Moral, Intellectual, and Spiritual effects of music confirm the supremacy of Indian Music.
Author contact Dr.Bhaskar Khandekar [Dedicated to Music Therapy Since 1993] Ph. D. in Music Therapy, M.A.Music Classical Violinist, Musicologist Founder-Music Therapy & Research Institute Director KALAVARDHAN Academy 577, Agrawal Colony, Nr. Jain Mandir Garha Road, JABALPUR (M.P.) India Phone - 91-0761 -4002775 Email - musictherapist(at)rediffmail.com THIS ARTICLE CAN BE CITED AS:
Khandekar, B. (2006) Music Therapy - “For - Brain, Body & Soul “ - A view on Indian music and music therapy. Music Therapy Today (Online 1st October) Vol.VII (3) 997-700. available at http://musictherapyworld.net
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Rhythm is the source of all existence - An Interview with Percussionist Greg Ellis
FIGURE 1.
Gregg Ellis
by Petra Kern Right under the Hollywood sign, thatâ&#x20AC;&#x2122;s were you find Greg Ellis in his percussion studio in Los Angeles, California. Greg Ellis is an extraordinary musician who strives for the pure essence of rhythm and its connection to the human spirit and soul. His talent and philosophy led him to work with masters in his field, including Taiko drum group KODO, Mickey Hart, Airto, Zakir Hussain, and Giovanni Hidalgo, as well as top 701
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rock musicians Billy Idol and Jeff Beck. From his work with his own critically acclaimed group VAS, to movie soundtracks (The Matrix, Dawn Of The Dead) to participating in musical collaborations and workshops, Greg always followed his path of pure devotional spirit. Drumming became for him a metaphor for life and source of all existence. I met Greg Ellis in 2001, when we gave a joint workshop at the American Music Therapy Association (AMTA) annual conference in Pasadena, California. His awareness of rhythm and his incredible musicianship harmonized very well with my philosophy as a music therapist. We both discovered that rhythm reaches people (no matter with or without disabilities) and has the ability to unify, heal, balance, and inspire not just our own being, but humanity as a whole. When one is exposed to rhythm, we are given a key to enter into the realm of a universal experience. Gradually understanding the healing aspect of rhythm and the drums, Greg’s primary focus of playing shifted from performing and entertaining to supporting wellbeing. With his RhythmTonics™, he created a set of seven real-time recorded CDs of non-traditional improvised percussion music. Greg’s intention behind the recorded cycle of music is to revitalize the natural flow of the intuitive mind, to balance spiritual and physical aspects of one’s being, and to facilitate being in the moment. His music is a synergetic blend of organic rhythms and sounds, free from all form of synthesized frequencies. Ellis’ unique way and intention of playing can also be experienced in live concerts in the L.A. area. (You might want to check his event calendar at www.rhythmpharm.com). This interview was recorded in Greg’s studio in L.A. While we were talking, a light breeze blew through the studio. Imagine being with us, surrounded by ancient drums, gongs, sound bowls, marimbas, thumb piano kalimbas, clay pots, bells, and other instruments from different parts of 702
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the world. You will hear them talk once in a while…. Let yourself be guided by percussionist Greg Ellis into the world of drumming and the power of organic rhythms.
Question: What does rhythm mean to you? Download Ellis_1.pm3 (1,3 MB)
Question: Where did your rhythm adventures take you in life? Download Ellis_2.pm3 (2,6 MB)
Question: How do you prepare yourself to get your intention out? Download Ellis_3.pm3 (3.6 MB)
Question: Would
you please address “mistakes” in music and their
meaning? Download Ellis_4.pm3 (2,3 MB)
Question: How does your audience respond to your transition points? Download Ellis_5.pm3 (3,1 MB)
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Question: What are RhythmTonics™ and Organic Music? Download Ellis_6.pm3 (3,5 MB)
Question: What are the classifications of the Tonics and how did you decided which quality goes along? Download Ellis_7.pm3 (3,6 MB)
Question: How did you assign the instruments to the colors? Download Ellis_8.pm3 (2,3 MB)
Question: Is there an idea behind the order of the Tonics? Download Ellis_9.pm3 (2 MB)
Question: What are the applications of the RhythmTonics™? Download Ellis_10.pm3 (3,2 MB)
Question: How do you see your work fitting into music therapy? 704
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Download Ellis_11.pm3 (3,6 MB)
Question: Which philosophical idea stands behind your work? Download Ellis_12.pm3 (3,9 MB)
Question: What do you wish to happen in the world? Download Ellis_13.pm3 (2,3 MB)
Thanks Greg for sharing your experiences and insights with the readers and listeners of Music Therapy Today. Thanks also to my former student Leanne McIntosh for her curiosity and endurance during the Pilot Study on “Music for Personal Growth and Wellness” using Greg’s RhythmTonics in the experiment.
Resources mentioned in this interview: Dee, J., & Taylor, L. (2004). Beginner’s guide to color therapy. NY, NY: Sterling RhythmPharm (n.d.), Retrieved September 15, 2006, from https:// www.rhythmpharm.com Watts, A. (1957). The Way of Zen. NY, NY: Vintage Books.
Resources mentioned in this interview:
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About the Author FIGURE 2.
Dr. Petra Kern
Dr. Petra Kern, MT-BVM, MT-BC is a member of the Music Therapy Today editorial board. This interview is an asset to a Pilot Study she and her student conducted at the University of Windsor in Canada. Petra returned to the Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill. Currently she works on a book of her research, teaching and clinical practice from her home in Santa Barbara, California, and enjoys catching up with old friends. Petra can be contacted at PetraKern@prodigy.net. THIS ARTICLE CAN BE CITED AS:
Kern, P. (2006) Rhythm is the source of all existence - An Interview with Percussionist Greg Ellis. Music Therapy Today (Online 1st October) Vol.VII (3) 701-706. available at http://musictherapyworld.net
About the Author
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Odds and ends, themes and trends Tom Doch Caution: We cannot claim responsibility for the content of other websites (it may become outdated quickly).
Better Lie Detectors Source: www.sciencentral.com/12. September 06 http://www.sciencentral.com/articles/view.php3?article_id=218392848 Having a foolproof lie detector has been a goal for centuries. As a ScienCentral News video explains, an old method of looking at brain activity might give us a new way to spot liars. PANTS ON FIRE?
One of the memorable moments in the film “Meet the Parents” was Ben Stiller’s profusely sweating brow as he sat strapped into a polygraph during his soon-to-be father-in-law’s invasive questioning. Sweating, along with blood pressure, respiration, and heart rate are all physiologic conditions measured by polygraphs, with the idea being that they might reveal deception-induced anxiety.
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Now, rather than focusing on the potential end-result of lying, Temple University scientists Scott Faro and Feroze Mohamed are developing a way to detect deception by looking directly at people's brain activity using MRI brain scanners. "We are going to the source, we are going to the region of the brain which is actually formulating a response," says Mohamed, the MRI physicist on the team. As Faro and Mohamed point out, because polygraphs only measure endresult changes in the sympathetic nervous system, tricking a polygraph might be achieved by simple relaxation. On the flipside, just being anxious about the test can generate a false positive. In fact, say the researchers, false positives are common. "About 25 percent of the time, if you're innocent, the polygraph is going to say that you're either guilty or it's indeterminate," says Faro, professor and vicechairman of radiology at Temple. MRI Lie Detector Researchers In this preliminary study, the researchers wanted to see whether brain scans can even pick up a significant difference between brain activity during lying versus when telling the truth. The researchers had six of eleven volunteers fire a gun, then lie and say they didn't. The other five could truthfully say they didn't fire the gun. All the volunteers were then given functional MRI and polygraph tests during which they denied having fired the gun. As they reported in The Journal of Radiology, the brain scans revealed unique areas that only lit up during lying. However, the researchers point Odds and ends, themes and trends
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Better Lie Detectors
out that there is never going to be one telltale spot in the brain that automatically indicates a lie. "There really is no one lying center," says Faro. "There are multiple areas in the brain that activate because there's a lot of processes that have to take place." Instead, Faro and Mohamed say that developing this method into a viable lie-detection system will depend on discovering complex patterns of brain behavior linked to lying. One of the most important of these is that the brain has to work much harder to lie than to tell the truth. "In the group that lied there were two times the number of areas throughout the brain that showed activation compared to the group that was telling the truth," says Faro. He explains that this is caused by the fact that to lie you have to actively suppress memories that are triggered by the question. That takes more effort than simply asserting the truth. Mohamed says that one of the most interesting parts of the study was coming up with â&#x20AC;&#x153;an ecologically valid design, as close to true life as possible." The researchers reasoned that lying about a real activity might produce a host of different responses in the brain, rather than just lying about known facts (such as falsely responding to questions like, â&#x20AC;&#x153;What is your name?â&#x20AC;?). "Because you actually had not just the memory of a gun firing, but you also had the tactile sense of feeling the gun, of hearing the explosion of the bullet, of smelling the gun powder. So we tried to really create a truelife scenario of memory, of reaction, of awareness that would correlate with a true criminal-type event," says Faro. MRI Lie Detector Mohamed
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Better Lie Detectors
Faro and Mohamed say a lot more research is needed, but they believe this method could one day be more accurate than a polygraph. Although they’re not yet certain whether it will be possible to trick the MRI, they say it’s harder to change what your brain is doing than suppress your nervous responses. "I think it will be very, very hard for somebody to cheat," says Mohamed. In fact, Faro hopes that this technology will usher in a new era of accuracy in lie detection, which could be applied in areas from preventing insurance fraud to freeing falsely-accused prisoners. "We have a lot of research that needs to be performed, but I think that in the near future – the next year or two, there will be some very positive results, and I'm very confident that this or a form of this test will be the new gold standard," says Faro. Because when you're a liar, it's your brain that's on fire. Faro and Mohamed’s research was published in the February 2006 volume of the Journal of Radiology and was internally funded by Temple and Drexel Universities. OUTDOORLINKS:
ScienCentral News video about the better lie detector http://www.sciencentral.com/articles/view.php3?article_id=218392848 Scott Faro http://www.temple.edu/medicine/faculty/f/faro.htm Feroze Mohamed Odds and ends, themes and trends
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New University of Leicester study identifies links between musical tastes and
http://www.temple.edu/medicine/faculty/m/mohamed.htm The Journal of Radiology http://www.jradiology.com/
New University of Leicester study identifies links between musical tastes and lifestyle Source: www.alphagalileo.org/12 September 2006 http://www.alphagalileo.org/index.cfm?fuseaction=readrelease&releaseid=515228 The music we listen to can tell a lot more than you might think about what kind of people we are, according to research findings by a University of Leicester psychologist. Now, Dr Adrian North is extending his research worldwide. He is looking for 10,000 people from all over the world to take part in an online survey at www.musicaltastetest.com, stating their preference from over 50 musical styles and completing a questionnaire. The survey, funded by the British Academy, will help Dr North and his team determine to what extent peopleâ&#x20AC;&#x2122;s musical tastes can be predicted on the basis of basic demographic information, such as age, sex and earnings.
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New University of Leicester study identifies links between musical tastes and
Dr North said, â&#x20AC;&#x153;Although we know a lot about musical preference, musicaltastetest.com is the largest ever academic survey of who likes what. Nothing on this scale has ever been attempted before.â&#x20AC;? Related research by Dr North about to be published in the journal Psychology of Music shows that a personâ&#x20AC;&#x2122;s musical preference tells a great deal about their lifestyle and interests. Over 2,500 people in the UK were asked to state which musical styles they liked most, and then complete a questionnaire about their living arrangements, political and moral beliefs, travel, personal finances, education, employment, health, media preferences, and leisure time interests. When it comes to relationships, beliefs and breaking the law, fans of different musical styles gave very different responses, with fans of hip-hop and dance music standing out in particular. 37.5% of hip-hop fans and 28.7% of dance music fans had had more than one sexual partner in the past five years, (compared with, for example, 1.5% of country fans). They were also the least likely to be religious, least likely to recycle, least likely to favour the development of alternative energy sources, least likely to favour raising taxes in order to improve public services, and least likely to favour the retention of a National Health Service. In addition, they were more likely to have broken the law. 56.9% of dance music fans and 53.1% of hip hop fans admitted to having committed a criminal act (compared, for example, to just 17.9% of fans of musicals).
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New University of Leicester study identifies links between musical tastes and
Hip hop and dance music fans were more likely to have tried a range of illegal drugs. However, about a quarter of the classical music and opera fans admitted to having tried cannabis, and 12.3% of opera fans had tried magic mushrooms. On questions concerning money, education, employment and health, fans were separated along the lines of socio-economic status. Fans of classical music and opera had lifestyles indicative of the middle and upper classes.
They had an average annual income of ÂŁ35,000 before tax, whereas dance music fans earned only ÂŁ23,311. Classical music and opera fans also paid a much higher proportion of their credit card bills each month than fans of dance music (75% and 49% respectively). They were also more likely to have been educated to a higher level. 6.8% of opera fans had a PhD, compared to none of the chart pop fans. When it comes to eating, fans of classical music, opera and jazz tended to spend rather more money on food and preferred to drink wine to a greater extent than fans of other musical styles. Results also showed that fans of different musical styles often had different tastes in the media. Viewers of BBC1 are more likely to be fans of rock or classical music, whereas ITV1â&#x20AC;&#x2122;s viewers are more likely to listen to disco and pop music. Readers of broadsheet newspapers are more likely to listen to classical and rock music, compared to readers of the tabloids, who prefer dance music, pop and music from the sixties.
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New University of Leicester study identifies links between musical tastes and
Dr North added: “Surprisingly, there have been very few studies on how people's age, sex, socioeconomic status, and personality relate to the music they enjoy listening to. Moreover, this limited amount of research has focussed almost exclusively on North America. This is despite the fact that music is enjoyed by people all around the world and, in addition, there are numerous stereotypes about the types of people who listen to certain musical styles that may or may not be true (e.g. goths are depressed, classical music fans are upper-class, jazz fans are like the presenter of The Fast Show's 'Jazz Club' etc.). “Musicaltastetest.com aims to recruit over 10,000 people to paint the first worldwide picture of who likes what.” OUTDOORLINKS:
Adrian North http://www.le.ac.uk/pc/acn5/acn.html Musical Preference and Taste Survey http://www.musicaltastetest.com Psychology of Music http://pom.sagepub.com/
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To Fight Stuttering, Doctors Look at the Brain
To Fight Stuttering, Doctors Look at the Brain By ANDREW POLLACK Source: www.nytimes.com/2006/09/12/ http://www.nytimes.com/2006/09/12/health/ 12stutt.html?pagewanted=2&ref=health When called upon in class, he would sometimes answer in the voice of Elmer Fudd or Donald Duck because he didn’t stutter when imitating someone. He found easier-to-say synonyms for words that stymied him. And he almost never made phone calls because he stumbled over a phrase for which there was no substitute: his own name. Now Dr. Maguire, a psychiatrist at the University of California, Irvine, wants to cure the ailment that afflicts him and an estimated three million Americans. He is searching for a drug to treat stuttering, organizing clinical trials and even testing treatments on himself. He could be getting closer. In May, Indevus Pharmaceuticals announced what it called encouraging results from the largest clinical trial ever of a drug for stuttering. Even larger trials are still needed, which could take two or three years. But if they succeed, the drug, pagoclone, could become the first medical treatment approved for stuttering. That is just part of a transformation of stuttering — in the medical view — from what was once widely considered a nervous or emotional condi-
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To Fight Stuttering, Doctors Look at the Brain
tion to a neurological one that is at least partly genetic. Using brain scans, DNA studies and other modern techniques, scientists — many of whom stutter themselves — are slowly shedding light on a condition that has flustered its victims as far back as Moses, who some scholars believe was a stutterer because he told the Lord that he was “slow of speech and of a slow tongue” and had his brother Aaron speak for him. “This is a total paradigm shift in the last 10 years,” said Dr. Maguire, who helped design the Indevus trial and was an investigator in it. “When I was in medical school, I learned nothing about stuttering.” Still, much remains to be learned about the causes of stuttering and how to treat it. It is estimated that about 1 percent of the population worldwide stutters, though that figure may be high. Men who stutter outnumber women by a ratio of about 4 to 1, for reasons not known. In most cases, stuttering begins between ages 2 and 6, when a child is just learning to speak. But three quarters of such children will stop stuttering within a few years without any intervention, said Ehud Yairi, emeritus professor of speech and hearing science at the University of Illinois, who stutters himself. Other children benefit from speech therapy. Those who stutter say the condition — marked by repetitions of syllables, long silences and the contortion of the face as a person seems to try to force the words out — can exact a terrible emotional toll. Many talk of jobs or promotions not received, of relationships broken or not pursued. Some structure their entire lives to avoid having to speak unnecessarily or to avoid being teased.
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“Stuttering is one of the last diseases it’s still O.K. to make fun of,” said Ernie Canadeo, an advertising executive from Oyster Bay, N.Y., who stutters. Alan Rabinowitz, a noted wildlife conservationist, has told of how when called upon by a teacher in elementary school, he once avoided answering by stabbing his hand with a pencil so he would be taken to the hospital. Still, many people overcome — if not totally cure — their stuttering, either through therapy or just the passage of time. Winston Churchill stuttered. So did Marilyn Monroe. Others who have coped with the problem include the author John Updike, Senator Joseph R. Biden Jr. of Delaware, the actor James Earl Jones, the newsman John Stossel, the singer Carly Simon and the sportscaster Bill Walton. Throughout history, various theories have been advanced for stuttering, including sexual fixations, emotional disorders, nervousness, and persistence into adult life of infantile nursing activities, according to the book “Knotted Tongues: Stuttering in History and the Quest for a Cure” by Benson Bobrick (Simon & Schuster, 1995). One of the more popular theories from a few decades ago was that parents caused stuttering by reacting negatively to the repetitions that normally occur when children first learn to talk. But a consensus is growing that stuttering is a neurological condition, though its exact nature is not clear. Emotional stress can make stuttering worse, however.
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Brain imaging studies have shown that the brains of people who stammer behave differently from those of people who don’t when it comes to processing speech. Luc De Nil, chairman of the department of speech and language pathology at the University of Toronto, said that in people who don’t stutter, speech processing is largely handled in the brain’s left hemisphere. With stutterers, there is an unusually large amount of activity in the right hemisphere. Dr. Maguire said studies that he and others had done also suggest there is an excess of the neurotransmitter dopamine in the brains of those who stutter. Stuttering also appears to be at least partly genetic. About half of the people who get treatment for stuttering have an immediate family member who also stutters, said Dennis Drayna, a geneticist at the National Institute on Deafness and Other Communication Disorders. Scientists believe there are many genes that can contribute to stuttering, each one perhaps having a small effect. That has made it more difficult to find the genes. But Dr. Drayna and his colleagues got a big break when a man from Cameroon wrote to an online forum on stuttering a few years ago. The man was part of a prominent family in which 48 of 106 adults stuttered, suggesting that the gene responsible for the family’s stuttering was inherited by changes in one gene. Studying the DNA from that family, Dr. Drayna and his colleagues have narrowed the search to a stretch of Chromosome 1 containing 50 to 60 Odds and ends, themes and trends
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To Fight Stuttering, Doctors Look at the Brain
genes. Another study using families from Pakistan with large numbers of stutterers found a region on Chromosome 12, and that specific gene is close to being identified, Dr. Drayna said. Other studies have found other chromosomal regions. If the cause of stuttering has baffled scientists, so has its treatment. A 16th-century Italian physician prescribed nosedrops to “dehumidify” the brain, according to Mr. Bobrick’s book. An American Indian tribe made stutterers spit through a hole in a board to drive the devil from their throats. Most people who are treated for stuttering nowadays undergo various types of speech therapy. Some therapies teach speech techniques, like elongating vowels or speaking slowly. Others emphasize reducing the anxiety and fear of speaking. “Adults can be significantly helped,” said Peter Ramig, a professor of speech language pathology at the University of Colorado, who stutters. “But it would be very unusual to see documented cases of adults who stutter being cured.” Some stutterers have been helped by devices. The best known is the SpeechEasy, which fits in the ear like a hearing aid and feeds the voice back to the speaker with a tiny delay and at a slightly different pitch. This is said to simulate the choral effect, in which people don’t stutter when speaking or singing in unison with others. The device costs about $5,000, and 6,000 have been sold since 2001, according to the manufacturer, the Janus Development Group of Greenville, N.C.
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719
To Fight Stuttering, Doctors Look at the Brain
Specialists say that the device helps some people but not others and that the effects can wear off.As for drugs, there have been some studies over the years using medications developed to treat other conditions. Dr. Maguire ran small trials of two schizophrenia drugs, Risperdal, from Johnson & Johnson, and Zyprexa, from Eli Lilly. Both drugs showed some effectiveness, but neither company took the drug into larger trials. That has frustrated Dr. Maguire, who said pharmaceutical companies could be missing a big market. In the past, some critics have accused pharmaceutical companies of taking conditions like anxiety or inattentiveness, which the critics say are not clearly illnesses, and turning them into medical problems so they could sell drugs. But stuttering, Dr. Maguire said, is clear cut. One obstacle is that stuttering has been primarily treated by speech therapists, who can’t prescribe drugs and might object to the condition being treated as a medical one. “There are many people who simply have a bias against it and don’t think it’s a good idea,’’ said J. Scott Yaruss, a speech therapist at the University of Pittsburgh. Another is that side effects might be worth risking for a serious disease like schizophrenia but not for stuttering. Zyprexa has been linked to weight gain and diabetes. Dr. Maguire himself has taken Zyprexa for seven years and says it has greatly helped his fluency. He has gained 20 pounds in that time but believes he would have gained some of it anyway because he was approaching middle age.
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720
To Fight Stuttering, Doctors Look at the Brain
Pagoclone, the newest candidate, was initially tested as a treatment for panic disorder and anxiety. Results were mixed, and Pfizer, which had the rights to the drug, returned them to Indevus. But in those trials a few people who stuttered said their speech improved during the trial. So Indevus got a patent covering the use of the drug for stuttering and began the clinical trial, in which 88 patients got the drug and 44 a placebo. The participants were videotaped in conversation and reading, both before starting on the drug or a placebo and four and eight weeks afterward. Evaluators, blinded to whether the patient was on the drug or the placebo when the video was made, counted the proportion of syllables stuttered and the duration of the three longest stutters. In a separate measure, clinicians evaluated the speech of their patients. In most cases, those who got the drug did better than those who got the placebo by a statistically significant amount. As evaluated by the clinicians, 55 percent of those who got the drug improved after eight weeks, compared with 36 percent on the placebo. The most common side effects were headache and fatigue. Still, until the results are published in a journal the company will not reveal how big the improvement was for people, or whether it was enough to make a real difference in their lives. Itâ&#x20AC;&#x2122;s also not quite clear how the drug is working, whether it is merely reducing anxiety or has some other effect on speech. The drug activates a receptor in the brain called GABA that is associated with a calming effect.
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721
To Fight Stuttering, Doctors Look at the Brain
Indevus has not said whether it will continue to pursue pagoclone for stuttering because it is outside its focus of urology and gynecology. It is also testing pagoclone as a treatment for premature ejaculation. The company, under a previous name, Interneuron Pharmaceuticals, developed Redux, a diet drug that became part of the fen-phen combination. Wyeth, which sold the drug, withdrew it from the market after it was linked to heart valve problems. Claire Byrne of Fountain Valley, Calif., who is taking pagoclone as part of an extension of the clinical trial, said, “I definitely think it’s helping me.” Another woman taking it said, “It’s left me feeling a little bit more free, and I engaged in more speaking situations.” Dr. Maguire is more enthusiastic. On a conference call for securities analysts held by Indevus, he said some patients taking the drug had finally gotten jobs they wanted or were able to approach others and go out on a date. “It’s almost an awakening, people coming out of their shells, so to speak.” OUTDOORLINKS:
Gerald A. Maguire http://www.ucihs.uci.edu/psych/old_psych/research-division/Stutter/ grouppics.htm Luc De Nil http://www.uhnresearch.ca/researchers/profile.php?lookup=1415 Dennis Drayna
Odds and ends, themes and trends
722
Detecting Awareness in the Vegetative State
http://www.cc.nih.gov/ccc/mfp/bios02/drayna.html J. Scott Yaruss http://www.shrs.pitt.edu/CMS/School/Faculty_Bio.asp?id=77
Detecting Awareness in the Vegetative State By Adrian M. Owen, Martin R. Coleman, Melanie Boly, Matthew H. Davis, Steven Laureys and John D. Pickard Source: www.sciencemag.org/8 September 2006 http://www.sciencemag.org/cgi/content/short/313/5792/1402 Vol. 313. no. 5792, p. 1402 DOI: 10.1126/science.1130197 We used functional magnetic resonance imaging to demonstrate preserved conscious awareness in a patient fulfilling the criteria for a diagnosis of vegetative state. When asked to imagine playing tennis or moving around her home, the patient activated predicted cortical areas in a manner indistinguishable from that of healthy volunteers. To whom correspondence should be addressed. Adrian Owen , E-mail: adrian.owen(at)mrc-cbu.cam.ac.uk
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723
I'm not ignoring you; I'm thinking. Gazing into the middle distance improves your
OUTDOORLINKS:
Adrian Owen http://www.mrc-cbu.cam.ac.uk/people/people-pages.php?id=101 Fachzeitschrift "Science" http://www.sciencemag.org/ Andreas Zieger http://www.a-zieger.de/ "Sch채del-Hirnpatienten in Not" http://www.schaedel-hirnpatienten.de/
I'm not ignoring you; I'm thinking. Gazing into the middle distance improves your concentration By Lucy Heady Source: www.nature.com/5 September 2006 http://www.nature.com/news/2006/060904/full/060904-6.htmldoi:10.1038/news060904-6 Teachers everywhere can be heard shouting "look at me when I'm talking to you". But research presented today at the British Association's Festival of Science in Norwich, UK, suggests that they should be doing exactly the opposite.
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724
I'm not ignoring you; I'm thinking. Gazing into the middle distance improves your
When posed with a conundrum, it is normal for adults and older children to look away, staring in an unfocused way out of the window or at a patch of the carpet. This aimless gaze isn't necessarily thanks to an attitude of indifference or indolence, but instead might be helping the brain to concentrate. Researchers at the University of Stirling in Scotland took a group of 25 five-year-olds and trained them to look away when they were being asked a question. The effect was a significant increase in correct answers to mental arithmetic questions, says Gwyneth Doherty-Sneddon, who led the research. She declined to give details as the work is in press with the British Journal of Developmental Psychology. Further experiments by the same group showed that the difficulty of both looking at a face and thinking about maths is so extreme it can cause a physiological response. In one study, around 30 adults were asked to perform a task requiring concentration, such as counting backwards from 100 in increments of 7, while staring at a human face. The combination of mental effort and emotional confusion caused the subjects to break out in a sweat. The sweatiest subjects, Doherty-Sneddon adds, were men being tested by a female researcher.
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725
Sound understanding of indoor acoustics could make hearing easier
We are so distracted by the barrage of emotional information transmitted in faces that it stops us from thinking clearly, Doherty-Sneddon says. So does this mean that teachers should be encouraging their students to look away from them? Doherty-Sneddon certainly thinks so. "I do this with my own kids while they're doing their homework" she says. "If they're looking at me then I know they're not concentrating." OUTDOORLINKS:
British Association's Festival of Science in Norwich, UK http://www.the-ba.net/the-ba/ Gwyneth Doherty-Sneddon http://www.psychology.stir.ac.uk/staff/gdohertysneddon/index.php
Sound understanding of indoor acoustics could make hearing easier Source: http://www.alphagalileo.org/08 Sep 2006 http://www.alphagalileo.org/index.cfm?fuseaction=readrelease&releaseid=515015 An innovative technique that, for the first time, accurately measures exactly how sound behaves in ‘real-world’ situations is now under development – and could improve acoustics in buildings ranging from concert halls to railway stations.
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726
Sound understanding of indoor acoustics could make hearing easier
The potential impact of the technique, which could also assist in the development of more effective hearing aids, will be described at this year’s BA Festival of Science in Norwich. The technique is designed to pinpoint precisely how indoor environments respond to music and speech while those areas are in everyday use. This opens up the prospect of basing acoustic design on more realistic information about the way sound behaves than has previously been possible. It may also contribute to the development of hearing aids that adapt the way they process sound according to the acoustic environment they are in, providing a much better listening experience for hearing aid users than is currently achievable. The conventional way of measuring acoustics has been to make a short blast of noise (e.g. a gunshot), record it and analyse how it dies away (or ‘decays’). The noise has to be very loud so that the environment’s effect on it can be assessed across the full range of sound, from very loud to very quiet – only in this way can comprehensive information on an environment’s acoustic performance be obtained. However, gunshot noise poses a risk to hearing and is unpleasant to listen to. This means that measurements taken in unoccupied areas are the norm even though these do not accurately indicate ‘real’ acoustic performance - when people are present, moving and talking etc. Now, engineers at the University of Salford are exploring whether music played at an average level of audibility, or even the conversation of people in the indoor environment being tested, could be used instead of the loud, short blast of noise. The work is being funded by the Engineering and Physical Sciences Research Council (EPSRC). Odds and ends, themes and trends
727
Sound understanding of indoor acoustics could make hearing easier
Exploiting the major advances in computing power and sophistication achieved in the IT sector in recent years, the team is developing groundbreaking computer programmes capable of isolating snippets or phrases from normal music or speech, analysing their decay and extrapolating this data so it provides an accurate indication of an environment’s effect on sound. Since loud test sounds are not required, this approach avoids the need to vacate the environment when testing takes place, enabling more realistic acoustic data to be gathered. Trevor Cox, Professor of Acoustic Engineering at Salford University, is leading this pioneering research and will be discussing progress at the BA Festival on 8th September. “Our work could deliver a step-change in understanding how rooms behave acoustically,” says Professor Cox. “It could help eliminate a lot of guesswork on the effect that actual usage of indoor environments will have on their acoustics.” The research could lead to changes within around 5-10 years in the way that indoor environments are designed and constructed. In visual terms, most changes are unlikely to be obvious. “The key differences could be in altering the way that building materials absorb or reflect sound by treating them prior to incorporation in a building,” says Professor Cox. “There’s a long way to go but the potential impact, in terms of improving quality of life for millions of people, is obvious.” OUTDOORLINKS:
Trevor Cox
Odds and ends, themes and trends
728
Music - the key to feeling good?
http://www.acoustics.salford.ac.uk/research/arc_cox.htm Engineering and Physical Sciences Research Council (EPSRC) http://www.epsrc.ac.uk/default.htm
Music - the key to feeling good? Source: http://www.alphagalileo.org/i05 September 2006 http://www.alphagalileo.org/index.cfm?fuseaction=readrelease&releaseid=515026 The Department of Psychology at the University of Helsinki is coordinating a wide-ranging EU-funded research project, Tuning the brain for music, or Braintuning, for short. The purpose of the project is to gain a deeper insight into the relationship between music, emotions and brain functions. The project has received EU funds totalling â&#x201A;Ź2.5 million. The Braintuning project aims to find out, among other things, why music has such a profound effect on our emotional life and how enjoying music and the emotions invoked by music are manifested in our brain functions.
Another fascinating line of research focuses on how individual differences in musical preferences and emotions inspired by music can be explained.
Odds and ends, themes and trends
729
Music - the key to feeling good?
In addition to the structure of music, the emotions invoked by it are also influenced by the listener’s personality and the listening environment. Certain regularities in the links between music and emotions are well known. A fast tempo piece in a major key is often felt to be happy and glad by Western adults, but different ways of playing can produce interpretations conducive to different emotions. A particular piece, when played in a certain way may sound aggressive, while played in another way, it may sound calming. The University of Helsinki will focus particularly on how permanent music emotions and preferences are and how much of them can be explained by cognitive brain functions. Answers to these questions are sought with the help of the latest methods in brain research, listening experiments as well as interview- and observation-based research methods. The Braintuning project will last three years. In addition to the Universities of Helsinki and Jyväskylä in Finland, participants include the Universität Leipzig, the Université de Montréal, Kungliga Tekniska Högskolan in Stockholm and the Vita-Salute San Raffaele University in Milan. OUTDOORLINKS:
Research: Christina M. Krause http://www.helsinki.fi/~ckrause/ Department of Psychology at the University of Helsinki
Odds and ends, themes and trends
730
General outline of "Milieus of Creativity" Second "Knowledge and Space"
http://www.helsinki.fi/psykologia/english/ Department of Psychology, Cognitive Science http://www.helsinki.fi/kognitiotiede/english/research.htm
Second "Knowledge and Space" Symposium at Heidelberg’s Villa Bosch Studio, 6 – 9 September 2006 General outline of "Milieus of Creativity"
Source:
http://www.knowledgeandspace.uni-hd.de/index.php?page=./
inhalte/ns_general_outline.txt From 6 – 9 September 2006, the second “Knowledge and Space” symposium will be taking place at Heidelberg’s Villa Bosch Studio, this time on the subject matter of “Milieus of Creativity”. The series of symposia, which is to encompass a total of ten events, is being financed by Heidelberg’s Klaus Tschira Foundation. Against the background of the current debate on the “Knowledge Society” and “Knowledge Economy”, questions pertaining to creativity and milieus of creativity have come to the fore as the research focus of numerous disciplines in recent years. Psychologists and cognitive scientists, economists, geographers and spatial planners, philosophers, sociologists and physicists will be conducting an interdisciplinary dialogue about what they understand by creativity and about the milieus in which it can be cultivated.
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731
General outline of "Milieus of Creativity" Second "Knowledge and Space"
The first day of the conference, entitled “Creativity and Problem-Solving – A Clarification of Concepts”, will serve to summarise the insights of psychological and cognitive research. At the same time, both the basic neurological principles of creative thought and action and the emergence of creativity in the context of social interaction will be addressed. To read more about the program please go to http://www.knowledgeandspace.uni-hd.de/index.php?page=./inhalte/ ns_general_outline.txt OUTDOORLINKS:
Knowledge & Space http://www.knowledgeandspace.uni-hd.de General outline of "Milieus of Creativity" http://www.knowledgeandspace.uni-hd.de/index.php?page=./inhalte/ ns_general_outline.txt Klaus Tschira Stiftung http://www.kts.villa-bosch.de/ Peter Meusburger http://www.geog.uni-heidelberg.de/wiso/mitarbeiter/meusburger.htm Arthur I. Miller http://www.ucl.ac.uk/sts/aim/ Margaret Boden Odds and ends, themes and trends
732
Feelings matter less to teenagers
http://www.sussex.ac.uk/informatics/profile276.html Markus Knauff http://cognition.iig.uni-freiburg.de/team/members/knauff/knauff.htm Ernst Helmstädter http://www.wiwi.uni-muenster.de/iif/orga/helmstaedter/index.html Scott G. Isaksen http://www.cpsb.com/contact.html Barney Warf http://www.fsu.edu/~geog/people.html
Feelings matter less to teenagers Source: www.alphagalileo.org/07 Sep 2006 http://www.alphagalileo.org/index.cfm?fuseaction=readrelease&releaseid=514991 Teenagers take less account than adults of people’s feelings and, often, even fail to think about their own, according to a UCL neuroscientist. The results, presented at the BA Festival of Science today, show that teenagers hardly use the area of the brain that is involved in thinking about other people’s emotions and thoughts, when considering a course of action.
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733
Feelings matter less to teenagers
Many areas of the brain alter dramatically during adolescence. One area in development well beyond the teenage years is the medial prefrontal cortex, a large region at the front of the brain associated with higher-level thinking, empathy, guilt and understanding other people’s motivations. Scientists have now found that, when making decisions about what action to take, the medial prefrontal cortex is under-used by teenagers. Instead, a posterior area of the brain, involved in perceiving and imagining actions, takes over. Dr Sarah-Jayne Blakemore of the UCL Institute of Cognitive Neuroscience, giving the BA Festival’s BAYS lecture, said: “Thinking strategies change with age. As you get older you use more or less the same brain network to make decisions about your actions as you did when you were a teenager, but the crucial difference is that the distribution of that brain activity shifts from the back of the brain (when you are a teenager) to the front (when you are an adult). “The fact that teenagers underuse the medial pre-frontal cortex when making decisions about what to do, implies that they are less likely to think about how they themselves and how other people will feel as a result of their intended action. “We think that a teenager’s judgement of what they would do in a given situation is driven by the simple question: ‘What would I do?’. Adults, on the other hand, ask: ‘What would I do, given how I would feel and given how the people around me would feel as a result of my actions?’ The fact that teenagers use a different area of the brain than adults when considering what to do suggests they may think less about the impact of their
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734
Feelings matter less to teenagers
actions on other people and how they are likely to make other people feel.” In the study, teenagers and adults were asked questions about the actions they would take in a given situation while their brains were being scanned using fMRI. For example, ‘You are at the cinema and have trouble seeing the screen. Do you move to another seat?’ A second set of questions asked what they would expect to happen as a result of a natural event eg. ‘A huge tree comes crashing down in a forest. Does it make a loud noise?’ Although teenagers and adults chose similar responses, the medial prefrontal cortex was significantly more active in adults than in teenagers when questioned about their intended actions. Teenagers, on the other hand, activated the posterior area of the brain known as the superior temporal sulcus – an area that’s involved in predicting future actions based on past actions. While children start to think about other people’s mental states at around age five, this new data shows that the neural basis of this ability continues to develop and mature well past early childhood. A second piece of research presented at the festival shows that teenagers are also less adept at taking someone else’s perspective and deciding how they would feel in another person’s shoes. Participants aged eight to 36 years were asked how they would feel and how they would expect someone else to feel in a series of situations. Adults were far quicker than teenagers at judging emotional reactions – both how they would feel and how a third party might feel in a given sitOdds and ends, themes and trends
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Feelings matter less to teenagers
uation. For example, ‘How would you feel if you were not allowed to go to your best friend’s party?’ or ‘A girl has just had an argument with her best friend. How does she feel?’ Dr Blakemore said: “It seems that adults might be better at putting themselves in other people’s mental shoes and thinking about the emotional impact of actions – but further analysis is required. The relative difficulty that teenagers have could be down to them using a different strategy when trying to understand someone else’s perspective, perhaps because the relevant part of the brain is still developing. The other factor to consider is that adults have had much more social experience.” “Whatever the reasons, it is clear that teenagers are dealing with, not only massive hormonal shifts, but also substantial neural changes. These changes do not happen gradually and steadily between the ages of 0–18. They come on in great spurts and puberty is one of the most dramatic developmental stages.”
OUTDOORLINKS:
BA Festival of Science http://www.the-ba.net/the-ba/Events/FestivalofScience/ Dr Sarah-Jayne Blakemore http://www.icn.ucl.ac.uk/staff-lists/MemberDetails.php?Title=Dr&FirstName=Sarah-Jayne&LastName=Blakemore
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736
The University of Granada publishes a book about the representation of
The University of Granada publishes a book about the representation of prosodemes in alphabetic writing Source: http://www.alphagalileo.org/01 September 2006 http://prensa.ugr.es/prensa/research/verNota/prensa.php?nota=378 El canto del lenguaje is the title of the extensive research carried out by Professor Jesús Luque Moreno in the field of word prosody and sentence prosody.The fundamental areas of this research, which has been published by the Editorial Universidad de Granada with the title “El canto del lenguaje. Representación de los prosodemas en la escritura alfabética” (The song of language. Representation of prosodemes in alphabetic writing), are the following: • • • • • •
traditional conceptions about each prosodeme, training and doctrines about their written representation the survival of these doctrines training in linguistics and in previous writing, rhythmical and tonal factors which delimit other major articulations of speech the graphic signs with which they are represented in writing.
The SAMAG group (Studium de antiquis musicis artibus Granatense) , which is headed by Professor Jesús Luque Moreno, from the Department of Latin Philology of the University of Granada, focuses its work in this field of study. ”This book refers to music, which involves language, which itself is prosody. It also implies the music of language, in other words, language sing-
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737
Stress in the City: Urbanization and ist Effect on the Stress Physiology in
ing, and especially the process of this linguistic discipline in GrecoRoman culture”, declares Luque Moreno. According to the UGR researcher, “this issue is at the very crux of relations between singing and speech, music and language. Formerly, these links were closer for us than nowadays, due to the characteristics of that music (which was closer to the speech than is currently the case) and the characteristics of that language (closer to music than our language, due to tonal and durational questions). The book, with more than 350 pages, is divided into two main chapters on word prosody and sentence prosody. It also includes an epilogue which deals with the question of Prosody between grammar and music Reference Prof. Jesús Luque Moreno, Email: jluque(at)ugr.es OUTDOORLINKS:
Jesús Luque Moreno http://www.ugr.es/~filatina/luque.htm
Stress in the City: Urbanization and ist Effect on the Stress Physiology in European Blackbirds By Jesko Partecke, Ingrid Schwabl, and Eberhard Gwinner
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738
Stress in the City: Urbanization and ist Effect on the Stress Physiology in
Source:
http://www.esajournals.org/esaonline/?request=get-
abstract&issn=0012-9658&volume=087&issue=08&page=1945 Ecology: Vol. 87, No. 8, pp. 1945â&#x20AC;&#x201C;1952 Abstract. Animals colonizing cities are exposed to many novel and potentially stressful situations. There is evidence that chronic stress can cause deleterious effects. Hence, wild animals would suffer from city life unless they adjusted their stress response to the conditions in a city. Here we show that European Blackbirds born in a city have a lower stress response than their forest conspecifics. We hand-raised urban and forest-living individuals of that species under identical conditions and tested their corticosterone stress response at an age of 5, 8, and 11 months. The results suggest that the difference is genetically determined, although early developmental effects cannot be excluded. Either way, the results support the idea that urbanization creates a shift in coping styles by changing the stress physiology of animals. The reduced stress response could be ubiquitous and, presumably, necessary for all animals that thrive in ecosystems exposed to frequent anthropogenic disturbances, such as those in urban areas. OUTDOORLINKS:
Jesko Partecke Odds and ends, themes and trends
739
University of Leicester study to investigate how fear and anxiety are formed in
http://orn.mpg.de/mitarbeiter/partecke.html Eberhard Gwinner http://webinfo.campus.lmu.de/view_person.cfm?ps=32741&cl=
University of Leicester study to investigate how fear and anxiety are formed in the brain Source: www.alphagalileo.org/31 August 2006 http://www.alphagalileo.org/index.cfm?fuseaction=readrelease&releaseid=514926 About 25 per cent of us will experience the effects of anxiety disorders at some point in our lives, with sometimes dire repercussions for friends, family and our own well-being. Yet little is known about the molecular mechanisms in the brain which contribute to stress-induced anxiety. A neuroscientist at the University of Leicester has recently been awarded major EU funding amounting to â&#x201A;Ź1.7m over four years to investigate how fear and anxiety are formed in the brain, in a project that could lead to more efficient ways of treating stress-related conditions. Dr Robert Pawlak, a researcher in the Universityâ&#x20AC;&#x2122;s Department of Cell Physiology and Pharmacology, has received the prestigious Marie Curie Excellence Grant to support his research project which will look at the mechanisms in the brain that lead to anxiety.
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740
University of Leicester study to investigate how fear and anxiety are formed in
Fear memories are encoded as changes in neuronal connections called synapses, in a process known as plasticity. Dr Pawlak and his colleagues have recently shown that proteases (proteins that cut other proteins) play a critical role in this process and significantly contribute to fear and anxiety related to stress. Dr Pawlak commented: “Understanding neural bases of stress, fear and anxiety is of immense importance to modern society. The most dramatic form, posttraumatic stress disorder (PTSD) is characterised by cognitive impairment, depression, fear, anxiety, and may eventually lead to suicide. “Understanding the neural mechanisms of PTSD, depression and anxiety disorders could reduce the personal and societal impact through development of more efficient therapies. This project looks at cellular mechanisms involved in experience-induced neuronal plasticity underlying learning, fear and anxiety.” Dr Blair Grubb, Head of the Department of Cell Physiology and Pharmacology, added: “EU Marie Curie Excellence Grants are extremely competitive and it is a major achievement that Robert Pawlak has made a successful application so early on in his independent research career. “Robert is one of a number of neuroscientists working in this department and this grant award adds significantly to our research profile in this general area. The proposed research programme will make a major contribution to our understanding of how stress leads to fear and anxiety.” OUTDOORLINKS:
Robert Pawlak
Odds and ends, themes and trends
741
Neural correlates of a mystical experience in Carmelite nuns
http://www.le.ac.uk/neurosciences/pawlak.html Blair Grubb http://www.le.ac.uk/neurosciences/grubb.html
Neural correlates of a mystical experience in Carmelite nuns By Mario Beauregarda and Vincent Paquettea Source: http://www.sciencedirect.com/ Volume 405, Issue 3 , 25 September 2006, Pages 186-190 oi:10.1016/j.neulet.2006.06.060 Copyright Š 2006 Elsevier Ireland Ltd All rights reserved Abstract The main goal of this functional magnetic resonance imaging (fMRI) study was to identify the neural correlates of a mystical experience. The brain activity of Carmelite nuns was measured while they were subjectively in a state of union with God. This state was associated with significant loci of activation in the right medial orbitofrontal cortex, right middle temporal cortex, right inferior and superior parietal lobules, right caudate, left medial prefrontal cortex,
Odds and ends, themes and trends
742
Now in the Recovery Room, Music for Hearts to Heal By
left anterior cingulate cortex, left inferior parietal lobule, left insula, left caudate, and left brainstem. Other loci of activation were seen in the extra-striate visual cortex. These results suggest that mystical experiences are mediated by several brain regions and systems. OUTDOORLINKS:
Mario Beauregard http://hendrix.imm.dtu.dk/services/jerne/brede/WOPER_51.html Vincent Paquette http://www.mapageweb.umontreal.ca/beauregm/Vincent_Paquette.htm
Now in the Recovery Room, Music for Hearts to Heal By Source: James Estrin/The New York Times/August 28, 2006 http://www.nytimes.com/2006/08/28/nyregion/ 28harp.html?ex=1157515200&en=e04378ecbc02bb90&ei=5070&emc= eta1 When George Moran woke up on Tuesday, he thought he had died and gone to heaven. It was not such an outlandish idea. Mr. Moran, 39, a music teacher in Long Valley, N.J., had had a cardiac valve repaired that morning at Morristown Memorial Hospital. During the surgery, his heart had to be stopped for 90 minutes, and he was placed on a heart-lung machine. Soon Odds and ends, themes and trends
743
Now in the Recovery Room, Music for Hearts to Heal By
after, he recalled, there was an attractive woman walking around, playing a small harp. Luckily, these celestial aspects of the recovery room did not send Mr. Moran into palpitations. Instead, researchers suspect, the gentle arpeggios of the harpist might have helped regulate his heart rate, blood pressure and breathing, aiding his recovery. Two hours a day, Alix Weisz, a harpist from Chester, N.J., strolls through the hospital’s Cardiac Post-Anesthesia Care Unit to test that premise. The recovery room staff monitors changes in patients’ vital signs every 15 minutes while she plays, and for an hour before and after. Results will be collected as part of a four-week study, one of several around the country trying to measure the health benefits of music in hospitals. One research project by a doctor at the Carle Heart Center in Urbana, Ill., has suggested that harp music in particular helped stabilize irregular heartbeats. With the Morristown study, which is financed by a local trust and still under way, evidence that music helps patients heal there is still anecdotal. But many patients and nurses say they have looked forward to Ms. Weisz’s visits. “When I was coming out of it, I was filled with tubes — a throat tube, an oxygen tube — and it was very hard to breathe,” Mr. Moran said. “You feel you’re going to gag. The music calmed my body and allowed me to stop thinking about what was going on. It allowed me to feel more relaxed and rested.” Odds and ends, themes and trends
744
Now in the Recovery Room, Music for Hearts to Heal By
Ms. Weisz has her own guidelines for playing her instrument of peace. “I try not to play anything recognizable, because there might be an unwanted emotional response, like if I played music a guy broke up with his girlfriend in Atlantic City to,” she said. She relies on chants, lullabies, and Celtic airs and ancient standards from books like “The Healer’s Way: Soothing Music for Those in Pain.” She plays quietly and slowly, and she said she tries not to glance over at the monitors above the beds, to see if any pulse rates are decreasing. While many of the patients in the recovery room are still anesthetized and unresponsive, she said Mr. Moran had given her the thumbs up while she played. “Sometimes people say, ‘Wow, I had a feeling I was in a big field,’ and that’s what we want these people to do, to think about where they’re going to be, where they’re going in life, and how this is just an episode,” she said, gesturing at the ashen patients on beds surrounded by intravenous drips and beeping machines. As part of the study, nurses are also taking note of their own stress levels when the music is playing. One nurse, Lisa Gingerella, recalled how one of her recent patients was very confused and agitated the day after his surgery. “Alix came, and he fell asleep, and his blood pressure and heart rate dropped dramatically — he slept all afternoon,” she said, adding that the music also has a similarly soothing effect on her.
Odds and ends, themes and trends
745
Cows also 'have regional accents' Cows moo with a regional twang
“She calms me the heck right down,” Ms. Gingerella said. “I want to take her home, or have her playing in the car on the way home.” The unit’s nursing manager, Lynn Emond, said she has noticed that her staff is much quieter when Ms. Weisz is playing. Thomas Kroncke, 55, stayed in the recovery room on Monday after an aortic valve replacement and, like Mr. Moran, has graduated to a regular room. Mr. Kroncke said he noticed how the harpist soothed and quieted the post-op unit. “You really didn’t notice the hustle and bustle,” he said. “I felt if I could just be feeling this calm and relaxed this soon after surgery, things are only going to get better.” OUTDOORLINKS:
Morristown Memorial Hospital http://www.morristownmemorialhospital.org/ Carle Heart Center in Urbana, http://www.carle.com/Heart/ep.shtml “The Healer’s Way: Soothing Music for Those in Pain.” (soundfile) https://www.episcopalbookstore.com/product.asp_Q_crit_E_1412
Cows also 'have regional accents' Cows moo with a regional twang Source: http://news.bbc.co.uk/2/hi/uk_news/5277090.stm
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746
Cows also 'have regional accents' Cows moo with a regional twang
Cows have regional accents like humans, language specialists have suggested. They decided to examine the issue after dairy farmers noticed their cows had slightly different moos, depending on which herd they came from. John Wells, Professor of Phonetics at the University of London, said regional twangs had been seen before in birds. The farmers in Somerset who noticed the phenomenon said it may have been the result of the close bond between them and their animals. Farmer Lloyd Green, from Glastonbury, said: "I spend a lot of time with my ones and they definitely moo with a Somerset drawl. "I've spoken to the other farmers in the West Country group and they have noticed a similar development in their own herds. "It works the same as with dogs - the closer a farmer's bond is with his animals, the easier it is for them to pick up his accent." Peer pressure Prof Wells felt the accents could result from their contemporaries. He said: "This phenomenon is well attested in birds. You find distinct chirping accents in the same species around the country. "This could also be true of cows. "In small populations such as herds you would encounter identifiable dialectical variations which are most affected by the immediate peer group."
Odds and ends, themes and trends
747
Killer whales are capable of vocal learning
Dr Jeanine Treffers-Daller, reader in linguistics at the University of the West of England in Bristol, agreed that the accent could be influenced by relatives. She said: "When we are learning to speak, we adopt a local variety of language spoken by our parents, so the same could be said about the variation in the West Country cow moo."
OUTDOORLINKS:
John Wells Homepage http://www.phon.ucl.ac.uk/home/wells/index.html John Wells Wikipedia http://de.wikipedia.org/wiki/John_C._Wells Cow moo recordings http://news.bbc.co.uk/2/hi/uk_news/5277090.stm Dr Jeanine Treffers-Daller http://www.uwe.ac.uk/hlss/llas/staff_treffers-daller_j.shtml
Killer whales are capable of vocal learning By Andrew D. Foote, Rachael M. Griffin, David Howitt, Lisa Larsson, Patrick J.O. Miller and A. Rus Hoelzel
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748
Killer whales are capable of vocal learning
Source:
http://www.journals.royalsoc.ac.uk/
(shf0hxjlexm3py45juxppm55)/app/home/contribution.asp?referrer=parent&backto=issue,1,68;journal,1,7;linkingpublicationresults,1:110824,1 ISSN:
1744-9561
(Paper)
1744-957X
(Online)
DOI:
10.1098/
rsbl.2006.0525 Abstract: The production learning of vocalizations by manipulation of the sound production organs to alter the physical structure of sound has been demonstrated in only a few mammals. In this natural experiment, we document the vocal behaviour of two juvenile killer whales, Orcinus orca, separated from their natal pods, which are the only cases of dispersal seen during the three decades of observation of their populations. We find mimicry of California sea lion (Zalophus californianus) barks, demonstrating the vocal production learning ability for one of the calves. We also find differences in call usage (compared to the natal pod) that may reflect the absence of a repertoire model from tutors or some unknown effect related to isolation or context. OUTDOORLINKS:
Rus Hoelzel http://www.dur.ac.uk/a.r.hoelzel/megwebpage1.htm
Odds and ends, themes and trends
749
Increases in deep ocean ambient noise in the Northeast Pacific west of San
Increases in deep ocean ambient noise in the Northeast Pacific west of San Nicolas Island, California By Mark A. McDonald, John A. Hildebrand and Sean M. Wiggins Source: http://scitation.aip.org/ August 2006 http://scitation.aip.org/getabs/servlet/GetabsServlet?prog=normal&id=JASMAN000120000002000711000001&idtype=cvips&gifs=Y es The Journal of the Acoustical Society of America -- August 2006 -- Volume 120, Issue 2, pp. 711-718 doi:10.1121/1.2216565 PACS: 43.30.Nb, 43.50.Lj, 43.60.Cg Recent measurement at a previously studied location illustrates the magnitude of increases in ocean ambient noise in the Northeast Pacific over the past four decades. Continuous measurements west of San Nicolas Island, California, over 138 days, spanning 2003–2004 are compared to measurements made during the 1960s at the same site. Ambient noise levels at 30–50 Hz were 10–12 dB higher (95% CI=2.6 dB) in 2003–2004 than in 1964–1966, suggesting an average noise increase rate of 2.5–3 dB per decade.
Odds and ends, themes and trends
750
Increases in deep ocean ambient noise in the Northeast Pacific west of San
Above 50 Hz the noise level differences between recording periods gradually diminished to only 1–3 dB at 100–300 Hz. Above 300 Hz the 1964–1966 ambient noise levels were higher than in 2003–2004, owing to a diel component which was absent in the more recent data. Low frequency (10–50
Hz) ocean ambient noise levels are closely
related to shipping vessel traffic. The number of commercial vessels plying the world's oceans approximately doubled between 1965 and 2003 and the gross tonnage quadrupled, with a corresponding increase in horsepower. Increases in commercial shipping are believed to account for the observed low-frequency ambient noise increase. ©2006 Acoustical Society of America
OUTDOORLINKS:
Sound Surveillance System http://de.wikipedia.org/wiki/Sound_Surveillance_System Sean M. Wiggins http://www-mpl.ucsd.edu/people/sean/Html/index.html John A. Hildebrand http://www.mpl.ucsd.edu/cg/people/jhildebrand.html
Odds and ends, themes and trends
751
Analgesic effect of TV watching during venipuncture
Mark A. McDonald â&#x20AC;&#x201C; Whale Acoustics http://www.whaleacoustics.com/
Analgesic effect of TV watching during venipuncture By Carlo Valerio Bellieni, Duccio M Cordelli, Morena Raffaelli, Beatrice Ricci, Guido Morgese and Giuseppe Buonocore Source:
http://adc.bmjjournals.com/cgi/content/abstract/
adc.2006.097246v1 Aim: To assess the analgesic effect of passive or active distraction during venipuncture. Material and methods: we studied 69 children aged 7-12 years undergoing venipuncture. The children were randomly divided into three groups: a control group (C) without any distraction procedure, a group TV in which passive distraction was used, using a TV cartoon, and a group M in which mothers performed active distraction. Both mothers and children scored pain after the procedure. Results: Main pain levels rated by the children were 23.04 (SD= 24.57), 17.39 (SD= 21.36) and 8.91 (SD= 8.65) for C, M, and TV groups respectively. Odds and ends, themes and trends
752
Binaural and cochlear disparities
Main pain levels rated by mothers were 21.30 (SD= 19.9), 23.04 (SD= 18.39) and 12.17 (SD= 12.14) for C, M, and TV groups respectively. Scores assigned by mothers and children indicated that procedures performed during TV watching were less painful (p<0.05) than control and procedures performed during active distraction. Conclusion: TV watching was more effective than active distraction. This was due the emotional participation of mothers in the active procedure, or of the distracting power of television.
OUTDOORLINKS:
Fachzeitschrift Archives of Disease in Childhood http://adc.bmjjournals.com
Binaural and cochlear disparities By Philip X. Joris, Bram Van de Sande , Dries H. Louage , and Marcel van der Heijden Source: www.pnas.org/ August 14, 2006 http://www.pnas.org/cgi/content/abstract/0601396103v1?etoc Published online before print August 14, 2006 Proc. Natl. Acad. Sci. USA, 10.1073/pnas.0601396103
Odds and ends, themes and trends
753
Binaural and cochlear disparities
Binaural auditory neurons exhibit "best delays" (BDs): They are maximally activated at certain acoustic delays between sounds at the two ears and thereby signal spatial sound location. BDs arise from delays internal to the auditory system, but their source is controversial. According to the classic Jeffress model, they reflect pure time delays generated by differences in axonal length between the inputs from the two ears to binaural neurons. However, a relationship has been reported between BDs and the frequency to which binaural neurons are most sensitive (the characteristic frequency), and this relationship is not predicted by the Jeffress model. An alternative hypothesis proposes that binaural neurons derive their input from slightly different places along the two cochleas, which induces BDs by virtue of the slowness of the cochlear traveling wave. To test this hypothesis, we performed a coincidence analysis on spiketrains of pairs of auditory nerve fibers originating from different cochlear locations. In effect, this analysis mimics the processing of phase-locked inputs from each ear by binaural neurons. We find that auditory nerve fibers that innervate different cochlear sites show a maximum number of coincidences when they are delayed relative to each other, and that the optimum delays decrease with characteristic frequency as in binaural neurons. These findings suggest that cochlear disparities make an important contribution to the internal delays observed in binaural neurons.
Odds and ends, themes and trends
754
Exposure to Degrading Versus Nondegrading Music Lyrics and Sexual Behavior
Contact: Philip X. Joris, E-mail: philip.joris(at)med.kuleuven.be
OUTDOORLINKS:
Philip X. Joris http://www.kuleuven.be/cv/u0015721.htm
Exposure to Degrading Versus Nondegrading Music Lyrics and Sexual Behavior Among Youth By Steven C. Martino, Rebecca L. Collins, Marc N. Elliott, Amy Strachman, David E. Kanouse, and Sandra H. Berry Source: pediatrics.aappublications.org/2 August 2006 http://pediatrics.aappublications.org/cgi/content/abstract/118/2/e430 PEDIATRICS Vol. 118 No. 2 August 2006, pp. e430-e441 (doi:10.1542/ peds.2006-0131) BACKGROUND. Early sexual activity is a significant problem in the United States. A recent survey suggested that most sexually experienced teens wish they had waited longer to have intercourse; other data indicate that unplanned pregnancy and sexually transmitted diseases are more common among those who begin sexual activity earlier.
Odds and ends, themes and trends
755
Exposure to Degrading Versus Nondegrading Music Lyrics and Sexual Behavior
Popular music may contribute to early sex. Music is an integral part of teens' lives. The average youth listens to music 1.5 to 2.5 hours per day. Sexual themes are common in much of this music and range from romantic and playful to degrading and hostile. Although a previous longitudinal study has linked music video consumption and sexual risk behavior, no previous study has tested longitudinal associations between the content of music lyrics and subsequent changes in sexual experience, such as intercourse initiation, nor has any study explored whether exposure to different kinds of portrayals of sex has different effects.
DESIGN AND PARTICIPANTS. We conducted a national longitudinal telephone survey of 1461 adolescents. Participants were interviewed at baseline (T1), when they were 12 to 17 years old, and again 1 and 3 years later (T2 and T3). At all of the interviews, participants reported their sexual experience and responded to measures of more than a dozen factors known to be associated with adolescent sexual initiation. A total of 1242 participants reported on their sexual behavior at all 3 time points; a subsample of 938 were identified as virgins before music exposure for certain analyses.
Odds and ends, themes and trends
756
Exposure to Degrading Versus Nondegrading Music Lyrics and Sexual Behavior
Participants also indicated how frequently they listened to each of more than a dozen musical artists representing a variety of musical genres. Data on listening habits were combined with results of an analysis of the sexual content of each artist's songs to create measures of exposure to 2 kinds of sexual content: degrading and nondegrading.
OUTCOME MEASURES. We measured initiation of intercourse and advancement in noncoital sexual activity level over a 2-year period.
RESULTS. Multivariate regression analyses indicated that youth who listened to more degrading sexual content at T2 were more likely to subsequently initiate intercourse and to progress to more advanced levels of noncoital sexual activity, even after controlling for 18 respondent characteristics that might otherwise explain these relationships. In contrast, exposure to nondegrading sexual content was unrelated to changes in participants' sexual behavior.
CONCLUSION.
Odds and ends, themes and trends
757
Mozart Therapy for Bereaved Elephant
Listening to music with degrading sexual lyrics is related to advances in a range of sexual activities among adolescents, whereas this does not seem to be true of other sexual lyrics. This result is consistent with sexual-script theory and suggests that cultural messages about expected sexual behavior among males and females may underlie the effect. Reducing the amount of degrading sexual content in popular music or reducing young people's exposure to music with this type of content could help delay the onset of sexual behavior.
OUTDOORLINKS:
Steven C. Martino http://www.med.yale.edu/psych/faculty/martino.html
Mozart Therapy for Bereaved Elephant Source: AFP/www.thepeninsulaqatar.com/June 30, 2006 http://www.thepeninsulaqatar.com/Display_news.asp?section=world_news&month=june2006&file=world_news200606308319.x ml ZAGREB - Suma, a 45-year-old elephant and long-time resident of the Zagreb Zoo, was bereaved and inconsolable after her pachyderm partner of tens years died of cancer. Until she heard Mozart.
Odds and ends, themes and trends
758
Mozart Therapy for Bereaved Elephant
"Suma became very depressed after her roomie Patna died in early May," head of Zagreb Zoo Mladen Anic told AFP on Thursday. "She was refusing to eat, became uncommunicative, showed all the signs of a serious depression." Then, by sheer accident, Suma's keepers discovered that the healing power of Mozart extends to the animal kingdom too. Earlier this month, the zoo the zoo organized a concert of classical music just opposite Suma's dwelling, Anic explained. At the sight of five musicians preparing themselves to start a concert, Suma became very nervous and aggressive, peppering the intruders with little stones that she blew out of her trunk. "But as soon as the concert started what we saw was really fascinating. Suma leaned against the fence, closed her eyes and listened without moving the entire concert," he said. Besides Mozart, she took in pieces by Vivaldi and Schubert too. When zoo authorities realized that classical music seemed to help Suma cope with her grief, they bought a stereo and installed it so she could get a daily dose of music therapy. The elephant especially adores Mozart, Anic said, but is also partial to the strains of Vivaldi and Bach. "We are so glad that we can provide -- at what is a rather advanced age for elephants -- things that Suma really enjoys," Anic said.
Odds and ends, themes and trends
759
Landscapes and human behavior - The North Desert Village landscaping
OUTDOORLINKS:
Milan Pernek, Email: milann@sumins.hr Zagreb Zoo http://www.zoo.hr/zoo_eng.html
Landscapes and human behavior - The North Desert Village landscaping experiment On Arizona State University's (ASU) Polytechnic campus, graduate student families in the cluster of six houses abutting lush lawns and ornamental bushes spend time together talking while their kids play outside. Meanwhile, the families in a nearby cluster of six homes barely know each other. But that may be in part because their homes sit on native Sonoran desert, not nearly as conducive to recreation as the lush microclimate researchers created in the first neighborhood. Social scientists and biophysical ecologists are finding that environmental surroundings may play a significant role in human social interaction, serving either as a social lubricant as in the first case, or as a barrier. David Casagrande (Western Illinois University) and Scott Yabiku (ASU) and colleagues are part of the Central Arizona-Phoenix long term ecological research project. In 2004 and early 2005, the researchers installed residential landscapes at 24 of about 152 virtually identical housing units in the "North Desert Village" of ASU's campus. The scientists selected five "mini neighborhoods" (groups of six houses) and altered four of them, leaving the fifth as a control with no landscaping. The four landscaping styles were:
Odds and ends, themes and trends
760
Landscapes and human behavior - The North Desert Village landscaping
* mesic: shade trees and turf grass, dependent upon flood irrigation for their high water demands * oasis: a mixture of high and low water-use plans and sprinkler-irrigated turf grass * xeric: low water-use plants (both native and non-native), individually drip-watered * native: Sonoran Desert plants and no supplemental water "We wanted to explore how the surrounding landscape affects people, both in terms of their perceptions and their behavior," explains Yabiku. "Since human behavior ultimately transforms the environment, the feedback people get from their surroundings is important to understand." The spectacular growth of Phoenix--which doubled twice in population size in the past 35 years--gives researchers a unique opportunity to monitor human-induced ecological transformations. "Experimental approaches are rarely used in studies of human-environment interactions,' says Casagrande. "By combining research approaches from both the social and biophysical sciences, we can gain new insights into how peoples' surroundings affect them." The study will run until at least 2010, but the results thus far suggest that even those individuals who grew up in the arid environment of Arizona prefer a more lush landscape conducive to recreation and social networking. In addition to the social interactions resulting from the different landscape designs, the researchers are also looking into residents' level of ecological knowledge, overall environmental values, and perceptions of Odds and ends, themes and trends
761
Music for Pain
landscapes. Yabiku and Casagrande hypothesize that residents' knowledge of flora and fauna will increase more in the mesic than in the native desert cluster.
OUTDOORLINKS:
Forscher Scott Yabiku http://www.asu.edu/clas/fhd/cepod/people/yabiku.html David Casagrande http://www.wiu.edu/users/dgc101/ Ecological Society of America http://www.esa.org
Music for Pain Source: www.sciencentral.com/ 08.08.06 http://www.sciencentral.com/articles/view.php3?article_id=218392834 A dose of music can be a prescription for pain relief. As this ScienCentral News video explains, a new systematic study of music for pain finds that while music won't replace painkillers, it can boost their effectiveness.
Lyrical Relief
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762
Music for Pain
Marion Good loves to play music in her spare time. But as a professor of nursing at Case Western Reserve University's Frances Payne Bolton School of Nursing, she also prescribes it for pain relief. Her interest in researching music for pain began when as a nurse on a neurology unit she worked with patients suffering from back pain. "I would bring music into the room -- soft quiet music. Their faces just relaxed ... pretty soon they fell asleep," she says. "I had to tiptoe out of the room and come back an hour or two later to pick up my tape recorder." Good has been testing music with post-operative patients for more than 15 years. "I found that music does reduce pain up to about 31 percent in my studies in addition to medication," she says. Now the conclusion of a systematic analysis combining 51 clinical studies is music to her ears. The Cochrane Review of Evidence-Based Healthcare found that patients exposed to music rate their pain as less intense and even use lower doses of painkillers. On a zero to 10 scale, patients reported an average .5 drop in their pain due to music. "It's not a huge amount," Good says, "but that's an average and for some people, it will be more, and for some it will be less." Since music has no side effects, she points out, there's no risk to trying it. The review found that it didn't matter if patients chose their own music or were prescribed certain music. But Good thinks that for chronic pain like cancer pain, patients are more likely to keep using it if it's music they like.
Odds and ends, themes and trends
763
Music for Pain
Good's latest study, conducted with Sandra Siedlecki of the Cleveland Clinic Foundation and published in The Journal of Advanced Nursing, found that patients with chronic pain who added music for pain relief got other benefits too. "We found that music reduced pain, reduced anxiety, reduced depressive symptoms and reduced pain disability," she says. The study focused on people with chronic non-malignant pain or CNMP, which typically does not go away with traditional treatments. According to the study, the pain can mix with depression, disability, and feelings of powerlessness. "Although frequently prescribed, the usefulness of medications such as opioids, non-steroidal anti-inflammatory agents, muscle relaxants, neuroleptics and antidepressants, is limited by the adverse side effects," Good and Seidlecki write in the study. While the Cochrane review cautions that music should not replace traditional primary treatments for pain, Good hopes this evidence will get other healthcare providers to think of music therapy as a complement to traditional treatment. Aware of Good's findings, her colleague Jane Suresky added music to her own care for her knee replacement surgeries. She says it's helped her to wean off her pain medication and cope with physical therapy. For her first knee replacement, in 2004, she used Good's prescribed music, while for her recent second knee, she purchased an MP3 player and programmed it with her own music. "Having that experience, I was better able to be a more active participant in terms of my own recovery this time," says Suresky. She even listened to her digital music player on the way to the hospital. Odds and ends, themes and trends
764
Music for Pain
"I had to give it up once I got to the pre-operative area," she says, "and I barely turned it over because I wanted it when I was finished." Both Good and Suresky teach their nursing students about the benefits of music, relaxation and other complementary therapies, "This will be consumer-driven in the future," Good says. "People will start asking for complementary therapies such as music to relieve their pain." Or like Suresky, they'll just bring their own. Suresky says that the music she uses to treat her pain fits her mood. "If I'm really stressed, I'll probably listen to some classical music ... If I'm going out walking with the walker, and I want to move a little bit more, I put my Cuban music on." Good's research was published in the June 2006 edition of The Journal of Advanced Nursing and funded by the Frances Payne Bolton Alumni Association, Case Western Reserve University, Sigma Theta Tau, and the National Institute of Nursing Research.
OUTDOORLINKS:
Marion Good http://fpb.case.edu/Faculty/Good.shtm Jane Suresky http://fpb.case.edu/Faculty/Suresky.shtm Case Western Reserve University's Frances Payne Bolton School of Nursing Odds and ends, themes and trends
765
Absolute Coding of Stimulus Novelty in the Human Substantia Nigra/VTA
http://fpb.case.edu/ Cochrane Review of Evidence-Based Healthcare http://www.sciencentral.com/articles/view.php3?article_id=218392834
Absolute Coding of Stimulus Novelty in the Human Substantia Nigra/VTA By Nico Bunzeck and Emrah D端zel Source: www.sciencedirect.com/3 August 2006 Neuron Volume 51, Issue 3 , 3 August 2006, Pages 369-379 Novelty exploration can enhance hippocampal plasticity in animals through dopaminergic neuromodulation arising in the substantia nigra/ ventral tegmental area (SN/VTA). This enhancement can outlast the exploration phase by several minutes. Currently, little is known about dopaminergic novelty processing and its relationship to hippocampal function in humans. In two functional magnetic resonance imaging (fMRI) studies, SN/VTA activations in humans were indeed driven by stimulus novelty rather than other forms of stimulus salience such as rareness, negative emotional valence, or targetness of familiar stimuli, whereas hippocampal responses were less selective.
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766
Scientists develop artwork that changes to suit your mood
SN/VTA novelty responses were scaled according to absolute rather than relative novelty in a given context, unlike adaptive SN/VTA responses recently reported for reward outcome in animal studies. Finally, novelty enhanced learning and perirhinal/parahippocampal processing of familiar items presented in the same context. Thus, the human SN/VTA can code absolute stimulus novelty and might contribute to enhancing learning in the context of novelty.
OUTDOORLINK:
Nico Bunzeck (University College, London) http://www.icn.ucl.ac.uk/Research-Groups/Clinical-neurophysiologyand-memory/group-members/MemberDetails.php?Title=Dr&FirstName=Nico&LastName=Bunzeck
Scientists develop artwork that changes to suit your mood Computer scientists from Bath and Boston have developed electronic artwork that changes to match the mood of the person who is looking at it Source: Press Release/University of Bath/03 August 2006 http://www.bath.ac.uk/news/articles/releases/artmodd030806.html
Odds and ends, themes and trends
767
Scientists develop artwork that changes to suit your mood
Using images collected through a web cam, special software recognises eight key facial features that characterise the emotional state of the person viewing the artwork. It then adapts the colours and brush strokes of the digital artwork to suit the changing mood of the viewer. For example, when the viewer is angry the colours are dark and appear to have been applied to the canvas with more violent brush strokes. If their expression changes to happy, the artwork adapts so that the colours are vibrant and more subtly applied. The project forms part of on-going research looking to develop a range of advanced artwork tools for use in the computer graphics industry. This has already resulted in software which produces highly-detailed artistic versions of photographs, and allows designers to create animations directly from digital footage. “The programme analyses the image for eight facial expressions, such as the position and shape of the mouth, the openness of the eyes, and the angle of the brows, to work out the emotional state of the viewer,” said Dr John Collomosse from the Department of Computer Science at the University of Bath. “It does all of this in real time, meaning that as the viewer’s emotions change the artwork responds accordingly. “This results in a digital canvas that smoothly varies its colours and style, and provides a novel interactive artistic experience.
Odds and ends, themes and trends
768
Scientists develop artwork that changes to suit your mood
“This kind of empathic painting only needs a desk top computer and a webcam to work, so once you have the programme and have calibrated it for the individual viewer, you are ready to start creating personalised art based on your mood. “The empathic painting is really an experiment into the feasibility of using high level control parameters, such as emotional state, to replace the many low-level tools that users currently have at their disposal to affect the output of artistic rendering.” The empathic painting project was carried out with Maria Shugrina and Margrit Betke from the University of Boston. The images used in the project were created by the researchers using advanced artistic rendering techniques which give the computer-generated artwork the appearance of having been painted onto canvas. The research was recently presented at the fourth International Symposium on Non-Photorealistic Animation and Rendering (NPAR) conference in Annecy as part of the International Animation Festival. http:// www.npar.org/2006/ For further information, please contact: Andrew McLaughlin, Email: A.McLaughlin(at)bath.ac.uk OUTDOORLINKS:
John Collomosse http://www.cs.bath.ac.uk/~jpc/ Empathic painting project
Odds and ends, themes and trends
769
Virtual realities against pain
http://www.cs.bath.ac.uk/~vision/empaint/ John Collomosseâ&#x20AC;&#x2122;s research page http://www.cs.bath.ac.uk/~jpc/ Department of Computer Science, University of Bath http://www.bath.ac.uk/comp-sci International Animation Festival NPAR 2006 http://www.npar.org/2006/
Virtual realities against pain Source: www.alphagalileo.org/21 July 2006 http://www.alphagalileo.org/index.cfm?fuseaction=readrelease&releaseid=514343 The feeling of pain produced during medical treatment can be reduced through sophisticated virtual reality helmets, a simple computer game and the determined predisposition of the patient. According to research psychologists at the Universitat Autonoma de Barcelona (UAB), this type of distraction even reduces the dosage of sedatives. Their research suggests putting greater emphasis on methodology and on psychological aspects of this technique in order to improve its property.
Odds and ends, themes and trends
770
Virtual realities against pain
For over a decade, the technique of distraction has been researched and successfully applied in clinical practice in order to reduce pain associated with certain medical procedures. The use of distraction is based on the assumption that there is an important psychological element in the perception of pain, with the amount of attention given to the harmful stimulus affecting the perception of the pain. Distraction techniques are based on the patient's limited capacity for attention, resulting in a reduction in the patient's attention to the stimulus and therefore a reduction in the stimulus itself. It was assumed that the ideal distractor would require an optimum amount of attention involving various senses (visual, auditory and kinaesthetic), an active emotional involvement, and participation from the patient to compete with the signals of the harmful stimuli. The advanced distraction techniques (ADTs) recently developed use 3D images combined with dynamic audio stimuli, making the techniques more likely to meet the requirements of an ideal distractor than the traditional distraction methods such as watching a film or playing a simple computer game. The ADTs simulate real-life situations, and the possibilities are infinite. For example, until now users could choose between taking a flight, driving, downhill skiing, exploring buildings and many more activities. In this study, peer-reviewed publications on ADTs and pain have been reviewed to determine the clinical effectiveness and importance of using these techniques as analgesic. Odds and ends, themes and trends
771
Virtual realities against pain
The results suggest that the ADTs can significantly reduce the pain associated with medical treatment. The use of analgesic was clinically revealing in most cases, especially in patients with very high or unbearable levels of pain. It was found that levels of anxiety were reduced during the exposure, and the side effects, such as â&#x20AC;&#x153;simulator sicknessâ&#x20AC;?, were hardly observed at all.
Although some studies continue to focus mainly on the technological aspects and the effectiveness of ADTs, greater consideration is being given to psychological aspects. Several personality traits (such as absorption and dissociation) have been identified as important factors for determining the level of involvement of the users, possibly modulating the effectiveness of technological progress. For example, some patients perceive a reduction in their visual field (due to the video helmet) and a loss of awareness of the activities of the medical practitioner, as well as a loss of control, leading to an increase in anxiety and pain; other patients see it as positive that they cannot see and perceive what the medical practitioner is doing. We can conclude that ADTs are very useful as analgesic, and can reduce the amount of analgesic administered. This new field of study can begin to move forward beyond its current initial phase by placing more emphasis on methodology and psychological aspects. Odds and ends, themes and trends
772
Specification of auditory sensitivity by Drosophila TRP channels
OUTDOORLINKS:
Universitat Autonoma de Barcelona (UAB) http://www.uab.es/servlet/Satellite?cid=1086256916816&pagename=UAB/Page/TemplateHomeUAB DEPARTAMENT DE PSICOLOGIA CLร NICA I DE LA SALUT http://seneca.uab.es/clinica/
Specification of auditory sensitivity by Drosophila TRP channels By Martin C Gรถpfert, Jรถrg T Albert, B Nadrowski & A Kamikouchi Source: www.nature.com/2 July 2006 http://www.nature.com/neuro/journal/vaop/ncurrent/abs/nn1735.html Ears achieve their exquisite sensitivity by means of mechanical feedback: motile mechanosensory cells through their active motion boost the mechanical input from the ear. Examination of the auditory mechanics in Drosophila melanogaster mutants shows that the transient receptor potential (TRP) channel NompC is required to promote this feedback, whereas the TRP vanilloid (TRPV) channels Nan and Iav serve to control the feedback gain. The combined function of these channels specifies the sensitivity of the fly auditory organ.
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Specification of auditory sensitivity by Drosophila TRP channels
Correspondence should be addressed to Martin C Gรถpfert, Email: m.gopfert@uni-koeln.de OUTDOORLINKS:
Fruchtfliege Drosophila melanogaster http://de.wikipedia.org/wiki/Drosophila_melanogaster Botanical Institute University of Cologne http://www.uni-koeln.de/math-nat-fak/botanik/
Odds and ends, themes and trends
774