UNIVERSITY OF KENT

BRUSSELS SCHOOL OF INTERNATIONAL STUDIES

DEVELOPMENT: THEORY AND PRACTICE

DRA. TUGBA BASARAN

‘HOW CAN MUSIC IMPROVE HOMELESS PEOPLE’S LIFE?’

AUGUSTO HERNANDEZ VIDAL

MAY 5, 2014

‘HOW CAN MUSIC IMPROVE HOMELESS PEOPLE’S LIFE?’

1. Introduction

In this paper it will be argued that music has positive effects in the human mind, since the

cognitive processes are motivated and particular chemicals are stimulated in the brain, leading to a

modification in world perception and behaviour. The positive effects of music can be used to help

the homeless people to engage in the process of addressing their own misconceptions and

eventually initiate social interactions and improvement of their quality of life. Some musical

sessions took place with homeless in Brussels to have a field experience about music and homeless

and it is concluded that music is not the only alternative to stimulate social interaction and life

quality improvement among homeless, because homeless can enjoy different activities than music

that may actually engage them in similar self-rewarding experiences.

2. The uses of music therapy for mental health

The human brain is sometimes compared to a river in the sense that is constantly changing. New

experiences may have positive or negative impacts that modulate the perception of the world by

the individual. The brain also tends to create repetitive thoughts as a result of significant

experiences, keeping the person in positive or negative spirals of perception of the outside world.

A healthy mind, evidently, is a mind that is able to assimilate experiences in the proper way in

order to produce positive thoughts and a positive perception of the world. Furthermore, a healthy

mind should also be able to transform negative thoughts into positive ones. According to the basics

of behavioural therapy, a cognitive distortion, that is thought disorders, lead to distorted behaviour

as in the case of depression1. Changing thought disorders is not an impossible task for the human

brain since its plasticity makes it possible to transform perceptions. According to the concept of

brain plasticity in neuroscience, there are changes in neural connections in the brain as a result of

learning or practising new activities, and these changes have impact in behaviour. Therefore,

creating positive experiences to promote confidence is an effective treatment for persons who

1 Aaron T. Beck. ‘Thinking and DepressionI. Idiosyncratic Content and Cognitive Distortions’. Archives of General Psychiatry. 1963, volume 9(4).

suffer of some kind of mind illness. For example, exercise ―promotes brain vascularization,

neurogenesis, functional changes in neuronal structure and neuronal resistance to injury‖2.

Music has been identified by health practitioners as an instrument to activate positive impacts in

the neuronal process and in behaviour since it triggers reward centres in the brain and reduces the

level of cortisol. Music calms the body and the mind, distracts attention from disagreeable

situations and enables individuals to experience new sensations. According to neuroscientists,

―music is a highly complex and precisely organized stimulus that interacts with the human brain

and modulates synaptic plasticity and neuronal learning/readjustment in the brain‖3. Various areas

of the brain are activated during listening to music, like the cerebellum, the basal ganglia and the

cortical motor area, and the areas activated increase when movement of the body is also present,

like in dancing or playing a musical instrument. The stimulation of the brain is even greater if

feelings are aroused during listening to music and as result relaxation is induced and pain, blood

pressure, respiratory and hearth rates are decreased. The features of music in human health have

been used also to improve the benefits of traditional interventions, for example, music has been

useful during surgery procedures to make the experience less traumatic for the patient. Music is

also combined with radiotherapy, rehabilitation of patients with Parkinson, among others.

The different uses of music in medicine are known as music therapy and it can be used without or

with combination of traditional interventions to enhance the intentions of the main intervention.

The various medical conditions that can be treated with music therapy include depression, in

which case music has shown to be useful to lift mood but only in a temporarily way, not for long

periods of time like weeks or months. However, when music is used in alliance with traditional

medical treatments their benefits are incremented. Through experiments it has been found that

music can modulate the presence of serotonin in platelets in the blood. The deregulation of this

substance in the blood is related to the pathopsychology of depression. Autism is another mental

disorder that can be treated through music, since music is a nonverbal and non-invasive activity

but yet a communicative tool. Music activates the right temporal lobe of the brain and so has a

significant role in language and cognitive processes. Music therapy has also been used to help

patients with schizophrenia with positive results in the presence of fewer negative symptoms in

comparison to patients receiving traditional treatment alone. In the case of dementia, which is a

progressive decline in cognitive function, music therapy has showed to decrease wandering, to

trigger memory and increase nutritional intake. Positive feelings from certain meaningful music

for the listener can be aroused and so reminiscence or retrieval of forgotten memories can be

2 Carl W. Cotman, Nicole C. Berchtold. ‘Exercise: a behavioural intervention to enhance brain health and plasticity’.

Trends in Neuroscience. Volume 25, Issue 6, 1 June 2002, Pages 295–301. 3 Shuai-Ting Lin et al. ‘Mental Health Implications of Music: Insight from Neuroscientific and Clinical Studies’. Harvard Review of Psychiatry. Volume 19, Number 1.

achieved with positive effects4. Music is also used to reduce agitation, by creating harmonious

atmospheres during mealtime for instance, but music should be chosen by the listeners to reduce

agitation since familiar music has better effects5. In the case of Substance Use Disorders (SUD)

―previous reports have found that music therapy can increase relaxation, energy, motivation, and

engagement, and decrease impulsiveness, isolation, depression, stress, anxiety, and anger‖6.

Anxiety and sleep disorders can also be helped with music therapy, as shown by experimentation.

Different disorders in children are also treated with music therapy, such as learning and

developmental disorders, experiencing of stressful life events, autism, among others7.

Perhaps, the most important use of music therapy refers to the treatment of post-traumatic stress

disorder (PTSD). In fact, some of the mental diseases quoted before like depression, sleep

disorders and dementia, may be symptoms of a PTSD. The term refers to the symptoms that a

person has after having a traumatic experience. In strict terms, the person ―must have directly

experienced or witnessed a threat to life, serious injury, or personal integrity, and responded with

helplessness or horror. Symptoms must include re-experiencing, avoidance, and hyperarousal, and

the person must have significantly impaired social, interpersonal, or occupational functioning.

These symptoms are severe and extend at least 12 weeks after the index trauma‖8. Usually persons

diagnosed with PTSD avoid the memories of the trauma and the confrontation with their feelings

about it, and they use drugs and alcohol to achieve that, resulting in difficulties to relate with

others. Here again music is helpful because allows to engage people in a non-invasive and

nonverbal context that is mostly enjoyed by everyone, helps people to relate with themselves and

creates relaxed atmospheres to engage in conversation about traumatic experiences. These are

advantages that cannot always be created with the traditional methods since they are based in

direct communication and patients are reluctant to flourish their thoughts or feelings about

traumatic experiences very often. The types of trauma experiences that are treated with music

therapy include refugees, people affected by war, sexual abuse, among others, with an important

prevalence of individual work with children. It is suggested that music therapy in people suffering

PTSD may be effective where traditional cognitive behavioural therapy has not been effective9.

4 Goodall D., Etters L. ‘The therapeutic use of music on agitated behavior in those with dementia’. Holistic Nursing Practice. 2005, vol. 19. Pgs.258–262. 5 Sung H., Chang A. ‘Use of preferred music to decrease agitated behaviours in older people with dementia: a review of the literature’. Journal of Clinical Nursing, 2005, vol.14. Pgs.1133–1140. 6 Shuai-Ting Lin et al. ‘Mental Health Implications of Music: Insight from Neuroscientific and Clinical Studies’. Op. cit. 7 Karline Treurnicht Naylor et al. ‘The Effectiveness of Music in Pediatric Healthcare: A Systematic Review of randomized Controlled Trials’. Evidence-Based Complementary and Alternative Medicine. Volume 2011. 8 Catherine Carr et al. ‘Group music therapy for patients with persistent post-traumatic stress disorder – an

exploratory randomized controlled trial with mixed methods evaluation’. Psychology and Psychotherapy: Theory, Research and Practice (2012), 85, 179–202. 9 Ibidem.

The methods in music therapy may vary. The therapies can be individual or collective, and active

or passive. Active therapy means that the patient is involved in some way in the activity further

than only listening to the music as in the passive manner, for example, by improvising music over

a harmonic arrangement or singing a significant song. In the active music therapy the listener can

be interpreting a musical instrument or creating music, could be guided into imagery with musical

environment or might be in reflective discussions around specially chosen musical pieces. A

collective passive kind of intervention is easiest to implement but also the one with less impact on

the listener, because the chances that the music being played has some emotional reaction on the

listeners is very low. However, it can be practiced in large amounts of people, for example, in

massive transportation stations, hospitals, public offices, etcetera. As explained, the musical

therapy should arise emotional states of mind in the listener to activate the neurological processes

that impact positively in the behaviour of the patient. The sole act of listening to music may not be

as beneficial as an active intervention in all cases, although merely listening to music shows

benefits by itself, like in the case of surgical procedures. Nonetheless, the most complex is the

mental illness of the patient, the most study and design of the intervention is needed in order to

have a positive impact in the mind of a person through music therapy. In all cases, is recognised

that the positive results of music therapy in listeners can be achieved only when the therapy has

intensity and durability, meaning that there should be sessions every day during three weeks at

least, since those positive effects are accumulative over time10

.

3. How can music improve homeless peoples’ life?

Homeless people are in a condition of social exclusion as a result of a variety of reasons. Many

have been through traumatic experiences that they hide from others and they are regular

consumers of alcohol and drugs in order to escape from the memories of the traumatic experience.

However, by escaping from these memories a person is only blocking the reminiscence of the

traumatic experience but not the mind disorders or symptoms that are present as a result. These

symptoms may include dementia, anxiety, hyperarousal, schizophrenia, etcetera. Nevertheless, is

difficult to say how many of the homeless people are suffering of PTSD since there are no studies

or statistics that have documented such a phenomenon, although is possible to sustain that some of

the homeless people are ex-combatants, displaced persons, persons abandoned by their relatives,

or, in general terms, members of the society who were excluded from society as a result of their

incapacity to overcome the symptoms of a traumatic experience. These symptoms make them

unable to enrol in normal domestic or occupational life. For example, a study that followed the

10 Moon Fai Chan et al. ‘The effectiveness of music listening in reducing depressive symptoms in adults: A systematic review’. Complementary Therapies in Medicine (2011) 19, 332—348.

process of 132 persons after 6 months of psychiatric hospitalization revealed that 36% of them

became homeless. ‗These individuals are particularly vulnerable to environmental stressor because

of problems in their cognitive functioning that leave them confused, disorganized, and unable to

negotiate the norms of society‘11

.

The same study identifies 4 types of homeless who were in psychiatric hospitalization: the

wanderers, the tenuous planners, the socially disadvantaged and the dropouts. The wanderers are

the homeless who look for shelter in a delusional world of their own where they feel comfortable

and so they are unable to understand the reality, they wander from shelters to friend‘s and family‘s

households but they are most of the time homeless although they could afford a place for their

own. The tenuous planners were able to find a place to live in despite of their deteriorated mental

condition, but the chances that they remain homeless after sometime are high. The socially

disadvantaged homeless are persons who do not admit or believe they are mentally ill although the

personality disturbances and the use of drugs and alcohol is frequent, and the lack of incomes

makes it difficult for them to have a place of their own to live. The last group, the dropouts, of less

importance, are persons who remain homeless in order to avoid the police to take them to judicial

authorities. Homeless from all of these groups have frequently been in jail.

Clearly, is not feasible to assert that all homeless are mentally ill or have some kind of personality

disorder, but yet is possible to assume, given the lack of statistics, that an important part of them

have been diagnosed with psychiatric pathologies and there might be an important number of

homeless who suffer them and have not been assisted, especially in countries where the social

security system is weak. Therefore, music therapy as a treatment for mental diseases in homeless

is a realistic alternative to improve their conditions of life. In fact, in 2007 ―the Cambridge Music

Therapy Clinic at Anglia Ruskin University has been awarded funds to run a music therapy project

for the homeless in Cambridge. In partnership with the Homeless Charity, Wintercomfort, they

have developed a project which will benefit from the Kick-Start Fund, created by Cambridge City

Council to help new projects with the homeless get off the ground‖12

. Music therapy may be used

with homeless people in order to stimulate mental processes that help them to overcome the

traumatic experiences they might have had. Even when the homeless do not actually have a PTSD

or a mental related symptom, music may be the stimulus they need to give some sense to their

lives. As a result, music therapy could help homeless to deal with their personal problems,

improve their behaviour and eventually look for their social reintegration in the best of the cases.

11

John R. Belcher. ‘On becoming homeless : a study of chronically mentally ill persons’. Journal of Community Psychology. Volume 17, April 1989. 12 ‘Homeless get chance to build self-confidence through music therapy’. Anglia Ruskin University website. 10 April

2007. http://www.anglia.ac.uk/ruskin/en/home/news/archive/music_therapy_homeless.html

4. Some considerations concerning homeless people and their relation with music

What would be the objective of treating homeless people with music therapy? What benefits are

obtained if is possible for homeless people to improve their mental health and their behaviour?

What is really possible to achieve when advocating for the improvement of homeless people

quality of life? The answer to these questions matter because is important to recognise that are

limitations given by society that defines what is important and what is not important in urban

livelihoods to subsist. Society somehow has agreed that is possible to maintain urban life with

homeless people living in the streets, metro stations and other public places, and has also approved

to allocate some resources to provide them with basic needs like clothes, food and personal

hygiene. As a consequence, society in general terms might not consider of high priority the

improvement of mental health of homeless people or their social reintegration. But the relatives of

those homeless, in spite of the lack of faith that they may have in their rehabilitation and progress,

they might be interested in their actual recuperation and reintegration because of the affective and

family ties that they have. Clearly, the homeless themselves are the ones interested in their own

progress. Therefore, the benefits obtained from treating homeless people with music therapy are

for the homeless themselves and their relatives, and those benefits consist in the possibility for

those families and individuals to have a normal family life, engaging in common social activities

or simply having a life with an acceptable standard of living. Since the objective of working with

homeless people is to encourage them to have positive experiences that activates new processes in

their minds, provide them with relaxation, recreation and joy, cultivate sensations of self-

awareness, self-confidence and self-esteem, and eventually face the possible traumas they have,

the design of such a project should be centred in improving the psychological state of each one of

these persons. The active commitment of the homeless in participating in the activities is important

since positive results are possible to achieve only after several weeks of getting involved.

In order to be more conscious of the possibilities and difficulties of working with homeless people

and music, 5 short sessions of musical experience were held by the author with homeless people

living in a metro station in Brussels, Belgium. The sessions took place as a casual experience, in

an improvised atmosphere and without protocols or the homeless knowing that they were

participating in the research. As a result of this experience, some considerations will be presented,

so they possibly contribute to debates. Some of these considerations are valid only under the

spontaneous setting of the research. Taking notes of the comments that the homeless did about

music in their lives was useful and some of them will be presented here.

In the first place, it was found that certain level of confidence should be settled between the

musicians who are volunteering and the homeless to create a musical experience with the

homeless. Because of the different languages spoken by the homeless, verbal communication was

not always easy but some easiness was built through music, by playing known tunes in acoustic

guitar. So the first consideration is that music creates confidence among the people participating in

the experience, even if they cannot communicate by any other means. One of the homeless said

about this:

“Music for me is a moment of happiness. When I am walking and hear some people

playing music I stop with my dog and dance. People at the beginning seem scared but

after some of them dance with me and play with my dog. During this magic moment I

forget my homeless statue, I am just dancing, singing, listening to this song… I can

speak with people and share this occasion which is unique because I enjoy socializing

but is hard on daily life when people are harrying to go to work, to go out. With music

around people want just to have fun, to relax, to escape from reality and for me is more

important and deep and my reality is harder because when music stop they come back

home but I am still here on the street. But I feel a happy moment remembering me that I

am funny because I forget… Sometimes because our society and this system show us

like dangerous or not appropriated to talk with”.

There is a process of finding value in the music that the other is interpreting in musical

experiences among homeless. Finding value in other people‘s skills is also a way to increase self-

esteem. However, not all of the homeless have similar taste for music, not all of them share

cultural backgrounds and some of them could even dislike some kind or any kind of music, due to

some negative experience in their past. Even though music is a common language, personal

preferences makes musical experiences to be more complex than that. In order to inspire emotional

involvement in the homeless through a musical experience, the musician who is working with the

homeless should identify the cultural background of each one of the homeless. This helps to know

what kind of music could motivate a homeless person when they listen to music or sing. There are

songs that are very popular among all societies and they are useful because is possible that many

homeless know the melody and so they can sing it along. So, although music can bring people

together, it can also be useful to address the misconceptions that we have about the world around

us, and sharing the reasons that support those misconceptions is also an opportunity to understand

a different point of view and eventually recognise a false impression. Perhaps one of the most

positive musical experiences for homeless happens when average citizens address them as

ordinary people, for example, by praising their musical skills. These are the words of a homeless

person about it:

“When we practise music we forget that we are homeless, poor, and bad seen by some

people and that we are excluded, because when people stop and listen to our song, they

smile, sometimes they clap hands, or dance so we feel this feeling, we share this moment

with them and we see that they are appreciating the artistic part of us. That is why I do

not want to stop playing music, because it allows me to feel that I am still like all human

because sometimes with this rude weather, or hunger… we don’t feel like human but

just like other animals in the street and it is hard, but with music, which is a language of

human’s emotions… we attract the attention and I find that is the best way, it is better

than arguing with people… and when I play music I remember many feelings which

help me to survive, to remember my best moments in the past and to keep this in mind.

That is what I love about music, just playing and showing in the street that I am like

many of them, and I can be touched by any song because at one moment in my life I was

not homeless”.

It is simple to make people who enjoy music to engage in musical activities, but on the other hand,

people who ignore or dislike music should have an initial positive experience with music in order

to involve them in those kinds of activities. Inviting them to a concert of the kind of music that

they choose could create that positive first experience. There also homeless who like music but

they do not have skills to interpret an instrument and they are the majority. In these cases an

alternative may be singing13

, playing basic rhythms in percussion instruments or simply listening.

Homeless who can play a musical instrument or have skills for singing are a source of inspiration

for others and so they could teach the homeless who are willing to learn. The kinds of activities

that make homeless work together in common goals are the experiences that inspire them to live in

better conditions because it gives them a different perspective of the world and gives them

something to believe in, further than their own everydayness. A reason to live for is what most of

them lack of. A homeless person said during the sessions:

“For me music is my unique escape because I have nothing to do but searching for

food, then playing music and I love that because people do not know that I am

homeless, they stop, give me money , or drink and ask me the name of the song… or how

my voice is so beautiful… but they do not ask why I am in the street… all this questions

makes you uncomfortable… so thanks to my guitar I just give people a pleasant

moment, because I need to feel that I can serve for something, that I am not just a

weight for this society. I want to see people smiling, dancing, because I see myself on

13 Yasmine Afif Illya. ‘Singing for Healing and Hope: Music Therapy Methods that Use the Voice with

Individuals Who Are Homeless and Mentally Ill’. Music Therapy Perspectives. 2011, Vol. 29. Issue 1.

them, they start to be like a mirror for me, because I refuse to see my face, to see this

reality”.

The homeless, after reaching certain level of confidence will uncover ideas and experiences they

have, and this exercise of listening to their point of view or a life experience they had is already

something positive for them. The opportunities to socialize are also stimulating for the mind and

music is a way to build confidence so the socialization can happen. When is possible for the

homeless to communicate their thoughts and they are understood and accepted by others there is

also a self-acceptance experience that raises self-esteem and encourages to change the own wrong

perspectives of the world. A spontaneous scheme in this kind of experiment makes it possible to

improvise the activities according to the happenings taking place during the sessions. I had the

opportunity to do an informal interview to a duo of musicians who were homeless and they said

about communication and music:

“When we listen to music, we enjoy this moment, we are having fun, laughing… but if it

is sad music we share other kind of emotions, but all is about emotions and

communication, verbal or physical communication, because we forget to communicate

with others and in our situation we lose our faculty of communication and expression

but music help us to express and communicate, to found our basic sense, and to let

people see that we still having emotion… because sometimes they think that we are

insensible , but it is not true, we can feel that also, we feel that we are inexistent in this

street but thanks to that kind of moment we remember that we have a hart, body and

tongue to speak with, to sing with”.

Music stimulates the mind and facilitates to the homeless to have special experiences to change

their perspectives of the world in order to improve their lives. However, some homeless do not

enjoy music and they may enjoy different kind of activities. It should be acknowledged that music

is not the only alternative to stimulate homeless and engender new social and individual

experiences. Practically any activity with the capability to produce motivation on people can work

to create those experiences in homeless. Music might not be stimulating for all the homeless and

many might prefer painting, meditation, religion or perhaps a mix of different activities. Here

again, the preferences of each particular person are essential.

5. Conclusions

Even though there is enough documentation and experience supporting that music is a stimulating

activity for homeless and can improve their quality of life, there are many other activities that can

have the same effect. More research and experimentation is needed to elucidate what other

activities can be useful to stimulate homeless people to improve their lives and if those activities

could be used in combination to increase their benefits.

BIBLIOGRAPHY

Aaron T. Beck. ‗Thinking and Depression. Idiosyncratic Content and Cognitive

Distortions‘. Archives of General Psychiatry. 1963, volume 9(4).

Carl W. Cotman, Nicole C. Berchtold. ‗Exercise: a behavioural intervention to enhance

brain health and plasticity‘. Trends in Neuroscience. Volume 25, Issue 6, 1 June 2002,

Pages 295–301.

Shuai-Ting Lin et al. ‗Mental Health Implications of Music: Insight from Neuroscientific

and Clinical Studies‘. Harvard Review of Psychiatry. Volume 19, Number 1.

Goodall D., Etters L. ‗The therapeutic use of music on agitated behavior in those with

dementia‘. Holistic Nursing Practice. 2005, vol. 19. Pgs.258–262.

Sung H., Chang A. ‗Use of preferred music to decrease agitated behaviours in older people

with dementia: a review of the literature‘. Journal of Clinical Nursing, 2005, vol.14.

Pgs.1133–1140.

Karline Treurnicht Naylor et al. ‗The Effectiveness of Music in Pediatric Healthcare: A

Systematic Review of randomized Controlled Trials‘. Evidence-Based Complementary and

Alternative Medicine. Volume 2011.

Catherine Carr et al. ‗Group music therapy for patients with persistent post-traumatic stress

disorder – an exploratory randomized controlled trial with mixed methods evaluation‘.

Psychology and Psychotherapy: Theory, Research and Practice (2012), 85, 179–202.

Moon Fai Chan et al. ‗The effectiveness of music listening in reducing depressive

symptoms in adults: A systematic review‘. Complementary Therapies in Medicine

(2011) 19, 332—348.

John R. Belcher. ‗On becoming homeless: a study of chronically mentally ill persons‘.

Journal of Community Psychology. Volume 17, April 1989.

‗Homeless get chance to build self-confidence through music therapy‘. Anglia Ruskin

University website. 10 April 2007.

http://www.anglia.ac.uk/ruskin/en/home/news/archive/music_therapy_homeless.html

Yasmine Afif Illya. ‗Singing for Healing and Hope: Music Therapy Methods that Use the

Voice with Individuals Who Are Homeless and Mentally Ill‘. Music Therapy Perspectives.

2011, Vol. 29. Issue 1.