Listen to this

philosophies

Beyond the medical

Saidie Kahn

Meet Mrs X ... and someone who believed in her.

Mrs. X. Recollection penetrated, but a chink in a tightly sealed door. Again, within this music therapy environment, that chink widened and finally the door opened completely when she was able to emerge into the world she had once belonged.

Psychiatric diagnosis: Paranoid disorder, Schizophrenia: much regressed. Hospitalised elsewhere for a number of years. Full records unavailable. Admitted to Town Hill Hospital aged 63. Discharged after three and a half years with the assistance of music therapy.

“The Return from the Dead” – Matron M M Markram, Senior Matron.

Recollection pierced the sealed door
The numerous reasons and conditions leading to this state of complete breakdown cannot be divulged. From the initial breakdown, gradual deterioration followed. At that point medication was of no avail.

Mrs X was transferred to Town Hill Hospital from another hospital where she had been hospitalised for a number of years. She sat in a chair, eyes shut, no speech, completely non-responsive. When her family and friends realized that she was unaware of their presence they no longer visited her. This patient had to be dressed and fed – everything had to be done for her. She sat in this silent, immobile state until she was taken for a short walk supported at each elbow by a nurse to exercise her limbs.

Matron Smith recognised the name. This patient had been a well known singing teacher many years previously Matron Smith tried to interest her in the choir activities but added, “She is too unconscious, I can’t reach her,” then added with her characteristic chuckle, “I'll bring her to your choir, you never know what may happen.”

We looked at this patient when she was brought in to my class.

The lifeless body was supported by a nurse at each elbow and followed by Matron. I spoke to Mrs X and welcomed her. No response. She was placed in the front row as I meant to observe her closely for any response there might be to the singing around her. I asked the nursing staff whether this patient ever reacted in any way to the classical music broadcast over the radio and was told that she apparently registered nothing.

She was given a typed copy of the words of the song we were singing at the time, but that fell from her lifeless hand. For several Thursday mornings when this class took place she was brought along. There was no response at all.

Week after week she sat in her silent, immobile state and showed no response to the singing around her. I wondered whether she was totally hearing impaired or was she brain dead?

Recollection, a break through
One morning we were singing “The Discomfitted Suitor” – J Brahms (Vergebliches Standchen). She called out in a strange voice, remember she had not spoke for years, “This is a German song, it sounds much better in German.” Recollection! Response!! I said, “Don’t you think this is a neat translation? The humour comes through clearly”. She did not reply.

I prodded the memory further, “When Erna Sack [a great singer in her day] came to this country she included this song in her recital. She projected much charm but many people did not know what she was singing about as she sang it in German”.

No response.

The next time when she was brought to class we were rehearsing this song again. She started to sing with us but she sang it in German.

Eyes still closed.

A week or two later, when she sang, she opened her eyes. It was a great moment to see that she had blue eyes. When a patient sits before one, eyes closed for a long time and at one moment opens her eyes, it is an indication that she has become aware of life outside herself. That slight chink when she had started to sing with us had widened a little more in her tightly sealed door.

We were planning for the end of the year concert. Enthusiasm had mounted. The patient actually asked whether she might take away a copy of this song as she would like to memorize the English words for next time. “You see, you can’t sing if you have to fumble for words.” The nurse thought Mrs X would forget about it once she left the class. Mirabile dictu! Mrs X had done her homework. She memorized the words of all four verses.

She sang with us. We told her she had a lovely voice. She said, “I was a trained singer. I used to sing – a long time ago!”

When the class stood to sing, Mrs X said, “Do you mind if I sit? I can’t stand on my own. I shouldn’t like you to help me. I am too heavy a person.” I did not mind.

One day when the class stood, this patient arose from her chair and stood up, unassisted, on her own. At first I thought her sense of balance would not hold her, considering also that her muscles had atrophied to a large extent due to years of inactivity but, she stood for the duration of the song, then sat down unaided.

I mention these steps in her recovery to try to convey the many mental and physical hurdles this patient had to overcome on her way to complete recovery.

Once the breakthrough had been achieved it was necessary to maintain the stimulus and interest to prevent her slipping back into a state of unconsciousness. My class provided the environment she needed.

Bearing in mind the Matron's report at the time when this patient was first brought to my class, “She is too unconscious, I can’t reach her", and reviewing the awakening to consciousness and the slow progress up to this point, one was aware that the critical stage towards recovery has been overcome and one could now look forward to the next stage.

Social interaction
Mrs X, never too friendly towards others and with little interest in people now began to interact with the group quite happily – another very important enfoldment towards social normality.

She was now part of the class, learning each song as we went along. Though Afrikaans was strange to her, she was “prepared to try” and keen to take away a copy of the words of a song to memorize for the next class.

By the end of the year this patient was on the stage with the others, participating in all the choir items, except in the Afrikaans group as she felt her Afrikaans pronunciation was not good enough! Much to the amazement of the medical and nursing staff from the previous hospital home, who were in the audience.

A new stage in her progress had been reached.

An incredible experience
We resumed classes at the beginning of the following year. I planned to prod her memory further. She had specialized in opera in her student days. C. G Jung tells us that what is stored in the sub-conscious brain, provided that the impressions are clearly ingrained, is never lost. Even after years of regression? I was to find out.

I suggested to Mrs X that we try the open opera section at the Eisteddfod* which was to take place in April.

She was very despondent that morning. She could not remember anything, she did not know what had happened to all her books and other possessions, etc. etc. I prodded her memory through Puccini, through Rossini, through Mozart. “Yes”, she said, “I’d like to try “A Lo So”, from “The Marriage of Figaro” “W A Mozart.” She also remembered “In Quello Trine Morbide” “G Puccini. I returned with the books to try these.

Then followed a dramatic experience.

She wanted to try “A Lo So” first. As she had not brought her reading spectacles with her, she leaned over my shoulder, looked closely at the page and read the Italian words syllable by syllable while I played the melodic line slowly Then she turned away from the piano, adjusted her posture and said, “Will you, please, play the accompaniment?”

I played the introduction and she started the aria. The Italian words came back to her. Musically she sang as one who knew Mozart well, every phrase and each nuance was in its place. Towards the end of the aria, Mozart takes the voice up to top B flat, nearly two octaves above middle C and places a pause upon it. She sang effortlessly. Her voice sounded as though nature had preserved it. I admit that I was bowled over. At the end she said, “I didn’t think I’d still remember it, I last sang it when I was at the Academy” [The Royal Academy of Music, London]. I said, “Were you then in your early twenties?” She was on that day sixty-four.

Still in a state of amazement I made my way to the nearest psychiatrist and related this experience. “We know something about the conscious brain, the unconscious and the super-conscious. Was this a neurological upheaval?”

The calm answer came, “Your methods are right, carry on. We don’t know the last word about the human brain, all but”.

I used the Eisteddfod not for the award that might be forthcoming, but as an incentive and goal for realizing the patient’s ability after an interim of many years of illness and regression.

I reminded Mrs X not to monopolise the sitting room for her practising where there was a piano, as there might be other people not as musical as she was, wanting to relax there.

Mrs X obtained an A certificate [about 85%] at the Eisteddfod. Had the adjudicator but known the steep hurdles this patient had had to overcome both mentally and physically to be able to stand before an audience and render this taxing aria “A Lo So”, she would have been as inspired as I was when I played the accompaniment.

The report was sent to her son who by now lived in another country.

A very significant stage in her progress had been reached.

This patient did not speak about herself at lessons, but at times she reminisced about some traumatic experiences she had encountered in London during her student days. While she re-identified with these experiences she became very agitated and distressed. It took days or longer before calm was restored.

I must digress a little. The Matron at the hospital where Mrs X had been for many years, came to Town Hill Hospital on promotion. She was on her way to visit wards for the first time that morning. Matron only knew Mrs X as a lifeless body sitting in a chair. Now Mrs X was walking briskly towards her. Matron stopped Mrs X and talked to her, though Mrs X did not know who Matron was. Later that morning Matron came to my room. This highly self-disciplined lady let her hair down, “I have just seen Mrs X.... if that is not a return from the dead, what is?”

I felt we could call it that and would have to see how far we could get.

This was a year of steady improvement and recovery. There were relapses, but on the whole improvement continued. She was granted town parole. At first she was accompanied by a nurse, and when she proved herself to be confident and reliable, she managed on her own. As she had means of her own, she liked to visit the local music shop to buy copies of the songs she wanted or place an order for the songs they did not have.

She was moving into the outside world.

At the end of the year concert she sang four solos.
“Se Mes Vero Avient” – R Hahn, in French
“Serenade” – Richard Strauss, in English
“A Lo So” – W A Mozart, in Italian
“A Quello Trine Morbide” – G Puccini, in Italian

Musicians will recognize these items as at performer’s standard.

This patient recovered and left the hospital. Her recovery can be summed up in three stages.

Stage I

1. The awakening through recollection;

2. The patient opens her eyes;

3. The patient is able to stand and sit down unassisted;

4. Participation in class activities;

5. Participation in the full programme at end of year concert.

Stage II

Further improvement.

1. Confidence is consolidated;

2. Participation in an Eisteddfod;

3. Town parole;

4. Consolidation of ground work and further expansion into new repertoire;

5. Performance ability is restored.

Stage III

The patient rendered advanced works at the annual concert and sang in English, French and Italian.

Before she left the hospital, she was somewhat nostalgic. Her music now meant much to her. Would she find an accompanist where she was going to live? Would she have the opportunities to sing in public? She said that she clearly remembered the turning point in her illness; it was when she returned to her music.

This lady was welcomed to live in her son's home.

A year or so later, I met her at a seaside town where she was spending a holiday with friends. She was beautifully dressed, sun tanned and full of the “joie de vive”. Being but human, there flashed before my mind's eye the lifeless body that was brought into my unit with nothing more than a hope, from Matron Smith, “You never know what may happen”.

These are awesome moments.

* An Eisteddfod is an adjudicated music competition.

This article: Kahn, Saidie. (1999). They shall have music. Cape Town: Pretext Publishers. pp 103-109