1953 reports of tape recording of specially selected music for electric and insulin shock therapy

1953 REPORTS OF TAPE RECORDINGS

OF

SPECIALLY SELECTED MUSIC FOR

ELECTRIC AND INSULIN SHOCK THERAPY BY

EDWINA EUSTIS and WALLACE KOTTER SPECIAL PROJECTS DIVISION

REPCRT ON SH;LECTED AND 'l'RANSCnIBED TAPE--REOORDED MUSIC AS AN ADJUllCT TO ELECTRIC AND INSULIN SHOOK THERAPIES

by Edwina Eusti•

At the re~uest of the Veterans Administration in Washington, a Special Project wa• undertaken under 'tllY direction bJ the Musicians hrgency Fund, vbiob

entailed making tape recordings or aueio to be used before and a!\er JU.eatrio Shook 1Teat.aents1 in VA Hospitals, and testing the recording• at fA Hoepital.8 1n tb• Nev York area. At the request of dootora in the•• hospital.a the tape reoordinga

nre aleo teated during Insulin Shook Treatments.

A preUminary conference was held in Washington wit.h Mr. Lenard Quinto,

Director ot Muaic1 Special SerTicea, Veter8J'UI A&tinietration. He specified that

there should be one halt hour of mueio tor the pre-ehook period, and one halt hour for the poat-lhook period, f ollowi.ng sequences worked out b1 • a\ the PUgr1a St.ate Hospital under Dr. Mary Holt. The music for the poet-shook period vaa to be divided.

into three sections, -- the firat to last 20 minutea, the aecond and third f1Te

Jninutea eaoh. Unfamiliar muaio was to be used to aToid poseible ae1ociat.1Te aemoriea. No Tocal music was to be included.

(Appended hereto for corIYenient reference, 18 the portion d91linc with Electric Shook Therapr ot my report to the Musicians l!lnergenc1 Fund on the apeoial project in Music Therapy conducted at Pilgrim State Ho1pital 1n 1949-19$0. Thia

aq be uae.ful as baokground material.)

Two method• of procedure were considered. The first would han inYol:Yed the following ateps a

-1. Selecting music frOlll our claaaitied liet. in the desired aequences,

2. HaTing epeoial arrangements made tor different oanbinationa of instruments,

J. Rehearsing to achieYe perf eoted pertormancea,

4.

Making the tape recordings, with the poaaibilit7 ot ha'rlng to correct and remake the tapes.

Th• MCond •ethod of procedure, the one fol.lowed, va• to haft the ta.pea made to order b7 a •all cmp8Jl1' engaged in designing and broadcuting background and functional aueic programa. The Cmnp&J')Y vhich undertook our wor~ i• MUSIO OF

DISTDrOTIOH1 IHO., Hotel Hcilpin, Nev York City. Iu Pnsident.t Hr. John R. Andrern,

u•i&Dlcl • to Mr. Darld Gordon, Progr ... Director. Both ot the genU . . n named gan to our project attention and intere•t1 out of all proportion to UT potential o~roial Yalue ot the recording• being made. Th• aucae•• ot the entire project

1a attribu\able in large aea8Ul'e to the underatandin& and expert technical abilit7 ot Mr. Gordon.

I turniahed Mr. Gordon with the la,you\ tor th• auaio Mquencea io be uaed in both prograaa, •• tollovas

Pre-shack period Progra II. Sect.ion l Seotion 2 Sect.ion f Plating time Rua o 31 ainutea

Alternating Cheerful-quieting, and Kildl.T-•tillulating1

(TaJ7ing r~• and teapoa). to ~ apprehension,

to keep patient• 1nterea\ed1 and tairq relaxed. ~oet-shock period (.30 ainutea)

20 lllinutee

Quieting (Slow, atead.71 rooking rhJ"tmu, without

Tariation). For uee immediately following ahock, when the doctor vi•he• the patient.a to remain 1n bed.

S

minute•

Cheerful-quieting (TaJ7ing rhythm•)

-To continue pos~1hock _p eri.od and becinni na to

arouse patient.a.

S

nnute•

Mildly-stimulating, to Stimulating. (Stimulation steadily increaain~o Concludirig Poat-ahock period

fully arousing patient••

nte Mood Scale fran which the foregoing were selected ia appended to thi• report.

-J-Aft.er correlation of the oategori••

or

'lff¥ Mood Scale with the ratings

Uri b7 the Cc:aparq, Kr. Gordon and I decided on the &Terage length of numbers, and h• ade a f onu.t ot the entire 61 llinute1 of recording. He eeleo\ed abo.ut

100 reoorcla fraa the librar, ot hia oc::apa.ey, from ~1Ch I was to choose the n-qu.U'ed nuabera. I el.illinated record• on th• baaia ot unde11rabl• inetrwnentation,

_. arrangeaent.J \Ul8ftn or 8)'11copated t.apiJ greatly nrpng d¥naioa1 n\llllMtr•

that wn ·too fuU1ar, depreaaing, or vith OTer-ccaplloated haraonie 8truc\un1

of uneTell .. 1oclio line.

1'h• t1.nal choice ot 22 number• va• then reTiewct, tilled, and edited

tor taping. Oorrect1on• included Uaiting qnaio• bT el.eotronib&l.4 alterina

onacendo•, cliainuendo•, eudden p1ania11ao1 and tortilalaoaJ outting introductJ.0111,

· •ndina•t and whole •ectiona which ct.rlated ,froa the principle aelodio and haraonio

line•J and achieving aegue1 b;r fading in and out illperceptiblT when cuta had been ude. Tie final tape• were made in two apeeda, ).

7S

and 7

.S

1.p.1.; u different

•ohine• an uaed 1n di!terent hoapital.11 and long-pl.a31n1 reoord.8 wen alao aada tor u1e 1n one State Hoapital which the Mueioiana Emerg-ency Fund •.ma, where no

tape aachine 1• &nilabla.

Following the completion and delinr7 ot the tapes, Mr. Wallace lotter,

ot ~ Ho1pitalized Veterana Muaio SerYiae, waa giTitD the aaaigmaent of te•tin& the tapea ia fiTe YA Hoepitala in the Rn York area. We wre fortunate 1n barlng

Mr.

lot\er &Tail.able tor this project, end are gratetul for the cooperation ginn hia

bJ'

\he ho•pital•• Hia tuli. report follow•. My own ooncluaiona and reamanda-\1ona are.inaerted after Mr. !otter'• report.

TISTllll SPECIALLY SELIOTID AHD TRAl.SORIB&D TAPl-RICORDID HUSIO

.AS Al ADJUIOT TO

ILECTRIO !MD DISULII SHOCJt THBRAPI

AD .ob•enat.ional projeo'\ undertaken la 'fETIJWiS AIIUIISTRATIOI HOSPITALS (l.P.)

b)' th•

HOSPITALIZED RTKRANS MUSlO SIRYIOI.

ot

the MUSIQWS ~ERO?

ruw,

DIO. OF DW tam:

June

JS, •

Auguat 61

19S3

fbi1pro3eo\ ••undertaken at th• requeet ot the '• A,. with the

tollov-ing obJect1V.• in vina

l. To observe the customary routine of the adminiatration of llectrio Shoclc Therapy• with special attention to the auaic,

it Al\Yi. ueed beton and attAr treatmen\.

2e To oba•tve whether ap•-ial.17 1eltoted and tranacrtbed

llWlio would be an aid in the adnd.nU\ration of 11.eotr:t.o

Shock Therapy_..

J. To ehow whether nobmuaie, record.eel on tape, could be

more efficien'bl.7 utilisttd in th• boapital. routine than

other method• ot preeentation.

(A\ the requeat ot dooton in tvo ho1pitale, th• tape•

were also teated 1n oonjunction vith lwlulln Shock Therapy).

Thie va1 a ahort-tena project and no attemp\ waa made to u1e oontrolat

or

to

arr11"8 at oonolueiona based on &IJ¥ mean.a other than' obJec~•• and

aubJ•oUTe

ob1enat.ion1. Without a control group, and carefully controlled eonditiona, it iat

ot

ooutae, illpoaaible to 1q tha\ arq- iaprOYement ehown by the patient• vae not clue

exolua1Yel;r \o the shock therapy alone. nor ie it poasibl.e to aq that 11u.1io in

conJunotion with the treatment baa ai~ed in it• ·ettectinneea. However, neither

Gould 1\ be asserted that the music did not contribute

to

th• th.er~ tiller• • ·

de.finite illprarement vu lhcnm bJ' the patient.

U

the 1n1a10

••nwd

onl1'

to •ke

the procedure eaeier for the patient and hospital personnel, \hat in i~aolt waa worth 1fhile. In thJ.a obeenatiomil projec\ there was · cloee contaot with UD1'

dootore and other hospital personnel who work onl;' vi.th mentallT

Ul

patient•, and

i\ m1q be that .thia project, ae well aa eimilar proJea\1 oondueted in other bo1pital•j

aould help point the way to a controlled experiment, it turther proof ot th•

ettieac7 of the use

or

special muaic as an adjunct to the ahock therapiee 11 deemed

I neoe•M.17•

Thi• project has been under the direction ot Hiaa Edwina Euetis• vhoae

report on the selection ot music and the mechanics of making the tape has been

.Arrangements were made

bJ

the Hoepitalit•d Veterans Music Senioe to

carry OU\ this project at four Vetarana Adminietration lioapitala tor a period

ot

. .

\w 1f9fikl at

each

hospital ... follovaa

l•

Franklin Delano Roo1eYelt i•tere.ne Adminiatration Hotpit.a.1₁ :' ·Jlontrcae; Rev Io:dl: •

2. Veteran.a Adminietration Hospital, J.qons, New Jer197.

J.

Veterane Adminia\ration Ho1pital, Bo~or\₁

Lons

Ill.and, I • Iollt.

4.

Veterana Admin11tration Hoapita,1₁ Ooateevilll, Penn1yl'tania.

At. the tir•t. three hoepikls lleotrio Shock Therapy (EST) 1a given three

' '

Ull••

••klJJ

at the lut, twice weekl.T, ill g1Ye Iuulin Shook Thetaw (IST) tiff .clap a Veeke Since p:rooedurea in th• lldlliniatratiOll of shock the,.apr Yariecl

trca _. boapital to hoapital1 and nen troa one ward \o anothetr vithla the _' hoapital.11 th• following 1• a report

or

the proJeot •• carried out in

••oh

hoapi\al ward.

The plan ot presentation

wu ••

tollon1.

Pre-shock (Program I) to be played for one-half hour

betore treatment, · and until treatmente

are

ocapleiede

Post-shock (Progreme llt III, IV) to be played fran

immediateq after

treatment until coaplete

-1-~~~ITAL le FRANKLIN DELA.HO ROOSEVELT VA HOSPITAL, MOMt:ROSE, .M.I.

PROQEDURES

. Pa\ienu await treatment, 1n '11• ~ocn 11h1cn 11 al•o ecoup1ed

bf

\he

'. nplar ward pa\iente. In turn each patien\ ie oalled b7 nae and i1 ••oortecl ·. b7 aa aide along· the hall \o the treatment roca. Atttr

treatment.

the patient 18

'-ktll on a vheel-table to the reooftr7 rooa at \he othet' •rid ot the hall. Thia .

ta1cea troll two t.o tin ainutea for each patient. When all treatments haTe bee

Ii••~ and. all patien\a haft ooapletel.7 reooTered th•7 are giYen retrelhmenta and

returned. t.o their

wards.

Th• \otal elapsed time trca the beginning.of aueio 1n pre-ehoolt un\il the l.aa\ patient; hU recovered Yarie• from ·on• hour and tori, ainutea \o .\vo hour• ud ten minutes, according tot.be DUmber

ot

patienta.

Mu1c,. enrtiouag u~e~t

Poa~shocks

. ~1ent

proJectt

tt••lhookt

Post-ahocka

Records or i-adio programs broadca1\ over the public addre••

eyatem from the hospital'• central radio studio. There are

two channelt aTailable, and selection ia mad4t bJ an aide or nurie who aleo seta the desired _•.

volume•

Rone •

Proeam l wae transcribed onto records and broadcast to the

dayroom. I\ vae played twice through ·eaoh dq, lat\ing

approximatel.7

one

hour and fiTe lidn.utea.

The tapamachine was set up in the recovery room. The firat two de.ye, progra:ou• were played in the following sequence a II, III; IV, III, IV. The laat two dqa the •equence waat

11 III, IV, III, IV.

The tirat

two

daya spent at thia hospital were expended in working out

the Yarious mechanical procedures and in obaeifvation of the hospital routine. It ia obvious that in order to haTe the pre-shock music pl..,ing for a halt hour before treatment ate.rte and continued until the le.It treatment. is g~ven, trhile a\ the 1ame time the auaic starts in the reco"fery room with the arriTal ot the first

patient, there iaan over•lap

ot

o~·balt hour or longer, which would necessitate .

two

M.Ohinea being operated •illultaneouaq. ln the Montroae noapital this was oftl'it ooaie bf transcribing Frogra11 I to records and broadcasting the through the public

addr••.•

111tea. .

Th• · change in sequence of programs in the ~ecoTery rooa waa made in responae to th• requeat of .the hoapital per1onnel and the patient. themeelvea for Unlier mueio • . The tirat tvo U;ra, vhil• Progr• II vaa played,

it

appeared to the doctor

and

aide•

that the pat.iente were takilig a longer time 1n recovery. When the livelier sequence ot Prograa

I, III, IV, lII

1 .

IY

wa1 pla7ed1 the patients were indeed up and

w'

1ooner than beretotore, •T•n though there were aore patients.

The doctor eaid that speed of reoo•er.r uana nothing ~oept that aid.ea •nd

nuraea are free

sooner

to go about other work, and that

patients

do

not

nece11arU.,-l>enetit from eithtr a long rest period or a quick recatery.

REACTIONS

The aid.ea, Hurse• and Recreation personnel feel that our pre-shook au.aic wae

little different from llbat tbq had been uing1 except tor the ab1ence ot "pop .tune11

ocmmerc1al1

and

announcement•"•

The doctor, •• well

as

all other peraonnel

and

pa\ienta, however, bighl.J' ·approved

or

aueic in the recover1 room. where \here had · been none before.

The patient.a themeelna thought the mueio we.a "nice", but. the general feeling vae tor li'Yelier music. Two patient• who h~d prerloueq been quite noi97 ccaing out

of coma were coru1iderabl.7 less ao the la.at dq. On the whole, the progr• was ao

well received in th1a hospital that the Director or Mueio 1ignified her intention or oont1nuing mueio in both pre-and-post-shock periods• using the PA system in the dayroom, and with long-playing records in the recowry room to be played b1 an aide or a

HOSPI.TAL ,21 VBTf&.NS _{. · .} ADMDI$TRATIOlt HOOPITAL, LYONS, _{. . . .} NEW JERSll .• _{. H}

WARJ) {Al

PROCEDURES

Tb• pa~ienta were brw.ght to the dqroom only a

t•w

Id.nut•• before treatment.

Tb•re ·i• T•rJ little waiting here between ar~iYal int.be clayroca.an4 ti-eatmen\.

Otheni8e th8 procedure ia the aama aa a\ Mont:to••• The recar•rr :room do•• bot

haft 1nwgh beda to

acoamaodate

all

patient. trea\ed,

ao u aooa u

P!>*•iblt atwr

reoOTery₁ on thole

dai•

when there are more patienta than beds, the paUent•

*"

.rttturned to the dayroaa

ror

ooaplete recovery and t"efreahmeaita in orier ·to be•

Md•

tor tollowl.ng pat:l.ente.

!!t!•ic .prenousb

uaeda

Present eroJect1

Pre•ehoekt AFRS (Armed Forces Radio Senice) or other record-ings broadcast owr the PA 911tem trcn the hoapit.al'•

central radio

etudio.

Poet-ahook1 lFRS and other recordings pl«red en a large reoorct··

player in tha reeovery rooa ( t•mporariq ou\

ot

order at \be time of

thia

prOJeot.)

Pre-ahockt A• the patients

wait

such a short tim9 1n th• d.ayr,oCll

before treatment, it wa1 deoided to continue the

cuatomarr routine, and plq \he tape reoorded auaio

in the reoovery room o.nl.T.

-Po1\-ahook1 The following sequence ot prograu ..,... pl.,-edt llt lll1 lf t I.

REACTIONS

Kuch interest waa shown in th• music at thia hoepital. The patients treated

in tbie vud were generall.T older and more regressed than th• group at Montrose. The

tape recordings were enthuaiaatically received by all BST personnel and the Director . ot Mu1ic • They found the quail ty ot the . tape recording tar superl. or to the recordings

Ule ·dootora. The Ohiet of Acute S.nioe vaepreeent .e>ne &ay·and

hi&hlT

ocnm•nded

our program.

It

wae

suggested. bT ao• of the personnel

tha\

it woUld be

a'

good thing

\o

have music even in the treatment room.

The patient• were much quiet.er the second day than the first, and th• auaic

••·given oredtt. tor it. Tvo patient• Who bad b.een Tel'Y di•turbed on reoonry were bOb

aort

tractable and quiet '\ban before. Another patient appearad . to

enJq

the

' '

•u•io ao auch that he would.at\ get up unill 1\ ne atopped.

our

progr•

waa

10 well reoeind th.a'\ \he Director ot Hwsio .1• pl.anning to

u•e record• ot a similar aood until reoordinge, which are aoat urgen\17 requeeted,

beooma available.

A&niniatration

or

ESI

WARD (B)₁

PROCEDURES

.. The pa\ien.\a wait in the dilroom and are ·then brought in tum to the ~ataent-reo0Yer7 rocm.1 wher• they are placod on a .bed; given shock, and. remain~

there until completel.7 recovered. Tbey ~ then return t.o the dayroom tor retreabaeate

betore returning to their own wards. Mueio PreTiousl.z Used!

h!-1hock1 Post-ahocka

~·s•nt

proJeota

Pre-ahocka

A'FRS and other recordinga broadcaat OYer the PA ayatem.

Same aa above.

In this moet disturbed ward 1' wa1 ntoeaaar1 to administer anaesthetic to seYeral

or

the patients.

Hanr

ot the patient•

wen

brought to treatment ttnder

violent protest, and it was hQp9d th• ilml1C would have a soothing effect. The fir•' daa" it was ·impo•• a1ble to play the tape uoh1na in the ~oom, aa

there was ow.,- one aide there1 and. on·· •ight of the machine the patients became so •gitated that the doctor

decided it was unsafe f o?" an operator to remain in the room. on the second dq more aide• were present

on the first day the sequence of programs nat II (S minutes), I, I, II, III,. IV.

·s.aond dayt · Ii• III, II, III,

IV.

On the firat day when .patient• b•gan coming in tor treatment, Program II . 1 btgun₁ but it •eemed depressing and moumtul in the excited atmosphere of \he

om, 10_1. \h• aueio waa changed to Program I which na played. twio•.• After all

~ienta were \nated, Program• II, III, IV wen plqed. On the second clay' Program I

• .played twioe in th• da.J:tom, after vhioh the maohinfi wa1 aOTed te the

tnatment-;oonry room tor th• recoft17 period.

REACTIONS

Two doctors were working on this _ward' and their tntereat in this proJect ll moat gratifying. ~ doctor particularq wanted muaio du.ring the pre-ahc:ok

triod

•inc•

th• 'pat.ant.a vho are aoat disturbed and rea11t treatment do not. heu

1110 1n the reo0Yer7 room, but during the pre-shock period the 11\1810 111¥ help to alieYe their ·anxiet7 and punishment reeling•. !he other doctor

and

a DUrH

pprOYeci ,bigh]J ot the mu1io in the r.,oowr;r room aa a quieting, reluing agent.

oth dootora, however, agreed that the auaiO va1 a definite aid in the administering

1

t

•hock therap7, and vould like to

ha••

a continuous euppl.r of the type

ot

auaio

11.ayed in this project. Doth doetora, hoveYBrt eaid that it would be hpoa•ibl• to

judge the auaic 'e effect. serious]¥ 1a lese than a month . or mal"• of continuoue Jlaying ~ experment under controlled conditions.

The aid•• and nurses want the music wry auch aa the7 •81' it helpa thu to

1ork better• This etteot of the music should be gone into aore tboroughl.J·, tor the pei-sonnal. who carry out th• EST and are ao close to the patients are denning

ot all the help t.hat can he given them.

The aide in charge or thia ward and another aide said that the patient•

•re considerably quieter and much easier to handle because ot the pre-shock

music, and that there vaa much less noise and resietance when this rausic was pJ.ard than was usual.

The interest of the doctore, nur111 and aides in thia pro~ect, and the

\IDQ.ualilied approval ot the music u i\ 1tands, show that tbe te.at was euccesatul

'·

here, ~d. that such music aa was proTided is indeed a neceeaary adjunct to their

·, The adminilltration of the treatment 1n this ward 1• neceaearU7 prolonged

beoau••

.ot

th• large number ot patients t.nat.ed and the need to adad.niater

anaeatheaia to •ant ot

th••

lNSULI.H SHOOK THERAPY

(JWU!

{Cl

PROCEDURES

A4!ini•~tt1on ot . IST ·

Here treatmen\ 1• giYeD earlierin the morning,

m.tween 6

and 1 AH.. The

patients

are

put. to bed, all in one large room, and remain there until the •nd ot

the recwery period, attar vhich t.he7

tau

showers and retum to the dayroOJ1.

Retreahmenu are given aa directed bJ the doctor at the end ot \he r•cove17

period,-. which 1•

4 to

4-l/2

houra ·art.er beginning ot treataeni.'

CUSTOMARY MUSIC 1 Radio programe and recordings OYer PA ayite11._·

Present proJect1 Sequence of programs pl.,-ed1

Firet dlQ"t II, I• II, III, IV.

Seoo.rd dayt II1 III, II, III, IV1 I.

Total elapsed time t approximatel.¥ l hour and. l5

Id.nut•••

On the first dq auaio (Program II) was begun at 8t4.$ AM1 after whioh th• dootor ea.id that the main Yalu• of the music would be after 9t.30 AM when patient.

would be beginning to come out of coma.,

He

eaid, however, to keep the au1ic going

oonUnuously a.a it might have some subconscious effect. The eecond

da1'

•ueic

wu

btgun at

9AM

while moat patients were still 1n coma, but a few were beginning t,o

come out. Although the rirat d81' was an unscheduled experiment. it was so euccese-ful that a second dq was achedu.led by request ot the doctor in charge ot IST and ·

ft!AOTIONS

Th• doctor talkecl to moat of th• patients aft.er reooTert and th.,- unan111ouelf

preferred this mueio to that which thq bad been hearing during treatment and recoT•

•rt ....

• ·•Dl ther liked 1' because it was soothing. The1 do net. want "~umw ~·••" or

•noia7 •1J1Phonio 11ua10• •. One patient in particular expresaed. hit great ot1ataot1on

with "bia "pleaean\ aoothing music • no noie7 bra11 ... real.17 liked i\"• ·. !he aide .

iA

ohara•

vu •urpriaecl to hear these remarks u thfl week before th1a patient ••

unable to liaten to I.XV muaic at

an,

and had to get. ... fraa radio, ff and 11\1$10 eoming onr the PA 818tem. .All patients and personnel desire t.bia

tn•

et au•io

t•

IST and hope

there

will be •

regular

Hnio•~;

Because

of

the

poor quality

ot

aoma4. Of aueio.

oOldng

emir the PJ.

eyatem u

well

aa

the uuui\able . (for.I.ST)

••leo\lon ot

auaic

'1197

uaual.17 hear,

the

doctor,

nu1e1 and all other pereonnel

de11re a

continual

now

ot aoothing, quieting auaic b•ginning about 9 AM and continuing until th• patienta gt\ up₁·vhen tb•7 suggest et:im.ulating Jm111io1 such aa Program If, for the final period

_.

ot reoaverr, and thq consider the taped llU81o Of t.hia proJect tar 1uper1or to \ha\ piped into the room over the PA aymtem, " A place would be made tor the Jl&Ohin• in the

HOSPITM.a _{. . .} ~,, . VETERANS ADIW\ISTRAT!OH HOSPITAL, MOR'l'Hf.Oll.'F_{. 1} LONG ISL.AND, N.I • _. ( . AdJd.ni.•traUC>G

or

IST

WARD (A)

PROOEDURES

-14-The patient• ue brough\ in one by one fran their varda and awa1'b treat-•n' 1a the treatment-reconry room itself. Aa each patient'• turn o01D.e11 he liea.

on a bed, 1• giYen treatment by mu.rua of a lhock machine on a wheel-table and

remainl on the !Mld until rec~ered, at which ti.ma he i• given refreshments and

returned. to hii

ward•

Mu•ic ererlOU81y

uaed1

·Pre-shocks lone

Po1t-8hockt None

. ~aen\ p.-oJectt

f!!_-and J?Olt•shOCkl . The tape machine vaa placed ODtl& . table near the Ohair

where the waiting pa\ien\ could. .eee the machine and hear th• au11C.i Music oon\inued through t~atment and

reconr,

ot

all ~tient1. Th•

aequeno• ot

progtau plqe4

.wut II, III1.IV. Total elap•ad timet 30 ainutes.

REACTIONS

The doctor had had previoul txperience with music in oon3unction with · EST and had not been taTarablT imprea1ed, but he oonceded that this type

ot

muaic

had posaibilities and Ula\ tape recordings ottered certain ad.Yantag•s in hoepital _work.

All the patients and personnel liked the :mus1c. A• tile t.ape maclll.ne vu

placed close to the chair in which the patient. waited tor hi.a treaim.nt• he vaa able to watch the machine, and became so interested 1n it and the music being

played that he was dia·t.raoted !rars watching the treatment which preceded him.

a,

harlng the machina and waiting chairs juat outside in the hall instead of 1n the actual treatment-recovery room, an even better procedure could be worked out for

Achinietration ot EST

WARD . (B)

PROOEDURES

-

-is-The patients for treatment wait in the dqroom. A• eaoll one 11 called in :·t.~ . h• · i•~; ~onduow4 _~ to the t:reatment-reo<frerr room, vheH he is placed a • ·

: • • " ! • • • • • • •

·'Md1 ~ven veatAent, and remain• until c~pletel.T recovered, after which h• 11 giTen .retreabmenta and returned to hi8 ovn varde

f!!f

1o 2rev1cual[ uad. t . Pre-ahooka . lone Post-shock• Mone

.ft•eent pro.1!ct1

lre•shock! Poet•shocka

Sequence

ot

program• pl.a.1edt I, · I.

Notet Th• first· day no.•usia waa played during the pn•ehock

periOd since the tape ucbine vu playing in Ward (A) during

this period. The third day the doctor wa• late, end Progr111

II va• plafad toUoving the two vl.a1·1D11

ot

hoP'• 1.

Sequence of program• pla.yedt

First da11 II, III₁ IV₁ I.

Second da7t 111 III, IV, III1 IV.

Third

&.1•

II1 1111 IV.

Total elapsed time l

hr.,

2t)"ainl• to l

hr.,

.SO ainlti

REACTIONS

Th• aide• and nurses reported that in this very dia\urbed ward the

pre-abock auaic had made a remarkable difference in the behavior ot the patienta •

. '

OuetomarU,there wae

no

muaic her• and formerly the attention ot the patient.

vaa directed ~o the treatment. room and the aounda ccning from there. low the7

vere di•traoted and quieted, b7 the music, and their fear waa p-tJatJ.¥ lessened. Thoae vbo had previcusly given much resistance going to treatment were now docile

and went willingly• The pa,tiente appeared to enjoy the aueic immensely·. The

first day that the music wasplayed in the dayroan their intereat vu arcuaed b;r the

machine and the mechanics ot operation. They came to watch it and ask questions.

.nother aat and watched the machine, asked questions, and lietened intentl.r to the IUlio •. Wha time came tor h.18 treatment he vent willingly, al\hough the laat time

~.had to be oarried into the treatment room. Some patient• tapped their fee\ and nodud their head• in time to the muaio, and one even tried to <lance for • while.

A

doctor, vhile Progrm II waa being played aaid. "tha\ auaio ia eoothing .. it 11 good&•

Qn\th• third .dal' the patient• arranged their chair• in rova·like

a

theatre facing the

·t,ape. machine, the better to hear the muaic.

The doctors genera14r apprOTed ot th• muaio and wanted it to be contimed. !be

nur•••

and aide• •re ••r1 anxiou• to ban the mu1io omt.inued u

they

noticed .

the great change ill the patients• baharlor when th• auaio wu being played. the Direetor ot Music vu awakened to the need tor auaio in EST and lSf 1 and intend•

to

vo~k out a plan t-o prov~de recorded muaic tor both t,pea of

•hook.

Admiilietration ot IST

INSUL.tH SHOOK THERAPl WARD (0)

PROOEDURES

.AA at. LJ-ona Hoapital, the insulin i• adminU\erecl bet.wen

6

1.nd

1

.AM ·

and the ,patient• remain 1n bed until the end

ot

the reo0Yer7 period• .

Muaio e:reviou117 used1

Usual]# a small table radio which play• during the entire treatmen\ and

reoanr7 time. When posaible,the doctor, who is deepq 1ntereate4 in the uae of

auaio ltitb this treats"nent, bringa hie own tape u.ohine to plq quieting m~aic which he has tranecr1b•d from hi• own record player at home•

Present project•

Sequence of programs played bot~ days 1

ll,

III, IV, II1 III, IV, I.

-17-REAOTIONS

the patients, when ukad if the;y liked th• muaic1 emiled• nodded their

hudt1 . &ad agreed unanimouel.7 in \heir enjoJ11$nt

ot

it. The

nur1••• .

aides end

ottm.-per•onnel were eager

\o

haTt.nch auaio

all th• \1-1

ed.

the

nurse1, _tb.em1e1Tae1

ottered

to

operate th• tape maohi.M it and when

tapl

and maohine lihould •Dr :Meome anil&blee Th• doetor vae moat en\huliuUo. ·· He detinitely th1nka au110 ha• a therapeutio value ~· - in •h<X' k treatment, and that this "amootb and <luieting• .au.aio . i• 3u1t right and ht owld •us• a lot ot

it"•

He

eit.ed relaxation

or

tenaiOil 1n th• patients,

a

pleaeanter, quieter atmosphere 1n the ward,

referrine

ma1n1T

to

Prognu

II• Ilit

and ~01\ ot

l.

legardingiipecUal tape recordbga . torShoo~

Theraw,

. HOSPITAL

Q•

VETERANS ADMilUSTRATiqH ,HOSPITAL, OOATESVILLEa PENNSYLVANIA

PROCEDURES

Aminietration at .EST .

Patient.

vai\

ror treatment

ln

the

dqrocma• .

The7 are ••oor'9d to

the

: treat.en\ .roaaa balt•wq d~ tbe hall t~• th• ~oom, and following treatment art · taken on. a wheel-table to a reo0Yer7 room. The7 ue here onq a abort time un\il

they ha.Ye regained oonaciousnes1 • and an then aaeiated baolc to the da,roaa to

aohien

tull recotr•?"T• In \h1a hospital EST 1a adminiata.-ed

onl.7 twice neklt•

Muaic pi:e•1oua1y uaeda

Pre•ahoclu In the paet, and oocaeionally now, records haft been pl.qed

in the dayro<a by a Tolunteer worker,

end

the

Recreation

Department hae proYided mOYiea and relies prineipalll' en

telerleion u a source of diversion tor tbe.patienta.

Poat-ehockl The:re baa been no MU1ic in th• ncoYIJ7 rooa

u

the patient.a

are \here au~h a abort tiM. · Present ProJectt

Pre-ehocka Progra I (twice)

Poe t•ahock I Sequence ot program! pla79d WI t

First

dayt

II

1

.III, II; III

1

IV,

III.

Second dqt 111 II, J;II; IV.

Third

d&Tt

lI, III, llt III, IV.

1Ju.e to preTious scheduling ot aovie1 and telef'ision, it vu bpoaaible to

OUT7 011\ the full progrD

ot

the project. as planned tor the pre-ehock,period. · The t:Lra\ dq no pre-ahock auaio as pie,ed. The second da.)-1 becauee

ot

·a dela7 in the

na1o program, it waa poeaible to carry out the pre-shook plan. Th• \bird

daT

our

program received tull cooperation. and was carried out •• scheduled. REACTIONS

The method with which EST is adminiete:red at thia hospital ukes mue.ic in the reoover7 room hardly necessary aa the patients are unconscious when brought in, and as soon as they are conscious, they are retumed to the dayroc:n tor complete

recoftr,-. There ia considerable noise because

or

the traffic• the activities ot the

deortaaed cona1derab]31 probably b~oause ot the music, and all patients were ,uieter.

In t.he dayroom ve:ry few

ot

the patients aho111d ant intereat in the movies or ~~ tel•vision programs. However; when programs II and III were played in the

dalrooa during final recovery, a definite change in the atmosphere ot the room vaa

disoernibl.e. The patients nre more relaxed and ware (lUieter • Enn th• aidea 1at qui•\17

enJoring

the aulic.

Although the doctor• at the head ot the ho•pital had ehown int.reet 111 ·our ·project, there vaa no reapoMe from the dootor in charge ot \he ward nor &DI'

other doctor in charge ot EST•~

ldminiat:rat.ion ot IS?

INSULIN SHOCK THEIW'I

WARD (B)

PROOIDURES

The treataen\ here ia thAJ eue a1 in the other hospitals, \he inaulin being adll.inietered between

6

and

1 AH

1 and the patients remaining in bed until \he

encl ot the :recoir err pe1~ iod. M\111c enrtoual:l uaeds

AFRS and other

recordin&•·

J>i:eaent project1

Sequence of progra.u playedt 11 II, III, IV, II, III, If 1 14

REA.OT IONS

A

shock treatment apecialiat nurse at this hospital vorked. in both

IST

and

IST. Although thie project vaa nc$ scheduled for the IB! ward; the apeoialist asked

\hat tba project. be extended two dqa to include IB!,~ Be atrongq tel\ that the

apeoi~ eelec~d music vu even more important. in thia oonneciion. He tound \hie

tape-recorded music ideall.7 euited to his needs in the insulin ward and 11 most d•airoua or harlng a continued source o! obtaining such music. The other nurses end

aidea were equ8.J.l.y enthusiastic about this music, and hopetul that it might be continued.

SUMMARY OF HOSPITALS

...

Treat- Daya of

Hospital Ward Daya menta

Dr•.

Nurse• Aide• ob•en'ation ti

prepua\ion

l. A

4

I

74

1 1

;

I A 2

_2S

2 1 I 6 2. B 2

46

2 )

s

₀

*

0 2

38

2 I

4

. . A l

s

I 1 I

s

·· , ' i

3.

B )

34

2 1

s

l

•

0 2

24

1 I 2 A

3

96

.~ 1

3

8 '

4.

1

*

B 2 JO 1

₄

4

: Total.a

,

21

372

1.J

19

..

"

l

*

Insulin

th• apecially selected ausio on t.ape.i wu pWed in oonJunction with shook

thtr1P7 on

nine

vardl

in tour hospital• during

a

total

ot

372

treatment•

1n

21 days.

ot

tba 13 doctors working on wards where the project waa carried out,

~ one waa skeptical or the outcome ot the project, and one other doctor showed no

interest whatsoever. The other eleYen doctors, although the7 did not all agree ••

-21-proJ~ot and their deeu•~ to haTe the music continued..

The general opinion was that although the ausio had not been erown to be a therapeutic agent, t.he patients had the right to reeeiYe all poaaible aid.

H1117 ot th• dootora had idea.1 of ·their own aa to the tJ"p• of music desirable and

S.\1.p:reaentation. One doctor had gona ·ao tar a• to brittg in bia ow tape machine

vitb hie own 1peci&lly selected program• or 911siq to be pl.aTed in con_1unct1on

with IST. other doctor• d.18agreed ae to the relative iaportance of pr .. ahock and poat-ahock auaio, and some expressed a desire for aore a\iaulating 11u1ic

than vas uaed in this project, while still o\hera to\llld th• quie"9r au•io ot

Program II to be the moat aatiatactory. But one can onl.J conolud• \bat in general they all want a serious music program carried out in conJunction with

the shock therapies.

AJIOng the 19 nurael and

44

aide& there 88 UNIDiMOUI •pproftl Of the

r•aul\a of the project. ET91l 1n the one lrard where th• aide• a\ tirat reeented

theintruaion of aueie on their own preoccupation vith tel••iaion, b7 the end

of th• eeoond dq the7 were 10 pleaeed td.tb the greater ea•• ot admin11tering

\he th~rap7 in conJunction with the .. quiet soothing aueic that th8J' nre von .ovtr

to the ai.td or the project • . In warda where the aidea had been unneceaaar117

noi1J7, laughing and joking, it vaa quite noticeable, particularl.T on the atcond

dat,

that a. the music continued there was increaeingl.;y leas noi•• and loud talk ..

In almost entry ward thft"e were dramatic lnatance1 in the ehang• of

patient•' behaYior. Those who had previouSl.7 had to be carried fm m th•

day-rooa to the treatment room, on the eecond or third dq

or

the project went

wl.llingly. Aa has been pointed out before, we cannot claim that the music alone

waa responsible tor thie change, as the patient& cited ma1 have made an equal improvement had there been no music. However, the enthusiasm of the nurses and aides and the general interest eho\Gl by ihe doctors would indicatt that the aueic

ehared in the effectiveness of the treatment. There waa no single inatance ot

entagoni1m toward the music among the patients. One patient who had preV-iously

ot

the vard·by expresaing his pleasure with the specially selected aueio uaecl

1n thia project.

One o~er group direotq inTOlTed with the carrying ou\ ot the projeot

. . th• leoreation and Mu1io etatf• of the hospital.a• Though aom• akept1o1• vu encountered occaaional.171 the pro.jeo\ waa given tall oooperation• and in tho• hcurpital.a when there had been no auio previouali th•7 art now at'tempting

to

. oarrr

out 1c:ne

ecrt

ot program.

'l'here are DUmJ aapecta ot the practical •ituation which preaente4 problem•.

Par eumple, .EST treatment.a uwall.y begin a\ 8130 or 9 AM, and th• ~·shook

auio lhould be plqing

tar

at leut 20 minute• before treatmmta begin. During

thi• project there were no tape-pl.a)ring machine• in any

ot

the ward11 ao that 1\ vu neoea1ar1 for th~ machine to be procured trca the Recr•ation.room• or the

Medical JJ.brary; e011Te7ed. to the ward, and 1et up, readt to

plaJ

1 bJ a little

atttr

8t00 AM. ·.It vu nece1s&rT to haft pre-arrangement vitb the dootara1

nu.r••

and

aides in order. 1ihat the7 would know exaotq what •• bt:ln1 undertaken, The place•

••nt ot the machine in the ward, and ma111 otherrdetalla₁ such u the locationiot

elect:rie outlets, had to b• 11Q%tked out~ In som hoepi'Ula thi• wae

tak9n

care ot b7 u alert Special Senice atatt J :t.n other•.· 1 t had to be arranged on the

tirat, day or tvo ot the project at that hospital.. It waa important to be aa

little in t.he 1r11 aa poeeible, ae selt•eutticient a1 poaaible, and to bring ali

tev demand• as poaeible on the bUST pereonnel.

Such

thing• a1 the reaction•

ot

patient• to an untamiliar

machine

had to

be taken into consideration. In one nry diaturbed ward the patientsaeemed to

think that the tape machine vu a part or the electric ehock apparatus and ehoved

eonliderable hostility at first. Howe-ver, once the7 realized what the machine.

vae, and came to know the operator, they were generally curious and tr1end1Jr₁ and

•bowed great interest in the machine and the muaio. At no time was 1\ teaeible to leave the machine 1Jn8.ttended.

Another problc vhich had to be worked out in eacth hoapital wa~ the carrying out of th• pre-shock program which inevitably overlapped the poet-•hock. As

plarmedt music was to be pl•ed traa 20 minutes betore treatMnt until the last

patient. had gone to treatnentJ alao, auaio was to beg~ 1n the

reooverr

room from

the •ntranoe of the t1r1t patient. Thi• would neceaeitate hartng au1io 1n tvo

pl.aee• at onoe1

aa •

b7 the time the tire\ treated pa ti•n\ 1a in th• reoow17 rooa1 ·

·the ••cond. patient i• nce1Ting treatment.. The onl.7 exception to th1• lid a\ .

llortbport, Ward (A), where t.h• patient.a were brmght into th9

treat.ent-reoowr.r

rocm to await treatnent. . In all other EST ward• there vu an oftrl.ap which would

aean aueio in two place• .at once. Thie problea wa1 solved

bJ"

\he Huaic Start at

Montrose b7 tranacribing the pre-shock music onto recorda and playing _it to the

dqro•

over th• PA

ayetmn.

Thus,

while thia

music -

plqing1

t.be

tape

aacbine

could begin 1n ~· recoverr roan •• aoon •• the t~1t pati•nt •• .btought in atter

treatment. At ell other hoapitala it waa neca111.17 to ehorten th• plqing till• in

either or both the pre-and poet-ahock period.1, or to torego one

tor

th,·

other .to

prOTide ocmplete auaical oOYerage tor eitherper1od.

l'erhape the aoat import.ant, probl~ ot al1 vaa the ael.ction of t.h• auaio io

be u1ed in the programa. Th• selections 1tade proftd to be •oet etteo\1•• with both

IST and IST, but tor a few exception•• The *'Dream Sonatatt in Progra

lI,

beoauae

i~ va• general.11' in minor key, ••emed to have a depnsaing effect. The "Second Serenade'* in the same program tended to irritate because

or

the prolOnged playing

ot

1tringed inatrumente at a high pitch.

All

inatrmentation 1n the middle and

lower regiatera coupled with amooth long melody linea and 1teacly rbythma j>rond to

be th• aoat suitable tor the pre-shock and the ear]¥ phase

ot

the poat-ahock music. Prograa IV could well have been longer and more stimulating.

There were a few instances when the music planned tor a certain part ot the treatment wae not suitable, and music in another mood had to be substituted. There

ahould always be available a selection of tapes· so that a change can be made

llYoid 'l;he poesibilit7 ot aroU1ing unhappy or disturbing memories, the •usio for the quiet period ahould be made up as much aa possible

or

untamiliar 1ale0Uona ot

a

olaaa1oal

or

semi-classical na·ture. However, the aildl.J etimul.ating aueio at the

~·c1Drd.ng, and th• athmlating mueio at th• end 111.7 conei•t ot au

knew

light

hleotiona from operettas, auaioal ocmedie1 and •oo\b awing auaic.

For

the

preaet, at leaat, .no vocal muaio nor ina\rumental eolo1 abould b9 inoluded. • .

J(eg&rding th• eeleotion of the 11u1io, one ob1eriation nooct out pllinl.J. The ;rounpr ,9atienta, 1eeaingl.y in tairl7 good contact, needed li•eller aua10

than the older ₁ aaore regreeaed patients• Ona young veteran, Upon

nconr7

one daJ, Nid₁ •I thought I va1 in Heaven when I came to, what. With \he harpa and _Tiolina1

bu\ I allow I'd like to knov I •• at.ill on earth with a few l••• harpe and tiddle•"• Although ~e doctor at Montrose eaid the quioknft11 ot .reoonq

_.no

oriterkm ot the effectiveneea

or

the treatment, nnerthelaea llh•n the slow quiet-ing 11uaio

ot

Program Il was plqed1 \.he patienta took a oonaiclerabl.1" longer tlme \o reoO't'er. However, with older and more regressed patienta, •• 1n Ward (A) a\ lf'one, this Idle mua1e. vu eminently' suit.able. The question ot what mood the au1io lhould

have a\ UV' \ime du.r hlg the treatmen' cannot be full.1 predetermined, but must b9

dtoid•d upon after due consideration of lll&111' factor• including the condition and

age ot the patients aa ·a whole and the prevailing atmosphere ot the ward•

One

ot

the objective• of the project was to determine the auitabilit," ot

tape recording• aa opposed to other met.bode ot preeentation ot llU81o 1D connection with •hock therap7. The AFRS

recordinga

referred to in thia

report.

are long-playing

reoorda ot programa bro adcaet to the Armed P'orcea. The7 are wpplied to the

hoapi tall b7 the Government t 1 Armed Force a Radio Service. TlJta.~, are musical programs

Of all type• on these records, but no more are the7 available. The7 pro'Yide an

The uee of radio and teleneion cannot be considered •• mu11.c therapy and need not be considered at length here. They- mq be entertainment,, and u

euoh diawaot the patient trom hi• anxiet7 ot th• coming treatment. h\ it baa been not•d ~t wen TV or radio ere available \o the pa\ient aoat ot hie va1d.ng houri, it ceaaea

to

have 8l11' pwtioular meaning to hi.a• excepting certain

tavor-it~ or apeoial progrw. It ia tak~ for granted b7 tho1e who an oontinuan,. IUbJected to it,and when it waa wsed for pre-shook and recovery periods, ·u 1\

wa1·at, one hospital, th• patient• did no\ bthaYe 901' difterent;q than other• in

wat<le where there vaa no mueio or entertainment during tho•• perioda. Wh•re

a

tpeoiall.7 choeen progrmn

or

•usic, designed to atteot the pat.ient in a certain

vq, could be considered 11t11ic theraw1 radio and

ff

can.be oonsiderecl onq aa

pae•1••

entertainment. Music tor iherap1 muat

be caretuJJ.t aeltoted

with a

partinlar purpoee in Tiev. Tape recording _prorldee a mean• ot presenting a

auatained progr• with a continuoue flow ot music in 8DJ selected aood. · The

tone 1• tar superior to that

o.t

the PA •T•tema, radioa, and moat di~ record

plarera aftilable in hospital wards. The tap•• ccne in Tarying lengthl, playing

tor one-halt hour or an hour without interruption. They are tairq •HT to handle

and the machine needll much less attention rraa the operator than a record player

do••• Since moat Recreation departments are unable to spare one of

their

pe:reonnel for a whole morning each shook day to carry out the Jiueical jlrograa, it is euggeeted that volunteers could eaailT handle the tape machine with

a

t8lf

s Radio Tab al Pre-ES'f Shook 0 0

'

0 Poet-Shock l l 0 6

IST

1 1 1 0 J

1qo

ot

the •ix IST varda auneyed int.he project, three had been u,ing .tht PA . •yatea to bring recordings and radio programs to the patient• during the pn•

...

lboc~ period, and three had no aueic. For the po•t-ahock.and rec0Ter1 period.a,

tow

had no music, one had been u.a 1ng records ₁ and one was uaing the PA 171term. All three IST warde had e~ kind of muaic. OM used the PA ty•tem, one ueed a record player, and one used radio or the. doctor•a

own

tape machine when .poeaible. Thia would indicate a need tor a planned prograa

tar

proTiding suitable muaic ·in conjunction _,., with shock treatments. .i'hJ.s need aa almon \U181limoualy acknowledged by '\be hospital personnel • doctor•• nurses and aides, and there 11 general agree. men' that the music ia indeed a useful adjUnct. to •hock theraw. The auaia should

'

certainl.y be provided without interruption in the form

or

camnercial• and

an-nouncement11· it should have a good toneJ it should be aelected tor the particular

aood, and 1 t should be adaptable to \he need of the moment. Tape recordings can

do all these things better than &lJT of the other means oba•rv•d on this project.

Although no arbit~8J7 rule• can be laid down, a general procedure can be

auggeated

fer

us• ot tape recordings in conjunction with

BST.

A tape-playing machin• ehould be assigned to the doctor or nurse of the EST ward, and inatruc•

tiona given in the operation of the machine ae well as use of the.music to be

l.t 1hould be -.de availa'bl• a1 therapy equipaont, not •• bcrea1im tqtilpmeaiJ• u4 1hou1d. ~-h. • . the ward when treatment la gi•n• The tape•• themaelve1, hmrenr~

11\c>Ul.4 'be under 'he

•uparTlal•

of i:hl W•t• Departm.ent, and l•llU.-4 i:o 'bbe

nr4•

u hflU••te4 by the doctor or

nur•••

The U.pe4au11o •houl4

be

en three 1epe.rate reela, ola11ltled ••toll°"*•

<•)

Ph••hoolc (Program I tfpe) to be playe4

tr•

20 idnuiJ•• btttore '.brntment m'bil the la1t pa.1sleat

c••

to \n&tment. (b) Poat••hook (Program II en4 III type) to be pl-reel

tr•

ti.

time the tir1t patient 11 brwg~ lnte

tu

N001'ftJ ro•

wtil all haft regained

oon1olou•••••

.

(o) Reco-..17 (Program; IV type) to be played. trom the

•tm.

i»he

latt patient bu regaln.t ton1tlOU11t•• until· all 1 ...

w

thl

..

~.

When wo4 par•011nel are too bu.eJ to operate the

...,h!n• •

a _.'ber of the

· ••io

1tatt

er

~ wluntetat OO\lld be a11S.gned

'o

the ts.et. .

A'b one hoepital Us na 1Ugge1te4 that mud.a ln the t1'8&~' room

ltaelt

111ght bt 'ben•tloial, Thia could. 1:ttt uran.ged

"1 ••• ot

a 1ma11

lows .,..._.

. plugged tnto

the

tap1 •ohln•• ManJ 4tm.t11·t1 tmd

aurgeon•

u1e m11o to · a llkt

llllDDe~ 1UGOe11tullJ•

· In o.JD~oticn wlth ISi a 1im11ar ~oeedurw eould. be reoOJDMDdef.• The ·W&1"4

abOtlld bl •••lgn•cl l'b• "11 maohin•• Programa ot •P••itiecl aooda 00\lld be prorl4e4 an4 th• u•• ot thom. expla1ne4 to the paraonnei., and the doe1'or.

nur••·

ff aid• la

oharc• ooulcl then be allowed t:o chooee the nualo naed.e4e Program J w°'11d M goocl at the ltegbning

ot

t .. eatment

tor

a 1hon tbe, then mato ot ~ht type

et

Pro~•

II ahou1d toll•• 11u110 or the Programs 111 and If type 1hould. oonolwl• 'he lan halt hour or

45

minute• ot ti. treatment wbm the p&tt.entse are gettbg

'*P• nu4

pereomtel uni nr1aU.7 Toluntoered 1Jo operate 'bhe maohine tor IS'l' •

To be etteotiw, tape-recorded. muaio to be used in ocmju.notlea .-!th B an4 l Shook Tblr~plea in hoapital1 would require a great number ot prcgrllBI in order to awfA exo•••in repetitJion• J:t woultt be nece11a17 to take into oonal4eraticri tht

rate

ottu.rnoYer

ot

patient• in treatment, aa each patient campletea his eerie•

or

•inll• :

treatm49nta and 1a .followed by othera. A certain uwnt ot repet.1 \ion ·

wouJA be ine•itable, but would be unnoticeable· to moat patien"'

U

not

offrdone.

LST ia given five days weekly, the oTer .. all time of treatment being approx1mateq

4•1/2

_. hours

da111'

1 wbereae EST 1• uauallJr given onJ.r three tinma a week, _, and .th•

aTerag• time tor tha treat-nta obaernd wa.a l•l/2 houre per daJ•

While it baa been shown tba\ 11u11o

tor

EST 11 highq desirable and

re-queatecl b7 moat doctor• and personnel, music for IST 11 generallJ und. and raoo#-nilfJcl a• a therapeutic agen\ with thia treatant. Huch au110 :le necesear.r and

urgentq requested

bJ'

all !ST peraoMel, and the auaie requested

1'•

1. ho or more hours of Progrma l type J11U1ic.

2 • Two or more houra ot Programs II and III type• ). One hour or less

ot

Program IV tJPe, progreaa1Tel1

more stimulating.

It waa generllq agreed by all EST and I.ST worke:re wbQ gan opinions

tn.t

the S11ooth orchestral arrangements were ideal. Hea17 a,mphonio muaic and

••r.r

atimulating·Ja~•. are undesirable u being too irritating, or too emotionallT

diatui-bing to those who understand them, and annoying to those who do not. Huaio

1n the high register, eepecia.117 it suatained tor any length ot time, l• irritating. Wind inltrumenta in lower register, ali well aa strings, are good, and the UH ot

braaa in the stimulating music would be weloC1Bad. Music vi.th much movement • deaoribed b7 several patients and personnel as "~erq .... bus,-•••• noiq" is also to

be aToided, even in the stimulating music.

It ia of paramount. importance that, some sort ot music programs be worked out tor these treatments. In the case of IST it was urgently requested that lllllaic

ot the right kind be made available. The AF'RS records,

so

frequently mentioned in this report, are no longer available. They were the only source or a large aupplJr

or aueio possible to use for this treatment,

and

they had the drawback ot announcers, aoloiets, and music continued in uneven mo~s. Until a practical program or

distributing the right kind ot muaio that baa no unwanted dietraotione to the

&Sf

and 15! wards ha• been put into ef'fect, those in charge of these · war~e will

continue with what they can get - radio, old AFRS and other recordings, the PA qatem, . TV and movies.

By meant .of controlled experiments and continual .observations and report•

tro•

wards \fhere epecial.l.T selected ausio · 11 played, it may be

po

seible one day .

to prescribe exactl.T the mueio needed tor a certain patient.

or

treatment.

Meantime, as one doctor aa1dt the patient ahould. be giTen every possible benefit

to help reatore him to a useful lite. It would ae• tJlat, wit.h \hie apecia.llT

recorded and eelected mu.sic, were it made &Tail.able for use in conjunction with ·EST and. ISTi ,.. would be taking a great step nearer the goal ot ausio a1 an

OONCLUSIONS and RECOMMENDATIOHS

'bJ Sebrina Eustis

On the baaia ot .,- experience at Pilgrim State Hoap!tal,in making th•••

.tape• vith Music ot Diatinction, Inc., and on the atrena\h

ot

Hr. lot\•r'• rep.ort, . oovering ·• much aborter period but a wider !i•ld ot obae:rT&tion, I

· eubmit the following .conclusions and recommendation& tor YA Ho8J)itala1

1. Tape reaordinge are preaentl.7 th• moat ideal means

ot

proViding music ror use in conJunotion with Shock

Therap1•••

2. It 11

or

utmoet importance that the auaio tor th11 purpoae

be oa.rtJfull¥ eel.acted and recorded.

J. The dif'ficultiea

or

mewing and placing the tape recorder•

will have to be accepted, except in hoapitala which haYe central broadcaeting roome and outleta ·in the varda whee Shock ia administered. (In euoh cases there au..t be

volume control on tha ward.a, and time ech9dul.ei wll · WOl'ked

out. b;y an upert technician.) ·

4.

Unless a Hospital baa an exteneiTe ·record librar1, 1uperior

equipment and techniciane !or tape recording, it 1•

adrl•-able \o have tapes made b7 a professional compal\Y•

I recommend, it these tapes .. are . to be used or further teated, tba\ the

progrmn

tor

t.he pre-shock period remain the eame, aud the prograu tor the

Pgat-ahock period be chanked aa follcnrst

S•otion lt Dream Donata, and Second Se:renade taken out and

replaced b7 two other numbers.

Section 2 t Be extended £1tteen minutes•

Section ) 1 Extended fifteen minutes with increasingly" stimulating

·~sic

or

the operetta type.

It the testing ie deemed canpletec:t, I recommend that each Hospital

accumulate half-hour tape recordings in at least three cat.egoriea to be used in whatever sequence and lengths or time individual doctors prescribe. These

-31-two other possible oategori••J one - the pattent used in our pre-ahock progr811lJ al.t.rnaiing llUaic that la Gheerful.=suieti:Bs with music that 1• MU4l,yia\1pnAat!agJ th• other (to be ueed oni, under a doctor•• direction and not recommended for

older_

patient•

or patients that are

disturbed)

Hueio

that

1• S!1!piatiqs:.

Thia _would pron.de half-hour program.a

in a

minimum ot three and a ilaldamll ot five

oa'8gorie1. · ~order to vary the programs a library

ot

maiv tape• 1n 811 oat.egoriea would have to be gradual.lJ" built up.

APPENDIX 11_A"

CLASSIFICATION ACCORDING TO MOOD SCALE STIMULATING Joyous Soaring Spirited Scintillating Exhilarating Sweeping Martial Dramatic Vivacious Impetuous Restless Exciting Agitated Sensational Thrilling Majestic Barbaric

(Sexually stimulating; syncopation; modern dissonant music) THIS GROUP BEST FOR PRACTICAL PURPOSES

CH;EERFUL-Mildly Stimulating Sprightly Playful Rippling CHEERFUL-Quieting Fanciful Quaint · Q.UIETING Dreamy Tranquil Meditative Stately QUIETING~Mildly Depressing Yearning Pleading Meltingly Tender DEPRESSING Gay Sparkling Comic ·· Graceful . Lilting Soothing Leisurely

Soft Rhythmic Flow Grave Sentimental Reveries Pathetic Mournful Doleful

Folk songs well known

-32-Sad Tragic Plaintive Solemn

APPINDIX "In

MUSIO IN CONJUNCTION WlTH

ILEOTRIO SHOCK TREATHEN't

---. (btnct from Edwina Eustis' Report . to the Musicians Etnergenq JUnd on the Special . Projeo\ in tlnaio Therapy, oond\toted at PUgrim State lloepital₁ 19la9-USO) • .

The· <bjeot

ot

th1a part ot \he project va1 to tr,· to determine vnather OClltrolled uM

ot

lllll8ic could •llP*l\ the b9nefite ot eleotrio ehook

tnatmema.

. '

The project luted lJ weeksJ tl'Oll

2S

to

h1

pat1en\I we:ra treated tvice . a week.

For a

Shon

while before w •tarted, au.sic bad been uaecl 1n the })OA-lhocll

dondt«>J7 .but hapbu&Tdly,

•inc•

the

•lectian

o.t

recorda,

pleolng

ot

the

··port.able Yictrola and cbanging reoords bad of necee•itJ been iD the hande of bll87

· atitendanta. The H.V.M.s. donated. eapeoially aeloc\ed records -111ob. wen ~

ca\tgorised u \hfi proJeo\ proceeded, and a detiniie pattu-n ot ·•equenoe worked

out. 'fha patiente waited for the treatment 1a a daJ•:tOOll which 1IU entinl7

••pa-nt.ad f'r<rra the large sectional· poet-treatment donnitory. The at\endiulta wre

inatructad ~ the objeotJ.vue

ot tbe

au11o treatment, and cooperated

bJ'

retraining

tna

umeoeaear7 ar

loud

~g, moving

the

bed• _{vi\h u} little noiae u'poeeible.

Fire\ we coniinued plAQ'ing the records in the dond.tor1, bu\

later,

at the requeat

or

aneral patients, in the waiting roan •• wll. We att.pted one tiXed position

tor

the rlotrola, bu\ found that it had to be moved from the waiting

!OOll

to the

ditt•rent aeotiona ot the domit,ory, as i't vae impoaeible to gain even volume

throughout the wing

ot

the building uaed, or to reach enrytme at the aame time. (TM ideal ae\-up would be to play the reoorda in a central control roQDl vith outlets 1D. the waiting roam and in each aection

ot

the dormitory.)

Our principal effort wae to create a de.finite atmosphere tor· each phase of the treatment. While waiting, the patientl li•tened t.o

cheertul.,

light

aua10.

Coming out or eboek, quiet eoothing ®eio wu used to calm and reassure the

patients. When it was time to arouse them for lunch, cheert~l, mildly stimulating

-.34- .

:'8Jl&1n in •• r••ttul a e~t• as possible tor the remainder ot the dal'· Pieoea

dtb audden .aaoenta or Yaeying cb'UmiC• were not uaed, and although :the vict~n. : •• no\ too good, reoorda were 1h14ded at. ta• start to avoid abrupt begillnings.

A• th1a was the

Onlf

part

ot

the proj.ect. in which patient• h.ad no choice

ln ~· utter ot listening, the originai plan had been to ban treatments without

weiO at tiXed intanals, and to make careful ob1ervationa ot pa\1.tPite' reaction• with .and without mueio. However, the first time t.he treatment wu ginn withou~

. ' . _{. .} '·

. .

1111110, there waa instant and al.moat, un.animoue demand b7 the patient• ~hat *1111' be oon\inued, with actual complaints over not having it, !net.such

general

.reat-l•aeneee and noise atter the ahock treatment that the doctor deoided thereafter ~he llUSiC ah~ not be omitted at !& timel

. On thie particular day, there were .36 patients treatect. ill oapable ot .

opiqion, except two, agreed to a decsided preference tor music wi\h the treatment.I.

fheM two Aid they didn't care whether the7 had it, or not. Hone found it in \h•

luat disturbing.

From the reactio111 obsened and recorded during the 13-wek period (tnn

with a .all portable Victrola, detiniteq not the ideal arrangement) one ia

•ncouragecl to belien that the proper uae of JaUaiO before and after Electrio Shock

Treatments will prove an aid in augmenting the etteota

ot

the treatment. . It helped to a.llq .th• patient's fear before being wheeled into the room where shock 1•

administered. After the treatment., it waa a calming- encouraging intluence vhen consoiousneaa :returned vith ite accompan.ring di1sin1e1, con.fuaion

and,

in sane caae1, nau.aaa, and it tended to assure and relax the patient•, thua making it

eaaier tor them to aleep or lie quietly. Patient• conatantlf exireased their

appreciation of the music. The atmosphere

or

the entire ward, including the

ahock-room, was diatinctl.y changed for the better.

Eleven patients, whose course of shock treatments started at the same time

aa

the. exper:iment with music and finished within the 1.3 weeks, vere brought

tollovinc ar• answers to four specitio queetionea

1., . What ~ you think or having music with the treatments,

"It•a wonderful"

ttit'e YeJ'Y goodu "I~•s ver,- nice"

"It•e a very good idea"

"We all think it•e so. good beoaun it help• eliminate eounde

ot

patients, eapecially betore going in" (referring to the

quite disturbing noises mad.9 b7 •ome patients before and

after Shock Treatments,. ·

"Music ia an aae•t when eoma one i• handicapped•

2. It music could be heard in

onq

one. plaoe - where would 1~ pr~er h&Yi~I itJ in the waiting room or in the dormitor;yJ

"Before going

tnA

·

"lee• while ve•rJ·waiting"

·"We're afraid before

w

go in"

3.

What kind ot auaic do 7011 like to haTe plqed,

"Sweet, not too loud"

(EYeryone was agreed on thie)

(Seven patients wanted popular mueic1 four wanted cluaical

music. The,.- ell finally decided. that a

good

balano• ot both

vould be beat). ·

4.

Would you like to eee the pe~aon who play-a the rec~da, or haTe it

ocae 10£\lT .from an outlet 1D the wall?

•.I liked

rour

nepeotabilit,y· - gentleneas. It helped a lot . because JOU looked 10 kind. n

(Thia particular patient cried, groaned, and whimpered for a

long time after treatment on the tirat day of the experiment,

while I observed. Fr cm then on I would ha to her when she regained eonsoiouanesa. With each auoceeding treatment •be cried less, and finally ehe emitted only slight groans vhicb. I could control b7 humming to her.)

"Person is better - if it'• the ~person•

·

"U it'a a singer on a reoord, tfii.tOOuld b9 good too • it it'• a

nice voice, and good personality"

31 like a melodious Yoice • in person" .

"A ·per•on, if she's Yerf good is more acceptable than a machine"

"It she likes music and likes people • a person. U ahe doean•t