How to ‘Discover the Beauty of Life’ in / against the Disease? Musicology in the Therapy for the Elderly with Oncological Illnesses

The factor that makes it more difficult to struggle with the disease is the sense of solitude experienced by the sick person. As it has been observed by Professor Jacek Jassem, an oncologist, member and former president of the Polish Oncological Society:

The Polish Oncological Society – a scientific-medical association whose ‘activity focuses on issues concerning propagation of scientific achievements in the field of oncology, stimulating research in this field, the professional skills of the staff of oncological centres, and propagating health education and prophylactic principles. The Society has over 1000 members, including doctors, pharmacists, biologists, chemists, and representatives of other specialisations employed in oncological institutions or conducting scientific research in this field’, https://pto.med.pl/misja-i-cele-pto-0 (accessed 14 September 2022).

The proposed changes which are supposed to result in an improvement of the condition of the sick patient are, on the one hand, the social work of ‘demystifying’ oncological illness on a mass scale, and on the other, the necessity of actions being coordinated on a multidisciplinary scale. According to Jassem:

[…] It is necessary to bind together all the elements of oncological care – currently too defragmented – from prevention and early detection, diagnostics and treatment supported by a psychologist, to full rehabilitation. If anything fails in the process, all the other elements collapse.

Jassem, p. 2.

Unfortunately, in practice the whole situation does not look good, especially in the case of a patient who does not require permanent hospitalisation but simultaneously struggles with an oncological illness. Such patients are often left on their own. There is a lack of systemic solutions, as the Polish National Health Fund (NFZ) – responsible for financing the system of health care in Poland – only finances stationary and home-based hospices but does not designate any resources for day-care hospices, which would be an option for sick but able-bodied patients. As an oncologist, Dr Ewa Anna Kosakowska, has put it:

NFZ (The National Health Fund) did not envisage the creation of a place where patients who do not require hospitalisation could spend time among nice and warm-hearted people, where they would be provided with rehabilitation, meetings with a psychologist (both individually and in a group), with a dietitian preparing healthy meals […], talking about the beauty of the world, places, people, and trips.

A. Mazurkiewicz, ‘Niektóre kwiaty kwitną jesienią’ [‘Some Flowers Bloom in the Autumn’], medical journal Puls, vol. 12, no. 1, Dec. 2012 – Jan. 2013, pp. 34–35, https://izba-lekarska.pl/numer/numer-201212/niektore-kwiaty-kwitna-jesienia/ (accessed 14 September 2022).

The problem of exclusion and loneliness especially affects the elderly, whose lives revolve around the hospital. ‘Between chemotherapies and radiations [these people – fn. S.M.] often stay alone at home, whereas the other members of their family go to work […]. They are left on their own, quickly losing energy and the will to live, often falling into depression […]’.

‘Uniwersytet III wieku dla chorych na raka’ [‘The Third-Age University for Oncological Patients’], 21 June 2013, http://sadyba24.pl/layout/item/351-uniwersytet-iii-wieku-dla-chorychna-raka (accessed 14 September 2022).

The non-governmental organisation ‘Jestem’ Foundation for the Support of Chronic and Terminally-Ill Patients was created at the end of 2011 and has since then operated in Warsaw. The management board is represented by an oncologist, Dr Ewa Anna Kosakowska, and by Izabella Dembińska. ‘Let us discover the beauty of life at every stage of the illness’ is the motto that underlies the Foundation's activity. It supports patients who are undergoing oncological treatment or have completed it. The goal is to ‘revive hope and joy in order to make recovery at each stage of the illness’.

The official website of ‘Jestem’ Foundation.

In their activity, the Foundation members are doing their best to approach patients holistically by taking care of all basic spheres of human life: spiritual, physical, behavioural, and social. This approach is reflected in the sequence of meetings organised for the patients of the Foundation. They are held once a week and consist of four permanent elements: a conversation with a psycho-oncologist, rehabilitation, a conversation about broadly defined beauty as well as learning healthy dietary habits, accompanied by cooking and a common meal. Each of the four parts lasts approximately an hour. The classes are regularly attended by patients (at various stages of illness) divided into two groups, each consisting of several patients. The Foundation supports adults between 50 and 80 years of age. The meetings are also attended by volunteers and patients' relatives. Participation in the classes is free of charge. Meetings are sometimes organised outside the Foundation's headquarters in the form of joint trips to the cinema, theatre, museum, concerts, as well as trips outside Warsaw (to Szymanów, Niepokalanów, Powsin, Nieborów, Żelazowa Wola). On some occasions such outings differ considerably from the standard activities; for instance, in June 2016 the patients had an opportunity to fly a balloon.

The Foundation aims to divert patients' attention away from the illness by showing beauty (in various dimensions) at each stage of their struggle with the illness. Similarly as in the globally recognised programme created by US oncologist Oscar Carl Simonton, a pioneer of interdisciplinary psycho-oncology,

See: O.C. Simonton, R. Henson and B. Hampton, Jak żyć z rakiem i go pokonać (original title: The Healing Journey), trans. J. Morka, Łódź, Feeria 2003.

An innovative solution in the Foundation's work is the presence in the structure of the classes of the so-called ‘hour on beauty’, which is characterised by meetings with interesting people such as journalists, actors, travellers, as well as students of the Institute of Musicology (University of Warsaw). There is no doubt that music and beauty are a perfect match and contemporary musicology offers an abundance of subjects and issues which may become the basis for projects of an educational, general developmental, and therapeutic character. Demand for accommodating an ‘hour on beauty’, which originated in the Foundation, perfectly correlates with the possibilities offered by the knowledge and competencies gained during musicological studies.

In the period between November 2013 and June 2022, within the scope of regularly conducted facultative classes

Coordinated and conducted by the author of this paper, apart from the period between October 2017 and June 2019 when Anastasiya Niakrasava (MA) was responsible for the cooperation.

The students' task is to design and conduct hour-long classes, attractive from the recipients' point of view, aimed at adults without prior musical education. Several years of cooperation with the Foundation has made it possible to develop innovative methods of working on the project. The starting point usually involves students' individual research interests and also in many cases their practical skills (e.g. the ability to play a musical instrument or to sing). Subsequently, students are selected to work in pairs or teams of three-to-four persons. The conceptual component consists in defining the topic of the project as well as preparing the precise scenario of the classes. All the concepts are discussed during facultative classes (conducted regularly as part of studies at the Institute of Musicology) with active participation of the students attending the classes and the lecturer.

As a result, various scenarios tailored to the Foundation's needs are created. They typically take the form of projects with music performed ‘live’ or some multimedia presentations (taking advantage, among others, of audio and audio-visual materials). In all the classes, a particularly important role is played by elements that activate patients (i.a. active, task-oriented listening to music, joint singing as well as improvisation e.g. with simple percussion instruments). Projects created so far are characterised by overall variety with regard both to subjects being discussed and methods of patients’ activation. This observation may be confirmed on the examples of selected classes held at the Foundation.

For further information on cooperation between the Institute of Musicology and ‘Jestem’ Foundation see: S. Makomaska, ‘O uwalnianiu “zamkniętych zmysłów”… Muzykologia wobec doświadczenia sytuacji granicznej’ [‘Activating “closed senses’… Musicology in the Face of Limit Situation Experience’], in S. Jaronowska (ed.), Człowiek w sytuacji granicznej. Filozoficzne, kulturowe i historyczne wymiary refleksji i jej implikacje pedagogiczne [Humans in Limit Situations. Philosophical, Cultural, and Historical Dimensions of Reflection and Its Educational Implications], Radom, Wydawnictwo Naukowe Instytutu Technologii Eksploatacji – PIB, 2015, pp. 196–206; S. Makomaska, ‘I Can Feel the World Again… Musician/Musicologist in the Therapeutic Projects for Oncological Patients’, in M. Sternal (ed.), Professional Musician. Between Art, Education and Management, Kraków, Akademia Muzyczna w Krakowie, 2017, pp. 155–168.

Pictures at an Exhibition by Modest Mussorgsky (1839–1881) became the main subject of the project prepared by musicology students Magdalena Goławska, Paulina Kowalska, and Wojciech Wieliczko.

Classes conducted at ‘Jestem’ Foundation on 25 April 2017.

The classes held at the Foundation were divided into two parts: theoretical-historical (a multimedia presentation), and a practical one which emphasised auditory analysis of individual miniatures. In the first part, the students presented interesting biographical facts from Mussorgsky's life (the composer's military career, his contacts with other artists belonging to the so-called ‘Mighty Handful’, the context of composing Pictures at an Exhibition). The practical part opened with a discussion on the subject of programme and illustrative music. Subsequently, auditory analysis was performed on each miniature. The main question concerned the ways in which the composer illustrated individual paintings with musical elements. Towards the end of the classes, attention focused on the many and varied musical transcriptions of Pictures at an Exhibition which, in the composer's intention, was originally a cycle of piano miniatures. Among others, the most famous orchestration by Maurice Ravel and the most innovative version by trash metal band Black Confusion were presented.

Less known trends in classical music (especially contemporary ones) constitute an equally interesting theme. The project titled Musique Concrète – from Avant-garde to Rock prepared by Milena Ginalska, Filip Marcinkowski, and Piotr Pęksa

Classes conducted at “Jestem” Foundation on 21 January 2017.

Schaeffer's innovative experiments contributed to the development of electronic music. Moreover, the achievements of musique concrète classics were adapted by authors of popular music such as Jean-Michel Jarre, Frank Zappa, Yoko Ono, and by rock bands (e.g. Pink Floyd).

The main part of the classes was dedicated to auditory analyses of selected études from Pierre Schaeffer's cycle Études de bruits (1948) and Pink Floyd's piece Alan's Psychedelic Breakfast (1970), which proved that even prosaic, everyday activities (such as breakfast preparation) may become a piece of art. The final element of the project was a workshop, whose goal was to create musique concrète. The participants were given ‘instruments’ and divided into four groups (consisting of about 5 people each). The first received sheets of paper, the second – empty plastic bottles, the third – plastic bags, the fourth – small glass jars with spoons. The patients were instructed on how to use these ‘instruments’. Subsequently, one of the hosts of the presentation conducted the ‘orchestra’ by means of charts presenting individual ‘instruments’, while the other two recorded the piece being performed. The composition created from the recorded sound files may be labelled without hesitation as musique concrète.

The main theme of another project, prepared by Alicja Cieloch and Karolina Staniszewska,

Classes conducted at ‘Jestem’ Foundation on 22 November 2017.

The main goal of the classes titled The Voice as the Closest-to-Human Instrument – How Everyone Can Become a Musician was thus to work and play with the voice. The students took advantage of their previous theatrical and musical experience. They wanted to draw patients’ attention to the fact that the human voice may be an essential and attractive tool of vocal improvisation. A set of practical exercises preceded by a brief theoretical lecture was meant to increase the participants’ awareness and stimulate their interest in issues related to the work performed by means of the voice.

The practical part was preceded by a theoretical introduction in form of a multimedia presentation. The starting point was a discussion of the structure of the vocal apparatus. The key question in this part of the classes was, among other things, why voice is important, how powerful it can be, and how and why one can work on it. Unusual ways of singing were also presented such as scat, throat singing and yodelling. The other part of the classes, with active participation of the patients, was based on practical exercises. Transition to practice began with a voice emission warm-up intended to relax and activate the participants, as well as warming up the vocal apparatus (jaws, lips, tongue, cheeks). The next stage consisted of diction exercises, with special focus on the function of vowels and accents in the Polish language. Another exercise was to read aloud several short sentences and texts. The patients especially liked the exercise in speech clarity, based on reading tongue twisters aloud with a carrot placed between their teeth. The exercise in voice emission involved, among others, uttering sentences with varied pitch. The participants were subsequently working in pairs or groups of three people, training the so-called resonators. The presenters explained how one can control the direction of sound and ‘feel’ it in different parts of the body (i.e. at the top of the head, back, nose etc.). The final point was an improvisation performed jointly on the vocal cords. With the students’ help, the patients created a piece that consisted of gradually added, individualised sounds. The high number of practical tasks influenced the group's activity in a positive way. The authors of the project believe that the skills acquired during the workshop will have a practical value and will contribute to increased awareness of one's own voice as well as drawing the participants’ attention to proper articulation.

The classes conducted at the Foundation's headquarters constitute the main but not the only way of organising the ‘hour on beauty’. A Walk in Chopin's Footsteps is an open-air project

Classes conducted with the participation of patients and volunteers from ‘Jestem’ Foundation, 26 June 2014.

The issue of the relationship between music, health, and the so-called well-being has become the subject of interdisciplinary scientific studies in recent years. A pioneering example of a comprehensive presentation of this subject is the collective work titled Music, Health & Wellbeing (2012).

See: R. MacDonald, G. Kreutz and L. Mitchell (eds), Music, Health & Wellbeing, New York, Oxford University Press, 2012.

Illustration 1

The fundamental goal of the classes conducted by the musicology students derives from the motto of ‘Jestem’ Foundation: ‘Let us discover the beauty of life at every stage of the illness.’

The official website of ‘Jestem’ Foundation.

Unfortunately, systematic evaluation of the effectiveness of regular activities conducted at ‘Jestem’ Foundation is difficult due to a number of factors pertaining to individual classes. The most important obstacles are the constantly changing structure of the group, the impact of external factors (such as the individual context of the classes depending on the current health of individual participants or the absence of patients assigned to a given group) and, most importantly, the fact that musicological classes are part of the entire programme provided by the Foundation.

Conducting reliable research in such a complex context, with conditions changing from one class to another, is rather difficult. The choice of research methods for the evaluation of musicology classes has also been dictated by the justified concern that interviews or surveys conducted after each class would negatively influence the patients themselves and might disrupt the time structure of meetings at the Foundation. Taking the existing conditions into account, an optimum indirect option has been applied. All the participants were invited to prepare a written response to an open-end question: ‘How did I benefit from the classes conducted by the musicology students?’ Twelve anonymous feedback forms of various lengths were obtained. Their analysis has made it possible to estimate the degree of goal achievement.

The functions most frequently indicated by the patients were: diverting attention away from the illness, the possibility of relieving negative emotions, stimulating interest in music (for instance, by individually looking for information on the subjects discussed during the classes), improved mental condition (the feeling of joy, return to childhood and adolescence, to the time before the ‘sentence’, pleasure derived from spending time with young people). It may be concluded with great satisfaction that these detailed goals were achieved.

The effectiveness of the applied methods has also been confirmed by observing patients during the classes.

On the basis of H. Cesarz, ‘Karta zachowania się pacjenta w trakcie muzykoterapii’ [‘Patient Behaviour Observation Card during Music Therapy’], in Stachyra (ed.), Podstawy…, pp. 288–291.

Therapy through musical education, making use of various methods of patient activation, is an effective and necessary element of therapy in adults (especially in the elderly) struggling with oncological illness. Excerpts from patients’ descriptions of their experience of classes conducted by musicology students undoubtedly motivate us to continue our cooperation with ‘Jestem’ Foundation:

Meetings with students from the Institute of Musicology are a great lesson for us, broadening our musical horizons, making us curious about new types of music […] [W]e listen attentively and after returning home we look for additional information on the Internet to deepen our knowledge […] For a while we forget our troubles which bring us down and we ‘fly away’ to the magical land of music.

A fragment of a written statement by a patient of ‘Jestem’ Foundation (a 56-year-old woman).

[The classes] force us to think independently, solve problems, and get involved in the subjects which are being discussed.

A fragment of a written statement by a patient of ‘Jestem’ Foundation (a woman, age not given).

Thanks to […] the students I get to know music in a different way: I can see it and feel it. I get to know composers, instruments, and artists. The meetings are a pure joy in these difficult moments of my life.

A fragment of a written statement by a patient of “Jestem” Foundation (a 60-year-old woman).

[…] the joy of youth that radiates, the joy of life and sharing what is needed and worthy of being admired.

A fragment of a written statement by a patient of “Jestem” Foundation (a 70-year-old man). Underlined by – S. M.

I am grateful to the Foundation for reminding me that, apart from the illness, there still exists another world.

A fragment of a written statement by a patient of ‘Jestem’ Foundation (an 84-year-old man).