Lippin Papers > The arts: are they real medicine?



Remarks at the Spirit of Hospice Awards Dinner

New Jersey Hospice and Palliative Care Organization (NJHPCO) Conference
Atlantic City, NJ
Thursday, October 1,1998

Keynote Address “The Arts: Are They Real Medicine?”

These remarks are dedicated to my late father-in-law

Murray Dienstman

Thank you. I want to especially thank Allan Ginsberg of Heritage Hospice for suggesting me as your dinner speaker. Congratulations to all of the awardees. It is very important for you to celebrate your successes and I am honored to be part of this evening’s proceedings - the first awards dinner of the New Jersey Hospice and Palliative Care Organization or NJHPCO. I usually say that I am honored to speak at these types of events but, in this special group, I feel moved to say that I am blessed to be among you as you strive to address, in my opinion, the most important aspect of the practice of modern medicine - helping our fellow human beings, that is our patients, cope with pain, suffering and ultimately dying and death. I’d like now to engage in a special exercise, which I call a collective pinch of ourselves. No, we are not dreaming. I believe that all of medicine is undergoing a very painful but necessary transition one characterized by three fundamental trends.

The first is a transition from reductionism to holism, the second is a transition from medical paternalism to empowerment or consumerism, the third is from a fear of death to a love of life, which I call the paradigm of medical optimism. The excesses of a truly miraculous era of modern biotechnology based medicine are beginning to bite back, backfire if you will. A new neuroscience driven, bio-psycho-social spiritual model of health care is emerging right now! After two hundred years of western medicine denying what I call “the reality of the anatomical existence of the neck, a mind-body medical model is finally getting it’s long overdo recognition.” I also refer to this as the democratization of psychiatry. The wisdom and humanism of caring is replacing the vanity of curing. Certainly, we can and should try to cure specific diseases but all mature individuals know that there is no ultimate “cure” for the human condition. The closest we have to that is love and beauty. I would contend that none of our patients ever become fully cured. I would say that only pickles and ham get cured. What we can do successfully is help people in trouble become healed and become whole.

The Hospice and Palliative Care Movement have been pioneers and remain on the forefront of this “healing revolution” - what I call “the late, great twenty-first century heal-in.” I believe, that you are practicing the best medicine by helping patients with their own self discovery process, that is assisting them with becoming who they really are, helping unfold their essence or what social scientist, Jean Houston, says is each individual’s “Entelechy” so that they can recognize their own unique identity, gifts and beauty which then allows them to experience the unconditional love and beauty of the universe.

What does all this have to do with the arts? In September of 1993, I had the privilege to spend a full day in New York City with prominent journalist, Bill Moyers. He had just won an Emmy for his series titled, “Healing in the Mind,” which helped popularized Alternative Medicine and, I believe, played a major role in its growth and acceptance. He and his production team were entertaining the idea of doing another series entitled, “Healing and the Ads.” Toward the end of the day, he made the following statement and posed the following question to me. He said, “We all know, Dr. Lippin, that the arts generally have a salutary affect on us in that they improve the quality of our lives but are the arts real medicine? Can they stand shoulder to shoulder with the three big guns of modern western medicine namely pharmacology, surgery and radiation?”

Well, let me tell you a little bit about what I told him that day beginning with the fact that the creative arts therapies have been with us since World War II. Now we have over 5,000 music therapists, over 2,200 art therapists, over 1,000 dance therapists and several hundred poetry and drama therapists. That furthermore there are over 140 undergraduate and graduate degree programs in creative arts therapy and at least 10 professional associations now exist. While these therapies had been applied successfully in mostly psychiatric settings, more recently, again because of modern neuroscience, we have the technical capacity to validate their effect in other medical specialities - most notably Physiatry, Pediatrics, Geriatrics, Oncology and, of course, Palliative Medicine. Some of us like to include the arts therapies in what we like to call “Arts Medicine,” a phrase I coined in 1985. In 1991, hearings were held by U.S. Senate’s Select Committee on Aging on the power of music on health entitled, Forever Young. Among those testifying was the renowned neurologist, Oliver Sacks, who is an ongoing advocate for the use of music especially in Alzheimer’s Disease. You may recall seeing the movie, Awakenings, with Robin Williams who portrayed the character of Oliver Sacks, as it relates to the use of music in post influenza encepalopathy patients. The following year in 1992, the same Senate Select Committee held another hearing on the healing power of dance and the visual arts. This lead the Health Care Financing Organization or HCFA to include music therapy as a reimbursable service under certain conditions within Medicare partial hospitalization policies. Let me also note that two of the inaugural grants by the Office of Alternative Medicine (OAM) of the prestigious National Institute of Health (NIH) were awarded for creative arts therapy research projects. Both, incidentally, were in my home state of Pennsylvania and included the impact of music on brain damaged individuals and the impact on dance on cystic fibrosis. In 1993, a group of scientists at the University of California Irvine made a breakthrough in the music area when they published an article in the prestigious British Journal, Nature, which concluded that spatial and abstract reasoning test scores could be improved significantly after specifically listening to the music of Mozart. This phenomena was validated in pre-schoolers and toddlers and trademarked as the “Mozart Effect,” which has literally spawned an industry which has all the earmarks and the marketing fanfare of the introduction of a new drug by the pharmaceutical industry. Professor Jane Stanley from Florida State University in Tallahassee has completed a meta-analysis of 92 empiric research studies on music and medicine, most of which were conducted during the last decade. She has published a book entitled, Research and Music Therapy, A Tradition Of Excellence, Outstanding Reprints from the Journal of Music Therapy, 1964 to 1996 (Allen Press, 1994). Dr. Ralph Spintge of Ludensheid, Germany, has studied over eighty thousand patients since founding the International Society for Music and Medicine (ISMIM) and has become an expert in the anxiolytic and analgesic effect of music on surgical patients. Many of you probably know that in 1993, Dr. David Eisenberg from Harvard published a landmark study in the New England Journal of Medicine (NEJM) indicating the number of individuals in this country who utilize alternative medicine. This and the Moyers series ignited a huge popular ground swell as it relates to the legitimacy of alternative medicine interventions in this country. I believe, we in Arts Medicine will have our “Eisenberg article”, which will put in motion forces for much greater acceptance of these interventions. This trend is beginning to manifest itself already. JAMA, the Journal of the American Medical Association, recently published an article on the reduction of autonomic activity and stress among surgeons while listening to music in a surgical theatre (note they call it a theatre) as well as a laboratory setting. Also, I am sure all of you are aware of the issue of polypharmacy and you have been reading about frightening occurrences of adverse drug effects in hospitalized patients. In April of this year, JAMA cited over one hundred thousand deaths due to this phenomena and 2.2 million serious side effects. Some experts say that the amount, types and mixtures of medicines consumed by patients above the age of 65 constitutes “America’s Second Drug Epidemic” and it is obviously a very important issue in your particular patient population. Will the Arts replace drugs? Of course not, but one of the distinct advantages of applying the Arts in Medicine is possible reduction in doses and numbers of medicine. As one expert said when you compare morphine to music, morphine win out will every time but if you can back off on the numbers of drugs, you have made real progress. In particular, in your fields of Thanatology and Palliative Medicine, you may know of Therese Schroeder-Sheker, who founded the Chalice Repose Project out of Missoula, Montana. Her program was featured last year on Ted Koppel’s show, Nightline. Schroeder-Sheker began tending to the dying using music over 25 years ago. Historically drawing from “Infirmary Music”, which had been an intimate expression of French monastic medicine in 11th Century Cluny, this application of music to the dying anticipated the Holism of the modern hospice and palliative medicine movement by almost 800 years. Central to cluniac spirituality was the understanding of the human need for beauty. Shroeder-Sheker defines Music Thanatology as a palliative medical modality employing very specific prescriptive harp and singing music to tend to the complex physical and spiritual needs of the dying. In Music Thanatology, the entire surface of the skin comes an extension of the ear. This therapy is used at the death bed vigil and at the very time of death or what is known as transitus. I ask each of you to compare these beautiful sounds of the harp and human voice to the consistent clicks, hisses, beeps and buzzes generated by so-called life support systems in hospital intensive care units. I might add that this group is taking steps now to develop an objective science of Music Thanatology. That over two decades of clinical experience and anecdotal material while valuable are yielding to more rigorous research, record keeping and data collection. We need to do this level of rigorous research in arts medicine and we need your help especially in specialties like yours.

Other benefits of the use the arts with the dying, including the important act of allowing the dying to share or leave behind a creative and personal gift which provides them with an opportunity to express gratitude as part of the importance of closure. The evocation of near and distant memories are so important to the dying from the standpoint of lifelong autobiographical review, communication deep and often hidden thoughts and feelings that cannot be expressed with words through the arts thus providing so called aesthetic distance and finally and simply, the addition of beauty and even pleasure in the dying process that the arts can provide.

Personally, I have always believed that one of the greatest tasks in life from its very beginning is to prepare for the good death. I figured out very early on in my own life that preparing for life paradoxically was an absolute prerequisite to achieving the good and full life. As Dr. Steven Levin says in his popular book, A Year To Live, preparing for death is one of the most rational and rewarding acts of a lifetime.

Thus, I somewhat tongue and cheek say that our toasts over a good meal or a happy occasion should reflect a new cultural awareness and maturity about death - So instead of toasting “to your good health, “Salut”, “A votre sante”, “L’Chiam” - maybe we should raise our glasses “to the good death.”

Let me tell you a brief, personal story. One day, my then seven year old son, Kenny, visibly shaken and obviously very fearful, began to cry saying that he could not believe or fathom that some day he would not be here on this planet earth. I believe this was literally the moment that he became aware of his own mortality, which he found very difficult to internalize. I held him in my arms and let him weep for several moments and then carried him to a framed poem, which we display to this day in our family room, that I had written many years ago about musicians. I told him that a very real part of me, his father, was literally inside that poem which would live forever and that expression through the arts was a wonderful way to achieve immortality - a view which he seemed to accept. Just a few months later he presented to myself and his mother a poem for which he won a Bucks County wide prize thus initiating his own lifelong artistic march toward immortality. Through that experience it became obvious to me that parents need to have the courage to listen attentively and caringly to their children’s fears about death and dying and not avoid these types of discussions because of their own fears and repression of this issue so frightening yet so central to human existence.

Let me close with the following poem which I found in the Journal of the American Medical Association (June 10, 1998):
Leaving The Clinic by Marilyn Taylor (Florida, 1996)
Having carried you own
terrible frailness
to the edge of the water
you bent your body sharply
like a broken stick, until
you were kneeling in the sand.
If the world weren’t so damned
beautiful, you said, maybe
dying wouldn’t be so bad -
But then you saw how a small rain
had pocked the creamy skin
of the beach overnight
causing snails to leave their sanctuaries,
and the pursed hibiscus buds
to fatten and explode,
and with the sea collapsing around us,
thinning to a glassy sheen
that blinded you
you hid your face
behind your hands and shook
with unrequited love.

Finally, I’ll leave you with what I call a behavioral prescription. Despite all the pain and suffering in the world, there is an abundance of beauty all around us - God’s gifts if you will. I urge each of you that in addition to utilizing this beauty through the arts with your patients put a healthy dose of the arts in your own life. Thustake thou (Rx) beauty now, often, at the hour of sleep, in life’s final chapters, at the moment of death and forever. God bless you for your remarkably creative, compassionate and extremely important work.

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