A compassionate society considers whether a person who has committed a violent offence against another human being was in his/her right mind at the time. His mental state and fitness to plead are assessed by a psychiatrist whilst he is in prison waiting to attend court. There are social and psychological reasons, as well and biological ones, for offending and mental illness.
The first consideration is for the victim and their family, but it is highly distressing to suffer a mental illness and horrific to learn of having harmed someone without being fully aware of what you were doing… that offence is called ‘manslaughter on grounds of diminished responsibility’. Thus, people with mental illness need treatment and care.
The overall goal of modern multi-disciplinary treatment in secure hospitals in the United Kingdom is to ensure that the risks of violence in a seriously mentally ill person are sufficiently reduced to ensure that he or she will not re-offend. The approach towards recovery involves helping the individual to understand himself better, gradually assessing whether the individual can feel remorse and may eventually want to make amends.
In forensic music therapy, there is always the risk that things might get out of control for the patient who has been violent. Therefore, a bit like the televised crime scene investigations, we need a specially designed forensic model of exploring how and why a person committed an offence.
The developments can play an active part in helping individuals to change for the better - by discovering new, more sociable ways to relate to other people without being impulsive.
The research has shown that when music therapy is properly grounded in an NHS-approved psychological model, such as Cognitive Analytic psychotherapy, it is particularly effective with ‘treatment resistant’, low motivated patients who have been incarcerated over many years.
Thanks to the developments in neuroscience of functional magnetic resonance imaging (fMRI), we know that vibration and music in particular are a mediating force that affects an area in the brain called the corpus callosum. This creates a bridge between the left and right hemispheres thereby enabling a greater sense of integration between the emotional self and the objective cognitive thinking self.
A group programme of cognitive analytic music therapy (G-CAMT) is carefully structured in stages that are laid out in the manual, starting with musical mindfulness, then building greater emotional recognition, followed by discovering how to tolerate distress which can reduce risky responses to others; in other words sociability was shown to improve as patients’ developed more ability to reconnect to their thoughts and feelings and to relate in a healthier way.
No previous experience of music is needed to benefit from music therapy treatment because music therapists in the UK are musically skilled, qualified professionals, trained to support and encourage their patients to feel safe enough to try out, gradually, a range of music therapy instruments without feeling criticised, judged, silly, embarrassed or incompetent.
Music therapy is not about becoming a pop star or going on X Factor. In forensic settings it is about recovery from mental illness and understanding what went wrong in life and taking responsibility for oneself. The patient expresses his or her own feelings and thoughts through making ‘live’ music with the music therapist. This means building a trusting relationship which develops through listening to each other and responding in a musical dialogue. This non–verbal musical dialogue can lead to greater ease to talk about difficult issues.
Making one’s own music activates inner creative forces, thereby extending ways that the individual can relate to others. Spontaneous music-making, rather than listening to recorded music or playing in a band creates a sense of having done something meaningful within a therapeutic relationship. This can feel good because jointly-created music can fit the patient’s mood in that moment, ranging from angry and hateful to calm and reflective.
The patient becomes more self-aware. Just as the majority of an iceberg is hidden below the water, so do we only use a very small percentage of our brains - until we learn how to grow psychologically.
This process can be a relief as stigma, fears, wariness and suspicion diminish. Important horrible or traumatic events that were forgotten and put ‘out of mind’ can be shared without shame after they have been expressed non- verbally and with feeling in group improvisations. Past experiences can then be understood better and from this comes a glimmer of hope of some sort of redemption from past mis-deeds.
By improvising music together which has the right mood and feel for the patient on that day at that time, the treatment resistant patient can gradually release what might have been locked away inside for a long time. These are his ‘untreated’ thoughts, feelings and memories which were imprisoned within, like something that has passed it’s ‘sell- by’ date’, festering and ‘going off’ in the fridge for far too long.
In this way people learn from each other how to be more sociable and empathic without actually being ‘taught’. They learn firstly just by watching, then imitating, then discovering that they can jointly-create some music and that they have something original to offer to which others might identify and connect. They start to understand others and their own experiences and feelings better.