Arts Therapies and New Challenges in Psychiatry

Karin Dannecker

• Publisher: Routledge
• Year: 2017
• Print ISBN:
  9781138671973
• eBook ISBN:
  9781317205531
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Despite their increasing popularity and reported effectiveness, there is a dearth of evidence-based research on the practices that fall under the umbrella of "the arts therapies". The successful treatment of a variety of psychiatric illnesses through the application of the arts therapies has long been recognized in many countries around the world, including psychosis, schizophrenia, depression and borderline symptoms.

Providing valuable data on the effectiveness of the arts therapies, Arts Therapies and New Challenges in Psychiatry fills an important gap in the literature on psychiatric illnesses. Contributors to this impressive volume have carried out research in psychiatry and mental health with patients diagnosed with a variety of illnesses. The international focus of the book shows the global, cross-cultural relevance of the arts therapies, whilst quantitative and qualitative evidence is used to demonstrate the need for art-, music-, drama- and dance therapy in a wide variety of contexts. This book shows that research in these fields can be carried out convincingly using a broad range of approaches, including each field's own professional matrix.

Providing a much-needed assessment of the arts therapies, this book will appeal to art therapists, music therapists, dance therapists and drama therapists, as well as psychiatrists, psychologists, psychoanalysts and educators of arts therapy training.

Chapter 1

Music therapy

Differentiation of emotions in schizophrenia

Susanne Bauer

Background

This chapter presents a study of relationships between music and disease, more specifically between the perception, expression and representation¹ of music by schizophrenic persons.

Many contemporary scientific disciplines deal with questions concerning “music and mankind”, how music and sound affect the body, intellect and soul of healthy and mentally ill people: such disciplines include developmental psychology and emotional psychology, the musicological sciences and music psychology, neurobiology and neurosciences, medicine and psychoanalysis. Some of these studies were considered relevant for understanding the basis of our experimental research. For example, musicologists and music and perception psychologists address the question of how people perceive music and exactly what they perceive, the emotional and physiological effects of music, and the psychic processes involved during musical representation and the musical expression of healthy people (Böttcher & Kerner, 1978; Frank, 1975; Harrer, 1975; Pekrun, 1985; Revers, 1975). Further, developmental psychologists explain the basics of normal affective interpersonal behaviour and early preverbal dialogue (Jörg et al., 1994; Papousek & Papousek, 1988; Stern, 1991; Trevarthen, 2002). On the other hand, psychologists and psychiatrists investigate the affective behaviour of schizophrenic persons in order to verify whether and how the illness influences perception and expression of feelings (Hufnagel, Steimer-Krause & Krause, 1991; Krause, Steimer-Krause & Ullrich, 1992; Steimer-Krause, 1996; Steimer-Krause, Krause & Wagner, 1990). Many of these findings converge in the discipline of music therapy, which forms the basis of this study. For music therapists in Germany, treatment of people with schizophrenia has been part of the everyday clinical routine for decades. Early publications on the subject appeared in the 1980s (Kneutgen, 1980; Meschede, Bender & Pfeiffer, 1983; Ostertag, 1985; Strobel, 1985). Musical behaviour patterns of schizophrenic persons described in case analyses lead to the conclusion that there are probably some repeating musical expression methods related to the clinical picture and that these may be disorder-specific (discussed in more detail later). Regarding research, it has been repeatedly demonstrated that music therapeutic treatment can positively influence so-called “negative symptoms” and improve social competence (Gold, Heldal, Dahle & Wigram, 2005; Gold, Solli, Krüger & Lie, 2009; Ulrich, Houtmans & Gold, 2007). The following section will present results which refer to perception, representation and experiencing of feelings and music in healthy and schizophrenic persons, as well as their significance for dialogue behaviour.

Perception psychology and musicology

Wellek (1982) provided an important contribution when he posed the question of “how” and “what” a person hears upon being subjected to musical stimuli. He established that “for the child and the childlike person in general, a picture or a musical piece has points of attraction or repulsion, which lead to immediate replies of attraction and rejection” (p. 250). In his opinion, a child cannot yet understand the gestalt as a whole, and understands just as little the gestalt depth of a musical piece (ibid.). Other gestalt psychological studies of music perception implied that the perception occurs through a focused identification and tracking of a “figure” on a “ground”. A melody can certainly be perceived as a figure or “good gestalt” even if it does not fit into the harmonic framework (Büchler, 1987, p. 53). Identification of ground and figure in music is related to previous learning and cultural processes. Every experience leaves an imprint in the brain, and new perceptions connect with existing “imprint gestalts” (“Spurgestalten”) (Thomas, 1990). According to Büchler (1987), the brain is aware of a logical and reliable continuation of a presented piece of music. If the expectation is fulfilled, the entirety acquires a meaning, but the result of an unfulfilled expectation is meaninglessness (ibid.). De la Motte-Haber (1996) conjectured that the perception of musical relationships occurs through assimilation of categorical structures, thereby creating not only regimes but also meanings, and that this process was “a fundamental form of information processing” (p. 156). Jourdain (1998) assumes that the brain seeks familiar indices and patterns: “We recognize musical stylistic devices, that is, we remember them from previous experiences. Memory is therefore a determining factor for musical perception” (p. 304). People select dominant or central features of a musical piece and generalise these to an overall impression, i.e. they interpret the part as the whole (“inductive process”). De la Motte-Haber (1996) determined that tempo is considered a typical dominant feature behind which other musical features recede in importance (pp. 158ff.). Jourdain (1998) also speaks of selective perception and generalisations in the evaluation (of music), particularly by untrained listeners (p. 320).

Developmental psychology

With reference to dialogue configuration, developmental psychologists were able to determine that affective-cognitive development is promoted by vocal stimulation (Altmann de Litvan et al., 2001; Beebe & Lachmann, 1994; Malloch, 1999; Papousek, 1981; Papousek & Papousek, 1988; Stern, 1991; Trevarthen, 2002). Papousek (1995) describes how learning of dialogue structure (turn-taking) takes place before learning of speech; mothers answer the tones or gestures of their infants, stimulate them to new action, wait again for their reactions and react anew. Motherly responses initially take the form of imitation, with increasing variations appearing later (Papousek, 1981; Stern, 1991). The quality and quantity of vocalisation behaviour in children change so greatly during the first months of life that by the 18th month they can carry on an actively structured and coordinated dialogue. Jörg et al. (1994) describe three early interaction schemes: (a) synchronicity: simultaneous occurrence of identical behaviour or feeling states with simultaneous eye contact; (b) reciprocity: reciprocal influencing through new stimuli; (c) elicitation: occurrence of behaviours which lead the communication in a new direction. A faulty interaction results when answers are inconsistent and when reactions are illogical or rigid, when a child’s negative signs and new stimuli go unperceived or disregarded, and when elicitations are not answered. Mutual lack and rejection of eye contact are also characteristic of an unsuccessful interaction.

Thus the healthy newborn child has a multitude of hereditary cognitive abilities such as perception, storage, organisation, differentiation and recognition of stimuli; these make it possible for the infant to undertake high-level communication with its environment. To make an appropriately weighted response to its early needs, the child requires an adequate system of affect understanding and affect coding (Osofsky & Eberhart-Wright, 1988), whereby the intensity of its affect utterances is linked to the cultural, familial and historical context (Hochschild, 1996; Krause, 1983). In addition to all of the pre-speech phase possibilities such as gesture, mimicry and voice, musical expression plays an increasingly important role in the early development of humans, particularly with respect to identity building and socio-cultural affiliation. The intersubjective relationship and interaction behaviours acquired in the early stages of development are reflected in adult dialogue behaviour and can be observed and altered in a therapeutic context (Stern, 2010).

Psychiatry and emotion psychology: affect and emotional behaviours

Scientific studies of psychiatry show that perception, affect behaviour and interaction are altered in people with schizophrenia. Numerous studies of persons with primarily negative symptomatology have found a constant tone of voice as well as facial expression which are independent of the spoken content, likewise an increased social withdrawal and abandonment of social relationships. Blunted affect and impoverishment of emotional life were also observed (Creer & Wing, 1989; Kanas, 1996; Katschnig, 1989; Wygotski, 1985). Other studies asked schizophrenic patients and healthy controls to identify feelings in facial expressions presented in photographs or pictures (Lewis & Garver, 1995; Toomey & Schuldberg, 1995; Walker, McGuire & Bettes, 1984). The schizophrenic patients identified feelings represented in the facial expressions significantly less accurately than did persons in the control group. Paranoid patients did have significantly better results than non-paranoid schizophrenic patients (Lewis & Garver, 1995). Other investigations measured facial expression and mimicry changes in schizophrenic patients and healthy controls during presentation of differently emotionally charged cinematic scenes (Kring, Kerr, Smith & Neale, 1993; Kring & Neale, 1996). The results showed distinctly reduced mimicry in persons with schizophrenia compared to the controls. Nevertheless, schizophrenic persons perceived positive and negative emotions just as well as the healthy controls. Krause et al. (1992) obtained similar results in their studies. They determined that the barrenness of mimic expression in schizophrenic persons was often accompanied by very intense experience-based and verbalised negative affects. Investigations of interactive behaviour of schizophrenic and healthy partners (Hufnagel et al., 1991; Steimer-Krause, 1996; Steimer-Krause et al., 1990) captured facial movements using the EMFACS coding system developed by Friesen and Ekman. The results showed that healthy partners adapted themselves to the mimic expression behaviour of their schizophrenic partners and conducted themselves with less expressiveness than partners of a healthy control group. On the other hand, schizophrenic patients tended to emotionally identify with the expressive behaviour of the healthy partner. In their investigation of subjective emotional activity of persons with schizophrenia in the year 2000, Myin-Germeys, Delespaul and deVries adopted the experience sampling method (ESM) to capture the emotional effect of everyday experiences; they found that the illness as such does not present an impediment to feeling emotions. Compared to a healthy control group, the experimental subjects even showed greater variability in negative emotions than the control group, though for positive emotions it was significantly lower. The intensity of feeling of positive emotions in members of the experimental group was thus significantly lower, whereas for negative emotions it was significantly higher. No significant differences in schizophrenic patients “with flat affect” and “without flat affect” were found in the subjective experiencing of emotions. The “flat affect” classified by the external raters using the Brief Psychiatric Rating Scale (BPRS) could not be confirmed by the experimental subjects themselves. Correlations were poor to non-existent. With respect to therapeutic procedure, the authors consider these results to be relevant, and they see it as a therapeutic responsibility to find a method which promotes the integration of emotions (Myin-Germeys et al., 2000, p. 851). The title of the study by Myin-Germeys and colleagues speaks for itself: “Schizophrenia patients are more emotionally active than is assumed based on their behaviour.”

In his meta-analysis of some 55 English-language studies on the subject of schizophrenia and emotions, Trémeau (2006) found that schizophrenic persons express their emotions via verbal, facial and acoustic channels more poorly than healthy controls, but that their behaviour does not clearly and significantly differ from that of depressive persons. On the other hand, the studies which he reviewed showed that schizophrenic persons suffer from a deficit in the identification, expression and experiencing of emotions. With respect to the experiencing of emotions, his conclusion contradicts the findings of Myin-Germeys. Trémeau explicitly points out the difference between recognition and appraisal of feelings: “recognition is part of emotional intelligence and social perception, whereas appraisal is part of emotion processing” (ibid., p. 60). In order to gain a better understanding of the effects of emotional processing deficits on social functioning, he recommends studies of further and as yet unidentified aspects of emotional processing (ibid., p. 67).

Investigations of the capability to perceive and different...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright page
• Table of Contents
• Notes on contributors
• Preface
• 1 Music therapy: differentiation of emotions in schizophrenia
• 2 From the “inside feeling” to narration: symbolisation and aesthetic emotion in music therapy
• 3 Dramatherapy work in the treatment of schizophrenic psychoses
• 4 Therapeutic effects of brief group interactive art therapy with war veterans
• 5 A neglected area in schizophrenia treatment and research: the efficacy of art therapy – results of a pilot randomized controlled trial and qualitative study
• 6 Changes in well-being of schizophrenic patients after movement therapy: results of a multicenter RCT study
• 7 Adapting Winnicott’s squiggle technique in group art therapy to a psychotic population undergoing a psychosocial rehabilitation programme
• 8 The borrowed image in art therapy with psychiatric patients: the internalization process
• 9 Longing for belonging
• 10 Assessing negative symptoms of schizophrenia by the use of Aristotle’s “Poetics” during a dramatherapy performance process
• Index