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From Music Therapy – Intimate Notes – case studies compiled by Mercedes Pavlicevic

Based on an interview with Judith Nockolds who works with elderly people with advanced dementia

When I first met Jim, he was sitting in the centre area of the Haven, so he could watch what was going on. He needed to know what was going on, who was who. .. and he was aware and alert, although he had a diagnosis of dementia. He'd had a history of ill-health, ending up with a brain tumour and a shunt. His wife says that about ten years ago, at the time of the brain tumour everything started to go wrong: it sounds to me like there was some sort of brain damage as well.

Jim was such a manly man, and needed to have that manliness reinforced. He was a flirt. One of the staff called him Romeo - and in the nicest way this was right. He needed to be reaffirmed. He was very, very angry at what had happened to him. His wife used to come to the Haven and visit him every morning, and at times he would be aggressive towards her: he was convinced that she was having an affair and would shout at her. She was in her eighties and couldn't cope with him anymore - that was one of the reasons he was in the Haven. He was so negative about himself, about his sexuality, his impotence... he'd been active in the Second World War and had been shot in Japan, he had three medals, and was constantly telling people about his medals - again, you see, reaffirmation about how useful he'd been as a man. He'd been shot in his legs, and although he could walk, he needed a walking frame. His preoccupation was very much that he used to be able to do things... 'and now I'm useless, useless to everyone, I should be dead, what is the point of being alive...'.

He spent a lot of time shouting, swearing, and being quite abusive and disruptive.

Jim was eighty-two years old, wore very thick, framed glasses and was balding, so you could see his shunt. He looked frail. When he walked it was a big effort: it would take us about twenty-five minutes to walk to the session, but it was important to him that he got there under his own steam. He would say to me, 'don't you get fed up with waiting for me?' and I would say 'we've lots of time, Jim, don't worry...'.

I gave him a drum and a cymbal at the first session. . . and I have never heard someone so frail make so much noise! It was as though all of the big manly Jim came out in his drum playing. His beating was quite chaotic, and it was difficult for me, at the piano, to find a way of working with his beat. I'm not sure that I ever succeeded, but after a while I realized that what was important was his emotional discharge: it was to make a big noise, to be a big person. So, rather than to try and frame this drumming, to try and code it into a nice steady beat, what I did with it was to contain his chaotic drumming by improvising some big and holding music, and this allowed him to just really go.

He would totally exhaust himself because he wasn't particularly strong... but his need to make a lot of noise was huge, and we did that for quite a few weeks.

He began to develop this fantasy that he was in a band, that he was my drummer and after every session he'd say 'I'm a useless drummer, are you sure you can't find a better drummer?' And I'd say, 'no Jim, I really want to make music with you, you are my drummer!'

He'd smile and walk out and say to everyone, 'did you hear me, I am a drummer, I'm really good at the drums' and the next week he'd come back and say 'I've been asked to play in a band!' It was such a positive experience for him to be valued for doing something that felt really important to him.

And he'd constantly need affirmation that what he was doing was OK.

Through the music, I could validate him. I don't think he heard my validation in words, if you like, but I think he heard it in the music, and he felt it.

He began asking every day, 'Where is Judith! Ring her up!' and get quite angry because I wasn't there - I was only there once a week. So when I got in each week, everyone would say, 'Oh go and see Jim please, he's been asking for you all week!' I'd go and see him and he'd grip my hands and say, 'I'm so glad you're here, I didn't think you were coming, do you want me today, do you want me to do the drumming today?'…………….

Then he had a stroke and lost all his movement. He was very very depressed. He couldn't walk any more, his speech became very blurred, it was difficult to understand what he was trying to say, and I had this gut fear of 'what are we going to do...Jim plays the drums and he can't do that anymore...' I was terrified that I was going to reinforce his sense of loss even more, by bringing him into a situation where he could no Ionger do what he had been doing. I questioned whether I should.

Mark had rung me up and said Jim had had a stroke and really wasn't very well, so I went to see him and his face absolutely lit up when he saw me. He was so pleased to see me - and I had the realization that the relationship is just as important as the drumming: trust it. We gave it a go, we got him in the wheelchair and I wheeled him along to the music therapy room. And he tried to tell me what had happened . .. 'I'm even more useless now'... I listened; listened to the sounds of his talking, the rhythm and phrasing of it as I wheeled him to the piano, and started to play.

What was so amazing. .. was that he found a way of being big through his voice. Unsolicited by me. He managed to build the sound up and up and up and suddenly he was still this big man in the session, and we worked vocally, and it was so beautiful... just because he was able to find that for himself! And it was so unexpected for me, I didn't trust that he could do that. But he did... here is a recording of our first session after his stroke.

The piano music on the tape is slow, tender and warm. Judith sings 'hello, Jim, hello Judith...' Jim joins in. His voice sounds strong and the music is unhurried, restful, in a major key, the music takes its time, it is spacious. And then begins to change. It moves towards more detached playing, with an um-pah, it becomes slightly jazzy with a lift, a bit of a kick and his voice begins to rise... towards long phrases. Then the music becomes stronger, it begins to broaden out towards a point of... something like rock 'n' roll - and he's there, with it, in it... there is no sense of the music pulling or pushing him: his impulse is part of Judith's impulse, and hers is part of him. . .. 'we can sing a song. . . together. . . Yeeeesss! We can sing a song... a song... together! 'They play it again, a speeded up version, Jim sings with his entire being - I hear all of him in his voice. . ..

……………

He then got to a point where he couldn't come to the music therapy room any longer. I'd go to his bed and sing with him. Well, I sang for him really. . . he was very weak.. . and I felt privileged that our music continued right to the very end. This helped me as well: knowing how to be with him when he was coming in and out of consciousness. .. I'd sit and hold his hand and sing... he showed me how to be with him. It was such a lesson in having faith in what I was doing - it was such a humbling experience because I was so terrified that there'd be nothing more we could do - and actually he showed me....

I was closely involved with his dying because I'd become friends with his wife, and the staff all knew that I was important to him. They told me when they thought he was going to go and I was able to go and say my goodbyes. It was important for me to do that. At his funeral I had such a sense of privilege of having been able to share with him what I shared with him. He was eighty-three when he died, his life had been challenging, and he'd also got a lot out of it. Again I felt a release for him, because he was not happy, being affected by the illness in the way he was....

I miss him. I miss the work with him.