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

Based on an interview with Clare Hobbs who works in acute and forensic psychiatry in London.

Miriam is from Uganda. She said she was twenty but we didn't know her age. She had become a refugee over there, with no knowledge of her mother or father and had been farmed out to look after local children.

She'd had a close relationship with her grandmother who died when she was about eight or nine. She'd then been sent for by a relation in England, and came over when she was thirteen, speaking no English.

She'd gone to school for a while, but had always been intensely isolated.

Then she got into a relationship which appears to have been very abusive, and had a baby when she was about seventeen. She killed the child (a girl) when she was three. It was on a Sunday last June, she smothered it because she felt that life was unbearable both for her and the child. She then planned to kill herself, had tried three times and failed, and after the third attempt she was found and taken to hospital.

She was charged with killing her child, sent to prison, was there for a week but was too depressed and was a major suicide risk so she was transferred to the Unit. This was only three weeks after the event. She said nothing, she looked dreadful. I returned to work after a break in September, about two months after she got there, and by this time she was willing to do anything to relieve boredom.

When you think about her cultural background and her whole life, she'd had no consistent care-giver, she'd been a refugee from when she was virtually a baby, and was then uprooted to a country far removed from the culture of her childhood. Here was someone who had lived in a very small village with a feeling that everybody is your family and you help everybody else ...and had then been dumped in this cold climate, in a culture where people don't generally relate like that!

Miriam was a bright woman, very able - and her child hadn't been buried by the end of September. There'd been a long inquest, and part of the whole process of working with her on the Unit was to try and encourage some kind of grieving for her child.

In the group music therapy sessions she used music instinctively: she could make connections between music and herself, she used it to communicate with people, and what she played influenced them in the music. I pointed these things out to her and she became more and more confident. What first struck me in the music therapy group was that she would play something to somebody and expect a response - this was an instinctive 'this is what music is for'. Hers was not an isolated, uncommunicative unrelated playing at all.

In one session, when we were doing an exercise playing something to influence other people, she was playing quite a small instrument in many different ways. It was as though she was playing a game and enjoying it - there was this spark of enthusiasm for life in her - and this is relatively rare in this setting.

And I thought, you don't seem to be psychiatrically ill, emotionally disconnected – you are deeply affected by everything that has happened to you, and all your natural instincts are just there - and nobody has really given you the opportunity to be this - you don't know how to make relationships with people in this culture, you don't know how to find help or find people who've been through similar experiences, but... you're not mad.

That is what I thought, through experiencing her playing in music therapy groups.

I think she knew that I recognized that she wasn't mad - and it was not only me, but others in the team also began to build up relationships with her. I never had to explain things twice - I could use any words I wanted; I could talk to her as if she were somebody I knew, at my level, and she would understand. . . but if you talked to her as if she were a disabled hospital patient, you'd drive her further into a kind of isolation.

In the music therapy group she found a voice.

The whole team started to get to what had really happened, what had led up to her killing her child. She did not have a personality disorder - it was a reactive depression - I don't think that she was even given a psychiatric label in the end: it really was caused by intense stress and the prison sentence was dropped.