Reshaping an enduring sense of self: the process of recovery from a first episode of schizophrenia

Aim: Although advances in the treatment of schizophrenia have been made, little is known about the process of recovery from first episode of schizophrenia (FES). To date, the study of recovery in the field of mental health has focused on long-term mental illness. This qualitative study addresses ways in which individuals with FES describe their process of recovery and how identified individuals (e.g. family members) describe their perceptions of and roles in the participant's process of recovery. Methods: Charmaz's constructivist grounded theory methodology was used to interview 10 young adults twice who self-identified as recovering from FES. In addition, 10 individuals were identified who had influenced their recovery and were interviewed once, for a total of 30 interviews. Data collection sources included in-depth semi-structured interviews. Data analysis methods were consistent with Charmaz's methodology and included coding, and constant comparison of data. Results: The results provide a substantive theory of the process of recovery from FES that is comprised of the following phases: ‘Who they were prior to the illness’, ‘Lives interrupted: Encountering the illness’, ‘Engaging in services and supports’, ‘Re-engaging in life’, ‘Envisioning the future’; and the core category, ‘Re-shaping an enduring sense of self’, that occurred throughout all phases. A prominent feature of this model is that participants' enduring sense of self were reshaped rather than reconstructed throughout their recovery. Conclusions: This model of recovery from FES is unique, and as such, provides implications for clinical care, research and policy development for these young adults and their families.     

Young People's Pathways to Well-being Following a Suicide Attempt

Little is known about young people's pathways to recovery following suicidal behaviour. An understanding of young people's experiences and transitions to recovery and well-being is required to inform the development of suicide prevention and mental health promotion initiatives. The aim of this study was to explore young people's experiences of recovery and well-being following a suicide attempt, through in-depth interviews with 27 young people who had presented to an emergency department. A number of useful techniques which may be helpful to young people in their transitions towards attaining a sense of self-responsibility and increased agency were identified, including active help-seeking from professionals and peers, practical problem-solving abilities, thinking positively and rediscovering a ‘will to live’.     

Depending on music to feel better: Being conscious of responsibility when appropriating the power of music

This study explores the beliefs held by young people about the power of music to help them feel better during challenging times. Participants included 40 young Australians, aged 13–20, who described their relationship with music and were progressively asked to recall times where music had not been helpful as well as when the consequences of engaging in music had been beneficial. Grounded theory analysis generated a theoretical explanation of why young people's beliefs about the positive consequences of music are so strong, even though the experience of young people with mental health problems sometimes contradicts these views. Implications for professionals are offered; with a particular emphasis on the importance of young people accepting responsibility for the ways they appropriate music in contrast to seeing the music as the source of power.     

A woman's voice: The politics of gender identity in music therapy and everyday life

In contrast to a comparative model of gender that implies that gender is something you have, a performative model of gender points towards gender as something that is construed in relationship and in context. From this perspective music therapy can be understood as an arena for performance and negotiations of gender. In this process, music therapy can conceal a range of socio-cultural and political dimensions significant in how people manage their sense of self, health, and well-being. This article explores how gender and sexuality are located through singing as a musical act and cultural gesture, and how the social presence of the voice is implicated in sexual politics. Using the experiences of a young woman in music therapy as a point of departure, this article examines the notion of interrupted voices in everyday life and therapy.     

Pleasurable emotional response to music: A case of neurodegenerative generalized auditory agnosia

Recent functional neuroimaging studies implicate the network of mesolimbic structures known to be active in reward processing as the neural substrate of pleasure associated with listening to music. Psychoacoustic and lesion studies suggest that there is a widely distributed cortical network involved in processing discreet musical variables. Here we present the case of a young man with auditory agnosia as the consequence of cortical neurodegeneration who continues to experience pleasure when exposed to music. In a series of musical tasks, the subject was unable to accurately identify any of the perceptual components of music beyond simple pitch discrimination, including musical variables known to impact the perception of affect. The subject subsequently misidentified the musical character of personally familiar tunes presented experimentally, but continued to report that the activity of ‘listening’ to specific musical genres was an emotionally rewarding experience. The implications of this case for the evolving understanding of music perception, music misperception, music memory, and music-associated emotion are discussed.     

Is there a role for music therapy in the recovery approach in mental health?

The recovery approach in mental health care emphasises the importance of the service user leading a fulfilling, meaningful life beyond the limitations of illness or symptomatology. This approach to care is increasingly included as a central part of mental health policy and service provision in a number of countries including the UK and Ireland, to address the needs of people who have severe and enduring mental disorders. It is an autonomous, holistic and empowering way of working with individuals as they journey towards healing. Fundamental to this model is the relationship fostered between service users and health professionals. The recovery philosophy of care mirrors some of the core principles of music therapy, including the importance of the therapeutic relationship and the possibilities for change and growth within this. This paper explores the congruence between music therapy and the recovery approach by providing: (1) An overview of current published evidence for music therapy in mental health care. (2) A discussion of this psycho-social creative arts therapy intervention within the specialized area of recovery in psychiatry, and (3) case vignettes to illustrate the application of this philosophy in music therapy work within a recovery service.     

Music therapy in children's hospices: An evaluative survey of provision

This paper presents the results of a survey of the range of music therapy practice in children's hospices in the UK. Music therapists are challenged to work with children with life-limiting and life-threatening conditions during short periods of respite care over several years or at end of life. Flexibility is fundamental to working both individually and in small groups in response to the shifting needs of the children and their families. In the context of a children's hospice music therapists are called upon to work creatively with siblings and family members and members of the multidisciplinary team in addition to the children themselves. A questionnaire and focus group for music therapists working in the children's hospices provided evidence of the range of work, priorities and future plans for development. Telephone interviews with specialist staff at children's hospices where music therapists were not currently working provided evidence of how music and musical activities were perceived and utilised, with any plans for future provision for a music therapy service and some of the practical and resource issues being itemised.     

Indigenous music therapy theory building through grounded theory research: The developing indigenous theory framework

There are diverse understandings within music therapy about what constitutes theory. Also, there is debate about whether research methodology, developed outside of the field of music therapy, is able to support the development of music therapy theory that is indigenous to the profession. In this paper, a framework, called the developing indigenous theory (DIT) framework, which allows for the development of indigenous theory through the use of grounded theory research methodology, is presented. A new definition of indigenous music therapy theory is provided. Here, indigenous music therapy theory refers to knowledge emergent from music therapy relationships which are able to be plausibly generalised across settings and time, allowing for the development of theory that is idiosyncratic to the field of music therapy. The difference between “precursors to theory” and actual “theory” are examined, and the outcomes of numerous studies are considered through the use of the framework. The distinction between complete and modified grounded theory studies is discussed. It is suggested that the DIT framework may hold relevance for the development of theory in other human relationship-based arts therapies.     

The psychological impact of Ney music

The current study investigated whether music therapy carried with the Ney (a wind instrument used in classical Turkish music) has a positive effect on decreasing people's anger and psychological symptoms. The Ney is a Turkish folk instrument and known as a great symbol of Sufi music. In Mevlana philosophy, the Ney makes people feel at ease, and make them feel closer to God. The participants were 14 university students, who were randomly assigned to two groups. This experimental group received music therapy sessions twice a week during 7 weeks, resulting in a total of 14 sessions. The control group did not receive any therapy. The research instruments were administered as a pre-test, a post-test, and a follow-up test. The findings revealed that music therapy carried with Ney music has a considerable long term effect on reducing the participants’ anger and psychological symptoms.     

‘Just When You Think You Got It All Sorted …’: Parental Dilemmas in Relation to the Developing Sexuality of Young Profoundly Disabled People

Sexuality is a neglected topic in the literature focusing on young profoundly disabled people. For parents and formal carers who work with parents and young people themselves, however, sexual development and identity pose fraught and complex challenges in understanding and addressing young people's needs. This paper is based on qualitative research which explored parents' experiences, feelings and understandings and the responses of formal carers to parents' perspectives. The parents faced contradictory pressures to deny and not to deny sexuality. Formal carers drew on beliefs about ‘good parenting’ in reactions to the position of parents. Both groups confronted real dilemmas with young people who are incapable, and may never be capable, of informed consent or self-determination in sexual relationships.     

Computer aided music therapy evaluation: Testing the Music Therapy Logbook prototype 1 system

Research indicates that music therapists are likely to make use of computer software, designed to measure changes in the way a patient and therapist make use of music in music therapy sessions. A proof of concept study investigated whether music analysis algorithms (designed to retrieve information from commercial music recordings) can be adapted to meet the needs of music therapists. Computational music analysis techniques were applied to multi-track audio recordings of simulated sessions, then to recordings of individual music therapy sessions; these were recorded by a music therapist as part of her ongoing practice with patients with acquired brain injury.The music therapist wanted to evaluate two hypotheses: one, whether changes in her tempo were affecting the tempo of a patient's play on acoustic percussion instruments, and two, whether her musical interventions were helping the patient reduce habituated, rhythmic patterning. Automatic diagrams were generated that gave a quick overview of the instrumental activity contained within each session: when, and for how long each instrument was played. From these, computational analysis was applied to musical areas of specific interest. The results of the interdisciplinary team work, audio recording tests, computer analysis tests, and music therapy field tests are presented and discussed.     

Editorial: Control alt delete – technology and children's mental health

With international contributions from Denmark, Peru, Italy, Turkey, Estonia, Russia, Canada, the USA, Australia and the UK, this special issue offers insights and evidence about the technology's ability to act as a force of good and a source of harm for young people's mental health. As we better understand the complex and bidirectional relationship between technology and mental health, we need to move beyond dichotomous narratives about it being good or bad; it is both, depending on how it is used. Collective responsibility across technology companies, researchers, public services and community organisations, parents and the young people themselves can make a difference in the way technology is used to protect and improve mental health.     

L’anhédonie musicale : des neurosciences à la psychiatrie

Music has always been part of our culture. Listening to it can convey strong and many emotions in humans. By its capacity to move us, it occupies an important value in the lives of people. There are important differences in the ability to enjoy listening to music. Some people will find music more enjoyable than others. Part of the population is unable to experience pleasure, or has lost the ability to do so. This fact is called “musical anhedonia”. Mas-Herrero et al. have developed a psychometric instrument that studies this sensitivity to musical reward; this is the “Barcelona Music Reward Questionnaire”. Mas-Herrero et al. in 2014, measured the physiological responses of subjects insensitive to music. They found that these people had no changes in their heart rate, temperature or sweat levels when listening to a piece of music, as well as no subjective sensations such as a chill. They thus confirmed the existence of this musical anhedonia. It is to be distinguished from amusia, which concerns the capacities of sensory perception to music. Amusia, that is not associating with the presence of musical anhedonia, is a rare phenomenon, which appears to involve the lower right frontal gyrus and the upper and right middle temporal gyrus. It is most often the consequence of ischemic or hemorrhagic vascular injury and is more frequent and severe in the presence of an injury to the right hemisphere. Several studies highlight the existence of a musical anhedonia in healthy subjects, not depressed, in the absence of amusia, but also in the absence of a loss of pleasure to the presentation of other stimuli, such as money in particular. We speak of “specific” musical anhedonia to describe a loss of pleasure that only concerns musical stimuli. It is a rare phenomenon. There does not seem to be a relationship between a perception deficit and musical anhedonia. In 5% of people, musical anhedonia is congenital. It can also be acquired following focal brain lesions of various locations. In this case, people with it have lost their ability to enjoy listening to music, which they were likely to experience before. Musical reward appears to be processed by the connectivity that exists between the auditory cortical areas, responsible for analyzing musical content and located at the level of the superior temporal gyrus, and areas of the reward system, responsible for assigning a value, such as the nucleus accumbens (at the level of the ventral striatum), the caudate nucleus (at the level of the dorsal striatum) and the limbic system (amygdala and anterior insula). The enjoyment of listening to music varies from individual to individual on a spectrum from musical anhedonia to musicophilia. Thus, some people are more sensitive than others to the emotional stimuli generated by music. The “Barcelona Music Reward Questionnaire” by Mas-Herrero et al. allows individuals to be divided into three classes according to their emotional and sensory experience of music: “anhedonic”, “hedonic” and “highly hedonic” or musicophiles. The context in which a melody is heard for the first time would be crucial. Indeed, there would be an association between a positive or negative emotional experience with music. It also appears that the same neural circuits are activated when listening to sad or happy music, resulting in dopaminergic release. Musical pleasure seems to remain intact in a wide variety of neurological disorders involving impaired cognitive functions, such as Alzheimer's disease, frontotemporal dementia and even Parkinson's disease. Anhedonia is one of the psychopathological features present in many mental disorders such as major depression and schizophrenia. Although anhedonia is a major symptom of depression, the literature on the subject has not yet established the link between musical anhedonia and depression. When it comes to schizophrenia, anhedonia can be considered a negative symptom of the disease. To date, we have not found any studies linking depression and loss of pleasure specific to music.     

Role of Affect and Cognition in Lay Judgments About the Need for Mental Health Treatment and Willingness to Help

Mental illness has become a major public health concern, but it is rarely studied from the point of view of laypeople. The current research used surveys to investigate ordinary people's perceptions of the need for mental health treatment in a target individual and willingness to help the target. It also investigated the mediating role of affect and cognition in these evaluative processes. Four experiments found that affect mediated the relationship between mental illness and evaluations of the need for treatment, but that cognition mediated the relationship between mental illness and people's willingness to provide help. We concluded that negative affective responses to the presence of mental illness result in increased perceptions of the need for treatment. When personal responsibility for helping was requested, people relied on cognitive processes likely associated with their own ability, knowledge, and willingness to help. This research provides a preliminary understanding of how to approach the treatment of mental illness from the point of view of the public.     

“I’m Coming Home,Tell the World I’m Coming Home”. The Long Homecoming and Mental Health Treatment of Iraq and Afghanistan War Veterans

This study explored the journey of American armed forces personnel from their decision to join the service, through their service in an active military conflict and how these factors may be associated with potential resistance for mental healthcare. The data came from qualitative interviews with 46 OIF/OEF/OND active-duty military, reservists, and discharged veterans of the average age of 25 years, who presented for a new episode of mental health treatment to a large Veterans Affairs Hospital (VAH) in Northeastern United States in 2011–2012. Qualitative analysis of veterans’ perceptions revealed several major themes describing how a mental health diagnosis would negatively impact both their sense of identity and pragmatic career-building goals: enlisting as a career-building avenue, ‘noble superhero’ identity, escaping from hardship, and mental illness as a career-killer. Findings suggest that factors making young veterans resist mental healthcare may be reduced by partnering VAH psychiatrists with career counselors, and by enhancing military leadership’s awareness and understanding about how to support soldiers with emotional and mental health needs, with a goal to eliminating stigma.     

The Role of Music in a Salutogenic Approach to Health

This article introduces the reader to the role of music in a salutogenic approach to health, focusing on lay musical practice in public health policy and mental health promotion. Several participants reported how they used music as an alternative to medication or medical treatment, often transcending pain and suffering through personal, musical practices. The participants described how musicking can enhance coping mechanisms, providing a sense of coherence and zest for life, for example how using music may activate individuals in difficult periods in their lives, and retrieve or mobilise a stronger self. Individuals have learned how listening, playing and singing for self or others can be used as a ‘technology’ to achieve a sense of wholeness in body and mind, often described as ‘musicking’. According to mood, context, need or situation, it is the combination of musical practices, properties and activities that tends to produce a personal or social healing effect.     

Editorial Perspective: A call to collective action – improving the implementation of evidence in children and young people's mental health

With growing mental health needs of children and young people and the increasing demand on children and young people’s mental health services, narrowing the evidence to practice implementation gap has never been more important. Implementation science and research provides useful theory, identification of barriers and facilitators as well as suggested strategies for improved uptake of evidence-based treatments, but the application of these is often limited. Supporting optimal learning and implementation cultures based on collaborative, relational and pragmatic action planning is likely key. We propose suggested next steps and recommendations to move this agenda forward within the children and young people’s mental health field with a ‘call to action’. With the need for specific roles and clear accountability, we emphasise that between clinicians, researchers, consumers and policy makers this is everyone’s business.     

Moderators and mediators on the mental health of young participants in active labour market programmes: Evidence from East and West Germany

This article addresses the mental health of young people taking part in an active labour market programme (ALMP). The subject of the paper follows the demand for research on the ‘permanent impermanence’ identified as a situation characterized by shifting in between different labour market training programmes, unemployment and odd jobs. The research on which the article draws was an evaluation study of an active labour market programme in Germany, known as JUMP. The article uses data derived from a participants’ survey and addresses the following questions: How can the mechanism of ALMP and mental health be described? What affects young people within an ALMP? Are there any differences according to the density of the surrounding labour market? Previous research has explored the impact of unemployment on mental health. This article investigates the possible impact of ALMP, referring to the complex relationship between the density of the labour market and young people's mental health. It then applies data derived from the JUMP participants’ survey to explore the influence on young people. The impact of the density of the surrounding labour market is addressed by separating the available data into East and West German participants. The article finally compares the research findings from young participants in an ALMP with previous research on unemployed young people and concludes with differences between East and West German young people.