Music-Thanatology
andTibetanBuddhism
AConfluenceofWest&EastinthePracticeofCompassion
DEBORAH MARSHALL
Graduate,ChaliceofReposeProject,1996
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Acknowledgements
MylifechangedcompletelywhenIwasacceptedintotheChaliceofRepose
Project,classof1996.IamindebtedtoThereseSchroeder-Shekerforhervision
ofthefieldofmusic-thanatology,thefacultyoftheChaliceofReposeProject,and
myclassmatesoftheclassof’96,allofwhomsharedthevisionandwere
dedicatedtoitsfruition.
IamhonoredtobeaprofessionalmemberofMusic-ThanatologyAssociation
International,whichhastakenupthejobofrefiningandexpandingthefieldof
music-thanatology.
Andfinally,mydeepestgratitudetoJan,GayleandJim;Janforhergrace,
patience,andskillsasmymentor,Jimforhisartisticsenseofstyle,andGaylefor
herediting,andlongtimefriendship.
DeborahMarshall
April,2012
Copyright©2012DeborahMarshall
Music-Thanatology&TibetanBudhism:
AConfluenceofWestandEastinthePracticeofCompassion
Iwascapturedbytheideaofmusic-thanatology sometimeinthelate1980s
whenIwasstoppedatadrive-through windowinthecitywhereIlivedand
workedatalocalhospital. IwaslisteningtoNationalPublicRadio,whichwas
airinganinterviewwithThereseSchroeder-Sheker,wholivedinDenveratthe
time.Theinterviewwasfocusedontheradicalideaofusingharpandvoiceatthe
bedsideofthedying.Schroeder-Sheker believedthatdyingwasaveryspecial
momentinanindividual’slifeandthatthedyingpersonshouldbesurrounded
withbeautyandreverenceandcompassion.AtthetimeIwasaRadiological
Technologistworkinginspecialproceduresandthecardiaccathlab;
coincidentally,Iwasalsotakingharplessons.Forme,theinterviewbrought
forthanepiphanyinwhichseveraldifferentelementscametogetheroutof
nowhereandproducedamostprofoun,andatthetimeunconscioustome,
dramaticshiftinthegroundonwhichmylifewasbeinglived.
InthehospitalwhereIworkedwehadjustrecentlyexperiencedthatmost
dreadedofoccurrences,thedeathofseveralpatientswhodiedduringthe
proceduresweweredoing.Thiswasanewexperienceforme,aswehaduntil
thattimenothadanydeaths,eventhoughtheproceduresweweredoingdidhave
adefiniteriskofthatpossibilityoccurring.Asastaffwewerequitedevastatedby
thesedeathsan,unfortunately,therewasnorecognitionatthattimeofthe
1
mental,emotionalandspiritualimpactthismighthaveonus.Wereceivedno
counselingabouttheseunexpecteddeathsanditwasassumedthatwewould
simply”getoverit”andwewouldgoonwithourworkasusual.
However,IfoundthatIhadbeenimpacteddramaticallybytheseevents.
AfterhearingtheNPRstory,IcouldputintowordswhatIfinallyrealizedIhad
beenfeeling-thatthepatientswhodiedhadnotbeensurroundedbybeauty,
reverenceorcompassion.Theyweresurroundedbythecontrolledchaosofthe
medicalemergency,withalltheelementsofcrashcarts,defibrillatorsand
massesofpeopleintheroomtryingtosavethemwhiletheirfamilieswaited
unknowinglyinthewaitingroom.Aseachcoveredbodywaswheeledoutona
cart,theschedulebecametheprimaryfocus,sincetheroomhadtobecleanedup
andpreparedforthenextpatient.Understandably,theroomwasfilledwith
feelingsofdisbelief,stunnedsilence,griefandguilt.Afternothavinganydeaths
duringthepreviousfouryearsIhadspentworkinginthisdepartment,we
sudenlyhadfive,allfordifferentreasons,inapproximatelyatwo-week period.
Followingtheseunprecedenteddeaths,thehospitalrequestedthatachaplain
blesstheirnew,latestandgreatesttechnologyroom.
InthefinalpartoftheradiointerviewwithThereseSchroeder-Sheker,she
expressedherferventintentionthatsomedayshewouldhaveaschoolforthis
newprofessionof”Music-Thanatology.”Althoughshedi’tknowwhen,where,
orhowthiswouldcomeabout,sheknewthatitwouldbecalledtheChaliceof
ReposeProject. AsIreflectedonhervisionofablesseddeath,surroundedby
beauty,intimacy,reverenceandcompassion,Irealizedthatthisprofessionand
theserviceitofferedwaswhatIwantedtodowiththerestofmylife.
2
Nearlytwentyyearsbeforelearningaboutmusic-thanatology, Ibecame
interestedinTibetanBudhismandspentmanyyearsreading,studying,
meditating,andattendingretreatswithTibetanandAmericanLamasfrom
severaloftheTibetanBudhisttraditions.Fromthesedecadesofstudy, I
becameawareofhowimportantthepracticeofcompassionistotheTibetan
Budhistperspectiveoftheworldandhowsomepartsofthatcouldinformand
balanceend-of-lifecarethroughmusic-thanatology.Thispaperwilladressmy
ongoingjourneyintotherealmsofcaringforthedyingwithprescriptivemusic,
andtheconfluenceofthefundamentalroleofcompassioninbothmusic-
thanatologyandTibetanBudhism.Iwillexplore:
1.Music-Thanatology:itsspirit,practicalities,andintentionsasamodel
foranewwayofdying
2.TibetanBudhism:aspiritualtraditioninwhichcompassionhasa
centralrole,andtheideaofthebodhisattva
3.Compassion:itsdefinitions, presentations,biologyandpossibilities
Iintendtodrawparallels,lookatdifferences,andarriveatanexpanded
imaginationofthepossibilitiesthatexistforthecareofthedying.
Music-Thanatology
Music-thanatology, acontemplativepracticewithclinicalapplications,is
nowaforty-year-oldfield.ThereseSchroeder-Shekerrealizedherdreamandthe
firstschoolofmusic-thanatology wasopenedin1992,atSt.Patrickhospitalin
Missoula,Montana,withthefirstclassgraduatingin1994.Newschoolsof
music-thanatologyhavesincecome intobeing,andaninternationalassociation
3
ofmusic-thanatologistswasformedtenyearsago.Music-Thanatology
AssociationIernationalisanorganizationwithmembersincountriesaround
theworldwhocollectivelyhaveparticipatedinover86,000vigilsforthedying.
Thedefinitionofmusic-thanatologyisfoundontheassociation’swebsite:
“Music-thanatologyisaprofessionalfieldwithinthebroadersub-specialty
ofpalliativecaremedicine.Itisamusicalclinicalmodalitythatunites
musicandmedicineinendoflifecare. Themusic-thanatologistutilizes
harpandvoiceatthebedsidetolovinglyservethephysical,emotionaland
spiritualneedsofthedyingandtheirlovedoneswithprescriptivemusic.”!
Duringamusicalvigilbothpatientandfamiliesreportareliefofphysical,
spiritualandemotionalpain.Thefamiliesfrequentlyfindthatthemusicalvigil
helpsthemtostarttheirowngrievingprocessandcantouchdeepemotions,
whichtheymayhavedifficultyacknowledging.Thestaffcaringforthedying
patientfindthatthevigilcanbringachangeintheatmosphereoftheroom,can
resultinmanypatientsrequiringlesspainmedication,andcanfacilitatedeep
sleep,whereasbeforethevigil,sleepwasnotalwayspossible.
Themusicalvigilcanservetoconnectthestaffwiththeirowngriefandthe
emotionalprocessingthattheymustdoaspartoftheirownself-careinthe
challengingworksituationstheyfaceonadailybasis.Music-thanatologistsare
alsofrequentlycalledupontobeinattendanceduringtheremovalofapatient
fromlifesupport.Themusicalvigilcansupportthefamiliesinthisdifficult
decisionandbringgracetowhatmaybeaverypainful,grief-filledsituation.A
musicalvigilusuallylastsfor45-60minutes..
4
TibetanBudhism
Budhismisanancientreligion,predatingtheChristianerabyfive
hundredyears.TheTibetansofthaterawereanoralcultureandwereawil,
fiercepeoplewhohadconqueredallthelandandpeoplesaroundthem,including
alargeportionoftoday’sChina.Aroundtheyear800CE,thegreatIndian
Budhistsage,Padmasambava,cametoTibet,bringingBudhismwithhim.This
startedanavalancheofchangeinTibet.Ittookabouttwohundredyearsforitto
fullyblossom,butwiththebackingofseveralenlightenedkingsandthecollective
commitmentofthepeople,theTibetansdecidedthattheydidnotneedto
continueaswil,savageconquerors.Withitsvisionofthebasicgooessand
compassionthatisinherentineachhumanbeing,Budhismhadtouchedthe
individualandcollectiveheartoftheTibetanpeopleandwroughtatremendous
change.Sobeganasoo-year project toliterallyinventawrittenlanguage,and
thentotranslateandrecordallthethousandsofBudhisttextsthathadbeen
broughtbypacktrain(atgreatphysicaldangerandheroicendeavor)overthe
mountainsintoTibet.Thisfeattookmanydecades,andtextswerebroughtfrom
allofthefarawayBudhistcountriesincludingIndia,Ceylon,Thailan,and
China.”
ThusbegananationalodysseythattodayhasresultedintheTibetan
peoplehavingbeenconqueredbytheCommunistChinese,theirlandsbeing
takenfromthem,andtheirculturebeingdevastatedbythisbrutaltakeover.And
yet,theTibetanpeoplefirmlyembracedthe1soo-yearhistory ofBudhismand
itsvisionoftheheartofcompassionandgooessthatbeatsineachofus.They
havesurvivedasanexiledpeople,andtheexpulsionfromtheirnativelandhas
5
resultedinthesewondrousandcompassionateteachingsbeingbroughttothe
West.Beforethecommunisttakeover,theTibetanshadlivedinaveryisolated
countrywithalmostnocontactwiththeoutsideworld. Thisenabledthemto
concentratealltheirfocus,attention,andcultureonthefurtherdevelopmentof
theoriginalBudhistteachingsthathadbeenbroughttothemsomanycenturies
ago.
Intheensuingyearssincethelossoftheirphysicalcountry,therehas
beenadiasporaoftheTibetanpeopleallovertheglobe,withpocketsofthemin
manycountries. The14thDaliLama,theexiledspiritualheadofthepeople,
settledwiththelargestnumberofTibetansinDharmsala,India.Thisamazing
mancrisscrossestheglobeeveryyearspeakingaboutandteachingthe
compassionofnotonlyhisreligionbutalsohisverybeing.Heldinhighregardby
theentireworl,hewasawardedtheNobelPeaceprizein1989.TotheTibetan
people,heisthelivingincarnationoftheTibetanenlightenedbeingChenrezig
(AvalokiteshvarainSanskrit),theBodhisattvaofCompassion,andrenownedas
theembodimentofthecompassion ofalltheBudhas.ABodhisattvaisone
whoisaspiritualwarrior,”willingtoenterchallengingsituationsinorderto
alleviatesuffering’c.InTheTibetanBookofLivingandDying,LamaSogyal
Rinpochestates:
“Weneed”bodhisattvalawyers,artists,politicians,doctors,economists,
teachers,scientists,technicians,andengineers,bodhisattvaseverywhere,
workingconsciouslyaschannelsofcompassionandwisdomateverylevel
andineverysituationofsociety…foramoremercifulfuture.”
6
Chenrezigmadeavowthathewouldnotrestuntilhehadliberatedallthe
beingsinalltherealmsofsuffering. Music-thanatologists, likewise, are
dedicatedtothereliefofsuffering.Theyembody theprinciplesofthe
bodhisattva,asmusicalbodhisattvas,offeringacompassionatepresenceasthey
deliverprescriptive musicwhichcreatesan”existentialcaringencounter,the
encounterbetweenthepatientandothersthatcancreatemeaningandalleviate
sufferingby’makingitbearable’ [attheendoflife].”e
Many TibetanBudhistteachersandpriestshavecometotheWest,
settingupcenterstoteachmediationandconductingretreatsintheuniqueand
finelyhonedpracticesofTibetanBudhism. Thisinturnhastriggeredarenewal
oftheconceptofcompassion, andhasenabledhundredsofthousandsof
Westernerstobetouchedbythemessageofcompassionthatissocentraltothe
TibetanBudhistperspectiveoflife.Budhismisrankedtodayamongstthetop
tenreligionsintheworld.v
Intoday’s medicalsetting, thereareamultitudeofreligious andethnic
backgroundspresentatanygiventime.Toservethedyingofanyreligiousor
ethnicbackgroundrequiresthatmusic-thanatologybefirmly groundedinthe
fundamentalpreceptsofinclusivity. Giventhatmusic-thanatology isa
contemplative,spiritualpracticewithclinicalapplications,itcanbeofvaluefor
thoseofanyreligiouspracticewhoarebeingserved inthecurrentmedical
setting.InMusicandMiracles, ThereseSchroeder-Sheker,founderofmusic-
thanatology,writes:
“Thiseffortinbecomingmorefullyhumaninvolves thelonging,the
gesturetowardshearing, receiving, andrespondingtotheDivinewhile
7
beingfullyengagedinthepracticalworkoftheworld.Nothingless…Itis
clearthatthecontemplativemusician, thenewmusic-thanatologist,in
workingwithdeathanddyinginthisway,isattentivetothereceptionof
spiritintomatterandthedissolutionofmatterintospirit.Aconscious,
blesseddeathchangeseveryoneinvolved.Theonewhoissingingvigil
breathesinlight,buttheonewhohasjustcrossedthethresholdbecomesa
sourceofluminosity…togetherherethelivingandthedyingformchoirs
ofcelebrantswhobridgethetwoworldsbydissolvingandcreating
themselvesinthemysticalbodyofChristortheRainbowBodyof
Budhism;ineithercase,thecreativityisasourceoflightfortheentire
community.”
Dr.AliceReich,ProfessorofAnthropologyattheformerChaliceofRepose
ProjectinMissoula,Montana,describedtheUnitedStatesasbeinglikea
“scrambledegg”8withnosingleidentity,ethnicityorreligion.Theinfused
curriculumfortrainingmusic-thanatologistsincludesmanyclassesondifferent
religionsaswellastheirtraditionsandbeliefsconcerningdeathanddying.
Compassion
Compassionisatermthatisnotcommonlyusedintoday’swestern
culture.TheimpulseandintentionoffirsttheIndustrialAgeandthenourmore
recentpost-modernsocietyinthewesthasseemingly madecompassion
irrelevant.Itiscertainlynotanaspectofcorporateorgovernmentalcircles,nor
wouldyoufinditasatopicofdiscussionatmostgatherings,exceptperhapsin
religiousorsocialworksettings.Inmodernoutcome-basedmedicine,where
spiralingcostsandlowstaffinglevelsleadtoburnout,compassionisalltoo
frequentlylefttothechaplainsandhospice.Accordingtoasurveydonebythe
8
SchwartzCenterforCompassionate Healthcare,”only53%ofpatientsand58%of
doctorsratetheU.S.healthcaresystemasacompassionateone,despitestrong
agreementamongpatientsanddoctorsthatcompassionatecareisimportantto
successfulmedicaltreatment…”9Veryseldomisitatopicofmedia,especially
television,unlessitisforaspecialstoryorduringthetimeofsomegreatglobal
disaster.Whenitiscoveredinthemedia,itiscoveredonlyaslongasthestoryis
intheheadlinesandthenitfadesbackintonon-relevance andobscurity.
Whenexploringthemeaningofcompassion,itbecomesquiteclearthat
compassionisasomewhatcontroversial wordinwesterncultureandmeans
differentthingstodifferentgroups.BothTibetanBudhismandwestern
behavioralsciencesdefinecompassionas”thefeelingthatarisesinwitnessing
another’ssufferingandthatmotivatesasubsequentdesiretohelp.”l0
Iscompassionaseparateemotion?Manypeopleseemtoconfuseitwith
saess,pity,sympathy orempathy. Afewlabelitasaformoflove. Again,
westernbehavioralsciencestudies showthatcompassionis:
“…itsownuniqueemotion…adistinctaffectivestate,witharesponse
profilethatdiffersfromdistress,saessorlove….Severallinesof
reasoningconvergeontheassertionthatcompassionisadistinctstatethat
differsfromrelatedstateslikelove,andthatthisstatemotivatesspecific
patternsofbehaviortowards othersinneed.”!’
TibetanBudhismandbehavioral sciencesagaincomeintoagreement,withone
Tibetanmonkgivingaremarkably eloquentdiscourseonthenatureof
compassion,anditsrelationshiptoanddistinctionfrom,saess.Hedescribed
compassionasbeing:
9
“…astate’beyondsaess,’ inwhich theheartisfilledwithadesireto
helpthose suffering. Incompassion, thesightorcontemplationof
sufferingmovesonetoaction….Saessispassiveincomparison…infact
thehighestrealizationofcompassion,known technically as’uncontrived
spontaneousgreatcompassion’ …isadirectandspontaneousreactionto
sufferingthatdoesnotinvolve saessasanintermediatestage….Saess
appears’asifthefacecollapses’, whilecompassionmanifestsasanintent
focusontheotherwhoissuffering,withanexpressionofaffectionand
gentleness. “12
Music-thanatology expressesthisinsimilarlanguage:
“[Music-thanatologists] arenotimmunetoordetachedfromthesuffering
theywitness. Instea,theyaredeeply engage,attentive toeventhe
smallestdetailofthepatient’s andfamily’s needs.Andtheydescribea
deeplovefortheworkandanongoinginterestinlearningmoreandmore
aboutthewaysinwhichmusiceasesthetransitiontodeath. Iwould
suggest thatitistheefficacy ofthemusicthatfacilitatesthepractitioners’
ability tocontinually remainpresenttothedyingprocess/'”
Observance andcontemplationofwestern culturetoday seemtoreveal
somedominantmythsaboutcompassion.W.DavidHoisington,PhD,identifies
sevenmythsthatinterferewiththedevelopmentofcompassioninourculture:
1.Compassion iscommonsenseandjustneedstobedone
2.Compassion isoftenviewed assomethingthatpeopledon’thaveandit
can’tbetaught
3.Thereisnothingthatcanbedonetoimprove compassionintheworld
4.Compassiondoesnotmake adifference initspracticeintheworld
5.Itispossible tohavetoomuchcompassionandthatthiscancreate
unhealthy relationships, withselfandothers
6.Compassion istoosoftandhasnopowertochangethedestructive
natureofman
7.Passionismoreimportantthancompassion=
10
Researchershavefoundthatitispossibletoteachcompassion.ISKaren
Armstrong,religioushistorianandwinneroftheTED(Technology,
Entertainment,andDesign)Prize, whichgrantsrecipients$100,000toput
towardrealizingawish,writesaboutcompassionasateachabletrait. Sheused
themoneyfromthisprizetocreateTheCharterforCompassion.wHerbook
entitledTwelveStepstoaCompassionate Lifedescribeshowhumanbeingscan
teachthemselvestobecomemorecompassionate. 17TibetanBudhismand
westernbehavioralscienceresearch studiesagreethatcompassionispartofour
geneticmakeupandthatourheartsandourbrainsrespondverybiologically to
thesufferingofothers. Aditionally, itappearsthatweare”wired” tomove
towardsthesufferingofotherswiththedesiretoalleviatethatsuffering.In
VisionsofCompassion,TheDaliLamastates; .
“Ibelievethatatthemostfundamentallevelournatu~eiscompassionate,
andthatcooperation, notconflict, liesattheheartofthebasicprinciples
thatgovernourhumanexistence.Agenuinerecognitionandappreciation
ofthisfundamentalnaturewillhaveprofoundethicalimplicationsfor
boththeindividualandsociety…Finallythereisthehumanimpulseto
createbeauty.Wecanseethecelebrationofbeautyinallcultures. Often
itisthroughtheexpressionandappreciationofbeauty thatweunlockthe
compassionatepotentialinthehumanheart.’?”
Beautyisinherentinmusicthanatology. Australianmusic-thanatologist
PeterRobertshasdocumentedthatallthosewhowereconsciousduringmusic
vigilsexpressedhowbeautifultheexperiencewas.Inavigilreportofapatient
whosefamily waspresentwhenheplayed andwhodied,Robertsstates:
11
“[Rose]acknowledgedherthankstomethroughhereyes.Iheldherhand
andsheheldmine-hergripwasfirmandlong…wehadadeep
connection.Shesaidtoherdaughter,’Nowdoyouunderstand?’and[her
daughter]replie,’Yes,itwasverybeautiful.’ Itseemedliketheyhada
sharedsecret,ortherewassomething[Rose]hadexperiencedthatshewas
tryingtolettheothersknowaboutbut[felt]theywouldnotunderstand.’:”
ClaudiaWalker,music-thanatologistpracticinginWashingtonState,
speaksofherpassionfortherolebeautyhastoplayinend-of-lifecare.”AsIget
older,moreandmoreIwantbeautyaroundme.Iwantcolor.Iwantflowersand
art.Andsowehavethislivingartthatwebringintoplacesoffearandanxiety
andIjustthinkit’sincrediblyimportant.Itdoeshavearipplingeffect.”>«
ThenarrativeofavigilIdeliveredalsorecordstheperceptionofbeauty
andhowitaffectedthepatient.”Onceagainsilenceentersthevigilspace.[The
husband]isrestingquietlywithasoftcountenancearidhiswiferemainsonher
sidewithhereyesclosed.Heopenshiseyesandtellsmethat[thevigilhasbeen]
anamazingexperienceandthatthemusicisverybeautifulandrestful.?»
Compassion,themostfundamentaltenetofBudhism,isalsothe
motivationofthemusic-thanatologist.”Music-thanatologistsconsidertheirwork
ascreatingasacredspace,akindofmetaphorical’containing’spaceborderedby
thepatient,themusic-thanatologist,andtheharpmusic.Itistheinter-
relationshipbetweenallthreethatcreatesthesacredandsafe[compassionate]
spacethatallowsfortheworkofleave-taking.”>»
12
AssumptionsofMusic-Thanatology
Music-thanatologyhassixfoundationalassumptionsasstatedbyits
founder,ThereseSchroeder-Sheker.ss Workingfromthesefoundational
assumptions,Iwillofferevidencewhichdemonstrateshowcompassionisa
centralpartofmusic-thanatologyjustasitisofTibetanBudhism.
FirstAssumption
Dyingisaspiritualprocessandisanopportunityforgrowth.
Prescriptivemusicdeliveredatthebedsideofthedyingservestoenhance
thispossibilitybecauseofitsinherent abilitytomediate,connectandsoothe.
MichaelKearney,MD,medicaldirectoroftheAnamCaraprojectfor
CompassionateCompanionshipinLifeandDeath,usesthetermsoulpainwhen
hedescribesthepersonwhoisdisconnectedfromthedeepestaspectsofhimself
andsoulworkasthequestforwholenessandmeaning.s-Musiclivesatthe
“thresholdofmatterandspirit.”25 Boethis,asixth-centuryRomanphilosopher
andstatesman,describedmusicasanall-pervadingforce,streamingthroughthe
universe,asacurrentthatweavesbody,soulandspirittogether.26InSeptember
2004,intheWelcomingAdresstotheparentsofincomingfreshmanstudentsat
theBostonConservatoryofMusic,musicianandeducatorKarlPaulnackhada
similarobservation:
“Oneofthefirstculturestoarticulatehowmusicreallyworkswasthe
ancientGreeks…theGreekssaidthatmusicandastronomyweretwo
sidesofthesamecoin.Astronomywasseenasthestudyofrelationships
13
betweenobservable,permanent,externalobjectsandmusicwasseenas
thestudyofrelationshipsbetweeninvisible,internal,hiden,objects.
Musichasawayoffindingthebig,invisiblemovingpiecesinsideour
heartsandsoulsandhelpingusfigureoutthepositionofthingsinsideof
“us.
PaulnackwaslivinginManhattanatthetimeoftheSeptember11,2001attack.
HenoticedthatthefirstorganizedpubliceventwastheBrahmsRequiem,
performedbytheNewYorkPhilharmonicatLincolnCenter.Thatwasourfirst
communalresponsetothetragedyoftheWorldTradeCenter,oneinwhich
music,inparticular,ledtheway.v
Themusicusedbymusic-thanatologistsiscontemplative,quiet,
meditative,andprescriptive.Theterm”prescriptivemusic”incorporatesgenres
ofmusic,the”rawmaterials”ofmusic,thedeliverystyleofthemusic,thestateof
thepatient,andtheieionofthemusicthanatologist.Whenanyoneofthese
elementsisnotpresent,itceasestobeprescriptive.
Genresofmusicutilizedbythemusic-thanatologist includebutarenot
limitedtoGregorianchant,lullabies,hymns,folkmusic,andblessings.Sincethe
dyingindividualhasnoenergytogive,themusicanditsdeliverymustembrace
andsupportwhateverishappeningwiththepatient,thusallowingthepatientto
simplyreceive.
Therawmaterialsofmusiccouldincludemelody,rhythm,mode,key,
dynamics,harmony,intervals,repetition,andsilence.Silenceisanessential
elementofmusic,especiallymusicplayedatthebedsideofthedying.Musicand
silencearetwoaspectsofthesamereality,butconstantmusicisactually
numbingtothelistener.Throughthealternationofmusicandsilence,the
14
silencebecomesricherandthemusicmorealive.28 Inthedeliveryofthis
musicalprescription,themusic-thanatologistisinaconstantstateoffocused
attentionandobservationofthepatient. Thisrequiresanawarenessof
everythingthatisgoingonintheroomwhilesimultaneouslyfocusingonthe
patientsothatthepatient”leadsthevigil.” Themusic-thanatologistisobserving
countenance,bodymovements, respirations,pulse,temperature,andanyverbal
cuesthatthepatientmightexpressifconscious.Alteringthemusicandits
delivery,asneededinthemoment,breathbybreath,themusic-thanatologist
respondstowhateverthepatientisexpressing.Thisiswhatmakesthemusic
dynamicandprescriptive,alive,anembodimentandpracticeofcompassion.
SecondAssumption
Themusicaldeathbedvigilisnotmerelyamechanicalfingertipskill,but
acoemplativepracticewithclinicalapplications.
Themusic-thanatologist isnotjustplayingarepertoireofmusicalpieces..
Theprescriptivedeliveryofmusicwithharprequiresatouchontheharpstrings
thatproduces”living,streamingmusicasanactivityoflove.t’= Theharpisso
perfectlysuitedforthissituation,asitisaportablepolyphonicinstrument. The
harpsusedarenotsmalllapharps butlarger leverharpsthathavelongerstrings,
moreoctaves,andarecapableofproducingrich,deep,warmtonalsoundsand
timbrethatisnotstimulatingtothepatient’sbodysystems.Harpstringsmovein
acircularpatternthatdoesnotinvadethespaceofadyingperson.avEthno-
musicologistMaruisSchneiderreferstothealchemicalvisionoftheharpas
standing”ontheborderlinebetween lifeanddeath…theyareconcrete,visible
15
appliancesthatallow invisibleenergiestoarise, thereby serving asmediators
between thedarkandlightworld.t’e-
Thevoiceistheotherinstrumentusedin”anointing thepatientwith
sound.”> Music-thanatologists aretaughttodevelopsingingasaconscious
spiritualactivity, bringingspirituality toearth.”33 AccordingtoSchroeder-
Sheker,onemustallow oneself tobecontinually impressedbythemusic, creating
theopportunity forthespiritual activityoffindingthevoice,freeingit,and
creating luminosity andproportion.a+ Marius Schneiderfurtherstates:
“…heorshewholetsthebreath,hencetheirlifeforce,flowconsentingly
asawilling soundsacrificefromthedepthsoftheirbody, singstheir
life…soundsetsthebodyofthesinger inperceptiblevibration…thevital
powerofancientsacredtextsorsyllableslayintheirdelivery(intention,
attitude)ratherthenprecisionofarrangements.t'”
Andfurther,
“Becausemusicisgatheredupand’swallowed’internallythroughthe
auditory system, thesurfaceoftheskin,andthecapacity oftheheartfor
feelingandresponsivity, thevigilmusic begins asapurely external
auditory administrationbutisquicklyanddeeplytakenintothebodyand
soul(orinteriority) ofthepatient” [andfamily orstaffpresentduringthe
vigil.] 36
InTheTibetan BookofLivingandDying, LamaSogyal Rinpoche
contendsthat”themostessentialthinginlifeistoestablishanunafrai,heartfelt
communicationwithothers, anditisnever moreimportantthanwiththedying
person….Sothefirstessentialthingistorelaxanytensionintheatmosphere.”37
Indeed, many patientsandfamilies commentonhowcalm, relaxedandserene
theroomhasbecomeasaresult ofthemusic-thanatology vigil.
16
ThirdAssumption
Deathisnotanenemy;itispartofthelifecycle.Itisunderstoodthat
whenallmedicalandsurgical procedureshavebeenexhausted,andthat
thepatie’s deathisimmine, deathisnotafailure.
FromtheTibetanBudhistperspective, LamaSoygalRinpochestates:
“FrommypointofviewasaspiritualpractitionerIbelieve dyingtobea
greatopportunityforpeopletocometotermswiththeirwholelives;andI
haveseenmanypeoplecometotermswiththeirwholelives;andIhave
seenmany,manyindividuals takethisopportunity, inthemostinspiring
way,tochangethemselves andcomeclosertotheirowndeepesttruth.?”
InTheGraceinDying,Kathleen Dowling-Singhincludessuchtermsas
withdrawal,radiance, interiority,silence, sacreess,transcendence, knowing,
intensityandperfectioninherdescriptionofthe”nearing-deathexperience.ras
JanMcArthur,music-thanatologistandformerpsychiatric nurse, seesthat
“Deathistightly woven intootheraspectsoflife,”andshequotesElisabeth
Kubler-Rosswhenshecallsit”thefinaldevelopmentaltaskoflife.”40
Incontemporaryculture,alltoooftenthisisnottheprevailingattitude
towarddeath.”Deathismorefeared thancelebrate,dyingissilence,anddying
peoplearemoreoftenthannothidenaway, relegatedtoamedicalstrugglethat
isinevitably, ultimately” 10st.41 Deathanddyinghavebecomeaprivatematter,
almostananonymousmatter. Eveninthefaceofstrongmovements toward
hospicecare,researchindicatesthatmostpeopledieinhospital,despitestudies
thatindicatethatmostpeoplewouldprefertodieathome. Wheninthepresence
ofadyingperson,mostofushavenoculturalmodelforwhattodo,howto
behave,andwhattosay.Manypeopleareuncomfortablewithsilencebecause
17
theythink thattheyaresupposedtobe”doing something” insteadofjustbeing
present(thepartoftheword “human being” towhichwetendnottopaytoo
muchattention, alltoooftenthinking ofourselves as”humandoings” insteadof
“humanbeings”).
Whatdyingcallsforisrelationship fromthelevelofbeing,becausethe
dyinghavenomore”doing”tobedone. Many dyingpatientswhohavetalkedto
caregiversandchaplainshaverelatedthatwhattheyreallywantisforsomeoneto
listen-truly, attentively listentothem.Thisisthelastchancetocometo
reconciliationwiththemany threadsofthelifelived. Intheprocessoftruly
listeningwithattentiontothedyingperson,thelisteneris”confrontedupclose
andpersonal” withtheirownmortality, andthisiswhatmostpeopledonotwant
toconfront, admit, orcontemplate.
Lama Sogyal Rinpochespeakscandidly ofhowone’s ownmortality
becomesmore obviouswhencaringforthedying:
“Workingwiththedyingislikefacing apolishedmirrorofyourown
reality. Youseeitinthestarkfaceofyourownpanicandofyourterrorsof
pain. Ifyoudon’tlookatandacceptthatfaceofpanicandfearinyourself,
howwillyoubeabletobearitinthepersoninfrontofyou?Whenyou
cometotryandhelpthedying,youwillneedtoexamineyourevery
reaction, sinceyourreactionswillbereflectedinthoseofthepersondying
andwillcontribute agreatdealtotheirhelpordetriment.Caring forthe
dyingisitselfadeepcontemplation andreflectiononyourowndeath.Itis
awayforyoutofaceandworkwithit.Whenyouworkwiththedying, you
cancometoakindofresolution, aclearunderstandingofwhatisthemost
importantfocusoflife,”?
Hegoesontostatethatinworking withthedying,”…wefindourselves inthe
beginningsofanunboundedcompassionthatwemayneverhavesuspected.”43
18
Thereisoftenagreatdealofsufferinginthedyingprocess.Accordingto
R.M.Liebanas,inhisarticleShame,DeathandDyingpublishedinPalliative
Medicine:
“…sufferingincludestheexperienceofseverepain,’sideeffectsand
complicationsoftreatments,lossofroles,lossofperceivedfuture,and
existentialandspiritualconcerns.Thislattercategoryincludes
hopelessness,futility,meaninglessness,disappointment,remorse,death
anxietyanddisruptionofpersonalidentity.Itisthislessacknowledged
existentialsufferingthatgetshidenwhenthedyingprocessisitself
hiden.Perhapsitisanapparentinabilityto’bewith’thisexistential
sufferingofanotherthatcontributestopeople’sinabilitytospeakoforbe
withdeath.?”
Thus,deathanddyinghavebecome”shamefuldimensionsoflifethatneed
tobehiden,deniedandavoided.”45Thisimageisinoppositiontotheimageput
forthbymanyreligions,thatofdeathasthefinalaccomplishmentoflifeandthe
onlywaytoeternallife,orfromtheBudhistperspective,thenextincarnation.
Liebanaslaments”thisimageofshame,sinceanessentialtaskofbecomingfully
humanistoincorporatedeathanddyingaspartoflife.”46 Themusicvigil
providesthe”container”inwhichconversation,reconciliation,contemplation,
andbeingpresentcanalloccur.Itopensupaspace,whichcanholdeverything
thatemerges,andwhichmaynothavebeenpresentbeforethevigil. It
acknowledgesthemysteryandpossibilitiesofdeath.
19
FourthAssumption
Thewayinwhicheachpersondiesisasimportaasthewayinwhich
thepersonlived,meaningthatbeauty,reverence,dignityandiimacy
areceraltohumanityatanytimeinthelifecycle,andespeciallysoin
death.
Theideaofa”gooddeath”isacentralcomponentinthisassumption.
Whatdoesthatphrasemean?Howcanbeauty,reverence, dignityandintimacy
bebroughttoasituation,whichisfullofphysical,emotional,andspiritual
suffering?Howcanthese”graces”bebroughttoadressthegriefandlossforthe
familyandfriends,nottomentionthe”messiness”ofbodysystemsthatare
shuttingdown,withalloftheaccompanyingsensoryimpressions?Tothemusic-
thanatologist,themusicalvigilistheopportunitytobringthesegracestothe
bedsideofthedyingandtothegrievingfamilies.LamaSogyalRinpoche
commentsthat:
“Ihaveoftenseenalsothatdyingpeoplewhoaresicklongtobetouche,
longtobetreatedaslivingpeopleandnotdiseases…agreatdealof
consolationcanbegiventotheveryillsimplybytouchingtheirhands,
lookingintotheireyes…orbreathinginthesamerhythmgentlywith
them.Thebodyhasitsownlanguageoflove;useitfearlessly,andyouwill
findyoubringtothedyingcomfortandconsolation.”?
Themusicvigiloffersagreatmanyofthesegraces.Thesolefocusof
music-thanatology,accordingtoShroeder-Sheker,is”tohelpthepersonmove
towardcompletionandtounbindfromanythingthatprevents,impedesorclouds
atranquilpassage.”48 Theworkofthemusic-thanatologististohelptheperson
completetheworkofleave-taking.JeriHowe,music-thanatologistpracticingin
20
Everett,Washington,callshermusic-thanatology workSacredHarmoniesand
offersitasalivinglanguagethatspeakswithoutwords.Likemanymusic-
thanatologists,sheunderstandshermusicistobemusicalmedicinethatis
prescriptivetothepatientandconveys asenseofserenityandconsolationthat
shedescribesasintensely soothing.Whileitisdeeplyspiritual,Howe also
describesitas”verypractical…[helping]peopletosleeporfindpeace.”49
“Researchsupportsthetherapeuticvalueofmusicinpalliativecare. Ithas
beenfoundtoreducedepression, tosupplementpaincontrolmethods,(cancer
patientswholistenedtomusichadasignificantreductioninpain), andto
enhancecommunicationbetweenthepatientandfamily andbetween thepatient
andclinicalandpastoralcareteams.Inadition,notonlywassufferingasan
emotionalexperiencereduce,buttheactualsensationofpainexperiencedwas
reduced.”so TibetanBudhistteachingsechothisverythought:
“Budhistmastersspeakoftheneedtodieconsciously withasluci,un-
blurre,andsereneamentalmasteryaspossible.Keepingpainunder
controlwithoutcloudingthedyingperson’s consciousnessisthefirst
prerequisiteforthis,andnowitcanbedone.Everyoneshouldbeentitled
tothatsimplecompassionatehelpatthismostdemandingmomentof
passage.’?’
FifthAssumption
Music-thanatology constalyrecognizesthatthiswork,nomatterhow
skilled, isnotmerelyacareer.Itisavocation.Thisorieationrequires
clearieionandatteion, toberenewedwhenservingateach
deathbedvigil.
21
Inthisassumptiontheparallelsbetweenmusic-thanatologyandthe
TibetanBudhistteachingsonieionandatteionruncloselyside-by-side.
InTibetanBudhism,theuseofintentionandattentionaredirectedtowardsthe
manyformsofmeditationpractice.Inmusic-thanatology,thefocusisonthe
skills,bothinteriorandexterior,thatthemusic-thanatologistdevelopsand
bringstothebedsideofthedying.Asstatedpreviously,bothTibetanBudhism
andwesternbehavioralsciencesagreethathumanbeingsare”hardwired”toact
withcompassionandtomovetowardsthosesufferinginordertoalleviatethat
suffering.
Oneofthemostintrinsicandessentialofalltheelementsthatmakeupa
musicalvigilistheieionofthemusic-thanatologist.Theintentionistobe
fullypresenttothedying.Themusic-thanatologistpromisesatgraduation”to
lovinglyservethephysical,emotional,andspiritualneedsofthedyingwith
prescriptivemusic.”Tofullymanifestthisintentionrequiresatteion.The
attentionrequiredisnotthepassiveformofattentionthatissimplyreactiveand
notdeliberateinanyway.”Whenattentionremainsdirectedatanobjectand
thereisashiftinclarityandviviess,weexperienceactiveattention.t’ssThe
formofattentionthatthedyingpersonrequiresisactiveatteion.Thisactive
attentionrequiresacontinualreturningagainandagaintowhatispresentin
eachmomentofthemusicalvigil. “Activeattentionisvolitional,stable,and
inclusive.Activeattentionisnotdisruptedbysounds,thoughts,sights,orother
eventsinourexperience.t’seTobepresentinthiswayservestheintentionofthe
musicalvigil. Theresultofthistypeofpresenceallowsfornewdimensionsofthe
expressionofthemusicandforincreasedattentionandawarenessforthemusic-
22
thanatologist.Forthemusic-thanatologist,thisactive attentionisactualized
throughanartisticidentitythatisunfailinglylinkedtoservice.Thisactive
attentionisthevehiclethroughwhichmusicandmysteryaremadeintimatein
thepresenceofthedying.
Creatingthisactive attention requiresanongoing, dailyspiritual
interioritypracticeonthepartofthemusic-thanatologist. Beingfullypresent
andservingineachmusicalvigilrequiresthedevelopmentofconstantrenewal,
andarefinementofthosepersonal qualitiesthatallow themusic-thanatologist to
takeofftheirownprotective armoringandbespiritually naked.Such
vulnerability canthencreateanopenheartthatmaybepiercedbytheneedsof
thedying,enablingthemusic-thanatologist torespondwithliving,streaming
musicthatisanaudibleexpressionofcompassionandlove.”Thehumanheart,
initsphysicalandenergeticforms, appearstobeacruciblethatholdsthe
potentialoftransformingourmental, emotionalandphysicalbodiesduringour
lives,andoffacilitatingtheirgreat changeinformfromonestatetotheother
duringdeath.t’e+ Activeattentionischaracterizedbythequalitiesofstabilityand
clarity-“stabilityinattentioniscalledmindfulness andclarityinattentionis
calledawareness.”ss Thisactive attentionisanunderlying principleinall
Budhistpractices.Throughthelensofactive attention, theintention,structure,
principlesandintelligenceofone’sspiritualpracticebecomemuchclearer. This
activeattentionisalsoanunderlyingprincipleinthemusicvigil.Onceattention
ispresent,theappropriateactions, skillsandcompassionflowquitenaturally.
Themusicalvigilcouldbecompared tocertaintypesofmeditationinaction, such
aswalkingmeditation,TaiChiorAikido.Theintentionisreliefofsufferinginits
23
manyformsasitmanifestsineachmomentofthevigil.Thestructureofthe
musicalvigilcouldberelatedtotherawmaterialsofmusicandthethematic
materialsofferedinresponsetothepatient.Theprinciplesandintelligenceofthe
musicalvigilaredirectlyconnectedtotheabilityofthemusic-thanatologisttouse
theliving,streamingmusicbothvocallyandontheharpinsuchamannerasto
actualizetheintentionofreliefofsuffering.Thus,inmanywaysthemusicalvigil
becomesanactivityofbothcompassioninaction,andmeditationinaction.
TheSixthAssumption
Theeducationofindividualsandcommunitiesindeathanddying
processesshouldbesupported,andissuesoflossandleavetakingshould
notbeignoredorreducedtolegalorcorporatemedicaldecisions.
Dyingintwenty-firstcenturyAmericaisavastlydifferentprocessthan
dyingwasin1900America.In1900,themajorityofpeoplediedathomewith
physicianscomfortingthemandtheirfamily.Today,althoughmostpeoplesay
theywouldprefertodieathome,57%ofpeopledieinahospitaland19%diein
nursinghomes.Thus,76%ofthepopulationisnotdyingwheretheywouldprefer
todoso.56Aditionally,thecontextinwhichdeathisexperiencedintheWest
hasshifte,andthesocialperspectiveofpostmodernsocietynolongerprovides
thesupportthatenablespeopletoemotionally,mentallyandspirituallyprepare
forandcopewithdeath,dying,griefandlossinameaningfulway.
Acentralquestion,giventheabovefacts,ishowcanwebringbeautyand
intimacyintothehospitalandnursinghomeroom,asthisiswherethemajority
ofpeoplewilldie?Musicthanatologycansupportthemeetingoftheneedsofthe
24
dyingandtheirlovedones, creatingasacredspacerightinthehospitalor
nursinghomeroom, andprovideacontextwithinwhichthepossibilitiesfor
meaning,connection,andcompassionate carecanoccur forthepatientand
families.
Westerncultureprovidespeoplewithtangiblessuchaslawsandlawyers,
willsandtrusts, andprepaidfuneral plansthatprovidethemechanismstodeal
withthephysicalleveloftheaftermathofdying. Wehavestartedtoprovide
livingwills,advanceddirectives, medicaldurablepowersofattorney, andother
legaldocumentsthatgivethedying persontheability andthelegalrightto
declarewhattheywantanddon’twantintermsofmedicalinterventionwhen
theyarediagnosedwithaterminal illness, sufferacatastrophicinjury, orare
dying.Unfortunately, however, toomany timesthesestatements.arenot
respectedorfollowedbydoctorsandevenbyfamilies.
Thebiomedicalculturalmindset stillholdstheviewthatdeathisthe
enemy andmustbeprevented atallcosts.Palliative careandhospiceprinciples
arestillnottaughtinmanymedicalschoolsandresidencyprograms.Ifthedying
patienthasnothadthatallimportant talkwiththeirdoctorandfamily inwhich
his/herwishesaremadeveryclear, advanced directives canfallbythewaysideas
familiestrytocopewiththedeathforwhichtheyarenotreallyprepared. When
medicaltreatmentcannolongerstaveoffdeath, deathbecomesaspiritual
problem,withthemedicalrolemoving fromtreatmentandprevention to
palliationandcomfortcare.Inthistypeofsituation,themusicalvigilcanprovide
theinteriorspaceneededforbothreflection,andforthepatientandfamilyto
considertheoptionsandstarttheprocessoflettinggo:
25
Thebeginningsoftheseproblemslieinourpostmodernculturalstory,the
storywetellourselvesaboutourselves.IntheWest,ourstorynowisallabout
distractionfromanddenialofdeathasanaturalpartofthelifecycle.Weworship.
youthandallthingsyouthful,agingisseenassomethingtobeavoidedatall
costs,andtheelderlyanddyingarehidenawayinnursinghomesorhospitals.
Collectively,ourattentionisabsorbedbyendlessconsumerism.Mostpeopleare
workingmanyhoursaweek(sometimesatmultiplejobs)topayforalloftheir
“stuff.”Ourchildrenaredemandingthatparentsprovidethemwiththelatestin
costlytechnology,designerjeansandshoes.Asasociety,wehavelittletime,
energyandattentionforspiritualendeavors,meditationpractices,retreats,or
evenregularchurchattendance.Withsomanypeopledrowninginthiscultural
story,itisnowonderthatwearelackinganyformofacknowledgmentthatdeath
willcometoeachandeveryoneofusandcouldcomeatanymomentinanyform.
Thus,wecollectivelyandindividuallyarecaughtunawareandunprepared.We
tellourselvesthattalkingaboutdeathismorbi,andevengosofarastosaythat
talkingaboutdeathwillsomehowhastenit.Wedon’tseemtohavethe
knowledge,skills,orwisdomtotalkaboutdeathinanon-catastrophicway,asthe
naturalendingofthelifecycle.
LamaSogyalRinpochecommentsthathewasshockedbythecontrastin
attitudestowarddeathbetweenEastandWest.Hestates:”ModernWestern
societyhasnorealunderstandingofdeathorwhathappensindyingorafter
death.”57Hegoesontosaythatmostpeopleeitherdenydeath,believingitis
nothingbutannihilationandloss,ortheyhaveaverynaive,thoughtlessattitude
thatitisnothingtoworryaboutorhavenotconsidereditatall.Theseareallnice
26
theoriesuntiloneisactually experiencinghis/herowndeathorthedeathofa
lovedone.Noneoftheseattitudesadressthethreephasesofdying: thedying
process,theeventofdeathitself,andthestatusofbeingdead.Eachoneofthese
partshasitsownphysical, emotionalandspiritualsuffering. Theideathatis
emergingintopopularcultureofa”gooddeath” isstillamudleofhalf-formed
ideasthatvariesamongreligions, family, cultural, andmedicalcommunities.
InTibetanculture,thelastdaysofone’slife,thedyingprocess,theevent
oftheactualmomentofdeath, theimmediatetimeafterphysicaldeath, anda
certainspecifiedtimeafterdeathareallconsideredtobethemostimportant
timeinalife.Accordingly, theTibetancultureandTibetanBudhism teachits
peoplehowtoprepareandwhattodoforthisall-importanttimeattheendof
life.Interestingly, thissameviewpoint waspresentinearlyChristianity.The
earlyChristianRomanChurchdevelopedtheordodefunctorum, apurification
ritualforthedying,inthefourthorfifthcentury. 58Infifteenth-century Europe,
theArsMoriendi(theartofdying)movementaisedpeople:
“…topreparethemselvesfordeatheverydayoftheirlives-andtoseethat
theirchildrenlearnedtofocusontheperilsoftheirowndeathbedscene
ratherthantobecomeattached totheamusementsandtemptationsof
earthly life.Thegooddeath wasredemptionandgrace; everything else
wasoflittlevalue.?”
Associetychange,sodidourperspectiveonlifeanddeath.
Unfortunately, verylittleoftheattitudesandritualsabouttheimportanceof
beingpreparedfordeathanddyingcamewithusintothetwenty-first century.
Tocompoundthisproblem,ourcultureisthat”scrambledegg”characterizedby
27
anthropologistAliceReich. Weareamixofmultipleethnic,religious,cultural,
historicalandfamilialbeliefs,customs,traditions,andlanguages.Whilethisis
enrichingtooursocietyasawhole,itcanalsobringaboutmisunderstandingand
conflict.Onecommonexampleoccurswhenalargeandlovingfamilytriesto
gatheraroundthebedsideofahospitalizedfamilymember.Thiscustomis
traditionalinsomeethnicgroups,asistheopenexpressionoffeelings.Intense
anddemonstrativefamilygatheringscanunnervehospitalpersonnelwhoseown
culturalrootsmaybelessexpressive,andsuchgatheringsmayevenbeagainst
hospitalpolicies.Suchsimpleactsastouchingandsingingtoadyingpersoncan
bevitalwithinoneethnictraditionandmystifyingorunsettlingtoanother.”60
Sointothisculturalstoryenterstheprofessionofmusic-thanatology.
Whenaskedhowtheywanttodie,manypeoplesaytheywanttodiequickly,
quietly,andintheirsleep.Tomanypeople,thisconstitutesagooddeath.
However,manyexperiencedhospicecaregiverstendtowardadifferentview.
Whentheirturncomes,theywouldwanttocompleteunfinishedbusiness,take
leaveofthepeoplemostimportanttothem,andreflectupontheirlivesandtheir
relationshiptoGod.Theseactionsrequirebothtimeandawareness.Driftingoff
tosleepandthendyingwouldbeaneasyending,butonlyaftertheyhadthe
opportunitytodowhatmustbedoneduringthedyingprocess.
Onesourceoffrustrationtophysiciansandnursingstaffistheirinability
tospendenoughqualitytimewithadyingpatient,andqualitytimeisoneofthe
criticalcomponentsofcompassionatecare.Timeinthemusicalvigilis
characterizednotsomuchbylineartimebutbysoultime.Thus,thesacred
spacecreatedbythemusiciswheretheinnerworldsandtheouterworldsmeet
28
inthephysicalityofthemusicalvigil. Thosewhohaveparticipatedinamusical
vigilfrequently sayitisasiftimehasstopped.Themusicalvigilusually lastsfor
aboutanhour,butthereisnosettimeandmusic-thanatologists arenot
constrainedbylineartime. Instead, thelengthofthevigilisdeterminedbyhow
muchmusicandreflectionisneededbythepatient.Duringthevigil,themusic-
thanatologistisfocusedonanddedicatedsolely tothepatient,arareeventin
today’s world.Routinecareisusuallysuspendedduringthistimeandphonesare
turnedofftoeliminateinterruptions. Thisallows forthemaking ofmore
intimateconnectionsbetween thedyingpatientandthefamily, thestaffandthe
music-thanatologist. Byproviding”sacredspaceforpatientsandfamilies, it
operateswithintheboundariesofthemedicalinstitutionwhiledelivering the
moreelusivequalitiesofbeauty,raptattentionandlove.”61 Thisspecialtimeis
oftenrememberedbyfamily membersyearsafterexperiencingavigil.They
frequentlydescribethecontinuedawarenessthatsomethingveryspecialandout
oftheordinaryhappenedinthatspace, andrecallitasapotentexperiencefor
themselvesandtheirlovedone.Thesesamefamilymembersspreadthewordto
friendsandeventostrangersabout howmusic-thanatology benefitedthemand
theirlovedone.
Institutionsthatemploy music-thanatologists expressthebeliefthat
music-thanatology impactsthecultureoftheirinstitutions.Theseinstitutions
practiceagreaterattentiontocompassionateend-oflife-care,andthiscan
influencebothpatient’s andphysician’s choiceofplaceforcare. Staffat
institutionswheremusic-thanatology isprovided feelthattheycanofferan
aditionalchoiceincompassionatecare,especially whenthelimitsofbio-
29
medicaltechnologiesandpharmaceuticals havebeenreache,andwhenthe
symptomsofagitation, fear,anddeepemotional painforthepatientandtheir
familiesarenotbeingrelieved.
Music-thanatologistsarecalledupontoprovidein-serviceeducationto
physiciansandstaffintheseinstitutions.Theyalsoattendmedicalrounds,
educatingstaffaboutwhatthemusicalvigilcanoffertotheirpatients. Music-
thanatologistsprovide similareducationwithinhospiceorganizations,andwithin
nursinghomesettings.
Intheworldoutsideofthemedicalinstitution,music-thanatologistsare.
makingoutreacheffortstothegeneralpubicbygivingtalkstochurchandcivic
groups,atseniorcitizencenters,andevenhighschoolcareerday.Manymusic-
thanatologistsplayatmemorialservicesandfuneralsforthosepatientswhohave
died. Theyarealsocalledupontoplayatmemorialservicesthatareperiodically
heldinmemoryofpatientsthathavediedinthehospital.Music-thanatologists
participateinconferencesondeathanddying,hospiceandpalliativecare.There
havebeennumerousnewspaper, magazine,andprofessionaljournalarticles,as
wellastelevisionshows anddocumentariesonthefieldofmusic-thanatology.In
thePacificNorthwest, music-thanatologists,throughpublicconcertsthatinclude
talksbyfamilieswhohaveexperiencedamusical vigil,educatethepublicabout
music-thanatology.
Throughallofthesemediums,practitionersofthefieldandvocationof
music-thanatologyaremodelingnewideasondeathanddying,thushelpingto
createamorecompassionatesociety.
30
Conclusion
Musk-thanatology andTibetanBudhismbothcomefromthepointof
viewofcompassion-recognizingsufferingandreaching outtoalleviatethat
suffering. Theoneeventthatallhumanbeings,richorpoor, manorwoman,will
experienceisdeath.Formostpeoplethiswillinvolvesuffering onaphysical,
emotionalandspirituallevel. Formusic-thanatologists,asmusicalbodhisattvas,
theywillembody compassionthroughtheirmusic, theirpresenceandtheirrapt
attention.Theywillalsomodelthepossibilitiesofnewideasincaringforthe
dyinginourmedicalsystemsthatarestrongintechnology andalltoooftenweak
incompassionatecare.Eachmusic-thanatologistcanbeabodhisattva, aspiritual
warriorwhoiswillingtoenterchallengingsituationsinordertoalleviate
sufferingwherever itisencountered.
OmManiPadmeHung
(TibetanmantrainvokingthecompassionandwisdomofChenrezig)
31
Goetz etal.
Face
Page38
•Compassion
rlFear
ClSadness
aHappiness
Figure2.
Recognitionaccuracy ofcompassion, fear,sadness, andhappiness byexpression modality.
Accuracyratescorrectedfornumberofchoices. Facialexpression findingsaveraged from
Haidt&Keltner (1999)andKeltner &Buswell (1996); touch findingsfromHertenstein etal.
(2006).
Touch
Psychol Bull.Authormanuscript; available inPMC 2011May1.
Table 1
TheoreticalPositionsonCompassionasEmotion
Theorist Quotation Theoretical Position
Batson (1991)
“[Empathy refers] tooneparticular setofcongruent vicarious emotions, thosethataremoreother-focused thanself-focused,
including feelingsofsympathy, compassion, tenderness, andthelike.” (p.86)
“The all-important emotion ofsympathy isdistinct from thatoflove. Amother maypassionately lovehersleeping andpassive
infant, butshecanhardly atsuchtimes besaidtofeelsympathy forit.”(p.129)
Empathy “maybedefmed asavicarious affective response toothers: thatis,anaffective response appropriate tosomeone else’s
situation rather tbanone’s own.” (p.128)
“Compassion …isnotasharing ofanother person’s emotional state, whichwillvarydepending onwhattheotherperson’s emotional
experience seems tobe,butanemotion ofitsown…Incompassion, theemotion isfeltandshaped intbeperson feeling itnotby
whatever theotherpersonisbelieved tobefeeling, butbyfeeling personal distressatthesufferingofanother andwanting to
ameliorate it.TIlecorerelational theme for.compassion, therefore, isbeing movedbyanother’s suffering andwanting tohelp.” (p.
289)
Darwin (187112004)
Hoffman (1981)
Lazarus (1991)
Post(2002)
“Compassion …isloveinresponse totheotber insuffering; sympatby …isloveinresponse totheotherwhosuffersunfairly” (p.
51)
“[S]ympathy …seem[s] torefer to[a]mixture ofsaess andlove…[itis]afeeling ofsaess foraperson wecareabout. ..[it]
Shaveretal.,1986 sharers] antecedents-and perhaps responses aswell-with bothloveandsadness.” (p.1082)
“Compassionate loveisanattitude toward otheris), eitber close othersorstrangers orallofbumanity; containing feelings, cognitions,
andbehaviors thatarefocused oncaring, concern, tenderness, andanorientation toward supporting, helping, andunderstanding
Sprecher &Fehr(2005)theotherts), particularlywhen theother(s) is(are)perceived tobesuffering orinneed.”(p. 630)
“[T[he emotion ofsympathy basbeenselected tomotivate altruistic behavior asafunction oftheplightoftherecipient ofsuch
behavior; crudely put,thegreater thepotential benefit totherecipient, thegreaterthesympathy andthemorelikely thealtruistic
Trivers(1971) gesture, eventostrange ordisliked individuals.” (p.49)
Distinct
Emotion
Vicarious
Emotion
x
x
x
x
Variant of
Loveor
Sadness
x
x
x
x
x
Goetz etaI. Page 40
Table2
Antecedents, Appraisals, andSubjective Experience oftheCompassionate Response
Antecedents Appraisals Subjective Experience
Babies &children inneed6,7,8,9,1 0,11,15 Selfandgoalrelevance 4,5,12 Adults (Multiple-item Measures): 1,2,3,4,5,7,8,1 0,12,13,16,17
Goal incongruence 14
Distress vocalizations 3,15,22 Target notresponsible 19,20,21 Compassionate
Pain1,3,11,16 Selfabletocope/help 14,16 Sympathetic,
Sadness 1,6,7
Move,
Illness, physical ormental
disability 6,9,10
Homelessness 1,5
Tender
Warm,
Softhearted
Poverty8
Touched
Victims ofcatastropheorloss1,4,7,16
Adults(Single-Item Measures):
Sympathy18
Pity20,21
Children: 6,7,9,11,12,13
Sorry forother
Concern forother
Note
1Batsonet aI.,1989;
2Batson etaI.,1987;
3Batson etaI.,1983;
4Batson etaI.,1997;
5Cialdini etaI.,1997;
6Eisenberg, Fabes, etaI.,1988;
7Eisenberg, Fabes,etaI.,1989;
8Eisenberg, Fabes,etaI.,1994;
9Eisenberg, Fabes, Schaller, Carlo &Miller, 1991;
JOEisenberg, Fabes,Schaller, Miller, etaI.,1991;
11Eisenberg, McCreath, &Ahn, 1988;
12Eisenberg &Miller, 1987;
13Eisenberg, Scballer, etaI.,1988;
14Ellswortb &Smith, 1988b;
15Fabes etaI.,1994;
16Mikulincer etaI.,2001, 2005;
Psychol Bull. Author manuscript; available inPMC2011May 1.
Goetzetal. Page41
170veisetal.,inpress;
18Reyna &Weiner, 2001;
19Rudolph, Roesch,Greitemeyer,&Weiner,2004;
20Weiner, Graham &Chandler, 1982;
21Weiner, Perry, Magnusson, 1988;
22Zabn_Waxler, Friedman,&Cummins, 1983.
Psychol Bull. Author manuscript; available inPMC 2011May I.
Goetz etal. Page42
Table3
Studies ofNonverbal Compassion Cues byMethod
Expression Component Observational Studies Recognition Studies
Orientation
Eyegazetowards partner Guthrie etal.(1997) Haidt&Keltner (1999)
Keltner&Buswell (1996)
Head &body orientation topartner Eisenberg,Fabes,etal.(1989)
Eisenberg, Schaller, etal.(1988)
Eisenberg etal.(1991)
Guthrie etal.(1997)
Forward lean Eisenberg,Schaller, etal.(1988) Haidt&Keltner (1999
Keltner &Buswell (1996)
Touch Hertenstein etal.(2006) Hertenstein etal.(2006)
Zahn-Waxler etal.(1992)
Facial Expression
Oblique eyebrows Eisenberg, McCreath &Ahn(1988) Raidt&Keltner (1999)
Keltner&Buswell (1996)
Furrowed eyebrows Eisenberg, Fabes, etal.(1989)
Eisenberg, SchaUer, etal.(1988)
Eisenberg etal.(1991)
Guthrieetal.(1997)
Lower eyelidraised Eisenberg,Fabes,etal.(1989)
Eisenberg, Schaller, etal.(1988)
Eisenberg etal.(1991)
Guthrie etal.(1997)
Slightmouth press Eisenberg,Fabes,etal.(1989) Haidt&Keltner (1999
Eisenbergetal.(1991) . Keltner&Buswell (1996)
Guthrie etal.(1997)
PsycholBull. Author manuscript; available inPMC2011May 1.
Table 4
CNS Regions Implicated inCompassion versusRelated StatesofPersonal Distress,Sadness andLove*
Amygdala ACC mPFC OFC !FC/alnsula Temp. Pole VTAlSNNS TPC PCunlPCC
Compassion rI,2 r1,2 i1,2 rI,2 r2 r2 r1 r1
Personal Distress
r5
r3,4 r3,4 r’ i3
Saess
t6
i7,8 r6.8 r6.7,8
t8
t6.8,V
Love•
t9
r9,13 tIO,l1 r9.11.13 t9.10 r9,I2,13
t13 t9
Note. r=increased BOLD activity, t=decreased BOLDactivity, –=inconsistent/unreported activation. ACC=anterior cingulate cortex,mPFC =medial prefrontal Cortex,OFC=orbital frontal cortex, IFC/
aInsula =Inferior frontalcortexandanterior insula, Temp.pole =temporal Pole, VTAlSNNS =ventral tegmental area,substantia nigraandventral striatum, TPC=temporal parietal corex, PcunIPCC =precuneus
andposterior cingulate cortex .
.
Neuroimaging studies oflove include ‘early intenseinfatuation’, ‘romantic/committed’, ‘maternal’ and’unconditional’ subtypes .
••
IImmordino-Yang, McColl, Damasio, &Damasio, 2009,
2Kim etaI.,2009,
3Sinha, Lacadie, Skudlarski, &Wexler, 2004,
4Liberzon etal.,2007,
5Costafreda, Brammer, David, &Fu,2008,
6Goldin etal.,2005,
7Damasio etal.,2000,
8O’Connor, Gundel, McRae, &Lane,2007,
9Bartels&Zeki, 2004,
IONitschke etal.,2004,
IINoriuchi, Kikuchi, &Senoo, 2008,
I2Fisher,Aron,&Brown,2006,
13Beauregard, Courtemanche, Paquette, &St-Pierre, 2009.
Notes
1WhatisMusic-Thanatology?, Music-Thanatology Association International,http://www.mtai.org/
2Curtis, LamaDavid, ClassesinBudhism, personal classnotes
3Chodron, Perna, Berliner, Emily, Comfortable withUncertaiy 108Teaching (Boston, MA:Shambala
Publications, 2005,5
.1Rinpoche, Sogyal,TheTibetan BookofLivingandDying: Sogyal Rinpoche (SanFrancisco, CA:
Harperiianlirancisco, 1992)364
5Leach,MD,Sarah, Cox,Professor, Helen, andRoberts, CM-Th,Peter, Relief ofSuffering attheEndof
Life,Institute ofMusic inMedicine, (Australia), December2005
6Chartofworldreligions, http://chartsbin.comlview/3nr
7Schroeder-Sheker, Therese, Musical-Sacrameal-Midwifery: TheUseofMusicinDeathandDying,
Campbell, Don,ed.,MusicinMiracles (Quest Books: Wheaton, IL.1992)23 .
8Reich, Dr.Alice, CORPsynopsis, 1994-95
9Nauert, PhD.,Rick, Compassion MissinginAmerican Health Care, PsychCentral, http://psvchentral.com,
(September9,2012)
10Goetz, JenniferL.,Keltner, Dacher,andSimon-Thomas, Emiliana, Compassion: AnEvolutionary
Analysis andEmpirical Review, Department ofPsychology, University ofCalifornia, Berkeley,
http://www.apa.org/pubs/joumals/bul, 2
11http://www.apa.org/pubs/journals/bul, 4-6
12Davidson, Richard. J,andHarrington, Anne, Visions ofCompassion: WesternScieistsandTibetan
BuddhistsExamineHumanNature, (Oxford:OxfordUP,2002),14
13Hollis, JenniferL.,Music attheEndofLife:Easing thePain andPreparingthePassage,(SantaBarbara,
CA,Praeger, 2010) 134
14Hoisington, PhD., W.David, Iroduction totheCompassion Handbook: AGuide toBeing AWarrior for
Positive Change, CompassionSpace, http://www.compassionspace.comJ, (January 26,2011)
15Keltner, Dacher, TheCompassionate Instinct,Greater Goo,Berkeley,
http://www.greatergood.berkelev.edularticle/item/the compassionate instinct/, (October, 2011)
16Armstrong, Karen, Charter forCompassion, http://www.charterforcompassion.org
17Armstrong,Karen,TwelveSteps toaCompassionate Life,(New York: AlfredAKnopf, 2011)
18Davidson, 68-69
19Leach, Cox,andRoberts, 57
20Hollis, 134
32
21Marshall, Deborah, VigilNarrative, 2010
22Leach,Cox,andRoberts,pg71
23Schroeder-Sheker,Therese,”MusicfortheDying”, JournalofHolisticNursing,(March1994):83-99
24Kearney, Michael, asquotedinLeach, Cox,andRoberts,Relief ofSufferingattheEndofLife,pg73
25Schroeder-Sheker,Therese, Intro.ToClinicalLife&theCoemplative Musician: Music-Thanatology
Principles 1,CORPsynopsis, (April6,1995)
26Schroeder-Sheker, Therese,March1994,89
27Paulnack, Karl, “KarlPaulnackWelcome Adress,” BostonConservatoryofMusic, (Boston, MA,),
September1,2004
28Schroeder-Sheker, Therese,”IntroductiontoClinicalLife&theContemplativeMusician:Music-
thanatology,Principles,II,CORPsynopsis, (April25,1995)
29Schroeder-Sheker,Therese,”Music-ThanatologyI:IntheContextofrelationship-centeredCare,Holism,
andTeamwork;”CORPsynopsis, (September12,1995)
30Schroeder-Sheker, Therese, “Music fortheDying”, inLeeds, Joshua, ed.SonicAlchemy, (Sausalito,
California;InnersongPress, 1997), 87
31Schneider,Marius,”AcousticSymbolisminForeignCultures,inGodwin,Joscelyn,ed.,CosmicMusic:
MusicalKeystotheIerpretationofReality: Essays,(Rochester,VT:InnerTraditions,1989), 73
32Schroeder-Sheker, Therese, “Music fortheDying”, Caduceus, Issue23
33Schroeder-Sheker, Therese, “Imagination oftheBody: TheLarynx, CORPsynopsis,November10,1994
34Murfin, Sharon,notes,classhandout,October,1994
35Murfin,Sharon, 1994
36Schroeder-Sheker, Therese, “MusicfortheDying”_Advances, Thejournal ofMind-Body Health, Vol.9,
Wier1993,45
37Rinpoche,Sogyal, 173
38Rinpoche, Sogyal,178
39Singh-Dowling, Kathleen, TheGraceinDying: HowWeAreTransformed Spiritually asWeDie,(San
Francisco, CA:Harpersanl-rancisco, 1998),7-18
40Hollis, Jennifer, L.,133.
41Leach, Cox,Roberts, 16
42Rinpoche, Sogyal, 179
43Rinpoche, Sogyal, 180
33
44Leach, Cox,Roberts, 18
45Leach, Cox,Roberts, 16
46Le’;ch, Cox,Roberts, 16
47Rinpoche, Sogyal, 175
48Schroeder-Sheker, Therese, Winter, 1994,
49Hollis, Jennifer, L,
50Leach,Cox,Roberts,21
51Rinpoche,Sogyal,76
52McLeo, Ken,52
53McLeod, Ken,52
54Denney,Jeanne,”TheEffectsofCompassionatePresenceonPeopleinComatoseStatesNearDeath”,
ProposedThesis, 2006, 120
SSMcLeod, Ken, 67
56Cassel, MD,Christine, andDemel, MPA,Beth, “Remembering Death:publicpolicy intheUSA, Journal
oftheRoyal Society ofMedicine, Vol.94,September 2001.
57Rinpoche,Sogyal, 7
58Paxton, Fred, Christianizing Death: thecreation ofaritual process inearly medieval Europe, 38
59KastenbaumRobert, Encyclopedia ofDeath andDying; TheGood Death, 3-4.
6oKastenbaum,Robert,5
61Hollis, Jennifer, 109
34
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Sheker, ThereseSchroeder. “MusicThanatology: Context ofRelationship CenteredCare,
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