Dementia, Music Therapy and the “Self”
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The number of older people living with dementia in the UK was estimated to be 885,000 (Wittenberg et al., 2019). Alzheimer’s Society’s own estimations put this figure closer to 982,000 in 2024 (Alzheimer’s Society, 2024). During a meeting with a Dementia charity in Bristol the idea of “many little deaths,” was brought up. It was a family member’s way of describing their experience of watching a loved one go through the stages of dementia, their loss of different capacities. As memory fades and as one’s ability to regulate emotion and connect through language changes it can feel from the outside as though we are forced to repeatedly lose and grieve for those we care about, their “many little deaths”.
I promise when I reference a conversation it isn’t mere contrivance, it did happen...
So, I was talking to a friend and The Ship of Theseus came up. The Ship of Theseus is a thought experiment. The Greek hero, Theseus, sails a ship that is well maintained by its crew. As it travels the oceans the crew replace damaged parts and planks to keep it in top condition. The question goes: “When all the last of the original parts has been replaced is it still the ship of Theseus?” This thought experiment might be better known from Only Fools and Horses in the Trigger’s Broom scene (YouTube, 2014).
The thought experiment doesn’t have a “right” answer. You can say that The Ship of Theseus is not actually the original ship in the same way that Del boy and co. are mystified at how Trigger can claim it is the same broom after 17 new heads and 14 new handles; its constituent parts have been completely replaced. You can also claim that The Ship of Theseus is the same ship and Trigger’s Broom is still Trigger’s Broom; its “beingness” is a quality that it tied to something other than its constituent parts. The question’s purpose is to tease out these ideas about the nature of identity.
Oliver Sacks’, psychiatrist and author, posed this question about dementia and identity, “… does the loss of one’s self-awareness, or some aspects of the mind, constitute loss of self?” (2008, p.372). The point, to my mind, is that our experiences of the many little deaths come from our experience as the outsider. What would the Ship of Theseus say to us about its identity if it was able to communicate something to us?
Dementia obviously affects those that live with it in profound ways, from a slowing down of mental processes and loss of memory, to physical weakness, movement problems, to communication issues. Some of the most obvious emotional effects of dementia are depression, agitation, anxiety, apathy and withdrawal (NHS, 2025). It is not as simple as “identity remains intact, we just have to communicate and everything is fine,” it’s a complex condition that affects the most complicated physical part of ourselves, the brain. However, this complexity offers opportunity. Music activates our brain in ways that speaking doesn’t. It’s this multi-processing that, I think, allows music to reach into our inner worlds in such a profound way; it literally electrifies so much of our brain when we hear it. In the same way that music therapists use music to bridge and support language centres of the brain for people who have had damage to them and are rehabilitating their speech, I believe that we see a similar thing when people with dementia encounter music (bear in mind that I am not a neurologist, although if anyone would like to put me on a research team to explore the brain and music processing please email!). There are many anecdotes and videos of individuals, possibly the most well-known videos are of Henry, featuring Oliver Sacks (YouTube, 2012), and Marta (YouTube, 2020).
Again, to ground ourselves we must acknowledge that there is no “cure,” at this moment in time. Music cannot reverse the effects of dementia, although some studies suggest that it may delay deterioration in some cognitive functions like short-term recall (Chu et al., 2014), but Henry and Marta are emotionally, and physically, moved by music in a way that speech and touch doesn’t. They display increased autonomy, animus and awareness; we might say that they “become” themselves. This “re-becoming,” speaks to Sacks’ point; a loss of capacity is not a loss of self. Instead, I think this loss of capacity obscures the self. Perhaps it is less a “re-becoming,” and more a “coming forth”.
“The aim of music therapy in people with dementia is […] this – it seeks to address the emotions, cognitive powers, thoughts, and memories, the surviving “self” of the patient, to stimulate these and bring them to the fore. It aims to enrich and enlarge existence, to give freedom, stability, organization, and focus.” (Sacks, 2008, pp.372-373)
Sacks’ believes music therapy to have a twofold purpose. Firstly, to “enrich and enlarge existence”. If we were to consider a person in therapy without dementia we might consider ways in which a person may find meaning or fulfilment in their life. To avoid engaging with the psychological and relational needs or desires of people with dementia is to, to my mind, treat them as if they no longer have a self to need or desire meaning and fulfilment. Secondly, music therapy offers a way to “come forth”; to reach across the chasm, providing a bridge that is accessible to the self so that it may reconnect to the outer world. There is, to my mind, a relationship between the inability to connect with another person and the experience of isolation, anxiety and depression. Music can offer a way for people with dementia to connect the self with the outside world, a music therapist offers a way of being together with another person through music.
“’Together’ is a crucial term, for a sense of community takes hold, and these patients who seemed incorrigibly isolated by their disease and dementia are able, at least for a while, to recognize and bond with others.” (Sacks, 2008, p.380)
Relationship, the connection between, is fundamental to our sense of self, core to being able to even conceive of an I and a Thou, to be able to say that we have some sort of identity separate to the Other. Whether you frame it in neurological terms, as a spiritual phenomenon, or as music being within us all, something about music allows people with dementia to connect with an Other, allows them to recognise the Other, and by extension bring forth and potentially recognise the self.
“Human existence is primordially a matter of mutual recognition, and it is only through mutual recognition that we are self-aware and strive for the social meanings in our lives.” (Solomon, p. 68)
We recognise ourselves in the reflection of others, we need relationships to flourish. Through connection with an Other we experience ourselves as individuals that can feel deeply and share those feelings, we experience ourselves as individuals that have potential in every moment, and as individuals that deserve dignity. For my work as a music therapist, this is what I feel most strongly about. Music has power to connect with those that can no longer, or never could, use our typical ways of “being with”. Music may provide a path to “come forth” along for those with dementia, it is the role of music therapists to then to help build that path towards a relationship in which the client can recognise themselves, and in which their life may be enriched and enlarged through meaningful experiences. Meaningful experiences may take the form of reminicience work, reconnection with family members during sessions, or something as simple as actively being with someone that is reaching out to them (the music therapist)
I think advocacy for the position of those with dementia still holding the self within them allows for hope. Hope that there is still meaningful experience and a life worth living. I think it allows us, as outsiders, to avoid the existential horror of slow slippage into nothingness. I think it allows us to remain compassionate and humane as the ones we love withdraw from us through no fault of their own. I think my strongest draw to this advocacy is because of my own experiences as a therapist. As Sacks puts it:
“Once one has seen such responses, one knows that there is still a self to be called upon, even if music, and only music, can do the calling.” (Sacks, 2008, p.385)
I still have thoughts on music therapy work with dementia. One that comes to mind is the agency and autonomy music therapists offer their clients through music. In a life of significant limitation, it feels important to offer choice and power back to the client, even if only for a short time. Another blog, perhaps.
Garrick Wareham
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References
Alzheimer’s Society, 2024, The Economic Impact of Dementia: https://www.alzheimers.org.uk/sites/default/files/2024-05/the-annual-costs-of-dementia.pdf
Chu, H. Yang, C-Y. Lin, Y. Ou, K-L. Lee, T-Y. O’Brien, A P. Ru, K-R. (2014) The Impact of Group Music Therapy on Depression and Cognition in Elderly Persons with Dementia: A Randomized Controlled Study. Biological Research For Nursing [online]. 16 (2), pp. 209-217. [Accessed 02 May 2025].
NHS, 2025, Symptoms of dementia, https://www.nhs.uk/conditions/dementia/symptoms-and-diagnosis/symptoms/
Sacks, O. (2008) Musicophilia. Revised and Expanded ed. London: Picador.
Solomon, R.C., 1988, Continental Philosophy Since 1750: The Rise and Fall of the Self, Oxford: University Press.
YouTube, 2020, (official) Alive Inside Film of Music and Memory Project - Henry's Story, https://www.youtube.com/watch?v=5FWn4JB2YLU
YouTube, 2014, Trigger’s Broom, https://www.youtube.com/watch?v=LAh8HryVaeY
YouTube, 2012, Former Ballerina With Alzheimer's Performs 'Swan Lake' Dance | Super Emotional, https://www.youtube.com/watch?v=IT_tW3EVDK8
Wittenberg et al,. 2019, Projections of older people with dementia and costs of dementia care in the United Kingdom, 2019-2040: https://www.alzheimers.org.uk/sites/default/files/2019-11/cpec_report_november_2019.pdf