Music Therapy & Epsom

The racecourse town as a music therapy pioneer

"Musick is a roaring-meg against melancholy, to rear and revive the languishing soul: affecting not only the ears, but the very arteries, the vital and the animal spirits, it erects the mind and makes it nimble."

Robert Burton (1577-1640) in Anatomy of Melancholy.

Music to Grieve to and The Hippocrates Prize introduced to The Hub the potential for the arts - music and poetry - to have clinical, as well as artistic benefit. Music to Grieve to quoted Forensic Psychiatry Professor John Tully saying, "tentative findings suggest (music) may be beneficial for dying patients". Alongside, Kaz Melvin hoped a Billie Eilish playlist helped her sister Ria through her final days.

Your profession saved my life, a speech by poet Michael Rosen to a Royal College of Nursing conference, on how nursing saved him from Covid, adds an additional intriguing suggestion. Among praise and thanks for the diligence of his nursing care, Rosen shared how nurses played him a family-and-friends curated playlist to aid his recovery from a 40-day induced coma. Thanks to former nurse Shona Floyd, healthcare engagement manager at the Brain Tumour Charity, for the reference.

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The Horton Chapel, Epsom

Picture: A poster in Epsom train station celebrating music therapy

at The Horton, created by artist Eliza Southwood / Copyright: Go Epsom

Walking past a poster at Epsom train station with the words "...the UK's earliest music therapy at The Horton... a town where trail blazing women led the way." made The Hub curious about the link between the chapel, the town and the therapy.

Talking about the poster she created, commissioned by Go Epsom, artist Eliza Southwood says: "I wanted to illustrate the Horton for the Epsom station artwork because it has such an interesting history and is a very striking building."

The Horton Chapel was built as a place of worship in 1901 for Horton Hospital, one of The Epsom Cluster of five psychiatric hospitals built on the Horton Manor estate, to provide solace for people experiencing mental distress. Manor Hospital, Horton Hospital, St Ebba’s (Ewell Epileptic Colony), Long Grove and West Park housed 10,000 patients over a 1,000 acre site, the largest cluster in the world.

Patients were drawn from across the London area and the hospitals became the town's largest employer, nearly doubling the local population. Staff from all over the world came to pioneer psychiatric treatments.

The chapel closed in 1997, reopening in 2021 as The Horton, a renovated arts and heritage venue. It is the only original publicly accessible building dating from the cluster. The Horton website has this statement and quote:

"From 1961 the chapel was also used as a place of musical therapy. “Sessions are often most successful when to an outside observer, they seem to be getting out of hand and almost riotous.” Lady Dea Forsdyke, Music Therapist, 1963"

Music as Recreation for Mental Patients

Music Therapy in Mental Health for Illness Management and Recovery, p. 59 cites: "In 1967, (Lady Dea) Forsdyke presented a paper, “Music as Recreation for Mental Patients” at the British Society for Music Therapy Conference and began to differentiate music activities for social engagement from music therapy to address clinical objectives.

She noted the largest diagnostic group in mental hospitals was patients with schizophrenia. Forsdyke stated clients with this disorder had a difficult time focusing attention and passive listening was often ineffective as clients withdrew into their dreams, delusions, or hallucinations.

If music therapy was to be successful, it was imperative for the clients to have an active role in listening and participating. However, skill or talent could not be expected in order to take part in the music. The standard of performance did not matter to either the therapist or listeners; thus, music therapy could be considered a process - rather than a product-oriented treatment modality.

Forsdyke also noted music was capable of alleviating the boredom of the monotonous restriction typical of mental hospitals by creating an easy and relaxed atmosphere. Forsdyke argued that although music therapy could not cure the illness, it could facilitate an interest and link with patients’ lives outside the hospital."

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Therapeutic Use of Music in a Mental Hospital

Picture: Horton Chapel exterior postcard shortly after opening. Image

reproduced courtesy of Francis Frith 1901. / Credit: The Horton

Henry Rollin, was a psychiatric consultant and the deputy medical superintendent at Horton Hospital from 1948 until his retirement in 1975. Rollin's memoirs Festina Lente: A Psychiatry Odyssey, published in 1990, contain a chapter on the use of music as a therapy at the hospital during his tenure. With thanks to Jeremy Harte, curator at Bourne Hall Museum, for the reference.

The Robert Burton quote at the top comes from the chapter. The following is an adaptation of the text. Rollin started by describing the impact of schizophrenia, and other psychiatric disorders, on the emotions.

"A characteristic of schizophrenia is emotional flattening or an inability to respond appropriately... to a given situation.

Among victims of affective disorders there is a morbid distortion of emotions ranging from elation or pathological happiness on the one hand, to melancholia or pathological unhappiness on the other.

Indeed, one would be hard put to discover any form of mental illness, psychotic or neurotic, in which the emotions are not “symptomatically” involved.

Rollin describes how music, was employed to, "attack these emotional upsets by stimulation or sedation, and the fundamental disease progress thereby mitigated".

He emphasised that: "Our sights were deliberately kept low." Music was not expected to replace the established methods of treatment of the day, like electroconvulsive therapy, psychotherapy, or chemical agent.

"It was always considered that music, in the light of our present knowledge at any rate, could be rated as only an ancillary form of treatment, or perhaps as a catalyst, facilitating other therapeutic procedures."

No Preconceived Notions

The music project at Horton Hospital began in 1955 with one music therapist employed one day a week. There were"no preconceived notions" of the precise objectives, or of how the project should operate. While there was an existing "music appreciation programme" open to all, it was felt the new project should be more specific and individual.

The only equipment was a restored antique piano salvaged from a ward and an electric gramophone. The project was housed in the hospital's large Victorian hall with its inadequate acoustics. But it was a start.

Nine male patients were chosen for their professional or amateur musical tuition, regardless of their mental disease. The idea was: reawakening a once pleasurable activity, "ought to be of therapeutic value".

Eight of the group were schizophrenics and one a manic depressive. One had been a professional pianist of some standing; one a student at an academy of music at the time of his breakdown; another an amateur violinist of above average ability, and the rest pianists of diverging achievement.

A Simple Schedule

The schedule was simple. The therapist and later the patients, played gramophone records. Then the therapist played piano solos, mainly by request. Finally, each patient was urged to play something - anything - at the piano. None of the patients had touched an instrument since admission to the hospital, varying from several weeks to 20 years.

The standard of performance varied from "fair to excruciating". Participation not virtuosity was the objective: obtained with cajolery and encouragement.

Rollin was heartened to see: "... retarded and/or deteriorated patients scramble, some way at any rate, out of their psychosis and communicate by means of the music they played with their fellow men. That the communication was received was manifest in the applause of the rest of the patients for the performance, no matter how inferior it was.

A group was formed spontaneously from individuals who by virtue of their mental illness tended to be solitary and asocial. It was the creation of this group - an association of people with a common purpose and a common language, in this case music - which paved the way to future endeavours."

The violinist sent home for his fiddle. His contributions as a soloist, duettist, and in small ensembles, were "greatly appreciated".

Later, similar groups of women patients, with similar success to the men, were added. By early 1956 more than 30 patients were included at their, or their relatives' request. A few especially gifted patients were given individual tuition.

Important Milestones

In the summer of 1956, a superb Steinway grand piano was acquired by an unusual example of Anglo-American cooperation. Madame Yolanda Mero-Irion, executive director of the Hospitalized Veterans Service of the Musicians Emergency Fund, Inc, negotiated a "very special price" with Messrs Steinway of London.

The Horton management committee's payment for the piano was a symbolic blessing to the music project. It was also a morale boost to patients and staff. Playing "this magnificent instrument" became a privilege. Causing competition between patients for the privilege to play it in the music therapy or practice sessions.

By now the number of patients receiving music therapy had steadily increased and the few patients receiving individual instruction had improved. In the spring of 1956 concerts by patients for patients started. The programmes were ambitious and some of the performances were "extremely good". Perfection was not aimed at, nor attained, but what was achieved, was a psychological triumph for performers and audience alike.

Reviewing the project at this stage, Rollin concluded: "The frequent rehearsals welded the performers into a large group. The fillip to their egos was obvious. They glowed with pride as they took their bows and on receiving gifts for their efforts. Fulfilling man's fundamental need – to be needed.

The mentally ill in a mental hospital, are failures. They have failed their social group, their families, and themselves. What better index of hope than to stand in the limelight, receiving the plaudits of their fellows?

The audience of over 300 patients, shared in the success and reflected glory of the performers. Becoming part of the group in the same way a school, a university, or town can identify with the triumph of their team. These patients' concerts caused more lengthy discussion than any outside artist concerts, however eminent."

Casting the Net Wider

In March 1957, percussion bands were formed with drums, tambourines, triangles, cymbals, bells, maracas, tambours, chime bars, trumpets, and "nightingales". The patients were chosen for these bands because no other form of treatment had held their interest. Clinically, they were the least hopeful in the hospital.

The technique was simple: the piano was played with a forceful rhythm, usually by another patient, while the patients were encouraged by staff to shake or beat the percussion instruments in their hands. They just needed to match the rhythm of the piano.

With a percussion band at full blast, the effect could be "very stirring". The schizophrenics were by nature "withdrawn, apathetic, and anergic". Spontaneous participation was not expected, or achieved. However, with coaxing and encouragement, most of the patients were induced to play their part, or their instrument, at first feebly, but later with growing gusto.

Success was measured by the volume of sound from the group. Perceptible by the volume of complaint from neighbouring departments or offices. The percussion groups "no doubt" achieved the limited objective set for them. Said Rollin: "It is most reassuring to see these lost, preoccupied beings become, for the moment at any rate, animated and “have a go" with whatever instrument they happen to wield."

The Acquisition of a Music Room

Picture: The Church, Horton Asylum, Epsom in 1914 from a postcard / Credit: The Horton

In July 1957, a second important milestone was reached: the acquisition of a music room. Like other assembly halls at Horton the chapel was of giant proportions, too large for the spiritual needs of the community of patients and staff.

The management committee and the ecclesiastical authorities granted permission to annex the back quarter of the chapel as a music room and concert hall. The Music Therapy Centre was opened by HRH Mary, Princess Royal and the Countess of Harewood, on 7 December 1961. The centre was renamed Harewood Hall in her honour in 1963.

A home of its own gave the music therapy project a fillip. New experimental schemes were set in motion. Another group, a recorder group with mouth organ and/or banjo and autoharp plus a percussion section, accompanied at the piano by a patient, was a great favourite. Patients' demands for practice time led to a second music room, fashioned from a disused general bathroom, housing two reasonable upright pianos.

A male patient of 32, under treatment for obsessive compulsive neurosis, had a professional training as a composer and conductor. He organised and trained a mixed chorus to "a laudable degree of efficiency", wrote suitable arrangements of popular songs and composed works for the group.

An Understandable Scepticism

Initially, the nursing staff had "an understandable scepticism". As the scheme got under way, and after the most successful patients' concerts, this gave way to a growing enthusiasm and increasing cooperation.

There were up to eight members of the nursing staff at the sessions. Their help was "particularly valuable" with the percussion groups where so much encouragement and coaxing was needed to ensure patients' participation.

Two male nurses with musical training joined the Horton because of its music therapy programme. Their help in carrying on the work, particularly with the ensembles, in the absence of the music therapist, was "most valuable".

The interest and cooperation of the occupational therapy department (OT) was wholehearted, and attendance at the groups was considered as an integral part of the training of student occupational therapists at the hospital. As a result, percussion band sessions were held as a regular feature of the OT department for its chronic patients, directed by one of its staff.

The Geriatric Wards

One of the most satisfactory developments was in the geriatric wards. Music was used in a variety of ways to combat the inherent problem of treating boredom in the aged.

The nursing staff suggested simple “keep fit” classes. Movement and relaxation to the accompaniment of gramophone records were encouraged. Then, the music therapist formed a percussion band which went "from strength to strength, or rather from volume to volume".

The most popular activity was, perhaps, the weekly concert-cum-dance. Live music was provided by members of the regular music therapy classes to a mixed group of 60 to 70 old people in a large women's ward. The afternoon programme was musical items provided by individuals and groups. Designed so the older people could join in choruses, add sound with percussion instruments, or merely clap or stamp their feet to the rhythm.

After a communal tea, "the Darbys and the Joans" spontaneously took the floor in an impromptu dance, or were encouraged to by the staff. The enjoyment was manifest by the party spirit, the applause for the entertainers and the degree of dressing up for the occasion.

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An Advocate of Music Therapy in Psychiatric Hospitals

Picture: Ernst Gombrich - Art historian / Credit: The Warburg Institute

A 2003 Psychiatric Bulletin obituary of Austrian-born art historian Professor Sir Ernst Gombrich, OM subtitled: “A‘hands-on’advocate of music therapy in mental hospitals”, again by Henry Rollin, shines additional light on music at the Horton Chapel.

Said Rollin: "The patients were adults of both genders, of a variety of ethnic and religious groups and, because of the geographical distribution of our catchment area in London, there was an overrepresentation of refugees from Nazi Germany."

Of the several forms of auxiliary treatments we had on offer at the hospital, music therapy was a particular source of pride. At the core of this most successful project, was Sir Ernst’s sister, Dea (Lady Anna Amadea Leonie Forsdyke who emigrated to London from Vienna in 1936 and married Sir John Forsdyke, the director of the British Museum), a distinguished violinist and an inspired teacher-cum-therapist. Sir Ernst’s wife, Ilse (Lady Gombrich) was an eminent professional pianist and piano coach. Sir Ernst, a talented cellist, was the third limb of an outstanding family trio.

A major attraction were monthly concerts for patients, staff, and a surprising number of patients’ relatives, who came mainly from London. From time to time, I invited a number of professional musicians who would play as a gesture of goodwill.

The Gombrich Trio

As the 'impresario' I invited the ‘Gombrich Trio’ to perform on a night in November 1965.

Despite the foul weather, the auditorium - the specially adapted rear third of the hospital chapel - was packed. I underwent all the agonies of these occasions: would the recital be interrupted or ruined by the unseemly and unacceptable behaviour of one or more members of the audience? The recital went off without a hitch: the vociferous applause at the end was loud and entirely appropriate.

Our artists stayed for a light supper, after which they were surrounded by patients anxious to shake their hands and express their gratitude in English or German for the musical treat they had enjoyed. Dea beamed with pride for her patients; Lady Gombrich met all of them with her customary graciousness, and Sir Ernst, well accustomed to the adulation of his audience, greeted them with warmth and civility, and without the slightest suggestion of condescension.

The following morning, a manic depressive, who was a man of education and cultivation and, when elated, a wit, bounded into my office with the sole intention of discussing the concert and expressing his gratitude to the artists. On leaving, he added, ‘What a delightful surprise to find that Sir Ernst, a world-class art historian, had at least one other string to his bow!’ "

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Art Therapies: Mid Surrey

Coming to the present day, on West Park Road, named after the fifth hospital to be added to Epsom's psychiatric cluster, lies Loughta House the site of Art Therapies: Mid-Surrey.

Says the blurb: Arts therapies are psychological interventions which combine psycho-therapeutic understanding with the arts.

They help by addressing a person's difficulties and aiding their understanding of:

• disturbing thoughts or experiences

• feelings of depression and demotivation

• why you feel what you feel

• difficulties with communication

• alternative perspectives

Music therapy allows people to express themselves and become aware of their feelings. It is interactive, primarily non-verbal intervention and can help individuals with severe emotional or behavioural disturbances.

Referrals are via one of the Community Mental Health Teams or Acute Therapies and Diversional Activities Services.

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Epsom Singing for the Brain

YouTube video: Singing for the Brain - an introduction - dementia services

Epsom Singing for the Brain is a dementia support group in the Wells Centre. It brings people together in a "friendly fun and social environment". Based around the principles of music therapy, "the stimulating sessions include vocal warm-ups and singing a wide variety of familiar and new songs".

In the video the Alzheimer's Society used interviews with a group leader, volunteers, people with dementia and their partners, to show how a supportive and enjoyable atmosphere makes Singing for the Brain "such a success".

Singing for the Brain is a service provided by the Alzheimer's Society in 30 locations. Says the charity: "Singing is not only an enjoyable activity, it can also provide a way for people with dementia, along with their carers, to express themselves and socialise with others in a fun and supportive group."

Singing for the Brain: A 2016 qualitative study by the Institute of Mental Health, University of Nottingham and the University of the Arts, London explored the health and well-being benefits of singing for people with dementia and their carers. The study identified the following potential benefits:

• Social inclusion and support

• A shared experience

• Positive impact on relationships

• Positive impact on memory

• Lifting the spirits

• Acceptance of the diagnosis

Further evidence, with thanks for sharing to Richard Whitaker the service manager at Arts Therapies: Mid Surrey, comes with Music therapy for autistic people. The May 2022 study reviewed the effects of music therapy, or music therapy added to standard care, for autistic people.

Reviewing the study's implications for practice, the authors' concluded: "The evidence in our review suggests music therapy may improve adaptive behaviour in autistic children during the intervention but not after the intervention, and identity formation in autistic children and adolescents measured in the period of one to five months after the end of the intervention, but not immediately after the intervention. Music therapy has been shown to be superior to standard care and to similar forms of therapy where music was not used, which may be indicative of a specificity of the effect of music within music therapy."

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Epsom Hospital Radio

The Hub has been using its Friday 2-4 pm Epsom Hospital Radio slot to collaborate with Clinical Community Matron Kathy Maskens at The Alexandra Frailty Unit at Epsom Hospital. Kathy suggested The Hub start a day time staff and patients request show. The idea was to use music through to give a fillip to hard working staff and to assist patients to maintain a sense of identity.

You can listen to The Hub's interviewee with Kathy on the collaboration and to a recording of The A Team, as the show is now dubbed, by clicking on the links below.

Kathy Maskens on Friday on The Hub

The A Team on EHR: 01/07/2022: 2 to 3 PM

The A Team on EHR: 01/07/2022: 3 to 4 PM

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