Imagine being told to put on a pair of headphones and listen to music three times a day instead of having to take handfuls of medication. This is what doctor and musician Steven van der Merwe hopes to do with his trailblazing work on music and dementia.
Although patients of Dr Van der Merwe’s Simon’s Town practice are, by all reports, most supportive of their GP, they may well be rolling their eyes and saying, what now? If it is not studying further about oncology or geriatric medicine, it is putting on a premiere of his composition Eleven – a Requiem for a Parent, in 2011, as part of his master’s degree in composition through Nelson Mandela University; his conducting of Pro Musica Divinia; or now, his PhD through UCT’s neuropsychiartry depart- ment.
For Dr van der Merwe, whose medical practice is 21 years old this month, music and medicine have always been two inseparable parts of his life.
“I will never give up medicine. It is a grounding passion. Otherwise I would be a composer with my head in the clouds,” he said with a smile.
The two passions of music and medicine have run side by side all his life. The music side started in childhood with playing the piano, organ and cello – although he is quick to point out that he is not a performer – and getting friends together (at the age of six) to try to conduct his composition for a Jew’s harp, recorder and what he recalls was probably a zither.
The power of music is an intense source of fascination to him, and a conversation with a gerontologist friend as well as seeing Alive Inside, the American documentary dealing with people with Alzheimers and how music can ease their suffering, inspired Dr Van der Merwe to develop this theme. What if a specific music could be composed to be used as a drug for dementia patients?
This new development builds on the work of people such as the late British-American neurologist (and musician) Oliver Sacks whose book Musicophilia looked at music and the brain.
Dr Sacks said that people with dementia are often confused, agitated, lethargic. They are losing their identity and some have lost language.
However, Dr Sacks found that all of them, without exception, responded to music. They would smile, respond, gain a measure of lucidity and pleasure that could last for hours afterwards.
Dr Sacks said memories, to some extent, were embedded in music, with the parts of the brain that responded to music being very close to the parts of the brain concerned with memory, emotion and mood.
He found that the past was recoverable by playing music from the past, especially songs the patients knew.
However recent studies have shown that this approach has its problems, said Dr Van der Merwe. Finding music appropriate to the memories of dementia patients depends on speaking to them before their dementia is too severe to remember music they might respond to, or speaking to friends and family members. But often these patients no longer have contact with family and friends.
The second problem is sometimes the memories evoked are not pleasant but painful. Dr Van der Merwe’s literature research is showing that music unknown to patients may have a more positive effect.
There has also been research relating to types of music and what part of the brain responds, but not much or not rigorous enough. This is also something Dr Van der Merwe will be looking at.
“I have settled on writing quasi-tone poems, describing a picture musically, soft mellow tones but not boring. The idea is to penetrate the parts of the brain that thrive on music.”
So that the chain is not broken, he will be writing the music, conducting his own string orchestra, seeing to the recording and then overseeing the patients using the music.
In order to determine which works better, fresh music or “preferred music” (music chosen according to the memories of patients or their families), he will be dividing his research group into three, one part listening to new music, one part preferred music and one part nature sounds.
He has already met with carers at Noordhoek Manor and Nerina Gardens in Fish Hoek.
“It was so inspirational. I was walking on air afterwards. They were so enthusiastic, saying ‘When do we start?’,” he recalled.
“Dementia is when the world almost abandons you,” said Dr Van der Merwe. Patients are ignored, partly because they are shut up in their own worlds.
“But the use of music increases the interaction between patient and carer and reminds each other of their humanness. In addition, music has none of the side-effects of medicinal drugs.
“This is the first of its kind in the world,” said Dr Van der Merwe. “If I can use music as a drug, a music ‘prescription’, then you can care for people in their own homes.” Just take some headphones and listen.
“I don’t want to stop here,” he said. “It could also be used with chemotherapy or intensive care.”
To give himself the time to do his research, Dr Van der Merwe now has been joined by Dr Riki Theunissen who also has the study bug and is doing an honours degree in underwater and hyperbaric medicine.
“I am not actually going away,” said Dr Van der Merwe. I don’t want my clientele to feel neglected. In fact, they have been very supportive. It is so touching. It’s like I am their brother or son and they say, ‘Go for it.’”