Hadsell, N. (1974). A sociological theory and approach to music therapy with adult psychiatric patients. Journal of Music Therapy, 11, 113-124.
UWEC bound journals

[M, B] Music Therapy here is defined as " the use of the unique properties and potential of music in a therapeutic situation for the purpose of changing human behavior so that the individual affected will be more able to function as a worthwhile member of today's as well as tomorrow's society". The therapist should operate in three areas: rehabilitation, education, and treatment. The theories of the etiology of Schizophrenia fall into three basic categories: genetic and chemical factors, psychological factors, and interpersonal and social factors. Abnormal amounts of adrenaline and taraxein have been found in patients with Schizophrenia. Early childhood trauma and deprivation may cause it. Some say the person's relationships or breakdown in communication may cause Schizophrenia. All three of the categories together actually seem to cause Schizophrenia. People with Schizophrenia may not be able to see how he fits into society and may not be able to deal with surroundings. The music therapist has to help in these ways: re-establish the patient with reality, draw him away from hallucinations and delusions, open communication with people around him, and learn adaptive behavior patterns which allow him to function more normally in society. Groups in therapy should be small to help rebuild communication skills. Let patients make decisions.

Stein, J. (1965). The music therapist's role in work with severely disturbed patients. Journal of Music Therapy, 2, 53-55.
UWEC bound journals

[M, M S] Music therapists should have skills used to work with severely disturbed patients including knowledge about restraining and what to do when the patient acts inappropriately within a sexual content. The music therapist should not depend on a nurse or other staff member to "handle" the patient. The article explains three steps that should be tried and modified for one's specific purposes:

1. Do your own dirty work- Learn restraint methods. If the person needs cleaning or a change of clothes, do it. By taking responsibilities alone, you will gain the respect of peers. The patient should see you are willing to help him or her and then hopefully cooperate better.
2. Learn your own reactions to problematical behaviors and let them show-by being open and honest with the patient to develop a mutual trust. He may cooperate better if he knows he can trust you.
3. Learn when not to interfere. Confine interference to issues that are of immediate importance to the patient's progress in music therapy. Give the patient as much responsibility as he can handle. Interfere only when problem relates to the therapy. Try going to a psychiatric ward for an hour or two everyday until you feel comfortable. Watch everything going on around you, but stay inconspicuous. This will let you observe experienced personnel deal with difficult situations, you will see how you feel in that environment, and you will begin to learn cues by which to judge whether or not a situation is a problem.

[M S, T, P A] National Institute of Mental Health. Schizophrenia questions and answers. [On line]
http://www.nimh.nih.gov/publicat/schizo.htmp/

This website is an online pamphlet from the NIMH about Schizophrenia. The foreword explains that about three million Americans will develop the disease in a lifetime. The topics of the pamphlet include: what it is, the possible causes, the possible treatments including medications and therapies, how other people can help, and an outlook into the future of the problem. Music therapists can use this site to learn more about Schizophrenia: adapting ideas for structuring music therapy sessions to help people with Schizophrenia planning discussions about the conditions and treatments with friends and family of the client, examining how music can be used to help client recover and assimilate into normal culture again.

[M S, T, P A] The experience of Schizophrenia.
http://www.mgl.ca/~chovil

This is an excellent resource to use to see into the brain and life of someone with Schizophrenia. Not only is there information about the disease but also history, charts and graphs about different aspects of the disease, relapse prevention information, housing and financial support in descriptions, meaningful activities in person's life, and family and social support. Music actually was important to one for anxiety reduction and it gave messages about destiny as an alien. I believe reading this will truly give the music therapist compassion for what Schizophrenics go through. If we can delve into the complicated thought processes of people with Schizophrenia, we can determine the best way to work with them. I responded in his guest book online, and he was very polite and prompt in returning an answer to my question.

[M S, T, P A] World Health Organization. ICD-10 classification of mental and behavioral disorders.
http://www.psy.med.rug.nl/0024/>

This site explains all the types of Schizophrenia as classified by the World Health Organization at the 1992 conference in Geneva: paranoid, hebephrenic, catatonic, undifferentiated, residual, simple, and post-schizophrenic depression. The characteristics, symptoms, and diagnostic guidelines for each type are stated. This information would be helpful to use when examining characteristics that correlate to the client's diagnosis and deciding what activities to use with the client.

Keefe, R.; Harvey, P. (1994). Understanding Schizophrenia: A guide to the new research on causes and treatment. Maxwell Macmillan International, New York.
UWEC call #: RC514 .K35 1994

[B, T] This book explains symptoms and characteristics of those with Schizophrenia, and explains different diagnoses and related disorders. It clarifies biochemical factors and brain dysfunctions that cause Schizophrenia in some and not in others. Also, it lists several types of treatment: behavioral and drug and different settings.

North, E. (1966). Music Therapy as an important treatment modality with psychotic children. Journal of Music Therapy, 3, 22-24.
UWEC bound journals

[M S, T]  We need to first establish relationships with these children. Use music to engage their interest and then build further relationships with it. Let children write notes on staff paper and then play for them what they have written. They will feel they have accomplished something. Introduce safe and interesting variations to them so they can deal with the varying everyday world. If one works with a catatonic child, place a drumstick in the child's hand and bang a drum for the child. Eventually the child should initiate movement with certain instruments. If the child has no direction and random behavior, music will bring structure, stimulation, and something that will help in relating to other people.

Benenzon, R. (1982). Music Therapy In Child Psychosis. Charles C. Thomas, Illinois
UWEC call #: ML3920.B3813 1982

[M S, M] This source discusses the problems associated with the language skills of children with Schizophrenia. Language disorders can make any therapy particularly difficult. A new approach needs to be considered when working with a schizophrenic child to open his or her communication channel. Sound or music can serve as the basic element in a new therapeutic technique, creating a unique pathway for the children with Schizophrenia. One success with many children with Schizophrenia has been the tape recorder. Most people with Schizophrenia change attitudes quickly when they hear changes in the
sounds coming from the recorder. The sound can capture their attention instantly. Music can help these children learn to focus and eventually improve their language skills.

Burleson, S.; Center D.; & Reeves, R. (1989). The effect of background music on task performance in psychiatric children. Journal of Music Therapy, 24, 198-205.
UWEC bound journals

[CS, M] This study involves four males, ages five through nine, two white and two black, with either Autism or Schizophrenia, and problems with task performance. Background music, defined as instrumental music without a strong rhythmic beat, was played while the children were given a task to sort color-coded chips. The study showed that the music reduced off-task responses that interfered with task performance, therefore increasing task accuracy. The possible explanation for this is that the music masked distracter stimuli that interfere with task accuracy. The results support using background music with children with mental illness.

Wolfgram, B. (1978).  Music therapy for retarded adults with psychotic overlay: A day treatment approach. Journal of Music Therapy, 15, 199-207.
UWEC bound journals

[M S, G, T] This day treatment approach in Milwaukee County (Wisconsin) is trying to develop work skills, academic skills, and social skills so the patients can return to appropriate functioning in the community. Each patient has five daily sessions including: music therapy, occupational therapy, activities of daily living, a service project, and coed recreation. Here are five advantages of day treatment: 1) family and community ties stay intact, 2) less shame and social isolation are experienced, 3) day hospital status implies trust that the client will be able to utilize his positive ego assets and functions, 4) family and community roles are more likely to stay open during day treatment and, 5) it gives the opportunity for gradual reintegration into the community. The most common diagnoses of these patients are schizo-paranoid, adult adjustment reactions, and depression. Music therapy is non-threatening and its goal is to develop behavior changes so the patient can adapt and have the ability to function normally in the community. The therapist needs to have a warm and accepting approach and to provide a structure and goal-oriented community. This article presents good ideas of activities to do with these types of patients.

Schullian, D.; & Sheon, M. (1948). Music and medicine. Henry Schuman Inc. New York, NY
UWEC call #: ML3920.S363

[M, C S] This book describes the effects of patients listening to music during their hydrotherapy treatments. Two patients were given continuous baths of 96 degrees Fahrenheit, while two other patients were given cold wet sheet packs of 55 degrees Fahrenheit. A female violinist played for them for up to 30 minutes during both therapies. Familiar tunes were the most effective in keeping the patients' attention. Waltzes preceded by lively tunes were also effective. The music seemed to be a helpful agent in decreasing verbal outbursts of the disturbed patients regardless of the temperature of the water. In this study, the music proved to be both a positive and soothing source physiologically and psychologically

Andreasen, N., M.D., Ph. D (1984). The broken brain: The biological revolution in psychiatry. Harper and Row, New York.
UWEC call #: RC455.4.B5 1984.

[B, T] Approximately one in one hundred people have Schizophrenia. The term means, "splitting of the mind". Some characteristics include: hallucinations, thinking disturbances, abnormal emotional responses, inability to feel and express emotion, being withdrawn, paranoia, disorganized but intelligible speech, inability to follow through on tasks, and an inability to enjoy relationships. Some possible causes of the condition are: neurochemical changes such as raised levels of dopamine, structural abnormalities in which parts may be enlarged and the corpus callosum may thicken, or genetic factors evidenced by the fact that the rate is clearly higher in the families of patients with a history of Schizophrenia. Some possible treatments are: raising endorphin levels in the body, chlorpromazine, or taking narcoleptic medications like Thorazine, Mellaril, Stelazine, Navane, Prolixin, and Haldol. The book elaborates with dosages and possible side effects.

The rest of the book explains other mental illnesses, discusses the history of mental illness and treatments, and the biological future of mental illness.
A music therapist could use this book to learn more about Schizophrenia and its treatments. By knowing the possible characteristics and problems of the person, the therapist can develop an appropriate treatment plan and goals for that person.

Benenzon, R. (1981). Music Therapy manual. Charles C. Thomas, Illinois
UWEC call #: ML3920.b413

[M S, M] This book describes different music therapy techniques according to different responses noted in specific cases of Autism, Symbiosis, and Schizophrenia. This author has worked with children with Autism and found they made little response to the sounds or change in sounds around them. He reported that he worked with people with Schizophrenia who responded constantly to sudden sound changes. The goal of this study was to increase the level and amount of communication in each group effectively through the use of music.

Aldridge, D. (1996). Music Therapy research and practice in medicine: From out of the silence. Jessica Kingsley Publishers, London.
UWEC call #: ML3920.A33 1996

[M S] This book had a rather negative view of the usage of music therapy with patients with Schizophrenia. The book states "no matter how effective the music therapy is, their health does not survive the test of daily living and the temptations of normal life” (Aldridge 62). Activity was apparently enhanced by instrumental playing, but reduced during dancing and listening to music. However, singing did have a positive effect, reducing the stress of the patients. Despite this data, the book examines Schizophrenia's negative influence on musical expression. "The lack of reciprocity from the schizophrenic patients seemed to be the factor which prevented contact and thereby disturbed communication” (Aldridge 63). Common hypotheses of this phenomenon were their peculiar speech habits might actually be associated to the inability to process musical information of people with Schizophrenia.

The Milwaukee Journal Sentinel. 3 Nov. 1997: Pg 1 and 2.

[M S, T, P A]  This newspaper article explains how patients can learn to reorganize their lives emotionally and physically. One particular patient, a 45-year old man with Schizophrenia, often complained of hearing voices. These hallucinations caused him to frequently shout uncontrollably to block them out. When this particular patient began to play an instrument or sing a solo on a microphone, it was as if he entered a new world. While singing he improvises his own "blues” as he calls it, and begins to snap his fingers rhythmically while providing his own choreography to his songs. He often sings about his day or his feelings. Mary Stryck, a music therapist, reports that during this 45 minute singing time, he has heard not one voice. Music has been very beneficial in dealing with auditory hallucinations. The activities have drastically helped him change his behavior and learn more about himself.

She also comments that music therapy can be a great tool in providing the patients with self-esteem. Many of the general problem areas associated with patients with Schizophrenia include deranged language skills, inability to express or feel emotions, hallucinations both visually and auditor ally, social withdrawal, poor concentration, confusion, and a distorted sense of reality.

There are many different musical activities as complements to drug or psychotherapy. Playing musical recordings for the patients followed by a discussion allows the therapist to observe the patients’ feelings and fantasies from their interpretations of the music. To help the patient become more conscious of his or her body as "expressive instruments,” structured movement such as folk dance and action dances can also help the patient become more aware of his or her body and the feeling of security in an ordered safe environment. Movement can allow the patient to release tension and often resolve past memories that have been locked up inside the individual. Rhythm has been shown to stimulate the body and its different systems. The harmony of music alone can help the schizophrenic consider musical sounds and the emotions involved. The concentration and coordination needed to listen to music, and the emotions necessary to express music through movement, or by playing an instrument, can have a definite calming effect on troubled patients. "Music is a stimulus used to increase the patient's perception of emotions and feelings by successively controlling exploration, attention, motivation, and reinforcement” (Unkefer, 1990). It is also very effective in allowing the patient to focus on something other than his or her pain or hallucinations. Participation in sing-a-longs can increase social interaction and become soothing to the patient. Relationships are also often formed between the music therapist and the patient, stimulating feelings and social interactions. If used correctly, music can become a wonderful tool in all aspects of health and illness.

Alvin, J. (1975). Music Therapy. Basic Books, Inc, New York.
UWEC call #: ML3920.A66 1975

[M S]  This book raises the question of the safety of music for quite a few people with Schizophrenia. Some hostile patients claim that music makes them feel uncontrollably angry or violent. Some patients claimed to become irritable because they found that other people's attitudes seemed to interfere with their own. "Many of the reactions are due not to the music itself and bear no resemblance to it, but to the personality of the patient, to his or her illness, or to past memories” (Alvin 137). The patients hear the music normally, but their interpretation of the sound may be "pathological.” Very often, just a common sound can cause an individual to build a negative or fearful situation around it, giving the sound a threatening meaning. Patients with Schizophrenia have also displayed difficulties in locating the physical sources of sounds. "The sound may be coming from beyond the patient's visual field, for example". (Alvin 138). Overall this source states that the use of music can be risky with some patients with Schizophrenia.

Podolsky, E. (1954). Music Therapy. Philosophical Library, New York
UWEC call #: ML3920.p752

[M S, C S]  This book explains that music in psychiatric settings has little effect on patients with schizophrenia. While music has been proven repeatedly to be extremely helpful in normal subjects, abnormal benefits are unknown. This is crucial because music therapy is being used with psychotic patients on the basis of what we know is valid in normal functioning persons. Although scientific experiments have been done, most of them are virtually inconclusive and difficult to design. The book describes an experiment done with people with Schizophrenia concerning their views of happy music versus sad music. The conclusions of the experiment have shown us that what normal individuals perceive as "happy” music, is often seen as "sad" music to those afflicted with Schizophrenia. This study indicates the difficulties in using music therapy in psychotic patients.

Gaston, T. (1968). Music in therapy. The Macmillan Company, New York
UWEC call #: ML3920.m897c.3

[M S, C S, T] This source focuses on children with Schizophrenia and some with Autism. The book encourages the use of a tape recorder and an instrument like the accordion in music therapy sessions. The accordion allows the therapist to have a face-to-face interaction with the child. It also draws the child closer to the instrument because of its moving parts. The tape recorder has also helped children form a sense of "self” through hearing their voices played back on tapes.

Torrey, E. (1997). Out of the shadows: Confronting America's mental illness crisis. John Wiley, New York.
UWEC call #: RA790.6.T673 1997.

[B, P A] People with disorders such as Schizophrenia are allowed to live untreated and in bad conditions, unlike those with brain disorders such as Alzheimer's or Multiple Sclerosis. Many people with Schizophrenia do not realize they have a problem and have limited insight to understand that they need hospitalization or medication. Studies show, those with insight would be more likely to be admitted voluntarily. Those without insight would be more likely to be committed involuntarily and would be less likely to cooperate with work rehabilitation programs. Patients who take medications regularly have a much lower re-hospitalization rate and a much higher rehabilitation rate. In the past not enough money was spent researching Schizophrenia, but support is developing. The suicide rate for individuals with Schizophrenia is ten to thirteen percent, while the general population has a suicide rate of one percent. Changes in neurochemistry, metabolism, electrical activity, neurological functions, and neuropsychological functions of the brain may be different in a person with Schizophrenia than a person without.
The rest of the book discusses why there are so many mentally ill individuals who are also homeless, why so many mentally ill people are in jails and prisons, and what the relationship/, if any, between mental illness and violence is. The history of research and care of the mentally ill is discussed. Lastly the author suggests what we should do to improve the care for the mentally ill and what we can do to make sure they get the treatment they need and deserve. The fact that patients aware of their schizophrenia committed to the hospital voluntarily suggests that they will be more willing to accept and participate in music therapy activities. This idea also suggests that the people who are admitted involuntarily may have a problem accepting the music therapist and the therapy- these people need extra special help, care, and attention.

Tsuang, M. (1982).  Schizophrenia the facts. Oxford Press Walton Street, New York
UWEC call #: RC514.T77 1982

[M, T]  This book provides simple facts and characteristics of Schizophrenia including a look at their
distorted view of reality and their emotional withdrawal. Studies have shown that Schizophrenia is a mental disability rather than a psychological maladjustment. The book focuses on different drugs that are often used as a treatment for hallucinations and other delusions. Ideally, drug treatment should be discontinued or reduced after the symptoms cease. However, drugs are not the safest therapy; it often excludes the family. Music therapy, with a combination of other therapies, can bring the family closer together, and should be a high priority.

Vinogradov, S. (1995). Treating Schizophrenia. Jossey-Bass Inc.; San Francisco CA.
UWEC call #: RC514.T686 1995

[M S, T, C] This book is designed to help researchers understand the intricate details of Schizophrenia. Causes, environment factors, and treatments are closely assessed. This source explains the biological and basic therapies used currently to treat those who have Schizophrenia-music therapy is not a well accepted treatment with researchers--however, many of the sources listed are dated.

Chey, J.; & Holzman, P. (1997). Perceptual organization in Schizophrenia: Utilization of the Gestalt Principles. Journal of Abnormal Psychology, 106, 530-538.
UWEC current journals.

[M S, T, B, C S, M] This article discusses several experiments used to see if patients with schizophrenia used Gestalt principles when performing perceptual organization tasks. The principles studied were: laws of proximity, similarity, and co linearity. The inability to focus consistently on relevant stimuli and the inability to filter out irrelevant stimuli, are characteristics of Schizophrenia. These studies concluded that the subjects used all three of the previously mentioned principles when performing perceptual organization tasks. The only area in which they had significant trouble in was identifying obscured parts of a given figure. Knowing that schizophrenics have an inability to filter out irrelevant stimuli, a music therapist could develop activities where the client had to concentrate on certain instrumental noises while ignoring others. Another activity could be creating a game using related instruments such as different drums along with other non-related instruments such as a harmonica and a keyboard. The therapist could give directions for the game, and the goal would be to get the client to concentrate on one group of related instruments and ignore the other unrelated instruments. Another activity could be a trust walk with voices.

Granholm, Eric; Morris, Shaunna K.; et al (1997). Pupillary responses index overload of working memory resources in Schizophrenia. Journal of Abnormal Psychology, 106, 458-467.
UWEC current journals.

[C S, M S, T]This article discusses experiments completed to examine working memory resources by using papillary responses as an index of resource overload. Different medications were taken into account during the experiments. The study showed that participants recalled fewer digits when asked to remember a long sequence of digits as compared to remembering more when the sequence was shorter. No correlation was found between recall scores and daily medications of the subjects. Pupils dilated more when processing and recalling a sequence of numbers than when they only had to passively listen to the sequence. These findings may suggest that patients with Schizophrenia have reduced storage capacity in the working memory.
A music therapist could use this information to make up activities that focus on expanding the storage capacity in the working memory. An example is laying five instruments on a table and making up sequences with them. Have the client play back the sequences demonstrated by the therapist. Increase the length and variety of the patterns, and eventually the patient with should increase his or her working memory.

Smith, G.; Large, M.; Kavangh, D.; et al (1998). Further evidence for a deficit in switching attention in Schizophrenia. Journal of Abnormal Psychology, 107, 390-398.
UWEC current journals.

[C S, M S, T]This study involved testing different types of attention such as attention to different colors, patterns, and switching attention in schizophrenic people. A newly developed Visual Attention Battery (VAB) was used. The six tasks of the VAB are: 1) a control task requiring sustained attention to stimuli which was a test of simple reaction time, 2) a task requiring selective attention to a color, 3) a task requiring selective attention to a pattern, 4) a task requiring divided attention to both color and a pattern, 5) a task requiring switching attention between color and pattern and 6) a task requiring attention to pattern but with regular updating of target patterns in working memory. Simple sustained memory was unaffected by Schizophrenia; however, patients were impaired on tasks of switching attention and reloading of working memory. Switching attention deficit was the prominent attention deficit in Schizophrenia. Attention and memory do improve with medication but patients who are no longer acutely ill may still have cognitive deficits when returning to the community.
A music therapist could use this information to create activities working on switching attention from one task to another or one item to another. Flashlights may be useful in directing attention to different musical stations set up around the room. Musical games may be used to help clients learn to switch attention from one topic to another.

Chambliss, C. (1996). Motor performance of Schizophrenics after mellow and frenetic antecedent music. Perceptual Motor Skills; Montana.
UWEC periodicals

[M S, C S, T]This article explained the results of an experiment done with a volunteer group of 19 medicated schizophrenic inpatients. They listened to a minute of three different types of music before attempting two motor tasks. One of the tasks was the Purdue Pegboard, which is a board that has two parallel rows of 25 holes. Ideally, the board assesses manual dexterity and manipulative skills. The second task was the Finger Oscillation Test. Subjects tapped their index fingers of their dominant hands on a counter key as fast as possible. The three types of music moods that the subjects listened to were frenetic, mellow, and white noise. White noise refers to the mechanical sounds coming from the rolling of the blank tape recording the finger taps. The subjects were asked to begin tapping after listening to one minute of each type of music. The study concluded that the Pegboard performance and tapping performance were faster after the frenetic music. However, both performances were unaffected by the mellow music.

[P A] The American Psychological Association categorized symptoms of Schizophrenia into eight areas of disturbances:

1. Content of thought- delusions
2. Form of thought- loose associations, flight of thought
3. Perception- hallucinations
4. Affect- blunted, flat, or inappropriate
5. Sense of self- loss of ego boundaries
6. Volition- lack of interest or drive
7. Relationship to external world- withdrawal into fantasy
8. Psychomotor behavior- pacing, rocking, hypo-activity, hyperactivity, or bizarre behaviors
9. Other possible problems: paranoia and disorganized speech

[M S, G] Music therapy goals for targeting those areas:

1. Re-establish client with reality
2. Draw client away from delusions and hallucinations
3. Open communication with people around client
4. Identify and express emotions
5. Reduce stress and anxiety
6. Control aggressive and destructive impulses
7. Learn adaptive behavior patterns which allow client to function normally in society

[M S, T] Music therapy activities for treatment of these problems:

1. Singing or scatting
2. Lyric analysis
3. Song writing- individually or in a group setting
4. Folk dance or structured dance
5. Improvisational instrumental music
6. Music and relaxation
7. Group guitar lessons

Added: 11/10/2000

Web Design: Jeffrey M. Miller

Our appreciation is expressed to the Office of University Research at the University of Wisconsin - Eau Claire for their funding and support of most of the projects represented in this website.