DEMENTIA AND THE POWER OF MUSIC THERAPY STEVE MATTHEWS Keywords dementia, social agency, narrative, well-being, music therapy ABSTRACT Dementia is now a leading cause of both mortality and morbidity, particu- larly in western nations, and current projections for rates of dementia suggest this will worsen. More than ever, cost effective and creative non- pharmacological therapies are needed to ensure we have an adequate system of care and supervision. Music therapy is one such measure, yet to date statements of what music therapy is supposed to bring about in ethical terms have been limited to fairly vague and under-developed claims about an improvement in well-being. This article identifies the relevant sense of wellbeing at stake in the question of dementia therapies of this type. In broad terms the idea is that this kind of therapy has a restorative effect on social agency. To the extent that music arouses a person through its rhythms and memory-inducing effects, particularly in communal settings, it may give rise to the recovery of one’s narrative agency, and in turn allow for both carer and patient to participate in a more meaningful and mutually engaging social connection. 1. INTRODUCTION As you walk down the street, or make your way to the living room, or enter the garden shed you abruptly realize that you’ve forgotten what it is that you thought you were doing. It’s both a familiar and uncanny, some- times unnerving feeling, and it brings agency to a halt. What we try to do in these situations is to trace back and reconstruct our purpose in an effort to make sense of what we are doing, for our behaviour now is almost always a segment of some larger narrative agency. The forgetful agent is endeavouring to situate her current behaviour within a larger story that best explains it. Now what if, for some agent, forgetting like this gradu- ally became pervasive, and the disorientation described above obtained as a near-global feature of daily life? Its effect would be impairing, not just of efficaciousness, but presumably of our sense of our own agency as such. I want to suggest that a fruitful way of understanding one central aspect of the losses for dementia sufferers is to see that condition as depriving them of their narrative agency, particularly in its social losses. 1 For it is a feature of quite severe dementia that, for a sufferer, you have quite literally ‘lost your story’, as Oliver Sacks has put it. 2 The argument that follows from this is that, aside from all the practical difficulties of inconvenience, many of these losses have concomitant moral losses – to wellbeing and 1 The phenomenon of wandering is related to the disorientation described above. Some 60% of those with Alzheimer’s dementia will exhibit wandering which is caused by the combined effects of memory loss, poor judgement and losses to abstract thinking. Becoming lost is then compounded if the person has also forgotten who they are. See MA Rowe. People with dementia who become lost. Am J Nurs 2003; 103: 32–39. Also, these losses in the capacity for memory overlap two of the cognitive domains for the Neuro-cognitive Disorders in DSM-5 – executive function, and learning and memory. For a detailed account of the links between failures of memory (and more broadly mental time travel) and losses to planning and control, see J Kennett, S Matthews. Mental Time Travel, Agency and Responsibility. In: M Broome, L Bortolotti, editors. Psychiatry as Cognitive Neuroscience: Philosophical Perspectives. Oxford: Oxford University Press; 2009. p. 327–351. 2 Quoted in R De Lauro. Music and Memory – Elders with Dementia Find Hope in a Song. Social Work Today 2013; 13: 18–21. Address for correspondence: Dr Steve Matthews, Plunkett Centre for Ethics, St Vincent’s Hospital, Victoria Street, Darlinghurst NSW 2010. Telephone: + 61 2 8382 2871 Fax: + 61 2 9361 0975. Email: Stephen.Matthews@acu.edu.au Conflict of interest statement: No conflicts declared Bioethics ISSN 0269-9702 (print); 1467-8519 (online) doi:10.1111/bioe.12148 © 2015 John Wiley & Sons Ltd