Lillian Eyre - Narrative & Schizophrenia Slides

8/7/2019 Lillian Eyre - Narrative & Schizophrenia Slides

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Lillian Eyre, MTA, MT-BCPhD (Temple University)Assistant Professor, Immaculata University,Malvern, Pennsylvania, [email protected]



�Clinical work in psychiatry

� Recognition of existential problems for persons living

with schizophrenia

� Interest in Narrative Therapy� Verbal techniques employed in Narrative Therapy

� Integration of narrative principles with music therapy

� Interest in music improvisation



�Michael White and David Epston (late 1980·s)

�´Storiesµ are events linked in sequence across

time according to plot

�Stories serve to make sense of our lives

�Meaning forms the plot of our life stories

�The stories we tell about ourselves directly

influence the way we see ourselves, ourpotential and limitations«

� And the future we create for ourselves



�We have many simultaneous stories about our lives

Dominant stories: co-constructed stories that make

meaning of personal life events

�Meanings are not neutral

�Have implications for present and future actions

Alternative stories

�

Emerge from untold or forgotten parts of dominantstories with different meaning

� Provide a greater reflective surface for

interpretation



�Self is viewed as a collection of internaldialogues among various self positions

�PLWS unable to maintain coherent dialogues

with self creating disruptions in sense of self� Internal dialogues of PLWS evolved into one of

three forms:� Barren and empty self-organization� Internal Cacophony� Self-constructions dominated by rigid, non-evolvingmonologues



1) Both involve relating self to other ² indicate

how we engage with the world

2) Both require the organization of events in time

and both are created in the moment to moment

3) Both evoke and express emotions

4) Both emphasize personal choice and agency

5) Both enhance the shaping of one's identity



Are verbal narratives of PLWS different when theyare preceded by music improvisation on thesame topic?

Compared ́ music narrativesµ with ́ verbalnarrativesµ in terms of Content, Form and Senseof Self

� How do verbal and musical narratives compare?

�

How do they develop?� How does music improvisation contribute to the

creation of narrative?



Stories of personal life experience are elicited from 8participants living with schizophrenia in two ways:

1) By asking the participant to verbally narrate on aspecific topic.

This is the non musically-prepared or verbal narrative

2) By asking the participant to:

a) Improvise on a specific topic

b) Listen to a recording of the improvisation

c) Create a verbal narrative on the same topicThis is the musically-prepared, or music narrative



Data of 4 narratives collected in 3 to 4 sessionsNarrative 1: Verbal narrative, baseline

� H ow I spend a typical day in the hospital

Improvisation practice after the first baseline narrative

Narratives 2 and 3: Music narratives� H ow I spent a typical day before I came to the hospital

� What I would like a typical day to be like when I leavethe hospital

Narrative 4:Verbal narrative

� T he steps I will take to get my life where I want it tobe



Rating Criteria for Narrative Analysis

1) Narrative Content: how the participant describes

external events and emotions

2) Narrative Form: how the participant constructs the plotand creates coherence

3) Narrator's Sense of Self: how the participant perceives

oneself and one·s relationship with others



Narrative (Tyrell: 1) Narrative (Tyrell: 1) 1(V)1(V) 2(M)2(M) 3(M)3(M) 4(V)4(V)

CONTENTCONTENT

External events:External events:Historical detailsHistorical details

Missing someMissing someminor minor

Missing someMissing somemajor,major,

many minor many minor

Missing someMissing somemajor,major,

manymany

minor minor

Missing someMissing someminor minor

Description of EmotionsDescription of Emotions

IntensifiersIntensifiers ExtremeExtreme ModerateModerate ModerateModerate ModerateModerate

Positive emotionPositive emotion LittleLittle None None ModerateModerate ModerateModerate

Negative emotion Negative emotion ExtremeExtreme ModerateModerate None None LittleLittle

Attribution of Attribution of

emotions to self emotions to self

ExtremeExtreme ModerateModerate ModerateModerate ModerateModerate

Awareness of othersAwareness of others ExtremeExtreme ModerateModerate ModerateModerate ModerateModerate

Affective ToneAffective Tone Anger,Anger,

Sadness,Sadness,

frustrationfrustration

Sadness,Sadness,

no sense of no sense of

controlcontrol

Joy, hope,Joy, hope,

fantasy,fantasy,

desiredesire

Frustration,Frustration,

hopehope



Í·m not allowed to sing late at night. I alwayshave to wait till seven in the morning causethey threaten me.«

And then I get dressed, and then I get ready

for breakfast, but I always, I can alwayscount on somebody making me cry during theday because I do have, there are certainpeople on the unit who don·t like me,«cause they slap me«

« and yet they still slap me in the faceanyway.µ



Í found my, I found my prince charming«µ

´Somehow I was able to express what I feltwith the xylophone.µ

Ýou understand?...And you know, I neverplayed that xylophone a day in my life.Never. «[I think ] that I must be gifted.µ



Éverybody on this unit is having sex with Tom,

Dick, and Harry, but I·m the only one on the

unit who·s not having sex. Everybody on the

unit has a lover and a partner but me.µÍ don·t have a partner and I·m not having sex,

and since I·ve been here, I haven·t had a

partner and I haven·t had sex. And that

pisses me off about the whole unit too.µ



´He won·t talk to me and that frustrates me.

As long as I feel this way and he be

interested in me, doesn·t talk to me and let

me know, make some kind of connection withme«µ

´Maybe at the park some sunny Friday or

sunny Saturday in the park. I would know

that somebody makes some moves that theylike me, see how they might respond back.µ



´Well you have people who are patients whoare never going to be mentally stable againno matter how much medication they take,and I·m very fortunate to have myself to be

stable on medication.µ

Ánd I feel very hurt that there are peoplethat are like that«. But I do pray for them.µ



Ít was hard for my family because they were

all trying to get me help desperately. I

wouldn·t take my medication for anyone. My

brotherswere trying to get me to take my

medication.µ

Ít·s been hard on my Mom, it·s been hard on

everybody in my family. They hate to see melike this, but I·m doing pretty good now and

they·re glad of that. They·re really happy

with that.µ



Ýou see, this is the thing. My freedom should

never, never have been taken off me. And my

dad told my sister and brother-in-law not to

302 me no more, and he said, ¶This is the bigMahaw, you know who this is? This is the Big

Mahaw, and I·m telling youse not to 302

[Roger] no more.· And they both did after he

died, time and time again And they sent meto Bucks County Prison.µ



´Going to concerts, going to Belmont Plateau

for uh, what do you call that? Earth Day.

Going to the beach («) and just having a

good time. I grew up in the 70·s. I liked itback then better than now.µ

´They said that I would have to go to 30th and

Market to a day program and there are too

much restrictions, and I·m going to do it untilI know that I can get out on my own again.µ



Positive Emotion

4/5 improved in 3(M); 2 maintained in 4(V)

Negative Emotion

6/8 improved in 3(M); 4 and 2

� Increase was a gain: greater expression for oneperson, and less denial for another

Awareness of Others

3/4 improved in 3(M); 1/4 improved in 4(V)

� Improvement was a reduction in awareness (fromextreme) for 2 persons and more awareness for 1



Attribution of Emotions to Self

2/4 improved in 3(M); 2 others regressed in 4(V)

� One person decreased extreme focus on self-emotions,another increased from having little self focus

Historical Detail4/5 decreased in 2 and 3(M); 1 had improvement ()

� Focus was less on detail of content in (M), more onemotional content

Exception was one person with extremely minimal

narratives who () detail in 3(M) and maintained in 4(V)Affective Tone

� 7/8 improved in 2 and 3(M); 3 regressed in 4(V)



Éat breakfast, go to groups, stay focusedin the day. They should let me go home. Idon·t want to be in the hospital. I·m so

tired. And that medication makes mesleepy. What time is it? «They gave me 30days or less in court today. That ain·t toobad is it?µ

´Look for a house, find a job. Find a jobthat pays well. See I wanna be self-employed. Never do drugs and alcohol, Inever do drugs and alcohol. Never, ever. Idon·t do that.µ



Logical Connections

3/4 improved throughout, 1 regressed in 4(V)

Transitions

3/4 improved in M; 1 improved in 4(V)Plausibility

3/4 improved in M

Disruption of Temporal Order

2/2 improved in M; 1 continued to improve in 4(V)



Í·ve learned that life had road blocks and

you·re going to face those road blocks and

you have to know how to overcome thoseroad blocks

and turn them into maybe peaceful stones

for yourself.µ



´ And it seemed like every day I was just going

on a down spiral. Because you know, I wasn·t

taking my medication at the proper time.

And I was just like rebellious, you know,fighting with my mother. And my mother·s

getting older you know. And it·s like, my son,

you know, it was hard for him to understand,

but he knew something wasn·t right about

me.µ



Í like to go home, there·s more freedom in

that I don·t have to share so much with

people. It·s a part of awareness of self and

self control that you need the isolation toself to grow.µ

Í·m adapting but I think I should be at home.

And then I could see my family wheneverthey come around.µ



´ [My brother] is real special to me. And um,

I·m waiting to see him. He·s real special.µ

´They were all really kind. They would offer

me their hospitality. They were real kindpeople, Generous, too.µ

Ánd my church friends as well. They·re really

special in church.µ



´But I always feel like somebody is playing a

game. I mean, it·s a game. And it·s a game

with my life.µ

´My daily activity is busy with myself trying to

develop something about myself« µ

Ánd I knew I had my place of serenity.µ



´ I like to stay in my room and pray to God.

I know God is on my side.µ «´Thanks for

meeting with me. That·s very considerate

of you. Very nice of you.µ

´ I·m gonna look for a job in personal care.

Charge my own price.µ «Í·m gonna

volunteer with the elderly and volunteerwith little children. Volunteer my love

and kindness to them. µ



R eflectivity

4/5 improved in music; 2 maintained, 2 regressed in4(V)

5/8 regressed in 4(V)

Awareness of Disorder3/5 improved in M; 2 maintained, 1 regressed in 4(V)

1 omitted in all; 2 adequate

R elationship with Others

8/8 improved in 2 or 3(M); 2 maintained, 2 improvedagain3 regressed in 4(V)



Agency

7/8 improved in M; 3 maintained the improvement; 1improved again in 4(V); 4 regressed in 4(V)

Social Worth

3/4 improved in M; 2 maintained, 1 regressed in 4(V)

1 improved only in 4(V)

4 omitted reference in 2 or more narratives and could

not be assessed



� Most changes first took place in the music narratives

� Many of these were sustained in the final verbalnarrative

� Occasionally participants regressed in the finalnarrative after having improved in the music narrative

� Most participants improved their narratives from thebaseline narrative where there was need of it

� Some changes occurred only in the final verbal narrative

� There was a cumulative effect of music improvisationon improving the narrative ² either having lesstangential verbosity, or including greater detail



Through the music and the instruments while creatingMusic Improvisations, Clients:

� Accessed positive memories and associations

� Became more connected to themselves and theirfeelings



� Positive change in affect helped to reduce psychotic andparanoid thoughts.

Calmer affect ² clearer thoughts� MI requires organizational skills similar to narrative

skills of syntax� MI requires that we continue to create sounds while

moving through time in continuous present.

This experience of form may be generalized toverbal expression, helping to create more

cohesive narratives



� MI engages one in a process of self awarenessthrough projection of self in the world: theself creates music that is a reflection ofoneself and provides a richer reflectivesurface on which to see oneself

� Opportunity to experience oneself as uniquein the music creation seemed to help personsto recognize personal strengths, abilities, andinterests



� Increased internal communication and greateraccess to positive memories in MI may havehelped some persons to consider new, or

forgotten options in life�MI involves the person in making choices about

one·s identity through instrumental choice andmusical elements (timbre, rhythm, melody).

�Taking responsibility for one·s musical choice

helped persons to recognize other areas of theirlives where they had greater control



Psychological processes in music improvisation:

�Music can contain overwhelming negativeemotions

�Music organizes internal chaos through theselection and expression of rhythmic andmelodic sounds that represents one·s chaoticenergy and impulses

�Music is a means of accessing pleasantmemories and associations



�Music evokes the person·s natural

capacity for creation

�Music evokes one·s capacity to soothe

oneself

�The relationship established with self

through sound, memory, and a particular

instrument may change the person·s

perspective of self in the world and

reveal different aspects of one·s identity



Lysaker and the Dialogical Self:

Need to foster the re-emergence of internal dialogue

Holma, Aaltonen and the Open Dialogue Narrative Approach:

Need to construct a life narrative that incorporated the person·sexperience of psychosis

Michael White and Narrative Reconstruction:

Need to help reconstruct the person·s dispossessed identity; useidentity documents

Recover aspects of life stories that have remained out of ourawareness in order to change the way we see ourselves and thuscreate the possibility of living an alternative story.



� Understanding how MI can contribute to narrativeconstruction

� Broadens the range of verbal techniques and musictreatment approaches that MT·s might use

� Provides specific examples that illustrate theoreticalconcepts related to the use of improvisation in therapy

� Indicates that some changes occurring in MI maygeneralize to thoughts and feelings as expressed innarratives



� Study provides students with concrete examples of

how improvisation functions as a therapeutic

medium

�Narrative Practice approach may be helpful inpreparing MT students to develop integrated verbal

and music techniques when working with verbal

clients



�Scope of the research: 8 participants withchronic schizophrenia

�Data analysis: pre-determined codes may have

caused me to overlook important information�Reliability: Did not include another reader to

rate the narratives

�Last narrative question may have been too

difficult, resulting in the regressions seen in thefinal narrative



� How can identity be strengthened by integratingreferential MI and Narratives for the therapeutictreatment of problems related to self concept? (PLWS)

� How can each of the different kinds of breakdowns in

self diaogue (Lysaker) be treated with MI?� What music therapy techniques could be used with

specfic Narrative Practices?

� Using results from this study that identified narrativecharacteristics that were most likely to change, could alarger quantitative study be designed to treat specificnarrative problems in schizophrenia? What would be therelevant tests and treatment protocols in such a study?



It appears from this study that music

improvisation may help PLWS to narrate their

life stories and to gain a richer perspective of

their lives. This might have important

implications for rehabilitation.

Narrative Practitioners embrace other theories

and therapeutic approaches. Music therapy

practices share much that is similar with NP.Thus further research is needed to examine the

ways we might enrich each others· practice.



T hank You

American Music T herapy ConferenceNew England Region

Brewster, MA.

2011

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