Music Therapy and Chronic Mental Illness: Overcoming the Silent Symptoms

The National Institutes of Mental Health (National Institutes of Mental Health, n.d.) reports that about 4.1% of the adult U.S. population, or approximately 9.6 million adults, suffer from serious mental illness, at an estimated yearly cost of over $300 billion per year. These statistics are admittedly conservative, however, since sources for collecting data often do not include population groups likely to suffer from mental illness, such as the homeless or the incarcerated. The National Alliance on Mental Illness (NAMI) (NAMI, 2013) estimates that about 13.6 million Americans live with serious mental illness, and that about two-thirds of these people experience co-occurring mental health and substance abuse disorders. Considering these kinds of numbers and costs, it is not surprising that our healthcare system focuses its attention on the stabilization of active symptoms that are troublesome and/or injurious and cause difficulty in the community. Those who work with the seriously mentally ill, however, know that stabilization of primary symptoms is really only the beginning of being able to function well in daily life, and that return to the community as functioning and productive members requires far more treatment and support than the simple abatement of the symptoms that cause them to be problematic or harmful to self and others.Non-pharmaceutical treatment philosophies for individuals with chronic mental illness (CMI) tend to center on behavioral and/or cognitive behavioral approaches in both in-patient and community placements, presumably because these approaches are considered "best practice" (Glancy & Saini, 2005). These approaches tend to be those which are most easily studied and objectively documented. Lack of rigorous testing of other treatment approaches, however, may suggest that these behaviorally based approaches can really only be considered the "most studied," as opposed to "best practice." Behavioral and cognitive-behavioral approaches to treatment can be quite effective for helping individuals with CMI learn to control some of their symptomatic behavior and develop more functional social skills, but may do little to identify and address the non-behavioral issues that tend to disrupt long-term stability.The impact of serious mental illness can touch every domain of an individual's life. It is not usual for relationships with family, friends, and other social support to be severely disrupted, and even severed completely, because of an individual's behavior during active episodes of symptoms like psychosis, mania, paranoia, and so forth. Dreams for the future can be erased, and the individual's identity as it was understood previous to mental illness can be destroyed. In some cases, individuals with CMI find themselves to be entwined in the legal system for criminal behavior committed while in a state of diminished mental capacity. Awareness of these losses as the individual regains some stability can be devastating and should be considered a major trauma. Individuals with CMI, who can have significant difficulty reintegrating as functional members of the community, may be repeatedly reminded of this trauma each time they encounter difficulties with illness management, interpersonal relationships, independent living, employment, and coping with the stressors of everyday life. They potentially deal with re-traumatization on a regular, and perhaps even daily, basis.Onset of numerous CMIs occurs in early adulthood, the time of life when individual identity is taking shape and the ability to exercise independence and pursue hopes and dreams is within reach. Serious mental illness can halt this development, and often shatters the possibility of return to the type of life imagined prior to illness onset. Individuals with CMI often experience a good deal of grief in relation to these losses. At the same time, symptomatology that is unresolved (e.g., negative symptoms) and the immobilization of emotions that sometimes occurs with pharmaceutical treatment make it difficult to actively work through and resolve feelings of grief. …