Dr.D. Dutta Roy , Ph.D. (Psy.)Psychology Research Unit

INDIAN STATISTICAL INSTITUTE, KolkataWeb:http://www.isical.ac.in/~ddroy/ddpro.html 

Venue: Rabindra Bharati UniversityDate: 22.12.2008

ROLE OF PERFORMING ART THERAPY IN MENTAL HEALTH SCIENCE 

Incidence of Mental health disturbances

Mental hospital status : A report• The city of Calcutta had the first mental hospital in India in the year

1787, followed by Bombay (Mumbai) and Madras (Chennai). There are now 37 mental hospitals in the country with a total bed strength of 18 024 (National Human Rights Commission, 1999). A study of the status of the mental hospitals commissioned by the National Human Rights Commission revealed gross inadequacies in all aspects of care, clinical services and rehabilitation. The subhuman living conditions in some of them were a stark violation of human rights and a painful eye-opener to many. Steps are afoot to allocate more resources to improving these

hospitals (National Human Rights Commission, 1999).

Ref: Thara, R., Padmavati, R. and Srinivasan, N. (2004). Focus on Psychiatry in India. British Journal of Psychiatry, Vol. 184, 366-373. (http://bjp.rcpsych.org/cgi/content/full/184/4/REF25)

THE DISCUSSION FORUM• Recent events at the Pavlov Mental Hospital where inmates were

stripped of their clothing and left naked in the hospital ward, have not only shocked but enraged us. The issue extends beyond this isolated incident. Its not just about the lack of respect and dignity shown to the mentally ill in this particular instance but to the general stigma and discrimination that they have to live with almost everyday.

• The Department of Psychology and Applied Psychology, University of Calcutta,  jointly addressed this issue through a discussion forum and open house on 19th April, 2008 in Meghnad Saha Auditorium of Calcutta University.

THERAPY

Localized (ECT,DRUG)

Non-Localized(Psychotherapy,

Performing Art Therapy)

MENTAL HEALTH SCIENCE

• A branch of medicine that deals with the achievement and maintenance of psychological well-being (ability to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life).

PERFORMING ART THERAPY

• It deals with the causes, treatment, and prevention of mental, emotional, and behavioral disorders through performing art (dance, drama and music). 

SOME MYTHS

MYTH 1

• It is a substitute of Psychiatric treatment.

NO, IT IS NOT SUBSTITUTE RATHER IT ACTS AS SUPPORT SERVICE TO THE AVAILABLE THERAPIES FOR PSYCHIATRIC DISORDERS (MEDICINE, ECT, PSYCHOTHERAPY, OCCUPATIONAL THERAPY).

MYTH 2

• Performing art therapist can not wok alone.

THIS IS NOT TRUE. BESIDES PSYCHO PATHOLOGICAL CASE, THERAPIST CAN WORK ALONE. THIS IS SPECIALLY TRUE IN CASE OF REMEDIAL TEACHING PROGRAM, GERIATRIC CARE, PAIN MANAGEMENT, REHABILITATION OF CHRONIC PATIENTS, SUBSTANCE ABUSE AND BEHAVIOUR DISORDERS AND EXPERIENCE OF TRAUMA. IN INDUSTRIES, THERAPIST CAN ACT AS SUPPORT SERVICE FOR THE IMPROVEMENT OF PRODUCTIVITY, WASTE CONTROL AND CONTROL OF ACCIDENT.

MYTH 3• It is basically commercialization of

performing art. Therapist has to buy certain musical gadgets for therapy.

NO, THROUGH THE COURSE, STUDENT WILL LEARN SCIENTIFIC MODELS ABOUT THERAPEAUTIC VALUES OF PERFORMING ART. THIS KNOWLEDGE WILL HELP THERAPIST TO IMPROVISE OWN MUSIC, DRAMA, OR DANCE ACCORDING TO THE NEEDS OF PATIENT.

MYTH 4

• It is the exercise of movement or expression.

PARTLY TRUE. IT IS BASICALLY EXERCISE OF OUR BRAIN SYSTEM. PERFORMANCE OF PATIENT ACTS ON THE COGNITIVE, EMOTIONAL AND PSYCHOMOTOR COORDINATION CENTERS OF BRAIN SYSTEM.

MYTH 5

• performing art therapy is applicable only when medicine is not enough.

PARTLY TRUE. NOT ONLY MEDICINE, WHEN WORD IS NOT ENOUGH.

PARADIGMS OF PERFORMING ART THERAPYRESEARCH

PARADIGMS OF PERFORMING ART THERAPYRESEARCH

Biological Psycho-Social

Brain Neurological Vibration Psychoanalytic Consciousness Group Dynmaics

BRAIN PARADIGM

Emotional centers

Cognitive centers

It facilitates brain plasticity

Brain Mapping

• Frontal Lobe– How we know what we are doing within our environment (Consciousness). How we initiate activity in

response to our environment. Judgments we make about what occurs in our daily activities. Controls our emotional response. Controls our expressive language. Assigns meaning to the words we choose. Involves word associations. Memory for habits and motor activities.

• Parietal Lobe– Location for visual attention. Location for touch perception. Goal directed voluntary movements.

Manipulation of objects. Integration of different senses that allows for understanding a single concept.

• Occipital Lobe– Vision

• Temporal Lobe– Hearing ability Memory acquisition Some visual perceptions Categorization of objects.

• Brain Stem– Breathing Heart Rate Swallowing Reflexes to seeing and hearing (Startle Response). Controls sweating,

blood pressure, digestion, temperature (Autonomic Nervous System). Affects level of alertness. Ability to sleep. Sense of balance (Vestibular Function).

• Cerebellum– Coordination of voluntary movement Balance and equilibrium Some memory for reflex motor acts.

Neurological Paradigm

The brain produces natural chemical messengers - called neurotransmitters - that send messages from one nerve cell to another. Serotonin is known as the "feel good" neurotransmitter because it plays an important role in the regulation of mood. Low levels of serotonin can cause excessive feelings of sadness and anxiety.

Two other important neurotransmitters - dopamine and norepinephrine - also affect mood. When the brain doesn't produce enough dopamine or norepinephrine, you can feel tired, unmotivated and foggy-headed.

Ref: http://www.amoryn.com/howamorynworks.html

VIBRATION PARADIGMProfessor Olav Skille noted

effect of low frequency vibration on cellular system of human body. Skille does not use any conventional “music”. The idea is to transfer vibrations into the body so that all cells are set in motion, which will eventually release stress.

PSYCHOANALYTIC PARADIGM

Repressed desires and conflicts

Consciousness

OTHELO

Outer Layer:-Missing-Anomalies

Inner Layer-Vividness-Orderliness-Complexity

Inner Core Layer-Harmony with Environment-Aesthetics-Cleanliness

CONSCIOUSNESS PARADIGM

GROUP DYNAMICS

• Professor J F Moreno by using music therapy in psychodrama noted different levels of team formation. He is able to demonstrate group morale and leadership development through the followings: – Guided imagery by music– No guided imagery only music– Music therapy in projecting self– Music therapy in psychodrama.

How it is learned

How it is learned INPUT (Music,

Dance, Drama)

MAN-PAT dialogue

Art expression

FEED BACK

PAT acts as support system to understand, to analyze and to make harmony among different layers of consciousness.

Appraisal of Reinforcement

CASE STUDIES

Effect of PAT on Psychiatric illness

• Illness is patient’s reactions to the experience of being sick.• Psychiatric illness refers to one’s reaction which can harm individual as well

as surroundings.• Therapist’s behaviour varies across 5 stages of Psychiatric illness.• Edward Schuman describes 5 stages of illness.

– The symptom experience stage: in which decision is made that something is wrong;

– The assumption of sick role stage : in which decision is made that one is sick and needs professional care;

– The medical care contact stage : in which decision is made to seek professional care;

– The dependent-patient role stage: in which decision is made that to transfer control to the doctor and to follow prescribed treatment;

– The Recovery or rehabilitation stage : in which decision is made to give up the patient role.

Case Studies• Response control of OCD;• Projection of depressed patient;• Understanding Self of Anxiety disorder ;

Response control of OCDA woman of 52 years old came to me with complaint of OCD to dirt. Patient reported her

inability to control washing compulsion. For last 30 years, she regularly goes to toilet for washing and cleaning hands. She always closes her hands tightly so that her hands will be completely cleaned. Before visit to me, she was treated by many psychiatrists and one psychologist. No notable changes are noticed except long time sleep.

• In the first session, I found very strong resistance in her to reveal herself to me. By experiencing my failure to establish rapport, I diverted attention to Tagore's songs - "Ananda loke, mangala loke" (moving to spiritual land). Two assumptions were there - (i) the words of song would provide feeling of divine/spiritual land or feeling of away from any guilt, vice etc. (ii)such spiritual feeling might help to open her closed hands as her constant concentration to hands would be diverted.

• Woman sang with me initially in very low voice and later loudly. She participated into my hand movement representing changes in music wave.

• In the 2nd session after 6 days, the client sang with me same song by standing. She moved her hands above head when she sang " Grahataraka chandra tapana byakula drutabege" (the planets, satellites are moving speedily). It is noted that her hands now completely opened.

• In the 3rd sitting, patient reported that she alone practiced two songs "Ektuku chona lage...." (feeling light touch), and "Eto din je bosechinu" (waiting for long days) at home. Finally, she sang with me both songs alongwith Ananda loke, danced and she never closed her hands.

Compulsive Behaviour• Definition: Compulsive behaviour refers to certain

action which is judged by the patient as uncontrollable.

• Development: Patient discovers that certain action reduces the anxiety attached to obsessional thought. Thus active avoidance strategies in the form of compulsions or ritualistic behaviours are developed to control anxiety. Gradually, because of their efficacy in reducing a painful secondary drive (the anxiety), the avoidance strategies become fixed as learned patterns of compulsive behaviour.

Projection of Depressed patient A neurotic depressed patient came to me with complaints of suicidal desires. She was co-operative.

In stead of using common psychodiagnostic test, I used Geetbitan She was asked to select 10 songs from Geetbitan, the famous Book of songs composed by Rabindranath Tagore.

Patient selected following 10 songs:

1. Akash bhara surya tara2. Aloker ei jharna dharay3. Ananda dhara bahiche bhubane4. Ananda loke mangala loke5. Aji jato tara tabo6. Amar mukti aloy aloy7. Ami chini go chini8. Aro aro prabhu aro aro9. Alo amar alo ogo10. E ki labonye punya

Next, I told her to rank them. Her rank was :First : 3, Second : 10, Third : 4

• Finally, she sang the first rank song. I followed her in singing.I have noticed that each line of this song reflects her current mental state and it is interesting to note that the song also provides the answer as how to recover from such problems.

Finally I have used that song for her psychological counseling.Therefore, I have developed following assumptions:1. Geetbitan as Psychological test;2. The words of Geetbitan advances knowledge of psychotherapy.

Understanding Self of Anxiety disorder ;• One anxiety disordered patient came to me with complaint of

inattentiveness to study and poor academic performance.

• Case history shows his inclination to Rabindra sangeet.

• Jadi tare nai chini...Kalke khoob advut ekta ghatana holo.

Ek student tar madhye asambhab prativa gulo ke helay phele diye exam result bhalo karbar janye ghar gunje parche. Jathariti exam. result poor.

Ami dekhlam besh gaaner gala ache. Barite gaaner culture o ache. Nije tabla bajate pare. Request karar par gaan gailo :

" Jadi tare nai chini go se ki amay nebe chineei naba falguner dine---- jani ne, jani ne"

Oke jigges karlam dharo boi tomay ei kahta ta bolche, tumi tabe ki uttar debe.

- janina

Ami bollam dekho kabi kato sundar bhabe gaaner madhya diye ei uttar diye gechen. Tumi jadi kauke na chinte paro, seo tomay chinte parbe na.O hasche, tarpor bollo tabe ami ki bhabe parbo ?

- take chenrar matan kare paro, take chinle se tomay chinbe, tomar exam (naba falgune) er samay sei tomay chinte parbe, tai take chenar matan kare paro.

Psychology Syllabus of PAT • Based on the earlier observation, the course includes

followings: – Perception of Musical patterns;(Gestalt theory)

Musical Intelligence;(Olav Skill's theory)Thinking and imagery process;(Moreno's theory)Learning;(Pavlov,Skinner,Titchner,Gestalists,Tolman)Musical communication:joint attention,intention and emotion;Musical Identity;Consciouness

– Effect of music on cognition, emotion and psycho motor coordinationCognitive Neuropsychology and Music [Book on Music therapy and rehabilitation]Theory of arousal and effect of music on stress (John Slobda)Principles of psycho-motor coordination

– Psychoanalytic, creative, behavioral and receptive music therapyFreud

PAT is the Journey to Harmony

THANK YOU