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D O Akombo

The Use of Drumming as Cure for Children with Post-Traumatic Stress Disorder (PTSD)

Copyright © 2003 by David Otieno Akombo, Ph.D

Post-Traumatic Stress Disorder (PTSD) can be an extremely debilitating condition that can occur after exposure to a terrifying event in which grave physical harm occurred or was merely threatened. Traumatic events that can trigger PTSD include violent armed conflict like that of Somalia, Rwanda and Burundi, and Sudan. Others may include personal assaults such as rape or mugging, natural or human-caused disasters, accidents, or military combat such as the veterans who are serving in Iraq or those who served in Vietnam and the Gulf Wars; rescue workers involved in the aftermath of disasters of the World Trade Center, survivors of accidents, rape, physical and sexual abuse, and other crimes; immigrants fleeing violence in their countries; survivors of the 1998 Nairobi US Embassy Bombing among others.

Effective treatments have now been developed to help people with PTSD. Research is also helping more scientists to better understand the condition and how it affects both the brain and body. Different forms of music such as drumming are becoming an important therapeutic tool. Drumming exercises greatly reduce stress among Vietnam veterans and other victims of trauma, apparently by altering their brain-wave patterns.

The effect of drum in the treatment of diseases should not be disputed. Since our ancestors first struck sticks and rocks against the ground, drumming has been a sacred ritual in many societies.(1) This belief emanates from the fact that throughout the world, the drum has been used for healing purposes. The traditional peoples of Africa, the Aboriginals of Australia, the Balinese of Southeast Asia, the Native American Indians, the ancient Celts among others all used drumming to bring the rain, the sun, a bountiful harvest, successful hunting and good health.(2) The drum has also been used in tribal societies with shamanistic traditions while communicating with the gods. In West-African wisdom teachings, Cottel (2001) noted that emotional disturbance manifests as an irregular rhythm that blocks the vital physical energy flow. Cottel also refers to current medical research which has shown that stress is a cause of ninety eight percent of all diseases such as heart attacks, strokes, immune system breakdowns, among others. Recent biofeedback studies (for example, Spintge 1992; Harner 1990; McIntosh 1996) show that drumming along with our own heartbeats alters brainwave patterns (increasing alpha) and dramatically reduces stress. Unlike the western cultures which rely on material evidence such as infection from bacteria or viruses, cell production such as cancer, or genetic defective chromosomes, the non-western cultures, relate to the diseases from a cultural perspective connecting the etiology to the metaphysical world. Their understanding of the disease etiology is embedded in their cosmology. For example the Luo tribesmen of Kenya believe that HIV/AIDS is caused by a curse. In this perspective, a curse is viewed as evil pronounced or invoked by another living person or the spirit of the dead. Among the Luo tribe, drum ensembles are performed with the object of exorcising the bad spirit from the patients.

Among the many African tribes, regular and balanced meter are regarded as a sign of good health. Even in improvisations, the performers are expected to render an exact replica of a standardized musical practice. These mythologies that relay regular and replicated rhythms to heal the person in an immediate and powerful way by removing blockages and releasing tension can be seen in the performance of a Kenyan tribal ritual dance, ngoma of the Taita as well. During this performance, a glissando is played by the lead drummer by gliding his left hand from the middle of the drum to the edge (kusira ngoma). By doing this, the drummer not only provides an expressively emotional pattern at the climax of the healing ritual but also provides a functional significance to the healing process because it is during this moment that the drummer sedates the pepo spirit to descend and exorcise the evil spirits from the patients. Kusira ngoma, which literally translates into "going beyond with music," is the climax of the healing ritual and its ultimate extreme. This is the stage at which the patients shiver, fall to the ground and ultimately go into trance. During this healing ceremony, the master drummer controls the emotions of the patient while the patient unlocks his or her inner subconscious mind. In the middle of the performance when the interlocking parts become intense, the patient is induced to a state where they start to dance pathogenically as they respond to the mwazindika drum, letting their souls soar into the supernatural world to meet the deity. In a similar supernatural mediation, Cornelius (1990: 127) found that the Afro-Cuban bata drums were believed to be capable of talking and communicating directly with the Orishas, Yoruba gods. But this power of the drum to be able to speak is also possibly seen as a catalyst to helping people to talk. Ms. Ruth Noonan, a practicing music therapist in Longmont United Hospital in Colorado has observed that in her recent practice, she has witnessed the drumming helping a patient to regain speech:

There have been magical moments as well. One man who did not speak due to a stroke is now able to tell me that he grew up on a farm and always loved music. Now he is participating for the first time in music instead of just listening and he loves it... and he is talking!!!

As the patients delve into subconscious worlds, the healer plays glissando (kusira ngoma) on the mwazindika. The healer, who occasionally wets his left thumb with saliva and glides it from the edge to the middle of the drum, continues to pound from the edge to the middle with his right hand until the patient stands and gets out of the healing arena.

Post-traumatic stress disorder is defined as a severe reaction to a traumatic event involving actual or threatened death or serious injury to self or others. According to the mental institute of health, PTSD can have an acute onset soon after the trauma, or a delayed onset in which the symptoms occur more than six months after the trauma.(3) It has been observed that an acute PTSD may resolve after three months, followed by a chronic form of the disorder which may persist even past that time. It should be noted that PTSD can occur at any age and can follow a natural disaster such as flood or fire, a man-made disaster such as armed conflict such as those experienced in Somali, Rwanda, Burundi, and Sudan. Others may include imprisonment, assault, domestic abuse or rape.

The causes of PTSD are not quite known. Many scholars (Konchin 2001; Shay 1995; ) have discussed and theorized extensively on the its causes, the National Institute of Mental Health points to psychological, genetic, physical, and social factors as its possible abode. The Mental Health Channel has observed:

The amygdala, a structure in the brain, is part of the limbic system that is involved in the expression of emotion, especially fear, autonomic reactions (e.g., increased heart rate and blood pressure, the startle response), and emotional memory. Dysfunction in this structure may produce symptoms of PTSD.(4)

PTSD alters the way our body responds to stress, effecting mediators such as stress hormones and neurotransmitters.(5) Prior exposure to trauma may increase risk, suggesting a kind of learned response. Music therapy plays a protective role. In studies of Vietnam veterans, drumming exercises greatly reduce stress among them and other victims of trauma by altering their brain-wave patterns.(6)

Prognosis of patients with Post-Traumatic Stress Disorder

The aim of treatment is to reduce the symptoms by encouraging the affected person to recall the event, to express feelings, and to gain some sense of mastery over the experience.(7) The drum has been used in many communities especially in Africa to help the victim recall the traumatic event and dance away the spirit. As a catastrophe, famine is one seasonal event that brings trauma to families all over the world. Among the Luo tribe of Kenya, each famine is allocated a name. This name is also synonymous with the bad spirit that is responsible for the famine. One such famine is nyawawa which emerges as a wind and sweeps across the Luo country. This wind is a spirit and may cause death and destruction including bringing famine. Whenever families think of famine, they remember their loved ones who may have died due to lack of adequate food as a result of this spirit. In many parts of the Luo tribe, the bad forces of nature that stop the rains and bring starvation are also responsible for causing other sicknesses as well. The National Institute of Mental Health identifies three stages of PTSD. The first state is where the patient experiences recurrent distressing memories of the event or experiences recurrent dreams of the event, or flashback episodes when the event seems to be re-occurring. The Luo community will play drums in such seasons to exorcise the spirits from the affected children and adults alike. This approach is consistent with the National Institute of Mental Health's Behavioral therapy which is used to treat avoidance symptoms. Behavior techniques used include the graded exposure to rhythms and melodies a like. Just like the medications act upon the central nervous system to reduce feelings of anxiety and associated ailments, so the drums elicit that effect. Antidepressant medications have been proven effective in treating PTSD, including newer compound agents such as Prozac, Paxil and Zoloft. Sedating agents can help with sleep disturbance. Anti-anxiety agents may be useful, but the benzodiazepines, a common class of these medications, can potentially become as addictive the drum music of the Luo. The second state is the avoidance where the patient exhibits significantly inability to recall important aspects of the trauma, or lack of interest in activities. The patient also shows feelings of detachment, sense of foreshortened future, psychic or emotional "numbing" and restricted range of affect.(8) The last state is the arousal state where the patient is highly irritable or shows outbursts of anger. The victim also exhibits sleeping difficulties and has difficulty concentrating leading to Attention Deficit Disorder (ADD) especially in children.

Prevention of PTSD

Early counseling and crisis intervention through music are important for people who have experienced extremely stressful situations. Musical interventions may help prevent chronic forms of PTSD and should be part of public health responses to groups at risk such as disaster victims.

Experience at the Shands Hospital at University of Florida

As part of my study of the use of music in health with Dr. Miriam Zach of the University of Florida School of Music, I have in the fall semester of 2003 devoted two hours weekly to the Intensive Pediatric Care Unit (IPCU) of Shands Hospital of the University of Florida. Drumming is becoming an important therapeutic tool. In this pediatric unit, I have been able to play miniature "drum circles" and other forms of drum therapy to help the patients reduce pain. In one instance, my drumming was instrumental in helping the nurse give routine injections to the children. Although my drumming temporarily reduced stress and fear associated with the jab and the piercing of the epidermis, this therapeutic intervention greatly helped the children. The effect was achieved by altering the children's brain-wave patterns.

On several occasions, while at the IPCU, I have a dozen children residents with disorders of the nervous system, disorders of the brain, meninges, and skull gathered for their weekly rhythm circle. With the help of therapist Kathy Dewitt, Rusti Brandman and John Graham-Poe, I had each child shake maracas to the tunes of Sani Bona, a South African tune. Some who seemed otherwise confused could nonetheless tap perfectly on cue. Patients unable to speak were able to sing childhood songs. Those barely able to walk could lift their limbs when the dancers moved to my drum beats. As yet, neuroscience has no sure explanation, but some experts think the brain's receptors for music and rhythm are spared the early ravages of senility. And while many scholars may argue that no amount of drumming can cure the disease with significant results, drumming can improve the quality of life and offer another way for pain relief and attainment of the highest satisfaction.

Footnotes

1 Dorian Friedman, US News and World report, June 9, 1997
2 Moonsong Music Company at http://www.holistic.ie/main/essays/music.htm
3 Institute of Mental Health Publication
4 Mental Health Channel
5 Ibid
6 Dorian Friedman (1997). Drumming To The Rhythms Of Life. US News and World report, June 9, 1997
7 Institute of Mental Health Publication
8 Ibid

References

anon (1994) Diagnostic and Statistical Manual of Mental Disorders. Vol. IV. American Psychiatric Association. 1994
anon (1998) Post-Traumatic Stress Disorder (PTSD).
Akombo, D. (2001) "Reporting on Music Therapy in Kenya". In Voices: A World Forum for Music Therapy, 1 (1), Oslo: Sogn og Fjordane University Press
Cornelius, S. (1990) "Encapsulating Power: Meaning and Taxonomy of Musical Instruments of Santeria in New York City". In Selected Reports in Ethnomusicology (8) 125-142
Cornelius, S. (2000) "They Just Need Money: Goods and Gods, Power and Truth in a west African Village". In The African Diaspora, Ingrid Monson (ed). New York: Garland Publishing Inc
Cottrell, A. (2001) Healing Musical Instruments.
Erdtsieck, J. (1997) Pepo As An Inner Healing Force: Practices of a Female Spiritual Healer in Tanzania. Amsterdam: Royal Tropical Institute
Fedders, A. & C. Salvadori (1979) Peoples and Cultures of Kenya. Nairobi: Transafrica
Finke, J. (2001) Traditional Music and Cultures of Kenya.
Finke, J. (2002) Music in Taita. Personal Communication, January 6th, 2002
Friedson, S. (1998) "Tumbuka Healing". In The Garland Encyclopedia of World Music Vol. 1, R.M. Stone (ed). New York: Garland Publishers
Good, Charles M. (1987) Ethnomedical systems in Africa: patterns of traditional medicine in rural and urban Kenya. New York: Guilford Press
Harper, P. (1969) "Dance In Nigeria". In Ethnomusicology, 9 (1), 280-295
Hobart, A., U. Ramseyer & A. Leeman (1996) The Peoples of Bali. Oxford: Blackwell Publishers Limited
Hollandsworth, J. (1990) The Physiology of Psychological Disorders: Schizophrenia, Depression, Anxiety, and Substance Abuse. New York: Plenum Press
Hood, M. (1982) The Ethnomusicologist. Kent: Kent State University Press
Horden, P. (2000) Music as Medicine: The History of Music Therapy since Antiquity. Hants: Ashgate Publishing House
Huebner, P. (2001) Nature's Laws of Harmony in the Microcosm of Music. From a lecture given by the classical composer Peter Huebner at the medical faculty of the University of Heidelberg, the University of Tel Aviv and the University of Magdeburg.
Janzen, John M. (1992) Ngoma: Discourses of Healing in Central and Southern Africa. Berkeley: University of California Press
Janzen, John M. (1978) "The Comparative Study of Medical System as Changing Social Systems". In Social Science and Medicine (12) 2B: 121-129
Konchin, D. (2001) Post Traumatic Stress Disorder: the invisible injury. Oxford: Success Unlimited Publishers
Kovach, A. M. (1985) "Shamanism and Guided Imagery and Music: A Comparison". In Journal of Music Therapy, XXII (3). National Association of Music Therapy, Inc.
Lazarof and Shimshoni (2000) "Reducing Blood Pressure in Patients with Neurodermatitis and Psoriasis".
Moreno, J. (1995) "Ethnomusic Therapy: An Interdisciplinary Approach to Music and Healing." In The Arts in Psychotherapy 22(4), 329-338
Mullings, L. (1984) Therapy, Ideology, and Social Change: Mental Healing in Urban Ghana. Berkeley: University of California Press
Nketia, K. (1962) "The problem of Meaning in African Music". In Ethnomusicology. Ann Arbor, Society for Ethnomusicology
Nketia, K. (1962) African Music in Ghana: A survey of Traditional Forms. Accra: William Clowes & Sons Limited
Nketia, K. (1979) The Music of Africa. London: Victor Gollancz Ltd.
Robert, S. & M. Louise (1961) Songs of power. Syracuse: Church of the Christian and Missionary Alliance
Senoga-Zake, G. (1986) Folk Music of Kenya. Nairobi: Uzima Press
Shay, J. (1995) Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: Touchstone/Simon & Schuster

Discography

Akombo, D. (2002). Folk Music of Kenya. Bowling Green: Music Therapy International Inc. Ohio.
This CD is a composite of traditional folk tunes of Kenya performed during cultural activities including healing ritual ceremonies

Online resources

Music Therapy International http://mtikenya.tripod.com
American Psychiatric Association http://www.psych.org
National Institute of Mental Health (USA) http://www.nimh.nih.gov
National Mental Health Association (USA) http://www.nmha.org

Author biography

David Otieno Akombo, Ph.D, Assistant professor of Music, Weber State University, is the author of Music and Healing Across Cultures. Intrigued by the peculiarities of medical and psychological practices and the arts in healing, Dr. Akombo has studied and researched the healing power of the arts as both scholar and performer. He is the founder of Music Therapy International (MTI), a dynamic not-for-profit organization designed to provide music healing services to the underprivileged both in the USA and in Africa. Music educator, ethnomusicologist, musician, composer and drummer, he has worked predominantly in Africa and Southeast Asia and has studied with Balinese artists. Contact info: Akombo D.O., Weber State University, 1905 University Circle, Ogden, UT 84408-1905, USA. Tel: + 1 (801)626-6741. Fax: +1 (801)626-6811. Email: dakombo@hotmail.com

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