Journal of Palliative Care & Medicine
Open Access

We usually talk about how music moves us. Being a ‘concerto’ of inaudible sound waves, the complicated human cerebral network of neurotransmitters associated with innumerable neurons and their connections identifies and transforms the energy from differentiated frequencies, resulting in the perception of music that indeed initiates emotions such as joy, passion, excitement, melancholy and even fury [1].

During historical periods, music has progressed enormously and today still occupies a central place in mythology, in religious systems and in various types of entertainments all over the world facilitating important spiritual manifestations. We sing or hum to make the baby fall asleep or to ‘wipe away’ a tear. Music is used for celebration, for grieving, for walking in line, for relaxation and enjoyment and many other purposes. The voice and musical instruments have a unique ritual and symbolic value of their own.

For more than 3,000 years, the harp has been an instrument of healing representing the unification of heaven and earth.

It is illustrated by the paintings of harps on ancient Egyptian temples and by the African Griots who brought healing to their community by playing their harps, telling stories, and connecting with the spiritual world. In ancient China, the first ‘divine’ ruler, Fu-Hsi is said to have invented music and the Ch’in, a table harp. It was played for health, longevity and enlightenment [2-4].

Pythagoras (500 BC, from Samos, Greece) recommended lyre music for bringing health to his patients. He believed each string echoed one of the heavenly stars. The lyre frame was a symbol of the physical body of humans, the strings a symbol for the nerves, and the music represented the human spirit. Playing the “nerves” created the harmony of the spirit [2-4].

From Biblical time we know the story of David, a shepherd and harpist, healing King Saul from anxiety and depression. From the Revelation: “And when he had taken the scroll, the four living creatures and the twenty-four elders fell down before the Lamb, each holding a harp, and golden bowls full of incense, which are the prayers of the saints.”[2-4].

In myths it was said that mermaids, water nymphs and sea sirens attracted hapless travelers to their doom by playing the harp. Apollo, the god of light, prophecy, music, and poetry, created the harp when he discovered that the sound of his bowstring would heal physical wounds and soothe souls. When Apollo’s son Orpheus were taught to play the lyre by the muses it is said that his songs could charm even rocks and rivers, with oak trees pulling up their roots to follow him. His playing even softened the hearts of Hades and Persephone – the Gods of the underworld – who allowed his wife Eurydice to return from the dead [2-4].

In early Christian times, harp music often accompanied telling, chanting or singing histories or hero tales. And finally harps were used in the religious rites of both pagans and Christians. At the French abbey of Cluny in the 11th century CE, monks played harps as part of their rites to assist the dying [2-4].

Live harp music has been performed at the bedside for many years at the Danish Hospice Sjælland (16 in-patient beds) by a Certified Therapeutic Harp Practitioner (CTHP) [5]. The purpose of harp music is to create well-being for seriously ill patients and their relatives and help establishing a more meaningful and tranquil atmosphere of transition. Harp Therapy is still a rare discipline in Denmark and the CTHP is the first in this country.

The importance of music therapy in general for addressing symptoms and lowering distress among patients is well documented [6-9].

The harp differs from many other instruments and the human voice by its vibrational patterns. A harp usually has 26 to 47 strings, and when you listen to a harp on which a string is being plucked, you will immediately experience a quality of sound that is more than just a single note.

Corresponding overtones and undertones multiply the vibrations of each plucked string. This rich mix of harmonic sound bathes the body, mind, and spirit of a listener with all of the vibrational energy which the sound carries.

Moreover, when the harpist plays, she usually plucks more than one string at a time. This enables the harpist to play both a melody line and harmony, and it distinguishes the harp from the human voice, flutes, brass instruments, violins and similar instruments.

Playing a melody line is a movement in time. The music moves horizontally and tells a story while it moves on note for note. In this way, it connects mostly to the personal realm and history. The harmonic part is not moving in time but is rather a vertical movement and experience that connects heaven and earth in a timeless state.

The harp therapist at Hospice Sjælland primarily uses her own compositions that especially adapt to every single circumstance that may appear in the room. Well-known music could create more tension because of potential memories that often relate to the music that we know, while unidentified music – still being very harmonious – gives a higher degree of relaxation to the patients.

Tuning-in musically and focusing on the intimate context in an endof- life setting is important for the harp therapist in order to palliate distressing symptoms. Most patients listening to harp music respond with a feeling of tranquility and a perception of feeling free and safe with less tension and pain. This can finally bring a peaceful acceptance of letting go. Certain musical modes may resonate differently according to the response of a given moment. Modes may change instantly by observing and addressing breathing patterns, mental distress or other specific objective and subjective signals. The harp music then resonates gently with the rhythms of the person's own body thereby creating harmony, and may even synchronize at the cellular level. That is why live music is preferable to recorded music, which is fixed in time.

Furthermore, many relatives often tell in a follow-up and postmortem rendezvous at the hospice that harp music brought the dying and the family closer together, because the patient's emotional needs are one of the most difficult areas for their close relatives to deal with. Even children usually love the sounds of the harp and we have often experienced that with a little help children plucked the strings and played for their dying parent.

The specific combination of touch and healing has been used for thousands of years in ancient Chinese and Indian medicine (acupressure). The “laying on of hands” is described as a miracle in the Bible and is still used as a part of religious, social and even royal practices in various cultures of today: “The tactile system is the earliest sensory system to become functional (in the embryo) and may be the last to fade” [10].

Physiotherapy is a very important co-factor in a palliative care setting, and it does indeed improve quality of life and the well-being of the patients. The physiotherapist at Hospice Sjælland also has a background in classical music as a pianist, and for more than a year the combination of harp therapy and palliative physiotherapy has been synchronized at the bedside as a non-pharmacological supplement to daily palliative management of symptoms.

It is interesting that this combination supports natural mechanisms such as pulse and natural breathing patterns and raises the patients’ quality of life measured by The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL questionnaire.

In many patients with dyspnea and anxiety, the breathing patterns are fast and thoracic, a so-called upper chest breathing. During the joint effort of the harp therapist and the physiotherapist, the patient will achieve relaxation and a predominantly diaphragmatic breathing pattern. The relaxation can improve a better night sleep and bring more energy during the day.

The harp therapist and physiotherapist usually perform in the patient’s room or in a group therapy setting. The physiotherapist uses different methods such as therapeutic touch, grounding, body awareness, massage or her voice guiding the patient into relaxation. The rhythm and the sounds from the harp gently guide the hands of the physiotherapist.

Both therapists adapt to each other easily. By being present and meeting the patient’s needs every new moment they are able to guide the patients into a deep state of relaxation and well-being. The aim of the music and physiotherapy is to attract attention to the interaction of body and mind and thereby create harmony and balance and bring inner peace.

It is notable that harp music therapy seems to have an important role in palliation by bringing relaxation and harmony to body and soul. The coupled, simultaneous effort of harp therapy and physiotherapy seems to improve this effect radically. The combination of these therapies has a strong synergetic effect in the management of somatic and mental distress in palliative care.

Further research into this topic is highly recommended.