Singing Therapy to Combat Parkinson’s Disease and Depression in South Korea
**********
Koreans love to sing. At least, they used to. I know, because I lived in South Korea in the 1970s as a Peace Corps Volunteer, and again in the 1980s as a university lecturer. This was before the days of K-pop and karaoke rooms, and virtually everyone knew a dozen songs or more to sing solo at dinner parties, on picnics, or when traveling as part of a group that had charted a bus for some kind of outing.
Singing was woven into the culture’s fabric. It seemed everyone had great voices. When the teachers at the middle school I worked at for two years went out for an all-faculty dinner party, we’d sit on the floor in a long private room at the restaurant and gorge ourselves on meat we cooked at the table. We’d down beer or soju (a vodka-like clear alcohol), and at some point, the leader in the group would stand up, make a short speech, and sing a song solo. When this person finished the song, he/she would carefully have to choose the next person to stand up and sing. It was kind of political who you chose, but by the end of the night everyone had sung, sometimes with tears streaming down their face, if, say, they were moving to another school. By the time I left Peace Corps, I knew a few dozen folk songs and pop songs by heart.
But this week, I read that Korean researchers seeking treatments for Parkinson’s disease are using singing lessons to improve the Parkie’s voice and to counteract depression.
The article, titled “Individual Therapeutic Singing Program for Vocal Quality and Expression in Parkinson’s Disease,” begins like this:
**********
Patients with Parkinson’s disease (PD) usually have inaudible voices, rapid monotonous speech, and hypokinetic dysarthria. [Note: “hypokinetic dysarthria includes limited pitch range or intonation, reduced emphasis of stressed syllables and words, reduced loudness, decreased accuracy of articulation, rapidly spoken phrases separated by extended pauses, and a raspy voice.” – Click!] Moreover, problems with phonetics, such as breathing, phonation, and articulation, also affect speech, leading to significant difficulties in communication. These communication difficulties can lead to social isolation and depression, which together may impair quality of life.
**********
The researchers worked one-on-one with 9 Parkies, using a singing course that the researchers developed themselves: Individual Therapeutic Singing Program for PD (IT-SP-PD). The program consisted of six 50-minute music therapy sessions, taught by a professional music therapist, over a two-week period.
The first session started out by having the Parkie experiment with vocal production, trying different ways to produce sounds at various degrees of loudness and pitch. Later lessons built upon the previous ones; by the last session the participants had explored how they could make and adjust sounds, and they knew how high/how low they could sing. They also practiced singing songs that appealed to them, and in the very last session, they invented their own songs based on their personal preferences.
The researchers interviewed the participants before the project began, after the first session, after the last session, and six months after that. The participants ran through a gauntlet of physical tests (such as you receive yourself when you visit your movement disorder specialist) and answered questionnaires about their mental/emotional health.
The researchers evaluated three aspects of the Parkies’ experience: vocal attributes, depression, and the Parkies’ response to the lessons.
For a glimpse at the issues the Parkies and researchers were dealing with, here’s the paragraph that sums up each participant’s concerns:
**********
Patient ‘A’ had daily communication problems due to unclear articulation, delayed phonation, and weak voice with tremor, as well as a less severe depressive mood. Patient ‘B’ had short breathing cycles during conversation, delayed speech, and low motivation to maintain daily life. Patient ‘C’ had dry mouth, a soft voice, and feelings of boredom in life. Patient ‘D’ had subtle voice problems daily. However, caregivers said she had difficulties expressing her own emotions and tried to hide her depressive mood from her family and friends. Patient ‘E’ had a soft and weak voice as well as a short breathing cycle. She complained of chronic fatigue and a depressive mood. Patient ‘F’ had lowered pitch phonation, problems with communication, and felt isolated and depressed. Patient ‘G’ had a weak and unstable voice with a short breathing cycle. She had anxiety about her illness and severe separation anxiety from her family. Patient ‘H’ had delayed phonation and lack of volume control, and he has flat affect which he could maintain in his work place when interacting with others. Patient ‘I’ had a soft and weak voice with tremor, and she had positive mindset due to which she had fewer problems communicating with others.
**********
By the end of the experimental treatment, the researchers felt they were on to something. Although individual success rates varied, in general their patients were singing better, speaking more clearly, and feeling less depressed. The researchers recommend that Parkies experience private singing sessions, not group lessons, and that the lessons be structured to ameliorate the Parkie’s fear of interacting with others, thus reducing the prospect of depression and self-isolation.
At this point I’d like to step in and talk more about Korean culture as it pertains to singing. Many of the traditional folk and other songs are based on feelings of loss, longing, hardship and strife. For example, a lover left on a boat and may never return. There are wisps of many clouds in the sky; my burdens are as numerous as those wisps. My older brother went on horseback to Seoul and said he would bring me a pair of silk slippers; when is he coming back?
The most famous Korean folk song is “Arirang,” in which a man has left his lover behind and is now walking over the Arirang Pass between two mountains, perhaps never to return, while his lover sings “He won’t walk ten li [about three miles] before his feet hurt.”
I was often struck at how wistful these songs were, yet people enjoyed singing them. Korea as a country endured countless hardships over the centuries, and I think many of the songs try to make sense of this.
Don’t you feel that now’s the right time to hear some traditional Korean songs? The following YouTube clip shows eight students from the charter school that I work at in the Bronx, performing three traditional songs at the Korean Cultural Center in New York. I taught them the songs, and for the first two songs I accompany them on the kayagum, a 12-stringed zither that I learned to play in Korea.
The first song they sing is “Arirang,” and the audience reception is wildly enthusiastic. (The second song is about picking up chestnuts after the wind knocks them out of the trees, and the third song is about looking for rabbits in the mountains. Both of these songs are upbeat.)
**********
**********
So back to the research article. As the authors of this experimental paper note, “Holistic outcomes of singing intervention led to alleviation of depressive mood and the amelioration of voice-related difficulties to improve the quality of life of patients with PD….Further randomized and well-designed studies using the IT-SP-PD will be required to better demonstrate its potential therapeutic effects.”
Sing out, Louise!
