First it was exercise on prescription, then it was arts on prescription, soon it could be singing on prescription, as the clinical evidence builds up,
and as more and more projects promote the benefits of singing to health and wellbeing, both for those in generally good health and those with physical
and mental health problems, or who find themselves socially excluded or isolated.
Consider this scenario: you go to your doctor and instead of coming away clutching a prescription for a bottle of pills or a referral to a counsellor, you have a leaflet about a local singing group. This is the vision of Grenville Hancox MBE, Director of the Sidney De Haan Research Centre for Arts and Health based at Canterbury Christ Church University in the UK.
Imagine the day, says Hancox, when your GP says: "Go and have a sing with that lot down the road" instead of "take these pills three times a day!"
Exercise on prescription schemes have been gaining ground all across the UK over the last decade, to the point where there are now national standards for GP exercise referral schemes. And more recently, Arts on prescription appeas to be growing too, as exemplified with projects by Healing Arts on the Isle of Wight (Time Being) and East Kent Health Promotion Department.
But the idea that involvement in group singing can benefit health and wellbeing is also growing; the Sidney De Haan Research Centre lists several established projects:
- Singing for the Brain, East Berkshire Alzheimer's Society.
- Sing Your Heart Out, Hellesdon Hospital, Norwich
- Serendipity Singing for Health Choir, Midlothian
- Singing is Good for You, Voices Foundation
- Singing Medicine, Birmingham Children's Hospital
- Sounds Lively Choir, Isle of Wight
Chreanne Montgomery-Smith, a support and development officer with the West Berkshire branch of the Alzheimer's Society founded Singing for the Brain in 2002.
She wrote in 2006 in the Journal of Dementia Care she believed there were seven therapeutic outcomes from singing in a group that were of particular benefit to people with Alzheimer's, although one can see how these might apply to people in many other situations too:
- Communication: the singing warm up (exercises involving whole body, neck, shoulders, jaw, face, lips, tongue, diaphragm) strengthen neural connections to the voice and breath, and doing them in a group is fun and non-threatening compared to doing it one-to-one.
- Cognition: singing challenges concentration and attention, especially when techniques such as singing from memory, combining rhythm with action, and mental substitution are used.
- Engagement: for example making eye contact across the group and expressing to the audience the emtional message of a song.
- Confidence: joining a singing group can build confidence from the gradual gaining of skills, vocal strength and the thrill of being able to remember so much. Fear of failure is lessened when everyone is in the same situation and group members laugh together when they make mistakes.
- Relationships: in a group with a shared purpose and a leader that treats everyone equally, there is a chance to get away from those situations where you are a person with a condition, and relate to people in a different way. You make friends, find and give support, and express frustrations and emotions about relationship problems in many songs that cover those areas of life (Montgomery-Smith gives the example of "A Fine Romance" as a "safe" way to express one's frustration with a life partner).
- Empowerment: by leading singing rounds, taking responsibility for setting out chairs, getting scores ready, writing lyrics, greeting new members, there is a wide range of roles that help people feel more in charge of themselves and their lives and what they contribute to a group. Former carers also benefit: giving them a new role when they have lost a major one.
- Exercise and stress reduction: an excellent way to reduce stress is learning to exhale; it increases circulation as the diaphragm massages internal organs. It releases endorphins and improves the immune response, according to research that showed immune system changes in salivary Immunoglobulin A and Cortisol.
But this all changed when the couple joined the Singing for the Brain project aimed at people with dementia.
"The first time we went to Singing for the Brain he did not join in. On the second session he was starting to join in and by the third he was thoroughly taking part," said Jean, explaining that they would take the song sheets home and sing them at home.
"He is 82 and likes all the old-time songs, but he also started singing some Beatles songs and songs from the Broadway shows and even some modern stuff as well," said Jean, adding that he "seemed to be able to slowly learn things again".
There is also evidence that singing is good for people with COPD, or chronic obstructive pulmonary disorder. A study by researchers at the University of São Paulo in Brazil, published in the International Journal of COPD in April 2009, concluded that regular singing may improve quality of life and help COPD patients' breathing by preserving their "maximal expiratory pressure".
The authors wrote in their background information that singing "involves strong and fast inspirations, followed by extended, regulated expirations", makes repeated demands on the diaphragm for "full aspirations" followed by "sustained contractions", resulting in a sequence of breathing control actions and respiratory muscle exertion that has the potential to change the pulmonary function of people with COPD.
It appears that patients with severe lung disease being treated at the Royal Brompton Hospital are also benefitting from regular singing practice. Hundreds now take part in the sessions, and 60 of them are also enrolled in a clinical trial expected to issue a report sometime in 2010.
Some patients told the BBC last summer that the singing has transformed their lives.
The sessions take part in the Royal Brompton's Victoria Ward, a place that specializes in high-dependency care for patients with severe lung disease.
Dr Nicholas Hopkinson, who is leading the study at the Royal Brompton, said the study was trialling a novel approach with teaching breathing techniques. Often, when you try to teach a patient directly, they become even more conscious of the need to breath correctly, and this can make things worse, he said.
By learning to sing, the patients are being approached more "from the side", said Hopkinson, they are learning to "use their voice and their breathing for a different purpose, for singing, hoping that the skills that they gain through that in terms of controlling their breathing will actually be helpful in day-to-day life," he told the BBC.
Voice trainer Phoene Cave said she saw improvements in breathing control after just one session.
"I'm helping them to become aware of their bodies in a way that they're not used to," she told the BBC.
The class always starts with vocal exercises, including collective sighing, buzzing noises, and making "ha-ha" sounds up and down the scales.
Research suggests that regular singing practice also helps people with dyspnea, improves mood and reduces depression.
John Townsend, a patient in the Royal Brompton and member of the singing group, said that the evidence was plain to see. He explained how when they start their lessons, people from the wards just come along and join in:
"You can hear it all the way along the wards. And people are cheerful."
"They become cheerful and they're not even singing. So of course it's a great thing," said Townsend.
As any member of a singing group will tell you, you are never too old or too young to take up singing and start enjoying its benefits to health and wellbeing, and experience for yourself, what 19th century German poet, Berthold Auerbach meant when he said:
"Music washes from the soul, the dust of everyday life".
Perhaps this is one New Year's Resolution worth making and worth keeping, and preempting the day when your GP suggests it.
Sources: BBC, NHS, Canterbury Christ Church University, Alzheimer's Society, Harmony Showcase Chorus.
Written by: Catharine Paddock, PhD