Opposition to Music Therapy? How Music Therapy is Affected by the Dominant Position of the Biomedical Model Pt 2
The biomedical model of medicine is the dominant health care model in many countries. What happens to other complementary and alternative treatments that do not fit into the mold? This hub is part 2 of a case study of Music Therapy in Singapore.
This hub is a continuation of the hub Sociology of Medicine: How Music Therapy is Affected by the Dominant Position of the Biomedical Model Pt 1
2. Access to Knowledge and Treatment
The dominant position the biomedical model occupies also influences the amount of information accessible to the public by controlling those who possess the information, and through other methods such as exclusion and marginalization. The former President of the Association for Music therapists (Singapore) shared how music therapists in Singapore struggle provide music therapy as a complementary treatment when many doctors are resistant to therapies that do not fit into their conceptualizations of the biomedical model. One reason provided was a lack of awareness, given the small number of local music therapists. Sociologically, exclusion is an indirect method biomedical authorities use to maintain their dominant position (Mizrachi, Shuva & Gross, 2005). This occurs when biomedical authorities allow the non-biomedical into the biomedical setting with many constraints, in turn strengthening their powerful position while other treatments remain marginalized.
Another strategy to preserve power involves controlling those who are “knowledgeable agents”, which refer to the music therapists themselves (Mizrachi, Shuva & Gross, 2005). This manifests in ways such as poor remuneration, accreditation and lackluster job prestige. In Singapore, there is a striking absence of formal recruitment avenues and institutional support for music therapy; music therapists adopt more informal means to find employment; unlike mainstream biomedical professions that have insurance schemes available, this is not the case for treatments such as music therapy and mental healthcare that exists beyond the infrastructure of the biomedical model. This erects barriers to entry as far reaching – prospective music therapists are deterred from entering the profession, and current music therapists face opposition from many fronts. Clients without the social and financial capital are also denied from treatment, and these clients from lower income backgrounds are often those who need the most help. On a wider scale, research funds are also allocated based on principles such as supply and demand, and in Singapore, most emphasis is placed on scientific biomedical research.
Ironically in Singapore, while we position ourselves as an international biomedical hub, we seem to embrace certain schools of treatment over others. We spend millions in pursuit of state of the art technology in medicine, and invest heavily in research and development ventures. We have attracted the major medical technology, pharmaceutical, biotechnological companies such as GlaxoSmithKline, and our Gross Expenditure on Research and Development is S$7.1 billion dollars in 2008 (Singapore Economic Development Board, 2001). In fact, it appears as though we favor the cutting-edge treatments over the more intuitive, creative, non-invasive simpler therapies. When the biomedical model occupies such a dominant position in the way our healthcare policies are designed and understood, not only are other schools of treatment further marginalized; our perceptions of other treatments are colored, which can even cause us to be suspicious and hesitant to accept them.
3. Attaching meanings to health behaviors and treatments
The power accrued to the biomedical model is reinforced by human agency and influenced by culture (Hewa & Hetherington, 1995). In Singapore, physiotherapy and speech therapy are regarded as the core therapies model while creative art therapies like music therapy are dismissed as optional. Music therapy is particularly misunderstood and simplistically regarded as listening to classical music when it is used as a core therapy in cases such as mental disablement (Tan, Loi & Ng, 2009).
A music therapist who was also a teacher also shared how culturally, psychotherapy remains unpopular among Singaporeans, although in realms such as education, people have begun to embrace the value of music and other arts. Music has been relegated to the aesthetics, a field that is subjectively constructed as whimsical, secondary and inferior to the sciences; these attitudes are projected onto music therapy and other treatments that do not fit the cultural stereotypes and expectations of being effective.
A US study done to understand the growing trend in getting alternative treatment unveiled that those who sought out alternative treatments tended to be more educated, perceived themselves as experiencing poorer health. Strikingly, these people reasoned that it was a fit with their life and health philosophies, instead of a strong dissatisfaction with the conventional healthcare that compelled them to turn to alternative healthcare (Astin, 1998). Although there is no formal local study, this illustrates the importance personal agency when engaging in healthcare behaviors, and helps to explain why certain treatments remain more popular than others.
Therefore, constructing the biomedical health model as the dominant healthcare ideology renders non-conforming treatments like Music Therapy as second-class, non-essential or even phony therapies in the perception of Singaporeans. Also, subscribing to this model has wider social, economic and institutional consequences that shape the policies, occupational prestige and other aspects surrounding these treatments that cause them to remain marginalized.
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I want to thank the music therapists who have taken the time to answer my questions. I have been so inspired by them, and this would not have been possible without their patience and generous help.
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