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Sociology of Medicine: How Music Therapy is Affected by the Dominant Position of the Biomedical Model Pt 1
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 a case
study of Music Therapy in Singapore.
Music therapy is one of the creative therapies popular in the West, although in Asia and in Singapore, it still struggles to be recognized. This hub explores why music therapy is marginalized in Singapore through examining how the construction of the biomedical health model impacts other institutions and affects Singaporeans’ views toward complementary and alternative therapies. Specifically, I argue that constructing the biomedical model as the superior and dominant healthcare model has influenced Singaporeans’ views towards treatments that do not fit into the dominant discourse, relegating Music Therapy to a fringe position.
Countries like the US classify music therapy under allied healthcare, while research journals classify it as complementary or alternative treatment. Music therapy can be grouped under several categories depending on its use, but in this paper, I refer to it in general as a treatment that does not fit the biomedical model mould.
The biomedical field has reached unprecedented levels of accomplishment and progress. Ironically, more people are turning to complementary and alternative therapies when they are ill, as conventional treatments are perceived as more invasive, impersonal, technologically oriented, and producing side-effects (Astin, 1998). In contrast, alternative and complementary therapies are generally believed to be more holistic in approach, using more organic remedies and time proven strategies. This trend in the West is gaining momentum in Singapore and it is worth examining why there exists a gap between the growing preferences for non-biomedical treatment and the institutional bias towards biomedical medicine.
What is Music Therapy and Why it is Important
In essence, music therapy is the use of music or music related activities to help others in a therapeutic setting and to promote heath. Music therapists can be found in special education schools, hospitals, rehabilitative settings, prisons, practically any setting where music can help to achieve a goal, which could be social, emotional, behavioral, physical or even psychological in nature. Music therapists are typically trained in one of the schools of thought, which include humanistic music therapy, behavioral music therapy and even biomedical music therapy. Biomedical music therapy is the closest fit to the biomedical model due to its scientific slant, where the brain is the locus of focus in the music therapy treatment process (Taylor, 2007).
Music therapy is special as it capitalizes on what is so ordinary yet so powerful and core to our human expression to help clients. The therapeutic aspect of music seems to be intuitive since biblical times when King Saul ordered David to play the harp when he felt troubled (1 Samuel 16:23, New International Version).
Max Weber’s theory of
rationalization included ideas of calculability, predictability and control,
which are argued to be the basis of the biomedical model that focuses on
disease rather than illness (Hewa & Hetherington, 1995). Sociologists like
Engel claim that the biomedical model inadequately fulfils the social and
scientific duty medicine has to society, proposing the need for a new model
that acknowledged the body and mind connection instead of separating them;
while rationalizing healthcare had social and economic gains, it eroded
traditional moral and spiritual ideals, alienating the human spirit (Hewa &
Although there is no Singapore statistics, studies done overseas illustrate how the prevailing biomedical model impacts on the attitudes and knowledge of other treatments. A study done on medical students in Melbourne revealed that most students had interest in complementary medicine, although 56% of them were largely ignorant about it (Hooper & Cohen, 1998). Another study done in the UK revealed that 25% of General Practitioners and Child Psychiatrists thought music therapy was ineffective or dangerous for mental health (Mutale, 1994). These findings are stark in light of the growing popularity of complementary treatments in the general public, and considering how music therapy is much more established as a therapeutic intervention in those countries than in Singapore.
Explaining the Effects of the Dominant Biomedical Model
In Singapore, the dominant model that the state endorses is the biomedical model. This has widespread social and economic impact on how alternative and complementary therapies are adopted into the mainstream healthcare.
1. An Inherent Misfit with the Biomedical Model
The biomedical model is shaped by Foucault’s notion of the ‘clinical gaze’, where “seeing = knowing”, priding itself for being evidence-based (Hewa & Hetherington, 1995). However, it is difficult for music therapy to have control groups of randomized controlled trails like clinical trials that use placebos or other experimental manipulation. This results in a misnomer that music therapy is not evidence based. For example in a report evaluating the various complementary and alternative treatments for autistic spectrum disorders, music therapy was not classified as evidence based treatment for individuals with autistic spectrum disorders, which the Association for Music Therapy (Singapore) had to clarify (Tan, Loi, Ng, 2010).
Music therapy is backed by physiological evidence in controlled studies done on post-surgery patients and field studies which report that group singing enhances feelings of well-being and social connectedness (Anshel & Kipper, 1988), important feelings that bolster oneself against stress and ill-health. Another example is how drumming during group music therapy in addiction rehabilitation mimics the high obtained during substance abuse, providing an efficacious alternative to patients who are trying to quit their addiction (Baker, Gleadhill & Dingle, 2007).
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More importantly, music therapy is personalized, approach, often involving improvisation and other aspects that are often client-initiated, unlike in biomedical sciences where doctors administer treatments and the patient is passive. Thus unlike biomedical sciences where there is a treatment that leads to specific tangible goals, it is trickier and harder to track these outcomes consistently in music therapy where the settings veer from sterile laboratory conditions. For instance, a core group of clients that music therapists work with have trouble expressing themselves, such as those with special needs and dementia. These individuals may not always display the predictable rational behavior that ordinary human beings exhibit; music therapists use music to help these clients holistically to achieve basic communication skills and to improve their well-being. Thus it would not always be appropriate to use the conventional biomedical standards to evaluate the outcomes of music therapy when its spirit and approach differs so vastly from the biomedical approach. This demonstrates how treatments outside biomedical boundaries are pressured to fit the mould of the biomedical model in order to be recognized, even with inherent disparities compared to the biomedical approach. Although there are instances when music therapy seems to fit biomedical boundaries nicely, more often it is illogical and impossible to do so. This explains why music therapy remains marginalized in the face of the biomedical model that is so prevalently endorsed in Singapore.
In fact, not only is there bottom-down pressure, but also pressure from within to conform to the standards and expectations of the biomedical model. In the newsletters of the Association for Music Therapy (Singapore) one main point of emphasis is that music therapy is “evidence-based” and that music therapists are “Persons who complete an approved college Music Therapy programme in the country of training… As credentials vary from country to country, the following are recognized…” (Tan, Loi & Ng, 2010). Being evidence based and providing credentials to support their professional status are important factors that has helped the biomedical model gain foothold as the dominant model. Interestingly, the music therapists are adopting this strategy in an effort to integrate the field of music therapy with the biomedical model to increase its legitimacy.
However, in reality, music therapy, like other new domains in medicine, is not always theory driven. In new fields of treatment, theory and clinical practice have a dynamic relationship; it is often clinical practice that influences the formulation of theory, which in turn provides groundwork for the development of clinical treatments. Not all biomedical treatments can be touted as evidence-based until a successful clinical trial. Yet, many people still embrace biomedical treatments as the best treatments, and remain unconvinced when evidence is presented to prove the efficacy music therapy. This discrepancy can be better understood when we examine how the dominance of the biomedical model regulates the access and dissemination of knowledge, shaping the attitudes of individuals to treatments like music therapy.
Continue to the next hub, Sociology of Medicine: How Music Therapy is Affected by the Dominant Position of the Biomedical Model Pt 2.