Abstract
The discussion in this paper is not intended to change your mind about major therapies for schizophrenia, but it is encouraged to open your mind to new thoughts that have been presented over the last few decades. By researching music therapy and its effects on schizophrenia, you may be able to understand more new concepts of how the brain works. This paper is written more for the individual who has no knowledge of psychology, psychiatry, neurological medicine or music therapy by bringing the various aspects together. The purpose of this research is to see how they all play a vital role together in the mind.

INTRODUCTION
When looking at patients that have been diagnosed with schizophrenia, psychologists, psychiatrists, and doctors need to look at all possible treatments for the patient. By taking into consideration alternative medicine, such as music therapy, these professionals are able to consider such options as a better possible therapy than traditional options, such as prescription medication alone.
By looking at music therapy as the alternative to modern medicine in assisting diagnosed patients with schizophrenia, it can be asked if music therapy is the best option for these patients. Like all treatments, each patient will respond differently to various treatments. By investigating the previous research on schizophrenia and music therapy, one can identify the causation dilemma, or the dilemma of anything that is producing an effect, among this form of therapy, if there is one, or the factors that support this type of therapy.
Another question to consider in using music therapy with clinically diagnosed schizophrenia is if all patients suffering from schizophrenia are alike. By asking this question, both topics can be observed and defined to a better understanding. Schizophrenia can and does differ among individuals due to the type of schizophrenia that the patient has been diagnosed with. Along with music therapy, there are a number of other treatments used in treating this illness.
After reviewing the data and research, like other forms of treatment, music therapy is not always the best option for all patients that are suffering from schizophrenia.
UNDERSTANDING SCHIZOPHRENIA
Although “there is no known single cause of schizophrenia” (Grohol, 2006; Grohol, 2006), it is known that it is sometimes hereditary, is likely to be associated with an imbalance in the brain, and in some cases, is associated with brain abnormalities. This will be discussed later under the topic of causes of schizophrenia.
In defining schizophrenia, there is a list of terms to consider. First, schizophrenia is termed as the splitting of the psychic functions (Pinel J.P.J, 1990/2006), or a major mental disorder of unknown causes typically characterized by a separation between the thought processes and the emotions (Agnes, 2007). Second, schizophrenia is listed as a psychiatric disorder, a disorder of psychological function sufficiently sever to require treatment by a psychiatrist or clinical psychologist (1990/2006). Third, Emile Kraepelin called it a discreet mental illness in 1887 and later introduced the term “dementia praecox” (Silverstein, Spaulding, & Menditto, 2006) and in 1911, the Swiss psychiatrist, Eugene Bleuler, coined the term schizophrenia by combining Greek words which mean “split mind” (Comer, 2007). Finally, schizophrenia was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a psychotic disorder under code 295. In the most recent publication of the DSM, version IV-TR, criterion B for the diagnosis of schizophrenia meant that the patient must have a deterioration in his or her functioning for at least six months (Harvey, 2005).
There are eight areas of disturbances as categorized by the American Psychological association; 1) Affect – blunted, flat, or inappropriate, 2) Content of thought – delusions, 3) Form of thought – loose associations, flight of thought, 4) Perception – hallucinations, 5) Psychomotor behavior – pacing, rocking, hypo-activity, hyperactivity, or bizarre behaviors, 6) relationship to external world – withdrawal into fantasy, 7) sense of self – loss of ego boundaries, and 8 ) volition – lack of interest or drive (Rasar, 2009). There are also other possible problems, such as paranoia and disorganized speech. These symptoms occur in various degrees in the five types of schizophrenia. These five types are as follows; disorganized, paranoid, catatonic, undifferentiated, and residual. There are also for additional types of schizophrenic disorders; simple schizophrenia, schizophreniform disorder, schizoaffective disorder, and post-schizophrenic depression.
In order to understand each type of schizophrenia, one must look at the definitions or explanations of each type.
“Paranoid Type: this type of schizophrenia is very suspicious of others and often has grand schemes of persecution at the root of their behavior. Hallucinations and delusions are a prominent part of the paranoid behavior.
Disorganized Type: this type of schizophrenia is characterized by incoherent or disorganized speech along with the expression of emotions based on the social situation and inappropriate moods. Generally, this type of schizophrenia does not experience hallucinations.
Catatonic Type: this type of schizophrenia is not only characterized by profound social withdrawal and isolation, but also has marked psychomotor disturbances.
Residual Type: in this type of schizophrenia, the patient is not experiencing delusions, hallucinations, or disorganized speech and behavior; however, they suffer from a lack of motivation and interest in day-to-day living.
Undifferentiated Type: this type of schizophrenia is actually classified as a subtype where individuals meet the diagnostic criteria for schizophrenia; however, they do not fall into any of the other types of schizophrenia. They also can exhibit the features of the other types without a particular set of characteristics.
Schizoaffective Disorder: this is a subcategory below the five types of schizophrenia and is a combination of symptoms. The patient, along with showing symptoms of schizophrenia, also shows signs of mood disorders such as major depression, bi-polar or mixed mania. It is presumed that Robert Schuman suffered from manic depression or schizoaffective disorder toward the end of his life” (Sacks, 2007).

“Schizophreniform Disorder: is another subcategory that is characterized by the presence of the symptoms of schizophrenia, including delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms. The disorder usually lasts longer than 1 month but less than 6 months.
Other types of schizophrenia include: a) simple schizophrenia, b) post-schizophrenic depression, and c) hebephrenic schizophrenia” (World Health Organization, 1992).
When a patient experiences an acute episode of schizophrenia, involving such symptoms as paranoia, delusions, confused thinking, and hallucinations, the aim of the medical professional is to control the psychotic symptoms. Although hospitalization may be required at this time, medication is typically the primary treatment. Once the patient has begun a treatment program and has begun to improve, as long as the acute symptoms have been controlled, this will begin the stabilization phase. Because patients are vulnerable to relapse, they can, and many of them do, experience bothersome, yet milder symptoms. The aim of the stabilization phase is to prevent relapse, to reduce the symptoms even more and move the patient forward to a more stable recovery phase.
This next phase of recovery is the maintenance phase; this is known as the long-term recovery phase. While in this portion of the treatment, it is the professional’s goal to sustain symptom remission or control, as well as, teach skills for daily living and reduce the risk of relapse and hospitalization. This portion of recovery typically involves supportive therapy, medication, family education and counseling, and vocational and social rehabilitation.
Since its discovery and the understanding of what schizophrenia does to a person, continued research is ongoing to find the exact reasons how the brain works in this illness. The major obstacle in the study of and treatment of schizophrenia is accurately defining it (Andreasen, 2000; Peralta & Cuesta, 2000; Pinel, 2006). Studies have shown that patients that have been diagnosed with schizophrenia typically have widespread brain abnormalities, including a small cerebral cortex and large cerebral ventricles (Pinel, 2006). Even though there have been numerous breakthroughs in the research of schizophrenia, medical professionals have yet to find a permanent cure for schizophrenia without a lifetime of medication or therapy. This is an illness with a low rate of full recovery (Harvey, 2005).
In looking at cases of schizophrenia, research has also shown that this neuro-developmental disorder is found to be in men and women equally; while men usually are found to have developed this illness typically around the age of 21, women develop the illness around age 27. While it is rather even when it comes to gender, race plays a different role; race and ethnic groups have different rates of occurrences. For example, as many as 2.1 percent of African-Americans received the diagnosis compared to 1.4 percent of white Americans (Comer, 2007). It has also been found that although the majority of cases of schizophrenia begin in a young adult, there have been reports of late life schizophrenia as well.
In late onset schizophrenia, researchers have found that the average age for onset in males was 31.2 years and in females was 41.1 years (Harvey, 2005). It was also found that even though early onset schizophrenia may have a family history with the illness; late onset schizophrenia was much less likely to have a history in the family related to the illness.
CAUSES OF SCHIZOPHRENIA
The prevalence of schizophrenia in the general population has been generally found to be about 1-1.5 percent (Silverstein, Spaulding & Menditto, 2006), and although the causes of schizophrenia vary from patient to patient, studies show that the three most common causes are genetics, chemical defect and physical abnormality.
As discussed earlier, the physical abnormality of a smaller cerebral cortex along with larger cerebral ventricles is just part of this cause. John Pinel says that the brain damage is not just kept to those two abnormalities, but that it is widespread (2006). One of the questions Pinel asks is if a) the brain of schizophrenics develop normally, or b) if they develop normally, do they suffer somewhere along development with brain damage?
Another cause of this illness, genetics, is a large question as well. Phillip Harvey, as noted earlier, said that it was found that late onset schizophrenia was less likely to be associated with family history (2005). Researchers believe that some people inherit the biological predisposition to this illness and find that they develop the disorder when they face extreme stress, which is usually during late adolescence or early adulthood. (If we were to keep an eye on male between the ages of 14 and 25 and females between the ages of 20 and 30 over the next five years, I believe we may see an increase in the patients that are diagnosed with schizophrenia, due to the wars in Iraq and Afghanistan along with the financial crisis we are facing at this time.) Studies have shown that schizophrenia is more common among relatives with the disorder (Comer, 2007). Well-replicated findings indicate that there is a substantial genetic component to the predisposition for schizophrenia (Conkiln & Iacono, 2002).
Finally, chemical defect can play a role in a person becoming ill with schizophrenia. The theory is that schizophrenia results from excessive activity of the neurotransmitter dopamine, or the dopamine hypothesis, has been developed by researchers over the past three decades (Comer, 2007). By releasing neurotransmitters, certain neurons using these dopamine transmitters are firing too often which transmits too many messages. This could be caused by a neuro-developmental disorder, when neurons form inappropriate connections during fetal development. This produces the symptoms of schizophrenia and has caused researchers to look at various antipsychotic drugs in order to help remove these symptoms.
MUSIC THERAPY
Music has been used throughout history and “has the potential to be a powerful healing tool” (Holden, 2008) as both an enjoyment and a medicine. According to the Bible, King Solomon was calmed down from what seemed to be manic episodes when harp music was played for him. However, it wasn’t until the 1950’s that Music Therapy became known as a medical field. Music therapy is defined as a psychotherapeutic method that uses musical interaction as a means of communication and expression (Gold, Heldal, Dahle, & Wigram, 2009). This growing field of non-mainstream health care helps individuals that are suffering from schizophrenia to learning disabilities, from Alzheimer’s to Dementia and everything in between and has been found to have a profound effect on both the body and the psyche. It also has been suggested in recent studies to have a wide range of benefits (Westly, 1998).
In his book, ‘Rhythm, Music and the Brain,’ Dr. Michael Thaut, Director of Colorado State University’s Center for Biomedical Research in Music at Fort Collins and Chair of the Department of Music, theatre and Dance, says that “the record of the complex role and function of music in human history is full of examples of how certain pieces of music express certain emotions, concepts or events for specific cultures and societies” (2005). For example, for people in their sixties and seventies that are suffering from Alzheimer’s disease, music from the Big Band Era often stirs pleasant memories and can improve cooperation and alertness (AMTA, 1994). With the variety of music and the variety of diseases, disorders and illnesses, there are a number of combinations of music available to treat each individual patient.
In treating patients with schizophrenia, music therapy is used to; 1) draw the client away from delusions and hallucinations, 2) help to identify and express emotions, 3) control aggressive and destructive impulses, 4) re-establish the patient with reality, 5) reduce stress and anxiety to assist in lowering the schizophrenic episodes, 6) learn adaptive behavior patterns which allow the patient to function in society, and 7) help to open the lines of communication with others that are around the patient (Rasar, 2009). This agrees with Christian Gold, et al., in that music therapy is a therapeutic method that uses musical interaction to help people with serious mental illness to develop relationships and to address issues they may not be able to using words alone (2009). By treating the patient with a sufficient number of music therapy sessions, the responsive patient will be able to obtain a better quality of life. “Many positive things can come from giving the gift of music to others” (Young, 2008).
When working with schizophrenic patients, music therapists have a wide range of possibilities of active improvisatory music therapy that they are able to use (Inselmann, 2007). Ute Inselmann describes how the schizophrenic patient may typically play with another person, but is always a bit “stepped apart” from the other’s playing. This could be because of fear of getting too close to others. In treating schizophrenia with music therapy, there are several activities that are typically used: 1) Analyze lyrics in music, 2) Relaxation with music, 3) Guitar lessons in a group setting, 4) Improvisational instrumental music, 5) Singing or scatting, 6) song writing in either a group or individually, and 7) Folk or structured dance (Rasar, 2009).
One of the best ways in this list of possible activities is singing according to Professor of Music Therapy at Colorado State University, Fort Collins, Dr. William Davis. In a personal phone conversation with Dr. Davis, he said that lyrics in singing help to bring the schizophrenic patient back to reality (personal conversation, February 17, 2009). Music and lyrics, or linguistical meanings, are intertwined and this actually can go beyond word painting to create meanings in a more sophisticated fashion. Word painting is the basics of intertwining linguistic and musical meanings (Patel, 2008).
ADDITIONAL TREATMENTS
With music therapy, a patient with schizophrenia can either be given one type of treatment, or multiple types of treatment which may include music therapy. Many of these therapies have been found to work well and some have yet to be proven to be good treatments. Some of the more well known therapies include; insulin therapy, shock therapy, electroconvulsive therapy, group therapy, cognitive-behavioral therapy (CBT), psychotherapy and drug therapy. Some of the lesser known therapies include; art therapy, music therapy, transcranial magnetic stimulation and nutrient therapy, which is growing among therapists.
In nutrient therapy, five nutrients are used in varying doses. These include a daily dose of 50 mg of zinc, 3 to 6 grams of Omega3 fatty acids, usually fish oils, 3 to 12 grams of asorbic acids and mineral salts, 1.5 to 9 grams of vitamin B-3 (niacin, niacinamide, or inositol niacinate), and/ or 100 to 1,000 mg of B6 or pyridoxine (schizophrenia.com, 2009).
Drug therapy is the most common step in the treatment of schizophrenia. The traditional drugs that are administered are antipsychotics, such as Loxapac, Thorazine, Abilify, and Seroquel. At this time, these medications have not proven as a cure, but rather, they work to reduce the symptoms. The interesting part of these medications is that some of the schizophrenic symptoms can respond in a few days and others it may take weeks or months before they respond. (However, like all medications, these drugs will affect people differently, and if seeking medical help for schizophrenia, seek the advice of the medication best for you and prescribed by your medical provider.) Diana is an example of one of these patients who has not only been on drug therapy, but has also gone through other treatments as well.
When Diana was younger, her parents divorced and her and her brother went to live with their father. Over the years, Diana felt that her mother abandoned her and began to experience numerous life stressors and traumas that took their toll on her mental health. After Diana had begun college, she started showing symptoms of schizophrenia and by the end of her first year Diana had dropped out of school. During this time she found herself having her first child and soon after disappeared from everyone she knew with her baby. For five years, Diana’s family had no idea where she or the baby were, or if they were even alive.
After Diana’s daughter had turned five, Diana came to her senses and began to accept a few things in her life. It was at this time that the family found out that Diana had sold the baby for twenty dollars in the child’s first year of life. What Diana did not know, was that the family had kept the baby safe for her until she was able to handle to pressures of life once again. After months of therapy, drug treatment and family counseling, Diana began to see an improvement in her mental state. Although she realizes that she must stay on the medications and see her therapist on a regular basis, it has been twenty years since her schizophrenic break and she has proven that therapy works. Diana now holds down a steady job in a big city, has received her Bachelor’s degree and attends spiritual services in order to help keep the schizophrenia at bay.
Today therapists are finding that there is more to treatment than counseling, medications and providing therapies already listed. By providing the three basic elements of shelter, diet and dignity, these help the patient advance in their treatment. First by providing shelter to the schizophrenic patient, this keeps them not only off the street but also out of rundown hotels and prisons. They have also found that by changing the patient’s diet and eliminating junk food and hidden sugars along with allergenic foods, this will also help the patient. Finally, dignity is one of the hardest issues to address for many schizophrenic patients. Because of the low quality care at metal hospitals, psychiatric wards, living on the streets or being stuck in the prison system, many patients suffering from schizophrenia do not receive the dignity that they deserve. This is a vital piece of help for the patient. By moving them off of the streets and out of facilities that treat them less than human, professionals can change the way schizophrenics live.
Finally, orthomolecular treatment is a therapy that uses a combination of vitamins, minerals, amino acids and other essential molecules to provide the brain and body with the best possible biochemical treatment (orthomed, 2009). This treatment goes further beyond than just simple nutrient therapy. The American Schizophrenia Association Committee on Therapy reports that out of 1,500 patients, an 80 percent recovery base came from orthomolecular treatment (2009). So the question that is left; why are not professionals taking the time to try everything that they can to help these patients with these different therapies to find out which one will help them get better?
CONCLUSION
Music therapy is the use of music in the accomplishment of therapeutic aims: the restoration, maintenance, and improvement of physical health. Music therapy is also an established allied profession using music and music activities to address physical, psychological, cognitive and social needs of individuals with disabilities or debilitating illnesses (Davis, Gfeller, & Thaut, 1992/1999). The fact is music therapy has a good methodology in treating schizophrenia. By helping the client test the reality of their perceptions in a supportive environment, anxiety is diminished and relaxation is induced. By structuring daily schedules of both therapy and activities, it can make reality less threatening and more predictable for the patient (1999).
Medicine has proven time and time again that not all treatments work for everybody. In their review of the article ‘Music Therapy for Schizophrenia or Schizophrenia-like Illnesses,’ Christian Gold et al. shows that through an analysis of nine comparisons, that some patients responded good while others responded poorly to music therapy when compared to standard care (2009).
Finally although research does not prove that every patient under the care of a music therapist is helped, it does not disprove it either. Many patients that suffer from schizophrenia have not had the opportunity to undergo music therapy treatments and not all of them are located near a music therapist. Therefore to conclude with accuracy, music therapy will probably not help all patients that suffer from schizophrenia.

Bibliography
DUE TO THE RISK OF MY PAPERS BEING PLAGERISED, ALL BIBLIOGRAPHICAL REFERENCES HAVE BEEN REMOVED.

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