Abstract
Complications experienced by grieving young adults have developmental, mental, and behavioral components. Music offers opportunities to promote healthy grieving. While song writing has been widely used as an informal therapy for centuries, current researchers are beginning to explore its benefits. There is a noticeable lack of literature regarding the role of music in the grieving process. The aims of this study were to explore the grieving experiences of young adults who had lost a family member or friend, to identify song elements most helpful in promoting healthy grieving, and then to use these findings to compose a piece of music. Fifteen 20- to 23-year-old participants were interviewed about the death of a close friend or family member using a structured interview guide that included questions about their experience with the death and their grief, as well as questions about what song elements might help in grief. These questions included specifics about the song tempo (speed), dynamic (volume), and whether the song should contain lyrics (words). Thematic analysis was used to analyze interviews. Themes derived from the interview that should be relayed in a song included: Grief can include joy and pain together; It will get better; There is value in community; and, It is ok not to be ok. For song elements, participants elected a slow tempo, a mixed or soft dynamic, and inclusion of lyrical content. All findings were integrated into a song composition that may help promote healthy grieving.
Keywords
Young adults (ages 18–26) (Institute of Medicine and National Research Council, 2015) may suffer long-term consequences of bereavement from loss of a parent; responses may include substance abuse/dependence, suicide, separation anxiety, post-traumatic stress disorder, depression, conduct disorder, decreased global functioning, and sub-optimal career development (Brent, Melhem, Heiney, S, 1995, Masten, Porta, & Payne, 2012; Hamdan et al., 2012; Hamdan, Melhem, Porta, Song, & Brent, 2013; Kaplow, Saunders, Angold, & Costello, 2010; Palmer, Saviet, & Tourish, 2016). Interventions focused on promoting healthy grieving, especially those incorporating music, may prevent prolonged and complicated grieving (Rosner, Kruse, & Hagl, 2010).
While music has been used to facilitate health throughout human history (Horden, 2016), music neuroscience is a rapidly developing field in which interdisciplinary researchers examine how music affects neurological processes and specific biomarkers associated with music therapy (O'Kelly 2016). Previous research has examined the therapeutic effects of listening to music in a variety of settings, including in neonatal patients (Loewy, 2015); anxiety associated with dental procedures (Bradt & Teague, 2018); and cancer patients in hospice care (Burns, Perkins, Tong, Hilliard, & Cripe, 2015). Other research has examined the effects of music choice on anxiety associated with medical procedures (Rossetti et al., 2017). However, activities connected to music creation have the potential to facilitate processes associated with healthy grieving. For example, grieving children and adolescents report that group songwriting activities are enjoyable (Fiore, 2016). However, there is limited research on how to develop songs to promote healthy grieving in young adults. The aims of this study were to explore the grieving experiences of young adults who had lost a family member or friend; to identify song elements indicated as most helpful in promoting healthy grieving; and then to use these findings to compose a song. In this paper, we describe method and design, themes, and findings, which culminated in a song based on the findings from our research.
Design and Method
Setting and Sample
This qualitative study was conducted in a southeastern state by a group of nurse researchers.
All three authors were either baccalaureate or doctorally prepared nurses, with musical, child and adolescent mental health, and pediatric experience. After university institutional review board exemption was obtained, a purposive sample of currently enrolled undergraduate and graduate students (n = 15) who had experienced the loss of a parent, close family member, or friend was recruited through a recruitment flyer, personal contacts, and snowball referrals. Ages ranged from 20 to 23 years. Nine were female; 12 were White, 2 were African American, and 1 was Asian.
Data Collection and Analysis
After obtaining informed consent, confidential audio-recorded interviews of each of the 15 participants were conducted at a private location of their choice. The interview guide included a series of questions that asked the participants to (a) reflect on their own grieving and (b) select song aspects they perceived to be helpful in dealing with grieving, including tempo (speed), dynamic (volume), and whether the song should contain lyrics (words). While some participants had some musical knowledge, including terminology, lay terms were used in the interview guide to facilitate understanding.
Interviews ranged from 15 to 45 minutes in length. The first four interviews were transcribed by the first author; the co-authors together completed initial coding using the transcribed interviews to enhance congruence between analyses and to create a coding rubric. This rubric was then used to code the remaining eleven interviews directly on the audio files. Using the six-step thematic analysis approach described by Braun and Clarke (2006), they: (a) individually reviewed each interview to familiarize themselves with the data, examining how each participant reflected on their grieving and described the role that music played in their grieving, and what each participant indicated would be appropriate in a song composed specifically to facilitate grieving; (b) assigned initial codes to the data to comprehensively describe the content; (c) reconvened to discuss and refine patterns and relationships between codes; (d) reviewed and then (e) named emergent themes, reflecting on how those themes represented the experiences of the participants; and finally (f) produced the report, using the findings to inform the song composition.
Data analysis and songwriting were iterative, concurrent, and ongoing processes, with the themes informing the technical and lyrical components of the song. Composition began immediately and iteratively as the interviews commenced, with each interview bringing a new story and additional perspectives. A list of respondents ‘phrases and words that might be included in the song was compiled and consulted during the composition process. In the following sections, themes that informed the lyrical content of the song are presented first, followed by the participants ‘preferences for the song's technical components. All names are pseudonyms; participant quotes are verbatim except for minimal edits to enhance clarity or ensure anonymity.
Not only is it important to be genuine in your emotions, but allowing yourself to grieve can prevent complications.
Findings
Grief Can Include Joy and Pain Together.
Most of the participants stated the need to include both the positive and negative emotions of grieving. Megan, who lost her close friend to an infection, explained, “When you are grieving, there are definitely really bad days, but there are also really good days when you're remembering good things.” Although grieving brought about a feeling of loss and hurt, there was also room for joyful remembrance and hope. William, whose father died from an aneurysm, suggested that the song should “be sad at the beginning and sorrowful, but eventually get to the place of joy, to finding joy in hardship.” Dylan, who lost his father to a heart attack, reinforced this understanding by saying the song should emphasize “the emotion that the pain and the hurt and the grieving is real, but [close] with some kind of resolution.”
It Will Get Better.
A common experience relayed by participants was the hopeful message that it will get better. When reflecting on his grieving, William noted, “Everyone has good days and bad days, but I have very few bad days now.” The pain of grieving never goes away completely, but they slowly learned to cope with their loss. Rachel, whose friend died in a car accident, added: “When you do lose someone, it feels like you will never get out of that hump … Use all of the great times you had together to help yourself cope … It will get better.”
There is Value in Community.
Another theme was valuing the presence of friends and family while grieving. “Community to me is everything,” said Nick as he reflected on his experience of grieving a close family member who died of cancer. For Katelyn, discussing her grieving after her grandfather's death, the most sincere form of empathy was found in genuine community: “There is so much of the grieving process that involves companionship and entering that space with someone and being there with them and walking with them so they know they're not alone.” Community was not only a sense of support, but also an outlet. Megan said, “There are also positive sides of grieving and positive sides of releasing those emotions when you talk about it. I think I would encourage people who are grieving to do so instead of bottling things up and letting it overcome you.”
It's OK not to be OK.
Many participants verbalized the importance of allowing raw emotions to be expressed, even unpleasant ones. Shelby, whose father died from Alzheimer's disease, reflected on this concept: “I think some people are afraid to not be ok … I think some people hide it or are ashamed by it.” Casey, who lost her close friend to suicide, found it valuable to acknowledge the difficulty of grieving by “not putting too much pressure on yourself to be perfect, and giving yourself a break. And realizing that it's ok. Never undermine what you're going through.” Not only was it important to be genuine in your emotions, but allowing yourself to grieve can prevent complications.
Song Elements
Although we used binary questions to evaluate preferences for the dynamics, tempo, and lyrical preferences (i.e., “Should the song contain lyrics or not?”), many participants expounded on their preferences through narrative comments.
Tempo and Dynamics.
Thirteen of the 15 respondents (87%) said the song should be slow. The other two preferred a mix of tempos or expressed no preference. Bryan, who had lost multiple family members, explained that slow music “allows more space for thought.” Jessica, who lost a close friend from an acute infection, reiterated this concept: “Slow [music] gives me more time to think.” Claire, whose grandfather died of cancer, related, “Slow music allows you to gather your thoughts and concentrate … It's a way to get in tune with your emotions in a way that doesn't stress you out.” Casey explained that she often felt that listening to fast music in grieving pushed her to feel a happiness that was not there: “It always felt like when I listened to happy music, I was trying to push something away instead of actually feeling it … I feel like slower is more beautiful, calm, and soothing.” Explaining her preference for slow music, Megan said, “It makes me feel closest to the song and closest to the lyrics, because I have more time to process the music and the lyrics and how it flows together.” The space and emotion created by a slower tempo allowed for a better connection and a healthier processing of emotion.
“Slow music allows more space for thought.”
Six respondents (40%) preferred a soft dynamic. Megan explained that she preferred soft music because she found it to be “more calming and easier to relate to.” Margaret, who lost her father to neurodegenerative disease, mentioned that she appreciated the “comforting aspect” of slow music. Conversely, Claire expressed a preference for loud music, saying, “I think music has a way of drowning everything else out in the moment that you're listening to it.” Seven respondents (47%) favored a mix of loud and soft dynamics. These participants felt it was necessary to address the wide variety of emotions that come with the grieving process, which could be expressed through dynamic contrast. “I think you have to have a mix [of dynamics]. I think certain parts of the song need to be slow and soft, and some parts need to be loud, building to something greater,” said Andrew, whose friend was killed by a drunk driver. Nick noted that, “As the volume changes, it changes the emotional tone.”
Lyrical Content.
Regarding components of the song, eleven of the 15 participants (73.3%) wanted words included in the song. As music played a role in their grieving, many participants noted that the lyrics of a song were an essential aspect of the music's therapeutic effect. Margaret stated, “I think I'm more driven by the lyrics in a song.” Others mentioned that words allowed them to form associations with the song and feel more connected. Casey commented, “Words are needed to connect to the story.” When asked if she wanted to include words or only instruments, Katelyn responded, “I would say words, as long as they're uplifting, because that's what sticks with me … [instrumental] mixed with words is a really great combination “ Dylan echoed this opinion: “I definitely would include … I feel like for the common, average person on the street, words are a much more effective way to communicate.” While music alone holds the power to be therapeutic in grieving, the addition of words allowed for a more effective medium to reach these young adults.
Song Creation
To honor the input from the participants, the culmination of this research project was the use of the themes to create a song, Behind the Clouds, that incorporated all aspects of their testimonies. Sarah Louise Faulkner McCurry composed a song with lyrics, but involved strategic instrumental sections as well. The lyrics are in the first person to create a sense of commonality and to decrease isolation. The lyrical content opens by expressing the emotional lows of grieving, while the chorus introduces prospects of hope, even if masked by current circumstances. The instrumental section creates a space for the listener to be introspective and reflect on the music. The second verse describes the epiphany of learning to cope with grieving and includes the coexistence of joy and sorrow. Building in dynamics, the song returns to the chorus, then concludes with another instrumental section.
Behind the Clouds
I'd paint you a picture of my heart
But I'm afraid it'd be too dark
I'm lost in its walls, blocking the light
No escape in my sight
A rock caught my chest and caused me to sink
In the seas behind my eyes
I'm learning to swim, perhaps one day
I'll redefine “alright”
Maybe there's a sun behind the clouds
That I can't see right now
And maybe there is more to be found out
they say don't trust your doubts
But right now all I see
Is the rain in front of me
(Instrumental)
Joy and sorrow could it be
That they can live in harmony
The two, they make a melody
That's meant for more than me
Maybe there's a sun behind the clouds
That I can't see right now
And maybe there is more to be found out
They say don't trust your doubts
So for now I'll find my peace
In the song outside of me
(Instrumental)
Behind the Clouds. Copyright Sarah Louise Faulkner McCurry, 2018
Conclusions and Implications for Future Research
Listening to music throughout the grieving process can assist young adults in releasing their emotions, remembering their lost loved one, and feeling they are not alone. For our group of grieving young adults, a song designed to be beneficial to them should be slow, have dynamic contrast, and include lyrics. The song should express raw emotions that could be felt by a grieving individual. The lyrical content can include messages of hope and community, as well as sincere pain. The song should provide comfort to listeners wherever they are in their grieving process, offering relatable material whatever their current emotions. Such music has the potential to powerfully aid grieving individuals in coping with their loss as they learn how to live with the emotional journey that grieving brings.
Footnotes
Disclosure. The authors have no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.
Funding. Partial support for study from Honors College, University of South Carolina. RMD was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number K23HL133596. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Sarah Louise Faulkner McCurry, BSN, RN, graduated from the University of South Carolina (USC) Honors College in 2018 where she pursued her passions by studying nursing and piano performance. This study was her senior thesis. She practices in an acute care setting at a Novant Health Presbyterian Hospital, Charlotte, NC.
Robin M. Dawson, PhD, RN, CPNP-PC, is an Assistant Professor and director of the Smart Start Nursing Program at the University of South Carolina College of Nursing. Her multilevel research program focuses on understanding the context and processes of communication and the development of practical and innovative interventions designed to facilitate optimal patient-provider communication.
Sue P. Heiney, PhD, RN, FAAN, practiced as a nurse psychotherapist and clinical researcher for 30 years prior to becoming the Dunn-Shealy Professor of Nursing at the USC College of Nursing. Her current program of research is psychosocial oncology interventions. Her children's grieving program created 30 years ago is still available to the community.