And the drum beats on …

 By Anna Swartzlander

While I was working in the psychiatric provider realm at the Nebraska Department of Corrections (NDCS), I learned more than just medicine and metrics. You cannot heal someone if you are not meeting their basic needs. A favorite mentor once told me, “There is not a pill for the anxiety that comes from not knowing where one is going to sleep at night.”

As I continue to practice as an Advanced Practice Registered Nurse (APRN), I see firsthand the impact of the mental health epidemic in America. I cannot help but be troubled by how medicine and healthcare contribute to the system of keeping poor people poor – and, I would even go so far as to say, keeping mentally unstable individuals – ill.

For instance, when an incarcerated individual at NDCS was thought to have suicidal thoughts, they were placed in a cell by themselves with nothing more than a strait jacket/blanket and a floor mat. Communication with loved ones, pens, paper and books had to be earned back by having less self-destructive ideations or behavior.

Of course, these policies are in place for a reason, but I personally can’t think of anything that would want to make me end my life more than being cut off from my loved ones … and books.

If you think about it, this practice is not that different than how we handle suicidal behavior outside of incarceration. If an individual is behaving or acting in a way in which self-harm becomes a safety concern, we lock them into psychiatric wards for “rehabilitation.” Electronics including phones are taken away, along with belts, shoestrings, perfumes, and anything else that may pose a threat. Showers are witnessed. A close monitoring system is set in motion. 

It is interesting to me that in an attempt for one to gain more independence over their life, their autonomy is stripped away. A stigma almost instantly develops between those that can live life happily without help (successful members of society!), and those who cannot (failures!).  

And although I understand policies are in place for a reason, and that suicide is not a subject to take lightly, I have long questioned: Is this system working? 

Statistics show that suicide rates have been increasing over the past several decades, and data shows that one of the most vulnerable and risky times for suicide attempts is in the first few weeks following discharge from a mental health facility.  

When an individual was placed on “suicidal watch” at NDCS, they were not allowed out of their cell for a specified amount of time, and/or until their risk level was reduced. As one of four psychiatric providers at an NDCS facility – which held over 1,000 individuals, including the department’s most mentally ill residents – I visited the suicide watch unit to complete daily assessments. Because I did not typically see individuals immediately prior to their cell placement, I cannot say if their mental health was improved by isolation on this unit. In some cases, I suspect it was.

However, in many cases, it was not. I saw so many grown men cry. I saw comatose behaviors daily. I witnessed manic exercise. I saw communication via feces on the walls. And, honestly, although unnerved and disturbed, I understood. These behaviors did not necessarily equate to insanity. Feces on the wall, after all, communicates just as well (or more effectively) as screaming at the top of one’s lungs.

It is getting harder to provide care in the American healthcare system. As an empathetic healthcare professional – someone who got into the field of nursing to help people, to care and provide aid, to minimize harm, and to increase quality of life – I realized too late that healthcare is unfortunately a business. 

Individualized creativity is essential to healthcare in general, and my time with NDCS taught me how correctional medicine is no different. It is critical to think outside the box, especially when policies and practices often limit therapeutic options, and even, sometimes, pens, paper and literature.

Faced with the dilemma of stabilizing mental wellbeing for those individuals on the suicide unit at NDCS, I began to research holistic ways to help prevent mental health crises. And one theme always stood out to me: Rhythm-centered music making (RMM), and how we can learn from other cultures and from history, by practicing simplistically and holistically.

RMM – the use of healing via rhythms or repetition – has ancient roots in Greece, Egypt, indigenous cultures and others, where drumming, chanting, dancing, and other rhythmic behaviors are used for emotional release.

Consider the Drum Circles and Healing Rituals in Africa in which simple drumming patterns and rhythms promote healing by providing a healthy, physical outlet for releasing built-up energy, allowing for overall stress reduction.

Or Sufi Whirling, a spiritual ritual practiced in Islamic cultures that includes rhythmic whirling that is thought to increase body-mind focus, self-regulation, positive-affect, unity and wholeness experience.

In India, Kathak Rhythmic Storytelling involves rhythmic footsteps, meaningful hand gestures (mudra) and emotional facial expressions to create a profound harmony between mind and body.

And in Brazil they practice Pregame Rituals/Rua de Fog with chanting and rhythmic jumping that increases emotional response and unity.

I’m sure some of these rituals sound familiar. Recently, there has been a resurgence of rhythm-related health methods in forms such as music therapy, heart rhythm meditation, yoga, drumming and many others. Almost everything that calms the mood involves some form of rhythm. Physical movement often involves some form of repetition or counting: rowing, swimming, dancing, music. 

These rhythmic behaviors have been shown to not only improve and regulate mood, but also to improve mobility, cardiopulmonary endurance, muscle strength, flexibility, balance, global cognitive function, and quality of life.

Repetitive motions are often associated with helping to calm, such as rocking a baby to sleep, or tapping one’s foot. Even the rhythm of breathing can aid in mood regulation. I constantly use a stress-reduction practice my children taught me from elementary school: four-squared breathing. It works like this: Inhale for four seconds, hold for four seconds, then exhale for four seconds, hold for four seconds. Repeat.

I wonder if I made time, as I did in my childhood, for jump roping, hula hooping, and making friendship bracelets, what effect this would have on my mental health? I remember pen-drumming being popular during my middle school years. Was this just a bunch of anxiety-driven pre-teens attempting to deal with life via desk-tapping?

Could these behaviors also help patients on suicide watch? Although they do not have access to a hula hoop, they do have their fingers and their brains. Could something as simple as tapping out a favorite beat with hands and feet help reduce the mental stress of captivity, loneliness and stigmatization?

I believe we would give suicidal individuals a better chance of recovery from mental health crises if we used rhythmic-centered methods instead of solitary confinement. Policies and procedures aside, imagine walking into a suicide watch unit that was full of music and meditation – versus cement walls and segregation. Imagine leaving the psychiatrist’s office with a prescription for a drum set instead of a lifetime supply of pharmaceuticals.

What can I say … After 20 years working in healthcare, I’m still a dreamer. I hope I’m not the only one.