Hospice Music Therapy

I’ve been a huge fan of Pixar’s films for as long as I can remember. To put that in perspective, I was one of the kids going off to college just a few years after Andy did when Toy Story 3 was released. All that to say, I was more than a little excited to see Coco on the big screen back in November. While I was fully expecting to love the movie, I did not anticipate how perfectly the film would demonstrate the power of music to stimulate long-term memory. I did not expect a funny, yet touching, animated scene to portray the ability of music to reduce pain and promote relaxation at the end of life. I was not expecting a Music Therapy Movie, but boy was I thrilled to see one!

…Okay, so maybe calling Coco a “Music Therapy Movie” is a bit of an over-statement. After all, none of the characters in the movie are Board-Certified Music Therapists. And beyond just the musical elements on display, there’s a whole lot to love about Miguel’s adventure through the Land of the Dead. But as a Music Therapist, seeing two of the most powerful moments in the film so closely tied to my occupation (and so beautifully depicted) gets me excited. The healing and connecting power of music in these moments is undeniable, and there are some very important specifics about the ways that music is used that really get to the heart of Music Therapy. Let’s take a look at these two scenes.
What exactly is happening, and what makes it (close to) Music Therapy?

***SPOILER ALERT:
Remaining content contains plot points from Disney-Pixar’s Coco***

SCENE 1: “Everyone Knows Juanita”
Miguel and Héctor arrive in a town where, according to Héctor, everyone has been more or less forgotten. There is no one left in the Land of the Living to remember them. In “Land of the Dead” terms, these people are nearing the end of their afterlives. When their living descendants no longer remember who they are, they will experience what Héctor calls the “second death.” No one knows what happens to these people, but their skeletal bodies fade away, and are not seen again. In “health profession” terms, Miguel and Héctor are entering hospice and palliative territory – end-of-life care. Enter Chicharrón.

Chicharrón is a grizzled old man lying in a pile of collected treasures – one of which is the guitar that Héctor has come to borrow. Chicharrón, though initially opposed to lending Héctor anything, experiences what appears to be an intense surge of pain as he glows orange: a mark of the impending “second death.” Chicharrón, defeated, says that he could no longer play the guitar anymore if he wanted to. After all, he is nearing his end. Chicharrón agrees to give Héctor the guitar on one condition: that Héctor plays him a song.
And then he says something important: “You know my favorite.”

What we see is an established relationship between Héctor and Chicharrón. Héctor is not just some kind stranger who has come to play soothing music. He knows Chicharrón. And Chicharrón knows, and feels safe (albeit acting a little gruff) with, Héctor. Rapport has already been established between the “therapist” (Héctor) and the “client” (Chicharrón). In fact, Chicharrón does not even have to name his favorite song. Héctor already knows. He begins to play a goofy song titled “Everyone Knows Juanita.” The lyrics of the song describe what might sound like unattractive features of a woman named Juanita, before “flipping the script”, as it were, with the final line:
“And if I weren’t so ugly, she’d possibly give me a chance.”

https://www.youtube.com/watch?v=c8q-pzrEIPc

Hardly a song one would expect in a Music Therapy session with a hospice patient who is actively dying. Right?
…Actually, this song is an important detail that makes this scene feel all the more like a good Music Therapy session!

A study by Laura A. Mitchell, BA (Hons.), MSc, PhD, and Raymond A.R. MacDonald, BSc, PhD –  published in the Journal of Music Therapy in December 2006 – examined the effects of “specially designed relaxation music”, as compared with “[clients’] own chosen music”, on pain perception, including tolerance time and pain intensity. And what they found seems to match what Héctor and Chicharrón knew intuitively: “While listening to their own preferred music, male and female participants tolerated the painful stimulus significantly longer than during both the relaxation music and control conditions” (Mitchell & MacDonald, 2006). And though only female participants reported significantly lower pain intensity during the “preferred music” condition, all participants reported feeling significantly more control in the “preferred music” condition. In other words, a song like “Everyone Knows Juanita”, goofy and “unusual” as it may be, is likely the best song to help Chicharrón relax and tolerate/reduce pain in this moment – because it’s his favorite!
Sure enough, Chicharrón sighs contentedly and lays back in his bed following the song – a stark contrast to the clenching pain he exhibits immediately prior. And with a “thank you”, he gently fades away.

SCENE 2: “Remember Me”
Alright, here’s the big one. The scene that will make you cry. The song “Remember Me” (Oscar Nominee for “Best Original Song”, by the way!) is present throughout the movie, but its most powerful, tender, and intimate moment appears near the end. Back home in the Land of the Living, Miguel softly sings with his great-grandmother, Mama Coco. The first thing to note in this scene is, again, Miguel’s song choice.

“Remember Me” was not merely a sweet song chosen at random.
Despite her significant cognitive decline and apparent unresponsiveness, Miguel has learned that Coco’s father (Miguel’s great-great-grandfather) wrote the song for her, and sang it with her when she was little. Thus, Miguel knew that the song was tied to an important (and emotional) memory for Mama Coco, and played it with a clear intention of sparking that memory.

And it does so in a beautiful way. First, we see her motor neurons begin to activate as she starts to tap her finger to the beat. Before long, Mama Coco, who has not spoken in quite some time, actually begins to sing with Miguel. She smiles and finally turns to look at Miguel as she sings with him. A woman who, not long prior, did not appear to recognize her own daughter, is recalling every word of a favorite childhood song. As Music Therapists, this is something we get to see a lot. Musical memory is some of the longest retained, as music activates so many parts of the brain: motor, speech and language, auditory, long-term memory, emotions, etc. By the end of the song, Coco does, in fact, recognize her daughter, and even begins to share stories about her parents. And so the Rivera family, who have chosen to hate music for generations, suddenly see it come through for them in a big way. Let’s pause here to check out this clip from “The Doctors” about music and the brain:

https://www.youtube.com/watch?v=B5QVCxg5A3o

Another important detail to examine in this touching scene is the fact that Miguel played the song live, as opposed to simply playing a recording of “Remember Me.” And using her father’s old guitar, no less! In the context of the movie, the only known recording of “Remember Me” is sung by the famous musician Ernesto de la Cruz at an upbeat tempo, complete with a full band, choir, and virtuosic guitar solo. An impressive song, but not the one Coco knows and loves. After her father left the family, and her mother vowed never to let music into their lives again, how could she have heard de la Cruz’s rendition of the song? Certainly not on the radio. No, Coco’s “Remember Me” is a quiet and tender lullaby, sung from a father to his daughter. And it’s this song, with its sweet and simple accompaniment, that Miguel plays for her. Miguel, having heard both versions, chooses to play in the style with which Coco is most familiar:
The style of her papa.

So there it is! No, technically nothing in Disney-Pixar’s Coco can be called Music Therapy, because “Music Therapy” implies the presence of a Board-Certified Music Therapist. I know.
But! The power of a therapeutic relationship, song preference, and live music to promote relaxation, reduce pain, and stimulate long-term memory is evident throughout the film.
And who knows?
Maybe Coco 2 will introduce audiences to a newly certified Miguel Rivera, MT-BC!

– Written by Kevin Middlebrooks, LPMT, MT-BC

Laura A. Mitchell, Raymond A. R. MacDonald; An Experimental Investigation of the Effects of Preferred and Relaxing Music Listening on Pain Perception, Journal of Music Therapy, Volume 43, Issue 4, 1 December 2006, Pages 295–316, https://doi.org/10.1093/jmt/43.4.295