In the corner of the room, a woman is screaming and struggling. Two nurses hold her and try to dodge her blows. The wound on 90-year-old Mrs Kessler’s arm is starting to fester, and they have to change the dressing.
She then stops screaming – but only so she can try to bite them.
My 18th-century cello and I are here at this dementia unit, housed within an assisted-living retirement facility, in my capacity as an art therapist, a role I’d then been in for almost a decade, alongside my career as a concert performer and teacher.
What happens next on this day, though, is new. I still don’t know what compels me to go over to Mrs Kessler. I don’t say a word. I just sit down and play the Andante from Schubert’s Piano Trio No 2 in E-flat Major.
Three seconds go by and her arm relaxes and drops. The screaming stops. The room goes quiet. The nurses are so quick I don’t have to play for long, perhaps ten minutes altogether.
Claire Oppert plays for one of the patients at a hospice in Paris
Mrs Kessler looks surprised, and is almost smiling. But this is more than surprising – it’s phenomenal. ‘You’ll have to come back,’ one of the nurses laughs, ‘to give the Schubert treatment.’
Just like that, the phrase ‘Schubert treatment’ has been coined – and will remain.
I know immediately that something significant has just taken place. For the first time, I have seen direct evidence of dramatic relief in a person in considerable pain and distress, purely thanks to me playing my cello.
That same week, I come back twice to play for Mrs Kessler as the nurses change her dressing, with the same results. Indeed, there was no other way her pain could be alleviated. Traditional painkillers were unable to relieve her agony, which was all-encompassing, a psychological suffering intertwined with physical pain.
As I play the Andante from Schubert’s Trio over and over again, she sits in her chair, ramrod straight, holding her arm out for the nurses. Her face glows so intensely it feels as if it lights up the room, the nurses, and me.
A year after that spontaneous experiment in 2012, I develop the Schubert treatment protocol, eventually working with more than 100 patients at a palliative care unit in Sainte-Périne Hospital in Paris, where I live, to trial the clinical effectiveness of my cello’s music at relieving pain.
The hospital’s department chief has already come up with a pithy, eloquent formula based on what he has seen of my work: ‘Ten minutes of Schubert is the equivalent of 5mg of Oxy’ (referring to OxyContin, one of the most powerful painkillers we have that is used to alleviate the most severe pain, like that seen in cancer patients).
And the results of the clinical trial, which I present at two international conferences, in 2016 and 2017, bears this dictum out.
Claire developed the Schubert treatment protocol – working with more than 100 patients at a palliative care unit in Sainte-Périne Hospital in Paris, where she lives, to trial the clinical effectiveness of her cello’s music at relieving pain
Fascinatingly, the treatment was effective even for those patients who did not have a love of music, writes Claire Oppert
Of the 112 patients ‘treated’ with Schubert and other live musical renditions courtesy of my cello – including classical composers, but also everything from Johnny Hallyday to rap and heavy metal – the data demonstrates a reduction in patient pain ranging from 10 to 50 per cent.
In many cases, caregivers were able to reduce painkiller dosage before a Schubert session – and in almost all cases, the care went much more smoothly with my cello as an accompaniment. You might wonder how music can reduce pain.
Numerous studies show that it can alleviate discomfort by prompting the release of ‘happy’ hormones such as endorphins and serotonin, as well as reducing catecholamine release by nerve cells.
High levels of catecholamines can cause stress responses, such as high blood pressure, palpitations and anxiety. And, of course, simply put, music can allow patients to be distracted from pain by evoking happy memories.
Little wonder, then, that, in terms of patient anxiety, the trial results saw a reduction of approximately 90 per cent. The positive emotional effect on caregivers is 100 per cent – all reported feeling more fulfilled.
The three-year study had all the exacting standards one would expect (which is why we were able to present the results later at medical conferences in the US, France, Switzerland, Spain, Italy, Canada and Japan).
With the support of France’s national pain management resource centre, we implemented a Schubert treatment observation chart, detailing specific clinical observations to compare prior to, during and after each procedure.
For instance, treatments with and without cello accompaniment were compared on alternating days to observe the extent to which live music’s sensory stimulation has a beneficial impact on patient pain and anxiety – but also on the psychological health of caregivers and family members.
We measured everything from the cognitive capabilities of the patients to the illnesses they suffered; pain levels before and after the treatment; and the duration of each treatment (which ranged from ten minutes to an hour and a quarter), for instance.
Fascinatingly, the treatment was effective even for those patients who did not have a love of music.
The same even goes for deaf patients – but in their case, it is the sound vibrations that travel through their body that bring such positive effects.
Numerous studies show that Claire’s cello can alleviate discomfort by prompting the release of ‘happy’ hormones such as endorphins and serotonin
All music – from classical to rap – worked, often in the most surprising ways. For example, there was a nun who asked me for some Ave Maria and then at the end whispered: ‘Do you have a little rock ‘n’ roll for me, please?’
As for the question of what instrument works best, the cello has a particularly powerful impact because its tone is similar to a combination of male and female voices. That said, I believe that all instruments can be effective, as long as the musician-caregiver is able to respond to the patient.
Of course, the research presents the absolute limitations of scientific study – based as it is, first and foremost, on shared emotions that defy quantification. There is also the emotional bias music creates, which can interfere with the evaluation.
All that said, again and again, the data we collect shows that my cello wields a distinct magic.
I’ve been in love with the cello since I was eight, and my parents took me to a concert by a pianist who was playing Beethoven sonatas with a young cellist.
I played in concerts throughout my teens, trained at the Moscow Conservatory and recorded seven albums, winning several international prizes for my music.
But for the past 20 years I’ve been working as an art therapist, inspired by my beloved doctor father and his infinite capacity to heal his patients.
As part of my role employed in several different care facilities, I work with many autistic children who were becalmed by my cello.
One patient, Amelia, who was around 14, was so aggressive she’d spent time in a psychiatric institution in restraints and knocked out by powerful antipsychotics.
Eventually, she was relieved enough to be able to return home, from where her mother sent a smiling photograph of her posing by the Christmas tree. Our music sessions proved to be the decisive element of her transformation.
Meanwhile, Mrs Vaillant, 75, who had Lewy body dementia – symptoms of which can include cognitive impairment and visual hallucinations – goes from screaming and stabbing fellow residents at her care home with her lunchtime fork, to writing poetry with me, after sessions where I play her Strauss’s Emperor Waltz, Bach’s gigue, the Marseillaise and more.
The Schubert treatment transformed me from musician to caregiver, writes Claire
And the trial showed that endless agonising treatments in palliative care – dressing wounds, mobilisations and blood tests – are mitigated by my cello’s music.
Indeed, the Schubert treatment transformed me from musician to caregiver from its very first official ministration in the palliative care centre, on March 29, 2013 at 3pm.
The first patient observed for the trial was Mr Roy, 74, who had metastatic colon cancer and had cognitive issues.
The nurses reported it had been difficult to take blood samples from his veins owing to his movements. Frightened, crying and fighting, his arms were bruised from attempts to insert the needle.
Now, though, as I recall, the cello’s warm, plaintive voice vibrates around the room with Schubert.
One of the attendants starts humming. She adjusts the needle and gently touches the patient’s arm. Schubert sings and the melody dives low for a few measures, rolling like waves on the sea.
Instead of screaming like he did the day before, the patient begins to sing too; he is even conducting with his right hand. The nurses look at each other and laugh. The blood fills the vial quickly.
Mr Roy is inspired now, a conductor leading his orchestra with sweeping arms. His face is relaxed and his eyes twinkle. They’re done with the blood test, but he keeps conducting. ‘OK, Mr Roy, all done.’ His imaginary baton stops in mid-air. He realises what’s just happened. ‘That was enchanting,’ he says. ‘More than just the heart, music touches the soul, and all the pain flies away.’
The nurses are smiling and swaying slightly as they put their things away.
The soul is again on show when I play for Mr Francois, who needs a bedsore dressing – a terribly painful treatment. A sedated, non-communicative patient, he listens to Albinoni’s Adagio with fat tears running down the grey marble of his face.
The nurses and I are emotional too, unsteady, as if waves were battering our hearts.
Mr Cardo, a patient with cancer that has spread to his bone and lungs, is in a coma. During his bedbath, the care team notes, ‘massive increase in expansion of the chest cage while music was playing’. This is significant because it is a tangible sign that the patient is responding to the world around them.
The care team go on: ‘Excellent experience for nurse/attendance team, a feeling of sharing or even communion between us.’
The silence in the room has been filled with music that is louder than the music itself. Mr Vincent, meanwhile, is a man with complex needs, a chronic pain patient who is dead set against any kind of care.
But with the gentle adagietto of Mahler’s Symphony No 5, his aggression evaporates. He lets nurses take him in their arms like a child and return him to his bed.
The nurses note: ‘Mr V allowed himself to be carried away today with the cello. He even stroked our hands without pushing us away. His eyes were clearly saying ‘thank you’.’
Some patients are true characters, even as they are set to leave this world. Mr Fridman – a 76-year-old with fine features, an aristocratic manner and a full head of hair – has advanced prostate cancer.
A former luxury clothing retailer who has travelled the world, he has had six wives and many mistresses. The wives are at his bedside one after another almost without interruption.
When we first meet, he asks me without hesitation for Beethoven’s Ode To Joy. ‘I forgot that I’m in the hospital,’ he says at the end of the piece. ‘A beautiful woman came to romance me! I’ll tell my wife.’ He blows me a kiss.
A cultivated man, our subsequent meetings against the background of Verdi and Puccini arias, are lighthearted, even flirtatious.
After two weeks, though, I find a very sick man whose condition has deteriorated. I play for him again. Lying on his bed, his face drawn, he watches the cello.
When I finish the Sarabande from Bach’s Fifth Suite, Mr Fridman doesn’t say a word. His lips quiver slightly. He gives me a wan smile and, as I’m about to leave, he rolls up his sleeve and shows me his Auschwitz number.
I come back to the bed. He strokes the tattoo on his arm and says, without looking at me, ‘in the face of the unspeakable and the unbearable, music ties us to the meaning of life. Thank you. It is a balm upon my heart’.
It also quickly becomes apparent how the Schubert treatment impacts staff, too. For example, bathtime for Mrs Moretti – 78, with metastatic cancer – had become torturous. Unresponsive and in severe pain, the nurses say how hard it is to turn her in her bed to wash her because her limbs are so stiff and tense.
When I begin to play, her fingers relax slowly and unfold one by one, and soon her hands are resting alongside her body. Beneath the white sheet, her feet drop apart like the petals of a water lily opening to the sun.
Her face softens. Several times, she opens her eyes, revealing a bright gaze. For a few moments, there is no pain. She can’t say it in words, but her entire body announces it. Her muscles are so relaxed it’s spectacular. The nurses describe their emotions in the chart: ‘We were more focused on the procedure, and happier too. We felt harmonious together.’
Indeed, on days when the cello sings along to painful procedures, there is joy on the unit. ‘We yell at each other less on Thursdays,’ the care team says. Unanimously, they report a greater sensitivity to their patients’ humanity and say they feel more serene and gentle in their work. But fittingly, perhaps the patient most affected by the Schubert treatment is the one who unwittingly inspired it: Mrs Kessler.
Five years after I first met her on the dementia unit, she was transferred to the palliative care centre. Spotting her name that May morning in 2016 was a moment that stilled my heart.
When I enter her room, clutching my cello, I can almost see death hovering at her dry mouth. I play Schubert – what else? – and, while she can’t move, her breathing expands under the taut sheets. After playing, I lean toward her. ‘Thank you. You’ve given me so much.’
Later that day, a nurse shares a strange phenomenon she witnessed that morning. While she was bathing Mrs Kessler, she left the room to get a washcloth. When she came back, her respiratory rate had increased to 42. She closed the door and continued washing her. Mrs Kessler’s respiratory rate dropped to 30.
When she opened the door again, it swelled to 42. Door closed, 30. Door open, 42. The nurse realised that the open door allowed her to hear the cello in the room across the hall. Her increased breathing rates reflect her contentment.
I see her again the following week. She is less responsive, but she still reacts to the cello. In fact, the cello is the only thing that seems to get a response out of her.
Mrs Kessler, who was admitted because she was in such pain, gradually cries out less. By June, her pain is more or less under control. She relaxes and stops moaning.
Slowly, she begins to go. Like a boat that has been moored for a long time, one by one she releases what binds her and drifts out to the open ocean. She slips into a coma.
On June 6, during her final Schubert treatment, her splendid face looks like it has been chiselled from white marble, and it’s bathed in an otherworldly light.
It’s like death is sitting on the edge of her bed, waiting for the end of the song’s movement. That day, her file reads: ‘Schubert treatment with Claire. Incredible: The patient, drowsy and with limited responsiveness, sang.’
The next day, after the Schubert treatment that began with her and which every week and for years has been taking people’s pain away, Mrs Kessler dies alone – peacefully.
Adapted from The Schubert Treatment by Claire Oppert (Greystone Book, £16.99), to be published on November 7. © Claire Oppert 2024. To order a copy for £15.29 (offer valid until November 9, 2024; UK P&P free on orders over £25), go to mailshop.co.uk/books or call 020 3176 2937.
Why listening to your favourite tune lifts mood
When we listen to music, it triggers a reaction in the brain that can ease stress, soothe pain and boost mood.
And it doesn’t matter if the music is live, recorded or if we just hum it to ourselves, says Clare Maddocks, a neurologic music therapist in Glasgow who works with brain injury patients (music can improve speech and articulation in these patients).
‘Any time we engage in playing, listening or even thinking about music, we activate multiple areas across the brain,’ she says. ‘That’s because music is made up of so many elements – harmonies, rhythm and tempo –and different parts of the brain process all of them. It’s an immersive experience.’
But how exactly does it boost our wellbeing? MRI scans taken while volunteers listened to music show it alters the levels of different types of electrical signals, or brain waves – especially if it’s a favourite tune.
For example, familiar music can significantly increase the levels of alpha waves (associated with being in a relaxed state) while reducing beta waves – high levels of which are linked with stress, strong emotions and tension.
When we listen to music, it triggers a reaction in the brain that can ease stress, soothe pain and boost mood
When it comes to pain, it’s thought this change in the brain’s electrical activity also prompts the release of more endorphins – naturally occurring painkilling chemicals – as well as dopamine, the ‘reward’ chemical that increases when we experience something we enjoy.
Studies show that even hearing a tune for the first time can have potent pain-relieving effects. In 2023, researchers at Thomas Jefferson University Hospital in the US, found playing music (in this case Mozart) to 100 newborns eased their pain and distress during procedures.
They analysed the babies’ crying, facial expressions, breathing patterns and limb movements while they underwent a heel-prick test – a standard check for genetic conditions. The results showed average pain scores for the babies exposed to Mozart before, during and after the procedure were significantly lower than for those not exposed to it.
But the effect of music on health is more pronounced when it’s a tune we enjoy.
A recent study in the Netherlands asked 548 volunteers to tune in to different genres (classed as urban, electronic, classical, rock and pop) while they were subjected to a cold pressor test – dipping one hand into a bucket of freezing water while researchers measured how long they could keep it there.
The results, published in Scientific Reports, showed that when it was a song they liked, pain tolerance increased by more than 20 per cent, compared to tunes they didn’t know or like.
‘The brain likes familiarity,’ says Clare Maddocks. ‘I had a patient once who found it incredibly relaxing to listen to heavy metal music.’
Pat Hagan
