Saturday, January 02, 2016


Steven H. Cornelius
Music and Stroke
Posted on July 13, 2014

I have been reading stroke blogs lately. Many offer practical advice. More than a few are inspirational. There are also posts expressing resignation, frustration, or anger. I witnessed all of these emotions among fellow patients during my stay (and later as a volunteer peer facilitator) at Spaulding Rehabilitation Hospital in Boston.

For me, the effects of stroke have been humbling and occasionally humiliating, but also profoundly educational. Without question, my stroke has stimulated my thought life. Although too often it doesn’t show, in working through my various disabilities I am slowly becoming a better person

I undertook rehabilitation with a sense of urgency. For me, recovery was a matter of social obligation and personal pride. I have met other stroke patients who pursued rehabilitation with equal tenacity. I have met others who put forth very little effort at all.

Why do some people work hard on their recovery and others do not?  And why do some who work equally hard achieve less success than others? I suspect that answers to these questions have to do with a great variety of factors, including: age and general physical health, current life responsibilities and future possibilities, emotional state, and the nature of one’s stroke (the part of the brain that has been damaged).  I was blessed that my own stroke, which initially left me physically and cognitively impaired in a great variety of ways, did not diminish my desire to return to wholeness.

Because recovery is always on my mind, I was particularly struck by some ideas in a New York Times (July 4, 2014) article titled, “The Secret of Effective Motivation.” It begins as follows:
There are two kinds of motive for engaging in any activity: internal and instrumental. If a scientist conducts research because she wants to discover important facts about the world, that’s an internal motive, since discovering facts is inherently related to the activity of research. If she conducts research because she wants to achieve scholarly renown, that’s an instrumental motive, since the relation between fame and research is not so inherent. Often, people have both internal and instrumental motives for doing what they do.
Acting from internal motives is the key to success, the authors contend. They go on to write that, “efforts should be made to structure activities so that instrumental consequences do not become motives. Helping people focus on the meaning and impact of their work, rather than on, say, the financial returns it will bring, may be the best way” to attain success.

I wonder. Aren’t all the above motives instrumental?  Don’t they all refer to outcomes external (to varying degrees, of course) to the activity? I suggest a different approach. The real key to success (the authors never defined that term, so I won’t either) is something else: perceptive, thoughtful, and imaginative engagement through the activity itself.

Over a decade ago, my wife decided to purchase a new (old) violin.  I became involved for a range of “internal/instrumental” motives. Initially, I did not have a particular interest in violins themselves.  As that process unfolded, however, I became increasing intrigued by the various instruments we were accumulating. By paying close attention I developed more discerning eyes and ears, and richer intuitions, I heard and saw previously unnoticed qualities. Each instrument had a unique personality. Many spoke; a few sang. As I studied them and read about their luthiers, I came to see the instruments as living works of art tied to (yet transcending) time and place. As works of art, they embodied the past. As professional tools, they could facilitate the present. And as vehicles for expanding the powers of musical imagination, they suggested future possibilities. After the purchase, with my instrumental motives satisfied, other tasks occupied my time (though my new-found appreciation for violins remains undiminished).

I told this story to suggest that “motives” are instrumental by nature, and that success in any particular endeavor may have less to do with the motives that one brings to an activity than the level of engagement brought to bear. I find my professional work inherently stimulating. That is why I have pursued it for so many years, not because research is what scholars do or because I was hoping to get ahead in the profession. (Not surprisingly, following my intuitions and curiosities has taken me away from a standard professional trajectory.)

Surely, mental and physical facility is the direct goal of rehabilitation therapy (which, if I understand correctly, the authors would term an internal motive, not an instrumental one). Even so, many stroke patients fail to maintain an active rehabilitation regimen.

I suspect this is the case in part because if one is not fully engaged, therapy can be both painfully boring and excruciatingly frustrating. Compounding the problem is the fact that recovery is difficult to visualize. Retaining that vision may be even harder. Rehabilitation is a long process, and full recovery is the exception rather than the norm. (Perhaps the goal of “recovery” is so amorphous/distant that it becomes an instrumental, rather than internal motive.  If that is the case, choosing a goal that is easily visualized [hand writing a letter or ambulating 20 feet] might provide a stronger motive than “recovery”).  But in any case, I suspect that reliance on any motive (at least “motive” as defined by the authors) is not the most efficacious rehabilitation strategy. Sooner or later, the motive’s psychic energy will diminish, if not be spent.

For me, the greatest successes seem to come when focusing on the activity itself (including paying close attention to one’s thoughts, and both emotional and bodily experience). I pay attention not because focus helps me attain my recovery goal (although it does), but because attentive and conceptually rich engagement is rewarding in its own right.  Engaging in this fashion builds psychic energy, rather than expends it.  By paying attention, each rehabilitation activity builds more awareness and clarity, which is plenty satisfying in its own right (especially when physical progress appears to stagnate).  Like my recently posted visualization and listening exercises, each activity holds potential for new and unexpected insights. Doing becomes its own reward.

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