The year was 1977 and I was a new psychiatric social worker at an 800 bed VA hospital in Pittsburgh Pa. Befitting my status at the bottom of a food chain with 20 psychiatrists, 30 psychologists and 30 social workers, I was assigned to a floor where fifty men, most of whom who had undergone prefrontal lobotomies, had been living for almost 30 years.

     They had violent, unpredictable behaviors as part of their acute psychiatric illnesses. When they didn’t respond to tranquilizers (pre-Thorazine) many underwent psychosurgery, the polite term for a lobotomy. The intention was to disconnect their frontal lobes from the rest of their brains and, in theory, reduce their violent outbursts.

     It worked. It reduced them to mostly helpless human beings who could not care for themselves and who lived in mostly peaceful oblivion.

     Years later, the only distinguishing features were some surgical scars and they behaved just like the men with other organic brain syndromes, some of whom had what we now know as dementia of the Alzheimer’s Type.

     Lobotomies came and went over a few years around 1950. My patients were in their 20’s when they were lobotomized. They were mostly around 60 when I showed up.  We know now that the frontal lobes are where "executive functions" are located in the brain.  Reasoning, abstract thinking skills, judgment, problem-solving, all the things we need to get by in community living require frontal lobe functioning.  In a curious twist of fate for me, the Veterans with lobotomies were eerily similar to the residents of the Fields with advanced dementia. "Frontal Lobe Syndrome" can be a consequence of psychosurgery and a dementia illness.



     Life was lived in ritualized slow motion for these people. The patients wore institutional work shirts and pants of mostly blue with some black and gray material. The staff, composed of female nurses and male nursing attendants wore bright, starched, white uniforms and white shoes.

     Uniformity and predictability were virtues.

     Change and variation were dangerous.

Tobacco, caffeine, Thorazine and Valium made the world go round.



     It was soon apparent to me that my career there would be very long or very short. I bribed a couple of maintenance men to move a dusty piano from the basement of the recreation hall to the fourth floor of Building 4, where we were.

     I’d like to think it was miraculous but I don’t believe in miracles. I bought sheet music entitled “Greatest Hits of the 30’s” and 40’s and 50’s. Bye Bye Blackbird (1926) was our national anthem. I played two 15-20 minute sessions a day, a few days a week.

     First they began tapping their feet and moving in their chairs, in time with the melodies. A few days later, some began to walk around, keeping time with the music. They took their chairs out of the circle where “group therapy” was conducted and moved them close to the piano. Some sang, some laughed at inner jokes whose punch lines only they heard.

     Word got out about the music. Senior staff, psychiatrists and administrators came to see us. I was given a career achievement award, which was important to my mother.

     I moved soon after to the oupatient division to do research on Agent Orange with Vietnam Vets for my doctoral dissertation.  The piano went back to the basement.



     Little did I know that many years later, therapists seeking non-pharmacologic ways to comfort people with Alzheimer’s disease would re-discover the “music brain” and make a pseudo science out of a natural phenomenon.

     “Music has charms to sooth a savage breast, to soften rocks or bend a knotted oak,” said William Congreve in 1697.

     Bellamy and Watson Fields each have a Yamaha Clavinova, a digital piano with electronic “instruments” and percussion built into the keyboards and controlled with dials and switches on either end of the 88 keys. They never need tuning.

     We have talented residents, families, staff and guest performers enjoying the unusual instruments. We have outside groups of singers and instrumentalists who use our pianos for accompaniment.

     If the keys are sticky with chocolate or stained with orange soda, that’s a good thing.

     “Make my bed and light the light, I’ll be home late tonight, blackbird, bye bye.”








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