In times of a care crisis throughout Europe, René van Munster is doing something different. 

As the population in many countries ages, health care budgets are cut and patients and health care staff suffer, van Munster is trying to make a difference — through music.

The Dutch cellist is part of a joint research project between the Groningen University Hospital and Prince Claus Conservatoire on the role of live music in health care. As part of the project, a team of three musicians and one mediator spend a week in a hospital ward playing music to the nursing staff and patients.

The project focuses on how live music can help to enhance relationships between patients and staff, both within themselves and with each other, as well as on helping patients to deal with pain and suffering.

“It will completely change their relationship with their patients and to me is just very inspiring to think of all the things that music can do in this sense — create or transform relationships between people,” he says.

Van Munster trained as a classical musician — undertaking a preparatory course at the Prince Claus Conservatory in 2006 before doing a BA at the Groningen Conservatory then completing a masters in Classical Cello at Tokyo University of the Arts — and he still performs traditional concerts in big concert halls. 

But his musical interests are diverse. Having discovered electronic music as a teenager, he has recently got back into DJing and production with a friend from his Ensemble. 

Photo: Moon Saris.

During his studies he also became interested in how music could have a social impact and got involved in various projects that had an overtly societal context.

Between 2010-12, he was part of the Ricciotti Ensemble, a street orchestra in the Netherlands existing since 1970 with the principles of “live music for everyone.” As part of this orchestra, van Munster played in schools, elderly people’s homes, health care facilities and prisons — experiences that laid the foundations for his work in hospitals today. 

Van Munster was recently in Kosovo to give a public lecture on Meaningful Music in Healthcare, after which K2.0 spoke to him about playing music for alternative audiences, the challenges and rewards and the powerful role that music can play in improving people’s lives.     

K2.0: How did you take this direction in music? Why do you do this, particularly therapeutic music?

René van Munster: A very important point is what we are doing is not music therapy. Because music therapy is a different thing, that’s not my expertise. I think the difference is that music therapy has a therapeutic goal, a clinical goal — you go in and you want to do something for somebody using music. And our goal is maybe just an artistic goal, we want to perform music and make people experience a meaningful musical moment. 

However, that goal already has therapeutic effects. That’s great, we’re very happy with that but we don’t want to say that we’re music therapists because that was never our goal and that’s a different expertise. But we can definitely learn from each other. 

And so, how I got into this specific project is when I graduated in Tokyo, I came back to the Netherlands and I was invited to do these lectorates to this research group. 

I was invited to participate and help this [hospital] project because I had already participated in various other projects including a lot of projects working with elderly people with dementia and using improvisation to communicate with them, to make their personality come out more, to improve the communication between people with dementia and their carers.

Can you walk us through a typical session of playing in a hospital?

Typically these projects last five or six days in one hospital ward and that is very important because then you get to revisit the same patients more often. You get to go deeper than when you would just go on one day and the next day to another ward. 

So, every morning, we go into the hospital. What we start with playing to the nursing staff. That’s typically during their coffee break, they make a little bit of time for us, where we not only play for them but also talk with them. 

We share experiences, maybe from the previous day, like, “Oh, it was such a special moment to hear that in Room 308, where it was this man…” Then we talk about the interaction we had and then they can relate to that and they can talk about their patients and how the music is affecting them. 

Then we play a piece of music for them — also, to hopefully help them to relax a little bit in their coffee break or help them… like sketch an image for them, how the interaction the day before had been in that room.

Afterwards we sit down with the head nurse of the ward and we talk through all of the patients in all the rooms. So, we go, “OK, who wants music?” because they do a walk around before and they ask who really doesn’t want it. 

So, we talk, we say, “OK, we’ll go to this room and maybe into that room” and for that we actually have an extra person in our team. It’s a team of three musicians, plus an extra person that we like to call the mediator. And so, the mediator not only makes a route for us to go through, but also is the person who enters the room before the musicians. 

And that’s what we find very important. We realize that when you enter a room with musical instruments, it’s very hard to say no, because they are already there and we’re like, “Hey, want some music?!”

What we have, is the mediator comes in, no instruments, nothing attached and asks, “Is this a good time? Can we play? We have musicians.” And so then the patient is free to say no. But if yes, then we come in and we take over. 

So typically, after we’ve had that briefing, one of us goes around the hallway and plays a little tune just to announce that the musicians are there, and then we go into the rooms. And in the rooms might be one patient, two patients, three or four. 

Depending on how many patients are on the ward we take a little bit more time or we have to move on a bit quicker. But on average we play two pieces of music per room. And so, we might focus on one patient or on all the patients together.

What genre do you play — is it always classical?

Basically, we try to find the right musical approach for that room, for that person in that moment. And how we do that is using a sense of repertoire — a fixed repertoire and improvisation. 

The repertoire is a very broad selection — about 10 to 12 pieces ranging from really classical music like Bach and Strauss and Ravel but also pop music like Coldplay or Elvis, this kind of stuff. Also, folk music — we’ve played Turkish and Dutch folk music. So, there will always be something for everybody. And there will always be something new for everybody.

We arrange everything ourselves as a trio — and we really learn it by heart. So, we use no music sheets — to really be able to communicate with the people in the room and with each other and to really have this open communication. 

On the other hand we have improvisation, which is a big part of this project. We think that through improvisation we can really connect to a person because typically what we do is something that you can call a person-centred improvisation. And this is actually a big thing also in music therapy. We get a lot of inspiration from that. 

Basically, you shape a piece of music according to the input that you get from somebody — in this case from the patient in front of us. We can ask this patient, for example, to describe a landscape, a feeling or to give us just a story. Or maybe they just start talking about something and we say, “Oh, we can make a piece about that,” and so we try to create something, using their inputs in that moment, something meaningful for them. 

What’s important in that I think is a feeling of ownership or control. So, what we don’t want is to just perform for people and people clap — because when you’re in this vulnerable situation you need something else. When you’re in the hospital you feel less control over your routine because everything is decided by other people and also the privacy, and so you can imagine that it’s a very powerful thing — to get a bit of control, to get a bit of ownership over a piece of music. 

And then hopefully create a sense that we’re all making this piece of music together, instead of just playing for somebody. 

It mixes their emotions, but it also just gives them a feeling of calm… it can also give energy to people. If some people ask for a rough sea and we do that — we really give that energy. Because we realized that you need different energy depending on the situation.

Was it hard learning to improvise based on just a feeling or their emotions? Sometimes they may not know what they’re feeling and they may be very abstract and vague about what they want, and that may be hard to improvise and produce there in that moment, together with the other musicians?

Absolutely, it’s a challenge. It’s kind of a complex thing where on one hand you have to listen to yourself and think about your own ideas you want to put into a piece of music, then listen to the other musicians and see what they’re feeling in the music, and then have the image of the patients in mind, what they just described to us, and see how we can put that into a piece of music. 

And also having your antenna open to what’s happening in the room. Because a patient might react or look at a specific person… that’s also nice to react to. If the patient is looking at the cello, to my instrument, very clearly, then I will play out more, give a little solo, and my colleagues will go back a little bit. So, there is a lot of awareness of different things at the same time. 

We really need to learn to accept that an improvisation might not work in that moment. It might not connect to the image of the person, we might not connect to each other in the group… and that’s fine. 

Photo: Deborah Roffel.

That’s also great that we have these five or six days that we can work and we really encourage the patients to tell us if it’s good here or if they could not connect because then we can try again and we can really find a sort of safe space that we can just discover things musically.

We had one patient where we played a couple of days for her and after a while she explained that she had [received] some bad news… she didn’t elaborate. But we asked: “Could we play a piece of music for you, maybe based on a certain feeling?” And she said: “I want to hear a piece about having to wear a mask all the time.”

And she described this feeling a little to us and we were really like, “OK, wow this is complex.” But we tried and we played it, and then she said: “No, I really don’t recognize this feeling; for me it’s more like this and this,” and she started to explain further and further. 

And then we tried it again, and it was much better and it really connected with her and she said: “OK, now I’d like a piece about catharsis.”

And then we played that and… then you’re actually on the verge of music therapy. But still we just tried to create a piece of music that really connected to her as a person, that connected to her feeling, but at the same time to our artistic identity as well. That was very meaningful interaction, very special. Also, for somebody to feel free to open up in that way and share. 

To feel safe to be vulnerable?

Yes, exactly. That’s very important in this work, that gets into the core because all these people are vulnerable but a lot of them will be very… they’ll try to be brave for some reason and there’s no need for that in the end, because I think when people open up and dare to be vulnerable — also us, the musicians, also if we make ourselves vulnerable — there are some really, really beautiful moments. 

Then you really feel like you’re in the same… I’m not a musician anymore, the patient is not a patient anymore: We’re just people, sharing a meaningful moment. 

What, if any, is the difference in the moods of people after you do improvisation compared to a fixed repertoire? 

That’s a very interesting question — it’s something that has been on my mind a lot I think, and I am still discovering what the exact difference is. But I think a big difference is the way the patients listen or the way the patients take in this music. 

Because a lot of times you see the repertoire will be familiar to them and that’s a very safe way of listening for them. They can lay back and just listen. We have had very, very intense moments with repertoire as well when somebody would have a really special connection with a certain piece of music. And that can be so meaningful. 

At the same time, improvisation is a very different way of listening because that’s always new for everybody. So, what’s different is that the patients are perceiving that differently, they might listen more actively… most of the time it’s not that I can lean back and relax but it’s more involved. Indeed, that would often give maybe more emotional involvement. 

Speaking of different ways of listening and perceiving, what do you find to be the difference between the patients or staff experiencing live music in places like that and listening to music on their electronic devices. Why can live music be more beneficial, if you agree it is?

Yeah, I think I agree. I also like projects with recorded music because it’s been shown that recorded music also has great benefits for patients recovering from surgery — and during surgery also, it has really interesting effects. 

What is not to be ignored is also the social aspect within a room, people closing themselves off. They go watch their TV with their headphones.

But when we’re in the room, if people are dealing [with difficulties], we try to incorporate all of them into the music. We’ve had situations where people really come together to give a story to us to play. 

We walked into a room where we had played for a couple of days and they said: “We actually thought of a story with the four of us.” 

One of them, who was the storyteller let’s say, he was really enthusiastic and he said: “There were two dramatic moments in this piece.” 

We actually had this conducting stick that we conduct improvisations with and we said: “Would you like to conduct this for us?” and he said: “Yesss!” — and he points to one musician and he would be very clear with the dramatic moves and so we would play like that. 

That’s of course super empowering to that person in the moment but also to see that group really come together, people of different ages and different backgrounds and they were all very into it. That’s something that’s very important in this live music thing, that you can bring people together instead of everybody listening to their own music. 

Do you have more touching/funny stories like this? 

Yeah, so many, so many of course. there was a patient, an elderly lady and she was going to go home to pass away because she could not be operated on anymore. And she had a very strong connection with one of the family members. 

She requested if we could play a piece of music for her by Robbie Williams, which is called Angels — so we made an exception because we normally have a set of repertoire and we don’t normally take requests, but in this case it was such a meaningful thing, that we practiced. 

We made an arrangement, we practiced it for the next day and then we played for the family member and it was just so… very painful, but beautiful at the same time. It was very difficult for us to focus on the music… because you’re on the verge of tears, because you just feel for this person… But in the meantime you have to be very dry and not to go into disharmony… to just keep yourself from cracking up. 

That was very beautiful and when we got out of the room, we really needed some time to sort of release some emotions as well — but we had to move on to the next room. And in the next room was a very different story because there was a man who just got a new liver and he requested that we play something about a new life, a new spring perhaps. 

And that is a completely different picture, but we have to completely adapt to that and that was like an emotional roller coaster. You literally see death and life in between minutes. That was extremely powerful. 

I feel so good that I can do something there, both in helping somebody in this process of passing away and in helping somebody to come to terms with the fact that there is new energy, new life.

Moments such as these must be both very rewarding but also extremely challenging, both as an individual and a musician. What are some of the other challenges in doing this kind of work? 

There are so many challenges. There is the challenge that you don’t connect musically to a person.

And the hospital is such a flexible environment, so things will change at the last minute and that is something to deal with as well. You promise a patient that you’re going to play the next day before they go home, but they had to go home earlier, so you just missed them or something. 

Or the patient isn’t feeling well and you really want to play for them and they also really want to listen but they’re not feeling well, so that too. 

And of course, another challenge is that you encounter a lot of beautiful moments but also so so many sad things. 

When we go to the oncology department, a lot of people get bad news and a lot of people are dealing with very heavy things and they might talk a bit about that and we are then exposed to actually a lot of sad stories, a lot of realizations; “Wow, some people are really dealing with things here.” And it’s also hard to keep that out because you also want to have meaningful conversations with people 

Does the project take account of these challenges: Does it foresee the emotional need for recharging and leaving time for unwinding?  

We definitely take it into account. We really try to build in time also within the team, with the head nurses as well. After each day we sit to talk about: “Was there something that really affected you in a certain way?” 

It’s hard to let go and this is why doctors and nurses are trained… to be able to empathise in a moment and to also not take that back home. That’s a different challenge that you don’t think about in a concert hall. 

Speaking of doing different things, can you talk very briefly about the experience of carrying out this musical work in elderly homes and prisons; how do these settings differ from the hospitals?

Not in Kosovo so much, but in the Netherlands, we have a huge elderly population, so dementia is a big thing. In Kosovo in a few years it may be the same.

There are a lot of elderly people with dementia and we’re just looking for projects to enhance their quality of life, the quality of care, because not all of these homes are nice. A lot of them are quite depressing in fact and with a lot of staff that are not properly trained. 

What we do at elderly homes is “music and dementia” we call it. We go to a facility with people with dementia, mostly people in the later stages of dementia. 

So, they might be very distant, very far, not responding so much but also very outspoken, without inhibition, sort of reacting immediately and saying what’s on their minds or saying something inappropriate, let’s say.

And so, for these people we all sit in a circle with people with dementia, and their carers as well, and we will really use improvised music to connect with them but also to make the person with dementia come forward, to put them into a different light for the carer. 

And then the carers that are there see the people they take care of [differently]: When they normally see a very grumpy man, all of a sudden they see a human being playing music. 

We have percussion instruments in the middle of the circle and we invite them to play with us. For example, I’ll take a percussion instrument and give it to a person and see just what kind of sounds you can get. We don’t say: “OK, please give us a beat,” but really facilitate so that they experiment with a sound — they might shake or tap it a bit… and then we try to listen to that and react to that.

Maybe we also tap our instruments and play a melody out of it and then ideally slowly a piece of music starts to happen. That really connects to the sense of ownership in the same way as in the hospitals. We try to give to somebody the feeling of, “Hey, I’m making this, together with the musicians.”

You get these very beautiful intimate moments where you just see the people come out of their shell, so to speak.

What about when you used to perform in prisons? I remember a movie with Johnny Cash when he went into prisons and it helped in a way to raise the mood. How was it in your experience?

Oh, yeah, sure! That was mostly during my days in this Ricciotti Ensemble and it’s a 40-person orchestra, mostly students. And yeah, we would go into prisons — it could be youth prisons or just normal prisons — and we would play a very broad range of repertoire, like jazz and pop and funk and classical music; also modern classical music to expose people to different kinds of music and really experience something that never happens in that setting. 

Playing in these prisons would be quite impressive for the orchestra because we got really clear instructions like, “Have your passport ready,” “If somebody asks you, do not give your address” — you know, it’s serious stuff. But then actually when you’re just playing there we have a bunch of people sitting in the hall and just having a great time. It’s just performing a nice concert.

We had moments when we played Bohemian Rhapsody, for example, and the whole front row of, like, super tough macho males were just like in tears, crying and singing along: “Mamaaa,” you know. 

But in those concerts you just realize they’re just people — everybody is just a person. Whatever happens, and whatever somebody has done, everybody is a human being and has a connection to music somehow and we just need to find it and it can put people in another light. K

Feature image: Layla Barake / DAM festival.

This conversation has been edited for length and clarity. The interview was conducted in English.