Composing Care: The Aesthetics and Politics of Music Therapy in the Clinic

This dissertation examines the care work of music therapists in North American hospitals. Based on sixteen months of fieldwork conducted between 2019 and 2020 in Canada and the United States, this ethnography investigates the clinical aesthetics of music therapy, or how music therapy is sensed and made sense of in the clinic. I show how, through its foundation in Western art music traditions, the profession of music therapy is depoliticized—grounded in the values of universality, rationality, and objectivity—and aligned with biomedicine. It is through an association with biomedical knowledge systems that, I argue, music therapy is made into a health profession. I found that music therapists struggle to have their work taken seriously as they care for patients on the margins of hospital systems. Music therapists are in pursuit of what I call clinical recognition—being seen and valued from a biomedical perspective. As they strive to be recognized as indispensable to biomedical care, I show how music therapists attempt to ameliorate biomedical care structures from within. They cultivate sensitivities to sensory experience, especially to sound, that inform their movement through hospitals and guide their interactions with patients and staff. By intervening in what I describe as the clinical sensorium—the dominant structuring of sensory modes of attention that shape what is sensible in the clinic—music therapists disrupt the stultifying anaesthetic, or numbing, qualities of the clinic by reconfiguring clinical attunements, composing atmospheres of care, and structuring feelings in their extra/ordinary care practices. These care practices, I argue, are grounded in reciprocity; through musical gift exchange, music therapists foster affective connections and attachments for hospital patients that reimagine care in ways that remain partially tethered to yet exceed biomedical logics. Mobilized for and against biopolitical care regimes that attempt to delineate, capture, and govern life and death, I argue the care practices of music therapists reimagine the sensory-affective possibilities of living and dying in the clinic.

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