Interview with Dr. Chase McMurren
Dr. Chase Everett McMurren [he&him] has Michif (Métis), Celtic, French and Ukrainian ancestors. Originally from Southern Alberta on traditional Blackfoot Confederacy territory, he’s been living in Tkarón:to | GichiKiiwenging | Toronto for years. His clan is the Turtle and his spirit name is Water Song Medicine Keeper. Chase is a harp-playing, home-visiting physician for long-living people, and an integrative psychotherapist for artists. He is the Theme Lead for Indigenous Health in the MD Program and Assistant Professor in the Department of Family and Community Medicine within the Temerty Faculty of Medicine at the University of Toronto. Chase is training as a nâtawihôwêw* [not-a-way-who-ee-oo], or Medicine Man (*in Michif) & is a certified practitioner of the Hakomi Method. Currently, Chase is honoured to co-chair the National Consortium for Indigenous Medical Education (NCIME) Physician Wellness & Joy in Work Working Group.
Q: To start, could you share a bit about yourself and your artistic background?
I’ve made music for most of my life, although I started studying piano when I was in elementary school and eventually started studying the harp and harp therapy, or music thanatology, in the last few years. I wanted to find a way to bring music into the work that I get to do, particularly in home-based care, and I realized that bringing pianos [to my patients] isn't particularly [feasible]. A lap harp felt like a really lovely way to bring music [to someone] and use it as a tool for supporting people as they're dying, or as someone they love is moving towards death.
Q: That's beautiful. As you mentioned, part of your practice involves making home visits to long-living elders, and you provide them with harp therapy. How would you define harp therapy and its goals?
Harp therapy really considers the use of the harp as a way of connecting with and supporting someone who's suffering, in a gentle and very responsive way. Something that I find really fascinating is a technique called prescriptive music: the musician or the therapist who's creating music plays in response to what they're noticing in the person they’re supporting. For example, a harp therapist will very caringly observe the breathing rhythm, heartbeat, and facial expressions that someone’s making, and then deliver a response to them. It’s the idea of attunement and connecting with someone where they are, and then playing in a way that helps them move towards more ease and peace. So, if someone is quite agitated, the therapist might match the person’s pace and temperament and help them shift by perhaps slowing the tempo of the music… responding in a way that helps the person feel more at ease. [Harp therapy] is definitely an improvisational approach. It's not playing like it’s a recital. It is much more about arriving, settling in, and slowing down—to really notice where a person is, in terms of their current level of comfort or discomfort and helping them be there and rest a bit more.
Music thanatology is another subfield, which was developed specifically by a person named Therese Schroeder-Sheker. She is a harpist who developed a whole curriculum, specifically focused on using the self and using music to support the dying process. I have not trained as a music thanatologist, though I love the term! It came to me a few years ago that I really wanted to play the harp, so I sought out a harp therapist in Toronto who was willing to teach me, and I started there. I've had ongoing lessons that are focused on purposefully the harp and creating music in a therapeutic, responsive way.
Q: How did your interest in using music to promote healing start?
To be honest, at different points along the way, I haven't had the courage to pursue music as a vocation. I remember in high school, I decided I wanted to become a music teacher, but my music teacher suggested that I choose a more employable subject area. She said that there are usually only one or two music teachers in a school, whereas there are a handful of English or science teachers. I took her advice seriously and chose to become a high school English teacher. I did my undergraduate in English and minored in music education. I had this idea in mind that it’s good to have a job.
Fast forward to shifting gears and choosing to study medicine—I had a similar relationship with music therapy, where I respected [the skills and profession], though was afraid of not having the security of employment. I think that's heartbreaking, and I kind of feel like a coward that I didn't have the courage to become a music therapist professionally. In the end, I made a deal with myself that in practicing medicine, I would make an effort to promote and advocate for music as a therapeutic approach.
It is a sad reality that in our colonial biomedical system, biomedicine is generally prioritized. Even within a team, whether we like it or not, physicians often get a bit more attention paid to them. Music therapy or art therapy programs are often perceived as add-ons, and in many contexts, they are reliant on donations or sponsorships or people making an [additional] effort to make them available.. It's not uncommon for volunteers to do this work instead of a professional health practitioners. Often, it’s not considered part of the therapeutic plan or approach to care. Hopefully, this will continue to change over time, though it's still quite typical that music is not seen as medicine, and if it is, it’s seen as a highlight for fundraising.
Q: You also work as a psychotherapist for artists. I'm curious to know, what does that involve?
What a delight to talk about this! It’s such an honour for me to offer this sort of support. I was privileged in my family medicine specialty training to get some extra training in providing psychotherapy. Initially, I trained in Cognitive Behavioral Therapy (or CBT). I shifted from that, and now I'm much more integrative with my approach to supporting artists. There are more than 400 modalities of psychotherapy. At the end of the day, there are some common factors that determine efficacy across the board, and it’s essentially the quality of the therapeutic relationship that seems to be healing. It’s the capacity to have a supportive, safe therapeutic relationship. It’s the opportunity to feel seen and heard and also repair a relationship when it's ruptured, or there’s a bump along the way. While uncomfortable, the misunderstandings and ruptures are often opportunities for really powerful healing, if we have the courage to slow down to be curious and humble.
When there are hiccups or conflicts in relationships, initially, there are barriers to healing it with ease. In therapy, the hope is that the practitioner has the nimbleness and capacity to [weather] the storm and not get pulled in [such that they] can't continue to provide support from a place of compassion, self-awareness, and kindness. While I’ll use techniques and tools from cognitive therapy (CBT), I tend to be more focused on how our bodies keep the score—in reference to the book by [Dr.] Bessel van der Kolk. Our bodies are an unconscious, physically-embodied memory of our lived experiences, and [our bodies] tend to have a more charged memory of difficult experiences. Anxiety is an interesting example where we can't really talk our way out of feeling anxious because that dismisses the reality that anxiety is experienced in our bodies. So much of my work these days is about supporting people in being able to notice what's happening inside themselves, in their bodies, and to develop the capacity to keep themselves company with kindness. As they notice strong feelings, to be with [those strong feelings] long enough to get a sense of what is needed for the discomfort to change in a way that feels good. This is a mix of cognitive practices and body-oriented approaches.
I specifically practice a type of therapy called Hakomi, which is based on the idea of being aware of our bodies and using that awareness to notice what happens habitually. That way, we can make our habits conscious, and then decide whether we want to keep the habits or not, at the same time respecting how the habits have been helpful somewhere along the way. So much of our day-to-day life happens on autopilot. We're often responding to ourselves and the world around us in a habitual way, mainly because our brain does that to make life easier. If we were conscious of everything all the time, there’d be too much to figure out. When we slow down to notice what's happening, we have the freedom to choose whether we want to keep operating in this default way or if we want to update our operating system, so to speak. Updating our operating system, not unlike with the iPhone, can be really scary because you never know what's going to happen. I think the work involves being curious and kind as we make room for change, because change is so uncomfortable.
One word that is helpful in describing this is turbulence, which was shared by Deirdre Fay, a trauma therapist with whom I trained. We’re making changes and moving off of autopilot, becoming more conscious and deliberate, and it can feel quite bumpy and unsteady because it’s unfamiliar and uncertain. That can often get in the way of making changes that we consciously know would be helpful, like cutting down smoking or going to bed earlier. Most people know what would be healthy, and yet there's often so much more going on outside of awareness that keeps us from making those changes because it feels so scary and destabilizing. In my work, I try my best to help journey alongside people while they make these changes, celebrating micro-progress along the way.
Q: Why is it important to have a space where specifically artists can benefit from psychotherapy?
I made the difficult decision to leave the Artists’ Health Centre as the Medical Director in January to make more space for my work in Indigenous Health at the University, as I realised that it’s hard to do so many things at once. That said, I continue to provide psychotherapy for artists, though in a more contained way in my private practice. Being curious and learning about the complexity of people’s lives is important to me.
The themes and difficulties [artists] face are somewhat similar. For example, there is the common challenge of precarious employment, where jobs come and go, particularly during the pandemic. People can have both an artistic practice and a “job,” like being a server during the day and a performer at night. All of that can [disappear] quickly, and there is often this terror of work changing or drying up. It’s also not uncommon for people to feel that if they say no to an opportunity, they’ll never be asked again, which creates a stress-filled and vicious loop of being ambivalent, burnt-out, resentful. When we, as practitioners, have an idea of what someone does for work and how they make a living and what brings them joy, we can pause before we go on autopilot and offer “fix-it'' solutions to complex crises.
There’s an implied idea that if we go see a doctor, we want the doctor to help us and tell us what to do. And yet, it's so much more nuanced and complex because most of us struggle with receiving advice. From a polyvagal theory perspective, our nervous system interprets advice as a threat. If we don't feel really connected with somebody, we're likely to fight, flee or freeze in response to being given advice—even if we've come to a physician for help. Recently, someone in my practice spoke to their family physician, who showed them how much money they could save if they got an IUD relative to paying for oral contraceptives. The process was well-meaning, though the person was so offended and hurt that this physician imagined they would have the money available to pay for an IUD [up front] as a lump sum. In moments like these, it’s important for us to not try to be clever or offer great ideas or solutions until we have a sense that someone wants to hear them! When in doubt, it can help to explore what someone has already considered and tried!
I think it's easy for us to imagine that people haven't already suffered immensely and tried a handful of approaches before they met us. Speaking for myself, my first instinct is not to book a doctor's appointment. It's such a hassle, and it’s stressful. There’s nothing easy about going to the doctor for most people. This person—the patient—is the protagonist of their story and has probably tried figuring whatever is afflicting them already. They’re not coming to us because they think we’re smart. They're coming to us because they feel like they need our help. Going back to music, I can’t think of something more upsetting than telling someone to just listen to a happy song. I would probably feel quite unseen. At the end of the day, there is this idea of connecting before correcting and the idea of acknowledging or validating someone’s experience, rather than offering reassurance or solutions. It might then come up in conversation that they want some ideas, or that they're open to suggestions. At that point, we can offer something or share our own experience… [A thought like], “I love listening to this song when I’m feeling down, because it reminds me of my grandma” is offered in a way that's not quick and efficient. It is not felt or experienced as reductive [by the recipient].
Q: How would you like to see art-based therapy grow in the future or be more explicitly integrated into our medical care?
I'm nourished and delighted by the curiosity and respect that current medical learners have for seeing an expanded view of healthcare and support. My hope is that with the openness that learners have towards this more expanded understanding of healing, complexity, and nuance, there will be more space to consider and explore other ways to support the healing process.
There’s a Rumi quotation that I really like: “Let the beauty we love be what we do. There are hundreds of ways to kneel and kiss the ground.” There may be an even more fitting quotation from Virginia Satir, who was an inspiring, trailblazing family therapist. She was a schoolteacher first and realized that her students were so affected by what was happening at home and that the complexity of what she was seeing in the classroom was a reflection of something more interconnected and complex. She said she did some “silly research” and found that there were more than 250 ways to wash the dishes, depending on who was washing and [what] ingredients [were] used. If we are stuck in believing there is only “one way” or “one viewpoint,” then we are shutting out most of life. I love this quotation because it's easy in medicine to get very persnickety and uncomfortable when things aren't the way we think they're supposed to be. It is a reminder for me to remember that “evidence-based medicine” (EBM) is based in a very particular context. Who decides what is studied, who is studied, and how? I find it helpful to imagine marginalised folk signing up for EBM studies. Are they reflected in the research that guides evidence-based practice?
My hope for medical learners is that they will become increasingly aware of what medicine is and what helps people heal or be well. It's so much broader than what we learn in medical school, and I hope that people practicing medicine or any health profession will develop a death-respecting approach to the way they support people. Advances in modern medicine are wonderful at extending life. Where I think we can do better is in how we support people in living well with advancing illness. In my humble opinion, I think it can be empowering to know that we all have an expiry date. That is something we can do consciously, or we can easily avoid it and talk about A1c’s and ejection fractions. Ideally, there can be room for both disease prevention and reduction along with reducing suffering while acknowledging dying as a healthy part of life.
In my opinion, physicians cannot be afraid of respecting dying and death as part of the circle of life. It is equally as important as birth and similar in so many ways. I hope we can turn inward individually to explore what's in our way of welcoming death when death is near. I know some people have trouble doing that because it's not something that we're culturally taught or [something] our society has much openness to explore. Looking back in time, within music thanatology, when medical advances weren’t there, music played a prominent role in helping people as they moved toward death and as a way for those around them to have something to do, like singing healing songs at the bedside. As practitioners, we tend to fix things by prescribing or looking for something to fix because it's so uncomfortable to simply be, where we feel like we're not doing enough or we're missing something. I think it’s similar for those who are supporting someone who's moving toward dying. Simply being often doesn't feel like enough. So, I think music can be one of those ways we can use our voice, which is something substantial. Each of us is the only person in all of history and all of creation who has our voice, so being able to use our ability to make sound and make noise—beautiful or not—can be a powerful way of showing up and connecting with others.
