by Victoria Hume

For the last few years I’ve been writing music about delirium – a state often induced by being in hospital and which can be characterised by paranoia, delusion and hallucination. It is immensely common, with a documented prevalence of around 20% in ‘normal’ care^[1][2] rising to 87% peak incidence in intensive care.^[3][4]

In 2013 I released a song cycle^[5] based on conversations with people in London and the south east of the UK who had experienced delirium, or cared for people who had; and in 2017 I followed this up with a new 45-minute composition based on similar conversations in Johannesburg, South Africa.

The process of making the South African piece (Delirium Part II) combined narrative research techniques with music composition. My contention is that the compositional aspect of this work – threaded through the interview, analysis and write-up processes – allowed for a different understanding of the experience, and a different kind of conversation with the participants; indeed it is now allowing for a different kind of dissemination of the study’s ‘results’.

The piece is structured around the three themes that emerged most strongly from interviews, observation and focus groups: violence, loss and humanity – and explores each of these in turn across a broad narrative arc.

With my colleague Megan Wainwright, I have written in this special issue about hierarchies of research that place the randomised controlled trial at the top and creative research at the bottom.^[6] Even within qualitative, a creative approach remains fairly novel, and is perhaps regarded as more subjective and questionable. Ten years ago Rita Charon was arguing for ‘intersubjectivity’ in clinical practice,^[7] and in the full dissertation that accompanies this piece^[8] I argue that it is the very subjectivity of this approach which creates an empathic space that may help us better understand an experience that is damaging precisely because – in the diverging reality of delirious delusion and hallucination – it separates the person who has experienced it from those around them.

By using fragments of sound from the hospital itself, alongside audio clips from interviews and focus groups with the people who generously volunteered to take part, I hope to connect our understanding of delirium with a better sense of how the hospital itself can affect us: how everything from treatment to architecture can work to dehumanise us – but also how moments of profound humanity can intervene at the loneliest and hardest times to support us.

You can listen to Delirium Part II here.^[9]

Delirium Part II was supported by the PRS Foundation for Music’s Women Make Music scheme. The recording was performed by Victoria Hume, Chris Letcher, and Waldo Alexander and mixed by Chris Letcher. See victoriahume.com/delirium for more about the whole Delirium project.

[1] Peter J. 2012. Delirium in General Medical In-Patients in South Africa: Development of The 4-Question ‘RACY’ Tool for Simple and Effective Delirium Screening [Unpublished thesis]. Retrieved from https://open.uct.ac.za/handle/11427/3452 on 4 January 2015.

[2] Ryan DJ, O’Regan NA, Ó Caoimh R, Clare J, O’Connor M, Leonard M, McFarland, J, Tighe S, O’Sullivan K, Trzepacz PT, Meagher D, and Timmons S. 2013. Delirium in an adult acute hospital population: Predictors, prevalence and detection. Epidemiology; BMJ Open.

[3] Maldonado JR. 2008. Delirium in the Acute Care Setting: Characteristics, Diagnosis and Treatment. Critical Care Clinics 24: 657-722.

[4] Cavallazzi R, Saad M, Malik PE. 2012. Delirium in the ICU: An Overview. Annals of Intensive Care [Online] 2(49). doi:10.1186/2110-5820-2-49

[5] Hume V. Delirium (Part 1). Available at https://victoriahume.bandcamp.com/album/delirium.

[6] Hume V, Wainwright M. 2018. Reflections on a field across time and space: the emergent medical and health humanities in South Africa. J Med Humanit. [special issue: Medical Humanities in Africa]

[7] Charon, R. (2008). Narrative Medicine. Oxford: Oxford University Press.

[8] Hume, V. (2017). Exploring the experience of delirium in hospital, and how music might expand our insight into this phenomenon. Masters dissertation, University of the Witwatersrand. Available at http://wiredspace.wits.ac.za/handle/10539/23811.

[9] Hume V. Delirium (Part 2). Available at https://victoriahume.bandcamp.com/album/delirium-part-ii.