“How Does Healing Sound” – to the Sound Projects of Yoko K. Sen

Screenshot from the video “Hospital of the Future”

Comment on the Article “Wie klingt Heilung” (How Does Healing Sound) (1) by Jean Odermatt.

Yoko K. Sen is a sound artist and founder of Sen Sound with the vision to change the sound environment in hospitals. In 2014, she was hospitalized due to health complications. There she was deeply disturbed by the sounds she heard, and her experience made her realize the impact of sound on well-being and dignity. In the years that followed, Sen was inspired to found Sen Sound, a social enterprise aimed at creating a better future for the sound environment in hospitals. 

The sound works of Yoko K. Sen draw attention to a fundamental problem in everyday hospital life: the handling of sounds. Acoustic backdrops are part of everyday life of hospitals, which can be classified more as noise than as melodious sound. Along with light, air, interruptions in work or precarious space conditions, noise is one of the numerous systemic problems in health care buildings. 

“The Future of Hospital Sound” – video by Yoko K. Sen

Since the beginnings of the modern hospital system in the 19th century, noise has remained a challenge for patients, staff and hospitals as a whole. Florence Nightingale, considered the founder of modern nursing, wrote in 1859 in her now famous “Notes on Nursing”: “Necessary noise is the noise that harms the patient. Unnecessary noise is the cruelest absence of care.” (2) 

Annoying noise is sound that disturbs psycho-social or physical well-being and causes a feeling of discomfort in those affected. Noise hinders communication, impairs concentration and often makes people ill.  

However, the term annoying noise cannot be defined objectively. Noise measurements and given reference values only give an indication of the degree of annoyance, as people react very subjectively to noise. Whether a noise is perceived as annoying or not depends on a number of other factors in addition to the volume. Decisive factors are the type of noise and, above all, the situation and the attitude of those affected to the noise source.  

It therefore makes little sense to meticulously collect measurement data while ignoring the emotional level of the affected people or their contextuality. Sounds can be healing or can be perceived as noise. The personal assessment is ultimately decisive as to whether someone feels disturbed by noise.  

However, noise is generally identified as one of the major stress factors in hospitals and is a source of frequent complaints from patients, families and staff. (3) 

Instead of the recommended 35 decibel (dB) (4), values of up to more than 100 dB are recorded today. Noise of this magnitude accelerates the heart rate, increases blood pressure and other stress measurements. Excessive noise in hospitals also reduces the intelligibility of speech and impairs communication, leading to annoyance, irritation and fatigue, and reducing the quality and safety of healthcare. 

The origin of these noise sources ultimately lies in the history of hospital construction. In order to escape the frequency of infection, bare, easy-to-clean surfaces were used, which in turn reflect and amplify sounds. Together with the growing need for space for medical equipment, the distances patients have to cover on their way through the buildings have also increased, which has led to further noise immissions. 

Researchers at Johns Hopkins University (5) have studied the noise in hospitals and presented alarming results: Since 1960, noise levels have risen dramatically – from an average of 57 to 72 dB during the day. This corresponds to the noise from a main road or vacuum cleaner. During the same period, the night-time noise levels in the clinic climbed from 42 to 60 dB. Many medical devices (6) show little or no reduction in night-time noise levels. Machine noises also have a greater negative impact on arousal than human voices. 

The increased noise pollution has many causes. For example, with increasing mechanization, the number of potential noise sources has also risen. Engine noises from automatic infusion pumps, special beds, or increased alarms in the corridors. The increasing freedom of movement in dealing with visiting rules is a further cause of the increase in ambient noise. According to experts, this constantly high noise level is responsible, among other things, for communication errors between medical staff and may, in the long term, lead to stress for staff. (7) 

But patients are also affected, as they have to put up with the noise. Studies show that noise and the associated restlessness can lead to sleep disturbances and ultimately to delayed recovery. 

A 2006 study by Willich (8) shows that chronic noise increases the risk of heart attack by 50%, largely irrespective of whether it is subjectively perceived as disturbing or not. The body reacts to constant noise with a permanent alarm: the adrenaline level rises, blood pressure and blood lipid levels climb, making the body more susceptible to cardiovascular disease. 

Soundscape 

In the sense of stimulus reduction, acoustic comfort is of particular importance. Music not only improves subjective well-being, but also changes bodily functions. Suitable melodies have a calming effect via the vegetative nervous system. The increased alertness of the body in case of pain is diminished by soft sounds and gives way to relaxation; pulse and blood pressure drop, breathing slows down. (9)  

Comfortable sounds have a stimulating effect and contribute to a higher quality of life. They support orientation and communication between the residents of nursing homes. 

The promotion of a sound culture in hospitals can contribute significantly to noise reduction and can be considered an essential part of safe and high-quality health care. This can be achieved, for example, through training or by technical means such as earplugs, noise warning devices, acoustic treatment panels or so-called “sound masking systems” (10), which reduce noise-induced disturbances in the background. 

An exemplary project was launched at Montefiore Medical Center in New York under the name Silent Hospitals Help Healing (SHHH). (11) The aim was to reduce noise levels by educating staff about noise control and identifying and correcting the sources of annoying noise. Various measures were taken to make hospitals quieter, e.g. repairing transport trolleys and switching telephones to vibration alarm. Shift handovers were made quieter and visitors were encouraged to speak more quietly. There are stickers on the doors, with a nurse holding a finger to her lips, calling for more silence. As a result, the noise level has dropped from a measured 78 db to values of 50 – 60 db. Initial effects were that patients slept significantly better and staff seemed less stressed. In contrast, acoustic overstimulation in people with dementia can lead to increased wanderlust, aggressive behaviour and agitation. (12)  

For people with Alzheimer’s disease or other dementias, singing together can alleviate aggression and favourite music can bring back faded memories. Music therapists find that people with dementia often remember melodies and lyrics from their childhood and youth, even if other things from that time have been forgotten. Some patients who can actually no longer walk start dancing. The positive effect usually lasts even beyond the therapy session: The patients are more alert, more responsive and more balanced. Apparently, it is the basic characteristics of music such as rhythm and harmony (i.e. acoustic fractals) that produce positive effects. 

Or just the implementation of sound worlds, as the example of Yoko K. Sen shows… 

More videos: 

http://www.sensound.space

Resonant Beauty


Notes 

(1) https://sz-magazin.sueddeutsche.de/die-loesung-fuer-alles/yoko-sen-interview-88847

(2 ) https://openlibrary.org/books/OL23322076M/Notes_on_nursing

(3) Ulrich R. S., Zimring C., et al., 2008 A Review of the Research Literature on Evidence-based Healthcare Design, in: Health Environments Research and Design. 

(4) The World Health Organization WHO recommends 35 dB for the night in the clinic and 45 dB during the day. An increase of only 10 dB doubles the noise intensity. 

(5) https://www.researchgate.net/publication/7352418_Noise_levels_in_Johns_Hopkins_Hospital

(6) Noise levels:  
– Portable x-ray unit flap:84 to 92 db  
– Suction catheter is torn apart:78 to 80 db 
– Urine bottles rattle loudly and cupboards close:up to 76 db 
– Septic fluid aspirator:more than 59 db 
– Dishwasher:70 db  
In addition, the monitors beep, the refrigerator and the cleaning of the rooms make noise. 
Buxton O. M., Elbow J. M., Wang W., et al 2012 Sleep disruption due to hospital noises: a prospective evacuation, in: Ann Intern Med: 157: 170-9 

(7) Buxton O. M., Elbow J. M., Wang W., et al 2012 Sleep disruption due to hospital noises: a prospective evacuation, in: Ann Intern Med: 157: 170-9 

(8) Stefan Willich, Director of the Institute for Social Medicine, Epidemiology and Health Economics at the Medical Centre Charité Berlin: The research results published in the cardiology journal “European Heart Journal online” in 2006 combine exposure to chronic noise with an increased risk of heart attack. The risk seems to be mainly related to the physiological effects of noise rather than the stress it causes. The results were consistent with the hypothesis that there is a link between long-term noise exposure and the risk of cardiovascular disease. 

(9) Hole J., Hirsch M., Ball E., 2015, Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis, in: The Lancet: 386:10004.  

(10) Sound Masking reduces or eliminates the perception of sound. This technology adds background noise to a room to reduce noise distractions and improve acoustic satisfaction. This improves people’s concentration and productivity. Sound masking is an effective solution for masking intruding noise. It can be used as a noise control solution to mask unwanted sounds such as intermittent noise from machines. 

(11) See for example Xyrichis A., Wynne J., Mackrill J., et al. 2018 Noise pollution in hospitals. BMJ (Clinical research ed.). 363. k4808. 
https://www.montefiore.org/body.cfm?id=1738&action=detail&ref=381
https://www.researchgate.net/publication/329071853_Noise_pollution_in_hospitals
https://www.kcl.ac.uk/news/noise-pollution-in-hospitals-a-rising-problem

(12) http://www.eph-demenz.de/gestaltung-_und_-ausstattung


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Jean Odermatt

Prof. Jean Odermatt is sociologist and interior designer. He is a professor emeritus at Bern the University of the Arts (HKB). His research focus is on how interior design can promote the process of recovery.

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