How can the ability to improvise music survive the onset of dementia? On one level, Four Notes is the story of one man’s musical imagination, even as he lives with dementia. But on another level it could reveal more about improvisation’s specific scope for music for wellbeing across different situations.

You are probably familiar with the story behind Four Notes: how improvising on his piano brought an 80 year old man who has dementia to the top of the iTunes and Amazon charts this autumn. Over the years, asking for four notes and improvising on them was a party trick Paul Harvey enjoyed: and it proved to be one he could still pull off. Paul’s son Nick gave his father four notes (F, A, D and B), and his improvisation was played live on BBC Radio 4’s Broadcasting House. The response was so positive that the BBC Philharmonic transcribed and recorded the improvisation, shooting into the charts.
What is immediately striking about the story is that Nick Harvey wanted his father to try improvising because he was struggling to play the compositions he once knew. He would play wrong notes. And as dementia isn’t solely about memory, declining motor skills were also limiting his physical ability to play. So why could improvisation overcome all this?
Was it the freedom and spontaneity which enabled Paul to express himself through those four notes? Liberated from the need to remember or to follow sheet music, maybe he could focus more on sheer sound, mood and imagination. Is improvisation more a question of intuition, a more instinctive way of playing? Maybe it is more connected to emotional memory, known to be a strength for people with dementia. Or maybe there’s a link to attention span and powers of concentration, so that brief spells of improvisation are more viable than sustained playing of a composition.
This could be mirrored by other experiences of people who have dementia. Many people living with these diseases respond to nature, in part because seeing a bird or even a tree is immediate and can also be fleeting or transitory. Many people with dementia struggle to follow a narrative, so that films and books make little sense or fail to hold their attention. Maybe here too, brief, random film sequences or writing could engage them more easily.
When you consider the commitment and memory involved when musicians learn a new piece (if they are truly to absorb and then interpret every nuance and shade) then it is no wonder that dementia might limit their ability to retain all this.
Improvisation is also important because it is far more personal than playing someone else’s composition. For people with dementia, who may be losing spoken or written language, as for people with trauma or other mental health issues, improvisation can create a new way to express mood, emotion or thought. Instead of interpreting another person’s ideas, improvisation allows the performer their own voice. And it may be used by people with no musical experience to enable them to contribute. Paul’s story is different here as he is a trained musician: one for whom improvisation is re-opening doors which dementia might have closed.
As Paddy O’Connell, presenter of Broadcasting House, reflected on Paul’s story in his Radio Times column, “It shines a light on the mysteries of memory and the language of music.” Four Notes highlights dementia’s diverse impacts on musical memory. Even as dementia progresses, many people do remember specific songs or pieces of music, and musical memory can prove more lasting than facial recognition. So there’s space for familiar songs and compositions, but there’s space for experimenting with improvisation as well. Music becomes freedom.
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