How music is used to heal the sick in Appalachia

Rodney Harmon of Floyd County, Virginia, has been flatfooting for 60 years, but never had he danced in a health clinic. He can thank Joe Smiddy for the pleasure.

Smiddy, an allegedly “retired” pulmonologist, is the volunteer medical director of the Health Wagon, a nonprofit that provides care to those in the region most in need. On a mild Saturday in September, Harmon is among patients who’ve traveled to the Remote Area Medical (RAM) pop-up clinic in the rural southwest Virginia town of Jonesville to take advantage of free healthcare services, those offered by Smiddy and the Health Wagon among them.

The queue for care began forming outside Lee High School in the wee hours. Folks now wait patiently, quietly, in the gymnasium. Smiddy, taking a break from pulmonary screenings, straps on his banjo. Dressed casually, as is his custom, he steps out on the gym floor and becomes a wandering troubadour. Approaching a woman, he asks, “Now, what town are you from?... Oh, I know your folks.” Together they sing “Amazing Grace,” “how sweet the sound.”

For another, he serenades with a few verses of “I’ll Fly Away.”

Some glad morning when this life is over
I'll fly away
To a home on God's celestial shore
I'll fly away

Then comes another favorite, “I Saw the Light.”

No more darkness, no more night
Now I'm so happy, no sorrow in sight
Praise the Lord, I saw the light

Harmon dances to “Rocky Top,” giving it his all. Winded, and much obliged for the music and care, he heads home.

Son of a legend

Smiddy is the son of the late Papa Joe Smiddy, a university chancellor, Appalachian music preservationist, and banjo player—a legend. Dr. Smiddy has played music all his life; it would make no sense to him not to incorporate it into the healthcare he administers.

The free medical, dental, and vision care services are what folks have come for, but Smiddy sees further opportunity.

These mountains of southwest Virginia and eastern Tennessee are home to a rich musical tradition shaped by the ballads and fiddle music of the British Isles, the banjo (an African instrument), hymns, the blues, and a smattering of other influences. It’s expressed in old time, bluegrass, country, gospel—the borders of genre are often indistinct.

The more traditional music is channeled through flatfooting, a dance style in which the feet stay close to the ground, as well as clogging, a full-body, high-stepping affair. Everyone in these parts was brought up dancing, or so it seems. Harmon judders, beckoning a muscle memory. He’s no more self-conscious dancing in a health clinic than he would be at home. It’s encoded in his being.

The RAM clinic is a welcome sight. This region faces some significant healthcare challenges. The four westernmost counties of Virginia–Buchanon, Dickenson, Lee, and Wise–all rank near the bottom in the state in health outcomes, including higher instances of asthma, COPD, and emphysema. Black lung disease remains prevalent; most alarmingly, an advanced stage, progressive massive fibrosis appears to be on the rise.

Smiddy is well aware that health outcomes are shaped by where you work, where you live, how you live, and your access to services and healthy food–the social determinants of health. When not in his office, he’s usually out on the region’s serpentine mountain roads, piloting his mobile X-ray unit, with which he also brings music.

For Smiddy, a song is a potential connection, one that allows him to gain insight into what’s brought this person to this moment of need.

“The connection starts when I say, “What’s your favorite song?” he explains. “Gospel, folk, bluegrass, whatever … in this neck of the woods, everybody’s got one.”

“Often they’ll say, ‘My mother’s favorite was …’ and we’re instant brothers and sisters.”

Music works in both magical and clinically substantiated ways. Music therapy is an evidence-based practice. Certified therapists earn degrees from one of more than 80 college and university programs approved by the American Music Therapy Association.

Smiddy isn’t a music therapist, but what he shares with its practitioners is a belief in the power of music to open doors. And he employs it in his work: “Music is a bond. A bond is trust. Trust in medicine starts a plan.”

Randy Wykoff, dean of East Tennessee State University’s College of Public Health and a mandolin player, is a believer in the medicinal qualities of music. As acceptance of the social determinants of health gains traction, Wykoff says, “we're also more willing to recognize that there are things like music and art that contribute to your well-being.”

Most fundamentally, Smiddy says, sharing a song offers a measure of human kindness. And that’s quality healthcare.

A reassuring space

Lollie Saria has been struggling with a heroin addiction for almost a decade. She now lives in Roanoke, Virginia, having relocated from West Virginia. “I tried to move away from it,” she says. “But then fentanyl became really predominant in this area, and I've been struggling with that.” She hasn’t used the drugs in more than three months.

Saria’s path to recovery entails regular visits with Jim Borling, a music therapist. He’s a professor emeritus of music and former director of music therapy at Radford University who practices the Bonny Method of guided imagery and music. These sessions offer Saria shelter.

The American Music Therapy Association defines music therapy as the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship. The settings in which its practiced span the life cycle, from neonatal ICU to hospice. Among the most common clinical populations served are children with developmental disabilities, adults with behavioral health issues, including substance misuse, and those suffering from dementia.

Noel Anderson is founder of Anderson Music Therapy in Roanoke, a practice specializing in care for children, commonly those with autism, Down syndrome, cerebral palsy, or attention deficit hyperactivity disorder (ADHD). She and her therapists work with kids to improve their cognition or executive-functioning skills.

“When we hear music, we’re instantly drawn toward it,” Anderson says. “It lights up our brain in so many areas.”

Music is predictable, she says, and that can be comforting. “There’s the verse, chorus, verse, maybe a bridge …” The pattern facilitates a sense of relief that can reduce anxiety.

The kids are encouraged to sing. We all need to be seen and heard, Anderson affirms, and to know there’s a place we belong. Music is a reassuring space.

Borling works primarily with clients confronting substance-use disorders and trauma. The Bonny Method, he says, is “highly experiential.” Success in his work with clients with a substance issue is dependent on their willingness to go beyond the physical challenge, to delve into potential emotional and spiritual issues.

Saria says her sessions with Borling improve her cognitive functioning and serve as a coping mechanism. They help her relax, and thereby reduce the triggers to relapse.

She lies on a futon, covered by a blanket. Borling encourages her to focus on her breathing, to turn inward, “quiet in body, quiet in mind.”

“As you anticipate the music, call to mind an image of a path–a path that you may see with some detail or simply sense in some other way.” The music, classical, begins, and builds. “Allow this music now to call you in to explore.”

Saria describes a calming sensation. Her path leads her to a pond, surrounded by animals. She’s drawn toward them; she feels safe. “Take the music right into that safe space,” Borling urges.

“This feels empowering,” Saria says softly.

At the end of the session, Saria acknowledges her need for healthy human connections. “That feeds my spirit,” she says. “I don’t prefer to be isolated.” But she’s striving to feel safe and content when alone.

“Which is an important shift for us as we step into a life of recovery,” Borling says.

A few songs and some memories

On a Thursday afternoon in October, Smiddy and his mobile pulmonary unit are in Bristol, Tennessee, parked outside Healing Hands, a health clinic that offers services to the region’s uninsured. He’s provided free screenings to a steady stream of patients today. Emily Orr of Johnson City is the last of them.

Oh, so soon, and very soon,

We are going to see the King

“We’re pleased to catch up with you,” Smiddy tells Orr, thanking her for coming while he uncases his guitar. Breanna Burke, a community health worker joins him in singing “Soon and Very Soon,” an Andrae Crouch gospel hymn.

Twenty-four hours later, 20 miles to the northeast, in Abingdon, Virginia, a banjo picker is making house calls. Mark Handy is a family physician, cattle farmer, country store owner, five-time national flatfooting champion, and, says 91-year-old Levonda McDaniel, a “precious person.” McDaniel is a resident of Commonwealth Senior Living, where Handy has several patients.

“Tell me where it hurts at, baby,” Handy asks, gently examining an injury to McDaniel’s leg. He checks her vital signs. They discuss other ailments and potential issues. Once finished, he picks up his banjo and composes a song in the moment about Poor Valley, where McDaniel was raised.

The music puts McDaniel in mind of her youth. “I fell in love with an Arthur Murray dance instructor, and I learned to dance. Then I fell in love with him,” she adds, nodding toward Handy–a pushover for a music man.

Handy shares a few songs out front for a dozen or so residents, then it’s back in the truck and on to the home of Priscilla Borders, 68, who lights up upon his arrival. These visits mean so much to her. Borders once loved to dance: “Just crazy dancin’ up off the floor. Movin’ with the beat.” She laments those days are over. “If I still could,” she contends, Handy would “be in trouble.” She’d dance him till he dropped.

The next patient is Joni Foster, 84, still grieving the death of her husband, Jim. She hums along with “God Gave Noah the Rainbow Sign.”

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I've got a home in that rock
Just beyond the mountaintop
Hide me over, Rock of Ages, cleft for me

Her husband was a deeply religious man. After Parkinson’s disease had taken hold, Handy would sit by his side for a few extra moments.

“You have no idea how blessed we’ve been to have this doctor,” Foster says.

It’s then a half-hour drive up Poor Valley into Saltville to look in on Cammy Frye.

Frye, 53, has Down syndrome. She’s been watching “Golden Girls,” of which she’s a huge fan. Handy tries to cajole her into naming her favorite. “Do you like Blanche? Sophia? Rose?” Frye parries the sacrilege, refusing to choose just one.

With the examination complete, a prescription ordered, it’s song time. Together they sing “(Give Me That) Old Time Religion,” and a couple other standards. But it’s “Will the Circle Be Unbroken” that truly moves Frye, her voice rising.

Will the circle be unbroken
By and by, Lord, by and by
There's a better home a-waiting
In the sky, Lord, in the sky

“I did it!” she shouts, elated with her vocal accompaniment. “Oh, golly!”

A lifeline

On this day, Frye is Handy’s final call. It’s after 5 p.m. A light rain begins to fall. These drives along Hayter’s Gap Road and countless other two-lanes nourish Handy’s soul. He treasures his visits to the homes up in the hills and hollows. Across four Virginia counties and two more just over the North Carolina line, there’s hardly a road on which he hasn’t made a house call.

Back at the office, there’s paperwork to do, then the 80-mile drive back to his farm in the Ennice community of North Carolina’s Alleghany County.

The following night, his band, Tune Town Old Time String Band, takes the stage at the Carter Family Fold, in nearby Hiltons, Virginia. The venue is run by Rita Forrester, Handy’s dear friend and granddaughter of Sarah and A.P. Carter, who, along with Sarah’s cousin Maybelle (often called the Mother of Country Music), comprised the original Carter Family band.

When the spirit summons, Handy drops his banjo and does a little flatfooting. This audience spans at least four generations, but the most spirited, and best, on the dance floor are, almost exclusively, the eldest. Some have arrived with partners, some have not.

Handy’s mom, Peggy, takes in the scene with considerable relish. “Look at her,” she offers, with a nod toward a fancy dancer. “Grinnin’ like a mule eatin’ briars.”

This is old time music. It resonates to the core of those who were raised on it.

“For a lot of the elderly community, I think it really is their lifeline,” says Dylan Locke, who, with his wife, Heather Krantz, owns and operates the Floyd Country Store in Floyd, Virginia, another iconic Appalachian music venue.

But that resonance is infectious. Old time music is alive and well. The Floyd Country Store has held a weekly Friday Night Jamboree for going on 40 years (though not through the depths of the pandemic). It also hosts a Sunday Music Jam.

Allison Hello, 36, is a regular at these sessions. On a recent Sunday, she hops in and out of the dance circle rimmed by a score of musicians playing a variety of instruments. “There’s something that happens, and nobody knows what it is,” she says, pausing to survey the scene. “But it’s super addictive.”

Randy O’Dell is another regular. He’s been attending these sessions for more than a quarter century. His wife, Eloise, passed away from Alzheimer’s in April 2019. For years, they danced here together. These gatherings are now his refuge. “When you’re doing this, you forget your troubles. I forget that I'm gonna go home to nobody,” O’Dell says. “This music has done for me what nothing else could.”

Keith Alessi plays banjo in this Sunday’s circle. In 2015, he had a successful career in business and a world-class banjo collection, none of which he could play. In need of change, he quit his job. Two weeks later, he learned he had esophageal cancer, with a 50/50 chance of living another year.

Alessi’s journey has brought him “to this circle, where I not only learned to play, but I found the healing power of the arts, the healing power of music.”

He now has an award-winning one-man show, “Tomatoes Tried to Kill Me But Banjos Saved My Life,” that he’s performed across the U.S. and Canada, including at the Soho Playhouse’s Fringe Encore Series, and that’s raised nearly a half-million dollars for cancer and music charities.

“This place is like a temple,” Alessi says of the Floyd Country Store. “I found healing here, emotional healing, and that, of course, involves physical healing.”

The desire to heal

Music reaches deep. Research indicates it can assist in lifting traumatic brain-injury patients out of a coma.

Earl White is a retired respiratory therapist and a fiddler. He recalls playing for a man who was on a ventilator, heavily sedated, incommunicative. As White played, a tear rolled down the man’s cheek. He survived and later told White that the music had inspired him to keep fighting, to live.

Music is there, ineffable, a soothing salve. It’s the spirit rising in Frye as she embraces “Will the Circle Be Unbroken,” embodies it, and is lifted by it–rapturous: “I did it!”

On the evening of the day Smiddy played “Rocky Top” for Harmon, he convenes with an informal band at Shades of Grace, a storefront church in downtown Kingsport that reaches out to the “Last, Least, Lonely and Lost.” Some among the musicians have experienced homelessness, addiction, trauma. A set of gospel numbers offers rich release.

During a service here, or when providing free medical care, Smiddy might say, “Raise your hand if you play piano.” Or, “Raise your hand if you play guitar.”

He’s then made a connection, and will ask, “Could we give you a COVID vaccine? How can we help you? What do you need?” The portal has opened.

These and other such moments of shared music endure. “It happens all the time,” Smiddy says. Someone will “remember the encounter and the song, and years later they’ll stop me on the street and say, ‘You sang my favorite song.’”

Magical and medicinal, music is an elixir. Two hours to the east of Kingsport, just across the North Carolina line, Handy gathers family and neighbors at his country store in Ennice for Saturday evenings of live music and dance. Young and old hit the dance floor; elders rule.

One of Handy’s grandmas died at 104, a great-grandpa at 106. It’s customary in his family to live well into your 90s. Handy speculates on why: unprocessed foods, healthy habits–certainly valid reasons. Then, too, there’s music in the air.

Does music truly have the capacity to heal?

“Music allows us to tap into that innate desire to grow that is already within us, that desire to move toward wholeness, that desire to heal,” says Borling, the music therapist.

“Music gives us a way to explore our feelings and get them out of our body,” Anderson, his colleague, asserts. “We can make feelings less abstract by putting them into a tangible medium.” The music can then be shared with others, “helping us realize that we’re not alone. That experience of belonging, support, and emotional release through music is healing.”