I recently had the privilege of going to a birthday party for Sam, a man with advanced dementia. His daughter brought a cake with candles. She, the Memory Care Unit staff and I gathered around his table and sang him Happy Birthday. Sam’s face filled with delight and he began to swing his arms in the air like a classical conductor.

“Wait, I want to get him on video,” one of the staff exclaimed. “Can we sing it again?” So we did. Sam’s reaction was no less ecstatic than it had been the first time. “Anyone know it in French?” one of us asked. Sam had grown up in Morocco during colonial times and had spent years in Paris before migrating to the United States. His pleasure seemed not to diminish as a Haitian aide sang “Joyeux anniversare!” “Hebrew?” someone then suggested. Sam had been an observant Jew his whole life. As we sang “Yom huledet sameach” he smiled and conducted, just like the first time.

Just then the music therapist showed up. “Sam, it’s your birthday? Let’s sing!” We sang it again, this time accompanied by the her ukulele.  Sam’s joy was as intense as it had been the first time.

As we sang this fifth version the thought occurred to me that the various Happy Birthdays we were singing comprised a kind of miniature biography. Sam had lived on three continents and, while he could still speak, was fluent in several languages. There’s no proving it, but one can imagine that each linguistic rendition we sang surely illuminated a different chapter of his life.

One person who knows a lot about music and memory is Dan Cohen, the founder of Music and Memory, an organization devoted to the life-giving power of music for people with dementia. I recently had the pleasure of hearing Dan Cohen talk about his project Music and Memory. If you haven’t heard of it, don’t live another second without watching this clip, from the 2014 documentary about his work, Alive Inside: https://www.google.com/search?client=safari&rls=en&q=alive+inside+henry&ie=UTF-8&oe=UTF-8

In 2008, Dan, who is a geriatric social worker with a technology background, decided to see what would happen if he programmed an iPod with the favorite music of a person with dementia. He interviewed the loved ones of residents at four memory care facilities, asking them, “What was the music your mom/dad/ etc loved in their youth? What song did your parents dance to at their wedding, or hum while doing the dishes? On the basis of their answers, Dan uploaded an individualized playlist for each of his residents.

In this movie clip, Dan puts the headphones on Henry, whose dementia has  rendered him unresponsive to the point that he doesn’t remember his own daughter’s name. But when his caregiver puts a pair of headphones on him and plays him some of the music he loves, he becomes animated, even articulate.

Dan reports that when he first started doing this, most health care professionals were skeptical: “People would often dismissively say, ‘Oh that’s nice, Dan. You’re giving the old people music’.”

But research by several independent sources showed that Music and Memory causes measurable improvements in heath outcomes. When people are given an hour of their music in the morning, they become more alert and motile for the rest of the day. Their speech improves. Nutrition improves, balance improves. The listener becomes more agreeable and less combative. Their need for psychotropic drugs decreases. Now, less than ten years after its inception, Music and Memory has become a standard of care for assisted memory care.

In addition to all these measurable benefits are some intangible ones. Music and Memory makes people happier, more connected to the people around them, including their caregivers. In the words of one such provider doing Music and Memory at St Barnabas Hospital in New Jersey: “We’re no longer just shooting for comfort; now we’re shooting for joy.”

It’s worth appreciating the difference between “comfort” and “joy.”  Comfort is the absence of pain and anxiety, something that we might achieve by drugs alone. By contrast, joy is not merely an absence, but a presence in and by itself of positive feelings.

What sort of feelings? Sensual pleasure, delight and fun may all be ingredients of joy. But there’s more to it. It’s the feeling we get when we enter a holiday, or when witness a wedding or another rite of passage. These moments are often pregnant with both our memory of holidays or rites of passage past—“I remember you when you were this high,…and now look at you!”—or maybe of expectation for the future—“Next year, in Jerusalem!” That’s what “Happy Birthday” is: a celebration of the past, a hope for the future (“…and many more!”), and the sweet cake of the present.

Hearing a new song on the radio can bring pleasure. But only hearing an old one can bring true joy: “Honey, they’re playing our song!” Giving a Christian person with dementia some devotional music might bring him comfort. But bringing him Christmas carols, the memory of which lies embedded into the sediment of his childhood mind, evokes joy. Joy is pleasure, plus time. Joy brings a sense of the fullness of time. A sense of having lived, and of being alive.

And Happy Birthday does it for nearly all of us. Even though he’s no longer able to speak, Sam is able to experience time’s fullness with cake and a song. Again and again.