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A woman expressively sings with her hands touching her lips.

Exploring the connection between music and mental health

The clubhouse model goes musical.
Filed Under
Written by
Alex Smith
Photography by
Kent Dayton
April 10, 2024
Read Time
6 min

After Joy Chesna retired, she grappled with feelings of loneliness. These became more intense, she says, after old friends died and as her husband’s health problems worsened. The COVID-19 pandemic made things even worse as panic seemed to envelop her community. “I wasn’t frightened of the COVID,” Chesna says, “I was frightened of the fear that was all around me.”

As Chesna’s mental health stress lingered, a friend who knew she enjoys singing wanted to cheer her up and sent Chesna a Zoom link to join a virtual open mic hosted by Tunefoolery. The Boston-area nonprofit organization provides paid musical gigs for people who have experienced mental illness and other mental distress. Not long after that open mic, Chesna, who lives in Boston, joined the musicians’ organization, and today the 76-year-old sings regularly as part of Tunefoolery’s roster, bringing Broadway showtunes, old Cole Porter standards, and tangos to places like nursing homes and hospitals.

She loves when her audiences join in on the choruses of her favorite musicals. And Chesna says Tunefoolery helped her overcome her loneliness. She’s even fulfilled a long-dormant dream of performing with an accordion accompanist. “The big dream was to sing with an accordion on the streets of Paris,” she says with a laugh. “I got the accordion. Maybe later, Paris?”

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About 150 musicians have been part of Tunefoolery, which turns 30 this year. It was originally developed in line with the clubhouse model, which uses a psychosocial rehabilitation approach to help individuals regain a place in their community. In the clubhouse model, participants are referred to as “members;” provided with paid work opportunities, and have free use of a drop-in center. The approach creates “a therapeutic environment” where people who join are valued club members, says Francesca Pernice, a psychologist at Wayne State University who studies the clubhouse model.

Research has shown clubhouse participants have lower rates of rehospitalization and report higher quality of life and better social relationships.

But clubhouses are challenging to operate, despite their track record, because they don’t fit easily in the fee-for-service payment model. Tunefoolery stopped being part of a clubhouse in 2008, when it had to move after state budget cuts caused the closure of its original home, the Cambridge-Somerville Social Club.

Pernice says Tunefoolery’s continued success suggests there is opportunity to adapt the clubhouse model “to innovate and change some systems of care.” The organization found a new home at the Boston University Medical Campus, with rehearsal space, offices, and a recording studio. Tunefoolery hosts community open mic events there, too, though most of its performances take place elsewhere in Greater Boston; the group even provides transportation for some musicians to get to the shows.

It still follows some of the clubhouse model’s practices—clubhouse facilities often provide employment to members who serve as organizers or cleaning staff, and Tunefoolery pays for musical gigs, through individual donations, grants, and performance fees. Participants are not called “patients” to reduce stigma; Tunefoolery members are simply musicians. “When musicians join the organization, they are comfortable with their identity as a musician in mental health recovery, but we do not ask people their medical histories,” says Linda Chin, Tunefoolery’s creative director. “It’s not a requirement, nor something that I know, as a director.”

Musicians looking to join Tunefoolery are screened, however, to ensure they are a good fit for the organization. There are roughly 25 active musicians on its roster; they are well past the beginning stages of recovery and have achieved the stability needed to perform. Musicians, who can range in skill level from amateur to professional, audition to demonstrate their aptitude.

Harrison Huang says playing the organization’s gigs provides benefits he wouldn’t get in more conventional performances. Huang is a senior at Middlesex School, a private college preparatory school in Concord, Massachusetts, and also a pianist with a fondness for Romantic composers like Franz Liszt. He learned about Tunefoolery when researching the intersection of music and mental health, looking for inspiration for a friend suffering from some mental health challenges. He invited Tunefoolery performers to visit his school last spring, and then he worked as a summer intern for the group.

He is a Tunefoolery supporter rather than a member, but his connection has also helped him cope with academic pressure since, as a boarding student from Nanjing, China, he has no family nearby. Huang says he felt overwhelmed at first with the adjustment of living in the U.S. Playing with other Tunefoolery musicians, he explains, has been particularly helpful. He says playing music together with others “is a really amazing experience—establishing that connection, working together, and seeing how we are taking that stress off our lives at the same time.”

Hear Harrison Huang perform “Hungarian Rhapsody #2” by Franz Liszt:

Chin has been encouraging more musical collaborations and even the creation of ensembles among Tunefoolery performers. She says that watching the musicians perform for audiences who are currently being treated for mental illness has been gratifying to witness. “That, in itself, is extraordinary,” Chin says. “That they have the courage and the resilience to go back and give these gifts back to other individuals that are struggling.”

For Tunefoolery musician Lou Mace Binswanger, who goes by the name “Lou Mace,” those kinds of performance have been especially meaningful.

At age 20, Lou Mace began experiencing manic episodes that led to a bipolar diagnosis and some intensive in-patient treatment. Lou Mace, who identifies as nonbinary and uses they/them pronouns, recalls feeling overwhelmed by the barrage of doctors and specialized care they encountered. They say that during their recovery, they longed for someone who could relate to what they were going through.

“I feel like the phrase that I wanted to hear the most was just ‘me too,’ or ‘I understand,’ or ‘I’ve experienced the same thing,’” they recall. “And that’s not something that I heard until I started connecting with others, through the people I met in treatment and through Tunefoolery.”

Hear Lou Mace perform “The Wolves,” an original song:

Today, five years later, Lou Mace is in a better place mentally. They live in Boston’s Allston neighborhood and work as a peer support counselor. Since joining Tunefoolery, they have also been writing original rock and folk songs, many of which express the frustrations and misunderstandings that they have experienced living with and being treated for mental illness. They say performing these songs for audiences in psychiatric wards has been particularly rewarding.

“I do feel inherently connected to the people that I’m performing for in a hospital because I know exactly what it’s like to be there,” they say. “It’s nice to feel that I can be entertaining but that I could also be healing.”

Top image: Joy Chesna performs with Tunefoolery recently in Boston.

Filed Under
Alex Smith
Alex Smith is a healthcare journalist whose work has appeared in outlets across the country, including The Washington Post, The Guardian, and numerous daily papers.
Kent Dayton
Kent Dayton is the senior photo editor and staff photographer at Harvard Public Health.

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