First and Last Breath – notes on a soundscape

by Kate Binnie.

Breathing is the bookend of our lived experience; the first thing we do at the moment of birth is inhale, and the last thing we will ever do at the point of death is exhale/expire. During our lifespan, we develop our own unique breathing pattern and identity, our particular breath-signature that is exquisitely attuned to the fluctuations of our nervous system, which itself has been sculpted by myriad factors from the quality of our earliest relationships to environmental and cultural influences. Breathing is so much more than an autonomic function of the body that starts at birth and stops at death like a mechanical bellows being switched on, then off. It is an exquisitely attuned barometer of our internal landscape that – as meditators and body-mind practitioners know and have understood for millennia – can be utilised as a powerful tool for supporting psychological and physical wellbeing.   

Generally in modern society however, the norm is restricted, shallow, over-fast and inefficient breathing.  Many of us – almost without knowing it – are chronically anxious. We’ve been snatching our breath whilst busy doing other things; we’re out of time and out of breath. Add-in asthma, chronic lung disease, advanced cancers and heart failure and you have a large number of people living with breathing difficulties relying on medical management, with little support for or understanding of how to improve their breath-related wellbeing. This is costly on many levels.  Now add-in a global pandemic where people with breathing problems to start with are the most vulnerable to serious complications from Covid-19 infection, and who continue to be isolated, anxious and at high risk of hospitalisation, long-term problems and mortality.  The pandemic has brought breathing and breathlessness into sharp focus; we dread the arrival of the Covid cough and post-Covid shortness of breath, we fear others’ exhaled breath and airborne infection, we see the ventilators and oxygen masks on TV in intensive care units with a sense of doom.  

In a less obvious way, perhaps, the experience of living through a respiratory pandemic has also brought home to us the preciousness of the free and unconscious breath; something we may have spent so carelessly up to now.  Those of us lucky enough to be able to breathe freely may now be aware that this is an invisible gift, something to treasure and enjoy while we can. We breathe, we are alive!  We might also recognise that the shared or interpersonal breath is a vital yet subtle part of human connection that isn’t quite the same on a screen or phone.  This is a live and pressing topic when care home residents are not allowed to share the intimacy of a loved one’s breath, which cannot be felt through a plastic screen. 

Breath is not only the foundation of our individual lived experience, it is the building block of relational experience. And we miss that now when dancing, laughing, singing, worshipping and shouting together has become a restricted and potentially dangerous activity. 

During my time as a music therapist working in palliative care settings with people towards the end of life (pre-Covid), I found that tuning into and regulating the shared breath-space helped patients who were in pain, breathless and anxious.   By simply noticing my own breath rhythm, depth, timbre and shape, I get a sense of what is happening on a visceral level; what I am feeling, hearing, sensing in the room for the patient and their family who may be distressed and not know what to do, how to be useful.   In a completely non-verbal way, breathing is a way to anchor and hold what Martin Buber [Ich unt Du, 1923] called the “sacred space” – the shared interpersonal space of the dying person and their loved ones.

The depth and effect of just being together, breathing, without “doing” lies in the primacy of co-breathing within our earliest embodied and relational experiences.  When we breathe together, just as the baby does at the mother’s breast, quite naturally we attune to one-another, co-regulating not only our breathing and heart rate, but at the same time our affective experience (emotions). This re-enactment of a deep resonant, pre-verbal experience has enormous power to help people who are frightened feel safe, and when they feel safe, they find their bodily symptoms (the soma) are less urgent. I have seen this time and again clinically in the hospice, and also with both my own parents during the dying phase.  

When my Dad died from cancer in a hospice where I was working in 2016, I was already interested in breathing textures, sounds and rhythms, and their link to affective and relational experience. Around this time, I began working with the Wellcome-funded Life of Breath project (an interdisciplinary project based at the Universities of Durham and Bristol exploring breathing and breathlessness), and was asked by our collaborators at Breathe Oxford to put together something creative about breath for a public event.

This was my first attempt at a soundscape; the idea was to create a ‘breath-voice collage’ to illustrate how I felt about the relationship between breathing and emotion. I started by recording an ‘anchor’ breath, which would act as a metronome throughout the piece. This was the sound of a heartbeat timed to a ‘coherent’ breath at six breaths per minute. This slow, relaxed breath with an equal focus on inhale to exhale is commonly used by meditators and yoga practitioners, and has been shown to help people recover from trauma and anxiety disorders, and to relieve physical and psychological pain.   

I then interwove recordings I had saved on my phone over the years; my children as babies, their sleeping breaths, an old recording of my partner and I singing Silent Night to get our child to sleep (he had to have the same song, in duet, with a ukulele for several years!) I also recorded a patient with chronic obstructive pulmonary disease (COPD) sitting with me in therapy and his words describing how he felt about his breathlessness. Lastly, I used a recording of my father’s sleeping breath during his final days in the hospice where he lay dying with metastatic prostate cancer. During that time, the sound of his breath was extremely important, precious and fragile because I knew it would end. In the liminal phase between life and death I sang to him, first breathing together, then voicing the breath to create a sort of lullaby or – towards the end – a “lullament” (lullaby/lament).  Dad’s childhood was spent in Scotland, and I often found the melodies I sang becoming Celtic folk songs.  The Skye Boat Song was one of his favourites….

This soundscape was created three years before Covid-19 and has lingered on a back-shelf podcast at the University of Oxford since then. In these breath-heightened times, it felt right to give it a new lease of life. I hope if you listen you will – like me – appreciate your own breath and that of those you love.

Listen to the soundscape with headphones for best effect. ***Emotional Trigger Warning – this podcast might provoke feelings of sadness or grief*** 

https://podcasts.ox.ac.uk/kate-binnie-first-and-last-breath-soundscape

Kate Binnie, Music Therapist, yoga and mindfulness teacher, MSc palliative care, senior research associate for the Life of Breath project.  Kate teaches courses on Breath-Body-Mind integration for healthcare professionals. Kate starts her PhD at the Hull York medical school in January 2021 exploring chronic breathlessness and emotion regulation. For more information contact kate.binnie@bristol.ac.uk

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