Peter Cooper, FRPharmS, investigates the therapeutic potential of music
"Music," wrote Ludwig van Beethoven, "is the mediator between the spiritual and the sensual life; although the spirit be not master of that which it creates through music, yet is it blessed in this creation which, like every creation of art, is mightier than the artist." And Johann Sebastian Bach remarked: "The aim and final reason of all music is the glory of God and the recreation of the mind."
Music has been defined as "the fine art concerned with the combination of sound with a view to beauty of form and expression of emotion" or, alternatively, "sounds in melodic or harmonic combination". When it originated in the human story is impossible to determine, but it is considered the most ancient of the arts. Nature, as primitive humans experienced her, was full of sounds of many different kinds, pleasant and unpleasant. There was birdsong, which for any community was inescapable. In all cultures, so far as we can judge, infants were crooned to by their mothers. Songs were, and still are, performed at festivals and ceremonies of all kinds, sometimes with a powerful rhythm and sometimes almost devoid of rhythm. Births and victories over enemies or rivals, or even assemblies of friends and neighbours, have always been celebrated in song and dance.
To add to the richness of the musical experience, to the voice were added the notes and beats of instruments of many shapes and sizes. There is archaeological evidence that our Neanderthaler predecessors made flutes from hollow bones, and stringed lyres or cithers seem to have appeared at an equally early stage in the development of societies. Drum and hand-claps were added to mark the rhythm, and instruments using bowed or percussed strings made music richer by introducing the elements of timbre and touch.
In primitive societies, music was an integral part of religious observances, and thus became regarded as associated with medicine and incantation in the treatment of sickness of body or mind. Deliberate therapy through music was attributed to Orpheus of Thrace in about 1350BC. His singing, accompanying himself on a lyre first of three strings and later of seven, was legendary. His idea was to restore harmony between mankind and the cosmos and so unite living and inorganic matter, an early expression of the holistic philosophy. Among the philosophers of ancient Greece, including Pythagorus, Plato and Aristotle, music was pronounced indispensable for the preservation of mental and bodily health, and to restore health where it had become broken by disease.
According to Aesculapius and Celsus, mental diseases and in particular melancholia, which today we call depression, should be treated with music, and the oriental physicians Rhazes (9th century), Avicenna (10th century), Avenzoar (11th century), Averroës (12th century) and Maimonides (12th century) adopted the ideas of their Greek predecessors. Melody and harmony were closely connected with dance, an activity used to promote emotional crises in the most primitive human societies. Cures of melancholia through music remained a tenet of all advanced ancient civilisations until the Renaissance, and music was believed not only to cure the sick and overcome contagions physical and mental, but to prevent crime. According to Isadore of Seville in the 7th century: "Music moves the feelings and charges the emotions. In battles, moreover, the sound of the trumpet rouses the combatants, and the more furious the trumpeting the more valorous their spirit. Music soothes the mind to endure toil, and the modulation of the voice consoles the weariness of each labour. Music also composes distraught minds."
One intriguing aspect of ancient music was revealed by a research report in 1993 that argues that music in Neanderthal and Neolithic times may have been encouraged by the habit of living in caverns. In the deep decorated caves of the upper palaeolithic period, sound levels are strangely amplified, and it may be significant that in caves whose walls depict horses, bulls, bison and deer the accoustic resonance is higher than in those depicting feline creatures.
The medieval notion that music aroused fury in warriors was not shared by Plutarch, who tells us in his Moralia that "the Spartans use the playing of pipes to remove from their fighting men a spirit of anger, and they sacrifice to the Muses before battle in order that reason may remain constant within them". Thucidides supports this idea, remarking that the pipes were preferred to give signals during a battle because "unlike horns and trumpets, which were apt to rouse and stimulate courage but disorganise concerted movements, pipes calmed the soldiers and restrained any impetuosity which might have disrupted their ranks". Some generals preferred the lyre, which seems a strange instrument for the battlefield. Aulus Gellius recorded that "the Cretans also commonly entered battle with the lyre playing before them and regulating their step". Herodotus mentions that Alyattes, king of Lydia, "had in his army and his battle array orchestras of pipe and lyre players, and even female flute players such as are the delight of wanton banqueters".
Whatever the disagreements of military leaders over the role of different types of music in combat, the physicians are in fair agreement over music's therapeutic potential. At the end of the 17th century, John Aubrey commented: "Physitians say, that Music conduces to the lengthening of life by stirring and reviving the Spirits, holding a Symphony with them; disposes the Maid to Vertue, especially an Organ well touch'd. 'Tis well known that some have such musical eares that they cannot judge of tunes or harmony, nor can learn to sing a tune, tho they are as quick of hearing as any. Some hold, that there is a musical nerve." And long before Aubrey, Plato could maintain: "Musical training is a more potent instrument than any other because rhythm and harmony find their way into the inward places of the soul, on which they mightily fasten, imparting grace and making the soul of him who is rightly educated graceful."
There are arguments over the relative roles of body and mind in determining the observed effect of music. Agnes Savill in 1923 asked herself a question: "Does the beneficent power of music come from the fact that the physical changes which are wrought in the body by the vibrations of sound lead to a healthier and less abnormal functioning of the cells? Or does it evolve from the ideas and high emotions directly produced by the healthier action of the mind?" Certainly music may have different effects on different individuals and at different times. Sir Thomas Browne confessed as much in 1642: "For there is a musicke wherever there is a harmony, order, or proportion . . . for even that vulgar and Taverne Musicke which makes one man merry, another mad, strikes in mee a deepe fit of devotion."
Apart from all considerations of taste and education, we must accept that musical experiences cause changes in blood pressure, pulse rate, respiration, psychogalvanic reflexes and other autonomic functions. An autonomic response may occur even when the sounds are not consciously perceived, as during sleep. We must therefore accept that music has important environmental influences and health implications. The nature and extent of the autonomic response to music depends on the type presented and the attitude of the listener to it. The right cerebral hemisphere is concerned with the recognition of musical pitch, timbre and harmony. Items such as marches and dance music predominantly spark off motor responses, while other types of music may elicit respiratory or cardiovascular responses. The active performance by a musician produces strong autonomic responses in the performer, differing from those in the passive listener in that they cannot deliberately be suppressed. Relaxing music tends to alter pulse rate together with respiratory rhythm. Dance music with a regular rhythm increases the action potential in the muscles of the cranial region and the extremities. Lullabies decrease and marches increase muscle grip in the hands. After doses of tranquillisers, music-induced autonomic responses are almost completely suppressed, but drugs usually do not change the emotional response unless the dose is high enough to diminish the autonomic response.
It is interesting to note that some individuals feel compelled to associate sounds with colours or shapes. This happens particularly with those endowed with artistic, aesthetic and generally sensitive personalities. Colour perception may occur not only with music strictly defined but with non-melodic sounds such as ticking clocks and whistles. Singing voices may arouse visions of green, brown, gold or yellow, contraltos producing violet vision, male voices pink to reddish-brown. Timbre, largely determined by the instrument playing, may affect colour associated with music. Piano, 'cello, harp, violin, flute and oboe have been claimed to generate violet, orange, red, yellow, blue and olive green, respectively. Major chords are characterised by green, blue, pink or red impressions, minor chords tending to be grey or black. Drugs may influence such impressions. Theophile Gautier, after experimenting with hashish, reported hearing notes in terms of green, red, blue and yellow.
However, the therapeutic applications of music have been listed as of five categories: background, contemplative, combined, performing, and creative. Background music has been used in hospital situations, generated by means of radio or television programmes, record players or tapes. The important consideration here is to avoid excessive volume of sound, to permit a background of calm during routine investigative or treatment procedures. Contemplative therapy may be individual or collective, involving sessions of music preceded by information regarding the composer and the work chosen. The choice of works must conform to the mood and individual taste of the patient. Combined therapy calls for a selection of music which agrees with other therapeutic measures. One example uses callisthenics, where a rhythm is matched to the emotional needs of the patient. Another uses hypnosis, where a group of patients suffering from sleep disorders are placed in comfortable surroundings, instructed to close their eyes, and allowed to relax to a melody. During the period of relaxation a therapist promises that the neurotic condition will subside. At the time of awakening, a more cheerful and invigorating musical theme is introduced to stimulate the patient. Music may also be combined with sessions of painting or poetry reading.
Creative music therapy is a form of catharsis. The simplest form is the choral performance, where patients co-operate in making music. A more complex example is the small chamber orchestral group. According to Schipkowenski, a Sofia professor of music, a choral society should be formed in any mental hospital, for the benefit particularly of long-stay patients. Singing strengthens self-confidence and self-evaluation of social worth. Studies in the United States of the use of music to treat psychological or physical disorders have indicated that music therapy helps to build a healthy relationship between patient and therapist, where shared music is the means of communication. It is useful in hospitals, hospices and rehabilitation centres as well as special schools, and is applicable to children and adults of all levels of intelligence, with disabilities of learning, physical functioning or emotional balance. During obstetric delivery, moreover, music stimulates the release of endorphins and reduces the need for analgesic drugs. It distracts from the perception of pain, and relieves anxiety and depression.
It has been reported by workers at the University of Hong Kong that to train a child in musical pursuits and interests improves verbal memory significantly. Adults who had a musical education before the age of 12 years have been found to possess a better memory for the spoken word than those who did not. Moreover, the study of music by children improves their cognitive skills when they come to study mathematics or one of the sciences. This finding has promoted attempts in the US to improve the intelligence of infants by letting them hear taped classical music - the so-called "Mozart effect". Despite claims that exposure to Mozart in infancy improves prowess in mathematics, engineering and chess, no convincing proof has yet been advanced. This effect, if it exists, may be limited to spatial-temporal tasks involving mental imagery and temporal ordering. Explanations that the perceived effect might merely represent a relaxational response to the sensation of pleasure seem unlikely, since the phenomenon has also been observed in rats. It is difficult to imagine that rats derive pleasure from hearing a Mozart sonata, although humans undoubtedly do if they have any musical leanings.
There is a darker side to music. Players of instruments sometimes find that excessive practice brings painful incapacities in its wake. Brass instruments are said to increase baldness in players, and it was once even suggested that people who habitually sit in the front stalls during operatic performances show a higher incidence of baldness than others. Perhaps the idea stems from the fact that some music may make hairs on the back of the neck in some people feel as though they were standing up. Piano playing, on the contrary, has been associated with long hair, witness Liszt and Liberace. Brass players may certainly upset the circulation of blood in their nasopharynx and head region, making them liable to conjunctival haemorrhages, detached retinas and cardiovascular accidents. String players, too, have their problems if they develop cramps and joint pains. Much has been done to minimise such disadvantages by new designs of seats in the orchestra. Performers threatened by disabilities have been greatly helped by the Alexander technique, where specially trained teachers impart an appreciation of the means by which inappropriate muscle tension may be overcome and a proper balance maintained during recitals and practices.
It is helpful to recollect what Heinrich Heine wrote in 1821: "Music is a strange thing. I would almost say it is a miracle. For it stands halfway between thought and phenomenon, between spirit and matter, a sort of nebulous mediator, like and unlike each of the things it mediates - spirit that requires manifestation in time and matter that can do without space. . . . We do not know what music is." And Edward Elgar wrote: "Music is in the air, music is all around us. You have only to reach out and take as much as you need."
Peter Cooper is a freelance pharmaceutical writer. Illustrations by Michaela Stewart