INTRODUCTION

Music has come a long way, from being an unorthodox health remedy, to getting recognised as a legitimate form of therapy in medicine. This essay discusses the history of music as a cure in medicine; evolving from a non-scientific concept in Biblical times, through the Middle Ages, to a widely recognised treatment in medicine supported by scientific research. This is achieved by highlighting the effects of music on emotional, mental, and physical health, and by describing how music is used in surgery and in the treatment of cardiovascular diseases, dementia and Parkinson’s disease.

 EARLY BEGINNINGS – MUSIC AS ‘MAGIC FOR THE SOUL’ IN THE AGE OF PHILOSOPHY

Music has always been linked to healing, dating back to pre-scientific times where illnesses and diseases were thought to be caused by evil spirits and supernatural phenomena (1). Music was believed to have magical powers. In Book 1 Samuel of the Bible (630-540 BC), David’s meditative lyre melodies put ‘evil spirits’ in Saul under a hypnotic spell (2), curing attacks of melancholy by expelling spirits out of the body (3). Later, Plato (428-348 BC) deduced that alternative instruments (e.g. stringed) were nowhere as effective as the lyre in treating illness (3), ‘verifying’ David’s instrument choice.

On the other hand, the Greeks viewed music as psychosomatic treatment to achieve balance between body and soul, improving health (3). This was supported by Pythagoras (570-490 BC), who claimed that music cleanses one’s soul and aids catharsis, regenerating the body’s mental natural balance (3). The same concept was supported in Ancient Chinese literature, where music was deemed the essential link for balance between mood, behaviour and the soul (4). This theory was attributed to similarities between music (樂) and medicine’s (藥) Chinese characters, leading the Chinese to believe that their Ancestors used music as treatment.

Although archaeology provides material evidence of instruments being used in antiquity, one can only assume that music had a therapeutic impact on health, as those accounts were not described in scientific detail (2). It is promising that qualitative variations in the propositions stemming from diverse cultures are minimal, this foreshadows the eventual acceptance and further development of theories regarding music and medicine.

 19TH TO 20TH CENTURY – MUSIC AS A ‘BALM FOR WELLNESS’ IN THE AGE OF A SCIENTIFIC QUEST

Advancing to the 19th century, scientific evidence surged after the use of music in medicine grew to become more mainstream practice. This was when music was first formally associated with its medical purpose of healing.

After successfully inducing sleep and alleviating pain and anxiety with soothing music, Frederick Harford was encouraged and founded the Guild of Cecilia (1891), a group of vocalists and instrumentalists (5). The group anonymously performed soft music to patients at Temperance Hospital in London, where a patient was temporarily relieved of pain in her broken leg; another with melancholia spoke for the first time in weeks, and one suffering from violent fits relaxed for the first time (5)(6). This was breakthrough evidence that suggested music was effective as treatment for physical and emotional stress, alongside ‘proper’ medical intervention (5). Scientifically, negative stimuli (pain, tension and fear) are ‘neutralised’ by sensory stimuli of subjectively pleasant melodies entering one’s nervous system, bringing comfort and satisfaction (7).

Moving on from Britain, World War 2 (1939-1945) played a pivotal role in cementing music’s growing role in healing the mentally and physically impaired in America (8). Playing instruments such as the Xylette (miniature piano) was believed to rehabilitate stiffened tendons in soldiers (9). Active participation in music also allowed for self-expression and satisfaction via the release of pent-up emotions, rather than burying emotions into the subconscious strata, improving the well-being and mental health of soldiers (9).

Breakthrough discoveries enabled by the development of medical technology included that the frontal cortex of the brain (responsible for storing memories) was linked to rhythm and melody processing (8). This explained why veteran soldiers could recall pleasant pre-war memories after recognising familiar tunes, which evoked happiness and relaxation.

Additionally, areas of the cerebellum involved in cognition and cortical regions in the Default Mode Network of the brain were identified to play a role in distinguishing timbral features (8). This emphasised again the importance of instrument choice as earlier portrayed in the Bible, supporting that different modes of music induced varied effects on health. It was observed that limbic areas of the brain associated with emotions and the reward system is responsible for the recognition of rhythm and tonality (8). This highlights the importance of employing appropriate music, not only in terms of mood and genre, but also music specifically tailored to individual preferences to maximize benefits of music in medicine.

However, to this day, the true “music centre” of the body linked to music appreciation has not been identified, following the falsification of a traditional claim (it was thought to be in the right hemisphere of the brain) (10). Is it possible that there are different centres, each responsible for stimulating different functions, such as memory and mood? Additionally, does this suggest that current scientific understandings are not reliable sources to base cures and treatments on?

 21ST CENTURY – MUSIC AS A PROVEN MEDICAL TREATMENT IN THE AGE OF SCIENTIFIC AND TECHNOLOGICAL ADVANCEMENTS

Now, music is mainly known for positive impacts and treatment of physical conditions, more specifically, Parkinson’s Disease, dementia, and cardiovascular diseases.

Parkinson’s Disease

Beginning from the time in their mothers’ wombs, babies experience soothing effects of a mother’s soft, rhythmic singing (11). Rhythm in music is vital for rehabilitation of Parkinson’s Disease sufferers, by reinforcing relations between motor and auditory systems (12). This is attributed to areas of the brain like the premotor cortex, supplementary motor area, cerebellum, and basal ganglia, which are responsible for movement, and also overseeing rhythm processing (12). Rhythmic pulses affect the kinetic system and activate the putamen, guiding the body to make movements, and compensating for the possible lack of dopamine activity (12). This results in improved gait, limb coordination, posture, and balance in Parkinson’s sufferers (12).

Dementia

Parkinsonian motor symptoms are also observed in DLM (Dementia with Lewy bodies) sufferers, where music also acts to minimize behavioural and psychological symptoms of dementia (13). Music enhances autobiographical memory, slowing cognitive and functional decline, reduces agitation, depression, irritability, and improves motor functions like swallowing and gait. These findings are attributed to the preserved ability of the brain in dementia to process pitch, timbre, and tonality of music, a result of less degeneration in parts of the brain responsible for music cognition (14)(15).

Cardiovascular disease

Cardiovascular conditions such as chronic heart failure and hypertension often come hand in hand with secondary illnesses including depression and anxiety (16). Music offers psychological relief of stress and anxiety (17), by stimulating regulatory mechanisms of the cardiovascular system (16). Calming tunes evoke respiratory synchronization and activate cardio-protective activity, lowering heart rate16. The accompanying drop in interleukin-6 protein levels further evokes a lower immune inflammatory response (17).

Surgery

Music even positively impacts surgical treatment outcomes. During operations, music played in the background can reduce cardiovascular responses and autonomic reactivity to stress. This promotes concentration and relaxation in surgeons, and even enhances dexterity and intellectual efficiency (16). Similarly, music can reduce anxiety in patients, reducing the need for analgesics to alleviate physical and mental pain, and possibly hastening recovery (17). The act of learning to produce or recognize musical melodies has also been proven to build on the cognitive skills of surgeons (17). This is attributed to the similarities between learning an instrument and operating. When honing one’s skills, one spends a large portion of time scrutinizing the most subtle and ineffable components of sound produced (10). Examples include accuracy in motor performance, hand-eye coordination, intense concentration, low reaction times, and efficient mental rotations (17).

 CONCLUSION

Although society’s understanding of music’s effects on physical, mental, and emotional health has advanced tremendously since pre-scientific days, there is still not a ‘one size fits all’ solution in music’s role in medicine, and there might never be! The auditory cortex is highly complex, and the way it transforms music-encoding neural patterns into auditory sensations, which plays a role in defining one’s personality, determines an individual’s experience with music (16). Since music is simply a psychological phenomenon generated by listeners’ brains, individually differing psychological and physiological mechanisms makes the effectiveness of generalized music therapy extremely subjective (16).

Ultimately, music has been, not incorrectly, recognized as a curative power for medical conditions since antiquity. Claims of music and its effects on the human body put forward in the past likely acted as fundamental sources of knowledge that future research was based on. The minimal disproving of old theories further solidifies the undeniable link between music and its healing properties. Prospective research could encompass detailed investigations into chemical processes of auditory pathways in the brain, which is currently poorly understood. Additionally, research on music and medicine should share standardized methods to enable easy data sharing, sped-up advancements, and mitigation of cultural and regional challenges.

 Bibliography

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2. Amnon Shiloah. Chapter 3. Jewish and Muslim Traditions of Music Therapy. Peregrine Horden. Music as Medicine: The History of Music Therapy since Antiquity. New York. Ashgate Publishing: 2000: 69-83.

3. Cochavit Elefant. An Investigation of Music in Therapy from Biblical Times Until the Beginning of the Middle Ages. Graduate Student Theses, Dissertations, & Professional Papers 1984; 7276: 1-41.

4. Wu, Yue. The Development of Music Therapy in Mainland China. Music Therapy Perspectives 2019; 37: 84-92.

5. Helen Tyler. Chapter 16. The Music Therapy Profession in Modern Britain. Peregrine Horden. Music as Medicine: The History of Music Therapy since Antiquity. Ashgate Publishing: 2000: 375-394.

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7. Frederick Harford. The Guild of St. Cecilia. The British Medical Journal 1891; 714: 2.

8. Vinoo Alluri, Mikko Sams, Enrico Glerean, et al. Large-scale brain networks emerge from dynamic processing of musical timbre, key and rhythm. NeuroImage 2012; 59: 3677-3689.

9. Margaret Rorke. Music and the Wounded of World War 2. Journal of Music Therapy 1996; 33: 189-207.

10. Anthony Komaroff, Anne Fabiny, David Cameron, et al. Music as Medicine: The impact of healing harmonies. Boston. Harvard Medical School. 2015. 1-46.

11. https://www.musictogethernyc.com/vlt12844.htm Accessed 6.10.2020.

12. Alfredo Raglio. Music therapy interventions in Parkinson’s disease: the state-of-the- art. Neurol 2015; 6: 1-4.

13. Julene Johnson, Maggie Chow. Hearing and music in dementia. Handb Clin Neurol 2015; 129: 667–687.

14. Shirlene Moreira, Francis Ricardo, Marcos Moreira. Can musical intervention improve memory in Alzheimer’s patients? Dement Neuropsychol 2018; 12: 133-142

15. Dan Cohen, Stephen Post, Angela Lo, Robin Lombardo, Brandon Pfeffer. “Music & Memory” and improved swallowing in advanced dementia. Dementia. 2018; 0: 1-10.

16. Wolfgang Mastnak. Music Therapy in Cardiovascular Patients. Today’s Geriatric Medicine. 2015; 8: 5

17. Pascal Vouhe. The surgeon and the musician. European Journal of Cardio-thoracic

 Published 31-03-2021

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