Why You Love Music: From Mozart to Metallica-The Emotional Power of Beautiful Sounds - John Powell (2016)
Chapter 5. Music as Medicine
Modern music therapy began as a simple attempt to cheer up American soldiers who had been wounded or traumatized in World War II by holding concerts in veterans’ hospitals. The medical staff soon noticed that the music seemed to be having a surprisingly positive effect on the physical and mental condition of the patients, so hospitals began hiring musicians to give their patients more regular exposure to music. Eventually everyone realized that the positive effects would be further enhanced if the musicians were trained as therapists, and so the first music therapy degree course was started in 1944.
The aim of music therapy is to use our subconscious responses to music to assist our recovery from a medical or psychological condition. Over the past few decades music therapy has been found to be effective in a wide range of applications. Here are a few examples of how it works.
Music therapy for depression and stress
One of the big problems with being depressed is that you’re too depressed to see any way out of your depression. Depression creates a vicious cycle: negative thoughts generate negative moods, which encourage negative thoughts, which generate negative moods, which generate…
Music has the power to break this cycle. This is not just happy-clappy mumbo-jumbo. Listening to pleasant music causes your serotonin and dopamine levels to rise, resulting in a genuine, positive mood change.1 It’s been found that music even generates increased levels of dopamine in stressed rats.
Once a mood change has been achieved, depressed patients are more receptive to positive thoughts and guidance to help them maintain a more positive view of themselves and the world around them.2 I suspect this is even true of the rats—but I’m not sure we want rats with a well-balanced worldview.
Depression is often linked to stress, so psychologist Suzanne Hanser decided to see if music-related activities could reduce stress and thereby reduce depression.3 She contacted thirty elderly people who were suffering from depression and, after getting them to agree not to take any antidepressant drugs for the duration of the eight-week test, divided them into three groups of ten.
The first group underwent personal training (at home, one hour a week for eight weeks) in music-related stress-reduction techniques, including movement to music, relaxation to music, using music to become energized, and using music to induce visual imagery. This group chose their own music for these exercises.
The second group received a diluted version of the first group’s treatment. They were given written instructions on what to do and suggestions of what music to use. They also got a phone call once a week from Suzanne in order to deal with any questions and to give them advice.
The third group got nothing—just the promise that they would be able to begin the therapy at the end of the eight weeks. “Pah!” they must have thought. “… Typical!”
All three groups were tested for depression and stress levels at the beginning and end of the eight-week period, and the results were impressive. All three groups had been (mildly) clinically depressed and stressed at the beginning of the period, and the group who had no therapy were in much the same state at the end. The two music therapy groups, by contrast, had improved so much that their depression and anxiety scores were closer to those of non-depressed people than to their own previous scores. What’s more, the improvement was long-lasting. Nine months later the depression/anxiety states of the music therapy groups hadn’t changed much, and some people were still improving.
For one of the subjects the music therapy was particularly successful because the music itself was important. Judy was sixty-nine years old when the study began, and having a dreadful time dealing with the recent death of her husband, Bernard. Bernard had been a clarinet player who loved big band music. Suzanne Hanser suggested that Judy use Bernard’s old big band records as her therapeutic music, and within a week there was a marked change in Judy’s attitude toward life. Nine months after the experiment, Judy wrote to Suzanne:
Before I took out all those records, I spent every day thinking that I would never see my husband again. I loved him so much. I couldn’t bear to be without him. But now, when I put on his music, it feels like he is with me. I think about all the great times we had and how much we shared. I love the records and I love listening to his records. Thank you for giving me back my husband.4
I think you’ll agree that this is pretty much an unbeatable result.
Music therapy and pain
Considering how widespread it is and how unpleasant it can be, we know surprisingly little about pain. Pain is not a thing—it’s a perception. The same injury can cause vastly different levels of pain in different people depending on a number of factors, including how busy they are and what mood they are in. If you stub your toe during a relaxed Sunday afternoon, you might feel a lot of pain. If you do the same thing as you are running to stop a small child from walking in front of a bus, you might not notice the pain at all.
Fortunately, because pain is a perception—a feeling—rather than something more concrete, music can help to minimize it. Music, as we’ve seen, can reduce stress, relax you, improve your mood, and focus your attention—all factors that can help reduce the pain you feel. In addition, the fact that your brain is having to process the music is a distractor—like seeing a child in danger—which interferes with the “Bloody hell! That hurts!” signal.5 Music has been found to be very useful in dealing with temporary pain such as dental treatment and headaches, particularly if the patient chooses the music and controls how loud it is. Interestingly, the music works best if the patient has been told that it will reduce the pain. If patients believe that they have some control over a method of pain reduction, the belief itself helps to reduce the pain.6
One study of the effects of music on pain involved asking volunteers to keep their hands in very cold water for as long as they could stand. Participants who chose their own music could keep their hands in the cold water for longer than people who listened to white noise or random relaxation music. Once more it seems that choosing the music made the volunteers feel more in control of the situation and this helped them cope with the pain for a longer time. Women who performed this test after choosing their own music not only coped longer with the pain but also felt that the pain was less intense; men coped longer but felt the same intensity.7
Music and speech therapy
When I was a child I had a guilty secret. (Now that I’m in my fifties I probably have several guilty secrets, but my memory is so bad I can’t remember them. Hurrah!) When I was nine years old, my secret was this: although I was an avid reader and therefore knew all the letters in the alphabet, I didn’t know what order the letters were in. I knew as far as A, B, C, D, E. But after that it was all a bit vague. Did M come before Q? Where did T fit in? I can’t say I lost much sleep over it, but it did trouble me that everybody else seemed to know. Then, when I was ten, someone sang an alphabet song to me, and I could remember the whole thing after about a dozen repetitions. The world took on a new luster; doors of opportunity opened up before me: I could even become a librarian when I grew up if I wanted to. I still rely on that alphabet song to this day. (It’s not the one most people know. It must be some sort of Manchester 1960s hybrid.) I don’t know if you have to do this, but if I’m looking through an index of any sort, I have to sing a bit of the song under my breath. If I want to know exactly what letter comes after L, I have to sing a full musical phrase from the song—“IJKLM.” So I don’t have a “proper” memory of the letters of the alphabet; I just know a song that can deliver the information on request.
Tunes are very handy for this kind of rote learning. It’s quite easy, for example, to teach kids to sing a song in a foreign language. As long as there is a melody involved, they can be trained to pronounce the words accurately even though they haven’t a clue what they are singing about. I’m sure many of you will remember singing “Frère Jacques” at school. You can probably still sing it, but I wonder how many of us kids knew what “Sonnez les matines” meant?* I think I was in my thirties before I found out. But it didn’t matter. At the age of six I could still pronounce fourteen seconds’ worth of understandable French words—which were just random sounds as far as I was concerned. This sort of memory feat would be incredibly difficult without the assistance of a tune.
This musical memory trick can be used to help some patients who lose the ability to speak as a result of a stroke or brain damage. In his excellent book Musicophilia, Oliver Sacks tells the story of a patient, Samuel S., who had been left totally without speech as the result of a stroke.8 Although he understood what other people were saying, Samuel could not pronounce a single word, even after two years of speech therapy. His brain simply didn’t know how to make his vocal equipment produce words anymore.
The situation was considered hopeless, but one day a music therapist overheard him singing a fragment of the song “Ol’ Man River.” Samuel still couldn’t speak, and he could sing only a couple of words, but it was a start. The music therapist began regular singing lessons with him, and soon he could sing all the words of “Ol’ Man River” and lots of other songs he had learned when he was younger. The singing kick-started his speaking abilities, and within a couple of months he could produce appropriate, though short, responses to questions. For example, if someone asked him how his weekend had gone, he could reply, “Had a great time” or “Saw the kids.” Music has been helpful in this way for a lot of patients for whom standard speech therapy didn’t work.
Music therapy, blood pressure, and heart attacks
Coronary heart disease is the most common cause of death in a lot of countries, including the United States and the UK. What generally happens is that prolonged stress causes a long-term increase in blood pressure, called hypertension, which often results in heart disease, heart attacks, and strokes. Experiments have shown that music therapy (music with relaxation/imagery exercises), combined with standard patient support, produces noticeable improvements in blood pressure, anxiety levels, and general well-being. As Suzanne Hanser puts it:
Individuals with cardiac conditions were able to take charge over the stress in their lives when they learned to recognize how music changed their heart rate and blood pressure.9
Biofeedback devices, which monitor your blood pressure and pulse rate, can be very useful in this context. You can put some of your favorite relaxing music on the stereo and watch your pulse rate and blood pressure fall, and train yourself to relax.
Music therapy and Parkinson’s disease
One of the main symptoms of Parkinson’s disease is that your physical movement becomes jerky, rather like a verbal stutter. It’s well known that people who have a verbal stutter generally lose it if they sing their words, but music can also eliminate or reduce Parkinsonian movement stutter. In the words of Oliver Sacks:
Parkinsonian stutter can respond beautifully to the rhythm and flow of music, as long as the music is of the “right” kind—and the right kind is unique for every patient.10
The “right” kind of music often needs to have a well-defined beat, but if the beat is too dominant, the patients can become enslaved and locked into it. The helpful effect of the music usually ends as soon as the music stops, so the modern proliferation of portable music players has been a great help to a lot of Parkinson’s sufferers.
Music, general well-being, and sleep
Music lowers stress levels, and this can have a positive effect on your entire immune system. For example, several studies have shown that music improves the level of the antibody immunoglobulin A in your saliva, which is a direct measure of the ability of your respiratory system to fight off infection.11 Psychologist Shabbir Rana has also found a direct link between the number of hours people spend listening to music and their scores on the General Health Questionnaire,* which is a test of your psychological well-being.12
And there is good news for a lot of those people who have trouble sleeping. As most of us know, getting a decent amount of high-quality sleep is extremely important to your quality of life. Sleep disorders can lead to fatigue, anxiety, depression, and poor daytime performance in both physical and mental tasks. Drugs can help, but they can also have negative effects on your daily life. Fortunately researchers have found that simply playing relaxing music at bedtime can alleviate sleep disorders for many people. Relaxing music reduces the amount of the stress hormone noradrenaline in your system, thereby reducing your level of vigilance and arousal and allowing you to sleep better.
If you’re a scientist working in the area of sleep problems and you need a reliable measure of how badly people sleep, you need look no further than… Pittsburgh. The Pittsburgh Sleep Quality Index (PSQI) is a four-page questionnaire about your sleeping patterns that gives you a score telling you how good a sleeper you are. If your score is lower than five, then you are a normal sleeper. (If you score one or less, you might actually be dead.)
Armed with the PSQI, psychologist Laszlo Harmat and his colleagues gathered together ninety-four students with sleeping problems and divided them up into three groups. The students were all between nineteen and twenty-eight years old. Before the tests began, all the subjects completed the PSQI questionnaire, and on average they scored six and a half: they were all poor sleepers. One group was given relaxing classical music to listen to at bedtime, a second group was supplied with an audio book, and the third group received nothing. Those with the music or audiobooks were asked to play them every night for forty-five minutes just before they went to bed.
After three weeks of bedtime listening, the average score in the music listening group dropped to just over three: they were now good sleepers—or at least most of them were. Of the thirty-five people in this group, thirty of them became good sleepers and the other five remained poor sleepers. Listening to audiobooks helped far fewer people: only nine out of thirty became good sleepers. The same students were rated as to how depressed they were before and after the three-week test. The depressive symptoms of the music-listening group decreased substantially during the test, but the audiobooks didn’t have the same effect.13
Music doesn’t just help young people, though; it also helps older people sleep better. In 2003 researchers Hui-Ling Lai and Marion Good carried out a similar study on people aged between sixty and eighty-three years old.14For this group the PSQI questionnaire revealed an average score of over ten: they were very bad sleepers.* The researchers handed out music tapes that were forty-five minutes long and asked the participants to listen to them after they had gotten into bed. (It normally takes an adult between thirteen and thirty-five minutes to drop off to sleep.) Once again, the bedtime music worked its magic, although this time on a smaller proportion of the people involved (possibly because the sleeping problems of this older group were more deeply embedded). Half of the music-listening group dropped below a PSQI rating of five and became good sleepers.
If you want to try relaxing bedtime music for yourself, you’ll find that there are plenty of “the most relaxing classical/jazz/blues music in the world/galaxy/universe” albums available, and of course you can also make up your own playlists. When you play them, it’s important to get the volume just right: too low and it’s irritating, too loud and you can’t sleep. And make sure that the final piece is one that fades out; otherwise you’ll be woken by the sudden silence. (One of our natural reflexes is to go on guard if it suddenly gets quiet.) Also, if, after a couple of months, you get bored to tears with “Air on the G String” and “Für Elise,” you could always do what I do and play albums of lute music.*
Music therapy: the future
The evidence is pretty overwhelming that listening to music you enjoy is good for you if you have either a physical or a mental disorder of any sort. The choice of music is important and, as we’ve seen, the patient must do the choosing. But what if you are suddenly struck down by a medical condition that prevents you from making choices?
This worry has led to the invention of the Advance Music Directive,15 also known as the “music living will.” With the assistance of a music therapist, you create playlists to be stored by someone you trust. Then, if anything dreadful happens to you, the appropriate playlist (calming, energizing, etc.) will be played to assist your recovery.
All this reminds me of a conversation I sometimes have with my friends in which we discuss the music we want to be played at our funerals.* The only difference is that the sickness playlists are much longer, and you have to be much more careful about your choices. You don’t want to be lying in a coma thinking “Oh no!—not ‘Seasons in the Sun’ again!”
So if you have a beloved friend or relative in some horrible bedridden state, make a playlist or two—it’s bound to do some good. If he is conscious and able to communicate, you could get him to help you compile the playlists (one for relaxing/sleeping, one for positivity). If he is unconscious, try putting the playlists together yourself—but remember two things: (1) The playlist should consist of music you imagine he would choose—not just music you would choose for yourself; (2) Never, under any circumstances, include “Seasons in the Sun” or “Chirpy Chirpy Cheep Cheep.”