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Music as Medicine

 

 

Article By

L. Dias

 

Think back to the last time you were at a wedding, a party, or a festival. Can you imagine any of these, but without music? Music is quite literally around us everywhere, even without us realising it.  It affects us, or even better said, it strikes a chord, in ways that many other modalities are unable to do so.

Music has been described as one of the longest-standing self-prescribed therapies in history. We have been using music to effect emotional, psychological or even physical change within us from the dawn of time. Through the ages, mothers have sung their babies to sleep with lullabies, religions have used religious hymns to awaken feelings of devotion and a sense of community, national anthems stir up patriotic fervour and solidarity, and football anthems unite fans. Sad songs can sometimes help heal heartbreak, while upbeat peppy music can motivate us to exercise or run or dance just a little bit longer. Often, the best tribute to a loved one at their memorial service is to sing or play their favourite song. Music has been an almost intuitive crutch or coping mechanism, in the ups and downs of our lives.

The definition of music therapy, however is something a little more specific: the use of music to improve health or functional outcomes. Again, this is a concept well-known through history, going back to antiquity. It is no coincidence that Apollo was the Greek God, of both, Music and Medicine. Aulus Cornelius Celsus recommended the sound of cymbals and running water for the treatment of some mental illnesses. Similarly, Hippocrates found that playing music alleviated the symptoms of patients with mental disorders. In many indigenous cultures ranging from Asia to Africa, the Americas and Australia, medicine men (and women) often employed (and in some instances still do) chants and dances as a modality of healing.

Music therapy came to the attention of the medical world in the West (particularly in the United Kingdom and the United States) in the aftermath of the two World Wars, when soldiers returned from the battle front with what was then described as (for want of a better term) “shell shock.” This is called post-traumatic stress disorder (PTSD) today.[1] Musicians would travel to hospitals and play music for soldiers suffering from war-related emotional and physical trauma. So, began the systematic clinical study of “music presented according to a specific plan in independently influencing recovery among service members with mental and emotional disorders.” 

In effect, these musicians had the task of using music to achieve “non-musical goals.” A good example of this is described by a friend of mine, a brilliant violinist Robert Vijay Gupta (incidentally, the youngest musician ever to enter the ranks of the Los Angeles Philharmonic Orchestra) in   one of his TED talks: In 2011, US Congresswoman and gun-control advocate Gabrielle Giffords survived an assassination attempt, but one of the bullets entered the left cerebral hemisphere and damaged the Broca’s area, the speech centre of the brain. In one of her recovery sessions (accessible on YouTube), while working with her therapist, she struggles to produce the most basic words, and bursts into sobs in sheer frustration. The therapist then tries a new approach, and they attempt to sing together. Through her tears, Giffords begins to sing along and is able to clearly enunciate the words of the song in one descending scale: “Let it shine, let it shine, let it shine.” As Gupta puts it, “this is a very powerful and poignant reminder of how the beauty of music has the ability to speak where words fail; in this case, literally, speak.”

One of the pre-eminent neuroscientists studying music and the brain at Harvard Medical School, Dr. Gottfried Schlaug, is a proponent of a therapy called “Melodic Intonation Therapy,” which is now quite popular in music therapy. Schlaug found that stroke victims who were aphasic and unable to form three- or four-word sentences, could still sing the lyrics of a song. After hours and hours of intensive singing lessons, Schlaug found that the music was able to literally “rewire” the brains of his patients and create a homologous speach centre in the right hemisphere to compensate for the left hemisphere’s damage.[2]

Using music to achieve “non-musical goals” is the mainstay of music therapy. The “non-musical goals” are created depending on the patient and on what their needs are. They could variously be: having the patient feel better; alleviating their symptoms; or helping them progress in their treatment.

The experiencing of music is an extremely complex phenomenon. It is the only life experience that gets processed in both hemispheres of the brain. Music has all the following elements in play, occurring simultaneously such as, melody, rhythm, words (lyrics), harmony, timbre, tempo, dynamics and form. Consider how as a human being we experience all of this: memory, emotion, participation type (active or passive) and familiarity. If you now consider all the areas of our brain that are processing all this information in real-time, it involves most if not entirely both hemispheres.

This has been demonstrated by researchers using functional magnetic resonance imaging (fMRI), to show multiple areas of the brain ‘lighting up’ all at once. These include the areas responsible for auditory processing, motor control, emotion, memory. And within these larger areas are even smaller areas that are more finely tuned to respond to this stimulus.[3]

Take just one element alone, for example, rhythm or pulse. Simply, the “beat” draws your brain into this idea called “entrainment.” So, your brain hears the beat, processes it and responds to it by “matching.” This aspect of music therapy has been used to good effect in the recovery of stroke victims or those with Parkinson’s disease, by giving them a steady beat by which they can pace their stride lengths. If they are given a beat, their brain will entrain to it (a phenomenon known as rhythmic auditory stimulation) and their feet will keep pace.

Music therapy has likewise been found to be effective in Alzheimer’s disease as well.[4] When brain damage occurs on one side of the brain, (and since music stimulates both sides of the brain), music therapy can encourage the homologous area in the opposite hemisphere to compensate for that loss. Through music, our brains can access long-term memory by these different neural pathways.

A music therapist is not just a competent musician, but also a flexible one, who should know how to engage and interact with patients across a multitude of diseases, disorders and conditions. These range from autism to others with special needs, rehabilitation of stroke victims,[5] Alzheimer’s and other forms of dementia, Parkinson’s disease, syndrome and other movement disorders, post-traumatic stress disorder, cardiovascular disease, psychiatric illness, cancer and palliative care for life-limiting illness and those suffering from chronic pain, alcohol and drug rehabilitation programmes, correctional facilities, and even in neonatal intensive care units, especially for prematurely-born infants. The list keeps on growing. Due to its versatility, music therapy is finding use in more and more areas of healthcare.

The standards of practice are, however, just as rigorous as any other therapy in healthcare. The tendency by some to label themselves as music therapists without undergoing the necessary training is quite unfortunate and discredits the profession. As explained, music evokes emotional and psychological, even physical reactions in us, and knowing what sort of music to use (or avoid), for whom, when, and for how long, is a learned science.  Music must be chosen purposefully, and with an understanding supported by evidence-based research for the therapy to be truly effective and meaningful.

TC- Jan 2019 (4)

TC- Jan 2019 (5)

 

References:

  1. Degmecic D, Požgain I, Filakovic P. Music as therapy. International Review of the Aesthetics and Sociology of Music. 2005; 36(2):290.
  2. Schlaug G, Norton A, Zipse L, Marchina S. Melodic intonation therapy: Shared insights on how it is done and why it might help. Annals of the New York Academy of Sciences. 2009; 1169:431-436.
  3. Meister IG, Krings T, Foltys H, Boroojerdi B, Müller M, Töpper R, Thron A. Playing piano in th mind-an fMRI study on music imagery and performance in pianists. Brain Res Cogn Brain Res.2004;19(3):219-28.
  4. Koger SM, Chapin K, Brotons M. Is Music Therapy an Effective Intervention for Dementia? A meta-analytic review of literature. Journal of Music Therapy. 1999; 36 (1):2–15.
  5. Magee WL, Clark I, Tamplin J, Bradt J. Music interventions for acquired brain injury. 2017; The Cochrane Database of Systematic Reviews. 1:CD006787.