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 literally everywhere we go, even without our realising it. And it affects us, strikes a chord, as it were, in ways that other modalities cannot.
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. Mothers have sung babies to sleep with lullabies, religions use hymns to awaken feelings of devotion and community, national anthems stir up patriotic fervour, and football anthems unite fans. Sad songs can 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 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’s 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 formally came to the attention of the medical world, in the West (particularly in the UK and US), in the aftermath of the two World Wars, when soldiers returned from the battlefronts with what was then, for want of a better term, described as “shell- shock”, but what we today call post-traumatic stress disorder. Musicians would travel to hospitals and play music for soldiers suffering from war-related emotional and physical trauma. The systematic clinical study of “music presented according to a specific plan in independently influencing recovery among service members with mental and emotional disorders” began subsequently.
In effect, musicians were using music to achieve “non-musical” goals. A friend of mine, brilliant violinist Robert Vijay Gupta (incidentally the youngest ever to enter the ranks of the Los Angeles Philharmonic Orchestra) describes this well 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 her left hemisphere and damaged her Broca’s area, the speech centre of her 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 tack, 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, 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, Dr. Gottfried Schlaug, is a proponent of 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 of intensive singing lessons, Schlaug found that the music was able to literally ‘rewire’ the brains of his patients and create a homologous speech centre in the right hemisphere to compensate for the left hemisphere’s damage.
The “non-musical goals” in music therapy are created depending on the patient, and on what their needs are. They could variously be: having the patient feel better; alleviating symptoms; or helping them progress in their treatment.
The experience of music is an extremely complex phenomenon. It is the only life experience that gets processed on both sides of our brain. Music has all of these elements in play, occurring simultaneously: melody, rhythm, words (lyrics), harmony, timbre, tempo, dynamics, and form. And consider how you as a human being experience all this: you have memory, emotion, participation type (so 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 all of both hemispheres.
This has been demonstrated by researchers using fMRI imaging, 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.
Take just one element, 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. 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 the use of music, our brains are able to 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, Alzheimer’s and other forms of dementia, Parkinson’s disease, syndrome and other movement disorders, post-traumatic stress disorder, cardiovascular disease, psychiatric illness, in cancer centres, palliative care 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 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 understanding supported by evidence-based research.
(An edited version of this article was published on 14 July 2019 in my weekend column ‘On the Upbeat’ in the Panorama section of the Navhind Times Goa India)