(Note to reader: This original essay was first published, in slightly edited form, in SCOPES Magazine, June 2004 issue)

"Play Two Symphonies and Call Me In The Morning."
Music As Medicine

For Pythagoras--the legendary, ancient Greek mystic-mathematician who gave us that famous geometric theorem--music and mathematics where intimately connected. It was not simply the mathematical basis of musical intervals, which he also discovered, that compelled him to assert this. It was more fundamental. Each reflected and expressed the truth, beauty, and perfection of the Cosmic Order. This 'perfection' manifested itself as 'the music of the spheres': the 'spheres' being the sun, moon, and various planetary bodies, with their precise orbital motions, being the 'music'. Pythagorus believed that each planetary motion must produce a sound, and that the sum of these sounds was a cosmological harmony. 

And so it was for most of Western history. Music accrued a great power and great purpose: to elevate the listener to this 'higher plane' of cosmic awareness and connection. This purpose would be called 'spiritual' today, or perhaps, more clinically, psycho-emotional. But to the ancients, there was no other purpose worthy of attainment. Music that was listened to for purely 'emotional pleasure', or that elicited mere sensual reverie, was viewed as the basest form of musical experience, and was, until the ascendance of ‘Romanticism’, disdained. 

Though today the issue of music's ability to "heal" is both fervently supported and contested, Pythagorus, were he present to witness this debate, would no doubt be surprised that such a purpose could ever be questioned. Sickness in his day was always a spiritual matter--or more accurately, a 'metaphysical' matter. To be 'sick' was to be out of harmony with the Universe. The proper music was obviously a means of restoring the ailing psyche to resonance with the Musica Cosmologica.

Fast forward to the early 21st Century: having now evolved a far more complex understanding of human sickness and wellness, we none the less come full circle. Our science and medicine are undeniably powerful tools, yet wielding them has not eradicated disease, nor have they provided the keys to complete wellness. The universally noted 'placebo effect' clearly implicates a psychological component to healing. But how this effect works--how it translates from mind to body--is still unclear. And so, into this great unknown rush the alternative therapy advocates, including those who advocate music as a 'healing agent'.

Intuitively, we accept as true Shakespeare’s maxim: ‘music hath charms which doth soothe the savage beast'. But is music more than simply soothing? What exactly is the scientific evidence supporting claims to the healing properties of music?

Much of the evidence is anecdotal, or inconclusive. Music therapy proponents have, in the past, made exaggerated claims and sometimes turned out to be charlatans, while other promising research awaits more critical analysis and follow up study. The fact that music can produce physiological effect in the brain does not equate with a therapeutic effect in the body. Still, the possibility warrants serious study. The mysterious relationship between sound, mind, and physiology has engendered the new science of psychoacoustics, which seeks to identify patterns of physiological responses to musical stimuli, and thereby develop specific compositions and protocols for therapeutic applications. Its practitioners have produced a great number of technological devices for administering 'sound therapy', but such work has not ended the debate or established a definitive theoretical framework.

There is, of course, a good deal of scientific evidence showing music's ability to lower [or raise] heart rate and blood pressure levels. In 1987, researchers showed that music alone brought about a decrease in the [typically] higher stress hormone levels induced by environmental stressors. (1)

Stress is mediated by hormones called catecholamines. Tests on patients in labor have shown that high catecholamine levels inhibit placental blood flow which can trigger fetal distress, as well as decrease the effectiveness of uterine contractions. (2) Anxiety is often accompanied by hyper-ventilation which can also interfere with placental blood-flow. Of course, anxiety in labor patients is normal and expected. In some cases, however, intense anxiety has been associated with fetal death in the third trimester. (3) Given these noted anxiety/stress-related effects, some researchers began to focus on the integration of music with pre-natal and post-natal care.

There is a fair amount of hospital evidence that the playing of music [mostly ‘classical’ or symphonic] significantly reduces the possibility of 'stress-induced premature labor' in expectant mothers. Music appears to reduce perinatal stress in general, as well as over-all pain during labor and post-natal recovery (4). Music played during labor also appears to facilitate faster labor (5), as well as influencing the mother's perception of labor duration (6).

Amongst premature babies, various studies have indicated strong correlations between use of music in NICUs [neonatal intensive care units] and increases in blood-oxygen saturation as well as decreased levels of agitation (7). No doubt the reduction in 'newborn agitation' also reduces nurses' stress levels [and thus nursing mistakes]. Perhaps not surprisingly, the playing of 'lullaby' music in the NICU resulted in fewer incidences of oxygen desaturation (8).

Additionally, two separate studies of premature babies conducted in the early-mid 1990's showed a positive effect on daily weight gain [nearly doubling DWG] of NICU newborns from exposure to 'music therapy'. (9) Further, several other studies involving music therapy and premature babies have shown a 3- to 5-day earlier discharge rate from the NICU (10). 

In terms of cost saving on both sides of the health equation, these last studies are perhaps the most persuasive for implementing music therapy protocols. 

Amongst adult patients, a 1993 study sought to explore 'music intervention' in the reduction of pain in adult female rheumatoid arthritis patients. (11) Thirty such women answered questions of pain perception prior to listening to their music of choice, during listening, and up to two hours after listening. Though of small sample size, the results of this study supported the use of music as a therapeutic intervention.

An additional study focused on 60 elderly patients diagnosed as having Alzheimer's disease. These patients were randomly separated into three groups of equal size and given questionnaires to measure their mood and mental state. For one group, "Big Band" music from the 1920s and 1930s was played during their daily recreation period. The other two groups were used as 'controls' and were offered either puzzles or standard recreational activities. A six month follow up questionnaire was again given to all participants. Results showed that the individuals in the first group were more alert, happier, and had higher recall of past personal history than patients in the other two groups. (12)

Symphonic music--as well as some popular and New Age music--appears to reduce stress responses and pain perception in humans, particularly if accompanied by guided visual imagery and/or verbal suggestion. (13) One Swedish research team found that recovering patients experienced less pain and fatigue when soothing music was played and surgical staff whispered "words of comfort" to the anesthetized patient. (14) Music, as an adjunct to a comprehensive health care program, can diminish the effect of stress on patient recovery times. And there is growing evidence for music as a vital component of wellness, general happiness, 'and quality of life' perceptions—and so perhaps longevity.

This seems to be in concordance with the work performed at the University of Pittsburgh's Health Enhancement Program. Using an in-house cable television system, the program provides soothing music and visual images to reduce anxiety and stress for hospitalized patients. According to the program's director, Bruce Rabin, M.D., Ph. D., there is overwhelming evidence that such therapies reduce the length of hospital stays and patient discomfort while in the hospital. 

"Lowered blood pressure and heart rate, reducing the perception of pain, and reducing the way that the brain responds to stress are all benefits of listening to music with a resultant benefit to better health and recovery from disease," asserts Dr. Rabin. And the benefits of music in health care environments extend beyond the patient--music benefits staff members, reducing their stress levels, which in turn enhances patient care. 

Still, conclusive evidence of a direct cause and effect relationship between music--whether a Beethoven symphony or Beatles anthology--and the healing of a specific disease [physical or mental] has yet to be produced. And it seems that virtually anything that is done to make the hospital environment more pleasing to the senses, more up-lifting to the mind, and less stressful to its occupants, is conducive to over-all health and recovery. And certainly music--with its 'charms which doth soothe'--promotes all of these factors.

I recall hearing Beethoven's 1st Symphony at Benaroya Hall some years ago, and being enraptured with its melodic and rhythmic dynamics. The standing ovation at its conclusion jolted me back to reality. But, for those twenty minutes or so, I felt both elated and transported to another 'plane of being' where I had no cares or worries. The effects of this experience stayed with me for some time afterwards. Perhaps this was akin to 'the music of the spheres'. Perhaps somewhere, the spirit of Pythagoras is smiling, knowingly.

Michael Ricciardi

http://www.chaosmosis.net/Essays.html

1.	Spintge, R. & Droh, R. (1987). Effects of anxiolytic music on plasma levels of stress hormones in different medical specialties. In R. R. Pratt (Ed.), The fourth international symposium on music: Rehabilitation and human well-being (pp. 88-101). Lanham, MD: University Press of America.

2.	Simkin, P.T. (1986). Stress, pain, and catecholamines in labor: Part 1. A review. Birth 13(4), 227-233.

3.	3. Myers, R. E. & Myers, S. E. (1979). Use of sedative, analgesic, and anesthetic drugs during labor and delivery: Bane or boon? American Journal of Obstetrics Gynecology. 133: 83-104

4. Hanser, S. B., Larson, S. C., & O'Connell, A. S. (1983). The effect of music on relaxation   
    of expectant mothers during labor. Journal of Music Therapy, 20(2), 50-58.

5. Winokur, M. A. (1984). The use of music as an audio-analgesia during childbirth.  
    Unpublished master's thesis, The Florida State University, Tallahassee.

6. Clark, M., McCorkle, R. & Williams, S. (1981). Music therapy assisted labor and delivery. Journal of Music Therapy, 18, 88-100.

7. Collins, S. K., & Kuck, K. (1991). Music therapy in the neonatal intensive care unit. Neonatal Network, 9(6), 23-26.

8. Caine, J. (1991). The effects on music on the selected stress behaviors, weight, caloric and formula intake, and length of hospital stay of premature and low birth weight neonates in a newborn intensive care unit. Journal of Music Therapy, 28(4), 180-192.

9. Coleman, J. M., Pratt, R. R., & Abel, H. (1996). The effects of male and female singing and speaking voices on selected behavioral and physiological measures of premature infants in the intensive care unit. Presented at the International Society for Music in Medicine symposium at San Antonio, 10/96, and Caine, J. (1991).

10. Standley, J. M. (1991). The role of music in pacification/stimulation of premature infants with low birth weights. Music Therapy Perspectives, 9, 19-25, Coleman, J. M., Pratt, R. R., & Abel, H. (1996), and Caine, J. (1991).

11. Schorr JA. Music and pattern change in chronic pain. Ans. Advances in Nursing Science, 1993 Jun, 15(4):27-36. (questionnaire used: McGill Pain Questionnaire)

12. Lord TR; Garner JE. Effects of music on Alzheimer patients. Perceptual and Motor Skills, 1993 Apr, 76(2):451-5. 

13. McKinney, C. H., Antom, M. H., Kumar, M., Tims, F. C. & McCabe, P. M. (1997). Effects of Guided Imagery and Music (GIM) therapy on mood and cortisol in healthy adults. Health Psychology, 16(4), 390-400.

14. A Swedish team of researchers led by Ulrica Nilsson, MD, of Orebro Medical Center Hospital, reported in the journal Acta Anaesthesiologica Scandinavica. Feb. 2002