Music as medicine | SIOBHÁN LONG

"Medics, musicians and music therapists gathered recently at a conference to try to identify what gives music its healing power

HAVE YOU EVER been at a concert and felt your mood shift inexorably in tandem with the music? Anyone who’s taken a pew at a Bobby McFerrin gig can attest to the sensory heights to which he lures his audience. Likewise, a slow air played with feeling on the pipes or the fiddle might entice a listener to a darker place that they hadn’t bargained on visiting – which might prove a welcome respite or induce an uncomfortable wince.

Musicians and music lovers alike have long recognised the healing power of music. That’s partly why we’re sometimes tempted to turn the volume up on Henryk Górecki’s Third Symphony, either to amplify an already funereal mood or to plumb emotional depths while in the company of greatness.

Earlier this month in Limerick, medics, music therapists and musicians tossed their tuppenceworth into the ring in an attempt to gain some understanding of the relationship between music and medicine. The University of Limerick’s Irish World Academy of Music and Dance hosted this inaugural conference of the International Association for Music and Medicine in association with UL’s Graduate Medical School.

At a time when Leaving Cert students are being asked to view the arts and sciences as diametrically opposed career choices in their CAO forms, there was a refreshing lack of territorialism on view at this crossroads where medicine and music intersected in the unlikeliest of ways.

Prof Jane Edwards, director of the MA in Music Therapy in UL, may have Antipodean roots, but she draws deep from the well of Irish traditional music in her exploration of the potential palliative properties of music.

“If you think of the three types of music here in Ireland: the lullaby (suantraí), the music of happiness (geantraí) and the music of sadness (goltraí),” she says, “you can see that music has been relied upon to depict emotion, and emotional states. There seems to be an implicit understanding here of the ability of music to affect you, and to lead you into a particular state. Take the music of sadness. The shared experience of creating that music with other people allows for the creation of a group expression of sadness or grief, rather than simply a sole or isolated experience.”

Making the most of the presence in Limerick of some leading international figures in the field of music therapy and medicine, Edwards organised a number of visits to three local healthcare settings, including the Mid-Western Regional Maternity and General hospitals and Milford Care Centre, a hospice and nursing home in Castletroy.

Over lunchtime presentations to staff, the visitors emphasised the potential for music to be used in hospital environments, and shared news of recent research findings which, for the first time, have begun to explain why and how music can exert a positive impact on recovery for a wide spectrum of individuals, including those with cancer, asthma, autism, cystic fibrosis and epilepsy. It can also be helpful to those who must be weaned off mechanical ventilation in intensive care units, babies in neo-natal intensive care units, those bereaved and those experiencing significant communication difficulties after strokes.

Music has also been shown to exert a positive influence on an individual’s ability to manage pain and on mothers’ ability to cope with labour pain. And let’s be honest, any woman who’s found herself, legs akimbo at the mercy of a gynaecologist, would jump at the chance to have an iPod to hand to mitigate the mechanical discomfort of the procedure.

THE POTENTIAL FOR music to soothe and sway, to support and direct patients’ recovery, straddles the boundaries of acute medicine and preventive healthcare. What’s more, it would appear that the research community is rapidly documenting its benefits and that medics are far more open to what music might have to offer than we might have expected.

Critically, given Ireland’s increasingly litigious culture, music has something to offer medical practitioners too: it can significantly reduce medical error, which, as Dr Joanne Loewy of the Louis Armstrong Centre for Music and Medicine in Manhattan’s Beth Israel Medical Centre says, is one of the leading causes of death in the US. There are more than 2,000 deaths per year there from unnecessary surgery, 7,000 deaths from medication errors and more than 80,000 infections contracted in hospital settings. Loewy believes that the lateral-thinking approach which sees the incessant loathsome beeps and alarms in a neo-natal intensive-care unit transformed into harmonious musical notes can contribute to increased attention on the part of the medical staff, and reduce the error rates that leave patients paying for the sins and slip-ups of their medics.

It can also enable patients to play an active rather than passive role in their health management.

“We now deliver asthma treatment programmes in schools,” Loewy explains. “Previously, this was seen as an emergency-room illness. There’s a huge denial factor with asthma, and people felt they had to be taking their last breath before they would seek out help. But they can learn, for example, to use a recorder to help regulate their own breathing. They then learn to take their own blood pressure and check their own heart rate. By doing that, they learn to take control of their own health, and music is playing a very empowering role in putting control into the hands of the individual. So their quality of life is better as a result.”

Granted, Loewy’s video clips of a guitar-playing music therapist in full scrubs serenading a pre- operative patient to sleep teetered a little too close to evangelism for this writer’s liking, but her clip of a young woman articulating, for the first time in a music therapy session, her hitherto suppressed grief for her dead father brooked few arguments from the sceptics in the room.

Here was a young woman who had been admitted to hospital and subjected to a raft of medical tests to determine the cause of her weight loss and depression. All the medication in the world couldn’t have quelled her fundamental need to express emotions so deep-seated that she herself didn’t understand how she felt until she had articulated them through music.

The use of music to unlock emotional expression in children who are ill, bereaved or suffering post-traumatically, is gaining traction in medical and paramedical circles, Edwards suggests.

“It’s more difficult for children to use the psychological mechanisms that we can use as adults,” she observes, referring to an adult’s ability to think things through in a logical manner or to compartmentalise experience so that problems are “parked” until an individual has either the time or inclination to deal with them. “If you’re four years old, it’s very hard to say, ‘I’ll deal with that later’, so sometimes children will find a way to cope by not speaking or not eating, which lead to them having to make greater psychological adjustments later on.

“Music can make a real difference in those situations, in helping children to break through those silences and those barriers.”

DR STEPHAN QUENTZEL, medical director of the Louis Armstrong Centre, spoke of the experience of a young adult with autism whose ability to communicate through music was vastly superior to his verbal communication skills. As a family physician, psychiatrist and holistic medical practitioner, Quentzel sees as a virtue the fact that his centre treats a vast array of musicians and performing artists “from Broadway to subway”.

Describing his approach to developing a model for treating musicians specifically, Quentzel presented a number of compelling case studies, including one which focused on the experience of an unnamed but highly accomplished jazz musician who had become immobile as a result of a number of medical conditions, which included diabetes, hypertension, chronic heart disease and obesity.

Music clearly played a central part in the woman’s life. Through music therapy and providing her with access to a keyboard (perched daintily across her armchair), her medical team found a route to addressing some of the emotional turmoil she was experiencing as a result of her diminished independence and increasing distance from the world of music which had been her life.

Western medicine, Quentzel claims, has to deal with a huge range of chronic stress-related conditions, such as cardiovascular disease, diabetes, hypertension, insomnia and anxiety. Many of these conditions occur due to the patient’s inability to regulate his or her autonomic nervous system, which produces the “fight or flight” response that was crucial when we were being chased by sabre-toothed tigers but is less frequently a requirement of modern life.

“As much as we value medicine,” Quentzel suggests, “it’s just as important that we understand the value of music, and in fact what’s also important is the relationship between the music, the patient and the music therapist. The bedrock of successful healing is the relationship between the patient and the music, so we should intentionally work that into our treatment programmes to enhance and expand our healing processes.”

DR SUZANNE HANSER is the chair of the music therapy department at Boston’s Berklee College of Music. She’s also intimately conversant with what she calls the “psychoneuroimmunology” of music. Hanser draws on research findings to explain much of what happens in music therapy, from the neural responses music causes in the brain to how it affects the immune system.

“We have this new concept now called ‘eustress’,” she explains, “which is the opposite of distress. It is a positive form of stress. Musicians have to have some form of stress to spur them on to even greater magnificence, even greater precision in their playing, and it’s that struggle and that stress that leads to the peak of creativity.”

Research is now helping us to explain this creative peak state, according to Hanser. “Nitric oxide – though not the kind that is used as dental laughing gas – is released in the brain just prior to a peak experience, and it works against the stress hormones which musicians produce when playing at their peak,” she says. “With this information, we now know that we can teach people coping strategies, cued by music, to cope with all kinds of things, such as depression and anxiety, in their daily lives. We’ve seen clinically significant changes in depression with maintenance of those gains into the longer term.”

Edwards acknowledges the restorative properties of music, but is just as keen to emphasise that it is no miracle cure. It’s a potentially powerful component of a holistic medical care programme, she suggests.

“Music therapy has some really good research findings,” she says, “about treating secondary symptoms, such as anxiety and sleeplessness, but less so about, for example, shrinking the size of a tumour. The patient’s psychological state and emotional response to their illness will have an impact on both the outcome of their treatment and on their ability to participate in everything that’s required of them. Music therapy can play a real role in how the individual adjusts to his or her personal circumstances.” (© 2009 irishtimes.com | SIOBHÁN LONG)