Songs in the Key of Health

The ability of music to engage the brain on different levels simultaneously gives it
a unique healing power. As scientists study exactly how we respond to its profound
influence, therapists are learning how to employ music to help people overcome
an array of physical, mental and emotional challenges.

By Allan Richter

October 2008

    The bedtime lullaby your mother sang. The rock ballad you danced to at your wedding. The hospital Muzak playing while you awaited the birth of your first child. The hymn sung at your parent’s funeral.

A lifetime of music surrounds us, though we each attach our own perceptions to which of it comforts, motivates, disturbs and uplifts. Teenagers playing air guitar to Van Halen’s “Panama” have an entirely different experience than Panamanian strongman Manuel Noriega did when US soldiers blasted the same song through loudspeakers to rout him from his hiding place. Or just consider the dozing man and his enthralled wife at the Philharmonic.

Couple that subjective nature of music with its vast array of styles and instruments on which to play them. Then toss improvised versus structured approaches into the mix. It is little wonder that music therapy is still an evolving discipline and that the neuroscience of music—less than 30 years old but with mounting research on how music affects health—remains largely mysterious.

Therapeutic Sounds
Health practitioners say the many colors of music let them apply it to a wide range of afflictions. “It facilitates recovery the way, I don’t want to say medications do, but it’s a complementary treatment. In some cases it can replace other treatments,” says Concetta Tomaino, DA, MT-BC, executive director of the Institute for Music and Neurologic Function at Beth Abraham Hospital in New York.

Music therapy is used in stress reduction and wellness maintenance for the general population, and in virtually all elements of early child development, including autism therapy. Music is also used to manage pain, to encourage healing before and after surgery, and among cancer, dementia, stroke and Parkinson’s disease patients.

Alan Turry, MA, MT-BC, NRMT, co-director of the Nordoff-Robbins Center for Music Therapy at New York University, says his treatment of Maria Logis, a corporate manager who had been diagnosed with non-Hodgkins lymphoma, underscores how the many dimensions of music can be harnessed. When Logis was diagnosed, she was numbed by the news. Then, with no background as a singer, she decided she wanted to sing. With Turry on piano, Logis improvised lyrics that put her in touch with her feelings for the first time since her diagnosis. First she sang about the cancer, then about her relationship with her mother and other parts of her life that had not been unearthed in years.

“The music was very powerful for her,” Turry recounts. “She would actually cry as she was singing. She was getting in touch with feelings that were repressed.” The full realization of those cathartic sessions came when Logis decided to perform, complete with a backup band, for friends and family. “She was affirming that she was not giving up,” Turry says, “that she was not going to succumb to her tendency to stifle herself, to isolate herself, to lose her voice.”

In many sessions, Logis was deeply immersed in the creative process and working out her issues. Other times, Turry says, her singing lacked emotion; it was “lighthearted” and “superficial.” So Turry put more drive in his playing to guide Logis to delve deeper into her feelings. He played lower in the register and repeated tones that might sound more ominous. He would play a cadence that ended in a questioning way instead of on a major tonic chord that would give the music finality. He played soft patterns that were at once nurturing and encouraging her to go forward. Or he would slow the tempo so Logis would stay with an important thought.

“I was asking questions in the music,” Turry says. “I would play a melodic idea on the piano saying, ‘I hear you. Can you go further?’ I might be playing music that is rhythmic and in some ways giving her energy but also holding dissonances that may trigger her to explore conflicts. Music holds many blends of emotional qualities. It can be encouraging and supportive at the same time that it can be challenging. Music can be as complex as the human condition.”

Later, Logis would say that music put her in touch with “my hunger, my fear, and my anguish. I have taken a journey deep into my underworld and I have come back changed.” Logis, whose cancer is in remission, continues to perform.

Therapists similarly applied several moods of a piece of music with a nervous man who could not stay in one place for more than half a minute and who functioned at an age much younger than his 28 years. “We were trying to challenge him to stay in the music even as it had elements of tension,” Turry says.

Therapists matched the patient, a guitarist, with a pianist, drummer and bassist. The patient endured longer periods of calm with each session—he ultimately played with the combo for 40 minutes at a time, keeping his emotions in check.

Music therapists find triggers to health in recorded music, too. Annie Heiderscheit, PhD, MT-BC, FAMI, uses songwriting and recorded music to help treat eating disorders, chemical dependencies and other maladies. In one group session, Heiderscheit asked each patient to return with a song each felt strongly about. One man in his early 50s had been addicted to cocaine for more than half his life. He brought to the session a recording of “Count On Me,” sung by Whitney Houston and CeCe Winans, as his way, he said, of letting the other group members know he was there for them. But Heiderscheit said the patient’s song choice offered clues to deeper issues. “One of the things that drew me in is that the vocalists of the song are two strong women,” Heiderscheit said. “Typically songs communicate what we want to say or what we want to hear. If this was something he wanted to say, the gender of the vocalist would have been male.”

Heiderscheit asked the patient if there was anybody in his life from whom he wanted to hear the words of “Count On Me.” “He could have said no,” the therapist said. “Instead he got very tearful and he said, ‘I want my wife to speak these words to me. I can’t get sober without her. I have made so many mistakes that I’m afraid she won’t stick with me.’” The breakthrough, Heiderscheit said, opened a path to conversations between the couple.

Singing Through Stroke Damage
Recent research supports the benefits of music for stroke victims, too. This year Finnish scientists found that stroke patients who listened to music a couple of hours each day improved their verbal memory and attention span by 60%. In contrast, patients who did not listen to music or who listened to audio books saw 29% and 18% improvements, respectively, according to the research published in the Oxford University Press journal Brain.

At Harvard Medical School, researchers had similar results using Melodic Intonation Therapy (MIT), which employs melody and rhythm and is aimed at engaging the right hemisphere of the brain. The speech of a stroke patient who sang and tapped with his left hand improved more than a patient who was treated with traditional speech therapy (Music Perception 4/08). That may give music a vital place in stroke therapy, since many strokes result in some form of aphasia, marked by partial or total loss of verbal communication.

One possible reason for the improvement using MIT is that singing can slow the speed of words, reducing dependence on the left hemisphere, the researchers said. In addition, the patient’s left-hand tapping likely engages the right hemisphere. That sparks verbal activity, the researchers said, the way a metronome has helped other motor activities through the anticipation of rhythm, or rhythmic entrainment, a physiological alignment with a beat.

Music therapists say other research has shattered the notion that music is solely the domain of the right brain, considered by scientists the place where creativity resides. Instead, diverse regions of the brain respond to rhythm, for example, and to different pitches. “How the brain perceives time and how rhythm imbues time is processed in many different areas of the brain, including some very basic brain structures like the cerebellum and brain stem, as well as the cortex,” says Beth Abraham Hospital’s Tomaino. As a result, music therapists can expand their use of rhythm to help improve motor coordination, attention and elements of speech. (For more on rhythm therapy at Beth Abraham, see “Drumming Up Wellness” on page 43.)

Basic Communication
Advocates of the health benefits of music support the idea that music developed before language, suggesting a deeper predisposition to music. Older regions of the brain respond more to music than speech, which indicates that music came before language, says Daniel J. Levitin, PhD, a neuroscientist and director of the Laboratory for Musical Perception, Cognition and Expertise at McGill University in Montreal.

“The other piece of evidence is just logical,” says Levitin, author of The World in Six Songs (Dutton). “If you look at the way our nearest genetic cousins, the chimpanzees, communicate with one another, or for that matter the way we believe Nean­derthals communicated with one another, the available evidence is it was variations of pitch and rhythm. That’s how chimpanzees communicate—the pant-hoot.”

As basic research continues on the connection between music and communication, applied research lets music therapists hone their craft. Levitin says the prospects for expanding music therapy are strong because the American Music Therapy Association (AMTA) defines the treatment around scientific evidence. “It’s not yet mainstream,” Levitin says, “but it aspires to be a field that uses data and science to establish its claims, and that’s a good thing.”

As research emerges, music therapists hope they can aim the treatment on more specific applications. “Where does rhythm perception originate in the brain? How does each part of the brain communicate with each other? If we knew this, we could target the use of music therapy and make it more effective and efficient,” says Tomaino.

Some music therapists want to standardize more elements of their treatment—a challenge because patient responses are so diverse, says Barbara Wheeler, PhD, MT-BC, president of the AMTA. “There are so many different ways that people think about what we do,” she says. Standardization could encourage more insurance coverage for music therapy and make the treatments more widely available.

The varied responses to music therapy are apparent in the video library at the Nordoff-Robbins Center at New York University, where co-founder Clive Robbins recently pored over some of the thousands of videotapes of children with autism and other neural afflictions the London-based group has been recording since 1959. Each child’s music therapy regimen must be tailored to his or her own “musical portrait,” Robbins observes. “Music itself is capable of so many different forms of expression, so many different intonations of energy and so many moods.”

But Robbins says virtually all of the children he has seen share a trait: “Putting a child into music is like putting a boat into water,” he says. “It floats.

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