INTRODUCTION
In the middle of the eighteenth century there were two prominent men in Paris whose conflict was typical of the controversial nature of the subject known as Musical Therapy. The Abbé Nollet was not only one of the most prominent clerics in France during his time but was in addition the most famous of its physicists. He had constructed some excellent models of machines which produced static electricity, but he had had no medical training. At about this time throughout western Europe, the subject of static electricity had become very popular. Several physicians claimed that it was of great use in the treatment of many diseases. Particularly did they say that it cured paralysis. The Abbé Nollet wrote a book about static electricity and in it told of the cases he had cured with it. The most prominent physician in Paris was Doctor Louis, who was the chief physician at the Salpêtrière Hospital, the largest and best known hospital in France. Dr. Louis tried to repeat the cures promised by Nollet but was unable to secure success in any of the patients whom he exposed to static electricity. He published the story of his failure to do so, which so excited Abbé Nollet that he wrote an entire volume condemning Dr. Louis. Instead of refuting the ability of Dr. Louis to diagnose paralysis and evaluate a cure, he climaxed his remarks with the classical question addressed to the doctor, “Is electricity your field?”[61]
For many centuries philosophers and musicians have claimed the ability to cure mental illness through the use of music, and have at times called this procedure Musical Therapy. Although the physicians might well say to these musicians that therapeutics is definitely not within the province of musicians, it is unlikely that a musician would at this time have the courage to ask physicians, “Is this your field?”
A thorough search of the history of medicine will show that almost all phenomena and substances have at one time or another been tried in an attempt to combat disease. Many of these agents were abandoned when they became unfashionable to a more sophisticated civilization, or were recognized as unwholesome by a more educated generation. The fact that few were given up merely because of their ineffectiveness can be seen in the great number of quack nostrums which still enjoy an active sale among the ignorant, and by the impossible claims of highly organized cults which continue to gain in numbers and followers in this country. Healing schemes based upon the use of herbs because they are delivered right from nature’s womb, or the fanciful notion that all diseases arise from the imaginary displacements of the spinal bones, are still in their ascendency. The liberal system we call democracy has not only permitted their growth but has rewarded their ingenuous and ingenious development. Exposure of the fraudulent methods involved serves little purpose because the mentality which is so susceptible to warped reasoning responds poorly or even antagonistically to enlightening guidance.
There are, however, certain valuable features in herb and spinal doctrines which have been partially ignored by reputable physicians because of the intimate relation of these ideas to cult practice.
In spite of a spirited rebirth of the movement towards the establishment of a system of healing based on music, there are many valuable uses of music in medicine which might suffer a like fate unless a critical analysis of the worth of music as a therapeutic agent is effected before Musical Therapy reaches the dubious distinction of classification as a healing cult.
This book has been written with a view to preserving for medicine that which is good for patients, and in an attempt to aid musicians under medical guidance in using music to help the sick.
Primitive peoples throughout the world still use music in association with the healing arts. This of course is an indication that they have probably used it for more centuries than are recorded in the pages of written history. Ancient civilizations frequently associated music with the divine, but placed diminished emphasis upon its association with healing. Even so, the Hebrews accredited to music curative and inspirational powers[7], as can be seen by the reference in Scripture: “And it came to pass when the evil spirit from God was upon Saul that David took a harp and played with his hand; so Saul was refreshed and was well and the evil spirit departed from him.”[63]
For the Greeks to whom we owe the origin of the word music, Apollo served as the God of both medicine and music, and there were some among them who suggested its use for both mental and physical disease. “Plato and Aristotle claimed that the Dorian mode was regarded as virile, energetic, and proper for the perfect citizen; the Phrygian made them headstrong and the Lydian included effeminacy and slack morals. The modes of Asiatic origin were considered suitable for banquets.” Five hundred years before the birth of Christ, Pythagoras[I.] founded a brotherhood “based on music as a means of life and moral uplift.”[70] The influence of music was so great among the Greeks that it is not surprising that they used it in all walks of life, including medical treatment. The extent to which they and the peoples who followed them, used music in this manner will be more fully discussed in the first chapter.
Nicholas Murray Butler once stated that “An expert is one who knows more and more about less and less.” There is much truth in this facetious definition. In ancient civilization the known facts were so few that it was possible for some scholars to acquire all the knowledge available. The professional thinkers or philosophers had a comparatively complete familiarity with biology, law, music, medicine, government and theology, and could easily write authoritatively about most of them. Some of the important discoveries in the arts and sciences were made by men equally well known in entirely unrelated fields. As late as the Roman Era, Celsus wrote a series of books on different subjects, each of which was so complete that it was considered an authority in its field. To cite one example, the ten volumes on medicine were accepted for the next thousand years as its gospel text. Although specialization was known to ancient society, its foundation was one of individual will rather than basic training in facts. With the passage of time more and more knowledge developed till the single volume could no longer hold all the known facts of a science and what had been titles of chapters became the titles of books. Knowledge may really be said to have progressed when books are written on subjects about which only one sentence could have been written previously, but knowledge progressed very slowly until the fifteenth century. The Renaissance in art and science developed simultaneously in a relatively small area. The Renaissance of both medicine and music, was in Italy during the fifteenth and sixteenth centuries. Here, instrumental music was asserting its importance over vocal music, and accurate descriptions of human anatomy finally replaced the old erroneous conceptions. Both of these changes were necessary for progress in these fields, but progress was slow in each because there is always a reluctance on the part of the people to accept new concepts. Individuals may be intellectually progressive, but the people find security and comfort in established folkways, whether it be of music or medicine. Fortunately, individuals continued to write of new discoveries and in new idioms, and that which was good was accepted by a few in the same generation and by more in succeeding generations. But each successive step was tedious and it was just as difficult to influence the new generation as it had been the old.
With the growth of knowledge came an increase in specialization and men understood less of subjects unrelated to their own. As the rolling mass of education grew, it threw off tangential bodies of information which moved farther apart from each other, and it is only comparatively recently that these diverging lines have begun to approach one another and offer mutual assistance. Music, the art, found the need for acoustics, the science. Industry has come to accept the importance of color and form, and government has been forced to employ mathematics. There was a time when such combinations would have been considered fanciful; now they are indispensable.
Music and medicine have had casual contacts through the ages, but neither has cried out to the other for help. Musicians and physicians are independent people, brooking no outside interference. There are those on both sides who would protest their marriage, not so much from a concern over connubial bliss as over the possible offspring and undesirable relatives. Medicine has never refused to try anything that might alleviate suffering or cure disease, but it has and will continue to ignore unfounded claims or secret remedies. To be acceptable, therapeutic measures must be applicable to all who suffer, and the ingredients must be available to all qualified practitioners of medicine. Physicians insist that therapeutic modalities be given under their guidance and reserve for themselves the right to evaluate their results. Very few physicians object to the use of music for and by their patients, but many object to calling that use musical therapy. If the musician is aflame with the desire to make music for patients there is no need for insisting that it be labelled anything but music, providing of course that it is music. Physicians do not discourage acts of kindness or personal attention to their patients. They want them to have clean bedding and fluffed pillows, but insist that such procedures be called nursing care and not therapy, regardless of the amount of joy it brings the patient. There are many uses to which music may be put in medicine and especially in hospitals. When one considers the number and variety of hospitals in this country, it is difficult to imagine a kind of music which can not find a place in at least one of them, but, for reasons which seem more obvious to musicians than physicians, music has been used in the past almost exclusively for patients suffering from mental illness. During the past few decades, hospitals have given increasing attention to music, and in some instances have developed impressive programs.
In 1944 the National Music Council sent questionnaires to more than three hundred hospitals which treated psychiatric disorders, and received replies from two hundred of them. A summary of the survey was published by them under the title of “The Use of Music in Hospitals for Mental and Nervous Diseases,” and some of the information contained in this pamphlet will be of interest to those who are considering this aspect of music as a career. Almost all mental hospitals use music in some form. In half of them, patients participate in music vocally or instrumentally. In many hospitals the use of music is increasing and in a few it is extensive. About one-quarter of the hospitals have some budgetary appropriation for music, such appropriations are not great at present.
Most hospitals look for musical workers among the members of their regular staff; but a few have consulted musical organizations. Trained musicians might think that hospitals would turn more uniformly to musical schools for this sort of assistance, but for the most part, few schools of music have openly encouraged the study of this subject,—in spite of the fact that one-half of all the hospitals questioned stated that they could use additional qualified workers.
Of greater interest perhaps to those who would like to become hospital music aides are the opinions expressed by the hospital authorities on the principal qualifications which they believed musical workers in mental hospitals should have. It must be remembered, however, that questionnaires submitted to hospitals are not answered in a uniform manner, and any survey of this type must be interpreted with caution. When questionnaires are sent to hospitals they usually pass first through the hands of the director or superintendent, who reacts as an individual and not according to a set pattern. One will turn the paper over to his secretary for reply; another will pass it on to a physician, nurse or occupational therapist. In many instances the answers will be filled out by the hospital music worker, and sometimes, if the superintendent is sufficiently interested, he may answer it himself. Each person to whom the questionnaire is submitted may transfer the burden of answering to a subordinate, if he is too busy to fill it out himself. The signature which appears at the bottom of the returned questionnaire is usually one of approval rather than of authorship. Surveys should list the titles of respondents. This one did not. Even if it did, the foregoing possibilities would have to be considered. In spite of this, the qualifications listed will be reviewed for the help they may offer the prospective hospital musician.
A majority agreed that a knowledge of music was necessary, and not only were all phases of music specified, but the ability to make intelligent selections of music and to operate commercial sound equipment was recommended by some. Experience in teaching music, particularly the piano, was high on the list of desired accomplishments, and the faculty of directing singing was even higher.
Many hospitals stressed the importance of a “wholesome personality”, but this is a term which defies suitable definition. However, the following qualifications were named: emotional stability, patience, refinement, congeniality, quietness, and a sense of humor. There are further recommendations that the worker should possess: imagination, tactfulness, consideration, energy, perseverance, sincerity, co-operation, adaptability and understanding of human nature. In the final chapter of this work a more realistic approach to this subject will be offered.
One final qualification is mentioned which is to be taken most seriously, and that is that the musician who would work with mental patients should have “a definite urge to help the mentally ill.” As a supplement to this he should have or be given a working knowledge of hospital procedure and the handling of the psychiatric patient.
From these comments by hospital authorities and the recent trends in institutions throughout the country, it is reasonable to assume that the demand for adequately trained hospital music aides will increase. Some hospitals will want one or more full-time workers, and others will want a part-time worker. This means that some musicians may be able to supplement their earnings by securing partial pay from hospitals in their communities, the remuneration offered varying with the size of the hospital, its endowment and income. It will never be a source of wealth to a musician, but it can be a stop-gap in the hard early years or a continuous position for those who seek the security of regular employment.
Some people fill positions for which their only qualification has been influence; but in the majority of cases the people who have spent the greatest effort in securing superior training will be the recipients of the best positions. The student of hospital music should prepare for his job as seriously as for any other aspect of music. Regardless of his other qualifications, he must of course be a musician, and a degree in music is valuable; in fact almost essential. The ability to play a second instrument even moderately well is useful. The universal appeal and advantages of the piano make a working knowledge of it important. The music aide should be able either to play the piano at sight or he should study one of the rapid systems of piano instruction for he will be called upon not only to accompany group singing but to assist visiting artists or talented patients.
Although a foundation in classical music is part of any good musical training, a musician who refuses to recognize the importance of popular music in American life is not suited to this work. If he has a positive dislike for popular music, he should look to other fields. It is not necessary that he be able to play all the types of modern jazz, but he should be familiar with the common jargon of jazz and should learn the distinctions which exist between these so-called musical forms. His musical tastes need not be catholic, but his attitude towards the tastes of others must be broadminded.
Advances in mechanical reproduction of music are progressing at a very rapid rate, so the technological aspects of music should be cursorily reviewed. A working knowledge of record players, record cutters, needles, tone control and amplification is not difficult to acquire. It may be part of the duties of a music aide to supervise record cuttings and a public address system. In some hospitals the library of musical recordings and literature may be large. A study of musical librarianship will save much time, and the study of classification systems and filing will become an additional part of the work of a music aide.
More often than not a musician approaches a problem with more emotion than analysis, and this becomes of great importance when the problem is a patient. There have always been and will continue to be physicians who with honest conviction or for greater glory will anxiously ally themselves with anything new or sensational, therefore musicians impassioned with the belief that music is necessary to health will have little difficulty in finding collaborators in the ranks of medicine. Musicians must be cautioned to consider the fact that their sincere efforts may result only in discrediting music, as a therapeutic agent. As a result its acceptance as the basis of such merits as it may possess may be undeservedly delayed because of antagonism aroused by extravagant claims made in its behalf.
Much has been written about music as a therapeutic agent, and recently there have been entire schools and organizations devoted to Musical Therapy. In spite of the great temptation to be in on a coming theory few physicians have associated themselves with these efforts, and what is more conclusive, no physicians of national repute have come forward in approval of the term “musical therapy” as applied to the handling of psychiatric patients.
The use of music should not be limited to mental hospitals, however. Those who have played music for mental patients are enthusiastic over the individual responses they have witnessed. The nature of this response is awakened interest or joy. Joy is a healthful symptom for all patients to experience and this joy should be available to patients in all hospitals. Many other phases of music are adaptable for hospital use and this book is written to outline the many approaches possible and delineate the scientific basis for some of them.
Of the better known books on musical therapy some, like the work by Hector Chomet, are built around the effects observed in individual patients; others, like the writings of Eva Vescelius, are pure phantasy which stem from unbridled emotion. For science was not applied until the appearance of psychologic investigations when common sense began to emerge from a chaos of wishful thinking. One of the first dependable surveys of the subject was in the Psychology of Music by C. M. Diserens. Since the appearance of this excellent work the passages stating his views have been often quoted—frequently without acknowledgment. Its chapter on Musical Therapeutics is recommended for its scholarly history and sober evaluations of facts and fancies.
This book has been written for the musicians who wish to learn how they may work with physicians for patients. Technical terminology has been reduced to simple terms wherever possible for a better understanding, but co-operation can be secured only if the musician is willing to forget his preconceived ideas and abide by the decisions of the physician, who may not be too familiar with music but is familiar with hospitals and patients.
The unemotional approach to this subject is of recent origin. Little has been written in that vein, and this book will lay no claim to originality or perfection. It is hoped that it will act as a guide to further study and an aid to those who wish to engage in this as yet uncharted venture.
Realizing that few sources of information are available in this field to musicians, and that some musicians may one day feel the urge or experience the need to participate in such work, the New England Conservatory of Music invited the author to give a series of lectures to its students on this subject. At the conclusion of the course they decided to offer this outline to those who might later wish to refer to its contents.
In preparing this work the author had the good fortune of personal interviews with some of the leading musicians, musicologists and musical psychologists in the country. Although no statements which appear in this volume are to be construed as the opinions of any of them, an expression of thanks is offered to the following for their willingness to exchange ideas with the author: Dr. Serge Koussevitsky, Mr. Igor Stravinsky, Dr. Harold Spivacke, Dr. James Mursell, and Dr. Carroll Pratt.
The author wishes to express his thanks to Mrs. Margaret E. Gurney and Miss Ida Evans for their assistance in the preparation of the manuscript.
The author wishes to express his deep gratitude to Mr. Clifton Joseph Furness, Director of Academic Subjects at the New England Conservatory of Music for his supervision in the editing of this book.
S. L.