Summary

Music can be used in psychiatry for its value in listening, group participation, and creation of sound, as follows:

CHAPTER FIVE
BACKGROUND MUSIC

The average mind is incapable of engaging effectively in two thought processes simultaneously, but it can in the course of daily routine accept a multitude of mental stimuli at any one moment. If one of these stimuli is sound, it may be the natural complement to the visual experience without which a feeling of incompleteness may result. The observer at the sea-side is intrigued by the cyclic rolling of the waves, and the periodic crashing of the breakers is an integral part of the pleasure of watching waves. Yet, that same series of sounds might be very disturbing to the same person who is trying to work out his income tax return in the quiet of his study. The importance of complementary sound becomes more apparent when one studies the reaction of an audience attending the “movies” during periods of faulty mechanical silence. Sound as a background to mental or physiologic processes may be natural or undesirable but can be very important. If carefully selected, there are few situations in which music cannot be used advantageously as a background to improve the quality or pleasure of activities and living.

At this point it must be repeated that the importance of music in the lives of people is not uniform and that, for those few who dislike music, background music is not recommended.

Background music, as its name implies, is always secondary to some other activity. Only those phases of the subject which touch upon hospital life will be discussed here, and they are, in order of importance: the music which accompanies meals, painful procedures, calisthenics, and work. Inasmuch as the latter two are not encountered in all hospitals they will be given only brief consideration. The subject of mealtime music is of sufficient importance to be treated at length and will be discussed in the following chapter.

Counter-irritation is a very old method of treating pain. For painful conditions where specific relief can be given in no other manner, physicians did and still do try to distract the mind from the site and severity of the pain by transferring attention to another area. This can be accomplished by irritating the skin over the affected area in the hope that the resultant inflammation will be more superficial and visible and in that way neutralize the pain. In a less physical sense people “take their mind off” unpleasant subjects by exposure to humor or other forms of entertainment. Avicenna, the great Bagdad physician (980-1037 A.D.) included in his Canons of Medicine[37] the following suggestions:

“1084 ... Other means of allaying pain: 3. Agreeable music, especially if it inclines one to sleep. 4. Being occupied with something very engrossing removes the severity of pain.”

Music has been used against pain for centuries not only by musicians and physicians, but by the people. We find this practice referred to in a letter from Maria Cosway to Thomas Jefferson concerning his recently sprained wrist:

“I wish you were well enough to come to us tomorrow.... I would divert your pain with good music[12].”

In 1915 two surgeons named Burdick and Kane used music as a diversion during local anesthesia. They ascertained the musical preference of the patient prior to operation and played recorded music in muffled tones during the operation. Later they played music in an adjacent room while general anesthesia was being induced and found that it was accomplished with less resistance[32]. Since that time other surgeons have used music for similar purposes. There are some operations which are done under local anesthesia and are prolonged. The absence of sounds other than awe-inspiring whispers, or the presence of technical talk may cause the patient unnecessary alarm.

The use of well selected music or a good radio program may be of great benefit in the operating room. Its value will depend upon the operating surgeon and how well he can operate while music is being played. There are times during an operation when delicate maneuvers become trying and the wrong music or increased volume might lead to exasperation. One advocate of music in the operating room has called it a “psychic anesthetic”[53].

The use of local anesthetics in dentistry has made possible the painless extraction of teeth. Most dentists, however, do not inject local anesthetics before drilling cavities. For many people, drilling is a frightful experience. Some dentists have advocated the playing of music at a loud level during this procedure. Still another has incorporated ear-phones into the head rest of the dental chair for diversional sound.

A more obvious use of diversional sound in the professional office is in the reception or waiting room to supplement the magazines and diminish the terror of waiting. Music may also be used during such time-consuming treatment as physical therapy, deep x-ray therapy, and fever-therapy.