Music in Medicine

by Sidney Licht

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.