MUSIC, HEALTH & the BRAIN
Lauren E. Liefland, PhD
www.DrLiefland.net
Daniel Levitin writes in This is Your Brain on Music that humans are distinguished from other living creatures by art, by symbolic representation, by music and the urge to create symbolic forms. Maybe we’re not the only ones, I don’t know what the peacock is thinking when he does a special dance in front of the female, or wolves who howl to the moon, or whales who vocalize to each other for bonding, communication, and even love – if music be the food of love, play on!
Remember Jane Goodall who did not have a PhD at the time of the inner sanctum of science and medicine in London when they thought and taught that what made us human was our ability to make tools? Then Jane saw the chimps take a sapling branch and strip it of bark, bumps and leaves to make it smooth and insert it deep into a termite hole to extract a tasty treat!
But I venture to say what does make us human is our capacity for enormous ranges of creativity through art, language, music and symbols – a need combined with a curiosity and mental capacity for endless variation and complexity.
Victor Frankel said that it was MEANING as much or more than drive for sex or power that characterizes our humanity. And that stripped of meaning we as humans are diminished or destroyed.
So what makes this philosophical poetic question meaningful to physicians and scientists used to quantifiable research?
When I was a fellow at the St Louis University School of Medicine under a clinical researcher who was a disciple of Joseph Wolpe, the emphasis on treatment programs was on quantifiable methods, and with that, ipso facto, the elimination of THOUGHT or EMOTION as a contaminant or pollutant of pure science and clinical research methods. They wanted replicability and clean numbers, not abstract - although appealing and romantic – notions of emotions, feelings, thoughts and individual creativity. This was not for HARD SCIENCE, not for the real players. Emotions were unmeasurable, OK for philosophers, artists and social studies perhaps, although even sociology majors were subjected to a mathematical model that tried hard to eliminate thoughts and emotions from analysis of human nature.
When I suggested that emotionally traumatized children could end up “bipolar” instead of just inheriting a “bipolar” gene, that the repetition of their emotional trauma and perception of danger could have an impact on their neurological wiring and effect their neuroendocrine systems, one supervisor (deep in the religion of exposure and response prevention and the uniform administration of treatment to an essentially passive patient so that all patients receive standardized quantifiable treatment) scoffed and sneered, “What do you suggest we do – dissect the brains of dead children?” This was the 1980s. I suggested we could look at elevated cortisol levels in saliva instead.
But now – voila! We can see the brain scans! We can see that music and art are measurable, are quantifiable, are intrinsic to our human functioning. That music excites more regions of the brain than almost anything – it affects motor centers, sensory perception, limbic system and brain stem, survival, love, food and pleasure centers, cerebral functioning, communication areas and alters a range of neurotransmitters like dopamine, GABA, acetylcholine and serotonin, affecting pain, sex drive, temperature regulation and blood pressure.
In this exciting time for an increased understanding of the human brain we can literally see the impact of music on our mental state. Research studies demonstrate the beneficial effects of music to enhance learning, improve mood and serve to benefit not only the individual listeners or musicians but the larger social community. Music can foster a sense of belonging, it can motivate and activate people to have courage in the face of extreme adversity and help soothe us when distressed.
It is only now that we can prove what we have known through all time that music stimulates and coordinates movement, emotion, thought and motivation. And that it is intrinsically bound up with what makes us human.
There was a period in psychological research when thought and emotion itself was considered a contaminate of scientific results, that treatments and replicable methods had to be “pure” from subjective, unmeasurable, “soft” science vagueries that spoiled experiments using “technologies” such as exposure and response prevention. It is now a hallmark of scientific method and research to show that these same aspects of our humanity are indeed scientific and replicable – as response to music and emotions generated by it have measurable effects on brain function. Not only is there response from environmental stimuli but as shown in studies at Stanford, McGill, USC, Johns Hopkins and other research centers, that we as humans generate our own inward signals from preferences, experiences and proclivities. These signals go from cortical areas to the sensory stem regions as well as coming in from them! In fact we experience music on multiple levels of the brain that all interact much like a symphony itself, more like an orchestra of interdependent instruments than a hierarchy of top-down order with unchanged primitive functions at the bottom.
Damasio at USC and Parvizi at Stanford claim that there is a cortico-central bias in neuroscience, to the neglect of the so-called lower regions of the brain such as the cerebellum and brain stem, which may not be less important or separate but integral to “higher” cognitive and emotional functioning. Alzheimer’s for example is shown to be affected by amyloid plaques and tangles in brain stem, not primarily cortical, areas. So the artificial classical neo-Darwinian notion of the hierarchical cortex directing the lower unchanged inferior subcortical areas is sadly a relic of Victorian thinking before the newer technologies helped us enlighten our understanding – the brain is more like a communication center of all the disparate areas signaling interdependently - like our planet itself! Woe to those who ignore the interdependence.
Dysregulation of emotion with pathological crying or laughter is found in patients with abnormalities or degeneration in the cerebellum. So Dasmasio, Parvisi and their team (including Damasio’s wife Hanna who co-chairs the Brain and Creativity Institute at USC and specializes in neuroimaging) conclude that emotions are also part of cerebellum function – not like previously thought, as only a primitive center for motor balance. And this changes everything; it revolutionizes our previous classical view of the brain so hierarchically structured to an interactive concept with a human mid- and hind-brain, not a “lizard” brain at all! Joseph LeDoux describes memory and emotions in “The Synaptic Self” with his elucidation of the amygdala and its role - he is also a singer and guitarist in his band the Amygdaloids!
Frances Rauscher in the 1990s published that keyboard-training caused long-term enhancement of preschool children's spatial-temporal reasoning (Frances Rauscher, Gordon Shaw, Linda Levine et al, Neurological Research, Volume 19 [1997], 2-8). A research group led by Dr. Frederick Tims, Chair of Music Therapy at Michigan State University, found that group keyboard lessons given to older Americans reduced stress, loneliness and anxiety while increasing levels of human growth hormone (hGH). Human growth hormone decrease is involved with such aging phenomena as osteoporosis, energy levels, wrinkling, sexual function, muscle mass, and aches and pains (presented at symposium Music Medicine: Enhancing Health Through Music, April 23, 1999, Miami, FL).
We can now see that musical activities are biological, not solely cultural or social, behaviors. Music receptivity is on both sides of the brain, and in multiple areas of the brain. In medical settings, music has been used widely to decrease patients' perception of pain, anxiety and depression, and boost their feelings of relaxation.
Playing music to stroke victims helps them regain their speech, memory and motor abilities more quickly. Patients who listened to a few hours of music each day soon after a stroke improved their verbal memory and mood, the researcher Sarkamo of University of Helsinki reported in the journal, Brain (Feb 20, 2008). After six weeks the patients who listened to music were twice as likely to have improved speech and verbal memory which indicates neural repair. Three months after stroke music listeners showed a 60 percent better improvement in verbal memory compared to an 18 percent benefit for those using audio books as a language medium. In addition, the researchers found that the music group experienced less depression and confusion. At three months, there was a significant difference in depression (P=0.031) and confusion (P=0.045).
Likewise in heart surgery patients, music helps to stabilize the erratic changes in blood pressure following bypass surgery. They can lower medications and achieve more stable blood pressure.
Cancer patients have shown improvement in subjective experience of pain and depression. A study from University of Rochester showed that bone marrow transplant patients, who are often hospitalized for a month or more, experienced fewer side effects of treatment, which often involved pain, nausea, fatigue, anemia and dehydration. Music also helped reduce feelings of isolation.
Musical abilities are among the last to be lost with stroke or brain injury and disease. Elderly patients with Alzheimer’s become more animated with improved attention by their favorite melodies, which often bring back memories and increased awareness. Oliver Sacks writes movingly of patients who have lost most of their immediate and delayed memory but can focus attention and regain verbal fluency with music and lyrics they recognize. The man “who mistook his wife for a hat” had, with advanced Alzheimer’s, lost his recognition of words or how to dress himself, but could perform these tasks and word recall with songs. Dr. Sacks describes and I have witnessed Parkinson’s patients move more freely to music.
Surgical procedures have been shown to be less stressful for patients who listen to music. A study of 500 patients who had major abdominal operations found those who listened to music as well as taking painkilling drugs had much less discomfort. The type of music did not matter as much as patients’ preferences.
Older adults who listened to their choice of music during outpatient eye surgery had significantly lower heart rate, blood pressure and cardiac work load than patients who did not listen to music according to a study by researchers at the University at Buffalo.
Studies at the University of London show a regular sing-along can reduce the risk of heart disease by lowering levels of stress hormones and giving the cardiovascular system a stimulating workout. Singing has physical benefits because it is an aerobic activity that boosts oxygenation in the bloodstream and exercises major muscle groups in the upper body. Perhaps churchgoers and religious circles have known this for centuries.
In some medical settings music therapy has been used widely to decrease patients' perception of pain, anxiety and depression, and boost their feelings of relaxation. It's also used in hospice to comfort terminally ill patients. But it's not commonly used in mental health units, ironically, where music could be helpful in both inpatient and outpatient settings!
Exercise is known to improve physical and mental health, enhance brain function and energy levels, but music combined with exercise is even better! Italian researchers found that subjects who exercised with upbeat music had lower blood pressure and heart rate than those in the group who worked out without music. Music helps with exercising or any prolonged physical exertion as was always known by men working in the fields, women making tortillas, prisoners on chain-gangs and soldiers on long marches. There are multiple neurotransmitters and hormones that music stimulates to dull pain (opioids), to increase pleasure (dopamine), to raise energy levels (adrenaline) and to improve mood (serotonin).
With the mounting body of research demonstrating physical and mental health benefits at such a low cost in terms of equipment, staffing, overhead and side-effects, it would be surprising indeed if insurance companies and health institutions did not implement music therapy for a wide range of medical and psychiatric problems.
We must honor and take into consideration a person’s preferences and tastes, and know that the music can stir and rekindle memories and emotions, movements and motivations. It has a measurable and palpable effect on blood pressure, stress hormones, heart muscle and motor response, and neurotransmittes that stimulate emotions.
Music therapy has been used in Uganda to help heal the trauma of brutal war and atrocities, much of which was inflicted upon, and by, children made to act as “soldiers” or sex slaves. When these children can play an instrument and sing again they experience a rebirth of hope, they participate in a community that builds instead of destroys and nourishes positive goals.
So let me close with the New York Times story and photograph of a young Palestinian violist, member of Jenin youth orchestra, playing for Isreali Holocaust survivors. One older woman began clapping her hands to the Darbouka drum…. Music can transcend all cultures and unite us in our humanity, soothe our fears and anxieties, lower blood pressure and improve immune systems, stimulate growth of cells and regeneration, improve learning and cognitive function, and yes, have implications not only for mental and physical health, not only for education and learning, but for intercultural understanding and public policy.
Perhaps my dear pianist friend Lennie, who was hit by a car and lay in a coma for a month, could have been listening to music, to his favorites like Art Tatum and Louis Armstrong. Our voices are like music too – as psychiatrists, physicians and health providers we can be more aware of this in our interactions with patients.
"Music begins where words end," Goethe noted, 150 years before brain imaging showed us. Others like Mark Tramo of Harvard believe that music and rhythm preceded language. Whatever the case music has always been an integral part of human life, an agent of healing, inspiring, bonding and expressing our deepest feelings and yearnings.
"Thou holy art how oft in hours of sadness,
When life's encircling storms about me whirled,
Hast thou renewed warm love in me and gladness,
Hast thou conveyed me to a better world,
Unto a happier better world."
(First stanza from "An Die Musik (To Music)," by Franz Schubert, English translation by Gustave Reese)
Lauren Liefland, PhD
