MUSIC IN MEDICINE
by
SIDNEY LICHT, M.D.
_Fellow, New York Academy of Medicine_
NEW ENGLAND CONSERVATORY OF MUSIC
BOSTON, MASSACHUSETTS
_Copyright, 1946, By_
SIDNEY LICHT, M.D.
All rights reserved, including
the right to reproduce this book
or portions thereof in any form.
_First Edition_
PRINTED IN THE UNITED STATES OF AMERICA
FOREWORD
In presenting a musician’s point of view on so specific a subject as
“Music in Medicine”, it seems to me necessary at the outset to clarify
the status of music as an independent aesthetic art, and its practical
adaptation for definite utilitarian purposes. We must clearly separate
the active individual process of artistic creation from the elements
of passive perception and from effects such perception may have when
applied for different realistic reasons.
Taken aesthetically, as an art, music is a social “superstructure”,
which, as far as the individual creative act is concerned, remains
an abstract manifestation of the human mind and imagination.
Its existence as a creative art is possible only as long as the
practical “possibilities” and potentialities of its effects in the
phase of passive perception, do not intrude into and interfere
with its character as an absolute non-utilitarian phenomenon in
the processes of the creative art. Art, by its very nature is a
product of individuality. As opposed to the anonymous craft, the
main requirement of an aesthetically artistic product assuming the
presence of professional skill and knowledge is that it be the work
of a human organism, which possesses acceptable qualifications of
vocation and expression. To this attribute we have given such names
as talent, genius, imagination, and many others. This phenomenon of
specific predestination must also be accompanied by a characteristic
property which has received such names as personality, individuality or
originality. It is obvious that these fundamentals of artistic creation
prevent any general or universal approach to the creative processes
which, with the exception of purely technical and formal elements of
craftsmanship and common expression of specific style, exclude the
pattern and definite utilitarian aims. All these factors are obviously
concerned only with the living moment of the musical art in the essence
and genesis of the individual creation.
Although music as a creative manifestation of the human mind does not
aim at social or utilitarian function, its materialized results may yet
find wide application in the manifold use of this aspect of passive
perception. This passive perception stimulates an active participation
by the listener in whom it may provoke definite emotional reactions
and mental modulations. If we think of music as the completed creation
of one mind, we can understand how its perception may have a genuine
influence on the listener’s mood and that it may be channeled into
desired directions which takes the forms of adaptation and adjustment.
This, in spite of the variety of tastes and reactions, can certainly be
generalized within limits by scientific methods.
Although I do not believe that music should be written for purely
utilitarian reasons (and I am speaking not of the material advantages
it may bring the artist, but of the aesthetics of creative art) I see
no reason for not using any composition to such practical advantage as
its application may offer. Music as an _art appliqué_ has been known
since ancient times in many different roles, not all as laudable and
noble as its use in healing. Its property of melodical expansion,
propulsive character, rhythmical vitality, nervous insistence, harmonic
intricacy, development in time rather than space, its wealth of moods
(which extend from static calmness to wild exuberance with an enormous
range of intermediary impressions, even in its abstract character
of pure organized sound) provokes in listeners a response which is
primarily psychological and emotional, but which frequently influences
physiology and the nervous system.
The use of music for work, marches, the stimulation of mass sentiment
or emotional impact (patriotism, war, etc.), for entertainment,
oblivion, mood change, mood creation, and background music for motion
pictures, evokes realistic responses, where music is applied for
its effect, rather than for its intrinsic value. It is therefore no
surprise that the applied use of music (which has nothing to do with
the active process of artistic creation) should be used in the care
and treatment of the sick mind and body. I do not know what subjective
responses result from such purely physical phenomena as vibration
and harmonics but I am convinced that listeners are physiologically
and psychically effected by such musical characteristics as mood,
intensity, pitch and rhythmical outline. It seems to me that the
right music should provoke remembrance and association of thoughts
and situations more easily in a mental patient than methods using
factual persuasion. Music can avoid the realistic approach and by its
absolute progression abstractly recreate a familiarity of situation
which may prove most useful in handling mental patients. By eliciting
a desired mood it may offer the physician a method of handling disease
as important as shock, and a result obtainable in no other way. To a
musician, completely unfamiliar with medicine and pathology this use
seems obvious and undeniable. Dr. Licht has made a thorough study
of this subject and has indicated some of the many uses of music
in mental and physical pathology. The work which has been based on
scientific research and clinical experience is most impressive and
encouraging. If we, as musicians, can bring our contribution to such a
wonderful purpose as healing, it would certainly be our most glorious
accomplishment for mankind, and the noblest use of our art.
But, as I have said, aesthetically it should not be the aim but the
effect of art which should be considered. If _applied use_ rather
than creation were to assume greater importance, art would lose its
essential characteristics and would become a social manifestation of
mass production instead of an abstract phenomenon. It might work out
usefully, perhaps for a time, but in losing those primordial elements
which condition its own existence, it would also lose the _effects_
which its use provoke not only in medicine but in other important
directions. The effects of music will progress satisfactorily to
the advantage of mankind only as long as it is permitted its normal
development regardless of motivations and their justifications. In
the long run it will find a greater and better use in the practical
sense, if its creation continues along traditional lines, and is not
diverted into the fallacious channel of anonymous mass production with
consequent loss of proper utility and aesthetic _raison d’etre_.
It is likely that scientific research and clinical experience will
motivate the production of musical compositions which are designed
for certain classes of patients. This will require much skill,
craftsmanship, gift of adaptation and assimilation of established
patterns as well as disciplined imagination, but the creation of
such planned utilitarian works would not be possible without the
continuation of music as a self sufficient art activated by its own
emotional and spiritual reaction and enjoyment. No derivative may
exist and progress by suppression of the source which must aliment it
continuously by its own growth and through the conservation of its
individual characteristics.
Music as an art has its own internal laws of creation and traditional
development. These laws are not casual but organic and they can not
be violated without self destruction. Consequently, the beneficial
effects of music can be applied for utilitarian purposes only if its
integrity is safe from external intervention, even if only temporarily,
and if the element of social usefulness does not influence the creative
process.
The criteria of artistic and practical values do not necessarily
coincide. Artistic value is defined only by time, the practical value
is a matter of present usefulness. Works of great artistic value may be
useful, whereas facile “hits” which fall into oblivion within a brief
period may prove extremely useful, and that is why the two conceptions
must be differentiated. Michelangelo’s _Medici Tomb_, or a Bach _Mass_
are completely useless in the practical sense of the work, and most
successful “hit-songs” are completely devoid of any artistic value
or originality. Yet both kinds supply the specific wants of those
who would lament the absence of either of them. This resolves itself
into a question of taste, educational background, musical culture and
other factors which I presume are of importance in the clinical use of
music. Patients will show preferential response to the music they like
regardless of the elements of mood, tempo, rhythm and pitch.
But classifications are always dangerous. Good music is not necessarily
useless, and useful music is not necessarily bad music. The eternal
principal of _suum cuique_ is the principle of individual human
taste which can be placed into approximate categories, but cannot be
standardized without the artificial interference of external factors.
The same principle certainly applies to music as a weapon of healing,
where selection should be determined by science but at the same time
we must strive to adapt the results of research of the individual
preferences of normal subjects.
Alexandre Tansman
Los Angeles, January 1946
CONTENTS
_Introduction_ ix
Chapter I
_History of Music in Medicine_ 1
Primitive use and the medicine man. Ancient
civilizations. Music against animal bites and mental
disease. Magic and the Middle Ages. The magic
flute. Recent developments.