Chapter XI

_Direction_ 118

Medical direction. Qualifications and duties of

the hospital musician. Training program and curriculum

for music aides.

_Bibliography_ 125

_Index_ 129

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.

FOOTNOTES:

[I.] _Pythagoras passed a black-smith shop one day and was struck

with the beauty of the two sounds he heard coming from it. He entered

the shop, studied the sounds closely and found that the two notes

were an octave apart. This observation stimulated him to a detailed

study of music which led to his musical philosophy. He believed that

all nature and knowledge were contained in harmonic numbers, and that

the world had been made in a musical harmonic accord. He invented a

sacred quartenary of harmonic numbers to explain the phenomena of life.

But Roussier believed that Pythagoras adapted his system from the

Chinese._[70]

_CHAPTER ONE_

HISTORY OF MUSIC IN MEDICINE

“Music exalts each joy, allays each grief,

Expels Diseases, softens ev’ry pain,

Subdues the rage of poison and the plague,

And hence the wise of ancient days ador’d

One pow’r of Physic, Melody and Song.”

“_The Art of Preserving Health_”

by John Armstrong (1709-1779)

In many fields of endeavor a scholar occasionally appears who not only

makes a personal contribution to the knowledge and advancement of his

subject but summarizes previously gained information so well that

his work becomes at once a milestone and a beacon. In the field of

music, such a man was Charles Burney, who began to publish a _General

History of Music_ in 1776. This book was so thorough and scientifically

critical that his conception is as modern as tomorrow. After listing

all the instances of music as a therapeutic agent, he concludes:

“Yet men delight in the marvellous; and many bigoted admirers

of antiquity, forgetting that most of the extraordinary effects

attributed to the music of the ancients had their origins in poetical

inventions, and mythological allegories, have given way to credulity

so far as to believe, or pretend to believe, these fabulous accounts,

in order to play them off against modern music, which according to

them, must remain in a state far inferior to the ancient, till it can

operate all the effects that have been attributed to the music of

Orpheus, Amphion and such wonder-working bards.”[15]

It is well to begin a study of music in medicine with Burney’s

restrained enthusiasm lest we fall into the error of building

impossible temples of healing on the thin ice of untested claims. We

shall begin with prehistoric times.

The use of music against disease is as old as music itself. In

fact, early history of music is intimately associated with healing.

The wishful thinking of primitive peoples called upon magic for

assistance, and magic is almost universally associated with words,

chanted words, in rhythmic incantation. Chateaubriand believed that

the chant was the offspring of prayers. Among primitive peoples, the

medicine-man combined the offices of priest, physician and magician,

and although all three functions were closely related, their functions

were dissociated on occasion. For instance, there were special songs

for the invocation of natural phenomena, for group activities, and

for accompaniment of healing rituals. “The belief in the efficacy of

musical magic is one of the most important facts in the history of

civilization.”[19]

Although no records exist, it is fair to assume that the truly

primitive peoples of today have not changed markedly from their

ancient customs, and that they resemble to some extent the status of

prehistoric men. The universality of certain folkways among widely

scattered tribes of primitive peoples today lends validity to this

theory.

For such studies we need look no further than our own continent. Even

though certain magical practices have been banned by law, the American

Indians number amongst their tribesmen, those who remember and to some

extent still use music in healing. Several investigators have become

interested in this study, but chief among them is Frances Densmore who

has analyzed and recorded the songs of many Indian tribes. Among the

Teton Sioux she found[21] that the sick appealed to the tribal medicine

man who gave the case some thought and claimed to find the cure in

dreams. “All treatment of the sick was in accordance with dreams.” The

patient was then placed in a dark tent and the medicine man sang his

dream song, as well as songs addressed to the sacred stones. The use of

herbs of the agency of magic might accompany the song. An example of

one of the songs used to cure wounds has the following text:

“Behold all these things

something elk-like

you behold

you will live”

Words like these have a certain sophistication which we may assume

constitutes a more recent development.

For many centuries primitive peoples have had different concepts of

the exact nature of disease, but for many of them it connotes some

connection between a demoniacal spirit and counter-spirits. There were

a great many methods employed to drive out the evil spirits. The idea

that music was efficacious in these cases persisted for centuries.

Martin Luther said, “The devil is a saturnine spirit and music is

hateful to him and drives him away from it.”

Densmore points out that among the Iriquois[22] the word _orenda_ is

used to designate the universal indwelling spirit. Nothing was regarded

by the Indian as supernatural, in our use of the term, but many Indians

desired an _orenda_ stronger than their own. When a medicine man began

to treat a sick person the result depended upon the power of his

_orenda_. _Orenda_ could be put forth in song. Those who possessed

_orenda_ strong enough to do wonderful things were called medicine men.

They were consecrated to their work, and the safety, success and health

of their people depended on their efforts.

In completing her analysis of Indian medicine songs, Densmore concludes

that they suggest “the confidence which the medicine man felt in his

own power, and which he wished to impress on the mind of his patients.”

Wallaschek[79] lists many examples of the healing use of music among

primitive tribes. Among the Wasambara in East Africa, the doctor

arrives with a small bell in his hand which he rings from time to

time. The patient sits before him on the ground and the doctor begins

speaking in a singing tone: “Dabre, dabre.” He repeats this several

times and the patient sings a simple response. In Australia, Wallaschek

found a tribal doctor shaking a bundle of reeds, an action otherwise

used during a song to mark time. In Borneo, the natives perform

recitatives and songs in order to catch the soul of the patient which

is supposed to have run away before the evil spirit. The Wallawalla

Indians in this country believe that song influences the cure of a

patient, and all the convalescents are directed to sing for several

hours daily. In British Columbia the doctor sings when he visits the

patient, while a chorus of people intones a song outside the house.

With the dawn of civilization, intellectual activity became more

progressive but folkways die hard.

“The ancient Egyptians called music ‘physic for the soul,’ and had

faith in its remedial virtues. We may presume that the incantations

presented in the medical papyri were likewise to be emitted with the

proper voice and therefore contain an element of music. The Persians

regarded music as an expression of the good principle Ahura-Mazda

and are said to have cured various maladies by the sound of the

lute”[24]. “The Lacedemonians agreed with the Egyptians and confined

the possessors of music to one family, and their priests like those

of Egypt were taught medicine and music, and initiated into religious

mysteries”[28].

The martial and moral values of music were appreciated by most of the

early civilizations. Both Confucius and Plato believed that music

was the most certain means of reforming public mores and sustaining

them at a high level.[25] Although many histories on effects of music

quote the scripture as evidence of the Hebrew use of music in healing,

the passage quoted[63] is subject to various interpretations. It

simply says that after listening to David play on the harp, Saul was

“refreshed and well,” this could refer more to loss of fatigue than

cure of a disease.

The great poets have always sung the praises of their beloved sister

muse. In Homer there is a story relating how the flow of blood from

Ulysses’s wound was stopped, charmed by the use of music.[13] Now it

is very possible that the blood of the famed warrior coagulated in its

wound during a musical interlude, but then, all wounds except those

involving a large artery will cease bleeding in about twenty minutes.

Homer also stressed good music and song as a means of elevating the

spirit and of overcoming depression of the soul or mind, agony,

anguish, anger and sorrow. He gives as an example the story in which

Chiron heals the sick with melody.[57] Cato[13] spoke of luxated

joints which were eased by the harmony of sound. We cannot be sure

of the diagnostic acumen of the observer, but for active people the

most common traumatic joint trouble is a “locked” knee. Most knees

which contain disturbed cartilage will unlock after a relatively short

period of rest. In each of these instances, music was an environmental

coincidence. Such observations would only begin to assume scientific

medical value if they could be repeated many times under identical or

similar conditions. They were not.

We may now return to the episodes related by Burney in his commentary.

Martianus Capella, an ancient author on music, assures us that “I have

often cured disorders of the mind as well as the body with music”[58].

He also claimed that the Aesclepiades, the state-recognized priests

of medicine, cured deafness by the sound of the trumpet. “Wonderful,

indeed!”, says Burney, “that the same noise which would occasion

deafness in some should be a specific for it in another.” In Plutarch’s

book _De Musica_ it is related that Thaletas the Cretan delivered the

Lacedemonians from the pestilence by the sweetness of his lyre.

“Thaletas, a famous lyric poet, appeared by command of an oracle and

all the songs he sang were prayers to the Gods. The disease probably

reached its highest pitch of malignity before he came, and began to

subside with his coming; but its disappearance was attributed to the

music of Thaletas.”

Many other cures are cited. Xenocrates employed the sound of

instruments in the cure of maniacs; and Appolonius Dyscolos claimed

that music was a sovereign remedy for dejection of the spirits and a

disordered mind, and that the sound of a flute would cure epilepsy and

sciatic gout. Athenaeus rendered the cure for gout more certain by

playing music in the Phrygian mode, while Aulus Gellius insisted that

the music be soft and gentle, the opposite of the furious Phrygian.

Coelius Aurelianus introduced a concept which reappeared at several

widely separated times. He called it _loca dolentia decantare_,

or enchanting the disordered places. He claimed that the pain

was relieved by causing a vibration in the fibres of the affected

part. There is little doubt that music causes a physical vibration

of the air, but the force that such vibrations could have on most

tissues is negligible. Other writers recommended that the instrument

be held against the part to be treated for direct transmission of

the vibrations, but if physical excitement is desired this can be

accomplished more uniformly by applications known as manipulation or

massage. Such manipulations are known to be helpful in some conditions,

but not curative in painful conditions such as sciatica.

Nearchus, who accompanied Alexander the Great in his conquests,

reported that in India the only remedy against the bite of a serpent

was a chant[70]. Galen, one of the soundest physicians of ancient

Rome, recommended music as an antidote to the bite of vipers and

scorpions[7], and for centuries music was recommended for the bite of

a tarantula. In the seventeenth century three physicians named Mead,

Burette and Baglivi explained this use of music. They said that it

threw the patient into a violent fit of dancing which brought out a

plentiful perspiration, and with it the poison. Since perspiration

consists of water and a few simple salts, such activity would increase

the concentration of the poison in the circulating blood, and neither

the explanation nor the treatment is acceptable[28]. Music was

recommended not only for the bites of the reptiles and insects; Desault

recommended it in the treatment of hydrophobia[23]. Not all bites

are poisonous, and it is likely that in the case of the two patients

mentioned the cure was more for fright than bite.

The effects of music on the mind were too obvious to escape the

ancients. When the armies of Greece took the field, they were

accompanied by the best musicians, who by their martial strains

inspired the soldiers with a kind of mechanical courage never

experienced by their enemies.

The distinction between mental health and disease was not advanced

among the ancients, but they did recognize varieties of insanity such

as delirium, melancholy and mania. Many physicians recommended music in

the treatment of mental disease, and Quarin spoke of a single case of

epilepsy cured by music. With the exception of severe epilepsy, many

patients who suffer from the symptoms which bear this name have only

occasional attacks and these disappear spontaneously, making the music

simply another coincidence.

* * * * *

Celsus, who was a great medical authority not only in his own time

but in subsequent centuries wrote of the mentally ill, “We must quiet

their demoniacal laughter ... and sooth their sadness by harmony, the

sound of cymbals and other noisy instruments”[16]. Areteus, another

great physician of ancient Rome, prescribed music for “corybantism,

a disease of the imagination”[24]. The great Dutch physician,

Boerhaave[11], said, “I do not know if all that one tells us of the

charms and enchantments could not be attributed to the effects of

music, in which the ancient physicians were well versed.” References

continued to appear concerning the magical relationship between music

and healing. Robert Grosseteste (1175-1253 A.D.) said that disease and

even wounds and deafness could be cured by music based upon a knowledge

of astrology and mathematics[75].

* * * * *

During the early part of the Christian Era, most of the arts were

sustained by the Church, and as a result the finest works in painting

and music were available to the average man only within places of

worship. Not until the Renaissance did serious music take on a secular

character. Music until then was largely identified with religion, and

as such was considered to have an influence on the soul. Bacon advanced

as a rule of health that people “recreate their spirits every day

with a piece of good music.”[13] He went a step further in his _Sylva

Sylvarum_.

“Seeing then the mind is so powerful an agent in particular disease,

I see no reason why the efficacy of music should not be tried in many

disorders which arise in the animal constitution; for music composes

the irregular motion of the animal spirits and more especially allays

the inordinate passion of grief and sorrow.”[7]

The restful and joyful qualities of music were praised by Shakespeare:

“But sweet music can minister to minds diseased

Pluck from the memory a rooted sorrow

Raze out the written troubles of the brain

And with its sweet oblivious antidote

Cleanses the full bosom of all perilous stuff

Which weighs upon the heart.”

Henry Beacham wrote in his “_The Compleat Gentleman_” in 1634 that

“the exercise of music is a great lengthner of life, by stirring and

reviving the spirits, holding a secret sympathy with them; besides

the exercise of singing opens the breast and pipes; it is an enemy

to melancholy and dejection of the mind, which St. Chrysostome

truly called ‘Devil’s Bath’. Besides the aforementioned benefit of

singing, it is a most ready help for a bad pronunciation, and distinct

speaking, which I have heard confirmed by many great Divines; yea, in

myself have known many children to have been aided in their stammering

in speech by it alone.”

In the dark ages there was very little added to the knowledge of

medicine, but during the Renaissance physicians became more progressive

and articulate. Among these was the famous Willis who said that

“Music not only is a delightful phantasy, but dispels sadness from

the grieving heart; and it also allays fevered passions and excessive

commotion of the breast.”[81]

Characteristic of the use of music as an aid to healing is an anecdote

quoted by Burney. Farinelli was one of the great operatic singers of

his day and his fame was equally great in all of western Europe and

England. One of the countries he visited was Spain. “It has often been

related, and generally believed, that Philip V. King of Spain, being

seized with a total _dejection_ of spirits which made him refuse to be

shaved, and rendered him incapable of attending council or transacting

affairs of state; the Queen who had in vain tried every common remedy

that was likely to contribute to his recovery, determined that an

experiment should be made of the effects of music upon the King, who

was extremely sensible to its charms. Farinelli was summoned and on his

arrival her Majesty contrived that there should be a concert in the

room adjoining the King’s apartment, in which the singer performed one

of his most captivating songs. Philip appeared at first surprised, then

moved; and at the end of the second air, made the virtuoso enter the

royal apartment. He plied him with compliments and caresses and asked

him how he could sufficiently reward such talents, assuring him that

he could refuse him nothing. Farinelli, previously instructed, only

begged that his majesty would permit his attendants to shave and dress

him, and that he would endeavor to appear in council as usual. From

this time the King’s disease gave way to _medicine_, and the singer

had all the honor of the cure. “The King,” according to the _London

Daily Post_ of September 26, 1736, “settled a pension of 3,150 pounds

sterling, per annum, on Signor Farinelli, to engage him to stay at

court.”

A great number of references during the sixteenth and seventeenth

centuries attests to the wondrous workings of music against mental

disturbances. Wilhelm Albrecht[1] reported a patient who was suffering

from melancholia. Many remedies had been tried, when as a last resort

the physician requested that a certain _ritournello_ be played. As

soon as the patient heard it, he began to laugh with all his might

and hopped out of his bed completely cured. More interesting is the

observation of Champlain[17] who wrote on his return from America, “It

is the custom in America when one is sick, to divert them with loud

music, to prevent brooding about the condition and thus help restore

health.”

Mozart was not the first to call the flute “magic.” To Democritus was

attributed the story of abolishing plague with its music. Jean-Baptiste

Porta claimed that one could cure all disease with music, provided

that one used a flute made of the wood of the plant which was a known

specific for the disease to be treated. Thus one could cure mental

disease with flutes made of hellebore stems. One could return some

vigor to the impotent with flutes made of orchid stems, and fainting

could be cured by playing on a flute made of cinnamon wood.[67]

Philippe Pinel, the physician credited with being the first to accord

the mentally ill humane treatment reported at least one instance of the

use of music in the treatment of epilepsy.

“During the attacks, the sense of hearing, far from being deadened,

seemed to have acquired more keenness. A skilful musician played on

the violin at the patient’s side during her paroxysm. Although she

then appeared insensible to the charm of music, she was so strongly

effected by it, that she admitted after having recovered entire

consciousness, that the music had thrown her into a state of rapturous

delight.”

Literature abounds with many accounts of the use of music by lesser

medical lights. Sauvages[18] mentioned a young man who had attacks of

intermittent fever accompanied by violent headaches which could be

soothed only by the sound of a drum played loudly. This same patient

did not like music when in good health. Instances of this nature may be

explained on the basis of counter-irritation, wherein a new disturbance

superimposed upon an old one may counteract it.

In the eighteenth century, Brocklesby[13] summarized the known

literature of music in relation to health and disease and, considering

the status of medicine in his day, made a fair appraisal of its value.

During the last century Hector Chomet[18], a Parisian physician, became

interested in music and its application to disease. He wrote a short

article setting forth his views, which he was to deliver to a group of

medical men in Paris, but was put off time and again by his colleagues

and by political upheavals. Each time, before replacing his paper on

the shelf, Chomet made additions. This work grew to be the important

thing in his life, and when he could contain himself no longer, he

published a book on the subject which showed considerable research

but which unfortunately contained as much invention as fact. Not

content with the known and proved existence of blood and lymph as the

chief body fluids, he added another--the “sonorous fluid,” which was

influenced for the good or bad by the vibrations of musical sounds.

At about the turn of the century Eva Vescelius, a woman of great charm,

beauty and perseverance, reintroduced the use of music for mental

disease under the guidance of a physician. There is little doubt that

she gave great joy to many patients, but a differentiation must be made

between personal attention and therapeutics. In her works[78] on the

subject one can read enthusiastic accounts of past performances, but

unfortunately her explanations and claims are pure phantasy, to wit:

“For fever, high pulse, hysteria, arrest the attention, play softly

and rhythmically to bring pulse and respiration to normal. Tests

with instruments will prove that music will do this. Do not change

too abruptly from one key to another; modulate and pause and let the

musical impression be absorbed. Select songs that depict green fields

and pastures new, the cool running brook, the flight of birds, the

blue sky, the sea.

“Fear is dissipated by music awakening in the listener the

consciousness of the all enveloping Good. A high nervous tension is

relieved and nerves are relaxed under the spell of a composition that

swings the body into normal rhythmic movement. Sluggish conditions

of body and mind are eliminated by the rhythmic waltz, polka or

mazurka--music affecting the motor system. Insomnia is cured by the

slumber-song, the nocturne, or the spiritual song that assures one of

the Divine protection.”

The use of music in hospitals is by no means limited to the application

to mental disease. Recreation is needed to avoid boredom, for as

Shakespeare said:

“Sweet recreation barr’d, what doth ensue

But moody moping and dull melancholy

Akin to grim and comfortless despair

And at her heels a huge infection troops

Of pale distemperatures and foes to life.”

The use of music as a diversion in hospitals received a great impetus

in the First World War but made its greatest leap forward with the

introduction of the portable bedside radio.

The use of music as an exercise for poorly moving joints and weakened

muscles is recent and may be said to have received its great impetus in

the Second World War (described in the Boston Sunday Post, February 11,

1945; A-5).

_CHAPTER TWO_

PHILOSOPHY AND PSYCHOLOGY OF MUSIC

I

In the realm of thought, opinions and theories sometimes find credence

long after they have been proved incorrect. In the field of the arts,

opinions may become so strongly rooted that there is occasional

resistance to any analytical attempts designed to disprove them, and

even after they have been exposed, there will be a significant number

of people who will continue to believe in them. The artist who would

make music for patients must approach such an endeavor with a full

knowledge of the elements involved, and should be willing to recognize

those prejudices, customs and thoughts concerning the effects of

music on the human body which have been fostered by well-meaning, but

misguided, enthusiasts. We must differentiate between the philosophy of

esthetics and the proved psychology of music. Musicians who refuse to

accept those results of scientific research which disagree with their

personal views will fall into the same difficulties which have beset so

many musicians in the past who have desired to help patients.

Before the advent of laboratory psychology, there was no satisfactory

test for the theories which dealt with music and the mind, and the

number and variety of theories advanced were great. Some of the most

unreasonable were the most attractive, and it is easy to understand

why they were accepted. But if any of these theories is used as a means

of attaining a scientific end it cannot succeed with any dependability

if it is unsound.

The psychologic effects of sound may be physiologic or intellectual.

They may be related to intensity, quality or direction on the one

hand, or to past or present mental associations on the other. To the

primitive man thunder, which seems to come from everywhere and is

louder than anything he can produce, is terrifying and supernatural;

the rustling of leaves is frequently caused by the wind, but from his

past experience may also instil the fear of the approaching enemy.

Sound is often frightening from its qualities or implications.

The psychologic reaction to the type of sound known as music may vary

from the reflex panic produced by the air-raid siren to the soothing

effect of a softly sung lullaby. For some people, certain musical

selections elicit almost no response, while in still others a truly

amazing chain of mental images results. The latter reaction is the

result of centuries of evolution in the development of music and

knowledge, and will be discussed later.

During the modern evolution of musical composition, many new forms

were devised bearing descriptive names. Some of these forms by their

distinctive tempo, dynamics, or title conditioned the informed

listener to a mental attitude consistent with the intention of the

composer. Some selections by the very nature of their execution cause

stimulation or assist repose. Superficially it might seem, therefore,

that the controlled administration of music could evoke desired moods

in listeners at will, and some practitioners declared that music is a

specific treatment for mental disease. It is undoubtedly possible to

influence the mood of healthy, trained musicians by the use of selected

compositions but to assume that all listeners will react in similar

fashion, or that the moods of the mentally deranged can be changed at

will by prescribed music, is to ignore the nature of mental disease and

the scientific finding of psychologists.

Music is many things, but physically it consists of sounds or notes

which have pitch, intensity, timbre and duration. These notes are

combined in patterns which have rhythm, tempo, melody and harmony and

these in turn are related to key, mode and form. Each of these elements

has been the subject of philosophic interpretation, and more recently

of psychologic investigations. Although the effect of music on the

human mind depends upon the reaction to the entire composition, it is

important to review the existing data in order to understand more fully

the effects of music, in spite of the difficulties; for as Ortman[71]

has said “the problem of analyzing and classifying responses of music

into types is at the same time intensely interesting and notoriously

difficult. The history of the problem is rich in unco-ordinated data

and poor in clear-cut conclusion.”

II

ELEMENTS OF MUSIC

_Pitch._ Heinlein[45] found that the same chords which called forth a

happy and bright feeling when played in high pitch were characterized

as gloomy or melancholy when played in low pitch. The voice of youth

and laughter is higher pitched than the grumbling of old age and may

be a conditioning factor. Beaunis[8] felt that the reaction to pitch

is the effect of experience and custom and cited a reversal among

Orientals in whom low pitched sounds effect joyous reactions and the

high, sadness and sorrow.

_Intensity._ Heinlein found that loud chords are rarely soothing, and

soft chords are almost always soothing. Beaunis stresses the fatiguing

quality of great intensity over a long period, and contrasts it with

“Very soft sounds as in Schumann’s ‘Danse des Sylphes’ ... which holds

you under the charm of delightful emotion.”

_Timbre_ is the quality of sound which identifies it with the

instrument of its production. Although many instruments can be

convincingly gay or subdued, most authors are agreed that some

instruments emit prejudicing tones. Chomet[18] considered the bassoon

mournful, the flute tender, and the trombone harrowing. He found that

the clarinet expresses grief, the oboe suggests reverie, but that the

violin “seems suited to express all sentiments common to humanity.”

Mursell[60] finds consistent tactile values in tone. Low tones are dull

and high tones cutting. He speaks of the French horn as smooth, the

piccolo sharp, the oboe as stringent, the cello velvety and the bassoon

rough.

Gundlach[38] believes that the timbre of an instrument is significant

in mood response. He finds the brasses triumphant and grotesque,

never melancholy or tranquil, delicate or sentimental; the woodwinds

mournful, awkward, uneasy, never brilliant or glad. The human voice

also has timbre, and distinctive values. There is the dramatic quality

of Marian Anderson and the syrupy flow of Bing Crosby; the virility of

the basso and the sparkle of the coloratura.

_Duration._ The sounding of a single note will attract attention,

but if the note continues for a sufficient period without changing

its characteristics it will become monotonous, annoying and finally

exasperating. If the sound is interrupted at equal intervals, this

reaction will take longer to develop, but if the intervals between them

are irregular, interest is sustained, especially if these variations

occur periodically; that is, with a certain rhythm.[8]

_Rhythm._ It is possible to have music without rhythm, but as

Rameau[68] pointed out long ago, “Music without rhythm loses all its

grace.” Since percussion instruments probably preceded all others,

rhythm was the first stage in the evolution of music. The proponents of

the motor theory of rhythm feel that muscular response to music with

pronounced rhythm is a physiological reflex. They point out that it is

difficult to walk deliberately out of time to a well accentuated march,

and Dunlap[26] has shown that in reclining subjects “With the utmost

possible relaxation of the entire body, good rhythmic grouping of an

auditory series can be obtained.” With the aid of the electromyograph

Jacobson[50] has shown that in complete relaxation mental activity

results in fleeting but specific muscle contractions invisible to the

eye and unknown to the subject.

Rhythm perception is a mental stimulant. Reade[69] observed that

African negroes when ordered to row a boat always began to sing as an

aid to overcome their natural laziness. Bücher[14] believed that rhythm

as exemplified in working songs facilitates the synchronous expenditure

of energy by individuals engaged in a common task.

Although rhythmic song will not necessarily elicit obvious motor

responses in all subjects, the wide-spread use of work songs among

groups of people engaged at hard work on land or sea throughout the

world is indicative of the value of background rhythm for communal

effort. Mursell[60] believes that “any notion that pure or ‘naked’

rhythm is more effective than rhythm clothed in tone is open to very

serious doubt.” But the chief effect of marked rhythm is the feeling of

excitement and happiness which it can arouse. Rhythm gives us a certain

pleasure because of its orderliness to which the mind is sensible.

_Melody_ as a musical element contributes chiefly to restfulness.[71]

If it is simple and recognizable it will recall other times and rest

the mind from the thoughts of present problems. If it is complex and

new it will distract the more musical but have a less desirable effect

on the uninterested.

_Mode._ The term _mode_ is applied to the arrangement of whole and

half-tones in the musical scale construction. Of the many possible

modes only two are used in our present system of music, the _major_

and the _minor_. There is only one form of the major mode, and it is

the one most people recall when they think of the scale. There are

three forms of the minor mode, but of these the _harmonic_ is the most

frequently used. It is formed by lowering the third and sixth notes by

a half-tone.[80]

When an author pioneers convincingly in a field which has long needed

clarification, it is likely that even his questionable remarks will

be accepted with the same degree of authority as his scientific

statements. In 1722, Rameau[68] published a treatise on harmony which

received wide acceptance because of its excellence and comprehension,

but in that work he prejudiced many of the writers who followed into

believing that the major triad was more pleasing and beautiful than the

minor. This concept was not only adopted but embroidered. Hauptman[44]

likened the minor triad to the branches of the weeping willow and

hence attributed to it a mournful downward drawing power. To the major

triad he assigned the property of an upward driving force. (When this

is taken literally, as it was, and applied to the patient, we can see

clearly why remarkable attributes were claimed for music.)

Now there is little doubt that if the triad of C minor is struck on a

piano after that of C major, most people will describe the sensation

elicited by the sound of the minor chord as melancholy. Helmholtz[46]

attributed the veiled or sad effect of a minor chord to certain notes

foreign to the chord which physical reasoning expects.

“The foreign element thus introduced is not sufficiently distinct to

destroy the harmony, but it is enough to give a mysterious obscure

effect to the musical character and meaning of these chords, an

effect for which the hearer is unable to account, because the weak

combinational tones on which it depends are concealed by other louder

tones, and are audible only to a practiced ear.”

But Gurney[40] refuses to admit to a sense of melancholy in this slight

dissonance, for as he points out

“the same slight degree of dissonance as exists in the minor triad

may be made to supervene on a major triad, by adding to it a certain

extremely faint amount of discordant elements: it would seem then

that the major triad thus slightly dimmed or confused ought to sound

melancholy, but it does not in the least. Another argument may be

found in the following fact. The minor triads of D and A are of

perpetual occurrence among the harmonies of C major; and yet they do

not seem then to convey the distinctly pathetic impression, instantly

produced by the appearance of the C minor triad.

“Music in a major key may be profoundly mournful; and it would

often be impossible for any description to touch the musically felt

difference between such music and mournful minor music. The minor mode

has a somewhat more constant range of effect.”

Such discussions continued until Valentine[76] decided to test the

mood effect of the modes on a group of listeners. He found that

“major intervals are described as sad or plaintive twice as often

as the minor.” Heinlein[45] not only substantiated this but found

that intensity was the dominant modifier of feeling. He reviewed

more than twenty-five hundred compositions for beginners and among

them found only seven per cent written in the minor mode. “It is a

difficult matter to obtain a composition in the minor mode written

for children that does not have a title which relates to the weird,

the mysterious, the sad and the gloomy. Apparently composers in their

attempts to differentiate the modes for children fall victim to the

method of introducing titles opposite to feeling content. To children,

the title of a composition is a very outstanding feature. It may be,

after all, that reaction to the modes is largely a question of the

extent to which association with descriptive titles of a specific

variety first establishes the affective impressions in the mind of

the beginner.” Thus it can be seen that composers have been nurturing

an old philosophy by titles rather than music. Beaunis has shown that

although among European composers, the major mode has been used for

bright and restful passages and the minor mode has been used for uneasy

and stirring selections, a study of the music of other races will

uncover an entirely opposite use. Hevner[47], in an elaborate series of

controlled studies, concluded that “all of the historically affirmed

characteristics of the two modes have been confirmed” but admits that

“in producing its effect on the listener, the mode is never the sole

factor.”

In a later study Hevner[48] continues to maintain that modality is

effective in the dimensions of sadness and happiness but quite useless

in the dimensions of vigor, excitement and dignity.

The reaction to mode is influenced by what has been heard immediately

previously, and by musical training. The reaction to mode is not

physiologic but offers one key to music for patients in that those who

identify the minor mode with sadness should not be given such music

when gay music is indicated.

_Key._ There was a time when particular keys were credited with

emotional powers. Lest such thoughts still persist, the following

quotation from Gurney[40] is offered.

“Particular keys are sometimes credited with definite emotional

powers. That certain faint differences exist between them on certain

instruments is undeniable, though it is a difference which only

exceptional ears detect. The relations between the notes of every key

being identical, every series of relations presenting every sort of

describable or indescribable character will of course be accepted by

the ear in any key, or if it is a series which modulates through a set

of several keys, in any set of similarly related keys. But as it must

have a highest and a lowest note it will be important, especially in

writing for a particular instrument, to choose such a key that these

notes shall not be inconvenient or impossible; and also the mechanical

difficulties of an instrument may make certain keys preferable for

certain passages. Subject to corrections from considerations of this

sort, the composer probably generally chooses the key in which the

gem of his work first flashes across his mind’s eye: and when the

music has once been seen and known, written in a certain key, the

very look of it becomes so associated with itself, that the idea of

changing the key may produce a certain shock. But the cases are few

indeed where, had the music been first presented to any one’s ears in

a key differing by a semitone from that in which it actually stands,

he would have perceived the slightest necessity for alteration; and

as a matter of fact when a bit of music is thought over, or hummed

or whistled, unless by a person of exceptionally gifted ear it is

naturally far oftener than not in some different key to that in which

it has been written and heard. Even the difference most commonly

alleged, between C major as bright and strong and D flat as soft and

veiled, comes to almost nothing when a bright piece is played in D

flat or a dreamy one in C.

“That a variety of emotional characters can be definitely attributed

to various keys is a notion so glaringly absurd that I would not

mention it, were it not that it is commonly held; and that such

doctrines are really harmful by making humble and genuine lovers of

music believe that there are regions of musical feeling absolutely

beyond their powers of conception.”

In an unnamed manual the following statements occur:

“C major expresses feeling in a pure, certain and decisive manner.

It is furthermore expressive of innocence, of a powerful resolve, of

manly earnestness, and deep religious feeling.

“G minor expresses sometimes sadness, sometimes, on the other hand,

quiet and sedate joy--a gentle grace with a slight touch of dreamy

melancholy--and occasionally it rises to romantic elevation. It

effectively portrays the sentimental, etc. Another author, quoted by

Schumann, found in G minor discontent, discomfort, worrying anxiety

about an unsuccessful plan, ill tempered gnawing at the bit. ‘Now

compare this idea,’ says Schumann, ‘with Mozart’s Symphony in G minor,

that floating Grecian Grace.’ He quotes from the same writer that E

minor is a girl dressed in white with a rose-colored breastknot.

“These are but abstracts, and a good deal of the humor is lost by

selection. For the ‘characters’ of several of his keys the author

gives a list of examples the choice of which, inasmuch as every

possible character might be exemplified from compositions in every

single key, cannot have been very difficult. It is something like

proving that Monday is a day ‘especially full of melancholy,’ on

the ground that some individual lost a relative on it, or that the

characteristic of Thursday is ‘confidence and hope,’ on the ground

that on it an individual came in for a fortune.

“These thoughts are similar to that of the Chinese philosopher who

traced the five tones of the old Chinese scale to the five elements,

water, fire, wood, metal and earth.”

_Tempo._ “The idea of forcing emotional characteristics on tempo is not

less preposterous than those on key. (Gurney quotes further ideas of

the same writer.)

“The common time expresses the quiet life of the soul, an inward peace

but also strength, energy and courage.

“The three-eight time expresses joy and sincere pleasure; but its best

characteristic is simplicity and innocence.

“The three-four time is expressive of longing, sincere hope and love.

“It would be interesting to hear from this writer what happens when

any one composes a piece in common time, which expresses the quiet

life of the soul and ‘inward peace’ and in the key of E minor, which

represents grief, mournfulness, and restlessness of spirit.”

Gundlach[38] found that speed was by far the most important factor in

distinguishing among several pieces played to a group. And Hevner[48]

found that for excitement the most important element was tempo, which

must be swift. “Dreamy sentimental moods follow slow tempo. Sheer

happiness demands a faster tempo.”

Hanson[42] believes that “everything else being equal, the further

the tempo is accelerated above _tempo moderato_ (which is about the

same speed as the human pulse rate) the greater becomes the emotional

tension.” He goes on to state that “as long as the subdivisions of the

metric units are regular and the accents remain in conformity with

the basic pattern, the effect may be exhilarating but not disturbing.

Rhythmic tension is heightened by the extent to which the dynamic

accent is misplaced in terms of metric accent, and the emotional

effect of ‘off-balance’ accents is greatly heightened by an increase

in dynamic power.” He is unduly alarmed by the effect “Boogie-Woogie”

may have on the younger generation because rhythm irregularity finds

its most fertile field in this jazz form characterized by “a repeated

figure in the bass (which) continues indefinitely in regular rhythm.”

_Sonority._ Hanson[41] has traced the development of music from the

highly consonant music of the Roman Catholic Church at about the time

of Palestrina to the dissonant music of certain modern composers. He

describes the early hymns as “calm, serene and in a sense impersonal.”

For him, “the expression of personal feeling in music seems inevitably

to be associated with the use of dissonance. Indeed the expression

of emotion in music seems to be bound up in the contrast between

dissonance and consonance, the former producing a sense of tension and

conflict to be either heightened by progression to a sonority of still

greater tension or resolved by a succeeding consonance.” It may be easy

for a musician to believe that the increased use of dissonance creates

an increase of emotional tension, but to the musically uncultured

listener dissonance may just as often create boredom or annoyance.

_Composition._ Although musical factors such as pitch, intensity and

melody can contribute to mood effect when isolated, the reaction to an

entire composition is quite different from reaction to tones of chords.

It may depend upon environment or association with the situation in

which the selection was first heard or is being heard. It may be

altered by the length of the composition or unanticipated contrasts of

intensity or the use of unusual patterns, rhythm or tempo. In listening

to music, expectation plays an important role. A sudden change or

interruption is apt to excite surprise. “The mere meeting of the

expectation in all its details affords pleasure of a kind. But great

as is the aesthetic pleasure, a far greater degree of enjoyment may at

times be attained by a carefully planned surprise, the appropriateness

and artistic skill of which is recognized and approved”[10].

Much has been written on the images or stories which musical

compositions evoke. Some musicians have tacitly implied that ability

to appreciate these stories results in greater pleasure, but

Gehring[34] wisely insists that “musical enjoyment does not depend on

interpretations, but it may also be reaped by those who abstain from

making them.” There are some people who can interpret any musical

selection, and others who find no story. Between these extremes is a

group who can get more pleasure from music if listening is preceded by

such preparation. As Damon[20] has pointed out, “A musical selection is

thought to be more beautiful and more colorful when the usual program

notes are supplied before hearing it.”

There are those who see specific color in sound. It was Isaac Newton

who first compared the diatonic scale with the seven colors of the

spectrum from red to violet beginning with C as red. Katz[71] reported

on strong color association of two case studies. For the first, C major

was jet black and for the other C major was brilliant white. But this

could be expected inasmuch as the scale of notes presents intervals

and proportions of the most definite kind whereas those of the color

spectrum are confluent and have no mathematic relation. Spectrum

analogy was discredited by de Marian in 1737[70]. “No two people

agree or hardly ever do, as to the color they associate with the same

sound”[30].

But color is only one element in a mental image; what about the others?

Is it possible for two people listening to a new, unnamed musical

selection for the first time to envisage the same story or picture?

T. Kawarski and H. Odbert[52] found no direct relationship between

color and music which held for more than a few individuals but certain

general relationships of photoism to special aspects of music were

found to recur constantly. Thus increase in brightness tends to

accompany rise in pitch or quickening of tempo. Whereas some one factor

like strong visual imagery or cultural influences or suggestions may be

dominant in some individuals and a totally different factor in another,

none of those factors operate in any pure and simple fashion.

Too often musical interpreters will see too much in a given selection.

Some will try to rhapsodize in words the theme as announced by the

title of the selection. Some enthusiasts will grasp at straws of

suggestion from the original source. Gurney cites an amusing instance

in connection with a sonata of Beethoven, of which the three movements

are entitled: _Les Adieux_, _L’Absence_, and _Le Retour_. These titles

were so inviting that some gushing comments were published about the

portrayal of passages from the life of two lovers. However, on the

manuscript, Beethoven wrote: “Farewell on the departure of His Imperial

Highness, the Archduke Rudolph, the 4th of May 1809.” and “Arrival of

his Imperial Highness, the Archduke Rudolph, the 30th of January 1810.”

The insistence by some of the specific images evoked by certain

selections can be disheartening to those lovers of music who accept

such interpretations as fact and are disappointed in their inability to

experience the same reaction as others, especially if the others are

recognized musicians.

“It is obvious that the power of music to depict objects, situations

or ideas is extremely indefinite. No matter how specific a pictorial

or dramatic program the composer may have in mind to present through

his music, the listener will never get that program from the music

itself. If the hearer is told what the music is supposed to depict

he will imagine the incidents and fit them into the music. Or if he

is given a title it will suggest to him a train of imagery which he

will read into the composition. And if he is given neither title nor

program his fancy might take him on a mental journey, the direction

of which will depend upon his mood, his mental set, his physical

condition, his past experience, and numerous other subjective factors,

for which music serves as a stimulus, but all of which lies outside of

the music itself.”[35]

Thus when Rubinstein read into the “Second Ballade” of Chopin the

story of a wild flower caught by a gust of wind, the struggles of the

flower and its final breaking, he confused the issue by adding a second

interpretation to the music which was inspired by Mickiewicz’s poem,

“Switez Lake,” the story of which is totally different. When Gilman

played this same song for his students there were many interpretations

which ran the gamut from “meaningless” to “creeping assassins.”[35]

* * * * *

Beethoven’s complaints of his interpreters and expounders were frequent

and bitter, but we must turn to the writings of the more literary

musicians, Mendelssohn and Schumann, for coherent expressions on the

subject. Mendelssohn wrote,

“What any music I like expresses for me is not thoughts too indefinite

to clothe in words, but too definite. If you asked me what I thought

on the occasion in question, I say, the song itself precisely as it

stands.”

Schumann’s position as regards verbal readings of music may be gathered

from the following passage:

“Critics always wish to know what the composer himself cannot tell

them; and critics sometimes hardly understand the tenth part of what

they talk about. Good heavens! will the day ever come when people will

cease to ask us what we mean by our divine compositions? Pick out the

fifths, but leave us in peace.”[40]

Some musical selections have been written to accompany a subject. Those

who know the story of _The Barber of Seville_ may associate the aria

“Largo al Factotum” with the despair of an over-worked barber, but

the same song might have been written to accompany almost any lively

subject and for people who have never heard the story and who do not

understand Italian, it is just a bright song, possibly humorous. As

Gurney says:

“The verbal titles which aim at summing up the expression of certain

compositions, however interesting, are so adventitious that they have

often been suggested by instead of suggesting the music; and a hundred

auditors, if left to guess the title for themselves, would originate a

hundred new ones.”[40]

Music can evoke specific emotions only when people have been

conditioned to it. The “Horst Wessel” song would not stir Americans

to hatred unless they could identify the title with the song and its

significance. Even then, the degree of hatred or contempt for the music

would be variable.

Edwin Franko Goldman’s “On the Farm” can leave little doubt in any

one’s mind as to its subject matter, but with the exception of such

very obvious music, or music to which we have been emotionally

conditioned, music cannot paint blue skies or green pastures.

What then are the feelings most frequently excited by music? According

to Schoen[72]:

“The data show that rest, sadness, joy, love, longing and reverence

appear most frequently as the effects produced. Vocal music has a

tendency to arouse well-defined emotional effects far more often than

instrumental, the probability being that the specific emotional effect

is due in the main to the words.”

The conclusions of Schoen on mood changes in a tested group sum up the

relationship between mood changes and enjoyment. Thus for practical

purposes we want to know not only whether a musical composition

produces a mood change in the listener, but also what is of greater

significance, whether the induced mood is also enjoyed, and to what

degree this enjoyment might depend on such factors as the type of

mood induced. The listener’s familiarity with the selection, and his

judgment of the quality of the selection, are also important.

The results of a large series of observations show as a rule, that

music produced a mood change in every listener, or that an existing

mood was intensified when it conformed with the mood of the music.

The tendency of the same composition to produce the same mood in

every listener was very marked. The degree of enjoyment derived from

the musical composition was in direct proportion to the intensity of

the mood effect produced, provided this effect was not due to the

conditions of the performance, such as a poor intonation or faulty

interpretation.

“No greater amount of enjoyment was derived from one type of mood than

from another type, unless the mood was due to dislike of the specific

type of music or to a poor performance. But when the mood change was

from joyful to serious, the enjoyment seemed to be slightly less than

when the change was from serious to joyful, provided the hearer was

not hampered by a knowledge of the critical estimate of the music to

which he was listening or by faulty interpretation. The evaluation of

the quality of the musical composition was in direct proportion to the

intensity of enjoyment.”

III

OTHER CONDITIONING FACTORS

In addition to the physical elements of music previously discussed

there are other factors which enter into the type of response of mind

and body to music. Mention has been made above of the value of program

notes. People who hear new music for the first time may or may not

develop a visual or emotional response, but if prepared by descriptive

writing they may “understand” or at least enjoy the music more.

“Program notes, oral comments, and the general setting of the

presentation are important because they concentrate and reinforce the

mood response. Indeed it has been shown that in a verbal introduction

offered before a composition is presented, what is said does not

matter much, and that almost any kind of comment will enhance the

listener’s enjoyment if it serves to cue him into appropriate

effective states of mind.”[60]

Music aides should take this finding seriously and preface the playing

of musical selections with verbal commentary. Even popular dance music

may be prefaced by remarks about the solo instrument featured or the

personalities involved.

With the exception of the effects of rhythm, all other reactions

thus far cited have been largely psychologic. Before leaving the

discussion of response, one bit of evidence demonstrating possible

physiologic action will be presented. Gundlach[39] studied the songs

of six different American Indian tribes. Now the language, customs

and music of neighboring European countries frequently have something

in common, but the absence of the wheel in transportation made the

scattered people of the Western Hemisphere strangers to each other.

The speech and songs of the different Indian nations are entirely

unrelated, yet the songs representing the same types of ceremonials

show considerable agreement. From this Gundlach concludes that “music

has some conventions grounded on a firm basis of physiologic structure

and behavioral similarity of human beings.”

_A_--_Live Music._ Most people will turn to the source of sound. Even

the most phlegmatic will turn if the sound is sudden and loud enough.

It is a protective mechanism because identification of the source may

prevent personal injury. There is also a sense of satisfaction in the

corroboration of the auditory and visual images. When the sound is

musical the desire to see its production is greatly increased. For

those who cannot make music themselves, it is like watching a conjurer

from behind. For musicians it offers the opportunity of inspection,

improvement or criticism. One of the most important psychologic

components of music is the physical presence of the music maker. About

twenty years ago a manufacturer produced piano-player rolls which

reproduced the manipulation of well known artists so well that experts

could not differentiate between the sounds produced on the piano by a

live pianist and the automatic player. Yet this method of reproduction

was a failure financially; it had every quality of the live musician

except the physical presence.

We demand far less in quality of music from a live band than from a

mechanical reproduction of band music. Groups of people who assemble to

dance will pay relatively high prices for inexperienced players with a

monotonous repertoire for the sake of having live music. The dancers

may complain of the poor musical execution, but will suffer a return

engagement in preference to the playing of recorded music.

There are cinema stars whose singing voices are harsh to most ears,

yet listeners will applaud them into an encore, not so much for the

sake of a beautiful experience, but to prolong the human contact. We

react not only to the sound, but to the motions and very presence of

music-makers. We listen to people as well as their music. Live music

stimulates, sustains and focuses attention. It should be used as often

as possible for patients. The “live” musician can get patients to

listen to musical forms which would be entirely ignored otherwise. If

musicians wish to spread the appreciation of “good” music and music

appreciation, one method is to be found in personal appearances at

hospitals.

_B_--_The Human Voice._ Of all the sounds of given pitch and intensity

the one which best attracts and maintains interest is the human voice.

We habitually turn to the human voice. Sometimes we do it as a matter

of courtesy. Again, we may do it for better understanding, or even out

of curiosity. The spoken language is understood by far more people than

is the so-called language of music. When words are set to music they

command greater attention than when they are spoken. They are usually

compact and in rhyme. We strain to hear each word to gather the full

meaning and humor or cleverness of the lyricist. Yet, we willingly

lower our literary standards when words are put to music. The verses

of many songs sound vacuous and repetitious without accompaniment. But

the words are made interesting by the melody, and melody takes on

additional meaning from words. “Vocal music has greater power to arouse

a definite emotional response than has instrumental music. Rest results

about equally from instrumental and vocal music.”[71]

Songs with words are ideally suited for arousing patient interest.

Community singing is the most valuable form of music for maximum group

response.

LISTENING

Violet Paget[55] sent questionnaires to one hundred and fifty people in

different parts of the world to obtain a global sampling of reactions

to music. From an analysis of their answers she found

“two different modes of responding to music, each of which was claimed

to be the only one in those in whom it was habitual. One may be called

‘listening’ to music; the other ‘hearing’ ... with lapses into merely

overhearing it. Listening implied the most active attention....

Hearing is a lesser degree of the same mental activity where active

attention occurs in moments like islands continuously washed over by a

shallow tide of other thoughts.”

This is very similar to Gurney’s classification of musical perception

as “definite” and “indefinite.” Vernon[77] lists the varieties of

response to indefinite listening as:

a. Reflex or physiological; soothing or stimulating.

b. General euphoria.

c. Stimulation of thought and wandering of attention.

d. Emotional moods of interpretation of the so-called “meaning” of

music.

e. Dramatic visual images of day-dreams.

f. Awareness that sounds are going on, but no further response.

g. Lapsing of this awareness into the “margin” of consciousness.

He found reactions a. and b. among primitives and infants; and

reactions c. f. and g. among the untrained.

Schoen[71] found that response to music is related to the psychologic

levels at which they occur, and to sensation, perception, and

imagination. The sensorial response is physiologic and possessed by

all. It is the source upon which all other musical development depends.

It requires a minimum amount of mental effort, and its effects are

within the easy reason of the intellectually inferior and superior

alike. As a sensation, music is either pleasant or unpleasant. Training

and experience may lead to higher types of response, depending upon

individual desire and ability to develop musical taste and education.

The next higher response is perceptual and its distribution level adds

excitement or repose. The highest level of response is imaginal.

“Much of the music we hear we have heard before, and because of this

fact we have associated it with a host of memories with pleasant or

unpleasant coloring. The hearer may not recall the exact time or

occasion on which he heard the selection before and yet he may have a

group of images which are definitely referred to his own past.”

Meyer[71] summarizes the appeal that music might have for listeners as

1. Emotional response, 2. Suggested associations, 3. Personification of

a subject, 4. Its value as an object.

IV

MUSICAL TASTE

The selection of music for patients can be handled in many ways. The

easiest and least reliable is to use the music best loved by the

musician guiding the program. Such programming will undoubtedly meet

with the approval of some of the patients but it is unlikely that it

will meet with the approval of all. Non-psychiatric patients should be

given the music _they_ want.

Much has been written concerning specific music for certain groups

of patients. There has been considerable prejudice in favor of “good

music”; that is “good” in its relation to intellectual values.

But music in itself can be neither good nor bad. Its execution or

appropriateness for the occasion or the individual may be open to

question, but the answer must come from the patient. We must keep

uppermost in our minds the goal of music for bed-ridden or chronically

hospitalized patients. They look to music as a morale-booster and a

source of enjoyment. Most people have favorite songs, but the degree

of desire for them or for any music will fluctuate with the time of

day, the kind of day, and many other considerations. The taste of

the patient will vary not only with age, training, nationality and

home back-ground, but with such intrinsic and unfathomable things as

personality and thinking habits.

“Musical taste is a folkway, a convention which behaves exactly as do

folkways in other realms of activity. Accompanying this taste is the

conventional ‘conscience’ which dictates what is ‘right’ and what is

‘beautiful.’ It is more or less impervious to contradiction and is

disturbed at the prospect of change”[59].

The music of any given composer does not change but the audience will

change as a result of the appearance of new forms of music and living.

The works of the eighteenth century, with few exceptions, were loved by

its contemporaries but find a small audience to-day.

The musical taste of an individual changes noticeably from childhood

to maturity but the change is gradual, and except for those studying

music intensively, during any one year of life the change is hardly

appreciable. Even established favorites will become less desirable to

the individual.

“After a certain number of repetitions, varying with both the founded

experience of the listener and the complexity of the item, the

enjoyment is diminished. One might here propose the hypothesis that

the rate of ascent to popularity is directly in proportion to the rate

of the decline ... as illustrated by the sharp rise to popular acclaim

of the ephemeral popular hits and their subsequent precipitous decline

into oblivion.”[59]

Among the many factors which sometimes have a great effect on musical

taste, contemporary events are outstanding. During a war, the people

welcome songs which sing of their prowess, impending victory, or

derision of the enemy. Such songs become popular because of their

literary rather than their musical content, but they affect taste

indirectly, since the only test of taste lies in the songs to which

people will freely listen.

Soldiers pick up foreign songs and marching songs and bring them home

as souvenirs and favorites. It is now well recognized how great and

prolonged such an influence can be.

Whatever the musical taste of the patient may be, and regardless of how

he came by it, it should be satisfied. As soon as an individual attains

the status of being a patient, there is an immediate mental depression

which may continue to increase if not checked. The patient may develop

anxiety, fear, self pity or boredom. There may be sensory depression

from pain, unpleasant sight or disability. In addition to these

saddening factors there may be undesirable response to environment,

personnel, and the monotony of medical or nursing routines. All efforts

should be directed at substituting joyful experiences for saddening

introspection. The formula for joy is very personal. Although most

people will laugh at some comic situations, the response to music

cannot be predicted except upon the basis of individual desire. The

person who becomes a patient may not have a fundamental change in

musical taste but his appetite may be altered by variations in mood,

and this is of prime importance.

“More people express a wish for music dynamically similar to the

existing mood than for music of the opposite effect. The amount of

enjoyment is slightly affected by the kind of mood change taking

place.”[71]

It is possible for sad music to be more enjoyable to those who are

receptive to it, than gay music. Nevertheless, other things being

equal, gay music is apt to give a greater degree of pleasure to those

who wish to hear it than sad music gives to its devotees.

The enjoyment of music depends not only upon its pleasantness, but also

upon its familiarity. This recognition may be one of identity or of

idiom. Most people like popular music because they are familiar with

its form or tempo; or because they can hum or name it.

The musical taste of the patient can readily be determined by offering

him a check-list with the names of fifty or more selections including

the entire gamut of musical forms. A general idea of the popularity

of classical selections can be determined from the sales records of

recordings and the frequency with which certain pieces are performed

by the better symphonic orchestras. The popularity of contemporary

offerings can be learned from surveys published in such magazines as

_Variety_ and _Down Beat_ or by listening to radio shows such as “The

Hit Parade.”

Musical taste is closely allied to performance. If chosen selections

are played improperly or without regard to certain elementary

considerations, the use of music will lose its value to the patient. A

brief consideration must include the effects of arrangement, tempo and

volume with which the selections are played, since these have been seen

to influence the effects of the selection. Many people when asked to

name their favorite music will name a performer or a band rather than

a specific piece because they have come to desire the characteristic

style of the artists preferred, and style in an orchestra is closely

related to these factors. Some listeners prefer loud music, but it must

be remembered that even though sound does not become painful until

the level of 125 decibels is reached, there are some people for whom

the painful level is much lower, and hypersensitivity to sound is an

important source of irritation. Others may be disturbed by music which

is too fast, which must be taken into consideration.

The role of expectation plays an important part in taste. Most people

who have been conditioned to expect the classic use of the scale and

traditional harmony cannot find joy in the unusual tonal structure

of the moderns as exemplified in Schönberg or even Stravinsky.

Hospitalization is not the proper period of life for indoctrination in

the beauties of innovations.

Musical taste is acquired and always relative, and is based as

Diserens[24] has pointed out, on the “habit of hearing.” An historical

illustration of this is the evolution of the consonances. The

Greeks regarded the octave as the only genuine consonance. In the

fifth century, the fifth and fourth intervals were admitted to this

classification. In the eleventh century, the major third was accepted

as such, but the minor third had to wait until the twelfth century. “In

music the habit of hearing is the Law, and through it, the exception of

yesterday becomes the rule of today.”

The best analysis of musical appetite can be found in the statement

of St. Thomas Aquinas, “Bonum est in quod tendit appetitus”--the good

is that toward which the appetite tends. We repeat there is no such

thing as good music or bad music. Music may be played poorly, but the

evaluation of the good in music is personal. “Pleasure, and pleasure

alone, is the proper purpose of art,” said Walter Sickert. Musicians

will do well to remember that since taste results from the gradual

blending of emotion, experience, and education, it is better to enjoy

wholeheartedly “a waltz of Lehar than to be able to make a thematic

analysis of a Beethoven sonata and yet remain unmoved by it.”[36]

V

SUMMARY

For non-psychiatric patients, musical programming should be based upon

patient requests. For stimulation the important factors are rapid

tempo, accentuated rhythm, and elevated volume. For sedation, slow

tempo and reduced volume are indicated, as well as simple recognizable

melodies. Some discussion of the selection to follow is a valuable aid

to the enjoyment of listening. Live musicians should be used as often

as possible.

_CHAPTER THREE_

MUSIC AS OCCUPATIONAL THERAPY