England, United Kingdom (Winter 2017)
“Rhythm and harmony find their way into the inward places of the soul.” – Plato
Statue of Wolfgang Amadeus Mozart (1756–91) taken by Mrs. Sanju Ramachandran (Vienna 2009)
The word music is derived from the Greek word “mousike”, meaning art of the muses. It is considered a form of entertainment combining a collection of sounds to form pleasurable tunes. A large chunk of the music played in our home was composed by Wolfgang Amadeus Mozart. I do experience conflicting emotions with his mature music finding that it combines qualities that are considered mutually exclusive; depth without turgidity, clarity without shallowness, simplicity without insipidity and sweetness without sickliness. Even within the same movement feelings could interchange without warning; sorrow and joy, fatigue and energy. Did others experience similar confusion? Hence, I recently researched the effect Mozart’s music had on individuals. Much of the literature was from 2006 when Mozart appeared everywhere; it was the 250th anniversary of his birth. The Telegraph had an article titled “Mozart and me.” It outlined the relationship that Mozart’s music had on the famous. Of these individuals it was David Cameron’s words that intrigued me. He said that he preferred Beethoven to Mozart, considering the second movement of the Emperor Concerto to be the most perfect piece of classical music; this fact is important as it may reduce subjective bias. However, he stated that Mozart’s music was therapeutic for his son who suffered from epilepsy at the time. Further, he confirmed that it appeared to work.
The power of music whether as a pleasurable experience or a physiological / psychological therapy is subjective. The question “does it matter?” is valid for an assessment of possible benefit. Objective measurements are essential if medical practice and healthcare policies adopt music therapy. Was David Cameron’s observation replicated in clinical trials? Lin et al five years later investigated the effect of Mozart’s Sonata for two pianos in D major (K448) in eleven children with long term refractory epilepsy for more than twelve months, receiving at least 2 anti-epileptic drugs1. Daily exposure to the music reduced mean seizure frequency reduction of 53.6%; eight of the children remained seizure free whilst the others demonstrated minimal or no effect.
My path of discovery now led me towards the “Mozart effect” described by Frances Rauscher, Gordon Shaw and Catherine Ky in 1993 and suggesting that the music of Mozart could improve mental function2. They showed that children when listening to K448 demonstrated a transient increase in IQ compared to those exposed to relaxation music or silence. Raucher, Ny and Shaw then reproduced these observations, comparing K448 to music by Phillip Glass3. Rideout et al in 1998 then observed that other music with similar characteristics of Mozart was also associated with similar IQ score shift4. However, Chabris whilst a graduate at Harvard University in 1998 looked at sixteen previous “Mozart Effect” studies and concluded that no real change in IQ was apparent5. Interestingly Lois Hetland, also at Harvard University, after studying 2,465 individuals found that those listening to Mozart performed spatial temporal performance tasks better than their counterparts6. Variability of study findings were apparent in subgroups; individuals of different gender, musical training, innate spatial ability and cultural background. Thus, although much research is still required there appears to be consensus that the “Mozart Effect” is real. It is reasonable to speculate that the Mozart Effect may not only apply to the music of Mozart, but to an interaction between certain characteristics of music and the individual. Thus, this effect could predate Mozart. I will now examine the music in the ancient civilizations and their effects on health and performance and use as therapy.
It is perhaps best to begin with ancient Greece, considered the embryonic stage of western civilization. Interestingly in Greece, music was represented in mythology with roles in ceremonies such as religious occasions, weddings and funerals. It was believed that music healed the soul and via this the body. To achieve this music was tailored to specific diseases, e.g. alternating harp and flute sounds were considered treatment for gout. Extending this power to a societal level, the Greek philosophers considered that music could shape society and outlined the dangers of “immoral” music. Plato was a firm believer that music had the ability to shape emotions and proposed that repetitive listening to music produces emotional states based on the tune. He believed that music delicately moulded the soul by fabricating emotions, stating that “rhythm and harmony find their way to the inmost soul and take strongest hold upon it, bringing with them and imparting grace, if one is rightly trained.” Music was considered a trigger by Aristotle, permitting us to experience emotional surges and fulfil our desire for emotional release.
Hippocrates, who believed that medicine should be practised as a science, leading to diagnosing, treating and interestingly to also prevent disease, used music to treat mental illnesses. Patients who were thought psychologically unstable were encouraged to listen to flute music which supposedly calmed the mind. Those diagnosed with depression were requested to listen to dulcimer music. Thus, music was a therapeutic medium with healing shrines and temples in Ancient Greece utilising musicians to heal emotional disorders.
Music therapy was interestingly included in mythology. Music and therapy was unified through Apollo the god of music and medicine. His son Asclepius was said to cure mental illnesses through the medium of music, possibly the first music therapist! Music therapy in Greece was known as asclepieia and practised at the Sanctuary of Asclepius in Epiduarus.
Sound therapy in Ancient Egypt perhaps pre-dated Greece. The power of sound is evident in the belief that the god Thot created the world just with his voice. Sound played an important role during ancient Egypt, with vowel sound chanting creating euphony. The design of burial chambers and places of worship suggested that ceremonies were sonic enhanced. Songs and dancing were often used to ward away evil spirits which would attack men with infectious diseases. The Egyptians further believed that the goddess Bat created music and musical tunes cleansed the soul and restored emotional balance. Belief existed that melody when correctly sung would heal infection. In temples, therapeutic music was provided by flutists, harpists and vocalists, the combination supposedly creating an atmosphere suited for spiritual healing. Priests of the temple of “Abidos” would use chants to cure infections. According to ancient papyrus scripts, Saint Abu Terbo healed epilepsy via pipe chants.
In ancient India, music therapy has a historical role. Apart from being entertainment, music was originally a way to gain eternal salvation. This perhaps explains why the most reputable composers of Indian music were saints and devotees. Like in Egypt, sages and seers believed that each word and mantra chanted or sung with perfect pronunciation led to profound healing effects. These effects were referred to in two of the four Vedas: Rig and Sama Veda. The Indus Valley remains reveal sculptures of musical instruments and images of Saraswati, the goddess of music. According to legend, the classical composer Thyagaraja resurrected a dead person with his Bilahari raga composition (cf. Asclepius).
To study the therapeutic role of music we turn to Sushruta, the legendary scholar of Indian medicine and surgery 2600 years ago, who compiled the Sushruta Samhita containing details of Ayurveda; the ancient medical science inherited from the Vedas. Ayurveda states that constitutional balance with free and unhindered energy flow is considered essential to maintain health. Thus, in ill health attempts are made to restore this balance via relaxation techniques and body exercises which include yoga and importantly music.
The use of music therapy was contained in the ‘Yellow Emperor’s Classic of Medicine’ documented nearly 2300 years ago. Classical Chinese music consists of 5 notes – jiao, zhi, gong, shang and yu. These notes, each corresponding to different natural elements were thought to heal specific illnesses. Jiao was considered to heal the liver and depression, zhi had positive effects on the heart. Recently the effects of this five element music therapy in patients with advanced cancer was assessed and found to have a positive impact on quality of life6.
It is clear that music as a therapeutic agent is not a new concept and is an expanding expressive therapy reaching out towards mainstream medicine benefitting physical and mental health. Associations and groups exist in many countries with the British Association of Music Therapy at the forefront in the United Kingdom. It would be interesting to compare and contrast international geographical variation in the methodology adopted. Exploration of this theme should look at possible existence of commonality which could be fundamental and variability which could be culturally determined.
We have seen that Music therapy has subjective and objective evidence of benefit. As in most scientific fields much more research is required to gain greater understanding of the mechanisms. It should include prospective studies confined to ethical boundaries. Further, it is dangerous to assume that findings can be applied universally; heterogeneity must be considered. Perhaps this is why Mozart’s music is often used in therapy and research. The varying emotions experienced whilst listening to Mozart perhaps overcome this possible heterogeneity.
Is the “Mozart Effect” the appropriate term for this phenomenon? It is clear that the power of music on health was recognised pre-Mozart. However, as Mozart is a universally recognized genius writing exquisite music in all genre, from chamber music to opera, it is probably right that his name is associated with the above described extra-musical phenomenon; the “Mozart Effect”.
- Lin LC,Lee WT, Wu HC, Tsai CL, Wei RC, Jong YJ, Yang RC. Mozart K.448 and epileptiform discharges: effect of ratio of lower to higher harmonics. Epilepsy Res, 89 (2010). 238-45.
- Rauscher FH, Shaw GL, Ky CN. Music and spatial task performance. Nature, 365 (1993). 611.
- Raucher FH, Shaw GL Ky N. Listening to Mozart enhances spatial-temporal reasoning: towards a neurophysiological basis. Neurosc Lett, 185 (1995). 44-7.
- Rideout BE, Dougherty S, Wernert L. Effect of music on spatial performance: a test of generality.Percept Motor Skills, 86 (1998). 512-14.
- Chabris CF. Prelude or requiem for the Mozart effect? Nature, 400 (1999). 826-7.
- Hetland L. Listening to music enhances spatial-temporal reasoning: Evidence for the “Mozart effect.” Journal of Aesthetic Education, 34 (2000). 105-48.
- Liao J, Yang Y, Cohen L, Zhao YC, Xu Y. Effects of Chinese medicine five-element music on the quality of life for advanced cancer patients: A randomized controlled trial. Chin J Integr Med, 19 (2013). 736-40.
I would like to acknowledge Dr Ahmed Abbas, Specialist Registrar in Neurology, University of Oxford for inspiring me in my endeavours.
HARISHNATH RAMACHANDRAN, aged 17 years is currently studying at Solihull School in the English Midlands and is hoping to gain entry to Medical School in 2018. He has an interest in Medical Humanities and considers this to be essential in creating a consummate doctor. Harishnath plays the piano (grade 7) and saxophone (grade 8) and has been curious of the impact that music has on physical and mental health, and this is the basis of his Extended Project Qualification. This led to examining the Mozart Effect which forms the basis of this manuscript.