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Doctor, Can You Prescribe Me Some Mozart?

By   /  August 8, 2011  /  11 Comments

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All of us have had the experience of being transported by the sheer beauty of music…suddenly feeling a sense of the sublime, or a great stillness within…”- Oliver Sacks

In a clinic, a young man is suffering from epilepsy because of a recent brain trauma. The electroencephalogram (EEG) measures his neuron activity. Erratic lines scrawl up and down continuously, and the nurses nearby shake their heads. The medications haven’t worked.

With the consent of the man’s parents, the clinic tries something different. Placing a portable stereo near his motionless head, neurophysiologists watch as the playful and rhythmic notes of the Mozart Sonata for Two Pianos in D Major stream into the man’s ear. After five days, the lines undulating on the EEG screen have become more even and regular – the music has altered the brain signals of the unconscious patient.  Finally, he awakes from his coma and slowly regains his motor skills and cognitive abilities.

Based on Gisela Kuester’s case study published in Epilepsy Behavior, the “Effect of Music on the Recovery of a Patient with Refractory Nonconvulsive Status Epilepticus,” this story depicts music as a powerful medical treatment. For years, however, researchers have been wary of the exaggerated assertions made about music’s ability to affect the brain; promoters of the “Mozart Effect” for instance, have famously claimed that individuals can increase their “spatial intelligence” simply by listening to the composer’s music. However, in “Mozart Effect-Shmozart Effect,” a 2010 meta-analysis study in the journal Intelligence, researchers showed the phenomenon to be scientifically irreproducible. Yet even if classical music may not make people “smarter,” it has been shown to help those experiencing mental distress in the form of epilepsy and other disorders.  For instance, the 2010 study “Mozart K.448 and Epileptiform Discharges: Effect of Ratio of Lower to Higher Harmonics” published in Epilepsy Research discovered that children with epilepsy showed more stable brain activity when exposed to Mozart’s melodies.

It is not just classical music, however, that helps improve patients’ mental health. According to the American Music Therapy Association (AMTA), World War I and II veterans’ physical and emotional states improved significantly when professional and amateur musicians performed in their hospital facilities. This kind of “music therapy” has morphed into a highly specialized field in the United States. Far from being a simple exercise of playing music to a passive listener, music therapy today is defined by the AMTA as “clinical and evidence-based use of music interventions.” Highly individualized and personal, music therapy generally involves one-on-one patient therapy applied to a wide range of illnesses, from Alzheimer’s to autism. Depending on the patient’s needs, certified music therapists design a unique musical program. A variety of activities have been devised—in addition to passive listening, patients can sing, play instruments, compose music, and even analyze songs.

The process of becoming a music therapist is fairly involved. After completing a university’s music therapist curriculum and a relevant internship, prospective counselors must pass a national examination delivered by the Certification Board of Music Therapists (CBMT). Today, the CBMT states that over 5,000 music therapists are board-certified—a number that may increase with the recent explosion of scientific findings supporting music therapy.
Students with emotional and behavioral problems, for instance, may improve their conduct after going through a music therapy after-school program. In “Education-Oriented Music Therapy as an After-School Program for Students with Emotional and Behavioral Problems,” a 2010 study published in The Arts and Psychotherapy, researchers found that “problem-behavior” decreased signifincantly after music therapy. They noted especially that these students’ aggressive, “acting-out” behavior seemed to be channeled through the percussion instruments, and that this emotional outlet eventually became a purposeful activity the students embraced.

Music therapy may also address the serious issue of social behavior in autistic children. Mentally impaired in a social sense, autistic children often struggle to react emotionally in an appropriate manner.  However, a 2009 study in the journal Autism on the “Emotional, Motivational and Interpersonal Responsiveness of Children with Autism in Improvisational Music Therapy” demonstrated that their situation can be improved by “musical attunement.” In this type of treatment, music therapists make facial expressions, eye contact, and bodily movements that are accompanied by music. Depending on the rhythm, tempo, and pitch of the song, the therapists adjust their body language to the “mood” of the piece. Meanwhile, participants are encouraged to mimic the therapists’ gestures and countenances. Compared to the autistic children in the control group—who were supervised only with toys—those who underwent  music therapy treatments showed a larger improvement in their behavior by initiating social interactions, sharing more joy with the therapist, and showing more overall compliance.

Musical treatment has also been found to alleviate cognitive problems associated with old age. Alzheimer’s disease, a mentally debilitating condition that degrades the memory and induces irrational emotional actions, affects over 5 million of the elderly nationwide. A 2009 study in the journal Dementia and Geriatric Cognitive Disorders found that twenty-four weeks of personally chosen music played for twenty minutes each week significantly improved emotions and memory recall for those with Alzheimer’s disease. In this study on the “Effect of Music Therapy on Anxiety and Depression in Patients with Alzheimer’s Type Dementia,” patients in the music therapy program were less agitated and depressed than those who did not participate. The nostalgia associated with the selected music seemed to have also helped participants remember long-term memories. “This music reminds me of my childhood memories,” and “I pictured myself at the ball, dancing how we used to,” were examples of heard responses.

Biological explanations for these effects have already been postulated. An article titled “Your Brain on Music” in the August 2010 issue of ScienceNews magazine describes various parts of the brain regions known to be activated by the processes of performing and listening to music.  In the hippocampus, long-term memories become associated with certain musical pieces. The amygdala is related to the detection of major and minor chords, and also responsible for producing the “chills” experienced when listening to music.

As for mood enhancement, a phenomenon that noted by all of the studies described above, researchers have observed music’s influence on the chemical nature of the brain in laboratory mice. In a 2010 Brain Research study “Anxiolytic Effect of Music Exposure on BDNFMet/Met Transgenic Mice,” mice exposed to music had increased levels of Brain-derived Neurotrophic Factor (BDNF), a protein that has been shown to relieve anxiety and depression. On the other hand, the mice not subjected to any music displayed more angst as well as lower levels of BDNF.

Music therapy and the research related to it have gained international recognition. Founded in 1985, The World Federation of Music Therapy currently includes music therapy leaders and workers from Africa, China, Spain, Australia, the USA, the UAE, and many other nations. Within the United States, music therapy has also been acknowledged as a viable treatment for senior citizens and children with developmental disabilities. Federal insurance programs and private insurers recognize the importance of effective music therapy: since 1994, Medicare has provided for music therapy services under the Partial Hospitalization Program, and three states—Michigan, Minnesota, and Indiana—provide Medicaid coverage for the music therapy treatments of children with developmental disabilities. Based on the “medical necessity” of the treatment, private insurance companies such as  Blue Cross/Blue Shield and Aetna provide funding for certain music therapy services.

Even so, there is a long way to go before music therapy becomes a truly widespread practice.  Both additional research studies and increased public awareness will be needed before society more widely experiences this approach. In “The Power of Music,” published in the journal Brain, Oliver Sacks  explains that he places importance on music therapy because “All of us have had the experience of being transported by the sheer beauty of music…suddenly feeling a sense of the sublime, or a great stillness within… they can still be evoked, as far as I can judge, even in deeply demented (and sometimes agitated or tormented) patients. Music can bring them, if only for a little while, a sense of clarity, joy and tranquility.”

This article was updated on 8/19/2011.

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11 Comments

  1. Thank you for writing such a clear description of the field of music therapy. As a board-certified music therapist, I do spend a lot of time helping people understand how music can help them, both through ideas they can try on their own, and through working with a music therapist to address more specific needs in a more focused way. I am excited to see our profession’s body of research growing, providing a stronger evidence base for the clinical practices that can benefit so many people. I am grateful for you sharing this with your readers!

  2. […] Doctor, Can You Prescribe Me Some Mozart? – Yale Journal of Medicine and Law […]

  3. Jeff says:

    I’ve always been a fan of music therapy. This must be music therapy week because I’ve read quite a few articles about it including drum therapy for children with learning disabilities in school. I hope this catches on in schools in a big way. With so many budget cuts, music therapy not only works, it’s cheap to implement and the kids really enjoy it.

  4. Research in the field is identifying the “why” and “how” of what I’ve seen as a board-certified therapist in clinical and school music therapy sessions since 1974: Music is a non-threatening catalyst for connections and conversation. Music draws individuals together, encourages active participation in music-making, and gives the therapist many real-world opportunities to help people build on their strengths and interests while at the same time learning new skills and learning to compensate for deficits. All of this while enhancing their overall quality of life. Can’t beat that!

  5. […] Doctor, Can You Prescribe Me Some Mozart? (tags: article musictherapy yalemedlaw) […]

  6. I am pleased to read this article. The potential for the widespread use of music therapy becomes more evident day by day. The diligence in education and training will continue to train talented musicians to use music therapeutically in a multitude of contexts:
    Goodman, K. (2011) Music Therapy and Education: From Theory to Practice. Springfield, Illinois: Charles C Thomas.

  7. […] are many recent studies and facts on the benefits of music therapy for seniors, according to the American Music Therapy […]

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  9. Greetings! Very useful advice in this particular post!
    It is the little changes which will make the most important changes.

    Thanks for sharing!

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