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MUSIC IN MEDICINE
MUSIC IN MEDICINE
by SIDNEY LICHT, M.D. Fellow, New York Academy of Medicine NEW ENGLAND CONSERVATORY OF MUSIC BOSTON, MASSACHUSETTS Copyright, 1946, By SIDNEY LICHT, M.D. All rights reserved, including the right to reproduce this book or portions thereof in any form. First Edition PRINTED IN THE UNITED STATES OF AMERICA...
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FOREWORD
FOREWORD
In presenting a musician’s point of view on so specific a subject as “Music in Medicine”, it seems to me necessary at the outset to clarify the status of music as an independent aesthetic art, and its practical adaptation for definite utilitarian purposes. We must clearly separate the active individual process of artistic creation from the elements of passive perception and from effects such perception may have when applied for different realistic reasons. Taken aesthetically, as an art, music i
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CHAPTER ONE HISTORY OF MUSIC IN MEDICINE
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
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I
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 ele
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II Elements of Music
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
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III Other Conditioning Factors
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 b
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IV Musical Taste
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
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V Summary
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. Until the latter part of the eighteenth century the institutional treat
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Technique
Technique
Assignment of patients to instrument-playing should be made in the same manner as other assignments in functional occupational therapy. The physician should prescribe the instrument which best meets the convalescent’s needs. He should explain to the musical aide in the presence of an occupational therapist the motions desired and the precautions to be followed. He should set the time limits for the first and succeeding lessons. In general, it may be said that the first lesson should last about f
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Voice
Voice
Singing has long been used for the treatment of stammering and other speech impediments. Singing can also be used to exercise the jaws, larynx, lungs and diaphragm. With proper instruction, singing can be an excellent exercise for the muscles of the chest and abdomen as well as a breathing exercise. For the patient with a recently wired fractured jaw, singing gives gentle joint motion and restores confidence in the ability to use the jaw again. The same thing applies to patients with recovering
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Summary
Summary
Music can be used in psychiatry for its value in listening, group participation, and creation of sound, as follows: The average mind is incapable of engaging effectively in two thought processes simultaneously, but it can in the course of daily routine accept a multitude of mental stimuli at any one moment. If one of these stimuli is sound, it may be the natural complement to the visual experience without which a feeling of incompleteness may result. The observer at the sea-side is intrigued by
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Physical Exercise
Physical Exercise
Some forms of physical exercise are carried out most successfully when accompanied by music. Plato recommended such a practice in his Republic . In the ancient triremes or boats with three banks of oars, there was always a tibicen or flute player, not only to keep uniform rhythm among the workmen, but to sooth and cheer them. From this custom Quintillian took occasion to say that music enables us more patiently to support toil and labor [15] . During the Six-Day Bicycle Race at the Madison Squar
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Remedial Exercise and Dancing
Remedial Exercise and Dancing
When one or more groups of muscles have become weakened as a result of misuse or disease, it is proper to engage them in strengthening gymnastics called remedial exercises. Although these can frequently be given to groups, the groups are ordinarily small. The nature of these exercises and their administration may lead to boredom rapidly. Soft music can be used as an antidote to their monotony. Those exercises for the correction of spinal deformity which require crawling and free swinging are wel
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Shop Work
Shop Work
In those hospitals which possess an occupational therapy shop, music may be used to increase the pleasantness of the surroundings and possibly to increase the endurance and efficiency of work projects. Music is not recommended as a background to work which requires mental concentration, even though it is used by a great many students who believe that they can do their home-work better with the radio on. If the melody is too interesting or too popular at the time, it may be distracting, but where
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CHAPTER SIX MEALTIME MUSIC
CHAPTER SIX MEALTIME MUSIC
Patients who are confined to bed, or for that matter, to a hospital, find meals progressively monotonous in spite of the fact that there is a greater variety offered them than was theirs at home. This monotony results in part from the color and nature of the environment, the personnel, the general atmosphere of the hospital, and the constraining nature of institutional restriction. While dining at home some of these factors are subconsciously dissipated by trivial intimate conversation, friendly
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The Bedside Radio
The Bedside Radio
More than any other single factor, the radio has increased musical knowledge and appreciation in this country. The programs of Bing Crosby and Alec Templeton have great popular appeal because of the extensive preparation, humor, and showmanship contained in them. Yet these programs never fail to include classical music, and introduce serious music to those who would not freely choose to listen to it. But more than any other single factor, the improper use of the bedside radio can make patients h
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Public Address System
Public Address System
Many hospitals have already been equipped with either loud-speaker or headphone installations. For those hospitals which are still in the deciding stage, some of the advantages of each will be briefly considered. Ideally, both speakers and head-phones should be available. This is a luxury in which few will be willing or able to indulge. When head-phones are used, they have a way of getting misplaced, broken or broken-down. Head-phones or listening devices are usually distributed to those patient
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Personalized Music
Personalized Music
The more musically inclined or susceptible patient may not be satisfied with the routine musical program as furnished by the public address system or even his radio. In hospitals where the majority taste is for modern popular music, there will be a few who will hunger for classical. If a musical aide is available this may be accomplished by the use of a music cart. A box-like device on wheels such as is used for many purposes on hospital wards may be fitted with a record player and a rack for re
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Choir
Choir
Listening to a combination of trained voices is pleasurable to most people. Where the patient population is relatively static, the music aide will be well repaid by time spent on training quartettes or larger groups of singers. Such groups can be of value not only in any of the musical programs for the assembly hall but may be used on the wards, for religious services and on holiday occasions. If, as is usual, both sexes are represented among the patients, the range of selections will be limited
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Diversion
Diversion
Music may also be used to help time pass less noticeably. Listening is enjoyable but does not focus or sustain attention in any way comparable to playing. There will always be patients interested in learning to play music. The instrument of choice will depend upon individual taste, which of course is conditioned by background, education, nationality, age, and many other factors. The instruments which will be most acceptable are those which are not too difficult to play and which emit a pleasant
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Program
Program
Music. The public address system should be operated on a rigid schedule in imitation of a commercial radio studio. This is necessary because the patients will come to expect certain features at specified times of the day and fluctuations may result in disappointment and reduced morale. The program policy should be the direct concern of the hospital superintendent and any service chiefs who are interested. The hours of use will vary considerably with the individual hospital from a few hours to a
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Instruments
Instruments
Participation. The number and nature of instruments which a hospital should have will depend only upon budget limitations and the interest of the community. There is no limit except storage space to the number and variety of instruments which a hospital should accept as gifts. Ideally there should be at least one of each of the major instruments. Each instrument should have its own case, and it is wise to engrave the hospital name on each instrument to minimize loss. The initials of the hospital
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The Music Library
The Music Library
The hospital music library may vary from a few recordings to a composite collection of all forms of musical literature available. General hospitals which treat all diseases and age groups will require the most extensive and catholic varieties of all kinds of music. Specialty hospitals can operate on a library tailored to their individual needs. A hospital for the aged will not require too much of contemporary popular music. For purposes of inclusiveness, the ideal will be discussed in the hope t
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Director
Director
Music for patients differs from music for the well. The average musician is not qualified to decide which patients should or should not have music. There are too many well meaning musicians who have had one or two personal experiences or heard of others in which the efforts of the musician were rewarded by apparent miracles of mental reaction. Musicians are not capable of evaluating such changes nor do they bother to recount what the condition of the patient was an hour or a day after this perso
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Music Aide
Music Aide
There is considerable disagreement concerning the title most desirable for the person conducting music in the hospital. The term “musical therapist” implies a training not only in music but in treatment. The occupational therapist has had a training not only in crafts, but in basic medical subjects, psychology, and some clinical subjects. Until musicians can take similar courses at accredited schools a different title seems wiser. At some hospitals the workers are called recreational aides, but
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Training
Training
At present, no accredited school of music or medicine offers a compete course of instruction leading to a degree in music in medical practice, or a major in that subject. It is believed that eventually the demand may bring about the establishment of such a course in a musical college, where it belongs. It will be necessary for the school of music to secure liaison with a medical college or school of occupational therapy and this will limit instruction to those cities where grade A institutions o
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BIBLIOGRAPHY
BIBLIOGRAPHY
[1] Albrecht, W., De effect. mus., Sect. 314, in Roger, J. L. [2] Altschuler, I., Occ. Ther. Rehab. , 1941, 20:75. [3] Altschuler, I., Proc. Mus. Teach. Nat. Assoc. , 1944, p. 154. [4] Altschuler, I., and Shebesta, B., Journ. Nerv. Ment. Dis. 1941, 94:179. [5] Ayers, I., Am. Phys. Ed Rev. , 1912, 16:321. [6] Barker, L., Psychotherapy , New York, 1940. [7] Bauer, M., and Peyser, E., Music Through the Ages , New York, 1932. [8] Beaunis, B., “L’Emotion Musicale” , Rev. Phil. , 1918, 86:353. [9] Bec
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