"Thou holy art how oft in hours of sadness,
When life's encircling storms about me whirled,
Hast thou renewed warm love in me and gladness,
Hast thou conveyed me to a better world,
Unto a happier better world."
--First stanza from "An Die Musik (To Music)," by Franz Schubert, English translation by Gustave Reese
Music has been an important part of my daily life ever since I met my wife. But I hadn't thought much about its relationship to mental health and psychiatric ethics until I recently came across two news items.
The first was a "60 Minutes" segment originally broadcast on April 13 about the outstanding success of the Simon Bolivar National Youth Orchestra in Venezuela. (CBS aired an updated segment on July 16.)
Then the renowned neurologist and author Dr. Oliver Sacks gave the Convocation of Fellows address at the American Psychiatric Association's 2008 annual meeting on May 5 that focused on his 2007 book, "Musicophila: Tales of Music and the Brain" (New York: Knopf). Considering that May 5 also is my birthday, I could not resist the assumption that this might be more than coincidence, and that I should therefore examine more thoroughly the possible connections between music, mental health, my life--and possibly yours.
Several books on the psychological and biological effects of music provide useful information on the topic: "Music and the Mind" by Anthony Storr (New York: Ballantine Books, 1992); "Healing Songs" by Ted Gioia (Durham, N.C.: Duke University Press, 2006); and "This Is Your Brain on Music: The Science of a Human Obsession," by Daniel J. Levitin, (New York: Penguin, 2006). Together, they leave no doubt that music is an essential part of the human experience.
Consider that music is ubiquitous in all human cultures in all times, dating back at least 50,000 years; that mothers everywhere sing to soothe their babies; and that music evokes emotions and coordinates disparate parts of the brain. We in the United States currently spend more on music than on medication.
Despite its importance, though, music seems peripheral to modern psychiatry. After all, music is not generally part of the routine diagnostic and treatment processes.
I do not incorporate music, per se, in my practice. However, after many years I have become exquisitely sensitive to timbre, that most important musical quality, the tonal sound of a patient's voice. Usually, from the timbre of the voice in our initial exchange I can sense a patient's emotional status. This is quite helpful in 15-minute med checks.
I certainly hope that the timbre of my voice is appropriately reassuring, supportive, concerned, or stern. In fact, a psychiatric colleague's suggestion a while back that our "therapeutic organ" is our voice might have been right on target. That colleague thought that singing might, therefore, be a natural avocation for psychiatrists.
On the other hand, some in the music field would claim that music should be of utmost importance to mental health healers. To reflect this stance, the legendary and innovative jazz saxophonist, Albert Ayler, titled one of his records, "Music Is the Healing Force of the Universe" (Impulse Records, 1969).
A Biopsychosocial Model
Can music be placed into a broader context for those of us fascinated by the workings of the mind? In medicine, a model for integrating different perspectives relevant to health and illness is the biopsychosocial one advocated by Dr. George Engel in the 1970s. If we begin by looking at the social part of this model, we see that music has served an important function throughout human history. Archeological evidence suggests that music preceded language as a tool of communication.
One of the first important social roles for music was as a means of healing. In the Old Testament, David is supposed to have healed the depression of King Saul by playing his harp. …