Music as Medicine

Parallels between philosophy and music in Renée Fleming's new book Music and Mind

Vitaly Gariev via Unsplash

Read this book! If you don’t remember anything else from today’s post, please remember to do yourself a favor and go buy the wonderful book Music and Mind: Harnessing the Arts for Health and Wellness, edited by opera singer Renée Fleming. I almost passed it by because I’ve been disappointed by this type of edited collection in the past and I wasn’t sure it would be worth my time and money. Thank goodness I decided to take a chance on it. Sometimes you strike gold, and Music and Mind is a true treasure.

For those who don’t know Renée Fleming, she’s a famous soprano who has achieved pretty much every honor an opera singer can receive, including 18 Grammy nominations and five Grammy wins. But what I didn’t know was that she has done an incredible amount of advocacy for music and health. Since 2016 she has co-led a collaboration between the Kennedy Center (of which she is artistic director) and the NIH on a project called Sound Health, which “explores the powerful impact of music and the arts on human health and the brain.” (You can watch the Kennedy Center’s free videos on this here.)

In this role Fleming (alongside NIH director Francis Collins) has shared the latest research on music and health everywhere from the International Vatican Conference to the Compton Lecture at MIT, bringing together researchers and perspectives from a wide range of music- and health-related fields, including music therapy, neuroscience, music education, and of course artists and performers themselves. Now she has brought these ideas together in book format, and Music and Mind is just as diverse, impressive, and full of cutting-edge research as you would expect from such a wide-ranging initiative.

The essays included in the volume cover everything you can think of that might be related to music: the neurological basis and potential evolutionary path of human musicality; the health benefits of singing in a choir; how music has helped people deal with disability, pain, and bereavement; the structure of our incredible human voice; ideas for bringing music education to underprivileged schools; and the futuristic technology that will soon enable doctors to diagnose a range of medical conditions by listening to someone’s vocal production.

If you have any interest in these topics at all, you will definitely find it worthwhile to dive into the whole collection. Keep in mind that the book is written for a non-expert audience, so even if you don’t know anything about music theory and you’re not a virtuoso musician, you will still enjoy it. In fact, one of the major themes of Music and Mind is that music performance should not be the preserve of elite composers and performers—we are all made to appreciate and create our own music. In a very essential sense, music is for everyone!

Music and Philosophy

While there are many thought-provoking chapters in the book, I’d like to focus on one particular piece that I see as very complementary to Stoic philosophy: music therapy.

How are philosophy and music alike, you might wonder? For one thing, they both integrate diverse aspects of our brain and psyche, touching cognition, emotion, physical responses, and consciousness. Stoicism is not just a theoretical and intellectual endeavor but rather a philosophy of life, meaning that it guides our decisions and emotional reactions as we live our lives, crossing boundaries between conscious and unconscious awareness, focused attention, habits, and even physiological regulation. Similarly,

Music appears to activate nearly every region of the brain that has so far been mapped, not just a single “music center.” Like vision, music is processed component by component, with specific neural circuits handling pitch, duration, loudness, and timbre. Higher brain centers bring this information together, binding it into representations of contour, melody, rhythm, tempo, meter, and, ultimately, phrases and whole compositions.

Aniruddh D. Patel and Daniel J. Levitin, p. 23

While I think it’s safe to say that music is more basic to humanity than philosophy—that is, it has evolutionarily deeper roots and is more universally practiced—both are essential aspects of a life well lived. And thanks to current research such as that contained in Music and Mind, we have proof of how effective music can be in facing physical and emotional challenges. Just as Stoicism is said to be a therapy of the passions, music can help us overcome some of the mental and physical pain endemic to human life.

In her incredibly insightful chapter called “Music for Chronic Pain Management,” researcher Joke Bradt (a professor of creative arts therapies at Drexel University) discusses her work on music therapy. Here are just two examples of Bradt’s studies on the healing power of music:

• People with chronic pain who frequently listen to music “reported better quality of life and needed less medical treatment” and “reported a greater enjoyment of life, more energy, lower levels of depression, and less interference of pain with daily activities” (p. 98).

• Participants in one music therapy intervention “reported greater improvements in pain interference, self-efficacy, sleep, and social functioning than those who received standard care” (p. 108).

Music is such an effective treatment for pain because, although we feel that pain occurs in a certain area of our body, “the experience of pain is always created in our brain as it orchestrates inputs from three major sources—namely, biological, psychological, and social” (p. 100). As Bradt notes (p. 101),

The presence of an injury and the extent of tissue damage are not major determinants of the intensity of pain a person experiences. The fact that people with similar bodily injuries report very different levels of pain, and the fact that pain is frequently reported in the absence of tissue damage…suggests that pain perception is more complex than simply a neural transmission of noxious stimuli.

Psychological factors that may influence pain perception include a wide gamut of factors. How we think and how we feel at any given moment have a major impact on how much pain we experience. Research has shown that negative mood states such as depression, anxiety, and anger make pain worse.

She is careful to note that even though pain is technically a product of the brain, that doesn’t mean it isn’t real. Pain is all too real and its impacts should not be downplayed. Her emphasis is on trying to understand the factors that contribute to the experience of pain and how various therapies might help people to feel better.

This reminds me very much of the Stoics diagnosis of pain, hardship, and other things that people usually consider bad. They feel very real, but they are essentially products of the mind and can therefore be manipulated (i.e., reduced) by the mind. As Epictetus reminds us:

It isn't the things themselves that disturb people, but the judgments that they form about them. Death, for instance, is nothing terrible, or else it would have seemed so to Socrates too; no, it is in the judgment that death is terrible that the terror lies. So accordingly, whenever we're impeded, disturbed, or distressed, we should never blame anyone else, but only ourselves, that is to say, our judgments. (Handbook, 5)

Death, which is regarded by most people as a Bad Thing, changed its aspect when Socrates saw it differently. In other words, the same thing can be experienced in completely different ways by different people, depending on their approach toward it. And if Socrates could do it, we can too. “What is death?” says Epictetus. “A bogey. Turn it round and you'll find out; look, it doesn't bite! … And what is pain? A bogey; turn it round and you'll find out” (Discourses, 2.1, 17, 19).

Or as Seneca puts it:

Don't make your own sufferings harder to bear by burdening yourself with complaints. Pain is a trivial matter when not augmented by belief. In fact, if you begin to encourage yourself, saying, “It's nothing, or at least it isn't much; let's put up with it until it's over,” then as long as you think of it as trivial you will make it so. Everything depends on belief. It is not only ambition, self-indulgence, and avarice that look to opinion; we feel pain by it as well. Each person is as wretched as he believes himself to be. (Letters on Ethics, 78.13)

Seneca may be somewhat overstating the case—I don’t think most of us would say that pain is ever going to be “a trivial matter”—but both music therapy and Stoic therapy suggest that, although pain is certainly very real, we can ameliorate it through our intentional efforts. This is not to diminish the struggle that so many people have with physical or psychological distress, but to say that there may be a way to lessen the pain that we are all subject to.

So let’s look at three ways that Joke Bradt suggests music therapy can help us heal. You will see, as we go through these areas, that there are strong parallels to the ways that Stoic philosophy can help us heal too.

Decreasing stress and anxiety

When we listen to relaxing music, several neurochemical pathways are activated, which helps reduce our perceived stress. It is believed that the anxiety-reducing effect of music is achieved through its suppressive action on the sympathetic nervous system (i.e., the part of our nervous system that is responsible for setting fight-or-flight responses into motion), leading to decreased adrenergic activity (e.g., lowered heart rate) and decreased neuromuscular arousal. Consequently, music listening may decrease stress hormones such as cortisol and enable our body to recover more quickly from a stressful event. (p. 102)

It's certainly no secret that music can help us relax and destress. But it’s interesting that just listening to music can also help us to be more resilient. By releasing a cascade of physical relaxation responses, such as decreased muscular tension and reduced stress hormones, it puts us in a better frame of mind to handle stress and hardship. And Bradt notes that specific therapies like “music-guided deep breathing and music-guided imagery or visualization” can be even more effective in reducing stress (p. 102). Rather than simply following the music, therapists can change the tempo of the music to induce changes in breathing and heartbeat, which in turn induces relaxation.

I love the idea of using psychophysical tools such as music to help put us in a better frame of mind for virtuous action. You might recall that we discussed this in a previous post on Psychophysical Holism in Stoicism. Since the mind arises from physical processes within the brain—which is very much connected to the rest of the body—we can reverse-engineer our mental states by calming the physical body. In doing so, we put ourselves in a better condition to make good choices. We’ve already discussed breathing techniques and physical practices like yoga, but it turns out that music is another excellent way to do this.

Accepting our Bodies

Embodied experiences help develop a more caring and accepting attitude toward one’s body. Acceptance has been found to play an important role in adjustment to chronic pain, in that patients who report greater acceptance of living with this pain also report less distress, disability, and overall, greater well being and everyday functioning. (p. 103)

The physical relaxation induced by music often leads to greater acceptance of the less-than-ideal condition of the body. Both music and Stoicism can helps us come to grips with our physical limitations and carry on cheerfully. As Seneca notes, “Philosophy does this: it enables a person to be…brave and cheerful no matter what condition his body is in, not giving up just because the body is giving out” (Letters on Ethics, 30.3).

This sentiment is echoed by one of my role models who deal with chronic pain, Karen Duffy. Duff is a former MTV VJ and model who deals with sarcoidosis, an inoperable brain tumor, and intense chronic pain. Yet she is one of the most sanguine and gracious people I’ve ever met. Not only is she an advocate for people experiencing chronic pain, but she also shares her hard-won wisdom in books like Backbone and Wise Up (which I recommend you read if you have not already done so).

In Wise Up: Irreverent Enlightenment from a Mother Who’s Been Through It, Duff shares how she has dealt with chronic pain for so many years:

A principal Stoic tenet is that we can’t control what happens; we can only control how we respond. If something great happens, I can enjoy it without getting too caught up or attached to it. If what happens is bad, like my chronic ill health and intractable pain, I have strategies for dealing with them. I have learned acceptance and resilience. (p. 18)

Cultivating Agency

Teaching people how to actively “use” music rather than letting music distract them is empowering and offers coping strategies that imply active engagement in their healing process. (p. 104)

This concept was a revelation to me. Bradt explains that many people believe music helps them deal with pain simply by distracting them. But research shows there is more to it than that. Music therapists can teach numerous techniques to harness the power of music for dealing with pain, including the music-guided deep breathing and visualization we looked at above. Other techniques include humming, toning (which is singing a long vowel sound), singing, and a process called entrainment, in which “live improvised music progresses from music that expresses a person’s pain into music predetermined by the person as healing” (p.106).

Another area of Bradt’s research is pain-related self-efficacy, which means “beliefs about one’s ability to do things despite the pain” (p. 108). Obviously people with chronic pain have difficulty with many types of activities, but music therapy can help them achieve “better physical functioning, increased participation in social activities, enhanced health and work status, and decreased pain intensity” (p. 109):

Findings from two studies that compared a vocal music therapy treatment program with a wait-list control treatment arm suggest a large treatment effect of vocal music therapy on pain-related self-efficacy…It seems that the music therapy sessions first helped people feel more in control over their pain, and this, in turn, helped them experience less pain and less negative impact of pain on their daily lives. (pp.109-110)

You don’t need me to tell you that Stoicism also deals heavily in agency. This is one of the first things many people learn about Stoicism, as exemplified in this quote from Epictetus:

Disease is an impediment to the body, but not to choice, unless choice will sit to be so. Lameness is an impediment to the leg, but not to choice. And tell yourself the same with regard to everything that happens to you; for you'll find that it acts as an impediment to something else, but not to yourself. (Handbook, 9)

This might sound like an unattainable ideal, but it is actually within our grasp when we work hard at it. My role model Karen Duffy describes how she maintains her sense of agency despite the terrible pain and disability her body has been through:

After living with a degenerative neurological disorder, after all my body has endured—chronic pain, neuropathy, impaired vision, and loss of smell—I am grateful for what I do have and what I can do. I don’t lament what I can no longer do. I play to my strengths. (p. 18)

What a wise approach to the challenging hand life has dealt her! Duff chooses to do what is up to her: carry on and play to her strengths. I think that is excellent advice for all of us.

Concluding Thoughts

Music and Mind showcases many more parallels between Stoicism and music therapy that I don’t have space to cover here: music as psychotherapy (Joanne Loewy’s chapter); music as a “portable sanctuary” that can be carried around with you (Sarah Johnson’s chapter); group singing to cultivate good emotions like “happiness, enjoyment, compassion, contentment, optimism, relaxation, peacefulness, unity, gratitude, and awareness of beauty” (Julene K. Johnson’s chapter, p. 305). But you’ll have to read the book to learn more about these!

I’d like to conclude with a few thoughts about the potential for combining music and Stoicism. If each of these are effective therapies on their own, what would it be like to put them together? What could we create?

It’s been done before. If you haven’t read my review of Melinda Latour’s prize-winning book The Voice of Virtue: Moral Song and the Practice of French Stoicism, 1574-1652, please check it out. As Latour’s groundbreaking study reminds us, during the Neostoic period artists and composers frequently drew on philosophical themes in their compositions. It was a time of great social, political, and religious turmoil, and artists and their patrons took solace in the timeless principles of Stoicism.

We seem to be undergoing a similar flowering of Stoic thought right now, and I hope there are some musicians and artists out there who might be able to lead the way in creating philosophical works for our times. I would love to hear from or about anyone who uses a combination of Stoicism and music (or other arts) to explore the human condition or grapple with life’s challenges.

And just in case you’re in need of inspiration, I’ll leave you with some last stirring thoughts from Music and Mind, this time from Christopher Bailey (“Sounding Joy,” p. 71) as he describes how music helped him deal with losing his vision:

As I listened to this music and was transported by this musical expression of my own grieving for the visual life I had lost, I suddenly was no longer hearing just the music, the tone, the volume, the tempo, the words, but hearing for the first time the actual sound itself, reverberating and caressing the Gothic architecture of the the church, the soft textures of the fabric, and the bodies of the audience around me. I was no longer listening to music, I was experiencing the Mozart literally passing through the physical space and living beings around me, creating an aural picture in my mind, creating the world around me. The music was not about life—it literally recreated the world for me.

Sight is deceptive. It literally captures only the surface of things. It is registering the light reflecting from an object. Sound, however, is an energy that passes through matter. It is more palpable, more immediate.  Once I entered fully this new world of sound, rather than feeling exiled and outcast, I found myself more intimately connected to it, sensing the sound that I hear passing through the objects and people around me, connecting us all, not as objects, but as one continuous song.

Thank you for joining me on this all-too-brief tour of Music and Mind. Remember to grab a copy for yourself, and maybe—just maybe—I will see you at a future event for Stoic music!

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