Healing Power of Music
Music therapy offers balm to the sick and may spark recovery for patients with severe impairment.
It was now or never. The patient, a 76-year-old laundress in the Dominican Republic, was scheduled for total bilateral knee replacements. But her blood pressure was so high—240/120—that her surgical team refused to operate. The patient’s face was contorted with worry. She couldn’t simply put off the procedure: The operation was part of a philanthropic program; her surgeons would not return to her hospital in Santo Domingo for a year at the earliest. And aggressive drug therapy was not bringing the pressure down.
The solution, it turned out, was song. In her room, the patient, a deeply religious woman, asked her nurses tentatively, “May I sing?” (She was worried about disturbing her three roommates.) After she’d crooned only two religious songs, her blood pressure dropped to 180/90. With her nurses’ hearty endorsement, she sang softly through the night; the next morning she was cleared for surgery. She had successful total knee replacements, wrote the doctors who published her case history in Arthritis Care & Research (April 2011).
Why does old-fashioned music sometimes succeed when state-of-the-art medicine is at a loss? “In a very specific way, music can excite areas of the brain that have been dormant; it can turn on verbal or visual pathways that cannot be accessed by other therapies,” notes Concetta Tomaino, D.A. (doctor of arts), a pioneer in the deployment of music to spark recovery in patients with severe disabilities. Dr. Tomaino is the co-founder, with noted neurologist Oliver Sacks, of the Institute for Music and Neurologic Function (IMNF) at Beth Abraham Family of Health Services in the Bronx. Its mission: to study “music’s extraordinary power to awaken, stimulate and heal.”
We’ve all seen music work its magic in our everyday lives. Recently I followed two professional guitarists and a soprano around a patient floor at Roosevelt Hospital—and saw singing bring patients instant ease and trigger deep emotion. These musicians were among the many professional players who volunteer to bring live performances to patients and caregivers in six New York City health-care facilities through Sing For Hope. “Do you care for a song?” the trio would ask, pausing in the patient’s doorway; about half the time, they’d be invited in.
Our most enthusiastic welcome came from a jovial elderly woman who wanted to hear “A Bushel and a Peck.” After the team launched into it, soprano Catherine Hancock began singing “Someone to Watch Over Me.” As the soothing melody pervaded the room, the patient relaxed and lay back, transported; her eyes closed as she silently mouthed the words. When the song was over, she told us, in a choked voice, that its message had affected her deeply; it had brought back memories of how she had watched over her husband in his illness, and it made her hope that the next day, during her operation, “God will be watching over me.”
What the Sing for Hope musicians were offering patients that day was “therapeutic music”—music that any laymen can provide to give moments of respite to those who are sick. But “music therapy,” Dr. Tomaino points out, is a tool employed in a serious effort at rehabilitation, and those who practice it have undergone rigorous academic training. “Most people don’t think of music therapy as a health-care field,” Dr. Tomaino says. “But it is.”
During the 16 years she has worked at the Institute for Music and Neurologic Function with patients suffering from stroke, traumatic brain injury, and chronic diseases like Parkinson’s and multiple sclerosis, Dr. Tomaino has seen music stimulate the memory of patients suffering from dementia; help stroke patients recover their power of speech; aid physical therapists strengthen the muscles of patients and extend their flexibility; assist Parkinson’s patients regain their ability to walk; and reduce severe anxiety in pre- and post-surgery patients. In a series of short, compelling videos, Dr. Sacks speaks eloquently of the transformations that he and Dr. Tomaino have witnessed over the years (see sidebar).
The New Science of Song
All of us can use music to bring pleasure to the sick; music therapists, however, know how to use music to treat patients. With guitar, keyboard, drums, or accordion (Dr. Tomaino’s instrument of choice), these specialists work in hospitals, nursing homes, rehab centers, schools, and hospices—and their expertise is available to patients at home as well. (See “Harnessing Music’s Restorative Power”, next page.) They work with special-needs children, people suffering from depression or dementia, patients disabled by accident or brain injury, and the dying. And they have credentials: A music therapist must be a proficient musician and college graduate with a degree in music therapy; he or she must have spent at least 1,200 hours in clinical training, including a supervised internship; passed a national certifying examination, and, in New York State, be licensed.
“An ordinary musician can sing along with a patient with aphasia, but he won’t know why she can sing, say, only the first and last words of “By the Light of the Silvery Moon,” explains Dr. Tomaino. “A music therapist [MT] will alter the music, perhaps exaggerating the range of the note where a patient gets stuck, and then have the patient repeat the phrase over and over until the repetition disinhibits the block in her brain. Then the MT will prepare a treatment program and monitor the patient’s progress.
“Parkinson’s patients have trouble initiating steps, cadence, and balance,” she continues. “People assume that if they play rhythmic music, a patient will follow it. But Parkinson’s patients don’t perceive the beat the way others do. MTs are trained to manipulate the beat until they see that the patient can feel it. And to help Parkinson’s patients with their speech, MTs will initiate vocalization: Since a patients’ vocal folds atrophy, one way to keep them soft is humming.”
Dr. Tomaino’s institute has CDs of “amazing” music that patients have created—therapists at IMNF urge patients to compose music and lyrics to help them deal with post-injury depression. “Music can be used in an in-depth, therapeutic way,” Dr. Tomaino notes. “It helps the body break through some of the inhibitions that result from traumatic injury. Many times patients can’t articulate what they are going through. Composing helps them do that.” She cites a young man who had lost both of his arms as a result of gang violence. After months and months of therapy, he composed a song that declared, “Life isn’t what you expect, but it’s a brand-new day.”
Today, advances in brain imaging enable researchers to chart the pathways that music follows in the brain. In her new book on the power of music, Elena Mannes, granddaughter of the founders of New York City’s Mannes College of Music, calls this research “the new science of song” (see sidebar).
And research—the randomized, controlled trials that are the gold standard of scientific study—has begun to validate what we laymen “know” and what clinicians like Dr. Tomaino have long observed: Music therapy can improve the medical outcome of patients with many different afflictions. The field is young: Many of these trials involve only small numbers of patients, and authors of the studies stress the need for further research. Still, using rigorous research methods, these small trials have shown that music therapy can, among its other benefits, lower blood pressure preoperatively and relieve depression. It may help children with autistic spectrum disorder improve their communicative skills, and help people with schizophrenia improve their global state. On music therapy’s effectiveness in pain relief, a 2006 review of 51 studies concluded, “Listening to music reduces pain intensity levels and [morphine and other opioids], but the magnitude of these benefits is small and, therefore, its clinical importance unclear.”