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Music, medicine, and embodiment

2010; Elsevier BV; Volume: 375; Issue: 9718 Linguagem: Inglês

10.1016/s0140-6736(10)60376-5

1474-547X

H. M. Evans,

Neuroscience, Education and Cognitive Function

I strongly suspect that the consolations of music are more apparent, and to overwhelmingly more people, than are those of any other form of art. This is reflected by the way in daily life so many people voluntarily and habitually access music rather than any other art form. Then why is music so overwhelmingly popular? The explanation is perhaps less a matter of neuroscience, evolutionary theory, or palaeoanthropology than of a partly philosophical account of human nature. The relevance of this to health and illness might not immediately be apparent but both the fact of music's enormous hold on us, and the kind of explanation we might give for it, are important for clinical medicine.A particular focus is the question of why music can have a therapeutic effect. This is distinct from the question of how it works therapeutically, because “how” questions tend to invite answers that identify mechanisms, usually physical ones. By contrast, “why” questions invite answers that involve meaning and significance in people's experience. There may well be physical mechanisms implicated in music's therapeutic effects but, since listening to music is first and foremost an experience, then its therapeutic potential must principally involve other things characteristic of experience—attitudes, expectations, affects, the imagination, memory, bodily self-awareness—that cannot be reduced to physical mechanisms alone.Let me forestall one distracting source of objection: in discussing music's therapeutic effect or potential, I am not referring to technical practices used by professional music therapists. I am concerned simply with the power of music to make people feel better, whether this be formalised within a technical clinical procedure or pursued individually as a source of fulfilment, consolation, or refreshment. So let me use the expression “music as therapy” to cover all instances of specifically therapeutic musical benefit, be they accidental or intended, informal or professional.Why does music make us feel good, and why might that feeling have therapeutic value? Feeling good doubtless in itself does you good. But medical science seems unwilling to let things rest there (hence the enormous interest in musical experience within neuroscience). So if we can be more specific about why music as therapy works then we might expect to secure its benefits more reliably and deliver them more effectively to the most responsive audience.One route to music-as-therapy's appeal might lie in understanding music's overwhelming popularity. But this is puzzling when we set music's popularity alongside the recognition that, in and of itself, music doesn't depict or represent anything. Instrumental music in particular is an abstract art form, not a representational one—unlike virtually all other art forms which standardly are representational. Generally people prefer visual and dramatic and literary art in their representational forms, and they dislike (or are at best mystified by) abstract painting, sculpture, dance, or surreal or expressionist literature or theatre. Yet—song lyrics and libretti apart—this general aversion to the abstract in art is frequently set aside in the case of what I would suggest is the single overwhelmingly most popular art form, where the abstract is central.In art, one plausible way of specifying the abstract is as a recognisable concern with forms rather than with representational content—a concern with the way things are put together rather than what they might be taken to depict. Instrumental music is characteristically like this: it is a kind of structured playfulness in sound, an experiment in combining its own materials. And what are those materials? In school-book isolation, they are principally its tones, intervals, rhythms, melodic sequences, harmonic progressions, structures. But these dry notions come alive in sound and they come alive, moreover, in our recognitions and expectations of sound. This means that, in a wider context, music's own materials also include the forms taken by our experiences of listening, singing, and playing. Music thus consists also in those expectations, in our sense of familiarity, of surprise, anticipation, tension, release, freedom, constraint, and so on; these are very much among the forms of embodied experience, and they suffuse the abstractions in which music deals.Now there is an obvious objection which, if sustained, would have consequences not only for this account of music, but also for the sort of explanation one might give for why music can be therapeutic. The objection is that music is indeed about something independent of itself: namely, human emotions both in general and also actual, specific, literal emotions supposedly endured by the composer and engendered in the performer and the listener. This objection arises from a general fixation with emotion as the object represented in, or expressed by, music—a fixation that is as widespread as it is mistaken. If the “emotion” account of music were correct, it would brand music as a representational art after all, and it would invite a merely cathartic explanation for the workings of music as therapy. But a widespread mistake is still a mistake, in this case perhaps part of a generally enduring hangover from the Romantic period. I think the reason for its grip upon us is that we are misled in two respects. First, I suspect an uncritical attachment to representation elsewhere in art makes us subconsciously yearn for it also in music. So we may attach to certain conventional forms and phrases a set vocabulary of usually dull and hackneyed specific emotions (happy, sad, tragic, triumphant) and invariably attribute them literally to composers and listeners alike, despite all evidence and reason to the contrary. But second, there is an important sense in which we are indeed moved by music, but much more literally, much less figuratively, than we suppose. The urges to tap along, or to dance, or to alternate muscular tension and relaxation, or to meter our breath, for instance, are certainly ways that music can move us. We have registered music's calling to a very physical sense of our own being, proprioception, willed movement, and agency—in short, a sense of our own physical and sensory embodiment—but we seem collectively to have mistaken this for something much less interesting and far less plausible, a narrow and clichéd litany of emotion-terms.Let us put all this in the context of what we might call the natural facts of life about music, which is, of course, a complex social activity. Music exhibits certain facts about our own embodiment—our size, the characteristic length of our limbs and vocal chords, the volume of our lungs, and the chambers of our hearts—that make particular resonances natural and comfortable for us both tonally and rhythmically. And music also reflects natural facts in the universe around us, including the subdivision of tonal frequencies that produce harmonies of vibration for us as for all material objects. Tonal systems do vary around the world, but less than the cultural relativist or the postmodernist might suppose: something close to the basic tonality of western music from William Byrd to The Byrds may be recognised in at least three continents.What I draw from this is that music expresses aspects of the forms of our embodied experience, forms that exhibit our natural physical state in its musculosensory reality. By this I mean those general forms of experience realised in rhythm, proprioception, and kinaesthesia; in muscular agency with its characteristic dynamic tensions; in anticipation and resolution; in willed changes to amplitude of movement; in a sense of oneself located both in closely cushioned immediacy and in vertiginous space; and no less in that sense of memory and identity that works alchemically upon sequence and repetition in music. Music stands in strongly natural relations to these fundamental facts about our shared embodied experience, although of course it is modulated, through socially understood varietal forms, by the agency of individual imaginations (on the part of composer, performer, and listener alike). In short, music expresses general forms of our experience, rather than specific emotional contents that must more plausibly be left to the literary and other representational arts. Musical experience is preorganised in our nature, but transformed by socially moderated imagination—as is all our experience, of course. And this takes us back to music as therapy that, as I noted at the outset, is first and foremost an experiential matter.When music works upon us therapeutically, it expresses, recalls, and even rekindles general features of our embodied experience and of our ordinary being. I am not suggesting that it causes a return to healthier or premorbid states in any mechanical sense, but rather that in recalling ordinary being it reinforces that being, and reinforces us—it inclines us in the direction of bodily and psychological fluency and vitality. The benefit may stop when the music stops, or it may persist—Oliver Sacks describes both outcomes—but in either case it arises, surely, out of a more strongly resonant fit between the organic fabric of agency and the imagination, brought about by music's deep engagement with the sorts of creatures we are.A final thought concerns another kind of philosophical “deep engagement”, although one that we must here allow to remain at the level of conjecture. Arthur Schopenhauer thought that the sorts of creatures we are—material beings but with consciousness and a direct knowledge of ourselves—gave us a glimpse of reality beyond the world of perception. Intriguingly, he thought that music also gave us fundamental insights into the nature of reality, and so Schopenhauer's philosophy unites music with the human body in a radical way. Although such intimidating conjectures are not necessary for us to begin to understand music's therapeutic capabilities, they do hint that music might be an expression not merely of our ordinary being but of our place in the universal order of things. Were this so, it would invite a far more radical conception of why music can always console us and, sometimes, can heal us. I strongly suspect that the consolations of music are more apparent, and to overwhelmingly more people, than are those of any other form of art. This is reflected by the way in daily life so many people voluntarily and habitually access music rather than any other art form. Then why is music so overwhelmingly popular? The explanation is perhaps less a matter of neuroscience, evolutionary theory, or palaeoanthropology than of a partly philosophical account of human nature. The relevance of this to health and illness might not immediately be apparent but both the fact of music's enormous hold on us, and the kind of explanation we might give for it, are important for clinical medicine. A particular focus is the question of why music can have a therapeutic effect. This is distinct from the question of how it works therapeutically, because “how” questions tend to invite answers that identify mechanisms, usually physical ones. By contrast, “why” questions invite answers that involve meaning and significance in people's experience. There may well be physical mechanisms implicated in music's therapeutic effects but, since listening to music is first and foremost an experience, then its therapeutic potential must principally involve other things characteristic of experience—attitudes, expectations, affects, the imagination, memory, bodily self-awareness—that cannot be reduced to physical mechanisms alone. Let me forestall one distracting source of objection: in discussing music's therapeutic effect or potential, I am not referring to technical practices used by professional music therapists. I am concerned simply with the power of music to make people feel better, whether this be formalised within a technical clinical procedure or pursued individually as a source of fulfilment, consolation, or refreshment. So let me use the expression “music as therapy” to cover all instances of specifically therapeutic musical benefit, be they accidental or intended, informal or professional. Why does music make us feel good, and why might that feeling have therapeutic value? Feeling good doubtless in itself does you good. But medical science seems unwilling to let things rest there (hence the enormous interest in musical experience within neuroscience). So if we can be more specific about why music as therapy works then we might expect to secure its benefits more reliably and deliver them more effectively to the most responsive audience. One route to music-as-therapy's appeal might lie in understanding music's overwhelming popularity. But this is puzzling when we set music's popularity alongside the recognition that, in and of itself, music doesn't depict or represent anything. Instrumental music in particular is an abstract art form, not a representational one—unlike virtually all other art forms which standardly are representational. Generally people prefer visual and dramatic and literary art in their representational forms, and they dislike (or are at best mystified by) abstract painting, sculpture, dance, or surreal or expressionist literature or theatre. Yet—song lyrics and libretti apart—this general aversion to the abstract in art is frequently set aside in the case of what I would suggest is the single overwhelmingly most popular art form, where the abstract is central. In art, one plausible way of specifying the abstract is as a recognisable concern with forms rather than with representational content—a concern with the way things are put together rather than what they might be taken to depict. Instrumental music is characteristically like this: it is a kind of structured playfulness in sound, an experiment in combining its own materials. And what are those materials? In school-book isolation, they are principally its tones, intervals, rhythms, melodic sequences, harmonic progressions, structures. But these dry notions come alive in sound and they come alive, moreover, in our recognitions and expectations of sound. This means that, in a wider context, music's own materials also include the forms taken by our experiences of listening, singing, and playing. Music thus consists also in those expectations, in our sense of familiarity, of surprise, anticipation, tension, release, freedom, constraint, and so on; these are very much among the forms of embodied experience, and they suffuse the abstractions in which music deals. Now there is an obvious objection which, if sustained, would have consequences not only for this account of music, but also for the sort of explanation one might give for why music can be therapeutic. The objection is that music is indeed about something independent of itself: namely, human emotions both in general and also actual, specific, literal emotions supposedly endured by the composer and engendered in the performer and the listener. This objection arises from a general fixation with emotion as the object represented in, or expressed by, music—a fixation that is as widespread as it is mistaken. If the “emotion” account of music were correct, it would brand music as a representational art after all, and it would invite a merely cathartic explanation for the workings of music as therapy. But a widespread mistake is still a mistake, in this case perhaps part of a generally enduring hangover from the Romantic period. I think the reason for its grip upon us is that we are misled in two respects. First, I suspect an uncritical attachment to representation elsewhere in art makes us subconsciously yearn for it also in music. So we may attach to certain conventional forms and phrases a set vocabulary of usually dull and hackneyed specific emotions (happy, sad, tragic, triumphant) and invariably attribute them literally to composers and listeners alike, despite all evidence and reason to the contrary. But second, there is an important sense in which we are indeed moved by music, but much more literally, much less figuratively, than we suppose. The urges to tap along, or to dance, or to alternate muscular tension and relaxation, or to meter our breath, for instance, are certainly ways that music can move us. We have registered music's calling to a very physical sense of our own being, proprioception, willed movement, and agency—in short, a sense of our own physical and sensory embodiment—but we seem collectively to have mistaken this for something much less interesting and far less plausible, a narrow and clichéd litany of emotion-terms. Let us put all this in the context of what we might call the natural facts of life about music, which is, of course, a complex social activity. Music exhibits certain facts about our own embodiment—our size, the characteristic length of our limbs and vocal chords, the volume of our lungs, and the chambers of our hearts—that make particular resonances natural and comfortable for us both tonally and rhythmically. And music also reflects natural facts in the universe around us, including the subdivision of tonal frequencies that produce harmonies of vibration for us as for all material objects. Tonal systems do vary around the world, but less than the cultural relativist or the postmodernist might suppose: something close to the basic tonality of western music from William Byrd to The Byrds may be recognised in at least three continents. What I draw from this is that music expresses aspects of the forms of our embodied experience, forms that exhibit our natural physical state in its musculosensory reality. By this I mean those general forms of experience realised in rhythm, proprioception, and kinaesthesia; in muscular agency with its characteristic dynamic tensions; in anticipation and resolution; in willed changes to amplitude of movement; in a sense of oneself located both in closely cushioned immediacy and in vertiginous space; and no less in that sense of memory and identity that works alchemically upon sequence and repetition in music. Music stands in strongly natural relations to these fundamental facts about our shared embodied experience, although of course it is modulated, through socially understood varietal forms, by the agency of individual imaginations (on the part of composer, performer, and listener alike). In short, music expresses general forms of our experience, rather than specific emotional contents that must more plausibly be left to the literary and other representational arts. Musical experience is preorganised in our nature, but transformed by socially moderated imagination—as is all our experience, of course. And this takes us back to music as therapy that, as I noted at the outset, is first and foremost an experiential matter. When music works upon us therapeutically, it expresses, recalls, and even rekindles general features of our embodied experience and of our ordinary being. I am not suggesting that it causes a return to healthier or premorbid states in any mechanical sense, but rather that in recalling ordinary being it reinforces that being, and reinforces us—it inclines us in the direction of bodily and psychological fluency and vitality. The benefit may stop when the music stops, or it may persist—Oliver Sacks describes both outcomes—but in either case it arises, surely, out of a more strongly resonant fit between the organic fabric of agency and the imagination, brought about by music's deep engagement with the sorts of creatures we are. A final thought concerns another kind of philosophical “deep engagement”, although one that we must here allow to remain at the level of conjecture. Arthur Schopenhauer thought that the sorts of creatures we are—material beings but with consciousness and a direct knowledge of ourselves—gave us a glimpse of reality beyond the world of perception. Intriguingly, he thought that music also gave us fundamental insights into the nature of reality, and so Schopenhauer's philosophy unites music with the human body in a radical way. Although such intimidating conjectures are not necessary for us to begin to understand music's therapeutic capabilities, they do hint that music might be an expression not merely of our ordinary being but of our place in the universal order of things. Were this so, it would invite a far more radical conception of why music can always console us and, sometimes, can heal us.