Music Therapy

1986, Vol. 6A, No. I, 3-12

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Music and Healing
HELEN LINDQUIST BONNY, Ph.D., R.M.T., C.M.T.

Traditional Western medicine has not seriously considered music as

a healing medium. The more recent ascendance of holistic medicine
is creating a change in the attitude held by practitioners and the
public to a position of greater acceptance of music therapy as a
healing mod;.
In this article the author surveys a selection of research pertinent to
the field. Music therapy is first defined, and the healing properties of
music delineated. A review of physiological and therapeutic
responses to music is followed by various opinions as to whichtypes
of music are most appropriate for music therapy procedures.

Throughout history, music has beenthought of as ahealingforce. More

recently modern medicine has not looked with favor on such pronounce­
ments. Most medical practitioners do not seemusic fitting into scientific
procedures which have hailed the left-brained mentality over right--brained
intuitive faculties. This situation may change with the ascendance
of holistic medicine, where the well-being of the total person is pursued.
The discipline of music therapy concerns itself with the remedial and be­
havioral effects of the use of carefully controlled music. Those who benefit
from this therapy are inpatients and outpatients with mental and emo­
tional disorders due to retardation, psychosocial problems and psychiatric
illnesses. The music therapist works in institutions with patients in long
term treatment or in schools for children with special problems. Clients
with disorders such ascerebral palsy, muscular dystrophy, sensory impair­
ments, epilepsy, birth defects and cancer have been helped. Until recent
years the goal of music therapy has beento correct the psychological and
behavioral imbalances created by these diseasesand conditions, making
few claims to music’s physically healing capacities. The emphasisand even
the identity of the field of music therapy is changing due, in large part, to
the introduction of holistic medicine and its acknowledgement that the
total person ­ mind, body and spirit - must be brought to the “healing
table.” Music is the ideal instrument for this change,since it is so intimately
4 Bonny

involved in both our inner and outer lives.

In his hallmark book, The Magic of Tone and the Art of Music, Dane
Rudyar says, “We usually attempt to control bodily problems from the

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‘outside’ with drugs rather than attempting to employ the individual’s
built-in capacity for self-regulation. In this regard, proper music can be
a most helpful and effective addition.” Most thinking people who under­
stand the power of music would agreewith this statement. Music therapists
must find how to structure and delineate the musical treatment mode to
affect a healing end, most particularly, a scientific and repeatable process
which can be effectively used by the medical practitioner. This paper does
not propose to have delineated such a system which may be premature in
light of the information and expertise now at our disposal. Instead a
picture will be painted of findings to date. Thesewill include both research
and observational reports illustrative, but not exhaustive. of the work that
is currently being done in the music and healing field.

WHAT IS MUSIC THERAPY?

A definition of music therapy may help us delineate and clarify the useof
music in healing. Music therapy may be defined as the systematic appli­
cation of music asdirected by the music therapist to bring about changesin
the emotional and/ or physical health of the person. As such, its functional
rather than its aesthetic and entertainment aspects are emphasized.
Becausemusic is so much a part of our modern environment, it is con­
sidered to be a non-threatening form of sound influence. This availability
and acceptance of music provides a positive framework upon which to
build further confidence. Effective music therapy is dependent upon the
skills of the therapist and upon an understanding of how music may con­
tribute to the healing mode.
What are the characteristics of music which contribute to its therapeutic
use?
1. Music is non-verbal. Verbal communication is linear and therefore
limited to one level of communication. Music is multi-dimensional,
crossing through verbal barriers and providing meaning on several
levels simultaneously.
2. Music evokes emotional responses.It is used in love songs, funeral
dirges and marches. These are general responses; more specific re­
sponses occur within selections or within each individual as music is
listened to. Music is considered a mood changer due to its ability to
influence our feeling states.
3. Music evokes physiological responses. Rhythm, the energizer of
music, is related to heart rate, blood pressure, breathing and the whole
multitude of vibrational periodicities that make up the body structures.
The tension/release dynamic inherent in Western musical composition
further enhance the rhythmic balances desired in good health. The
Music and Healing 5

newest research in brain hemispheric differentiation and the triune

brain (Pearce, 1986) explains the wide dissemination of sound
phenomena throughout the body. It is speculated that the production of

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morphine-like peptides or endorphins may be connected to certain
musical experiences.
4. Music stimulates symbolic representation. Images, whether kin­
esthetic, emotional or visual are a part of treatment in various diseases.
Carefully chosen music can effectively enhance the flow of imagery and
fantasy or renewal of memories, where clinical situations dictate these
as the treatment of choice.
5. The sensory stimulation of music can create synesthesias of other
senses. Touch, taste, vision and smell are enhanced when music is
deeply listened to, creating a basis for work with the sensorily handi­
capped.
To note the characteristics of music which contribute to its therapeutic
effects is not to form a complete theory or body of data than can explain
music’s effect on us. The current state of research allows us to be no more
specific than to say that “we respond to music by a complex mix of psycho­
logical and physiological reactions triggered by numerous aspects of the
music itself” (Rosenfeld, 1985, p. 56).
Music is not transmitted to the brain exclusively by the mechanisms of
the ear. Music reachesus through the mediums of skin, bones and viscera.
The ear is extremely sensitive to vibrations in the air and conveys the pat­
terns of these vibrations in a form that the brain recognizesas sounds and
speech. One does not have a similar sensing device in the hand, for
example, even though one feelsa sensation of sound from the hand when it
is struck by sound waves, or a vibration in the chest and thigh areaswhen
one is in close proximity to the heavy low amplitudes of rock or marching
music.
We use the terms “touch and sound” and “sound presence” to describe
the effects of music on the surfaces, muscle systems, and glandular and
chemical functions of the body. In the past we have considered these to be
affective responses. Now we realize that by labeling such responses as
affective, a separatecategory has beencreated where none should exist. In
Beyond Illness, Larry Dossey illustrates that most physicians believe:
Diseaseoriginates due to breakdown at the molecular level and is,
thus, physical by definition. This way of thinking legitimizes certain
forms of therapy over others: physicalistic approaches -drugs and
surgery-that exert actual physical changesare most valued. Other
therapies, such as behavioral modalities, are valuable only to the
extent that they bring about demonstrable somatic changes;
therapies that “make one feel better” are said to “really not do any­
thing” and are suspected as fundamentally useless.(1984, p. 16)
On the other hand:
Michael Ruff of the National Institute of Health reminds us that
6 Bonny

“psychological stress impairs the immune system.” Anxiety, there­

fore, increasesour vulnerability to disease.Emotions and feelings are
fundamentally biochemical in nature and thus effect the immune

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system both directly and indirectly. (Dixon, 1986, p. 65)
As medicine moves toward holistic approaches that integrate body, mind
and emotion, it becomes more like music, which has always concerned
itself with a person’s total beingness.
When compiling a summary of published research on music in healing
procedures, traditional definitions of physical illness and diseaseare called
into question. This paper will review the traditional approach and then
continue with studies that show the close connections between body, mind
and music.

PHYSIOLOGICAL RESPONSES TO MUSIC

Studies reported in the literature before 1981 “clearly support the
hypothesis that listening to music does influence a person’s physiological
responses. However, the data do not show support for the nature of this
influence” (Hodges, 1980, p. 396). A common theme of the early re­
searchers was a comparison of the relative effects of stimulative and
sedative music. Stimulative music was defined as that which “emphasizes
rhythm rather than melody and is characterized by soft, legato passages
with narrow pitch ranges” (Gaston, 1951, p. 43). The often tested hy­
pothesis that stimulative music increases physiological responses,while
sedative music decreasesthem, was not unanimously accepted. Heart and
pulse rates, blood pressure, skin responsesand muscular/ motor responses
all show changes in responseto music, but in no particular direction. The
reasons for this may be threefold: the definitions of stimulative and seda­
tive music may be too general; measurementsof the various physiological
responsesmay be unreliable or inaccurate; and variables such asthe testing
situation, movement on the part of patients, and extraneous sights and
sounds, are difficult to control.
More recent studies have recognized the rhythms of the body as being
related to the rhythms of the world around us. The three inescapable
rhythms in which we live are the rotation of the earth, the moon and the
earth around the sun; the three basic environmental periodicities are the
daily, lunar-tidal and annual. Biological rhythms have different timing
systems.“Bio-function works by oscillation: heartbeat, breathing, trans­
mission of nerve impulses. These impulses are not related to external time
but have to do with demands of the body tissues for oxygen” (Ayensu,
1981, p. 53).
A recognition of the correlation between the rhythms of the body and
those in music servesas a basis for promising research into music’s effect
on a person, A technique called entrainment utilizes these rhythms by
causing periodic phenomena to “time lock.” For example, musical tempi
may be synchronized with the physical/ biological state; when entrainment
is complete, physical change is caused by musical variations. Human
Music and Healing 7

characteristics other than body rhythms, such as mood states, are

influenced by and influence body imbalances. Entertainment can therefore
utilize both the tempo and the mood of music to effect change in mood and

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body rhythms.
In a study ofentrainment, Rider (1985) useddifferent types ofmusic and
imagery to reduce pain and affect muscle relaxation. Of the five indepen­
dent variables, the entrainment music in which the prevalent mood shifted
from tension to relaxation wassignificantly most effective in reducing pain
and electromyographic (muscle tension) levels. The entrainment music
contained both synthesized and acoustic guitar and exhibited a definite
shift from unpleasant to pleasant.
Another currently considered audioanalgesic effect involves endorphin
production through thrill response. Goldstein, of the Stanford Addiction
Research Center, used music chosen by the subjects to induce “musical
thrills.” It was suggestedthat thesemusically induced highs may be caused
by the releaseof endorphins into the bloodstream on musical command.
To test his hypothesis, Goldstein injected several subjects with naloxone,
which blocked the endorphin effect. Naloxone did appreciably lessenthe
thrills of somelisteners. In a subsequent study, Goldstein( 1982) asked250
people what gave them the greatest thrill. All but 4% of the respondents
mentioned music.
Spintge reported that music to reduce anxiety and pain in dental surgery
patients reduced blood levels of the stress hormone ACTH, but raised
levels of the endogenous opiod beta-endorphin (Harvey, 1985).
The auto-conditioning effects of music in childbirth were reported by
Clark, McCorkle and Williams (1981) in the study of 50 women at the Uni­
versity of Kansas Medical Center. With the music therapist in attendance,
patients listened to pre-selected musical works throughout labor and
delivery. The authors found that music can have many functions in pre­
pared childbirth. Music has the potential for becoming an effective atten­
tion-focusing stimulus, thereby increasing pain tolerance. Certain musical
pieces can be intrusive, can penetrate the listener’s awareness and hold
attention enough to distract the listener from external and internal dis­
comfort. Music also has excellent potential to be a conditioned stimulus
for relaxation. Repeatedaudition of specific music in the pre-labor classes,
while in a state of muscular relaxation, can provide a carry-over to the
birth itself. Researchhas demonstrated that classical music evokes greater
enjoyment and interest with repeated hearings, while popular music
declines in effectiveness with repetition (Downey and Knapp, 1927).
The use of Guided Imagery and Music (GIM) in six preliminary music
sessionsencouraged prospective mothers to focus on imagic representa­
tions of possible fears and pleasures relating to both childbirth and their
new roles asmothers. Music can reinforce the breathing patterns learned in
childbirth preparation classes.The breathing becomes,in part, a physical
responseto the rhythm and tempo of the music. Experimental data suggest
that women who participate in this music therapy protocol experience
significantly more positive perceptions of their childbirthexperiences than
8 Bonny

their non-music therapy counterparts.

Research by Hanser, Larson and O’Connell at the University of the
Pacific emphasized the autoanalgesic effect of music and cued rhythmic

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breathing, assisting the women to relax by prompting positive associations
with music. The study yielded dramatic results “in that 100%of the experi­
mental mothers displayed fewer pain responseswhile music was playing
during labor” (1983, p. 57).

THE SELECTION OF MUSIC FOR HEALING

The type of music used in the above mentioned studies is of particular
importance. In the study by Clark, McCorkle and Williams. music appro­
priate for imagery induction was chosen by the researchers.On the other
hand, the music therapist developed individualized music programs based
on the mother’s preferencesand on observations of the tempo and pace of
her breathing in the study by Hanser et al. Musical excerpts of gradually
faster tempi were recorded to correspond with the prospective mother’s
breathing rates.
Music and medicine have often gone together as vocation and
avocation. Dr. L’Echevin, a French surgeon, is also a conductor, pianist
and double bassist. In his recently published book, Musique PI Medecine,
he tells of an experiment in a Japanese factory involving 120 working
mothers who were nursing. One group listened to Western classical music,
the second to jazz and pop; some through earphones, some through
speakers. The group listening to classical music through speakers was
found to have a lactation increase of 20%; the increase was 100% with
earphones. Lactation in the second group went down by 20% and 50%,
respectively (Zwerin, n.d.).
Selection of the most appropriate music for healing purposes is an
ongoing debate. In 1983 the author conducted a study in two hospital
intensive coronary care units using sedative-type music. Patients were
given a choice of either classical or popular music in 20-minute taped
programs. Nurse evaluators looked for changes pre-to post-music in heart
rate, blood pressure, need for pain medication and, on an emotional rating
scale, for relief from anxiety and depression. A significant reduction in
heart rate and lowered systolic and diastolic blood pressure, greater toler­
ance of pain and suffering, and lessenedanxiety and depression were noted
at the conclusion of each music program. An unexpected finding was a
strong preference in both patient and nursing staff for the classical music
program over the popular one. Patients in a weakenedstate responded less
to music which was familiar and preferred in everyday life. It was
concluded that severeillness createsa right brain propensity for reception
of meaningful stimuli. Great music that has lived through time is more
readily accepted on physical and intuitive levels.
Research on the music-assistedimagery processcalled Guided Imagery
and Music (GIM) found that personal music preferenceswere not usually
applicable or healing when used in therapeutic settings. In GIM the client
Music and Healing 9

is encouraged to relax into a deeply altered state and, asthe specially pro­
grammed classical music plays, s/he is asked to allow images relating to
personal issuesto emerge. These images are related to the therapist who

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helps bring about synthesis and resolution. Although this process was
designed to foster personal growth in psychological and spiritual dimen­
sions, occasional healings of a physical nature do occur (Bonny, 1978).
During a GIM workshop experience a patient named Robert noticed an
abrupt change occurring in his heart rhythm. He said that he felt a few
thumps, and that his rhythm was regular thereafter. His doctor verified
that in the past he had suffered from recurrent episodes of atrial flutter
which had beenconverted to regular sinus rhythm with cardioversion and
drugs. After the music session, however, the cardiogram was normal,
showing the presenceof regular sinus rhythm and, untypically, there was
no recurrence of the atria1 flutter. The doctor volunteered EKG documents
verifying the change in Robert’s condition with the accompanying note,
“My communication with you does not intend testimonial. but is merely
a statement of documented fact. It is most impressive, however” (A.E.
Bacon, personal communication, July 12, 1979).
With the successof taped music in the coronary care unit of the hospital,
the anesthesiologist requested music for the surgery areas, since patients
are anxious before and after surgical procedures. Classical music tapes
were played over loudspeakers in the pre-op areas and through
headphones in the operating rooms. In the recovery room, the music was
changed to stimulative, or more active tempos, to encourage return to
normal consciousness. Patients reported substantially reduced pre- and
post-operative pain and anxiety, and anesthesia requirements were
reduced. (Bonny & McCarron, 1984, p. 57)
Other studies indicating successful use of music in hospital settings
include:
Music used as part of a comprehensive preoperative teaching
session for pediatric patients. The children who received music
therapy before medication were rated as showing lessanxiety for the
surgical procedure. (Chetta, 1981)
Studies by MUZAK report a significant reduction in stressfor 286
pre-operative patients, and a highly consistent reductive effect on
systolic and diastolic blood pressure, pulse rate and respiration rate.
(MUZAK, ad.)
A study at the Sloan-Kettering Cancer Center in New York found
that music produces physical and emotional changes in hospitalized
cancer patients. It was demonstrated that live music affects hospi­
talized patients significantly more than does tape-recorded music of
the same material. (Bailey, 1983)
Brain hemispheric studies show that both cortical and subcortical areas
are involved in music making and listening. “When subcortical areas are
damaged or disconnected from the cortical area, patients rarely care about
music” (Rosenfeld, 1985, p. 54). Emotional response mechanisms are
severed, and music, the language of emotions, cannot be appreciated.
Studies of hemispheric differentiation have indicated that most people,
with the exception of trained musicians, process music through the right

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temporal lobe. (Hodges, 1980, p, 202)
For stroke victims, specially prepared music can play an important part
in recovery. Melodic Intonation Therapy was developed at Boston
University School of Medicine to enable stroke victims to learn to sneak
again.
In a Pueblo, Colorado Nursing Home, Jack Stucki usesrelaxation, pink
sound, music and healing suggestions to create ahealing climate for stroke
and arthritis victims. His purpose is to help patients changetheir reactions
to stress, and to encourage them to use body parts which were once
paralyzed. He uses feedback equipment to encourage clients to move
muscles. Muscle movement triggers electronic impulses, which are
changed by an oscillator into tones. These tones give the client positive
reinforcement, prompting him/ her to maintain movement, and allowing
the self-generated music to continue. Pink sound, a variation of white
noise which uses selected frequencies in a wave-like sound sequence, is
combined by a mixer with self-generated tones, taped music and the
therapist’s voice to provide a very successful treatment milieu (Stucki,
1979).

THE USE OF MUSIC TO PREVENT ILLNESS

This paper has summarized research studies which demonstrate the use
of music in the alleviation of physically and emotionally generated human
illnesses. Most of the music procedures utilized have beenthe more passive
ones, which include listening to musical phenomena. We must now address
prevention. Can music performance and listening preserve health, even
extend life? A study of the life spansof major symphonic conductors seems
to imply longevity for that profession. John Diamond states that 80% of
conductors are still alive and working at age70. He concludes “a conductor
is thus vigorously tonifying certain energy systems by the gestures he
makes each day (Diamond, 1979,p. 157),at the sametime that he is being
flooded by the healing qualities of the music.”
Exciting new theories which explore the neurophysiology of emotion in
music performance are being uncovered by Manfred Clynes, an inventor,
neurophysiologist and concert pianist. Clynes’ book, Sentics, the Touch of
Emotions, outlines a biological basis for communication of emotion
through musical expression. Music involves expressive forms in time, and
every good composer usesa wide range of essenticforms in his/ her musical
expressions. Clynes defines essentic form as “the biologically given
expressive dynamic form for a specific emotion”( 1985,p. 3). A performer’s
technical ability is gauged by his/ her ability to reproduce the precision of
these essentic forms in musical performance. Clynes proposes, “For each
primary emotion - love, hate, anger, joy, grief -­ there is an innate brain
program which provides a ‘command shape’ for all expressions of that
Music and Healing 11

emotion. Contours so formed become essentic forms and show stability

and constancy” (Jonas, 1972, p. 41). These forms are the key to one’s
ability to communicate feelings precisely to another human being. In

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performance, emotional affect may pass through the musicians’ fingers,
pressure and breath to become a palpable essence for the listener,
particularly so if the sentic cycles of the composer are faithfully re­
produced. In reference to the healing aspect of his theory, Clynes states,
The release of specific neurochemicals in the brain associated with
essentic forms of basic emotions may produce changes in the organism
which depend on the context in which essentic form is viewed” (1985,
p. 13). In Clynes’ work there is a promise of startling new insight into the
microstructure behind the emotional components of music, which could
have interesting repercussions on the healing field.
New Age music strives to a relaxing musical mood, and much is written
about its healing effects. After a few hearings, however, the samenessof its
dynamics, the lack of reaching a climax or resting point, and the unvarying
rhythms, can become irritating rather than restful. In an article entitled,
“Muzak for a New Age,” Newsweek reported, “Converts to New Age
music are first dazzled, then disappointed. People hear this nice soft music,
and they think, ‘wow, this is beautiful,’ but they reach a point when they
say, ‘Where’s the real music? ” (Barol, Uehling & Raine, 1985, p. 68).
No definitive studies have determined which type of music has the
greatest healing qualities. Before this can be accomplished, the variables
within music and how they specifically affect certain people must be
further delineated. These variables are diverse, people’s taste in music is
diverse, and habitual listening postures have much to do with the final
effects of music stimuli on body, mind and spirit.

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Helen Lindquist Bonny, PhD, RMT, CMT, is co-founder of the Institute for Music and
Imagery. She originated and developed the Guided Imagery and Music technique and
developed Music Rx, a program of taped music for use in hospital settings. She is co-author
of Music and Your Mind. and author of several monographs and numerous articles.