Heart and Soul

Illustration by Lily Xu

Illustration by Lily Xu

With what seems to be an endless midterm season, I often find myself dragging my feet to Olin library, the only place I’ll ever get my work done. As soon as I settle into my chair, I put in my earphones and turn on my Spotify playlist. Looking around my surroundings, I see that my peers have done the same — there are rows of students listening to music, plugged into their earphones, completely absorbed in their studies. Music surrounds us all the time, from the fifteen minute bells that ring throughout the school to that tune your friend  keeps humming over and over again while walking to class with you. Despite how routine and ordinary music may seem, it actually carries great potential and power for clinical applications as a form of healing and repairment.

These applications are part of a field called music therapy. According to the American Music Therapy Association, music therapy is the “clinical and evidenced-based use of music interventions to accomplish individualized goals within a therapeutic relationship…to address physical, emotional, cognitive, and social needs” (1). Music therapy can take effect in very extensive and individualized forms, allowing the therapist to accurately assess and provide specific treatment for each client. Treatments include a range of music-related activities such as “creating, singing, moving to, and/or listening to music” (1).

Music therapy, as it so happens, also has roots that reach far into the past. Ancient Greeks characterized “music as therapeutic… reflecting and projecting the harmony of the cosmos onto the mind and thus creating or reestablishing inner harmony.”  During the 18th century, German physician and chemist Ernst Anton Nicolai wrote about the “affective effect of music on the mind and soul which… will influence the physical-physiological state of the body” (2). More recently, music therapy was established as a profession in the 20th century “after World War I and World War II when community musicians… went to Veterans hospitals around the country to play for thousands of veterans suffering both physical and emotional trauma from the wars” (3). With the establishment of the profession, people with developmental and physical disabilities, elderly people in nursing homes, handicapped children, and prisoners became clients of music therapy.

With the increasing prevalence of music therapy, researchers have observed patterns improved social interactions and wellbeing that come with the benefits of music therapy. Although, concrete neurophysiological effects of music therapy are seldom recorded because the effect of music therapy differs from person to person, recent literature suggests that music therapy for people who are affected by reduced white matter structure can prove effective and increase neuroplasticity.

The most common technique in studying and analyzing structural properties of the brain’s white matter is diffusion tensor imaging (DTI). This method “measures the characteristics of diffusion of water molecules in brain tissues” to measure “biological features, such as axonal size, density, coherence and degree of myelination [which] all constrain water molecule motion” (4). Researchers primarily use voxelwise fractional anisotropy, a measurement that exhibits directional movement of water molecules, to analyze the brain’s white matter. Uniform movement of water molecules through axons produces high fractional anisotropy values, whereas random movement of water produces low FA values, suggesting abnormalities (5).

With recent literature on white matter structures and connectivity within the brain, music therapy has become increasingly prevalent in improving the wellbeing people affected by various mental conditions such as dementia and autism spectrum disorder. For instance, autism spectrum disorders involve structural deviations from the brain’s white matter. Recent research has elucidated the presence of biomarkers that indicate physiological and biological abnormalities in autism spectrum disorder. Many studies have associated decreases in volume, fiber connections, and fractional anisotropy with autism spectrum disorder (5). One such study has shown that abnormal development of white matter pathways found in infants of less than a year of age are at high risk to develop ASD by their second year (6). Scans from people with ASD indicate lack of neural connectivity in areas essential for cognitive skills such as motor function, language, and social behavior. Research findings that relates autism as an impairment in connectivity corroborates the effectiveness of music therapy and suggests potential neuroplasticity and new wiring in white matter structures.

From a study that involved 23 healthy children completing 9 months of music training using percussion tubes, Dr. Dies-Suarez, the chief radiologist at Hospital Infantil de México Federico Gómez in Mexico City says, “these tasks involve hearing, motor, cognition, emotion and social skills, which seem to activate…the need to create more connections between the two hemispheres of the brain” (5). Active music therapy, in which patients themselves get to partake in creating music, stimulates and exercises the part of the brain involved in motor functions and cognitive skill demonstrated by increased connectivity white matter connectivity.

A study of white matter structure and its association with autism spectrum disorder and attention-deficit/hyperactivity was conducted by Dr. Yuta Aoki at the department of Child and Adolescent Psychiatry at NYU Langone Medical Center. DTI data was analyzed from 174 children and focused primarily on the corpus callosum. DTI results showed that there were abnormal diffusivity resulting “lower fractional anisotropy, along with greater mean diffusivity and radial diffusivity, in multiple corpus callosum regions both characterized ASD diagnosis, as well as ASD traits across children” (7). When compared with a study that observed the neuroimages of experienced dancers and musicians, musicians showed “increased coherence of effector specific-fibre pathways” in the right hemisphere (4). The two studies, in comparing white matter structure in the corpus callosum, show that music training may stimulate increased fiber pathways near the corpus callosum. Although we cannot definitively correlate the two studies to prove that music therapy yields to increased white matter structures, the studies suggests that white matter structure is an essential part of neuroplasticity.

Music therapy has far-reaching influences for people living with dementia. Recent research on the effect of music on the human brain has brought further insight on the way music therapy affects social behavior, cognition, and memory. According to 2018 statistics from Alzheimer’s Association, Alzheimer’s is the sixth leading cause of death in the United States. Music therapy can serve as a non-pharmacological and cost-effective way to improve the wellbeing of people living with dementia (8).  Musical intervention for various dementia cases prove to be associated with biography of the individual. Therefore, it is quite important for music therapy to incorporate individualized music to evoke a personal experience and facilitate communication between family members and friends.

In a study that investigated the effectiveness of music therapy patients using endocrinological and behavioral evaluations, ten patients with senile dementia, six with Alzheimer’s, and four with vascular dementia were evaluated for eight consecutive weeks of music therapy using music that was familiar to patients. The researchers evaluated subjects on a standardized test for ‘irritability’ and collected salivary chromogranin A (CgA), a protein that was used as a biochemical marker of stress, from the twenty individuals (9).

The results showed a significant decrease in irritability after eight weeks of the music session. In the case of an 86-year old male patient with vascular dementia. Before the music intervention, he demonstrated confused and agitated behavior, including “hitting or scratching the nursing staff… not taking initiative or speak voluntarily,” but after the eight weeks of therapy, “his agitated behavior at night-time decreased, hitting and scratching while the nurses were changing his diaper decreased” (9). On the 16th session, his levels of CgA before music intervention was 1.903 ρmol/mL and 0.837 ρmol/mL after. Similar results were obtained for the other patients.

This study suggests that musical intervention is effective in decreasing irritability and stress levels, as shown by the CgA levels, among people living with dementia. This also suggests the power and importance of music in a clinical setting. Cognitive stimulation using music produces substantially positive effects on the wellbeing and mood of dementia patients.

The previous study utilized music that the patients closely associated with. Similarly, in a review written by Dr. Steve Matthews, “Dementia and the Power of Music Therapy,” Matthews describes the case of Henry and how music therapy restored his narrative social agency, the ability to recognize close relationships and aspects of self, like favorite activity or favorite song. Henry is described as an elderly man with severe dementia, idle, unresponsive, and unable to recognize his daughter. When exposed to his favorite song, Henry entered a “period of animation and cognitive awakening” (10). After listening to the music, Henry states, “I’m crazy about music… Cab Calloway was my number band guy I liked… It gives me the feeling of love, romance” (10). In a response to Henry’s case, Oliver sacks, renowned neurologist and author, remarks, music seem “to touch springs of memory and emotion which may be completely inaccessible to them” (10).

In Henry’s case, music therapy ignited a part of his heart and soul that allowed him to recall a part of himself that was lost from dementia. Even though music therapy cannot cure Henry’s disease, music therapy reconnected him with his love music and dancing. As I finished reading Henry’s case, I looked up from my laptop. Same people, sitting in rows, plugged into their music, quietly studying for their midterms. I couldn’t help but think, music is about self-care. It’s about healing. It’s about remembering. It’s about feeling. Music and emotion married into a sweet phrase, speaking to our aspirations, our despair, and our triumphs, has incredible ways of working within our lives.

Edited by: Irene Antony

Illustrated by: Lily Xu

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