Sri Balaji Vidyapeeth University
GLITTERING MEMORIES The CME-Cum-workshop organized by the department of music therapy, MGMC&RI on 27th July, 2012 is the first of its kind to be conducted in Puducherry
Release of the Souvenir by the Vice-Chancellor, Prof. D.R. Gunasekaran
Lighting of the ‘Kuthuvilakku’ by the international resource person from USA, Dr.Lucanne Magill Harmony Bulletin
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Editorial The Music Medicine Unit(MMU) in MGMC&RI was inaugurated in November, 2010, with the blessings of our Hon’ble Chairman. Utmost dedication to patient care is our motto. Since its inception, the MMU has been involved in research along with patient care, and several research publications have been documented in international journals. The MMU focusses on undertaking case studies, which bring an important facet to clinical research-that of personal application. Single cases are special examples drawing attention to anomalies in practice, alerting practitioners to matters of urgent attention. Music Therapy in India is now speedily developing from its rudimentary stage in the 90s. I request my colleagues and clinicians to assist in the sprouting of this hidden potential in music, into a full-fledged clinical discipline, as seen in the Western and certain Eastern countries. Let us reflect on Dr. Lucanne Magill’s words “ India is a fertile ground for music therapy, because of the innate timeless understanding of the relationship between man and music”. “ If I had my life to live over again, I would have made it a rule to…listen to some music at least once every week; for perhaps the parts of my brain now atrophied would thus have been kept active through use.” - Charles Darwin
Contents
Glittering Memories 2 Music Therapy or Music Medicine ?
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Indian Music Reorganizes time and establishes homeostasis 8 A Case Vignette 13 News & Views 15 Vol 1 Issue 1 September 2012
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Music Therapy or Music Medicine ? Dr. P .Barathi, M.D.,
The choice ultimately rests on the availability of skilled personnel as well as patient-preferred musical pieces, ease of administration and other factors‌‌ An overwhelming increase in stress-induced psychosomatic ailments are evident today as a result of the impact of global crises culminating in social and environmental issues such as inflation, war, social violence, communicable diseases, epidemic outbreaks, etc., The ramifications are far-reaching, affecting not only the directly impacted victims and survivors, but also the indirectly affected among the population, such as those edged on the poverty line, middle- class people, and the class of business executives who strive to keep their endeavours going in spite of the vicious cycle of corruption, lay-offs, strikes and other non-cooperative movements by the workers. Music therapy nourishes the mind and spirit of the psychologically afflicted individuals, but in a country like India it is not easily accessible to one and all, since it necessitates the need for trained personnel in order to establish a therapeutic relationship through music, involving the triad of music, client, and therapist. A trained music therapist implements a music intervention in an on-going therapeutic process, invoking personally tailored music experiences. The discipline of music therapy is still in its sprouting stage in the fertile soil of India, though it is exhibiting signs of rapid evolution from its nascent stage before a decade. Music medicine or the use of pre-recorded music comes to the rescue, since it is affordable, patient-friendly, with the possibility of the musical piece for selection by the patient himself for regular listening at home, under proper clinical supervision, and at suitable intervals..
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Music medicine is widely used in medical interventions to enhance or facilitate the treatment, and to assist rehabilitation. Music is used to influence the patients’ physical, mental, or emotional states before, during, or after medical, dental, or paramedical treatments like physiotherapeutic procedures ( Bruscia,1998 ; Dileo,1999). There is usually no therapeutic relationship established through music administered during such procedures. From a paradigmatic point of view, music medicine might be seen as a cognitive-behaviourally oriented intervention model, since it is based on a stimulus-response paradigm, unlike music therapy which is purely relational. In music medicine interventions, the patient simply listens to pre-recorded music that is offered by a medical professional. There is evidence that both music medicine and music therapy are effective. Dileo and Bradt (2005) examined the therapeutic effects of the two practices in 11 medical areas, based on 183 controlled studies. Their conclusions were that both practices have a significant effect in 10 of the 11 areas, Therefore, it can be concluded that both music medicine and music therapy are effective and can serve as complementary practices in somatic care. Now let us glean an insight into the discipline of music medicine from the perspective of a Cognitive-Behaviourally oriented intervention model. In Cognitive-Behavioural Music Therapy (CBMT) music is used to modify behavior through conditioning, and the results can be analysed by applied behaviour analysis. The therapeutic process is based on a stimulus- response paradigm, and as a dependent variable the music must be controlled. This explains why specific music, often recorded, is preferred to improvisation in the treatment of patients using this procedure (GroTrondalen and Ole Bonde,2012). Many types of behaviours such as physiological, motor, psychological, emotional, cognitive, perceptual, and autonomic behaviours are manipulated in CBMT. A patient-preferred music stimulus is given or withdrawn as related to the patient’s target behavior, for example, continuing the music if the subject attentively listens to it, and vice versa. The session format has a firm structure as well as well-defined protocols, though it is adapted to suit the cognitive or behaviour modification goals. The sessions necessitate factors such as predictability and control of the musical stimulus. The music acts as a reinforcing stimulus of non-musical behavior- CBMT is therefore music in therapy, music being used as a means to achieve cognitive and behavioural changes. Vol 1 Issue 1 September 2012
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Neurological rehabilitation is an important arena for CBMT, and Michael Thaut has developed a specific training in ‘neurological music therapy’, based on the principles of CBMT ( Thaut, 2000, 2005). People with Parkinson’s disease, autistic children, premature infants, geriatric population and adolescents with developmental disabilities respond to this therapy. CBMT is recognized by the scientific community, since it ensures the possibilities of replication and standardization. Extensive research has been carried out to determine what types of music will promote specific therapeutic and treatment objectives. Thaut has shown that pulsed, rhythmical music can facilitate good walking patterns in patients with Parkinson’s disease. According to Thaut, the rhythm in itself has a high potential for gait training, and a metronome can be sufficient to produce the right stimulation ( Thaut and Abiru, 2010). Music with slower tempos is used when older adults are prompted to move or dance. The effect of the music medicine/ music therapy intervention over time is assessed through applied behavior analysis by the researcher or the therapist. According to a Cochrane systematic review headed by Dr. Joke Bradt of Drexel University, Philadelphia,USA, both music therapy and music medicine employing pre-recorded music demonstrate positive results, and that there is not enough evidence currently to determine if one intervention is more effective than the other. The trials were conducted with cancer patients that had been offered recorded music, (17 patients) or music therapy with a trained therapist( 13 patients). The results indicate that both music medicine and music therapy remarkably decrease anxiety based on clinical anxiety scores in comparison to those on standard treatment regimes. Similar studies done on patients subjected to mechanical ventilation, and coronary heart disease reveal that both types of music interventions are effective in improving psychological and physical outcomes. My opinion is that in addition to conventional therapies, clinicians should also focus on developing suitable music medicine protocols (apart from nurses and music psychologists), in order to extend soothing hands to embrace the stress-afflicted population, loaded inadvertently with toxic allopathic drugs which leave their undesirable, permanent imprints on liver and renal physiology.
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REFERENCES 1.Bruscia, K.E.(1998). Defining music Therapy. Second Edition ed. Lower Village: Barcelona Publishers. 2.Dileo, C.(ed.) (1999). Music Therapy and Medicine: Clinical and Theoretical Applications. Silver Spring, MD: American Music Therapy Association. 3.Dileo, C. and Bradt, J.(2005). Medical Music Therapy: A Meta-Analysis of the literature and an Agenda for Future Research. Cherry Hill, NJ: Jeffrey Books. 4.GroTrondalen and Lars Ole Bonde (2012). Music Therapy: Models and Interventions : Music, Health and WellBeing. Eds : Raymond Mac Donald, Gunter Kreutz, and Laura Mitchell, Oxford University Press. 5.Thaut, M.H.(2000). A scientific model of music in therapy and medicine.St. Louis, MO: MMB Music. 6.Thaut, M.H.(2005). Rhythm, human temporality, and brain function. In : D. Miell, R. Mac Donald, and D. J. Hargreaves(eds.) Musical Communication, pp.171-92. Oxford: Oxford University Press. 7.Thaut, M. and Abiru, M.(2010). Rhythmic auditory stimulation in rehabilitationof movement disorders: A review of current research. Music Perception: An Interdisciplinary Journal, 27(4), 263. 8.Bradt,J., Dileo,C. Grocke,D., Magill, L.(2011). Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database of Systematic Reviews, issue 8. Art. No: CD006911
PYTHAGORAS Physician, musicologist, mathematician, founder of our scientific age – he created the pre-conditions for utilising harmonically structured music in medicine.
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INDIAN MUSIC THERAPY INDIAN MUSIC REORGANIZES TIME AND ESTABLISHES HOMEOSTASIS Homeostatic effects of Rag Ahir Bhairav on the circulatory system “ Music can form a bridge between external and internal worlds making whole out of apparent disparate elements” According to Mozart, man is an antenna, a ceaseless receptor of the waves and rhythms in the universe( Alfred Tomatis, 1991). The biological and neuro-physiological rhythms are attuned to and in balance with the cosmic rhythms that are beyond human auditory perception. Music awakens the fundamental rhythms existing in each of us. Cardiac and respiratory rhythms are made to synchronize with the deeper, innate rhythms existing in each of us through the medium of music putting man into resonance with the universe. Indian classical ragas can adapt the eternal rhythms to our neurons, and the body in turn resonates in tune with the melodic modes. The latent harmony existing in each of us is aroused, and the body re-establishes its lost equilibrium. The homeostasis established by music administration has been documented in a study conducted in Tokai University, Japan. The study reveals that music has homeostatic effects on emotion, when listeners were analysed by the Profile of Mood States (POMS), a psychological test for measuring emotion (yamamoto et al., 1999). How does Indian Music establish homeostasis? Music exerts homeostatic effects by harmonizing psychological and biological time. Music, as an external oscillator entraining our internal oscillators, has the potential to affect not only our sense of time, but also our sense of being in the world ( Mari Reiss jones,1989). Jones postulates a propensity for an individual’s endogenous rhythms to synchronize with the musical item, the entrainment experiences varying according to physiological, and psychological factors, as well as the stage of development of the listeners exposed to identical musical pieces. The subjects slowly drift into the realm of ‘reorganized time’, the metaphysical domain where intellectual abilities are replaced by imaginary realities. I have documented several case studies after administering Rag Ahir Bhairav to patients with acute as well as chronic hypertension, and was Harmony Bulletin
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amazed to find that it not only brought down the elevated blood-pressure in hypertensives but also restored the normal blood pressure in hypotensive individuals. An exploration into the entrainment properties of music will throw a light on such homeostatic phenomena. Brain, Entrainment, and Physiological rhythms Two aspects of the new view on the brain seem to be relevant in this context : a) most brain functions can best be described as cooperative, synchronized activity of large,distributed ensembles of neurons, and b) a large part of this synchronized activity is of an oscillatory nature(Basar 1983; Nunez et al 1993). These autorhythmic oscillatory properties of neurons in the central nervous system are a consequence of their electrochemical properties. The cooperative and oscillatory activities of these neurons can be seen, amongst others, as the basis for the timing of sensory-motor coordination ( Llinas 1988). With these new views on the functioning of the brain, it seems most promising to apply the concept of entrainment to the analysis of human interactions at the interpersonal and social level as well. Indeed, such applications have been pursued in the social sciences in parallel with the development of neuroscientific approaches, the mathematics of coupled oscillators, and numerous other related strands of research(Martin Clayton et al,2004).. A good deal of current medical research is concerned with the behaviour of endogenous physiological rhythms in humans (such as the variation of body temperature over the 24-hour cycle), and how the study of those rhythms might be further developed as a tool in the diagnosis of pathological states and ultimately lead to the development of new treatments ( Glass 1996). An important part of this work is the consideration of entrainment and in particular, identifying which physiological rhythms entrain to which stimuli, and under what conditions. There are many examples where relatively stable and entrained biological rhythms are associated with good health (the enhanced stability of the heart rate afforded by a pacemaker is an example of this), while conversely asynchrony and instability of rhythmic processes can be associated with pathologies. The behaviour of our endogenous cardiac rhythm ought to be predictable when stimulated by a pacemaker, but if the period of the pacemaker were set outside a certain range, the behaviour of the cardiac rhythm would be for practical purposes unpredictable. But entrainment does not necessarily imply stability of biological rhythms, and in any case stability is not necessarily associated with good health. In the case of brain waves, Vol 1 Issue 1 September 2012
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for example, we have a different pairing: stable brain waves may indicate a pathology (epilepsy) while unstable waves may indicate a healthy state. Indeed, a certain amount of flexibility and dynamic equilibrium seems to be associated with health in many systems. Examples of endogenous or naturally occurring rhythms within the human body include the heartbeat, blood circulation, respiration, locomotion, eyes blinking, secretion of hormones, female menstrual cycles, and many others. It has been suggested, indeed, that all human movements are inherently rhythmic: Jones writes that “All human performance can be evaluated within a rhythmic framework”. Music psychologists have begun to apply an entrainment model in which rhythmic processes endogenous to the listener entrain to cues in the musical sound (Large and Kolen 1994). Although there is much to be done in this area, the entrainment model seems to reflect the cognitive processes much better than do previous other models. What is special about musical entrainment? It seems that certain kinds of musicking can afford particularly precise synchronisation between individuals’ behaviours. This may in fact be one of the basic reasons for the development of different kinds of musical repertories, since musical metre is often (although is not invariably) more regular, with more hierarchical levels, than the rhythmic patterning of speech and other communicative behaviour. Since certain degrees of entrainment between individuals seem to be associated with positive affect, it may be the case that particular patterns, periodicities, hierarchies or intensities of entrainment afford particular affects. It is also possible that particular kinds of music may promote the switching of attention between temporal levels. Musical experience, while individually unique in every case, is nevertheless always social. Through exploring the phenomena of entrainment, ethnomusicologists are able to better understand how musical sound serves as an interface that connects selves—viscerally and cognitively—to society. Measured music is a realm of ‘reorganized time’, but so is nonmeasured music. Both types of music display high temporal coherence, at least if they are studied as dynamic systems, not as static products. A brief glance at Chinese folk songs may serve to illustrate this. There are several Harmony Bulletin
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Chinesefolk song performances in which the lyrics sung are essentially meaningless. In these performances the whole act of singing seems meaningless, except in its quality of ‘organized time’: a capacity of people to employ sound (i.e. voices) to revive bonds and fates shared beyond daily realities, in the realm of metaphysics. Just how many new hard core facts we will be able to unearth via ‘entrainment’ remains to be seen: if entrainment is the study of‘reorganized time’, it is also, by definition,the domain of metaphysics – a realm where poets operate more successfully than most academics. Indeed, “rhythmical entrainment” and its physicality are not everything. The bio-physicism of rhythmical entrainment leads to the attuning of other psychological realms, to the transformation of persons’ state of mind, which is also a form of periodicity. By disconnecting the mind from its ordinary cycles (regularities or irregularities), inner oscillators and oscillations set up an affected perception, sensitivity or emotional availability. This is how – in an “extended” version of the theory of entrainment – the contextual variety of music’s effects can be understood or explained. Physical entrainment refers to the synchronization of concrete objects in the world, determined by some objective measure, while cognitive entrainment refers to the appearance of synchronization as determined by the subjective measure of an observer or participant. Cognitiveen trainment is the process whereby an individual comes to sense a certain degree of synchronization between two or more rhythmic processes in the world. From the above references, we can hypothesize that some heptatonic ( having all the 7 notes of the octave) ragas like Ahir bhairav have the inherent capacity to ‘cognitively reorganize’ psychological time, thereby influencing the biological time and the associated homeostatic mechanisms, rectifying the disordered homeostasic mechanisms towards their normal rhythmic balance. About Rag Ahir Bhairav It is characterized by the use of Komal Re and Komal Ni. Often times, this rag is referred to by its south Indian name of Chakravaka. This is an early morning rag. . Arohana Avarohana
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Sri Balaji Vidyapeeth University Jati :Sampurna – Sampurna;Time-Early Morning :That-Chakravaka
REFERENCES 1. Alfred Tomatis(1991).”Pourquoi Mozart ?” Paris: first edition, pp-91-92. 2.. Basar, E. (1983) EEG and synergetics of neural populations. In Basar, E. et al. (Eds.), Synergetics of the brain (pp. 183-200). Berlin, Heidelberg, New York: Springer. 3. Clayton, M., Sager, R., and Will, U. (2004). In time with the music: The concept of entrainment and its significance for ethnomusicology. ESEM CounterPoint, 1, 1-45. 4. Glass, L. (1996). Synchronization and rhythmic processes in physiology. Nature, 410 (6825), 277-284. 5. Jones, M.R. (1976). Time, Our Lost Dimension:Toward a New Theory of Perception, Attention, and Memory. Psychological Review, 83(5), 323-355. 6 . Large, E.W. and Kolen, J.F. (1994). Resonance and theperception of musical meter. Connection Science: Journal of Neural Computing, Artificial Intelligence and Cognitive Research, 6(2-3), 177208. 7 . Llinas, R. (1988). The intrinsic Electrophysiological Properties of Mammalian Neurons. Science, 242,1654-1664. 8. Nuñez, A., Amzica, F., and Steriade, M. (1993).Electrophysiology of Cat Association Cortical Cells in Vivo: Intrinsic Properties and Synaptic responses. Journal of Neurophysiology, 70, 418-430. 9. Yamamato Kenji, Iga Tomiei, Takahashi Sachiko, Schimuzu Tetsuo (1999). Tokai journal of Sports Medical science: Tokai university
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A Case Vignette from Music Medicine Unit, MGMC&RI Mr. M – Schizoid personality disorder, 25 year old student AREA
PSYCHOMOTOR
COGNITIVE
BASELINE Stiffness and moderate rigidity. He does not move to music Inability to concentrate, to think and memorize Difficulty in maintaining attention. Disoriented sense of time
AFTER MUSIC THERAPY INTERVENTION Exhibits movements in tune with the rhythm Listens to the music from the beginning to the end . Maintains attention and focus on activity. Sense of time is more organized
EMOTIONS
Difficulty to recognize and express his own emotions, pathetic look on his face
He is able to verbalize his emotions to musical experiences. He feels that he has now got an outlet to release his emotions. Feels pleased with himself after listening to MT1.
PERSONAL AND INTERPERSONAL
Difficulty in communicating with others, in socializing and interacting with others of his group
Gives attention to people and lets out his feelings and difficulties
Difficulty in identifying his emotions arising due to music listening
Identifies the differences in emotions evoked by different musical pieces, and synchronizes his emotions well with the emotions inherent in the different melodic modes. Able to categorize his varying emotions with the variations in melodies.
INTEGRATION
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Mr. M was administered two different variations (MT1 and MT2) of the same melodic mode, viz. Rag Bilahari. In MT1, Rag Bilahari was played with a predominance of the Western Major Scale, accompanied by a slow, steady rhythm based on Indian percussion instruments (tabla, mridangam). The music in MT1 was soft and soothing, rendered by an European Chamber Violinist along with bass Cello. In MT2, the same rag was rendered in a folk style, veena acquiring predominance in the background of bass guitar and key-board synthesizer. Mr. M had the feeling that his mother was soothing him, harmonizing his disordered thoughts, awakening his child-like instincts, when he was listening to MT1. On listening to MT2, his emotions were stirred up, his pent-up feelings surfaced, followed by a tremendous relief after releasing his suppressed thoughts and feelings like ‘nobody understands me’, ‘everybody thinks I am not up to the mark’ and so on. After verbalizing his emotions as they surged up from deep within on listening to MT2, a smile appeared on his previously pathetic face. The above example illustrates the fact that the same melodic mode or Raga when rendered in different styles with varying emphasis on the notes, using different instruments, can produce variations in the emotions evoked. In general, folk-music has a powerful effect in stirring the emotions and inducing emotional release, since the hurtful feelings accumulated in the past start surfacing above, in order to be released. Such is the beauty of Indian ragas or melodic modes, endowed with the innate characteristic of piercing into the psyche and transforming the self.
The CME-Cum-workshop Conducted by the Dept of Music therapy, MGMC&RI on 27th July, 2012 was covered by the Hindu, Indian Express, Dinathanthi, Sun News and local TV Channels. We are presenting Dr.Lucanne Magill’s interview which apppeared in the Hindu and the Indian Express. Harmony Bulletin
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News & VIEWS
Dinathanthi, July 28
About the CME Cum-workshop in MGMC&RI on 27th July, 2012
The Hindu, Aug 1 Indian Express, July 28
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PATRON Shri.M K RAJAGOPALAN
ADVISORY BOARD
EDITORIAL BOARD
MEMBERS
Prof. GUNASEKARAN D R
EDITOR-IN-CHIEF
Dr. BALACHANDER
Prof. MUTHURANGAN G
Prof. BARATHI P
Dr. CHETAN ANAND
Prof. ANANTHAKRISHAN N
EXECUTIVE EDITORS
Mrs. ASHA SURESH BABU
Prof. SRINIVASAN A R
DESIGN & LAYOUT
Ms. UMA A N
Mr. GEORGE FERNANDEZ
Prof. MYLSAMY K Prof. MADANMOHAN
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