WeRead Powered by ReaderPub
Music in Medicine cover

Music in Medicine

Chapter 7: I
Open in WeRead

Explore more books like this:

About This Book

This work examines the relationship between musical art and its therapeutic applications, distinguishing the creative, aesthetic process from passive perception and utilitarian use. It argues that while music's moods, rhythm, pitch, and harmonic structures can elicit measurable psychological and physiological responses useful in treating mental and physical ailments, its efficacy depends on preserving artistic integrity. Drawing on clinical observation and scientific reasoning, the author surveys ways music may modulate mood, memory, and nervous function, discusses practical applications in patient care, and cautions that systematic therapeutic use should develop without reducing music to anonymous mass production, while encouraging research and specially composed material for clinical needs.

CHAPTER TWO
PHILOSOPHY AND PSYCHOLOGY OF MUSIC

I

In the realm of thought, opinions and theories sometimes find credence long after they have been proved incorrect. In the field of the arts, opinions may become so strongly rooted that there is occasional resistance to any analytical attempts designed to disprove them, and even after they have been exposed, there will be a significant number of people who will continue to believe in them. The artist who would make music for patients must approach such an endeavor with a full knowledge of the elements involved, and should be willing to recognize those prejudices, customs and thoughts concerning the effects of music on the human body which have been fostered by well-meaning, but misguided, enthusiasts. We must differentiate between the philosophy of esthetics and the proved psychology of music. Musicians who refuse to accept those results of scientific research which disagree with their personal views will fall into the same difficulties which have beset so many musicians in the past who have desired to help patients.

Before the advent of laboratory psychology, there was no satisfactory test for the theories which dealt with music and the mind, and the number and variety of theories advanced were great. Some of the most unreasonable were the most attractive, and it is easy to understand why they were accepted. But if any of these theories is used as a means of attaining a scientific end it cannot succeed with any dependability if it is unsound.

The psychologic effects of sound may be physiologic or intellectual. They may be related to intensity, quality or direction on the one hand, or to past or present mental associations on the other. To the primitive man thunder, which seems to come from everywhere and is louder than anything he can produce, is terrifying and supernatural; the rustling of leaves is frequently caused by the wind, but from his past experience may also instil the fear of the approaching enemy. Sound is often frightening from its qualities or implications.

The psychologic reaction to the type of sound known as music may vary from the reflex panic produced by the air-raid siren to the soothing effect of a softly sung lullaby. For some people, certain musical selections elicit almost no response, while in still others a truly amazing chain of mental images results. The latter reaction is the result of centuries of evolution in the development of music and knowledge, and will be discussed later.

During the modern evolution of musical composition, many new forms were devised bearing descriptive names. Some of these forms by their distinctive tempo, dynamics, or title conditioned the informed listener to a mental attitude consistent with the intention of the composer. Some selections by the very nature of their execution cause stimulation or assist repose. Superficially it might seem, therefore, that the controlled administration of music could evoke desired moods in listeners at will, and some practitioners declared that music is a specific treatment for mental disease. It is undoubtedly possible to influence the mood of healthy, trained musicians by the use of selected compositions but to assume that all listeners will react in similar fashion, or that the moods of the mentally deranged can be changed at will by prescribed music, is to ignore the nature of mental disease and the scientific finding of psychologists.

Music is many things, but physically it consists of sounds or notes which have pitch, intensity, timbre and duration. These notes are combined in patterns which have rhythm, tempo, melody and harmony and these in turn are related to key, mode and form. Each of these elements has been the subject of philosophic interpretation, and more recently of psychologic investigations. Although the effect of music on the human mind depends upon the reaction to the entire composition, it is important to review the existing data in order to understand more fully the effects of music, in spite of the difficulties; for as Ortman[71] has said “the problem of analyzing and classifying responses of music into types is at the same time intensely interesting and notoriously difficult. The history of the problem is rich in unco-ordinated data and poor in clear-cut conclusion.”

II
Elements of Music

Pitch. Heinlein[45] found that the same chords which called forth a happy and bright feeling when played in high pitch were characterized as gloomy or melancholy when played in low pitch. The voice of youth and laughter is higher pitched than the grumbling of old age and may be a conditioning factor. Beaunis[8] felt that the reaction to pitch is the effect of experience and custom and cited a reversal among Orientals in whom low pitched sounds effect joyous reactions and the high, sadness and sorrow.

Intensity. Heinlein found that loud chords are rarely soothing, and soft chords are almost always soothing. Beaunis stresses the fatiguing quality of great intensity over a long period, and contrasts it with “Very soft sounds as in Schumann’s ‘Danse des Sylphes’ ... which holds you under the charm of delightful emotion.”

Timbre is the quality of sound which identifies it with the instrument of its production. Although many instruments can be convincingly gay or subdued, most authors are agreed that some instruments emit prejudicing tones. Chomet[18] considered the bassoon mournful, the flute tender, and the trombone harrowing. He found that the clarinet expresses grief, the oboe suggests reverie, but that the violin “seems suited to express all sentiments common to humanity.” Mursell[60] finds consistent tactile values in tone. Low tones are dull and high tones cutting. He speaks of the French horn as smooth, the piccolo sharp, the oboe as stringent, the cello velvety and the bassoon rough.

Gundlach[38] believes that the timbre of an instrument is significant in mood response. He finds the brasses triumphant and grotesque, never melancholy or tranquil, delicate or sentimental; the woodwinds mournful, awkward, uneasy, never brilliant or glad. The human voice also has timbre, and distinctive values. There is the dramatic quality of Marian Anderson and the syrupy flow of Bing Crosby; the virility of the basso and the sparkle of the coloratura.

Duration. The sounding of a single note will attract attention, but if the note continues for a sufficient period without changing its characteristics it will become monotonous, annoying and finally exasperating. If the sound is interrupted at equal intervals, this reaction will take longer to develop, but if the intervals between them are irregular, interest is sustained, especially if these variations occur periodically; that is, with a certain rhythm.[8]

Rhythm. It is possible to have music without rhythm, but as Rameau[68] pointed out long ago, “Music without rhythm loses all its grace.” Since percussion instruments probably preceded all others, rhythm was the first stage in the evolution of music. The proponents of the motor theory of rhythm feel that muscular response to music with pronounced rhythm is a physiological reflex. They point out that it is difficult to walk deliberately out of time to a well accentuated march, and Dunlap[26] has shown that in reclining subjects “With the utmost possible relaxation of the entire body, good rhythmic grouping of an auditory series can be obtained.” With the aid of the electromyograph Jacobson[50] has shown that in complete relaxation mental activity results in fleeting but specific muscle contractions invisible to the eye and unknown to the subject.

Rhythm perception is a mental stimulant. Reade[69] observed that African negroes when ordered to row a boat always began to sing as an aid to overcome their natural laziness. Bücher[14] believed that rhythm as exemplified in working songs facilitates the synchronous expenditure of energy by individuals engaged in a common task.

Although rhythmic song will not necessarily elicit obvious motor responses in all subjects, the wide-spread use of work songs among groups of people engaged at hard work on land or sea throughout the world is indicative of the value of background rhythm for communal effort. Mursell[60] believes that “any notion that pure or ‘naked’ rhythm is more effective than rhythm clothed in tone is open to very serious doubt.” But the chief effect of marked rhythm is the feeling of excitement and happiness which it can arouse. Rhythm gives us a certain pleasure because of its orderliness to which the mind is sensible.

Melody as a musical element contributes chiefly to restfulness.[71] If it is simple and recognizable it will recall other times and rest the mind from the thoughts of present problems. If it is complex and new it will distract the more musical but have a less desirable effect on the uninterested.

Mode. The term mode is applied to the arrangement of whole and half-tones in the musical scale construction. Of the many possible modes only two are used in our present system of music, the major and the minor. There is only one form of the major mode, and it is the one most people recall when they think of the scale. There are three forms of the minor mode, but of these the harmonic is the most frequently used. It is formed by lowering the third and sixth notes by a half-tone.[80]

When an author pioneers convincingly in a field which has long needed clarification, it is likely that even his questionable remarks will be accepted with the same degree of authority as his scientific statements. In 1722, Rameau[68] published a treatise on harmony which received wide acceptance because of its excellence and comprehension, but in that work he prejudiced many of the writers who followed into believing that the major triad was more pleasing and beautiful than the minor. This concept was not only adopted but embroidered. Hauptman[44] likened the minor triad to the branches of the weeping willow and hence attributed to it a mournful downward drawing power. To the major triad he assigned the property of an upward driving force. (When this is taken literally, as it was, and applied to the patient, we can see clearly why remarkable attributes were claimed for music.)

Now there is little doubt that if the triad of C minor is struck on a piano after that of C major, most people will describe the sensation elicited by the sound of the minor chord as melancholy. Helmholtz[46] attributed the veiled or sad effect of a minor chord to certain notes foreign to the chord which physical reasoning expects.

“The foreign element thus introduced is not sufficiently distinct to destroy the harmony, but it is enough to give a mysterious obscure effect to the musical character and meaning of these chords, an effect for which the hearer is unable to account, because the weak combinational tones on which it depends are concealed by other louder tones, and are audible only to a practiced ear.”

But Gurney[40] refuses to admit to a sense of melancholy in this slight dissonance, for as he points out

“the same slight degree of dissonance as exists in the minor triad may be made to supervene on a major triad, by adding to it a certain extremely faint amount of discordant elements: it would seem then that the major triad thus slightly dimmed or confused ought to sound melancholy, but it does not in the least. Another argument may be found in the following fact. The minor triads of D and A are of perpetual occurrence among the harmonies of C major; and yet they do not seem then to convey the distinctly pathetic impression, instantly produced by the appearance of the C minor triad.

“Music in a major key may be profoundly mournful; and it would often be impossible for any description to touch the musically felt difference between such music and mournful minor music. The minor mode has a somewhat more constant range of effect.”

Such discussions continued until Valentine[76] decided to test the mood effect of the modes on a group of listeners. He found that “major intervals are described as sad or plaintive twice as often as the minor.” Heinlein[45] not only substantiated this but found that intensity was the dominant modifier of feeling. He reviewed more than twenty-five hundred compositions for beginners and among them found only seven per cent written in the minor mode. “It is a difficult matter to obtain a composition in the minor mode written for children that does not have a title which relates to the weird, the mysterious, the sad and the gloomy. Apparently composers in their attempts to differentiate the modes for children fall victim to the method of introducing titles opposite to feeling content. To children, the title of a composition is a very outstanding feature. It may be, after all, that reaction to the modes is largely a question of the extent to which association with descriptive titles of a specific variety first establishes the affective impressions in the mind of the beginner.” Thus it can be seen that composers have been nurturing an old philosophy by titles rather than music. Beaunis has shown that although among European composers, the major mode has been used for bright and restful passages and the minor mode has been used for uneasy and stirring selections, a study of the music of other races will uncover an entirely opposite use. Hevner[47], in an elaborate series of controlled studies, concluded that “all of the historically affirmed characteristics of the two modes have been confirmed” but admits that “in producing its effect on the listener, the mode is never the sole factor.”

In a later study Hevner[48] continues to maintain that modality is effective in the dimensions of sadness and happiness but quite useless in the dimensions of vigor, excitement and dignity.

The reaction to mode is influenced by what has been heard immediately previously, and by musical training. The reaction to mode is not physiologic but offers one key to music for patients in that those who identify the minor mode with sadness should not be given such music when gay music is indicated.

Key. There was a time when particular keys were credited with emotional powers. Lest such thoughts still persist, the following quotation from Gurney[40] is offered.

“Particular keys are sometimes credited with definite emotional powers. That certain faint differences exist between them on certain instruments is undeniable, though it is a difference which only exceptional ears detect. The relations between the notes of every key being identical, every series of relations presenting every sort of describable or indescribable character will of course be accepted by the ear in any key, or if it is a series which modulates through a set of several keys, in any set of similarly related keys. But as it must have a highest and a lowest note it will be important, especially in writing for a particular instrument, to choose such a key that these notes shall not be inconvenient or impossible; and also the mechanical difficulties of an instrument may make certain keys preferable for certain passages. Subject to corrections from considerations of this sort, the composer probably generally chooses the key in which the gem of his work first flashes across his mind’s eye: and when the music has once been seen and known, written in a certain key, the very look of it becomes so associated with itself, that the idea of changing the key may produce a certain shock. But the cases are few indeed where, had the music been first presented to any one’s ears in a key differing by a semitone from that in which it actually stands, he would have perceived the slightest necessity for alteration; and as a matter of fact when a bit of music is thought over, or hummed or whistled, unless by a person of exceptionally gifted ear it is naturally far oftener than not in some different key to that in which it has been written and heard. Even the difference most commonly alleged, between C major as bright and strong and D flat as soft and veiled, comes to almost nothing when a bright piece is played in D flat or a dreamy one in C.

“That a variety of emotional characters can be definitely attributed to various keys is a notion so glaringly absurd that I would not mention it, were it not that it is commonly held; and that such doctrines are really harmful by making humble and genuine lovers of music believe that there are regions of musical feeling absolutely beyond their powers of conception.”

In an unnamed manual the following statements occur:

“C major expresses feeling in a pure, certain and decisive manner. It is furthermore expressive of innocence, of a powerful resolve, of manly earnestness, and deep religious feeling.

“G minor expresses sometimes sadness, sometimes, on the other hand, quiet and sedate joy—a gentle grace with a slight touch of dreamy melancholy—and occasionally it rises to romantic elevation. It effectively portrays the sentimental, etc. Another author, quoted by Schumann, found in G minor discontent, discomfort, worrying anxiety about an unsuccessful plan, ill tempered gnawing at the bit. ‘Now compare this idea,’ says Schumann, ‘with Mozart’s Symphony in G minor, that floating Grecian Grace.’ He quotes from the same writer that E minor is a girl dressed in white with a rose-colored breastknot.

“These are but abstracts, and a good deal of the humor is lost by selection. For the ‘characters’ of several of his keys the author gives a list of examples the choice of which, inasmuch as every possible character might be exemplified from compositions in every single key, cannot have been very difficult. It is something like proving that Monday is a day ‘especially full of melancholy,’ on the ground that some individual lost a relative on it, or that the characteristic of Thursday is ‘confidence and hope,’ on the ground that on it an individual came in for a fortune.

“These thoughts are similar to that of the Chinese philosopher who traced the five tones of the old Chinese scale to the five elements, water, fire, wood, metal and earth.”

Tempo. “The idea of forcing emotional characteristics on tempo is not less preposterous than those on key. (Gurney quotes further ideas of the same writer.)

“The common time expresses the quiet life of the soul, an inward peace but also strength, energy and courage.

“The three-eight time expresses joy and sincere pleasure; but its best characteristic is simplicity and innocence.

“The three-four time is expressive of longing, sincere hope and love.

“It would be interesting to hear from this writer what happens when any one composes a piece in common time, which expresses the quiet life of the soul and ‘inward peace’ and in the key of E minor, which represents grief, mournfulness, and restlessness of spirit.”

Gundlach[38] found that speed was by far the most important factor in distinguishing among several pieces played to a group. And Hevner[48] found that for excitement the most important element was tempo, which must be swift. “Dreamy sentimental moods follow slow tempo. Sheer happiness demands a faster tempo.”

Hanson[42] believes that “everything else being equal, the further the tempo is accelerated above tempo moderato (which is about the same speed as the human pulse rate) the greater becomes the emotional tension.” He goes on to state that “as long as the subdivisions of the metric units are regular and the accents remain in conformity with the basic pattern, the effect may be exhilarating but not disturbing. Rhythmic tension is heightened by the extent to which the dynamic accent is misplaced in terms of metric accent, and the emotional effect of ‘off-balance’ accents is greatly heightened by an increase in dynamic power.” He is unduly alarmed by the effect “Boogie-Woogie” may have on the younger generation because rhythm irregularity finds its most fertile field in this jazz form characterized by “a repeated figure in the bass (which) continues indefinitely in regular rhythm.”

Sonority. Hanson[41] has traced the development of music from the highly consonant music of the Roman Catholic Church at about the time of Palestrina to the dissonant music of certain modern composers. He describes the early hymns as “calm, serene and in a sense impersonal.” For him, “the expression of personal feeling in music seems inevitably to be associated with the use of dissonance. Indeed the expression of emotion in music seems to be bound up in the contrast between dissonance and consonance, the former producing a sense of tension and conflict to be either heightened by progression to a sonority of still greater tension or resolved by a succeeding consonance.” It may be easy for a musician to believe that the increased use of dissonance creates an increase of emotional tension, but to the musically uncultured listener dissonance may just as often create boredom or annoyance.

Composition. Although musical factors such as pitch, intensity and melody can contribute to mood effect when isolated, the reaction to an entire composition is quite different from reaction to tones of chords. It may depend upon environment or association with the situation in which the selection was first heard or is being heard. It may be altered by the length of the composition or unanticipated contrasts of intensity or the use of unusual patterns, rhythm or tempo. In listening to music, expectation plays an important role. A sudden change or interruption is apt to excite surprise. “The mere meeting of the expectation in all its details affords pleasure of a kind. But great as is the aesthetic pleasure, a far greater degree of enjoyment may at times be attained by a carefully planned surprise, the appropriateness and artistic skill of which is recognized and approved”[10].

Much has been written on the images or stories which musical compositions evoke. Some musicians have tacitly implied that ability to appreciate these stories results in greater pleasure, but Gehring[34] wisely insists that “musical enjoyment does not depend on interpretations, but it may also be reaped by those who abstain from making them.” There are some people who can interpret any musical selection, and others who find no story. Between these extremes is a group who can get more pleasure from music if listening is preceded by such preparation. As Damon[20] has pointed out, “A musical selection is thought to be more beautiful and more colorful when the usual program notes are supplied before hearing it.”

There are those who see specific color in sound. It was Isaac Newton who first compared the diatonic scale with the seven colors of the spectrum from red to violet beginning with C as red. Katz[71] reported on strong color association of two case studies. For the first, C major was jet black and for the other C major was brilliant white. But this could be expected inasmuch as the scale of notes presents intervals and proportions of the most definite kind whereas those of the color spectrum are confluent and have no mathematic relation. Spectrum analogy was discredited by de Marian in 1737[70]. “No two people agree or hardly ever do, as to the color they associate with the same sound”[30].

But color is only one element in a mental image; what about the others? Is it possible for two people listening to a new, unnamed musical selection for the first time to envisage the same story or picture?

T. Kawarski and H. Odbert[52] found no direct relationship between color and music which held for more than a few individuals but certain general relationships of photoism to special aspects of music were found to recur constantly. Thus increase in brightness tends to accompany rise in pitch or quickening of tempo. Whereas some one factor like strong visual imagery or cultural influences or suggestions may be dominant in some individuals and a totally different factor in another, none of those factors operate in any pure and simple fashion.

Too often musical interpreters will see too much in a given selection. Some will try to rhapsodize in words the theme as announced by the title of the selection. Some enthusiasts will grasp at straws of suggestion from the original source. Gurney cites an amusing instance in connection with a sonata of Beethoven, of which the three movements are entitled: Les Adieux, L’Absence, and Le Retour. These titles were so inviting that some gushing comments were published about the portrayal of passages from the life of two lovers. However, on the manuscript, Beethoven wrote: “Farewell on the departure of His Imperial Highness, the Archduke Rudolph, the 4th of May 1809.” and “Arrival of his Imperial Highness, the Archduke Rudolph, the 30th of January 1810.”

The insistence by some of the specific images evoked by certain selections can be disheartening to those lovers of music who accept such interpretations as fact and are disappointed in their inability to experience the same reaction as others, especially if the others are recognized musicians.

“It is obvious that the power of music to depict objects, situations or ideas is extremely indefinite. No matter how specific a pictorial or dramatic program the composer may have in mind to present through his music, the listener will never get that program from the music itself. If the hearer is told what the music is supposed to depict he will imagine the incidents and fit them into the music. Or if he is given a title it will suggest to him a train of imagery which he will read into the composition. And if he is given neither title nor program his fancy might take him on a mental journey, the direction of which will depend upon his mood, his mental set, his physical condition, his past experience, and numerous other subjective factors, for which music serves as a stimulus, but all of which lies outside of the music itself.”[35]

Thus when Rubinstein read into the “Second Ballade” of Chopin the story of a wild flower caught by a gust of wind, the struggles of the flower and its final breaking, he confused the issue by adding a second interpretation to the music which was inspired by Mickiewicz’s poem, “Switez Lake,” the story of which is totally different. When Gilman played this same song for his students there were many interpretations which ran the gamut from “meaningless” to “creeping assassins.”[35]


Beethoven’s complaints of his interpreters and expounders were frequent and bitter, but we must turn to the writings of the more literary musicians, Mendelssohn and Schumann, for coherent expressions on the subject. Mendelssohn wrote,

“What any music I like expresses for me is not thoughts too indefinite to clothe in words, but too definite. If you asked me what I thought on the occasion in question, I say, the song itself precisely as it stands.”

Schumann’s position as regards verbal readings of music may be gathered from the following passage:

“Critics always wish to know what the composer himself cannot tell them; and critics sometimes hardly understand the tenth part of what they talk about. Good heavens! will the day ever come when people will cease to ask us what we mean by our divine compositions? Pick out the fifths, but leave us in peace.”[40]

Some musical selections have been written to accompany a subject. Those who know the story of The Barber of Seville may associate the aria “Largo al Factotum” with the despair of an over-worked barber, but the same song might have been written to accompany almost any lively subject and for people who have never heard the story and who do not understand Italian, it is just a bright song, possibly humorous. As Gurney says:

“The verbal titles which aim at summing up the expression of certain compositions, however interesting, are so adventitious that they have often been suggested by instead of suggesting the music; and a hundred auditors, if left to guess the title for themselves, would originate a hundred new ones.”[40]

Music can evoke specific emotions only when people have been conditioned to it. The “Horst Wessel” song would not stir Americans to hatred unless they could identify the title with the song and its significance. Even then, the degree of hatred or contempt for the music would be variable.

Edwin Franko Goldman’s “On the Farm” can leave little doubt in any one’s mind as to its subject matter, but with the exception of such very obvious music, or music to which we have been emotionally conditioned, music cannot paint blue skies or green pastures.

What then are the feelings most frequently excited by music? According to Schoen[72]:

“The data show that rest, sadness, joy, love, longing and reverence appear most frequently as the effects produced. Vocal music has a tendency to arouse well-defined emotional effects far more often than instrumental, the probability being that the specific emotional effect is due in the main to the words.”

The conclusions of Schoen on mood changes in a tested group sum up the relationship between mood changes and enjoyment. Thus for practical purposes we want to know not only whether a musical composition produces a mood change in the listener, but also what is of greater significance, whether the induced mood is also enjoyed, and to what degree this enjoyment might depend on such factors as the type of mood induced. The listener’s familiarity with the selection, and his judgment of the quality of the selection, are also important.

The results of a large series of observations show as a rule, that music produced a mood change in every listener, or that an existing mood was intensified when it conformed with the mood of the music. The tendency of the same composition to produce the same mood in every listener was very marked. The degree of enjoyment derived from the musical composition was in direct proportion to the intensity of the mood effect produced, provided this effect was not due to the conditions of the performance, such as a poor intonation or faulty interpretation.

“No greater amount of enjoyment was derived from one type of mood than from another type, unless the mood was due to dislike of the specific type of music or to a poor performance. But when the mood change was from joyful to serious, the enjoyment seemed to be slightly less than when the change was from serious to joyful, provided the hearer was not hampered by a knowledge of the critical estimate of the music to which he was listening or by faulty interpretation. The evaluation of the quality of the musical composition was in direct proportion to the intensity of enjoyment.”

III
Other Conditioning Factors

In addition to the physical elements of music previously discussed there are other factors which enter into the type of response of mind and body to music. Mention has been made above of the value of program notes. People who hear new music for the first time may or may not develop a visual or emotional response, but if prepared by descriptive writing they may “understand” or at least enjoy the music more.

“Program notes, oral comments, and the general setting of the presentation are important because they concentrate and reinforce the mood response. Indeed it has been shown that in a verbal introduction offered before a composition is presented, what is said does not matter much, and that almost any kind of comment will enhance the listener’s enjoyment if it serves to cue him into appropriate effective states of mind.”[60]

Music aides should take this finding seriously and preface the playing of musical selections with verbal commentary. Even popular dance music may be prefaced by remarks about the solo instrument featured or the personalities involved.

With the exception of the effects of rhythm, all other reactions thus far cited have been largely psychologic. Before leaving the discussion of response, one bit of evidence demonstrating possible physiologic action will be presented. Gundlach[39] studied the songs of six different American Indian tribes. Now the language, customs and music of neighboring European countries frequently have something in common, but the absence of the wheel in transportation made the scattered people of the Western Hemisphere strangers to each other. The speech and songs of the different Indian nations are entirely unrelated, yet the songs representing the same types of ceremonials show considerable agreement. From this Gundlach concludes that “music has some conventions grounded on a firm basis of physiologic structure and behavioral similarity of human beings.”

ALive Music. Most people will turn to the source of sound. Even the most phlegmatic will turn if the sound is sudden and loud enough. It is a protective mechanism because identification of the source may prevent personal injury. There is also a sense of satisfaction in the corroboration of the auditory and visual images. When the sound is musical the desire to see its production is greatly increased. For those who cannot make music themselves, it is like watching a conjurer from behind. For musicians it offers the opportunity of inspection, improvement or criticism. One of the most important psychologic components of music is the physical presence of the music maker. About twenty years ago a manufacturer produced piano-player rolls which reproduced the manipulation of well known artists so well that experts could not differentiate between the sounds produced on the piano by a live pianist and the automatic player. Yet this method of reproduction was a failure financially; it had every quality of the live musician except the physical presence.

We demand far less in quality of music from a live band than from a mechanical reproduction of band music. Groups of people who assemble to dance will pay relatively high prices for inexperienced players with a monotonous repertoire for the sake of having live music. The dancers may complain of the poor musical execution, but will suffer a return engagement in preference to the playing of recorded music.

There are cinema stars whose singing voices are harsh to most ears, yet listeners will applaud them into an encore, not so much for the sake of a beautiful experience, but to prolong the human contact. We react not only to the sound, but to the motions and very presence of music-makers. We listen to people as well as their music. Live music stimulates, sustains and focuses attention. It should be used as often as possible for patients. The “live” musician can get patients to listen to musical forms which would be entirely ignored otherwise. If musicians wish to spread the appreciation of “good” music and music appreciation, one method is to be found in personal appearances at hospitals.

BThe Human Voice. Of all the sounds of given pitch and intensity the one which best attracts and maintains interest is the human voice. We habitually turn to the human voice. Sometimes we do it as a matter of courtesy. Again, we may do it for better understanding, or even out of curiosity. The spoken language is understood by far more people than is the so-called language of music. When words are set to music they command greater attention than when they are spoken. They are usually compact and in rhyme. We strain to hear each word to gather the full meaning and humor or cleverness of the lyricist. Yet, we willingly lower our literary standards when words are put to music. The verses of many songs sound vacuous and repetitious without accompaniment. But the words are made interesting by the melody, and melody takes on additional meaning from words. “Vocal music has greater power to arouse a definite emotional response than has instrumental music. Rest results about equally from instrumental and vocal music.”[71]

Songs with words are ideally suited for arousing patient interest. Community singing is the most valuable form of music for maximum group response.

LISTENING

Violet Paget[55] sent questionnaires to one hundred and fifty people in different parts of the world to obtain a global sampling of reactions to music. From an analysis of their answers she found

“two different modes of responding to music, each of which was claimed to be the only one in those in whom it was habitual. One may be called ‘listening’ to music; the other ‘hearing’ ... with lapses into merely overhearing it. Listening implied the most active attention.... Hearing is a lesser degree of the same mental activity where active attention occurs in moments like islands continuously washed over by a shallow tide of other thoughts.”

This is very similar to Gurney’s classification of musical perception as “definite” and “indefinite.” Vernon[77] lists the varieties of response to indefinite listening as:

a. Reflex or physiological; soothing or stimulating.

b. General euphoria.

c. Stimulation of thought and wandering of attention.

d. Emotional moods of interpretation of the so-called “meaning” of music.

e. Dramatic visual images of day-dreams.

f. Awareness that sounds are going on, but no further response.

g. Lapsing of this awareness into the “margin” of consciousness.

He found reactions a. and b. among primitives and infants; and reactions c. f. and g. among the untrained.

Schoen[71] found that response to music is related to the psychologic levels at which they occur, and to sensation, perception, and imagination. The sensorial response is physiologic and possessed by all. It is the source upon which all other musical development depends. It requires a minimum amount of mental effort, and its effects are within the easy reason of the intellectually inferior and superior alike. As a sensation, music is either pleasant or unpleasant. Training and experience may lead to higher types of response, depending upon individual desire and ability to develop musical taste and education. The next higher response is perceptual and its distribution level adds excitement or repose. The highest level of response is imaginal.