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The hospital of the future

Music and health through the ages

This timeline, though it is certainly not exhaustive, is a general overview of the most important milestones in the relationship between music and health from the ancient civilisations to the present day.

PALAEOLITHIC The discovery of a 35,000-year-old flute in southern Germany has made anthropologists think that music strengthened social ties and improved new forms of communication, indirectly driving the demographic expansion of modern humans.

ANCIENT CHINA The therapeutic use of music is mentioned in the seminal text on traditional Chinese medicine, The Yellow Emperor’s Inner Classic (ca. 2600 BC). The five tones of the Chinese musical scale were integrated in the theory of the five elements (water, fire, metal, wood and earth), and each element was associated with a musical note and an organ of the human body.

ANCIENT EGYPT Papyri dated to around 1500 BC seem to suggest that the Egyptians used music as a balm for healing the body, calming the mind and purifying the soul. They also believed that music had the ability to improve a woman’s fertility.

INDIA In Ayurveda, the ancient Indian system of medicine, mantras (chants) were believed to have therapeutic properties. The Atharvaveda, a medical text written in northern India around 1200–1000 BC, contains over 6,000 mantras and 700 hymns. According to the Sushruta Samhita, another Ayurvedic medical text (third or fourth century AD), gentle sounds and pleasant sights promote good digestion.

ANCIENT GREECE Pythagoras (sixth century BC), in his theory of “the music of the spheres”, stated that mathematical and musical relationships between the heavenly bodies were the source of the universe’s harmony. As those proportions were reflected in the human soul, music had the power to restore harmony in individuals—for example, in cases of mental illness. Plato (fifth-fourth century BC) believed in the divine nature of music and its pleasing and sedative powers. In The Republic, he noted the importance of music for the education of youth and underscored the moral superiority of certain scales to others (Greek modes). Aristotle (fourth century BC) acknowledged the great power that music had over people. In Politics, he wondered about the Greek musical modes and their suitability for different purposes, such as education versus recreation. When formulating his theory of ethos, he argued that music affects one’s mood and character according to its rhythm, melody and harmony (the pillars of music therapy).

ANCIENT ROME In De institutione musica, the philosopher Boethius (fifth-sixth century AD) defended the importance of music for balancing the four humours of the human body.

ISLAMIC WORLD The Persian physician and philosopher Avicenna (11th century) mentioned the arts (dance, music, poetry, painting and others) over 150 times in his seminal Canon of Medicine (1020).

The relationship between music and health has evolved over the centuries, from magical healing rituals to highly specific therapies based on hundreds of scientific studies.

MIDDLE AGES Abbess Hildegard of Bingen (11th-12th century), a polymath, pioneer of monastic medicine and author of the medical treatises Physica and Causae et curae, believed that “every creature has its own sound”. Music was considered a branch of philosophy and mathematics, and in medicine it was recommended to prevent and cure afflictions of the spirit. Its prescription is associated with the regimina sanitatis and pain management. The physician and theologian Arnau de Vilanova (13th-14th century) recommended using music therapy to “distract the intellect of the spirits with musical instruments” and to treat pain.

RENAISSANCE People still believed that heavenly bodies, musical tones and bodily humours were all connected. The first studies on melancholia appeared in Europe, with some references to music. In Le Istitutioni Harmoniche (1558), Italian theoretician and composer Gioseffo Zarlino claimed that the four musical modes corresponded to the four humours of the body and the four elements. In her Nueva filosofía de la naturaleza del hombre, Spanish philosopher Oliva Sabuco (1562–1646) wrote a chapter with the descriptive title “On music, which doth cheer and strengthen the brain and bring health to every ailment”. English clergyman and scholar Robert Burton (1577-1640), in The Anatomy of Melancholy (1621), stated that melancholic music could alleviate melancholy as well as induce it, freeing the mind from that state and finding balance based on the homoeopathic principle of using the apparent cause of an ailment to cure it.

MODERN HISTORY During the 18th century, medical treatises increasingly mentioned music, and the first scientific studies of its effects on the body were conducted. Many doctors with musical training debated the therapeutic power of music in their writings. For instance, in 1748 the French physician Joseph-Louis Roger published a treatise titled Traité des effets de la musique sur le corps humain in which he analysed the basic principles of acoustics, the human perception of sound, and the psychology of music and speculated on the possible curative effects of sound vibrations on the body. Meanwhile, in his Reflections on the Power of Music (1749), British surgeon Richard Brocklesby acknowledged the tremendous therapeutic potential of music but warned of the need for further scientific research in this field.

17TH AND 18TH CENTURIES A relationship was established between music therapy and tarantism (a form of convulsive hysterical behaviour with psychiatric symptoms, popularly associated with a tarantula’s bite). Dissertatio de historia, anatome, morsu et effectibus tarantulae, a work by the Italian physician Giorgio Baglivi (1668–1707), influenced Spanish musical therapy treatises on tarantism. The most important was Tarantismo observado en España (1787) by Francisco Xavier Cid, which included 35 cases of tarantulees treated with music.

19TH CENTURY Scientific discoveries ushered in a new way of practising medicine, less holistic and more focused on biology, occasionally to the detriment of certain aspects of healthcare. Even so, new uses were found for music in health, particularly in psychiatry. Illenau Asylum (Baden, Germany) exemplified arts-in-health activism. They had a choir, a band, a chamber orchestra, 140 performances each year, and a music instructor on staff to work with the medical personnel. They even compiled a hymnal that was used in other German asylums. In 1879, the great English composer Edward Elgar was appointed resident composer and bandmaster of the Worcester County Lunatic Asylum, where he wrote dances for the patients. In France, psychiatrist Wilhelm Horn reported that the eight stone baths of an asylum bath house had been fitted with an organ, drums and cymbals as an unusual form of shock therapy.

20TH CENTURY The two world wars inspired numerous music programmes for convalescent soldiers. Most were focused on entertainment rather than music therapy per se, but there were some like the “Music in Reconditioning in ASF (Army Service Forces) Convalescent and General Hospitals” programme, launched in the USA in 1945, which used all-women military bands to boost the wounded men’s morale.

1950: the National Association for Music Therapy is founded in the United States.

1958: the British Society for Music Therapy and Remedial Music, which would go on to publish the immensely prestigious British Journal of Music Therapy, is established in the United Kingdom.

1974: Paris hosts the 1st International Music Therapy Congress. The Asociación Español de Musicoterapia is also founded in Spain, although it did not begin operating until 1976.

1985: the World Federation of Music Therapy is founded in Italy.

1999: the African continent’s first music therapy programme is launched in Pretoria, South Africa.

21ST CENTURY

2012: the Música en Vena association embarks on a mission to improve hospital stays with live music.

2016–2019: the Música en Vena association conducts its scientific study of Musicians In Residence at Hospital 12 de Octubre in Madrid.

2017: Oxford University Press publishes Arts in Health: Designing and Researching Interventions, by Daisy Fancourt, a seminal reference book that systematically explains how to design and deliver arts-in-health interventions, making it a valuable handbook for professional artists, project managers and healthcare workers who want to implement the arts in healthcare settings.

2019: the Regional Office for Europe of the World Health Organization publishes a report that highlights the importance of the arts in the health and well-being of its citizens and, for the first time, urges governments to include art and culture in healthcare systems and protocols, and to systematically support scientific research in this field: What is the evidence on the role of the arts in improving health and well-being? A scoping review.

December 2019: Fundación Cultura en Vena is created with the aim of, among other things, continuing the MIR Project, publishing and sharing the results, and bringing Musicians In Residence to as many hospitals as possible.

2020: the coronavirus pandemic hits Spain, exposing the strengths and weaknesses of our healthcare system and culture industry. In September, the Senate urges the Spanish government to declare culture an essential commodity . “We should include culture and the arts in the framework of healthcare, as music, art and cultural activities have great benefits for our bodies and our emotions.”