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MUSIC AND THE BRAIN:

THERAPEUTIC USE OF MUSIC

DR ROMESH SENEWIRATNE

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Contents:

Introduction - therapeutic use of music

1. Developing an integrated model of music neuroscience

2. Musical instincts and instinct theory..

3. The neural processing of music.

4. Development of musical appreciation.

5. Music, mood and emotions

6. Melody and pleasurable scales..

7. Harmony and the mysterious delights of dissonance..

8. Timbre, tone and the beauty of smooth sounds..

9. Time, rhythm and biological clocks.

10.The neurobiology of dance

11. The neurobiology of creativity.

12.Using music for health of muscles, bones and joints.

13.Music and relief of stress

14.Music for development of sanity..

15.Music and memory improvement.

16.Music, Parkinsonism and Parkinsons Disease..

17.Music and healthy hearts..

18.Music and the immune system

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19.Music and pain relief..

20.Music and respiratory health .

21.Music and the digestive system.

22.Conclusion.

23. Appendix...

24. References..

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Detailed Contents
Contents: ........................................................................................................................................ 2
INTRODUCTION: THERAPEUTIC USE OF MUSIC ......................................................... 8

1....................................................................................................................................................... 9
Developing an Integrated Model of Music Neuroscience .......................................................... 9
In two (or more) minds about music ..................................................................................... 22
Getting my head around the brain ........................................................................................ 25
A typically amusical medical training ................................................................................... 28
Brainwashed by drug propaganda ........................................................................................ 31
An Anthropologist from Mars opens my eyes and ears ...................................................... 35
The first of many commitments ............................................................................................. 39
The dangerous territory of love ............................................................................................. 53
An atypical training in music ................................................................................................. 58
An Integrated Theory on Human Instincts .......................................................................... 65
Instinct Theory ........................................................................................................................ 66
Psychologists discover the importance of thinking .............................................................. 70
A New Model of Motivation ................................................................................................... 77

2..................................................................................................................................................... 85
MUSICAL INSTINCTS ............................................................................................................. 85
Baila dancing and the Peacocks Tail.................................................................................... 85
Hot Debate about Evolution of the Music Instinct .............................................................. 86
Darwins Strongest Passions .................................................................................................. 88
A dancing cockatoo contributes to the instinct controversy ............................................... 90
Why cant chimpanzees keep a groove while parrots can?................................................. 95
Bipedalism and evolution of the human sense of rhythm ................................................. 100
Could musicality have evolved because it confers hunting advantages? ......................... 103
Hunting and human evolution ............................................................................................. 104
On the evolution of the human sense of rhythm ................................................................ 110
On the evolution of the human sense of harmony .............................................................. 115
Did musicality evolve because it is good for our health? ................................................... 115
On the relationship between language and music instincts .............................................. 116

3................................................................................................................................................... 121
NEURAL PROCESSING OF MUSIC .................................................................................... 121
Hemispheric lateralisation of speech and music ................................................................ 127
Overview of the auditory system ......................................................................................... 133
Cortical and Subcortical Processing ................................................................................... 140
Cortical processing of music ................................................................................................ 141
Post-cortical processing of music ......................................................................................... 145
Mental associations and their neural substrate.................................................................. 146
Is the Insula involved in musical and other aesthetic taste? ............................................. 148
Pre-cortical processing in the thalamus .............................................................................. 152
Post-cortical processing in the thalamus............................................................................. 152
Post-cortical processing in the basal ganglia ...................................................................... 152

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Pre and post-cortical processing in the cerebellum ........................................................... 153

Pre and post-cortical processing in the limbic system ....................................................... 153
The neural substrate of musical memories ......................................................................... 154
Neural mechanisms in attention and concentration .......................................................... 154
Neural plasticity and development of the auditory system ............................................... 154
The neurobiology of rhythm ................................................................................................ 165

4................................................................................................................................................... 171
DEVELOPMENT OF MUSICAL APPRECIATION ........................................................... 171
Ontology of the musical brain .............................................................................................. 171

5................................................................................................................................................... 173
MUSIC, MOOD AND EMOTIONS ........................................................................................ 173
Flaws in research on the physiology of excitement ............................................................ 176
PRIMARY, SECONDARY AND TERTIARY EMOTIONS ........................................... 184
The delight of violating expectations ................................................................................... 187
The neurobiology of music emotions ................................................................................... 187
The effect of music-induced emotions on the hypothalamus ............................................ 190
Exciting music and the pathologisation of excitement....................................................... 191
Excitement, Elevated Mood and Criteria for a Label of Mania ....................................... 192
Professor Allen Frances speaks out about Disease Creation and the DSM..................... 197
Programmed Insensitivity the Structured Interview...................................................... 198
A Brave New World where Big Pharma Rules .................................................................. 206
Racial and Cultural Bias in Labelling Excitement as Abnormal ..................................... 210
Treatment of Excitement in the Twentieth Century ......................................................... 211
Why happy music doesnt always make you happy .......................................................... 215
Why sad music doesnt always make you sad .................................................................... 215
Depressing music and music for depression ....................................................................... 215
Scary music and music for anxiety ...................................................................................... 215
Angry music, irritating music and the music of angry young men .................................. 216

6................................................................................................................................................... 220
MELODY AND PLEASURABLE SCALES .......................................................................... 220

7................................................................................................................................................... 223
HARMONY AND THE MYSTERIOUS DELIGHTS OF DISSONANCE ........................ 223

8................................................................................................................................................... 229
TIMBRE, TONE AND THE BEAUTY OF SMOOTH SOUNDS ....................................... 229

9................................................................................................................................................... 230
TIME, RHYTHM AND BIOLOGICAL CLOCKS ............................................................... 230
Universities discover Groove ............................................................................................... 232
The Neurobiology of Rhythm .............................................................................................. 235

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10................................................................................................................................................. 238
THE NEUROBIOLOGY OF DANCE .................................................................................... 238
Why do we dance? ................................................................................................................ 239
Neural structures implicated in dancing............................................................................. 239
The Interesting Tail of the Caudate Nucleus ...................................................................... 241

11................................................................................................................................................. 242
THE NEUROBIOLOGY OF CREATIVITY ........................................................................ 242
Neural mechanisms of music creation .................................................................................... 242

12................................................................................................................................................. 243
USING MUSIC FOR MUSCULOSKELETAL HEALTH ................................................... 243
Drumming and playing percussion instruments ................................................................ 243
Dancing .................................................................................................................................. 243

13................................................................................................................................................. 243
MUSIC AND RELIEF OF STRESS ....................................................................................... 243
Listening to pleasurable music ............................................................................................ 243
Singing.................................................................................................................................... 244
Playing musical instruments ................................................................................................ 244

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MUSIC FOR DEVELOPMENT OF SANITY ....................................................................... 244

15................................................................................................................................................. 246
MUSIC FOR CONCENTRATION AND MEMORY IMPROVEMENT ........................... 246

16................................................................................................................................................. 246
MUSIC, PARKINSONISM AND PARKINSONS DISEASE ............................................. 246

17................................................................................................................................................. 251
MUSIC AND HEALTHY HEARTS ....................................................................................... 251

18................................................................................................................................................. 256
MUSIC AND THE IMMUNE SYSTEM ................................................................................ 256
The Pineal the Seat of Soul Music? .................................................................................. 258
The Pineal and the Immune System .................................................................................... 290

19................................................................................................................................................. 291
MUSIC FOR PAIN RELIEF ................................................................................................... 291

20................................................................................................................................................. 291
MUSIC FOR RESPIRATORY HEALTH.............................................................................. 291

21................................................................................................................................................. 291
MUSIC FOR GOOD DIGESTION ......................................................................................... 291

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22................................................................................................................................................. 291
CONCLUSION ......................................................................................................................... 291

LITERARY REFERENCES: .......................................................................................... 292

MUSICAL REFERENCES: ............................................................................................ 293

appendix
MENTAL STATES ASSOCIATED WITH MUSIC ............................................................. 295
EMOTIONAL REACTIONS FROM MUSIC ....................................................................... 296

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INTRODUCTION: THERAPEUTIC USE OF MUSIC

Im not sure what to call this book. The title, as it stands, promises to elaborate on
how knowledge of music and the brain can lead to therapeutic use of music. I
believe it can, but Im not certain how. Not because of the procedure of music
therapy but because of its politics. During the years I worked as a family doctor I
rarely tried to use music as a therapy, and have never referred a patient to a
professional music therapist (though I have urged hospitals and governments to
employ them). Most of what I have gathered about music and the brain has been
the result of slow self-directed learning using the miracle of the internet, and my
personal experience with music, medicine, medicos and madness.

I am not a professional academic and the ways I like to write reflect this. I much
prefer drawing diagrams and writing in longhand to typing. It has been a labour of
love to type this manuscript with two fingers. So why have I taken the trouble to
write this book? What do I think I can contribute to a sensible discussion about
music, the brain, and the use of music as a medicine?

In my present frame of mind I think the reason I have written this book is because I
am interested in both music and the brain and regret not having used the cheap,
effective therapy that music can provide, to prevent illness and recover from it in
myself and in the patients I have treated over the years. Though music is
ubiquitous the style of medicine I was trained in and practiced for many years
excluded music as a social or therapeutic tool.

The fact that many successful music therapists have little knowledge of or interest
in the brain suggests that knowledge of how music affects the brain (and the brain
affects the music we perceive and create) is not necessary to use music
therapeutically. However, no music therapist can ignore the effect of music on the
minds of their patients, or how their clients mental state affects their response to
music. This book is mainly about the relationship between music, medicine and the
mind. It is obvious that the brain and the rest of the body are influenced by music
mainly through the mind.

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Developing an Integrated Model of Music Neuroscience

All over the globe, people are, at this very moment, creating musical sounds and
listening to them. Some of these people are enjoying the music they can hear;
others are not. Some are actively listening to music, others are enjoying it as
background music. Some are trying not to listen to what they are experiencing as
unpleasant noise. Many are hearing music, but not actively listening to it, for a
variety of reasons. While it might be assumed the people who are playing music
around the world are doing so in the hope that those who hear it will like it, this is
not necessarily the case. Music is used, and has been over the centuries, for
different reasons and with different effects including deliberately terrifying or
tormenting people.

When I studied medicine at the University of Queensland, the healing powers of

music were not mentioned. Neither was the use of music in torture, or in fact,
anything else about music. Though aware of the existence of professional music
therapists, during the years I trained and worked in Australias public hospital
system I never saw one in action, simply because very few were employed by the
hospitals. We had lectures and tutorials on neurology, psychiatry and psychology,
but the neural processing and mental processing of music (such as it was
understood in the 1980s) were not regarded as subjects essential to the training of
Australian doctors. It has taken me three decades to unlearn an unconscious bias
against music therapy instilled by my textbooks and teachers.

Many years working as a family doctor revealed to me serious limitations and

flaws in my medical education and training. This training had some merits, of
course. My teachers emphasized the importance of taking a careful history and
making a thorough physical examination before ordering often expensive
investigations that would prove unnecessary if time had been spent on the history
and examination. We were trained well, or reasonably well, in the subtle art and
science of diagnosis the detection and confirmation of disease states, their
scientific names and who to refer to if we didnt know what was wrong with a
patient or what to do about it. We were taught enough medical terminology to
communicate in professional jargon with other doctors and members of our elite
healing profession if we thought our patients needed treatments we did not have
the skills or government authority to provide. Unfortunately treatment, in my
mind and that of many other young doctors, meant a choice between drugs or

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surgery. For non-drug treatments we were encouraged to refer to some of the

allied health professions, too mainly physiotherapists, dieticians, and
psychologists, and even what were then called alternative practitioners such as
acupuncturists and chiropractors, but not to music therapists.

Although the therapeutic benefits of music have been recognised for thousands of
years, recent decades have seen a marginalisation of music as occupational
therapy or diversionary therapy. Often we see music therapy lumped together
with other alternative therapies. This is despite an increasing number of qualified
music therapists, and thousands of scientific papers proving the effectiveness of
music therapy in alleviating a wide range of medical problems.

From what I have read, the first professional qualifications in music therapy were
awarded shortly after the Second World War, when the value of visiting
entertainers in alleviating the boredom that afflicted injured soldiers was
recognised in American military hospitals. Since then there has been a steady
growth in the music therapy industry, with the emergence of several therapeutic
methods including the well-known Nordoff-Robbins improvisational technique
which has been used in the more progressive paediatric units in Europe and
America for some decades. More recently Neurologic Music Therapy, developed
in the USA by Michael Thaut, has offered treatment for Parkinsons Disease and
other neurological problems in adults. These and other techniques have been
repeatedly shown to provide significant benefit to patients suffering from much
more dangerous maladies than boredom. Studies proving the effectiveness of
music therapy have been published in the scientific and medical press, for
conditions ranging from depression and anxiety to psychosis and dementia in
psychiatry, angina and hypertension in cardiology, Parkinsons disease and stroke
in neurology and to reduce the drugs used in anaesthesia in addition to various
areas of paediatrics (especially neonatology, oncology and child mental health).
Listening to music can aid in the reduction of stress, and a stress response is known
to contribute to many illnesses.

Modern recognition of the healing value of music and attempts by the Western
medical establishment to use this therapeutic tool in the business of health
promotion are long overdue. Music has been used around the world since ancient
times for its healing effects. Historical and archeological evidence from around the
world indicate that music has long been a fundamental feature of human society.
This is supported by cross-cultural observations of contemporary human societies.

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Why this neglect of music as a therapy when it has been used as a free, natural
remedy for various physical and mental ills for thousands of years, across the
world?

One factor, in my opinion, is the inadequacy of medical training. Around the

world, this is characterized by an over-emphasis on what we consume (meaning
food and drugs) rather than what we see, hear and do. Another is vested interests in
providing far more expensive treatments. These two factors are geographically,
politically and economically linked and have created a global medical enterprise
that is adept at treating acute problems of the body (but not the mind) with drugs
and surgery, but with a tendency to create chronic illness and drug dependency
after the acute illness has resolved. The medical establishment is rather worse at
treating sometimes equally serious chronic illnesses and miserably unsuccessful at
healing the mind of the various problems society and the medical profession, or
sections of it, have contributed to if not created. Though mental stress is widely
recognised as contributing to illness of both the body and mind, doctors (who are
often stressed themselves) are not trained well in identifying or alleviating stress. If
they do, they are trained to reach for their prescription pad to treat the stress.

Recent decades have been characterized by an increasing dominance of drugs and

surgery in medical treatment strategies. Drugs are promoted for the treatment of
disease and for its prevention. Though many of these are valuable medications, all
drugs have potential risks and adverse effects. If their use can be minimised or
avoided by incorporating music-based strategies, the potential benefit to society is
obvious.

This book is a corrected, expanded version of a manuscript I began in 1999 and

thought I had finished in 2001. I titled this manuscript Music and the Brain:
therapeutic use of music and made a few photocopies which I have given people
over the years, including a few academics at the universities in Melbourne and
Brisbane that are allowed to award medical degrees. I selected academics I
thought might be interested in my perspective on how music might be used as a
treatment, especially of Parkinsons Disease and anxiety/depression which were
two illnesses I had developed specific music-based strategies to treat. My tentative
approach to Melbourne academia was not entirely rejected. I was graced with an
hour of the time of a professor of neurosurgery who was said to be a strong
supporter of music therapy at the Royal Childrens Hospital, and another hour with
a senior research neurologist at Monash University who was investigating
treatments for Parkinsons disease.
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Unfortunately the neurosurgeon was too busy to read the 60 pages of text or more
than glance at the diagrams. Though he agreed that the basal ganglia and reticular
activating system were likely involved in what I was calling a dance instinct and
had no difficulty accepting that music could and should be more widely used as a
therapy, he was clearly unimpressed by the modest list of references and lost
interest completely when he learned that I was not, unlike himself, classically
trained. So you cant read music? he asked. Not very well, I had to admit.

The neurologist at Monash University was polite and invited me to meet him for a
discussion, following which he offered to show me the Parkinsons research
laboratory theyd established in the anatomy department. I turned the invitation
down when he told me the experimental technique they were using. Weve got
monkeys playing video games, while we test their motor control, strength and
response under different conditions. Different conditions, he explained, meant
different drugs. When I foolishly asked why the monkeys played these games
(imagining monkeys enjoying a Space Invaders encounter) the neurologist looked
at me as if I came from another planet. Theyre conditioned. He might as well
have added, stupid.

In this book I will attempt to develop further ideas about how music can be used as
a medicine within a broader context of how we can achieve better health by
changing our behaviour in a positive way. Though the advertising industry has
obvious expertise in the field, how we are affected by what we hear and see is
largely ignored by the medical model. This is despite much research into the visual
and auditory systems, and knowledge of the neurological pathways involved in
remembering, perceiving and creating musical sounds. An integrated model of how
music affects our minds and brains (for better or worse) is presented in the chapters
to follow, and specific therapeutic strategies for medical and psychological
problems, derived from this model, can be found at the end of relevant chapters.

I began developing the theoretical model presented in this book in 1995, after
several years working as a full-time family doctor and part-time musician. During
that time the model has been revised and added to as more data has come to light,
and I have identified numerous errors, false assumptions and over-simplifications
in the model as I first developed it. The information I have relied on to construct
this model includes research done by the many investigators involved in music
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cognition, music therapy and music neurology. Some inferences have been made
from knowledge of the neural circuits involved in auditory perception more
broadly, and some from my own introspective analysis of how my perception of
music has changed and grown over the years, especially during the past decade,
when I have spent more time working as a musician than a doctor. Other
information has been obtained from a wide range of scientific disciplines
medicine and neurology, physics and biochemistry and evolutionary biology.

The model I will be describing differs significantly from the traditional medical
model, especially in the areas of psychology and psychiatry. The existing model of
psychiatry is exclusively a disease model, and rarely acknowledges the value of
aesthetic development, creative activity or musicality. Hundreds of 'disorders' have
been named and described, all 'treatable' with one drug or another, but none truly
'curable' (instead, ridding oneself of symptoms is regarded as 'remission' rather
cure). In my own work I have attempted to create a health rather than a disease
model, since logic dictates that belief that one is incurably ill can create incurable
illness.

At the same time, it is necessary to use psychiatric terminology to explain how, I

believe, music can be used to treat psychiatric disorders as they are defined by the
medical profession in the modern world. Terms such as depression, mania,
schizophrenia and 'personality disorder' will be briefly deconstructed in order to
identify which symptoms might be amenable to music therapy and which might be
worsened by the wrong music or the right music at the wrong time or in the wrong
place.

The model of mental health presented in this book is the product of sixteen years of
theorising on how disease creation by the medical profession can be avoided, and
the mechanisms by which health of the mind promotes health of the body. One
reason for my endless revisions and corrections of the theories I have developed
over the years has been doubt as to whether mental health does promote physical
health. Why, then, do the good die young so often? Sure, music can reduce stress,
but isnt a certain degree of stress important to maintain motivation? Music can
elevate the mood, but wont that make a manic patient with a pathologically
elevated mood more manic still? These are some of the problems I encountered
when trying to make scientifically and logically valid generalisations about music,
the brain and the mind. During these sixteen years, during which I have been
hospitalised against my will more than forty times, I have been motivated to
understand the mind and the medical treatment of it (psychiatry) more than wading
through the complex jigsaw puzzle that modern music neuroscientists have given
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those with an interest in music and the brain tantalising pieces of.

Since the advent of modern dynamic imaging techniques, including functional

Magnetic Resonance Imaging (fMRI), Magnetoencephalography (MEG) and
Positron Emission Tomography (PET) scanning, there has been a resurgence of
research into the perception of music and its creation, from a neurological point of
view. A large amount of new data remains to be integrated into a meaningful
whole. In this book I will try to bring together research findings from various
disciplines that have been exploring music cognition, including perception of
melody, harmony, beat and rhythm, timbre, pitch and loudness.

Not being a trained neuroscientist, it has been a steep learning curve to discover the
location of the numerous regions of the brain seemingly activated by various
musical tasks in the hundreds of published studies using fMRI, PET and MEG
scans in recent years. Despite several years trying to understand them, how these
parts of the brain are connected to each other, structurally and functionally,
remains personal challenge. This difficulty is shared, Id imagine, by many
professional neuroscientists, but when I had the audacity to first develop my own
theories on how the brain and mind worked I knew far less about the neural
structures known to be involved in music than was common knowledge amongst
those who researched music and the brain for a living - a select group of cognitive
neuroscientists on the other side of the world who were sharing ideas and
revolutionary discoveries about the neurobiology of music with each other and
with the world, while I was busily prescribing antibiotics, anti-depressants and
anti-hypertensives rather than music.

......insert para:

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The diagram that follows presents an overview of the main neural structures
known to be involved in the brains processing of sound and music, as I understood
it in 2000. This diagram is very simplified. The early, so-called sub-cortical
processing of sound (and music) is largely omitted other than an arrow between the
cochlear nerve and the inferior colliculus (which I have incorrectly indicated as
being located in the brainstem rather than the midbrain); the pathways from the
inferior colliculus to the thalamus and from the thalamus to the auditory cortex,
and how these influence the limbic system and basal ganglia are not as clear as
they could be.

When I drew this diagram in 2000 I was attempting to illustrate possible

connections between the medial geniculate nucleus of the thalamus, the auditory
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cortex in the temporal lobes and brain structures known to be involved in emotions
(the limbic system) and movement (basal ganglia). I was exploring the neural basis
for the distinctly human tendency to move rhythmically in time to music, and it
seemed obvious that these structures must receive the auditory data from the inner
ear in some way, since according to my rudimentary knowledge of the brain the
limbic system was the main structure involved in emotional reactions, and the
basal ganglia, together with the motor cortex in the frontal lobes and cerebellum
control voluntary movement. These are all simplifications, if not
oversimplifications or frank inaccuracies. Despite my medical qualification and
more than a decade working as a family physician my knowledge of neuroanatomy
was shaky. My knowledge of neurophysiology was not much better.

In late 2009 I sent this and some other diagrams I had drawn at the time to Daniel
Levitin, a cognitive psychology professor at Canadas McGill University. I did this
with some trepidation after reading his bestseller This is Your Brain on Music.
Much to my delight I received an email from Professor Levitin the next day in
which he thanked me for trusting him with what he described as most interesting
drawings. The thing I like about them he wrote, is that they appear to be very
well thought out and they do indeed lead to testable hypotheses.

I was flabbergasted, flattered and slightly frightened. Flabbergasted because I had

expected no reply or a dismissive one, based on the response of the Australian
medical fraternity to my work, and flattered by his generous words. I was
frightened because I knew I didnt really understand my own diagrams, at least not
well enough to explain them adequately. This is Your Brain on Music had revealed
to me how little I knew about music and how limited and flawed was my
knowledge of brain anatomy. It provided insight into how little I knew about the
extraordinary progress psychologists working within a neurological paradigm have
made over the past two decades, in particular.

When I began theorising on music and the brain one of my objectives was to create
a scientific model that explained what my clinical and personal experience made
clear that music can be both an agent of healing and of disease. My medical
training did not prepare me well for this task. This was largely focused on the
diagnosis of disease meaning ascertaining the correct name of disease through
history, examination and (an increasing range of) investigations and prescribing
what was thought, according to medical specialists in various fields, to be the best
treatment. Usually this meant drugs or surgery, though much of general practice
involves reassurance that the problem will resolve by itself and that no
treatment is necessary. This is the so-called allopathic disease model, the
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paradigm in which I was trained in the early 1980s at the University of Queensland
and allied teaching hospitals.

Over the years I recognised how little emphasis was placed and dollars spent
investigating the bodys natural healing mechanisms. And how what we see and
hear, rather than consume, affect our health for better or worse. The medical
literature that we were forced to read to comply with the Royal College of General
Practitioners CME (Continued Medical Education) program only tested
practitioners of their knowledge of the latest drug treatments and contemporary
specialist opinion about each of the major specialties endocrinology, cardiology,
gastroenterology and psychiatry in particular. It so happens that these are the
biggest pharmaceutical markets. Not that much of a coincidence though the
major drug companies sponsor a great deal of the independent publications of
the RACGP, including its CME program.

The little psychology I studied was firmly anchored in the behaviourist paradigm.
The author of our prescribed textbook Psychology and Life was Philip Zimbardo,
responsible for the notorious Stanford Prison Experiment. Professor Zimbardo
devotes (most of) a single page of his 767-paged introductory psychology textbook
to music, and is limited to a cursory description of ways in which music in five
(American) movies (including Hitchcocks Psycho) affect mood and convey or
emphasise meaning in various scenes. These would, of course have to be watched
to understand what Zimbardo had to say about music.

However, the same piece of music can make one person feel better and another feel
worse, or affect an individual differently at different times. Also, it cannot be
assumed that feeling better is an accurate indication of being better. A person
feeling euphoric because of a drug they have taken may feel extremely well, and
likewise those who believe their cancer has been cured by prayer. People can feel
better than they are, in other words. Nevertheless there is copious evidence that a
good mood does promote both physical and mental health, and there is no doubt
that music can be used to elevate the mood. I believe that integrative approach,
assimilating known facts from anatomy, physiology and psychology can provide a
coherent model as to why improvement in mood improves physical health and why
music is such an excellent therapeutic tool. The problem is distinguishing what are
truly facts from what are not.

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A common neurological problem in the elderly, Parkinsons Disease is

characterized by stiffness, tremor and difficulty in initiating movement. When I
studied medicine at the University of Queensland we learned that Parkinson's
Disease was caused by degeneration of dopamine-secreting neurones in the basal
ganglia, what symptoms and signs (such as tremor, stiffness and emotional
flattening) are typical, what drugs are effective in its treatment, and what drugs can
be used if 'first-line' drugs don't work, or cause unacceptable side-effects. The
possibility of using music to promote the desired mobility and mood was not
mentioned.

Music is capable of stimulating movement in the form of an urge to dance. This

urge follows stimulation of the mind (and brain) by particular rhythms, which, for
reasons that will be explored later, make people feel like moving. Could this
property of rhythmic music be used in the treatment of Parkinsons disease? Could
it also be used for the treatment of drug-induced Parkinsonism, and other diseases
(such as paralysis from strokes) in which stimulation of movement is needed? The
role of the basal ganglia and the neurotransmitter dopamine will be looked at in
Chapter 8, drawing on recent findings about the neural substrate of rhythm
perception. A music-based strategy for the treatment of Parkinsons Disease can be
found at the end of the chapter.

Millions of people around the world are taking drugs (often a combination of
tablets) to control their blood pressure. They are being treated for 'hypertension'
(high blood pressure) which, according to extensive statistical and clinical
evidence, increases their risk of atherosclerosis (hardening of the arteries).

Can music be used to lower blood pressure and thus reduce the risk of these
problems? Can it be used instead of drugs, or enabling less drugs to be used? Can
music be used to reduce stress, in the knowledge that stress has been associated
with causing or worsening a wide range of illnesses, including hypertension, peptic
ulcers, diabetes, rheumatoid arthritis, heart disease and impaired immunity? In
Chapter 2, Music and Emotions, a series of hypotheses will be presented
suggesting that, through effects on neural structures deep in the brain and their
effect on the autonomic nervous system, music can indeed be used be used to
alleviate a wide range of stress-related or aggravated health problems. Specific
strategies for stress reduction are included in Chapter 10 and subsequent chapters.
Cardiovascular health promotion using music is explored in Chapter 13.
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There are several biblical and other historical references to people who were
possessed by evil spirits and deranged being cured by music (King Saul, for
example). Myths and legends from around the world attest to the power of music in
the treatment of madness and other mental problems. Music has been used to calm
the furious and terrified. It has been used to motivate and elevate the spirits. It has
been used to lull people to sleep and to wake them up in a good mood. Logically,
the potential value of music to psychiatry is obvious. Yet it remains psychiatrys
most under-utilised tool. Despite an increasing number of people diagnosed as
suffering from depression and the obvious potential for music to affect mood,
few doctors inquire of their patients about what music they listen to and what
music they like (or dislike). Few doctors, even among psychiatrists, attempt to use
music in a scientific way to help people become healthy, or promote health and
prevent illness in the community. In Chapter 11, Music and Sanity, how music
can be used for various mental disorders, including depression, mania and
psychosis will be explored.

Music is an obvious tool for improving mood and concentration, but it is rarely
mentioned in therapeutic strategies for the much-publicised condition 'attention
deficit hyperactivity disorder (ADHD). People diagnosed with ADHD are instead
inevitably treated with drugs, although more recently there has been a welcome
trend towards psychotherapy, particularly Cognitive Behaviour Therapy (CBT).
How music might be used to improve mood and concentration, as an adjunct to
CBT, will be discussed in depth in Chapter 2, with specific strategies for treatment
of depression, ADHD and psychosis outlined in Chapter 11.

It is a common observation that people with advanced dementia who have lost their
ability to converse are able to sing along with familiar songs, using words they are
unable to access in normal speech. While dementia is one area in which music
therapy is often used, its potential in this area is largely unrecognised. Often all the
music therapy that occurs in nursing homes is an unpaid volunteer coming in once
a week and playing a few good time oldies on an out-of-tune piano, or strumming
out a sad rendition of old popular songs. Even this is more than most people with
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dementia receive, despite evidence that well-designed music therapy programs can
cause profound improvement in mental and physical functioning in people
suffering from dementia.

Though the celebrated 'Mozart effect', in which listening to a particular

composition by the famous classical composer was shown to improve measures of
IQ, wider exploration of possible benefits to learning by simultaneous listening has
been slow, especially in terms of rhythm-oriented music. That musical training and
exposure to music have positive effects on memory, especially word memory, has
been established by several studies. The potential for utilizing this phenomenon in
prevention and treatment of Alzheimers disease and other forms of dementia will
be explored in Chapter 12, Music and Memory Improvement.

Pain relief is another area in which music has been shown to be highly effective.
Several studies have shown that music, of the patients choice, dramatically
reduces need for anaesthetic drugs in surgery. It can also be used to distract people
from pain, physical and mental. Again, despite plenty of convincing research
attesting to its efficacy, music has only slowly found its way into operating
theatres, or pain clinics, where again drugs have been the dominant focus over the
years.

Pain relief and distraction from pain and suffering are of considerable importance
in the management of cancer. Though music is increasingly used in oncology
wards, especially in palliative care and paediatric oncology wards, the benefits of
music are still largely unappreciated by health workers, including medical doctors.
Music can be expected to be of use in prevention of cancers (and infections) since
there is plenty of evidence that stress reduction, which can be achieved by the
judicious use of music, has positive effects on the immune system. Conversely,
stress is known to have suppressive effects on immunity, making malignancies and
infections more likely and more aggressive. How music can be used for pain relief
is explored in Chapter 15. Hypotheses regarding the neural, endocrine and
physiological mechanisms behind these observations are included in Chapter 14,
Music and the Immune System.

The idea that music can be used to promote respiratory and digestive health may
surprise some readers, and it is true that music is likely to be effective only in
conjunction with other stress reduction measures, and only for conditions known to
be caused or aggravated by stress. It is known, however, that respiratory problems
like asthma and many digestive problems (including peptic ulceration, reflux
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oesophagitis and irritable bowel syndrome) are worsened by stress. Music-based

strategies, and hypotheses as to why they are likely to be effective for respiratory
and digestive health are presented in chapters 16 and 17.

The effect of music on the brain and mind was not alone in being ignored in the
medical curriculum when I studied at the University of Queensland in the late
1970s and early 80s. Though far more time was spent studying the visual system
than the less thoroughly researched auditory system there was no discussion of the
effects of television or advertising on mental function (including beliefs, emotions
and prescribing habits) and no advice on differentiating drug company propaganda
from unbiased scientific literature. There was no discussion of visual aesthetics and
the obvious human instinct to seek visual beauty, just as there was no discussion of
the human auditory aesthetic. Needless to say, there was no mention of how we
doctors could use the positive instincts that motivate people to pursue beauty in
what we see and hear to improve health or prevent disease in ourselves or our
patients.

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In two (or more) minds about music

Ive been listening to music to motivate myself, to de-stress and to elevate my

mood for as long as I can remember. Though I didnt think about what I was doing
in these terms, when I listened to a record or tape I was providing self-therapy for
the inevitable stresses of childhood and adolescence. Actually, it was the various
artists I listened to who provided the therapy. I was able to use the therapeutic tool
they provided by means of two amazing modern technological inventions a reel-
to-reel tape recorder and a record player.

We often take technology for granted. Widespread availability of magnetic tape

was a revolution for music. It allowed the public to record the music they liked
and play it as frequently as they liked. It hugely expanded musical therapeutic
options, previously limited to what was available (in ones country) on vinyl.
Magnetic tape in the form of audio cassettes allowed young people to record their
own musical efforts, too (and doctors to record letters on a Dictaphone rather
than dictating them to a stenographer writing in furious shorthand). Unfortunately
few doctors, including myself, thought of suggesting that our patients recorded and
listened to music of their choice to relax, self-motivate, improve their mood or
improve their social life during the rise and fall of the audiotape, despite using the
technology to heal ourselves (at least of the epidemic disease of boredom) during
our youth.

Musical therapeutic options have multiplied with the digital revolution. The
technology to access high-quality healing music continues to head in the opposite
direction to pharmaceuticals in terms of cost and risk. Music is cheaper than it has
ever been and making high-quality recordings is easier than its ever been. Yet
government policies, at least in Australia, do not reflect an awareness of this. Even
the rudimentary use of music in therapy remains outside the clinical habits of the
vast majority of doctors. For many years I was such a doctor. And I had less
excuse than most, since I was passionately involved in music, yet failed to keep
abreast of the growing body of scientific literature proving time and again that
music can and should be used as a first line therapy by doctors and other health
professionals.

Having experienced this splitting of my mind on music recognizing its

therapeutic value in myself but not others I can understand why music is not used
more by doctors. It is not because its value has not been proven, or that it is

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expensive or time consuming. It is not because doctors are all seeking bribes and
kickbacks from drug companies (though a few, disproportionately influential ones,
might be). It is because during our medical training we became blinkered,
indoctrinated into a medical paradigm that excluded music. Music, and more
generally the arts were outside medical territory. We were instructed, in great
detail, how to take a history, but this was divided into a medical history
(including all the drugs our patients had ever taken, what diagnoses theyd been
given, by whom and when) a surgical history (all the operations theyd had,
when, and by whom), family history (what diseases ran in the family the keen
students would draw a little family tree diagram) and an occupational history. If
the patient was not a professional musician music would not be mentioned in the
most thorough medical history. It stands to reason, though, that taking a musical
history, including previous likes and dislikes, prior training and the availability of
musical equipment is a necessary first step to using music therapeutically.

A key problem in our medical education was that we were not taught how to heal.
Nor were we taught even the rudiments of how to prevent illness by curtailing, or
at least controlling, our inevitable professional pessimism. I can only guess how
much disease I have caused, over the years, by unintentionally instilling self-
fulfilling prophesies of illness in the minds of my patients. What passed for
preventive medicine, as I studied it, was frightening people about their risk-
factors and urging them to take increasingly expensive drugs despite the fact that
they felt quite well. I convinced people to take antidepressants though they denied
feeling depressed, having been convinced by the psychiatry sub-profession that
many depressed people lack insight into what I accepted was a medical illness.
I prescribed anti-hypertensive drugs without exploring the possibility of using
music and other means to reduce the stress reaction that commonly contributes to
what I learned was essential hypertension. I memorized, along with the rest, that
essential in this case meant unexplained, but not how the medical profession
came to use this odd terminology.

The objective of treatment in these and many other treatable diseases was
control or at best remission, not cure. My patients, I believed, needed to be
convinced to take the drugs in the long term to maintain control of the disease
process the term the medical profession uses is compliance. Like many doctors
I reassured reluctant patients about the risks and possible dangers of the drugs I
was prescribing in an effort to get them to comply with the regimes I believed were
necessary. Though I tried to simplify the drug cocktails many of my elderly
patients had been placed on by doctors in the hospital system, I was a true believer
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in the merits of the medical discipline as I had been trained in it.

I later found that we doctors were not allowed to heal, or claim that we could heal.
We were only allowed to treat. If we didnt want to treat, thinking no treatment
was necessary, we faced, we were told in medical school, the spectre of litigation
by a hostile, increasingly litiginous public. I recall our single lecture on medical
ethics, given by a suave gentleman with (we were told breathlessly) both a medical
and a law degree. The professor, who went on to head a major medical insurance
company, told us how to avoid being sued, and stressed the importance of
protecting ourselves (when we graduated) with professional indemnity insurance.

Realistically, the paradigm shift necessary for the self proclaimed healing
profession to take even the first steps in using music therapeutically may be a long
time coming. Fortunately, music therapy does not require therapists or doctors.
One can self-medicate, though there are some risks in overdose, which I will
discuss later. First I will tell you something of my musical and medical
background, so you can decide whether to read on or look for a book about music
and the brain written by experts on the two subjects. I am neither a professional
musician nor a professional neuroscientist. And I must admit to have struggled to
understand both neurology and musicology.

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Getting my head around the brain

To say I had difficulty getting my head around the brain, as a medical student, is an
understatement. The brain is complicated, and I was not blessed with great powers
of 3-D visualisation, an essential mental faculty to understand the convoluted
structure of the organ, and the circuits that are created by bits of grey and white
matter with complicated and confusing Latin and English names.

At the beginning of the second year of our medical training we were introduced to
the large room in which we were to learn anatomy meaning, we were told, the
parts of the body. The course would be divided between lectures on surface
anatomy, which required us to strip down to our underwear or togs (as male and
female swim-wear is called in Australia) and deep anatomy, which meant the
anatomy of everything under the skin. Surface and deep anatomy comprised the
two branches of gross anatomy. What happened on a microscopic level the
structure of cells was covered by a different subject histology. The lessons in
surface anatomy would be conducted by the professor himself, who was graced
with a fine physique for a man of his age. This, we heard, was due to his regular
practice of calisthenics. He was not employed to teach calisthenics, though, so the
sinewy professor only shared with us basic information about important landmarks
on our scantily clad bodies. Those of us who were embarrassed about our bodies,
togs or both had difficulty concentrating on which bump meant what, or what it
was called, apart from the obvious ones that even little children know the names
of. We did learn the Latin names of important bony landmarks, including some on
the head; I retained the useful fact that the eye-brow ridge is delightfully called the
glabellum, but soon forgot most of what I crammed for the anatomy exams.

From the perspective I had at the time, real anatomy was the rest of the subject
what people look like on the insides. Surface anatomy was just that what was on
the surface. I was interested in what was hidden beneath the skin, but not prepared,
emotionally or intellectually, to cope with learning about deep anatomy by slowly
dissecting the left half of the head and neck of a dead man. The fact that this grisly
undertaking was to be conducted under the cold neon lights of the anatomy room
with its pungent smell of formalin added to the rapid loss of enthusiasm I suffered.
This was obviously shared by the young woman who was supposed to dissect the
right half of the dead mans face. She cut out a big chunk of the mans cheek and
parotid gland so she could dissect and display the facial nerve more carefully in the
comfort of home.

In the early nineteenth century, the so-called Continental style of learning

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anatomy favoured by the French professors required each medical student to have
his own cadaver to dissect. In 1980, when we Queensland medical students were
accorded the privilege of dissecting a precious cadaver the university could only
afford one body per six students. Accordingly, we had the choice of right or left
head and neck, thorax and upper limb, or abdomen and lower limb. I expected the
head and its contents to be more interesting than the limbs and trunk, though I soon
realised that dissection of the brain would not be part of my experience. I was
supposed to carefully dissect the muscles and nerves of the neck and face, and
demonstrate them to my five co-dissecting peers.

Despite my head start over the two thirds of medical students who did not get to
study first-hand the anatomy of the head and neck in a real (albeit dead) human
being I struggled to get my head around the brain. The anatomy room had several
formalin-filled steel vats containing dismembered limbs and chunks of human
torso with the muscles still attached to various bones by tendons with complex
origins and insertions that we were supposed to memorise, but no brains.
Muscles, joints and tendons are useful knowledge if one specializes as an
orthopaedic surgeon; they are not so helpful in understanding the brain, though
knowledge of muscle groups, how they work and how they can be improved is
certainly essential medical knowledge and does have relevance to the brain and to
music you cant sing, dance or play a musical instrument without muscles
contracting and relaxing.

Since brains could not be preserved in the cadavers at the St Lucia campus we
were not required, or allowed, to dissect human brains. I recall we had to cut up a
lambs brain - a couple of hours that demonstrated that these mammals also have
two cerebral hemispheres joined by a tract of white matter and an outer cortex
divided onto four lobes, like our own. We learned that this connection, the corpus
callosum, has also been severed in living humans as a last ditch treatment for
epilepsy. I didnt think then to wonder if the failed treatments that justified the
neurosurgery included music therapy. Had I done so, in the pre-digital age there
was no access to the scant international literature on the use of music to prevent
rather than cause seizures.

Most of the little brain anatomy I gathered as a student was from diagrams and
photos in textbooks. This was information largely devoid of historical perspective,
and with only cursory reference to the functions of the parts of the organ I learned
the names of. I also memorized the names of many structures the location of which
I was uncertain of, and became confused by a multiplicity of names for the same
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part of the brain, and the fact that there is academic disagreement about what sub-
structures should be included in various structures such as the limbic system,
thalamus and basal ganglia. These problems in understanding the brain plague
neuroscience students everywhere and are routinely mentioned in the opening
pages of many a neuroanatomy text. It is only recently, with access to the Internet
and research into the history of neuroscience research, that I have been able to start
finding my way around the brain.

My understanding of brain physiology was equally deficient, and remained poor

during the decade I worked as a family doctor, enthusiastically prescribing drugs
that are known to affect the brain. I was encouraged to remain ignorant of the
damage I was doing by the oft-repeated claim that no-one really understands the
brain, and the reassurances of my colleagues that though the mechanism of action
of various drugs I was prescribing were unclear, controlled studies and double-
blind trials had demonstrated they did, in fact, work. Such claims are made
frequently regarding two classes of drugs in particular psychiatric drugs and anti-
hypertensives. If I knew more about the anatomy and physiology of the brain I am
certain I would have used less drugs and more music in my clinical work as a
general practitioner.

Teaching medical students was and is the responsibility of various departments,

each a minor empire competing for funding and teaching hours the department of
anatomy, department of physiology, department of pharmacology, department of
medicine, department of surgery, department of psychiatry and department of
biochemistry were the most influential ones in terms of the medical curriculum.
The department of psychology, not being a member of the scientific faculties but
of the arts didnt get much of a look in. We also had some sociology lectures in
which we learnt the social prejudices of the time but little else. The faculty of
music (which now includes the music therapy department) was presumably
regarded as too obscure, not to mention geographically distant, to be granted
opportunities to teach medical students. Not that those in the music faculty at that
time would have had the first idea what to teach to two hundred and forty young
men and women inducted into reductionist, chemically dominated paradigm with
enough electricity thrown in to make sure we knew how to use, but not question to
deeply, the new diagnostic tests, tools and gadgets of the healing profession.

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A typically amusical medical training

The Australian medical education system is part of a global enterprise centred in

the universities in the worlds capital cities and what are called, in Australia and
elsewhere, teaching hospitals. There are several teaching hospitals in Brisbane,
all linked with the University of Queensland, the main campus of which is located
on a bend of the Brisbane river at St Lucia. The Medical School, however, is
located in the inner city suburb of Herston, directly adjoining the Royal Brisbane
Hospital, where I did my hospital training before leaving the hospital system to
pursue a career in family medicine.

In my post-graduate second year I enrolled in a program run by the Royal

Australian College of General Practitioners called the Family Medicine Program.
This involved a three-month term in the central Queensland town of Dalby. There I
learned how little my medical training, thus far, had prepared me for work as a GP
when people came to me asking what to do about such things as a painful back,
abdominal bloating, tiredness, dizziness or headache all common, often vague,
complaints that patients in the real world, rather than the insular hospital
environment, complain of.

Like other doctors, my medical education, in the hospital, and before that, at
university and school (in England, Sri Lanka and Australia) was piecemeal. In our
first three pre-clinical years at the St Lucia campus, we learned countless, poorly-
integrated facts about subjects divided (by department and discipline) into
physics, chemistry, mathematics (especially statistics and vectors), zoology,
parasitology, biochemistry, physiology, anatomy, endocrinology, embryology,
pharmacology and sociology. Once we moved to the Herston Medical School, for
the last three clinical years which included terms at various teaching hospitals,
we added to our confusion with terms in psychiatry, medicine, surgery,
orthopaedics, obstetrics and gynecology (but no term in mens health, despite half
of us being of that gender) and paediatrics.

When I studied medicine at Queensland Uni, it was under the old system. The
course was an undergraduate degree and most of us were 17 and 18-year olds fresh
out of high school. Our brains were sponges but largely devoid of scepticism
regarding what we were taught by lecturers and read in medical and scientific
journals and textbooks. The old medical course included more dedicated lectures
and tutorials in anatomy and physiology than today, when it has been replaced by a
shorter postgraduate degree, but the subjects were poorly integrated, in that
anatomy was taught separately from physiology and teaching of relevant
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knowledge in these disciplines was not synchronised. In other words, we might be

learning about the functions of the kidney in our physiology lectures, while
simultaneously trying to fill our heads with the location, name, size, shape and
connections of parts of the brain, while peering down the microscope and trying to
differentiate the mysteriously named Islets of Langerhans in the pancreas.

Our six-year course was divided into three pre-clinical years at the beautiful
sandstone campus by the Brisbane River at St Lucia followed by three clinical
years, when we were based in a dark old mansion building adjacent to the Royal
Brisbane Hospital in Herston, north of the city - the Medical School. During our
last three clinical years we were obliged to spend time in the wards and
basically do whatever we were told by the senior doctors who held teaching
positions in the public hospitals we were consigned to. None of them mentioned
music or used music in their clinical work and few told us anything of note about
the anatomy or physiology necessary to understand the neurophysiology of music
(or the mind-body relationship more broadly) we were expected to have already
been taught the necessary anatomy and physiology to serve as competent doctors
in our pre-clinical years.

Unfortunately, anatomy and physiology had been packed into a monstrously

demanding second year; a bombardment of information from prescribed reading
from (almost exclusively American) textbooks. We were expected to read,
understand, and remember copious data about bits of the body most of us were
hearing about for the first time. The bits of information were disconnected from
each other and from our previous experience as Australian teenagers. It was a
recipe for losing sight of the forest for the trees.

Teaching the neural processing of music would doubtless have made

neuroanatomy and neurophysiology more relevant and interesting, and might have
shaped a generation of doctors that used music clinically rather than resisting or
ignoring the healing powers of music.

Though I was not an especially conscientious student at university, I gathered some

general knowledge about zoology, parasitology, histology, physiology,
biochemistry, immunology, haematology, pharmacology and even a bit of physics.
This was mostly accurate information, absorbed from lectures, tutorials and
textbooks, and by looking at slices of various organs through microscopes. I also
gained what passed as an acceptable knowledge of human anatomy, but the
complex anatomy of the brain was beyond me. This remained the case till well
after I graduated, though when we were introduced to the dubious delights what

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was appropriately called gross anatomy in second year I was lucky enough to be
allowed to dissect the left side of the head (and neck, which came with the head)
rather than the chest and arm or abdomen and leg of the formalin-infused cadaver,
as was the fate of less fortunate students.

After three years post-graduate training at the Royal Brisbane and Royal
Childrens Hospital my knowledge of the brain had not progressed much, since I
was not given terms in adult or paediatric neurology, though I did acquire a
working grasp of what it meant to be a good doctor. You were supposed to
respect, or at least not publicly disagree with, your superiors, especially in the
presence of patients. You needed to keep up to date, meaning you read the
literature. When in doubt, refer to your senior. Also some practical wisdom
maintain a healthy respect for the wisdom and experience of the nursing staff, and
whatever you do, dont get the Matron offside.

The years I spent in the hospital system were exhausting. Every night I dreamt of
another day at work. As we rotated though different three month terms in
obstetrics, paediatrics, anaesthetics, orthopaedics, surgery, medicine, neonatology
and psychiatry my indoctrination into the medical so-called allopathic disease
model of the body and mind continued. By the time I left the hospital system to try
my hand at general practice all I knew how to do was to look for disease,
diagnose, prescribe and refer. The idea that physicians should heal was an
anachronism from the superstitious past. Bones can heal, drugs can heal, even
surgery can sometimes heal, but physicians must not aspire to healing. Sure, you
can reassure someone that they are not ill (as long as they are not, in fact, ill) but to
claim healing powers is dangerous territory for physicians in the modern era. To do
so means being branded as a charlatan, a religious fanatic or a madman. To claim
that music can heal is similarly anathema to those with vested interests in
expanding, rather than reducing, the market for treatment services. This market is
best served by incurable, chronic illness in more and more people. The last thing it
needs is cures. The profit-driven treatment industry is the natural enemy of free
treatments such as music, walking, gardening, conversation and play.

Things have changed since I was a medical student, but not necessarily in a healthy
direction. Music therapy and the large body of scientific literature relating to the
neuroscience of music continue to be ignored in Australian medical education.
Though the move to a post-graduate training in medicine might be expected to
produce more mature doctors, the entire education system, from primary school
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upwards, ensures induction into a chemical paradigm. This is encapsulated in the

axiom you are what you eat, which is in fact a false axiom. You are also what
you see, what you hear, what you feel and what you taste. All the senses are
bringing information and psychic energy into the body by means of the brain and
mind.

Brainwashed by drug propaganda

The holistic approach I have been exploring since 1995 when I began theorizing on
how what we see and hear affect us was destined to collide with the paradigm I had
been introduced to at the University of Queensland. After my graduation this
paradigm had been reinforced through cunningly disguised propaganda from drug
companies mental illness is caused by chemical imbalances in the brain.

This collision occurred only after many years in general practice during which I
liberally prescribed each new, improved antidepressant as it came on the market
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and was enthusiastically promoted by drug reps and independent medical experts.
I didnt know then that senior dons regard themselves as independent if they
dont favour one drug company over another. Promoting all drugs and accepting
bribes from every company offering one is routinely justified in this way.

My recognition of how seriously I had been brainwashed by drug companies was a

gradual process. I had always prided myself on being skeptical about drug reps
with their glossy cards with almost unreadable small print, offers of poorly
disguised bribes and sometimes grotesque gimmicks (One rep came into the room
dressed in a red suit carrying a fruit cake adorned with sparklers to celebrate the
anniversary of the anti-inflammatory drug Naprosyn - I had to ask him to leave
and take his fruit cake with him). I was doing general practice locums in Brisbane
during the scandalous promotion of the then new antihypertensive Capoten where
GPs prepared to start ten patients on the drug were given a computer to monitor
the clinical trial. They were allowed to keep the computer.

Though I recognized blindingly obvious drug company propaganda as such I

remained a true believer in the medical model I was trained in until my experience
as a family doctor at Willow Lodge Medical Centre in Melbournes outskirts. Over
a period of seven years, when I was in solo practice in what was generously (self-)
titled the Willow Lodge Mobile Home Village my skepticism about drug
companies and dismay at the nonchalance of my colleagues to what I saw as
serious corruption in our profession grew. Still, I continued prescribing
antidepressants, tranquillisers, antihypertensives, antibiotics and cholesterol
lowering drugs as I had been trained to, and neglected to ask people about the role
of music in their lives. Like most other doctors, even with a deep love of music, it
did not cross my mind, until the end of my time at Willow Lodge, to suggest
music-based treatments. When I did start using music as a therapeutic tool it was
occasionally and tentatively: mostly suggestions that my patients listen to music
they enjoyed to relax or if they suffered the common malady of boredom (which is
often misdiagnosed as depression and treated with antidepressant drugs rather
than interesting activities).

My medical practice was located in the building complex of the mobile home
village, and most of my patients came from the village of about 1000 people. Many
were elderly pensioners but I also looked after younger families who shared the
plight of being poor. Poor in financial terms, that is. Some of the people living in
the Willow Lodge Mobile Home Village had rich lives, full of friends, music and
laughter. Most did not, however. Most were financially, socially and educationally
impoverished; many were culturally impoverished, having spent every evening
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tuned to commercial TV for as long as they could remember. Inevitably the catchy
tunes they listened to were accompaniments to carefully edited visual stimuli
designed to make them buy things they did not need and could not afford.

Commercials exhorting my female patients to buy insurance, fast food and

fashionable shoes would wake them out of the trance of the soap operas they
discussed among themselves when they were fully awake. The music in the daily
daytime soapies, obligatory viewing for many of my female patients, was
designed to manipulate their emotions to raise their levels of excitement and
interest in the program. Too keep them wanting more:
Like sands through the hourglass
So are the Days of Our Lives

My male patients didnt watch the soapies. Those who did wouldnt admit it,
probably. Im not sure what the men who had retired did in the daytime; I do know
that many were plagued by chronic boredom. At night they sat in front of the
ubiquitous box with their wives if they were married or alone if they were not.
Many battled the urge to sneak out for a cigarette during the commercial breaks.
Before they ended up at Willow Lodge most of the men worked in factories the
fate of many European migrants during the years of the White Australia policy.
Some had also worked on the railways and dams. Some were war veterans and war
invalids from the First and Second world wars. Most had been smokers during
their working life but been told by one doctor or another that they should stop
smoking for their health. For many years this was one of my primary focuses in
preventive medicine frightening my patients into quitting.

I had other priorities as a family doctor, all embedded in my mind during my

medical training. I screened patients for high blood pressure, high cholesterol and
high blood glucose and treated hypertension, hypercholesterolaemia and
hyperglycaemia with a combination of diet, exercise and drugs. Though I
recognized these problems can be aggravated by stress and understood some of the
physiological mechanisms for this, my training had been hopelessly inadequate
when it came to identifying the causes of stress and advising my patients what they
could do to about it.

My medical practice was busy, and though I tried to do preventive medicine this,
in the paradigm in which I was trained, meant promoting immunization, regular
screening for various cancers, and reducing cardiovascular risk factors meaning
obesity, high blood pressure, high LDL cholesterol and triglycerides, cigarette
smoking and high blood sugar. I advised patients to reduce their saturated fat
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intake and increase the fish, whole-meal cereals, fruit and vegetables in their diet
and to walk more. But as for stress, a hidden killer when it comes to heart disease
(partly because physiologically the stress response raises blood lipids, pressure and
glucose) like many doctors I placed it in the too hard basket. How do you reduce
the stress of being lonely, bored, impoverished, illiterate, insecure or worried about
your children?

The main priority for any General Practitioner is to diagnose and treat what is
called the presenting complaint. Patients do not often ask for advice about
maintaining long-term health. Mostly they come to see the doctor because they
think they may be ill, because they have been injured or because they need a
script. Many medical consultations in Australian suburban general practice are for
repeat scripts.

It is the job of a good family doctor to make sure that any script requested is
actually needed. It is also their responsibility to warn their patients about risks,
dangers and known toxic effects of any drug (or immunization) they prescribe. I
took the first of these professional obligations more seriously than the second.
Frequently I would advise that patients did not need antibiotics for what I knew
was a viral infection, and tried to teach simple relaxation exercises to get to sleep
rather than prescribe the frequently-requested sleeping tablets. When it came to
risks and dangers, though, I minimized them. I mimimised them in my own mind
and I didnt share even what I did know for fear that the patients would not comply
with the treatment. This attitude had been instilled in my training. I remember
being told that if patients knew all the prescribing information about a drug
theres no way theyd take them. It was a condescending attitude that we wise
medicos could understand how low these risks were, or at least that they were risks
worth taking, while the lay public (however well educated) would get confused
by the details. In fact, it was we who were confused.

After I gained more clinical competence and confidence I refused more scripts, and
tried to simplify the often complex drug regimes my elderly patients had last been
discharged from hospital on, but taking patients off drugs is a political process and
needs to be done diplomatically. Most doctors, especially if they are specialists in
their field, do not like hearing that another doctor has taken their patient off a
drug they had deemed necessary in their clinical judgment. Unfortunately doctors
with drugs are like politicians with laws more keen to introduce new ones than
get rid of old, useless ones.

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Three medical problems dominated my thinking in my clinical work at Willow

Lodge. These were cardiovascular risk factors (with the slogan heart disease is the
biggest killer in Australia ringing in my ears); investigating for and excluding
cancer (a medical obsession since Nixons War on Cancer) and what has been
recently described as another hidden killer- obesity. These priorities were a
reflection of how I was taught to look after an ageing population in my training.
As the years went by I fell under the spell of what later evolved (or degenerated)
into the National Depression Initiative, convincing myself that more and more of
my patients were depressed and therefore in need of antidepressant drugs.

In Australia the Pharmaceutical Benefits Scheme (PBS) ensures that the public
pays for the essential drugs individuals cant afford. Pensioners pay a small
fraction of what the drug companies receive the PBS pays the rest. This is, I
believe, a good thing. What is not so good is that the biggest drains on the public
pharmaceutical budget in Australia, namely hypertension, hypercholesterolaemia
and depression have long been amenable to music therapy, but music is rarely
suggested by doctors, because it is not a medical treatment.

An Anthropologist from Mars opens my eyes and ears

In early 1995 I bought a book that had a profound effect on my thinking about
neurology, psychology and psychiatry Oliver Sacks An Anthropologist from
Mars. The case studies in this book were interesting but it was the drawings that
led to a paradigm shift in my thinking these were done not by the famous
neurologist but by his patients. There were several by two children diagnosed as
autistic so called idiot savants. These children were capable of amazingly
accurate drawings of things they were looking at, or they had seen and
remembered, yet were deficient in other areas of their mental and social
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development.

I knew little about autism until I read Oliver Sacks book. I had heard about
autism, of course, in my medical studies and been told that the condition was
thought to be related to schizophrenia in that many autistic children develop
schizophrenia later in life. The condition was said to be rare. Children with
autism, we were told, are unable to form normal emotional connections with
others, including their parents, and do not play with other children. The fact that
these children typically develop minimal eye contact with others was also
mentioned, but I did not then recognize the relationship between eye contact, trust
and confidence.

After I had read Oliver Sacks accounts of patients with autism I read the section
on mental illness in the paediatric text I had bought when I was a registrar at the
Royal Childrens Hospital in Brisbane, back in 1986. Nelsons Textbook of
Pediatrics suggested that children with autism present major behavioural problems
and that these were usually managed with benzodiazepine tranquillisers and major
tranquillisers (which were also called neuroleptics or antipsychotics but were
all, in those days, dopamine-blocking drugs).

I was shocked to read this, since I had assumed that music and art therapy would
have played a central role in management of children who often had remarkable
musical and artistic sensitivity and ability. To my surprise there was no mention of
art and music therapy in this book at all, as far as I could see, and the same was the
case in other medical and psychiatric textbooks in my library. I went out later to
the University bookshops in Monash University and the University of Melbourne
and found the same to be the case with current textbooks.

For many years I had regarded eye-contact as a central aspect of good

communication, not least because I had difficulty with eye contact as a child. This
problem came to my conscious awareness only after I came to Australia (aged 15)
and resolved as I emerged from adolescence. Between the ages of 10 and 15 I was
unable to maintain eye contact (or often even achieve it temporarily) with any
unfamiliar adult. I would often cover my face with my hand when confronted with
an adult I did not know.

It was only in my late teens that I started developing good eye contact with others
and it dawned on me that I had been missing the subtle nuances of what people
meant until then. In fact I remember, as a medical student, feeling that other people
did not seem as real as myself. I had difficulty empathising with others until I
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developed eye contact with them. Once I did, my empathy has kept growing. It is
no exaggeration that the eyes are the windows of the soul they are the only part
of the brain we can observe directly when talking (or listening) to someone.

It seemed obvious, from analyzing my own difficulty with eye contact as a child,
that the problem was directly related to self-confidence. The lack of eye contact
was fear-related, in other words. As my fear of adults diminished with age, my
ability to gain and maintain eye contact with them improved considerably. It is a
common observation that children avert their eyes when admonished, and I
couldnt see how the medical professions experts in child health could fail to
focus on strategies to improve eye contact in children who were being diagnosed as
having Autistic Spectrum Disorders and Aspergers Syndrome partly, or
largely, as a consequence of reduced eye contact.

Autism is one condition in which the use of music therapy is well established,
despite such treatment not being mentioned in Nelsons Textbook of Pediatrics.
Had I known where to look I might have realized that my insights that music might
be used to establish trust, communication and eye contact in children who have
been labeled with autism (and related disorders) had occurred in the minds of
many others. Therapy tapping into the improvisational abilities of children was
already well established in many parts of the Western world in 1995. In the rest of
the world, children were rarely labeled with autistic spectrum disorders in the first
place.

As a suburban general practitioner caring for a mainly elderly population, I had no

clinical experience of autism or Aspergers syndrome. I did not question the
application of such labels until some years later, when it was clear that the terms
were being applied to more and more children with less and less reason. When I
began developing ideas about non-drug management of autism it was within a
broader context of facilitating health by encouraging what I regarded as universal
instincts for communication, curiosity and play. This was one aspect of an
integrated theory of motivation that got me into a lot of trouble.

The model I began developing in early 1995 postulated that our behaviour is the
consequence of an interplay between three factors the terms I used were
instincts, conditioning (by which I meant all environmental influences) and
will. Regarding volition or will, though I have sometimes used the term free
will in the past, this phrase can be confusing. The decisions we make are generally
based on a choice between alternatives and these alternatives are profoundly
shaped by our experiences, including our formal education and broader learning
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experiences (from family and friends, books and magazines, television and movies
etc, not to mention the increasingly pervasive influence of the Internet). In that
sense the decisions we make to perform (or not perform) various actions are never
completely free. At the same time it escapes the attention of many who learn that
our behaviour is based on the interplay of (only) nature and nurture that this
dichotomy ignores the possibility of free will, and relegates us to automatons. It
also makes a mockery of the legal system, which assumes intent, volition and will
and the personal and moral responsibility consequent of decisions we make of
our own free will.

Debate between various schools of thought in philosophy on the existence or

otherwise of free will has continued, unabated, for thousands of years, and I do not
hope to resolve the issue to the satisfaction of hard determinists. I do hope to
raise awareness of the importance of the matter of (fairly free) will as it relates to
promotion of physical and mental health, noting that to believe in predestination is
disempowering, to say the least.

Many opinions expressed in my theory of human motivation might appear obvious

and self-evident to the lay reader. They are commonsense, including much of my
thinking about instincts and conditioning. The idea that communication, curiosity
and play are instinctual is such an opinion, along with instincts that I have
proposed for dancing, walking, listening and looking.

When I started thinking seriously about how the brain worked I was particularly
interested in the development of aesthetic appreciation in the visual and auditory
senses. It is obvious that humans and other primates are especially strongly
affected by what we see and hear; this makes beautiful visual and auditory stimuli
obvious choices as therapeutic tools to improve health of the mind. In both areas I
analysed my own changes and this contributed to theories on how appreciation of
auditory and visual experiences, including music, can grow through life. I was
keen to develop strategies to use light (and colour) as well as music to improve my
own health and the health of others. This has proved an enduring quest.

Though subjective self-analysis is not generally regarded (these days) as a means

of legitimate scientific inquiry, I must admit to having analysed my own behaviour
and motives, over the years, in an effort to develop an integrated model of the brain
and mind. In addition to the findings of scientific researchers, I have also drawn
on the opinions of other writers, including philosophers, poets and songwriters in
an effort to understand the complex thinking and motivations of others. Often
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greater wisdom is contained within the lyrics of thoughtful songwriters than the
convoluted, counter-intuitive arguments and false paradoxes philosophers tend to
delight in.

In addition to analyzing my own aesthetic I have discussed musical taste with

many people. Some of these have been musicians, others have not. I have found,
over the years, that I share the musical taste of some and not others. Most often I
like some of their favourite music but am indifferent to, or dislike, other pieces,
depending on several factors (including the music genre I am especially left cold
by opera and country and western music). In this I am like most people I have
unique taste in music, just as I have had unique musical experiences. This is a
problem when trying to make generalizations about musical aesthetic and taste
from ones own, and contributes to difficulties when trying to look scientifically at
how the human brain and mind process music. Differences in taste also mean that
music that is therapeutic for one person is not necessary health-promoting in
another.

When I began theorizing on the mind, brain and body, I tried to integrate what I
had learned in university with what I had discovered during my years in general
practice and what I had observed in my family, friends, acquaintances and myself.
The result was a model of motivation that got me formally certified as insane.

The first of many commitments

On the night of April 7, 1995, I was committed for the first time. I was 34 years
old, and had been working as a doctor since I graduated at the University of
Queensland in 1983. At about 9.00 p.m. that night I was handcuffed in my home,
marched to a police car by two burly white men and driven, protesting loudly, to
Meduna Ward at the Royal Park Hospital. Having moved to Melbourne from
Brisbane, where I studied medicine, I didnt know anything about the Victorian
psychiatric system. Not its history, nor its politics. I was soon to find out about the
latter. The hard way.

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Three weeks earlier I had been surprised to find two men, one in a remarkably
garish shirt buttoned to the top, but without a tie (a commoner sight in the mid 80s
than the mid-90s) standing outside the dark entrance to the flat I was renting in St
Kildas Fitzroy Street. I thought they might be Jehovahs Witnesses trying to sell
me their Watchtower magazine, but I was told by the man in the gaudy shirt that he
was a doctor Im Doctor Barrett. Weve been sent to see if you are alright.
Were with the CAT team.

I had never heard of CAT teams, other than teams of burglars with feline stealth,
but recognised the name Rajan Thomas, the psychiatrist who had sent them to visit
me. My mother had told me that one of my fathers friends who was working as a
de-facto psychiatrist in Melbourne knew an Indian psychiatrist who might be
interested in my theories on autism, aesthetic and motivation. This wise doctor, I
gathered, was working at the Junction Clinic, just up the road from where I was
living, and maybe Id like to discuss my work with him?

It was some years before I discovered the truth about what transpired in March and
April 1995, after some of the relevant correspondence and medical records were
released to me under FOI (Freedom of Information) laws. Though I havent had
the time or inclination to read the copious notes in every detail, I have been able to
piece together a much clearer picture of what various doctors thought about my
supposed madness, and what they proposed to do about it.

For Dr Rajan Thomas the important question, posed by my family (according to

his notes) was whether or not I could be sectioned. This is what he wrote a
couple of weeks before he committed me for treatment:

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No hallucination
The theory of motivation
producing movement causes
improvement in mental illness
Grandise in his thinking
No other abnormality
Acknowledges that he was excited
about this theory But denies that he
is ill
? Is he sectionable

Family wants to section

him and treat him

? not sure whether he

could be sectioned at
present

To get second (written as

IInd) opinion from Dr Sacks

Unsure if I could be legally sectioned (detained involuntarily) Dr Thomas sought

a second opinion from Dr Toby Sacks, who was director of the psychiatric
outpatient clinic. I was delighted, at the time, to have an opportunity to discuss my
ideas with Dr Sacks (I didnt know the issue to be addressed was whether or not I
could be sectioned). The reason for my excitement was Dr Thomass surprising
revelation that Toby Sacks was a nephew of the famous neurologist Oliver Sacks.
It was Oliver Sacks bestseller The Man Who Mistook His Wife for a Hat that
sparked my interest in the mysteries of neurology, and his intriguing An
Anthropologist from Mars that prompted me to develop my own theories on the

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causation of autism and how it could be treated by art and music therapy.

I liked Toby Sacks, and found I could develop reasonable rapport with him. Mind
you, I was trying to discuss my work, while he was trying to diagnose me. This is
what he wrote after our meeting, in elegant fountain pen:

There is currently no evidence of

flight of ideas, pressure of speech,
risk-taking behaviour or
impulsivity in his actions.
Throughout the interview he
remained calm, cooperative & was
able to establish good rapport.
Affect was reactive and generally
appropriate.

Dr Sacks did not understand my theory of motivation either. He wasnt interested

in understanding it. He was only concerned with how strongly I held my opinions,
not what, exactly, they were. Hence his odd assessment of my theory that we
humans are motivated by social instincts for communication, curiosity and play (in
addition to others):

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The overvalued ideas/hypotheses about behaviours, mood etc. are strongly

held, but not with delusional conviction.

Consequently, Dr Sacks did not think I could be legally sectioned. As for me,
never crossed my mind that believing communication, curiosity and play are
instinctual was controversial, let alone a scientific heresy. I discovered, some years
later, that any original theory is delusional by the standard psychiatric definition
that delusions are beliefs inconsistent with ones culture and education. Also, what
is rated as delusional is not the craziness of the supposedly unusual thoughts but
how strongly they are held.

Rajan Thomas had been called upon to assess the state of my mind by my
concerned medical family when I started claiming to have had insights about how
what I assumed to be instincts for communication, curiosity and play could be used
to treat autism, dementia, depression and schizophrenia. To be fair, this was a big
claim, appearing somewhat grandiose unless I was listened to carefully. I wasnt
claiming these conditions could be cured just that facilitating learning and
integration of existing factual knowledge could be achieved by encouraging these
instincts.

In the model I was developing I integrated some of the ideas popularised by

Sigmund Freud, such as subconscious aspects of thinking and the so called
pleasure principle (organisms are motivated to seek pleasure and avoid pain). It
seemed logical that we experience pleasure when our instinctual needs are met. I
rejected, though, Freuds model of superego, ego and id, which I had been
introduced to at university. I never quite understood his idea that instinctual drives
can be simplified to a conflict between eros and thanatos. I rejected entirely, like
most others of my generation, his grotesque claims of penis envy in girls and that
most adult psychopathology can be attributed to the thwarting of infantile sexual
fantasies. To be frank, Ive always thought Freud to be pretty weird.

Though it is obvious that humans have sexual and territorial instincts as well as
instincts for seeking food, drink and shelter, it was not these that I focused on when
developing my own model of motivation. That communication, curiosity and play
are instincts came to me as an insight after spending some hours painting with my
then two-year-old daughter. It was obvious to me that curiosity is seen in young
mammals and birds as much as in humans, but also that maxims like curiosity
killed the cat might well kill curiosity in our children. The attitudes of my own
teachers in secondary school were not exactly encouraging of curiosity, especially
if it was outside the interests or expertise of the teacher. I felt that suppression of
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natural (instinctual) curiosity by our educational system and society may have been
contributing to the depression and dementia that I was reading were reaching
epidemic proportions.

In line with my training my initial models of motivation were focused on

chemicals specifically the well-known neurotransmitters dopamine, noradrenalin
and serotonin. Equally in line with my training, I knew far less about the parts of
the brain I was theorising about than I might have with a broader and more
thorough education in the neurosciences.

Among the FOI documents from the Alfred Hospital, I found the following page
on which is a diagram I drew on Junction Clinic (Heath Department) stationary
when trying to explain the outline of my theory of motivation to the psychiatrist,
Rajan Thomas.

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Unfortunately, despite my best attempts, the psychiatrist (according to his notes)

gathered only that I was arguing that producing movement causes improvement in
mental illness. I had hoped hed understand a bit more of my theory than that!

For those having difficulty understanding the model I was trying to explain when I
drew this diagram, the illustration is the outline of a brain indicating forebrain,
midbrain and hindbrain. What I was calling midbrain was what I thought was the
main site of production of the neurotransmitters serotonin, dopamine, noradrenalin
(written as NA) and acetyl choline (Ach). These are the main neurotransmitters
affected by psychiatric drugs and I was trying to build on what I assumed was
common knowledge for psychiatrists. With the exception of acetyl choline, these
neurotransmitters are mainly produced in areas of the midbrain. But the model is
seriously flawed, as I will explain.

The square box in the middle of the page is where my argument began.
Subconsciously, I theorised to Dr Thomas, we have a instincts to seek new
experiences from which we can learn curiosity and develop new skills. This
drive to seek new experiences contributes to the development of discrimination in
our various senses and the development of aesthetic appreciation in the different
elements of what we see and hear (including line, form, composition and colour in
visual art and melody, harmony, rhythm, timbre in music). I argued that increased
discrimination resulting from greater exposure shaped the development of aesthetic
pleasure in the respective sense. I regarded our instinct for play as a means of
acquiring and practising new skills; this could be expressed by playing musical
instruments with more pleasure and less risk than various competitive sports,
especially contact sports which are so popular in Australia and cricket, a game in
which, my experiences at school taught me, the ball is dangerously hard. We also
have instincts for communication, resulting in pleasure when we are successful in
communicating honestly with people.

I elaborated on the drive for movement meaning all volitional actions

suggesting that the subconscious instincts we have for communication, curiosity
and play might be mediated by activity of the neurotransmitter dopamine in the
basal ganglia (indicated as BG in the diagram). This was one of many areas of
contention in my evolving theory, and as you will see in later chapters my ideas
about the basal ganglia and their role in motivation, emotion and music have
changed considerably since I found out more about this interesting collection of
nuclei in the core of the brain.

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I drew the arrow from the midbrain (highlighted in a box on the right of the
diagram) to the word subconscious trying to explain my theory that we have
instincts to integrate experientially-acquired knowledge and to communicate what
we have discovered. This was where I (perhaps mistakenly) thought integrating
knowledge after seeking it (using the instinct of curiosity) may work as a cure for
schizophrenia. I now think integrating knowledge (as long as it is genuine factual
knowledge) is a cure for delusions, but not for schizophrenia if the term is being
used to describe people who experience auditory hallucinations rather than solely
because of (supposed) delusions. My present belief is that the term schizophrenia
should be dropped by the medical profession as a stigmatising and unhelpful
misnomer with no more scientific credibility than the rest of the now discredited
pseudoscience of phrenology. Back in 1995, when I began theorising on autism
and schizophrenia, I believed, as I had been taught, that these were the
consequence of subtle brain abnormalities that they were diseases of the brain
rather than labels of behaviour. I had read, though, about plasticity in the brain and
believed that our actions, and thereby what we saw and heard, what we looked at
and listened to, what we did with our hands, feet and mouths, could shape the
connections the wiring in the brain, not just in childhood but throughout life.

At the time I regarded communication, curiosity and play as (subconscious)

instincts generated by the midbrain, whereas I regarded will (by which I meant
volition), memories and wakening consciousness as generated by the cortex. This
is contentious to say the least, but not the reason I was suspected of being mentally
ill. My subsequent diagnosis of mental illness was not the consequence, either, of
the neologism I created for this model of bestial drives emanating from what I
mistakenly labelled as rhinencephalon (rather than hindbrain or
rhombencephalon, which is what I meant). This first attempt at a model integrating
neurochemistry, neurophysiology, neuroanatomy and an original health
psychology was full of holes, including the idea that the hindbrain is more
responsible than higher parts of the brain for sexual, territorial and basic drives
for food, drink and shelter (what I was calling bestial drives because they are
shared by other beasts, not because they are bad).

Ironically my concept of bestial drives (which I dropped after a few weeks of

toying with the idea) was the only bit of my theory of interest when I foolishly
tried to discuss my ideas with an eminent professor at the University of Melbourne
before I was committed.

I had read Derek Dentons new book about the progress being made in
understanding the brain, The Pinnacle of Life, and was delighted that the
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physiology professor was prepared to give me an hour of his time. This was about
around the same time as my first meeting with the psychiatrist Rajan Thomas, in
March 1995.

I made my way to the Howard Florey Institute, where Professor Denton conducted
his research on brain physiology. I was discouraged by the strong smell of
experimental animals, but steeled myself and walked up the stairs to the small,
dark office in which the aged professor sat behind a large paper-covered desk. I
was intimidated, not having an academic background and, after introducing myself,
proceeded to blurt out my ideas about instincts for communication, curiosity and
play and how these might relate to motivation and development of the human
aesthetic in vision and hearing. I tried to outline the model I was developing, but
without the assistance of a piece of paper and pen to draw diagrams, I was doomed
to failure. Much to my disappointment, after twenty minutes or so of listening to
my babble, Professor Denton closed his eyes and appeared to be asleep.

Trying not to take it personally, I continued to explain that I did acknowledge we

have basic homeostatic drives as well, and instincts for seeking sex, food, shelter
and territory. I told the professor I was terming these basic drives bestial drives,
and thought they could be equated with the hindbrain. He pricked up his ears at
last. I like that term, bestial drives. But frankly doctor, if you could come up
with a proper definition of consciousness, youd be able to get a grant straight
away. I didnt know what to make of this statement, and soon my time was up.
Professor Denton didnt indicate he wanted to meet me again, and Im not
surprised. I must have sounded like a raving madman to him.

When I prepared myself to meet Professor Denton I resolved to discuss with him
my developing ideas about a network of neurons known to be involved in the state
of consciousness of all vertebrates the reticular activating system (RAS). This
network of nerve cells, centred in the brainstem, has long been known to release
the neurotransmitter noradrenalin (NA) at its synapses. True to its name the long
axons of the RAS form a network throughout the brain, regulating the level of
consciousness, meaning states of wakefulness, sleep and unconsciousness
(meaning coma rather than physiological sleep). This was ascertained many
decades ago by unpleasant experiments on cats. In the behaviourist experimental
neuroscience tradition, the brainstem was sectioned at different levels. It was
found that cats were rendered comatose or constantly wakeful depending on the
level of the section. The reticular activating system, noradrenalin and their role in
consciousness was mentioned in The Pinnacle of Life, so I thought this structure
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would be a good place to start my planned discussion with Professor Denton.

Ignorant of the way research is funded in Australia, I had hoped the professor
would assist me to get a grant to study and integrate scientific discoveries about
the RAS with the objective of knowledge for the sake of knowledge. I did have
some ideas about how this knowledge could be used therapeutically, though. I had
tried to explain this to the psychiatrist Rajan Thomas, with even less success (RAS
is circled directly below midbrain in the diagram I drew when trying to explain
my model of motivation to him).

My logic went like this. It has been known for fifty years or more that the
neurotransmitter noradrenaline is synthesized in neurons from dopamine, and that
dopamine also acts as a neurotransmitter in specific areas of the brain. Well known
sites of dopaminergic activity were, according to what I had read, the basal
ganglia and the limbic system. The latter was said to be the emotional circuitry
in the brain.

It is obvious that emotions play an important role in motivation. If dopamine is an

important neurotransmitter in both the limbic system and basal ganglia, which I
equated with subconscious urges for movement, could this provide a
neurobiochemical link between emotions and instinctual urges (or drives) for
movement? Since the expression of instincts for communication, curiosity and play
as behaviour requires movement, does this not suggest the dopaminergic circuits
in the basal ganglia and limbic system are involved in our instinctual behavior?
Since dopamine is converted to noradrenaline and the latter neurotransmitter is
released throughout the brain at the synapses of the RAS, does this explain the
mechanism of action of the tricyclic antidepressants, which were said to increase
noradrenaline levels in the brain?

I had been taught about the basal ganglia at university and its known role in
Parkinsons disease, where there is a depletion of nerve cells that produce
dopamine in a structure within the basal ganglia called the substantia nigra, the
black substance in Latin. The substantia nigra is so named because the nerve
cells are pigmented with a variation of the black pigment found in the skin, iris and
retina, melanin. I knew that DOPA, the chemical precursor of dopamine (and
therefore of noradrenalin and adrenalin which is synthesized from NA) is a
constituent molecule of melanin. I also knew that melanocyte stimulating hormone
(MSH), one of several important hormones secreted by the pituitary gland, controls
the synthesis of melanin in both the skin and the brain.
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The effects of blocking receptors for the neurotransmitter dopamine in the basal
ganglia were said to be responsible for the common side-effect of Parkinsonism
an iatrogenic (treatment-induced) disease caused by what were then called major
tranquillisers or neuroleptics but are now usually described as the old anti-
psychotic drugs. Sometimes the word terrible or notorious is used. When I
studied psychiatry in the horrible days before the new generation of anti-psychotic
and anti-depressant drugs, it was usual to see people young and old, shuffling
around the locked wards with Parkinsonism. Medical residents and students
callously called it the Modecate Shuffle.

Treatment for the Modecate Shuffle and other so-called extra-pyramidal side-
effects (abbreviated to EPSE in medical jargon) was to offer the patient Cogentin
or Artane in tablet or injection form. These are drugs developed for the treatment
of (idiopathic) Parkinsons Disease and are less effective in relieving drug-induced
Parkinsonism, which though it shares features of stiffness with the former,
idiopathic disease, is significantly different in cause and symptoms. One difference
is the accompaniment in drug-induced EPSE of a distressing muscular restlessness
called akathesia. This unpleasant effect of dopamine blocking drugs is not found
in idiopathic Parkinsons Disease and does not respond to the anti-Parkinsonian
drugs we were taught to offer our patients if they complained about the anti-
psychotic drugs we were convinced they needed to get well. If the patient did
not want the tablets, theyd be told they had to put up with the symptoms. They
were never warned about the known risk of long-term, permanent brain damage
from these drugs. This is a grotesque neurological disorder known as Tardive
Dyskinesia (TD).

The big claim of the manufacturers of the new generation of antipsychotic drugs is
that they produce less risk of patients developing tardive dyskinesia, which is now
generally accepted as being caused by non-selective blockade of dopamine
receptors. Over the years, this being a major area of pharmaceutical interest, many
different types and subtypes of dopamine receptor (named D1, D2, D3..etc) have
been discovered. Their distribution is complex and varies considerably in different
parts of the brain (ranging from none in some areas to most neurons in others). The
distribution of dopamine receptors in the basal ganglia is complex as is the
cytoarchitecture and gross morphology of the structure. Claims to be more
selective, blocking some types of receptors and not others, and therefore less likely
to cause adverse effects has been a repeated claim with the launch of new
antipsychotics since the 1950s and the development of atypical drugs. Always the
new atypical drug is more expensive and often, but not always, they are less toxic
than the original typical dopamine-blocking antipsychotic drug chlorpromazine
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(Largactil).

I did not know much about the cell types in the brain, nor its internal structure
when I discovered the importance of the RAS. My knowledge of
neurobiochemistry was rudimentary and inaccurate in many respects and I had
only a vague idea about the shape and location of the basal ganglia, limbic system,
thalamus and midbrain, brain structures I was reading about when trying to
understand how the reticular activating system was connected to the rest of the
brain. This diagram I drew in February 1995 shows the philosophical,
psychological and biochemical morass I found myself in when I tried to integrate
what I was learning:

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When I went to see Professor Denton I was particularly interested in what role the
RAS might play in the known pharmacology of a large class of drugs that I
prescribed frequently tricyclic anti-depressants. Though for many years I had
convinced my patients to take these drugs, it slowly dawned on me that they often
caused more problems than they cured. In fact, they didnt cure anyone, and
eventually killed one of my favourite patients.

Shirley was in her seventies and had been one of the first patients to trust the new
doctor at Willow Lodge Medical Centre when I began working there in 1988. She
was obviously miserable and came to me asking for valium and sleepers. She
lived in a small mobile home, alone. She had a dry sense of humour and that
delightful frankness so common in people of her generation. Over the years I
enjoyed conversations/consultations with her in which we discussed things ranging
from the weather and whats on TV to the local politics of Willow Lodge. She was
reluctant to discuss her family, but I gathered she had a son who never visited her.
With hindsight I can see that the one thing she needed to discuss her family
was the one she avoided discussing with me or anyone else.

In line with my training I convinced Shirley that she should try an antidepressant,
of which the safest and most effective were the tricyclic antidepressants (this was
before Prozac and other SSRI drugs). I wrote a script for Prothiaden, since the drug
rep from Boots and my father, who is still an enthusiastic prescriber of
antidepressants, had convinced me that this drug boasted advantages over the
older antidepressants. Specifically, it was available in both 25 and 75 milligram
tablets and could be taken in a single dose at night. The big advantage, Id been
told, was that it had a mild hypnotic effect, so it could double as a sleeping tablet.
The down side was, like other tricyclics it was prone to causing abnormal rhythms
in the heart, and could be lethal in overdose. It could also cause weight gain,
fatigue, impotence and a range of other side-effects and it was stressed in our
medical training and by the medical literature GPs are inundated with, that patients
should be warned that all antidepressant drugs take 6 weeks to start working.
This was regarded as essential information to ensure compliance with a drug that
started off making them feel worse than they felt when they came to see the doctor.

My strongest motivation in weaning patients off valium and other benzodiazepine

drugs was the knowledge that they are highly addictive, and that ruthless
promotion of valium as the housewifes panacea in the 1960s had resulted in a
generation of Australian women addicted to what were called minor
tranquillisers. During my years at Willow Lodge I became increasingly disturbed
by the number of patients who were addicted to Valium and Serepax, popping a
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pill whenever they felt anxious. Many of these patients were convinced to try and
wean off the drugs when I explained that the withdrawal symptoms of Valium
were identical to the anxiety they thought they were treating.

Unfortunately, rather than teaching other ways they could relax I tended to start
them on what I regarded as a non-addictive alternative. This meant Prothiaden or
another of the cornucopia of antidepressants advertised in MIMS. I did have the
alternative of referring the patient to a psychiatrist or a psychologist to try and
change their patterns of thinking. I did refer a few patients to both species of
mental health specialist.

In Australia, the universal Medicare system provides the same protection for the
poor and disabled as the Pharmaceutical Benefits Scheme (PBS). When I was
working with the impoverished residents of Willow Lodge, few of my patients had
private insurance with the extras required to claim the cost of psychology
consultations. They could see one of several psychiatrists who, being medical
doctors, could bulk bill them, as I did. These economic considerations were of
prime importance in determining who I referred my patients to, and one of the
reasons the style of medicine I practiced and participated in was as drug-oriented
as it was. Inevitably, the psychiatrists I referred patients to were even more keen to
prescribe drugs than I was.

After several years on Prothiaden, during which she reported feeling mostly
better and sometimes worse in response to my superficial questioning about the
depressive illness she and I were convinced she suffered from, Shirley committed
suicide. The coroners report confirmed my fear that she had taken a whole packet
of 75 mg tablets at once. I never found out what had caused the misery that had
etched deep, sad lines on her face when I first started giving her medical advice to
the best of my knowledge and ability.

This death of a patient I had thought I had known for many years disturbed me
deeply and prompted me to question my counseling ability with good reason. It
was obvious that my medical ability which was a source of pride to me at the time,
had failed. Shirley had killed herself with the drug I had convinced her to take after
she came to me for help. I had diagnosed her sadness as depression, but I had
failed to understand what motivated her, what interested her, what she loved.

Love is a word that was not used in medicine, even in psychiatry as I was taught it.
Yet it is obvious that love is all-important in human life, and the lives of other
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animals. There would be no great literature, music or art without love passion for
their work by those who create it. There would be no families, no children and no
motivation to procreate. Love, in my model of motivation, is a vital emotion. I now
think I was wrong love is much more than an emotion, and there is nothing
wrong with emotionless love.

It was obvious that Shirley suffered from a lack of love. She had few friends and
rarely had anything nice to say about anyone. Her sarcastic wit was, in fact, one of
her charms. She was also very resistant to change, and like many of my elderly
patients regarded herself as too old to change or learn anything new. This was a
common protestation at my tentative suggestions my patients learn simple muscle
relaxation techniques I used successfully myself on the rare occasions I had
difficulty falling asleep. My therapeutic armoury was limited to drugs and a few
tips on natural methods I had gathered over the years from sources outside the
medical establishment.

In my search for a more holistic model of the brain and mind, I knew I could not
ignore love. But how does one study love scientifically? What part of the brain is
responsible for love? What is love, exactly?

The dangerous territory of love

The scientific study of (what was purported to be, and advertised as) love has an
ugly history. These included the grotesque experiments of Harry Harlow in the
1960s, who pioneered attachment theory by giving baby rhesus monkeys the
choice of two surrogate mothers. One was made of mesh, with a scary metal face,
and the other was softer, made of toweling, and had a less unpleasant artificial
head. The good (toweling) mother was more cuddly and did not have the capacity
of the bad (metal) mother of suddenly hitting or otherwise traumatising the baby
monkeys. Harry Harlow promoted this cruelty as research into love, coming up
with the startling observation that the tortured infant monkeys developed long-term
neurotic behavior and that they preferred to clutch the softer, gentler, terry-
toweling mother than the metal mother, even if the monstrous contraption
provided the milk the infant monkeys needed.

This was an example of research into love during the long era of behaviourism
in experimental psychology. Professor Denton was, from what I read in The
Pinnacle of Life, thinking entirely within a behaviourist paradigm. His book was an
exploration of the brain and mind, but what he called physiology of the brain was
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exclusively what had been ascertained from animal studies. I knew that talking
about love and instincts I believed (and still believe) we have for seeking love
needed to be couched in more scientific terms. So, as I had done when I tried to
discuss my model of motivation to Dr Thomas the psychiatrist, I left love out it.

In the weeks before my commitment I drew several diagrams and pages of

handwritten flows of thought. Many of these were lost when I was first locked up
at Royal Park, along with my stereo, some of my musical instruments, my
emergency drug bag, a few of my CDs and my birth certificate, credit cards and
passport. It was some years before the most important of these were returned to me
by various parties who thought theyd help themselves to my possessions once the
police had taken me away and I was safely inside a locked ward where theyd not
need to listen to my manic ravings any more.

Word had got around that I was mad mentally ill, psychotic, derangedif I came
back at all it would be as a changed man. Id be a psych patient and everyone
knew that once a lunatic always a lunatic. Pseudoscience from the not-so-distant
age of eugenics meant that many members of my family, members of my band and
other friends were of the opinion that mental illness is permanent, incurable and is
largely due to genetic factors. It is inherited in the DNA, in other words. This is
how I explain the fact that several young men I loved and respected stole my
property when I was locked up, some with no intent of giving it back. Others took
what they could into their safe hands and returned them to me when I returned to
Melbourne in August 1995, nursing the trauma of being locked up for several
weeks during which I was force-fed and injected with the very drugs I had been
concerned about when I read about their use in children labeled with autism.

I have written elsewhere about my experience of being a mental patient, and this is
a book about music and the brain. I think it important, though, to explain what my
psychiatric experience is. In addition to not being a specialist in the brain or music,
my understanding of psychiatry is more from the perspective of a patient than of a
psychiatrist. The truth is, I have scant respect for this particular branch of
medicine, and am of the firm opinion that psychiatry causes more mental illness in
our country (and around the world) than it cures or prevents. It is this opinion,
more than any other, that has resulted in over 40 admissions in mental hospitals in
Brisbane and Melbourne. These confinements have strengthened my conviction
about the damage hospital and university-based psychiatry is doing to public
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mental health in Australia, but could lead to an unintentional bias in my thinking

when I write about how music can be used in various psychiatric disorders as
they tend to be called these days. The drug treatment I was subjected to, which
includes more than a dozen different drugs, including both the old and new
antipsychotic drugs does give me the ability to describe first-hand the effects they
had on how I thought and felt, and how they dulled my musical abilities.

Movement, motivation, attention and concentration, memory and its role in

positive and negative preconceptions how they affect behavior, especially
seeking new experiencesaesthetic drive.creativity.chakra
concept.pineal.truthhonestygoodnessspiritual a word often
misunderstoodethics and morals, good and badpolarities and
paradoxes..possibility and desirability of changepositive and negative
emotions problems with this model (love versus fear)..other instincts talking
about love and interest.eros, philos and agape. What is love?...is it an
emotion?...dangerous territory

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In the diagram above, drawn when brainstorming on instinctual aspects motivation

gives an indication of my style of theorizing on the brain and mind and the limits
of my neurological knowledge at the time. Specifically, I was still laboring under a
false dichotomy between left and right sides of the brain, regarding aesthetic
pleasure from visual and musical stimuli (which I attributed to the right side of the
brain, whereas pleasure from love of honest communication I attributed to the left
hemisphere).
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Regarding my contentious theories of 1995 about the pineal, the comments on the
lower right of the diagram show my line of thinking regarding its possible function
back in February-March 1995. I was hypothesizing that the pineal, perhaps through
its role as a magnetic organ, might act as a link between the conscious and
subconscious minds, and that its postulated role as a body clock might be related
to our sense of musical rhythm as well as the hormonal rhythms described by
endocrinology researchers since the 1960s. I also postulated that the pineal may be
fundamentally involved in the timing of our thoughts - an idea so alien to
mainstream psychiatry and medicine that, even amidst my excitement at my theory
of motivation, I knew not to discuss it with the various psychiatrists and
psychiatric registrars called upon, by the Australian public hospital system, to
become my treating doctors. My refusal to agree that my theories were delusional
was, in the usual manner of the psychiatric profession, regarded as the typical lack
of insight that affects manic and hypomanic patients. Any psychiatry book will
explain that people with these conditions, feeling on top of the world and that
everything is falling into place often refuse to accept that, rather than inspired,
they are ill.

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An atypical training in music

My formal training in music was something of a disaster. It was traumatic to both

my piano teacher and I. It was many years before I played this wonderful
instrument for pleasure. I began piano lessons when I was eight, shortly after we
moved to my parents homeland, Sri Lanka (then called Ceylon) and was allowed
to stop them when I was fourteen, pleading that they were interfering with my
studies. I also argued that I needed to grow my nails to a length my piano teacher
disapproved of (shed say I was clanking on the keys) if I was to play guitar. This
was not exactly true I was clutching at straws to avoid these dreaded lessons and
the agony of preparing for more piano exams. Though I was allowed to stop piano
lessons, my strategy backfired in that, from then on, my father developed an
increasing conviction that practicing guitar, which I loved, would be a similar
impediment to my all-important academic performance.

My early childhood had been spent in England, where I had become a fan of the
Monkees and Beatles, but a greater fan of Batman, having seen these icons on our
little black-and-white TV. I didnt have much enthusiasm for Haydn, Bach, Chopin
and Mozart, but I painstakingly learned the classical pieces I was given and played
them which as much accuracy and sensitivity I could muster in front of my teacher
and a series of bored music examiners. I practiced piano only because of pressure
from my parents and never played classical pieces for fun.

My exposure to Western pop music and culture was transformed when we moved
to Sri Lanka. Transformed and attenuated, but not by any means extinguished. In
fact, in some ways it was intensified, but through a peculiarly Sri Lankan lens.
What I absorbed of pop culture depended on what was allowed into the country
and allowed on the radio (there was no TV on the island until after I came to
Australia). The exceptions, which turned out to be some of the most influential
music on my developing aesthetic, were records and tapes that were smuggled into
the country.

At the time the Sri Lankan government was trying to limit imports of luxury goods,
and vinyl records were a definite luxury. The only Western records for sale in
Kandy were on a single rack in Cargills, the towns biggest import store. All were
of the American Country and Western singer Jim Reeves, with the exception of a
few records by Englebert Humperdink, whose mutton-chop sideburns had a bigger
impact on me than his music. Fortunately my cousins in Colombo, where we often
spent our Christmas holidays, had a modest collection of smuggled records. My
favourite music at that time were mostly tracks for these albums by Eric Clapton,
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Moody Blues, Deep Purple, Elton John, James Taylor and Crosby, Stills, Nash and
Young.

You may notice that, in terms of black and white, these were all white artists,
some from Britain and some from the USA. I was not exposed to the music of
famous black artists of the 1970s including Stevie Wonder, Gil Scott-Heron,
Aretha Franklin, Marvin Gaye and B.B. King till many years later when I was
introduced to their music by white Australians. I had not even heard of reggae
and no one I knew was interested in jazz (which became my favourite genre until I
discovered the rest of the world). My other favourite musicians and singers were
all white, and mostly from England, where I was born, or the USA George
Harrison, John Lennon (whose solo work I preferred to their recordings with the
Beatles), Bob Dylan, Supertramp, Pink Floyd and Steely Dan recordings have
remained among my favourite music. This acculturation into the customary
instrumentation, scales, timbres, rhythms, chords, harmonies and melodies of
white Western pop/rock music has, needless to say, shaped my taste in music.

My piano teacher did not share my developing taste, though also conditioned into
Western scales, harmonies and melodies. She was a classically-trained piano and
violin player, and though she tried broadening her taste by listening to what she
called Oriental Music she was turned off by any music that went, as she said,
bang, bang, bang. She meant drums played on a drum kit. All my favourite
music had drums.

Unfortunately for her and I, this lady was my auntone of my mothers fifty-six
first cousins, but that constitutes an aunt and a close relative in Sri Lanka. It
meant she could not sack me as a student despite my obvious reluctance to learn
what she was trying to teach me. My problem was not a lack of musicality, she
eventually told my mother, but a lack of application. This welcome honesty only
eventuated when I finally blurted out that I used to erase the ticks she had made in
my music book indicating my new pieces and she hadnt even noticed.

My poor aunt was trying to teach me using John Thompsons Piano Method and
prepare me for annual examinations in Music. Though I still remember the first
piece Papa Haydns Dead and Gone, having played it umpteen times, the memory
is not a fond one. Looking back, I suspect that my difficulty in reading notation
was how the bass and treble staves were introduced to me. Rather than seeing the
patterns of the notes, I was told to memorise the lines on the stave as Every Good
Boy Deserves Favour (EGBDF) for the upper treble stave and Good Boys
Deserve Favour Always (GBDFA) for the lower bass stave. No wonder my sight-
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reading was slow every note had first to be processed though the verbal parts of
my brain.

I do not think it wise to try and teach children to read music before they learn to
listen to it. I also believe that teaching children and adults how to listen to music, to
get the most out of what they are hearing, is an essential part of musical training
that is often neglected. In my case I was expected to practice three pieces every
week and play them to my teachers satisfaction on Tuesday afternoon, after
school. My father would pick me up after he finished work at the Hospital (if he
rememberedif he forgot my mother would remind him, but that could mean I
was picked up three or four hours late). This meant I had to listen to the next
student (and only other student for the day) subjected to a violin lesson. Tuesday
afternoon was a miserable experience.

I suffered from various musical maladies, according to my piano teacher. I tended

to thump, which is good for marches, but not for quiet pieces, Romesh; I tended
to speed up (in which case I would be told to count aloud, which I hated) and I was
terrible at sight-reading. These were what we needed to focus on if I were to pass
my next exam. The whole objective of my piano lessons was preparing for
increasingly demanding annual examinations. It was worse than school I mostly
enjoyed academic exams, but the prospect of trying to read and play music Id
never seen before in front of an examiner always filled me with dread.

It was during one of these music tests that I had my first experience of involuntary
shaking induced by music. It wasnt caused by the groove it was brought on by
anxiety. I was sitting in front of the examiner and the sheet music ready to play one
of my prepared pieces. Suddenly my right leg started wobbling uncontrollably. It
was a strange experience I had again a year later, under the same circumstances.
This particular wobbling of one leg from anxiety has only happened to me once
since this was when I was playing guitar in front of a few hundred people at the
finals of the Queensland Rock Awards. It appears to be a specific manifestation of
music performance anxiety and has never happened when I have been scared or
worried about anything else. If nothing else, this proved to me that playing
musical instruments is not always good for the health especially if the play and
the fun associated with the word play is absent.

I managed to pass five exams, mainly on the strength of the written test and what
were called aural tests. The latter were simple tests of musicality and memory,
where we had to repeat short melodies and rhythms after the examiner, singing
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them in tune and time. I remain unable to sight-read music and cannot manage the
double staff of classical piano notation. My knowledge of music theory has not
progressed a huge amount since then, though I can now read chord charts fluently
and have a reasonably sensible discussion about modes and scales. What has really
improved, since I stopped trying to read music and started trying to play it is my
hearing. My ability to hear sounds that are in or out of tune, to recognize subtle
differences in timbre and all those other aspects of listening that develop with the
practice of listening carefully to music. Though I retained an inclination to speed
up during songs when playing guitar (unless the drummer did not share the
tendency) once I started playing more percussion in later years I kept better
(metronomic) time.

My childhood in Sri Lanka was punctuated by regular visits to St Pauls Cathedral

in Kandy, where the congregation sang to the accompaniment of an organ-player,
and we had an organ-player at Trinity College (Kandy not Cambridge) where I
endured high school and twice-weekly sessions of Chapel before our lessons
began. I found the sermons mostly boring but enjoyed singing hymns (or any other
songs I knew) and marveled at the skills of the organ-player, especially because he
was blind. I wondered how he knew where all the keys were. By touch, my
piano teacher told me, but she didnt teach me how to play the notes I was thinking
by touch. This was not a skill her classical training had developed.

It has taken me many years to feel comfortable playing piano by touch, acquiring
this skill only after a lot of mistakes. Knowing where a note is by feel is a quite
different thing from knowing where it is by sight. It is especially valuable when
improvising if one can play the note one wants automatically ones fingers
going to the right key (or fret) without visual assistance. Playing by feel can also
circumnavigate various theoretical constraints we tend to assume when
approaching improvisation in a theoretical, linguistic fashion, assuming need for
more proper musical grammar than is necessary.

I have experienced considerable change in my musicality over the years in the

areas of improvisation and composition, two things I have actively sought to
develop since I started playing guitar when I was thirteen. Neither was tested or
encouraged in my earlier music training, which was totally focused on acquisition
of the motor skills and notation-reading skills sufficient to pass piano
examinations, in which only Western classical pieces would be tested.

The instrument that eventually saved me from piano lessons was an old guitar my
father had bought some years earlier. It was what he called a Spanish Guitar; hed
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intended to convert it to a Hawaiian Guitar by raising its bridge, turning it on its

back and playing the steel strings with a flat piece of steel, which he told me was
called a steel. My father liked the sound of Hawaiian guitar more than that of
Spanish guitar and tried to teach me to play My Bonnie Lies Over the Ocean as
he did some of my cousins, but I was showed even less enthusiasm for the tune
than they did.

One of my uncles, fortunately, was able to teach me to play the chords of a few
songs that were more to my taste, and recorded them on a cassette so I could play
along with the tape. Here Comes the Sun by George Harrison, Sounds of Silence
by Simon and Garfunkel and Imagine by John Lennon are a few that spring to
mind. I discovered that I could work out the chords of other songs if I played along
with the recordings and delighted in developing this skill, which had not been
nurtured in my previous piano lessons. Using chord charts from assorted sheet
music to guide me, I slowly started understanding the names of different chords,
which chord went with which, and what the shape of the chord was, meaning the
shape my hand adopted when playing the chord, rather than what the chord looked
like when written in classical notation.

I focused on learning guitar for many years and, in retrospect I focused on listening
to the guitars in any recordings at the expense of the gestalt of the music. Listening
selectively to the guitar meant I often didnt listen to the lyrics, even when I
learned them by rote and sang them while strumming my guitar. There were
exceptions, like some of the Dylan compositions I sang, when I did have some
inkling of what I was singing about, but it didnt really matter to me if the
sentiments he expressed were far removed from my own.

Some years ago I was surprised when the new vocalist in our band refused to sing
any songs she couldnt relate to. To be honest I thought she was being a bit
precious about it. I feel very differently about this now. Singing a song one doesnt
mean is akin to acting. While acting has its place in culture, and I enjoy watching a
good actor (whether theatrical, musical or political) it is also important to be able
to express oneself. Expressing oneself without rehearsal is akin to speaking without
preparation improvising, in other words. I believe improvisation, the ability to
improvise and confidence to take risks by winging it, is at the root of creativity.
I suspect that being creative, in a general sense, is good for the health. Expressing
ones own emotions seems likely to be more cathartic than trying to mimic those of
others. If one does successfully get into the correct mind-set to sing someone elses
song with feeling would one not run a risk of developing the same mental
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tendencies? And so many songs have bitter, sad, angry or pompous lyrics.

Ive sung a lot of lyrics I didnt mean, over the years. Have I been affected by
singing with feigned anger the many verses of Bob Dylans Idiot Wind? The song
begins with a clearly paranoid outburst:

Someones got it in for me

Theyre planting stories in the press
Whoever it is I wish theyd cut it out quick
But when they will, I can only guess

What has been the effect on my mind of singing in church, year after year, Onward
Christian Soldiers, marching as to war?

Actually, I dont think the damage has been too bad. Like many others, I have a
tendency to dissociate lyrics from music when I listen to it and even when I sing
songs. The memorized words become melodic objects rather than semantic objects.
True, they retain their meaning if one directs ones attention to them and
concentrates on the words throughout the song, but that is a rare event for me, and
doubtless many others. At the same time, there are many who listen to music with
a primary interest in the lyrics. This variation in style of listening has important
implications for music therapy that will be explored later.

The relationship between music and words has been debated by neuroscientists for
many decades, and by philosophers for many centuries. In recent years there have
been indignant arguments by music-oriented neuroscientists against the opinion of
language-oriented neuroscientists in the USA who accept we have a language
instinct but not a music instinct. Thousands of neurological and psychological
studies, utilising the newest, most-expensive technology available at the time have
sought to localize specific language-related functions and music-related ones.
These have revealed a consistent over-simplification of the neural processing of
both language and music by previous researchers, and the complexity of how we
process music, with and without lyrical content, is more widely appreciated. In
fact, the data regarding the subject, especially the often surprising findings from
non-invasive MRI scans in musicians and non-musicians has turned orthodoxy on
its once simplistically phrenological head.

All of us have the ability to improvise conversations, and many have untapped
potential to improvise on musical instruments. Realising this potential, though,
requires introduction to a reasonably wide range of musical instruments, because
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different instruments suit the mentality, anatomy and physiology of different

people. At the same time, rather than distracting one, as was once thought the case,
every instrument learned makes the next easier to play. Whats more, learning to
play different musical instruments fundamentally changes the wiring and activity
of the brain.

One of the startling findings of recent research is that motor areas of the brain
including both cortical and sub-cortical structures are activated by listening to
music and not only with playing instruments or dancing. It has also been
discovered, using modern neuroimaging techniques, that specific parts of brain
involved in relevant movements are active when listeners are familiar with the
instrument being listened to. It is as if the listener is mentally practicing producing
the same sounds indeed, subconsciously, that is what they seem to be doing. This
occurs if, and only if, the person has learned how to make the relevant movements
learned to play the instrument they are listening to, in other words. Interestingly,
this activation of relevant motor areas occurred when people heard the music, even
when not consciously imagining playing along with it.

People in modern times have an unprecedented opportunity to benefit from music,

and music can enrich life in many ways. This includes listening to music, singing
and playing musical instruments. Myriad musical instruments are being used to
create beautiful (and not so beautiful) sounds at this very moment around the
world, and the range of instruments continues to grow, along with the range of
sounds they can produce. Since the advent of analog and digital recording media,
music from around the world and played by the finest musicians of the past
seventy years has been increasingly available to people across the globe. Music of
many varieties has been transmitted as radio waves twenty-four hours a day, over
an ever-increasing choice of radio channels for decades. Although there is plenty
of irritating noise to be heard on the radio, it also provides a rich source of healing
music.

Access to fine music has grown dramatically with the Internet. In addition, with
websites such as YouTube, musicians from around the world are able to share their
own beautiful (and ugly) sounds. These include their renditions of others
compositions as well as their own. The cost and ease of recording and playback
technology continues to head in the opposite direction to house prices and drug
prices. In addition to the growing diversity of recorded music available in the
modern world, live musical performances can also bring health benefits, both to
the musicians and their audience. They do, however, have dangers: from the music,
from the way instruments are played (incorrectly or even 'correctly') or the
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environment in which it is played.

In the following pages I will focus on the power of music itself (and lyrical
content) for potential to damage and heal, rather than the environment in which it
is played. The paradigm to be presented is centred on the neural processing of
sound and light, and original theories on the psychological effects of hearing and
vision. The model includes hypotheses relating to the physiological and endocrine
(hormonal) effects of music (and sound) as suggested by these neural pathways.

An Integrated Theory on Human Instincts

The instinct-based model of human behaviour I began developing in 1995 is at

odds with popular movements in psychology and psychiatry that go as far as to
deny instinctual behaviour in humans (though conceding it in animals) or at least
limit discussion of instinctual drives to maintenance of homeostasis such things
as temperature regulation, eating and drinking. Social instincts (such as
communication and language acquisition) and sensory instincts (such as instincts
to look and listen) as described in my model of human motivation, are alien to
modern psychiatric thinking, especially that of so-called biological psychiatry.
Many of these social instincts are accepted as such by other schools of psychology,
however, especially those leaning towards evolutionary and cognitive psychology.

Psychology is a diverse field, with many schools of thought. The ideas and
assumptions, the discourse and practical applications of knowledge about the mind
(and behaviour) differ considerably between individual psychologists and between
followers of various psychology icons, and styles or schools. What clinical
psychologists or behaviourists talk about and teach is fundamentally different to
the ideas believed and propagated by social psychologists, Jungian or
Freudian analysts, or evolutionary psychologists. The jargon used by the different
types (or schools) of psychology is profoundly different Jungians talk of
archetypes and synchronicity, Freudians of repression, ego defence and libido.
The medically oriented schools, including many regarded as clinical psychology
uses psychiatric terminology, with an extra dose of statistics. Statistics is the
obsession of many modern psychology sub-specialities armies of trained
psychologists are collecting statistics about the global incidence of mental illness
as defined by the medical profession, while thousands more are collecting raw data
on written answers to increasingly elaborate, and maddeningly confusing
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questionnaires so-called tools for evaluation of mental illness and its response
to treatment.

Darwin, and other zoologists of his time, considered it self-evident that we have
social instincts. All social animals (from ants to anthropoid apes) can be expected
to have evolved such instincts. They serve to increase social cohesion, ease
communication between members of the group and other groups of the same, and
even of other, species. The acquisition and use of spoken and gestured language
can be regarded as social instincts, as well as instincts for the development of
sympathy, empathy, altruism, reciprocity, and sense of justice or fair play. An
instinct to climb the social ladder, to ascend the social hierarchy that is so evident
in the behaviour of chimpanzees and other social primates (not to mention the
pecking order of birds) is another social instinct, one that continues to be a major
driving force in human behaviour. In fact, all our social instincts have found
expression in modern society, since they are part of our genetic programming. That
is not to say they are expressed equally in all people in fact, humans have a
remarkable capacity to suppress their instinctual drives, including their instincts for
communication, for seeking love, for curiosity, for creativity and for music.
Fortunately we also have a well-developed capacity to suppress our instincts for
hitting people we dont like (seen so often in infants) and for territorialism (seen
often in infants and very frequently in professionals, experts and nationalists).

Instinct Theory

In the 19th century instincts were regarded as important aspects of mental function
and behaviour in humans and other animals. In The Origin of Species (1859)
Charles Darwin devoted a whole chapter of 29 pages to instinct. Though he does
not attempt a precise definition of the term, he argues that every one understands
what is meant, when it is said that instinct impels the cuckoo to migrate and to lay
her eggs in other birds nests.

Nest-building by birds is one behaviour that is still regarded by zoologists as being

instinctual, but most of the hundreds of possible instincts proposed in the late
19th century were abandoned during the 20th century especially after the
dominance of the psychoanalytical theories of Sigmund Freud, who reduced
human instincts to what he called eros (life instinct) and thanatos (death instinct).

Sigmund Freud (1856 1939) created a model of the mind, not one of the brain,
drawing on Greek mythology, in particular, in his choice of terms (what soon
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became the official jargon of psychoanalysis). In doing so he founded

psychoanalysis, in that he led a group of medically-trained doctors who called
themselves psychoanalysts and differentiated their style of psychotherapy from
other schools (including various schools of hypnosis) as psychoanalysis (as
theorised by Freud and his friends/associates). Though he was familiar with and
admiring of Darwins work, the model of the psyche Freud expounded, tormented
by conflicts between id, ego and superego, and the life-long repercussions of
repressing infantile sexual fantasies, had little in common with Darwins astute
observations of instincts and emotions in humans and other animals. Though Freud
may be credited with reducing the complexity of concurrent theories on instincts,
emotions, volition and learning by simplifying instinct theory into eros and
thanatos, the replacement he dreamt up was loaded with neologisms that could
only be comprehended by reading his earlier writings, when he explained what he
meant by id, the Oedipal Complex and so on.

The popularity of Freuds model among psychiatrists in the USA, followed by the
ascendance and subsequent dominance of behaviourism resulted in the lucidity of
Darwins observations and analysis of emotions and instincts falling by the
wayside in academia in the USA and elsewhere. It remained the case that both
emotions and instincts were largely ignored until the cognitive psychologists
exposed the obvious problem in defining psychology as synonymous with the
study of behaviour. What about thinking, emotions and the mind?

The history and politics of the mental health professions must be considered to
understand why the role of instincts, including musical instincts, in motivation
and behaviour has been downplayed, sidelined or ignored altogether. The history
and politics of the advertising industry suggests that knowledge of our instinctual
drives was not lost altogether, when the scientific discipline of medicine
(including neurology and psychiatry) sidelined, and even denounced, instinct
theory in favour of various chemical imbalance theories.

Psychiatry, from the Greek psyche + iatros (treatment) is a medical specialty and
to qualify as a psychiatrist one needs, all over the world, to first qualify as a
medical doctor. Though much has been said about the art of medicine, the
profession regards itself (and is regarded by others) as a scientific discipline.
Thus psychiatry, being a branch of scientific medicine, assumes the cloak of
scientific credibility (however transparent).

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Psychology, from psyche + logos (literally word, but generally interpreted as study
of) evolved out of the discipline of philosophy, which is a branch of the arts in
terms of the fundamental academic division between the arts and science in the
entire Western education system. This system, during the time of colonialism, was
exported to what, after the Second World War, was called the Third World.

In 1979, when I studied from the 10th edition of Psychology and Life, the United
States of America and its allies, including Australia, were waging war against the
forces of communism meaning the USSR and China in what was called the
Cold War. Though never acknowledged, this war had profound effects on what
was taught to university students in Australia, including what was taught in the
fields of psychiatry and psychology.

One casualty of the Cold War, as in all wars, was truth. Another was instinct
theory. With the dominance of B.F. Skinners style of experimental psychology
at Harvard, the oldest university in the USA, and one of the most respected
universities in the world, the discipline of psychology, once a branch of philosophy
devoted to the study of the mind and mental processes, became the study of
behaviour. This resulted in dramatic changes in the accepted methods of research,
what was accepted as proof, and the entire discourse of psychology departments
and the publications that emanated from them. Animal studies on variously
mistreated birds and mammals (especially rodents, cats and monkeys) in
experimental psychology laboratories replaced the careful observation of domestic
and wild animals that characterised Darwins scientific technique and others like
him. Statistics became the standard way of presenting the results of psychology
research.

A parallel change occurred in (medical) psychiatry. Even more than in

experimental psychology, statistics became the preoccupation of university-based
psychiatry. The deep rift between the study of the brain (neurology) and treatment
of mental disorders (psychiatry) deepened throughout the 20 th century. This had
not been the case when Freud and his contemporaries studied medicine he was
trained in neurology (though oddly, he gained his medical degree with a thesis on
the spinal cord of lower fish species, and his first published paper presented his
failure, after 4 weeks of meticulous dissection, to find the hitherto elusive testicles
of eels!).

The widespread acceptance of Darwins theories heralded a revolution in biology,

such that any credible theory of animal and plant behaviour, physiology or
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morphology was required to satisfy the principles of natural selection. It was some
years before the same applied to theories in the discipline of psychology, though
Freud regarded his theories to be consistent with Darwins discoveries.

The impact of Sigmund Freuds school of psychoanalysis far exceeded its merits,
as far as clinical medicine and the promotion of health is concerned. The same may
be said for his model of the mind, complete with confusing concepts and terms
borrowed from classical Greek mythology. The dominance of the small cabal of
medical doctors headed by Freud, professing expertise in analysing the psyche,
resulted in many sensible theorists, teachers, philosophers and psychologists of the
late nineteenth and early twentieth century being ignored and largely, if not
completely, forgotten. Instead, countless hours and pages have been devoted to
arguing for and against the competing ideas of Freud, Jung, Adler and the other
founders of psychoanalysis, few of whom had much to say about music.

Of course analysis of the mind by deep thinkers began long before Sigmund Freud
founded his school of psychoanalysis as an alternative to existing techniques of
psychotherapy. The latter included persuasion, suggestion, and hypnosis, all of
which were regularly employed by medical doctors in the early 1800s. At this time
the benefits of music to calm the troubled breast was well known, and was
employed in the more enlightened hospices and sanatoriums of the time. However,
the institutions in which the mentally ill, then called lunatics, were confined were
not enlightened hospices. The treatments inmates of the crowded mental asylums
could expect ranged from whips and chains, through spinning chairs and electric
shocks, to slightly improved rations and less unpleasant work (occupational
therapy) as a reward for good behaviour. Freud, being trained, like all
psychiatrists, in the asylum system, was presented a distorted view of humanity by
his employment and the environment he chose to work in; his theories reflect this.

In addition to shaping the theories of Freud, his associates and his disciples,
Charles Darwins books heralded the beginning of a war of words between
creationists and evolutionists. This has continued, at least in the USA, until
today. It also spawned the pseudo-science of eugenics and the related social
disaster popularised as Social Darwinism. During this era, which ended rather
abruptly with the end of the Second World War, instinct theory prospered, and then
floundered under its own weight, as thousands of human instincts were proposed in
the scientific literature. This set the stage for the popularity of Freuds simple
model that proposed only two instincts eros, the life instinct and thanatos, the
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death instinct.

Francis Galton, who used Darwins ideas to support his racist eugenic theories
and doctrines, also used the term instinct. After his explorations in Southern Africa
he became convinced that black Africans possess a slavish instinct and readily
fall into the ways of slavery. He does not mention their patently obvious instinct
for music for rhythm, pitch, harmony, melody and timbre.

Following the end of World War Two in 1945, dominance, in the USA, of the
behaviourist school of psychology in research and publications created a radical,
but widely held view, that thinking and thought cannot be studied scientifically,
and the only thing that can be measured (and therefore legitimately studied) is
behaviour. The decades in which Skinner, at Harvard, dominated experimental
psychology discourse, were characterised by increasingly ingenious, and
frequently grotesquely cruel, attempts to manipulate behaviour by positive and
negative reinforcement. Emotions of fear, anger, and pain were concentrated on,
while various parts of the brain of cats, monkeys and chimpanzees were severed by
a series of psychologists and neuroscientists to study the impact of calculated
mutilations on their behavioural response when confronted by pleasant and
unpleasant stimuli. The pleasant stimulus was usually a small reward of food, the
unpleasant ranged from terror-inducing environmental manipulations and
injections with various toxins to, most popularly, electric shocks.

Psychologists discover the importance of thinking

Neuroscience research, as it tends to be called nowadays, has tended towards

fashions and fads. In the late 19th century several battles arose within the
professionals who professed to know more than everyone else (other than other
recognised experts) about the mind and the brain. During the years that Professor
William James star was fading at Harvard, along with the introspective means he
advocated to understand the mysteries of the mind, a school of thought arose in the
USA that what can be observed and measured objectively is behaviour. The mind
cannot be studied scientifically, only behaviour can, according to those who wore
the public mantle of behaviorists, such as John Watson, and others who agreed
with this influential doctrine.

The academic discipline of psychology includes followers of numerous, frequently

conflicting, schools of thought. When I studied medicine the psychology we were

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exposed to was heavily dominated by behaviourism in fact the first page in the
American textbook we were taught from defines psychology, not as the study of
the mind, thought or thinking but the study of the behavior of organisms. Unlike
the psychiatry and neurology texts we were exposed to, music is mentioned in this
textbook of over 700 pages it has a whole page (at least, most of a page) devoted
to the subject. This page only discusses the use of music to affect (in this case
manipulate) emotions in movies (the strategies used in Jaws and Psycho are two of
the six examples).

In an effort to gain kudos as a scientific endeavour, psychologists aligned with

the Harvard-centred behaviourist school shunned aspects of the mind that cannot
be measured including emotions. The mind could not be studied scientifically,
nor emotions, according to the doctrines of the behaviourists what could be
studied was stimulus and response. A complex jargon evolved, later taught in
schools and universities around the world, to describe ways of training rodents and
other experimental animals to avoid electric shocks and other unpleasant or painful
stimuli by producing the desired response (that desired by the experimenters, not
the rats). Fortunately, for the study of music and the mind, rodents, cats, dogs,
monkeys and chimpanzees, the favourite test subjects for experimental
psychologists during the dominance of behaviourism in academic psychology, do
not respond to music in a way remotely akin to that of humans.

The prescribed psychology textbook for medical students when I studied at the
University of Queensland in the early 1980s, Psychology and Life, was then in its
10th edition. The first seven editions (1937-67) of this widely used textbook were
authored by Floyd L. Ruch of the University of Southern California, the 8 th and 9th
co-authored by Ruch and Philip G. Zimbardo of Stanford University and the 1979
tenth edition (from which I studied psychology at university), is attributed to Philip
Zimbardo, though credited as from earlier editions by Floyd L. Ruch.

Rather than psychology being, as the Greek roots of the word suggest, study of the
mind (or soul, as some translate psyche) the textbook begins with the following
definition of Psychology (presented under the caption Psychology is Scientific:
It is formally defined as the study of the behaviour of organisms.
Setting the tone for the rest of Psychology and Life, the text continues:
Using careful observation and rigorous experiments, psychologists look for
the causes of various behaviours of human beings and other animal species.
By using the methods of scientific inquiry, they can often give precise and
valid answers to questions about the underlying processes that determine the
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complexity of our behaviour. (Psychology and Life, p.3)

Ironically, given that curiosity does not feature in the index of Psychology and Life
(while cannibalism does) and is not mentioned as a human instinct in the two pages
devoted to discussion of instincts, the introduction to the discipline on the first
page continues, after claiming that psychology is scientific, with the assertion
that Psychology is Curious:
It involves questioning reality, asking How come? Why is it so? What
would happen if...? How important is X? If Y changed, then what?
What made it do that? and so on. Some psychologists try to make sense out
of apparently bizarre behaviour, such as madness or vandalism. Others are
excited by the challenge of discovering how the eye and brain enable us to
perceive the outside world so accurately. Curiosity leads some to probe the
realm of the inner eye, unlocking the secrets of a mind that is conscious of
its own being. For all psychologists, human nature is an endless puzzle
waiting to be solved but a puzzle that keeps changing even as theories and
research try to reveal its hidden treasures. (Psychology and Life p.3)

The section in this 767-paged psychology textbook on instincts runs for a little
under 2 pages, in a chapter entitled Personality: Issues and Theories. Under the
title Psychodynamic theories, the enthusiasm with which Darwins ideas about
survival instincts were embraced after the publication of Origin of Species, and the
subsequent reaction to them are (partially) explained:
Toward the end of the nineteenth century, Charles Darwin made the world
aware of the common bonds that link human beings and animals.
Psychologists were quick to borrow Darwins concept of instinct. From its
original use in accounting for stereotyped patterns of animal behavior, this
concept came to represent the force behind virtually all human actions. If a
person went around hitting other people, it might be because of an inborn
instinct of pugnacity. If someone was miserly, it was a hoarding instinct.
Yet, this sort of explanation did not work out very well. If psychologists had
a new kind of behavior they wanted to explain, they had only to postulate a
new instinct, which left them with a new psychological term but no more
understanding of the psychological process than before. Naming something
is not the same thing explaining the determinants of the effect. By the 1920s,
according to one survey (Bernard, 1924), at least 849 different classes of
instincts had been proposed. Clearly a more fruitful approach was needed.
Sigmund Freud not only gave new meaning to the concept of human
instincts, he revolutionized the very conception of human personality.
(p.478)
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 73

The passage above contains a valid criticism of the practice of endless naming as
though the giving of a name provides an explanation of cause. In fact, the reverse
is often the case, especially in terms of human behaviour. Naming an increasing
number of mental disorders (now over 300) by the American Psychiatric
Association (APA) in its Diagnostic and Statistical Manual of Mental Disorders
popularly known as the DSM, now in its 5th edition, might well be subjected to the
same criticism. This reference textbook given almost biblical authority by
psychiatrists and courts in Australia and other parts of the world that have come
under strong influence of American psychiatric theory. In Europe and the UK, the
World Health Organizations International Classification of Disease provides a
similar model, and is compiled with major input from the American psychiatric
establishment, headed by the American Psychiatric Association.

The other school of psychology that dominates in the medical model is focused,
again in the interests of being scientific on statistics. The mainstay of psychiatric
diagnosis in Australia and the USA is the Diagnostic and Statistical Manual of
Mental Disorders (DSM) published by the American Psychiatric Association. The
statistics are based on psychological questionnaires and other forms of
psychological assessment. The development of such tools is an industry in itself,
with various variations on the same theme competing for popularity. These tests
were developed largely for testing one drug against another for clinical
effectiveness in the treatment of various disorders as described in the DSM. This
has relevance to the slowness of the inroads music therapy has made into clinical
medicine and psychiatry.

There are more reasons for this slow progress. One is the fact that music, though of
immense value as a therapeutic agent, does not result in increased drug sales.
Consequently drug companies, which sponsor so much of the research conducted
in universities around the world, are not interested in funding studies that show the
benefits of music or music therapy. The cornucopia of publications sponsored by
the pharmaceutical industry has failed to report the numerous high-quality
scientific studies that have demonstrated the effectiveness of music therapy over
the past decades.

Vested interests sponsoring medical research and publications may have hindered
the recognition of music therapy by the medical profession, but it hasnt stopped it.
Thousands of papers and books on music therapeutics have been published since
the 1940s, most of them in the past two decades. However, what doctors tend to do
is strongly influenced by what they learn at university and their post-graduate
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hospital training. This is not a bad thing unless what they learn is incorrect or,
more commonly, incomplete.

A third, more recent, school of psychology is poised to curtail the drug-domination

of the mental health system. This is Cognitive Behaviour Therapy (CBT) which
emerged in the 1980s and 1990s as a sometimes uncomfortable alliance between
the old behaviourists and their rivals, the cognitive psychologists. CBT is a
practical, effective way of changing behavior by changing thinking patterns what
is termed reframing. The principles of CBT are commonsense, and based on
changing negative, unhelpful patterns of thought with more positive thoughts by
looking at a particular event or situation differently. Seeing a half full glass rather
than a half empty one, for example.

The 10th (1979) edition of Psychology and Life was authored by Professor Philip
Zimbardo, then already famous (or infamous, depending on ones perspective) for
conducting the Stanford Prison Guard Experiment on unwitting psychology
students. We medical students at the University of Queensland were not given a
perspective of any sort on the author of the psychology textbook we were to
purchase and digest. I was able to digest very little of it, and have still not read all
of the 767 pages. When I re-read the passage on behaviourism recently I found
something I had missed, not about music, but about the cognitive model. This
paragraph explains why this model was always going to triumph over the narrow
perspective of what Zimbardo calls the behavioristic model:
While behaviorists do not believe in anything that cant be seen directly,
psychologists who take a cognitive approach are willing to believe that there
is more to human nature than the public actions of human beings. They
broaden the domain of psychological reality beyond the limits of behavioral
reactions to external stimuli. Mental processes attending, thinking,
remembering, planning, expecting, wishing, fantasizing, and consciousness
itself are the stuff of the cognitive psychologists. (p.26)

It is easy to see why behaviourism had such a negative impact on the psychological
study of music. Attention, remembering, planning, anticipation (expectation) and
these other mental processes that were deemed outside the legitimate field of
psychological study by Watson, Skinner and the other behaviourists are of vital
importance in the creation and appreciation of music.

According to Zimbardos textbook John B. Watson, the founder of behaviourism,

was reacting to trends of his times which placed undue importance on vaguely
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defined mental states and endless lists of instincts that supposedly explained (but
really only named) everything. Later in the text he elaborates on this. By the
1920s, when John Watson declared behavior rather than thinking to be the sole
domain of scientific psychology, at least 849 different classes of human instincts
had been proposed. Other writers have claimed figures over one thousand. It is
generally accepted (and repeated in Zimbardos account) that this unwieldy list of
instincts was simplified by the theories of Sigmund Freud, who created a model
of the mind based on only two fundamental instincts a life instinct (eros) and
death instinct (thanatos).

When I studied at the University of Queensland in the early 1980s, Psychology and
Life was in its 10th edition. The first seven editions (1937-67) of this widely used
textbook were authored by Floyd L. Ruch of the University of Southern California,
the 8th and 9th co-authored by Ruch and Philip G. Zimbardo of Stanford University
and the 1979 tenth edition (from which I studied psychology at university), is
attributed to Philip Zimbardo, though credited as from earlier editions by Floyd L.
Ruch.

Rather than psychology being, as the Greek roots of the word suggest, study of the
mind (or soul, as some translate psyche) the textbook begins with the following
definition of Psychology (presented under the caption Psychology is Scientific:
It is formally defined as the study of the behaviour of organisms.
Setting the tone for the rest of Psychology and Life, the text continues:
Using careful observation and rigorous experiments, psychologists look for
the causes of various behaviours of human beings and other animal species.
By using the methods of scientific inquiry, they can often give precise and
valid answers to questions about the underlying processes that determine the
complexity of our behaviour. (Psychology and Life, p.3)

Ironically, given that curiosity does not feature in the index of Psychology and Life
(while cannibalism does) and is not mentioned as a human instinct in the two pages
devoted to discussion of instincts, the introduction to the discipline on the first
page continues, after claiming that psychology is scientific, with the assertion
that Psychology is Curious:
It involves questioning reality, asking How come? Why is it so? What
would happen if...? How important is X? If Y changed, then what?
What made it do that? and so on. Some psychologists try to make sense out
of apparently bizarre behaviour, such as madness or vandalism. Others are
excited by the challenge of discovering how the eye and brain enable us to
75
 76

perceive the outside world so accurately. Curiosity leads some to probe the
realm of the inner eye, unlocking the secrets of a mind that is conscious of
its own being. For all psychologists, human nature is an endless puzzle
waiting to be solved but a puzzle that keeps changing even as theories and
research try to reveal its hidden treasures. (Psychology and Life p.3)

The section in this 767-paged psychology textbook on instincts runs for a little
under 2 pages, in a chapter entitled Personality: Issues and Theories. Under the
title Psychodynamic theories, the enthusiasm with which Darwins ideas about
survival instincts were embraced after the publication of Origin of Species, and the
subsequent reaction to them are (partially) explained:
Toward the end of the nineteenth century, Charles Darwin made the world
aware of the common bonds that link human beings and animals.
Psychologists were quick to borrow Darwins concept of instinct. From its
original use in accounting for stereotyped patterns of animal behavior, this
concept came to represent the force behind virtually all human actions. If a
person went around hitting other people, it might be because of an inborn
instinct of pugnacity. If someone was miserly, it was a hoarding instinct.
Yet, this sort of explanation did not work out very well. If psychologists had
a new kind of behavior they wanted to explain, they had only to postulate a
new instinct, which left them with a new psychological term but no more
understanding of the psychological process than before. Naming something
is not the same thing explaining the determinants of the effect. By the 1920s,
according to one survey (Bernard, 1924), at least 849 different classes of
instincts had been proposed. Clearly a more fruitful approach was needed.
Sigmund Freud not only gave new meaning to the concept of human
instincts, he revolutionized the very conception of human personality.
(p.478)

The passage above contains a valid criticism of the practice of endless naming as
though the giving of a name provides an explanation of cause. In fact, the reverse
is often the case, especially in terms of human behaviour. Naming an increasing
number of mental disorders (now over 300) by the American Psychiatric
Association (APA) in its Diagnostic and Statistical Manual of Mental Disorders
popularly known as the DSM, now in its 5th edition, might well be subjected to the
same criticism. This reference textbook given almost biblical authority by
psychiatrists and courts in Australia and other parts of the world that have come
under strong influence of American psychiatric theory. In Europe and the UK, the
World Health Organizations International Classification of Disease provides a
similar model, and is compiled with major input from the American psychiatric
76
 77

establishment, headed by the American Psychiatric Association.

A New Model of Motivation

In the following model behaviour is seen as being shaped by an interplay of three

motivational forces: instinct, conditioning and free will.

Instincts

Conditioning Behaviour
(environmental
influences)

Free Will
(decisions)

Definitions used:
By definition, instincts enhance survival and/or reproductive success of the
individual or their close genetic relations.
Instincts are found cross-culturally, and are evident in the behaviour of infants and
young children brought up under different cultural, social and other environmental
influences.
Instincts and the innate drives they cause are inherited, and though modified by
conditioning, continue to motivate behaviour throughout life.
Instincts may, however, only become fully evident with maturity.
Instincts drive development of perceptive, cognitive, social and motor skills, but
are subject to variation in their expression (or suppression) by conditioning and
volition (exercise of will).
Conditioning refers to all environmental influences that come into play in the
development of the brain and nervous system, including critical intrauterine
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influences (especially sound vibrations). These shape the connections of neurons,

including the hard-wiring of neuronal synapses and the creation of memory.
Unlike computer analogies, neural plasticity results in dynamic neural circuits that
change, in terms of hard-wiring, with sensory experience, movement, recollection
and other behaviours.

Free will is expressed though decision making and voluntary movement, largely
under the neurological control of the frontal lobes of the brain.

Instinctual behaviour is driven by a hedonistic or pleasure principle a drive to

seek pleasurable experiences and avoid painful ones. This hedonistic behaviour can
be over-ridden by conditioning and by exercise of will, though denial of instinctual
drives in this way can create internal stress for the individual. At the same time,
unrestrained expression of the instinctual drive to seek pleasure can result in
provoking external causes of stress, notably societal (and familial)
disapproval/punishment.

Instinctual behaviour is genetically determined, ultimately through manufacture of

proteins as determined by genotype (DNA). Expression of DNA, in terms of the
proteins manufactured by cells in the nervous system, is subject to change as a
result of epigenetic factors, which are influenced by environmental factors
(conditioning) and by the activities of the individual. In other words, behaviour and
experiences may not change the DNA itself, but it can change the expression of the
DNA.

Localisation of instinctual drives in terms of neurological reductionism is not

possible, however what are here described as instincts are likely centred on the
limbic structures involved in emotion, the hypothalamus and diencephalon, brain
stem (including the pons) and the cerebellum. At the same time, all instincts, as
here hypothesised, require activity of the cerebral cortex, since cortical activity is
necessary for all skeletal (voluntary) muscle contraction, and thus voluntary
movement, a pre-requisite for all behaviour. Cortical activity is also necessary for
visual, auditory, olfactory and other sensory perception, evidenced by the known
activity of the occipital, temporal and parietal lobes. The model hypothesises,
though, that instinctual drives (including sensory instincts) promote development
of the cortex along with the central nervous system, more generally. It is also
hypothesised that instinctual drives promote motor development as well as
cognitive skills, emotional development and other complex aspects of human
learning and behaviour.

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PHYSICAL/MOTOR INSTINCTS
Evidenced by so-called primitive reflexes in newborns and behaviour of infants:
Stepping
Grasping
Sucking/rooting
Stretching (spine, limb extension)
Withdrawal from heat/cold/pain
Breathing
Vocalisation
Crying
Facial expressions

SOCIAL and SURVIVAL INSTINCTS

Evidenced by cross-cultural behaviour of infants:
Exploratory (including crawling, climbing)
Security-seeking
Identifying sources of danger (see sensory instincts below)
Pushing/hitting
Communication
Play
Curiosity (instinctual drive for learning)

SENSORY INSTINCTS:
Listening (development of auditory circuitry)
Looking (development of visual circuitry)
Smelling/sniffing (development of olfactory circuitry)
Tasting (development of gustatory circuitry)
Touching
Proprioception
Kinaesthetic perception
Balance (involves proprioceptive, kinaesthetic, motor and vestibular
integration)

Postulates:

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1) Development of sensory neural circuits fosters development of aesthetic in

relevant sense. This presumably involves integration of sense-related
memories with emotion-related structures in the brain. Neurologically this
suggests integration with sensory cortex with limbic structures including
hippocampus, nucleus accumbens and amygdala.
2) Aesthetic can develop to greater or lesser extent regarding different aspects
of the sensory experience depending on experience and intrinsic factors.
3) Instinctual behaviour, relating to senses, is motivated by drive towards
pleasurable sensory experiences (hedonistic principle) and locating and
identifying sources of danger.
4) All sensory experience requires consciousness, implying activity of the
noradrenergic Reticular Activating System of the pons-medulla and other
neural structures involved in maintenance of attention and concentration.
5) Sensory experiences produce complex physiological effects mediated by the
hypothalamus, thalamus and limbic structures (see diagrams).
6) Loss or absence of particular senses (e.g. blindness, deafness) can result in
greater development of other senses.
7) Though instinctual drive for sensory development is universal, experience
(including acculturation) shapes likes and dislikes, or taste (aesthetic
development).

SOCIAL INSTINCTS EVIDENCED IN YOUNG CHILDREN

Language acquisition
Communication 1) verbal
2) non-verbal
3) artistic (see below)
Curiosity
Play
Dancing
Competition
Nurturing
Cuddling

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Empathy
Seeking approval
Avoiding disapproval
Ego defence
Seeking safety
Avoiding danger
Gathering/collecting/arranging

Postulates:
Social instincts as listed above are seen in other social mammals (and birds) other
than verbal and artistic communication.
Symbolic and semantic aspects of language acquisition are vastly developed in
humans even in comparison to our closest primate relatives (chimpanzees).
Nevertheless birds and other social animals do acquire the specific language of
the species concerned.
Curiosity may be broadly included in exploratory instincts, but greater
understanding of social and cognitive drives may be achieved by considering
social curiosity and intellectual curiosity separately from physical exploration (as
in behaviour of crawling infants).
Social instincts evidenced in infancy (such as communication by facial expression
and body language, crying and vocalisations) continue to be expressed, but in
increasingly complex ways during early childhood, influenced by conditioning
(including modelling).
What are described as artistic means of communication include musical
expression, drawing and painting, dancing etc.
The dance instinct appears to be a uniquely human attribute, though possibly
shared by some bird species that have been observed to spontaneously dance, as
humans do, in response to external rhythmic stimuli. These occasional
observations of bird dances in response to external music are not seen commonly
within those few species from which such behaviour has been reported. Though
bird courtship dances are certainly instinctual, the human dance instinct (dancing
in response to external music) has likely developed under different forces of
natural selection (these are explored in my 2002 book Music and the Brain).

COGNITIVE INSTINCTS EVIDENCED IN YOUNG CHILDREN

Creation of mental associations
Intellectual curiosity

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Logical thinking recognition of cause and effect

Counting
Arranging
Pattern recognition
Symbolic thinking (including semantics, essential for verbal language)
Abstraction (development in later childhood)
Selective memory for important/relevant learning experiences
Mimicry (mirroring)
Self-awareness (self-consciousness increases with maturity)

Postulates:
Cognitive instincts, like all instincts, evolved under forces of natural selection, and
confer a survival advantage to individuals and/or the human species.
Creation of mental associations is fundamental to learning, memory and human
intelligence more broadly. The mental associations that develop throughout life are
individually different and unique, depending on conscious, subconscious
(preconscious) and unconscious experiences (including dreams).

INSTINCTS SUGGESTED BY BEHAVIOUR OF CHILDREN AND ADULTS

Mothering (includes nurturing/protection of family/nesting)
Fathering (includes nurturing/protection of family/nesting)
Sexual (see postulate 2 below)
Competition (climbing the pecking order see below)
Play (see postulates below)
Territorial defence/aggression (see postulates below)
Seeking revenge/retribution
Exploring (first seen at crawling stage)
Climbing (first seen in early childhood also in other predators)
Hunting
Gathering
Bathing (see postulate below)
Seeking truth
Seeking justice (sense of fairness)
Seeking meaning/understanding

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Seeking love
Doing good (altruism)
Creativity (see below)
Sense of time and timing
Sense of direction

Postulates:
1. Some instincts have evolved that are only expressed, or fully expressed, in
mature adults. Such is the case throughout the vertebrate and invertebrate
animal world.

2. The existence of sexual instincts and drives is obvious, and is a central

feature of Freuds psychoanalytical model. It is important, however, to
distinguish between different motivations for what might be broadly classed
as sexual instincts. Sensory gratification/enjoyment, need for intimacy,
desire to have children and peer pressure can all motivate sexual activity.

3. A competitive drive or instinct is evident between siblings, who often

compete for parental approval. It is also clearly evident in young children
playing together, and more so in the behaviour of adults. Because
competitiveness is strongly promoted in educational systems around the
world, and parents often consciously or subconsciously encourage their
children to become more competitive (by doing well at school, well at
sports etc.) competitive instincts may be exaggerated in modern society.

4. A competitive drive can be readily observed in other mammal and bird

species (and elsewhere in the animal world) especially when it comes to
impressing potential mates. This instinctual drive is obvious in adolescent
and adult behaviour of both sexes (though usually manifest differently
between the genders, and strongly subject to cultural and familial
influences).

5. The instinct for play, listed as an instinct evident in early childhood,

continues into adulthood, though some adults are more playful than others.
Adult play may be competitive or non-competitive, and might be regarded to
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include playing music and musical instruments. Development of sense of

humour, including word play, might be thought of as a function of this
instinct. It is reasonable, however to consider a musical instinct distinct
from other play.

6. Territorial behaviour is seen in adults of most mammals (and many other

vertebrates and invertebrates). Territorial instincts can be expressed as subtly
as establishing body space to warfare between tribes and nations.
Territorialism is common in trades and professions, and is a major cause of
human conflict. Territorialism may be defensive or aggressive. Aggressive
territorialism is a feature of empire-building (by nations, or by corporations,
institutions and organisations, including educational, financial, military,
political and religious organisations).

7. A drive for retribution for personal and family injustices, or perceived

injustices is seen cross-culturally, and though it may be more obvious in
adults, may be seen in children too. How, why and whether
retribution/punishment is sought is strongly culture-dependant.

8. An instinct for exploration might be seen as an aspect of a broader curiosity

instinct, however physical exploration can be regarded as distinct from
intellectual and social curiosity, for example. An instinct for physical
exploration is of benefit to societies (and family groups) but is
counterbalanced by the inherent dangers in physical exploration of the world
(intellectual and social curiosity also have their dangers, of course). The
prominent characteristic humans populating all corners of the world is
evidence of an instinct for exploration. The excitement of both danger and
discovery provide an emotional drive for this instinct. The need for food,
water, shelter, and aesthetic (beauty) etc provide impetus for exploration.
Physical exploration is also driven by benefits achieved by improving
vantage points (including climbing trees, hills etc).

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MUSICAL INSTINCTS

Baila dancing and the Peacocks Tail

The only time I played the piano for my own enjoyment as a child was when I tried
to play bailas. The term baila, meaning dance, was adopted from the Portuguese
who introduced this Latin rhythm to Ceylon when they conquered the coastal parts
of the island in the 17th century. Since then, bailas have become the most popular
folk music in Sri Lanka, sung in the Singhalese language by an assortment of
young and ageing men, but rarely women. The reason for baila singing being a
dominantly male activity is not entirely clear to me, but it may have something to
do with peacocks, and their outsized, colourful tails. At least, thats the argument
currently being put forward by a well-known American cognitive psychologist to
explain evolution of the human music instinct.

Geoffrey Miller, an associate professor of psychology at the University of New

Mexico, argues that our minds evolved as courtship machines rather than just
survival machines. He believes that excessive focus on survivalist
explanations, rather than what Darwin called sexual selection through mate
choice, has resulted in failure to explain the more ornamental and enjoyable
aspects of human culture. These, he lists, in The Mating Mind (2000) as art,
music, sport, drama, comedy and political ideals. By focusing, instead, on the
sexual choices our ancestors made, the evolution of these human abilities can be
better explained.

The evolution of the peacocks tail is the classic example used by Miller to
illustrate the difference between adaptations for survival and adaptations for
courtship. Cumbersome tails pose a clear disadvantage when it comes to escaping
from predators. The peacock has evolved its beautiful tail because peahens find
such tails attractive.

I read some years ago that peahens find most attractive the males with the largest
and most immaculate tails because the peacock overcoming the disadvantage of its
over-sized tail advertises his fitness to the peahens. Miller has a more
aesthetically-oriented view. He explains that the peacock tails biological function
is to attract peahens and they have evolved bright plumage with iridescent blue
and bronze eyespots because peahens preferred larger, more colourful tails.

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Miller suggests that the human minds most impressive abilities are like the
peacocks tail: they are courtship tools, evolved to attract and entertain sexual
partners. The evidence he uses to support his claim that music is one such ability
includes the numerous sexual liaisons of certain famous rock musicians. Miller has
also done psychological tests he interprets as showing that women prefer to have
sexual encounters with men who show creative intelligence ahead of material
wealth during their peak fertility more so than at other times of their menstrual
cycle, in addition to a study revealing that lap dancers made more money at the
time of ovulation.

Miller makes a valid point, which he acknowledges was raised by Darwin himself.
However long an organism lives, if it does not produce any offspring it will not
contribute to the genetic inheritance of the next generation. At the same time he
risks over-emphasising the role of attractiveness to mates in the evolution of
musicality. In supposing that music evolved and continues to function as a
courtship display, mostly broadcast by young males to attract females Miller
ignores the fact that across cultures and continents mothers are lulling their babies
to sleep by singing to them, people of all ages are singing together and sharing
music with their family and friends, while others are singing, playing various
instruments or listening to music all by themselves, just for the pleasure of doing
so. Meanwhile, as they have done since ancient times, young men are preparing
for, or marching to, war to the steady beat of drums.

In some ways the Singhalese version of the baila is a classical courtship dance,
similar to that of birds. Men compete to impress the ladies by striking often
comical poses while dancing to the upbeat, syncopated rhythm. This rhythm is
often, at the parties where a baila session extends into the early hours, played on
the spoons. A good spoon player is always in demand at such parties. Much
music and musical activity, however, does not appear to have much to do with
courtship, and more to do with socialisation and social bonding. Even bailas, as
played in Sri Lanka, are more to do with having fun and sharing the experience of
dancing, singing and playing together than procreation.

Hot Debate about Evolution of the Music Instinct

Charles Darwin believed that the human music instinct evolved because it provides
an advantage in courtship and hence reproductive success. This is undoubtedly

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the case in bird song and dance: it is well-established that many male birds dance
to impress potential mates, and the complexity and beauty of their dances is
obvious even to human observers. Birds sing for many reasons, and courtship is
one of them. These facts support Darwins idea that our music instinct provides an
evolutionary benefit by making us more attractive to the opposite sex. However, a
closer examination of human musical behaviour and that of birds suggests other
factors that may have contributed to the evolution of this instinct.

To understand the evolution of our music instinct, it helps to define the terms we
are using. This is not easy, when it comes to music or instinct or evolution, for
that matter. Darwinian use of the term evolution is not the only reasonable one
when it comes to music. Music itself has evolved, and continues to evolve, in a
more Lamarckian than Darwinian manner. The next generation inherits the
acquired characteristics of the previous generations, as Lamarck had proposed in
his competing explanation for why the giraffe has a long neck. Though the French
zoologist was wrong in his analysis, believing, as he did, that the effort of
stretching its neck to get at the high leaves led to the giraffes offspring having
longer necks, when it comes to music, language and so-called cultural capital,
evolutionary change occurs much faster than biological, as in genetic, change.

Instinct theory in scientific academia has waxed and waned, and is currently
increasing in popularity again. Not long ago many textbooks, especially those
leaning towards behaviourism, limited possible instincts to basic drives for
homeostasis, feeding and sex. This narrowed definition was hardened by the
assertion by the Nobel-prize-winning zoologist Konrad Lorenz that instincts are
characterised by what he called fixed action patterns. Lorenz, who achieved fame
for his studies of imprinting goslings, is the scientist who first demonstrated that
birds (he studied geese) would follow and later attempt to mate with the first
creature they lay their eyes on after they hatch out of the egg. By his definition
(which was repeated in many a sociology and psychology text in the 1960s, 70s
and 80s) humans have no instincts as such (fixed action patterns like coughing,
sneezing and withdrawal from pain are reflexes rather than instincts). The building
of nests and courtship dances of birds do qualify as instincts by Lorenzs definition
but the building of houses and human dance is not instinctual, since such
behaviour is not fixed. By this narrow definition humans have no evidence of a
music instinct, nor can such things as curiosity and play (or language) be regarded
as instinctual.

In the hypotheses that will be proposed, what I mean by the music instinct is the
innate tendency and ability the capacity we have - for appreciating, analysing and
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creating music, for feeling intense emotions, and the urge to move, pleasurably, in
response to music.

In Origin of Species (1859) Darwin devotes an entire chapter to instinct, though

he focuses on only two of the most wonderful instincts with which we are
acquainted. These turn out to be hive-making by bees and the slave-making
instinct of certain species of ant.

In The Descent of Man (1871) the father of evolutionary biology had more to say
about the music instinct. He hypothesised that musical notes and rhythm were
first acquired by the male or female progenitors of mankind for the sake of
charming the opposite sex. Thus, wrote Darwin, musical tones became firmly
associated with some of the strongest passions an animal is capable of feeling, and
are consequently used instinctively.

Darwins Strongest Passions

Whether or not Darwin meant by musical tones (which become firmly

associated with some of the strongest passions) the timbre of the music, melody or
music more generally, he is clear about the emotional impact of music. As
everyone knows, music can have profound effects on emotions.
But what are the strongest passions, and in what way could humans use musics
ability to rouse the passions instinctively? Many people in modern society might
tend to think of love and hate as the strongest passions and certainly music can
stimulate these strong emotions. Bliss is another strong passion. Music can
certainly cause bliss, and any degree along the spectrum of pleasure intensity
including joy, elation and ecstasy.

The obvious way in which this emotion-manipulating tool can be used is to arouse
bliss and love for the music in the mind of the person being courted. Sing a love
song to the object of ones affections, take them to a cool (or hot) gig, or give them
an album theyll love, in modern terms. In Darwins day it might have been
singing and playing the piano, or maybe taking ones intended to the ballet or opera.

Another strong passion that can be aroused by music especially when

accompanied by appropriately rousing lyrics is pride, including patriotism and
pride in the group sharing the song. This less benevolent property of music has also
been used since time immemorial to unite people in a single repertoire sung in

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unison under a single flag, and ruled by a single king, emperor, tsar, politburo or
pope. Oliver Cromwell exhorted his roundhead army to sing Christian hymns as
they charged in a killing frenzy. The soldiers of countless armies have marched to
the steady beat of drums the drummer boy was a vital part of the infantry through
the centuries of European colonial expansion.

In The Expression of the Emotions in Man and Animals (1872) Darwin makes it
clear that he regards the expression of emotions (though not necessarily
recognition of the emotions that are felt) as instinctual. In this book he discusses
the physical expression (in terms of facial expression and body language) of
various emotions, including fear, terror, anger, rage, joy, love, jealousy and
sympathy in humans of various races as well as higher and lower animals. The
cross-cultural similarity of emotional expression, Darwin concluded, indicates that
all the human races originated from the same species of proto-human, rather than
from different species, as some biologists of his day were maintaining. He also
uses the term passion to refer to any strong emotion, including rage.

Music can elicit many strong passions, from the most pleasant to the most
unpleasant. Playing music people hate repeatedly, and loudly, can drive them mad,
and certainly cause rage. In fact, even playing a piece a person loves continuously,
especially at high volume, can cause terrible mental anguish. This distress can be
compounded by playing the music through speakers that distort the sound, and by
restraining the person so they cannot escape the music. Such use of music has
also been studied scientifically, and is one of the so-called soft torture techniques
reportedly used in the American military prison camp at Guantanamo Bay.

Darwin may have been looking at music through rose-coloured glasses when he
proposed that music evolved for courtship. Maybe it evolved for war? Maybe it
evolved for many reasons, including courtship and war, the promotion of social
cohesion, soothing infants and the development of complex mental and physical
skills. Maybe our musical instincts evolved because of health, and therefore
survival, benefits appreciating and creating music have conferred on our ancestors
(they evolved because music is good for our health, in other words). Maybe human
musicality evolved because of an evolutionary advantage conferred on individuals
who were good mimics, capable of convincingly mimicking the sounds of intended
prey (including birds) and a stable bipedal gait enabling them to run for long
distances (unlike other primate species).

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A dancing cockatoo contributes to the instinct controversy

Chimpanzees and other primates do not respond to rhythm as we do. Though it

may be possible to train a chimpanzee of monkey to dance (or a horse or dog,
for that matter), this is very different to the spontaneous rhythmic movement in
response to the music that we see in human babies and infants. Our human ability
to dance and create music is rivalled only by that of birds, and one bird in
particular, a Sulphur-crested Cockatoo by the name of Snowball.

You can see Snowball on You Tube. He is quite a celebrity, and has even been on
the David Letterman show.

Snowball, the dancing cockatoo, now eleven years old, has enjoyed serious
scientific study by psychologists at Harvard and MIT. Ironically, this extraordinary
parrot is being used to bolster the claim that music does not provide any
evolutionary benefit to humans (or parrots) at all. According to an influential group
of linguistically-oriented cognitive psychologists in the USA, music is what the
zoologist Stephen Jay Gould called a spandrel a behaviour that came along for
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the ride, as it were - what Steven Pinker at MIT has described as auditory
cheesecake. In the opinion of Pinker there is no music instinct. We are able to
create and appreciate music because it is processed by neural structures that
evolved to enable language. Acquiring language is instinctual, but enjoying music
is not, according to this eminent psychologist.

How can a dancing cockatoo, however famous, be used to bolster Pinkers

auditory cheesecake hypothesis? The answer can be found in a recent paper
based on the scientific study of this particular, unusually gifted, bird.

The Elsevier journal Current Biology contains, in its May 2009 issue, a paper
entitled Spontaneous Motor Entrainment to Music in Multiple Vocal Mimicking
Species. The study, conducted by Adena Schachner and colleagues at Harvard,
was quite delightful, and involved searching You Tube for dancing animals, and
analysing whether they move in time to the rhythm of the music. They looked at
thousands of videos and found a handful of creatures that convincingly danced in
time to externally-generated beats (within music). Fourteen of the fifteen were
parrots, including the amazing Snowball, who had been previously studied by the
MIT neuroscientist Aniruddh Patel. The fifteenth dancing creature was not a parrot
or a bird (many species of which are famed for their dancing ability, though not in
time to external rhythms) but an elephant. No further information is provided in the
paper about this apparently dancing elephant, although elephants are listed, along
with various members of the parrot family, magpies, hummingbirds, sparrows,
whales and bats, as vocal mimics.

The claim, it turns out, that elephants are capable of vocal mimicry comes from a
2005 Nature article (consequently publicised in a Scientific American article) about
two elephants in captivity, one in Kenya and one in Switzerland. The Kenyan
elephant (called Mlaika) was found to be mimicking the sound of moving trucks,
while the Swiss pachyderm (Calimero, by name) was observed to make the typical
calls of Asian, rather than African elephants. Calimero was a 23-year-old African
elephant that had been in a Swiss zoo for 18 years, and shared a compound with
two female Asian elephants. The authors claimed that this discovery in elephants
is the first example of vocal imitation in a nonprimate terrestrial mammal. Such
mimicry is, though, a far cry from the sophisticated vocal mimicry demonstrated
by many birds, and by human beings.

None of the rhythmically responding animals were non-human primates. Though

monkeys (like parrots) were among the first human pets, only parrots are known to
dance in time to human-created beats (or any other pulsed acoustic stimuli). For
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centuries, circus trainers and street entertainers have been trying to convince
audiences that they possessed dancing animals dogs, monkeys, even horses.
These animals, though, are trained to perform according to visual and other non-
auditory cues. Their movements are then synchronised with the music.

The authors of Spontaneous Motor Entrainment to Music in Multiple Vocal

Mimicking Species claim their evidence of entrainment (to external rhythm) in
non-human animals supports the recent hypothesis that human entrainment
capacity evolved as a by-product of our capacity for vocal mimicry. When you
realise they are talking about human capacity to dance, sing, drum and play
musical instruments in time as human entrainment capacity, the claim that
shared tendency to dance between humans and parrots is not just connected, but
that human musicality developed as a by-product of vocal mimicry appears to be a
rather long shot. Even if it were true, it does not necessarily follow that musicality
confers no evolutionary benefit.

Schachner and her co-authors authors claim their study of Snowball the dancing
cockatoo (described, with appropriate subject confidentiality as subject 2) and
subject 1, a less accomplished, but also thoroughly-studied, African grey parrot,
lays to rest the misconception that aligning movement to an external auditory pulse
is uniquely human. In the article, this ability to align movement is thenceforth
described as entrainment; their quest being to find animals that could be
entrained to align movement to auditory pulses dance in time to the beat, in
other words.

Subject 1, the African grey parrot, is also a famous bird, and had been trained and
studied for many years by one of the co-authors, Irene Pepperberg. His name was
Alex and study of his extraordinary linguistic and cognitive abilities was
interrupted by his unexpected death during the course of the experiment. This bird
was able to name objects according to colour, number and composition (naming
wool, wood, paper, etc) and demonstrated ability for more than mimicry he
clearly understood a limited vocabulary of (English) words and was able to apply
this knowledge with intent to communicate specific wishes. When Alex died after
30 years of study by Pepperberg, she demonstrated his language-acquisition
capacity was not unique by training another African Grey parrot, Griffin, to
understand and speak a smaller number of words and phrases. Pepperberg can be
seen in the photo below with Griffin. The others are photos of Alex the famous
talking parrot.

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Griffin and Alex can be seen in You Tube clips clearly expressing their wishes in
English with broad American accents. Go back now, give me water, pick up
corn were three of the phrases Alex used in one of the many clips featuring this
linguistically-accomplished bird. Though it was not mentioned in the paper, Alex,
who was trained and studied by Pepperberg at Brandels University for thirty years,
was such a
famously
gifted bird
that his
death was
reported
on CNN.

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Adena Schachners team from Harvard and MIT analysed the movements of these
two birds (Snowball and Alex) under controlled conditions, presenting novel music
to the famous parrots. After videotaping the parrots dancing to external auditory
pulses (music with a strong beat), they analysed their movements in extraordinary
detail to establish that the birds kept the beat more reliably than would be expected
at random (using sophisticated statistical analyses). This demonstrates the
difficulty in proving the visually obvious in numbers and statistics. All one has to
do, to establish beyond doubt that Snowball the dancing cockatoo is a groovy
dancer who keeps better time, and has more ingenious dance moves in his
repertoire, than a great many humans, is look at the several videos of this avian
celebrity on You Tube.

Having demonstrated, statistically, that these birds were certainly bobbing their
heads in time to the music, and that Snowball also displayed foot-lifting
movement in response to the music, the authors argue that:
Claims of human uniqueness are defeated by even one well-documented
case study demonstrating the existence of the capacity in a non-human
animal; here we report entrainment in two non-human subjects. These data
rule out the claim that entrainment is unique to humans and provide initial
support for the hypothesis that vocal mimicry is necessary for entrainment.

This hypothesis, the summary introducing the article explains, was proposed by
Aniruddh Patel in 2006, in a paper entitled Musical rhythm, linguistic rhythm and
human evolution (published in Music Perception in September 2006) and a book
published by Oxford University Press in 2008, Music, Language and the Brain. In
the first of these references Patel introduces the subject as follows:
There is now a vigorous debate over the evolutionary status of music.
Some scholars argue that humans have been shaped by evolution to be
musical, while others maintain that musical abilities have not been a target
of natural selection but reflect an alternative use of more adaptive cognitive
skills.

Patel cites as one of the skeptics the head of cognitive psychology at MIT,
Steven Pinker, who has been arguing that music is an enjoyable mental
technology built from existing cognitive skills since 1997. These thinkers,
writes Patel, echo the sentiment of William James, who said that love of music is
a mere incidental peculiarity of the nervous system with no teleological
significance . The debate (such as it is, given that William James is said to have
been tone deaf) can be resolved, writes Patel, by adopting an approach advocated
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in two 2005 articles in which efforts are made to determine whether there are
fundamental aspects of music cognition which are innate and which cannot be
explained as byproducts or secondary uses of more clearly adaptive cognitive
abilities such as auditory scene analysis or language. This approach had been used
to relegate pitch discrimination to a by-product of language evolution, according to
Patel, and he hoped to apply the same approach to musical rhythm.

In the last chapter of his thought-provoking and informative This is Your Brain on
Music, McGill Universitys Daniel Levitin convincingly argues against Pinkers
auditory cheesecake claim, and the contentious claim that musicality does not
confer any evolutionary benefit. Levitin mentions several possible reasons for
evolution of a music instinct suggested by different theorists over the years,
including Darwins sexual-selection hypothesis. These include social bonding and
cohesion, and general promotion of cognitive development. The evidence he
presents in support of a music instinct (rather than music being a spandrel or
auditory cheesecake) includes the fact that music has been a ubiquitous part of
human society, across cultures and across the globe, for millennia. Also, there is
considerable evidence that though some neural structures are involved in
processing both music and language, others appear to be devoted specifically to
music. Further evidence supporting different neural substrates for music and
language is the well-documented (but uncommon) observation that brain damage
(usually from strokes) can result in loss of ability to speak (aphasia) but not to sing,
and vice versa.

Why cant chimpanzees keep a groove while parrots can?

Recently, comparative studies using modern genetic techniques have been

employed to try and elucidate the differences in gene expression in various primate
brain structures, in order to understand their evolution. These studies are largely
focussed on what has long been regarded as a unique human capacity for language
acquisition and use. Comparing human brains with the brains of chimpanzees, our
closest living primate relatives, is also one way the evolution of human musicality
might be explored, since chimpanzees can neither sing in tune nor dance in time,
even with years of training. Yet parrots can. What do our brains have in common
with those of parrots, that we do not share with chimpanzees?

There was a startling increase in size in the brains of our distant ancestors between
2,500,000 years ago and 200,000 years ago. During this period of time the hominid
brain increased in size by almost 300 percent, in terms of weight, but considerably
more in terms of potential complexity. Though all parts of the modern human brain
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are bigger than their equivalent in chimpanzees (our brains are twice as big) some
brain structures are disproportionately so notably parts of our frontal lobes
(outlined in red in the illustration).

Though not as dramatic, the human

temporal lobes, especially the
superior temporal gyri (green in the
illustration) are also large compared
to those of the chimpanzee. The
superior temporal lobes contain the
primary and secondary auditory
cortex, cortical areas known to
processes all sounds including
music, speech and sirens.

Though chimpanzees have brains

that are structurally similar to our
own, they do not demonstrate what
might be reasonably called a music
instinct. Of course, there are
significant differences as well, other
than the fact that the human brain is
considerably larger. These differences inform, and provide constraints for,
hypotheses about the neuropsychology and neurobiology of human music
perception and creation. The neural processing of music will be explored in
Chapter 3.

Of course, humans did not evolve from chimpanzees, but we did share common
ancestors, estimated to have lived 6 to 8 million years ago. If chimpanzees do not
possess music instincts, it can be assumed (with qualifications) that our common
ancestors did not either.

For many decades now, scientists have been trying to teach chimpanzees to talk
(usually in American-English) and to test their capacity for acquiring and using
language. Though, like parrots, chimpanzees are able to communicate using
arbitrary, learned signs and symbols, they are unable to use their voices to
communicate their wants, likes and dislikes, or to answers to the questions and
problems they have been tested on by experimental psychologists and other
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scientists over the years. This is thought to be because their vocal apparatus is
unable to create the range of sounds needed for speech. Parrots, on the other hand,
have a particular knack, even among songbirds and accomplished mimics, to
reproduce sounds similar to human voices. Though they tend towards a nasal tone,
they can mimic many different human timbres, for example the characteristic
timbral tones of different members of the household they live in. Capacity for
mimicry, though it may be a necessary precursor of language acquisition, cannot
be regarded as language unless it is used for communication, and even then many
would have reservations, arguing that language is much more than mimicry, even
if the mimicry is used for communication.

One essential difference between simple mimicry and proper verbal language
resides in semantics and understanding. The words and sentences mean something,
and the individual sounds, combined with each other in different temporal
sequences mean different things. Another difference is that while mimicry is
limited to repetition of the learned words or phrases, human language is
characterised by ability to use words and phrases in different combination,
extending them to create sentences of limitless variation. There is evidence,
though, that parrots, chimpanzees and probably many other animals are able to
understand words and simple phrases used by their human trainers.

The frontal lobes of the human brain are especially large compared to those of
chimps, especially the premotor cortex, the strip of grey matter immediately in
front of (rostral to) the motor strip. This suggests that humans have a far greater
capacity for planned actions, especially those involving the fingers, hands, face
(including mouth) and tongue, since movement of these body parts command
relatively large amounts of motor cortex (to which the premotor cortex is directly
connected, structurally and functionally).

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Fig 1. Motor homunculus in human brain. The main figure is a diagrammatic representation of a
section of the precentral gyrus (motor cortex) sectioned parallel to the central sulcus (separating
the frontal and parietal lobes). Identification of these areas and their corresponding motor
function was achieved by the Canadian neurologist Wilder Penfield who observed the effects of
electrically stimulating various parts of the human cortex in the 1940s. He used electrodes
applied directly to the brains of conscious patients and carefully noted which parts of the body
moved when he applied a weak current through them.

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Figure 2. Brain of chimpanzee, showing functional localisation in the motor cortex. It can be
seen, from comparison with figure 1, that, as in humans, the hands and face (including tongue)
occupy a large area in comparison with the body (trunk) reflecting greater muscular control of
these areas. The unshaded area immediately in front of the motor cortex is the premotor cortex.
This is considerably larger in humans than chimpanzees, relative to the total size of the brain.

The large size of the pre-motor areas in the human brain are consistent with the
view that intelligent, pre-planned, voluntary movements are particularly (if not
uniquely) human attributes. The intelligent use of tools, including those used for
hunting probably played a key role in human evolution including evolution of the
brain and the body parts it controls. Dextrous opposable thumbs and fingers
capable of writing, drawing and playing musical instruments may have evolved for
efficient gathering as much as for hunting and tool-making, perhaps more so.
Again, comparisons with chimpanzees, which also hunt and gather but do not
show the acquisitive tendencies of humans may be informative. As far as gathering
is concerned, humans are experts among animals. We also seem to have an
instinct for gathering things we regard as valuable/useful/beautiful and arranging
them in ways that delight us. Infants do this, and so do collectors and musicians.
Rather than tangible objects, musicians gather and arrange sounds, but the
principle is the same in several respects. A mental capacity and tendency to
arrange and organise objects to create visible beauty is art, doing the same thing
with sound is music.

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The human vocal apparatus is unrivalled among terrestrial mammals, in terms of

the range of pitches and tones we are capable of producing. Without the wide range
of sounds we can produce, and the accuracy of pitch most humans can control,
singing would not be possible, and our capacity for spoken language would be
hugely impoverished. The fact that our vocal apparatus is so much more
sophisticated than that of chimpanzees, our closest primate relatives, is generally
regarded as one of the primary reasons that chimps cannot speak, despite their
ability to use abstract symbols, including sign language, for communication.

Despite understanding many words and phrases, no chimpanzee has yet been
taught to produce anything resembling human speech, although the brain of a
chimpanzee is very similar to our own. This is remarkable because, as has been
recently confirmed by the American scientific establishment, parrots, whose brains
are very different to ours, are capable of talking meaningfully and dancing in time.

The intelligence required for tool development and use is not, in itself, adequate to
explain our musical or verbal capacity. Many primates (including all the large
apes) and birds are known to use tools, and make rudimentary tools. Chimpanzees
break off twigs, and strip them of leaves, to flush termites out of a nest, for
example. Stones are used by chimpanzees and many birds to break nuts and shells.
Though young apes (especially gorillas) are known to hit things rhythmically and
clap their hands at times, and male gorillas to beat their chests in order to impress
(again rhythmically), these abilities and the neuromuscular circuitry subserving
them, have not given rise to the tendency, so obvious in humans, to move
rhythmically - to dance - to the created rhythms.

Bipedalism and evolution of the human sense of rhythm

Balancing, walking and running on our hind-limbs are among a handful of abilities
that humans share with many species of bird, but not with other apes. It is
obviously of great survival benefit to be able to run fast if one is a hunter (or a
hunters prey). Running tests endurance and ability to run fast, and run great
distances displays physical superiority both likely to be selected because of
societal approbation as well as sexual attractiveness (judging by their fan clubs and
star status athletes continue seen as sexually desirable along with musicians and
actors). Among the 4000 or so known mammals, Homo sapiens is the only living
species of mammal that can run on two legs, though most mammals can run (or
jump) rhythmically on four. Not only do humans run, we run for the pure
enjoyment of running, and do so even as young children. In fact, as soon as we are
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able to run, we have an urge (which usually increases in early childhood, with
increased motor skills, and then diminishes with age, and loss of them). Running
is, in other words, instinctual in humans.

Walking on our hind-limbs is obviously instinctual, and provides a possible clue to

why humans and parrots dance, but chimpanzees do not. The rhythms of our gait
alternating our weight from left to right, and stepping forward are controlled by
circuits that can be over-ridden voluntarily, by action of the motor cortex, but when
we are not so exerting our will, once we decide to start walking it becomes
automatic. We do not need to concentrate on moving our feet correctly to walk,
unless suffering from specific neural deficits. The brain structures that evolved to
control walking and running are shared by other mammals, birds and reptiles the
cerebellum, the pons and brainstem to which the cerebellum is attached, the red
nuclei (which lessen in prominence in higher vertebrates, with increasing
development of the motor cortex), and the basal ganglia.

The cerebellum, pons, brainstem, midbrain, basal ganglia, thalamus and

thoroughly-studied parts of the frontal lobe of the brain (including the motor
cortex) are the main structures involved in dancing, as well as walking and
running. The role of these neural structures is well-established as far as walking
and running are concerned, because it can be proved by selectively damaging these
areas in chimpanzees, monkeys, cats, dogs and rats, which share these
phylogenetically ancient structures. The same structures exist in the brains of birds,
and are proportionally larger in bird brains than those of mammals.

These structures, which evolved to control our gait and coordinate our movements,
probably played a key role in subsequent evolution of the music instinct
especially in the evolution of dance and our capacity to create and respond to
rhythms. The brains of birds are endowed with these structures, as are those of all
mammals, but birds and reptiles do not have a cerebral cortex. In fact, the
cerebellum and basal ganglia constitute a considerably larger portion of a birds
brain than that of a monkey or man (partly because the volume of primate brains is
dominated by the folded layers of cerebral cortex, which birds lack).

Fig. 3

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Figs 3 and 4: Two views of the

right side of the human brain. In
the lower illustration, the lateral
part of the cortex has been removed
Fig.4
to show the location of the three
major input nuclei of the basal
ganglia. These are the putamen,
caudate nucleus and nucleus
accumbens. F

Nucleus Accumbens
Nucleus Accumbens

The motor cortex, discussed earlier, is only one component of the primate brains
motor system. The motor strip is intimately connected with the other major
components, including the basal ganglia and cerebellum, which play key roles in
regulating the movement and learning new motor skills.

The cerebellum is known to be centrally involved in both correcting and learning

movements, and is thought to function as a time-keeper, though the details of
how this function is achieved are uncertain. There is an accumulating body of
evidence that the cerebellum is also involved in emotional reactions, and especially
pleasurable responses to rhythm. Fascinating research by Daniel Levitin and
colleagues at McGill has shown that cerebellar activity (on fMRI scans) increases
when people listen to pleasurable rhythmic music they have heard before, but not
when they listen to novel music, even if this music is experienced as pleasurable.
There are also neural structures other than the cerebellum that are implicated in
ability to maintain a steady beat. These include the basal ganglia and a specific part
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of the right parietal lobe known as the precuneus. These structures and the research
suggesting their importance in time keeping will be discussed in chapters 3, 9 and
10, in which I will attempt to integrate these findings in a holistic neurobiological
model.

Could musicality have evolved because it confers hunting advantages?

It is widely accepted that for tens of thousands of years, before the curiously
synchronous dawns of civilization in the Middle-East, Asia and America, all
humans were hunters and gatherers. Around the world hunters, mainly men,
provided essential protein for their kith and kin by stalking and hunting animals
(often large ones), while gatherers, mainly women and children, collected wild
grains, fruit, yams, roots, shellfish other edibles of untold variety. This hunting
lifestyle obviously shaped our evolution, and our genetic inheritance.

The earliest of human art, and anthropological study of modern hunter-gatherer

societies, attest to the importance accorded to a successful hunt, and the
development of hunting skills, especially among males in the society. One of these
essential skills, one that every experienced hunter is aware of (if not accomplished
in) is how to attract birds and other potential prey by imitating their calls,
especially their mating calls. Is it possible that the unique human vocal apparatus,
notably the extra-ordinary control we have over tongue, cheek, larynx and
diaphragm, and the anatomical differences in our voice box (lower position of the
hyoid bone and larynx compared to other apes) evolved because of survival (and
reproductive) advantages generated by our capacity to imitate birds?

After this possibility occurred to me I looked for similar hypotheses on the internet
and found none, but I did find many advertisements for gadgets that could be used
to imitate bird calls. These were clearly targeted at bird-hunters. There were CDs
complete with portable speakers, mechanical contraptions that could reproduce the
calls of dozens of bird species, and the older traditional bird-call whistles.

In the modern world there is also a small market for sophisticated portable units
that produce wild bird calls for less lethal shooters photographers, who have also
increasingly used the trick of attracting birds to be shot (with a telephoto lens).
Ornithologists and amateur bird-watchers have long used this open secret to get

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closer to birds or stalk them, using the hunting term that is often adopted by
photographers and bird-watchers.

Hunting and human evolution

Changes in dentition indicating a meat-eating diet is an important evolutionary

finding from comparison of Australopithecine and Homo erectus teeth and jaws.
The heavy brow ridges of Australopithecus (shared with modern day chimpanzees
and gorillas) are thought to relate to the strong muscles needed to crush hard
vegetable fibre. Though bipedal, the pelvis and lower limbs of Australopithecine
remains suggest that these 2 to 4-million-year old hominids, our likely ancestors,
were unable to run for long periods. This is an ability that evolved alongside an
increase in meat in our common ancestors diet, some time before Homo erectus
left Africa, 1.5 to 2 million years ago (or thereabouts).

Fossil remains of the prehistoric hominids Australopithecus, Homo habilis and

Homo erectus show a steady increase in cranial capacity, development of running
ability (evidenced by evolution of Achilles tendons, narrow pelvis and longer
legs), a diet including hunted meat, changed dentition and the possibly related use
of fire for cooking. Meanwhile stone tool-making evolved from virtual absence
among Australopithecines to the simple stone flake tools of Homo habilis and early
Homo erectus, to the considerably more sophisticated Acheulean culture (including
stone-axes, hammers and cleavers) of late Homo erectus. The tools of early Homo
sapiens show further refinement in comparison to those of Homo erectus. These
(relatively) suddenly became more finely crafted about 40 to 50 thousand years
ago, from which period the earliest cave art and bone flutes yet discovered have
been dated.

During this period of around three million years, cranial capacity increased,
according to the fossil record, from an average of 450 cc for Australopithecus, 650
cc for Homo habilis (dated between 2.4 and 1.5 million years ago), 750-1225 cc for
Homo erectus (1.8 mya to 300,000 years ago), to 1450 for modern Homo sapiens.
Early erectus skulls tend towards the smaller end of the range (750cc), while the
oldest crania identifiable as archaic Homo sapiens were closer to 1200 cc than the
modern average.

The size of the brain does appear to correlate with increase in intelligence in
hominid evolution, though it should be mentioned that there is a considerable
normal variation in brain size, as there is in height (the two are closely correlated,
of course). Consequently the average volume of mens brains is larger than that of
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womens, and those of people 2 metres tall are larger than those a metre tall. There
is no evidence that bigger brains correspond to higher intelligence in these
situations (though considerable time and effort were spent trying to prove such to
be the case in the nineteenth century).

The larger brain capacity of Homo erectus appears to coincide with migration from
the central forests to the open savannah of East Africa, and change of habitat such
that the forests where our ancestors lived were replaced by grasslands and open
scrub, where running became a more important survival skill. Fruits and vegetables
are less plentiful in drier areas, leading to a change in diet of our Homo erectus and
early Homo sapiens ancestors. Wild grains and hunted meat are two of the more
popularly imagined additions to the diet of cave men, and there is certainly
evidence of both being important factors in human physical and cultural evolution.
However, large game was probably less of an obsession to our ancestors 500,000
years ago than it was during the age of African big game hunting in the 19 th
century. Our distant ancestors were probably more interested in hunting smaller
and less dangerous quarry such as birds and their eggs, the very nutritious larvae of
beetles and other insects, and the rich pickings of the shallow seas and beaches of
the East African coast.

Discoveries of many species of avian bones from Neolithic cave sites, and the
more recent analysis of human coprolites (fossilised faeces) from later hunter-
gatherer cave sites indicate that birds have long been a source of animal protein in
the human diet (along with small animals including fish, rodents, lizards and
whatever small animals have been available for hunting). Particular types of birds
appear to have been favoured large flightless ones, doves and waterbirds,
including ducks, coots and geese amongst them.

The recent (2007) discovery by Jill Pruetz and co-workers of wild chimpanzees in
the Senegalese savannah making and using spears (for spearing bush babies)
suggests that the move from the forest to the open savannah may have provided an
evolutionary pressure for the human development of spears and similar (wooden)
weapons at an early date. Pruetz observed that these savannah chimps fashioned
spears and used them, whereas forest chimpanzees have not been known to (though
they do use other simple tools). Interestingly, it was mainly the female savannah
chimps that made and used the spears. The discovery of 400,000 year-old wooden
spears in Germany in the 1990s (presumably made by Homo erectus) further
supports the view that hunting has played an important role in human evolution.

Our hunter gatherer ancestors, who had to attract birds without the help of such
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modern technological wizardry as recorded bird songs and fancy playback devices,
would have been initially limited to use of their mouths and hands to create
convincing bird sounds. Later, they probably used simple tools like leaf-borders
and, later still, reed and bamboo flutes. It stands to reason that those who could
best reproduce the voices of birds would have been the most successful hunters,
enjoying the various benefits such status could be expected to bring. These include
both reproductive and survival benefits, as well as social benefits and survival
advantages to the (fed) group as a whole.

Of course, birds are not the only potential protein that can be attracted by
mimicking their voices, and the particular sounds they make at various times for
various reasons. Many mammals, such as deer, which have been hunted through
the ages, can also be attracted by mimicking their vocalisations. Also, being able to
reproduce the sound of a growling lion, tiger, bear or rattlesnake provides obvious
evolutionary benefits. Frightening off unwanted animals or humans by growling
and making frightening sounds is seen cross-culturally, and seems to come
naturally to us (in fact Darwin mentions the evolutionary benefit of such ability in
The Expression of the Emotions in Man and Animals).

Could it be that the vast range of sounds that human beings can make, ranging
from birds to bears, and dogs to dugongs, evolved because of a combination of
benefits in attracting mates and attracting (and repelling) birds and animals?

Of course, such a hypothesis does not explain the evolution of human musicality. It
may, however, contribute to an explanation of the huge differences in the anatomy
and physiology of our vocal apparatus when compared to our nearest primate
relatives. When our ancestors moved out of the forests into the open plains of
Africa millions of years ago, there would have been natural selection for those who
could run fast (rather than swing fast through trees), both for escape and pursuit.
There would also have been a selection advantage for those who could imitate the
sounds of the birds and animals of the areas they were migrating into, and the
cognitive skills enabling use of this physical capacity in intelligent ways
attracting birds, for example requires much more than the ability to mimic their
calls. One needs to recognise the difference between a mating call, social call and
an alarm call, and the intelligence to decide when to use each to best effect.

Our brains may also have evolved to experience the sounds of birds as exciting
partly because of our hunting instincts. In addition, survival advantages from
prowess at hunting may have promoted our distant ancestors ability to recognise
the same melodies and rhythms (initially of bird calls) in different pitches. A bird
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singing the same tune in a different key is likely to be the same type of bird. A
keen ear (auditory perception) for different timbre is also essential for the
recognition of different birds (and other hunting quarry) and would have acted as a
survival advantage. The ability to recognise as relevant the same notes for longer
duration, variations in melody (as many birds demonstrate in their song) would
also have been favoured by natural selection among our early hunter-gatherer
ancestors (recognising bird calls is also useful for locating the eggs of wild birds).
The timing and tempo of bird calls are also important for hunter-gatherers. A birds
alarm call is frequently similar to its other vocalisations but faster more urgent
sounding. Recognising such calls as a warning that a predator (or potential hunting
quarry) may be nearby is of obvious benefit to survival.

It is worth noting that though genes can only be transferred to the next generation
by individuals successful in producing progeny sexual selection in other words
any attributes that promote survival to an age of sexual maturity as well as those
that favour survival of the group (or species) will also evolve according to the
theory of natural selection as espoused by Darwin. In addition, those attributes that
favour survival to old age may be selected by social species such as ourselves,
where survival of youngsters, and of the group as a whole, are fostered by the
wisdom, knowledge and practical assistance of elderly individuals. Furthermore,
an adaptation that confers even a modest advantage (hunting birds, for example, in
a general context of hunting) will be naturally selected.

The small brain capacity of the 3 to 4 million-year-old hominid Australopithecus,

which was clearly bipedal, lends support to the theory that a large human brain
capacity developed after we started walking upright, rather than the nineteenth-
century assumption that our big brains came first. This evidence that upright
posture preceded the increase in brain size that distinguishes humans from other
primates (and other mammals) lends support to the hypothesis, proposed after the
discoveries of Australopithecine fossils by the Leakey family in East Africa in the
1960s, that our ancestors (and other extinct large-brained hominids) developed
large brains, and disproportionally large forebrains, because they had their hands
free. They were thus able to develop their use of tools, resulting in increase in the
size of areas involved in tool-making and use.

The earliest hominid stone tools have been dated to over 2 million years ago. Stone
tools have been found with fossils of Homo habilis and Homo erectus (but not
Australopithecus), further suggesting a connection between the increase in brain
size and tool use (the sophistication of tool use also corresponds with increase in
cranial size over hundreds of thousands of years of hominid evolution). Stone
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tools, however, were not likely to be the first tools used by our ancestors. Tools
(including reed flutes) and shelters made of leaves, twigs, and other perishable
materials do not survive long in the stratigraphic record. Tool use may have been
acquired before the vocal and mental skills necessary for conversation, or
language, as we understand it today. In all likelihood this early tool use preceded
our ability to create music but probably not our primitive sense of beauty in tone,
melody and rhythm. These may well have evolved when our ancestors were still
living in forests, surrounded by the sounds of tropical birds. It would not be
surprising if the songs of birds shaped our instinctual aesthetic regarding which
sounds we perceive as pleasant and which we do not.

The first musical instruments on which melodies could be played were probably
flutes. Prehistoric bone flutes have been dated to over 40,000 years ago, and it is
very likely that bamboo and reed flutes were invented before then. The sound of
such flutes has the timbre of bird voices, and they may well have been used to
attract birds. The melodies that the early flautists played would doubtless have
been influenced by the songs that trilled around the planet long before our
ancestors came down from the trees, where they had acquired their acute colour
vision (which primates share with birds, but not most other mammals). These
tunes, their melodies and rhythms, inspired by the most beautiful songs of birds,
would likely have won hearts in prehistoric times, just as they do today. Bird songs
would thus have contributed directly to the evolution of our music instinct, through
straightforward sexual selection. Women who could mimic the most beautiful
songs of birds, and embellish and vary, or just draw inspiration from them to create
their own unique songs would have enjoyed a similar benefit, in terms of
attractiveness to males.

Once such skills as playing flutes were acquired, competition for mates may have
driven the development of the human musical instinct in a more Lamarckian than
Darwinian way. At the same time, even in strict Darwinian terms, a strong sexual
preference for musical individuals could have resulted in intense selection pressure
and therefore rapid change in genetic endowment. Such rapid genetic change may
have occurred early in human evolution, or it may have occurred later, perhaps
explaining racial differences in musicality.

The evolution of our capacity for recognising and creating a large range of vocal
sounds, and to accurately control the pitch of these sounds, which I am suggesting
may have been contributed to by advantages for skilful bird-mimickers amongst
our hunter forebears, is a precondition for singing. It is likely that the beauty of
bird songs (at least our perception of them as beautiful) shaped the timbres,
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melodies and scales humans reproduced in their early musical attempts, as they
continue to today. Watching and hunting birds have doubtless influenced human
dance since prehistoric times. In this, and in many other ways, humans have drawn
cultural and artistic inspiration from birds much more than from our closest
primate relatives, chimpanzees, bonobos and gorillas. Singing or dancing like a
monkey, ape or gorilla brings rather less beautiful images to mind than singing or
dancing like a bird (not to say that birds do not perform comical dances).

Western classical music is full of references to bird songs, and it is even possible
that we love the scales we do because of the intervals between the notes birds tend
to sing (there are other theories, of course). From dancing the funky chicken and
European ballet to the traditional dances of Australian Aboriginals and Asian folk-
dances the movements, posture and gait of birds have provided examples of
elegance to humans (maybe not the Funky Chicken). The natural grace of birds is
equalled by few mammals and fewer reptiles and amphibians. It is a fact that
humans try to dance like birds much more than birds try to dance like us.

The preference for regular rhythms with a strong beat by the famous dancing
cockatoo Snowball indicates that such rhythms have cross species appeal. A
review of modern music from around the world suggests a cross-cultural human
preference for regular (but not monotonous) rhythms. Like Snowball, we also
appear to favour rhythms with components that are, like pitches, characterised by
simple ratios. The most popular music around the world is played in 4/4 or 2/4
time, with 3/4 (waltzes) and 6/8 (swing) less so. Not too many successful popular
songs are written in 5/4 time, and when they are catchy (like Brubecks Take Five,
or Everythings Alright from Jesus Christ Superstar) it is because the five beats are
broken into regular, repeating groups of 3 and 2. We do not often feel like tapping
our foot to a 5/8 or 7/8 rhythm. Within the meter, we also tend to enjoy regular
groupings of strong and weak beats. Though syncopated rhythms can be very
danceable, those with the most appeal as far as the dance urge (or instinct) is
concerned are regularly syncopated (such as various Latin rhythms).

There are some obvious reasons for a mental preference for regularity in rhythm,
and a preference for 2/4 and 4/4 time. One is our bipedal gait, and another is the
reassuring, calming effect of predictability. Regularity, or predictability, is of great
importance in aesthetic response we enjoy listening to music that satisfies our
expectations and anticipations. However, predictability, repetition and regularity in
music (and in other aspects of life) are paradoxical. Violation of expectations is an
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important pleasure stimulus when listening to music. People enjoy music that
contains melodic, harmonic, timbral and rhythmic surprises but not too many of
them. Too few departures from what is anticipated and the music sounds boring.
Here exposure to music is all-important. The music we have heard in the past
shapes our expectations what we predict we will hear as the musical piece
unfolds.

On the evolution of the human sense of rhythm

Clapping hands and banging objects to create rhythmic sounds are among an
infants earliest actions. Though chimpanzees can be trained to clap (for a reward)
and young gorillas do clap and hit their thighs repeatedly, as well as beat their
chests (as do male adults), they do not so in time, as (most) human toddlers do. By
the time they are three most young children can clap, or hit a drum, in time; many
express this instinct even earlier. Usually, before they can sing in tune (by 4 or 5),
most children can dance in time (2 or 3). Response to rhythm occurs even earlier in
human infants, and some studies have shown a preference for rhythm over infant-
directed speech in children under a year old. These observations suggest that the
human capacity to respond to and create rhythms is instinctual, in a way that is not
the case with chimpanzees, bonobos, gorillas or orang-utans (or by any other
primates).

The evolution of the human sense of rhythm remains a scientific mystery, though
recently considerable progress has been made in localising parts of the brain
involved in creating and responding to musical rhythms.

Of the main elements of music (rhythm, melody, harmony and timbre) rhythm has
been relatively neglected by psychologists and neuroscientists over the years. This
is partly to do with a tradition embedded in European classical music and a view
that serious (and therefore good) music should be food for the intellect rather
than the emotions (a reflection of the traditional dichotomy between thinking and
feeling). Though musicians and their audiences were certainly meant to feel
emotions at a classical music concert, it was not good form to jump around with
excitement that was for the common folk with their folk music. The influence
of Western classical music and this particular traditions great composers on music
perception and creation and on the neurosciences generally is to be expected, since
the scientific study of the brain and mind is centralised in the global university
system, which is dominated by the oldest universities in the biggest cities of the

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worlds most vociferous nations, each with their own classical musical heritage
to honour and proclaim.

Universities are conservative institutions, and like old men, the oldest universities
tend to be the most conservative, meaning tradition-bound (rather than any
economic connotation). This is not necessarily a bad thing the academic tradition
has a lot to be proud of, and to conserve. It can, however, lead to a narrowness of
view and reluctance to embrace new ideas, especially when they threaten the
existing curriculum, or opinions and interests of particular academics who have
established empires at that university. Like other hierarchical institutions, there is a
ladder to climb in universities, and each discipline or faculty provides different
ladders. The highest echelons of these faculties, especially in science, but also in
the arts, is dominated by men. Until very recently these men were among the
minority of the worlds population that listened largely, or exclusively, to classical
music. The research projects they approved were only those they could defend as
studying serious music. It should be remembered that until relatively recently
many of the worlds more famous orchestras were composed entirely of men (with
the interesting exception of harpists).

Since the 1960s and the ground-breaking work of Brenda Milner at McGill
University, women have been at the forefront of music neuropsychology. This is in
stark contrast to the medical profession, including the specialties of neurology and
psychiatry (the two specialities that might be expected to understand music and the
brain), which are dominated by men, especially in terms of senior academic and
research positions. Chauvinism may be a relevant factor in the shameful neglect of
music as a therapy and as a subject worthy of serious scientific study (and funding)
by the medical profession over the past half century. Unfortunately, in Australia
and many other countries (of which Canada is an exception) little public money, if
any, is used to fund music neuropsychology or music therapy research, and the
other major sources of medical research funding the drug companies are hardly
likely to sponsor research that might establish music as a serious competitor in the
therapeutic market.

The paradigm of modern neuroscience has emerged from a sometimes

uncomfortable integration of psychology, psychiatry and neurology with
pharmacology, evolutionary biology, biochemistry and biophysics. The fossil
record has underpinned the development of the modern neuroscience paradigm,
which has been especially concerned with those attributes that have been regarded
as uniquely human language, and intelligence as measured by various
behavioural tests in animals and psychological tests in humans. Though music
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has been regarded as one of a relatively small number of uniquely human

abilities, the use of psychological tests developed for other reasons being adapted
for research into the neuroscience of music has resulted in confusing and
contradictory findings, especially when it comes to the emotional reactions (most)
people have to music.

Human sensitivity to timbre and rhythm are fundamental to our musicality, and to
the sounds that make us feel like tapping our and feet, bobbing our heads, and
moving our bodies in time to the music. Harmony and melody may make us smile,
but timbre and rhythm make us dance.

It is precisely because of its primitive appeal, and its propensity to induce people
to gyrate their bodies in sexually suggestive ways that rhythm has long been
regarded as the least respectable of the elements of music. The angels in religious
paintings over the centuries were usually depicted playing harps, or at worst
trumpets, never drums. Drumming was associated with voodoo, black magic, black
people and the dangerous allure of hypnotic trances. Dark-skinned people dancing
semi-naked around an open fire in a frenzy inspired by sweat-covered men beating
drums was a familiar image Hollywood reserved to depict the savages in
Darkest Africa through the 1950s and 1960s, prior to the international explosion
of Rock and Roll. Rock changed everything when it came to what music and
musicians were venerated but the neuroscience establishments were, predictably,
not the first bastions to crack under the sonic onslaught of Rock. Rock music was,
and is, all about rhythm.

Its not that great grooves began with Chuck Berry and Rock and Roll. But the
popularity of Berry, followed by the fanatic enthusiasm for Elvis Presley and later
the Beatles and Rolling Stones brought Berrys rock version of the rhythm and
blues to a vast new global audience. The Beatles, in particular, inspired huge
numbers of young people to take up the guitar, bass and drums and form their own
bands in towns and cities around the world. When these pop musicians were
first featured on television variety shows and the radio was playing their recordings
there was predictable opposition from many conservative members of the older
generation who complained that the new music was loud noise, much as several
previous generations had regarded jazz, which is distinguished by complex,
syncopated rhythms in the melodies and in the rhythm section (bass and drums).
It was only in the 1990s that the Western worlds universities evolved musically to
a point where the senior echelons of the relevant faculties grew up on pop, rock
and jazz. Though music schools were slow to add jazz studies and its focus on
improvisation to their curricula, and slower to add rock and roll, the popularity of
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the guitar, more so than any other instrument, guaranteed that even academia had
to yield to the rhythm oriented music that has since transformed human culture in
the north, the south, the east and the west. All around the world musicians have
been incorporating guitars into their music.

The other standard instruments of a rock/pop band (originating from a format

shared between country, folk and blues, all of which contributed to the synthesis
Chuck Berry popularised as Rock and Roll) are bass (first acoustic, later electric)
and a drum kit. These instruments have also been incorporated into popular music
sung in hundreds of languages around the world.

The new generation of neuroscientists, brought up on a diet of beat-oriented music

has belatedly begun a serious, systematic study of human perception of the
temporal events of music using the most modern imaging techniques available
functional magnetic resonance imaging (fMRI) and positron emission tomography
(PET) being favourites. Though older investigations, such as surface electrical
readings (EEGs), these new (and relatively expensive) scans allow imaging of
increased blood flow to various parts of the brain. With careful experimental
design it has been possible to localise many of the brains musical functions,
though much remains unknown in this area (despite brain localisation of musical
functions being a popular research objective). One thing that has become clear is
that though small areas of the brain are primarily involved with music-related
functions (mainly in the right temporal lobe), most music cognition and creation
involves parts of the organ and networks that are used for other, non-musical
functions, including language, (non-musical) movement and the complex circuits
and neural structures that subserve our emotions.

In the past decade several facts have been established about the neural processing
of pitch, melody and rhythm, by neuroscientists in the USA, Canada and Europe
who were using a combination of new and older radiological techniques and a
human experimental population ranging from professional musicians through
students and members of the general public, to people with localised brain damage
(from disease and surgery). More is known about our processing of pitch and
melody than about rhythm, partly for the reasons mentioned, and partly because of
the deep structures that appear to be involved in our mental processing of time,
timing and rhythm. These structures, including the cerebellum and basal ganglia
are less accessible to testing by sticking electrodes onto the scalp or directly into
the brain, which has, until recently, been the mainstay of neuropsychology
research as far as brain localisation was concerned.

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In their 2005 review of the literature two of the worlds leaders in music
neuroscience, Robert Zatorre of McGill and Isabelle Peretz of the University of
Montreal report several important discoveries about the neural processing of
(musical) time relations. One is that creating a rhythmic pattern appears to be
processed more by the left side of the brain, while beat perception causes more
right-sided activity. This theory is supported by the fact that it is easier to tap a beat
with the left hand and a rhythm with the right (I tried it myself, and found it to be
true, at least in my case). The authors argue that this supports the hypothesis that
the right hemisphere handles meter, whereas grouping would rely essentially on
the left. The argument is that extraction of the beat from a piece of music (meter)
results in the metrical organization corresponding to periodic alternation between
strong and weak beats. Grouping, the function ascribed more to the left
hemisphere, is the segmentation of an ongoing sequence into temporal groups of
events based on their durational value.

Though the evolution of human musical rhythm remains unexplained, some light
may be shed on the matter by imagining what rhythms might have been heard by
our hunter gatherer ancestors, which of these might have excited their minds (and
nervous systems) and which rhythms might be expected to have calmed them. In
terms of the latter, rhythms reminiscent of the maternal heart beat and the rhythm
of calm breathing are likely candidates. The rhythms of flowing water, from drops
of rain dripping from a leaf or a trickling brook to the hypnotic decrescendos of the
oceans waves, might be expected to have been relaxing to our pre-musical
ancestors. As for exciting rhythms there are many possibilities, and the sound of
advancing and departing hoofs is among them. Such a hypothesis may explain (in
part) why crescendos in music have been observed to cause the heart and breath to
quicken (suggesting sympathetic nervous system activation). It is possible that the
sounds of birds (their calls and the flutter of their wings) are exciting to us because
of our hunter ancestry.

There are many other reasons, though, than vestiges of a hunting instinct, for the
evolution of musicality, and our sensitivity to, and excellent memory for, rhythms.
Looking at musicality as one of many social instincts might help explain the
evolution of the (almost) uniquely human sense of rhythm. Another obvious key to
understanding human rhythm and our instinct to move in time to the beat is
bipedalism. In walking and running comfortably on our hindlegs we share an
instinct with birds but not other mammals, including other primates.

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On the evolution of the human sense of harmony

Certain aspects of music temporally and melodically, are based on firm physics
foundations. What is a regular rhythm, or the pitch interval that constitutes an
octave are obvious examples. Also, in terms of melody and harmony, the intervals
that sound consonant are those with small ratios between their frequencies, while
those that sound dissonant have large ratios (the notes are close to each other in
pitch). Thus the intervals of the tonic with the fourth or fifth are naturally
consonant, and are seen in musical scales from cultures around the world. It is
interesting that recent observations of a young chimpanzee in a Japanese zoo have
indicated a preference for consonant over dissonant (classical) music. This
chimpanzee, named Sakura, was trained to activate consonant or dissonant music
by pulling a piece of string, and chose the consonant music significantly more
frequently.

It has also been shown that some birds can also recognise consonant versus
dissonant pitches, and to discern octaves, but a preference for consonant harmonies
was not demonstrated.

Did musicality evolve because it is good for our health?

All brains have intrinsic rhythms and human brains are no exception. In fact, the
human brain perceives time and rhythm with a sensitivity unmatched in the animal
world. Our sense of time has been profoundly affected by language, by music, and
by history. It is only recently, though, that scientific study has focused on our
perception of time and rhythm. These are important areas that impact on
fundamental aspects of human health, since the rhythms our brains and bodies
respond to can be of profound health benefit. Is it possible that our unique sense of

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rhythm and the urge to dance to particularly appealing ones, evolved because of
such health benefits?

This line of reasoning suggests an additional hypothesis to the theory that

musicality evolved to improve reproductive success directly through courtship
and thus likelihood of copulation. Musicality may have evolved partly because
music has healing effects on the body and mind. Because it hath charms to soothe
the troubled breast, as William Congreve put it.

On the relationship between language and music instincts

Of course, humans did not evolve from chimpanzees, but we did share a common
ancestor, supposedly 6 to 8 million years ago. If chimpanzees do not possess music
instincts, it can be assumed (with qualifications) that our common ancestors did not
either. It should be mentioned that one recent study of a Japanese chimpanzee

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named Sakura (published in the journal Primates in 2009) does suggest that
chimpanzees do have a preference for consonant over dissonant music, as do most
humans who are not tone deaf or, to use the medical terminology, suffering from
amusia. Recognising consonant over dissonant intervals (known to be a mental
capacity of birds but not of tamarin monkeys) is essential for musicality, but in
itself cannot be regarded as evidence of a music instinct. It has been found that
playing Mozart to mice affects the levels of neurotransmitters in their brains, but
few would reasonably regard this as evidence that rodents are blessed with a music
instinct. The harmonic principles that underlie the sounds we hear as dissonant are
based on hard physics facts, and interference patterns that occur when two adjacent
notes (semitones) vibrate at a frequency (pitch) close to each other. Likewise there
are fundamental physical reasons, related to their wavelength and frequency, that
certain intervals of pitch (notes) harmonise with each other.

One thing that the new genetic discoveries have indicated is that many mental
functions (including memory, language and music) are widely distributed through
the brain, and involve novel connections and uses of various brain structures,
rather than the development of new structures. How the brain is wired, and how
components of the circuitry are activated and inhibited appear to be more
responsible for unique human abilities, than evolution in our brains of new
organs of language, morality, aesthetics or music, as the phrenologists of the
nineteenth century maintained.

Modern genetic techniques, including m-RNA cloning, have enabled scientists to

pinpoint active segments of DNA in the genome of various species, and to identify
a rapidly growing number of gene loci. These include genes that code for proteins
that affect the growth of neuronal connections, such as the intriguingly named
Forkhead Box Protein P2 (FOX P2). Other proteins, such as those that stimulate
neuronal stem-cell replication and differentiation, migration of neurones in the
embryonic brain and the relative growth of different parts of the brain (and the
relative populations of different cell types) are likely to be discovered in increasing
numbers in coming years.

Levels of neurotransmitters, and the protein receptors on neurone cell membranes

that bind with them, are among the many physiological factors that can vary
between species and within species. The amount of DNA that is expressed (used as
a template for protein synthesis) varies according to cell type, and, as modern
epigenetics has shown, this selective expression is subject to environmental (and
learning) experiences.
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The scientific study of bird brains has advanced in leaps and bounds in recent
years, and resulted in a profound rethinking of the evolution of avian intelligence
and the neural structures subserving it. Expert consensus that a misguided tradition
that regarded most of the birds brain as basal ganglia (or striatum) has led to
misnaming of many parts of the organ, and resulted in a systematic, international
revision of nomenclature. The old idea that most of a birds brain was an
elaboration of the basal ganglia inferred instinctual rather than volitional
behaviour in birds as opposed to supposedly higher mammalian mental capacity
for voluntary movement, and thus deliberate actions.

For many decades now, scientists have been trying to teach chimpanzees to talk
(usually in American-English) and to test their capacity for acquiring and using
language. Though, like parrots, chimpanzees are able to communicate using
arbitrary, learned signs and symbols, they are unable to use their voices to
communicate their wants, likes and dislikes, or to answers to the questions and
problems they have been tested on by experimental psychologists and other
scientists over the years. This is thought to be because their vocal apparatus is
unable to create the range of sounds needed for speech. Parrots, on the other hand,
have a particular knack, even among songbirds and accomplished mimics, to
reproduce sounds similar to human voices. Though they tend towards a nasal tone,
they can mimic many different human timbres, for example the characteristic
timbral tones of different members of the household they live in. Capacity for
mimicry, though it may be a necessary precursor of language acquisition, cannot
be regarded as language unless it is used for communication, and even then many
would have reservations, arguing that language is much more than mimicry, even
if the mimicry is used for communication.

One essential difference between simple mimicry and proper verbal language
resides in semantics and understanding. The words and sentences mean something,
and the individual sounds, combined with each other in different temporal
sequences mean different things. Another difference is that while mimicry is
limited to repetition of the learned words or phrases, human language is
characterised by ability to use words and phrases in different combination,
extending them to create sentences of limitless variation. There is evidence,
though, that parrots, chimpanzees and probably many other animals are able to
understand words and simple phrases used by their human trainers.

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Human language is characterised by a unique capacity for the abstract use of

sounds. Our countless different languages ascribe arbitrary meanings to particular
sounds (words) which are understood by others only if they have had prior learning
in that particular language. What means one thing in one language may mean
something quite different in another, and most words do not sound anything like
what they mean semantically. The exceptions, which do sound like their meaning,
are so exceptional they have the special category of onomatopoeias.

The earliest human languages, or proto-languages, may well have been comprised
largely, maybe only, of onomatopoeias. A bear was referred to by its growl, and
bird was referred to by its call. Even today, many birds common names are
based on their calls (the Currawong is an example that springs to mind, here in
Australia). During the hundreds of thousands of years it took to progress from the
manufacture and use of stone tools to the earliest settled agriculture, the human
instincts for language and for music evolved side by side to take their place among
the most highly valued of individual and cultural achievements.

Could birds have had anything to do with this? And could the development of our
linguistic and musical abilities have contributed to the increase in brain size that
has been attributed to use of our hands rather than use of our tongues, lungs and
vocal apparatus? Why is it still the greatest compliment for a woman to be told she
sings like a bird? (assuming she sings well if not one might be regarded as
insincere or sarcastic!)

The brains of chimpanzees are much more similar to our own than those of parrots,
yet many species of parrot can dance in time, while no non-human primates,
including chimpanzees, are known to have this capacity. Though there has been
recent evidence that at least one chimpanzee (in Japan) prefers consonant (German
classical music) over the same tunes made dissonant by flattening all the Gs and Cs
by a semitone (using orchestration software) no chimpanzee has been trained to
dance in time to music, let alone dance spontaneously to music it likes.

It should be mentioned that one recent study of a Japanese chimpanzee named

Sakura (published in the journal Primates in 2009) does suggest that chimpanzees
do have a preference for consonant over dissonant music, as do humans, even as
babies (excepting the 3 percent who are tone deaf or, to use the medical
terminology, suffering from amusia).

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Recognising consonant over dissonant intervals (shown to be a mental capacity of

birds but not of tamarin monkeys) is essential for musicality, but in itself cannot be
regarded as evidence of a music instinct. It has been found that playing Mozart to
mice affects the levels of neurotransmitters in their brains, but few would
reasonably regard this as evidence that rodents are blessed with a music instinct.
The harmonic principles that underlie the sounds we hear as dissonant are based on
hard physics facts, and interference patterns that occur when two adjacent notes
(semitones) vibrate at a frequency (pitch) close to each other. Likewise there are
fundamental physical reasons, related to their wavelength and frequency, that
certain intervals of pitch (notes) harmonise with each other. Recognition of
harmonic consonance and dissonance is necessary for musicality, but do not
necessarily imply a musical sensibility.

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NEURAL PROCESSING OF MUSIC

What happens in the brain and nervous system when we listen to music and when
we create musical sounds? This is a puzzle that has unraveled considerably in
recent years, during which neuroscientists have investigated neural activity in
people with intact brains (including variously trained musicians) using new
imaging techniques. Such research has followed a longer tradition of inferring the
function of parts of the brain by studying people with acquired musical deficits
(amusia), and the use of increasingly sophisticated cognitive evaluations of the
musicality of subjects with and without known brain damage. Attempts to integrate
these and other findings have led to both consensus and controversy about the
neural processing of music.

That music perception is 'subjective' is sometimes put forward as a reason to

support the argument that music cannot be studied 'scientifically' at all. It is true
that one person's 'music' is another's 'noise'. At times, what one listener loves may
incite boredom or even hatred in another. The experience of music is subjective in
many ways, and the development of taste can be idiosyncratic.

At the same time, certain fundamentals can be identified in terms of such things as
pitch, harmony, tone (timbre), melody, rhythm, and lyric. These provide a means
of sensibly discussing the neural and mental processing of the sounds we identify,
differently, as 'music'. These music parameters or elements have been vigorously
researched in universities around the world over the past 40 years or more, with
most of the global publications emanating from the USA, Canada and Europe.

Musical thought is complex and includes many distinct processes. Different

mental states and processes associated with music can be identified. These include
processes involved in the perception of music and processes involved in the
creation of music. These may be combined, however they can also occur
independently. It is possible to create music without hearing the sounds one is
creating, or without even making any sound. The latter was famously done by
Ludwig Beethoven in the writing of his last symphony (at which time he was
deaf); a remarkable feat of musical thought and action. While most people do not
possess the theoretical skills to write down in musical script the creations of their
mind, and the complexity of such creations varies considerably, most people do
have the ability to think up new melodies and rhythms in their mind, although they

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may not have developed this perhaps uniquely human gift.

The mental creation of musical sounds (singing silently) does not involve
physical movement of the body or activity in the ear itself or, probably, in the
auditory nerves, which carry sound from the inner ear to the brain. It does,
however, involve several areas of the brain including the superior temporal lobes.
Auditory imaging can include verbal imaging and musical imaging. One can
imagine a conversation or a song one has heard in the past. Most people can also
create tunes, just as they can create conversations.

One can also sing in ones mind, replacing the original words of a song with
different words, or meaningless sounds, while maintaining the same tune;
humans have a singular ability to sing the same tune in various keys in our minds,
slowing or speeding up the tempo at will. One can sing the song out loud, which
involves yet more areas of the brain, notably those involved with physical
movement of the diaphragm and other breathing muscles, larynx, tongue and face.
As soon as one starts to sing, other neural circuits involved in the perception of
external sound are activated, involving the auditory nerves, auditory sensory cortex
and other areas of the brain.

Considerable progress has been made in recent years localising specific parts of the
brain involved in creating and responding to music. Recent advances in radiology,
especially functional Magnetic Resonance Imaging (fMRI) scans have transformed
knowledge of how music affects the human brain by revealing unexpected activity
in structures deep in the brain, including supposedly primitive areas of the brain
thought to be more involved with control of movement and balance rather than
higher mental functions such as aesthetic response to music.

In the past decade numerous studies have been done in universities around the
world investigating the different areas of the brain activated by various music-
related tasks using fMRI and other new radiological techniques such as Positron
Emission Tomography (PET) and magnetoencephalography (MEG). These have
included experiments where subjects are asked to listen to music, read musical
notation and even sing and play musical instruments in the claustrophobic confines
of a scanner (which requires a minimum of movement). Differences in brain
activation when people sing silently or overtly have been measured, and the blood
flow in the brain when singing has been compared with that when speaking.
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Musicians have been compared with non-musicians and children with adults, using
MRI, PET and MEG scans as they had been with the older techniques of
electroencephalography (EEG) and studying the effects of drugs and electrical
stimulation (using electrodes applied to the surface of the brain).

Rhythm, harmony, melody and timbre have all been studied using the new
radiological techniques, and the findings have been published in a range of
respected peer-reviewed journals, though few of the findings have yet found their
way into neurology, psychology or psychiatry texts.

Since their advent in the 1990s functional Magnetic Resonance Imaging (fMRI)
scans and other modern imaging techniques have transformed our understanding of
the parts of the brain involved in music cognition as well as of many other mental
functions including emotional reactions and moods. Various aspects of music
cognition have been studied by fMRI and insights gained from thoughtfully-
designed studies of the brains of healthy people (rather than people with damaged
brains) though many questions remain unanswered. These new technologies are of
particular value in identifying subcortical structures involved in music-related
emotions which were inaccessible to older techniques that measured electrical
activity on the surface of the scalp (such as EEGs). However, the newer scans,
despite the high resolution of MRI, lack the temporal precision of directly
measuring the electricity generated by the brain as in EEG. MRI scans measure
blood flow in different parts of the brain, a slower physiological process. This is
not always borne in mind when conclusions are drawn about what fMRI scans tell
us about the neural processing of music. PET scan reveal different metabolic
activity in various parts of the brain, such as glucose or oxygen use these are not
of much use in studying the rapid physiological changes that occur in response to
the complex dynamics of real music in the real world.

In the main, these recent studies have confirmed what many previous investigators
had theorized using older techniques, including the careful study of people who
have lost their musical ability from local brain injuries that to some degree
various parameters of music, such as harmony, timbre, melody and rhythm are
processed in different parts of the brain, and again to some degree, music and
verbal language are processed in opposite sides of the brain language on the left
and music on the right.

The caveat to some degree is because the simple idea that music is a right brain
activity and speech a left-sided function, while having some truth in it, does not
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tell the whole story. In fact, making and listening to music can involve almost all
parts of the brain, including all four cortical lobes on both sides of the brain, as
well as key structures deep inside the brain such as the limbic system, thalamus
and basal ganglia. Even the cerebellum and the hind brain play important roles in
responding to and creating music. Also, though most of the 10 percent of left-
handed people also have their speech centres on the left side (as in all right-handed
people) there exists a sizeable population of left-handed people whose speech is
localized to the right hemisphere. Whether these individuals show corresponding
left-sided selectivity for musical pitch, melody and timbre has not yet been
determined.

A longstanding debate has centred on the neural processing of language versus

music. Attribution of speech to the dominant left hemisphere, and localisation of
speech expression and comprehension to separate localised areas of cortex has
been part of medical orthodoxy since the
famous French neurologist Paul Broca
described selective loss of speech capacity
in patients with damage to a small area in
the left, inferior frontal lobe, as confirmed
at post-mortem. The discovery of what is
now called Brocas Area, occurred in
the 1860s and rekindled a waning
enthusiasm for phrenology the often
misguided science of localising aspects of
the mind to specific parts of the brain.
Though the first phrenological maps in
the early nineteenth century included an
organ of tune separate from an organ of
language its proposed location was more
whimsical than scientific.

Early 19th century

Phrenological map

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Sylvian (transverse) fissure

Wernickes area

Operculum

Brocas area

Primary Auditory Cortex (PAC)

In 1874, not long after Brocas discovery of expressive aphasia following localised
damage to an area of cortex in the left frontal lobe, the German neurologist Carl
Wernicke described a specific deficit in understanding speech (receptive aphasia)
following damage to another part of the cortex, again on the left side, but posterior
to the auditory cortex. This area, located in and around the angular gyrus that
curves around the tip of the Sylvian fissure, is now known as Wernickes Area.

The basic model of Wernicke, that auditory information is transmitted from the
medial geniculate nucleus of the thalamus to the primary auditory cortex (in the
temporal lobes), and from there to Wernickes area has stood the test of time well,
although minor adjustments to the model have been necessary to accommodate
subsequent clinical and neurological findings. His hypothesis that words which are
read are also comprehended in Wernickes area has been subsequently disproved:
visual information seems to be transmitted along a separate pathway, although it
does pass through the lateral geniculate nucleus of the thalamus as Wernicke
theorised. There also appears to be different processing, involving different parts of
the brain, for words that make sense and nonsense words and Wernickes model

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fails to explain and integrate the emotional reactions elicited by words, speech and
language.

The complex mental processes that occur in comprehending speech and

communicating verbally involve many areas of the brain at the same time,
including areas associated with recognition of words, comprehension of phrases,
memory formation and recall, creation of ideas and language, simultaneous visual
imagery, and emotional response. The neural mechanisms and pathways
underlying these mental processes are likewise complex and widely distributed in
the brain, as they are in music cognition.

Following the discovery of receptive and expressive speech centres in the left side
of the brain in all right-handed people and most left-handed and ambidextrous ones
as well, the non-linguistic aspects of music as well as other non-verbal
environmental sounds have been commonly ascribed to the right side of the brain.
In fact, music can truly be said to provide exercise for the whole brain (and with
practice, the whole body). It is true, however, that particular aspects of musical
thought involve different parts of the brain, some of these being lateralised, as is
the comprehension and generation of speech. The right temporal lobe, in particular,
has been associated with specific musical functions, although both right and left
temporal auditory cortex as well as frontal, parietal and occipital lobes appear to be
involved in various aspects of the perception and creation of music. In addition to
these (outer) cortical areas, other areas in the core of the brain are also involved in
musical activity. These will be further explored in the following analysis.

The identification of Brocas and Wernickes speech areas in the left-sided cortex
led to a resurgence of phrenological thinking, with neuroscientists agreeing that
many, or most, mental functions are localised to parts of the cortex. There were
exceptions to this, however. Some mental functions, such as memory, and
consciousness itself, were regarded by many neuroscientists as emergent properties
from the organisation of the whole brain. It became an accepted dogma that speech
sounds are processed on the left side of the brain while non-verbal sounds
(including music) are processed on the right. Though an oversimplification, this
remains a reasonably valid generalisation.

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Hemispheric lateralisation of speech and music

Much knowledge of the neural processing of music has been acquired over the
years through the study of people who have lost musical ability after suffering
localised brain injuries. It has been observed that people may develop different
forms of 'amusia' after strokes, brain surgery or head injuries, including deficits in
perception, expression, or both. Sometimes, after such injury, verbal deficits
accompany the musical deficit, sometimes not. Musical deficits acquired in this
way may specifically affect one or more aspects of musical perception - for
example pitch discrimination has been noted to suffer with damage to the right
temporal lobe cortex, in particular.

Although rare (perhaps because musical deficits are rarely tested for), isolated loss
of various aspects of music perception can result from strokes. This can affect
perception of, say, melody or timbre but not rhythm or tempo, suggesting a degree
of independence between musical elements in the perceptual analysis of music.
Such amusia has been reported following damage to the right side of the brain and
right temporal lobes especially. Amusia has also been reported, though, following
damage to the left temporal lobe.

Other evidence localising the perception of at least some elements of music to the
right temporal lobe has come from studies of people who have had surgical
excision of the temporal lobes (usually for the treatment of temporal lobe
epilepsy). The occurrence of musical auditory hallucinations in temporal lobe
epilepsy provides further support for the view that the temporal lobes and right
temporal lobe in particular are involved in the memory and perception of music.

The relative importance of the left and right hemispheres of the brain in processing
music have been the subject of scientific study since the mid-19th century and the
first description, by Jean-Baptiste Bouillard in 1865, of a musician who continued
to be able to play, read, write and compose music after a brain injury that left him
unable to speak, read or write in words. Since then it has been established that
injuries affecting speech may leave musical ability intact and vice versa,
suggesting that different areas of the brain are necessary for speech and music. The
fact that amusia was more likely to be noted with right-sided brain injuries and
aphasia with left-sided ones strengthened the view that music is a right brain
activity while language is left brained.

Studies since the 1940s have revealed much greater complexity. Most often brain
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injuries causing musical deficits affect language as well (and vice versa) though
there have been many detailed reports of specific loss of various musical functions
with linguistic ability spared. While timbre, melody and pitch discrimination do
appear to be lateralised to the right side (to some degree, in most people) other
elements of music, especially rhythm, do not show the same degree of
lateralisation. Furthermore, brain injuries can selectively affect pitch
discrimination, melody recognition and musical memory, maintaining a steady
tempo, emotional reactions from music and other aspects of sub-processing.
Certain aspects of timbre discrimination may be affected and not others. In terms
of temporal relations, there is evidence that meter and rhythm (patterns of strong
and weak beats) have opposite lateralisation the grouping aspect of rhythm is
more associated with the left hemisphere while the maintaining and synchronising
with a regular meter in music appears more right-sided. Such findings have
contributed to the wide acceptance of a modular processing model the view that
different elements of music and language employ both shared and distinct neural
substrates.

The first site of cortical processing of all sounds is the primary auditory cortex
(PAC), which receives auditory data from the Medial Geniculate Nucleus (MGN)
of the thalamus, an important sub-cortical structure that will be discussed shortly.
Unlike visual data, auditory information is distributed to both sides of the brain
from each ear. Though information is distributed bilaterally, more is transmitted to
the opposite (contralateral) side than the side of the stimulated ear (ipsilateral). The
result of this bilateral, (though asymmetrical distribution) is that damage to the
PAC on one side of the brain only causes a 20 percent or so decrease in auditory
acuity. Bilateral PAC damage, which is far less common, does cause sensory
deafness.

The location of the primary auditory cortex in the temporal lobes has been known
for more than a hundred years, along with the knowledge that bilateral damage to
this area causes deafness at least conscious deafness. Studies have shown that
people (and other mammals) who are deaf due to bilateral damage to the primary
auditory cortex do retain some response to, for example, alarming sounds, due to
sub-cortical processing (this is not seen if the deafness is due to damage to the
auditory nerves and the lower connections in the auditory pathways).

Brain localisation in the 20th century was focussed on cortical function, with
widespread use of electrical stimulation of the cortex of humans and other animals
using fine electrodes. Many of the orthodoxies of neuropsychology can be credited
to the pioneering work of the US-trained Canadian neurosurgeon Wilder Penfield
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who reported in a series of widely-cited papers the results of systematically

stimulating the surface of the brain with small electrical shocks using (then) state-
of-the-art needle electrodes. This work contributed to cortical maps indicating
secondary auditory cortex in the adjacent temporal lobe gyri (notably the superior
and middle temporal gyri). These gyri and the superior temporal sulcus, which
separates them, were found to occasionally elicit complex auditory sensations,
including long-forgotten songs and conversations.

More recently, cognitive psychologists in Canada, including Robert Zatorre, Isabel

Peretz and Daniel Levitin have been pioneers in developing detailed models of
music processing based on integration of recent research findings with older
studies, in which Montreal played a leading role. Specifically the work of Wilder
Penfield and his team at the Montreal Neurological Institute contributed
immensely to the science of brain localization until his death in 1976. Penfield,
who pioneered a technique for brain scar excision (when such scars were causing
epileptic foci) is famous for mapping the cortex functionally by stimulating it with
a fine electrode. Since the surface of the brain has no pain sensors, the
neurosurgeon was able to do this in patients who were awake and therefore able to
tell him what they were experiencing.

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One of the icons of music neuroscience, Brenda Milner, worked under Wilder
Penfield at the Montreal Neurological Institute he had founded some years earlier.
In an article published shortly after his death in 1976, Milner includes diagrams,
including the one reproduced above, indicating the parts of the cortex that evoked
complex auditory experiences when Penfield stimulated the respective area with an
electrode. These studies, part of the neurosurgeons pre-operative evaluation before
excising (or advising against excision of) part of the cortex, were conducted in the
years following the Second World War on patients, mainly men, who had
developed localised (focal) epilepsy following brain trauma. As Milner explains, as
Canadas most famous neurosurgeon, Wilder Penfield had unprecedented (and
subsequently unrivalled) access to patients with focal epilepsy resulting from war-
related head injuries.

Penfields studies, which were also used as the basis of the motor and sensory
homunculi that are essential inclusions in every introductory neuroscience text
(despite criticism that they can be misleading) led to auditory cortex maps
indicating the secondary or association cortex as a ring around the primary
auditory area in Heschls gyrus. Milner stresses that the complex auditory
experiences reported by Penfield and herself were never evoked by stimulation of
the primary auditory cortex. This area (coloured yellow in this reproduction of the
original image) only evoked simple ringing or buzzing sounds under the
neurosurgeons stimulating electrode.

Milners studies compared musical ability before and after surgery using the
Seashore Measure of Musical Talents, a standardised test developed by the
psychologist Carl Seashore in the 1930s. Her findings, which suggested a specific
role of the right temporal lobe in at least some aspects of musical perception, were
supported by the experimental results of Kimura and others, also in the 1960s, who
studied hemispheric dominance in people with intact brains using dichotic listening
tasks. These involved presenting different musical stimuli to the left and right ears,
and relied, for their interpretation, on the assumption that most sound from the
right ear is transmitted to the left hemisphere and most from the left ear to the right
hemisphere. Thus Kimuras discovery that melodies are more easily recognised
when played to the left ear and speech sounds when played to the right have been
interpreted as supporting Milners findings.

Kimuras pioneering studies were significantly different from Milners because

they involved healthy volunteers, these being students and postgraduate nurses
rather than trained musicians. In 1972 Kimura and King, working with students
(again with intact brains), demonstrated left ear (and by inference, right
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hemisphere) dominance for non-speech vocal sounds like laughing, crying,

moaning and coughing.

The findings of Gordon (1970) suggested, as Werner had postulated in the 1940s,
that differences may exist in the neural activity of trained musicians. Again using
dichotic listening tasks, Gordon found left ear preference for chords but no
asymmetry in perception of melodies. To explain Gordons findings, Bever,
Chiarello and others have suggested, in line with Werners views, that the right
hemisphere is involved in holistic appraisals, whereas the left performs the
detailed, piecemeal analysis.

It has become increasingly clear that the processing of auditory information once it
reaches the forebrain is extremely complex, and involves several 'music centres'.
Some of these have been elucidated in recent decades with the help of functional
Magnetic Resonance (fMRI) scans. Progress in identifying these music centres has
accelerated since the older view, that music and other environmental sounds were
exclusively the domain of the right hemisphere, while language is a left-brain
activity, was challenged. More recently the long-running right-left dichotomy (and
the inevitable arguments between different schools of thought one might call
them leftists and rightists were it not for the political inferences) has been revised
by emphasis on the modular organisation of music cognition.

While studies continue to show that certain aspects of music cognition are
lateralised, some are more left-brain than right-brain. As suspected in the pre-MRI
age, most people are better at recognizing melodies with their right ear and speech
in their left ear. In addition, studies have consistently demonstrated that musical
training results in a shift from right to left in terms of greatest neurological activity.
However, large individual variations in brain activity in response to music have
been demonstrated, in both musically trained and untrained subjects.

A shift from right to left sided brain activity with musical training suggests that
change in the way people think about music can result in physiological and
structural changes in the brain. Werner identified a possible cause of this in terms
of a changed focus to parts of the melody rather than the melody as a whole. This
may affect more elements and aspects of music than melody alone. It is possible to
focus ones attention on elements of harmony, rhythm, tone and other qualities of
music when listening to it. This is a significantly different mental activity from
listening to a piece of music as a whole. A shift from right to left sided activity
would be consistent with the view that the right hemisphere is involved with more
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holistic or gestalt perceptions than the left.

Another aspect of musical thinking that may explain a shift towards the left
hemisphere relates to language. Music has linguistic elements and spoken language
has musical elements. It may be that as people are trained in music, linguistic
aspects of musical thought become more pronounced.

Training in music is a complex subject and people can be trained in very different
ways. Education in music, as in other matters, may be broad or narrow. People can
learn to be extremely discriminating listeners, and feel great love for music without
playing any musical instruments themselves. People may learn to read written
music, but be unable to play by ear or improvise. They may develop virtuosity on
one instrument but be unable to play another with which they are unfamiliar. Some
people who have great musical virtuosity in playing instruments or singing are
poor readers or completely unable to read musical notation. Reading and writing
music involves learning a language (or languages) as specific and complex as
verbal language. Particular symbols decided on and defined by convention and
common use have particular meanings.

In this way, reading music and thinking about music in terms of musical symbols
and theory are fundamentally different from listening to and thinking about music
without theoretical knowledge. One has to learn the specific rules of a particular
musical language, equivalent to the grammar and syntax of written language, in
order to fluently read and write musical notation (script). It is a skill few people,
even among those who play musical instruments, develop. This may have a direct
bearing on the described shift from right to left hemispheric activity in trained
musicians.

Another aspect relates to the perception of time, timing and rhythm and its
relationship to phrasing and prosody in verbal language. Some studies have
suggested that the right temporal lobe is particularly involved in perception of
prosody (vocal pitch and tone) as well as musical pitch and tone. There is also no
doubt that damage to the left side of the brain affecting linguistic ability often also
affects musical ability. Studies in the 1960s by Milner, however, demonstrated no
significant impairment in pitch discrimination, loudness, rhythm, time, timbre and
tonal memory following unilateral damage to the left hemisphere, whereas
significant musical deficits (especially in discrimination of timbre and tone)
resulted from right sided temporal lobectomy (sparing the primary auditory
cortex).
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Functional MRIs have also shown greater activation in the right temporal lobe
when subjects are focusing on aspects of harmony and when discriminating
between different timbres of musical instruments, though not necessarily of
speech. This is an interesting area of ongoing research, and fMRI and similar new
technologies may cast more light on one of the most sensitive of human abilities
our capacity for discriminating between tiny differences in timbre, such that we are
able to recognize the voice of a loved one as soon as we hear the first phoneme
they utter over the phone. The capacity of a trained saxophone or guitar listener to
identify by their tone (meaning timbre) numerous musicians they have never seen
or heard live is truly extraordinary. There is no reason to believe that this is a
unique human capacity, though. Other animals have extremely sensitive hearing
and recognition of different timbres provides obvious survival benefits (in addition
to musical benefits).

MRI studies have also revealed the surprising finding that that previously learning
to play an instrument results in motor cortex activation in areas responsible for
movements required to play the particular instrument one is familiar with, even
when one is not physically moving or consciously imagining playing the
instrument. This finding, which has been confirmed by several researchers,
requires a re-evaluation of conventional ideas about the brains motor function
generally, and the role of the motor cortex in generating voluntary movements.

These recent studies have also demonstrated the important role of other
subcortical motor areas of the brain in appreciating and creating music, especially
the basal ganglia and the cerebellum.

Overview of the auditory system

The neural processing of information arriving through the senses is traditionally

divided between subcortical and cortical stages. In the auditory sense, all the
processing of sound between the ear and the primary auditory cortex (PAC) is
subcortical; once the sound (which has been transduced into electrochemical
impulses in the inner ear) reaches the cortex, the cortical processing begins. From
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the PAC the auditory-evoked signals are distributed to other parts of the brain,
including adjacent gyri in the temporal lobes that constitute the secondary
auditory cortex and areas of association cortex that exist between the temporal
lobes and occipital lobes (containing the visual cortex) and parietal lobes
(containing the somato-sensory cortex).

Auditory information, according to this rather computer-like model, is also

distributed to the frontal lobes, which are known to play an important role in short
term memory and emotional reactions (in addition to many other mental functions)
the insular cortex (located between the temporal lobes and frontal lobes) and to
deeper structures. These deeper structures, including those traditionally described
as comprising the limbic system and the basal ganglia are subcortical, as is the
thalamus, to which electrical impulses return, having been sent to the PAC from
the Lateral Geniculate Nucleus, a body of grey matter at the caudal end of the
thalamus. The following model illustrates this general sequence of auditory data
processing and will be used to explore the neural processing of music.

The flow diagram above is a simplified model of how auditory impulses are
transmitted through the brain, and how what we hear may affect diverse aspects of
physiology through the known effects of the hypothalamus on the secretions of the
pituitary and pineal glands. These will be explored later, but first I should point out
some flaws and over-simplifications in this diagram, which I drew in 1999.

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Transduction of the kinetic energy of the air vibrations we perceive as sound into
electrical impulses in the organ of Corti (in the cochlea of the inner ear) requires
metabolic energy in the sensory neurones of the inner ear, so it should not be seen
as a pure process of electrical transduction, since additional metabolic energy is
contributed by the nerve cells. The electrical impulses that travel along the auditory
nerve and subsequent transmission along the chain of neurones that carry the
auditory information through the brainstem and midbrain to the thalamus likewise
require metabolic activity in the these cells. These electrical impulses are better
described as electrochemical, since they are created by waves of chemical ions
passing in and out of cells through the semi-permeable cell walls of neurones and
their axonal and dendritic processes. It is important to note that most of the
synaptic activity in the brain is inhibitory rather than stimulatory. This inhibition is
essential for selective attention and to stop the brain from being flooded by sensory
information.

Sound requires matter - atoms and molecules - to vibrate at various frequencies to

exist at all. There can be no sounds in empty space. In the human ear (and those of
other animals and birds) the vibrations in the air generate movement in the eardrum
(tympanic membrane) which are transmitted through the air-filled middle ear to the
inner ear, where they cause corresponding vibrations in the fluid-filled cochlea.
Here they result in stimulation (or inhibition) of the electrochemical activity in
neurones (nerve cells) which carry the raw data along the auditory nerves to the
brain.

The perception of (external) music requires analysis of the information coded as

electrical signals, which are decoded the brain. These electrical impulses are
generated by sensory cells in the organ of Corti in the cochlea of the inner ear in
response to vibrations of cilia on specialised sensory cells. Sound vibrations are
transmitted from the eardrum to the inner ear via three small connected bones
(ossicles) which cross the air-filled middle ear. Aeration of the chamber of the
middle ear is maintained by the eustacian tube, which connects the middle ear with
the pharynx. The eardrum vibrates due to vibration in the air within the auditory
canal, and this air forms part of our external environment, presenting to our brain
information about the world, which we can listen to if we choose to.

Listening to sound, and more specifically to music, is a more active mental process
than just hearing it. Even without actively listening to it, however, music can have
significant effects on the mind. Background music can be irritating, calming or
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energising. This is obvious from everyday experience. It is not as clear as to what

the effect of subliminal lyrical content is, although some influence on thought and
behaviour would be expected, probably depending on such things as the volume at
which it is played and the clarity of the words.

Actively listening to music requires mental focus (attention and concentration).

This is a skill which can be developed with practice and presumably involves
activity of the widely distributed network of reticular activating system neurones
(amongst other things). The reticular activating system (RAS) is known to be
involved in attention and concentration (as well as conscious state) and has been
extensively studied in the medical specialty of anaesthetics. It also involves the
pathways which conduct auditory signals around the brain. These pathways have
been partially elucidated, by neurological study.

There are several stages of relay and neural processing between the auditory nerves
and the medial geniculate nucleus (MGN) of the thalamus. These include the
cochlear nuclei in the brainstem which project to the superior olivary nuclei, also
in the brainstem. The cochlear nuclei and olivary nuclei project to neural structures
in the midbrain in a complex way, with some nerve fibres continuing on the same
(ipsilateral) side, while others cross to the opposite (contralateral) side.

The main auditory structures in the midbrain are the lateral lemniscus and inferior
colliculus. These relay the auditory impulses to the MGN. These subcortical
structures do not function as mere relay stations they are involved in processing
the sound in various ways and are subject to feedback from each other, from the
cortex and from neural structures involved in such things as attention and
concentration, memory (and anticipation) and movement (including reflex
movement of the head and eyes towards sounds). It is possible that this subcortical,
pre-cortical neural activity contributes to the distinctly (and almost uniquely)
human tendency to move rhythmically to the beat of music what may be called
our dance instinct. This diagram shows the location of the subcortical structures
mentioned; their function will be looked at in more detail later:

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Primary Auditory Cortex (PAC)

Medial geniculate nucleus (MGN)

Inferior colliculus

Lateral lemniscus

Cochlear nucleus Superior olivary nucleus

The auditory cortex, like other neocortical areas, is composed of six interconnected
layers. These can be distinguished under the microscope by the relative density of
different cell types. Layers III and V contain pyramidal cells, while layers II and
IV contain smaller stellate cells that appear granular when stained with methylene
blue. Layer V, the inner pyramidal layer, is the output layer of the cortex long
cell processes (axons) emerge from this layer to make connections with other
cortical areas and with deeper structures. Some leave the brain to synapse in the
spinal cord, others make output connections with the basal ganglia, limbic
structures and input ganglia of the cerebellum. The vast majority though, carry
information to other areas of the cortex. Most of these connections are with
adjacent gyri, though long tracts of white matter conduct neural impulses between
the various lobes of the brain. One such tract, connecting the temporal and frontal
lobes, is shown in Fig. 4, in which the overlying parts of the frontal, parietal and
temporal lobes have been removed:

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Fig.4

White matter tract

connecting frontal and
temporal lobes.

The relative thickness of the different layers gives an indication of what a

particular area of cortex does. Primary sensory areas of cortex are characterised by
a thicker layer IV populated with small granular neurones. This is the case in
primary somatosensory cortex (in the parietal lobes), primary visual cortex (in the
occipital lobes) and the primary auditory cortex. The location of these other
primary sensory areas and their main connections is relevant to understanding the
neural processing of music and the cross-modal associations integral to evaluation,
appreciation and verbal description of music.

Fig 5. Areas of primary sensory cortex.

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Angular gyrus

Superior temporal gyrus

Middle temporal gyrus Superior temporal sulcus

Cortical and Subcortical Processing

Because the size of the cortex was thought to be closely allied with intelligence
(with some reason) the outer layer of the brain, which shows progressive increase
in size and convolutions across increasingly intelligent primates, has long been the
primary focus of neuroscientists with an inclination towards psychology. Those
with an inclination towards physiology spent many decades engaged in grotesque
brain reduction experiments in an effort to identify what the deeper structures
did. Cats and monkeys bore the brunt of this horribly cruel neurophysiology and
neuroanatomy research. While confirming that deep brain structures were essential
to emotions and other mental faculties including memory, this mode of research
contributed little to understanding the complexity of human emotions and less to
an understanding of the neural processing of music (not least because rats, cats,
dogs and monkeys do not respond to music remotely like humans).

One unfortunate consequence of the division between cortical and subcortical

processing is a spurious idea that cortical function is where intelligence resides
and that the subcortical structures are both less important and more primitive.
This reflects a long-held prejudice in the neurosciences that emotions are
antithetical, and inferior, to reason. It is true that these structures, such as the
cerebellum, basal ganglia and thalamus are more primitive, in the sense that they
are well-developed in subhuman species. It is certainly not true that they are less
important than the cortical layers of the brain. It is through the constant interaction
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of the cortex with these structures that perception, movement, motivation and
emotions become possible in humans as much as in other animals. In terms of
music perception the auditory cortex is an early processing area it is what
happens after the auditory signals reach the PAC that determines whether we
perceive the sound as music or noise, and whether we are motivated to listen to (or
escape) the music.

Cortical processing of music

The auditory cortex, is, like the rest of the neocortex, about half a centimetre thick
and consists of six thoroughly studied layers. These layers have complex
connections with each other and with all parts of the brain and the body, directly or
indirectly. Directly under the cortical layer are dense tracts of white matter the
axons of nerve cells projecting to neurons in the cortex and those emerging
(descending) from the outer cortical layer of the brain.

The granularity of cortical layers is an indicator of sensory inputs all of these,

other than smell (olfaction), arrive at the cortex from relay neurones in the
thalamus. This granularity is greatest in the external and internal granular layers
(layers II and IV) of cortex; layers III and V the external and internal pyramidal
layers are characterised by larger, agranular pyramidal neurones with long axons
that carry information from a particular area of cortex to other cortical areas on
both sides of the brain, and subcortical structures including the basal ganglia,
thalamus, midbrain and brain stem.

Fig 2. An MRI showing the

primary auditory cortex (PAC) in
horizontal section. Te 1.0 (dark
green) is highly granular,
indicating this area receives the
auditory signals before they spread
to the less granular Te 1.1 and Te
1.2 areas (blue and light green).
(reproduced from Morosan et al
2001)

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This image is from a 2001 paper by German researchers from the Vogt Institute of
Brain Research published in the journal Neuroimage. Their study (on post-mortem
human brains) showed that though the primary auditory cortex is contained within
Heschls Gyrus as has long been known, examination of the cell types in the
cortical layers suggest that considerable variation exists between people in the
extent of the what is assumed to be primary auditory cortex due to its highly
density of granular neurones (koniocortex). Also, these areas (Te 1.0, Te 1.1 and
Te 1.2) do not conform precisely to the visible landmarks on the surface of the
brain. The study did confirm, though, that the primary auditory cortex is located
where it has been thought to be for a century the first transverse temporal gyrus,
also known as Heschls gyrus.

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Brocas area
(speech generation)

Insular cortex
Insular cortex

Heschls Heschls gyrus (location of PAC)

gyrus
(PAC)

Thalamus

Wernickes area
(speech
comprehension)

Functional MRIs in living people have confirmed the location of auditory areas in
the temporal lobes bilaterally and that listening to (or just hearing) sounds
increases blood flow in Heschls gyrus. Listening to music also increases blood
flow (which is what is measured in fMRI) in many other parts of the brain, as
might be expected. The precise areas have come as something of a surprise for
those who underestimated the importance of subcortical brain structures when it
comes to what many would regard as the pinnacles of human cultural achievement
our music, literature and art, human activities driven by aesthetic and a sense of
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delight in beauty.

Insula

Primary Auditory Cortex

(Heschls gyrus)

The primary auditory cortex (PAC) occupies the first transverse gyrus of the
temporal lobes bilaterally. Most of this gyrus, also known as Heschls gyrus, is
buried in the Sylvian Fissure that separates the temporal and frontal lobes; in the
diagram above parts of the (left) parietal and frontal lobe that form the operculum
(lid) have been removed, exposing the first transverse gyrus and the intriguing
area of cortex immediately anterior to it the insula. Research in recent years has
shown the insula to play an important role in music perception and appreciation,
something that was not suspected in the past.

It has been known for many years that the nerve cells in the PAC are tonotopically
arranged neurones of the medial part respond to high frequencies (high sounds
shown in blue) while the lateral part of the gyrus responds more to lower frequency
sounds (shown in red). This mirrors the tonotopic arrangement of sensory fibres in
the cochlea of the inner ear and their connections through the lower part of the

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brain through to the thalamus. How this tonotopic arrangement relates to higher
auditory functions to secondary and subsequent processing of sound remains
the subject of considerable uncertainty and debate. These higher functions are, of
course, essential to the complex auditory perceptions involved in listening to
music. They are also of vital importance when considering appreciating music
something that requires emotional reactions. Here the limitation of thinking about
music neuroscience in terms of cortical and subcortical processing becomes
clear.

Brain structures that are subcortical are not necessarily functionally pre-cortical.
This is the case with the basal ganglia, thalamus and the limbic structures which
appear to play important roles in post-cortical music processing, including complex
emotional reactions to various aspects of music. The fact that there is separation of
aesthetic appreciation in different elements of music can be seen in the common
experience of liking some aspects of a piece of music and not others one can like
the groove but not like the timbre of particular instruments or the singing. One may
like the melody, or parts of it, but find the rhythm boring and any number of
permutations and combinations of likes and dislikes that affect overall (or gestalt)
aesthetic judgement of the music. This observation is congruent with what is now
known about the neural processing of various elements of music.

Post-cortical processing of music

Primary auditory cortex

Tempero-parietal association
cortex
Secondary auditory cortex
Tempero-frontal association cortex
Insular cortex Tempero-occipital association
cortex
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Basal ganglia including

amygdalae and nuclei
accumbens Thalamus

Motor
cortex
Cerebellum

Mental associations and their neural substrate

Mental associations are fundamental to appreciation of music, with and without

words. That they are fundamental to understanding the lyrical content of music is
self-evident, however the vital nature of mental associations in perceiving,
appreciating, understanding and creating music is less widely appreciated.

It seems to reasonable to infer that mental associations in perception and memory

of timbre, melody, rhythm and harmony reflect neural connections, including those
of the sensory association cortex the large areas of cortex in the occipital,
temporal and parietal lobes between the primary sensory areas that occupy much
smaller areas of these lobes.

Several (English language) terms used to describe musical characteristics,

including pitch, timbre, harmony, melody and rhythm suggest cross-modal mental
associations. Some of these associations suggest connections (functionally and
anatomically) between the temporal lobe auditory cortex and other sensory cortices
the visual cortex in the occipital lobe and somato-sensory cortex in the parietal
lobes. Others suggest associations with more abstract and intellectual concepts
that are more suggestive of associations between the temporal and frontal lobes.

Visual associations in music are obvious and easily identified:

High notes/low notes (pitch)
Bright/dull tone (timbre)
Bright melody
Pretty melody (we dont say something tastes or feels pretty)

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Brilliant musicianship/solo/performance

The visual cortex is also necessarily involved in reading music notation and chord
charts; visual information also augments somatosensory (including kinaesthetic
and proprioceptive) information relevant to movements of mouth, face, trunk and
limbs when playing music and dancing.

Somato-sensory (parietal)
Sharp (pitch) visual also
Flat (pitch) several meanings visual connotations also
Smooth sound/tone (timbre/gestalt)
Steady rhythm
Hard
regular
Soft
Light (also visual)
Heavy bass
Thick sound (esp. Bass)
Hot solo
Warm sound
Cool organ/guitar (e.g. chorus pedal)
Contour of melody (also visual associations) ?R STG

Associations with words and letters:

No musician wants to leave people cold!

Multi-modal view....
Separate, parallel processing of different aspects of timbre, rhythm, tempo,
melody, harmony the elements of music.
Prosody in language, phrasing in music....
Semantics meaning of words...is there an equivalent on R side

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What is the function of the Brocas and Wernickes analogues on the R side?
Evidence from MRI of multilingual people
Association cortex and secondary auditory cortex...note Wernickes area
adjacent areas known to be involved in extracting meaning from written and
spoken words.

Parietal lobes
Occipital lobes

Frontal lobes and role in emotional processing of music

Is the Insula involved in musical and other aesthetic taste?

The insular cortex has been known to be involved in taste as in the gustatory
sensation produced by various chemicals stimulating sensory receptors on the
surface of the tongue. The diminution of taste when smell is prevented (by
blocking the nose) indicates the role that olfaction plays in augmenting taste. But
the word taste is also used in reference to various aesthetic preferences taste in
music, taste in art, taste in literature. Could this reflect shared neural circuitry
between brain structures involved in the different senses? If this is the case, could
the insula be one of these structures?

Central Sulcus separating

Frontal and Parietal lobes.

Anterior Insula

Primary
Posterior 148 Auditory Cortex
Insula
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Fig.1:
Left hemisphere with frontal and parietal parts of operculum removed.

The anterior insula (including the insular cortex and underlying white matter) is
located behind (caudal to) the primary motor area for speech (Brocas Area) which
occupies the frontal lobe section of the operculum and the gyrus in front of (rostral
to) it:
Fig.2: horizontal section of brain
at level of Heschls gyrus

Brocas Area primary

speech motor area
Anterior
Insula
Posterior
Insula
Heschls gyrus location of
primary auditory cortex

The posterior insula is located

adjacent to the primary auditory
cortex (located in the first
transverse gyrus of the temporal
lobes, bilaterally). The first
transverse gyri are also known as
Heschls gyri after the German
anatomist Richard Heschl (1824-
1881) who is credited with their
first scientific description. These
gyri were identified as home to
the primary auditory cortex in the
early twentieth century, however what happens to the auditory signals when and
after they arrive in Heschls gyri remains subject to debate. Recent discoveries
about the many functions of the insula may fill some of the gaps in our knowledge
about how perceive and respond to music (and other sounds) and how the primary
auditory cortex works in concert with neighbouring parts of the brain. Other more
distant parts of the brain have also been implicated in the neural processing of
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music by fMRI, PET and magnetoencephalographic (MEG) studies in recent years.

Of these, the basal ganglia, including the nuclei accumbens and amygdalae are of
particular relevance to the insula and its possible role in what we call taste in
music, because of their extensive connections with this multimodal area of cortex.

The insulae show left-right asymmetry but usually have 5 to 7 sulci, 3-4 short sulci
in the anterior insula and 2-3 long sulci in the posterior insula. Recent
neuroimaging studies have shown the insulae to play key roles in music cognition.
A 2003 literature review by Bamiou, Musiek and Luxon (of the National Hospital
for Neurology and Neurosurgery in London and the University of Connecticut)
refers to several findings indicating the importance of the insulae in music
cognition on the basis of PET and fMRI scans. These showed differences between
the left and right insula in auditory processing, including that of rhythm. According
to these authors, the left insula is thought to be involved in musical rhythm
processing, while the right is involved in auditory sequencing and sound
movement detection.

These have also shown functional asymmetry between left and right sides, with the
left insula more activated by verbal activity, with the right insula activated with
singing out loud but not silently (Riecker, 2000). Opposite hemispheric
lateralization effects during speaking and singing at motor cortex, insula and
cerebellum was published in the journal Cognitive Neuroscience in June 2000,
and is available free on line. The reported study, by Axel Riecker and colleagues at
the University of Stuttgart in Germany is one of hundreds of scientific papers
revealing an extraordinary range of activities that are accompanied by increased
blood flow and metabolic activity in the insula. This study used functional MRI to
compare changes in cerebral blood flow in eighteen healthy right-handed German
men and women aged between 22 and 63. The musical task of singing the notes of
a familiar German tune was compared to the verbal task of reciting the months of
the year from January to December. Importantly the researchers compared the
blood flow when these tasks were performed overtly and silently.

This simple, indeed mundane, task revealed fascinating inter-hemispheric

differences in blood flow between silent and overt singing and silent and overt
speaking. Silent (covert) singing revealed exclusive activation of the right motor
cortex/posterior inferior frontal gyrus as well as the left cerebellar hemisphere.
Silent (covert) speech resulted in an opposite hemispheric localisation activation
of the left motor cortex and right cerebellum. Overt singing and speaking resulted
in bilateral activations (though greater in the right cortex and left cerebellum with
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singing, and left cortex and right cerebellum with speech) but also hemispherically
asymmetrical activation of the insulae. The left anterior insula was activated during
the verbal task of reciting the months of the year, the right insula with singing the
tune (without words).

The role of the left anterior insula in spoken language is not surprising, given that
Brocas speech area lies in the adjoining frontal cortex extending into the frontal
part of the operculum (the lid covering the insula). The activation of the insulae
with overt but not covert singing and speaking raises doubts about the classical
motor circuits in the brain, meaning the motor cortex, basal ganglia and
cerebellum. Though these structures are certainly involved in initiating, changing,
correcting and learning movements, their relative contributions to voluntary
movement (including vocalisations) may have been exaggerated relative to their
role in mediating emotions, including the plethora of feelings that listening to and
playing musical instruments, and listening to and singing with or without words,
silently, quietly or at the top of ones voice.

Another study of the insula in 2004 by Patrick Wong and colleagues at the
University of Texas used Positron Emission Tomography (PET) scanning
comparing native speakers of Mandarin Chinese versus English to show that the
left anterior insula is implicated in pitch pattern perception with a linguistic
context. The left anterior insula showed increased activity when Mandarin
listeners discriminated pitch embedded in Mandarin lexical tones, but when they
discriminated pitch patterns embedded in English words, the homologous area in
the right hemisphere activated, as it did in English-speaking listeners
discriminating pitch patterns embedded in either Mandarin or English words.

These findings further refine the long-held view that the right hemisphere is more
involved with music while the left is more involved with words. This is an
oversimplification in some ways, and a spurious dichotomy in others, since the
line between music, singing and speaking may not be as definite as has been
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traditionally supposed.

Pre-cortical processing in the thalamus

Post-cortical processing in the thalamus

Post-cortical processing in the basal ganglia

The structures commonly known as the basal ganglia are actually nuclei rather
than ganglia (ganglia are defined as collections of nerve cells outside the central
nervous system, but the basal ganglia are located deep inside the brain). Their
role in controlling movement has been recognised for many decades, and the
structures have been extensively researched, since dysfunction in the basal ganglia
are known to cause the movement disorder known as Parkinsons Disease. Though
Parkinsons Disease is known to be associated with depression, it is only in recent
decades that a particular structure within the basal ganglia system has been
identified as playing a key role in emotional reactions. This structure, the nucleus
accumbens, appears to be specifically involved with the experience of pleasure.

One thing that the new genetic discoveries have indicated is that many mental
functions (including memory, language and music) are widely distributed through
the brain, and involve novel connections and uses of various brain structures,
rather than the development of new structures. How the brain is wired, and how
components of the circuitry are activated and inhibited appear to be more

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responsible for unique human abilities, than evolution in our brains of new
organs of language, morality, aesthetics or music, as the phrenologists of the
nineteenth century maintained.

Pre and post-cortical processing in the cerebellum

The motor cortex, discussed earlier, is only one component of the primate brains
motor system. The motor strip is intimately connected with the other major
components, including the basal ganglia and cerebellum, which play key roles in
regulating the movement and learning new motor skills.

The cerebellum is known to be centrally involved in both correcting and learning

movements, and is thought to function as a time-keeper, though the details of
how this function is achieved are uncertain. There is an accumulating body of
evidence that the cerebellum is also involved in emotional reactions, and especially
pleasurable responses to rhythm. Fascinating research by Daniel Levitin and
colleagues at McGill has shown that cerebellar activity (on fMRI scans) increases
when people listen to pleasurable rhythmic music they have heard before, but not
when they listen to novel music, even if this music is experienced as pleasurable.
(Ref....)

Pre and post-cortical processing in the limbic system

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The neural substrate of musical memories

Neural mechanisms in attention and concentration

Neural plasticity and development of the auditory system

In the 1940s, the theory was put forward by Werner that a shift in activity occurs in
musically experienced listeners to involve the whole of the brain (or towards the
left side) from being a mainly right-sided function in inexperienced listeners. His
explanation was that musically experienced listeners have learned to perceive a
melody as an articulated set of relations among components rather than as a whole.
Werners theory has gained support from recent imaging studies and
neuropsychological studies suggesting greater left hemisphere activity in trained
professional musicians than in amateurs, who show more right hemisphere activity.
This observation is interesting, and may reveal profound insights into the
development of the brain and its capacity for what has been termed plasticity.

For many years it was assumed that once the brain has grown to adult size no
fundamental changes occur in its structure and function other than gradual (or
sudden) loss of brain cells, and, with them, mental ability. Loss of brain cells was
thought to be irreversible and loss of function due to death of cells was regarded as
permanent. This is now known not to be entirely true. Though there is an overall
loss of neurones from early childhood, the cells that survive can continue to grow
throughout life. They continue to make new axonal and dendritic connections that
link the electrically active cells in a dynamic (and potentially expanding) network.
While new synaptic connections are forming through the growth of axons and
dendrons, other synapses and cells are being lost.

The key factor determining overall gain or loss appears to be use: the principle of
use it or lose it applies to the brain as well as other parts of the body. Our

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potential to create new synaptic connections throughout life, and to improve the
efficiency of those already established has profound implications for learning and
the development of strategies to prevent dementia.

Plasticity of the brain (and neurones) allows for cells previously involved in one
type of activity to assume a different function in the event of damage to the cells
that usually perform this function. This phenomenon is a limited one, however. No
cases have been recorded of people who are blind because of damage to their
occipital lobes (visual cortex) gaining their sight by their frontal, parietal or
temporal lobes developing vision-processing capability. In the instance of musical
perception and creation, greater plasticity is likely than in vision, however, similar
limitations do exist.

There are other less dramatic, but equally important, aspects of neural plasticity.
Neural pathways that are used frequently become more easily activated. This
involves a form of plasticity of the synapses, affecting how easily they conduct
impulses. Myelination of nerves, though not generally called plasticity affects the
speed and efficiency of neural transmission. The myelin of the white matter of the
brain and nerves, secreted by specialised cells that wrap the fatty material around
the axons of neurons, insulates the nerve fibres and also greatly speeds the
transmission of electricity along the nerve. Myelination of the white matter of the
brain continues through life, and it has been noted that loss of white matter
precedes loss of grey matter in age-related loss of brain tissue. This loss has been
correlated with declining mental powers with age.

Recent research, including fMRI, have confirmed an increase in left sided brain
activity in trained musicians, along with structural changes in the brain. One
consistent finding is that the corpus callosum, the large tract of white matter that
connects the two hemispheres, is larger in trained musicians. This is thought to be
a result of musical training rather than because people with large corpus callosa
are more likely to become musicians. The fact that efficient communication
between motor functions of the hemispheres is important when playing instruments
with both hands makes this finding less surprising; the finding does suggest that
learning to play musical instruments may protect against loss of brain function
later in life.

Neural plasticity is also of fundamental importance in memory and learning during

the ontological development of the brain. In the developing foetus the structure of
the brain and the way the layers of cortex are connected to subcortical brain
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structures is established by the migration of cells from the inner wall of the
developing neural tube. This forms the basic structure of the brain and determines
how various collections of cell bodies (grey matter) are connected with each other.
The connections established by the growth of axons from the developing nerve
cells become the tracts of white matter, and provide an obvious mechanism for pre-
natal experiences, including musical experiences, to shape the developing brain.
Plasticity of this sort is the basis of auditory learning generally, and continues
through life.

The auditory system, though functional in a third trimester foetus, continues to

develop rapidly in the first two years of life. At this stage, according to
contemporary thinking, the process of pruning begins. Pruning results in loss of
nerve cells and the processes (axons and dendrons) that grow out of the cell bodies.
It is generally accepted that those connections that are not used are pruned, and this
stands to reason. What is not used does not, however, mean what is not needed.
The ontological development of these structures and neural pathways will be
looked at in the next chapter.

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MUSIC PERCEPTION AND PHYSIOLOGICAL CHANGES

(original integrative theory, 2010 Dr Romesh Senewiratne)

Awareness of Sound Perception of sounds

(requires consciousness RAS, brainstem) as
musical

No interest Interest (primary emotion)

(no further physiological change) (Temporal, frontal,
limbic, cerebellum)

Attention
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Concentration Memory of music heard in past (RAS,

cortex, thalamus)
(temporal and association cortices, hippocampus)
Expectation-Anticipation

Intellectual analysis of music Secondary emotions

and cross-modal associations (cortex, limbic, cerebellum, basal
ganglia)
Pleasure-
enjoyment/comfort
Discomfort

Physiological changes Tertiary emotions

via hypothalamus, Dance
impulse, bliss
pituitary, pineal and ANS
Irritation-anger

The strange tale of the Island of Reil

Back in the 1980s when I gained what passed as an acceptable knowledge of

neuroanatomy to become a medical doctor in Australia, one of the few things I
knew for a fact was that the cortex of the brain is divided into four lobes. I
memorised the names of these frontal, parietal, occipital and temporal where
they were located on the (external) surface of the brain and what I was told they
did what their function was, such as it was known at the time. Known, that is, by
the anatomists, physiologists, physicians and psychiatrists who taught me. It is
only recently that I learned, to my surprise, about a mysterious hidden lobe what
Grays Anatomy made famous as the Island of Reil.

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Island of Reil

Though Grays Anatomy was a standard reference text when I studied medicine at
the University of Queensland, the Island of Reil escaped my attention, though I
vaguely remember hearing about bit of the brain called the insula. As to where
this important part of the cortex was, or indeed the fact that is was part of the
cortex, was not part of my knowledge base during the decade I worked as a general
practitioner. It is only recently that I discovered some unusual facts about the
insula, including why it was once called The Island of Reil and some intriguing
new research that casts light on its somewhat mysterious function. The strange tale
of the Island of Reil also casts light on the modern medical treatment of the mind,
since it was Professor Johann Christian Reil who first coined the term psychiatry.
Johann Christian Reil (1759-1813) was a famous
German physician in his day, and was even consulted by
the poet Goethe. He founded the first German journal
devoted to physiology, publishing articles ranging
across a range of disciplines physics, chemistry,
histology, biology and comparative anatomy. He was
highly regarded as a teacher, and insisted that surgeons,
in particular, should have more regard for the psychic
aspects of their patients.

When he was consulted on the formation of the then

new medical school at the University of Berlin in 1810,
Professor Reil suggested that the institution should
award three medical doctor degrees Doctor of
Pharmacy, Doctor of Surgery and Doctor of Psychiatry. At the University of Halle,
where he had been director of the clinical institute since 1788, he had argued that a
new medical discipline should be devoted to scientific study of the mental aspects

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of patients, urging that the psychic aspects of disease not be forgotten, and that
psychotherapy can provide benefits equivalent to those of surgery and drugs, even
in somatic diseases.

Though Reil argued that we will never find pure mental, pure chemical or
mechanical diseases since there is continuity between psyche and soma, when
the University of Berlin adopted his advice and the medical specialty of psychiatry
spread to Berlin from Halle (where it was born) the division between study of
diseases of the mind and those of the body (soma) became institutionalised, first in
Germany, later around the world. These divisions deepened as medical treatment
of the mind (psychiatry) became divorced from neurology study of the brain and
nervous system. Unfortunately, there is some merit in the criticism that this
resulted in the emergence of mindless neurology thoughtlessly combined with
brainless psychiatry.

In 2008, the Global Psychiatry Establishment celebrated its 200th anniversary, with
opportunities to wax lyrical about its manifold achievements, mainly in the area of
drug development and prescription. Amongst the celebrations were some tributes
to the German professor who created the discipline of psychiatry, by suggesting it
in a paper he wrote in 1808. One such tribute was an editorial in the British Journal
of Psychiatry titled Psychiatrys 200th Birthday. It was penned by Professor
Andreas Marneros, a medical graduate of Greeces Aristoteles University in
Thessaloniki, now Professor and Head of the Department of Psychiatry,
Psychotherapy and Psychosomatics of the Martin Luther University, Halle-
Wittenberg.

Having been a psychiatry professor in Halle since 1992, Professor Marneros knows
more than most about Professor Reils contributions to German medicine, and
extols his predecessors efforts to improve the treatment and care of the mentally
ill by improving the education of doctors and of the public efforts should be
made to de-stigmatise mental illness; lunatic asylums should be changed to
mental hospitals, where the incurable are separated from the curable; humane
mental institutions are the basis of high-quality care; only the best physicians shall
become psychiatrists. Indeed, from Dr Marneros account, Professor Reil sounds
amazingly enlightened. There is a bit more to the story, though.

According to a less glowing account, one of the humane methods of shock

treatment advocated by Reil involved plunging patients into vats of live eels.
Another strategy for shocking unresponsive patients into action, if not sanity, was
the katszenklavier or cat-piano. This outrageous instrument was described by Reil
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in 1803 in his mysteriously titled Rhapsodieen uber die Anwendung der

psychischen Curmethode auf Geisteszerruttungen (Rhapsodies on the Application
of Psychological Methods of Cure to the Mentally Disturbed). The Katsenklavier is
a grotesque German musical instrument invented during the Renaissance. It
produced ascending notes in a scale from the howls of cats that were subjected to
pain (through various means) with the pressing of each key. Reil explained how
the cats should be tortured, for maximum therapeutic effect from the infernal
contraption:
[the cats should] be arranged in a row with their tails stretched behind
them. And a keyboard fitted out with sharpened nails would be set over
them. The struck cats would provide the sound. A fugue played on this
instrument when the ill person is so placed that he cannot miss the
expressions on their faces and the play of these animals must bring Lots
wife herself from her fixed state into conscious awareness. (Reil, 1803,
translated by Richards, 1998)

A rival to Professor Johann Reils idea of psychiatrie was the Physiognomic

System of Doctors Gall and Spurzheim, which was being propounded in German
universities before they were exported to an adoring public in Britain, Canada,
Australia and the USA by the flamboyant German head-dissecting duo, Franz Gall
and Johann Spurzheim. Reil was unimpressed when Gall gave a lecture on the
system of psychoanalysis he had created, then already famous in German, French
and English-speaking intellectual and academic circles as phrenology taken
from the Greek for mind/breath (phren) and knowledge/word (logos).

Professor Reils written denouncement of Galls increasingly popular model was

published a few months after the phrenologists lecture at the University of Halle,
which was an event prodigious enough for the even great poet Goethe to attend.
Apparently to his annoyance Gall used the famous poets head to illustrate the
shape of the cranium of the universal genius. The two famous men seated on
either side of Goethe, one a musician and the other a linguist were reportedly
flattered, rather than offended, when their turns to show the special characteristics
of their crania came, immediately after Goethes head had been revealed as the
ideal shape of a deeply thinking man the advanced form of Homo sapiens.
The medical historian Robert Richards recounts the details:
Gall next turned to Reichardt, seated at Goethes left, as he indicated that
sublime musical talent would produce bulges in the temporal regions of the
skull, which the kapellmeisters perfectly bald and powdered pate
exemplified. Gall then prepared to discuss the organ of language. But before
he could even smile towards Wolf, on Goethes right, the great philologist
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took off his glasses and swivelled his head in all directions. (Richards,
1998)

In March 1806, after witnessing this spectacle in July 1805 and conducting his own
dissections and measurements of the skull and brain, Reil expressed a well-
founded, but hotly debated, opinion that, Gall understands the structure of the
skull as little as that of the brain; he has issued not one single correct remark
concerning these structures.

Though Professor Marneros does mention Johann Reils postulation of a soul

organ, in which all his studies in psychiatry, physiology, neurology and anatomy
coalesce no mention is made of phrenology, or of the founder of this other new
discipline, Franz Gall, whose lectures and demonstrations of the convolutions of
the brain inspired Reil to turn his attention to the structure and function of the
brain.

It was phrenology that provided the integrated model of mental function and its
relationship with the shape of the skull and face which Reil hoped to train the best
new medical graduates in, before they could call themselves psychiatrists. In his
view, such training was essential, so they were scientifically equipped to treat
(iatros) the organ of soul and the mind (phrenos) and body (soma) that the soul
(psyche) controls, according to the ancient European tradition of the Greeks.
According to this model, the soul is the organ of will of volition, or as modern
psychology jargonises it, (sense of) agency. What the animal experimenters (who
long abandoned discussion of souls, thought or will) started calling behavior after
the public branding of phrenology as a pseudoscience.

Somehow psychiatry, born in the same place at the same time, and conceived of
within the same academic tradition, drawing on a common armoury of racist and
misogynist ideas coupled with emerging knowledge about the anatomy, physiology
and ontology of the brain and nervous system, and propagandised with the same
authoritarian, patriarchal and condescending attitudes (towards patients, the public
and non-experts) managed to escape similar pseudoscience stigma at least,
until the second half of the twentieth century.

Phrenology, the integrated neuropsychology of the 19th century

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The mind and body are inextricably connected and, argued the Professor, the
territory of the mind was being dominated not by medical men, but by
philosophers and clergymen. The psyche, as he called it, was the province of
medical science, not religion or philosophy, at least as it pertained to the causes
and cures of disease.

by the process of suggestion. He wrote a paper suggesting it, and provided

convincing arguments for the creation of a new area of medical expertise. The

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The neurobiology of rhythm

Of the main elements of music (rhythm, melody, harmony and timbre) rhythm has
been relatively neglected by psychologists and neuroscientists over the years. This
is partly to do with a tradition embedded in European classical music and a view
that serious (and therefore good) music should be food for the intellect rather
than the emotions (a reflection of the traditional dichotomy between thinking and
feeling). Though musicians and their audiences were certainly meant to feel
emotions at a classical music concert, it was not good form to jump around with
excitement that was for the common folk with their folk music. The influence
of Western classical music and this particular traditions great composers on music
perception and creation and on the neurosciences generally is to be expected, since
the scientific study of the brain and mind is centralised in the global university
system, which is dominated by the oldest universities in the biggest cities of the
worlds most vociferous nations, each with their own classical musical heritage
to honour and proclaim.

Universities are conservative institutions, and like old men, the oldest universities
tend to be the most conservative, meaning tradition-bound (rather than any
economic connotation). This is not necessarily a bad thing the academic tradition
has a lot to be proud of, and to conserve. It can, however, lead to a narrowness of
view and reluctance to embrace new ideas, especially when they threaten the
existing curriculum, or opinions and interests of particular academics who have
established empires at that university. Like other hierarchical institutions, there is a
ladder to climb in universities, and each discipline or faculty provides different
ladders. The highest echelons of these faculties, especially in science, but also in
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the arts, is dominated by men. Until very recently these men were among the
minority of the worlds population that listened largely, or exclusively, to classical
music. The research projects they approved were only those they could defend as
studying serious music. It should be remembered that until relatively recently
many of the worlds more famous orchestras were composed entirely of men (with
the interesting exception of harpists).

Since the 1960s and the ground-breaking work of Brenda Milner at McGill
University, women have been at the forefront of music neuropsychology. This is in
stark contrast to the medical profession, including the specialties of neurology and
psychiatry (the two specialities that might be expected to understand music and the
brain), which are dominated by men, especially in terms of senior academic and
research positions. Chauvinism may be a relevant factor in the shameful neglect of
music as a therapy and as a subject worthy of serious scientific study (and funding)
by the medical profession over the past half century. Unfortunately, in Australia
and many other countries (of which Canada is an exception) little public money, if
any, is used to fund music neuropsychology or music therapy research, and the
other major sources of medical research funding the drug companies are hardly
likely to sponsor research that might establish music as a serious competitor in the
therapeutic market.

The paradigm of modern neuroscience has emerged from a sometimes

uncomfortable integration of psychology, psychiatry and neurology with
pharmacology, evolutionary biology, biochemistry and biophysics. The fossil
record has underpinned the development of the modern neuroscience paradigm,
which has been especially concerned with those attributes that have been regarded
as uniquely human language, and intelligence as measured by various
behavioural tests in animals and psychological tests in humans. Though music
has been regarded as one of a relatively small number of uniquely human
abilities, the use of psychological tests developed for other reasons being adapted
for research into the neuroscience of music has resulted in confusing and
contradictory findings, especially when it comes to the emotional reactions (most)
people have to music.

Music that stimulates the mind rather than the body, the objective of the
intellectual aesthetic favoured by the Western classical music tradition, was
focussed on the musical elements of harmony and melody rather than timbre and
rhythm. This is ironic, since the human sensitivity to timbre and rhythm are
fundamental to our musicality, and to the sounds that make us feel like tapping our
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and feet, bobbing our heads, and moving our bodies in time to the music. Harmony
and melody may make us smile, but timbre and rhythm make us dance.

It is precisely because of its primitive appeal, and its propensity to induce people
to gyrate their bodies in sexually suggestive ways that rhythm has long been
regarded as the least respectable of the elements of music. The angels in religious
paintings over the centuries were usually depicted playing harps, or at worst
trumpets, never drums. Drumming was associated with voodoo, black magic, black
people and the dangerous allure of hypnotic trances. Dark-skinned people dancing
semi-naked around an open fire in a frenzy inspired by sweat-covered men beating
drums was a familiar image Hollywood reserved to depict the savages in
Darkest Africa through the 1950s and 1960s, prior to the international explosion
of Rock and Roll. Rock changed everything when it came to what music and
musicians were venerated but the neuroscience establishments were, predictably,
not the first bastions to crack under the sonic onslaught of Rock. Rock music was,
and is, all about rhythm.

Its not that great grooves began with Chuck Berry and Rock and Roll. But the
popularity of Berry, followed by the fanatic enthusiasm for Elvis Presley and later
the Beatles and Rolling Stones brought Berrys rock version of the rhythm and
blues to a vast new global audience. The Beatles, in particular, inspired huge
numbers of young people to take up the guitar, bass and drums and form their own
bands in towns and cities around the world. When these pop musicians were
first featured on television variety shows and the radio was playing their recordings
there was predictable opposition from many conservative members of the older
generation who complained that the new music was loud noise, much as several
previous generations had regarded jazz, which is distinguished by complex,
syncopated rhythms in the melodies and in the rhythm section (bass and drums).
It was only in the 1990s that the Western worlds universities evolved musically to
a point where the senior echelons of the relevant faculties grew up on pop, rock
and jazz. Though music schools were slow to add jazz studies and its focus on
improvisation to their curricula, and slower to add rock and roll, the popularity of
the guitar, more so than any other instrument, guaranteed that even academia had
to yield to the rhythm oriented music that has since transformed human culture in
the north, the south, the east and the west. All around the world musicians have
been incorporating guitars into their music.

The other standard instruments of a rock/pop band (originating from a format

shared between country, folk and blues, all of which contributed to the synthesis
Chuck Berry popularised as Rock and Roll) are bass (first acoustic, later electric)
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and a drum kit. These instruments have also been incorporated into popular music
sung in hundreds of languages around the world.

The new generation of neuroscientists, brought up on a diet of beat-oriented music

has belatedly begun a serious, systematic study of human perception of the
temporal events of music using the most modern imaging techniques available
functional magnetic resonance imaging (fMRI) and positron emission tomography
(PET) being favourites. Though older investigations, such as surface electrical
readings (EEGs), these new (and relatively expensive) scans allow imaging of
increased blood flow to various parts of the brain. With careful experimental
design it has been possible to localise many of the brains musical functions,
though much remains unknown in this area (despite brain localisation of musical
functions being a popular research objective). One thing that has become clear is
that though small areas of the brain are primarily involved with music-related
functions (mainly in the right temporal lobe), most music cognition and creation
involves parts of the organ and networks that are used for other, non-musical
functions, including language, (non-musical) movement and the complex circuits
and neural structures that subserve our emotions.

In the past decade several facts have been established about the neural processing
of pitch, melody and rhythm, by neuroscientists in the USA, Canada and Europe
who were using a combination of new and older radiological techniques and a
human experimental population ranging from professional musicians through
students and members of the general public, to people with localised brain damage
(from disease and surgery). More is known about our processing of pitch and
melody than about rhythm, partly for the reasons mentioned, and partly because of
the deep structures that appear to be involved in our mental processing of time,
timing and rhythm. These structures, including the cerebellum and basal ganglia
are less accessible to testing by sticking electrodes onto the scalp or directly into
the brain, which has, until recently, been the mainstay of neuropsychology
research as far as brain localisation was concerned.

In their 2005 review of the literature two of the worlds leaders in music
neuroscience, Robert Zatorre of McGill and Isabelle Peretz of the University of
Montreal report several important discoveries about the neural processing of
(musical) time relations. One is that creating a rhythmic pattern appears to be
processed more by the left side of the brain, while beat perception causes more
right-sided activity. This theory is supported by the fact that it is easier to tap a beat
with the left hand and a rhythm with the right (I tried it myself, and found it to be
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true, at least in my case). The authors argue that this supports the hypothesis that
the right hemisphere handles meter, whereas grouping would rely essentially on
the left. The argument is that extraction of the beat from a piece of music (meter)
results in the metrical organization corresponding to periodic alternation between
strong and weak beats. Grouping, the function ascribed more to the left
hemisphere, is the segmentation of an ongoing sequence into temporal groups of
events based on their durational value.

Levels of neurotransmitters, and the protein receptors on neurone cell membranes

that bind with them, are among the many physiological factors that can vary
between species and within species. The amount of DNA that is expressed (used as
a template for protein synthesis) varies according to cell type, and, as modern
epigenetics has shown, this selective expression is subject to environmental (and
learning) experiences.

One of the startling findings of this research is that motor areas of the brain
including both cortical and sub-cortical structures are activated by listening to
music and not only with playing instruments or dancing. It has also been
discovered, using modern neuroimaging techniques such as fMRI that specific
parts of brain involved in relevant movements are active when listeners are
familiar with playing the instrument being listened to. It is as if the listener is
mentally practicing the production of the same sounds indeed, subconsciously,
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that is what they seem to be doing. This occurs if, and only if, the person has
learned how to make the relevant movements learned to play the instrument they
are listening to, in other words. Interestingly, this activation of relevant motor areas
occurred when people heard the music, even when not consciously imagining
playing along with it.

It has been long established that the movement of the fingers the right hand, and
the right hand and arm (and leg), come under the control of the motor cortex of the
left hemisphere. Correspondingly, movement of the left arm and leg come under
the control of the right hemisphere motor cortex. This is evident from the paralysis
of the right arm and leg suffered by people who have damage to the left side of the
brain (from a stroke, for example) and the contralateral paralysis that results from
damage to the right side of the brain.

Adding credence to the theory that perception and creation of music is

predominantly a function of the right side of the brain, damage to the left
hemisphere affecting capacity for generating and/or understanding speech may
leave musical ability unaffected. Cases have been described of people being unable
to speak following a stroke, but still retaining an ability to sing songs with words.
This is not, however, a consistent observation.

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DEVELOPMENT OF MUSICAL APPRECIATION

Ontology of the musical brain

The foundations of music appreciation what notes, timbres and scales, and
perhaps what rhythms one enjoys in later life are probably established during
infancy and early childhood, perhaps even before birth.

Intriguing (fairly) recent research has shown that babies respond to music while
still in the womb. One elegant study played babies and mothers the music through
headphones. When the headphones were applied directly to the abdomen, the foetal
heart rate increased independently of the mothers. In another study one-year-old
infants were found to look longer at a speaker playing a song that had been played
repeatedly during late pregnancy (but not since then) than a matched speaker
playing a different passage of unfamiliar music that had been matched for tempo
and style (or genre).

These studies, though modest in their design and conclusions, are supported by the
embryological fact that the auditory system is developed to a functional level some
months before birth, and the observation that newborns respond to sound in
surprisingly complex ways. This response includes a natural love of the singing,
female voice especially the singing voice of the childs mother. One field of
medicine in which music has become part of worlds best practice (as our
hospitals like to declare of their care) is neonatology. Several studies have shown
statistically significant reductions in the amount of drugs used and length of stay of
premature babies in neonatal intensive care units if music is played to the babies
though speakers near their cribs. Consequently, music is used in neonatal units
around the world to various degrees far more than in other medical specialties.

Newborns are also alarmed by sudden, loud, harsh sounds, and this produces the
distinctive startle reflex I was taught to elicit when I worked for a few months
as a paediatric registrar at the Royal Womens Hospital in Brisbane. When babies
are startled by alarming sounds (including a hand clap if it is loud and sudden
enough) they jerk their arms open as if they are startled. That is doubtless because
they are, but it takes a functional brain to be startled, and eliciting the startle
reflex is one of several routine clinical tests of a newborns brain and nervous

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system. Others include the grasp reflex and stepping reflex; these are different
from later motor behaviours according to medical orthodoxy, because they
disappear after the first few weeks if the baby is developing normally. How
these primitive reflexes as they are called may relate to instinctual behavior,
including our musical instincts will be explored in the next section.

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MUSIC, MOOD AND EMOTIONS

One obvious thing about music is that it can stimulate emotions. It is also obvious
that the same piece of music can elicit different emotional reactions in different
people, and even in the same person at different times (influenced by such things
as mood, repetition and environment). Why is this so, and how can allowance be
made for these differences when using music therapeutically? How can, and
should, emotions be measured?

On the scientific study of emotions

The science of emotions is a controversial area, since there is neither popular nor
scientific consensus on what emotions humans are capable of, how to classify
them, or what parts of the brain (and body) are involved in feeling different
emotions. Adding to this the confusing use of the term affect by the medical
profession to describe emotions, and the difficulty in defining different emotions,
let alone conflicting opinions on the distinction between moods, affect and
emotions, and the difficulty in measuring emotions, the question of how the
emotional aspects of human musicality evolved becomes a thorny one.

The paradigm of modern neuroscience has emerged from a sometimes

uncomfortable integration of psychology, psychiatry and neurology with
pharmacology, evolutionary biology, biochemistry and biophysics. The fossil
record has underpinned the development of the modern neuroscience paradigm,
which has been especially concerned with those attributes that have been regarded
as uniquely human language, and intelligence as measured by various
behavioural tests in animals and psychological tests in humans. Though music
has been regarded as one of a relatively small number of uniquely human
abilities, the use of psychological tests developed for other reasons being adapted
for research into the neuroscience of music has resulted in confusing and
contradictory findings, especially when it comes to the emotional reactions (most)
people have to music.

Since the dark age of behaviourism, when animals were thought not to have much
in the way of emotions, and psychology experiments were obsessively focussed on

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measuring stimulus and response, there has been a relatively rapid recognition of
the complex emotions of other mammals, and how similar they are to our own.
This is, in fact, a rediscovery of observations made a hundred and fifty years ago
by Darwin, though now we have a much clearer idea of the brain structures the
neural substrate of emotions. The deep structures of the limbic system, once
denigrated as the primitive lizard brain, whose essential components are shared
by reptiles, birds and mammals, is belatedly being recognised as being essential for
the most human of mental attributes - emotions, or feelings. Structures like the
hippocampus, thalamus, cingulum, amygdala and nucleus accumbens have been
studied in considerable detail for decades, using various techniques, but only
recently have we seen meaningful syntheses of the complex and sometimes
contradictory findings of researchers around the world.

Since their advent in the 1990s, functional Magnetic Resonance Imaging (fMRI)
scans have transformed our understanding of the parts of the brain involved in
music perception and creation, as well as of many other mental functions,
including emotional reactions and moods. Various aspects of music cognition have
been studied by fMRI (and other modern imaging techniques, such as Positron
Emission Technology, or PET, scans). These technologies are of particular value in
locating subcortical structures involved in music-related emotions, such as the
basal ganglia and structures that comprise the limbic system.

Though the terms limbic system and limbic structures are widely used to refer
to the neural circuit that underpins emotions, there has been a steady stream of
evidence, from the 1960s onwards, that the original emotional circuit proposed
by the neuroanatomist James Papez (1883-1958) in 1937 and elaborated by Paul
McLean (who popularised the term limbic system) in 1952 is inaccurate and
incomplete. In particular, the amygdala and nucleus accumbens and insular cortex,
structures now recognised to play a vital role in emotions, were not included in
Papez model, while the hippocampus and mammillary bodies, now known to be
more important to memory than to emotional reactions, were key structures in the
Papez Circuit. His errors were understandable injecting rabies into the brains of
cats is perhaps not the best way of studying emotions scientifically.

Attempts to study emotions scientifically have been hampered by the paradigm of

experimental physiology propounded by Harvards Walter Cannon during and
after the First World War (1914-1918). Cannon (1871-1945), who coined the
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phrase fight or flight to describe the activity of the sympathetic nervous system,
was credited by Papez (1883-1958), in the latters landmark 1937 paper (A
Proposed Mechanism of Emotion) as one of a handful of scientists who greatly
advanced knowledge of the functions of the hypothalamus, a structure at the base
of the brain on which the neuroanatomist Papez placed great emphasis within the
emotional circuit he proposed.

Cannon was responsible for developing the theory of emotion commonly referred
to as the Cannon-Bard theory. This theory had replaced, as the dominant paradigm
of American psychology, the counter-intuitive theory by William James (1842-
1910) that our emotions follow our physiological arousal.

In his 1884 paper titled What is an Emotion? James explained how the less
enlightened, commonsense view differed from his own insights:
Our natural way of thinking about these standard emotions is that the
mental perception of some fact excites the mental affection called the
emotion, and that this latter state of mind gives rise to the bodily expression.
My thesis on the contrary is that the bodily changes follow directly the
PERCEPTION of the exciting fact, and that our feeling of the same changes
as they occur IS the emotion. (James, 1884, his emphasis)

James explained than in his opinion, rather than seeing a bear, feeling afraid and
running away, as seems intuitively to be the case, what really happens, is we see
the bear, run away and therefore feel afraid. Likewise, he claimed, we feel scared
because we tremble, angry because we strike and sorry because we weep.

In his 1884 paper, What is an Emotion? William James refers to Darwins work
and the well-known evolutionary principle that when a certain power has once
been fixed in an animal by virtue of its utility in presence of certain features of the
environment, it may turn out to be useful in presence of other features of the
environment that had originally nothing to do with either producing it or
preserving it.

James was trained in medicine, but spent his whole career as an academic at
Harvard since 1873, shortly after Darwin published The Descent of Man (1871)
followed by The Expression of the Emotions in Man and Animals (1872). Initially
employed as instructor in physiology and anatomy, he rose to the position of
professor of psychology (then a fledgling science) and professor of philosophy at
Harvard, Americas oldest and most esteemed university. Though many others
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doubtless voiced doubts about the veracity of William James theory of emotions,
it was only when another Harvard professor, Walter Cannon disproved it that the
mainstream abandoned the James-Lange theory for the Cannon-Bard theory.
How William James theory was disproved by Cannon says a lot about the
direction experimental physiology went in once personal introspection as a
means of understanding the mind was renounced in favour of hard facts. James
came to his contentious conclusions by analysing his own emotions; Cannon
proved him wrong by showing that dogs in which he had severed the nerves
carrying visceral information to the brain still expressed emotions.

Cannon and Bard are credited by Papez in his landmark 1937 paper, A Proposed
Mechanism of Emotion, among of a handful of scientists who greatly advanced
knowledge of the functions of the hypothalamus, a structure at the base of the
brain on which the neuroanatomist placed great emphasis within the emotional
circuit he proposed. The other two scientists the neuroanatomist credits with
contributing to our understanding of the hypothalamus (and emotions) are
Northwestern Universitys Professor Stephen Ranson and Canadas famous Dr
Wilder Penfield. These two neuroscientists were pioneers in the other major
technique used to localise functions of the brain stimulation of the brains outer
cortical layer with small electric currents delivered by metal electrodes inserted
into the brain tissue.

Flaws in research on the physiology of excitement

The physiology of excitement has been studied scientifically using a range of

methods over the past century. The thousands of published studies about
excitement, though, interpret the word excitement in different ways a few mean
positive emotions, many more infer negative emotions (including rage and terror),
and some physiologists and psychologists take excitement to mean sexual
excitement (and/or fear and anger). Much neurobiological use of the term
excitement through the twentieth century was unrelated to emotion as such.
Neuroscientists wrote about their observations of exciting nerves or localised
areas of the brain with electrodes, in mice and men. Passing an electric current
directly into the brain, sufficient to cause nerve cells to fire electrical pulses of
their own, and observing motor, sensory and physiological responses (such as
blood pressure, heart rate and sweating) was a mainstay of experimental
neuroscience throughout the twentieth century. During this time the popularity of

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passing large electrical through the whole brain (sufficient to cause convulsions)
promoted as a treatment for manic excitement as well as depression and
schizophrenia rose and fell.

The physiology and biochemistry, and the neural circuits involved in rage and
terror (and their milder forms, anger and fear) have been researched intensively by
universities around the world since before the First World War, with major
injections of funding into the study of rage, terror and other nervous excitements
during the Second World War and Cold War. The principle means of study,
including experiments that established many enduring doctrines in medical and
physiological science (including some factual ones), involved creating these
emotions deliberately in cats, dogs, monkeys and apes. In a misguided line of
inquiry spearheaded by Harvard Universitys Professor Walter Cannon and his
junior associate Philip Bard during and after the First World War (1914-1918),
bigger and bigger chunks of the brains of cats were removed, while continuing to
provoke the animals in increasingly cruel but meticulously calculated ways.

The traditional paradigm of autonomic physiology has serious limitations when it

comes to explaining the ways musical emotions, and emotions more generally,
affect our health. During the First World War, the appropriately named Dr. Walter
Cannon coined the phrase flight or fight to describe activity of the sympathetic
nervous system, while the parasympathetic nervous system was responsible, he
said, for rest and digest physiological changes. The first of these phrases, more so
than the second, caught on, and became a core doctrine of neurophysiology.
Schoolchildren learn about fight or flight, and the phrase is commonly bandied
about in the media.

Walter Cannons phrases have seen such popularity is because, for one thing, they
have catchy rhymes and describe the relationship between the two branches of the
autonomic nervous system reasonably well. Activity in the sympathetic nervous
system stimulates the heart, raises blood pressure and heart rate and contractility,
diverts to the muscles and brain and away from the digestive tract, dilates the small
airways in the lungs (allowing more oxygen to enter the blood) and the pupil of the
eye dilates, allowing more light into the eye. These are clearly adaptations to
danger and characteristic physiological responses to fear (flight) and anger (fight).

The problem with the traditional model is that activity of the sympathetic nervous
system and the catecholamine neurotransmitter molecules it synthesises and
releases have essential functions that have little to do with anger or fear and less to
do with fighting or running away. This function might reasonably be described as
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activation, meaning both physical and mental activation.

Of course the parasympathetic nervous system is also involved in activation of

the salivary and other digestive glands, of the involuntary muscles in the lungs and
elsewhere, and the neurotransmitter released from its synapses, acetyl choline, is
one of several (usually) stimulatory transmitters. Having said that, the sympathetic
nervous system plays a more obvious role in mental excitement and preparation of
voluntary muscles for action.

Walter Cannon (1871-1945) spent his working life at Harvard University, doing
research at the Department of Physiology from 1900 till his retirement in 1942
(during the Second World War). His position as Professor and Chairman of the
Department of Physiology at Harvard Medical School (since 1906) helped make
his catchphrases fight or flight and rest and digest famous around the world, but
it is less often taught to medical students as to what the nature of his research was.
What his techniques were, what animals he experimented on, or how and why he
conducted the particular experiments he performed.

The title of the book in which he coined the phrase fight and flight gives a good
idea of where Cannons interests lay, in terms of human and animal emotions:
Pain, Hunger, Fear and Rage: An Account of Recent Researches into the Function
of Emotional Excitement. It is clear that what the eminent physiology professor
meant by emotional excitement is not what advertisers are trying to provoke with
their slick photos of new cars, elegant perfume bottles, exotically-named
confectionaries and travel destinations. He was not talking about the excitement of
buying things, or the excitement of music, love or of new discoveries and insights.
No, Walter Cannon, seen in this portrait, had a grim view of what it means to be
excited the unpleasant emotions of pain, hunger, fear and rage.

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Cannon studied thirst, as well. An example of his style of research was his
investigation of the Dry Mouth Hypothesis he had put forward that people get
thirsty because their mouths get dry and not because they are not getting enough
hydration. To investigate his hypothesis, Cannon slit the throats of experimental
dogs and inserted a tube that collected the water they drank before it got to the
stomach. He reported that these dogs drank the same amount of water as control
dogs that had not been mutilated in this way. Thus Cannon proved his own
hypothesis at the Harvard University School of Medicine, at least to his own
satisfaction.

The Cannon-Bard Theory of Emotion was developed in the 1920s as an

alternative to the counter-intuitive James-Lange theory, which had dominated
American psychological doctrine about emotions since it was proposed by the
famous philosopher and psychologist William James, in the 1880s. James had
argued that our natural way of thinking that the emotion precedes the bodily
expression of that emotion is incorrect. In his opinion the emotion followed the
bodily changes mediated by the autonomic nervous system. Rather than running
away after seeing a bear and feeling afraid, according to James, we feel afraid
because we run away. Likewise we feel sad because we cry, rather than the
intuitive (and correct, as it turns out) idea that we cry because we feel the emotion
of sadness. Even more oddly he argues that we feel angry because we strike.

In his celebrated 1884 paper, What is an Emotion? James explained how the less
enlightened, commonsense view differed from his own insights:
Our natural way of thinking about these standard emotions is that the
mental perception of some fact excites the mental affection called the
emotion, and that this latter state of mind gives rise to the bodily expression.
My thesis on the contrary is that the bodily changes follow directly the
PERCEPTION of the exciting fact, and that our feeling of the same changes
as they occur IS the emotion. (James, 1884, his emphasis)

In What is an Emotion? William James refers to Darwins work and the well-
known evolutionary principle that when a certain power has once been fixed in an
animal by virtue of its utility in presence of certain features of the environment, it
may turn out to be useful in presence of other features of the environment that had
originally nothing to do with either producing it or preserving it.

This is undoubtedly true, and the basis of arguments that musicality is a spandrel
or evolutionary cheesecake. These arguments are flawed, however. Consider the
feathers of birds, which probably evolved for insulation rather than flight. Once
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they did, plumage became a key factor in bird evolution various types of feathers
evolving for flight, communication, camouflage and courtship. Creating and
responding to music likely recruited existing neural circuitry, including auditory
circuits, motor circuits and emotional circuits that evolved because of selection
pressures in our pre-musical, pre-literate, and perhaps pre-lingual ancestors. These
ancestors were, the fossil record suggests, hunter-gatherers. One could reasonably
argue that verbal language evolved as a spandrel because of evolution of body
language something all social and even non-social mammals display. Birds, and
even cold-blooded fish, amphibians and reptiles display rudimentary body
language, though primate capacity for displaying emotion, desires and intents by
movements of the face, head and hands are unrivalled. Among primates, humans
have the most sophisticated body language as well as verbal language, but
chimpanzees, gorillas and other apes also communicate by gesture and facial
expression, and through vocalisations. Many of these gestures and expressions are
remarkably similar to our own, supporting Darwins argument that our emotional
expression is instinctual.

William James (1842-1910) was trained in medicine, but spent his whole career as
an academic at Harvard. He began his career at the famous university in 1873,
shortly after Darwin published The Descent of Man (1871) followed by The
Expression of the Emotions in Man and Animals (1872). Initially employed as
instructor in physiology and anatomy, James rose to the position of professor of
psychology (then a fledgling science) and professor of philosophy at Americas
oldest and most esteemed university. Though many others doubtless voiced doubts
about the veracity of William James theory of emotions, it was only when another
Harvard professor, Walter Cannon disproved it that the mainstream abandoned
the James-Lange theory for the Cannon-Bard theory.

How William James theory was disproved by Cannon says a lot about the
direction experimental physiology went in once personal introspection as a
means of understanding the mind was renounced in favour of hard facts. James
came to his contentious conclusions by analysing his own emotions; Cannon
proved him wrong by showing that cats in which he had severed the nerves
carrying visceral information to the brain still expressed emotions.

Cannon continued his misguided effort to prove William James wrong by severing
the spinal cord and brain stem at different levels and later by carefully removing
various parts of the cat brain to work out what each bit does. In this he was assisted
by several trained surgeons who abandoned medical practice to work in Cannons
famous laboratory at Harvard. In addition to fight and flight and rest and digest
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the famous medical physiologist did seminal work in localising various

homeostatic mechanisms to the hypothalamus, and sensory functions to the
thalamus.

Cannons approach became dominant during the Great Depression and Second
World War. This style of research, later called behaviourism was centred on
mutilating and torturing animals, always using more palatable euphemisms, of
course. Cannon coined the term sham rage to describe the behaviour that cats
deprived of their cerebral cortex displayed on the least provocation baring teeth,
arching their backs with hair standing on end. This phenomenon was then further
investigated at the expense of many cats by Philip Bard, who was able to establish
that cats displayed behaviour that looked much like rage even when most of their
brains have been removed so-called decerebrate and decorticate cats.

Bard, who is credited with formulating, with his mentor, the Cannon-Bard theory
of emotion, proudly described, in his 1942 paper Neural Mechanisms in Emotional
and Sexual Behavior how he had been able to keep decerebrate cats alive for
several months. These were cats in which the entire cerebral hemispheres had been
surgically removed:
Recently M.B.Macht and I have been able to maintain for long periods of
time, i.e., up to periods of over 3 months, decerebrate animals in which the
remaining parts of the central nervous system are: spinal cord, medulla,
cerebellum, and various portions of the mid-brain. (Bard, 1942)

To the surprise of the mutilators, not much brain needed to be left behind for cats
to continue to show rage when they are subjected to threat or pain. Thinking this
could not be real emotion, Cannon, Bard and the many thousands of researchers
who embarked on further mutilations of cats and, later, monkeys, apes and
humans, termed the hissing, back-arching, tooth-baring behaviour they provoked in
these poor cats sham rage.

Philip Bard (1898-1977) was particularly interested in two instinctual behaviours

rage and sex. He was appointed professor and director of the Department of
Physiology at the John Hopkins Medical School in 1933, at the unusually young
age of 34. He himself was surprised at the appointment, according to his National
of Sciences biography, since other than studying under Walter Cannon he had
distinguished himself with only three published papers of scientific research. In
1942, Bard explained the work his team had accomplished after nine years of
labour and dedicated mutilation of cats. At the end of Neural Mechanisms in
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Emotional and Sexual Behavior (1942) he mentions what his studies, and others in
the same vein, had revealed about instinctual capacities:
These observations, together with others on postural reactions and
temperature control, lead to the conclusion that the mesencephalon and
upper portions of the medulla serve to provide many important instinctual
capacities and that they normally operate only when activated by influences
of cortical, striatal or hypothalamic origin.

Bard had earlier summarised his own observations at John Hopkins University on
the emotional expression of cats in whom various parts of the brain had been
destroyed or removed. These mutilations he described as preparations, further
variations of which he regarded as the way forward for future research:
...in unpublished work, Magoun and Bard, found that cats in which the
entire hypothalamus was destroyed, but in which all other parts of the brain
remain intact, are capable of displaying rage behaviour. Whether the
presence of the cerebral cortex in these preparations is a factor in conferring
upon them this capacity remains to be determined. At any rate this
observations led us recently to prepare chronic decerebrate cats.

The physiology professor was proud to report that:

Recently M.B.Macht and I have been able to maintain for long periods
of time, i.e., up to periods of over 3 months, decerebrate animals in which
the remaining parts of the central nervous system are: spinal cord, medulla,
cerebellum and various parts of the mid-brain. (Bard, 1942)

Walter Cannons tradition, in the scientific investigation of emotions was

continued at Cornell University in Ithaca, New York, by the neuroanatomist Dr
James Papez (1883-1958). He mapped out what he regarded as the emotional
circuit in what came to be called the Limbic System by injecting the deadly virus
rabies into the brains of cats.

James Papez
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Papez was careful about his technique, but typically insensitive to the suffering of
animals. He injected the lethal virus specifically into the hippocampus, within the
temporal lobes. He then carefully observed the effects on the cats while
sacrificing some at critical times on their journey towards paralysis and death. By
observing the development of the black-pigmented Negri Bodies that are
characteristic of rabies infection, Papez mapped out the progression of these
lesions by killing cats at various stages of their illness. Thus he elucidated what has
since been known as the Papez Circuit. This circuit continues to be taught as
synonymous with the Limbic System the ring of neural structures credited with
sensing emotions.

In his 1937 paper A Proposed Mechanism of Emotion Papez makes the important
distinction between emotional expression and emotional experience. The
former is a way of acting, the latter a way of feeling. He makes it clear, on the
second page of the paper that the ensemble of structures he proposed as
representing the anatomic basis of the emotions was that subserving emotional
expression (something he could observe in cats with rabies). He admits that for
subjective emotional experience the participation of the cortex is essential. The
structures he included in the emotional circuit he proposed, were those that
remained after Philip Bard and Walter Cannon at Harvard had done brain
reduction experiments in cats:
The experiments of Bard have demonstrated that emotional expression
depends on the integrative action of the hypothalamus rather than on the
dorsal thalamus or cortex, since it may occur when the cerebral hemispheres
and the dorsal thalamus are totally removed.
(Papez, 1937)

Cannon and Bard are credited by Papez in his landmark 1937 paper, A Proposed
Mechanism of Emotion, among of a handful of scientists who greatly advanced
knowledge of the functions of the hypothalamus, a structure at the base of the
brain on which the neuroanatomist placed great emphasis within the emotional
circuit he proposed. The other two scientists the neuroanatomist credits with
contributing to our understanding of the hypothalamus (and emotions) are
Northwestern Universitys Professor Stephen Ranson and Canadas famous Dr
Wilder Penfield. These two neuroscientists were pioneers in the other major
technique used to localise functions of the brain stimulation of the brains outer
cortical layer with small electric currents delivered by metal electrodes inserted
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into the brain tissue.

Neuroscience research, as it tends to be called nowadays, has tended towards

fashions and fads. In the late 19th century several battles arose within the
professionals who professed to know more than everyone else (other than other
recognised experts) about the mind and the brain. During the years that Professor
William James star was fading at Harvard, along with the introspective means he
advocated to understand the mysteries of the mind, a school of thought arose in the
USA that what can be observed and measured objectively is behaviour. The mind
cannot be studied scientifically, only behaviour can, according to those who wore
the public mantle of behaviorists, such as John Watson, and others who agreed
with this influential doctrine.

During the First World War, the ironically named Professor Cannon coined the
phrase flight or fight to describe activity of the sympathetic nervous system,
while the parasympathetic nervous system was responsible for rest and digest.
The first of these phrases, more so than the second, caught on, and became a core
doctrine of neurophysiology. Schoolchildren learn about fight or flight, and the
phrase is commonly bandied about in the media.

The problem is, what has been researched as excitement has usually meant those
emotions that stimulate the fight or flight response in animals fear and anger,
their intense forms, terror and rage and chronic states, anxiety and aggression.
Little attention has been paid to the more positive aspects of excitement and related
mental processes (including emotions). When such enjoyable emotional states
develop, the thinking and behaviour of the affected person fulfils textbook
criteria for diagnosis of mental illness specifically the serious psychotic
disorder known as mania and the less serious, non-psychotic mental state
termed hypomania . Despite abundant evidence to the contrary from cognitive
neuroscience (let alone commonsense) it is maintained by the more hardline
members of the psychiatry profession that hypomania inevitably leads to mania if
untreated. Treatment, in this instance, means drug treatment.

PRIMARY, SECONDARY AND TERTIARY EMOTIONS

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This model hypothesises interest as the primary emotion. Without interest in the
music, the auditory stimulus will ignored (as far as possible) regardless of how
cherished are the same sounds by those with different taste in music. Interest, by
this definition includes both positive and negative interest, meaning one can be
interested because you like what you are hearing or expect to like what you hear if
you turn your attention towards (listen) to the music. Alternatively, you can be
interested because you dont like the music. Listening to music you dont like may
raise questions in the mind: Why dont I like it? What dont I like about it? How
much do I dislike it?

Of course, most people do not listen to music with the intent of not liking it. We
hope the music we play for ourselves and others will cause enjoyment to those who
listen to it, and are usually disappointed if they dont like the music we play for
them (or create for ourselves). The fundamental emotions of pleasure versus
displeasure (including boredom) are referred to, in this model, as secondary
emotions.

Further, more complex emotions, and greater intensities of pleasure and

displeasure, are here described as tertiary emotions. These may be conceived of
as being dynamic emotional extensions of the primary and secondary emotions of
interest and pleasure/displeasure.

In the following diagrams the neural structures implicated in these emotional

responses to music, and how they are likely to affect the physiology of the brain
and rest of the body will be explored.

Cross-modal exchange of incoming sensory information and potential sites of

sensory (auditory) influence on motor and emotional circuits related to music and
the dance impulse could occur at several levels in the brain. These include the level
of the forebrain (cortex and basal ganglia), diencephalon (especially the thalamus),
the midbrain (inferior colliculi and lateral lemniscus) and the hindbrain
(cerebellum and pons).

Scientific study of the subject is hampered by the fact that the panorama of
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emotions which can be elicited by music are difficult to define in words. Many
words that are commonly used to describe music harsh, bright/dark, light,
heavy, smooth etc - are borrowed from the descriptive lexicons of other senses.

Some research studies get around this by the fact that most people experience a
piece of music as either pleasant or unpleasant. On a simple level this is how
most people experience music emotionally. Here some emotional paradoxes are
evident, though. Even the sadness of particular pieces of music can be
experienced as beautiful and pleasant. The same can be the case in the experience
of visual arts. Also the same piece of music can be experienced as pleasant or
unpleasant at different times, depending on such things as mood, how recently the
music was heard, what music preceded it, and the environment in which it is
played. It is also true that music can be experienced as neither pleasant nor
unpleasant one can be entirely indifferent to the sound. Whether such sounds,
either the music or the embedded words, affect mental processes subliminally is
still a matter of debate despite considerable research in the field during the early
years of the Cold War.

When listening to recorded music, particular pieces of music and styles of music
may be associated with particular emotions for several reasons. Memory influences
the experience of music in many, often idiosyncratic ways. A specific
piece of music or album (or artist) may be associated with pleasant or unpleasant
memories. These may be of particular people, places, times, smells or activities,
depending on the individual experiences of the listener.

The experience of music may also conjure up various visual images, including
those previously registered while listening to a piece of music. These may be of a
video or film-clip, or recollections of aspects of the surrounding environment (and
accompanying response) when listening to the piece in the past. They may be
composite mental images of the artists who are creating the sounds or of the
person who composed the music (these may be the same person or persons) or of
the musical instruments featured in the recording. The possibilities are limitless in
their variations. Music may stimulate recall of visual images deliberately
connected with the music for commercial reasons. This is a basic strategy used in
advertising. Music may also remind one of a film or television program in which
the piece of music features, stimulating complex visual imagery.

Given no such images and associations from the past, experiencing new music can
also elicit a range of emotions ranging from the most pleasant (ecstasy or bliss) to
the very unpleasant. Of significance, hearing music of a completely new genre can
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be an exhilarating, even blissful experience. This is interesting, since it reveals

something of musics cross-cultural appeal. People brought up on a diet of
European classical music may love jazz or Chinese folk music and vice versa. At
any age, people can discover new types of music they enjoy and appreciate. One
can also discover new sources of pleasure in music one has heard in the past and
maybe not fully appreciated.

Nevertheless, people are influenced generally in their taste by what they have
heard and enjoyed in the past, although the recommendations and opinions of
others can also affect what music people like (and say they like). Previous musical
experiences dictate what rhythms and scales people are familiar with, and also
what melodies and harmonies they find pleasurable. People also limit their
listening choices according to what genres of music (and which particular artists)
they think they enjoy the most. It is common for this to change with maturity,
although people may retain a fondness for familiar tunes from their childhood and
adolescence. The existing musical preferences of a listener are the obvious starting
point for music therapy from which likes can be broadened and appreciation
deepened.

The delight of violating expectations

What we expect when we listen to music depends of our memory and our
extraordinary capacity for recognising (and creating) patterns. It also depends to
some degree on how we categorise various genres, and even individual artists.
What might not surprise us, being typical of one style of music, might well delight
(or disturb) us if we hear the sound in a piece we categorise as belonging to a
different genre. This could be a harmonic, melodic, timbral or rhythmic element.
If many of these elements are foreign to what we expect of the genre, we are led to
a re-classification of the style of music or the artist playing it. This may or may not
lead to a loss of appreciation of the music. The emotional responses we have to
music are complex, and so is what we know of the neural activity underlying these
responses.

The neurobiology of music emotions

Despite inherent difficulties in scientifically studying emotional reactions

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generally, considerable progress has been made during the past two decades in
identifying the neural substrate (as it is often called) of emotions. Several brain
structures are now known to be centrally involved in human emotional reactions to
music. Importantly, patterns of neural activation appear to be different for familiar
versus unfamiliar music, and for music sensed as pleasant (or enjoyable) as
opposed to music experienced as unpleasant.

Emotions have been studied intensively in more recent years, when the new
discipline of cognitive neuroscience has increasingly included emotions as an
essential part of cognition. A few years ago, the term cognition was limited to
perception, memory, and other aspects of what was broadly called thinking (or
intellect). Emotion was specifically excluded from the theories and research of
cognitivists who were antagonistic to the views of emotivists. Isabelle Peretz
explains:
The antagonism between cognitivists and emotivists is not limited to
music psychology. It has a long history starting with Descartes early
separation between emotion and reason. Still today, the majority of
experimental psychologists are cognitivists by default. They tend to ignore
emotions. This neglect partly reflects the information-processing approach
that started in the early sixties, which used the computer as a metaphor for
mental functions. According to this view, the brain is a machine, devoid of
emotions. (Peretz, 2010, p.2)

The cognitive revolution in psychology can, then, be seen to have had two
phases. First thinking had to be re-included from a narrow focus on behaviour
and then emotions had to be included within the domain of cognition. The
second phase of the revolution, pioneered by such neuroscientists as Antonio
Damasio, Joseph Le Doux, Daniel Levitin and Peretz herself, has only just begun.
These scientists recognise that emotions are an integral part of decision-making
and that reason is not a unique human faculty to control irrational emotions. They
argue, also, that emotions are not confined to subcortical brain structures,
although the rather misleading terms limbic system and limbic structures
continue to be used, more often than not, as synonymous with emotional centres
in the brain.

Since auditory stimuli, including music, can affect our emotions it is obvious that
information reaching the PAC must be transmitted to parts of the brain involved in
emotional reactions. From what is known, these are mostly subcortical structures
notably the amygdaloid complex (amygdala) and nucleus accumbens. More
recent imaging studies have confirmed the view, derived from electrical
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stimulation of these structures, that the amygdalae are activated with fear, anger
and sexual excitement, while the nucleus accumbens appears to be specifically
associated with feelings of pleasure. Other areas of the brain (including areas of
cortex) have associated with displeasure and disgust.

What happens between the Primary Auditory Cortex and the brain structures
involved in subjective feelings? And how adequate are existing models of the
neurobiology of emotions to explain the agonies and ecstasies of music?

The neural processing of speech, having been studied more thoroughly than that of
music, might be expected to provide a useful model for understanding emotional
reactions to other auditory stimuli. Unfortunately, though cortical areas specifically
involved in speech comprehension and generation were identified a hundred and
fifty years ago, the common observation that understanding speech and expressing
oneself vocally can cause pleasure has not yet been explained in terms of
neuropsychology.

The neurobiology of music emotions, though investigated with state-of-the-art

imaging techniques, has remained obscure. As in other areas of experimental
psychology, music neuroscientists have tended to concentrate on happiness,
sadness and fear as basic emotions. Such emotions are easily recognised cross-
culturally and several studies have tested ability to differentiate happy and sad
music in people with damaged and intact brains. Others have observed relative
activity in parts of the brain when experimental subjects have listened to music
they liked, compared with music they disliked. These have generally confirmed the
view that music emotions remain mysterious. Isabelle Peretz, a world leader in
music neurobiology at Canadas University of Montreal concluded recently:
Although many questions about the neurobiological basis of musical
emotions remain unsolved, there is evidence that musical emotions depend
on a specialized emotional pathway that may recruit various subcortical and
cortical structures that might be shared, at least in part, with other
biologically important systems. This emotional pathway is not simple. There
is not a single, unitary emotional system underlying all emotional responses
to music. For instance, most of the neural pathway underlying emotional
responses to dissonance has been delineated and involves a complex and
distributed system in the brain. (Peretz, 2010, p.18)

In Towards a neurobiology of musical emotions Peretz discusses complex and

sometimes contradictory findings about the cortical and sub-cortical processing of
even the basic emotions.
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The effect of music-induced emotions on the hypothalamus

The emotions triggered by music have direct physiological effects on various parts
of the body. This occurs with emotional changes generally, and is mainly mediated
by the autonomic nervous system (ANS). The ANS affects such things as blood
pressure, heart rate, respiratory activity, digestive activity and glandular activity. In
fact, most aspects of physiology are in one way or another affected by activity of
the autonomic nervous system.

Of particular importance to public health is the effect of music on blood pressure,

an effect predictable from the obvious effect of music on emotions and the known
effect of emotions on blood pressure. These effects are largely mediated by the
autonomic nervous system, with activation of the sympathetic nervous system
causing rise in pressure and activation of the parasympathetic nervous system
causing fall in blood pressure. The sympathetic nervous system is stimulated
during what is commonly described as the fight or flight reflex and the
parasympathetic with rest and digest physiological activity.

Although fear and anger can certainly cause rise in blood pressure secondary to
sympathetic nervous system arousal, this branch of the autonomic nervous system
also plays an important role in healthy and necessary physiological changes and
activity, including increasing blood flow to limbs, stimulation of the heart with
increased physical activity and dilation of airways in the lungs. It is necessary for
health to have balanced activity between the sympathetic and parasympathetic
branches of the autonomic nervous system, and this is likely to be assisted by
emotional balance. Emotional balance is, however, not easy to define, let alone
achieve.

Having said this, it is easy to find examples of emotional imbalance causing or

aggravating physical health problems. Anxiety, in addition to raising blood
pressure, predisposes to problems such as stomach ulcers, intestinal dysfunction
and headaches, to mention but a few. Many of these problems can be explained on
the basis of known activities of the sympathetic and parasympathetic nervous
system. In addition to direct synaptic contact, the sympathetic nervous system also
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has direct effects on cells around the body by increasing levels of catecholamines
(dopamine, noradrenaline, adrenaline) in the blood. These biogenic amines also
have the effect of raising blood pressure, especially adrenaline, which is secreted
into the blood by the adrenal glands in response to sympathetic stimulation.

The following diagram illustrates some of the mechanisms by which mental stress
can raise blood pressure and contribute to the development and worsening of heart
disease. It stands to reason that if music can be used to alleviate stress, it is likely
to have beneficial effects on cardiovascular health by impeding these
pathophysiological processes. In the integrated model presented in this diagram the
fight/flight responses of the sympathetic nervous system are focused on. These are
the bodys physiological responses to threat and danger, driven by the primary
emotions of anger and fear. This model of sympathetic nervous system,
popularized by Walter Cannon and Philip Bard at Harvard prior to the Second
World War continues to have relevance today, but is limited by the serious bias
against excitement. Excitement inspired by music also involves stimulation of the
sympathetic branch of the autonomic nervous system, but is obviously not caused
by anger or fear. The effect of exciting versus calming music on blood pressure
and the development of coronary heart disease and other stress-related diseases
will be an important area for future research in music therapy.

Exciting music and the pathologisation of excitement

In this era of mass-media advertising and Hollywood Blockbusters, the term

excitement is popularly used in a positive way. We are exhorted to watch the
newest exciting movie, buy an exciting new (or old) house or car, and travel to
exotic, exciting destinations where we get to enjoy exciting foods, wines and
entertainments. Advertisements for the newest technological toys, and even the
drabbest of political figures, stress how exciting the future will be if we consumers
make the right choice. People like feeling excited, and advertisers have long
known this. People, especially young people, delight in exciting music.

But the word excitement has a dark history when it comes to medical use of the
term, and even today excitement is measured as a sign of mental illness according
to psychological rating scales which continue to pathologise this enjoyable

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emotion.

Excitement, Elevated Mood and Criteria for a Label of Mania

The terminology of modern psychiatry is mostly based on Greek linguistic roots

(including the term psychiatry itself). Mania literally means madness in Greek, and
manic thus means behaving like a madman (or madwoman or mad child). Use
of the word mania as a suffix has diminished in recent decades as a result of
popular recognition of prejudices inherent in labels of various monomanias, such
as nymphomania (specifically applied to promiscuous girls and women, but not to
men) and drapetomania (the madness that affected slaves in the grip of the
madness that made them want freedom). Though some monomania terms, such
as kleptomania and pyromania persist in popular parlance, the use of mania
and manic by todays psychiatrists and psychologists describes a more general
change in mental state, characterised by abnormal elevation of mood and
observable (or reported) behavioural changes.

Mania is regarded as a serious, uncommon mental illness. Less than two percent of
the population is ever diagnosed with mania, or its milder form, hypomania. This is
in contrast to a much larger population that is diagnosed, at some stage, with the
supposed opposite of mania depression. Consequently the market for anti-
depressants is considerably larger than the market for anti-manic drugs.

Awareness of the relative rarity of mania relative to its apparent opposite has
long been reflected in the priorities of drug companies. Lots of money has been
spent on developing and marketing drugs to treat depression in the past decades;
not so mania until very recently, when there has been a concerted effort by drug
companies to promote the labels of hypomania, mania and bipolar disorder in the
interests of marketing so-called atypical antipsychotics and mood stabilisers.
Bipolar Disorder (BD), also referred to a Bipolar Affective Disorder (BAD) is a
modern name for the condition first described and named manic depression by
the influential German psychiatry professor Emil Kraepelin a little over a century
ago.

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Professor Emil Kraepelin

The mainstay of treatment of mania remains lithium, a drug first used for this
purpose in the late 1940s, and notorious for its toxicity (but very cheap, for a
modern drug). Increasingly, lithium has had some competition from the anti-
epileptic drugs Tegretol and Epilim, which were used to treat epilepsy long before
their manufacturers sought broadened indications, including stablilization of mood.
Anti-psychotic drugs like haloperidol are used only for the acute management of
manic patients. The following typical example of the correct use of
haloperidol for the treatment of mania is taken from the 1981 third edition of An
Introduction to Clinical Psychiatry, the prescribed textbook for medical students in
Victoria from 1966 to 1994 (when it was replaced by a new textbook featuring
chapters by various senior academic psychiatrists from the University of
Melbourne and Monash University):

From the chapter titled Tranquillizing Drugs and Hypnotics:

Very disturbed man with manic symptoms. Haloperidol (Serenace) 20mg.
i.v. stat., then 5 mg. i.v. 3-hourly, along with anti-parkinsonian drugs. Then
when the patient quietens, give drugs by mouth, e.g. 10 mg. Haloperiodol +
2 mg. Cogentin b.d. Continue drugs for several weeks or months, then
withdraw them gradually. (p.138)

On page 71 Professor Brian Davies, the sole author of this student text, summarises
manic illness as follows:
Manic illness alone is an uncommon illness that is essentially the concern
of the psychiatrist. The symptoms are the exact converse of depression
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elation grandiose thoughts overactivity and pressure of talk and activity.

Sleep is disturbed and sex drive increased.

In 1994 Melbourne University Press published a new introductory psychiatry

textbook to replace Brian Davies text - Foundations of Clinical Psychiatry, edited
by Professors Sidney Bloch and Bruce Singh. The chapter on Mood Disorders by
Melbourne Universitys Associate Professor Issy Schweitzer presents the clinical
features of mood elevation in more detail than the albeit cursory summary in the
older textbook:
Mood elevation or elation usually has a rapid onset, over days. It may be
preceded by a depressive syndrome and can be precipitated by
antidepressant therapy. The patient reports feeling unusually happy about
current circumstances. What seemed ordinary assumes an abnormal degree
of importance and the sense of self becomes inflated. Patients regard
themselves as unusually gifted and talented (grandiosity). The euphoric
mood is infectious, but, if their wishes are thwarted, they often become
irritable and aggressive. They are excessively energetic, hyperactive and
have a reduced need for sleep. Speech is rapid, loud and pressured, with
jokes, puns and plays on words. In more severe cases, the rate of word
production is so accelerated that an almost continuous flow of ideas, with
jumping from one thought to the next, may occur (flight of ideas). Speech
may become incomprehensible. Judgement is severely impaired and the
social consequences can be devastating, patients spending excessively,
driving recklessly, involving themselves in silly business decisions and
performing sexual indiscretions. Delusions such as a belief of extraordinary
power or hallucinations like hearing God telling them of a special mission
occur in severe states. These symptoms improve rapidly with resolution of
the mood disturbance. (p.133)

At the end of the chapter, Professor Schweitzer presents the standard treatment
for management of elevated mood states to the next generation of student
doctors:
The assessment and treatment of the patient suffering from acute
hypomania or mania is essentially the management of the acutely psychotic
patient. Organic conditions, including drug-induced states, need to be
excluded. For reasons of safety, most patients need hospitalisation which,
because of the lack of insight, may need to be recommended. The mainstay
of pharmacotherapy are the neuroleptics, such as Haloperidol or
Chlorpromazine. Although lithium carbonate is an effective antimanic agent
at relatively high concentration, risks of toxicity discourage its use.
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Occasionally, for particularly severe cases, ECT is needed.

In the long-term, most patients with Bipolar Mood Disorder receive

prophylactic treatment with lithium carbonate. It is effective in preventing
relapses of both elation and depression in up to 80 per cent of patients.
Recently, Carbamazepine has also proved effective in prophylaxis and may
therefore be substituted if lithium fails or causes excessive side-effects.
Lithium prophylaxis may also be appropriate for patients with cyclothymic
disorder if symptoms are disabling. (p.144)

The descriptions of a manic state presented by Professor Davies in An

Introduction to Clinical Psychiatry and Professor Schweitzer in Foundations of
Clinical Psychiatry are not derived from a study of Australian people. Rather, they
are repeating doctrines developed in Europe (especially Germany), Britain and
North America (the USA and Canada) over the past two hundred years. These
doctrines have been promulgated around the globe since the First World War by
First World universities.

Those in Australia have always repeated the doctrines generated from the relatively
ancient (and thus hallowed) universities at Cambridge, Oxford, Heidelberg, and
Massachusetts (Harvard). After the huge expansion of the International Psychiatry
enterprise with the formation of the World Health Organization and World
Federation for Mental Health following the end of the Second World War, many
other American universities got to share the power, influence and money that
treating mental illness and promoting mental health offered. These have
contributed to the tragic situation we find ourselves in, where the medical
establishment is treating mental health and promoting mental illness.

When I studied medicine at the University of Queensland we were instructed to

buy a small book called Fishs Clinical Psychopathology authored by Frank Fish,
senior lecturer at the University of Edinburgh. This book has been a standard
textbook in many British-established universities since the publication of the first
edition by the (British) Royal College of Psychiatrists in 1967. We were also
obliged to purchase a larger textbook for psychology the 10th edition of
Psychology and Life by Philip Zimbardo of Stanford University. This was a
standard psychology text in the USA, the first edition of which was published in
1937 (authored by Floyd L. Ruch of the University of Southern California).
Though we were told about it we were not expected to purchase, nor directly
familiarise ourselves with the content of, the American Psychiatric Associations
Diagnostic and Statistical manual of Mental Disorders, the third edition of which
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was published in 1980, when I was a third-year medical student.

The texts medical students study from shape, and are intended to shape, the minds
the beliefs and behaviour of doctors. Unfortunately, what is taught to student
doctors about the mind is distorted by the biases, prejudices and particular
enthusiasms of the authors. Though I did not see a copy of the Diagnostic and
Statistical Manual of Mental Disorders until years after I had started working as a
doctor, I gathered as a student, and from my psychiatry term as an intern, that the
DSM was the authoritative text on psychiatric diagnosis. I had imagined, till I saw
the fourth edition of the DSM in 1996, that this manual produced by the American
Psychiatric Association would contain a comprehensive discussion of treatment
options and theories regarding the cause of the hundreds of described mental
disorders. This is glaringly not the case. The DSM merely lists criteria for the
application of mental disorder labels, purporting to be neutral regarding
aetiology (meaning usually not mentioning it at all) and leaving the treatment
options to other sources effectively those marketing the treatments, foremost
among them the major drug companies.

When I bought a copy of the DSM IV from the Monash University bookshop in
1996, I didnt know what to expect. I gathered quickly that this was a reference
book for the application of legal labels of mental incapacity, with its attendant
complications. Mental incapacity may mean diminished responsibility when one
breaks the law; it may mean one can be abducted from ones home and locked up
in a hospital where one is injected against ones will and subjected to other
indignities and humiliation. The DSM does not warn of the potential misuse of the
disorders it names and describes, though it does mention, in its description of
hypomanic episode (which Professor Schweitzer of Melbourne University
informs students should be treated in the same way as mania in the 1994
Australian textbook) that:
In contrast to a Manic Episode, a Hypomanic Episode is not severe
enough to cause marked impairment in social or occupational functioning, or
to require hospitalization, and there are no psychotic features (Criterion E).
The change in functioning for some individuals may take the form of a
marked increase in efficiency, accomplishments, or creativity. (p.335)

No wonder so many people diagnosed with hypomania resist treatment, and regard
themselves as mentally well no sensible diagnostic system would pathologise
increase in efficiency, accomplishments and creativity. No reasonable model of
psychology would assume that such changes herald worsening mental illness
rather than improvement in mental health.
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Professor Allen Frances speaks out about Disease Creation and the DSM

In a piece he wrote for the Los Angeles Times in March

2010, Professor Allen Frances makes an extraordinary
admission:
As chairman of the task force that created the
current Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV), which came out in 1994, I
learned from painful experience how small changes
in the definition of mental disorders can create
huge, unintended consequences.
Our panel tried hard to be conservative and careful but inadvertently
contributed to three false epidemics attention deficit disorder, autism and
childhood bipolar disorder. Clearly, our net was cast too wide and captured
many patients who might have been far better off never entering the mental
health system.

This is admission of disease creation by the American psychiatry profession is

extraordinary, indeed unprecedented, since it is Professor Allen Frances who is
making the public admission. Frances is emeritus professor of psychiatry at Duke
University and was the chairman of the team of dozens of psychiatrists that revised
the (revised) 3rd edition of American Psychiatric Associations official manual on
what and what does not constitute a mental disorder. Professor Frances, an icon
of the American psychiatry establishment was also involved in revisions of
previous editions. In a constant dramatic trend, each edition of the DSM has
contained diagnostic criteria for many more labels of mental disorder than its
predecessor.

Professor Frances warns, also, that the first draft of the next edition of the
DSM...is filled with suggestions that would multiply our mistakes and extend the
reach of psychiatry dramatically deeper into the ever-shrinking domain of the
normal. This wholesale medical imperialization of normality could potentially
create tens of millions of innocent bystanders who would be mislabelled as having
a mental disorder. The pharmaceutical industry would have a field day despite
the lack of solid evidence of any effective treatments for these newly proposed
diagnoses.

The phrase Professor Frances uses to euphemise disease creation (or disease-
mongering as some have described it) is an interesting one medical
imperialization. Here in Australia not many doctors heeded the editorial in the
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Winter 1979 volume of the (American) Journal of Community Health, in which Dr

R.L.Kane predicted that:
If we are not careful, the medical establishment may found the greatest
empire in history and its largely our fault. We have gradually sought to
expand the domain of medicine to cover all sorts of problems from marital
discord to exercise.

Unfortunately, we were not careful, and what Dr Kane warned about has
transpired. One of the proposed new labels in the new DSM (expected in 2012) is
Relational Disorder, persistent patterns of behaviours or emotions that occur
between two or more people, such that the relationship, not the individuals that
comprise it, is viewed as being disordered (Kamens, 2009).

The medical establishment has always had imperial ambitions along with a
tendency to support the development of empires (and fiefdoms) within the
institutions that comprise it. A lust for power can be seen in university politics as
much as in party politics. In university departments prestige and power is measured
by the number of publications generated (preferably peer-reviewed), the number
and amount of research grants obtained and the number of employees and
underlings/students. Professor Allen Frances reassures us that the almost universal
tendency to expand their favourite disorders shown by experts is not, as alleged,
because of conflicts of interest for example, to help drug companies, create new
customers or increase research funding but rather from a genuine desire to avoid
missing suitable patients who might benefit. He admits, though, that
unfortunately this therapeutic zeal creates an enormous blind spot to the great
risks that come with overdiagnosis and unnecessary treatment.

Professor Frances may be being overly generous to his colleagues, though he

clearly has no illusions about the motives of the pharmaceutical industry, who
would have a field day with the broadened criteria for diagnosis of mental illness
expected in the next edition of the DSM.

Programmed Insensitivity the Structured Interview

The Brief Psychiatric Rating Scale (BPRS) has been the most frequently used
psychiatric rating scale since the 1960s, when it was adopted as a basic source of
psychometric data by the American National Institutes of Mental Health. It had
been developed for military (veterans affairs) drug trials on soldiers who had
come back depressed, shell-shocked, or insane from the Korean War and Second
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World War by the psychologists Donald Gorham and John Overall, and was first
published in 1962 just in time for the Vietnam War. The purpose of the scale was
to quickly elicit evidence of mental illness and record its severity in a way that
enabled multi-center trials using different raters (the people who were trained,
again quickly, to administer the scale) in order to test out various drug treatments
and compare drug treatments with placebo in double-blind trials.

To achieve standardization, such that they ensured high levels of inter-rater

reliability, various structured interviews intended to elicit the data were
developed over subsequent decades, as the use of various adaptations of the scale
competed for popularity (and royalties). These structured interviews were meant
to take just 15 to 20 minutes to complete and included set questions that were read
or recited word-for-word in a clearly defined order.

John Overall, the psychologist-statistician who developed the original BPRS with
the more senior Donald Gorham at the Veterans Administration Central
Neuropsychiatric Research Laboratory in Maryland in 1962 explained, in 1978 (by
which time the paper introducing the scale had been cited 533 times) that:
The BPRS has been a success primarily because it filled a need at a
particular period in the development of psychiatry as a rational science. The
need was for an instrument that could be used on a broad scale to evaluate
treatment effects while at the same time imposing minimal additional burden
on overworked psychiatric staff. It has often been suggested that the success
of the BPRS has been due to the judicious use of the word brief in the
title.

In the same 1978 article Overall admits that the big issue at that time was whether
drugs really were of value in treatment of psychiatric disorders. He also mentions
that a major boost was given the BPRS when it was designated as one standard bit
of data to be collected in most NIMH grant-supported clinical drug studies for
several succeeding years.

The original 1962 BPRS rated 16 measures in a questionnaire (instrument) that

could be administered rapidly. Of these measures excitement was one of several
that was seen as a sign of schizophrenia or mania. In practice, the precise
diagnosis was irrelevant in terms of acute treatment dopamine-blocking
neuroleptic (later called antipsychotic) drugs were already standard treatment,
in the 1960s, for excitement regardless of whether the patient was diagnosed as
schizophrenic or manic. In terms of chronic treatment, whether the favoured
diagnosis was schizophrenia or mania was very important those with mania
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routinely being given lithium (or another mood stabiliser) and usually taken off
the dopamine-blocking drug after some months, while those given a label of
schizophrenia were condemned to long term dopamine-blockers. These were given
by injection if the patient refused to take the recommended drugs voluntarily.

Twenty-five years after Gorham and Overall published the Brief Psychiatric Rating
Scale for the first time (in Psychological Report, 1962, Vol 10, pp.799-812) a team
of psychologists at the University of California came up with a new, improved
(broadened) version of the BPRS, expanding it to 24 measures.

The original 1962 list of Gorham and Overall included somatic concern; anxiety;
emotional withdrawal; conceptual disorganization; guilt feelings; tension;
mannerisms and posturing; grandiosity; depressive mood; hostility; suspiciousness;
hallucinatory behaviour; motor retardation; uncooperativeness; unusual though
content; and blunted affect. The original authors added excitement and
disorientation in 1967.
In 1986, the UCLA Neuropsychiatric Institute team, led by the psychologist David
Lukoff, added suicidality, elated mood, bizarre behavior, self-neglect,
distractibility and motor hyperactivity. This was described (and marketed) as
the Expanded Version of the Brief Psychiatric Rating Scale.

Following Lukoffs departure to San Francisco in 1986, his co-authors who

remained at the Neuropsychiatric Institute in Los Angeles, including Joseph
Ventura and the psychiatrist Robert Paul Liberman, have continued to produce
further adaptations of the BPRS to the present time. The following was the
version promoted by the University of New South Wales, NSW Institute of
Psychiatry, World Health Organization and the Belgian drug company Janssen-
Cilag in the WHO-copyrighted publication Handbook for the Schizophrenic
Disorders in 1995. Later this phenomenological list will be compared with the
newer scales being promoted by one of Janssen-Cilags competitors, AstraZeneca
in the current (2010) push to increase their share of the Bipolar market.

Brief Psychiatric Rating Scale (BPRS)

From Ventura, Green, Shaner & Liberman (1993) Training and quality assurance with the brief psychiatric
rating scale: "The drift buster" International Journal of Methods in Psychiatric Research.

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Instructions

This form consists of 24 symptom constructs, each to be rated in a 7-point scale of severity
ranging from 'not present' to 'extremely severe' If a specific symptom is not rated, mark 'NA' (not
assessed). Circle the number headed by the term that best describes the patient's present
condition.

1 2 3 4 5 6 7
not very moderately
mild moderate severe extremely severe
present mild severe

1 Somatic concern NA 1 2 3 4 5 6 7
2 Anxiety NA 1 2 3 4 5 6 7
3 Depression NA 1 2 3 4 5 6 7
4 Suicidality NA 1 2 3 4 5 6 7
5 Guilt NA 1 2 3 4 5 6 7
6 Hostility NA 1 2 3 4 5 6 7
7 Elated Mood NA 1 2 3 4 5 6 7
8 Grandiosity NA 1 2 3 4 5 6 7
9 Suspiciousness NA 1 2 3 4 5 6 7
10 Hallucinations NA 1 2 3 4 5 6 7
Unusual thought
11 NA 1 2 3 4 5 6 7
content
12 Bizarre behaviour NA 1 2 3 4 5 6 7
13 Self-neglect NA 1 2 3 4 5 6 7
14 Disorientation NA 1 2 3 4 5 6 7
Conceptual
15 NA 1 2 3 4 5 6 7
disorganisation
16 Blunted affect NA 1 2 3 4 5 6 7
Emotional
17 NA 1 2 3 4 5 6 7
withdrawal
18 Motor retardation NA 1 2 3 4 5 6 7
19 Tension NA 1 2 3 4 5 6 7
20 Uncooperativeness NA 1 2 3 4 5 6 7
21 Excitement NA 1 2 3 4 5 6 7
22 Distractibility NA 1 2 3 4 5 6 7
23 Motor hyperactivity NA 1 2 3 4 5 6 7
Mannerisms and
24 NA 1 2 3 4 5 6 7
posturing

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The 1993 adaptation of the American Brief Psychiatric Rating Scale by the
psychologists Joseph Ventura and his team at UCLA instructs interviewers and
researchers to make the following assessments in order to grade Excitement from
1 (no excitement) to 7 (extremely severe):

Very mild (2): subtle and fleeting or questionable increase in emotional

intensity. For example, at times seems keyed-up or overly alert.

Mild (3): subtle but persistent increase in emotional intensity. For example,
lively use of gestures and variation in voice tone.

Moderate (4): Definite but occasional increase in emotional intensity. For

example, reacts to interviewer or topics that are discussed with noticeable
emotional intensity. Some pressured speech.

Moderately severe (5): Definite and persistent increase in emotional

intensity. For example, reacts to many stimuli, whether relevant or not, with
considerable emotional intensity. Frequent pressured speech.

Severe (6): Marked increase in emotional intensity. For example, reacts to

most stimuli with inappropriate emotional intensity. Has difficulty settling
down or staying on task. Often restless, impulsive, or speech is often
pressured.

Extremely severe (7): Marked and persistent increase in emotional intensity.

Reacts to all stimuli with inappropriate intensity, impulsiveness. Cannot
settle down or stay on task. Very restless and impulsive most of the time.
Constant pressured speech.

The key feature, according to this rating scale is emotional intensity not the
type of emotion, but how strong the emotion appears to be to the interviewer. In
this modern (1993) adaptation of the Brief Psychiatric Rating Scale the authors
explain what they mean by excitement before providing the details for
appropriate pathologisation, or grading (in terms of severity):
Heightened emotional tone or increased emotional reactivity to interviewer
or topics being discussed, as evidenced by increased intensity of facial
expressions, voice tone, expressive gestures or increase in speech quantity
and speed.

To understand how cruel this style of assessment is, one needs to consider the real
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world situations in which people who do not think they have sick minds are rated
for the severity of their mental illness, often after being detained against their
will, and the topics being discussed when they are subjected to the list of
questions in the BPRS.

A script of questions is provided in this new, improved BPRS for sixteen of the
measures (though not the original sixteen). It is these questions that constitute the
topics being discussed, to which the patient is expected to stay on track,
answering an increasingly intrusive, rude and insensitive series of questions
without showing too much emotional intensity (be it amusement, irritation, anger,
fear or boredom). The style of questioning, and rating the answers in a way that
can easily be marked by a computer is more akin to an interrogation than a
discussion. The diagnostic interview as it is called is a far cry from a therapeutic
discussion.

It is important to note that these questions are not intended as a guide to eliciting
evidence of the various supposed pathology. They are meant to be asked as they
are written in the manual and the answers simplified (or misrepresented) so they
can be scaled that way the results can be compared in a scientific way,
without human sensitivity (or even common courtesy) getting in the way of good
statistics. In the manual from which the rating scale for excitement is taken, as
measure number 21 of 24 items, the interviewer is required to rate the emotional
intensity of the patient after 10 to 15 minutes of relentless questions. The
interviewer is interested in the patients response only in so far as satisfactory
completion of the rating. After all, time is money. So they cut to the chase.
The questions begin innocently enough:
2. Have you been concerned about your physical health?
3. Have you had any physical illness or seen a medical doctor lately?
4. Has anything changed regarding your appearance?
5. Has it interfered with your ability to perform your usual activities and/or
work?
6. Did you ever feel that parts of your body had changed or stopped working?

The first five questions are asked to establish rapport. This means, in effect,
feigning concern, since the interviewer is not trained, nor inclined, to further
explore the patients physical health problems and make helpful suggestions. Their
job is to rate their somatic concern, in terms of severity. The answers do not form
the basis of later questioning, as they should in genuine medical history-taking.
Instead, they are graded as follows:

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Very mild (2): Occasional somatic concerns that tend to be kept to self.
Mild (3): Occasional somatic concerns that tend to be voiced to others (note that
the patient has been specifically asked about his or her concerns, so the assumption
that they tend to be voiced to others is dubious; besides, one should surely be
allowed to voice ones concerns about ones health to medical staff without being
accused of abnormal somatic concern).
Moderate (4): Frequent expressions of somatic concern or exaggerations of
existing ills OR some preoccupation, but no impairment of functioning. Not
delusional.
Moderately Severe (5): Frequent expressions of somatic concern or exaggerations
of existing ills, OR some preoccupation and moderate impairment of functioning.
Not delusional.

The version of the BPRS from which the above instructions are transcribed was
developed by a team of psychologists led by Ventura, and a single psychiatrist
(Robert Liberman) from the extravagantly named Faculty of the UCLA Center for
Research on Treatment & Rehabilitation of Psychosis. This particular adaptation
was included as Appendix 6 in publication funded and published by the World
Health Organization (WHO) entitled The Management of Mental Disorders,
Volume 2, Handbook for the Schizophrenic Disorders. I obtained a copy when I
was doing a general practice sessions for a family doctor in Melbourne in 1996
he told me the book had been left at the clinic by a drug rep from Janssen-Cilag,
and that I was welcome to it.

I was puzzled and concerned when I first looked at the book, not least by the
information provided on the cover of the
cheaply-printed handbook. Have a look at the
front and back cover:

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World Health
Organization
Training and Reference
Centre for CIDI

You may notice the logo at the bottom of the back cover. Its very subtle for a drug
company ad. This is supposed to be a publication by the World Health
Organization, after all, and not a promotion for drugs produced by the Belgian drug
company Janssen Cilag (which has, since this 1995 publication, become part of the
American pharmaceutical giant Johnson and Johnson).

I was puzzled because, while the book was being handed out to general
practitioners by drug representatives, it was published copyright of the World
Health Organization, which I had naively assumed was independent of drug
company vested interests. Further, the inside cover boasts that The Management of
Mental Disorders was underwritten by the New South Wales Institute of
Psychiatry, and was written, not by drug companies, but researchers from the
Clinical Research Unit for Anxiety Disorders of the University of New South
Wales at St Vincents Hospital in Sydney (Australia). Surely academic psychiatry
was not in bed with the pharmaceutical industry not that glaringly?

This is not your average academic publication, though it has some pretences in that
direction. It contains a bibliography, and an index promising general information
on schizophrenia (including description, diagnosis, differential diagnosis,
epidemiology, course and prognosis) and sections on management of the acute
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episode (including first episode psychosis) and specific interventions. It was

scan-reading these sections that first raised my concerns that was before I got the
appendices and the grotesque structured interview of UCLAs 1993 adaptation of
the Brief Psychiatric Rating Scale.

The manual makes it clear that antipsychotic medication is an essential starting

point for treatment for reducing symptoms and disturbed behaviour. Agitation,
hallucinations and delusions are specified as the symptoms that drugs are effective
against. These are so-called positive symptoms of schizophrenias. Negative
symptoms, such as emotional blunting and withdrawal, loss of motivation and
drive and downward social drift are less amenable to treatment with dopamine-
blocking drugs. This has been accepted by the psychiatry profession for some time,
but only recently has the obvious fact that dopamine-blocking drugs worsen
negative symptoms been admitted in the psychiatry press. It is increasingly
accepted that these drugs, which block dopamine receptors in the emotional and
motor centres in the brain, do not just worsen negative symptoms, they are
responsible for causing them in the first place.

A Brave New World where Big Pharma Rules

The BPRS is only one of several competing psychiatric rating scales. Since the
1960s, fed by the increasing dominance of the drug industry in psychiatry, a sub-
industry has emerged in the creation and marketing of diagnostic instruments as
statistics-oriented psychologists like to call their creations. The Brief Psychiatric
Rating Scale, developed in the early 1960s with the express aim of making it
quicker and easier to perform drug trials, has remained among the favourites of the
American psychiatric establishment. With the endorsement of the BPRS by the
World Health Organisation in its 1995 manual on the treatment of the
schizophrenic disorders the ongoing dominance of the BPRS in the rating scale
market was guaranteed.

Janssen-Cilag, whose drug reps were distributing Professor Andrews Handbook

for the Schizophrenic Disorders to Australian family doctors, free of charge, had a
vested interest in the promotion of the BPRS increasing its market share of
antipsychotic drugs, by subtle promotion of haloperidol, which they have been
selling since the 1960s as Haldol. This dopamine-blocking drug is available as

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tablets, syrup and injection, and is listed on page 11 of the manual, along with its
competitors at the time. These drugs are described as biological interventions,
illustrating the systematic misuse use of the term biology (the study of life) by
the pharmaceutical industry in unholy alliance with a sub-population of
increasingly influential psychiatrists who describe themselves as biological
psychiatrists. Biological treatments in their books, means drugs and electric
shocks to the brain (ECT or electro-convulsive therapy) as opposed to
psychological treatments or surgical treatments.

The table above, recommending haloperidol long-acting injections as an

appropriate treatment for schizophrenia mentions two trade names under which the
drug was being marketed in Australia in 1995. After the drug was developed by
Janssen pharmaceuticals in the late 1950s (which continue to sell it as Haldol
syrup, tablets and injections) rights to manufacture the Belgian-invented chemical
restraint were sold to the American company Searle. The drug was marketed as
Serenace by Searle, until the license was transferred to the Australian Sigma

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pharmaceuticals with rather convenient timing for Searle. The dominant role of the
typical antipsychotics like haloperidol and chlorpromazine was about to be
seriously threatened by the new atypical antipsychotics or second generation
antipsychotics. These included the extremely expensive Risperdal that had been
developed by Janssen-Cilag to compete in the growing antipsychotic market with
Eli-Lillys Zyprexa (olanzapine) and Novartis Clozaril (clozapine). Depot
injections of haloperidol were dispensed at 25 to 50 Australian dollars each, with
recommendations for two weekly injections in the treatment of chronic
schizophrenia. Risperdal, likewise injected every fortnight is priced between 400
and 800 dollars for equivalent doses. The big advantage is the newer drugs do not
cause as much permanent brain damage as the first generation or typical
antipsychotics.

The dopamine-blocking drug haloperidol was invented by the Belgian founder of

Janssen Pharmaceuticals, Dr Paul Janssen (1926-2003) who set up his own
research laboratory at the University of Ghent in 1953, with a loan of 50,000
Belgian Francs from his father. With four of the drugs he created (including
haloperidol) on the World Health Organizations list of essential medicines, he is
celebrated as a Great Belgian, was made a Baron in 1990 (by King Baudouin I)
and received numerous medical prizes and honorary doctorates before his death in
2003. With a certain irony, given the socio-political use of haloperidol, the Dr.
Paul Janssen Award for Biomedical Research founded by the British
chemical/medical giant Johnson and Johnson in 2005 was set up to reward passion
and creativity in biomedical research. As will be seen, passion and creativity, both
intrinsically linked to excitement, have been systematically suppressed by the
dopamine-blocking drug created by Janssen.

The senior author of Handbook for the Schizophrenic Disorders, and the only
medical doctor of the three credited authors, is this
man, Professor Gavin Andrews, a senior psychiatrist at
the University of New South Wales. Fifteen years after
the publication of Handbook for the Schizophrenic
Disorders, on the University of New South Wales
School of Psychiatrys website he currently writes of
his research interests:
No country can afford the health care its citizens
desire. Resources should be deployed in terms of
burden of disease and the cost-effectiveness of
interventions for it is the most efficient policy but how do you reconcile
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fairness, equality and caring for the sick? We have a research program active
in this area. In developed countries chronic disease is the problem: both
prevention of the disease and better patient centred management once they
occur. We have an active program to develop school based prevention of
anxiety and depressive disorders. We have an active program to improve
patient education in primary care [see http:www.climate.tv].

It is clear that Professor Andrews keeps up with technology in his valiant effort to
get everyone assessed for signs of mental illness, and his particular subspecialty,
the drug treatment of depression and anxiety disorders. And what better way to
increase the population with a depressed mood than to promote the treatment, with
dopamine-blocking drugs, of people with elevated mood?

It may seem unbelievable that feeling on top of the world or like everything is

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falling into place could be seen as abnormal, let alone a sign of a moderately
severe mental disturbance. Combined with the pathologisation of excitement, the
pathologisation of elevated (improved) mood is a recipe for disaster.

Proving that antipsychotic drugs improve scores on scales such as the BPRS
means they reduce emotional intensity, and the (often reluctant) patient no longer
feels better than ever before or that everything is falling into place. Is this a good
thing, though?

Racial and Cultural Bias in Labelling Excitement as Abnormal

It is common knowledge that people of different racial and cultural backgrounds

typically show different emotional tone and reactivity in terms of facial
expressions, variation in voice tone, and gesticulation with speech. There are also
cultural (though probably not racial) variations in what people tend to talk about,
the speed of their speech and its speed.

In the USA statistical data regarding health has long been collected and collated
according to skin colour and race contrasting blacks and whites for many
decades, prior to more recent categories of Hispanic, Asian and Native
American. In terms of blacks (meaning African-Americans) and whites
(meaning of British/North-Western European ancestry) there are easily observable
differences in what would be rated as emotional intensity some of these
differences are cultural, others may well be genetic (the dynamism of facial
expressions, for example). Among northern Europeans, the Scottish and Belgians
have a reputation, among the British at least, for being dour and phlegmatic
low in apparent emotional intensity, in other words. Italians, and others from
southern Europe, are known to usually gesticulate when speaking to a degree that
would be abnormal in England.

These differences are doubtless partly cultural and, of course, there are
considerable variations between individuals in the intensity with which they speak
and react to speech (and environmental stimuli more broadly). The words and
phrases people use (having learned them) influence both the type and intensity of
their feelings. Someone who uses the word happiness a lot may well feel this
emotion than someone who speaks frequently of anger or misery. A fifteen minute
structured interview is not nearly adequate to make such assessments, yet the
raters are expected to evaluate increased emotional intensity and increased

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emotional reactivity.

Since the assessment of excitement is to be made by an evaluation of the

patients behaviour during the structured interview (and not by self-reporting as
to whether the individual feels any increase in their level of excitement) when a
determination is made of increased emotional intensity the yardstick is an arbitrary
one. The intensity is more than they are used to seeing, in other words. And what
they are used to seeing depends on their past experiences and the racial and
cultural mix of the people they have observed over the years.

Treatment of Excitement in the Twentieth Century

The Brief Psychiatric Rating Scale, or BPRS, included in Handbook for the
Schizophrenic Disorders, was originally developed as a psychological measuring
tool at the Veterans Administration Hospital in Maryland, USA, in 1962. The
original tool, comprising 16 measures to evaluate the mental state of patients, was
expanded by psychologists at the University of California in the early 1990s. It is
this expanded scale of 24 measures that is included in Handbook for the
Schizophrenic Disorders.

It is of interest that the measure of excitement (along with disorientation) was

added to the scale in 1967, during the Vietnam War, and was not included among
the original 16 measures proposed by Gorham and Overall. It should be
remembered that the original scale was developed for the assessment and treatment
of returned soldiers (veterans), many of whom were suffering from what was
called, in the First World War, shell-shock. Following an epidemic of pensions
for shell-shock after WWI, during World War Two psychiatrists were
discouraged from making this diagnosis. Instead soldiers were given the older label
of depression, or melancholia. Not many of the returned men were suffering
from an elevated mood.

Excitement and the medical (psychiatric) label of mania are inextricably

connected. Before the DSM became the bible of psychiatric diagnosis in the USA,
the influential LA psychiatrist Aaron Rosanoff listed past and present treatments
for excitement as he saw things prior to the Second World War. From the 1920
edition of his Manual of Psychiatry and Mental Hygiene comes this summary of
treatment options - treatment for what he called excitement:

He begins by claiming that perhaps the greatest progress in the therapeutics of

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mental illness within the past twenty years has been in our methods for the
treatment of excitement. With more than a trace of wishful thinking he continues,
by degrees, means of restraint, always useless, often barbarous, have disappeared
from institutions, replaced, according to the manual by rest in bed, hydrotherapy,
isolation and medication.

This is followed by some treatments that were cutting edge in the 1920s. Rest in
bed, he advised, was best achieved by making the patients sleep collectively in
dormitories, such that the example of other patients pressured new inmates to stay
in bed. The euphemistically-termed hydrotherapy included use of the wet pack
a sheet soaked in cold water and closely wrapped around the entire body from
twenty minutes to several hours (Rosanoff warns that, if kept on too long it can
cause attacks of syncope).

In terms of medication, few of those recommended by Rosanoff are used today,

due to a combination of addictiveness and toxicity. He recommends opium pills
and tincture, and subcutaneous morphine injections for excitement in the
psychoses (though he warns about the danger of creating a habit with prolonged
use). The mainstay of treatment of non-psychotic excitement is, according to the
psychiatrist, various preparations of chloral hydrate for which he gives formulae
suitable for oral or rectal use. He recommends that oral preparations be sweetened
with syrup of currant berries, while the chloral hydrate enemas should be prepared
with yolk of egg and milk to make up 120 ml. He also promotes the use of several
other drugs, including bromides, sulphonal, trional and tetronal, which apparently
bring about calm and prolonged sleep in cases of moderate excitement.

The Nervous Soldier, A Handbook for the Prevention, Detection and Treatment of
Nervous Invalidity in War, is a small book published by the University of
Queensland in 1943. In it, the psychiatrist authors, John Bostock and Sydney Evan
Jones, indicate that the criteria for diagnosis of acute mania remained a
continued state of motor excitement, talkativeness amounting to incoherence and
emotional exaltation. Patients diagnosed as such (pigeon-holed is the term they
use) should be sent to base, where specialist psychiatric treatment could be
administered. In 1943, treatments included persuasion and explanation, suggestion,
hypnotic suggestion, simple analysis in the waking state, hypno-analysis, narco-
analysis, convulsion (shock) therapy, insulin therapy, narco therapy and what is
described as physio-therapy. Physio-therapy, according to this handbook for the
treatment of soldiers in WWII, included the administration of electric shocks to the
head or neck to cause discomfort if not pain. This treatment, the text advises,
has the merit of being uncomfortable and therefore carries with it the suggestion,
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get well quickly and be finished. (p.61).

Shock therapy, then widely used in the treatment of mania, schizophrenia and
depression (melancholia) involved the induction of a convulsion by chemical or
electrical means. In The Nervous Soldier only chemically-induced convulsions
(using cardiazol or phrenazol) are mentioned, however electrically-induced
convulsions had been increasingly used since the late 1930s, when the Italian
psychiatrist Ugo Cerletti popularised its use for a wide range of mental problems
(including mania).

After the end of WWII two drugs revolutionised the treatment of mania and
excitement, lithium and chlorpromazine (Largactil/Thorazine). In the 1950s these
drugs competed with ECT and psychosurgical approaches pioneered in the 1930s
by the Portuguese neurologist Professor Egas Moniz and the notorious Dr Walter
Freeman in the USA. Freeman performed thousands of crude mutilations of people
with a range of mental problems, causing worse ones. A shameless showman and
self-promoter, Freeman, who boasted spectacular cures from his technique of
inserting an ice pick through the back of the eye-socket to the frontal lobes of the
brain, was known to alternatively enthral or appal audiences by performing two
such operations at the same time, holding an ice-pick in each hand.

During the course of the 20th century, the diagnosis and treatment of mental
excitement and of the global population has been fundamentally shaped by
warfare, and the First and Second World Wars, in particular. The Vietnam War and
the broader Cold War were also significant factors in changing both diagnostic
criteria and treatment strategies. These have also been shaped by other influences,
including public attitudes, technological developments and, most importantly, the
dramatic increase in the power of the pharmaceutical industry. The diagnosis of
mental disorders has also been shaped by facts, fads and fashions. And, of course,
by politics and religion. A key factor in these changes has been the increasing
power and globalisation of the mass-media, hand-in-hand with mass-marketing.
There can be no doubt that liquid lobotomies beat surgical lobotomies in the 20 th
century battle for the psychiatric dollar. Psychological treatments and the health
of the masses were the clear losers. Music was, at best, thought of as a
psychological rather than a physical treatment.

Following the Second World War asylums were even more overcrowded than they
were after the First. Most of those diagnosed with schizophrenia or manic
depression remained institutionalised for years, if not for life. The fact that many
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more were admitted than discharged was a guarantee for the problem to keep
worsening.

The 1957 Yearbook of Neurology, Psychiatry and Neurosurgery, the psychiatry

section of which is edited by S. Bernard Wortis, Professor of Psychiatry and
Neurology at the University Hospital in New York reported favourably on Four
Years Experience with Chlorpromazine in Treatment of Psychoses, advising that
in agitation and mania, as in mental confusion, delirious manifestations and
various more or less acute psychoses, neuroleptic treatment with chlorpromazine is
superior to electric shock. The authors explain that it is the psychic indifference
and disinterest produced by the drug that seem beneficial, causing gradual
detachment from delirious preoccupations.

Chlorpromazine was developed by the French drug company Rhone-Poulenc in the

early 1950s and, following studies by the French psychiatrists Jean Delay and
Pierre Deniker, rapidly became the mainstay of drug treatment for acute psychoses,
including schizophrenia and mania. The emotional dulling (psychic indifference)
that the drug caused was seen as a positive effect, something stated explicitly by
Heinz Lehmann, the psychiatrist who confirmed chlorpromazines effectiveness in
Canada, contributing to the drugs popularity in North America and the English-
speaking world.

Lehmann, who migrated to Canada from Germany in 1937, was appointed Clinical
Director of Montreals Douglas Hospital in 1947 and was Chair of the McGill
University Department of Psychiatry from 1971 to 1975, had engaged in grotesque
experiments on patients at Montreals Verdun Protestant Hospital from the time he
arrived in the country. According to the (Canadian) medical historian Edward
Shorter, in addition to trying out large doses of various drugs (including caffeine)
he tried injecting turpentine into the abdominal muscles with the objective of
producing a huge sterile abscess (which had to be opened in the operating room,
he said) and, following the supposed effectiveness of malaria infection in treating
syphilis-caused madness, attempted to cause fevers through various means in an
effort to alleviate psychotic conditions and the major affective disorders (Shorter,
1997, p.247).

Following the success of chlorpromazine, several drugs that shared its biochemical
action of dopamine-receptor blockade were produced. Haloperidol was the most
widely used of these until the advent of atypical antipsychotics in the 1990s.
Meanwhile, a simplistic theory was popularised regarding the causation of what
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Eugen Bleuler, the Swiss psychiatrist who coined the term, described as the
schizophrenias. According to the biological psychiatrists of the post-Largactil age,
schizophrenia (now regarded as a single disease rather than a collection of
maladies of possibly different aetiology) was caused by high dopamine levels,
evidenced by the fact that dopamine-blocking drugs were effective in controlling
its symptoms.

Since excitement is a more intense emotional state than mere attention or interest,
it might be expected that areas of the brain known to be involved in emotional
reactions would show greater activity when an individual is excited. There are
problems with such studies, however.

Why happy music doesnt always make you happy

Why sad music doesnt always make you sad

Depressing music and music for depression

Scary music and music for anxiety

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Angry music, irritating music and the music of angry young men

Chronic anger and hostility can also cause health problems (and social problems)
although, like fear, anger has important physiological, psychological and social
functions (anger about injustices is, for example, an important motivator for
positive social change). It is hard to find redeeming features for hostility,
aggression and rage, and it seems clear that their disadvantages far outweigh their
motivational advantages. Both fear and anger (in their acute and chronic forms) are
increasingly common in modern society, reflected by such phenomena as road
rage and more diagnoses of panic disorder, anxiety disorders and depression.

There is no doubt that music can be used to pacify anger and placate fear. It has
been used in this way for thousands of years, and is intuitively being used for these
reasons by people around the world at this very moment. Creating music, singing
and listening to music can all calm anger and fear. However, selection of music
and other factors are important for success. Music can be irritating, and playing
musical instruments can be frustrating, as can be singing. Playing instruments and
singing can also provoke anxiety about the judgement of others, and some music
can cause anxiety when listened to. Leaving aside the complex issue of the
emotions associated with learning and playing musical instruments, listening to
music can be enjoyable, and thus change, at least temporarily, a previously agitated
emotional state. The enjoyment of music can include calm, tranquil states and
emotions of excitement, surprise and amusement. Used in this way music can be a
valuable distraction from worries and unreasonable fears, and take ones mind off
things that irritate and upset. If the limits of music were such, it could reasonably
be called diversionary therapy, albeit a greatly under-utilised diversionary
therapy, but they are not. Music can have far more profound effects on health than
distraction from the troubles of the world.

In addition to temporary influence on emotions, music can change beliefs, attitudes

and long term emotional health: for good or ill. Unfortunately, little serious work
has been done in this area, resulting in concern that unless scientists (including
medical and psychological researchers) start looking for good uses and effects of
music it will remain an underused therapeutic tool and the music which is
supported by the government, big corporations and others, and played on the radio
and television may cause more harm than good in terms of the overall health and
wellbeing of society.

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The technological explosion of the 1980s and 1990s has been accompanied by the
development and promotion of a range of new music genres, including styles
heavily dependent on the new technology. These include dubbed music of various
sorts, usually with computer or drum-machine generated rhythms. Some of these
genres are minimalist regarding lyrical content, or without words, and others
(including various rap styles) are dominated by fast and sometimes furious lyrics.
Unfortunately, despite the existence of thoughtful and philosophically sound rap
music, over the past twenty years the most promoted artists have been those
shouting boastful, aggressive and violent tirades, often with racist and misogynist
sentiments. The genre styled gangsta rap also rapped about problems of poverty,
violence, racism and drug abuse in black urban ghettos in the United States of
America, real problems which need to be articulately voiced without glorification
or the production of either stereotypes or destructive role-models. There are many
rap artists as well as other musicians who have been doing this for many years,
however their faces are rarely seen on television in Australia, or in other countries
where more confused philosophies receive considerable airplay.

The philosophical content of the lyrics of modern music merits critical analysis
given the rising rates of youth suicide in several nations where potentially
destructive styles of music are heavily promoted. An obvious example is so-called
death metal music, a style derived from the heavy rock of the 1970s.
Characterised by morbid lyrics glorifying death, suicide and a nihilistic world-
view, this genre is particularly popular among male adolescents and young men in
Australia, one of the groups with the fastest-rising rate of suicide and depression in
this country.

Another way the technological explosion has affected music is in the level at which
music is played at various venues. Rock music and dance music are often played
through modern amplification equipment far louder than was the case fifty years
ago, levels at which damage to the ears and brain can be expected. A hundred years
ago music was listened to only at normal accoustic levels. Some of the most
lyrically dangerous music (such as death metal) is also listened to louder and
louder, as sound engineers and disc jockeys turn up the volume.

Of course, music can be, and is, used to express the noblest of human sentiments
and to convey messages of great importance. The collective wisdom of thousands
of recorded songs equals (at least) the philosophical and political wisdom, as well
as the psychological insight, of the academic disciplines devoted to their study. If
budding politicians study Bob Marleys and John Lennons philosophies, maybe
there will not be as many wars. They may also feel like dancing.
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Bob Marley tried to make people dance. Reggae music has a rhythm which is
irresistible to many, and to this music Marley sang songs about love, peace,
freedom and other matters of great importance. Music has a power to carry
messages as well as exalt emotions, and these messages may be universal and
enduring. They may be profound and enlightening. Music can be a powerful social
and political force for beneficial change as well as a valuable therapeutic tool.

Messages of positivity and optimism also abound in musical lyrics, as well as more
pessimistic comments and expressions of personal anguish. These can be
selectively listened to if the intent is to elevate the spirits or develop insight into
the suffering of others, as the case may be. If a person is feeling tired, energising
music can be played, and if angry, calming music can be of benefit. Paradoxically,
people often play music that reflects their mood and play sad music when feeling
sad and angry music when feeling angry. This may be a cathartic experience, in
which case it may be helpful, however it may aggravate the situation. Much more
study needs to be done in this area.

There can be no doubt, however, that music has profound effects on emotions, and
it is likewise certain that all emotional states have corresponding physiological
effects, including effects on neurotransmitters and effects on various parts of the
brain and autonomic nervous system. Emotional changes can also affect hormonal
activity in the body, via the hypothalamic-pituitary axis. The hypothalamus is
directly involved in the processing of memory and is directly connected to the
limbic system and thalamus, both of which are involved in the neural processing of
musical sounds (perhaps including recognition of particular sounds as musical
ones, and very likely, our emotional responses to them). The hypothalamus is also
intimately involved with activity of the autonomic nervous system.

Although the limbic system has been described as an emotional centre,

neurophysiological studies and logical analysis indicate that the complex emotional
responses elicited by music cannot be accurately localised to a single area of the
brain (Wertheim, 1977). Listening to music involves several areas of the brain, in
both the left and right hemispheres. Creation of musical sounds involves others, as
well as the areas involved in listening. A complex interplay between conscious and
subconscious factors occurs.

It is not just the sounds that are beautiful, but the silences between them.
Simplicity may be more delightful than complexity.

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The emotional reactions that music elicits depends on the listener as much as the
music. How one listens and what one listens for. It is possible to listen critically or
to listen sympathetically. In the former situation one is listening for the worst and
in the latter one is enjoying the best. Critical listening is essential if one is to find
the flaws in ones own performance or recordings, for example, but can be
discouraging. Being able to function as a music critic is important for professional
musicians and critics, but for broad appreciation of music, sympathetic listening is
a far more important skill to develop.

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MELODY AND PLEASURABLE SCALES

The richness of music includes an infinite variety of harmonies and melodies, and
these aspects of music can be of immense psychological benefit. Technically,
melody refers to the sequence of notes which constitute the tune, and is often the
most memorable aspect of a piece of music. Melody, like rhythm is fundamentally
related to time: the melody is established by the temporal sequence of notes. This,
for some reason, can cause immense pleasure depending on the particular pattern
and arrangement of different tones. Which patterns are experienced as most
pleasurable vary considerably between people, however the huge popularity of
some songs over others suggests that some melodies have wider appeal than others.
Which melodies are enjoyed the most depend, to a degree, on familiarity of scale
and elements of repetition. Unfamiliar scales may be experienced with discomfort,
although they may have a special appeal because they are different, and new.
While people listen to familiar scales most of the time, they can also become bored
with hearing similar melodies, and while repetition is an integral aspect of both
rhythm and melody, too much repetitiveness can also be boring.

A unique ability of human beings is their ability to mentally create and vocalise a
limitless variety of melodies. While the melodies sung by birds may be equally
beautiful, these are largely stereotyped according to species and birds are not
capable of improvised singing the way humans are. Most mammals do not sing,
notable exceptions being whales. In whales, as in humans, singing performs an
important social function.

Not surprisingly, the human voice holds a special appeal to human emotions, and
people of all cultures sing and respond to singing. Although good singers have
cross-cultural appeal, the types of voice favoured by individuals (and by different
cultures) are highly variable in modern society. This reflects the wide range of
qualities that may be appreciated by the listener, including the passion of the
singing, clarity or other aspect of their voice, technical ability, improvisational
ability and choice of songs. Some have broader taste than others, appreciating a
wide range of vocal styles and many types of music. This often changes with age,
sometimes broadening and sometimes becoming narrower. As far as overall
happiness is concerned, however, it would seem that a constantly broadening taste

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could logically be expected to be helpful: it allows for an ever increasing range of

pleasurable experiences to choose from as one discovers more music and new joy
in old music.
One attribute in singers that is highly valued across cultures (though considered
more important in some than others) is ability to sing in tune. This means that the
singer is able to sing precise notes, requiring fine control of their vocal cords, and
fine auditory perception. Little children rarely sing in tune. The ability develops
with increasing control of their larynx, tongue and respiratory muscles together
with more accurate auditory perception in the different parameters of music
(rhythm, tone, melody and harmony). Some people never develop ability to sing in
tune, but with practice, most people can achieve it. The phrase of something being
'music to my ears' indicates the broader meanings - inevitably associates with
pleasure - of the word 'music'. In terms of musical sounds, though,

The physics of music is centred on sound wave frequencies and how they unfold in
time.

What sounds harmonious to the human ear is not entirely subjective. It is based on
clearly definable (and measurable) physical facts such as frequency, waveform and
amplitude. Consider, for example, the phenomenon of musical scales - the
sequences of frequencies (notes) that sound 'natural' and 'harmonious' in music.
While what might sound like a 'normal' (or pleasant) scale varies between countries
and cultures, certain phenomena such as 'octaves' are objective physics facts. The
same note recurs when the frequency of vibration is doubled (or halved). For
example, the frequencies of a pure tone of A are 55, 110, 220, 440, 880 and 1760
cycles per second (Hertz). What is defined as a middle C remains 256 (to 260)
Hertz in any culture. The variation between 256 and 260 Hertz for the 'same note'
indicates that the frequencies we ascribe to different notes are approximate only
(and to a degree arbitrary). If the middle C is defined, though, at 258 Hertz, the C
note an octave above will be exactly (and not approximately) 516 Hertz. If defined
at 256 Hertz, the higher C will be exactly an octave above at 512 Hertz.

The familiar 13-note chromatic scale, 8-note melodic scale and 5-note pentatonic
scale can be interpreted in terms of physics and frequencies, though the emotional
responses they elicit are not so easily defined, needless to say.

Singing (or playing) 'in tune' is therefore not a subjective, but an objective,
phenomenon, although how this affects the listener (or producer) of the sounds is

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highly subjective and variable. Some listeners (or singers) are disturbed when a
note is out of tune, others don't notice it at all. At the same time the perceptual
discrimination necessary to recognise when a note is slightly out of tune can
develop throughout life. Few young children sing perfectly in tune, and inevitably
those that do, improve further with practice and experience.

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HARMONY AND THE MYSTERIOUS DELIGHTS OF DISSONANCE

A recent study of a Japanese chimpanzee named Sakura (published in the journal

Primates in 2009) suggests that chimpanzees have a preference for consonant over
dissonant music, as do humans, even as babies (excepting the 3 percent who are
tone deaf or, to use the medical terminology, suffering from amusia).

Recognising consonant over dissonant intervals (shown to be a mental capacity of

birds but not of tamarin monkeys) is essential for musicality, but in itself cannot be
regarded as evidence of a music instinct. It has been found that playing Mozart to
mice affects the levels of neurotransmitters in their brains, but few would
reasonably regard this as evidence that rodents are blessed with a music instinct.
The harmonic principles that underlie the sounds we hear as dissonant are based on
hard physics facts, and interference patterns that occur when two adjacent notes
(semitones) vibrate at a frequency (pitch) close to each other. Likewise there are
fundamental physical reasons, related to their wavelength and frequency, that
certain intervals of pitch (notes) harmonise with each other. Recognition of
harmonic consonance and dissonance is necessary for musicality, but do not
necessarily imply a musical sensibility.
Another vocal ability which can be developed is ability to hear and sing harmonies.
Harmony refers to the simultaneous interplay of different notes which are played at
the same time. It is, like melody, determined by scales, and strongly influenced by
culture. Culture determines which harmonies are experienced as pleasant and
unfamiliar harmonies may sound discordant. Discordance in harmony is itself,
however, an important element of most types of music: it helps build musical
tension which is then resolved with different harmonies. This is easily seen in jazz
improvisations where the soloist often takes the listener on a melodic and harmonic
journey from the familiar to the unfamiliar and often back again to the familiar, at
the end of the piece. Many classical compositions follow a similar pattern.

The emotional experience of different harmonies is subjective, and defies

objective or accurate description with words. Minor scale harmonies are often said
to be sad while major scales are happy. The pentatonic blues scale can also be
said to have a sad sound. However many very happy and uplifting pieces of
music are full of minor chords and/or are based on a blues scale. Moreover, the
sadness elicited by music is quite different to the sadness elicited by tragic life

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events. Music that brings tears to the eyes is highly valued, and it produces an
emotional reaction that is difficult to describe, but definitely not unpleasant.

Like rhythm, harmony has a broader philosophical meaning, one which has great
relevance to the psychological and social health of humankind. In The Republic,
Plato wrote:
For rhythm and harmony penetrate deeply into the mind [psyche] and
have a most powerful effect on it, and if education is good, bring balance
and fairness, if it is bad, the reverse.

Plato goes on to denounce ugliness, which he felt should be rejected by one who is
well educated:
And moreover the proper training we propose to give will make a man
quick to perceive the shortcomings of works of art or nature, whose ugliness
he will rightly dislike; anything beautiful he will welcome, and will accept
and assimilate it for his own good, anything ugly he will rightly condemn
and dislike, even when he is still young and cannot understand the reason for
so doing, while when reason comes he will recognise and welcome her as a
familiar friend because of his education. (p. 401)

Plato connects harmony, rhythm, education, balance and fairness. He suggests that
condemning and disliking ugly aspects of art and nature is a desirable result of
good education, as is the practice of welcoming anything beautiful. Indeed, he
considers that the object of education is to teach us to love beauty (p.403). He
makes it clear that he is referring to beauty in character rather than absence of
physical defects: qualities of discipline, courage, generosity, greatness of mind
and others akin to them.

The popular saying beauty is in the eye of the beholder is the antithesis of
Platonic ideas about the absolute nature of beauty. The ancient Greek philosopher
saw beauty as a fundamental quality applying to nature as well as works of art.
People could learn to recognise beauty, but what was inherently beautiful was not
subject to change. This is very different to the common supposition that perception
of beauty and ugliness is just a matter of taste, an idiosyncratic judgement based on
likes and dislikes and devoid of inherent goodness or badness. It is not
considered politically correct to say that something is bad music or bad art, only
that one doesnt like it.

The brains of chimpanzees are much more similar to our own than those of parrots,
yet many species of parrot can dance in time, while no non-human primates,
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including chimpanzees, are known to have this capacity. Though there has been
Recent evidence suggests that at least one chimpanzee (in Japan) prefers consonant
(German classical music) over the same tunes made dissonant by flattening all the
Gs and Cs by a semitone (using orchestration software) no chimpanzee has been
trained to dance in time to music, let alone dance spontaneously to music it likes.
A study of a Japanese chimpanzee named Sakura (published in the journal
Primates in 2009) does suggest that chimpanzees do have a preference for
consonant over dissonant music, as do humans, even as babies (excepting the 3
percent who are tone deaf or, to use the medical terminology, suffering from
amusia).

Recognising consonant over dissonant intervals (shown to be a mental capacity of

birds but not of tamarin monkeys) is essential for musicality, but in itself cannot be
regarded as evidence of a music instinct. It has been found that playing Mozart to
mice affects the levels of neurotransmitters in their brains, but few would
reasonably regard this as evidence that rodents are blessed with a music instinct.
The harmonic principles that underlie the sounds we hear as dissonant are based on
hard physics facts, and interference patterns that occur when two adjacent notes
(semitones) vibrate at a frequency (pitch) close to each other. Likewise there are
fundamental physical reasons, related to their wavelength and frequency, that
certain intervals of pitch (notes) harmonise with each other. Recognition of
harmonic consonance and dissonance is necessary for musicality, but do not
necessarily imply a musical sensibility.

Leaving aside the complex question of ethically good and bad music (but
fundamentally related to it), it is important to identify factors in music which can
promote or hinder health. These may vary from person to person, however it may
be possible to identify universally beneficial/detrimental aspects of sound and
music. It may also be possible to identify music which is usually beneficial or often
harmful. The potential for music to affect physical and psychological wellbeing
can be studied objectively and scientifically, even if some aspects of music
perception are subjective and difficult to describe in words.

The Italian psychiatrist Roberto Assaglioli, wrote in Psychosynthesis (1965):

The harmful effects of music on body and mind are due to various
factors. The most important of these is the kind or quality of the music. But
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there are others of a secondary character which can be influential and at

times even decisive. These are: the amount of the music heard; the psycho-
physiological constitution of each listener; the particular emotional state in
which he or she is at the time. Thus, a piece that is disturbing and upsetting
to one person may have no or little injurious effect on another (p.242)

Assagioli has rather prudish views about music that arouses the instincts and
appeals to the lower passions, judging certain parts of Salome by Richard
Strauss as apt to produce injurious effects because it excites by its sensual
enchantment. One wonders how he would have judged modern music videos had
he lived to see them. Of more scientific merit are his concerns about melancholy
and depressing music, in terms of basic principles, although not necessarily in
terms of specific example:
A second group of musical pieces of a harmful kind consists of those
that are very melancholy and depressing, as they express languor and
weariness, grief and distress, agony and despair. This kind of music may
have great artistic merit and may have afforded relief to the composer
himself and been a means of artistic catharsis, but it is likely to act like a
psychological poison on the listener who allows its depressing influence to
permeate him. Of this kind are certain pieces by Chopin, notably his
nocturnes, in which that unhappy soul has given vent to his poignant
melancholy and to his weakness and homesickness. They have contributed
to the cultivation of that languid and morbid sentimentality which afflicted
the young women of the romantic period of the last century.

In his chapter on music as a cause of disease and as a healing agent, Assagioli

makes some important points about music which are of even greater relevance
today, but sometimes fails to distinguish his subjective opinion from the objective
(a scientific objective which is very difficult to achieve in theorising about music,
or psychology, without losing the richness of the subject-matter). He also
demonstrates some cultural prejudices in his derogatory references to primitive
music and jazz:
Another type of music apt to be injurious consists of those musical
compositions which, while representing interesting experiments in new
forms of musical expression, reflect, with their frequent dissonances, their
lack of form, their irregular and frenzied rhythms, the modern mind in its
condition of stress and strain. Many modern dances, particularly jazz,
combine over-stimulation with the disintegrating influence of their
syncopated rhythms. (p.244)

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Seven years before the publication of Assagiolis book, on the 9 th of March 1958,
six musicians in America recorded a beautiful rendition of the classic tune
Autumn Leaves. Julian Cannonball Adderley played the first solo on alto
saxophone. He sang a beautiful song with amazing subtlety, dexterity and
precision. His tone is warm and gentle when he starts his improvisation, but as his
melody unfolds, a panorama of emotions is expressed. After the alto saxophone
had spoken, Miles Davis improvised over the familiar chord progression with his
unique walking on eggshells muted trumpet sound. A new melody with a unique
sequence of notes syncopated in a unique way was played for the first time. This
essential aspect of jazz music, that of improvisation, is not mentioned by Assagioli,
who is more concerned about frenzied rhythms.

Autumn Leaves, which was released on Cannonball Adderleys Somethin Else

album in 1958, is now considered by many people to be a very relaxing piece of
music as well as an artistic triumph, and one very conducive to good psychological
and physical health. It is a piece of music full of beautiful harmonies, tones,
melodies and rhythms. It can be listened to, danced to and improvised along with.
However there are some who do not like this music. They hear discordance where
others hear interesting and enjoyable harmonies. They hear confusing rhythms
where others feel like tapping their hands and feet. They hear an unpleasant jumble
of notes where others hear a beautiful and unique conversation between five gifted
musicians. It is difficult not to see the latter as more fortunate.

Listening to music at too loud a volume can cause tinnitus and reduced hearing.
Repetitive strain injuries are common, and some instruments are hard on the back.
It is possible to injure oneself dancing, though dance can also be used for physical,
mental and social benefits.

The many exceptional musicians who have died young demonstrate that passionate
involvement with music and a musical lifestyle does not guarantee a long and
happy life. In fact, musicians have an unfortunate reputation as tortured artists
and also one for premature death, often associated with drug addiction. This may
reflect a preoccupation with such stereotypes by the mass-media, and the creation,
by the media and music promoters, of myths and legends about musical heroes
glorifying the only the good die young cliche. The early death of Jimi Hendrix,
Janis Joplin, and other music stars in the 1960s and 1970s added to the myth that
the most brilliant musicians die young, perhaps as a result of tempestuous
personalities, one enshrined in history books as well as psychological and even
neurological texts (e.g.,Trethowan, 1977).

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However, socio-political factors are being ignored in making such a generalisation.

The gifted musicians named above are amongst the many young people who have
died prematurely due to the self-administration of drugs. Since the 1950s,
musicians have been increasingly troubled by drug addiction. Using drugs to
stimulate creativity has a history that began long before the 1950s, however it was
the first decade after the end of the Second World War that heralded the modern
era of dominance of medicine by the pharmaceutical industry. This era has seen the
increasingly pervasive mass-media harnessed to sell drugs and alcohol. The people
most sensitive to what comes in through the eyes and ears may well be artists and
musicians - along with susceptibility to the hypnotic powers of television and
magazines.

Although the lifestyles of pop stars and touring musicians may have dangers, they
are risks that can be avoided with good sense, and which do not affect most people.
Many performing musicians have, of course, lived long and happy lives, creating
music well into their nineties, maintaining both physical and mental powers into
advanced age.

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TIMBRE, TONE AND THE BEAUTY OF SMOOTH SOUNDS

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TIME, RHYTHM AND BIOLOGICAL CLOCKS

The perception of time, when mentioned at all in scientific writing, is usually

separated from perception of rhythm although the two are clearly related. Several
neuroscientists have identified the suprachiasmatic nucleus of the hypothalamus as
our body clock and recognised its importance, together with the pineal organ, in
the physiological and hormonal changes associated with longer biorhythms such as
circadian rhythms and diurnal rhythms in humans and various other mammals
(Reiter, 1984). Medical discussion of biorhythms is generally limited to diurnal
and circadian rhythms, rhythms which can be detected chemically, and are found
throughout nature. Sense of musical rhythm has hardly been studied in comparison,
and rarely is included in a discussion on biorhythms (or otherwise) in medical or
neurological texts. More surprisingly, sense of rhythm is rarely mentioned in
psychology texts either.

It is obvious that particular emotions can stimulate the urge for movement and that
movement can also stimulate emotional responses. In the emotional journey all of
us experience throughout our life there is a constant interaction between emotion
and movement. Perceived movement as well as actual physical movement can
stimulate emotional response (think of emotional reactions to flying dreams, for
instance). Our emotional life is also profoundly influenced by our senses: most
obviously our sight and hearing.

Although it is common to refer to our five senses, a careful look makes it clear
that we have many more than this. Each of these senses is associated with distinct
emotional reactions, each of which feels fundamentally different. While reading
an interesting book and listening to a favourite piece of rhythmic music can both
stimulate pleasurable emotional reactions, they have different physiological
effects, partly because of our sense of time. This clearly seen in the urge to
dance.

Our sense of time, like our sense of right and wrong (conscience) and sense of
direction can be ignored if psychological study is restricted to five senses. These
are complex senses which do not have clearly defined sense organs, however
they can be important for health. They are certainly worthy of scientific study, and
can be analysed in a scientific way.

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Time and the passage of time are perceived with variable accuracy by adults and
children, and with the years, perception of time changes. We become aware of
passing minutes, hours, days, weeks, months and years, but also develop deeper
understanding of more abstract aspects of time and the relationship between time
and the sensory stimulation our waking day is full of. We also develop a sense of
rhythm involving aesthetic development and development of discrimination
between temporal patterns of sound. The relationship between time and sound is
central to our perception of music, and whether we consider particular sounds to be
music, as well as whether they make us feel like dancing (or tapping our hands or
feet).

Moving rhythmically in response to music is seen in young children and even

babies a few months old. Children of all races dance, but not all children dance.
Some respond to rhythm from a very early age, others appear less moved by it.
Undoubtedly an environment in which they see people dance and do not develop
self-consciousness about dancing fosters the activity in children, adolescents and
adults. Of course, what people feel like dancing to and their actual styles of
dancing are culturally dependent and individually variable. Some aspects of dance,
however, including a fundamental instinct for dance are not. This is borne out by
the fact that people who are brought up listening to one type of music can feel like
dancing in response to music from a different continent, music unfamiliar in scale,
melody, instrumentation and harmony. What is necessary, however, for the
stimulation of an urge to dance in this situation, is a pleasurable rhythm. The
rhythm must also have a tempo which is conducive to dance, and the same rhythm
can lose its effect if it is too fast or too slow (or played too loud or soft).

What constitutes a pleasurable rhythm, and what areas of the brain are involved in
perception of rhythm, tempo and timing? How can music be used to stimulate
movement, and can the same music be used for all people for this purpose?
Although these questions remain unanswered by the neurosciences, an integrated
approach can be used to cast light on them: one integrating known neuroanatomy,
neurophysiology, psychology and musicology. A model resulting from such an
approach is presented in the accompanying diagrams. This is intended as a
theoretical framework which can be built upon and is necessarily simplified, with
some generalisations to which there are doubtless exceptions.

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Universities discover Groove

The worlds universities discovered groove rather late in life some havent found
it yet. Universities are conservative institutions, and like old men, the oldest
universities tend to be the most conservative, meaning tradition-bound (rather than
any economic connotation). This is not necessarily a bad thing the academic
tradition has a lot to be proud of, and to conserve. It can, however, lead to a
narrowness of view and reluctance to embrace new ideas, especially when they
threaten the existing curriculum, or opinions and interests of particular academics
who have established empires at that university. Like other hierarchical
institutions, there is a ladder to climb in universities, and each discipline or faculty
provides different ladders. The highest echelons of these faculties, especially in
science, but also in the arts, is dominated by men. Until very recently these men
were among the minority of the worlds population that listened largely, or
exclusively, to classical music. The research projects they approved were only
those they could defend as studying serious music. It should be remembered that
until relatively recently many of the worlds more famous orchestras were
composed entirely of men (with the interesting exception of harpists).

Of the main elements of music (rhythm, melody, harmony and timbre) rhythm has
been relatively neglected by psychologists and neuroscientists over the years. This
is partly to do with a tradition embedded in European classical music and a view
that serious (and therefore good) music should be food for the intellect rather
than the emotions (a reflection of the traditional dichotomy between thinking and
feeling). Though musicians and their audiences were certainly meant to feel
emotions at a classical music concert, it was not good form to jump around with
excitement that was for the common folk with their folk music. The influence
of Western classical music and this particular traditions great composers on music
perception and creation and on the neurosciences generally is to be expected, since
the scientific study of the brain and mind is centralised in the global university
system, which is dominated by the oldest universities in the biggest cities of the
worlds most vociferous nations, each with their own classical musical heritage
to honour and proclaim.

Since the 1960s and the ground-breaking work of Brenda Milner at McGill
University, women have been at the forefront of music neuropsychology. This is in
stark contrast to the medical profession, including the specialties of neurology and
psychiatry (the two specialities that might be expected to understand music and the
brain), which are dominated by men, especially in terms of senior academic and
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research positions. Chauvinism may be a relevant factor in the shameful neglect of

music as a therapy and as a subject worthy of serious scientific study (and funding)
by the medical profession over the past half century. Unfortunately, in Australia
and many other countries (of which Canada is an exception) little public money, if
any, is used to fund music neuropsychology or music therapy research, and the
other major sources of medical research funding the drug companies are hardly
likely to sponsor research that might establish music as a serious competitor in the
therapeutic market.

Music that stimulates the mind rather than the body was the objective of the
intellectual aesthetic favoured by the Western classical music tradition. This may
explain why so much neurological study of music was focussed on the musical
elements of harmony and melody rather than timbre and rhythm, or the emotions
associated with music. This is ironic, since the human sensitivity to timbre and
rhythm are fundamental to our musicality, and to the sounds that make us feel like
tapping our and feet, bobbing our heads, and moving our bodies in time to the
music. Harmony and melody may make us smile, but timbre and rhythm make us
dance.

It is precisely because of its primitive appeal, and its propensity to induce people
to gyrate their bodies in sexually suggestive ways that rhythm has long been
regarded as the least respectable of the elements of music. The angels in religious
paintings over the centuries were usually depicted playing harps, or at worst
trumpets, never drums. Drumming was associated with voodoo, black magic, black
people and the dangerous allure of hypnotic trances. Dark-skinned people dancing
semi-naked around an open fire in a frenzy inspired by sweat-covered men beating
drums was a familiar image Hollywood reserved to depict the savages in
Darkest Africa through the 1950s and 1960s, prior to the international explosion
of Rock and Roll. Rock changed everything when it came to what music and
musicians were venerated but the neuroscience establishments were, predictably,
not the first bastions to crack under the sonic onslaught of Rock. Rock music was,
and is, all about rhythm.

Its not that great grooves began with Chuck Berry and Rock and Roll. But the
popularity of Berry, followed by the fanatic enthusiasm for Elvis Presley and later
the Beatles and Rolling Stones brought Berrys rock version of the rhythm and
blues to a vast new global audience. The Beatles, in particular, inspired huge
numbers of young people to take up the guitar, bass and drums and form their own
bands in towns and cities around the world. When these pop musicians were
first featured on television variety shows and the radio was playing their recordings
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there was predictable opposition from many conservative members of the older
generation who complained that the new music was loud noise, much as several
previous generations had regarded jazz, which is distinguished by complex,
syncopated rhythms in the melodies and in the rhythm section (bass and drums).
It was only in the 1990s that the Western worlds universities evolved musically to
a point where the senior echelons of the relevant faculties grew up on pop, rock
and jazz. Though music schools were slow to add jazz studies and its focus on
improvisation to their curricula, and slower to add rock and roll, the popularity of
the guitar, more so than any other instrument, guaranteed that even academia had
to yield to the rhythm oriented music that has since transformed human culture in
the north, the south, the east and the west. All around the world musicians have
been incorporating guitars into their music.

The other standard instruments of a rock/pop band (originating from a format

shared between country, folk and blues, all of which contributed to the synthesis
Chuck Berry popularised as Rock and Roll) are bass (first acoustic, later electric)
and a drum kit. These instruments have also been incorporated into popular music
sung in hundreds of languages around the world.

The new generation of neuroscientists, brought up on a diet of beat-oriented music

has belatedly begun a serious, systematic study of human perception of the
temporal events of music using the most modern imaging techniques available
functional magnetic resonance imaging (fMRI) and positron emission tomography
(PET) being favourites. Though older investigations, such as surface electrical
readings (EEGs), these new (and relatively expensive) scans allow imaging of
increased blood flow to various parts of the brain. With careful experimental
design it has been possible to localise many of the brains musical functions,
though much remains unknown in this area (despite brain localisation of musical
functions being a popular research objective). One thing that has become clear is
that though small areas of the brain are primarily involved with music-related
functions (mainly in the right temporal lobe), most music cognition and creation
involves parts of the organ and networks that are used for other, non-musical
functions, including language, (non-musical) movement and the complex circuits
and neural structures that subserve our emotions.

It is precisely because of its primitive appeal, and its propensity to induce people
to gyrate their bodies in sexually suggestive ways that rhythm has long been
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regarded as the least respectable of the elements of music. The angels in religious
paintings over the centuries were usually depicted playing harps, or at worst
trumpets, never drums. Drumming was associated with voodoo, black magic, black
people and the dangerous allure of hypnotic trances. Dark-skinned people dancing
semi-naked around an open fire in a frenzy inspired by sweat-covered men beating
drums was a familiar image Hollywood reserved to depict the savages in
Darkest Africa through the 1950s and 1960s, prior to the international explosion
of Rock and Roll. Rock changed everything when it came to what music and
musicians were venerated but the neuroscience establishments were, predictably,
not the first bastions to crack under the sonic onslaught of Rock. Rock music was,
and is, all about rhythm.

Its not that great grooves began with Chuck Berry and Rock and Roll. But the
popularity of Berry, followed by the fanatic enthusiasm for Elvis Presley and later
the Beatles and Rolling Stones brought Berrys rock version of the rhythm and
blues to a vast new global audience. The Beatles, in particular, inspired huge
numbers of young people to take up the guitar, bass and drums and form their own
bands in towns and cities around the world. When these pop musicians were
first featured on television variety shows and the radio was playing their recordings
there was predictable opposition from many conservative members of the older
generation who complained that the new music was loud noise, much as several
previous generations had regarded jazz, which is distinguished by complex,
syncopated rhythms in the melodies and in the rhythm section (bass and drums).
It was only in the 1990s that the Western worlds universities evolved musically to
a point where the senior echelons of the relevant faculties grew up on pop, rock
and jazz. Though music schools were slow to add jazz studies and its focus on
improvisation to their curricula, and slower to add rock and roll, the popularity of
the guitar, more so than any other instrument, guaranteed that even academia had
to yield to the rhythm oriented music that has since transformed human culture in
the north, the south, the east and the west. All around the world musicians have
been incorporating guitars into their music.

The Neurobiology of Rhythm

In the past decade several facts have been established about the neural processing
of pitch, melody and rhythm, by neuroscientists in the USA, Canada and Europe

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who were using a combination of new and older radiological techniques and a
human experimental population ranging from professional musicians through
students and members of the general public, to people with localised brain damage
(from disease and surgery). More is known about our processing of pitch and
melody than about rhythm, partly for the reasons mentioned, and partly because of
the deep structures that appear to be involved in our mental processing of time,
timing and rhythm. These structures, including the cerebellum and basal ganglia
are less accessible to testing by sticking electrodes onto the scalp or directly into
the brain, which has, until recently, been the mainstay of neuropsychology
research as far as brain localisation was concerned.

What is regarded as a pleasurable rhythm is clearly subjective and varies between

individuals. Which rhythms make people feel like dancing also varies, influenced
by cultural factors and individual preference. It also varies according to age and
other factors such as mood in the same individual. As a rule, children dance to
simpler rhythms than adults, just as they respond to simpler melodies and
harmonies. Along with other parameters of musical perception, taste in rhythm
matures with years and experience, as well as discrimination between different
elements and aspects of rhythm. This may occur without conscious awareness of it,
and occurs to a different extent and in different ways in different people, however
development in perception of rhythm with experience is a general developmental
phenomenon.

Throughout childhood, as motor skills improve, ability to dance improves with

them, along with total musical knowledge and music related skills. The rate at
which they improve depends on environmental factors and natural aptitude.
Environmental factors influencing the rate of musical development include the
amount and type of music played to and by the child, active teaching and the
examples of influential people (such as parents and siblings).

As children mature, development of the sense of rhythm occurs in several ways, as

does perception of the passage of time. These include aesthetic changes,
recognition of familiar rhythms and knowledge about the source of the rhythm.
The aesthetic changes include changes in what rhythms and pieces of rhythmic
music are liked and disliked, and which make one feel like dancing. Familiarity,
hence memory, can influence emotional reactions to different rhythms. These
connections between the perception of rhythms, memory and emotional reactions
suggest involvement of the limbic system in the perception of musical rhythm,
together with the temporal lobes, which are involved in auditory processing.
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Earlier than they understand the more complex word and concept of rhythm, young
children usually become familiar with the beat of music. The two are not exactly
the same, although the beat is the most obvious part of musical rhythm. Some
music does not have an obvious beat, however it is an essential part of dance music
and music that makes one feel like dancing. Numerous genres of music have been
developed with the specific intent of stimulating listeners to dance. Dance has, in
this situation, important social functions, and in some cultures, religious and
spiritual importance as well. Most rhythmic music is not specifically intended for
dance, although this does not preclude their use in this way. The rhythm and beat
of music are fundamental to its appeal across a wide spectrum of styles from
around the world, including music intended for listening without dancing.

The concept of rhythm is, of course, much broader than that of musical rhythm
alone. The aesthetic perception of beautiful timing can apply to words (and
speech) as well as music, and it can be a part of visual as well as auditory
perception. Developing an acute sense of timing and an awareness of the beauty of
rhythms can have far-reaching benefits.

Timing ones movements precisely is a fundamental aspect of playing any musical

instrument and of singing. Learning new instruments involves development of the
neural circuits and muscles required to play the instrument, and practice brings
greater and greater ease in the necessary movements, as well as precision and grace
in their execution. Which parts of the brain and body develop depend, of course, on
the particular instrument being learned. Some musical instruments only involve the
use of the hands, others of the hands and mouth, yet others of the hands and feet.
Musical training involves the independent and integrated development of timed
movements of various parts of the body, a complex activity which, with time and
practice, becomes largely automated. The learning of musical instruments
obviously involves development of the motor cortex in addition to other parts of
the brain.

In their 2005 review of the literature two of the worlds leaders in music
neuroscience, Robert Zatorre and Isabelle Peretz reported several important
discoveries about the neural processing of (musical) time relations. One is that
creating a rhythmic pattern appears to be processed more by the left side of the
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brain, while beat perception causes more right-sided activity. This theory is
supported by the fact that it is easier to tap a beat with the left hand and a rhythm
with the right (I tried it myself, and found it to be true, at least in my case). The
authors argue that this supports the hypothesis that the right hemisphere handles
meter, whereas grouping would rely essentially on the left. The argument is that
extraction of the beat from a piece of music (meter) results in the metrical
organization corresponding to periodic alternation between strong and weak
beats. Grouping, the function ascribed more to the left hemisphere, is the
segmentation of an ongoing sequence into temporal groups of events based on their
durational value.

10

THE NEUROBIOLOGY OF DANCE

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Why do we dance?
The brains of chimpanzees are much more similar to our own than those of parrots,
yet many species of parrot can dance in time, while no non-human primates,
including chimpanzees, are known to have this capacity. Though there has been
recent evidence that at least one chimpanzee (in Japan) prefers consonant (German
classical music) over the same tunes made dissonant by flattening all the Gs and Cs
by a semitone (using orchestration software) no chimpanzee has been trained to
dance in time to music, let alone dance spontaneously to music it likes.

Neural structures implicated in dancing

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The Interesting Tail of the Caudate Nucleus

While other animals (especially birds) may be said to dance, their dances are
stereotyped, largely limited to courtship and display, and not synchronised with
external music. Human dance is a very different phenomenon. People feel like
dancing: it can be a compelling urge, one brought about largely by audible
rhythms. Human dance is also unrivalled in its complexity and our capacity to
improvise new movements and combinations of movements in aesthetically
appealing sequences (which is an anatomical and clinical way of describing
dance). This complex activity obviously involves several parts of the brain,
including those involved in movement of various body parts, conceptualisation and
planning of dance movements, and memory, as well as those involved in listening
to and responding to music.

Of particular interest, giving rise to possible treatments for Parkinsons disease

using music, is the involvement of the basal ganglia in dance, and the urge to
dance. The basal ganglia, positioned lateral to the thalami on each side of the brain
are known to be involved in initiating and maintaining movement. They have been
likened to the starter motor of a car, although this analogy can be taken too far.
Actual voluntary movement also requires the simultaneous activity of the motor
cortex (of the frontal lobe), however the symptoms of Parkinsons disease, which
results from dysfunction of dopaminergic neurones in the basal ganglia, point to
the importance of these nuclei in the core of the brain in enabling normal
movement.

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11

THE NEUROBIOLOGY OF CREATIVITY

Neural mechanisms of music creation

Creating music is an ambiguous term. Performance, meaning playing instruments

and singing, requires movement of voluntary muscles, obviously requiring the
recruitment of motor pathways in the brain. Singing and playing musical
instruments usually (but not necessarily) requires activity in the auditory areas of
the brain. These will be explored before considering the more complex actions of
playing instruments, drumming and clapping, singing and music composition.
Though the physical creation of music requires muscle movements, mental
creation of rhythms, melodies and harmonies, meaning singing in ones head, does
not.

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12

USING MUSIC FOR MUSCULOSKELETAL HEALTH

Drumming and playing percussion instruments

Dancing

13

MUSIC AND RELIEF OF STRESS

Listening to pleasurable music

The effect of pleasurable music on physiological measures of stress, including

blood pressure, heart rate and skin conductivity have been studied in recent years.
These have confirmed the intuition that music can cause classic relaxation
responses, characterised by decreased activity in the sympathetic nervous system.
Music that stimulates a relaxation response is predictably experienced as
pleasurable. Not all pleasurable music causes relaxation, though, at least in terms
of neural activity. Often music is listened to, and played, for the opposite reason.
Often people listen to and create music with the express intent of causing
excitement in themselves and others. This may appear paradoxical, but the effect
of music on emotions is more complex than can be explained in terms of simple
dichotomies and polarities like happy-sad or relaxation-excitement. In terms of
autonomic nervous system activity, the health benefits of music cannot be simply
explained in terms of increase or decrease in sympathetic (fight/flight) or
parasympathetic (rest/digest) activity. This will be explored shortly.

The mechanisms by which stress induces illness and disease are well established, if
not fully understood in terms of detail. It is clear though, that many illnesses
(including, but not only, mental illnesses) are worsened, or caused by stress. Other

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than heart disease the list of stress-related diseases includes peptic ulcers, asthma,
immune-suppression, auto-immune disease and diabetes. In terms of mental health,
it is widely accepted that stress can trigger or aggravate depression, anxiety
problems, and psychosis. It stands to reason that if music can reduce stress, it can
also be used to combat various stress-related illnesses. These include psychological
and psychosomatic conditions that are primarily caused by stress, and the
numerous physical illnesses that are known to be worsened by stress.

Singing

Playing musical instruments

14

MUSIC FOR DEVELOPMENT OF SANITY

My parents taste in music did not leave me entirely cold. I enjoyed many of the
light classical piano pieces my mother used to play and liked several of their
classical albums, especially Beethovens sixth symphony. It was this symphony
that opened my ears to the miracle of headphones.

Listening to music through headphones is a very different experience to listening

to the same piece though external speakers. Headphones are still external but the
music is perceived as if the sound is being generated inside the brain. When I
listened to the Pastoral Symphony through headphones for the first time, at the age
of thirteen, I had a blissful experience. It was pure bliss something I had not
experienced though music before. I had enjoyed lots of music in the past, but this
was different. I also noticed subtleties that had escaped my attention when listening
to the famous composition before. Part of the reason for this unusually intense
experience was undoubtedly the fact that I listened to the whole symphony lying
on my back with my eyes closed. I was deeply relaxed while concentrating on the
music.

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Headphones are ubiquitous nowadays, and we hear regular warnings about risks of
damage our hearing by turning the volume up too loud. I had never heard mention,
though, of the risk of madness caused by headphones, until I asked one of my
patients, some years ago, about her first breakdown. This lady was one of my
regular patients and was already on multiple psychiatric drugs when I started
seeing see and her husband in my medical practice in Melbourne in the early
1990s. It was some years before I asked her about this traumatic event, and only
after I noticed that she was developing what I recognized as early signs of Tardive
Dyskinesia, a degenerative disease of the brain known to be caused by long-term
use of anti-psychotic drugs.

Tardive Dyskinesia is one reason that anti-psychotic drugs should be prescribed

with caution and for the shortest time necessary, and the justification used these
days to use the (far more expensive) new generation/atypical antipsychotic drugs
that are expected to be less prone to causing permanent brain damage. My patient
had been on a low dose of an old antipsychotic drug in addition to large doses of
tricyclic antidepressants for more than 10 years. The reason for this, I was told by
her psychiatrist, was an initial psychotic presentation. Apparently the doctors at
the hospital had wondered whether she had a frontal lobe syndrome before
deciding she probably had late onset schizophrenia because of auditory
hallucinations she was experiencing at the time. The psychiatrist, who she had
been seeing since her discharge from hospital, favoured a diagnosis of psychotic
depression, hence the big doses of anti-depressants and the small dose of an anti-
psychotic.

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15

MUSIC FOR CONCENTRATION AND MEMORY IMPROVEMENT

16

MUSIC, PARKINSONISM AND PARKINSONS DISEASE

Parkinsons disease, which usually affects older people, is characterised by tremor,

stiffness and difficulty in initiating movement. It is also often accompanied by
psychological depression, which is at least partly caused by the physical symptoms
of the disease and its gloomy prognosis. There is no known cure for Parkinsons
disease, and, although improvement in symptoms with drugs usually occurs,
eventual lack of response to the drugs and progression of the disease is common.
Diagnosed depression in people with Parkinsons disease is routinely treated with
antidepressant drugs, and music does not currently play a significant role in the
medical treatment of Parkinsons disease.

Ironically, very similar symptoms to those of the naturally occurring Parkinsons

disease occur as an unfortunate consequence of medical treatment with dopamine-
blocking drugs, an iatrogenic (treatment-caused) condition known as Parkinsons
syndrome or Parkinsonism. This movement disorder, again characterised by
tremor, stiffness, difficulty in movement and depression mainly affects young
people who are being treated for psychotic illnesses. Dopamine-blockers, which
are the mainstay of medical treatment for schizophrenia and mania (and are also
used, at times, in the management of elderly patients with dementia), cause
Parkinsonism routinely, as well as a number of other movement disorders (such as
tardive dyskinesia and akathesia). An analysis of these abnormal movements can
help us understand the activity of dopaminergic neurones in the brain, and perhaps
enable strategies to be developed for music to alleviate both Parkinsons disease
and iatrogenic Parkinsonism. Music may even help restore normal movement in
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the terrible condition of tardive dyskinesia for which there is currently no

available drug treatment, and which is caused exclusively by dopamine-blocking
drugs.

There are dopamine-sensitive neurones all over the brain, however they are
concentrated in two areas, both of which appear to be involved in dance: the limbic
system and basal ganglia. Dopamine, a neurotransmitter manufactured in the brain
from the dietary amino acid tyrosine, also acts as a neurohormone and has
significant physiological effects (such as raising blood pressure), although this may
be caused by dopamine produced elsewhere in the body. Dopamine, a
catecholamine, is the precursor molecule of the important neurotransmitter
noradrenaline (norepinephrine) which is itself the precursor of the well known
catecholamine adrenaline (which is manufactured from noradrenaline in the
medulla of the adrenal glands).

It is evident from the different symptoms of drug-induced Parkinsonism and the

many effects of dopamine-receptor stimulants that stimulation and blockade of
dopamine receptors causes different effects in different parts of the brain. This is
not surprising given the known functional design of the brain and the cells within
it. A cell behaves according to intrinsic properties of the particular type of cell, as
well as its location. When a neurotransmitter attaches to a specific receptor on the
neurones cell membrane, various metabolic processes in the cell and its electrical
activity may be stimulated or inhibited. The result of the stimulation or inhibition
depends on where in the brain the neurone is located and other factors, including
psychological factors.

The fact that both the limbic system and basal ganglia have many dopaminergic
neurones raises another possibility regarding stimulation of the basal ganglia to
produce an urge to dance and the stimulation of movement more generally. It may
be that the basal ganglia are stimulated directly via their connections with the
limbic system (rather than the thalamus), a theory more consistent with the
importance of emotional factors (especially pleasure) in the urge to dance. It is
possible, however, that stimulation of limbic system neurones releases dopamine
which affects other parts of the brain through a different mechanism. It may be that
the dopamine released in the limbic system (and elsewhere in the brain) affects the
basal ganglia via dopamine in extracellular fluid, via cerebrospinal fluid, or even
by the blood circulation within the brain or a combination of all of these. It is
also possible that the metabolite of dopamine, noradrenaline, has effects secondary
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to dopamine production and release by neurones.

The structures commonly known as the basal ganglia are actually nuclei rather
than ganglia (ganglia are defined as collections of nerve cells outside the central
nervous system, but the basal ganglia are located deep inside the brain). Their
role in controlling movement has been recognised for many decades, and the
structures have been extensively researched, since dysfunction in the basal ganglia
are known to cause the movement disorder known as Parkinsons Disease. Though
Parkinsons Disease is known to be associated with depression, it is only in recent
decades that a particular structure within the basal ganglia system has been
identified as playing a key role in emotional reactions. This structure, the nucleus
accumbens, appears to be specifically involved with the experience of pleasure.

The actual act of dancing obviously involves those areas of the brain involved in
voluntary movement (such as the motor cortex), and dancing can provide exercise
for the whole body. An involuntary urge to dance is different from a decision to
dance. The latter can be made without feeling like dancing, and one can have the
urge to dance but consciously resist it. This urge may be caused by direct
neurological stimulation of the basal ganglia or by generally increased dopamine
activity in this part of the brain consequent on stimulation of emotional circuits in
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the limbic system. Whether or not the basal ganglia are directly involved in the
urge to dance, but especially if they are, it is apparent that music can be put to good
use in the treatment of Parkinsons disease and other conditions where stimulation
of voluntary movement is desirable. It can be used to elevate the mood and
energise, and it can be used to develop motor skills. Regardless of what parts of the
brain are involved, the dance urge can be used therapeutically for neurological, as
well as psychological, problems.

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17

MUSIC AND HEALTHY HEARTS

Of recent research on cardiovascular health benefits of music, a study of 740

subjects by Dr Pedrag Mitrovic of the University of Belgrade is particularly
interesting, due to the large number of experimental subjects and the long duration
of the study period. In this study, reported at the 2009 Congress of the European
Society of Cardiology, half the subjects (370 patients) were instructed to listen to
music twice a day for 12 minutes, while the other half were not permitted to listen
to music at all. The 740 patients had all undergone revascularisation operations for
coronary artery disease, and were followed up for 7 years. Those who were
allowed to listen to music showed less hypertension and angina, with lowered rates
of subsequent heart attacks, and need for subsequent surgery. Mitrovic also
reported lowered ratings for anxiety among those who listened to music, though
this was not regarded as statistically significant, unlike the unequivocal benefit to
cardiovascular health.

This study, and the reporting of it in the media, is interesting. Mitrovic, in an

interview with Heartwire explained that though most of the patients reported that
they listened to classical music, this was sometimes because they were
embarrassed about their real musical preferences for what he calls national
(Serbian) music. The report in Heartwire also describes the 24 minutes of music-
listening as music therapy. Of course, skilled music therapy involves
considerably more than listening to recordings of ones favourite music, and might
be expected to provide considerably greater health benefits. This study does,
however, indicate that listening to music one enjoys is good for ones health.

Other studies, including hundreds from American and Western European

universities, have usually involved much smaller numbers. There is also a
considerable variety of style, and probably quality, of music therapy. Some
researchers regard just asking people to listen to music as music therapy, while
others have shown the effectiveness of individual and group therapy by
professionally-trained music therapists in a range of health problems. Such
research is, however, still in its infancy, and few studies have been done on music-
related activities and general health.

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The effect of pleasurable music on physiological measures of stress, including

blood pressure, heart rate and skin conductivity have been studied in recent years.
These have confirmed the intuition that music can cause classic relaxation
responses, characterised by decreased activity in the sympathetic nervous system.
Music that stimulates a relaxation response is predictably experienced as
pleasurable. Not all pleasurable music causes relaxation, though, at least in terms
of neural activity. Often music is listened to, and played, for the opposite reason.
Often people listen to and create music with the express intent of causing
excitement in themselves and others. This may appear paradoxical, but the effect
of music on emotions is more complex than can be explained in terms of simple
dichotomies and polarities like happy-sad or relaxation-excitement. In terms of
autonomic nervous system activity, the health benefits of music cannot be simply
explained in terms of increase or decrease in sympathetic (fight/flight) or
parasympathetic (rest/digest) activity.

Mitrovic explains the cardiovascular benefits he has demonstrated as being due to

lessening of activity in the sympathetic nervous system (SNS) the so-called fight
or flight branch of the autonomic nervous system. This is a reasonable hypothesis,
since heart rate and blood pressure are known to rise under sympathetic
stimulation, and high levels of SNS activity are known to accompany states of
mental stress. Drugs that block SNS activity (beta-blockers) are routinely used to
lower blood pressure and to slow the heart rate. However, this explanation is
incomplete, since the SNS also increases cardiac contractility, and dilation of the
coronary arteries which one might expect to protect against angina and infarction
(heart attack).

The following diagram (figure 1) shows some of the mechanisms by which heart
disease can be created or aggravated by stress. Hypertension (high blood pressure)
can be seen as one of several inter-related factors that contribute to cardiac
problems. The lower part of the diagram includes some of the commoner adverse
effects of drugs used for the prevention and treatment of heart disease (including
medications to lower blood pressure and cholesterol). If music can be used to
alleviate stress, such adverse effects (along with the not inconsiderable cost) of
these drugs could be avoided, or at least greatly reduced.

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Atherosclerosis, which results in worsening blockage of arterial blood vessels in

various parts of the body, is the cause of most heart attacks (myocardial
infarctions) and ischaemic heart disease. These problems occur if the coronary
arteries, small hard-working arteries that supply the constantly-active heart muscle
with blood, become blocked. If blood vessels supplying the brain become
occluded, atherosclerosis can cause cerebral infarction (strokes) or multi-infarct
dementia. Similar blockage in the blood flow to the legs and feet can cause
claudication, and if not surgically corrected, may result in gangrene requiring

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amputation. Sustained or very severe hypertension can also cause direct damage to
organs (especially the kidneys and heart) and can also lead to haemorrhage in the
brain (stroke).

Hypertension is thus a risk factor for all these conditions (because it promotes
atherosclerosis) and, although high blood pressure usually does not make people
feel unwell, it is treated aggressively (with drugs) by the medical profession due to
these associated risks.

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18

MUSIC AND THE IMMUNE SYSTEM

Many of the brains intrinsic rhythms, and those of the various internal organs it
regulates, are shared by other mammals, and even insects and plants. Various
circadian rhythms are examples of these the secretion of hormones, activity of
the immune system, body temperature and sleep cycles vary with night and day,
some depending on sleep patterns, but others (relatively) independent of them.
Research since the 1960s has identified important neural structures involved in the
brains regulation of circadian rhythms, including the suprachiasmatic nucleus of
the hypothalamus (SCN), the pineal gland (or organ) in the middle of the brain and
the sympathetic nervous system, which transmits information about environmental
light conditions from the SCN to the pineal, via a direct connection with a single
synapse in the superior cervical ganglia of the neck.
Figure 1:

The hypothalamus is a small part of the brain of extraordinary complexity and vital
importance to every organ in the body. It has also been very closely studied in
humans and other animals, since its importance was recognised early in the history
of neuroscience. Composed of several well-delineated nuclei, the connections and
functions of which have been studied by the usual means, the hypothalamus is
known to control activity of both the sympathetic and parasympathetic branches of
the autonomic nervous system, and the complex and vitally important secretions of
the pituitary gland. The SCN is a small nucleus (collection of neurons) about the
size of a grain of rice, located above the optic chiasma (where the optic nerves
from each eye cross). Though evidence of its importance, along with that of
melatonin, the pineal hormone it controls the synthesis of, has been growing
steadily during five decades of dedicated research, little if any of the research
findings about circadian rhythms has been integrated into music neuroscience or

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found their way into medical texts, let alone clinical practice.

Circadian rhythms do not have an obvious connection with musical sense of

rhythm, although research findings from 2000 showing that music therapy raised
melatonin levels of patients with dementia is intriguing in this regard. They are
also important because of the innervation of the pineal, established in the 1960s, by
the sympathetic nervous system, and the many known and hypothesised functions
of the hormone melatonin, which is synthesised in the gland from serotonin (which
also acts as a neurotransmitter elsewhere in the brain). This synthesis is known to
occur mainly at night, and to be inhibited by exposure to bright light during the
night. It has been established that fibres from the sympathetic nervous system,
emanating from the superior cervical ganglia (which are located in the upper neck)
synapse with pineal cells, releasing the neurotransmitter noradrenaline
(norepinephrine). This well-known catecholamine stimulates synthesis of an
enzyme that is essential for the rate-limiting step in the synthesis of melatonin from
serotonin. The melatonin is secreted from the pineal into the network of capillaries
with which the gland is liberally endowed, and thus reaches all parts of the body. It
is known that melatonin also affects other parts of the brain, notably the pituitary
and hypothalamus, probably through local diffusion of melatonin (and other
substances, of which the pineal produces several, though in lesser amounts).

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The Pineal the Seat of Soul Music?

In early 1995 I read, for the first time, that the famous French scientist and
philosopher Rene Descartes had thought the pineal to be the seat of the soul, and
that the ancient Indians had thought the organ to be the third eye. This is, of
course, common knowledge, but I had not learned these historical facts in medical
school or in continued medical education during my years as a family physician.

I must admit I was not a particularly keen student, when I studied medicine at the
University of Queensland, from 1978 to 1983. Id entered university straight from
school, and had consumed most of my academic fervor by the time I was
seventeen. As such, it is possible I missed the lecture on the pineal, and the main
hormone it produces, melatonin, or was playing pinball when the more
conscientious students were learning about Descartes famous (if contentious)
theories about the function of this mysterious, pea-sized organ in the middle of the
brain.

After six years as a medical student in Brisbane, followed by three years of post-
graduate training (the last as a paediatric registrar) at the Royal Brisbane Hospital,
when I embarked on a career as a general practitioner in 1986, all I knew about the
pineal organ in the brain was its rough location and that it often calcifies the older
one gets. If such calcification is evident, seen as a white spot in the middle of the
brain, the pineal, we learnt, can be used to detect midline shift on anterior-
posterior X-ray views of the skull. Midline shift, we were taught, suggests a space
occupying lesion on one side of the brain such as a brain tumour or subdural
haematoma.

In the pre-CT-scan days, when I trained to become one of thousands of Australian

doctors, looking for midline shift of pineal calcification on skull X-rays was
imprinted into our minds as an essential investigation for unexplained headaches or
loss of consciousness. In a sense, an unconscious patient, or one with a suspected
brain tumour, was lucky if he or she had a calcified pineal it meant mid-line
shift could be picked up early, allowing early diagnosis and treatment. Such
calcification as seen on plain X-rays of the skull, first described by Schuller in
1918, was regarded as physiological meaning not pathological (indicative of
disease).

Pineal calcification was recognized as sometimes being abnormal, and suggestive

of pineal tumours. Radiologists were trained to report calcification greater than
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1cm in diameter (larger than the usual size of the pineal), since this could mean the
gland was enlarged by a tumour, of which there are several types. Pineal
calcification less than a centimeter in diameter was regarded as physiological, or
normal, and therefore not worth reporting.

The question of whether or not so-called physiological calcification is actually

normal, or whether it indicates loss of function of the pineal, only became relevant
after the discovery at Yale University, by the dermatologist Aaron Lerner and co-
researchers, of melatonin, the principle hormone secreted by what was then
recognized, again, as a gland (the famous Roman physician Galen given it the
name glandaris pinealis in the 4th century AD).

The pineal has been the subject of one of the biggest, and least commented on,
reversals of opinion in modern medicine and physiology. Up until 1958, when the
hormone melatonin was isolated from cattle pineal glands by Aaron Lerner, the
pineal body, as it was called, was widely regarded as vestigial by the medical
profession. The fact that the organ tends to calcify with age was taken as proof that
it serves no function in humans. This claim is made explicitly in the 1957 edition
of the reference text Histology by Arthur Ham, Professor of Anatomy at the
University of Toronto and Head of the Division of Biological Research at the
Ontario Cancer Institute in Canada:
The pineal body, also called the epiphysis, is a little cone-shaped body
about 1 cm. in length. Although it originates from, and remains connected
to, the posterior end of the roof of the third ventricle, it projects backward so
that it lies dorsal to the midbrain
The pineal body of mammals is the vestige of the median eye which
was probably a functioning organ in certain amphibia and reptiles that
are now extinct. Like other vestigial organs in man, it tends to reach its
greatest development relatively early in life and thereafter to degenerate.
One evidence of the latter process is the formation of calcified bodies of a
laminated appearance in the organ. These constitute what is called brain
sand. (pp745-6, emphasis added)

Photomicrograph of pineal tissue

in 1957 edition of Hams
Histology

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Though maintaining that the pineal is a vestige, Arthur Ham explains, in his 1957
text (a standard textbook in histology for medical students in Australia) that:
The function of the pineal has been studied by the same means that
have been employed for the study of endocrine glands. The effects of the
removal of the pineal body from young animals have been investigated, as
have the effects of grafting a series of pineal transplants into animals.
Various types of extracts made from pineal bodies have been fed or injected
into animals. The effects of pineal tumors on men and women have been
noted. The net result of all this study is difficult to assess. The experimental
results are conflicting. Nevertheless, there is some evidence to suggest that
there is some association between the sexual development of the male and
the pineal body. However, the nature and significance of this association are
still obscure. (pp.746)

Aaron Lerner, who also discovered the pituitary hormone Melanocyte Stimulating
Hormone (MSH), was looking for the pineal factor that had been observed, back in
1917, to cause lightening of frog skin. Though the dermatologists hope that the
discovery may help understand, or treat, the de-pigmenting skin disease vitiligo
remains unrealized, his discovery of the chemical structure of melatonin, in 1958,
spawned a fascinating chain of research that has continued to the present day. This
research, from many disciplines, has shown the pineal to influence on the
endocrine and immune systems, in particular. In addition to influencing the timing
of pituitary hormone release (thus influencing our entire endocrine system),
melatonin has been shown to be a potent anti-oxidant and scavenger of free
radicals a property of the molecule with considerable relevance to the prevention
of heart disease, stroke, dementia and cancer.

Importantly, the secretion of melatonin, which occurs at night, is suppressed by

exposure to bright light, and synthesis of melatonin from the well known indole
amine serotonin comes under control of the autonomic nervous system, mainly the
sympathetic branch, though more recently parasympathetic innervation of the
pineal has also been reported.

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The sympathetic innervation of the pineal gland was first described by the Dutch
neuroscientist Johannes Ariens Kappers in 1960. Kappers discovered that the
primary innervation of the mammalian pineal comes, not from the brain, but the
superior cervical ganglia in the upper neck, the uppermost of the paravertebral
sympathetic ganglia. Though the initial studies demonstrated this to be the case in
rodents, subsequent studies showed the same to be the case in other mammals,
including humans.

Between 1960 and 1980, during what some authors have described as the era on
pinealology, numerous studies elucidated the mystery of what had been regarded
as a vestigial organ, further. It was established that the sympathetic inputs to the
pineal (from the superior cervical ganglia) came under the control of the
suprachiasmatic nucleus (SCN), a structure the size of a grain of rice in the anterior
hypothalamus. The SCN plays a central role in circadian rhythms, and has been
described as a biological clock. It was established that the suprachiasmatic nuclei
receive neural input from the eyes, and that changes in environmental lighting alter
neural activity in the SCN, and consequently secretory activity in the pineal.

During these years, details of the synthesis of melatonin from the amino acid
tryptophan via the increasingly well-known molecule serotonin were worked out,
including the enzymes and co-factors involved in the biochemical pathway. The
fact that melatonin has an effect on the timing of pituitary hormone release
(especially pituitary gonadotrophins) was established; this was shown to be the
case in many mammals, including humans. Details of the mechanism by which the
neurotransmitter noradrenaline (norepinephrine) in the sympathetic synapses
stimulates synthesis of melatonin from serotonin were elucidated, and it was
shown that synthesis of the enzyme NAT (N-acetyl-transferase), the rate limiting
step in the synthesis of melatonin, was stimulated by noradrenaline and inhibited
by exposure to light shone into the eyes. It was also reported that people who are
totally blind (and rats that have their optic nerves severed or their eyeballs
removed) lose the usual circadian rhythmicity of melatonin secretion.

Regarding so-called physiological pineal calcification, the first indication that

this may not be normal came from startling reports from Uganda and Nigeria in
the early 1970s that sub-Saharan Africans had much lower incidences of
calcification, as seen on X-ray, than had been reported in the USA and Europe. A
subsequent study in Cincinnati General Hospital, published in 1974, compared
black and white Americans, and found that in populations living in a similar
environment, the 300 blacks studied (9.8% of whom had visible pineal
calcification) showed significantly less calcification than the 16% of 200 whites in
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whom a pineal opacity could be seen, though considerably more than that reported
from populations in Nigeria (5 percent of 952 patients reported by Daramola and
Oluwu in 1972) and Uganda (2 percent of 100 patients by Murphy in 1968).

Since pineal calcification increases with age, and appeared to vary between the
sexes, the 1974 study by Adelola Adeloye (Rockefeller Fellow at the Childrens
Hospital Research Foundation at the University of Cincinnati in Ohio) and
Benjamin Felson (Professor of Radiology at the University of Cincinnati College
of Medicine) compared different age groups of blacks and whites, as well as
gender (comparing black and white populations remains a common feature of
American medical science, although more recent papers and texts tend to include
Hispanics as a third group for comparison).

Published in the November 1974 issue of the American Journal of Roentgenology,

Adeloye and Felsons paper, entitled Incidence of Normal Pineal Gland
Calcification in Skull Roentgenograms of Black and White Americans, presented
their findings in the following table:

As can be seen, most of the subjects in the study were children under the age of 19;
only two of these showed pineal calcification, both black. In older age groups there
was a greater tendency to calcification in whites, when the number of blacks (300)
and whites (200) are taken into consideration, with more tendency towards
calcification seen in white males and black females above the age of 20. The
following table, from the same paper, shows the relevant percentages:

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The fact that by the mid-1970s it had been conclusively shown that pineal
calcification is not a ubiquitous phenomenon, affecting American Caucasians
significantly more than African-Americans, and dramatically more than Indians,
Polynesians and Africans, escaped the attention of doctors, like myself, who
trained in Australia. The idea, then commonly expressed in the international
literature, that pineal calcification may be abnormal or unhealthy was not
suggested to us.

It is the findings of such research that will be integrated in this work, in which a
new functional model of the pineal gland will be hypothesized a model that
suggests the pineal, though certainly having a glandular function, also has other
physiological activity almost certainly neuronal (electrical), and possibly
magnetic; functions that may well justify the title of pineal organ, rather than
(just) pineal gland.

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The pineal gland, as it is usually termed, was so named because of its shape the
famous Roman physician Galen thought it resembled a pine cone. Galen, whose
medical writings were unchallenged for more than a thousand years in the West,
wrote that the ancient Greek physicians Herophilos and Erasistratos regarded the
pineal gland, the glandaris pinealis, to be of special importance.

Partly based on its prominent midline location, the fact that it is an unpaired
structure and the organs generous blood supply; Rene Descartes accorded equal
respect to the pineal.

Though the pineal has been known of since ancient times, and such luminaries of
classical Greek and Roman science as Erasistratos, Herophilos and Galen accorded
importance to it, through most of the 20th century the pineal body was described
in most medical texts as a useless vestigial remnant of our evolutionary ancestry
from lower vertebrates. The calcification noted on post-mortem and frequently
seen on X-ray was seen as further evidence that the pineal served no physiological
function in humans, despite mounting evidence of its extraordinary range of
activity in both cold and warm blooded vertebrates, ranging from fish, amphibians
and reptiles to birds and mammals.

A summary of zoological findings regarding the pineal, and their relevance to

evolutionary biology can be found in Chapter 4, on Comparative Zoology and
Evolutionary Biology, before I focus on the mammalian pineal and, particularly,
evidence concerning its function in humans. Briefly, evidence has mounted, since
the 1960s, that the pineal acts as a neuroendocrine transducer an organ that
converts electrical neural signals into hormonal (endocrine) signals. Specifically,
release of the hormone melatonin (which occurs mainly at night and is suppressed
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by exposure to light) affects the timing of pituitary hormone release, thereby

affecting the timing of widespread physiological events in the body. In addition, it
has been conclusively proven that the main innervation of the pineal organ in
mammals (including ourselves) comes from the sympathetic nervous system the
so-called fight or flight branch of the autonomic nervous system.

The story of my search for the truth about the pineal has lasted for fourteen years,
and, though much closer than I was, I am still not satisfied with my understanding
of this curious part of the brain. The research data, and conclusions made by
various pineal authorities are complex and sometimes contradictory. While
volumes and careers, in the fields of anatomy, physiology, endocrinology,
neuropsychiatry and neurology, have been devoted to study of the pineal organ,
textbooks that might be expected to describe the known physiology and
metabolism of the pineal and its secretions, say nothing about the gland, especially
in the late 1980s and 90s, when drugs known to affect pineal function were widely
(and wildly) prescribed. At the same time, other literature, ranging from science
fiction to religious and parapsychology writings, has had a lot to say about the
pineal and its association with what was described as a Third Eye.

The association between the Eastern concept of the Third Eye and the pineal may
have been a significant motivating force behind Western scientific skepticism
towards discoveries by zoologists that the pineal organ does, in fact, function as a
light-sensitive third eye in certain living reptiles and amphibians (and not just in
extinct ones as was thought up till the 1960s). Likewise, Descartes famous quote
that the pineal is the seat of the soul may have acted as a disincentive for the
modern scientific establishment abandoning the previously dominant vestigial
theory. Talk of souls and spirits is generally viewed as the domain of priests,
philosophers and psychiatric patients by the largely atheistic scientific and medical
research industry.

When I began theorizing on the function of the pineal in 1995, I did so as a family
doctor with no specialist training in neurology, endocrinology or psychiatry, the
three specialist disciplines most involved in pineal research. I arrived these early
theories by integrating insights I had, at the time, into instincts, conditioning and
free-will, as part of a more general theory of motivation. The possible magneto-
sensory role of the pineal in humans, which I found, some years later, had been
postulated back in the 1970s by Dr Robert Becker, occurred to me independently,
due to my interest in ornithology.
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I had been painting native birds since I was a child living in the hill town of
Kandy, in Sri Lanka, and had read somewhere, in the early 1970s, that the pineal
organ, thought to be vestigial in humans, was involved in migratory behavior in
birds and appeared to be sensitive to the earths geomagnetic field it is involved
in their sense of direction, in other words.

I hypothesised, at the time, that, in addition to its well-recognised (by 1995)

function as the gland that secretes melatonin, then being promoted for prevention
of jet lag, the pineal might be sensitive to both extrinsic and intrinsic magnetic
fields. The intrinsic magnetic fields, I postulated, would be caused by coordinated
electrical impulses travelling in the nervous system.

The following rough diagram give an indication of my evolving ideas at the time,
and was drawn shortly before my theory of motivation was declared delusional,
and I was committed as an involuntary patient to the notorious, and now
demolished, Royal Park Hospital in Melbourne. I drew the diagram on clinic
stationary while trying to explain my theory of motivation to Dr Rajan Thomas, the
psychiatrist nominated to assess my mental state. His notes indicate that he
assessed me to as possibly having hypomania which was settling spontaneously,
and that there were no grounds to have me sectioned (certified), noting that
family wants him sectioned:

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In the diagram above, drawn when brainstorming on instinctual aspects motivation

gives an indication of my style of theorizing on the brain and mind and the limits
of my neurological knowledge at the time. Specifically, I was still laboring under a
false dichotomy between left and right sides of the brain, regarding aesthetic
pleasure from visual and musical stimuli (which I attributed to the right side of the
brain, whereas pleasure from love of honest communication I attributed to the left
hemisphere).

In terms of the pineal, the comments on the lower right of the diagram shows my
line of thinking regarding its possible function back in February-March 1995. I was
hypothesizing that the pineal, perhaps through its role as a magnetic organ, might
act as a link between the conscious and subconscious minds, and that its
postulated role as a body clock might be related to our sense of musical rhythm

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as well as the hormonal rhythms described by endocrinology researchers since the

1960s. I also postulated that the pineal may be fundamentally involved in the
timing of our thoughts - an idea so alien to mainstream psychiatry and medicine
that, even amidst my excitement at my theory of motivation, I knew not to discuss
it with the various psychiatrists and psychiatric registrars called upon, by the
Australian public hospital system, to become my treating doctors. My refusal to
agree that my theories were delusional was, in the usual manner of the psychiatric
profession, regarded as the typical lack of insight that affects manic and
hypomanic patients. Any psychiatry book will explain that people with these
conditions, feeling on top of the world and that everything is falling into place
often refuse to accept that, rather than inspired, they are ill.

The diagram above was actually drawn in Brisbanes Prince Charles hospital in
June 1995, after I had been re-admitted with the following admission letter this
clearly indicates that my theories on the pineal, along with theories on the
causation of autism and schizophrenia (which developed from my general theory
of motivation) were cited as evidence of delusions/psychosis, justifying diagnosis
of the serious psychotic mental illness known as mania:

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Talk of third eyes is only one of many reasons that the pineal organ has been the
subject of scientific, religious, political and financial intrigue, secrecy and
suspicion, over recent decade. Another, very obvious one, is the financial rewards
of selling drugs in the case of the pineal, selling melatonin as a nutritional
supplement and for treatment of jet lag and insomnia, amongst many reasons
plant-derived melatonin is voluntarily ingested these days.

Pineal research is fundamentally related to serotonin research, serotonin being the

neurotransmitter targeted by LSD, MDMA (Ecstasy) and SSRI drugs, of which
Prozac (fluoxitine) was the first. The role of the drug giant Eli Lilly, the CIA and
allied war effort against the Red Peril during the Cold War years from 1946 to
1990 will be explored in relation to hypothesized pineal function in Chapter 13
(The Pineal and Serotonin from LSD to SSRIs).

Although Descartes has been ridiculed by later scientists for his claims about the
pineal, he has, more often than not, been taken out of context and misunderstood.
Russell Reiter, in his three-volume specialist text The Pineal Gland writes that
Descartes stressed that the soul cannot be localised or confined to any single part
of the body:
Rene Descartes (1596 to 1650) or Cartesius is commonly cited as stating
that the pineal gland is the seat of the soul. Often, modern scientists consider
this statement quite incomprehensible and even ridiculous due to the general
failure of forgetting that, in historical as well as modern times, most ideas
and theories are influenced by the knowledge and philosophical background
prevailing at the time in which they are conceived. This holds very strongly
for the work of Descartes. At the end of the 16th and the beginning of the 17th
century, the problem of the localization of the soul was very much discussed
by both scientists and philosophers. Having a synthesising mind, Descartes
gave expression to current ideas which were, however, mostly based on
ancient concepts. He reasoned systematically using rather ingenious
mechanistic theories on the function of the brain, the sense organs, and the
muscles which were based, mostly, on those of earlier authorsIn his
Passions de lAme, Descartes emphatically says that the soul, his anima,
cannot be localized exclusively to any precise part of the body because it is
related to all body parts according to its very nature. This is, in fact, an old
Aristotolean doctrine to which Augustinus (354 to 430) did agree, although
Aristotle finally thought that the soul would be seated in the heart. (p.5)

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The pineal has been the subject of one of the biggest, and least commented on,
reversals of opinion in modern medicine and physiology. Known since ancient
times, medical textbooks up until the early 1960s stated categorically that the
pineal was a useless vestigial organ in humans, like the appendix. The pineal,
which tends to calcify with age, was said to be a function-less remnant of primitive
parts of the brain that are important for fish, amphibians, reptiles and birds but not
for mammals, and especially not for humans. The emotional circuits of the brain
known as the limbic system were similarly regarded for many years. The fact that
the pineal calcifies was itself taken as proof that the organ has no physiological
purpose in humans, and this calcification was given the curious name of brain
sand.

In 1958, however, Professor Lerner, who also discovered the structure of the
pituitary hormone Melanocyte Stimulating Hormone (MSH), identified the
chemical structure of melatonin:

Lerners discovery transformed scientific knowledge about the pineal, triggering a

flurry of research at universities around the world, including Yale, where the
dermatology professor had been seeking to identify the active agent in cattle pineal
glands, which had been known, for many years, to lighten amphibian skin.

The era of pinealology, as it has sentimentally been called by more recent

researchers, lasted from 1958, when melatonin was discovered, until the early
1980s, when it was replaced by the era of SSRI antidepressants and the Prozac
generation. This generation had not been taught, and therefore could not
remember, that only a few years earler the pineal was thought to be as useless as
the appendix.

During the 1960s, much was discovered about the pineal organ in humans and
other vertebrates. It was discovered that melatonin is synthesised from serotonin,
and serotonin from the amino acid tryptophan. The chemical structures of these
indole amines was discovered along with those of the enzymes involved in the
synthesis of serotonin and melatonin. It was discovered that light shone into the
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eyes suppressed nocturnal melatonin production, and that the neuro-hormone

affects secretion of other neurohormones, especially those secreted by the pituitary
organ (with which the pineal is sometimes confused).

It was also found that the pineal functions as a third eye in certain reptiles and
amphibians, and probably as a light-sensitive magneto-sensory organ in birds. The
function of the organ in various mammals remained controversial, however.

That pineal tumours can cause precocious puberty (abnormally early development
of puberty) was known as early as the 1890s, however only in the 1970s did it
become evident as to why this may occur. Even now opinion is divided, but it is
generally agreed that the secretion of melatonin (and other pineal hormones) affect
the gonadotropins secreted by the pituitary gland (FSH and LH). These affect the
endocrine activity of the testes and ovaries. Specifically, melatonin appears to
inhibit the activity of luteinizing hormone, the anterior pituitary hormone that
regulates secretion of testosterone in male mammals and oestrogens in females.
The full story of the pineals role as an endocrine organ is much more complex
than this and it is now thought that melatonin affects the activity of the immune
system as well as the endocrine system. This would not be surprising, since the two
systems are closely related and many hormones have effects on multiple systems.

The 1980 edition of Harrisons Principles of Internal Medicine (published by

McGraw-Hill) contained a clue as to why information about the anatomy and
physiology of the gland may be so conspicuously absent from recent medical and
neurological texts:
There isreason for optimism that our understanding of pineal
physiology and pathophysiology, and of the possible medical use of pineal
compounds, will soon expand. (p.1812)

Melatonin began to be marketed in the early 1990s as a treatment for jet-lag,

insomnia, aging, cancer and seasonal affective disorder with scant regard for the
long-term safety of ingesting the hormone. SSRI antidepressants, which selectively
affect serotonin, the indole amine from which melatonin is synthesised, and which
is concentrated in the pineal (although it is also active as a neurotransmitter in
other parts of the brain) were launched, beginning with Prozac, in the late 1980s
and with similar nonchalance about long-term and short-term dangers.

In the 1980 edition of Harrisons Principles of Internal Medicine Professor

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Richard Wurtman (Professor of Endocrinology at the Massachusetts Institute of

Technology) who wrote that the pineal is now regarded as a neuroendocrine
transducer acting, one might say, as an interface between the brain and
hormonal systems, continued his introduction to Diseases of the Pineal Gland
with the revealing passage:
Since the discovery of melatonin in 1958, compelling evidence has
accumulated that the mammalian pineal is not a vestige but an important
component of a neuroendocrine control system. This organ has been
shown to function as a neuroendocrine transducer. It receives a cyclic
input of sympathetic nervous information which is suppressed when the
retina responds to light. In response to this input, the pineal secretes a
hormone, melatonin, into the bloodstream, much as the adrenal medulla
releases epinephrine [adrenaline] in response to cholinergic [using acetyl
choline] nervous stimulation. The synthesis and secretion of melatonin
vary with a 24-h periodicity, thereby providing the body with a
circulating clock apparatus. Until very recently, no assay was available
to permit measurement of melatonin in human blood or urine. Largely as a
consequence, human pineal physiology remained largely conjectural, and the
only disease states that could clearly be associated with pineal malfunction
were those caused by pineal neoplasms [tumours]. Now the melatonin in
blood and urine can be measured by bioassay and radioimmunoassay, and it
is apparent that the same factors that control the synthesis and secretion of
this hormone in experimental animals also do so in humans. There is thus
reason for optimism that our understanding of pineal physiology and
pathophysiology, and of the possible medical use of pineal compounds,
will soon expand. (p.1812) (emphasis added)

A few years after these words were written melatonin began to be marketed as a
treatment for jet lag and was available for public consumption. It could be
purchased in airports around the USA and was being marketed as a safe, natural
tablet to reset the body clock. It was later marketed as a treatment for seasonal
affective disorder (SAD, or winter blues), which was said to also respond to
light therapy. Light therapy, as it was practiced, meant merely exposing the
sufferer to artificial light (winter blues was thought to be caused by chemical
imbalances consequent on the shortening of daylight hours in winter). The
concept of a biological clock, and its relevance to the pineal, melatonin and
psychiatry are tied together by Professor Arendt in Melatonin and the Mammalian
Pineal Gland in a section titled melatonin in psychiatric disorder:
Abnormalities in circadian function have been postulated in depression
and mania. Melatonin is arguably the best index of biological clock function:
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only bright light masks the expression of the endogenous rhythm, and it
has been extensively used in psychiatry and in other fields to assess
biological clock status. There is evidence for a decline in amplitude of the
melatonin rhythm in depression and in schizophrenia. In depression this is
associated with an increase in cortisol. There is possibly an increase in
amplitude in mania although not all studies are consistent.
There is little evidence for abnormal timing of melatonin, although
Lewy (Lewy et al., 1987) has reported exceptionally delayed melatonin
rhythms in winter in patients with seasonal affective disorder (SAD)
compared to the small delay seen in normals. This observation remains to be
confirmed but is of considerable theoretical interest. The treatment proposed
for SAD patients was the creation of an artificial summer day length using 3
hours of bright full spectrum light (Vitalite, 2500 lux) morning and evening.
The melatonin hypothesis predicted that such light treatment would shorten
the duration of melatonin secretion thus generating a summer day length
signal by analogy with animal work. The light treatment appears to be
efficient but it does not appear to work through melatonin. Bipolar (manic
depressive) patients are more sensitive to light suppression of melatonin than
normals. This observation may prove to be of both diagnostic and
therapeutic importance.
Most pharmacological antidepressant treatments will stimulate
melatonin secretion through increased availability of the precursors
tryptophan and serotonin and the major pineal neurotransmitter noradrenalin,
or by direct action on serotonin and catecholamine receptors. There may be a
link between an increase in melatonin production and efficacy of treatment
and this possibility merits exploration. (p.237)

Professor Arendt and her co-workers at the University of Surrey in the UK have
tested melatonin levels in many psychiatric patients including people diagnosed
with anorexia nervosa, manic depression, depression, schizophrenia and mania.
Although in the introduction of her book she says that pineal research is truly
interdisciplinary and its participants are required to keep their perspectives broad
while still remaining absolutely rigorous, in terms of the mind sciences she looks
no further than the latest psychiatric labels from the British and American
psychiatric professions. Seasonal Affective Disorder, conveniently abbreviated
to SAD is a new label for an old phenomenon (that may be worsening in
negativistic societies) many people feel sad during winter, at least, sadder than
they do in spring, summer and autumn.

There are many reasons as to why people may feel unhappy, tired, and bored in
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winter (in temperate regions) other than shortened day length, and many social and
environmental consequences that accompany shortened day length which can
contribute to depression (a broad term which can include sadness, boredom,
anxiety and anger). The obvious reason is that it is cold and tends to rain more. In
England and Canada it snows too. People tend to stay inside more, and the overall
level of social isolation in society tends to increase. Many people feel socially
isolated anyway, and feel better with even minimal attention from others (because
they get so little).

This may explain why the Vitalite, 2500 lux works to alleviate SAD. People who
are sad and isolated may be particularly prone to placebo effects and suggestions
that treatments will be efficacious. Sitting in bright light may well be safer and
more effective than taking Prozac or Prothiaden (a commonly prescribed tricyclic
antidepressant). Both these drugs, along with others of their class, evidently affect
pineal function and the secretion of melatonin together with their better known
effects on serotonin and noradrenaline. It is also clear that the long-term risks of
interfering with pineal activity are presently unknown, as are the full functions of
the organ although this has not stopped several researchers, including Professor
Arendt herself, experimenting on themselves by taking timed melatonin since as
far back as 1981. In the acknowledgements of her 1995 book she wrote:
Vincent Marks gave essential help and encouragement both to establish
my laboratory in the UK and to fund our work. John Wright enables our
clinical studies in many ways not least by his ability to stay awake all night
while taking blood samples. He and I first took timed melatonin in 1981 and
realized its potential.

The list of sponsors for her research gives some indication of those with a
particular interest in knowing about melatonins role in humans:
Our work has primarily been funded by the Swiss National Science
Foundation, the MRC [British Medical Research Council], the AFRC, the
Wellcome Trust, the British Antarctic Survey, the South West Thames
Regional Health Authority, the Ministry of Defence, several pharmaceutical
companies and our own company Stockgrand Ltd.

Professor Arendt promotes the therapeutic benefits of melatonin enthusiastically in

the foreword of Melatonin and the Mammalian Pineal Gland (although she does
present some concerns at the end of the book):
At present it could almost be considered the best candidate for a
universal panacea. It has been proposed as the treatment of choice for an
enormous range of ills, the most reasonable being natural rhythm
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disturbance accurring when our biology conflicts with our culture such as
shift work and jet lag, and the unnatural lighting conditions, especially in
wintwer, in which we live. It has essentially founded a whole new
pharmacology which is yet in its early infancy. (p.4)

On page 282 Professor Arendt summarises what she regards as the problems with
the therapeutic use of melatonin:
1. Its effects are time and dose dependent.
2. The effects may be stimulatory, inhibitory, or ineffective depending on
current and previous photoperiodic experience, circadian status,
developmental stage, and previous exposure.
3. There may be long-term consequences of treatment which are beneficial.
On the other hand they may also be detrimental.
4. There are no published full toxicity studies.
5. There may be undesirable effects on cardiovascular function including
clotting. [a potentially disastrous risk]
6. Intermittent reported undesirable side effects include headache and nausea.
7. Its interactions with other drug treatments are unknown.

These are all significant reasons to exercise caution in taking melatonin, and there
are others. The fact that there are no published full toxicity studies illustrates that
what is published tends to favour the use of drugs rather than discourage it. At the
same time propaganda prematurely proclaiming the effectiveness of new drugs
has now been expanded through the mass media we now are subjected to various
drug promotional strategies when we watch television, listen to the radio or visit
our local library. It was on a visit to my local library in 1997 that I discovered, for
the first time, how deeply the psychiatric profession has been involved in pineal
research and melatonin promotion.

The book that drew my attention to this was written by an American psychiatrist,
Micheal Norden, and published by Harper Collins in 1996. It is called Beyond
Prozac and claims, on the back cover, to be a provocative and enduring classic in
the modern literature about mental health. The promotional blurb on the back
cover boasts:
In Beyond Prozac, Dr. Michael Norden, a psychiatrist and pioneer in
developing new applications of Prozac, explains how the toll of modern-day
life has undermined our health and led to a national epidemic of depression,
anxiety, and weight problems. But there is hope. Based on seven years of
groundbreaking research and clinical work, Beyond Prozac offers solutions
to these chronic health problems that go beyond simply prescribing Prozac
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from incredibly effective alternative treatments such as light therapy,

regulation of sleeping habits, and specialized diets to the next generation of
safer and more effective depression medications. A decisive voice in the
debate about depression, Beyond Prozac is a provocative and enduring
classic in the modern literature about mental health.

Dr Norden does not write about mental health he writes about new drugs for the
treatment of depression the name of his book says it all. Although a psychiatrist
by profession, he does not write much about the mind he writes, instead, about
behavior and chemicals, repeatedly making the familiar claim of chemical
imbalances as being at the root of mental illness. In addition to promoting the
new SSRI antidepressants, Dr Norden also promotes St Johns Wort (hypericum, a
European herb which is now being marketed in capsule or tablet form), light
therapy units (which he says can be bought for less than $200) and melatonin
supplements. The latter he recommends to boost the immune system and as an
anti-ageing hormone, and for the treatment of sleep disorders, stress and
depression, admitting that he had conducted trials on his own patients:
I recently began using melatonin on a limited basis in my practice.
Some patients reported excellent improvement in their sleep. More exciting,
some found that melatonin also reduced their stress and improved their
mood. These anecdotal observations certainly made me eager to see further
investigation of melatonin therapy for a range of stress-related conditions.
(p.53)

Stress-related conditions, ageing people (who are concerned about their ageing)
and people who want to boost their immunity provide a growing market for
melatonin marketers in the USA and around the world. Not as many people are
shift workers and even fewer suffer from jet lag. As far as risks are concerned, Dr
Norden urges less caution (and caution for different reasons) than Professor
Arendt:
Apparently millions of Americans are already taking melatonin. This
amounts to a massive uncontrolled experiment, not unlike many aspects of
our modern living [an obvious attempt at reassurance]. People need to know
that there is a risk involved in this experiment. One aspect of the risk
involves the lack of control regarding the strength and purity of the
melatonin supplements. Under no circumstances would I suggest anyone
take melatonin derived from animal sources; you never know what might
show up in such a preparation. This is one time when clearly natural
sources are inferior you want synthesised melatonin. Fortunately, most all
the melatonin now available appears to be synthesized. Attempt to obtain
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pharmaceutical-grade melatonin and choose the most established

manufacturers, as they have the most to lose from any lapse in quality
control. Watch for reports of independent testing of preparations.
Melatonin itself appears to be one of the most benign substances known.
There is no indication that any amount is lethal, which cannot even be said
for water, let alone oxygen which is quite toxic in high doses. However, it is
known that high doses of melatonin will suppress gonadal function in
animals. Most users, therefore, should try only low physiological doses.
Testicular atrophy is presumably not one of the aspects of enhanced
sexuality claimed by ardent proponentsSome companies now claim
sustained release action for their preparations, which in theory should be a
more natural way to deliver melatonin, simulating the bodys continued
release through the night. (p. 60)

The most obvious concern about taking melatonin is dismissed without discussion,
or clarification as to whether this problem has been looked for:
One particular concern is the possibility that taking melatonin may
suppress the bodys own production of melatonin, though there is no
evidence that this occurs. (p. 60)

Surprisingly, Professor Arendt does not address this concern (or mention it) in her
list of problems with the therapeutic use of melatonin. She agrees with Dr
Norden that melatonin can be used in clinical trials with safety and has very
low toxicity (p.250) and is reassured by the results of early trials with enormous
doses of melatonin:
Enormous doses of melatonin (50 mg to 6.6 g = 33 million pineals!) in
the daytime had no beneficial effects on Parkinson patients, Huntingtons
chorea, depression (in fact depression was worsened) and schizophrenia.
Skin pigmentation was not affected: human pigment cells do not resemble
amphibian melanophores in pigment migration phenomena. Small decreases
in plasma LH and FSH were observed. Large amounts of melatonin such as
these may produce headache and abdominal cramps. This may possibly be
due to a false transmitter effect on serotoninergic systems. (p.251)

One wonders if the Parkinson patients knew that they were being given the
equivalent of 33 million pineals in a single dose one which stimulates an
exclamation mark in the otherwise dry and unemotional text of Melatonin and the
Mammalian Pineal Gland. It is evident that once human trials with melatonin
began in earnest in the 1980s, psychiatric patients, as in the case of insulin in the
1920s and oestrogen in the 1930s, provided a convenient captive population on
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which to experiment. While there is no doubt that Professor Arendt knows a great
deal about the pineal and melatonin, it is evident from her many references to
psychiatric labels that she has not considered deeply or critically the social and
political history of psychiatry, nor its contemporary theory and practice. She
routinely refers to melatonin levels in various categories of patient (Parkinson,
schizophrenic etc.) comparing them with normals. One gets the impression that
she spends more time analysing labelled blood tubes and urine specimens than
listening to labelled human beings. In fact, she provides an argument for using
melatonin levels to biochemically label people as manic depressive.

Earlier, in the preface to Melatonin and the Mammalian Pineal Gland Professor
Arendt makes a surprising admission, and a profound endorsement of the
importance of tolerance, love and understanding:
The small Channel Island of Guernsey, where most of this was written,
restores my sanity at frequent intervals. Finally I have to say that without the
tolerance, understanding and love of my husband and family I would not
have been able even to contemplate this book. I hope they feel that their
domestic and other supportive efforts have allowed me to produce
something worthwhile.

The surprising admission is that the small Channel Island of Guernsey restores the
professors sanity at frequent intervals. What sort of insanity does she suffer from
when she stays in Surrey for too long?

If you ask a medical doctor what the pineal organ is and does, you will, more likely
than not, be told it is a small gland in the brain about which little is known. You
might be told that it secretes a substance called melatonin, and that this is produced
mainly at night. If the doctor is well-informed, you might be told that the organ
also secretes other substances, that melatonin is made in the pineal from the well-
known indole amine, serotonin, and that the pineal was thought, by the French
scientist Descartes, to be the seat of the soul back in the 1600s.

These facts are all true, but there is much more to the story of the pineal and a
much more profound mystery associated with the pineal than the important
scientific question of what melatonin does. The biggest mystery about the pineal is
why most doctors do not know even rudimentary facts about an important organ in
the brain, and why these facts are omitted from student texts and post-graduate
medical texts about the brain but not from the medical literature altogether. Why
it is mysterious is that no other part of the brain has been subject to the same
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treatment. Neurosciences textbooks contain much detail about the pituitary gland,
and the hypothalamus, other important parts of our endocrine system, however the
same books often fail to mention the pineal. They not only fail to mention the fact
that it secretes serotonin and melatonin, but sometimes ignore the organs
existence completely (see Kandel, 1995; Kotulak, 1996; Kolb & Whishaw, 1990;
Weintraub, 1995 and others). This is despite more and more evidence of the
organs importance in human and in other mammals.

Since I noticed this anomaly, in 1995, I have considered several theories about
what has caused it. The first was that little is known about the pineal, and because
what has been discovered is uncertain, it is not presented in textbooks. This theory
was refuted by the observation that important recent discoveries about the pineal
were included in the 1980 edition of the reference medical text Harrisons
Principles of Internal Medicine (published by McGraw Hill) but excluded from
later editions of the same textbook. These discoveries include the fact that the
pineal is a complex organ with an intricate blood supply and a nerve connection to
the visual system and the autonomic nervous system. This allows the glandular
cells in the organ to modulate the amount of melatonin and other hormones it
releases into the bloodstream according to physiological needs. The textbook
describes this function of the organ as that of a neuro-endocrine transducer,
meaning that is provides an interface between the brain and endocrine system. As
such, it is obviously of central importance in understanding the brain-body
relationship and the mind-body relationship. But that is not the only vital fact about
the pineal that modern doctors are being deprived of by those who decide what is
published in textbooks.

The sympathetic innervation of the glandular cells in the pineal is adrenergic that
is, it involves the catecholamine neurotransmitter noradrenaline.

Back in the 1960s, noradrenaline was shown to be involved in the conversion of

serotonin to melatonin, which occurs mainly at night and is suppressed by light
entering the eyes. The influence of environmental lighting conditions on pineal
activity shows that the connection between the visual system and the pineal, well
documented in fish, reptiles and birds, is retained in mammals, including humans,
although in mammals most of the fibres from the visual system make a circuitous
connection from the suprachiasmatic nucleus of the hypothalamus (above the optic
chiasma) to the superior cervical ganglia (in the upper neck). Nerve cells in the
superior cervical ganglia send ascending sympathetic fibres to the pineal.

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The suprachiasmatic nucleus, which has been described as our biological clock
is known to be involved in the regulation of circadian rhythms in various
mammals, and is also involved in diurnal and other physiological rhythms (Reiter,
1981; Arendt, 1995).

The 1980 edition of Harrisons Principles of Internal Medicine mentions Kappers

discovery but not the evidence that suggested the pineal also has other nerve
(neuronal) inputs. In fact, Kappers discovery is taken as meaning that because the
pineal has a sympathetic nervous system input, it must be the only input it has:
In 1960, Kappers made the important discovery that the primary
innervation of the mammalian pineal originates not within the brain but
rather from sympathetic cell bodies in the superior cervical ganglia.
Subsequent studies using the electron microscope revealed that the
sympathetic nerve endings terminate directly on pineal parenchymal cells in
an anatomic relationship that resembles the synapse. The sympathetic
innervation of pineal glandular cells appears to be a new evolutionary
adaptation, which by itself invalidates the vestige theory of pineal
function. (p.1812, emphasis added)

The American physician Richard Relkin (Professor of medicine at the Hahnemann

Medical College in Pennsylvania), in his 1983 endocrinology text The Pineal
Gland explained that, although the most obvious nerve tract (the nervus conarii)
entering the pineal is connected with the sympathetic ganglia in the upper cervical
(neck) region, the gland also has nerve fibres which enter the organ directly from
the brain. These enter via the stalk of the pineal and have been largely ignored by
researchers, who maintained for many years that they are aberrant fibres (and
thus of no significance). These fibres (most of which appear to enter, rather than
emanate from the pineal) are connected with many parts of the brain, and notably
with the thalamus and the auditory and visual systems. Professor Josephine Arendt,
a British pineal researcher at the University of Sussex wrote, more recently, in
Melatonin and the Mammalian Pineal Gland (1995):
there is reason to believe that multiple nervous inputs from
peripheral sympathetic innervation and direct central [from the brain]
innervation influence pineal function. The transmitters concerned with
direct innervation may include a number of peptides such as vasoactive
intestinal peptide (VIP), peptide histidine isoleucine (PHI), arginine
vasopressin (AVP), arginine vasotocin (AVT), oxytocinand luteinizing
hormone releasing hormone.
Initially, it was thought that central neural projections to the pineal
formed hairpin loops in the pineal stalkand thus did not innervate the
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pineal. The loops certainly exist, but there is now substantial evidence for
central innervation as described above. (p.15, emphasis added)

Earlier, Professor Arendt refers to studies demonstrating direct inputs to the pineal
from the hypothalamus (including, but not only, from the suprachiasmatic
nucleus). In addition to this central innervation the pineal is also innervated, she
writes, by the pineal nerve, which carries both efferent [outgoing from the brain]
and afferent [incoming to the brain] fibres, and whose function is presently
unexplained:
In the human, sheep and rabbit a pineal nerve is present, deriving
from the subcommissural organ, with indications of both afferent and
efferent fibres. This nerve has no known function at present but may be
incorporated into the pineal stalk as part of adult central innervation.
(p. 16, emphasis added)

The peptide oxytocin, mentioned by Professor Arendt as one of the transmitters

involved in the pineal, is known to be secreted by the posterior lobe of the
pituitary, after being synthesised in the hypothalamus (see figure 9, on p.247).
Known for many years to be involved in contraction of the uterus during labour,
the hormone has recently been associated with feelings of affection and love.
Luteinising hormone releasing hormone (LHRH), also thought to be active as a
transmitter in the pineal, is so named because of its well-known effect on the
anterior lobe of the pituitary, where it stimulates the release of luteinising hormone
(LH). LHRH release is thought to be regulated by noradrenaline and dopamine in
the hypothalamus (Kohler, 1980, p.1669). LH, secreted into the blood stream by
the pituitary, travels all over the body, but its main known action is on the gonads,
where it stimulates testosterone production and release in men and oestrogen
production and release in women (Kohler, 1980, p.1670). Oestrogen (which is
mainly produced by the ovaries) and testosterone (mainly secreted by the testes),
like all the other steroid hormones (including cortisol) are manufactured from
cholesterol (Harper, 1965, p.392). LHRH also regulates release of the other
anterior pituitary gonadotropin, Follicle Stimulating Hormone (FSH), which
stimulates the development of the ovarian follicle during the female reproductive
cycle in mammals and spermatogenesis in males (Kohler, 1980, p. 1669).

The sections in Snells Clinical Neuroanatomy (1980) on the hypophyseal portal

system and functions of the hypothalamus contain a useful integration that is
absent in many later texts (see figure 9, on page 251):
The hypophyseal portal system is formed on each side from the
superior hypophyseal artery, which is a branch of the internal carotid
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arteryThe portal system carries releasing hormones and release-inhibiting

hormones, which are produced in the neurons of the hypothalamus, to the
secretory cells of the anterior lobe of the hypophysis [pituitary]. The
releasing hormones stimulate the production and release of
adrenocorticotropic hormone (ACTH), follicle-stimulating hormone (FSH),
luteinizing hormone (LH), thyrotropic hormone or thyroid-stimulating
hormone (TSH), and somatotropic or growth hormone (STH). The release of
inhibiting hormones inhibits the release of the melanocyte stimulating
hormone (MSH) and luteotropic hormone (LTH). LTH (also known as
prolactin) stimulates the corpus luteum to secrete progesterone and the
mammary gland to produce milk. (p.403)

The importance of the hypothalamus to control of the endocrine system, is equalled

by its importance to the autonomic nervous system, as Professor Snell continues in
Clinical Neuroanatomy (1980):
The hypothalamus has a controlling influence on the autonomic
nervous system and appears to integrate the autonomic and
neuroendocrine systems, thus preserving body homeostasis. Essentially,
the hypothalamus should be regarded as a higher nervous center for the
control of lower autonomic centers in the brain-stem and spinal cord.
Electrical stimulation of the hypothalamus in animal experiments shows
that the anterior hypothalamic area and the preoptic area influence
parasympathetic responses; these include lowering the blood pressure,
slowing the heart rate, contraction of the bladder, increased motility of
the gastrointestinal tract, increased acidity of the gastric juice,
salivation, and pupillary constriction.
Stimulation of the posterior and lateral nuclei causes sympathetic
responses, which include: elevation of blood pressure, acceleration of the
heart rate, cessation of peristalsis in the gastrointestinal tract, pupillary
dilation, and hyperglycemia. (p.404, emphasis added)

The text also mentions evidence of the involvement of the hypothalamus in

temperature regulation and regulation of food and water intake, again based on
experimental stimulation [electrocution]:
Stimulation of the lateral region of the hypothalamus initiates eating and
increases food intake. This lateral region sometimes is referred to as the
hunger center. Stimulation of the medial region of the hypothalamus inhibits
eating and reduces food intake. This area is referred to as the satiety center.
Experimental stimulation of other areas in the lateral region of the
hypothalamus causes an immediate increase in water intake; this area is
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referred to as the thirst center. In addition, the hypothalamus exerts a careful

control on the osmolarity [concentration of salts] in the blood through the
secretion of vasopressin by the posterior lobe of the hypophysis and its
influence on the distal convoluted tubules of the kidneys. (p.405)

Finally, Professor Snell mentions control of circadian rhythms as another

function of the hypothalamus, omitting the pineal from his neuroanatomical
perspective on circadian (24 hour) rhythms, temperature regulation and
sympathetic innervation:
The hypothalamus controls many circadian rhythms, including body
temperature, adrenocortical activity, eosinophil count [a type of white blood
cell], and renal secretion. Sleeping and wakefulness, although dependent on
the activities of the thalamus, the limbic system, and the reticular activating
system, are also controlled by the hypothalamus. Lesions of the anterior part
of the hypothalamus seriously interfere with the rhythm of sleeping and
waking. (p.405)

The pineal is, nevertheless, discussed in the 1980 edition of Clinical

Neuroanatomy (unlike several contemporary neurosciences texts):
The pineal gland or body is a small, conical structure that is attached by
the pineal stalk to the diencephalon. It projects backward so that it lies
posterior to the midbrain. The base of the pineal stalk possesses a recess that
is continuous with the cavity of the third ventricle. The superior part of the
base of the stalk contains the habenular commissure; the inferior part of the
base of the stalk contains the posterior commissure.
On microscopic section, the pineal gland is seen to be incompletely
divided into lobules by connective tissue septa that extend into the substance
of the gland from the capsule. Two types of cells are found in the gland, the
pinealocytes and the glial cells. Concretions of calcified material called
brain sand progressively accumulate within the pineal gland with age.
The pineal gland possesses no nerve cells, but adrenergic sympathetic
fibers derived from the superior cervical sympathetic ganglia enter the gland
and run in association with the blood vessels and the pinealocytes.
The functions of the pineal gland are not fully understood. Melatonin and
seratonin are present in high concentration within the gland. The
noradrenalin from the sympathetic fibers probably stimulates the release of
these substances from the pinealocytes. It is not known whether these
substances leave the pineal through the capillaries or through the pineal
recess into the cerebrospinal fluid of the third ventricle. There is increasing
evidence that the pineal gland influences the output of gonadotrophins
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through the hypothalamus. Whether melatonin or seratonin is involved in

this activity is unknown. (p226-7)

The influence of melatonin from the pineal on pituitary hormone secretion in

mammals was discovered during an intense period of pineal experimentation
(using various animals) in the 1960s and 70s, and provides an explanation for the
earlier clinical finding that pineal tumours can produce precocious puberty,
reported in 1898 by the German physician Huebner. This earlier finding, which
should have prevented the misconception, prevalent in the 1950s, that the pineal is
vestigial, is mentioned by Professor Kappers in the introductory chapter of the first
of a 1981 three volume series edited by Russel Reiter, Professor of Anatomy at the
University of Texas, and, like the Dutch Professor Kappers, an international
authority on the pineal. In Volume 1: Anatomy and Biochemistry in The Pineal
Gland Kappers writes:
In 1898, Huebner was the first to describe a boy showing signs of
premature puberty and suffering from a pinealoma. At the end of the first
decade of the 20th century, Marburg coined the term pubertas praecox or
genitosomia praecox for the clinical syndrome which is characterized by
premature development of the primary and secondary sex organs and a
pineal tumourAccording to Marburg, the human pineal gland is an
endocrine organ which, in infancy, would normally inhibit the function of
the hypothalamus and thus, the development of the reproductive systemIt
is not surprising that, in those days, the pineal gland was termed
Keuschheitsdruse or chastity gland by some German authors. In the 1920s,
Berblinger also attributed an inhibitory activity on gonadal development to
the pineal, while Engel surmised from some experiments that pineal extracts
would contain an antigonadotrophic hormone. Such extracts, like glanepin,
were even used in clinical treatment. (p.9)

From Professor Ariens Kappers account it is evident that pineal extracts (made
from crushed animal pineals) were being used as a medicine in Germany several
decades before melatonin was discovered because of its speculated role in
suppressing fertility. The theory on which this treatment was based was that
because destruction of the pineal (such as had been described by Heubner) caused
premature puberty, pineal extracts might contain an antigonadotrophic (anti-
fertility) hormone.

During the era of pinealology which followed the discovery of melatonin by

Aaron Lerner it was established beyond reasonable doubt that the hypothesised
mammalian antigonadotropic hormone was, in fact, melatonin at least in rats.
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Kappers explains:
the antigonadotrophic effect of melatonin seemed well-established, at
least in rats, by a number of experimental investigations of which only a few
will be mentioned here. Daily administration of melatonin to maturing
female rats appeared, for instance, to cause retardation of the normal
increase in ovarian weight, delay of normal vaginal opening tinme, and
decrease in incidence of estrus, while the high incidence of estrus following
pinealectomy could be blocked, at least statistically, by melatonin
administration. Injections of melatonin administered to adult male rats
resulted in a very conspicuous decrease in size of the seminal vesicles.
(p.15)

Professor Josephine Arendt, in Melatonin and the Mammalian Pineal Gland

(1995) describes these observations of the 1960s, and says that they were further
clarified by the discovery that melatonin inhibited luteinizing hormone release
from cultured pituitary gland cells in vitro, and delayed pubertal development in
male and female rats (Arendt, 1995, p.274). She also suggests that, these results
partially support the contention that in large doses, suitably administered,
melatonin can inhibit human reproductive activity. The repeated and consistent
finding that exogenous melatonin adversely affects reproductive function in rats
and other mammals suggests that similar effects might be expected (and predicted)
in humans who take melatonin tablets or drugs that influence the metabolism of the
indole amines (notably SSRI antidepressants, clozapine, MDMA and tricyclic
antidepressants). More recent evidence that the pineal is also involved in
maintaining health of the immune system raises further questions about the safety
of these drugs.

That melatonin from the pineal has an antigonadotropic effect is not in dispute,
nor that this includes effects by the pineal on the pituitary release of luteinising
hormone. Professor Mac Hadley of the University of Arizona, in the specialist
textbook Endocrinology (1984), wrote, in the chapter on the endocrine role of the
pineal gland:
There is evidence for brain, pituitary and peripheral antigonadotropic
actions of melatonin. The evidence for a CNS [central nervous system]
effect is derived from the following information. Pinealectomy [surgical
removal of the pineal] leads to increased motor and EEG activity, whereas
melatonin administration reduces spontaneous motor activity, promotes
sleep with slow EEG activity, and prolongs the duration of barbiturate
induced sleep. Melatonin may modify CNS neurotransmitter function as
increased levels of gamma aminobutyric acid (GABA) and serotonin have
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been noted in the brain after melatonin administration. Melatonin implants

into the medial preoptic and suprachiasmatic and retrochiasmatic areas of
the mouse brain mediates its hypothalamic effect by inhibition of
gonadotrophin-releasing hormone (GnRH) synthesis and secretion. (p.476)

This 1984 text, another Prentice-Hall medical publication, continues with more
reasons why the ingestion of melatonin and drugs that affect indoleamines might
be expected to interfere with sexual function and other oestrogen and testosterone-
dependent (or modulated) physiological activities (and hormonal balance, more
widely), and why the mutilation of rats and hamsters is leading to confusion among
pineal researchers:
There is also evidence that exogenous melatonin decreases testicular
androgen synthesis and that the indoleamine is inhibitory to the growth
response of the rat ventral prostate gland to exogenous testosterone.
Melatonin also decreases the weight of both the testes and the ventral
prostate gland of hypophysectomised [pituitary-excised] rats receiving
testosterone. Pinealectomy enhances the growth response of the seminal
vesicles to testosterone in castrated rats and administration of the
indoleamine prevents the response to the androgen. These results suggest
that the inhibitory influence of systematically administrated melatonin on the
accessory sex organs may be due to its antagonistic effect at the level of the
gonads. Melatonin excretion in normal males and females increases at
puberty, and melatonin may play a role in adrenarche (pubertal changes
induced by adrenal androgens) by an action on adrenal steroidogenesis.
(p.476)

In 1997 it was reported in the Lancet that the age when children reach puberty is
falling in the USA, following a study at the Kansas Childrens Hospital that found
6.7% of Caucasian girls and 27.2% of African-American girls had breast
development or pubic hair by the age of seven (Bonfiglioli, 1997). Although it has
been known since the 1890s that pineal destruction can cause precocious puberty,
and the known involvement of the pineal (and melatonin) in the hypothalamo-
pituitary-gonadal axis, pineal dysfunction was not suspected as being involved in
this phenomenon. Could it be?

It is known that exogenous (from outside) administration of melatonin suppresses

gonadal (sexual organ) activity this is thought to occur due to suppression of
pituitary gonadotrophins (Luteinizing Hormone, in particular) and direct effects on
the gonads (ovaries and testes). This suggests, but does not prove that endogenous
(produced within) melatonin has physiological effects on the gonads and
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sexual/reproductive function. The effects of pinealectomies in animals and pineal

tumours in humans have further supported this theory but also indicated that, like
the other amines, natural melatonin has many other physiological effects. These
include effects on other pituitary hormones, on other parts of the brain and on cells
throughout the body. The latter are of particular importance to an understanding of
the mind-body relationship and the brain-body relationship. They also provide
further reasons for caution in the ingestion of melatonin or drugs that affect the
incompletely understood, but undoubtedly vital, indoleamine and catecholamine
pathways.

While there is irrefutable evidence that environmental lighting conditions affect

pineal hormone synthesis and secretion (especially that of melatonin), it has been
generally assumed that the visual information that enters the pineal via nerve fibres
is concerned only with quantity (intensity and duration) rather than quality (light
and visual experience in all its complexity). The neural connections of the pineal,
including the intensively studied sympathetic connections and the less well-known
direct connections (with the midbrain) allow for much more profound and subtle
effects than the commonly cited fact that light entering the eyes suppresses
nocturnal melatonin secretion.

Children in the Western World are, as a whole, undoubtedly subjected to more

sexually explicit material, and more sexually-directed messages than was the case
40 years ago mainly as a consequence of television and the mass-media (and the
advertising motto that sex sells). The neural mechanism by which precocious
sexual development could result from pre-pubertal sexually-oriented audio-visual
experiences (television programs, in particular) can be hypothesised in terms of
known pineal neural and endocrine connections. Such a hypothesis cannot be
proved or disproved unless considered. This is the case also for the theory that
watching television at night interferes with natural melatonin rhythms, thus
contributing to depression, and the theory that watching violent television
programs increases violence in society. Of course, no theory can be proved or
disproved until it is considered.

Melatonin is sometimes confused with melanin, the dark pigment produced by

melanocytes in the skin, hair follicles, eyes and brain. Melanin, named from the
Greek melas (black) is synthesised from the amino acid tyrosine, as are the
catecholamines. In fact, melanin and the catecholamines dopamine, noradrenaline
and adrenaline have been known, for over three decades, to share the same
precursor molecule DOPA, which is synthesised in the brain and skin from
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tyrosine (Harper, 1965, p.295; Hadley 1984, p.166). The most obvious function of
melanin in the skin is protection of deeper tissues from the damaging effects of
radiation. In the retina and the iris of the eye melanin is thought to absorb scattered
light, improving visual clarity (people with albinism, who do not have melanin in
their retinae, are known to suffer from visual deficits as a consequence). In the
brain, the function of melanin has not been clearly elucidated, although its
distribution has been well documented it is most conspicuously present in the
pigmented substantia nigra (of the basal ganglia), damage to which causes
Parkinsons disease. The neuroanatomy text Clinical Neuroanatomy (1980) by
Professor Richard Snell of the George Washington University mentions this, but
not much else, about melanin:
Melanin granules are found in the cytoplasm of cells in certain parts of
the brain (for example, the substantia nigra of the midbrain). Their presence
may be related to the catecholamine-synthesising ability of these neurons.
(p.54)

This is the only reference to melanin in the textbook, but it is more than is included
in the contemporary (1995) neurosciences text, Kandels Essentials of Neural
Science and Behavior, a prescribed text for medical students in Australia (edited by
Professors Kandel, Schwartz and Jessell of Columbia University in the USA). This
text fails to mention the pineal gland at all, and neither the pineal, melanin nor
melatonin feature in the 27-paged index. The single reference in the text to melanin
is on page 544, in a chapter titled Voluntary Movement, in a passage subtitled
The Basal Ganglia Consist of Five Subcortical Nuclei. It reads:
The basal ganglia consist of five extensively interconnected nuclei: the
caudate nucleus, putamen, globus pallidus, subthalamic nucleus, and
substantia nigra. The caudate nucleus and putamen develop from the same
structure in the forebrain; as a result, they are composed throughout of
identical cell types and are fused anteriorly. The two nuclei are the input
componenets of the basal ganglia and together are called the neostriatum (or
striatum)
The globus pallidus (or pallidum) is derived from the diencephalon and
is divided into internal and external segments. The subthalamic nucleus lies
below the thalamus at its junction with the midbrain. The substantia nigra
lies in the midbrain and has two zones. A ventral pale zone, the pars
reticulata (or reticulate zone), resembles the globus pallidus cytologically
[in terms of cell appearance, under a microscope]. A dorsal pigmented zone,
the pars compacta (or compact zone), comprises dopaminergic neurones
whose cell bodies contain neuromelanin. This dark pigment, a polymer
derived from dopamine, gives the substantia nigra its name (Latin, black
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substance), because in humans this part of the brain appears black in cut
sections. (p.544)

The 2000-paged ninth edition (1980) of the reference text, Harrisons Principles of
Internal Medicine, had considerably more to say about melanin, but not what its
role might be in the central nervous system:
The presence of melanin, oxyhemaglobin, reduced hemoglobin, and
carotene accounts for the kaliedoscope of normal human skin colors, but
melanin is the principal pigment responsible for the color of human skin,
hair and eyes. Melanin is also a filter that decreases the harmful effects of
ultraviolet light on the dermis [skin] and thereby provides protection against
acute sunburn reaction and chronic actinic damage, including skin cancer.
Derived from the Greek word melas, black melanin is a protein-
bound polymer formed by the oxidation of tyrosine [also the amino acid
precursor of the catecholamines] by tyrosinase to dihydroxyphenylalanine
(dopa) within melanocytes, which are specialized epidermal dendritic cells
of neural crest origin. The precise chemical nature of melanin is unknown
because it is so insoluble that all attempts to degrade it into identifiable
fragments have failed. However, all animal melanins are known to contain
indoles and are composed basically of indole 5,6-quinone units, in contrast
to plant melanins which contain catechols (p.248)

Professor Richard Wurtman of the Massachusetts Institute of Technology and the

Massachusetts General Hospital, in the same textbook, was responsible for the
information provided on melatonin, which is given in the chapter titled, Diseases
of the Pineal Gland. Under the subheading anatomy and biochemistry of the
pineal, he wrote about early studies on amphibian skin, which subsequently led
the dermatologist Aaron Lerner to the discovery of melatonin:
In 1917, McCord and Allen showed that the pineal gland of the cow
contained a factor that causes amphibian skin to blanch. When pineal
homogenates [crushed cow pineals] were fed to tadpoles, the melanin
granules within dermal chromatophores [pigment organelles] aggregated
around the cell nuclei, thereby lightening the skin. (This effect is opposite to
that produced by the melanocyte-stimulating hormone, MSH, which is
secreted by the pars intermedia of the pituitary gland.) Four decades later,
Lerner and his colleagues identified this pineal factor as melatonin (5-
methoxy-N-acetyltryptamine). It remains to be shown that melatonin has any
effect on the melanocytes which are responsible for normal skin
pigmentation in human beings or, for that matter, in amphibians.
Melatonin was shown to be a derivative of serotonin, a widely
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distributed indole stored in very large quantities in mammalian

pineals. (p.1812, emphasis added)

Dr Aaron Lerner, the discoverer of melatonin, was a medical specialist (a

dermatologist or skin specialist) working in the respected laboratories of Yale, and
it seems reasonable to trust the institutions directly involved with the discovery of
melatonin, in the areas of neurobiology and biochemistry, although not necessarily
in the areas of politics or philosophy, since these institutions are built on
aggressively capitalist foundations. Even in terms of biochemistry the
pronouncements (and research objectives) of university-based research in the USA
and elsewhere are, unfortunately, influenced by the interests (and agenda) of the
pharmaceutical industry. This turns out to be particularly so in the case of the
pineal organ.

The Pineal and the Immune System

The connection between depression, the pineal and the immune system is
interesting. It is generally accepted that psychological depression can cause
immune depression an observation famously made by the Athenian general
Thucydides 2500 years ago when describing the effects of a diagnosis of plague:
The most terrible thing of all was the despair into which people fell
when they realised that they had caught the plague; for they would
immediately adopt an attitude of utter hopelessness, and, by giving in this
way, would lose their powers of resistance. (Thucydides quoted from Clark,
1995, p.221)
Could the pineal play a role in mediating the known effects of mood on the
immune system?

Many of the complex neural connections of hypothalamus have been deciphered

after decades of intensive research into the structure. Its role in controlling the
autonomic nervous system, and its secretion of various chemicals (including
hormones, endorphins and factors controlling activity of the pituitary, to which it is
attached) have been extensively studied. Its role in memory has also been studied,
though with less success in understanding the mysterious process of memory
deposition and retrieval. The hypothalamus also plays a key role in the neural
circuit known as the limbic system, the ring of structures around the core of the
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brain popularly known as our emotional brain.

19

MUSIC FOR PAIN RELIEF

20

MUSIC FOR RESPIRATORY HEALTH

21

MUSIC FOR GOOD DIGESTION

22

CONCLUSION

Although music has been used for thousands of years as a therapeutic tool, the
scientific use of music by medical practitioners has lagged far behind drug
therapies and other interventional treatments. The neuropsychology of music is
complex and its details are still a mystery, however, it is clear that perception of
music and creation of music involve many parts of the brain. Despite uncertainty
about details of brain function in relation to music, there is no doubt that music can
be used to alleviate a range of medical problems and, more obviously,
psychological problems. These include depression and movement disorders such as
Parkinsons disease. The dance impulse, which probably involves the basal ganglia
of the midbrain has been analysed in terms of neuropsychology and
psychophysiology in this book and the accompanying diagrams. Known facts
about the neural processing of sound and music have been integrated with more
speculative findings and logical reasoning to present an integrated model which, it
is hoped, can be used as a framework for the development of new therapeutic
strategies using music.
In addition to physical conditions such as hypertension and Parkinsons disease
which are specifically discussed in this paper, there is known benefit from music in
the treatment of psychological problems, especially melancholia (depression), but
also for psychosis (Schipkowensky, 1977). The careful scientific study of the wide
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range of recorded music now available for specific use in different clinical
situations, including both psychiatric and general medical ones is an exciting
prospect for physicians who wish to utilise the full range of therapeutic tools and
minimise the drugs they prescribe for a range of conditions. In addition to
psychological problems, Parkinsons disease and hypertension, therapeutic benefit
from music-based therapies may be of assistance in epilepsy, recovery from stroke
and traumatic brain damage and a range of stress-related diseases (those caused or
aggravated by mental stress), as well as non-neurological diseases characterised by
difficulty with movement such as arthritis.
Despite many studies confirming the importance of music and the many
possibilities of use of music therapeutically, the medical profession and the health
system more generally, has been slow to grasp the fact that music has long been
undervalued as a therapeutic tool, and underestimated in terms of its potential to
cause mental and physical illness. The potential of music to transform public health
for the better has not yet been realised and until music is taken seriously as a
powerful psychological force the potential for music to harm may overcome its
potential to heal.

LITERARY REFERENCES:

1. Altenmuller, E. How many music centers are in the brain? Annals of the New
York Academy of Science (2001) 930: 273-280
2. Assagioli, R. Psychosynthesis, Crucible: UK (1965)
3. Benton, A. The Amusias in Music and the Brain (Critchley, Henson, eds),
Heinemann: U.K (1977)
4. Borchgrevink, H. Prosody, musical rhythm, tone pitch and response initiation
during amytal hemisphere anaesthesia in Music, Language, Speech and Brain,
Macmillan: U.K (1991)
5. Damasio A., Damasio H. Musical Faculty and Cerebral Dominance in Music
and the Brain (Critchley, Henson, eds), Heinemann: U.K. (1977)
6. Harper, H. Review of Physiological Chemistry, Lange: USA (1965)
7. Henson, R. Neurological Aspects of Musical Experience in Music and the Brain
(Critchley, Henson, eds), Heinemann: U.K. (1977)
8. Isselbacher, Adams, Braunwald, Petersdorf, Wilson (Eds). Harrisons
Principles of Internal Medicine, McGraw-Hill: USA (1980)
9. Kandel, E., Schwartz, J., Jessell, T. Essentials of Neural Science and Behavior,
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Prentice Hall: USA (1995)

10.Kolb, B., Whishaw, I. Fundamentals of Human Neuropsychology, Freeman:
USA (1990)
11.Plato. The Republic, Penguin: UK (1955)
12.Reiter, R. The Pineal Gland, Raven: USA (1984)
13.Schipkowensky, N. Musical Therapy in the Field of Psychiatry and Neurology
in Music and the Brain (Critchley, Henson, eds), Heinemann: U.K. (1977)
14.Stone, M. Healing the Mind, Pimlico: U.K (1997)
15.Trethowan, W. Music and Mental Disorder in Music and the Brain (Critchley,
Henson, eds), Heinemann: U.K. (1977)
16.Wertheim, N. Is there an Anatomical Localisation for Musical Faculties? in
Music and the Brain (Critchley, Henson, eds), Heinemann: U.K. (1977)
17.Weiser, H. Music and the Brain: Lessons from brain diseases and some
reflections on the 'emotional' brain, Annals of New York Academy of Science,
2003 Nov; 999:76-94

MUSICAL REFERENCES:

1. Adderley, Julian Cannonball. Somethin Else. Blue Note: (1958)

2. Marley, Bob. Legend. PolyGram (1984)

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PSYCHOLOGY OF MUSIC 2000 Romesh Senewiratne

Perception of Sounds Discrimination between musical

and non-musical sounds
Recognition of human voice
Sensation of rhythm
Perception of loudness/softness

Attention and focus on auditory sense

Intellectual analysis Mental concentration

Conscious and subconscious analysis of singing

Words Musical analysis
Phrases Aesthetic response:
Lyric Melody
Meaning (semantics) Harmony
Narrative Timbre
Emotive force Tone
Tone Accoustics
Pitch Rhythm
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Loudness-softness Specific focus

Dynamics and rhythm Instruments
Phrasing (re.syntax and rhythm) Sections
Melody
Harmony

Secondary emotional reactions

Stimulation of dance movement

Stimulation of original creativity

MENTAL STATES ASSOCIATED WITH MUSIC

1.Background (ambient) perception

2. Active listening (repeated music/new music)
(i) holistic listening
(ii) specific listening-exploratory listening
(iii) critical listening
3. Creative listening (added creative input) creative actions
4. Mental creation of music (with/without external influence)
5. Audible creation of music
(i) with voice
(ii) with breath
(iii) with upper limbs
(iv) with lower limbs
6. Combined auditory-visual focus
(i) synchronised
(ii) non-synchronised
(iii) intermittent focus
7. Musical experience with
(i) Conceptual journey
(ii) Emotional journey journeys may be
(iii) Memoric journey combined & inter-related
(iv) Visualisation journey
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8. Musical experience with dance

(i) improvised dance
(ii) rehearsed dance Dance movements may be
(iii) imitated dance combined and integrated
(iv) intuitive dance
9. Trance-suggestible state
10. Uncomfortable states: e.g. irritation, boredom, anxiety

2000 Dr Romesh Senewiratne

EMOTIONAL REACTIONS FROM MUSIC

Instrumental music:
1. Elation, joy
2. Interest
3. Pleasure
4. Tranquility
5. Excitement
6. Love
7. Nostalgia
8. Sadness
9. Jealousy
10.Drowsiness
11.Boredom
12.Irritation
13.Disquiet
14.Fear, anxiety
15.Revulsion, disgust

Music with words:

As above, also:
1. Understanding, revelation
2. Confusion

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3. Empathy
4. Sympathy
5. Vocabulary and concept changes
6. Aggression and hostility/friendliness
7. Depression and suicidality/positivity

SOME PRINCIPLES for MUSIC THERAPY:

1. Develop listening and expressive skills

2. Broaden range of appreciated music
3. Increase perceptive skills regarding tone, timbre, pitch, melody, harmony
4. Increase auditory discrimination
5. Deepen understanding and appreciation of music
6. Develop respect for music as a therapeutic and developmental tool
7. Increase mental creation of music
8. Develop physical musical skills (dexterity etc)
9. Develop ambidextrousness
10.Develop sense of rhythm and timing
11.Free inhibitions regarding singing
12.Free inhibitions regarding performance
13.Free inhibitions regarding dancing
14.Use many of brain and many parts of body
15.Increase pleasant musical memories
16.Increase musical repertoire
17.Increase musical vocabulary
18.Learn to use music for specific needs

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2000 Romesh Senewiratne

HEALTH PROBLEMS WITH POTENTIAL FOR TREATMENT WITH

SPECIFIC MUSIC THERAPY:

1. PSYCHOLOGICAL:
(i) Depression
(ii) Anxiety
(iii) Agitation
(iv) Irritation/anger
(v) Boredom
(vi) Insomnia
(vii) Autism
(viii) Tourettes syndrome
(ix) Attention deficit disorder
(x) Psychosis

2. NEUROLOGICAL:
(i) Parkinsons disease and Parkinsons syndrome
(ii) Stroke (cerebral infarction)
(iii) Dementia
(iv) Brain injury (v) Epilepsy

3. CARDIOVASCULAR:
(i) Hypertension
(ii) Ischaemic heart disease
(iii) Cardiac failure

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4. RESPIRATORY:
(i) Asthma
(ii) Chronic obstructive airways disease
(iii) ?Cancer

5. GASTROINTESTINAL:
(i) gastrointestinal reflux and peptic ulceration
(ii) Irritable bowel syndrome
(iii) Cancer
(iv) Inflammatory bowel disease
(v) Obesity/eating disorders

6. MUSCULOSKELETAL:
(i) Osteoarthritis (ii) Rheumatoid arthritis

PHYSICAL AND PSYCHOLOGICAL BENEFITS FROM (selected) MUSIC

and from increased musical involvement (including dance):

PSYCHOLOGICAL:
1. Social interaction
2. Aesthetic development
3. Emotional arousal and development
4. Development of attention and concentration
5. Pleasant memories
6. Distraction from disturbing thoughts
7. Development of sensitivity to timing and rhythm
8. Communication of messages and ideas
9. Development of knowledge and understanding
10.Development of respect for others
11.Improved self-esteem
12.Countering undesirable emotional states
13.Development of improvisational ability
14.Improved verbal and mathematical skills
15.Development of empathy and sensitivity to others
16.Improved auditory discrimination and acuity
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17.Motivation
18.Increased general creativity

PHYSICAL:
1. Increased dexterity and fine motor control (face, limbs)
2. Improved coordination (between limbs, between senses, between
movement and thought)
3. Physiological changes due to effects on autonomic nervous system
(influenced by emotional reactions to music)
4. Physiological changes due to effects on hormones and chemical
metabolism (via limbic system-hypothalamic connection)
5. Improved flexibility and strength of joints and limbs

SOME DANGERS FROM MISUSED MUSIC:

1. Hearing loss (if excessive volume)

2. Stimulation of irritation-anger
3. Stimulation of addictive behaviour
4. Development of nihilism, pessimism and negativity
5. Loss of self-esteem
6. Development of melancholia
7. Depression and induction of suicidality
8. Overuse injuries and strains
9. Stimulation of aggression
10.Propagation of violent ideas and images
11.Propagation of bigoted ideas and attitudes
12.Propagation of delusions
13.Conceptual and emotional confusion
14.Hero-worship

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