Sri Balaji Vidyapeeth University
AN ONGOING RESEARCH PROJECT IN MUSIC MEDICINE UNIT
Bilaskan With His Father Tansen, And His Guru, Swami Haridas.
The Music Medicine Unit focuses on research on ethnic Indian ragas. One of the current research projects is based on the healing effects of Rag Bilaskhani Todi, a Hindustani classical raga, believed to combat ageing and stress. The name of the rag is derived from its composer, Bilaskhan, the son of the great composer Tansen, who lived during the 16th century A.D. Tansen is considered as the greatest composer- musician in Hindustani classical music. He was among the navaratnas ( nine jewels) at the court of the Mughal emperor Akbar. According to legend, Rag Bilaskhani Todi was composed and sung spontaneously when he was grieving over the death of his father, Tansen. According to preliminary reports from our study, Rag Bilaskhani Todi alleviates symptoms of anxiety, depression, stress, etc. in medical students who have recently joined the career. Harmony Bulletin
2
Vol 1 Issue 2 October 2012
Sri Balaji Vidyapeeth University
Editorial
Each and everyone of us is subject to the limitations of human perceptions. But the power of music transcends all human perceptions, and in those who are endowed with appropriate musical intelligence, emotional responsiveness and receptivity, it does not fail to elicit miraculous healing effects. Music’s emotional effect, which is people’s primary motivation for listening, may prepare them to attain or maintain a state of well-being. Be it in any of its many forms, music can evoke powerful emotional reactions in people. Listening to music affects the emotional and cognitive experience of an individual as well as physiological arousal. The special feature of this month ‘Responders versus non-responders to music therapy’ discusses the phenomenon of musical intelligence in detail. “Music, uniquely among the arts, is both completely abstract and profoundly emotional. It has no power to represent anything particular or external, but it has a unique power to express states or feelings. Music can pierce the heart directly; it needs no mediation”
Oliver Sacks
Contents An Ongoing Research Project In Music Medicine Unit
2
Effect of Rag Bowli (early morning raga) on a case of monosymptomatic nocturnal enuresis associated with nocturnal polyuria 4 Sound Doc’s Panel
9
Responders Vs Non-Responders to Music Therapy
11
Overview of the favored periodic duration (frequency ranges) of the rhythmic functions in humans.
15
Vol 1 Issue 2 October 2012
3
Harmony Bulletin
Sri Balaji Vidyapeeth University
INDIAN MUSIC THERAPY Effect of Rag Bowli (early morning raga) on a case of monosymptomatic nocturnal enuresis associated with nocturnal polyuria Music has a remarkable power to stimulate many social-emotional processes and to influence emotions in everyday life ( Bernatzky et al.,2002). Music stimulation may also relieve negative cognitions such as feelings of helplessness and hopelessness and undesired stresses that many patients experience ( Spintge,1992). In recent years, a number of studies based on principles of evidence-based medicine which have proven the effectiveness of defined interventions, have suggested music as a powerful resource for the treatment of various illnesses ( Hillecke et al.2005). Music exerts effects on subcortical brain centers and has a strong influence on the psychological and physiological state of the organism ( Panksepp and Bernatzky,2002). The emotions aroused due to music stimulation are elicited either by sounds themselves, or as a result of associations in patients’ memories, and these emotions can enhance self-experience and coping strategies. Here we present a case of nocturnal enuresis which responded to music therapy based on the early morning raga, Bowli. B aged 25, came to the Music Medicine Unit of MGMC&RI with the complaints of mono- symptomatic nocturnal enuresis associated with nocturnal polyuria, for which he was treated with anxiolytics and detrusor inhibitors for the past 2 years. He was asked to continue the pharmacological treatment along with music based on the early morning raga known as Bowli. This raga was chosen because he had the habit of going early to bed when compared with others of his same age, and this raga would facilitate his awakening early in the morning, inducing arousal and feelings of refreshment, in synchrony with the morning atmosphere. He listened to the music between 7 to 8am in the mornings, continuously for a period of 1 month, twice a day, each session lasting for half an hour. After a month of continuous listening, he came back reporting that the frequency of nocturnal polyuria had decreased from 9 times to 4 times during the nights. After a gap of one month, he was given another music based on a different rag which had no specific time cycle attributed to it. After a month of continuous listening, he came back reporting that his nocturnal polyuria remained at the same frequency, i.e 4 times at night. The above finding makes one ponder whether there could be a Harmony Bulletin
4
Vol 1 Issue 2 October 2012
Sri Balaji Vidyapeeth University
possible link between circadian rhythmic mechanisms present in renal and other tissues and certain types of ragas endowed with specific temporal attributes. Absence of the circadian rhythm of GFR leads to nocturnal polyuria: Several studies have confirmed that the circadian timing system plays a major role in renal function ( Voogel et al.,2001; Buijsen et al., 1994). The findings reveal that renal excretory rhythms are driven by circadian changes in both glomerular filtration and tubular reabsorption/secretion, due to a large number of genes essential for water and solute homeostasis following a well-marked circadian expression pattern ( Zuber et al., 2009). The vast majority of them are based on self-autonomous local circadian oscillators (self-sustained intrinsic renal clock mechanism) which regulate the homeostatic mechanisms by controlling the activity of certain metabolic enzymes and transport systems, and also interact and affect the core clock mechanism located in the supra-chiasmatic nucleus of the hypothalamus. The circadian rhythm of GFR in normal individuals : Day time- maximum of 122 ml/mt Night time- minimum of 86 ml/mt ( Koopman et al.,1989). In healthy adults, the ratio of day time to night time urine production is usually greater than 2:1, so that only about 25% or less of daily urine output occurs during sleep( 70 to 80 ml/hr during the waking period vs 30 to 40 ml/hr during sleep), these rates of urine production being linked to the day-night sleep pattern. Beyond the age of 60, there is a decline in the molecular clock oscillations due to ageing, and this causes a shift towards a greater proportion of urine production to the night time. In the case of B, ageing cannot be the reason for the disrupted renal circadian rhythm, since he is only 25 year old. Other factors like anxiety, stress etc. could have played a role. Finding ways to restore the lost circadian rhythm might lead to a possible therapy for biological clock damage and help in the prophylaxis of such disorders. The relationship between the Time Cycle of Ragas and tissue-specific functional rhythms: It is well known that music influences neuronal, immunological and endocrine systems, and modulates homeostasis and vegetative functions because of its intrinsic properties (Aldridge,1989). According to Panksepp and Bernatzky (2002), music listening activates cortical and subcortical neural networks in the human brain, that are associated with endocrine systems and homeostatic responses. Recent studies have implicated that Vol 1 Issue 2 October 2012
5
Harmony Bulletin
Sri Balaji Vidyapeeth University
brain circuits of structural and functional relevance to the hypothalamopituitary axis are implicated in the emotional processing of music. Ragas belonging to different Time Cycles have their corresponding impact on the emotionality and affect of listeners. A raga or melodic mode creates an atmosphere which is associated with particular feelings and sentiments, making us synchronize completely with nature. The time cycle of ragas is based on the presence or absence of flat notes ( komal swaras in Hindustani terminology), particularly Re, Dha, and Ga ( rishabh, dhaivat and gandhar respectively). The fourth note Ma is rendered as sharp note ( teevra swar) when singing the twilight ragas after sunset, to define the change in mood between the two hours before sunrise and sunset. In Indian music the entire mood of the raga changes with the subtle change in one note : Ma1(Ma flat) Ma2( Ma sharp) Sunrise period Sunset period These twilight melodies convey a certain pathos or a feeling of yearning. Biological basis of the differences in affect produced by changes in rendition of the same note from flat to sharp and vice versa : Our emotional behavior and motivational drives are controlled by the limbic system, which decides the affective nature of the sensations, i.e. whether they are pleasant or unpleasant. Brain imaging studies have revealed that intensely pleasurable music activates numerous brain areas including ventral striatum, amygdalae, and anterior cingulate cortices (Blood and Zatorre,2001), known as reward or satisfaction areas. In contrast, when other nearby areas in the same circuitry are stimulated electrically, terror, pain, fear and other unpleasant sensations are felt, and these are labeled as punishment centers( Ganong,2005 ). Only a narrow margin separates the pleasure and pain centers, similar to the narrow margin separating the flat and sharp Ma ( madhyam), which evoke just the opposite feelings, sharp Ma conveying a feeling of pathos in contrast to flat Ma which induces a pleasant feeling. The affective components of Indian music include two main features: 1) Bhava or emotional expression, and 2) Rasa or aesthetic essence which that bhava engenders in the listener. Eight ‘emotive stereotypes’ or ‘permanent emotions’ known as sthayibhavas have been elucidated, each of which evokes a corresponding rasa or aesthetic essence ( Rowell,1992). Harmony Bulletin
6
Vol 1 Issue 2 October 2012
Sri Balaji Vidyapeeth University
All musicologists agree that the bhava or the essence of raga is knowable only through direct experience ( performance or listening), and is not the result of its inherent scale type, transilience, tessitura, characteristic motion etc. The affective responses like emotional expression and its aesthetic essence are no doubt induced by a raga, but are also tinged by the listeners’ temporal experience, since they believe that it denotes a specific meaning, due a prior conditioning as a result of the knowledge of association between performance and context. In short, musical meaning is coloured by the listeners’ conditioning through generations dating millennia back. At this juncture, we can hypothesize that listening to music that is synchronized with the sympathetic overtones of the time and hour of the day harmonizes the individual with the natural environment, and regulates his moods. Early morning ragas create a very tender, calming and refreshing mood that helps us to step out of sleep into a harmonious waking state. This waking state is associated with a steady increase in the levels of stress hormones like cortisol, which show a specific and well-defined day- night rhythm. The attunement to a refreshing state in the mornings may be enhanced by the synergistic effect created by listening to such early morning ragas, which are synchronized with the sympathetic overtones of the morning hours, inducing appropriate changes in the affect of the listeners, by acting on the brain circuits of structural and functional relevance to the hypothalamo-pituitary axis implicated in the emotional processing of music. Such an influence may be exerted on the set of circadian genes driven by systemic humoral or neuronal circadian signals, which are connected with the core oscillators. An interesting finding which emerged from treating the above case is that, the disease process even though partly rectified, remains at the same level of improvement even after cessation of music-listening, unlike pharmacologic treatments which need to be continued indefinitely to prevent the recurrence of symptoms in cases of such chronic duration. One can readily surmise that music has acted at some deep, inner level connected with endogenous rhythms, reaching out to physiological homeostatic mechanisms via affective channels, and once the disorder is set right, it attains a state of permanent stability. More exploration is needed regarding the connection between the time-cycles designated to different ragas and tissue- specific functional rhythms which interact with and affect the core clock mechanism. Vol 1 Issue 2 October 2012
7
Harmony Bulletin
Sri Balaji Vidyapeeth University
REFERENCES 1. Aldridge, D.(1989). Music, communication and medicine: Discussion paper. Journal of the Royal Society of Medicine, 82, 743-6. 2. Bernatzky, et al. (2002). Emotional sounds and the brain: the neuroeffective foundations of musical appreciation. Behavioural Processes, 60, 133-55. 3. Blood, A.J. and Zatorre, R.J.(2001). Intensely pleasurable responses to music correlate with activity in brain regions implicated with reward and emotion. Proceedings of the Natural Academy of sciences, 98, 11818-23. 4. Buijsen JG, et al.(1994). Circadian rhythm of glomerular filtration rate in patients after kidney transplantation. Nephrol Dial Transplant. 9: 1330-1333. 5. Ganong, W.F.(2005). Review of Medical Physiology (Lange Basic Science). The Mc graw-Hill Companies, Inc. Twenty second edition. pp-256-259. 6. Hillecke, T., Nicke, A., and Bolay, H.V. (2005). Scientific perspectives on music therapy. Annals of the New York Academy of Sciences,1060, 271-82. 7. Koopman et al.(1989). Circadian rhythm of Glomerular Filtration Rate in normal individuals.Clin.Sci.,77(1): 105-11. 8. Rowell, Lewis (1992). Music and Musical Thought in Early India. Chicago: University of Chicago Press. 9. Spintge,R.(1992). Toward a research standard in music medicine/ music therapy: A proposal for a multimodal approach. In R. Spintge, and R. Droh(eds). Music Medicine, pp 345-47. Saint Louis, MO: MMB. 10. Voogel AJ et al.(2001). Circadian rhythms in systemic hemodynamics and renal function in healthy subjects and patients with nephritic syndrome. Kidney Int., 59: 1873-1880. 11. Zuber AM et al.( 2009). Molecular clock is involved in predictive circadian adjustment of renal function. 106,(38) : 16523-16528. About RagBowli – ( Early morning raga.) ArohanS R1 G3 P D1 S Avarohan- S N3 D1 P G3 R1 S Harmony Bulletin
8
Vol 1 Issue 2 October 2012
Sri Balaji Vidyapeeth University
Sound Doc’s Panel A physician examines a patient, comes to a preliminary diagnosis, prescribes some medicines, and advises him to come for a follow-up. In what way music therapy differs from the routine clinical practice ? Amrita, II MBBS Student All forms of music therapy include musical experiences such as performances, improvisations and listening experiences. Such experiences, as well as the related physical, emotional, affective, cognitive, behavioural reactions develop during each session and throughout the complete set of sessions which make up the whole music therapy relationship. All these experiences and the related reactions develop in time- a temporal development process. To sustain the whole process, it necessitates a core of conceptual contents that must maintain a certain level of stability which is designated as structure. A professional relationship is maintained which is marked out by the level of consciousness the professional therapist has of the structural elements he is placing at his patient’s disposal while performing his role, in contrast to a ‘normal’ relationship where the structural factors can function automatically without us necessarily being aware of them. The music therapeutic process involving application of music includes musical experiences which characterize the relationship between the music therapist and the client, the therapeutic process being chosen, planned, led, judged, concluded, interrupted or carried on according to the structural elements constituting it, namely, the psychological and cultural factors through which one interprets the process. The therapist needs to possess a consciousness of his own psychological balance, which necessitates training in order to develop his personal consciousness followed by ‘didactical analysis’- in other words, it is of prime importance to develop ‘interpretive competence’. It is necessary to distinguish between two types of ‘supervision’ in music therapy: Vol 1 Issue 2 October 2012
9
Harmony Bulletin
Sri Balaji Vidyapeeth University
Classical Supervision Model • Has an absolutely firm ground from both a theoretical and methodological point of view. • Historically well-established. • Clearly identifies everyone’s roles, spheres of competence, responsibilities. • Involves the danger of relegating music to a condition of inferiority or irrelevance. • Music is recognized to be a significant element only if it is translated into the psycho-therapeutic language, basically different from itself, so that a great deal of its essence or specific musical dimension inevitably gets lost. •Includes music therapy models based upon psycho- dynamic, humanistic, cognitive- behavioural approaches. • The music therapist sees his place in the hierarchy of the different kinds of knowledge, knowing whether he is competent or not as for a why socially recognized as related to the care of health- capable of being reduced to a merely technical acting, which sticks to the standard norms of operation. • The therapist’s knowledge is usually included among the ‘ interpretive logoi’ which are traditionally recognized, and he is conferred the responsibility and power for orientating clinical or ‘curative’ processes. Technical Supervision Model • Musically-oriented music therapy. • The music therapist should be a musician ‘provided with musical skills’ being able to achieve true interpretative quality through his musical practice. • There is a gradual unfolding of the process in development, based on the communication between the music therapist and his client. • The musician grasps the ‘why’ dimension, which is the basis for interpretation, guided by his intuition- the artist gains access through an intuitive why. • Whereas the musician usually pursues aesthetic goals, the music therapist aims for some responsible ‘care’ of his client. • The music therapist should have reached a true psychological maturity, which allows him to meet the Other in music through non- mystifying and non-‘projective’ attitudes, unlike a pure musician, who aims at appreciable artistic results. • In this way music therapy becomes an autonomous and not merely operative discipline, in other words a therapeutic application of music.
Harmony Bulletin
10
Vol 1 Issue 2 October 2012
Sri Balaji Vidyapeeth University
SPECIAL FEATURE Responders Vs Non-Responders to Music Therapy During music administration to patients, I have always been confronted with the interesting phenomenon of coming across patients who respond well to music therapy on the very first session itself, these individuals gradually exhibiting signs of improvement after a duration of 3-4 weeks, as opposed to others who either show no response at all or become restless even before 10 minutes of listening, and it is not surprising that they fail to show any improvement even if they are made to listen regularly. I found that this phenomenon was repeated, even if the patients were made to choose the music according to their own preferences. What could be the reasons behind these unique variations among individuals regarding music stimulation? 1. Musical Intelligence- The “Expression” in Music as Interpreted or Felt by a Performer/ Audience : According to Dr. Howard Gardner there are 7 Emotional Intelligences, viz., verbal( the ability to use words), visual( the ability to see things in your mind), physical( the ability to use your body well), musical( the ability to understand and use music), mathematical/logical( the ability to apply logic), intrapersonal( the ability to understand thoughts and feelings), and interpersonal (the ability to relate well to others). The common issue faced by researchers is that it is hard to classify music based on its emotional content. The emotional content of music is difficult to discuss since it is a ‘subjective” experience, meaning that each listener or performer may construct a slightly different personal experience, even for the same music. It is important to consider the fundamental issue between music and human perception: the possibility of educating or enhancing our emotional responses to music. Many people take it for granted that listening to music requires no skill, but it is vital to remember that not only musicians but also listeners need to improve the ability to understand music in order to fully appreciate it. Differences among interpretations of music do exist, our perception of emotion from music varying, depending on varying situations and individual differences in perception- not everybody associates the same musical features with the same emotion. According to Feieraband,JM(1995), individuals with high music intelligence “think music” with greater clarity and are affected more deeply by music, in an aesthetic sense, than those with less music intelligence. Vol 1 Issue 2 October 2012
11
Harmony Bulletin
Sri Balaji Vidyapeeth University
Musical Intelligence and Response to Music Therapy Recent insights about the psychological development of musical thinking have revealed that musical intelligence is nurtured by the children at a very early age. Since synaptic connections are at their peak production at the age of 2, music stimulation should begin immediately at birth in order to preserve musical intelligence, because it starts declining prior to the age of 5. According to researchers, a child stores a mass of musical impressions well before commencing school education, and what a child has heard in his first six years of life cannot be eradicated later. Therefore, it is of utmost importance to stimulate musical intelligence well before the child starts entering school life. How to stimulate musical intelligence? To develop musical intelligence, one must develop neuronal pathways for musical thinking early in life. If the musical mind is engaged in early stimulation through music listening or playing, we establish neuronal pathways that will understand and perceive music from this intellectual framework, since the synapses are formed, strengthened, and maintained by interaction with repeated experience, as a result of the information being processed through certain conditioning. Appropriate stimulation of musical intelligence from the earliest experiences is necessary, if the pathways are to be built to understand musical phenomena from a musical perspective. Once the pathways for understanding musical or any other phenomenon for that matter are established, it is difficult to reshape the mind to perceive that same phenomenon from a different perspective. “It is much more difficult to reorganize a brain than it is to organize it in the first place. Organization inhibits reorganization. Carving out neuronal tracks for certain types of learning is best accomplished when the synapses for that particular skill are malleable, before they harden up around certain types of responses.” Jane M. Healy. Musical intelligence can be demonstrated by the fact that individuals who learn to play an instrument through ready notation- without appropriate musical skills such as singing and moving with music- engage only their logical/mathematical intelligence and would most likely have later difficulty to play by ear. Edwin Gordon has suggested that music intelligence is determined by one’s ability to “think” music, or in his words to “audiate” music. The better one is in creating music inside one’s head, the better developed is one’s potential to succeed in real musical understanding and appreciation.
The emotional content of music is difficult to discuss since it is a
Harmony Bulletin
12
Vol 1 Issue 2 October 2012
Sri Balaji Vidyapeeth University
‘subjective” experience, meaning that each listener or performer may construct a slightly different personal experience, even for the same music. 2.The Psycho- Neuro- Endocrinologic Responses to Music Stimulation It is well known that individuals and cultures identify emotionally with different musical stylings. What is stimulating for one may induce a neutral response to another. The reason could be attributed to the psychoneuro-endocrine effects of music in the human brain and body which provide direct links between music stimulation, activations in the brain during music processing and emotional response at both physiological and subjective levels. Music emotion research at the hormonal levels might yield more information regarding the relationship between perceived and felt emotions during music stimulation. In other words, by understanding how music affects the endocrine system, we will increase our knowledge of how music affects emotions. Ultimately, research in psycho-neuro-immunology should contribute to answering questions about how musical behaviours function as psychological components in processes related to wellbeing and health ( Kreutz et al., 2012). According to Blood &Zatorre (2001 ), intensely pleasurable responses to music are associated with activity in brain regions implicated with reward and emotion. Pleasurable music invokes emotions releasing the reward hormone dopamine, in correlation with the “chills” running up and down the spine during intense peak responses. It has already been established that strongly felt emotions could be rewarding in themselves in the absence of a physically tangible reward or a specific functional goal, and it is amazing to find that there is also an anticipatory release of dopamine to an aesthetic stimulus- a stimulus that is abstract, complex and not concrete (Salimpoor et al.,2009). Are there any other factors that play a role in healing the signs and symptoms of the disease process in those who respond well to music therapy? The intricate biological time structures in humans : The results of modern chronobiology and chronomedicine have shown that the human organism does not only have a complicated interior design in terms of space structure, but also has a foundation based on an intricate time design, being composed of numerous rhythmical time structures_the intricate biological time structures in humans (Vide Fig:1). Figure : 1 shows a spectrum of the main types of rhythmical functions, arranged logarithmically according to the periodic duration. It includes approximately 2 into 12 octaves, from approximately one millisecond to an order of one year. With an increasing periodic duration, the complexity Vol 1 Issue 2 October 2012
13
Harmony Bulletin
Sri Balaji Vidyapeeth University
of the rhythms grow, from the cellular rhythms via the tissue and organ rhythms towards the rhythms of more complexity, finally including the entire organism and even the population rhythms- a hierarchical structure existing and determining the way in which the longer wave rhythms include the shorter ones. This illustrates that there are structures in humans which follow musical conformities to a natural law. The whole of the human organism participates as a moving entity, as a sensory being, and as an intellectual receptor in experiencing music. This could be the ultimate achievement for music in entraining the organism and shaping regularities from irregularities.
REFERENCES Blood AJ and Zatorre RJ (2001). Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion. Proceedings of the National Academy of Sciences of The United States of America ; vol. 98 ( 20) 11818-11823. Edwin Gordon (1968).A Study of the Efficacy of General Intelligence and Musical Aptitude Tests in Predicting Achievement in Music. In Bulletin of the Council for Research in Music Education.No. 13, pp. 40-45.University of Illinois Press Feierabend, J.M.(1995). Music and Intelligence in the Early Years. The Hartt School University of Hartford From Early Childhood Connections. Gardner, Howard (1983; 1993) Frames of Mind: The theory of multiple intelligences, New York: Basic Books. Gutenbrunner,C., Moog,R, and Hildebrandt,G, Chronobiology & Chronomedicine. Peter Lang GmbH
(1993).
In
Kreutz G., Murcia CQ, and Bongard,S (2012). Psychoneuroendocrine Research on Music and Health: An Overview. In Music, Health, & Wellbeing. MacDonald R, Kreutz,G,and LauraMitchell (Eds). Oxford University Press. Salimpoor VN, Benovoy M, Longo G, Cooperstock JR, Zatorre RJ (2009) The Rewarding Aspects of Music Listening Are Related to Degree of Emotional Arousal. PLoS ONE 4(10): e7487. CENSUS FOR THE MONTH OF AUGUST, 2012 OLD PATIENTS - 12
NEW PATIENTS - 13
TOTAL CENSUS - 25 Harmony Bulletin
14
Vol 1 Issue 2 October 2012
Sri Balaji Vidyapeeth University
Overview of the favored periodic duration (frequency ranges) of the rhythmic functions in humans. The scale of periodic duration is divided logarithmically. The stable frequency ranges of the spontaneous rhythms are specially emphasized.
Figure : 1
Vol 1 Issue 2 October 2012
15
Harmony Bulletin
PATRON Shri.M K RAJAGOPALAN
ADVISORY BOARD
EDITORIAL BOARD
MEMBERS
Prof. GUNASEKARAN D R
EDITOR-IN-CHIEF
Dr. BALACHANDAR M
Prof. MUTHURANGAN G
Prof. BARATHI P
Dr. CHETAN ANAND
Prof. ANANTHAKRISHAN N
EXECUTIVE EDITORS
Mrs. ASHA SURESH BABU
Prof. MYLSAMY K
Prof. SRINIVASAN A R
DESIGN & LAYOUT
Prof. MADANMOHAN
Ms. UMA A N
Mr. GEORGE FERNANDEZ
Visit The Harmony Online at http://www.mgmcri.ac.in