Macaulay Thesis

The Medicine of Music:
Spirituality in Modern Healthcare
By Jordan Fogle
Chul-Young Roh, Advisor
A thesis submitted in partial fulfillment of the requirements for the Degree of Bachelor of
Arts with Honors in Health Services Administration
LEHMAN COLLEGE
New York, New York
May 25, 2015

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“Without music, life would be a mistake.”
-Friedrich Nietzsche, Twilight of the Idols, Or, How to Philosophize With the Hammer
It seems diving headlong into a world of personally selected aesthetics is an
obsession of ours. Look in any direction and you can witness myriad passersby immersed
in their very own sonic realm, music being pumped into their brains through headphones.
Why? What better method is there to heal the ailments inflicted upon your psyche by a
40-hour workweek than unwinding to your favorite Brain Eno record? What better way
to release aggression toward your quibbling boss or your crumbling country than by
gnashing your teeth to The Adverts? Physically attending concerts is often even more
therapeutic than recorded music. And for those of us who make it, we are aware of the
catharsis that takes place in the profound act of musical creation. Perhaps music is
humanity’s oldest, most mysterious medical intervention.
In his book Original Wisdom, Robert Wolff remarks that, “Doctors and patients
alike are so overawed by the miracles of modern chemistry that we forget who healers
were and what they did before penicillin. Both doctors and patients believe that healing
comes from drugs, from outside intervention, forgetting that until recently healing was
always what the body did, perhaps aided or stimulated by a healer…” (Wolff).
Hippocrates—the so-called father of Western medicine—and his contemporaries did not
view the field of medicine as a mere stockpile of ultimately knowable facts, and therefore
he neither pretended nor aspired to be all knowing. He knew that quality care meant
paying heed to every aspect of his patients’ well-being: Mind, Body, and Spirit. In his

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day, the worlds of poetry, music, and medicine were intertwined, undistinguished. This is
because the ancient Greeks envisioned their models of knowledge and thought in a vastly
different way than we do. It wasn’t until Aristotle came along that a word even existed
that denoted the arts and humanities as something separate from the sciences. To this
point, Robert Burton, in The Anatomy of Melancholy, remarks, “It is a disease of the soul
on which I am to treat, and as much appertaining to a divine (cleric or theologian) as to a
physician and who knows not what an agreement there is betwixt these two professions?
A good divine either is or ought to be a good physician, a spiritual physician at least, as
our Savior calls Himself, and was indeed. They differ but in object, the one of the body,
the other of the soul, and use divers medicines to cure: one amends animam per corpus
[the soul through the body], the other corpus per animam [the body through the
soul]…(Burton).” For these thinkers, the scientist is the philosopher and vice versa.
It is important at this point to define “spirituality.” I use it to invoke the human
faculty that craves a greater understanding of the self in the context of the greater whole.
I believe that in the US, healthcare facilities have been rendered spiritual deserts due to
our capitalist culture and its harsh implications for doctor-patient intimacy (which I
discuss in the Conclusion section). Healthcare is a “service” now, not a “practice.”
Bodies are repaired like cars. Shamans and healers have been replaced with lab-coated,
clipboard-clutching, collegiate intellectuals who coolly target symptoms, explain disease
solely in terms of underlying biological deviations from normal functioning, and ignore
the quintessential elements of psycho-spiritual engagement required in treating patients as
a whole. Few question the callous, scientific disposition of modern medicine.

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The purpose of this paper is to call for a reunification of spiritual thinking and
medicine in modern healthcare. I will focus on music, as I believe it to be a universal
mode of spiritual transmission. Music is a crossroads between all peoples, regardless of
their cultural background or beliefs. In an age of waning affiliation with religious
institutions and a movement toward personal spirituality (think of Lennon’s classic
“We’re [The Beatles] more popular than Jesus now” quote), it is timelier today than ever
for us to employ music’s universality. Music allows a soundtrack to the journey of inner
reflection on existential issues. It can accompany contemplation on the nature of health
and sickness as a being in the universe, especially in the grips of disease. As Lou Reed
once said in a 1998 interview titled The Gospel According to Lou Reed, “The most
important part of my religion is to play guitar” (Gabriella).
Even beyond the scope of music therapy, music’s medicine is vastly under
utilized. I will provide a history of music therapy, which I believe is ultimately a revival
of ancient wisdom surrounding music’s vital role in healing. I will establish its efficacy
with a literature review investigating music’s physical and emotional power. I will offer a
snapshot of the music therapy field in light of the Affordable Care Act, and the
bourgeoning holistic paradigm. I will describe a first hand account of my experience as a
drum circle facilitator at Coney Island Hospital. I will conclude with my thoughts on
advocacy and influencing organizational culture.

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History
To discuss the history of music therapy, it is essential to outline the origin of
music, music’s history in ritual, and the nature of music itself. Knowledge surrounding
music’s emergence is murky. The modern human brain came into being 50,000 to
100,000 years ago (Moore). Cave drawings, artistic weaponry, and sculptures dated
within this interval serve as evidence that the creative impulse has been around since
nearly the dawn of Man. The oldest instrument to date is a 40,000 year-old bone flute, so
it is not unfathomable that people were at least singing well before this time (Moore).
Traditionally, researchers postulated that music was an evolutionary by-product of
language; merely “auditory cheesecake,” as Steven Pinker put it in How the Mind Works
(Pinker). However, the notion that music is not an unnecessary by-product, but is instead
a core function of our brain, is gaining traction among experts. In the acclaimed This Is
Your Brain On Music, Daniel Levitin proposes that, “music may be the activity that
prepared our pre-human ancestors for speech communication and for the very cognitive,
representational flexibility necessary to become humans (Levitin).” Drawing upon
evidence from early childhood development and language acquisition, researchers
hypothesize that language ought be considered a special type of music.
Nevertheless, whether one thinks the human affinity for music is literally etched
into our DNA, or that it is a happenchance phenomena cultivated by various, other
faculties, one cannot deny that music has been a central fixture of every human culture.
As Oliver Sacks says in the preface of Musicophilia, “We humans are a musical species

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no less than a linguistic one” (Sacks). Birth songs, lullabies, naming songs, puberty
songs, greeting songs, love songs, marriage songs, funeral songs; nearly every point in
the lives of communities is marked by song. Societal organization is dictated and upheld
in the hymns of a people. The medicine of music has not been put into practice more
throughout human history than in religious ritual and worship.
Black Elk, the famous Lakota medicine man, speaks about an ancient rite of the
Oglala Sioux referred to as “lamenting.” It is performed by people of all ages for many
different reasons, and sometimes many times a year. Great visions occasionally come to
qualified individuals and are said to give strength and health to the Sioux nation.
Lamenting’s most important use, however, is to help the lamenter realize their oneness
with all things in nature, and to give thanks to Wakan-Tanka, the creator. The ritual
involves fasting for purification, taking the sacred pipe, going to a sacred place on a hill
and crying for a vision. Before embarking on the lonely journey, a ceremony is held for
the lamenter. All the attending men sing:
Grandfather, I am sending a voice!
To the Heavens of the universe, I am sending a voice;
That my people may live! (Tedlock)
Once the lamenter has returned and formally recounted his or her experience to
the holy men and community, the congregation concludes the rite by singing this sacred
chant:

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Grandfather, behold me!
Grandfather, behold me!
We who represent all the people,
Offer ourselves to You,
That we may live! (Tedlock)
This is a powerful illustration of how humans utilize music to interact with, and
situate themselves within, their conception of the cosmos. People often depend on
practices like this to preserve precepts of health and harmony, individually as well as
collectively. The word “lamenting” itself evokes a kind of musical catharsis, a purging of
interior vibrations.
In Native American traditions, music is believed to have mystical powers. Music
has been used in healing rituals since times immemorial, often in the form of singing and
chanting with percussive instruments like drums and rattles. The Shaman, or medicine
man, is believed to have the ability to combine magic and music to heal the injured, cure
the sick, ward off evil, and reveal hidden truths (Stevens). The Shaman’s power is usually
acquired in a dream during which a supernatural being teaches him sacred songs and
instructs him in the use of various “medicines.” For most of human history this was the
primary mode of healing.

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Ancient doctrines have much to say about the nature of music. Eastern
philosophical traditions hold that sound played an essential role in the formation of the
universe, not unlike the Judeo-Christian God speaking the world into existence in
Genesis. In tantric philosophy, the material universe originated from a cosmic sound
caused by vibrations that emanate when Shiva and Shakti have sex. This notion of
vibrations permeating everything is actually a scientific fact (Byrne). In quantum
mechanics, matter is said to be composed of energy—music, essentially. In countless
ancient creation myths, this motif arises. Lao Tzu, who fathered Taoism sometime in the
6th century BC, said, “Music in the soul can be heard by the universe” (Spiritual
Experiences). The Roman philosopher Boethius later termed this inner music “musica
humana” (Boethius). Perhaps they were pointing out the blurry line between the Self and
the Universe, interconnected as they are, and in communion with one another. To the
Western Mind, entrenched in dualism, this seems absurd! Yet, the notion that movements
at the core of our isolated, physical beings are linked to and of the universe itself, that the
human body is somehow a microcosm of the macrocosm, resonates with us. It is not
wrong to say that all matter is composed of a singular “cosmic sound.”
Around 590 BC came an important insight into the nature of music. Pythagoras of
Samos, a very wise teacher of ancient Greece, proposed that, “There is geometry in the
humming of the strings, there is music in the spacing of the spheres” (The Mystery of
Matter). He first discovered the mathematical congruencies between the notes, and
presumed that we find specific harmonies more pleasant than others because the
“celestial music,” the music humans inaccurately imitate, emanates from the “spheres”

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that hold the planets. Pythagoras even demonstrated that the correct sequence of sounds
played on a musical instrument can change behavior patterns and accelerate the healing
process.
Plato, a student of Pythagoras’s teachings, said, “Music is an art imbued with
power to penetrate into the very depths of the soul” (Harvey). Schopenhauer further
remarked how it accomplishes this “entirely without reality and remote from its pain…
Music expresses only the quintessence of life and its events, never these themselves”
(Schopenhauer). I have long considered music a most peculiar medium for this reason. It
is absolutely abstracted from the material world, yet somehow voices the concrete
struggles of life. “Music inflames temperament,” Jim Morrison posthumously mutters in
The Doors’ “Ghost Song.”
Music is transient in nature; it only exists in the moment it is perceived. Live
improvisation allows musicians to react “in the moment” and create an aural portrait of
their emotions by capitalizing on the medium’s ephemerality. A story unfolds note by
note. Notes disappear like rings of smoke. As Eric Dolphy, the legendary free jazz
saxophonist/flautist/bass clarinetist once said, “When you hear music, after it’s over, it’s
gone, in the air, you can never capture it again” (Steinbeck). The immediacy of musical
experience allows it to penetrate the player’s/listener’s innermost feelings, before their
culturally sanctioned egos have time to project outward and direct their rational
judgments of the sound. Could it be this characteristic that has kept music flowing
through places of worship, no matter the denomination, resounding through the streets of

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crowded cities, and reverberating across the valleys?
Many have speculated as to what purpose music serves for humanity. Hazrat
Inayat Khan, the 20th century Sufi master, speculated that, “There will come a day when
music and its philosophy will become the religion of humanity” (Khan). A religion of
music would be stripped of dogmatism, and rooted in our sensory experience of nature
itself. Igor Stravinsky thought that, “Music is given to us with the sole purpose of
establishing an order in things, including, and particularly, the coordination between man
and time” (Stravinsky). Music aids us in making sense of and orienting ourselves in the
universe. Ludwig van Beethoven said, “Music is a higher revelation than all wisdom and
philosophy. Music is the electrical soil in which the spirit lives, thinks and invents”
(Beethoven). He was noting how effective the medium is for transmitting universal
truths, without being confined to the imperfections of the written word, or rational
thought. Whichever purpose you think music serves for humanity, the recent advents of
recorded music and the Internet will only make music grow in ubiquity and significance.
What is Music Therapy?
In Ancient Greece, we have the first instances of music’s application in “clinical”
settings. Patients in manic states were often instructed to listen to specific instruments,
such as the dulcimer, given what the illness was. In community healing shrines, hymn
specialists worked alongside physicians (Harvey). Since then, a few cases for music
therapy as an effective treatment method have been made in various cultures, though they

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are few and far between. In the Bible, King Saul was treated for his depressive symptoms
by David’s harp playing (Dobrztnska). A “dancing mania” took hold of Germany in
1374; it involved groups of people dancing erratically, sometimes thousands at a time.
People of all ages danced until they collapsed from exhaustion. Musicians accompanied
dancers in order to ward off the mania, but this sometimes backfired by encouraging
more to join in (Harvey). In Constantinople around 1560, individuals with psychiatric
disorders were hospitalized in psychiatric hospitals and treated with music (Ansdell).
Then, during the Renaissance, Italian composer and music theorist Zarlino believed that
musical harmony had healing capabilities. (Dobrztnska). In the late 1600s, religious
motives for such interventions would be replaced by scientific aims, as a fundamental
shift was occurring in Westerners’ relationship to the world.
In How Music Works, David Byrne observes that during the late 17th century, a
scientific conception of the universe was beginning to take hold. It was the physics of the
universe that drove music, not the other way around (Byrne). The universe was no longer
enchanted, and music’s significance diminished as the Protestant, materialist worldview
grew, which viewed ritual as unnecessary. Concerts came to fill a spiritual void left by
the rejection of musical traditions. Byrne asks, “Who could say that music
performances—in opera halls, cabaret bars, rock clubs, and outdoor festivals – are not
rituals? …they heal and consecrate community bonds. The ritual was preserved under
another name” (Byrne). A new paradigm might have been blossoming, but still we
sought music for its curative, life-affirming powers.

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In his revelatory lecture “Shamanic Schizophrenia and Cultural Healing,” Terence
McKenna proposes that in the modern, Western world “we have gone sick by following a
path of untrammelled rationalism, male dominance, attention to the visible surface of
things, practicality, bottom-line-ism. We have gone very, very sick. And the body politic,
like any body, when it feels itself to be sick, it begins to produce antibodies, or strategies
for overcoming the condition of dis-ease.” He believes, “the 20th century is an enormous
effort at self-healing. Phenomena as diverse as surrealism, body piercing, psychedelic
drug use, sexual permissiveness, jazz, experimental dance, rave culture, tattooing, the list
is endless. What do all these things have in common? They represent various styles of
rejection of linear values. The society is trying to cure itself by an archaic revival, by a
reversion to archaic values” (McKenna). I would assert music medicine as yet another
archaic, tribal value that is reentering consciousness, but through the guise of a rational,
scientific pursuit: music therapy. The health benefits of music are so readily observable
that music therapy is steadily becoming a more and more uniform discipline.
In the US, the American Music Therapy Association has been instrumental in this
unification. It formed in 1998 as a merger between the National Association for Music
Therapy and the American Association for Music Therapy. Their website describes how
the profession formally began after World War I and World War II. Community
musicians began visiting Veterans hospitals around the country to alleviate physical and
emotional trauma from the wars. It was later used with children and adults in psychiatric
treatments and to aid in the treatment of developmental disorders. By the 1970s, music
therapy had evolved beyond the specialized fields of psychiatry and rehabilitation to

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nursing homes and to private hospitals. Doctors noticed the healing power demonstrated
by the presence of music, and demand grew for a college curriculum (American Music
Therapy Association). Since then, music therapy’s recognition and influence has steadily
increased. It is now a common part of the services offered by hospice and other
healthcare institutions to help promote patients’ physical, mental and spiritual well-being.
The AMTA asserts that, “Music therapy is the clinical and evidence-based use of
music interventions to accomplish individualized goals within a therapeutic relationship
by a credentialed professional who has completed an approved music therapy program.
Music therapy is an established health profession in which music is used within a
therapeutic relationship to address physical, emotional, cognitive, and social needs of
individuals…Research in music therapy supports its effectiveness in many areas such as:
overall physical rehabilitation and facilitating movement, increasing people's motivation
to become engaged in their treatment, providing emotional support for clients and their
families, and providing an outlet for expression of feelings” (American Music Therapy
Association). It is distinguished from other musical experiences, such as attending
concerts or playing instruments, in that it is strategically developed using clinical
assessments, treatment planning, and evaluations. What does it look like? Breathing
exercises, dancing, singing, instrument playing, music listening; anything that will help
people decrease pain, stress or improve mental function and movement.

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Meta-Analysis/Literature Review
In my literature review, I posed two research questions. Firstly, is music therapy
efficacious in improving perceived quality of life? And secondly, does evidence exist that
rhythm related interventions are useful in improving health and perceived quality of life?
Upon investigating whether music therapy generally improves perceived quality
of life, I found four studies that clearly affirm that it does. In “Effects of Live Music
Therapy Sessions on Quality of Life Indicators, Medications Administered and Hospital
Length of Stay for Patients Undergoing Elective Surgical Procedures for Brain,”
published in the Journal of in Fall, 2008, Walworth et al. examined the effects of live
music therapy on quality of life indicators for persons receiving elective surgical
procedures of the brain. The subjects were 27 patients admitted for some type of surgical
procedure of the brain. 13 subjects were randomly assigned to the control group receiving
no music intervention and 14 were assigned to an experimental group receiving pre and
postoperative live music therapy sessions. Anxiety, mood, pain, perception of
hospitalization or procedure, relaxation, and stress were measured using a self-report.
Experimental subjects received live and interactive music therapy sessions, including a
pre-operative session, continuing with daily sessions until the patient was discharged
home. Control subjects received routine hospital care without any music therapy
intervention. Using a Wilcoxon Matched-Pairs Signed-Rank test, differences in
experimental pretest and posttest scores were analyzed. Results indicated statistically
significant differences for 4 of the 6 quality of life measures. This indicates that live

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music therapy using patient-preferred music can be beneficial in improving quality of life
indicators in patients undergoing surgical procedures of the brain (Walworth).
Mohammadi et al. published “An evaluation of the effect of group music therapy
on stress, anxiety and depression levels in nursing home residents” in the Canadian
Journal of Music Therapy in January 2011. The study was a randomized, controlled trial,
conducted to evaluate the effect of music therapy on stress, anxiety, and depression levels
of a group of the elderly who resided in a nursing home. The experimental group received
10 weeks of daily, 90-minute sessions (which included listening to and creating music).
The control group did not. The 21- item Depression Anxiety Stress Scale was used as a
pre-and post-intervention measure in each group. Differences in pre- and post-
intervention scores indicated significant reductions in mean scores of anxiety, stress, and
depression in the experimental group as compared with the control group (no music),
proving that participation in the sessions had improved levels of anxiety, stress, and
depression (Mohammadi).
In 2009’s “The Effect of Group Music Therapy on Quality of Life for Participants
Living with a Severe and Enduring Mental Illness,” published in the Journal of Music
Therapy, Denise Grocke conducted a10-week group music therapy study designed to
determine whether music therapy influenced quality of life and social anxiety for people
with a severe and enduring mental illness. Qualitative data were gathered through focus
group interviews. Statistically significant improvement was found on five items of the
WHOQOLBREF Quality of Life Scale. The ten, weekly sessions included song singing,

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song writing and improvisation. Themes from the focus groups were the joys and
pleasures of music therapy, how working as a team was beneficial, how participants were
pleasantly surprised at their creativity, and how they took pride in their songs (Grocke).
In the winter of 2011, Claire Ghetti published “Active Music Engagement with
Emotional-Approach Coping to Improve Well-being in Liver and Kidney Transplant
Recipients” in the Journal of Music Therapy. Her research indicates that music therapy in
combination with other interventions is also highly effective improving well-being. This
study evaluated the impact of music therapy with and without a specific emphasis on
emotional-approach coping. A randomized, controlled trial that paired Active Music
Engagement and Emotional-Approach Coping was chosen to test 29 post-operative liver
and kidney transplant recipients. Ghetti found that music therapy using Emotional-
Approach Coping led to significant increases in positive affect (Ghetti).
Browsing through the existing literature on music therapy’s efficacy, I was struck
by the notion that to establish more evidence-based music therapy programs, more
attention must be given to using robust research. Randomized clinical trials using more
rigorous measures (such as structural magnetic resonance imaging) would cement music
therapy’s efficacy in popular thought. Further translational research could then be
conducted to understand how inexpensive, easily disseminated, and safe music therapy
programs are. While lessening the healthcare expenses, these efforts would provide more
quality treatment.
Upon investigating the topic, I found a tremendous number studies confirming

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that rhythm related interventions are useful in improving health and perceived quality of
life. The applications of rhythm are varied, and have been proved effective time and time
again. Though I was intuitively confident about the power of drum medicine, I was
curious about the scientific details.
In 2000, neurologist Barry Bittman of the Mind-Body Wellness Center in
Meadville, Pennsylvania led an innovative study titled, “Composite effects of group
drumming music therapy on modulation of neuroendocrine-immune parameters in
normal subjects.” It found patients who took part in drum circles experienced increased
levels of disease-fighting immune system cells called natural killer cells. His study was
the first clinical intervention of its kind to use group-drumming music therapy as a
modulator of biological variables in “normal” subjects (meaning no prior musical or
drumming experience). He used a single trial experimental intervention with control
groups. Bittman tested the blood chemistry of 111 healthy people (55 men and 56
women, with a mean age of 30.4 years) before and after a one-hour experiment. Six
groups were studied using various control and experimental paradigms designed to
separate drumming components. Results showed that participants in all groups
experienced a drop in stress indicators, but only the group of physically active drummers
had a significant increase in NK cells. Bittman attributes this response to the stress-
reducing benefits of self- expression and camaraderie with fellow participants (Bittman).
This study was replicated by researchers all over the world, and yielded similar results.
Rhythmic auditory cueing has been shown to facilitate immediate improvement in
gait parameters of persons with neurological injuries (McIntosh; Thaut; Hurt). Studies
show that rhythm positively impacts motor output. This suggests that the element linking

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music to motor behavior is time. The neocortex, basal ganglia, cerebellum (Thaut) and
thalamus (Krause) assist in different aspects of processing time. Studies have also
demonstrated that rhythmic synchronization is an effective tool for gait rehabilitation in
persons with many ailments such as Parkinson’s disease (Miller; Thaut; McIntosh;
Prassas; Howe; Arias and Cudeiro; Rochester), traumatic brain injury (Hurt; Kenyon),
spinal cord injury (de l’Etoile), and stroke (Thaut; Roerdink; Hayden). Due to the success
of these studies in demonstrating the positive impact of rhythm in motor rehabilitation, it
has also been argued that rhythmic input can improve sensorimotor functioning in
individuals with Autism (Hardy).
Percussion activities have been shown to be especially effective in improving
perceived quality of life. Authors Kerstin Thornberg, Staffan Josephsson, and Ingrid
Lindquist published “Experiences of participation in rhythm and movement therapy after
stroke” in Disability and Rehabilitation. The aim of this qualitative study was to
investigate how persons with stroke experience participation in rhythm and music
therapy, specifically the Ronnie Gardiner Rhythm and Music Method. A
phenomenographic approach was taken. After 17 interviews with stroke patients,
researchers identified that feelings of being connected to the body arose as a result of the
challenging tasks. Patients felt more confident in carrying out difficult tasks. This
increased joy and the overall desire to do things (Thornberg, Josephsson, and Lindquist).
When people are happier, they are better able to maintain health.
The reason I asked this particular research question was because of my life long
obsession with the drums. Regardless of ethnic and cultural background, musical
preferences or age, percussive activities are useful in creating groups. When participants

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are actively making music together, a sense belonging to the group arises. The sustained
repetition of a steady beat is meditative and brings people together physically and
emotionally (rhythmic entrainment). Most importantly, percussion activities can be done
with little or no previous musical training. I believe this unique attribute makes drum
medicine, of all the music medicines, the easiest to systematically spread throughout
health communities.
The Future
With the passage of the Patient Protection and Affordable Care Act (PPACA),
and the burgeoning holistic paradigm, music therapy faces an uncertain future. The
PPACA was enacted to increase the quality and affordability of health insurance.
Regardless of pre-existing conditions, insurance companies are now required to cover all
applicants within new minimum standards. Healthcare remains the highest expenditure
for the federal government. The PPACA introduced mandates, subsidies, and insurance
exchanges to accomplish its aim. State or federal run insurance exchanges are companies
that provide insurance for those who cannot obtain insurance through their employer.
Music therapy is not specifically mentioned in the Act. Access to music therapy
through insurance and medical facilities may be affected as a result to changes in funding
(the ACA cuts $716 billion from Medicare). In skilled nursing and rehabilitation
facilities, music therapy is sometimes included in billing to Medicare as part of the array
of services offered. This money is usually a fringe benefit, though. Recreational therapies
will be impeded unless they are advocated for and specifically mentioned in coverage
plans (Tague).

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On the implementation of the PPACA, Jordana A. Bailey, the Associate
Executive Director of Ambulatory Care Services at Coney Island Hospital in New York
City, stated that, “… although it began slow, there are many initiatives under the ACA
that have really increased the momentum of the overall plan. For example: PCMH
(Patient Centered Medical Home), ACO (Accountable Care Organization) and DSRIP
(Delivery System Reform Incentive Program) all have a common aim to make
the patient the "center" of our efforts as healthcare providers by taking into account all
their medical conditions and treating them as a whole unit. By doing this it allows a
whole broad picture/perspective on the patients appropriate plan of care which will allow
patients to be seen in a follow-up outpatient setting as opposed to coming in as an
emergency through the ER or in a hospital in-patient stay, which are basically the goals
of ACO & DSRIP--to have a 25% reduction in hospital admissions over 5 years.”
In 2012, the Supreme Court upheld the overall law but also exacerbated struggles
between the states and the federal government. This resulted in the new law being
nothing like a "national healthcare" plan. Ms. Bailey added that, “I feel NYS did a good
job of providing educational support and guidance as well as grants, such as the Home
Medical Home Project (aka: "HMH") which allowed re-structuring outpatient practices to
transform the way they needed to provide care to patients under the new act. This grant
provided funding for electronic medical records, meaningful use initiatives as well as
reimbursement dollars for primary care practices who transformed into the PCMH model
and met quarterly quality metrics.” The increase in people getting healthcare through

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Medicaid will probably not directly increase access to music therapy services. Medicaid
coverage has not traditionally paid for services like music therapy except through state
agencies that receive block grants of Medicaid money to use at their own discretion
(Tague).
Many speculate that the lack of standardization will be a real hindrance to
improving reimbursement rates for music therapy and other recreational therapies. Bailey
agreed “that the lack of standardization not only creates a division of healthcare services
but also limits other areas that patients can benefit from (such as music therapy and other
similar services), especially if we are supposed to be treating patients as a
whole. Although I do not know much about music therapy, I do know that for certain
people/patients, music is a form of release (for example: stress-relief), which from a
health-care perspective, stress plays a huge role in patients health, whether it is an
increase in blood pressure, migraines, etc. These interventional services can help treat
the patient in some cases, almost as good as prescription medicine.”
Conclusion
In 1860, Florence Nightingale, aka The Lady with the Lamp, authored Notes on
Nursing: What it is, What it is not. It became the basis of nursing practice and research.
Here she conceived the Environmental Theory, which emphasized the environment
configuration according to a patient's health or disease. She writes, “People say the effect
is only on the mind. It is no such thing. The effect is on the body, too. Little as we know
about the way in which we are affected by form, by color, and light, we do know this,

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that they have an actual physical effect. Variety of form and brilliancy of color in the
objects presented to patients, are actual means of recovery” (Nightingale). She also
stressed the importance of a quiet or noise-free environment, but this was due to her
tending to Crimean War casualties who needed minimal noise to prevent non-epileptic
seizures. Considering the theory’s premise, it seemed obvious that tastefully selected
musical activities could enhance the recovery process for suitable patient populations. To
test this idea myself, I became involved in a program at Coney Island Hospital that
allowed me to devise my own drum circle curriculum, facilitate weekly sessions in
various inpatient settings, and also perform. The initiative is called Healing Without
Borders, and targets undergraduate students that are self directed and passionate about
enlivening the sterile hospital atmosphere. I was trained on the jazz drums and have
always been involved in music, so I had faith I could live up to the task.
When I started, I immediately noticed that very little instruction was needed for
participants to have a healing experience. With my ragtag assortment of second hand
drums, patients instinctively guided themselves through a drumming ceremony. When it
was time to leave, whether in the psychiatric ward or the anger management unit, patients
would ask me when I was coming back. Ambivalent faces had turned ecstatic. Soon, I
was notified that patient surveys indicated drum circles were among the highest rated
recreational activities.
One personal anecdote of mine illustrates the strong impact of music on patient
well-being, and also its status in modern healthcare. If you’ve ever had the opportunity to

22
visit a psychiatric ward, you may have gotten the feeling that they are designed to make
you mad and keep you mad, with their harsh florescent lighting and drab decor. I was
playing a djembe (a West African hand drum) at Coney Island one day, letting the drum’s
sound echo through the hallways, into the rooms. A pie-eyed woman in a wrinkled gown
wandered over to where I was positioned. She leaned against the wall, closed her eyes,
and intently listened until I was finished. As I stood up to leave, she introduced herself
and spoke of the power of live performance. She mentioned that she came from a musical
family, and that her cousin was too a percussionist. She said, “You brought me home to
myself.” I sensed her identity was something that escaped her from time to time. She
thanked me, but she was really thanking the music. I receive similar feedback nearly
every time I visit the hospital. Just as we parted, I overheard a nurse complain to her
superior about my presence, saying I was a nuisance. To me, this demonstrated how
novel and misunderstood the presence of live music is in the healthcare environment.
Clearly outside of her comfort zone, the nurse dismissed my drumming as
inconsequential or even destructive. Though the staff’s reception is mostly warm,
displays of close-mindedness such as this have not been uncommon in my experience. A
cultural war must be waged within places of care to make holistically minded
interventions such as art and music therapies not just standard, but revered. Failing to
recognize how these interventions are inextricably linked to healing only serves to
devalue the creative therapist as a clinician. In fact, such therapists transcend procedural
or material technicians, as their mediums are exempt from reification as material
techniques (Abrams).

23
Ms. Bailey suggested that current music therapy professionals, “Educate
and advocate on health care reform & transformation topics; Focus is shifting towards the
outpatient health care setting so more emphasis should be placed on initiatives related to
this area of health care; health care is still a business, so staff need more training on
customer service and improving the overall patient experience.” Furthermore, I believe
that music should be used far beyond the scope of the music therapy discipline (namely
the Nordoff-Robbins approach and the Bonny Method of Guided Imagery and Music),
which deems only certain ailments treatable. I am aware that prominent, academic
medical centers like New York-Presbyterian/Columbia University Medical Center are at
the forefront of pioneering ways to bridge music and medicine. The reasoning behind this
must quickly trickle down into the popular arena. After all, the poorer, public institutions
need music’s medicine the most in improving overall patient experience. That means
championing innovative creative therapy initiatives (such as Healing Without Borders
and many others) through letter writing, phone calls, emails, and personal visitations to
upper level management. You don’t have to be Mickey Hart or Barry Bernstein to be an
influential advocate in this field.
Interdiciplinarity is especially important in medical education as we move into an
era of comprehensive care. As I stated before, the scientist is the philosopher and vice
versa. It is not a mere coincidence that doctors and nurses are often creative people. The
primary mode of healing for most of human history was shamanic, which hinges upon the
use of imaginative faculties. I propose that by casually incorporating cultivated artistic
talents into their practice, doctors will recover lost modes of treatment excluded from
modern medicine. Organizational culture is transformed from the inside out.

24
And while on the topic of organizational culture, I think it is important to discuss
the doctor-patient relationship. In Original Wisdom, Robert Wolff offers insight into how
bomohs, or native Malaysian healing practitioners, interact with their patients. Sick
people in the kampongs, or tribal communities, physically go to the bomoh’s house. The
visit begins with a casual chat and the bomoh eases into learning what the issue is. The
intake interview is conducted without instruments and without pay or records. It is rare,
but if a bomoh prescribes an antibiotic, they personally administer each dose, instructing
the patient to make daily visits until the cycle of medication has been completed. Wolff
portrays bomohs as friendly individuals who practice a “noninvasive, personal, and
informal method of healing” (Wolff). Though Western cities lack social structures like
that of localized, tribal communities, rendering a healthcare system similar to rural
Malaysia impossible, we still have much to learn from the fluidity of their doctor-patient
relationships. Primary care physicians in the States, who essentially parallel the bomoh’s
role, are much more detached. I asked Ms. Bailey about pairing Western and native
conceptions of medicine. She said, “The ideal would be the combination of both styles of
practice.” Using the styles together, physicians are put directly in touch with a patient’s
overall need for healing through intimate, psycho-spiritual engagement, and can use
prescription medicine at their discretion if it is needed to resolve an issue. In the US,
excellent care means gaining a competitive advantage in the market.
Wolff also argues that the structure of our vast, kaleidoscopic healthcare system
“is rooted in our unique beliefs about health and illness, life and death.” For instance, our
value of the “individual” leads us to believe that death is “something to be conquered,

25
defeated, denied as long as possible.” He claims that because of this, “A disproportionate
amount of money, technology, and time is devoted to mechanically prolonging the
breathing of terminally ill people. We spend much more time, money, and energy on
keeping a few people alive than on helping to keep all people healthier.” To him, because
our very worldview dictates the structures we have in place, it becomes difficult for us to
imagine the world any other way. “Thus we think that ours is the only true reality, that
other people, other cultures, are backward, archaic, under-developed, and so on. By
judging others as less than ourselves, we cannot learn from them. That is sad, because we
throw way, suppress, and deny the accumulated wisdom of generations of ancestors”
(Wolff). There are public health efforts going on all over the world to educate indigenous
peoples on hygiene practices and provide families with anti-parasitic medications.
Though it can take time to for them to reconcile tribal cosmologies with Western
interventions, progress is often made. It would be a great tragedy not to learn from them
as well.
On a final note, about nine percent of adult Americans suffer from diagnosable
depression (National Center for Health Statistics). Studies show that rates have risen
dramatically in the past 50 years (globally, as well). Depression is the measure of a
spiritual deficit, a “soul sickness,” if you will. One factor is that our postmodern times are
characterized by isolation. In the Information Age (aka the New Media Age), it can
become difficult to know what or who to believe, difficult to locate oneself in the larger
scheme of things, difficult to feel in harmony with Nature. I believe another major
contributor to the rise of depression is increased socioeconomic disparity generated by
corporate capitalism. I would argue most people still walk around dis-eased and

26
unsatisfied on a deep psychological level, long after doctors permit them to leave. People
feel helpless when they can't get ahead, or when their worth as a human is linked solely
to economic productivity. Inequities in education, food quality, and healthcare will
deprive one the opportunity to strive toward self-actualization (think of Maslow’s
Hierarchy). This is a fundamental issue that must be solved before America is a truly
“healthy” nation. I suspect this will take many, many years.
In the mean time, by modeling our healthcare institutions after proper values,
perhaps we can begin to restore the proper values within ourselves. Refocusing on
holistically minded medicine will alter people’s relationship with their bodies. Attuned to
all the facets of their health, they will be better equipped to maintain well-being. In
modern healthcare, reunited spiritual thinking and medicine will provide the bedrock for
an economically efficient, yet thoroughly altruistic, future. Let music be the golden
thread that mends these vital components of the human tapestry back together.

27
MLA Citations
Abiru, M., Kikuchi, Y., Tokita, K., Mihara, Y., Fujimoto, M., and Mihara, B. (2008). The effects
of neurologic music therapy on gait disturbance in a cerebellar ataxia: a case study.
Gunma Med. J. 87, 213–218.
Abrams, Brian. Musica Humana: When Music Breaks the Sound Barrier in Music Therapy.Web.
http://www.healthhumanities.org/documents/AHRC-Health-and-Music-Workshop-Brian-
Abrams.pdf
“American Music Therapy Association,” n.d. http://www.musictherapy.org.
Ansdell, G. (2004). Book review: Music as medicine- The history of music therapy since
antiquity. Psychology of Music, 32, 440-444.
Arias, P., and Cudeiro, J. (2008). Effects of rhythmic sensory stimulation (auditory, visual) on
gait in Parkinson’s disease patients. Exp. Brain Res. 186, 589–601.
Beethoven. “Letter to Bettine Von Arnim,” 1810.
Bittman et al., “Drumming Strengthens Immune System: Composite Effects of Group Drumming
Music Therapy on Modulation of Neuroendocrine-Immune Parameters in Normal
Subjects,” Journal of Alternative Therapy 7 (2001): 38-47.
Boethius. De Institutione Musica. N.p.: n.p., n.d. Print.
Byrne, David. How Music Works. McSweeney’s Publishing, 2012.

28
de l’Etoile, S. K. (2008). The effect of rhythmic auditory stimulation on the gait parameters of
patients with incomplete spinal cord injury: an exploratory pilot study. Int. J. Rehabil.
Res. 31, 155.
Dobrztnska, E., Cesarz, H., Rymaszewska, A. K. (2006). Music therapy- history, definitions and
application. Archives of Psychiatry and Psychotherapy, 8 (1), 47-52.
Gabriella. NY Rock. “The Gospel According to Lou Reed,” 1998.
http://www.nyrock.com/interviews/loureed_int.htm.
Ghetti, C. M. "Active Music Engagement with Emotional-Approach Coping to Improve Well-
being in Liver and Kidney Transplant Recipients." Journal of Music Therapy 48.4
(2011): 463-85. Web.
Grocke. "The Effect of Group Music Therapy on Quality of Life for Participants Living with a
Severe and Enduring Mental Illness." The Journal of Music Therapy (2009): n. pag.
National Center for Biotechnology Information. U.S. National Library of Medicine. Web.
12 May 2015.
Hardy, Michelle W., and A. Blythe LaGasse. “Rhythm, Movement, and Autism: Using
Rhythmic Rehabilitation Research as a Model for Autism.” Frontiers in Integrative
Neuroscience 7 (2013): 19. PMC. Web. 5 May 2015.
Harvey, A. W. (1980). The therapeutic role of music in special education; Historical
perspectives. The Creative Child and Adult Quarterly, 5 (3), 196-204.

29
Hayden, R., Clair, A. A., Johnson, G., and Otto, D. (2009). The effect of rhythmic auditory
stimulation (RAS) on physical therapy outcomes for patients in gait training following
stroke: a feasibility study. Int. J. Neurosci. 119, 2183–2195.
Howe, T. E., Lovgreen, B., Cody, F. W., Ashton, V. J., and Oldham, J. A. (2003). Auditory cues
can modify the gait of persons with early- stage Parkinson’s disease: a method for
enhancing Parkinsonian walking performance? Clin. Rehabil. 17, 363–367.
Hurt, C. P., Rice, R. R., McIntosh, G. C., and Thaut, M. H. (1998). Rhythmic auditory
stimulation in gait training for patients with traumatic brain injury. J. Music Ther. 35,
228–241.
Kenyon, G. P., and Thaut, M. H. (2000). A measure of kinematic limb instability modulation by
rhythmic auditory stimulation. J. Biomech. 33, 1319–1323.
Khan, Hazrat Inayat, The Music of Life: The Inner Nature and Effects of Sound (New Lebanon,
NY: Omega Publications, 205). 63.
Krause, V., Schnitzler, A., and Pollok, B. (2010). Functional network interactions during
sensorimotor synchronization in musicians and non-musicians. Neuroimage 52, 245–251.
Levitin, Daniel J. This Is Your Brain On Music. PLUME, 2007.
McIntosh, G. C., Brown, S. H., Rice, R. R., and Thaut, M. H. (1997). Rhythmic auditory-motor
facilitation of gait patterns in patients with Parkinson’s disease. J. Neurol. Neurosurg.
Psychiatry 62, 22–26.

30
McKenna, Terence. “Eros and Eschaton: Living in the State of Twilight Imagining,” n.d.
http://www.wilderutopia.com/performance/literary/terence-mckenna-on-shamanic-
schizophrenia-and-cultural-healing/.
Miller, R. A., Thaut, M. H., McIntosh, G. C., and Rice, R. R. (1996). Components of EMG
symmetry and variability in parkinsonian and healthy elderly gait. Electroencephalogr.
Clin. Neurophysiol. 101, 1–7.
Mohammadi,, Ali Z. "An Evaluation of the Effect of Group Music Therapy on Stress, Anxiety,
and Depression Levels in Nursing Home Residents /ÉValuation Des Effets De La
Musicothérapie De Groupe Sur Les Niveaux De Stress, D'anxiété Et De Dépression
Auprès De Résidents D'un Centre D'hébergement." An Evaluation of the Effect of Group
Music Therapy on Stress, Anxiety, and Depression Levels in Nursing Home Residents
17.1 (2001): n. pag. "" by Mohammadi, Ali Zadeh; Shahabi, Tanaze; Panah, Fereshteh
Moradi. Web. 12 May 2015.
Moore. “Which Came First: Music or Language?” Psychology Today, September 20, 2012.
https://www.psychologytoday.com/blog/your-musical-self/201209/which-came-first-
music-or-language.
National Center for Health Statistics.
Health, United States, 2011: With Special Feature on Socioeconomic Status and Health.
Hyattsville, MD. 2012.
Nightingale, Florence. Notes on Nursing: What It Is and What It Is Not. Wilder Publications,
2007.

31
Pinker, Steven. How the Mind Works. W. W. Norton & Company, Inc., 1999.
Prassas, S. G., Thaut, M. H., McIntosh, G. C., and Rice, R. R. (1997). Effect of auditory
rhythmic cuing on gait kinematic parameters in stroke patients. Gait Posture 6, 218–223.
Robert Burton. The Anatomy of Melancholy. The New York Review of Books, 2001.
Robert Wolff. Original Wisdom. Inner Traditions International, 2001.
Rochester, L., Burn, D. J., Woods, G., Godwin, J., and Nieuwboer, A. (2009). Does auditory
rhythmical cueing improve gait in people with Parkinson’s disease and cognitive
impairment? A feasibility study. Mov. Disord. 24, 839–845.
Roerdink, M., Lamoth, C. J. C., Kwakkel, G., van Wieringen, P. C. W., and Beek, P. J. (2007).
Gait coordination after stroke: benefits of acoustically paced treadmill walking. Phys.
Ther. 87, 1009–1022.
Roerdink, M., Lamoth, C. J. C., van Kordelaar, J., Elich, P., Konijnenbelt, M., Kwakkel, G., et
al. (2009). Rhythm perturbations in acoustically paced treadmill walking after stroke.
Neurorehabil. Neural Repair 23, 668–678.
Sacks, Oliver. Musicophilia. Vintage Books, 2007.
Schopenhauer, Arthur. The World as Will and Representation. Vol. 1. Dover Publications, Inc.,
1969.

32
Spiritual Experiences. (2012). Spiritual quotes from Lao Tzu. Retrieved from
http://www.spiritual-experiences.com/spiritual-quotes/quote.php?teacher=20.
Steinbeck, John. Holiday, Vol. 58 (1977), p. 13
Stevens, Christine. Music Medicine. Sounds True Inc., 2012.
Stravinsky, Igor, An Autobiography (NY: Norton, 1998), pp. 53f.
Tague, Daniel. Ph.D., MT-BC. “The Effect of the Affordable Care Act on Music Therapy: A
Call for Advocacy.” Music Makes Sense, January 31, 2013.
http://musicmakessense.blogspot.com/2013/01/the-effect-of-affordable-care-act-
on.html
Tedlock, Dennis and Barbara. Teachings from the Ameraican Earth. Liveright Publishing
Corporation, 1992.
Thaut, M. H., McIntosh, G. C., and Rice, R. R. (1997). Rhythmic facilitation of gait training in
hemiparetic stroke rehabilitation. J. Neurol. Sci. 151, 207–212.
Thaut, M. H., McIntosh, G. C., Rice, R. R., Miller, R. A., Rathbun, J., and Brault, J. M. (1996).
Rhythmic auditory stimulation in gait training for Parkinson’s disease patients. Mov.
Disord. 11, 193–200.
Thaut, M. H., McIntosh, K. H., McIntosh, G. C., and Hoemberg, V. (2001). Auditory
rhythmicity enhances movement and speech motor control in patients with Parkinson’s

33
disease. Funct. Neurol. 16, 163–172.
The Mystery of Matter. Edited by Louise B. Young. p. 113, (1965).
Thornberg, Josephsson, and Lindquist. "Experiences of Participation in Rhythm and Movement
Therapy after Stroke." Disability and Rehabilitation (2014): n. pag. National Center for
Biotechnology Information. Web.
Walworth, D. "Effects of Live Music Therapy Sessions on Quality of Life Indicators,
Medications Administered and Hospital Length of Stay for Patients Undergoing Elective
Surgical Procedures for Brain." Journal of Music Therapy (2008): n. pag. National
Center for Biotechnology Information. U.S. National Library of Medicine. Web. 12 May
2015.

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