Abstract
The editors of this volume set out with an ambitious challenge: to bring together an ‘international and multidisciplinary group of articles’ (p. viii) but it is a goal they quite clearly succeed in attaining. Right from the opening pages, we are plunged into a journey of music’s effects on health and wellbeing stretching back to our first written records from Neolithic times (Chapter 1) and reaching around the globe (Chapter 31). We trace music’s influence on us from our time in the womb through to our ‘liberation phase’ and beyond (Chapter 11); focusing on individuals as well as expanding our gaze to entire societies; looking through our microscopes at its impact on the inner workings of specific illnesses alongside its broader effects on general mortality rates (Chapter 28). Music is considered not just as an aural effect, but as a complex social, physical and personal process (Chapter 14). And to achieve all this, disciplines including musicology, music psychology, biology, chemistry, physics, ethnography, epidemiology, physiology, sociology, and philosophy are brought within our orbit. It is a sensational rollercoaster ride that leaves us longing for more.
It would be easy in a book such as this, for a reader from just one of the many disciplines involved, to become lost amidst a flurry of terms and concepts. But, in fact, one of the book’s highlights is its accessible style. Concepts are expressed clearly throughout, and in particular, some of the early chapters provide useful definitions on crucial terms, including most fundamentally health (Chapter 1) and wellbeing (Chapter 8). There is also significant effort undertaken to expand our understanding of common concepts within this field which can sometimes become oversimplified, such as Trodalen’s and Bonde’s description of the six key types of music therapy (Chapter 4) and Murray’s and Lamont’s explanation on the 96 different definitions of community (Chapter 6). However, the difficulty of standardizing these definitions is highlighted by a few discrepancies that still exist within the book, such as ‘music medicine,’ defined quite broadly by Spintge as ‘the scientifically based, medico-functional application of music in order to complement usual medical procedures in prevention, therapy and rehabilitation’ (Chapter 20) yet reduced to ‘the use of pre-recorded music to improve patient status and medical care’ by Trondalen and Bonde (Chapter 4). It is hoped that these discrepancies will be ironed out as the field becomes better established.
The book also grounds itself well in current political issues and broader global health moves. For example, there has been recent debate on the benefits of moving healthcare from hospitals into the community (Carter & Oldman, 2013); something that is eloquently discussed in relation to music by Ansdell and DeNora (Chapter 8) in their analysis of music as ‘pathways’ between different treatment locations, and between illness and health. Also, a number of health systems worldwide are beginning to explore salutogenic models of illness prevention rather than relying on the curing of disease (Alivia, Guadagni, & Roberti di Sarsina, 2011); something discussed by Murcia and Kreutz in relation to dance and health (Chapter 10). Music is also linked into existing structures within healthcare systems such as perioperative patient ergonomics and patient experience (Chapter 20). These links are important to draw because they demonstrate how music could be (and in some cases already is being) properly integrated into healthcare rather than it being seen as an enjoyable add-on, and lead to more sustainable models for its application. Overall, the way that music and health are interrelated throughout the book is rather beautifully done. A highlight is Stige’s metaphor of health as a type of performance, showing its intrinsic artistic basis (Chapter 14).
Another strength of this book is the realistic way it tackles some of the myths entrenched in the public perception of music and health. Superstitions and fantastic tales of music’s powers have dogged the scientific study of music for centuries (Fancourt, 2013), but this book takes a firm no-nonsense approach, and music is set out right from the start as ‘not an ultimate panacea, a magic bullet that can cure all ills’ (p. 10). Instead, unsubstantiated claims, such as the infamous ‘Mozart effect’ are refuted as ‘more a fantasy than a reality’ (p. 334), and it is pointed out that the ‘conclusions that can be drawn about the impact of music listening on health and wellbeing are both disappointing as well as promising’ (p. 334). This might seem like a risky angle to take, discrediting research in the field at the same time as trying to promote its strength. But in fact it is precisely this honesty on the quality of research so far that makes the rest of the evidence put forwards in the book more convincing.
Furthermore, the book considers not just the positive effects of music on health, but also a host of ways it can in fact have deleterious psychological and physical impact, from musicians performing ‘at the expense of their own health’ (p. 370) to the effect of music on both internalizing and externalizing psychopathologies (Chapter 34). Indeed, the entire volume closes with the sentiment that ‘adaptive and maladaptive music listening behaviours may co-exist’ (p. 525). Perhaps this is a low note to end on, but actually, it is an important point to raise, particularly in relation to the ethics of research in this field; something not explicitly discussed in the book but nonetheless a relevant thing to consider where music interventions can be so closely intertwined and directly impact on with people’s personal lives and medical problems.
Perhaps the most controversial facet of the book is the many discussions on methodologies. It is highlighted in the opening page that there has been an expansion in research methods and techniques in music and health over the past few years; clearly necessary because, as the editors write, ‘research into the relationship between music, health and wellbeing necessitates novel approaches from right across the academic spectrum’ (p. 3). A range of qualitative and quantitative methods are described across the chapters, and the book actually ends with a positive call for the involvement of both in ‘longitudinal mixed research methods . . . that can untangle the complex causal pathways involved’ (p. 526). However it is in these discussions of methodologies that it is clear research problems still need to be addressed. Firstly, Daykin explains that there is ‘as yet little consensus about what clinical outcomes should be measured and what methodologies should be used to evaluate arts and health activity’ (p. 65). In some cases, the variety of tools available to researchers have led to a crisis of choice and meant that, as the editors explain, there is a ‘lack of coherence of research in this field’ (p. 4). Secondly, the editors go on to describe how there are ‘serious obstacles in theory building’ that ‘could well compromise progress in this field’ (p. 4). Indeed, Ansdell and DeNora raise an interesting point by asking whether theory-building should actually be our goal. They argue that theoretical perspectives ‘have seldom proved compatible bed-fellows with the realities of practice’ and instead call for musical-social practice to ‘explain itself’ without being reduced to the instrumentalization of a single theory of any type’ (p. 106, Chapter 8). Thirdly, the design of music and health research is scrutinized, particularly relating to whether the use of medical ‘gold-standards’ such as randomized control trials are relevant to music or whether they are ‘too procrustean,’ only really accurate for ‘testing physical matter (and physiological reactions) and not wellbeing, let alone “community health”’ (p. 104). However, Wigram and Gold usefully point out that while some people will naturally have a greater propensity to believe in music’s health benefits, and others will be convinced through individual, personal experience, there are some who may be more sceptical and it is for these people that rigorous research evidence adhering to scientifically recognized protocols will have the greatest importance. It is a positive feature of the book that it raises these debates and contradictions as it is clear that solutions will need to be teased out over the coming years, not least because we are reminded that some existing research contains ‘noticeable methodological limitations’ which ‘raises questions concerning the credibility of the evidence and implies the need for a more thorough approach’ (p. 246.)
Overall, the book is very well structured. Potential areas for confusion such as the differences between community music making and music therapy are cleverly cleared up for the reader through the juxtaposing of respective chapters (Chapters 7 and 8). Elsewhere, ideas set up in individual chapters such as singing for health and dancing for health (Chapters 9 and 10) are then elegantly combined in a chapter that considers the benefits of their fusion (Chapter 11). It is also clear that areas of research that previously might have been separate, such as the neurology of music (Chapter 2) and music therapy (Chapter 4), are now overlapping more and more through the rise of neurological music therapy (NMT, Chapter 12). The book copes well with this fluidity and rather than attempting to smooth it over, instead brings it to the reader’s attention so that the blending of ideas can be appreciated. The only difficulty seems to arise when trying to outline the field of music, health and wellbeing as a whole. The editors start the volume with a four-circle Venn diagram conceptual framework designed to provide an overview of all the areas involved which goes on to provide the structure of the book. MacDonald (2013) has since updated this to include a fifth circle (music medicine) (See Figure 1). However, whilst this diagram does illustrate nicely the many different health realms in which music can operate, it also demonstrates that music and health is such a broad and varied field now that things do not necessarily sit neatly. For example, some groups of people fall between the stools provided, such as professional musicians. Performing musicians are considered whilst in higher education and so still falling under the music education umbrella (Chapter 24), but after this it becomes unclear where they should sit (or whether they even warrant a circle of their own). Similarly, a number of the articles within the book are placed under specific headings, but actually have a direct relevance to other subject areas. For example, neurological effects of music are considered in the introduction, in music therapy, educational contexts and everyday uses. Regardless of whether the settings in which the research took place were different, the knowledge gained from these studies is clearly applicable across the divisions suggested by the headings. As healthcare starts to move into community and educational arenas, it could be that the overlapping sections of MacDonald’s circles grow larger and even end up blurring entirely into a single arts and health circle and mind, body, social and individual effects begin to be combined and considered in tandem with one another in a more overarching holistic and comprehensive way.
Conceptual framework for music, health and wellbeing. From MacDonald (2013).
Two other interesting models are also proposed within the book. The ‘Arts and Health diamond’ (Macnaughton, White, & Stacy, 2005) is put forwards by Murray and Lamont, but as ‘art’ and ‘health services’ are put at opposing sides of the spectrum it implies that their combination is not as natural as the rest of this book might lead us to believe. And a theoretical model for ‘health musicking’ (adapted from Ansdell, 2001) is put forwards by Trondalen and Bonde. This is perhaps the most useful conceptual model as it considers how music is effecting different numbers of people rather than considering the location in which it is taking place and allows studies to be placed according to how important certain aspects such as ‘social engagement’ are to them. However, what these different models highlight is that providing a neat conceptual model of music and health is not necessarily possible. Consequently, over the coming years, a challenge for researchers will be to continue linking research into very diverse aspects of music, health, and wellbeing together and to maintain a sense of unity within the field at the same time as allowing the scope and breadth of our enquiry to broaden.
An inevitable question after reading a book such as this is how do we move forwards with research into and application of music in health and wellbeing? Fortunately, suggestions abound. Certain key research gaps are highlighted, such as a need for more longitudinal studies and studies in public health (Chapter 27), more discussion of the neurological links between music and depression (Chapter 29), and the biological implications of music-induced emotional changes (Chapter 22), more social contextual studies (Chapters 8 and 17) and more on music and movement (Chapters 10 and 16), amongst others. It is also highlighted that research in this field has predominantly focused on classical music so far, whilst research into other genres has been neglected (Chapter 25) or only explored for its negative effects (Chapter 33). Perhaps these are all promising avenues to be explored.
The question of how research such as that presented in this book can influence practice is also raised. The concept of ‘evidence-based practice’ is both attacked and revered, as a ‘religious doctrine’ (p. 164) and a ‘key area for further development’ (p. 225). Whether or not we should hold systematic reviews and meta-analyses as the true measure evidence and base the commissioning of music projects on their guidance is a large and complicated discussion, but it is logical and desirable that the practice of music in healthcare contexts be informed by the research that is carried out in order to try and achieve the strongest outcomes, and several chapters give practical guidance on the application of music in their specific health environments, including useful advice on logistics, hygiene and selection of music for operative settings and pain clinics (Chapters 19 and 20). An ‘urgent need’ for more training of music practitioners is called for in discussing music therapy (p. 53), and from my work within the NHS, I can echo this for musicians engaging with patients delivering live performances and workshops, where the complexities and sensitivities of working with patients with a range of conditions need to be comprehensively understood for the best work to take place. Hopefully practical suggestions such as these will be put into practice in the near future.
Overall, this book provides a comprehensive and exciting insight into how music, health, and wellbeing can be brought together. Music and science balance well throughout, with the acknowledgement that the scientific investigation of music ‘has strengthened our appreciation of music as both a powerful stimulus and as an art form’ (pp. 153–154). A central theme to this book is the ‘timeliness’ of research in this field, and it is hoped that the book will act as a springboard for more research studies over the coming years.