I Heard There Was a Secret Chord: Music as Medicine

by Daniel J. Levitin

Beliefs about music’s power to heal the mind, body, and spirit date back to the Upper Paleolithic era, around 20,000 years ago, when ancient shamans and other healers used drumming in the hopes of curing a wide range of maladies, from mental disorders to wounds and illnesses. Our word shaman comes from the Russian shaman, for a person of special status within a tribe who acts as an intermediary between the natural and the supernatural worlds, using magic to foretell the future, cure illnesses, and control spiritual forces. The term was originally applied to the Tungusic

music’s ability to heal, to provide a brighter day, to promote physical and mental health, knows no boundaries of language or culture. As Longfellow famously penned: Music is the universal language of mankind. Centuries earlier, a continent away, Confucius wrote: Music produces a kind of pleasure which human nature cannot do without.

It has been said that “Music gives soul to the universe, wings to the mind, flight to the imagination, and charm and gaiety to life and to everything.” Plato believed that music can bypass our rational mind: “More than anything else, rhythm and harmony find their way into the inmost soul and take strongest hold upon it.” It is perhaps no surprise to learn, then, that the Greek god of medicine, Apollo, was also the god of music.

and Athenian physicians would prescribe particular tonalities to heal colds, aches, depression, or injuries. For example, Dorian mode was considered suitable for mourning; Phrygian mode was used to control digestive problems; Lydian imparted good cheer, optimism, friendliness, and a tendency to laughter, love, and song when it was well executed, but could lead to weeping and sadness when not. Seven hundred years later, Ptolemy, living in the Roman Empire, wrote his treatise Harmonics, in which he elaborated on the relationship between music, emotions, and therapy.

The power of music, then, probably comes not from specific frequencies, but from trance-inducing rhythms, or a combination of musical elements as they stand in relation to one another—elements including harmonic structure, melody, tonality (major or minor), rhythm, and tempo. In other words, whatever effect a piece of music or sequence of sounds has on you, it’s unlikely that it would stop having that effect if it were shifted by a few hertz (Hz, cycles per second) in one direction or the other.

The inferior colliculus helps with sound localization, pitch perception, and auditory attention, and is part of the startle reflex, an unconscious process that causes us to get out of the way if we hear a sudden, loud sound. This startle circuit connects sound arriving at the brain stem with movement centers in the cerebellum, thalamus, and motor cortex. Our conscious awareness of what’s happening sonically only occurs after the signal makes its way to the cortex, starting in the temporal lobes at what we call the auditory cortex.

We’ve seen patients who can recognize the pitches in a song but not the rhythm, and vice versa; patients who are “timbre deaf” and can no longer distinguish one musical instrument from another, yet still recognize a melody.

All sound begins with some kind of motion, something that disturbs molecules in air, water, steel, wood, or other medium. Isaac Newton noted that light waves are colorless; the perception of color only occurs in the brain of a living organism. The same is true of sound. Thus perception of sound begins at our eardrums—before it hits our eardrums, it is nothing more than the disturbance of molecules. We can measure that disturbance with gauges and instruments, but until it hits a brain, it is not sound. You may have heard the old philosophical riddle, “If a tree falls in the forest and no one is there to hear it, does it make it sound?” No, because sound is a psychological concept, a product of brains. That tree will disturb molecules and make a mess, but if no creature hears it, no bird, fox, or human, it has not made sound.

Any medium can transmit sound, so long as it contains molecules that can be disturbed, which is why we can press our ears to the ground to sense approaching trains and buffalo herds, and why we, and fish, can hear under water. It’s also why there is no sound in the vacuum of space: there are no air molecules to disturb.

What begins as some kind of impingement on one or more sensory receptors ends up as an experience in our brains, constructed out of photons, or pressure waves, or interactions between certain molecules and chemicals in our nose, mouth, and tongue. A lemon is not “sour” or “yellow” in the real world; these are interpretations of the world. Musical instruments do not make music—musicians do, using their brains to guide their fingers, hands, and breath. A famous story illustrates this: A woman approached a musician after a concert (in some versions, it is Jascha Heifetz) and said, “Maestro, your violin sounds so wonderful.” He smiled at her and held the violin up to his ear and said, “I don’t hear a thing.” The lady was perplexed. The musician smiled again. “Madame, the violin doesn’t make the music. The music is being made by the man who is holding the violin.”

Musicians† hold a mental image of what they want to hear and then make suitable gestures in order to approximate what they intended.

your knowledge of the world, you learned just by passive listening how music works. The process begins in the womb, and the auditory system is fully functional by 20 weeks of gestation. Music is filtered through the amniotic fluid, and the developing brain becomes accustomed to the rhythmic and melodic patterns it hears, constructing a representation of what is to be expected in music. As infants, and through childhood, we construct our mental model of music based on what we hear. If you grew up listening to Chinese opera, your brain became wired to recognize its typical patterns, as opposed to, say, Indian ragas or Western classical music.

When we hear music that we don’t like, especially when we can’t get away from it (think of music in a public space), that activates the fear center in the amygdala. Many people list unwanted music in public spaces as a chief annoyance of modern life, and the U.S. Environmental Protection Agency (EPA) amended the Clean Air Act to include unwanted music under the heading of noise pollution.

Musical experience, even in the absence of formal training, changes the very structure and wiring of the brain. The changes not only facilitate the flow of information across the left and right hemispheres, they also connect the frontal lobes, the seat of higher thought, with the motor cortex. Peter Vuust at Aarhus University in Denmark went on to show that professional musicians display enhanced neuroplasticity in connections between auditory and visual areas. Musical perception is truly multimodal, and can lead to lifelong improvements in brain function and connectivity.

As far as we know, all societies in some way acknowledge the special status of the octave, which is produced by a ratio of 2:1 (in string length, the length of a pipe, and indeed, the ratio of vibrations). Pentatonic (five-note) scales are common, and our American blues scale is a pentatonic scale with an added “blue” note, the tritone. In our Western musical system, the octave is divided into 12 equal steps, and we tend to use only seven of them at a time; depending on which seven, and the order we play them in, we get a major or a minor scale. Music in Arab and Indian cultures uses microtones, notes between the notes on our piano keyboard; this is one of the reasons their music sounds exotic to Westerners. Some writers have claimed these constitute 48-note scales, but the reality is that most of the microtones are used as passing tones and ornaments, not components of a melody.

Within these individual differences, some people are drawn to rhythm, others to melody, and others to lyrics. Some people know every nuance of a drum part but not the subtle filigrees and ornaments of a melody. My wife Heather can identify a song from the first few notes of the melody, or the chord progression, but has difficulty recalling the lyrics. Many performing musicians can play thousands of songs from memory, but need to have the lyrics in front of them on an iPad—even when they wrote the lyrics themselves.

Music has the ability to calm our brains, our hearts, our nerves. We tend to like music that reminds us of something we’ve heard before, but not too much. We like music that strikes the sweet spot between novelty and familiarity, simplicity and complexity, and between predictability and surprise. The job of the composer, and of the musicians who interpret the composition, is to hit these in just the right balance.

the history of live performance, this stands as one of the most mesmerizing, thrilling demonstrations of mastery. And what is mastery if not the ability to deal with the unexpected as though it was expected? To take an error and turn it into something better than if there had been no error at all? This level of mastery requires deep memory for the tools of one’s craft, arrived at through thousands of hours of practice, memorization of procedures, facts, and conventions, until one’s art or craft reaches a state of automaticity, what some call the flow state.

Neurobiologists learn a great deal about memory by studying forgetting. To forget something means we had to have known it at some point, and that’s different than never having known it in the first place.

And even when we think we know something, memory is fallible in two distinct ways. First, we can lose things in our memory banks, sometimes temporarily, sometimes for a lifetime. Second, when we do locate and retrieve a memory, it can be fantastically distorted without our realizing it.

Through further specialized processing circuits, the rich world of music materializes into a mosaic of the nine dimensions that engage and shape our perception: melody, contour, harmony, timbre, meter, tempo, tactus, spatial location, and distance.

Those neurons become members of a special subset of neurons that represent that song. Brain scans from our laboratory show that when people imagine listening to music versus actually hearing it, the activation patterns are nearly identical. That is, the act of remembering music causes activation of the same neural circuits that were active when we heard the music in the first place. That special, dedicated subset of neurons that were tied together in listening comes online again when remembering.

Memories are not static or passive, but rather dynamic and evolving, subject to constant revision and reinterpretation. The meaning of a song can’t be summed up by an appeal to the notes that constitute it, and if an especially emotional memory becomes associated with a song at any point, you will probably never hear it the same way again. That song you loved when you were dating so-and-so might be difficult to listen to after an acrimonious breakup. Hearing it and experiencing those negative feelings will cause these new negative feelings to become attached to the memory and then stored along with it. As the most recent feelings stored, they may dominate the older ones so that it will be hard to recall a time when you ever enjoyed that song.

Your brain is changing all the time, and so are your emotional states, and so the “music medicine” you receive is essentially a brand-new medicine each time. The brain that hears that favorite song today is different from the brain that heard it last month. The journey through music is a never-ending one, guiding us through moments of joy and sorrow, discovery and nostalgia, a faithful friend that is always there to lift us up or help us through rough times. As long as we keep listening, we move forward, one note at a time.

When we were through with lunch, we got a couple of coffees to go. We walked through campus and talked some more—Lee taught me that one often does the best thinking while walking in nature.

It is difficult to identify the precise neural deficits associated with congenital amusias because no two brains start out the same; they grow and remap in ways that are influenced by genetics, environment, culture, and random factors. The acquired amusias aren’t all that much easier because damage to the brain is never exactly the same from one patient to the next—nature’s experiments are not carefully controlled the way laboratory experiments are. But we have been able to draw out some patterns.

Scientists delight in being wrong; the most exciting part of the job is not providing more evidence for an old theory, but finding evidence that refutes one. When that happens, we know we’ve misunderstood something about the world. An unexpected or weird result is a gift that tells us we didn’t know what we thought we did. And then the fun begins—of trying to design the right experiments that will fill in our knowledge gap.

When that happens, we immediately and instinctively become aware of our bodies, our position in space, as a precursor to a possible emergency that would require us to duck, jump, or move out of the way. This is partly what the precuneus is doing. But the precuneus is only connected to the rest of the DMN when we listen to music that we like. When we listen to music we dislike, the precuneus severs its ties with the DMN. It’s as though the brain is saying, “This is not part of me.” That explains the neuroscience underlying why people find unwanted, piped-in music in public places so aversive: they are actively rejecting it: “This is not me, this is not my auditory space.”

The elephant in the room, the existential quandary as it were, is what to make of different meditative states. Mindfulness meditation prompts its practitioners to dwell in the continuous present, gently observing their thoughts, emotions, and bodily sensations with curiosity, devoid of judgment or preconception. This is the state that most musicians aspire to when playing music. For both meditation and playing music, this means that the brain needs to deactivate circuits associated with self-consciousness and with judgment—the finger-wagging schoolteacher in your brain that is saying “that’s terrible!” or “you’re not good enough.” That school marm is useful when you’re editing, but anathema to creativity and spontaneity.

Meta-awareness is a double-edged sword. It can help you understand consciousness and conscious processes; it is what allows the student violinist to be able to step outside the sheer joy of listening in order to study how to play the instrument. That same meta-awareness, however, can prevent us from becoming fully absorbed. When that happens, we hear only the flaws in our own performances; we sit at the concert and analyze what is happening, rather than synthesizing and experiencing it. Richard Davidson frames it this way: “Across a range of traditional and contemporary contemplative traditions, the absence of meta-awareness is viewed as an impediment to various forms of self-monitoring, self-regulation, and self-inquiry.” Some meta-awareness is clearly necessary; too much of it robs us of truly becoming one with those things in life we care most about.

As one gets older, life loses its mystery. Good music puts the mystery back in life because you’re always in a state of anticipation, wondering what’s about to happen in the next few bars. No matter how many times you’ve heard, say, “Dewey Square,” Bird’s always gonna surprise you with exactly the way he pulls off the next phrase. It’s a beautiful trip.

The implication for music therapy will depend on one’s therapeutic goals. If the therapist aims to facilitate entry to the default mode, they should select music that hits the sweet spot between surprising and predictable, especially when it falls slightly to the “predictable side” to calm us, but not so much that it puts us to sleep or annoys us with its repetitiveness. This kind of music will reinvigorate us, allowing us to hit the reset button in our brains, and to calm all the chatter and distraction that our attempts at multitasking create.

For decades, it was believed that music therapy was effective simply because it was pleasurable, or distracting, taking our minds off our pain, both bodily and psychic. We now understand that music is one of the few things that is present across all these different modes of attention (even sleep—many people hear music in their dreams). Music can then help to serve as a unifying source, a glue that connects our different modes of awareness with our internal narrative, our sense of self, where we’ve been, and, perhaps most important, where we want to go.

We are all budding scientists, asking questions about the world, a process that started in early childhood, but that many of us unfortunately had trained out of us by well-intentioned but impatient parents, teachers, and older siblings. We are all budding music therapists, too. Most people in the world today use music in some medicinal fashion, and most people know what music to reach for when they want to maintain or alter their mood state (which is, neuroscientifically speaking, a brain state). We know what combination of sound waves will change our brain waves.

As we approach treating diseases such as Parkinson’s disease, Alzheimer’s disease, PTSD, and depression, among others, we would do well to bear in mind that there is never going to be a musical prescription when it comes to the particular musical pieces we use. And that whatever music works for treatment for a few weeks or months may need to be adjusted. If it’s beginning to sound as though music therapy is a guessing game, with treatments that may or may not work, and that may work but only for a while, ask a doctor how often they have to switch up a prescription drug for their patients—statins, blood pressure medications, antidepressants, even antibiotics for infections like strep, pneumonia, or sepsis. It’s not that a particular drug doesn’t work, it’s that our bodies, our lives, our minds, our intentions, and the sum total of our experiences are continually changing us.

Music treatment begins as an invitation to start exploring new music, and feeling the joy of discovery.

Additional evidence for this hierarchy comes in the kinds of errors that musicians make. Performance mistakes almost always occur at the stitching points, not in between them where the sequence is well established. Also common is to miss a note by only a semitone—a finger slip—rather than by a large interval—and these finger slips also suggest that the motor hierarchy is intact. Musical mistakes almost always preserve the tempo and meter of a piece—I’ve never heard a musician, in the middle of a difficult passage, suddenly substitute a flurry of wrong notes at twice the tempo the piece was in, or substitute 3/4 time in the middle of a 4/4 metered piece. There are parallels to this in language: speech errors tend to preserve the grammatical class, and something of the semantic relation. Nouns get substituted for nouns, verbs for verbs, and so forth. So instead of saying “after three blocks, take a left turn at the lamppost” we might say “after three blocks, take a left turn at the fire hydrant.”

When we look at slow-motion video of people moving their fingers while touch-typing, or playing a fast musical piece like Charlie Parker’s Bird Gets the Worm or Rimsky-Korsakov’s Flight of the Bumblebee, we see that whatever their fingers are doing now, their hands and fingers begin to twist, curl, stretch, or contract, as they prepare to move into the next position that will be required. Their muscles seem to know just what to do, independent of their brains. What we call muscle memory is not literally in our muscles, but in the part of our brain that controls those muscles, united with circuits that store sequences and patterns.

Fritz Kasten, an accomplished drummer who played with Vince Guaraldi and Joy of Cooking, notes: A part of learning the instrument—not exclusive, certainly, to drums—is concentrating on relaxing. Assuming a normal neurology, invariably it’s tension that creates the problems. . . . Most of us have experienced some degree of disturbed coordination in several musical situations such as learning new material. The more experienced—and confident—the player, the less the problem. Most musicians—if they’re honest—will admit to tension in various situations, tension that affects their playing.

Collaborative songwriting improves veterans’ PTSD symptoms of avoidance, depression, hyperarousal and hypervigilance, and overall coping skills. Often, individuals are encouraged to write something like a personal theme song, something that reminds them of who they were or who they want to be. This can take the form of an affirmation, a personal mantra, a song that makes the individual feel safe, or one that makes the individual feel power and agency. Comparable to prolonged exposure therapy, the reductions in PTSD symptoms may be due to the collaborative songwriting intervention gently and repeatedly exposing veterans to an artistic reinterpretation of their trauma. Listening to their song over and over may allow veterans to habituate to their trauma experience, dampening the associated heightened physiological response and avoidance.

A cautionary note is that music can occasionally trigger PTSD. A number of veterans report that when they hear music they were listening to in combat prior to a traumatic event, it brings up the mood they were in during the trauma. This trigger can put them into a hypersensitive and hypervigilant state. It doesn’t just happen to people who were in combat. There are pieces of music that remind us of relationships gone bad, and the mere hearing of them can send us into a tailspin.

The very structure of popular songs supports this duality, when, for example, a verse tells a sad story, with the bridge coming in to bring brightness and hope. Often the verse talks about a situation in the here-and-now, and the bridge pulls you out of that corporeal world, into a timeless interlude that gets you out of the current moment. Perhaps it’s a nod toward something ethereal and heavenly, pointing to a larger, broader truth or a moment of wisdom bestowed on the listener by the writer; the bridge gives you a release from tension and an assurance that you’re on the right path.

Joni insisted I record the song. But with what kind of an arrangement—solo guitar and voice, band? One of the important lessons Joni taught me: if I can find the authenticity in the song and what it means to me, it can be therapy for me, as her songs have been for her. That authenticity requires not just lyrical honesty but musical honesty as well. Grandpa Joe loved big bands. I loved rock. The right musical treatment would marry those sensibilities. My chords were already taken from jazz harmonies, not pop: the basic riff was B minor 7, F-sharp augmented 7, G-sharp augmented 7 (B-7, F#+7, G#+7). And so the choice was obvious, and Joni and I blurted out the answer at the same time: Steely Dan.

Effective music relaxation for stress relief requires personalized music, not “off-the-shelf” relaxation music. Neurologically this is because familiar or self-chosen music reduces cortisol levels, and promotes activation of the brain’s

medicine. Just as using an individual’s DNA can guide treatment decisions and prescribe drugs that are an optimal match to an individual’s genetic makeup, AI may one day extract the DNA of music to identify precisely what music will help meet an individual’s therapeutic needs.

Within this context, music therapy holds a special role. By fostering neuroplasticity and nurturing neural networks that span the breadth of the cerebral landscape, music therapy emerges as an invaluable tool. Many patients harbor an aversion toward physical therapy, often demonstrating noncompliance when confronted with the prospect of rigorous exercises within the confines of their own homes. The introduction of music-guided motor therapies ushers in a more joyous and engaging alternative—one that has the potential to instigate remarkable transformations. Rather than supplanting traditional limb motor exercise training, music seamlessly complements and amplifies its efficacy. Additionally, music therapy improves dysphagia (difficulty swallowing), a common symptom among stroke patients.

Patients are taught to sing everyday requests such as “I would like a glass of water” or “I need to go to the bathroom.” Because musical circuits in the brain are evolutionarily (phylogenetically) older than speech areas, they are more robust in the face of injury or neural decay.

used for Giffords are also effective for restoring language after strokes, tumors, and Alzheimer’s disease; they are especially effective when the damage is to the left hemisphere, allowing the right hemisphere’s music centers to drive the recovery process.

If an expert musician sees on a sheet of music that they have to make a rapid stepwise passage down two octaves, they’ll look at the first note and the last note and use their knowledge of scales to get from the top note to the bottom—they don’t need to read, or even think about, each individual note. Similarly, they encode chord sequences as chunks rather than individual chords, akin to textual or numeric chunking, allowing for a relatively sparse schematic representation of each song. A musician knows that a blues song will have a dominant I chord, IV chord, and V chord (in the key of A: A7, D7, E7)*—they don’t need to remember any more than the sequence and with experience, they can feel when it’s time to change the chord. Performance expectations for classical musicians, particularly soloists, are different than those for popular music performers, and classical musicians are indeed expected to play the music as written. But this still does not require that they necessarily memorize each individual note—they employ the same strategies mentioned above.

And they know what order they’ll occur in. For a 12-bar blues, A7 (4 measures), D7 (2 measures), A7 (2 measures), E7 (1 measure), D7 (1 measure), A7 (2 measures; or 1 measure each of E7, then A7). This is so ingrained that an expert musician can play around with the form, adding chord substitutions (as jazz pianists typically do) without getting lost in the progression.