At the quarterly meeting of the Dutch Psychological Society, held at Utrecht on November 27th last, Dr. van Deventer opened a discussion on the above topic. He reviewed the position held by music among the ancients, and cited numerous classical authorities who have made mention of its curative influence in bodily and mental disease. Following such quotations he brings us to the days of Pinel and Esquirol, who made special investigations with this agent in the treatment of mental aberrations. Their immediate successors appear to have over-estimated its influence and over-strained its use, for by some it was even regarded as the only psychical specific; theories were freely promulgated by which the nature of mental disturbances and the favourable influence of music on such were to be explained, while a connection was demonstrated between mental operations and musical sounds. In their experiments and mode of treatment eminent musicians lent their aid and guidance, but in many cases with anything but a gratifying result to the patient; with the laudable aim of curing the sufferer, but frequently against his will and inclination, they would, for days in succession, have the finest musical masterpieces performed in some adjacent apartment, the consequence being that the condition of some of the patients was frequently aggravated rather than improved, and that extreme mental exaltation even supervened at times. The measures adopted by Esquirol in 1824 and 1825 had been more systematic, he first tried the effect on selected patients, and subsequently on a large assemblage of insane, chosen mainly from convalescents, quiet maniacs, and some melancholiacs, and under the personal supervision of himself and his medical staff at the Salpêtriere. His observations led him to advise that with the insane the musicians should be always placed out of sight, that the number of instruments should be limited to a few, and that a process of selection should always be adopted, a proper estimate being taken of the mental condition of each patient; the preference was to be given to musical pieces which prior to his malady had proved agreeable to the patient, and such especially as brought to his mind the memories of his youth. Notwithstanding these precautionary measures its influence would be undetermined and doubtful so long as the affection itself was active; improvement in such cases was rare and cure never resulted. Some patients, among whom were musical adepts, declared that harmonies were discordant or terrible to their ears, and even the most capable of these became irritable and excited on hearing what to the normal ear were pleasant melodies. In the period of convalescence, however, music would be found of value if precautions were taken against undue excitation of the imagination and an excessive rousing of the passions. From this we gather that music is by no means to be regarded as a harmless form of mental treatment; the factors that come into play are numerous and varied, the use of vocal, instrumental, or concerted music, the instrumentation, the tone, musical colour, rhythm, subject, harmony, and delivery, the duration, associations, and meaning of the subjects performed, the time of life and individuality of the hearer, his social status and mental culture and development, and his morbid leanings and disposition all have to be studied. The same music too will have different effects on different psychic states. Primarily it must be urged that in all acute mental conditions music is directly contra-indicated, bodily and mental rest being here of the first consideration. In melancholiacs in this stage the condition of listless apathy is thereby much increased, and sometimes agitated excitement may result, the patient feeling acutely the antithesis between his feelings and his surroundings. Some patients who perform on some sort of instrument take refuge therein in an attempt to banish their feeling of desolation, or, roused thereto by their surroundings, endeavour to instil some cheerfulness into their depressed spirits, or to divert their thoughts. In the more chronic forms, as well as during the period of reversion to mental health, it frequently serves a beneficial purpose, acting favourably by inducing natural sleep; a favourite melody may thus at times exercise an extremely salutary effect even in cases in which for a lengthened period no hopeful symptoms have been observed. During such a performance of music, unmistakable signs of emotion manifest themselves, and the patient begins to show interest in his surroundings, and the first symptoms of improvement appear, he becomes more cheerful, and shows a mental comprehension of what was previously unintelligible to him. In acute mania its application during this stage simply increases the unbridled excitability, though frequently the attempt is made to manage such patients or occupy them by pianoforte playing; they will often demonstrate by their performances the boisterous turbulence of their mental states. In chronic mania music is frequently of service to inure the patient to an orderly and regulated form of life, and thus to bring him back within the pale of social conduct from which his malady may have caused him to drift. On the other hand, during the return from mania to mental health, a patient will show himself to be extremely sensitive to music, and relapses may occur if such a form of recreation or employment be too readily adopted. In moral insanity, at least in the more expressed forms, it appears to produce no effect, and the patient seems to remain uninfluenced. In those cases of moral insanity in which the condition is the outcome of education and environment, music will be found to exercise an excellent influence, and it may, therefore, be regarded as of some value as a differential diagnostic of the cause of the malady.
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