Music as Medicine: How to Harness its Therapeutic Power, with Daniel Levitin (Part One)
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Welcome to Intelligence Squared, where great minds meet. I'm Head of Programming, Conor Boyle. Today's episode is part one of our recent live event in London's Smith Square Hall with Daniel Levitin. He's a neuroscientist, musician and author of the new book, Music as Medicine, how we can harness its therapeutic power. He was joined in conversation by journalist and broadcaster, Ridola Shah, and music was played by violinist, Anna Mitchell.

If you're an Intelligence Squared Plus subscriber, you can get access to the full conversation right now. Now, without further ado, let's go to the episode. Good evening, everybody. Welcome to this Intelligence Squared event. I'm Ruthullah Shah. Five nights a week, I present Calm Classics on Classic FM. And the whole premise of the show is that classical music should help you relax at the end of the day. And judging by the messages I get and by the audience figures, it seems to be quite successful.

Well, I'm delighted then to introduce tonight's speaker who takes our understanding of the power of music much, much further than that with a rigorous and really scientific approach.

Daniel Levitin is the author of Music as Medicine: How We Can Harness Its Therapeutic Power. And Daniel knows a thing or two about how our brains work. He's a neuroscientist and a cognitive psychologist and is professor emeritus at McGill University in the US. And he's written a number of best-selling books including This Is Your Brain on Music, The World in Six Songs, and of course Music as Medicine which we'll be talking about tonight.

And to bring some of Daniel's ideas and research to life, I'm delighted that we're also going to hear from Anna Mitchell. Anna's a violinist for Sinfonia Smith Square, and she's also played with the Irish Chamber Orchestra and the RTE Concert Orchestra. So it is going to be a fabulous evening. Welcome. Thank you.

Right, Daniel, there are so many brilliant stories peppered throughout your book. I am going to start a bit weirdly in the middle of the book and then we'll circle back to some definitions. In March 2015, the singer-songwriter Joni Mitchell suffered from a burst aneurysm and she was really seriously ill. Thankfully, she survived, but for three months she couldn't walk or talk after three months. She eventually came home to 24-hour care. What happened next?

Joni and I met in 1996, and we were friends and collaborators. In fact, I wrote pieces of most of my books in her garden while she was painting in one room and I'd be in the garden writing. It was a wonderful relationship, and when she got back from the hospital,

An aneurysm is really a pop in a blood vessel, a little button that opens up and bleeds, and it bleeds out so it has the effect of a hemorrhagic stroke. And the dramatic blood loss caused a lot of damage to her brain. The prognosis was so poor that the doctors who sent her home from the hospital didn't schedule any care.

She couldn't walk, she couldn't talk, and they figured that was the end of that. And she'd been home only a couple of days when

I got a phone call from a nurse who said she was at Joni's house and she had seen my phone number on the corkboard in the kitchen with just my name and number and she didn't know who I was or anything but she figured she'd call and I explained what I do for a living and she said, "Well, that's really interesting because when we nurses change shifts or take breaks, one of us might be in the kitchen listening to music while we're

on break and Joni will be in the next room and it seems as though she perks up when music's coming out of our cell phones. Wow. What does that mean and what can we do? The context here is Joni was really not responsive. Again, she couldn't walk, she couldn't talk, she seemed disoriented from having been in a coma and the rest. And fortunately,

Many years earlier, Starbucks had a short-lived record label called Hear Music, and they sold these CDs in their stores, and they had this series of CDs called Artist's Choice, where they asked eminent artists to put together a desert island disc of their favorite songs that they would want to have with them on the proverbial desert island. And Joni had asked me to come over to her house way back in the early 2000s as she had this task

for a series of listening parties where we just sat around and she would spin records and CDs and we'd listen to all of her favorite music and she'd talk about it and she was sort of thinking out loud, "Well, maybe I should put this on or this one and, you know, I like this one but, you know, I don't know if I want to have this one." And it was a wonderful exchange of ideas about music that spanned several late nights. So she had created this thing that

she had no way of knowing would be useful in the way that kind of a medical directive is, right? This is my favorite music. If I'm ever in trouble, this is what I need to hear. So I told the nurses, "Start playing this. Ask her permission first." Because... Why was that important? In any kind of a therapy, and in particular music therapy, you want the patient's permission.

to intervene. The patient needs to feel agency, they need to not feel helpless, they need to not feel like something's foisted upon them. It's not just an ethical requirement, but it's a practical one. One of the things that people complain about as one of the biggest irritants of modern life, you might call it an irritant, not just an irritant, is unwanted music piped into public places. They really hate that. Train stations,

elevators, and so she had to assent. But I said, you know, ask her if she wants to hear this music, and she apparently, I'm told, nodded slightly yes, and they put it on. And over a period of just a couple of days, she was transformed. She got back in touch with a part of herself that she had lost. And we know from research in my lab with Vinod Menon and

my colleague at Stanford and research in other labs, that when you listen to music that you like, it produces dopamine. Dopamine is a neurochemical that motivates you to do things that are healthful, like seeking food when you're hungry, seeking a drink when you're thirsty. In this case, it motivated her to want to try and start walking, it seemed.

So we quickly scheduled a physical therapist, a speech therapist, and a cognitive therapist, a neurologist to come by the house, and we kept playing her music, and...

Within about a year, she was able to speak simple sentences, but able to speak. And then, of course, a couple of years ago, she was at Newport singing. And performed, which was extraordinary. So I wanted to put that story out there because it is an extraordinary illustration of the power of music. So let's go back, holding that thought, a really, really, really powerful thought. When we think about music, do we all understand it to be the same thing?

I don't think so. Music is... There's no one song that we all like, there's probably no one song we all hate.

Except maybe Baby Shark. But kids like that. So the idea is that musical taste is subjective, but all our tastes are subjective. Our tastes in food are personal and somewhat idiosyncratic. Our taste in a choice of mates, books, movies. Some people like the city, some people like the countryside. So why wouldn't our taste in music also be subjective?

personal and idiosyncratic, but we don't all regard things as music. To my parents,

The Beatles were indistinguishable from the Carpenters and it was just noise. And I worked at Stanford University in the music department for many years and there was a cohort of professors there who thought that anything written after 1480 was not real music. So people have very strong opinions. It's quite a large part of the canon.

The parts of the brain though that process music, are they the same as those which process speech? What's the relationship between the two? Yes and no.

On the one hand, there are overlapping areas because it's all auditory. So the signal enters your ear, your ear is a conduit to sound, and then it sets off a neurochemical, neuroelectric chain of events where the sound goes from the eardrum, middle ear, the basilar membrane, auditory cortex, cerebellum, these are different regions of the brain. And what happens there is that the brain has to

translate that wiggling in and out of your eardrum in response to vibrations, translate it into pitch and rhythm, loudness, timbre, the sound of the tonal color of musical instruments or voices that allow you to distinguish one from another. And we do all that for speech as well. So there's some overlapping circuits. But again, with Vinod Menon, we show that when people are listening to music,

even those overlapping circuits, those neural circuits, operate differently when it's music. And the other big difference is that speech activates a so-called speech network. Music activates every area of the brain that we know of. That's interesting. So much more widespread. Your brain kind of lights up. It does light up and it's a whole brain activity.

listening, playing music, and what music does, beyond what speech does, is it connects parts of the brain that normally might not be connected at all. It's a great unifying source for the brain. So, for example, one thing is that music with a beat, with a noticeable rhythm, makes you want to move.

Babies move even without knowing that they're doing it. They kind of wiggle to the sound. And that's because there are direct connections between the auditory music parts of the brain and the movement centers of the brain. - I remember when my children were very, very small,

And before they could speak, I would sing to them because that was a way of talking when there was really nothing to talk about. And children respond very well to that kind of singing. So what does it mean for children? What does music mean for babies who perhaps still don't have the power of speech? This episode is sponsored by NetSuite.

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Infants go through a period of musical babbling. We know of the speech babbling before when they're pre-verbal, they go goo, ga ga, blah, blah, blah. But they also are singing. They're singing with rhythms and pitches. Musical babbling often precedes the speech babbling. It suggests that the music is hardwired. It's hardwired in our brain through our DNA. We are a musical species. And that shows up

the old phrase, ontogeny recapitulates phylogeny. It shows up that infants are doing what we as different species did. Birds and whales had song long before there were humans. So the idea is that music was innate and fundamental. And is there an element... By the way, you said something really, really crucial here. Your children respond to music even before they know it means anything.

And that's really the power of music, is that it doesn't necessarily mean anything specific. A composer can have an intent, a performer can have an intent, certainly lyricists have an intent, but good lyrics contain the kind of ambiguity that good poetry does.

And music is intentionally non-referential. It doesn't mean anything in a conventional sense. There's no melody I can play you that says, "Would you pass me the water?" Right. Or, "Would you open the door? It's hot in here." Or anything like that. So it allows us to map our own experience onto this canvas of music.

for the music to be personal and mean something different to us from day to day and from person to person. And for children, really small children, is music a way for them to learn pattern recognition, to understand perhaps how sentences work or the rhythm of language? The mammalian brain, if nothing else, is a pattern detector.

And the reason it's a pattern detector is it's a giant prediction device. The brain is evolved in order to predict what is going to happen next in the world. That's an adaptive strategy so that you can get out of the way of harm, so that you can figure out, you know, if there's some sequence of events, what will come next. Music is a wonderful exercise and play for the brain because it is highly structured and patterned.

And I wonder if we might bring Anna out to demonstrate something like that. This is Anna Mitchell, who is rather wonderfully going to play the violin for us. Welcome, Anna. So one thing that we do is, what music does in that game of prediction, is it sets up for us a pattern that we absorb. Whether you're a musician or not, whether you know it or not, your brain is trying to figure out

what the basic concept is. And nobody does this better, to my mind, than Beethoven. And you all know Beethoven's famous Fifth Symphony. He starts with a four-note motif, and then what does he do? He moves it around in pitch space, just like moving a glass from a position in physical space a little bit lower, and he does this.

And then he continues to develop it. So from the beginning, those same four notes are transformed in pitch and in time, if you would. One of the reasons that piece is so enduring and so popular is because it's all laid out for you right there. In the first movement alone, Beethoven uses that same four-note motif

either 252 or 254 times depending on how you count it. There's an ambiguous statement in the French horns. He even does it upside down bum bum bum bum bum bum bum bum instead of bum bum bum bum. So it's a giant game of play, expectation, prediction for the brain. That's fantastic.

So let's just think about the place, the peculiar place of music in our lives. Why is it that I struggle to remember, for instance, what I ate yesterday, but I can remember song lyrics from sort of 40 years ago? A song will come on the radio that I haven't heard for decades, and I will know the words. Are you going to sing for us? No. I'll spare you that. Well, music is highly structured, and what we mean by that is there are only 12 notes,

They can be combined in a lot of different ways. But the structure of it and then lyrics, the mutually reinforcing cues of rhyme, accent structure, meaning, create a set of constraints. So for example, I could say a sentence like, here, answer me, I'm gonna leave a blank. When I point, answer. The pizza was too hot to eat. Again, the pizza was too hot to...

Most of you said handle. Most of you said nothing. Some of you said handle. Some of you said eat. Some of you said handle. There's a limited number of ways you can finish that sentence. It would be odd if I were to say the pizza was too hot to jog. I mean, it's still a verb. It's a part of speech. You recognize that it's weirdly poetic, but not

not sensible. And so we do this with music. Even young children have this expectation for where a melody is going to go. We'll get to words in a minute, but if you could play the first little part of what you have on your music, and when I point, everybody, please, everybody sing what you think comes next.

Effortless, right? Some of you are laughing because it's so childishly simple. A five-year-old can do that. That is the scale. We've got seven notes in the scale. We complete it with the octave. It's obvious. Children learn that in the womb. They learn the structure of their musical scales without even knowing that they've done that. But what a...

skillful composer might do is play around with your expectations for how that's going to work and that's where the reward and the interest and the novelty comes in which makes it memorable in a different way. You might do this, almost more satisfying right because the expectation, the resolution of it was delayed or what emotion would you associate with that ending? Melancholy.

She's ending on the note that's the relative minor that leads to a more sad expectation. That's cultural, it's not universal. People from other cultures wouldn't interpret that way, but a lifetime of listening to music has taught us that certain sounds are associated with sadness, others with joy.

when it comes to lyrics, again, you can remember the lyrics because they make sense. They make rhythmic sense. They're hung to a melody that you know, and that's the power of it. There is a famous example that you cite, which I remember listening to without understanding its significance, which was Ella Fitzgerald back in 1960 forgetting the words to Mack the Knife, which became kind of a

a whole kind of new genre performance ultimately, but she just made up the words. What did that, what does that tell us about what she'd remembered and what she'd forgotten?

For those of you that haven't heard the recording, it's worth finding. It's Ella Fitzgerald live in Berlin. She's singing the song "Mack the Knife" from the Three Penny Opera. Previously, Bobby Darin and Louis Armstrong had had hits with it. She wanted to introduce a new song into her repertoire. She was a little nervous in front of this live audience in Berlin, and she forgot the lyrics. But what she did next was extraordinary.

She didn't stop, she kept on singing and she made up lyrics about how she was forgetting the lyrics and how she was making a wreck of Mack the Knife. And she kept the rhyme scheme. She knew in her head what the rhymes were at the end of the line, she just couldn't get the words. So it tells us, for an experimental psychologist, this is a wonderful window into how the brain works. A lot of the information was there, not quite enough,

but enough that she could keep going. She kept the rhyme scheme, she kept the rhythm.

The recording, by the way, if you have a copy of the book, there's a QR code on it, and if you point your phone at it, it'll unlock a webpage that links to all six major streaming services, and every song mentioned in the book in the order mentioned can be found on one of the streaming services, and you can hear Ella's, and in the actual versions that I talk about in the book. So you can hear Ella. - It is an extraordinary performance. - And we can't do it here for copyright reasons.

I can't even sing Mack the Knife here. Oh, gosh, yes. No, that's interesting, isn't it? Anyway, that's a different conversation for a different day.

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for 24-7 support in Massachusetts or call 1-877-8-HOPE-NY or text HOPE-NY in New York. So we've talked a little bit about memory. We can come back to that in more kind of severe contexts when people suffer from specific illnesses. But what about, we talk a lot about things like mindfulness these days, the need to be in the moment, but music can transport us. It can send us to a sort of dreamlike state. What's happening then?

We in in the neuroscience field we discovered a kind of mode of consciousness or awareness called the default mode and it was discovered by accident but the basic idea is that there are two primary modes of wake wakeful attention one is when you're

deliberately trying to focus on something. You're focusing on your work or on driving or reading or a conversation and that takes a lot of mental resources to marshal that attention. The phrase paying attention is an apt metaphor because attention is a limited capacity resource and you pay for it

with the fuel of the brain, oxygenated glucose, and when that runs out, you become tired. You're paying for it. There's a limited amount of attention you have. When your attention starts to flag, you enter what we call the default mode. That's where your brain wants to be. It's the mode of mind wandering, where you're no longer in control of your thoughts. They're loosely connected.

One way to get into the mind-wandering mode is just to be really tired and you start daydreaming. Another is maybe you're at a beach and you're having one of those fancy drinks with the umbrella in it and you're really relaxed and you're looking out at the waves. Often, I have the experience that I'm reading a book

and a couple of pages will go by and I realize my eyes were following the words but I didn't really register what I was reading because my mind was in that daydreaming mode. Meditation can put you in that mode.

The reason it's an important mode is that it's restorative. That's the mode that restores the spent glucose so that you can then pay attention again later. But again, that's a kind of a therapeutic value of music because music can definitely trigger that state. Music is one of the most reliable ways to get into that state. And again, I keep mentioning Vinod Menon, my colleague at Stanford,

terrific systems neuroscientist. He and I discovered that music puts you into the default mode network, the daydreaming network, in a brain scanning experiment. And we also figured out where the neurochemical switch in the brain is that takes you from one mode to the other. It's in a portion of the brain called the insula. This will be on the test later. And it's about an inch and a half below the center of your head here, deep in the brain. It acts as the switch to bring you from one to the other.

Fascinating. I should at this point point out, I've got lots more questions, but there will be an opportunity for all of you to ask questions. So please, you know, keep them in your head and we'll get to them in a little while. So, okay, mindfulness, dreamlike state, that's one thing. What about pain? There's lots of research, and I think you've conducted quite a bit, that shows how music can be used to mitigate pain. What is the evidence?

I'll back up a second and say when I wrote my first book in 2005, it was published in 2006, "This is Your Brain on Music", I wanted to talk about music and its therapeutic value, and particularly music and pain, because there were so many anecdotes about people using music to treat injury and pain, and to lessen the sense of pain.

But the science really wasn't very good back then, and wearing my scientist hat, I feel an obligation to not say things for which I lack ample evidence. So I didn't write that into the book, but in the intervening years, a whole lot of research has been done. 8,000 papers in the last two years alone on music and medicine, many of them on music and pain, and one of the things that

is relevant here is that my lab showed about 10 years ago that when you listen to music that you like, it doesn't matter the genre, it just matters that you like it,

It can be classical, it can be hip-hop, jazz, country, it can be Tuvan throat singing or Chinese opera. My favorite. It doesn't matter. If it's music you like, it releases endogenous opioids. Your brain's own opiates are released and they act as an analgesic, as a pain reliever. They raise your pain threshold so that you feel less pain. So it's a distraction, it's a mood enhancer? What is it?

Yes, and yes. There's different things going on. It's not just one thing. The pleasure centers of the brain are releasing these opiates. In addition, music is distracting. It distracts your attention away from the pain. It modulates your mood by releasing serotonin, which puts you in a better mental state and makes you think more positive thoughts. One of the problems with being in pain is

similar to being depressed is there's this phenomenon called state-dependent memory retrieval. When you are in one emotional state, it's very difficult to recollect, to call up from memory other emotional states. So when we're depressed, it's very hard to remember times when we were happy and vice versa. When we're in pain, it's hard to remember times when we're pain-free. And so, you know, it's all of those things.

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