Music as Medicine: How to Harness its Therapeutic Power, with Daniel Levitin (Part Two)
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Welcome to Intelligence Squared, where great minds meet. I'm Head of Programming Conor Boyle. Today's episode is part two 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. I think you were going to play us a piece that was going to talk about the relationship of music and pain. It's a piece called Roisin Dove. Let's hear a little bit of that. So just tell us a little bit about it. You explained the piece really beautifully earlier. Thank you. Yeah, so it's called Roisin Dove and it's a really old Irish song.

very popular back in, well it's from the 16th century, but it basically means black rose and it's a love song, but I suppose the love song is a bit of a disguise for Ireland and the song is about Ireland and one's love for one's country. Thank you. So when we're thinking about pain, I mean that's a very emotional piece, even if you don't know the explanation that Anna's just given us.

But you're saying that stirs something in me, but if I was to look at my pain, trying to reduce pain, should I be in pain? It wouldn't be that piece. It would have to be a piece that spoke to me in the same way that we were talking about how you trigger memory, you trigger people's wellness through music. So as we were talking about, music is very personal. Our tastes are individual.

We develop our taste through a lifetime of listening. A lot of it is social. It's what our friends listen to. It's what we listened to when we were between the ages of 12 and 18. It's what we shared with our friends. And it's associated with songs or pieces associated with different experiences in our life move us. But new songs can move us too. And we haven't quite figured out the science of that. So...

If that piece resonates with you, even though it may be unfamiliar, that could have all of the beneficial effects. The trick, of course, is finding the right music. It turns out most of... We've brought people into the laboratory, and most people know if you say bring in something relaxing, you find relaxing. And then we wire them up and we look at their blood pressure and their pulse and their respiration rate, muscle tension. It really is relaxing.

And most people know what kind of music will get their heart rate going through an exercise workout or motivate them to finish the exercise workout. There's a profession of music therapy, which is a certification, which is a form of psychotherapy that uses music, either helping patients to write their own songs or play along with music, to sing or to listen to music. And one of the roles of the therapist there is to help

us find music that will help us reach various therapeutic goals. The idea there is that even if you have a favorite song, you may not want to hear it all the time. And if you've got a song that relaxes you, it may not relax you all the time. And you may run out. They may have dug too deep a neural rut. You need new things. So the therapist can help you there. Or increasingly, you

the streaming services make recommendations that are pretty good. Not as good as they could be, but they're getting there.

Actually, the idea of personalization, that's something that could happen with AI in a streaming service. I mean, they're already trying to vlog your stuff, aren't they? They take you down algorithmic routes. But could that actually be quite positive? I see it as quite negative right now. Well, there are 200 million songs now on the streaming services, across all the streaming services. 200 million songs. That's a lot. Pretty much any song that has ever been recorded, if it's not on a streaming service, it's somewhere on the web.

including songs that were made in field recordings of hunter-gatherer tribes that had been cut off from Western civilization. Somebody went there and used a portable recorder and then put it up on their website. It's all there, and there are 100,000 new songs being uploaded every single day at last count. That doesn't even count the ones that are being created and not uploaded. So somewhere out there, there's music that you might love.

that you just don't know about. And AI will have, in the coming couple of years, the ability to look at your listening history and extract some patterns, some regularities from that, and help find, in a multidimensional space, probably 150 dimensions of musical taste, what is nearby or in orbit of the songs that you already like, or in particular, the songs that you like for relaxing, for comforting,

for a social lubricant at a party, dance music, that sort of thing. - Extraordinary. So let's talk about really quite severe illnesses and how people can be helped by music. In the book you talk about MS and

how patients with MS, their walking can be improved depending on the kind of music that's played to them. What is that about? Just explain that to us a little bit more. So multiple sclerosis MS is caused by degradation of the myelin sheath.

Your neurons are carrying electrical signals, and like the electrical wires in your house, they're insulated. It's a fatty white substance, which is why we call it white matter, and it's acting like the rubber or non-conductive insulation around wires in your home, and as you know, if rats chew through it, you can get a short circuit. And so you want to have myelin in your brain to prevent neural short circuits,

When it's degraded due to this disease, you end up with multiple sclerosis and often an inability to walk. Similar case of an inability to walk is Parkinson's disease, although for different reasons. The disease doesn't degrade myelin, but it degrades the very circuits in a region called the basal ganglia that allow you to time when you're going to put one foot in front of the other

Walking has to be done in a certain order. You can't have both feet up in the air at the same time. And because of the degeneration of the clocks that regulate the pace of your footsteps, people have trouble whether they have MS or Parkinson's. But music that is at the tempo of your walking speed, your gait, can allow you to synchronize. It acts as an external clock. There are entire populations of millions of neurons in your brain that synchronize automatically

even in young children, to the beat of the music. It has to have a beat, it can't just be ambient music with no rhythm. And that happens automatically. So do we have an internal rhythm then, in general? Can we talk about having an internal rhythm?

You know, there's been research into whether there's a preferred rhythm, whether there's a set point where some people prefer some tempos over others. The work is kind of messy. There may or may not be. We don't know for sure. But there certainly is a natural speed for your gait. There's a natural speed at which people talk. And when those internal clocks are degraded, an external clock such as music steps in. This episode is sponsored by NetSuite.

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You illustrate the effect of Parkinson's and how it can be overcome by talking about Bobby McFerrin, who is able to perform extraordinarily despite suffering from this illness. What's going on then? Again, it's this rhythm, it's this memory that is coming to the fore despite the fact that he is... So Bobby's an interesting case. He was diagnosed with Parkinson's a few years ago. I write about him in the book.

He doesn't have trouble walking right now in particular, but he does have trouble with fatigue, profound fatigue. And what he discovered on his own was that the act of performing is energy producing, not energy draining.

I know a lot of musicians who can't perform because it saps the energy out of them. I don't know her, but Carly Simon has said, for example, that she can't perform because it sucks all the energy out of her. And so she rarely tours. She made records during her career in the 70s and 80s.

Other performers thrive on it, people like James Brown, you know, they're performing all the time, they get energy back. Bobby's like that. Bobby gets so much energy back from the audience that his way of self-medicating the fatigue from Parkinson's is to perform every week for an hour and a half in Berkeley, California, near where he lives.

And no two shows are alike. It's entirely improvised. He'll conduct the audience into... He'll assign them parts and they make chords and he improvises over it. It's a tremendously healing process for him and for the audience. Fascinating. Again, part of it is dopamine.

Dopamine is a neurochemical that unlocks certain circuits in your brain that motivate you. It's also associated with the pleasure network. And then oxytocin is a neurochemical associated with increased feelings of trust and bonding towards other people.

People who sing together release oxytocin and that unlocks separate neural circuits that engender trust and bonding. So returning to memory and how musicians learn music, Anna, when you think about learning a piece and how you memorize pieces, if that's what you have to do, what's the process for you? Is it about repetition?

Yeah, I suppose, well definitely the more you do it, the easier it gets. It's like a muscle in itself. And I suppose you would never approach a whole piece at one time. You would break it up into smaller sections that kind of make sense in themselves. And I suppose a lot of that is predicting what will come musically. So yeah, the more you do it, I suppose it gets easier. So Daniel, when we think about neurological disorders,

Are there situations where repetition can help, this constantly having learned something in this way?

Well, a good case of that is loss of the ability to speak, what we call expressive aphasia. This typically happens when a part of your brain in the left hemisphere called Broca's area becomes damaged from an injury or a stroke or disease. This happened to Congresswoman Gabrielle Giffords in the US in 2011. She was shot in the head in Tucson and the bullet took out her speech centers and she couldn't speak, but she could still sing.

This is a well-known phenomenon because, as we were talking about earlier, musical circuits are separate, they are evolutionarily older, they're phylogenetically older, they're deeper in the brain, and so those remained intact. So she was taught to sing things like

"I need a glass of water," or "Show me to the bathroom." She could do that fine. And with those circuits intact, and through the act of intense repetition and therapy, called melodic intonation therapy, she was able to build, to construct new neural pathways that allowed her eventually to speak what she wanted to say spontaneously and without singing.

So what's the application of that then to people with dementia? You know, I have a friend whose mother literally can't remember what she had for lunch, but she goes to the choir and she can sing songs that she's known since childhood. She can still speak French, but she can't remember what happened. Bien sûr. Bien sûr. Well, you know, so this is... Dementia doesn't present the same way in any two people. There's no really typical progression other than that

One of the paradoxes of it is that it can affect short-term memory profoundly, but long-term memories stay intact. A principle of memory is that the first memories that go in are the last ones that come out. They're the last ones that are damaged.

because memory builds up hierarchically in layers, as it were, at least metaphorically. So we remember things from our youth. We don't remember what we had for breakfast yesterday. My father doesn't have dementia. He's 92, but he does have short-term memory loss, and it's really very interesting because he'll say, "When are we having dinner?" And my mom will say, "In half an hour." And then 30 seconds later, "When are we having dinner?"

After dinner, he'll say, when are we having dinner? But he'll remember that I'm coming over on Saturday, and he'll remember that my mother just painted a new painting, and she's going to be showing it in a gallery. But then he won't remember having gone to the gallery. So it's spotty. It's not all or nothing. But the music is still there. And he played piano as a child, and at night, he hasn't played in probably...

80 years, but he's getting back to it and it's coming back faster than you can believe. That's amazing. So actually if anybody is in that situation with an aging parent or somebody with dementia, you could use music as a kind of therapy if they're open to it. Absolutely. It's something that still makes sense. What we often see in care facilities for older adults, when profound memory loss

hits, either from Alzheimer's or other forms of memory loss. Sometimes the person reaches a point where they no longer know where they are. They don't know how they got there. They don't recognize loved ones. They may not even recognize themselves in the mirror. This is so deeply disorienting and disturbing that people tend to respond in one of two ways. They either become violent and aggressive because nothing makes sense,

Then they have to be medicated, sedated, and that really is bad for everyone, quality of life. It harms memory even more. Or they fold in on themselves because nothing makes sense, so they shut down. And we've seen so many cases of introducing music into a care facility, music of the person's youth, where, like Joni, they suddenly are able to reconnect with a part of themselves they had lost.

they become themselves again for a few moments and the effects can linger for days. Astonishing, it is really, it is jaw-dropping. A few things I want to get through before we open it up to questions. So we've talked a little bit about the emotional impact of music

and lots of us, you know, will have that feeling if you hear your favorite piece of music and, you know, it lifts your mood and equally it can bring you down. But can music actually help people who are suffering from really severe depression, which is obviously of a different order from having a slightly bad day?

Depression is one of the biggest problems. Antidepressants work in only about 50% of the people, and then they only work about 50% of the time. It takes a long time to discover whether they're going to work or not before the doctor switches you to a different dose or a different formulation. Talk therapy seems to work a little bit, but not always. The combination of talk therapy and medication is better than either one alone.

But music often is not by itself but part of a program of different approaches. And in particular, people who are depressed respond well to sad music. That seems a bit counterintuitive. It does, but if you think about it, when people are depressed, in some sense, they tend to feel misunderstood, misjudged, cut off from others.

The right piece of music comes on, and within a few moments, you feel, "Oh, that's how I feel. Somebody understands me." And they're there at the edge of the abyss, staring into it with me. We're together in this. Oh, and at least subconsciously realize they've been through this experience, they came out the other side, and created a beautiful work of art. There's hope for me. I'm not alone.

So we've talked about music, but what about the power of songwriting, the words? How do words and music interact together, and why can that have a really particular impact on us? So lyrics are not... Lyrics can have poetic qualities, but they are not poetry. They are intended to be accompanied by music. And then there are... Certainly some great musical pieces don't have lyrics, but when you combine them...

you're really allowing for the expression of emotion on the part of the songwriter. And oftentimes when a songwriter... Most of my friends are songwriters and musicians, and most of the songwriters

are writing songs in order to work out their own experiences, the way somebody might talk to a therapist or a best friend or write in a journal. They're trying to process some emotion they don't understand. And I was very, very lucky because Joni served as a songwriting mentor for me over many, many years, as did another fabulous songwriter, Rodney Crowell. They both helped to... They didn't help me write songs, but they helped me think about the process of expressing myself.

And I remember going to Joni's house one day with a song. I had just broken up with my girlfriend, and I was having mixed feelings. I was kind of relieved because it wasn't that great a relationship, but I was also sad. I was despondent, but also hopeful. It was just a jumble. And I had this line in the song that was authentic and true, and I don't know how I feel. I get to that line in the song, and Joni yelled,

She said, "What do you mean you don't know how you feel?" I said, "I don't. You told me I have to be honest." She said, "It is your job as a songwriter

to figure out how you feel. Nobody wants to know that you don't know how you feel. You've got to peel back the layers of the onion until you get there. It could take days or weeks or years, but you have no business writing the song until you figure it out. People want to hear that you've figured it out. Some of us have relied on Joni Mitchell to tell us how we feel most of our lives. That's right. And so for me, it's been, I think for many songwriters, an exercise in understanding

my own emotions. And if a songwriter is lucky, they can talk about a very particular experience and in the details and peculiarities of it, it becomes universal. It's Joni writing about something written on a napkin in a bar. It's Rodney Crowell writing about feeling the earth in his bare toes as he's walking barefoot.

That may be so very particular and it may never have happened to you, but you feel the common humanity in it. Wow. What's up? I just bought and financed a car through Carvana in minutes. You? The person who agonized four weeks over whether to paint your walls eggshell or off-white bought and financed a car in minutes. They made it easy. Transparent terms, customizable down and monthly. Didn't even have to do any paperwork. Wow. Mm-hmm.

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who, there's a program in the US called Songwriting with Soldiers and soldiers suffering from post-traumatic stress disorder are paired up with professional songwriters and they get that trauma outside their body and their psyche out into the world in the form of a song and it no longer haunts them. The light is shining on it. It becomes out there and they can cope. So Daniel, is this the moment when we get to hear from you and one of your songs?

If you insist. It would be lovely. This is a song that I wrote at one point Rodney suggested

that I write songs that are not about my own experience, that I try to put myself in the experience of others as an exercise in empathy and tolerance and really to expand my mind. And so both Rodney and Joni and many great songwriters have taken Greek myths and written about them. Leonard Cohen wrote "Hallelujah" about King David playing music for King Saul. I heard there was a secret chord that David played and it pleased the Lord.

And so I had a songwriting friend named Chris Williamson who gave me a picture from Life magazine from the 1950s of a waitress in a cafe. That was an exercise in trying to write a song from her perspective. And just the song, it was this very mysterious process where I didn't know anything about her. All I had was the picture. But as I wrote the song...

It seemed as though she was telling the story. And so I'll share that song with you. But first I will tune, because I care. The guitar was in tune, but then the heat of your bodies in the room changed the wood. Do you need to retune? Anna is going to join me. This is an arrangement by Olivier Manchon, who is the arranger for a group called Claire and the Reasons that I just love, one of my favorite groups.

So this is a song between a, it's a duet between a waitress and a coffee shop and a truck driver. I'm going to sing both parts. She starts. Standing at the counter of the Digby Cafe, I never did marry. My heart is a brand new cup, unfilled with dreams so sweet to carry. His turn.

I bring the coal to your cold house. I bring the fire to your stove. I try to catch your eye as you serve. Give me one more smile for the road. I pour a lonely cup of coffee. Bring it slowly to my lips.

Like the objects in the mirror of the truck you drive up here. Oh honey, I'm closer than I appear. I know how you like your hash brown, crispy and well done. I cut your grapefruit segments and then I get that special spoon.

You deserve a perfect man, one who don't drink or fight. But life's a burned out cigarette, and we all could use a light. I pour a lonely cup of coffee, bring it slowly to my lips. Like the objects in the mirror of the truck I drive up here. See, I'm closer than I appear.

One morning, as the roosters crowed, the kitchen broke out in a fire. Digby and everyone else raced out. I fell down and thought I heard the angels quiet. I ran to her, held her high across my chest, laid her down outside and kept her from the wind.

Cradled her head gently in my hand. Her eyes were closed, her breathing thin. Poured a loving cup of coffee. Raised it slowly to her lips. And as she raised her head, her eyes were bright and clear. She said, honey, I'm closer than I appear. We both said, honey, you are closer than we appear.

Thank you. That was fabulous. Thank you so much. Well, that is a fantastically inspirational place to end. Thank you very much, Daniel Levitin, for a great conversation. Thanks also to Anna Mitchell. And Daniel's going to be signing copies of his book, so please do stick about for that. And thank you also for your great questions and hope to see you again at Intelligence Squared. Thank you. Thanks for listening to Intelligence Squared. This episode was produced by myself, Conor Boyle,

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