Mozart , Music and Medicine

According to the first publication in 1993 by Rauscher et al. [Nature 1993; 365: 611], the Mozart effect implies the enhancement of reasoning skills solving spatial problems in normal subjects after listening to Mozart’s piano sonata K 448. A further evaluation of this effect has raised the question whether there is a link between music-generated emotions and a higher level of cognitive abilities by mere listening. Positron emission tomography and functional magnetic resonance imaging have revealed that listening to pleasurable music activates cortical and subcortical cerebral areas where emotions are processed. These neurobiological effects of music suggest that auditory stimulation evokes emotions linked to heightened arousal and result in temporarily enhanced performance in many cognitive domains. Music therapy applies this arousal in a clinical setting as it may offer benefits to patients by diverting their attention from unpleasant experiences and future interventions. It has been applied in the context of various important clinical conditions such as cardiovascular disorders, cancer pain, epilepsy, depression and dementia. Furthermore, music may moduReceived: May 27, 2013 Accepted: May 27, 2014 Published online: July 19, 2014 Prof. emer. Dr. Ernest K.J. Pauwels Via di San Gennaro 79B IT–55010 Capannori (Italy) E-Mail ernestpauwels @ gmail.com © 2014 S. Karger AG, Basel 1011–7571/14/0235–0403$39.50/0 www.karger.com/mpp Prof. Pauwels dedicates this paper to Maestra Sonia Rubinsky, who helped him tremendously with her musical and pianistic interpretation of the sonatas of Mozart and Scarlatti. Th is is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only. Pauwels /Volterrani /Mariani /Kostkiewics Med Princ Pract 2014;23:403–412 DOI: 10.1159/000364873 404 harmonic music is able to soothe people and cure ailments of the spirit, body and soul. He believed that the mathematical nature of music influenced the mind and the body and termed it ‘musical medicine’. In addition, he believed that the principles of harmony had the power to incite various emotions [1] . In The Republic , book III, Plato declared musical training a more potent instrument than any other because ‘rhythm and harmony find their way into the inward places of the soul’ [2] . In book 8 of Aristotle’s Politics , it is argued that music has cathartic effects and that catharsis should be understood as a harmless release of emotions [3] . In modern times, a definite link was made between music and emotion, intuitively felt – and experimentally assessed by Goldstein [4] – as when one experiences chills and shivers while listening to preferred music. Recent papers confirm that listening to music for pleasure is related to a change in emotional arousal [5, 6] . In this way, music has a positive effect on psychological well-being, giving rise to a higher level of performance. It is likely that the so-called Mozart effect, first described in an article published in 1993 by Rauscher et al. [7] as comprising better spatial reasoning skills in normal subjects after listening to Mozart’s piano sonata K 448, comes into this category. Subsequent multidisciplinary research in the music domain has attested that musical stimuli can activate physiological pathways that can modulate body responses [8] . Growing evidence shows that listening to preferred music shows beneficial effects in the areas of cardiac and neurological function [9, 10] . On this basis, it is plausible that listening to pleasurable music is suitable as an adjunctive therapeutic tool in the treatment of various heartand brain-related diseases, a field known as ‘music therapy’ [11] . Examining recent studies, mostly not older than 5 years, this review will elucidate relevant neurobiological effects of music listening in adults, followed by some remarks on the above-mentioned Mozart effect. After this, the use of music for medical ailments will be illustrated, highlighting various beneficial aspects in adults. We like to emphasize that the effect of music on domains such as speech, language abilities and verbal intelligence is beyond the scope of this paper. Neurobiological Studies and Music Positron Emission Tomography and Functional Magnetic Resonance Imaging Studies Modern imaging techniques [positron emission tomography (PET) and functional magnetic resonance imaging (fMRI)] suggest that a large bilateral cerebral area, known as the limbic (e.g. amygdala and hippocampus) and paralimbic structures (e.g. the orbitofrontal cortex, parahippocampal gyrus and temporal poles), is engaged when listening to music. Koelsch [12] has mapped the music-evoked areas that are repeatedly reported by various researchers. It appears that the amygdala, the nucleus accumbens and the hippocampus are frequently mentioned as activated structures, and this suggests that music is able to modulate activity in the core areas of emotion, among other regions. fMRI studies have also demonstrated that unpleasant irregular chords may elicit brain activity related to emotional processes, as evidenced by increased bilateral blood oxygen levels in the amygdala [13] . A number of studies have attempted to map the effects of tonality on neural activation. It has been observed that the minor keys activate larger areas of the brain than do major keys, which suggests that the two musical modes are processed differently [14] . When minor consonant chords are perceived as beautiful, the right striatum is strongly activated. This structure is known to be strongly involved in the processing of rewards and emotional processing. By contrast, major consonant chords induce activity in the left middle temporal gyrus, which is related to coherent information processing [15] . A recent study by Trost et al. [16] using fMRI confirmed that high-arousal joyful musical activity takes place in the left striatum and insula, whereas low-arousal nostalgic sad music activates the right striatum and orbitofrontal cortex. Other researchers have also demonstrated that distinct parts of the brain are activated by music as a function of tonality. For example, Pallesen et al. [17] demonstrated that the minor tonality, compared with the major one, showed a selective engagement of the amygdala, retrosplenial cortex, brain stem and cerebellum. On the other hand, Brattico et al. [18] found that sad music, often associated with the minor key, induced activity in the right caudal head and the left thalamus. Green et al. [19] revealed that minor tonalities cause an increased activity in the left parahippocampal gyrus, the left medial prefrontal cortex and the bilateral ventral anterior cingulate. From these imaging experiments, it is clear that various cerebral structures may be activated, which is ascribed to different factors in the classification of emotion and dissimilar neural activation [20, 21] . Neurobiochemical Features of Music Listening The biological mechanisms involved in music appreciation are far from understood, but some hypotheses based on experimental results are worth considering. Fukui and Toyoshima [22] mention that listening to music