09.02.2017
by Since music is a combination of melody, rhythm, and instruments, it represents a collaboration between history, geography, art, folklore, and therapy. From this perspective, musical values come into play. The 12,000–14,000-year-old figures of dancing humans at Gobustan, the 6,000–8,000-year-old figures of dancing humans near the city of Hotan in East Turkestan, the 4,000-year-old Pazyryk zither, and the 1,200-year-old Göktürk bowed lute all attest to this richness.
According to Uyghur and Chinese sources, we see that music and movement have played a significant role in daily life dating back to around 3000 BCE. It is also noted that in ancient times, the Uyghur Turks had healers known as “pirhon,” while the Kazakh, Kyrgyz, Altai, Turkmen, and Uzbek Turks had healers called “kam” or “baksı” (bahşa, bahşı), and it is observed that some of their practices continue to this day. These healers seek to establish a connection with Ataru by combining melodic performance with sacred concepts and figures, and they apply the experiences they have gained through intuition to the patient. The musical instruments they generally use include the stringed kopuz, the dombra, the mouth kopuz, and percussion instruments. Musically, they conduct therapy using pentatonic (five-note) melodies and four-beat rhythms. It has been determined that this five-note music, used in ancient times, is currently applied to autistic children at the world-renowned London Rempton Institute, where it has been found to boost self-confidence and determination and increase alpha and theta waves in the brain. The institute’s therapeutic and educational activities have gained worldwide recognition and have established the fundamental tradition of music therapy in many countries.
In Turkish culture, the pentatonic scale continues to serve both as a means of creating and healing, while also serving as the foundation for folklore and artistic expression in conveying certain emotions.
While the aforementioned pentatonic system continued to evolve, maqam music also developed within the Khorasan culture—which encompasses Turkmenistan, Uzbekistan, Afghanistan, Kazakhstan, Iran, Azerbaijan, the Uyghur, and Altai regions—and, Over the course of millennia, nearly five hundred musical modes have emerged, and about forty of these have been incorporated into the literature on music therapy of Turkic origin. They have been classified in the works of many figures in medicine, art, and culture, most notably al-Farabi, Ibn Sina, and Abu Bakr al-Razi. These classifications convey experience-based knowledge regarding which modes affect which organs and emotions, and under what circumstances. Furthermore, this information was used to select musical modes and to form opinions regarding the diagnosis of illness, treatment, and treatment outcomes through methods such as pulse diagnosis, facial color diagnosis, urine analysis, and speech history, among others. As far back as 900 years ago, music therapy was used systematically for the first time at the Nurettin Hospital, commissioned by Seljuk Sultan Nurettin Zengi. In subsequent periods, therapeutic applications in this field were carried out in the hospitals of Kayseri, Sivas, Amasya, Manisa, Bursa, and Edirne, and it is recorded—particularly in Evliya Çelebi’s travelogue and other works—that appropriate musical modes were performed for patients three days a week using the ney, çeng, santur, miskal (musikar), ud, violin, rebab, and percussion instruments—as documented particularly in Evliya Çelebi’s travelogue and certain other works.
The history of music therapy dates back as far as that of medicine. This is because people often used these therapeutic tools together. Homer used music during surgeries and was successful. Plato placed great emphasis on the teaching of music. Asclepius is famous for using a trumpet to treat deafness. Both Cicero and Celsus speak of the beneficial effects of music on the mentally ill. Celsus states the following regarding the treatment of mental illnesses: “Just as aggression in the mentally ill can be brought under control by flogging, so too must the aggression of all others be curbed. In some patients, unwarranted laughter, outbursts, and threats must be curbed; in others, melancholic thoughts must be dispelled, and music and loud noises can be used for this purpose” (5).
Aristoxenes says that music goes well with meals because its symmetry counteracts mental and physical excesses. Maerobius also states that music heals the sick (5).
It is said that among the Scandinavian peoples, songs and melodies were used to treat the sick, make people sick, heal wounds, stop bleeding, relieve pain, or induce sleep (5).
The Havamal, an ancient Icelandic poem, contains the following lines: “I have songs that no king’s wife, no son of man, can repeat. One of them is called ‘The Helper.’ It helps you when you need it—in sickness, in sorrow, and in all your hardships. I know such a song that all men should sing if they wish to become skilled physicians” (5). Anglo-Saxon texts contain references to songs believed to have therapeutic value (5).
One of the first people to introduce music therapy into clinical practice was the renowned neurologist Philippe Pinel. In 1872, while Pinel was still young, the Revolutionary Committee granted him permission to take fifty mentally ill patients from two large church hospitals out into the sunshine and to break their leg irons (6).Pinel, who was the first to undertake this bold initiative, later proposed incorporating music into moral therapy while working at the Bicêtre Hospital.
Dr. Willer Van de Wall was one of the pioneers of music therapy in the United States. In 1920, he researched the effects of music on the human psyche in hospitals and prisons in the states of Pennsylvania and New York. According to Wall, music has both calming and stimulating effects on the human psyche (6).
Licht examines music therapy in two distinct categories: active and passive. Music enhances patients’ attention, sustains their interest, and influences their behavior, thereby providing a sense of comfort (6).Radin, after noting that music has positive effects on primitive people, states that it holds value in therapy because it serves as a symbol of the priest and helps control the evil spirits that cause illness (6).According to Zanker and Glatt, music acts on the unconscious, bringing repressed feelings to the surface and thereby providing a form of catharsis (6). Murineddu and Drake also view music as a stimulus that focuses attention and a force that directs behavior. Music not only calms agitated patients but also awakens withdrawn patients. By playing music for patients, their attention is directed, and they are distanced from pathological thoughts. Thanks to music, the patient’s engagement with reality and the environment increases, and the patient begins to feel more socially connected (3).
While Frey notes that music has a hypnotic effect and soothes agitated patients (4), the Polish scholar Damianowski views music therapy for mental illnesses as a form of conditioned treatment, in accordance with Pavlov’s theory of conditioned reflexes (6).
However, despite all these preparations, music therapy has only found its way into psychiatric clinics over the past fifty to sixty years. Altshuler has incorporated music into the treatment program at the Michigan State Hospital since 1947 (1).Altshuler was followed by Ainlay in 1948, Mann in 1950, Blair in 1955, Gilliland in 1956, and Shervin in 1957 (6).
Gaerdner and Paul in neuroses, Jaedicke in climacteric psychoses, Gillis and Lesceiles in schizophrenia, Altshuler and Lucas in depression,Kratter in oligophrenia, and Zanker and Glett in alcoholics and patients with neuroses, have achieved positive results with music therapy (6).
In recent years, Oswald (1967) and Koh and Hedlund (1969) studied schizophrenic patients; Diephouse (1964) and Scott (1970) conducted research in child psychiatry; Zonneveldt (1969) in cases of neurosis, Weber (1967) in experimental psychoses arising from various psychodysleptic conditions, and Neli (1965), Schultz (1969), Ruiz and Pilon (1969), Üirich (1969), Koffer (1969), and Dickens and Sharpe (1970) have applied music therapy in group psychotherapy (6).
Research into music therapy methods first began in the United States after World War II at the Music Research Center and a division of Walter Reed Hospital (6).The Music Therapy Society is still active in the United States, and only those who have conducted research on music and its use in psychiatry are accepted into this society. Candidates for membership are evaluated not only on their personality, adaptability, and professional competence but also on their musical abilities. Today, specialized music therapy courses are offered at medical colleges and universities, many of which are located in the central and western regions of the United States. However, it is mandatory for those engaged in this field to undergo specialized training. The state of California was the first to officially mandate music therapy as a treatment method. Following this, other states, taking California as a model, have begun to implement this method (6).
The use of music therapy for children with intellectual disabilities dates back to the 1940s. Kratter, Michael and Smith, Hutt and Gibby, Gaston Francis and Rarick, Hunt, Hudson, and Spivack have achieved positive results with children exhibiting intellectual disabilities (6).According to Michael, because music is a form of nonverbal communication, it strengthens interpersonal relationships in children with intellectual disabilities and empowers them socially (6).In another study conducted with Smith, Michael applied music in conjunction with psychotherapy to children with intellectual disabilities (6). Gaston points out that music makes a significant contribution to strengthening group dynamics and that it creates an ideal therapeutic environment (6).Dybwad, Hutt, and Gibby; Stockbine, Weigl, and Goda have noted that music therapy can yield positive results even in children with severe intellectual disabilities (6).
For children with autism, music serves as a way for them to move beyond their introverted nature and open up to the outside world. It has been observed that these children pay attention to music in an abstract way even outside of therapy. The first study on this topic was conducted by Despert in 1947 (14, 20). This was followed by studies by Bergman, Escalone (1949), Mahler (1952), Shervin (1953), Settiage (1959), Rimland (1964), and Robinson (1966) (6).
For elderly patients with mental illness, music may not offer much in the way of therapeutic value. However, the act of participating in rhythmic and vocal activities can foster a sense of togetherness, a feeling of not being alone, and a sense of security, and can help reduce distress. This form of therapy was first implemented by Wells in 1954. His work was later followed by studies by Andrus (1955), Hail (1957), Altshuler (1960), Hart (1960), Wallin (1962), Chachere (1966), and Kurz (2,6,7).
With this type of treatment in elderly patients, their hostile and aggressive attitudes soften, their selfish and childish behaviors decrease, their memory is strengthened, and they develop a sense of tolerance (6,7).
Today, there are many music therapy specialists around the world who use various musical elements (melody, rhythm, instruments, etc.) in their work. For example, it is reported that there are 3,000 music therapy specialists in Germany and 1,000 in South Korea.
In various Western countries, evidence-based research has been conducted to establish the acceptance of music and movement therapy; following numerous laboratory findings, its validity has been indisputably accepted, leading to its integration into education and practice.
Until recently, Western countries, which were unfamiliar with the therapeutic effects of the Turkish tradition of music and movement therapy, have come to recognize the benefits of this tradition following evidence-based studies: Research conducted at the Meidling Clinic in Vienna, Austria (EEG recordings revealed an increase in alpha and theta rhythms when patients in a coma in the neurology department were administered appropriate Turkish music therapy. Additionally, projects examining the effects of Turkish music in the fields of geriatrics, oncology, immunology, and cardiology are ongoing at the Meidling Clinic), neurophysiology research and clinical applications at Berlin’s Urban Hospital, the applications and observations in the field of cardiology by Dr. Mehmet Öz, a cardiac surgeon at Columbia University’s New York-Presbyterian Hospital, and the music and movement therapy clinical psychology doctoral research and applications conducted by Assistant Professor Dr. Rahmi Oruç Güvenç in the Department of Psychiatry at Cerrahpaşa Faculty of Medicine between 1976and 1994 by Assistant Professor Dr. Rahmi Oruç Güvenç in the Department of Psychiatry at Cerrahpaşa Faculty of Medicine; algology research studies conducted in 2007 by Prof. Dr. Avni Babacan and his team in the Department of Algology at Gazi University (in this study, patients’ blood values were measured before and after sessions, and a 40% decrease in stress hormones was observed after the sessions), and studies conducted at the Department of Child Psychiatry at Gazi University bystudies conducted by Prof. Dr. Elvan İşeri and her team (tests administered after the sessions revealed improved learning and communication in children with autism, cerebral palsy, and intellectual disabilities who participated in the sessions), and music and movement therapy applications for patients undergoing chemotherapy at the Oncology Department of Ankara Numune Hospital(anxiety and complication tests are administered), bioresonance studies conducted by Dr. Gülşat Akmemet (significant positive changes in energy levels were observed in those tested with the bioresonance device), studies conducted at Istanbul Memorial Hospital by cardiologist Prof. Dr. Bingür Sönmez, anesthesiologist Dr. Erol Can, and their teams since approximately 2006(in the cardiology intensive care unit, music therapy is administered to heart patients, and clinical observations confirm a reduction in emotions such as fear, worry, anxiety, and restlessness).
In general, studies conducted worldwide on this topic have shown that when music is played at an appropriate volume and rhythm, using natural instruments in an improvisational style, it affects the limbic system in the brain, leading to changes in emotions and hormonal changes, psychogalvanometric reflexes change, and anxiety levels shift, among other effects.
Sources
1. ALTSHULER, I. M.: “The Theory and Practice of Music Therapy.” Proceedings of the IInd International Congress on Psychiatry, Zurich, Switzerland 111:365-371, 1957.
2. BOXBERGER, R., COTTER, W. V.: “Music Therapy for Geriatric Patients”. *Music in Therapy* (Ed. E.T. Gaston). New York: Macmillan Company, 1968, 271–278.
3. ÇOBANOĞLU, E.: “The Treatment of Mental Illnesses with the Fine Arts.” Journal of the Faculty of Medicine, Ankara University, 13: 257–262, 1962.
4. FREY, E.; “Music and Psychotherapy.” (Schweiz Arch. Neurol. Psychiatrie. 67:2, 274-291, 1951).
5. GARRISON: “Music and the Art of Healing” Bulletin I.
6. GREBENE, Dr. Bekir: “Music Therapy”. Güven Kitapevi Publications, Ankara, 1978.
7. NORDOFF, P., ROBBINS, C.: “Improvised Music as Therapy for Autistic Children. Music in Therapy.” (Ed. E.T. Gaston). New York, Macmillan Company, 1968, p. 329.