Music as Medicine?

Daniel Levitin: Music as Medicine. How We Can Harness Its Therapeutic Power.Cornerstone Press, 2024. 405 pages.

I visit my favorite downtown bookstore with a certain sense of anticipation to purchase Daniel Levitin’s new book. I’ve come across countless references to his earlier book, This Is Your Brain on Music, where he explores the connections between music and brain functions. Now he turns directly to music medicine and music therapy—or does he sufficiently distinguish between the two disciplines?

Levitin is one of those best-selling super-communicators—a cognitive psychologist, neuroscientist, musician, and, not least, a gifted science writer. He writes seductively well, moving seamlessly from one topic to another. He explains complex phenomena in simple language, enriched with anecdotes and references to his own experiences as a songwriter and musician (saxophone and guitar, among others).

Cognitive Psychology

In the first chapters, he offers an introduction to topics from cognitive psychology. We learn about the neuroanatomy of music, memory, and attention. For me, these are familiar subjects, which makes me slightly impatient when Levitin takes many pages to get to the point. Other times it works better, with references to interesting research findings and articles cited at the back of the book. I enjoyed looking up the original articles and reading the research results without Levitin’s mediation. As he gradually approaches topics in music medicine and music therapy, it becomes truly engaging.

The Brain’s “Default Mode

At the end of this introductory section, there’s a chapter on how the brain operates in different “modes.” That is, the brain functions differently during introspection and meditation than during goal-oriented cognitive activity. But first, we note that Levitin is cautious about attributing musical processes solely to specific areas of the brain. He emphasizes identifying networks instead. He writes that everything happening in the brain is interconnected, involving distributed networks. Music, therefore, is not something processed only in isolated areas. “Indeed, music appears to recruit nearly every region of the brain that has so far been mapped,” he writes.

One of these networks is activated when we engage in goal-directed cognitive tasks—what is called the "central executive mode." The other mode, the so-called “default mode network” (DMN), switches on when we are “off,” daydreaming, meditating without a specific focus, and—most importantly—when we listen to music. This is where Levitin sees music’s therapeutic potential.

The DMN consists of a collection of distributed and interconnected brain regions that deactivate when our attention is focused on the external environment. When we disengage and let our thoughts wander, the DMN activates. This allows for internal reflections, the recall of autobiographical memories, or envisioning the future. It’s a network that’s active when the brain is at rest—when we take a quiet walk or daydream. We constantly shift between these two networks. When I read Levitin’s book, I have to switch on my “attention network.” But I need breaks, and often the other network activates, and I drift from the text, letting my mind wander—until I reconnect and continue reading. In the past, these breaks were unfortunately cigarette breaks. Now I check my smartphone.

I rely on these two networks to function, to avoid burnout, and to stay creative and in the flow. When I write, I also shift between these states. To get into a writing flow, with a steady stream of ideas and phrases, I have to silence the inner critic chasing comma rules. I want to enter a flow state. Of course, the downside is poor language and typos. When I review what I’ve written, I reactivate the network that reflects on my earlier spontaneous and less conscious thoughts. This metacognition is necessary to do the tedious work of revising the text into better, more correct language.

Self-Reflection

This default mode network is essential for self-reflection, for creating coherence in our lives and understanding what is happening to us. Levitin notes that this network is activated when we listen to music. Music triggers a state of daydreaming. “When we listen to music—really listen, give in to it, allowing it to take us over—we often find our minds drift to thoughts of who we are, where we’ve been in our lives, and where we’re going. When we are not task-oriented in listening to the music, instead just letting it wash over us and through us, this self-reflection naturally comes up (...) This is how music helps us center the default, mind-wandering mode, and once there, to stay in it.”

One might agree that this is one way to relate to music, alongside other listening modes that music psychology has identified. I’ll leave that aside and instead highlight why Levitin believes this is useful knowledge for music therapy.

The implication for music therapy depends on the goal, says Levitin. If the goal is to facilitate a default mode state, we should choose music that hits a balance between the surprising and the predictable—ideally more predictable if we want music that calms without inducing sleep. Such music will vitalize us, press the brain’s “rest button,” and reduce the distractions caused by our multitasking and mental chatter. As a BMGIM therapist, I find this reasoning a bit simplistic—music contains many layers of complexity we must consider.

A Theory of Consciousness

It should also be noted that this view of the brain’s networks and how they interact reflects a particular model of consciousness. That is, we don’t operate with a unified consciousness. Instead, we have multiple simultaneous forms of awareness, systems that monitor and inform us about ongoing processes.

Levitin places great emphasis on the role of the default mode network. This network underpins our understanding of our individual and deeply personal experiences. If it were to stop functioning, we would be unable to tell the story of ourselves. The brain would simply not be able to connect experiences into a coherent internal narrative of our experiences and shared social interactions. Music can engage all forms of attention—it can act as the glue binding different forms of awareness to our inner narrative, our sense of self, where we come from, and where we’re going.

A Music-Medical Credo

Levitin spends the first hundred pages establishing music’s potential in therapy before turning to various applied fields in the chapters that follow. In an introductory “interlude,” I note his music-medical explanations. He claims that music accesses these networks through what he calls “the multifactorial qualities and modalities” through which we engage with music. Research has identified the anatomical, neurophysiological, electrical, and chemical processes that form the synaptic circuits behind complex states. Music provides access to the networks that generate emotions, memories, desires, and sensations. Based on this, he presents a range of domains where music acts as effective medicine (note the clinical-medical language).

Movement and Neurological Disorders

There is much to learn here about how the brain collaborates with the body to initiate or inhibit movement. I try to teach my only piano student not to play too fast, to avoid creating faulty neural pathways. I use metaphors of treading new and old paths in the forest to describe how synaptic maps are drawn. But he seems more focused on expressing the musical idea he has formed, playing it out without looking at the notes. Honestly, I don’t think that’s so bad—it’s joyful to shape something musical and feel the rhythm in your body.

We are given clear explanations of how the brain controls motor functions. Examples are drawn from stuttering and Tourette’s syndrome. Those who stutter when speaking often sing without issue. Individuals with Tourette’s may find their involuntary movements vanish when they engage in music. Wayne Shorter was a near-stutterer, and it’s said that this was reflected in his music through certain kinds of repetitions. Billie Eilish says her Tourette’s exhausts her, but all tics disappear when she performs.

Levitin discusses Multiple Sclerosis (MS), suggesting that music can at the very least provide the energy needed to participate in activities that make life easier. He uses the opportunity to introduce Michael Thaut and his neurological music therapy, which is especially relevant for Parkinson’s patients. Levitin also effectively presents the method of Rhythmic Auditory Stimulation (RAS), where music and rhythm are used to stimulate gait in individuals with Parkinson’s.

Before dedicating a full chapter to Parkinson’s and music, Levitin touches on Huntington’s disease—another group of neurological disorders that music therapists in Norway have also worked with. Specialized language training programs have been developed here, alongside general music therapy measures to improve quality of life. We also meet drummer Trey Grey, who has kept the disease at bay for many years through an active musical career. He attributes his resilience to drumming:“Drumming, I’m using all four limbs, getting blood and oxygen flowing, firing up the brain. Four limbs at a time (doing) different things. Imagine that in your brain—the neurons and stuff that are firing. It’s fantastic,” he says.

Parkinson’s Disease

We are, of course, introduced to the neurological basis of Parkinson’s disease—the dopamine deficiency that affects so many bodily functions, especially gait. Much of the narrative here revolves around Levitin’s friendship with Bobby McFerrin, the incredibly creative singer who has been diagnosed with Parkinson’s. Yet McFerrin continues to perform. He uses his creativity to adapt his singing and improvisation in line with the limitations or changes brought on by the disease. And there is no indication that the quality of his performances has diminished.

Not all artists are able to adapt to the disease. Linda Ronstadt lost the timbre of her voice after being afflicted. The repetitive movements required for singing were disrupted by the dopamine deficiency. The chapter also provides several references to current research on music therapy and Parkinson’s disease.In this chapter, Levitin recounts one of his many personal experiences—this time from a Miles Davis concert, where he had a powerful bodily experience and was so captivated by the improvisation that, at the age of 21, he decided to become an improvisational musician.

Trauma

Levitin moves into the field of mental health as he writes about trauma and traumatic experiences. The starting point here is how trauma causes structural changes in the brain. However, therapies—such as cognitive behavioral therapy—can alter these neural pathways, creating new connections that reduce post-traumatic symptoms.He points to new research in the field of music and epigenetics. This concerns how genes carry instructions for making proteins that support neuronal health and plasticity. Preliminary evidence suggests that listening to music can modulate gene expression and activity in ways relevant to how impulses are rewarded or routed. Levitin writes that this "upregulation" of genes may partially explain why music therapy has lasting effects in cases such as PTSD.

One way to overcome traumatic memories is to recontextualize them in a more neutral and less fear-inducing setting before they are re-stored in long-term memory, in a process called reconsolidation. This occurs in cognitive behavioral therapy and exposure therapy. Another treatment approach for PTSD and other forms of trauma is songwriting. This is well known among composers and songwriters, who use the creative process to work through their own traumas. There are also songwriting workshops where the process itself often has therapeutic value. This has been systematized for American war veterans with PTSD, who are offered group songwriting sessions based on personal experiences. Drum circles are another researched approach. That said, Levitin emphasizes that such methods may also trigger memories and retraumatize participants.

Mental Health

When addressing music and mental health—or music therapy in the mental health field—Levitin adopts a strictly clinical, medical perspective. He becomes anecdotal and ventures into neurobiological hypotheses about the causes of schizophrenia. He perpetuates myths about schizophrenia and creativity. There is no trace of alternative perspectives or acknowledgment of criticism of the biomedical model that has repeatedly failed to explain schizophrenia over the past hundred years. That there are other ways to approach mental health in music therapy appears to be unknown to Levitin. He seems unaware of community music therapy, the recovery philosophy, or other approaches that place music therapy in a broader context.

He also touches briefly on eating disorders and music in addiction treatment but offers no new insights before sharing more anecdotes about Springsteen, Quincy Jones, and Tchaikovsky and their experiences with music, anxiety, and depression.

When it comes to music’s role in anxiety and depression, he mentions methods familiar from music therapy, such as drumming exercises, group music therapy, and improvisation. He also refers to "Five-Element Music Therapy," a Chinese practice that uses tones to balance energy in the body and mind.

As an explanation for severe anxiety and depression, within the neurobiological paradigm, he first describes a health risk driven by what he calls "cortisol toxicity"—the harmful effects of excessive cortisol. These mechanisms are complex and not fully understood. One explanation is that music triggers emotional and psychological responses. When we listen to music that brings us joy, the brain’s reward systems are activated, releasing neurotransmitters like dopamine. This can elevate mood and relieve symptoms.Engaging with music activates the parasympathetic nervous system, promoting relaxation and reducing heart rate, blood pressure, and cortisol—hormones associated with stress. Music can also serve as a distraction and stimulate cognitive processes. Whether singing, playing an instrument, or listening actively, attention is diverted from negative thoughts and rumination. This redirection can interrupt depressive and anxious thinking and offer respite from symptoms.

Levitin also notes that neuroplasticity, leading to brain reorganization, may be an explanation—especially in brain areas involved in emotional regulation, memory, and executive function. Music’s social and communal functions can also influence mental health. Engaging in music with others fosters social connections and a sense of belonging. “These social factors are integral to mental well-being,” Levitin writes.

Memory Challenges and Stroke

Levitin appears more confident when writing about brain diseases. In Chapter 10, on memory loss, dementia, Alzheimer’s, and stroke, we again get a mix of anecdotes and scientific explanations of what happens in the brain when it is affected by illness or injury. The stories of musicians who have suffered strokes or Alzheimer’s vividly illustrate how the effects on their relationship with music can vary.We read about Keith Jarrett, who suffered two strokes in succession, severely impacting his motor skills and musicality. He more or less stopped playing and lost the immense creativity that fueled his remarkable improvisations.

After several years, he now plays a little with the one functioning hand—but only a couple of times a month, and he is unlikely to return as a performing artist.

We also learn more about jazz singer Tony Bennett, another personal favorite of mine, who was diagnosed with Alzheimer’s late in life but could still sing for 45 minutes nonstop, from a repertoire of hundreds of songs whose lyrics he remembered. Levitin writes about musicians’ extraordinary memory; some have stored thousands of songs and can easily “fake” a couple thousand more, according to one musician. Guitarist Glen Campbell also continued touring after being diagnosed with Alzheimer’s. He had no trouble playing or remembering the music, but no longer knew which city he was in and would sometimes play the same song multiple times in a row because he forgot he had already played it.

The most moving story is about Levitin’s friendship with Joni Mitchell, who suffered a brain aneurysm in 2015 that left her completely incapacitated. Levitin had previously worked with Mitchell to create a playlist for Starbucks' "Artist’s Choice" series, so he knew her musical taste, record collection, and where she stored her music at home. When a nurse called Levitin for help motivating Mitchell during rehabilitation, he recommended using that specific CD. This apparently lifted Mitchell’s spirits, and Levitin later followed up with new music suggestions—Herbie Hancock, Wayne Shorter, Charlie Mingus—that he knew she loved.

We also get the story of Congresswoman Gabby Giffords, who was shot in the head, lost her ability to speak, and regained it through MIT—Melodic Intonation Therapy, where phrases are sung instead of spoken. For example: “Can I have a glass of water?” In such cases, language is recovered because music takes alternate pathways in the brain, relying on structures that are phylogenetically older than the language areas. Music simulates neuroplastic changes that might otherwise have been lost. Levitin visited Mitchell regularly and reports that in 2023—eight years later—she was back, singing Summertime when she received the Library of Congress Gershwin Prize.

Pain and Personalized Music

Levitin is very clear that personalized music is the most effective, especially if we aim to use music for relaxation and to reduce cortisol production. The neurological explanation behind this is that music familiar to us—and which reduces cortisol levels—activates the brain's reward center, where the production pathways for dopamine, serotonin, and opioids are found. These have receptors associated with pain reduction, euphoria, and addiction. Activating this musical reward system enhances the functional connections in the brain. It links areas of cognition, perception, and motor activity that might otherwise deteriorate with aging.

Levitin sees a challenge in identifying the right personalized or individualized music. He notes that we do not have enough music therapists to carry out such assessments and places his hopes in the development of AI that might one day make effective and well-adapted selections of music that can meet individual therapeutic needs.

Neurodiversity and Musicality

Chapter 12 begins with neurological disorders in children diagnosed with Williams syndrome—a remarkable condition that involves impaired cognitive functions combined with striking musicality. Most of these children display an exceptional interest in music; some sing all day and know hundreds of songs despite significant challenges in other areas of life.

The cause of the syndrome lies in genetics, which quickly leads Levitin to discuss whether genetic components might underpin musicality. Since Howard Gardner introduced his theory of multiple intelligences, it has been natural to consider that musicality might also have a biological basis. It should be noted here that Levitin operates with a traditional concept of musicality—he does not refer to “communicative musicality,” which is now more commonly used among music therapists. Nevertheless, his discussions are interesting, not least because he problematizes what we actually mean by “music” and which parameters must be considered. His conclusion is that it seems nearly impossible to find empirical evidence for a direct link between genetics and all the different ways musicality is expressed.

Musicians and Health

Levitin lived as a professional musician for thirteen years before growing tired of the touring life and returning to university, where he completed the necessary degrees and became a researcher. When he later published his book on music and the brain, he reconnected with musicians interested in resuming collaboration. Through his extended time as a researcher , Levitin had rediscovered the joy of playing. He sees this as the main reason he was contacted by musicians like Steely Dan, Sting, Bobby McFerrin, Stevie Wonder, and many others.

This chapter focuses on the many benefits of learning to play an instrument. At the same time, he discusses why so many professional musicians have poor health statistics—especially those in rock, heavy metal, and popular music, who live life on tour, often with marginal income and long periods away from family. Substance and alcohol abuse hardly help, and many are involved in accidents. Levitin cites statistics showing that the mortality rate for professional musicians is twice that of the general population, often due to suicide, homicide, accidents, overdoses, and liver diseases—particularly among country, metal, rock, and jazz musicians. The statistics also show that 71% of British musicians have experienced panic attacks and/or high levels of anxiety, and 69% report depressive disorders—three times higher than in the British population.

Classical musicians also experience immense pressure to perform at a high musical and technical level every time they play, often resulting in elevated stress levels. “Happy are the amateurs,” writes Levitin. They can play without pressure, enjoy music from the great masters, and take joy in informal musical friendships. Or do as pianist Arthur Rubinstein (whom I experienced as a teenager playing Chopin in the University Aula, from my standing spot at the very back of the balcony): “I make mistakes. I don’t practice much. I live life.” Another of my favorites, referenced by Levitin, is Paul Simon—“still creative after all these years.”

The Joy of Playing

In band settings, playful musical and social interaction can create beautiful moments, as Levitin recalls from his teenage years in amateur bands. He also refers to research highlighting the benefits of playing music. He dismisses numerous correlational studies linking musical skills with the development of intellectual and academic abilities. However, he also presents causal studies that clearly show brain changes occurring shortly after one begins learning an instrument—not only in childhood but well into adulthood and old age. These studies show that music education enhances verbal abilities in a lasting way, in addition to improving brain health. Practicing an instrument is associated with improved focused attention and processing speed in aging individuals. Always nice to know as I struggle through new jazz arrangements I’ve ordered online—even though this information is not necessarily at the forefront of my mind while I’m playing.

The reason for these positive effects is that making music activates the entire brain: “It is a whole-brain activity – not simply left or right, not simply cortical or subcortical,” writes Levitin. Playing an instrument involves generating accurate motor plans, memorizing and selecting nuanced movement patterns, and precisely starting and stopping movements. These actions must be sequenced and require memory, focus, emotional regulation, and goal-setting. Singers and wind players train breath and diaphragmatic control along with lip, tongue, and jaw movements. Drummers train by mastering different rhythms with each hand while coordinating arms and legs. This is what takes 10,000 hours if one aims to become truly skilled. It’s also where we see the effects of neuroplasticity in musicians, evident in synaptic changes and the growth of neurons, dendrites, and myelination.

Music in Everyday Life

In this chapter, Levitin explores how music influences us physically and mentally in everyday situations. Topics include lullabies, music used to cover silence, and studies on how shared family listening experiences affect relationships. This is especially relevant today, as music listening seems to have become an individual activity—we sit with earbuds in our own private sound worlds. But in studies where families engaged in shared daily listening experiences, music impacted relationships in various ways: more shared meals (with over half reporting that food tasted better), significant reductions in negative emotions, closer physical proximity between participants, and more frequent sexual activity among couples.

Levitin also discusses music in the workplace, finding that it can be beneficial for repetitive tasks that don’t require much thought, but detrimental for more intellectually demanding work. The ideal use of music, he suggests, is during breaks, where it effectively resets the brain and prepares one to resume work with renewed focus.

Elsewhere, Levitin writes optimistically about how shared listening can foster empathy and create a positive atmosphere before conflict negotiations, enhance physical performance and endurance, and help educators set a welcoming tone by playing music as students enter a lecture hall.

He also describes an experiment where young people were invited to join a dementia choir, each paired with a person experiencing memory challenges. Before the project began, 65% of the words the young participants used to describe those with dementia had negative connotations—such as sad, sick, helpless, and decaying. After three months of singing together, 75% of the descriptors were positive, including words like unity, love, and care.

Levitin emphasizes that one of the most reliable findings from this research is that the music people choose for themselves is more effective than music chosen by others. This brings him back to artificial intelligence: connected to smartphones that continuously collect biometric data, combined with personal information and musical preferences, AI can generate playlists that meet your needs in real time. You could be awakened by specially designed music just as you’re emerging from deep sleep, avoiding grogginess. Music can then be tailored to every activity throughout the day. For those of us who prefer silence, this sounds more like a nightmare!

A Lack of Holistic Understanding

In one of the final chapters, Levitin links music analysis with linguistic theory to demonstrate how music and meaning are connected. These are music-aesthetic questions that I won’t delve into here. However, I did note in his brief section on music therapy models that Levitin reads the field somewhat differently than I do. He begins with Neurologic Music Therapy, then moves to Creative Music Therapy, followed by Nordoff/Robbins (which actually calls itself “Creative Music Therapy”), says something about Orff-Schulwerk (sic), and finally Diane Austin’s Vocal Psychotherapy—which is certainly appropriate. But where is analytically (or analytically oriented) music therapy?

Levitin separates GIM and Helen Bonny’s BMGIM into two categories and ends with “Chinese Five-Element Music Therapy,” which is based on traditional Chinese medicine and, as he notes, is not a scientifically recognized concept. But what about community music therapy, feminist music therapy, or critical anti-oppressive music therapy?

Perhaps one should not criticize an author for what he does not write about. This book will be widely read and will shape how music therapy is perceived. Undoubtedly, the book brings attention and recognition to music therapy. But it may also promote an uncritical and simplified view of what music therapy entails. Music therapy does not exist solely within clinical contexts or the American capitalist healthcare system. It now exists globally, in countries with different cultural traditions and socio-economic conditions for therapy.

One consequence of focusing so heavily on what happens in the brain and body is that it overshadows the fact that we, with our brain and body, always experience, react, and act in specific situations. It is not the brain alone that creates these experiences, but the brain in a social context—where people, music, body, culture, and atmosphere together shape our capabilities and competence.

This focus on the individual and the brain can easily obscure this situated understanding. It is therefore no coincidence that Levitin too easily skips over community music therapy, with its emphasis on the socio-political conditions that shape how music can initiate change. Levitin presents new research and many exciting perspectives on music’s medical potential, and it hardly makes sense to criticize him for what he merely touches on. Nevertheless, most readers will encounter music therapy and music medicine only through this book—and will likely gain a positive, but not sufficiently nuanced, picture of what music therapy can be about.