Musicking as a cultural immunogen. Music therapy, health psychology and public health.

Even Ruud

www.comunitasonore.it

First of all, I would like to thank the organizers for inviting me to come to Verona. It is a great pleasure for me to be here and to share some ideas about the development and future of music therapy. I have decided to try to speak in Italian – even though I do not speak it perfectly – and I hope this will not make it difficult to understand what I want to communicate. Of course, you can also follow the interpreter, or read my presentation – in Italian or in English – on my website: evenruud.net

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To begin with, I would like to provide a brief historical contextualization of music therapy. Since the mid-1950s, music therapy has gone through an evolution. At first, research focused on the effects of music on the body and biology, with experimental studies on physical reactions to listening. Later, attention shifted to the psychology of learning, giving rise to a “behavioral” music therapy oriented toward measurable outcomes. At the same time, “analytical” music therapy emerged, centered on the unconscious aspects of musical experience. Over time, approaches developed that emphasized personal and spiritual growth, such as “humanistic” and “existential” music therapy, and eventually “transpersonal” perspectives. Finally, Bruscia identifies the “cultural” approach as the most recent stage of this trajectory. Today, all these forms coexist: neuroscience-based, behavioral, analytical, humanistic, transpersonal, and cultural approaches – for instance in community music therapy.

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Since this trajectory still seems to be evolving, we may ask ourselves: what will be the next step? Perhaps new theoretical perspectives that can broaden the field of music therapy even further. In my view, we are now moving toward an additional phase: a more sociological perspective. Within this framework, I propose that we consider music therapy as a resource for public health. By this I mean that we can use music, in everyday life, to regulate our emotions and to promote our subjective well-being.

From this perspective, I would like to connect two ideas: Hartmut Rosa’s theory of resonance and my proposal to consider music as a cultural immunogen – that is, something that can strengthen our health and our sense of connection with the world.

Introduction

Through practice, professional training, and research, music therapy has now demonstrated in many ways that music can play an important role in improving the health of various individuals and groups. The evidence comes from scientific studies, from theoretical reflections, and from the direct experiences of music therapists. All of this shows us how music can help people regain energy, feel more active and empowered to make choices, find a place in the community, and give meaning and hope to their lives.

These effects are not limited to music therapy in the strict sense: even in everyday uses of music, each of us can find support for maintaining or improving our health and quality of life. The knowledge that comes from working with people in vulnerable situations is also very useful for health promotion and prevention, central themes in health psychology and related disciplines. This is particularly important today, in a world where problems related to stress, anxiety, depression, and sleep disorders are on the rise. For this reason, we suggest looking at music therapy also as a kind of folk medicine, ready to be integrated into public health practices.

The first major question that this lecture aims to address is: in what ways can music contribute to a better life, to health, and to everyday well-being? And how can this knowledge be useful to health psychology? We must also ask how music, understood as an existential resource and a source of meaning, can support quality of life – especially in the light of the concept of “resonance.”

I will therefore begin by presenting some issues in health psychology, to show how music therapy can offer concrete responses to the health challenges of modern Western societies. Then I will introduce my idea of music as a “cultural immunogen” and outline the four main ways in which musicking can contribute to health and well-being. Finally, I will turn to Hartmut Rosa’s sociology and his theory of resonance, which I consider particularly relevant to the theme of this conference: Resonance.

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The Field of Health Psychology

Health psychology studies how our thoughts, emotions, and behaviors influence health and illness. It also investigates how social and cultural factors may affect our well-being. In my view, this field still pays too little attention to the positive effects of cultural and artistic activities – and in particular musicking – on health.

In this lecture, I start from the concept of behavioral immunogens, introduced by the American psychologist Joseph Matarazzo in the 1980s. He was one of the first to show how psychology and medicine could work together to improve public health. He documented how health-promoting behaviors could significantly reduce the risks associated with the major diseases of that time, such as heart disease and cancer. Back then, infectious diseases were declining thanks to advances in medicine and improved social conditions, but new challenges were mainly linked to unhealthy lifestyles and stress factors.

Matarazzo also spoke of behavioral pathogens – harmful habits that increase the risk of death (such as smoking, unhealthy eating, or living under chronic stress). His innovative idea was to propose the opposite: behaviors that protect and strengthen health, the so-called behavioral immunogens. These include simple everyday actions such as maintaining a healthy diet, quitting smoking, sleeping well, avoiding alcohol abuse, taking care of oral hygiene, and fastening one’s seat belt in the car.

In the 1980s, the main concerns were heart attacks and cancer. Today, however, many challenges are related to conditions such as anxiety, depression, insomnia, stress, and chronic pain. These are often treated as individual problems, but in fact, they are strongly connected to social conditions: economic inequalities, limited possibilities for self-determination, isolation, and the loss of social bonds. All of this can generate alienation, stress, and a sense of emptiness.

In this context, “pathogenic” behaviors can trigger “immunogenic” responses of a cultural kind. A clear example could be seen during the Covid-19 pandemic: isolation and being confined at home were experienced as stressful and lonely. Yet in Italy, many people responded by singing from their balconies. This collective musical gesture became a meaningful and health-promoting response to a negative experience, capable of reducing anxiety, boredom, and feelings of isolation.

This reminds us that even diseases with well-known biological causes, such as Covid-19, have psychological and social consequences. And some of these can be addressed precisely through music and other cultural practices.

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Cultural Immunogen and Musical Antigens

I would now like to expand on the idea of a cultural immunogen, which takes up and extends the concept of a behavioral immunogen. In practice, it means considering artistic and cultural practices – especially music – as resources that can promote health, on a par with more traditional health behaviors such as eating well or engaging in physical activity.

To better connect with the language of health psychology and medicine, I deliberately use metaphors from the medical field. Words such as immunogen, pathogen, and antigen help us explain how music can function as a kind of “cultural antibody” against life’s difficulties. From this perspective, musicking becomes a concrete way of taking care of oneself and strengthening well-being.

I therefore speak of musical antigens to describe the main ways in which music supports health. I have identified four:

1. Emotional regulation – using music to manage and transform emotions.

2. Agency – feeling active and capable of influencing one’s own life.

3. Social resource – music as an opportunity for encounter, bonding, and belonging.

4. Meaning-making – music as a way to bring sense, depth, and value to one’s experience.

   
   

These aspects are intertwined with other important phenomena, such as identity, self-efficacy, shared emotions, social networks, but also spirituality and openness to something greater. In the “laboratory” of music therapy – that is, through clinical practice and research – we can observe how these processes take shape. In particular, I will focus on the last point: the link between aesthetic experience, meaning-making, and existential health, in dialogue with the theory of resonance proposed by the sociologist Hartmut Rosa.

To speak of music as a cultural immunogen is therefore to highlight its fundamental role in protecting and strengthening quality of life. Although music has always been a kind of “folk medicine” in everyday practices – from listening to concerts to making music together – it is still not sufficiently recognized in our public health system. Yet research and clinical experience clearly demonstrate its therapeutic value, while the constant presence of music in everyday life confirms how powerful and widespread a resource it truly is.

Four Musical Antigens

A cultural immunogen is a metaphorical application of the term immunogen taken from medical science. During the Covid-19 pandemic, we learned how scientists developed new vaccines containing various antigens to protect us from the virus. An antigen is a substance that protects us from being contaminated by a threatening virus. In a metaphorical sense, a cultural immunogen is a type of behavior within the cultural sphere – in particular, musicking – that can perform the same function as an antigen, not on a biological level but on a psychological or symbolic one.

Although there is interesting research in the field of psychoneuroimmunology on how music listening may influence our immune system, this is not my focus here. I will, however, discuss the strong connection between the experience of a meaningful life, a greater motivation to take care of one’s health, and a lower incidence of stress-related illnesses (Schnell, 2021).

I have explored cultural immunogens linked to musical behavior. This includes listening to music, playing and learning an instrument, participating in choirs or shared singing, performing in rock bands and other ensembles, as well as attending concerts – and how all these activities influence subjective health and well-being. I have identified four categories of antigens, which I will elaborate: vitality and emotional regulation, agency, belonging, and meaning-making.

Vitality and Emotional Regulation

I would like to briefly focus on the first three “musical antigens,” and then give more space to Hartmut Rosa’s concept of resonance. Let us begin with two central elements: vitality and emotional regulation.

In recent years, much research has shown how closely music is tied to our emotional lives. Music helps us to recognize emotions, to name them, to tolerate them, and to express them. It can strengthen awareness of what we feel, but it can also challenge us, pushing us to engage with emotions we might prefer to avoid.

Thanks to new technologies – the internet, streaming, smartphones – music has become accessible at every moment of the day. We can use it as a kind of “a technology of self", to manage moods and energy: to calm ourselves, to motivate ourselves, to concentrate, or to change our state of mind.

Emotional regulation is a key topic in psychology, and it is closely connected to vitality, that is, to feeling alive and energized. Regulating emotions means knowing how to recognize and accept them, but also learning to modify them. For example, we can reduce stress by listening to a relaxing piece of music, or transform a moment of sadness into something brighter with a song that lifts us up.

All of us have a repertoire of strategies and techniques for managing emotions: going for a walk, running, keeping a diary, meditating, sleeping, or relaxing in a warm bath. But music occupies a special place in this repertoire. Thanks to its immense variety of genres, artists, and songs, it is an especially powerful medium for regulating our moods.

Many of us experience this daily: we choose playlists according to the mood we want to evoke – “music to relax,” “music for working out,” “music for concentration.” Musical engagement can take many forms: listening to our favorite songs, playing alone or with others, singing in a choir, dancing, or attending a concert. In all these cases, music becomes an effective tool to feel better, recharge, and connect with ourselves and with others.

Agency

The second “musical antigen” concerns agency, that is, the capacity to feel active, competent, and in charge of one’s life. Music therapy has long observed how musicking helps people develop skills, strengthen self-esteem, and build a sense of accomplishment.

Music becomes a powerful tool for self-expression and identity formation: it allows us to connect with our cultural roots, with our personal values, and with the experiences we share within a community. In this way, music not only helps us feel better, but also strengthens our ability to make health-promoting choices. Agency, belonging, and meaning are closely linked: each reinforces the others.

A useful example comes from Albert Bandura’s theory of self-efficacy: when we believe we can do something, the likelihood that we will succeed increases. The same applies to the concept of empowerment, which means gaining power and autonomy in our lives. Music contributes to this process, helping people feel more confident, to build trust in themselves, and to develop a sense of social belonging.

Belonging and Social Participation

Another fundamental characteristic of music is its ability to create connection and belonging. One of today’s great social problems is the widespread sense of isolation: loneliness and lack of social bonds are real threats to health.

Amateur musical practice offers a concrete response: choirs, bands, orchestras, and other ensembles allow people to participate, to meet, and to feel part of a community. In this sense, music becomes a “cultural antigen” capable of counteracting the negative effects of loneliness.

The experiences of community music therapy make this clear: music can foster integration, create bonds, and strengthen social networks. In other words, making music together is not only a source of joy, but also a way of caring for one’s own health and for collective health.

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Meaning, Transcendence, and Existential Health

Making music – or experiencing music – not only brings energy, belonging, and personal growth. It can also offer us profound experiences of meaning and even moments of transcendence, those in which we feel deeply moved, as if everything suddenly made special sense. Such moments often lead us to a sense of resonance, a concept the sociologist Hartmut Rosa uses to describe how, in certain instants, we feel truly connected to the world. In health psychology, such experiences belong to what we call existential health.

But what does existential health mean? It is not simply “not being ill,” but giving meaning to one’s life, feeling oriented, connected, and “at home in the world.” According to Tatjana Schnell (The Psychology of Meaning in Life), meaning is not something ready-made: we create it by attributing value to experiences. What is meaningful to me may not be meaningful to others, and even for me, it may change over time. Meaning is alive; it is built within relationships.

According to Schnell, meaning in life is based on four dimensions:

• Coherence – Seeing a thread in one’s experiences and goals. In music therapy, for example, a “musical autobiography” helps us understand how music has shaped us.

• Significance – Feeling that one’s actions matter. Music may be central or secondary, but when it is part of identity, its absence leaves a void.

• Orientation – Having direction and purpose. Engaging in music means choosing, focusing, and finding a deeper kind of happiness.

• Belonging – Feeling “at home in the world.” Music fosters both social and existential connection, reducing existential isolation.

  
  

Motivation and Moderation

Meaning in life influences health in two main ways: it motivates and it protects.

1. Motivation – Those who find life meaningful take better care of themselves. Music, for example, can provide energy and focus, encouraging behaviors that improve well-being. Feeling motivated by something important also strengthens resilience against stress.

2. Moderation – A sense of meaning reduces the impact of negative events. Difficulties become part of a larger story, making people more resilient and able to face obstacles without being overwhelmed.

   
   

Studies show that people who live with meaning are less stressed, more optimistic, and more socially integrated, with physical benefits such as better heart rate variability and a stronger immune system. Having a sense of purpose can even reduce the risk of mortality.

A key element here is self-transcendence, that is, moving beyond oneself toward others or the world. Music can facilitate this experience: in moments of deep musical connection, people often feel part of something larger – a phenomenon Hartmut Rosa calls “resonance,” with profound therapeutic and existential significance. Rosa himself, for example, has described how his favorite musical genre, heavy metal, has had for him a transcendental function.

Resonance

Hartmut Rosa’s theory of resonance helps us understand how music can make life more meaningful. Rosa describes resonance as a way of being in the world made up of genuine, emotional, and reciprocal relationships with people, activities, and the environment around us. It is the opposite of alienation, when we feel disconnected, indifferent, or overwhelmed by the world.

Rosa observes how rapid economic and technological development makes us live in a constant rush and under stress, often worsening our quality of life. In other words, modern society can distance us from the possibility of living well. As a sociologist, Rosa shows us how social structures influence our ability to build a meaningful life.

Rosa’s concept of “dynamic stability” refers to the fact that we must always grow and increase our resources in order to keep up with economic development. Everything has to move faster: we must do a little more every year. It is like going down an escalator that keeps speeding up—if we stop, we go backwards. This accelerated rhythm applies to the economy, technology, society, and culture. Rosa explains that growth requires further growth, and we feel trapped in a cycle where we must increase the pace, produce more, and live faster. This can leave us feeling never good enough and prone to burnout.

Acceleration is a hallmark of modernity: faster transportation, rapid communication, constant cultural changes. Everything makes us rush, multitask, and feel constantly pressed for time. Technology demands that we stay updated: new apps, new ways of buying tickets, handling banking, using software, accessing essential services. We often end up doing what is urgent before what is important. The faster we live, the less time we feel we have.

Rosa says that living at a fast pace is not negative in itself, but it becomes so when it leads to alienation. Alienation means feeling detached, cold, unable to enter into a meaningful relationship with the world. It brings a painful sense of separation from people and situations.

The solution lies in “resonance.” Resonance means living in deep relationships with the world, where people and environment mutually influence and transform each other. It arises from authentic encounters that truly touch who we are. It cannot be forced; it happens only when interactions are genuine and sincere.

The concept of resonance is often used in a romantic sense, as if it referred to a deep longing. Rosa argues that these romantic ideas actually reveal something universal: we all long for closeness, belonging, fulfillment, meaning, and transformation.

For Rosa, resonance is a relationship with the world where we and what surrounds us meet and change one another. It happens when we are emotionally engaged, when we respond according to our own interests, and when we feel we can influence what happens. Resonance is a living and reciprocal connection, not a mere echo.

Three Axes

Rosa speaks of three “axes of resonance” or “lines of connection,” also called “spheres of resonance,” which help us understand how we relate to the world.

• The first axis is horizontal and concerns everyday connections: family, friends, political life, and community. Here we find the most immediate possibilities for resonance—the moments when we feel truly listened to or understood by others.

• The second axis of resonance includes everything related to objects, work, school, sports, and consumption. These connect the horizontal lines with the vertical ones, since in these activities we pursue goal-oriented practices: learning something, producing, participating in a tangible outcome.

• The vertical axes concern our relationship with larger realities, such as religion, nature, art, and history. These are spheres we often experience as “higher” or even “transcendent,” because they open us to broader dimensions of life, such as nature, the divine, the cosmos, time, or eternity. Here we can project deep human desires and questions, finding meaning in something that goes beyond everyday life. Through art, ideologies, or rituals, we can challenge reality as it is and feel part of something greater.

  
  

When these axes of resonance remain silent, burnout or depression may appear. Rosa is deeply interested in understanding what blocks access to these connections. The acceleration of modern society fosters alienation, which is the opposite of resonance. Alienation manifests as a cold, silent, rigid relationship with the world, without genuine connection. It is a relationship without relationship. It can arise from a wounded sense of self, from social conditions or objects that do not foster resonance, or from a misalignment between ourselves and part of the world. In these moments, the axes of resonance seem mute, and we feel cut off from others and from situations.

Final Comments

Rosa’s theory of resonance is highly relevant for music therapy. It shows how a deep and resonant relationship with music can become an important element of our existential health, a true “cultural immunogen” that helps improve quality of life. This experience never occurs in a vacuum: it always develops in social, cultural, or political contexts, linking music therapy to sociological thought.

This supports the idea of everyday “health musicking”: music as a health practice in daily life, a way to care for ourselves and others, and to promote wellbeing in society. On this basis, it is natural to consider music as an integral part of health psychology. It would be very valuable to see large-scale studies showing in detail how everyday health musicking can genuinely influence our health and wellbeing, thus making a contribution to public health.

Literature

Antonovsky, A. (1979). Health, stress, and coping. San Francisco, CA: Jossey-Bass.

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191

Bonde, L. O., Ruud, E., Skånland, M. S., & Trondalen, G. (Eds.). (2013). Musical life stories: Narratives on health musicking (Vol. 6). Oslo, Norway: Centre for Music and Health, Norwegian Academy of Music.

Bonde, L. O., Ruud, E., & Stensæth, K. (2023). Music and health: A comprehensive overview.

Bonde, L. O., & Theorell, T. (Eds.). (2018). Music and public health: A Nordic perspective. Cham, Switzerland: Springer. 

Caneva, P. A., & Mattiello, S. (2018). Community music therapy: Itinerari, principi e pratiche per un’altra musicoterapia. Milano, Italy: FrancoAngeli.

DeNora, T. (2000). Music in everyday life. Cambridge, UK: Cambridge University Press.

Disoteo, M. (2022). La musica scrive la vita: Note per una musicologia autobiografica. Milano, Italy: Mim Edizioni SRL.

Fredrickson, B. L. (2000). Cultivating positive emotion to optimize health and well-being. Prevention & Treatment, 3. 

Gabrielsson, A. (2008). Starka musikupplevelser. Stockholm, Sweden: Gidlunds Förlag.

Lavrusheva, O. (2020). The concept of vitality: Review of the vitality-related research domain. New Ideas in Psychology, 56.

Matarazzo, J. D. (1984). Behavioral immunogens and pathogens in health and illness. In B. L. Hammonds & C. J. Scheier (Eds.), Psychology and health: The master lecture series (Vol. 3, pp. 5–44). Washington, DC: American Psychological Association.

Rosa, H. (2019). Resonance: A sociology of our relationship to the world. Cambridge, UK: Polity Press.

Rosa, H. (2023). When monsters roar and angels sing: Eine kleine Soziologie des Heavy Metal. Stuttgart, Germany: Kohlhammer.

Ruud, E. (1988). Music therapy: Health profession or cultural movement? Music Therapy, 7(1), 34–37. 

Ruud, E. (1997a). Music and identity. Nordic Journal of Music Therapy, 6(1), 3–17. 

Ruud, E. (1997b). Music and the quality of life. Nordic Journal of Music Therapy, 6(2), 86–97. 

Ruud, E. (2002). Music as a cultural immunogen: Three narratives on the use of music as a technology of health. In I. M. Hanken, S. G. Nielsen, & M. Nerland (Eds.), Research in and for higher music education (NMH-publikasjoner 2002:2). Oslo, Norway: Norges Musikkhøgskole.

Ruud, E. (2013). Can music serve as a cultural immunogen? An explorative study. International Journal of Qualitative Studies on Health and Well-being, 8, 20597. 

Ruud, E. (2020). Et økologisk musikkbegrep. In Ø. Varkøy & H. Holm (Eds.), Musikkfilosofiske tekster (pp. 45–66). Oslo, Norway: Cappelen Damm Akademisk.

Schnell, T. (2021). The psychology of meaning in life. London, UK: Routledge.