Music as Therapy: A Bio-Cultural Problem

Carol E. Robertson-DeCarbo
Ethnomusicology, Vol. 18, No. 1. (Jan., 1974), pp. 31-42.
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MUSIC AS THERAPY: A BIO-CULTURAL PROBLEM

Carol E. Robertson-DeCarbo
ulture and personality theory has generally tended t o underestimate the
importance of cognition in favor of regarding motivational processes as
the significant variables on the individual's side of the culture-personality
relationship. The proper functioning of social institutions and systems upon
which they depend, rests on the performance of the variety of roles that
comprise these systems. Appropriate role behavior of individuals, which
constitutes the basis of societal functioning, is dependent on the presence of
motivations which lead individuals t o want t o perform in compliance with
special role expectations (Spiro: 1965).
This trend of thought in both psychological and anthropological
psychodynamic personality theories has placed all other processes as subordinates to the motivational processes. However, it is these traditionally subordinate processes which are t o be the focal point of this study.
In 1961 Anthony F. C. Wallace, working in the Hallowell-Rorschach
tradition, put forth the view that psychic unity of groups is based, not on
shared motivational structures, but rather on shared cognitive orientations.
Wallace states that the basis of orderly cultural participation does not lie in
the realm of human needs or motivations, but in a common universe of
learned meanings t o which individuals within a particular group are oriented.
The most viable solution t o the theoretical controversy mentioned above
is that psychological realities in any context contain both a motivational and a
cognitive aspect. If we can prove that motivation is conditioned by learned
meanings and concepts then we can consider motivation t o be the surface
structure, and cognition and internalization t o be the deep structure of
behavior.
The symptomatology and physiology of mental disorders will be
discussed in this paper with the intention of corroborating the significance of
cultural cognition as demonstrated by the role of music in psychotherapy.

Social scientists must remain aware of the immense semantic schisms

which lie beneath the seemingly objective scientific surface of psychiatry,
clinical psychology and anthropology. The semantic ambiguities of nomenclature in Western science are compounded by the diversity with which human

32

ROBERTSON-DECARBO: MUSIC AS THERAPY

cultures conceive of, and respond to illness, and by the variety of ways in
which these deviances from accepted behavior are expressed. Despite the
particular process involved, what is regarded as 'mental illness' in one society
may be viewed as predictable and acceptable behavior in another.
Neither symptoms, treatment, nor hospitalization, are valid definitions
of mental illness on a cross-cultural level. Anthropological definitions tend to
center around notations of behavioral deviance or abnormality as the universal
sign of mental illness. Such a definition may either refer to a quantitative
distribution as the locus of abnormality, or it may emphasize non-conformity
with an appropriate behavioral pattern as defined within a specific social
order.
The advantage of this type of definition is that it forsakes the biases of
Western psychology in favor of the categories and mechanisms of social
diagnosis perceived by the society itself as the measure of behavioral
normality.
From the beginnings of fieldwork to the present time, anthropologists
have speculated on the fact that symptoms of mental disorder vary, depending
on the cultural context of the patient. Sometimes the patterning of symptoms
is so unlike Western clinical cases as to suggest a new type of mental disease.
The most frequently cited examples are amok and latah in Southeast Asia;
piblokto among the Eskimo and imitative arctic hysteria in northern Siberia;
and windigo psychosis among Algonkian forest hunters. Even in New York
City, Opler and Singer (1956) point out symptomatic differences between
members of different ethnic groups; in this study, they state that Irish male
schizophrenics tend t o be quiet and withdrawn, while their Italian counterparts tend t o be noisy and aggressive.
Moreover, Anthony Wallace suggests that Algonkian windigo psychosis,
with its common pattern of somatic delusions, ideas of reference, supernatural
persecution complex, and cannibalistic panic, is an equivalent image of
paranoid schizophrenia as observed in the Western world; except that the
persecution fantasies of the Algonkian are apt to be oriented toward different
cultural referents (Wallace: 1960).
Assuming that these analogies can be drawn, it follows that most 'ethnic
psychoses' reflect in their symptomatic behavior the specific cultural content
of the patient's society, and are reducible t o local varieties of a common
disease process to which human beings are vulnerable. At this point, it would
seem necessary to clarify some of the classifications of mental illness in order
to facilitate further analysis.
Two main categories of mental illness are recognized in the Diagnostic
Matzital of Mental Disorders ( 1 968 revision) of the American Psychiatric
Association: 1.) The organic brain syndromes, a group of disorders caused by
or associated with impairment of brain tissue function. 2.) Disorders not

ROBERTSON-DECARBO: MUSIC AS THERAPY

33

attributable t o organic conditions and presumably of psychogenic origin or

without clearly defined physical cause or structural change in the brain.
The above differentiation is based essentially o n the principle that,
where an organic disturbance of brain tissue is known to be the precipitating
factor, the disease is classified as a disorder of brain function; on the other
hand, where no such organic disturbance is known to be responsible for the
disorder, the illness is classified as functional or psychosocial. The remaining
portion of this paper addresses itself t o the relationship between music and
the treatment of the psychosocial syndromes.
T H E ENCULTURATIVE MECHANISM

Alan Lomax (1968:s) has stated that, "In the end, a person's emotional
stability is a function of his command of a communication style that binds
him t o a human community with a history." Ethnomusicologists have demonstrated that music plays a vital part in the process of incorporating an individual into the particular communication style of his cultural milieu.
We are told by Waterman (1956) that music functions for the Australian
aborigine of Yirkalla as an enculturative mechanism, a means of learning
Yirkalla culture. It instructs him about his natural environment and its utilization by man; it reinforces his understanding of status and kinship concepts,
and also releases tensions in the moiety and lineage by heightening emotion
during rituals. Such statements assign a behavioral function to musical
phenomena, but d o not lead us t o an understanding of the psycho-dynamic
nature of music sound and its associations.
It is the storing and cognition of associations, among them music, which
enables us t o react in 'stimulus-response-reinforcement' sequences. The Gestalt
school, in its own psychodynamic tradition, explains these sequences in terms
of a schemata stored in the brain as a result of learning, and inferable from
both behavioral and verbal interaction. Thus, emphasis is placed on the
'stimulus equivalence', or the tendency of a subject t o respond in the same
way t o different conditioned stimuli. The actual stimulation of the sense
organs, o r receptors, by a given object o r event may vary depending on such
variables as context, time, space, and similar relationships. However, once the
stimulus is received, it is sorted through a sifting mechanism which accepts or
rejects, and ultimately defines, confirms, and reinforces the signals received. It
would seem that the subject of such reinforcement is a mediating schemata,
rather than a unique set of relationships between a single sequence of receptor
images and a single corresponding sequence of physical responses.
Thus, the question t o be asked is, what are the mediating schemata-the
structures or processes in the brain that must be assumed to account for such
phenomena as stimulus and response circuits? It is these circuits, including

34

ROBERTSON-DECARBO: MUSIC AS THERAPY

numerous internal reinforcers, which are somehow established through enculturation and operative in such cognitive processes as perceptual classification and interaction. Unfortunately, these processes which, in addition to
stimulus-response learning might contribute t o the formation, maintenance,
and application of schemata are still too complex and ambiguous to present
here. However, it is these mostly undefined areas which have been drawn
upon to answer the question of where the response variations come from. For
the evolutionist, the answer has been natural selection, a variable behavior
from which the subject may select, resulting in mutation or acquired characteristics. For cognitive theory, the answer has t o be an automatic alternateschemata synthesizer.
Modern psychotherapists are beginning t o believe that these schemata
may have a nesting structure, the deepest structure being the most abstract
and least restricted as to domain; and the superficial structure being the most
concrete and most similar t o the environmental stimuli and responses in its
imagery. Relationships of contradiction and dissonance also exist, sometimes
in insulation and sometimes in conflict, and much human energy seems
devoted t o the process of relating each schemata, either by resolving the
oppositions or b y disassociating the schemata so that the contradictory
schemata are not utilized simultaneously. It is to these structures that clinical
psychologists are now attempting t o address research. The difficulties involved
in this approach have been stated by Wallace: "The psychotherapist does not
expect a new patient t o be able to understand the symbolic equations and
interpersonal strategies by which he strives to avoid anxiety and attain
libidinal satisfaction (1961:84)." All these schemata are unconscious, in the
sense that they cannot always be stated in abstract form by the subject even
though his perceptions and responses are precisely determined by them; they
must be inferred by behavior, both verbal and nonverbal.
We now know that neural tissue is by nature active, with its own characteristic rhythms and synchronies of firing sequences which can be recorded on
the electroencephalograph for the infant at the very moment of birth. These
patterns, which form a basic substratum of neural activity, are consistently
broken into by sensory activity associated with outside stimuli (Mueller,
1964: 17). In this view, the important factors are: 1) the hypersynchronies or
firing sequences, as they are inherited, modified, and stabilized in one's
personality by his learning, and, 2) the flow of stimulus-response activity with
always new firing sequences which impinge on the outside environment. It is
the conflict aroused by this exchange system which both constitutes and
maintains mental life; it is the degree and quality of the facilitation and
resistance which determines the degrees and qualities of behavior.
Instead of supporting the rhythmic, long, slow waves already being discharged at birth, the internalization of outside sensory activity has the

ROBERTSON-DECARBO: MUSIC AS THERAPY

opposite effect. It breaks up the established firing sequences and gradually

changes them throughout life in the never-ending learning process. It is this
give-and-take of the action patterns which makes for normal, adaptive rules.
SOUND AND TRANS170RMATION

The phenomenon of sound is perceived by physics in terms of the

radiant energy of a particular wave length as determined by an adequate
receptor. As regards psychology, the answer requires the concomitant presence
of the radiant energy of appropriate wave length, and, of course, the human
receptor. The human receptor possesses infinitely greater response capabilities
than any instrument, and it is this capacity for response and its gamut of
expressions which which we are concerned.
The physical presence of man is so obvious that his relatedness t o his
environment has received more analysis than the human receptors creating
interplay with it. Communication with the environment invokes a need for
reaction t o it, and communication then becomes a prime requisite for survival
in it. The fully developed, acting, adult human being is environmentally
oriented with a great awareness to sound. His dependence o n hearing and his
auditory perceptive growth is one of the greatest contributors t o his
behavioral patterns.
Penfield has demonstrated that electrical stimulation of the temporal
lobe evokes responses from mental patients, usually in reference to recollected
experiences. It is in the temporal lobe that the auditory receptor is found and
experience is stored. This is in close proximity to those anatomic areas
revealed by Penfield to contain certain information as related t o recollection
and perceptual judgment. Thus, a stimulus may invoke a re-experience of a
series of related events with correlated emotional assessment-, such as
psychotic hallucinations, reminiscence, or dream therapy (Cyrus, 1966).
The possibilities of music as the stimuli in the above cases have come
into consideration only recently. Responses learned from social interaction
predominate over innately determined behavioral patterns in humans; such
learned responses are related to definable bodies of traditional concepts,
beliefs, and institutions which transcend the lifetimes and experiences of the
individuals whose lives they mold. It is in part the effective sorting of positive
and negative experiences and reinforcements which produces behavioral variability.
According t o the Sapir-Whorf hypothesis (Wallace, 1970), these mediating schemata or sorting mechanisms are so basic, so deep, and so abstract that
they manage t o structure many domains of experience, and thus can be said
to characterize the culture as a whole (Wallace, 1970). I t is this biological and
neurological analysis that is leading some social scientists to believe that, while

36

ROBERTSON-DECARBO: MUSIC AS THERAPY

manifestations of culture such as beliefs and ritual, and the deviance from
accepted patterns of action constitute the surface structure of behavior, both
normal and abnormal, the neurological functions of the mediating schemata
may constitute the underlying deep structure. It should be noted that these
structures have been consciously borrowed from linguistics, and that the terms
'surface' and 'deep' are used solely for the purpose of facilitating or illustrating the analogous levels of neurological functioning.
Washburn (1960) points out the role of the cortex in the control of
autonomic function. The autonomic nervous system is always active, but only
consciously so in time of crisis, fright, and anger. Fusilades of orders up and
down the neurons of the cortex make homeostasis possible most of the time.
This reticular system, both ascending and descending, is the basic integrating
mechanism for the entire organism. This is the oldest brain, which acts as
sifter and censor. As man organizes reality, his reactions t o all experiences, be
they sensory or any other communication, are sifted and stabilized by the
reticular system.
Dealing with the linguistic process, Chomsky states that "Because a
person can produce a number of grammatical sentences in his language, he has
not learned particular strings of words, or parts of speech, or even a stochastic
matrix for generating such strings, but rather a basic grammatical structure
from which, by applying transformational rules, he can generate a number of
sentences (Gaston, 1948). The same could be applicable to the process by
which information and associations are stored in the cortex, the transformational rules being dictated by the mediating schemata.
Tlle challenge t o any music therapist or ethnomusicologist dealing with
human behavior thus becomes that of considering man not only as a sociological and psychological unit, but also as a biological unit; his cultural
experience being sorted, defined, re-defined, and often interrupted by his
biological make-up; a single, politypical species closely related, and chiefly
distinguished, by a greatly developed cerebrum of twelve t o thirteen billion
neurons which make possible articulate speech, verbal and mathematical
communication, and non-verbal signaling and reception in forms such as
music.
MUSIC AS THERAPY AND ITS RELEVANCE TO

ETHNOMUSICOLOGY AND ANTHROPOLOGY

In attempting to relate music as therapy to ethnomusicology we should

first set u p the following levels of criteria:
a) Culture as the provider of series (or sets) of communications.
b) A system of neurological mediating schemata through which the
individual selects appropriate behavioral patterns condoned by his
society.

ROBERTSON-DECARBO: MUSIC AS THERAPY

37

c) Culture as the provider of an "environment" or context for mental

illness.
d) Culture as therapy through possible re-association and re-ordering of
communication sets.
e) Methods (in this case, music) by which a series of communications
can be restated for the reinforcement of the behavioral values set by
the social context.
It has already been stated that the experiential knowledge of how to
respond is stored in the cortex of the temporal lobe. Information is filtered
through the complex system of schemata in a constant flow of signals. Most
psychopathic cases not resulting from chemical alterations point to a breakdown in communication, indicating that 'traffic directions' have been confused. Our question, then, is whether music can help re-establish this lost
communication.
Dealings with music have emphasized its metaphysical rather than its
physical aspects as a therapeutic effect. The transcendence of sound from that
of a physical phenomenon t o an experience with attendant behavioral
reactions is probably accomplished with ease. However, the steps and
processes traversed should not be taken for granted.
Western therapists are beginning to note that music is often the only
effective stimulus for many psychotic patients, particularly those in a
catatonic stage. A patient who refuses t o eat, sit in more than one position,
speak, or even open his eyes, will quite often respond to sound stimulus.
Experiments run at several rehabilitation institutions show that many patients
responding to this treatment at all, d o so more readily when the music used
relates t o their previous social context. This is by no means a startling
observation.
The principles involved in this type of therapy have been used in folk
psychiatry for centuries. Devereux (1951) has found that among the Plains
Indians, the shaman provides not psychiatric cure, but some kind of corrective
emotional experience which seems t o reinforce the communication system.
In "Folk Psychiatry of the Apaches of the Mescalero Indian Reservation" (1964), Bryce Boyer clarifies the shaman's associative powers with the
following description:
When the shaman had exposed the symbol of the patient's distress (bear,
snake, lightning, and so forth), he attempted to determine why the
embodiment of evil 'bothered' his patient. For the answer to this question
he invokes his 'power'. He sings his ceremonial songs and recites his prayers
in an effort t o communicate with his 'power', to obtain its aid in tracing
down the forces which have made his patient ill and t o gain its support in
opposing those forces (p. 404).

ROBERTSON-DECARBO: MUSIC AS THERAPY

During the above activity, the shaman warns the patients that facts must
not be withheld. Subjected to strong suggestion techniques, his memory
jogged with the data he had suppressed or repressed, the client would sometimes react associatively, and the actual event or trauma that had crystallized
the mental disease was recalled.
Raymond Prince cites a similar example in "Indigenous Yoruba Psychiatry" (1964:87). The Yoruba have a specific psychiatric nomenclature for
several different types of psychosis. Dindinrin refers t o a withdrawn,
suspicious, and uncommunicative psychotic of the chronic schizophrenic type.
Some religious specialists and healers say that were and asinwin (mentioned
below) might become dindinrin if they are not properly treated. Danidani (or
edani) refers t o either a severely regressive psychotic or a mental defective.
However, very few patients seem to be labeled with this term. Were alaso (or
were that wears clothes) refers to a psychotic with a well-preserved personality. In our terms this would fall into paranoid-schizophrenia. Were agba
denotes psychosis associated with old age. Abisinwin is postpartum psychosis.
Most reports show that it generally starts about three days after delivery. All
such patients have their children removed from them out of fear that they
might strangle them. Were d'ile is hereditary psychosis.
Most healers make severe distinctions in the treatment used for each
type of psychosis. The curing ceremony involves a great deal of symbolism
and textual references t o the client's condition. The treatment is preceded by
dove sacrifices and palm oil libations on the threshold of the healer's house.
The following is a rough translation of one of the incantations recited during
the ceremony:
He who awakens and makes a bargain with God.

He who awakens and is God's peer.

Health is the bondsman of my father

and I crossed the river t o seek him.

Let this woman have health today

Doves dwell in tranquility

All men are at peace with water

Of it we take to bathe
Of it we take to drink
Let
Let
Let
Let
Let

asinwin pass from this woman today

were pass from this woman today
dindinrin pass from this woman today
danidani pass from this woman today
all the evil on her head follow the water away
If it is the work of an alfa
Of a babalawo 's curse

ROBERTSON-DECARBO: MUSIC AS THERAPY

Perhaps a hunter or farmer paid money for this evil
Or a sorcerer or a witch or any other cause of cvil upon her
As she drinks and bathes in water,
Let water bear all evil things away.
Let only peace and contentment l'ollow her home.
Water always flows forward-it never comes back,
Water always flows forward-it never comes back.
(Prince, 1964: 102)

These are only a few of the many examples available in which music
and its text play an intrinsic role in psychotherapeutic healing. Although
many other activities are involved in the curing session, it seems safe to say
that the musical formulae used do have strong influences on the patient, and
perhaps the text more than the rnusic itself.
Lomax has remarked that "The most important thing for a person to
know is just how appropriate a bit of behavior or communication is and how
to respond to it appropriately. The rules of suitable interaction . . in social
anthropology are only crude approximations of the patterns or models of
repeated, learned behavior to which they refer (1 968: 12)." Lomax goes on to
profess that the music of a given culture reflects the values, structure, and
interaction patterns of the society; a statement of much controversy created
by this study.
Should we, then, regard music as an interpersonal message with certain
healing properties? We have already stated that the sense of hearing is frequently the only major sense still accessible in withdrawn psychotic patients,
the one they are least able t o close off from outside stimulation. This might
make it possible t o reactivate some sense of mastery over experience; a relearning t o anticipate and react through music associations in their cultural
context.
This leads more t o a therapy of reaffirming old bonds rather than an
explicit music therapy (Cody, 1965). The meaning of music is derived from its
relationship with the extra-musical world and all that it contains of objects
and events, including human experiences, reactions, and emotions. Musical
formulae, whether immediately understood by the patient or not, are representations of these extra-musical elements. This musical language can serve as
a stimulus of associations and reinforcements. Moreover, the order, both
mathematical and acoustical, found in music may serve to bring order into a
malfunctioning schemata sorting system.
Ari Kiev (1964) has dealt extensively with folk psychiatry, emphasizing
the impact of cultural factors on the form and content of psychiatric treatment. He has also noted that the effective core of magico-religious healing lies
in the ability t o elicit hope by capitalizing on the patient's dependence on
others and on an expectation aroused by the healer's personal attributes and

40

ROBERTSON-DECARBO; MUSIC AS THERAPY

paraphern;~lia,which gain power from culturally assigned meanings. Within the

category of paraphernalia falls the repertory of chants and incantations
accompanying the curing rite. These may be familiar t o the patient either as
recognized parts of the curing process, or as formulae conductive t o the
reprocessing of neural order and to the reorganization of material within a
referent of confused signals.
The aim of music therapists in Western culture is to bring about changes
in behavior through music. The non-Western curing specialist is also trying to
bring about changes through external stimuli, one of which is music. Music
therapists, medical antliropologists, and folklorists can continue to use music
as a stiniulus and to study music behavior, psychotherapy, and folk psychiatry
with a more thorough knowledge of how the nervous system functions. In
doing fieldwork we often note that music is used as a means of therapy in
healing, but seldom d o we delve into the process by which music is effective
in healing.
The question is, have music therapists just begun t o discover what
healing specialists in non-literate societies have been practicing for centuries'?
In a sense, the non-Western psychotherapist uses even stronger weapons than
tlie modern clinical psychotherapist. He works not only with the strength of
his own personality, but tlie rite he is performing is part of tlie common faith
of the community which often even participates directly in the healing rite.
Music is in all societies a primary coding device. These musical meanings
are received through the reticular system and transmitted to the cortex. When,
through neural rather than chemical means, psychosis is produced, this
receptor system is altered and signals become confused and difficult to
coordinate. It is here tliat tlie auditory experience becomes one of the few
systems of communication still available. Through tlie psycl~otlierapist's
knowledge of tlie patient's past social background and context, lie can use
music to reestablish and reinforce tlie world which the patient has lost contact
with.
A primary obstacle in this type of study is tliat, at this point in time,
etlinoniusicologists know practically nothing about tlie internalization process
of music. How is music stored, along with other data, in the brain? How do
the mediating schemata become altered in the psychotic patient? Exactly how
does the order in music contribute to the ordering of socio-cultural perceptions? These and many other questions remain unanswered. However, it
would seem of utmost importance that students of human behavior begin to
examine not only the obvious manifestations of interaction, but also tlie
underlying mental and biological structures that help determine the performance patterns of man-both as a social and biological being.

ROBERTSON-DECARBO: MUSIC AS THERAPY

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Boyer, L. Bryce
1964 "Folk Psychiatry of the Apache of the Mescalero Indian Reservation." In
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Cody, John
1965 "The cryptic message of music," Journal of Music Therapy vol. 2,
June:45-52.
Cyrus, Andrew E., Jr.
1966 "Music for
June:65-69.

Receptive Release,"

Journal of Music Therapy, vol. 3,

Devereux, George
1951 Reality and Dreams: Psychotherapy of a Plains Indian. New York: IUP
Caston, Thayer E.
1948 "Psychological 1:oundations for Functional Mucic," American Journal of
Occupational Therapists, vol. 2, February: 1-8.
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1964 Magic, Faith, and Healing. London: I'ree Press of Glencoe.
Lomax, Alan
1968 Folksong Style and Culture. Washington, D.C.:AAAS.
Mueller, Kate Hevner
1964 "The Aesthetic Experience and Psychological Man," Journal of Music
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42

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Music as Therapy: A Bio-Cultural Problem
Carol E. Robertson-DeCarbo
Ethnomusicology, Vol. 18, No. 1. (Jan., 1974), pp. 31-42.
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[References Cited]
Culture and Cognition
Anthony F. C. Wallace
Science, New Series, Vol. 135, No. 3501. (Feb. 2, 1962), pp. 351-357.
Stable URL:
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