Before I went into the exam room last week, the nurse told me my patient had “white coat syndrome.” His blood pressure was very elevated and he was clearly anxious. I reviewed the chart before entering the room, but there wasn’t much information available on this new student. I entered the room to find my adolescent patient doing deep breathing exercises. He apologized, and told me he was anxious. I sat down quietly, doing my best to reassure him and offer him whatever support would help.
We lasted a few minutes talking about things like where he was from, what he enjoyed, and what he hoped to study. Then he decompensated, grabbing his head and starting to cry. I knew by this time that he had autism spectrum disorder, though it didn’t seem he knew that. I offered options I knew worked for others—we could open the door, I could wait to see him until another time, we could change rooms, we could even go outside.
He didn’t want me to change anything. He kept trying to change himself. He allowed me to quietly stay seated nearby. Then I asked him if he liked music. His face relaxed ever so slightly. Yes, and he loved to sing. Could he sing a favorite song for me? He smiled and loudly complied.
Next, he sang again while I retook his blood pressure. I grinned, telling him he had a beautiful voice AND an excellent blood pressure. It’s hard to keep the intensity of an anxiety attack going while you immerse yourself in a favorite song. The rest of the exam was a relative breeze, and I later heard him belting out a show tune in the bathroom.
In truth, I was grasping when I asked him to sing. I was anxious myself, trying to help our situation, when the idea just popped in my head. I knew that most of the children I see with autism love music. Some are even quite gifted in it. I just wanted to connect with him and to get him to a different place—free from the crushing hold of anxiety. And in that moment, I thought that it would be hard to keep a blood pressure elevated while singing a happy song.
Afterwards, I wondered about my approach. What did the research say about music and anxiety? I know that I always feel a profound calm when certain types of music are played. From the time my oldest was just a little boy, he could play improvised piano pieces that we referred to as “movie music,” and each time he did, my spirits soothed. The biblical David played the lyre to calm Saul from his desperate moods. Spotify has countless pieces sorted as spa, relaxation, chill and Zen.
Well, the research says quite a lot. Music has been used as a component of medical therapy since ancient times. Asclepius, the Greek god who gave us the medical symbol of the staff and snakes, used music to treat mental illness. Musicians worked alongside physicians in the Arab world. The Latin West followed suit. Over and over again, the historical record shows that music was used to both maintain health and to treat disease.
Currently, music is one alternative to opioids in the treatment of both acute and chronic pain. Some emergency departments are hiring professional musicians to play the harp, sing or otherwise perform pieces for patients who request them. Hospice centers have a long history of using music as a palliative tool. Music therapy is itself a specialty, formally used for a variety of problems, including autism.
Curiously, the research shows that exposure to music is supposed to increase our language ability and strengthen social attachments. I say curiously, because these are the very issues that people with autism struggle with, and yet so many seem particularly drawn to music. Music exposure assists the formation of new neural pathways in our brains, increasing our connections. It also seems to increase our human connections. The emotions produced by music have neurochemical roots in the amygdala and hippocampus, but also produce what is called an “emotional contagion,” spreading these effects to others within the hearing group.
Most of us have had moments when a piece of music overtakes us. We had no intention of being emotionally vulnerable, but find ourselves brought to tears. Faith communities have long included music in their worship, both to collect the community into a gathered oneness and to distant the constant distractions of our everyday thought and replace them with something more open to mystery.
Researchers say that some emotions that music elicits might be particularly desired because they are rare in everyday life. They offer that wonder and a sense of the transcendent are two such emotions. And, they add, music does not provoke emotions of shame and guilt. (Unless they are accompanied by the lyrics of certain hymns!) These ideas seem particularly fascinating to me.
Transcendence is when we are ultimately connected to each other, the Divine, and all that is. Wonder is when we are in a state of encountering something beautifully inexplicable. I felt both of these emotions on a hike the other day, when the sun was bright, the lake sparkling, and the whole earth seeming to tilt toward spring. I thought then, on that walk, about awe, and about how gratitude seems to be wrapped up with being able to feel awe. I think if I had heard a symphony orchestra play right there on that trail, it would have seemed absolutely fitting.
So where am I wandering in this wondering? I’m not sure, except I think there is so much more to know about what it means to be human, to feel and act and interact with each other. We are all mysteriously connected, even if our connections also have distinct pathways that seem paradoxical to the idea of wholeness. In reaching toward a sense of transcendence and wonder, we stretch out of ourselves and into the world. No wonder shame and guilt aren’t prominent—they are so very inward looking. I think my patient is able to transcend some of his inabilities to communicate every time he sings. And I can be fully with him in that musical interlude, even if just for a moment.
Although the research is chock full of things I haven’t even touched on, I think it’s fair to say that all of us are musical. And everyone belongs.
*If you want to read a comprehensive study on music and emotions, see: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5705548/