Can ragas heal?

Music as medicine is something many talk about. DH journalist Harsha signs up for a 21-day music therapy programme to learn more

Two doctors near Mangaluru in Karnataka have been offering music therapy for the elderly for seven years.

Dr Prabha Adhikari M R, head of the department of geriatric medicine, Yenepoya Medical College, Deralakatte, and her colleague Dr Vijayalakshmi S, head of otorhinolaryngology, have been working in tandem to create awareness about the ‘healing power’ of music.

Dr Vijayalakshmi hails from a family of Carnatic musicians. She serves as the general secretary of the 100-member Indian Music Therapy Association.

She has designed therapies for expectant mothers, students, social workers, special educators, patients on dialysis, and the terminally ill. She rolled out a 60-hour music therapy certificate course for health professionals during the pandemic.

She offers therapy free of cost. The Indian music therapy scene is at a nascent stage and she says she would like people to give it a try without worrying about expenses.

Unlike in the West, there is no governing body to issue licences for music therapy in India yet, Dr Vijayalakshmi says. She has attended many workshops and certificate courses in music therapy.

First, the basics

Music therapy isn’t just about listening to a playlist curated by experts.

In Dr Vijayalakshmi’s programme, it starts with ‘client assessment’ where she asks questions about family background and cultural upbringing. Next, the client fills up a ‘music preference questionnaire’, and sets
realistic goals. The doctor then designs an ‘intervention’.

The final step involves the client listening to music at a specific time every day till the goal is achieved. After this, feedback and check-ups follow from time to time.

Designing music therapy is about trial and error because how we react to music is extremely subjective. For instance, she says, a client from a rural area may find folk tunes more appealing than classical music. Or, a client from Maharashtra may take to abhang (a form of devotional poetry) more than to other forms.

In clinical trials, results of a drug tested on about 1,000 people are extrapolated to a larger population. But in music therapy, treatment has to be personalised, she says.

Dr Vijayalakshmi says she has had a fair amount of success in dealing with certain conditions. A Yakshagana
‘barahagara’ (playwright) suffering from dementia had forgotten his wife’s name. Dr Vijayalakshmi sang many songs to him. But when she sang the Purandaradasa devaranama ‘Yashode ninna kandage….’, the elderly husband responded and called out the wife’s name. Her name was Yashoda. Tears rolled down her face.

“We train caregivers to play music to patients with dementia at a particular time to help them remember simple things like brushing their teeth,” the doctor says.

Therapy begins

I signed up for a 21-day music therapy programme with Dr Vijayalakshmi and Anju Ullas, who is researching music therapy under her and Dr Prabha.

Tests just before the therapy began revealed that my blood sugar (162 mg/dl) was slightly higher than normal. I was diagnosed with diabetes in 2021.

My close family was excited about my mission. They wanted to know if music therapy could control my blood sugar level. They dragged me to a store and selected the best earphones there with `smart noise cancellation’. They told me I had to focus completely on music.

That same evening, I filled up a questionnaire online. It had 17 questions such as ‘Do you feel overwhelmed by the demands of living with diabetes?’, and ‘Do you feel that your friends and family are not supportive of your self-care efforts?’. On a scale of 1 to 6, I had to indicate the impact these problems were having on me.

Many countries in the West have designed their own questionnaires. In India, only one questionnaire has won psychometric validation, says Dr Vijayalakshmi. It is designed by Dr Durgesh Upadhyaya from the department of psychology, Mahatma Gandhi Kashi Vidyapith, Varanasi. He designed it with a north Indian population in mind, says Dr Vijayalakshmi, whose team modified a few questions for clients like me down south.

As I tuned in…

I was required to listen to pre-recorded instrumental music at 6 am and 6 pm for 21 days from January 19. Anju has curated these clips specifically for diabetes patients.

I was curious to know nuances of the music I was listening to. So I consulted my cousin, Keerthana Rao. A trained classical singer, she had sung Haridasa compositions to help me and my family ‘cope with’ grief after
the sudden loss of my father in 2019.

The morning tracks included ‘Gajananayutham’, a composition in raga Chakravaka, and a fusion number. Chakravaka invokes energy and happiness, she explained. The evening repertoire included raga Yadukula Kamboji, and fusion music again. This raga has a calming effect, and can evoke empathy (karuna bhava), she told me.

Instruments like the flute and morsing were dominant in raga Chakravaka. Yadukula Kamboji is predominantly played on the veena and had elements of fusion music.

Can the ragas slotted for the morning and evening sessions be interchanged? Dr Vijayalakshmi says her team has found that the notes in raga Chakravaka keep listeners active throughout the day whereas raga Yadukula Kamboji ensures good sleep.

The first day of my music therapy did not go as planned. After 12 minutes, I realised that my laptop’s Bluetooth had not been paired with my earphones. The last time I had listened to music on headphones was 20 years ago, so I could not make out the difference!

In the evening, I decided to find a quiet corner in the Deccan Herald office in Balmatta and play the clips on my smartphone. A few minutes later, I was fielding a request for an article, and soon after, the traffic noise made it impossible for me to focus on the music.

On the second day, I woke up at 5.31 am to tidy the room and my table. My family ensured I stayed alone in the room for 30 to 40 minutes.

I started enjoying the music I was till then unfamiliar with. Time stood still when the strains of the flute came wafting. The subsequent fusion recording is mixed with forest sounds and the pitter-patter of rain. It was engaging and relaxing at the same time.

I realised over the first few days that the music demanded my attention. I had to detach my thoughts from work and rush home in time to be able to focus on therapeutic music. A colleague teasingly likened me to
Cinderella!

One day I could not get home by 6 pm. I was travelling through the Chikkamagaluru district in a taxi. I asked the driver to stop near Kalasa. I put on my earphones, played the prescribed music, and watched the sunset for 21 minutes. Through the rearview mirror, the driver looked at me, puzzled.

Soon, attending the therapy sessions dominated my thoughts. Earlier, I was preoccupied with thoughts of interviewing people, filing news stories, and chasing deadlines. But on some evenings, I found it hard to focus on the music. Thoughts about scheduling the next day’s work would take over my mind. This happened as early as Day 3, which was a Sunday, my day off!

To prevent my mind from drifting, I tried to focus on my breathing. Another time, I visualised myself as a veena artiste playing to a live audience. I stopped these attempts after Dr Vijayalakshmi told me there was no need for me to feel guilty if I couldn’t concentrate.

On the fifth day, I started listening to the prescribed music while lying in bed. On the 11th day, a Sunday, my wife woke me up half-amusedly. It was 7.10 am. I had drifted off to sound sleep.

I listened to the same tracks for the full three weeks. The instrumental rendering of Yadukula Kamboji raga left me in a trance every evening. So did the sound of fingers moving over the frets. The fusion music took me back to my childhood. I could recall waking up in the wee hours and walking on a deserted stretch leading to the house of an engineer, my father’s colleague at Kudremukh Iron Ore Company. It was the summer of 1991 and the PU examinations were around the corner. I would get to his house by
6 am, and the engineer would teach me mathematics.

I later learnt that music, like smell, can invoke memories. They call it memory triggering.

Dr Vijayalakshmi says white noise or pink noise are based on Western concepts. These refer to varying
frequencies of noise and are used to filter out things that distract, promote sleep and improve concentration.
In some studies, they have yielded
positive results. In others, they haven’t. “More proof is needed,” she says.

According to Dr Vijayalakshmi, even the categorisation of music listening as active and passive is a Western concept. Listening to Indian music involves “engagement” while you can listen to white noise and pink noise passively, she says.

Test reports

At the end of the first week, I had blood tests done. The results disappointed Anju and left me dejected. Contrary to my expectations, my blood sugar had gone up from 164 to 207. It could have been because of what I had eaten that morning. My wife Prameela blamed it on work-related stress. Maybe. Chief Minister Basavaraj Bommai was scheduled to unveil a statue of Parashurama in Karkala, 52 km from Mangaluru.

Anju said the same ragas had shown a positive impact on patients suffering from painful foot ulcers. She asked me if I was listening to songs as prescribed.

Dr Vijayalakshmi called me for a second round of assessment. She told me listening to music was complementary therapy, and not an alternative to medicines. She got diabetologists to change my medicines.

Now I also had to follow a diet chart prepared by a dietician. My intake of rice was reduced. I started eating fox millet, little millet, kodo millet, broken wheat, and salads. I was asked not to eat fruits after dusk.

My final blood test showed a fasting reading of 142 and post-prandial reading of 190.

Life after therapy

I don’t know if it’s because of music therapy or because I have been listening to feel-good music since, I have started noticing subtle changes in me.

Earlier, if the garden hose slipped when I was watering plants at my home, I would curse under my breath. Now I feel less jittery — I fix the hose back on and carry on. I had a migraine attack in the course of the music therapy but it was not intense, as it used to be earlier. I think I am managing stress better now. Sleep is still erratic, but I seek music.

Dr Vijayalakshmi said the goal of my music therapy programme had been to reduce blood sugar levels by 3 to 5 per cent and achieve overall wellbeing. The next task is on sustaining the goal till it is achieved, she said.

The therapy was designed for 21 days because a task done daily without fail for 21 days becomes a habit, she said.

What does science say?

Located in Nimhans, Bengaluru, Music Cognition Lab is India’s first facility to research the effects of music-based intervention on cognition, language, emotion, and functionality in neurological and psychiatric conditions. Faculty-in charge, consultant neuropsychologist, and Hindustani vocalist Dr Shantala Hegde decodes the pursuit of music therapy:

The World Federation of Neurorehabilitation now accepts music therapy as a serious intervention. Studies to measure its impact on neuroplasticity (brain’s ability to rewire itself functionally and structurally), behavioural changes, symptom reduction, etc, are underway across mental and physical conditions.

In our lab, we investigated the effect of music on cognitive function in diabetes mellitus type 2 patients. Reduction in stress and cortisol, and improved attention and memory in varying degrees was reported. The study is published. For a yet-to-be published study, we introduced music listening to a patient ahead of spinal surgery to measure the depth of anesthesia, that is, how much dosage is required to make a patient go to an unconscious state.

The interest in music therapy began in the post-World War II era when music was played to army men in military hospitals to recuperate. They responded positively and a need was felt to put this social science model through rigours of scientific examination, which was subsequently aided by tech like FMRI (Functional magnetic resonance imaging) and EEG (Electroencephalogram).

Now it’s known that music engages all areas and functions of the brain – motor and emotional processing, sensory, auditory and visuospatial functions, limbic system, dopamine pathways, reward centres etc. It’s also known that neurogenesis (brain development) is possible till old age. These reasons and the fact that patients take more easily to music than, for instance, physiotherapy, has fuelled the interest in music-based interventions.

But listening to music is just one task under music therapy. Since music is subjective, a therapist may consider a client’s music preference for pop, Western music or ragas. But some components are common to Western and Indian music. I work with patients with neurological conditions and ask them to to practise the 1,2,3,4 rhythm, or sing ‘Twinkle Twinkle Little Star’ to grasp pitch. In another exercise, I hum ghazals and ask stroke patients to fill in the last word. There are different schools of thought in music therapy, and songwriting may be one task under psychoanalytics to look at expressiveness.

Does music therapy have a downside? We are doing a study on patients with depression of high-risk behaviour to see if music listening is lifting or bringing down their mood, etc.

Personalising therapy may not be possible all the time. Scientists and clinical researchers need to look at ways to standardise it. In India, where cost is a hindrance, there is a greater need to provide home-based interventions. For now, as we await more evidence, it should be used as an adjuvant therapy.