Better Together? Music and mental health

Professor in health psychology Arne Holte says that our country's – and perhaps also the world's - most crucial resource – is good mental health.

Today, trends show that our psychological health is getting worse and worse. In the state budget that was presented these days, many new millions have been allocated for work against mental health and addiction.

According to Holte, everyday mental health is closely connected to 7 areas. He calls them health rights. These are:

1. Identity and Self respect
2. Meaning in life
3. Mastery
4. Belonging
5. Safety
6. Participation
7. Community

Holte says these are the domains on which institutions and organisations should be measured if they want to create mental health-promoting institutions. For example, kindergartens, schools, and universities: Do they deliver in these areas?

What about NMH? Does NMH as an organisation deliver? Does NMH promote identity, self-respect, meaning, mastery, belonging, participation and bonding among students, teachers and their administrative staff?

My name is Karette Stensæth. I am Professor and Director of the Centre for Research in Music and Health at the Academy. And I think about health and its connection to music every day.

I saw my speech announced today – in English!

So, I will speak in English. I hope this makes it easier for us to connect. After all, good and clear communication is also connected to good mental health in so many ways.

So, what is the relation between NMH and mental health?

NMH's slogan is: "Better together". So far, the slogan seems to respond to at least two of Arne Holte's areas: community and participation. Together - is how we can build a mental health-promoting organisation.

Focus on relations

NMH's new strategy also focuses on "relations." Developing good relations, both on micro and macro levels, is a core element in good mental health, also according to Holte.

Before moving further into the material, we need to agree on what health actually is.

The WHO states: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. In music therapy, we are not so fond of the idea of health as something complete – as if it there is an endpoint: “THERE!” Rather it is more like a process, something we need to work on always. It is like a piece of music that you play and need to play over and over again – and always in new ways – to vitalize and re-vitalize yourself and make sure not to freeze and become numb.

Body, heart, head and brain are closely connected

I like to think of the origin of the Norwegian word health – “helse”– which comes from the old Norwegian “heill”, which means WHOLE. “Helse” is also the origin of “heilag” (sacred in English). So, back then, in the really good old days, they didn’t divide health into physical or mental health. Body, heart, head and brain were then and are still closely connected. So, we need to see health as something more complex than just connected to mental states. Physical health also affects mental health, such as anxiety and depression!

In Latin the word for health is "salus", which refers to salvation, safety. This suggests that that what is good for the body, soul, and spirit is combined in one word: Salus. When we raise our glasses and say Salute, we wish each other good health. Without prompting drinking here – because we know that poor mental health is often closely connected to addiction – I repeat: being together and celebrating our companionship and our relations is a way of creating mental health-promoting communities. And isn't music one of the best ways of being together and celebrating each other? Do we realise the potential of being together in music, both at work and in our leisure time, to promote mental health?

Back to health: what is it? I will descrive two well-known health perspectives:

• Patogenese: this is what causes illness. Often, when we talk about health, we talk about illness. Pathogenese – pathological – is often connected to hospitals where illnesses are treated to improve your health.
• Salutogenese: this is what gives health. This perspective is often known through researcher Aron Antonovsky’s theories on stress handling. Stress is a well-known problem area for musicians. Antonovsky’s salutogenic model posits that a sense of coherence is vital to all of us. This means that life neds to be understood as more or less comprehensible, meaningful, and manageable. A strong sense of coherence helps the individual to mobilize resources to cope with stressors and manage tension successfully, says he. Again, do we, as musicians know this, and do we utilise music's potential in this?

Both pathogenesis and salutogenesis are needed to understand health. But often, the salutogenic perspectives are forgotten – left out.

At the announcement of my speech today, I was presented as a "Dementia Choir expert participating in the popular documentary Demenskoret". So I will use it as an example of how the two perspectives on health are needed:

Music and dematia

Dementia is a disease, a pathological illness. Music can, to a certain extent, do something with the illness the dementia symptoms. At least we know from research that music therapy can reduce depression and anxiety, but it also affects behaviour and cognition (language skills f. ex).

However, research also shows that music therapy is salutogenetically beneficial, even for people with illnesses like dementia. It provides a better quality of life, positively affects mood, and is an overall vitalising force.

The dementia choirs provide, in addition, feelings of community and experiences of mastery; again, these are two of the domains in Arne Holts's 7 areas for good mental health. For people living with dementia, these elements are essential to prevent loneliness, social isolation, and apathy, which are perhaps the biggest challenges for people living with dementia and their loved ones. Social isolation and loneliness are some of the biggest public health threats worldwide. So, there is proof that music and singing can, to some extent, treat dementia – the illness, but there is also proof that it can promote overall mental health and even prevent poor health development. These aspects are all essential for the life of the person with dementia and the family around them. And many of us live with dementia in our families today. And within 30 years, because we live longer, the number of people living with dementia will be doubled. Understandably, as a society, we must live a healthy and good life in the middle of the illness and its negative progression.

Easiest type of music-making

Being active, like singing, which perhaps is the easiest type of music-making, and being active together becomes an effective and meaningful activity. It creates a health-promoting community in which people can flourish and deal with pain and illnesses.

Now, I do not think that these effects I have spoken about here apply to people with dementia only.

I think singing together, as well as other types of active music making, has the same effects on all of us. In music therapy we know that this is the case, and we have therefore developed solid tools to use to motivate people to engage in music. Even simply knowing about its effects and potential can make us want to use it more mindfully.

Do you all come together to sing and make music together, as well as outside rehearsals and practising?

You may know that NMH and CREMAH have a collaboration agreement with Oslo municipality to perform research on dementia choirs. Maybe someone here today wants to work with this in the future? I understand that twisting the focus from yourself as a musician – where you and your achievements and performances are in the centre of everything – towards others and their needs in music could be exciting. Perhaps it could even teach you something about the meaning of music and music-making in your own life.?

In social media, it looks like musicians always struggle with their mental health. There is a kind of perception that musicians should experience hell at times. Is this true? For whom? Is it more connected to the pop music culture, perhaps? As she worked in Creo, Christine Thomassen once said, "As musicians, we are what we do – musicians - and that is precisely why it is so difficult to set boundaries". Jonas Vaag has researched musicians' mental health. He, as I did, visited CEMPE and NMH last year at their conference on Musikeren og psyken (The Musicians and their mental health). Here, he told us that musicians have a significantly higher incidence of anxiety, depression and sleep difficulties and that they also seek mental health care more often. This particularly applies to freelance musicians and, most of all, those who combine freelance life with a permanent position. Musicians are not different from other people in terms of personalities; they are not more sensitive or easily depressed or something like that. Instead, it is an uncertain financial situation, and great competition and high pressure to perform affect their mental health, he explains.

Gap between demands and resources

Vaag and his colleagues believe it is essential to focus on the gap between the demands placed on the musicians and the resources they feel they have. External demands can, for example, be a continuous demand to perform, easily creating a lot of pressure and stress! This, in turn, could lead to poor mental health and struggles with coping, which, again, could affect their sense of coherence in life, as Antonovsky talked about. Accordingly, life becomes less meaningful. And: Health easily becomes poorer.

But there is hope. Better use of individual resources can be used to cope better and sort out how to make sure you have a better sense of when work is work and when it is not work. According to Vaag, resources are about the internal resources and individual possesses and about the joy the musicians experience from performing their work. Resources can also be about motivation, recognition and perceived support from colleagues. (Again, areas that align with Arne Holtes 7 areas.)

So, we may ask again: Can playing music itself be a type of internal resource, either alone or together with others (in orchestras and bands, for example)? Can it affect our mental health? Can our playing, in turn, affect others' mental health? What about outside work?

We need more studies to understand the complexity of these questions. In 2020, CREMAH and colleagues in our Nordic Music and Public Health research network surveyed musicians. We defined musicians as music educators/pedagogs, music therapists, music performers, and music academics. Music students in these domains were involved, too. We asked if they looked at music and used it as a resource for their psychological health. Our study focused on (individual) aspects of psychological health, i.e. music for relaxation and energy, affective experiences and mood regulation, for belonging, personal growth, and concentration.

504 respondents participated from across Denmark, Norway, Sweden, and Finland. 68 % were women, and most were between 27 and 67 years old.

Feel the feeling

The results showed that the musicians showed high levels of self-reported health and health behaviours. They also acknowledged the idea that music was a resource for their psychological health. Music's most important psychological function for them was that music provided affective experiences. Music helped them feel, helped them feel the feeling. As we know, identifying the feeling is the first step in every successful therapy process. In a loud world that we live in today, we know that many young people feel numbed and have difficulties defining what they feel. Creating playlists to regulate feelings f ex is often used to help them regulate their emotions.

The study informants also connected their relation to music to belonging and mood regulation. Least prominent was concentration, but this wasn’t bad either. Interestingly, we found that music students were less likely to believe that music activities and musical experiences can help keep them feel healthy than instrument teachers. Is this true for you students?

There was a firm agreement with the statement that music helps maintain psychological health among musicians: 69 % said yes, definitely, and 29 % said yes, to some extent. They also used music to increase energy (e.g., for physical training, housework, etc.), for self-respect, self-confirmation, and self-realisation, and to experience community and belonging. Everyone felt that music gave them a lot of joy (and everything that comes with this) both at work and in leisure time. 4.5 out of 5 possible was the score there. This shows that many of these musicians used music in ways that Holte suggested are good for mental health. Because when we asked them if they experienced the job as lonely, the score was 2,5 (not good, not bad).

In all, music teachers and therapists reported significantly higher use of music as a personal internal resource for mental health than music performers. It could be that music educators and music therapists have greater knowledge of how music can be a mental health support and, for that reason, are also more aware of relating to this as a possibility, or?

My returning questions are: Are we at NMH aware of the mental health benefits of music-making together? Are students and staff at NMH provided with knowledge on this? And would this, to a greater degree, make students and others at NMH use music as a mental health-promoting means?

NMH’s slogan, “Better together”, is on to something. If there is one thing research shows, whether it is dementia choirs or symphony orchestras, but also outside professional contexts, it is that togetherness and active participation in music have promising mental health benefits.

NMH also has a strategy for musician health. This is good, too. For NMH, this means that teachers, student contacts, and other resource persons must get involved in the student's learning environment, which affects mental health and promotes a good psychosocial environment.

Alongside the strategy, we now have two PhD projects on musician's health: Sigrun Eng asks: What can musicians' experienced inner life world tell us (about health)? Ioannis Theodoridis investigates musicians’ physical struggles.

So, there are a lot of good things going on. But I wonder, again: Do we focus too much on the musician in singular form? Should we shift to caring more for students as a group or a community? Should we look more at musicians, students, and staff (plural form) and see what we can do for each other? After all, and as I have repeated several times, it is together, as a community, both through active participation in music and in other community building, that we can best maintain a mental health-promoting environment, again, with reference to Arne Holte.

Today, 10 October, is the World Mental Health Day. Today is a day to reflect on this these things. I, as a music therapist, am a forever believer in that:

Music gives life. Music can save lives. Music can change lives.

Music is a strong means; it has enormous power, which is why it is also easily misused sometimes, for ex, to recruit vulnerable young people to Jihad over suggestive YouTube music videos. But when used with wisdom, music can have great value and impact on our health at individual and societal levels and the world at large. Perhaps you can all agree with me on this? So, then, let us tell the world about this. Let us act accordingly and make the world a better place for all. In its most straightforward way, it starts with a tone, a sound, a vibration - and the sharing of it with others!

I wish you all good mental health. Take care of yourself and each other. Make music together. Salute!