The Role Mozart Plays in Psychodynamic Psychoanalysis

 

Sigmund Freud first introduced psychoanalysis in the 1890s and its basic tenets are as follows:

  • A person’s development is largely determined by forgotten, or repressed events from early childhood,
  • Attitudes, thought and behaviours are influenced by irrational drives found in the unconscious,
  • Conflicts between the unconscious and conscious can manifest in neuroses, and
  • Alleviating neuroses from the unconscious mind is done so by bringing these thoughts, memories and ideas into the conscious mind.

Since the approach was first presented, things have continued to change and evolve, including different schools of thought, and different theories. Psychodynamic psychoanalysis is typically regarded as the least successful/useful form of therapy, particularly due to its founder and his theories and ideas relating to the unconscious mind. Most regard Freud and his theories as hyper-sexualized, and relying too heavily on psychosexual development, and said development as the reason for most if not all neuroses.

The nature of Psychoanalysis is to delve into a person’s psyche, to present to them what the root of the issue is. This makes it so a client who says they are feeling depressed is not given a quick fix, rather, they see what is causing those feelings and focuses on dealing with that, as to avoid the feelings reoccurring. The techniques used are as follows:

  • Anamnesis: recalling past memories and bringing them to the forefront of our minds. The patient is to remember facts, behaviours or emotions related to the occurrence of the symptoms. (By remembering the antecedent of a symptom, we may find the answer for why the symptom presented itself to begin with.)
  • Free Association: The patient is asked to lie on a couch, (in order to create a relaxing state/mood) and is asked to say anything and everything that crosses their mind, without restriction. This act of free association is to allow ourselves to avoid censure, which means we will freely speak of immoral, unethical, neurotic and narcissistic things that cross our minds. By allowing ourselves to freely speak of things, we offer the therapist a way to better understand our condition. This method does not end when the talk stops, rather, it is the therapist’s role to analyze these thoughts, and find the associations between the talk and the condition.

The act of free-association was argued by Freud to be more helpful than anamnesis in bringing thoughts and feelings from the unconscious to the conscious mind. Essentially, through free association, the client is revealing his psyche to the therapist, and his self. So what role does Mozart play in all of this? Music has been found to influence a person’s subjective emotional state (Georgi, R.V., Gobel, M and Gebhardt, S, 2010), effects neocortical structures associated with analysis and synthesis, as well as subcortical structures associated with the processing of both negative and positive stimuli, (Georgi, R.V., Gobel, M and Gebhardt, S, 2010). This supports the idea that music significantly influences mood, and understanding of that mood.

With this in mind, by way of using Mozart throughout the therapy session, then the act of free association may become much easier for the client. By activating emotions, and essentially opening the clients psyche more so than if we were to rely solely on free association, the client may feel more in tune with themselves, and may feel more open to express themselves. It may also help the client understand why they are saying what they are saying –and may be able to “come to a realization” during free association.

Why Mozart in particular? As Norman Doidge points out in his most recent book “The Brain’s Way of Healing”, Mozart’s compositions provide the most continuous sounds that are “easy on the ear,” and it motivates the emotional flow of language (Doidge, N, 2015). Further, the music used in sound therapy enhances the connection between brain areas that process positive reward and the insula, which is involved in paying attention. Music rewires the “noisy” brain, which Doidge defines as an overactive brain that fires neurons senselessly and without direction (Doidge, N, 2015). By re-wiring the brain and these neuronal connections, the brain, and the mind, are quieted and cleared in such a way that enhances clarity, focus and attention. All of which are essential for recalling repressed and unconscious emotions.

Why combine Mozart with psychoanalysis, instead of having patients listen to Mozart outside of therapy? The combination will work in such a way that the client becomes much more open to their past memories and current emotional availability, so that free association will occur with more direction than before. Further, the music will allow the client to be in a more relaxed state, which is essential in free association. Although some have found it necessary to choose one type of therapy, and argue its validity and efficacy, I believe that we should incorporate and rely on more than one form of therapy for the treatment of neurotic symptoms. If music proves therapeutic for some patients, and offers a sort of lucidity, why not pair it with a proven form of therapy, such as psychoanalysis?

 

 

 

 

 

 

 

References.

 

 

Blood AJ, Zatorre RJ, Bermudez P, Evans AC (1999) Emotional responses to pleasant and unpleasant music correlate with activity in paralimbic brain regions. Nature Neuroscience 2, 382-387.

 

 

Blood AJ, Zatorre RJ (2001) Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion. Proceedings of the National Academy of Sciences 98(20), 11818-11823.

 

Brown S, Martinez MJ, Parsons LM (2004) Passive music listening spontaneously engages limbic and paralimbic systems. Neuroreport 15(13), 2033-2037.

Freud, Sigmund. (1895). Studies on Hysteria.

Griffiths TD (2003) The neural processing of complex sounds. In: Perez I, Zatorre RJ (eds.) The cognitive neuroscience of music. Oxford, New York: Oxford University Press, pp 168–177.

Krumhansl CL (1997) An exploratory study of musical emotion an psychophysiology. Canadian Journal of Experimental Psychology 51, 336-352.

McFarland RA, Kennison R (1989) Asymmetry in the relationship between finger temperature changes and emotional state in males. Biofeedback and Self Regulation 14, 281-290.

Nyklicek I, Thayer JF, van Doornen LJP (1997) Cardiorespiratory differentiation of musically-inducted emotions. Journal of Psychophysiology 11, 304-321.

Panksepp J, Bernatzky G (2002) Emotional sounds and the brain: the neuro-affective foundation of musical appreciation. Behavioural Processes 6, 133-155.

 

Schubert E (2001) Continuous measurement of self-report emotional response to music. In: Juslin PN, Sloboda AA (eds.) Music and Emotion. Oxford: Oxford University Press, pp 393–414 Schubert E (2004) Modeling perceived emotion with continuous musical features. Music Perception 21(4), 561-585.

 

Sloboda JA (1991) Music structure and emotional response. Psychology of Music 19, 110-120.

 

Tramo MJ (2001) Music of the Hemispheres. Science 291, 54-56.

 

Vaitl D, Vehrs W, Sternagel S (1993) Prompts – Leitmotiv – Emotionen: Play it again, Richard Wagner. In: Birbaumer N, O ̈ hman A (eds.) The structure of emotion: psychophysiological, cognitive, and clinical aspects. Seattle: Hogrefe and Huber, pp 169–189.

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What are the Voices Saying?

Schizophrenia is one of the most misunderstood disorders of the mind; it presents differently for most people, and there are a number of different symptoms outside of the most commonly known delusions and hallucinations. Due to this misunderstanding, a number of treatment methods are bypassed to subdue the client, or “quiet” the symptoms. Although medication can be helpful to many, both atypical and typical antipsychotics have a number of severe side effects that may cause more damage than help (Leucht et al., 2009/Stroup & Marder, 2013/McKim, 2007). Of course, the best approach to any mental illness is the incorporation of both medication and therapy, but sadly, this is not always the case. Typical psychotherapy is sometimes regarded as fruitless in regards to treating schizophrenia, possibly because there are a significant amount of symptoms that could “get in the way” of a therapy session. However, R.D. Laing was very successful in treating individuals with schizophrenia through therapy (Laing, 1960), and by implementing a very humanistic approach, through his use of compassion for the client. I believe that this approach should be revisited, and when dealing with hallucinations and delusions in particular, we should be asking the client and ourselves “what are the voices saying?”

Typically, the response to a delusional thought or hallucination is to either 1.) get rid of it or 2.) play into it. Neither is the proper response. If we do not know where this delusion is coming from, how will we be able to properly treat it? We won’t be doing anything other than taking a shot in the dark. By asking the client what the voice is saying, we get a closer look into their psyche, and a closer look into the root of the problem. Understandably parents wish to separate themselves from their child’s mental illness; they do not wish to be blamed for it. Freud was, however, correct in identifying the impact parents have (genetically and environmentally) on the child’s development (Freud, 1918/1923/1949). Early childhood experiences are undeniably, a contributing factor to any mental illness and we should not be ignoring this impact.

How we were treated in our childhood (by parents, peers, other adults), has a significant impact on how we view ourselves, and by extension how we behave. For an individual with schizophrenia, these memories and experiences are quite possibly repressed, and just now, manifesting in negative, neurotic ways. For instance, a client who is hearing a persecutory voice telling them they are worthless, ugly, or that they do everything wrong/can’t do anything right, is a client who quite likely has heard these phrases prior to the onset of symptoms. I have discussed in a previous article the impact a disintegrated self has on the psyche, so too has Laing (Laing, 1960). This inability to integrate certain aspects into the self (memories, experiences, aspects of personality), will present themselves later in the form of symptoms. For those with schizophrenia, this typically manifests in hallucinations and delusions.

By way of simply knowing what the voices are saying, we are able to perform psychoanalysis successfully. Instead of shying away from treating schizophrenia with therapy, we should be approaching it the same as any other mental disorder. Let me give an example.

A young woman, aged 26, has been experiencing delusions for the past year and a half. She is hearing voices telling her that she will “never amount to anything” and “without me you’re worthless.” These voices are of course, very distressing to her, and cause a significant amount of anxiety and worry, which leads to depressive feelings. She begins to believe these voices, and her lifestyle changes significantly from “normal” functioning prior to the onset of symptoms, to a disorganized, chaotic, and dysfunctional lifestyle. She finds it difficult to get out of bed, to eat properly, to get dressed –all of which are simple, everyday tasks most of us are able to perform without thinking consciously about it. This is because she is focused on the voices, combating them, and struggling so hard to repress them.

If we were to ask her “what are the voices saying?” we could discover the source. These thoughts have been repressed for some time, and perhaps, they originate from previous feelings of self-worth (or lack thereof). If we analyze and assess the clients’ history (childhood and beyond), we may get a better understanding of where these thoughts are coming from. It is normal for each of us, from time to time, to have negative thoughts about the self – but do we not also understand, with a little introspection, to some degree where they are coming from?

Say for instance, we were to discover, through our analysis, that all throughout her childhood her parents verbally and physically abused her. When she went into school it was difficult for her to make friends, and she was teased and bullied all throughout middle and high school. She tried her best to ignore this negativity, in an attempt to “survive” her years in school until graduation. This is of course, a very extreme case, however, by ignoring and repressing these negative thoughts and behaviours, they resurface later.

In order to combat these thoughts and experiences properly, we should be counseling, and employing cognitive behavioral therapy (CBT) (Beck, 1967). By counseling, I am referring particularly to counseling parent-child relationships (should this be found to be one of the main sources of negativity). By communicating our feelings, and working through the negativity instead of keeping it inside and ruminating about it, we are more likely to deal effectively with the source. This should not be the only resource we rely on for combating these delusions. We should also be employing CBT – challenging thoughts and behaviours.

By getting to the root of the problem, that is, the source of these thoughts and voices, we can address them directly. We can ask the source (parent, friend, teacher etcetera), why. We may also be able to determine that this is not a fundamental aspect of the clients’ personality. They are in fact not worthless, or ugly, and whatever else the voices may be saying. The first step is of course to confront the source, and the next step is to combat the continuing voices. Just because we have addressed the source does not mean the voices will dissipate. We must change the way in which we think, because this thought pattern, although separate from our selves, has become somewhat integrated into the self. We are able to combat these thoughts and change them, through CBT – by using exercises and homework. These must be taken seriously in order to experience change, because we are trying to alter negative thought patterns that have been with the client since childhood or beyond. As we know, it is very difficult to break a habit, so too is it difficult to break a thought cycle.

Therefore, we must confront those with schizophrenia not as helpless and beyond cure. Instead, we should confront these clients with compassion and new ways of understanding their illness. For many, these thoughts will represent something very real to them. These thoughts should be regarded as a manifestation of repressed thoughts, experiences and memories. As Freud has taught us, when we understand the impact a memory has on an individual, we are able to treat it effectively (Freud, 1895). Even just speaking of the source is cathartic. Instead of ignoring the voices, and repressing them even more, we should be asking what are they saying, and what does this mean?

 

References:

 

Beck, A.T. (1967). The diagnosis and management of depression. Philadelphia, PA: University of Pennsylvania Press. ISBN 0-8122-7674-4

Freud, Sigmund., & Breuer, Josef. (1955). Studies on Hysteria. (James Strachey, Trans.). London: Hogarth press. (Original work published 1895).

Freud, Sigmund. (1918). “From the History of an Infantile Neurosis”, reprinted in Peter GayThe Freud Reader (London: Vintage, 1995).

Freud, Sigmund. (1927). The Ego and the Id. (Joan Riviere, Trans.). London: Hogarth Press (original work published 1923).

Freud, Sigmund.(1989). An Outline of Psycho-Analysis. (James Strachey, Trans.). New York: Norton & Company. (Original work published 1949).

Laing, R.D. (1960).The Divided Self: An Existential Study in Sanity and Madness. Harmondsworth: Penguin

Leucht, S., Corves, C., Arbter, D., Engel, R.R., Li,C., & Davis, J.M. (2009). Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet, 373 (9657): 31-41. doi: 10.1016/S0140-6736(08)61764-X.

McKim, W. (2007). Psychomotor Stimulants. Drugs and behaviour: An Introduction to behaviour pharmacology. Pearson Prentice Hall.

Stroup TS, and Marder S. (2013). Pharmacotherapy for schizophrenia: Acute and maintenance phase treatment. Retrieved from http://www.uptodate.com/contents/pharmacotherapy-for-schizophrenia-acute-and-maintenance-phase-treatment