The origin of music it self is unknown, but the use of music in healing ceremonies is an ancient practice. It is believe that among primitive people, illness was viewed as originating from magico-religious forces, or form the breaking of taboos (for review, see Sigerist, 1944). Thus, music in combination with dances or words, along with songs, and the music producing instruments were considered to be efficacious in exorcising disease or healing wounds. In fact, the oldest known documentation of medical practices, the Kahum papyrus, refers to the use of incantations for healing the sick (Prickett, C & Standley, J, 1994). In classical antiquity, disease was viewed as an imbalance in harmony between a personÕs physical and psychical nature (Tyson, F. 1981). Music, in this case, was believe to have divine significance, and thus, extremely important for restoring harmony and heath.

In the Middle Ages, disease was still seen as a punishment and a result of sinful doing. Hence, the mentally ill were considered to be possessed by evil spirits; leading to cruel torment and exorcised, and murder of thousands of men and women (for review, see Sigerist, 1944). For instance, in Europe, thousands of mentally ill men and women were killed because their hallucinations or delusions was interpreted as a "possession by the devil" (for review, see Stone, 1966).

By the end of the 18th century, scientists began to investigate the effects of music on the human body. It was during this time that the effect of music on function such as cardiac output, respiratory rate, pulse rate, circulation, blood pressure, on electrical conduction of tissues, on fatigue-ness, and on general vibratory effects on the body was initiated (for review, see Diserens, 1922, 1926; Prickett, C & Standley, J, 1994).

By the end of the 19th century, a growing number of researchers started to study the effect of music systematically. Researchers also began looking for relationships between music and physiological or psychological responses. The relationship between music and emotion became a hot topic for lab researches. Hence, music became the emotional reflection of the composer. The utilization of Ôdissonance and rhythmic irregularityÕ of music accelerated into the 20th century (for review, see Hanson, 1948).

The development of music therapy as a profession is believed to be a hospital-developed practice that originated in psychiatric hospitals. Much of the contribution to it popularity and establishment originated from wars. Wars are considered to have had a big influence to both bringing in mental illness to the fore, and in establishing strategies for treating the problem. For instances, the civil war help create the field of neurology, which advanced our understanding of brain diseases; World War I, led to the acceptance of psychiatry as an integral part of medical treatment; World War II lead to the development of large-scale screening techniques, group therapy, and increase use of music in hospitals (Tyson, F. 1981).

In sum, the applications of music therapy was believe to have gradually evolved along the following four main lines:

1. In Functional Occupational Therapy (FOT)- During World War I, it was observed that military patients recovered from wounded limbs more quickly as a result of physical therapy. The goal of FOT was to increase the functions of muscle strength, joint mobility, and coordination of movements. Physical and coordination rehabilitation via specialized exercises was also applicable to cases of severe burns, and of nerve destruction and diseases. Music was prescribed as exercise for re-strengthen and retraining most of the joints and muscles of the body (through playing the instruments), and singing and blowing provided the means to exercise the lungs and the larynx. These methods of treatments are still used today.
2. As an adjunct to psychiatric treatment- Music was reported by Gilman and Paperte in 1952, as having the following attributes in the treatment of mental illnesses:
   • Ability to command attention and increase its span;
   • Power of diversion and substitution;
   • Capacity to modify the mood;
   • Capacity to stimulate pictorially and intellectually;
   • Capacity to relieve internal tensions;
   • Capacity to facilitate self-expression;
   • Capacity to stimulate re-socialization. Furthermore, there are three empirically derived assumptions that has been used primarily in neuropsychiatric hospitals:
   • That rhythmic stimuli set up muscular tensions which seek immediate release through physical activity and which help, therefore, to pull the patient out of his morbid preoccupations and direct his attention toward things and events around him;
   • That the moods created by different types of music stimulate emotional responsivity;
   • That music awakens real or fantasized associations and memories, thus facilities the expression of repressed, unconscious material.
3. As a direct anesthesia- It was observed that when phonographs was introduced into veteranÕs hospitals during World War I, the music not only entertained but also relaxes the patients. Phonographs was first introduced into the operating room by doctors as a psychological aid. It was soon realize that patients could be anesthetized more easily and did not require as high a dose of medication after the operation. Similar results were also observed in dentistry.
4. As a psychological stimulus in the total hospital environment- Music was observed to be an effective accompaniment to meals, calisthenics and remedial exercises. It is also shown to increase the endurance and efficiency of work projects in the Occupational Therapy shop, which is to reduce anxiety and relax patients in the administering of certain shock therapies (when used in conjunction with hydro-therapy and electroshock therapy it has been shown to have a synergistic effect); and to divert patients during time-consuming physical therapy and deep x-ray therapy treatment.

By the 1930Õs, music therapy has taken a new aim; to modify moods, as well as destructive or immoderate physical activity on the open ward (Tyson, F. 1981). When the development of tranquilizer became available in the 1950Õs, it became possible to utilize therapeutic strategies to meet the psychological needs of patients. Furthermore, it was report by Gaston in 1968, that the most commonly shared goals reported by music therapists were: 1) The establishment or re-establishment of interpersonal relationships; 2) The bringing about of self-esteem through self-actualization (Tyson, F. 1981).

At about the time of World War II, the role of music in healing advanced to new heights. As wounded soldiers filled hospital beds, doctors noted that music did more than provided a morale-booster; it greatly enhanced the recovery process. Music was then incorporated into the ArmyÕs Reconditioning Program, which uses music for physical reconditioning, educational reconditioning, and occupational reconditioning program, which was under the direct supervision of medical personnel. This became the first official recognition of music as a therapeutic means to be used in military hospitals in assisting the sick and injured during recovery (Tyson, F. 1981). Toward the end of World War II, musicians were assigned to military hospitals to work directly with patients and it was during this time period that led to the establishment of the music therapy profession. Given the overview of how music therapy came to be, we are now ready to look specifically at how music is used in medical settings as a means of reducing pain.

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Music Therapy in Clinical Settings