Music has been used as a mean of therapy through the centuries to counter all kinds of disorders by various peoples. Physicians and musicians in the Ottoman civilization were aware of the music therapy in continuation of previous Muslim similar practices. There are numerous manuscripts and pamphlets on the influence of sound on man and the effect of music in healing, both in works on medicine and music. Ideas of Al-Farabi, Al-Razi and Ibn Sina on music were followed by several Ottoman physicians. This article presents a study of music as a therapeutic mean by Ottoman medical authors, and presents comprehensive information on their use of the effects of music on man's mind and body.
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Is music an efficient means of healing? Can disease be hindered by melodies? Music has been used as a means of therapy through the centuries to heal all kinds of diseases and disorders by various peoples, in spite of discussions about it. Turkish communities have also been practicing music therapy since the pre-Islamic era. Kam, the Turkish shaman tried to get into relation with the spirits of the other world by means of his or her davul, the drum and oyun, the ritual ceremony; hence they tried to benefit from their supernatural powers. The kam tried to affect the spirits by utilizing music, either driving evil spirits away, or attracting the help of good spirits so as to achieve treatment.
We find Ottoman books and pamphlets on the influence of sound on man and the effect of music in healing, both in works on medicine and music. Ideas of Al-Farabi, Al-Razi and Ibn Sina on music were followed by several Ottoman writers such as Gevrekzade (d. 1801), Şuuri (d. 1693), Ali Ufki (1610-1675), Kantemiroǧlu (Prince Dimitrie Cantemir, 1673-1723) and Haşim Bey (19th century). The study of music by these writers as a therapeutic means and comprehensive information given by them on the effects of music on man's mind and body note the existence of interest and curiosity on the subject during the Ottoman period. Ottoman medical writers such as Abbas Vesim (d. 1759/60) and Gevrekzade offered music to be included in medical education, along with mathematics, astronomy and philosophy, as in order to be a good physician one ought to have been trained in music. This recalls us that music had been included in the quadrivium, the Latin curriculum taught at universities until the late Middle Ages and whih included arithmetic, geometry, astronomy and music.
According to the earliest Turkish sources, the cosmos was created by the word kü / kök, the order of the creator, that is by means of sound. This means that the initiation of the cosmos was started by sound. This is an expression of the Creator's sound coming down and the "Godly sound approach" that is found in cultures of various ancient peoples. This being in accordance with the Islamic belief, which is based on several verses in the Koran, "when He decrees a thing, He only says to it ‘Be', and it is" (Qur'an, Bakara 2/117). The Turkish peoples' idea on the divine character of sound was reinforced after conversion to Islam from the 11th century on. The belief that God was comprehended through words and sound being perceived as letter, the essence of existence was believed to be "sound". The number and differences of letters were related with the variety in the creation and existence. Hence, words were believed to be the cover of essence. This relation played an important part in fostering the belief that music therapy might re-establish the upset harmony of the patient, creating a sane balance between body, mind and emotions.
In pre-Islamic Turkish music theory, there was a different melody for each day of the year; in addition there were nine melodies which were to be played every day; and specific melodies were to be played during certain hours of the day. That is, the time of the day was an important factor to be respected in playing music. Although the pre-Islamic Turkish calendar, its calculations, and the pre-Islamic Turkish cosmology differed from the Islamic ones in some respects, the traditional Uyghur Turk's nöbet, the turn of playing before a sovereign or ruler, was a stable tradition which continued as a symbol of sovereignty in the Seljuk and Ottoman period. The mehter music is the best evidence of this.
Muslim scholars appropriated the ancients musical theories and information related with therapeutic music, which can be traced back to the Hellenistic sources, borrowed mainly from Sumerian, Babylonian and Egyptian concepts, perspectives and mysticism. While Muslim Turks traced the ideas of the ancient people, being a part of the Islamic society, they at the same time acted as the main transferors of the Chinese and Indian, that is far eastern ideas to the Near and Middle East and especially to Anatolia, meanwhile introducing their original concepts of central Asian music therapy tradition. These were being reflected specially in Sufi rituals, the zikr.
The ancient theory of numbers and harmony of spheres, that is the motion of the stars, their intrinsic properties, and their effect and influence on mankind, the scheme of cosmic music were reflected to Islamic, hence Ottoman music theory. The theory of numerology expressed in musical terms was developed by Pythagoras, who was influenced by Babylonian astrology. Ottoman writers too "related sound to the cosmos through a mathematical conception of sound vibrations connected with numbers and astrology." The inaudible sounds produced by the movement of celestial bodies, called the "harmony of the spheres" were believed to express the mathematical harmony of the macrocosm. Hence, modes, or sequences of musical notes were believed to have a mathematical meaning. "The search for reason and intellectual logic in music therapy depended on the idea that man was a part of the universal harmony." Just as celestial bodies were believed to have counterparts in the human body, sound vibrations as a reflection of celestial bodies as well, were supposed to affect a diseased part of the body. Attaining harmony between body and soul led to health.
Patients suffering from a certain illness or the emotions of persons with a certain temperament were expected to be influenced by specific modes of music. Certain makams, that is musical modes, were prescribed for therapeutic purposes. Makam is "a concept of melody which determines tonal relations, as well as an overall indication of the melodic patterns." Modes, as patterns of organized sounds, were believed to express special meanings. Though there are about 80 Turkish modes; usually only 12 were prescribed for therapy, in accordance with the limitation of the related theories of cosmic elements and numerology, as it is in the Islamic and ancient sources. From the old texts we can deduce the kind of music which was supposed to cure a certain disease or create certain feelings and favour certain behaviours; though the musical modes of those days are not the same as those that we know today.
The aims of Ottoman music therapy by playing specific modes prescribed for certain physiognomies and nations can be classified as: treatment of mental diseases; treatment of organic diseases; maintaining/re-establishing the harmony of the person – a healthy balance between body, mind and emotions by pleasing him/her; leading the way to emotions, such as getting people laugh or making them cry etc., preventing vicious feelings and attracting good ones, training the self and thus reaching perfection.
Figure 2: Painting by Nil Sari depicting the treatment of an insane patient by musical therapy. Inspired from the scene in Figure 1.
The writers who regarded music as a means of treatment seemed to attribute a lasting value to its effects. That is, the effects of the music applied systematically as a preventive or curative means on physical and mental state were stated as predictable; for example, the musical mode rast was supposed to be therapeutic for the paralyzed. Others were believed to cause sleeping, sadness or joyfulness or motivated intelligence etc. Thus, some produced effects of relaxation, or soothed the soul, others caused excitement etc. While illness, that is the lost balance of the four humours was tried to be restored by means of music, the temperament and physiognomy of the patient also had to be observed and valued. This meant that, although there were modes of music which were means for healing specific illnesses, the best suitable mode could be reached in accordance with the response it could elicit from the patient, which was supposed to depend on his or her temperament.
It is interesting that musical modes were believed to have power on physical processes and functions as well as the moods and emotions as a whole. That is, the responses to music were supposed to have both physical and emotional effects. Those who suffered from anxiety, insomnia, indigestion, paralysis, dysuria etc. were all expected to be treated and cured through the effect of suitable music. For example, sciatica was expected to be treated by nevâ, an Ottoman musical mode. Even malicious infections were recommended to be treated by musical modes, which can be traced back to the antique ideas of Democritus. For example, Ottoman writers advised the mode hüseyni against fevers, and the musical modes zengule and irak for the treatment of sersam, that is meningitis. Then being incurable, what was the purpose of music therapy applied for treating malicious infectious diseases? Was it only a theory?
Was music used merely as a means for pleasing patients? Or, was music regarded as an imaginary substitute for a dysfunction or misbehavior? Today we know that "music contains suggestive, persuasive or even compelling elements, specially depending on the harmonies present in any particular sound." But, how was it explained? "Did writers/physicians presume that music influenced the emotions and created moods which in turn acted on the body; or did it work in reverse, from the body to the psyche? " Today we know that "most of the time the two processes react on each other;" and that "even without cortical involvement sound can arouse the activities of the autonomic nervous system." Ottoman physicians and musicians of the 17th and 18th centuries were not informed of modern physiology and psychology, but were aware of the body-mind interaction. The manifestations of the autonomous nervous system have been observed through the ages since ancient times. We find evidences of it both in literature and illustrations, displaying the influences of music on various parts of the body or specific organs, mainly the heart. The physiological responses to musical vibrations could not be measured, but changes in the cardiac and respiratory processes, that is heart beats and breathing were described. Today we know that emotional impact of music may provoke certain involuntary physiological responses, such as changes in blood circulation and breathing. It is also a fact that the heart is an organ whose function is deeply effected by emotions.
Above all, rhythmical patterns together with a melody have been used through the ages as a means of stimulating muscular action, that is physical activity. The Ottoman band of musicians of the palace, the mehter was also used to enhance and built up physical energy on the way to war.
Figure 3: A music therapy scenario from Edirne History of Medicine Museum.
As we learn from the Book of Travels (1664) of Evliya Çelebi and the Adjustment of Temperaments by the physician Şuuri (d.1693), treatment by music therapy was through listening; and music therapy in Ottoman hospitals was not practiced as one - to - one relationship, but a group of patients listened to a group of players and singers, that is music therapy was probably a collective activity. But, if in theory its effect was supposed to differ from one temperament or illness to another, it must have been practiced on members of a group of specific temperaments or diseases. Whether or not or to what degree practice depended on theory is a matter of discussion not solved so far. There is no description of the way of application by music therapy in Turkish texts; only advises were made for treating illnesses, without any detail such as the distance between the patient and the player or singer. Nothing is noted in medical works about the healer and his or her relationship with the patient, and no mention is made of whether patients played instruments or not.
In Ottoman medical manuscripts dealing with music therapy, we find only the prescription of special modes to be used for certain illnesses. Music therapy was speculative, but it was used empirically, too. There is no mention of religious healing or the use of music as a means of communication with the supernatural world, and cure through the divine intervention. Music therapy is not stated in medical manuscripts as a faith therapy of supernatural origin, but was rationalized by being based on the theory of four elements and humours. Scholarly medical writings of the Ottoman period being on the same lines with Hippocratic teaching, had a rational attitude to illness and made use of music as a method of rational healing. However, there is almost no criticism of the kind we come across frequently in medical books about the different evaluations of the humoral theory and practices in accordance with it. There seems to have been no need for discussion in the prescribed musical modes and their effects. This impresses one as scholastic information transferred through centuries. It should also be noted that only some of the medical works of the Ottoman period include chapters on music therapy, though medical subjects of the day are regularly included in all of the medical books. I wonder if music therapy was not considered as a subject of discussion, because it was not regarded as an inevitable method of therapy.
In spite of the detailed information about the time- in which day of the week and which hour of the day which musical mode should be played to which temperament, I have not come across knowledge about how long the therapy should be continued, except for a 16th century trust of deed of Tire, an Aegean district, which notes that the insane should be treated by listening to songs and instrumental music for two hours in the afternoon. But, there is no detail about how many times it should be repeated. However, detailed tables that show the days and times when and to which temperament musical modes should be played, were formed. Since the same modes and temperaments are cited several times, so we may assume that music therapy was expected to be repeated at certain intervals, that is it was a cure to be continued so long as needed.
Patients' responses to or effects of music therapy is not noted in the sources studied, except by Şuuri of the 17th century. Şuuri describes giving up music therapy at the Bayezit II.'s hospital in Adrianople, as a result of its being regarded as an entertainment by those who spoiled the rules of the hospital and have them neglect their duties, that is, it had been abused and also disturbed some patients. This reflects a critical attitude, though no criticism is found about the success of music therapy. However, this evidence can be taken as an example of music therapy being failed for the time. We may also conclude that in hospitals purely recreational approach to music may not have been considered appropriate. Leader philosophers of the Islam, however, agreed with the idea of using music for recreation, provided it didn't provoke lust. That is, it was considered improper to let lust overcome the mind by means of music.
The philosopher, the physician and the Sufi, observing that some music modes have joyful and others have saddening influences, they utilized the effects of sounds. It was generally believed that using music's influence in the right way trained the soul. Ottoman writers on music expected music to be also a means to develop an ideal character. Attaining harmony between intellect and emotions could lead a man to become conscious of himself. We recall that ancient philosophers Plato and Aristotle believed that certain musical modes possessed an ethical value and produced certain effects on the morality of the listener and helped in the development of character.
For the Sufi, purification and enlightenment came through the heart. The heart was described as the most virtuous organ and the symbolic center of man's existence and the feeling of love felt through the heart was accepted as the key of being aware of the existence of the Creator. This was an educational approach to music. Sufi music was used as a means of training for ideal perfection, which also meant becoming harmonious with oneself. Man, being accepted as the symbol of the universal creation, was described and evaluated as a micro-cosmos. It was believed that all the characteristics of the universe were awarded to man by the Creator. Therefore, the ultimate aim of music was to attain freedom of the self (nefs), so as to reach his/her soul to the divine origin.
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*Professor Nil Sari, Ph. D., from Istanbul University Cerrahpasa Medicine Faculty, Department of Deontology and History of Medicine, is a world expert scholar in the history of medicine, Islamic medicine and culture and Ottoman science and medicine. Professor Sari is also a key FSTC associate. Presently Professor Nil Sari is Head of the Medical Ethics and History Department, Istanbul University, Cerrahpaşa Medical School.