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By Nuné NikoghosyanThis contribution is based on a talk at the panel “Effects of music on health – what scientific evidence?”, with participants Alexia Stantzos (Psychiatry department, CHUV), Gilles Bangerter (HESAV), Angelika Güsewell (R&#38;D HEMU Lausanne), Yann Chateigné (Department of Visual Arts, HEAD-GE) on the 29.09.2016, during the week themed “Arts and health: the role of music in the promotion of health and wellbeing” of the Master of Advanced Studies in Public Health at the Institute of Global Health, University of Geneva.In an interdisciplinary discussion, together with practitioners of medicine, psychologists and professionals from art and music schools, sociology may perhaps do its best by suggesting to (re)think the mutual effects of music and health through the use of examples. For if music can affect wellbeing, as seen in various studies (in medicine, psychology, psychotherapy, and neurosciences) and discussed throughout this week’s panels, then health and wellbeing can in turn have an effect on music, and culture more largely.Before going further, however, let us not forget that health and music are social activities rooted in mundane things we do (or avoid) in our everyday lives. In fact, health in itself is rather relative as a category: what is good or bad health? We may easily be seen to be in good health according to certain criteria, and bad health in relation to others. We may be in good health according to the criteria used in one country, but in bad health in another. The list continues: definitions of health depend on the context (social, political, cultural), the historical moment, the group and community that we belong to, who we compare ourselves to, according to the criteria and definitions, etc. A typical example of this relativity may be the case of homosexuality, once seen not only as an illness, but also contagious, later classified as a mental disorder alongside a sin and a crime. Needless to say that in many countries this is still very much the case today. This “condition” has seen many people put behind closed doors, to either be treated or to protect others from the contagion or the crime (Foucault 1961, 1976). The question that arises, together with Michel Foucalt’s work on the topic, is: if we can be mistaken in our judgements of what counts as an illness, then how do we justify imprisonment or isolation for treatment? Who decides, on what criteria? The same goes for census and prohibition, be it in healthcare or cultural products.Art so unkindTurning to examples more specifically related to culture and arts, let us start with the most recent and perhaps most far-fetched one: the announcement in 2014 on Adobo Chronicle (a parody magazine publishing fake news), taken on by many major news sites, that taking selfies has now officially become a mental disorder according to the American Psychiatric Association. The announcement was later shown to be a hoax, but the Internet had already vibrated with this news that had become “viral”. A cultural activity, a form of photography, that more and more people practice nowadays had come to be defined as a health issue. Even if the news wasn’t entirely true, there are aspects of it that most probably are according to still ongoing studies in psychology [1] [2]: the link between an obsessive use of selfies and narcissism, psychopathy and even Body Dysmorphic Behaviour.Similarly, some 20-30 years ago cultural fanaticism (a relatively recent phenomenon) was considered a pathology and fans of cultural products and artists were seen as crazy, deranged, and even dangerous (Jenson 1992). This is perhaps no accident, since the 1960-90s saw a constant expansion of “pop culture” and celebrities, but also of mass media and TV sets in homes. Alongside this, there were times when a fan went as far as killing his/her idol, such as in the case of John Lennon. Immediately, these fans were labelled “deranged” and either put in intensive psychiatric care or in prison. The “fan” was seen, then, as “the other”, the dangerous one to avoid in the crowd, and had come to be so dangerous because of the music or cultural product that led him/her to craziness. Today, being a fan has become, on the contrary, a positive trait when we speak of culture and celebrities. The word “fanatic”, however, still remains a label for isolated cases that we may view as pathologies – religious fanatics, for example.But can we safely say that we no longer view music (or culture) as capable of leading to a pathology, mental disorder, or any other form of ill health? There is still much talk today, especially in the press and everyday discourses, about the malice of certain genres of music that lead young people to depression, different kinds of mental health problems, violence and even suicide. As Adrian North and David Hargreaves (2012) argue, the link between youth suicide and the music they listen to (mostly rap, metal and gothic rock) has too easily led to the assumption of a simple causality: the lyrics of these songs call for violence and praise misogyny, hence leading their young listeners to crimes and eventual suicide. The authors further argue, however, that the causality may even be reversed: young people who already find themselves in difficult situations (poverty, lack of support, social difficulties, etc.), perhaps even in a depressive state, turn to this music as a refuge: it is almost a cathartic effect to listen to lyrics that say what one feels. It may even prevent from taking action, by substituting the urge to act for words. The suicides of these young people, then, would have happened regardless of the music and its lyrics, say North and Hargreaves. Furthermore, other studies have analysed the lyrics and plots of famous operas and concluded that around a quarter of these include violence and suicide (Stack 2002), though there is no debate today about censuring or prohibiting them, as is the case with hard rock.[caption id="attachment_451" align="aligncenter" width="283"] "Skriet", by Bildfabriken (CC license)[/caption]Continuing with the sombre side of music, we must perhaps also mention the use of it in contexts of prisons, torture and war (Grant 2013, O’Connell &#38; Castelo-Branco 2010). If music and sound at a very high volume or of a certain pitch can physically do harm to the human body and ear, it can also have an effect at a psychological level if played repeatedly during long hours. Moreover, war songs have long played their own role in encouraging soldiers, giving a sense of patriotism, group cohesion and a “here and now” of the act.We must perhaps also mention the cases when music affects us at a subconscious level. One such case is the use of music in supermarkets to regulate the flow of people, but also to attract a certain audience and age group according to cultural tastes (Hallam 2012, Kassabian 2013). That is, slow music in a supermarket or a commercial environment will most probably make us walk slower, as we tend to walk to its rhythm, hence probably spending more time inside the shop, eventually leading us to find things to buy. Music with a faster rhythm, though, is more practical for shops during crowded times – to make everyone walk faster and make space for newcomers. Similarly, a certain genre being played in a shop will attract more or less the age group associated with it: a shop aimed at teenagers will most probably play the most recent pop music and not any other genre more associated with older age groups (and vice versa). A coffee shop like Starbucks even produces its own “world music”, that it plays and sells in the shops, as part of its marketing strategy to create associations between its products (and shops) and the exotic imagery of far-away countries associated with the production of coffee and, as if by chance, world music (Kassabian 2013).Blessed be artBut, let us not get too carried away with the negative aspects, since the positive effects of music on health are perhaps far more numerous. There are more and more practitioners of therapies of music and arts nowadays, with the backup of professional associations (such as World Federation of Music Therapy, Arts Health Network, and many more) and growing scientific research. Some exploratory studies even argue that music can have an analgesic effect on the body (Mitchell &#38; MacDonald 2012) and may be used in operating theatres or intensive care units. Music therapies have not only shown to help the individual both psychologically and physically, but also from a sociological viewpoint (Ansdell &#38; DeNora 2012). Since music is usually made and played with others, it can easily create relations and networks that can later be mobilized for help, support, etc.In a similar argument, the psychologist Even Ruud (2012) calls music a “cultural immunogen”: its use in preventing ill health and promoting wellbeing. This is especially so in what may be called “problematic” contexts, such as prisons, shelters for the homeless, refugee camps, etc. While music may not immediately solve any of these problems, which are generally entangled in a web of issues, it may help in other ways, such as to ease the stress, create networks, and give a sense of belonging to a community. We thus come back to the argument put forward by Tia DeNora (2007) that music is a “technology of self” and a “technology of health” in everyday life – the use of music to consciously regulate our moods, what it makes us do (and not) and its effects on us and our social interactions with others.This leads us to yet another case that psychology has long studied, and that may be refined with a sociological insight: the so-called Mozart effect. The beginning of 1990s saw both the scientific community and the general population expand its interest in the results of a study showing that after listening to Mozart, the participants’ cognitive abilities were sharpened as compared to those who didn’t listen to this music (Schellenberg 2012). This “Mozart effect” quickly became a widespread phenomenon, with certain people almost forcing themselves to listen to Mozart in order to have a sharper mind and even become more intelligent (do better at school, thus find a better job, and so on). Later studies showed, however, that listeners of Mozart weren’t necessarily becoming smarter. As Glenn Schellenberg (ibid.) explains, the “effect” is now believed to be not so much in Mozart as in the pleasure of listening to a piece that we like, which in turn positively stimulates the brain and the senses, and only in the short run. It is this same positive stimulus coming from pleasure that can distract the brain’s attention away from negative stimulus such as pain. Again, music becomes an everyday tool in our hands to stimulate the brain, change moods, etc.Related to the widespread interest for the Mozart effect, the 1990s also saw large media campaigns calling for the benefits of music practicing on intellectual capacities (Costa-Giomi 2012). The observation was simple: students who studied or regularly played music usually had higher grades at school than those who didn’t. The conclusion that followed was also simple: learning to play an instrument makes the brain more intelligent, hence all students should play music at school for better achievements in all subjects. Nevertheless, further studies in psychology and sociology now call to nuance this conclusion, even reverse the causality. In fact, many of the students who regularly play an instrument during many years are, even before taking up music, already achieving higher grades at school. Second, most of these students are from families with higher socioeconomic statuses, certain family backgrounds, parents with higher education diplomas, etc. We may even say that their socioeconomic status allows them to not only take up music (buy an instrument, pay for lessons, find free time to play instead of working…), but continue over longer periods of time and then later access universities that demand both high grades and high fees. These criteria are harder to fulfil for students from families with lower socioeconomic statuses. While a correlation between playing music and higher grades may be true, the causality is only implied, even speculated.What health does to artLet us now turn to the other face of the coin: the effects of health on music and arts. How does physical disability, a certain physiological condition or a mental disorder affect how musicians create, work and perform on stage? Many famous musicians from pop/rock/jazz had some sort of a health issue, be it blindness, deafness, polio, epilepsy and so on (McKay 2013). These medical issues didn’t, however, stop them from performing or becoming world famous. Perhaps, like in the cases discussed above related to music as therapy, these musicians also found some refuge in creating and performing? Did their state of (ill) health influence their creations? Are musicians with health issues constrained to certain instruments? Moreover, regardless of the genre or instrument played, long years of professional activity as a musician can affect health, even causing to quit or reduce playing (Ginsborg et al. 2012).These questions may remind us of other examples, such as the Collection de l’art brut in Lausanne (Switzerland) that showcases “outsider creations” and artwork by “people on the fringes of society” who have never had an artistic education of any kind. The collection originally counted works by inmates of psychiatric hospitals and prisons. The simple fact that art created by people with mental health issues needs to be separated from other traditional museums in order for it to find its place and be showcased raises a question: what place do we give to this art? Does it necessarily differ from “other” art? Are other artists, showcased in more traditionally known museums and collections necessarily in good health? How and why did health conditions come to separate artworks by certain groups of people? The issue becomes more complex once we look at who those “other” artists are, only to find that many of them also, indeed, had a range of health problems, including mental disorders. Let us give just the example of Vincent van Gogh who has long been referred to as being “crazy”, suffering from “madness” (Heinich 1992). It is difficult to tell what condition he had exactly using today’s terms, since almost the only word used at the time to label a mental disorder was “madness”. Today, however, van Gogh is as known for his art as for his “madness”, as Nathalie Heinich argues (ibid.) – a certain craziness to his personality, a genius difficult to understand rationally, a talent unmatched, etc. Although, it is sometimes argued today that this was all done deliberately by the artist himself, such as cutting his ear, to attract attention at a time when his art was going unnoticed. Nevertheless, deliberately or not, the “crazy” dimension of this artist made him what he is today.Health, culture, and public authoritiesIf most collections such as the Art Brut and art therapies have most often been the fruits of the passion and dedication of private persons, at least in the beginning, more than public initiatives, this leads us to the question of the link between health, arts and public authorities. In a way, such collections give the power of visibility to this art and its creators (people with disabilities or diverse health issues) – a power that the other artists, in more legitimate and traditional museums, already have. But then again, are artists in these “other” museums necessarily in better health? If a case like van Gogh’s and many other famous artists’ can prove the contrary, then how and on what grounds do we distinguish the “outsider” art from “insider” art, especially based on the artist’s health conditions? The question is indeed more complex than what we can discuss here, but let us concentrate on the role of public authorities, for they often show reluctance towards all things “outsider”: creations, methods, therapies, and so on. In our so-called Western culture, music is seen belonging to the aesthetic domain and almost never the “practical” domain of medicine. As Elliott and Silverman write, “Given the cultural hegemony of the aesthetic concept, the mere suggestion that music is, or could be, ‘good for’ anything ‘extramusical’, such as health and wellness, may surprise or disturb many of today’s classically trained musicians, scholars, music educators, and healthcare workers who simply assume that the value of all music or some music is intrinsic, that music exists ‘for its own sake’.” (2012: 29)Indeed, in other cultures of the world, such as in Asian countries, music is seen in a more holistic approach as being part of not only everyday life itself, but also healing, meditation, wellbeing, and more. In our “Western” minds, music and art therapy belong in the “alternative medicine” category compared to what is called “Western” or Evidence-Based Medicine (EBM). Our societies, together with public authorities, are still very much reluctant towards this “alternative medicine”, due to several reasons (Wigram &#38; Gold 2012; DeNora 2013). First of all, because its effects are at times difficult to measure with standardized and objective tools, as can more or less be the case in EBM. Second, because most of the ways of measuring are very subjective and rely on the patient’s own assessment of the situation (whether the therapy helped or not). Lastly, the effects can at times take much longer to be felt or seen, contrary to certain treatments in EBM that show (almost) immediate results.All of this, and many more complex arguments that require more research and work to decipher, leads to the “alternative medicine”, including art and music therapies, being less financed today by public authorities than EBM practices. From a sociological point of view, however, it is not so much a question of being right or wrong, as of social and cultural norms, values and education that differentiate these practices. As with the case of meditation and yoga, for example, these “alternative” methods, therapies, sports, and lifestyles can, indeed, be transposed from one culture to another – it is more a question of willingness and education, whether they lead to a measurable effect or not.ReferencesAnsdell, Gary; Tia DeNora (2012) “Musical Flourishing: Community Music Therapy, Controversy, and the Cultivation of Wellbeing”, in MacDonald, R., G. Kreutz, L. Mitchell, eds. Music, Health, and Wellbeing, Oxford University Press, 97-112.Costa-Giomi, Eugenia (2012) “Music Instruction and Children’s Intellectual development: The Educational Context of Music Participations”, in MacDonald, R., G. Kreutz, L. Mitchell, eds. 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