The dark side of music as ‘therapy’

A violinist plays in a cancer ward. A playlist loops in the waiting room. A surgeon hums along to the radio mid-operation. We assume, almost without thinking, that music helps. But what if it doesn’t – or worse, what if it harms?

Music has been used since the beginning of time, in every culture, as a positive part of social and ceremonial events, including eating, hunting, courtship, weddings, funerals, coronations, sports and social celebrations. But music has also been used as a weapon of war, to torture, humiliate and disorientate people.

Music was used as a form of torture in Guantanamo Bay after 9/11 and by the Nazis, who forced musical prisoners to entertain their captors while they starved and awaited death. It’s a jarring thought that the same force that moves us to tears at a concert can be weaponised to break people.

Similarly, in hospitals and clinics, music is generally seen as a low-risk and harmless way to reduce anxiety in waiting rooms, as background support for staff in the operating theatre and as a stimulation to exercise in rehabilitation. It is rare to recognise music as a double-edged sword.

Music therapists are healthcare professionals, trained to use music as a clinical tool rather than simply a pleasant distraction. They work across a wide range of settings – in hospitals, hospices, mental health units, care homes, specialist schools and community clinics – and their work is grounded in evidence, not instinct. They are experts in using music to improve health and wellbeing, attuned to whether music might cause harm or support wellbeing, yet the research in this field rarely focuses on whether music might sometimes do more harm than good.

In practice, music therapists do remarkable work. They help people with dementia to communicate and connect when words have failed them. They support children with brain injuries to develop speech. They help stroke survivors regain physical movement. Music is also used to help people work through complex trauma. These are serious, skilled interventions – not background noise.

The wrong note

But music can cause real harm too, and we don’t talk about this nearly enough.

Think about what happens when music is imposed on people who haven’t asked for it. Premature babies and patients with disorders of consciousness are particularly sensitive to sensory overload. Blasting music at them isn’t soothing, it’s stressful.

Residents in care homes are routinely subjected to music they didn’t choose, played at times that suit the staff rather than the people living there. Well-meaning volunteers turn up to hospital wards with guitars and ukuleles, and nobody asks whether the patients actually want a performance. Good intentions don’t cancel out a bad outcome.

Doctors and managers in hospitals and care homes are reaching for music as an easy, feel-good intervention without asking hard questions about whether it’s appropriate. Music can connect people and bring joy, but it can also exclude, irritate, distress and disorient. The same qualities that make it powerful make it problematic when used carelessly.

The principle should be simple: music should always be chosen by the person listening to it, never imposed on them. It should be thoughtfully selected and of decent quality. A study found that more than half of patients on an older people’s ward had no say over what was on the radio or television. That’s not music as therapy – it’s just noise.

This doesn’t mean music shouldn’t be used in hospitals and care homes. Used well, it can reduce pain, lift mood, aid recovery and help people feel less alone. “Used well” means assessing whether a patient actually wants music. It means choosing the right music for the right person at the right moment. It means training staff to understand when music helps and when it doesn’t. And it means being honest that a cheerful playlist isn’t a neutral act, it’s an intervention. And like any intervention, it can go wrong. It’s about qualified music therapists working with music to improve patient wellbeing.

Family visitors can create meaningful playlists to leave with the patient, and listening to music together is possible when other shared activities are difficult. But always ask first, and remember that silence can be just as valuable as any playlist. As the American entertainer Will Rogers said: “Never miss a good chance to shut up.”