The history of music therapy: from philosopher-physicians and Ottoman hospitals to veterans' wards, the first university degrees and Turkey today.
A volunteer playing the guitar in a hospital corridor, a daughter playing her mother's favourite folk song from her phone in intensive care, or an elderly man suddenly coming alive to an old song in a care home... We all know intuitively that music affects people. Yet the history of music therapy is the story of how this intuition turned into a field tested through training programmes, professional associations and research. In this article we trace the path from what philosopher-physicians wrote about music, through Ottoman hospitals (darüşşifa), to veterans' hospitals in the United States after the two world wars, the first university programmes and the situation in Turkey today. Along the way we will take particular care to keep one distinction: historical beliefs are one thing, today's scientific evidence is another.
Where Does the History of Music Therapy Begin?
The idea that music affects the soul is very old. Aristotle's view that tragedy brings about a kind of purification through pity and fear, known as "catharsis", is one of the most frequently cited ancient ideas about the effect of art on the emotions. The Asclepion of Pergamon is also described as an ancient healing centre where sleep, water, theatre and music were used together; however, the details of the practices there are not known for certain.
The philosopher-physicians of the Islamic world made music a serious subject of thought:
- Al-Kindi wrote ten treatises on music, four of which have survived. He associated the four strings of the oud with the heavenly bodies, the signs of the zodiac, the seasons and the four elements, and tried to explain the effect of sounds on the human body within this framework. It is reported that he also recommended using colour and scent to strengthen the effect of music.
- Al-Farabi wrote the Kitab al-Musiqa al-Kabir (The Great Book of Music), a systematic work on makams (the modes of the classical tradition), instruments and acoustics. He is counted among the thinkers who held that music affects the human soul.
- Avicenna (Ibn Sina) devoted a section of the Kitab al-Shifa (The Book of Healing) to music and defined it as a mathematical science studying sounds and the intervals of time between them.
For most of these thinkers, music was counted among the mathematical sciences. In other words, their interest was not a "treatment protocol" in today's sense but a comprehensive system of thought about sound, harmony and the order of the universe. A considerable number of the "this makam is good for that illness" type of statements attributed to these figures in popular sources cannot be verified in the primary texts.
Music in the Darüşşifa: A Legacy from the Ottomans
The darüşşifas of the Seljuk and Ottoman periods, which were founded through charitable endowments and provided their services free of charge, are often mentioned when the history of music therapy is told. The most frequently cited example is the Bayezid II Darüşşifası in Edirne. In this complex, completed in 1488, it is said that patients suffering mental distress were cared for with the sound of water, music and the scent of flowers; Evliya Çelebi writes that an ensemble of musicians performed for the patients three days a week. At the Hafsa Sultan Darüşşifası in Manisa, too, handicrafts, music and the sound of water are reported to have been part of care.
The medicine of this period rested on the theory of the four humours and temperament. In later treatises, makams were matched with particular illnesses; some lists, for example, state that the rast makam was good for paralysis. These pairings contradict one another from source to source, have not been tested scientifically, and the theory they rest on has been abandoned by modern medicine. They are therefore valuable as the belief of their time; they cannot be used today as a recommendation for treatment. We discussed this subject in detail in our article on music and healing in the Ottoman period.
The music of the darüşşifas leaves us not a prescription but the idea that care can be directed at the whole person.
From War Hospitals to a Profession: The History of Modern Music Therapy
The birth of music therapy as a profession in today's sense took place in the 20th century, largely in the aftermath of war. After the First and Second World Wars, community musicians in the United States began playing in veterans' hospitals, where soldiers who had returned with physical and psychological wounds were staying.
The positive effects observed in patients after these visits caught the attention of hospital teams. Doctors and nurses asked for musicians to be employed in hospitals on a regular basis. But it soon became clear that being a good musician was not enough to work with patients in a hospital setting. Understanding the patient's condition, respecting boundaries, working within a team and using music towards a purpose all required a separate training.
This need was the real driving force that set the professionalisation of the field in motion. The move from voluntary goodwill to structured practice is one of the most important turning points in the history of music therapy.
Imagine you were a nurse working in a hospital at that time. You notice that after a pianist comes to the ward in the evenings, some patients fall asleep more easily, while others become restless during certain songs. This is exactly where the question "For whom, when and how?" arises. The birth of the profession is, in essence, the moment this question was taken seriously.
Universities and Professional Associations: How Did Training Become Established?
The need for training soon found an academic response. The first undergraduate programme in music therapy opened in 1944 at Michigan State College, led by Roy Underwood. Some sources describe it as the first programme in the world; although this claim varies by source, there is broad agreement that the programme laid the academic foundations of the field.
Professional associations also took shape during this period:
- 1950: The National Association for Music Therapy was founded in the United States.
- 1971: The AAMT was founded as a separate professional association.
- 1998: The two associations merged under today's name, the American Music Therapy Association (AMTA).
The founding of professional associations made it possible to define training standards, ethical principles and areas of practice. In the process, music therapy moved beyond simply "playing music to patients" and became work carried out within a therapeutic relationship.
What this transformation meant in everyday practice is also important. A practitioner no longer starts playing straight away on first meeting a patient; they first try to understand the person's needs, their relationship with music and what is troubling them. The aims of the work are set, what happens in sessions is recorded, and progress is reviewed together with the team. The possibility that a song may sometimes awaken a painful memory is also taken into account. In other words, music stops being a well-meant gift and becomes a tool used with care. This rigour is what gives the field its credibility.
A similar professionalisation was seen in other creative approaches. In the United Kingdom, the painter Adrian Hill was one of the first to use the term "art therapy"; in the United States, Marian Chace was one of the founders and the first president of the American Dance Therapy Association, established in 1966. The place of the creative arts in mental health became a set of professions in parallel in the middle of the 20th century.
Music Therapy in Turkey: Regulation and Training
In Turkey, music therapy is one of the fifteen methods defined in the Regulation on Traditional and Complementary Medicine Practices (Geleneksel ve Tamamlayıcı Tıp Uygulamaları Yönetmeliği), which came into force on publication in the Official Gazette on 27 October 2014. Within this framework, the authority to practise rests mainly with certified physicians; according to statements by the Ministry of Health, certified allied health personnel may take part under a physician's supervision in some methods, such as music therapy.
On the academic side, Anadolu University's Institute of Health Sciences has a department of music therapy and a non-thesis master's programme. The programme describes itself as Turkey's first master's degree in music therapy; it requires an undergraduate degree in health, music, education or special education along with instrumental skills, and includes at least 700 hours of practical work. For current admission requirements, it is necessary to check the announcements published each year. You can find more on training and authority to practise in our article on music therapy training.
Although the field's history in Turkey is short, interest is high. Part of this interest comes from curiosity about the darüşşifa legacy, and part from the observable effect music has in hospitals, care homes and special education institutions. The way to put this interest on a healthy footing is not to confuse historical narratives with present-day evidence. Telling the story of the darüşşifa legacy with pride on the one hand, while on the other turning to research-tested methods and competent, trained practitioners when seeking support for a loved one today, is the way to hold these two perspectives together without setting them against each other.
What Does the History of Music Therapy Teach Us? What Does Research Say Today?
Since the hospital visits of volunteer musicians, the field has increasingly been put to the test through research. Cochrane reviews provide an important framework here:
- Depression: A 2017 review reports that music therapy added to usual care may reduce depressive symptoms in the short term. The certainty of the evidence is low to moderate.
- Autism: A 2022 review describes a probable improvement in overall symptoms at the end of treatment; the effect on social interaction and communication, however, is uncertain.
- Dementia: Music-based interventions are reported probably to reduce depressive symptoms, but no marked effect should be expected on agitation or cognitive functioning.
- Cancer: A 2011 review covering 30 studies and 1,891 patients reports that music-based interventions reduced anxiety and may have had positive effects on mood, pain and quality of life. For some outcomes, the certainty of the evidence is low.
The common limitations are also clear: most studies have small samples, participants know what they are taking part in, measurements often rely on self-report and follow-up periods are short. In addition, by Cochrane's definition, music therapy involves musical interaction with a trained practitioner; simply listening to recorded music does not fall within this definition.
Three misconceptions carried from history to the present
The long history of music therapy has also brought some mistaken beliefs with it. Recognising them protects both you and your loved ones from needless expectations:
- "Every illness has its makam." Makam–illness lists come from historical treatises, contradict one another and have not been tested scientifically. Listening to makam music can be enjoyable; but it cannot take the place of treatment for an illness.
- "Babies who listen to classical music become cleverer." The so-called "Mozart effect" attracted wide attention following a single experiment. However, it has not been shown that listening to music permanently raises babies' intelligence.
- "Certain frequencies repair cells." Claims about frequency music such as "432 Hz", often seen on social media, are not supported by scientific evidence. You may find such content relaxing, but it should not be credited with healing power.
These misconceptions do not diminish the value of music; they simply put it in a realistic place. The power of music lies not in exaggerated claims but in its capacity to bring people into contact with their feelings and to connect them with others.
In short, the history of music therapy is a journey from grand promises towards measured findings. Today, music-based approaches play a supportive role; they do not replace psychotherapy or, where needed, an assessment by a psychiatrist. We described how music is used in therapy today in our article on music therapy.
Music in Everyday Life and When to Seek Professional Support
The simplest lesson we can carry from history into the present is that music has a powerful relationship with our feelings. To use this relationship consciously in everyday life, you could try the following:
- Pause briefly during the day to notice your mood, and ask yourself what kind of music you need at that moment.
- Compare what you listen to on your way to work or school in the morning with what you listen to on the way home in the evening; note which calms you and which makes you tense.
- If you play an instrument or love singing, do it just for yourself, without performance anxiety.
These are self-care activities, not therapy. It may help to speak with a mental health professional in the following situations:
- You have been experiencing low mood, reluctance or an inability to enjoy things for more than two weeks
- There are marked changes in your sleep, appetite and energy
- You no longer want to listen even to the music you love
- The feelings you are struggling with are disrupting your work, school or family life
Work in the area of depression and mood is grounded in evidence-based approaches such as cognitive behavioural therapy; enjoyable activities such as music can be added to the process as part of rebuilding daily life. If you are having thoughts of harming yourself, call 112 (emergency services) without delay.
Frequently Asked Questions
Where did music therapy first emerge?
The idea that music affects the soul goes back to antiquity and to the philosopher-physicians of the Islamic world. As a profession in today's sense, however, music therapy became established in the 20th century in the United States, following experiences in veterans' hospitals.
Do the practices in Ottoman darüşşifas count as music therapy?
The music of the darüşşifas is a valuable historical example of music being used in care. However, the practices of the period were based on the theory of temperament and are not the same as today's music therapy, with its framework of training, ethics and research.
When was the first music therapy programme opened?
The first undergraduate programme in this field opened in 1944 at Michigan State College in the United States. Although the description "the world's first programme" varies by source, this programme is remembered as the academic beginning of the field.
Is music therapy legally defined in Turkey?
Yes, music therapy is one of the methods defined in the Regulation on Traditional and Complementary Medicine Practices, which came into force in 2014. It is necessary to follow current legislation on the conditions of practice and authority to practise.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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