PDF Summary:I Heard There Was a Secret Chord, by Daniel J. Levitin

In I Heard There Was a Secret Chord, award-winning neuroscientist and musician Daniel J. Levitin discusses music’s history and potential as a form of medicine. Drawing from scientific research, he demonstrates how music therapy can effectively treat conditions ranging from Parkinson’s and Alzheimer’s diseases to cognitive injuries, depression, and chronic pain—making a research-based case for music’s ability to restore health and ease suffering.

In this guide, we’ll explain how we process music and its impact on the brain, before exploring the everyday benefits of listening to and playing music. Then, we’ll discuss the specific therapeutic benefits of music for a variety of mental and physical health conditions. Throughout the guide, we’ll explore the neuroscience behind music’s therapeutic value and provide examples of music therapy in action.

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According to Levitin, rhythmic auditory stimulation (RAS) can help people with MS move more easily. The treatment is straightforward: Patients walk to music or a steady beat, which helps their brain and body get back in sync. Over time, this practice can improve their walking and balance.

(Shortform note: RAS is adaptable to different rehabilitation needs and settings. In home-based programs, patients can practice daily walking exercises to music selected to play at a tempo slightly faster than their natural walking pace, typically 10% above their normal cadence. Professional rehabilitation facilities integrate RAS into structured physical therapy sessions, allowing for supervised practice and immediate feedback. Additionally, emerging research explores the potential of wearable devices that deliver rhythmic cues, while also tracking and analyzing gait parameters, providing valuable data about patient progress and response to treatment.)

Levitin provides the example of Courtney Platt, a professional ballet dancer who performed with Ballet Arizona, but was best known for her appearance on Season 7 of So You Think You Can Dance. When Platt was diagnosed with MS at the age of 23, she was afraid it would end her dancing career. However, according to Levitin, by participating in RAS treatment regularly, she was able to maintain her balance and coordination despite her diagnosis. Practicing walking and moving to specific rhythms allowed her to manage her symptoms and continue dancing, eventually becoming both a performer and teacher while advocating for MS awareness.

(Shortform note: Since her MS diagnosis, Platt has maintained a career as a dancer, actor, and choreographer, appearing in productions like VH1’s “Hit the Floor” and “Grease Live!” while also teaching on-demand fitness classes for CLMBR. She’s become an advocate for MS awareness, partnering with organizations like the National Multiple Sclerosis Society and launching MS in Harmony, an online platform that provided interactive ways to explore music therapy for people living with MS, but no longer appears to be active.)

Huntington’s Disease

Huntington’s disease is an inherited condition that causes brain cells to break down over time, almost always proving fatal. People usually start showing symptoms in middle age, experiencing uncontrollable movements and severe declines in their thinking abilities and personality. As the disease progresses, they begin to lose their independence, requiring full-time care as they become unable to walk, speak, swallow, or care for themselves.

(Shortform note: Huntington's disease (HD) is a relatively rare genetic disorder, affecting approximately 6.52 to 13.7 per 100,000 people worldwide. Traditional treatments for HD focus on symptom management, as there is currently no cure. These treatments include medications like tetrabenazine for involuntary movements, antipsychotics for severe irritability, and selective serotonin reuptake inhibitors (SSRIs) for obsessive-compulsive symptoms and milder mood issues.)

Levitin explains how a treatment called Huntington Speech Music Therapy (HSMT) combines music with speech exercises to treat the symptoms of the disease. Patients practice speaking while following musical rhythms and melodies, which can help them maintain clearer speech and better control of their movements. These exercises seem to help “rewire” the brain’s pathways, temporarily bypassing some of the damage caused by the disease. Though this treatment can’t stop the disease’s progression, it offers a way to help people maintain their abilities longer.

(Shortform note: HSMT works best during early to middle stages of Huntington’s disease when patients still have some control over their speech and movement. During these stages, the therapy can help maintain existing abilities and potentially slow the decline of speech and movement functions. As Huntington’s disease progresses to advanced stages, HSMT becomes less effective because patients develop more severe cognitive and physical impairments that make it difficult for them to participate in and benefit from the therapy.)

Parkinson’s Disease

Parkinson’s disease affects the brain cells that produce dopamine, a chemical that helps control movement. When these cells break down, people experience symptoms like tremors, stiff muscles, and difficulty with coordination, which can make daily activities challenging.

(Shortform note: Nearly 90,000 new cases of Parkinson’s disease are diagnosed annually in the US. By 2030, an estimated 1.2 million people in the U.S. will be living with Parkinson’s. Common treatments include medications like levodopa, which is the most effective and widely used therapy, as well as dopamine agonists and MAO-B inhibitors. Surgical options such as deep brain stimulation (DBS) and focused ultrasound (FUS) may benefit some patients. While there’s no cure for Parkinson’s, these treatments aim to reduce symptoms and enhance functioning.)

According to Levitin, music therapy has proven to be a powerful and customizable tool for managing Parkinson’s symptoms, with options ranging from walking exercises to singing and playing instruments. These treatments work in two ways: First, music’s steady beat acts as a timing device for the brain, helping patients achieve smoother movement, better stability, and improved coordination compared to traditional physical therapy alone. Second, music naturally triggers dopamine release in the brain, which can be so effective that some patients are able to reduce their medication doses when combining them with music therapy.

(Shortform note: Unlike traditional music therapy, which is often offered in clinical settings, some programs bring music therapy into patients’ daily lives. For example, the Ambulosono program offers an at-home approach to helping people with Parkinson’s disease. Patients wear a sensor (an iPod Touch with a special app) that plays music only when they take sufficiently long steps. This creates a simple reward system—take bigger steps and the music plays; take smaller steps and it stops. The program works by using the patient’s preferred music as a reward for better walking patterns and helping patients apply these improvements to daily life. The sensor also tracks progress precisely over time, making it easier to see improvements.)

However, music therapy doesn’t work for everyone, as evidenced by the experiences of musician Linda Ronstadt, diagnosed with Parkinson’s mid-career. Unlike some other musicians, Ronstadt has been unable to harness music as a source of relief. Her experience with the disease specifically impacted her ability to perform the repetitive motions necessary for singing, forcing her to stop performing.

(Shortform note: Since her diagnosis, Linda Ronstadt has become a powerful advocate for Parkinson’s disease awareness, using her platform to speak openly about her experience and champion the importance of research. Through media appearances and documentaries, she helps both musicians and the general public better understand Parkinson’s impact on people’s lives.)

Mental Health Disorders

While the therapeutic benefits of music may vary for those with physical conditions like Parkinson’s, research suggests it can be particularly effective in addressing mental health challenges. According to Levitin, music can improve mental health outcomes in two ways: First, listening to and playing music produces brain chemicals that improve your mood. Second, music offers a means to express emotions and connect with others when someone doesn’t want to talk or doesn’t have the words to describe their experience.

(Shortform note: Music therapy’s adaptability across formal and informal settings makes it a particularly effective approach for treating mental health conditions. In clinical settings, certified therapists implement structured programs tailored to specific conditions, integrating music with traditional therapies for a holistic approach. Beyond the clinic, people can engage with music therapeutically through personal playlists for stress relief or join a choir, which foster social connection and emotional expression. The growing adoption of music therapy in workplaces and schools further underscores its versatility in promoting mental well-being across diverse environments.)

Let’s explore in greater detail how music therapy helps treat specific mental health conditions.

Depression and Bipolar Disorder

Depression and bipolar disorder both result from disrupted dopamine activity in the brain, which contributes to persistent low mood, diminished interest in activities, and poor emotional regulation. The key difference between these conditions is that depression typically involves ongoing sadness, while people with bipolar disorder alternate between depressive lows and manic or hypomanic highs, reflecting distinct patterns in how brain chemistry imbalances manifest.

(Shortform note: Dopamine plays a crucial role in mood regulation, motivation, and reward processing in the brain, which explains why disrupted dopamine activity contributes to depression and bipolar disorder. Impaired dopamine signaling affects the prefrontal cortex and limbic system, causing persistent low mood, emotional instability, and anhedonia (inability to feel pleasure). In bipolar disorder, dopamine imbalance triggers mood swings—high levels may cause mania while low levels lead to depression. Dopamine dysfunction also impairs cognitive functions like attention and decision-making and weakens stress responses.)

Many people with these conditions instinctively turn to music for relief, and research has validated this approach. According to Levitin, when patients listen to music they enjoy, their brains release dopamine in the nucleus accumbens (the brain’s pleasure center). This release occurs both during emotional peaks in the music and in anticipation of those moments. Since this provides a healthy, nonaddictive way to stimulate the dopamine system, music therapy can be an effective tool for managing symptoms, helping to naturally counter the disrupted dopamine activity that underlies these conditions.

(Shortform note: Although music can help people cope with depression and bipolar disorder, sad music may be less effective. Researchers have found that while many find comfort in sad songs because it validates what they’re feeling, those prone to rumination often experience worsened symptoms after listening to sad music because it keeps them stuck in negative thought cycles rather than helping them process their emotions. Brain scans confirm this difference—sad music activates reward centers in some people but intensifies negative emotional responses in others. This underscores the importance of being mindful about music choices, particularly for young people who might not recognize how certain songs affect their emotional state.)

PTSD and Trauma

PTSD and trauma disorders are characterized by a dysfunctional fear response system, where the body remains in a heightened state of “fight-or-flight” arousal and can be easily triggered into overwhelming stress reactions. As a result, ordinary stimuli, like loud noises or crowds, can provoke debilitating panic attacks, flashbacks, or emotional shutdown. To avoid these experiences, survivors may start to restrict their lives, limiting opportunities for work, relationships, and new experiences.

(Shortform note: People with trauma disorders like PTSD and Complex PTSD struggle with regulating emotions beyond just fear. When triggered, people can also experience intense anger, guilt, and shame that overwhelm their usual coping mechanisms, making it difficult to return to a calm state. They experience heightened reactivity to everyday situations and persistent difficulty managing feelings. This is more than a physiological response—trauma experiences can fundamentally shift how survivors interact with others and view the world.)

Levitin argues music therapy has proven particularly effective for these conditions because it can directly activate the body’s natural relaxation pathways, helping to calm an overactive stress response system. Clinical trials demonstrate that regular music therapy leads to measurable improvements in patients’ ability to regulate their emotional states. Participants show reduced stress levels, enhanced emotional stability, and improved daily functioning, with better overall well-being and capacity to manage day-to-day responsibilities.

(Shortform note: Songwriting with Soldiers is a program that demonstrates the powerful impact of music therapy for treating mental health conditions, particularly for veterans dealing with trauma and PTSD. The program pairs veterans with professional songwriters to transform their military experiences into songs. A Harvard Mass General study found a 33% reduction in PTSD symptoms, 25% reduction in depression, and significant increases in hope (77%) and creative engagement (83%) among participants.)

Cognitive Decline

Cognitive decline encompasses conditions that affect memory and mental function, from mild age-related changes to severe dementia, which impacts over 55 million people worldwide. These conditions can make everyday tasks difficult and often force people to depend on others for help with basic needs like cooking, managing money, and remembering important information.

(Shortform note: Age is the primary risk factor for cognitive decline, as natural cellular aging processes gradually affect brain function over time. Our brains experience physical changes including shrinking volume, reduced blood flow, and inflammation that impact memory and thinking skills as we age. Fortunately, while you can’t control aging or genetics, research shows that regular mental and physical activity can help protect brain function. Simple daily habits like exercise, staying socially connected, and challenging your mind can significantly reduce cognitive decline risk, even with genetic predispositions or advancing age.)

According to Levitin, music therapy is an effective treatment for cognitive decline because the brain’s specialized musical processing networks often remain intact even as other cognitive functions decline. Unlike typical memories that depend on recalling specific details, musical memories are encoded through pattern recognition, making them more resistant to deterioration. This explains why many people with advanced dementia, who may no longer recognize family members or remember recent events, can still sing entire songs from their past with remarkable accuracy.

(Shortform note: In Musicophilia, neurologist Oliver Sacks explores how music engages the brain beyond just pattern recognition, tapping into deep emotional networks. He presents the case of Clive Wearing, a musician with severe amnesia who could only maintain conscious memory for about 30 seconds. While Wearing couldn’t remember basic daily events or recognize people he’d just met, he could still play Bach perfectly and conduct choirs with full emotional expression. Cases like Wearing’s led Sacks to develop his concept of “emotional-autobiographical memory”—the idea that music creates a sort of emotional timestamp in our brains that persists even when conventional memories fade.)

Levitin explains how music therapy helps address cognitive decline through multiple mechanisms:

First, when people with dementia engage with familiar music, it stimulates the release of dopamine, reducing agitation and anxiety. The songs can also serve as memory anchors, helping people access associated memories from their past. (Shortform note: Music can also unlock preserved muscle memory, as seen when Marta C. González Saldaña, a former ballerina with Alzheimer’s dementia, began dancing along to Tchaikovsky’s “Swan Lake,” recreating choreography she had performed decades before. Since muscle memories are stored separately from declarative memories and persist longer during cognitive decline, music can momentarily reconnect people to otherwise lost abilities and identities.)

Second, for those recovering from strokes or other brain injuries, music therapy supports speech recovery by engaging multiple neural networks simultaneously. (Shortform note: Melodic Intonation Therapy (MIT) helps stroke patients speak again by bypassing the damaged parts of the brain. Many stroke patients who can’t talk can still sing because these abilities rely on different brain regions. MIT uses simple melodies and rhythmic tapping to prompt the healthy musical side of the brain (right side) to take over some jobs from the damaged speech side (left side). Patients practice “singing” everyday phrases, gradually rebuilding their ability to communicate normally.)

Finally, and perhaps most importantly, shared musical experiences create meaningful moments of connection between people with cognitive decline and their loved ones, helping maintain emotional bonds even as other forms of communication become challenging. (Shortform note: Studies have found that while familiar music can create meaningful moments between patients and loved ones, it doesn't necessarily help people with advanced cognitive decline recognize people, even if the music is linked to shared memories.)

These benefits have led many care facilities to implement personalized music programs, where residents listen to curated playlists throughout the day. Research has demonstrated that this approach significantly reduces anxiety while helping people maintain connections to their memories and relationships.

(Shortform note: A 2022 study found that personalized music intervention not only improved quality of life for patients, but for their caregivers as well. Caregivers reported feeling less overwhelmed, and the music sessions and personalized playlists fostered stronger connections between caregivers and patients. The research demonstrated how music can serve as a powerful tool for relationship-building and enhance the well-being of those taking care of loved ones who experience cognitive decline.)

Pain Management

According to Levitin, music offers a different approach to managing pain. Pain is the most common reason people seek medical help, and doctors typically prescribe medications like aspirin or opioids to treat it. While these drugs can be effective, they often come with serious drawbacks. Over-the-counter pain medications can damage the stomach and liver when used long-term, while opioids carry risks of addiction and require increasingly higher doses to maintain the same effect.

(Shortform note: Pain management practices and aggressive pharmaceutical marketing in the 1990s led to the widespread overprescription of opioid painkillers, particularly medications like OxyContin. However, as regulations later tightened, many users shifted to heroin, then to illicitly manufactured fentanyl—50-100 times stronger than morphine. Multiple factors intensified this evolving crisis: health care policies favoring medication over comprehensive treatment, chronically underfunded addiction services, economic distress in affected communities, and persistent stigma. These elements combined to transform what began as a prescription medication problem into a complex public health emergency spanning decades.)

In contrast, Levitin explains that music can alleviate pain by:

• Redirecting attention away from discomfort
• Improving mood, which can make pain feel less intense
• Triggering the brain to release its own natural painkillers
• Enhancing pain relief through the power of positive expectation—when people believe music will help, it often works better

(Shortform note: Scientists are investigating which specific elements of music are most effective for pain relief. Research shows that music with stable rhythms particularly helps by regulating heart rate, breathing patterns, and other physiological processes, creating a more balanced state that reduces pain sensitivity. While pleasant, non-arousing music generally decreases pain perception, different types of music offer varying benefits—with a person’s favorite music showing particular promise due to its ability to modulate neural responses throughout the cortex, brainstem, and spinal cord. Interestingly, for older adults, the effectiveness of music interventions remains consistent regardless of the specific genre or delivery method.)

How effective is music-based pain management? Research shows that using music during and after medical procedures can reduce the amount of pain medication patients need. For instance, patients who listen to music during surgery often require less anesthesia, and those who listen after surgery often ask for fewer pain medications. Scientists are now studying which specific elements of music—like speed, musical key, or choice of instruments—work best for pain relief.

(Shortform note: Despite its proven benefits, music therapy for pain management remains relatively uncommon in traditional medical settings. Limited high-quality research and lack of standardization make it difficult for the medical community to fully embrace this treatment approach, while conventional medicine tends to prioritize pharmacological interventions. Additionally, limited awareness among health care professionals, resource constraints, and skepticism toward nontraditional therapies have hindered widespread adoption. However, growing interest and ongoing research suggest music therapy may become more common as a complementary treatment option.)

Neurodevelopmental Disorders

While music therapy shows promise for various medical conditions, some of its most fascinating applications, according to Levitin, involve neurodevelopmental disorders, particularly Williams syndrome (WS) and autism spectrum disorder (ASD).

Williams Syndrome

Williams Syndrome (WS) is a genetic condition affecting about 20-27 genes on chromosome 7. People with this syndrome typically have IQs ranging from 40 to 112, with an average of around 68, placing them in the mild intellectual disability range. Despite these cognitive challenges, they often show remarkable strengths, including enhanced musical abilities, unusually high sociability, and surprisingly strong language skills relative to their overall cognitive function.

(Shortform note: Scientists believe studying people with Williams syndrome can help us understand the genetic basis of musical ability. By examining the specific genes affected in Williams syndrome and how they relate to musicality, researchers can gain valuable insights into how our ability to process music is encoded in our DNA. For example, identifying which of the 20-27 affected genes correlate most strongly with musical ability could help us better understand the genetic factors that influence pitch perception, rhythm processing, and musical creativity in all people.)

Brain scans show that people with Williams syndrome process music differently than others. They show less activity in the hearing-related brain regions that are typically activated when people listen to music, but more activity in emotion-processing areas like the amygdala. Their brain activation patterns when listening to music are also more spread out across different brain structures than people with neurotypical brains.

(Shortform note: The widely distributed network of activation observed in people with WS during music processing could potentially impact their ability to better learn and remember information when it’s presented musically. A study found that individuals with WS who had participated in formal music lessons performed significantly better on a verbal memory task when sentences were sung rather than spoken. This suggests that musical presentation of information might enhance learning and memory in WS individuals. However, this effect was only observed in those who had formal musical training, indicating that the relationship between music processing and memory in WS is complex and may depend on individual experiences and skills.)

Levitin explains that music therapy works especially well for people with Williams syndrome because it builds on their natural musical strengths. For example, people with Williams syndrome who struggle with fine motor control can often play rhythm instruments with greater coordination when following musical cues, and participating in group singing activities helps them develop better turn-taking and social interaction skills.

(Shortform note: While evidence supports the efficacy of music therapy for people with WS, research indicates that many music therapists lack specific training and experience working with them, potentially limiting the effectiveness of therapeutic intervention and highlighting the need for targeted education and professional development to better serve people with WS.)

Autism Spectrum Disorder

Autism spectrum disorder (ASD) often involves challenges with social communication and interaction. People with autism typically have restricted interests and may demonstrate repetitive behaviors, such as hand-flapping, rocking, or repeated phrases. They might also insist on sameness through strict routines or become intensely focused on specific topics or objects. Many people with autism struggle to recognize emotional cues in everyday situations, yet can show remarkable strengths in specific areas, including musical processing.

(Shortform note: While medical experts have historically approached ASD as a disorder requiring correction or treatment, the neurodiversity movement emphasizes that neurological differences, including those associated with autism, represent natural variations in human brain function rather than deficits that need to be “fixed.” By viewing autism through this lens, neurodiversity advocates challenge the pathologization of neurological differences and instead promote accommodation and appreciation of diverse neurological experiences. This shift in perspective calls for society to adapt to neurodivergent people rather than demanding that neurodivergent people conform to neurotypical standards.)

Music therapy works well for people with autism because it provides a safe, structured way to process emotions through patterns. Since many people with autism excel at pattern recognition, they can understand emotions in music more easily than in faces or voices. In this way, music acts as a kind of emotional translator. Studies show regular music therapy produces lasting benefits, including improved communication, emotional understanding, and social engagement.

(Shortform note: While some studies have shown benefits of music therapy for people with autism spectrum disorder (ASD), others have found no significant differences between music therapy and other interventions or treatment as usual. First, how autism manifests varies widely, making standardized approaches difficult. Different music therapy techniques produce different outcomes, and while some autistic people respond well to music, others find certain sounds overwhelming. These inconsistencies don’t mean music therapy is ineffective—rather, they suggest its benefits are highly individualized, highlighting the need for personalized approaches tailored to each person’s unique needs and preferences.)

The Future of Music as Medicine

According to Levitin, learning more about music’s effects on the brain and body have opened up new possibilities for the role of music in health care. Scientists are exploring how to use existing research and new technology to develop increasingly sophisticated approaches to music-based treatment.

(Shortform note: This scientific progress has begun to attract more significant institutional interest and investment in the field. For example, the National Institutes of Health’s Sound Health initiative awarded $20 million in 2019 for research on music’s therapeutic applications for neurological disorders. While approximately 60 clinical trials on music interventions were ongoing as of 2021, researchers also acknowledge that rigorous evidence remains limited, partly due to challenges in recruiting sufficient participants for large-scale studies.)

Levitin argues that using digital technology could help health care providers develop more targeted music therapy treatments for a variety of conditions. He envisions AI systems connected to health trackers that monitor biometric data—including heart rate, breathing patterns, and muscle tension—to select the most therapeutic music for each individual patient. This personalized approach would offer greater precision than current standardized methods, potentially expanding music therapy’s effectiveness across a wider range of health conditions.

(Shortform note: One company already turning this vision into reality is MediMusic, a British health tech startup that has developed an AI-powered platform delivering personalized music therapy to reduce pain, anxiety, and stress in patients. The system analyzes music’s “digital DNA” and patient demographics to create targeted 20-minute playlists delivered through their MediBeat device with physiological monitoring via a wrist sensor. The platform’s Digital Drip Technology adjusts tracks based on heart rate feedback and provides health care professionals with performance metrics. NHS trials demonstrated up to 22% reduction in heart rate among dementia patients during Covid-19.)