Sound is created by fluctuations in air pressure caused by a vibrating source that stimulates hearing in humans. We produce sound with the help of organs such as the vocal cords, lungs, and muscles. Humans speak using sounds at the limited frequencies they can perceive (20 Hz-20 kHz).

Music is defined as the artistic expression of emotions, thoughts, and symbols in one or many voices. Scientists have established music’s positive or negative effects on the human body in all conditions and environments and determined that our body reacts differently to various types of music and sound. The nature of this effect may vary depending on parameters such as the emotional state of the person, time, and place.

Music therapy is an independent specialty of modern medicine and has been used since antiquity. In Islamic civilization, Sufis mentioned the use of music in the treatment of mental and neurological disorders, and scholars like al-Farabi (d. 950) and Ibn Sina (d. 1037) defined the principles of music in treatment.

According to scientists, music can not only be used effectively in the treatment of diseases—it can also be deployed as a shield against psychological problems such as stress and intense anxiety by selecting the appropriate rhythm, sound, and musical genres. Recent years have witnessed several studies on the psychological and physiological effects of music on humans [1]. According to these studies, music affects the human brain at an anatomically measurable level; this explains how music can change a society’s understanding of culture and art [2].

By altering the levels of mood-affecting hormones such as serotonin, dopamine, adrenaline, testosterone, and serotonin, music can lower respiration, heart rate, and body temperature; stabilize blood pressure and cerebral blood flow; and lead to deep relaxation and enhanced quality of life [3]. It reduces anxiety and nausea and alleviates insomnia by diverting patients’ attention to other activities. Music also plays an important role in improving the quality of life of end-stage cancer patients [4]. The positive effects of music on pain and anxiety are prominent.

Which area of the brain perceives music?

It is crucial to be familiar with the relevant musical terminology to have a better understanding of this matter. Timbre is the characteristic that distinguishes the sound produced by the vibration of an object from the sound produced by a different object at the same height. Rhythm is the harmony of sound resulting from the repetition of stress, length, or sound features and stops in a verse or a note. Melody is a sequence of sounds created in line with a certain rule.

These sounds are processed in different regions of the brain that are separate but close to one another. Damage to these areas, through trauma or similar reasons, may complicate hearing or distinguishing the relevant sound. For instance, damage to the auditory cortex in the right temporal region may result in the inability to keep a regular tempo, while damage to the cerebellum and basal ganglia may result in impaired rhythm perception and inability to produce rhythm. While rhythm is detected in the motor area, timbre is sensed in the auditory area. The right hemisphere of the brain has better frequency resolution, which is crucial for processing precision. Meanwhile, the left hemisphere has better temporal resolution, which is imperative for speech analysis.

Timbres activate the right auditory cortex, whereas rehearsing music stimulates the dorsolateral and inferior frontal cortex. Melodies are typified abstractly in the brain while emotional melodies activate the fronto-occipital region of our brain. The superior temporal cortex detects the instrument and speed changes. Our secondary auditory cortex is activated when we visualize music; listening to a favorite piece of music activates a different sensory area [5].

In temporal lobe disorders, some may lose certain musical abilities such as playing and identifying melodies, singing, and following rhythm. For instance, Maurice Ravel, one of the greatest composers of the 20th century, could listen to pieces of music but could no longer compose after cerebral palsy affected the left hemisphere of the brain.

 Effects of noise on human physiology

Noise is the common name for meaningless and unpleasant sounds that have an adverse effect on people. While some may hear sounds as music, others may hear them as noise. The threshold of discomfort varies from person to person.

The effects of noise on human physiology are divided into short-term effects that disappear with the cessation of noise and long-term effects that can last for hours or even days. In most people, noise causes short-term effects such as stress, changes in heart rate, respiratory rate and blood circulation, muscle spasms, startles, and insomnia. These side effects are felt more acutely during sleep, with automatic reactions to sudden and loud noises. In addition, gastritis, ulcers, high cholesterol, hypertension, and migraine disorders are common long-term effects of noise. Even in cases where people think they are accustomed to noise, these side effects cannot be inhibited [6].

Exposure to intense and loud music, defined as music intoxication, increases the height of alpha waves in brain electrical activity. This situation varies from person to person, but as reported in some people even toxic doses can be considered normal. This explains why music is perceived and processed differently by different people, and while in the same person, character and music perception show parallelism.

Musicogenic epilepsy

Current technological developments have expanded our access to all kinds of music. Studies have shown some disorders can be triggered in line with the type and volume of music listened to. Epilepsy tops the list of these disorders. It is well known that exposure to sunlight or flashing or flickering lights in the 16-25 Hz range can trigger epileptic seizures. While some patients made to listen to music during a seizure benefited from the music and their seizures ceased, others’ seizures deteriorated [7]. The reason for this bidirectional effect of music on epileptic attacks is not yet fully understood.

Musicogenic epilepsy, where epileptic seizures are triggered by music, is a rare form of epilepsy, first defined in 1937. The French composer Berlioz, who contributed significantly to the composition of the modern orchestra, suffered from musicogenic seizures. Affecting one in a million people, these seizures are often triggered by listening to or playing music, or by its inspiration or conception. It has even been shown that some patients’ seizures can be triggered by the type of music, instrument, or composer they listen to. Church bells, the melody of La Marseillaise (the national anthem of France), some hymns, and even some songs sung in a low, muffled, or metallic voice have been shown to trigger such seizures [8]. Experts say the therapeutic efficacy of music can be demarcated by understanding the mechanism.

Musical pharmacology

Musical pharmacology is when, after a diagnosis, various kinds of music protocols are uploaded to digital tablet device and sent to the patient’s home. Analyzing the music pieces the patient prefers to listen to, the active parts are extracted and blended into balanced medical compounds. The most common areas where such medical compounds are used include psychosomatic disorders, pain, anxiety, depression, insomnia, and certain cardiac arrhythmias [9].

Studies examining the effects of music therapy during pregnancy suggest that nurses and midwives providing maternity care would be wise to take advantage of the positive effects of music. In pregnant women with pre-eclampsia, music can help keep fetal movement and heart rate at normal levels by lowering blood pressure [10].

Newborn babies, especially premature ones, benefit the most from music in terms of stress reduction, pain detection, and hearing improvement [11]. This notion is supported by the common practice of singing lullabies to calm crying babies or babies who have trouble falling asleep, or singing prayers, for instance the call to prayer (adhan) in Muslim cultures, often achieving the desired result.

A study in Japan has shown fetuses feel their mothers’ reaction to noise, and that noise increases the incidence of low-birth-weight babies. The human cochlea, an important component of hearing, completes its development by 24 weeks of gestation, and by 26 weeks, the fetus can respond to sound stimuli. By the 35th week of gestation, the fetus can distinguish between sounds with a frequency of 250-500 Hz and between the sounds, “baa” and “bee.” This shows that babies’ sense of hearing develops significantly before birth [12].

As seen, human interest in music and sound begins in the womb and continues over a lifetime. When we listen to a piece of music that suits our mood, we unconsciously follow the rhythm with our brain waves, heart rhythm, breathing and emotional state. Each person reacts differently to music and sound. This is due to the two-way effect of music. People like or dislike music based on the effects it has on the body. This is an individual response, based in part on our anatomical, physiological, and psychological functions.

During speech, Broca’s and Wernicke’s areas in the left hemisphere of the brain are mentally active. It is believed these areas may have another feature representing feelings and emotions. This feature perceives the emotional components of speech, including melody, intonation and gestures. Voices, words, gestures and facial expressions move humans indiscriminately. Likewise, reciting prayers with a beautiful voice and its impacts on the human nervous and endocrine physiology is a subject for further research.

We can liken the human organism to a unique work of art and an ensemble of tunable, delicate instruments [13]. Everyone should discover the music and rhythms in sync with the physiology of their own body, and not tune their body to random types of music and sounds. Hence, it would be wise to manage our body like a conscious conductor. It is essential to find the music that suits our nature.

References

• F. S. Ünal, “Müzigin ses olarak insana fizyolojik etkisi”, Kültür Evreni Dergisi, 6(22), 2014, s. 118–125, www.kulturevreni.com/22-118.pdf.
• S. A. Azizi, “Brain to music to brain!”, Neuroscience Letters,459, 2009, s. 1–2.
• N. Karamizrak, “Ses ve Müzigin Organlari Iyilestirici Etkisi”, Kosuyolu Heart Journal, 17(1), 2014, s. 54–57.
• H. Covington, “Therapeutic music for patients with psychiatric disorders”, Holist Nurs Pract, 15, 2001, s. 59–69.
• A. J. Blood ve R. J. Zatorre, “Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion”, Proc Natl Acad Sci US, 98(20), 2001, s. 11818–11823.
• MEB. Gürültünün Etkileri. Ankara: Millî Egitim Bakanligi, Aile ve Tüketici Hizmetleri, 2012, s. 1–25.
• A. T. Berg ve ark. “Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology”, 2005–2009; Epilepsia, 51, 2010, s. 676–685.
• S. E. Brien ve T. J. Murray, “Musicogenic epilepsy”, Can Med Assoc J, 13, 1984, s. 1255–1258.
• I. Ün, “Farmakoloji ile müzik arasinda olasi etkilesimlerin arastirilmasi”, Lokman Hekim Dergisi, 6(3), 2016, s. 159–164.
• E. Toker ve N. Kömürcü, “Effect of Turkish classical music on prenatal anxiety and satisfaction: A randomized controlled trial in pregnant women with pre-eclampsia”, Complementary Therapies in Medicine, 30, 2017, s. 1–9.
• J. Loewy ve ark. “Sleep/sedation in children undergoing EEG testing: a comparison of chloral hydrate and music therapy”, Am J Electroneurodiagnostic Technol, 46(4), 2006, s. 343–355.
• S. E. Trehub, “The developmental origins of musicality”, Nat Neurosci, 6(7), 2003, s. 669–673.
• D. Campbell, Mozart Etkisi, Istanbul: Kuraldisi Yayincilik, 2002, s. 156–343.

The phrase “striking their faces and their backs” leaves us wondering why “faces and backs?” What is special about these body parts in the context of death? The Qur’an is the word of the All-Wise and it is not possible for it to be completely deciphered by human reasoning. Yet, it is our duty as human beings to contemplate the message that our Creator has revealed for us. The moment of death is spoken of in many other Qur’anic verses and Hadiths. The experience of death is a great agony for the disbelievers: The (angels who) snatch (the souls of the disbelievers) forcibly. And those who gently take (the souls of the believers) joyfully (Qur’an, 79:1-2).

Undoubtedly, the experience of death is painful. Leaving the discussion about “faces and backs” to later in this article, let us first look at what pain is from a physiological aspect. It is common knowledge that the sensation of pain is conducted to the brain via the sensory nerves which connect with almost every single part of the body, particularly to the skin. The skin has different corpuscles (sensory cells) for the sensation of touch, temperature, and pain. When a nociceptive (pain inducing) stimulus is applied to the skin, this information is conveyed through the peripheral nerves in the form of small electric pulses (called action potentials), first to the spinal cord, next through the spinothalamic pathways, and then to the higher centers of perception in the brain. These little electrical pulses are felt as pain, temperature, or touch in various centers of the brain (e.g. somatosensory cortex), depending on where the signals originate in the skin. If a particular area is wired to a pain sensing corpuscle in the skin, the brain circuitry will be trained to perceive this signal as pain from early postnatal development. If, on the other hand, a particular nerve is connected to a temperature sensing corpuscle in the body, the part of the brain center that it is connected to will be trained to perceive this as temperature from early on in life. So, the perception of sensory information depends on how these little electrical signals are interpreted by the brain. However, the connection map of the nerves and the circuits that interpret them in the brain form very early in life and these connections are hard wired, that is, it is very difficult to change them.

Pain may be perceived without a real source of nociceptive input as a result of some neurological disorders. For instance, in an amputee, after a limb has been surgically removed, the cut ends of the sensory nerves may generate little electrical pulses (action potentials) on their own without a pain inducing stimulus. The subject might feel an intense feeling of pain in the missing limb! This is clinically known as “phantom pain.” The phenomenon known as “referred pain” has an interesting explanation, also based on neuro-anatomy. The pain conducting sensory nerves from various dermatomes (areas of skin) and some other nerve fibers that originate in the visceral (internal) organs of the body enter the spinal cord side by side as a bundle (spinal roots). When some of these visceral organs, such as the heart and lungs, contract a disease, the sensory signals generated by these organs are not perceived as pain because there are no pain sensing nerve endings in these organs. But, the sensory signals generated by these organs activate the pain sensing fibers at the point where they enter the spinal cord together. The pain therefore is felt by the brain as if it were originating in a certain dermatome. For instance, heart problems are felt as a pain in the left arm. Again, the interesting point is that the perception of pain depends very much on the wiring of the nervous system at the periphery and in the brain.

Needless to say, if the subject is deep asleep or unconscious for any reason, he or she would not feel pain because the brain has been entirely blocked from any sensory input. In the context of body-mind connection, we may consider these states where the soul has minimal connectivity to the brain.

What about the moment of death? According to Qur’anic verses the experience of death is different for believers and unbelievers. Is it possible that the intensity of pain that one experiences at the moment of death is related to whether or not the soul is still “connected” to the brain? Those who die in their sleep do not seem to show any signs of pain, at least not to those who are witnessing the event. We should note that Prophet Muhammad, peace be upon him, stated that sleep shares many common properties with death.

It is reported that whenever God’s Messenger (may peace be upon him) went to bed, he said: “O God, it is with Your Name that I live and it is with Your Name that I die.” And when he got up he used to say: “Praise is due to God, Who gave us life after our death (sleep) and unto Him is resurrection” (Muslim, 35:6549).

Qur’an 6:60 says:

“He is the One who puts you to death during the night, and knows even the smallest of your actions during the day. He resurrects you every morning, until your life span is fulfilled; then to Him is your ultimate return. He will then inform you of everything you had done.”

Is it then plausible that the intensity of pain felt during death is a consequence of how connected the soul is to the body at that moment? These questions may or may not have been addressed by religious scholars in the past. However, information about the physiological events taking place during death is certainly very limited in the religious literature.

Let us take a quick look at the human nervous system, and perhaps this will shed some light on the verses we quoted at the beginning of the article. The peripheral nerves converge together and form bundles, called spinal roots, before they enter the spinal cord at one of the 33 different vertebral segments along its length. The brain and the spinal cord together constitute the central nervous system (as opposed to the peripheral nervous system). The only other neural pathways between the brain and the body are the cranial nerves, the nerves that enter the brain from underneath. There are twelve cranial nerves, most of which carry sensory information from the head or motor information to the head, with the exception of the vagus nerve (Xth nerve), which actually serves the visceral organs. So, it would be accurate to say that the sensory information that comes to the central nervous system enters either at the back (through the spinal cord) of a person or directly from the facial area. The phrase “their faces and backs” thus sums up all the neural pathways through which the sensation of pain can be conveyed to the brain, the interface where the body meets with the mind, or the soul.

It is possible that at the time of death, the pain receptors in the skin and deeper parts of the body start generating action potentials at a faster rate, as if great pain has been inflicted on these body parts. The ionic concentrations in the extracellular medium around the sensory cells can change as a result of diminishing blood supply, and this is probably felt more severely in the extremities at first. The increased rate of firing of action potentials is commonly observed in neuroscience experiments when a cell starts “dying” as a result of perturbations to the extracellular or intracellular ionic concentrations. A train of action potentials with an increasing rate of firing is frequently observed and eventually the action potentials stop completely when the cell can no longer function. A similar phenomenon may occur during the death of an entire living organism due to a reduction in the blood supply that is provided to the body parts as well as due to changes in the pH level from a lack of oxygen. This fast rate of action potentials will be perceived by the brain in the same way as a strong source of pain, e.g. crushing or ripping apart of the body. The principle concept is very similar to what happens in the case of “phantom pain.”

The choice of the word daraba (striking or smiting) in Verse 47:27 is also interesting to note. We describe a pain sometime as “throbbing,” because every time the heart beats the increased blood volume in the area makes the pain receptors fire faster episodically. It may be that this pulsating pain sensation is described as “striking,” using a figurative language in the Qur’an.

Of course, the fundamental question is whether the soul is still in the body and thus able to feel the agony at the time of death. Are the souls of believers taken by the angels before the agony of death starts so that they do not suffer through it? We have no evidence to answer this question one way or another. But, it is certainly within the power of God to make the soul feel the pain or to save a person from it.

Mesut Sahin, PhD

New Jersey Institute of Technology

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