How does improvisation affect mental health? A review of psychological research literature

*I have been recently sharing my journey of researching wellbeing for musicians in my master’s course in music psychology in online here on my blog, and on my weekly livestream discussions titled Musician’s Therapy and Tea. Below is a recent review of pre-covid literature surveying psychological research on jazz musicians and wellbeing, noting an unacceptable dearth and understanding of improvisation within academia. This paper was submitted in fulfillment for the course MUS 642 Psychological Research Methods at the University of Sheffield. It was slightly edited after feedback was received.* - November 2020

“A study of wellbeing in Danish musicians reports Professional musicians suffer the most health problems, while amateurs suffer health problems less than professionals do, and non-musicians or inactive amateurs had significantly better health than both amateurs and professionals.”

- Bonde et. al., 2018

Introduction

How does music participation and musical improvisation affect our well-being? A predominant amount of research on the subject shows the many therapeutic benefits of musical improvisation has on our health, evidenced in various studies of music therapy patients exhibiting conditions such as dementia, Parkinson’s disease, and paralysis. Why is it then, that most artists and professional musicians who teach and practice the discipline of improvisation daily are three times as likely to suffer from mental health issues such as anxiety, depression, as well as physical pain and injury from the tolls of performance and practice of musical instruments? The intention of this literature review is to present psychological scholarly research conducted concerning the improvisational music and wellbeing in musicians, to consider and critique published and unpublished research, and to examine gaps and areas in the research in need of further attention and development with regards to music participants such as amateurs, music students, and professional musicians.

Can Music Make You Sick? 

Improvisation clearly has health benefits in clinical studies in music therapy, but research demonstrates mental health issues suffered by an overwhelming majority of professional musicians in the music industry. A pilot study by Sally Gross and Dr. George Musgrave surveying 2,211 professional musicians in the UK music industry indicated that 71% of musicians reported experiences of anxiety and panic attacks, 68.5% reported depression, 52.7% experienced challenges in getting help, and 54.8% stated gaps in available help (2016, p.5).  This was supported by the authors’ 2017 qualitative follow up study, and its findings were then published in the book “Can Music Make You Sick: Measuring the Price of Musical Ambition” (Gross and Musgraves, 2016, 2017, 2020). Nearly 70% of the subjects worked in pop, rock, world, jazz, and other non-classical genres where musicians improvise professionally; classical musicians constituted 31.2% of participants.

Only a few other studies examined professional musicians and depression in various European countries (Vaag, Giæver, and Bjerkeset, 2014; Vaag, Bjørngaard, & Bjerkeset, 2016). A study of wellbeing in Danish musicians reports professional musicians suffered the most health problems, while amateurs suffered health problems less than the professionals did, and that non-musicians or inactive amateurs had significantly better health than both amateurs and professionals (Bonde et. al., 2018).

Present literature suggests that participation in professional music and the music industry likely contributes to anxiety, depression and mental health issues, however there were very little quantitative and qualitative studies targeting the overall mental health of musicians. A recent essay by a cultural studies expert in capitalism and the music industry analyzes the exploitation of music labor by the recording industry in a boldly titled essay, “The labour that dare not speak its name”, undoubtedly a nod to the silence musicians maintain about the pressures of practice and performance to keep appearances (Toynbee, 2017), also demonstrated in his earlier book Making Popular Music: Musicians, Creativity and Institutions (Toynbee, 2000). A recent essay by a cultural studies expert in capitalism and the music industry analyzes the exploitation of music labor by the recording industry in a boldly titled essay, “The labour that dare not speak its name”, undoubtedly a nod to the silence musicians maintain about the pressures of practice and performance to keep appearances (Toynbee, 2017), also demonstrated in his earlier book, Making Popular Music: Musicians, Creativity and Institutions (Toynbee, 2000).

Literature suggests that the pursuit of playing music professionally and creating music itself creates mental health issues, possibly due to the nature of capitalist exploitation of recorded music and the structure of the music industry.  Today, musicians are expected to take on increasing amounts of unpaid distribution and promotion labor in addition to composing and performing  (Toynbee, 2000, 2017). It is clear this area in research is neglected, but has powerful potential for implications on wellbeing.

Wellbeing and Musicians

While scholars have debated and continue to debate the definition of what constitutes psychological wellbeing, psychologist Martin Seligman (2004; 2008; 2011; 2018) contributed the most cited measurement scale of wellbeing, imperative to the field of ’positive psychology’, and used widely as an examination method of music and wellbeing. Seligman introduced the PERMA model of measuring wellbeing, which measured wellbeing in terms of one’s hedonic (immediate pleasure) and eudaimonic (life purpose and fulfillment) wellbeing in five categories: Positive emotions, Engagement (flow), Relationships, Meaning (having purpose), and Accomplishment. An activity that promotes high levels in each of these categories demonstrate the ability to flourish, or rather, the goal of wellbeing.

Ascenso, Williamon, and Perkins (2017) examine a small group of professional musicians’ wellbeing using the PERMA model in their research methods, and found musicians are largely satisfied eudaimonically through ‘meaning’ and ‘accomplishment’ from internal goals that are set and met in internalized practice and performance, and have enriched ‘relationships’ via the unique nature that making music socially offers. However, while Ascenso et. al examines the complexities of making music and its effects on wellbeing, it does not address the stress that relationships with other musicians, or how performance within social ecologies contribute to individual psychological stress and anxiety. Gross and Musgraves (2017, p.7) note “musicians exist in an environment of constant critical feedback – an endless feedback loop of comments – that is just as significant as being ignored and overlooked.” Ascenso et. al. claim musicians benefit by having a clear sense of self (p.65).

However, Gross and Musgraves (2017) note that musicians’ embodiment and work integration with self and identity is one of the major themes why musicians suffer from depression and anxiety, because it leads to vulnerability and instability largely because they are subject to the ‘precarity of their environments’ (p.7). Perhaps either the differences in sample group sizes (thousands versus a dozen), the methods used (quantitative versus qualitative), as well as purpose (to highlight mental illness suffered by music industry workers, versus measured wellbeing through Seligman’s theoretical PERMA model) by the two different researchers lend the ability to interpret results differently. Dianna Kenny (2004) found that musicians have “highest levels of job satisfaction, but also the highest levels of exhaustion, stomach aches, headaches, and sleep disturbances, and are five times as likely to suffer from mental illness than the general population”, which succinctly captures this mystery and gap in our understanding of how music participation effects the wellbeing of musicians. 

Research exhibited of musicians and wellbeing qualitatively using Seligman’s PERMA model for wellbeing tended to show the benefits that musicians experience in terms of job satisfaction, flow state, and internal reward. However, PERMA studies neglected to show the anxiety produced by musicians’ social ecology, performance anxiety, physical pain, or the mental anxiety of trying to make a living. Studies by Gross and Musgraves (2016, 2017, 2020) and others highlighted the overwhelming evidence of mental health issues suffered by professional musicians.

Improvisation and Music Therapy

Improvisation, importantly for this literary scope, offers access to altered states of consciousness, giving it unique properties that assist the patient into surpassing physical and neurological blockages by tapping into subconsciousness. As countless music therapy studies note, improvisation’s ability to connect conscious with unconscious processes and allows the improviser to express emotions non-verbally (MacDonald, 2014), offering a perfect way to engage socially but non-verbally with autistic patients.

Noting the second wellbeing measure within the above PERMA model to be ‘engagement’, two PhD dissertations on flow state within musical improvisation offer in depth insight into consciousness alteration experiences by jazz-based scholars in the early 2000s (Kossak, 2008; Jeddeloh, 2003). Music therapy literature contains the bulk of information covered on improvisation and wellbeing, predominantly claiming improvisation offers many health benefits to ameliorate symptoms in neurological, psychological and medical conditions (MacDonald, 2014), as well as benefits of improvisation by patients of Parkinson’s Disease, dementia, and hysterical paralysis (Tomaino, 2013).

Improvisation and Wellbeing of Jazz Musicians 

While there are numerous studies on the benefits of improvisation for patients in music therapy, there are very few studies on the effects of improvisation on musicians at large, whether amateur or professional, of any genre. Additionally, few studies distinguish an understanding of improvisation as a specific moment, a performance, or as a musician’s way of life. Despite extensive searches, only one single retroactive study was found on the mental health of jazz musicians, using content analysis from published biographies of forty deceased famous mid-century jazz innovators, by Geoffrey Wills (2003). Subjects included Charlie Parker, Bill Evans, Charles Mingus, Dizzy Gillespie, John Coltrane, Miles Davis, Paul Chambers, Art Pepper, Paul Desmond, and Thelonious Monk. The musicians were studied through literature currently available; no musicians were interviewed through current research methodologies. Out of the sample size of forty musicians, twenty-one (52.5%) had been addicted to heroin at some point in their lives, others had alcohol dependency (27.5%), and mood disorders (28.5%). Two subjects had anxiety disorders (5% - that is, John Coltrane and Art Pepper), three subjects had schizophrenia (7.5% - including Thelonious Monk and Bud Powell), and two suffered notable cases of dysthymic disorder (chronic depression). Drug use was noted for its effects on listed disorders, notably in heroin, cocaine, barbiturates, and alcohol dependency; largely due to the era of the musicians and common use of heroin in the 1950s and 1960s. No female subjects were studied; only male jazz musicians were studied, which could be resulting in such high rates of substance abuse and mental health disorders.

Research shows that being a professional improvising musician has historically been rife with mental health disorders, indicating historic jazz innovators tragically suffered from multiple mental health and substance related disorders, such as dysthymic disorder, cyclothymic disorder, schizophrenia, mood disorders related to sickle cell anemia, and substance-induced psychotic disorder. While perhaps popular drug trends have come and gone and come again since the 1950s, it is clear today’s jazz musicians are still no stranger to anxiety and depression, in addition to a bleak existence and identity of practicing a music that has an extremely small audience and is no longer mainstream as it was prior to the 1950’s, few opportunities for financial security through art practice, and an exhausting task of security musical work within jazz and income outside of jazz as a means to pay bills, which can often subject a musician to social discrimination within certain music ecologies, in particular within the disciplined cutthroat tradition of bebop and the gatekeepers who at major historic jazz venues today.

So if improvisation has the power to treat and improve wellbeing for patients with Parkinson’s, autism, anxiety, and paralysis, how is it that the majority of historic improvising innovators struggle with addiction, mood and anxiety disorders? How is it that more than two-thirds of musicians in the UK presently suffer from depression (Gross and Musgraves, 2016)?  There is a huge gap in the already limited research. Studies on improvisation largely miss the experience of the musician and the evolution of their emotional catharsis, rather they focus on piecemeal ideas that fit keywords searches better than the felt sense of music.  Bonneville-Roussy et al. (2011) claimed that 99% of expert musicians are passionate, claiming then that “passion may be one of the most important psychological drives that make musicians thrive, not only in their performance levels, but also in terms of their general well-being.” Another study found improvisation to improve memory, and that musicians have superior emotional memory than non-musicians (Diaz Abrahan, Shifres, Justel, 2020). However, these fail to address the nature of performance plateau and apathy of the most passionate and accomplished professional musicians, noted by Ericsson (2006). These findings do nothing for the problems confirmed by overwhelming evidence that musicians are five times as likely to suffer from mood and anxiety disorders, though they do fuel new questions.  

Improvisation is a social activity. Although musicians improvise solo, one unpublished dissertation suggests jazz pianists need to observe and communicate with each other within a community to sustain the tradition and keep their levels of performance thriving (Campillo, 2013, p.30).  According to Gross and Musgraves (2017), “music makers appear to be reflective and self-critical. They exist in an environment of constant critical feedback – an endless feedback loop of comments – that is just as significant as being ignored and overlooked.” As suspected, research shows that existing in an ecology sounds quite painful, but is needed for survival and existence.

Conclusion 

The dearth of research on the examination of improvisation and jazz music as a whole within psychology is disappointing, given most research focuses on classical musicians, and the case is no different for wellbeing studies. Very few psychological studies have been done on the wellbeing of improvisers, present or past. To improve future research, I encourage future studies use experience sampling methodology, extensive qualitative research, grounded theory, or other methodologies, if I may, including individual live journaling and keeping track of an individual improviser’s lived experience and social media engagement might reflect today’s musicians’ experience of mental health, would be more beneficial, rather than quantitative surveys that risks simplification of documenting something as profound as the experience of improvisation, or any one certain aspect of it on a simple multiple choice questionnaire. It is important that future studies take heed to apply alternative methodologies when examining wellbeing of musicians of all genders and demographics. Improvisation, mental health, and wellbeing have primarily only been documented in music therapy studies indicating positive health benefits from application and experience.

So, how does music participation and musical improvisation affect our well-being? Clinical research suggests improvisation and music participation are primarily benefitted by those who are not musicians,  and primarily, music therapy patients. The reviewed literature shows that musicians have the highest job satisfaction but are in the highest risk profession for anxiety disorders, depression, suicide, and substance abuse related disorders. As Bonde et. al. (2018) shows, the benefits of wellbeing from music go primarily to the non-musicians: listeners, audiences, and patients of music therapy, rather than to the musicians themselves, who are left vulnerable to anxiety disorders and depression caused by an unstable occupation. By understanding how music, music production, and music participation affects professional musicians positively or negatively, and what drives them to continue, we might gain the ability to understand our needs for altered consciousness, emotional expression, disconnection, connection, community, ritual, and social gathering all as they pertain to wellbeing and flourishing. Doing so offers the potential to understand how to change society for the better.

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Brittany Anjou is a jazz trained pseudo performance artist, composer, improviser, pianist, vibraphonist, writer, working musician, educator, and lead singer of the experimental punk metal band, Bi TYRANT. She holds a bachelor’s in jazz and philosophy from NYU, and is a current M.A. student in Music Psychology, Education and Wellbeing postgraduate program at the University of Sheffield (2021), designing and conducting a pilot thesis study on the wellbeing of musicians in NYC during the Covid-19 pandemic. Her research interests include wellbeing for professional musicians, improvisation, transcendence, consciousness, attunement, phenomenology, oral traditions, cultural studies, performance studies, and psychology of performance. Her critically acclaimed album Enamiĝo Reciprokataj can be heard here. She currently loves Tibetan singing bowls now more than ever.

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