An Interview with Professor Jagmeet Kanwal
Jagmeet Kanwal, Ph.D. is an associate professor in the department of neurology at Georgetown University. His research focuses on the auditory processes involved in the coding and decoding, neural integration and perception of communication sounds, specifically the effects of music on patients in the hospital ICU.
Preeti Kota: Okay, thank you for joining us today. Hi, I'm Preeti Kota and I'm a research intern here at Seattle Anxiety Specialists. I'd like to welcome with us, Dr. Jagmeet Kanwal. Dr. Kanwal is an Associate Professor in the Department of Neurology at Georgetown University. His research focuses on the auditory processes involved in the coding and decoding, neural integration and perception of communication sounds. A deeper understanding of these processes can provide new insights on speech and music perception in humans.
Today, we are going to discuss his ongoing study on how music may help overcome pain perception and produce physiologic and metabolic changes that facilitate recovery in ICU patients. Before we begin, can you please tell us a little bit about yourself, some of the work you've done, as well as what got you interested in studying for a doctorate in physiology and zoology?
Jagmeet Kanwal: Hi, Preeti. Good to be participating in this and have the opportunity to talk to you about some of our work. I'm originally from New Delhi, India, and I came to the United States to pursue graduate work in neuroscience. I was fascinated one day to visit a research laboratory when I was a kid. Where cats were walking around with some contraption implanted on their heads, that was the work of a well-known physiologist, Dr. Sheena at the All India Institute of Medical Sciences in India, who was studying the feeding and satiety centers in the hypothalamus. He later also did research on yoga and meditation and how some of the yogis would lower and even stop their heartbeat, simply by meditating.
So I was fascinated by all of this type of work and decided to pursue my own career in neuroscience. As a kid, growing up in the late 1960s and '70s, I was very interested in all things nature and particularly in animals and animal behavior. And so when I got the opportunity to do graduate work in the United States, neuroscience was not yet well-established. I wanted to understand how the brain controls behavior, and had the good fortune of working on my doctoral work in the Department of Zoology and Physiology at Louisiana State University in Baton Rouge, Louisiana.
This was a perfect environment because it not only kept me in touch and learning more about animals, but also getting a deep understanding of physiology and particularly of neurophysiology as a basis of guiding behavior. Some of my earlier work related to understanding how sensory systems work. I initially started studying chemosensory systems in fish, and then became interested in the auditory system, which was an excellent system to study in bats, because bats use this to echolocate, which means they can literally see their environment with their ears by producing sounds.
Fast forward to my appointment as an Assistant Professor at the Georgetown University Medical Center, where I became interested in how humans use sound. One of the most intriguing ways in which humans use sound is by producing music. So I began to wonder why do humans produce music, how the brain processes it and how does it affect our physiology? At that time functional MRI was a relatively new technique that allowed us to peer into the brain and in humans for the first time and see the processes involved in sensory processing, perception, learning and memory, and many other behavioral functions. We used both functional MRI and electroencephalographic or EEG studies to learn more about auditory processing of musical sounds. The current study on ICU patients is then a continuation of some of that early work on the perception and imagery of music in normal individuals.
Preeti Kota: Wow. I love how that all connected and you're basically just doing what got you started or interested in your career, but it's very fascinating, all the projects you mentioned.
Jagmeet Kanwal: Yeah. It's a gradual continuation and transformation of, as you go along and learn new things, as I'm sure you will also discover as you pursue your career.
Preeti Kota: Yeah. So my first question is, can you describe your current study about how music may help to facilitate recovery in ICU patients and what you expect to find?
Jagmeet Kanwal: Yeah, so the current study was partly inspired by the work of Julia Langley, who is the Director of the Lombardi Arts and Humanities Program in Georgetown University. And so we met actually a few years ago when she was leading a tour at the art museum, at the Smithsonian Gallery. And so we started talking and then one day we met and this project was born.
So for many years, actually, she and her predecessors at the Lombardi Arts and Humanities Program had been using music to enhance and improve the hospital environment for those recovering from anesthesia and other life-threatening diseases at the Georgetown University Medical Center. So together with her interest in the arts, in the medical setting, and my background on the auditory system that I just explained, we decided to examine how music might affect the physiologic and metabolic processes during periods of high stress in one's life.
We were also inspired by the work of Andrew Schulman, a professional guitarist and musician in New York City, who had a close brush with death at the age of 57. He survived the incident against all odds with the help of music. The physicians hailed this as a medical miracle. Once he had recovered, Andrew resolved to use his musical gift to help critically ill patients in the same ICU where music had helped save his own life. Later, he wrote a book titled Waking the Spirit. That's the one over here. And in this, he related his experiences and efforts to help people recover from their trauma in the ICU setting with the aid of music. In his book, Schulman posited that the relationship between the pain we feel and the songs and compositions we love has its roots in a tender transcended form of symbiosis.
So in our study, funded by the National Endowment for the Arts, we wanted to understand the physiological and neural pieces of this symbiosis and how music can trigger healing and save someone's life. We postulated that if music can indeed trigger this or play this role, it could improve the lives of many and save millions of dollars in drugs and the costs associated with patients having to stay in the ICU or hospital environment for a long period of time. From a purely scientific perspective, it was intriguing also to think of how music, something that is apparently a human creation, primarily for our entertainment, can indeed play such a vital role in our health and recovery.
By our study, we therefore expect to discover some of the brain and bodily mechanisms that play a role in our wellbeing and the processes by which music can intervene and facilitate recovery.
Preeti Kota: Oh, wow. That's exciting. I didn't even know he wrote a book actually.
Jagmeet Kanwal: Yeah, he did. He has created now the music for our study. He specially created that and recorded it and we now have a CD. So we are going to play his music that he created using his eight-string guitar, I believe. And so he has some kind of an idea of how the music should be, in this particular situation to help the patients, because he actually goes around and plays music to, he said he's done this to thousands of patients. And in fact he now has this organization called Medical Musicians who actually are now trained in this particular setting to use music to help patients and physicians who have experienced and seen his work and seen the effects, they obviously believe in it. So that's going on, at least in New York City, and probably even more outside other cities now with his establishing this particular group of people.
Preeti Kota: Yeah. That's really inspiring. Would you mind just going into a little more detail about his journey and inspiration for starting this kind of...
Jagmeet Kanwal: I don't know too much about him, but we have talked and met and he has played the music to me. And from what he explained to me, he was in a coma for many days and was not coming out of it. And so then the physicians were getting worried and his wife was getting worried. And then one day, she went to the physician and she said, "I know he loves music. And there is this piece that he used to play frequently and likes it a lot. So can I actually play this in his ear?" And so they said, "Okay." And so apparently after she did that, that started triggering his recovery. So everybody was pretty intrigued by this happening. And since he was a musician himself, he really understood how music affects him. And he felt that if music can be so beneficial to me, then why not help other people? So that's what he's been doing.
Preeti Kota: Wow. Okay. That leads me into my next question that, are certain types of music more beneficial than others? Or is it dependent on the individual person and their personal likes?
Jagmeet Kanwal: So we don't yet fully understand the biological mechanisms by which music plays a beneficial role, but clearly, certain types of music are more effective or different in different situations. For example, there are some common elements in religious music around the world that help to soothe and calm our nerves and reduce anxiety. Music is of course very rich and its acoustic content can be used both for our wellbeing and also to excite and energize us to act. Not only to celebrate at weddings and other situations, but also sometimes to kill others, as is the case with war music that is prevalent in all cultures.
So sounds and music are really fascinating and that's really why I continue to study that, because it has such a powerful effect on us. And it's something that we can create. We have the ability with our own body, with our own vocal organs. We cannot create light, but we can create sound. And so it creates some kind of a feedback loop that perhaps gives us the ability to modify our own feeling. So we may dance at a wedding of a close friend or relative, but also engage, as I mentioned, in war dances to attack our enemies. It's all in the sound. How the sound is used, what type of sound is used. And that's what, therefore, is very interesting to see how the brain is wired up to use these different types of sounds.
Preeti Kota: Do you think that music, in terms of your experiment and study, is it more helping patients through relaxing their nerves or exciting their nerves?
Jagmeet Kanwal: Actually, that's a very interesting question. In talking to Andrew, he said the way he is creating music is actually to do a little bit of both. So when a patient is in a coma, you want to do a little bit of excitation to wake up his brain and certain parts of the brain that might be involved in the healing process. The way I believe that he has created his music is to, a little bit stimulate the person, get him excited a little bit, but then also calm down. So it's a process of push and pull, perhaps. And then he also has in fact different music pieces that he created for playing in the morning versus in the evening, when you want the person to have a good rest and then be able to recover from the day's stress and going through all of the treatment that they're probably going through. That's the way it's supposed to work.
Preeti Kota: Does the excitation part occur simultaneously or before the relaxation part?
Jagmeet Kanwal: I think it's alternating between those two, so you want to excite the person a little bit, but you don't want to excite them too much. We know, for example, rock music, when you play that, literally your heart starts to beat faster. So one of the ideas is that the beat of the music directly affects your rate of heartbeat. That is why a lot of the dancing type of music has a faster beat, as compared to more relaxing classical music or religious music has a slower and a different beat. So beat has a lot to do with it, in addition, of course, to the harmony of the sounds.
So he does a little bit, because you want to, for example, you may want to stimulate the heart a little, but you don't want to do too much so that you don't want to increase the blood pressure too much. So it's an alternation between those two types of music, as far as I understand.
Preeti Kota: Okay. So what are the brain regions involved in music perception and pain perception, and how are these related?
Jagmeet Kanwal: That's a good question. So of course we are learning a lot about music over the last decade or two, there's a lot of work going on. Compared to when I first started studying music perception, it was very little. Even now there's almost nothing in the textbooks, but even thinking of music as something that should be scientifically studied was questionable.
Now we know a lot more about some of the brain regions that are involved, but still the interaction between for example, pain perception and music is still not well-established. So we do know that many brain regions are involved. And so we start with musical sounds entering through our ears, and reaching a nucleus called the cochlear nucleus within the brain stem. This nucleus receives input from a spirally, coiled structure inside our inner ear that vibrates to the slightest of sounds. Then it amplifies the mechanical energy in those vibrations and transduces that into electrical signals. That electrical energy then can be used by the brain for doing different kinds of things.
So from there, the sound signals then travel as electrical impulses throughout the auditory system that parses and integrates them into a perceptual hole that can be used by other brain centers, such as our limbic system, where emotions are thought to reside.
So now, one of the well-studied limbic brain structures is the amygdala, and where pain signals are also reached from various parts of our body. Thus, one of the structures, at least, would be the amygdala and within the amygdala, both music and pain then come together. So both of those inputs are coming in, into the same brain structure. And so we believe that perhaps here, the music can override and suppress the perception of pain signals.
So it's like a gateway. From there, if the pain signals go to our conscious memory, because the amygdala is connected to our frontal cortex, which is more involved in our perception, then perhaps the music gates can cut it off, the pain signal, from reaching more conscious parts of the brain. So you can’t do much from the signal that's coming through the body, but that's not the only place where you can do something about it. It goes eventually into the brain, and that's really where we perceive the pain. And so if there, the pain signal can be suppressed, then that would be a way to deal with pain. And so perhaps music does that.
So in fact, we put an electrode into the amygdala and we recorded and we wanted to test if sounds do really reach there. And of course, these studies you cannot do in humans. So we did that in animals and in bats that we were studying at that time. And indeed, we were among the first to show that these signals so forth, these sound signals do reach the amygdala. So the neurons in the amygdala, they respond to the sound. And about the same time people were studying also the amygdala in humans using fMRI, and they discovered that the amygdala responds to laughing and crying type of sounds.
So that's when it was established that the sounds in fact, do go into the amygdala. And so that would be a basis of the musical sounds also going into the amygdala, because we were looking at actually animal communication sounds, which also have an emotional component, and so just like music had an emotional component. So then at least we have the beginnings of a possibility of how music and where in the brain it can actually play a role in the perception of sounds.
Now intriguingly, we also not only put our electrode into the amygdala and recorded the response to sounds, but at the same location, we delivered a small electrical signal, a little electrical pulse. And when we did that, we discovered that lo and behold, the heart rate of the animal changed. So the heart rate went up, the breathing rate went up. So that was amazing because that means that the same area that is receiving the sounds, in fact has a control on our bodily functions, particularly the heart rate, in this case, and breathing rate.
And so that provides a very direct connection. In fact, that was like the first evidence that the control of our heart rate is not just from the brain stem, as it is in the textbooks, but there is another higher center in our emotional areas of the brain, in here, particularly the amygdala, that can also affect our heart rate. And of course we know from our everyday experience that if we get scared or we have some different feelings, our heart rate is affected accordingly. That's probably happening in the amygdala. That's what we are hoping to find out more about.
Preeti Kota: And then depending on the type of music, is there a more lasting impact on the amygdala for certain types or..?
Jagmeet Kanwal: Right. That's something that we don't know yet, and there would be new studies that would have to be done in humans where you would record their activity in the amygdala and present different types of music. Something I really always wanted to do, because we know we have so many different types of music and they have different effects on us. It'd be interesting to see which kind of music influences the amygdala more than others. But a lot of the studies on fMRI are typically focused more on the cortex, because it's a large area. And so you can easily see the activation and so on. The amygdala is a deeper structure in the brain, relatively smaller structure.
So it's a little bit more difficult to do the studies on that. And also the MRI, it creates a lot of sound by itself because every time you send a magnetic pulse, very high magnetic pulse, there's a vibration associated with that. That makes it a little bit more difficult also to do sound studies using fMRI, but there are some ways to get around that. So I think in the future, hopefully, we will know more about that.
Preeti Kota: Do you think it'll interfere with that? The MRI pulsing?
Jagmeet Kanwal: Yeah. It does, but we put earphones on the person's ears, and what people do is that they... So because the MRI signal takes a little time to build up, so what they do is that when they present a sound, they collect the signal to that sound a little bit later, so that it's phase-locked to the time of the presentation of the sound and not so much, there is less of a component that is affected by the sound of the magnet itself. So the timing of those two are a little different. And so that way, they can extract the signal that is more to the presentation of the sound that they want to test.
So there are ways of getting around that. But it's a pretty loud sound so there can also be some interference that's hard to take out.
Preeti Kota: And then just touching back on what you mentioned earlier about how the music sample that you are using, it was personal to, I forget, I'm sorry. I'm forgetting his name.
Jagmeet Kanwal: Andrew Schulman.
Preeti Kota: Yes. Do you think that will lead to varying effects on playing it for people who it's not personal to?
Jagmeet Kanwal: That's a very good question. And we struggled with that, because a lot of the other music studies, they actually present the music that a person likes, because everybody doesn't like the same music and obviously you don't want to present some kind of music to somebody they don't like.
So typically, in this kind of a situation, when people want to study the effect of music in a medical setting, they give the patient a choice of many different types of music and then the person chooses, "Yeah. I'd like to hear this when I'm recovering from my anesthesia," and so on. In our case, we decided to go with the music that he created because apparently he has been using this music on different patients. And so there's some, apparently, universality to the type of music that he has created.
In some ways there's a little bit of an issue, but in other ways it makes it more uniform. And so we can then see how the music is affecting and we know the different parts and therefore we can parse out the different musical pieces and perhaps see their effect on the heart rate and so on. So it'll also provide some more consistent data. So it's a trade off, but that's what we decided to do for this study.
Preeti Kota: And I guess there's a lot more variables if you use subjective music based on the person's taste, based on the rhythm and types of-
Jagmeet Kanwal: Exactly. And already, there's a lot of variation in humans. So it just adds to that.
Preeti Kota: Are there certain health conditions in which music may be more helpful than others, like a stroke or coma, for example?
Jagmeet Kanwal: Yeah. So music has been known to play an important role in many health conditions, such as in Alzheimer's, Parkinson's, catatonic conditions resulting from trauma and various other anxiety disorders. In addition, music can help pregnant women to relieve the pain during the process of childbirth, labor, and delivery, and many other conditions that humans may suffer from. So there have been a lot of studies actually on the fact that the pain threshold really changes when one is listening to music, but from a scientific point, a lot of those are observations. And so to have a scientific understanding of how it happens, that is still missing in the literature. And so we think that music may be particularly helpful in facilitating recovery based upon the data that, for example, Andrew Schulman's work has provided. And so that's what we would like to find out more about during our study.
Preeti Kota: Okay. So just recovery in general or..?
Jagmeet Kanwal: Yeah. For us, it'll be more like recovering from anesthesia after a surgery. So we are targeting currently people who have liver transplants, because those are well-defined, we know that they're going to have the surgery in advance and so we can prepare for that. It's a risky surgery and there is deep anesthesia involved. So that's the population we are targeting in the beginning. Later on, we may do other studies. We didn't want to work with patients who have had a stroke because then part of their brain maybe damaged. And we don't really know which part. And because we feel that the brain is playing a role in this recovery and that's what we want to study more, so that's why this is the patient population that we chose to start, at least, our study.
Preeti Kota: Okay. And then how is this applicable to other situations and how do you think it might benefit people on a daily basis?
Jagmeet Kanwal: Surprisingly, we may not realize this, but the music industry is clearly much bigger than the drug industry because all humans engage in listening to music, from the tinkling sounds placed in our crib soon after birth, and many songs we hear about twinkling stars to the more exciting type of music we hear as teenagers. And then the more calm and mellow music that people prefer in their older age. So we know that music plays an important role in our mental and physical health, even in normal individuals, we just don't think of it that way, that it may be continuously playing a role in our wellbeing. And so we hope that our study then will shed some light on this phenomenon so we can better understand and utilize this listening to music in the most appropriate way.
Preeti Kota: Also, I just thought of a question about how you were talking about the amygdala before, but is there personalized music sensitivity that varies from person to person?
Jagmeet Kanwal: Good point. Clearly, some people may not pay particular attention to music. Most people do, but then there are the musicians who are really tuned to the music. In fact, there are people who have perfect pitch, which means that if they hear a particular tone, they can immediately say what is the pitch or the frequency of that tone. So people have done the study studies and they found that their auditory cortex is very well-organized. Over there, it's not like a diffuse activation, a particular frequency only activates a particular band in their auditory cortex.
So basically, musicians are much more sensitive to music, probably it plays a more important role in their lives. And I've heard musicians say that they literally could not live without music. So it does vary with people, as do many other things, but in general, it seems to have a big effect and role in most of us.
Preeti Kota: So to precisely assess the effect of music, what do you plan to measure in the body?
Jagmeet Kanwal: To precisely assess the effect, we hope to measure many of the brain and body parameters that may be associated with the healing effect of music. These include tracking the heart rate, blood pressure, breathing rate, as well as brain activity. So we would also like to measure the level of cortisol changes in our body by taking saliva samples and also determine if the levels of oxytocin, the hormone that is known to play an important role in bonding, may facilitate our health and wellbeing, because it's been shown that even when we hear some sounds, even two people talking, leads to increased level of oxytocin. And oxytocin appears to have many benefits in our body and brain. And so we want to also look at that.
Many of these physiological parameters are already being measured in patients within the ICU. They're already measuring the heart rate, the blood pressure and so on, and tracking that. Therefore, we think that this is a unique opportunity to take advantage of these data that are already there and being recorded. And so now what if we play some music and then be able to see the effect on those data? In the ICU setting, we don't even have to do a lot of things on our own, those are already being recorded. And so we said, "Oh if we look at the effect in this situation, then we will easily get a lot of data." That's the goal, using all of the... And then a few additional things that we do. And then hopefully we'll be able to put that together and see what effect it had and whether when we started playing the music, that triggered or facilitated an acceleration in the recovery of the patient.
So perhaps patients who listened to ICU music on the whole will recover faster. Maybe they get out of the ICU a day before than the other patients who didn't. That would be a big saving right there, in terms of being in the ICU and additional stress, nobody likes to be in the ICU and plus all of the cost of the patient being in the ICU.
Preeti Kota: Just out of curiosity, how do you measure levels of oxytocin?
Jagmeet Kanwal: That's a little tricky, but one of the ways that people have seen, also you can measure that in the saliva. So the same saliva sample that we take to measure cortisol, which is much more standard is thought to be also one of the best ways to measure the level of oxytocin.
Preeti Kota: Okay. Very interesting. Lastly, is there anything else you would like to share with our listeners in general or about your research?
Jagmeet Kanwal: Yeah. I would like to say that much of my past research has been aimed at achieving a basic understanding of how sounds are encoded within neural activity in the brain. So I've always been very interested in animals, as I mentioned earlier, and their behavior and have been studying social communication behavior in bats.
So about 30 years ago, I helped to restart the field of neural processing, of communication sounds that had come to a halt because of the difficulty of the complex and relatively difficult-to-study brain mechanisms associated with the processing of complex sounds. So speech and music can be thought of as complex sounds basically. And so at that time, and to a great extent, even now, to obtain funding for auditory research, it was necessary to relate one's research to speech processing because speech is considered to be unique in humans and everybody accepts the importance of speech. And so that was one of the ways that people would justify their getting funds to do their research, especially on animals.
So it's one of our unique abilities. Everybody understands that. So when I started studying how bats use sound to not only echolocate, but also to communicate with each other, then I gradually discovered that some of the brain structures involved in their processing are primarily designed to process emotions. So that's like, I was talking about the amygdala, when I mentioned that we were among the first to report the activity of sounds in the amygdala.
That suggested to me that music does not exist only in humans because there are other sounds that can affect our or the animals' emotions too. So these emotion-processing brain structures are more primitive, because they are there, we know in animals, compared to other brain structures in humans, such as the frontal cortex and so on.
And yet we consider that music is something that humans invented. So we say, "Oh, we play this music and invent, obviously no other animal does that." And so music is very new. It makes us human, this is our thing. But when you look at the brain structures, where it's being processed, they're very primitive and other animals have those too, the emotional brain structures. The limbic brain, I mean the reptilian brain, even they have that.
So how come music is going in those structures? That was very intriguing to me. So this suggested that music does not exist only in humans, but the social communication sounds that I was studying in other animals are probably more closely is connected to our music than to our speech, because both have this emotional component. And yet people were using their studies to justify speech processing, getting a better understanding of speech processing and so on.
So in fact, looking around, we see that music is everywhere in nature. From the many songs we hear birds sing in the morning to the sonic and ultrasonic songs of crickets and bats. Yeah, bats sing as well in the evening. And the thumping of their chest by gorillas in a forest are all reminiscent of music that is not only ours, but exists universally in nature.
So understanding and studying the brain and body mechanism by which these sound are perceived and can improve our wellbeing is a privilege, I feel that I have the good fortune to experience and be engaged in. So I hope that this type of basic research with many potential applications will be supported not only by the scientific community, but also by society at large, until their human benefits become more clear.
That's something that I wanted to share with you and hopefully others, that just trying to understand some basic phenomena can eventually lead us to many results and information that can benefit in the future, even though we may not think it's relevant when we are doing those studies.
Preeti Kota: That's fascinating how it ties into even evolution.
Jagmeet Kanwal: Exactly. Right, because these brain structures are evolutionarily primitive, but we never really considered there. And yet they're really important because they are the ones that control the vital functions of the body. So what we label as feelings is really, actually, they're very important. We say, oh we should not base our decision on feelings and so on, yet we really rely on our feelings for a lot of decisions and they have a direct connection with our physiology.
So when we think of feelings in a scientific way, we call it feelings, but they actually are vital physiological mechanisms that are important for our survival. So if we feel that we are afraid of something, that means we should get out of that situation, that will be good for our wellbeing. So, it's that system that I think we are activating by music and that system is clearly important.
Preeti Kota: Your research is very exciting.
Jagmeet Kanwal: Good to know that. Thank you.
Preeti Kota: Definitely. But on that note, I just wanted to thank you so much for sharing your career and your research and all your work. It's very thrilling to hear about. And I just wanted to thank you for your time and hope you enjoy the rest of your day.
Jagmeet Kanwal: Wonderful to know that. And I want to thank you for your interest and your questions and for your eagerness and interest to participate in our study. So we look forward to working together and finding, hopefully, new things.
Preeti Kota: Yes, of course.
Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.
Editor: Jennifer (Ghahari) Smith, Ph.D.