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The author describes what music meant to one of his patients. Like a neurotic symptom, it represented simultaneously a defense against and gratification of libidinal impulses. Music is like forepleasure; it serves to discharge libido in a substitute form. The sounds of music give narcissistic, autoerotic gratification. The author substantiates by clinical studies the magic, omnipotent, and animistic qualities of human breath and singing. He uses Reik's hypothesis about the shofar, and other mythological and anthropological studies, to corroborate his conclusions, namely:
1. Musical sounds, regardless of words or manifest content associated with them, are derived from shouting as a manifestation of or defense against anxiety. 2. Repressed oral sadistic impulses underlie both music and shouting. 3. Pleading, praying to the gods, and singing have been associated in the human mind since the beginning of history. 4. The cry at birth is the model for all crying, shouting, and singing in future anxiety-ridden situations. 5. Music is somewhat analogous to wit because in enjoyment of music the superego is bribed by intellectual pleasure. 6. Music helps to maintain a reactive defense against patients' persecutory and paranoid fears. 7. It is similar to melancholic and maniacal states, in which feelings of inferiority are but a façade for guilt over oral cannibalistic, anal-sadistic (flatus, the expulsion of gas), and homosexual feelings, all related to the Oedipal situation. 8. The cry (shouting or sobbing) becomes subjugated, as happens in melancholia, to a severe superego and is then transformed into music. 9. In the elaboration of music we see operations resembling the primary process, such as displacement, condensation, inversion, and representation by the opposite. The form of melody is, essentially, an orderly construction, followed by repetition of it and variations of it.
An abstract cannot do justice to the author's clinical substantiation of these hypoth