In popular discourse, and in some research on music and health, a vague but universal healing potential is sometimes attributed to music in general. An important counterpoint appears in heavy metal music, which is often assumed to have deleterious effects on listeners and on society. This article reviews debates in politics, news media and research on health and metal music from the 1970s to the present, with particular focus on the UK and US contexts. Showing that research has been influenced by moral panics and legal controversies, the article demonstrates how ideas about transgressive religiosity have often influenced debates about health and harm surrounding metal music. A disciplinary and methodological polarisation is noted between, on one hand, psychological and behavioural lab experiments, and on the other, social sciences and humanities research with more ethnographic or contextual approaches. Noting that some lab-based methods seem highly contrived and even unethical, this article argues for an approach to research in this field which studies real listening practices. A case study of violence, religion and health is then outlined concerning the extreme subgenre of drone metal. In this music culture, listener discourses touch on mysticism, ritual and the sacred; on health, healing and catharsis; and on different modes of abstract and physical violence, in highly interrelated and sometimes surprising ways. The article concludes that noise and extreme music may offer particularly powerful —yet under-appreciated, at least to critics outside metal cultures— resources for positively influencing listeners’ health.