May 25, 2016

Music and Dance v. Parkinson's

I recently attended "Update on Parkinson's Disease" by an eminent neurology professor. From his purely medical point of view "nothing new" has happened since discovery of the response to L-Dopa in the 1960's and probably nothing will for years to come. You start L-Dopa when the patient needs medicine for tremor and reduced mobility, the medicine helps for awhile but then becomes less and less effective as the disease relentlessly progresses. We can't do anything to slow the progression.

There can be no better illustration of the 1) insadequacy of a purely medical approach and, 2) truth that any person's (and their family's) experience with Parkinson's depends mainly on what they can learn about the condition in order to help themselves.


Almost 80% of people with Parkinson's initially consult their doctor for one of four kinds of symptoms, the 'motor' symptoms of Parkinson's: 

  1. Tremor
  2. Clumsy, weak limb
  3. Stiff, aching limb
  4. Gait disturbance
Correct diagnosis may be delayed among patients in the last three categories, especially by primary care physicians who care for half of all patients in the US with the condition.

The professor barely touched on the 'non-motor' manifestations of Parkinson's, probably because they don't respond well to his purely medical treatment. But they increase the distress--and risk of falls--of Parkinson patients: 

  • anosmia (loss of sense of smell)
  • micrographia (smaller and smaller writing)
  • sweating, salivation, dysphagia (poor swallowing)
  • bladder disturbance and constipation
  • sleep disturbance including sleep apnea
  • heart rhythm and blood pressure increase and/or decrease
  • postural and balance disturbance (lightheadedness and problems remaining upright)
  • depression (often limiting necessary mobility)
  • dementia (a late complication)
  • falls (cause often misinterpreted, "I tripped," but a serious complication)

Responsibilities of people with Parkinson's are many, ranging from discovering precisely how and when the medicine acts in his/her case in order to determine the dose levels and intervals, to finding how to mitigate all the manifestations, medically and in other ways. 

One of the other ways is exercise. A stringent Cochrane review of 16 studies in 2015 concluded: 
treadmill training in patients with PD may improve . . .gait speed and stride length. . . . The results must be interpreted with caution . . . and it is not known how long improvements last. . . .
It seems reasonable to extend those results, 1) to all kinds of exercise -- from Tai Chi to tango -- whatever each individual can do regularly and, 2) to the assumption that benefits will probably continue so long as the exercise continues.

Oliver Sacks and others have emphasized that Parkinson patients tend to synchronize with a rhythmic beat. For example, their small rapid steps, called "marche a petit pas," will lengthen and slow when they march to a real march, like Stars and Sripes Forever, that bandmasters customarily conduct at 120 beats/minute, twice each second. Watch David Leventhal do that in the dance studio: (if you don't see the video below, click here then return to this page)


video


Note how Leventhal and his class synchronize their arms, legs, and torsos to the beat.

Walking, of course, is great exercise partly because it is available to almost everyone at home without a treadmill and also can be done in company of (and synchrony with) others. Walkers with Parkinson's could play a march on a smartphone and split the music into two pairs of earbuds.

Or they could use a walking stick or staff. Rhythmic placing of the staff ahead along the path creates the beat and the walker takes 3-4 steps to each beat as he/she walks past the staff. The neurologist inventor of the "Neurostaff" claims furthermore that:
"The incorporation of the arms and legs in a whole body motion creates a synergy of proprioceptive sensations providing the brain with additional posture information to deliver better balance and hence psychological confidence."
The tip of a staff on the ground or floor provides not only a beat but also a third source of proprioceptive (position sense) signals to the the sensorimotor regions of cerebral cortex that program walking. Once Parkinson patients accustom themselves to the walking stick, their small steps may become longer (as seen on neurostaff.com). Balance becomes more stable with three points of contact, falls less frequent, and confidence increases. (I find that to be true for myself and I don't have Parkinson's.)

Exercise is just one method people with Parkinson's can help themselves. Singing in a choir is another and perhaps a discussion in another post. The hypothesis that Parkinson's relates to environmental toxins entering the body through the gastrointestinal or olfactory system and then moving through the nervous system like infectious agents was also not mentioned in the Update.  Another fascinating question.




April 25, 2016

Purple BRain

The unexpected death last week caused me try to recall what planet I lived on when Prince burst onto the stages of earth. Before last week if someone had mentioned "Purple Rain" I would have imagined some kind of climate aberration. I was trying to make a go as a medical associate professor and celebrating the fact that Gretna Music had just signed Dave Brubeck, Marian McPartland, George Shearing and members of the Chicago Symphony to our summer concert schedule. Prince was a star that appeared at the far edge of my universe.

Until last week I could not have named any of the songs that have become, beyond my awareness, cultural treasures known to more humans than the combined songs of Schubert, Schumann, Mahler and maybe even Walt Disney. My aging ears can't even understand the words. The performance video clips celebrating Prince's life are all new to me.

Now at first hearing much of the music sounds to me like other rock music: loud, harmonically, lyrically and rhythmically simple, opaquely arranged, and frankly uninteresting. The costumes and prancing around resemble angry aggressive preening male strutting. Lights, smoke, sexual gestures are all apparently necessary to hold the attention of younger generations who probably can't find middle C on a piano. It's more about performance, and social commentary, than music.

I admit I am missing something important, that Prince was an example of new and valid music, that he was probably a genius, that he was a wonderful and charitable human, the loss of whom I mourn. I wish I had paid more attention to his work and learned to understand it and know him. I am embarrassed that my behavior is exactly what I have criticized in others, in particular the tendency to arbitrarily categorize music made by humans, confine my listening to just one or two categories and dismiss the others as not worthy of my time.

So why don't I understand Prince? I can think of two reasons, though there are undoubtedly more. 1) Dan Levitin, musical psychologist, says:

"Fourteen is a sort of magical age for the development of musical tastes. Pubertal growth hormones make everything we’re experiencing, including music, seem very important. We’re just reaching a point in our cognitive development when we’re developing our own tastes. And musical tastes become a badge of identity."
At age 14 I was playing in an orchestra at Interlochen. When Prince arrived, my musical tastes at age 40+ were set and my brain was less receptive to new ones, though not totally unreceptive.

2) I didn't listen to rock music (Elvis at my age of 14, others after). When my brain was most receptive, during my first two decades, I listened to Schubert, Mozart and Beethoven. Tastes laid down early are fed by listening through life.

If I understood, maybe I would have a fuller life. I am not alone in this. Others close to me have told me the same. But before you label us as compleat musical snobs, tell me how many of Schubert's songs you can name. Here's the best obit I have seen.

April 14, 2016

Our Summer of Love

by Carl Ellenberger, MD

“As much as I’d like to believe there’s a truth beyond illusion, I’ve come to believe that there’s no truth beyond illusion. Because, between ‘reality’ on the one hand, and the point where the mind strikes reality, there’s a middle zone, a rainbow edge where beauty comes into being, where two very different surfaces mingle and blur to provide what life does not: and this is the space where all art exists, and all magic. 

And—I would argue as well—all love....”

--The Goldfinch by Donna Tartt 

From Shakespeare’s “thy sweet love remembered such wealth brings” to  [I❤️My Labradoodle] “love” is an overused word. Love you, as we say goodbye to a friend. Give her my love. Love your necklace! I’d love to, in response to an invitation. I love you, from the silenced lips of a diva throwing kisses to a raving audience. ’Google’ “love” for 4.6 trillion more examples!

The word defies definition; dictionaries suggest affection more intense than the equally common word “like.” I like Justice Potter Stewart’s workaround: “I know it when I see it” (applied to an even more problematic word) but time has not always proved me right. 

Ancient Greeks worshipped an Olympian goddess, Aphrodite, who with her companion Eros, embodied erotic love as well as beauty, pleasure and procreation. Their word, agápē served for universal transcendent love between God(s) and mankind, and philēo expressed brotherly love. It makes sense to break up a broad concept into manageable pieces. For most serious observers love has a purely spiritual source uninfluenced by external social pressures. St. Paul (1 Corinthians 13) considered love as God’s spiritual gift to humans:

And now abide faith, hope, love, these three; but the greatest of these is love.

Poets may have the best chance at a definition in words:
Love is anterior to life,
Posterior to death,
Initial of creation, and
The exponent of breath.
—Emily Dickinson

Love gives naught but itself and takes naught but from itself.
Love possesses not nor would it be possessed;
For love is sufficient unto love.
—Kahlil Gibran

Over the centuries what has shaped our concept of love most strongly has been art. “It is through novels, poems, songs and, latterly, films that we have acquired our ideas about what aspects of our feelings we should value and where our emotional emphases should fall.” (Alain de Botton in Financial Times, Apr 22, 2016) “This is unfortunate,” he continues. “It’s not that the art has been bad; indeed a lot of it has reached the highest aesthetic pitch. It’s simply that representations of love in culture have frequently been profoundly misleading at the psychological level.” Too bad, he muses, that Madame Bovary could not have read Flaubert’s novel before she decided her marriage was humdrum and began her ultimately fatal flings!

Part of the problem could be that scientists have yet to discover how to measure love, though we can quantify memory and intelligence and blood pressure. Can we use the duration of a kiss? The eloquence of an expression? Fervor measured in kilowatt hours? In dark moods I may think that true love will be revealed by the one who comforts me when I’m dying. Psychologists use the word “limerence” to stand for an almost instantaneous but short-lasting bloom of attraction that eventually fades (often leaving all sorts of problems). Even long-lasting love seems to vary in quality and apparent intensity over a lifetime. Love eludes measurement as well as a clinical definition. 

Scientists can measure the hormone oxytocin, endorphins, and the brain neurotransmitters serotonin and dopamine, chemicals that ‘mediate’ emotional experiences such as pleasure in close relationships. They flow among ‘pleasure’ regions in the brain: the ventral tegmental area, the nucleus accumbens and the insula, the parts of the brain also most affected by addictive drugs. But none of these measurements help much to understand love in daily life.


Music, In pathways parallel to language, activates similar neural networks in the brain, and stimulates the same neurotransmitters and hormones as love and other pleasures. Ancient Greek actors sang their tragedies to enhance the emotional impact of the stories. 

The Met Opera’s recent premiere of Donizetti’s Roberto Devereux demonstrated the awesome power of love — loving is indeed "playing with fire,” both its needed and welcoming heat as well as its power to destroy—and showed how music can express that power. Franz Schubert and Robert Schumann knew this as did other composers including Gustav Mahler:“With songs one can express so much more than the words directly say…. The text actually constitutes only a hint of the deeper content that is to be drawn out of it, of the treasure that is to be hauled up.”  The Met’s Elektra demonstrated the awesome power of music to bring an ancient tragedy back to a new life after thousands of years, and remain truly hair-raising to humans living now.

Love is rarely more powerful than when it is lost, through death and by leaving and being left. Music, poetry and art enter the picture here too as both a means of expressing the pain of loss and for healing and of solace.

Music can also be a sexual stimulant, though you may argue that some contemporary performers go beyond civilized limits to engage pubescent 14-year-olds just in process of developing life-long musical taste and identities. Musical psychologist, Dan Levitin, also claims that couples who spend time listening to music ‘out loud’ together make love more frequently than those who listen in solitude through ear buds. ‘Out loud’ music in homes, he further claims, makes entire families happier. 

And think of it: music on our stage synchronizes the brain activity of all of us sitting together in the audience! Your mind might wander to the “Furtwängler concerts,” music of German masters— Bruckner, Beethoven, Wagner — broadcast in 1944 Germany and heard by both the “free” German people and inmates of Buchenwald through the camp public address system. Music finds its special conduits among humans.

As agápē inspired Bach, love inspires other composers. Robert Schumann must have made Clara Weick feel abundantly loved by courting her with over 200 love songs, such as “Widmung” (“Dedication”) played with other Schumann love songs for us by Lise de la Salle on Aug 14. Friedrich Rückert wrote the words: “You are my heart and soul, my bliss and pain, my heaven, my good angel, my better self.” As you listen, note how the music can make those words, though only imagined in the piano version, more powerful. After Clara married Schumann their love and his compositions changed. He dedicated his Piano Quintet (July 31) to Clara, as Wagner later composed Siegfried Idyll as a present for his wife, Cosima (July 10). 


Clara and Brahms remained unmarried lovers for their entire lives, long after Robert’s death. Late in life Brahms dedicated to Clara Six Piano Pieces, op.118, in my view some of the most poignant instrumental expressions of love. I wish we could have played those pieces for the two lovely ladies we have lost since last summer, Nancy Hatz, age 100 and Pat Pinsler, age 89, in return for their abiding love of music and Mt. Gretna, though Leon Fleisher’s All the Things You Are by Jerome Kern was a perfect farewell for Nancy. She threw a kiss to Leon from the front row.

Humans have always made music. Some scientists argue that it has endured since the appearance of our species (homo sapiens, maybe even earlier) because those who play or sing may have an evolutionary selective advantage: singers (and dancers like BalletX on Sept 3), may pass on their genes more often than their less expressive, or less graceful, competitors.

We arrived at “love” as a programming theme for this summer in a roundabout way, first landing at “Sweet Sixteen” but then remembering that 2017 will be the 50th Anniversary of the original “Summer of Love” in San Francisco and around the world, though some of us remained more or less oblivious to that until afterwards. (I was in the Army.) We quickly realized that Jimi Hendrix and The Grateful Dead have passed on and probably wouldn’t appeal to our audiences. And none of us knew where to find any good acid anyway. This summer we’ll venture only so far toward Haight-Ashbury as Hollywood. (Alexis Cole sings her unique versions of Disney love songs on July 28.)

Our choice of love for a theme this summer may prove prescient as the election year unfolds. We hope our concerts will replenish love in the air, at least in our neighborhood and in your hearts, after its trampling during a long tedious and rancorous election season.


More summer highlights not mentioned above include: a Dvorak Romance (July 31), Sibelius’ The Lovers  and Schoenberg’s Transfigured Night (July 10), Wagner’s Liebestod from Tristan und Isolde and pieces from Prokofiev’s Romeo and Juliet (August 14). Many more lovely works to come are listed in this booklet.

We hope you have had love in your life. Without it, and music of course, life is hardly worth living.



The late harpsichordist, Doris Ornstein, and the author 
discussing Bach in 1989 in Lancaster’s St. James Church

February 1, 2016

Listening to Grass Grow (Not)

While mining our 40 year history, I was gratified to remember the many people who joined my effort. More recently, preparing for the annual submission of grant proposals to fund next summer’s 41st season, deeper mining revealed more interesting stuff. We clearly did not

rest our heads upon the grass
and listen to it grow.
—Splendor in the Grass (Pink Martini, not Wordsworth)

Among the ~1200 artists who appeared in over 700 Gretna concerts 37 have won Grammy Awards, countless more have been nominated, and five are MacArthur (“genius”) Fellows. Next year I may try to count the many winners of competitions, like the Cliburn, Leventritt, Young Concert Artists, Queen Elizabeth, and Tchaikovsky.

Not only did our musicians represent major orchestras in the US like the Metropolitan Opera, Chicago Symphony, Cleveland and Philadelphia Orchestras, others came from more than 20 countries abroad like China, Bulgaria, Russia, and Brazil. They have been soloists in Carnegie Hall, Lincoln and Kennedy Centers, Severance Hall, Hollywood Bowl and Walt Disney Concert Hall, and the Tanglewood, Blossom and Aspen Festivals. 

We offer great young performers before they become household names or win Grammys and iconic performers after they have, but not the growing fad of ‘recreative tributes.’ So we have heard the ‘real’ Dave Brubeck, Sonny Rollins, George Shearing, Cleo Laine, The Four Freshmen, The Modern Jazz Quartet, Stéphane Grappelli and Lionel Hampton. Pianist Leon Fleisher (July 1) was taught by a student of a teacher who was a student of a teacher who was taught by Beethoven.

We have commissioned and premiered dozens of new works. In many cases the composers, like David Baker, William Bolcom, Edgar Meyer and Allen Krantz, performed their own music. Dancers danced their own choreography and jazz singers sang their own songs. When Tierney Sutton sang songs of Joni Mitchell, she put her inimitable stamp on them as Joanna Pascale did for Paul McCartney’s songs.

It was fun looking back, but the challenges are in the future. In words of conductor Alan Gilbert, we must always try “to sharpen our sense of purpose and . . . justify our very existence.” How do we do that? By taking new paths, some of which may be dead ends, and trying new ways, not all of which will succeed. By keeping our eyes open for new ventures and connections. By infusing our organization with new people. And by listening to you.

January 25, 2016

More the Matter With Classical Music

Attention span is "the amount of concentrated time on a task without becoming distracted" and it can easily be measured under proper conditions. In a recent New York Times column Timothy Egan cites recent data: the average attention span (among Canadian subjects) has fallen to 8 seconds, down from 12 in the year 2000.

Imagine orchestra players distracted every eight seconds! Rehearsals and performances would be chaos. It’s harder to imagine a task requiring more intense and prolonged concentration than is demanded of an orchestra violinist. Developing the ability to maintain attention may underlie the benefits of learning to play an instrument in childhood. It’s almost certainly a skill ‘transferrable’ later to other endeavors, as is reading by children.

Listening to classical music does not require quite such a high degree of attention — it’s natural for your mind to wander during a movement of a symphony (not, we hope, to Donald Trump or ISIS) — but the music is composed to travel from a beginning to an end, a narrative, so to speak. That progression, sonata-allegro form only a simple example, is one of the main distinguishing characteristics of ‘classical’ music. It takes you on a musical journey with wonderful sensations and mental images along the way, one leading to another. You aren’t supposed to get off the train whenever you want.

I suppose digital generations can’t imagine not texting or checking email every eight seconds, so there’s little chance for them to withstand Schubert’s ‘heavenly length’ without the frequent breaks they are accustomed to in pop music concerts. Those resemble sports events more than the original concert invented in the 19th century. “Why can’t we talk to friends? Get a beer?” Maybe the reason pop music concerts are so ear-shatteringly loud is to keep the attention of the fans.

As for the claim that they have evolved a new ability to ‘multitask,’ Dan Levitin in The Organized Mind says that multitasking is a very good way to sabotage productivity, efficiency and accuracy.

December 31, 2015

Preoccupations

According to John Eliot Gardiner in Bach: Music in the Castle of Heaven the "future preoccupations" of the young (~21 years of age) JS Bach and GF Handel, both members of the "Class of '85" (born, in Germany in 1685), were:


Bach: life, death, God and eternity



Handel: love, fury, loyalty and power  



I thought about my preoccupations at that age. Definitely life and love. Probably wisdom as wellNot power, fury, God, death or eternity.






December 10, 2015

Is Music the Ultimate Placebo?

by Carl Ellenberger, MD


What theory explains why homo sapiens, almost alone among species (excepting a few exotic birds on YouTube), have made music since the ‘origin’ of their species?

That is a common question and subject of books, periodically pondered and researched without definitive results. One intuitive answer is that music confers a selective (evolutionary) advantage onto those humans who make it or listen. Exactly what that advantage may be remains elusive. A few possibilities include:

1. Music is sexy and promotes procreation. Someone who can sing and dance might be a more attractive mate and produce more offspring.

2. Music enhances social cohesion that increases survival. A part of that is nurturing of infants and children. Lullabies may help motherly love keep infants alive.

3. Music can be learned easily by the young developing brain, as can all languages, before the brain can handle more complex tasks, like philosophy and physics. It exercises the brain early (in 'pre-school') to develop certain abilities and skills when it is most receptive (plastic), gaining capacities that peers, coming later to education, may never acquire. "Perfect pitch" is a trivial example. (A corollary: so deeply hardwired into the brain these abilities remain through life and are the last to succumb to degenerative processes like Alzheimer's so they can be excavated and exploited in therapy.)

4. Music generates a true and salutary placebo response in the brain.
“Placebos are drugs, devices or other treatments that are physically and pharmacologically inert. Placebo interventions do not, by definition, have any direct therapeutic effects on the body. However, all treatments are delivered in a context that includes social and physical cues, verbal suggestions and treatment history. This context is actively interpreted by the brain can elicit expectations, memories and emotions….” * (my emphases)
Studies reliably show a success rate of around 30%, or higher, if the therapist is caring and convincing (the "context"). The context of acupuncture, for example, includes ritual, tradition ('proven over centuries'), positive expectations, value (it's not cheap), and perceived competence of a skilled practitioner exhaustively trained in an ‘ancient art.’ The needles don’t even have to puncture, just prick, so long as the patient experiences the context.

The placebo response is not a product of trickery or deception; it accompanies actual physiological/chemical changes in the brain, such as production of endorphins and dopamine, and changes in blood flow and connectivity, similar to changes evoked by other means like talk therapy, medications, and indeed, music. Wounds aren't healed, causes aren't eliminated and the effects are usually temporary, but patients come away feeling better -- as I do on the descending escalator in Disney Hall or walking home from the Gretna Playhouse after concerts.

The idea that music may generate something like a placebo response came to me as I read John Eliot Gardiner’s magnificent, Bach: Music in the Castle of Heaven. Monteverdi wrote L’Orfeo in 1607 during a time when “the emotional life of human beings was becoming a topic of the utmost fascination – with philosophers and playwrights trying to define the role of passions in human destiny, and with painters as varied as Velázquez, Caravaggio and Rembrandt all intent on portraying the inner life of men and women . . . . Monteverdi made the decisive creative leap – from a pastoral play, intended to be sung and not spoken throughout, to a musical-drama with emotions generated and intensified by music . . . ." (my emphasis)


This idea, however, may not support, at least in the views of some,** the theory that music indeed gives humans a selective adaptive advantage. We would probably be much the same humans without it, but it does give to life comfort and pleasure as does making and viewing art, burning fossil fuels, wearing fine clothes, and drinking a fine wine, all longstanding drives, not likely to disappear.

5. I should also mention another theory that musical sounds were homo sapiens' first language, carried over from pre-human ancestors, common to us and to those who now play in Bernie Krause's The Great Animal Orchestra. Providing better communication, spoken language prevailed many millennia ago and music, outmoded, became an unnecessary skill (or "frill") among humans, "auditory cheesecake," according to psychologist, Steven Pinker. I always wonder whether some of the sounds I hear coming from my grandson's earbuds are examples of the final throes of musics' extinction.


December 4, 2015

Flutes and Stethoscopes

by Carl Ellenberger, MD

Even as a physician and flutist, I was unaware of the same duality in the career of the young French doctor, René Laennec, inventor of the stethoscope.
In 1816, I was consulted by a young woman labouring under general symptoms of diseased heart, and in whose case percussion and the application of the hand were of little avail on account of the great degree of fatness. 
Such "percussion and the application of the hand," augmented by placing the ear directly on the chest, were used by Laennec's contemporaries to examine the heart. The fact that Laennec played the flute might account for the novel way he solved his problem.
I rolled a quire of paper into a kind of cylinder and applied one end of it to the region of the heart and the other to my ear, and was not a little surprised and pleased, to find that I could thereby perceive the action of the heart in a manner much more clear and distinct than I had ever been able to do by the immediate application of the ear.
Eventually, he constructed other instruments out of various materials and called the technique, "mediate auscultation."
The most dense bodies do not, as might have been expected from analogy, furnish the best materials for these instruments.... Bodies of a moderate density, such as paper, the lighter kinds of wood, or Indian cane, are those which I always found preferable to others. A greater diameter renders its exact application to certain parts of the chest, impracticable; greater length renders its retention in exact apposition more difficult, and when shorter, it...frequently obliges [the doctor] to assume an inconvenient posture.... 
Flutes in Laennec's time were almost all made of wood. One might wonder whether Laennec as a flutist was especially able to evaluate sounds made by flow, of air through the flute and of blood through the heart. Laennec named his instrument, “stethoscope” (from the Greek stethos, chest or heart, and skopos, observer). Here is his drawing:


and an early model

and an early flute



Further reading: Edelman and Weber, Tenuous Tether, The New England Journal of Medicine, 373:2199, 2015. The authors lament the displacement of the stethoscope by modern techniques, like ultrasound, where the "mediate" part of the auscultation is a technician with a machine between the doctor and the patient. 

December 3, 2015

Musical Lives of Cells

Speaking of MacArthur ("genius") fellows, as I did in the Fall Newsletter -- we have had five on our stage, I came across a comment by a recent one, Dr. Lorenz Studer, Professor of Neuroscience at Weill-Corner Medical School and founding director of the Center for Stem Cell Biology at Memorial Sloan Kettering Cancer Center. He spoke about the process through which a stem cell becomes a nerve cell.

Normally, as a cell begins its journey from a fertilized egg to a young nerve cell -- that takes about eight weeks-- it is exposed to a number of molecular signaling pathways that essentially nudge the cell toward becoming a brain cell and not, for instance, a liver cell.
"A cell has to make a set of decisions to ultimately end up at a very specific fate. I compare it with playing a music piece. You can play jazz and get the liver [cell], or you can play classical and get something else. By now we can do that for about 40 cell types, and nearly all the time we can go from the stem cell to the young neural cell, then to a specialized subtype of nerve cell."
Of course, he doesn't actually expose developing cells to music, but the musical metaphor helps illustrate the complex process of cell development and how we can influence it. The metaphor can achieve reality during whole brain development in childhood when the brain cells are deciding how to fit in and what to do in their new universe inside your skull.

November 12, 2015

Orchestral Distress

Carl Ellenberger, MD

I suppose it is necessary to ask questions, as Peter Dobrin does,in this time of empty seats and unbalanced budgets. I had thought an orchestra's purpose was just to play music, but that was in an earlier time of sold-out subscriptions. Dobrin asks, "What is the job of this orchestra in this city in this day and age?" [re Philadelphia] His answer in part: "I'd get all the input I could and hold a public forum on the question...more money to program and market properly...." The orchestra awaits a consultant's report.

Dobrin sees the cause of the problem as “undercapitalization.” That prevents the orchestra from expanding and improving activities necessary to generate more revenue (and in Philadelphia from honoring salary commitments), a vicious cycle. This condition affects more than a few other orchestras and musical organizations (not including Gretna Music). 


It seems reasonable to link that condition to a general diminished interest in classical music among our society. Sure, there is enough violence and misery in the world to distract any sensible person these days, but I don't see many empty seats in the stands for the Fall sports lineup (based on what I see as I pass by ESPN on the cable dial and one actual physical presence at a Virginia Tech football game last month--with >60,000 others). 


Attempts to treat the problem that tend to be short term, focused on the music and its players, and often called "thinking out of the box," have brought limited success:

1) Changing the music to appeal to a broader audience. Most 'crossover' and 'pops' concerts are unfortunate examples of a quest for 'relevance' and 'accessibility.'

2) Changing the concert: shorter duration, less intimidating ritual and formality, 
better 'communication' 


3) Taking concerts to more venues, conventional and unconventional.
4) Seeking a 'new image' by 'creative marketing'
5) Going digital: streaming and filming 
6) Avoiding the word, "classical"
Despite these efforts the recent words of conductor Jed Gaylin remain, in general, true: 
"We need to figure out ways for the potency of great music to reach audiences that admittedly bond, socialize, recreate, and rejuvenate with technologies unforeseen in the era when the symphony orchestra was born." 2
When I see our musicians connect that "potency" with literally every member of our audience again and again each season, my first thought is always, "Why aren't more people here seeking this same amazing spiritual connection?" Tickets are affordable, walk-ups welcome, pre-requisites not necessary. Some people I'm talking about are sitting on porches just a few houses away -- in a Chautauqua!!!

I would argue that classical music and concerts are very healthy (and 'relevant'), in large part because increasing numbers of children all over the world manage to discover they want to play. The current abundance of good musicians, and resulting stiff competition, is why orchestras, and smaller ensembles, have been improving for decades, at least over my lifetime. 


I can only conclude that changes in the "wider cultural environment which surrounds classical music" 3 have not increased the number of listeners, and patrons, apace with the number of players. 


David J. Skorton, MD, cardiologist, and new Secretary of the Smithsonian, dug up what I think is one root of the problem: "As long as we consider the arts as a frill and as intrinsically less important than learning to code a computer, we're going to systematically disinvest. In school, when something's gotta go, it's art and music." (WSJ, Oct 24)  In contrast, investment in sports -- in schools and beyond -- seems to be increasing as we continue becoming a "shouting culture."4 


As in good medical practice, it's important to explore causes, including the environmental ones, before prescribing treatment. I buy tickets for the Cleveland Orchestra when I am East and LA Phil when West because I think they're worth $89 and $127 respectively. I don't similarly value mid-range seats for the Cleveland Browns ($269), but obviously not enough people's values align with mine. 


Why do I value an orchestra? The answer, I think, goes way back. My earliest memories include my mother playing the piano and my father blowing his old trumpet, both instruments untouched since their school years. Now it's clear; they resurrected those skills just for my (and my sister's) benefit! Neither played well but how was I to know? They also played records; my mother liked Somewhere Over the Rainbow, my father loved Schubert. Absent similar parental guidance you might find 3rd graders today blasting JZ's Big Pimpin out of their ear buds. Adult participation is clearly desireable.5


When I was in the third grade, after-school home piano lessons interrupted my play, but I learned, in 15 minutes of gently encouraged daily practice, how to make notes printed on pages into tunes, rhythm, and harmony, my first second language, easy to learn at age 8. After that math and Latin classes came easier. 


Using my new language skills, I could solo with the plastic 'flutophone' band by the end of the 4th grade. When I finally picked up a real flute, reading and figuring came easy and I enjoyed being excused from class to play in the small orchestra. In succeeding years the school bands were even more fun (except the marching part). The gentle parental encouragement became pride and admiration.


Sensitive developmental periods for the brain to acquire skills, like sensorimotor musical skills and aesthetic taste, come and go before age 9 or 10 (March 5, 2013). We have to learn certain skills while we can. If kids participate only in sports during those years, their future may take them in different directions, eventually to stadiums rather than concert halls. Though only a handful of my friends continued playing instruments after high school (more than continued football), enough of them learned to value the cost of symphony tickets and support their symphony. And sing in church.


My parents got as much of a thrill hearing me in school orchestras as other parents get from seeing their sons 'suit up' for the team. There is a risk, of course, that adults hearing only an average school ensemble will decide they don't like 'classical' because they have never heard it played well. But some parents clearly do get inspired; there are few performances more exciting than a really good orchestra of kids who amaze you by how well they play The Firebird.


Summer music camp at Interlochen brought me the confidence that I could compete successfully with good players and learn a large slice of the repertoire sealed my fate as a musician and lover of music.


In medical science single case studies like mine don't prove much but can be educational. I think my example may help explain why at least some of the symphony audience are in their seats, and suggest that the decline of music in schools is one reason for their dwindling numbers.


Imagine the impact of a good orchestral brass quintet or string quartet visiting a third grade classroom! Maybe not on all kids, but enough of them. Dobrin too advises the Philadelphians to conceive of 
"programs that reach every public school student, regularly, in a serious way."

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1. Peter Dobrin: The Philadelphia Orchestra needs to rethink its future

2. Jed Gaylin: Being Relevant -- Who Cares?

3. Philip Clark: What’s wrong with the classical concert experience in the 21st century?
. . . And perhaps it’s the wider cultural environment which surrounds classical music that has a problem.

In a culture increasingly obsessed with ephemeral celebrity, fed by a spin drier of rehashed PR trivia presented as ‘news’, where sport is the new religion, where Saturday night fluff like Strictly Come Dancing is analysed seriously and given acres of press coverage, then a cultural landscape invested in supporting all that activity damn well ought to have a problem with classical music – with its difficultly, with its emotional ambiguity, with its allusiveness, with its celebration of individuality, with its refusal to conform, with its ability to move our emotions beyond something that can be controlled and manipulated into turning a profit.

. . . the real reasons that students quit is often beyond their own understanding.  It is up to teachers and parents to create “magical moments” during the year for students to want to continue on their instrument, especially during the early years of study, in order for the child to be successful and stay with their craft.