Music vs. Alzheimer

by Carl Ellenberger, MD

"I hope (with no evidence) that playing the flute (actually practicing hard and thoughtfully) every day improves my physical and mental health and may delay (for how long?) Alzheimer's or vascular disasters." (CAN MUSIC HEAL? July 6)

That hope made sense to me in several ways partly because music is a language and multilingualism has been found in studies to delay Alzheimer's Disease.

My hope is also supported by a study I just stumbled upon by psychologists at the University of Toronto. After testing middle to older-age adults, they concluded:

Musicians outperformed non-musicians on [several transfer tasks] and on a composite measure of cognitive control. The results suggest that sustained music training or involvement is associated with improved . . . cognitive functioning in older adults.

("Transfer" means the transfer of skills learned in one task, like playing the flute, to others like, say, building a birdhouse, though they didn't test those particular tasks.)  

The article is understandable by anyone without specialized training. It reviews evidence supporting other benefits of playing music at all ages. It is a good example of what I said (July 6) about the difference between hopes, aims, claims, programs, unequivocal beliefs, ultimate goals, and evidence-based science--when you talk about the reasons for playing and listening to music. 

It isn't, however, the 'final answer' to any question, just one small piece that needs to be confirmed in the mosaic of understanding music in the brain, which is one only aspect of brain function. It points in the direction of more experiments.

Even more accessible to the general reader is Secrets of the Creative Brain by Nancy Andreasen in The Atlantic (July/August). In a wonderful article she mentions a 2007 study that found that orchestral musicians have a more active Broca's area of neocortex, one of the areas associated with language. Creative people more likely have mood disorders and families with schizophrenia.

Welcome to our 2014 Festival of Russian Music, Pt. II

(to Follow Pt. I, June 29)


The first great Russian composer to import native Russian music traditions into the realm of secular classical music was Mikhail Glinka (1804–1857), who composed the early Russian language operas A Life for the Tsar and Ruslan and Ludmila (listen to Anna Netrebko’s 1995 recording of that opera.) They were neither the first operas in the Russian language nor the first by a Russian, but they gained fame for relying on distinctively Russian tunes and themes and the vernacular.

Russian folk music became the primary source for the next generation composers. A group that was inadvertently named by a journalist and called itself "The Mighty Little Band" (moguchaya kuchka) of talented musical mavericks and autodidacts, headed by Balakirev and including Rimsky-Korsakov, Mussorgsky (July 6), Borodin and César Cui, proclaimed its purpose to compose and popularize Russian national traditions in classical music. Glinka and the kuchka (A.K.A. "Mighty Five") based their works on Russian history, folk tales and literature and they are now regarded as masterpieces of romantic nationalism in music. Tchaikovsky (July 6 and 20 Aug 9,) was the first Russian composer to rise beyond nationalism and gain international fame, benefitting from the French ballet industry seeking patronage in Russia as its support dwindled in France. He participated in the inaugural concert of Carnegie Hall in 1891.

The lives and works of twentieth-century Russian composers, in particular Stravinsky (Aug 9 and 31), Rachmaninov (Aug 3, Sept 7), Prokofiev (July 6 and 20), and Shostakovich (Aug 9), all intersected the World Wars, the 1917 Russian Revolution and the rise of the Soviet Union. They and others were strongly influenced by these collisions.

Stravinsky found refuge in Paris early enough escape persecution and to benefit from collaboration with the celebrated (Russian émigré) dance impresario Serge Diaghilev. He burst onto the world stage at age 28 with three ballets between 1910 in 1913 including Le Sacre du Printemps that caused a riot. He later emigrated to New York.

Emigrating on an open sled with his family to Helsinki in 1917 at age 44 Rachmaninoff also escaped persecution and wars and embarked on a busy career in the US managed by a concert agent as pianist and conductor. His burden was the feeling, shared by others, that he left his inspiration behind, in Russia and also in the 19th century. He wrote Vespers (All-night Vigil) in Petrograd in 1915 (to be performed Sept 7).

Prokofiev and Shostakovich became literally prisoners of Joseph Stalin. Lured back from the US to Russia in 1936 (the year he wrote Peter and the Wolf) hoping to rescue a faltering career, Prokofiev was largely disappointed—and then the exit doors closed. Unhappy, he left his wife Lina for a student, and shortly afterwards Lina was imprisoned for 8 years in the gulag. Prokofiev died in 1953, literally unnoticed because Stalin also died that day and Russians flocked into the streets for days of ceremonies and parades. After her release Lina spent the rest of her life, 33 years, as her former husband’s cultural ambassador.

In 1936 after walking out of a command performance Stalin threatened Shostakovich’s life in a ‘review’ in Pravda. The opera, Lady MacBeth of the Mtsensk District, like the musical plays of the skomorokhi, threatened the dictator (a “formalistic” work that justifies murder of a tyrant: “a muddle instead of music”). The threat could not escape notice of all Soviet composers and some sided with the regime. Shostakovich withdrew his Fourth Symphony--a musical prediction of the horrors to come -- and offered the (apparently) less ‘formalistic’ Fifth Symphony, “a composer’s response to justified criticism.” Oblivious to the irony in the subtitle and the ‘forced rejoicing’ in the music, a cheering audience gave a 30-minute standing ovation at the premiere. The Fifth may have saved the composer’s life (but not the lives of some of his family and friends). Thereafter arose the tendency to look for hidden messages in Soviet art and especially in Shostakovich’s music.

After WW II The Soviet Ministry of Culture convened in 1946-8 an extraordinary series of conferences at which charges were brought against deviant artists in literature, film and music. All were charged with “formalism,” writing works that were “against the people,” a code for elite modernism, something that the doctrine of socialist realism expressly forbade (as Aaron Copland was persuaded to tone down the end of his ‘modernistic’ Third Symphony on the US side of the cold war). Shostakovich’s works were banned, he was fired from the Moscow Conservatory, and that is when he wrote the “antiformalistic rayok,” to the tune of Stalin’s favorite song, Suliko, satirizing the regime and echoing the medieval skomorkhi. Conscripted to write music for Stalin’s self-congratulatory films Shostakovich felt that assignment may have actually prolonged his life, at least until Stalin died. After the dictator’s death the Fourth Symphony premiered in 1961.

On a rare visit to the West in 1958, according to Isaiah Berlin, “Shostakovich looked like a man who had passed most of his life in some dark forbidding place under supervision of jailers…his face would assume a haunted, even persecuted expression and he would fall into a terrified silence.” The humor of the student concerto we will hear on August 9 eventually turned more dark and sarcastic. He was clearly affected by the horror of repression during the war and the Soviet era and most compositions reflect that. Shortly after he was diagnosed with ALS he dedicated his String Quartet No 8 in 1960 "to the victims of fascism and war." His son, Maxim, interprets this as a reference to the victims of all totalitarianism, while his daughter Galina says that he dedicated it to himself and that the published dedication was imposed by the Russian authorities. Shostakovich's friend, Lev Lebedinsky, said that Shostakovich thought of the work as his epitaph and that he planned to commit suicide around this time. We remember the bird in the rafters of the Playhouse that, contrary to the score, continued singing after the final quiet cello solo ended.

The death of Stalin brought a liberalizing trend--freedom from the “accessibility,” “transparency,” and affirmative public statements demanded by the Soviets. Students were no longer expelled from the Moscow Conservatory for possessing scores of Stravinsky and Schoenberg, and Soviet musicians came into previously risky and forbidden contact with the music of the European avant-garde, Pierre Boulez, for example. Twelve-tone music began to flourish.

But in the 1970’s Alfred Schnittke abandoned serial technique in favor of eclecticism that he called “polystylistics.” His works, clearly those of a resentful marginalized artist, were still prohibited by the regime until the glasnost’ of Mikhail Gorbachev. Then all hell broke loose with 22 concertos, many for an outstanding generation of late-Soviet soloists, abandoning any limits. (Schnittke “undressd in public,” one critic said). His music contains “plush romantic lyricism, chants and chorales and hymns (real or made up), actual or invented ‘historical’ flotsam (neoclassic, neobaroque, even neomedieval), and every make and model of jazz and pop” and “tackled life-against-death, love-against-hate, good-against-evil, freedom-against-tyranny, and I-against-the-world” (Taruskin) much as Shostakovich had tackled evil-against-good.

Schnittke began to command Shostakovich’s immense following. By the time the cold war ended in Europe (with the fall of the Berlin Wall in 1989, followed by the dissolution of the Soviet Union in 1991) not only Schnittke, but practically his whole generation of Soviet composers--including Sofia Gubaidulina (Aug 31)-- were living abroad...the result of a mass migration or “brain drain” that paralleled the one that attended the beginning of Soviet power in 1917. Of actual “Tatar” or Mongolian descent Gubaidulina’s predilection for religious subject matter has been considered a mark of political dissidence in the waning years of Soviet authority that deemed her music “irresponsible.” Shostakovich encouraged her to continue down her “mistaken path.”

It is always fascinating for me to ponder how the lives of artists affected their work. That is an easier, but frequently a very sad task, when it is about Russians. 

Our Russian Festival continues next Sunday, July 20, at Ware Center in Lancaster at 7:30. Pianist Claire Huangci will play ballet scenes from Prokofiev's Cinderella and Tchaikovsky's Sleeping Beauty. You can use all the same tickets there you usually bring to the Playhouse. Buy more here.
Спасибо за прибытие,
Карл Элленберджер

CAN MUSIC HEAL?

Byron Janis is a magnificent pianist. I admire his recordings and treasure my old vinyl disk of his Strauss Burleske with Reiner and the Chicago Symphony. So I was intrigued when a board member asked me as Gretna Music's "resident" (not "renowned") neurologist to comment on Janis' "A Healing Art" in the WSJ (May 8). 

Almost immediately popping into the cloud above my head was an image of a pot of chicken soup, still considered ‘therapeutic’ for just about any ailment. Indeed, sometimes it is -- when you need hydration, nutrients, electrolytes, warmth, loving care from friends and relatives. 

Janis’ pot contains a variety of good stuff: broad generalizations, aims, and assertions like, “the ancients’ drums, rattles and digeridoos--had huge diagnostic and healing properties,” or music “enhances the brain’s ability to facilitate healing,” or “music is believed to recruit uninjured parts of the brain to compensate for parts that have been injured, and help those parts that are injured recover.” 

And Janis throws into his pot anecdotes like “music brought back all the joys the house had known,” or “slowly brought back her ability to speak,” and “many told me how much music had helped their recovery,” or “patients went from being catatonic to fully functional.”

Janis describes a program at Walter Reed National Military Medical Center where, according to the hospital, "working with actual instruments, patients learn, play, compose and record music." The program "aims to enhance the healing process . . . enrich the lives of patients, visitors and staff and help relieve the stress often associated with a hospital setting." Novel idea. Good aims. Maybe we could (hoho) try it in schools?

'All of the above' are good intentions and maybe some will take off. I have no doubt that music can help some people sometimes feel better. Music can soothe or boost emotions. For many people it provides instant comforting familiarity. It can trigger memories and bring to mind forgotten words or verses. Like William Styron (Darkness Visible) I turn to music sometimes when I feel sad. And I hope (with no evidence) that playing (actually practicing hard and thoughtfully) my flute every day improves my physical and mental health and may delay (for how long?) Alzheimer's or vascular disasters. 

Some Parkinson patients can move or walk better to music. And we think that teaching music in early education is more effective for developing young brains than trying to teach statistics or philosophy to pre-kindergartners. And it seems self-evident that teaching children to play the violin in a small group is better education in the long term for some of them than busing the class to a symphony concert. I am all for having a piano, Yamaha or Steinway, in every home, all children learning music, and hope that we can eventually prove that music heals in many ways.

As he disclosed in the WSJ, Janis serves as Presidential Advisor for the Yamaha Music and Wellness Institute (YMWI). Associated, I presume, with Yamaha Corp, manufacturer of musical instruments, YMWI states its "ultimate goal is to enable individuals of all ages, regardless of prior experience, to discover the joy and personal benefits of playing a musical instrument" (for sale by Yamaha). YMWI president, the actual "renowned" neurologist referenced by Janis, Dr. Barry Bittman, has been among a group of authors who published a small amount of "peer-reviewed scientific research focusing on stress reduction from psychosocial to genomic levels utilizing novel creative music expression strategies."

But whether, and how, music may be therapeutic is a huge, complex, daunting challenge. What modes of therapy in what conditions? There are far more hopes, aims, claims, programs, "unequivocal" beliefs, "ultimate goals," articles like this--and apparently conflicting interests--than science bearing on the issue. 

Most medical and "alternative" therapies are used for decades before anyone thinks to test their effectiveness, many enriching the therapists more than the patients, at least after their hope wears off. In previous centuries people fervently believed in the efficacy of leeches, phlebotomy, tonsillectomy. These therapies are still used--but only in specific circumstances, not as universal cures, of everything for everyone. We need to learn the specifics of music therapy too. That's the "challenge" Julene Johnson refers to in a recent PBS Special Report. 

The field or Discipline of "Music Therapy," taught in universities, is "the evidence-based use of music in clinical situations that help people reach desired health outcomes." What actually happens too often is application of the term "music therapy" to any attempts, rarely "evidence-based" to improve lives using music. (Warning: What qualifies me with an ancient board certification in Neurology to pronounce judgment on the entire new discipline of Music Therapy that I know little about? Answer: Not much! But I know what "evidence-based" means.)

The questions must be specific, far more so than "Can Music Heal?" Scientists are working, each with a very narrow piece of the puzzle. Among dozens or hundreds of variables, you must isolate one (say starting piano lessons at age 5 vs. age 8), level all other variables, study large enough groups for valid statistics, and carefully measure the outcome. (Doing so they have found that the earlier age group developed larger corpus callosums in their brains. Note that is not evidence that proves a larger corpus callosum is a good thing or therapeutic, just that early experience can influence the structure of a developing brain.) 

Despite the fact we all think music is good -- err, what kind of music?  Schubert? Phil Dirt and the Dozers? Pit Bull? digeridoos?  -- its therapeutic potential is not self-evident and must be studied and proved in each instance. 

We don’t even know the relative contributions, to musicianship or appreciation, of nature vs. nurture. Are three generations of the Preucil family outstanding musicians because it is in their genes or because all were expected to start practicing at the age of 3 years? (Ans: It's likely that both are necessary, neither alone is sufficient. See * below.)

Yes, we need cheerleaders, like PBS reports, to engage more people and stimulate more research, programs, efforts, etc. All that should come---if the planet survives. 

I do think an easier armchair argument can be made that music (of most kinds) and early music education promote a better (and healthier) humanity than do some sports, especially American football, or the gratuitous violence in films.

* Wonderful example of good brain science anyone can understand.