Preoccupations

by Carl Ellenberger

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 well. Not power, fury, God, death or eternity.

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.

* Wager and Atlas, The neuroscience of placebo effects.
** Patel, Music, Language, and the Brain
More about placebos
Even more

a taste of L’Orfeo

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. 

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.