The Art of Medicine

An excerpt from "The Art of Medicine: Thoughts on a G String" from The Lancet (2009):

There have been writings about the relation between
medicine and the listening aspects of music, but nothing
on the playing of music. Why do so many doctors pursue
music? Why does the orchestra of doctors in Boston (the
Longwood Symphony) receive audition inquiries on a
daily basis?

Mark Jude Tramo, a neurologist, songwriter/musician,
and director of The Institute for Music and Brain Science
at Harvard and Massachusetts General Hospital, feels that
“there is overlap between the emotional and social aspects
of relating to sick patients and communicating emotion to
others through music…Some would speculate that there is
[also] an overlap between aptitude for science, which most
premeds major in, and for music.”

Lisa Wong—violinist, paediatrician, and president of
the Longwood Symphony Orchestra—speaks for the
many who came to medicine after years dedicated to
serious musicanship. “The music we create builds in us
an emotional strength, sense of identity, and sense of
order. Then it is given away—we play for others, we play in
ensembles. We come to medicine and it is the same thing.
The giving, the service—in music and medicine—is a natural
connection.”

I was surprised to find my eyes watering after reading the article. Surprised to find myself laughing sighs. It struck me as a deeply personal grasp of my own motive for becoming a doctor, and I suppose an afirmation of it in some way other than my own head was more than just reassuring.

The musician touches others through music--a statement banal enough. What gets less noticed are transformations music brings upon the musician. Music is a beautiful gift, and all the more beautiful because it has helped me realize that medicine works the same way, and beyond. Music and medicine are about sharing something beautiful, about creating something extraordinary together—musician and listener, physician and patient. Musicians may craft an experience to bring their listeners adventure, escape, relief; Doctors may craft an experience to bring their patients life. Sometimes life seems so ordinary that we forget that it is extraordinary. Yet, life—is something more beautiful, far richer than any song could express. Medicine, music, and most things I suppose, are about touching others.

We're all mad here: Rachmaninoff and Hypnotherapy

Rachmaninoff fell into a deep depression after the disastrous debut of his First Symphony in 1897, and underwent hypnotherapy as a result. He reportedly produced his Piano Concerto No. 2 through the help of regular sessions. The composer himself stated: “… I heard the same hypnotic formula repeated day after day while I lay half asleep in an armchair in [Dr. Nikolai Dahl]’s study. ‘You will begin to write your concerto. … You will work with great facility. … The concerto will be of excellent quality.’ I felt that Dahl’s treatment had strengthened my nervous system to a miraculous degree. Out of gratitude I dedicated my Second Concerto to him.” (source: Philadelphia Orchestra)

I used to believe that hypnosis was in fact, not an altered state of consciousness, but one in which one finds one's own expectations and the expectations of others vastly altered, so that you believe in yourself. I saw it as a kind of extreme placebo effect. And, as a fervent believer in the power of belief (naturally), I was satisfied with that.

But, I'm beginning to believe in the wonders of hypnosis as going behind the mind, or perhaps more aptly stated, having physical influences (mind to body), as Rachmaninoff remarks, "strengthened my nervous system to a miraculous degree". All this is more compelling by the accepted use of self-hypnosis to allow women to undergo natural childbirth with minimal pain, as one example. I'm starting to wonder, where do we draw the line between mind and body? (Related post: Body and Soul)

Interestingly though, Rachmaninoff's statement reminds me of the power of religion, which is itself the power of belief manifested in a different form--"had strengthened me... to a miraculous degree...out of gratitude I dedicated my Second Concerto to him." I'm a bit of a skeptic of hypnosis and religion, yet I have a respectful sense of awe toward both.

Just a thought. Also another thought--Rach 2 is mad. It's so often associated with madness. In Rachmaninoff's case, it's a journey out of the madness of depression. For the case of the schizoaffect-ed pianist, David Helfgott, it's said to be the piece that brought "madness" upon him. It's mad in so many ways and we love it in so many ways.

Well, I guess for us musicians, scientists, skeptics--"We're all mad here."

Paul Bloom: The Origins of Pleasure

Another great TED talk.

Why do we like an original painting better than a forgery? Psychologist Paul Bloom argues that human beings are essentialists -- that our beliefs about the history of an object change how we experience it, not simply as an illusion, but as a deep feature of what pleasure (and pain) is.

Paul Bloom: The Origins of Pleasure


This video became a "rhyming event" for me today. I watched it just seconds before going to the home society where I've been playing piano for kids with developmental disabilities this summer. As I enter, I see that John, one of the kids, has a freshly-painted finger-painting sitting on his lap. It's of a heart. He says it's for me. That meant so much to me, and I though it was such a beautiful painting. Most people would probably look at it, see a blob of red and pink, and shrug.  But I'd rather have this painting than a Vermeer. So yes, it goes to show, the "history" of an object makes all the difference in our experience of it.

Paul Bloom brings up good points about our experience of music as well. The piece, 4'33 has been under scrutiny in relation to so many topics--how do we define music? how does the fact that Cage composed it change how we view the piece? I find it amusing that not only is 4'33 on iTunes, but you can enjoy it here on youtube performed by a full orchestra and a packed audience that gives it a standing ovation (and plenty of coughing between movements). The Joshua Bell "experiment" (in quotes because it wasn't really a controlled experiment) mentioned in the video has a slew of other factors involved as well, like the environment (I disagree with the video--the listeners in the noisy subway, busy with places to be, were not listening to the same Joshua Bell played in a perfectly acousted concert hall. "History" can't account for everything of course.

Once again, psychology has shown us the power of belief in shaping our experiences.

The mind is its own place,
and in itself
Can make a Heaven of Hell,
a Hell of Heaven

--John Milton

Desiderata: Does Expressive Writing Make You Happier?

Written by Max Ehrmann to his diary, c.1920

Desiderata

Go placidly amid the noise and haste, and remember what peace there may be in silence.

As far as possible, without surrender, be on good terms with all persons. Speak your truth quietly and clearly; and listen to others, even to the dull and the ignorant, they too have their story. Avoid loud and aggressive persons, they are vexations to the spirit.

If you compare yourself with others, you may become vain and bitter; for always there will be greater and lesser persons than yourself. Enjoy your achievements as well as your plans. Keep interested in your own career, however humble; it is a real possession in the changing fortunes of time.

Exercise caution in your business affairs, for the world is full of trickery. But let this not blind you to what virtue there is; many persons strive for high ideals, and everywhere life is full of heroism. Be yourself. Especially, do not feign affection. Neither be cynical about love, for in the face of all aridity and disenchantment it is perennial as the grass.

Take kindly to the counsel of the years, gracefully surrendering the things of youth. Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with imaginings. Many fears are born of fatigue and loneliness.

Beyond a wholesome discipline, be gentle with yourself. You are a child of the universe, no less than the trees and the stars; you have a right to be here. And whether or not it is clear to you, no doubt the universe is unfolding as it should.

Therefore be at peace with God, whatever you conceive Him to be, and whatever your labors and aspirations, in the noisy confusion of life, keep peace in your soul.

With all its sham, drudgery and broken dreams, it is still a beautiful world.

Be cheerful. Strive to be happy.

I had forgotten about this little piece of prose poetry until my little sister was assigned to memorize it for her gifted class. And I had a sudden flashback to my own eighth grade self memorizing this as well. I'm starting to realize how much that class has shaped who I am, as much as people may scoff and say, "We never learned anything in gifted."


Desiderata raises something of psychological interest: Max Ehrmann wrote this to his diary. Did that make him happier? Healthier? Pennebaker's expressive writing paradigm showed that people who engage in expressive writing report feeling happier and less negative than before writing. In the expressive writing paradigm, participants were asked to write about traumatic, stressful or emotional events for 15–20 minutes on 3–5 occasions. Those who did so generally had significantly better physical and psychological outcomes compared with those who wrote about neutral topics. 


The Pennebaker writing paradigm seems to suggest that the expression of emotion helps to cope with the emotion. However, the results seem to go against another study by Bonanno & Keltner (1997), in which the expression of emotion in facial expressions led to higher levels of grief. This supports the facial feedback hypothesis, somatic marker hypothesis, and James-Lange theory, which all say that the body greatly influences emotional experience. 
"Avoid loud and aggressive persons, they are vexations to the spirit."


Perhaps we can resolve the dilemma of "to express or not to express" in this way: express through the mind instead of letting the body dictate. Perhaps expression through writing distracts from one's physical expressions by focusing energy elsewhere. Perhaps crafting words allows you to look at your experience in a different light, perhaps see it as a lesson learned, or growing experience.


It might not work for everyone, but why not try?--write in a diary, write a poem, write a song. "Be cheerful. Strive to be happy."