When the Music Came Back
Author:
Michael Gordon, MD, MSc
Citation:
Gordon M. When the music came back. Consultant. 2017;57(8):481-482.
It is always difficult for physicians to write about their own illnesses, because in some ways it exposes them to open scrutiny by other physicians and, most difficult, colleagues. On the other hand, exposing one’s experience with illness from the perspective of a physician may be helpful to medical colleagues and to the public. For example, Oliver Sacks, MD, was one of the more renowned physician writers who chronicled his own eventually fatal illness. Dr Sacks was famous for his writings long before he was stricken with the terminal phase of a malignancy that he thought he had successfully conquered years before.
Personal Perspective
I have been an internist and a geriatrician for more than 40 years, having received the first certificate in geriatrics in Canada in 1986. Like most people, I have had the range of mostly intercurrent illnesses and a few that are now called chronic diseases, such as glucose intolerance (not yet diabetes), degenerative disk disease, and benign prostatic hyperplasia. During my medical school days in Scotland, I had my first episode of what, looking back, was probably a mild depressive or dysthymic episode, which was not treated with medications (amitriptyline had just been released). Over the course of a few months, which had included a trip to Poland, the darkness and heaviness of spirit that I had been experiencing gradually lifted—but it took some time.
Over the following 30 years, I had a number of episodes of similar symptoms, and with the help of a psychiatrist, we either talked them through, or I was given a relatively short course (by today’s standards) of antidepressants—one of the early selective serotonin-reuptake inhibitors (SSRIs), which have gradually replaced the use of tricyclic antidepressants in most physicians’ practice. In each instance, I eventually responded to the medication; after a few months, the symptoms abated and the drug was stopped, and I returned to my “normal”—which had always tended to be cyclothymic.
Over the past couple of years, I have lived with a diagnosis of multiple myeloma, compounded with the effects of light chain deposition disease, resulting in cardiac and renal amyloidosis, which has left me considerably exercise-intolerant. Fortunately, other than a mild nephrotic syndrome, my renal function has remained within the normal range. The treatment regimen has been quite rigorous for 9 months—in addition to the chemotherapeutic agents, I was receiving hefty doses of corticosteroids, which really played havoc with my weight and mood. During the past 9 months, the regimen has become less rigorous, and the dose of corticosteroids has been substantially reduced.
I have been seeing a psychiatrist for many years to help me through many of my challenges at work, as I assumed very challenging but mostly rewarding administrative roles. Other than 2 relatively short courses of SSRIs during this period, most of the therapeutic intervention has been talk therapy and attempts at meditation and other such treatments, which offered some benefit—although I found it difficult at times to carry through with them.
I then seemed to enter a period of feeling much more depressed than usual—with periods of feeling quite despondent—with a focus on my illness and the need to plan for my family with legal and financial issues. I became very anxious over almost every major decision of the type in my “just do it,” quasi type-A personality that I previously would “just do.” My sleep was disturbed partially due to nocturia but mostly due to anxiety. I finally revealed the degree of my symptoms to my psychiatrist, told her I did not think the usual talk and meditation would do, and requested that I be given antidepressants. It was determined that, in addition to mood disturbances, I had an abundance of vegetative symptoms, including a muted enjoyment of music, which in general is one of the great joys of my life.
I was started on the medication and, as often predicted, I was plagued initially with a collection of adverse effects, which although annoying were tolerable, and I knew that if I could hang in there, these effects would likely pass and after a couple of weeks the potential beneficial effects might occur. Gradually, the adverse effects abated, and I began to feel less black, and my mood and my sleep improved despite the nocturia.
After 5 weeks, when my mood was for sure improving, I noticed something while driving and listening to my favorite classical music program, which during the previous months had not brought me much enjoyment. I realized that the music was sounding more vibrant, as if a muffler had been removed from the speakers, and I found myself moving to the music and even humming to it.
Figure. The author’s 2 Abyssinian cats apparently enjoying his wife’s piano playing.
On Listening to Music
Prior to this recognition of improvement, I found that even when listening to my favorite pieces of music, those associated with critical experiences in my life, I did not even get the associative thrill or mood elevation that I would normally have experienced.
My family knows that my favorite of all classical piano concertos is Rachmaninoff’s Piano Concerto No. 2, which I associate with my late engineer father hooking up a 45-rpm record player to an old console radio so that the player was broadcast through the speakers. That was my first experience with something other than the old 78-rpm records, and the fact that it was 5 red-colored vinyl records embedded that concerto played by Arthur Rubinstein in my brain and soul.
A second piece that no longer gave me the usual associative pleasure was Brahms’s Piano Concerto No. 2, which was associated with a case of personal unrequited love while finishing my first year of medical training in Aberdeen with a Norwegian medical student whom I met on the ferry going from the United Kingdom to Norway for a holiday ski trip. Our time together was often spent lying in front of a coal fire, listening to the recording, and hugging but not engaging in any physical sexual encounter; she was mourning the death of a lover a number of months earlier and said she could not engage at the time—or, as it turned out, at any time.
There were a number of other such associations, such as my first time hearing a broadcast of Van Cliburn’s performance when he won the Tchaikovsky music competition prize in Moscow, which I heard late at night over the radio from WQXR, the New York City radio station, when I as 17 years old.
I found that even these pieces did not move me or capture me as they normally would—and then the muffs came off, and the music came alive again. I realized that for me, it was a critical step and was evidence that my brain is hard-wired for music. There is, in fact, a growing body of neurophysiologic evidence demonstrating that the response to music of the human brain and perhaps of other mammals (those who have pets may know that many of them respond to music).1 Work done with the functional magnetic resonance imaging and positron emission tomography scanners has been able to show that a release of neurochemicals associated with pleasure can occur in the human brain when music is heard.2,3
The Science Behind the Observations
The science behind the observed benefits of music in the therapy of affective disorders is not as robust as the clinical observations,2,3 but there is a growing body of scientific evidence to support the biologic importance of music in the structure and function of the human brain.4,5 In the field of dementia, there is a better correlation between observed clinical benefits and the scientific studies that appear to support those clinical observations. These scientific observations have been implemented therapeutically in the use of personalized music to help those living with dementia reconnect to the world and to their pleasurable memories.
The now famous documentary film, Alive Inside: A Story of Music and Memory, has been transformed into major programs to help revitalize those living with dementia and other conditions.6 The medications that are most often used to treat depression, as was the case in my own experience, work through the serotonin system, one of the neurotransmitters that is released during pleasurable experiences and that seems to become deficient during periods of clinical depression. Understanding and appreciating the place of music in the human brain helps us to understand our own human history and the place of music within it, irrespective of cultural or other human groupings.7
For me (and I expect, for other patients experiencing depression), it might be worth it for therapists to ask questions specifically about responsiveness to music and use the transformation to enjoyment when it has been lost as one measure of successful treatment with an antidepressant. When it occurs, it is truly a blessing.
Michael Gordon, MD, MSc, is a geriatrician at Baycrest Health Science Centre and a professor of medicine in the Division of Geriatric Medicine at the University of Toronto in Ontario, Canada.
REFERENCES:
- Becker K. Species-appropriate music for your pet. Healthy Pets website. http://healthypets.mercola.com/sites/healthypets/archive/2012/06/08/music-for-pets.aspx. Published June 8, 2012. Accessed June 20, 2017.
- Maratos A, Crawford MJ, Procter S. Music therapy for depression: it seems to work, but how? Br J Psychiatry. 2011;199(2):92-93.
- Zhao K, Bai ZG, Bo A, Chi I. A systematic review and meta-analysis of music therapy for the older adults with depression. Int J Geriatr Psychiatry. 2016;31(11):1188-1198.
- Zatorre RJ, Salimpoor VN. Why music makes our brain sing. New York Times. June 9, 2013:SR12. http://www.nytimes.com/2013/06/09/opinion/sunday/why-music-makes-our-brain-sing.html. Accessed June 20, 2017.
- Zatorre RJ, Salimpoor VN. From perception to pleasure: music and its neural substrates. Proc Natl Acad Sci U S A. 2013;110(suppl 2):10430-10437.
- Alive Inside. http://www.aliveinside.us. Accessed June 20, 2017.
- Levitin DJ. This Is Your Brain on Music: The Science of a Human Obsession. New York, NY: Penguin Group; 2006.