Drew Jurecka and Rebekah WolksteinThere is a buzz in the air at Toronto’s Kensington Gardens seniors home, as a pair of virtuoso violinists tune up their instruments in the chapel. The residents are gathering in neat rows next door in the Multipurpose Room lit by blinding white fluorescent beams. Some shuffle in, bony hands clutching hefty walkers. Others, slumped forward in their wheelchairs, are pushed by staff. Near the front, a nervous senior wrings her hands and chuckles. “Oh my goodness. It’s so exciting to have the kids – it’s such a warm atmosphere,” she says. In the back, a man with translucent skin and a rich baritone voice is getting into the mood, snapping his fingers and crooning a love song to anyone who’ll listen.

Rebekah Wolkstein and Drew Jurecka stride in, introduce themselves, and plunge deep into Dvořák’s Humoresque. Jurecka half-closes his eyes as he taps the beat with his feet. Wolkstein wrinkles her forehead as she meshes her part with his. The violin bows whizz in perfect synchrony, connected by an invisible skein of sound.

Sparked by the players’ youthful vitality, the residents are jolted to attention. Some sit a bit straighter, a new glow in their gaze. Others start to sway. The nervous woman’s eyes are riveted on the artists, and she starts bobbing her head to their beat. A young girl wraps her arms around the waist of a loved one, and the two rock back and forth in tandem.

Wolkstein and Jurecka have performed at illustrious concert halls across Ontario and beyond: Toronto’s St. Lawrence Centre for the Arts, Ottawa’s National Arts Centre, London’s Aeolian Hall. But this afternoon, away from the red carpet, the plush seats and glitzy curtains, the duo is equally at home in this downtown Toronto long-term care residence. “I like these intimate concerts the most,” says Wolkstein. “When you look out, you can tell you’re bringing so much joy to these people who are really isolated.”

This is, in fact, their mission. Jurecka and Wolkstein have been sent here by the Concerts in Care (CIC) program run by the Health Arts Society of Ontario (HASO), who bring the thrill of high-quality concerts to seniors sequestered in longterm care (www.concertsincareontario.com). HASO selects classical and jazz musicians from the province’s elite arts organizations, including the Canadian Opera Company, the Toronto Symphony and Tafelmusik Baroque Orchestra. Supported by corporations such as Azrieli Foundation, BMO Financial Group, government agencies, private sponsors, and modest fees from the homes, the group has presented almost 1200 concerts for 61,500 seniors in Ottawa, Pembroke, Sudbury and the GTA.

Concerts in Care started more than a decade ago. It’s the brainchild of Canadian retired insurance executive David Lemon, who founded the Health Arts Society of British Columbia in 2006. Watching a close elderly friend wither away in a nursing home left a deep impression on the philanthropist. “She had a huge amount of time on her hands, with nothing to do,” says Lemon. As dementia robbed her ability to communicate, loved ones stopped visiting, and she languished in loneliness.

By the end of her life she was cooped up in a room without mementos, separated only by plastic curtains from three confused roommates whose cries woke her up at night. Lemon was devastated by these insults to her dignity. “We as a society are not doing a good job giving full respect to these people,” he says.

After her death, it gradually dawned on the lifelong music lover that he could make a dent in their despair. Drawing on his network of musicians as well as his own success running an insurance business, he hit on the notion of bringing top-notch concerts to seniors facilities. While these places had long hosted amateur entertainers, Lemon felt that residents deserved more. “It’s so wrong to think that’s good enough for our frail elders,” he says. “They’re entitled to the same quality as we are.”

Since the first Concerts in Care recital comforted clients at a rehab hospital in Vancouver, six more sister societies, each one autonomous but bound by the same values, have emerged across Canada. The Health Arts Society of Ontario (HASO), was established in 2011. Together these groups have regaled the elderly across most of Canada.

The shows provide more than just first-class entertainment for shut-ins. They also help to ease the pain of estrangement which pervades many seniors homes.  

“It can be very lonely even in a large institution,” says Health Arts Society of Ontario executive director Debra Chandler. While some gregarious seniors welcome the opportunity to befriend others in their building, many yearn for their old social life and have trouble adjusting to their new reality. Some will barricade themselves in their rooms, seeking comfort from a few familiar belongings. “Whatever facility they are in can feel like a prison,” says Chandler.

And there’s little to fill the vacuum left by these losses. “They might get a movie or a bingo game once a week if they’re lucky,” says Jeanne Lamon, artistic director of HASO. “There isn’t much to stimulate their minds.”

York University researcher Ami Rokach studies the problem of loneliness. The clinical psychologist says there are 1.4 million elderly Canadians who suffer significantly from the condition. “That’s a public health crisis.” The cumulative loss of loved ones with increasing age, as well as a decline in mobility can both lead to social isolation. Elders deposited in seniors facilities, rarely visited by relatives steeped in the “me first” Western culture, often feel abandoned.

Persistent loneliness can become toxic. “People begin to think they’re alone because they’re inferior and unlovable,” says Rokach. Patients who feel worthless often neglect their health, worsening any pre-existing medical problems. As well, the chronic stress of alienation wears down the mind and body, triggering depression, elevated blood pressure, lowered immunity, and even a shortened lifespan.

The live concerts at least partially redress the sting of rejection. “People at the top of their game are coming to play just for them – that means they care,” says Rokach.

Musicians are chosen for their kindness as well as their capability, says Lamon. Once a potential performer has aced the audition, Lamon usually attends their first concert and evaluates their capacity to relate to residents. “I look at how the musicians talk to the audience – I can sense whether they’re in their own world, or reaching out to them,” she says. Performers are expected to supplement the pieces with stories. A Tafelmusik ensemble, for instance, might provide historical context by describing the instruments used during the Renaissance. Players sometimes share personal anecdotes. On one occasion, a young man introduced Liszt’s Spanish Rhapsody by describing the Spanish woman who had taught him the dance steps in the piece. “This makes people feel like they know him a little bit – and turns the concert into a social experience,” says Chandler.

Wolkstein has a special kinship with seniors. After her grandfather moved to a nursing home following a series of strokes, she visited him regularly. Since he had trouble talking, they couldn’t communicate through language, so the violinist reached out to him through their shared medium of music. When she played familiar songs, he would start conducting with his good hand, often moved to tears, says Wolkstein. “It was the best way we had to connect to him.”

Wolkstein draws on this well of compassion to make her listeners feel welcome. “There’s this warm space we create for people to come out of their rooms and enjoy something together,” she says. While she sticks to the program during her formal recitals, Wolkstein sometimes invites personalized requests during her gigs with Concerts in Care. “That means so much to people when you can play the exact piece they want to hear,” she says.

Jurecka also makes an effort to bring the most vulnerable residents into the fold. Once after a concert at a hospice, he was asked to play at the bedside of a dying patient. The man’s family requested one of his favourite pieces, Amazing Grace. By the time the final notes soared to the ceiling, everyone was in tears. “Music reaches deep and evokes strong emotions,” says Jurecka.

It seems to be firing up today’s listeners. At times too much. One resident provides a running commentary throughout the show, steadfastly ignoring the embarrassed caregiver trying to shush her. The man with the beautiful baritone seems to think it’s an open mike day and spontaneously belts out A Nightingale Sang in Berkeley Square in perfect harmony with the instrumentalists.

The performers don’t mind when audience members crash the show. “We’re trained to deal with distractions,” says Wolkstein. Besides, their enthusiasm shows that they’re having fun. The singer knew all the words to the song and seemed to be stoked by his solo, says Wolkstein. “It’s wonderful that we can bring this gift to people who enjoy the music that we love,” she says.

Rebekah Wolkstein and Drew Jurecka performing at Kensington Gardens. Photo by Vivien FellegiWhile musicians have always recognized the therapeutic potential of pieces, research is finally validating these beliefs. Listening to our favourite tunes releases pleasurable chemicals, including dopamine and opioids, which elevate the mood and reduce stress, says neuroscientist Daniel Levitin, professor emeritus at McGill University, who details these effects in his book, This is Your Brain on Music.  Songs also keep us company. “If you’re depressed or feeling disconnected, it can be uplifting to listen to sad music and realize that you’re not alone – the composers have felt the same way,” says Levitin.

Live concerts are especially invigorating. In one recent study, Levitin showed that the brainwaves of people listening to the same music simultaneously began to coordinate with each other. He speculates that we secrete small amounts of oxytocin, the “cuddle hormone,” in these situations, stimulating a sense of trust and bonding.

Music’s ability to rekindle memories can also boost our spirits, says Levitin. Familiar tunes can evoke strong sentiments which transport us back to good times associated with these experiences. These soothing recollections can dispel some of the loneliness, he says.

Care staff have also witnessed the transformations wrought by tunes. “People leave the concerts in better spirits, smiling and dancing back to their rooms,” says Abiola Awosanya, programs manager at longterm care home Cedarvale Terrace. The music can take residents back to happier times when they attended shows with loved ones. The shared enjoyment also yokes audience members together, says Awosanya. “They look at each other, nod in agreement, and sometimes even reach out to hold hands.” Afterwards, some residents continue socializing, trading reminiscences sparked by the songs.

Chandler has heard similar testimonials from caregivers. At one Ottawa long-term care residence, a nurse began to cry after a musician performed for a client with dementia. “He’s been catatonic for years,” she told Chandler. “I’ve never heard him humming, but he’s humming today.”

At Kensington Gardens, the musicians wrap up the concert with a rousing, toe-tapping tango. The audience erupts into applause, one man shouting “Bravo, bravo” over and over. The duo bow and bid the crowd a wonderful afternoon.

It seems they’ve already made the residents’ day. The nervous lady seems calmer now, her hands still. “I think it’s amazing how good this is for people,” she says. Back in his room on the fifth floor, the man with the beautiful baritone is revelling in the afterglow of the limelight. “I’m old but I still have a good strong voice,” he says. “I held the show together.”

The musicians leave feeling satisfied that, for a short while at least, they’ve catalyzed a closeness amongst their listeners. “There are so many people who are lonely in Toronto – that’s why I love to put on concerts and see people come together and bridge those unseen divides,” says Wolkstein.

Vivien Fellegi is a former family physician now working as a freelance medical journalist.

Danielle Flax bannerDanielle Flax conducting. Credit Vivien FellegiOn a chilly fall Saturday at Toronto’s Tranzac Club, Recollectiv’s musicians with brain injuries and their care partners get ready for their regular hour-long sanctuary from stress. Caregivers find their charges’ name tags and seat them in a sunlit room decorated with instruments. As they catch up, their loved ones sit sedately. One man with a dazzling smile seems to invite conversation, but only speaks in monosyllables. A woman with orange hair stares into space.

Today’s conductor, Danielle Flax, welcomes the group and, with a flourish of her arms, leads off You are my Sunshine. The participants perk up. They sit straighter. Some sing along to the golden oldies. Others just bob their heads to the beat. The woman with orange hair flips through her music book, while the man with the smile croons a love song to his wife. Music blurs the boundaries amongst the crowd, and their voices soar in unison.

Recollectiv’s founder, singer and entertainer, Ilana Waldston, is pleased every time she witnesses the magic of melodies. “When I see the smiles, I know some kind of therapy is benefitting them,” she says. These joyous moments don’t come readily to those with meandering minds. But music retains its charm long after clients have forgotten how to read. “Maybe the memories aren’t there, but the feelings can still transport you back to better times,” says Waldston.

The choir welcomes caregivers along with their loved ones. Waldston recognized the need for this forum when her mother, Shimona, the woman with orange hair, withdrew into dementia. As Shimona’s interests narrowed, her daughter took her to the symphony which Shimona still enjoyed. But when Shimona began to sing along with the soloists, Waldston realized she had to find a safe place where they could both indulge their passion for performance.

In the summer of 2017, Waldston heard a radio show about The 5th Dementia, a California-based band for musicians with cognitive deficits and their companions, and decided to spearhead a similar ensemble in Toronto. Her goal was for members to enjoy a meaningful activity in a barrier-free space. “I wanted both participants and caregivers to feel whole again,” she says. Recollectiv – which combines “recollect” and “collective” – debuted in March 2018.

Wound up by music, Danielle Flax is a whirlwind of energy. She bounces from one foot to another as she conducts, and her frizzy ponytail swings in tandem. Though this is her first time filling in for the absent Waldston, the seasoned singer is in her element. But while the 34-year-old Flax makes it look easy, she’s had to fight for her accomplishments. Almost a decade ago, surgery for a brain tumor compromised her memory, making her forget words. Even worse was the erasure of milestone moments, which made her self-conscious when her friends reminisced. “I’m the downer because I’ll go ‘I can’t remember that,’” she says.

Flax turned to songs for solace. Though she struggled to speak, she could still belt out pieces which predated her malady. “That reduced my anxiety,” she says. Even better, music revived happier times. Hearing a lullaby her mother had once hummed would whisk her back to the security of childhood.

Music’s ability to channel the past can help soothe patients with dementia, says neurologic music therapist, researcher and University of Toronto assistant professor, Corene Hurt-Thaut. Because familiar tunes and musical genres evoke strong emotions, they can transport us back to events associated with those sentiments. A tune chanted by their father, for instance, can conjure up the safe haven of their school days and reduce their anxiety. “They start talking about these positive memories and their whole mood changes,” says Hurt-Thaut.

Music can rekindle memories not just for events, but also for lyrics, says Hurt-Thaut. Clients who have forgotten their children’s names can still spout the words to their favourite songs. That’s because these are stored in different, more resistant parts of the brain than spoken language.

This multiplicity of vocalization pathways can be harnessed for patients with trouble talking (aphasia), says music therapist and neuroscientist Concetta Tomaino, executive director and co-founder of New York’s Institute for Music and Neurologic Function. Though aphasia patients struggle with oral expression, they can still sing lyrics. While singing and speaking are distinct abilities, their underlying brain circuits overlap in some of the smaller pathways that are spared following an injury to the primary speech centre. This means you can spark the speech circuits by igniting the closely linked musical ones.

Therapy for aphasia gradually grafts speech elements onto the intact musical ones, says Tomaino. Clients begin by singing songs with familiar lyrics. They tap their fingers to the beat, drawing out the words through the insistent rhythm. As they improve with repetition, the melody is gradually withdrawn and replaced by spoken words. Eventually, clients develop robust new speech circuits.

Music not only stirred Flax’s mind, it also helped process her pain. Flax’s memory troubles thwarted her dream to practise psychology, and she lost her direction. She became depressed, slept in until 2pm every day, and stopped socializing. “God had messed up my path to be a psychologist – I was angry,” she says.

Flax leaned on her old ally for relief. On a bad day she would listen to sad tunes and cry. “I could feel the feelings through the songs – that was very therapeutic,” she says. Producing a CD of her own compositions was cathartic and boosted her self-esteem. By last year, Flax was ready to rejoin a musical ensemble. She felt immediately at home at Recollectiv, and quickly began forging new friendships. “Making connections with others that have similar situations gives you a sense of community,” she says.

But though the group might vent to each other at break time, it is their shared communion with music that glues them together. Flax and volunteer Alan Gotlib often harmonize their voices when they’re close. “I get goosebumps when we’re riding the same wavelength,” she says. Besides restoring Flax’s sense of belonging, Recollectiv helped her recover a broken piece of herself. She has become a mentor for the group, sharing both her inspiring story and her artistry. “Helping others in this form of therapy is the missing puzzle piece of my life,” she says.

Though Flax’s response to the medicine of music isn’t unusual, it’s only recently that scientists are pinpointing how this works.

Just listening to our favourite songs gives us a natural high, says neuroscientist Daniel Levitin, professor emeritus at McGill University, and author of This Is Your Brain on Music. That’s because it stimulates the same brain reward pathways as a chocolate binge, good sex or illicit drugs. As a familiar piece builds towards its climax, listeners eagerly anticipate its resolution, producing the feel-good substance dopamine as they thrill to the chase. Then, as the excitement peaks, they release endogenous opioids (the natural versions of drugs like heroin). Both brain chemicals flood our bodies with pleasure.

Music also helps us regulate our internal balance, says Levitin. We select fast-paced music to motivate us for a workout. As our brains absorb the rapid beat, the heart rate, blood pressure and arousal all increase. When we are anxious, however, we seek low-pitched, slower songs which reduce stress hormones and calm our senses. Music can alter our moods as well as our physiology, says Levitin. If we’re feeling rejected, playing a mournful song can help us feel understood.

Making music together is an even better way to cheer up, says Levitin. This is a valuable tool to fight the depression that can complicate the slow slippage of cerebral function, adds Tomaino.

People suffering from depression tend to focus inwards on their problems, says Levitin. But when we’re trying to mesh our parts together in an ensemble, we have to tune in to our fellow musicians. “That pulls you out of yourself and breaks the cycle of self-consciousness,” says Levitin. The hormone oxytocin, commonly known as the “cuddle hormone,” is produced during these moments, cementing our feelings of trust and bonding.

Ilana Waldston dancing with her mother Shimona. CREDIT Miranda RogoveinBack at the Tranzac Club, Flax introduces Moon River, and Waldston’s mother begins shuffling her feet. Gotlib recognizes the movement as a signal that she wants to dance. He grabs her hand and they sway and spin in perfect symmetry. She starts singing “La, la-la.”

Shimona’s lifelong love of dance is one of the few remaining things that can rouse her from apathy, says Waldston. “She and my father tore up every dance floor they could find,” she says. Waldston imagines that a strong beat revives these special moments. “I see her eyes sparkle and she lights up.”

Shimona’s response isn’t an anomaly. Human beings are wired to react to rhythm, says University of Toronto alumnus, Dana Swarbrick, MSc. candidate, Rehabilitation Sciences. “When a groovy song comes on, you can’t help but tap your toes,” she says. This reflex can serve Parkinson’s patients, Swarbrick explains. These clients have trouble walking due to degeneration in the brain region that initiates movement. But music can provide an alternate route to stimulate motion. When neurons in the brain’s sound processing centre detect music, they begin to fire in correspondence to the beat. These nerve cells then relay the rhythmic message to their counterparts in the motor area, which resonate in conformity and jumpstart the muscles. Over time Parkinson’s patients incorporate these new patterns into their gait.

Another element of music, its vibrations, has been used to treat some brain disorders, says Amy Clements-Cortes, music therapist and assistant professor, University of Toronto Faculty of Music, who worked with U of T’s professor emeritus Lee Bartel to pioneer rhythmic sensory stimulation for Alzheimer’s patients. Neurons have to pulse in synchrony to transmit messages, says Clements-Cortes. One of the brain’s crucial frequencies, 40 hz (corresponding to a low E on the piano), is vital for communication amongst its segments.

In Alzheimer’s, dying nerve cells reduce the strength of the critical gamma range brain waves, interfering with neuronal messages and dulling thought. But sound can reboot these deficient brain signals from without. In a 2016 pilot study, Alzheimer’s patients sat on a medical-grade chair equipped with speakers emitting a 40 hz sound which was both heard and felt. After just six sessions, patients with mild to moderate Alzheimer’s were temporarily sharper and more alert and aware of their surroundings.

Music’s healing power extends to the caregivers as well as to the participants. Tomaino witnessed these benefits firsthand in The Unforgettables, a New York choir she helped create for clients with dementia and their significant others. The group offered caregivers the opportunity to socialize and to see their loved ones revive in the spotlight’s warm glow. On one occasion, a man with severe memory loss performed a long solo by rote. “For partners that’s a gift that’s really hard to put a value on,” says Tomaino.

Recollectiv is generating similar rewards. The man with the smile, Bob Adolph, is gently tapping his wife’s hand in time to the beat. Rheba Adolph is thrilled at how well this first outing with the band has turned out. “It’s wonderful to watch him being so happy,” she says.

It hasn’t been easy to find activities where the couple can interact, since Bob Adolph has trouble talking. Once a professor of English literature, now words fail him and hamper his ability to communicate. But today’s songs have loaned him a new language that transcends the need for speech. “Aphasia is so isolating,” says his wife. “But music brings out feelings of closeness in both of us.”

Recollectiv sings its final song for the day. Gotlib thanks Shimona for the last dance and kisses her goodbye.

Flax beams at the band. “Great job!” she tells them, clapping. Flax feels buoyed by her first stint as a conductor. “It gave me energy,” she says. But she’s even more stoked about the gift she’s bestowed on the group, including the Adolphs. “They looked like they were walking down the memory lane of love,” she says. “I love helping people connect.”

Adolph helps her husband out of his chair. The couple leave the room, still holding hands.

For more information about Recollectiv, visit recollectiv.ca.

Vivien Fellegi is a former family physician now working as a freelance medical journalist.

Photo by Bo HuangIt was the first time that Dvořák’s joyous Symphony No.8 had failed to move Kitchener-Waterloo Symphony’s concertmaster Stephen Sitarski. He knew each note by heart, and he usually looked forward to its most exhilarating passages. But on that matinee performance at the packed Guelph River Run Centre over a decade ago, something was very wrong. Though his body churned out the melody by rote, he felt like a robot. “I was disconnected completely from the music – I felt empty and soulless,” he says.

For a moment he considered getting up, apologizing to the conductor and walking offstage. But years of discipline kicked in and he finished the piece. “I’m someone who doesn’t give up, who sacrifices to the end to get the job done.”

Shortly after that incident Sitarski was diagnosed with severe depression.

Sitarski is not alone. The rate of depression is higher amongst musicians than in the general population, says Dianna Kenny, professor of psychology and music at Australia’s University of Sydney. In one study, 32 percent of one orchestra’s players ticked off symptoms of depression in a questionnaire.

The artistic temperament puts many musicians at risk for depression, says Susan Raeburn, clinical psychologist in Oakland, California. The same sensitivity that drives them to self-expression makes them vulnerable to emotional pain.

Children’s musical education may ramp up their sensitivity to stress, says physician Dr. John Chong, director of the Musicians’ Clinics of Canada. Traditional teachers hold students to exacting standards, ripping them apart when they fall short. Auditions and competitions add to the relentless judgment. Some young musicians internalize these critical voices, becoming perfectionists who are never satisfied with themselves, says Raeburn. They are especially vulnerable to developing severe, suicidal depression, she says.

Some of these prodigies resent the loss of their childhood, says Kenny. “Instead of exploring the world, they’re locked away in their music room practising.”

Life doesn’t get any easier for adult artists. Orchestral musicians face relentless competition for few spots, financial insecurity, long hours, inadequate rehearsals, and exhausting tours which take them away from loved ones, says Chong.

But the psychological pressures are the toughest. While young musicians are encouraged to find their own voice, recording companies, agents and conductors stifle their creativity, says Chong. Conflict within the orchestra can also diminish workplace satisfaction, says Kenny. “An orchestra is a very closed universe – when you see people day in and day out, then travel together in close quarters when on tour…certain animosities will develop,” she says. Public humiliations by abusive conductors can add to the strife, says Chong.

Sitarski suffered many of these pressures over his career. He has always been emotional, turning to music to express his feelings. “I am compelled to play – if I don’t perform I feel emptiness.” But some of his teachers sabotaged his enjoyment, comparing him unfavorably to other students and belittling him when he lost a competition. Sitarski soon adopted their impossibly high expectations. “If we don’t shoot for perfection, we don’t improve, but we beat ourselves up when we don’t reach it,” he says.

Sitarski encountered a whole new set of stressors after graduation. He endured anxiety-provoking auditions, hidden behind a screen, knowing that his future depended on only ten minutes of playing. After winning one of a few coveted spots in the Winnipeg Symphony, he had little bargaining power to challenge the exhausting workload, insufficient preparation and arduous tours.

Losing his artistic integrity was even worse. One conductor at the Kitchener-Waterloo Symphony was especially authoritarian. “He would often choose interpretive styles and tempi that were extremely uncomfortable, but when someone would express that he would dismiss them outright,” says Sitarski.

Ironically, it was the firing of this particular conductor that pushed Sitarski over the edge. Some of those who opposed the dismissal blamed Sitarski, the concertmaster, giving him the cold shoulder. But the show had to go on. “The repression was huge – we had to sit with a smile pasted on our faces for the sake of the audience,” he says.

The body keeps score of these kinds of cumulative mental injuries, says Chong. Each time we’re stressed, we activate the fight or flight system which helps us cope with a threat. The hormone cortisol is a weapon in this arsenal, releasing proteins called cytokines which generate inflammation. With repeated crises, these chemicals accumulate in the muscles, causing soreness, and attack brain cells, precipitating depression.

The illness dulls thinking, flattens emotions and sucks the joy out of life. “You’re like a zombie,” says Chong. Some musicians funnel their emotional suffering into physical agony, developing aches in their joints and muscles, says Kenny.

Chronic stress can also spark stage fright in musicians with reactive nervous systems or difficult childhoods, says Kenny. Depression can follow. “Musicians know they’re going to get terrible anxiety every time they get onstage, and this wears them out,” she says.

As the psychological insults piled up like toxins in his system, Sitarski’s body succumbed to illness. First he grappled with overwhelming performance anxiety, triggering a racing heart, clammy hands, and sheer terror before a show. While the problem wasn’t new, it increased after the rift. “I worried when I went onstage that I’d screw up and the ‘other side’ would feel vindicated.”

Then Sitarski got sicker. He was always exhausted, and his normally efficient reflexes slowed down. “I would be practising something and it just wouldn’t stick – I’d stumble all over and make mistakes.” Worse was the nihilism, the certainty that nothing mattered. And though he didn’t feel tempted to harm himself, he recalls one sobering night when he understood the rationale for suicide. “It’s this very cold, logical decision made by someone who has lost his ability to feel any kind of joy.”

But Sitarski kept soldiering on until one day he woke up with a kink in his neck. “It was my body’s signal telling me that I couldn’t keep doing what I was doing.” He tried massage, acupuncture and physiotherapy. Nothing worked. Finally his family doctor referred him to the Musicians Clinics of Canada, where, Sitarski says, Chong took one glance and diagnosed him with depression.

Awareness of a condition can lead to effective ways of addressing it. Antidepressants can address the biochemical imbalances, says Chong. Dialectical behaviour therapy teaches self-soothing techniques such as mindfulness meditation, breathing exercises and physical exertion which can calm the nervous system and keep emotions in check, says Raeburn.

Therapy can be another important ingredient in healing. Cognitive behavior therapy (CBT) focuses attention on the rigid and self-critical thinking of depressed clients, substituting extreme statements like “Either I’m perfect or I’m total crap,” with more balanced assessments, like “No one’s perfect,” says Raeburn. Newer versions of CBT can help some patients defuse disturbing thoughts and feelings by stepping back and observing them non-judgmentally.

Psychodynamic therapy likewise enables some depressed musicians to dig deeper into the root causes of their ailment, mining the layers of trauma and uncovering the buried emotions which combusted into illness. These could include a teacher’s insistence on winning, a conductor’s humiliation, or a fraught domestic situation – anything that causes uncontrolled anger to ignite the nervous system’s stress response. Once these factors come to light, some musicians can make healthier choices in their lifestyles.

Finally, interpersonal neurobiology can work to redress dysfunctional relationships. Children whose parents were not attuned to their needs have difficulty trusting people and are vulnerable to anxiety and depression, says Chong. For instance, the prodigy whose stage parents value only his genius, will “freak out” if he doesn’t triumph in the Chopin contest. A therapist can guide insights into these unhealthy patterns and model secure and healthy attachments, says Raeburn.

Sitarski’s first visit with Dr. Chong was pivotal. An antidepressant recharged his energy and meditation helped him to relax. A counsellor reconnected Sitarski with his numbed-out feelings. “I’m much better now at recognizing when some button is pushed.” He began to realize that just going to work every day was jarring. “I couldn’t see that group of people without bringing back all these unbelievably intense negative emotions,” he says.

Awareness led Sitarski to reboot his life. “I renewed my outlook and my career, and began enjoying things again.” Sitarski left the Kitchener-Waterloo orchestra, becoming concertmaster of the Hamilton Philharmonic Orchestra a year later. He recharged his ambition with new opportunities, freelancing for the National Ballet, the Canadian Opera Company and the Toronto Symphony.

Sitarski has also become a mental health advocate. He began instructing Performance Awareness at The Royal Conservatory’s Glenn Gould School, a course which points out the challenges unique to musicians, and showcases resources such as yoga to tackle the potential pitfalls. Because he’s gone public with his struggles, the young musicians sometimes approach him for advice on their own problems. “Sharing my experience so someone maybe doesn’t have to go through it makes me feel better,” he says.

Sitarski’s journey through depression has helped him crystallize his identity. “I know who I am and I’m comfortable in my skin,” he says. And though he still relies on medication to keep the demons at bay, he’s grateful for his health and hopeful about the future.

Best of all, he has reconnected with the magic of music. On this particular night the Hamilton Philharmonic Orchestra is performing Dvořák’s New World Symphony at the FirstOntario Concert Hall. Sitarski feels every note beating in his blood and his colleagues mirror his motions to stay in synchrony. His bow resurrects the composer’s long-ago lament, conjuring from the faded score a pulsing pathos.

The audience absorbs the players’ energy and refuels them with its own electricity. Sitarski revels in the intimacy of this interplay. “I’ve become a human being again,” he says.

Vivien Fellegi is a former family physician now working as a freelance medical journalist.

Liona Boyd - Photo by Dean MarrantzShe will always remember those moments of perfection during her best performances. Eyes half closed, she sways to the beat, blonde mane swinging back and forth. Her fingers dance effortlessly over the frets of her guitar. Time and space shrink to a pinpoint and only the music is real.

It didn’t happen at every concert. But when she got in the zone, nothing else could beat that rush. “It’s an out-of-body experience – it’s like being in love,” says 68-year-old Canadian guitar legend Liona Boyd.

But in 2000, these moments of bliss stuttered to a stop. While her technique once flowed almost effortlessly, Boyd began struggling to control the movements of her right middle finger. For the first time in her career, her smooth tremolos, once deemed the best in her business, became jagged. Her arpeggios followed suit.

At first Boyd was hopeful that the mysterious ailment could be fixed. She quit playing and trudged from one health practitioner to the next, enduring hypnotherapy, botox injections, and even an immersion into Scientology. “Every therapy you think will work, then your hopes are dashed.” Eventually Boyd was diagnosed with musician’s focal dystonia, an overuse condition caused by mindless and frequent repetition of movements, which burn out the brain signals controlling muscle function. The diagnosis forced her to confront the bitter edge of reality. “I would never be the guitar virtuoso I once was – it was heartbreaking.”

Boyd is not alone. Eighty-four per cent of musicians will face a significant injury during their lifetimes, says physician Dr. John Chong, medical director of the Musicians’ Clinics of Canada. Musicians make extreme demands on their bodies, practising the same notes up to six hours without a break. “There is no off switch in the excellence-driven process,” says Chong. Chronic stress also plays a role in generating injuries. Workplace conditions, including job insecurity, ramp up muscle tension amongst performers, making them more prone to strains.

The emotional fallout can be disastrous. Musicians’ injuries are devastating because music is not just a livelihood, it’s their identity, says Lynda Mainwaring, registered psychologist and associate professor of kinesiology and physical education at the University of Toronto. Injuries also deprive performers of the joy brought about by the flow state, a transcendent experience where they lose themselves in concentration. “Flow can be a way of coping and forgetting problems – if musicians can’t get there, they’ll be frustrated.”

For some musicians, injuries rupture the harmonious relationships with their instruments, says osteopath Jennie Morton, wellness professor at the Colburn School in Los Angeles. Many view their violins and oboes as almost human, even going so far as to name them. “But when things go wrong, their former friends can turn into enemies,” says Morton.

Boyd was devastated by her condition, shedding tears every time she tried to coax her guitar to cooperate. “The joy was robbed – that was the worst thing.” It was almost as if her beloved guitar had turned against her. “You feel your best friend has let you down.”

Denial compounds injuries. Half of injured musicians play hurt, says Chong. From a young age, musicians are trained to sacrifice their well-being for the greater good of the audience. They are also reluctant to draw attention to their health issues because they fear losing solos as well as job opportunities. But playing through pain worsens the problem.

For a while Boyd too tried to combat her wayward finger. She ramped up her practising, but that only worsened the dystonia. Later, after her diagnosis, Boyd kept it under wraps. “I didn’t want people feeling sorry for me.”

Fortunately, there are constructive ways to deal with injuries. Rapid diagnosis and treatment by a physician trained in musicians’ health will resolve many conditions, says Chong. But in one study, 50 per cent of injured musicians felt they had never fully recovered, says Morton.

When injuries impact their careers, musicians need to allow themselves to grieve, says Mainwaring. “The loss of that part of life is like a death.” Some benefit from expressing their feelings through writing, while others prefer talking to a therapist. Deep breathing, mindfulness meditation, yoga and exercise can all help to relax tense muscles, says Morton. Reaching out for support, especially from other musicians who have gone through similar crises can be reassuring, says Mainwaring. “It helps them feel they’re not alone.”

As injured musicians begin to reconstruct their lives, it’s important for them to dig down deep and figure out why they picked up their instruments in the first place, says Dr. Chase McMurren, MD, medical director and psychotherapist at the Al & Malka Green Artists’ Health Centre at the Toronto Western Hospital. Most just wanted to make beautiful music, not caring if they made mistakes. But over the course of their careers, many have internalized the expectations of their teachers and families, and absorbed the competition for fame and money. Injured musicians need to discard the weight of these burdens and try to recoup the pure thrill of their artistry.

Even if they’ve stopped playing, musicians can still participate in their craft, says Mainwaring. Sidelined artists can contribute to their profession by sharing how they dealt with their own setbacks. Teaching music can be another fulfilling option.

But injured performers can also find solace outside their métier. If music has always been the driving purpose in their lives, they need to unearth new sources of meaning, says Mainwaring. This could mean spending more time with family, or possibly switching to a new vocation. “They will be more fulfilled if they have other satisfying outlets.”

Daniel Blackman - photo by Christopher WahlToronto Symphony Orchestra viola player, Daniel Blackman, had to reconstruct his life after a career-threatening injury. In the summer of 2010 he was struck by a car while cycling and left for dead. He woke up in St. Joseph’s Hospital with a collapsed lung, a concussion and multiple fractures. But the worst problem for his career was nerve damage and reduced flexibility in his left, instrument-holding arm.

It wasn’t until he was home that the impact of his accident sank in. He feared he might never regain his top form. “If you have a career and it’s taken away, you feel like your life as you knew it has come to a close.” Blackman lay in bed, day after day, riddled with self-pity.

Fortunately, his partner didn’t allow him to wallow in despair. After a few weeks rest, she pried him outside for a walk. Although he barely managed one block, by autumn he was doing four-hour hikes. Walking in natural settings became his salvation. “The air is amazing, I don’t feel closed in, and my mind expands.”

Blackman’s physiotherapist also helped to pull him out of his funk. She had overcome her own medical issues, and shared her struggles with her client. “If you see someone else who had a major situation and is thriving, it’s really motivating.”

Just over a year after his accident, Blackman returned to work. But although he was capable of performing in the orchestra, he had to quit his quartet and no longer plays solos. “In chamber music you’re exposed, and everything you do is high stakes.” Blackman made his peace with his new circumstance. “Luckily I’d had a full career already – I didn’t feel that I had to prove anything.”

Instead of dwelling on his own losses, Blackman shifted his focus to young, up-and-coming performers, supporting them financially. But he gets back as much as he gives. “Watching these young careers succeed is a pleasure.”

Today Blackman is thriving. Though he still sometimes misses the spotlight, he sees his life overall as a blessing. Having almost died three times after his accident, he’s just happy to be kicking around.
“I was given a gift of life.”

Boyd too has successfully reinvented herself, a process she describes in her newly released memoir, No Remedy for Love. She simplified her technique and expanded her repertoire, blending the purely classical with more forgiving folk and new age elements. “When you play classical music and you make a slip, you almost stop breathing, but in folk style, a little squeak is not the end of the world.” Performing as a duo [with Andrew Dolson] allows her to share the responsibility for the tricky parts and gives her companionship on stage. “It’s more collaborative and fun than being on my own.”

Boyd also fashioned herself into a singer-songwriter. Although a childhood teacher had once squelched her confidence in singing, the instructor was no match for Boyd’s tenacity. “I’m a very determined person – I don’t know any classical instrumentalists who become singers.” And though she says her voice isn’t trained, it has a natural quality which suits the type of music she composes.

Songwriting brings Boyd a whole new means of self-expression. “I’m able to say things both melodically and with lyrics, so it’s added another level of creativity.” She finds inspiration everywhere, singing about love, her adopted land of Canada, and even a prayer for planet Earth.

Best of all, composing has restored to Boyd the fulfillment of flow. As she racks her brain for the perfect word, she loses track of time. Hours can whizz by. Sometimes a whole night when she’s on a roll. And when the lyrics and the melody speak her truth, it’s ecstasy. “This whole other world opens up. I get shivers.”

Boyd hopes her own triumph over trauma will inspire musicians with focal dystonia and other injuries, who are still in the closet. Her advice is simple. “Life throws you curve balls. You can get dragged down. But it’s never too late to turn your life around.”

Audiences today are as moved as ever by this new Liona Boyd. Fans say that her songs have delighted wedding guests, soothed the sick and inspired children to learn the guitar. (Even her late cat, Muffin, curled up by her side and fell asleep when she played). These testimonials are Boyd’s most valuable rewards. “It’s amazing when people tell me how much my music means to them. That makes all the struggles worthwhile.”

Vivien Fellegi is a former family physician now working as a freelance medical journalist.

2208 Music and Health BannerPerforming Arts Medicine Association Conference, February 11-12, 2017: Faculty of Music, University of Toronto

2208-Music and Health.jpgAs the name Performing Arts Medicine Association (PAMA) suggests, this is an organization composed of health care professionals and performing artists dedicated to the treatment and prevention of the various occupational health hazards to which performing artists, including musicians and dancers, are particularly vulnerable. While performing artists do not have a monopoly on any of these physical and psychological problems, they are prevalent enough for artists’ health to be a focus for health care.

According to Dr. John Chong, the medical director of the Musicians’ Clinics of Canada, professor in the Faculty of Health Sciences at McMaster University and a past president and treasurer, Performing Arts Medicine Association, the risk factors for the development of some sort of problem over the lifetime of a performing artist are a whopping 84 percent, triple the national average. 

The theme of the February 11-12 conference was the pressure on performers to conceal their physical injuries and psychological stressors until they are at a critical point of no return. The aim of the conference, as I understood it, was educational. According to the PAMA website’s description of the event: “The more this issue is brought to light, the earlier artists can seek treatment, and the better their chances are of full recovery.” The site goes on to say that “prominent performers will share their stories of health challenges concealed and revealed, and pioneers in the field of Performance Health will add their clinical and research wisdom.”

The well-known Canadian violinist, Stephen Sitarski, at one time the concertmaster of the Kitchener-Waterloo Symphony Orchestra, speaking from his own experience, gave what could have been the keynote speech, a comprehensive look at everything from the psychological profile of a performing artist to the various stresses to which artists are subject.

According to Sitarski there is a fundamental contradiction between what motivates musicians to dedicate years of focused work to become good enough to perform professionally and the workplace and working conditions they find themselves in. The motivation is centred around the development of the artist’s voice, his/her authentic individuality and its expression. The workplace, especially symphony orchestras, where the conductor’s authority is more or less absolute, of course, demands the subjugation of the individual artist’s expression to the artistic vision of the conductor. But there are other stresses as well, not the least of which is the demand to be sufficiently employed to be able to make a living. For many local musicians this involves being part of what Sitarski called “the 401 Philharmonic,” necessitating long trips along the 401 to destinations anywhere from Windsor to Kingston, performing late into the evening, driving home even later and getting up early the next morning to get to a morning rehearsal, followed by another evening performance. As one of the other speakers, Andrew Cash, a former musician himself and now a member of Parliament, put it just a few hours later, “The arts can be a great way to get rich but a terrible way to make a living.” This arduous and bleak routine – the essence of which is the loss of control and independence and the suppression of everything he had become a musician to express – eventually led Sitarski in the direction of depression and burnout. Fortunately Dr. John Chong was there and with his help Sitarski was able to find his way back to a better frame of mind and make adjustments to his professional life.

Variants of Sitarski’s story were told by several of the other speakers. Lol Tolhurst, formerly of the rock band The Cure, spoke of his experience of what he called “maladies of the spirit”; and cellist, Bryan Epperson, spoke of his struggles with similar experiences.

Some of the medical professionals were able to shed some light on the reasons for these sorts of problems. Lynda Mainwaring, a U of T psychology professor specializing in performance, health and rehabilitation psychology, characterized burnout as the result of both the chronic mismatch of you and your workplace and a lack of recognition; stress as the absence of connectivity; and engagement as the opposite of burnout. Jennie Morton, psychologist, osteopath and author of The Authentic Performer, told us that her research had led to the discovery that creative people have fewer dopamine receptors, which tends to make them more vulnerable to stress. She also connected these sorts of maladies of the spirit with a confusion of the artist’s authentic identity with his/her identity as a performer. Cash linked the artistic temperament, in particular the fact that artists by definition are not joiners, to the chronic shortage of money which plagues many musicians. In fact, early in the day some income statistics were presented and as I recall, the average annual income of musicians in this country is around $16,000. Musician and songwriter, Tom Wilson, made a connection between addiction, which came up repeatedly over the course of the day, and the rigours of the artistic life: “Addiction comes from trying to survive.” He also brought us a musicians’ joke, which provided an element of “folk wisdom”: Q. What would a musician do if he won a million dollars? A. He’d keep playing until he ran out of money.”

This conference raised a couple of questions and concerns for me: one was that there are musicians who do not suffer the afflictions explored over the course of the day. What are they doing right, so to speak, which some of their colleagues are doing wrong? Also, it came up a couple of times over the course of the day that doctors trying to help performers with depression and burnout sometimes prescribe anti-depressants, and one or two people who spoke about this approach told us that they would be taking these prescription drugs as long as they lived. While admittedly not ideal, a “managed addiction” (to anti-depressants) is better than chronic depression.

This brings me to the PAMA’s upcoming international symposium June 29 to July 2 in Snowmass, Colorado. Among the many topics being addressed at this event are the following two: “...the risks, benefits and side effects of opioid management for pain” and “... non-medication pain management options.”

The problems discussed at this conference are real, and it is better to address them than not, as the consequences of not addressing them can be dire.

If you or someone you know is suffering from the sorts of issues raised here, Dr. Chong recommends getting a referral to the Musicians’ Clinics of Canada from a family physician. The clinic has offices in both Toronto and Hamilton. Information about them is readily available at their website: musiciansclinics.com. The Performing Arts Medicine Association’s address is artsmed.org.

Allan Pulker, flutist, is co-founder and chairman of the board of The WholeNote.

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