Music and Health

She 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.”

Toronto 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.

Performing Arts Medicine Association Conference, February 11-12, 2017: Faculty of Music, University of Toronto

As 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.

There’s a surprisingly active world of live music performance in Toronto – and it takes place in the city’s health-care centres. These concerts employ musicians, giving them the satisfaction of giving back to the community, and in turn their audiences, collectively numbering in the thousands, receive the many rich benefits that music can bestow on us all. Yet these musical events fly under the usual media promotional radar, hidden from public earshot and evaluation – and in many cases that’s just the way institutional representatives like it.

Often institutionally filed under “therapeutic recreation services,” music performed in the health or long-term care context can provide a wide variety of benefits to patients and their families, as well as to their caregivers. Career music therapists talk about “modalities:” the ways in which music helps their clients, serving as a form of lifelong learning, creative expression, or accompaniment to expressive movement and physical fitness. Research has demonstrated that meaningful interactions with music can also facilitate brain fitness and plasticity, memory, meditation and coping strategies including stress and pain management.

Anecdotally, musicians among us know the psycho-physical act of making music can provide useful sensory stimulation. Music can not only put us in our “happy place,” but also into our spiritual place. Those who make music in a band, ensemble, orchestra or choir can vouch for the perks of doing so – not least the powerful social connection that comes from engaging with like-minded peers in deeply meaningful sonic and emotional collaboration.

Baycrest Health Sciences: Music therapy helps at end of life. North Toronto’s Baycrest Health Sciences, which brands itself as “a global leader in geriatric residential living, health-care, research, innovation and education, with a special focus on brain health and aging,” continues to foster research investigating this subject. Its senior music therapist/practice advisor Dr. Amy Clements-Cortes, for example, conducted a 2011 study that looked at the role of music in palliative care. Participants engaged in a variety of interventions including writing songs, recording music to leave as a legacy gift for families, improvising to music, singing and compiling musical autobiographies. Several motifs emerged, including that music therapy provides a safe place to express feelings, enhances communication and acts as a vehicle for reminiscence and revisiting memories.”

Princess Margaret Cancer Centre: Financially supported by the Tauba and Solomon Spiro Family Foundation, Princess Margaret Cancer Centre’s Music in the Atrium provides weekly concerts to patients, families and staff through the months of September to May in downtown Toronto. They are held on Wednesdays at noon in the centre’s Main Floor Atrium. SarahRose Black, an accredited music therapist and registered psychotherapist, and Andrew Ascenzo, a Toronto-based professional cellist, program the concerts in collaboration with the Princess Margaret Cancer Foundation. Founded nearly 21 years ago, the series is run by the hospital’s Department of Supportive Care. Performers take to the Atrium each week, offering a wide variety of styles and genres, including classical, Broadway, folk, world fusion, opera, funk and soul music. “The performers are generally professional Toronto-based musicians,” says Black. “However, the program often features highly trained musicians who have built careers in other areas but perform around the city.”

During the warm summer months, the weekly concert series turns jazzy. Moving up to the Max Tanenbaum Roof Garden on the 16th floor, patients, families and staff gather on Fridays at noon for Jazz for the Soul, featuring professional jazz musicians of multiple stylistic affiliations from around the GTA and beyond.

During its two decades of music programming, the hospital has hosted some of Toronto’s top musicians. They include jazz pianists Hilario Durán and Bernie Senensky, bassist Artie Roth, guitarist Joel Schwartz, and singers Jackie Richardson and Michael Burgess, as well as Justin Gray’s Indo-jazz ensemble Synthesis and students of the Glenn Gould School at the Royal Conservatory of Music. Looking forward, on December 7 cantor Tibor Kovari celebrates Hanukkah, while on December 14 Princess Margaret’s own Dr. David Loach, a medical oncologist who also sings and plays keyboards, headlines a holiday concert alongside program directors Black and Ascenzo.

Much of this music-making wouldn’t be out of place at Koerner Hall or the Jazz Bistro, but has for the most part flown under the mainstream media radar. Yet this is a space where many musicians pursue their careers, while staff, patients and families gain the many benefits from their musicking.

Kensington Hospice: SarahRose Black also works as a music therapist at Toronto’s centrally located Kensington Hospice. Here, some of the current research on music’s power to comfort and aid people at end of life, as well as their loved ones, is put into practice. One of Black’s duties is to manage the hospice’s volunteer musician program, which hosts frequent live performances. In the recent past, concerts in this program have been held in conjunction with our next organization, the Health Arts Society of Ontario (HASO).

Health Arts Society of Ontario: Established in 2011, HASO’s mandate is to bring the work of professional musicians to audiences sequestered in long-term care in Ontario (and through its other provincial partners, to all ten provinces). According to their website, “the largest audiences in health-care for arts programs are found in residences for elders.” The website also points out that many of these people would otherwise be unable to access live music or theatre arts for the rest of their lives, and that most public health authorities do not have mandated standards or budgets for providing quality of life programs for people living in chronic-care residences. This is where HASO wants to see this situation change and its concert program is an agent of that change.

HASO hopes “to rapidly develop…along the lines [already] established by Health Arts Society (BC) and Société pour les arts en milieux de santé (Québec).” Its growth indeed appears to have been exponential. HASO already presents 200 concerts per year under the banner of Concerts in Care and, to date, over 10,000 concerts have been delivered to audiences in care in Canada by the Health Arts Societies, reaching a national audience of over 400,000.

Those are impressive audience numbers by most metrics. And in terms of the quality of music on offer, on January 29, 2016, HASO appointed Jeanne Lamon, the former music director of the Tafelmusik Baroque Orchestra, as the society’s new artistic director. Her role includes guiding HASO’s Concerts in Care program of professional music concerts. The announcement was accompanied by a concert presented by Lamon (violin) along with colleagues Cristina Zacharias (violin), Christina Mahler (cello) and Lucas Harris (lute) at the Castleview Wychwood Towers long-term care home in Toronto.

Michael Garron Hospital: Carol Kirsh, the volunteer concert music programmer at Michael Garron Hospital (formerly Toronto East General), is holding an ethnic musical mirror up to the multiple communities East General serves – and which serve it. In our recent telephone conversation and email exchange, Kirsh – who is herself an amateur musician – told me that she is attempting to stretch the cultural envelopes of the music and musicians she presents, to better reflect the cultural backgrounds of the hospital’s patients, health-care workers and surrounding east-Toronto community.

“The catchment area of our hospital is the most diverse in Toronto,” Kirsh told me. “I am working with musicians to put on free noon-hour concerts – about four per year – featuring the music of [our diverse] heritages. I want to reflect the soul of the community. [While the concerts are free,] we nevertheless recognize the importance of paying fees to professional musicians.”

The first concert in the series was held November 15, featuring Toronto’s stylishly virtuoso Payadora Tango Ensemble. It performed repertoire drawn from the core Buenos Aires tango tradition, as well as signature compositions by Astor Piazzolla. “A Venezuelan hospital volunteer opened the concert with South American music,” said Kirsh. The series continues on January 17, 2017 with Toronto-based Demetri Petsalakis curating a concert of Greek music, reflecting the musical identity of the nearby Greektown on the Danforth. Petsalakis and his group will perform in a wide variety of styles, with an instrumental accent on his masterful Greek and Middle Eastern lute playing.

What about the future of music programming at Michael Garron Hospital? Kirsh intends to extend the musical mix further, “to reflect the huge Filipino community at our hospital, particularly our health-care workers.” She looks forward to the late spring, when she plans to hold a concert in an appropriate outdoor space on hospital grounds, with music provided by members of Toronto’s vibrant Filipino community.

As each of these five examples show, the power of music to build social and emotional connections is already being put into practice in Toronto’s health-care spaces – and is finding resonance with the communities involved.

Andrew Timar is a Toronto musician and music writer. He can be contacted at worldmusic@thewholenote.com.