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.

2204 Music and HealthThere’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.

“My apologies if you disagree with my viewpoint” began the distressed letter I received. “It’s not often that I send an email to everyone in my inbox, but I am angry and frightened at this most recent round of cuts made by the Federal Government to the Canada Coun-cil for the Arts…”

The letter included a link to an article by James Bradshaw in the September 24 Globe and Mail, as well as a link to a petition written by improvisational musician Nilan Perera. Nilan Perera’s petition already had 5,600 signatures at the time I clicked through: people in the wider music community are feeling crushed and betrayed.

“In a move to provide more money for Canadian artists to tour internationally and focus on commercially viable projects, the Tories have redirected funds that were used to help artists on the musical fringe record their work” Bradshaw wrote in his Globe piece. In effect, on July 31 this year, when the Conservative government renewed funding for the Canada Music Fund for five years, it “streamlined” the fund by eliminating two of seven categories, in order to beef up the funds for the remaining five. Gone entirely is the Canadian Musical Diversity category which provided grants of up to $20,000 for the recording and distribution of  music which “places creativity, self-expression or experimentation above the demands and format expectations of the mainstream recording industry,” and has “significance beyond being just entertainment.”

Fringe music? No. As Nilan Perera’s petition states:

“This is the music that commercial artists mine for new sounds and examples of new forms. Its existence is as critical to music culture as medical research programmes in the universities are to the well-being of the public.”

Canadian saxophonist, clarinetist and composer Quinsin Nachoff proposed a similar analogy:

“I sat on one of the Sound Recording juries and it is a very competitive process. Only the very best are awarded funding, and only with a realistic budget to match. This is an extremely important grant that might be considered akin to that of a scientific research grant. I am cer-tain that the removal of this particular program will slow the growth of the creative and original music sector in Canada. Musicians will be forced to work longer at commercial work, teaching or working a day job to gain the necessary capital to self-produce their creative works. This will make Canadians less competitive in a market competing with Europeans who are supported by their governments or Americans who have a much larger market to support their product.

“It seems ignorant to remove this particular program as it is a necessary element to access other types of support: touring presupposes a product to tour. A recording is the essential building block and business card of the musician. The recordings I have made all led directly to tours, commissions, collaborations, and certainly affect my commercial endeavours: I am hired to teach (U of T and Humber College) be-cause of my experience ... as documented on recordings.

“Without a chance for the best Canadian creative music to be documented the cultural landscape will be staid; imitations of European or American art or pop culture. It is imperative we foster creativity and the aim of documenting our identity or quest for it.”

Pianist and music educator Mark Eisenman grimly commented:

“As an educator at York University in the field of jazz, I see the elimination of The Specialized Recording Grants as another nail in the coffin of jazz in Canada. There seems to be no reason to be teaching this music to the next generation of students. The hope of them getting any support for what is essentially a non-commercial music is looking more grim than ever. There is more to the value of things than just money, and the study of jazz and the discipline it takes is well worth the effort to teach it….”

Eisenman finished with an admonition:

“Have you ever looked at how many CDs you have received from Canadian jazz musicians that have the Canada Council logo? Check your CD library.. Now …imagine that any recording with a Canada Council logo never existed. Because in the future that’s the reality.”

Not healthy.

Here are links to the petition and Globe article. And there’s an ad on p.46 of our magazine for an October 26 “Wake” to mourn the cut funds, and celebrate the music. PDF Version Here

Update on September’s column


Last month we spoke with violinist Wren Canzoneri who had recently started working with physiotherapist Ginette Hamel, who works with musicians. Here’s a follow-up visit!

50Wren_CanzoneriWren says that the summer was a good time to get started working on a regimen of healing exercises, and on teaching his muscles new ways to approach work he has done for years. The benefits are obvious to him. He feels as if his pain is 25% less, and his strength and flexibility 25% improved. He’s feeling better and playing better. Wren and Ginette have a pretty clear sense of what the causes have been, included some tears to his rotator cuff which were confirmed by ultrasound. While he feels it will be about six months before he feels “fixed,” he’s keenly aware of the extent to which learning to think like an athlete on an ongoing basis will protect him from further injury and allow him to continue playing for many years.

The biggest challenge right now is not the morning regimen of yoga, nerve gliding exercises, stretching, practicing, stretching and then icing that he has become accustomed to. The challenge is keeping it all up in a regular way, making it fit in as the music season ramps up and his schedule has also to accommodate the demands of his business, TorMusic Entertainment, such as organizing  the Concert Party at the Old Mill concert series, and playing with the Hamilton Philharmonic, and the Toronto Philharmonia.

Curtis, 61 years old, plays with the Hamilton Philharmonic, occasionally subs with the TSO. He also runs a business called TorMusic Entertainment – contracting musicians for corporate, private, and commercial performances.

I had a separated shoulder from a skiing accident in 1985. Looking back I’ve had problems with my back since my 20s, but when I was the Assistant Concertmaster for Showboat, a while ago, my back went totally out of whack, and I found myself in and out of  various kinds of physio. At the time it was probably yoga that helped the most… Recently all the shoulder problems cropped back up: a lot of pain, spasms in my shoulder, neck, and arm. Wendy Rose (Associate Principal Violinist in the TSO) said I should see Ginette Hamel, who works part-time out of the Artist’s Health Centre but also sees clients at her home.

Ginette thinks the problem is “bio-mechanical”: having to do with the way bones, muscles and nerves work (or not) together. There are 3 or 4 nerves needing to be freed in my neck, so I’m learning some exercises she calls “nerve gliding”, and learning about stretching and relaxation for the muscles needed to play the violin.

We’re also working on strengthening something called the multifidus muscles ( in your back): it’s what dancers use to stabilize the lower body: as a violinist you need them to be able to sit properly. What I’m hoping to achieve is not to have pain so that I can continue to do a lot of playing into my 70s.

Ginette  doesn’t give you a general programme. Her approach is  “Okay.. what precisely do you have to do, and what isn’t working,?” And then we work together…

45GinetteHamelGinette Hamel is a physiotherapist who has worked for more than two decades with elite and amateur athletes of all kinds. You will find her clients competing at international games,  but also at renowned ballet schools, in dance companies, and on stage and in the pits with Canada’s finest ballet, opera, and symphony orchestras.

“Dancers as athletes” isn’t a new concept: over time it has benefited both communities, affecting how dancers and athletes think of themselves in terms of  body awareness and self-care. The public has come to have an increasingly sophisticated appreciation for people who are able to push their bodies to achieve extraordinary things, but without the corresponding need to glorify the pain and injuries.

Ginette began working in sports physiotherapy but says  the leap to working with dancers, which began with the Royal Winnipeg Ballet, “just made sense.” She was immediately struck by how much need there was for a similarly specialized approach.

There’s no point in saying to athletes or dancers “well if it hurts just don’t do it anymore”. They have too much at stake doing something they love, are driven to do. You have to find out how they can be more comfortable, and why something is not working…you teach them to be more aware of their bodies, to pay attention, so that they can be even better at what they do.

But musicians as athletes? This is a concept whose time has not only come but is long overdue. Ginette confirms that  a long-standing stigma has kept many working musicians from admitting even to themselves, that they were “working wounded”.

They used to be so afraid, if they told someone they were hurting, they would not be hired. That this made them look bad.

Working with dancers at the innovative

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