Jul 27 2012

Faces of Public Health: Richard Kogan, MD

“Music hath charms to soothe a savage breast, to soften rocks, or bend a knotted oak.” William Congreve

About twenty percent of students who apply to the Weill Cornell Medical School in New York City are gifted musically, ranging from strong amateurs to students who have trained at conservatories. Giving students a chance to keep up with their music, and discover what benefits that might have for their patients, was the impetus behind the school’s Music and Medicine Initiative, begun several years ago. The initiative includes rehearsal and performance space for students, as well as some partnerships devoted to music and healing. NewPublicHealth recently spoke with Richard Kogan, director of the Music and Medicine Initiative, and himself an accomplished concert pianist.

NewPublicHealth: What’s the goal of the Music and Medicine Initiative?

Richard Kogan: Our original mission was to create the most musician friendly medical center in the country, but we’ve extended it well beyond the students. We want the entire community to feel that music is an essential part of the experience. Our feeling is that music is an underutilized modality in healing. Music has an unparalleled; truly, I think capacity to reduce pain, to soothe anxiety, to lift spirits. Music is an effective medicine for a whole variety of disorders, Parkinson’s, Alzheimer’s, strokes, depression, it can reduce blood pressure. Research is being done that I think demonstrates something we intuitively sense, which is that music has healing properties.

And in addition to forming an affiliation with the Julliard Conservatory of Music in New York City–students at Julliard and our Weill Cornell students and other members of the Weill Cornell community have together hosted concerts to benefit victims of the earthquake in Haiti and to benefit the victims of the earthquake and tsunami in Japan–we’ve had symposia and salons on topics bettering the interface between music and medicine. Topics have included performance anxiety, and perfect pitch.

NPH:  What do you think is the intersection between music and medicine?

Richard Kogan: In the 21st century, music and medicine are generally thought of as separate domains or disciplines, and generally we see people put them in separate categories and think that there’s very little overlap between the two, but it wasn’t always that way. The ancient Greeks designated Apollo as the god of both medicine and music. In lots of primitive cultures, the roles of physician and musician were played by the same person. I mean, you have Shamans in these communities who are all purpose healers; sometimes they used musical instruments, and sometimes medical instruments. Their overarching purpose was to heal. I think we live now in more specialized times.

And, actually, both music and medicine have become increasingly specialized even during my professional lifetime. And while something’s possibly gained by the increase in specialization, my feeling is that much has been lost in that a perspective that incorporates both music and medicine is helpful. I think as medicine becomes more technologically driven, the humanistic values that music embodies I think are actually more valuable today in 21st century medicine.

NPH:  You’ve mentioned some medical benefits of music. What are others?


Richard Kogan:  I think music has been demonstrated to improve memory in some patients who have cognitive impairment. Patients can sometimes access memory when they hear music that they heard when they were much younger and their memory was more intact. Music has been extremely valuable in Alzheimer’s patients. In patients with Parkinson’s, it seems that the rhythm, the rhythmic aspect of music has led to improved motor control in some patients. Music has been demonstrated to improve mood in individuals who are depressed.

NPH:  You yourself are a concert pianist. What has been your most recent intersection between your music and your medicine?

Richard Kogan: Well, I have an active music life and perform about 50 concerts a year. For many years I had parallel careers as a musician and a physician. I was a practicing psychiatrist and a concert pianist. In recent years, I’ve actually established what almost can be considered a third career, which is something of a merger between the two. I focused on the role of mental illness primarily but also physical illness in the creative process, and I looked at the impact of either psychiatric or medical illness on the creative output of some of the greatest composers in history, composers like Mozart and Beethoven and Tchaikovsky.

NPH:  What is an example of a great composer whose music intersected their well-being or their illness?

Richard Kogan: There are so many examples I can give you. Beethoven is an example of a composer who had a serious illness. He became deaf. He started losing his hearing in his late 20s and by then…he was completely deaf and it had an enormous impact on his creative ability, early in his career. As he lost aural contact with the world and retreated into the silent world of his imagination, he actually began imagining and conjuring up forms and sounds that were unprecedented, that were unlike anything that anybody had ever heard.

Deafness is a hardship for anybody. For a musician it’s catastrophic, and not surprisingly, when Beethoven began losing his hearing he contemplated suicide. But he made the decision that he would hold off on that until he had fulfilled his destiny as an artist and through a really truly extraordinary development, deafness had actually made Beethoven a much greater composer.

The music particularly late in his life, he never would have been able to write it had he not lost his hearing. This is a case, and I’ve actually seen many, many cases like this of resilience, of cases in which illness has let people become creative not just in spite of their illness but actually because of it.

NPH: How has being a psychiatrist impacted your efforts on the intersection of music and medicine?

Richard Kogan: One of the things that I’ve done a lot of in my career is to focus on destigmatization. Still here in the 21st century there is enormous stigma associated with mental illness, lots of shame. So, I’ve done a lot of benefit performances for organizations like NAMI, the National Alliance for Mental Illness. My sense is that by performing the music of composers who suffer from mental illness, I feel I’ve been able to suggest that mental illness should not be so shameful.

So, for instance, Robert Schumann, the great 19th century German composer, he had what I believe to have been a pretty classic case of what we now would call bipolar disorder or manic depressive illness. There was no language for that in the 19th century. People knew that he was psychologically disturbed in some ways. He lived the last couple years of his life in an insane asylum, and effective treatment for the mentally ill had not been developed at that point. We’ve made enormous advances in reducing the suffering associated with mental illness, but he suffered enormously because of it. He asked for help, he knew he needed help.

If you look at the patterns of his creation, he had these bursts, periods where he was enormously productive, he wrote prolifically, and then he had long stretches which lasted often more than a year in which he was unable to create at all. The periods with writer’s block were associated with depressed moods and the periods of prolific writing were associated with elevated moods. The illness probably helped his creativity. The great writers, artists, musicians, poets seem to be over represented in the population of individuals with mood disorders. We are beginning to study why that is.

NPH:  What’s upcoming for the center?

Richard Kogan:  There are always performances. Among the exciting events coming up, we’re joining forces with a medical center from Munich, and we’ll perform the Mozart Requiem at St. Bart’s Cathedral (in New York City) in September, and we’re going to have a symposium on Mozart, and psychiatric issues.

NPH: Has the Initiative become a resource for physicians looking to help patients?

Richard Kogan:  Oh yes. This is an important component of what we do. We have musicians who play for patients to make them feel better, and we’ve been spending a lot of time thinking about music therapy, how music can actually help, what kind of impact it can have clinically. Yes, it’s something that we are devoting lots of attention to. It’s a very exciting area.

Bonus Video: Watch http://www.youtube.com/watch?v=PDNhzfcNJqQ&feature=player_embeddedto Richard Kogan talk about Beethoven and mental illness, and perform a selection of the artist’s work

Bonus Link: In a new interview http://www.newyorker.com/reporting/2012/07/30/120730fa_fact_remnick published this week in the New Yorker, Bruce Springsteen talks about depression: “…With all artists, because of the undertow of history and self-loathing, there is a tremendous push toward self-obliteration that occurs onstage. It’s both things: there’s a tremendous finding of the self while also an abandonment of the self at the same time. You are free of yourself for those hours; all the voices in your head are gone. Just gone. There’s no room for them. There’s one voice, the voice you’re speaking in.”

Tags: Faces of Public Health, Mental Health, Q&A