Sweet and Heartbreaking

The first talk in the Library of Congress's Music & the Brain series this autumn featured a distinguished panel of speakers - Dr. Kay Redfield Jamison of Johns Hopkins, Julliard Provost and Dean Ara Guzelimian and Dr. J. Raymond DePaulo of the Johns Hopkins School of Medicine - speaking on "Music and Grief."

The talk was held in the Coolidge Auditorium and included a performance of the first movement of Felix Mendelssohn's string Quartet in Fm by the Afiara String Quartet from Julliard.

Devastating Loss

Dr. Jamison, an senior adviser on this series and the author of An Unquiet Mind: A Memoir of Moods and Madness spoke about the loss of her husband, the late Dr. Richard Wyatt and how she grieved him.

Much of what she said followed her book Nothing Was the Same: A Memoir . I purchased a copy and read it cover to cover after the talk. During the lecture, Dr. Jamison - who has a history of bipolar illness - said she was scared of lapsing into depression and detailed her struggle to discern between the two.

A Winding Valley

Dr. Jamison quoted C.S. Lewis - "Grief is like a long valley, a winding valley where any bend may reveal a totally new landscape," she said. "Grief provides a path by those whom broken can find their way. I knew madness well, but I did not know grief.

Jamison said she was distraught, but it was not the agitation of depression. "I was able to reason and imagine that the future held things better for me," she said.

"Yet Richard's death stirred up such a darkness in me that I was forced to examine those things that grief and depression held in common and those that they did not," the Hopkins researcher told the crow.

"I knew depression to be unrelenting, impervious to event. Grief was different; it hit in waves and caught me when I was most alive," Jamison said. "Depression is malignant; grief cut me slack. There was occasional sweetness. My thoughts did not dwell on the pointlessness of life; they dwelt instead on the pain of missing an individual life."

"In depression," she added, "one cannot access the beat of life."

The Hopkins scholar told how she turned instinctively to music, and how hymns brought her comfort. Her book details how she and her late husband had planned his funeral, down to the readings and the hymns, before his death. But nothing really prepared her for his loss. She even tells of dreams in which she conversed with Dr. Wyatt, and then said "wait, you're dead."

"Yes, I am," he replied. And then she awoke.

Reading the details of Jamison's journey was heart wrenching, but the overall tone of the work was one of hope. Jamison said one regret she had was giving away her classical music collection because "Beethoven and Schumann hit me." Jamison told the crowd that in literature grief is talked about for what it can do while in medical literature, most of the focus is on what grief is and not what it does.

She compared grief and its benefits to a visit to the Natural History Museum in Washington, where she saw a group of stuffed owls. "I would have preferred to have seen them in life, or to take a mouse to beak," she said. "Had it not been for their deaths I could not have seen what made them live. Death had something to give. Grief lashed as it is to death instructs, and preserves the salient past. There is a grace in death: there is life."

Mendelssohn

The discussion then centered on composer Felix Mendelssohn and the effect the death of his sister had on his music and his life. Dr. Guzelimian focused on a brief biography of the composer, followed by a discussion of his relationship with his sister, Fanny.

She was five years older that Felix, and was quite an impressive musician, having memorized all of Bach's "Well Tempered Clavier". The Julliard Provost mentioned that Felix and Fanny had "a private world together," in which each depended on the others understanding.

But in 1847, when Felix is at a point of what Guzelimian called "a point of staggering celebrity and activity" Fanny died suddenly of a stroke.

Felix then spiraled into a deep depression. Guzelimian then read a letter Mendelssohn wrote on May 19, 1847 just days after Fanny's death.

"'God help us,' was all he wrote," Guzelimian said. "Since yesterday I don't know what else to say and think' Mendelssohn wrote. For many days to come I shall not know what to write except but 'God help us.' I cannot write or think anything but Fanny," he said.

"He wrote to his brother in law," Guzelimian read, "and said 'we have nothing left now but to weep from our inmost hearts.'"

Dr. Guzelimian told in aching detail how Felix Mendelssohn sank into a deep depression, losing weight, becoming pale, and looking aged and stooped even though he was only 38. Mendelssohn's first burst of creativity was not in music, but in his paintings, including a series of watercolors, many of which feature images of water.

Within months, Mendelssohn was dead - from a stroke like his sister. Hauntingly, Mendelssohn had said "I shall die like Fanny." Clara Schumann wrote in her journal that his death was "an irreparable loss for all those who loved him."

"Other than a handful of works, the only large work he did shortly before his death was the string quartet in Fm," Guzelimian said. "The quartet is an extraordinary departure for Mendelssohn; it is an extreme piece matching the string quartets of Beethoven," he added.

The Julliard Dean said a series of repeated figures - including tremolos and bare octaves - punctuate the work. The music features a punctuation of what Guzelimian called "an unrelenting drive of vehemence and extraordinary energy - a profound expression of grief."

A couple of questions came to mind: is it our expectation that affects what we hear in a piece of music or does what we hear force us to think in a specific direction? Also, I wondered whether the Quartet in Fm was composed in a burst of emotion or did Mendelssohn take a more methodical approach to composition?

Either way, the audience got a chance to hear the first movement of the quartet performed by the Afiara String Quartet. The talent of these young musicians shone even in a work of great grief and despair. Jamison called it "restless, wild, agitated grief."

What is Grief? What is Depression?

Dr. J. Raymond DePaulo of the Johns Hopkins School of Medicine then spoke about the physiological aspects of grief. The world renowned scientist is known for his study on bipolar illness and a leading clinician treating biploar disorder.

DePaulo said grief or bereavement tendsto come in phases. "The experts tell me that they have different tenor, different meaning, but there is a progression of things, which makes it quite easy to distinguish from depression," he said.

The initial stage is shock which is a time when people are surrounded by family and friends doing the rituals associated with grief.

"That is usually followed by a period of profound and deep sadness. But even in those weeks with ups and downs that are really quite noticeable. It goes for some in weeks but for others months and quite longer," DePaulo said.

That period is followed by a time when the bereaved is beginning to function more normally, but "punctuated by tears of extreme sadness, tears, and memories of the lost loved one," DePaulo told the crowd. "I know mothers who have lost children who will tell me that 50 years later they will have these times of sadness," he said. "But as time goes on they have more of the fondness of recollection," he added.

"I guess the other point is that recently, Kay and I have talked a lot about the concept and a phrase that comes up, like complicated grief," he said. "In extreme forms, particularly in people who are vulnerable, one can be sick with grief. And that's when it becomes hard to tell the difference between grief and depression," DePaulo said.

DePaulo contrasted the experience of grief with depression where there is a change in mood, but "only half of patients would describe their mood as sad," DePaulo said. "There is often a loss of physical and mental vitality." And unlike grief, depression is persistent, with the waxing and waning being very small.

"And there is a marked change in one's self attitude," he said. "Patients with depression are often reported to be apologizing all the time," DePaulo added.

Other points include the classic course of depression is toward remission and relapses. Recovery occurs in about two years, but relapses are very common. DePaulo told the crowd that causes of depression can be the loss of a loved one, but also childbirth, life stress, Parkinson's disease, Huntington's disease, and high-dose steroids can trigger the disease.

The Hopkins scholar said grief and depression have to be differentiated and they teach their clinicians to discern between the two and act quickly. "We not only want to give solace to the bereaved, but we want to diagnose and treat depression," he said.

Questions and Answers

During a question and answer period, one questioner mentioned having feelings of grief, but he could not say what he was grieving. The questioner also wanted to know about animal grief. Jamison mentioned the grief of elephants and dogs.

"There is no reason to assume that our species is the only one," she said. "But we have not looked at it more clinically."

Another question from a jazz musician who is working on Parkinson's disease wanted to know about scientific research on what music produces in the brain, particularly music that produces grief.

"The evidence is there of an affect," DePaulo said. "One of the things I am excited about is that the functional brain imaging studies that are emerging do let us see the human brain at work doing things other than responding to a reflex hammer or walking down the street."

Guzelimian spoke about Oliver Sack's Musicophilia, which deals with the questions in depth. "He's also profoundly musical. One of my favorite quotes of his was that he said when he was five he decided his favorite things were Bach and smoked salmon and now that he is in his 70s he knows that those are his favorite things."

Another questioner spoke of the loss of his wife in January 2009 and said he was suprised that no one had told him of the process and the feelings of grief. He wanted to know the panel's thoughts about the ongoing loss suffered in wars and terrorism.

Jamison repsonded that looking at great epidemics like plague or the flu or WWI shows a wide variety of reactions.

"Some people just never talked about it till they died. Others had what we call post-traumatic shock, and others never got over it, " she said.

DePaulo added "there is a adjustment of some sort, so that for example kids can go out and play when the killing stops ... it's not to say that these things don't have a cumulative and profound effect, but there appears to be an attenuation of the immediate response," he said. "They have got to go one they have got to survive."

One question spoke about music therapy, and Dr. DePaulo asked her whether the quality of the music made a difference. She said it did make a huge difference.

I asked the panel about the cathartic effects of music on those who are grieving, and I asked the musicians about playing a piece like Mendelssohn's Fm quartet, whether they had to identify emotionally with the piece to play it.

One player said the reason he plays is because it has all these powerful emotional connection and understanding things like timing and dynamics and sound colors a musician needs to understand both the composer's intention and their own emotional attachment to the piece. The cello player said that he lost his father at 12 and that was what pushed him to want to take the instrument more seriously.

"I found an outlet in the music," he said. "No so much redemption, but the beginning of a language that was wiser than my command of English. From there I tried to understand the depths of what Beethoven was saying, what he was going through when he wrote the piece."

Dr. Guzelimian told of his surgery a few years ago, and how he put together an "Emergency kit" of music. "One of the pieces I chose for myself was an aria from Bach's Cantata No. 82 "I have had enough',"he said.

"Initially I thought 'why am I choosing this?' but there is something profound about Bach's faith and that was what I was listening to when the anesthesia took hold. About a month after that my closest friend died and it took me months before I could listen to that piece again," he said.

"I could use that piece to talk about the philosophical subject of my own death, but I couldn't for my friend. Any music that really mattered to me for the longest time unlocked things that I wasn't able to absorb and deal with. And there was a real progression of the grief."

As in all of these talks, I found myself wishing that the discussion could go one for several more hours, particularly with several glasses of our favorite beverage. I look forward to the remaining lectures.