TRANSACTIONS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION, VOL. 127, 2016
THE BERT AND PEGGY DUPONT LECTURE MUSIC AND MEDICINE: GEORGE GERSHWIN RICHARD KOGAN, MD NEW YORK, NEW YORK
Music and medicine are generally regarded as separate disciplines nowadays, but it wasn’t always that way. The ancient Greeks designated Apollo as the god of both medicine and music, and in many primitive cultures the roles of physician and musician were played by the same person. The shaman sometimes used medical instruments and sometimes used musical instruments, but his clear goal was to be an agent of healing. Music and medicine eventually drifted apart and each of these domains became increasingly specialized. Something has been gained by the increase in specialization, but my concern is that something has also been lost. It is vital for those of us in the medical community not to lose sight of music’s remarkable capacity to reduce pain, to soothe anxiety, and to lift spirits. The life of the American composer George Gershwin (1898−1937) is an excellent example of the benefits of a perspective that incorporates both medicine and music. He had a childhood that could easily have gone off the rails were it not for the introduction of music as a force for healing, and toward the end of his life he had an illness that had a significant impact on his creative process. George Gershwin was the second oldest of the four children of Rose and Morris Gershwin. George demonstrated significant behavioral problems as a youngster. A hyperactive child, he regularly engaged in fist fights, stole food from pushcarts, vandalized property, and set fires. His aunt described him as a “wild boy,” and his father predicted that George would “grow up to be a bum.” He was a poor, inattentive student who had trouble sitting still in the classroom. His older brother Ira was George’s temperamental opposite — Ira was shy, soft-spoken, calm, and an excellent student. A modern-day psychiatrist examining the young George Gershwin would have likely diagnosed him with conduct disorder or attention-deficit hyperactivity disorder and might have started him on a Correspondence and reprint requests: Richard Kogan, MD, Clinical Professor of Psychiatry, Weill Cornell Medical College, 30 Central Park South, Suite 13A, New York, NY 10021, Tel: 212-744-3324, Email: [email protected]. Potential Conflicts of Interest: None disclosed.
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psychostimulant medication. But without any professional intervention, Gershwin made a remarkable behavioral transformation. When he was 10 years old, he heard a classmate, violinist Max Rosenzweig, perform Dvorak’s Humoresque. He was utterly transfixed by the beauty of these sounds and vowed that he would devote the rest of his life to the study of music. The fist fights and stealing stopped once he persuaded his parents to allow him to take piano lessons and devote all his considerable energy to the pursuit of a music education. The George Gershwin story is a wonderful illustration of music’s capacity to truly transform the lives of youngsters. Gershwin summed up his childhood succinctly: “Studying the piano made a good boy out of a bad one.” Gershwin dropped out of school at age 15 and took a job as a song plugger promoting the songs under contract at Remick’s, a music publishing house on Tin Pan Alley. He eventually began writing his own songs with his brother Ira as lyricist. The brothers had an extraordinarily close relationship throughout their lives together. George and Ira became a successful songwriting team almost immediately, but George had greater ambitions. He wanted to write a largescale instrumental work which combined elements of jazz, classical, and pop — genres which at that time were considered to be distinct. On a trip to Boston to attend the premiere of the Gershwin musical Sweet Little Devil, the then 25-year-old George Gershwin concentrated on the sounds of the train — the whoosh of the steam engine, the steely clicks of the train on the tracks — and as he listened to these sounds, the entire construction of Rhapsody in Blue revealed itself to him. Gershwin throughout his life had an astonishing ability to extract music out of what others would have considered to be merely noise. In 1928, he visited Paris and noticed that the Parisian taxi horns sounded different than the taxi horns he was accustomed to hearing in New York City. When he composed the symphonic poem An American in Paris, he incorporated the exotic-sounding Parisian taxi horns into the orchestral score. Rhapsody in Blue dazzled the audience that heard it at its world premiere performance on February 24, 1924 (see video clips 1 and 2 listed below). The mood and tenor of the work is consistent with Gershwin’s hyperactivity, which persisted for his entire life. Parts of Rhapsody in Blue are difficult to imagine being composed by someone who was not hyperactive (e.g., Video clip 2 at 4:20). Gershwin’s hyperactivity was also apparent in his performance style. He played even his most melodious songs in a fast tempo and an animated, clipped manner, explaining “We are living in an age of staccato, not legato.” I believe that Gershwin may have been living in a central nervous system of staccato and not legato.
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In spite of the hyperactivity, the adult George Gershwin would not have received an attention-deficit hyperactivity disorder diagnosis if he underwent a 21st century psychiatric evaluation. By this point he had an excellent attention span and was no longer prone to impulsive behavior. And unlike so many children who demonstrated behavior consistent with conduct disorder, Gershwin had no signs of antisocial personality disorder as an adult. In 1934, on a tour in which he performed Rhapsody in Blue in 28 cities across America, the 35-year-old Gershwin reported smelling burning garbage, apparently an olfactory hallucination that may have been the first sign of the temporal lobe malignancy that would eventually kill him. Increasing depression, anxiety, and a variety of somatic complaints led Gershwin to a consultation and treatment with psychoanalyst Dr Gregory Zilboorg. Dr Zilboorg was the first of a series of physicians who missed the brain tumor diagnosis. During the year and a half that Gershwin was in treatment with Dr Zilboorg, he composed his operatic masterpiece Porgy and Bess. Porgy and Bess focuses on somber themes such as poverty, social injustice, racism, and death. It represented an enormous artistic stretch for a composer whose previous output consisted primarily of peppy love songs and flashy concert pieces. It is conceivable that mood changes associated with the temporal lobe malignancy contributed to the emotional depth and profundity of such songs as My Man’s Gone Now, Summertime, and Bess You Is My Woman Now (see video clips 3 and 4). After Porgy and Bess ended its run on Broadway, Gershwin moved to Southern California to become a composer of Hollywood film scores. While living in Beverly Hills, the neurologic symptoms worsened — he had repeated episodes of smelling burning rubber, he had difficulty holding utensils, his piano playing and general motor coordination deteriorated, and he exhibited volatile moods. After weeks of unremitting headaches, he was brought to Cedars of Lebanon Hospital, where he was examined by an internist and neurosurgeon and discharged with a diagnosis of hysteria. On July 9, 1937, Gershwin fell into a coma and was rushed back to the hospital, where he had surgery to remove a large glioblastoma in his right temporal lobe. He died 2 days after the hospital admission. Gershwin’s untimely death at age 38 is one of the great tragedies in music history. Given the steady development of his skills as a composer, it boggles the mind to imagine what he might have produced had he lived out a normal life span. George Gershwin lived a life that is a testimony to the power of music. Part of the reason that his physicians and friends missed the
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diagnosis is that he continued to compose great music right up until the final weeks of his life. The gorgeous final song that George and Ira wrote together carries the bittersweet title Our Love is Here to Stay.
BIBLIOGRAPHY Gilbert, Steven. The Music of Gershwin. New Haven, Connecticut: Yale University Press, 1995. Jablonski, Edward. Gershwin. New York, New York: Da Capo Press, 1987. Peyser, Joan. The Memory of All That: The Life of George Gershwin. New York, New York: Billboard Books, 1998. Pollack, Howard. George Gershwin: His Life and Works. Berkeley: University of California Press, 2006.
Video Clips 1. https://www.youtube.com/watch?v=01EKwZl2NoQ 2. https://www.youtube.com/watch?v=1-v1nq3gvc0&list=RD1-v1nq3gvc0#t=21 3. https://www.youtube.com/watch?v=rkxLcVoBDRE 4. https://www.youtube.com/watch?v=LNkAKfe1Ygo
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THE BERT AND PEGGY DUPONT LECTURE MUSIC AND MEDICINE: GEORGE GERSHWIN RICHARD KOGAN, MD NEW YORK, NEW YORK
Music and medicine are generally regarded as separate disciplines nowadays, but it wasn’t always that way. The ancient Greeks designated Apollo as the god of both medicine and music, and in many primitive cultures the roles of physician and musician were played by the same person. The shaman sometimes used medical instruments and sometimes used musical instruments, but his clear goal was to be an agent of healing. Music and medicine eventually drifted apart and each of these domains became increasingly specialized. Something has been gained by the increase in specialization, but my concern is that something has also been lost. It is vital for those of us in the medical community not to lose sight of music’s remarkable capacity to reduce pain, to soothe anxiety, and to lift spirits. The life of the American composer George Gershwin (1898−1937) is an excellent example of the benefits of a perspective that incorporates both medicine and music. He had a childhood that could easily have gone off the rails were it not for the introduction of music as a force for healing, and toward the end of his life he had an illness that had a significant impact on his creative process. George Gershwin was the second oldest of the four children of Rose and Morris Gershwin. George demonstrated significant behavioral problems as a youngster. A hyperactive child, he regularly engaged in fist fights, stole food from pushcarts, vandalized property, and set fires. His aunt described him as a “wild boy,” and his father predicted that George would “grow up to be a bum.” He was a poor, inattentive student who had trouble sitting still in the classroom. His older brother Ira was George’s temperamental opposite — Ira was shy, soft-spoken, calm, and an excellent student. A modern-day psychiatrist examining the young George Gershwin would have likely diagnosed him with conduct disorder or attention-deficit hyperactivity disorder and might have started him on a Correspondence and reprint requests: Richard Kogan, MD, Clinical Professor of Psychiatry, Weill Cornell Medical College, 30 Central Park South, Suite 13A, New York, NY 10021, Tel: 212-744-3324, Email: [email protected]. Potential Conflicts of Interest: None disclosed.
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psychostimulant medication. But without any professional intervention, Gershwin made a remarkable behavioral transformation. When he was 10 years old, he heard a classmate, violinist Max Rosenzweig, perform Dvorak’s Humoresque. He was utterly transfixed by the beauty of these sounds and vowed that he would devote the rest of his life to the study of music. The fist fights and stealing stopped once he persuaded his parents to allow him to take piano lessons and devote all his considerable energy to the pursuit of a music education. The George Gershwin story is a wonderful illustration of music’s capacity to truly transform the lives of youngsters. Gershwin summed up his childhood succinctly: “Studying the piano made a good boy out of a bad one.” Gershwin dropped out of school at age 15 and took a job as a song plugger promoting the songs under contract at Remick’s, a music publishing house on Tin Pan Alley. He eventually began writing his own songs with his brother Ira as lyricist. The brothers had an extraordinarily close relationship throughout their lives together. George and Ira became a successful songwriting team almost immediately, but George had greater ambitions. He wanted to write a largescale instrumental work which combined elements of jazz, classical, and pop — genres which at that time were considered to be distinct. On a trip to Boston to attend the premiere of the Gershwin musical Sweet Little Devil, the then 25-year-old George Gershwin concentrated on the sounds of the train — the whoosh of the steam engine, the steely clicks of the train on the tracks — and as he listened to these sounds, the entire construction of Rhapsody in Blue revealed itself to him. Gershwin throughout his life had an astonishing ability to extract music out of what others would have considered to be merely noise. In 1928, he visited Paris and noticed that the Parisian taxi horns sounded different than the taxi horns he was accustomed to hearing in New York City. When he composed the symphonic poem An American in Paris, he incorporated the exotic-sounding Parisian taxi horns into the orchestral score. Rhapsody in Blue dazzled the audience that heard it at its world premiere performance on February 24, 1924 (see video clips 1 and 2 listed below). The mood and tenor of the work is consistent with Gershwin’s hyperactivity, which persisted for his entire life. Parts of Rhapsody in Blue are difficult to imagine being composed by someone who was not hyperactive (e.g., Video clip 2 at 4:20). Gershwin’s hyperactivity was also apparent in his performance style. He played even his most melodious songs in a fast tempo and an animated, clipped manner, explaining “We are living in an age of staccato, not legato.” I believe that Gershwin may have been living in a central nervous system of staccato and not legato.
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In spite of the hyperactivity, the adult George Gershwin would not have received an attention-deficit hyperactivity disorder diagnosis if he underwent a 21st century psychiatric evaluation. By this point he had an excellent attention span and was no longer prone to impulsive behavior. And unlike so many children who demonstrated behavior consistent with conduct disorder, Gershwin had no signs of antisocial personality disorder as an adult. In 1934, on a tour in which he performed Rhapsody in Blue in 28 cities across America, the 35-year-old Gershwin reported smelling burning garbage, apparently an olfactory hallucination that may have been the first sign of the temporal lobe malignancy that would eventually kill him. Increasing depression, anxiety, and a variety of somatic complaints led Gershwin to a consultation and treatment with psychoanalyst Dr Gregory Zilboorg. Dr Zilboorg was the first of a series of physicians who missed the brain tumor diagnosis. During the year and a half that Gershwin was in treatment with Dr Zilboorg, he composed his operatic masterpiece Porgy and Bess. Porgy and Bess focuses on somber themes such as poverty, social injustice, racism, and death. It represented an enormous artistic stretch for a composer whose previous output consisted primarily of peppy love songs and flashy concert pieces. It is conceivable that mood changes associated with the temporal lobe malignancy contributed to the emotional depth and profundity of such songs as My Man’s Gone Now, Summertime, and Bess You Is My Woman Now (see video clips 3 and 4). After Porgy and Bess ended its run on Broadway, Gershwin moved to Southern California to become a composer of Hollywood film scores. While living in Beverly Hills, the neurologic symptoms worsened — he had repeated episodes of smelling burning rubber, he had difficulty holding utensils, his piano playing and general motor coordination deteriorated, and he exhibited volatile moods. After weeks of unremitting headaches, he was brought to Cedars of Lebanon Hospital, where he was examined by an internist and neurosurgeon and discharged with a diagnosis of hysteria. On July 9, 1937, Gershwin fell into a coma and was rushed back to the hospital, where he had surgery to remove a large glioblastoma in his right temporal lobe. He died 2 days after the hospital admission. Gershwin’s untimely death at age 38 is one of the great tragedies in music history. Given the steady development of his skills as a composer, it boggles the mind to imagine what he might have produced had he lived out a normal life span. George Gershwin lived a life that is a testimony to the power of music. Part of the reason that his physicians and friends missed the
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diagnosis is that he continued to compose great music right up until the final weeks of his life. The gorgeous final song that George and Ira wrote together carries the bittersweet title Our Love is Here to Stay.
BIBLIOGRAPHY Gilbert, Steven. The Music of Gershwin. New Haven, Connecticut: Yale University Press, 1995. Jablonski, Edward. Gershwin. New York, New York: Da Capo Press, 1987. Peyser, Joan. The Memory of All That: The Life of George Gershwin. New York, New York: Billboard Books, 1998. Pollack, Howard. George Gershwin: His Life and Works. Berkeley: University of California Press, 2006.
Video Clips 1. https://www.youtube.com/watch?v=01EKwZl2NoQ 2. https://www.youtube.com/watch?v=1-v1nq3gvc0&list=RD1-v1nq3gvc0#t=21 3. https://www.youtube.com/watch?v=rkxLcVoBDRE 4. https://www.youtube.com/watch?v=LNkAKfe1Ygo
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