>> Michael Andor Brodeur: Hi everyone. Are you having a good day so far? >> Yes. [Applause] >> Michael Andor Brodeur: Okay, good. So, we're going to try to make this better. This is not my panel. It's not about me. But I want to start with a personal note. Nearly 7 million people in America live with some sort of neurodegenerative disease or disorder, which means that more people are being affected by these disorders as caretakers or as friends, loved ones or relatives. So, my path to this panel is very personal, because I lost my mother to Alzheimer's last year, and music was such a huge part of how we connected, even as she lost language. So I'm so glad that there's two beautiful, well-constructed, beautifully written books like this, because there's going to be more of us that need this information and these stories. So, I just wanted to start out with that. I think a lot of people will find a personal way into these books just by living your life. So, thank you two for writing these books. That's how I would start. That said, I would like to know from each of you what your personal entry point into this topic was. Now, obviously, you're a performer and a singer, Renee, but what was it about music as medicine that first got you interested in pursuing this? >> Rene Fleming: Well, I had difficulties in my own career with somatic pain. So performance pressure was really difficult for me, especially for hard, high pressure performances. Some of you can maybe have some sense of what it would be to sing on the stage repertoire that's been known for 300 years and people having strong opinions about it, critic aside [Laughter] And it's a lot of pressure. So anyway, I would have this awful pain that would make me believe that I could not sing, and then it would lift magically the minute I walked on stage. But the torture for the two weeks leading up to it was difficult. So I did a lot of research. I discovered mind body connection, Doctor Sarno I discovered I also realized that people were scientists were studying the brain and music and various aspects of music and health. And I met Doctor Francis Collins at a dinner party and asked him why. And this started an entire new project for me that's become an extraordinary passion. >> Michael Andor Brodeur: And what about you, Daniel? How did-- You know, obviously, coming as a musician, as a neuroscientist, how did it connect with you personally? Was there a trigger in your own life? >> Daniel J. Levitin: It's interesting. There was a kind of pivotal moment. Uh, my grandmother, my mother's mother was born in Berlin as a Jewish woman during the Nazi occupation and escaped in 1939, just barely with her nuclear family. Everybody else was gassed and she came to America, and on her 80th birthday in 1977, she happened to mention to my mother and me that how much, she was talking about how much she loved this country that had taken her in and allowed her to raise three beautiful girls, and that she sang God Bless America every morning, a song written by another Jewish immigrant, Irving Berlin, and it filled her with joy to be able to do it. And so, my mother and I went out and got her a little Casio electronic keyboard, and we put pieces of tape on it with numbers. One, two, three, four, five, six so that she could play the song and we gave it to her for her birthday present, and on her 81st birthday, she had removed the tape because she had memorized what to play. And by her 82nd birthday, she had worked out a kind of rudimentary left-hand harmony. And she lived to be 97. She played that keyboard every single morning with gratitude and lived to be 97. And we know from the teachings of the Dalai Lama and the neuroscientist colleagues of ours who've studied people who practice gratitude meditation, that gratitude is one of the strongest forces contributing to quality of life. Being happy for what you have, not thinking about what you don't have. And so, I saw in a very deep and personal way, the power that music had in my grandmother's life. And then around the time that you had met Francis Collins, my friend Joni Mitchell had an aneurysm and lost her ability to speak and to move, and it was music that helped bring her back. Back to the biggest stages in the country now. And so, yeah. >> Rene Fleming: I was her greatest fan when I was a teenager and in my 20s. So that's a wonderful connection that we have actually. >> Michael Andor Brodeur: There's a chapter that covers Joni Mitchell's personal playlist when she was in recovery, and one of the most interesting things about that was this idea that for patients who have experienced brain trauma or going through some sort of neurodegenerative disease, songs that they choose tend to have a more effective, relaxing effect or calming effect on them than what you call off the shelf relaxing music. Could you talk a little bit about that distinction? >> Daniel J. Levitin: Yeah, so when we talk about music therapy, as Renee says, you know, ask your doctor if music therapy is right for you. [Laughter] >> Rene Fleming: That's the advertisement I'm waiting to see. [Laughter] >> Daniel J. Levitin: Music therapy to be effective, has to be personalized because our musical tastes are idiosyncratic and subjective, and they change over time. And we know from brain scans that people listening to different pieces of music, wildly different, opera, third world music is, as it used to be called, or basically indigenous people's music, jazz, country, heavy metal, it doesn't matter. You can get identical brain activity across these different kinds of music. If it's music you like, it still activates the pleasure centers. And so, um, it's not that different than what we're going to see coming down the pike with conventional medication. In the in the next five years, they'll be able to sequence your genome. They're already doing it for some cancers, but in five years they'll be able to sequence your genome. If you've got cancer, specify a particular prescription for your genotypical cancer, not just a broad-spectrum thing. And so, we'll be doing that with music. We'll be looking at what kind of music you enjoy and applying it to things like Parkinson's disease, depression, multiple sclerosis chronic pain, post-traumatic stress disorder. >> Rene Fleming: Well, my understanding too is that the music that you like that's most powerful, especially later in life with dementia or Alzheimer's disease, is music that you loved when you were 16, when you were a young person and somebody explained that that's because that's when we form our forming strong social relationships. You're sharing that and it's salient. Do you have anything to add to that? It's so wonderful to sit next to Dan, who's such a brilliant neuroscientist. >> Daniel J. Levitin: I didn't win a Fulbright, though. I couldn't even win a half bright. [Laughter] >> Rene Fleming: Yes, I am very grateful for my Fulbright. I wouldn't be a Strauss specialist if I didn't have it. So. >> Daniel J. Levitin: So, the primary mission of the brain between the, for the first 15 years of life or so, is to create as many neural connections as possible. An infant brain might make a million connections in a day. That's how rapidly things are changing. And your brain is literally wiring up to the experiences that surround you, including music. After the age of 15 or so, the primary mission of the brain shifts to prune out unneeded connections. And of course, it doesn't mean you can't learn anything after that age. But learning takes on a wholly different quality, which is why most people who learn to speak a foreign language after the age of 15 or 16, end up speaking it with an accent. They can be fluent in it, but they still have that accent. And so, yes, with Alzheimer's, we're talking about a disease that causes neuro degradation of memory in many cases. And the most recent memories are the ones that go first, and it kind of works backwards. We've seen patients now who no longer recognize their spouse or their children, or will walk by a mirror and not recognize themselves, and the tragedy of it is not, as you were indicating at the beginning of the session, it's not isolated to them. It's horrible enough for them. But their loved ones and their caregivers have a terrible time because they are agitated. They look in the mirror. They don't know who that is. They they gesture, they think the person is mocking them. I mean, yeah, it's terribly. And so, a lot of what happens in old age homes, assisted living facilities is medication to reduce their aggressive and agitated tendencies. And as you say, music from their youth is something they recognize. It restores their connection to themselves. >> Rene Fleming: Can you share what your mother most loved? >> Michael Andor Brodeur: Yeah. I mean, for us, it was interesting. I know you caution against the idea of taking the metaphor of the map to literally when applying it to the brain, like, this happens here and this happens there. But for us, music was a way. It was almost like a backdoor to the house that was left open where no one used the front door anymore. So, using old Irish songs that she sang in her childhood, songs that she associated with meeting my father, all of those she knew, all the lyrics and right to life. >> Daniel J. Levitin: What was the effect on her? If she was like other patients, I'm imagining that the effect lasted after the music stopped. >> Michael Andor Brodeur: It did. It did. Especially during Sundowning. Sundowning is the period like later in the day when dementia patients start really kind of coming undone in a lot of ways. Music would bring her back to the road. It would calm her down. We could redirect. Music became an essential part of not just the strategy of how to care for her, but how to care for ourselves in the process. >> Rene Fleming: That's wonderful. >> Daniel J. Levitin: I've often thought that we should all make playlists and leave them with our wills or our advanced medical directives >> Rene Fleming: True. True, If we're lucky enough to live long enough that we need that. >> Michael Andor Brodeur: Uh, can I ask about the relationship between artists and scientists? One magnificent thing about Renee's book is it's sort of a virtuosic work of editing in that it claims to be an anthology, but it really becomes this giant story that brings in medical research, personal essays, a couple of experimental pieces in there, in both senses. And it all works. And there's something about the magnetism between artists and scientists that I think is unexpected to a lot of people, but seems like a very fruitful place for very productive research to start. >> Rene Fleming: Well, first of all, it's a singing around the world. My whole career I used to wonder, wow, how is it that I always get great doctors wherever I go, you know, anywhere in the world? And I finally said, oh, they're all amateur musicians, so they know who I am. So, they're, you know, they're happy to sort of help me if I have a sore throat or something. But I wanted artists to be part of this storytelling. I mean, certainly Rosanne Cash is one, authors Ann Patchett and Richard Powers, who are so brilliant. But we also have we have Mark Morris, we have dance, we have architecture with Liz Diller and Anna Deavere Smith talking about her history with playwriting because and becoming her. So, there are a lot of different ways in with this. And some of my most, the most moving chapters are young people who saw a need in their communities, and they created an initiative that not only thrived but helped so many people. Francisco Nunez in New York with a choral group for young people. Sanford Thomas in Philadelphia with play on Philly and they're moving. Tom Sweitzer, the music therapist in Middleburg who's created a whole community center for everyone. So, there's a little bit and a lot of science, of course. So, I loved putting this together and drawing on my history, you know, brief history within this field. But what I especially love is that I always tell people, start with Ani Patel, who talks about evolution, because that was my way in, because I couldn't figure it out. Why is this working? Why are scientists looking at the arts and at music? And that was the explanation for me. And so that's right in the beginning. And then of course, Dan's chapter on neuroanatomy. So those are two crucial chapters, I think, and Nina Krauss on sound. Then you can kind of explore and just look at whatever interests you. Childhood development, pain Definitely disorders of aging, movement disorders, but also, depression, mental health. I mean, it really touches on everything. Frankly, it can have a positive effect on us throughout the entire lifespan. That's what's so beautiful about this. And it saves a lot of money in health care. If we finally can get it kind of distributed throughout all of our initiatives and hospitals, etc. >> Michael Andor Brodeur: Why? I mean, given the long history of this unlikely seeming relationship between music and medicine, you point out in the book that Apollo is both the god of music and medicine. Why is it taking so long for this to be to transcend what's called soft science? Where does this hesitation come from, and why isn't music already part of our primary therapeutic arsenal? >> Rene Fleming: Well, that's changed dramatically in the last 6 or 7 years. I don't hear soft science nearly as much as I did in the beginning. But Dan, you probably have a better answer to this because you are in both. >> Daniel J. Levitin: Well, I mean, in one sense, maybe it's a public policy question and I'm just a simple country neuroscientist. I don't really understand how public policy gets made. But you're in Washington. You're closer to-- I don't know how the government or big health care organizations make decisions, but I can talk about on the science side why, it was a late bloomer, and that is that scientists want to conduct experiments where they hold as many variables constant as possible, and then just manipulate a single one so that they know that that's the thing that had a difference. And so, I mean, the obvious example is with medication, we take 100 people who have as near as we can figure, identical headaches, and we give half of them an aspirin and we give half of them a placebo, a pill with nothing in it that looks just like the aspirin, and the doctor doesn't know which one is being given and the patient doesn't know which we're getting. And we wait and see. And when you do that, experiment with opiates, by the way, for, you know, severe pain beyond the aspirin headache, opiates work 40% of the time and the placebo works 38% of the time. So that's a very thin margin. And so, when you're talking about studying music, the field made the mistake for decades of playing everybody the same song. >> Rene Fleming: Right, right. >> Daniel J. Levitin: Whether they liked it or not and whether they had the same emotional reaction to it or not in an attempt to hold everything constant. And you know, that kind of set us back. >> Rene Fleming: The other thing that, I think, the integrative medicine movement has really helped us tremendously, this notion that we are whole people, that we have to treat the whole person and that we are also and this is really understood now, mental health figures into our health in a very meaningful way. Covid taught us a lot about the power of the arts, and we saw it immediately when the pandemic began that people wanted to communicate. They really wanted to reach out that we are social beings who need. And we're also, we know now tribal beings, but we need to really connect through this artistic lens. So, I think that that's helped us a lot as well. >> Daniel J. Levitin: Do we have any librarians here? [Applause] >> Rene Fleming: Thank you. >> Michael Andor Brodeur: Let's shout out to librarians. >> Daniel J. Levitin: I just wanted to say I can't do my work without librarians. Librarians, and people think of librarians as the ones who shushed you in elementary school. But no, they in universities and in public libraries, they have a great deal of expertise that the rest of us lack. And I mentioned librarians because librarians tell me, and then corroborated by booksellers, that during the pandemic, the number one kind of book that was checked out and according to Amazon, the number one kind of book that was sold were coloring books. People suddenly had kids at home and they wanted to make art. >> Rene Fleming: I recommend your brain on art. If you didn't read that last year, and the Neuroarts blueprint, which really starts with that whole broad theme. It's an umbrella of aesthetic experiences, beginning with nature. So, I am the poster child this year because I knew it was going to be a hard year, an election year, etc. and I said, I am not going to spend all day on my phone. I'm going to give myself the gift of aesthetic experiences every day, whether it's theater or music or a walk in the park. And boy, do I feel better. Yeah. So doodling. Coloring. Absolutely. I recommend it. >> Michael Andor Brodeur: In Renee's book, in your essay and on Rene's book, you write about how dementia is not or music is not, this thing that's encapsulated by one word. It's this complex system of interacting forces. And I had to write this down because there was no way I was going to memorize this. The quote is music is a model system for understanding what genes can accomplish and how they relate to experience. Now, at first, I giggled when I read that because that's not how I've ever thought about music as a critic. But the more I thought about that framing, the more I enjoyed it. And I wondered if you could unpack that thought a little bit. >> Daniel J. Levitin: Well, so the work that we do as scientists and a lot of the work that artists do is funded by the government through the National Endowment for the Arts or through the National Institutes of Health. >> Michael Andor Brodeur: Government. >> Rene Fleming: Yay! [Laughter] >> Daniel J. Levitin: And when my colleagues and I want to study music in the brain or music in health we have to justify why we're doing it. We can't just say it should be obvious that this is important and that you should give us money to run these studies. So that line came out of a grant application. It's a model system for studying genetics. [Laughter] And it is, I mean, it's not the way I think of music either. But you know, if I've got some administrator thinking, why should we give money to this and not to cigarette smoking or the genetics of athleticism or something? Music is different than cigarette smoking or athletics in a very important way. It activates every area of the brain that has so far been mapped, and it's something that feels very personal to most of us as listeners. It's something at which we can excel if we choose to like athletics, it's something that gives us pleasure, like cigarette smoking, although it's non addictive. And so, it is a model system. Any question you would want to ask about how the brain works. How do we remember things? How do we categorize them? How do we learn them? How do we orchestrate movements to something? All of that. How do we make decisions? Memory. >> Rene Fleming: Memory is a huge part of this too. But I think, you know, I love hearing you talk about this because this activation of more parts of the brain, this is what Francis Collins, Doctor Collins said to me the first time I met him, I said, why are scientists studying music? And he said, because music activates more parts of the brain. We have a brain institute. We want to understand the brain. This is a great way to do it. So, we're looking for these activities that in an in an FMRI or some sort of-- Technology has really made this possible by the way, the changing technology, we want to be able to see what's happening in the brain. >> Daniel J. Levitin: That's the other thing that caused a change. In 1998, the very first brain scan study was conducted. The technology was invented by Marcus Rakell, who, not coincidentally, is a violinist at Washington University in Saint Louis, and his colleagues. And what they did was they used a scanner that had been used to look for things like cancer or broken legs, and they put people's heads in it, and they watched where the blood was flowing as people were asked to do certain tasks. So, when you pick up the Washington Post or The New York Times and you see these pictures of brains with different colors, what you're looking at is blood flow. The idea is that the part of the brain that's doing the most work needs the most blood. It's carrying oxygenated glucose, that's the fuel. And so, Marcus had people mentally practice their tennis serve or think about how would you use a hammer. And they're visualizing going like this. And then a part of the brain lights up that they're doing this. And, you know, some of the earliest studies were people listening to music and suddenly we had an objective biological measure of music. >> Rene Fleming: And so, I did one at the National Institutes of Health that had me imagining singing and speaking and imagining singing was by far the most powerful in my brain, which really surprised all the scientists who were analyzing it. But then they said, well, you're a singer, so singing probably wasn't such a big deal. Right. So, but it was-- I said they should have done an experiment with a non-singer right after me. They could have, but I was in the machine for two hours. >> Daniel J. Levitin: This experiment has been done actually. >> Has it? >> So, when we put people in a scanner and we ask them to imagine music, and then we have them actually listen to it, the brain scans are almost indistinguishable. Imagining and listening use the same circuits. And so, the quality of the match has to do with how well you can imagine it. And you don't have to be a musician to imagine music vividly, and not a lot of non-musicians do that, and a lot of musicians don't because they don't have to. They can read the notes on the page. >> Rene Fleming: Right, right. Yeah. It's so fascinating who we are as artistic creatures who can play instruments. Now they make instruments that can be played >> Daniel J. Levitin: In the magnet. Yeah. >> Rene Fleming: And I love the studies about improvisation, for instance, because speech is a kind of improvisation. But improvisation shows that you have to shut off the whole frontal part. You could just mention that because I think that's so fascinating. The part of your brain that judges yourself has to be turned off for you to be able to improvise. >> Daniel J. Levitin: That's basically it in a nutshell. This is one of the most exciting findings in our field in 20 years. Charles Limb, who was then at Hopkins here in D.C. he's now at UC San Francisco running a Sound Health Network center. Charles Limb is an MD and a surgeon, also a jazz pianist. And he wondered when jazz musicians are improvising over the most complicated chords, What's going on in the brain? And all of us thought, oh, well, there's all kinds of parts of the brain we've never mapped before that are coming online because it's so hard to do. So you had musicians sit in the scanner, and he played them chord changes that were very complicated and they'd never heard before. And they're playing the piano. And he didn't find activity in some new area and he didn't find peaks of activity. What he found was that there was a whole area of the brain, as you mentioned, up here, that had to shut down. And that's the inner critic, the part going, you're not good enough. Who told you to play that note? That stinks. You know, in order to be an improviser, you have to just go with it. >> Rene Fleming: It's a flow state, right? >> Yeah. >> Michael Andor Brodeur: The composer Tod Machover at MIT. I was fascinated by his chapter in your book, Bringing Up This Frequency. Your book is called I Heard There Was a secret Chord. This is a secret frequency that's low 40Hz frequency that apparently has almost a regenerative effect on on some of these dead cells. >> Rene Fleming: It cleans up plaques and tangles. If you listen to this 40Hz vibration or and also look at it so it's in light and sound. If it's got to be exactly right. And they're doing a lot of studies on it now. And in fact I think it's going through an approval process. So you're going to be able to go into CVS in a few years and go into a booth and have your brain cleaned up. Wouldn't we love that? Or go to a concert and have 40Hz music? >> Daniel J. Levitin: It'll be like roto-rooter for the brain. >> Rene Fleming: Yes. [Laughter] Tod has written a piece actually with a 40Hz bass. And I finally recorded a vocal version of it for him, too. So you could actually go to a concert and have the same effect. >> Michael Andor Brodeur: There was another scientific aspect of sound that Daniel's book had my head spinning thinking about is that the information that we call sound isn't really sound until it encounters your brain. So as a critic, this is very unsettling. [Laughter] >> Sorry about that. >> No. That's okay. It's not your fault. But I believe the phrase is the cohesion of the signal is always effectively an illusion. And that sound is the product of your brain. Could you tell me more about that? >> Rene Fleming: Kraus does these great experiments playing back how your brain sounds listening to something and children who've had strong musical education and played an instrument, for instance, the sound of what's played back has much more clarity to it. So it really does affect the lasting changes in the brain after two years of music study in a child. >> Michael Andor Brodeur: Wow. That's wild. >> Rene Fleming: I'm sure you have more to say about that. >> Michael Andor Brodeur: I would love to hear more about this, because the idea of sound being something that we are generating by listening to it, it certainly recalibrated my sense of myself as a listener, as did, you know, the music therapy that we did with my mother completely recalibrated the work that I do. You know, my job is to go and listen and evaluate and sort of take this kind of cold, objective view of music, seeing what it did for both my mother and the other women that were in the wing of her memory care center, the transformative effect that it had, I have no choice but to view music as a medicinal substance now, as this thing that we do not fully understand but that we throw ourselves into. >> Rene Fleming: I mean, that's why I feel evolution is the way in. It's been with us since before speech, and most of most of history before we could write was passed down, either in poetry or in song. So it is just very powerful. We just don't evolve quickly. And so it's all still there. So that's why these things can be so healing. And so really beneficial to us. >> Daniel J. Levitin: And some of the oldest artifacts we find in burial sites, even pre-human burial sites. Neanderthal burial sites are musical instruments. Yes, bone flutes and things like that. But to get to your point about the cohesion or the componential deconstruction of sound, all sound, you probably know that there's no sound in outer space in the vacuum of outer space. Sound requires some medium, because what's really going on is an instrument is being bowed or plucked or struck, or air is being blown through a column, like vocal cords or a clarinet or a French horn. There's some movement of air happening, and when we move the air molecules are disturbed and that disturbance of molecules eventually hits your eardrum. Your eardrum wiggles in and out in response to that, and all of the complexity of sound, whether it's our voices here or a symphony orchestra um, all of that has to be reconstructed just from this wiggling in and out. How does your brain do that? It's really astonishing. It's as though I were to put a cork and have it bobbing up and down in a lake, and just by looking at the bobbing up and down of the cork, you could tell me if there was a sailboat on the lake versus a rowboat, and which direction it was going, and whether there were fish and how many there were. Your entire understanding of the auditory world comes from this wiggling in and out or bobbing up and down. And so what happens in the brain is that the brain extracts separately the pitch of things, the pitch of the sounds, how long they last, how loud they are. And from those three elements, it ties together the pitches into melodies or into harmonies. It ties together the durations into rhythms and meter. Whether it's three, four time or much time, it ties together all of those and the loudness to create what we call timbre. Timbre is the sound, is the quality of two instruments playing the same note that allows you to tell them apart. >> Rene Fleming: Well, and the other thing is the predictive element that we can pretty much predict where it's going, which is interesting. Or as I walked down the music, I immediately entrained with the music rhythmically and started walking in step. You probably all did too. There's so many elements. It's very complex, isn't it? >> Daniel J. Levitin: And so whether you know it or not, and whether you're a musician or not, the-- >> Rene Fleming: Thank you. >> Daniel J. Levitin: Your brain is, is trying to figure out what's going to come next in any of those parameters. So when I say that there's this cohesion, your brain analyzes these features separately. It all comes together later, where later is maybe 40,000th of a second and you just hear the music. You don't hear the amplitude separate from the duration. But we've seen patients who do hear that way, after brain damage, they have only rhythm and no melody, or they lose melody, but they preserve rhythm. >> Rene Fleming: Do you all know Oliver Sacks? Probably many of you have read Oliver Sacks. He was really great at kind of finding those stories and sharing them. Um, you mentioned Connie Tomaino, I think as well, her chapter, she has a book out as well. But when you hear about the beginning of this neurological discovery and how people were treated, that people with dementia were put in a room on their own with zero stimulation just and tied down to their chairs. I was really shocked when I read that. >> Yeah, yeah. >> Daniel J. Levitin: So, if you were to ask me, where is music? Music is in the mind of the performer and the composer. Some gesture creates a disturbance of molecules. Your brain as the listener has to reconstruct it. The music is in here. And so if a tree falls in the forest and no one's there to hear it, does it make a sound? Well, no. It disturbs my, you know, molecules, but it doesn't make a sound which is a product of the brain. And so I think of the act of creation as not really coming to full fruition when Mozart wrote the last note on the page, it's when you sang it and then an audience member heard it. That is when creation happens. >> Rene Fleming: And what a wonderful thing it is that we have and have had for all of human history. It's a human invariant, meaning it was with every single culture since the beginning of mankind. It's really one of the only things. And I love that Neanderthals had the same vocal mechanism I do. I think we should write a Neanderthal opera. [Laughter] Just kind of imagine it. Exactly. >> Michael Andor Brodeur: I'd be so honored if this panel was the genesis of Renee Fleming's Neanderthal opera. [Laughter] [Applause] >> Rene Fleming: I would be willing to wear the eyebrows, I would. [Laughter] >> Michael Andor Brodeur: You were speaking of rhythm. I was fascinated by the research about Parkinson's. We've been talking about a lot about dementia, but Parkinson's research is also tied a lot to using rhythm as a way of, from my understanding, almost reorienting these systems that are damaged within the brain by using external rhythms. Is that at all accurate? >> Daniel J. Levitin: Yeah. So I write a chapter about our friend Bobby McFerrin, who was diagnosed with Parkinson's a few years ago. And probably the most easy to understand case of music therapy is Parkinson's. Parkinson's patients, including Bobby, have trouble walking. And the reason is that there's a timekeeper in your brain, a sort of internal clock that keeps a beat, which allows you to hold a steady gait. If you couldn't hold a steady gait, you would trip and fall, or you would freeze, or you would run when you meant to walk. And that's what's been happening with many, many Parkinson's patients. It's because the disease degrades. It kills some of the important cells in a part of the brain that are where this timekeeper lives. And so if you play music with a steady pulse, it can entrain different circuits, redundant circuits that are not damaged and allow the person to maintain the steady gait and it can last. This is called rhythmic auditory stimulation. The results can last for months after you've trained up the brain to do this. >> Rene Fleming: Yeah, plasticity of the brain is one of the discoveries recently that's really led to so much more understanding about why things work. My favorite is melodic intonation therapy, which does a similar thing. It transfers speech to singing, and with one session with a music therapist, someone who's had a stroke or traumatic brain injury can regain speech. It doesn't always work that way, but it's it's miraculous when it does, but how many people know about it? So these kinds of things. I mean, movement disorders are so, it's so beneficial to have beat or music. I've also discovered that when I'm walking I tend to slow down. And so if I have just in my imagination, a very rhythmic song, like When the Saints or This Land Is Your Land, I can hold a conversation with someone and keep my pace up. Yes. [Laughter] That came out at Strathmore. We had another convening with the National Institutes of Health, and somebody presented a study that talked about this. >> Daniel J. Levitin: When you were asking earlier about the connection between artists and scientists and just hearing Renee talk, I think one of the things that artists and scientists have in common is an abiding, intrinsic curiosity, always wanting to learn new things. And it rests on an idea that what we are both trying to pursue is the truth. What is the truth? In art, it's emotional truth. In science, it's natural truth. And in both cases, it's not fixed. Artistic truth changes. I'm imagining that, I mean, you probably know that scientists are changing their minds all the time. It's not because we don't know what we're talking about, but we wait for new information to come in. We're willing to change our minds, like with masks and Covid and wiping off your cardboard boxes. And I imagine that each time you reperform a piece, you're looking for some new emotional truth. >> Rene Fleming: Always looking, always searching for a deeper, more layered interpretation. And the other thing we definitely share is creativity. I think there's so much in common in the way a scientist thinks about what could be, and we do the same thing, and especially a composer, a creative person who makes the art that we're performing. It's incredible, I think. >> Daniel J. Levitin: We each have to imagine a world different than the one that we're in. You have to imagine a piece being performed differently. Scientists have to imagine experiment different than the one that's been done before. >> Rene Fleming: When I think the innovation that exists in our two worlds can really do a lot for our society. When you think about the health care potential, when you think about groups coming together in a in a situation where we have lost, we have such loneliness and isolation. It's an epidemic around the world. I'm with the World Health Organization and Doctor Tedros said depression is up 30% in the world. He's very concerned. And if we come together again and sing together or dance or make art together, this can be one thing that moves the needle to us having more cohesion. >> Michael Andor Brodeur: Now, books like this are going to help bring music therapy into a more or less anecdotal place. But what has to happen on the large scale to move thinking about music and medicine from the realm of novelty and anecdote into something of relative urgency? If you look at the way that by 2050, I think I have the figure here, the amount of folks in America with Alzheimer's projected to rise from 7 million people to 13 million by 2050. Worldwide, 55 million people live with dementia. So this is going to be a problem that's getting bigger and bigger and bigger and more urgent to address. So what systemically has to happen? >> Rene Fleming: Well, this is policy going back to that. And it's also getting it covered by insurance. There are only 12 states that now license music therapy and creative arts therapists. We need every state. We need licensure in every state. Illinois just passed it. I did a video for Pennsylvania who have a vote coming up and enabling these therapists to earn a living doing what they're doing. And it's very inexpensive compared with anything else. Certainly compared with pharmaceuticals or other interventions. And so I think it's just a matter of time and getting the message out. This is the level of research and the quality of the research is relatively new because it has to be evidence based. And in order for government, Medicare insurance companies to say, wow, this is this is going to save us a fortune if we add creative arts therapies to our treatments. And it will. So the Neuroarts blueprint is doing a new study and the results are shocking. The one they already did shows a return of 3 to 1 in investment in elder care facilities with Alzheimer's just bringing music interventions in. So the new study is even more shocking and they haven't released it yet. So I'll wait. But it's going to definitely move the needle when I think when these entities discover that they're going to save a lot of money. >> Daniel J. Levitin: And I think also, in addition to allowing music therapists to earn a living wage, to be certified as, there is the American Music Therapy Association, it's a certification. It's a special course of study. It's not nothing. >> Rene Fleming: Mostly master's degree, mostly six years of study. >> Daniel J. Levitin: I think we also need to create a society in the United States where artists, creative artists, musicians can earn a living. When I grew up-- [Applause] Music should be a profession. It shouldn't be something that you have to support by being a waiter or a, you know, an Uber driver. Some of the best musicians I know are driving Uber and, you know, they get home at the end of a long day and they don't feel as creative as they might if they were able to make their living at it. When I grew up, television used to be free and I had to pay for music. Now you have to pay for television and I pay for a bunch of channels I probably don't even watch and I don't even know about it. And music is effectively free, and the artists I know are really struggling. We tend to think of the big ones like Taylor Swift and Bruce Springsteen, and the Stones were making a lot of money, but you know as well as I do, about 98% of the money goes to 2% of the artists. And most musicians in this country are living at or below the poverty level. And so how are they going to create healing music? >> Rene Fleming: It's the same for dance or visual arts or all of our artists art, all of our professional artists. >> Daniel J. Levitin: We're one of the wealthiest countries, and we spend the smallest amount per capita on supporting art. >> Rene Fleming: It's true. >> Daniel J. Levitin: So that needs to change. With your help, everybody here. >> Rene Fleming: The NEA is miraculous. [Applause] What the NEA accomplishes with a tiny budget that their budget is the same as New York City's cultural budget. One city. And they do this all across the country. I admire the NEA so much. >> Daniel J. Levitin: Every major country, every major Western country has a minister of culture. We do not. >> Rene Fleming: We do not. >> Daniel J. Levitin: I think you should be a cabinet level. [Laughing] [Applause] >> Rene Fleming: There we go. Thank you. [Applause] >> Daniel J. Levitin: I nominate Renee Fleming. [Laughing] >> Michael Andor Brodeur: I second that. One of my favorite lines from Renee's book came from Mark Morris, the choreographer. I don't know if it just stood out because he just has a unique voice among all these scientists and doctors and whatnot. He says, and as much as I think as I have learned, I never want to understand all of the mysteries. I don't really want to know why we can't live without these seemingly pointless activities. [Laughing] >> Michael Andor Brodeur: I love that. And it made me think about demystification. And the more we study music, the more we get inside what it is and how it works and what it does to us and what we can do with it. Is there any risk as a performer of demystifying? >> Rene Fleming: I wouldn't call it pointless. I grew up in the disco era and do I miss dancing? I want that disco ball back again every Friday night. >> When you're Minister of Culture. >> Yeah. >> Daniel J. Levitin: This is her campaign platform. A disco ball in every home. [Laughing] >> Michael Andor Brodeur: This is a really productive panel. >> Rene Fleming: Yeah, exactly. We're getting things done. No, but, um, you know, the mystery piece. I think it's always going to be mysterious. Because no matter how much I understand a piece of music, and I've studied it, and what I have to do to learn something. Then when I hear it again, if I go to a performance, it's magical all over again. It's moving. It's emotional. The words, everything about it, I think, engage us. They talk about the human condition. There's nothing better for really understanding who we are as human beings. And we need that. And we certainly need history to explain that. Why do we make these mistakes over and over again as a species? History is really helpful. And so all of the music that I sing is at least 150 years old and sometimes 300 years old. It was amazing the first time I sang a Mozart opera and I said, What? We're still the same. >> Daniel J. Levitin: I remember the night before I began my first day at the Berklee College of Music in Boston, and I thought, maybe I don't want to do this after all, because if I learn everything there is to know about music, I won't love it as much as I do. And I realized that was just the arrogance of youth and hubris. I mean, there is no end to the knowledge or the mystery. And it's like a game of whack a mole each time. Each time you, you discover the answer, some little piece of the puzzle four more miraculous questions come up. And you know this story. So forgive me for repeating myself, but at the beginning of the pandemic, I started to work on a piano piece, the Beethoven Pathtique Sonata, and I decided I wanted to spend all this extra time I had trying to find the emotion in it, and I worked on it for three years, and I went to Paris to visit my friend Mari Kodama, who is an eminent, wonderful, world class pianist. And I asked her, you know, to give me some feedback and some guidance. And in the course of that, she had just finished recording a Beethoven piano sonata cycle, and she said she's been working on that piece her entire life, and her mentor, Alfred Brendel, has been working out his entire life. And he's, you know, 25 years older than she. And then I went to YouTube and I found 80 different versions of this piece. No two of them sound alike. And even among my favorites, like Maury or Daniel Barenboim, they change over time, the way they approach it. And I think those of us who, those of you who are not enmeshed in classical music, don't realize classical music has an enormous amount of variability and personal interpretation, and two versions can seem unrecognizable from one another. And that's the whole point, to discover yourself in the piece, to put your own imprint on it. >> Rene Fleming: Michael, that's another panel. Yes. The variability of performances. It's true. No, but you're absolutely right. It's so true. And that's one of the pleasures of it is kind of teasing out, oh, that was interesting. This is what I tell all young singers. You should listen to everything and draw on the history, the recorded history that we have. >> Daniel J. Levitin: There is no end because Renee mentioned neuroplasticity. That's a fancy name for the brain changing itself or growing new connections, and you're growing new connections all the time. If you heard the myth that the brain stops growing neurons, that's absolutely false. Until the day you die, you're growing new neurons. You're making new connections. Every time you learn something new, that's a bunch of new connections, tens of thousands of them. And every time you listen to a piece of music, your brain's a little different. And every time you approach performing, your brain is different, your experience is different. So the mystery, you know, mushrooms and explodes. >> Michael Andor Brodeur: And I'm hoping that this panel created many, many new neurons. [Laughing] >> Rene Fleming: Exactly. [Applause] Thank you. >> Michael Andor Brodeur: On that note, we do have some time for some audience questions. We have microphones here and here if you'd like to line up. We would love to take them. >> Rene Fleming: Oh, good. This is a great group. Look at you've come forward. >> Michael Andor Brodeur: Oh, wow. >> Daniel J. Levitin: We already wore out one translator. [Laughter] >> Michael Andor Brodeur: All right, let's begin with you, sir. >> Good evening. Miss Fleming. I'm one of your wackiest fans. I have every recording you've ever made. >> Rene Fleming: Oh. Thank you. >> But I do have a question about performance, because you had alluded earlier that there's a lot of tension. And when you know that the audience is very familiar with the music. And I recently saw a performance you gave in 1992 at the New Year's Eve performance of the Berlin Philharmonic with Claudio Abbado, and you sang the last trio from Der Rosenkavalier. I wonder if you can describe the experience of creating such incredible beauty and transcending the nerves you felt those many years ago, and that you do you, in that process of singing such incredibly beautiful music that you capture within you and your relationship to the audience, the power of musical beauty and that it carries you forward so that you yourself lose that fear that you brought into that performance. >> Rene Fleming: Oh, that's such a wonderful and romantic notion. [Laughing] You know, and I'm not going to dispel that. I mean, we do love the music. In fact, Jan Degaetani was one of my wonderful teachers, said you should do all your crying in the practice room so the audience can cry when you're performing. And so there's so much skill involved in figuring out how to bend and turn phrases so that you can have maximum effect, and also a tremendous amount of skill just to be able to sing this music and sing it well and sing it beautifully. You know the first phrase of the trio of Rosenkavalier? >> Yes. >> Yeah, exactly. So I think it's a combination. So once I have mastered it and also, I highly for stage fright or any kind of performance anxiety, I always say be prepared weeks in advance. Be really prepared so that muscle memory can take over for you if you need it to. And then I just feel now, when I really had the worst bout, what I learned was a book on from Beverly Sills on public speaking that gave me this notion of transferring what it is that you're performing to the audience, that you are a conduit, that you are-- This flow state absolutely is true. And I'm always, almost always in it when I'm performing. It's not what I had envisioned, which is that the audience was judging me and there was a negative flow coming towards me. And once I made that switch and did some therapy and did some, you know, a little bit of also behavioral modification, then I had it, then I was fine. And now I love performing. >> Thank you for that answer. >> Rene Fleming: Yeah, I love it. >> Daniel J. Levitin: The great thing about being a performer is it's unlike an athletic event, a sporting event where half the audience wants you to fail. [Laughter] >> Rene Fleming: True. >> Daniel J. Levitin: The people who come to your concerts love you. And the people who don't love you, stay home. [Laughter] >> Rene Fleming: Yes. It's true. Although I did talk to a sports psychologist once. I mean, we saw this in the Olympics. The American team was so well prepared with the psychologists they work with in terms of mental focus. So that's that's very helpful to see. And I hope whoever did that will write a book and teach us about what that preparation entailed. >> Thank you for all of this. I'm wondering what you would say the implications are of this research for our daily lives as individuals, but also as communities. >> Rene Fleming: Oh my gosh, I feel strongly that this will be the greatest benefit because it will impact the most people. But it's remembering that we need creativity. We need to be actively making art and engaging in artistic practices with other people as well, because it's in our DNA. And so that's why Susan Magsamen and Ivey Ross's book, Your Brain on Art, is such a fabulous introduction to this idea. I highly recommend it. And then the community piece, we need that tremendously right now. Do you know that for someone with severe postpartum depression, singing in a choir reduces symptoms by a surprising amount, and the worse your depression, the more it works so that you could if you sing, for instance, you can slow down the progression of your cardiac failure, for instance, because for you, you'll have better vascular function and and your endothelial function is better. I mean, there's just so many examples, but the singing in a group, a stroke choir, if you sing together with other people, your symptoms also will improve. There's a lot of research all of a sudden on singing together, most of the research has been done on instrumental playing for children, I'm talking about these types of activities, but there's tremendous benefit really. And the more we learn about it and can get the message out, the more we'll encourage the public to begin to do this. Do you all know who Dan Buettner is? Blue zones. Well, every time-- Yes. So I love, yeah, these are fabulous programs. And every time I see him I say, Dan, you have to put the arts in this because not everybody is going to be able to do the things you're saying. There are a lot of people who are more sedentary, they're older, etc. Please bring in artistic practices. So he said, no, the next one is going to be great. It's in Scandinavia where everyone sings. I said, good, good, good. >> Michael Andor Brodeur: Well, if you live in D.C., you can do that here. There's more choirs here than in any other city. >> Rene Fleming: It's amazing. >> Michael Andor Brodeur: This is the place to join a chorus. >> Rene Fleming: How many of you sing? >> Michael Andor Brodeur: Yeah. There we go. >> Rene Fleming: Wow. Thank you. >> Rene Fleming: How many of you play an instrument? Wow. Even more, I think. Super. >> Hello. For Miss Fleming, as an aspiring opera singer, how do you navigate the mental health challenges such as burnout, vocal fatigue, imposter syndrome in such a competitive field, and vocal music? >> Rene Fleming: Boy, you're right, it is true. I mean, I think, first of all, having strong alliances with other singers can really help. I also learned from other singers how to be more confident. I watched them and I copied them, but there's no-- there's no question. And I think the pandemic, having to learn on Zoom was really difficult. You're back-- Where are you in your education? >> I'm a junior in high school. >> Rene Fleming: In high school. Okay, good. So find friends who are positive, who give you a positive feedback and find a supportive environment in which to learn. I hope you have good instructors. That's incredibly important. So are you planning on pursuing singing? >> Yes. >> Oh, wonderful. So you're preparing for auditions and college applications, etc? Yeah, but you're you're absolutely right. The fact that you're asking that question means you will start to seek out solutions. Mindfulness is incredibly helpful. Um, really feeding yourself positive suggestions. I became much better at auditioning when I gave myself three things to do. You have to learn not to pay attention to the thing you just did wrong, and then keep thinking about that, right. You have to move on, but just give yourself be your own cheerleader. That really helped me. I wrote a book with Ann Patchett called The Inner Voice that might be perfect for you. It's all about the process of learning how to sing. >> Michael Andor Brodeur: It's a good book. You should read. >> Thank you. >> Daniel J. Levitin: This idea about surrounding yourself with supportive friends, one of the hazards of high school is, one of the many hazards. People are laughing because they've been to high school, and they remember. A lot of times we have a friendship group of people who are snarky and who are trying to tear us down rather than build us up. And that can really work against any artistic career. And you may think that you know, it's fun to be with this person because snarky people can be entertaining, but they can also whittle away at your very soul. >> Michael Andor Brodeur: Good to know. We have time for one more question. >> Hi. As a music therapist myself, I appreciate the research and advocacy both of you do. My question is what do you see as the next big chapter or exciting venture for research in music in the brain and the applications you are excited about for music therapy and or the average person? >> Rene Fleming: Well, why don't you answer that one first? >> Daniel J. Levitin: Well, very simply, one of the things we need to do is understand not just that it works, but how it works. And in the jargon of the field, it's the underlying mechanism. Why is it that, I mean, I gave you a kind of hand-wavy explanation about Parkinson's, but why does it happen? Why does it happen better with music than with, just, say, a metronome? So, when we get that, then the drug companies and the policymakers will believe it more. That's the way science works. >> Rene Fleming: And I'm finding investigator awards through the Aspen Institute in their Arts blueprint. And I interviewed the scientists yesterday, their young postdoc scientists who are working with an artist and looking after some sort of artistic intervention and research. And I was so moved by it. So, they are learning how to explore things that we haven't even thought of. It's very exciting. So dosage is one. How much do you need? What should it be, you know, and how personalized and all of this has to really be decided I think before medicine really says, okay, we're going to-- we accept this as valid-- >> Daniel J. Levitin: Another important part, and Renee is too modest to admit this. You helped with Francis Collins, to co-sponsor a big event here in D.C. in December. And for the first time, not only were there scientists in the room and grant administrators, but musicians, the first time. And one of the musicians, our friend Victor Wooten, asked, oh, well, why is this the first time? Why are you only now getting around to asking us who have done this our whole lives, what we think? And so you launch this grant, this grant award for musicians to partner with scientists. And that's going to be the biggest change, is that we are going to have this productive dialogue because they know things. Well, we are both scientists and both musicians. But what I mean to say is musicians know things that scientists traditionally didn't and vice versa. And so, it's going to be great. >> Rene Fleming: This is all online. It's on the NIH website. So two days of presentations by incredible neurosurgeons and scientists and also music therapists and artists. And the first one, the one that inspired me in 2015 is also on their website. You can see me sitting next to Francis Collins and Deborah Rutter going, Wow. >> Michael Andor Brodeur: Having your mind actively blown. >> Rene Fleming: I love this. >> Michael Andor Brodeur: I want to thank you, Renee. I want to thank you, Daniel, and I want to thank you for being such a fabulous audience. [Applause] I hope you had a good day today. Buy these books, please. [Applause] And have a great evening. Thank you so much for coming. [Music]