The Infectious Nature of Classical Music

Dr. Dan Petrescu, Division of General Internal Medicine, University Health Network

January 10, 2017

Posted by Nadine Abdullah, MD, MEd, FRCPC

The Scene of the Death of Mimi, from Puccini’s opera “La Bohème”
(Photo credit AllPosters.com)

This week, Dr. Dan Petrescu dimmed the stage lights to take us on a beautiful journey through opera and infectious diseases. Two seemingly divergent topics paired naturally as he expertly guided us through Four Acts – a metaphor for the theme. The beautiful aesthetic of watching and listening to operatic clips in a darkened hospital auditorium in the middle of our busy clinical work day and high-stakes meetings slowed us down, and allowed us pause to listen, breathe, alert our calming senses, and quiet our activating fight-or-flight reflexes. A stark departure from the typical noon medicine rounds on infectious diseases.

To begin, Dr. Petrescu introduced us to the influence of magical thinking in understanding illness. We saw how delirium and febrile hallucinations preceding the death of a child were believed, at the time, to be an assault afflicted by a supernatural being, depicted in Schubert's Opus 1, a musical rendition of Johann Wolfgang von Goethe's poem Erlkönig.

From delirium, we moved on to syphilis and tuberculosis. Mental illness has long been portrayed in music and art, but who would have thought to look for infectious diseases? Learning about the historical context of opera story-telling to understand the societal perceptions of illness in various eras gave us deeper understanding into how communities have stigmatized disease throughout history, such as TB and syphilis. Violetta in Verdi's La Traviata was portrayed glamorously as a thin, pale, diaphoretic, debutante consumed by tuberculosis and sensuous desire, at centre stage surrounded by admirers, on the verge of nuptials. In contrast, we felt the squalor and isolation of Mimi in Puccini’s La Bohème amidst the poverty of her bohemian, disenfranchised and forgotten artists, taking her last breath. The critical event that shaped the latter portrayal was the scientific influence of bacteriology, and the discovery of Mycobacterium tuberculosis as the infectious agent causing consumption, and the airborne means of transmission leading to a shift from admiration, toward isolation and stigma. On a simplistic level, we can use this to illustrate where infection control and isolation practices in public health were born. But on a deeper level, can we use this study in contrast to better understand our community of patients and see illness through their eyes, and see what it means to them? Where the stigma comes from and why they may not align with our proposed treatments?

Reminiscent of how close reading of literary passages is taught in narrative medicine to heighten the listening, observation, and critical thinking skills of healthcare professionals, the study of opera can be seen as another form of close reading. Ranging from discussing music and composer history, to uncovering illness perceptions and biases, to the concrete analysis of key transitions, instrumental voice and themes to indicate mood and meaning, the opportunities to make opera relevant to medicine are immense. And just as one need not be an English major to incorporate narrative medicine into practice, musical training is not a requirement for one's medical practice to benefit from the study of music and opera. It is so commonplace that many medical humanities courses and programmes have emerged throughout North America, combining the study of arts and humanities with medicine. Our very own Drs. Linda and Michael Hutcheon, from the University of Toronto Departments of English and Medicine were early leaders, lecturing internationally on opera and medicine.  It is no wonder that many of us in the audience were classically trained musicians, and why the majority of medical school applications that I read have Royal Conservatory of Music Certification alongside the competitive GPA and volunteer hours.

Infectious disease as portrayed in the arts may now be more obvious to me, but what about other illnesses, like cancer? Verdi's portrayal of tuberculosis resembles that of Susan Sontag's description in Illness as Metaphor, whereas in her historical review, cancer was abhorred, despised, and people were considered to be stricken by dread and shunned. Is this stigma what persists in some communities today, the ones from which emerge the protests: "Don't tell mom she has cancer?" As though receiving the diagnosis would lead to her death, independent from the disease process itself.

The audience was engaged again this week, stimulated, and the inevitable question was indeed answered in closing the talk: Why does paying attention to opera matter in medicine? Opera is a classic, overly indulgent and melodramatic characterization of all that is the best and the worst of human nature and relationships. It is a rich backdrop for delving deeply into people's motivations and choices, a study into human psychology. In health care, one of the professions most reliant on understanding human nature, this deeper understanding of opera can engender empathy, and strengthen our doctor-patient relationships. Dr. Petrescu left us with some of his wisdom. Humans have long sought to understand life and death, illness and misery, and have found meaning and expression through the arts and music. Opera is a rich genre that heightens our senses to the knowledge of the time. The doctor-patient human relationship suffers if we don't step back and listen.

Resources:

Sontag, S. Illness as Metaphor. Vintage Books, 1979

Hutcheon, L and Hutcheon, M. Opera: Desire, Disease, Death. U of Nebraska Press, 1996

A complete medical education includes the arts and humanities

Opera and Medicine Bodily Charm: Living Opera

Physicians in opera - reflection of medical history and public perception

Bio – Dan Petrescu, MD

Dan Petrescu is a graduate of the Internal Medicine and Infectious Diseases training programmes at the University of Toronto. He currently practices both Internal Medicine and Infectious Diseases at Markham Stouffville Hospital and is a Clinical Assistant in the Division of General Internal Medicine at Toronto Western Hospital, attending on the CTU. He takes a special interest in the interaction between the humanities and medicine and has given presentations across the GTA on topics ranging from interesting clinical cases, to classical music as it relates to Infectious Diseases, to the history of vaccines and anti-vaccination movements.