Connecting Music and Mind with Singer Renée Fleming

Episode Transcript

Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Peters:
And I am Dr. Katy Peters and this is The Brain & Life Podcast.

Dr. Correa:
Welcome back and welcome to The Brain & Life Podcast. Katy, what do you experience in your mood, brain and body when you listen to music?

Dr. Peters:
Well, music, just like the sports gets me moving and I love to dance, so when I hear music, the dancing will start and I will often sing along. It is always off key and quite loud, so it is much safer for all involved, all participants to have me dancing rather than singing. Now I know you love dance and you actually go to many dance shows and expeditions. Does music inspire you to personally get up and move?

Dr. Correa:
I do. Sometimes I have to work on finding a little time for quiet and meditation and getting into nature and not having everything filled with a soundtrack. But I am generally one of those people that there is a type of music and rhythm for every part of my life. I've found that music helps me rest and relax when I'm stressed, focused, when I'm studying, and as you mentioned, it gets my heart and legs moving when it comes to dancing, salsa and other Caribbean music and sometimes the musical background for some of the dance performances I get to go see is just as much of the experience that I get out of being there in that kind of moment of both live music and live dance that only last in that moment that we're there.
But understanding how we all react, respond, and maybe even improve with music is not just a conversational exercise for us, but it's an active area of science and collaboration with the arts. Our guest today is one of the ambassadors of The Music and Mind Program and the famed opera singer Renee Fleming. After my discussion with Renee Fleming, we continue the episode with former NIH director and champion of the Music and Mind Initiative, Dr. Francis Collins. I hope you all find inspiration to go listen to new music and incorporating music into your lives from this episode.
Welcome back to The Brain & Life Podcast. Now, today I have the pleasure of continuing our discussion with many different amazing artists, but truly one that really shouldn't need any introduction or bio, but today I'm here with Renee Fleming. She is an internationally renowned musician and artist. Many of you have heard her probably on the radio or in many different classical and operatic musical performances, and she's continued her work and love for music by crossing and understanding how it impacts our health and our mind. In fact, in a new book called Music and Mind. Thank you so much Renee for joining us here today and continuing this discussion.

Renee Fleming:
Thank you, Daniel. It's great to be with you.

Dr. Correa:
So I wanted to learn more a little bit about you. I mean, you are an individual who has had a plethora of interviews out there, a full 60 minutes interview, stage performances where people may have heard your voice and your story through your emotion. Apart from maybe the most nuanced music fans, are there some parts of Renee Fleming that the rest of us don't know about?

Renee Fleming:
Oh gosh. I mean, I would say the public at large probably knows almost nothing about me. Our art form is a niche and it's a wonderful, wonderful niche, and it's certainly one of the older art forms that we celebrate in western classical music is beloved. I mean, when you think of music of Bach and Beethoven and so many different composers and vocal music, of course predate speech, it's thought. I love being part of my world. It's taught me to appreciate history and my life has been secondary. It's really my life on stage that is known to anyone.

Dr. Correa:
Many people living with neurologic disorders can have a variety of different associated pain symptoms. You yourself in the book and in other stories have shared that there's been times when pain has nearly limited your ability to perform. When did that start and how did you come to learn about your experience with pain?

Renee Fleming:
Yeah, it's so interesting. I had stage fright from a young age. I was not a natural performer at all. I was a very shy, reserved and a bookworm. So I actually wrote music and was a composer throughout my teen years to kind of allow me to express something. And then it was actually when I was at Juilliard and I had an audition and my back just went out. I mean, it happened twice I think where I just couldn't move for a day. And I happened to read this book, it was an article actually in a newspaper. I picked it up in a magazine about Dr. John Sarno, and within a couple of hours my back pain lifted and I never had it again. So I knew that a lot of the somatic pain that I would eventually have related to high pressure performances, as awful as it was, and as much as I suffered because it wasn't my back then, it was all the muscles that really keep my throat and my singing relaxed just would tense up and be very painful and then it would lift right as I walked on stage.
But it is a type of, that combined with stage fright really made me question whether I was in the right field. I thought, "There's got to be something better." And so I struggled with that and that's what sort of led me to discovering that scientists were studying music.

Dr. Correa:
And I think so many people would've encountered an experience like that questioning whether or not they're prepared for this area or this field that they're passionate about, whether it's medicine or like your experience in the arts. How did you find your way around understanding that that was a learning experience and something to build in and not something actually meaning that you were, as some people might say, an imposter going in the wrong direction?

Renee Fleming:
Well, certainly stage right I really got a handle on and I had the right help. I had to kind of unlock the roots of it, and then I also had to do a lot of behavioral work, just reframing how I saw the audience. The critical world was very powerful throughout a lot of my career. It's less powerful now because it's so fractured. We have social media, we have critics everywhere, but then it was really, critics had a big audience, and so I had adapted that voice that was my inner voice was also judging me. So I had to kind of change that and really see myself as a vehicle for beauty as I was transferring something a composer had created or a poet had created to the audience, I was just a vehicle. And that helped me a lot. That really changed my relationship to performing.
And then part two of that was making sure I was ultra prepared. But the pain symptoms, I still get them. I still, if I stop and sort of say, "Okay, this is a new ailment, how does it relate to the one I had last week?" It's just constantly shifting. The mind is unbelievable the ways in which if we've learned that kind of mechanism of using pain as a kind of avoidance or to protect, it's really a protection. It's a form of protection, I think.

Dr. Correa:
And did you see doctors at some point to help you navigate understanding whether or not these pain symptoms were a warning sign of a destructive or injurious process or if they were much more a response as you said and a protective psychological mechanism?

Renee Fleming:
It's interesting. I don't think I found my way to the right medical help along the way, for a lot of my career, because I've been singing for a long time. Doctors I would go to just didn't acknowledge it. They treated your pain as if it was a real symptom and very often it was arthritis and various things are, it's all there, but whether people have pain with it or not tends to be more individual. So no, and I think there's a lot that's known about it. In fact, I love the fact that medicine is starting to really unlock what pain is, that it's in the brain, that it's individual for each person. I mean, it's really fascinating. So I have to say, I think you're in the most amazing field because neurology is at the heart of a lot of this. So yeah, I would say I probably never did get to the right people.

Dr. Correa:
It is exciting that the brain is in and of itself a universe to explore, and then each person in their own experience with it is its own beautiful complexity.

Renee Fleming:
Yes.

Dr. Correa:
So it's great. And now I'm wondering, so your book comes out of many years of a collaboration with Dr. Francis Collins. For our listeners, Dr. Francis Collins is a famous geneticist and for many years the director of the NIH. The two of you, how did you come together and how did your work with the NIH and exploring the science behind music and our mind start?

Renee Fleming:
Well, we met at a dinner party in 2015. He wrote the foreword for my book and tells the story, but it really was an incredible gathering. And Dr. Francis Collins, I hadn't met him before. That was my first meeting and he brought his guitar. Now I know he does that consistently. So I asked Dr. Collins, I said, "So why are scientists studying music?" And he said, "We have a new brain initiative and music impacts every known mapped area of the brain and we want to understand more about it. And so it's a good vehicle for doing that."

Dr. Correa:
And what did that trigger for you and wanting to explore more ways that you could get involved with the NIH and these health initiatives?

Renee Fleming:
I had just been kind of identified as an advisor to the Kennedy Center. And so when I met him, I said, "I think that the Kennedy Center could provide a platform for science with the audience. And I think our audience would be as fascinated by this as I am understanding what happens to us when we're listening to music or when we're engaged with art, what does it do? What's the underlying science, et cetera." And so we started, we had the first convening. He agreed, and Deborah Rutter who runs the Kennedy Center also agreed. And we also invited the NEA to join us, the National Endowment for the Arts. And so it's been a fantastic collaboration that started with convening in 2017 that brought therapists and researchers together at the NIH for two days.
And I got to sit and listen, and that was when I was hooked. I just said, "I really want to be an advocate for this work and share it with my audience." So I've given 60 plus presentations, always inviting local scientists and healthcare providers and it's been a phenomenal project.

Dr. Correa:
And from the different varieties of events where you've seen scientists discuss their work in these areas, what has been one of the things that has carried through or you remember the most about the work that they're doing in music and understanding its connections to our brain?

Renee Fleming:
I probably could have answered that a few years ago, but the whole area has exploded to the degree to which it's kind of almost overwhelming. There's so much, but I mean from the first convening, seeing a nonverbal child with autism who's on the spectrum, learn how to speak with melodic intonation therapy was just mind-boggling to me. Witnessing somebody who'd had a stroke, also regain speech with the same technique. The plasticity of the brain, of course is at the heart of all of this. And through singing, that's remarkable, remarkable in one session. And also seeing someone with Parkinson's who can't walk suddenly move fluidly just with the addition of music or rhythm. So these are some of the really powerful and validated points of research that need to be kind of more broadly known in healthcare, I would say.

Dr. Correa:
So Renee, in your book you share about some of the nuances and differences about music therapy that can occur one-on-one as opposed to together in a community or as in a group. At the Montefiore Center we have a Montefiore Melodies Program where people recovering from stroke can participate in a community rehab setting together as a choir. What have you learned about that and some of the differences that scientists are seeing about this type of music therapy in groups?

Renee Fleming:
Well, I've seen so much more research just recently on singing in general, and it's remarkable that the benefits of singing in a choir seem to outweigh the benefits of singing Alone. And Julian Johnson's chapter, which is really focused on group singing and especially for the aging population, and she's been doing this work for a very long time, is interesting. But there are so many other chapters that touch on it. I mean, I really love Tom Sweitzer's work as a music therapist in Middleburg, Virginia because he serves his community in a broader way than anybody could.
It's remarkable what he's built, but singing in a choir is a big part of it. He has a stroke choir as well, and there are several around the country, and I just think it's exciting to see. One of the things that I heard recently was about postpartum depression and the benefits of singing in a choir, reducing the most serious type of depression more than any other activity. So it'll be fascinating to see what happens. MIT just released a discovery that found brainwaves consistent in various layers of the brain in across all mammals. And so because brainwaves are a type of rhythmic and musical expression, I think we'll find a lot of more research around that discovery.
In fact, the person who talked about it said, "I can't believe we haven't found this before because it was right there in plain sight," one of those things.

Dr. Correa:
It's amazing. These are all areas where we're growing so much more, how we understand, how we interact with music ourselves, how the auditory and processing areas of our brain integrate and understand that music and then think about us interacting with others. And many times we'll have much more of a qualified discussion around the science coming out with new therapies and rehab. But what's amazing is the idea of music and participating in music as a community or as an individual is such a low and hopefully very approachable threshold for many people.
We get a lot less concerned about the possible side effects of choosing to listen to music that you love and explore new music. The challenge, I think, is getting more buy-in and understanding from insurance companies and some of the people who pay for the higher level of things like music therapy. So just in context as we're discussing in this, yes, this is all growing science for our listeners, but thankfully these are all tools that are hopefully at our fingertips or ear tips for us to engage with and then to connect with in ways to grow our community. We're hoping musical therapy is more accessible to our community overall.

Renee Fleming:
Well, the World Health Organization has a new initiative also that's related to arts and health, but what's interesting about all of the countries, the member countries is that in so many of them, they never stopped using music as a healing modality or using the arts as a healing modality. When you think about the benefits of just working on an art project, reducing stress by 25%, so this is why studies are so important, but in our culture, it's necessary.
I mean, we have to have evidence-based research in order for anyone to accept this in healthcare. And I think eventually the arts will be embedded in healthcare because it is low-cost and non-pharmaceutical and non-invasive. It works and the research is now supporting it.

Dr. Correa:
We talked a little bit earlier about how in some ways your book has grown out of the work with Dr. Collins and your collaboration with the NIH, but how does your book expand on that previous work or differ from the other active projects going on?

Renee Fleming:
The book is an anthology, and so what I really wanted to do was present the spectrum and the breadth of the whole sector as it is right now because I found it so inspiring and because I didn't know anything when I went into that first meeting, I only knew what we as artists understand intuitively and from experience. And so it was a fantastic learning curve. And again, I'm providing this to the public. I told even the most scientific chapters, I said, "Please remember, this is for the general public, and if you're going to use terminology that we don't know, at least try to explain it if you get a chance."
So I think it's actually really interesting because there's also theater and architecture and the visual arts as well. And if I had to do a book today, it would have more of that because I'm so involved within the NeuroArts Blueprint, which is a larger umbrella than the work with the NIH is and the NIH, understandably, because they're the largest funder of biomedical research in the world, and they really are finding things that can be in medicine, they are interested in looking at things that can be measured and it's technology that makes that possible right now.
So that's why music kind of has the largest body of research, but they're adding dance because of the Parkinson's and other movement disorders that are very helpful. So the book is really, and the artist chapters are a great way in. They're shorter, they they're fascinating. I mean to have also Richard Powers and Ann Patchett writers kind of way in, it's meant to be something that is so kind of comprehensive, but people can read just about the things that interest them, the section on, for instance, education in children. So that was the intention with the book.

Dr. Correa:
And from the authors of the chapters, the many scientists that you've interacted with, what have you learned about the effect of music on our brain?

Renee Fleming:
Well, it's extraordinary. I mean, besides the things that have actual interventions that have been created that can be used in a healthcare setting, there's general health and wellness. I've changed my life. I don't change my performing. Performing is what it is, but I think in a slightly different way about the audience, the fact that our brain waves are aligning when I'm singing and they're listening and you feel this. I mean, the more we understand about the power of the arts to have an effect on our health and wellbeing, the more you'd want to go to live performances, the more I'm going to museums in every city where I perform now. I'm going to theater, which I love. And being outside in nature, I'm having aesthetic experiences that definitely are having a huge effect on my mental health. I highly recommend it.

Dr. Correa:
You mentioned there's so many aspects of other art therapy and visual art therapies that didn't all necessarily get into the book, and even your future thought of the book would be even more expanded. Can you share with us some experiences that you've observed through your connections with other scientists about other types of art therapy or therapy for neurologic conditions?

Renee Fleming:
Absolutely. On John Chatterjee's chapter on visual art research at Walter Reed with veterans is powerful, but I actually toured Walter Reed and got to see it in action. They have a music therapist, but they also have an extensive visual therapy department. And it just makes so much sense when people are traumatized or have PTSD, even children who are traumatized for any reason, words are difficult, expressing it is very difficult and sometimes impossible. Teens with cancer, same thing. So they need another way of expressing what their feelings are. And visual art therapy can work extremely well. The masks that were made by veterans are so powerful and so expressive that it just becomes clear that this is a great way to kind of get through to healing for them.
So that is interesting, but also Liz Diller's work in architecture and there's now a NeuroArts had a conference recently called Intentional Spaces that talks about the fact that typically and historically architects haven't really given too much thought about what we need in building. It's really another kind of type of clothing in a way that's encasing us. And when you add green space, when you add different shapes, when you add experiences, whether in sound or textiles, that make us feel comfort, it can be very useful in a healing setting.

Dr. Correa:
Yeah, I mean, I think we all need more healing and comfortable spaces around us. Now in the book you take us through with the authors of the chapters, various different situations and many different perspectives. I was hoping here we could go through a few life stages of how music may impact individuals. And so starting off, you share some experiences and some stories about how music can impact the experience of a child either in their development or a child with a neurologic disorder. But I'm wondering if you could reflect back to your own experience as a mother and how you experienced incorporating music into raising your children and how that informed some of what you thought about with children's experiences in the book?

Renee Fleming:
Well, one of the things I noticed with my children also is how much they benefited from rote learning. Usually with a song, whether it's 50 states or it starts with eight and threes, obviously when children are really young and you never forget it, this memory and music are so aligned, which is why in Alzheimer's it's the last memory to go. So it gets embedded in our systems as it were. And even when I learn an opera for instance, I depend in the end on muscle memory so that I know that that Russian is going to come out no matter what I do or if I'm distracted or what. So it's fascinating to me. But my own children, I would say one of the things I found is they're very open-minded when it comes to music. And another thing that people don't know is that there's no good music.
It's whatever you like everything, all of these therapies are connected to taste-based, your favorite music, and kids are open to everything. There's an aria from Mozart's Magic Flute that the Queen of the Night sings, and I have never heard that played when every child in the room doesn't want to sing it and we'll sing it in the car for the next three years. So some of it can be a little painful, but it is definitely attractive to them. But I tried to give them kind of an arts education in general, visual arts and certainly going to performances. They obviously heard me sing all the time and were totally open to and able to be part of my rehearsals or interrupt me or I never wanted them to feel like they were competing with music for my attention.

Dr. Correa:
And you referenced before you were bringing up melodic intonation therapy and its use in studies that are looking at using it in children with developmental disorders and language disorders. Can you share with us some of what you've learned from other scientists that are exploring using this?

Renee Fleming:
It's incredibly beneficial. I mean, with aphasia and also there's a film called Music Got Me Here about a young teenager who had a traumatic brain injury while snowboarding without a helmet and many, many surgeries later. But music intonation therapy actually gave him the ability to speak again. He hadn't spoken in two years in this process of getting better. And it's a beautiful film. And that's Tom Sweitzer again, who's the music therapist in Middleburg. So just watching it work is incredible and seeing a jazz pianist who's blind having, if his brain is scanned when he's playing, his visual cortex has been repurposed for hearing.
So in a sense, he's actually seeing with his ears. And so the brain is just endlessly fascinating and we still don't know a lot about it. So it'll be fabulous to see what gets discovered in the next 50 years, a hundred years, I don't know.

Dr. Correa:
And you yourself sang opera, a classical musician, but in the book and several of the other people that you've worked with have highlighted how it's not just necessarily a Western and classical music that can show an impact in people's brain and in this type of engagement. Share with us really, is it limited or has people shown that it's certain types of music or is it more expansive and inclusive?

Renee Fleming:
So I just listened to, I was in Atlanta presenting and there was a therapist who spoke up who is working with veterans, and she said the only thing that really calms her down her go-to when she needs to de-stress is Metallica. So we all kind of went, "Oh no, I haven't heard that before," because you would imagine that Metallica would give you the opposite energy and all of that. So to each his own, it is really just dependent on what works for you. With one exception, music therapists will sometimes say if they really need someone in a healthcare setting to calm down, even if they love heavy metal, they might encourage them to listen to something a little bit slower.

Dr. Correa:
Yeah. We had had a previous interview a while back with an artist, a musician who lives with migraines, and it actually impacts the kind of music that she creates in helping trying to figure out intonation and type of music that either might trigger her headaches, it changes the whole tone and the types of bands that she works with. So it's just interesting each person's experience in what music and how it activates each of us is very different.

Renee Fleming:
Yeah. I have a friend actually who had a brain bleed recently and she couldn't look at screens and she actually was only helped because she had agonizing pain for the first days, only helped by the loudest possible Jimi Hendrix that she could play in the earphones, that she turned them up as far as they would go, and anytime the volume came down or the music came off, she was in pain again. So I actually wrote about that and sent it to my neurologist friends at the NIH, and they gave me, sent me some studies for her because of course everybody told her she was imagining it. They sent me some studies that showed in fact that they don't know if it's a distracting element or why it works, but for her, it was only the loudest most kind of head banging music.

Dr. Correa:
Wow. Now you shared and we talked about how you would have somatic pain sometimes that would just be a feature and factor of the stress of going out to perform. Yet at the same time, music can be a very effective mood stabilizer and a stress management for adults and even care partners. As you have worked through the book, what were some of the stories that showed you examples of the impact on caregivers and care partners?

Renee Fleming:
It's really powerful. There's a new film that my publicist has put together about Lewy body dementia, and it was basically, they were flies on the wall with three couples, and in the end, the film is focused on the caregiver because although the patient is declining, the person who is a hundred percent responsible for their care is also declining, also suffering. So there's no question, and many performing arts organizations are now offering concerts and performances specifically for patients and caregivers that benefit the caregivers is much and sometimes more than the patient, depending on what the disorder is or the problem is.
So we have a real problem in our country. I saw this with my own mother who passed away in September, an issue if you have a parent with a difficult case, you can't get care for them. And I said, finally, I just said, "What do people do?" They said, "You take them home and you do it yourself." And so our system is not really, it doesn't really protect everybody in a meaningful way.

Dr. Correa:
Yeah. We need a lot more services for all of us in many different ways.

Renee Fleming:
You would know far more than I do, so yes.

Dr. Correa:
Yeah. And you've also shared and said that rhythm is a basis of all of our experience and music and have shared in the book and in various ways how music can help people. You've mentioned before people living with Parkinson's disease and even multiple sclerosis, moving better with music, also with dance. How have you witnessed that and how have the scientists helped you understand this?

Renee Fleming:
I just watched a brief film that was created for Novartis about MS and drumming. So drumming circles, and frankly just working with a music therapists in general, but again, in a group setting. I mean, first of all, it's so much joy, but people start playing and they can't even move really. And within a few minutes everything is fluid. Again, I think that's plasticity, that's the brain being able to bypass in the moment and find joy again. Zakir Hussain has talked about these great musicians in India who had tremor, very serious tremor and would sit down and couldn't play for a minute, and then pretty soon they could play for two hours and just smoothly, vigorously. I mean, it'll be really exciting to see what research finds about this and if it can kind of be used at some point to extend those moments of rigor or of memory or all of the things that it seems to do.

Dr. Correa:
And some adults may, unfortunately sometimes at other ages, but some adults may themselves be living with dementia or other neurodegenerative diseases. You share in the book, it weighs how dementia has been shown to improve. And you talked about and mentioned before, it's tied to memory. What's a story that you recall from your different experiences of really seeing an impact of music and music therapy for an individual or as a community with dementia?

Renee Fleming:
Well, I was introduced to this by Mickey Hart, who's the drummer for the Grateful Dead, and he was very good friends with Oliver Sacks and Concetta Tomaino who has a wonderful chapter and a new book out actually about aging and music. And this whole neurological research center in Westchester County, which still exists. She's still doing this work, was very focused on patients with dementia and Alzheimer's disease. And it shocks me when I read her chapter to discover how they were treated. That's only one generation ago.
And Oliver Sacks was brilliant and the two of them together, and Mickey also was part of this, so have made a massive difference in how we treat these patients. And we still have a long way to go actually. It needs to become even more humane than it's now and more understanding. But I learned a lot about that. But I saw it myself because I visited with my husband, his aunt who was being cared for by his sisters, and she was in a bed already, was not moving, was not really opening her eyes, certainly not speaking and not knowing any of the people around her. But if you said three words to her, if you said, "I'm looking," she would finish all the lyrics and sing the whole song. And there were four songs like that. And it was joyful to be in the room and see that she still had that ability.

Dr. Correa:
With my own grandmother who recently passed away, even late in her stages, we could listen to music together or sing along some songs that I remember her singing with us in my childhood. And often it was very briefly, but for a period of time right after that we could engage and have conversation about past memories and experiences and sometimes things that had just had recently happened in the preceding minutes, but in any other situation, the time and memory would've lapsed very quickly. But with that integration of sound and music, somehow we tapped into a part of preserved memory.
So throughout both with your book and throughout all these different initiatives and collaborations, you've been an advocate for integrating the arts throughout healthcare. How have you seen it evolve and where do you see it now?

Renee Fleming:
Oh, we have a long way to go. The research itself is relatively new and I'm talking about the research that could be and can be funded. I just created, actually, we call it Investigator Awards, but it's in order to strengthen the research pipeline is to have scientists who are really gifted young scientists and pair with an artist. And it's also possible that it's a scientist who is also an artist. That's happened as well. So we've just announced our winners, NeuroArts Investigator Awards. So that's exciting. And I do think that this type of work will eventually lead to everyone understanding that it's to our benefit to have this in health care.
I talked to a palliative care expert recently who said, "Medicine treats disease, but not necessarily people." And so we're understanding with integrative medicine that we're part of this larger network, and it's not even just the person who is the patient, it's the family, it's the ecosystem around the person. It's even the healthcare providers. We learned with COVID how deeply they were affected with low morale, and that's important. It's important for them. I went to a drumming circle in a hospital in New York just for nurses and doctors. So I do think that we're getting there. And again, it's because it's low cost and you have this human connection, it can sometimes make a huge difference in someone's treatment.

Dr. Correa:
Thank you so much Renee, for not only bringing the many years of beautiful music and voice to us, but now helping advocate for connecting us together as a community through music and hopefully improving all of our health.

Renee Fleming:
Thank you, Daniel. Pleasure talking with you.

Dr. Correa:
Can't get enough of The Brain & Life Podcast, keep the conversation going on social media when you follow @NeuroDrCorrea and at Brain and Life Mag or visit Brainandlife.org. I truly appreciated the time that we got with Renee to talk to her about her book and about Music and the Mind. And now we're going to be continuing our discussion with one of the people that she interviewed for her book that has been part of a lot of this initiative, Dr. Francis Sellers Collins. He's truly the model of a physician scientist and we'll get into explaining what we mean by that. But he is one of the people who discovered genes associated with and many scientific breakthroughs in understanding a number of diseases, had led the Human Genome Project and then served as the director of the National Institute of Health or what many of us here as the NIH from 2009 to 2021 and has been an advocate for the NIH BRAIN Initiative and Music and Mind and the NeuroArts Blueprints that we've mentioned here in our previous discussion with Renee Francis.
It's a little odd to say that and not just refer to you as Dr. Collins, but Francis, thank you so much for joining us and it's a great pleasure to have you here today.

Dr. Collins:
Oh, it's a pleasure to be with you and I will call you Daniel and we'll all get very comfortable with each other.

Dr. Correa:
Now, we started out by describing you and we describe many colleagues as clinician or physician scientists, aside from maybe an interest in Star Trek or just the general science of the world around us, what do we really mean when we talk about someone as being a physician or clinician scientist?

Dr. Collins:
Well, there's a lot of us who are both interested in the whole science of healthcare and how you try to take care of people either to prevent disease or to try to treat it effectively if it happens, but who also are curious about what the basis is of illness. And the more you can learn about that, maybe the better we can do at actually helping those who might otherwise end up in a bad place. So a physician scientist oftentimes both has as a laboratory, as a place where they do basic science trying to uncover the cause of an illness, but they also go to see patients in their clinic or the hospital trying to translate those findings into better medical care.
It's a privilege, I must say, to be able to have those experiences in one professional life. I've been greatly fortunate, I think, to be able to both be with patients and also be with people working in the lab trying to understand how we can do a better job of caring for them.

Dr. Correa:
And you trained as an internal medicine specialist, cared for patients with a variety of internal medicine conditions, and then before joining the NIH, you did research for years on DNA and understanding and really developing and a lot of our basis of our understanding of DNA. What were some of your early experiences developed your scientific curiosity about DNA?

Dr. Collins:
I had a bit of a strange background in that I wasn't that interested in life science when I was an adolescent. I was interested in chemistry and physics. Life science seemed way too messy, and so I kind of avoided that and got all the way to halfway through a PhD in physical chemistry before I realized I'd kind of missed out on some really exciting things that were happening in biology recombinant DNA was being invented. So I changed my direction completely and decided to apply to medical school, not sure that anybody would take me after this sort of strange history of only recent having this vision of being a doctor, but the University of North Carolina said yes, and in the first month as a medical student, I could see how it was all going to fit together.
I was excited about the idea of human medicine, but I was also really excited about genetics and I had this feeling way back now 50 years ago that there might actually be an opportunity for genetics to go through a real blossoming of scientific power that would enable discovery of the causes of lots of diseases and maybe even the ability to cure some of them and that is now coming true.

Dr. Correa:
And you worked with collaborators over the years in your research to identify genes associated with Huntington's and neurofibromatosis along with many other conditions. But thinking of the community living with neurologic conditions, why is it important specifically to find the gene associated with a medical condition? How does that help us as physicians?

Dr. Collins:
If you're trying to really come up with an effective way to prevent or treat a disease, but you don't understand its molecular basis, you're just kind of feeling your way in the dark, and if a disease like Huntington's is known to be inherited in a dominant fashion, likewise neurofibromatosis, that means there's a gene involved that must be driving all of the consequences. If you could figure out what that gene is and particularly how it's misspelled in somebody who's affected, you're light years ahead of being able to come up with a strategy that's really going to work. Otherwise you're kind of trying to treat the symptoms instead of the underlying cause.

Dr. Correa:
And over the years you've been as a part of the NIH, really getting a sense of the pulse of science and human medicine in so many different ways. I'm wondering if you reflect back to your sense of the importance of DNA 50 years ago, are we there with something else that's new and future discovery that we're going to be looking back at 50 years as being so essential?

Dr. Collins:
Yeah, DNA has been an amazing adventure and the Human Genome Project, which I had the privilege of leading, laid out for the first time, all the letters, 3 billion of them that make up our DNA instruction book, and we've been building on that over the last 20 years to transform a fair number of ways that we approach medicine. Cancer would be a particularly prime example. So what's like that now? I would have to point to the BRAIN Initiative, which is maybe even bolder than reading out the human genome. You could kind of think of the human genome as an instruction book made up of 3 billion letters in a particular order.
The brain is much more complicated than that, because it's three dimensional and it's all interconnected. We think there are about 86 billion neurons in the brain. I think one can make the case, this is the most complicated structure in the known universe right there between your ears and to sort out how that works, not just one neuron at a time, but how by all of the circuits that they participate in amazingly complex actions can be carried out by us humans. That is probably the most challenging scientific project of anybody's lifetime, and it will take a long time before you can say, "Okay, we got it figured out," decades to be sure, but we're making pretty steady and exciting progress based on this BRAIN Initiative that started just about 10 years ago.

Dr. Correa:
I mean, it's one of the things that catches my imagination and excitement to any greater sense. You won't get any argument against me against the BRAIN Initiative. Now, a lot of our discussion with Renee and a big part of her life has been music, and I'm wondering how has music been a part of your life, whether inside the lab or in the hospitals or outside in your own personal life?

Dr. Collins:
Well, I think it was mostly outside until recently, and it's really joyful now to have these things start to come together. I grew up in a family where music was really important, grew up on a small farm with no indoor plumbing and no television. What we did after dinner was music. My father was a classical violinist. My mother had an exquisite voice. I had three older brothers who all played instruments, so I'd better learn quick or I'm going to be left out. So I started playing keyboard when I was four or five years old and learned the guitar a few years after that.
I found this to be just an incredibly satisfying, enjoyable experience, especially if you can do it with other people, having an ensemble of some sort. Sometimes I'd get pulled into a string quartet to play the continuo. Sometimes it was rock and roll, sometimes it was American folk music, which my father was an expert on, and it just was part of my life and has been for all of my 74 years practically. But it always sort of seemed like, well, there's that music thing, but now you're a scientist, so you should be working on something much more serious. Well, I'm so glad that we've now reached the point where the intersection between neuroscience and music is incredibly exciting and scientifically very serious and very inspiring so that I don't have to have these parts of my life often separate parts of my calendar or separate parts of my brain. We can put them all together.

Dr. Correa:
And as you've learned more about the intersection of these things, what have you learned about music and your own health or the impact of music on other people's health?

Dr. Collins:
It's clear that the field of music therapy, which has been around since World War II has made a number of pretty impressive insights into how music can help healing people who suffer from chronic pain or PTSD or have had a stroke. But it's always been kind of an anecdotal kind of scientific description. I think more and more we're learning through more rigorous studies, which NIH is now strongly encouraging and even has a toolkit to help people design such study in the most effective way that there really are insights here that are reproducible and that give profound relief to people.
I'll just tell you, having seen a lot of those studies, I had significant surgery three months ago and I was having a lot of post-op pain, and I really didn't want to take a lot of opioids to deal with that and said, "Okay, let me follow my own medicine here, so let's turn up James Taylor and see how that does. If it's just in the right sweet spot, if that starts to wear thin, well let's go to Alison Krauss, and if that still isn't doing it, then let's pull up some of the most amazing Bach preludes and fugues played on some massive pipe organ in Europe and see if that will distract you from what your body is doing, telling you you're hurting." It worked. I mean, it really did.
That's the first time I've been in a situation where I really had to test this out for myself for in this case, acute, not chronic pain, and it was quite powerful and it was good to sort of try it out on yourself and not just read papers about it.

Dr. Correa:
That relates to a question I had for a little bit later, but I'm going to jump ahead to it. You've talked about various different types of musical styles and music changes through time, what the generations now are listening to, maybe very different, but what's amazing, we all have access to many generations of music and there's also many cultural differences in what we consider as our typical or colloquial music. How much do we know really about how different types of music styles or rhythms actually interact differently with our brain?

Dr. Collins:
Not nearly enough. I think we are just by observing the kinds of music that are common in various cultures around the world, perceiving that there are a lot of similarities, even to the point where you think our brains are in a certain way wired from music to have an effect maybe to draw us together when we need that or to help us grieve or help us go to war if we need to do that or have a mother sing a lullaby to a baby. The actual tonality is different. There are certain intervals that may be favored in some cultures and not so favored in others. I'm a guy who sort of grew up on the sort of classical tradition, so I'm very happy with a major chord that includes the third and not just the first and the fifth. Some people are like, "Ooh, that doesn't sound right."
So all of that is ingrained within us by the culture we've grown up in. But I do think, and Renee's book has a very strong article about this from Ani Patel, that evolution has shaped our brains a long time ago to be responsive to music in ways that are beyond what happens just with sound of other sorts. It's not like street noise or even spoken voice. There's something about tone and even melody that is part of our survival. Otherwise it would not have been put to such an extensive architectural use in our brains. I think that's fascinating, and there's certainly people who believe that maybe music even preceded speech.

Dr. Correa:
Yeah, that's the chapter I was actually thinking about is that it's amazing this idea that there are so many different sounds around us and how somehow there is a difference between how our brains interpret and understand music from just a combination of other sounds, and yet we don't necessarily understand it, but it has to be tied back to some evolutionary process because otherwise, like our language, we wouldn't really have a way of organizing that as a separate concept from other sounds.

Dr. Collins:
A really fascinating study done by Neurosurgeon Eddie Chang at UC San Francisco where he is studying people with epilepsy where he needs to put all kinds of measurements using special electrodes across the surface of their brain, trying to figure out where that seizure is starting. But during that, you're sort of waiting for the seizure, and many of those folks are, "Well, can we do something interesting here?" So he will ask them to listen to music and record what happens in the acoustic cortex, the part of the brain just inside your ear, which is taking those sound waves and turning them into electricity.
And he's recently discovered there are three different circuits in the acoustic cortex that respond to music. One of them is about pitch. That kind of makes sense. Okay, is it high or is it low? If you're well-trained, is it an A flat or is it an A natural? The next circuit is about interval. What was the note before it? And this one, did you go up? Did you go down? Did you go up a lot? Did you go down a little bit? And those all kind of made sense, but the third circuit is actually your brain predicting what the next note is going to be. I think that is just fascinating, and after knowing that, it kind of sort of makes sense that when you're listening to a tune you haven't heard before, you kind of think you know where it's going, and if it doesn't go there, it catches your attention and maybe you like it because it was surprise or maybe you don't like it because you're like, "No, that's not the way it's supposed to go."
Now, that third circuit, I'm guessing, and this ought to be tested, is probably culturally trained quite a bit because my expectation of where a song's going to go might be very different than somebody in a tribe in Africa, but the fact that it's there just tells you how sophisticated this system is.

Dr. Correa:
Yeah, that's wonderful. And we have so many different senses, and in music itself is not a sense, it's utilizing multiple senses in how we're interpreting it, but why is it that particularly this combination of senses that we experience as music are different from how we study vision or hearing on its own or taste?

Dr. Collins:
Yeah, because clearly those have different effects on us, although, and they operate through very different circuits. Your acoustic cortex we were just talking about that responds to sound. It does not respond to taste or to vision. The vision has its own remarkable set of pathways that we're beginning to sort out. What they all have in common though is that they connect somehow to your emotional centers so that the effect of a particularly powerful visual or auditory experience or a taste experience can all kind of get you at the center of where you are. I think all of us have had the experience where a particular piece of music just gives you chills or brings tears to your eyes.
When you measure what's going on there, at the level that we can right now, you just dumped a whole lot of dopamine in your ventral striatum. That is the effect that that has. Now, how you get from those circuits in the auditory cortex, I was just talking about all the way to your ventral striatum is a mystery that we need to sort out. But again, the power of that for healing, for motivating, for encouraging, for dealing, not just with things like chronic pain, but also with mental health issues. We know there's a lot more that's going to be possible there if we understand this just a bit better.

Dr. Correa:
So one thing I also wanted to get to here is we were just speaking with Renee. She has interviewed many different people who are working on the NIH, NeuroArts Blueprint, but I'm wondering, we learn a lot beyond just the lab and neuroimaging techniques and other research, we learn more from our community. What have you learned from Renee and others about the importance of music?

Dr. Collins:
Renee is an incredible force of nature when it comes to this intersection between musical performance, music therapy, and neuroscience. She has taught herself science at a level that I have rarely seen in somebody who doesn't have that kind of formal background, and her energy and her commitment to bringing these fields together is just unmatched. She and I didn't even know each other seven years ago, and now she feels like one of the best partners I've ever had on anything because of the way she's put her time into learning the science and also the vision that has about where to take it. She's a pretty good convener too. If you want to have a bunch of people get together and talk about music and the mind, one of the conveners is Renee Fleming, a lot of people decide to show up.
That's been wonderful. Scientists for the most part are more likely to be interested in music maybe than the average person or even to be performers of music. There's a lot of scientists who play instruments, and it's been joyful to see at NIH how those folks have come out of the woodwork when they heard, "Oh, there's going to be a project here on music and the mind." But Renee's ability to inspire and to ask people to go even further than they thought they could has just been a critical part of the success of this effort on which we've now spent about $35 million of new funds trying to investigate how music actually works in these various settings all the way from basic to clinical.

Dr. Correa:
Now, none of this moves forward without really, as you said, people stepping up and showing up and the community's engagement. I wanted to get back to over your time at the NIH, how would you relate to the community and our listeners about the importance of the NIH?

Dr. Collins:
Well, the NIH is the largest supporter of biomedical research in the world. The funds for it come from the people through the Congress who makes those allocations. When you hear about a breakthrough on some topic, maybe it's heart disease or cancer or diabetes or the cure of Sickle cell disease, and it comes from some institution across the country that's a university for instance, it's extremely likely that this was in fact supported by the National Institutes of Health. That's how it does its work, is by sending the money out there to all of those bright brains that are coming up with the new ideas and making the discoveries. It is the reason that American biomedical research has been at the very top of the world's achievements in this field and will continue to do so as long as the support continues to be there. It's incredibly diverse.
It's based on peer review, so nobody gets money just because they're a famous person. They have to have an idea, they have to defend it. It gets reviewed by their peers, and only if it looks like it's in the top 20% is it likely to get funded. So it's focused on excellence, but it's also focused on risk-taking and bold ideas. As the NIH director for those 12 years, it was my job also to sort of look across the whole landscape and say, "Are there some things that are just ripe for expansion that are sort of ready, but they're not quite happening?" And then, "Okay, let's see if we could mount a big exciting initiative to draw more investigators into this field." That's how the BRAIN Initiative got started with a lot of help from President Obama, who is a big fan of it.
That's how other projects like All of Us, which is enrolling a million Americans in a long-term study of health and disease got started, and that's how Sound Health or Music and the Mind, we have various names for it got started because you could see there was a possibility here, but it was going to take kind of creating a new community, a new field of endeavor.
So let's put out the word and say, "Want to be part of this? Come to a workshop and let's shape it together."

Dr. Correa:
Now at the same time, let's acknowledge and highlight that there is some hesitancy to participating in research and in scientific studies at times, and there has been a dark past for different research organizations of the ways research have been conducted in our communities. How is the NIH and other research organizations working to address that and make sure those things don't happen again in the future?

Dr. Collins:
No, very important. There have been some chapters in the past where research was done in an unethical way, asking people to take part in research without fully informing them what the risks might be. And in one very awful circumstance, the Tuskegee Initiative actually withholding effective therapy from people who would've benefited from it, but weren't even told that it existed. That cannot happen anymore. Any clinical trial, any trial or project that involves participants who are volunteers has to go through rigorous review by an institutional review board, which includes members of the public and ethics experts to make sure that what's being done is ethical, and the people involved then get a full explanation and sign a consent form if they want to go forward so they know what they're getting into.
That doesn't mean that it always turns out well, if somebody has a terrible advanced cancer and we're trying to come up with a new way to help, it doesn't always succeed, but people know that as they're going into the study and are prepared to be our partners as we try out new things to see if something's going to help.

Dr. Correa:
And for our listeners and the community out there, how important is it that they reach out and support different research organizations, whether it's the NIH, federally funded, or other research organizations without their advocacy, how does this move forward?

Dr. Collins:
We need that advocacy. I'm afraid we're at a time right now in this country, maybe in the world where people are kind of cynical about a lot of things. We've kind of approached a point where there's a lot of divisiveness. There's a tendency to be distrustful, and sometimes that even spills over into things that have a long track record of being contributions to society. I think medical research has that track record when you consider where we are now compared to a hundred years ago when the average survival was like age 48, all of that, that's happened since then. Much of it built on medical research, and we have so much more that we can do now because the speed of discovery is just going faster and faster, and so the applications come along even quicker.
This would be a terrible time to lose that momentum, but I think that does mean people seeing this as a priority, supporting the research organizations in their own community, and if they have the chance to their elective representative saying, "Guys, this is a government activity that actually has real value and it's not partisan." It really never should be, and it's something that ultimately is also good for our economy. The return on investment is substantial from all of this research that builds up new ideas that lead to new companies. So it's a winner all the way around, but sometimes that gets lost in our current discussions where everything seems to take on a bit of a negative spin.

Dr. Correa:
And as you've been tapped into some of the latest science in many different areas, what are some things that you've learned about your own brain health that you've taken into your own life?

Dr. Collins:
Well, I'm fortunate that I was raised by my parents, taught at home until the sixth grade and taught how to gain joy out of learning new things. And I've carried that with me ever since. And I think the science would say that is a really good thing for your brain health to be curious, to go on brain adventures, looking into things you didn't know much about. And then music, we've done a lot to see what happens in music experience, whether a listener or a performer.
The thing that most lights up the largest part of your brain is music improvisation. And I happen to be somebody who loves the opportunity to improvise. So through the wall there is my baby grand piano, and at least once a day I will just go and sit down and see what happens. I don't know until I start and it's usually some composition that has never been heard before and never will be again, but it just sort of flows and then I feel enlivened.

Dr. Correa:
Well, I hope I have a future opportunity to either hear you playing the piano or the guitar, and thank you Francis so much for taking the time to talk with us and to share about your experiences and about the Music and Mind Initiative.

Dr. Collins:
Well, Daniel, thank you for what you're doing to spread the word. I'm a very fortunate person indeed to have gotten engaged in all of these different aspects of science and this latest one on music is just particularly joyful because like I said, it brings together parts of my life that I thought were going to have to be kept separate and now they can just be all mashed in there into a project that has so many great questions and occasionally some great answers.

Dr. Correa:
Thank you again for joining us today on The Brain & Life Podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive The Brain and Life Magazine for free at brainandlife.org. Don't forget about Brain and Life in Espanol.

Dr. Peters:
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Dr. Correa:
You can also find that information in our show notes and you can follow Katy and me and The Brain Life Magazine on many of your preferred social media channels. We are your hosts, Dr. Daniel Correa, connecting with you from New York City and online @NeuroDrCorrea

Dr. Peters:
And Dr. Peters, joining you from Durham, North Carolina and online @KatyPetersMDPhD.

Dr. Correa:
Most importantly, thank you and all of our community members that trust us with their health and everyone living with neurologic conditions.

Dr. Peters:
We hope together we can take steps to better brain health and each thrive with our own abilities every day.

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Connecting Music and Mind with Singer Renée Fleming

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