Talking music and the mind with Francis Collins and Renée Fleming

Opera superstar and former NIH director help catalyze research

This was also posted over at my blog at Science and goes with this editorial. So much fun talking to these two.

At the nexus of art and health are two leading practitioners of music and biomedical research—Renée Fleming and Francis Collins. Both advocate for a better understanding of the connections between music and the brain (see the Editorial). I spoke to them recently about their shared interest in this area, their hopes for the future of this young field of study, and Renée’s new book, Music and Mind: Harnessing the Arts for Health and Wellness. Here’s the full text of our interview.

Holden Thorp: Let's talk about one of the things I thought was interesting at the beginning of the book. There's a lot of interest in why musicality exists. Did it evolve specifically or is it just hitching a ride on other traits that got selected for? You seem to be coming down on the side that it's here for a reason. What's important about musicality being a primary trait?

Renée Fleming: It was the only way for me to understand why we're even having this conversation—that evolution was the crucial piece. The science behind it has more to do with the fact that it predated speech, which is really interesting to me. People were copying animal sounds probably in hunting, but then also perhaps in communication, signals, tribal cohesion. Then, it had to turn to seduction. Storytelling recorded history until 10,000 years ago, and it was all in song. So, those are just some thoughts, but wonderful people have written about this.

Francis Collins: There’s interesting work in the neuroscience arena about how we respond to music. Connection with the NIH BRAIN Initiative is going to make it evolve even faster. Eddie Chang, a neurosurgeon, has been putting electrodes in people's brains when the skull is open in anticipation of epilepsy surgery. Data that he showed in our December workshop indicated that there were three kinds of music response circuits—one for pitch, one for interval, and one that anticipates the next note. That last one blew me away. It wouldn't be there for no reason. To me, this says that because our brains don’t evolve that quickly, there has been a strong evolutionary advantage built into our ability to perform and respond to music. We know from personal experiences that music can draw people together, help move people in a direction of going to war, like a fight song, or mourning, like a dirge, or celebrating, like a happy birthday song.

Those are the kinds of experiences across humanity that have drawn us together and allowed us to do things as a cooperative effort—things that single individuals might not have been able to achieve. Evolution has indicated that this is beneficial by providing the kinds of circuitry that makes music a powerful influence on who we are. We know this is powerful—music can move us in ways that are surprising and go well beyond what words alone can achieve.

Holden Thorp: Renée, what drew you to wanting to engage in the basic science? Do you think other musicians of your caliber are interested in this?

Renée Fleming: I do, insofar as they’re intellectually curious about other things in the world and about the underpinnings of what we do, why it affects people, why it affects us, and why we devote ourselves to it. In my case, I often think, “God, if aliens heard this, they would think it’s so bizarre that we make these noises.”

I had somatic pain throughout most of my career as a hedge against, or a reaction from, real pressure and stage fright and things that were making performance hard. So, I just started reading and trying to figure out what’s going on. I stumbled upon the idea that scientists were looking at the brain and music. When I met Francis, it was the perfect opportunity to ask why.

Holden Thorp: I also thought in Daniel Levitin’s chapter, he did a really good job of making the case that there is some innate musical talent that comes from genetics. You can’t just practice your way into being a great musician. Francis, why do you think that would be?

Francis Collins: Good question. Has that provided, in some selective way, survival advantage? I think that humanity is endowed with the general capability to appreciate and even to produce music. It comes in different doses, just like other aspects of who we are. It certainly responds to environmental encouragement, however. I don’t think I would be as interested in music or as willing to get myself out there in a performance mode, like singing a duet with Renée Fleming, if I had not grown up in a family where music was what you did. From the time I was old enough to know anything, music was part of the environment. My dad was a folk song collector. He played the violin.

Everybody in the family had to play something or you were going to be left out of the after-dinner party. Maybe I was also blessed with a bit of inherited musical tendencies, but a lot of it was just the exposure. You probably have seen some of the data there. If somebody has had rigorous musical training before age seven, the size of their acoustic cortex is measurably larger. That tells you there is a lot of plasticity. Let nobody say, “Well, I guess I just didn’t get the music genes.” We’ve all got the music genes, but they have been manifested somewhat differently depending on one’s environment.

Renée Fleming: Another thing that that helped me understand is that rhythm is at the heart of all of our experiences. It happens in the womb, because we’re exposed to so much rhythm that exists in the body. It’s interesting to me that rhythm is the basis for speech.

One of the things that Miriam Lense is discovering is that when children are having difficulties, we’ll know that in advance—say, dyslexia in advance because of difficulty with rhythm. With Parkinson’s and multiple sclerosis, exposure to rhythm and music will help those patients move fluidly and gracefully. That’s been a strong area of research.

Holden Thorp: How do you react to the idea that there’s a genetic component? You’ve worked very hard to be a world-class singer, but there are probably some people who think that this is just some gift and you just started singing as you sing now. A lot of singers say to me, “I hate it when someone says, ‘Oh, you have such a great gift.’ I didn’t get a gift. I worked to be able to do this.” So how do you balance those two things when you think about your life and singing and music?

Renée Fleming: Well, it’s interesting. I share with Francis this early exposure and immersion in music through my family. Plus, my parents were vocal music educators in public schools, and I had great public school programs throughout my school career. I’m definitely a poster child for things coming to me more easily because I had innate musicianship, great ears, et cetera. However, some of the greatest singers in history could not, for example, read music, like Luciano Pavarotti.

So, it didn’t make you or break you necessarily that you had ability and exposure. Some people were gifted and became historic singers. Now, instrumentalists are different. It takes so much practice and devotion to those instruments well before they’ve reached their teen years, but singers have a slightly lower bar.

Holden Thorp: I don’t know about that. I think you probably worked pretty hard on your breathing and technique. I think it takes a lot of work to be a world-class singer.

Renée Fleming: Well, there’s pitch, there’s style, and virtuosity that has to be built in. You have to learn a vast amount of music in as many as 10 or 11, 12 languages. There’s a different type of skill set.

Holden Thorp: It’s in your book and in your PBS NewsHour piece that imagining singing stimulates your brain more than actually singing. Remember the book, The Inner Game of Tennis?

If you imagine playing tennis the right way, that’s how you got to be a great tennis player. Michael Jordan always said, “I’ve imagined myself flying through the air. That’s a big part of how I’m able to do this.”

Renée Fleming: Imagining singing helps me save my voice, and it’s also how I know that I have something fully memorized. If I can hear every part, every other singer, all their texts and my text, then I know I have the piece memorized. Some pieces are 3 hours’ long, so it takes time to get to that place. Audiation, as we call it, has been useful for other things too. I just heard about a study in December that reported how a Parkinson’s patient can use audiation to cross the street just by hearing a rhythmic song. I started to use imagining when I exercise to keep my tempo up. Imagining singing is one of the skills that we use a lot to not get too tired.

Holden Thorp: Are you able to turn it off when you don’t want to do it?

Renée Fleming: No, but interestingly, when I’m in an opera, the earworms are never what I have learned in my own music. It’s always what someone else is singing. It’ll just be a brief phrase and I can’t get rid of it. I don’t know if there’s science about earworms.

Francis Collins: Not enough for the amount of distress they cause. I’m in a rock-and-roll band and I was just working out a new song, because we’re trying to dredge up some things we haven’t done before. I had to come up with the chord changes to the Miley Cyrus song “Flowers” and now it’s just stuck in my head. What’s the evolutionary advantage there? I don’t know. That seems like a misfire.

Holden Thorp: Well, except that apparently it helps people perform, right?

Francis Collins: To a point. It is certainly possible if I’m rehearsing for something where I don’t have access to a guitar or keyboard, I can make progress just by imagining playing the chords or the keys and figuring out where the tricky parts are. I’m probably activating more of my brain when I’m doing that than if I’m playing it in real time.

The most dramatic example of activating your whole brain is doing jazz improvisation, because everything is unpredictable, and every part of your brain has got to be engaged or the whole thing’s going to collapse. It is just a different way to get into the music zone that is anything but rote and expected.

Renée Fleming: The thing I love about jazz improvisation or comedy—this relates to the Charles Limb studies—is that you have to turn off the judgmental part of your brain to even start. It’s a version of flow, I think. It’s good practice for all of us.

Holden Thorp: Definitely. Renée, you’ve been hanging around with scientists now. A lot them are people who have musical brains. What have you observed about the musical scientists who you’ve been interacting with?

Renée Fleming: I find that musicians tend to be good at math because you’re breaking down the structure of the musical form. I had a high-level musical education once I got to graduate school at the Eastman School of Music, and I enjoyed it. But until then, as a singer, I was working mostly by ear.

Francis Collins: I’m still a bit mystified about what the real connections are. Such a high proportion of scientists are musically inclined and many of them play instruments. If you are a Nobel Prize–winning physicist, you probably play either the violin or the piano. It particularly seems true in physics, but lots of scientists and other disciplines have this same connection. I do think, Renée, you’re right. It’s something to do with the mathematical aspect. Music has a rhythm, it has a beat.

It has wonderful physics behind why certain intervals sound good and others sound jarring. Once you understand that, it’s very satisfying to know why you liked one chord and didn’t like another. But also, it must somehow tap into systematizing or this desire to try to create something beautiful out of what might otherwise be chaos. I think that’s what scientists are doing. They’re trying to create something beautiful in terms of understanding its nature, which can seem very chaotic. Through experiments, you can begin to understand the simplicity and the beauty of how something makes sense. Music is like that too. You’re taking what could be a cacophony of noises and turning it into something that gives you this elevation of this spirit that is hard to come by in other ways.

Renée Fleming: Well, math scores go up by 20% if music education is in schools. After 2 years of musical training, you have lasting changes in the brain, and it probably makes a difference. Not to mention the discipline and the focus and all of the other impacts of learning to play music.

Francis Collins: It’s math and language too that are facilitated by musical training. Yet most schools consider music a frill and have removed it from the curriculum, because budgets are tight. Terrible mistake.

Holden Thorp: We don’t have a standardized test that people are teaching to that has music on it.

Renée Fleming: Ken Elpus has done fabulous statistics for the National Endowment for the Arts for a long time. The thing that I noticed between his writing and my experience in Chicago is that kids stay in school if they have something they enjoy. So, that’s another simple reason. There’s so much truancy around the country, especially in urban areas, that’s causing a tremendous number of social ills.

Holden Thorp: Renée, I think one of the inspirational things about your section of the book is talking about your own stage fright. It’s always good when people who have achieved a lot help other folks realize they have complicated thoughts and emotions too. Do you think anxiety is correlated with musical ability?

Renée Fleming: No, but performance is. It’s built into the word. How many people have a job where you’re literally reviewed in the paper the next day in public? I don’t know anyone else other than performers and classical musicians.

I would say that it’s performance pressure One thing that’s interesting is reexamining education and bringing joy back into the equation, bringing nature back into the equation, and allowing the whole system to see what children’s individual talents are and play to those strengths.

Holden Thorp: You don’t think stage fright is correlated with musical thinking? You think it’s just the performance.

Renée Fleming: In my case, it really went back to my early learning. You have to find the roots of it first, but then there’s a lot of behavioral modification that has to take place. I was seeing the audience as incredibly judgmental, so I had to rethink that. I also had to understand that I was sharing something beautiful with the audience rather than them judging me. Cognitive behavioral therapy was very useful for me in that respect. I had to unpacking the thoughts that were making this an incredibly challenging exercise while seeing colleagues who loved performing.

Bryn Terfel can play eight rounds of golf and then sing Wagner with no problem. I thought, “What’s different about him and why am I suffering so much?” Knowing the science has helped me tremendously.

Francis Collins: I like what you said about recognizing the audience is not against you. I had somebody tell me when I was first starting out as a professor and I was pretty anxious about presentations in front of a large crowd of what appeared to be skeptical students. The answer was not to worry, because most of the time your audience wants you to succeed. They come with that hope. So, you’re starting out in a frame that’s a lot more positive than you think.

Holden Thorp: I’m sure that’s true for you. Your audience wants you to give them a glorious experience. They’re counting on that being the most likely outcome.

Renée Fleming: Even in an audition, I tell young singers, we really want you to do well. We’re not dying to write down, “This was bad, this was bad, this was bad.” No, we’re rooting for you.

Holden Thorp: Now I want to give both of you an opportunity to promote what you’re working on, so that we can get more readers engaged in this. What’s the most surprising and exciting application of all this you’ve seen?

Francis Collins: It’s a long list and it’s happening every day with new kinds of studies that are being funded, many of them by NIH, because we now have a significant research program on music as medicine. There was a study that I was particularly impressed with about the benefits of singing for one’s general mental state. One group trained with a coach to sing, but it was just a solo experience for each person. The other group was assigned to a choir and a choir director where they all learned singing together. At the end of 13 or 14 weeks, the solo singers did a little better across various measures.

The group singers were dramatically benefited by every measure of chronic pain, because many of them were elderly people whose chronic pain had gone down. Their oxytocin levels went up. Their measure of generosity was particularly affected in a positive direction by having had this experience. That was a well-designed study with a pretty clear end point. I thought that was a pretty cool example of music affecting us in ways that are truly positive.

Renée Fleming: I didn’t hear anything about singing research for about the first 5 years that I was working with Francis in the field. All of a sudden, there seems to be this explosion of multiple studies that have provided tremendous benefits. One of the surprises for me was related to postpartum depression. I would never expect that a woman with serious postpartum depression who joins a choir would have such improvement. The World Health Organization is now spreading that information all over several countries in Europe. They’re really using that research.

The other surprise is cardiac health, because Jacquelyn Kulinski, who receives funding from the NIH, has discovered that a couple of sessions of singing a week improves endothelial markers. It is really extraordinary. When you think about it, so many people with chronic conditions are sedentary either from the condition or in general. So, singing has an athleticism to it. You’re holding your breath. You’re producing sound. You’re also stimulating the vagus nerve. So, that was really a surprise to me.

Holden Thorp: So, if there’s one application you’d love to see people put more emphasis on, what would that be?

Francis Collins: For me, it’s this general area of trying to effectively bring together the music therapy community, which has been doing wonderful things since World War II, with the basic neuroscientists who are taking all the circuits in the brain to a whole new level of understanding. There has got to be a lot of sparks that can fly when these disciplines get together well enough to understand and learn from each other.

So much of music therapy is powerful, but oftentimes seems a bit puzzling in terms of how it works. Sometimes it seems a bit anecdotal. One wants to understand the mechanisms better to make music therapy even more effective than it is. I think the way to achieve that might well be to get these disciplines to really learn to talk to each other, appreciate each other, learn from each other, develop a whole new discipline of how you can take the therapeutic benefits to the next level as we begin to unpack how the brain works.

Renée Fleming: For me, I just started Investigator Awards with The NeuroArts Blueprint at Johns Hopkins and the Aspen Institute. We’ll have the announcements on April 1st, but it’s to continue and create a pipeline for research. This requires scientists, usually postdocs who have access to a lab, to collaborate with artists. I think we bring a certain type of inquiry to the conversation and help with designing studies. It would be useful to have artists involved.

We have extraordinary applications for this program and a fabulous team of people who are vetting the applications, including Emmeline Edwards from NIH’s National Center for Complementary and Integrative Health. It’s thrilling to be able to help move the needle. We created a toolkit, for instance. Emmeline and her team improved the rigor of the research. One thing Francis said recently, which I have been telling everyone, is that pairing creative arts therapies with neuroscience in terms of education would be smart.

Francis Collins: Absolutely. We’re at an inflection point. Over the course of the last 6 or 7 years, interest has been building about possible applications in human health. Now, it’s time to take it to the next level. You can feel this community beginning to come together and enlarge.

Holden Thorp: So, last question. What is one thing we could understand about music and the brain that we don’t know yet?

Renée Fleming: Well, I’ll throw out one thing. MIT just posted an interesting study reporting that brainwaves are consistent across various layers of the brain and across all mammals. This is a revelation that will probably spawn a lot of research because brainwaves are a type of rhythm. It’ll be exciting to see what else we learn about the power of music to affect the brain and body as technology improves,

Francis Collins: I would love to really unravel how music intersects with circuits in the brain that connect to central pain and then make the power of music beneficial to people who are suffering with significant pain. So, you’d have a nonpharmacological analgesic that would be so much better than the opioids that are now causing so much terrible pain and loss.

Instead of writing a prescription for a pill, a doctor writes a prescription for a symphony.

Holden Thorp: Boy, wouldn’t that be amazing? That’s what we need.

Renée Fleming: I have a friend who had a serious brain bleed, not an aneurysm, and she said the only thing that alleviated the excruciating pain that she had in the first days was listening to the loudest music she could stand. She couldn’t read, she couldn’t do anything else. If the volume went down, the pain came back.

Maybe the same receptor that’s causing the pain is switching to something else. Who knows? Well, thanks to where everything’s going in neuroscience, we may know the answers to these things before too long.

Francis Collins: We will.

Renée Fleming: Absolutely.

Holden Thorp: Thanks to both for all you’re doing.