Election Year Stress? How Music Can Help the Mind Relax

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Mark ( 00:00 ):
The following is an encore presentation of Conversations on Health Care.
( 00:08 ):
Our guest is the editor of a new book, Music and Mind: Harnessing the Arts for Health and Wellness.
And she knows the subject well, as her voice and performances have brought countless joy and healing
to fans around the world. She's superstar soprano, Renee Fleming.
Margaret ( 00:25 ):
Renee Fleming has received the National Medal of Arts. She's the Goodwill Ambassador for Arts and
Health for the World Health Organization, has won five Grammys, and is a Kennedy Center Honors
awardee. And this is Conversations on Health Care.
Mark ( 00:45 ):
Renee Fleming, what an honor to have you on our show and welcome to Conversations on Health Care.
Renee ( 00:51 ):
Thank you, Mark and Margaret. I'm so thrilled to be with you today.
Mark ( 00:55 ):
Boy, the book is such an incredible contribution to the arts and science. I had to have a notepad on the
side, because there was so much wonderful factoids. But before we get into the book, let's start with
your own personal connection to music and the mind. You write about an experience you had when you
were attending Julliard and your back went into spasms the day before an important audition. Tell us
how that led to your understanding of anxiety in the body.
Renee ( 01:27 ):
Well, between that and stage fright, I knew there was a mind body connection, because with stage
fright, my symptom was somatic pain. And it took me a long time to unpack that one, because this was
before people were really looking at this as a possibility. And I discovered that my back would go into
spasm right before an important audition when I was incredibly nervous in a high stress situation, and
this continued through most of my career. I still struggle with it once in a while. And the point is that you
really have to understand that we are emotional beings and then we're thinking beings, but the
emotions come first. And in my case, it was really anxiety about having to perform and having to achieve
these yardsticks at every turn, especially early in my career.
Margaret ( 02:22 ):
Well, on a personal level, you write about NIH researchers who asked you to take part in a functional
MRI experiment. So let me say thank you for taking one for the science team, that's generally not
anyone's idea of a great time, but it was important to them. So tell us about the experience and what
was learned from the experience.
Renee ( 02:42 ):
Well, it was really extraordinary. I spent two hours in the MRI machine, so this is a functional MRI that is
measuring blood oxygen in the brain. And the activity included speaking, singing, and imagining singing.

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And imagining singing in my experiment was the most impactful part of the experiment. So it activated
more parts of my brain than the other two activities. And the scientists were perplexed by this, because
they assumed that singing would be the most powerful activity. But what they ultimately surmised is
that because I'm a singer, singing is second nature, whereas imagining singing took a little bit more
effort to tune out the noise of the MRI machine and to stay focused on the audiation. So I was audiating
the actual music at the same time. But it was fascinating to see what it looks like in the brain and how
many different parts... Really all parts of the known mapped brain show signs of experiences with music.

Mark ( 03:47 ):
Well, that is quite fascinating. But I also thought was fascinating is that Dr. Francis Collins, former
director of NIH, wrote the introduction to the book. What a wonderful introduction. We know him,
we've had him on our show before. We would've loved to have been in that small gathering of you all
singing together with the Supreme Court Justice. Tell us about the connection back to NIH.

Renee ( 04:11 ):
So I met him rather randomly at a dinner party when I first was coming to DC on a regular basis. And it
was a wonderful dinner party, because we were with the justices literally the day after the marriage
equality decision. I would say there was a little tension between them. This was such a fraught decision.
And we know how close Anthony Scalia and Ruth Bader Ginsburg were. They were close friends. And I
was seated between them, because they're both opera lovers. But it took a while for people to relax and
warm up a little bit. It was a great evening. And Francis Collins, now I know this to be normal for him,
brought his guitar, and we joined with the trio that was performing and had kind of a sing along with
everybody. And one of the most, I would say, symbolic songs was The Times They Are A-Changin'.
( 05:05 ):
And I asked him that night, why are scientists studying music? I, at that time, couldn't understand why
they might be looking at music in the brain. And he said, because we have a new brain institute and we
want to understand more about the brain, and we've discovered that music in particular is so impactful.
And I said, well, I just started at the Kennedy Center as an adviser, what do you think about us providing
a platform for science at the Kennedy Center? Because I think audiences would be fascinated to know
what's happening when we're experiencing great art. And so this has become a tremendous passion for
me to share this work with the public and really to be an advocate for the field of arts and health.

Margaret ( 05:51 ):
Well, that is such important work, and as people engaged in healthcare, we really applaud you taking it
right to that level. But Renee, as editor of the book, you made the choice to include authors who also
write about their experience with or as healthcare professionals, who actually have begun to prescribe
activities that are artistic and nature-based, whether it's music, or dance, or painting, or being out in
nature, as Yo-Yo Ma said so beautifully in his chapter, in order to achieve improved health outcomes,
and in fact that these actions can play a big role in dealing with the country's mental health crisis. Tell us
about the Sound Health initiative specifically and the focus of research in that area.

Renee ( 06:36 ):
Well, we're talking about social prescribing, which is being done in the UK, it's being done in several
states in the US as well. So there are programs developing that enable healthcare to really make... Well
prescribing, but also to say you might actually consider going into a park, you might consider taking

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these classes working with these creative arts therapists. The Sound Health Network is actually an
organization that was founded by the NEA. I kept complaining that we needed a website, we needed a
resource center, that some of the research was redundant, because people didn't know what they were
doing. And finally the NEA said, Sunil Iyengar, who's so brilliant, who was really head of research for the
NEA, said, okay, let's see what we can do.
( 07:24 ):
And at UCSF now, the Sound Health Network has become a fabulous resource center for anything music
related and art, because the research needs to be compiled. People need to have some place to go to
see what everyone else is doing, to see what has been learned, and to also gain in resources to help
them also create better versions of integrating arts in healthcare. So it's been incredibly successful and
it's grown tremendously. The entire field has grown tremendously. And the other organization that is
creating a resource center that will launch this fall is NeuroArts. So the NeuroArts Blueprint, which is
located at Johns Hopkins and also in combination with the Aspen Institute, will have a different kind of a
global resource center for everything under the NeuroArts umbrella, which includes visual art therapies,
it includes dance, it includes our response to nature. It's all about neuroaesthetics, which is how we as
human beings receive aesthetic experiences.

Mark ( 08:36 ):
That's wonderful. I was thinking that our movement of community health centers started with Dr. Jack
Geiger prescribing food to patients instead of medicine, because that's what they needed. And now the
coming full circle of prescribing go sing in your community choir might be the thing. But Margaret and I,
Renee, were reading the book and we were calling each other trying to figure out what was the best
chapter we loved. I think we both may have alighted on Yo-Yo Ma's chapter there. And Margaret said
earlier about the imagery, here he is in Arcadia National Park singing with an indigenous community. But
he writes so brilliantly about the wisdom of indigenous cultures, climate change and planetary health.
That's a lot to take on. How does he tie it all together?

Renee ( 09:29 ):
Well, I'm doing a major project with National Geographic now that's based on Voice of Nature: The
Anthropocene, which is the album I won a Grammy with last year. And they've created extraordinary
films to kind of illustrate why we should love the planet and take care of the planet, and also the effect
that we as human beings have had on the planet, that's the Anthropocene part, or if you're from Canada
or the UK, the Anthropocene. And so he's looking at something similar and relating it to indigenous
cultures, who have all along not only appreciated, but respected the Earth and had sustained practices
that were great examples of sustainability. And by the way, this all plays into music and mind, and arts
and health, because climate change is wreaking havoc on our health. We're having pulmonary issues,
we're having all kinds of depression and anxiety as a result in young people worried about the future. So
this all ties together, and I think Yo-Yo's chapter is a perfect example of that.

Margaret ( 10:38 ):
Well, I also loved reading choreographer David Leventhal's words about music and movement, and the
effort to create dance for Parkinson's disease. Certainly one of the more common as the population
ages, one of the more common health conditions and movement disorders, and he writes that as a
dancer. He's a transistor that converted musical energy into movement. Tell us more about that work.

Renee ( 11:04 ):

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Oh, this is such an extraordinary program, because it's well established. COVID actually gave him a
wonderful opportunity to expand to telehealth. Whereas he was training 20 teachers, he's now training
800 all over the world at one time. And the other good news is that the NIH has now agreed to add
dance to their research, because dance and movement are related as we know, certainly for any
movement disorders, it would be Parkinson's, or MS, or sometimes even certain brain trauma can cause
movement disorders. And this adding rhythm is incredibly impactful. So rhythm and music together can
help us. Now, we use audiation for that as well, and I have started to apply it to my own walking and
hiking. So I can even carry on a conversation and hear in my mind's ear When The Saints Go Marching In,
something up-tempo to keep up my pace, because otherwise I want to slow down. There are good
health and wellness benefits for some of these techniques as well.

Mark ( 12:14 ):
Oh, that's great. You were talking a little bit about telehealth and COVID, and how impactful telehealth
came because of the pandemic that impacted us, and there have been a lot of changes that have
happened because of it. But I want to focus on something you wrote. Nearly half the US states allow for
limited Medicare and Medicaid arts therapy coverage for certain conditions and populations, but
reimbursement is often on a case-by-case basis. This is also true for private insurance. Many would like
to see greater coverage of creator art therapies. I'm wondering, how do we overcome the hurdles that
exist in terms of these important reimbursements that would help people access this important
intervention?

Renee ( 13:05 ):
I'm so glad you asked this, because it starts with licensure around the country. This is on a state-by-state
basis. So that's the first step, is to license our creative arts therapists. The training they receive is on a
very high level, and what we've discovered is that it's low cost, it's non-invasive, and it's non-
pharmaceutical, so it's incredibly beneficial. Also for healthcare providers and for caregivers, we now
understand that they are under tremendous stress as well. But what can happen I think with the
licensure, is that they can be embedded in healthcare across the boards and be incredibly supportive,
because we have the actual interventions that are created by science that work, and this is relatively
new. It comes with technology, it comes with our ability to look at the brain and see what's happening in
the body in a more meaningful way, but it's also about the arts being embedded in healthcare as a sort
of music medicine way.
( 14:08 ):
So I started these investigator grants that have just launched. They'll be announced April 1st. The first
recipients for the collaboration with Johns Hopkins and the Aspen Institute of the NeuroArts. So it's
funding young scientists who have access to a lab, they're usually postdoc students, with an artist in a
collaborative effort to create a stronger pipeline. And this is kind of what it will take to be able to
integrate arts interventions and creative arts therapies in our healthcare system. But it's coming. It's
definitely coming. There's been such an explosion of interest in this work in recent years. Susan
Magsamen and Ivy Ross's book, Your Brain on Art, was a bestseller last year. And Dan Levitin is coming
out with another book in August that's on music specifically. And of course you have my book, which is
the anthology perhaps could be thought of as an introduction to arts and health, because it's so broad, it
covers so many aspects of it.

Margaret ( 15:13 ):

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Well, it certainly touches on key issues to our society really. And I'm going to go back again to the aging
population, as we spoke about with Parkinson's, and get your thoughts a little bit on music and
dementia. And I know the research suggests that musical memories from our early years are stored in
the brain right up until the later stages of dementia. And that if we can elicit those familiar musical
memories, we can reduce some of the distressing behaviors and agitation in the population, certainly
helping those individuals as well as those who care for them. So what are the implications? Should we
be writing down those songs that make us happy that we sing all the time, while we're fully aware, and
keep them handy for later in life for our caregivers?

Renee ( 16:03 ):
Absolutely, because it's all taste-based. It's all based, as you said, on experience. And our memory and
music are so powerfully intertwined that most of our major life events, if there was music attached to it,
when we hear that song again, we know we're back at our wedding, we're back at high school
graduation, or whatever major events we had, and sometimes they're sad ones as well. So definitely it is
the last memory to go in patients with dementia and Alzheimer's, which is so powerful when you think
about it. It has something to do with the location in the brain of that type of memory not being affected
by certainly Alzheimer's disease until its latest stages. People can play guitar. Look at Glen Campbell. I
don't know if you saw that documentary, but there are examples like that. Tony Bennett, his last
concert, I could not believe his [inaudible 00:17:01] was such a high level.
( 17:03 ):
So what researchers are trying to do, in fact, [inaudible 00:17:08] is looking at how to sustain and extend
the connection to self that occurs. Oliver Sacks talked eloquently about it when people listen to music at
that point. But for aging also, it's remarkable to me that research is being done on singing and
cardiovascular disease, that the endothelial function improves with just singing a couple of times a
week. So there's a great research that is happening, and this all of course points to evolution. It's
because we do not evolve quickly. And arts and the expression of arts, singing, vocalization, rhythm,
drumming, all of these things have been with us since before the beginning of time and also before
speech. So that's interesting to think about. Before we even developed language, we had other ways of
communicating, and they still work.

Mark ( 18:04 ):
I was just thinking about my father-in-law, Robert Alexander, who just passed away recently in his 90s
and had Alzheimer's in the end of his life, but could probably two weeks before he passed away, get up,
play show tunes, knew all the musicals on Broadway, and it reduced his pain, gave him such relief. So it's
absolutely so important. But you have a great chapter on music education and a few myth busters in
there. For instance, the Mozart effect, the idea that listening to certain types of music, Western
classicals in particular, can make a child more intelligent, didn't seem to work with me, or at least my
wife said it didn't. But what does the research really tell us about the best kind of music to listen to?

Renee ( 18:58 ):
Well, and the Mozart effect was debunked in having to do with the research that was underpinning that
notion. So the best kind of music is the music that's meaningful to you. However, for certain disorders
and certain training, as I said, rhythm is incredibly important. Rhythm can also sort of tell us if a child has
learning disorders at a young stage, difficulty with rhythm. So again, non-invasive, but can give us a lot of
information and very much help with children on the autism spectrum. It definitely depends on the

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intervention. If a music therapist is working or a researcher, then they will be looking for outcomes that
relate to specific types of music. But in general, it's what means the most to us, as we said earlier.

Margaret ( 19:47 ):
Well, Renee, I wonder if I could ask you to comment a little bit maybe on, I don't know if it's more policy
than political area, but certainly we all are no strangers to the budget cuts that happen in educational
systems, to what should be included in our schools and not included in our schools. And yet we can't
help but conclude from reading all of the incredible chapters in your book, that to deny children the
opportunity to learn music, as well as to express music, to participate fully in art has positive mental
health and cognitive intellectual development applications. What's your sense of where the community
of artists that you interact with are on really trying to advocate for this kind of support for the next
generation to have access to these experiences artistically and musically?

Renee ( 20:44 ):
Well, we did take a big step back in the last 20 years on arts education in general, because of cost. But I
was very close to public schools in Chicago and some initiatives that were occurring there to bring arts
back into schools. And what superintendents realized in the city school district was that truancy has
been a tremendous problem in some of our cities. And to bring arts back into schools means that kids
have a better reason to stay in school, because they're doing something they really love and they enjoy.
It also helps so much with pro-social behavior, with identity, which is increasingly important when
there's so much that they have to contend with and trauma. And one of the things I learned from
Turnaround Arts, which is now housed at the Kennedy Center, is that especially with children who've
experienced trauma, a visual art therapy can help them really work through that, because they can't
verbalize what's happening or what has happened to them, but they might be able to draw it or to
express it, writing lyrics.
( 21:52 ):
So children with cancer, if you get them to write hip hop lyrics, they will say how they're feeling and
what's happening with them. They'll connect with their family again. These are initiatives that in a
hospital setting can be incredibly useful. I mean, I've really come to believe that having some kind of
creative art studio, especially in children's hospitals, should just be a must. It should be there from the
earliest planning stages.
( 22:18 ):
And one other thing I'd like to mention, I'm working on a project called Art Care, that you would go to,
for instance, your insurance provider, and up there with all of the health and wellness possibilities,
because people understand integrative medicine now, would be art care. And by zip code, you would be
able to find all of the existing programs that wonderful performing arts venues supply for people with
children with special needs or caregivers and their family members with Alzheimer's who are now so
often being cared for at home. So things that are needed could be supplied in that way, but maybe just
for creative aging, just joining a choir, as you said, or learning to play a new instrument. This would be a
wonderful way to kind of disseminate the research and all of the things that we're learning about the
benefits of arts and health.

Margaret ( 23:14 ):
From cradle to grave.

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Renee ( 23:16 ):
Yes.

Mark ( 23:16 ):
Well, thinking about providing folks instruments, I think I heard on the Oscars the other day that the
school system in Los Angeles still provides every child a musical instrument, and I think that's so
important across the board. This is really for our tech and AI folks who are listening in here, because
we're living in this digital AI revolution that includes the music sector. And I just want to get your on the
use of Auto-Tune, which alters the pitch in vocal and instrumental music recordings. I'm wondering if
these technologies help or hurt with the benefits of music in the mind.

Renee ( 24:00 ):
Well, it's interesting because... Well, it's something that's done in post-production or also in live
performance. It's used in live performance as well. I think people are so used to the sound now that one
major recording executive in Nashville told me that people are auditioning and they have learned, young
people, they've learned to mimic the sound of Auto-Tune on the voice, which was quite extraordinary.
Just as, for instance, a lot of young children now mimic the Disney Princess sound, which is something
that I've really heard. It's not just a timbre, but it's also a style of singing. So I don't think it's had a
negative effect at all, because I think whatever it is that the public follows and loves, is something that
will enrich their lives. As long as they're engaged with music in some way or with the arts in some way,
I'm not terribly particular about what it is.

Mark ( 24:53 ):
There's no wrong door.

Margaret ( 24:55 ):
Exactly.

Renee ( 24:56 ):
No, definitely not. And in fact, technology is starting to really come up with some of the most innovative
uses of this work. There's VR for cognitive decline, mild cognitive decline. I want to play that game. I
want to be able to have that game available to me. There's also VR, this is through Adam Gazzaley's
Neuroscape. There's VR for ADHD. Now, that seems really strange to me that you would play a game to
learn how to focus, but they built it into the game, and I think it's available as an app now.

Margaret ( 25:28 ):
Yeah. Well, Renee, you have a foundation that's focused on these issues that convenes experts from the
fields of neuroscience and music therapy, and medicine. We're well familiar with the application to
foundations process. And one measure is always that you have to show what kind of outcomes you're
looking for, either quantitative or qualitative. What do you see or when your foundation is considering
these applications, what are the kind of outcomes that you're hoping that people will look to measure
and see what the impact is?

Renee ( 26:02 ):

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So because the NeuroArts Investigator Awards are new, and we have our first class really being chosen
on April 1st, I'm hoping to see this pipeline be strengthened not only for scientists, but for scientists,
they have to collaborate with an artist. Because I believe firmly that we as artists have a lot in common
with scientific rigor, but also the practice, the creativity of it, the imagination that goes into what we do.
I think science is incredibly creative. You develop a hypothesis or you develop a line of inquiry that you
follow. It's the same for us, only we have access to centuries of our art form to kind of mine for these
ideas. So pairing them I think is a great idea, because artists, we don't know enough not to ask
questions, whereas a scientist would say, wow, I didn't think of that, let's follow that track. And then we
can also help in the implementation of the science.

Mark ( 27:06 ):
We remember seeing you last year as we brought our audience to Aspen Ideas: Health, which is a
gathering of visionary health leaders and innovators. So we're all big fans of Aspen, but getting to places
like Aspen or the Kennedy Center can be expensive. So maybe share with our audience what are best
tips for bringing mindfulness and music into our lives wherever we're located.

Renee ( 27:32 ):
Well, I have to tell you, I started doing this for myself. I am a living example of the power of the arts,
because I was getting very anxious about the coming year, the election, about what's happening in the
world. And if you start paying too much attention to your newsfeed, you're going to get very concerned.
So I thought, I'm going to step away from it. I'm not doing opinion news anymore. I am just looking at
the actual news, network news once a day, and I am enjoying reading, being out in nature, going to
plays and museums again, wherever I travel. And it's incredibly fulfilling finding things that I love, color,
expressions of sound and color, for instance. So it's all out there. We have to just choose to spend time
and not feel guilty about spending time doing it. Some of us have a tendency to want to work all day,
like me, but I've discovered that no, I'm leading a much more balanced life if I allow myself to have the
cultural experiences that I am touting, and it's working.

Margaret ( 28:45 ):
Well, that is great. And Renee, thank you so much. Your book is Music and Mind: Harnessing the Arts for
Health and Wellness. It's published by Penguin Random House. Thanks to our audience for being here,
and please be sure to subscribe to our videos on YouTube, find us on Facebook and X with our account
name CHC Radio. As always, go online to CHCradio.com to sign up for email updates, and please share
your thoughts and comments about this program with us. Renee Fleming, thank you so much for your
contributions to the quality of all of our lives and for joining us today on Conversations on Health Care.

Renee ( 29:22 ):
Thank you so much, Margaret, and thank you, Mark.

Margaret ( 29:28 ):
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