This article has been reprinted with permission from Harvard Medical Alumni Bulletin, Volume 81, Number 2; Spring 2008
Sergei Rachmaninoff dedicated his Piano Concerto No. 2 to an unlikely muse: his psychiatrist. The Russian composer had suffered from a debilitating depression since the disastrous premiere of his Symphony No. 1 three years earlier, and the illness had robbed him of his ability to compose music. After his psychiatrist cured his creative block through hypnosis, Rachmaninoff produced his second piano concerto, which became arguably his most celebrated work. The arc of the composition reflects his emotional trajectory: the piece opens with mournful, elegiac chords and ends in triumph; Rachmaninoff marked the tempo of the piece’s final section risoluto.
The relationship between Rachmaninoff’s illness and his music intrigues me, for I’m a psychiatrist by day and a concert pianist by night. Ten years ago, the American Psychiatric Association asked me to give a presentation on the connection between creativity and mental illness. Until that time, my careers had progressed on parallel tracks. But that experience helped me appreciate the synergy between the two domains. My psychiatric training enabled me to identify patterns of illness in the life stories of the great composers, and this understanding gave me insight into the creative process.
Posthumous diagnoses can be tricky, of course; it’s difficult enough to diagnose correctly the living, breathing patients I see regularly in my office. But my exploration into composers’ lives has taught me more about the very nature of music—and affirmed for me its healing powers.
For all its healing properties, artistic production, unfortunately, often reflects a darker side. The notion that mental illness disproportionately affects practitioners of art, literature, and music dates to ancient times. All great artists and philosophers, Aristotle believed, had to suffer from melancholy. Epidemiologic surveys have suggested, in fact, that the incidence of mental illness is somewhat elevated among artists.
It’s important, though, not to romanticize the notion of mental illness as essential to creativity. Johann Sebastian Bach, Joseph Haydn, and Felix Mendelssohn are among the members of the classical music pantheon who seem to have escaped the burden of mental illness. And such maladies as depression are usually too paralyzing to be considered an asset to creativity.
Even so, an interplay often exists between illness and creativity. In Maurice Ravel’s most famous work, Boléro, for example, the seemingly endless repetition of a single musical phrase dominates. In creating this work, Ravel was clearly perseverating, an early symptom of the dementia that would eventually overtake him. He may even have sensed the imprint of his illness on his work; he once trivialized Boléro as a “piece for orchestra without music.”
The link between mental illness and creativity requires a special sensitivity in treating mood disorders in artists. Psychotropic medications can lead to the blunting of emotional intensity. Some of the artists I treat have confided they would rather retain their creativity and suffer than sacrifice their expressive abilities. They raise a legitimate concern. Would Robert Schumann have been as productive a composer if he had taken mood stabilizers for his bipolar disorder?
Music and medicine are both healing arts, and music has often provided salvation to great composers. It was Pyotr Tchaikovsky, tormented by suicidal impulses for much of his life, who perhaps best summarized music’s therapeutic properties. “Without music,” he once declared, “I would go insane.”
Richard Kogan has a distinguished career both as a concert pianist and as a psychiatrist. Dr. Kogan has gained renown for his lecture/recitals that explore the role of music in healing and the influence of psychological forces on the creative output of composers. He has given these presentations at music festivals, concert series, medical conferences, and scholarly symposia throughout the world.Dr. Kogan is a graduate of the Juilliard School of Music Pre-college, Harvard College, and Harvard Medical School. He completed a psychiatry residency and academic fellowship at NYU. He has a private practice of psychiatry in New York City and is affiliated with Weill Cornell Medical College as Co-Director of its Human Sexuality Program. He is also Vice Chairman and Artistic Director of the recently established Weill Cornell Music/Medicine Initiative.