World-renowned soprano Renée Fleming is also a leading advocate for research and public education on the therapeutic power of music to heal the mind. Music’s psychological and neurological impact can help people suffering with dementia, Parkinson’s disease, and other brain disorders, and even restore speech after a stroke. Recorded live at Juilliard, this episode also explores the brain’s incredible musical memory mechanism and why learning and healing through song can be so transformative.
Dr. Stieg: I'm thrilled as a fan and an opera lover to be recording live today at Juilliard with world-renowned soprano Renée Fleming, winner of four Grammy Awards and the National Medal of Arts. Renée Fleming is also a leading advocate for the study of the effects of music on the brain as well as music and arts application in human health. Renée, welcome. I'm so happy to have you here to talk about a topic near and dear to both of us: How to leverage the power of music to heal the brain and most importantly the mind.
Renée Fleming: Thank you. Thank you. Great to be here.
Dr. Stieg: It's been pretty well documented in literature that music at an early stage in life, even within the womb, is important in terms of instituting the neural networks that develop in our brains. And I understand that you grew up in a household where both of your parents were music teachers.
Renée Fleming: Absolutely. In fact, the family folklore was that I definitely sang before I spoke. And in fact I was a late speaker and music was just a part of every day. My mother taught lessons singing and piano, and I sort of parked underneath the piano all day.
Dr. Stieg: So you started singing at what age?
Renée Fleming: Oh gosh. I don't know. Very early, three, probably before then.
Dr. Stieg: When you did start singing professionally, as I understand it, you focused more on jazz than you did on classical music?
Renée Fleming: I discovered a real passion for jazz, and I ended up singing with a trio in a club every Sunday night for about two years, which was phenomenal education. And now we know that improvisation is the best thing you can do for brain health.
Dr. Stieg: That’s the question I wanted to ask you: Did you feel in your mind there was a difference in processing what you were doing for classical music versus what you did with jazz?
Renée Fleming: Oh, hugely different, because classical music for me was about really hitting the marks in terms of an education of centuries-old best practices with learning languages and a tremendous amount of skills that need to be gained. But jazz was about freedom and it was about where does my imagination, where is it taking me vocally, where is it taking me in terms of, you know, you have to fit within the harmonic framework. But for a singer, it's really fun and great, great education.
Dr. Stieg: I want to talk a little bit about something that I know you're very passionate about: Your relationship with the NIH and the NEA regarding music and the mind. Can you explain to us what you're doing there?
Renée Fleming: Well, I'm an advisor at large at the Kennedy center, and I met Francis Collins at a dinner party and I had become very interested in all of the research I was reading about in the newspaper. So there just every month there would be an article that somebody was looking at music and I thought, gosh, I just can't, they must have better things to do. These scientists, why are they doing this? And Francis explained that it's the brain Institute that has really gotten him interested in it and trying to understand the brain and music kind of affects more parts of the brain than other activities, particularly engaging in playing music. It's not a listening. Listening has definite advantages, but playing an instrument. They're not looking at singing, they're just starting to look at singing. It's very powerful.
Dr. Stieg: Are you focusing on music and the brain primarily as an anti-aging or as a mechanism for expanding people's intellectual and cognitive skills?
Renée Fleming: Well, so what I said to him was can we collaborate? The Kennedy center and the NIH, two major national institutions. I said, I think we should be providing a platform for science to the public. So the areas are the basic science, and that research is really interesting and includes animals, and certainly childhood development, looking at childhood development, playing instruments, that really helps children with their auditory understanding. And we all know focus and discipline, too, of course. And of course there are about 50 different music therapy interventions that are also being studied and some of them work quite well. So the trick is to get the NIH to support them. That's what we're trying to do.
Dr. Stieg: The average person out there — not the person who is sitting here on 65th and Columbus who's slightly above average, along with all the Lake Wobegon people — what do you, what do you want them to get? What do you want them to understand from your work?
Renée Fleming: Well, you know, for me, first of all it was I had to learn a lot from day one. I didn't know anything about the brain. In fact, I never gave my brain a thought. I just assumed it was what we were born with and it never changed. And we had no way to have an effect on it. And you know, and that's, I'm, you know, I'm a product of my generation. So that was our knowledge. So learning just from day one that there are so many things that can be done to help. For instance, somebody who's had a stroke with one music therapy session can regain speech through the neuroplasticity that allows the singing centers is a favorite one of mine. To enable someone to communicate again. I've had so many "a ha" moments like that that I want to share with the public.
Dr. Stieg: I'm struck by how music crosses all cultures. I was watching Casablanca the other night, you know, there's the Paul Heinrich singing the French Anthem and then the Germans singing their Anthem and how it just evokes emotions. Why do you think that is? What is it about music and culture that's so important?
Renée Fleming: The only way that I've been able to understand the power of this is evolution. So the fact that the elements of music have been with us for millennia before modern history. Neanderthals had those same vocal mechanism that I do, which I find, you know, thinking about those operas back then. You know, I just think it's so fascinating to know that in the womb, of course we're hearing the heartbeat, we're hearing elements of rhythm from the very first moment of life. And so rhythm is powerful. Social cohesion throughout time has also been created with drumming and vocalizing and who knows what. I mean, you know, there's some, you know, we found a bone flute from 40,000 years ago and I'm sure there's much more than that that we don't know. So that's gotta be where it's from. It's the fact that social cohesion came from these types of activities.
Dr. Stieg: The Four Last Songs by Strauss apparently has a profound impact on you from a meditative and contemplative standpoint. Do you meditate regularly?
Renée Fleming: Yes. In music. I would say music is my meditation.
Dr. Stieg: So you don't go and take 20 minutes of mindfulness or yoga or like that daily?
Renée Fleming: I do. I'm a Pilates person myself, which has elements of yoga and then I think, but really for me, music is my center and Four Last Songs is 20 minutes of meditation. The poem is enigmatic enough that we can apply our own lives to it and make it individual, but there's a sustained quality. It's like swimming. It's like long-distance swimming to sing it. It's such a joy.
Dr. Stieg: Do you feel your heart rate go down?
Renée Fleming: Yes, absolutely. Absolutely.
Dr. Stieg: So you do enter a sublime state.
Renée Fleming: Well, and my best performances are in flow in the zone anyway, and it's magic.
Dr. Stieg: So you're in this magical moment. Do you take the time then also to look out into the audience and see whether you're reaching them? And if not, what do you do?
Renée Fleming: For me it is 100 percent a shared experience. I had terrible stage fright when I started out. The last bad episode was about 20 years ago, and how I learned to love performing was to understand that I'm part of the flow. Then it goes, it goes to me. It's something I share with the audience. It's not, I had seen it the other way around, that the audience was judging me. So when I learned this actually from reading a book on public speaking, the other way that you're sharing something to me suddenly was the key to feeling comfortable on stage. So I absolutely am always looking at the audience…
Dr. Stieg: …and you feel like you're telling a story?
Renée Fleming: Yes, yes. You know, I mean, I sing a huge variety of repertoire, all different things. So there's not any one kind of mode. I would say even within a given performance, there are several, but you're definitely sharing the text, and communicating a text.
Dr. Stieg: Yeah… do you have…
Renée Fleming: it's, it's good daily
Dr. Stieg: …routines that you go through, exercises, mind games, whatever vocal exercises that you do to get ready for your performance?
Renée Fleming: I sing a lot, so I don't, other than warming up, I don't worry too much about my voice anymore, thank goodness. But I'm learning a lot. I'm always constantly learning new music. So there I'm coaching all the time, but I would say performance day, I definitely have a religious discipline about a performance day. I do not typically go out. I don't talk on the phone very much. I work quietly and I love it. I get a lot done.
Dr. Stieg: So what I do before an operation, as I run through it about 15 times in my mind, you're going to go do an opera this evening. Do you run through every act in your mind? The position of the other actors, what they're going to be singing, and how you're going to respond? You're far enough along now that you probably don't have to do that 15 times, but at least do you do that?
Renée Fleming: God, I'm so interested to hear you say that. I do it if I need to. I mean if it's something new, if it's something I'm thrown into, then I review, review, review., absolutely — not 15 times because operas are long. But you know, in the music that I'm learning, you know, for instance, I have three concerts this week with the New York Philharmonic and it's challenging music. So yeah, I definitely am studying.
Dr. Stieg: Well, I find that, but I personally do it just so that I'm ready for the catastrophe, you know, each inflection point where something bad could happen, to get ready for that.
Renée Fleming: Wow. That's fascinating.
Dr. Stieg: Earlier on we were talking about brain function and what's really going on with music. We can expand on that.
Renée Fleming: I would love to talk to you about that. So you know, one of the things and memory music and memory is a real, is a tremendous fascination and I think a lot of people as I've traveled and give these presentations everywhere, I sing now pretty much. And basically it's an opportunity to just sort of give an overview for my audience and then invite a local researcher to join me, a music therapist possibly, or university, and collaborate with the performing arts folks. And audiences are terrified of Alzheimer's disease, right now I'm finding across the board. Parkinson's in music has a tremendous use for in terms of helping patients with movement disorders because of the rhythm and what happens with the rhythm and when it bypasses parts of the brain. So I'm just wondering from you where you see the potential in particularly in terms of technology, the development of technology.
Dr. Stieg: I won't say how long ago I did my PhD, but when I was doing it there was the Malarian hypothesis that the brain cells that you were born with where the brain cells you had, and now we understand that to be completely wrong. There is this whole concept of neuroplasticity and the fact that we can learn till later in our lives. We might learn differently, we might learn at a different pace, but we can still continue to learn. The technological aspects that are being advanced are clearly in the, you know, the functional MRI area in terms of MRI imaging. We are getting into smaller and smaller electrodes that we can slip into blood vessels or in the brain so we can analyze brain function. We can look at the extracellular environment with little pipettes and look at the metabolism of the brain.
Dr. Stieg: I think that our neuropsychological assessment of cognitive function is getting significantly better and in particular we can correlate it with the functional MRI. An example of that would be, you know what's happening when you ask a person to improvise. You know, in an MRI you can see that the a specific region of the brand, the dorsal medial frontal cortex, turns on and that's more of the organizational management part of your brain. The dorsal lateral frontal cortex, which is kind of the inhibitory part of your thinking, turns down. And then that is all integrated via a neural network with your hippocampus to draw on memory, your temporal lobes to draw on speech and notes, and the superior temporal lobe where were we hear things and we can appreciate them. So there's this massive integration, which in my lifetime we won't understand.
Renée Fleming: Well, you know, Charles Lamb, who's out in San Francisco, has been studying various people who improvise. So not just musicians, but also comedians and certainly jazz musicians and you know, it's the shutting down of that sort of more judgmental side of the brain that has been most useful.
Dr. Stieg: Right. And the other old dictum that was thought, remember there was a book written, Drawing on the Right Side of the Brain, that you think that creative art was all in your right parietal lobe. That's been fairly debunked now. And there are some classic syndromes, if you bang up your left parietal lobe. The other reason I asked why whether you meditated or not is that the part of the brain that communicates the two hemispheres is called the corpus callosum. And with meditation we can see that that thickens, and we can see that the cortical mantle — meaning the cell bodies of your brain cells where they sit — actually thickens. And there is this crosstalk between the two hemispheres as well as between the various regions that are integrated via these neural networks.
Renée Fleming: That's interesting. I would've thought that the actively kind of going back and forth in terms of your processes or thought would do that, but actually meditation does that. Yeah, that's fabulous.
Renée Fleming: I participated in a study at the NIH was in the fMRI machine for two hours singing, speaking, and imagining singing and imagining singing was the most powerful. Can you explain that?
Dr. Stieg: Most powerful in what sense?
Renée Fleming: Well it reached more parts of brain actually than the other two. The scientists who looked at the actual study were surprised by the results.
Dr. Stieg: Well, the interesting thing about speech is that it used to be thought to be in what's on the left side of your brain and Broca's area was the motor component and Wernicke’s area in the temporal lobe was the sensory part and that those were the two parts. We now know that not to be true. Your entire temporal lobe, if we map out speech when we're doing awake craniotomies on patients, we find varying effects on a person's ability to speak. Why there's more activity going on in terms of singing? Singing, you would have to say is you're doing something that you already know and you already understand, so you don't have to activate the creative components, there is some memory. You know there's the speech components, but then again when you're singing, like you said, you want to create an emotion and so there's the emotional component versus listening to music, the motor function that's involved. I mean it can get back to involving the cerebellum as well because part of your mood, amazingly enough, the cerebellum, the back part of your brain, is involved with mostly motor coordination, but we know in children that if we section a part of it, we can make you a mute and we can change your mood
Renée Fleming: Amazing.
Renée Fleming: Have you worked with musicians who've had playing disorders or some type of disorder?
Dr. Stieg: Yes, and I've not taken the liberty of recording somebody playing, you know, the violin or the guitar in the operating room. I have one patient who had a ruptured aneurysm that was involved in the music business, who to this day strongly believes that her recovery to normal life was greatly influenced by how she got back into music, listen to music. She wasn't a performer, but the role that the music played in her overall recovery.
Renée Fleming: How powerful is emotion for someone's recovery, for their healing, for their, how powerful is that part of the mind in terms of healing?
Dr. Stieg: It's a very pertinent question. I always tell patients that the day after surgery when I go on round on them, I say, I've done my job. The rest is up to you. And you know, it's really up to them to be motivated to have a positive outlook. And I can tell you that people that are glass-half-empty will start having problems with urinary tract infections and blood in their legs because they're just not as motivated to get up and get going. So it's extremely important. And that's where music, photographs of the family, you know, family being there are exceedingly important.
Renée Fleming: Oh, that's so incredible.
Dr. Stieg: Much like for you, the audience feeding you, like you said, it's a dialogue.
Renée Fleming: I find that your work and the idea of aging in the brain, so we're talking about this kind of cognitive reserve. This is a term that I'm hearing a lot now. Do you believe that this will continue to be something that people are encouraged to do? For instance, later in life, learning experiences, et cetera?
Dr. Stieg: I can turn that question around and ask you, name one disease that prevention doesn't play a major role? And cognitive decline is the result of bad behaviors that start when you're five years old: eating bad food, and then those things persist. I'm very interested in this and that's why we have created the brain health system at Weill Cornell. It's certainly doing crossword puzzles, reading books, going to book clubs, obviously going to the opera or any kind of music, and then having a dialogue about it. Social interaction, regular exercise, normal sleep. All of those things are good and then there's some nutrients that are important, selenium, that might be important in terms of staving off the impact or the onset of Alzheimer's disease.
Renée Fleming: Well, I'm going to pick up improvisation again. I decided somehow stretch.
Dr. Stieg: You certainly have the talent.
Renée Fleming: Yeah, we'll see. I don't know. I think I used to, but they, again, it's sort of challenging yourself, right?
Dr. Stieg: I asked you to sing a song that you maybe sang 10 years ago and you're able to draw it right out in your memory. Is it just because you've locked it away in your hippocampus, or is there some other memory mechanism, is a little melody that brings it back to you?
Renée Fleming: So musical memory is so powerful. I mean, when we think as children that, you know, my children learn different songs than I did, but all of the learning that occurs in a song and you carry that with you for life. I don't know why we don't do more learning through songs because it's powerful. And secondly, it's the last memory to go in patients with dementia and Alzheimer's. And I saw this firsthand with my husband's aunt, who the whole last year of her life, only sang if you fed her one word, she knew all the words. She didn't know who the people were around her, but she knew the words of the song. So for me it's muscle memory too. It's gotta be locked in and then it basically doesn't go away.
Dr. Stieg: In regard to your work with the NIH, are you doing anything in terms of Alzheimer's disease? Is that one of the focuses?
Renée Fleming: It's one of many, certainly all of these disorders, whether it's Parkinson's or stroke or autism even, I mean to see in a video the kind of intervention that allows a nonverbal child to speak. And it's, and it's a lot of this melodic intonation therapy that is useful also for traumatic brain injury. I mean, it's amazing to watch how this works and it just all refers back to plasticity again. But what's happening with this project, though, is that there's an explosion of interest in this field, you know, and it will expand to all of the arts. Certainly what Mark Morris has done with Parkinson's in terms of movement and allowing music and creativity to infer movement ability on people who are otherwise locking and freezing, et cetera. So those kinds of interventions are powerful. But I just have to say that I think people are starved for something that brings them together in terms of thinking about health and to combine the arts with health is such a positive thing. And also when you think about it, we're both service providers for healthcare facilities and performing arts facilities in cities. We provide a service to the community. And why not work together? But the NIH has given $20 million in funding for research over five years, which given the amount of money they give out is not a lot, but it's a huge amount in terms of the validation for an inquiry like this. So we're finding that people are feeling empowered and pursuing it.
Dr. Stieg: You've got to get it incorporated into people's lives. The whole concept of music and the unification that you're emphasizing, that that occurs, but also the positive circuits that are developed as a result of the music. We've got to start early.
Renée Fleming: Well, I think this is the reason for the research dollars, is that they are actually quite enthusiastic about the results that are coming in now and putting in. Nothing happens in this country without data, nothing. Certainly nothing in medicine happens without data and it has to be hardcore and it has to be really something that is serious — and it's happening. You know it's happening. It's baby steps at this point, but I think we're going to get there.
Renée Fleming: Depression is really the number one problem that we're having and it's not just in the US, it's worldwide. This is something that the arts can really, truly have an effect on. But talk about depression for a second because it's something you probably have seen quite a bit of as well. Why is there so much of it?
Dr. Stieg: Postoperatively, we see a lot of people that have a period of depression, either given the diagnosis or what we've done to their brain. Sociologically, we see a lot of depression because there's just a lot of stress and anxiety out there. So what are the things that we can do to prevent that? What we’re trying to do, the goal is to increase the dopamine and serotonin levels in the brain. Okay, so what does that? Music, sleep, relaxation therapy, meditation, contemplation, talking with friends. What makes it worse? Stress, absence of sleep, too much alcohol, too many drugs, too many fats in your diets. So you've got inflammation in your belly, your serum cortisol level goes up. You don't get enough REM sleep. That all induces inflammation throughout your body and in your brain. It's all harmful.
Renée Fleming: That's a prescription right there – I love it! Yeah.
Dr. Stieg: Renée, I can't tell you how delightful it's been to sit here and spend time with you, and how honored I feel to have spent time with you. I think that the work that you're doing with the NIH and the NEA is of extreme importance, and I implore you not to give up. And finally, I would also implore you not to give up performing because it's an absolute pleasure to see you in person. Thank you.
Renée Fleming: Thank you so much for being a joy to be here. Thank you.
Soprano Renée Fleming with Dr. Stieg, live at Juilliard. Photo copyright Juilliard