Life In The Vortex

Introductory Notes of a Musician-Physician

Bruce S. Victor, MD

It’s not clear when the transition to physician-musician really occurred.

Perhaps it started about four years ago, when I was looking at a website of well-known guitar makers. Amid the wonderful guitars was a reference to the general manager’s ten-year-old daughter, who had recently been hospitalized with juvenile-onset bipolar disorder. Without the awareness of something audibly “clicking,” I was quite clear that I needed to organize a benefit concert for this girl and her family. After all, I had been the Chairman of the Professional Education Committee for the Northern California Psychiatric Society, I'd given more than a hundred talks on mood disorders, and—hell, I had been a guitar player for more than forty years. There was no subjective feeling of actual decision, because there was no conscious experience of deliberation that preceded initiating this course of action.

In retrospect, then, the transition to Physician-Musician involves trusting a part of one’s self that is not always encouraged by the mores and areas of cerebral emphasis that have achieved value and emphasis in psychiatric culture. It involves doing things that will not always seem purposive or rational at the time. It is analogous to being Kevin Kostner's character in the movie Field of Dreams: “If you build it, they will come.” Inchoate as are the dictates of this aspect of one’s psychospiritual development, there is the sense that one ignores them at one’s peril.

The concert was a great success. I collaborated with music legends John Sebastian and David Grisman and felt the synergy of their energy behind the overall effort and the enthusiastic response of the audience. It was a “healing community” indeed, for those hours. However, this concert then tripped off a string of seemingly coincidental events that led to my hosting (and continuing to host) a series of house concerts. This concert series is called “The Acoustic Vortex House Concert Series,” named (by Stevie Coyle, a master finger-style guitarist) for this whirling, unseen force that seems to link people and events despite themselves.

The establishment of the concert series, in turn, triggered a series of events and meetings with other musicians and music aficionados that led the Acoustic Vortex to comprise an ever-expanding collective of people who are present for, and do things for, others through music. Most of the musicians in the Vortex have played concerts for Bread and Roses, an organization started by Mimi Farina that brings live music and other forms of entertainment to people in institutions (visit www.breadandroses.org). In December 2007, members of the Acoustic Vortex put on a benefit concert for Bread and Roses in conjunction with the breathtakingly talented Tuck and Patti. New Year’s Eve was spent playing at a drug rehabilitation center. A May 23 concert at the 142 Throckmorton Theatre (www.142throckmortontheatre.com) in Mill Valley will also benefit Bread and Roses. And the Acoustic Vortex will continue to stage benefit concerts for social organizations that reach out to improve the lives of others.

The great theologian Abraham Joshua Heschel wrote, “When I was a young man, I admired clever men; now that I am older, I admire kind men.” Perhaps the transition from physician to physician-musician parallels that sense of psychospiritual growth to which Rabbi Heschel referred. I simultaneously honor but acknowledge the limitations of psychiatric training and physicianhood, as well as reconceptualize what it’s about. And this has grown in parallel with, and has been profoundly influenced by, my recent development as a musician.

When I was young, I admired clever men…The allure of psychoanalytic theory was its belief in the power of “insight” as both transformative an liberating. Yet nearly absent from Freud’s writings, as well as those of his acolytes, is any reference to altruism, empathy, even compassion—thus quietly, covertly, but no less inexorably reifying the “clever” or “insightful” man as the ontologic touchstone. Even further, the relentless reductionism of Freud and his followers, while providing an interesting starting point in my search for the meanings of behavior, became analogous to (in the words of Woody Allen) “taking all of the music and dancing out of My Fair Lady   and turning it back into Pygmalian.” And while the efficacy of recent psychopharmacologic advances helped elucidate the importance of the right carburetor mix at the synapses, it too lacked a theoretic fulcrum by which we could understand both transcendent experience and more profound interconnection with one another.

However, my increasing fascination with and subsequent study of the interrelationship between music, healing, and the nature of enhanced human interconnection began on the deck of my friend Stevie Coyle. On one beautiful morning in May, we are playing a guitar duet on a tune entitled (I’m not making this up) “One Morning in May.” We were playing in complementary tunings and the harmony simply emerged, without a musical blueprint or battle plan. Sure, I was listening to Stevie and had some forethought regarding what I was going to do next; it wasn’t really one of those mystical fusion experiences, despite the aforementioned deck’s location in deepest Marin County.

But I began to wonder, how is all this harmony possible? How did we tune into one another? And is the way we did so musically a metaphor for how individuals can “tune into one another” without instruments in their hands, conversing rather than singing?

It occurred to me that certain factors that are the process and the product of successful psychotherapy also apply in this kind of musical exchange. For openers, the process is predicated on a reduction of anxiety about the process itself. If I was anxious about judgment or retribution for either wrong notes, excessive ornamentation, slipping out of rhythm, or any of the other musical inevitabilities, then my fingers and hand would lose the dexterity needed for delicate finger-picking. Plus, any preoccupation with the contents of my own mind would have meant I wouldn’t be able to really hear Stevie. Further, while I probably have my own idiosyncratic sound and intonation when I play, I can neither be wedded to it nor be unable to modify it—indeed, I need to play with it as I play.

Further, there was—as in any good psychotherapy—an underlying structure here: agreed-upon rules about trying to stay in the same rhythm, about playing pretty much the same chords (even in different tunings) or complementary ones, and about following when the spirit moved one of us further out on a harmonic trail (with a reciprocal obligation on the part of the trail leader to make sure he didn't lose the follower). And there was also an implicit understanding that adherence to the structure made it possible to barrel out of one’s own confines in a way that produced more euphony and harmony than propulsive, cacophonous escape.

Sitting on Stevie’s deck, it therefore struck me as unfortunate that psychiatrists and nonmedical psychotherapists have paid so little attention to the transformative power of music—especially as it acts upon the player, not just the listener.

It is similarly unfortunate that most people believe that a certain amount of “talent” is the prerequisite for permitting oneself to continue in music. How many times have I heard in my own practice, “I love playing music, but I quit because I just wasn’t good enough…..”

Of course, self-denigration and hopelessness, no matter how focused, circumscribed, or even seemingly rational, has always constituted a clinical focus for us psychiatrists. Patients feel isolated, alone, and especially anxious that their sense of isolation and loneliness will continue. Part of the core of the dynamic basis for these painful states is the feeling that one isn’t “good enough” and will therefore be sentenced (even as self-fulfilling prophesy) to, in the words of H.D. Thoreau, “lives of quiet desperation.”

In my own practice, I have seen this disqualification from participating in music taken not only metaphorically but literally. And there was much healing to be had in addressing both simultaneously. Albert, for instance, was a fifty-year-old man whose obsessive self-recriminatory ruminations and depression had kept him from enjoying life. While there were solid dynamic, familial reasons for his self-contempt and hopelessness, the actual symptoms of his depressive disorder required prodigious doses of Prozac and Buspar. But still life was joyless, almost colorless. Last year he mentioned that the only thing in life to give him any real pleasure was English madrigal singing—a statement he made without realizing that I was about to devote myself to a six-week musical sabbatical.

Over the next few months, however, Albert purchased and began to use an iPod that provided him with a ready source of mellifluous auditory stimuli that provided an alternative to the nasty commentary of the malevolent Greek chorus inside his head. He became happier than I had ever seen him. He realized that “music takes me into the moment, into the present … and I then realized that what was inside my head was neither in the moment nor in the present…. It helps me be aligned with that which is beautiful.”                                                

As comedian Emo Phillips once noted, “I used to think that the mind was the best part of a human being … until I remembered what was giving me that thought.…” This statement is a fitting reminder that psyche referred to “soul,” not “mind,” despite the modern conflation of these two entities. As I continue to evolve as a physician-musician, I increasingly see the overlap of spirit in the service of healing. In music I am reminded of my true province as a psyche-trist.

Bruce S. Victor is Clinical Professor of Psychiatry, School of Medicine, University of California at San Francisco; he also maintains a private practice in San Francisco.