An Interview with Dr. Eckart Altenmüller, the world’s leading expert on focal dystonia
Towards the end of the summer, I had the opportunity to visit the University of Music and Drama, Institute of Music Physiology and Musicians’ Medicine in Hanover, Germany. There I met with Dr. Eckart Altenmüller, the Director of the Institute.
The Institute of Music Physiology and Musicians’ Medicine is a unique institution in Europe whose scope includes (as its name suggests) teaching the basics of music physiology and musicians’ medicine. The Institute also conducts research into the physiology and neurobiological principles of professional music performance and music perception. Futhermore, it explores the causes of occupational injuries in musicians and provides resources for prevention, diagnosis, and treatment of such injuries.
All first-year students at the music school are required to take a course in physiology and biomechanics (taught by professors or researchers at the Institute) to help the students understand the fundamentals of how the body works and how to use the body, arms, hands and fingers in the most natural way. This aspect of music education is vital and should be taught at all American music schools. Additionally, all music students at the University have free access to Institute doctors whenever they develop problems or pain associated with playing their instruments.
During my visit, Dr. Eckart took time out of his busy schedule to spend a few hours explaining and discussing a number of aspects about the Institute and the work that is conducted there.
String Visions: You are doing fascinating research here at the Institute on a great variety of topics. One of the research fields that you focused on involves emotional reactions to music and musical memories. You are also doing research on on sensory motor learning in musicians. Can you tell us a little about that?
Dr. Altenmüller: Yes we are covering a wide variety of aspects but it is all about music and the brain. Day to day in addition to the music students, I see patients from all over Europe, and they mainly come with three problems.
First is motor problems. That means that the movement control is not perfect.
Second is chronic pain. That’s something which we are also very much into because this can be very well-treated if you diagnose and explain what’s going. For this we have to consider the instrument and the interface, between instrument and human.
And then [there are] psychological problems. I see quite a lot of patients, with anxieties, etc.
String Visions: It’s amazing that so many musicians develop problems over the years.
Dr. Altenmüller: I will say this: we have two phases of high psychological stresses. The first is in the beginning of a professional career in the orchestra, and the second one is towards the end. You know, when the young musicians come, that often produces a lot of stress for the older players. So I also see a lot of musicians that have self-doubts.
String Visions: Getting back to your research, what can you tell us about your work on emotional reactions to music?
Dr. Altenmüller: Before getting into that I would like you to think about this: if you consider the last viola sonata of Brahms [sings], and the introduction of the piano, it’s a nice, melody. It’s a little bit sad. But then if you look closer at it, it’s a quotation of [sings], Wenn ich einmal soll scheiden, from Bach’s St. Matthew’s Passion. Brahms wrote this [sonata] a couple of months before he died. So [one could say] it’s about his own death. Now, if you link this kind of information to the listener and when you know what it’s about, [that knowledge] creates a much stronger emotional connection [between the listener and the music].
String Visions: Oh, yes. That’s incredibly powerful.
Selected Interview Audio: Dr. Altenmüller discusses the Brahms Viola Sonata
String Visions: It is the same with perfomers–the more they know about the background of the piece, the better they are able to interpret it!
Dr. Altenmüller: Yes, [when] I told this [story] to several famous clarinet players and famous viola players, they hadn’t realized it. But it’s very clear [that] Brahms always very much relied on Bach, and he quoted him all of his life, but of course he did it [in a hidden [way].
With music there are many aspects that somehow cannot be exhaustively researched because there are always things which are beyond our scientific measures. But in the research project about music and emotions where we asked the participants to report “chills” or strong emotion-related bodily reactions such as goosebumps or “shivers down the spine,” we found that it was individually different. Everybody had different reactions and got goosebumps for different music.
String Visions: As one of the leading experts in the world on focal dystonia, you must see a lot of patients with that problem?
Dr. Altenmüller: Yes at the present, the outpatient clinic of the Institute offers medical care for more than 500 patients with this disorder. That’s the largest group in the world.
String Visions: That is a big number of patients, I did not know that so many musicians had that disorder. When did we first know about focal dystonia?
Dr. Altenmüller: The first dystonia appeared in 1831 and that was Robert Schumann. His was the first case in the world.
Selected Interview Audio: Dr. Altenmüller discusses the origins of the first case of focal dystonia
String Visions: I was not aware that Schumann had that problem. The story most often told was that Schumann developed the problem from working with a finger-strengthening machine.
Dr. Altenmüller: No. Schumann had developed a task-specific loss of voluntary control of the middle finger in the right hand. By means of a finger-stretching devise, Schumann tried to improve the situation.
String Visions: What are some of the reasons for this disorder?
Dr. Altenmüller: In my opinion, there was a change of paradigm in the 19th century. At that time musicians started to strive to be virtuosos like Paganini and Liszt. The piano works became much more technically demanding. The composers started to somehow change the whole working environment by producing technically difficult etudes, etc. Of course, the Goldberg Variations of Bach are highly virtuosic and Mozart had written highly virtuosic things, but [for them] the technical part was not such a special aesthetic value.
String Visions: It was not virtuosity for the sake of virtuosity.
Dr. Eckart Altenmüller: Yes, exactly. Long playing every day, a lot of very similar motor actions, those are some of the risk factors.
String Visions: Schumann, of course, did not know exactly what the disorder was?
Dr. Altenmüller: No, he didn’t know it, but of course he knew that he was overdoing it. He blamed himself, even writing, “Well, I think I have overdone it with my hand.” And later he wrote a very touching letter to his mother: “Dear mother, Do not worry about the finger! I can still compose, and I would hardly be any happier as a traveling virtuoso–for that, I was spoiled at home. It doesn’t bother me when I improvise.”
Schumann had all the risk factors. He was somebody who was very nervous when performing and really had performance anxiety. He was compulsive, highly ambitious, and he was a perfectionist in many things. As a law student at the University of Heidelberg he had increased his practice time up to 7 hours daily, neglecting his law courses.
String Visions: I think it is fascinating that you, as a physician, can diagnose a disorder such as what Schumann had almost 200 years later.
Dr. Altenmüller: Yes, but my real goal is to find ways to reduce the number of people with this and other playing- related disorders. That’s why we are also very interested in collaborating with instrumental teachers and music educators to find better ways of practicing.
Selected Interview Audio: Dr. Altenmueller shares his thoughts on the most important challenges with focal dystonia.
String Visions: The music world and musicians specifically, are indeed lucky to have a person such as you with your vast knowledge about music and medicine, and your having dedicated your life to this fascinating topic. Thank you for spending time with me and for sharing your knowledge with the readers of String Visions.
Check back on Friday when musicians’ health expert Brianna Richardson presents the first of her 3-part series on focal dystonia.
This is such a phenomenal resource. Dr. Altenmüller shares truly valuable and incredible information here. This is an issue that all musicians (and non-musicians) should be aware of.
is it not possible he was suffering from more than one illness? is there any foundation to the suggestion that thomas mann based his ”dr faustus” on poor schumann ?
The quote of Schumann contains a startling sentence which seems to me highly significant, and which I have never read in any article about pianist’s dystonia. “It doesn’t bother me when I improvise”
I am a sixty-six year old amateur pianist, but a very hard working, obsessive amateur. A few years ago my left index finger exhibited peculiar behaviour which threw my whole playing mechanism out of balance. I assume it was a dystonia, as it has taken me five years of struggle to get rid of it.
But here is the funny thing. Over that time I recorded about a hundred CDs of improvisation, containing, on the face of it, far greater difficulties of execution, far deeper and more intense musical concentration. Not a sign of the problem. Yet playing Chopin studies, stride and ragtime was a nightmare for three years. Same or close movements at times, but utterly different state.
There has to be some deep implication of this. What is it ? What is going on in the brain during improvisation which bypasses dystonia ?
I had better add that the offending finger was not simply avoided during improvisation, and of course I cannot prove I had a focal dystonia at all. I had no curling or lack of finger independence as described by pianists, just an intermittent spastic movement enough to unbalance the hand. Also, I suspect classical concert pianists who also improvise for hours on end and also have dystonias are exceedingly rare. So the benefits or otherwise would be next to impossible to prove anyway.
The ways I beat it were also highly counter-intuitive, which is why I took so long to find them.
i am almost 80 yrs old and i am a swiss amateur violinist.i have also the titel specialist in occupational diseases and i had to handle mostly problems of industrial workers.after retirement i found that physical training is most important for musicians.many of them use equipment for this so i do now in a club for sport to give my muscles and central nervous system an additional training.other than the well known problem of robert schumann
which decades ago i considered mainly orthopedical is the rather psychological trembling of the bow on the stage of belgian violinist eugene ysaye. not having played in public any more for years in 1928 he successfully performed the beethoven concerto in barcelona pablo casals conducting.