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The Royal College of Psychiatrists Improving the lives of people with mental illness

Stephen Brown interview‏

Stephen Brown

My prejudice is that psychiatrists ought to be rounded human beings, citizens of the world with what Denis Healy called  'hinterland', that we ought to be able to engage both sides of the brain and the bit at the front as well...

Stephen Brown is Professor of Developmental Neuropsychiatry in the Peninsula Medical School. He recently retired from clinical work but is still involved in research and teaching. He specialised in Epilepsy for nearly 30 years and is a past chair of the British Epilepsy Association and an Internal Ambassador for Epilepsy.

Stephen is also a trained classical musician, conductor and composer. He is the cello player with the Corineus String Quartet and also plays regularly with the orchestra of New Devon Opera, and for many other shows and choral societies in Devon and Cornwall. He belongs to Cornish Airs (a group of local composers) and is also Musical Director of Bodmin Musical Theatre Company. 

I interviewed him for this blog and he provided some intriguing insights into life as a musician and psychiatrist, thought-provoking views on the connection between music and other abilities, and a philosophical perspective on coughing at concerts.


JT: In my research for this blog I have encountered quite a number of psychiatrists who are also musicians or have a deep interest in music. Have you any thoughts on why this may be the case?

SB: It would be easy to construct an answer that included words like 'creativity', 'sensitivity', 'non-verbal communication' and so on but it would be quite evidence-free! Over the years I've encountered a small number of psychiatrists who were fine musicians, and a very large number who were not! I have however met many doctors from other specialities who were good players and I guess all the doctors together outnumber any other profession that also appears in the music world, with lawyers a close second. There is also a subgroup of those who went to music college, and then developed careers in another field for obvious economic reasons, such as accountancy or IT (one excellent musical colleague retrained as an Air Traffic Controller) but who still turn up on the freelance performing circuit.

So I rather think the idea that musical ability is specially represented in the field of psychiatry is sadly just a wish-fulfilling fantasy. But note I did say 'sadly'... because deep down I think it ought to be.

I think there are three major sets of skills that we need to consider. There are craft skills, to do with the technique of playing music, getting the fingering right, sustaining the downbow to the end of the note or phrase (that's for a 'cellist, the violin equivalent would be an upbow) counting difficult rhythms, playing in tune and so on. It's why some people practice scales, and the difficult acquisition of this skillset is probably the main reason people abandon lessons when they're beginners. Then there are receptive skills, which are those involved in listening to and appreciating music, and finally what I call expressive skills. These concern the ability to tell a story in performance, to communicate the message beyond the notes.

My prejudice is that psychiatrists ought to be rounded human beings, citizens of the world with what Denis Healy called 'hinterland', that we ought to be able to engage both sides of the brain and the bit at the front as well, and since the nature of our work often involves sensing the significance of communication that isn't just in the form of words, then we must have a subtle understanding of prosody, and a sensitivity to mood, inflexion and gesture. And I think it's arguable that these skills with meta-language are basically the same ones that allow both the appreciation and performance of music, the receptive and expressive skills.  Which perhaps begs the question, why do conservatoire trained musicians sometimes become accountants or software engineers, where arguably these characteristic aren't in such great demand? Part of the answer is that they don't all do that - one of the best professional musicians I had the pleasure of performing with a few years ago suddenly decided to retrain as a psychotherapist. I gave her a bit of a hard time when she told me, and offered the opinion that she'd do people far more good by continuing to perform professionally (I was going through a bit of an anti-psychodynamic phase at the time) but she did go on to have a highly successful second career. Another reason might relate to the reasons people choose to enter the music profession in the first place. There's a bit of a myth you sometimes hear that many musicians are on the autistic spectrum (well aren't we all, that's why it's called a spectrum) and I don't specially buy into such a generalisation, but occasionally I can't help noticing some have mild attentional issues that I guess are helped by the

activity of performing music.

And remember music is a craft as well as an art, so fine motor skills, left-right coordination and so on play a part, which may not be essential attributes for psychiatrists. So, basically, appreciation and understanding of music (which we might call receptive skills) could potentially be in the repertoire of psychiatrists even if performance at a high level may not be, whereas trained musicians need the physical skills as well as expressive ones.

People in the audience do not, as a rule, cough intentionally in concerts. They do not do it to annoy performers and they do not do it because they are stupid or ignorant.   Mostly in fact they try very hard to suppress their coughing until a break between pieces, and if it's persistent they will quite often leave the room.

How have you managed to balance a successful musical career alongside your work as a psychiatrist? We would be very interested to know about a day or week in the life of a doctor-musician.

Well the straightforward stuff has involved only accepting gigs that don't clash with the on-call, and using annual leave if given enough notice. Also, being married to a freelance professional 'cellist has been incredibly helpful as occasionally we've passed gigs on to each other. Freelance work is precarious because if you turn it down you may not get asked again by the same fixer! Years ago I was offered a particular very good and very popular annual choral society booking, but it clashed with an overseas conference where I had to present some research, so I passed it on to Sue. I've never got that one back! For a number of years I played with an opera company that had grants to do performances in a number of different venues in the south west, and the standard was really high. The band was always booked a few months in advance of the season, so I used to take annual leave to cover the time to get to & from the venues, which included taking some half days.

Because of my particular clinical and research interests I occasionally used be contacted by colleagues for advice even when I wasn't on-call. Fortunately this was never so urgent that it couldn't wait till the tea break in a rehearsal or the interval in a concert if I kept the mobile on vibrate only mode. I'm now in my anecdotage, so here's one: for my mobile ring tone I have the first movement of Mozart's K136, which I took from a CD. It's not a regular supplied ring tone that comes with any phone. Once when I forgot to switch it to vibrate only during an opera rehearsal one weekend (no I wasn't on call) someone did indeed ring me for some clinical advice. It happened just as the conductor stopped us to say something but instead everyone looked round to see where this unexpected Mozart string quartet was coming from, and all eyes fell on me as I pulled the phone out of my gig bag. The conductor looked at me and just said “Pretentious, toi?”. Which leads to another story. That particular K136 is a rather historic quartet recording and the 2nd violinist on it continued working on the freelance circuit in the west country until fully retiring recently. He was a real gentleman and I always enjoyed chatting to him on gigs. Once, in the Green Room, I played him my ring tone and told him that it was his recording that I used. He looked a bit puzzled and then asked, “So do I get a royalty every time someone calls you?”. Sadly no.


You play as part of a string quartet. The recent film A Late Quartet gave an interesting (if perhaps somewhat melodramatic) perspective on the dynamics of such a group. Can you tell us about your role and the dynamics of your particular group? How do the others feel about your being a psychiatrist, for example?

I heard about the film, but it has yet to get to the Wadebridge Regal down here in Cornwall, probably because it doesn't have lots of CGI, chase sequences or enough explosions. Or else I just missed it. Anyway... I've played in several quartets and small chamber groups over the years, and so has my wife, and of course every one is different. Quite often one dominant personality tends to take control of the rehearsals and decides on the interpretation, and this is usually, but surprisingly not always, the first violinist. One hears stories of some professional quartets where the leader can be quite a fearsome termagant or bully depending on gender, and I know of situations (fortunately not involving me) where members have been reduced to tears in a rehearsal. Thank goodness none of that happens with the Corineus String Quartet. At least not yet! We jointly agree the repertoire, usually after playing through various candidate pieces, and everyone has a say in interpretation. Of course we disagree sometimes so a discussion ensues but it's never acrimonious.

As I write this we've just started rehearsing the Schubert String Quintet with guest cellist Patrick Gale, who is also an award-winning novelist as well as an excellent musician, so we are fitting in the rehearsals and performances around his busy international book-signing schedule. I took the liberty of asking them all about this question, and it did elicit a certain amount of hilarity, especially since we had just had a robust discussion about how closely we should slavishly follow the ‘urtext’ Schubert edition. For example, informed scholarship tends to think the bar before the exposition repeat in the first movement should be a first time bar and therefore omitted if you don't do the repeat, as is the case in some recordings that we've listened to (and between us we've listened to a lot as due diligence in preparation). The reason is that it makes more musical sense that way. It wasn't published in Schubert's lifetime so the urtext is based on manuscript that could easily have mistakenly omitted the first time bar mark. Schubert was a notoriously fast writer after all, and would have had a chance to correct proofs before publication, but that never happened so we have to make musical sense of it ourselves. As you can probably guess I'm on the side of making musical sense rather than slavishly following a possibly flawed manuscript for the sake of it. After a couple of weeks' thought we are nearly in agreement, but eventually we'll do what the leader Ian decides and I'll be happy with that. Meanwhile I'm tempted to draw a comparison with the way the phase 'evidence-based medicine' can be abused by some, so that just invoking it even when it's incorrectly applied adds a spurious strength to an argument. So it is with the urtext, which is a skeleton on which we must put flesh, clothes, life movement and motivation. Meanwhile we suggested to Patrick that these sort of tensions might find their way into a scene in a novel, so wait and see! It occurs to me that although I express myself quite strongly when I do have an opinion, most of the time I listen and occasionally say something intended to sum up and move on, which I suppose has some parallels with psychodynamic group work except that there's no interpretation. Heaven knows what would happen if I even tried thinking that way.


As for what the others feel about me being a psychiatrist.... it's only really come up once. One day between the afternoon run through and the evening concert everyone, as usual, retired to a pub for a meal. I was late getting to the pub as I was meeting a friend off the bus who was coming to the concert, so when I got there the others had already ordered. Debs the violinist handed me the menu and suggested that as a psychiatrist I should be able to guess what meal each of the others had ordered. Ian was easy - the biggest portions obviously. Can't remember how I did with the rest. And that's it really. I guess they think it slightly amusing and like to tease me about it. Having a novelist in the group though... that's much more intriguing. Actually we're all good friends and enjoy just about everything we do together.


Do you have a preference between live performance and recording? From the psychological perspective of the performer, what are the key differences between the two in your view?

When in the zone, a good live performance is an unbeatable, peak experience, whether as listener or performer. Sometimes when not in the zone though I find it a bit excruciating. We recently did a well-attended quartet concert on a Sunday afternoon with Schubert's Rosamunde and Shostakovich's 8th. Being the time of year, the sun was low in the sky and extremely bright. During the concert the sunlight moved across the window at the back, starting off by not focussing on any of us, but as the concert went on at least two of us in turn were dazzled by an incredibly bright beam of light in the eyes. We discovered that if you see this in the corner of your visual field while you're looking at music on a stand there's an irresistible urge to glance up. No really, it's irresistible. And if you glance up you're basically blinded for a second or three. This wasn't helpful to the leader in a difficult bit of the Schubert last movement, and it struck me in the eye at the most difficult part of the Shostakovich. But the point is, although we both felt something must have gone really badly wrong, the feedback from the audience was superb and several people made a point of coming up to us afterwards and saying how moving and beautiful it was. Also, we recorded it for our own feedback purposes, and sound-wise you wouldn't notice anything had happened. However, definitely slipped out of the zone for a bit and it was uncomfortable.

Corineus String Quartet

I've been involved with a couple of commercial recordings in the past and we plan to do some more with the quartet in the future. Of course in this situation the tension is off and if you have a good sound engineer you can get a good quality tone and dynamic changes and stitch together something with all the right notes in the right order. But as I said, the tension is off; we have to beware of the product being less emotionally satisfying if we don't also continually remind ourselves that we're telling a story and have the audience in mind.


Who and what are your favourite composers and pieces to play? What is it about these composers and pieces that you find compelling? Can you give us a recommendation of a classical piece with healing qualities?

It's a great indulgence to be allowed to give an opinion that doesn't depend on a literature search or meta-analysis of top level evidence and where I can just say what I think. Obviously that not all music is mood enhancing, or meant to be. Great music, like all great art I expect, tells us a story,

sometimes with an explicit narrative, but often more abstractly so if we wish we can project a personal narrative into it. There is typically some contrast, possibly some conflict, and hopefully resolution. When I listen to recorded music, as opposed to being in the audience at a concert or performing it, I rarely if ever do so just to cheer myself up, More likely I want to calm down or enhance my concentration on another task, or, quite frequently, I want to familiarise myself with a piece I might be playing. Incidentally many professional musicians that I know find background music really distracting and somewhat unpleasant presumably because their training and general sensitivity makes them unable to avoid analysing and focusing on it and distracts them from other tasks. In fact it's been suggested to me that this is a key difference between amateurs and professionals, though I think that's an exaggeration. Nevertheless your question about 'healing' music got me thinking about which composers, and which pieces, are basically happy. This is purely subjective of course, but to me there's a sort of first division group of composers whose music is psychologically well-adjusted and whose output has a positive, uncomplicated feel to it. The ones that come to mind straight away are Handel, Haydn and Dvorak, with a sort of second division that includes Vivaldi, Corelli, Rossini, Mendelssohn and Saint-Saens. Beethoven typically has a sense of optimism that often shines through the tribulation, whereas Mozart has a lot of flashes of joy, especially in the earlier works, but he can also display an underlying melancholy if you but look for it. And Shostakovich can laugh and cry at the same time, but he's a very special case.


That's not the same list as my 'favourite' composers, or pieces. That list varies from week to week! This week I am mainly enjoying Mozart, and also the Australian composer Peter Sculthorpe (recommend you look him up if not familiar to you!), and I've recently finished listening to the complete works of Thomas Tallis and a complete cycle of Beethoven piano sonatas. Next week it'll be some other composers, I'm sure. Mozart piano concertos are always good in the car and remind me of driving in Tuscany. In fact no long journey is complete without numbers 18 & 19 (number 20 on the other hand is a bit too melancholy for that, but has its place in the home, and number 21 too distractingly beautiful to have on while negotiating a difficult junction).

My wife Sue and I occasionally discuss what we'd like played at our funerals, and that sometimes changes a bit. I think we'd both like the Cavatina from Beethoven Op. 130, but last week she prodded me and said “Andante from Mozart 29, don't forget that!” and then I listened to it and thought yes I'd like that too.

As for pieces that might be healing, well, I'll take that at face value and start with Handel's Concerto Grosso Op 6 no 7. If I listen to that from beginning to end I definitely feel that all is good with the world, and everything's going to be OK. It is like walking through an English garden in full bloom on a beautiful day in late spring or early summer. Of course the performance is important. Some groups take parts of it far too quickly in order to show off how good they are at fast finger passages, so the audience thinks how clever the performers are, but I think that seriously misses the point. As in most other music, the performer’s task here is to be a bridge between the composer and audience, not to be needy and attention-seeking. The same movement when played a little slower with careful phrasing is a beautiful gracious acoustic miracle.

Also in the category of healing or uplifting pieces would be several extracts from Haydn's Creation, most notably the first part closing number The Heavens Are Telling which I find relentlessly and infectiously happy and uplifting. The New Created World chorus earlier in the piece is also just about in this category. I've played the cello in at least three performances of this over the years (plus one where I was singing in the choir) and look forward to doing it again as I'm sure one of the local choral societies will get round to it.

If we're just talking about performing I'd also bring in Brahms, especially the clarinet quintet and the string sextet in B flat. Also I'm really enjoying the Schubert string quintet that we're rehearsing at the moment.


I interviewed the pianist James Rhodes last year. He has been quite outspoken about stuffiness or snobbery in the classical music world. Have you encountered this in any way? Would you like to counter the view?


I'm pleased to say that in everyday situations I've found most professional musicians to be remarkably unstuffy and indeed keen to break down any barriers of perceived elitism. At our quartet concerts we always have a chat with the audience about each piece before we play it, and in orchestral gigs I don't think anyone minds at all if, for example, there's applause between movements, in fact I would take it as positive feedback!

There is however a tranche of professional musical behaviour that is frankly precious, truly pretentious and absolutely open to the criticism of being elitist, and I disapprove of it immensely. It is exemplified by some recent stories in the press about what happens when someone in the audience coughs during a performance. Now just let me mention first of all that there are many fine musicians who don't work in the conventional 'classical' genre. They might do jazz, folk or nightclub work, and it would be ludicrous if they got worked up about audience coughing! It's only some rarefied folk who really ought to get over themselves who seem to have a problem. One of the reasons I feel strongly about this stems from my professional work with people with disabilities. In a previous job I used to arrange concerts that were often attended by people with learning disability and/or cerebral palsy and it was quite normal for there to be 'noises off'. This still happens of course and I'm pleased that people come to our concerts and enjoy them. As musicians we can learn how to play through it not be put off. I have always found audiences to be inclusive and accepting of this. And as far as coughing is concerned… well I was astonished recently to hear an eminent pianist whom I used to know quite well many years ago holding forth on the radio about how terrible people who cough in concerts are, and really being quite dismissive and pejorative about the people who buy tickets to listen to them and are therefore their source of income. I think it was a discussion about some German research that also seemed to miss the point. So here's my opinion:

1. People in the audience do not, as a rule, cough intentionally in concerts. They do not do it to annoy performers and they do not do it because they are stupid or ignorant. Mostly in fact they try very hard to suppress their coughing until a break between pieces, and if it's persistent they will quite often leave the room. Generally speaking the audience is on the side of the performers, even if the performers sometimes behave as if they are not on the side of the audience.

2. The reason that people cough is because something has set off the cough reflex, a normal and typically involuntary biological process.

3. But here's a thought – if you are concentrating really hard on something you may swallow less often. Saliva may accumulate in the mouth and dribble back, get accidentally inhaled and set off a cough. So someone listening intently to music in a concert may actually be more likely to cough.

This can go for performers too. It's happened to me a couple of times in a concert over the years, intense concentration leading to a barely suppressed coughing fit. I didn't do it deliberately and the other musicians didn't stop and ask me to leave. They didn't even accuse me afterwards of attention-seeking behaviour!


Do you listen to much music outside of the classical genre? Have your tastes changed over the years and if so how? Can you give us a non-classical favourite?

I guess my knowledge of popular music and my enjoyment of it froze sometime in my 20s, which means I'm a child of the 60s & 70s and have fond memories of sixth form discos and university parties and the background music to those events. Like most musicians these days, I sometimes get involved in the wedding music playing circuit and this can mean producing arrangements of contemporary songs, so I get some exposure to the modern stuff. What strikes me about present-day popular music is that the songs often have one idea that just gets repeated and there's no development or middle section or modulation. I'm sure this is just a current trend and won't last, but frankly I find a lot of it quite boring. It crossed my mind that it might be related to whichever recreational drugs are popular at the time; amphetamine-related drugs do tend to make people stare at the wall for prolonged periods of time and the music kind of goes with that sort of mindset. Whereas in the 60s & 70s, LSD and related drugs were matched with psychedelic music (late Beatles, Jimi Hendrix, Blind Faith, etc).

Right now in the CD rack in the car apart from the Mozart I have a Beach Boys collection and some French Cafe music. I live in Cornwall. On a sunny day driving along with the sea in sight Californian surfing music is a perfect match, whereas driving back late at night some Serge Gainsbourg or Brigitte Bardot goes down a treat.

Finally, years ago Jacques Loussier made an LP called Pulsion which consisted of his original compositions and was therefore completely different to his Bach or Satie interpretations. It was absolutely brilliant. I had a copy and have lost it. I wish it could be reissued on CD.



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Minds in Music

Minds in Music

  John Tully  


Dr John Tully is a forensic psychiatrist and researcher at the Institute of Psychiatry, Psychology and Neuroscience, London. He is also a musician and is interested in the role of the arts in mental health.