A Disorder That Stops the Music

Just because you’re a hypochondriac, to paraphrase Joseph Heller’s wry comment on paranoia, doesn’t mean you aren’t sick. And the brilliant Canadian pianist Glenn Gould was, in a phrase uttered at a medical conference over the weekend, “a world-class hypochondriac.” He was also a perfectionist, easily frustrated.
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“Opening theme of Casella was unbalanced, and notes appeared to stick, and scalelike passages were uneven and uncontrolled,” Gould wrote in his diary about his 1977 performance of Alfredo Casella’s “Due Ricercari sul Nome B-A-C-H,” taped for television.

“During the next two weeks problems increased,” he added later. “It was no longer possible to play even Bach Chorale securely — parts were unbalanced, progression from note to note insecure.”

In 2000 Dr. Frank R. Wilson, a neurologist, suggested in a paper, “Glenn Gould’s Hand,” that Gould had a problem little understood in his time, least of all by him. Today, though it is by no means fully understood, the disorder is called focal dystonia.

Dr. Wilson read a condensed version of that paper on Saturday at the Grand Hyatt New York during the two-day “Musician’s Summit” presented by the Dystonia Medical Research Foundation and its program, Musicians With Dystonia. In those diary entries Dr. Wilson said, Gould “was telling us what dystonia feels like at the outset.”

Dr. Wilson spoke of Gould’s “hand that does not easily widen” and noted that his “middle and ring fingers keep close company.” To judge from the photographic and video evidence Dr. Wilson offered, he was referring mainly to the left hand, though when questioned afterward, he said that it wasn’t entirely clear whether Gould himself was concerned with one hand or both.

Despite the conference’s title, it was dominated not by musicians but by medical specialists in dystonia from the United States and Germany.

The problem is by no means new. The 19th-century composer Robert Schumann was mentioned in passing on Friday for his fingering difficulties at the keyboard, and his case was analyzed more closely on Saturday in a historical survey by Hans-Christian Jabusch, the director of the Institute of Musicians’ Medicine at the Hochschule für Musik Carl Maria von Weber in Dresden.

After a number of unsuccessful remedies, Dr. Jabusch said, Schumann simply “avoided dystonic moves.” Dr. Jabusch cited Schumann’s Opus 7 Toccata, which “hardly used the middle finger of the right hand.”

Isolated instances apart, what brought hand dystonia to prominence were the devastating cases of Leon Fleisher and Gary Graffman, two of the brightest lights of a stellar generation of American pianists, in the 1960s and ’70s. Each lost control in his right hand; both continued to play works written for the left and developed major careers in education. Mr. Fleisher, after decades of strenuous effort and treatment, regained control of his right hand and has resumed performing with both hands.

The research foundation defines dystonia as “a neurological disorder characterized by involuntary muscle contractions and postures.” It can be generalized or focal, meaning that only a certain part of the body is affected. The foundation cites estimates that 1 to 2 percent of professional musicians are known to be affected, almost all of them classically trained and most of them male.

Eckart Altenmüller, the director of the Institute of Music Physiology and Musicians’ Medicine at the Hanover University of Music, Drama and Media, provided numbers from his research, saying that in a group of instrumentalists with dystonia, 93 percent were classical musicians, and 81 percent were male. Part of the problem of being a classical musician, he said, is that “you have to hit the target exactly” every time. The problems of being male he didn’t specify. Other risk factors, he added, are general anxiety and perfectionism of the Gould variety.

Musician’s dystonia most commonly affects the hand, causing fingers to curl under or jut out inappropriately. It occurs not only among pianists but also among string and woodwind players, guitarists and percussionists. In addition, brass and woodwind players are susceptible to embouchure dystonia, which may cause the lips to tremble or the jaw to lock, or otherwise affect the face, mouth and tongue.

There seems in many cases to be a genetic predisposition to the disorder, and its physiology is centered in the brain. That much, though not too much more, I was able to glean from the highly specialized discussions of DYT1 and DYT6 genes and brain imaging on Friday.