Opera and Neuroscience

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CHAPTER

Opera and neuroscience

19Lorenzo Lorusso*,1, Antonia Francesca Franchini, Alessandro Porro{*Department of Neurology, Mellino Mellini Hospital Trust, Brescia, ItalyDepartment of Clinical Science and Community Health, University of Milan, Milano, Italy{Department of Medical and Surgical Specialties, Radiological Science and Public Health,

University of Brescia, Brescia, Italy1Corresponding author: Tel.: +39 (030) 7102631; Fax: +39 (030) 7102622,

e-mail address: [email protected]

AbstractOpera is the most complete form of theatrical representation, characterized by musical accom-

paniment, both instrumental and vocal. It has played an important role in sociocultural spheres,

affecting the various social strata and reflecting customs and ideas in different centuries. Com-

posers have created pieces that have also shown the development of medicine. Since the birth

of opera in seventeenth century in Italy, neuroscience has played an important role in influenc-

ing the representation of madness and neurological aspects. From theFolly of the Renaissance,

a path toward a representation of madness was developed, initially linked to the myths of clas-

sical antiquity. In the seventeenth and eighteenth centuries, madness was represented as com-

ical or funny, of a loving nature and influenced by the spread of the Commedia dellArte

(Comedy of Art). In the nineteenth century, with the rise of the first scientific theories of

the mind, insanity took more precise connotations and was separated from other psychiatricand neurological diseases. The operas of the twentieth century depicted psychiatric and neu-

rological diseases, taking into account newer medical and scientific discoveries.

Keywordsopera music, mesmerism, madness, stroke, epilepsy, headache, sleepwalking, dementia,

neuropsychiatry, neuroscience

1 INTRODUCTION

Historically, neurology and psychiatry were considered a single entity until the mid-nineteenth century when neurology became an autonomous field, thanks in part to

the French physician Jean-Martin Charcot (18251893). This change advanced med-

ical and scientific knowledge in various fields, including psychiatry itself. The op-

eratic representation of neuropsychiatric conditions reflected this chronological

development. Insanity, or madness, has been a recurrent theme in lyrical opera,

Progress in Brain Research, Volume 216, ISSN 0079-6123,http://dx.doi.org/10.1016/bs.pbr.2014.11.016

2015 Elsevier B.V. All rights reserved.389
http://-/?-http://dx.doi.org/10.1016/bs.pbr.2014.11.016http://dx.doi.org/10.1016/bs.pbr.2014.11.016http://-/?-


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one closely associated with an even more popular theme, that of women in love

(Fabbri, 2003; Sala, 1994).

The term madness and the many ways to represent it have varied with historical

periods, with different composers and also with the music itself (e.g., comical vs.

serious genres;Ropert, 2003; Pieri, 2006; Verdeau-Pailles et al., 2005). Accordingto Brener Neil (1990), in his comment on a series of articles by Mark Jones, which

appeared in the 1990s and titled The Psychiatry of Opera, one can distinguish three

forms of representation of madness: the first is expressed in scenes of madness cov-

ering the period from the eighteenth century until the mid-nineteenth century, begin-

ning withOrlando(1733) by Georg Friedrich Handel (16851759) and ending with

Lucia di Lammermoor(1835) by Gaetano Donizetti (17971848); the second type of

representation is that of physical suffering that can be seen in operas by Giuseppe

Verdi (18131901) in the late-nineteenth century, which shows a lack of depth in

their psychiatric aspects, because of how difficult it was to show this using Romantic

melodies; and third in the twentieth century, there is a psychoanalytic characteriza-

tion that expresses itself in works including Richard Strausss (18641949)Elektra

(1909), Alban Bergs (18851935) Wozzeck (1925), and Igor Stravinskys

(18821971)Oedipus Rex(1927). These three composers deal with this subject from

different points of view, although all are influenced by Freudian theories and share a

common cultural origin (Brener, 1990; Jones, 1990a).

In contrast,Ropert (2003)emphasizes the social role of madness as a rebellion by

women against social prejudices.In the late-eighteenth century, this rebellion coincided

with the shift from the Classical to the Romantic Period, and from a social viewpoint,

there was an adaptation to the demands of the emerging middle class that represented

the new, replacing the noble and clerical classes (Raynor, 1976; Zaccaro, 1979).

The success of new operas is partly due to the ability of composers to satisfy the

changing tastes of their growing audiences. Over time, this made lyrical opera per-

formances a form of entertainment, not just for the rich but also for the growing mid-dle to lower classes, boosting its commercial success (Abbate and Parker, 2012;

Baia, 2011; Erfurth and Hoff, 2000; Sadie, 1992).

2 THE ORIGINS OF MADNESS IN OPERARepresentations of madness have been an integral part of the history of opera from

the outset. It began with the resurrection of material from classical mythology.

Mede e(1693) by Marc-Antoine Charpentier (16431704) provides one of the earli-

est examples of loss of contact with reality, when madness takes hold of Creon. The

relationship with Greek tragedy is also evident in an opera by Claudio Monteverdi(15671643), who in the Incoronazione di Poppea (The Coronation of Poppea)

(1642) described the death of Seneca (4 B.C.65) in the aria Amici e giunta lora

(Friends, the hour has come), sung while Seneca accepts suicide as a natural, inev-

itable final act. The topic of suicide is, in fact, widely represented in opera as a sign of

fate or as an extreme act of defeat in irreparable situations ( Feggetter, 1980).

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The combination of madness and older material continued in the eighteenth cen-

tury by Handel. HisOrlandowas based on theOrlando Furioso(1532) (The Furious

Orlando) by Ludovico Ariosto (14741533). Here, the protagonist exhibits a loss of

reason when he discovers that Angelica, the woman he loves, prefers another man

(Dura-Vila and Bentley, 2009).During the same period, we can also see a different approach in depicting mad-

ness, inNina o sia la Pazza per amore (Nina, or the Madwoman by Love) (1789) by

Giovanni Paisiello (17401816). This opera was based on the story ofNina,ou La

folle par amour(1786). The libretto was written by Marie Benoit-Joseph Marsollier

of Vivetieres (17501817), and Nicolas Dalayrac (17531809) provided the music. It

presents madness as female amorous madness (Chiappini, 2006;Table 1).

This change was made possible by the spread of the representations ofCommedia

dellarte, Italian comedy of the sixteenth to eighteenth century, improvised from

standardized situations and stock characters, which had already started in 1589 with

La pazzia di Isabella (The Madness of Isabella), then withLa finta pazza(The False

Madwoman) (1641) with music by Francesco Sacrati (16051650) and the libretto

by Giulio Strozzi (15831652), which was first performed in Venice (Rosend, 2007;

Sala, 1994; Scala, 1976). These Baroque Period operas were characterized by gro-

tesque or terrifying madness.

Another feature that enhanced the spread of the comic opera associated with mad-

ness was the emergence of folk dance, probably of Portuguese origin, during human-

istic Renaissance Era. In this domain, the movements of the body are uncompounded

and do not follow the usual rules of courtesy. Musical motifs are instead repeated

and insistent, like those performed in fertility rituals in which everyone seems to lose

their reason. This constituted a melodic pattern that was the basis of genderFolia

(Follia), or its variants,Madness,Folias,or Folies. This pattern inspired composers

throughout the Renaissance, during the Baroque Era, and up until the middle of the

Romantic Period. It also involved the religious sphere.The musicians dealing with madness also showed particular skills in the exercise

of extravagance, oddness, and caprice (Carrer, 2005a). The compositional basis, typ-

ical of the Renaissance and the early-seventeenth century, was to use short circular

harmonicrhythmic sequences related to dance steps called bassi ostinati (ground

basses or obstinate basses), which progressed with their hypnotic repetitions, impro-

visations, and variations (Carrer, 2005b). These obstinate basses were the backbone

not only of theFolliabut also of the Romanesca, theRuggiero, theAria di Genova,

and the Neapolitan dance calledFedeleor evenAlta Regina, favored in the so-called

singing century. In the mid-seventeenth century, this continued as the popular off-

spring of the lateFollia, in which writers and musicians identify the voice of musical

theater and a fertile ground for the application of novelty or the preservation of theancient. To define the singular and very recognizable profile of the Follia, we can

look to the Italian origin composer Jean Baptiste Lully (Giovanni Battista Lulli)

(16321687) and other famous musicians, such as Domenico Scarlatti

(16601725), Handel, and Antonio Vivaldi (16781741), all of whom composed

cantatas, sonatas, and concertos dedicated to madness and to operas, such as Orlando

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Table 1 Female madness in opera (chronological order of the main

rappresentations)

Composer Opera Year

Andreini Francesco and Isabella La pazzia di Isabella 1589

Giramo Pietro Antonio Il pazzo con la pazza 1630

Sacrati Francesco La finta pazza 1641

Cimarosa Domenico Armida immaginaria 1777

Anfossi Pasquale La pazza per amore 1785

Dalayrac Nicolas-Marie Nina, ou La folle par amour 1786

Paisiello Giovanni Nina, o sia la pazza per amore 1789

Caignez Louis-Charles La folle de Wolfenstein 1813

Piccinni Louis Alexandre Jean Sbogar 1818

Quaisain Adrien Le belvede` re ou La vallee de LEtna 1818

Schaffner Nicolaus Albert Les fre` res invisible 1819

Carafa Michele Jeanne dArc a` Orleans 1821

Ducange Victor La fiancee de Lammermoor 1826a

Bellini Vincenzo Il pirata 1827

Donizetti Gaetano I pazzi per progetto 1830

Donizetti Gaetano Anna Bolena 1830

Donizetti Gaetano Gemma di Vergy 1834

Donizetti Gaetano Lucia di Lammermoor 1835

Coppola Pietro Antonio La pazza per amore 1835

Persiani Giuseppe Ine` s de Castro 1835

Bellini Vincenzo I puritani 1835

Desnoyer Charles La folle 1836

Donizetti Gaetano Roberto Devereux 1837

Donizetti Gaetano Maria di Rudenz 1838

Mercadante Saverio La vestale 1840

Pacini Giovanni Saffo 1840

Donizetti Gaetano Linda di Chamonix 1842

Clapisson Louis Jeanne la folle 1848

Muzio Emanuele Giovanna la pazza 1852

Chiaromonte Francesco Giovanna di Castiglia 1852

Concone Giuseppe Graziella 1856

Meyerbeer Giacomo Le pardon de Ploermel 1859

Petrella Errico Celinda 1862

Bizet Georges Jolie fille de Perth 1867

Thomas Ambroise Hamlet 1868Catalani Alfredo Edmea 1886

Massenet Jules La navarraise 1894

Caffi Rinaldo Graziella 1894

Rimsky-Korsakov Nikolai The Tsars Bride 1899

Strauss Richard Elektra 1909

aSimilar stages were performed by Carafa Michele (1829), Rieschi Luigi (1831), Beltrami Pietro

Mazzuccato Alberto (1834), and Donizetti Gaetano (1835).



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Furioso and Orlando finto pazzo: Danziam signora,la follia dOrlando.Suonate!

Suonate! (Let us dance lady, the madness of Orlando. Play! Play!) (1727) (Carrer,

2005b; Powell, 2001).

In this context, before and during this period, it is clear that the fool was distinct

from the bulk of the poor, the sick, the plague victims, the lepers, or the possessed,who are a homogeneous group left to their fate. The fools, including the curious and

the pathological, are a subject of separate interest. They constitute an iconographic

model of various artists of that time, e.g., theNave dei Folli (Ship of Fools), but also a

social model, so that institutions reserved for the insane in Spain and Italy were

established and called casas de locos orHospitali dei pazzi (Hospital for insane)

or, more simply, pazzarelli (Zanies). The first was built in Valencia, Spain, in

1409 and called theHospital de los Innocenteson the initiative of wealthy merchants

solicited by a monk Fray Juan Gilabert Jofre (13501417) of the Order of Mercede

Friars (this Order was devoted to slaves redemption). Other hospitals followed in

Zaragoza (1425) and Seville (1436), and in Italy, the first hospital for the insane

was founded in Rome and called Hospitale della Pieta de Pazzi (Mercy Hospital

for the Mad) in Piazza Colonna (1550). It was followed by the Pia Casa di Santa

Dorotea de Pazzerelli (Pious home of Saint Dorotea of Zanies) in Florence

(1647) and then a specialPazzeria(Madness) section at the Hospital of Santa Maria

Nuova (1688), a model subsequently followed by other cities, such as Naples,

Venice, and Milan.

In confirmation of a privileged interest in the topic, there are literary references in

the pages of Felix Lope de Vega y Carpio (15621635) (Los locos de Valencia) and

Miguel de Cervantes Saavedra (15471616) (Don Quixote), and joking, in literature

and music, makes the theme lighter, because the mad are protagonists in places and

times in which abnormal behavior has free reign, such as during a celebration or a

carnival. Several examples, such as Il pazzo con la pazza (The Madman with the

Madwoman),Il lamento della pazza: chi non mi conoscepazzia venuta da Napoli(The Madwomans Lament: who does not know memadness comes from Naples),

andLHospitale per i pazzi (Hospital for the Insane) (1630) by the Neapolitan Pietro

Antonio Giramo (1619after 1630). This showed, with Neapolitan verve, a sense of

celebration of those who were locked up in this hospital and who suffer from ex-

cesses of passion, in the tradition of Orlando mad with love. His madness describes

a topsy-turvy world of triumph, laughter, play, and joy, but also the bitter realization

that, at celebrations end, he must return to reality.

In the same vein, we have La pazzia senile. Ragionamenti vaghi et dilettevoli

(The Senile Insanity. Delectable and Vague Reasoning) (1598) by Andrea Banchieri

(15681634),La finta pazza by Sacrati, and the aforementioned famous comedy,

La pazzia di Isabella, by the comic authors Francesco (ca. 15481624) andIsabella Andreini (15621604). This last story is built around a thwarted love affair,

which ends in madness from disappointment in love and that sinks into the black

mood of melancholy and sorrow; a model for the representation of many follies

and extravagances of love. The story was inspired by the Trattato sulla follia

(Treatise on Madness) by Girolamo Fracastoro (14781553) and was represented



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on the occasion of the marriage of Ferdinand I de Medici (15491609) and Christine

of Lorraine (15651636) in Florence in 1589, with great success. On the same

occasion, Girolamo Bargagli (15371586) provided an interlude, la Pellegrina

(The Pilgrim) (1589), which contains a case of simulated insanity (Carrer, 2005c;

Molinari, 1983).Thus, comic operas included the character of a woman who becomes mad due to

increasing and intensifying love. We now find this inLa pazza per amore(The Mad-

woman of Love) (1785) by Pasquale Anfossi (17271797) and the aforementioned

Paisiello. These composers returned with a romantic trilogy published in 1784 by

Antonio Piazza (17421825), which preceded the opera of Benot-Joseph Marsollier

(17501817) and Nicolas Dalayrac (17531809) by about 2 years and was called La

pazza per amore ovvero la conchiusione dellimpresario in rovina e della Giulietta

(The Madwoman for Love or the Conclusion of an Impresario in Ruins of Juliette).

The female madness displayed here will now represent the feminine archetype

for the imagination and sensitivity of the different protagonists of many operas of

the late-nineteenth century. The ways to represent her (e.g., with messy hair, the

transition from crying to laughing, in a white dress, with a bouquet in her hands, with

unsteady gait, hesitating, groaning, and with a tendency to sit on a bench) is, of

course, present in the comic genre. But it can also take on a more pathetic look

and can encroach on the semiserious opera (Peri, 1988; Sala, 1994).

The representative model of female madness ofopera buffawill influence many

European composers, the most famous being Wolfgang Amadeus Mozart

(17561791). He was influenced by Anfossi, because at the age of 14, in 1770,

his father Leopold (17191787) took him to Naples where he had the opportunity

to learn about the music of this composer. He paid particular attention to some of

the music in Anfossis operas: Il curioso indiscreto (The Curious Indiscreet Man)

and Le gelose fortunate (The Lucky Jealous Women), performed in Vienna in

1783 and 1788, respectively. Moreover, there seems to be some correspondencebetweenLa finta giardiniera(The False Gardener) by Anfossi and later by Mozart;

the latter followed some formal aspects of the Italian composer, reprising even

the rhythmic invention dividing the aria into two parts, with different tempos and

rhythms (Capone, 2007; du Parc Poulain Saint-Foix and Wyzewa, 19121946;

Zanetti, 1978).

Mozarts relation to Italy was also political. Due the Habsburg domination of

Lombardy, there were exchanges with a sensitivity to each others musical worlds.

Even during the Napoleonic period, these exchanges of ideas and musical praxis

remained uninterrupted. Thus, there were figures that connected medicine and music

closely, not only in terms of music therapy, but also in composition, and who were

clearly influenced by the music of the Mozart family of Salzburg.Peter Lichtenthal (17801853) was a major figure in the first half of the nine-

teenth century, who moved from his native Pressburg (todays Bratislava) in 1810

to Milan, where he remained for the rest of his life. He was a doctor, a composer,

and the author of important works of medical bibliography. He composed instrumen-

tal music, sacred music, and music for ballets played at Teatro Alla Scala



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(Lichtenthal, 1970).1 In one of these compositions, he brings us in contact with

mental pathology, when dealing with the myth of Dido and his tragic suicide. The

dramatic events at the end of Didos life include many features of psychological dis-

tress, from dejection to psychomotor agitation and to the act of suicide itself (Didone,

1821). Lichtenthal was also a friend of the Mozart family, and particularly of the sonKarl Thomas (18741858), who resided in Milan from 1805 until his death (he was

the last of the family). Lichtenthal also transcribed some of Mozarts music

(Falconi, 2008).

Another type of madness can be partly associated with old age. This appeared in

thePazzia senile(Senile Madness) (1598) by Banchieri, but when it was juxtaposed

in his other opera,Saviezza giovenile(Young Wisdome) (1607), it is even more ap-

parent. In the genesis of Italian opera, especially in the form of the madrigal comedy,

which takes advantage of a proposed series of characters from the Commedia del-

lArte, we find characters representing the elderly, even as an expression of stereo-

types of ancient origin. The theme of an elderly man falling in love with a young

woman is an expression of the subversion of normality. It was often presented as

an example of pathology in the sixteenth century, especially in the European Catholic

world, in which adherence to the new ideas of the Protestant Reformation was

regarded as a sign of pathology.

This is obvious in scientific treatises, such as the Trattato de la vita sobria (Treaty

of a Sober Life) (Cornaro, 1558) by Alvise Corner (Luigi Cornaro 14751566), who

includes Lutheranism in pathologies of the elderly. This mention is not accidental,

since Corner was the chief patron of Angelo Beolco, known as Ruzzante or Ruzante

(14961542). In this evident case, the world of science and comedy meet, while

during that period the concept of humor was emerging (Cesa-Bianchi et al.,

2013). The relationship between madness and humor was to become especially

evident in Elizabethan theater.

This heterodoxy (both religious and cultural) is defined in the pathological sense,not only against a foreign reality (coming from northern Europe) but also in relation

to Jews (anti-Semitism) within the territories of the Italian peninsula. Jews, in fact

also represented a type of madness, with their strange language, customs, and cere-

monies. Yet, they were often portrayed in humorous ways. We can find this way of

representing Jewish people in Orazio Vecchis (15501605) work. The Amfiparnaso

is his most famous madrigal comedy, performed in 1594 and published in 1597. The

lyrics were written by the Bolognese poet Giulio Cesare Croce (15501609). In

them, rather vulgar representations of the Jewish community stand out. Some involve

money lending with ambivalent exploitation of the elderly, embodied by Pantalone

(a character from Bologna) struggling with the young Hortensiathe mad senile

man falling in love with a far younger woman. Regarding pathology of the elderly,we can also look to the comedies of Giovanni Croce (15571609) and Banchieri.

1See also Dedalo played in December 26, 1817; Il Conte dEssex played in October 24, 1818; Le

sabine in Roma played in December 26, 1820.



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If we move from Modena to Venice, we find the same characters, such as

Pantalone, in the operas of Giovanni Croce. And without great effort, we can also

find other stereotypes regarding the elderly. For example, hearing disorders not only

show us a functional, anatomical sclerosis, but also represent a precise satire to the

alleged gerontocracy of the Venetian patricians. Further, in his Teriaca musicale(Musical Theriac) (1595), there are strong links with health and disease.

Lastly, in the already mentioned opera by Banchieri, under the theme of patho-

logical falling in love, the character is always identified with the figure of Pantalone.

3 MOZART AND MESMERISMMozarts interest in madness, stems partly from the fact that the Mozart family had

the opportunity to learn about the theories of Mesmerism, a form of hypnotism or

physician-induced suggestion, by German physician Franz Anton Mesmer

(17341815), who wrote and practiced in Vienna and Paris (Goldovsky, 1986).

Mozart characterizes this with the role ofElektra in the opera seria Indomeneo, re

di Creta ossia Ilia e Idamanete (Indomeneo, King of Crete or, Ilia and Idamanete)

or simply Indomeneo, first presented in 1781 in Munich (Ropert, 2003), and

also by presenting quirky characters with a certain charming ability to enchant

or mesmerize. Mesmer (1766), in his medical thesis titled Dissertatio physico-

medica de planetarum influx in Humanum corpus (The Influence of the Planets

on the Human Body), brought together several theories when constructing what

he called his animal magnetism: e.g., the presence of an invisible fluid in the cos-

mos, which can be transmitted through objects and can affect the nervous system and

hence the body. Moreover, although influenced by Newtonian ideas, he also

borrowed liberally from older authors, such as Paracelsus (Philippus Aureolus

Theophrastus Bombastus von Hohenheim, 14931541) and Richard Mead(16731754) (Finger and Gallo, 2004).

The Mozart family had a friendly relationship with Mesmer in Vienna, where

Wolfgang might first have become familiar with his theories. In 1768, the young

composer presented his first operetta (Singspiel)Bastien and Bastiennein Mesmers

garden. According to some authors, it was commissioned by Mesmer. Inspired by

Jean-Jacques Rousseaus (17121778)Le devin du village, its first documented pre-

sentation took place in Berlin in 1890 (Goldovsky, 1986).

Mesmers influence on Mozart is decidedly more apparent in the opera Cosfan

tutte,ossia la scuola degli amanti(Thus do they All, or the School for Lovers; also

translated as Women are Like That) (K 588). This comic opera was first presented in

Vienna in 1790, and it is the last of the three operas written for Mozart by the famedItalian librettist, Lorenzo da Ponte (17491838); the other two being Le Nozze di

Figaro (Marriage of Figaro) and Don Giovanni.

In the first act ofCosfan tutte, the maid, Despina, disguised as a fraudulent doc-

tor using pompous flowery Latin and a few words of Greek and Hebrew, attempts to

apply a magnetic stone (originated in Germany and spread to France) to the heads of



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the two lovers, Fernando and Guglielmo, who had taken arsenic in a desperate act of

love (Carmody, 1991; Goldovsky, 1986; Norio, 2007; Worth, 1993). Imitating and

making fun of Mesmer, the doctor moves this piece of magnet. The stone which

the great Mesmer discovered over their bodies, while trying to pull out the arsenic in

this farcical scene. After this action, Despina and Don Alfonso affirm: In poche ore,lo vedrete, per virtu del magnetismo/finira quel parossismo, torneranno al primo

umor(Very soon now youll see, by virtue of magnetisms power/The end of this

paroxysm, and theyll be as they were before).

In 1784, in France, Mesmerism was repudiated by a royal commission headed by

Benjamin Franklin (17061790), but his doctrine remained widespread in Central

Europe (Finger and Gallo,2004; Worth, 1993), where it continued to influence some

composers even to today.2 The ability of Mozart to create absurd situations is also

witnessed in the scene of the trioSoave sia il vento(Gentle is the Wind). It includes a

comical situation in which Don Alfonso, along with Fiordiligi and Dorabella, prays

that the wind will gently lift the ladies clothes, while Guglielmo and Ferrando are

hidden and Don Alfonso exclaims, Non son cattivo comico (I am not a bad actor).

This is done with a musical background that makes the atmosphere light, and it is

not seen as a cynical representation of the character.

Another example of the use of ambiguous characters can be found in Don

Giovanni, presented first in 1787 in Prague. The central character is framed as an

antisocial individual with little respect for rules, a man incapable of feeling guilt.

Yet Mozarts music is effective enough to perceive his charisma and his ability to

manipulate and attract others in seductive scenes, including in the duet La ci darem

la mano (There, with your hand in mine) and in the aria Deh, vieni alla finestra

(Come to the window). Don Giovannis behavior is considered insane by his servant

Leporello, who, in the 15th scene of the first act, says: Io deggio ad ogni patto per

sempre abbandonar questo bel matto. . . (In any case, I must leave this madmans

service). Don Giovanni himself agrees with Leporello, at the end of the first actremarking:E confusa la mia testa, non so piu quel chio mi faccia, e unorribile

tempesta minacciando, oddio! Mi va! (My thoughts are whirling! The situation is

out of control. O God what a horrible tempest threatens) (Dura-Vila and Bentley,

2009; Jones, 1990c; Rusbridger, 2008).

The technical capabilities of Mozarts musical orchestrations are enhanced by

incorporating physiological functions, such as the heartbeat. This is done in an

amorous situation in Don Giovanni, when Masetto places his ear on the chest of

Zerlina, and again in a scene with Guglielmo and Dorabella in Cos fan tutte

2Thomas Manns (18751955) storyMario und der Zauberere(Mario and the Magician) (1929) haddifferent operatic stages, the first with the Hungarian composer Ja nos Vajda and the libretto by Gabor

Bokkon in 1989; and 3 years later by the Canadian composer Harry Somers (19251999) with the

libretto by Rod Anderson and the last adaptation in 2005 by the American composer Francis Thorne

with the librettist Joseph Donald McClatchy. The story is about the character, Cipolla, a hypnotist who

uses his mental powers to control his audience during the Fascist Period. Cipolla represents the

mesmerizing power of authoritarian leaders in Europe before the Second World War.

3973 Mozart and mesmerism


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(Goldovsky, 1986). This almost hypnotic aspect of Mozarts music, from a technical

and contextual point of view, is expressed in a more sublime way in the Singspiel,

Die Zauberflote (The Magic Flute), which debuted in 1791 in Vienna.

Thus, Mozart represented some of his characters, both in comic and opera seria,

in ways that drew upon current thinking, such as Mesmers pseudoscientific theory ofanimal magnetism. These roles will take on more precise psychological connota-

tions, especially in women, in the next century in opera seria, reflecting changing

medical approaches to psychiatric issues.

4 NINETEENTH-CENTURY PATHOLOGICAL MADNESSAt the turn of the nineteenth century, a new kind of theatrical representation began to

influence operas. Theme lodrameemerged in Paris between 1800 and 1830, antic-

ipating the theatricality of Romantic dramas with their characteristic emotional par-

oxysms, reinforced by the music and their librettos (Baldrini, 1988; Hibberd, 2009;

Sala, 1994). According toEmilio Sala (1994), the time of transition from French

melodrame, which had a happy ending, to Romantic Italian operas, with their more

dramatic endings, is around 1820. The birth of Italian Romantic operas at this

time would create a revolution in opera music from artistic and socioeconomic

perspectives.

From a socioeconomic point of view, French opera was directed at a narrow, aris-

tocratic audience. In contrast, the new Italian operas became a more popular phe-

nomenon. They required more technical and commercial management to meet the

continuous and urgent demands of a growing public that would now fill opera

houses, first in Italy but soon all across Europe (Baia, 2011; Della, 2012; Raynor,

1976; Sala, 1994).

The woman who becomes insane during a love affair is the central character inboth the French and the Italian dramas. Indeed, it is almost always the women who go

madthe few exceptions being inMaria Padilla,Agnes, andNabucco(Peri, 1986).

This successful formula was based on a growing interest in human emotions. Accord-

ing to physician JeanEtienne Dominique Esquirol (17721840), in his bookDes pas-

sions(1805), and Philippe Pinel (17451826), in his treatises (e.g., Pinel, 1846), the

female is more inclined to suffer nervous afflictions caused by the constrictions of

everyday domestic life and the claustrophobic, imprisoning roles they carried out.

Thus, in addition to the physiological conditions typical of the female, such as the

menstrual cycle and innate hyperemotionality, the woman is forced to live as a per-

petual prisoner in a domestic menagerie (Chiappini, 2006; Erfurth and Hoff, 2000).

This would ensure that the female public would be exploited into to attending thetheater by certain kinds of musical representation (Esquirol, 1805; Ghidetti, 1987;

Sala, 1994).

Le folies sentimentalesof the female loving madness, which are characterized by

violent external physical manifestations, can become more composed and internal-

ized, a real sickness of the soul. What evolves will no longer be an exceptional



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stratagem or an abnormal situation, such as we find in Baroque operas with the in-

volvement of both sexes, but a very sad pathological condition, a real personality

disorder. This marks a transition from Romantic era psychiatry to brain

psychiatry, one which will have features of irreversibility (Table 2) (Chiappini,

2006; Erfurth and Hoff, 2000).Female madness will have its special mode of scenic representation. It will be

characterized by an unsteady and slow walk, a pale complexion, staring eyes, dishev-

eled clothing, and so on.

This can be seen and heard in the second act of Vincenzo Bellinis (18011835)

opera IlPirata(The Pirate), which debuted in Milan in 1827. Here, we find Imogene

entering, raving, while the English choir sings: Ella e delirante. Si inoltra a lenti

passi, guardando intorno smarrita. Ella piange (She is delusional. She is walking

slowly forwards, looking around bewildered. She cries) (Chiappini, 2006; Sala,

1994). The protagonist Imogene is in love with the pirate Gualtiero and her mad

scene ends with the words E giorno o sera? Son io nelle mie case o son sepolta?

(Is it day or night? Am I in my house, or am I buried?) (Willier, 1989).

The introduction of the mad scene helped change the musical structure of the op-

eraseria. The recitative was now typically accompanied by music that would best

express the sudden changes of the atmosphere, the emotions, and the characteristics

of a disturbed personality, i.e., mental alienation. This is sometimes accomplished

with a full orchestra, but sometimes with just a few instruments or even one musical

instrument, such as the glass armonica or (when armonica players could not be

found) the flute, as in Donizettis 1839 masterpiece, Lucia di Lammermoor (see

Chapter Benjamin Franklin and His Glass Armonica: From Music as Therapeutic

to Pathological by Finger and Zeitler).

The three most famous Romantic composers of Italian opera, namely Bellini,

Donizetti, and Verdi, succeeded, through a process of rhythmic and melodic frag-

mentation, to express the disordered thoughts and extreme emotions of the femaleprotagonists, tragically separated from the men they love. For example, Bellinis

I Puritani(The Puritans), first presented in Paris in 1835, can be described as an al-

ternating melodic deployment of the various scenes of madness between the singer

Elvira and the orchestra (Rosen, 1995; Sala, 1994).

Table 2 Representative differences of madness between the eighteenth and

nineteenth centuries in opera

Eighteenth century Nineteenth century

Male and female Female

Ordinary people Upper class or aristocracy

Psychosocial condition Pathological condition

Transition condition Irreversible condition

Curable at home Needs institution

3994 Nineteenth-century pathological madness


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In addition, Donizetti portrayed madness with its pathological variants, that is,

with the presence of well-defined neuropsychiatric features, in Anna Bolena (first

performed in Milan in 1830). Anna exhibits full-blown hallucinations before Percy

in this opera, where we hear: Al dolce guidami/castel natio/ai verdi platani/al queto

rio. . .

(Guide me to the sweet/mansion of my birth/to the green plane trees/to thequiet river). The ravings of Anna appear in last two scenes (12 and 13), in which

the protagonist goes from moments of sadness to the rapid, sardonic, quickly flashing

smiles of madness (Chiappini, 2006).

The most famous and well-analyzed scene of madness, briefly mentioned earlier,

is of course the final scene of Donizettis Lucia di Lammermoor, with its libretto

written by Salvatore Cammarano (18011852). Interestingly, prior to Lucia,

Cammarano had written a scene depicting madness for the 1835 opera, Ines de

Castroby Giuseppe Persiani (17991869). Returning toLucia, the heroine fully ex-

presses a delirious madness that is out of control. She has been forced by her brother

to marry another man, whom she does not love, for reasons of political and financial

expediency. Her heart broken, she stabs the imposed groom before appearing before

the guests with her blood-stained bridal dress. The guests are shocked: Par dalla

tomba uscita! (She is as if risen from the grave!) (Chiappini, 2006; Jones, 1990b;

Nagel, 2008; Poris, 2001; Sala, 1994; Smart, 1992). The soprano now quickly

switches from high to low notes with changes between major and minor tonalities.

As noted, the singing is accompanied by a single woodwind instrument (usually a

flute). The sound of the flute adds to the internal dialog, even though it is a fill-in

for the glass armonica, which during the Romantic Era was closely associated with

nerve disorders (Chiappini, 2006; Finger and Gallo, 2004; Lorusso et al., 2011;

Nagel, 2008; Pugliese, 2004; see Chapter Benjamin Franklin and His Glass

Armonica: From Music as Therapeutic to Pathological by Finger and Zeitler). It

has been suggested that the representation of the madness scene, with its colorful

features, may be an expression of Donizettis own suffering (Fig. 1). He died of par-alytic dementia due to syphilis, which he contracted before marrying Virginia Vas-

selli (18111837) (Lorusso et al., 2010; Nagel, 2008; Oliaro, 1938; Peschel and

Peschel, 1992).

Nonetheless, madness procured a certain attraction in society, especially among

artists, many of whom were affected by it. The list is long and, in addition

to Donizetti, one can find Niccolo Paganini (17821840), Robert Schumann

(18101856), and Bedrich Smetana (18241884), to name but three famous com-

posers (Bazner and Hennerici, 2010; Erfurth and Hoff, 2000; OShea, 1988, 1990;

Wintersgill, 1992).

The madness expressed by Verdis Lady Macbeth faithfully reflects that of

William Shakespeares (15641616) play, in terms of witchcraft, demons, etc. Verdi,however, gives major psychological features to the characters with the support of

music. He probably knew something about madness, because he suffered from

depression, and because one of the few friends and admirers who followed him

was psychiatrist Cesare Vigna (18191892), director of the Saint Clemente female

asylum of Venice (Riva et al., 2014).



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InMacbeth(first presented in Florence in 1847), there are also other neurological

abnormalities, such as Lady Macbeths sleepwalking, which is different from that of

Amina in BellinisLa Sonnambula, where the afflicted person is an innocent girl, not

a guilty and crazed murderer (this opera opened in Milan in 1831) (for details, see

Chapter by Somnambulism in Verdis Macbeth and Bellinis La Sonnambula:

Opera, Sleepwalking, and Medicine Finger, Sironi, and Riva). Verdi shows greater

psychological insight and character development but is less melodic than his prede-

cessor. Verdis musical characterization influenced the opera The Tsars Bride(1899), by the Russian composer Nikolai Rimsky-Korsakov (18441908), which

represents the character Marfa, who became insane. This opera was a reaction against

Richard Wagners (18131883) musical style.

Psychopathological conditions, dictated by the new cognitive approaches to hys-

teria and mental illness by Charcot in Paris, also influenced operas (Finger, 1994;

Pugliese, 2004). Two are Parsifal (debuting in Bayreuth in 1882) by Wagner and

Pelle as et Me lisande (in Paris, 1902) by Claude Debussy (18621918) (Atfield,

2011; Charcot, 1880; Dunn, 2006; Hyer, 2007).

5 OPERATIC DEVELOPMENT OF NEUROLOGICAL ANDPSYCHIATRIC CHARACTERSOpera reached its maximum popularity during the nineteenth century, because it was

the point of connection between popular cultures and also learning, now reflecting an

increased demand for scientific explanations, which were to come with rapid

FIGURE 1

Gaetano Donizetti, on the right, affected by paralytic dementia, and his nephew Andrea

Donizetti (Daguerreotype performed on August 3, 1847, in Paris).

Courtesy by Fondazione Bergamo nella storia onlus, Museo DonizettianoBergamo.

4015 Operatic development of neurological and psychiatric characters


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scientific developments supported by positivism (Riva et al., 2010). In addition to its

popular representations of madness, operas during the nineteenth century began to

show people suffering from neurological diseases that can relate to or mingle with

those long considered mental illnesses, so-called neuropsychiatric disorders.

Over time, mental deterioration or decline has played an increasingly importantrole in society, due to increase in life expectancy and diminution of cognition in the

elderly (Porro and Cristini, 2012). Unsurprisingly, the representation of madness in

the elderly and its evolution with clinical classifications are described in operas,

some with literary references.

Some of the best known examples of insanity in general come from Shakespeare,

a keen observer and describer of diverse characteristics of the human mind and be-

havior (Schmidgall, 1990). One can cite the character of Jaques, an elderly man, inAs

You Like It (first performed in 1603 and published in 1623), with these words:

. . .Last scene of all. That ends this strange eventful history, is second childishness

and mere oblivion, sans teeth, sans eyes, sans taste, sans everything (Paciaroni and

Bogousslavsky, 2013; Wells and Taylor, 1998). Shakespeares use of the word

insane in Macbeth (1611) became dementia when Verdi wrote his opera of the

same name: tu sei demente (youre demented) (Piave et al., 1847; Schmidgall,

1990; Wells and Taylor, 1998).

The development of the story of King Lear allows us to recognize with sufficient

reliability the progression of the disorder through todays neurological and psycho-

logical knowledge about dementia, a possible dementia with Lewy bodies, which

affected an elderly person with cognitive fluctuation decline and visual hallucina-

tions (Fogan, 1989; Matthews, 2010b; Paciaroni and Bogousslavsky, 2013). The op-

era was rewritten in 1820 by William Thomas Moncrieff (17941857) and again in

1895, by Italian composer Antonio Cagnoni (18281896), though not presented until

2009 (Grandi, 2013).

A clear reference to Alzheimers disease can also be found in the recentEnglish opera, Lions Face (performed in Brighton in 2010). This opera was

commissioned by the group of psychiatrists from Kings College Hospital in London

and has music by Elena Langer and a libretto by Glyn Maxwell. It focuses on the

sufferings of an Alzheimers patient from a clinical point of view and the relationship

of the patient with healthcare staff and family (Fuller, 2012).

In Verdis Macbeth (above), we recognized some neurological disorders, most

notably sleepwalking, for which the comparison is with La Sonnambulaby Bellini.

Both are considered artistic representations of psychiatric conditions that anticipate

subsequent scientific theories about the disorder (Furman et al., 1997; see

Chapter Somnambulism in Verdis Macbeth and Bellinis La Sonnambula: Opera,

Sleepwalking, and Medicine by Finger, Sironi, and Riva). There is even an earlierreference to somnambulism in opera, specifically in the ballet-pantomime La

Somnambule (1827) of Frenchman Ferdinand Herold (17911833) (Hibberd,

2004), following Napoletan operas, such as the comic Il Matrimonio segreto

(1792) (The Secret Marriage) by Domenico Cimarosa (17491801). This opera

debuted in Vienna in 1792, and in it Count Robinson, in addition to suffering from



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migraine headaches, has a dialog with Elizabeth in which he says: Son sonnambulo

perfetto/che dormendo vo a girar.Sogno poi,se son a letto/Di dar calci e di pugnar

(I am a perfect sleepwalker/I go around in my sleep. Dream on, if I am in bed/I kick

and punch) (Bertati and Cimarosa, 1893). Another is provided by Michele Antonio

Carafa (17871872) with a drama calledIl sonnambulo (The Sleepwalker) (1824). Init, the character Duke Ernest is a sleepwalker.

The historical study of this disorder reveals how it has evolved from a phenom-

enon of demonic possession to a mental disorder and now as a specific disorder of

deep sleep. In Verdis Macbeth, the sleepwalking scene in the fourth act takes place

in the presence of a physician, and the psychological elements are enhanced through

Verdis music. In Bellinis opera, the sleepwalking has a more Romantic context, and

takes place twice in the first act:Dorme/Esonnambula(She sleeps/She is a sleep-

walker). It occurs again in the second act, where there is an explanation of Aminas

state by count Rodolfo to her lover, Elvino: E chiamati son sonnambuli/Dallandar e

dal dormire (They are called sleepwalkers/Because they sleep walk around)

(Romani, 1990). The representation of sleepwalking in Macbeth is more complex

and is classified in a more of a medical context than that of Amina, who lives in

a small Swiss village and is not attended by a physician, in La Sonnambula. Verdi

provides us with a real appreciation of what physician believed about Somnambu-

lism in Shakespeares time, whereas this is more subtle and indirect in Bellinis opera

(Paciaroni and Bogousslavsky, 2013; Riva et al., 2014).

In other Verdi operas, we can recognize characters for whom there is psycholog-

ical development coupled with deformities due to neurological diseases. One is

Rigoletto, who remarks: Oh rabbia! Esser difforme! (Oh what to do! To be de-

formed!). Rigoletto has a kypho scoliosis, a form of spinal deformation with various

origins: genetic, traumatic, or suggestive of neuromuscular diseases (Fardon, 2002;

Matthews, 2010a,b) (Fig. 2). This deformity also has an influence on Rigolettos per-

sonality. He is paranoid, and not only of those who attend the Court of the Duke ofMantua, remarking in the second act, Cortigiani,vil razza dannata(Courtiers, vile

cursed kind), but also of his family, including his daughter Gilda and her guardian

Giovanna (Bergstein, 2003; Grier, 2011).

InOthello, the protagonist has an epileptic seizure at the end of the third act in the

original Shakespeare play. In 1887, in Milan, in their production of opera Otello,

Arrigo Boito (18421918) and Verdi did not highlight it in the libretto, possibly be-

cause of the difficulty of representing it. They instead left it to later directors to em-

phasize this neurological sign when Iago, seeing Otello stretched on the ground

unconscious, stands erect, with a loathsome gesture of triumph, pointing to the inert

Otello and says: Ecco il Leone! (Behold the Lion!) (Boito and Verdi, 1887;

Matthews, 2010a,b). Otello also suffers from headaches, and in the third act, he saysto Desdemona: Ancor lambascia del mio morbo massale, tu la fronte mi fascia

(I have that pain again; bind you my forehead) (Paciaroni and Bogousslavsky, 2013).

The different diseases in later operas by other authors continue to show the pro-

gress of medical science, as in the expressionistic opera Wozzeckby the Viennese

composer Berg. In the second scene of the second act, a doctor stopped by the captain

4035 Operatic development of neurological and psychiatric characters


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points out that the captain himself has physical traits that have the stigmata of risk

factors for cerebrovascular disease: Und Sie selbst! Hm!/Aufgedunsen, fett, dicker

Hals/Ja, Herr Hauptmann/apoplektische Konstitution!/Konnen Sie eine apoplexia

cerebri kriegen (You yourself! Hm!/Bloated, fat, thick neck/apoplectic constitu-

tion!/Yes, Captain/You can be affected by apoplexia cerebri). The opera tells thestory of a soldier, Franz Woyezeck, who becomes a laboratory animal for the

captains experiments in order to earn needed money. He becomes jealous of his girl-

friend, who he discovered with a rival, and suffers from hallucinatory phenomena

that lead him to kill her (Steinberg et al., 2007)(Table 3).

The ongoing discussions about psychoanalytic theories and the role of the indi-

vidual in society, which were spreading at the beginning of the twentieth century, can

be found in other expressionistic operas. Here we can point to Strauss Elektra, first

presented in Dresden in 1909. Strauss addressed the murderous madness of the main

character, Elektrathe dramatic theme ofOedipus (Chessick, 1988).

Another example is Peter Grimes, which opened in London in 1945, and was

composed by Benjamin Britten (19131976). The protagonist, Grimes, has a weakpersonality and is unable to face the challenges of mid-twentieth society. In the third

act, second scene, he exhibits a transient psychotic episode: Do you hear them all

shouting my name?/Dyou hear them?(Dura-Vila and Bentley, 2009).

Great emphasis on issues involving social conflicts that can affect human behav-

ior appear in Hans Werner Henzes (19262012) operas. Two are Elegie fur junge

FIGURE 2

RigolettoAct 3 (Season 19911992). Gilda (Ruth Ann Swenson) and Rigoletto (Matteo

Manuguerra). Rigoletto reveals his kypho scoliosis.

Courtesy by The Metropolitan Opera Archives New York.



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Liebende (Elegy for Young Lovers), performed in Schwetzinger in 1961, and Wirerreichen den Fluss (We Come to the River), which opened in London in 1976.

The latter opera is a denunciation of the effects of war, a tragedy of the human mind.

6 CONCLUSIONSWe have tried to describe how what was known about neurology and psychiatry, and

more broadly, the neurosciences, have been portrayed operas, demonstrating how

various composers were able to express the ideas and medical theories of their times.

We have shown that the librettist was often a faithful interpreter of the sociocultural

phenomena and medicine. We have also seen that what we now consider neuropsy-

chiatric disorders played various roles in operas, revealing complex relationships be-

tween the sufferings of the soul and those of the body mediated by the mind, as well

as between the afflicted and changing societal conditions.

ACKNOWLEDGMENTSOur thanks to Stan Finger for his precious comments and discussion on different aspects of this

chapter. Our appreciation for the revision as experts of music by Matteo Sartorio and Mario

Armellini. Our gratitude to Adriana Bartolotti for her kind collaboration on the figure on

Geatano Donizetti and to John Pennino for the figure on Rigoletto.

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Table 3 Neurological disorders in opera

Disease Opera (The first representation) Composer

Dementia Re Lear (2009) Cagnoni Antonio

Lions Face (2010) Langer Elena

Epilepsy Otello (1887) Verdi Giuseppe

Headache Otello (1887) Verdi Giuseppe

Migraine Il matrimonio segreto (1792) Cimarosa Domenico

Sleep disorder Il matrimonio segreto (1792) Cimarosa Domenico

Il sonnambulo (1824) Carafa Michele

La sonnambula (1831) Bellini Vincenzo

Macbeth (1847) Verdi Giuseppe

Spinal deformation Rigoletto (1851) Verdi Giuseppe

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