Friday, September 14, 2012

A Most Sublime Torso: Unraveling the Threads of the Mozart Requiem


Wolfgang Amade' Mozart
The unfinished
enlargement of the original
1782 oil painting by
Mozart's brother-in-law,
Joseph Lange
      Of the many ineffable compositions birthed from the genius that was Johannes Chrystostomus Wolfgangus Theophilus Mozart (1756-1791), none has engendered more lasting fascination and such a profound degree of wistfulness than his last and most powerful work, the unfinished Requiem Mass. The reasons for the Requiem’s commission, the tragic and premature end of Mozart’s life while he was in the process of writing it, and the strange and unlikely trajectory subsequently taken by this haunting and wondrous piece of music are still being debated today, over two hundred years after its conception. The chronology and musicology of this enduring legacy in the musical firmament, from its most brilliant star, is itself a remarkable narrative.
In the summer of 1781, after years of concertizing in and away from Salzburg, and always chafing there under his subjugation by Archbishop Colloredo, Wolfgang Mozart moved permanently from his birthplace to Vienna, the capital of the Hapsburg empire and one of the epicenters of musical life in Europe.
Mozart soon thereafter married Constanze Weber, and he developed a reputation and modest income as a piano tutor and musician giving subscription concerts. While continuing to work in the musical vernacular of his time, that of Classical Style, Mozart transformed the felicitous ideas of Johann Christian Bach, and Michael and Joseph Haydn, investing them with an extraordinary tonal harmony and a richness of invention. Mozart achieved an evolutionary summit of sublime and polished perfection across the spectrum of compositional genres: symphony, concerto, string and instrumental trios, quartets and quintets, as well solo piano, lieder, sacred music, and opera.  

     By the summer of 1791, Mozart had been appointed assistant Kapellmeister at St Stephen’s Church, had scored varied successes with the three da Ponte operatic collaborations (Le Nozze di Figaro, Don Giovanni and Cosi' fan tutte), and was about to be commissioned by his  friend and fellow mason, Emanuel Schikaneder, to compose a Singspiel, a german-language fairy tale and masonic allegory, Die Zauberflöte (The Magic Flute).

Sometime in July, 1791, under pressure to finish  both Zauberflöte and another commission (this time from Prague, a work which would become the opera La Clemenza di Tito, for the installation of Emperor Leopold II as King of Bohemia), Mozart received a visitor, the mysterious and so-called “grey messenger,” who asked him to write a Requiem Mass, a musical work for the deceased. Mozart was handed 30 ducats, half the total commission, with the balance to be given him upon its completion. The other strange proviso from the messenger was that Mozart was never to know or inquire about the individual who commissioned the work. 

The poster for the
1984 film, based
on the 1979 play
by Peter Shaffer
    Peter Shaffer and Milos Forman saw the potential to take this incredible story and conjure both a play (1979) and ultimately the eight Academy-award winning film (1984), Amadeus.  In their highly-fictionalized version, Antonio Salieri was the “grey messenger” (here, however, Salieri wears a black, Janus-faced Venetian carnival mask), and the moral of both play and film was the cosmic and metaphysical irony that Mozart, the musical genius with the scatological mouth, absolute pitch and eidetic memory, could effortlessly toss off masterpieces, while Salieri, a devoutly religious man but a journeyman court composer, could only create mediocrity.  Despite many stretches of the truth in both the play and movie, they were both deservedly hailed not only for bringing Mozart’s sublime music to a broader public, but also for demonstrating the creative process of genius. The real account of the commission of the Requiem is more prosaic but stranger than fiction. 

Count Franz Walsegg zu Stuppach (Stuppach is a town 30 miles south of Vienna) was a wealthy gypsum mine owner and a passionate amateur flutist and cellist. His curious pastime was to commission works from professional composers, copy them out, and then pass them off as his own compositions, performing them with his colleagues, family and friends in twice-weekly chamber recitals on his estate at Schloss Stuppach

The Requiem commission which Walsegg sought from Mozart through an intermediary was to honor the anniversary of the death of Walsegg’s bride, Anna, who had passed away at the age of twenty from puerperal sepsis in February. The mysterious "grey messenger" who visited Mozart was either Franz Anton Leitgeb, who was Walsegg’s steward, or more likely Johann Sortschan, his lawyer. Mozart sketched a few ideas for the Requiem in August, 1791,  but quickly put away the work to concentrate again on Zauberflöte and Tito. During that time, Mozart was revisited by the messenger, who was checking  back on the Requiem's progress.

     Mozart began to have paranoid ideations that the Requiem commission he had begun composing was intended for his own funeral.  Constanze recalled the two of them walking in Vienna’s Prater Gardens in September, 1791, when Mozart confided to her that, “I believe that I am writing my own funeral mass.” Mozart was convinced he was being slowly poisoned; he was not, neither by the Freemasons, who revered him, nor by Antonio Salieri, though that latter tale became fodder for an 1830 Pushkin play and an 1897 Rimsky-Korsakov opera, Mozart and Salieri.

    Despite his young age at the time of his death, not yet thirty-six, Mozart was plagued with episodes of ill health. The litany of diseases which Mozart presumably had at various times in his life sounds like the differential diagnosis scene from an episode of the popular TV series with a certain Doctor G.H.  These include, inter alia, recurrent streptococcal infections, variola (smallpox), quinsy (tonsillar abscess), rheumatic fever, infectious endocarditis, chronic renal disease (from post-streptococcal glomerulonephritis or Henoch-Schönlein purpura), cyclothymia, antimony overdosage (paradoxically, Mozart was self-medicating with this potential poison), subdural or extradural hematoma, hypertension, and even the possibility of acute trichinosis (he had eaten some under-cooked pork cutlets a month before he died).

   A distinction should be made between these chronic illnesses and Mozart's presumed medical conditions which were immediately proximate to and causative of his abrupt and early demise.  Peter Davies M.D. (J. Roy. Soc. Med. 1991) has suggested that this was a consequence of a cerebral hemorrhage resulting from hypertension secondary to an acute nephritis (kidney inflammation) from Henoch-Schönlein purpura (a rare disease which can result from streptococcal infection); Mozart was likely severely anemic and already in uremic coma. 

Mozart's death certificate (no autopsy was performed) stated “hitziges Frieselfieber” (“heated miliary fever”), a common diagnosis of the time, one which is far too non-specific a term on which to opine a diagnosis, but which may relate to the inflammatory rash of rheumatic fever, which in turn may have been a result of Mozart's presumed strep infections. 

Richard Zegers M.D. (Ann Int. Med. 2009) reviewed the records of 5,011 Viennese adults who died in the two months before and after December 1791, and compared that data to comparable months in 1790 and 1792,  finding a higher than normal rate of death from an epidemic of presumed streptococcal infection.    

     Even the details of Mozart’s last days are fraught with inconsistencies. Constanze’s testimony and that of her sister Sophie Weber Haibl not only do not jibe, they were only offered in 1825, thirty-four years after Mozart expired!  On the last full day of his life, December 4th, 1791, Mozart was said to be in bed composing the Lacrimosa and rehearsing other sections of the Requiem with family and colleagues.  Mozart had been working in the prior week with Franz Xaver Süssmayr, a composer of modest repute who was also the copyist who had previously assisted him with several of the Tito arias. According to Constanze, Mozart had given Süssmayr instruction on how to finish the Requiem in the eventuality that Mozart would die before its completion.

The putaive death mask
of Wolfgang Mozart,
either by Count Dehm or
by Taddeus Ribola
     Mozart was extremely uncomfortable by this point, his body markedly edematous (Wassersucht), with myalgias that made it painful for anyone even to touch him. Sophie Haibl recalled that Mozart was puffing out his cheeks to imitate the trombone solo in the Tuba Mirum section of the Requiem when he lost consciousness. Mozart’s physicians, Thomas von Sallaba and Nicholas Closset, two of the most respected in Vienna, who also consulted with Doctor Gudener von Lobes, diagnosed him as having “una deposita sulla testa  (“a deposit on the head)” from rheumatic fever. They hastened the demise of their patient by recommending venesection (blood-letting), creating in him a hypovolemic state, even as he was already anemic from the putative renal disease. At 12:55 AM on December 5, 1791, Mozart died.

Mozart Requiem
Introitus:Requiem aeternam
Note forged signature  by Sussmayr
on  top right
1792 "W.A. Mozart"
    At the time of his death, of the fourteen individual sections in the Requiem, Mozart fully completed only the first section, Introitus: Requiem aeternam.  He wrote out the vocal parts and supporting bass line for eight subsequent sections (particella writing), along with episodic inner instrumental motivic measures in some of the movements, from the Dies irae to the Hostias.  Mozart composed only the first eight bars of the Lacrimosa, but did not put pen to paper for the Sanctus, Benedictus or Agnus Dei.

    On December 10, 1791, Schikaneder and Baron Gottfried von Swieten arranged for a memorial service for Mozart at which the Requiem was played. What Requiem could this have been? What was performed of Mozart’s work was only the completed first movement, the Introitus:Requiem aeternam and a patched-up Kyrie Eleison, scored by Süssmayr and Franz Freystädtler by doubling the vocal parts in the orchestra. 

    Constanze, in significant debt, needing to raise funds immediately, and knowing that there was the balance of the commission owed her for the completed Requiem, began to seek out a composer who could finish the Requiem score as it then existed, in a handwriting style close to Mozart’s, and continue the deception by delivering it as the autograph to Walsegg.  She asked Joseph Eybler, a composer admired by Mozart, to do the completion, but after a few weeks with the autograph he only finished a small portion, and curiously returned it to Constanze.  She eventually offered the score back to Sussmäyr, who completed it and, mirabile dictu, did so in a handwriting style that was indistinguishable from Mozart’s (at least to Walsegg), forged Mozart’s signature on the frontispiece, and returned the “finished” Requiem sometime in late February, 1792.  

Constanze Weber Mozart
As a widow in 1802
    The deceptions continued. Though Constanze promised the autograph only to Walsegg and did get the balance of the commission, she also had several copies made of it, one of which she sold to the publishers Brietkopf and Härtel; Constanze shrewdly made money on each sale. Walsegg eventually found out, threatened legal recourse, then backed off when he realized he would be outed as a fraud.

    Süssmayr was later contacted by Breitkopf and Härtel, who requested his statement on authorship. Süssmayr maintained he finished the orchestrations of the Dies irae to Hostias, and composed the Sanctus, Benedictus and Agnus Dei completely on his own. The Breitkopf edition of Mozart’s Requiem never mentioned Süssmayr’s contribution.

     Constanze claimed that Mozart had written a majority of the composition, and that there also existed, according to Constanze, some “scraps of paper” (Zettelchen) from Mozart, such as the one containing the other-worldly Amen Fugue" fragment for the end of the  Lacrimosa next to a Rex tremendae sketch, (discovered by Wolfgang Plath in 1962 and the only sketch ever found), which she said gave Süssmayr the melodic ideas for those last three sections, as well as recommending that Süssmayr repeat the theme of the Kyrie eleison after the Lux aeterna in the last movement Communio. This allowed Constanze to maintain that the overall concept of the Requiem, if not every note, was indeed Mozart’s.

Requiem: Dies Irae
Sussmayr completed the inner
instrumental parts
    The first performance of the “completed” Requiem was in January 1793, at a benefit for Constanze arranged by von Swieten.  Walsegg finally performed it (as his own composition!) in December 1793, almost three years after his wife’s passing, had it transcribed for string quintet, and never performed it again. Upon his death, the autograph score in his possession passed to what is now the Austrian National Library, which also received a fragment that Eybler had obtained and subsequently donated (right after he had a stroke while conducting the Requiem in 1833) and another fragment which Süssmayr had been given by Constanze in 1800. The totality of these fragments is the torso which has come down to us as the Requiem and which most modern audiences recognize.

      As a result of these insufficiencies, there have been a number of modern-day completions of the Requiem, including efforts by Richard Maunder, Robert Levin, Duncan Druce, H.C. Robbins-Landon and Franz Beyer. Of these, the Beyer version (1971), which is being performed this evening, has certain advantages. Beyer elected not to add any of his own musical ideas or additional scoring.  He allowed Mozart’s music, with the completion by Süssmayr (who was, despite all the criticism heaped upon him for his compositional inadequacies, a late eighteenth-century composer  in the Viennese international Classical Style just like Mozart, who was Mozart's copyist, who had an understanding of  what Mozart envisioned in his  Requiem, and whose version of it is widely recognized), to stand out.

   Beyer corrected numerous and obvious technical errors that Süssmayr had made, and which, ironically, further demonstrate that the autograph score could not have been only in Mozart’s hand. These mistakes were most evident in the basset horn parts, a clarinet-like instrument which Mozart much admired, knew intimately from his close friendship with Anton Stadler (for whom he wrote the clarinet concerto, K.V. 622, two months prior) and for which he would have never sloppily composed.

W. Mozart
The posthumous 1819 oil
by Barbara Kraft
Gesellschafft der
     Those two essential aspects of musical genius, eidetic memory and absolute pitch, gave Mozart an extraordinary ability to recall and adapt, whether consciously or not, a vast array of melodic material he had heard during his life; during his Vienna years, he became obsessed with Baroque music and J.S. Bach in particular.  Musicologists have discerned a number of thematic antecedents in the Mozart Requiem. Strains of Handel’s The Ways of Zion do Mourn from the Funeral Anthem of Queen Caroline, With his Stripes we are Healed from Messiah,  and a refrain from one of his Dettingen Anthems, have been found in the score. One of the te decet hymnus Gregorian chants from Michael Haydn’s Requiem can also be heard within (ref. Wolff). 

Yet these possible borrowings do not detract from the many sublime and uniquely Mozartean melodies which abound in the Requiem: four-part settings; archaic double fugue cadences in the Kyrie eleison; the French Baroque motif of the royal double-dotted figures in the Rex Tremendae; the empfindsamer stil melody echoing C.P.E. Bach that underpins the aching beauty of the Recordare; the agitated strings which open the Confutatis and which accompany the powerful double chorus and suddenly create soft arpeggios; adventurous chromatic intervals and  counterpoint throughout; and moments that prefigure Romanticism (ref. Wolff, ibid). Given Mozart’s strong Masonic beliefs, despite his Catholic faith, there are Masonic references in the Requiem as well, in the prominent use of basset horns and bassoons that he had employed in his earlier Freimauermusik, and in certain specific triadic chordal and motivic structures throughout the work.

The Domine Jesu section of
the Requiem, with the
 "Quam Olim d.c. (da capo)"
Note the tear in the lower right.
Were these Mozart's last words?
    Mozart, who had not composed a piece of sacred music since he left Salzburg ten years earlier, was now pointing in a new direction, first with the motet, Ave Verum Corpus (KV 618), which he penned in September of 1791, and then  the Requiem, towards a  textured and nuanced trajectory for sacred music, a style that was at once chordally complex and melodically rich.
    The Mozart Requiem has served as an enduring memento through the centuries. It was played at the funerals of Haydn (1809), Beethoven (1827), Napoleon (reburial, 1840), Constanze Mozart (1842) and Chopin (1849), and at the funerals of both of the Mozarts’ surviving sons (1844, 1858). It was part of President Kennedy’s memorial mass in Boston in 1964. Most poignantly, it was performed by over two hundred orchestras and choruses around the world on the anniversary date of 9/11.

     We can never hope to hear the Requiem fully as Mozart had fully conceived it.  There will never be found a version from Mozart’s hand that has not been amended by another composer, and it would be a fool’s errand to assume that this essay has answered fully the many questions which still swirl concerning the Requiem or the cause of Mozart’s illnesses and death. The Mozart Requiem will always be a torso, a musical composition unfinished by its creator. Each time one experiences the Mozart Requiem, even as  they are transported by the architecture and sweep of this composition as gloriously and uncontestably that of Mozart,  it remains the product of more than one mind and one heart.  Nonetheless, this mystical, transcendent work of art is imbued with such an overwhelming feeling of sacred, uplifting nobility and hope, that it will always remain one of the greatest touchstones of civilization.
 ©Vincent P. de Luise, M.D. 2012

Sic transit gloria mundi
P. Davies, J. Roy. Soc. Med., 1991
C. Wolff , Mozart's Requiem: Historical and Analytical Studies, Documents and Score,

     U. California Press, 1994
D. Leeson, Opus Ultimum: The Story of the Mozart Requiem, Algora Pub., 2004.
B. Dewitt, Mozart's Requiem:Labyrinth of Deception   2009
R. Zegers, Ann. Int. Med., 2009

© Vincent P. de Luise,  M.D.  2012        

Thursday, September 6, 2012


We worry about this. 
So, we diet (episodically and in the long run, never quite successfully enough), we run (rarely), we do yoga and pilates, drink green (or  preferably white) tea, learn to play golf, eat less bacon, forego that second scoop of ice cream, buy organic tomatoes, and yearn for more sleep. Yet, all of these many and noble endeavors remain fragmented and directionless without an overarching principle on how to lead one's life.

Among the splendid and life-affirming philosophies that were birthed by the ancient Greeks during their Golden Age between the 6th through 4th centuries B.C.E. (the P.C. acronym for B.C., i.e., Before the Common Era), there is one that is epicentric. This is the concept of Sophrosyne (σωφροσύνη).

Sophrosyne was one of the
"eudaimonia" or "good spirits," who
escaped Pandora'"s box, as seen in this
pre-Raphaelite style painting
J.W. Waterhouse (1849-1917)
In Greek myth, Sophrosyne was one of the so-called "Eudaimonia," or "Good Spirits," who, along with Pistis (Trust), escaped from Pandora's box when she opened it. Aristotle, in his Nichomachean Ethics, commented on the notion of eudaimonia, defining it as "living well and doing well." Perhaps a better definition for the present-day would be "purpose." 

Another mythological deity, the foundational goddess Themis, who was one of the original Greek Titans birthed through the union of Ouranos (Uranus, or Sky) and Gaia (Earth), manifests  the qualities of Sophrosyne in her aspect of what the Greeks called "divine order."

Divine Order

I have long enjoyed going to the Online Etymology Dictionary (that other O.E.D.), to find the ultimate sources of words, all the way back to their P-I-E (Proto-Indo-European) roots. Here, then, are the P-I-E sources for Sophrosyne:

Sophrosyne Greek, “prudence, moderation,” from sophron “of sound mind, prudent” (see Sophronia):

Sophronia Greek, femine, proper name, from sophronia, from sophron, sophronos, "discreet, prudent," prop. "of sound mind," from sos, "safe, sound, whole" + phren, " heart, mind, midriff."

The Egyptian
foundational goddess
Ma-at, embodying
Restraint, Justice,Balance
Inherent in this notion of Sophrosyne is the concept of moderation, integrity and humility, and that everything that the individual does should be done in perfect balance. These ideas are so essential that all great civilizations have thought about them and grappled with their meaning and import. Before the Greeks, the Egyptians recognized the relationship of balance and integrity, and anthropo-morphized it in the goddess Ma-at, which they also rote about as the principle of Ma-at. To the Egyptians, Ma-at was a central tenet of an individual leading the "good life," the life of balance, restraint and self-awareness. Ma-at was represented by a young woman with an ostrich feather on her head, which was used on a balance scale as a weight against the "lightness" of a person's heart before they entered the after-life.

As Helen North discusses in her eponymous book on the subject, Sophrosyne contains all of these many and disparate principles of self-knowledge, self-awareness and self-restraint. Sophrosyne thus becomes a moral belief system which, if intuited and practiced, can lead to a healthier and more wholesome life.

   The Greek philosopher Socrates equated Sophrosyne with temperance, "everything in moderation," and that those who practiced this belief system, "would not need medication except in the most extreme of cases." Socrates believed that the pusuit of self-development was more noble than the achievement of material wealth, and that virtue was the most valuable of all of one's possessions.

Socrates' pupil, Plato, wrote about Sophrosyne in his Republic, as one of the four cardinal virtues, along with prudence, justice and fortitude.  Plato stated that physical exercise should be done in combination with "cultivating the mind" and "exercising the intellect" which would accrue to the betterment of one's memory. This concept of mind-body synergy was the personification of Sophrosyne

One of the virtues of Sophrosyne is self-control. For the Stoics, Sophrosyne was one of the cardinal virtues, along with courage, prudence and justice. Plato, in the Charmides, discusses this attribute of Sophrosyne.

The Romans conceptualized several ideas akin to Sophrosyne: in Juvenal's maxim, mens sana in corpore sano, which captured the balance and mutual necessity of "the sound mind in a sound body," and in their constructs of constantia (fidelity), sobrietas (restraint), temperantia (temperance) and dignitas. The term dignitas  does not translate to "dignity" as one might intuitively expect; it is more complex and nuanced than that. In the Roman context, dignitas was defined as an aspect of social standing, wherein a person's integrity was seen as a manifestation of the idealized life, much as the Egyptians understood a life under the rubric of Maat. 

Sophrosyne is also rooted in the notions of balance and health-mindedness.  The concepts of balance and integrity are embedded in the teachings of Hinduism, Buddhism, Taoism, and the analects of Confucianism.

The universality of these ideas can be found, for example, in Hinduism, where parallels to Sophrosyne are seen in the concept of dharma (the law supporting the order of the universe),  in the hathayoga (the balancing of opposite forces), and in the tenet of artha  The artha is one of the four puruṣārthas (Sanskrit पुरुषार्थ : "goals of life")  within Vedic belief, which concern themselves with the concept of "proper living" as espoused in its great epics, the Ramayana and the Mahabharata. Thus, Egyptian, Greek, Roman and Hindu philosophies each contain similar concepts embedded within Sophrosyne.

A few years ago, I enrolled in the course in Mindfulness at the University of Massachusetts Medical Center. Mindfulness, viewed through the lens of Sophrosyne, becomes its modern-day avatar, a philosophy which also incorporates balance, thoughtful (which is to say, mindful) quietude, self-observation, meditation and basic hathayoga. It was at the U. Mass Medical Center in 1979 that Dr. Jon-Kabat Zin first defined and then developed the Mindfulness-Based Stress Reduction (MBSR) program, articulating it as a methodology for reducing life stress and anxiety, and increasing life balance. Over the last thirty-five years, a rich and robust series of controlled trials published in the peer-reviewed literature, at different medical centers, has corroborated both the validity and efficacy of Mindfulness.

What struck me as I got to know some of my fellow students in the Mindfulness course was that a significant portion of them were health care professionals as myself - there were several physicians, nurses, medical technicians in our group - and what became abundantly evident as the course unfolded was how necessary this type of strategy is in the lives of us all.

One of several tools one learns in Mindfulness practice is to internalize, and then actualize in daily practice, the acronym S.T.O.P. - Stop, Think, Observe, Proceed. The S.T.O.P. acronym has utility as a response to life stressors. Even as this S.T.O.P. mnemonic may appear to be yet one more self-evident and "throw-away" concept, it is also a much ignored aspect of modern-day life. There seems to be no time to stop and observe anymore. Today, society moves at warp speed, with multi-tasking being largely rewarded, and only rarely punished (for example, if one gets caught texting while driving). There is no time to actually listen, to smell the flowers, as it were. Yet the Mindfulness practitioner actually takes the time to think and observe before responding. Responding,  instead of Reacting Reflexively.

Andrew Weill M.D. has coined the term "news fast." Avoid TV, radio and internet news for, say, a week. Read books.  Yes, a physical book. Look at nature. Play music, or an instrument, if you do. See what happens to your stress and blood pressure.

Chade-Meng Tan, one of the original engineers at Google, founded a course at the company that he named "S.I.Y." for "Search Inside Yourself." He developed S.I.Y. with nine instructors in mindfulness in the workplace. One of the mantras in the S.I.Y. course is a notion similar to S.T.O.P. and has its own acronym - S.N.B.R.R. for "Stop, Notice, Breathe, Reflect, Respond." (Given that this is Google, that acronym also has an affectionate technological nickname - "Siberian North RailRoad"). Both of these mantras - The Mindfulness S.T.O.P. and the S.I.Y. term S.N.B.R.R.- remind us to reflect and respond, and NOT simply react, to stress.

In the workplace, this concept of reflection and response leads to more mindful interactions with colleagues, mindful e-mailing (meaning not just firing off endless reactive e-mails, but taking the time pre-emptively to think about the recipients of those myriad zingers), and less anger, envy and resentment among coworkers.

A common response one gets when telling peers and colleagues about the Mindfulness course is that, to them, it sounds and feels way too "touchy-feely" or "new age." 
Yet many of the principles intrinsic to Mindfulness are the very things that we already do in our daily routines, whether individually or in groups. Yoga, for example, is quite popular as a stand-alone activity, even rising to the level of cult sport-like status in some circles. Blending some of the more straightforward tenets of yoga's basic postures and salutations (asanas) with mindful meditation can become a potent resource in achieving life balance. Others of us meditate, engage in breathing exercises, or spend time in quiet reflection, all of which are aspects of Mindfulness, during our increasingly busy and disrupted days.

Within the quiet place that Mindfulness resides, one does not judge, one does not react, one is never defensive. Instead, Mindfulness teaches the concept of being "in the present moment," of acceptance and letting be, and that beyond a certain point, no one is truly in control.

I believe that aspects of Sophrosyne should populate medical school education, as part of what I have termed and collated as  "A Curriculum in Compassion." This curriculum of  "High Touch" should include narrative and reflective writing, mindfulness and yoga, art and aesthetic appreciation, basic music performance and appreciation, dance and movement, and a deeper understanding of nutrition and exercise. The skills that comprise the curriculum would be transferred to the medical students, throughout their four years of medical school, thus informing them as physicians. This curriculum should also be extended back into college and university in the education of "pre-meds", and extended forward into the internship and residency years, and into clinical practice when physician burn-out and disengagement is greatest.

Sophrosyne is no longer a long-forgotten  Greek word; it has been reborn in our own time. Sophrosyne has become a vital and relevant concept today, spawning modern
-day correlates like S.T.O.P. and S.N.B.R.R., and being a part of a humanistic medical school  education, indeed a roadmap for everyone, that when practiced, will be enduring and life-enhancing.

copyright 2012 Vincent P. de Luise M.D. A Musical Vision.