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Opera and neuroscience


Lorenzo Lorusso* , Antonia Francesca Franchini , Alessandro Porro{


*Department of Neurology, Mellino Mellini Hospital Trust, Brescia, Italy

Department 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, Italy
Corresponding author: Tel.: +39 (030) 7102631; Fax: +39 (030) 7102622,
e-mail address: lorusso.lorenzo@gmail.com

Opera is the most complete form of theatrical representation, characterized by musical accompaniment, 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. Composers 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 influencing the representation of madness and neurological aspects. From the Folly of the Renaissance,
a path toward a representation of madness was developed, initially linked to the myths of classical antiquity. In the seventeenth and eighteenth centuries, madness was represented as comical 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 psychiatric
and neurological diseases. The operas of the twentieth century depicted psychiatric and neurological diseases, taking into account newer medical and scientific discoveries.

opera music, mesmerism, madness, stroke, epilepsy, headache, sleepwalking, dementia,
neuropsychiatry, neuroscience

Historically, neurology and psychiatry were considered a single entity until the midnineteenth century when neurology became an autonomous field, thanks in part to
the French physician Jean-Martin Charcot (18251893). This change advanced medical and scientific knowledge in various fields, including psychiatry itself. The operatic 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.



CHAPTER 19 Opera and neuroscience

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-Paille`s et al., 2005). According
to 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 covering the period from the eighteenth century until the mid-nineteenth century, beginning with Orlando (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 characterization 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 performances a form of entertainment, not just for the rich but also for the growing middle to lower classes, boosting its commercial success (Abbate and Parker, 2012;
Baia, 2011; Erfurth and Hoff, 2000; Sadie, 1992).


Representations 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.
Me`dee (1693) by Marc-Antoine Charpentier (16431704) provides one of the earliest 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, inevitable 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).

2 The origins of madness in opera

The combination of madness and older material continued in the eighteenth century by Handel. His Orlando was based on the Orlando 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 madness, in Nina o sia la Pazza per amore (Nina, or the Madwoman by Love) (1789) by
Giovanni Paisiello (17401816). This opera was based on the story of Nina, ou La
folle par amour (1786). The libretto was written by Marie Benoit-Joseph Marsollier
of Vivetie`res (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 of Commedia
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 with La 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 grotesque or terrifying madness.
Another feature that enhanced the spread of the comic opera associated with madness was the emergence of folk dance, probably of Portuguese origin, during humanistic 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 gender Folia
(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, typical 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, improvisations, and variations (Carrer, 2005b). These obstinate basses were the backbone
not only of the Follia but also of the Romanesca, the Ruggiero, the Aria di Genova,
and the Neapolitan dance called Fedele or even Alta Regina, favored in the so-called
singing century. In the mid-seventeenth century, this continued as the popular offspring of the late Follia, in which writers and musicians identify the voice of musical
theater and a fertile ground for the application of novelty or the preservation of the
ancient. 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



CHAPTER 19 Opera and neuroscience

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




Andreini Francesco and Isabella

Giramo Pietro Antonio
Sacrati Francesco
Cimarosa Domenico
Anfossi Pasquale
Dalayrac Nicolas-Marie
Paisiello Giovanni
Caignez Louis-Charles
Piccinni Louis Alexandre
Quaisain Adrien
Schaffner Nicolaus Albert
Carafa Michele
Ducange Victor
Bellini Vincenzo
Donizetti Gaetano
Donizetti Gaetano
Donizetti Gaetano
Donizetti Gaetano
Coppola Pietro Antonio
Persiani Giuseppe
Bellini Vincenzo
Desnoyer Charles
Donizetti Gaetano
Donizetti Gaetano
Mercadante Saverio
Pacini Giovanni
Donizetti Gaetano
Clapisson Louis
Muzio Emanuele
Chiaromonte Francesco
Concone Giuseppe
Meyerbeer Giacomo
Petrella Errico
Bizet Georges
Thomas Ambroise
Catalani Alfredo
Massenet Jules
Caffi Rinaldo
Rimsky-Korsakov Nikolai
Strauss Richard

La pazzia di Isabella
Il pazzo con la pazza
La finta pazza
Armida immaginaria
La pazza per amore
Nina, ou La folle par amour
Nina, o sia la pazza per amore
La folle de Wolfenstein
Jean Sbogar
Le belvede`re ou La vallee de LEtna
Les fre`res invisible
Jeanne dArc a` Orleans
La fiancee de Lammermoor
Il pirata
I pazzi per progetto
Anna Bolena
Gemma di Vergy
Lucia di Lammermoor
La pazza per amore
Ine`s de Castro
I puritani
La folle
Roberto Devereux
Maria di Rudenz
La vestale
Linda di Chamonix
Jeanne la folle
Giovanna la pazza
Giovanna di Castiglia
Le pardon de Ploermel
Jolie fille de Perth
La navarraise
The Tsars Bride


Similar stages were performed by Carafa Michele (1829), Rieschi Luigi (1831), Beltrami Pietro
Mazzuccato Alberto (1834), and Donizetti Gaetano (1835).

2 The origins of madness in opera

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., the Nave 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 or Hospitali dei pazzi (Hospital for insane)
or, more simply, pazzarelli (Zanies). The first was built in Valencia, Spain, in
1409 and called the Hospital de los Innocentes on 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 special Pazzeria (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),
and LHospitale 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 excesses 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) and
Isabella 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



CHAPTER 19 Opera and neuroscience

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 in La pazza per amore (The Madwoman 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 of opera buffa will 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 correspondence
between La 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 nineteenth 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 instrumental music, sacred music, and music for ballets played at Teatro Alla Scala

2 The origins of madness in opera

(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 distress, 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 son
Karl 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
the Pazzia senile (Senile Madness) (1598) by Banchieri, but when it was juxtaposed
in his other opera, Saviezza giovenile (Young Wisdome) (1607), it is even more apparent. 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 dellArte, we find characters representing the elderly, even as an expression of stereotypes 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 ceremonies. 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.

See also Dedalo played in December 26, 1817; Il Conte dEssex played in October 24, 1818; Le
sabine in Roma played in December 26, 1820.



CHAPTER 19 Opera and neuroscience

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


Mozarts 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 of Elektra 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 physicomedica 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 cosmos, 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 Bastienne in Mesmers
garden. According to some authors, it was commissioned by Mesmer. Inspired by
Jean-Jacques Rousseaus (17121778) Le devin du village, its first documented presentation took place in Berlin in 1890 (Goldovsky, 1986).
Mesmers influence on Mozart is decidedly more apparent in the opera Cos` fan
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 famed
Italian librettist, Lorenzo da Ponte (17491838); the other two being Le Nozze di
Figaro (Marriage of Figaro) and Don Giovanni.
In the first act of Cos` fan tutte, the maid, Despina, disguised as a fraudulent doctor 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

3 Mozart and mesmerism

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 trio Soave 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 act
remarking: 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

Thomas Manns (18751955) story Mario und der Zauberere (Mario and the Magician) (1929) had
different operatic stages, the first with the Hungarian composer Janos 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.



CHAPTER 19 Opera and neuroscience

(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 of
animal magnetism. These roles will take on more precise psychological connotations, especially in women, in the next century in opera seria, reflecting changing
medical approaches to psychiatric issues.


At the turn of the nineteenth century, a new kind of theatrical representation began to
influence operas. The melodrame emerged in Paris between 1800 and 1830, anticipating the theatricality of Romantic dramas with their characteristic emotional paroxysms, reinforced by the music and their librettos (Baldrini, 1988; Hibberd, 2009;
Sala, 1994). According to Emilio 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
From a socioeconomic point of view, French opera was directed at a narrow, aristocratic audience. In contrast, the new Italian operas became a more popular phenomenon. 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 in
both the French and the Italian dramas. Indeed, it is almost always the women who go
madthe few exceptions being in Maria Padilla, Agnes, and Nabucco (Peri, 1986).
This successful formula was based on a growing interest in human emotions. Accord
ing to physician Jean Etienne
Dominique Esquirol (17721840), in his book Des passions (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 perpetual prisoner in a domestic menagerie (Chiappini, 2006; Erfurth and Hoff, 2000).
This would ensure that the female public would be exploited into to attending the
theater by certain kinds of musical representation (Esquirol, 1805; Ghidetti, 1987;
Sala, 1994).
Le folies sentimentales of the female loving madness, which are characterized by
violent external physical manifestations, can become more composed and internalized, a real sickness of the soul. What evolves will no longer be an exceptional

4 Nineteenth-century pathological madness

stratagem or an abnormal situation, such as we find in Baroque operas with the involvement 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, disheveled clothing, and so on.
This can be seen and heard in the second act of Vincenzo Bellinis (18011835)
opera Il Pirata (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 opera seria. 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 fragmentation, to express the disordered thoughts and extreme emotions of the female
protagonists, 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 alternating 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

Ordinary people
Psychosocial condition
Transition condition
Curable at home

Upper class or aristocracy
Pathological condition
Irreversible condition
Needs institution



CHAPTER 19 Opera and neuroscience

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 the
quiet 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
Castro by Giuseppe Persiani (17991869). Returning to Lucia, the heroine fully expresses 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 paralytic dementia due to syphilis, which he contracted before marrying Virginia Vasselli (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 composers (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).

5 Operatic development of neurological and psychiatric characters

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.

In Macbeth (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 Bellinis La 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 predecessor. 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 hysteria 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
Pelleas et Melisande (in Paris, 1902) by Claude Debussy (18621918) (Atfield,
2011; Charcot, 1880; Dunn, 2006; Hyer, 2007).


Opera 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



CHAPTER 19 Opera and neuroscience

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 important
role 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 behavior (Schmidgall, 1990). One can cite the character of Jaques, an elderly man, in As
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 psychological knowledge about dementia, a possible dementia with Lewy bodies, which
affected an elderly person with cognitive fluctuation decline and visual hallucinations (Fogan, 1989; Matthews, 2010b; Paciaroni and Bogousslavsky, 2013). The opera 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 recent
English 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 Sonnambula by 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 earlier
reference 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

5 Operatic development of neurological and psychiatric characters

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 called Il sonnambulo (The Sleepwalker) (1824). In
it, the character Duke Ernest is a sleepwalker.
The historical study of this disorder reveals how it has evolved from a phenomenon 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/E sonnambula (She sleeps/She is a sleepwalker). 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 Somnambulism 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 psychological development coupled with deformities due to neurological diseases. One is
Rigoletto, who remarks: Oh rabbia! Esser difforme! (Oh what to do! To be deformed!). 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 personality. He is paranoid, and not only of those who attend the Court of the Duke of
Mantua, 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).
In Othello, 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 because of the difficulty of representing it. They instead left it to later directors to emphasize 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 says
to 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 progress of medical science, as in the expressionistic opera Wozzeck by the Viennese
composer Berg. In the second scene of the second act, a doctor stopped by the captain



CHAPTER 19 Opera and neuroscience

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.

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 constitution!/Yes, Captain/You can be affected by apoplexia cerebri). The opera tells the
story 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 girlfriend, 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 individual 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 of Oedipus (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 weak
personality 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 behavior appear in Hans Werner Henzes (19262012) operas. Two are Elegie f
ur junge


Table 3 Neurological disorders in opera


Opera (The first representation)



Re Lear (2009)
Lions Face (2010)
Otello (1887)
Otello (1887)
Il matrimonio segreto (1792)
Il matrimonio segreto (1792)
Il sonnambulo (1824)
La sonnambula (1831)
Macbeth (1847)
Rigoletto (1851)
Wozzeck (1925)

Cagnoni Antonio
Langer Elena
Verdi Giuseppe
Verdi Giuseppe
Cimarosa Domenico
Cimarosa Domenico
Carafa Michele
Bellini Vincenzo
Verdi Giuseppe
Verdi Giuseppe
Berg Alban

Sleep disorder

Spinal deformation

Liebende (Elegy for Young Lovers), performed in Schwetzinger in 1961, and Wir
erreichen 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.

We 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 neuropsychiatric disorders played various roles in operas, revealing complex relationships between the sufferings of the soul and those of the body mediated by the mind, as well
as between the afflicted and changing societal conditions.

Our 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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