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Vision Loss and Hearing Loss in Painting and Musical Composition
Vision Loss and Hearing Loss in Painting and Musical Composition Michael F. Marmor, MD This article considers the impact of vision and hearing loss on great painters and musical composers. The visual work of Mary Cassatt, Georgia O’Keeffe, Edgar Degas, and Claude Monet all showed alterations as their vision failed. In contrast, Gabriel Fauré, Bedrich Smetana, and Ludwig von Beethoven wrote many of their best compositions while totally deaf, and Georg Friedrich Handel and Frederick Delius struggled to compose late in life when they lost their vision (although their hearing remained excellent). There are 2 major distinctions between the role of vision and hearing for these artistic disciplines. First, there is a surrogate means of “hearing” music, through the musical score, which allows composers to write and edit music while totally deaf. The greatest problem with deafness for a skilled composer is interference from internal noise (tinnitus). There is no surrogate for vision to allow a painter to work when the subject is a blur or the colors on the canvas cannot be distinguished. Second, although the appreciation of art is visual and that of music is auditory, the transcription of both art and musical composition is visual. Thus, visual loss does pose a problem for a composer accustomed to working with good sight, because it disrupts habitual methods of writing and editing music. Ophthalmology 2014;-:1e6 ª 2014 by the American Academy of Ophthalmology.
Impaired vision altered or ended the work of many painters, including Mary Cassatt, Edgar Degas, Claude Monet, and Georgia O’Keeffe,1 whereas musical composers such as Ludwig van Beethoven, Gabriel Fauré, and Bedrich Smetana wrote some of their finest works while totally deaf. What distinguishes a loss of vision from a loss of hearing for creative pursuits? One critical distinction between art and music is that there is a surrogatednonauditorydlanguage for music, whereas there is no surrogatednonvisualdlanguage for painting. Musical notation can describe the sound, rhythm, and even expression of a musical composition in great detail, and a skilled composer can read a score and “hear” music internally in all its complexity. However, distorted hearing or intrinsic noise (tinnitus) that is associated with deafness can be disruptive. In contrast, no words or auditory code can describe the incredible complexity of scenes in the natural world or of paintings on canvas, and a visually impaired painter can never see his or her art the way it appears to nonimpaired eyes. Creative artists, in either the visual arts or music, have the ability to conceptualize their productions internally. Neither blindness nor deafness blocks this ability, just as most of us can contemplate a scene or tune. But the creation of works of art and music typically involves 3 stages beyond the internal conception for which altered sensation can pose a problem: (1) recording of the work on canvas or in musical notation, (2) evaluation of the work (to judge if it meets the artist’s standards), and (3) revision and refinement (which may go on for months or years). Because of the requirements to transcribe and edit music, visual loss can be a problem for composers as well as painters. 2014 by the American Academy of Ophthalmology Published by Elsevier Inc.
Painters with Visual Impairment Total blindness makes the creation of visual art virtually impossible, but many artists have struggled to continue their work with partial visual loss. Stylistic changes in an artist’s work often are made for personal and aesthetic reasons, and generally should not be used to diagnose eye disease.1 However, when serious visual loss is present, its effect usually is evident in an artist’s work. Some examples of changing style are discussed below and are illustrated for Degas and Monet with computer simulations of their vision.2 Mary Cassatt (1844e1926) had cataracts late in life, associated with diabetes, and in the last few years before she elected to stop painting, her works began to lose precision and delicacy in the portrayal of faces.1,3 Georgia O’Keeffe (1887e1986) had bilateral age-related macular degeneration which first affected her vision in 1964.1,4 By 1972, her vision had fallen to 20/200, and she stopped painting in 1977. During the 1970s, her canvases became larger and larger, and the images became flatter and increasingly devoid of the delicate shading that was so much a part of her major work. Edgar Degas (1834e1917) had progressive visual loss that is well documented in letters and commentary and was probably a type of maculopathy. Estimations of his visual acuity suggest that it was near 20/100 in 1890, 20/200 in 1900, and 20/400 by 1910.1,2 He could paint realistically or freely early in his career, but the option for precision disappeared, and his pastels in later years show an increasing loss of precision, coarseness of shading, and lack of facial features (Fig 1).1,2,5 But Degas continued to paint, because his aesthetic focus was on form and posture, which could still be recognized with relatively poor visual acuity. ISSN 0161-6420/14/$ - see front matter http://dx.doi.org/10.1016/j.ophtha.2014.01.009
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Figure 1. Edgar Degas pastels on paper of women in the bath. A, Woman Combing Her Hair, c. 1886. Her limbs are sharply defined and the musculature is beautifully and delicately shaded (Metropolitan Museum of Art, New York [public domain image]). B, After the Bath, 1899. Shading lines are more visible and less delicate (Musée d’Orsay, Paris [public domain image]). C, Woman Drying Her Hair, c. 1905. The outlining is now very coarse, as are the shading lines (Norton Simon Art Foundation, Pasadena, California). D, The same image blurred with Adobe Photoshop to match Degas’ vision in 1905 (roughly 20/300; courtesy of the author).2
Computer simulation2 of his impaired view late in life (Fig 1) shows that he could no longer see well enough to draw details, although the blur also prevented him from seeing the coarseness that is so evident to us. Perhaps this also encouraged him to keep painting. Claude Monet (1840e1926) had cataracts that became progressively dense and brown between 1912 and 1923, when he finally had surgery.1,2,6 He wrote in 1918 that colors were muddy and he was choosing pigments by name. By 1922, his visual acuity was 20/200, and his color discrimination was severely compromised. Figure 2 shows
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how the cataracts altered his view of the garden at Giverny and compares his mature Impressionist style from approximately 1900 with a painting from 1915 that shows flatter and more intense fields of color (perhaps to see them better through the cataracts). A computer simulation2 shows how a strongly colored and almost abstract painting from approximately 1922 would have appeared dark and muted to Monet. We do not know whether these late works were attempts to paint an internal vision, to paint canvases that looked proper to him, or to paint canvases that were meant to look as they do to us. After successful
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Figure 2. Claude Monet: photographs and oils on canvas of his garden at Giverny. A, Monet’s garden as it appears today (photograph by Elizabeth Murray, reprinted with permission). B, Adobe Photoshop simulation of how the garden would appear through his dense cataract in 1922, which blurred vision and also distorted colors like a pair of dark brown sunglasses (courtesy of the author).2 C, Oil painting of The Japanese Footbridge, 1899 (National Gallery of Art, Washington, DC. Gift of Victoria Nebeker Coberly, in memory of her son John W. Mudd, and Walter H. and Leonore Annenberg [public domain image]). D, Water Lilies, 1914e1917, showing flatter intense fields of blue (Musée Marmottan Monet, Paris [public domain image]). E, The Japanese Bridge, 1918e1924, showing unusually strong colors (Musée Marmottan Monet, Paris, France/Giraudon/The Bridgeman Art Library). F, Simulation of how the painting would appear through Monet’s cataract (courtesy of the author).2
cataract surgery Monet returned to his more typical Impressionist style.
Composers with Deafness Total deafness from birth would preclude an appreciation of music as it is usually defined. However, several famous composers developed hearing loss later in life.
Bedrich Smetana (1824e1884) had hearing loss that came on rather quickly in 1874, possibly after an infection, although not necessarily the neurosyphilis that ended his life.7 He became totally deaf, but the greatest handicap to composing was persistent tinnitus.8e10 He told a friend that “written music . . . comes to life in my imagination without any effort of will on my part, as though I could really hear the instruments and voices,” adding, “deafness would be a relatively decent condition, if only all was quiet
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Ophthalmology Volume -, Number -, Month 2014 in my head . . . strident whistles to ghastly shrieks . . . drowns the threads of the music which had been born or were being born in my imagination, so that I have to leave my work.”8 Gabriel Fauré (1845e1924) first noticed hearing loss in 1902 and had very limited hearing by the end of his life.11,12 He described distortion and extraneous sounds: “I get an absurd phenomenon: low-sounding intervals get changed as they go lower, and the high-sounding intervals get changed as they get higher.”11 And he heard what he described as “noises that don’t exist,” adding, “I feel I’m going mad!”12 He had to give up composing on the piano and, as his biographer describes, “content himself with a little ink, a pen and some manuscript paper.”12 Ludwig von Beethoven (1770e1827) first reported hearing loss at approximately age 28 and was almost totally deaf by age 50.13e16 He became aware of high tone loss early, was hypersensitive to loud noises, and was greatly bothered by tinnitus that continued even as deafness worsened.14,16 He wrote at age 31 that “my ears continue to hum and buzz day and night.” Despite his deafness, he wrote every morning, carried a sketchbook for jotting down ideas, and reviewed scores frequently to edit and revise (Fig 3).13,15 His biographer Schindler wrote that “the master no more needed to hear with his ears what he had written down than another person needs to read aloud a letter he has just written.”13 There is no consensus on whether Beethoven’s deafness influenced his music in any direct way. Two reports found fewer high tones used in the
middle quartets and piano sonatas, relative to the late ones composed when he was almost totally deaf.17,18 However, a frequency analysis of sound content found no consistent pattern in the symphonies.19 Several composers have illustrated their tinnitus in music. The finale of Smetana’s famous string quartet From My Life contains a repeated sustained high E in the first violin to mimic the high-pitched tones that rang in his ear as his deafness began.10 Brent Michael David (b. 1959) wrote the Tinnitus Quartet in 2005, which has a ringing tinnitus tone throughout the piece.20
Composers with Visual Loss It is useful to distinguish between composers who are blind early in childhood and those with blindness acquired late in life. Composers who are blind early adapt to their disability and learn at a young age to compose and edit works with assistance and through a process of transcription. Composers with late visual loss become accustomed to reading and writing music quickly, so that blindness interrupts an ingrained method of work.
Early Loss John Stanley (1713e1786), a contemporary of Handel, was almost totally blind as a result of a domestic accident at age 2, but played piano and organ superbly. He was famous for his improvisatory performances, but all of his compositions had to
Figure 3. Ludwig von Beethoven: manuscript page from his 1826 String Quartet Opus 131, showing typical and extensive revisions (collection of the British Library [public domain image]).
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be written down by associates.21 His sister-in-law served as an amanuensis and is said to have contributed a musical “basis” on which Stanley would “build his harmonies.”22 Baroque composers often improvised melodic and contrapuntal lines on a figured bass. Stanley could not edit his manuscripts freely, and he favored musical forms with many repeated passages that would ease the burden of dictation.23 Joaquín Rodrigo (1901e1999) was a Spanish composer most famous for Concierto de Aranjuez and for music with guitar. He suffered ocular damage at age 3 from diphtheria, leaving him with bare light and color perception; operations by Dr. Ignacio Barraquer (patriarch of the ophthalmologic family) in Barcelona were of little benefit.24 He learned music early and began to compose in his teens, writing on a Braille machine and then dictating the notes.24,25 He wrote many works, but transcription was a tedious process. He commented, “What worries me isn’t the composing, it’s the dictation.”25
Late Loss Georg Friedrich Handel (1685e1759) lost vision in 1751, first in the left eye and soon after in the right eye. The disease was called gutta serena (blindness without visible damage) and may have been anterior ischemic optic neuropathy; he underwent couching unsuccessfully for cataracts.26,27 Handel, like Stanley, composed quickly and with a technique that used improvisation on a bass or harmonic line.28 However, he also made occasional sketches of musical ideas, and his draft scores show numerous edits and deletions. This compositional method was compromised severely when his vision failed while writing his last great oratorio, Jephtha. He complained bitterly and took long breaks to finish the work. Afterward, unable to read or write, he found a colleague to assist with composing, but this was now a laborious process. Handel remained a brilliant improviser on the organ, but his late compositions are derivative, and musicologists agree that blindness effectively ended his compositional career.29,30 Frederick Delius (1862e1934) fought mightily to keep composing in the last few years of his life, when he lost all vision as a result of tertiary syphilis. His efforts were complicated by severe paresis, so that he also could not use his hands to play the piano. A young musician, Eric Fenby, struggled to interpret Delius’ verbal descriptions of melody and harmony.31 Fenby finally learned to play snippets of dictated music that Delius would criticize and revise until he had a satisfactory composition. This was a slow process, but he did manage to finish at least 2 major works.
Vision Loss Versus Hearing Loss Musical composing and painting are arts that we define by vision and hearing, but there are important differences. There is no nonvisual surrogate for a painting or visual scene. However, a written score describes the complexities of a musical piece very well. Thus, although visual loss has been severely disruptive to major artists, hearing loss has had surprisingly minimal effects on major composers
because the score maintained access to the music. However, partial deafness (with distortion) or internal sounds (tinnitus) can interfere seriously with a composer’s concentration. Thus, paradoxically, the major impact of deafness on a composer is not the silence, but the sound. Written music is a more than a surrogate for hearing: it is also the primary means of transcription. Paradoxically, again, visual loss can be as devastating to composers as to artists, when they are forced to abandon traditional habits of composition. We can only speculate how Beethoven, who was very dependent on his sketchbooks and his vigorous process of revision, would have coped with blindness (and its tedious dictation), rather than deafness. Although cataracts (in earlier eras) and macular degeneration should not be rare among elderly musicians, I have not discovered any major composer who produced a substantial body of work after late visual loss. Of course, this statement is tempered by the fact that some great composers died young, and some aging composers lost creativity for other reasons. The impact of visual loss on composition may change in the future with the modern availability of musical instrument digital interface (MIDI) and related computer programs that can transcribe and print music directly from a keyboard or play written music out loud. These new tools minimize the difficulty of composing and editing without sight, although they do require a degree of sophistication and enough vision to run the equipment. Picture the elderly Handel, hooked up to headphones and a synthesizer, improvising a new concerto while a computer spits out the written score. This article has looked at painters and composers with known sensory deficits. However, it is risky and unwise to try to diagnose eye or ear disease based on the characteristics of a painting or musical composition.1,23 The computer simulations of artists’ vision in this article are all based on historical medical knowledge, and although they cannot show the thought process of the painter, they demonstrate the degree of distortion and the obstacles that the painter faced.2 Similar stylistic changes could have been chosen for aesthetic or personal reasons (artistic license). El Greco’s elongations are not a result of astigmatism.1 And 12-tone music is not a result of distorted hearing. Furthermore, it is difficult to predict the effects of a particular sensory deficit on style. A painter with a brownish cataract may paint a yellow world or may intensify blues to make sky or water appear more like they do in memory. A composer with high-tone loss may write with fewer high notes to match what is being heard or may intensify the high tones to make them more audible. Furthermore, the auditory and visual centers of the brain adapt and alter their circuitry to chronic changes in sensory input, so that the ultimate effects on creative expression can be even more complex.32 In summary, although we define painting as visual and music as auditory, this division is asymmetric when sensation is lost. There is a written surrogate for auditory music, but not for visual art. Although art is visual to the viewer and music is auditory for the listener, both disciplines traditionally have required vision to make a transcript of the work. These distinctions help to explain the differing effects of blindness and deafness on great artists and composers.
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Ophthalmology Volume -, Number -, Month 2014 Acknowledgments. The author thanks James Ravin, Robert Jackler, Jonathan Berger, Stephen Hinton, and James Breeden for comments on versions of this article and John Prescott for discussion about the working methods of Stanley and Handel.
References 1. Marmor MF, Ravin JG. The Artist’s Eyes: Vision and the History of Art. New York: Abrams; 2009. 2. Marmor MF. Ophthalmology and art: simulation of Monet’s cataracts and Degas’ retinal disease. Arch Ophthalmol 2006;124:1764–9. 3. Hale N. Mary Cassatt. Reading, PA: Addison-Wesley; 1987: 243–76. 4. Drohojowska-Philp H. Full Bloom: the Art and Life of Georgia O’Keeffe. New York: WW Norton; 2004:490–534. 5. Kendall R. Degas and the contingency of vision. Burlington Magazine 1988;130(1020):180–97, 216. 6. Ravin JG. Monet’s cataracts. JAMA 1985;254:394–9. 7. Höschl C. Bedrich Smetana: art and disease. Psychiatria Danubia 2012;24(suppl):176–8. 8. Smetana B. Letters and Reminiscences. Bartos F, ed. Rusbridge D, trans. Prague: Artia; 1955:148e166, 180e91, 211e12. 9. Large B. Smetana. New York: Praeger; 1970:233–316. 10. Clapham J. Smetana. London: Dent; 1972:37–56. 11. Fauré G. Gabriel Fauré: A Life in Letters. Jones JB, trans. and ed. London: Batsford; 1989:111e112, 180. 12. Nectoux JM. Gabriel Fauré: A Musical Life. Nichols R, trans. Cambridge, UK: Cambridge University Press; 1991:292e312, 481e94. 13. Schindler AF. Beethoven As I Knew Him. MacArdle DW, ed. Jolly CS, trans. Mineola, NY: Dover; 1996. 14. Asherson N. Beethoven’s deafness and the saga of the stapes. Trans Hunter Soc 1965e66;24:7–34. 15. Cooper B. Beethoven. Oxford: Oxford University Press; 2000. 16. Davies PJ. Beethoven in Person: His Deafness, Illnesses, and Death. Westport, CT: Greenwood Press; 2001:42–65. 135e63.
17. Saccenti E, Smilde AK, Saris WH. Beethoven’s deafness and his three styles. BMJ 2011;343:d7589. 18. Wainapel SF. Ludwig van Beethoven: the influence of hearing loss on his musical development. Med Probl Perform Art 1995;10:90–3. 19. Liston SL, Yanz JL, Preves D, Jelonek S. Beethoven’s deafness. Laryngoscope 1989;99:1301–4. 20. Halpern S. “Tinnitus Quartet.” Davids BM, composer. Carnegie Hall. October 28, 2005. 21. Williams G, Johnstone HD, Boyd M. New light on Stanley. Music Times 1976;117:810–5. 22. Hawkins LM. Anecdotes, Biographical Sketches and Memoirs. Vol. I. London: FC and J Rivington; 1822:197–215. 23. Prescott JR. John Stanley, “A Miracle of Art and Nature”: the role of disability in the life and career of a blind eighteenthcentury musician [dissertation]. Berkeley, CA: University of California, Berkeley; 2011:52–63. Available at: http:// escholarship.org/uc/item/6cn0h2r2. Accessed December 23, 2013. 24. Kamhi de Rodrigo V. Hand in Hand with Joaquin Rodrigo: My Life at the Maestro’s Side. Wilkerson E, trans. Pittsburgh, PA: Latin American Literary Review Press; 1992:61e75,105e120. 25. Joaquín Rodrigo’s Century. In Spanish with English subtitles [videotape]. New York: Films Media Group; 2000. 26. Blanchard DL. George Handel and his blindness. Doc Ophthalmol 1999;99:247–58. 27. Bäzner H, Hennerici H. Georg Friedrich Händel’s strokes. Cerebrovasc Dis 2004;17:326–31. 28. Hurley DR. Handel’s Muse: Patterns of Creation in his Oratorios and Musical Dramas, 1743e1751. Oxford: Oxford University Press; 2001:12–35, 275e82. 29. Hogwood C. Handel. Rev. ed. London: Thames and Hudson; 2007:222e231. 30. Burrows D. Handel. 2nd ed. Oxford: Oxford University Press; 2012:464e504. 31. Fenby E. Delius as I Knew Him. Rev. ed. Republished. New York: Dover; 1994:131e157. 32. Frasnelli J, Collignon O, Voss P, Lepore F. Crossmodal plasticity in sensory loss. Prog Brain Res 2011;191:233–49.
Footnotes and Financial Disclosures Originally received: October 16, 2013. Final revision: January 4, 2014. Accepted: January 6, 2014. Available online: ---.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Manuscript no. 2013-1742.
Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.
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Correspondence: Michael F. Marmor, MD, Byers Eye Institute at Stanford, 2452 Watson Court, Palo Alto, CA 94303-3216.
Impaired vision altered or ended the work of many painters, including Mary Cassatt, Edgar Degas, Claude Monet, and Georgia O’Keeffe,1 whereas musical composers such as Ludwig van Beethoven, Gabriel Fauré, and Bedrich Smetana wrote some of their finest works while totally deaf. What distinguishes a loss of vision from a loss of hearing for creative pursuits? One critical distinction between art and music is that there is a surrogatednonauditorydlanguage for music, whereas there is no surrogatednonvisualdlanguage for painting. Musical notation can describe the sound, rhythm, and even expression of a musical composition in great detail, and a skilled composer can read a score and “hear” music internally in all its complexity. However, distorted hearing or intrinsic noise (tinnitus) that is associated with deafness can be disruptive. In contrast, no words or auditory code can describe the incredible complexity of scenes in the natural world or of paintings on canvas, and a visually impaired painter can never see his or her art the way it appears to nonimpaired eyes. Creative artists, in either the visual arts or music, have the ability to conceptualize their productions internally. Neither blindness nor deafness blocks this ability, just as most of us can contemplate a scene or tune. But the creation of works of art and music typically involves 3 stages beyond the internal conception for which altered sensation can pose a problem: (1) recording of the work on canvas or in musical notation, (2) evaluation of the work (to judge if it meets the artist’s standards), and (3) revision and refinement (which may go on for months or years). Because of the requirements to transcribe and edit music, visual loss can be a problem for composers as well as painters. 2014 by the American Academy of Ophthalmology Published by Elsevier Inc.
Painters with Visual Impairment Total blindness makes the creation of visual art virtually impossible, but many artists have struggled to continue their work with partial visual loss. Stylistic changes in an artist’s work often are made for personal and aesthetic reasons, and generally should not be used to diagnose eye disease.1 However, when serious visual loss is present, its effect usually is evident in an artist’s work. Some examples of changing style are discussed below and are illustrated for Degas and Monet with computer simulations of their vision.2 Mary Cassatt (1844e1926) had cataracts late in life, associated with diabetes, and in the last few years before she elected to stop painting, her works began to lose precision and delicacy in the portrayal of faces.1,3 Georgia O’Keeffe (1887e1986) had bilateral age-related macular degeneration which first affected her vision in 1964.1,4 By 1972, her vision had fallen to 20/200, and she stopped painting in 1977. During the 1970s, her canvases became larger and larger, and the images became flatter and increasingly devoid of the delicate shading that was so much a part of her major work. Edgar Degas (1834e1917) had progressive visual loss that is well documented in letters and commentary and was probably a type of maculopathy. Estimations of his visual acuity suggest that it was near 20/100 in 1890, 20/200 in 1900, and 20/400 by 1910.1,2 He could paint realistically or freely early in his career, but the option for precision disappeared, and his pastels in later years show an increasing loss of precision, coarseness of shading, and lack of facial features (Fig 1).1,2,5 But Degas continued to paint, because his aesthetic focus was on form and posture, which could still be recognized with relatively poor visual acuity. ISSN 0161-6420/14/$ - see front matter http://dx.doi.org/10.1016/j.ophtha.2014.01.009
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Figure 1. Edgar Degas pastels on paper of women in the bath. A, Woman Combing Her Hair, c. 1886. Her limbs are sharply defined and the musculature is beautifully and delicately shaded (Metropolitan Museum of Art, New York [public domain image]). B, After the Bath, 1899. Shading lines are more visible and less delicate (Musée d’Orsay, Paris [public domain image]). C, Woman Drying Her Hair, c. 1905. The outlining is now very coarse, as are the shading lines (Norton Simon Art Foundation, Pasadena, California). D, The same image blurred with Adobe Photoshop to match Degas’ vision in 1905 (roughly 20/300; courtesy of the author).2
Computer simulation2 of his impaired view late in life (Fig 1) shows that he could no longer see well enough to draw details, although the blur also prevented him from seeing the coarseness that is so evident to us. Perhaps this also encouraged him to keep painting. Claude Monet (1840e1926) had cataracts that became progressively dense and brown between 1912 and 1923, when he finally had surgery.1,2,6 He wrote in 1918 that colors were muddy and he was choosing pigments by name. By 1922, his visual acuity was 20/200, and his color discrimination was severely compromised. Figure 2 shows
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how the cataracts altered his view of the garden at Giverny and compares his mature Impressionist style from approximately 1900 with a painting from 1915 that shows flatter and more intense fields of color (perhaps to see them better through the cataracts). A computer simulation2 shows how a strongly colored and almost abstract painting from approximately 1922 would have appeared dark and muted to Monet. We do not know whether these late works were attempts to paint an internal vision, to paint canvases that looked proper to him, or to paint canvases that were meant to look as they do to us. After successful
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Figure 2. Claude Monet: photographs and oils on canvas of his garden at Giverny. A, Monet’s garden as it appears today (photograph by Elizabeth Murray, reprinted with permission). B, Adobe Photoshop simulation of how the garden would appear through his dense cataract in 1922, which blurred vision and also distorted colors like a pair of dark brown sunglasses (courtesy of the author).2 C, Oil painting of The Japanese Footbridge, 1899 (National Gallery of Art, Washington, DC. Gift of Victoria Nebeker Coberly, in memory of her son John W. Mudd, and Walter H. and Leonore Annenberg [public domain image]). D, Water Lilies, 1914e1917, showing flatter intense fields of blue (Musée Marmottan Monet, Paris [public domain image]). E, The Japanese Bridge, 1918e1924, showing unusually strong colors (Musée Marmottan Monet, Paris, France/Giraudon/The Bridgeman Art Library). F, Simulation of how the painting would appear through Monet’s cataract (courtesy of the author).2
cataract surgery Monet returned to his more typical Impressionist style.
Composers with Deafness Total deafness from birth would preclude an appreciation of music as it is usually defined. However, several famous composers developed hearing loss later in life.
Bedrich Smetana (1824e1884) had hearing loss that came on rather quickly in 1874, possibly after an infection, although not necessarily the neurosyphilis that ended his life.7 He became totally deaf, but the greatest handicap to composing was persistent tinnitus.8e10 He told a friend that “written music . . . comes to life in my imagination without any effort of will on my part, as though I could really hear the instruments and voices,” adding, “deafness would be a relatively decent condition, if only all was quiet
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Ophthalmology Volume -, Number -, Month 2014 in my head . . . strident whistles to ghastly shrieks . . . drowns the threads of the music which had been born or were being born in my imagination, so that I have to leave my work.”8 Gabriel Fauré (1845e1924) first noticed hearing loss in 1902 and had very limited hearing by the end of his life.11,12 He described distortion and extraneous sounds: “I get an absurd phenomenon: low-sounding intervals get changed as they go lower, and the high-sounding intervals get changed as they get higher.”11 And he heard what he described as “noises that don’t exist,” adding, “I feel I’m going mad!”12 He had to give up composing on the piano and, as his biographer describes, “content himself with a little ink, a pen and some manuscript paper.”12 Ludwig von Beethoven (1770e1827) first reported hearing loss at approximately age 28 and was almost totally deaf by age 50.13e16 He became aware of high tone loss early, was hypersensitive to loud noises, and was greatly bothered by tinnitus that continued even as deafness worsened.14,16 He wrote at age 31 that “my ears continue to hum and buzz day and night.” Despite his deafness, he wrote every morning, carried a sketchbook for jotting down ideas, and reviewed scores frequently to edit and revise (Fig 3).13,15 His biographer Schindler wrote that “the master no more needed to hear with his ears what he had written down than another person needs to read aloud a letter he has just written.”13 There is no consensus on whether Beethoven’s deafness influenced his music in any direct way. Two reports found fewer high tones used in the
middle quartets and piano sonatas, relative to the late ones composed when he was almost totally deaf.17,18 However, a frequency analysis of sound content found no consistent pattern in the symphonies.19 Several composers have illustrated their tinnitus in music. The finale of Smetana’s famous string quartet From My Life contains a repeated sustained high E in the first violin to mimic the high-pitched tones that rang in his ear as his deafness began.10 Brent Michael David (b. 1959) wrote the Tinnitus Quartet in 2005, which has a ringing tinnitus tone throughout the piece.20
Composers with Visual Loss It is useful to distinguish between composers who are blind early in childhood and those with blindness acquired late in life. Composers who are blind early adapt to their disability and learn at a young age to compose and edit works with assistance and through a process of transcription. Composers with late visual loss become accustomed to reading and writing music quickly, so that blindness interrupts an ingrained method of work.
Early Loss John Stanley (1713e1786), a contemporary of Handel, was almost totally blind as a result of a domestic accident at age 2, but played piano and organ superbly. He was famous for his improvisatory performances, but all of his compositions had to
Figure 3. Ludwig von Beethoven: manuscript page from his 1826 String Quartet Opus 131, showing typical and extensive revisions (collection of the British Library [public domain image]).
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Blindness and Deafness in Art and Music
be written down by associates.21 His sister-in-law served as an amanuensis and is said to have contributed a musical “basis” on which Stanley would “build his harmonies.”22 Baroque composers often improvised melodic and contrapuntal lines on a figured bass. Stanley could not edit his manuscripts freely, and he favored musical forms with many repeated passages that would ease the burden of dictation.23 Joaquín Rodrigo (1901e1999) was a Spanish composer most famous for Concierto de Aranjuez and for music with guitar. He suffered ocular damage at age 3 from diphtheria, leaving him with bare light and color perception; operations by Dr. Ignacio Barraquer (patriarch of the ophthalmologic family) in Barcelona were of little benefit.24 He learned music early and began to compose in his teens, writing on a Braille machine and then dictating the notes.24,25 He wrote many works, but transcription was a tedious process. He commented, “What worries me isn’t the composing, it’s the dictation.”25
Late Loss Georg Friedrich Handel (1685e1759) lost vision in 1751, first in the left eye and soon after in the right eye. The disease was called gutta serena (blindness without visible damage) and may have been anterior ischemic optic neuropathy; he underwent couching unsuccessfully for cataracts.26,27 Handel, like Stanley, composed quickly and with a technique that used improvisation on a bass or harmonic line.28 However, he also made occasional sketches of musical ideas, and his draft scores show numerous edits and deletions. This compositional method was compromised severely when his vision failed while writing his last great oratorio, Jephtha. He complained bitterly and took long breaks to finish the work. Afterward, unable to read or write, he found a colleague to assist with composing, but this was now a laborious process. Handel remained a brilliant improviser on the organ, but his late compositions are derivative, and musicologists agree that blindness effectively ended his compositional career.29,30 Frederick Delius (1862e1934) fought mightily to keep composing in the last few years of his life, when he lost all vision as a result of tertiary syphilis. His efforts were complicated by severe paresis, so that he also could not use his hands to play the piano. A young musician, Eric Fenby, struggled to interpret Delius’ verbal descriptions of melody and harmony.31 Fenby finally learned to play snippets of dictated music that Delius would criticize and revise until he had a satisfactory composition. This was a slow process, but he did manage to finish at least 2 major works.
Vision Loss Versus Hearing Loss Musical composing and painting are arts that we define by vision and hearing, but there are important differences. There is no nonvisual surrogate for a painting or visual scene. However, a written score describes the complexities of a musical piece very well. Thus, although visual loss has been severely disruptive to major artists, hearing loss has had surprisingly minimal effects on major composers
because the score maintained access to the music. However, partial deafness (with distortion) or internal sounds (tinnitus) can interfere seriously with a composer’s concentration. Thus, paradoxically, the major impact of deafness on a composer is not the silence, but the sound. Written music is a more than a surrogate for hearing: it is also the primary means of transcription. Paradoxically, again, visual loss can be as devastating to composers as to artists, when they are forced to abandon traditional habits of composition. We can only speculate how Beethoven, who was very dependent on his sketchbooks and his vigorous process of revision, would have coped with blindness (and its tedious dictation), rather than deafness. Although cataracts (in earlier eras) and macular degeneration should not be rare among elderly musicians, I have not discovered any major composer who produced a substantial body of work after late visual loss. Of course, this statement is tempered by the fact that some great composers died young, and some aging composers lost creativity for other reasons. The impact of visual loss on composition may change in the future with the modern availability of musical instrument digital interface (MIDI) and related computer programs that can transcribe and print music directly from a keyboard or play written music out loud. These new tools minimize the difficulty of composing and editing without sight, although they do require a degree of sophistication and enough vision to run the equipment. Picture the elderly Handel, hooked up to headphones and a synthesizer, improvising a new concerto while a computer spits out the written score. This article has looked at painters and composers with known sensory deficits. However, it is risky and unwise to try to diagnose eye or ear disease based on the characteristics of a painting or musical composition.1,23 The computer simulations of artists’ vision in this article are all based on historical medical knowledge, and although they cannot show the thought process of the painter, they demonstrate the degree of distortion and the obstacles that the painter faced.2 Similar stylistic changes could have been chosen for aesthetic or personal reasons (artistic license). El Greco’s elongations are not a result of astigmatism.1 And 12-tone music is not a result of distorted hearing. Furthermore, it is difficult to predict the effects of a particular sensory deficit on style. A painter with a brownish cataract may paint a yellow world or may intensify blues to make sky or water appear more like they do in memory. A composer with high-tone loss may write with fewer high notes to match what is being heard or may intensify the high tones to make them more audible. Furthermore, the auditory and visual centers of the brain adapt and alter their circuitry to chronic changes in sensory input, so that the ultimate effects on creative expression can be even more complex.32 In summary, although we define painting as visual and music as auditory, this division is asymmetric when sensation is lost. There is a written surrogate for auditory music, but not for visual art. Although art is visual to the viewer and music is auditory for the listener, both disciplines traditionally have required vision to make a transcript of the work. These distinctions help to explain the differing effects of blindness and deafness on great artists and composers.
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Ophthalmology Volume -, Number -, Month 2014 Acknowledgments. The author thanks James Ravin, Robert Jackler, Jonathan Berger, Stephen Hinton, and James Breeden for comments on versions of this article and John Prescott for discussion about the working methods of Stanley and Handel.
References 1. Marmor MF, Ravin JG. The Artist’s Eyes: Vision and the History of Art. New York: Abrams; 2009. 2. Marmor MF. Ophthalmology and art: simulation of Monet’s cataracts and Degas’ retinal disease. Arch Ophthalmol 2006;124:1764–9. 3. Hale N. Mary Cassatt. Reading, PA: Addison-Wesley; 1987: 243–76. 4. Drohojowska-Philp H. Full Bloom: the Art and Life of Georgia O’Keeffe. New York: WW Norton; 2004:490–534. 5. Kendall R. Degas and the contingency of vision. Burlington Magazine 1988;130(1020):180–97, 216. 6. Ravin JG. Monet’s cataracts. JAMA 1985;254:394–9. 7. Höschl C. Bedrich Smetana: art and disease. Psychiatria Danubia 2012;24(suppl):176–8. 8. Smetana B. Letters and Reminiscences. Bartos F, ed. Rusbridge D, trans. Prague: Artia; 1955:148e166, 180e91, 211e12. 9. Large B. Smetana. New York: Praeger; 1970:233–316. 10. Clapham J. Smetana. London: Dent; 1972:37–56. 11. Fauré G. Gabriel Fauré: A Life in Letters. Jones JB, trans. and ed. London: Batsford; 1989:111e112, 180. 12. Nectoux JM. Gabriel Fauré: A Musical Life. Nichols R, trans. Cambridge, UK: Cambridge University Press; 1991:292e312, 481e94. 13. Schindler AF. Beethoven As I Knew Him. MacArdle DW, ed. Jolly CS, trans. Mineola, NY: Dover; 1996. 14. Asherson N. Beethoven’s deafness and the saga of the stapes. Trans Hunter Soc 1965e66;24:7–34. 15. Cooper B. Beethoven. Oxford: Oxford University Press; 2000. 16. Davies PJ. Beethoven in Person: His Deafness, Illnesses, and Death. Westport, CT: Greenwood Press; 2001:42–65. 135e63.
17. Saccenti E, Smilde AK, Saris WH. Beethoven’s deafness and his three styles. BMJ 2011;343:d7589. 18. Wainapel SF. Ludwig van Beethoven: the influence of hearing loss on his musical development. Med Probl Perform Art 1995;10:90–3. 19. Liston SL, Yanz JL, Preves D, Jelonek S. Beethoven’s deafness. Laryngoscope 1989;99:1301–4. 20. Halpern S. “Tinnitus Quartet.” Davids BM, composer. Carnegie Hall. October 28, 2005. 21. Williams G, Johnstone HD, Boyd M. New light on Stanley. Music Times 1976;117:810–5. 22. Hawkins LM. Anecdotes, Biographical Sketches and Memoirs. Vol. I. London: FC and J Rivington; 1822:197–215. 23. Prescott JR. John Stanley, “A Miracle of Art and Nature”: the role of disability in the life and career of a blind eighteenthcentury musician [dissertation]. Berkeley, CA: University of California, Berkeley; 2011:52–63. Available at: http:// escholarship.org/uc/item/6cn0h2r2. Accessed December 23, 2013. 24. Kamhi de Rodrigo V. Hand in Hand with Joaquin Rodrigo: My Life at the Maestro’s Side. Wilkerson E, trans. Pittsburgh, PA: Latin American Literary Review Press; 1992:61e75,105e120. 25. Joaquín Rodrigo’s Century. In Spanish with English subtitles [videotape]. New York: Films Media Group; 2000. 26. Blanchard DL. George Handel and his blindness. Doc Ophthalmol 1999;99:247–58. 27. Bäzner H, Hennerici H. Georg Friedrich Händel’s strokes. Cerebrovasc Dis 2004;17:326–31. 28. Hurley DR. Handel’s Muse: Patterns of Creation in his Oratorios and Musical Dramas, 1743e1751. Oxford: Oxford University Press; 2001:12–35, 275e82. 29. Hogwood C. Handel. Rev. ed. London: Thames and Hudson; 2007:222e231. 30. Burrows D. Handel. 2nd ed. Oxford: Oxford University Press; 2012:464e504. 31. Fenby E. Delius as I Knew Him. Rev. ed. Republished. New York: Dover; 1994:131e157. 32. Frasnelli J, Collignon O, Voss P, Lepore F. Crossmodal plasticity in sensory loss. Prog Brain Res 2011;191:233–49.
Footnotes and Financial Disclosures Originally received: October 16, 2013. Final revision: January 4, 2014. Accepted: January 6, 2014. Available online: ---.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Manuscript no. 2013-1742.
Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.
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Correspondence: Michael F. Marmor, MD, Byers Eye Institute at Stanford, 2452 Watson Court, Palo Alto, CA 94303-3216.