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Alexander Scriabin: His chronic right-handpain and its impact on his piano compositions
ARTICLE in PROGRESS IN BRAIN RESEARCH · FEBRUARY 2015
Impact Factor: 2.83 · DOI: 10.1016/bs.pbr.2014.11.031 · Source: PubMed

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From Eckart Altenmüller, Alexander Scriabin: his chronic right-hand pain and Its impact on his piano
compositions. In: Eckart Altenmüller, Stanley Finger and François Boller, editors, Progress in Brain
Research, Vol. 216, Amsterdam: Elsevier, 2015, pp. 197-215.
ISBN: 978-0-444-63399-6© Copyright 2015 Elsevier B.V.
Elsevier

Author's personal copy
CHAPTER

Alexander Scriabin: hischronic right-hand pain and
Its impact on his piano
compositions

9

Eckart Altenm€uller1
University of Music, Drama and Media, Institute of Music Physiology
and Musicians’ Medicine, Hannover, Germany
1
Corresponding author: Tel.: +49-511-3100-552; Fax: +49-511-3100-557,
e-mail address: eckart.altenmueller@hmtm-hannover.de

Abstract
Alexander Scriabin was an outstanding pianist and an avant-garde composer who influenced
later generations with his innovative “multimedia” conceptions of aesthetic experience. As anadolescent, he was systematically trained as a concert pianist and received lessons from
Vassily Safonoff, one of the founders of the legendary Russian Piano School. At age 20,
Scriabin suffered an overuse injury of his right hand when attempting to improve the soundquality of his piano touch. This injury caused a deep crisis and influenced his later compositionstyle in his piano works. From this time on, his works were frequently dominated by unusual
virtuosic use and wide spans of his left hand. Rest, restricted repertoire, and an increased focus
on composition contributed to recovery; however, he always remained anxious concerning thestamina of his right hand. The case report impressively demonstrates the stressors an aspiring
young pianist had to cope with at the end of the nineteenth century. Furthermore, it is a convincing example of how resource-oriented behavior and intuition lead to the improvement ofhealth status. Differential diagnoses and the modern concept of multimodal pain therapy inchronic overuse injury will be discussed from a historical perspective.

Keywords
overuse injury, chronic pain, left-hand piano playing, rehabilitation, Alexander Scriabin

1 INTRODUCTIONIn April 2015, the musical world will commemorate the 100th anniversary of thedeath of the eminent Russian pianist and composer, Alexander Scriabin. Beginningin his youth as an important pioneer of late romantic eclecticism in the tradition of
Progress in Brain Research, Volume 216, ISSN 0079-6123, http://dx.doi.org/10.1016/bs.pbr.2014.11.031© 2015 Elsevier B.V. All rights reserved.

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Frederic Chopin, he developed a substantially atonal and dissonant musical system,
which went along with his personal mysticism. His later works were influenced by
the concepts of synesthesia. He associated each of the tones of his atonic scale with a
specific color and planned holistic sensual experiences, not only including colors but
also the generation of scents and sensation of touch and taste in his last symphonicwork “Mysterium.” His color-coded circle of fifths was influenced by theosophy, anesoteric philosophy which sought the direct knowledge of presumed mysteries of being and nature, particularly concerning the nature of divinity.
Scriabin was one of the most innovative, though controversial, Russian composers. Leo Tolstoy once described Scriabin’s music as “a sincere expression of
genius” (Garcia, 2004). Although Scriabin had a major impact on the music world
over time and influenced composers such as Igor Stravinsky and Sergei Prokofiev(Bowers, 1996), his works are not frequently performed and remain marginal in
the repertoire of soloists and orchestras. After the Russian revolution, Scriabin’s importance in the Soviet musical scene drastically declined. According to his biographer Faubion Bowers, “No one was more famous during their lifetime, and few weremore quickly ignored after death” (1996). Nevertheless, his musical aesthetics havebeen reevaluated, and his 10 published piano sonatas, which have arguably provided
the most consistent contribution to the genre since the time of Beethoven, have been
increasingly valued and performed (Powell, 2014). With respect to his piano playing,
Scriabin was not a typical child prodigy who was exposed at early age to the public;
however, in his 20s he became an internationally recognized concert pianist, performing extremely difficult pieces at a young age. What is less known is that in
his late adolescence, his permanent quest for pianistic excellence came at a highprice, spoiling his life for years and leading to depression and despair: the chronic
pain in his right arm.
This chapter addresses his pain caused by playing the piano. What were the circumstances leading to this pain? Did Alexander Scriabin suffer from the consequences of an accident he incurred as a boy? Or was it musician’s dystonia, a lossof motor control of highly trained movement patterns known to have afflicted young
Robert Schumann at about the same age as Scriabin developed his ailment? Or were
the pains largely psychosomatic, brought on by the many stress factors in his younglife: the excessive demands placed on him by his family, his high ambitions, the competitiveness of his environment, financial pressures, and exacting teachers? Or, finally, were they simply caused by an overuse injury as a consequence of“brainless” practicing?
In this chapter, we offer a detailed analysis of these questions with the help of
biography, original documents, expert research, and modern-day knowledge in musician’s medicine. In this way, we want to demonstrate how Scriabin’s medical problems typically reflect the darker side of virtuosity, specialization, and the modern
concert scene. Finally, we deal with risk factors and prevention strategies for maintaining musician’s health. Although most of the literature on Scriabin is devoted to
his later years, his “philosophy and music of desire” (e.g., Lobanova, 2004;
Sabanejew, 2005; Schloezer, 1987; Smith, 2013), we do not comment on his bizarre

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1 Introduction

philosophical pretensions and his megalomaniac musical projects which could beinterpreted as signs of an eccentric personality, if not as symptoms of bipolar disorder. Furthermore, we do not address his many psychological conflicts arising fromalmost constant turmoil caused by his love affairs and complicated female relationships. However, some of these conflicts may have contributed to produce and sustain
chronic pain.
In this chapter, I have tried to let the Scriabin speak for himself or be spoken about
by his contemporaries, those who actually heard him playing and who lived with him.
As, unfortunately, I am not able to read Russian, I had to rely on translations of his
letters into German by Christoph Hellmundt (1988) and of diaries and letters of his
contemporaries and entries in his own notebooks into English by Faubion Bowers(1996), who in turn was able to draw from the original sources.

1.1 ALEXANDER SCRIABIN’S LIFE
Alexander Nikolayevich Scriabin was born into an aristocratic family in Moscow on
Christmas Day, 1871, according to the Julian calendar, which translates to January 6,1872 in the Gregorian calendar. His father and all of his uncles were military officers
and had partly successful military careers. When he was only a year old, his motherdied of tuberculosis. She had been a concert pianist and former pupil of Theodor
Leschetizky, who himself was a former student of Carl Czerny and one of the mostprominent piano teachers at that time. After her death, Scriabin’s father completed
his education in the Turkish language in St. Petersburg. He subsequently became adiplomat and finally left for Turkey. Scriabin’s father would later remarry, giving
Scriabin a number of half-brothers and -sisters.
Alexander Scriabin stayed with his grandmother, great aunt, and Aunt Lyubov.
The latter, his father’s unmarried sister, educated him. She, only 23 years young, decided to devote her life to the education of the 3-year-old “Sasha.” As a boy, Scriabin
revealed extraordinary musical abilities and received piano lessons by his aunt, who
was a talented amateur pianist. In 1882, Scriabin entered the junior military academy
in Moscow; his musical talent attracted the attention of his teachers and classmates.
In 1883, he began to take regular piano and composition lessons with Georgi Conus,
who himself was still a pupil at the Conservatory. These lessons continued until thespring of 1884, when Sasha determined to enter the Moscow Conservatory. Fromapproximately 1885 on, he received private lessons from Sergei Tanejeff, an excellent pianist and leading figure in Russian composition. Tanejeff advised Sasha totake piano lessons with Nikolai Zwerev, who was the most adulated piano teacherof Moscow’s high society and associate professor of the Conservatory. In 1887,
Scriabin entered Moscow Conservatory, still a student in the junior military academy. He studied piano with Vassily Safonoff, continued music theory lessons with
Tanejeff, and took a course in free composition and fugue with Anton Arensky. It
was then that Scriabin decided to abandon his military education and dedicate himself entirely to music. Nevertheless, in 1889, he obtained a finishing diploma in the
military academy.

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His musical talents developed rapidly during his conservatory years, but he still
was mainly regarded as a pianist rather than a composer. During the summer holiday
in 1891, Scriabin tried to improve his pianistic technique and suffered from an overuse injury of his right hand, which will be the main topic of this chapter. Although hehad only partially convalesced, he graduated from Moscow Conservatory as a pianist
in 1892. In subsequent years, Scriabin built his career as a composer and an interpreter of his own works, but he was always concerned about the lack of enduranceof his right hand. In 1895, Scriabin accompanied his friend, benefactor, and publisher, Mitrofan Belaieff, to Central Europe, where he made his first extensive tour
as a pianist. He visited Germany, Holland, Belgium, France, and Italy and spent a
longer time close to Lake Geneva in Switzerland, where he attempted to definitely
cure his right hand.
In 1897, Scriabin married Vera Isakovich, a pianist who had just graduated from
Moscow Conservatory. After a brief trip to Paris, the couple returned to Moscow,
where the director of the Moscow Conservatory who was also his former pianoteacher, Vassily Safonoff, engaged Scriabin as a professor of piano. Scriabin established his reputation as a composer and composed his only piano concerto among
other works, mostly for the piano. For a period of 5 years, Scriabin was based in
Moscow, during which time his former teacher, Safonoff, conducted the first twoof his symphonies.
In 1903, Scriabin left the Conservatory, and in spring 1904 he traveled to
Switzerland, where he began to work on the composition of his Symphony No. 3.
While living in Switzerland, Scriabin was separated legally from his wife. The
symphony was performed in Paris in May 29, 1905. A former pupil of Scriabin,
Tatiana Fyodorovna Schloezer, now accompanied Scriabin. With the financial
assistance of a wealthy sponsor, they spent several years traveling in Switzerland,
Italy, France, Belgium, and the United States. Scriabin composed more orchestralpieces, including several symphonies. He also began to compose “poems” for the
piano, a free, improvisatory form with which he is particularly associated. In
1909, he returned to Russia for good; there he continued to compose, working
on increasingly grandiose projects. For some time before his death, he had planned
to create a holistic “multimedia performance” in the Himalaya Mountains, the“Mysterium.” This work was “to culminate in the spectacle of cosmic conflagration,
which would precipitate an apocalyptic doomsday, a grandiose religious synthesis of
all arts which would herald the birth of a new world” (quoted according to Boris desSchloezer, p. 269, following). Inspired by the theosophical philosophy, Scriabin conceptualized the first part of this “Gesamtkunstwerk,” the “Acte préalable.” In 1915 at
the age of 43, he died in Moscow from septicemia as a result of a sore on his upper lip.

1.2 ALEXANDER SCRIABIN’S PIANISTIC TRAINING
As a child, Scriabin was frequently exposed to piano playing and, according to thememoirs of his Aunt Lyubov, showed, from the early days on, interest in sounds ingeneral and specifically in the piano sound. His aunt recalls in her diary that the firstAuthor's personal copy
1 Introduction

words of Sasha were “Aunty, sit”—which meant that Lyubov should play the piano(Bowers, 1996, p. 110). Apparently precocious, Scriabin began to play the piano at
the age of 5, or even before. It seems that in the beginning, he did not receive astrictly formal pianistic education but was encouraged by his aunt and family tospend time at the piano in a more playful way which included hours of improvisation and imitation of sounds. For example, he was able to reproduce the two- or
three-voiced tunes of organ grinders, who came for begging in the courtyard of
their Moscow domicile (Bowers, 1996, p. 110). When he was 7 years, Sasha started
building miniature pianos, first with cardboard and later with wood, wire, and nails.
He was fascinated by piano mechanisms and constructed small pianos with sounding boards, keys that moved, pedals that worked, and lids that open and closed. In 1
year, he built 10 such pianos and gave them away to houseguests who admiredthese instruments. Interestingly, he lost all interest in the instruments as soon as
they had been completed. During this period, Lyubov portrays Scriabin as very
shy and unsociable among his peers, but appreciative of adult attention. His physical appearance was fragile; he was thin, pale, nervous, and overly serious. Aunt
Lyubov took him to the physician, Grigory Zakharin, a specialist in nervous
disorders. He assured her “that there was nothing specifically wrong, but goodnourishment, summers out of Moscow, and clean air might calm him” (Bowers,
1996, p. 113).
With respect to his pianistic development, his aunt noted that already at the age of
7, Scriabin studied without stopping the whole day, be it “at the piano or writing
poems and theater plays. His only sport was jumping, he would leap from the topof the piano to the floor with ease, giving us all a fright. Sometimes he amused
us by imitating ballerinas turning ‘en pointe. . .’” (Bowers, 1996, p. 114). When Aunt
Lyubov tried to teach him to read music and to improve his technique by studying
finger exercises such as scales and arpeggios, which constitute the technical prerequisites of piano playing, young Scriabin was uninterested. He was reluctant to readmusic and preferred to improvise or play by ear, and he was not at all willing to systematically train technical skills. Unsure about Scriabin’s musical development,
Aunt Lyubov took him to the eminent pianist and composer Anton Rubinstein in
St. Petersburg for an assessment of his musical talent. Rubinstein assessed theboy and noted his perfect pitch, exceptional memory, and outstanding ability to imitate anything by ear. Furthermore, he listened to some of his improvisations. He nodded sagely when Aunt Lyubov told him that the boy preferred the piano to toys.
“Don’t push him” he advised. “Allow him to develop freely, for everything will
surely come to him of its own accord” (Bowers, 1996, p. 114).
His first public appearance, according to Faubion Bower’s biography, was inNovember, 1882 at a fund-raising concert in the Cadet Corps which Scriabin had
entered a couple of months before. Here, Scriabin played one of Mendelssohn’s“Gondolier’s Song” and a Gavotte by J.S. Bach. According to the recollectionsof his Aunt Lyubov, he “was so excited he forgot the ending of the Gavotte. He
paused an instant and improvised the rest with his own made-up chords”(Bowers, 1996, p. 121).

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After this debut at the Cadet Corps, Scriabin asked his aunt for formal music lessons. However, it was not before summer 1883 that Scriabin started to study with
Georgi Conus. Conus was 21 years old and still a student himself of Tanejeff andArensky at the Conservatory. Conus wrote to the first biographer of Scriabin, JuriEngel, about his lessons with Scriabin:
What a puny boy he was! Pale, short, looking far younger even than his years. He
played piano neatly and fluently, but weakly. The first piece, I gave him Weber’s“Perpetuum mobile” Op 24, and, though he played it fast enough, he hadn’t thephysical stamina to make it anything more than something ethereal, and therefore
monotonous. All that summer of 1883 I taught him, while the old ladies always told
me how talented his mother had been.
Quoted according to Bowers (1996, p. 137)

In the winter of 1883, Scriabin’s lessons with Conus stopped, and in October 1884, hestarted to study with the famous piano pedagogue Nicolai Zwerev (1832–1893) inMoscow. At this point, it seems that Scriabin rapidly developed his pianistic technique, because the repertoire he mastered was increasingly difficult. He played
Haydn’s Variations in f-minor and learned all 12 difficult “Wanderbilder” by Adolf
Jensen (Op. 17) by memory in 1 week. He studied Chopin and astonished Zwerev byhis virtuosity when interpreting Schumann’s “Etude on a Paganini Caprice” in E-flat,
Op. 10 (Bowers, 1996, p. 134).
In April 1885, the 13-year-old Scriabin played Schumann’s Papillons in public.
Aunt Lyubov notes: “Alexander missed every one of the bass d’s and the high, towerclock chime at the end. I laughed and leaned over to my friend: My Shurinka is doing
badly. She answered me: if he had played nothing but wrong notes, you would stillnote that he is a true talent” (Bowers, 1996, p. 135).
Not long after this concert, Scriabin was involved in an accident threatening his
pianistic career. He was run down by a horse carriage and broke his right clavicle.
However, there are no further hints in the available sources concerning a prolonged
pause or pains following this mishap.
In 1887, after 3 years of private studies with Zwerev, Scriabin was admitted to the
Moscow Conservatory without an entrance examination as Vassily Safonoff, thehead of the piano department, had followed his pianistic development since his debutof Schumann’s Papillons. The training at the Conservatory took 5 years and included
piano as a major subject in addition to a year each of theory, solfeggio, and harmony,
1 year of counterpoint and fugue together, and 2 years of free composition. In 1887,
the piano faculty consisted of Safonoff, a former student of Leschetizky (asScriabin’s mother had been); Paul Schloezer, the eminent concert pianist; and Paul
Pabst and Alexander Siloti, former students of Liszt. The climate was extremelycompetitive and tense, and intrigues were a daily occurrence. Zwerev hated Safonoff
and sent his “star-student” Rachmaninoff to Siloti. As a teacher, Safonoff became
one of the most important founders of what is known today as the “Russian Piano
School.” His teaching methods have been described in detail by some of his former
students and published in his book, Novaya formula (Safonoff, 1916). Safonoff paid

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close attention to technical issues, such as seating and the position of the hands. He
put together special piano exercises involving the thumb, which he considered to be“the pivot of all technical difficulties” (Safonoff, 1916). He taught the students to use
their hands and arms as a whole, using smooth and rounded movements without any
fixed and “dead spots” (Leikin, 2011, p. 21). Chords were never to be prepared in a
stiff position, and the hand had to fall from above onto the keyboard using gravity.
As soon as the chord sounded, the fingers had to immediately relax and close again
into a soft fist while the hand was moving up. Difficult virtuoso passages were to
be practiced pianissimo, without the pedal, and in a slower tempo. Chords were to bevoiced differently depending on the circumstances and either the top notes or the
lower notes had to be highlighted. Brilliance in octaves was usually achieved
through emphasizing the outermost voices. Pedaling played a prominent role inhis teaching, and he demanded clarity of his sound. His credo was that the“vividness of tone is the only condition of fruitful study” (Leikin, 2011, p. 23).
Indeed, all these pedagogical principles aimed at achieving the best tone quality
with the least physiological effort. It was not by chance that so many eminent
pianists, such as Joseph Lhevinne, Nikolai Medtner, and of course Alexander
Scriabin, came from his class. Obviously, Scriabin made further progress. In
February 1891, at the age of 19, he performed the first movement of Henselt’s Piano
Concerto. A review of this concert published in the “Moskovskie vedomosti” onFebruary 28, 1891 praises his accomplishment:
Henselt’s Piano Concerto, whose unconventional virtuosic techniques make it oneof the most difficult piano compositions, was played by Scriabin, student of Professor V.I. Saffonof, with such calm and self-assurance that can only be expectedfrom an experienced virtuoso. Scriabin definitely makes huge progress and not
only with his technique; his playing is extremely charismatic, having all signsof purely artistic talent.
Quoted after Leikin (2011, p. 23)

2 SCRIABIN’S INJURY IN 1891
In the last lesson of the school year, in the summer of 1891, Safonoff asked Scriabin
to “deepen his tone. . .sink into the keys, don’t skitter over them” (Bowers, 1996,
p. 149). In this year, Scriabin had been much impressed by his classmate Joseph
Lhevinne who had played the “Réminiscences de Don Juan,” an extremely virtuosic
opera fantasy by Franz Liszt. This work imposes a number of extreme technicaldemands on the pianist, among them fast passages in chromatic thirds, rapid leapsin both hands across almost the whole width of the keyboard, and long and loudoctave passages and tenths, which were almost impossible to execute for Scriabin,since he could barely grasp a ninth with his relatively small hands (Fig. 1).
Obviously, Scriabin practiced this piece extensively during the summer holiday.
His family had rented a farmhouse at the banks of the Klyazma River and had

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FIGURE 1
Excerpt from Franz Liszt’s “Réminiscences de Don Juan” (LW 80): shown is a passage of thevariations on the “Champagne Aria.” The rapid octave passages in the left hand and theforceful chords and wide span arpeggios in the right hand are extremely difficult.

probably also borrowed an upright piano as they used to do during the previous summer holidays. Bowers imagines that during this summer, “From the river, from deep
within the forest, the music of Mozart as viewed by Liszt resounded. He pounded andpounded mercilessly repeating every difficult passage over and over. . .” (Bowers,
1996, p. 150).
It remains open whether the indeed countless repetitions or the technical demands of the piece itself produced the injury. Scriabin never precisely described
the symptoms in his letters or in his diary; however, it seems that he suffered frompain and also weakness and a deterioration of motor control of his right hand. He
mostly refers to his “suffering right hand” or to his “weak right hand” (see below).
The symptomatology can be more deduced from the diagnoses of the doctors heconsulted.
When he returned after summer to meet Safonoff, it is reported that the latter advised him to take Oleum Rizini (castor oil), which is known as a medicinal purgative.
Furthermore, Safonoff wisely encouraged Scriabin to continue playing, but work
very lightly on Mozart’s d-minor piano concerto. He commented, “this will relieve
your indigestion from Don Juan’s hot spices” (Bowers, 1996, p. 150). Scriabin visited several doctors, who had less positive news for him. According to Anatole
Leikin (2011, p. 24), Dr. Zakharin, professor of medicine, concluded that it was
not an overexertion due to long hours of practicing. Rather, it was paresis thatafflicted the same arm that had been hurt in the accident Scriabin had had 6 years
earlier at age 14 when he was struck by the horse carriage in Moscow and his collarbone was broken. Dr. Grigory Zakharin, the same physician who had calmed Aunt
Lyubov 14 years earlier, now concluded that Scriabin’s paresis was incurable. He
ordered him to abstain from all practicing and prognosticated the end of his career
as a public performer (Leikin, 2011, p. 25).

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Scriabin was devastated. He wrote in his notebook:
At twenty—Gravest event of my life. . .Trouble with my hand. Obstacle to my supreme goals—GLORY, FAME. Insurmontable according to the doctors. This was
my first real defeat in life. First serious thinking: Beginning of self-analysis.
Doubted, however, that I will NEVER recover, but still my darkest hour. First
thinking about the value of love, religion, God. Still a strong faith in HIM(Jehova rather than Christ). I prayed from the bottom of my heart, with fervor,
went to church. . ..Cried out against fate, against God. Composed first Sonata with
“Funeral March.”
Bowers (1996, p. 168)

After the catastrophic summer in 1891, Scriabin practiced with his left hand alone.
He developed an extremely independent and proficient virtuosic style that is reflected
in his 1894 compositions for left hand alone and in many of the later left-hand passages of his piano compositions. Obviously, he recovered partially, because he wasable to pass his final exams in spring 1892, albeit not without pain. Each candidate
was required to perform an easy and a difficult piece. According to Bowers (1996,
p. 154), the pain had returned acutely before the examination. As his difficult piece,
Scriabin played the very same Don Juan fantasy that was the cause of the previous
year’s disaster—and performed brilliantly. He was awarded the “Little Gold Medal.”His classmate, Rachmaninoff, however, won the Great Gold Medal for “excellency
not only in piano, but also in composition.” Scriabin was now a “Free Artist.”
In the subsequent 2 years, Scriabin increased his activities as a composer and also
as a piano teacher. His teaching style benefited from his personal experiences. For
example, in a letter from June 11, 1892 addressed to his adored Natalya Sekerina, headvises her:
How are your musical studies going? Were my exercises useful, and if yes, do yourfingers hurt? In any case I advise you not to despise the exercises: after a month,
the usefulness will become apparent. One only must not overstrain the fingers,
because then you might overuse the muscles which is extremely painful.
Quoted according to Hellmundt (1988, p. 44).

His pains were recurrent, and Scriabin refrained from playing and practicing his
usual pianistic repertoire, as he had been obliged to do before his exams. It seems
that he was afraid of contracting new overuse pains. As a consequence, after 1892
no longer played repertoire other than his own pieces in public. A planned concert
tour in winter, 1892/1893 had to be postponed due to his hand pains. In his letters, hefrequently apologizes for his bad handwriting, which he blamed on his lack of exercise, not having been able to write longer letters (Hellmundt, 1988, p. 46). However, the increase in the length of letters and the fact that he stopped mentioning thepains between the summers of 1892 and 1894 are clear hints that at least his writing
abilities recovered (see letters no. 3–9 according to Hellmundt, 1988).
New aspects concerning his health became apparent. In summer, 1893, he again
visited Dr. Grigory Zakharin because of recurrent pains. Scriabin gave his friend
Natalya Sekerina a detailed report:

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His examination lasted a long time and touched every facet of my life. . . .. It seems
there was not a single stone he left unturned. . . . Then he brought up the questionof my moodiness. How unnatural it was, he said for me to change so quickly up anddown. This affects me horribly. So much volatility works on the nervous system. In
brief he dressed me down. Then he passed sentence on me: A quiet life in the Caucasus and bathing in the Black Sea. He promises that this treatment will restore
my hand. . .
Hellmundt (1988, p. 47)

Another doctor was consulted: Dr. Alexander Belyaev, chief physician at the Surgical Clinic of Moscow University. Both doctors agreed that the cure for both the hand
and the nervousness of Scriabin was a regular and tranquil life, bathing in seawaterand consuming a diet of kumiss. Kumiss is a traditional Tartar and Mongol dairy
product, similar to kefir, made from mare’s milk and containing 1–3% alcohol. Toward the end of the nineteenth century, kumiss had a strong reputation as a cure-all.
Among the notables who tried the cure were the writers Leo Tolstoy and Anton
Chekhov. Scriabin went to Samara and wrote long letters to Natalya:
Just as you play my letters on your piano, I put yours by my music papers andpencil. But I have to admit that work of any kind is rarely possible during the kumiss cure. One cleverly calls the treatment “harmless alcoholism”
Letter between June 28 and July 10, 1893, Hellmundt (1988, p. 54)

Interestingly, Scriabin learned that his friend Kolja Avierino, a talented violin player
with whom he shared a flat in Moscow for some months as a conservatory student,
was also suffering from severe hand problems and visited the world famous Prof.
Charcot in Paris, who prescribed electricity and massage. Scriabin wrote angrily
to Natalya in August, 1983:
The professor has examined him at length and prescribed electricity and massage.
That was all he advised him, nothing new. So that is the latest most advanced
school! They just look at the breakneck passages that produce cripples and study
how people injure themselves, instead of serving the true, good, and the artistic.
No one protests! No one abolishes this. They are concerned with statistics, howmany musicians injure themselves. . .
Hellmundt (1988, p. 60)

In the above letter, Scriabin laments the lack of specialized doctors who understood
the real needs of the musicians. To my knowledge, this is the first documented call ofan active musician to express the need for a field that eventually became known as“Musician’s Medicine.” It took almost a century until this field emerged in 1989 (fora review, see Harman, 2010).
In 1894, Scriabin met the influential publisher and Maecenas, Mitrofan Belaieff.
Belaieff was the wealthy owner of a wood dealer enterprise and dedicated to the promotion of Russian composers. In 1884, he became the founder of the “Glinka prize,”
which was awarded annually. In the first years, the winners included Borodin,

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Balakirev, and Tchaikovsky; later, Scriabin won the award several times. Belaieff
was deeply impressed by the creative talent of the young composer and persuaded
Scriabin to compose for his publishing company. He further arranged a concert in
St. Petersburg, where Scriabin gave a concert on March 7, 1895. The reviews werepredominantly positive. César Cui wrote in the Journal that week:
Such is my joy of devoting these few lines to A. N. Scriabin, an unquestionable
great talent for composition. . ..He is still quite young, only 22, and unless I am
mistaken, he has written only for piano and small pieces at that. . . .They are nervous pieces, and by their prevailing minor key bear some of the marks ofsickliness. . .
As a pianist his playing is nervous, arhythmical, and at times unclear. He exaggerates soft and loud contrasts. His left hand is stronger than his right and sometimes smothers it. He played better with one hand in the Nocturne than he did with
two hands in the other pieces.
Regardless of his unsatisfactory performance, he had considerable success. In thiscase, in contrast with what usually happens, the composer carried the performer.
Quoted after Bowers (1996, p. 197)

In this review, the renowned Russian composer César Cui first clearly addresses the
weakness in tone of the right hand, by saying that the left hand is “smothering” theright. Furthermore, he mentions the Nocturne for left hand alone, Op. 9 for the firsttime. We will later comment on the special effects Scriabin was able to achieve inthis work.
After this concert, Scriabin returned to Moscow riding the wave of success.
He played an official debut on March 11, 1895. His friend and publisher wrote
to Scriabin’s former piano professor Safonoff concerning the pianistic side of
Scriabin’s performance:
As a performer he is regarded more mistrustfully, and it seems that this is not without foundation. Is this a result of his nervousness? Or is it because he always plays
solo and never with partners? Sometimes he ruffles up his pieces and confuses thelistener. The performance is often to the detriment of the music, and you cannot
assimilate either the rhythm or the melody. . .My desire is that he play his compositions so superbly that this performance will form the basis of a future tradition.
Quoted according to Bowers (1996, p. 198)

Belaieff was worried about Scriabin’s health. After the concerts in Moscow, he proposed that Scriabin consult a European specialist about his nerves. Since Charcot had
died in December 1893, the German specialist Dr. Wilhelm Erb (1840–1921) was
consulted. Erb was the leading neuropathologist in Germany and professor of nervous disorders at the Heidelberg University. The appointment took place on May
16, 1895. Scriabin reported to Belaieff:
First he was very kind and listened to my entire repertoire of stories (we spoke
French of course). Second he gave me masses of advice, and finally made his

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overall prescription, namely hydrotherapy in Switzerland—a four week course ofthis at Sch€
oneck on Lake Vierwaldstettersee—then a journey through Switzerland
and finally sea bathing in Italy.
Hellmundt (1988, p. 83)

Unfortunately, the records of Erb’s consultation have not been handed down; however, the proposed treatment is rather general, pointing at a general neurasthenic
problem—similar to the “kumiss cure” 2 years before—and does not specifically address the motor system or pain in the right hand. In keeping with this, a couple of days
later, Scriabin complained in a letter to Belaieff about headaches, which seem to havelasted several days and prompted him to shave his head (Hellmundt, 1988, p. 87).
During the subsequent weeks at the Lake Vierwaldstättersee, in his letters
Scriabin constantly complains about moodiness, depressive states, and inner tensions, but does not mention one word about his hand (e.g., letters from June 18,
1895, Hellmundt, 1988, p. 92). Only in the fall of 1895, when he was back in St.
Petersburg, was he unsure about the condition of his hand. Concerning an upcoming
concert, in which he was supposed to play his first piano sonata, he wrote to Belaieff,
Since I first was unsure (about the condition of my hand) I asked Igumnov to playin my place . . ..however, K€
onnemann was the first who played my Sonata with loveand so conscientiously. . ..But now things are changing: I think I will be able toplay. . .However, you may decide on it.
Hellmundt (1988, p. 97)

Good news also appeared in a letter from October 23, 1895, concerning the planned
concert tour to Paris, in which Scriabin wrote,
I will be honest: I am more and more enthusiastic about performing in Paris. The
hands do not trouble me so much—thank God.
Hellmundt (1988, p. 99)

After this point, Scriabin built up a successful career as a concert pianist, performing
his own compositions. In August, 1897, Scriabin married the young pianist Vera
Ivanovna Isakovich and then toured in Russia and abroad, culminating in an
extremely successful concert in Paris in 1898. That year he became a teacher at the
Moscow Conservatory and began attempting to consolidate his reputation as acomposer. During this period, he composed his cycle of etudes, Op. 8, several setsof preludes, his first three piano sonatas, and his only piano concerto, among otherworks, mostly for piano. The right-hand pain occasionally is mentioned in letters inlater years. For example, in a letter to his long-term mistress (his first wife never consented to a formal divorce), Tatjana de Schloezer, Scriabin writes in February 1911:
Just coming from Leipzig. I had great successes, although I played worse than in
Dresden. My right hand hurt a little bit. The audience probably did not notice it.
Hellmundt (1988, p. 315)

In this correspondence, he also apologizes again for his bad handwriting (e.g., letterfrom December 1911 to Matjew Presman, Hellmundt, 1988, p. 321). Anatol Leikin

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2 Scriabin’s injury in 1891

(2011) comes to the conclusion that Scriabin’s right hand “. . .occasionally acted
up throughout his entire performing career and remained weaker than his left hand.
He felt extremely anxious before every concert and always complained to friends that
his right hand was hurting. Several critics noted in their reviews of Scriabin’s concerts
in his maturity that the composer’s left hand seemed stronger than the right one; manyof them praised Scriabin for the outstanding technical prowess of his left hand” (p. 25).

2.1 CONSEQUENCES FOR HIS PIANO COMPOSITIONSIn Scriabin’s writings, there are many hints toward the impact of his pain syndrome
and its accompanying psychological disaster for his compositions. His first sonata(Op. 6) was finalized in the first few months of summer, 1892; however, the firstdrafts date back to the profound crisis in 1891, when he believed that he would never
be able to reach his ambitious goals. This sonata is an overtly romantic piece, which,incidentally, Scriabin performed only once in his life in 1894. Generally, the technical demands are higher for the left than for the right hand. A dominant preference
for abbreviated three note chords (an octave filled in with a fourth or a fifth), insteadof full four or five note chords, can be noted for the right hand. This would become acharacteristic of his style, as are the wide spans in the left hand. For example, in thefirst movement, the chords of the left hand span up to 11 white keys, which have to beplayed simultaneously. The third movement is a presto “tour de force” of incessantleft-hand octaves demanding an enormous endurance and strength, comparable
to Franz Liszt’s legendary transcription of Schubert’s song, “The Erl King.” Finally,
the last movement, the “Funeral March” starts with an unyielding bell ringing in thebass. The right hand joins in with a fragile sighing motive. In the middle part,the funeral march includes a pianissimo passage “quasi niente,” full of unconventional harmonies played at half-pedal and ghostly coloration. Here, it is remarkablethat the left hand has to play tenths, spanning 10 white keys, whereas the right“weak” hand is confined to octaves, spanning 8 keys. Larger spreads of his right handmight have still been painful (Fig. 2).
In 1894, Scriabin published his two pieces for the left hand alone, the Prélude andthe Nocturne, Op. 9. Later, audiences and critics frequently termed these compositions as “magical pieces.” They indeed are unique since they were composed in acompletely different manner than any left-hand solo piece before. Scriabin attempted
to create the perfect illusion of two hands playing. The means were ingeniously
simple: he avoided any arpeggios (chords not played in synchrony but each note
subsequently with very short time intervals in-between) and restricted the maximal
left-hand span to a tenth. The illusion of “two hands” was created by rapid leaps ofthe left hand on the keyboard that had to be executed in a very controlled manner so
as not to impair the enchanting musical atmosphere, giving the impression of sadpeacefulness and resignation. The leaps between the registers create a wonderful melodic soprano voice and a soft bass voice which, although slightly temporally out ofphase, produce the impression of two separate auditory streams according to the“Gestalt law” of “proximity in pitch,” producing each a musical entity (Carlyon,

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FIGURE 2
Excerpts from the funeral march of the first sonata, Op. 6. The large hand span in the left handis a tenth; in the right hand-only octaves are demanded.

FIGURE 3
Excerpt from the Prélude, Op. 9. The score nicely demonstrates the “two-hand illusion” whichis created by rapid leaps in the left hand.

2004, see also Fig. 3). This stands in contrast to earlier compositions for the left handalone, for example by Johannes Brahms or Carl Reinicke, which were more conceptualized as etude-like pieces to improve dexterity of the left hand and to the tragic
attitude of the highly virtuosic concert for the left hand alone composed by Ravel forthe unfortunate pianist Paul Wittgenstein, who had lost his right arm in World War 1(see chapter “Paul Wittgenstein’s right arm and his phantom: the saga of a famousconcert pianist and his amputation” by Boller and Bogousslavsky, this volume).
Neither the characteristics of an etude nor of a tragic plaint against fate can be foundin Scriabin’s beautiful illusionary pieces.

2.2 SOME DIAGNOSTIC CONSIDERATIONSPain disorders caused by playing an instrument have always been a common problem
and continue to be so to the present day. Fishbein et al. (1988) carried out the mostcomprehensive study of this topic in the United States. They ran a survey of 4025
professionally performing musicians from 48 American orchestras in which they
asked specific questions about pain disorders. A total of 2212 musicians responded
to the survey. Of these, 76% stated they had “serious problems” which affected theirplaying. Forty-nine percent of those with serious problems suffered from

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2 Scriabin’s injury in 1891

musculoskeletal pain, its actual location depending on the instrument played and theparticular strain involved. Violinists typically had problems with shoulders and arms,
while cellists and wind players were generally affected in the neck and back.
Another study of young pianists showed a lifetime prevalence of 25% for pain
syndromes that required at least 2 days away from the instrument (Shields andDockrell, 2000). The sheer volume of ailments is astonishing, but it seems that incidental pain when playing is an everyday occurrence for most musicians.
Extensive practicing (overuse), instrumental constraints, posture abnormalities,
inappropriate or poor technique, stressful psychosocial constraints (e.g., performance anxiety), previous injuries, and genetic predispositions are some of the risk
factors contributing to the development of playing-related disorders.
It is always challenging to make a precise posthumous diagnosis, as the critical
criteria for the diagnosis are usually not available. In Scriabin’s day, it was not possible
to detect signs of nerve compression through electromyography or the measurement of
nerve conduction velocities. The symptoms described are vague, and the term“paresis” was frequently used. Paresis denoted not only motor weakness due to centralor peripheral nerve injury but also any problem of motor agility in a limb. Nevertheless, it seems extremely improbable that the diagnosis of Dr. Zakharin, who attributed
the symptoms to the broken collarbone 5 years ago, was correct. Theoretically, anirritation of the brachial plexus would have been possible shortly after the bone
fracture—for example, due to callus tissue accompanying bone healing. But such
pathophysiological mechanisms cannot be assumed after such a long time has
elapsed. The injury happened 6 years before, and not one report of any medical problem afterward was passed on. In contrast, Scriabin was able to intensify piano practicewithout any pain, paresthesia, or weakness for years. Furthermore, a compressionof the upper fascicle of the brachial plexus, below its passage under the clavicle,
would have caused tingling, paresthesia, and muscular atrophy, symptoms which
would have never been missed by Professor Erb, who was world famous as specialist
for the brachial plexus. Incidentally, in neurology, Erb’s point, a site at the upper trunkof the brachial plexus, located 2–3 cm above the clavicle is named after him!
Any rheumatism also seems unlikely as there is no evidence of the symptoms
included in the criteria for Rheumatoid Arthritis which are classified by theAmerican College of Rheumatology: swelling or reddening of the joints, morning
stiffness, pain occurring mainly in the mornings and at night, and rheumatic nodules(Hammer, 2006). Furthermore, in the case of rheumatism, one would expect a
positive family history and a relapsing worsening of the condition at long term.
The available sources show no indication for such a condition.
Another differential diagnosis has to be discussed—namely, musician’s dystonia.
Musician’s dystonia is a movement disorder with the predominant symptom of lossof motor control due to extensive practice (for a review, see Altenm€uller andJabusch, 2010). It affects about 1% of professional musicians and is still extremely
difficult to treat. In most instances, as was the case with Robert Schumann, it terminates a career as a performer and remains a chronic condition (Altenm€uller, 2005).
Pain is usually not an accompanying symptom. The diagnosis of musician’s dystonia

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has been suspected by researchers, mainly because Scriabin composed pieces for theleft hand alone, which nowadays are repertoire pieces for pianists suffering fromright-hand dystonia. However, this suspicion cannot be substantiated: first, Scriabin
never complained about a loss of motor control of his right hand, which is the cardinal symptom of pianist’s focal dystonia. Instead, his doctors used the somewhat
blurred term “paresis,” which at that time did not differentiate between pain and motor weakness (Altenm€uller et al., 2015). Second, after the acute phase, he was able tocontrol his right hand, however suffered from chronically recurrent pain and lack ofstamina. Third, since focal dystonia is a chronic, and frequently progressive disorder,
one would expect a worsening of symptoms over time, which clearly was not thecase. Finally, the handwriting of Scriabin did not deteriorate, which also would
be expected, since frequently a spread of symptoms to other fine motor activities occurs (Rosset-Llobet et al., 2007). The published facsimiles of his handwriting—be itin letters or in his compositions—show a fluent, well-controlled, and not at all spidery hand writing (see Hellmundt, 1988, figures 19 and 21).
Diagnostically, all the signs point to a chronic myofascial pain syndrome linked
to overuse. This term describes pain which is caused by excessive strain on muscles,
tendons, joints, and soft connective tissues and which is characterized by tight muscles and dull, often shifting pains that get worse upon exertion. No abnormalities
show up in laboratory tests or X-rays. Characteristic symptoms include painful trigger points, particularly at tendon insertion points. Furthermore, the lack of motor
agility due to spinal reflex activity and increased muscular tension as well as pain
when forcing the fingers apart are typical. Both symptoms were part of Scriabin’s
condition. Myofascial pain syndrome linked to overuse is by far the most common
medical condition suffered by musicians and, more specifically, by pianists. The pain
normally occurs in that part of the body which is put under strain due to repetitive
movements over a long period. So, pianists typically suffer from pain in the forearms,
hands, and finger joints, and occasionally also in the upper arms and shoulders. Obviously, Scriabin also had problems in these areas. The pain is normally set off by
overuse and at first is only felt while playing the instrument but not during everyday
activities. There is evidence that this was Scriabin’s experience. The pain is triggeredby extended periods of playing while preparing for important concerts and practicing
unaccustomed techniques under time pressure. These were also clearly factors for
Alexander Scriabin, if we think of the new technique of “deep sound” he attemptedto achieve in Franz Liszt’s Don Juan Fantasy.

3 A MUSICAL-MEDICAL ASSESSMENT
How would Scriabin’s ailments be treated today? Acute overuse injuries are very
common and generally do not require any specific medical treatment. A few days’
rest, cold or heat treatment, and careful stretching exercises are all that is needed forthe majority of these injuries to clear up very quickly. If the pain lasts longer than 3days, then nonsteroidal anti-inflammatories should be taken under a doctor’sAuthor's personal copy
4 Codasupervision. Alexander Scriabin’s pains lasted clearly longer than 3 months, so wemust assume they had become chronic. Our understanding of chronic pain has changed over the last decades. Nowadays, it is believed that chronic pain is mainly due tomaladaptive central nervous plasticity. Via increasing efficiency of synaptic transmission in the dorsal horn of the spinal chord and downregulation of pain-inhibiting
circuits, persistent pain leads to increased afferent inflow to the thalamus and themore centrally located neural networks relevant for pain processing (Fields andBasbaum, 1999). Moreover, the anxiety caused by what is perceived as a serious pain
event—which Scriabin clearly experienced—promotes a change in the somatosensory representation of the painful limb in the parietal cortex. According to Flor et al.
(1997) and Henry et al. (2011), in chronic pain, the homuncular topography is distorted, enlarged, and dedifferentiated. This prominent change in neural representations correlates to pain memory. Typical for pains related to such an associative
network of pain memory, symptoms mostly arise when playing, and they occur indifferent locations and in different forms. A crucial part of therapy is to allay thepatients’ anxieties in order to break the vicious circle of feeling under threat and prevent the pain from becoming fixed in the pain memory. The sufferers should once
again start to play their instrument, and it has been shown that it is best to playfor no more than 10 min at a time, several times a day at first. Scriabin’s teacher
Saffonof gave him the right advice in encouraging him to study technically less demanding pieces by W.A. Mozart in order to cure him from the “hot spices of Don
Juan.” Unfortunately, Dr. Grigory Zakharin did not react in a supporting way. Tellingyoung ambitious Scriabin, who was so driven and determined to excel and to become
famous as a concert pianist, that he would never be able to attain his high-flying goals
only increased the psychological pressure and contributed to the downregulation ofpain thresholds. For Scriabin, Zakharin’s verdict was metaphorically a “death
sentence.” With respect to the kumiss cure, which both Dr. Grigory Zakharin and
Dr. Alexander Belyaev had recommended, it can be assumed that it was mainly
intended to reduce the accompanying psychological distress, which was probably
a major symptom in the months after the acute pain. Likewise, in favor of a more
psychosomatic disorder is the assessment and counseling of the eminent neurologist
Erb, who recommended a bathing cure close to Lake Geneva. When he examined
Scriabin, the latter already had found his way back to the piano and probably was
predominantly suffering from psychological issues, such as uncertainties about his
financial status, marital conflicts, and anticipatory anxieties concerning the longterm ability to work under pressure with his previously injured right hand. Of course,
these fears may well have originated in his perfectionist and constrained personality.

4 CODA
Alexander Scriabin’s medical history is instructive in many ways. He received excellent training from an eminent teacher of the famous Russian Piano School, and he
was clearly an excellent pianist, as he was able to perform his own highly virtuosic

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piano works. Contemporary reviews of eminent experts and witnesses of his piano
recitals in Europe and the United States praised his playing. As further, even more
vivid evidence of the quality of his playing and his highly captivating personal style,the original Welte-Mignon and Hupfeld piano-roll recordings of his works can be
consulted (Leikin, 2011).
His crisis as a young man is a warning to all aspiring young pianists: A change oftechnique, for example, of sonority of sound or of repertoire, needs the careful preparation and supervision by an experienced teacher and should not be undertaken
alone. This is especially important if the student is inclined toward compulsive working behavior, a self-destructive and self-exploiting lifestyle, or to excessive demands
on himself. From a musical-medical point of view, Scriabin’s is an interesting casebecause we have at our disposal sufficient source material, which allows us to trace
many details of a major historic artist’s case history. The causes of pain, the courses it
took, the desperate efforts to fulfill his concert commitments, and the psychologicalconsequences it produced are typical for any ambitious young artists seeking help ina present-day musician’s medicine clinic. From a musicological standpoint, the energetic diversion of Scriabin’s creative potential away from piano playing to composition shows the tremendous will for creation, which had already set him apartas an adolescent. For us, Scriabin’s decision to follow a career as a composer rather
than as a pianist was a blessing, because it allowed his creative talent to be developed
to masterful perfection.

ACKNOWLEDGMENT
The author would like to thank Maria Lehmann for her careful language editing and improvement of the original manuscript.

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