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This study investigated death anxiety in patients with primary brain tumor (PBT). We examined the psychometric properties of two validated death anxiety measures and determined the prevalence and possible determinants of death anxiety in this often-overlooked population.
Two cross-sectional studies in neuro-oncology were conducted. In Study 1, 81 patients with PBT completed psychological questionnaires, including the Templer Death Anxiety Scale (DAS). In Study 2, 109 patients with PBT completed similar questionnaires, including the Death and Dying Distress Scale (DADDS). Medical and disease-specific variables were collected across participants in both studies. Psychometric properties, including construct validity, internal consistency, and concurrent validity, were investigated. Levels of distress were analyzed using frequencies, and determinants of death anxiety were identified using logistic regression.
The DADDS was more psychometrically sound than the DAS in patients with PBT. Overall, 66% of PBT patients endorsed at least one symptom of distress about death and dying, with 48% experiencing moderate-severe death anxiety. Generalized anxiety symptoms and the fear of recurrence significantly predicted death anxiety.
Significance of results
The DADDS is a more appropriate instrument than the DAS to assess death anxiety in neuro-oncology. The proportion of patients with PBT who experience death anxiety appears to be higher than in other advanced cancer populations. Death anxiety is a highly distressing symptom, especially when coupled with generalized anxiety and fears of disease progression, which appears to be the case in patients with PBT. Our findings call for routine monitoring and the treatment of death anxiety in neuro-oncology.
MUSIC HISTORY SINCE 1789 is a series of footnotes to Beethoven, and in some respects this book simply adds to their number. The chapters that follow offer a new theory of music historiography, one that builds on antagonistic interpretations of Beethoven, and then instantiate this critically and analytically grounded historical theory in a sequence of essays on Beethoven.
It is a truth universally acknowledged by concertgoers and listeners at home that Beethoven's music was a significant event in the history of human art, comparable to the work of Homer, Dante, or Shakespeare. It may surprise such people, whose views must be taken to be overwhelmingly the majority, democratic view on classical music, that many musicologists would consider their Ludwigolatry ‘problematic’, ‘Eurocentric’, ‘tediously canonical’, and ‘elitist’. As a member of the band of elite consumers of classical music, there is a considerable irony, as well as an abundant lack of humility, in the fact that so much as one musicologist could hold such jaundiced views of the general population, but this is the world we inhabit. The author of a recent study, Beethoven: The Relentless Revolutionary, who has (from one musicological perspective) the brazen gall to argue for a political as well as a musical revolutionary quality – i.e. an anti-elitist, progressive quality – to Beethoven's music writes apologetically, ‘as must surely be evident by now, I am not a musicologist’, and while ‘I hope this study will be of interest to music professionals, I have presented my perspective on Beethoven so as to be accessible to lay readers’ (Clubbe 2019, xviii). Such is the anxiety this discipline of musicology causes among the scholarly population.
I am utterly at ease with calling artists like Beethoven ‘geniuses’, and enjoying with the rest of classical-music-loving humanity the ‘transcendent’ experience that his and other composers’ music can bring. Such reprobate behaviour befits my station as a low-born scion of a family in which only three men (I am the third) who have lived since the premiere of the ‘Eroica’ Symphony were not coal or tin miners.
SHORTLY BEFORE THE RECAPITULATION in the first movement of Beethoven's Violin Sonata in A major, op. 47, the so-called ‘Kreutzer’ Sonata, the pianist plays a pp chord of G– (see Example 6.1).
This chord (bb. 324–5) barely merits a mention in two recent analyses of the movement, one that appears in a broader study of musical ‘becoming’ by Janet Schmalfeldt (Schmalfeldt 2011, chapter 4) and one by David Damschroder which is written in conscious dialogue with hers (Damschroder 2016, chapter 10). Both are worth examining in detail. Although she explains what it leads to, Schmalfeldt says nothing about the pp G– chord itself:
Beethoven … [gives] the violinist a sequential repetition of the pianist's cadenza, here prolonging the dominant of the subdominant (iv) – that is, the dominant of the very harmony with which the exposition eccentrically began. The violinist's sequence in turn motivates a full-fledged statement (at mm. 326–35) of the main theme's first phrase, but now in D minor; this is of course the ‘wrong’ key for a conventional recapitulation, but the right key, the subdominant, for a false recapitulation in this movement. A great advantage of this maneuver is that it lands the phrase on an F-major chord at m. 334 – one more opportunity to reinforce the role of F♮ as a pivotal tone in this movement. The semitone with which the false recapitulation began – A–B♭ – then serves (at mm. 336–40) as the impetus for the move toward the true home-key recapitulation; but note that the chord on F (at mm. 340–43) plays the penultimate role in this modulation (Schmalfeldt 2011, 103).
Schmalfeldt is so keen to describe the gesture which establishes a false recapitulation, and its conversion to a true recapitulation, that she fails to mention the G– chord which is strangely interposed between the dominant she highlights and the tonic that it indicates. Her point is well made that D– is the ‘right key … for a false recapitulation in this movement’, because the exposition's P theme starts on that chord, which (as she has already noted earlier in her analysis) is prepared at length in the preceding slow introduction.
IT IS THE ‘ENDLESS sameness’ of merely empirical data to which Constructionist, reactive music historians, such as Mathew and Rumph, wish to direct us: the bland facticity of the period of the Napoleonic Wars of 1803–15 which overlap with the heroic style as commonly understood. Beethoven's heroic style, in words such as ‘Kreutzer’ and ‘Eroica’, has a subjective alignment, as part of the body which forms the faithful subject, with the Jacobins whom it postdates by a decade, but the links are not fundamentally empirical in nature. Some empirical connexions certainly do exist, as for instance the melodic gestures Beethoven inherited in a direct line from Revolutionary musicians. But it is not those gestures which constitute the revolution in this music, and it is for that reason that the foregoing analysis has said so little about them. Not in their empirical ‘sound’ (the saleable object that exercises such interest to neoliberal ‘sound studies’) but in its processes of argumentative generation – or to put it another way, in the content rather than in the form – do we find the ‘meaning’ of these works. These works attempt to establish in music a new possibility that is characterized not by something newly fixed – such as an abandonment of Tonic–Dominant polarity and its replacement by something else (or nothing) as the prime ordering principle of tonality – but by a determinate negation of the restrictive ideological laws of really existing musical forms. Their composer, their genre, their high aesthetic register, and the country in which they were written, are among the long list of empirical irrelevancies to an evental history. The exigent questions for evental history is never ‘Who wrote this?’, or ‘What genre is it in?’, but always ‘What is the subject of this music?’, and ‘What role does this music play in producing a present in a past moment?’
The pseudo-Beethoven of the Reconstructionist school, the composer whose reactive ‘Eroica’ means what Wellingtons Sieg outwardly shows, fits revolutionary propositions to conservative custom, in a reactive subjective response on the model of the Thermidoreans. Such Beethovenian music could and does exist, and Wellingtons Sieg may be an example of it.
CONSCIOUSLY WRITING IN THE shadow of Hayden White's pioneering work (White 1973, 1990), contemporary theorists of history, principal among whom are F. R. Ankersmit (Ankersmit 1994, 2001, 2012), Keith Jenkins (Jenkins 1991, 2003), and Alun Munslow (Munslow 2006, 2010), advocate a theoretically sophisticated model of history-writing which can treat what they diagnose as a crisis of epistemology for the writing of history in the post-war West. Broadly postmodern–deconstructionist, and for that reason explicitly anti-empiricist, the theory of history which has taken shape in their writings is one that requires traditional historical scholarship to respond to the ‘devastating’ challenge represented by an assortment of intellectual repositionings which are familiar across the humanities – ‘the linguistic turn, deconstructionism, post-structuralism, post-feminism, post-colonialism, post-Marxism, postmodernism, etc.’ (Jenkins and Munslow 2004, 1). The crucial doctrine of this postmodern historiography is that history-writing is fictive, i.e. that as a form of writing above all else, it is an act of imagination which recasts the past in narrative form. This does not mean, though, that history is fictional, ‘for in fiction the imagined goes “all the way down”’, but it is rather ‘fictive in the sense of fictio; that is to say, made up, fashioned, created, fabricated, figured’ (Jenkins and Munslow 2004, 3).
In consequence of this contention they advance an interesting critique of what might seem like a historical commonplace, namely an epistemological commitment to what philosophers call ‘the correspondence theory of truth’. Simply expressed, the theory holds that ‘x is true if and only if x corresponds to some fact’ and therefore ‘x is false if and only if x does not correspond to some fact’. Philosophers between Aristotle and Immanuel Kant were largely content with this theory, but it has come under general fire since. Although arguments have taken various forms, the closest to that of the postmodern theorists of history is one which echoes the ‘immaterialist’ dictum of George Berkeley that ‘an idea can be like nothing but an idea’ – though the theorists’ more proximate source may be Jacques Lacan's claim that ‘there is no such thing as a sexual relationship’,
WHEN A WORK IS as familiar as Beethoven's ‘Kreutzer’ Sonata, it can be easy to forget how atypical it is of its genre and form. In a brief analytical essay on it, Donald Francis Tovey comes straight to the point:
It was, and still is, a very unusual thing that a work introduced so broadly in a major key should proceed to a stormy and passionate first movement in the minor. I am aware of only two instances before the ‘Kreutzer’ Sonata, the first being Mozart's G major Violin Sonata (K. 379), where, however, the opening adagio is felt as something much more independent than an introduction, and the second being a very early pianoforte quartet on precisely the same lines as the Mozart sonata, by Beethoven himself – a work which he afterwards carefully disowned. … It is only the first four bars (for the unsupported violin) that are really in A major, though their breadth is such that the seal of A major seems at once set upon the work. But the entry of the pianoforte casts a most dramatic cloud over the opening and sets the tone for that wonderfully wistful, yet terse anticipatory expression that makes this introduction one of the landmarks in musical history (Tovey 1944, 135).
This ‘dramatic cloud’ invites comparison with a mid-nineteenth-century landmark in music history, the opening of Tristan und Isolde. Example 7.1(a) offers a voice-leading analysis of the piece, showing the function of the ‘Tristan chord’ as an example of what Riemann labels one of four ‘characteristic dissonances’, that is notes added to an upper or lower dominant which are ‘borrowed from the other dominant’.
The ‘Tristan chord’ is based on the example Riemann gives in A minor: ‘for the minor subdominant, the prime of the minor upper-dominant and fifth of the major upper-dominant respectively (in A-minor, b | d f a…)’ (Riemann 1893, 55). Ernst Kurth, who reads the harmonic function in a different way, notes the psychological effect of Wagner's pungent melodic dissonance in b. 2.
WE MUST WRITE MUSIC history from the perspective of truth; truth is what we cannot access empirically. That is the hard urging of evental history, and it is necessary to determine how the scholarship this calls for can be achieved without simply replacing an old family of dogmatisms – the various genres of empirical history writing – with a new and equally pernicious form. Were the truth of the Event to be misprised as a kind of arcane knowledge, on the basis of which every historical datum can be allocated a determinate meaning, a new and essentially Constructionist dogmatism would thereby frustrate all attempts to reorientate the field of music history.
To escape dogmatism, it is therefore necessary to critique one of the oldest notions in aesthetics, that art imitates nature, with meaning flowing untrammeled between them. Adorno complicates this idea by making three interrelated, paradoxical points that provide a useful way forward, even though this entails taking steps away from Adorno and from the European tradition of philosophy. The paradoxes are that (1) art imitates nature, which does not exist; (2) art presences truth, which cannot be made; and (3) truth negates the artwork which presences it. He unfurls them with characteristic reconditeness:
Nature, to whose imago art is devoted, does not yet in any way exist; what is true in art is something nonexistent. What does not exist becomes incumbent on art in that other for which identity-positing reason, which reduced it to material, uses the word nature. This other is not concept and unity, but rather a multiplicity. Thus truth content presents itself in art as a multiplicity, not as the concept that abstractly subordinates artworks. The bond of the truth content of art to its works and the multiplicity of what surpasses identification accord. Of all the paradoxes of art, no doubt the innermost one is that only through making, through the production of particular works specifically and completely formed in themselves, and never through any immediate vision, does art achieve what is not made, the truth. Artworks stand in the most extreme tension to their truth content. Although this truth content, conceptless, appears nowhere else than in what is made, it negates the made.
REFLECTING ITS ADVENT IN an age when the wonted relation between tradition and new forms of subjective experience had been cast into revolutionary doubt, the aesthetics of music composed, performed, and listened to in the decades after 1789 seemed preoccupied with a question: What kind of object is music? Is it a ‘work’, the product of creative labour by one or more human beings (operating at a level anywhere between genius and incompetence), whose identity as a work can be fixed by its notation in a score; an object to some degree autonomous from general history because it exists for its own internal compositional logic? Or is it some species of quantum sonic event discernible only in performance, which may or may not have a notated trace; its salient attribute not logic but expression (of an idea, an emotion, or the joy of bodily stirring)? If music is better understood as performance, then its essence is to be found in the social functions it discharges and supports; if it is better understood as a ‘work’, then in its disinterested and self-ruling inner workings we can descry a form of cognition without representational concepts, which betokens latent danger for a social world that it no longer assuredly flatters by imitation.
A more abstract and pointed question therefore forms the half-hidden foundation for the busy surface of musical activity: Is it possible to critique convention, and thus become free from it, or should one find a comfortable accommodation with convention, and so remain bounden to it? At this point music's theme discloses itself as an unexpected analogue to the political question asked in the 1770s and 1780s, first in the British colonies of North America and then in France: Should people be subjects of a monarch or citizens of a republic? And in this neither politics nor music was breathing peculiar air, as even the briskest scrutiny of developments in science or the other arts would corroborate. If urged to fix a name to the spectre haunting the age, one could do worse than submit that almost every theoretical, moral, practical, and amatory sphere of human activity was preoccupied with considering what to make of the call to emancipation – which can be considered the watchword of the unfinished project of modernity.
CRITICAL VIEWS ON BEETHOVEN's heroic style can be roughly split into two traditions. The first, classic, view states that certain elements of Beethoven's heroic style can be traced to music composed in France in the wake of the French Revolution. But in the last two decades, in contrast, scholars such as Stephen Rumph and Nicholas Mathew have argued that neither Beethoven's politics nor his music can be so easily linked to the French Revolution. They argue that his works should instead be situated in the context of more conservative German responses, and that we should be paying more attention to his occasional works such as Wellingtons Sieg rather than focusing just on canonic works such as the Third Symphony. I shall return to this revisionist account, but will start with the classic tradition.
The evidence of revolutionary influence on the heroic style is extremely substantial. Maynard Solomon writes that:
The influence of French Revolutionary music on Beethoven was no secret to his contemporaries and early admirers. Beethoven's most brilliant critic, E. T. A. Hoffmann, pointed to Cherubini's presence in the Overture to Coriolan; another German music critic, Amadeus Wendt, likewise heard echoes of Cherubini in the Leonore Overture; and Robert Schumann recognized the influence of Méhul's Symphony in G minor on Beethoven's Fifth Symphony. That Fidelio was adapted from a French post-Revolutionary opera subject and that the opera was a German example of French ‘rescue opera’ has long been known. But it took the researches of twentieth-century scholars – Hermann Kretzschmar, Ernst Bücken, Hugo Botstiber, Adolf Sandberger, Ludwig Schiedermair, Arnold Schmitz, Alfred Einstein, Boris Schwarz, and others – to establish and trace in some detail the breadth of these influences in the formation of Beethoven's post-1800 style. For example, Schmitz unearthed many examples of parallels between Beethoven's music and the works of Gossec, Grétry, Kreutzer, Berton, Méhul, Catel, and Cherubini and […] documented the use of French material in such works as Beethoven's First, Fifth, and Seventh Symphonies, the Egmont and Leonore overtures, the ‘Funeral March’ Sonata, op. 26, and the Violin Sonata, op. 30, no. 2 (Solomon 1977, 138).