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In 2017, New York City (NYC) boasted 57,500 jobs in the music industry,

 making it one of the largest music cities in the worldand creating a uniquely musical population that considers the art part of its culture. It is one of the world’s largest and most influential music ecosystems.

In 2019, digital distribution platform Record Union surveyed on 1500 musicians and found that 73% of independent music makers suffer from negative emotions in relation to their music creation.

 When the COVID-19 pandemic started, the musical platform was gone overnight and it has been noted that musicians all over the world have been struggling emotionally,

 with reports of waves of musicians committing suicide.

 Studies from the United Kingdom via UK-based charity Help Musicians found that 87% of music artists cite a decline in their mental health after the pandemic,

 but no studies are currently available regarding the status of US musicians, let alone NYC musicians.

As a psychiatrist and fan of music, I cannot help but wonder what is happening to musicians in NYC. As part of answering my own questions, with the hope of shedding some light on the underappreciated other side of the stage, I conducted separate interviews with 2 NYC-based professional musicians. 

Musician A is a drummer who completed his musical studies in NYC and has been touring with his band since 2014. Musician B is a pianist who has collaborated with many other musicians since 2016. Both musicians wanted to remain anonymous.

Eds note: This interview has been edited for clarity.

Dr Hong: Would you tell me about your life as a musician before the pandemic?

My band has been on a slow ride for a while. And—for the first time—we had tours lined up when the pandemic hit, and everything got canceled.

 I am a pianist; also studied music therapy and worked as a music therapist. My husband was a full-time musician.

Dr Hong: Tell me about your story after the pandemic hit.

My studio that I usually practiced in shut down, and I could not play drums at all. So, I did not have an outlet—could not see my bandmates. Then I was told $40,000 had gone down the drain from canceling the tour. For so many months, we were just kept in the dark like, 

 After last summer, we thought it would be over, then another surge happened, then I went back down. And then again in the winter, we had another surge, and I hit a very hardcore depression. I have questioned everything because we do not know how long this will go on. I have thought about how I am going to make my life, kind of stuck home in a room. I had no failsafe.I did not know if I had to completely change career like, 

maybe I should start to learn how to code.

Let’s say it was not a good place to be…

Yeah, it was definitely hard. It was a combination. There was a pandemic and also my immigration status. I was in sort of an immigration limbo, and I could not go back and had to be away from my family for a long time. And that was a big part of my mental health crisis. There [was a] lot of anxiety. I was depressed for some time, like after a few months. I still had work because I am a therapist as well, but my husband—he was really hit hard. He literally lost everything in his books for a year. All the gigs, all the tours, all the projects were halted. So that took a really, really big toll on him. And of course, that affects both of us.

Dr Hong: Tell me more about your thoughts on mental health issues during the pandemic.

Honestly, I started drinking very heavily for a while because I did not know what else there was to do. All I had been doing was being in studios playing drums, playing shows, and all of that was taken away. I had nowhere to turn, but just to be alone with my own thoughts. There is no music happening for a year-and-a-half, and this is how you make money. Either you need to find another job, or have a good savings account.

The spring—the beginning—was very, very hard. Summer was a little better because we started doing little things outside and were able to play again with people. And then when it started getting cold, and we were still in this shit show, it was hard again, because we could not play. When the fall came, we were like, 

 It is the beginning of a New Year—there are still no gigs. We are at home all the time. It is very, very hard—many months of a lot of despair, and depression, and anxiety.

Dr Hong: Did you get any help when you noticed that mental health problem?

 I did not feel like it was worth talking about because everyone’s going through something.And unless someone handed it to me, I did not know where to go. I did not really seek out too much. It did not feel like it was an option, like finding somebody to talk to.

For me, I started therapy with a new therapist. Oh, it was very clear to me that that was a huge, huge shift. But it is never easy financially to be in the therapy; that has always been a burden. And finding the right therapist has also been hard.

Dr Hong: What helped you the most to get through the pandemic?

 Realizing there was going to eventually be an end—when you started to see the vaccines come into play, and to see venues opening up at 30% capacity. At least there was a little bit of a light at the end of the tunnel. I was lucky to have my core group of people like my lead singer, who is a mental health advocate. I think that kind of network where musicians understanding other musicians and having a space to talk was very, very helpful. It is very difficult to find people who can understand what you are going through, especially when anxiety and depression are part of your fuel to make your art. For me, knowing someone’s listening—that is already half the battle. Just to be like, 

, and there is someone I can talk to about this. That made me feel a lot less anxious.

For my husband, not knowing what things were going to [happen] was the hard part. We did not know when we were going have gigs again. 

Are we starting to change our whole life? Are we starting a new profession? 

It was helpful just having people starting to plan and starting to have things in the books. Even if they did not happen yet, but they started being talked about as a plan, I think what was helpful to know, 

OK, this is going to happen again one day, and I need to be patient.

Dr Hong: Could you tell me about your thoughts on musicians’ mental health?

Everyone who’s a musician is a little crazy in the best way possible. What I mean is, if you choose to do this for a living, you have to be alittle crazy.And… mental health issues, in my opinion, are probably more rampant in the music industry.

A lot of musicians are very insecure. There is a lot of uncertainty in this profession. You do not know when your next gig is going to be, and all of a sudden, you have a month of full work, but you do not know if it is going be the same for the next month. I am talking about people who only gig—only do shows. We could see last year how people just all of a sudden lost everything they had. You live from day to day. So, there is a lot of uncertainty, which is a huge part of instability. Mental instability or mental hardship that musicians can experience may be from that. On top of that, there is all the other things that go into being a musician, like being sensitive and comparing yourself to others.

Dr Hong: What do you think is needed to support the mental health of musicians?

I think the biggest obstacle is insurance. Nothing seems affordable unless you already have good insurance or can afford good insurance. I think that the music industry should work towards labels being able to give their musicians health insurance.I have never seen that coming. So even most successful musicians—they are not getting it through labels. We are still paying out of pocket. A lot of art was consumed during the pandemic, but for the artists who were making it—they were left to the side, not taken care of.

I think mental health services that are accessible and affordable and easy to find—that is one. And in general, the perception of musicians as real professionals. I hope there is a shift in how society sees a musician. We dedicate our lives to do that, and free people to express and bring them joy, and we should be paid for that. 

Dr Hong: Is there anything you want to add?

 I wish there would be more open conversation like this, and I am so happy to talk about this with you. I think both myself and my bandmates are pretty open about talking about mental health. And I am excited to hit the road again—it has been way too long. Even just going back to our rehearsal space and playing drums loud. It feels good.

Note: Both musicians added their thoughts about streaming services and how to support musicians further.

 Streaming, in my opinion, is the worst thing to happen to musicians. It is great for the consumer: You pay for a CD, it is $20, versus $10/month on Spotify for every song that has ever come out.Musicians make 1/3 of a penny for every song. You would need to play that song 10,000 times for a musician to make about $30. So, if you are talking about streaming, it is not how musicians make a living.That is why so many musicians were affected after the pandemic because the bread-and-butter of income for musicians is live music—that is where the majority of your income is coming from. It is not from streams. For example, ifyou play my song 1000 times on Spotify—I make $3.

 We hate Spotify. We do not use it. These horrible streaming services either need to start paying musicians a different amount or they should not exist, because they are basically making money off of art. So that is a suggestion I have.

I started this conversation as a personal curiosity, but after interviewing these 2 musicians, I felt a sense of duty as a psychiatrist to let their voices be heard by a bigger crowd. Musicians who come to NYC to realize their dreams have a vast spectrum of backgrounds, but when they face mental health issues, they all share similar difficulties. I found that the nature of their profession—the unaffordable insurance, lack of information, lack of channels for open communication, widespread misunderstanding of music as a profession, and systemic problems in the way we consume music—all put musicians in a very vulnerable category for poor mental health outcomes. There should be more accessible and affordable tools, as well as more resources providing tailored advice and information for musicians. All of this can be addressed with regular and open communication—at the industry level one day, I hope—regarding how to turn those ideas into practical measures.

I would like to thank these 2 musicians for sharing their thoughts with total honesty. I hope this interview will help increase the public’s understanding of mental health issues among musicians, and that it will help other musicians who may be struggling with their mental health.

 is a fourth-year psychiatry resident at Maimonides Medical Center in Brooklyn. Prior to current residency training, she obtained a medical degree and became board-certified as a psychiatrist in South Korea. She experienced various cultures growing up and aspires to provide mental health care to underserved populations, including immigrants, LGBTQ+ individuals, and those with socioeconomic disadvantages.

1. Banerjee S, Mank T, Curreri G, et al. 

Economic Impact, Trends, and Opportunities: Music in New York City

. June 17, 2019. Accessed November 23, 2021.

. Songbirds must sing: how artistic voice users perceive their voice in times of COVID-19

 [published online ahead of print, 2020 Aug 18]. 

Nearly 100 unemployed musicians committed suicide during pandemic—opposition deputy

. September 17, 2020. Accessed November 23, 2021.

Study: 87% of surveyed musicians say mental health deteriorated during COVID-19 lockdowns

. March 22, 2021. Accessed November 23, 2021.

One resident interviews 2 NYC-based musicians about their experiences during the pandemic.

Musicians’ Mental Health in the Empire City During COVID-19

Walter Benjamin, (1892-1940) is widely considered the most important German-language cultural theorist of the first half of the 20th century.

 In an intellectual career that spanned and combined Jewish mysticism and political Marxism, he maintained high productivity despite life-long depressive tendencies, but finally took his own life when his desperate flight from the Nazis was frustrated.

 Though virtually unknown to psychiatrists, the key importance in his thought of the concept of “experience”—whether immediate, remembered, degraded, or fulfilling, etc—makes him relevant.

Here, by way of introduction, I refer to his short essay “On the Mimetic Faculty.”

Written in 1933 and only published posthumously, it is elegantly constructed and compact. At 2-and-a-half pages long, it is suggestive rather than conclusive. Attentive to language’s figurative as well as lexical nature, a major concern of the author was its truthfulness whether in reading, speaking, script, or any other form.

Imitation, most obviously in the form of mimicry, is a natural phenomenon. It suggests a “reading” of surroundings resulting in correspondence between organism and environment. Writing before the discovery of DNA, Benjamin proposed that it was based on perceiving “non-sensuous similarities,” another key concept of his even if never defined operationally. Dancing (to the stars) was also an early form of reading, embodying meaning and conviction of truth. Confidence was justified, as it must have had evolutionary survival value. Therefore, though entirely nonverbal, dance has truth content. Over time, however, both organism and environment have changed, and dance and related communal practices (eg, cultic rituals) have weakened in persuasiveness and utility. If some early forms of reading have atrophied, others have emerged. Reading the firmament had survival value for a hunting and migrating species. Naturally acquired fascination with the sky then led to astrology and, later, astronomy and physics, contributing to previously unimaginable insights into and manipulation of nature.

Benjamin was excited by the promise of technology, but anxious that any decline in ability to perceive non-sensuous similarities impoverishes experience. Alluding for support to the theory that words have onomatopoeic origin—even all words, according to some—he speculated that language embodies non-sensuous similarities, too:

“If words meaning the same thing in different languages are arranged about that signified as their centre, we have to enquire how they all—while often possessing not the slightest similarity to one another—are similar to the signified at their center.”

A beloved analogy was that of forming the beautiful image of a mosaic through combining fragments, with each fragment appearing trivial by comparison to the whole, yet vital to completion. Benjamin was very interested in hieroglyphics understood as such fragments, and curious about then-contemporary scholarly theories that they were cyphers of some almost mystical code. Script is an “archive” of non-sensuous similarities—artwork, too.

If contemporary psychiatrists are prepared to engage with Benjamin’s evocative suggestions, poetic in part, all this emphasizes the rather discomforting poverty of the language of DSM—also, the limited “vocabularies” of phenomenology and brain imaging, even genetics, compared to the fullness of experience. Because similarity appears “like a flash,” we must attend carefully to words, behavior, and lab findings, but we miss something if we do not use our mimetic faculty to immerse ourselves more fully in our patients’ worlds to appreciate non-sensuous similarities: learn to “dance” together “to read what was never written.” As “play is to a great extent its school,” not the classroom, the mimetic faculty is also available to patients—sometimes more so—and, for better or worse, it colors their experience of what their psychiatrist is like, as well.

As humanities is more important than ever in our scientific era,

 we will explore issues relating to Benjamin, poetics, experience, truth, and psychiatry in forthcoming publications.

is a medical doctor licensed to practice by the United Kingdom General Medical Council, with a Certificate of Completion of Specialist Training in General Adult Psychiatry (General Medical Council number 2729800). His contributions to psychiatry include being coauthor of the current European Psychiatric Association Guidance on Roles and Responsibilities of Psychiatrists. In 2014, he was elected Honorary Fellow of the Royal College of Psychiatrists. He reports no known conflicts of interest.

An almost preventable suicide: Walter Benjamin (15 July 1892–26 September 1940)—psychiatry in literature

Revolution and History in Walter Benjamin: A Conceptual Analysis

Fulfilling experience: Walter Benjamin—psychiatry in philosophy

5. Benjamin W. On the mimetic faculty. In: Jennings MW, Eiland H, Smith G. eds. 

Walter Benjamin: Selected Writings, Vol. 2: Part 2

Humanities more important than ever in the era of scientific psychiatry

Epilogue: mind, state, society and ‘our psychiatric future.’

Mind, State and Society: Social History of Psychiatry and Mental Health in Britain 1960-2010

8. Ikkos G, Stanghellini G. Walter Benjamin: brooding and melancholia. 

9. Ikkos G, Stanghellini G. Charles Baudelaire (1821-1867): spleen and the city. Submitted for publication, 2022.

10. Stanghellini G, Ikkos G. C Baudelaire (1821-1867), W Benjamin (1892-1940), and the social aesthetics of psychiatry and mental health. Chapter in preparation, 2023.

One doctor introduces the work of philosopher and critic Walter Benjamin and elements of his conceptualization of “experience.”

Non-Sensuous Similarities: Language, Poetics, and Psychiatry

In specializing in cultural psychiatry over my 50-year career, one of the ongoing questions has been: does it take one to know one? Actually, that is a basic question in all of psychiatry. Can clinicians who have never had mental illness empathize and understand well enough those who have? In cultural psychiatry, that translates into potential matches of those of different or similar cultural backgrounds and values. All other things being more or less equal, seeing someone from a similar background often, but not always, helps understanding and comfort.

That cultural challenge has come to the fore once again with renewed attention to racism. Can those thought to be privileged understand racism well enough, and what antiracism role should they have?

In a different area of culture, that of the arts, 2 new productions suggest that surely people of different cultures can cross that bridge successfully. One is the play “The Lehman Trilogy,” which just closed on Broadway and will be moving to Los Angeles, and then hopefully other cities. My wife and I were privileged to see it last November.

“The Lehman Trilogy” is a play written by an Italian writer, produced successfully first in London. It is a story about 3 Jewish brothers who came from Bavaria to Alabama in the 1840s to eventually build a Wall Street behemoth that failed in 2008 after the last family member was bought out. The play is directed by a Brit, and acted by 3 British actors, including 1 Jewish man and 1 Black man.

On Christmas Day, my wife and I watched the new MSNBC movie “Paper & Glue.” The title refers to the greatly enlarged photographs produced by a French artist of the dispossessed in the US, Brazil, and France that were put up in different locals, producing increased self-esteem for those photographed. Even the skeptical maximum security prison inmates of various cultures and gangs worked successfully together on the project. Follow-ups suggest some lasting change for the better, including a prison program to voluntarily have tattoos removed, like the swastika on an inmate’s cheek.

Perhaps sometimes in society and psychiatry, it takes someone from another culture to creatively and successfully see the humanity and potential of another.

is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues relate to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

Does it sometimes take distance to better understand one another?  

The Lehman Trilogy, Paper & Glue, and the Clinical Question: Does It Take One to Know One?

As may be apparent in our weekday daily columns “Psychiatric Views on the Daily News,” as well as the companion weekly Wednesday video on “Psychiatry & Society,” I have been trying to convey that our unique knowledge and skills can contribute to society beyond the crucial importance of our clinical patient care, which inevitably spirals and ripples out into society. Let us also not forget that others have been contributing articles, poems, and videos on social aspects of psychiatry for 

This is not a new challenge and interest on the part of psychiatrists. Although the recent dominance of the biological in our 

has put the social in the background, we have role models from the past who have contributed much to the conversation, but have unfortunately passed away this year.

In the past, we have collected several eulogies in one article, some of these recently deceased psychiatrists made society a particular focus of their career. Therefore, we decided to use a few of our daily columns to eulogize them one at a time, including: 

, Charles Atkins, MD, and Richard Gerhardstein, MD. As usual, I’ll rely on my personal knowledge of them and public obituaries.

As our national Thanksgiving holiday approaches, what better time to thank them, as well as those psychiatrists who are still alive and carrying on their work? Moreover, given our current challenges of 

, if you will, what better time is there for others to join the cause? Solutions will take more than a village; they will need the world of psychiatry.

Is psychiatry doing enough to address societal challenges? We can honor those who have made a difference but have recently passed by taking up the charge.

In Memoriam: Psychiatrists Who Helped Address Societal Challenges

With the Biden Administration’s plans to resettle 95,000 

 in the United States, there is a good chance that we will come across some of our new neighbors in the community or in our workplaces. Here are a few thoughts on how we can be humble, aware, and respectful of their culture and religion. For the sake of simplification, each bullet point starts with a letter of the word, Afghanistan.

- Acknowledge that Afghans are not a homogeneous group. They do not speak one language, and they do not practice one religion; they come from diverse backgrounds.

- Find out about them. Be genuinely curious and interested. Ask questions rather than making assumptions, have a student attitude, and let them teach you. Say things like “walk me through this.”

- Get familiar with their beliefs and customs. Most Afghans are Muslims, and they lean on family, community, tribal elders, local healers, Imams and religious leaders, and spirituality (both faith articles and religious rituals) in addition to cultural practices as their healing tools.

- Have a comprehensive and holistic plan when working with them. Make sure your plan addresses their immediate basic needs in the here-and-now, but also have the pre-, intra-, and post-resettlement trauma context in mind.

- Ask about how things have been for them so far. The new Afghans, given their special visa status, might not enjoy the honeymoon phase we observed in refugees from other countries. Their work with the coalition forces could subject them to suspicion, alienation, or even hostility from the rest of the community.

- Never give false hope, but never preach despair. Three themes are important at the moment: 1) safety through leaning on family and being welcomed by the established Afghan community and the larger society; 2) hope through government and non-government organizations that help them find decent housing and with their legal status; and 3) skill-building to help them learn the American system and navigate how they care for themselves and their families in a new environment.

- In working with Afghans, remember that Islamophobia is real. The American dream might not be a rosy picture, given that Islamophobia is a danger that may be facing many Afghans when they move to America. Be careful not to be part of the abuse, and try to understand the culture before you make judgments or generalizations about women’s dress code, family hierarchy, and other dynamics.

- Set culturally humble services and resources for the youth so they do not lose their language, culture, or religion. Youth master the English language quickly and can learn new habits in public schools and the mainstream American culture that might contradict their cultural norms at home, creating power imbalance and threatening the family system. Empowering Mosques and community centers and collaborating with bicultural Muslim mental health practitioners and clinicians will likely be very helpful.

- Try to understand the culture. Given that cultural norms differ when it comes to parenting, it is important for the Afghan community to have strong relationships with agencies like the US Department of Homeland Security and Child Protective Services so that common ground and guidelines can be established in advance.

- Acknowledge the transgenerational trauma by creating programs that empower all family members. Like what we noticed with the Iraqi, Syrian, and Rohingya refugees, I predict that many Afghan men will show symptoms of depression, forcing women to start driving or working outside the house.

- Never feel or show despair if you do not know the answers to their questions. Do not feel pressure to be everything for your clients. Do not react to their reactions, but rather be their sounding board, bear witness, and refer them to available inner and outer resources.

is a practicing psychiatrist, Providence Healthcare System, Portland, Oregon.

Many Afghan refugees are coming to the United States. How can we effectively work with our new neighbors?

Working—and Connecting—With Afghan Refugees

Napoleon B. Higgins, Jr, MD, and Rona J. Hu, MD, presented on the impact of cultural differences on health disparities and unequal access to care at the 

2021 Neuroscience Education Institute (NEI) Congress

 Friday, November 5, in Colorado Springs, Colorado.

In their presentation, titled “Nurturing Cultural Humility in Mental Health Care,” Higgins and Hu discussed the impact of history on current mental health care outcomes; the effects of racism on mental health; the ways oppression, racism, access barriers, and other sociocultural factors lead to health disparities and mental health sequelae; and the importance of cultural humility in mental health care settings. They reported that, due to many historical incidents of racism and oppression over the years in mental health care, patients from minority communities have often been excluded from research studies; diagnostic assessments have not been sensitive for minority populations; diagnostic and treatment algorithms often pay little attention to diversity; not as much is known about the differences in the ways individuals from different cultures may express symptoms of mental illness; and, therefore, many patients from minority communities may distrust the medical system. This lack of information about—and trust from—these communities is problematic in part because there is predicted to be a 90% increase in racial and ethnic minorities by 2050, according to the United States Census Bureau.

In order to improve outcomes with patients from minority communities, Higgins and Hu suggested that practitioners recognize their privilege and the historical role of privilege in oppressive systems; recognize their own biases and stereotypes, and the ways these impact reactions to microaggressions and other cultural issues in therapeutic settings; and practice cultural humility, which Higgins and Hu defined as a willingness and lifelong dedication to learn from patients about their experiences by asking questions—rather than making assumptions—while acknowledging their own embeddedness in culture(s).

 “We don’t want to make assumptions—we always want to ask and be inquisitive,” Higgins said during the presentation. “When you show that you’re inquisitive, it shows interest, not ignorance. When you ask the question, it shows that you’re interested in that person’s story.”

Higgins is president and CEO of Bay Pointe Behavioral Health Service, Inc., and South East Houston Research Group; medical director of the Hold My Hand Residential Treatment Center; and a staff psychiatrist in the Prairie View A&M University Student Center. Hu is a clinical professor in the Stanford Medical Center Department of Psychiatry and Behavioral Sciences, and associate dean of Academic Affairs at the Stanford University School of Medicine.

1. Higgins, Jr. NB, Hu RJ. Nurturing cultural humility in mental health care. Presented at 2021 NEI Congress. November 5, 2021.

How can cultural humility in therapeutic settings improve patient outcomes?

Nurturing Cultural Humility in Mental Health Care

No one is a poet from eight to twelve and from two to six. Whoever is a poet is one always, and is continually assaulted by poetry. —Jorge Luis Borges

Write the anatomy lab’s cold steel table,

your cadaver’s swollen face, formalin’s

funk soaked into your skin, the scalpel’s

fierce friction when you severed her breast.

when he recovered, corralled your shoulder,

Write the names of hospitals you’ll never forget—

the Reed Zone Center, where Jesus Christ himself

blessed you as his psychiatrist and disciple,

the purple-robed Dean as you swore your oath.

Write elegies for prescription pads and progress

odes to the stethoscope and Queen’s Square hammer,

to care for patients with a caregiver’s love.

Write mentors who modeled bedside manners,

the way their gaze steadied spinal needles

you threaded home. Write about not having time

to write, hours you read journals, double-checked doses,

worried who might crash. Write the fear of getting sued.

Write the cemetery where you commune with dead patients.

Praise their lessons. Then write yourself perfect,

your Hallelujah! when you nailed a diagnosis

and felt like a god. Write a limerick about doctors

who feel like gods. Write every day. Write

what you love. Write a career adding up to a life.

has been writing a poem about his experience
of being a doctor every month for the past 23 years in 

 in a column called “Poetry of the Times.” He is instructor in psychiatry, University of Massachusetts Medical School, Worcester, MA.

Prompts (for Doctors Who Write Poetry)

Psychiatry Comic: Finish What You Started

For more of the Any Good Poem series, see 

has been writing a poem about his experience of being a doctor every month for the past 23 years in

in a column called “Poetry of the Times.” He is instructor in psychiatry, University of Massachusetts Medical School, Worcester, MA

"...Rising out of the ground like a swamp mist, and falling out of heaven like soft dew..."

Cultural Psychiatry