PA In simple terms could you explain the effects of 'Focal Dystonia' relative to your guitar playing.
K The best way of describing it is to say the brain no longer recognises which finger is which on my right hand. It's a neurological problem. Mine seems to focus on the thumb and first finger; the thumb especially awkward to move.
PA And this is purely guitar specific?
K Mainly. It affects my typing too.
PA When did you first become aware of problem?
K I can trace the beginnings to about 3 years ago. Certain things on the guitar became harder. I thought my hands were tired - physically tired that is. I played a lot, practically all the time. The guitar never left my hands - only to eat. When I told the specialist I played 10 hours a day for fifteen years she thought it remarkable it hadn't happen sooner. She thought I was joking.
PA So much for 'practise makes perfect' ?
K I think it's more a case of 'perfect practice makes perfect'.
PA So the problem developed through many hours of the same, repetitive motion.
K Exactly. But more importantly, sometimes inaccurate motion. This is what I mean about 'perfect practice'. Sometimes to keep that alternate movement between the index finger and middle finger constant can be hard. It's my theory that over the years and because I sometimes didn't always physically maintain this technique the brain developed an 'alternative' pathway, if you like. I was instructing one finger to move subconsciously but consciously I moved another. Maybe a new neural pathway formed and threw a spanner in the works. But like I say that's just a theory. I have no idea if that's true or not.
PA Can you describe the symptoms?
K Tremolo became impossible. That was the first thing to go. I used to practice it all the time. I couldn't get the fingers going. I couldn't even do it slowly. Tremolo is a funny thing. It comes and goes; sometimes it's silky smooth, sometimes it's a bit ragged but on this occasion it felt stiff and difficult. Impossible actually. I've always believed fingers were not meant to do things like this. It's not the most natural of finger exercises.
PA But you could still play all the other material?
K To an extent - although I couldn't record the way I would have liked. Any difficulties I had I put down to lack of practice which, with hindsight, seems ironic. I could still play Bach, I could still play Albeniz and I could still write and compose but I was aware of something being amiss and I had to scrap plans for a recording project as well. I didn't feel comfortable with recording at only 70%.
PA And then, presumably, something happened that suggested all was not well.
K About three months after the tremolo problem I woke up one morning and tried to play the Fugue from Bach's Lutesuite No.2. I had practised it the night before. It's a slow piece but like a lot of Bach's music tempo is no real indicator of difficulty. I found the opening bars 'stiff'. There seemed to be a slight delay between going for the note and actually getting it, like the brain had sent the signal but the finger wasn't responding. It all seemed a bit 'tight'.
PA Did this worry you?
K It did. I thought I would rest, not play for a few days and all would be well. I was approaching the end of my playing season and had no commitments to fulfill which helped. I just hoped the break would do me good.
PA Did you seek medical advice at this point?
K No. I went back to Thailand, which has been my winter home for a few years. I hoped the warm weather and relaxed atmosphere might help. Unfortunately I also hoped to memorise Bach's Chaconne and Rodrigo's Concerto De Aranjuez and considering what I know now that was probably a crazy thing to do.
PA Two very technical pieces to master. This must have been very hard on the hands and the condition itself.
K Yes. Unfortunately over the months it got worse. It became a vicious circle - the harder it was to play the harder I tried to play.
PA So by this time you realised you had to seek medical help.
K I was concerned now, yes. I visited a doctor and explained the problem. I thought I was at an early stage of Carpal Tunnel Syndrome but there was no pain. He did a few tests and said there was nothing wrong. He said that my hand muscles were fatigued. If I had CTS then I would have known for sure.
PA And you left it at that?
K No, I went to an acupuncturist in Bangkok and had five sessions. It made no difference. I then tried some pretty intensive massage which seemed to make a slight difference but ultimately not enough.
PA Where to next?
K Well, I know this will sound quite odd but I believe fate has a way of sometimes giving you a lovely gift in the worst possible wrapping paper. I couldn't do anything about this problem which I thought maybe psychosomatic. So I stopped fighting it and assumed I was being 'led' along a certain path. I know it sounds crackers but I had been working on some songs over the months I wanted to record. Circumstances always prevented it from happening. Now I thought: 'What the hell. Now's the time.' I couldn't play my normal classical repertoire but I could use a plectrum to play the guitar in a certain way. Basically I did anything I could to focus my thoughts elsewhere. It felt very liberating.
PA Could you expand on that?
K Well, it was mentally stimulating to do something different in a musical sense. The usual problems of solo guitar work didn't exist. I was using drums, percussion, bass, keyboards. My guitar playing was secondary to the song which made a nice change. The recording wasn't without it's problems - laptops and recording can be a real nightmare - but from a personal point of view, to change tack completely and do something that wasn't straightforward classical felt very liberating. The pressure wasn't there. Sometimes it's not easy playing in front of people with just a guitar. The stress of it all can destroy the pleasure of playing. To be able to play but not be the centre of attention was so relaxing. It also broke the routine I had been slavish too for a few years. For a little while at least I didn't have the worry of having to play to earn money. It sounds incredibly shallow, I know, but I can honestly say if I were a rich man I would probably still be sitting on the beach without a care in the world just writing music and uploading it onto the web page. Technology can save you a very long journey these days. I made a point of enjoying the enforced change to circumstances . I grew to like it. A beach in Thailand is not the worst place in the world to be holed up in.
PA But you eventually visited the specialist here in London.
K When the recording was done the mind started to wander. I became the world's biggest internet surfer looking up anything to explain the problem. There is something quite worrying about a condition you have no name for. I wasn't sure if was degenerative to the point where my day-to-day life might start to suffer. I got back to london and contacted the Musician's Union. They sent me to a doctor working for BAPAM, a charity organisation that thankfully funded the consultation. He didn't know what the problem was either so he referred me to the Devonshire Hospital near Harley Street where I saw a specialist called Kathy Butler. It was quite funny looking back at it. I took my guitar with me and she said, ' OK, Keith. Play me something.' I played for about five seconds - literally - and she said. ' OK. That's fine. You've got Focal Dystonia. Looks like a dystonic thumb.' Just like that. She had seen it so many times.
PA Did you know what this was?
K Never heard of it.
PA Were you treated in any way?
K Rather bizarrely she cut the finger off a rubber surgical glove and then rolled it over my thumb. 'There,' she said. 'Now play'
K Well it felt like there was 50% more control. The thumb seemed more independent. It wasn't perfect by a long way but it helped. I could feel the difference immediately. You could see the difference in the hand's movements. The sensation of the rubber touching my thumb had further confused my brain taking the problem full circle if you like. She described the problem to me quite graphically: if you could imagine the five dots on the face of a dice representing the number five, each dot representing a digit on my right hand, the focal dystonia had the effect of merging those five dots together creating a Venn diagram pattern, the circles overlapping. She called it a 'smearing'. This in turn created a muddled pathway for the brain's signals to travel along. I might well have been instructing my thumb to move but the merging of the 'dots' sent that signal to the other digits as well resulting in total confusion in the hand.
PA And this purely a result of over practise.
K Yes. Like I said earlier, she couldn't believe I had played so many hours for so long.
PA Is this common amongst musicians?
K Classical musicians are probably the worst ones for it. 1 in 500 apparently. Classical music requires intense study and repetitive motion and this is the result.
PA Why only the right hand, or should I say the picking hand?
K The left hand, the fretboard hand, is the one most people think would suffer but you have to remember this condition is brought about by acute repetition. Although the left hand seems to be doing a lot more - and it is - it is also less likely to repeat itself in the broadest sense. Conversely, the right hand - regardless of the music you are playing - does the same action over and over and over again, ie, the alternate motion of the fingers. There is little variation on the theme. The movements are also more precise and intensive. Ask any classical guitarist; he will tell you most of the study is in the right hand. Most players can move their fretboard fingers quickly but to pick those notes with the right hand at the same time is very hard. The left hand - the fretboard hand - is not so difficult. Also, playing the guitar is a very unnatural thing to do. If you consider how your arms are positioned and how your leg is raised and so on, it's not something we can consider 'normal'. Like anything after a while I suppose something has to 'give.'
PA So how is it that someone like Paco De Lucia or Julien Bream has never suffered this problem?
K They may have had their little worries - maybe slight bouts of tendonitis. Seriously though, it leads us back to the 'perfect practice' theory. Their technique is perfect. Whatever they instructed their fingers to do their fingers did it. I don't think there were any subconscious errors. Lots of guitarists often use the same finger to pick two or even three notes in a row occasionally. This is not good technique and over a long period of time I think the brain gets confused as to which finger it really should be moving. I really believe that. I know I did this occasionally and I did it for a long time and I'm positive it must be a contributing factor.
PA So now you know what it is can it be cured?
K It can but the timescale is unclear. It could take three months, it could take ten years.
PA What do you have to do? Do you now play with a piece of rubber glove over your thumb?
K I wear the whole glove.
K Absolutely. OK, I don't perform with the glove on but I have to practice for an hour a day wearing one on my right hand. I have to play very lightly. In fact I use two or three gloves, each with a different finger removed to apply a different touch sensation to my hand. I also use this blue putty stuff for doing hand exercises to strengthen the muscles in my right hand.
PA And this works?
K Some days it's better than others. That's all I can say. I also have to do a very cerebral routine when I wake up that involves handling 5 small objects in my left hand - coins, toothpaste tube tops, that kind of thing - twisting them over one at a time in my left fingers and then passing them to my right hand to do the same. The hope here is the brain will re-learn what the proper 'pattern' should be from my 'good' hand.
PA And does it?
K Have to give it time. It took a long time to get like this. It might take the same getting rid of it
PA For many musicians this would be the worst nightmare come true. The thing you love most almost taken away from you completely, your livelihood threatened…It must effect you deep down.
K There was a moment when I sat down feeling very glum. I was so fed up with it. I couldn't even look at the guitar. I didn't want to touch it. I had to hide it behind the sofa. After a while I forgot I played the thing. I used to look for things to do and it would suddenly strike me maybe I should practice a bit. This from a person who used to practice 10 hours a day. I hated my inability to play. My whole lifestyle changed but I'm not one for moping around for too long. Pointless. I go mad for an hour - maybe a few days and then snap out of it. Perspective is a wonderful thing and in the big scheme of things a guy not being able to play his guitar any more is hardly earth-shattering news. If it were I would sell the story.
PA You seem far from unhappy now. What changed?
K I woke up one morning and said: 'Who cares?' I say that often. It's easy to be miserable but I don't like being miserable. I would rather find the bright side. Good things have happened because I can't play like I once did. I have written books I always meant to write but didn't have time for. I have recorded stuff forever on the back burner. I have learnt how to use my recording equipment: how to mix and master; how to program sequencing software. All this opens up many more avenues. There wouldn't have been the time or inclination otherwise. And I met my girlfriend in the most beautiful circumstances. I have had far more time for her than otherwise possible. We would never have crossed paths if I could still play the way I did. And there's also the matter of guitar strings - they last so much longer.
PA No need to change them so often then.
K I'd happily pay someone to change my strings. But seriously, there is a deeper issue in this. When fully able to play I felt a great sense of expectation. I felt I had to maximise my ability. This can weigh heavy after a while - especially when the success you aim for doesn't come your way. The problem was always one of guilt. If I didn't play, if I didn't try to further myself I felt guilty. Now expectation has gone I feel much more relaxed and happy. Some might think that a strange thing - maybe a psychologist could link the problem with that mindset and they might have a point but whatever, I feel good in general. In fact, I really don't care at all about it. Well, maybe sometimes…
PA And you're playing again - using a plectrum to play Bach of all things. Is that really possible?
K Where there's a will….. I have a much freer, relaxed attitude to playing and subsequently I take more risks. I like that. It's amazing what you can play with a plectrum. You have to rearrange the bass notes onto adjacent strings next to the melody line so you can hit them with one strike of the plectrum. It works quite well. The more contrapuntal the more impossible it becomes but the Cello Suites and Violin Sonatas and Partitas are mainly arpeggiated pieces open to adaptation. I want to record them at some stage. It's a different slant on the old theme and I think Bach would approve. After all, it was the great man himself who said something like: 'try not to concentrate on technique too much but the notes themselves.' Something like that.
PA Focal Dystonia is a terrible thing to happen to a musician. I would imagine some may react to it in a very different way to you. What advice would you offer to someone suffering from the same thing. What would be the best way to deal with it?
K I really don't know what advice to give. Visit a specialist and try their methods. They might work. Everyone is different. I can imagine some people cracking up. I can imagine some going mad and some like me just saying: 'Nice while it lasted.' What you really need is perspective. One thing I noticed when this happened was just how much of my life the practice and playing took up. When I could no longer do it I had to do other things. I started noticing things more, good and bad. The guitar had been a cocoon. Being out of that cocoon let me see things in a different way. That's a good and bad thing but it certainly gives a broader perspective. If you think your problem is the end of the world then that's what it is. You have to simultaneously recognise its seriousness to you as a musician but also trivialise it, if you like, to stop it driving you mad. I couldn't help look at my condition as a newspaper headline: ' Keith Can't Play Guitar Like He Did Last Year. World Exclusive.' Can't see the 'Sunday Telegraph' doing a feature on that one.