by Oliver Sacks
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Musicophilia
Tales of Music and the Brain
Oliver Sacks
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Alfred A. Knopf
New York • Toronto
2007
For Orrin Devinsky,
Ralph Siegel,
and Connie Tomaino
Preface
What an odd thing it is to see an entire species— billions of people— playing with, listening to, meaningless tonal patterns, occupied and preoccupied for much of their time by what they call “music.” This, at least, was one of the things about human beings that puzzled the highly cerebral alien beings, the Overlords, in Arthur C. Clarke’s novel Childhood’s End. Curiosity brings them down to the Earth’s surface to attend a concert, they listen politely, and at the end, congratulate the composer on his “great ingenuity”— while still finding the entire business unintelligible. They cannot think what goes on in human beings when they make or listen to music, because nothing goes on with them. They themselves, as a species, lack music.
We may imagine the Overlords ruminating further, back in their spaceships. This thing called “music,” they would have to concede, is in some way efficacious to humans, central to human life. Yet it has no concepts, makes no propositions; it lacks images, symbols, the stuff of language. It has no power of representation. It has no necessary relation to the world.
There are rare humans who, like the Overlords, may lack the neural apparatus for appreciating tones or melodies. But for virtually all of us, music has great power, whether or not we seek it out or think of ourselves as particularly “musical.” This propensity to music shows itself in infancy, is manifest and central in every culture, and probably goes back to the very beginnings of our species. Such “musicophilia” is a given in human nature. It may be developed or shaped by the cultures we live in, by the circumstances of life, or by the particular gifts or weaknesses we have as individuals— but it lies so deep in human nature that one must think of it as innate, much as E. O. Wilson regards “biophilia,” our feeling for living things. (Perhaps musicophilia is a form of biophilia, since music itself feels almost like a living thing.)
Given the obvious similarities between music and language, it is not surprising that there has been a running debate for more than two hundred years as to whether they evolved in tandem or independently— and, if the latter, which came first. Darwin speculated that “musical tones and rhythms were used by our half-human ancestors, during the season of courtship, when animals of all kinds are excited not only by love, but by strong passions of jealousy, rivalry, and triumph” and that speech arose, secondarily, from this primal music. His contemporary Herbert Spencer held the opposite view, conceiving that music arose from the cadences of emotional speech. Rousseau, a composer no less than a writer, felt that both had emerged together, as a singsong speech, and only later diverged. William James saw music as an “accidental genesis…a pure incident of having a hearing organ.” Steven Pinker, in our own time, has expressed himself even more forcibly: “What benefit could there be [he asks, echoing the Overlords] to diverting time and energy to making plinking noises?…As far as biological cause and effect are concerned, music is useless…. It could vanish from our species and the rest of our lifestyle would be virtually unchanged.” There is, nonetheless, much evidence that humans have a music instinct no less than a language instinct, however this evolved.
We humans are a musical species no less than a linguistic one. This takes many different forms. All of us (with very few exceptions) can perceive music, perceive tones, timbre, pitch intervals, melodic contours, harmony, and (perhaps most elementally) rhythm. We integrate all of these and “construct” music in our minds using many different parts of the brain. And to this largely unconscious structural appreciation of music is added an often intense and profound emotional reaction to music. “The inexpressible depth of music,” Schopenhauer wrote, “so easy to understand and yet so inexplicable, is due to the fact that it reproduces all the emotions of our innermost being, but entirely without reality and remote from its pain…. Music expresses only the quintessence of life and of its events, never these themselves.”
Listening to music is not just auditory and emotional, it is motoric as well: “We listen to music with our muscles,” as Nietzsche wrote. We keep time to music, involuntarily, even if we are not consciously attending to it, and our faces and postures mirror the “narrative” of the melody, and the thoughts and feelings it provokes.
Much that occurs during the perception of music can also occur when music is “played in the mind.” The imagining of music, even in relatively nonmusical people, tends to be remarkably faithful not only to the tune and feeling of the original but to its pitch and tempo. Underlying this is the extraordinary tenacity of musical memory, so that much of what is heard during one’s early years may be “engraved” on the brain for the rest of one’s life. Our auditory systems, our nervous systems, are indeed exquisitely tuned for music. How much this is due to the intrinsic characteristics of music itself— its complex sonic patterns woven in time, its logic, its momentum, its unbreakable sequences, its insistent rhythms and repetitions, the mysterious way in which it embodies emotion and “will”— and how much to special resonances, synchronizations, oscillations, mutual excitations, or feedbacks in the immensely complex, multi-level neural circuitry that underlies musical perception and replay, we do not yet know.
But this wonderful machinery— perhaps because it is so complex and highly developed— is vulnerable to various distortions, excesses, and breakdowns. The power to perceive (or imagine) music may be impaired with some brain lesions; there are many such forms of amusia. On the other hand, musical imagery may become excessive and uncontrollable, leading to incessant repetition of catchy tunes, or even musical hallucinations. In some people, music can provoke seizures. There are special neurological hazards, “disorders of skill,” that may affect professional musicians. The normal association of intellectual and emotional may break down in some circumstances, so that one may perceive music accurately, but remain indifferent and unmoved by it or, conversely, be passionately moved, despite being unable to make any “sense” of what one is hearing. Some people— a surprisingly large number— “see” color or “taste” or “smell” or “feel” various sensations as they listen to music— though such synesthesia may be accounted a gift more than a symptom.
William James referred to our “susceptibility to music,” and while music can affect all of us— calm us, animate us, comfort us, thrill us, or serve to organize and synchronize us at work or play— it may be especially powerful and have great therapeutic potential for patients with a variety of neurological conditions. Such people may respond powerfully and specifically to music (and, sometimes, to little else). Some of these patients have widespread cortical problems, whether from strokes or Alzheimer’s or other causes of dementia; others have specific cortical syndromes— loss of language or movement functions, amnesias, or frontal-lobe syndromes. Some are retarded, some autistic; others have subcortical syndromes such as parkinsonism or other movement disorders. All of these conditions and many others can potentially respond to music and music therapy.
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FOR ME, the first incitement to think and write about music came in 1966, when I saw the profound effects of music on the deeply parkinsonian patients I later wrote about in Awakenings. And since then, in more ways than I could possibly imagine, I have found music continually forcing itself on my attention, showing me its effects on almost every aspect of brain function— and life.
“Music” has always been one of the first things I look up in the index of any new neurology or physiology textbook. But I could find scarcely any mention of the subject until the 1
977 publication of Macdonald Critchley and R. A. Henson’s book Music and the Brain, with its wealth of historical and clinical examples. Perhaps one reason for the scarcity of musical case histories is that physicians rarely ask their patients about mishaps of musical perception (whereas a linguistic problem, say, will immediately come to light). Another reason for this neglect is that neurologists like to explain, to find putative mechanisms, as well as to describe— and there was virtually no neuroscience of music prior to the 1980s. This has all changed in the last two decades with new technologies that allow us to see the living brain as people listen to, imagine, and even compose music. There is now an enormous and rapidly growing body of work on the neural underpinnings of musical perception and imagery, and the complex and often bizarre disorders to which these are prone. These new insights of neuroscience are exciting beyond measure, but there is always a certain danger that the simple art of observation may be lost, that clinical description may become perfunctory, and the richness of the human context ignored.
Clearly, both approaches are necessary, blending “old-fashioned” observation and description with the latest in technology, and I have tried to incorporate both of these approaches here. But above all, I have tried to listen to my patients and subjects, to imagine and enter their experiences— it is these which form the core of this book.
Part I
Haunted by Music
1
A Bolt from the Blue: Sudden Musicophilia
Tony Cicoria was forty-two, very fit and robust, a former college football player who had become a well-regarded orthopedic surgeon in a small city in upstate New York. He was at a lakeside pavilion for a family gathering one fall afternoon. It was pleasant and breezy, but he noticed a few storm clouds in the distance; it looked like rain.
He went to a pay phone outside the pavilion to make a quick call to his mother (this was in 1994, before the age of cell phones). He still remembers every single second of what happened next: “I was talking to my mother on the phone. There was a little bit of rain, thunder in the distance. My mother hung up. The phone was a foot away from where I was standing when I got struck. I remember a flash of light coming out of the phone. It hit me in the face. Next thing I remember, I was flying backwards.”
Then— he seemed to hesitate before telling me this— “I was flying forwards. Bewildered. I looked around. I saw my own body on the ground. I said to myself, ‘Oh shit, I’m dead.’ I saw people converging on the body. I saw a woman— she had been standing waiting to use the phone right behind me— position herself over my body, give it CPR…. I floated up the stairs— my consciousness came with me. I saw my kids, had the realization that they would be okay. Then I was surrounded by a bluish-white light…an enormous feeling of well-being and peace. The highest and lowest points of my life raced by me. No emotion associated with these…pure thought, pure ecstasy. I had the perception of accelerating, being drawn up…there was speed and direction. Then, as I was saying to myself, ‘This is the most glorious feeling I have ever had’— SLAM! I was back.”
Dr. Cicoria knew he was back in his own body because he had pain— pain from the burns on his face and his left foot, where the electrical charge had entered and exited his body— and, he realized, “only bodies have pain.” He wanted to go back, he wanted to tell the woman to stop giving him CPR, to let him go; but it was too late— he was firmly back among the living. After a minute or two, when he could speak, he said, “It’s okay— I’m a doctor!” The woman (she turned out to be an intensive-care-unit nurse) replied, “A few minutes ago, you weren’t.”
The police came and wanted to call an ambulance, but Cicoria refused, delirious. They took him home instead (“it seemed to take hours”), where he called his own doctor, a cardiologist. The cardiologist, when he saw him, thought Cicoria must have had a brief cardiac arrest, but could find nothing amiss with examination or EKG. “With these things, you’re alive or dead,” the cardiologist remarked. He did not feel that Dr. Cicoria would suffer any further consequences of this bizarre accident.
Cicoria also consulted a neurologist— he was feeling sluggish (most unusual for him) and having some difficulties with his memory. He found himself forgetting the names of people he knew well. He was examined neurologically, had an EEG and an MRI. Again, nothing seemed amiss.
A couple of weeks later, when his energy returned, Dr. Cicoria went back to work. There were still some lingering memory problems— he occasionally forgot the names of rare diseases or surgical procedures— but all his surgical skills were unimpaired. In another two weeks, his memory problems disappeared, and that, he thought, was the end of the matter.
What then happened still fills Cicoria with amazement, even now, a dozen years later. Life had returned to normal, seemingly, when “suddenly, over two or three days, there was this insatiable desire to listen to piano music.” This was completely out of keeping with anything in his past. He had had a few piano lessons as a boy, he said, “but no real interest.” He did not have a piano in his house. What music he did listen to tended to be rock music.
With this sudden onset of craving for piano music, he began to buy recordings and became especially enamored of a Vladimir Ashkenazy recording of Chopin favorites— the Military Polonaise, the Winter Wind Étude, the Black Key Étude, the A-flat Polonaise, the B-flat Minor Scherzo. “I loved them all,” Cicoria said. “I had the desire to play them. I ordered all the sheet music. At this point, one of our babysitters asked if she could store her piano in our house— so now, just when I craved one, a piano arrived, a nice little upright. It suited me fine. I could hardly read the music, could barely play, but I started to teach myself.” It had been more than thirty years since the few piano lessons of his boyhood, and his fingers seemed stiff and awkward.
And then, on the heels of this sudden desire for piano music, Cicoria started to hear music in his head. “The first time,” he said, “it was in a dream. I was in a tux, onstage; I was playing something I had written. I woke up, startled, and the music was still in my head. I jumped out of bed, started trying to write down as much of it as I could remember. But I hardly knew how to notate what I heard.” This was not too successful— he had never tried to write or notate music before. But whenever he sat down at the piano to work on the Chopin, his own music “would come and take me over. It had a very powerful presence.”
I was not quite sure what to make of this peremptory music, which would intrude almost irresistibly and overwhelm him. Was he having musical hallucinations? No, Dr. Cicoria said, they were not hallucinations— “inspiration” was a more apt word. The music was there, deep inside him— or somewhere— and all he had to do was let it come to him. “It’s like a frequency, a radio band. If I open myself up, it comes. I want to say, ‘It comes from heaven,’ as Mozart said.”
His music is ceaseless. “It never runs dry,” he continued. “If anything, I have to turn it off.”
Now he had to wrestle not just with learning to play the Chopin, but to give form to the music continually running in his head, to try it out on the piano, to get it on manuscript paper. “It was a terrible struggle,” he said. “I would get up at four in the morning and play till I went to work, and when I got home from work I was at the piano all evening. My wife was not really pleased. I was possessed.”
In the third month after being struck by lightning, then, Cicoria— once an easygoing, genial family man, almost indifferent to music— was inspired, even possessed, by music, and scarcely had time for anything else. It began to dawn on him that perhaps he had been “saved” for a special reason. “I came to think,” he said, “that the only reason I had been allowed to survive was the music.” I asked him whether he had been a religious man before the lightning. He had been raised Catholic, he said, but had never been particularly observant; he had some “unorthodox” beliefs, too, such as in reincarnation.
He himself, he grew to think, had had a sort of reincarnation, had been transformed and given a special gi
ft, a mission, to “tune in” to the music that he called, half metaphorically, “the music from heaven.” This came, often, in “an absolute torrent” of notes with no breaks, no rests, between them, and he would have to give it shape and form. (As he said this, I thought of Caedmon, the seventh-century Anglo-Saxon poet, an illiterate goatherd who, it was said, had received the “art of song” in a dream one night, and spent the rest of his life praising God and creation in hymns and poems.)
Cicoria continued to work on his piano playing and his compositions. He got books on notation, and soon realized that he needed a music teacher. He would travel to concerts by his favorite performers but had nothing to do with musical friends in his own town or musical activities there. This was a solitary pursuit, between himself and his muse.
I asked whether he had experienced other changes since the lightning strike— a new appreciation of art, perhaps, different taste in reading, new beliefs? Cicoria said he had become “very spiritual” since his near-death experience. He had started to read every book he could find about near-death experiences and about lightning strikes. And he had got “a whole library on Tesla,” as well as anything on the terrible and beautiful power of high-voltage electricity. He felt he could sometimes see “auras” of light or energy around people’s bodies— he had never seen this before the lightning bolt.
Some years passed, and Cicoria’s new life, his inspiration, never deserted him for a moment. He continued to work full-time as a surgeon, but his heart and mind now centered on music. He got divorced in 2004, and the same year had a fearful motorcycle accident. He had no memory of this, but his Harley was struck by another vehicle, and he was found in a ditch, unconscious and badly injured, with broken bones, a ruptured spleen, a perforated lung, cardiac contusions, and, despite his helmet, head injuries. In spite of all this, he made a complete recovery and was back at work in two months. Neither the accident nor his head injury nor his divorce seemed to have made any difference to his passion for playing and composing music.
