Musicophilia

by Oliver Sacks

  Now all of Kinnison’s competitive cycling is accompanied by bracing musical imagery (usually from operatic overtures). Many athletes have had similar experiences.

  I have found it similar with swimming. In swimming freestyle, one usually kicks in groups of three, with a strong kick to every armstroke followed by two softer kicks. Sometimes I count these to myself as I swim— one, two, three, one, two, three— but then this conscious counting gives way to music with a similar beat. On long, leisurely swims, Strauss waltzes tend to play in my mind, synchronizing all my movements, providing an automatism and accuracy beyond anything I can achieve with conscious counting. Leibniz said of music that it is counting, but counting unconsciously, and this is precisely what swimming to Strauss is all about.

  * * *

  THE FACT THAT “rhythm”— in this special sense of combining movement and sound— appears spontaneously in human children, but not in any other primate, forces one to reflect on its phylogenetic origins. It has often been suggested that music did not evolve on its own but emerged as a by-product of other capacities with more obvious adaptive significance— such as speech. Did speech, in fact, precede music (as Steven Pinker suggests); did song precede speech (as Darwin thought); or did both develop simultaneously (as Mithen proposes)? “How can this dispute be resolved?” Patel asks in his 2006 paper. “One approach is to determine whether there are fundamental aspects of music cognition which…cannot be explained as by-products or secondary uses of more clearly adaptive abilities.” Musical rhythm, with its regular pulse, he points out, is very unlike the irregular stressed syllables of speech. The perception and synchronization of beat, Patel feels, “is an aspect of rhythm that appears to be unique to music…and cannot be explained as a by-product of linguistic rhythm.” It seems probable, he concludes, that musical rhythm evolved independently of speech.

  There is certainly a universal and unconscious propensity to impose a rhythm even when one hears a series of identical sounds at constant intervals. John Iversen, a neuroscientist and an avid drummer, has pointed this out. We tend to hear the sound of a digital clock, for example, as “tick-tock, tick-tock”— even though it is actually “tick, tick, tick, tick.” Anyone who has been subjected to the monotonous volleys of noise from the oscillating magnetic fields that bombard one during an MRI has probably had a similar experience. Sometimes the deafening ticks of the machine seem to organize themselves in a waltzlike rhythm of threes, sometimes in groups of four or five.4 It is as if the brain has to impose a pattern of its own, even if there is no objective pattern present. This can be true not only with patterns in time, but with tonal patterns, too. We tend to add a sort of melody to the sound of a train (there is a wonderful example of this, raised to the level of art, in Arthur Honegger’s Pacific 231) or to hear melodies in other mechanical noises. One friend of mine feels that the hum of her refrigerator has a “Haydn-ish” quality. And for some people with musical hallucinations, these may first appear as an elaboration of a mechanical noise (as with Dwight Mamlok and Michael Sundue). Leo Rangell, another man with musical hallucinations, commented on how elementary rhythmic sounds, for him, became songs or jingles; and for Solomon R. (in chapter 17) rhythmic body movements gave rise to a singsong cantillation— their minds giving “meaning” to what would otherwise be a meaningless sound or movement.

  * * *

  ANTHONY STORR, in his excellent book Music and the Mind, stresses that in all societies, a primary function of music is collective and communal, to bring and bind people together. People sing together and dance together in every culture, and one can imagine them having done so around the first fires, a hundred thousand years ago. This primal role of music is to some extent lost today, when we have a special class of composers and performers, with the rest of us often reduced to passive listening. We have to go to a concert, or a church, or a musical festival to reexperience music as a social activity, to recapture the collective excitement and bonding of music. In such a situation, music is a communal experience, and there seems to be, in some sense, an actual binding or “marriage” of nervous systems, a “neurogamy” (to use a word the early mesmerists favored).

  The binding is accomplished by rhythm— not only heard but internalized, identically, in all who are present. Rhythm turns listeners into participants, makes listening active and motoric, and synchronizes the brains and minds (and, since emotion is always intertwined with music, the “hearts”) of all who participate. It is very difficult to remain detached, to resist being drawn into the rhythm of chanting or dancing.

  I observed this when I took my patient Greg F. to a Grateful Dead concert at Madison Square Garden in 1991.5 The music, the rhythm, got everyone within seconds. I saw the whole vast arena in motion with the music, eighteen thousand people dancing, transported, every nervous system there synchronized to the music. Greg had had a massive tumor which had wiped out his memory and much of his spontaneity— he had been amnesic and inert, barely responsive except to music for many years. But he was taken over and animated by the thumping, pounding excitement of the crowd around him, the rhythmic clapping and chanting, and soon he, too, began shouting the name of one of his favorite songs, “ ‘Tobacco Road,’ ‘Tobacco Road’!” I say I “observed” all this, but I found myself unable to remain a detached observer. I realized that I, too, was moving, stamping, clapping with the music, and soon lost all my usual diffidence and inhibition and joined the crowd in communal dancing.

  Augustine, in his Confessions, described how, on one occasion, he went to a gladiatorial show with an aloof young man who professed disgust and contempt at the scenes before him. But when the crowd grew excited and began a rhythmic roaring and stamping, the young man could resist no longer, and joined in as orgiastically as everyone else. I have had similar experiences in religious contexts, even though I am largely lacking in religious faith or feeling. When I was a boy, I loved Simchas Torah, the Rejoicing of the Law, which was celebrated, even in our normally sober Orthodox congregation, with ecstatic chanting and dancing round and round the synagogue.

  While in many cases religious practice now tends to be somewhat decorous and detached, there is evidence that religious practices began with communal chanting and dancing, often of an ecstatic kind and, not infrequently, culminating in states of trance.6

  The almost irresistible power of rhythm is evident in many other contexts: in marching, it serves both to entrain and coordinate movement and to whip up a collective and perhaps martial excitement. We see this not only with military music and war drums, but also with the slow, solemn rhythm of a funeral march. We see it with work songs of every sort— rhythmic songs that probably arose with the beginnings of agriculture, when tilling the soil, hoeing, and threshing all required the combined and synchronized efforts of a group of people. Rhythm and its entrainment of movement (and often emotion), its power to “move” people, in both senses of the word, may well have had a crucial cultural and economic function in human evolution, bringing people together, producing a sense of collectivity and community.

  This, indeed, is central to the vision of cultural evolution presented by Merlin Donald in his astonishing 1991 book Origins of the Modern Mind, and in many subsequent papers. An essential feature of Donald’s vision is his concept that human evolution moved from the “episodic” life of apes to a “mimetic” culture— and that this flourished and lasted for tens, perhaps hundreds of thousands of years before language and conceptual thinking evolved. Donald proposes that mimesis— the power to represent emotions, external events, or stories using only gesture and posture, movement and sound, but not language— is still the bedrock of human culture today. He sees rhythm as having a unique role in relation to mimesis:

  Rhythm is an integrative-mimetic skill, related to both vocal and visuomotor mimesis…. Rhythmic ability is supramodal; that is, once a rhythm is established, it may be played out with any motor modality, including the hands, feet, mouth, or the whole body. It is apparently self-reinforcing, in
the way that perceptual exploration and motor play are self-reinforcing. Rhythm is, in a sense, the quintessential mimetic skill…. Rhythmic games are widespread among human children, and there are few, if any, human cultures that have not employed rhythm as an expressive device.

  Donald goes further, seeing rhythmic skill as a prerequisite not only for all music, but for all sorts of nonverbal activities, from the simple rhythmic patterns of agricultural life to the most complex social and ritual behaviors.

  Neuroscientists sometimes speak of “the binding problem,” the process by which different perceptions or aspects of perception are bound together and unified. What enables us, for example, to bind together the sight, sound, smell, and emotions aroused by the sight of a jaguar? Such binding in the nervous system is accomplished by rapid, synchronized firing of nerve cells in different parts of the brain. Just as rapid neuronal oscillations bind together different functional parts within the brain and nervous system, so rhythm binds together the individual nervous systems of a human community.

  20

  Kinetic Melody: Parkinson’s Disease and Music Therapy

  William Harvey, writing about animal movement in 1628, called it “the silent music of the body.” Similar metaphors are often used by neurologists, who speak of normal movement as having a naturalness and fluency, a “kinetic melody.” This smooth, graceful flow of movement is compromised in parkinsonism and some other disorders, and neurologists speak here of “kinetic stutter.” When we walk, our steps emerge in a rhythmical stream, a flow that is automatic and self-organizing. In parkinsonism, this normal, happy automatism is gone.

  Though I was born into a musical household and music has been important to me personally from my earliest years, I did not really encounter music in a clinical context until 1966, when I started work at Beth Abraham Hospital, a chronic care hospital for patients in the Bronx. Here, my attention was immediately drawn to a number of strangely immobile, sometimes entranced-looking patients, the post-encephalitic survivors I was later to write about in Awakenings. There were nearly eighty of them at the time; I saw them in the lobby, in the corridors, as well as on the wards, sometimes in strange postures, absolutely motionless, frozen in a trancelike state. (A few of these patients, rather than being frozen, were in the opposite state— one of almost continuous driven activity, all their movements accelerated, excessive, and explosive.) All of them, I discovered, were victims of encephalitis lethargica, the epidemic sleeping sickness that swept the globe just after World War I, and some had been in this frozen state since they had entered the hospital forty or more years before.

  In 1966, there was no medication of any use to these patients— no medication, at least, for their frozenness, their parkinsonian motionlessness. And yet it was common knowledge among the nurses and staff that these patients could move on occasion, with an ease and grace that seemed to belie their parkinsonism— and that the most potent occasioner of such movement was, in fact, music.

  Typically, these post-encephalitic patients, like people with ordinary parkinsonism, could not easily initiate anything, and yet often they were able to respond. Many could catch and return a ball if it was thrown, and almost all of them tended to respond in some way to music. Some of them could not initiate a single step but could be drawn into dancing and could dance fluidly. Some could scarcely utter a syllable; their voices, when they could speak, lacked tone, lacked force, were almost spectral. But these patients were able to sing on occasion, loudly and clearly, with full vocal force and a normal range of expressiveness and tone. Other patients could walk and talk but only in a jerky, broken way, without a steady tempo, and sometimes with incontinent accelerations— with such patients, music could modulate the stream of movement or speech, giving them the steadiness and control they so lacked.1

  * * *

  THOUGH “MUSIC THERAPY” was hardly a profession in the 1960s, Beth Abraham, most unusually, had its own music therapist, a dynamo called Kitty Stiles (it was only when she died in her late nineties that I realized she must already have been over eighty when I met her, but she had the vitality of a much younger person).

  Kitty had a special feeling for our post-encephalitic patients, and in the decades before drugs such as L-dopa were available, it was only Kitty and her music which could bring them to life. Indeed, when we came to make a documentary film about these patients in 1973, the film’s director, Duncan Dallas, immediately asked me, “Can I meet the music therapist? She seems to be the most important person around here.” So she was, in the days before L-dopa, and so she continued to be when the effects of L-dopa became, in many patients, erratic and unstable.

  While the power of music has been known for millennia, the idea of formal music therapy arose only during the First and Second World Wars, when large numbers of wounded soldiers were gathered in veterans hospitals, and it was found that their pain and misery and even, seemingly, some of their physiological responses (pulse rates, blood pressure, and so on) could be improved by music. Doctors and nurses in many veterans hospitals started to invite musicians to come and play for their patients, and musicians were only too happy to bring music to the dreadful wards of the wounded. But it was soon evident that enthusiasm and generosity were not enough— some professional training was needed as well.

  The first formal music therapy program was set up in 1944 at Michigan State University, and the National Association for Music Therapy was formed in 1950. But music therapy remained, for the next quarter of a century, scarcely recognized. I do not know whether Kitty Stiles, our music therapist at Beth Abraham, had any formal training or was licensed as a music therapist, but she had an immense intuitive gift for divining what could get patients going, however regressed or disabled they might appear. Working with individual patients calls upon empathy and personal interaction as much as any formal therapy, and Kitty was very skilled at this. She was also an audacious improviser, and very playful— both on the keyboard and in life; without this, I suspect, many of her efforts would have been futile.2

  I ONCE INVITED the poet W. H. Auden to one of Kitty’s sessions, and he was amazed by the instant transformations which music could effect; they reminded him of an aphorism of the German Romantic writer Novalis: “Every disease is a musical problem; every cure is a musical solution.” This seemed almost literally to be the case with these profoundly parkinsonian patients.

  Parkinsonism is usually called a “movement disorder,” though when it is severe it is not only movement that is affected, but the flow of perception, thought, and feeling as well. The disorder of flow can take many forms; sometimes, as the term “kinetic stutter” implies, there is not a smooth flow of movement but brokenness, jerkiness, starts and stops instead. Parkinsonian stutter (like verbal stuttering) can respond beautifully to the rhythm and flow of music, as long as the music is of the “right” kind— and the right kind is unique for every patient. For one of my post-encephalitic patients, Frances D., music was as powerful as any drug. One minute I would see her compressed, clenched, and blocked, or else jerking, ticcing, and jabbering— like a sort of human time bomb. The next minute, if we played music for her, all of these explosive-obstructive phenomena would disappear, replaced by a blissful ease and flow of movement, as Mrs. D., suddenly freed of her automatisms, would smilingly “conduct” the music, or rise and dance to it. But it was necessary— for her— that the music be legato; staccato, percussive music might have a bizarre countereffect, causing her to jump and jerk helplessly with the beat, like a mechanical doll or marionette. In general, the “right” music for parkinsonian patients is not only legato, but has a well-defined rhythm. If, on the other hand, the rhythm is too loud, dominating, or intrusive, patients may find themselves helplessly driven or entrained by it. The power of music in parkinsonism is not, however, dependent on familiarity, or even enjoyment, though in general music works best if it is both familiar and liked.

  Another patient, Edith T., a former music teacher, spoke of her need for music. Sh
e said that she had become “graceless” with the onset of parkinsonism, that her movements had become “wooden, mechanical— like a robot or doll.” She had lost her former naturalness and musicality of movement; in short, she said, she had been “unmusicked” by her parkinsonism. But when she found herself stuck or frozen, even the imagining of music might restore the power of action to her. Now, as she put it, she could “dance out of the frame,” the flat, frozen landscape in which she was trapped, and move freely and gracefully: “It was like suddenly remembering myself, my own living tune.” But then, just as suddenly, the inner music would cease, and she would fall once again into the abyss of parkinsonism. Equally dramatic, and perhaps in some way analogous, was Edith’s ability to use, to share, other people’s ambulatory abilities— she could easily and automatically walk with another person, falling into their rhythm, their tempo, sharing their kinetic melody, but the moment they stopped, she would stop, too.

  The movements and perceptions of people with parkinsonism are often too fast or too slow, though they may not be aware of this— they may be able to infer it only when they compare themselves to clocks, or to other people. The neurologist William Gooddy described this in his book Time and the Nervous System: “An observer may note how slowed a parkinsonian’s movements are, but the patient will say, ‘My own movements seem normal to me unless I see how long they take by looking at a clock. The clock on the wall of the ward seems to be going exceptionally fast.’ ” Gooddy wrote of the sometimes enormous disparities such patients can show between “personal time” and “clock time.”3