Musicophilia

by Oliver Sacks

  Tolstoy was deeply ambivalent about music, because it had, he felt, a power to induce in him “fictitious” states of mind— emotions and images that were not his own and not under his control. He adored Tchaikovsky’s music but often refused to listen to it, and in “The Kreutzer Sonata,” he described the seduction of the narrator’s wife by a violinist and his music— the two of them play Beethoven’s Kreutzer Sonata together, and this music is so powerful, the narrator comes to think, that it can change a woman’s heart and cause her to be unfaithful. The story ends with the outraged husband murdering his wife— though the real enemy, he feels, the enemy he cannot kill, is the music.3

  25

  Lamentations: Music and Depression

  Robert Burton, in The Anatomy of Melancholy, wrote at length of music’s power, and John Stuart Mill found that when he fell into a state of melancholia or anhedonia as a young man, music and nothing else had the power to pierce through this, to give him, at least for a while, a feeling of pleasure and being alive. Mill’s depression, it is thought, stemmed from the ruthless regime imposed by his father, who demanded incessant intellectual work and achievement from the time John Stuart was three, while doing little to nurture or even recognize his son’s emotional needs. Not surprisingly, the young prodigy had a crisis when he reached adulthood and entered a state in which nothing could give him any pleasure except music. Mill was not choosy about the music; he wanted cheerful, lively melodies, and Mozart, Haydn, and Rossini were equally to his taste. His only fear was that he might exhaust the musical repertoire and have nothing left to turn to.

  The continuing and general need for music which Mill described is distinct from the crucial effect that particular pieces of music may have at particular times. William Styron, in his memoir Darkness Visible, described such an experience, when he was very close to suicide:

  My wife had gone to bed, and I had forced myself to watch the tape of a movie…. At one point in the film, which was set in late-nineteenth-century Boston, the characters moved down the hallway of a music conservatory, beyond the walls of which, from unseen musicians, came a contralto voice, a sudden soaring passage from the Brahms Alto Rhapsody.

  This sound, which like all music— indeed, like all pleasure— I had been numbly unresponsive to for months, pierced my heart like a dagger, and in a flood of swift recollection I thought of all the joys the house had known: the children who had rushed through its rooms, the festivals, the love and work…

  I have had a few similar experiences myself, in which music has “pierced my heart,” in Styron’s words, when nothing else could— especially, perhaps, in bereavement.

  I was passionately fond of my mother’s sister, my Auntie Len; I often felt she had saved my sanity, if not my life, when I was sent away from home as a child, evacuated from London during the war. Her death left a sudden huge hole in my life, but, for some reason, I had difficulty mourning. I went about my work, my daily life, functioning in a mechanical way, but inside I was in a state of anhedonia, numbly unresponsive to all pleasure— and, equally, sadness. One evening I went to a concert, hoping against hope that the music might revive me, but it did not work; the whole concert bored me— until the last piece was played. It was a piece I had never heard before, by a composer I had never heard of, The Lamentations of Jeremiah by Jan Dismus Zelenka (an obscure Czech contemporary of Bach’s, I later learned). Suddenly, as I listened, I found my eyes wet with tears. My emotions, frozen for weeks, were flowing once again. Zelenka’s Lamentations had broken the dam, letting feeling flow where it had been obstructed, immobilized inside me.

  A similar reaction to music was described by Wendy Lesser in her book Room for Doubt. She, too, lost a Lenny, in her case a beloved friend rather than a beloved aunt. Where for me the releaser of emotion, the cathartic, was Zelenka’s Lamentations, for Lesser it was Brahms’s Requiem:

  That performance of the Brahms Requiem had a powerful effect on me. I went to Berlin thinking I would write about David Hume there…but…as the waves of music poured over me— listening with my whole body, it seemed, and not just my ears— I realized I was going to have to write about Lenny instead.

  I had been carrying Lenny’s death in a locked package up till then, a locked frozen package that I couldn’t get at but couldn’t throw away either…. It wasn’t just Lenny that had been frozen; I had, too. But as I sat in the Berlin Philharmonic Hall, and listened to the choral voices singing their incomprehensible words, something warmed and softened in me. I became, for the first time in months, able to feel again.

  WHEN I GOT the news of my mother’s death, I flew at once to London, to the parental house, where, for a week, we sat shivah for her. My father, my three brothers, and I, along with my mother’s surviving brothers and sisters, all sat on low chairs, nourished emotionally and physically by the continual succession of relatives and friends who brought food and memories. Very movingly, many of my mother’s patients and students came to pay their respects. Everywhere there was warmth, care, love, support, a flowing and sharing of feelings. But when I returned after this week to my empty and frigid apartment in New York, my feelings “froze” and I fell into what is inadequately called a depression.

  For weeks I would get up, dress, drive to work, see my patients, try to present a normal appearance. But inside I was dead, as lifeless as a zombie. Then one day as I was walking down Bronx Park East, I felt a sudden lightening, a quickening of mood, a sudden whisper or intimation of life, of joy. Only then did I realize that I was hearing music, though so faintly it might have been no more than an image or a memory. As I continued to walk, the music grew louder, until finally I came to its source, a radio pouring Schubert out of an open basement window. The music pierced me, releasing a cascade of images and feelings— memories of childhood, of summer holidays together, and of my mother’s fondness for Schubert (she would often sing his Nachtgesang in a slightly off-key voice). I found myself not only smiling for the first time in weeks, but laughing aloud— and alive once again.

  I wanted to linger by the basement window— Schubert and only Schubert, I felt, was life. Only his music had the secret of keeping me alive. But I had a train to catch and kept walking. And I fell into my depression again.

  A few days later, by chance, I heard that the great baritone Dietrich Fischer-Dieskau would be performing Schubert’s Winterreise at Carnegie Hall. The performance was sold out, but I joined a crowd of people outside hoping to get in, and managed to buy a ticket for a hundred dollars. This was a huge amount in 1973, and my earnings then were modest, but it seemed a small price to pay (as I put it to myself) for my life. But when Fischer-Dieskau opened his mouth to sing the first notes, I realized that something was terribly wrong. He was, as always, technically flawless, but his singing for some reason seemed utterly flat, horribly and completely devoid of life. All around me people seemed to be in a raptus of attention, listening with profound and unfathomable expressions. They were simulating these, I decided— politely pretending to be moved, when they knew as well as I that Fischer-Dieskau had lost the wonderful warmth and sensibility that used to pervade his voice. I was, of course, totally mistaken, as I came to realize afterwards. The reviewers the next day agreed that Fischer-Dieskau had never been better. It was I who had become lifeless again, cocooned and frozen— so frozen this time that not even Schubert could get to me.

  Perhaps I was defending myself, walling myself up, against feelings that threatened to be overwhelming; perhaps, more simply, I was demanding that the music work, where experience had shown me that demanding never succeeds. The power of music, whether joyous or cathartic, must steal on one unawares, come spontaneously as a blessing or a grace— as it did when the music stole from the basement window, or when I was prized open, helplessly, by the brokenhearted eloquence of Zelenka’s Lamentations. (“The Arts are not drugs,” E. M. Forster once wrote. “They are not guaranteed to act when taken. Something as mysterious and capricious as the creative impulse has to be released be
fore they can act.”)

  John Stuart Mill wanted cheerful music, and it seemed to act as a tonic for him, but Lesser and I, both dealing with the loss of a beloved figure, had very different needs and a very different experience with music. It is not coincidental that the music which released our grief and allowed emotion to flow again was a requiem, in Lesser’s case, and a lamentation, in my own. This was music designed for occasions of loss and death, the only sort of music, perhaps, which could speak to our condition.

  The psychiatrist Alexander Stein has described his experience of 9/11: he lived opposite the World Trade Center and he saw it hit, watched it crumple, and was caught up in the terrified crowds fleeing down the street, not knowing whether his wife was alive or dead. He and his wife were homeless refugees for the next three months. During this time, he writes,

  My internal world was dominated by a dense and silent pall, as if an entire mode of existence were in an airless vacuum. Music, even the usual internal listening of especially beloved works, had been muted. Paradoxically, life in the auditory sphere was in other respects heightened immeasurably, but calibrated, so it seemed, to a narrow spectrum of sounds: my ears now were attuned more to the roar of fighter jets and the wail of sirens, to my patients, to my wife’s breathing at night.

  It was only after several months, he writes, that “music finally returned as a part of life for and in me,” and the piece he first heard internally was Bach’s Goldberg Variations.

  On the recent fifth anniversary of September 11, on my morning bike ride to Battery Park, I heard music as I approached the tip of Manhattan, and then saw and joined a silent crowd who sat gazing out to sea and listening to a young man playing Bach’s Chaconne in D on his violin. When the music ended and the crowd quietly dispersed, it was clear that the music had brought them some profound consolation, in a way that no words could ever have done.

  Music, uniquely among the arts, is both completely abstract and profoundly emotional. It has no power to represent anything particular or external, but it has a unique power to express inner states or feelings. Music can pierce the heart directly; it needs no mediation. One does not have to know anything about Dido and Aeneas to be moved by her lament for him; anyone who has ever lost someone knows what Dido is expressing. And there is, finally, a deep and mysterious paradox here, for while such music makes one experience pain and grief more intensely, it brings solace and consolation at the same time.

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  The Case of Harry S.: Music and Emotion

  Perhaps one should not have favorite patients, or patients who break one’s heart— but I do, and among them was Harry S. He was the first patient I saw when I came to Beth Abraham Hospital in 1966, and I saw him frequently until his death thirty years later.

  When I met him, Harry was in his late thirties, a brilliant mechanical engineer— he had studied at MIT— who had had a sudden rupture of a brain aneurysm while cycling up a hill. He had bled extensively into both frontal lobes, and the right was severely damaged, the left less so. He was in a coma for several weeks and remained irreparably damaged, so it seemed, for months afterwards— months in which his wife, despairing, divorced him. When he finally left the neurosurgical unit and came to Beth Abraham, a hospital for the chronically ill, he had lost his work, his wife, the use of his legs, and a large chunk of his mind and personality. And though he began slowly to regain most of his former intellectual powers, he remained severely impaired emotionally— inert, flat, and indifferent. He would do very little by himself, or for himself, but depended on others for incentive and “go.”

  He still subscribed, out of habit, to Scientific American and would read every issue from cover to cover, as he had before his accident. But while he understood everything he read, none of the articles, he admitted, excited his interest, his wonder, anymore— and “wonder,” he said, had been at the core of his previous life.

  He would read the daily papers conscientiously, taking in everything, but with an uncaring, indifferent eye. Surrounded by all the emotions, the drama, of others in the hospital— people agitated, distressed, in pain, or (more rarely) laughing and joyful— surrounded by their wishes, fears, hopes, aspirations, accidents, tragedies, and occasional jubilations, he himself remained entirely unmoved, seemingly incapable of feeling. He retained the forms of his previous civility, his courtesy, but we had the sense that these were no longer animated by any real feeling.

  But all this would change, suddenly, when Harry sang. He had a fine tenor voice and loved Irish songs. When he sang, he showed every emotion appropriate to the music— the jovial, the wistful, the tragic, the sublime. And this was astounding, because one saw no hint of this at any other time and might have thought his emotional capacity was entirely destroyed.

  It was as if music, its intentionality and feeling, could “unlock” him or serve as a sort of substitute or prosthesis for his frontal lobes and provide the emotional mechanisms he seemingly lacked. He seemed to be transformed while he sang, but when the song was over he would relapse within seconds, becoming vacant, indifferent, and inert once again.

  Or so it seemed to most of us at the hospital; others had doubts. My colleague Elkhonon Goldberg, a neuropsychologist especially interested in frontal lobe syndromes, was not convinced. Goldberg stressed that such patients may involuntarily echo another’s gestures or actions or speech, and tend to a sort of involuntary simulation or mimicry.

  Was Harry’s singing, then, nothing more than an elaborate, automatic sort of mimicry, or did the music somehow allow him to feel emotions to which he normally had no access? Goldberg was uncertain about this. For myself, and many others at the hospital, it was hard to believe that these emotions we saw in Harry were simulated— but perhaps that speaks to the power of music for the listener.1

  In 1996, the last time I saw Harry, thirty years after his accident, he had developed hydrocephalus and large cysts in his frontal lobes; he was too ill and fragile for any surgical intervention. But, though so weak, he gathered his last bit of animation and sang for me— “Down in the Valley” and “Goodnight, Irene”— with all the delicacy and tenderness of his earlier days. It was his swan song; a week later he was dead.

  27

  Irrepressible: Music and the Temporal Lobes

  In 1984 I met Vera B., an elderly woman who had just been admitted to a nursing home because of medical problems (including severe arthritis and breathlessness) that made independent life increasingly difficult for her. I found no neurological problems, but I was struck by the fact that Vera was so high-spirited— talkative, jokey, and a trifle flirtatious. I did not think this was of any neurological import at the time, but just an expression of character.

  When I saw her again four years later, I observed in my notes, “She shows impulses to sing old Yiddish songs, and at times, a near-irrepressible chutzpah. It seems to me now that she is losing her inhibitions.”

  By 1992, this picture of disinhibition had become florid. Sitting outside the clinic, awaiting me, Vera was singing “A Bicycle Built for Two” in a loud voice, interlarding the lyrics with words of her own invention. In my office, she continued to sing: songs in English, Yiddish, Spanish, Italian, and a polyglot mixture that contained, I suspected, all of these, plus some of her native Latvian. When I phoned Connie Tomaino, our music therapist, she told me that Vera now tended to sing nonstop the entire day. Previously, she had not been terribly musical, Connie said, but “she’s musical now.”

  It was not easy to have a conversation with Vera. She was impatient with questions and often broke off in mid-answer to sing. I did what mental testing I could, and it was obvious that Vera was basically alert and oriented to her surroundings. She knew that she was an old lady in a hospital; she knew Connie (“a young maideleh— I forget her name”); she was able to write and draw a clock.

  I was not sure what to make of all this. “A peculiar form of dementia,” I wrote in my notes. “Cerebral disinhibition has proceeded apace. This may be due to an Alzhe
imer-like process (though surely with Alzheimer’s she would be more impaired and confused). But I cannot help wondering about other, rarer entities.” In particular I wondered whether she had damage to the frontal lobes of the brain. Damage to the lateral portions of the frontal lobes can lead to inertia and indifference, as with Harry S. But damage to the medial or orbitofrontal areas has a very different effect, depriving one of judgment and restraint and opening the way to a nonstop stream of impulses and associations. People with this type of frontal lobe syndrome may be jokey and impulsive, like Vera— but I had never heard of excessive musicality as one of its symptoms.

  When Vera died a few months later, from a massive heart attack, I tried to get an autopsy, wondering what the brain would show. But autopsies had become rare and difficult to obtain, and I was not successful.

  I was soon distracted by other matters and did not think about the puzzling case of Vera, with her strange and in a way creative disinhibition, the wild singing and wordplay that had characterized her final years. It was only in 1998, when I read a paper by Bruce Miller and his colleagues in San Francisco on the “Emergence of Artistic Talent in Frontotemporal Dementia,” that I suddenly thought of Vera again, and realized that it was probably just such a dementia that she had had— although the “emergence” with her had been musical rather than visual. But if there could be emergence of visual, artistic talents, why not musical ones? Indeed, in 2000, Miller et al. published a short paper on the emergence of unprecedented musical tastes in some of their patients in the dementia unit at the University of California–San Francisco and a longer, comprehensive paper, with vivid case histories, on “Functional Correlates of Musical and Visual Ability in Frontotemporal Dementia.”