by Oliver Sacks
Mrs. B. described how she had tests for Lyme disease (she had read that this could cause musical hallucinations), brainstem-evoked audiometry, an EEG, and an MRI. During her EEG, she heard “The Bells of St. Mary’s”— but nothing abnormal showed. She had no signs of hearing loss.
Her musical hallucinations tended to occur during quiet moments, especially when she went to bed. “I can never turn the music on or off, but I can sometimes change the melody— not to just anything I want to hear, but to something that has already been programmed. Sometimes the songs overlap, I can’t stand another minute, so I turn on WQXR and go to sleep by some real music.17
“I’m very fortunate,” Mrs. B. concluded, “that my music isn’t all that loud…. If it were, I’d really go crazy. It takes over in quiet moments. Any audio distractions— conversation, radio, TV— effectively drown out whatever I’m hearing. You observe that I seem to get on with my new addition ‘amiably.’ Well, I can cope okay, but it can be very annoying…. When I wake up at 5 a.m. and can’t get back to sleep, I don’t appreciate having a chorus reminding me that ‘the old gray mare ain’t what she used to be.’ This is not a joke. It really did happen, and I might have thought it amusing if it hadn’t kept singing the same refrain over and over again.”
A decade after she first wrote to me, I met with Mrs. B., and I asked her whether, after so many years, her hallucinated music had become “important” in her life, in either a positive or a negative way. “If it went away,” I asked, “would you be pleased or would you miss it?”
“Miss it,” she answered at once. “I would miss the music. You see, it is now a part of me.”
* * *
WHILE THERE IS no doubt of the physiological basis of musical hallucinations, one has to wonder to what extent other (let us call them “psychological”) factors may enter into the initial “selection” of the hallucinations and their subsequent evolution and role. I wondered about such factors when I wrote in 1985 about Mrs. O’C. and Mrs. O’M.; Wilder Penfield, too, had wondered whether there was any sense or significance in the songs or scenes evoked in “experiential seizures” but had decided there was not. The selection of hallucinatory music, he had concluded, was “quite at random, except that there is some evidence of cortical conditioning.” Rodolfo Llinás, similarly, has written of the incessant activity in the nuclei of the basal ganglia, and how they “seem to act as a continuous, random motor pattern noise generator.” When a pattern or fragment might escape now and then and thrust into consciousness a song or a few bars of music, Llinás felt this was purely abstract and “without its apparent emotional counterpart.” But something may start randomly— a tic, for example, bursting out of overexcited basal ganglia— and then acquire associations and meaning.
One may use the word “random” with regard to the effects of a low-level mishap in the basal ganglia— in the involuntary movement called chorea, for example. There is no personal element in chorea; it is wholly an automatism— it does not, for the most part, even make its way to consciousness and may be more visible to others than to the patient himself. But “random” is a word one would hesitate to use in regard to experiences, whether these are perceptual, imaginary, or hallucinatory. Musical hallucinations draw upon the musical experience and memories of a lifetime, and the importance that particular sorts of music have for the individual must surely play a major role. The sheer weight of exposure may also play a significant part, even overriding personal taste— the vast majority of musical hallucinations tend to take the form of popular songs or theme music (and, in an earlier generation, hymns and patriotic songs), even in professional musicians or very sophisticated listeners.18 Musical hallucinations tend to reflect the tastes of the times more than the tastes of the individual.
Some people— a few— come to enjoy their musical hallucinations; many are tormented by them; most, sooner or later, reach some kind of accommodation or understanding with them. This may sometimes take the form of direct interaction, as in a charming case history published by Timothy Miller and T. W. Crosby. Their patient, an elderly deaf lady, “awoke one morning hearing a gospel quartet singing an old hymn she remembered from childhood days.” Once she had ascertained that the music was not coming from a radio or television, she rather calmly accepted that it was coming “from inside my head.” The choir’s repertoire of hymns increased: “the music was generally pleasing, and the patient often enjoyed singing along with the quartet…. She also found that she could teach the quartet new songs by thinking of a few lines, and the quartet would supply any forgotten words or verses.” Miller and Crosby observed that a year later the hallucinations were unchanged, adding that their patient had “adjusted well to her hallucinations and views them as a ‘cross’ she must bear.” Yet “bearing a cross” may not carry a wholly negative connotation; it can also be a sign of favor, of election. I recently had occasion to see a remarkable old lady, a pastor who developed musical hallucinations— mostly of hymns— as she became hard of hearing. She came to see her hallucinations as “a gift” and has “trained” them to a considerable extent, so that they occur while she is in church or at prayer, but not at mealtimes, for instance. She has incorporated her musical hallucinations into a deeply felt religious context.
Such personal influences are fully allowed— indeed required— in Konorski’s model, and in Llinás’s, too. Fragmentary music patterns may be emitted or released from the basal ganglia as “raw” music, without any emotional coloring or associations— music which is, in this sense, meaningless. But these musical fragments make their way to the thalamocortical systems that underlie consciousness and self, and there they are elaborated and clothed with meaning and feeling and associations of all sorts. By the time such fragments reach consciousness, meaning and feeling have already been attached.
PERHAPS THE MOST intensive analysis of musical hallucinations and their shaping by personal experience and feeling, their continuing interaction with the mind and personality, has been pursued by the eminent psychoanalyst Leo Rangell. For Rangell, musical hallucinations have been the subject of continuing self-study that has lasted now for more than a decade.
Dr. Rangell first wrote to me about his musical hallucinations in 1996.19 He was eighty-two, and had had a second bypass surgery a few months before:
Immediately upon awakening, in the ICU, I heard singing, which made me say to my children, “Hey, there’s a rabbi school out there.” It sounded to me like an old rabbi who…was teaching young rabbi students how to sing, and perform their things. I told my family the rabbi must work late, even midnight, since I heard the music then too. My kids looked at each other, and said amusedly and tolerantly: “There’s no rabbi school out there.”
I of course soon began to know this was me. This gave me both relief and concern…. The music must have been continuous, but I paid little or no attention to it for large blocks of time, especially during the busy hospital routines. When I left the hospital, after six days…the “rabbi” followed me. He was now outside my windows at home, towards the hills; or was he in the canyon? On my first plane trip a few weeks later, he came with me.
Rangell had hoped that these musical hallucinations— perhaps, he thought, a product of the anesthesia, or the morphine he had received after surgery— would go away with time. He had also experienced “copious cognitive distortions, which every bypass patient I know has had”— but these had quickly cleared up.20
After six months, however, he feared they were becoming permanent. During the day, he could often push the music aside when otherwise absorbed, but at night, the musical hallucinations kept him awake (“I feel quite ragged from lack of sleep,” he wrote).
Dr. Rangell did have a significant hearing loss. “I have had nerve deafness for many years now, familial. The musical hallucinosis is related, I feel, to the hyperacusis that goes with the hypo-hearing. The internal, central auditory pathways must overwork and enhance sounds.” He speculated that this over-activity of auditory brain p
athways might at first be based on external rhythms of wind, traffic, or humming motors or on internal rhythms of breath or heartbeat— and that “the mind then converts these to music or song, establishing control over it. Passivity is overcome by activity.”
Dr. Rangell felt that his internal music reflected his moods and circumstances. At first, in the hospital, the songs varied; they were sometimes funereal, elegiac, rabbinical, sometimes lilting and happy (“Oo la la, oo la la” alternating with “oy vey, oy vey, oy vey, vey, vey”— later he realized these were to the same tune). When he was due to come home from the hospital, he began to hear “When Johnny Comes Marching Home Again,” and then “jaunty, jolly ones” like “Alouette, gentille alouette.”
“When there is no official song that comes on by itself,” he continued, “my brain-mind makes one up— the rhythmic sounds are put to music, often with nonsense words— maybe the last words someone said, or I read or heard or thought.” This phenomenon, he felt, was related to creativity, like dreams.
I continued to correspond with Dr. Rangell, and in 2003 he wrote:
I have lived with this thing now for almost eight years. The symptom is always there. One senses it is 24/7…[but] to say that it is always with me does not mean that I am always aware of it— that would indeed send me to a loony house. It is part of me in that it is there whenever I think about it. Or whenever my mind is not occupied, that is, attending to something.
But I can bring the tunes on in the most effortless way. I have but to think about one bar of music or one word of a lyric and the total work rushes in and gets going. It is like the most sensitive remote control. It then stays as long as “it” wishes— or as long as I let it….
It is like a radio with only a turn-on key.
Rangell has lived with his musical hallucinations for more than ten years now, and increasingly, they seem less meaningless, less random to him. The songs are all from his younger years, and “they can be categorized,” he wrote:
They are romantic, or poignant, or tragic, or celebratory, about love, or make me cry— everything. All bring memories…. Many are of my wife…she passed away seven years ago, a year and a half after this began….
They are structurally like a dream. They have a precipitating stimulus, relate to affects, bring back thoughts automatically whether I want to or not, are cognitive as well, have a substructure if I want to pursue them….
Sometimes when the music stopped, I would find myself humming the tune I had just wished would please stop. I found I missed it…. Every psychoanalyst knows that in every symptom (and this is a symptom), behind every defense is a wish…. The songs that come to the surface…carry urges, hopes, wishes. Romantic, sexual, moral, aggressive wishes, as well as urges for action and mastery. They are in fact what brought [my musical hallucinations] to their final shape, neutralizing and replacing the original interfering noise. Complain as I will, the song is welcome, at least partially so.
Summarizing his experiences in a long article published online in the Huffington Post, Rangell wrote:
I consider myself a kind of living laboratory, an experiment in nature through an auditory prism…. I have been living at the edge. But a very special edge, the border between the brain and the mind. From here the vistas are wide, in several directions. The fields over which these experiences roam cover neurologic, otologic, and psychoanalytic realms, converging into a unique symptomatic combination of them all, lived and experienced not on a controlled couch but on the stage of an ongoing life.
Part II
A Range of Musicality
7
Sense and Sensibility: A Range of Musicality
We often speak of people as having or not having “a good ear.” A good ear means, as a start, having an accurate perception of pitch and rhythm. We know that Mozart had a wonderful “ear” and, of course, he was a sublime artist. We take it that all good musicians must have a decent “ear,” even if not one of Mozartian caliber— but is a good ear sufficient?
This comes up in Rebecca West’s partly autobiographical novel The Fountain Overflows, a story of life in a musical family, with a mother who is a professional musician (like West’s own mother), an intellectually brilliant but unmusical father, and three children— two of whom, like their mother, are deeply musical. The best ear, however, belongs to the “unmusical” child, Cordelia. She, in her sister’s words,
had a true ear, indeed she had absolute pitch, which neither Mamma, nor Mary, nor I had…and she had supple fingers, she could bend them right back to the wrist, and she could read anything at sight. But Mamma’s face crumpled, first with rage, and then, just in time, with pity, every time she heard Cordelia laying the bow over the strings. Her tone was horribly greasy, and her phrasing always sounded like a stupid grown-up explaining something to a child. Also she did not know good music from bad, as we did, as we had always done.
It was not Cordelia’s fault that she was unmusical. Mamma had often explained that to us…. [She] had taken her inheritance from Papa.
An opposite situation is described in Somerset Maugham’s story “The Alien Corn.” Here the elegant young son of a newly ennobled family, being groomed for a gentleman’s life of hunting and shooting, develops, to his family’s dismay, a passionate desire to be a pianist. A compromise is reached, in which the young man goes to Germany to study music, with the understanding that he will return to England after two years and submit himself to the opinion of a professional pianist.
When the time comes, George, newly returned from Munich, takes his place at the piano. Lea Makart, a famous pianist, has come down for the day, and all the family is gathered around. George throws himself into the music, playing Chopin “with a great deal of brio.” But something is amiss, as the narrator observes:
I wish I knew music well enough to give an exact description of his playing. It had strength, and a youthful exuberance, but I felt that he missed what is to me the peculiar charm of Chopin, the tenderness, the nervous melancholy, the wistful gaiety and the slightly faded romance that reminds me always of an Early Victorian keepsake. And again I had the vague sensation, so slight that it almost escaped me, that the two hands did not quite synchronise. I looked at Ferdy and saw him give his sister a look of faint surprise. Muriel’s eyes were fixed on the pianist, but presently she dropped them and for the rest of the time stared at the floor. His father looked at him too, and his eyes were steadfast, but unless I was much mistaken he went pale and his face betrayed something like dismay. Music was in the blood of all of them, all their lives they had heard the greatest pianists in the world, and they judged with instinctive precision. The only person whose face betrayed no emotion was Lea Makart. She listened very attentively. She was as still as an image in a niche.
Finally, Makart delivered her judgment:
“If I thought you had in you the makings of an artist I shouldn’t hesitate to beseech you to give up everything for art’s sake. Art is the only thing that matters. In comparison with art, wealth and rank and power are not worth a straw…. Of course I can see that you’ve worked very hard. Don’t think it’s been wasted. It will always be a pleasure to you to be able to play the piano and it will enable you to appreciate great playing as no ordinary person can hope to do.”
But George had neither the hands nor the ear, she continued, to become a first-rate pianist, “not in a thousand years.”
George and Cordelia are both incurably deficient in their musicality, though in quite different ways. George has drive, energy, dedication, a passionate feeling for music, but he lacks some basic neurological competence— his “ear” is deficient. Cordelia, on the other hand, has a perfect ear, but one has the feeling that she will never “get” musical phrasing, will never improve her “greasy” tone, never be able to tell good music from bad, because she is profoundly deficient (although she does not realize it) in musical sensibility and taste.
Does musical sensibility— “musicality” in the most general sense— also
demand a specific neurological potential? Most of us can hope that there may be some harmony, some alignment, between our desires and our powers and our opportunities, but there will always be those like George whose abilities do not match their desires, and those like Cordelia who seem to have every talent except the most important one: judgment or taste. No one has all the talents, cognitively or emotionally. Even Tchaikovsky was keenly aware that his great fertility in melody was not matched by a comparable grasp of musical structure— but he had no desire to be a great architectonic composer like Beethoven; he was perfectly happy to be a great melodic one.1
Many of the patients or correspondents I describe in this book are conscious of musical misalignments of one sort or another. The “musical” parts of their brains are not entirely at their service, and may indeed seem to have a will of their own. This is the case, for example, with musical hallucinations, which are imposed upon, and not sought by, those who have them— and are thus quite different from the musical imagery or imagination one feels to be one’s own. On the performance side, this is what happens with musician’s dystonia, when the fingers refuse to obey one’s will and curl up or show a “will” of their own. In such circumstances, a part of the brain is at odds with one’s intentionality, one’s self.
Even if there is no misalignment of a gross sort, where mind and brain are in conflict with one another, musicality, like other gifts, can create its own problems. I think here of the eminent composer Tobias Picker, who also, as it happens, has Tourette’s syndrome. Soon after I met him he told me that he had “a congenital disorder” that had “bullied” him all his life. I assumed that he was talking about his Tourette’s, but he said no— the congenital disorder was his great musicality. He had, it seemed, been born with this; he had recognized and tapped out tunes in the first years of life and had started to play the piano and compose at four. By the age of seven, he could reproduce long and elaborate pieces of music after a single hearing and constantly found himself “overwhelmed” by musical emotion. He said that it was understood, practically from the start, that he would be a musician, and that he had little chance of doing anything else, because his musicality was all consuming. He would not, I think, have had it any other way, but he sometimes felt that his musicality controlled him, rather than the other way around. Many artists and performers, no doubt, have the same feeling at times— but with music (as with mathematics) such abilities can be especially precocious and may determine one’s life from a very early age.