Musicophilia

by Oliver Sacks

  While Cytowic was investigating synesthesia in the United States, Simon Baron-Cohen and John Harrison were opening up the subject in England, and in 1997 they published a review volume, Synaesthesia: Classic and Contemporary Readings.

  Galton believed that genuine synesthesia was strongly familial, and Harrison and Baron-Cohen noted that a third of their subjects reported close relatives who also had synesthesia. Nabokov, in his autobiography, Speak, Memory, wrote of how as a child he saw all the letters of the alphabet as having distinct colors and was deeply upset when he was given a box of colored letters and found that nearly all of them were the “wrong” color. His mother, also a synesthete, agreed with him that the colors were wrong, but not on what they should be. (Nabokov’s wife, too, was a synesthete, as is their son.)

  While synesthesia has been regarded as quite rare, affecting perhaps one person in two thousand, and to have a strong gender preference (with a female to male ratio of about six to one), a recent study by Julia Simner, Jamie Ward, and their colleagues has brought both of these suppositions into question. Using a random population of almost seventeen hundred subjects, and objective tests to separate genuine from pseudosynesthesia, they found that one person in twenty-three had some kind of synesthesia— most commonly for colored days— and that there was no significant gender difference.10

  Prior to 1999, there were no objective psychological tests for synesthesia. But in the past few years, V. S. Ramachandran and E. M. Hubbard have brought great experimental ingenuity to the testing of this. In order to distinguish true synesthesia from pseudosynesthesia, for example, they have devised tests that only a genuine synesthete can “pass.” One such test (described in their 2001 paper in the Journal of Consciousness Studies) presents the subject with a medley of rather similar-looking 2s and 5s, all printed in black. The ordinary person would be hard put to distinguish these at a glance, but a color-number synesthete can distinguish them easily by their different “colors.”

  Functional brain imaging has now confirmed that there is activation of visual areas (especially color-processing areas) in synesthetes when they “see” colors in response to speech or music.11 There is little room for doubt, anymore, as to the physiological as well as the psychological reality of synesthesia.

  Synesthesia seems to go with an unusual degree of cross-activation between what, in most of us, are functionally independent areas of the sensory cortex— such cross-activation could be based on an anatomical excess of neural connections between different areas of the brain. There is some evidence that such “hyperconnectivity” is indeed present in primates and other mammals during fetal development and early infancy, but is reduced or “pruned” within a few weeks or months after birth. There have not been equivalent anatomical studies in human infants, but as Daphne Maurer of McMaster University notes, behavioral observations of infants suggest “that the newborn’s senses are not well differentiated, but are instead intermingled in a synaesthetic confusion.”

  Perhaps, as Baron-Cohen and Harrison write, “we might all be colored-hearing synesthetes until we lose connections between these two areas somewhere about three months of age.” In normal development, according to this theory, a synesthetic “confusion” gives way in a few months, with cortical maturation, to a clearer distinction and segregation of the senses, and this in turn makes possible the proper cross-matching of perceptions which is needed for the full recognition of an external world and its contents— the sort of cross-matching which ensures that the look, the feel, the taste, and the crunch of a Granny Smith apple all go together. In those individuals with synesthesia, it is supposed, a genetic abnormality prevents complete deletion of this early hyperconnectivity, so that a larger or smaller remnant of this persists in adult life.

  Synesthesia seems to be commoner in children. As early as 1883, the same year that Galton’s book was published, the eminent psychologist Stanley Hall described music-color synesthesia in 40 percent of children interviewed— a figure which may err on the high side. But a variety of more recent studies agree that synesthesia is a good deal commoner in childhood and tends to disappear at adolescence. Whether this goes with hormonal changes or cerebral reorganizations, which are both occurring at this time, or with a movement to more abstract forms of thinking is unclear.

  While synesthesia usually appears very early in life, there are rare situations which may provoke its appearance later in life— for example, it can occur transiently during temporal lobe seizures or under the influence of hallucinogens.

  But the only significant cause of permanent acquired synesthesia is blindness. The loss of vision, especially early in life, may lead, paradoxically, to heightened visual imagery and all sorts of intersensory connections and synesthesias. The rapidity with which synesthesia can follow blindness would scarcely allow the formation of new anatomical connections in the brain and suggests instead a release phenomenon, the removal of an inhibition normally imposed by a fully functioning visual system. In this way, synesthesia following blindness would be analogous to the visual hallucinations (Charles Bonnet syndrome) often associated with increasing visual impairment or the musical hallucinations sometimes associated with increasing deafness.

  Within weeks of losing his sight, Jacques Lusseyran developed a synesthesia so intense as to replace the actual perception of music, thus preventing him from becoming a musician, as he had intended:

  I had no sooner made a sound on the A string, or D or G or C, than I no longer heard it. I looked at it. Tones, chords, melodies, rhythms, each was immediately transformed into pictures, curves, lines, shapes, landscapes, and most of all colors…. At concerts, for me, the orchestra was like a painter. It flooded me with all the colors of the rainbow. If the violin came in by itself, I was suddenly filled with gold and fire, and with red so bright that I could not remember having seen it on any object. When it was the oboe’s turn, a clear green ran all through me, so cool that I seemed to feel the breath of night…. I saw music too much to be able to speak its language.12

  Similarly, V. S. Ramachandran, in A Brief Tour of Human Consciousness, described one patient who felt himself “invaded” by intrusive synesthesia after becoming blind at the age of forty. When his patient touched objects or read Braille, Ramachandran wrote, “his mind would conjure up vivid visual images, including flashes of light, pulsating hallucinations or sometimes the actual shape of the object he was touching.” These confusing sensations were “often irrelevant and always irrevocable and intrusive…a spurious and distracting nuisance,” and greatly interfered with every aspect of life.

  There is a world of difference, of course, between acquiring a condition later in life and being born with it. For Lusseyran, who acquired it in mid-childhood, color-music synesthesia, though beautiful, was intrusive and prevented him from enjoying music. But for those born with color-music synesthesia, it is different.

  There is a wide range in people’s attitudes to congenital synesthesia, the importance it may have for them, and the role it may play in their lives. This is evident even in the small sample of individuals I have described. Michael Torke, while he has a very strong and specific musical synesthesia, which at one time influenced both his musical sensibilities and his compositions, has come to think over time that “it is no big deal.” David Caldwell and Patrick Ehlen, on the other hand, feel that their synesthesia continues to be central to their musical identity and plays a most active part in their process of composing. But for all of them, synesthesia is natural, almost an extra sense— so much so that such questions as “What is it like?” or “What does it mean to you?” are as unanswerable as asking “What is it like to be alive? What is it like to be you?”

  Part III

  Memory, Movement, and Music

  15

  In the Moment: Music and Amnesia

  You are the music while the music lasts.

  — T. S. ELIOT, The Four Quartets

  In January 1985, his wife records, Clive Wearing, an eminent English
musician and musicologist in his mid-forties, was reading “The Lost Mariner,” a piece I had written about a patient with severe amnesia. My patient, Jimmie, I wrote, was “isolated in a single moment of being, with a moat or lacuna of forgetting all round him…. He is a man without a past (or future), stuck in a constantly changing, meaningless moment.”1

  “Clive and I,” Deborah Wearing wrote in her memoir, Forever Today, “could not get this story out of our heads and talked about it for days.” They had no way of knowing that they were, as Deborah put it, “staring into a mirror of our own future.”

  Two months later, Clive himself was struck by a devastating brain infection, a herpes encephalitis, affecting especially the parts of his brain concerned with memory; and he was left in a state far worse even than that of the patient I had described. Jimmie had a memory span of about half a minute; with Clive, it was only a few seconds. New events and experiences were effaced almost instantly, as Deborah wrote:

  His ability to perceive what he saw and heard was unimpaired. But he did not seem to be able to retain any impression of anything for more than a blink. Indeed, if he did blink, his eyelids parted to reveal a new scene. The view before the blink was utterly forgotten. Each blink, each glance away and back, brought him an entirely new view. I tried to imagine how it was for him…. Something akin to a film with bad continuity, the glass half empty, then full, the cigarette suddenly longer, the actor’s hair now tousled, now smooth. But this was real life, a room changing in ways that were physically impossible.

  In addition to this inability to preserve new memories, Clive had a devastating retrograde amnesia, a deletion of virtually his entire past.

  When he was filmed in 1986 for Jonathan Miller’s extraordinary BBC documentary, Prisoner of Consciousness, Clive showed a desperate aloneness, fear, and bewilderment. He was acutely, continually, agonizingly conscious that something bizarre, something terrible, was the matter. His constantly repeated complaint, however, was not of a faulty memory, but of being deprived, in some uncanny and terrible way, of all experience, deprived of consciousness and life itself. As Deborah wrote,

  It was as if every waking moment was the first waking moment. Clive was under the constant impression that he had just emerged from unconsciousness because he had no evidence in his own mind of ever being awake before…. “I haven’t heard anything, seen anything, touched anything, smelled anything,” he would say. “It’s like being dead.”

  Desperate to hold on to something, to gain some purchase, Clive started to keep a journal, first on scraps of paper, then in a notebook. But his journal entries consisted, essentially, of the statements “I am awake” or “I am conscious,” entered again and again every few minutes. He would write: “2.10 pm: this time properly awake…. 2.14 pm: this time finally awake…. 2.35 pm: this time completely awake,” along with negations of these statements: “At 9.40 pm I awoke for the first time, despite my previous claims.” This in turn was crossed out, followed by “I was fully conscious at 10.35 pm, and awake for the first time in many, many weeks.” This in turn was canceled out by the next entry.2

  This dreadful journal, almost void of any other content but these passionate assertions and denials, intending to affirm existence and continuity but forever contradicting them, was filled anew each day, and soon mounted to hundreds of almost identical pages. It was a terrifying and poignant testament to Clive’s mental state, his lostness, in the years that followed his amnesia— a state that Deborah, in Miller’s film, called “a never-ending agony.”

  Mr. Thompson, another profoundly amnesic patient I knew, dealt with his abysses of amnesia by fluent confabulations.3 He was wholly immersed in his quick-fire inventions and had no insight into what was happening; so far as he was concerned, there was nothing the matter. He would confidently identify or misidentify me as a friend of his, a customer in his delicatessen, a kosher butcher, another doctor— as a dozen different people in the course of a few minutes. This sort of confabulation was not one of conscious fabrication. It was, rather, a strategy, a desperate attempt— unconscious and almost automatic— to provide a sort of continuity, a narrative continuity, when memory, and thus experience, was being snatched away every instant.

  Though one cannot have direct knowledge of one’s own amnesia, there may be ways to infer it: from the expressions on people’s faces when one has repeated something half a dozen times, when one looks down at one’s coffee cup and finds that it is empty, when one looks at one’s diary and sees entries in one’s own handwriting. Lacking memory, lacking direct experiential knowledge, amnesiacs have to make hypotheses and inferences, and they usually make plausible ones. They can infer that they have been doing something, been somewhere, even though they cannot recollect what they have been doing or where. Yet Clive, rather than making plausible guesses, always came to the conclusion that he had just been “awakened,” that he had been “dead.” This seemed to me a reflection of the almost instantaneous effacement of perception for Clive— thought itself was almost impossible within this tiny window of time. Indeed, Clive once said to Deborah, “I am completely incapable of thinking.”

  At the beginning of his illness, Clive would sometimes be confounded at the bizarre things he experienced. Deborah wrote of how, coming in one day, she saw him

  holding something in the palm of one hand, and repeatedly covering and uncovering it with the other hand as if he were a magician practising a disappearing trick. He was holding a chocolate. He could feel the chocolate unmoving in his left palm, and yet every time he lifted his hand he told me it revealed a brand new chocolate.

  “Look!” he said. “It’s new!” He couldn’t take his eyes off it.

  “It’s the same chocolate,” I said gently.

  “No…look! It’s changed. It wasn’t like that before…” He covered and uncovered the chocolate every couple of seconds, lifting and looking.

  “Look! It’s different again! How do they do it?”

  Within months Clive’s confusion gave way to the agony, the desperation, that are so clear in Miller’s film. This, in turn, was succeeded by a deep depression, as it came upon him— if only in sudden, intense, and immediately forgotten moments— that his former life was over, that he was incorrigibly disabled, and that the rest of his life would be spent in institutions.

  As the months passed without any real improvement, the hope of significant recovery became fainter and fainter, and towards the end of 1985 Clive was moved to a room in a chronic psychiatric unit— a room he was to occupy for the next six and a half years, but which he was never able to recognize as his own. A young psychologist saw Clive for a period of time in 1990 and kept a verbatim record of everything he said, and this caught the grim mood that had taken hold. Clive said at one point, “Can you imagine one night five years long? No dreaming, no waking, no touch, no taste, no smell, no sight, no sound, no hearing, nothing at all. It’s like being dead. I came to the conclusion that I was dead.”

  The only times of feeling alive were when Deborah visited him. But the moment she left, he was desperate once again and by the time she got home, ten or fifteen minutes later, she would find repeated messages from him on her answering machine: “Please come and see me, darling— it’s been ages since I’ve seen you. Please fly here at the speed of light.”

  To imagine the future was no more possible for Clive than to remember the past— both were engulfed by the onslaught of amnesia. Yet at some level, Clive could not be unaware of the sort of place he was in, and the likelihood that the rest of his life, his endless night, would be spent in such a place.

  But then, seven years after his illness, after huge efforts made by Deborah, Clive was moved to a small country residence for the brain-injured, much more congenial than a hospital. Here he was one of only a handful of patients, and in constant contact with a dedicated staff who treated him as an individual and respected his intelligence and talents. He was taken off most of his heavy tranquilizers, and seemed to enjoy his walks around
the village and gardens near the home, the spaciousness, the fresh food.

  For the first eight or nine years in this new home, Deborah told me, “Clive was calmer and sometimes jolly, a bit more content, but often with angry outbursts still, unpredictable, withdrawn, spending most of his time in his room alone.” But gradually, in the last six or seven years, Clive has become more sociable, more talkative. Conversation (though of a “scripted” sort) has come to fill what had been before empty, solitary, and desperate days.

  THOUGH I HAD corresponded with Deborah since Clive first became ill, it was only twenty years later that I met Clive in person. And he was so changed from the haunted, agonized man I had seen in Miller’s 1986 film that I was scarcely prepared for the dapper, bubbling figure who opened the door when Deborah and I went to visit him in the summer of 2005. He had been reminded of our visit just before we arrived, and he flung his arms around Deborah the moment she entered.

  Deborah introduced me: “This is Dr. Sacks,” and Clive immediately said, “You doctors work twenty-four hours a day, don’t you? You’re always in demand.” We went up to his room, which contained an electric organ console and a piano piled high with music. Some of the scores, I noted, were transcriptions of Orlandus Lassus, the Renaissance composer whose works Clive had edited. I saw Clive’s journal by the washstand— he has now filled up scores of volumes, and the current one is always kept in this exact location. Next to it was an etymological dictionary with dozens of reference slips of different colors stuck between the pages and a large, handsome volume, The 100 Most Beautiful Cathedrals in the World. A Canaletto print hung on the wall, and I asked Clive if he had ever been to Venice. No, he said (but Deborah told me they had visited several times before his illness). Looking at the print, Clive pointed out the dome of a church: “Look at it,” he said, “see how it soars— like an angel!”