Musicophilia: Tales of Music and the Brain

In the 1990s, Sacks worked with a patient named Tony Cicoria, who at age 42 developed a sudden, intense interest in music as a result of a lightning strike. Cicoria describes leaving his body after the strike and watching himself being resuscitated. After the incident, his doctor thought he was fine and virtually unchanged from the incident. A couple of months later, Tony started to dream about music, to crave the piano, and to compose music automatically in his mind. What was once a casual interest became an obsession that took over most aspects of his life, although he maintained his work as a surgeon. He became more spiritual and sought answers to the afterlife. In a similar situation, another patient named Salimah M., a chemist, had a grand mal seizure and afterward developed a deep and passionate need to be surrounded by music. She also became a warmer, more compassionate person, as if emotions that she had long repressed were finally being released. Sacks cites a case study from 2006 in which a patient who had experienced years of temporal lobe seizures felt a sudden, overwhelming need for music after these seizures were brought under control with medication. The researchers, Rohrer, Smith, and Warren, theorized that the seizures had built a stronger connection between her temporal lobes and limbic system. Sacks believes that the changes these patients experienced are rooted in their neurology, but admits that there is insufficient data to explain them. Perhaps even stranger are cases in which people suddenly develop a talent or passion for music without any sort of injury or physical change at all; still, one such person notes how her brain has certainly changed with her new love of music, and that with each song she learns to play, new synapses form and it changes even further.

One of Sacks’s patients, Mr. S, experienced a sudden seizure in his temporal lobes at age 45, at a time when he was otherwise perfectly healthy. He recalls hearing a strangely familiar violin melody just before the seizure and being unable to place its source. While at the hospital, he had another seizure, which was also preceded by the same music. He was never able to identify where he had heard it before, or if he had at all. Sacks notes that the early neurologist John Hughlings Jackson found that many patients would experience a feeling of familiarity before a temporal lobe seizure. A musician named Eric Markowitz experienced just that when a tumor caused him to start having seizures in which he remained conscious but would hear loud music. Eric often cannot tell if the music is coming from within his brain or from the external world, and notes that the music produced by his mind during these seizures often has “a frightening and almost dangerous” (23) effect on him.

A neurologist named Macdonald Critchley observed several patients in the 1930s who experienced seizures as a result of exposure to music. The cases varied widely, as the type of music, sound, volume, and many other factors seemed to play a role. One patient had seizures only upon hearing brass instruments, and another with old-time tunes. The seizures experienced vary as well, from minor to severe, from a total lapse into unconsciousness to a sort of waking seizure in which the person only has a subtle experience of disconnection or nostalgia. One woman would sometimes slip into past memories. The experiences that go along with these types of seizures may be either positive or negative. Some patients report enjoying a slight, otherworldly feeling, while others experience serious physical effects such as convulsions. Those who experience negative effects during a seizure as a result of exposure to music sometimes develop a phobia or aversion to music. Sacks notes one patient whose seizures became so frequent and severe that she underwent brain surgery to remove part of her temporal lobe. Afterward, the seizures became a rare occurrence and she was no longer averse to the music that had previously triggered them.

Sacks refers to peoples’ ability to imagine music in their minds as “musical imagery” (32), and notes that it can often be as powerful as listening to music auditorily. Musical imagery can be voluntary or involuntary—just as humans will fill in missing letters and words while reading, the brain will also fill in missing parts of music subconsciously. On the other hand, intentionally imagining music is a strategy used by musicians everywhere, and practicing music mentally seems to amplify learning as opposed to simply physically practicing. Sacks speaks of his own personal experiences in relation to musical imagery, such as his ability to visualize himself playing the piano when he is not, or his regular fixation with particular artists or songs. Listening to a particular composer over and over causes his mind to play the music even when he isn’t listening to it. What Sacks considers more interesting, though, are those moments in which a song rushes back into the mind after years or even decades of absence and with no obvious trigger. Sacks cites Theodor Reik, a psychoanalyst who believed that music brought up from the unconscious is not accidental, and that it is instead a way that the subconscious mind communicates with the conscious mind. One neuroscientist named Rodolfo Llinas posits that the basal ganglia, an area of the brain that handles repetitive actions, is responsible for these spontaneous bursts of musical imagery because it is constantly active and works unprovoked by other brain areas. Psychiatrist Anthony Storr sees musical imagery as biologically beneficial, as it staves off boredom, provides energy, and improves mood.

Sacks compares earworms, or fragments of music that play repeatedly in one’s head, to tics or seizures: An autonomous, repetitive firing of a signal that people often have little ability to stop. These repetitions can last for minutes, hours, or even days and can impede peoples’ ability to function. He notes that “jingles” and similar catchy types of music have been a part of history since the invention of folk music at least. Looking back on his earliest experiences with earworms, Sacks notes that they often had a “tonal or melodic oddness” (47) to them, and were usually associated with something emotional, such as his family history. Songs that repeated these distinct melodies many times were particularly prone to causing an earworm. A couple of past patients with Parkinson’s disease have reported to Sacks that they experience earworms that come out of nowhere and last for hours. One woman with an advanced form of the disease would enter a frozen state as she felt trapped by the music. Sacks believes that earworms have something to do with short term memory function; visual images can similarly linger on the brain long after they are gone. The underlying difference, he states, between the two phenomena is that visual memories may be seen from an infinite number of angles and will almost certainly leave out details and even add others; when it comes to music, peoples’ repetitive memories of it are often almost identical to the original source. Sacks muses that the brain seems to find music irresistible and will in a sense become stuck within it. He notes that the past century has seen a massive shift in peoples’ relationship to music, as it is now everywhere and playing all the time; beyond hearing loss, he wonders what other consequences may arise from this ubiquity.

In 2002, Sacks saw a patient in her seventies named Sheryl, who was experiencing progressive hearing loss. She was prescribed prednisone and a few days later began experiencing loud, intolerable hallucinations of familiar songs playing in her head “as if broken records were being turned on and off in her brain” (55). Sacks found nothing on an MRI or electroencephalogram (EEG), and Sheryl feared that her hallucinations were a sign of mental illness or that they would worsen over time. Sacks believes that Sheryl’s brain was compensating for a lack of auditory stimulation, especially because neuroscientific studies have shown that the same brain areas are activated by both real and hallucinated music. After trying two different medications that didn’t help, Sacks advised Sheryl to try a cochlear implant. Her hearing returned, but the implant limited her ability to detect tone and she could no longer enjoy listening to music. The musical hallucinations did not cease, but she gradually learned to live with them. Another patient, Dwight Mamlok, experienced similar musical hallucinations alongside a decline in his hearing. He began to hear imaginary music as he listened to the sound of the engine on plane rides. When it spilled over into the rest of his life, he sought treatment and was given gabapentin, an epilepsy medication. Although the medication seemed to quell the hallucinations for a while, they soon slipped through again, and Dwight decided he too must learn to live with them.

Sacks describes a patient named John C., a composer with no hearing problems, who had what he described as an iPod inside his head that would play popular tunes for which he had no particular liking. Because John C. composed music for the piano, the songs in his head would be transcribed from their original form into piano music. Sacks notes that his own mother experienced musical hallucinations. In the 1980s, soon after publishing his account of working with two patients who experienced musical hallucinations, Sacks experienced an influx of letters from people with similar experiences. Most of these people reported that they initially thought the music came from some external source, only later realizing that its origin was in the brain. A violinist spoke about being able to play one song while another song played autonomously in his brain, and although drug treatments did help quell the hallucinations, the violinist, like many others, simply learned to live with it.

While most of Sacks’s patients with musical hallucinations have been elderly people with hearing loss, he recalls one nine-year-old boy, Michael B., whose musical hallucinations began by age five and became louder and more irritating the more stress he experienced. Sacks notes that musical hallucinations can be highly intrusive or relatively subtle and unbothersome. Some patients have even reported only experiencing these hallucinations while lying down, or after a seizure. Overall, he has found that the vast majority of people with musical hallucinations are not able to stop them, only shift or dampen them. Sacks points out that musical hallucinations act as their own “ignition, kindling, and self-perpetuation” (79), making them very similar to epilepsy.

Sacks and others theorize that hearing loss triggers musical hallucinations as the brain tries to compensate for sensory deprivation. Similarly, long periods of silence and isolation may also lead to musical hallucinations. Sacks describes a sailor who heard the sounds of the boat as if they were bagpipes. In 1967, a neuroscientist named Jerzy Konorski determined that not only do sensory organs (such as the skin, eyes, and ears) connect to the brain, but there are also neural circuits which lead from the brain to these sense organs. In other words, it is quite possible for the brain, anyone’s brain, to trick the senses into perceiving something that is not real. As Sacks observed in his patients, this tends to happen when the brain is deprived of sensory input. Reflecting on what he has learned about musical hallucinations, Sacks notes that these experiences are deeply personal, and that while they may begin as seemingly meaningless signals sent out from the basal ganglia, they quickly become suffused with meaning and personal connotations as they work their way through the rest of the brain: “By the time such fragments reach consciousness, meaning and feeling have already been attached” (88). A psychoanalyst named Leo Rangell experienced musical hallucinations of his own and spent over a decade studying the phenomenon. His hallucinations corresponded to his mood and were strongly related to past memories. Rangell experienced his musical hallucinations as inseparable from himself and his psyche, describing himself as “an experiment in nature through an auditory prism” (92).