Musicophilia Tales of music and the brain

URBAN legend has it that when a patron fell ill in Carnegie Hall and the call went out for a doctor in the house, half the audience stood up to help. Perhaps the concert was a medical benefit; more likely, it never happened. But there does seem to be no shortage of doctors who are musical, at least in New York, and one of them is Oliver Sacks, a neurologist and author, who has now combined two of his passions in one book. In his earlier collections of clinical tales - most famously in "Awakenings" (1973) and "The Man Who Mistook His Wife for a Hat" (1985) - Sacks presented with compassion, sensitivity and learning what, in coarser hands, might have been freak shows of the mind. The genre could have been an exploitative sideshow: a parade of misfits whose brains have been weirdly affected by disease, trauma, congenital defect or medical treatment. But Sacks is adept at turning neurological narratives into humanly affecting stories, by showing how precariously our worlds are poised on a little biochemistry. The result is a sort of reverse-engineering of the soul. His new collection starts quite literally with a bolt from the blue, when a 42-yearold surgeon, Tony Cicoria, was struck by lightning in 1994. Cicoria's heart apparently stopped, but he was resuscitated, and a few weeks later he was back at work. Everything seemed normal until this fan of rock music was suddenly seized by a craving for classical piano music. He bought recordings, acquired a piano and began to teach himself to play. Then his head began to be flooded with music that seemed to come, unstoppably, from nowhere. Within three months of his electrocution, Cicoria had little time for anything other than playing and composing. A dozen years later, Cicoria is still an extreme musicophiliac but has no desire to investigate his own condition with the finer-tuned forms of brain scanning that are now available. He has come to see his condition as a "lucky strike." The music in his head is, he says, "a blessing ... not to be questioned." (He was certainly lucky not to be killed. Standing in thunderstorms cannot yet be recommended as a new answer to the old question of how to get to Carnegie Hall.) Thanks to the willingness of others to be scanned, though, we now know that musicians' brains are different. The corpus callosum, which connects the brain's two hemispheres, is bigger in professional musicians. And people with absolute pitch (that is, those who can immediately name a heard note) have an asymmetric enlargement in a part of the auditory cortex. Because of this, and because of other distinctive differences in the distribution of gray matter, Sacks says that anatomists now have no difficulty in spotting the brain of a professional musician. (They cannot yet do this for the brain of a writer or visual artist.) It is not clear to what extent such marks of a musical brain are innate and to what extent they are the result of musical training and practice. But according to Sacks, these markers are strongly correlated with the age at which musical training begins and with the intensity of practice. Even with no training or practice, some unusual patients embrace music with an enthusiasm almost as intense as Cicoria's. These are people with Williams syndrome, whom Sacks calls a "hypermusical species." The syndrome is caused by a rare genetic defect that produces a strange mixture of strengths (sociability, liveliness, large vocabularies and a fondness for telling stories) and weaknesses (most have I.Q.'s under 60). They also have heart defects and distinctive faces, with wide mouths, small chins and upturned noses. All, it seems, are extremely responsive to music from an early age. Some have striking gifts of musical memory, though not all are musically talented. If music gives these individuals a joy that helps to compensate for their other disadvantages, it is little short of a lifeline for Clive Wearing. Wearing is an English musicologist and musician who contracted a severe brain infection and was left with a memory span of just a few seconds. His case is the most distressing in Sacks's collection and was featured in a BBC documentary aptly titled "Prisoner of Consciousness." With no past, not even one from a minute ago, Wearing does not really occupy a present either. "It's like being dead," he once told his wife. Although he does not remember her, he is always overjoyed to see her, continually meeting her for the first time. It is similar with his music. Asked to play a Bach prelude, he says he has never played any of them before; but then he plays one and says, while playing, that he remembers this one. In an intriguing and paradoxical conjecture, Sacks suggests that "remembering music is not, in the usual sense, remembering at all.... Listening to it, or playing it, is entirely in the present." Music has been used successfully as a treatment for many kinds of mental suffering. Indeed the benefits of the singing cure are more evident than those of the talking one. The first formal programs of music therapy began in the 1940s, and it is now used successfully to ameliorate the symptoms of motor and speech disorders, aphasia and several forms of dementia Sacks describes as astonishing the sight of deeply demented patients waking from their torpor or casting aside their agitation to focus on songs that are played to them. He also recounts an extreme case of Tourette's syndrome in another English musician, who was racked by nearly 40,000 compulsive tics per day. The man's life was transformed when his family got a piano. He now finds relief only when performing. Yet in rare cases, music can become a torture rather than a balm. At the end of his life, Schumann was tormented by musical hallucinations that degenerated into a single incessant note. Sacks describes a child who has been plagued by continuous involuntary music in the head from the age of 7. Such people must sometimes wish they were as unmusical as Ulysses S. Grant, who apparently claimed to know just two tunes: "One is Yankee Doodle and the other is not." Freud, despite being both Viennese and a medical man, said he was almost incapable of obtaining any pleasure from music: "Some rationalistic, or perhaps analytic, turn of mind in me rebels against being moved by a thing without knowing why I am thus affected and what it is that affects me." In the end, Sacks's catalog of oddities sheds little systematic light on the mystery of music. He cannot be blamed for this - the science of music is still in its early days. Readers will probably be grateful that Sacks, unlike Freud, is happy to revel in phenomena that he cannot yet explain. Music is used to treat mental suffering. Indeed, the singing cure seems more beneficial than the talking one. Anthony Gottlieb podcasts for The Economist and teaches the history of ideas at the CUNY Graduate Center. He is writing a book about nothingness.

A Bolt from the Blue: Sudden Musicophilia Tony Cicoria was forty-two, very fit and robust, a former college football player who had become a well-regarded orthopedic surgeon in a small city in upstate New York. He was at a lakeside pavilion for a family gathering one fall afternoon. It was pleasant and breezy, but he noticed a few storm clouds in the distance; it looked like rain. He went to a pay phone outside the pavilion to make a quick call to his mother (this was in 1994, before the age of cell phones). He still remembers every single second of what happened next: "I was talking to my mother on the phone. There was a little bit of rain, thunder in the distance. My mother hung up. The phone was a foot away from where I was standing when I got struck. I remember a flash of light coming out of the phone. It hit me in the face. Next thing I remember, I was flying backwards." Then--he seemed to hesitate before telling me this--"I was flying forwards. Bewildered. I looked around. I saw my own body on the ground. I said to myself, 'Oh shit, I'm dead.' I saw people converging on the body. I saw a woman--she had been standing waiting to use the phone right behind me--position herself over my body, give it CPR. . . . I floated up the stairs--my consciousness came with me. I saw my kids, had the realization that they would be okay. Then I was surrounded by a bluish-white light . . . an enormous feeling of well-being and peace. The highest and lowest points of my life raced by me. No emotion associated with these . . . pure thought, pure ecstasy. I had the perception of accelerating, being drawn up . . . there was speed and direction. Then, as I was saying to myself, 'This is the most glorious feeling I have ever had'--SLAM! I was back." Dr. Cicoria knew he was back in his own body because he had pain--pain from the burns on his face and his left foot, where the electrical charge had entered and exited his body--and, he realized, "only bodies have pain." He wanted to go back, he wanted to tell the woman to stop giving him CPR, to let him go; but it was too late--he was firmly back among the living. After a minute or two, when he could speak, he said, "It's okay--I'm a doctor!" The woman (she turned out to be an intensive-care-unit nurse) replied, "A few minutes ago, you weren't." The police came and wanted to call an ambulance, but Cicoria refused, delirious. They took him home instead ("it seemed to take hours"), where he called his own doctor, a cardiologist. The cardiologist, when he saw him, thought Cicoria must have had a brief cardiac arrest, but could find nothing amiss with examination or EKG. "With these things, you're alive or dead," the cardiologist remarked. He did not feel that Dr. Cicoria would suffer any further consequences of this bizarre accident. Cicoria also consulted a neurologist--he was feeling sluggish (most unusual for him) and having some difficulties with his memory. He found himself forgetting the names of people he knew well. He was examined neurologically, had an EEG and an MRI. Again, nothing seemed amiss. A couple of weeks later, when his energy returned, Dr. Cicoria went back to work. There were still some lingering memory problems--he occasionally forgot the names of rare diseases or surgical procedures--but all his surgical skills were unimpaired. In another two weeks, his memory problems disappeared, and that, he thought, was the end of the matter. What then happened still fills Cicoria with amazement, even now, a dozen years later. Life had returned to normal, seemingly, when "suddenly, over two or three days, there was this insatiable desire to listen to piano music." This was completely out of keeping with anything in his past. He had had a few piano lessons as a boy, he said, "but no real interest." He did not have a piano in his house. What music he did listen to tended to be rock music. With this sudden onset of craving for piano music, he began to buy recordings and became especially enamored of a Vladimir Ashkenazy recording of Chopin favorites--the Military Polonaise, the Winter Wind Étude, the Black Key Étude, the A-flat Polonaise, the B-flat Minor Scherzo. "I loved them all," Tony said. "I had the desire to play them. I ordered all the sheet music. At this point, one of our babysitters asked if she could store her piano in our house--so now, just when I craved one, a piano arrived, a nice little upright. It suited me fine. I could hardly read the music, could barely play, but I started to teach myself." It had been more than thirty years since the few piano lessons of his boyhood, and his fingers seemed stiff and awkward. And then, on the heels of this sudden desire for piano music, Cicoria started to hear music in his head. "The first time," he said, "it was in a dream. I was in a tux, onstage; I was playing something I had written. I woke up, startled, and the music was still in my head. I jumped out of bed, started trying to write down as much of it as I could remember. But I hardly knew how to notate what I heard." This was not too successful--he had never tried to write or notate music before. But whenever he sat down at the piano to work on the Chopin, his own music "would come and take me over. It had a very powerful presence." I was not quite sure what to make of this peremptory music, which would intrude almost irresistibly and overwhelm him. Was he having musical hallucinations? No, Dr. Cicoria said, they were not hallucinations--"inspiration" was a more apt word. The music was there, deep inside him--or somewhere--and all he had to do was let it come to him. "It's like a frequency, a radio band. If I open myself up, it comes. I want to say, 'It comes from heaven,' as Mozart said." His music is ceaseless. "It never runs dry," he continued. "If anything, I have to turn it off." Now he had to wrestle not just with learning to play the Chopin, but to give form to the music continually running in his head, to try it out on the piano, to get it on manuscript paper. "It was a terrible struggle," he said. "I would get up at four in the morning and play till I went to work, and when I got home from work I was at the piano all evening. My wife was not really pleased. I was possessed." In the third month after being struck by lightning, then, Cicoria--once an easygoing, genial family man, almost indifferent to music--was inspired, even possessed, by music, and scarcely had time for anything else. It began to dawn on him that perhaps he had been "saved" for a special reason. "I came to think," he said, "that the only reason I had been allowed to survive was the music." I asked him whether he had been a religious man before the lightning. He had been raised Catholic, he said, but had never been particularly observant; he had some "unorthodox" beliefs, too, such as in reincarnation. He himself, he grew to think, had had a sort of reincarnation, had been transformed and given a special gift, a mission, to "tune in" to the music that he called, half metaphorically, "the music from heaven." This came, often, in "an absolute torrent" of notes with no breaks, no rests, between them, and he would have to give it shape and form. (As he said this, I thought of Caedmon, the seventh-century Anglo-Saxon poet, an illiterate goatherd who, it was said, had received the "art of song" in a dream one night, and spent the rest of his life praising God and creation in hymns and poems.) Cicoria continued to work on his piano playing and his compositions. He got books on notation, and soon realized that he needed a music teacher. He would travel to concerts by his favorite performers but had nothing to do with musical friends in his own town or musical activities there. This was a solitary pursuit, between himself and his muse. I asked whether he had experienced other changes since the lightning strike--a new appreciation of art, perhaps, different taste in reading, new beliefs? Cicoria said he had become "very spiritual" since his near-death experience. He had started to read every book he could find about near-death experiences and about lightning strikes. And he had got "a whole library on Tesla," as well as anything on the terrible and beautiful power of high-voltage electricity. He felt he could sometimes see "auras" of light or energy around people's bodies--he had never seen this before the lightning bolt. Some years passed, and Cicoria's new life, his inspiration, never deserted him for a moment. He continued to work full-time as a surgeon, but his heart and mind now centered on music. He got divorced in 2004, and the same year had a fearful motorcycle accident. He had no memory of this, but his Harley was struck by another vehicle, and he was found in a ditch, unconscious and badly injured, with broken bones, a ruptured spleen, a perforated lung, cardiac contusions, and, despite his helmet, head injuries. In spite of all this, he made a complete recovery and was back at work in two months. Neither the accident nor his head injury nor his divorce seemed to have made any difference to his passion for playing and composing music. I have never met another person with a story like Tony Cicoria's, but I have occasionally had patients with a similar sudden onset of musical or artistic interests--including Salimah M., a research chemist. In her early forties, Salimah started to have brief periods, lasting a minute or less, in which she would get "a strange feeling"--sometimes a sense that she was on a beach that she had once known, while at the same time being perfectly conscious of her current surroundings and able to continue a conversation, or drive a car, or do whatever she had been doing. Occasionally these episodes were accompanied by a "sour taste" in the mouth. She noticed these strange occurrences, but did not think of them as having any neurological significance. It was only when she had a grand mal seizure in the summer of 2003 that she went to a neurologist and was given brain scans, which revealed a large tumor in her right temporal lobe. This had been the cause of her strange episodes, which were now realized to be temporal lobe seizures. The tumor, her doctors felt, was malignant (though it was probably an oligodendroglioma, of relatively low malignancy) and needed to be removed. Salimah wondered if she had been given a death sentence and was fearful of the operation and its possible consequences; she and her husband had been told that there might be some "personality changes" following it. But in the event, the surgery went well, most of the tumor was removed, and after a period of convalescence, Salimah was able to return to her work as a chemist. She had been a fairly reserved woman before the surgery, who would occasionally be annoyed or preoccupied by small things like dust or untidiness; her husband said she was sometimes "obsessive" about jobs that needed to be done around the house. But now, after the surgery, Salimah seemed unperturbed by such domestic matters. She had become, in the idiosyncratic words of her husband (English was not their first language), "a happy cat." She was, he declared, "a joyologist." Salimah's new cheerfulness was apparent at work. She had worked in the same laboratory for fifteen years and had always been admired for her intelligence and dedication. But now, while losing none of this professional competence, she seemed a much warmer person, keenly sympathetic and interested in the lives and feelings of her co-workers. Where before, in a colleague's words, she had been "much more into herself," she now became the confidante and social center of the entire lab. At home, too, she shed some of her Marie Curie-like, work-oriented personality. She permitted herself time off from her thinking, her equations, and became more interested in going to movies or parties, living it up a bit. And a new love, a new passion, entered her life. She had been "vaguely musical," in her own words, as a girl, had played the piano a little, but music had never played any great part in her life. Now it was different. She longed to hear music, to go to concerts, to listen to classical music on the radio or on CDs. She could be moved to rapture or tears by music which had carried "no special feeling" for her before. She became "addicted" to her car radio, which she would listen to while driving to work. A colleague who happened to pass her on the road to the lab said that the music on her radio was "incredibly loud"--he could hear it a quarter of a mile away. Salimah, in her convertible, was "entertaining the whole freeway." Like Tony Cicoria, Salimah showed a drastic transformation from being only vaguely interested in music to being passionately excited by music and in continual need of it. And with both of them, there were other, more general changes, too--a surge of emotionality, as if emotions of every sort were being stimulated or released. In Salimah's words, "What happened after the surgery--I felt reborn. That changed my outlook on life and made me appreciate every minute of it." From the Hardcover edition. Excerpted from Musicophilia: Tales of Music and the Brain by Oliver Sacks All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.