EP#24: Musicophilia: Tales of Music and the Brain, Oliver Sacks, 2007

November 2025 – February 2026

This is the 24th entry in the Essays Project. We continue on our quest to read the complete Sacks oeuvre.

Afterwards: There were essays in this that I enjoyed, but overall the book seemed lacking to me. That’s especially true of the first half. I can’t really put my finger on what is missing, although perhaps it had to do with Sack often reporting on the what other neurologists had learned of other patients with cases similar to those of Sack’s patients…

Contents

Preface

It is a bit of a mystery why humans appreciate music. Darwin remarked on this in The Descent of Man, as have subsequent neurologists and psychologists such as Pinker. Pinker and others argue that our musical powers are a consequence of recruiting neurological systems developed for other purposes and that music has, in the words of William James, entered our mind by “the back stairs.“

Yet music is found in all cultures and, with a very few exceptions, all humans can perceive tones, timbre, pitch, intervals, melodies, harmony, and rhythm. Music, as well, seems to have a deep conection and resonance with emotions.

Our auditory systems, our nervous systems, are indeed exquisitely tuned for music. How much this is due to the intrinsic characteristics of music itself-its complex sonic patterns woven in time, its logic, its momentum, its unbreakable sequences, its insistent rhythms and repetitions, the mysterious way in which it embodies emotion and “will”-and how much to special resonances, synchronizations, oscillations, mutual excitations, or feedbacks in the immensely complex, multilevel neural circuitry that underlies musical perception and replay, we do not yet know.

ibid. xii

To me, it seems evident that music is a means by which humans bond with one another, and strengthen connections within a community. I think back to Putnam’s observation that the best predictor of the economic success of towns in Italy was whether they had a chorale society, music being a way, as he saw it, to create social capital. It seems odd to me that Sacks (and others he cites) do not appear to pick up on this.

Part I: Haunted by Music

C1: A Bolt from the Blue: Sudden Musicophilia

The tale of Tony Circola, a surgeon who was struck by lightning. At the time, he had both an out of the body experience and a near-death experience, the first being a form of perceptual illusion and the second having the hallmarks of a mystical epxerience. Six to seven weeks later he developed first, a love of piano music, and a little later began hearing music in his head. He took up piano (he’d had a few lessons as a child, but was largely indifferent) and at 42 learned to play competently and compose.

Sacks briefly describes other cases in which an interest and sometimes talent for music emerged spontaneously, often but not always associated with temporal lobe damage or seizures.

C2: A Strangely Familiar Feeling: Musical Seizures

Music is often associated with seizures or damage in the temporal lobes. Sacks relates two examples, and reminds us of Hughling Jackson’s concept of doubled consciousness: “an odd superimposed state in which they experience strangemoods or feelings or visions or smells –or music.“

C3: Fear of Music: Musicogenic Epilepsy

Music — or passages of music or even particular pitches or notes — can trigger seizures. Sacks describes several cases. The type of music that triggers a seizure seems entirely idiosyncratic. Non-musical sounds (usually of a monotonous nature) can be triggers as well. A neurologist by the name of Macdonald Critchley devoted a lot of study to this.

C4: Music on the Brain: Imagery and Imagination

Begins with an observation that people vary greatly in their ability to imagine (mentally hear) music in their minds. Some can mentally hear it so vividly that they may not be able to distinguish between auditorially hearing it and internally hearing it. (cf. Jerome Brunner anecdote)
Brain imaging techniques do show that imagining music stimulates the auditory cortex almost as strongly as hearing it, and that imagining music can also stimulate the motor cortex. Sacks cites his own experience of not just mentally hearing music, but seeing his hands playing it on the piano.
This cortical activity can also be observed by playing someone a familiar piece and then leaving a gap in it — auditory cortical activity can be observed during the gap; this does not occur for unfamiliar pieces.
Sacks notes that one aspect of musical ‘imagery’ is that it emerges spontaneously rather than being summoned or evoked by events (though, of course, both of the latter can and do happen): “A tendency to spontaneous activity and repetition seems to be built into them [systems involved in perceiving music] in a way that has no analog for other perceptual systems.”
Sacks refers to work by the neurologist Llinas, who postulates that the self emerges from interactions between the cortex and thalamus, in particular the basal ganglia. He suggests that the basal ganglia is constantly ‘playing’ motor patterns and snippets of motor patterns all the time. He has a book called The I of the Vortex.

… reading break …

C5: Brainworms, Sticky Music, and Catchy Tunes

Earworms are short — 4 or 5 bars — of a theme or melody that can repeat in the mind for hours or days; the tunes may be pleasant, unpleasant, or even hateful. Earworms can have a motor component, a subvocal humming or singing.
Some people claim to be able to stop eagworms by playing or singing the song of which it is a part clear through to the end.
People with certain neurological conditions may find themselves repeating words or bits of music, in a manner reminiscent of Tourette tics or OCD.
Certain drugs (e.g., lamotrigine, a drug for bipolar disease) may exacerbate the tendency for earworms.
Sacks notes that repetition is commonly a fundamental part of music. And he speculates that because a piece of music must be constructed or reconstructed in very much the same way (in contrast to a visual scene), it may be more liable to undergoing repetitive replay. [This is not actually very convincing to me.]

— second pass on notes —

Musical imagery, especially if it is repetitive or intrusive, may often have a motor components (e.g., humming under one’s breath). In some cases, progressive relaxation techniques focused on the motor apparatus implicated in the imagery may allieviate it.
Nicholas Slonimsky, is said to have deliberately composed tunes intended to act as earworms.

“…during her frozen states she had often been “confined,” as she put it, in “a musical paddock” -seven pairs of notes (the fourteen notes of “Povero Rigoletto”) which would repeat themselves irresistibly in her mind. She also spokeot these forming “a musical quadrangle” whose four sides she would have to perambulate, mentally, endlessly. This might go on for hours on end, and did so at intervals throughout the entire forty-three years of her illness…”

–ibid., 48

Similarities to the ways in which people with autism, Tourettes, and OCD may become ‘hooked’ on a word or sound or noise and repeat it for months.
It is not uncommon for ‘musical imagery to contract to a single phase. The duration of these loops is 15-20 seconds, about the same length as visual loops in palinopsia, in which a single scene is replayed repeatedly.
Why is music most prone to this sort of repetition? One possibility is that music inherently contains repetition at various scales. Another is that if one is recalling a musical passage, there is only one order of recall which is ‘correct;’ in contrast a visual or social scene may be reconstructed in any number of ways.

… reading break …

C6: Musical Hallucinations 

Some drugs – lamotrigine (for bipolar); prednisone – have been observed to trigger musical hallucinations which continue even after the drug is stopped.
Musical hallucinations are often associated with loss of hearing, or, in a few cases, long periods of silence. Also, many people with MH often have some form of tinnitus. 3In one case, when hearing was restored via a cochlear implant, the hallucinations ceased.
Some MHs appear to be triggered by long exposure to droning sounds, as in a train or plane trip.
MH’ers report that the can sometimes suppress hallucinations by engaging in concentrated mental activity, conversation, or playing or singing a song.
Musical hallucinations differ from visual imagery. They are very realistic, so much so that when experienced for the first time those experiencing them often look for an external source of the sound.
MH tend to reflect the taste of the times rather than the taste of the individual; often individuals dislike the music they are hearing. `
Mrs. C reported that her hallucinations were fragments of music, just a few bars that would switch from one to another, sometimes even in mid-bar. “If I can hear a whole verse, I’m very happy.”
Some MH’ers, after years of living with their hallucinations, reach a sort of accommodation, and begin to feel as though the hallucinations are part of who they are.
DMs MHs began on a plane trip, associated with the continuous drone of the plane engine. The drone persisted as a humming after the trip, and over time differentiated into music. The music he hallucinated was usually orchestral in origin, but in his hallucinations it was transposed into piano music, often in a different key; he also reported that he would find his hands physically playing these pieces.
Although musical hallucinations were originally associated with temporal lobe seizures, Sacks experiences (e.g., correspondence received in the wake of a response he contributed to ‘Dear Abby) suggest that temporal lobe seizures are a very infrequent cause, and that the phenomenon is relatively common and likely has many causes.
Rebuilt, Michael Chorost: https://www.amazon.com/Rebuilt-Pa-Michael-Chorost/dp/0618717609
Some people report MH’s that occur only when they are in particular positions, typically recumbent.

“In most cases of musical hallucination, there is a sudden onset of symptoms; then the hallucinatory repertoire expands, becoming louder, more insistent, more intrusive and the hallucinations may continue even if one can identify and remove the predisposing cause. The hallucinations have become autonomous, self-stimulating, self-perpetuating. At this point, they are almost impossible to stop or inhibit, though some people may be able to shift them to another tune in the “jukebox,” provided it has some similarity of rhythm, melody, or theme. Along with this stickiness or stubbornness, there may develop an extreme susceptibility to new musical inputs, so that whatever is heard is instantly replayed. This sort of instant reproduction has some resemblance to our reaction to catchy tunes, but the experience for someone with musical hallucinations is not mere imagery, but often physically loud, as-if-heard “actual” music.

These qualities of ignition, kindling, and self-perpetuation are epilepsy-like characteristics (though similar physiological qualities are also characteristic of migraine and of Tourette’s syndrome!? They suggest some form of persistent, uninhibitable spreading electrical excitement in the musical networks of the brain.” .

—ibid., 79

Jerry Konorski. Inverted the question of ‘why do hallucinations occur?’ to ‘why do not hallucinations occur constantly?’ He noted that there are afferent nerves that go from the brain to the sense organs, and speculates that sensory input normally suppresses afferently-generated activity. It is only when de-afferentiation occurs that we see “release hallucinations.” See Integrative Activities of the Brain. There is now good evidence supporting this from brain imaging studies that show patterns of activity during MH to be highly similar to those that occur when actually hearing sound.
Another theory involving activity in the basal ganglia is offered by Rodolfo Linás in The I of the Vortex, Cambridge, 2001.
“ 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.”Rangall, a doctor who has experienced and studied MHs for a decade, views them as dream-like and imbued with urges, hopes and wishes.

…reading break…

Part II: A Range of Musicality

C7: Sense and Sensibility: A Range of Musicality

Sacks distinguishes between musical competence – ability to judge pitch, ability to play instruments – and musicality – the feeling for the nuances and expressiveness of music, and engagement with the emotions it produces.
As little as a year of intensive training in violin produces striking changes in evoked potentials in the auditory cortext of young children, though it is not clear to me what, if any, long term effects this has. Likewise, some researchers have shown that listening to Mozart will temporarily enhance abstract reasoning , though this has been disputed by others.
Gottfried Schlaug and others at Harvard have identified neuroanatomical differences in the brains of musicians (enlarged corpus callosum, altered auditory cortex) that distinguish the brains of musicians of others. A neuroanatomist “can recognize the brain of a professional musician without a moment’s hesitation.”
Unlike language, there appears not to be a “critical period” for exposure to music; some people do not develop musicality until later in life.
The various threads that make up the fabric of musicality are all dissociable:

“…what one calls musicality comprises a great range of skills and receptivities, from the most elementary per. ceptions of pitch and tempo to the highest aspects of musical intelligence and sensibility, and that, in principle, all of these are dissociable one from another.

—ibid. 104

C8: Things Fall Apart: Amusia and Dysharmonia

We take out sense for granted. We construct a coherent visual world from a variety of elements, unconsiulsy syntheisizing it into a a seeming whole. But that is not true for everyone; deficits at various levels – from sensory cells (e.g. non-functional red/green cones) to deficient cortical activities (e.g., agnosias). This is also true for hearing, and thus there are many forms of amusia.
In contrast to what was mentioned in the last chapter, there appears to be a critical period of learning rhtymic patterns, analogous to that for learning phonemes. Hanon and Trehub havwe shown that by six months infants can detect all rhythmic variations but by 12 months they can only detect those they have been exposed to it, although they can the latter with more sensitivity.
The only indispensable elements of music are discrete tones and rhythmic organization. Particular scales, and other features, do not appear to be innate.
A footnote describes a scientist who was unable to carry a tune but decided to try taking music lessons; after a year he showed measurable improvement in his ability to control his pitch, project his voice, and produce musical phrasing; these qualitative improvements also corresponded to changes in brain activity in appropriate regions of the brain.
People, including Sacks, report temporary episdoes of amusia, where music loses its …musicality and becomes noise. For Sacks it appears to be associated with a migraine aura.
People with congenital amusia are normal in their speech production and patterns. This seems quite surprising, and suggests that there is a deep neurological distinction between music/song and speech.
Peretz et al. feel that there are two basic categories of amusia: deficits in recognizing melody and the other in perceiving rhythm. Impairments of melody perception seem to go with left hemisphere regions; impairments of rhythm are not correlated with hemisphere, suggesting (in line with other evidence) that rhythm perception is more widespread and robust.
Amelodia, or tune-deafness, is a higher order deficit – people can hear a sequence of notes, but can not recognize it as having a sense or order to it.
“I never realized that music can make people feel different things.” P 120
Interesting story of Rachel L, a gifted composer and performer, who lost her musical abilities as a result of a car accident, and then slowly regained some of them. She describes hearing different beams or lines of music, and being unable to integrate them into a harmonic whole. However, if she has a musical score in front of her, while it doesn’t help her integrate the sound, it prevents it from “spreading all over the place..

….reading break – next discussion 12/19…

C9: Papa Blows His Nose in G: Absolute Pitch

Ordinary people can identify upwards of 70 tones, most in the middle range of hearing, each distinct from the others.
Absolute pitch. People who have absolute pitch describe being able to instantly identify a note, in the same way that they can identify a color as red or blue… Each note has its particular character or color.
People with AP may experience distress when hearing music they learned in one key being played in another, and/or may experience difficulties in distinguishing intervals between notes, and/or hearing harmonies. It seems likely that this is because they are so aware of the chroma of the individual notes.
AP. People with absolute pitch can tell when a note is a half or even quarter tone off — I’d like to know how accurate this discrimination is in terms of hertz, but the chapter does not report on this.
Diana Deutsch quote aptly depicts the oddness of ordinary relative pitch perception (as observed by a person with absolute pitch) by providing an analogous account of someone perceiving a color but without being able to name it.
predictors of AP.
- 50% of people who are congenitally blind have absolute pitch.
- People who receive early training in music, and/or who speak tonal languages, are more likely to have absolute pitch, suggesting that there is a critical period before the age of 8 (the same period during which phoneme discrimination is fine-tuned).
Adaptivity. There is speculation that in infancy perfect pitch is adaptive, but that later on it can be maladaptive. There is a (very speculative) theory that the first form of language was based in singing…

C10: Pitch Imperfect: Cochlear Amusia

The organ of Corti in the cochlear membrane contains about 3500 hair cells. Young people can distinguish 10 octaves, or about 1,400 tones, from 20 to 12,000 Hz. The average ear can distinguish 1/17th of a tone…
Tuning of hearing by the brain. The outter hair cells appear to be able to “tune” or calibrate the inner hair cells — they have efferent connections, that is, they receive input from the brain. So the brain and ears are a two-way system… Thus, the ability of the ear to pick out a soft voice in the din of a crowded restaurant appears to rely on such tuning.
Range distorition and contextual remedies. It is reported that particular ranges of pitch perception can become distorted — that is, problems can affect particular ranges of hair cells and not others. In cases where someone is dealing with such a distortion, it may be possible to ease it when the music being heard is richer (i.e. orchestral) rather than sparer or thinner (e.g. solo instruments). A corresponding phenomenon is found in visual perception where an apparent distoritoin of, say, a horizontal line or edge may be decreased or eliminated by tracing the edge with a finger.

C11: In Living Stereo: Why We Have Two Ears

Loss of stereophony — hearing in one ear — can have a drastic effect on the perception of music. One person who suffered this described losing the ability to feel the emotion in the music (after he lost hearing in his right ear); others describe the music as becoming flat.
Ways of compensating
- Some who suffer from stereophony appear to be able to compensate, to a degree, by learning to draw on other contextual cues about the spatial location of sound.
- There is a claim that people move their heads slightly while listening to things, and that this movement helps increase the richness with which they hear sounds.

Speaking for myself, I used to hear “buildings” whenever I heard music – three-dimensional forms of architectural substance and tension. I did not “see” these buildings in the classic synaesthetic way so much as sense them in my sensorium. These forms had “floors,” “walls,” “roofs,” “windows,” “cellars.” They expressed volume. They were constructed out of interlinked surfaces which depended on each other for coherence. Music to me has always been a handsome three-dimensional container, a vessel, as real in its way as a scout hut or a cathedral or a ship, with an inside and an outside and subdivided internal spaces. I’m absolutely certain that this “architecture” had everything to do with why music has always exerted such an emotional hold over me….

—ibid. 159-160

C12: Two Thousand Operas: Musical Savants

Recap of Martin (A Walking Grove, in …Mars).
Blindness. More than a third of all musical savants are blind or have severe vision problems
Autism. Savants are almost always autistic.
Concrete vs. Abstract. Savantism almost always involves ‘concrete’ skills, and deficits are almost always in abstract skills.
Inhibition (and release there of) of right hemisphere by left. There is evidence that the left brain inhibits certain types of functionality in the right brain. Furthermore, the left hemisphere develops more slowly, so that the right brain may dominate more during the first few months of infancy, and then the developing left brain achieves parity/dominance and begins inhibiting right brain function.
- The rapidity with which savantism develops suggests that it is due to a release or disinhibition of right hemisphere functions.
- Snyder and Mitchell (1999) have shown that using transcranial stimulation to temporarily supress regions of the brain implicated in abstract thought can cause transient increases in ability to draw, calculate and proof read. A similar study by Young, et al. showed similar results, but with only with 5 out of 17 people.
Slower development and fragility of left hemisphere. Also, the immaturity of left hemisphere functionality (and possibly immunological development) may render it more susceptible to damage, which in turn would eliminate left hemisphere inhibition of right hemisphere functionality. Another thing that slows the development of the left hemisphere is testosterone, and the predominance of this in males may explain why “a striking preponderance” of people with autism, savantism, tourettes and other congenital neurological issues are male.

….reading break – next discussion: 12/26?…

C13: An Auditory World: Music and Blindness

Being congenitally blind is associated with heightened musical abilities. In one study 40-60% of blind children (and in another, 60% of blind musicians) had absolute pitch.
Approximately one third of the cortex is devoted to vision, and various studies show that among those born blind, or blinded early in life, much (all?) of the visual cortex is reallocated, primarily to hearing and or touch. Such reallocation can occur in those blinded later in life as well.

C14: The Key of Clear Green: Synesthesia and Music

Source	Mapped to…
Sounds, music (notes, keys, rhythm, tempo, timbre, patterns, moods, instruments), letters, numbers, days-of-week,	colors (and ‘Martian colors’); smells; tastes;shapes;curves, moving-shapes; positions; flashing, brightness etc.; topography/landscapes.

5% have synthesia. 1 person in 23 (5%) has some kind of synesthesia — most common is color—day-of-week.
Confirmed by brain imaging. Brain image has confirmed synesthesia, particular for activity in color processing areas of the brain in response to speech.
Common in infants until ‘pruned.’ There is some evidence that synesthesia is common in primates in infancy, and then synaptic pruning eliminates it in first few weeks/months after birth.
Evoked transient synesthesia. Can result from temporal lobe strokes or other damage, or use of hallucinogens.
Permanent acquired synthesia. This only occurs in response to blindness; and it occurs so rapidly that it does not seem due to new acquired connections, but rather to a release of inhibitiion.
Interference/Separation. Sometimes the results of synesthesia interfere with sensory input (e.g., sound), other times it is entirely separate (e.g. colors) — though these may perhaps only be true for particular individuals.
One person described being able to enjoy a rock concert because it didn’t trigger her synesthesia.

Part III: Memory, Movement, and Music

C15: In the Moment: Music and Amnesia

Depressing.
Primarily an account of Clive Wearing (an eminent musicologist) who lost most of his ‘span of attention’ — he could only retain a few seconds of memory. This chapter is primarily based on interviews with Clive’s wife Claire, and her memoir: A memoir of Love and Amnesia.
As might be expected, this was profoundly disabling, and a terrible experience. He was only able to recognize his wife, and to sing. But when singing he is able to creatively improvise, so it is more than a purely rote action.
Over the course of years (decades), he stabilized a bit, increasing his span a little, and developing a verbal bonhomie/confabulation involving ‘incontinent’ puning, rhyming, etc. that allowed him to (sort of) engage with other people. “These small areas of repartee acted as stepping stones with which he could move through the present. They enabled him to engage with others.”

By moving rapidly from one thought to another, Clive managed to secure a sort of continuity, to hold the thread of consciousness and attention intact-albeit precariously, for the thoughts were held together, on the whole, by superficial associations. Clive’s verbosity made him a little odd, a little too much at times, but it was highly adaptive-it enabled him to reenter the world of human discourse.
—ibid., 215

Clive seems to have procedural memory, but very little semantic memory, and no episodic memory to speak of.

C16: Speech and Song: Aphasia and Music Therapy

People with aphasia, parkinons, dystonias, autism, and other obstructive neurological damage that make it difficult for them to move or speak fluidly often are still able to sing and/or dance, and or perform other well learned motor-sequence activities (e.g., swimming, or reciting poetry or speeches they have previously memorized). This chapter looks at the degree to which music, song and related activities can be used in therapy.
There is an account of Mr. S, who developed severe expressive aphasia as a result of a stroke, first learning to sing a song (with words), and then gradually developing (recovering?) the ability to speak simple sentences.
Sacks notes that the ability of such patients simply to sing is important, because it provides them with a way of signaling that they are ‘alive,’ and can also provide them with a way of expressing emotion.
Sacks comments that patients with non-fluent aphasia have not only lost knowledge of vocabulary and grammar, but also have lost the rhythms, intonations and prosody of normal speech.
There is a type of aphasia called “dynamic aphasia,” where people lose the ability to begin to speak, but once they get started are able to utter complete sentences.
Inhibition and Release. Luria argues that with brain trauma, there is a core of damage that is irreversible (or only reversible over a very long time), surrounded by a penumbra of inhibition of function, the latter which can be released spontaneously, often with a period of weeks.
Music therapy is a very intimate process of two people working together. Sacks (and others) speculate that mirror neurons are activated which enable the patient to first imitate and then perform the actions being addressed.
Melodic Intonation Therapy (MIT). Patients are taught to sing phrases, and then the musicality is gradually scaled back…
Release of lateral inhibition. One theory, supported by brain imaging, is that corresponding areas in each hemisphere of the brain tend to mutually inhibit one another, and that when one is damaged, the corresponding area becomes able to entirely inhibit the other (“malignant hyperactivity”) — and MIT works be decreasing this inhibition.

C17: Accidental Davening: Dyskinesia and Cantillation

Very short and unsure of the point. A man with a repetitive movement disorder turned it into a form of ritual movement/prayer called davening — involving rocking and chanting — and I think found that this accommodation was helpful to his lived experience.

C18: Come Together: Music and Tourette’s Syndrome

Whereas in C16 we were talking about obstructive neurological syndromes, here was are talking about explosive neurological syndromes that produce excessive activity/excitation like Tourette’s and some forms of Parkinson’s…
Sacks describes Tourette’s patients who exhibit a sort of “phantasmagoric” response to music:

The music seemed to trigger a cascade of wild mimetic representations of the tone, the tenor, the landscape of the music, and all the images and emotional reactions these provoked in him as he listened. This was not just an exacerbation of ticing, but an extraordinary Tourettic representation of the music, a very personal expression of his sensibility and imagination, though dominated by Tourettic exaggeration, parody, and impulsiveness.

—ibid., 248

Some Tourette’s describe being able to channel their explosive reactions into music, as a way of staying in control — or at least steering — the excess of energy/activity. One described the ticcing as being “harnessed and focused,” and said that his compulsion to touch could be focused on the piano keys.

Tourette’s brings out in stark form questions of will and determination: who orders what, who pushes whom around. To what extent are people with Tourette’s controlled by a sovereign “I,” a complex, self-aware, intentional self, or by impulses and feelings at lower levels in the brain-mind? … Normally we are not aware of what goes on in our brains, of the innumerable agencies and forces inside us that lie outside or below the level of conscious experience—and perhaps this is just as well. Life becomes more complicated, sometimes unbearably so, for people with eruptive tics or obsessions or hallucinations, forced into daily, incessant contact with rebellious and autonomous mechanisms in their own brains. They face a special challenge; but they may also, if the tics or hallucinations are not too overwhelming, achieve a sort of self-knowledge or reconciliation that may significantly enrich them, in their strange fight, the double lives they lead.

— ibid., 252-253

C19: Keeping Time: Rhythm and Movement

A recap of Sacks’ leg accident and recovery and the role played by music.
“The embedding of words, skills, and sequences and xxx in melody and meter is uniquely human.”
Sacks argues that music, just as it can knit together disjoint activities for an individual, can perform the same function socially: “In every culture there is some form of music with a regular beat, a periodic pulse, that affords temporal coordination among performers and elicits synchronized motor responses from listeners.“
Merlin Donaldson, in The Origins of the Modern Mind (1991):

An essential feature of Donald’s vision is his concept that human evolution moved from the “episodic” life of apes to a “mimetic” culture-and that this flourished and lasted for tens, perhaps hundreds of thousands of years before language and conceptual thinking evolved. Donald proposes that mimesis—the power to represent emotions, external events, or stories using only gesture and posture, movement and sound, but not language—is still the bedrock of human culture today. He sees rhythm as having a unique role in relation to mimesis:

Rhythm is an integrative-mimetic skill, related to both vocal and visuomotor mimesis. … Rhythmic ability is supramodal, that is, once a rhythm is established, it may be played out with any motor modality, including the hands, feet, mouth, or the whole body. It is apparently self-reinforcing, in the way that perceptual exploration and motor play are self-reinforcing, Rhythm is, in a sense, the quintessential mimetic skill.

—ibid., p 268-269

Donaldson’s View

Episodic cognition. Episodic culture characterizes ape cognition—a mentality tied to concrete, remembered events without the capacity to generalize or represent them beyond the immediate context (‘seize the moment!’). Episodic culture characterizes ape cognition—a mentality tied to concrete, remembered events without the capacity to generalize or represent them beyond the immediate context. This capacity is generative: it entails breaking one’s own motions into parts and reassembling them in different combinations
Mimetic cognition. Homo erectus assimilated and reconceptualized events to create prelinguistic symbolic traditions: rituals, dance, and craft. Mimetic culture enabled modeling of group structure (shifting from individual relationships to social roles), establishment of group norms, voluntary emotional display, coordinated hunting with division of labor, and skill transmission through demonstration. Mimetic action proved especially effective at conveying emotion, maintaining crowd control, and teaching certain tasks.
Exetended (oral) cognition. Mimesis was succeed by two modes of cognition: The first of these was spoken language development, enabling a complex preliterate culture with more precise communication, and collective knowledge passed on through oral lore, totemic art, and mimetic song, dance, and ritual, with narrative—not syntax—as the primary linguistic function.
Distributed cognition. The second mode began with the appearance of writing systems (cuneiform, hieroglyphs, ideograms), creating “external storage systems” that enabled information retrieval to replace rote memorization, allowed the development of external representations, and permitted analysis, this giving rise to theoretic culture: science, philosophy, and systematic investigation.

C20: Kinetic Melody: Parkinson’s Disease and Music Therap)

While Parkinson’s is usually thought of as a movement disorder, it also affects the flow of perception, thought, and feeling.
The explosive-obstructive character of Parkinson’s can be, in some cases, overcome by music, though the type of music that is helpful varies from patient to patient. Generally, though, it is legato and has a well-defined rhythm. Sometimes even imagining music will suffice to break the frozenness…
Some Parkinson’s patients can take advantage of other kinetic flow states — for instance, they can walk along with another person, falling into their tempo and rhythm. But when the other stops, they stop.
Sometimes a ticking metronome can enable movement, though it lacks the normal fluidity and rhythm of natural walking.
Parkinsonians often have a disorder of temporal perception, moving much faster or slower than normal — but not aware of it until they compare their actions with another person, or with a clock.
Gerald Edelman, The Remembered Present.
Dancing can be helpful therapeutically, especially the Argentine tango.
One anecdote describes a person with Huntington’s chorea who gets stuck in cognitive or behavioral ‘loops,’ but is free of them if he plays tennis, for the duration of the game.

It is music that the parkinsonian needs, for only music, which i ngorous yet spacious, sinuous and alive, can evoke responses that are equally so. And he needs not only the metrical structure of thythm and the free movement of melody-its contours and tectories, its ups and downs, its tensions and relaxations-but the “will” and intentionality of music, to allow him to regain the fredom of his own kinetic melody.

—ibid., 283

… Discussion break (didn’t make it all the way through reading)…

C21: Phantom Fingers: The Case of the One-Armed Pianist

Amputees (including Ludwig Wittgenstein’s brother, Paul, a pianist) may have an image of their lost limbs, and be able to move it (for example, imagine moving the fingers to play the piano). This can last for decades. Recent brain imaging studies have confirmed that the entire sensory-cognitive-motor system is engaged during such activity.

C22: Athletes of the Small Muscles: Musician’s Dystonia 

This chapter is about dystonia, in musicians, the loss of the ability to use certain fingers or other muscles in playing music.

One example is a violinist who lost the ability to use three of his fingers when playing, though for other activities they functioned normally. Apparently this dystonia is not that uncommon, and is found among people who make rapid and repetitive use of their small muscles — musicians are the obvious example, but it has been observed in people who, for example, write a lot (like lawyers).
The basic mechanism seems to be a loss of balance between inhibitory and excitatory actions of muscles.
Neurophysiological research indicated that there were disturbances in the cortical sensory system, with images of the hands distorted both anatomically and functionally.

Hallett’s group found that the mapping of dystonic hands in the sensory cortex was disorganized both functionally and anatomically. These changes in mapping were greatest for the fingers which were most affected. With the onset of Astonia, the sensory representations of the affected fingers sarted to enlarge excessively, and then to overlap and fuse, to de-differentiate.” This led to a deterioration in sensory discrimnation and a potential loss of control – which the performer, usually, would fight against by practicing and concentrating more, or by playing with more force. A vicious cycle would develop, abnormal sensory input and abnormal motor output exacerbating each other.

ibid., 295

… reading break…

Part IV: Emotion, Identity, and Music

C23: Awake and Asleep: Musical Dreams

In the hypnogogic and hypnopompic states (falling asleep, and awakening) free-floating and hallucinatory apparitions are common: they tend to be “highly visual, kaleidoscopic, elusive, and difficult to remember.”
Irving J Massey: Music is the only facility that is not altered by dreaming: it does not become distorted, fragmented, or incoherent; in contrast, dreams distort action, character, visual elements and language. Why is music the exception? Perhaps it an autonomous system, disconnected from our consciousness.

C24: Seduction and Indifference

Emotional appreciation and musical understanding seem to be independent: one may have high degrees of one but not the other, or vice versa. Or both or neither, of course.
Strokes may deprive a person of the emotional appreciation of music, or, to the contrary, induce it in one who formerly lacked it.

C25: Lamentations: Music, Madness, and Melancholia

This chapter did not do much for me. It had anecdotes on music as a way of dealing or coming to terms with grief. One small bit of interest was that one person reported that it was only the production of music (playing the piano) and not the listening that affected his move.

C26: The Case of Harry S.: Music and Emotion

About Harry S, one of Sacks favorites, a patient for 30 years. A cerebral aneurysm left him with severe frontal lobe damage, and though he could read and understand scientific articles, they did not inspire or fill him with wonder as they used to. It was only when he sang that he seemed filled with emotion. Sacks and others are unsure of whether music actually gives him access to emotions he can no longer experience otherwise, or whether his performances are simply superb mimicry.

… reading break …

C27: Irrepressible: Music and the Temporal Lobes

Describes a longtime patient of Sacks, Vera B, who began singing all the time, eventually almost constantly. She seemed unable/unwilling to repress it.
Frontotemporal Dementia often starts with disinhibition of various types of behavior. This seems to be the cause of many of the cases in which previously amusical people have developed musical interests and abilities.
Another patient, Louis F, had issues similar to Vera B. Louis was fortunate to have a ‘job’ of, twice a week, leading singing session in a senior session. This worked well for him, and Sacks speculated that singing was his way of maintaining his identity. Outside of singing, he seems to have no ability to engage with the world or interact with people.
A correspondent, described gaining musical sensitivity — the ability to track what multiple instruments in a recording were doing at all times –in the wake of a cerebral anyurism that gave him aphasia. This lasted for two to four weeks, but faded as he recovered his linguistic abilities.
Sacks speculates that damage to the linguistic areas of the brain may result in disinhibition of the musical areas.

C28: A Hypermusical Species: Williams Syndrome

This chapter discusses people with William’s syndrome:

…all of them had wide mouths and upturned noses, small chins, and round, curious, starry eyes. Despite their individuality, they seemed like members of a single tribe marked by an extraordinary loquacity, effervescence, fondness for telling stories, reaching out to others, fearlessness of strangers, and, above all, a love of music.

—ibid., p 354

While all those with Williams syndrome love music, they are not necessarily talented. They do show the ability to develop musically (they are not like savants who manifest expert abilities instantly).
Along with a fascination for music, Williams people are also hypersocial and show a special feeling for narrative. They have a great longing to connect and bond with others. They seem to be the opposite of people with severe autism.
Williams syndrome people, besides their familial resemblance in appearance, tend to have very low IQs and heart problems — those who reach middle age are rare.
The brains of Williams people are very distinct anatomically, with much smaller occipital and parietal lobes but normal or supersized temporal lobes. Brain imaging studies show that they process music very differently from ordinary people.
“There are no strangers, there are only friends.” (A Williams person to her mother in response to a warning about strangers).

C29: Music and Identity: Dementia and Music Therapy

The aim of music therapy for people with dementia is not to try to restore abilities they’ve lost, but rather to simply give them access to emotions and feelings that they have lost touch with, and also to allow them to express their own identity and, perhaps, to enjoy the interest and acclaim of others.
Sacks raises the question of whether, when a person with dementia is singing expressively, apparently with deep and appropriate feeling, that person has really tapped into a part of their minds that are otherwise inaccessible, or whether they are just triggering mimetic behavioral programs…
The mood engendered by singing can last a while, even outlasting the memory of having sung. On page 387 Sacks comments the emotional, behavioral, and cognitive effects of music can persist for hours or even days.
Sacks presents various anecdotal reports of music providing alzheimer’s patients with, in effect, a different world in which they can be engaged and content.
The effect of music does not require that it be familiar — novel tunes can catch the attention of those with dementia.

# # #