Abstract painting of musicians in an orchestra

In Review

Music on Your Mind

Rehearsal of the Pasdeloup Orchestra at the Cirque d’Hiver (ca. 1879) by John Singer Sargent. Original from The Art Institute of Chicago. Digitally enhanced by rawpixel.

By James Clyde Sellman

In Musicophilia, Oliver Sacks explores the realm of music and its complex connections to the brain and the mind. He makes clear that music (regardless of whether we’re making it, appreciating it, or even trying to avoid it) is a uniquely human activity—and by no means an inconsequential one. He sees our musical propensities, our “musicophilia,” as “a given in human nature.” Sacks is a neurologist and clinician, teacher and writer of deeply humane interests. He also has a profound love of music, particularly classical music, but Sacks is probably best known as the author of Awakenings (1973). That work tells  of a group of survivors of a 1916–27 pandemic of encephalitic lethargica who were left in a more-or-less permanent trancelike or twilight state, and Sacks’s use in the mid-1960s of a then-experimental drug, L-dopa, to return them—briefly—to consciousness. (The book inspired the 1990 film of the same name, starring Robert De Niro and Robin Williams.)

Like that book—and The Man Who Mistook His Wife for a Hat (1985) and An Anthropologist on Mars (1995)—Musicophilia is structured around a series of case studies. In Musicophilia, the accounts focus on extreme experiences or dysfunctions involving music, due, for example, to Parkinson’s disease, epilepsy, stroke, dementia, autism, Tourette’s syndrome, or other neurological conditions. But the case studies bear little resemblance to what you might find in a medical journal. Sacks is less interested in detailed clinical summaries than in sharing the experiences, perceptions, and adaptations of individuals in unprecedented circumstances.

The opening chapter is doubtless the most striking. It tells of Dr. Tony Cicoria, a 42-year-old surgeon from upstate New York who developed a powerful interest in piano music after being struck by lightning. Dr. Cicoria had never been much interested in music prior to his 1994 near-death experience. He’d never studied it seriously, didn’t own a piano, and—when he listened—preferred rock music. But after recovering, he developed an insatiable appetite for piano music. He listened to it incessantly and bought countless classical piano recordings—and then a piano. He began painstakingly teaching himself to play it. Then he began hearing music in his head and in his dreams. He wanted to capture that music; he wanted to compose and perform it. At last, on October 17, 2007, Cicoria premiered his first composition, entitled (what else?) the “Lightning Sonata.”

But that wasn’t the only transformation that Cicoria underwent. Just as he hadn’t been particularly musical before the accident, he wasn’t religious either. Afterward, however, he told Sacks that he was at a loss to explain his experience save in spiritual terms. The author countered that the changes probably had “some physical basis or at least some physiological correlate in neural activity.” When he tried to convince his patient to have further testing of his brain function, Cicoria initially assented, but after a moment reconsidered and said (in Sacks’s words), “[P]erhaps it was best to let things be.” For Cicoria, Sacks explains, “the music, however it had come, was a blessing, a grace—not to be questioned.”

Musicophilia addresses a wide range of musically related neurological phenomena. The author describes how, for some people with epilepsy, music serves as a forewarning, in the form of a musical aura shortly before a seizure (analogous to the premonitory visual auras experienced by some migraine sufferers). He explores the musical losses or deficits that can result from injury, illness, and congenital conditions. A stroke, the rupture of an aneurysm, or some other trauma to the brain can wreak all sorts of havoc. After the car in which she was riding skidded off the road and struck a tree, the gifted com-poser and performer Rachael Y. developed “amusia,” finding herself unable to integrate musical sounds. Where once she effortlessly took in melody, harmony, rhythm, timbre, and dynamics, now the parts no longer comprised a seamless whole: “[W]hen I listen to an orchestra,” she wrote to Sacks, “[i]t is extremely difficult to integrate all these different voices into some entity that makes sense.” And since that 1993 accident, she has been unable to compose.

While much of his story concerns musical losses, Sacks also reports instances of unusually expanded or robust abilities (only one of which involves lightning). He discusses perfect pitch, for example, and the phenomenon of synesthesia—in which two or more senses intertwine or overlap. Synesthetes may, for example, perceive music not simply as sound but also as color. Thus, contemporary composer Michael Torke sees each and every key in its own distinct shade, each a sort of “transparent, luminous brilliance.” Sacks also notes how music (even, in some instances, imagined music) can temper the tics of Tourette’s or unblock and smooth the movements of people with Parkinson’s disease. And he addresses the neurological factors at work in musical savantism and Williams syndrome. People with the latter, a congenital disorder caused by the deletion of a segment of chromosomal material, typically have IQs under 60 but also marked verbal abilities, a strong emotional response to music, and—in some instances—astonishing musical talents.

What comes through most vividly in Sacks’s writing is his profound empathy. Rather than modeling clinical objectivity, these case studies highlight the humanity of his patients. While he does from time to time (and without great fuss) summarize the scientific literature on the topics he addresses, he is fascinated more by the particulars of individuals than by broad theorizing. And Sacks clearly knows the value of good storytelling. Moreover, the stories themselves—like the chapter on Tony Cicoria—offer fertile ground for broader reflections. Yet it is here, if anywhere, that Musicophilia suffers. With its heavy reliance on individual cases, the book feels at times like a documentary with too many “talking heads”; the tightly framed narrative can neglect more sweeping vistas.

The question here isn’t the typical one, about “representativeness.” These individuals aren’t meant to be representative. Sacks focuses on people in highly unusual circumstances (what he calls “the far borderlands of neurological and human experience”). But how do we take “back bearings” from these outer reaches to more familiar realms—where do we take what we’ve learned? Certainly, Sacks grapples with some matters of quite broad relevance, as in his discussion of what he terms “brainworms,” those irritating little musical snippets that rattle around in our minds, unwanted and unbidden, some-times for hours—or days—on end. Music that takes this sort of neural-viral form (what is it, after all, that makes tunes “catchy” or rhythms “infectious”?) seems omnipresent—above all, enticing us to buy things—and is itself a highly bankable commodity.


Musicophilia: Tales of Music and the Brain,  by Oliver Sacks. Knopf, 400 pages, $26

Among African American slaves in the antebellum South, spirituals not only nurtured the dream of freedom but also carried the details of the path to get there.

Similarly, music can help drive us to war, lull us when we’re “stuck on hold,” or hotwire our emotions as we watch a movie. It has powerful links to memory as well. Particular strains of music (like particular scents) can suddenly transport us back to key moments in our lives. The indigenous people of Australia used “songlines” as mnemonic aids. Singing these songs, which encoded terrain and landmarks, helped them successfully navigate across vast distances. Some evidence suggests that among African American slaves in the antebellum South, spirituals such as “Follow the Drinking Gourd” not only nurtured the dream of freedom but also carried details of the path to get there. Music can be a potent force for both inspiration and identity. Freedom songs helped propel the Civil Rights movement, and labor organizers have long understood the value of union songs on the picket line.

Throughout history, music has also been linked to the divine, and sacred music in its many forms—from many faiths and cultures—attests to the depth and universality of that connection. However, Sacks (a self-professed “old Jewish atheist”) resists the religious interpretations that some patients offer for their musical experiences, and is equally reluctant to plumb his own memories of music and faith. Thus, after noting the “almost irresistible power of rhythm” and—very briefly—alluding to the “ecstatic dancing and chanting” that accompanied Simcha Torah in the “normally sober” synagogue of his youth, he heads back to more comfortable, secular terrain. But the meeting ground of faith and rhythm (or faith and music) is vast and hard to blink. African American gospels center on its extended and highly rhythmic climax, in which the lead singer improvises lyrics while the other performers—and often the audience—maintain a propulsive, driving vamp, raising the emotional intensity and opening sinners to salvation. In more meditative traditions, such as Zen Buddhism, rhythm tends to be less evident—traditional music for the shakuhachi, a Japanese bamboo flute, is played to the pace of one’s own breathing, with a distinct ground beat all but absent. Some religious traditions—such as my own, that branch of the Society of Friends that practices silent worship—have sought to proscribe music altogether. In the early and mid-nineteenth century, Quakers were so wary of music (which they viewed as incompatible with simplicity), that Friends who participated in musical activities risked being “read out of meeting.” Yet, whether it was spurned or embraced, the power of music has been recognized by peoples and cultures around the world. All the more surprising, then, that it took Western medicine so long to consider its therapeutic value.

The power of music has been recognized by peoples and cultures around the world. All the more surprising that it took Western medicine so long to consider its therapeutic value.

In the latter half of the book, Sacks turns his attention to such therapeutic uses of music. Anyone involved in (or contemplating) work with patients in long-term care (who may well include one’s own parents) will be particularly drawn to his discussions of music therapy for those with various chronic conditions—particularly Alzheimer’s dis-ease. It’s estimated that roughly 10 percent of Americans age 71 and over—some 2.4 million individuals—suffer from Alzheimer’s dementia. And as the population ages, those numbers are expected to go up, per-haps sharply. For his part, Sacks insists that a person with Alzheimer’s (or some other form of dementia) “is never sans everything, never a tabula rasa. . . . [A]spects of one’s essential character, of personality and personhood, of self, survive—along with certain, almost indestructible forms of memory—even in very advanced dementia.”

And his website notes that “music occupies more areas of our brain than language does.” The complexity of this neural wiring helps ensure that even as other memories and skills are lost, musical abilities and awareness may remain—often surprisingly intact. So, for some patients with dementia, music can literally be the key to memory, reopening—albeit partially and briefly—their personal histories and selves after the synaptic ravages of disease have otherwise locked and barred the doors.

Research also suggests that certain types of music can quell agitation and influence behavior, even in patients with severe dementia. In 2003, a small Australian study reported that listening to slow-tempo baroque music (Handel, Bach, Vivaldi) reduced adverse behaviors among patients with dementia by 40 percent. Vivaldi (and particularly The Four Seasons) has been the focus of a number of subsequent studies that suggest potential benefits for dementia patients. And Israeli researchers, in a 2007 Journal of Music Therapy study, found that familiar background music significantly increased Alzheimer’s patients’ positive behaviors and decreased their negative ones.

Other evidence suggests that participatory and live musical activities, such as group exercise and singing, offer even greater benefits. In 2007, Canadian researchers published the results of a small randomized controlled trial—also in the Journal of Music Therapy—in which music therapy improved such patients’ cognitive abilities, not only immediately following the sessions but the next morning as well. And researchers at Sweden’s Karolinska Institute concluded that social dancing was able to improve the “positive feelings, communication, and behavior” of dementia patients. Individual cases studies and anecdotal reports also tell of late-stage Alzheimer’s patients who remain responsive to music. American shakuhachi master John Kaizen Neptune recalled that while he was performing a solo meditation piece at a Japanese nursing home, “an old woman began to sing very loud.” Neptune forged ahead, and the woman, somewhat disconcertingly, continued her singing. Afterward, nurses told him that she had advanced Alzheimer’s disease and “had not spoken or reacted to anything in more than three years.” Other sources speak of Alzheimer’s patients who are unable to speak or recognize family members, yet still can sing familiar songs, verse by verse—and in tune.

While we lack conclusive evidence for the therapeutic value of music—the avail-able studies have been small, and few have been randomized controlled trials, the gold standard for medical research—Sacks, for one, is convinced. “Familiar music,” he writes, “acts as a sort of Proustian mnemonic, eliciting emotions and associations that had been long forgotten, giving the patient access once again to moods and memories, thoughts and worlds that had seemingly been completely lost.”

In attesting to the profoundly human, healing, and—indeed—redemptive power of music, Oliver Sacks shows himself to be a man of both science and faith. And regardless of whether one leans more in one direction or the other on this supposed dichotomy, Musicophilia offers rich ground for reflection and awe.

James Clyde Sellman is a writer who lives and works in Newton, Massachusetts. He received his PhD in American social history from Harvard University.

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