Musicophilia: Tales of Music and the Brain

“What could be the neurological basis of this?”

Sacks regularly poses direct questions such as this, and they are illustrative of both his own personal queries and wonderings, as well as his hope that his readers will ask these questions themselves. Since much of musical neurology is still unknown, Musicophilia becomes more of a partnered exploration of the topic between Sacks and his reader than a statement of fact from the knowledgeable to the ignorant.

“He went on to say that his epileptic music—seemingly contextless and meaningless, though hauntingly familiar—seemed to exert a frightening and almost dangerous spell on him, so that he was drawn deeper and deeper into it.”

Subtle repetition and dramatic diction gives Sacks’s writing an emotional tone that reflects his deep love and appreciation for music. Many of Sacks’s patients and correspondents had a conflicted relationship with music, including those who experience musical seizures and are unable to control the music, its volume, or its genre.

“But why this incessant search for meaning or interpretation? It is not clear that any art cries out for this and, of all the arts, music surely the least—for while it is the most closely tied to the emotions, music is wholly abstract; it has no formal power of representation whatsoever.”

Music is often seen as endowed with meaning, but it is in fact an objective, neutral mechanism until people interpret it in some way. Notes on a scale are just notes on a scale until someone feels or remembers something in response to them. In his usual conversational style, Sacks wonders out loud about why people ascribe meaning to music and what the neurological basis of this tendency might be.

“It is this fidelity—this almost defenseless engraving of music on the brain—which plays a crucial part of predisposing us to certain excesses, or pathologies, of musical imagery and memory, excesses that may even occur in relatively unmusical people.”

People like Clive Wearing, Gloria Lenhoff, and Woody Geist show that music outlasts all other memories, and that it permeates so many different parts of the brain that it is almost impossible to wipe it out except through very specific brain injuries or diseases. This whole-brain response to music and the ability to remember it in accurate detail like nothing else can be, is part of what leads Sacks to view Music as an Innate Human Characteristic.

“Some people—a few—come to enjoy their musical hallucinations; many are tormented by them; most, sooner or later, reach some kind of accommodation or understanding with them.”

Adaptation and acceptance of one’s neurological condition are central to improving quality of life. Most of the people Sacks has worked with or received letters from experienced a period of resistance and discomfort with their musical hallucinations, but they soon come to an understanding within themselves and learn to adjust. Musical hallucinations, especially when they are set off by a seizure or stroke, are an indication that music has a neurological basis.

“What we call musicality compromises a great range of skills and receptivities, from the most elementary perceptions of pitch and tempo to the highest aspects of musical intelligence and sensibility and that, in principle, all of these are dissociable from one another.”

In his observations, correspondences, and work, Sacks has found that appreciation and skill in regard to music has many separate facets, and that none of these depends on the other to exist. Some people may love music but have no technical understanding of it, while others may understand and can accurately perceive music but have little emotional interest in it. This all lends to the supposition that music activates many different brain areas.

“We take our senses for granted.”

Although music seems to be an innate part of the human experience, Sacks points out that people tend to take its presence and the ability to perceive and appreciate it for granted. Many people with amusia (tone deafness) still enjoy music, but cannot perceive its tones, melodies, and other intricacies. Amusia can come suddenly in life as the result of brain injury or even as a spontaneous occurrence, such as what happened to Sacks when he suddenly heard some of his favorite pieces as abrasive and irritating.

“It seems curious, in a way, that absolute pitch is so rare (it is estimated as occurring in less than one person in ten thousand). Why don’t all of us hear ‘G-sharpness’ as automatically as we see blue or smell a rose?”

Synesthesia is difficult to describe to those without the disorder, and Sacks himself does not have synesthesia, but he expresses the experience of this neurological difference but comparing it to sight and smell. Rather than speaking in the third person in instances like this, Sacks uses the first person collective to bring the reader into his thoughts.

“You work with the ears you have, not the ear you want.”

A man named Jacob suffered cochlear deterioration and became less and less able to perceive higher octaves on his piano. His resilience and drive to continue playing despite this difficulty speaks to Music as a Tool of Adaptation, Resilience, and Healing. The adaptive power of the human brain is pronounced in cases like Jason’s, and his matter-of-fact statement holds true not only for him but many other people that Sacks discusses.

“I gained a pseudostereo effect, which although it cannot have been as it used to be, gave me ample compensation. The music was not stereo, but it was all the same broad and rich. So, in the opening funeral march of Mahler’s Fifth, after the trumpet announces the gloomy depth of a funeral procession, the full orchestra fortissimo, I was almost lifted out of the chair.”

Many of the people that Sacks refers to in his book found ways to work around their newly acquired neurological conditions. In this account, Dr. Jorgensen found a way to trick his brain into hearing in stereo, largely by relying on memory and visual cues of the room and location of instruments. He writes poetically of his transformation, as Sacks does when he speaks of his own musical experiences. The rhythm of music ignites a rhythm in writing.

“One must infer that there are, in many individuals, at least, very concrete eidetic and mnemonic powers which are normally hidden, but which may surface or be released under exceptional conditions.”

Musical savants, Sacks points out, almost always carry some other neurological deficit or difference which music seems to compensate for. This is the case in people with Williams syndrome, who are often unable to perceive shapes or make calculations but who can sing or perform with ease and skill. Many people with autism also show proficiency in musical abilities. Perhaps most strikingly, brain injuries/infections and dementia, which deteriorate various brain areas, have been known to also produce extraordinary musical ability even late in life.

“The image of the blind musician or the blind poet has an almost mythic resonance, as if the gods have given the gifts of music or poetry in compensation for the sense they have taken away.”

The blind musician is an archetype which, as Sacks points out, has existed for at least 1,000 years. To add humanism and another branch of interest to the topic of musicophilia, Sacks includes historical context, which also helps lay a foundation for what people are experiencing in the present. Sacks’s poetic style comes through here as well, as he uses alliteration and combines scientific and religious language.

“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.”

Sacks devotes a long chapter to telling the story of Clive Wearing, his wife Deborah, and Clive’s deterioration and then gradual but limited progression following his illness. Sacks tells Clive’s story with emotion and empathy, and in such a way that it is deeply impactful. Clive’s story, more than most, shows the true power of music and the resilience of human beings, and brings about questions of how the brain hangs onto its memories of music when all else is lost.

“Listening to music is not a passive process but intensely active, involving a stream of inferences, hypotheses, expectations, and anticipations.”

Listening to music, as Sacks points out, combines past, present, and future, as people perceive all three at once while the music plays. They make logical guesses about what will come next based on what has been before and what is happening now. This process activates several different brain areas and brings people like Clive Wearing and those with diseases like dementia into the present; it gives them something to hold onto.

“It may be that Clive, incapable of remembering or anticipating events because of his amnesia, is able to sing and play and conduct music because remembering music is not, in the usual sense, remembering at all. Remembering music, listening to it, or playing it, is entirely in the present.”

As is demonstrated throughout Sacks’s book, philosophy and psychology often intertwine and in some instances become difficult to separate. Music accesses parts of a person that often cannot be erased in even the most extreme of circumstances. Remembering music is theorized to be procedural; it is something that is done through action. Thus, a person need only to do it again to remember it in many cases.

“Though singing is not propositional communication, it is a very basic existential communication. It not only says, ‘I am alive, I am here,’ but may express thoughts and feelings that cannot be expressed, at this point, by speech.”

For those with aphasia, communicating through speech is extremely difficult or impossible. However, for many of these people, singing music breaks through this barrier, and they are able to use words again. Singing is a powerful tool of expression that accesses the emotional center of a person, which is why it can be used as a tool for healing not only a person’s communication abilities, but their sense of self.

“Beyond the repetitive motions of walking and dancing, music may allow an ability to organize, to follow intricate sequences, or to hold great volumes of information in mind—this is the narrative or mnemonic power of music.”

Various neurological conditions, including brain and spinal injuries, Alzheimer’s, and more, render a person unable to organize their thoughts or perceptions. Music provides a sense of structure and organization that people need to navigate their world, to remember, and to be themselves again.

“I had read Nietzsche’s notes on physiology and art as a student, many years before, but his concise and brilliant formulations in The Will to Power came alive for me only when I came to Beth Abraham (Hospital) and saw the extraordinary powers of music with our post-encephalitic patients—its power to ‘awaken’ them at every level: to alertness when they were lethargic, to normal movements when they were frozen, and, most uncannily, to vivid emotions and memories, fantasies, whole identities which were, for the most part, unavailable to them.”

People who experience brain inflammation or infection may also experience brain damage that seems to erase certain abilities or aspects of who they were. In Sacks’s experience, music is resistant to these conditions, and a memory of music often prevails when others do not. He speaks metaphorically and literally of the awakening power of music.

“Music calls to both parts of our nature—it is essentially emotional, as it is essentially intellectual.”

Sacks uses parallel language to illustrate the parallel components of music. His experience working with patients with various neurological conditions has led him to the conclusion that music accesses the two essential aspects of human beings: their intellect and their emotions. Music has a unique power to unite the intellectual and emotional aspects of the human brain.

“In some sense, then, it seemed to me that Louis existed only in the present, in the act of singing or speaking or performing. And, perhaps because of this abyss of nonbeing which yawned beneath him, he talked, he sang, he moved ceaselessly.”

Sacks met a man named Louis with frontotemporal dementia. He had low inhibitions and talked or sang constantly, and Sacks wondered if this was Louis’s way of adapting to what had become a terrifying and debilitating condition for him. Much like Clive Wearing and many of Sacks’s Alzheimer’s patients, music harnessed Louis to reality and helped him come back to himself. Sacks’s poetic style comes through as he describes Louis, personifying the abyss of Louis’s mind.

“We move onto more uncertain ground with regard to certain historical figures who have been, by their own and others’ description, indifferent (or sometimes averse) to music.”

Sacks involves the reader directly in his thoughts, his structure, and his reasoning. He acknowledges the possibility of historical inaccuracy and the sometimes-exaggerated nature of personal accounts. Still, he chooses to include these as a source of interest and in the absence of scientific data on the subject of musical indifference.

 “The musical or artistic powers that may be released in frontotemporal dementia or other forms of brain damage do not come out of the blue; they are, one must presume, potentials or propensities that are already present but inhibited—and undeveloped.”

Sacks’s writing is enriched with poetic style, including his use of alliteration, his subtle inclusion of a relatable cliché, and the flow between words that occurs as one reads them. Sacks’s own personal theories are based on his research, his work, and his own personal experiences, and this makes his writing on the topic particularly approachable.

“The three dispositions which are so heightened in people with Williams syndrome—the musical, the narrative, and the social—seem to go together, distinct yet intimately associated elements of the ardent expressive and communicative drive that is absolutely central in Williams syndrome.”

Sacks’s writing combines science with poetry, as do his ideas and the ways in which he formulates his chapters. Sacks sees the importance in both worlds and in both views and chooses to use them in unison.