Musicophilia: Tales of Music and the Brain

Expressive and receptive aphasia are the inability to use or understand language as a result of injury to the corresponding brain area. One patient at the hospital where Sacks worked was unable to speak but could sing simple tunes. After months of music therapy, the patient was able to speak short phrases. For people with expressive aphasia, singing can be the bridge of communication that they need. Music and language share similarities in that they both employ structure, rhythm, and melody, but there are also differences in how they are remembered, processed, and used. It seems that the type of speech used in song is methodical and repetitive, making it different from improvised speech. Having a solid relationship with one’s music therapist drastically affects the chances of improvement, as the mirror neurons activated by imitating words and actions is crucial to the process of music as a form of speech therapy. The music therapist also provides comfort, support, and encouragement to patients who may otherwise feel lost or hopeless. Another form of music therapy involves introducing melodic phrases and gradually transitioning them to speech. The right hemisphere, particularly the Broca’s area, may sometimes overcompensate for loss of speech function in the left hemisphere, and music therapy seems to quell this back to a state of normalcy. In turn, the left Broca’s area becomes less inhibited and some function returns.

A patient named Solomon developed dyskinesia (movement disorder) in which he produced exasperated sounds simultaneously with a sort of lurching of his body. Sacks observed this and also heard Solomon speaking Hebrew as he did so, and wondered if Solomon was davening—a Jewish form of prayer that sometimes involves swaying the upper body (shuckling in Yiddish). Initially this was not the case, but Solomon soon took interest in the process because of his dyskinesia, finding that prayer gave form and purpose to his involuntary movements. A woman who worked with a similar patient wrote to Sacks, reporting that she was able to communicate with her patient by engaging in the same rocking motion and rhythmic speech that he did.

Some people with Tourette’s find that their symptoms respond to music, sometimes positively and sometimes negatively, depending on the type of music and other factors. A few of these people, such as Sydney A., experience a more complex and almost expressive form of ticcing in response to music, including body and facial gestures as well as sounds. Some people with this type of Tourette’s take up Jazz or Classical music, often as a way to mask tics or release energy. Drumming in particular is a therapeutic technique used to channel and control tics, and groups are formed that also provide a source of social support and community. Although the tics return when the music stops, a brief relief and sense of control is much needed.

In 1974, Sacks’s quadricep was sprained in a climbing accident and he was unable to walk. Alone on the mountainside, he managed to rhythmically row himself down to safety where he could be cared for. In the aftermath, Sacks’s leg felt disconnected from his body, and he walked in an awkward, highly intentional way. While listening to a concerto by Mendelssohn, Sacks was able to find rhythm in his steps and walk naturally again. One of his patients soon after had a similar experience, and Sacks used music to help her slowly make use of her leg again. Inhibited motor functions as the result of injury can clearly be healed through music, as it seems to provide a sense of structure and narration that other actions can then accompany. Music is used in this way by all people: Basic concepts are taught through song, for example, and people sometimes remember long numbers by setting them to rhythm. Around the world, people respond physically to music, using their bodies to match the rhythms they hear, and this suggests the possibility that the auditory and motor cortex are inextricably connected. From infancy or shortly thereafter, people begin to tap, move, and shake to the rhythms they hear. The motor response is sent before the auditory information is received, suggesting that people are predicting the tempo before hearing it. The dorsal premotor cortex is directly connected to the auditory cortex, lending further credence to the idea that humans are born with the ability to perceive music. A sense for rhythm seems separate from that for speech since it is a tempoed rhythm rather than sporadic. Rhythm of music also serves to synchronize groups and provide a sense of cohesion and communality, and this can be seen in churches, concerts, classrooms, and more.

In the 1960s, Sacks began working at a hospital that housed many victims of a severe encephalitis epidemic. Some of these patients experienced an extreme form of Parkinsonism. Some were in a frozen state, while others moved constantly and without control. Most of these patients, however, responded to music, showing drastic reductions in speech and movement impairments even when no other therapies had worked. The music therapist at the hospital, named Kitty, was seen as an integral part of patient recovery and quality of life. Sacks notes that music therapy first came into formal use during World War II, when soldiers with post-traumatic stress disorder (PTSD) were found to respond positively to music. Parkinsonism affects the perception of flow of movement, but can also affect flow of speech, thought, and feeling, and music seems to offer a way to smooth these again. Different types of music affect different patients in unique ways, but primarily music that is softer yet rhythmic seems most beneficial. One patient, Ed, who had fast movements on one side of his body and slow movements on the other, could not be medicated as other patients would be, but was able to find rhythm and connection through playing his organ. The defining factor of Parkinsonism is damage to the basal ganglia, which paralyzes the person until they are “called into action” (277) by something like music or mimicry. One of Sacks’s patients, Rosalie, was in a partially frozen state unless prompted to play or imagine music. For many patients, dancing has the same profound effects. Sacks refers to Friedrich Nietzsche’s observations on music: Nietzsche noted that music inspires people to participate, to remember, and to feel—precisely what it does for people with neurological conditions such as Parkinson’s.

During the Civil War, a physician named Silas Weir Mitchell observed that veterans who had lost limbs in the war often reported feeling sensation—frequently in the form of pain—in the missing limb. Mitchell theorized that the brain was sending signals as if the limb was still intact. Pianist Paul Wittgenstein, after losing his right arm, was able to play the piano with his left hand while precisely imagining the movements of his missing right hand. Sacks muses on the future possibility of prosthetic limbs that allow musicians like Wittgenstein to fully play the piano again.

Sacks recalls a letter he received from a violinist who gradually lost motor control in the fingers of his left hand, with seemingly no initial cause or reason. These problems worsened, and no treatment seemed to help. Repeated use of small muscles seems to sometimes cause this problem in musicians and other professionals, such as writers. The problem has often been interpreted as one of delusion or hysteria, and the resulting stigma has made people reluctant to talk about it. In the 1980s, a pianist named Gary Graffman publicly professed the loss of his abilities due to a slow curling of his fingers, and another pianist named Leon Fleisher openly described his experience and the years of useless treatments. In the 1980s, neuroscientist David Marsden suggested that the phenomenon was a type of dystonia (muscle spasming) resulting from a dysfunction of the basal ganglia. Sensory representations in the brain have been found to be disorganized in people with this particular problem. Increased scientific and general awareness of dystonia will hopefully lead to further advancements in treatment. Currently, Botox injections help some musicians’ relax their muscles enough to use them, but this treatment can exacerbate the condition over time. For pianists like Leon Fleisher, however, the treatment is effective enough to allow them to return to what they love.