remarkable tales of music & the brain by Oliver Sacks –  reviewed by Tim McKamey

     Much of this book deals primarily with a number of extreme and often quite bizarre pathologies of the brain involving music in one form or another. There is some discussion of the direct healing properties of music, primarily for people suffering from Parkinson’s and Alzheimer’s. But we learn much about the positive aspects of music and the brain in this work by what the negative aspects show us. As a practicing physician and neurologist, Oliver Sacks has had an opportunity to treat an amazing array of physical and mental conditions. As a musician he has an intuitive and experiential understanding of the role music plays in our lives.

Many of the patients he has treated or corresponded with are composers or musicians themselves, and these individuals shed valuable insight on how we are affected by music.

     By looking at some of the pathological conditions brought on by brain injuries, or physical conditions such as deafness or blindness, we learn for example that the brain does not simply produce sensations, a large part of its work is involved in inhibiting and suppressing sensations. This is why for example, upon losing one’s sight, speech, or sight, suddenly we can be assaulted by all manner of auditory hallucinations. When our sense of hearing is intact, we focus on the external sounds in the environment. When that sense disappears, suddenly the brain may start releasing whole pieces of music from memory, or disturbingly distorted versions of music. This appears to have something to do with the brain’s insistence on establishing meaning from whatever stimulus is available and its remarkable capability to respond to and generate rhythmic patterns and melodies from the unconscious, just as easily as it can derive these things from the external world. A positive aspect of this phenomenon is how upon losing one’s sight, for example, other senses are heightened. What we see in these cases is that there is a great deal going on at the sub-cortical level of the brain that we are normally not aware of. Certain physical disabilities then have a way of releasing the inhibitions that are generally in place in the healthy brain.

     This tells us something valuable about the brain and music that can be of use to us in the practice of healing music. One of the most remarkable tales Sacks tells is in Chapter 15, In the Moment: Music and Amnesia, and the very strange story of Clive Wearing. For over 20 years Clive is unable to recall the previous moment, or anything about his life that occurred after his brain suffered lesions from a serious case of encephalitis. “He is a man without a past (or future), stuck in a constantly changing, meaningless moment.” Whenever his wife visits him at the nursing home, he is astounded to see her again, even if he only saw her the day before, he has no episodic memory, so it is a constant source of both joy and despair rolled up into one. He recognizes her, and recalls that they have children, when she mentions them, but has no idea of the time that has passed and how lives have changed, how the world has progressed and so forth.

     Yet for all this, he can sit down at the piano in his room and play whole pieces of music straight through from start to finish, beautifully, full of emotion and expression. Not only this, but when he is taken to his church to conduct the choir he once worked with, he can lead them through the songs flawlessly and beautifully. The experience of music is a timeless moment for him, it has continuity even though the rest of his life has none. As devastated as Clive’s brain is from the encephalitis, as unable as he is to function normally in almost every respect, in music he is made whole again, at least as long as the music plays. This tells us without a doubt that music works where very little else can.

     There are many other amazing stories in this book that reveal without any doubt the miraculous power music has in our lives. One such is the account of the woman who at 8:59 every Sunday evening will have an epileptic fit. This remained a mystery until someone finally figured out that each Sunday evening she would listen to the BBC on radio and at 8:59pm a certain bell tower was sounded to announce a weekly program. The pitch and timbre of this particular bell sound set off her epilepsy.

     The last twenty years has seen a huge increase in research on the matter of music and the brain. Sacks has been working on the front lines of neurology during all this time and has had frequent occasions to see how music can have startling, unforeseen effects on us. When he worked at Beth Abraham hospital in the Bronx in the 1960s, Music Therapy was hardly even a recognized discipline, the first formal program having only been set up in Michigan in 1944.  But there was gifted music therapist working at Beth Abraham named Kitty Stiles who had a particularly intuitive gift for working with post-encephalitic patients. Sacks invited the poet W.H. Auden to one of Kitty’s sessions, and the poet was amazed by the instant transformation music could affect in the patients. It reminded him of an aphorism by the German Romantic writer Novalis: “Every disease is a musical problem; every cure is a musical solution.”

     When Kitty Stiles retired in 1979, Beth Abraham Hospital hired Concetta Tomaino who would go on to become president of the American Association for Music Therapy and earn one of the first generation of doctoral degrees in music therapy. Tomaino and Sacks both appear in several segments in the PBS documentary The Music Instinct; The Science of Song.

     People who suffer from Parkinson’s Disease often fall into a ‘frozen’ state of immobility and lose their ability to speak (aphasia). They may also develop severe ‘tics’ or tremors that render them incapable of performing simple tasks such as walking.  I first noticed this in a music history teacher I had at Cornish. She had played piano all her life, accompanying string soloists on the stage around the world.  Now, well past the age of retirement, she loved music and would not give up teaching despite the early stages of Parkinson’s and the tremors it produced. It was quite visible when she would talk to us. But the moment she sat down at the piano to play an example, the tremors would vanish and she could play steady, with grace and finesse.

     Sacks describes how a person with advanced Parkinson’s can be sitting in their wheel chair in a frozen state, apparently unable to interact in any way with the world around them. But throw them a ball and they will catch it, and even throw it back! Then they return to their immobility. Sometimes it is possible to get a person with Parkinson’s up out of their chair and begin walking them down the hall. Amazingly, they will fall in step and be able to walk with a steady gait, as long as we remain with them. So apparently in these situations, they can entrain themselves to rhythms imposed from the external world and this takes over their muscular activities in a constructive way, temporarily at least overcoming the disabling effects of the Parkinson’s.

     This explains why music works so well to at least temporarily alleviate the aphasia that occurs in many conditions in addition to Parkinson’s. The rhythms of the music and the memories invoked by the melodies have the ability to reach the patient through alternate pathways that bypass the cognitive roadblocks created by all kinds of conditions, from autism to Alzheimer’s.

     In other examples, many people with Tourette’s Syndrome have found creative ways such as drum circles and even orchestral composition, to channel the otherwise destructive energy of their unpredictable tics. Focused and engaged in music, the symptoms vanish, or are subsumed into a creative outlet. Once disengaged from the task, the symptoms return.

     There is the savant-like musical talent exhibited by many born with Williams Syndrome. Even with an IQ of 60 or less, many of these individuals have a vibrant appreciation for music and show unusual musical abilities singing and playing instruments, even when as simple a motor skill as tying their shoes or buckling their instrument case shut causes them problems. One young woman with Williams Syndrome learned to sing operatic arias in over 30 languages! Another at age 38 had over 2,000 songs in her repertoire which she could play on her full-size piano accordion. In most all other regards in life these people would be regarded as having ‘retarded’ development, needing help to perform basic life-skills. Yet somehow their affinity for music overrides these shortcomings.

     The final chapter on dementia and music therapy chronicles several stories from Sacks’ experience with patients in his hospital, and in work done with Connie Tomaino. One significant difference in music’s effect on Alzheimer’s and other forms of dementia as compared to its effect on Parkinson’s patients is that with Parkinson’s the effects wear off almost immediately after the music stops. With Alzheimer’s and other dementias however, the patient may partially recover for hours or even days after sessions with a music therapist. Familiar songs seem to evoke memories from the person’s life at such a deep level, that it not only brings them up from the depths of their isolation, but seems to keep them up for at least a short time as if something dormant has once again been activated. Alzheimer’s patients can also respond to non-familiar music in positive ways if it “reaches” them in the same way the familiar music reaches them. If the music “gets to them”, it releases something that brings them back to the surface. They have not lost the self, as Sacks puts it, the self that is still there emerges with the help of music.

     Much in this book bears re-reading, and much of the work is ongoing.  There are many fascinating stories here, like the chapter on one-armed pianists and phantom limbs and musician’s dystonia. The famous philosopher Ludwig Wittgenstein’s brother Paul was a renowned pianist who lost his right arm, but continued to teach. His students were amazed at how accurately he could convey to them the proper fingering to use in their right hands, when his was gone! Obviously the brain remembered, and still played with all 10 fingers, and he could communicate this to his students. He also urged several great composers to write pieces for solo left hand piano. So years later when Leon Fleisher developed dystonia in his right hand, he was able to continue performing using the piano pieces written for left hand. And eventually new techniques were developed to cure his dystonia and today he plays again with both hands!

     Music pervades the brain like nothing else we know of. It coordinates and activates many different areas of the brain simultaneously. We have only begun to scratch the surface of how this happens. The future holds many exciting discoveries and we look forward to many more tales of music and the brain.

See these related stories about music and the brain:

Elements of Music,

If a Tree Falls in the Forest…, and

Restoration of the Missing Fundamental.

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