Musicophilia: Tales of Music and the Brain (10 page)

A
LTHOUGH COLMAN,
in 1894, wrote specifically about “Hallucinations in the Sane, associated with local organic disease of the sensory organs, etc.,” the impression has long remained both in the popular mind and among physicians, too, that “hallucinations” mean psychosis— or gross organic disease of the brain.
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The reluctance to observe the common phenomenon of “hallucinations in the sane” before the 1970s was perhaps influenced by the fact that there was no theory of how such hallucinations could occur until 1967, when Jerzy Konorski, a Polish neurophysiologist, devoted several pages of his
Integrative Activity of the Brain
to the “physiological basis of hallucinations.” Konorski inverted the question “Why do hallucinations occur?” to “Why do hallucinations not occur all the time? What constrains them?” He conceived a dynamic system which, he wrote, “can generate perceptions, images, and hallucinations…the mechanism producing hallucinations is built into our brains, but it can be thrown into operation only in some exceptional conditions.” Konorski brought together evidence— weak in the 1960s, but overwhelming now— that there are not only afferent connections going from the sense organs to the brain, but “retro” connections going in the other direction. Such retro connections may be sparse compared to the afferent connections, and may not be activated under normal circumstances. But they provide, Konorski felt, the essential anatomical and physiological means by which hallucinations can be generated. What, then, normally prevents this from happening? The crucial factor, Konorski suggested, is the sensory input from eyes, ears, and other sense organs, which normally inhibits any backflow of activity from the highest parts of the cortex to the periphery. But if there is a critical deficiency of input from the sense organs, this will facilitate a backflow, producing hallucinations physiologically and subjectively indistinguishable from perceptions. (There is normally no such reduction of input in conditions of silence or darkness, because “off-units” fire up and produce continuous activity.)

Konorski’s theory provided a simple and beautiful explanation for what soon came to be called “release” hallucinations associated with “de-afferentation.” Such an explanation now seems obvious, almost tautological— but it required originality and audacity to propose it in the 1960s.

There is now good evidence from brain-imaging studies to support Konorski’s idea. In 2000, Timothy Griffiths published a detailed and pioneering report on the neural basis of musical hallucinations; he was able to show, using PET scans, that musical hallucinations were associated with a widespread activation of the same neural networks that are normally activated during the perception of actual music.

I
N 1995
I received a vivid letter from June B., a charming and creative woman of seventy, telling me of her musical hallucinations:

Mrs. B. enclosed her “play list,” which included “Amazing Grace,” “The Battle Hymn of the Republic,” Beethoven’s “Ode to Joy,” the drinking song from
La Traviata,
“A-Tisket, A-Tasket,” and “a really dreary version” of “We Three Kings of Orient Are.”

“One night,” Mrs. B. wrote, “I heard a splendidly solemn rendition of ‘Old Macdonald Had a Farm,’ followed by thunderous applause. At that moment I decided that, as I was obviously completely bonkers, I’d better have the matter looked into.”

Mrs. B. described how she had tests for Lyme disease (she had read that this could cause musical hallucinations), brainstem-evoked audiometry, an EEG, and an MRI. During her EEG, she heard “The Bells of St. Mary’s”— but nothing abnormal showed. She had no signs of hearing loss.

Her musical hallucinations tended to occur during quiet moments, especially when she went to bed. “I can never turn the music on or off, but I can sometimes change the melody— not to just anything I want to hear, but to something that has already been programmed. Sometimes the songs overlap, I can’t stand another minute, so I turn on WQXR and go to sleep by some real music.
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“I’m very fortunate,” Mrs. B. concluded, “that my music isn’t all that loud…. If it were, I’d really go crazy. It takes over in quiet moments. Any audio distractions— conversation, radio, TV— effectively drown out whatever I’m hearing. You observe that I seem to get on with my new addition ‘amiably.’ Well, I can cope okay, but it can be very annoying…. When I wake up at 5 a.m. and can’t get back to sleep, I don’t appreciate having a chorus reminding me that ‘the old gray mare ain’t what she used to be.’ This is not a joke. It really did happen, and I might have thought it amusing if it hadn’t kept singing the same refrain over and over again.”

A decade after she first wrote to me, I met with Mrs. B., and I asked her whether, after so many years, her hallucinated music had become “important” in her life, in either a positive or a negative way. “If it went away,” I asked, “would you be pleased or would you miss it?”

“Miss it,” she answered at once. “I would miss the music. You see, it is now a part of me.”

W
HILE THERE IS
no doubt of the physiological basis of musical hallucinations, one has to wonder to what extent other (let us call them “psychological”) factors may enter into the initial “selection” of the hallucinations and their subsequent evolution and role. I wondered about such factors when I wrote in 1985 about Mrs. O’C. and Mrs. O’M.; Wilder Penfield, too, had wondered whether there was any sense or significance in the songs or scenes evoked in “experiential seizures” but had decided there was not. The selection of hallucinatory music, he had concluded, was “quite at random, except that there is some evidence of cortical conditioning.” Rodolfo Llinás, similarly, has written of the incessant activity in the nuclei of the basal ganglia, and how they “seem to act as a continuous, random motor pattern noise generator.” When a pattern or fragment might escape now and then and thrust into consciousness a song or a few bars of music, Llinás felt this was purely abstract and “without its apparent emotional counterpart.” But something may start randomly— a tic, for example, bursting out of overexcited basal ganglia— and then
acquire
associations and meaning.

One may use the word “random” with regard to the effects of a low-level mishap in the basal ganglia— in the involuntary movement called chorea, for example. There is no personal element in chorea; it is wholly an automatism— it does not, for the most part, even make its way to consciousness and may be more visible to others than to the patient himself. But “random” is a word one would hesitate to use in regard to
experiences,
whether these are perceptual, imaginary, or hallucinatory. Musical hallucinations draw upon the musical experience and memories of a lifetime, and the importance that particular sorts of music have for the individual must surely play a major role. The sheer weight of exposure may also play a significant part, even overriding personal taste— the vast majority of musical hallucinations tend to take the form of popular songs or theme music (and, in an earlier generation, hymns and patriotic songs), even in professional musicians or very sophisticated listeners.
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Musical hallucinations tend to reflect the tastes of the times more than the tastes of the individual.

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. This may sometimes take the form of direct interaction, as in a charming case history published by Timothy Miller and T. W. Crosby. Their patient, an elderly deaf lady, “awoke one morning hearing a gospel quartet singing an old hymn she remembered from childhood days.” Once she had ascertained that the music was not coming from a radio or television, she rather calmly accepted that it was coming “from inside my head.” The choir’s repertoire of hymns increased: “the music was generally pleasing, and the patient often enjoyed singing along with the quartet…. She also found that she could teach the quartet new songs by thinking of a few lines, and the quartet would supply any forgotten words or verses.” Miller and Crosby observed that a year later the hallucinations were unchanged, adding that their patient had “adjusted well to her hallucinations and views them as a ‘cross’ she must bear.” Yet “bearing a cross” may not carry a wholly negative connotation; it can also be a sign of favor, of election. I recently had occasion to see a remarkable old lady, a pastor who developed musical hallucinations— mostly of hymns— as she became hard of hearing. She came to see her hallucinations as “a gift” and has “trained” them to a considerable extent, so that they occur while she is in church or at prayer, but not at mealtimes, for instance. She has incorporated her musical hallucinations into a deeply felt religious context.

Such personal influences are fully allowed— indeed required— in Konorski’s model, and in Llinás’s, too. 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.

P
ERHAPS THE MOST
intensive analysis of musical hallucinations and their shaping by personal experience and feeling, their continuing interaction with the mind and personality, has been pursued by the eminent psychoanalyst Leo Rangell. For Rangell, musical hallucinations have been the subject of continuing self-study that has lasted now for more than a decade.

Dr. Rangell first wrote to me about his musical hallucinations in 1996.
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He was eighty-two, and had had a second bypass surgery a few months before:

Rangell had hoped that these musical hallucinations— perhaps, he thought, a product of the anesthesia, or the morphine he had received after surgery— would go away with time. He had also experienced “copious cognitive distortions, which every bypass patient I know has had”— but these had quickly cleared up.
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