Musicophilia: Tales of Music and the Brain (24 page)

Is the concept of fixed action patterns any more illuminating than that of procedural memories in relation to the enormously complex, creative performances of a professional musician? In his book
I of the Vortex,
Llinás writes:

But for a performer, Llinás writes, it is not sufficient to have implicit memory only; one must have explicit memory as well:

This, too, is very much the case with Clive, who, for all his musical powers, needs “close direction” from others. He needs someone to put the music before him, to get him into action, and to make sure that he learns and practices new pieces.

What is the relationship of action patterns and procedural memories, which are associated with relatively primitive portions of the nervous system, to consciousness and sensibility, which depend on the cerebral cortex? Practice involves conscious application, monitoring what one is doing, bringing all one’s intelligence and sensibility and values to bear— even though what is so painfully and consciously acquired may then become automatic, coded in motor patterns at a subcortical level. Each time Clive sings or plays the piano or conducts a choir, automatism comes to his aid. But what comes out in an artistic or creative performance, though it depends on automatisms, is anything but automatic. The actual performance reanimates him, engages him as a creative person; it becomes fresh and alive, and perhaps contains new improvisations or innovations. Once Clive starts playing, his “momentum,” as Deborah writes, will keep him, and keep the piece, going. Deborah, herself a musician, expresses this very precisely:

Clive’s performance self seems, to those who know him, just as vivid and complete as it was before his illness. This mode of being, this self, is seemingly untouched by his amnesia, even though his autobiographical self, the self that depends on explicit, episodic memories, is virtually lost. The rope that is let down from heaven for Clive comes not with recalling the past, as for Proust, but with performance— and it holds only as long as the performance lasts. Without performance, the thread is broken, and he is thrown back once again into the abyss.
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Deborah speaks of the “momentum” of the music in its very structure. A piece of music is not a mere sequence of notes, but a tightly organized organic whole. Every bar, every phrase, arises organically from what preceded it and points to what will follow. Dynamism is built into the nature of melody. And over and above this, there is the intentionality of the composer, the style, the order, and the logic which he has created to express his musical ideas and feelings. These, too, are present in every bar and phrase.
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Marvin Minsky compares a sonata to a teacher or a lesson:

A piece of music will draw one in, teach one about its structure and secrets, whether one is listening consciously or not. This is so even if one has never heard a piece of music before. Listening to music is not a passive process but intensely active, involving a stream of inferences, hypotheses, expectations, and anticipations (as David Huron and others have explored). We can grasp a new piece— how it is constructed, where it is going, what will come next— with such accuracy that even after a few bars we may be able to hum or sing along with it.
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When we “remember” a melody, it plays in our mind; it becomes newly alive.
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There is not a process of recalling, imagining, assembling, recategorizing, re-creating, as when one attempts to reconstruct or remember an event or a scene from the past. We recall one tone at a time and each tone entirely fills our consciousness, yet simultaneously it relates to the whole. It is similar when we walk or run or swim— we do so one step, one stroke at a time, yet each step or stroke is an integral part of the whole, the kinetic melody of running or swimming. Indeed, if we think of each note or step too consciously, we may lose the thread, the motor melody.

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.

Victor Zuckerkandl, a philosopher of music, explores this paradox beautifully in his book
Sound and Symbol:

It has been twenty years since Clive’s illness and, for him, nothing has moved on. One might say he is still in 1985 or, given his retrograde amnesia, in 1965. In some ways, he is not anywhere at all; he has dropped out of space and time altogether. He no longer has any inner narrative; he is not leading a life in the sense that the rest of us do. And yet one has only to see him at the keyboard or with Deborah to feel that, at such times, he is himself again and wholly alive. It is not the remembrance of things past, the “once” that Clive yearns for, or can ever achieve. It is the claiming, the filling, of the present, the now, and this is only possible when he is totally immersed in the successive moments of an act. It is the “now” that bridges the abyss.

As Deborah recently wrote to me, “Clive’s at-homeness in music and in his love for me are where he transcends amnesia and finds continuum— not the linear fusion of moment after moment, nor based on any framework of autobiographical information, but where Clive, and any of us,
are
finally, where we are who we are.”

S
amuel S. developed severe expressive aphasia following a stroke in his late sixties, and he remained totally speechless, unable to retrieve a single word, despite intensive speech therapy, two years later. The break for him came when Connie Tomaino, the music therapist at our hospital, heard him singing one day outside her clinic— he was singing “Ol’ Man River” very tunefully and with great feeling, but only getting two or three words of the song. Even though speech therapy had been given up with Samuel, who was by then regarded as “hopeless,” Connie felt that music therapy might be helpful. She started to meet with him three times a week for half-hour sessions in which she would sing with him or accompany him on the accordion. Mr. S. was soon able, singing along with Connie, to get all the words of “Ol’ Man River,” and then of many other ballads and songs he had learned growing up in the 1940s— and as he did this, he started to show the beginnings of speech. Within two months, he was making short but appropriate responses to questions. For instance, if one of us asked Mr. S. about his weekends at home, he could reply, “Had a great time,” or “Saw the kids.”

Neurologists often refer to a “speech area” in the premotor zone of the brain’s dominant (usually left) frontal lobe. Damage to a particular part of this— an area first identified by the French neurologist Paul Broca in 1862— whether from a degenerative disease, a stroke, or a brain injury, may produce expressive aphasia, a loss of spoken language. In 1873 Carl Wernicke had described a different speech area in the left temporal lobe— damage to this area was apt to produce difficulty understanding speech, a “receptive” aphasia. It was also recognized, at much the same time, that brain damage could produce disturbances of musical expression or appreciation— amusias— and that while some patients might suffer from both an aphasia and an amusia, others could have aphasia without amusia.
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We are a linguistic species— we turn to language to express whatever we are thinking, and it is usually there for us instantly. But for those with aphasia, the inability to communicate verbally may be almost unbearably frustrating and isolating; to make matters worse, they are often treated by others as idiots, almost as nonpersons, because they cannot speak. Much of this can change with the discovery that such patients can
sing
— sing not only tunes, but the words of operas, hymns, or songs. Suddenly their disability, their cut-offness, seems much less— and 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. Being able to sing words can be a great reassurance to such patients, showing them that their language capacities are not irretrievably lost, that the words are still “in” them, somewhere, even though it may take music to bring them out.

Speech itself is not just a succession of words in the proper order— it has inflections, intonations, tempo, rhythm, and “melody.” Language and music both depend on phonatory and articulatory mechanisms that are rudimentary in other primates, and both depend, for their appreciation, on distinctly human brain mechanisms dedicated to the analysis of complex, segmented, rapidly changing streams of sound. And yet there are major differences (and some overlaps) in the processing of speech and song in the brain.
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Patients with so-called nonfluent aphasia not only have an impairment of vocabulary and grammar, but have “forgotten” or lost the feeling of the rhythms and inflections of speech; hence the broken, unmusical, telegraphic style of their speech, to the extent that they still have any words available. It is such patients who, as a rule, do best with music therapy, and who feel most excited when they are able to sing lyrics— for in doing so, they discover not only that words are still available to them, but that the flow of speech is also accessible (though bound, apparently, to the flow of song).

This may also be the case with a different form of aphasia, so-called dynamic aphasia, where it is not the structure of sentences that is affected but the initiation of speech. Patients with dynamic aphasia may speak very sparingly, yet produce syntactically correct sentences on the rare occasions when they do speak. Jason Warren et al. described how an elderly man with mild frontal lobe degeneration and extreme dynamic aphasia was nonetheless unimpaired in musical initiative. He played the piano, could read and write music, and took part in a weekly singing group. He was also able to recite, as Warren et al. noted: “He was able to read a passage chosen at random from the Torah using the heightened intonation (distinct from both singing and ordinary reading) reserved for reading aloud.”

Many aphasic patients can get not only the words of songs, but can learn to repeat sequences or series— days of the week, months of the year, numerals, etc. They may be able to do this
as
a series, but not to disembed a particular item from the series. So one of my patients, for instance, can recite all the months of the year in order (January, February, March, April, May…); he knows what the current month is, but when I ask him, he cannot respond, simply, “April.” Indeed, aphasics may be able to reproduce much more elaborate familiar sequences— a prayer, or lines from Shakespeare, or an entire poem— but only as automated sequences.
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Such sequences unfold, once they are started, in much the same way as music does.

Hughlings Jackson long ago distinguished “propositional” speech from what he called, variously, “emotional,” “ejaculate,” or “automatic” speech, stressing that the latter could be preserved in aphasia, sometimes to a startling extent, even when the former was grossly impaired. Cursing is often cited as a dramatic form of automatic speech, but singing familiar lyrics can be seen as equally automatic; a person with aphasia may be able to sing or curse or recite a poem but not to utter a propositional phrase.

The question of whether singing has any use in the recovery of speech, then, can be formulated another way: can language embedded in unconscious automatism be “released” for conscious, propositional use?

During the Second World War, A. R. Luria began to investigate the neural basis of speech and language, of different forms of aphasia, and of methods for restoring speech. (His work was published in Russian in a massive monograph,
Traumatic Aphasia,
in 1947, and in a small, startling book,
Restoration of Function After Brain Injury,
in 1948— though neither was translated or known in the West until several decades later.) Given an acute injury to the brain such as he saw in the stroke patients or injured soldiers he studied, Luria emphasized, there would always be two levels of disturbance. First, there was a “core” of tissue destruction, which was irreversible; and second, a larger, surrounding area, or “penumbra,” of depressed or inhibited function, which under certain conditions, he felt, might be reversible.