Musicophilia: Tales of Music and the Brain (26 page)

Aldridge relied on music frequently, both to mask his tics and to channel their explosive energy: “I would learn to harness the enormous energy of Tourette syndrome and control it like a high-pressure fire hose.” Harnessing his Tourette’s and expressing himself in creative, unpredictable musical improvisations seemed to be deeply intertwined: “The urge to play and the desire to release the endless tension of Tourette syndrome fed on each other like fuel on fire.” For Aldridge, and perhaps for many with Tourette’s, music was inseparably linked to movement and to sensation of all sorts.

The attractions, the joys, and the therapeutic powers of drumming and drum circles are widely known in the Tourette’s community. In New York City recently, I took part in a drum circle organized by Matt Giordano, a gifted drummer with severe Tourette’s. When he is not focused or engaged, Matt is in constant Tourettic motion— and, indeed, everyone in the room that day seemed to be ticcing, ticcing in their own time. I could see eruptions of tics, contagions of tics, rippling around the thirty-odd Touretters there— but once the drum circle started, with Matt leading them, all the ticcing disappeared within seconds. Suddenly there was synchronization, and they came together as a group, performing “in the moment with the rhythm,” as Matt puts it— their Tourettic energy, motor exuberance, playfulness, and inventiveness all drawn upon creatively and given expression in the music. Music here had a double power: first, to reconfigure brain activity, and bring calm and focus to people who were sometimes distracted or preoccupied by incessant tics and impulses; and second, to promote a musical and social bonding with others, so that what began as a miscellany of isolated, often distressed or self-conscious individuals almost instantly became a cohesive group with a single aim— a veritable drum orchestra under Matt’s baton.

N
ICK VAN BLOSS,
a young English musician, has Tourette’s of considerable severity— he reckons that he has nearly forty thousand tics a day, including his obsessions, imitations, counting compulsions, compulsive touchings, and so on. But when he plays the piano, he shows scarcely a hint of this. I asked him to play some Bach for me (Bach is his favorite composer, and Glenn Gould is his hero), and he did so without interruption. The only tics he displayed, a mild facial grimacing, were far less disturbing, I thought, than Gould’s famous humming. Van Bloss developed his first, rather explosive symptoms when he was seven, attracting savage ridicule and bullying from his schoolmates. There was no intermission in his ticcing until his family got a piano, and this was to transform his life. “Suddenly I had a piano,” he writes in his memoir,
Busy Body,
“and, as if handed to me on a plate, I found my love…. When I played, my tics almost seemed to disappear. It was like a miracle. I would tic, gyrate, and verbally explode all day at school, get home exhausted from it all and run to the piano and play for as long as I could, not only because I loved the sounds I was making, but primarily because when I played I didn’t tic. I got time off from the ticcy normality that had become me.”

When I discussed this with van Bloss, he spoke of it partly in terms of “energy”— it was not, he felt, that his Tourette’s had disappeared, but that it was now being “harnessed and focused” and, specifically, that his compulsions to touch could now be consummated by touching the keys of the piano. “I was simultaneously feeding and fuelling my Tourette’s by giving it a thing it so craved: touch,” he writes. “The piano appealed to my fingers…provided touch heaven for me— eighty-eight keys all sitting and waiting for my needy little fingers.”

Van Bloss feels that his repertoire of tics was fully developed by the age of sixteen and has changed little in the years since, but he is now far more accepting of them, for he recognizes that his Tourette’s, in a paradoxical way, plays an essential role in his piano playing.

I found it especially fascinating to listen to a conversation between Nick van Bloss and Tobias Picker, the distinguished composer, who also has Tourette’s— to listen to them compare notes on the role that Tourette’s has played in their music making. Picker also has many tics, but when he is composing or playing the piano or conducting, his tics disappear. I have watched him as he sits almost motionless for hours, orchestrating one of his études for piano at his computer. The tics may have vanished, but this does not mean that the Tourette’s itself has gone. Picker feels, on the contrary, that his Tourette’s enters into his creative imagination, contributing to his music but also being shaped and modulated by it. “I live my life controlled by Tourette’s,” he said to me, “but I use music to control it. I have harnessed its energy— I play with it, manipulate it, trick it, mimic it, taunt it, explore it, exploit it, in every possible way.” His newest piano concerto, in some sections, is full of turbulent, agitated whirls and twirls. But Picker writes in every mode— the dreamy and tranquil no less than the violent and stormy— and moves from one mood to another with consummate ease.

Tourette’s brings out in stark form questions of will and determination: who orders what, who pushes whom around. To what extent are people with Tourette’s controlled by a sovereign “I,” a complex, self-aware, intentional self, or by impulses and feelings at lower levels in the brain-mind? Similar questions are brought up by musical hallucinations, and brainworms, and varied forms of quasi-automatic echoing and imitation. Normally we are not aware of what goes on in our brains, of the innumerable agencies and forces inside us that lie outside or below the level of conscious experience— and perhaps this is just as well. Life becomes more complicated, sometimes unbearably so, for people with eruptive tics or obsessions or hallucinations, forced into daily, incessant contact with rebellious and autonomous mechanisms in their own brains. They face a special challenge; but they may also, if the tics or hallucinations are not too overwhelming, achieve a sort of self-knowledge or reconciliation that may significantly enrich them, in their strange fight, the double lives they lead.

N
ineteen seventy-four was an eventful year for me, in several respects, for it was a year in which I had musical hallucinations, twice; attacks of amusia, twice; and the complex musico-motor events I would later describe in
A Leg to Stand On.
I had had a bad climbing accident on a mountain in Norway, tearing off the quadriceps tendon of my left leg, as well as doing some nerve damage to it. The leg was useless, and I had to find a way to get down the mountain before nightfall. I soon discovered that the best strategy was to “row” myself down, somewhat as paraplegics do in their wheelchairs. At first I found this difficult and awkward, but soon I fell into a rhythm, accompanied by a sort of marching or rowing song (sometimes “The Volga Boatmen’s Song”), with a strong heave on each beat. Before this I had muscled myself along; now, with the beat, I was musicked along. Without this synchronization of music and movement, the auditory with the motor, I could never have made my way down the mountain. And somehow, with this internal rhythm and music, it felt much less like a grim, anxious struggle.

I was rescued halfway down the mountain and taken to a hospital, where my leg was examined, X-rayed, and put into a cast, and then I was flown to England, where, forty-eight hours after the injury, I had surgery to repair the tendon. Nerve and other tissue damage had to await a natural healing, of course, and there was a fourteen-day period, therefore, in which I could not use the leg. Indeed, it seemed to be both numb and paralyzed, and not really even a part of me. On the fifteenth day, when it was judged safe for me to put weight on the leg, I found that I had, strangely, “forgotten” how to walk. There was only a sort of pseudo walking— conscious, cautious, unreal, step-by-step. I would make steps that were too large or too small, and on a couple of occasions managed to cross the left leg in front of the right one, almost tripping on it. The natural, unthinking spontaneity, the automaticity of walking completely evaded me until again, suddenly, music came to my aid.

I had been given a cassette of Mendelssohn’s Violin Concerto in E minor— this was the only music I had, and I had been playing it for two weeks almost nonstop. Now suddenly, as I was standing, the concerto started to play itself with intense vividness in my mind. In this moment, the natural rhythm and melody of walking came back to me, and along with this, the feeling of my leg as alive, as part of me once again. I suddenly “remembered” how to walk.

The neural systems underlying the newly rediscovered skill of walking were still fragile and easily exhausted, and after half a minute or so of fluent walking, the inner music, the vividly imagined violin concerto, stopped suddenly, as if the needle had been lifted from a record— in that instant, walking stopped, too. Then, after I had rested for a while, the music and motion came back to me, again in tandem.

After my accident, I wondered if this sort of experience occurred with others. And barely a month had gone by when I saw a patient at a nursing home— an old lady with an apparently paralyzed and useless left leg. She had suffered a complex hip fracture, followed by surgery and many weeks of immobility in a cast. Surgery had been successful, but her leg remained strangely inert and useless. Though there was no clear anatomical or neurological reason for this, she told me she could not imagine how to move the leg. Had the leg
ever
been able to move since the injury? I asked her. She thought for a moment and said yes, it had— once: it had kept time at a Christmas concert, “by itself,” when an Irish jig was being played. This was enough; it indicated that whatever was going on, or not going on, in her nervous system, music could act as an activator, a de-inhibitor. We bombarded her with dance tunes, especially Irish jigs, and saw for ourselves how her leg responded. It took several months, for the leg had become very atrophied; nevertheless, with music, she was not only able to delight in her own quasi-automatic motor responses— which soon included walking— but to extract from them an ability to make whatever discrete, voluntary movements she desired. She had reclaimed her leg, and her sensorimotor system, in full.

H
IPPOCRATES,
more than two thousand years ago, wrote of people who fell and broke their hips, which in those presurgical days demanded months of bandaging and immobility to let the bones knit. In such cases, he wrote, “the imagination is subdued, and the patient cannot remember how to stand or walk.” With the advent of functional brain imaging, the neural basis of such “subduing” has been clarified.
1
There may be inhibition or deactivation not only peripherally, in the nerve elements of the damaged tendons and muscles and perhaps in the spinal cord, but also centrally, in the “body image,” the mapping or representation of the body in the brain. A. R. Luria, in a letter to me, once referred to this as “the central resonances of a peripheral injury.” The affected limb may lose its place in the body image, while the rest of the body’s representation then expands to fill the vacancy. If this happens, the limb is not only rendered functionless, it no longer seems to belong to one at all— moving such a limb feels like moving an inanimate object. Another system must be brought in, and it is clear that music, above all else, can kick-start a damaged or inhibited motor system into action again.

Whether it was the singing of a simple rowing song on the mountain or the vivid imagining of the Mendelssohn Violin Concerto when I stood up in the hospital, the rhythm or beat of the music was crucial for me, as it was for my patient with the fractured hip. Was it just the rhythm or beat of the music, or was the melody, with
its
movement, its momentum, also important?

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. It was very clear with my patient Dr. P., who had lost the ability to recognize or identify even common objects, though he could see perfectly well. (He may have suffered from an early, and primarily visual, form of Alzheimer’s.) He was unable to recognize a glove or a flower when I handed it to him, and he once mistook his own wife for a hat. His condition was almost totally disabling— but he discovered that he could perform the needs and tasks of the day if they were organized in song. His wife explained to me:

Patients with frontal lobe damage may also lose the ability to carry out a complex chain of actions— to dress, for example. Here, music can be very useful as a mnemonic or a narrative— in effect, a series of commands or promptings in the form of rhyme or a song, as in the childhood song “This Old Man.” It is similar with some autistic people and with severely retarded people, who may be unable to perform fairly simple sequences involving perhaps four or five movements or procedures— but who can often do these tasks perfectly well if they set them to music. Music has the power to embed sequences and to do this when other forms of organization (including verbal forms) fail.