Musicophilia: Tales of Music and the Brain (28 page)

This, indeed, is central to the vision of cultural evolution presented by Merlin Donald in his astonishing 1991 book
Origins of the Modern Mind,
and in many subsequent papers. An essential feature of Donald’s vision is his concept that human evolution moved from the “episodic” life of apes to a “mimetic” culture— and that this flourished and lasted for tens, perhaps hundreds of thousands of years before language and conceptual thinking evolved. Donald proposes that mimesis— the power to represent emotions, external events, or stories using only gesture and posture, movement and sound, but not language— is still the bedrock of human culture today. He sees rhythm as having a unique role in relation to mimesis:

Donald goes further, seeing rhythmic skill as a prerequisite not only for all music, but for all sorts of nonverbal activities, from the simple rhythmic patterns of agricultural life to the most complex social and ritual behaviors.

Neuroscientists sometimes speak of “the binding problem,” the process by which different perceptions or aspects of perception are bound together and unified. What enables us, for example, to bind together the sight, sound, smell, and emotions aroused by the sight of a jaguar? Such binding in the nervous system is accomplished by rapid, synchronized firing of nerve cells in different parts of the brain. Just as rapid neuronal oscillations bind together different functional parts within the brain and nervous system, so rhythm binds together the individual nervous systems of a human community.

W
illiam Harvey, writing about animal movement in 1628, called it “the silent music of the body.” Similar metaphors are often used by neurologists, who speak of normal movement as having a naturalness and fluency, a “kinetic melody.” This smooth, graceful flow of movement is compromised in parkinsonism and some other disorders, and neurologists speak here of “kinetic stutter.” When we walk, our steps emerge in a rhythmical stream, a flow that is automatic and self-organizing. In parkinsonism, this normal, happy automatism is gone.

Though I was born into a musical household and music has been important to me personally from my earliest years, I did not really encounter music in a clinical context until 1966, when I started work at Beth Abraham Hospital, a chronic care hospital for patients in the Bronx. Here, my attention was immediately drawn to a number of strangely immobile, sometimes entranced-looking patients, the post-encephalitic survivors I was later to write about in
Awakenings.
There were nearly eighty of them at the time; I saw them in the lobby, in the corridors, as well as on the wards, sometimes in strange postures, absolutely motionless, frozen in a trancelike state. (A few of these patients, rather than being frozen, were in the opposite state— one of almost continuous driven activity, all their movements accelerated, excessive, and explosive.) All of them, I discovered, were victims of encephalitis lethargica, the epidemic sleeping sickness that swept the globe just after World War I, and some had been in this frozen state since they had entered the hospital forty or more years before.

In 1966, there was no medication of any use to these patients— no medication, at least, for their frozenness, their parkinsonian motionlessness. And yet it was common knowledge among the nurses and staff that these patients
could
move on occasion, with an ease and grace that seemed to belie their parkinsonism— and that the most potent occasioner of such movement was, in fact, music.

Typically, these post-encephalitic patients, like people with ordinary parkinsonism, could not easily initiate anything, and yet often they were able to
respond.
Many could catch and return a ball if it was thrown, and almost all of them tended to respond in some way to music. Some of them could not initiate a single step but could be drawn into dancing and could dance fluidly. Some could scarcely utter a syllable; their voices, when they could speak, lacked tone, lacked force, were almost spectral. But these patients were able to sing on occasion, loudly and clearly, with full vocal force and a normal range of expressiveness and tone. Other patients could walk and talk but only in a jerky, broken way, without a steady tempo, and sometimes with incontinent accelerations— with such patients, music could modulate the stream of movement or speech, giving them the steadiness and control they so lacked.
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T
HOUGH “MUSIC THERAPY”
was hardly a profession in the 1960s, Beth Abraham, most unusually, had its own music therapist, a dynamo called Kitty Stiles (it was only when she died in her late nineties that I realized she must already have been over eighty when I met her, but she had the vitality of a much younger person).

Kitty had a special feeling for our post-encephalitic patients, and in the decades before drugs such as L-dopa were available, it was only Kitty and her music which could bring them to life. Indeed, when we came to make a documentary film about these patients in 1973, the film’s director, Duncan Dallas, immediately asked me, “Can I meet the music therapist? She seems to be the most important person around here.” So she was, in the days before L-dopa, and so she continued to be when the effects of L-dopa became, in many patients, erratic and unstable.

While the power of music has been known for millennia, the idea of formal music therapy arose only during the First and Second World Wars, when large numbers of wounded soldiers were gathered in veterans hospitals, and it was found that their pain and misery and even, seemingly, some of their physiological responses (pulse rates, blood pressure, and so on) could be improved by music. Doctors and nurses in many veterans hospitals started to invite musicians to come and play for their patients, and musicians were only too happy to bring music to the dreadful wards of the wounded. But it was soon evident that enthusiasm and generosity were not enough— some professional training was needed as well.

The first formal music therapy program was set up in 1944 at Michigan State University, and the National Association for Music Therapy was formed in 1950. But music therapy remained, for the next quarter of a century, scarcely recognized. I do not know whether Kitty Stiles, our music therapist at Beth Abraham, had any formal training or was licensed as a music therapist, but she had an immense intuitive gift for divining what could get patients going, however regressed or disabled they might appear. Working with individual patients calls upon empathy and personal interaction as much as any formal therapy, and Kitty was very skilled at this. She was also an audacious improviser, and very playful— both on the keyboard and in life; without this, I suspect, many of her efforts would have been futile.
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I
ONCE INVITED
the poet W. H. Auden to one of Kitty’s sessions, and he was amazed by the instant transformations which music could effect; they reminded him of an aphorism of the German Romantic writer Novalis: “Every disease is a musical problem; every cure is a musical solution.” This seemed almost literally to be the case with these profoundly parkinsonian patients.

Parkinsonism is usually called a “movement disorder,” though when it is severe it is not only movement that is affected, but the flow of perception, thought, and feeling as well. The disorder of flow can take many forms; sometimes, as the term “kinetic stutter” implies, there is not a smooth flow of movement but brokenness, jerkiness, starts and stops instead. Parkinsonian stutter (like verbal stuttering) can respond beautifully to the rhythm and flow of music, as long as the music is of the “right” kind— and the right kind is unique for every patient. For one of my post-encephalitic patients, Frances D., music was as powerful as any drug. One minute I would see her compressed, clenched, and blocked, or else jerking, ticcing, and jabbering— like a sort of human time bomb. The next minute, if we played music for her, all of these explosive-obstructive phenomena would disappear, replaced by a blissful ease and flow of movement, as Mrs. D., suddenly freed of her automatisms, would smilingly “conduct” the music, or rise and dance to it. But it was necessary— for her— that the music be legato; staccato, percussive music might have a bizarre countereffect, causing her to jump and jerk helplessly with the beat, like a mechanical doll or marionette. In general, the “right” music for parkinsonian patients is not only legato, but has a well-defined rhythm. If, on the other hand, the rhythm is too loud, dominating, or intrusive, patients may find themselves helplessly driven or entrained by it. The power of music in parkinsonism is not, however, dependent on familiarity, or even enjoyment, though in general music works best if it is both familiar and liked.

Another patient, Edith T., a former music teacher, spoke of her need for music. She said that she had become “graceless” with the onset of parkinsonism, that her movements had become “wooden, mechanical— like a robot or doll.” She had lost her former naturalness and musicality of movement; in short, she said, she had been “unmusicked” by her parkinsonism. But when she found herself stuck or frozen, even the
imagining
of music might restore the power of action to her. Now, as she put it, she could “dance out of the frame,” the flat, frozen landscape in which she was trapped, and move freely and gracefully: “It was like suddenly remembering myself, my own living tune.” But then, just as suddenly, the inner music would cease, and she would fall once again into the abyss of parkinsonism. Equally dramatic, and perhaps in some way analogous, was Edith’s ability to use, to share, other people’s ambulatory abilities— she could easily and automatically walk with another person, falling into their rhythm, their tempo, sharing their kinetic melody, but the moment they stopped, she would stop, too.

The movements and perceptions of people with parkinsonism are often too fast or too slow, though they may not be aware of this— they may be able to infer it only when they compare themselves to clocks, or to other people. The neurologist William Gooddy described this in his book
Time and the Nervous System:
“An observer may note how slowed a parkinsonian’s movements are, but the patient will say, ‘My own movements seem normal to me unless I see how long they take by looking at a clock. The clock on the wall of the ward seems to be going exceptionally fast.’ ” Gooddy wrote of the sometimes enormous disparities such patients can show between “personal time” and “clock time.”
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But if music is present, its tempo and speed take precedence over the parkinsonism and allow parkinsonian patients to return, while the music lasts, to their own rate of moving, that which was natural for them before their illness.

Music, indeed, resists all attempts at hurrying or slowing, and imposes its own tempo.
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I saw this recently at a recital by the eminent (and now parkinsonian) composer and conductor Lukas Foss. He rocketed almost uncontrollably to the piano, but once there, played a Chopin nocturne with exquisite control and timing and grace— only to festinate once again as soon as the music ended.

This power of music was invaluable with one extraordinary post-encephalitic patient, Ed M., whose movements were too fast on the right side of his body and too slow on the left side. We could not find any good way to medicate him, for whatever improved one side would worsen the other. But he loved music, and he had a small organ in his room. With this— and this only— when he sat down and played, he could bring his two hands, his two sides, together in unison and synchrony.

A fundamental problem in parkinsonism is the inability to initiate movement spontaneously; parkinsonian patients are always getting “stuck” or “frozen.” Normally there is a virtually instantaneous commensuration between our intentions and the subcortical machinery (the basal ganglia, especially) that allows their automatic enaction. (Gerald Edelman, in
The Remembered Present
, refers to the basal ganglia, along with the cerebellum and hippocampus, as the “organs of succession.”) But it is the basal ganglia especially which are damaged in parkinsonism. If the damage is very severe, the parkinsonian may be reduced to virtual immobility and silence— not paralyzed but in a sense “locked in,” unable by himself to initiate any movement, and yet perfectly able to respond to certain stimuli.
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The parkinsonian is stuck, so to speak, in a subcortical box, and can only emerge from this (as Luria brings out) with the help of an outside stimulus.
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Thus parkinsonian patients can be called into action, sometimes by something as simple as throwing them a ball (though once they catch the ball or throw it back, they will freeze again). To enjoy any real sense of freedom, a longer release, they need something which can last over time, and the most potent unlocker here is music.