Musicophilia: Tales of Music and the Brain (29 page)

This was very clear with Rosalie B., a post-encephalitic lady who tended to remain transfixed for hours each day, completely motionless, frozen— usually with one finger “stuck” to her spectacles. If one walked her down the hallway, she would walk in a passive, wooden way, with her finger still stuck to her spectacles. But she was very musical, and loved to play the piano. As soon as she sat down on the piano bench, her stuck hand came down to the keyboard, and she would play with ease and fluency, her face (usually frozen in an inexpressive parkinsonian “mask”) full of expression and feeling. Music liberated her from her parkinsonism for a time— and not only playing music, but
imagining
it. Rosalie knew all of Chopin by heart, and we had only to say “Opus 49” to see her whole body, posture, and expression change, her parkinsonism vanishing as the F-minor
Fantasie
played itself in her mind. Her EEG, too, would become normal at such times.
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When I came to Beth Abraham in 1966, music was chiefly provided by the indefatigable Kitty Stiles, who spent dozens of hours each week at the hospital. Sometimes there was music from a record player or radio, though Kitty herself seemed to have a stimulating power of her own. Recorded music was not portable at this time— battery-powered radios and tape recorders were still large and heavy. Now, of course, everything has changed, and we can have hundreds of tunes on an iPod the size and weight of a matchbook. While the extreme availability of music may have its own dangers (I wonder whether brainworms or musical hallucinations are more common now), this availability is an unmitigated boon for those with parkinsonism. While most of the patients I see are the severely disabled residents of chronic care hospitals and nursing homes, I get letters from many parkinsonian people who are still relatively independent and living at home, perhaps with a little help. Recently Carolina Yahne, a psychologist in Albuquerque, wrote to tell me about her mother, who, because of Parkinson’s disease, had had great difficulty walking. “I made up a goofy little song,” the daughter wrote, “called ‘Walkin’ Mama’ that included a finger-snapping beat. I have a rotten voice, but she liked hearing it. She would play it with the tape recorder hooked on her waistband, and earphones. It really seemed to help her navigate around the house.”

N
IETZSCHE WAS
intensely interested, throughout his life, in the relationship of art, and especially music, to physiology. He spoke of its “tonic” effect— its power of arousing the nervous system in a general way, especially during states of physiological and psychological depression (he was himself often depressed, physiologically and psychologically, by severe migraines).

He also spoke of the “dynamic” or propulsive powers of music— its ability to elicit, to drive, and to regulate movement. Rhythm, he felt, could propel and articulate the stream of movement (and the stream of emotion and thought, which he saw as no less dynamic or motoric than the purely muscular). And rhythmic vitality and exuberance, he thought, expressed itself most naturally in the form of dance. He called his own philosophizing “dancing in chains” and thought the strongly rhythmic music of Bizet as ideally suited to this. He would often take his notebook to Bizet concerts; he wrote, “Bizet makes me a better philosopher.”
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I had read Nietzsche’s notes on physiology and art as a student, many years before, but his concise and brilliant formulations in
The Will to Power
came alive for me only when I came to Beth Abraham and saw the extraordinary powers of music with our post-encephalitic patients— its power to “awaken” them at every level: to alertness when they were lethargic, to normal movements when they were frozen, and, most uncannily, to vivid emotions and memories, fantasies, whole identities which were, for the most part, unavailable to them. Music did everything that L-dopa, still in the future, was subsequently to do, and more— but only for the brief span while it lasted, and perhaps for a few minutes afterwards. Metaphorically, it was like auditory dopamine— a “prosthesis” for the damaged basal ganglia.

It is music that the parkinsonian needs, for only music, which is rigorous yet spacious, sinuous and alive, can evoke responses that are equally so. And he needs not only the metrical structure of rhythm and the free movement of melody— its contours and trajectories, its ups and downs, its tensions and relaxations— but the “will” and intentionality of music, to allow him to regain the freedom of his own kinetic melody.

S
ome years ago I received a letter from Erna Otten, a piano student who had once studied with the Viennese pianist Paul Wittgenstein. Wittgenstein, she explained,

As a postscript, she added, “His finger choice was always the best!”

The varied phenomena of phantom limbs were first explored in detail by the physician Silas Weir Mitchell during the Civil War, when great numbers of veterans came to the many hospitals established to treat their wounds, including what was known as the “stump” hospital in Philadelphia. Weir Mitchell, a novelist as well as a neurologist, was fascinated by the descriptions he received from these soldiers, and he was the first to take the phenomenon of phantom limbs seriously. (Prior to this, they had been regarded as purely “in the mind,” apparitions conjured up by loss and grief, like the apparitions of recently deceased children or parents.) Weir Mitchell showed that the appearance of a phantom limb occurred in every patient who had an amputation, and he surmised that it was a sort of image or memory of the lost limb, a persistent neural representation of the limb in the brain. He first described the phenomenon in his 1866 short story “The Case of George Dedlow,” published in
The Atlantic Monthly
. It was only some years later, in his 1872 book
Injuries of Nerves and Their Consequences
, that he addressed his fellow physicians on the subject:

Such phantom memories and images occur to some extent in almost all amputees, and may last for decades. Although the phantoms may be intrusive or even painful (especially if the limb was painful immediately before amputation), they may also be of great service to the amputee, enabling him to learn how to move a prosthetic limb or, in the case of Wittgenstein, determine the fingering of a piano piece.

Before Weir Mitchell’s account, phantom limbs were regarded as purely psychic hallucinations conjured up by bereavement, mourning, or yearning— comparable to the apparitions of loved ones that mourners may experience for some weeks after their loss. Weir Mitchell was the first to show that these phantom limbs were “real”— neurological constructs dependent on the integrity of the brain, the spinal cord, and the remaining, proximal portions of the sensory and motor nerves to the limb— and that their sensation and “motions” were accompanied by excitation in all of these. (That such an excitation in fact occurred during phantom motion was proved for him by its “overflow” into movements of the stump.)

Recent neurophysiology has confirmed Weir Mitchell’s hypothesis that the entire sensory-ideational-motor unit is activated in phantom motions. Farsin Hamzei et al. in Germany described in 2001 how there can be striking functional reorganization in the cortex after the amputation of an arm— in particular, “cortical disinhibition and enlargement of the excitable area of the stump.” We know that movement and sensation continue to be represented in the cortex when the limb is physically lost, and Hamzei et al.’s findings suggest that the missing limb’s representation may be conserved and concentrated in the now-enlarged, hyperexcitable stump area of the cortex. This might explain why, as Otten noted, Wittgenstein’s stump moved “in an agitated manner” when he “played” with his phantom arm.
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The last few decades have seen great advances in neuroscience and biomechanical engineering, advances particularly pertinent to the Wittgenstein phenomenon; and engineers are developing highly sophisticated artificial limbs with delicate “muscles,” amplification of nerve impulses, servomechanisms, and so on, that can be married to the still-intact portion of the limb and allow phantom motions to be turned into real ones. The presence of strong phantom sensations and of willed phantom movements is, indeed, essential to the success of such bionic limbs.

Thus it seems possible, in the not-so-far-off future, that a one-armed pianist may be fitted with such a limb, and with it be able to play the piano again. One wonders what Paul Wittgenstein or his brother would have thought of such a development.
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Ludwig Wittgenstein’s final book speaks of our first, grounding certainty as being the certainty of our bodies; indeed, his opening proposition is, “If you do know that here is one hand, we’ll grant you all the rest.” Although Wittgenstein’s
On Certainty
is well known to have been written in response to the ideas of the analytic philosopher G. E. Moore, one must wonder, too, whether the strange matter of his brother’s hand— a phantom, indeed, but real, effectual, and certain— did not also play a part in inciting Wittgenstein’s thinking.

I
n 1997 I received a letter from a young Italian violinist, who related to me how he had started playing the violin when he was six, had gone on to the conservatory, and then embarked on a career as a concert violinist. But then, at the age of twenty-three, he started to experience peculiar difficulties with his left hand— difficulties which, he wrote, “have cut short my career, and my life.

“Playing pieces of a certain degree of difficulty,” he continued, “I found that the middle finger was not responding to my commands, and imperceptibly tended to shift from the position where I wanted to place it on the string, affecting the pitch.”

He consulted a physician— one of many he was to consult in the years to come— and was told that the overwork of this hand had caused “an inflammation of the nerves.” He was advised to rest and desist from playing for three months— but this, he found, had no effect. Indeed, when he resumed playing, the problem had become worse, and the strange difficulty in controlling finger movement had spread to the fourth and fifth fingers. Now only the index finger remained unaffected. It was only when he played the violin, he stressed, that his fingers “disobeyed” him; they functioned normally in all other activities.

He went on to describe an odyssey of eight years in which he had consulted physicians, physiotherapists, psychiatrists, therapists, and healers of every sort, all over Europe. He had been given many diagnoses: strained muscles, inflamed tendons, “trapped” nerves. He had undergone carpal tunnel surgery, faradization of nerves, myelograms, MRIs, and a great deal of intensive physical therapy and psychotherapy— all to no avail. Now, at thirty-one, he felt that he could no longer maintain any hope of resuming his career. He had a deep sense of bewilderment, too. He felt that his condition was organic, that in some way it came from his brain, and that if there were any peripheral factors, such as nerve injuries, these had at most played a subsidiary part.

He had heard, he wrote, of other performers with similar problems. With almost all of them a seemingly trivial problem had grown steadily more severe, resisted all attempts at treatment, and ended performance careers.

I
HAD RECEIVED
a number of similar letters over the years and had always referred my correspondents to a neurologist colleague, Frank Wilson, who had written an important early paper in 1989, “Acquisition and Loss of Skilled Movement in Musicians.” As a result, Wilson and I had been corresponding about so-called focal dystonia in musicians for some time.

The problems my Italian correspondent described were not, indeed, anything new— such problems have been observed for centuries, not only in players of musical instruments, but in a variety of other activities that demanded continuous, rapid movements of the hands (or other parts of the body) over long periods. In 1833, Sir Charles Bell, the famous anatomist, gave a detailed description of the problems that could affect the hands of people who wrote incessantly, such as clerks in government offices. He later called this “scrivener’s palsy,” though it was already well recognized among such writers, who called it “writer’s cramp.” Gowers, in his 1888
Manual
(of diseases of the nervous system), devoted twenty close-packed pages to discussing writer’s cramp and other “occupation neuroses,” the generic term he adopted for “a group of maladies in which certain symptoms are excited by the attempt to perform some oft-repeated muscular action, commonly one that is involved in the occupation of the sufferer.”

“Among clarks who suffer” writer’s cramp, Gowers said, “lawyers’ clarks constitute an undue proportion. This is no doubt due to the cramped style in which they commonly write. On the other hand, writers’ cramp is practically unknown among those who write more, and under higher pressure, than any other class, shorthand writers.” Gowers attributed this freedom to their using “a very free style of writing, generally from the shoulder, which is also adopted by them in long hand writing.”
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