Musicophilia: Tales of Music and the Brain (3 page)

He prepared two pieces for his concert: his first love, Chopin’s B-flat Minor Scherzo; and his own first composition, which he called Rhapsody, Opus 1. His playing, and his story, electrified everyone at the retreat (many expressed the fantasy that they, too, might be struck by lightning). He played, said Erica, with “great passion, great brio”— and if not with supernatural genius, at least with creditable skill, an astounding feat for someone with virtually no musical background who had taught himself to play at forty-two.

W
HAT DID I THINK,
in the end, of his story, Dr. Cicoria asked me. Had I ever encountered anything similar? I asked him what
he
thought, and how he would interpret what had happened to him. He replied that as a medical man he was at a loss to explain these events, and he had to think of them in “spiritual” terms now. I countered that, with no disrespect to the spiritual, I felt that even the most exalted states of mind, the most astounding transformations, must have some physical basis or at least some physiological correlate in neural activity.

At the time of his lightning strike, Dr. Cicoria had both a near-death experience and an out-of-body experience. Many supernatural or mystical explanations have arisen to explain out-of-body experiences, but they have also been a topic of neurological investigation for a century or more. Such experiences seem to be relatively stereotyped in format: one seems to be no longer in one’s own body but outside it, and, most commonly, looking down on oneself from eight or nine feet above (neurologists refer to this as “autoscopy”). One seems to see clearly the room or space around one and other people and objects nearby, but with an aerial perspective. People who have had such experiences often describe vestibular sensations like “floating” or “flying” in the air. Out-of-body experiences can inspire fear or joy or a feeling of detachment, but they are usually described as intensely “real”— not at all like a dream or hallucination. They have been reported in many sorts of near-death experiences, as well as in temporal lobe seizures. There is some evidence that both the visuospatial and vestibular aspects of out-of-body experiences are related to disturbed function in the cerebral cortex, especially at the junctional region between the temporal and parietal lobes.
1

But it was not just an out-of-body experience that Dr. Cicoria reported. He saw a bluish-white light, he saw his children, his life flashed past him, he had a sense of ecstasy, and, above all, he had a sense of something transcendental and enormously significant. What could be the neural basis of this? Similar near-death experiences have often been described by people who have been, or believed themselves to be, in great danger, whether they are involved in sudden accidents, struck by lightning, or, most commonly, revived after a cardiac arrest. All of these are situations not only fraught with terror but likely to cause a sudden drop in blood pressure and cerebral blood flow (and, if there is cardiac arrest, a deprivation of oxygen to the brain). There is likely to be intense emotional arousal and a surge of noradrena-line and other neurotransmitters in such states, whether the affect is one of terror or rapture. We have, as yet, little idea of the actual neural correlates of such experiences, but the alterations of consciousness and emotion that occur are very profound and must involve the emotional parts of the brain— the amygdala and brainstem nuclei— as well as the cortex.
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While out-of-body experiences have the character of a perceptual illusion (albeit a complex and singular one), near-death experiences have all the hallmarks of mystical experience, as William James defines them— passivity, ineffability, transience, and a noetic quality. One is totally consumed by a near-death experience, swept up, almost literally, in a blaze (sometimes a tunnel or funnel) of light, and drawn towards a Beyond— beyond life, beyond space and time. There is a sense of a last look, a (greatly accelerated) farewell to things earthly, the places and people and events of one’s life, and a sense of ecstasy or joy as one soars towards one’s destination— an archetypal symbolism of death and transfiguration. Experiences like this are not easily dismissed by those who have been through them, and they may sometimes lead to a conversion or metanoia, a change of mind, that alters the direction and orientation of a life. One cannot suppose, any more than one can with out-of-body experiences, that such events are pure fancy; very similar features are emphasized in every account. Near-death experiences must also have a neurological basis of their own, one which profoundly alters consciousness itself.

What about Dr. Cicoria’s remarkable access of musicality, his sudden musicophilia? Patients with degeneration of the front parts of the brain, so-called frontotemporal dementia, sometimes develop a startling emergence or release of musical talents and passions as they lose the powers of abstraction and language— but clearly this was not the case with Dr. Cicoria, who was articulate and highly competent in every way. In 1984, Daniel Jacome described a patient who had had a stroke damaging the left hemisphere of his brain and consequently developed “hypermusia” and “musicophilia,” along with aphasia and other problems. But there was nothing to suggest that Tony Cicoria had had a stroke or experienced any significant brain damage, other than a very transient disturbance to his memory systems for a week or two after the lightning strike.

His situation did remind me a bit of Franco Magnani, the “memory artist” of whom I have written.
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Franco had never thought of being a painter until he experienced a strange crisis or illness— perhaps a form of temporal lobe epilepsy— when he was thirty-one. He had nightly dreams of Pontito, the little Tuscan village where he was born; after he woke, these images remained intensely vivid, with a full depth and reality (“like holograms”). Franco was consumed by a need to make these images real, to paint them, and so he taught himself to paint, devoting every free minute to producing hundreds of views of Pontito.

Could Dr. Cicoria’s lightning strike have set off epileptic tendencies in his temporal lobes? There are many accounts of the onset of musical or artistic inclinations with temporal lobe seizures, and people with such seizures may also develop strong mystical or religious feelings, as he had. But then, Cicoria had not described anything resembling seizures, and had apparently had a normal EEG following the event.

And why was there such a delay in the development of Cicoria’s musicophilia? What was happening in the six or seven weeks that elapsed between his cardiac arrest and the rather sudden eruption of musicality? We know that there were immediate after-effects of the lightning strike: his out-of-body experience, his near-death experience, the confusional state that ensued for a few hours, and the disturbance of memory that lasted a couple of weeks. These could have been due to cerebral anoxia alone— for his brain must have been without adequate oxygen for a minute or more— though there could also have been direct cerebral effects from the lightning itself. One has to suspect, however, that Dr. Cicoria’s apparent recovery a couple of weeks after these events was not as complete as it seemed, that there were other, unnoticed forms of brain damage, and that his brain was still reacting to the original insult and reorganizing itself during this time.

Dr. Cicoria feels that he is “a different person” now— musically, emotionally, psychologically, and spiritually. This was my impression, too, as I listened to his story and saw something of the new passions which had transformed him. Looking at him from a neurological vantage point, I felt that his brain must be very different now from what it was before his lightning strike or in the days immediately following this, when neurological tests showed nothing grossly amiss. Changes were presumably occurring in the weeks afterwards, when his brain was reorganizing— preparing, as it were, for musicophilia. Could we now, a dozen years later, define these changes, define the neurological basis of his musicophilia? Many new and far subtler tests of brain function have been developed since Cicoria had his injury in 1994, and he agreed that it would be interesting to investigate this further. But after a moment, he reconsidered, and said that perhaps it was best to let things be. His was a lucky strike, and the music, however it had come, was a blessing, a grace— not to be questioned.

J
on S., a robust man of forty-five, had been in perfect health until January of 2006. His working week had just started; he was in the office on a Monday morning, and went to get something from the closet. Once he entered the closet, he suddenly heard music— “classical, melodic, quite nice, soothing…vaguely familiar…. It was a string instrument, a solo violin.”

He immediately thought, “Where the hell is that music coming from?” There was an old, discarded electronic device in the closet, but this, though it had knobs, had no speakers. Confusedly, in a state of what he later called “suspended animation,” he groped for the controls of the device to turn the music off. “Then,” he says, “I went out.” A colleague in the office who saw all this described Mr. S. as “slumped over, unresponsive,” in the closet, though not convulsing.

Mr. S.’s next memory was of an emergency medical technician leaning over him, questioning him. He could not remember the date, but he remembered his name. He was taken to the emergency room of a local hospital, where he had another episode. “I was lying down, the doctor was checking me over, my wife was there…then I started to hear music again, and I said, ’It’s happening again,’ and then, very quickly, I was out of it.”

He woke up in another room, where he realized he had bitten his tongue and cheeks and had intense pain in his legs. “They told me I had had a seizure— the full thing, with convulsions…. It all occurred much quicker than the first time.”

Mr. S. had some tests and was put on an antiepileptic drug to protect him against further seizures. Since then, he has had more tests (none of which showed anything amiss— a situation not uncommon with temporal lobe epilepsy). Though no demonstrable lesion showed up on brain imaging, he mentioned that he had suffered a fairly severe head injury at the age of fifteen— a concussion, at least— and this may have produced slight scarring in the temporal lobes.

When I asked him to describe the music he heard just before his seizures, he tried to sing it but could not— he said he could not sing any music, even if he knew it well. He said he was not too musical, in any case, and that the sort of classical violin music he had “heard” before his seizure was not at all to his taste; it sounded “whiny, catlike.” Usually he listens to pop music. Yet it seemed
familiar
somehow— perhaps he had heard it long ago, as a child?

I told him that if he ever did hear this music— on the radio, perhaps— he should note what it was and let me know. Mr. S. said that he would keep his ears open, but as we talked about it, he could not help wondering whether there was just a
feeling,
perhaps an illusion, of familiarity attached to the music, rather than an actual recollection of something he had once heard. There was something evocative about it, but elusive, like the music heard in dreams.

And there we left it. I wonder whether I will get a call from Mr. S. one day, saying, “I just heard it on the radio! It was a Bach suite for unaccompanied violin,” or whether what he heard was a dreamlike construction or conflation which, for all its “familiarity,” he will never identify.

H
UGHLINGS JACKSON,
writing in the 1870s, remarked upon the feeling of familiarity that is so often a feature of the aura which may precede a temporal lobe seizure. He spoke, too, of “dreamy states,” “déjà vu,” and “reminiscence.” Such feelings of reminiscence, Jackson noted, may have no identifiable content whatever. Although some people lose consciousness during a seizure, others may remain perfectly aware of their surroundings yet also enter an odd, superimposed state in which they experience strange moods or feelings or visions or smells— or music. Hughlings Jackson referred to this situation as a “doubling of consciousness.”

Eric Markowitz, a young musician and teacher, developed in his left temporal lobe an astrocytoma, a tumor of relatively low malignancy, which was operated on in 1993. It recurred ten years later, but was then considered inoperable due to its proximity to the speech areas of the temporal lobe. With the regrowth of his tumor, he has had repeated seizures, in which he does not lose consciousness but, as he wrote to me, “music explodes in my head for about two minutes. I love music; I’ve made my career around it, so it seems a bit ironic that music has also become my tormentor.” Eric’s seizures are not triggered by music, he emphasized, but music is invariably a part of them. As with Jon S., Eric’s hallucinatory music seems very real to him, and hauntingly familiar:

Though Eric (unlike Jon S.) is quite musical, with an excellent musical memory and a highly trained ear, and though he has had more than a dozen such seizures, he is (like Mr. S.) completely unable to
recognize
his aural music.

In the “strange yet familiar confusion” which is an integral part of his seizure experience, Eric finds it difficult to think straight. His wife or friends, if they are present, may notice a “strange look” on his face. If he has a seizure while at work, he is usually able to “wing it” somehow, without his students realizing that anything is amiss.