Musicophilia by Oliver Sacks
by Oliver Sacks
Knopf. 400 pp. $26.00
A general surgeon once remarked to me that neurologists do not cure disease—they admire it. While the fairness of this statement is debatable, it is true that the therapeutic armamentarium of the neurologist is rather limited. When a bit of brain tissue is lost to a stroke, infection, or some other malady, the knowledge and skills that depend upon it tend to be lost as well, often irrecoverably. It is for precisely this reason that the disorders of the nervous system inspire wonder about the nature of thought, identity, and consciousness in a way that disorders of the gastrointestinal system, for example, generally do not.
By the surgeon’s standard, Oliver Sacks—the author of Awakenings, The Man Who Mistook His Wife for a Hat, and An Anthropologist on Mars, among other books—must rank as one of his generation’s foremost neurologists. Indeed, it would be hard to name a more prolific or more eloquent admirer of neurological disease than Sacks, whose finely crafted essays about his patients and correspondents over the past four decades are like picture windows into the malfunctioning brain. The disorders he describes are not necessarily obscure, but Sacks has the ability to make even common ailments seem both personal and profound.
His latest book, Musicophilia, is a kaleidoscopic examination of the human response to music, and of the various ways in which that response can be altered by brain dysfunction. This is a topic that is obviously very close to the author’s heart; Sacks has more than a passing appreciation of music, and he candidly tells us that the emotional resonance of music has at times assumed a crucial role in his own life. As a clinician, he first became aware of music’s powerful effects in the late 1960’s, when he observed that some patients frozen in a Parkinsonian state (the same patients he described in his memoir Awakenings) could be fleetingly reanimated by exposure to song and rhythm.
The book starts out with the premise that the propensity to create, perceive, and react to music is an innate component of human nature, no less a core characteristic of our species than is language. Moreover, Sacks maintains that our experience of music is woven integrally into the fabric of the nervous system, supported by complex and, presumably, specially dedicated motor, auditory, emotional, and mnemonic circuits.
When these circuits break down, we get a glimpse of their intricacy. Among the disorders that may result are various forms of “amusia”—the selective lack of musical perception, either from birth or as the result of brain injury. Sacks’s chapter on amusia catalogs several types, each affecting a different aspect of musical experience. For instance, there are amusics who are completely insensitive to rhythm, pitch, and timbre, and who, like Vladimir Nabokov, experience music as “an arbitrary succession of more or less irritating sounds.” Others—those with so-called amelodia—are perfectly capable of perceiving the individual elements of music, but are utterly unable to distinguish one tune from another. Amusia that strikes suddenly can be devastating, as Sacks illustrates in the poignant case of Rachael Y., a young performer whose musical abilities were shattered by head trauma.
Conversely, there are times when other parts of the brain fail but when the neural music box continues to play with remarkable fidelity. Patients who have lost the ability to speak can often still sing; indeed, in melodic-intonation therapy, the preservation of song is used as a stepping-stone in the recovery of language. Likewise, Sacks describes how Clive Wearing, a British musicologist with amnesia so profound that he cannot retain new information for more than a few seconds, is nevertheless able to conduct an orchestra as if he had no impairment at all. More remarkable still is the case of Gloria Lenhoff, a professional opera singer who has memorized arias in more than 30 languages. Gloria also happens to have a developmental disorder called Williams syndrome, and is by conventional measures profoundly mentally retarded.
In still other instances, the brain’s propensity for music seems to run amok, hijacking other neural systems in ways that range from curious to disabling. Most of us have experienced what Sacks calls “brainworms,” catchy tunes that get “stuck” in one’s head, replaying themselves endlessly until they finally flicker out. A surprising number of people also have musical hallucinations; one of Sacks’s young correspondents, Michael B., has been tormented by the incessant playing of an internal “radio” since the age of seven. Then there are musical synesthetes, for whom every note, key, or tune evokes a sensation in another modality—most often color, though at least one individual has been reported to have music-taste synesthesia for specific intervals, experiencing a minor second as sour but a major third as sweet.
For readers who have come to appreciate Oliver Sacks’s characteristic combination of clinical insight, intellectual curiosity, and linguistic dexterity, Musicophilia does not disappoint. Tantalizing tales of exotic conditions like synesthesia and Williams syndrome are interspersed with discussions of more familiar—but, as Sacks shows, equally intriguing—phenomena like musical imagery, tone-deafness, and perfect pitch. Occasionally Sacks elaborates on the neuroanatomical correlates of music perception and its dysfunction, and he draws liberally from the scientific literature to illustrate the point that the varieties of musical experience are rooted, in the final analysis, in the activity of the brain.
Despite its subtitle, however, Musicophilia is not really a book about the brain; or at least it is not a book about brain science, any more than Awakenings was a book about movement disorders. Like Sacks’s other works, Musicophilia deals more with the phenomenology of human experience than with theories about the underlying psychological and biological mechanisms that shape this experience. A corollary is that Sacks tends to skirt the significant scientific debates about the relationship of music to the rest of cognition. Is musical perception “modular”—that is, a self-contained, dedicated neural system that is separate from the recognition of other sounds and patterns? Does music serve some specific adaptive function, or is it merely an enjoyable byproduct of more essential cognitive faculties, like language and motor learning? And if music is adaptive, what is it for?
Musicophilia hints at some of these questions, though without venturing close to any answers. This is reasonable, if one assumes that the book’s aim is not so much to provide answers as to demonstrate human beings’ deep biological affinity for music. Nevertheless, Sacks makes clear his sympathy for the view that music is a special adaptation, and that the human brain has evolved uniquely to accommodate it. This stance is problematic, however, and the evidence for it is much less substantial than Sacks seems prepared to acknowledge.
The main problem is that music seems to serve no particular function—an oddity first recognized in this context by Charles Darwin, who proposed in The Descent of Man that music must have been “acquired by the male and female progenitors of mankind for the sake of charming the opposite sex.” The anthropologist Steven Mithen, whose book The Singing Neanderthals (2005) is cited approvingly by Sacks, provides a more up-to-date review of the possible benefits of music, including Darwin’s suggestion as well as other hypotheses about the role of music in group cohesion, competition, and child care (in the form of lullabies).
None of these, unfortunately, is very convincing. Moreover, the evidence against music as an adaptive faculty is compelling: people who care little for music, perplexing as this may be to musicophiles, are at no obvious disadvantage in the affairs of life. If one compares the inability to appreciate music with the inability to use language, one can readily apprehend the deficiency in Sacks’s pronouncement that “we humans are a musical species no less than a linguistic one.”
The alternative view, as popularized by Steven Pinker in How the Mind Works (1997), is that music is a kind of “auditory cheesecake.” On this hypothesis, music is a cultural invention that exploits the sensitivities of mental systems designed for other purposes, in much the same way that cheesecake provides a kind of gustatory pleasure that satisfies deep-seated cravings for nourishment but is not in itself essential to human survival. A similar if less evocative comparison might be made with written language, which is clearly invented and not innate. Indeed, from the brain’s perspective, written language behaves much like music: some people have difficulty acquiring it, some never acquire it, some lose it altogether, some excel at it, and some become obsessed with it.
But whether an adaptation or an invention, it remains a mystery why music is capable, for some people, of exerting such an intense effect on mood and behavior. How can a sequence of sounds lift a person out of depression, or calm tattered nerves? From what source does music derive its emotional strength?
“It is not easy to deal scientifically with feelings,” Sigmund Freud observed in Civilization and Its Discontents. Freud was referring here to religious feelings, and in particular to the peculiar, ineffable, “oceanic” sensation that is the wellspring of religious belief. Or so, at any rate, it had been suggested to him: while the great psychiatrist admitted that he had no personal experience of such a sensation, he imagined it as a “feeling of indissoluble connection, of belonging inseparably to the external world as a whole.”
Reading Musicophilia, one gets the sense that a similar feeling may lie at the root of music’s power—even though this feeling, like religious conviction, may not be experienced by everyone to the same degree, and may not be experienced by some at all. (Interestingly, as Sacks notes, Freud was also indifferent to music.) Sacks’s patient Mrs. N., for example, referred to one of her musical hallucinations as “the gates of heaven.” In describing the power of music to “move” a crowd of listeners, both figuratively and literally, Sacks even goes so far as to speculate that “rhythm binds together the individual nervous systems of a human community.”
Of course, this kind of speculation brings us little closer to understanding why music has the effects it does, or what it is in the brain that corresponds to the experience of music. Sacks’s slightly incongruous use of the term “nervous systems” reminds us how far away we are from understanding the biological substrates of consciousness. From a scientific point of view, his statement would have been no less informative if, for “nervous systems,” he had substituted “hearts,” “souls,” or “egos.”
The tales in Musicophilia may justly impress us with the brain’s complexity—as well as its fragility—but more than that, they illuminate the richness of human thought and emotion, compared to which our empirical understanding still seems somewhat meager. It may be fortunate, in this regard, that Musicophilia is not a book about science.