Musicophilia: Tales of Music and the Brain by Oliver W. Sacks

decade after she first wrote to me, I met with Mrs. B., and I asked her whether, after so many years, her hallucinated music had become “important” in her life, in either a positive or a negative way. “If it went away,” I asked, “would you be pleased or would you miss it?”
    “Miss it,” she answered at once. “I would miss the music. You see, it is now a part of me.”

    * * *
    W HILE THERE IS no doubt of the physiological basis of musical hallucinations, one has to wonder to what extent other (let us call them “psychological”) factors may enter into the initial “selection” of the hallucinations and their subsequent evolution and role. I wondered about such factors when I wrote in 1985 about Mrs. O’C. and Mrs. O’M.; Wilder Penfield, too, had wondered whether there was any sense or significance in the songs or scenes evoked in “experiential seizures” but had decided there was not. The selection of hallucinatory music, he had concluded, was “quite at random, except that there is some evidence of cortical conditioning.” Rodolfo Llinás, similarly, has written of the incessant activity in the nuclei of the basal ganglia, and how they “seem to act as a continuous, random motor pattern noise generator.” When a pattern or fragment might escape now and then and thrust into consciousness a song or a few bars of music, Llinás felt this was purely abstract and “without its apparent emotional counterpart.” But something may start randomly— a tic, for example, bursting out of overexcited basal ganglia— and then acquire associations and meaning.
    One may use the word “random” with regard to the effects of a low-level mishap in the basal ganglia— in the involuntary movement called chorea, for example. There is no personal element in chorea; it is wholly an automatism— it does not, for the most part, even make its way to consciousness and may be more visible to others than to the patient himself. But “random” is a word one would hesitate to use in regard to experiences, whether these are perceptual, imaginary, or hallucinatory. Musical hallucinations draw upon the musical experience and memories of a lifetime, and the importance that particular sorts of music have for the individual must surely play a major role. The sheer weight of exposure may also play a significant part, even overriding personal taste— the vast majority of musical hallucinations tend to take the form of popular songs or theme music (and, in an earlier generation, hymns and patriotic songs), even in professional musicians or very sophisticated listeners. 18 Musical hallucinations tend to reflect the tastes of the times more than the tastes of the individual.
    Some people— a few— come to enjoy their musical hallucinations; many are tormented by them; most, sooner or later, reach some kind of accommodation or understanding with them. This may sometimes take the form of direct interaction, as in a charming case history published by Timothy Miller and T. W. Crosby. Their patient, an elderly deaf lady, “awoke one morning hearing a gospel quartet singing an old hymn she remembered from childhood days.” Once she had ascertained that the music was not coming from a radio or television, she rather calmly accepted that it was coming “from inside my head.” The choir’s repertoire of hymns increased: “the music was generally pleasing, and the patient often enjoyed singing along with the quartet…. She also found that she could teach the quartet new songs by thinking of a few lines, and the quartet would supply any forgotten words or verses.” Miller and Crosby observed that a year later the hallucinations were unchanged, adding that their patient had “adjusted well to her hallucinations and views them as a ‘cross’ she must bear.” Yet “bearing a cross” may not carry a wholly negative connotation; it can also be a sign of favor, of election. I recently had occasion to see a remarkable old lady, a