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

pastor who developed musical hallucinations— mostly of hymns— as she became hard of hearing. She came to see her hallucinations as “a gift” and has “trained” them to a considerable extent, so that they occur while she is in church or at prayer, but not at mealtimes, for instance. She has incorporated her musical hallucinations into a deeply felt religious context.
    Such personal influences are fully allowed— indeed required— in Konorski’s model, and in Llinás’s, too. Fragmentary music patterns may be emitted or released from the basal ganglia as “raw” music, without any emotional coloring or associations— music which is, in this sense, meaningless. But these musical fragments make their way to the thalamocortical systems that underlie consciousness and self, and there they are elaborated and clothed with meaning and feeling and associations of all sorts. By the time such fragments reach consciousness, meaning and feeling have already been attached.

    P ERHAPS THE MOST intensive analysis of musical hallucinations and their shaping by personal experience and feeling, their continuing interaction with the mind and personality, has been pursued by the eminent psychoanalyst Leo Rangell. For Rangell, musical hallucinations have been the subject of continuing self-study that has lasted now for more than a decade.
    Dr. Rangell first wrote to me about his musical hallucinations in 1996. 19 He was eighty-two, and had had a second bypass surgery a few months before:

    Immediately upon awakening, in the ICU, I heard singing, which made me say to my children, “Hey, there’s a rabbi school out there.” It sounded to me like an old rabbi who…was teaching young rabbi students how to sing, and perform their things. I told my family the rabbi must work late, even midnight, since I heard the music then too. My kids looked at each other, and said amusedly and tolerantly: “There’s no rabbi school out there.”

    I of course soon began to know this was me. This gave me both relief and concern…. The music must have been continuous, but I paid little or no attention to it for large blocks of time, especially during the busy hospital routines. When I left the hospital, after six days…the “rabbi” followed me. He was now outside my windows at home, towards the hills; or was he in the canyon? On my first plane trip a few weeks later, he came with me.
    Rangell had hoped that these musical hallucinations— perhaps, he thought, a product of the anesthesia, or the morphine he had received after surgery— would go away with time. He had also experienced “copious cognitive distortions, which every bypass patient I know has had”— but these had quickly cleared up. 20
    After six months, however, he feared they were becoming permanent. During the day, he could often push the music aside when otherwise absorbed, but at night, the musical hallucinations kept him awake (“I feel quite ragged from lack of sleep,” he wrote).
    Dr. Rangell did have a significant hearing loss. “I have had nerve deafness for many years now, familial. The musical hallucinosis is related, I feel, to the hyperacusis that goes with the hypo-hearing. The internal, central auditory pathways must overwork and enhance sounds.” He speculated that this over-activity of auditory brain pathways might at first be based on external rhythms of wind, traffic, or humming motors or on internal rhythms of breath or heartbeat— and that “the mind then converts these to music or song, establishing control over it. Passivity is overcome by activity.”
    Dr. Rangell felt that his internal music reflected his moods and circumstances. At first, in the hospital, the songs varied; they were sometimes funereal, elegiac, rabbinical, sometimes lilting and happy (“Oo la la, oo la la” alternating with “oy vey, oy vey, oy vey, vey, vey”— later he realized these were to the same tune). When he was due to come home from the hospital, he began to hear