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

head is virtually gone…. My life has changed in a truly significant way.”
    After two months, however, the music started to escape from the control of the gabapentin, and Mr. Mamlok’s hallucinations became intrusive again, though not as much so as before the medication. (He could not tolerate larger doses of gabapentin, because they caused excessive sedation.)
    Five years later, Mr. Mamlok still has music in his head, though he has learned to live with it, as he puts it. His hearing has declined further and he now wears hearing aids, but these have made no difference to the musical hallucinations. He occasionally takes gabapentin if he finds himself in an exceptionally noisy environment. But the best remedy, he has discovered, is listening to real music, which, for him, displaces the hallucinations— at least for a while.

    J OHN C. , an eminent composer in his sixties with no deafness or significant health problems, came to see me because, as he put it, he had “an iPod” in his head which played music, mostly popular tunes from his childhood or adolescence. It was music he had no taste for but which he had been exposed to when growing up. He found it intrusive and annoying. Though it was inhibited when he was listening to music, reading, or conversing, it was apt to return the moment he was not otherwise engaged. He sometimes said, “Stop!” to himself (or even aloud), and the internal music would stop for thirty or forty seconds but then resume.
    John never thought his “iPod” was anything external, but he did feel that its behavior was quite unlike the normal imagery (voluntary or involuntary) which was so much a part of his mind and which was especially active when he was composing. The “iPod” seemed to go on by itself— irrelevantly, spontaneously, relentlessly, and repetitively. It could be quite disturbing at night.
    John’s own compositions are particularly complex and intricate, both intellectually and musically, and he said that he had always struggled to compose them. He wondered whether, with the “iPod” in his brain, he was taking “the easy way out,” indulging secondhand tunes from the past instead of wrestling with new musical ideas. (This interpretation seemed unlikely to me, because though he had worked creatively all his life, he had only had the “iPod” for six or seven years.)
    Interestingly, though the music he hallucinated was usually vocal or orchestral in origin, it was instantly and automatically transcribed into piano music, often in a different key. He would find his hands physically “playing” these transcriptions “almost by themselves.” He felt that there were two processes involved here: the refluxing of old songs, “musical information from the memory banks,” and then an active reprocessing by his composer’s (and pianist’s) brain.

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    M Y INTEREST IN musical hallucinations goes back more than thirty years. In 1970, my mother had an uncanny experience at the age of seventy-five. She was still practicing as a surgeon, with no hearing or cognitive impairment, but she described to me how one night she had suddenly started to hear patriotic songs from the Boer War playing incessantly in her mind. She was amazed by this, for she had not thought of these songs at all for nearly seventy years and doubted if they had ever held much significance for her. She was struck by the accuracy of this replaying, for normally she could not keep a tune in her head. The songs faded after a couple of weeks. My mother, who had had some neurological training herself, felt that there must have been some organic cause for this eruption of long-forgotten songs: perhaps a small, otherwise asymptomatic stroke, or perhaps the use of reserpine to control her blood pressure.
    Something similar happened with Rose R., one of the post-encephalitic patients I described in Awakenings. This lady, whom I had put on L-dopa in 1969, reanimating her after decades in a “frozen” state,