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

(such as hearing impairment) or central (such as seizures or strokes), there seems to be a final common path, a cerebral mechanism common to all of them. Most of my patients and correspondents emphasize that the music they “hear” seems at first to have an external origin— a nearby radio or television, a neighbor putting on a record, a band outside the window, whatever— and it is only when no such external source can be found that patients are compelled to infer that the music is being generated by their brain. They do not speak of themselves “imagining” the music, but of some strange, autonomous mechanism set off in the brain. They speak of “tapes,” “circuits,” “radios,” or “recordings” in their brains; one of my correspondents called it his “intracranial jukebox.”
    The hallucinations are sometimes of great intensity (“This problem is so intense it is wrecking my life,” wrote one woman), yet many of my correspondents are reluctant to speak of their musical hallucinations, fearing that they will be seen as crazy— “I can’t tell people, because God knows what they would think,” one person wrote. “I have never told anyone,” wrote another, “afraid they would lock me in a mental ward.” Others, while acknowledging their experiences, are embarrassed by the use of the term “hallucination” and say they would be much more at ease with these unusual experiences, much readier to acknowledge them, if they could use a different word for them. 7
    And yet while musical hallucinations all share certain features— their apparent exteriority, their incessancy, their fragmentary and repetitive character, their involuntary and intrusive nature— their particulars can vary widely. So too can their role in people’s lives— whether they assume importance or relevance, become part of a personal repertoire, or remain alien, fragmentary, and meaningless. Each person, consciously or unconsciously, finds their own way of responding to this mental intrusion.

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    G ORDON B., a seventy-nine-year-old professional violinist in Australia, had fractured his right eardrum as a child, and subsequently had progressive hearing loss following mumps in adulthood. He wrote to me about his musical hallucinations:

    About 1980, I noticed the first signs of tinnitus, which manifested itself as a constant high note, an F-natural. The tinnitus changed pitch several times during the next few years and became more disturbing. By this time, I was suffering quite a substantial hearing loss and distortion of sounds in my right ear. In November 2001, during a two-hour train trip, the sound of the diesel engine started up the most horrific grinding in my head, which lasted for some hours after I left the train. For the next few weeks I heard constant grinding noises. 8
    “The following day,” he wrote, “the grinding was replaced by the sound of music, which has since been with me twenty-four hours a day, rather like an endless CD…. All other sounds, the grinding, the tinnitus, disappeared.” 9
    For the most part, these hallucinations are “musical wallpaper, meaningless musical phrases and patterns.” But sometimes they are based on the music he is currently studying and creatively transformed from this— a Bach violin solo he is working on may turn into “a hallucination played by a superb orchestra, and when this happens, it goes on to play variations on the themes.” His musical hallucinations, he pointed out, “cover the full gamut of moods and emotions…the rhythmic patterns depend on my state of mind at the time. If I’m relaxed…[they are] very gentle and discreet…. During the day the musical hallucinations can get loud and remorseless and very violent, often with tympani beating an insistent rhythm underneath.”
    Other, nonmusical sounds may influence the musical hallucinations: “Whenever I mow the lawns, for example, I get a motif starting up in my head which I recognize as only ever