Musicophilia

Contents

Cover

Title Page

Dedication

Preface

Part I: Haunted by Music

1. A Bolt from the Blue: Sudden Musicophilia

2. A Strangely Familiar Feeling: Musical Seizures

3. Fear of Music: Musicogenic Epilepsy

4. Music on the Brain: Imagery and Imagination

5. Brainworms, Sticky Music, and Catchy Tunes

6. Musical Hallucinations

Part II: A Range of Musicality

7. Sense and Sensibility: A Range of Musicality

8. Things Fall Apart: Amusia and Dysharmonia

9. Papa Blows His Nose in G: Absolute Pitch

10. Pitch Imperfect: Cochlear Amusia

11. In Living Stereo: Why We Have Two Ears

12. Two Thousand Operas: Musical Savants

13. An Auditory World: Music and Blindness

14. The Key of Clear Green: Synesthesia and Music

Part III: Memory, Movement, and Music

15. In the Moment: Music and Amnesia

16. Speech and Song: Aphasia and Music Therapy

17. Accidental Davening: Dyskinesia and Cantillation

18. Come Together: Music and Tourette’s Syndrome

19. Keeping Time: Rhythm and Movement

20. Kinetic Melody: Parkinson’s Disease and Music Therapy

21. Phantom Fingers: The Case of the One-Armed Pianist

22. Athletes of the Small Muscles: Musician’s Dystonia

Part IV: Emotion, Identity, and Music

23. Awake and Asleep: Musical Dreams

24. Seduction and Indifference

25. Lamentations: Music, Madness, and Melancholia

26. The Case of Harry S.: Music and Emotion

27. Irrepressible: Music and the Temporal Lobes

28. A Hypermusical Species: Williams Syndrome

29. Music and Identity: Dementia and Music Therapy

Acknowledgments

Bibliography

About the Author

Also by Oliver Sacks

Praise for Oliver Sacks’s

Copyright

For Orrin Devinsky,

Ralph Siegel,

and Connie Tomaino

Preface

What an odd thing it is to see an entire species—billions of people—playing with, listening to, meaningless tonal patterns, occupied and preoccupied for much of their time by what they call music. This, at least, was one of the things about human beings that puzzled the highly cerebral alien beings, the Overlords, in Arthur C. Clarke’s novel Childhood’s End. Curiosity brings them down to the Earth’s surface to attend a concert, they listen politely, and at the end, congratulate the composer on his great ingenuity—while still finding the entire business unintelligible. They cannot think what goes on in human beings when they make or listen to music, because nothing goes on with them. They themselves, as a species, lack music.

We may imagine the Overlords ruminating further, back in their spaceships. This thing called music, they would have to concede, is in some way efficacious to humans, central to human life. Yet it has no concepts, makes no propositions; it lacks images, symbols, the stuff of language. It has no power of representation. It has no necessary relation to the world.

There are rare humans who, like the Overlords, may lack the neural apparatus for appreciating tones or melodies. But for virtually all of us, music has great power, whether or not we seek it out or think of ourselves as particularly musical. This propensity to music—this musicophilia—shows itself in infancy, is manifest and central in every culture, and probably goes back to the very beginnings of our species. It may be developed or shaped by the cultures we live in, by the circumstances of life, or by the particular gifts or weaknesses we have as individuals—but it lies so deep in human nature that one is tempted to think of it as innate, much as E. O. Wilson regards biophilia, our feeling for living things. (Perhaps musicophilia is a form of biophilia, since music itself feels almost like a living thing.)

While birdsong has obvious adaptive uses (in courtship, or aggression, or staking out territory, etc.), it is relatively fixed in structure and, to a large extent, hardwired into the avian nervous system (although there are a very few songbirds which seem to improvise, or sing duets). The origin of human music is less easy to understand. Darwin himself was evidently puzzled, as he wrote in The Descent of Man: As neither the enjoyment nor the capacity of producing musical notes are faculties of the least use to man…they must be ranked among the most mysterious with which he is endowed. And, in our own time, Steven Pinker has referred to music as auditory cheesecake, and asks: What benefit could there be to diverting time and energy to making plinking noises?…As far as biological cause and effect are concerned, music is useless…. It could vanish from our species and the rest of our lifestyle would be virtually unchanged. While Pinker is very musical himself and would certainly feel his own life much impoverished by its absence, he does not believe that music, or any of the arts, are direct evolutionary adaptations. He proposes, in a 2007 article, that

many of the arts may have no adaptive function at all. They may be by-products of two other traits: motivational systems that give us pleasure when we experience signals that correlate with adaptive outcomes (safety, sex, esteem, information-rich environments), and the technological know-how to create purified and concentrated doses of these signals.

Pinker (and others) feel that our musical powers—some of them, at least—are made possible by using, or recruiting, or co-opting brain systems that have already developed for other purposes. This might go with the fact that there is no single music center in the human brain, but the involvement of a dozen scattered networks throughout the brain. Stephen Jay Gould, who was the first to face the vexed question of nonadaptive changes squarely, speaks of exaptations in this regard, rather than adaptations—and he singles out music as a clear example as such an exaptation. (William James probably had something similar in mind when he wrote of our susceptibility to music and other aspects of our higher aesthetic, moral and intellectual life as having entered the mind by the back stairs.)

Yet regardless of all this—the extent to which human musical powers and susceptibilities are hardwired or are a by-product of other powers and proclivities—music remains fundamental and central in every culture.

We humans are a musical species no less than a linguistic one. This takes many different forms. All of us (with very few exceptions) can perceive music, perceive tones, timbre, pitch intervals, melodic contours, harmony, and (perhaps most elementally) rhythm. We integrate all of these and construct music in our minds using many different parts of the brain. And to this largely unconscious structural appreciation of music is added an often intense and profound emotional reaction to music. The inexpressible depth of music, Schopenhauer wrote, so easy to understand and yet so inexplicable, is due to the fact that it reproduces all the emotions of our innermost being, but entirely without reality and remote from its pain…. Music expresses only the quintessence of life and of its events, never these themselves.

Listening to music is not just auditory and emotional, it is motoric as well: We listen to music with our muscles, as Nietzsche wrote. We keep time to music, involuntarily, even if we are not consciously attending to it, and our faces and postures mirror the narrative of the melody, and the thoughts and feelings it provokes.

Much that occurs during the perception of music can also occur when music is played in the mind. The imagining of music, even in relatively nonmusical people, tends to be remarkably faithful not only to the tune and feeling of the original but to its pitch and tempo. Underlying this is the extraordinary tenacity of musical memory, so that much of what is heard during one’s early years may be engraved on the brain for the rest of one’s life. Our auditory systems, our nervous systems, are indeed exquisitely tuned for music. How much this is due to the intrinsic characteristics of music itself—its complex sonic patterns woven in time, its logic, its momentum, its unbreakable sequences, its insistent rhythms and repetitions, the mysterious way in which it embodies emotion and will—and how much to special resonances, synchronizations, oscillations, mutual excitations, or feedbacks in the immensely complex, multilevel neural circuitry that underlies musical perception and replay, we do not yet know.

But this wonderful machinery—perhaps because it is so complex and highly developed—is vulnerable to various distortions, excesses, and breakdowns. The power to perceive (or imagine) music may be impaired with some brain lesions; there are many such forms of amusia. On the other hand, musical imagery may become excessive and uncontrollable, leading to incessant repetition of catchy tunes, or even musical hallucinations. In some people, music can provoke seizures. There are special neurological hazards, disorders of skill, that may affect professional musicians. The normal association of intellectual and emotional may break down in some circumstances, so that one may perceive music accurately, but remain indifferent and unmoved by it or, conversely, be passionately moved, despite being unable to make any sense of what one is hearing. Some people—a surprisingly large number—see color or taste or smell or feel various sensations as they listen to music—though such synesthesia may be accounted a gift more than a symptom.

William James referred to our susceptibility to music, and while music can affect all of us—calm us, animate us, comfort us, thrill us, or serve to organize and synchronize us at work or play—it may be especially powerful and have great therapeutic potential for patients with a variety of neurological conditions. Such people may respond powerfully and specifically to music (and, sometimes, to little else). Some of these patients have widespread cortical problems, whether from strokes or Alzheimer’s or other causes of dementia; others have specific cortical syndromes—loss of language or movement functions, amnesias, or frontal-lobe syndromes. Some are retarded, some autistic; others have subcortical syndromes such as parkinsonism or other movement disorders. All of these conditions and many others can potentially respond to music and music therapy.

FOR ME, the first incitement to think and write about music came in 1966, when I saw the profound effects of music on the deeply parkinsonian patients I later wrote about in Awakenings. And since then, in more ways than I could possibly imagine, I have found music continually forcing itself on my attention, showing me its effects on almost every aspect of brain function—and life.

Music has always been one of the first things I look up in the index of any new neurology or physiology textbook. But I could find scarcely any mention of the subject until the 1977 publication of Macdonald Critchley and R. A. Henson’s book Music and the Brain, with its wealth of historical and clinical examples. Perhaps one reason for the scarcity of musical case histories is that physicians rarely ask their patients about mishaps of musical perception (whereas a linguistic problem, say, will immediately come to light). Another reason for this neglect is that neurologists like to explain, to find putative mechanisms, as well as to describe—and there was virtually no neuroscience of music prior to the 1980s. This has all changed in the last two decades with new technologies that allow us to see the living brain as people listen to, imagine, and even compose music. There is now an enormous and rapidly growing body of work on the neural underpinnings of musical perception and imagery, and the complex and often bizarre disorders to which these are prone. These new insights of neuroscience are exciting beyond measure, but there is always a certain danger that the simple art of observation may be lost, that clinical description may become perfunctory, and the richness of the human context ignored.

Clearly, both approaches are necessary, blending old-fashioned observation and description with the latest in technology, and I have tried to incorporate both of these approaches here. But above all, I have tried to listen to my patients and subjects, to imagine and enter their experiences—it is these which form the core of this book.

Part I

Haunted by Music

1

A Bolt from the Blue:

Sudden Musicophilia

Tony Cicoria was forty-two, very fit and robust, a former college football player who had become a well-regarded orthopedic surgeon in a small city in upstate New York. He was at a lakeside pavilion for a family gathering one fall afternoon. It was pleasant and breezy, but he noticed a few storm clouds in the distance; it looked like rain.

He went to a pay phone outside the pavilion to make a quick call to his mother (this was in 1994, before the age of cell phones). He still remembers every single second of what happened next: I was talking to my mother on the phone. There was a little bit of rain, thunder in the distance. My mother hung up. The phone was a foot away from where I was standing when I got struck. I remember a flash of light coming out of the phone. It hit me in the face. Next thing I remember, I was flying backwards.

Then—he seemed to hesitate before telling me this—I was flying forwards. Bewildered. I looked around. I saw my own body on the ground. I said to myself, ‘Oh shit, I’m dead.’ I saw people converging on the body. I saw a woman—she had been standing waiting to use the phone right behind me—position herself over my body, give it CPR…. I floated up the stairs—my consciousness came with me. I saw my kids, had the realization that they would be okay. Then I was surrounded by a bluish-white light…an enormous feeling of well-being and peace. The highest and lowest points of my life raced by me. No emotion associated with these…pure thought, pure ecstasy. I had the perception of accelerating, being drawn up…there was speed and direction. Then, as I was saying to myself, ‘This is the most glorious feeling I have ever had’—SLAM! I was back.

Dr. Cicoria knew he was back in his own body because he had pain—pain from the burns on his face and his left foot, where the electrical charge had entered and exited his body—and, he realized, only bodies have pain. He wanted to go back, he wanted to tell the woman to stop giving him CPR, to let him go; but it was too late—he was firmly back among the living. After a minute or two, when he could speak, he said, It’s okay—I’m a doctor! The woman (she turned out to be an intensive-care-unit nurse) replied, A few minutes ago, you weren’t.

The police came and wanted to call an ambulance, but Cicoria refused. They took him home instead (it seemed to take hours), where he called his own doctor, a cardiologist. The cardiologist, when he saw him, thought Cicoria must have had a brief cardiac arrest, but could find nothing amiss with examination or EKG. With these things, you’re alive or dead, the cardiologist remarked. He did not feel that Dr. Cicoria would suffer any further consequences of this bizarre accident.

Cicoria also consulted a neurologist—he was feeling sluggish (most unusual for him) and having some difficulties with his memory. He found himself forgetting the names of people he knew well. He was examined neurologically, had an EEG and an MRI. Again, nothing seemed amiss.

A couple of weeks later, when his energy returned, Dr. Cicoria went back to work. There were still some lingering memory problems—he occasionally forgot the names of rare diseases or surgical procedures—but all his surgical skills were unimpaired. In another two weeks, his memory problems disappeared, and that, he thought, was the end of the matter.

What then happened still fills Cicoria with amazement, even now, a dozen years later. Life had returned to normal, seemingly, when suddenly, over two or three days, there was this insatiable desire to listen to piano music. This was completely out of keeping with anything in his past. He had had a few piano lessons as a boy, he said, but no real interest. He did not have a piano in his house. What music he did listen to tended to be rock music.

With this sudden onset of craving for piano music, he began to buy recordings and became especially enamored of a Vladimir Ashkenazy recording of Chopin favorites—the Military Polonaise, the Winter Wind Étude, the Black Key Étude, the A-flat Major Polonaise, the B-flat Minor Scherzo. I loved them all, Cicoria said. I had the desire to play them. I ordered all the sheet music. At this point, one of our babysitters asked if she could store her piano in our house—so now, just when I craved one, a piano arrived, a nice little upright. It suited me fine. I could hardly read the music, could barely play, but I started to teach myself. It had been more than thirty years since the few piano lessons of his boyhood, and his fingers felt stiff and awkward.

And then, on the heels of this sudden desire for piano music, Cicoria started to hear music in his head. The first time, he said, it was in a dream. I was in a tux, onstage; I was playing something I had written. I woke up, startled, and the music was still in my head. I jumped out of bed, started trying to write down as much of it as I could remember. But I hardly knew how to notate what I heard. This was not surprising—he had never tried to write or notate music before. But whenever he sat down at the piano to work on the Chopin, his own music would come and take me over. It had a very powerful presence.

I was not quite sure what to make of this peremptory music, which would intrude and overwhelm him. Was he having musical hallucinations? No, Dr. Cicoria said, they were not hallucinations—inspiration was a more apt word. The music was there, deep inside him—or somewhere—and all he had to do was let it come to him. It’s like a frequency, a radio band. If I open myself up, it comes. I want to say, ‘It comes from heaven,’ as Mozart said.

His music is ceaseless. It never runs dry, he continued. If anything, I have to turn it off.

Now he had to wrestle not just with learning to play the Chopin, but to give form to the music continually running in his head, trying it out on the piano, getting it on manuscript paper. It was a terrible struggle, he said. I would get up at four in the morning and play till I went to work, and when I got home from work I was at the piano all evening. My wife was not really pleased. I was possessed.

In the third month after being struck by lightning, then, Cicoria—once an easygoing, genial family man, almost indifferent to music—was inspired, even possessed, by music, and scarcely had time for anything else. It began to dawn on him that perhaps he had been saved for a special purpose. I came to think, he said, that the only reason I had been allowed to survive was the music. I asked him whether he had been a religious man before the lightning. He had been raised Catholic, he said, but had never been particularly observant; he had some unorthodox beliefs, too, such as in reincarnation.

He himself, he grew to think, had had a sort of reincarnation, had been transformed and given a special gift, a mission, to tune in to the music that he called, half metaphorically, the music from heaven. This came, often, in an absolute torrent of notes with no breaks, no rests, between them, and he would have to give it shape and form. (As he said this, I thought of Caedmon, the seventh-century Anglo-Saxon poet, an uneducated goatherd who, it was said, had received the art of song in a dream one night, and spent the rest of his life praising God and creation in hymns and poems.)

Cicoria continued to work on his piano playing and his compositions. He got books on notation, and soon realized that he needed a music teacher. He would travel to concerts by his favorite performers but had nothing to do with musical friends or musical activities in his own town. This was a solitary pursuit, between himself and his muse.

I asked whether he had experienced other changes since the lightning strike—a new appreciation of art, perhaps, different taste in reading, new beliefs? Cicoria said he had become very spiritual since his near-death experience. He had started to read every book he could find about near-death experiences and about lightning strikes. And he had got a whole library on Tesla, as well as anything on the terrible and beautiful power of high-voltage electricity. He thought he could sometimes feel auras of light or energy around people’s bodies—he had never seen this before the lightning bolt.

Some years passed, and Cicoria’s new life, his inspiration, never deserted him. He continued to work full-time as a surgeon, but his heart and mind now centered on music. He got divorced in 2004, and the same year had a fearful motorcycle accident. He had no memory of this, but his Harley was struck by another vehicle, and he was found in a ditch, unconscious and badly injured, with broken bones, a ruptured spleen, a perforated lung, cardiac contusions, and, despite his helmet, head injuries. In spite of all this, he made a complete recovery and was back at work in two months. Neither the accident nor his head injury nor his divorce seemed to have made any difference to his passion for playing and composing music.

I HAVE NEVER MET another person with a story like Tony Cicoria’s, but I have occasionally had patients with a similar sudden onset of musical or artistic interests—including Salimah M., a research chemist. In her early forties, Salimah started to have brief periods, lasting a minute or less, in which she would get a strange feeling—sometimes a sense that she was on a beach that she had once known, while at the same time being perfectly conscious of her current surroundings and able to continue a conversation, or drive a car, or do whatever she had been doing. Occasionally these episodes were accompanied by a sour taste in the mouth. She noticed these strange occurrences, but did not think of them as having any neurological significance. It was only when she had a grand mal seizure in the summer of 2003 that she went to a neurologist and was given brain scans, which revealed a large tumor in her right temporal lobe—the cause of her peculiar episodes. The tumor, her doctors felt, was malignant (though it was probably an oligodendroglioma, of relatively low malignancy) and needed to be removed. Salimah wondered if she had been given a death sentence and was fearful of the operation and its possible consequences; she and her husband had been told that it might cause some personality changes. But in any event, the surgery went well, most of the tumor was removed, and after a period of convalescence, Salimah was able to return to her work as a chemist.

Before the surgery, she had been a fairly reserved woman who would occasionally be annoyed or preoccupied by small things like dust or untidiness; her husband said she was sometimes obsessive about jobs that needed to be done around the house. But now, after the surgery, Salimah seemed unperturbed by such domestic matters. She had become, in the idiosyncratic words of her husband (English was not their first language), a happy cat. She was, he declared, a joyologist.

Salimah’s new cheerfulness was apparent at work. She had worked in the same laboratory for fifteen years and had always been admired for her intelligence and dedication. But now, while losing none of this professional competence, she seemed a much warmer person, keenly sympathetic and interested in the lives and feelings of her co-workers. Where before, in a colleague’s words, she had been much more into herself, she now became the confidante and social center of the entire lab.

At home, too, she shed some of her Marie Curie–like, work-oriented personality. She permitted herself time off from her thinking, her equations, and became more interested in going to movies or parties, living it up a bit. And a new love, a new passion, entered her life. She had been vaguely musical, in her own words, as a girl, had played the piano a little, but music had never played any great part in her life. Now it was different. She longed to hear music, to go to concerts, to listen to classical music on the radio or on CDs. She could be moved to rapture or tears by music which had carried no special feeling for her before. She became addicted to her car radio, which she would listen to while driving to work. A colleague who happened to pass her on the road to the lab said that the music on her radio was incredibly loud—he could hear it a quarter of a mile away. Salimah, in her convertible, was entertaining the whole freeway.

Like Tony Cicoria, Salimah showed a drastic transformation from being only vaguely interested in music to being passionately excited by music and in continual need of it. And with both of them, there were other, more general changes, too—a surge of emotionality, as if emotions of every sort were being stimulated or released. In Salimah’s words, What happened after the surgery—I felt reborn. That changed my outlook on life and made me appreciate every minute of it.

COULD SOMEONE DEVELOP a pure musicophilia, without any accompanying changes in personality or behavior? In 2006 just such a situation was described by Rohrer, Smith, and Warren, in their striking case history of a woman in her mid-sixties who had intractable temporal lobe seizures with a right temporal lobe focus. After seven years, her seizures were finally brought under control by the anticonvulsant drug lamotrigine (LTG). Prior to starting on this medication, Rohrer and his colleagues wrote,

she had always been indifferent to music, never listening to music for pleasure or attending concerts. This was in contrast to her husband and daughter, who played the piano and violin…. She was unmoved by the traditional Thai music she had heard at family and public events in Bangkok and by classical and popular genres of Western music after she moved to the United Kingdom. Indeed, she continued to avoid music where possible, and actively disliked certain musical timbres (for example, she would shut the door to avoid hearing her husband playing piano music, and found choral singing irritating).

This indifference to music changed abruptly when the patient was put on lamotrigine:

Within several weeks of starting LTG, a profound change was noted in her appreciation of music. She sought out musical programmes on the radio and television, listened to classical music stations on the radio for many hours each day, and demanded to attend concerts. Her husband described how she had sat transfixed throughout La Traviata and became annoyed when other audience members talked during the performance. She now described listening to classical music as an extremely pleasant and emotion-charged experience. She did not sing or whistle, and no other changes were found in her behavior or personality. No evidence of thought disorder, hallucinations, or disturbed mood was seen.

While Rohrer et al. could not pinpoint the precise basis of their patient’s musicophilia, they hazarded the suggestion that, during her years of incorrigible seizure activity, she might have developed an intensified functional connection between perceptual systems in the temporal lobes and parts of the limbic system involved in emotional response—a connection that only became apparent when her seizures were brought under control with medication. In the 1970s, David Bear suggested that such a sensory-limbic hyperconnection might be the basis for the emergence of the unexpected artistic, sexual, mystical, or religious feelings that sometimes occur in people with temporal lobe epilepsy. Could something similar have occurred with Tony Cicoria, too?

LAST SPRING, Cicoria took part in a ten-day music retreat for student musicians, gifted amateurs, and professionals. The camp doubles as a showroom for Erica vander Linde Feidner, a concert pianist who also specializes in finding the perfect piano for each of her clients. Tony had just bought one of her pianos, a Bösendorfer grand, a unique prototype made in Vienna—she thought he had a remarkable instinct for picking out a piano with exactly the tone he wanted. It was, Cicoria felt, a good time, a good place, to make his debut as a musician.

He prepared two pieces for his concert: his first love, Chopin’s B-flat Minor Scherzo; and his own first composition, which he called Rhapsody, Opus 1. His playing, and his story, electrified everyone at the retreat (many expressed the fantasy that they, too, might be struck by lightning). He played, said Erica, with great passion, great brio—and if not with supernatural genius, at least with creditable skill, an astounding feat for someone with virtually no musical background who had taught himself to play at forty-two.

WHAT DID I THINK, in the end, of his story, Dr. Cicoria asked me. Had I ever encountered anything similar? I asked him what he thought, and how he would interpret what had happened to him. He replied that as a medical man he was at a loss to explain these events, and he had to think of them in spiritual terms. I countered that, with no disrespect to the spiritual, I felt that even the most exalted states of mind, the most astounding transformations, must have some physical basis or at least some physiological correlate in neural activity.

At the time of his lightning strike, Dr. Cicoria had both a near-death experience and an out-of-body experience. Many supernatural or mystical explanations have arisen to explain out-of-body experiences, but they have also been a topic of neurological investigation for a century or more. Such experiences seem to be relatively stereotyped in format: one seems to be no longer in one’s own body but outside it, and, most commonly, looking down on oneself from eight or nine feet above (neurologists refer to this as autoscopy). One seems to see clearly the room and people and objects nearby, but from an aerial perspective. People who have had such experiences often describe vestibular sensations like floating or flying. Out-of-body experiences can inspire fear or joy or a feeling of detachment, but they are usually described as intensely real—not at all like a dream or hallucination. They have been reported in many sorts of near-death experiences, as well as in temporal lobe seizures. There is some evidence that both the visuospatial and vestibular aspects of out-of-body experiences are related to disturbed function in the cerebral cortex, especially at the junctional region between the temporal and parietal lobes.¹.

But it was not just an out-of-body experience that Dr. Cicoria reported. He saw a bluish-white light, he saw his children, his life flashed past him, he had a sense of ecstasy, and, above all, he had a sense of something transcendental and enormously significant. What could be the neural basis of this? Similar near-death experiences have often been described by people who have been, or believed themselves to be, in great danger, whether they are involved in sudden accidents, struck by lightning, or, most commonly, revived after a cardiac arrest. All of these are situations not only fraught with terror but likely to cause a sudden drop in blood pressure and cerebral blood flow (and, if there is cardiac arrest, a deprivation of oxygen to the brain). There is likely to be intense emotional arousal and a surge of noradrenaline and other neurotransmitters in such states, whether the affect is one of terror or rapture. We have, as yet, little idea of the actual neural correlates of such experiences, but the alterations of consciousness and emotion that occur are very profound and must involve the emotional parts of the brain—the amygdala and brain-stem nuclei—as well as the cortex.².

While out-of-body experiences have the character of a perceptual illusion (albeit a complex and singular one), near-death experiences have all the hallmarks of mystical experience, as William James defines them—passivity, ineffability, transience, and a noetic quality. One is totally consumed by a near-death experience, swept up, almost literally, in a blaze (sometimes a tunnel or funnel) of light, and drawn towards a Beyond—beyond life, beyond space and time. There is a sense of a last look, a (greatly accelerated) farewell to things earthly, the places and people and events of one’s life, and a sense of ecstasy or joy as one soars towards one’s destination—an archetypal symbolism of death and transfiguration. Experiences like this are not easily dismissed by those who have been through them, and they may sometimes lead to a conversion or metanoia, a change of mind, that alters the direction and orientation of a life. One cannot suppose, any more than one can with out-of-body experiences, that such events are pure fancy; very similar features are emphasized in every account. Near-death experiences must also have a neurological basis of their own, one which profoundly alters consciousness itself.

What about Dr. Cicoria’s remarkable access of musicality, his sudden musicophilia? Patients with degeneration of the front parts of the brain, so-called frontotemporal dementia, sometimes develop a startling emergence or release of musical talents and passions as they lose the powers of abstraction and language—but clearly this was not the case with Dr. Cicoria, who was articulate and highly competent in every way. In 1984, Daniel Jacome described a patient who had had a stroke damaging the left hemisphere of his brain and consequently developed hypermusia and musicophilia, along with aphasia and other problems. But there was nothing to suggest that Tony Cicoria had experienced any significant brain damage, other than a very transient disturbance to his memory systems for a week or two after the lightning strike.

His situation did remind me a bit of Franco Magnani, the memory artist of whom I have written.³. Franco had never thought of being a painter until he experienced a strange crisis or illness—perhaps a form of temporal lobe epilepsy—when he was thirty-one. He had nightly dreams of Pontito, the little Tuscan village where he was born; after he woke, these images remained intensely vivid, with a full depth and reality (like holograms). Franco was consumed by a need to make these images real, to paint them, and so he taught himself to paint, devoting every free minute to producing hundreds of views of Pontito.

Could Tony Cicoria’s musical dreams, his musical inspirations, have been epileptic in nature? Such a question cannot be answered with a simple EEG such as Cicoria had following his accident, but would require special EEG monitoring over the course of many days.

And why was there such a delay in the development of his musicophilia? What was happening in the six or seven weeks that elapsed between his cardiac arrest and the rather sudden eruption of musicality? We know that there were temporary aftereffects—the confusional state that ensued for a few hours, and the disturbance of memory that lasted a couple of weeks. These could have been due to cerebral anoxia alone—for his brain must have been without adequate oxygen for a minute or more. One has to suspect, however, that Dr. Cicoria’s apparent recovery a couple of weeks after these events was not as complete as it seemed, that there were other, unnoticed forms of brain damage, and that his brain was still reacting to the original insult and reorganizing itself during this time.

Dr. Cicoria feels that he is a different person now—musically, emotionally, psychologically, and spiritually. This was my impression, too, as I listened to his story and saw something of the new passions which had transformed him. Looking at him from a neurological vantage point, I felt that his brain must be very different now from what it was before his lightning strike or in the days immediately following this, when neurological tests showed nothing grossly amiss. Could we now, a dozen years later, define these changes, define the neurological basis of his musicophilia? Many new and far subtler tests of brain function have been developed since Cicoria had his injury in 1994, and he agreed that it would be interesting to investigate this further. But after a moment, he reconsidered, and said that perhaps it was best to let things be. His was a lucky strike, and the music, however it had come, was a blessing, a grace—not to be questioned.

Postscript

Since first publishing Tony Cicoria’s story, I have received many letters from people who were not struck by lightning and seemed to have no special physical or psychological conditions, but, often to their great surprise—in their forties or fifties or even eighties—have found themselves with sudden or unexpected creative gifts or passions, either musical or artistic.

One correspondent, Grace M., described the rather sudden onset of her own musicality at the age of fifty-five. Shortly after returning from a vacation in Israel and Jordan, she started to hear song fragments in her head. She tried to record them by drawing lines on paper—she did not know formal musical notation. When this did not work, she bought a tape recorder and sang into it. Now, three years later, she has recorded more than thirty-three hundred fragments, and, arising from these, about four complete songs a month. Grace noted that while she has had popular tunes running through her head for as long as she can remember, it was