Present at the Future (5 page)
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Authors: Ira Flatow
OLIVER SACKS: MUSIC MAKES THE MEMORY
Every disease is a musical problem.
—NOVALIS
You remember Oliver Sacks. Robin Williams portrayed him in the 1990 film Awakenings. He brings back to life a room full of hospitalized comatose patients suffering from Parkinson’s disease by giving them a drug called L-dopa. Neurologist and famed author Oliver Sacks has spent a good deal of his life translating medical mysteries into common language, bringing science and medicine into the public arena in a way like no other storyteller. Through his musings and writings about his patients and his own life, Dr. Sacks has brought us greater understanding of neurological maladies, including autism, prodigies, vision loss, coma, and migraines and how they affect people in their daily lives.
As clinical professor of neurology at Albert Einstein College of Medicine and adjunct professor of psychiatry assigned to neurology
at New York University School of Medicine, Sacks continues to discover and explore fascinating and mysterious workings of the brain. His latest project: music and memory, how music offers a unique way to look at the human brain, how the power of music transcends otherwise devastating memory loss to make life more bearable for people who are afflicted with memory loss.
First, some perspective. Sacks’s interest in music and memory goes back decades, to 1966, to the patients portrayed in Awakenings. He discovered that before L-dopa was available as a treatment, his nurses reported that some of his patients would respond to music. “And then I rapidly saw this myself, that sometimes these people who could not take a step could dance. Some of these people who couldn’t utter a syllable could sing. And that while they sang and while they danced, they were able to move freely. It was almost as if their Parkinsonism and their other neurological problems were bypassed. But the moment the music stopped, they stopped too.”
Intrigued, Sacks called for a second opinion.
“I took the poet W. H. Auden along to the hospital to see this, and he quoted something of the German poet Novalis, who said, ‘Every disease is a musical problem; every cure is a musical solution.’ And certainly, one had the feeling that this was the case, although only for the few seconds or minutes that music lasted, with these patients.
“And then I was very struck. At some of the hospitals where I work, we have a lot of people with Alzheimer’s disease and dementia.” Sacks was struck by “how often how some of these people, although they’d lost the powers of thought and language, might recognize music, might sing along, might suddenly become lucid when they were exposed to music.” It changed his views about the brain. “I think music perception, because it has such a widespread basis, is very robust, and even patients with widespread brain damage are usually able to respond to music.”
A few years later, in the 1970s, Sacks saw a strange case of amnesia that made him think again about the power of music. “I saw a
patient, one I call ‘Jimmy,’ who had lost so much memory he couldn’t remember people or events, but he had a good memory for music.”
Jimmy would be the first person Sacks met who could remember music quite well but only remember things he’d seen for just a few seconds. But Jimmy would not be the last case or the most extreme case like this. That would be Clive. Clive Waring.
Clive was an eminent musician and musicologist in England, an expert on Renaissance music, who in 1984 had devastating encephalitis due to herpes—shingles. This had the effect of destroying much of his memory; in particular, it destroyed what’s sometimes called event memory, or episodic memory, so that he couldn’t remember what had happened five seconds before.
The illness also deleted all the memories Clive had of the two or three decades before his encephalitis. At best, those days were but hazy apparitions. “He probably seemed to have no reliable memories since childhood. He didn’t recognize the room in which he was. And so it came as a great surprise, given this utter devastation, when it turned out that his memory for music and his ability to sing, to play the organ or piano, to conduct an orchestra or choir, was brilliant and quite unimpaired.”
Even with devastating brain damage, Clive could sit down at the piano and play a whole piece of music from beginning to end. He could stand before musicians and conduct an entire orchestra “and beautifully, turning to all the different sections of the orchestra and, obviously, knowing the piece in great detail. When he conducts an orchestra or a choir, when he sings, he seems absolutely normal. You wouldn’t think that anything was the matter. But five or ten seconds after he’s finished, he’ll have no recollection of it. And sometimes if you ask him, ‘Do you know such-and-such a piece?’ or ‘Do you know this particular Bach prelude and fugue?’ he’ll say no. But if you start him on one note, then he’s got it. So he’s not entirely conscious of what he has.”
Clive will also forget faces. A few seconds after he meets you, he will not remember having met you.
“You might not realize this at first from the charming way in which he greets people. He improvises his greetings, but he doesn’t genuinely recognize anybody except his wife. The two of them were married a little bit before his encephalitis, and they’re still very much in love.
Clive does not recognize his wife, though, when she walks by. But he does remember her “sound.”
“He recognizes her footsteps. He recognizes her voice. He recognizes her gestures, her approach. And above all he recognizes her kisses. So he recognizes sort of physical and auditory contact with his wife.”
Sacks says Clive has retained other small vestiges of normality. He is able to dress himself “very nattily and to talk fluently and to walk around” and perform all sorts of various skills. But it’s Clive’s preserved musical powers that very much interest Sacks.
“People sometimes use a different term and call this procedural memory. But whether this rather narrow-sounding term can be expanded to include all of his musical powers, I don’t know.”
Sacks says he is interested in other memory-musical phenomena such as musical hallucinations, “where sometimes relatively unmusical people will hear something in great detail, a detail they never knew that they knew. Typically in musical hallucinations, the music hallucinated is usually music from early life, sometimes very, very early life. I begin to get the impression that musical memory can be extremely exact and faithful in pitch, in time, and all the subtleties in almost everybody.”
Sacks says that while most of Clive’s musical skills were learned before his brain was injured—“it’s more a preservation of skills and knowledge, musical knowledge, than any enlargement of them”—he thinks that Clive and some other people with amnesia can continue to learn.
“Some years ago, in my Anthropologist on Mars book, I’d described an amnesic young man musically inclined called Greg and how on
one occasion I took him along to the Grateful Dead. He’d been a Deadhead in the 1960s. He sang along with the earlier songs. He was very puzzled by the later songs. He said it’s like the music of the future, which in a way it was for him. Later he had no recollection of having been to Madison Square Garden, but he did have some recollection of the new music. And so I think that new music can be learned by the amnesic.”
Sacks has known about Clive since the mid-1980s. Most of the research about Clive’s unique musical abilities involve merely observing him as he goes about his life. But Sacks believes just watching him and taking notes is not scientific enough.
“He also needs other sorts of studies like brain imagery to show exactly what is going on in his brain when he perceives music, when he recollects music, when he plays music. The techniques like this weren’t available twenty years ago.”
Sacks uses techniques common to studying brains today—brain scanners—which can observe the parts of the brain as they become activated by music. He’s found that music is widely infused throughout the brain.
“So many parts of the brain light up when music is being played or imagined or hallucinated or recollected. It’s not only in many areas of the cortex on both sides.” He noticed that the music energizes the cerebellum and the basal ganglia—near the brain stem—which, he says, may be involved in the sense of rhythm and timing, “which, for example, is knocked out in Parkinson’s disease, which is why music is so important for people like that.”
Whether there’s any sort of final music area, the way there is a language area, people are not certain. But there may be one in one of the temporal lobes.
As a clinician, Sacks continues to study the surprising effects that music has on the brain. He has met people in whom seizures have been elicited by music.
“I saw a lady who was originally found unconscious with a bitten
tongue by the radio. The last thing she could remember was that there had been Neapolitan songs on the radio. No attention was paid to this but then when this occurred again and again, it became clear that Neapolitan songs—and no other music—were a specific trigger for her, and again this must tell one something about the brain.
“I did recently write about a patient, a woman, who had become aphasic—who had lost language—but had not lost her musical abilities and how sometimes she could get the words of a song, not only the music of a song but also the words of a song. This at least pleased her very much because it showed that the language was there somewhere, whether or not it could be disembedded from the song.”
MUSIC THERAPY
If music has the power to evoke such hidden talents in brain-damaged people, perhaps it has healing powers too. Many physicians, says Sacks, use music as therapy.
“In 1973, when a documentary of Awakenings was made, when the film director came to our hospital, he said, ‘Can I meet the music therapist? She seems to be the most important person around here.’ At one of the hospitals where I work, we have an institute for music and neurological function. And I think music therapists are very important, both in practice and as researchers and opening doors, and I have great respect for them.”
One region ripe for research, says Sacks, are the brain’s frontal lobes, the creative, inquisitive part of the brain. Music may offer a window inside. We are only just beginning to study creativity and what goes on in the brain, says Sacks. “Certainly the improvising musician is the nicest, and, in a way, simplest and most accessible example of creativity at work, and I agree it would be lovely to do such studies.
“So I think of music as an unexpected way of getting into the mind and brain, in all sorts of ways, in all sorts of directions. And it’s
relatively new. If you look at a neurology or neuroscience book of twenty, twenty-five years ago, you don’t find any reference to music.”
Yet music, says Sacks, is “as rich as language. I think we are a musical species, no less than a language species,” but the musical side of our species has been ignored, he says, “or treated anecdotally” because we don’t think it’s important to survival of the species.
“Certainly, Steven Pinker [cognitive psychologist at Harvard] has referred to music as auditory cheesecake—or just something which happens. And I suspect, as some others do, that the origins of music and speech go together, and the two of them coevolved. There’s certainly no culture in which music isn’t important, whether as a means of expression or communication or ritual or enjoyment.”
He raised his eyes languidly from the old black-letter volume which he had opened. “It is cocaine,” he said, “a seven-per-cent solution. Would you care to try it?”
—SHERLOCK HOLMES,
The Sign of the Four
If you look back in history, whenever we didn’t understand a disease or an illness, our response to people who got sick was always the same: We blamed the person with the illness. There was a time when people who had cancer were stigmatized. No one would dare say the c-word out loud. The same was true, and still is, to a certain extent, for mental illness, such as depression.
But as we become more enlightened about disease and disease processes, we have come to understand that cancer or mental illness is not a moral failure or a character weakness but a disease. The same can be said about our attitudes toward addiction. Only now are we beginning to understand that addiction is a disease—that there are real biophysical changes that occur in the brain that can make some
people vulnerable to becoming addicted and make it nearly impossible for them to quit; time after time, they relapse.
“There is no question that addiction is a disease,” says Dr. Nora Volkow, director of the National Institute on Drug Abuse, part of the National Institutes of Health. “Research has shown that it affects the brain in very specific ways that can help us understand why, through this damage, the person loses control of his or her action, as it relates to taking drugs. Despite this, it is still not accepted as a disease by most people.”
Even physicians, at times, have trouble. “Unfortunately, yes, indeed, even physicians do not recognize that sometimes it’s a disease.” One of the problems is understanding when a habit becomes an addiction, when it crosses the line from just being an annoying trait to a life-threatening one. “We have a number of things that we look for, in terms of when we begin to call something an addiction,” says Dr. Shelly Greenfield, associate professor of psychiatry at Harvard Medical School and associate clinical director of the McLean Hospital Alcohol and Drug Abuse Treatment Program, in Boston. “We’re really looking for adverse consequences in the person’s life, such as a person spending more time using the substance, or using it in greater quantities than they want to, giving up activities because they’re using the substance or recovering from it. They continue to use something in spite of the fact that they know it jeopardizes their physical or their mental health.”