In the preface of Oliver Sacks’ landmark book Musicophilia, he muses about how human interactions with music might puzzle a highly intelligent alien being with no frame of reference conjuring a scene from the world of Arthur C. Clarke. Science fiction aside, music is central to human existence, and yet on the surface it’s confounding trying to discern its purpose. Music can touch us in ways nothing else can. It can provide great solace. It can bring us to tears. It can excite us and inspire us. It can stimulate the brain and enhance learning. It can also torment us. Music can have these effects on us just by listening as well as in the course of making music. In the face of certain brain injuries or disease, it can also provide insights helping with diagnosis and can reach people who are otherwise uncommunicative. Drawing on extensive case studies, Dr. Sacks instructs, entertains, and enlightens readers on the complexities of human perceptions of music and just how important music is in innumerable circumstances. While this book will fascinate any musician wanting to understand their own musical drive, it will also delight non-musicians by opening up a whole world of perception they previously took for granted.
Oliver Sacks was a world-renowned neurologist and psychiatrist attuned to the various facets of brain physiology and sensory perception. He was also a classically trained pianist who, over time, incorporated a person’s perception of music into his practice not only for diagnostic purposes, but he also used it for therapeutic treatment. He worked closely with music therapists in clinical settings helping to expand the understanding of the field. As an author, Dr. Sacks was best known for his book Awakenings (later made into a major motion picture starring Robin Williams as Sacks) which explored his discovery of the use of L-dopa on post-encephalitic parkinsonian patients in treatments to “awaken” them. While it turned out that the effects of L-dopa were temporary, he found that music could also reach most of them in unexpected ways.
Musicophilia is broken into four main parts including:
Each of these sections are further broken into topical chapters discussing patients from Dr. Sacks’ years of practice. Rounding out the book, Sacks includes a vivid preface, a detailed bibliography, and a useful index. He also includes a wealth of detailed information as footnotes along the way. He carefully balances the technical aspects of his studies with an approachable narrative that immediately captures the reader’s attention. Sacks is as skilled at storytelling as he is in the sciences, making the complex interactions involved in our perceptions of music come alive.
In the preface, Sacks tantalizes readers with a colorful description of how perceiving music isn’t just auditory and emotional, it is also motoric often causing involuntary physical rhythmic responses. He intrigues the reader with an introduction to various distortions that many of us have experienced such as musical earworms as well as others that are far more intrusive when the complex neural machinery malfunctions in myriad ways. He makes it clear that the human connection to music is a species-wide phenomenon, and he notes that every culture has some relationship to music on multiple levels. Human attraction to music is innate, and it surfaces more or less from birth, developing and deepening over time.
In the first section of the book Sacks digs more deeply into how various injuries or diseases can intensify a person’s connection to music. The first chapter explores how, after being hit by lightning, a doctor suddenly became obsessed with music after previously having been somewhat indifferent to it. He spent most of his non-working or sleeping time pursuing music by playing the piano and composing new pieces. This particular case was the most extreme Sacks had seen, but he also describes other patients with a sudden onset of musical or artistic interests when they previously had none to speak of when afflicted with temporal lobe tumors. Other chapters within the first section explore other maladies such as musical seizures, in some cases causing a palpable fear of music. Sacks also discusses different types of musical hallucinations especially in patients with hearing loss. The brain can sometimes latch onto musical memories and replay them so intensely that they get in the way of normal living as external hearing decays. This goes well beyond the typical earworms most people experience at one time or another.
In the second section of the book, Sacks explores the wide range of normalcy with respect to musicality and music perception. He touches upon the advantages of studying music, recounting how it enhances learning:
“It has been said that even a brief exposure to classical music can stimulate or enhance mathematical, verbal, and visuospatial abilities in children – the so-called Mozart effect. This … beyond dispute is the effect of intensive early musical training on the young, plastic brain. Takako Fujioka and her colleagues, using magnetoencephalography to examine auditory evoked potentials in the brain, have recorded striking changes in the left hemisphere of children who have had only a single year of violin training, compared to children with no training.”
Even some capabilities that most people would find extraordinary are taken as normal for those who’ve not known life without them. These can include more common advantages such as absolute pitch. Most hearing people have some form of absolute pitch at birth, but in the majority of people, this ability disappears as an infant’s neural pathways develop prior to the initiation of formal musical training unless that training is started very early. Sacks also discusses other enhancements such as synesthesia which can also occur in some people, and for those so endowed, this seems perfectly normal. Sacks notes that it is difficult to determine exactly how common synesthesia is in the general population because of its seeming normalcy to those so affected. In the case of musical synesthesia, one of the more common manifestations is associating color to music. This particular combination has been sought for centuries, although there has been no universal physical correlation. Still, for those so enabled, one might always visualize a correlation between color and musical key, and Sacks has determined, through case studies, that there is indeed a physiological basis for such abilities. Sacks also discusses other abilities such as those of musical savants who can play a complex musical work after a single hearing.
In the third part of the book, Sacks ventures into some significant abnormalities where memory or movement are affected by music. Several studies beyond what Sacks has documented have been done involving stroke victims and how various musical abilities remain even when speech or memory are missing. The same has been shown for various brain infections. Sacks discusses one such patient who was an accomplished musician and musicologist and suffered a serious brain infection – a case of herpes encephalitis. After recovering from his illness, he was left with no episodic memory at all and lived completely in the moment as though just awakening from nothingness. Within moments, what he’d just done was gone. He had no history. Even so, he could speak and retained his piano skills, and his reading abilities. Although he had no memory of particular pieces, he could sit down at a piano and read and play pieces he’d learned beautifully. For the duration of a piece, he was whole and his former self playing with full expression. As soon as he finished the piece, he had no memory of having played it. Sacks also discusses patients with various movement disorders, and in some situations, they are able to harness the energy in their disorders and direct it into their musical performance. In a few of these cases, various musicians attribute some of their musical prowess to having these disorders. Sacks also discusses instances of musical dystonia, an affliction of the small muscles in the hands causing involuntary spasms that are sometimes an occupational hazard within the music community shortening or even ending performance careers. This is a serious and particularly debilitating kind of repetitive motion dysfunction.
In the final section of the book, Sacks moves into how emotion and identity are affected by or expressed through music. He covers a wide range of how music tugs at emotions, or with certain pathologies, stops doing so, but the most striking discussions are in the final two chapters of this section. In the penultimate chapter, he launches into a deep discussion of Williams syndrome through an enlightening recounting of a camp session for those afflicted with this genetic condition. As in Down syndrome, Williams syndrome manifests with various characteristic traits such as learning disabilities, a trusting, outgoing personality, and often enhanced musicality, both for listening and often for performance. In the final chapter, Sacks rounds out the book with a detailed discussion of dementia and the benefits of music therapy.
Musicophilia is one of those rare books that brings science and the humanities together in explaining something universal to all of us. Since we are all affected by music in some way, readers can appreciate this book for helping us all, no matter our musical prowess, to understand how and why this happens. In the process, Dr. Sacks gives us a deeper appreciation for something that has the power to bring us together in ways nothing else can.
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