Conversation was far from easy, partly because of Mrs O’C.’s deafness, but more because I was repeatedly drowned out by songs— she could only hear me through the softer ones. She was bright, alert, not delirious or mad, but with a remote, absorbed look, as of someone half in a world of their own. I could find nothing neurologically amiss. None the less, I suspected that the music was ‘neurological’.
What could have happened with Mrs O’C. to bring her to such a pass? She was 88 and in excellent general health with no hint of fever. She was not on any medications which might unbalance her excellent mind. And, manifestly, she had been normal the day before.
‘Do you think it’s a stroke, Doctor?’ she asked, reading my thoughts.
‘It could be,’ I said, ‘though I’ve never seen a stroke like this. Something has happened, that’s for sure, but I don’t think you’re in danger. Don’t worry, and hold on.’
‘It’s not so easy to hold on,’ she said, ‘when you’re going through what I’m going through. I know it’s quiet here, but I am in an ocean of sound.’
I wanted to do an electroencephalogram straightaway, paying special attention to the temporal lobes, the ‘musical’ lobes of the brain, but circumstances conspired to prevent this for a while. In this time, the music grew less—less loud and, above all, less persistent. She was able to sleep after the first three nights and, increasingly, to make and hear conversation between ‘songs’. By the time I came to do an EEG, she heard only occasional brief snatches of music, a dozen times, more or less, in the course of a day. After we had settled her and applied the electrodes to her head, I asked her to lie still, say nothing and not sing to herself, but to raise her right forefinger slightly—which in itself would not disturb the EEG—if she heard any of her songs as we recorded. In the course of a two-hour recording, she raised her finger on three occasions, and each time she did this the EEG pens clattered, and transcribed spikes and sharp waves in the temporal lobes of the brain. This confirmed that she was indeed having temporal-lobe seizures, which, as Hughlings Jackson guessed and Wilder Pen-field proved, are the invariable basis of ‘reminiscence’ and experiential hallucinations. But why should she suddenly develop this strange symptom? I obtained a brainscan, and this showed that she had indeed had a small thrombosis or infarction in part of her right temporal lobe. The sudden onset of Irish songs in the night, the sudden activation of musical memory-traces in the cortex, were, apparently, the consequence of a stroke, and as it resolved, so the songs ‘resolved’ too.
By mid-April the songs had entirely gone, and Mrs O’C. was herself once again. I asked her at this point how she felt about it all, and, in particular, whether she missed the paroxysmal songs she heard. ‘It’s funny you should ask that,’ she said with a smile. ‘Mostly, I would say, it is a great relief. But, yes, I do miss the old songs a little. Now, with lots of them, I can’t even recall them. It was like being given back a forgotten bit of my childhood again. And some of the songs were really lovely.’
I had heard similar sentiments from some of my patients on L-Dopa—the term I used was ‘incontinent nostalgia’. And what Mrs O’C. told me, her obvious nostalgia, put me in mind of a poignant story of H.G. Wells, ‘The Door in the Wall’. I told her the story. ‘That’s it,’ she said. ‘That captures the mood, the feeling, entirely. But my door is real, as my wall was real. My door leads to the lost and forgotten past.’
I did not see a similar case until June last year, when I was asked to see Mrs O’M., who was now a resident at the same home. Mrs O’M. was also a woman in her eighties, also somewhat deaf, also bright and alert. She, too, heard music in the head and sometimes a ringing or hissing or rumbling; occasionally she heard ‘voices talking’, usually ‘far away’ and ‘several at once’, so that she could never catch what they were saying. She hadn’t mentioned these symptoms to anybody, and had secretly worried, for four years, that she was mad. She was greatly relieved when she heard from the Sister that there had been a similar case in the Home some time before, and very relieved to be able to open up to me.
One day, Mrs O’M. recounted, while she was grating parsnips in the kitchen, a song started playing. It was ‘Easter Parade’, and was followed, in swift succession, by ‘Glory, Glory, Hallelujah’ and ‘Good Night, Sweet Jesus’. Like Mrs O’C., she assumed that a radio had been left on, but quickly discovered that all the radios were off. This was in 1979, four years earlier. Mrs O’C. recovered in a few weeks, but Mrs O’M.’s music continued, and got worse and worse.
At first she would hear only these three songs—sometimes spontaneously, out of the blue, but for certain if she chanced to think of any of them. She tried, therefore, to avoid thinking of them, but the avoidance of thinking was as provocative as the thinking.
‘Do you like these particular songs?’ I asked, psychiatrically. ‘Do they have some special meaning for you?’
‘No,’ she answered promptly. ‘I never specially liked them, and I don’t think they had any special meaning for me.’
‘And how did you feel when they kept going on?’
‘I came to hate them,’ she replied with great force. ‘It was like some crazy neighbour continually putting on the same record.’
For a year or more, there was nothing but these songs, in maddening succession. After this—and though it was worse in one way, it was also a relief—the inner music became more complex and various. She would hear countless songs—sometimes several simultaneously; sometimes she would hear an orchestra or choir; and, occasionally, voices, or a mere hubbub of noises.
When I came to examine Mrs O’M. I found nothing abnormal except in her hearing, and here what I found was of singular interest. She had some inner-ear deafness, of a commonplace sort, but over and above this she had a peculiar difficulty in the perception and discrimination of tones of a kind which neurologists call amusia, and which is especially correlated with impaired function in the auditory (or temporal) lobes of the brain. She herself complained that recently the hymns in the chapel seemed more and more alike so that she could scarcely distinguish them by tone or tune, but had to rely on the words, or the rhythm.[14] And although she had been a fine singer in the past when I tested her she sang flat and out of key. She mentioned, too, that her inner music was most vivid when she woke up, becoming less so as other sensory impressions crowded in; and that it was least likely to occur when she was occupied—emotionally, intellectually, but especially visually. In the hour or so she was with me, she heard music only once—a few bars of ‘Easter Parade’, played so loud, and so suddenly, she could hardly hear me through it.
When we came to do an EEG on Mrs O’M. it showed strikingly high voltage and excitability in both temporal lobes—those parts of the brain associated with the central representation of sounds and music, and with the evocation of complex experiences and scenes. And whenever she ‘heard’ anything, the high voltage waves became sharp, spike-like, and frankly convulsive. This confirmed my thought that she had too a musical epilepsy, associated with disease of the temporal lobes.
But what was going on with Mrs O’C. and Mrs O’M.? ‘Musical epilepsy’ sounds like a contradiction in terms: for music, normally, is full of feeling and meaning, and corresponds to something deep in ourselves, ‘the world behind the music’, in Thomas Mann’s phrase—whereas epilepsy suggests quite the reverse: a crude, random physiological event, wholly unselective, without feeling or meaning. Thus a ‘musical epilepsy’ or a ‘personal epilepsy’ would seem a contradiction in terms. And yet such epilepsies do occur, though solely in the context of temporal lobe seizures, epilepsies of the reminiscent part of the brain. Hughlings Jackson described these a century ago, and spoke in this context of ‘dreamy states’, ‘reminiscence’, and ‘physical seizures’:
14
A similar inability to perceive vocal tone or expression (tonal agnosia) was shown by my patient Emily D. (see ‘The President’s Speech’, Chapter Nine).