This is borne out, dramatically, and often comically, by the examples Penfield gives. The following list is extracted from his great final paper:
‘White Christmas’ (Case 4). Sung by a choir ‘Rolling Along Together’ (Case 5). Not identified by patient, but recognised by operating-room nurse when patient hummed it on stimulation ‘Hush-a-Bye Baby’ (Case 6). Sung by mother, but also thought to be theme-tune for radio-programme ‘A song he had heard before, a popular one on the radio’ (Case 10) ‘Oh Marie, Oh Marie’ (Case 30). The theme-song of a radio-programme ‘The War March of the Priests’ (Case 31). This was on the other side of the ‘Hallelujah Chorus’ on a record belonging to the patient ‘Mother and father singing Christmas carols’ (Case 32) ‘Music from Guys and Dolls’ (Case 37) ‘A song she had heard frequently on the radio’ (Case 45) ‘I’ll Get By’ and ‘You’ll Never Know’ (Case 46). Songs he had often heard on the radio In each case—as with Mrs O’M.—the music was fixed and stereotyped. The same tune (or tunes) were heard again and again, whether in the course of spontaneous seizures, or with electrical stimulation of the seizure-prone cortex. Thus these tunes were not only popular on the radio, but equally popular as hallucinatory seizures: they were, so to speak, the ‘Top Ten of the Cortex’.
Is there any reason, we must wonder, why particular songs (or scenes) are ‘selected’ by particular patients for reproduction in their hallucinatory seizures? Penfield considers this question and feels that there is no reason, and certainly no significance, in the selection involved:
It would be very difficult to imagine that some of the trivial incidents and songs recalled during stimulation or epileptic discharge could have any possible emotional significance to the patient, even if one is acutely aware of this possibility.
The selection, he concludes, is ‘quite at random, except that there is some evidence of cortical conditioning’. These are the words, this is the attitude, so to speak, of physiology. Perhaps Penfield is right—but could there be more? Is he in fact ‘acutely aware’, aware enough, at the levels that matter, of the possible emotional significance of songs, of what Thomas Mann called the ‘world behind the music’? Would superficial questioning, such as ‘Does this song have any special meaning for you?’ suffice? We know, all too well, from the study of ‘free associations’ that the most seemingly trivial or random thoughts may turn out to have an unexpected depth and resonance, but that this only becomes evident given an analysis in depth. Clearly there is no such deep analysis in Penfield, nor in any other physiological psychology. It is not clear whether any such deep analysis is needed—but given the extraordinary opportunity of such a miscellany of convulsive songs and scenes, one feels, at least, that it should be given a try.
I have gone back to Mrs O’M. briefly, to elicit her associations, her feelings, to her ‘songs’. This may be unnecessary, but I think it worth trying. One important thing has already emerged. Although, consciously, she cannot attribute to the three songs special feeling or meaning, she now recalls, and this is confirmed by others, that she was apt to hum them, unconsciously, long before they became hallucinatory seizures. This suggests that they were already unconsciously ‘selected’—a selection which was then seized on by a supervening organic pathology.
Are they still her favourites? Do they matter to her now? Does she get anything out of her hallucinatory music? The month after I saw Mrs O’M. there was an article in the New York Times entitled ‘Did Shostakovich Have a Secret?’ The ‘secret’ of Shostakovich, it was suggested—by a Chinese neurologist, Dr Dajue Wang—was the presence of a metallic splinter, a mobile shell-fragment, in his brain, in the temporal horn of the left ventricle. Shostakovich was very reluctant, apparently, to have this removed:
Since the fragment had been there, he said, each time he leaned his head to one side he could hear music. His head was filled with melodies—different each time—which he then made use of when composing.
X-rays allegedly showed the fragment moving around when Shostakovich moved his head, pressing against his ‘musical’ temporal lobe, when he tilted, producing an infinity of melodies which his genius could use. Dr R.A. Henson, editor of Music and the Brain (1977), expressed deep but not absolute scepticism: ‘I would hesitate to affirm that it could not happen.’
After reading the article I gave it to Mrs O’M. to read, and her reactions were strong and clear. ‘I am no Shostakovich,’ she said. ‘I can’t use my songs. Anyhow, I’m tired of them—they’re always the same. Musical hallucinations may have been a gift to Shostakovich, but they are only a nuisance to me. He didn’t want treatment—but I want it badly.’
I put Mrs O’M. on anticonvulsants, and she forthwith ceased her musical convulsions. I saw her again recently, and asked her if she missed them. ‘Not on your life.’ she said. ‘I’m much better without them.’ But this, as we have seen, was not the case with Mrs O’C, whose hallucinosis was of an altogether more complex, more mysterious, and deeper kind and, even if random in its causation, turned out to have great psychological significance and use.
With Mrs O’C. indeed the epilepsy was different from the start, both in terms of physiology and of ‘personal’ character and impact. There was, for the first 72 hours, an almost continuous seizure, or seizure ‘status’, associated with an apoplexy of the temporal lobe. This in itself was overwhelming. Secondly, and this too had some physiological basis (in the abruptness and extent of the stroke, and its disturbance of deep-lying emotional centres: uncus, amygdala, limbic system, etc., deep within, and deep to the temporal lobe), there was an overwhelming emotion associated with the seizures and an overwhelming (and profoundly nostalgic) content—an overwhelming sense of being-a-child again, in her long-forgotten home, in the arms and presence of her mother.
It may be that such seizures have both a physiological and a personal origin, coming from particular charged parts of the brain but, equally, meeting particular psychic circumstances and needs: as in a case reported by Dennis Williams (1956):
A representative, 31 (Case 2770), had major epilepsy induced by finding himself alone among strangers. Onset: a visual memory of his parents at home, the feeling ‘How marvellous to be back’. It is described as a very pleasant memory. He gets gooseskin, goes hot and cold, and either the attack subsides or proceeds to a convulsion.
Williams relates this astounding story baldly, and makes no connection between any of its parts. The emotion is dismissed as purely physiological—inappropriate ‘ictal pleasure’—and the possible relation of ‘being-back-home’ to being lonely is equally ignored. He may, of course, be right; perhaps it all is entirely physiological; but I cannot help thinking that if one has to have seizures, this man, Case 2770, managed to have the right seizures at the right time.
In Mrs O’C.’s case the nostalgic need was more chronic and profound, for her father died before she was born, and her mother before she was five. Orphaned, alone, she was sent to America, to live with a rather forbidding maiden aunt. Mrs O’C. had no conscious memory of the first five years of her life—no memory of her mother, of Ireland, of ‘home’. She had always felt this as a keen and painful sadness—this lack, or forgetting, of the earliest, most precious years of her life. She had often tried, but never succeeded, to recapture her lost and forgotten childhood memories. Now, with her dream, and the long ‘dreamy state’ which succeeded it, she recaptured a crucial sense of her forgotten, lost childhood. The feeling she had was not just ‘ictal pleasure’, but a trembling, profound and poignant joy. It was, as she said, like the opening of a door—a door which had been stubbornly closed all her life.