SPIEGEL Interview with Neurologist Oliver Sacks 'I Think of Us as a Musical Species'

Oliver Sacks' new book "Musicophilia" deals with the mysteries of music and the brain. SPIEGEL speaks with him about the Jewish patient who had hallucinations of Nazi marching bands, the Tourette's percussion orchestra and about why he wants to kill people with iPods.

SPIEGEL: Dr. Sacks, close your eyes and think about music. What do you hear?

Oliver Sacks: A Chopin mazurka is coming to me. It is one in B flat major, and I feel an itch in my hands to play it. I can sort of see the keyboard in front of me...

SPIEGEL: The tune, the mazurka, the keyboard. All of these seem to be present all of a sudden. How can that be?

Sacks: Don't all of us probably have latent powers and passions of one sort or another that can hit us unexpectedly?

SPIEGEL: You are obviously aware of your own passion for music. However, in your latest book, "Musicophilia," you claim that music can strike even completely unmusical people out of the blue.

Sacks: Yes, that's how it was with Tony, a patient of mine. Tony was a busy surgeon who had no particular interest in music and no special talent for music. But then, in fall 1994, he was transformed after he had been struck by lightning and was clinically dead for a brief period of time. He had a cardiac arrest probably for 30 seconds, and his brain didn't get enough oxygen. And, since then, he has been a changed man, in that he now has a passion for music, and he’s discovered a considerable talent for music. He is also, to use his own word, 'obsessed' -- or 'possessed' -- by music. It comes with a certain mystical or religious feeling that it is a gift from heaven.

SPIEGEL: Do you have a rational explanation for what might have happened to his brain?

Sacks: I'm sure that the lack of oxygen caused some type of reorganization in Tony's brain. Nerve cells were presumably damaged or there was some new growth, so that certain parts of the brain that were previously inactive have become active -- and have become constantly active. He feels he hears piano music all the time, his own compositions. This is not dissimilar to what happens to people with frontotemporal dementia, but in that case there's a very clear mechanism whereby damage in this area removes the inhibition in other areas. With Tony, though, it's not clear.

SPIEGEL: Has Tony been possessed, or has he become a good player?

Sacks: He is no (acclaimed Russian-American pianist Vladimir) Horowitz, but he can play Chopin scherzos well enough to fill a concert hall and attract an audience, and he will always play some of his own compositions. His own latest composition is called the "Lightning Sonata," an attempt to put in musical terms some of the strange events of 1993.

SPIEGEL: Can such people suppress their musical urges for years and then have it set free by dementia or even a bolt of lightning?

Sacks: I think the brain is a dynamic system in which some parts control or suppress other parts. And if perhaps one has damage in one of the controlling or suppressing areas, then you may have the emergence or eruption of something, whether it is a seizure, a criminal trait –- or even a sudden musical passion.

SPIEGEL: And how is this expressed? Do affected people sing all day long?

Sacks: The powers that tend to come out are of a highly concrete and sensory quality. There will typically be a flow of patterns, perhaps musical patterns, perhaps visual patterns, perhaps numerical patterns. People affected by this will probably enjoy it because it seems to be a gift, something which has been added to their life, although it could be intrusive in the way that hallucinations can sometimes be intrusive.

SPIEGEL: What does the human way of dealing with music tell you about the human mind and its workings?

Sacks: What is apparent is that there is no one part of the brain which recognizes or responds emotionally to music. Instead, there are many different parts responding to different aspects of music: to pitch, to frequency, to timbre, to tonal intervals, to consonance, to dissonance, to rhythm, to melodic contour, to harmony. So, if you do brain studies, you find that the same areas which are active in listening to music are also active when you imagine music, and this includes the motor areas, too. That explains why earlier, even though I was only thinking of the mazurka, I was thinking in terms of movement.

SPIEGEL: How is it, then, that some people can be prodigies, while others go that extra mile and practice every day but always remain average?

Sacks: It's clear that there is a great deal of variation, much more so than with language. With language, every human being -- even quite severely retarded people -- acquires language, and grammatically competent language, if they're exposed to it. But not everyone can master a musical instrument. I'm not sure how to explain it. But even though there's variation, I think there is no culture in which music is not very important and central. That's why I think of us as a sort of musical species.

SPIEGEL: Are we really the only musical species? Legend has it, for example, that cows give more milk when they listen to Mozart...

Sacks: First of all, I'm not a veterinarian, and I don't possess a dog, although I would like to. I tend to stick to my own observations, which are about patients. Now, if a man with a dog sits quietly enjoying music and smiling, his dog might sit down beside him and smile, too. But who knows whether the dog is having a comparable experience or whether the dog is simply happy that his master is happy. My impression is that a sense of rhythm, which has no analog in language, is unique and that its correlation with movement is unique to human beings. Why else would children start to dance when they're two or three? Chimpanzees don't dance.

SPIEGEL: According to Steven Pinker, a psychologist at Harvard University, music is useless in an evolutionary sense and has no adaptive value.

Sacks: Steven Pinker is himself very musical, and I think he would be very unhappy if music suddenly disappeared from his life. But, to deal with that question, my feeling is that certain aspects of music are hard-wired, built-in, biological, universal and arose in the course of evolution. For this reason, even babies just a few weeks old wince when certain musical intervals, like a major second, are performed. Beyond the sort of very general universals of timing and tone, I suspect that music is a cultural construct which makes use of whatever is available in the brain.

SPIEGEL: The linguist Noam Chomsky proposed a similar mechanism for the acquisition of language. According to him, babies are born with a sense for grammar that allows them to quickly pick up the respective language in their environment.

Sacks: I suspect that music has qualities both of speech and writing -- partly built in, partly individually constructed -- and this goes on all through one's life. So, if one is used to Western European music, you may not be able to make anything of Hindu music. But then, if you continue to listen, you start to get it. You start to see patterns.

The Musical Brain

SPIEGEL: If you look at the brain of a musician and compare it to a brain of a not-so-musical person, what do you see?

Sacks: The differences can be very, very striking. The neurologist Gottfried Schlaug in Boston has been making these comparisons for several years using MRIs in the brain and measuring carefully the size or thickness of gray matter. He has found many different things. The corpus callosum between the hemispheres, for example, tends to be larger in musicians. Auditory areas are often larger, too, but so are motor areas, and there may be enlargement of gray matter in the cerebellum -- to the extent that you can even see it with your bare eyes.

SPIEGEL: Can differences like that reveal whether someone is a born or a trained musician?

Sacks: This is not always easy to say because gifted musicians are likely to be highly trained and training early. But one can demonstrate that some of these changes happen with training. So the power of music and the plasticity of the brain go together very strikingly, especially in young people.

SPIEGEL: In rare cases, people can suddenly lose their sense of music. Did you encounter any of those cases?

Sacks: Oh yes. Since there are particular parts of the brain associated with particular aspects of music, they can be damaged through an accident, a stroke or a tumor. I have some patients who have experienced this. Incidentally, the sense of music might get lost, but it might also get enhanced.

SPIEGEL: As happened to Tony, who was struck by lighting?

Sacks: Yes. I once had a patient, a woman, who had a tumor in her right temporal lobe, and when that was removed, she found herself much more musical.

SPIEGEL: Was she happy about that?

Sacks: She seemed to enjoy it a great deal. In any case, it was much more pleasant than something that happened to me many years ago, when I lost my sense of music for a short time after a migraine attack.

SPIEGEL: So you don't need to have a tumor or a stroke for that to happen, then?

Sacks: Not at all. Usually with migraines one has visual disturbances of one sort or another, but I had a musical disturbance. I had been listening to a piece in the car, a Chopin ballad, and it seemed to lose all its tone, and finally it became a sort of flat banging of a rather metallic sort, although the rhythm was preserved. I was very puzzled about it, and then it came back after about 10 minutes. And I phoned the radio station and said, "What happened? Was that a joke? Was that an experiment?" They said, "You'd better check your car radio." But it happened again when I was at home and not listening to the radio.

SPIEGEL: Have you ever had a musical hallucination?

Sacks: No. But for people who do have them, it can be very startling. You look around. You're puzzled. You wonder if other people are hearing it. You look to see: Is the radio on? Is there a band outside? There's an overwhelming feeling of an external source. It may also be very loud, too, physically loud. You may actually be deafened by a hallucination.

SPIEGEL: Can these hallucinations be connected to deafness or hearing loss?

Sacks: In some cases, yes. It seems that the brain always has to be active, and if the auditory parts of the brain are not getting sufficient input, then they may start to create hallucinatory sounds on their own. Although it is curious that they do not usually create noises or voices; they create music.

SPIEGEL: What kind of music?

Sacks: It could be anything: sometimes hymns, sometimes popular tunes, and often melodies that were in the culture during one's childhood. Occasionally, it can be rather frightening, as it was with one patient I describe, who heard Nazi marching songs which terrified him because he was a Jewish boy growing up in Hamburg in the 1930s. Fortunately, that was then replaced by Tchaikovsky.

SPIEGEL: How do you treat patients with music hallucinations?

Sacks: I may suggest some further tests, but basically I think my role is a reassuring one, to say: You're not crazy, and there is no similarity between this and hearing voices, like psychotic schizophrenic voices. Sometimes very small doses of tranquilizers or anticonvulsants can be useful. They just generally dampen the excitability a bit.

SPIEGEL: You quote the German Romantic writer Novalis, who wrote that every disease is a musical problem and every cure is a musical solution. Can music be a cure?

Sacks: Absolutely, and in many different ways. It was this which attracted my attention as a physician some 40 years ago with the patients I describe in my book "Awakenings." These were people suffering from very severe Parkinson's, who were often completely motionless. They couldn't initiate movement by themselves, but music liberated them. They could dance, they could sing, they could do completely normal things. The rhythm of music is very, very important for people with Parkinson's, and this may go back to what we were saying before about this human proclivity to move with rhythm -- even if you have Parkinson's. But it's also very important with other sorts of patients, such as patients with Tourette's syndrome. Music helps them bring their impulses and tics under control. There is even a whole percussion orchestra made up exclusively of Tourette's patients.

SPIEGEL: Music even appears to have a positive effect on people suffering from Alzheimer's.

Sacks: Right. Even when other powers have been lost and people may not even be able to understand language, they will nearly always recognize and respond to familiar tunes. And not only that. The tunes may carry them back and may give them memory of scenes and emotions otherwise unavailable for them.

SPIEGEL: So does this mean that music is their only connection to the outside world?

Sacks: I would actually say their only connection to the inner world.

SPIEGEL: You say that people shouldn't read while listening to music because music challenges your brain all the time. What do you think when you see people running all over the place with iPods?

Sacks: I want to kill them.

SPIEGEL: Why?

Sacks: Not long ago, I was on my bicycle, when I saw a woman with earphones on, who was obviously thinking of crossing the bicycle path. I rang my bell; she didn't hear it. I have a police whistle; she didn't hear it. Then she jumped in front of me, and I had to jam on the brakes. I went over the handlebars and got quite injured. So, although I think it is wonderful to have the whole world of music available in something that small and to have it conveyed with such fidelity almost straight into the brain, I think the technology is also a danger.

SPIEGEL: Are you not over-dramatizing a little?

Sacks: Don't you think one has to be careful about walking around in the real world functionally deaf? My neighborhood, Greenwich Village, used to be nicer. There used to be more street life. People used to speak to one another. And now it is as if they're all hallucinating. They're all speaking to invisible presences on cell phones, listening to invisible music.

SPIEGEL: But can't invisible music make us happy, too?

Sacks: Music originally had a social function. You were in church, in a concert hall, a marching band; you were dancing. I'm concerned that music could be too separated from its roots and just become a pleasure-giving experience, like a drug.

SPIEGEL: Doctor Sacks, thank you for this interview.

Interview conducted by Samiha Shafy and Jörg Blech.

Oliver Sack's "Musicophilia: Tales of Music and the Brain"  will be published in German in June.