Tucked away in the cabinets of Oliver Sacks’s Greenwich Village office are hundreds of small black notebooks, each filled with jottings and sketches, newspaper clippings, and photos. These are the accumulated reflections from a lifetime spent observing the extraordinary ways the human brain can misfire and misbehave: a man who believes his own leg does not belong to him, an autistic woman with a gift for understanding animals, and the man who mistook his wife for a hat—the case that inspired one of Sacks’s most famous books.
What people may not know about Sacks, however, is that the 74-year-old neurologist has spent much of his career regularly treating patients in mental-health facilities around New York City. Those patients have more commonplace problems such as dementia, sciatica, gait disorders, and seizures. He does love the challenge of an unusual case, of course, and those kinds of cases keep finding him. After his book Awakenings was adapted into an Oscar-nominated movie starring Robin Williams, the letters started pouring in, and they continue to today. Many are from people who are experiencing an interesting neurological phenomenon, or know someone who is. “My assistant Kate removes about nine-tenths of them,” Sacks says. “That leaves me about a thousand per year to read.”
In his latest book, Musicophilia: Tales of Music and the Brain, Sacks focuses on unusual cases having to do with music’s effects on the mind, such as a man who found relief from Tourette’s syndrome by playing the drums, and another who was driven to the edge by an unwelcome and unending tune that cycled uncontrollably through his head.
Seated at an aging wooden desk in front of a wall of tacked-up photos that include snapshots of past patients, Sacks spoke to DISCOVER about his recent musical investigations, his experiments with unlocking his own secret wells of creativity, and why he accentuates the positive with his patients whenever he can.
You are so famous for your books that most people don’t realize you have a day job. What is your regular work like?Well, I see a few patients. Some of them are in nursing homes or in chronic disease institutions, like Beth Abraham Hospital, where the events in the book Awakenings happened 40 years ago, or the Little Sisters of the Poor, whom I’ve also been with for almost 40 years. I also go to a clinic, and I do a few house calls, which I’m fond of. For example, I personally called on a lady with amusia [the inability to perceive musical tones and rhythms] in the Bronx.
A world without music: What is her life like?This is a delightful, intelligent lady, a former schoolteacher, who from her earliest years has been unable to recognize any piece of music, or indeed to hear it as music. She herself said to me, “You want to know what I experience when you play music? Go into the kitchen and throw the pots and pans around. That’s what I hear.” So although there are people who are considerably tone deaf, this is nothing compared to the absolute inability to perceive or conceive of music, which this otherwise gifted and articulate woman has. She was extremely relieved to find out that this so-called congenital amusia has a clear neurological basis. It’s not just in her mind; other people have it, although it’s pretty uncommon. She used to go to concerts with her husband. She says she wished she had been diagnosed 70 years earlier. She might have been spared a lifetime of being polite but bored, bewildered, and sometimes excruciated while listening to music.
In Musicophilia, you describe an intense personal experience with music 33 years ago, after you badly injured your leg while mountain climbing. How did music help you?
I found myself with this useless, floppy leg, and I was up at five or six thousand feet on a mountain. No one knew where I was—this was before the era of cell phones—and I had to try and save my life. I happened to have an umbrella with me, and I snapped off the top and splinted my leg. I tried to move myself down the side of the mountain, pushing myself along with my elbows, which was quite a cumbersome movement. Then I found the Volga Boatmen song going through my mind. I would make a big heave and a ho on each beat in the song. In this way, it seemed to me that I was being “music-ed” down the mountain. It became fun and easy and efficient. Everything was sort of coordinated and synchronized by the beat.
And music helped with your recovery, too?Yes, after I was safe and my leg had been put together, I was still out of action neurally. In an injury like this, the body image changes. There have been functional MRIs that show this sort of thing. If a limb has been inactive for a while, it starts to lose its representation as part of the body image that is mapped in the cerebral cortex, and becomes difficult to use. Sheer will alone may not be enough to get it back; you almost have to be tricked back into action. Something spontaneous has to happen. For me, one form of this was when music suddenly came to me—this tape I’d been listening to again and again [Mendelssohn’s violin concerto]. It sort of came to me like a hallucination and got me going, triggering the ability to walk again. I once saw an older woman who had had a broken hip; no one knew why her leg didn’t move. She told me that it had moved once, when she was listening to an Irish jig.
You’ve also found that people with aphasia—the inability to speak because of neurological damage—can sometimes sing.A good proportion can. So automatically when I see aphasia patients, I engage them in “Happy Birthday.” Beyond propositional speech and making sentences, there seems to be language embedded in song and in automatism of various sorts. I don’t like the word “automatism,” but when you recite a poem, it’s there, and it’s used as a different form of memory [than the memory of regular speech]. It’s used as procedural memory. But this doesn’t mean that it’s just mechanical.
Music seems to be involved with so many functions of the brain: It can aid memory, assist movement, and trigger emotions. Why is that?However music started—and it may be that the evolution of rhythmic sense is quite different from that of tonal sense—it has now taken up residence and demands many, many different parts of the brain, certainly more than language. And by the same token, music is very robust neurally. There are people with a huge amount of cerebral disease who are still responsive to music.
Does that suggest that music is somehow essential to human survival, or at least to social survival?This is a big question. I can only say that there is no culture without music. There are almost no individuals without music. The lady in the Bronx is a one-in-a-million sort of exception. And in every culture, music forms a social cement for dancing, for singing. It’s invariably part of ritual and religion, and then there are things like work songs and martial music. Steven Pinker said, “Music could vanish from our species and the rest of our lifestyle would be virtually unchanged.” I strongly disagree with that and I think no anthropologist in the world would agree with that.
You’ve been fascinated with music for so long—why are you only writing about it now?Going back 40 years, I was very struck by the therapeutic power of music with many of the patients I saw: Parkinson’s patients, patients with aphasia, patients with dementia. But just in the last 20 years, there has grown up an ability to examine the living brain when people are listening to music or imagining music or composing music and to define—in a way which would have been unimaginable 30 years ago—what goes on in many different parts of the brain when one listens to music, imagines music, composes music, et cetera. Although I was experiencing both the power of music and the varieties of musical experience 20 or 30 years ago, I couldn’t have given it the scientific backing which is possible today.
In Musicophilia, you argue that emotional responses to music may be distinct from other emotional reactions. What do you see as the difference?
I think the emotional responses to music can be unbelievably complex and mysterious and deep. You can be sort of agonized, sort of ecstatic, and you don’t know what’s happening. You can’t even say what the feeling is. The usual feelings just can’t begin to match the musical experience. On the clinical side, in some cases, people—maybe after a head injury or a stroke—suddenly cease to enjoy music, while still enjoying everything else, and while perceiving music perfectly well. And then there’s the opposite of this, which gives the title to my book: people who develop an oddly specific need for music—they must have it.
It seems strange that music can become a hunger, like the need for food or sleep or sex.I agree. And it can be very, very specific—because often, you don’t just want music; you’ve gotta have Brahms, or you have to have a particular pianist. That exact music will speak to your condition and will fill a particular void—and nothing else can.
There’s a notion that savant abilities may be universal or latent in all of us and could be released.
And other people are musical savants, with musical abilities far beyond the norm. What have you learned about them?Savants are people with extraordinary capacities of calculation or music or drawing, mixed with generally low intelligence—a very startling anomaly. I first saw savant syndromes in an institutionalized autistic population at Bronx Psychiatric Center. The savant I have seen in most detail is Steven Wiltshire. One really does have the feeling with him of something autonomous. There will be a brief sidelong glance at a landscape, and then he’s drawing it. He may be looking around as he’s drawing it; he’s whistling. There doesn’t seem to be concentrated attention. And it may be done in a very odd way. He doesn’t do a sketch first; he doesn’t do salient features. He will start at one edge of the paper and go over like that [Sacks makes a trilling noise and motions from one side of the page to the other]. He’s also a musical savant. Not only does he have absolute pitch, he is able to get the structure of a fugue. It’s very, very startling to see someone who is dazzling in one way and grossly defective in others. This disparity tends to be increased by practice and possibly obsession—because, of course, this may be the one highly pleasurable and rewarding thing in their lives.
What is happening in the brain of a person like that?Some neurologists think that what may go on in the savant may be a relative preservation and heightening of primitive perceptual and computational powers in the right hemisphere—powers of a sort that are normally inhibited with the development of abstract intelligence and language. If abstract intelligence and language don’t develop, it could be possible that they may be, in a word, freer. Something which might support this idea may be the late appearance of savant-like powers in people, say, with frontal temporal dementia; it is precisely with the decline of verbal and abstract intelligence that we sometimes see this emergence of artistic powers. There are much-discussed and somewhat disputed experiments in Australia, where a researcher named Allan Snyder is using TMS—transcranial magnetic stimulation—to try and damp down the left dominant temporal lobe. I tried this myself, but it just gave me a headache after 15 minutes. And I was actually slightly afraid of the effects of TMS on my own nervous system.
You stimulated your own brain in an attempt to unlock your creativity? What happened?I was asked to draw a dog. I’m very bad at drawing. And my dog—well, it doesn’t quite look like an amoeba, but it’s a diagrammatic quadruped. It could equally well be an elephant or a mouse, pretty much. The experimenters wanted to see whether I might lose some of this abstract formulaic quality and draw an appealing dog in profile. Maybe if I’d stayed with it longer . . . but I was getting this peculiar sort of face ache. I don’t know why. It may be an idiosyncratic reaction. But certainly, there’s a tantalizing notion that such savant abilities may be universal or latent in all of us, and could be released in certain circumstances. But if the release entails a loss of enunciation—of our higher powers—it may not be such a good bargain.
Have you ever tried anything else to alter your brain function?Well, I mention a rather autobiographic thing with amphetamines in a footnote in my new book—this is more than 40 years ago. [Sacks had experimented with massive doses of amphetamines.] I got into a very strange state for two weeks, a state in which I, who cannot draw, found myself able to do the most accurate anatomical drawings. I have a notebook from that time full of anatomical drawings of a sort I had never done before and have never done since. This also affected things like musical reproduction and sense of smell. I could recognize most people and most places by smell. And so I did have an experience myself of having various perceptual powers released. When it all disappeared, I had mixed feelings. It was a great relief, and also some regret. However, I think the amphetamines are terribly dangerous, and I’m glad I survived that time.
Some critics suggest that you romanticize your subjects—that you write sentimentally, even joyously, about some very sad cases. Why do you focus so much on the positive?Well, I want to draw attention to it, but it’s there with the negative. In the old-fashioned medical notes, one would write about the HPC, or “history of the present complaint.” The patient comes to a doctor because something is the matter; they have a complaint. And one goes through it with the patient, but one also wants at the same time to remind them of the powers which are preserved and which they can perhaps use and which can mitigate life. My interest is very much in rehabilitation. I won’t say “recovery.” And maybe rehabilitation sounds rather technical, but it’s making the fullest possible life under the circumstances.
One of the most dramatic examples of music and rehabilitation comes in the story of your patient Clive. Can you describe this case?Clive was an eminent musician and musicologist in England. In the mid-1980s he had a rare form of encephalitis caused by a virus, a herpes encephalitis. This caused massive destruction to various parts of his brain, but especially the temporal lobes and the hippocampal system, which is crucial for personal memories. As a result, when Clive recovered from the high fever—an acute symptom of the illness—he was profoundly amnesic; that’s to say he could not remember anything said to him or anything which happened in front of him for more than a few seconds, and there was also a retrospective deletion of memory. So what had happened for many years preceding this illness, and to some extent throughout his whole life, was gone. In a sense, he was a man without a memory. As such, he seemed utterly devastated and not there, very terrified and disorganized. But it was discovered by his wife, Deborah, who is also a musician and had been in his choir, that his musical sense—his ability to recognize and perform music at the highest professional level—was completely intact. He was able to sing, to play the piano, to conduct an orchestra or conduct a choir beautifully. So here is a paradox: The memory of events had been practically wiped out, whereas the memory of how to perform was completely intact, and in particular, how to perform music. He remained at a virtuoso level—it’s still the situation more than 20 years later.
Your chapter on Clive is strangely uplifting because he seems so happy when he conducts. That paradox really comes out in your book.Clive was—I was going to use the F-word. Clive was tragic. One can pick out the high points, but he’s been wiped out in so many ways. I mean, mercifully, there is the music. . . . I hope I don’t romanticize unrealistically.
I think my business and the business of the physician is, one way or another, to try and help someone live—live realistically.