Music is so ubiquitous and ancient in the human species—so integral to our nature—that we must be born to respond to it: there must be a music instinct. Just as we naturally take to language, as a matter of our innate endowment, so must music have a specific genetic basis, and be part of the very structure of the human brain.

An unmusical alien would be highly perplexed by our love of music—and other terrestrial species are left cold by what so transports us. Music is absolutely normal for members of our species, but utterly quirky.1 Moreover, it is known that music activates almost all the human brain: the sensory centers, the prefrontal cortex that underlies rational functions, the emotional areas (cerebellum, amygdala, and nucleus accumbens), the hippocampus for memory, and the motor cortex for movement. When you listen to a piece of music your brain is abuzz with intense neural activity.

Oliver Sacks is fascinated both by the normality of this oddity and by its abnormal manifestations. Daniel J. Levitin, in his recent book This Is Your Brain on Music: The Science of a Human Obsession,2 deals largely with the normal human response to music—particularly with the brain mechanisms that underlie ordinary human listening—but Sacks’s interest is more in the pathologies of musical response, not surprisingly in view of his occupation as a clinical neurologist. Where Levitin gives us the peculiarities of the everyday, Sacks ventures into the outlandish and exotic—into the deficits and excesses of the musical brain. Yet both authors recognize that the normal is exotic enough in itself, and the abnormal merely variations on a theme (so to speak).

In a sense, nothing about music is quite “normal,” except purely statistically. Sacks’s style and method in Musicophilia will be familiar to readers of his earlier works: he provides us with descriptive summaries of various cases he has studied or encountered, which blend the humanistic and the clinical in a uniquely Sacksian style (the adjective seems warranted). We never lose sight of the human being exhibiting the pathology, but we are also continually reminded of the role of the brain in producing both normality and abnormality. The person, for Sacks, is irreducibly a center of thought, feeling, and will, yet is also a puppet of the circuits and nuclei that make up the brain. The brain is our ineluctable fate, but the person is more than a mere syncopation of brain regions. And you have to live with the brain you’ve got, making the best of its contingent strengths and weaknesses, not the brain you might ideally have preferred. Accordingly, Sacks’s chapters contain little in the way of theory and explanation, or even systematic taxonomy, dwelling rather on the details of specific cases, with that unique mixture of empathy and detachment I mentioned. His prose style has become, perhaps, more restrained than in his earlier books, less prone to hyperbole or poetic flights; but the result, especially in this book, is a more affecting and informative accounting, at least to my mind. The case studies here are finely observed, judiciously expressed, and genuinely fascinating.

Sacks opens his book with a striking case, rather literally striking. Tony Cicoria, a forty-two-year-old orthopedic surgeon, was making a phone call to his mother when he was struck in the face by lightning. He thought he was dead immediately following the event but sustained no serious injuries and went back to work a few weeks later. But then, quite unexpectedly, he experienced an intense craving to listen to piano music—something he had never felt before. He started listening to piano music all the time, couldn’t get enough of it. Then, a little later, he started hearing piano music in his head, insistently and powerfully; he felt the need to write it down, though he had no training in musical notation. Soon he was teaching himself to play the piano, playing the tunes that came to him unbidden at all moments. He played the piano at every opportunity, driving his wife to distraction. He had a bad case of sudden-onset musicophilia, somehow triggered by the brain alterations wrought by the lightning. He had become, in effect, a completely new person, evidently because of having had his brain electrically rewired.

The rest of the first section of the book, aptly entitled “Haunted by Music,” deals with musical pathologies, great and small. Sacks notes that not only do human beings listen to music a lot, they also imagine music constantly; so even if your ears aren’t being musically stimulated, you may be self-stimulating musically the rest of the time. Sometimes, we voluntarily produce musical images, as when we sing a song to ourselves for the fun of it, but we can also be subject to involuntary musical imagery. We are all familiar with that insistent tune that runs through our head against our will and taste (I was recently subjected to the chorus of Tom Jones’s “She’s a Lady” for about a week—a song I dislike and despise).


Sacks calls these “brainworms” and the term is appropriate: musical imagery can be remarkably intrusive and annoying, subverting our ability to control our own imaginative lives. It gets in there and it won’t let go. That is the “normal” case, but it can get much worse in abnormal cases. For some people, involuntary musical imagery crosses the line into outright musical hallucination, with loud and unwelcome music assaulting the sufferer’s consciousness from dawn till dusk. Sacks describes a number of cases of musical hallucination, one of whom, a certain Mrs. O’C., eighty-eight and slightly deaf, suddenly started hearing Irish songs from her youth, so loudly and clearly that she thought the radio had been left on; they stopped, just as unaccountably, after a few weeks. Gordon B., a professional violinist, could not stop his oppressive musical hallucinations, but he could control their course, shifting from one theme to another. Generally, such hallucinations were not welcome.

Then there are those who suffer from musicogenic epilepsy, in which convulsions are brought on by musical stimulation. What is remarkable is that the stimulus can be extremely specific; only particular types of music will provoke an epileptic seizure—it might be Frank Sinatra songs. In these cases, musical sensitivity is not a gift but a curse—the musical brain running amok, without regard for the well-being of its owner. Maybe, Sacks speculates, there is too much music these days, with the advent of recorded sound; maybe the human brain simply can’t deal with this degree of musical bombardment and develops strange pathologies in reaction. Or maybe the music is just too good—in the sense of its power of psychological penetration.

The range of human musicality is also remarkable, descending from the musical genius to the completely amusical. (Vladimir Nabokov once confessed: “Music, I regret to say, affects me merely as an arbitrary succession of more or less irritating sounds…. The concert piano and all wind instruments bore me in smaller doses and flay me in larger ones.”) Some people have perfect pitch, naming notes as easily as the rest of us can name colors, though they may lack musical taste and aesthetic appreciation. There are musical savants with unusually low general intelligence and poor linguistic capacity; Sacks recites the case of Martin, who was a retarded man but who knew by heart some two thousand operas (I didn’t know there were that many operas). Some people are deaf to melody but can appreciate rhythm, and some have the reverse problem (Che Guevara apparently fell into the latter category). I myself have a very good rhythmic sense, being a drummer, but I cannot carry a tune, to my great chagrin. Blindness can often lead to unusual musical talent, as with Stevie Wonder, suggesting that the lack of visual stimulation allows the brain to develop in the auditory sphere.

Then there is the phenomenon of musical synesthesia, in which particular notes are associated with visual impressions: Sacks reports that for the composer Michael Torke, say, D major is associated with the color blue, and G minor with ochre. It has been speculated that infants are natural synesthetes, their senses not yet properly differentiated, and that we lose this capacity as we mature (at least most of us do). It may even be that musical talent is more widespread than we realize, because the brain works actively to suppress it; when the inhibition is released, the natural ability is free to flow.

The human memory for music is generally excellent; people can remember songs from their childhood, for example, with striking accuracy. The case of Clive Wearing provides a dramatic illustration of the resilience of musical memory, since he suffers from extreme and debilitating amnesia, yet retains a remarkable amount of his old musical memories. He has little long-term memory in general but he also cannot acquire new memories from his passing experience, so that everything seems unfamiliar from second to second. It is a deeply disturbing predicament that Wearing is in, but at least he can still play and conduct music (he was an accomplished musicologist before the brain infection that destroyed his memory).

Wearing retains his musical “procedural memory,” i.e., the kind that is manifested in practical skills, but he also retains his musical taste and appreciation. This suggests that musical memory is a distinct subsystem in the human brain, possibly widely distributed, and strongly resistant to degradation. Strange as Clive’s case is, it reminds us of something we all know from our own experience: that musical memory has a power all its own. Moreover, musical memory connects with our sense of self, since musical taste and experience are closely linked to personality and emotion. The music we remember is, without exaggeration, part of who we are.


Perhaps this is why music therapy works as well as it does—another theme of Sacks’s book. It taps into the deeper regions of the psyche, where emotion, memory, and self intersect. Musical therapy can help patients suffering from aphasia and Parkinsonism; and music can also modulate the ticcing behavior characteristic of Tourette’s syndrome. Music can trigger movements that other stimuli cannot, sometimes producing coordination out of chaos. Sacks cites Tourettic jazz drummers who can channel their motor cascades into coherent rhythms, and therapeutic drum circles that bring together such individuals to synchronize their Tourettic energy.

The capacity of melody to soothe and rhythm to excite is obvious to anyone with musical sensitivity. Music is so intimately connected with emotion and movement that its power can be tapped to elicit both sorts of response. Music is known to excite the motor cortex even when the listener isn’t actually moving, so closely linked are musical hearing and bodily movement. This is why sitting still at a concert goes so much against the grain for most people. Yet the propulsive power of rhythm, so evident in our everyday experience of music, is actually quite puzzling. Why should the mere regularity of a beat cause the body to jerk so? What is the precise relation between the temporal sequence of heard sounds and movements of the limbs and trunk? We don’t respond that way to language and other sounds—so why to musical sounds?

The last part of Musicophilia discusses depression, dementia, and Williams syndrome. In severe depression, say after bereavement, music may lose its appeal, sounding flat and pointless. Yet, as Sacks reports from personal experience, it may also be the trigger that lifts profound depression. In dementia, dormant musical powers can be released, as the more cognitive functions deteriorate. In people with Williams syndrome, caused by a highly localized genetic defect, we find a combination of hypermusicality and cognitive limitation; such people also exhibit extreme friendliness to strangers combined with indifference and ineptitude with respect to the inanimate environment—being often unable to draw simple geometrical figures or even tie their own shoelaces. They show a unique blend of psychological strengths and weaknesses, with a corresponding divergence from normal in their brain structure (smaller than normal visual cortex and larger auditory cortex). Here brain physiology maps neatly onto psychological profile, thus demonstrating that the brain is indeed fate.

At one point in his discussion of music and the emotions Sacks has this to say:

States of ecstasy and rapture may lie in wait for us if we give ourselves totally to music; a common scene during the 1950s was to see entire audiences swooning in response to Frank Sinatra or Elvis Presley—seized by an emotional and perhaps erotic excitement so intense as to induce fainting.

I was struck by that “perhaps”: not much perhaps about it, I would have thought. Sacks generally confines himself to classical music in this book, saying little specifically about jazz and rock music—unlike Levitin, who favors the latter over the former. Anyone would think Sacks had never seen the kind of response elicited by the Beatles and other rock bands: the raw power of music to excite and move (literally) is at its clearest in the case of these more recent musical forms—and its connection to the sexual never more unmistakable. But Sacks tends to treat all music as psychologically equivalent; at any rate, it might have been useful to ask how different musical forms affect the mind and brain. The increasing dominance of rhythm in popular music, at its starkest in rap music, must surely tell us something about how the human brain responds to music.

In Levitin’s book there is a subtle and instructive discussion of the creation of groove in rock music, involving considerations of the listener’s expectations and playing with the mental beat set up in his or her mind; it is not a simple matter of metronomic exactitude (“In the Midnight Hour” by Wilson Pickett, for example, has a powerful groove, resulting from several interleaving aspects of the song’s sound). This is specific to one genre of music, and must involve special brain mechanisms. I doubt very much, based on introspection, that my brain responds the same way to classical and rock music—as is evident from my tendencies to movement in the two cases. People can be made to sit still at a classical music concert, but try doing that at a live rock concert and you would have a riot.

Sacks generally eschews theoretical speculation in Musicophilia, but he does raise one theoretical possibility that has influenced thinking about mind and brain from the great British neuroscientist Hughlings Jackson on, namely the notion of disinhibition. Sacks writes:

Normally there is a balance in each individual, an equilibrium between excitatory and inhibitory forces. But if there is damage to the (more recently evolved) anterior temporal lobe of the dominant hemisphere, then this equilibrium may be upset, and there may be a disinhibition or release of the perceptual powers associated with the posterior parietal and temporal areas of the non-dominant hemisphere.

This is an extremely intriguing theory, because it suggests that the brain contains untapped potential that is released only in unusual conditions. With damage to the left hemisphere, in which language is primarily located, the right hemisphere tends to come into its own. Blindness and deafness can result in an access of musical achievement, as the brain devotes itself to activities other than seeing and hearing. Strokes can result in newfound talents precisely because they turn off the inhibitory mechanisms in the brain. Synesthesia may be lurking within all of us, if only our brain weren’t tamping it down all the time. Savants may get the way they are simply because they don’t have the brain circuits that put clamps on the natural abilities we all share.

In other words, the brain is forever reining itself in, slowing itself down, suppressing its natural powers—all in order to preserve that precious equilibrium. Remove the abstract rational and linguistic structures and the suppressed portions of the brain can break free and flower. In the case of music, it may be that, despite our obvious musicality, we are potentially far more musical than we appear—if only our musical brain wasn’t being held in check by the rest of our brain. This is why damage to the inhibitory parts of the brain can result in the release of our musical potential.

Admittedly, this theory is still rather speculative, and there is little direct physiological evidence in its favor, but it certainly has a prima facie appeal. After all, the structure of the human brain is the outcome of millions of years of evolutionary accretion, stretching back to our prehominid ancestors, and the newer portions may well have needed to dampen down the excesses of the earlier brains they augmented, in order to maintain the right kind of balance of psychological functions (Freud’s special notion of repression is a version of this basic idea of cerebral inhibition and its release).

Although Sacks endorses the notion of a music instinct, he says little about why such an instinct might have arisen; but Levitin devotes an entire chapter to the subject. The answer he proposes, adapted from Darwin, is that musical performance works as a courtship display, thus falling into the category of Darwinian sexual selection (as distinct from natural selection). Musical ability is like the peacock’s tail: a trait that advertises fitness and health, without directly aiding in the serious business of survival—a luxury that only the most vital can afford to possess.

The ability to sing and dance well, in particular, serves to attract mates, because it signals intelligence, agility, and emotional quality—though it may not always go with a propensity to long-term child-rearing commitment. Levitin conjectures that this is why male rock stars and their music are so erotically appealing, despite the poor prospects of such performers as dedicated husbands: they are tapping into the primordial power of sexual selection through musical display.

From this point of view, unusual musical ability looks like an evolutionary advantage, despite its oddity when considered purely as an adaptation to the environment. The reason we are a musical species is that our success in the mating game depends upon it. In that respect, we are not so different from birds. The erotic power of music, so tentatively alluded to by Sacks, is therefore central to its prevalence in the human species. Why, after all, is the love song the most popular form of music in the world? Because love songs are about the very thing that the music instinct is designed for—the selection of mates.

Oliver Sacks’s great success as a popular writer might seem to need some explanation. He writes mainly about people with neurological damage, and he can be dry and clinical, as well as technical. No doubt his fine literary style is part of the explanation—and there is in his work always a natural interest in the strange and abnormal.

But I think it goes deeper than that. He reminds us of our extreme psychological complexity, and of the fragility of the human mind. From the inside, the mind can seem simple and automatic, like a pearl in an oyster, but actually it all depends on the complex orchestration of the millions of neurons that compose our brains: and if anything goes even slightly amiss in the machinery the mind can be altered beyond recognition. This realization gives us the feeling that we are suspended over an abyss, totally reliant on the mechanics of the physical organ that sustains the self. That organ is marvelously impressive, but it is also alarmingly prone to breakdown and malfunction; just deprive a tiny part of it of oxygen for a few seconds and all hell can break loose at the level of the conscious self. It makes you feel nervous about your nerves, does it not?

Sacks is an expert at making the reader feel queasy in this way. But there is also, I think, a tacit ethical message in everything he writes: namely, that even in the midst of tremendous neurological upset there is still a human self throbbing within. The aphasic or the Touretter or the amnesiac or the catatonic is still a center of consciousness, capable of feeling and thought. The human mind can take many forms, Sacks is saying, and some can indeed appear bizarre and threatening, but there is always a self that underlies these myriad forms—and that self can sometimes enjoy virtues and powers not found in the normal.

His implied message is therefore one of tolerance and understanding. At one point he shows a flash of this moral sense, when discussing a book about Alzheimer’s disease called The Loss of Self, by Donna Cohen and Carl Eisdorfer:

For various reasons, I deplored the title (though it is a very good book as a resource for families and caregivers) and set myself to contradicting it, lecturing here and there on “Alzheimer’s Disease and the Preservation of Self.”

The preservation of self: that could be the motto for all of Sacks’s writing on neurological disorders. The so-called normal case is highly contingent, he seems to be saying, depending on the physical integrity of the brain beneath, and in what we refer to as the abnormal case we are still dealing with a self in the fullest sense. There is always an “I” there, someone to whom things matter; so long as there is consciousness at all, there is a subject of that consciousness. Even if you can’t tell your wife from a hat, there is still a you that must deal with this disability. Ultimately, then, Sacks’s clinical case studies are exercises in love and respect.

This Issue

March 6, 2008