Oliver Sacks is a famed neurologist whose books of case studies combine the latest neuroscience with deep humanistic learning. He not only describes his patients with great precision, but also seeks to enter empathically into their experience and then, by means of limpid prose, to communicate it to the general reader. Ever since the publication of his book Awakenings, about patients with encephalitis lethargica who were recalled to life by the drug levodopa after decades of immobility, he has deservedly found a large and appreciative audience. He has had many imitators but no equals.
Case studies are not favoured in contemporary medical literature as they once were. True, medical journals such as the famed New England Journal of Medicine carry case reports of rare diseases or unusual presentations; but after a brief summary of the patient’s symptoms, there follows a vast array of hi-tech laboratory and imaging data, ending with a triumphantly clever diagnosis (even if it is made only at post mortem). In these case reports, the patient seems almost to have only a walk-on part. His job is to provide brilliant and erudite doctors with an opportunity to display their arcane erudition.
While Sacks is perfectly au fait with the latest research, and is no enemy of technological brio, he also belongs to an older and more leisurely medical tradition, namely that of very detailed history-taking and analysis of what the patient says about his own experiences of his condition. His case histories sometimes read like those of the 19th-century French psychiatrists, who are now largely forgotten, but who not only wrote most beautifully, elegantly and clearly, but were also masters of the art of finding significance in seeming trifles.
In his latest book, Sacks turns his attention to the neurology and pathology of music (it comes as no surprise to learn that he himself is something of a pianist, and plays Chopin on his father’s 1894 Bechstein grand). He provides us with large numbers of case histories drawn from his immense clinical experience. He does not really have an overall thesis to propound, except the rather weak one that a liking for music seems to be inborn in man and in no other species; instead, we learn of all the neurological vicissitudes to which the musical faculty is subject.
Musicophilia is more fragmented than Sacks’s other books, but it still contains much to instruct, fascinate and amuse. Music can be used therapeutically, for example, in patients with Parkinson’s disease, or in people who have had strokes. People can lose a sense of rhythm without losing appreciation of melody, and vice versa. There are forms of epilepsy provoked by only one specific piece of music. Some people experience colours or tastes when they hear certain sounds; people who suffer from very profound amnesia can retain their musical abilities. Musical hallucinations are not uncommon, are caused by a variety of neurological conditions, and can range from the gratifying to the torturing. There are forms of mental retardation in which musical ability is accentuated; there is one idiot savant who can sing 2,000 opera arias in every language known to opera.
We learn that perfect pitch, the ability to name any note, is not only rare but also unevenly distributed both within and between populations. Children who take up music very early in their lives are much more likely than others to have perfect pitch; intriguingly, a far higher proportion of Chinese than Europeans have perfect pitch, perhaps because their language is tonal. (If this hypothesis is correct, perfect pitch should be common among the Yoruba also.) But perfect pitch is not an unmixed blessing, for those who possess it are extremely sensitive to the sound of instruments that are slightly out of tune, which other people cannot detect.
The whole phenomenon of musicality is a very strange one, unique to mankind; no other animal has even a rudimentary sense of rhythm, for example; and yet, as Sacks tells us, it is a phenomenon that lacks a satisfying explanation. There are a few people with a complete absence, congenital or acquired, of musical appreciation, but it is not easy to see at what evolutionary disadvantage this places them. A race of beings just as intelligent as men could, presumably, have arisen without a musical faculty; any answer to the puzzle must remain purely speculative.
How and why is it that combinations and series of sounds, that are inherently abstract and without propositional content, have the power to move us so deeply, to shake us to the very core of our being? There is a difficult philosophical question lurking here, one which Sacks does not broach, namely: what would count as an explanation? No doubt you could show with the new technology what parts of the brain were stimulated or were active when a person was moved by music, but would this, or any similar information, cause you to think that now, at last, you had understood?
We tend to think of musicality as an unmixed blessing, but not everyone agrees. Sacks doesn’t mention Plato’s hostility to music, but he mentions Tolstoy’s. Tolstoy was in fact highly susceptible to music, and indeed once wrote to Tchaikovsky to tell him that he was developing a new musical theory. Tchaikovsky replied that Tolstoy didn’t know what he was talking about, and this seems to be the only time in Tolstoy’s life when he bowed to superior knowledge.
In The Kreutzer Sonata, Tolstoy suggests that music’s emotional power is such that it is capable of destroying moral judgment and thereby of inducing immorality. This is not inherently an absurd idea. In the prison in which I worked, a prison officer of Jamaican origin discovered that if he played prisoners rock music they became agitated and aggressive, but if he played them baroque music they became calm and docile. I suggested Gregorian chant to the management, but no one took me seriously.
Since Sacks mentioned Tolstoy’s hostility to music, he might have mentioned also Lenin’s famous remark after listening to the Apassionata sonata, that it made him want to pat the heads of children out of general benevolence, and that therefore music was to be abjured. If only Lenin had allowed his susceptibility to music to flourish, how much less awful would have been the history of the 20th century!
There are many irresistible, astonishing and moving stories in this book, none more so than that of an orthopaedic surgeon in his forties who was struck by lightning and subsequently developed a passion, which he had not had before, for playing the piano and for composing. There is a Finnish entomologist who has such perfect pitch that he is able to recognise the species of insects by the frequency of the sound made by their wing beats. There are the patients with Tourette’s syndrome whose tics cease only when they are performing music. There is the chemistry student who remembers every word of her professor’s lectures because she sets them to music in her mind as she hears them. If it doesn’t all add up to anything very much in the end, because there is no overarching theory to account for all the disparate phenomena, we don’t really mind because we have learnt so much on the way.