Saturday, February 18, 2012

Talent “ex nihilo”: How brain damage can make people more musical

When you think of brain damage, what effects come to mind?  If you’re like me, probably mental and physical handicaps – aphasia, amnesia, perhaps loss of coordination or personality changes.  As I finish Musicophilia, one of the standout surprises for me was that brain damage can sometimes add function… or so it seems.

Owing to the book’s focus, Dr. Sacks focuses on several cases of brain damage or disease contributing to “hypermusicality,” an enhanced appreciation of and/or talent for music.  The most striking example comes at the beginning of the book, where he describes a patient who became obsessed with music after an encounter with a bolt of lightning (see what I did there?).

Image credit: David Selby
The patient, Tony Cicoria, apparently had no major adverse health effects apart from burns to his face and left foot as well as some temporary sluggishness and memory loss that lasted a few weeks.  However, Circoria had a sudden irrepressible urge to learn piano music, despite having virtually no interest in performing music in his forty or so years.  He bought recordings of Ashkenazy playing Chopin and adored every one.  Around that time, a family babysitter needed somewhere to store her piano, and this was just the ticket he needed to start making music himself.

Then, he began hearing music in his head.  “It’s like a frequency,” he said, “a radio band.  If I open myself up, it comes.  I want to say, ‘It comes from heaven,’ as Mozart said.”  After the lightning strike, he also became hyper-religious, believing that he had been saved for some purpose, and that purpose was his music.

This incessant influx of music needed an outlet, and he began composing at every available opportunity.  It totally possessed him during every waking hour, and his wife was none too pleased.  (I can relate: when I go through obsessive piano binges, it can certainly intrude upon time together with my wife!)  In the intervening years, Cicoria has developed a veritable musical career, presenting his compositions first at informal recitals and later at more formal concerts.  All this despite having only a handful of piano lessons as a young boy, about thirty years before.

So, after being assaulted by several thousand amps of electricity, Cicoria’s brain was not only unimpaired, but revealed talents and interests that he never possessed before!

This sort of phenomenon is not restricted to those struck by lightning.  Sacks also describes several patients with frontotemporal dementia (FTD, or Pick’s disease), a neurodegenerative disease that is similar to Alzheimer’s except that it specifically affects the front and side portions of the brain.  Here is an image of a brain from a patient with advanced FTD:

Note the shrinking of the gyri (folds) of the brain towards the front, on the right.
Unlike Alzheimer’s, the first symptoms of FTD do not involve memory loss, but changes in personality and loquacity.  The symptoms of FTD vary a lot, but in general the patients become more outgoing and less inhibited, which is not surprising since the frontal lobe is involved in suppressing socially questionable behaviors.  Sacks discusses some patients that begin to spontaneously burst out into song, and even some that suddenly develop extraordinary gifts of composition out of the blue.  Bruce Miller described one such man who began composing music at the age of 68!  Sack speculates that these probably don’t represent entirely new behaviors of the brain, but result from the de-inhibition of existing thought patterns that are then free to flourish.

This reminds me of a few occasions I've had to speak French with native speakers while mildly intoxicated.  With a few glasses of wine in my system, I was actually more fluent.  It was as if my conscious brain gave way to a more fluent unconscious self.  Unfortunately, sobriety brought the return of my more typical halting, clumsy manner of speaking.  I have never experimented with psychoactive drugs, but I would not be surprised if such de-inhibitions were responsible for the bizarre creative visions of some drug-using artists and religious cults.

Sadly, most patients lose their newfound abilities as the FTD progresses further.  Many remain ebullient and enthusiastic, but their semantic memories usually begin to fail.  One elderly man would gaily sing “We Wish You a Merry Christmas” but could not tell his doctor precisely what Christmas was.  As Sacks put it,
The musical or artistic powers that may be released in fontotemporal dementia or other forms of brain damage do not come out of the blue; they are, one must presume, potentials or propensities that are already present but inhibited – and undeveloped.  Once released by damage to these inhibitory factors, musical or artistic powers can potentially be developed, nurtured, and exploited to produce a work of real artistic value – at least as long as frontal lobe function, with its executive and planning powers, is intact.  In the case of frontotemporal dementia, this may provide a brief, brilliant interlude as the disease advances.  The degenerative process in frontotemporal dementia, unfortunately, does not come to a halt, and sooner or later, all is lost – but for a brief time, for some, there can at least be music or art, with some of the fulfillment, the pleasure, and joy it can so uniquely provide.
One must wonder, finally, about the “Grandma Moses” phenomenon – the unexpected and sometimes sudden appearance of new artistic or mental powers in the absence of any clear pathology.  Perhaps one should speak of “health” rather than “pathology” here, since there may be, even at an advanced age, a relaxing or release of lifelong inhibitions.  Whether this release is primarily psychological, social, or neurological, it can unleash a torrent of creativity as surprising to oneself as it is to others.
What hidden creative potentials lie in each of our brains, ready to burst out but inhibited by the tyranny of rational thought?  Still, I’m not eager to get struck by lightning or stricken with dementia to find out.

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