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Author | Oliver Sacks |
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Cover artist | Chip Kidd |
Language | English |
Publisher | Knopf |
Publication date | 2007-10-16 |
ISBN | 978-1-4000-4081-0 |
OCLC | 85692744 |
781/.11 22 | |
LC Class | ML3830 .S13 2007 |
Preceded by | Oaxaca Journal (2002) |
Followed by | The Mind's Eye (2010) |
Musicophilia: Tales of Music and the Brain is a 2007 book by Oliver Sacks. It explores a range of psychological and physiological ailments and their connections to music. It is divided into four parts, each with a distinctive theme: Haunted by Music examines mysterious onsets of musicality and musicophilia (and musicophobia); A Range of Musicality looks at musical oddities musical synesthesia; parts three and four are entitled Memory, Movement, and Music and Emotion, Identity, and Music. Each part has between six and eight chapters, each of which is in turn dedicated to a particular case study (or several related case studies) that fit the overarching theme of the section. Four case studies from the book are featured in the NOVA program Musical Minds aired on June 30, 2009.
According to Sacks[ citation needed ], Musicophilia was written in an attempt to widen the general populace's understanding of music and its effects on the brain. As Sacks states at the outset of the book's preface, music is omnipresent, influencing human's everyday lives in how we think and act. However, unlike other animal species (such as birds) whose musical prowess is easier to understand in relation on a biological/evolutionary level, humanity's draw towards music and song is less clear-cut. There is no "music center" of the brain, yet the vast majority of humans have an innate ability to distinguish, "music, perceive tones, timbre, pitch intervals, melodic contours, harmony, and (perhaps most elementally) rhythm." With that in mind, Sacks examines human's musical inclination through the lens of musical therapy and treatment, as a fair number of neurological injuries and diseases have been documented to be successfully treated with music. This understanding (along with a medical case Sacks witnessed in 1966 wherein a Parkinson's patient was able to be successfully treated via music therapy) is what galvanized Sacks to create an episodic compilation of patient cases that all experienced and were treated by music to some capacity. In doing so, Sacks concertizes each example by explaining the neurological factors that play into each patient's healing and treatment in ways that relate to a lay yet curious audience.
In a review for The Washington Post , Peter D. Kramer wrote, "In Musicophilia, Sacks turns to the intersection of music and neurology—music as affliction and music as treatment." Kramer wrote, "Lacking the dynamic that propels Sacks's other work, Musicophilia threatens to disintegrate into a catalogue of disparate phenomena." Kramer went on to say, "What makes Musicophilia cohere is Sacks himself. He is the book's moral argument. Curious, cultured, caring, in his person Sacks justifies the medical profession and, one is tempted to say, the human race." Kramer concluded his review by writing, "Sacks is, in short, the ideal exponent of the view that responsiveness to music is intrinsic to our makeup. He is also the ideal guide to the territory he covers. Musicophilia allows readers to join Sacks where he is most alive, amid melodies and with his patients." [1]
Musicophilia was listed as one of the best books of 2007 by The Washington Post . [2]
Sacks includes discussions of several different conditions associated with music as well as conditions that are helped by music. These include musical conditions such as musical hallucinations, absolute pitch, and synesthesia, and non-musical conditions such as blindness, amnesia, and Alzheimer's disease.
Sacks first discusses musical seizures, and he mainly writes about someone who had a tumor in his left temporal lobe which caused him to have seizures, during which he heard music. Sacks then writes about musical hallucinations that often accompany deafness, partial hearing loss, or conditions like tinnitus. Sacks also focuses a lot on absolute pitch, where a person is able to immediately identify the pitch of a musical note. Another condition Sacks spends a lot of time on is synesthesia. Sacks discusses several different types of synesthesia: key synesthesia, non-musical synesthesia centered on numbers, letters, and days, synesthesia centered on sounds in general, synesthesia centered on rhythm and tempo, and synesthesia in which the person sees lights and shapes instead of colors. Sacks also describes cases where synesthesia has accompanied blindness.
Sacks discusses how blindness can affect the perception of music and musical notes, and he also writes that absolute pitch is much more common in blind musicians than it is in sighted musicians. Sacks writes about Clive Wearing, who suffers from severe amnesia. Sacks writes about how, even though Clive suffers from such severe amnesia, he still remembers how to read piano music and play the piano. However, Clive can only remember how to do so in the moment. Sacks also writes about Tourette syndrome and the effects that music can have on tics, for example, slowing tics down to match the tempo of a song. Sacks writes about Parkinson's disease, and how, similar to with people who suffer from Tourette's, music with a strong rhythmic beat can help with movement and coordination. Sacks briefly discusses Williams syndrome and how children with Williams syndrome were found to be very responsive to music. Sacks finishes his book with a discussion of Alzheimer's disease and dementia. He discusses how music therapy can help people with these conditions regain memory.
Certain portions of the brain are associated with how we use the brain to interact with music. For example, the cerebellum, a portion that coordinates movement and stores muscle memory, responds well to the introduction of music. For example, an Alzheimer's patient would not be able to recognize his wife, but would still remember how to play the piano because he dedicated this knowledge to muscle memory when he was young. Those memories never fade. Another example is the Putamen. This portion of the brain processes rhythm and regulates body movement and coordination. When introduced to music, if the amount of dopamine in the area is increased, it increases our response to rhythm. By doing this, music has the ability to temporarily stop the symptoms of such diseases as Parkinson's Disease. The music serves as a cane to these patients, and when the music is taken away, the symptoms return. When it comes to which music people respond best to, it is a matter of individual background. In patients with dementia, it is found that most patients respond to music from their youth, rather than relying on a certain rhythm or element. Neuroscientist Kiminobu Sugaya explains "That means memories associated with music are emotional memories, which never fade out-even in Alzheimer's patients". [3]
Since the 1970s, there have been multiple studies on the benefits of music therapy for clients with medical conditions, trauma, learning disabilities, and handicaps. Most of the documented studies for children have shown a positive effect in promoting self-actualization and developing receptive, cognitive, and expressive capabilities. [4] [5] While the studies conducted with adults 18+ had overall positive effects, the conclusions were limited because of overt bias and small sample sizes.
Since music is a fundamental aspect of every culture, it embodies every human emotion and can even transport us to an earlier time through our memory. Oliver Sacks, author of Musicophilia, acknowledges the unconscious effects of music as our body tends to join in the rhythmic motions involuntarily. [6] Working with clients with a variety of neurological conditions, Sacks observed the therapeutic potential and susceptibility to music. Even with the loss of language, music becomes the vehicle for expression, feeling, and interaction.
Well-known music therapists Paul Nordoff and Clive Robbins documented their work with audio recordings and videos of the transformative results of music with children who had emotional or behavioral problems, traumatic experiences, or handicaps. Robbins classifies the "Music Child" as the inner self in every child that evokes a healthy musical response. [4] It is music that becomes the catalyst for discovering the child’s potential. In essence, musical play creates an atmosphere that emboldens a child to free expression and reproductive skills. Sometimes family members observe immediate effects because selfhood is encouraged and nurtured and thus a child’s personality develops in response to music.
First, the music therapist assesses each client to determine impairments, preferences, and skill level. Notably, every person appreciates different musical genres. Next, treatment is determined based on individualized goals and selection as well as frequency and length of sessions. Finally, the progress of the client is evaluated and updated based on effectiveness. Although sessions are typically structured, therapist also remain flexible and try to meet clients where they are at emotionally and physically.
When music therapy was first introduced in tandem with other medical fields, it was mostly receptive and patients listened to live solo performances or pre-recorded songs. Today, music therapist allow for more creative interactions by having clients improvise, reproduce music or imitate melodies vocally or with an instrument, compose their own songs, and/or listen during artistic expression or with movement.
Recently, studies have been conducted on the effects of music with chemo patients, stroke patients, [7] [8] patients with Alzheimer, [9] spinal or brain injury, [10] [11] and hospice patients. [12] According to a 2017 report from Magee, Clark, Tamplin, and Bradt, [13] a common theme of all their studies was the positive effect music had on mood, mental and physical state, increase in motivation and social engagement, and a connection with the client’s musical identity. From 2008-2012, the Department of Oncology/ Hematology of the University Medical Center in Hamburg-Eppendorf orchestrated a randomized pilot study to determine if music therapy helped patients cope with pain and reduce chemotherapy side effects. [14] The sessions were given twice a week for twenty minutes and patients could choose either receptive or active methods. Each week, the quality of life, functioning ability, and level of depression/anxiety were assessed. Although emotional functioning scores increased and perception of pain improved significantly, they determined the outcome was inconclusive because patients have differing levels of manageable side effects and a hope to survive may influence expectations of treatment. However, patients rated the program helpful and potentially beneficial. Moreover, the feasibility of these studies allows for music therapists to practice in educational, psychiatric, medical, and private settings. Although there haven’t been any statistical significance based on few empirical adult studies, the trend shows improvements on most measures.
Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease prevention, and health promotion. Physical therapist is the term used for such professionals in the United States, and physiotherapist is the term used in many other countries.
Dementia is a syndrome associated with many neurodegenerative diseases, characterized by a general decline in cognitive abilities that affects a person's ability to perform everyday activities. This typically involves problems with memory, thinking, behavior, and motor control. Aside from memory impairment and a disruption in thought patterns, the most common symptoms of dementia include emotional problems, difficulties with language, and decreased motivation. The symptoms may be described as occurring in a continuum over several stages. Dementia ultimately has a significant effect on the individual, their caregivers, and their social relationships in general. A diagnosis of dementia requires the observation of a change from a person's usual mental functioning and a greater cognitive decline than might be caused by the normal aging process.
A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Sleep disorders are frequent and can have serious consequences on patients' health and quality of life. Polysomnography and actigraphy are tests commonly ordered for diagnosing sleep disorders.
Apraxia is a motor disorder caused by damage to the brain, which causes difficulty with motor planning to perform tasks or movements. The nature of the damage determines the disorder's severity, and the absence of sensory loss or paralysis helps to explain the level of difficulty. Children may be born with apraxia; its cause is unknown, and symptoms are usually noticed in the early stages of development. Apraxia occurring later in life, known as acquired apraxia, is typically caused by traumatic brain injury, stroke, dementia, Alzheimer's disease, brain tumor, or other neurodegenerative disorders. The multiple types of apraxia are categorized by the specific ability and/or body part affected.
Music therapy, an allied health profession, "is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program." It is also a vocation, involving a deep commitment to music and the desire to use it as a medium to help others. Although music therapy has only been established as a profession relatively recently, the connection between music and therapy is not new.
Art therapy is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition. Art therapy encourages creative expression through painting, drawing, or modelling. It may work by providing a person with a safe space to express their feelings and allow them to feel more in control over their life.
Cognitive disorders (CDs), also known as neurocognitive disorders (NCDs), are a category of mental health disorders that primarily affect cognitive abilities including learning, memory, perception, and problem-solving. Neurocognitive disorders include delirium, mild neurocognitive disorders, and major neurocognitive disorder. They are defined by deficits in cognitive ability that are acquired, typically represent decline, and may have an underlying brain pathology. The DSM-5 defines six key domains of cognitive function: executive function, learning and memory, perceptual-motor function, language, complex attention, and social cognition.
In neurology, semantic dementia (SD), also known as semantic variant primary progressive aphasia (svPPA), is a progressive neurodegenerative disorder characterized by loss of semantic memory in both the verbal and non-verbal domains. However, the most common presenting symptoms are in the verbal domain. Semantic dementia is a disorder of semantic memory that causes patients to lose the ability to match words or images to their meanings. However, it is fairly rare for patients with semantic dementia to develop category specific impairments, though there have been documented cases of it occurring. Typically, a more generalized semantic impairment results from dimmed semantic representations in the brain.
In neuropathy, primary progressive aphasia (PPA) is a type of neurological syndrome in which language capabilities slowly and progressively become impaired. As with other types of aphasia, the symptoms that accompany PPA depend on what parts of the brain's left hemisphere are significantly damaged. However, unlike most other aphasias, PPA results from continuous deterioration in brain tissue, which leads to early symptoms being far less detrimental than later symptoms.
Speech–language pathology (a.k.a. speech and language pathology or logopedics) is a healthcare and academic discipline concerning the evaluation, treatment, and prevention of communication disorders, including expressive and mixed receptive-expressive language disorders, voice disorders, speech sound disorders, speech disfluency, pragmatic language impairments, and social communication difficulties, as well as swallowing disorders across the lifespan. It is an allied health profession regulated by professional bodies including the American Speech-Language-Hearing Association (ASHA) and Speech Pathology Australia. The field of speech-language pathology is practiced by a clinician known as a speech-language pathologist (SLP) or a speech and language therapist (SLT). SLPs also play an important role in the screening, diagnosis, and treatment of autism spectrum disorder (ASD), often in collaboration with pediatricians and psychologists.
The Institute for Music and Neurologic Function (IMNF) is a US nonprofit organization conducting research into and applying music therapy. It is located in Mount Vernon, New York.
According to some music therapists, the use of Music in the therapeutic environment has an affinity with psychoanalysis in that it addresses obstructions in the mind that might be causing stress, psychic tension, and even physical illness. Music has been used, in conjunction with a psychoanalytic approach, to address symptoms of a variety of mental disorders, as well as forms of emotional distress, such as grief, loss, mourning, and trauma.
Alzheimer's disease (AD) is a neurodegenerative disease that usually starts slowly and progressively worsens, and is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems with language, disorientation, mood swings, loss of motivation, self-neglect, and behavioral issues. As a person's condition declines, they often withdraw from family and society. Gradually, bodily functions are lost, ultimately leading to death. Although the speed of progression can vary, the average life expectancy following diagnosis is three to twelve years.
Richard E. Cytowic is an American neurologist and author who rekindled interest in synesthesia in the 1980s and returned it to mainstream science. He was nominated for the Pulitzer Prize for his New York Times Magazine cover story about James Brady, the Presidential Press Secretary shot in the brain during the assassination attempt on President Reagan. Cytowic’s writing ranges from textbooks and music reviews, to his Metro Weekly "Love Doctor" essays and brief medical biographies of Anton Chekhov, Maurice Ravel and Virginia Woolf. His work is the subject of two BBC Horizon documentaries, “Orange Sherbert Kisses” (1994) and “Derek Tastes of Earwax” (2014).
The temporal dynamics of music and language describes how the brain coordinates its different regions to process musical and vocal sounds. Both music and language feature rhythmic and melodic structure. Both employ a finite set of basic elements that are combined in ordered ways to create complete musical or lingual ideas.
For patients with Alzheimer's disease, music therapy provides a beneficial interaction between a patient and an individualized musical regimen and has been shown to increase cognition and slow the deterioration of memory loss. Music therapy is a clinical and evidence-based intervention that involves music in some capacity and includes both a participant and a music therapist who have completed an accredited music therapy program.
Musical hallucinations describes a neurological disorder in which the patient will hallucinate songs, tunes, instruments and melodies. These hallucinations are not correlated with psychotic illness. A majority of patients who have symptoms of musical hallucinations are older and have onset conditions predisposing them to the disease. While there is no set form of treatment, research has discovered medications and alternative therapies to be successful in alleviating the hallucinations.
Music therapy for non-fluent aphasia is a method for treating patients who have lost the ability to speak after a stroke or accident. Non-fluent aphasia, also called expressive aphasia, is a neurological disorder that deprives patients of the ability to express language. It is usually caused by stroke or lesions in Broca's area, which is a language-dominant area that is responsible for speech production located in the left hemisphere of the brain. However, when lesions form in Broca's area this only affects patients’ speech ability, while their ability to sing remains unaffected. Since several studies have shown that right hemispheric regions are more active during singing, music therapy involving melodic elements is deemed to be a potential treatment for non-fluent aphasia, as singing might activate patients’ right hemisphere to compensate with their lesioned left hemisphere. Aside from singing, many other music therapy techniques have also been attempted such as rhythms and poetic emphasis, which is shown to add to the effectiveness. Although there are many possible explanations for the mechanism of music therapy, the underlying mechanism remains unclear, as some studies indicate contradictory results.
Music as a coping strategy involves the use of music in order to reduce stress, as well as many of the psychological and physical manifestations associated with it. The use of music to cope with stress is an example of an emotion-focused, adaptive coping strategy. Rather than focusing on the stressor itself, music therapy is typically geared towards reducing or eliminating the emotions that arise in response to stress. In essence, advocates of this therapy claim that the use of music helps to lower stress levels in patients, as well as lower more biologically measurable quantities such as the levels of epinephrine and cortisol. Additionally, music therapy programs have been repeatedly demonstrated to reduce depression and anxiety symptoms in the long term.
Medical ethnomusicology is a subfield of ethnomusicology, which according to UCLA professor Timothy Rice is "the study of how and why humans are musical." Medical ethnomusicology, similar to medical anthropology, uses music-making, musical sound, and noise to study human health, wellness, healing and disease prevention including, but not limited to, music as violence.