Hallucinations of musical notation: new paper for neurology journal Brain by Oliver Sacks

Professor of neurology, physician, and author Oliver Sacks M.D. has outlined case studies of hallucinations of musical notation, and commented on the neural basis of such hallucinations, in a new paper for the neurology journal Brain.

In this paper, Dr Sacks is building on work done by Dominic ffytche et al in 2000, which delineates more than a dozen types of hallucinations, particularly in relation to people with Charles Bonnet syndrome (a condition that causes patients with visual loss to have complex visual hallucinations). While ffytche believes that hallucinations of musical notation are rarer than some other types of visual hallucination, Sacks says that his own experience is different.

“Perhaps because I have investigated various musical syndromes,” writes Dr Sacks, “and people often write to me about these… I have seen or corresponded with a dozen or more people whose hallucinations include – and sometimes consist exclusively of – musical notation.”

Sacks goes on to detail eight fascinating case studies of people who have reported experiencing hallucinations of musical notation, including:

• A 77 year old woman with glaucoma who wrote of her “musical eyes”. She saw “music, lines, spaces, notes, clefs – in fact written music on everything [she] looked at.”

• A surgeon and pianist suffering from macular degeneration, who saw unreadable and unplayable music on a white background.

• A Sanskrit scholar who developed Parkinson’s disease in his 60s and later reported hallucinating ornately-written music, occurring with a Sanskrit script. “Despite the exotic nature of the script the result is still western music,” he said.

• A woman who reported seeing musical notation on her ceiling upon waking in the morning.

• A woman who said she wasn’t a musician, but would hallucinate when she had high fevers as a child. She said that the notes were “angry, and [she] felt unease. The lines and notes were out of control and at times in a ball.”

It is striking that, of Dr Sacks’ eight case studies, seven were gifted musicians. Sacks comments, “This is perhaps a coincidence, but it makes one wonder whether there is something about musical scores that is radically different from verbal texts.” Musical scores are far more visually complex than standard (English) text, with not just a variety of notes, but also many symbols that indicate how the notes should be played.

Dr Sacks also says that he has a mild form of Charles Bonnet syndrome himself, in which he sees a variety of simple forms whenever he gazes at a blank surface. “When I recently returned to playing the piano and to studying scores minutely, I began to ‘see’ showers of flat signs along with the letters and runes on blank surfaces.”

Another striking feature of these hallucinations is that – like text hallucinations – they are generally unreadable. They can seem playable at first, but on closer inspection it transpires that the music is often nonsensical or impossible to play, such as an example reported in one of the case studies: a melody line three or more octaves above middle C, and so may have half a dozen or more ledger lines above the treble staff.

Usually, the early visual system analyses forms and sends the information it has extracted to higher areas, where it gains coherence and meaning. Normally, in the act of perception, the entire visual system is engaged. Paradoxically, according to Sacks, “one may have to study disorders of the visual system to see how complex perceptual and cognitive processes are analysed and delegated to different levels… and hallucinations of musical notation can provide a very rich field of study here.”

Speaking a tonal language (such as Cantonese) primes the brain for musical training

Non-musicians who speak tonal languages may have a better ear for learning musical notes, according to Canadian researchers.

Tonal languages, found mainly in Asia, Africa and South America, have an abundance of high and low pitch patterns as part of speech. In these languages, differences in pitch can alter the meaning of a word. Vietnamese, for example, has eleven different vowel sounds and six different tones. Cantonese also has an intricate six-tone system, while English has no tones.

Researchers at Baycrest Health Sciences’ Rotman Research Institute (RRI) in Toronto have found the strongest evidence yet that speaking a tonal language may improve how the brain hears music. While the findings may boost the egos of tonal language speakers who excel in musicianship, they are exciting neuroscientists for another reason: they represent the first strong evidence that music and language – which share overlapping brain structures – have bi-directional benefits!

The findings are published today in PLOS ONE, an international, peer-reviewed open-access science journal.

The benefits of music training for speech and language are already well documented (showing positive influences on speech perception and recognition, auditory working memory, aspects of verbal intelligence, and awareness of the sound structure of spoken words). The reverse – the benefits of language experience for learning music – has largely been unexplored until now.

"For those who speak tonal languages, we believe their brain’s auditory system is already enhanced to allow them to hear musical notes better and detect minute changes in pitch," said lead investigator Gavin Bidelman, who conducted the research as a post-doctoral fellow at Baycrest’s RRI, supported by a GRAMMY Foundation® grant.

"If you pick up an instrument, you may be able to acquire the skills faster to play that instrument because your brain has already built up these auditory perceptual advantages through speaking your native tonal language."

But Bidelman, now assistant professor with the Institute for Intelligent Systems and School of Communication Science & Disorders at the University of Memphis, was quick to dispel the notion that people who speak tonal languages make better musicians. Musicianship requires much more than the sense of hearing and plenty of English-speaking musical icons will put that quick assumption to rest.

That music and language – two key domains of human cognition – can influence each other offers exciting possibilities for devising new approaches to rehabilitation for people with speech and language deficits, said Bidelman.

"If music and language are so intimately coupled, we may be able to design rehabilitation treatments that use musical training to help individuals improve speech-related functions that have been impaired due to age, aphasia or stroke," he suggested. Bidelman added that similar benefits might also work in the opposite direction. Musical listening skills could be improved by designing well-crafted speech and language training programs.

The study

Fifty-four healthy adults in their mid-20s were recruited for the study from the University of Toronto and Greater Toronto Area. They were divided into three groups: English-speaking trained musicians (instrumentalists) and Cantonese-speaking and English-speaking non-musicians. Wearing headphones in a sound-proof lab, participants were tested on their ability to discriminate complex musical notes. They were assessed on measures of auditory pitch acuity and music perception as well as general cognitive ability such as working memory and fluid intelligence (abstract reasoning, thinking quickly).

While the musicians demonstrated superior performance on all auditory measures, the Cantonese non-musicians showed similar performance to musicians on music and cognitive behavioural tasks, testing 15 to 20 percent higher than that of the English-speaking non-musicians.

Bidelman added that not all tonal languages may offer the music listening benefits seen with the Cantonese speakers in his study. Mandarin, for example, has more “curved” tones and the pitch patterns vary with time – which is different from how pitch occurs in music. Musical pitch resembles “stair step, level pitch patterns” which happen to share similarities with the Cantonese language, he explained.

Love of musical harmony is not nature but nurture

Associate Professor Neil McLachlan from the Melbourne School of Psychological Sciences said previous theories about how we appreciate music were based on the physical properties of sound, the ear itself and an innate ability to hear harmony.


“Our study shows that musical harmony can be learnt and it is a matter of training the brain to hear the sounds,” Associate Professor McLachlan said.
 “So if you thought that the music of some exotic culture (or Jazz) sounded like the wailing of cats, it’s simply because you haven’t learnt to listen by their rules.”


The researchers used 66 volunteers with a range of musical training and tested their ability to hear combinations of notes to determine if they found the combinations familiar or pleasing.


“What we found was that people needed to be familiar with sounds created by combinations of notes before they could hear the individual notes. If they couldn’t find the notes they found the sound dissonant or unpleasant,” he said.
 “This finding overturns centuries of theories that physical properties of the ear determine what we find appealing.”


Coauthor on the study Associate Professor Sarah Wilson also from the Melbourne School of Psychological Sciences said the study found that trained musicians were much more sensitive to dissonance than non-musicians.


“When they couldn’t find the note, the musicians reported that the sounds were unpleasant, whereas non-musicians were much less sensitive,” Assoc. Prof Wilson said.
 “This highlights the importance of training the brain to like particular variations of combinations of sounds like those found in jazz or rock.” 


Depending on their training, a strange chord or a gong sound was accurately pitched and pleasant to some musicians, but impossible to pitch and very unpleasant to others. “This showed us that even the ability to hear a musical pitch (or note) is learnt,” Assoc. Prof Wilson said.


To confirm this finding they trained 19 non-musicians to find the pitches of a random selection of western chords. Not only did the participants ability to hear notes improve rapidly over ten short sessions, afterward they reported that the chords they had learnt sounded more pleasant – regardless of how the chords were tuned.

The question of why some combinations of musical notes are heard as pleasant or unpleasant has long been debated. “We have shown in this study that for music, beauty is in the brain of the beholder,” Assoc. Prof McLachlan said. The study was published in the Journal of Experimental Psychology: General.

Early music lessons boost brain development

If you started piano lessons in grade one, or played the recorder in kindergarten, thank your parents and teachers. Those lessons you dreaded – or loved – helped develop your brain. The younger you started music lessons, the stronger the connections in your brain.

A study published last month in the Journal of Neuroscience suggests that musical training before the age of seven has a significant effect on the development of the brain, showing that those who began early had stronger connections between motor regions – the parts of the brain that help you plan and carry out movements.

This research was carried out by students in the laboratory of Concordia University psychology professor Virginia Penhune, and in collaboration with Robert J. Zatorre, a researcher at the Montreal Neurological Institute and Hospital at McGill University.

The study provides strong evidence that the years between ages six and eight are a “sensitive period” when musical training interacts with normal brain development to produce long-lasting changes in motor abilities and brain structure. “Learning to play an instrument requires coordination between hands and with visual or auditory stimuli,” says Penhune. “Practicing an instrument before age seven likely boosts the normal maturation of connections between motor and sensory regions of the brain, creating a framework upon which ongoing training can build.”

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This Music Video Was Filmed Inside an MRI Machine

Musicians sometimes describe their music as an intimate look inside their minds. But an artist named Sivu has taken that notion literally with the music video for his song Better Man Than He that was actually filmed inside an MRI machine.

Birdsong study pecks at theory that music is uniquely human

A bird listening to birdsong may experience some of the same emotions as a human listening to music, suggests a new study on white-throated sparrows, published in Frontiers of Evolutionary Neuroscience.

“We found that the same neural reward system is activated in female birds in the breeding state that are listening to male birdsong, and in people listening to music that they like,” says Sarah Earp, who led the research as an undergraduate at Emory University.

For male birds listening to another male’s song, it was a different story: They had an amygdala response that looks similar to that of people when they hear discordant, unpleasant music.

The study, co-authored by Emory neuroscientist Donna Maney, is the first to compare neural responses of listeners in the long-standing debate over whether birdsong is music.

“Scientists since the time of Darwin have wondered whether birdsong and music may serve similar purposes, or have the same evolutionary precursors,” Earp notes. “But most attempts to compare the two have focused on the qualities of the sound themselves, such as melody and rhythm.”

Earp reviewed studies that mapped human neural responses to music through brain imaging.

She also analyzed data from the Maney lab on white-throated sparrows. The lab maps brain responses in the birds by measuring Egr-1, part of a major biochemical pathway activated in cells that are responding to a stimulus.

The study used Egr-1 as a marker to map and quantify neural responses in the mesolimbic reward system in male and female white-throated sparrows listening to a male bird’s song. Some of the listening birds had been treated with hormones, to push them into the breeding state, while the control group had low levels of estradiol and testosterone.

During the non-breeding season, both sexes of sparrows use song to establish and maintain dominance in relationships. During the breeding season, however, a male singing to a female is almost certainly courting her, while a male singing to another male is challenging an interloper.

For the females in the breeding state every region of the mesolimbic reward pathway that has been reported to respond to music in humans, and that has a clear avian counterpart, responded to the male birdsong. Females in the non-breeding state, however, did not show a heightened response.

And the testosterone-treated males listening to another male sing showed an amygdala response, which may correlate to the amygdala response typical of humans listening to the kind of music used in the scary scenes of horror movies.

“The neural response to birdsong appears to depend on social context, which can be the case with humans as well,” Earp says. “Both birdsong and music elicit responses not only in brain regions associated directly with reward, but also in interconnected regions that are thought to regulate emotion. That suggests that they both may activate evolutionarily ancient mechanisms that are necessary for reproduction and survival.”

A major limitation of the study, Earp adds, is that many of the regions that respond to music in humans are cortical, and they do not have clear counterparts in birds. “Perhaps techniques will someday be developed to image neural responses in baleen whales, whose songs are both musical and learned, and whose brain anatomy is more easily compared with humans,” she says.

New Research Shows Music Improves Health and Disease

Music has been incorporated into medical practice since before the ancient Greeks. However, though practitioners have been convinced of music’s health benefits for thousands of years, there had been little peer-reviewed research to back them up. But recent studies are providing an empirical backbone for the anecdotal evidence. A 2012 scientific review, published in the journal Nutrition, collects information from a number of studies to support music’s influence on the hypothalamic-pituitary-adrenal (HPA) axis, the sympathetic nervous system (SNS) and the immune system. These results support the experiences of complementary practitioners, who have long used music to help heal.

“As an integrative physician and traditional Chinese medicine practitioner, the healing power of music has always been an important part of my practice and family life,” says integrative medicine pioneer Isaac Eliaz, M.D. “Harmony and tempo help synchronize the rhythms of the natural world with the music of the heart – each person’s individual energetic pattern, expressed in their pulse.”

Proven Medicine
The review highlighted a number of studies that confirm music’s healing potential. For example, music reduces levels of serum cortisol in the blood. An important player in the HPA axis, cortisol increases metabolic activity, suppresses the immune system and has been associated with both anxiety and depression. A number of studies have shown that exposing post-operative patients to music dramatically lowers their cortisol levels, enhancing their ability to heal.

Other studies in the review measured music’s impact on congestive heart failure, premature infants, immunity, digestive function and pain perception. In particular, music’s effects on the limbic and hypothalamic systems reduced the incidence of heart failure. Other studies showed that surgical patients required less sedation and post-operative pain medication.

“These results only confirm what I have observed for many years in my practice,” says Dr. Eliaz. “Music produces quantifiable healing. For example, my daughter Amity, a professional musician, regularly plays her songs for chronically ill patients who express how uplifting her music is. These performances do more than encourage good feelings, they help the body heal on a molecular level.”

Powerful Impact
Perhaps the most interesting aspect of music’s healing properties is how widespread they are. For example, music also aided recovery time following strenuous exercise. Other studies showed that fast-paced music can increase resting metabolism, which may prove helpful for people trying to lose weight.

“Modern science has just begun to scratch the surface of music and sound in terms of healing potential,” says Dr. Eliaz. “However, traditional medical systems from around the world have long revered the beneficial vibrations of music, harmony and rhythm for health and vitality. The effects are instant and tangible, but they are also powerful and long lasting.”

Why Music Moves Us

Universal emotions like anger, sadness and happiness are expressed nearly the same in both music and movement across cultures, according to new research.

The researchers found that when Dartmouth undergraduates and members of a remote Cambodian hill tribe were asked to use sliding bars to adjust traits such as the speed, pitch, or regularity of music, they used the same types of characteristics to express primal emotions. What’s more, the same types of patterns were used to express the same emotions in animations of movement in both cultures.

"The kinds of dynamics you find in movement, you find also in music and they’re used in the same way to provide the same kind of meaning," said study co-author Thalia Wheatley, a neuroscientist at Dartmouth University.

The findings suggest music’s intense power may lie in the fact it is processed by ancient brain circuitry used to read emotion in our movement.

"The study suggests why music is so fundamental and engaging for us," said Jonathan Schooler, a professor of brain and psychological sciences at the University of California at Santa Barbara, who was not involved in the study. "It takes advantage of some very, very basic and, in some sense, primitive systems that understand how motion relates to emotion."

Universal emotions

Why people love music has been an enduring mystery. Scientists have found that animals like different music than humans and that brain regions stimulated by food, sex and love also light up when we listen to music. Musicians even read emotions better than nonmusicians.

Past studies showed that the same brain areas were activated when people read emotion in both music and movement. That made Wheatley wonder how the two were connected.

To find out, Wheatley and her colleagues asked 50 Dartmouth undergraduates to manipulate five slider bars to change characteristics of an animated bouncy ball to make it look happy, sad, angry, peaceful or scared.

"We just say ‘Make Mr. Ball look angry or make Mr. Ball look happy,’" she told LiveScience.

To create different emotions in “Mr. Ball,” the students could use the slider bars to affect how often the ball bounced, how often it made big bounces, whether it went up or down more often and how smoothly it moved.

Another 50 students could use similar slider bars to adjust the pitch trajectory, tempo, consonance (repetition), musical jumps and jitteriness of music to capture those same emotions.

The students tended to put the slider bars in roughly the same positions whether they were creating angry music or angry moving balls.

To see if these trends held across cultures, Wheatley’s team traveled to the remote highlands of Cambodia and asked about 85 members of the Kreung tribe to perform the same task. Kreung music sounds radically different from Western music, with gongs and an instrument called a mem that sounds a bit like an insect buzzing, Wheatley said. None of the tribes’ people had any exposure to Western music or media, she added.

Interestingly, the Kreung tended to put the slider bars in roughly the same positions as Americans did to capture different emotions, and the position of the sliders was very similar for both music and emotions.

The findings suggest that music taps into the brain networks and regions that we use to understand emotion in people’s movements. That may explain why music has such power to move us — it’s activating deep-seated brain regions that are used to process emotion, Wheatley said.

"Emotion is the same thing no matter whether it’s coming in through our eyes or ears," she said.