Hearing Things: When Sounds Come Unbidden

Everybody hears things. If I asked you, right now, to play "God Bless America" in your head (go on, do it), you could make it happen.

If I asked for "Michelle My Belle," as sung by Paul McCartney, most of you could do that, too.

We are all, to some extent, human jukeboxes, able to program for pleasure and for reference. And while music sometimes sticks around longer than we would like — like a hit tune or an advertising jingle — for the most part we control what's inside our heads.

This story, however, describes what can happen when a person loses control.

For some people, the music comes unbidden, sticks around, makes too much noise and won't go away.

Cheryl C., (not her real name) is a patient of the well-known author and neurologist Dr. Oliver Sacks. Her story appears in his new book Musicophilia.

What Is Going On?

About five years ago, Cheryl was in bed reading when all of a sudden she heard a tremendous clamor. As Sacks tells it, "There were sirens, there were voices, there were bells, there was screaming, there was clanging.”

She jumped up, rushed to the window to see what could be creating such noise. But when she looked she saw nothing.

“I suddenly realized that these horrendous noises were in my head,” she says.

After about 20 minutes or so, equally mysteriously, the cacophony suddenly turned into music, a much too loud version of "Michael Row Your Boat Ashore," which then resolved into another song, then another. The outdoor noise had stopped, but the music kept going and going.

Eventually she went to Sacks, who examined and tested her and offered a possible explanation for what had happened.

A Proposal

Cheryl had been growing deaf and by her late 60s, her hearing was so compromised she could barely hear people on the phone. When she played bridge, her partners would have to repeat their bids in extra loud voices. There was less and less sound reaching her brain.

Sacks suspected that the region of her brain devoted to auditory work had so little input, so little to do, the cells in that part of her brain began fabricating output. In other words, her brain was hallucinating.

"Dr. Sacks explained to me that my brain just decided to make some music so I’d hear something," she says.

"This is not uncommon. This is not psychotic. This is often associated with deafness," says Sacks.

Musical hallucinations appear in a small percent of people who are very deaf. People in sensory deprivation chambers find themselves hearing mysterious sounds within an hour or so. It can happen to sailors who spend time alone at sea, to people on empty stretches of desert, to people who are extravagantly bored or unstimulated by their environments. And maybe, Dr. Sacks suggested, not hearing triggered the music inside Cheryl.

Three Intriguing Questions

First, where do these musical hallucinations come from? Why "Michael Row Your Boat Ashore"? Why the cars crashing? Why does an amateur sailor tell us (he’s in the Morning Edition broadcast) he heard a heavy metal guitar solo when he hates heavy metal? Why an intricate bagpipe tune when he has no special knowledge or fondness for bagpipes?

Who is choosing these sounds? Obviously the brain got them from somewhere. Or maybe the brain is making them up from scattered parts, creating its own montage? Or are they memories? Right now, it is fair to say nobody really knows.

When I asked Sacks if he thought the music was entirely accidental, all random, he scoffingly quoted his friend the poet W.H. Auden, "random, my bottom!" There is some method here, but that’s still a mystery.

"I mean, by the nature of things, there cannot be anything random in the mind. You know, there must be determinance," Sacks says.

Second, Cheryl C. reasoned that if her brain cells needed real sounds from the outside world, she could provide them. She recently got a modern hearing aid, a cochlear implant, surgically placed in both ears.

Now her brain cells are getting signals from real voices, real places, and yet, while in some people cochlear implants immediately stop musical hallucinations, in Cheryl C. it didn’t work. Her inner music continues. Why?

Third, what is it like to be stuck with relentless music, music that arrives unbidden? How does one cope? Cheryl C. says for her it isn’t so terrible (and she has been listening for five years). Should something like this ever happen to you or to someone you know, her advice:

"I think the best way to deal with it is to just get on with your life, and do what you have to do and keep it in the background and in perspective," she says.

The story of Cheryl C. can be found in detail in Oliver Sacks’ new book, Musicophilia (Knopf 2007).

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