This is Fresh Air. I'm David Bianculli, TV critic for Broadcasting and Cable Magazine and, sitting in for Terry Gross. Our first guest today is one of the world's best known neurologists, Dr. Oliver Sacks.

He's famous for his books chronicling case studies of patients with neurological disorders that have produced strange distortions of reality. One now famous example is the title story of his book, "The Man Who Mistook His Wife for a Hat." In his book, "Awakenings," which was made into a movie, he told the stories of patients awakened by medication after years of being institutionalized with a Parkinsonian sleeping sickness. Through such stories, Sacks offers insights into the brain and our experiences of reality.

His latest book updated with new information and now out in paperback is called "Musicophilia: Tales of Music and the Brain." It's about the profound affect that music has on us and tells the stories of people whose neurological disorders have altered their perceptions of music and their musical abilities. These case studies pose larger questions such as why do some people have perfect pitch while others can't carry a tune? Terry spoke with Olivier Sacks last year, when "Musicophilia" was first published.

TERRY GROSS: Olivier Sacks, welcome back to Fresh Air. You have told many amazing stories in the book. The book opens with one of those stories of a 42-year-old orthopedic surgeon who is using a pay phone in a phone booth during a lightning storm, and his head was struck by lightning through the phone. What change did it produce in him musically?

Dr. OLIVER SACKS (Neurologist, Author): He was hurled backwards, and he was, in effect, killed for a short time. He had a cardiac arrest for maybe 30 seconds, and, of course, his brain got no oxygen during that time. And he had some immediate consequences, loss of memory and so forth.

This came back, but then he developed a sudden insatiable passion, as he put it, for hearing piano music and then for playing piano music, despite the fact that he'd been really without any particular musical taste or talent all his life. Then he started to have dreams that he was composing music, and when he woke, the music was still going through his head, and so then he wanted to be a composer as well as a performer.

And all of this happened, really, in the course of two or three days in which he was completely transformed. He continued to work as a surgeon, but he started getting up at three in the morning. He got himself a piano teacher. He learned to transcribe the music which was going through his mind. But this change has been permanent, and in 15 years now, he has become quite an accomplished musician in a way which could never have been predicted before.

GROSS: What does that story tell you about what happens neurologically with music? What do you take away from that story?

Dr. SACKS: Well, I don't know exactly what has happened with him, and I hope we can sort of get some brain imaging, a functional brain imaging, and see what has happened. This sort of imaging was not available really in the early 90s, when he was struck by lightning. But there are a number of situations in which maybe a rather sudden astonishing release or emergence of heightening of musical abilities - one sometimes sees this with epilepsy, with temporal lobe epilepsy, one sometimes sees it with a rare disease called frontotemporal degeneration, when the temporal lobes get released, and music and visual patterns can play in the mind. I suspect that something like that happened with the surgeon.

GROSS: You mentioned epilepsy. You worked in an epilepsy clinic for a while, so you're exposed to a lot of people with epilepsy, and you write about how some people with seizures would hear like beautiful music, but other people would be tormented by music. The music would be horrible for them.

Dr. SACKS: Well, occasionally, music can cause a seizure. I saw a patient, I'll describe her, who told me that she had been found unconscious with a bitten tongue next to the radio three or four years ago. And all she could say was that she had heard some Neapolitan songs being played on the radio, songs which she normally loved, but these produced a queer feeling, a strange faint feeling, and then she couldn't remember anymore. And this was regarded as an unhelpful piece of history, but then she had another seizure, another convulsion, also following a Neapolitan song, and it became apparent that Neapolitan songs would give her seizures and no other music.

She came from a large Sicilian family, and Sicilian and Neapolitan music was always being played. If it was played a wedding, she had about 20 seconds to block her ears and get out of ear shot. Otherwise, she would be taken over. And she was sort of heartbroken because this was music she loved, and now, she started to dread it.

GROSS: Which part of the brain deals with music?

Dr. SACKS: Well, a great many different parts of the brain deal with the music, but the auditory parts of the brain obviously deal with music in the first place with a sound of music. Then there is analysis of the pitch and the rhythm and the tempo and the melody, melodic contours and other aspects of music in different parts of the brain. The motion of music, the tempo, and the rhythm is separately registered and so also is the emotional reaction to music. So there are really 20 or 30 different parts of the brain which are being recruited in the musical experience. And these are never quite the same in any two people.

GROSS: Is language as complex as that? Does it call on as many parts of the brain as music does?

Dr. SACKS: Language doesn't seem to call on as many parts of the brain, and this may be a reason why, if one has a stroke or something and loses language and knocks out a particular language area in the left hemisphere, one usually retains one's musical sensibility, and one can still recognize and sometimes sing songs.

GROSS: If you're just joining us, my guest is the neurologist Dr. Oliver Sacks, and his new book is called "Musicophilia: Tales of Music and the Brain." What have MRIs allowed researchers to see about the differences between musicians and non-musicians in the brain?

Dr. SACKS: Well, there have been very very striking findings here. You know, people have been looking for some sort of cerebral correlate of intelligence or of musicality or artistic gifts or literary gifts for ages. When Einstein died, his brain, in fact, was stolen by the pathologist and subsequently cut into little bits and distributed. People wanted to find out what was Einstein's secret. And nothing clear cut really came of this. And in general, if you look at a brain, either in life with an MRI or later, you can't tell whether it's the brain of a genius or fool, whether it's the brain of a visual artist or a literary artist.

But you can look at a brain and say that's probably the brain of a musician because musical training and involvement of music enlarges various parts of the brain, the corpus callosum, the great band which goes between the two cerebral hemispheres, parts of the auditory cortex, parts of the cerebellum, parts of the frontal lobe cortex. There are striking changes which can occur within a year or within a single year of musical training. And these are changes which are really visible to the naked eye, at least if one knows where to look. So the power of music to alter the brain is very very striking.

GROSS: Is this is a chicken-and-egg thing? Is there a person with a certain kind of brain and certain enlarged parts within the brain that becomes a musician, or is it that musical training that has the impact on the brain?

Dr. SACKS: Well, we don't fully know because usually, one does not do an MRI on a three-year-old or a four-year-old, a gifted three or four-year-old, before they start musical training. I think we need to do this, but what we do know is that the musical training itself can make very great changes as - though, obviously, some people are born with greater musicality and others not. Usually, innately musical people get early and intense musical training.

GROSS: Have you ever looked at an MRI of your brain and, like, analyzed your brain?

Dr. SACKS: Yes, actually quite recently - both the structural MRI, which, to my relief, did not show Alzheimer's or anything like that.

GROSS: So what did you learn from your own MRIs about your brain?

Dr. SACKS: Basically, it seems similar to other people's brains.

(Soundbite of laughter)

Dr. SACKS: Although, having said that...

GROSS: Uh huh.

Dr. SACKS: You know, as one examines this in more detail, you do, in fact, find that MRIs, and especially functional MRIs, are as individual as fingerprints, and this is especially so with musical responses. No two people are exactly the same, and sometimes, you know, an individual's functional MRI with music may change over the years as they change, as perhaps, you know, as you described earlier, when perhaps, say, a tune which didn't move you much, heard years later is strangely familiar and gets you, something must have happened. And I think that, you know, that could probably be showing up if one had an MRI of the earlier hearing and then the functional one of a later hearing.

GROSS: You know, you described somebody who has perfect pitch in your book, and who wonders why is it that people are mystified at perfect pitch. Yet everybody seems to be able to describe a name - to see and name colors. Now, to me, being able to identify a G or, you know, a G above C or an A sharp or something is completely different than being able to say that's turquoise.

Dr. SACKS: I take it that you don't have absolute pitch then.

GROSS: I sure don't.

(Soundbite of laughter)

Dr. SACKS: Well, nor do I. It's - but to people who do have it, it seems to be as natural to say G sharp as to say turquoise. And they don't have to make any explicit comparison with, you know, with any other pitch, just as we can say something is turquoise without having to compare it to pink or green.

There's some suggestion that all of us may have absolute or perfect pitch in the first year of life, but then the vast majority of us then lose it. Although with intensive musical training, it's more apt to be retained, so absolute pitch may occur in something like one in 10,000 people in the general population, but it's closer to one in 10 or one in 15 with professional musicians.

GROSS: But do you think it's - notes like G and A and B flat, they're just kind of like human constructs, like they don't exist. That scale doesn't exist in nature. It was created by humans, so...

Dr. SACKS: Well, I mean, I suppose one might say that blue and green don't exist in nature. I mean, they're obviously - there is a continuous spectrum of wave links, but we arbitrarily pick out a certain segment to that and say, we'll call this blue, or we'll call this green. And similarly, I think out of a tonal continuum, we will pick out a particular thing, and, you know, we will divide an octave. An octave is a universal - is a mathematical universal and is a physiological universal. Middle C has double the frequency of the C below it, half the frequency of the C above it. And if a human being can tell an octave, and if we then divide an octave arbitrarily into, say, 18 steps or whatever, then we get our particular scale. The Hindu scale is different. I mean, obviously, culture comes into it, but there is something natural, as well.

GROSS: You know, one thing I often wonder is why are familiar melodies so special to us? You know, like you can go to a concert and really like the new songs a performer does, but when the performer does the song that you already know and like, the familiar song, there's just a different feeling that overcomes you. And I have found that even songs I might not have liked in their own time, when I hear them now, this isn't always true. But it's sometimes true that the familiarity of it kind of overtakes me. Do you wonder, like, what causes that? Why is there, like, a special groove in your brain that seems to resonate with familiar melodies?

Dr. SACKS: Yeah. Well, I mean, familiarity always goes, I think, for the feeling of a particular memory, a particular place, a particular mood, a particular emotion, and there's a very, very intense relationship between music and memory and emotion. I think music has a tremendous mnemonic power, which, of course, Proust writes about. I think nothing, you know, it's almost as powerful as taste or smell. Music brings back things, but as you say, familiarity alone can do it and can sort of give one goose bumps, bring back one's early years.

GROSS: You write not only about music that we hear, but you write about music hallucinations, music that only exist in our minds, and you said that you became interested in musical hallucinations when your mother at the age of 75 started hearing patriotic songs from the Boer War playing incessantly in her mind. First, you should tell us what the Boar War was and why your mother would know those songs?

Dr. SACKS: OK. Well, my mother herself was surprised because she was only seven at that time, and the Boer War was going in South Africa. And in general, a seven-year-old child is not that interested in a remote war. But there were lots of patriotic songs that were being sung in England at the time.

But my mother was intensely surprised. She said that she, you know, she thought these songs had never meant anything much to her in the first place. And secondly, she hadn't given them a thought, a conscious thought, in nearly 70 years. And now, suddenly, they were erupting inside her. She knew that it was going on in her head. She didn't feel that, you know, the songs were actually being played, and so she wondered what had happened. She herself had been trained in neurology. She wondered if she'd had a little stroke. She wondered if it was the medications she was taking for high blood pressure. Whatever it was, it's sort of - the songs died down in a week or so, and they never recurred. And it was just a strange little episode.

GROSS: What do you make of it?

Dr. SACKS: Well, I was intrigued and also slightly frightened by this. I mean, I'm now in my 75th year, and it doesn't seem that old. But, you know, but at the time, I thought of my mother as very old, and I wondered whether, you know, in my end is my beginning, whether the mind was somehow preparing to go, preparing to depart, and regurgitating very early memories.

But I was also very much reminded of something which I had read a few years earlier when the - about people with temporal lobe epilepsy who would sometimes suddenly have songs come into their head and has been found that particular part of the brain responded to that. Although that was different, because they would have, as it were, a seizure with a song going through their head for two minutes and maybe some twitching movements, maybe unconsciousness where, as what my mother described, was a sort of a kaleidoscope of songs going on continuously for hours on end.

And I didn't know what to make of it, but I was intrigued. And later, in the 1970s, I was to encounter this in several of my patients, most of whom were rather deaf, although at that time, I noted that they were deaf without making any explicit connection between the auditory hallucinations and the deafness.

And in some of these cases, people were really very uncertain as to what was going on. One old lady was woken in the middle of the night by hearing Irish songs played tremendously loudly. You know, a hallucination is quite unlike imagery. You feel a musical imagery as your own. You think of a song where the hallucination startles you. You look around. You wonder what's going on. Has someone turned on the radio? Was there a band outside?

And this woman wondered why music was playing loudly in the middle of the night in a nursing home. She wandered out. She was amazed that everyone else was asleep. She thought they'd all been sedated. She couldn't find a radio. She wondered whether a filling in her tooth was acting as a crystal radio, as a transistor. And then finally, she had to infer that something was occurring in her brain, what she called a radio in her brain, which was behaving autonomously and convulsively.

This could be very frightening to people. They - you know, one associates hearing things, people wonder, are they going mad? You know, is their brain rotting? And, in fact, there's been a great underreporting of musical hallucinations. I think, it looks - people are afraid to mention them.

GROSS: Well, as I say, I hear much more about visual hallucinations than auditory ones, though, you know, people who hear voices...

Dr. SACKS: Yeah.

GROSS: Have auditory hallucinations, but I guess that's different from music hallucinations.

Dr. SACKS: Yeah. It's completely different because, you know, the voices are accusing, persecuting, humiliating, seductive, whatever. The voices seem to be addressed to one. They seem to be moral agencies. They make one acutely uncomfortable, and none of this is the case with a musical hallucination, which is like a sort of automatic replay of music one has heard in early life, which may not mean anything in particular to one.

Typically, people with musical hallucinations never get voice hallucinations. And one of the first things, you know, if people have these, is to, you know, is to listen carefully to their story and reassure them that this is not psychotic, that it's completely different from a psychotic hallucination.

GROSS: Dr. Sacks, it's been great to talk with you again. Thank you so much.

Dr. SACKS: Lovely talking with you, Terry.

BIANCULLI: Oliver Sacks speaking to Terry Gross in 2007. His latest book "Musicophilia: Tales of Music and the Brain" is now available and updated in paperback.

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