Please excuse my absence....I just got the book but am up to this chapter which iI find highly unsatisfying.
The examples of musical hallucinations are indeed, to those of us not affected, fascinating and even entertaining. The trials and tribulations of experimenting with various therapies and the drugs (complete with dose) that are mentioned are, obviously, pertinent.
However, from the point of view of a non-neurologist, I am less interested in which treatments may work or how they affect people in general than in the recurring mention of the type of music that is being heard.
It would be worth an investigation to figure out why Christmas carols (or patriotic songs, which are often based on simple religious tunes from other cultures) seem to be the "hallucination of choice". Granted, some patients hear excerpts from Beethoven or Bach but the majority mentioned tend to hear carols and marches.
But why? I feel he leaves the most exciting question out of the chapter. Is it due to the simplicity? The rhythm? The repitition within the music? How does this relate to the part of the brain that is responsible (Boyer) for religion? And this brings up the question of music and its role within the religious realm.
I'll continue reading. Perhaps insights are in spe in the following chapters!

Perhaps the common thread across musical hallucinations is music hear/learned early in life. That would make Christmas carols and patriotic songs reasonable since they are often first heard as young children. There is no hint of religion, per se, having an influence on muisical hallucinations other than the fact that religious music is often early music.

No, there isn't any hint of religion having an influence on musical hallucinations, that is correct. I was going ahead of my thoughts there. But I am indeed interested in the proximity of the areas of the brain responsible for music and for religion. Guess Wikipedia will have to do for now. Sigh. I do think, however, that music underlines aspects of our lives, both conscious and unconscious and I believe religion uses this aspect to its full intent. As to Christmas carols, as mentioned, the tunes are usually catchy and easy to remember, perhaps underscoring some pleasant memory. But some of the music brought more unpleasant memories back to life.
A science magazine show on tv here called NANO presented a recent study suggesting any active participation in music, be it singing, playing an instrument or consciously listening intently to music, exercised the "brain" more than anything else and worked against some of the more frightening aspects of aging, such as Alzheimer and dementia. I unfortunately missed most of the programme and need to check into this.
I have also spent the better part of the day thinking about what horror it must be to constantly have a few bars of some ditty playing in your ears at full volumne all day. On the other side, what an almost religious experience it is walking into a cathedral and listening to Gregorian chant.

I don't remember which chapter but Sacks makes the statement somewhere that even just one year of music lessons at a young age causes a specific area in the left hemishere of the brain to enlarge and stay enlarged for life.

Interesting stuff, more interesting than all thoses individual stories that pretty much reinforce each other but often don't offer any explainations.

AHHHHH everyone's ahead of me again!! I will be returning to this thread once I get caught up on this chapter and probably the next so I'm not behind again!!

Stay tuned, true believers...

This chapter was long and, as oblivion said, pretty unsatisfying. I felt that Sacks made his point with the first few cases, but then continued on and on until I almost couldn't read anymore.

What was interesting to note, for me, however, is that every medication mentioned so far in the treatment of seizures or these hallucinations are medicines I have been prescribed or have been highly recommended to me. For example, the use of the drug Lamictal (lamotrigrine) in the musical seizures chapter is also used to treat the manic and depressive cycles of bipolar disorder, which I was diagnosed with several years ago, and I was on different doses of it at length several times throughout my different courses of treatment. I have also been prescribed Seroquel (quetiapine), which is an anti-psychotic drug that is often used to calm psychotic episodes in schizophrenics and is approved to treat the manic side of bipolar disorder. One of my former psychiatrists called it a "rescue drug" that she would prescribe for a few weeks when a patient was in a severe manic or depressive state, then taper off as the episode slowed down. It is very sedative, as the patients in this chapter have expressed, and at the dosage useful for psychiatric and mood disorders, it makes everyday functioning extremely difficult. It can make you sluggish, dazed, and is notorious for short term memory loss and inability to concentrate. Overall, I found it to be a terrible drug, and have since refused to take it or any other anti-psychotics, as I have had allergic reactions to most of the others in this class of drug.

The Neurontin (gabapentin) that seemed to be the most helpful for a few patients was highly recommended to me by a psychiatrist I had no trust in because he advised me to continue taking an anti-psychotic medication when it was clear I was having the kind of negative reaction the pharmaceutical company recommends to stop taking immediately if present. This doctor kept trying to push Neurontin on me, even when I showed reluctance and found many lawsuits being launched against the company that made it because it isn't approved to treat the disorders many psychiatrists have been trying to prescribe it for. It is mainly approved only to treat epilepsy, and has many dangerous side effects that it is not worth being a guinea pig for some doctor's pet treatment idea. I found it interesting that it was used in the cases in this chapter and received well, for I have heard nothing but horror stories about it from everyone except that one doctor.

Nothing in this chapter seemed new to me, or that intriguing, really, because it made sense to me that once the physicality of hearing is impaired or lost to the extent in most of these cases, that the brain would then try to "make up" for the lack of stimuli. My own brain does this frequently, and although I do know it is internal and not external, it is fairly constant and is often fragmented or reduced to one or two notes, as some of the patients mentioned. Concentration or physical aural stimulation overrides it, and when there is nothing it starts again. It also isn't always music. Sometimes it's the last line of the movie I just watched, or the last sentence I read, or the last thing I said to someone that repeats several times. Having obsessive-compulsive disorder also plays a part in this, I think, because I do tend to repeat things I say over and over in my head, the way some people count the tiles in the bathroom or how many stairs there are as they are climbing. Having OCD may lend itself to this kind of constant repetition of music or words, I'm not really sure, but I can't control it and either just try to tune it out or find some other distraction to keep me from falling into a panic attack.

I find I really am relating to all of these people because of my musical background as well as my psychiatric disorders. Even though what I go through isn't as volatile as seizures or hearing loss and fierce auditory hallucinations, my brain can cause me to feel just as much agony, and I would like to see how Sacks would face someone with problems similar to mine with a musical but medical mind. I think it could be very helpful for me and others who suffer the same.

Some links to make some of my points clearer:
Bipolar disorder: http://en.wikipedia.org/wiki/Bipolar_disorder
Schizophrenia: http://en.wikipedia.org/wiki/Schizophrenia
Lamictal (lamotrigine): http://en.wikipedia.org/wiki/Lamictal
Seroquel (quetiapine): http://en.wikipedia.org/wiki/Seroquel
Neurontin (gabapentin): http://en.wikipedia.org/wiki/Neurontin
OCD (obsessive-compulsive disorder): http://en.wikipedia.org/wiki/Ocd

Thanks for the explanation concerning the drugs, Bleached. Having no idea what he was referring to, I rather glossed over those sections. The insights were very welcome!

I'm glad they were. I find it interesting that, in this book, at least, I'm suddenly the pharmaceutical expert because I've taken most of the drugs he refers to (but doesn't explain, oddly enough). I find it interesting that he includes the use of these drugs in his stories, but doesn't explain what the drug is usually used for and how it works. Having personal experience with these drugs, I happen to know how they work, but unless you have one of these disorders or have a good medical background, most other readers wouldn't understand why these drugs are helpful, and I think Sacks could have explained that better.

That being said, I am glad my experience could be helpful.

I guess I am in the minority here but I actually like this chapter although I will admit Sacks' propensity for describing maladies with little connection to the actual brain systems can be disappointing.

I have MS (in long term remission fortunately) and I have experienced at different times hallucinations myself. I know they are not real, there is no doubt in my mind about the reality, it is nerve damage. With less frequency now than after my attacks, 26 years ago, I could see images or hear noises. The image was like after image, or similar to if you apply pressure to your eyes. I often would see in the bottom third of my vision a chain of colored beads with yellow and black being the predominant colors. It often moves as though one were pulling on a string of beads in a circular loop. It is sort of weird, if I try to look at it directly, it will fade, if I look across the room it will strengthen. It can remain for hours. Again it is more of a after image than a strong visual image. I can see it better in the dark or with my eyes closed, but it defies a direct look. The other hallucination I frequently had was a fluttering in usually my right ear but sometimes both. Imagine restraining a small bird about 4 inches from your ear. The fluttering could last anywhere from a few seconds to a few minutes, and often repeats every 10 minutes or so but not with a timed regularity. It was very audible but not uncomfortably loud, but also had somewhat of a physical sensation of something quivering but I could never feel anything with my fingers. A cochlea quake perhaps.

Like I say I never had any doubt to the reality of these sensations and they actually in themselves were not unpleasant. But there is always that question of now what and where is this going to stop? I had a whole body muscle spasm shortly after my original attacks that I genuinely thought was going to kill me. It eased up as suddenly as it started. I mentioned it to the neurologist and he said "Yeah that stuff happens with MS." I said "Well thanks for warning. I thought I was going to die." He replied "If I were to tell you every weird thing that can happen as a result of MS, we would be here for days."

Even though I have always known this stuff was the result of nerve damage from the MS, I still found the distinction between neurological and psychotic hallucinations in the book to be comforting.

I'm sorry to hear about you condition (glad it is in remission, though), and thank you for sharing your experience with us. I'm glad you could get a sense of peace from Sacks' explanation of hallucination, knowing that your hallucinations have nothing to do with those of people with severe forms of psychosis. In many of those cases, those suffering from the hallucinations cannot always be sure that they are hallucinating, and can often choose the hallucination over reality because it is so strong and convincing for them. Since you are aware that what you are seeing is not real but a symptom of the disease you know you have, you are definitely far more grounded in reality than those with psychotic related hallucinations.

Again, thanks for sharing. I hope you are feeling ok lately.

It's fascinating to consider. Do the hallucinations follow the rhythm precisely? I wonder what mechanism accounts for our 'internal clock'. The delay between each note must somehow be stored. I know, that happens even when you memorize a song. But talking about hallucinations just made it a bit clearer for me. How do neurons store a period of time? Now I need to go read a Dennet book.

It is interesting that you bring up internal clocks and timing. I believe I read in "This Is Your Brain On Music" by Daniel Levitin that our musical memories are quite accurate in tempo. That is if you play a tune in your head, the beat is going to be very close to the piece that you are remembering. (Don't hold me to this, I have a terrible memory).

When I was in college, I developed some interest in classical music. The cool thing about classical was that you could pick up some great music for little cost. There were a lot cheap records made by struggling post war European orchestras. In listening to these, I developed an internal program of what a particular piece sounds like.

In the late 80s (after my MS attacks) my interest in classical returned. My stereo and turntable had long fallen into disrepair so I got a new stereo with a tape deck. I couldn't play my old records, so I went about replacing my records with tapes, which was still a bargain. But for the most part I couldn't replace the exact recordings of my records--that had long faded from the market. I could get stuff recorded in the 60's by Bernstein and Ormandy for a fraction of the cost of what newly recorded pieces were going for, but it was not my original music. Any "new" music I bought sounded fine, but the pieces that I tried to replace from my record collection never sounded right. The french horns are too muted. Where the hell did the cellos go. Why do they play it so fast. My replacement tapes did not sound like the music that I remembered from my records. My records sounded right and this new crap was just all wrong and always played too damned fast. What is the rush? I ended up not listening to any of my replacement music because it was irritating. It was like going into a Karaoke bar and trying to convince your self that yeah! That really is the Beetles!

Last summer I bought Led Zeppelin 3 & 4 (Zoso) on CD. I had heard neither album since the 70s (before my attacks). At first listen the Immigrant Song sounded a little too fast, and then as it went on it was OK. The rest of the songs were fine. Truly the same Led Zeppelin that I remember (as to whether it really is could debated--but it certainly sound the same). So buying the same music sounds the same (except for that first little tweek), but buying different orchestral music sounds all wrong. Different conductors emphasize different things, but the modern guys always play the damn thing too fast.

I had two nasty MS attacks in 1984. And while I have been fortunate and not had any additional attacks, I still live with the damage wreaked in the original attacks, bad balance, weak shoulders, numb hands, a loss of IQ (didn't have much to begin with so the loss was somewhat devastating), terrible memory, and I don't think as fast as I used to. The best way to describe it is that my clock speed slowed down. I have no basis of saying of how slow, but I know that it takes me a lot more time to process information than it did before my attacks. I have found the intellectual and memory problems from the MS to be more troublesome than the physical.

Last fall I read an article in Vanity Fair about the big fight that Jackie and Robert Kennedy had with William Manchester over "The Death of A President". This piqued my interest and I found a copy of the book at Alibis and read it. Fascinating, a bit naive, but really a great book. Anyone old enough to get junk mail from AARP probably remembers watching Kennedy's funeral on TV. I can remember the solemn drone of Walter Chronkite's fatherly voice giving us the details while caisson went slowly through the streets of Washington to the beat of the drums:

Boom boom boom...ratatatatat...boom boom boom...ratatatat...boom boom boom...ratatatat...boom boom de boom......... (Yeah I know it sucks, but you get the idea). I can hear those drums in my mind's ear as though it were yesterday.

Well in the process of reading "Death Of A President", I started to look at YouTube videos while I read. I watched the motorcade at Dallas, Johnson taking the oath on Air Force One, and the various videos of the funeral at the same time that I read the chapters in the book. I found the one with Walter Chronkite and the drums. Walter sounds fine, the drums are ridiculously too fast. This can't be right. They speeded it up on YouTube to save server space! OK Sherlock, but why doesn't Walter Chronkite sound like Minimouse and why aren't the cars moving about at 25 miles an hour rather than walking pace. Only the tempo of the drums sounds fast, everything else seemed normal.

Suddenly a light goes off...BINGO! My clock speed slowed down! The drums are the same in video that they were in November of 1963. The tempos of the replacement symphonies are probably fine. It is my slow clock speed and memory that makes everything seem too fast. The symphonies did not sound right because they were not exactly the same. The emphasis of instruments is different but the tempos are probably OK. Led Zeppelin started to set off an alarm then I made an internal adjustment and it was fine. Led Zeppelin still sounded the same but just a bit too fast until I adjusted the timing. So perhaps I should lend my brain to science so it can see where the lesions are in the myelin sheathing and thus find the location of the internal BIG BEN! I probably wouldn't miss it much, it has been rather unreliable for past two decades.

Growing up in Vienna, Austria, I was always surrounded by classical music to the point where I could identify a specific orchestra by the sound of the piece or even tell if Herbert von Karajan conducted. I could identify the composer and the piece within a few measures. Later, after many years in this country, I collected classical music on vinyl, mostly Deutsche Grammophone, they always sounded most authentic. I bemoan the fact that all this knowledge is gone due to neglect on my part. I tried to rekindle the passion with some CDs even later in life, but it was not the same. Things happened, life moved on. I’m sure the vinyls are still around in the shop, probably all wharped. And the turn table? Music sounded so much better then.

However The Tinnitus is a common condition and can affect different people in different ways. Some experience, such as low-frequency hum or rumbling noise. Others will have their music heard songs or music tunes in their head illusion .