10/03/2006 04:58 pm ET | Updated May 25, 2011

Music in the Head: Living at the Brain-Mind Border; Part 3

As I lived these songs coming from outside of me, I came to know I am not alone. Intrusive sounds, rhythms, music, do not set me apart from others. Most human experiences are relative, occurring more in some and less in others. The song itself is only one in a series of spontaneous sounds. People have neighboring, contiguous moments. They hum, or whistle, or to an inner urge, tap their fingers or feet. If they ask themselves, these are not all voluntary. One feels himself humming a song he knows not from where. Or people "whistle while they work"; but their attention is on the work. There are not many who do not know ringing in the ear. A hiss, high-pitched, insistent, can be more than a nuisance. For myself, I know now that I always have that too. I have but to listen, and it is always there. But I can turn away, and it is gone. It is not alien enough to make it a big deal. Although coming from within, many of these intrusions are not compelling, and not felt as foreign. They are ego-syntonic, acceptable to the normally-functioning mind. These varied sounds and rhythms, not voluntary but also not offensive, connect me, with my more pronounced version, to the human race.

Song is in fact the outcome, not the original intruder, the ultimate after a series of predecessors. I hear any phase of a series, noise, rhythms, beginning sounds of attempted music, then tunes, melodies and, when I succeed in finishing the series with words attached, there is the song. As the mind constructs a finished dream upon awakening (we call this the "secondary revision" of a dream), wrapping these sounds up with the words is the final packaging of a song. Begun in the unconscious, polished and tied up preconsciously, noise is converted to song. The whole process makes the unwanted acceptable, the unbearable bearable; the unpleasant ultimately enjoyable. The Israeli psychiatrist Pinchas Noy, wrote "The ego --- develops a superior capacity to organize auditory stimuli, to discern among their various shades, and in particular to transform painful stimuli so that they can provide gratification and pleasure. Listening to music becomes an activity of the ego with a service of mastering auditory stimuli that, in their deeper meaning, are threatening and frightening"! ([From The New Yorker, Kissin the musical genius, August 26th and September 2nd, 1996: Page 119).

I hear every stage, depending on when I "tune in". Sometimes noise, a rush of air, a roar, like background traffic, sometimes a rhythm, steady or changing, up and down, side to side, large or small, like waves of every kind and dimension. Or there are intermediate forms, sometimes barely a song, just a hint of one, unrecognizable, or even a tune deciding between two songs, or mixing up two or even more, or finally, as if the uncertainty has been solved in favor of a dominant one, a regular, ongoing, firm, confident song, sometimes first the tune, then combined with the lyrics; this then takes the stage and stays on.

When there is no official song which comes on by "itself", my brain-mind may make one up. At times, with no known music coming, I hear an attempt at a new song, beginning with some gross rhythmic phrases looking for some regular order. I might then add an arbitrary nondescript tune, and graft upon this any experimental nonsense or gibberish words that pop into my head, maybe the last words someone said, or I read or heard or thought, to make an ersatz "song" take off. I might find myself repetitively or rhythmically singing "Yippee, yippee, yippee", or "ooh, la, la", or in a different mood "oy vey, oy vey, oy vey, vey, vey", or a random word or some name I just heard (Ju, Ju, dee-dee-dee), in a regular sequence and mode, as firmly and confidently as I might be singing "auld lang syne". The syndrome is related to creativity, mostly an absence of it (here is where I need an Irving Berlin). I generally have to lean on others. The dream is also a creative product given to everyone; for this, one does not need help.


At the center of this unusual syndrome is its hyperacoustic nature. There is too much hearing. I hear where I do not want to. I am forced to listen when I prefer to be quiet. As engineers speak of "noise in the machine", from electrical, hydraulic, or air pressures, the biological machine has its own inner, operational noise. That was why I was moved to check the rhythms I heard against my pulse, to see if there was a connection. There was not; it was not coming from the vascular system; it was not noise from blood flow. It comes from the stimulation of the auditory apparatus of the nervous system.

Strangely, and seemingly ironically, I feel that this hyperacusis is related to the opposite existing condition, i.e., that I am hard of hearing. The condition came on in my early fifties. I have long known it to be due to an inherited congenital nerve deafness, which I have become familiar with, and have attended to medically through the 4 to 5 decades since its onset. My father had it, and 2 of my 3 siblings, and now one of my four children is experiencing its early stages. The onset of the symptoms of this inherited gene typically comes after age 50.

But the type of deafness I have inherited is associated at first with excessive along with diminished hearing, hypo- and hyperacusis combined. A degenerative process that destroys neurones may irritate contiguous ones as well. Along with a diminution of hearing, there are at first also sounds that are too loud. My son feels that his wife speaks too softly, while sounds around him are loud and jarring. Gradually, all hearing becomes involved. Later, with hearing aids, amplification necessary to make voice distinct also makes ambient noise loud and in need of control. It has followed this course in all of us who have it. While some voices cannot be heard, and words are indistinct, and words cannot be made out, and consonants are worse than vowels, and treble is more difficult to understand than bass, other sounds are excessive, to the point of jangling. Dishes and voices and music in a restaurant become unbearable to at least this hard of hearing population. So it is with any extraneous noise or sound, such as traffic or the purr of an engine. An airplane or helicopter overhead roars like thunder, drowning out everything else. Or a motorcycle, or the sound of a motor.

The unwelcome music is also an excessive sound impinging. I experience it as any other intrusion or imposer upon the equilibrium of the mind or body. One wants to eliminate or if not neutralize it. While akin to ego-alien obsessions and compulsions, the aural condition I have springs from organic sources not under the control of the mind. The songs are inner attempts to counter this mindless noise, to neutralize, limit or control its power. The mind works on the intruder. Noise becomes sound, which becomes rhythm, which is transposed into music, which is added to by song. I am the locus of all of these stages, and can become aware of any stage. At different times, I am hearing different phases of this sequence.

The volume of the inner music is unaffected by my hearing aids. It has its own volume, and is always the same. My unconscious is not hard of hearing. Pretty hard evidence that the songs have a separate life from "me", at least the conscious me.

I made a surprising discovery--which should not have been surprising. Sometimes when the music stopped, I would find myself humming the tune I had just wished would please stop. I found I missed it. I was now doing it myself. "My God, I wish it". Duh! Every psychoanalyst knows that in every symptom--and this is a symptom-- behind every defense is a wish! Like every symptom, this one too contained a repressed impulse. The songs that come to the surface, that managed to survive the conflict, carry urges, hopes, wishes. Romantic, sexual, moral, aggressive wishes, as well as urges for action and mastery. These are in fact what brought them to their final shape, neutralizing and replacing the original interfering noise. Complain as I will, the song is welcome, at least partially so.


I have been living at the edge. But a very special edge, the border between the brain and the mind. From here the vistas are wide, in several directions. The fields over which these experiences roam cover neurologic, otologic, and psychoanalytic realms, converging into a unique symptomatic combination of them all, lived and experienced not on a controlled couch but on the stage of an ongoing life. Arising from the psychic depth, a neuro-psycho-otologic window has been opened to me by this personal experience.

As an old neurologist, then psychiatrist and full-time psychoanalyst, I consider myself a kind of living laboratory, in a position to have made many observations and to draw some conclusions. As an experiment in nature through an auditory prism, I have by now some kind of built-in feeling of the way sounds and moods interact, how rhythms and quiet periods mesh with how individuals feel from moment to moment. I have tried to coordinate the emotional moments I live through with what we know about brain-mind functions, how the complex brain intersects with the dynamics, structure and rules by which the mind operates.

Hearing starts when a vibrating sound wave stimulates the organ of Corti within the cochlea, which connects to the cochlear division of the 8th cranial nerve, which carries the impulse to the dorsal and ventral cochlear nuclei in the caudal portion of the pons, from there to the lateral lemniscus mostly of the opposite side, then to the medial geniculate bodies, from which radiating fibers sweep to the auditory center in the cerebral cortex, situated on the anterior transverse gyrus of the temporal lobe, and the superior temporal convolution with which it is contiguous. From modern neuroscience, we know today that there is an intricate collateral network from this structural path to centers in the mid brain, through which cognitive inputs fuse and integrate with emotional experiences to produce the complex reactions that stamp the human species. The amygdala, hypothalamus, anterior insula, somewhat the hippocampus and other areas in the basal ganglia connect what Paul MacLean has called the neo-mammalian and the lower, reptilian sections of the triune brain, to tie emotional reactions to their cognitive counterparts. Music and song are examples of how these are fused. It is in these nuclei of the mid-brain that there is probably a symphony of neuronal activity in the brains of those in rapt attention in Carnegie Hall or at a Woody Allen or New Orleans jazz club.

This is the machinery, not the operator. Where the brain ends, the mind begins. While the 20th century was the century of the science of the mind, its last decades supplied the years of the brain. It is the domain of neuro-psycho-science in this new century to work out their functions in unison. A dissection of Einstein's brain will never reveal his theoretical contribution, nor Mozart's the galvanizing power of his musical scores. However much brain scans will pinpoint where the central structural activity takes place, the mind "out there" surrounded by the culture is the agent of discovery and creation. The locus of creativity cannot be seen under a microscope. Phyllis Greenacre, an awesome scholar of psychobiography, demonstrated the power of early childhood traumatic experiences in the lives of genius and the gifted, studying in depth the histories of Charles Darwin, Samuel Butler, Jonathan Swift and Lewis Carroll.

If the last century contributed anything enduring, it is that the mind does not overlap with consciousness. The songs that visit me come into consciousness from somewhere else, from the dynamic unconscious. The brain and mind, the body too, are acting together in a circumscribed area of functioning, the auditory aspect of sensory life, producing a particular, unusual form of hearing. Psychosomatic and somatopsychic operate in unison, stimulation being exchanged and fused in both directions. The duality of mind and body, organic and mental, the psychosomatic unity, the fusion of ideas and emotions, of the subjective and objective, the confluent and mutually supplemental functioning operative in the hearing phenomenon I am describing typify how the human being operates in many aspects of being human. "Use your brain" is matched by "use your imagination", whether a potpourri of visual images to a painter, or of a succession of dizzying variable auditory phrases to a composer. Where too much imagination, accompanied by a loss of reality function, leads to delusions or hallucinations, anti-psychotic or other psychopharmacologic agents are used to suppress the image-making--usually at the expense of a normal amount of this desirable functioning, which includes dreaming, day-dreaming, creating and inventing.

The vascular complications conventionally feared by the medical profession, and articulated to every patient undergoing cardiac surgery, were gratefully absent at my surgery. But a less heralded complication came upon the scene. The vascular supply to the auditory apparatus was partially and temporarily compromised, sufficient to bring about a degree of malfunctioning in a susceptible system, already deficient and working below par, a neuronal tract which was the locus of least resistance to further vascular insult or insufficiency. What we can postulate is that it was mainly inhibitory circuits that were involved and reduced by the physical trauma, modulating fibers that normally keep loud external noises from impinging too strongly on the receptive hearing apparatus. The result was a general increase in ambient sound. Converting the formless but jarring noise into enjoyable song, by the mind that had been intruded upon, was a creative act.

I know I have been living at a normal border, between the brain and the mind, but, like it or not, with a magnifying lens. Driving home one evening from a concert at Disney Hall, a friend, who hears well and not too much, said she could not get the waves of Mahler's 9th Symphony, which we had just heard, out of her head. But not long later, she said, "It's gone", attesting to the fact that she had not joined the ranks of the abnormal normal.

At the end, I can no longer say for sure that I am not a composer. As I walk along the Pacific edge, with a regular rhythmic step, on a clear, crisp afternoon, my hum becomes a cadence, I am adding some kind of music, and I search for words to go with it. It is not a success, perhaps a dismal failure. But some nonsense words and syllables do catch on and become integrated into a rhythmic melody. The composite sound, tune, rhythmic sequence, and nonsensical words, becomes structured, remains steady, and begins to roll on its own, i.e., it continues after I stop the inner humming, and I begin to hear it as an outsider. I feel quite up, maybe creative. For half a day, I am listening to music coming that I made up. Later that evening, I listen again. I hear something similar, but not quite the same. The nonsense words are of course out of memory. But the tune as well, as I come to recognize it, is not what it was earlier in the day. It is the theme music from The Bridge on the River Kwai, which has long been on my inventory, and which comes up many times. As I sing along, I see not me on my walk, but Alec Guiness marching across the bridge, with his head held high.

Part One