Third Screen: An Interview with Dr. Oliver Sacks

It seems -- this is my interpretation -- that neuroscience is turning into art, even independent film. It's all about the beautiful, remarkably detailed, and sometimes navigable images created by PET scans and MRIs. I caught up with Dr. Oliver Sacks this week, just as his latest book, "Musicophilia," is being released as a Vintage paperback, and he had the most wonderful things to say about how, in scans, the brain can look like a galaxy or even pop art.

"Awakenings" -- the Oscar-nominated film starring Robin Williams as Dr. Oliver Sacks -- was based on Sacks' work at Beth Abraham, a chronic-care hospital in the Bronx, where several of his patients, frozen solid for years by neurological illness, come alive for a while with the aid of a drug called L-Dopa. Now, according to the eminent neurologist, we've found something equally startling and useful for treating the brain -- music.

Far more than a way to enhance your focus and mood, it's turning out to be capable of bringing large skill sets, memory, language, and more, back to people with neurological conditions produced by strokes, Alzheimer's or Parkinson's disease. And singing "Happy Birthday to You" may be more effective than listening to Beethoven's Ninth.

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Third Screen: What does music do for the brain?

Dr. Sacks: Music profoundly affects the brain. I first encountered this back in 1966 when I went to Beth Abraham Hospital in the Bronx and met the large group of patients I later wrote about in Awakenings. At that time, there was no medical approach of use to them. They were transfixed and unable to initiate speech or movement. Some of them had been this way for several decades. They couldn't say a single syllable - unless music was there. Music had this amazing ability to allow them to move and speak and think. It was very startling. I've seen it numerous times since, but it still astounds me.

Third Screen: How do you account for it?

Dr. Sacks: I can only speculate, but I think all human beings respond to rhythm and musical beat in a synchronized way. You see it spontaneously in small children when they hear music or imagine music. The human brain, unlike the chimpanzee brain, is particularly set up for it. I used to say the brain among mammals is particularly set up for music, but people started to write to me about cockatoos and certain other bird species. And I just got a letter from Katye Payne, a marvelous researcher who works on elephant and whale communication, and she tells me that these species may have musical brains, too. But humans are among a very small number of species capable of responding to music. And we now know and can see on brain scans that if, for example, one has Parkinson's, the brain circuits that respond to music are in tact. Especially those that process rhythm.

Third Screen: If the circuits are in tact in the brain when someone has Parkinson's, what breaks down?

Dr. Sacks: With Parkinson's, there is nothing deficient in attention span. It's a disorder of timing. Therefore, timing and tempo and regularity are crucial. The response to music is not a response to something mechanical - not tick-tock or a metronome - you need a subtle musical rhythm.

Third Screen: Are you suggesting that you need beauty?

Dr. Sacks: In some sense, it is the fact that music is alive and a quickening art. There is something alive about music, and it's this alive part. People with Parkinson's can also be helped by some sort of visual pacing -- in the movie Awakenings, there was a checkerboard floor which helped the patient move. It was a visual equivalent of the pace of the music - its feeling of movement, of life.

Third Screen: Does it matter if the music is live rather than recorded?

Dr. Sacks: I would like to say yes, it is more effective when music is delivered alive from a singer, but in Parkinson's, this may not make so much difference. Carrying an iPod is just as useful. But you have to be able to turn on the iPod. The difficulty, with Parkinson's, is starting or stopping. This may sound more like a subject for a car mechanic, but ignition is key. Something has to "ignite" the brain.

Third Screen: Does the music need to carry strong emotion?

Dr. Sacks: I don't think the music needs to be either familiar or particularly evocative emotionally for people with Parkinson's, but if it is, then so much the better. For people with Alzheimer's, where you're not looking so much to induce movement but to prompt memory or feeling, then yes.

Third Screen: Do you have a favorite piece of music for firing up the brain?

Dr. Sacks: A favorite piece of music? I mostly deal with the elderly and I am myself now among the elderly. My notions go back a long way. My mother taught me - when tandem bicycles were just coming in - A Bicycle Built for Two ... Daisy, Daisy, give me your answer, do .... Whenever I see a tandem bicycle - I like biking - I automatically start hearing it.

Third Screen: What exactly happens to people with neurological disorders when they listen to music?

Dr. Sacks: There are many different categories of neurological disorder. I've talked about those with movement disorders, like Parkinson's disease, and those with dementia, like Alzheimer's. Another group of people suffer from aphasia - the loss of ability to express themselves in language, usually in the aftermath of a stroke. But people with aphasia can still sing the words to a song. Whenever I see such a patient, I start singing Happy Birthday to them, even if it's not their birthday. Everyone knows Happy Birthday. It's a way of getting an aphasiac person to respond.

Third Screen: And it works?

Dr. Sacks: Yes. People who feel they have lost language forever find, often to their own surprise, that language is still there. Sometimes we can take the words and separate them from the music to get someone talking again. This has been done by Gottfried Schlaug and his group at Harvard. Basically, people with Parkinson's or dementia respond to music straightaway. But with aphasia, what you want to do is see if the patient can re-acquire language. It requires very intensive therapy, but it may work when nothing else does and, astonishingly, it may induce linguistic parts of the brain to become active again.

Third Screen: Are these new findings?

Dr. Sacks: Before the 1980s, we didn't have any way of looking at the living brain other than doing electrical recordings, EEGs, which can tell us a lot, but tend to deal with large areas of the brain. Visualizing the anatomy of the brain in detail became possible only in the 1990s, with PET scanning and functioning MRIs. With these technologies, you can look at much smaller structures in the brain. And while such imaging is being done, one can listen to, imagine, or hallucinate music - so musical tests of brain activity can now be very closely monitored.

Third Screen: What's next? What are you most excited about on the horizon?

Dr. Sacks: The sort of thing that we are beginning to approach but I don't really touch on in my book is the nature of creativity and imagination and visualization. I wrote this book as a physician who has people come to him with musical problems, and as a physician who sees the therapeutic power of music in patients. It's not on musical imagination as such. But now we are able to put a musician in an MRI scanner and ask him to compose. We can see all the different lobes and convolutions of the brain that are activated when he imagines music. It's rather beautiful.

Third Screen: Will we ever be able to see exactly the neurological processes behind creativity or memory?

Dr. Sacks: Yes! Soon, I think, it will be possible to get pictures on a much smaller scale still, and we will one day be able to watch the brain generate ideas, compose symphonies. Fifty years ago, when I was a medical student, the only ways you could look at even the blood vessels of the brain were very dangerous. One didn't take these things lightly. Now, technology is advancing at an incredible rate. We have pictures from Mars and Jupiter, and we will eventually have a much more precise picture of the brain creating, remembering, and imagining.

Third Screen: Freud wrote an essay entitled "The Uncanny" about how the brain invests objects with life. Does it apply here?

Dr. Sacks: I think Freud would be very fascinated by all this. He was a very good neurologist before he turned to other things. In particular, he wrote a book on aphasia. He was the first to use terms like "regression" in a neurological context. In 1897, he had this project, Psychology for Neurologists, where he tried to imagine what went on in the nervous system. He realized that this project was a sort of brilliant failure back then, because the technology simply did not exist. But he understood that there must be a biological underpinning to it all. I think he would be very excited now with the coming together of psychology and neurology, with modern neuroscience. This does not in the least devalue his insights about psychiatry. Understanding each individual's questions and conflicts is still crucial. But increasingly, many aspects of psychiatry and neurology are merging. A few things will be left behind - the death instinct Freud talked about, perhaps. But it is now becoming possible, for example, to look at the nature of depression as an organic, physical disorder, as well as a state of mind.

Third Screen: And in your latest book, the Vintage paperback of Musicophilia, what are some of the latest findings and additions you've included?

Dr. Sacks: My publishers were rather startled when I told them I wanted to revise the book so soon, and I've made about a hundred additions. They come mostly from people who wrote to me about the original book. For instance, quite a lot of people were interested in a condition I write about called musical hallucinations. Apparently, it's much more common and varied than we knew. My correspondents would say things like, "I have a hallucination you don't seem to describe," and they would tell me of their own experiences. With musical hallucinations, you hear music which seems to be absolutely real. The people who get this may be terrified, think they're going nuts, must be crazy to be hearing things. They are afraid to talk about it , even with their doctors. But I think 99 per cent of the people who hear "music that is not there" are not psychotic.

Third Screen: Who suffers from it then?

Dr. Sacks: People who are somewhat or severely deaf are very prone to musical hallucinations, just as people who are visually impaired are prone to visual hallucinations. They hear music almost as if they are listening to a distant radio. Often they "hear" music which they were exposed to in their younger years. I had one patient, who grew up in Nazi Germany, who hallucinated the songs which used to be sung by the Hitlerjugend as they roamed the streets. Needless to say, this was very frightening and unsettling. Even if one hallucinates Christmas carols or popular music, it may be very loud and intrusive. But many people learn to live with this.

Third Screen: You are giving people an opportunity to come forward.

Dr. Sacks: I'm a great believer in the right sort of coming forward or telling. The whole business of telling stories of real people is very delicate.

Third Screen: Will this knowledge affect your new research on creativity?

Dr. Sacks: I think there are dozens or hundreds of different forms of creativity. Pondering science and math problems for years is different from improvising jazz. Something which seems to me remarkable is how unconscious the creative process is. You encounter a problem, but can't solve it. Years later, often, the solution starts to come in. I'm especially interested in that long period of incubation. How things can explode into consciousness after being submerged for years. Our brains contain about 50 billion neurons organized into groups of 1,000 or 10,000 each, interacting in a myriad ways each moment - "an enchanted loom," as Sherrington called it. To actually visualize this working, we will have to be able to see thousands of points in the brain in real time, as they connect and disconnect and communicate in fractions of a second. Like stars winking in and out, astronomically or hyper-astronomically. I don't know if I'll see this in my lifetime, but it would be very nice if we could understand more about consciousness and imagination and the brain. I think in the next few decades, we will.

Comments

[Scarabus]

Whoa! This is cool. I've read This Is Your Brain on Music, but not the hardback version of Dr. Sacks' book. I'll have to order it. It's a matter of personal interest (my son-in-law is a well-known Alzheimer's researcher) and of professional interest as well. I teach Humanities.