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Are You Hearing What I’m Hearing? Musical Hallucinations: Blessing & Curse

Updated on August 31, 2016
Natalie Frank profile image

Natalie Frank (Taye Carrol), a Ph.D. in Clinical Psychology, publishes on multiple topics in health, behavioral science, and other fields.

What we Know About Musical Hallucinations

The occurrence of musical hallucinations, where individuals perceive music although no external musical stimuli are present, has rarely been discussed in the mental health literature. Given how infrequently musical hallucinations are reported, the research has generally consisted of small, single case studies and case series. This type of psychotic symptom has been connected to a number of related conditions including several psychiatric disorders, neurological disease, brain lesions, the effects of chronic drug use, and different types of hearing impairments.

One large scale study conducted with just under 400 subjects conducted by the Mayo Clinic determined that regardless of co-morbid conditions or causes, neurological disease was found in a quarter of the subjects while brain lesions were found in just under 10 percent of the subjects. Visual hallucinations were more frequent in the neurological disease group while auditory hallucinations were more common in the psychiatric group. Lesions associated with musical hallucinations were discovered in both hemispheres and all cases except two involved the temporal lobe. Hearing impairment was frequently found in subjects. Subjects suffering from an underlying neurodegenerative disease or hearing impairment were inclined to register more unrelenting music, which was often religious or patriotic while those suffering from a lesion tended to perceive more modern music. Those with psychiatric disorders reported hearing mood-congruent music. This research demonstrates that musical hallucinations can appear along with a broad variety of conditions, with neurological disorders and brain lesions occurring the most frequently (Golden & Josephs). While this research in interesting in determining factors that may contribute to musical hallucinations, it leaves out the most important part; why these hallucinations develop in certain people, how they are experienced by the individual and why this phenomenon has such significant effects on those who suffer from them. Clues to the answers to these questions likely lie in the place music plays in our lives, what we associate with different types of music, the importance it has held for us and the consistency of this importance, and the factors that contribute to what gives it meaning for different people.


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Possible Functions of Musical Hallucinations

Some hints as to meaning related from musical hallucinations can be gleaned from other associated syndromes, events or disease symptoms. For example, musical hallucinations have been seen observed in patients suffering from physical trauma, epilepsy and near death experiences as well as in those undergoing emergency surgical procedures. In these cases, there tends to be an obsessional quality to the hallucinations which goes beyond just hearing the music - these individuals want to compose it, practice it, play it, and put components of the melody together until they have created their own special songs, each one filled with meaningful emotionally laden musical phrases. This is not surprising as one commonly used technique for self-soothing when experiencing traumatic memories is to listen to music. At the same time, sometimes those who have experienced traumatic experiences do not have positive responses to anything they knew or took comfort in before the trauma occurred. This is particularly the case when the trauma is recurring and unpredictable as in uncontrolled epilepsy where seizures may come out of the blue, the individual has a sense when seizures are about to happen but cannot stop them, experiences extreme embarrassment when the seizure occurs in public, constantly worries about having another seizure, or the epilepsy is caused by a traumatic event such as a severe head injury leading to a complex trauma response. When this is the case, it is not unusual for an individual to feel the need to create a new self-soothing technique which is not associated with a time before the trauma began or can remain private.

Another potential hint as to how musical hallucinations are experienced has been suggested by elderly patients whose hallucinations are believed to be the result of chronic and significant hearing loss. These cases do not seem to fill the person with a musical passion or obsessional qualities as seen in the previously discussed types of cases did. This is likely, in part, due to the stimulation which triggers the hallucination not being traumatic in nature as in the previous example. It has been posited that in elderly patients musical hallucinations are likely largely due to sensory deprivation that occurs over a long period. Hearing loss experienced by the elderly is usually a gradual process starting at a much earlier age and worsening slowly such that it is often not noticed until it reaches a certain level of severity most often in the later years. Similarly, it appears that the musical melodies that are hallucinatory in these individuals often begin at a mild level sometimes at the subconscious level initially not noticed by the individual. The hallucinations to through a gradual, continuous progression from the subconscious level, to becoming just barely sensed at a sub-threshold level, to fully perceived at a conscious level though still severe enough to engender distress, slowly continuing to become more prominent over time until the frequency and/or intensity results in anxiety and suffering. Given this slow progression, when the hallucinations begin to be fully perceived, the development had been subtle enough that the individual didn’t notice their development in terms of a binary or as something that didn't exist then did exist. Therefore, elderly patients who experience musical hallucinations often believe they had always been a part of them and were nothing unusual. Since it is seen as normal by the person they don't think to discuss it with friends or relatives nor do they tend to bring them up as an abnormal symptom with their physician. The fact that the hallucinations seem to increase at the same rate as hearing diminishes is believed to suggest the possibility that when one loses externally stimulated hearing, one turns inward to find it and the brain may compensate by creating the experience of music in the absence of actual musical stimuli. It is possible that this means that, at least in the elderly with common hearing loss, musical hallucination may be more common than statistics suggest due to their being under reported. However, additional research needs to be conducted to determine if only some individuals with certain characteristics are likely to experience musical hallucinations as the result of hearing loss and why, if they are the brains way of coping with this loss, they often reach a level that causes distress or if this is just the case in those that are reported.

Historical & Current Perspectives on Music in Our Lives

Oliver Sachs in his book Musicophilia, asserts that the human race is musically focused as much as linguistically focused, and this “Musicophilia” takes numerous forms. With few exceptions we can all perceive pitch, timber, harmony, rhythm among other facets and we combine all these musical components in different ways to construct music in our minds. Yet this doesn’t occur in any one area of the brain as no single area is responsible for perception of music or musical ability. He adds that this largely unconscious process is not accidental, as shown by the frequently intense and emotional response we have to music. It has meaning to us.

According to Shopenhauer, the depth of music lies in the fact that while it expresses all our innermost emotions, it does so in the abstract so we are kept separate from the actual events that created these emotions. Nietzsche adds physicality to the experience of music, asserting music is not merely auditory and perceptual but motoric as well. He believed we experience music in our muscles keeping time by tensing and releasing muscle group and through facial expressions, such as peacefulness or grimacing. Based on these few philosophers, it’s clear that human beings function entirely within the sphere of a musical world.

van der Schyff builds a model that encompasses the effects of music in terms of both physical and cognitive-expressive effects. He terms the mechanism for this the "embodied mind," suggesting that in regards to the physical aspects of music the entire body is effected which is overseen by the organization of the mind. van der Schyff suggests that as it is known that the nature of therapeutic responses to music is largely determined by an embodied conceptualization that the cognitive view focusing exclusively on cognitive evaluations, perceptions and interpretations is inadequate to fully explain the affective response to music. He concludes that enorporating physical, cognitive and affective componants of the positive effects of music through the model of the embodied mind may suggest a concepualization of musical meaning that begins with our most basic and fundamental interactions with the world


NOVA Documentary on Oliver Sachs's Book "Musicophilia: Tales of Music and the Brain"

Music, Emotion, Cognition and Physicality: The Embodied Mind

Increasing Musical Lives May Lead to New Perceptual Experiences

Being informed by these scientists, it shouldn’t be surprising that there is an increasing amount of music in out lives as technology makes it available to us practically anywhere. Take a walk on a busy street and look at others going by. It is likely the majority will have an ear bud, with the majority of those listening to an ipod or other musical device. This is a common occurrence in grocery stores, libraries, gyms, coffee stores, lecture halls – practically anywhere an individual isn’t engaged in social interaction. It’s as if we have turned into beings who can’t bear to be without music now that we largely don’t have to. Exposure to almost constant musical stimulation is becoming a commonality in our world.

However, what if you were listening to your favorite music – only with no external stimuli? In other words there’s no iPod, no music playing anywhere nearby and no one singing. And you’re the only one hearing it. This may become more and more commonplace as so many of us almost never leave home without earbuds and some sort of mobile technology that allows us to have our favorite music playing on demand downloaded through free apps or just listen to music as background through online apps like Pandora, Spotify or iHeartRadio. Whether this constant access to music changes the prevalence, qualities of music hallucinations or the age range during which they manifest remains to be seen and is another area research could inform.

Be Careful What You Ask For as You Just may Get it

Zimmer relates the story of a woman woken by a small earthquake, who when attempting to return to sleep heard the song, “When You and I Were Young, Maggie”. Maggie had been her mother’s name, and when the family was in a joyous, silly mood, her father would sing the song to her mother. The song repeated itself for hours and continued off and on over the following months.

Before long other songs related to childhood memories of he parents were added to the first, always loud and clear – the merry-go-round calliopes from bringing memories of her parents joining her on the ride; Silent Night reminding her of the winter twilights when the family would go Christmas Caroling’ her sporting a fake fur muff given to her by her mother Christmas’s before when she had begged for it but never thought to receive it, as money was dear, later learning her mother had gone without anything new for herself the entire year to pay for it; The Star Spangled Banner bringing forth images of tears sliding down her father’s cheeks as he remembered friends lost beside him in battle, always telling her when hearing this song, to never take freedom for granted.

These songs would last for hours in her head, becoming more than annoying but troubling and distracting to the point it became difficult to drive or sleep.

According to Zimmer this woman’s experience “is typical -- if not universal -- among people who have musical hallucinations. Many sufferers are elderly and the songs often emerge from the deepest recesses of memory. One patient heard Italian opera that her parents used to listen to. Others hear hymns, sea shanties, jazz or pop tunes.” They remember songs that hold special meaning related to memories of the most important relationships in their lives.

Sacks stated that music can act as a “Proustian mnemonic, eliciting emotions and associations that had been long forgotten, giving the patient access once again to mood and memories, thoughts and worlds that had seemingly been completely lost.” Perhaps this occurs even when the individual is convinced they only want to be rid of the internal music and memories that come unbidden.

The woman described by Zimmer attempted everything to make the songs disappear finding the only thing that was successful was turning on the radio to songs that were in no way emotionally laden for her. These songs continued to torment her for months until treated for Lyme disease when she discussed her symptoms with her physician who normalized them for her. Resigned to live with the hallucinations, she was surprise to find that after 3 days taking an antibiotic for her Lyme disease the songs suddenly stopped.

While at first she relished the silence, she found after all the months of complaining that something was missing in her life. She realized the songs were helping to keep her parents alive in her mind. At that moment she recognized she mourned the loss of the music as she had her parents. While not to say she didn’t enjoy the peace at times, she stated that she’d give anything for a single chorus of “When You and I Were Young Maggie.”

When You and I Were Young Maggie

References

Cox, C. (2006). Nietzsche, Dionysus, and the Ontology of Music. In Keith Ansell Pearson’s (ed.) A Companion to Nietzsche. Blackwell Publishing Ltd., New York. (pps. 495-513)

Golden, E. C., & Josephs, K. A. (2015). Minds on replay: musical hallucinations and their relationship to neurological disease. Brain, 138(12), 3793-3802.

Nietzsche, F. Twilight of the Idols; and the Anti-Christ. Trans. R. J. Hollingdale. Harmondsworth: Penguin, 1977.

Sachs, O., (2008). Musicophilia: Tales of Music and the Brain. Random House Digital, Inc., 425 pages.

Schiavio, A., van der Schyff, D., Cespedes-Guevara, J., & Reybrouck, M. (2016). Enacting musical emotions. sense-making, dynamic systems, and the embodied mind. Phenomenology and the Cognitive Sciences, 1-25.

Schopenhauer, A. Die Welt als Wille und Vorstellung, vol i, bk iii, sec 52 (1819)(S.H. transl.) in Schopenhauers sämmtliche Werke in fünf Bänden, vol i, pp. 346-48

Zimmer, C., (2004). Can't Get It Out Of My Head: Brain Disorder Causes Mysterious Music Hallucinations. The Sunday Telegraph Magazine.

© 2016 Natalie Frank

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