Musical Hallucinosis — Too Much Of A Good Thing?

He was over 60 years old when he walked into my office; a colorful relic of the sixties, with his multicolor T-shirt, love beads, turquoise earrings.  Like many people found in Southern California who are a little older than their “moment of fame” in the entertainment industry, he had frozen that moment.  I did not recognize his name, but someone who followed the music scene in the sixties may have known his group.
Many of the numbers for which he was known back then were associated with “getting high,” something he told me he had done infrequently then, for it impaired his ability to perform.  He certainly had not done it much since, for there had been some odd jobs (of which he spoke little, obviously not proud he had to do them) and some performances on some kind of a 60’s revival circuit, where he was revered for still being who he was.  There were some problems.

He did have obsessive compulsive disorder.  He had been on a variety of medications which one might expect to be helpful with that, but which had not.  In my experience this was not uncommon.  He was seeing a therapist who was trying to help him with this, but who was doing traditional “insight oriented” therapy.  Of course, this did not work. His worries were mainly about cleanliness and order; common ones.  I recommended the most recent edition of hte book I have been recommending for years, in its most recent edition. (Bantam Press) Despite my efforts to avoid making his therapist sound like an idiot, I sent him to some of the wonderful free self-help you can find on the internet. But wait, there’s more.  He said that he frequently heard, in his head certain lines or phrases of songs he had performed in the sixties. Not whole songs or even parts he liked.  Just opening lines, or one line or phrase, that would repeat an infinity of times.  He had tried to drown it out, all sorts of things, and yet he felt victim to it. It was frustrating and he did not know how to stop it.  This was not conventional obsessive compulsive disorder.

They call it “musical hallucinosis.” I first read about it some years ago in some of the earlier writings of Oliver Sacks, most likely “The Man Who Mistook His Wife for a Hat.” In the discipline of neurology which has historically been dominated by deficits, Sacks has done a wonderful job of humanizing and recounting richly the cases of people with brain dysfunction who simply do not fit any kind of model. Like the person who only looks for lost keys under the streetlight because that is the only place that is lit, most people, including doctors, never find things unless they are looking for therm.  I remember being told in medical school, by a very wise female obstetrician, that the toughest part of the job is vigilance.  Knowing what to look for and remaining vigilant even when seeing plenty of routine patients who might bore you into missing things; that was the tough part.  Especially because there is always more to learn, always more things to look for. More people are learning more about musical hallicinosis.  I think this is because they are looking for it. Another way to deal with this, besides learning and postulating, is thinking historically. I read years ago about the associations between musical composition and something going on in the right (non-dominant) temporal lobe.  A piece of schrappnel in the anterior right temporal lobe of Dimitri Shostakovich, documented, according to my ancient recall, in a technologically primitive CAT scan in New York City.  I remember reading that the brain tumor that took George Gershwin affected that same region. I even remember that Robert Schumann, who had bouts with what we now believe to be manic depression, reported the hallucinosis of a particular “A” tone which was so precise he could match it on the piano.  If that sent him to the asylum, especially when little treatment or medication available, surely any living person could empathize.

As for my patient, like many with musical hallucinosis, he did not hear anything original.  Just repetitions that became bothersome.  We discussed some practical things he could try, like “masking” with other music, or even simply finishing the songs that the hallucinations started.  This latter strategy seems to have worked for him.  After all, he felt he was taking enough medication and he did not want to take any additional medications for hallucinations.  I thought that was just fine; most people are taking too many medications, anyway.

As for what else to do, I really did not have enough evidence from my reading of the medical literature to do very much.  Most series, like the article already cited, suggest that this phenomenon seems to be most frequently where there are hearing difficulties.  I ordered him a hearing test, a simple screening one.  They call it “pure tone audiometry.”

An appointment requested from an overburdened system, but we are pressing forward, as much as he and the system will bear.  Always a delicate balance, between personal need and t he ability of the system to respond. I smile to know my love of music and fascination at reading the medical literature may have helped me help this patient.  The ideal, hard to make real, is to treat every patient in his or her individual integrity, as a human, as a research subject, as a source of wonder, as a life original.

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