Chapter 15 of

The Man Who Mistook His Wife For A Hat


Oliver Sacks

Mrs. O'C was somewhat deaf, but otherwise in good health. She lived in an old people's home. One night, in January 1979, she dreamed vividly, nostalgically, of her childhood in Ireland, and especially of the songs they danced to and sang. When she woke up, the music was still going, very loud and clear. "I must still be dreaming", she thought, but this was not so. She got up, roused and puzzled. It was the middle of the night. Someone, she assumed, must have left a radio playing. But why was she the only person to be disturbed by it? She checked every radio she could find - they were all turned off. Then she had another idea: she had heard that dental fillings could sometimes act like a crystal radio, picking up stray broadcasts with unusual intensity. "That's it", she thought. "One of my fillings is playing up. It won't last long. I'll get it fixed in the morning." She complained to the night nurse, who said her fillings looked fine. At this point another notion occurred to Mrs. O'c.: "What sort of radio-station", she  reasoned to herself, "would play Irish songs, deafenly, in the middle of the night? Songs, just songs, without introduction or comment? And only songs that I know. What radio station would play my songs, and nothing else?" At this point she asked herself: "Is the radio in my head?"

She was now thoroughly rattled - and the music continued deafening. Her last hope was her ENT man, the otologist she was seeing: he would reassure her, tell her it was just "noises in the ear", something to do with her deafness, nothing to worry about. But when she saw him in the course of the morning, he said: "No, Mrs. O'c., I don't think it's your ears. A simple ringing or buzzing or rumbling, maybe: but a concert of Irish songs - that's not  your ears. Maybe", he continued, "you should see a psychiatrist." Mrs. O'C. arranged to see a psychiatrist the same day. "No, Mrs. O'C.", the psychiatrist said, "it's not your mind. You are not mad - and the mad don't hear music, they only hear "voices". You must see a neurologist, my colleague, Dr. Sacks." And so Mrs. O'C. came to me.

Conversation was far from easy, partly because of Mrs. O'C.'s deafness, but more because I was repeatedly drowned out by songs - she could only hear me through the softer ones. She was bright, alert, not delirious or mad, but with a remote, absorbed look, as of someone half in a world of their own. I could find nothing neurological amiss. None the less, I suspected that the music was "neurological".

What could have happened with Mrs. O'C. to bring her to such a pass? She was 88 and in excellent general health with no hint of fever. She was not on any medication which might unbalance her excellent mind. And, manifestly, she had been normal the day before.

"Do you think it's a stroke, Doctor?", she asked, reading my thoughts.

"It could be", I said, "though I've never seen a stroke like this. Something has happened, that's for sure, but I don't think you're in danger. Don't worry, and hold on."

"It's not so easy to hold on", she said, "when you're going through what I'm going through. I know it's quiet here, but I am in an ocean of sound."

I wanted to do an electroencephalogram straightaway, paying special attention to the temporal lobes, the "musical" lobes of the brain, but circumstances conspired to prevent this for a while. In this time, the music grew less - less loud and, above all, less persistent. She was able to sleep after the first three nights and, increasingly, to make and hear conversation between "songs". By the time I came to do an EEG, she heard only occasional brief snatches of music, a dozen times, more or less, in the course of a day. After we had settled her and applied the electrodes to her head, I asked her to lie still, say nothing and not "sing to herself", but to raise her right forefinger slightly - which in itself would not disturb the EEG - if she heard any of her songs as we recorded. In the course of a two-hour recording, she raised her finger on three occasions, and each time she did this the EEG pens clattered, and transcribed spikes and sharp waves in the temporal lobes of the brain. This confirmed that she was indeed having temporal-lobe seizures, which, as Hughlings Jackson guessed and Wilder Penfield proved, are the invariable basis of "reminiscence" and experiential hallucinations. But why should she suddenly develop this strange symptom? I obtained a brain scan, and this shoed that she had indeed had a small thrombosis or infarction in part of her right temporal lobe. The sudden onset of Irish songs in the night, the sudden activation of musical memory-traces in the cortex, were, apparently, the consequence of a stroke, and as it resolved, so the songs "resolved" too.

By mid-April the songs had entirely gone, and Mrs. O'C. was herself once again. I asked her at this point how she felt about it all, and, in particular, whether she missed the paroxysmal songs she heard. "It's funny you should ask that", she said with a smile. "Mostly, I would say, it is a great relief. But, yes, I do miss the old songs a little. Now, with lots of them, I can't even recall them. It was like being given back a forgotten bit of my childhood again. And some of the songs were really lovely."

I had heard similar sentiments from some of my patients on L-Dopa - the term I used was "incontinent nostalgia". And what Mrs. O'C.  told me, her obvious nostalgia, put me in mind of a poignant story of H.G. Wells, "The Door in the Wall". I told her the story. "That's it", she said. "That captures the mood, the feeling, entirely. But my door is real, as my wall was real. My door leads to the lost and forgotten past."

I did not see a similar case until June last year, when I was asked to see Mrs. O'M., who was now a resident at the same home. Mrs. O'M. was also a woman in her eighties, also somewhat deaf, also bright and alert. She, too, heard music in the head and sometimes a ringing or hissing or rumbling; occasionally she heard "voices talking", usually "far away" and "several at once", so that she could never catch what they were saying. She hadn't mentioned these symptoms to anybody, and had secretly worried, for four years, that she was mad. She was greatly relieved when she heard from the Sister that there had been a similar case in the Home some time before, and very relieved to be able to open up to me.

One day, Mrs. O'M. recounted, while she was grating parsnips in the kitchen, a song started playing. It was "Easter Parade", and was followed, in swift succession, by "Glory, Glory, Hallelujah" and "Good Night, Sweet Jesus". Like Mrs. O'C., she assumed that a radio had been left on, but quickly discovered that all the radios were off. This was in 1979, four years earlier. Mrs. O'C. recovered in a few weeks, but  Mrs. O'M. 's music continued, and got worse and worse.

At first she would hear only these songs - sometimes spontaneously, out of the blue, but for certain if she chanced to think of any of them. She tried, therefore, to avoid thinking of them, but the avoidance of thinking was as provocative as the thinking.

"Do you like these particular songs?" I asked, psychiatrically. "Do they have some special meaning for you?"

"No", she answered promptly. "I never specially liked them, and I don't think they had any special meaning for me."

"And how did you feel when they kept going on?"

"I came to hate them", she replied with great force. "It was like some crazy neighbour continually putting on the same record."

For a year or more, there was nothing but these songs, in maddening succession. After this - and though it was worse in one way, it was also a relief - the inner music became more complex and various. She would hear countless songs - sometimes several simultaneously; sometimes she would hear an orchestra or choir; and, occasionally, voices, or a mere hubbub of noises.

When I came to examine  Mrs. O'M.  I found nothing abnormal except in her hearing, and here what I found was of singular interest. She had some inner-ear deafness, of a commonplace sort, but over and above this she had a peculiar difficulty in the perception and discrimination of tones of a kind which neurologists call amusia, and which is especially correlated with impaired function in the auditory (or temporal) lobes of the brain. She herself complained that recently the hymns in the chapel seemed more and more alike so that she could scarcely distinguish them by tome or tune, but had to rely on the words, or the rhythm. And although she had been a fine singer in the past when I tested her she sang flat and out of key. She mentioned, too, that her inner music was most vivid when she woke up, becoming less so as other sensory impressions crowded in; and that it was least likely to occur when she was occupied - emotionally, intellectually, but especially visually. In the hour or so she was with me, she heard music only once - a few bars of "Easter Parade", played so loud, and so suddenly, she could hardly hear me through it.

When we came to do an EEG on  Mrs. O'M. it showed strikingly high voltage and excitability in both temporal lobes - those parts of the brain associated with the central representation of sounds and music, and with the evocation of complex experiences and scenes. And whenever she "heard" anything, the high voltage waves became sharp, spike-like, and frankly convulsive. This confirmed my thought that she had too a musical epilepsy, associated with disease of the temporal lobes.

But what was  going on with Mrs. O'C. and  Mrs. O'M.? "Musical epilepsy" sounds like a contradiction in terms: for music, normally is full of feeling and meaning, and corresponds to something deep in ourselves, "the world behind the music", in Thomas Mann's phrase - whereas epilepsy suggests quite the reverse: a crude, random physiological event, wholly unselective, without feeling or meaning. Thus a "musical epilepsy" or a "personal epilepsy" would seem a contradiction in terms. And yet such epilepsies do occur, though solely in the context of temporal lobe seizures, epilepsies of the reminiscent part of the brain. Hughling Jackson described these a century ago, and spoke in this context of "dreamy states", "reminiscence" and "physical seizures":

It is not very uncommon for epileptics to have vague and yet exceedingly elaborate mental states at the onset of epileptic seizures .... The elaborate mental state, or so-called intellectual aura, is always the same, or essentially the same, in each case.

Such descriptions remained purely anecdotal until extraordinary studies of Wilder Penfield, half a century later. Penfield was not only able to locate their origin in the temporal lobes, but was able to evoke the "elaborate mental state", or the extremely precise and detailed "experiential hallucinations" of such seizures by gentle electrical stimulation of the seizure-prone points of the cerebral cortex, as this was exposed, at surgery, in fully conscious patients. Such stimulations would instantly call forth intensely vivid hallucinations of tunes, people, scenes, which would be experienced, lived. as compellingly real, in spite of the prosaic atmosphere of the operating room, and could be described to those present in fascinating detail, confirming what Jackson described sixty years earlier, when he spoke of the characteristic "doubling of consciousness":

There is
(1) the quasi-parasitical state of consciousness (dreamy state), and
(2) there are remains of normal consciousness and thus, there is double consciousness ... a mental diplopia.

This was precisely expressed to me by my two patients;  Mrs. O'M. heard and saw me, albeit with some difficulty, through the deafening dream of "Easter Parade", or the quieter, yet more profound dream of "Good Night, Sweet Jesus" (which called up for her the presence of a church she used to go to on 31st Street where this was always sung after a novena). And  Mrs. O'C.  also saw and heard me, through the much profounder anamnestic seizure of her childhood in Ireland: "I know you're there, Dr. Sacks. I know I'm an old woman with a stroke in an old people's home, but I feel I'm a child in Ireland again - I feel my mother's arms, I see her, I hear her voice singing." Such epileptic hallucinations or dreams, Penfield showed, are never fantasies:  they are always memories, and memories of the most precise and vivid kind, accompanied by emotions which accompanied the original experience. Their extraordinary and consistent detail, which was evoked each time the cortex was stimulated, and exceeded anything which could be recalled by ordinary memory, suggested to Penfield that the brain retained an almost perfect record of every lifetime's experience, that the total stream of consciousness was preserved in the brain, and, as such, could always be evoked or called forth, whether by the ordinary need and circumstances of life, or by the extraordinary circumstances of an epileptic or electrical stimulation. The variety, the "absurdity", of such convulsive memories and scenes made Penfield think that such reminiscence was essentially meaningless and random:

At operation it is usually quite clear that the evoked experiential response is a random reproduction of whatever composed the stream of consciousness during some interval of the patient's past life .... It may have been (Penfield continues, summarizing the extraordinary miscellany of epileptic dreams and scenes he has evoked) a time of listening to music, a time of looking in at the door of a dance hall, a time of imaging the action of robbers from a comic strip, a time of waking from a vivid dream, a time of laughing conversation with friends, a time of listening to a little son to make sure he was safe, a time of watching illuminated signs, a time of lying in the delivery room at birth, a time of being frightened by a menacing man, a time of watching people enter the room with snow on their clothes ... It may have been a time of standing on the corner of Jacon and Washington, South Bend, Indiana ... of watching circus wagons one night years ago in childhood ... a time of listening to (and watching) your mother speed the parting guests ... or of hearing your father and mother singing Christmas carols.

I wish I could quote in its entirety this wonderful passage from Penfield (Penfield and Perot, The brain's record of visual and auditory experience: a final summary and discussion. Brain 86:595-696 (1963). It is the essential reference and inspiration to the whole of this section. More readable than many novels, it has a wealth and strangeness of material which any novelist would envy.) It gives, as my Irish ladies do, an amazing feeling of "personal physiology", the physiology of the self. Penfield is impressed by the frequency of musical seizures, and gives many fascinating and often funny examples, a 3 per cent incidence in the more than 500 temporal-lobe epileptics he has studied:

We were surprised at the number of times electrical stimulation has caused the patient to hear music. It was produced from seventeen different points in 11 cases. Sometimes it was an orchestra, at other times voices singing, or a piano playing, or a choir. Several times it was said to be a radio theme song ... The localisation for production of music is in the superior temporal convolution, either the lateral or the superior surface (and, as such, close to the pint associated with so-called musicogenic epilepsy).

This is borne out, dramatically, and often comically, by the examples, Penfield gives. The following list is extracted from his great final paper:

"White Christmas" (Case 4) Sung by a choir.

"Rolling Along Together" (Case 5). Not identified by patient, but recognized by operating-room nurse when patient hummed it on stimulation.

"Hush-a-Bye Baby" (case 6). Sung by mother, but also thought to be theme-song for radio-programme.

"A song he had heard before, a popular one on the radio" (Case 10).

"Oh Marie. Oh Marie" (Case 30). The theme-song of a radio-programme.

"The war March of the Priests" (case 31). This was on the other side of the "Hallelujah Chorus" on a record belonging to the patient.

"Mother and father singing Christmas Carols" (Case 32).

"Music from Guys and Dolls" (Case 37).

"A song she had heard frequently on the radio" (Case 45).

"I'll get By" and "You'll Never Know" (case 46). Songs he had often heard on the radio.

In each case - as with  Mrs. O'M. - the music was fixed and stereotyped. The same tune (or tunes) were heard again and again, whether in the course of spontaneous seizures, or with electrical stimulation of the seizure-prone cortex. Thus these tunes were not only popular on the radio, but equally popular as hallucinatory seizures: they were, so to speak, the "Top Ten of the Cortex".

Is there any reason, we must wonder, why particular songs (or scenes) are "selected" by particular patients for reproduction in their hallucinatory seizures? Penfield considers this question and feels that there is no reason, and certainly no significance, in the selection involved:

It would be very difficult to imagine that some of the trivial incidents and songs recalled during stimulation or epileptic discharge could have any possible emotional significance to the patient, even if one is acutely aware of this possibility.

The selection, he concludes, is "quite at random, except that there is some evidence of cortical conditioning". These are the words, this is the attitude, so to speak, of physiology. Perhaps Penfield is right - but could there be more? Is he in fact "acutely aware", aware enough, at the levels that matter, of the possible emotional significance of songs, of what Thomas Mann called the "world behind the music"? Would superficial questioning, such as "Does this song have any special meaning for you?" suffice? We know, all too well, from the study of "free associations" that the most seemingly trivial or random thoughts may turn out to have an unexpected depth and resonance, but that this only becomes evident given an analysis in depth. Clearly there is no such deep analysis in Penfield, nor in any other physiological psychology. It is not clear whether any such deep analysis is needed - but given the extraordinary opportunity of such a miscellany of convulsive songs and scenes, one feels, at least, that it should be given a try.

I have gone back to  Mrs. O'M. briefly, to elicit her associations, her feelings, to her "songs". This may be unnecessary, but I think it worth trying. On important thing has already emerged. Although, consciously, she cannot attribute to the three songs special feeling or meaning, she now recalls and this is confirmed by others, that she was apt to hum them , unconsciously, long before they became hallucinatory seizures. This suggests that they were already unconsciously "selected" - a selection which was then seized on by a supervening organic pathology.

Are they still her favourites? Do they matter to her now? Does she get anything out of her hallucinatory music? The month after I saw  Mrs. O'M. there was an article in the New York Times entitled "Did Shostakovich Have a Secret?". The "secret" of Shostakovich, it was suggested -by a Chinese neurologist, Dr. Dajue Wang - was the presence of a metallic splinter, a mobile shell-fragment, in his brain, in the temporal horn of the left ventricle. Shostakovich was very reluctant, apparently, to have this removed:

Since the fragment had been there, he said, each time he leaned his head to one side he could hear music. His head was filled with melodies - different each time - which he then made use of when composing.

X-rays allegedly showed the fragment moving around when Shostakovich moved his head, pressing against his "musical" temporal lobe, when he tilted, producing an infinity of melodies which his genius could use. Dr. R.A. Henson, editor of Music and the Brain (1977), expressed deep but not absolute scepticism: "I would hesitate to affirm that it could not happen."

After reading the article I gave it to  Mrs. O'M. to read, and her reaction was strong and clear. "I am no Shostakovich", she said, "I can't use my songs. Anyhow, I'm tired of them - they're always the same. Musical hallucinations may have been a gift to Shostakovich, but they are only a nuisance to me. He didn't want treatment - but I want it badly."

I put  Mrs. O'M.  on anticonvulsants, and she forthwith ceased her musical convulsions. I saw her again recently, and asked her if she missed them. "Not on your life." she said. "I'm much better without them." But this, as we have seen, was not the case with  Mrs. O'C., whose hallucinosis was of an altogether more complex, more mysterious, and deeper kind and, even if random in its causation, turned out to have great psychological significance and use.

With  Mrs. O'C. indeed the epilepsy was different from the start, both in terms of physiology and of "personal" character and impact. There was, for the first 72 hours, an almost continuous seizure, or seizure "status", associated with an apoplexy of the temporal lobe. This in itself was overwhelming. Secondly, and this too had some physiological basis (in the abruptness and extent of the stroke, and its disturbance of deep-lying emotional centres' uncus, amygdala, limbic system, etc., deep within, and deep to the temporal lobe), there was an overwhelming emotion associated with the seizures and an overwhelming (and profoundly nostalgic) content - an overwhelming sense of being-a-child-again, in her long-forgotten home, in the arms and presence of her mother.

It may be that such seizures have both a physiological and a personal origin, coming from particular charged parts of the brain but, equally, meeting particular psychic circumstances and needs as in a case reported by Dennis Williams (The structure of emotions reflected in epileptic experiences, Brain 1956; 79:29-67):

A representative, 31, had major epilepsy induced by finding himself alone among strangers. Onset: a visual memory of his parents at home, the feeling "How marvellous to be back". It is described as a very pleasant memory. He gets goose skin. goes hot an cold, and either the attack subsides or proceeds to a convulsion.

Williams relates this astounding story baldly, and makes no connection between any of its parts. The emotion is dismissed as purely physiological - inappropriate "ictal pleasure" - and the possible relation of "being-back-home" to being lonely is equally ignored. He may, of course, be right; perhaps it all is entirely physiological; but I cannot help thinking that if one has to have seizures, this man managed to have the right seizures at the right time.

In Mrs. O'C.'s case the nostalgic need was more chronic and profound, for her father dies before she was born, and her mother before she was five. Orphaned, alone, she was sent to America, to live with a rather forbidding maiden aunt. Mrs. O'C.  had not conscious memory of the first five years of her life - no memory of her mother, of Ireland, of "home". She had always felt this as a keen and painful sadness - this lack , or forgetting, of the earliest, most precious years of her life. She had often tried, but never succeeded, to recapture her lost and forgotten childhood memories. Now, with her dream, and the long "dreamy state" which succeeded it, she recaptured a crucial sense of her forgotten, lost childhood. The feeling she had was not just "ictal pleasure", but a trembling, profound and poignant joy. It was, as she said, like the opening of a door - a door which had been stubbornly closed all her life.

In her beautiful book on "involuntary memories" (A Collection of Moments, 1970), Esther Salamna speaks of the necessity to preserve, or recapture, "the sacred and precious memories of childhood", and how impoverished, ungrounded, life is without these. She speaks of the deep joy, the sense of reality, which recapturing such memories may give, and she provides an abundance of marvellous autobiographical quotations, especially from Dostoievski and Proust. We are all "exiles from our past", she writes, and, as such, we need to recapture it. For Mrs. O'C., nearly ninety, approaching the end of a long lonely life, this recapturing of "sacred and precious" childhood memories, this strange and almost miraculous anamnesis, breaking open the closed door, the amnesia of childhood, was provided, paradoxically, by a cerebral mishap.

Unlike Mrs. O'M. who found her seizures exhausting and tiresome, Mrs. O'C. found hers a refreshment to the spirit. They gave her a sense of psychological grounding and reality, the elemental sense which she had lost, in her long decades of cut-offness, and "exile", that she had  had a real childhood and home, that she had  been mothered and loved and cared-for. Unlike Mrs. O'M. , who wanted treatment, Mrs. O'C.  declined anticonvulsants: "I need these memories", she would say. "I need what's going on .... And it'll end by itself soon enough."

Dostoievski had "psychical seizures", or "elaborate mental states" at the onset of seizures, and once said of these:

You all, healthy people, can't imagine the happiness which we epileptics feel during the second before our fit ... I don't know if this felicity lasts for seconds, hours or months, but believe me, I would not exchange it for all the joys that life may bring.
(T. Alajouanine, Dostoievski's epilepsy, Brain 1963;86:209-21)

Mrs. O'C. would have understood this. She too knew, in her seizures, an extraordinary felicity. But it seemed to her the acme of sanity and health - the very key, indeed the door, to sanity and health. Thus she felt her illness as health, as healing.

As she got better, and recovered from her stroke, Mrs. O'C. had a period of wistfulness and fear. "The door is closing", she said. "I'm losing it all again." And indeed she did lose, by the middle of April, the sudden irruptions of childhood scenes and music and feeling, her sudden epileptic "transports" back to the world of early childhood - which were undoubtedly "reminiscences", and authentic, for, as Penfield has shown beyond doubt, such seizures grasp and reproduce a reality - an experiential reality, and not a fantasy: actual segments of an individual's lifetime and past experience.

But Penfield always speaks of "consciousness" in this regard - of physical seizures as seizing, and replaying, part of the stream of consciousness, of conscious reality. What is peculiarly important, and moving, in the case of Mrs. O'C. , is that epileptic "reminiscence" here seized on something unconscious - very early, childhood experiences, either faded, or repressed from consciousness - and restored them to full memory and consciousness. And it is for this reason, one must suppose, that though, physiologically, the "door" did close, the experience itself was not forgotten, but left a profound and enduring impression, and was felt as a significant and healing experience. "I'm glad it happened", she said when it was over. "it was the healthiest, happiest experience of my life. There's no longer a great chunk of childhood missing. I can't remember the details now, but I know it's all there. There's a sort of completeness I never had before."

These were not idle word, but brave and true. Mrs. O'C.'s seizures did effect a kind of "conversion", did give a centre to a centerless life, did give her back the childhood she had lost - and with this a serenity which she had never had before and which remained for the rest of her life: an ultimate serenity and security of spirit as is only given to those who possess, or recall, the true past.


"I have never been consulted for 'reminiscence' only ..."said Hughlings Jackson; in contrast, Freud said, "Neurosis is  reminiscence." But clearly the word is being used in quite opposite senses - for the aim of psychoanalysis, one might say, is to replace lost or fantastic "reminiscences" by a true memory, or anamesis, of the past (and it is precisely such true memory, trivial or profound, that is evoked in the course of psychical seizures). Freud, we know, greatly admired Hughligs Jackson - but we do not know if Jackson, who lived to 1911, had ever heard of Freud.

The beauty of a case like Mrs. O'C.'s is that it is at once "jacksonian" and "Freudian". She suffered from a Jacksonian "reminiscence", but this served to moore and heal her, as a Freudian "anamnesis". Such cases are exciting and precious, for they serve as a bridge between the physical and personal, and they will point, if we let them, to the neurology of the future, a neurology of living experience. This would not, I think, have surprised or outraged Hughlings Jackson. Indeed it is surely, what he himself dreamed of - when he wrote of "dreamy states" and "reminiscence" back in 1880.

Penfield and Perot entitle their paper "The brain's record of visual and auditory experience", and we may now meditate on the form, or forms, such inner "records" may have. What occurs, in these wholly personal "experiential" seizures, is it an entire replay of (a segment of) experience. What, we may ask, could be played in such a way as to reconstitute an experience? Is it something akin to a film or record, played on the brain's film projector or phonograph? Or something analogous, but logically anterior - such as a script or score? What is the final form, the natural form, of our life's repertoire? That repertoire which provides not only memory and "reminiscence", but our imagination at every level, from the simplest sensory and motor images, to the most complex imaginative world, landscapes, scenes? A repertoire, a memory, an imagination, of a life which is essentially personal, dramatic and "iconic".

The experiences of reminiscence our patients have raise fundamental questions about the nature of memory (or mnesis) - these are also raised, in reverse, in our tales of amnesia or amnesis ("The Lost Mariner" and "A Matter of Identity", Chapters 2 and 12). Analogous questions about the nature of knowing (or gnosis) are raised by our patients with agnosias - the dramatic visual agnosia of Dr. P. ("The Man Who Mistook His Wife for a Hat") and the auditory and musical agnosias as Mrs. O'M, and Emily D. (Chapters 9, "The President's Speech"). And similar questions about the nature of action (or praxis) are raised by the motor bewilderment, or apraxia, of certain retardates, and by patients with frontal lobe apraxias - apraxias which may be so severe that such patients may be unable to walk, may lose their kinetic melodies, their melodies of walking (this also happens in Parkinsonian patients, as was seen in Awakenings).

As Mrs. O'C.  and Mrs. O'M suffered from "reminiscence", an upsurge of melodies and scenes - a sort of hyper-mnesis and hyper-gnosis - our amnesic-agnosic patients have lost (or are losing) their inner melodies and scenes. Both alike testify to the essentially "melodic" and "scenic" nature of inner life, the "Proustian" nature of memory and mind.


Experience is not possible  until it is organised iconically; action is not possible  unless it is organised iconically. "The brain's record of everything - everything alive - must be iconic. This is the final form of the brain's record, even though the preliminary form may be computational or programmatic. The final form of cerebral representation must be, or allow, "art" - the artful scenery and melody of experience and action.


Since the original publication of this book I have been consulted for innumerable cases of musical "reminiscence" - it is evidently not uncommon. .... Patients with severe nerve-deafness may have musical "phantoms". Why the musical parts of the brain, above all, should be so prone to such "releases" remains far from clear.