Natalie Frank (Taye Carrol), a Ph.D. in clinical psychology, publishes on multiple topics in health, behavioral science, and other fields.
What Are Musical Hallucinations?
Musical hallucinations involve hearing music when there are no sensory stimuli present, in other words, when no music is playing anywhere in hearing distance. It is not unusual for people to hear sounds that others cannot hear, but this is usually a condition called tinnitus and involves simple sounds such as buzzing or ringing.
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 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.
A large, 400-subject study by the Mayo Clinic found the following:
- Neurological disease occurred in a quarter of the subjects while brain lesions occurred in just under ten percent of the subjects. These findings were not affected by any type of co-morbid conditions or causes.
- 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, and the prevalence rate of hearing problems did not differ by group.
- Subjects suffering from an underlying neurodegenerative disease or hearing impairment reported hearing more unrelenting music, which was often religious or patriotic.
- In contrast, those subjects suffering from a lesion tended to perceive more modern music.
- Those with psychiatric disorders reported hearing mood-congruent music.
These findings demonstrate that musical hallucinations can appear along with a broad variety of conditions, with neurological disorders and brain lesions occurring most frequently (Golden & Josephs). While this research indicates some of the 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. Possible clues may be found when thinking about the role 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 give it unique meaning for different people.
Possible Functions of Musical Hallucinations
Some hints as to the meaning and specifics of musical hallucinations can be gleaned from other associated syndromes, events or disease symptoms.
Epilepsy and Trauma Survivors
For example, musical hallucinations have been 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. They attempt to create their own special songs, each one filled with meaningful emotionally laden musical phrases.
This finding is not surprising as one commonly used technique for self-soothing when experiencing traumatic memories is to listen to music. At the same time, often 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, for instance, in uncontrolled epilepsy where seizures come out of the blue.
In this type of epilepsy, the individual has a sense when seizures are about to happen but cannot stop them, experiences extreme embarrassment when the seizure occurs in public, and constantly worries about having another seizure. Additionally, epilepsy may be 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. 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 probably 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 over time such that it is not noticed until it reaches a certain level of severity in 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, and is not initially noticed by the individual. The hallucinations go through a gradual, continuous progression from the subconscious level to becoming just barely sensed at a sub-threshold level. They then become fully perceived at a conscious level though still not severe enough to engender distress. They slowly continue to become more prominent over time until the frequency and/or intensity results in anxiety and suffering.
The development of the hallucinations is subtle enough that the individual doesn't notice their development in terms of something that didn't exist one moment then did exist the next. Given the slow progression, once the hallucinations begin to be fully perceived, elderly patients often believe they have always experienced them and they are thus, 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 this means that, at least in the elderly with common hearing loss, musical hallucinations may be more common than statistics suggest due to their being under-reported.
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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. It will also be important to learn why, if these hallucinations are the brain's way of coping with hearing loss, they often reach a level that causes distress or if this is just the case in those that are reported.
Historical and Current Perspectives on Music in Our Lives
Oliver Sachs, in his book Musicophilia, asserts that the human race is as musically focused as they are linguistically-focused, and this “musicophilia” takes numerous forms. With few exceptions, we can all perceive pitch, timbre, harmony, and 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 the 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 incorporating physical, cognitive and affective components of the positive effects of music through the model of the embodied mind may suggest a conceptualization 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"
Increasing Music in Our 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 our 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 earbud, with the majority of those listening to an ipod or another musical device. This is a common occurrence in grocery stores, libraries, gyms, coffee stores, lecture halls—practically anywhere when 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 is another area research could inform.
Music, Emotion, Cognition and Physicality: The Embodied Mind
One Woman's Story
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 her parents were added to the first, loud and clear—the merry-go-round calliopes from memories of her parents joining her on the ride; Silent Night reminding her of the winter twilights when the family would go Christmas Caroling; 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 surprised to find that after three days after 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 that 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
What is musical ear syndrome?
Musical ear syndrome (MES) is a disorder in people with hearing loss which causes them to experience auditory hallucinations that are non-psychiatric. In older individuals, it can be confused with dementia. The condition is believed to be related to Charles Bonnet syndrome which causes people with visual impairments to experience non-psychiatric visual hallucinations. MES is believed to be caused by hypersensitivity in the auditory cortex which is related to hearing-related sensory deprivation. The hallucinations experienced in MES are usually musical and can represent any type of music from popular to experimental to symphonies or anything in between.
Are hallucinations a sign of dementia?
Hallucinations or false perceptions of objects or events involving the senses in the absence of any causal stimuli can be caused by a number of things. Hallucinations can occur in individuals with dementia. In people with Alzheimers, they can be caused by changes in the brain but don’t usually occur until late in the disease. However, dementia is not the only cause of hallucinations. Other possible causes include:
- Physical disorders, such as kidney or bladder infections, severe dehydration, extreme, long-lasting pain, or alcohol or drug abuse
- Eyesight or hearing deficits
Can you hear a hallucination?
Hallucinations can involve any one of the five senses including hearing. Hearing hallucinations are referred to as auditory hallucinations and they are the most common type. Most often auditory hallucinations take the form of voices, either an individual voice or two or more voices talking to each other.
Is tinnitus a hallucination?
A hallucination is a sensory experience or perception in the complete absence of physical stimuli normally needed to produce it. Tinnitus is similar but not exactly alike. Tinnitus is perceived sound in the human ear, such as ringing, high or low pitches, in the absence of external sound. However, it is believed that tinnitus can result from several conditions (see below). It is important to note that some individuals suffer from both tinnitus and auditory hallucinations.
What is ringing in your ears caused by?
Ringing in your ears, or tinnitus, is thought to be caused by several conditions. While there are no external stimuli, it is clear that there is something physiological occurring either in the brain or within the ear itself which is causing the person to hear a sound that others can’t hear. In individuals with hearing loss, it may also be caused by the brain trying to fill in gaps that aren’t clearly heard. The brain works hard to hear despite reduced auditory input or perception so it may actually make up the background sounds it misses.
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.
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© 2016 Natalie Frank