Melodies and Maladies

A physician examines patients with heads full of music.

Oliver Sacks listens to Alfred Brendel's performance of Beethoven's Path¿tique Sonata.

MUSICOPHILIA

Tales of Music and the Brain

By Oliver Sacks

Knopf. 381 pp. $26

The classic Oliver Sacks case-vignette is a moral fable: A patient presents a dramatic neurological problem. Using cutting-edge tools, the medical profession corrects the abnormality. But soon the treatment fails, or the patient displays a preference for the prior state, the seemingly disabled one. The tale argues against hubris and for an appreciation of eccentricity. In Sacks's breakthrough book, Awakenings, the targeted condition was severe, paralyzing Parkinson's disease. The technology was a medication, L-dopa. The unexpected advantages of the ailment were various, but they centered on protection from the bustle of the modern world.

A physician who contributes regularly to the New Yorker, Sacks has put epilepsy, autism, Tourette's syndrome, blindness and deafness to similar use. "Defects, disorders, diseases," he wrote in An Anthropologist on Mars, "can play a paradoxical role, by bringing out latent powers, developments, evolutions, forms of life, that might never be seen, or even be imaginable, in their absence." In apparent answer to the upbeat science writing popular for much of the 20th century (think of Paul de Kruif's Microbe Hunters or Berton Rouech¿'s The Medical Detectives), Sacks argued in Awakenings that the health-giving drug is a "chimerical concept," a corruption of any true notion of the human condition. Accommodation to our ailments is "finally -- our only friend."

In Musicophilia, Sacks turns to the intersection of music and neurology -- music as affliction and music as treatment. Sacks's passion for music is well known. Describing his response to injury when hiking (in A Leg to Stand On), he wrote that he "musicked along," using the beat of the "The Volga Boatmen's Song" to will himself down a mountain; later, he relearned the rhythm of walking by responding to Mendelssohn's Violin Concerto. As an enthusiast, in Musicophilia he forgoes irony. He admires music as an anodyne, and at times he seems to forgive his patients' tuneful maladies more than they themselves do.

Lacking the dynamic that propels Sacks's other work, Musicophilia threatens to disintegrate into a catalogue of disparate phenomena. On the pathology side: A doctor struck by lightning develops a mania for music; certain epileptics hear music as an aspect of seizing, while others have seizures triggered by particular genres; pianists develop disorders of fine muscle movement; people with hearing loss suffer musical hallucinations. On the restorative side: An amnesiac plays a Bach concerto; aphasics sing what they cannot say; Irish jigs allow an immobilized woman to resume walking; and frozen Parkinson's patients thaw -- if momentarily -- in the warmth of music therapy.

Because music is already justified as an aspect of our soulfulness, Sacks forgives it, as he will not forgive L-dopa, for being only fleetingly effective: "It is music that the parkinsonian needs, for only music, which is rigorous yet spacious, sinuous and alive, can evoke responses that are equally so. And he needs not only the metrical structure of rhythm and the free movement of melody -- its contours and trajectories, its ups and downs, its tensions and relaxations -- but the 'will' and intentionality of music, to allow him to regain the freedom of his own kinetic melody."

This rhapsody serves as a Luddite stand against a juggernaut of medical technology -- and perhaps technology more generally. Among musical devices, the most suspect is the iPod. Sacks wonders whether "the extreme availability of music may have its own dangers," increasing the incidence of musical hallucinations.

What makes Musicophilia cohere is Sacks himself. He is the book's moral argument. Curious, cultured, caring, in his person Sacks justifies the medical profession and, one is tempted to say, the human race. Nothing is alien to him. If he has been saved by music, he also has been briefly afflicted by amusia, an inability to hear music as music, rather than "toneless banging." In his daily consciousness, Sacks embraces music at an extraordinary level. He writes in passing, "I have lately been enjoying mental replays of Beethoven's Third and Fourth Piano Concertos, as recorded by Leon Fleisher in the 1960s. These 'replays' tend to last ten or fifteen minutes and to consist of entire movements." Sacks is, in short, the ideal exponent of the view that responsiveness to music is intrinsic to our makeup. He is also the ideal guide to the territory he covers. Musicophilia allows readers to join Sacks where he is most alive, amid melodies and with his patients. ¿

Peter D. Kramer is the author of "Against Depression" and, most recently, "Freud: Inventor of the Modern Mind."