Music and Medicine

 

The Vision of Music
A physician who conducts music reflects on the healing powers of mingling the senses.
by Samuel Wong

When Edgar Degas could no longer see well enough to paint, he turned to sculpture, relying on a newfound tactile keenness. When French the color of music composer Gabriel Fauré’s hearing became deranged, he cried, “I only hear horrors.” Ludwig van Beethoven persisted in writing symphonies yet confided to his brothers, “I am deaf…how would it be possible to admit the deficiency of a sense I ought to possess to a more perfect degree than anybody else?”

A painter loses his eyesight; a composer loses his hearing. How might we treat and rehabilitate such patients? How can we take advantage of the healing mechanisms of neuroplasticity and sensory transfer to lift the spirit of a devastated artist? How might we harness the associative power of music and the visual arts to amplify one sense so as to replace the loss of another?

I have spent my professional life immersed in issues of sight through my work as an ophthalmologist and sound through my work as a symphony conductor. I have enjoyed inhabiting both of these worlds, so it is perhaps not too surprising that I would be captivated by thoughts of how their intersection might benefit others, particularly people who have lost the use of a sensory capacity that is vital to their creative expression.

My interest in exploring these possibilities has led me to probe the physiological aspects of synesthesia, a perception by one sense, such as vision, through stimulation of another sense, such as hearing. Could
our understanding of how the brains of synesthetes—and nonsynesthetes—respond to sensory stimulations give us clues to
therapies for those who’ve lost a perceptual window to their worlds?


Coda Blue

Synesthesia derives from the Greek terms syn, meaning together or with, and aesthesis, meaning sensation or perception. The scientific community became aware of this condition in the late 1880s when Sir Francis Galton, a half-cousin of Charles Darwin, wrote in Nature about individuals who saw colors when viewing letters of the alphabet or hearing music.

Synesthesia can find expression in several ways. In music-color synesthesia, individuals experience tones or sounds in response to colors or shapes. For those with ordinal-linguistic personification, ordered sequences, such as letters, numbers, days, or months bear distinctive personalities: Wednesdays, for example, might be perceived as an impish adolescent.

Spatial-sequence synesthetes can experience three-dimensional perceptions; months may appear near the ground. In the rarest form, lexical-gustatory, words cause taste sensations in the mouth—“echo,” for example, may always elicit the taste of buttered toast—while in the most common form, grapheme-color, thought to be experienced by 68 percent of synesthetes, letters or numbers have identifying colors.

Although the prevalence of synesthesia is imprecisely known, researchers estimate that, at minimum, it appears in one in twenty thousand but that certain types manifest in one of every two hundred people. It is a lifelong condition, possibly heritable, and is remarkably consistent: If the letter M is perceived to be purple, it will always be purple. This latter trait has been perhaps most famously expressed by Vladimir Nabokov. “In the green group,” he wrote, “there are alder-leaf f, the unripe apple of p, and pistachio t….In the brown group, there are the rich rubbery tone of soft
g, paler j, and the drab shoelace of h.”

Some musicians strongly associate sound with color. For the composer Nikolai Rimsky-Korsakov, the key of C major was white, while the key of B major was a gloomy steel blue. Franz Liszt exhorted an orchestra, “That is a deep violet, please, depend on it! Not so rose!”


Tone Poems

My interest in synesthesia and the brain led me to functional MRI. By showing neurons at work, it allows us to spy on artists’ brains and to watch their creative processes unfold. So, in an attempt to understand what parts of my brain engage when I listen to, read, think, or translate a piece of music, I submitted myself as a candidate for an experiment. While on a conducting assignment, I spent a week rehearsing an orchestra in Beethoven’s Fifth Symphony. Between rehearsals I had my brain scanned while undertaking five different activities: listening to a recording of Beethoven’s music; thinking of the music but in silence, with my eyes closed; reading a score of Beethoven’s Fifth in silence; moving my fingers as if playing the symphony on the piano, again in silence; and thinking of the motions I would use when conducting this music.

The functional MRI revealed differences in the responses in my auditory and visual cortices, as I expected. But dramatic differences also appeared in the associative areas of my brain, in the V4 region, the temporoparietal-occipital junction, the corpus collosum, and the limbic system, regions whose interplay contribute to our perception of color. The experiment showed me how incredibly rich and varied the musical experience can be, a knowledge that gives me a greater understanding for the diversity that audience response can take. It also provided me a startling glimpse of the responses that synesthetes—whose perceptual pathways may be differently wired or, possibly, less disinhibited—can enjoy.

Our growing knowledge of functional brain anatomy will allow us to continue gathering clues about artists’ creative processes. In the same way, we can begin to capture the associative power of music and painting into art therapy. Some blind patients, for example, have found comfort in musical training, which has inducted them into a rich sonic world of subtle beauty. Visual patterns can be transformed into sound patterns for recognition and appreciation. Such synesthetic techniques can be helpful for patients with sensory loss.


Breaking the Sound Barrier

I often find comfort in late-night music. In Gustav Mahler’s work I hear the end of mankind, as did the late Lewis Thomas ’37, an observation recounted in his book Late Night Thoughts on Listening to Mahler’s Ninth Symphony. But in Beethoven’s Ninth, I hear and see a fist-shaking, gravity-defying, deaf-be-not-proud maestro and the indomitable spirit of mankind.

My role as a conductor allows me to imagine the power offered by a synesthetic world. Sometimes, when I’m conducting an orchestra, I’ll close my eyes, and memories of past performances, a teacher’s lessons, landscapes, colors, and the faces of musicians all flash together. Then the images disappear as quickly as they came, as a musical note evaporates in thin air after it is made. Only its memory and aftertaste linger in the mind, sometimes for years or even a lifetime.

Moving from the concert theater to the operating theater, I am often struck by how the brinkmanship inherent in the work of conductors also exists in the work of surgeons. When a conductor closes his score and his eyes to conduct a searing performance of The Rite of Spring, he faithfully reproduces Igor Stravinsky’s carefully calculated arrhythmias. One misstep, one deviation of a few milliseconds, and the fine synchronization and ensemble are threatened. Drums may lose their entrainment and rhythms unravel.

During an eye operation, if a surgeon presses a few micrometers too deep, phaco tip may penetrate the posterior lens capsule, and lens fragments may fall back to the retina. Fortunately, such complications rarely occur in either the musical or surgical endeavors.

The accolades in both fields, when they occur, can be palpable. The applause in the clinic can be as resonant as that in a concert hall, though often quiet: The gratitude of patients shines through their eyes when, after cataract surgery, they relive the wonder of unimpeded vision.

It would give me great joy to be able to help artists regain critical sensory mechanisms they have lost, much as my surgery can help those encumbered by cataracts regain their view of the world. Our growing understanding of the neuromechanisms of sensory perception may make this possible one day. By learning how the brains of synesthetes process sensory stimulation and by comparing that information with that derived from experiments similar to my own, we may be able to rehabilitate those who—through stroke, aphasia, or other devastations to their neural landscapes—have lost the ability to make those connections.

To ensure that research and interest in “music medicine” grows, I have launched the Global Music Healing Institute, a foundation engaged in studying the effects of music on the autonomic system, on mood, and on speech and cognition. It is my hope that by stimulating research, public awareness, and interdisciplinary knowledge of the medical benefits of music, this organization will help build bridges that will allow patients—perhaps even a Degas or Fauré of today—reconnect with the perceptions and functions that help make their lives full.

Samuel Wong ’88 has held music directorships in New York, Hong Kong, Hawaii, and Michigan. He has led the Royal Philharmonic on tour and recorded two award-winning discs with the Hong Kong Philharmonic. He now practices ophthalmology in New York.

This article appeared in the Spring/Summer 2007 issue of the Harvard Medical Alumni Bulletin.

Photo: © istockphoto.com/Emrah Turudu

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