32896589326509350

come to enjoy their internal music and may feel it as an enrichment of life. Ivy L., a
lively and articulate eighty-ve-year-old, has had some visual hallucinations related to
her macular degeneration, and some musical and auditory hallucinations stemming from
her hearing impairment. Mrs. L. wrote to me:
In 2008 my doctor prescribed paroxetine for what she called depression and I called
sadness. I had moved from St. Louis to Massachusetts after my husband died. A
week after starting paroxetine, while watching the Olympics, I was surprised to
hear languid music with the men’s swim races. When I turned o the TV, the music
continued and has been present virtually every waking minute since.
When the music began, a doctor gave me Zyprexa as a possible aid. That brought
a visual hallucination of a murky, bubbling brown ceiling at night. A second
prescription gave me hallucinations of lovely, transparent tropical plants growing
in my bathroom. So I quit taking these prescriptions and the visual hallucinations
ceased. The music continued.
I do not simply “recall” these songs. The music playing in the house is as loud
and clear as any CD or concert. The volume increases in a large space such as a
supermarket. The music has no singers or words. I have never heard “voices” but
once heard my name called urgently, while I was dozing.
There was a short time when I “heard” doorbells, phones, and alarm clocks ring
although none were ringing. I no longer experience these. In addition to music, at
times I hear katydids, sparrows, or the sound of a large truck idling at my right
side.
During all these experiences, I am fully aware that they are not real. I continue
to function, managing my accounts and nances, moving my residence, taking care
of my household. I speak coherently while experiencing these aural and visual
disturbances. My memory is quite accurate, except for the occasional misplaced
paper.
I can “enter” a melody I think of or have one triggered by a phrase, but I cannot
stop the aural hallucinations. So I cannot stop the “piano” in the coat closet, the
“clarinet” in the living room ceiling, the endless “God Bless America”s, or waking
up to “Good Night, Irene.” But I manage.
P
ET and fMRI scanning have shown that musical hallucination, like actual musical
perception, is associated with the activation of an extensive network involving many
areas of the brain—auditory areas, motor cortex, visual areas, basal ganglia,
cerebellum, hippocampi, and amygdala. (Music calls upon many more areas of the brain
than any other activity—one reason why music therapy is useful for such a wide variety
of conditions.) This musical network can be stimulated directly, on occasion, as by a
focal epilepsy, a fever, or delirium, but what seems to occur in most cases of musical
hallucinations is a release of activity in the musical network when normally operative
inhibitions or constraints are weakened. The commonest cause of such a release is