08: Things Fall Apart: Amusia and Dysharmonia

In this chapter, Dr. Sacks discusses the cases he encountered of two patients with two different conditions that influenced the way they perceived, or did not perceive music. The first patient, who he called D.L., was a 76-year-old woman who had suffered from congenital amusia her whole life. This musical disorder that D.L. had can mainly be described as the inability to hear sounds as music, and since she was born with this condition, she claimed to have never heard music at any point in her life and does not know what it sounds like. While this disorder did not disable her from hearing and distinguishing between voices and environmental sounds, she was impaired in recognizing pitch and melodies present in music, and these were her main symptoms and the reasons why she could not hear music. Instead, she would perceive music as really annoying irrelevant sounds such as the cluttering of pots and pans. The second patient Dr. Sacks came across was a female composer and performer, by the name of Rachael Y., who was in her early 40s and suffered from dysharmonia after being in a horrific car accident that left her paralyzed in her legs, right arm, and deaf in her right ear. This disorder impaired her ability to hear harmony in almost every sound, especially music, while leaving her ability to understand melody intact. Therefore, she lost the ability to hear the integration of instruments playing in unison, and instead she was now only able to hear the intensity of the individual instruments playing in all directions, rather than together as one. She was also experiencing a lack of integration in her auditory environment, for the sounds were isolated and she heard each one on its own, rather that a mesh of all of them together as the background sound normally heard.

Although it is not mentioned by Dr. Sacks, the area in the brain that may be directly responsible for these disorders is the auditory cortex. Specifically, the pitch and volume of the music is analyzed in the core of the cortex, while the timbre, melody and rhythm are analyzed by surrounding regions. Therefore, in the case of D.L., she may have been born with deficits in both the core and surrounding areas of the auditory cortex. In Rachael’s case, the accident may have caused damage to the cortex and to the left hemisphere of her brain, for the right side of her body experienced the most impairment. It was also unclear whether the dysharmonia she suffered from could have been caused by the deafness in her right ear or the damage to the cortex.

Sadly, both of these patients’ disorders were not treatable, and the first patient D.L. was okay with that and had learned to read, play, and comprehend music without actually hearing it. Rachael Y., trained her mind and right arm to write and play music again, even though she could not distinctly identify or hear the music. She used a music-processing computer and the help of a collaborator in order to aid her in composing the music that cannot be stored for long in her memory after she has played it.

Acquired amusia, resulting from brain damage, is much more common than congenital amusia, which is inherited from birth and what D.L. suffered from. The fact that she is one of the extremely few people in the world who had this disorder and therefore has never and will never know what music sounds like is precisely what makes this case so unique. What makes Rachael’s condition so unique is the fact that she was a music composer and performer before her accident, and the disorder greatly impacted the abilities that she had fully relied on prior to the incident. If any other individual experienced this disorder, it would not affect them as much because they would not have had that distinct ear for musical components like she did.