WHEN MUSIC HEALS

But it was only when I became a patient myself that I experienced a physical need for music. A bad fall while climbing a mountain in Norway had left me incapacitated by damage to the nerves and muscles of one leg. After surgery to repair the torn tendons in my leg, I settled down to await some return of function in the torn nerves.

With the leg effectively paralyzed, I lost all sense of its existence--indeed, I seemed to lose the very idea of moving it. The leg stayed nonfunctional for the longest 15 days of my life. These days were made longer and grimmer because there was no music in the hospital. Radio reception was bad. Finally, a friend brought me a tape recorder along with a tape of one of my favorite pieces: the Mendelssohn Violin Concerto.

Playing this over and over gave me great pleasure and a general sense of being alive and well. But the nerves in my damaged leg were still healing. Two weeks later, I began to get small twitches in the previously flaccid muscle and larger sudden, involuntary movements.

Strangely, however, I had no impulse to walk. I could barely remember how one would go about walkingÑuntil, unexpectedly. a day or two later, the Violin Concerto played itself in my mind. It seemed, suddenly, to lend me its own energy, and I recovered the lost rhythm of walkingÑlike remembering a once- familiar but long-forgotten tune. Only then did walking regain its natural, unconscious, kinetic melody and grace.

Music can have the same effect on the neurologically impaired. It may have a power beyond anything else to restore them to themselvesÑat least in the precious few minutes that it lasts.

For reasons we do not yet understand, musical abilities often are among the last to be lost, even in cases of widespread brain damage. Thus, someone who is disabled by a stroke or by Alzheimer's or another form of dementia may still be able to respond to music in ways that can seem almost miraculous.

After a stroke, patients may suffer from aphasia, the inability to use or comprehend words. But the ability to sing words is rarely affected. even if an aphasic cannot speak them.

Some patients can even be "reminded" in this way of words and grammatical constructions they have "forgotten." This.in turn, may help them start to regain old neural pathways for accessing language or to build new pathways in their place. Music becomes a crucial first step in a sequence followed by spontaneous improvement and speech therapy.

Some of my patients with strokes or Alzheimer's are unable to carry out a complex chain of actions: to dress, for example. Here, music can work as a mnemonicÑa series of promptings in the form of verse or song. as in the childhood rhyme "One, two, buckle my shoe."

My patient Dr. P. had lost the ability to recognize or identify even common objects, though he could see perfectly well. He was unable to recognize a glove or a flower when I handed it to him, and he once mistook his own wife for a hat. This condition was almost totally disabling Ñbut he discovered that he could perform the needs and tasks of the day | if they were organized in song. And so he £ had songs for dressing, songs for eating, songs for bathing, songs for everything.

As a result of a brain tumor, my patient Greg has not been able to retain any new memories since the 1970s. But if we talk about or play his favorite Grateful Dead songs, his amnesia is bypassed. He becomes vividly animated and can reminisce about their early concerts.

I first saw the immense therapeutic powers of music 30 years ago, in the post- encephalitic patients I later wrote about in Awakenings. These 80 individuals all were victims ot encephalitis lethargica, the viral sleeping sickness thai swept the globe just after World War I. When I came to Beth Abraham Hospital in the Bronx in 1966, most of them had been "frozen,'' absolutely motionless, for decades.

Their voices, if they could speak, lacked tone and force: they were almost spectral. Yet these patients were able to sinvs, loudly and clearly, with a normal range ofexpressiveness and lone. Among those who could walk and talkÑthough only in a jerky, broken wayÑmusic gave their movement or speech the steadiness and control it usually lacked. We could observe this effect on the patients' electroencephalograms. If we found music that worked, their EEGsÑ often exceedingly slow, reflecting their frozen statesÑwould become faster and more regular. We noted this when patients listened to music or sang it or played itÑeven when they imagined it.

Take Rosalie B., a patient who had a severe form ofparkinsonism. She tended to remain transfixed for hours a day, completely motionless, stuck, usually with one finger on her spectacles. But she knew all of Chopin's works by heart. and we had only to say ''Opus 49" to see her whole body. posture and expression change. Her parldnsonism would vanish as soon as she even imagined Chopin's Fanlaisie in F minor. Her EEG would become normal at the same instant the Chopin played itself in her mind.

Clearly, human brains are able to tenaciously hold and replay musical stimuli. This is why tunes may repeat themselves endlessly, sometimes maddeningly. in the mind. Musical hallucinations are far more common than visual hallucinations. There even seems to be a sort of normal "reminiscence" or "recycling"' of early musical memories. especially in the aging brain.

To help. however, the music must be the right kind for each patientÑmusic that has meaning and evokes feeling for that individual. Music therapists who work with a geriatric population often find that only old popular songs can bring such patients to life. While singing them, these patients are able to find a brief but intense sense of community and connectedness with their past livesÑand perhaps a deep emotional catharsis.

This almost universal responsiveness to music is an essential part of our neural nature. Though analogies often are made to birdsong or animal cries, music in its full senseÑincluding complexities of rhythm and harmony, of pace. timbre and tonality no less than of melodyÑ seems to be confined to our own species, like language. Why this should be so is still a mystery. Our research is only now beginning to unlock those secrets.