Wednesday, June 10, 2009

Götterdämmerung Halluzination

Sara Krulwich/The New York Times

Katarina Dalayman as Brünnhilde, in the Metropolitan Opera production of Götterdämmerung.

Musical hallucinations have been reported in the psychiatric literature, most often associated with schizophrenia, depression, and OCD [also with deafness]. The incidence has been estimated to be somewhere between 0.16% to 27% (Schakenraad et al., 2006). They are less commonly observed during confusional states, when visual hallucinations are more typical. Rentrop et al. (2009) have reported an unusual case study of a 74 year old mathematician and opera buff, who presented at the hospital for emergency surgery of the colon. Shortly thereafter...
...he began to suffer from near complete insomnia and mentioned only briefly that ‘this monkey music’ kept him awake. His condition deteriorated and 5 days later he admitted, that he heard complete operas at night from the very first to the last chord, ‘and you know how long these operas are’. He could not offer any explanation as to where these sounds came from, could not distance himself from his elaborate musical perceptions, had no means of interrupting them, and feared the first notes of another overture (which reliably rang out soon after sunset). On examination during daytime he appeared tired and irritable, rather uncooperative with poor concentration, but without overt evidence of a severe confusional state. His medical history was inconspicuous, but it became obvious that he was a dedicated opera-lover with a profound musical expertise, which he had acquired over decades of studying scores and librettos in every detail.
His labs and CT scan appeared to be relatively normal. The patient was started on the atypical antipsychotic drug olanzapine, and after 7 days:
He regained his strength, became friendly, cooperative, and still appeared puzzled about the vivid orchestrations of his musical memory. His neuropsychiatric status was completely normal at discharge.
The authors ended their Letter to the Editor in deadpan fashion:
"...this is (probably) the first report of a patient with a musical hallucinosis of complete operas."


Rentrop M, Knebel C, Förstl H. (2009). Opera-hallucinosis. Int J Geriatr Psychiatry 24:432-3.

Schakenraad SM, Teunisse RJ, Rickert MG. (2006). Musical hallucinations in psychiatric patients. Int J Geriatr Psychiatry 21:394–397.

Wagner's Götterdämmerung: The greatest test in opera for singers, conductor, orchestra – and audience

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At June 11, 2009 11:55 AM, Blogger Neuroskeptic said...

I quite often hear music when falling off to sleep - sometimes music I've heard, sometimes "new" music (as far as I can tell)... Paul McCartney famously woke up with the tune to Yesterday in his head and wrote it down. the ability to have musical "hallucinations" seems very common, although most people don't have them while wide awake.

At June 11, 2009 12:53 PM, Blogger The Neurocritic said...

These phenomena can perhaps account for the variable estimates. The Schakenraad et al. paper says:

"The prevalence of 27% presented by Hermesh et al. (2004) is very high. Probably, inclusion of imagery has inflated the prevalence in the latter study, as the questionnaire that was used did not distinguish between musical hallucinations and obsessive musical imagery."

At June 14, 2009 6:22 AM, Blogger Neuroskeptic said...

Right - of course the line between hallucinations and imagery is blurred though.

I've always wondered what would happen to someone who was brought up in a culture that denied the existence of, say, the imagery you experience when you're falling off to sleep.

We write it all off as "just imagery", something normal and entirely "in our heads", but might they not experience it as a hallucination?


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