Musical Hallucinations

A paper on auditory hallucinations of music was presented
this afternoon at the 2007 Annual Meeting of the American Psychiatric
Association in San Diego, California.

The researcher looked at 22 people diagnosed with schizophrenia and
23 with schizoaffective disorder at Maimonides Medical Center in
Brooklyn, New York. The question was whether it would be possible to
use the presence of musical hallucinations to distinguish between
schizophrenia and schizoaffective disorder. The conclusions from the
study were that these auditory hallucinations of music were more common
in people with schizoaffective disorder and that voices with a
religious or superstitious content were more common in people with
schizophrenia.

Though it is good to see someone examine the content of hallucinations, this was a very puzzling study.

First, there is always a lot of debate around the “schizoaffective”
diagnosis. Although there are clear criteria for it in the DSM-IV, many
experts believe that most people who have been labeled
“schizoaffective” actually have a form of bipolar disorder. But in any
case, bipolar disorder and schizophrenia probably lie on a spectrum.
People’s diagnoses often change over time. Not because of disagreement
or inaccuracy, but because people change over time. The term
“phenomenological drift” has been used to describe this observation.
What that means is that we always need to be sure of the diagnosis at
the time of the study, rather than what was written in the chart in the dim and distant past.

The other point is that genuine musical hallucinations are very
rare. The world literature contains under a hundred papers in European
languages, and the classic paper,
published by German Berrios in 1991 was an analysis of just 46 cases.
Berrios is regarded by many as one of the finest phenomenologists in
Europe, so it is surprising that the investigator in New York found so
many cases.

It will be good to see if the author or someone else can replicate
the work. The classic teaching about musical hallucinations has been
that they:

• Are more common in women
• Are more common in people who have hearing problems or are deaf
• Are more likely to occur in people with neurological diseases, including Alzheimer’s disease
• If they occur in people with neurological disease, it is more
  likely that the damage will be in the right or non-dominant hemisphere
  of the brain. (In men, language tends to be in the dominant hemispheres
  and music in the non-dominant. The pattern is a bit more complicated in
  women, but they also usually sing and recognize music with the right or
  non-dominant hemisphere)

A recent report from Japan reported that an elderly man with musical hallucinations was helped with the cholinesterase inhibitor donepezil (Aricept), suggesting that cholinergic neurons are somehow involved in generating musical hallucinations.

Many of us have music or tunes giong round in our heads, but that is quite different from hallucinating music.

And let me repeat: hearing things is common, and does not mean that someone is mentally ill.