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Musical Accompaniment

August 16, 2010

I have a soundtrack playing in my head, nearly 24/7. It beats the hell out of my tinnitus, but it can be distracting at times. I wake up in the middle of the night to the music playing in my head. I have conversations while it phantom plays; I type and it’s there, playing in the background. 

Call it the ultimate in multitasking and totally easier than walking around with an MP3 player and earbuds. It’s exclusively in my head, though; thankfully it hasn’t branched out to musical hallucinations, where people hear music that isn’t there. No, this is just my mind playing on. The last week or so it’s been the Court Yard Hounds; I’ve listened to the cd often enough that it’s cycling in my head in an endless loop.

If my soundtrack appeared to be originating outside my head, in that I was hearing music no one else was, then it would perhaps be more troublesome. However, as long as the music plays in my head, it does seem to effectively dampen the ringing.  Also, as long it’s music I want to be listening to, it’s hardly a problem. I wonder if this particular perseveration, hearing the Court Yard Hounds in my mind (right now it’s “Gracefully”), is simply an extension of my perseveration of listening to the cd each time I get in the car since the cd was released. In other words, I’m hooked on the album, and my brain generates the music for me.

The question is, since my mind always turns to what scientists know about a topic, is has this been studied? What kind of variation are there for phantom music? So we know that people have auditory hallucinations, hear voices that register as external, and it appears that people can hear music as external. Some people believe the music to be real, while others know it is not.  Mocellin, Walterfang, and Velakoulis (2008) explain the difference between hallucinations and hallucinosis:  “Hallucinations attributed to structural CNS disease are often differentiated by the term hallucinosis’.  In general, hallucinosis and hallucinations are usually separated by the nature of the associated insight. Hallucinations in psychiatric disorders are defined by the absence of insight in which the person experiencing the phenomena does not understand it as morbid. In general, those describing hallucinosis have some degree of insight, often being able to comprehend their experiences as  tricks of the mind’.”

I try to imagine how it would feel to actually hear the music outside my head. I’ve had the ringing in my ears for over seven years. It was incredibly frustrating until I learned to work around it with white noise machines and fans in every room of the house running around the clock. The constant music is relatively new in comparison; most of us have had the experience of having a song stuck in our head; we either jam along with it or get incredibly frustrated. Last year, for a week or so I had the song my son danced to at his concert at the day center, “Another One Bites the Dust.” Kathleen would send me links to songs on you tube in an attempt to knock it out.

Okay, neither of these (musical hallucinations or musical hallucinosis) really fit. According to the American Tinnitus Association, music is one of the sounds that individuals with tinnitus may hear. So, is the soundtrack playing in my head (that has my head shaking in time to the beat) simply a change in how my tinnitus manifests? Maybe, except the bzzzz from the tinnitus is experienced as a real sound, while the music in my head is internal.

Access to a good database and a boundless curiousity allows the opportunity to keep asking questions and to find all sorts of goodies. Perhaps it’s a pseudohallucination? Hah, no seriously, there’s an article that has a case study of a patient with OCD and musical obsessions:

 “The musical symptoms in the present patient were experienced as produced in his own mind and not imposed from outside. The music was experienced as repetitive, intrusive and inappropriate, which caused marked anxiety, distress and impairment of social–occupational functioning. It was not simply associated with excessive worries about life problems. The musical symptoms were accompanied by full insight into the senselessness and excessiveness of the symptoms, and the patient attempted to suppress the music or neutralize it with other thoughts. Thus, the musical symptoms observed in the present case are consistent with the psychopathological characteristics of obsessions” (Praharaj et al., 2009).

Oh, hell. Hee. I jest. I don’t think this is an issue unless I want it to be. And it would be kind of silly, wouldn’t it? It is what it is. And the soundtrack can be silenced by playing music; it just resumes when the music is off. Must mean I’ve got a song in my heart, right?

Praharaj et al. go on to explain the differences between musical hallucinations, pseudohallucinations, and obsessions. Pseudohallucinations “lack concrete reality, are heard in the subjective space, are a constant
phenomena unlike images, are independent of will and the person retains insight into the phenomenon.”

Ah, okay, maybe. Do I need a hard name for this subjective experience? Do I need to pathologize it? I don’t think I do. And Praharaj et al. note that “internal hearing is another related phenomenon that is found in skilled
musicians, which also needs to be differentiated from musical obsessions.” I am not a skilled musician, but isn’t that what this is to some degree, internal hearing? 

I have a running dialogue in my head, a flurry of ideas, thoughts, stories. It’s a busy place up there, and I often have thoughts running across each other, overlapping and cutting across other thoughts. In other words, bored isn’t something I really experience. Skin jumpy, yes. Oh my. And maybe that has to do with that jumble of competing thoughts and interests. Perhaps this business demands a soundtrack? Who am I to argue with it when I could dance along with it?

Isn’t that the key? Do we dance with the music, ride the waves, go with the flow, or do we scream that we just want to get off the damn ride and have some peace and quiet? And I suppose another question is, do I want to knock the Court Yard Hounds out of my head? Not really. Not yet. I just wish I could sing in tune with it.  But if you see me with a little bounce in my step, humming and be-bopping, you’ll know I’ve got my own internal music box providing me with my own soundtrack. And you’ll know I decided to dance. 


Mocellin, R., Walterfang, M., & Velakoulis, D. (2008). Musical hallucinosis: case reports and possible neurobiological models Acta Neuropsychiatrica, 20 (2), 91-95 DOI: 10.1111/j.1601-5215.2007.00255.x

Praharaj, S., Goyal, N., Sarkar, S., Bagati, D., Sinha, P., & Sinha, V. (2009). Musical obsession or pseudohallucination: Electrophysiological standpoint Psychiatry and Clinical Neurosciences, 63 (2), 230-234 DOI: 10.1111/j.1440-1819.2009.01926.x


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