Musical Obsessions or Hallucinations?

SIR: We read with interest the article by Zungu-Dirwaryi et al.,¹ in which they reported two cases of musical “obsessions,” but we wonder about their diagnoses.

First, the essential feature of obsession is that it appears against the patient's will.² However, their patient of Case 1 was asked to bring her musical tunes to mind, as if to mimic the state in which she usually had these “obsessions,” when the SPECT of the brain was performed. If the patient could hear musical tunes, this is contrary to the feature of obsessions. Conversely, if she could not hear music, the findings revealed by the SPECT study might not have been directly related to her musical tunes. On the other hand, there are some reports^3,4 of musical hallucinations where the patients were able consciously to alter the tune or its speed or volume.

Second, Zungu-Dirwaryi et al.¹ diagnosed their patients' musical tunes as musical “obsessions” because the source of musical hallucinations is presumably often experienced as outside the head, whereas in their patients the music was experienced as an internally generated cognitive product. However, there is an opinion that pseudo-hallucinations are not located in objective space but in subjective space.²

Finally, both of their patients did not suffer from any other compulsions or obsessions.

Thus, we believe that musical hallucinations (strictly speaking, musical pseudo-hallucinations) rather than musical obsessions seem to be appropriate diagnoses for their patients' musical tunes. Even if their diagnoses are changed from musical obsessions to musical (pseudo-)hallucinations, the SPECT findings are still important because thereby they suggest the functional relationship between musical hallucinations and temporal lobe abnormalities, which we⁵ have also indicated by using a finding of electroencephalography.