Beethoven’s Stimming: Op. 95 and Tourette’s

T  he hypnotic effect of Beethoven’s variations on this obsessive figure is relieved by the A major middle section, marked Dolce, which withholds the spondees but retains the dactylic rhythm, now sounded in the lowest strings. It is as though the music is marking time (Riezler) before returning to the ostinato processional path... The Allegretto’s sequences of datyls and spondees [achieve their] quasi-hypnotic effect by repetitive incantatory and rhythmic means.”
  —  Maynard Solomon, regarding Symphony No. 7, pp. 110, 122.

A lthough some people with autism spectrum disorders play music, and some of them have reached a high degree of technical proficiency, they do not report being emotionally moved by music. Rather, the anecdotal evidence is that they are attracted to the structure of music. Temple Grandin, a professor who is autistic, has written that she finds music ‘pretty’ but that, in general, she just ‘doesn't get it’—she doesn’t understand why people react to music the way they do.”
  —  Daniel Levitin, p. 259.

T  wenty-one minutes of sharply compressed music that shows him in all his violent, tragic, angry, plaintive, contemplative guises. It’s impulsive, defiant, pained, adversarial. It has qualities of conciseness, directness and instant confrontation of contrast. Op. 95 is called the ‘Quartetto Serioso,’ a rare instance in which Beethoven himself bestowed a subtitle… The F minor Quartet is not a ‘pretty’ piece, but it is terribly strong — and perhaps rather terrible… Everything unessential falls victim, leaving a residue of extreme concentration, in dangerously high tension. But strength, not strain, is the commanding impression.”
  —  Joseph Kerman,‘Beethoven Quartets’.

Bruce Adolphe renders a musical diagnosis: Tourette's Syndrome in Beethoven’s Op. 95, a program that he has given on 11-DEC-2007 at Curtis Institute of Music in Philadelphia and on 14-FEB-2008 in Joplin, Missouri—with the able assistance of the Daedalus Quartet. As a composer, Adolphe has been written works for many renowned artists (Itzhak Perlman, Yo-Yo Ma, Sylvia McNair, the Beaux Arts Trio, the Orpheus Chamber Orchestra, the National Symphony, St. Luke’s Orchestra, the New York Chamber Symphony, the Brentano String Quartet, the Miami Quartet, The Chamber Music Society of Lincoln Center, Chicago Chamber Musicians, etc.). Formerly on the faculties of the Juilliard School and New York University and a Visiting Lecturer at Yale, Adolphe has been a lecturer for the Chamber Music Society of Lincoln Center since 1992, and has been featured in national Live from Lincoln Center television broadcasts.

Adolphe has authored three books on music:

• The Mind’s Ear: Exercises for Improving the Musical Imagination;
  
• What to Listen for in the World; and
  
• Of Mozart, Parrots and Cherry Blossoms in the Wind: A Composer Explores Mysteries of the Musical Mind.

Did Beethoven move his lips when he wrote Op. 95? Tourette-ish or not, the thing either works or it doesn’t. It’s successful for us as listeners or performers because it creates a coherent, if disturbing, atmosphere. Its beauty and comprehensibility lie in the simplicity and in the repetitions, which lead us to grasp a kind of endless and seemingly pre-ordained, hypnotic movement. If the thing were truly scatological—an illogical assemblage of Tourette-ish involuntary and disparate elements and dynamics—it wouldn’t ‘work’, except as an acoustical nuisance.

Op. 95 is (at the very least) an example of neurodiversity—defying musical conformity or elitism.

Did Beethoven make successive revisions to Op. 95? Yes! It was begun in 1810 and sketched and re-sketched several times within a year, but it was only finished four years later. It wasn’t blurted out, Tourette-style. And think, too, about 1810: more or less at the end of the Beethoven’s Middle Period, here is this new, compressed, chromatic language that flowers in his later quartets. Beethoven’s annotation ‘serioso’ really means, “En garde, performers and audience!” It’s a post-revolutionary existential assertion that the world is uncertain; there are no guarantees; and conventional resolutions are a thing of the past. If Op. 95 is a Tourette’s ‘tic’, it’s one hell of a tic!


Musicologists write about how the first movement uses the tension created by a half-tone slide of the theme (a “Neapolitan step”) to throw things off-balance; about how Beethoven modulates to unexpected keys that create tensions around the key of D-flat; about how the D major second movement is incongruous with the F minor first movement, and what we feel is dislocation, a happy D major that we can’t trust. The Allegro assai vivace ma serioso is a perversely ‘grumpy’ scherzo: Beethoven scholar Joseph Kerman called it “a march – a serious, three-legged, tough little quick-march.” The coda bursts like a Rossini overture out of the shadows of F minor and hurtles the work into a major-key ending. All of these surprises and reversals: were they tics after all?

Lawrence Kramer’s book 20 years ago addressed idea that music means something, something we can talk about, and he mostly relied on Beethoven sonatas as examples. Kramer said that the semantic precision or imprecision of music simply doesn’t matter—because music, among other things, is a cultural practice. As such, it’s less an attempt to ‘say’ something than an attempt to ‘do’ something. If there are indeed Tourette-like stereotyped compositional features in Op. 95, maybe it’s best to consider them as actions with rewards that accrue to deeds, rather than as utterances with rewards that accrue to comprehensible texts.


The repetitive, hypnotic figures in Op. 95—maybe they are a kind of ‘mitigated echolalia’, a term coined by Pick in 1924 and still used by psychiatrists and neurologists today. The person (in this case, Beethoven) is aware of his own echolalia and tries to control it but doesn’t succeed? After all, neither fluent speech nor the ability to repeat speech is necessary for ‘echolalia’ per se. To require those would be too narrow a definition…

Anatomically, a lesion in the left medial frontal lobe in the brain can be a cause of what neurologists call ‘effortful echolalia’. But the cause doesn’t have to be structural or anatomical. In the cases of amphetamine-induced stereotyped behavior, Parkinsonism, the acute dyskinesias, and tardive dyskinesia, there’s evidence that some involuntary disorders of movement are biochemically mediated. In any case, ‘organicity’, in varying degrees and involving different anatomical and physiological/biochemical causes, is characteristic of Tourette’s Syndrome, Parkinson’s Disease and Huntington’s Disease and the vocal and motor abnormalities seen in each. But these conditions’ effects on writing have not been systematically studied—or at least haven’t been published so far as I can tell.

Is there any evidence of Tourette’s-type dysgraphia in the original manuscript for Op. 95? Is there evidence of Tourette’s-like episodic nonspecific urge resolution or labile non-resolution of themes in Op. 95? Adolphe seems to think so.

Note that the speech patterns described by Gilles de la Tourette can take two forms: they either turn around a specific theme and serves as a specific and repetitious commentary; or they take the form of arbitrary [scatological] ‘punctuations’. That the semiotic function of these Tourette patterns isn’t evident to the rest of us doesn’t mean that they have no semiotic function—only that we don’t understand what, if any, function they may have. In other words, ‘illogical’ is a judgment that depends upon what logic and axioms you assume; the motives that would explain whatever logic Beethoven may have been using are context-dependent—his context, his motives.


There are two more sub-forms of echolalia: immediate echolalia and delayed echolalia. Immediate echolalia was once defined as ‘the meaningless repetition of a word or word group just spoken by another person’ (Fay & Schuler, 1980). But Prizant and others have shown that echolalia may serve several purposes for the person with autism or Tourette’s (therefore, it’s not ‘meaningless’, just inscrutable). Researchers find that immediate echolalia taps into the person’s short-term memory for auditory input. The crypto-semiotics of immediate echolalia are part of the extemporaneity of it in real-time. Its function is inscrutable because the rhythmic, punctuational, self-stim compensatory ‘memory’ purpose is alien to conversation between neurotypical normals. The need to repeat is not a compulsion, not really. It’s a rhythm; it’s a practice; it’s a ‘self-stim’ reflex. It just happens to be one that most of the rest of us ‘don’t get’. Beethoven: ‘stimming’ in Op. 95!

The semiotic function may, in fact, be clearer in written forms (including music) than in spoken forms. Written manifestations of repetitive, stereotyped self-stim exist. Poetry is full of this; ‘minimalist’ compositions, too. Stimming is repetitive stereotypic behavior of the types commonly found in autism and Tourette’s, but it’s also found in other developmental disabilities. These behaviors may involve any or all of the senses in various degrees in different individuals. Several examples are listed below.

• Visual – staring at lights, blinking, gazing at fingers, lining up objects
  
• Auditory – tapping fingers, snapping fingers, grunting, humming
  
• Olfactory – smelling things repeatedly
  
• Taste – licking objects, placing objects in mouth
  
• Tactile – chin scratching, clapping, thumb rubbing, feeling objects, nail biting, hair twisting, toe-walking,
  
• Vestibular – rocking, spinning, jumping, pacing
  
• Proprioception – teeth grinding, pacing, jumping

Some autism spectrum clues:

• Difficulty learning to ride a bike or ride a horse
  
• Clumsy, uncoordinated, and accident prone
  
• Walks with hands clasped behind back
  
• Difficulty walking on uneven surfaces
  
• Difficulty with fine motor tasks such as buttoning, zipping, tying, knitting, sewing, playing games with small parts, closing zip-loc bags
  
• Confuses right and left sides
  
• Prefers sedentary tasks like composing music, and avoids sports or physical activities
  
• Difficulty with handwriting; takes a long time to write things legibly
  
• Frequently bumps into people and things
  
• Easily fatigued with physical tasks
  
• Frequently slips or misses when putting objects on a table
  
• Messy eater, difficulty with eating utensils, spills and drops food
  
• Knocks drinks or other things over when reaching for them
  
• Frequently drops items
  
• Has to talk self through tasks
  
• Hums or vocalizes while concentrating on a task
  
• Difficulty learning to tie a tie
  
• Difficulty with motor tasks requiring several steps
  
• Difficulty lining up numbers correctly for math problems or tallying a bank account
  
• Difficulty learning new motor tasks... a new dance, a new musical instrument

Every hinged object becomes a [self-stimulation] stimming toy; a wheel becomes something to spin for hours. Does Adolphe seriously think that Op. 95 is like this? Well, to a degree, yes. The obsessive intervallic figures in mm. 34-36, with reversals/inversions, for example.


Disruptive echolalia and coprolalia are involuntary: what happens happens in real-time. But composition happens off-line. There’s plenty of time for censoring and editing off-line. Does Adolphe see evidence of echographia and coprographia in Op. 95? Does he think the limbic lobe of Beethoven’s brain was involved in ‘episodic productions’ in Op. 95? Yakovlev once wrote that the limbic part of the brain plays a role in ‘emotive motility’ which is essentially automatic. The involvement of the limbic lobe wouldn’t explain, though, why tics and echolalia and other repetitive behaviors aren’t censored by internal control mechanisms. It seems that Adolphe hasn’t explored these aspects yet…

Verbal impulsion, the classic feature of Tourette’s Syndrome, also occurs with frontotemporal dementia. People with this often are progressively unable to read silently. Externally triggered inner speech may be represented by silent reading. With frontotemporal dementia, loss of silent reading is equivalent to a loss of control over the verbal utterance of inner speech. The person’s ability to keep his/her inner speech ‘inside’ is lost, and the reader involuntarily now speaks out loud while reading.

Vercueil’s 2003 paper reviews the loss of control of inner speech in two Tourette’s Syndrome patients. Two adult patients with a diagnosis of Tourette’s since ages 7 and 10, respectively, commented on their present or previous abilities to read silently. The first patient never read silently as a child while the second patient did read silently but had a tendency to move his lips.

Vercueil speculates that the key role of prefrontal cortex, especially the orbito-frontal areas, in the inhibitory control of current behavior, can be responsible for the deficit in the control of inner speech. Recently, fMRI imaging performed in patients with Tourette’s Syndrome has shown a striking deficit in the activation of these areas during tics. It would be of great interest to address this specific question in determining the frequency of difficulties in silent reading in Tourette’s individuals as compared to those without Tourette’s. I will discuss this with Adolphe…

Tests that reflect reward—reduced ability to experience reward (anhedonia) and aversion (dysphoria)—are a ‘hot topic’ today because many psychiatric conditions that are currently intractable in humans (e.g., major depression, bipolar disorder, addiction) are characterized by dysregulated motivation. But Op. 95 isn’t dysphoric or anhedonic. Instead, it’s, if anything, hyper-hedonic. Has Adolphe thought about this aspect, I wonder?

S ometimes peoples’ disorders are what make them worth having as friends.”
  —  Bruce Adolphe, 15-FEB-2008.

What else? Autistic spectrum and obsessive-compulsive spectrum disorders may be viewed along a continuum, with purely compulsive or ego-dystonic disorders characterized by good insight and risk avoidance at one end, and purely impulsive ego-syntonic disorders characterized by poor insight and risk-seeking behavior at the other, with mixed forms in between. So is there evidence that Op. 95 shows poor insight plus risk-seeking aberrant compositional choices?


Robertson at University College London and Kerbeshian and colleagues at the University of North Dakota have studied the roughly 10% association between Tourette’s and bipolar disorder. It’s surely possible that Beethoven’s bipolar disorder may have had some comorbid Tourette’s-type qualities. The estimated risk of developing bipolar disorder among the study group of children, adolescents, and adults with Tourette’s was more than four times higher than the level expected by chance, but this finding did not reach statistical significance. It was indicative of trends, however.

Depression is common for these people, with a lifetime risk of about 10% and a prevalence of between 1.8% and 8.9%. Depression and depressive symptoms are found to occur in 13% and 76% of Tourette’s Syndrome patients attending specialist clinics, respectively. Clinical correlates of depression in people with Tourette’s are these:

• tic severity and duration;
  
• echolalia and/or coprolalia;
  
• premonitory sensations;
  
• sleep disturbances;
  
• obsessive-compulsive disorder (OCD);
  
• self-mutilation;
  
• aggression;
  
• conduct disorder (CD) in childhood; and
  
• attention deficity hyperactivity disorder (ADHD).

Tics typically diminish in severity as we get older, even for those of us who have relatively severe tic symptoms as kids. And we affected adults develop ways of unobtrusively masking our tics. Beethoven walked with his hands clasped behind his back—to mask the motor tics in his hands, and as a ritual OC gesture to keep himself from touching objects and people. A single string quartet in F minor does not a diagnosis make, but plausible clues, yes, they’re there.

To me, it seems that Adolphe is fitting Beethoven into a procrustean bed—cutting and adjusting facts to fit his theory. It’s not disparagement masquerading as a diagnosis—like the perennial suggestions that Mozart had Tourette’s. It’s more a romantic transfiguration of ‘Beethoven-as-martyrous-Tourette’s-sufferer’. Supposedly, Tourette’s only manifests itself in spoken unintentional tics, not in written ones. But that view’s only applicable to ordinary people in everyday situations, not composers and writers and artists practicing their professions. [How, after all, does this CMT blog post come to have the Tourette-ish quirks that it has? That is to say, if Tourette’s is one’s lot in life and one is creating a work of art that’s about Tourette’s, it’s inevitable one will select and preserve some features that epitomize the condition and its impact.] The Tourette-ish features of Op. 95 may have arisen unintentionally, but they were intentionally left-in through the 4 years of edits and revisions that Beethoven applied to the piece. They were part of Beethoven’s cultural practice, as Kramer might say.


Click on the screenshot below to download a spreadsheet to estimate the likelihood of Tourette’s Syndrome.

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B eethoven is the friend and contemporary of the French Revolution, and he remained faithful to it even when, during the Jacobin dictatorship, humanitarians with weak nerves of the Schiller type turned from it, preferring to destroy tyrants on the theatrical stage with the help of cardboard swords. Beethoven, that plebeian genius, who proudly turned his back on emperors, princes and magnates—that is the Beethoven we love for his unassailable optimism, his virile sadness, for the inspired pathos of his struggle, and for his iron will which enabled him to seize destiny by the throat.”
  —  Igor Stravinsky.

Welcome to My Pitch Universe: Carbamazepine, Aripiprazole, and Pharmacological Pitch-Bending

H aving perfect pitch, I find listening to these [Baroque historically-informed] performances very jarring. Even when I put in Podger’s recording of Bach I had to really adjust. I can’t listen to Quarta’s Paganini 1, which is tuned up. It’s just too strange.”
  — Pieter Viljoen, 04-DEC-2006.

This wouldn’t likely be noticed by anybody who doesn’t have ‘perfect pitch’ [‘absolute pitch’]. But she was triply gifted—with perfect pitch, mild autism, and epilepsy. Having ‘absolute pitch’ was sometimes helpful—in sight-reading, for example, or a capella singing or improvising jazz. But most of the time it was a nuisance. It was especially disturbing to her to tune her violin to A415 Hz or other Baroque tunings.

Perfect pitch [also called ‘absolute pitch’] is the ability to hear a particular note (or chord) and know, without any instrument or other pitch reference, which note it is. Compare this to ‘relative pitch’, which is the ability to hear the difference in pitch between a note and a given reference (musical interval). Most people have relative pitch to some degree, but perfect pitch only occurs in about 1 per 10,000 people. Here’s how it works: I’d wake her up at 3 a.m., sing some note of my choice, and she could tell you right away that I sang A above middle-C, and I sang it flat, about 427 Hz she thought.

So she was chronically on aripiprazole (Abilify™) for her autism, and then her doctor switched her from her regular anticonvulsant medication to carbamazepine (Tegretol™).

The first two days after the Tegretol was added to the Abilify, she yelled about the piano. Said it was horrifically out of tune. Asked whether I had done something despicable to the thermostat.

Within a few days after she started taking the Tegretol, when she played the piano she felt as if each note was a half-step lower than its position on the keyboard. The notes were consonant with her internal pitch-universe, just transposed down a half-step. During that period, if you woke her up at 3 a.m. and sang your note she would tell you that it was G# above middle-C and you are flat, about 412 Hz. At that time she was taking 15 mg per day of the Abilify and 200 mg twice per day of the Tegretol. She complained that modern recordings sounded to her like the musicians were using Baroque tuning. It was disorienting—like people were trying to play ‘tricks’ on her.

And then two seizures happened in one week—so the doctor bumped the Tegretol dose up to 400 mg twice per day. Within three days each note sounded to her like it was a half-step plus a quarter-tone lower than its position on the keyboard. You woke her up at 3 a.m. and sang your note and she told you that it was G above middle-C and way-sharp, hideous, about 404 Hz. She looked at her digital tuning meter in utter disbelief. She refused to listen to certain CDs, claimed that there must be something wrong with the CD player. Said she was being sucked into a ‘black hole’, that ‘gravity’ was pulling on her mind. Hated it.

Then she developed a skin condition, ‘toxic epidermal necrolysis’ (TEN), and the doc took her off the Tegretol and switched her to lamotrigine (Lamictal™). After about 3 days following the discontinuation of the Tegretol, she said I was singing G# again. Then, a week later, she said I was singing an A, slightly flat, like I used to do. We were back in the same universe.

The neurologists, naturally, were oblivious to all of this. None of them had any familiarity with the accumulating evidence of a carbamazepine-activated effect on the peripheral auditory system, which increases the sensitivity to low-pitched sounds and causes the altered pitch perceptions. We only found out about that ourselves, by searching around on PubMed and elsewhere on the web.

Most of the journal articles and scientific reports say that musical performances by people with perfect pitch who are on carbamazepine are heard as a semitone lower than they are in actuality. The condition is probably a lot more common than the occasional case-reports would suggest. If my friend had not been able to discern absolute pitch, she would’ve been unable to detect a lowered pitch perception.

Functional MRI (fMRI) imaging of the structure in the brain called the planum temporale shows asymmetries that are associated with perfect pitch, but no fMRI to-date have been performed on people with perfect pitch who are on carbamazepine.


Most of the medical literature reports of pharmacologically-induced pitch-bending involve Tegretol by itself. I can’t find any reports that involve two or more anticonvulsant medications. I can’t find any reports that involve a drug used for autism-spectrum disorders, like Abilify. I can’t find any reports that involve Abilify with an SSRI or other antidepressant.

And even the case-reports for Tegretol don’t really address the dose-ranging aspect. When you go from 10 mg/kg/24h up to 35 mg/kg/24h (to 1600 mg/24h, say), for example. None of the reports addresses dose-escalation related pitch-bending, like what my friend had.

Probably the most comfort we got came from the recent paper in the Proceedings of the National Academy of Sciences (PNAS) last Fall, from the UCSF team who’ve been conducting a large study of absolute pitch for several years. Helped us, at least, to know how ‘not alone’ we are.


Side-effects may include dizziness, drowsiness, disturbances of coordination, confusion, headache, fatigue, blurred vision, visual hallucinations, transient diplopia, oculomotor disturbances, nystagmus, speech disturbances, abnormal involuntary movements, peripheral neuritis and paresthesias, depression with agitation, talkativeness, tinnitus, and hyperacusis. ‘Hyperacusis’. Oh, yeah. You who write these drug package-inserts, you have no idea. No. Idea.

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• Perfect Pitch Illness blog on Myspace
  
• John Petrucci thread on perfect pitch

Mozart: Affliction and Art

M ozart often wrote to Leopold that certain variations or sections of his pieces were so successful that they had to be encored immediately, even without waiting for the piece to end.”
  —  Emanuel Ax

DSM: Is there any evidence that Mozart understood what it is like to be old? Well, yes! Think of his Requiem in D minor, K. 626. Not just the scope of what it means to grow old, but the nuances of progressive debility and loss are in this. Mozart also comprehended coercion and conflict—consider the dark power of some of his finest masterpieces, such as the Piano Concerto No. 24 in C minor, K. 491. There is much evidence that he grasped fully the depth and despair of what it is to be human, regardless how much sweet, serene, light-hearted harmonious writing he produced.

CMT: There are no scholarly medical papers indexed in Medline that discuss any evidence that Mozart had Asperger’s Syndrome. And yet there is a considerable lore that exists suggesting that he did have this syndrome. And when I listen to Mozart it always reminds me of behaviors of someone I once knew, who has Asperger’s. The Emanuel Ax quote above is emblematic of this sense of urgency or compulsion in Asperger’s. There is a perseveration, a sort of excessive insistence, an automatism in people who are afflicted with this. It’s hard to deny that Mozart’s letters and the accounts of his behavior do have features consistent with Asperger’s. And his father was clearly protective of Wolfgang to a late age—to 1781 and beyond—as though the father thought Wolfgang would have difficulty attending to the practical necessities of daily living, difficulty staying alive. This would be typical for a parent of an Asperger’s child. Parents often first notice the symptoms of Asperger’s syndrome when their child starts preschool and begins to interact with other children. Features of Asperger’s syndrome include:

• Unable to understand social cues and lack inborn social skills, such as being able to read others’ body language, start or maintain a conversation, and take turns talking.
  
• Dislike for any changes in routines.
  
• May appear to lack empathy.
  
• Unable to recognize ordinary but subtle differences in speech tone, pitch, and accent that alter the meaning of others’ speech—may not understand a joke or may take a sarcastic comment literally.
  
• Has a formal, readerly, stilted style of speaking. For example, the child may use the word “beckon” instead of “call,” or “returning here” instead of “coming home.”
  
• Avoids eye contact.
  
• Has unusual facial expressions or postures or tics.
  
• Preoccupied with one or only few interests, which he or she may be very knowledgeable about.
  
• Peculiarly interested in parts of a complex whole thing or in unusual activities, such as doing intricate jigsaw puzzles, designing houses, drawing highly detailed scenes, or astronomy.
  
• Talks a lot, or compulsively, usually about a favorite subject. One-sided conversations are common. Internal thoughts are often expressed out loud.
  
• Delayed motor development. Late in learning to use a fork or spoon, ride a bike, or catch a ball. Handwriting is often poor.
  
• May have heightened sensitivity to loud noises, lights, or strong tastes or textures.

Most symptoms persist through the teen years. And while teens with Asperger’s can begin to learn those social skills they lack, communication often remains difficult. They continue to have difficulty reading others’ behavior. Asperger’s syndrome is a lifelong condition, although it tends to stabilize over time, and improvements are often seen. Adults usually achieve a progressively better understanding of their own strengths and weaknesses. They are able to learn social skills and how to read others’ social cues. And their own grasp of their situation as a mixed bag of endowments and disabilities enables most Asperger’s people to empathize with and understand the perplexity of the human condition—including loss and aging—as well as any other human can do. They just may not be able to express it as readily as others. Or the habitual patterns of expression that are their preference may prevent the expression of these other dimensions.

DSM: You know, Heaton in London has shown that children with autistic spectrum disorders like Asperger’s typically show impairments in processing ‘affective information’. But music, so rich in emotional and affective content as it is, is characteristically processed and apprehended readily by people with autism or Asperger’s. Heaton studied fourteen children with autism or Asperger syndrome and fourteen age and intelligence matched controls. They were tested for their ability to identify the affective meanings of melodies in the major and minor keys. The groups didn’t differ in their ability to ascribe the musical examples to happy and sad affective categories. So, in contrast to their performance troubles in other social and interpersonal domains, children with autistic disorders showed no deficits in processing affect in musical stimuli. In fact, in many cases people with Asperger’s or autism may have superior ability to correctly ascertain affective and transactional meanings in music, compared to ‘normal’ people.

CMT: There is an account in Harnoncourt’s book, where he examines Mozart’s letters to his father and finds evidence that Mozart had a superior sense of drama—the ghost scene in Hamlet. The ghost’s recitative needs to be shorter than the text as Shakespeare wrote it, for the recitative to have the necessary frightening effect. So here is Mozart in 1781, at age 25, opining that Shakespeare wrote the play incorrectly, correcting the great Shakespeare.

T ell me, don’t you think that the speech of the subterranean voice is too long? Consider this carefully. Picture it to yourself and remember that the voice must be terrifying—must penetrate—that the audience must believe that it really exists. Well, how can this effect be produced if the speech is so long, for in this case will not the listeners become more and more convinced that it means nothing?”
  —  W.A.Mozart,
   in Letters of Mozart and His Family,
   E. Anderson, Macmillan & Co., 1938.

DSM: And there is James McConnel’s documentary 3 years ago on BBC. He said Mozart’s fascination with wordplay and making each line in his letters rhyme, his obsession with clocks, shoe sizes and gadgets and his documented foot-tapping and twitching all suggested Tourette’s syndrome, not Asperger’s. He said the strongest clues are found in the music itself, not in the correspondence. The mixture of chaos and control in the music. Tourette’s is a constant battle between the two, having a compulsion and trying to control it, and that translates into music.

CMT: While McConnel suggested the syndrome might have directed the nature of Mozart’s works, he never said it was the source of Mozart’s genius. While it may have affected the way in which his genius manifested itself and made him go against the grain of society, Mozart would have been a brilliant composer without Tourette’s. This has also been the directon of some of Karhausen’s analysis.

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• Mozart and Tourette’s Syndrome