INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY

Int J Geriatr Psychiatry 2005; 20: 658–660.

Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/gps.1338

Hymns and arias: musical hallucinations in older

people in Wales
Nick Warner1* and Victor Aziz2
1
Magnolia House, Yeovil, Somerset, UK
2
Specialist Registrar, South Wales Rotation, UK

SUMMARY
This is a phenomenological study of 30 consecutive referrals of older people with musical hallucinations concentrating on
the names of the melodies heard. Hymns and Christmas carols were the most common experience with ‘Abide with Me’
particularly frequent. Copyright # 2005 John Wiley & Sons, Ltd.

key words — music hallucination; deafness; religion

Abide with me: fast falls the eventide; the darkness
falls; O Lord, with me abide . . . Hold Thou Thy cross
before my closing eyes; Shine through the gloom,
and point me to the skies: Heaven’s morning breaks
and earth’s vain shadows flee: In life, in death, O
Lord, abide with me! (Henry F. Lyte, 1847).
METHOD
We recorded information on 30 consecutive referrals
to one old age psychiatry service in South Wales with
a catchment population of about 20,000 people aged
over 65 years old, over a 15-year period. Berrios
(1990) published a 46-case series mainly from a
review of case reports, but this is the largest series
from a single source.
We analysed the demographic data, diagnosis and
presence of other disorders. We recorded the predo-
minant melodies and musical form of the hallucina-
tions, and the patients understanding of who was
singing and where the music came from. We noted
the treatment and outcome.
*Correspondence to: Dr N. Warner, Consultant Psychiatrist, Yeovil
Magnolia House, Preston Road, Yeovil, Somerset. BA20 2BN, UK.
Tel: 01935 431725. Fax: 01935 411063.
E-mail: nick.warner@sompar.nhs.uk
Copyright # 2005 John Wiley & Sons, Ltd.
RESULTS
The mean age of cases was 78.2 years, 87% were
women, and 77% lived alone. Thirteen per cent of
patients had bilateral hearing impairment and 20%
unilateral usually the left ear. One person also had tin-
nitus. In 2/3 of cases musical hallucinations were the
only abnormality. Other psychiatric disorders were
diagnosed in one-third of patients. Four had dementia;
four psychosis (paraphrenia, bipolar disorder and per-
sistent delusional disorder), and two major depres-
sion. Visual hallucinations were also present in five
cases, two of whom had Charles-Bonnet Syndrome.
In all but one case when the onset coincided with a
stroke, the onset had been gradual over several
months. No patient could modify the musical halluci-
nations. In 87% the hallucinations were perceived in
the nearby space while for the remainder the source
was the neighbourhood. Most patients maintained
insight that their experience was abnormal.
The hymn ‘Abide with me’ was clearly the most
frequent music heard. In 2/3 of cases religious music
predominated, with Christmas music also common. In
most cases the music took the form of solo voice
(male or female) with instrumental backing. Two peo-
ple could identify the singer (George Formby and
Luciano Pavarotti). The melodies were familiar in
all but four cases, and all identified tunes were in a
Received 1 March 2004
Accepted 1 February 2005
 hymns and arias: musical hallucinations in older people in wales 659

Table 1. Melodies heard Lack of cortical stimulation may be a mediator in

—Abide with me (6 people) musical hallucinations, indicated by the association
—Silent night (2 people) of deafness and musical hallucinations already well
—Away in a Manger (2 people) established (Berrios and Brook, 1985; Berrios,
—The Old Rugged Cross (2 people) 1990). Compared to the general population, patients
—Hark the Herald Angels Sing (2 people) were more likely to be living alone.
—Good King Wenceslas
—Jingle Bells This series suggests that elderly people in Wales
—Love Divine who have musical hallucinations have a one in five
—O come all ye Faithful chance of hearing the hymn ‘Abide with Me’ with var-
—How Great Thou art ious Christmas Carols accounting for another 20%.
—On the Cross, where I found the Lord
—Cwm Rhondda
The source of the melody has previously been attrib-
—Onward Christian Soldiers uted to experience in early life. Ross et al. (1975) sta-
—The Welsh National anthem ted that musical hallucinations ‘almost always reflect
—The American National Anthem past musical memories.’ While this may be true in
—I love you
—Three Blind Mice
some of our cases it is not the norm, e.g. ‘Don’t cry
—Show me the Way to go Home- for me Argentina’ would be heard first in mature adult
—How much is that Doggy in the Window life.
—Yes We have no Bananas ‘Abide with Me’ is a hymn associated with evening
—When I’m Cleaning Windows services and funerals, and therefore not frequently
—Stars and Stripes
—The Red Flag sung in services attended by our patients in their
—Roll out the barrel youth. We considered whether there could be psycho-
—Down at the Old Bull and Bush dynamic reasons for the content of the hallucinations.
—Danny Boy We do not know nearly enough about most individual
—Over the Sea to Skye patient’s past experiences to speculate and we can
—Beautiful dreamer
—Don’t cry for me Argentina only address this in general terms relating to the psy-
—I Remember chological circumstances of old age. Older people
—God Save the Queen have anxieties about dying (Blazer et al., 1986).
—See you in the Morning ‘Abide with Me’ is a hymn strongly associated with
—When you Beguine the Beguine
death; hope of heaven, and prayer for God not to
abandon us when dying. It is plausible that hearing
this hymn arises from need for reassurance as death
draws nearer.
Christmas carols may feature frequently simply by
major key. Subjects who could identify the music the cumulative effect of repetition over many Christmas
named between one and three tunes. The content of Seasons. Could repetitive musical exposure therefore
the hallucinations is summarised in Table 1. be a risk factor for later musical hallucinations? The
Ninety per cent of patients received medication as composers Glinka, Schumann and Beethoven had
part of treatment; the majority lost the hallucinations musical hallucinations (Gordon, 1996; 2001). Although
completely, and the remainder experienced a reduc- probably mediated by neurosyphillis could the relative
tion in intensity and frequency. Twenty-three were frequency of hallucinations in composers also be a
treated with anti-psychotic medication, mainly Tri- reflection of the risk of exposure?
fluoperazine 2 mg per day. Further research might show interesting difference
in musical hallucinations in different areas of the UK
DISCUSSION or other countries.

This case series suggests that on average there will

be one new case of musical hallucinations present-
ing annually to old age psychiatry per 10000 people
over 65. We suspect this is an underestimate of inci-
dence. Many patients were not distressed by their
symptoms, suggesting some patients may not pre-
sent to general practitioners because they do not per-
ceive a problem.
CONCLUSION
Older people with musical hallucinations frequently
hear hymns and carols. There may be a psychological
explanation of the content of the hallucination in
some cases, although the cumulative effect of the
recurrent experience of the same music may also be
important.

Copyright # 2005 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2005; 20: 658–660.
660 n. warner and v. aziz

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Copyright # 2005 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2005; 20: 658–660.