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What is amusia?

Last update on Aug 19th, 2024

Amusia: the inability to appreciate music and chords

Amusia is a neuropsychological deficit that results in the inability to understand and play music: it can affect both the recognition of a known melody, with pitch, timbre and rhythm, and the harmony of the piece of music.

Amusia: history and definition

It is important not to confuse this deficit with a simple ‘going out of tune’, i.e. the person who finds it difficult to reproduce musical notes correctly, or ‘being deaf’, which refers to the impossibility or difficulty of perceiving sounds and noises. People affected by amusia hear voices and noises correctly, but do not notice if they are out of tune, no matter who makes them, and in the most severe cases, they do not even perceive melodies or find them irritating and unpleasant.

Since the 1980s, the neuropsychology of music has concentrated on improving these disorders: it is now considered that amusia can be alleviated in young people, especially thanks to constant exercise, whereas it seems to be irreversible in adults.

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Symptoms and signs of amusia

The main symptoms of amusia are:

Inability to recognise a melody (both tone and timbre) and the rhythm and harmony of a piece of music;
Inability to perceive the out-of-tune nature of a piece of music, either those made by oneself or those caused by others; and
Perception of music as unpleasant or annoying;
In the most severe cases, pain when listening to a song or piece of music.

Social and emotional consequences of amusia

People suffering from amusia have special emotional responses when listening to music: some describe this experience as unpleasant and annoying, others as a real pain, which inevitably conditions their daily life.

What many cannot imagine is that amusia can have social implications that go beyond the pleasure of listening to a beautiful piece of music or distinguishing a rock song from a classical composition; amusia significantly affects the ability to understand some types of languages, especially tonal ones, such as Mandarin Chinese; in these cases, this disorder can invalidate communication as it causes difficulties in active and passive knowledge of the language and jeopardises both the ability to express oneself and to speak and the understanding of what other people are saying.

How is amusia diagnosed?

Many people suffering from amusia are simply not aware of it: it is often difficult to reach a diagnosis without specific preliminary examinations, especially when it is not accompanied by other neurological or neuropsychological disorders.

Amusia can be tested with the hearing test, but it requires multiple investigation tools, described in the Montreal Protocol for the Identification of Amusia (MBEA - Montreal Battery of Evaluation of Amusia). The protocol foresees a series of tests to assess six components of music making: scale, contour, interval, rhythm, meter and musical memory.

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What causes amusia?

People affected by amusia suffer from inadequate understanding and translation of signals transmitted to the ear, caused by anatomical and functional defects in the brain, resulting in a severe inability to listen and play music. Amusia is usually due to lesions of the non-dominant temporal lobe, but in many cases the contralateral lobe may also be involved; in case the inferior frontal region is affected, people affected by this disorder cannot even recognise the words accompanying the music. In general, amusia can be caused by:

congenital disorders, due to inherited genetic factors;
brain damage in the frontal lobe;
brain damage to the temporal lobe;
damage to the auditory cortex.

Among the scholars who have tried to understand this disorder, Isabelle Peretz of the University of Montreal in Canada has distinguished herself the most. A number of studies and essays have been published, including ‘Prevalence of congenital amusia’ and ‘The Cognitive Neuroscience of Music’.

Types of amusia

Amusia can be:

congenital: due to generic factors, one study has estimated that it may affect, to varying degrees, up to 4% of the population;
acquired: following brain damage to the frontal or temporal lobe, or to the auditory cortex.

For each type, there are various forms of rhythm deafness, related to the severity of the disorder: from mild to profound.

Congenital amusia or tone deafness

Congenital amusia is also known as tone deafness, and is caused by genetic factors: to all intents and purposes, it is a musical disability that cannot be explained by a previous brain injury, hearing loss, cognitive defects or lack of environmental stimuli. It affects approximately 4% of the population and the sufferer appears to lack the musical predisposition with which most people are born.

Congenital amusia is related to other disorders, and often manifests concomitantly with dysphasia (a language disorder consisting of the inability to order words according to a logical scheme) and dyslexia (a neurological disorder characterised by the inability to read and understand the whole of a written text, even if every single word is understood).

Acquired amusia

Acquired amusia, on the other hand, is caused by brain damage to the frontal or temporal lobe, or auditory cortex, and is more common than congenital amusia. Sufferers of this particular form of amusia may have significantly more lesions to the frontal lobe and auditory cortex of the brain, as well as to the temporal bone, caused by other diseases or disorders. Finally, acquired amusia is a common occurrence after an ischaemic MCA stroke, i.e. a stroke of the middle cerebral artery.

Amelody or musical deafness

Amelody is a disorder characterised by the loss of melody or emotional intonation when speaking: the result is an emotionless response that is easily misinterpreted as depression.

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Other amusia-related disorders

Dysthymia

Dysthymia is a disorder of musical perception that prevents people from distinguishing different sound timbres.

Simultanagnosia

Simultanagnosia is a disorder that consists in the inability to identify several elements that are presented at the same time: the person identifies the details of an object or a complex image but does not perceive them as a whole. There are two forms of this disorder: one, more severe, caused by lesions in the parietal occipital part; the other, milder, caused by lesions in the temporal occipital part.

Rhythmic deafness

Rhythmic deafness affects 2 to 3% of the population and consists of the inability to perceive the rhythm of a melody or sound. In general, milder forms of this disorder can be improved and fine-tuned with constant musical practice.

Amusia or dysmusia?

Amusia should also not be confused with dysmusia, or musical dyslexia, which is the difficulty in reading the notes and symbols of musical language. In 2000 Neil Gordon hypothesized the existence of this disorder. Dysmusia is also distinguished from misophonia, a strong intolerance to certain types of specific noises that often leads to fits of rage, anxiety and panic.

How to treat amusia?

Some experienced musicians, such as W. A. Mathieu, composer, pianist and conductor, have addressed congenital amusia (tone deafness) in adults and believe it can be correctable with training and exercise.

In the case of acquired amusia, however, a recovery may occur in the post-stroke phase, when it is associated with a variety of cognitive functions, particularly attention, executive functioning, and working memory.