Charles Limb, MD — Jazzology & Your Brain

Charles Limb is a medical doctor whose lifelong love of music inspired his career choice. He plays dual roles as associate professor of otolaryngology—head & neck surgery—at John Hopkins and is also a faculty member of the Peabody Conservatory of Music. A talented saxophonist, he interweaves music and medicine through his innovative research into how creativity affects the brain. Here he speaks with ABILITY’s Chet Cooper.

Chet Cooper: What kind of surgery did you do this morning?

Dr. Charles Limb: They call it an encephalocele, where brain tissue herniates down into the temporal bone, above the ear. I had to go in behind the ear to try to elevate and reduce the brain tissue, and reconstitute the bony division.

Cooper: So all went well for the patient?

Limb: Really well. As a temporal bone surgeon, everything I do is related to the ear. It’s a field I enjoy, it suits my interests and skill set nicely. I feel pretty lucky.

Cooper: Did your love of music lead you to become an ear doctor?

Limb: I was a musician who loved music my whole life. I’m just crazy about it. I not only like to listen to it, but to think about it and study it, read about it and explore it. I want to understand it better. It always mattered to me, well before I settled on a career, or had an inkling that I could combine music and science.

Cooper: So you had an epiphany that you could connect the two?

Limb: It was a process. At some point, every musician grapples with whether they’re going to pursue it as a profession, or do something else to make a living. Some musicians absolutely feel that there’s no other road for them. And then there are other people, like me, who could have gone into music, but I didn’t feel like I deserved to. And what I mean by that is I wasn’t willing to suffer for my art. You have to have the conviction, that you can ride out the lows, to be a really successful musician.

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In the meantime, I was good at scientific things. I loved music because it was about life captured in all its essence, all of its beauty and all of its pain. To me, medicine was similar. It captures life at its most profound and its most mundane. Maybe, in a philosophical sense, I felt very comfortable deciding to pursue a career in medicine. My motivation may have been linked to music in some internal way, but the reality of it was that I was going to medical school to become a doctor. During those years, I thought to myself: You know what? I can study hearing. And then, several years later, I thought: I can study music; this could literally be the focus of what I do.

Cooper: Do you pipe in music when you perform surgery?

Limb: Whenever I can, because it enhances the aural environment in which I work. Soft music allows me to enter a state of concentration that’s different from when the ambient sound is noisy or unpleasing, given the sounds of the drill and other operating room equipment.

When I was growing up, I always preferred to work with music playing; it allowed me to sit at a desk and work for hours, whereas without music the silence was a distraction.

Cooper: Can your patients hear the music playing in the background during their operation?

Limb: No, typically they’re asleep.

Cooper: So you don’t do local anesthesia?

Limb: Every once in a while I do; in those situations I ask the patient if they would like to hear soft music or not. It’s up to them. But most of my patients don’t hear well, which is why I’m doing surgery on them.

Cooper: Do you place cochlear implants?

Limb: Exactly. That’s my area.

Cooper: So you get to speak to patients who may be hearing for the very first time?

Limb: Yeah, it’s a pretty neat thing. Now, there are many different kinds of hearing loss and many people get implants who did hear before their surgery. A lot of them are people who haven’t heard in a long time. So if you or I lost our hearing today, we’d become a cochlear implant candidate. When the implant is activated, it wouldn’t be the first time we were hearing, but it would be a whole new way of hearing.

Cooper: Do you know Kathy Buckley?

Limb: I do not.

Cooper: She’s a stand-up comedienne and probably the most notable stand-up comedienne who is deaf. Kathy was an advocate against implants for a long time, as are many people within the deaf culture; they don’t feel there is anything wrong with being deaf. But Kathy went on to get a cochlear implant some years ago and afterwards we interviewed her. She talked about how, before the surgery, she used to feel the vibration from the audience’s laughter and watch them participating. After the surgery, when she first heard the actual laughter, she was so moved that she broke down crying.

Charles LimbLimb: Yeah, there are so many things we take for granted in this world and one of them is to hear the sounds in it. Yet, what’s interesting to me is that whenever I talk to patients after they’ve had cochlear implants activated, their first observations tend to be pretty mundane. For example, many patients say, “I didn’t know the toilet was so noisy.”


Limb: Or, “I didn’t know that when the dryer stops, it makes a loud, obnoxious beep.” What a funny way to encapsulate the world of sound after your hearing’s been activated.

Cooper: I saw your TEDx talk about your study of improvisation on YouTube.

Limb: Actually, I did two TED talks. The other one deals with music perception in patients with cochlear implants.

Cooper: I saw the one about the different studies around jazz and rap. You spoke about different activities within the brain and I noticed the part where you said that when jazz is really happening, the brain suppresses self-awareness. This makes me think about those moments when singers close their eyes and go into their own space, as if they don’t realize they’re in front of millions of people watching on TV or thousands in a live audience. Do you think that’s what’s happening with them?

Limb: Yeah, and without being too sweeping in my generalizations about creativity, I think that what most forms of art share in common is that their creator is in a different mode of thinking, if you will, than when they’re doing something that’s not creative. What I’m getting at is that I think creativity, neurologically speaking, is a very different state of mind, where you’re generating lots of ideas with some facility and some sense of reward or pleasure is achieved in this process. I think that humans are hardwired to create. It’s not arbitrary that we do this kind of thing. I suspect that it’s part of our very basic biology.

Now, to try to establish how that breaks down into different art forms, for example, jazz vs. poetry vs. architecture—that’s where it starts getting much harder for scientists to connect the dots.

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Cooper: Some say, to be creative, you have to turn off your brain.

Limb: That is what my studies of jazz imply; there’s a certain component of conscious self-monitoring that one has to let go of, to an extent.

Cooper: Because it’s too restrictive.

Limb: Correct. You overthink. Trying too hard to execute something impedes your ability to do so.

Cooper: I was talking to some athletes about being in the zone and I feel like there’s something similar to what you’re talking about.

Limb: Definitely.

Cooper: I ride motocross and there’s a different space, a zone. It’s hard to get into it and sometimes you just can’t. But when you do, everything flows with such ease.

Limb: That’s right. Your conscious perception of reality is altered and you’re able to do things by letting your subconscious neuromechanisms flow, which you can’t do if you’re consciously trying to force them.

Cooper: Do you have goals for your studies around improvisation and creativity?

Limb: These studies are in their infancy. We’re just beginning to understand how creativity occurs in the brain. These are the questions of a lifetime and I don’t believe that they’ll be answered quickly. I have far too much respect for music and the arts to think that a couple of scientific studies are enough to explain the whole thing. Yet it’s possible that in a cleverly designed science experiment, you could get closer to the truth.

My goal is to come up with a series of well-designed experiments, so we can start to describe some of the fundamental neurobiology of art and creativity. These studies of multiple art disciplines would be ongoing and use different scientific techniques. The challenge is that it’s very costly. It requires grants and this is not an area where there are a lot of clear funding sources. It’s been difficult for me to get the backing to continue these experiments, despite the fact that they’ve been well received and have generated so much interest in the media and the public. The NIH [National Institutes of Health], for example, doesn’t feel that understanding creativity is a part of its mission.

Cooper: Perhaps you’ll have to be more creative in the way you write up your study, so that it fits in with something that they can understand is a part of their mission.

Limb: Yes. I may have to be a little more strategic.

Your Brain on Improv

Building the Musical Muscle


This is an excerpt from Limb’s 2010 TEDx Talk:

I’m going to start off by playing a video of Keith Jarrett performing; he’s a well-known jazz pianist and an iconic example of someone who takes improvisation to a high level. He’ll improvise entire concerts off the top of his head, and never play it that exact same way again.

How can the brain generate that much information, that much music, spontaneously? I set out with this scientific concept that artistic creativity is magical, but it’s not magic.

Is it truly possible to study creativity scientifically? It may be. In my lab, I ask what is this brain doing to enable us to be creative?

The main method that I use to take pictures of active areas of the brain is functional Magnetic Resonance Imaging (fMRI). When you’re in an fMRI scanner, you’re in a big magnet that’s aligning your molecules in certain areas. When a neural area is active, it shunts blood flow to that area, causing an increase in local blood with a deoxyhemoglobin (hemoglobin not combined with oxygen) change in concentration in that area. Deoxyhemoglobin can be detected by an MRI, whereas oxyhemoglobin (hemoglobin and oxygen combined) can’t. So through this method of inference, where we measure blood flow instead of neural activity, we say that an area of the brain that’s getting more blood is active during a particular task.

Using the fMRI [during a creative activity], an area that’s thought to be involved in self-monitoring is turned off and this area that’s thought to be autobiographical or self-expressive is turned on. And we think, at least in this one study, which could be wrong, that to be creative, you have to have this weird dissociation in your frontal lobe. One area turns on, and a big area shuts off, so that you’re not inhibited. You’re willing to make mistakes and not constantly shut down all these new generative impulses.

When I think about improvisation and language, what’s next? Rap, of course and specifically, freestyle. I’ve always been fascinated by it. There are a lot of similarities between what takes place in freestyle rap and what happens in jazz. So how do you study rap scientifically? You have a freestyle artist come in and memorize a rap that you wrote for them, and then you give them key words and have them freestyle.

Limb raps:
Thump of the beat in a known repeat
Rhythm and rhyme make me complete
The climb is sublime when I’m on the mic
Spittin’ rhymes that hit you like lightning strike
I search for the truth in this eternal quest
My passion’s not fashion you can see how I’m dressed
Psychopathic words in my head appear
Whisper these lyrics only I can hear
The art of discoverin’ that which is hoverin’
Inside the mind of those unconfined
All these words keep pouring out like rain
I need a mad scientist to check my brain


So the freestyler gets cued different words. He doesn’t know what’s coming, but hears something off the cuff. And when we put him in the fMRI scanner and have him freestyle, then we look at what gets activated.

With the rapper’s brain, we saw language areas lighting up, but with the freestyler, we saw major visual areas light up. There’s major cerebellar activity, which is involved in motor coordination. This research is very preliminary, but kind of cool.

I think that over the next 10, 20 or 30 years, a real science of creativity is going to flourish, because we now have new methods to take a complex process, such as jazz improvisation and freestyling, and study it. For now, we ask far more questions than we can answer.

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