Silent ‘Piano Man’ whose only language is music

//' cannot be displayed]From The Independent, this fascinating story of a man in his 20’s or 30’s found five weeks ago in dripping wet evening wear from which all the labels had been removed wandering near the Kentish seashore. Psychiatrically hospitalized, he has not said a word since and cowers in fright upon anyone’s approach. Left with pencil and paper, he produced a detailed sketch of a grand piano and, given access to a piano, he has played exquisitely for hours on end, including long pieces that appear to be his own compositions.

‘An unconfirmed report has it that he played a “beautiful” performance of Tchaikovsky’s Swan Lake.

A spokeswoman for the West Kent NHS Trust said, “There was nobody he was with skilled enough to recognize the music, they just knew it was classical music and he played very well.” ‘

It is not clear whether he understands English, and he has not responded to entreaties in various Eastern European languages. Ironically, even though his caregivers have noted that “if you put him in front of a piano, his whole demeanour changes. He completely relaxes and is oblivious to people around him,” he has been moved to a different ward where there is no piano. He avoids television and radio and continues to produce his sketches of grand pianos. There has been an overwhelming response (BBC )to publication of his picture with requests for assistance from anyone who could identify him. However, curiously, his caregivers say they have not had the time to follow up on the most promising leads, and that they are not sure they will ever know who he really is. What’s up with that??

A number of theories about who is is, how he came to be found, and the nature of his distress are discussed in the article. He is such an enigma that the assumptions of those speculating about him may at this stage say more about them than about him. The extent of his fright and silence suggests traumatic amnesia to some, but I wonder about acute paranoia as well. The detail about his avoidance of t.v.’s and radios is something I have often seen in patients who are suffering an acute paranoid psychotic episode, who may feel that they are receiving messages through the media or that the devices can pick up and broadcast their thoughts. Of course, they don’t tell you that at the time; all you notice is that they avoid the media. Elective muteness is seen in acute psychosis as well, and I consider the deliberate obliteration of evidence of his identity (such as the removal of his clothing labels) more characteristic of a psychotic break than a post-traumatic condition. Several outlandish theories as to how he came to be in the ocean — e.g. that he was an asylum-seeker dropped off near the shore — are discussed, but without mention of the obvious possibility that he had attempted to kill himself by drowning. I hope those caring for him have also considered the possibility that his mutism, his possible amnesia, his acute fearfulness, his wandering, etc. are sequelae of a neurological rather than a psychological condition. I have at least one neurologist reader of FmH; I wonder what he thinks of the case. There are some conditions that would affect the so-called ‘speech centers’ of the brain but leave musical expression intact. A neurological workup would require procedures he may yet be too frightened to undergo, such as cerebral imaging studies and bloodwork.

We are hearing from his social worker and other ward staff; has his attending psychiatrist made any public statements? And why in the world don’t they (a) continue to facilitate his access to a piano; (b) bring in some people who know music better; and (c) get on the stick following up on those leads about who he is?