Recently, neuroscientists have discovered that music influences the reward circuit of the nucleus accumbens (NAcc), even when no explicit reward is present. In this clinical case study, we describe a 60-year old patient who developed a sudden and distinct musical preference for Johnny Cash following deep brain stimulation (DBS) targeted at the NAcc….

Mr. B., a 59-year old married man, was referred to the department of Anxiety disorders, suffering from obsessive-compulsive disorder (OCD) for 46 years. He reported obsessions about fear for uncertainty and illogical things, and compulsions about seeking reassurance and hoarding…. Suffering from treatment-refractory OCD, Mr. B., was included for treatment with deep brain stimulation (DBS) targeted at the nucleus accumbens …. Within 6 weeks after surgery Mr. B. experienced a decline in anxiety and obsessions …. [F]or the first in years, he was not seized by panic and able to postpone his compulsions….

Mr. B., had never been a huge music lover. His musical taste was broad, covering Dutch-language songs [the study was apparently conducted in the Netherlands -EV], the Beatles and the Rolling Stones, with a preference for the last named. While music did not occupy an important position in his live, his taste in music had always been very fixed and his preferences stayed the same throughout decades.

On average, a half year after DBS surgery, Mr. B. stated that he was turning into a Johnny Cash fan. He had been listening to the radio, when he coincidentally heard “Ring of Fire” of the Country and Western singer and experienced that he was deeply affected by the song. Mr. B. started to listen to more songs of Johnny Cash and noticed that he was deeply moved by the raw and low-pitched voice of the singer. Moreover, he experienced that he preferred the performance of the songs in the Seventies and Eighties, due to the fullness of the voice of the older Johnny Cash in that period. His favorite songs, “Folsom prison blues”, “Ring of fire” and “Sunday morning coming down” had a certain rhythm with a fast tempo in common that moved him.

Mr. B. reported that he felt good following treatment with DBS and that the songs of Johnny Cash made him feel even better. From this moment on, Mr. B. kept listening simply and solely to Johnny Cash and bought all his CD’s and DVD’s. When listening to his favorite songs he walks back and forth through the room and feels like he finds himself in a movie in which he plays the hero’s part. He reports that there is a Johnny Cash song for every emotion and every situation, feeling happy or feeling sad and although Mr. B. played almost simply and solely Johnny Cash songs for the following years, the music never starts to annoy him. From the first time Mr. B. heard a Johnny Cash song, the Dutch-language songs, the Beatles and the Rolling Stones have been banned. Except when the stimulators run down or accidentally go out. Then, Johnny Cash is unconsciously ignored and his old favorites are played once again, just as it was for the past 40 years….

One may, of course, argue that during stimulation the patient developed a new kind of obsession and compulsion while his former obsessions of fear for uncertainty and illogical things declined. His preference for Johnny Cash, however, does not match the definition of obsessions or compulsions. Listening to Johnny Cash is pleasurable and not preceded by anxiety, nor is discomfort provoked when the patient is prevented from listening. The patient does not feel obsessed with Johnny Cash, nor compelled to listen and his behavior does not result in reduction of anxiety or tension.

Alternatively, DBS may have changed musical preference by influencing self-confidence. In contrast with the patients’ life before surgery, having far less OCD, anxiety and depressive symptoms, he felt highly confident after DBS, characterizing himself as “Mr. B. II”. It could be suggested that the image he creates when listening to songs of Johnny Cash seems to match his “new” confident self. Like Mr. B. states: “it seems as if Johnny Cash goes together with DBS”. Eventually, the strong feelings of pleasure that this self-created image elicits, implies that the associated behavior is rewarding and is likely to be repeated (Sloboda and Juslin, 2001; Huron, 2006).

It has been shown that self-esteem influences musical preference, although it does not explain the largest part of the relationship between individual factors and musical taste. Besides, it appears that one of the reasons for listening to a favorite musical style for men is to use imagination and to create an image of oneself (North, 2010). Together with the aspect that music is rewarding due to the emotions it enhances (Salimpoor et al., 2009), both prefacing factors may have influenced the development of a distinct musical preference for Johnny Cash in our patient….