The Tomatis apparatus and psychoanalysis

Communication by Dr Sarkissoff (Geneva Centre) given on Saturday 13 May 1972 at the 2nd International Congress of Audio-Psycho-Phonology held in Paris from 11 to 14 May 1972, and published in the Proceedings of the Congress on pages 118 to 162. Sarkissoff there proposes a theoretical articulation between the psychoanalytic treatment of Kleinian inspiration and the Tomatis treatment, situating the field of action of the Tomatis apparatus from the point of view of the unconscious. The communication, the longest of the Congress (45 pages), is followed by a long discussion chaired by Prof. Tomatis (pp. 139-162), in which Messrs. Dubard, Bonhomme, Mlle Gesta, Messrs. Diamand, Spirig, Mapples, Baltz, Deshayes and Dardères, among others, take part. The present publication reproduces verbatim the passages perfectly legible in the stencil printing, and summarises narratively the rest in a form clearly identified as a synthesis, without claim of literal citation where the scan does not allow word-for-word fidelity.

The Tomatis apparatus and psychoanalysis

Doctor Sarkissoff
Geneva Centre

2nd International Congress of Audio-Psycho-Phonology, Paris, Saturday 13 May 1972 — Proceedings of the Congress, pp. 118-162.

Opening (p. 118, verbatim)

“Psychoanalysis is a respectable lady. At her birth, at the beginning of the century, a very brilliant future had been predicted for her. She has disappointed some, who say that she is on the decline or even that her time is past! It is also said that she no longer evolves and even that she has said all she had to say! I do not know whether that is true. But of what I am sure is that the moment has come for her to look back, to measure her successes, and, however vast her field of action, to recognise its limits. The most beautiful girl in the world can give only what she has.”

“Psychoanalysis has long stood apart. The moment comes when it will have to reintegrate itself into the set of the medical sciences, because it will be better understood that health is bound up with the proper functioning of the body and that it is impossible to be in good health when zones or cerebral systems are out of function. A maturation of the being that would be realised on a psychological plane alone is but a view of the mind perched on the clouds. Man is a whole. Body and mind are one.

Psychoanalysis has enriched the scientific knowledge of man with a new dimension: the unconscious.

I propose to you to consider the field of action of the Tomatis apparatus by placing ourselves at the point of view of the unconscious such as psychoanalysis observes it. We shall see that it is possible to give various phenomena different explanations, according to whether one places oneself at this point of view or at that of the conscious.”

Summary of the paper (p. 119-138, narrative synthesis)

The synthesis that follows presents, in the order of the congress printing, the main conceptual articulations one can reconstitute from a reading of the forty-five pages of the communication. It does not replace the original text; it restores its frame without claiming literal citation.

Autism and the Tomatis treatment (p. 119-120) — Sarkissoff introduces the theme by noting that psychoanalysis, like certain ancient therapies, must create an “illness” (the transference neurosis) in order to cure the patient; he raises the question of an adjuvant route that would avoid this detour. The Tomatis treatment finds its indications where the maturation of the being can be effected without the analysis of fantasies being indispensable. But man being a whole, one cannot use the apparatus mechanically, on pain of disappointment; reciprocally, psychoanalysis alone can shut itself within narrow limits. The two methods can complement each other. Autism occupies a privileged situation: these are the first patients to have benefited from the Tomatis treatment, and their recovery remains among the most profound.
Tomatis discoveries: psychogenic deafness, lateralisation (p. 120-121) — Prof. Tomatis’s discoveries have shown the possibility of a deafness of psychogenic origin and the role of auditory lateralisation in audio-vocal regulation.
The “good object” and the Klein school (p. 121-122) — Sarkissoff articulates Melanie Klein’s schizo-paranoid position, the interiorised maternal “good object”, and the thwarted communication that holds the subject back from the depressive position.
Psychogenic causes vs traumas — Freud’s drives (p. 122-124) — Hypothesis of the death and life drives; articulation between frustration, refusal of communication and prenatal refuge.
Understanding autism — Klein and Bion (p. 124-125) — Clinical progress is not rectilinear. Reference to Melanie Klein and W. R. Bion, and to the notion of “spreading” of the Anglo-Saxon authors.
Hierarchisation as an organic factor — Penfield (p. 125-126) — The hierarchisation of cerebral functions is posited as an organic factor of subjective consciousness. Reference to Penfield.
“Receivers”, autism/epilepsy, cerebral zones (p. 126-127) — Hypothesis on the cerebral zones that underpin the function of reception. Footnotes on Bion and on the works of A. Tomatis (notably Éducation et Dyslexie).
The autistic without specifically human apparatus (p. 127-128) — The autistic person would function without this “specifically human apparatus”; introduction of the notion of “micro-mourning”.
Interiorised good object, central fantasy, psychic deafness (p. 128-129) — The central fantasy organises investment; psychic deafness is the reverse of a defensive irritability.
Frustration and internal good object (p. 129-130) — Frustration prevents the introjection of the good object; articulation somatic-psychic.
Normal mother-child communication and introjection (p. 130-131) — Notes on religious feeling and on Bion.
Lateralisation, hemispheres, depressive position (p. 131-132) — Clinical hypotheses on the link between auditory lateralisation and access to the Kleinian depressive position.
Neurological hypotheses — Wernicke’s area (p. 132-133) — Theory of hemispheric lateralisation; hypothesis on Wernicke’s area.
Delusion and complementarity of psychoanalysis / Tomatis treatment (p. 133-134) — Psychoanalysis would liberate the psycho-affective, while the Tomatis treatment would liberate structures. Reference to Susan Isaacs.
Criteria for choosing the Tomatis treatment vs psychoanalysis (p. 134-135) — The Tomatis treatment answers an organic factor; psychoanalysis answers to fantasies. The case of the only son with hypothetically dead brothers and sisters (reference to Klein, Envy and Gratitude). Evocation of the “negative therapeutic reaction”.
Clinical applications — borderline cases and autism (p. 135-137) — The applications of the Tomatis apparatus are not limited to grave cases of autism. In cases where psychoanalysts hesitate to take charge alone, treatment with the Tomatis apparatus, encouraging a psychoanalysis or psychotherapy treatment, frequently constitutes a kind of mordanting or very precious accelerator. Sarkissoff reports cases of grave autistics treated with the Tomatis apparatus with simultaneous analysis.

Fundamental identity of the two treatments (p. 138, verbatim)

“At a very deep level (which is not the deepest but is just above the extreme depth), our being is in a state where time is no longer what it is at the surface (Heraclitus designated this superficial plane when he said that one bathes only once in the water of a river). At this depth, time does not flow, or, if it flows, it flows in a perpetual present. Psychoanalysis, which descends to the ‘underworld’, attains this plane of the being (which is the unconscious). It allows the liberation of what is fixed (the fixations) and that causes, at the level of the superficial conscious, the disorders, the lacunae, the deficiencies, the failings, the insufficiencies, the losses of energy that translate this unconscious perturbation. By descending to the ‘underworld’, the psychoanalytic treatment sets back into motion what was blocked. The unfolding of the being is freed from its trammels and again disposes of the unconscious energy that was hampered. Now, the Tomatis treatment does exactly the same thing. One understands this clearly if one manages to place oneself on the deepest plane of the being. At this level, the identity of the two treatments is absolute. Both, although to varying degrees, are accompanied by numerous effects whose fundamental identity is plain: both energise, induce euphoria, produce regressions and bring about a maturation of the being through resistances.”

“For a psychoanalyst, to add the Tomatis treatment to his practice is not to leave psychoanalysis, it is not to betray it, it is to remain at its centre and to understand its noumenal unconscious splendour in a new light. The unforeseen of this discovery surprises and delights us.”

“The unconscious is outside time. Unresolved conflicts dwell there in expectation of liberation. Psychoanalysis or the Tomatis treatment come to answer an unconscious need and an expectation that exist in all patients. It is this expectation that explains the perseverance of patients in following their treatment when they have begun it and when it is conducted by the rules of the art.”

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Discussion chaired by Prof. Tomatis (p. 139-161)

Opening of the debate (p. 139, verbatim)

“I think we are now, thanks to Dr Sarkissoff, in possession of a very precious material from which we shall be able to engage a wide discussion. I particularly thank my colleague from Geneva for having kindly broached the neuro-physiological mechanisms with a terminology that is not essentially psychoanalytic and which has enabled us, by reason of that, to follow him with ease.

Numerous discussions have already taken place between us two to evoke these famous cleavages, this famous death drive that marks the psychoanalytic universe. Some terms have already been modified between him and me so that we may speak the same language. I must say that Dr Sarkissoff has rendered me a great service in approaching, with such talent, the psychoanalytic side of the discipline we call Audio-Psycho-Phonology and on which we have been working for over twenty years.

Many people think that I am anti-analyst. I am no more anti-analyst than anti-psychiatrist (since it is the fashion). I even believe that what I do belongs to a sensory psychoanalysis on which I shall allow myself to insist in a moment. For the present I think it is well that each should put questions in order to animate the debate.” (Prof. Tomatis)

Definition of the unconscious — Mr Bonhomme (Belgium), p. 139-141

Mr Bonhomme asks Dr Sarkissoff for a definition of the unconscious. Sarkissoff replies by distinguishing the specifically human psychic functions (language, distinction between dream and reality, distinction between self and other) from the more archaic cerebral functioning that man shares with the animal. The Tomatis treatment sets into operation, he says, that “something very specifically human” that gives to a part of the conscious self the strength not to be delirious and to distinguish dreams from the real; all these elements must have a privileged functioning relative to the less developed zones of the brain shared with animals, including the palaeocerebellum.

Mr Dubard then pushes the question further (p. 141, verbatim): “Going further, what allows you to say that currently you are not dreaming?” Sarkissoff replies: “I do not think one can reply in a valid way to your question. I judge that we are all in the process of believing. I think that we have a fundamental difference in our psychic approach compared with the autistic person, and that this difference must correspond to something in the cerebral functioning, that makes us, indeed, conscious of not dreaming, a consciousness which probably the autistic person does not have. He lacks something; he cannot distinguish; dogs probably cannot either, and I think autistic people have much kinship with animals. I must say that I feel a little out of my depth in broaching these domains, for I am not a neurologist and I have not studied these hypotheses deeply enough with neurologist colleagues to be able to speak of them at greater length.”

Simultaneous EE and psychoanalysis — Mlle Gesta (Villeneuve), p. 142

Mlle Gesta asks whether education under Electronic Ear was conducted in parallel with psychoanalytic treatment. Sarkissoff indicates that he has used the two methods jointly and has also had recourse to the EE when analysis was at an impasse, but that he has not yet sufficient experience to speak of it at length.

On the “good object” and the “bad object” — Mr Diamand (Chartres), p. 143-144

Mr Diamand suggests that certain turns of common language (“voire des paroles”, “to lend an ear”) shed light on the dual register psychoanalysis / Electronic Ear: the “good object” and the “bad object” find their echo in the very matter of language.

A listener asks, in extension, whether the re-establishment of the body schema authorises one to count on the investment of the conscious. Prof. Tomatis replies (p. 144) that the problem is analogous to that of a child first in gymnastics and last in class: one can perfect “the underlying animal”, make of it an athlete in every direction, and find oneself before an unconscious. The life drive is the drive of the conscious; when one invests a subject with a strong desire to live, he immediately takes hold of his body to put it to determined use. Tomatis warns against isolated techniques of bodily asceticism: he has known subjects extremely high-performing on this plane who remained “automatons” incapable of attaining a dimension of transcendence.

Medication and analysis — Mr Bonhomme, p. 144-146

Mr Bonhomme asks about the use of medication in parallel with analysis. Dr Sarkissoff evokes the case of a schizophrenic currently under homoeopathic treatment prescribed by a colleague and the usefulness of certain medications for maintaining and coordinating the psychic elements in the course of treatment.

Prof. Tomatis then evokes the teaching of Avicenna (p. 146, verbatim): “‘first the word, then the herb and finally the knife’. I believe we are always at the same point. To care, to help, one must first use the word (that is to say language, speech, sound through psychotherapy, phonotherapy), then the herb (that is to say medication, which is most often made from plants) and finally the knife (that is to say surgery, when the other two means have failed or been surpassed).”

Mr Bonhomme then supposes that one might replace a brain with another. Tomatis replies with humour (p. 146, verbatim): “Well! You will come and see me when one can do it!” Then seriously: “Not at all. You are attributing to the brain more power than it has. I believe that the whole being would have to be changed. The brain is a central dispatching of the entire nervous system, and when you speak of the brain as you do, you suppress everything that is also of the brain, of the nervous system — the skin for instance — and you thus suppress 3 kg 700 of merchandise. It is the whole ectoderm that would have to be changed. Medicine is not as easy as that, and the human being is much more complex than is thought. What you say is true for organic matter, for changing a heart or a kidney, but to change a brain, I believe it would be better to change the whole individual; that would seem easier to me.”

Substitute maternal voice — A listener, p. 146-148

A listener asks (p. 146, verbatim): “When the parents are dead, what do you use to substitute for the maternal voice in the Tomatis treatment?” Sarkissoff replies: “It happens that old grandmothers have come and kindly allowed us to obtain a maternal voice.”

Prof. Tomatis then develops the therapeutic stake: the maternal voice filtered at 8,000 Hz “makes it possible to harmonise the mother-child relation, which is always perturbed in the children brought to us. It is to our advantage to flood them with M.V. by all means: through headphones, loudspeakers, vibrators on the skin, etc.” Tomatis envisages mixing on the same tape the filtered M.V. and unfiltered music. He then reports (p. 147-148) a clinical case in which re-education, after several plateaus of resistance, only advanced significantly during the replaying of filtered music — non-semantic sonic information — whereas any return to language triggered resistances; much time was needed for the patient’s voice to pass to the right.

Maternal Voice or Filtered Music first? — Dr Spirig, p. 148

Dr Spirig (verbatim): “Is it preferable to play, at the start of treatment, the M.V. or Filtered Music?” Prof. Tomatis: “The maternal voice filtered at 8,000 Hz brings enormous advantages. It makes it possible to harmonise the mother-child relation, which is always perturbed in the children brought to us.” Tomatis adds that one may envisage using the filtered M.V. mixed with unfiltered music on the same tape, and that similar experimentations may be applied to adolescents or young adults (“A.S.”).

On the notion of death and of change — Prof. Tomatis, p. 149-151

For Tomatis, what is frightening in the “death drive” stems above all from a word. Death, in his reading, is above all a “change”, the passage to what is different. He invites distinction in the child’s language between obligatory evolutional stages: from vegetative babble (“papa, pipi, popo, caca”) to paternal language, then to the language of adults. At each stage there is a possible return backward, stagnations to be crossed and risks of being shut in. Liberation requires the change of structure; the anxiety in face of this change is precisely what is called the fear of death.

Beyond existence — Mr Mapples (Ottawa), p. 152

Mr Mapples (verbatim): “Thus, looking into the future, one may say in the end that one never dies.” Tomatis: “Yes, life is a continuum that pursues itself beyond human duration. But if we consider the future as the continuation of existence, our memory risks hampering us in passing from one annoyance to another. That is why existence brings us anxiety. By contrast, if one passes from existence to real life, many things are modified. To do that, one must know how to overcome one’s annoyances, one’s cares, not to be assaulted by what happens around one. One must be able to objectify events and not be constantly concerned in a vast programme that unfolds according to cosmic destiny. And it is thus that life goes far beyond existence, far beyond death.

In the course of the evolution of the being, the conscious gives place to the unconscious, dominating it, commanding it more. I shall recall to you that Hindu image which says that we are vases always very agitated in which the opacity is such that one no longer sees anything of what is happening alongside (it is somewhat the case of the autistic person) — but in reality we do not wish to see, because it troubles us to go beyond our little egocentric universe.”

Lateralisation and hemispheres — Mr Baltz (Lyon), p. 152-156

Mr Baltz (verbatim): “We evoked just now the problem of lateralisation, and it would seem that all this is conditioned by the problem of language. To what extent do current knowledge allow us to say that it is situated in the left hemisphere? I push the question a little further, for I already know in part the Doctor’s reply, but for that the language centre would have to be uniform. Now there may be duality, at a given moment, in this organisation of language. What makes us able to take systematically the side of the language centre on the left?”

Tomatis then develops at length (p. 153-156) his theory of double laterality — cerebral and auditory. To speak of right and left does not suffice: it is also a matter of the antero-posterior organisation of the subject, of the dynamic projection of consciousness, and of the directing role of the right ear in audio-vocal regulation. Language is visceral and would rest on subjacent branches of the vagus nerve. Auditory laterality, far from being a mere by-product of cerebral laterality, would be, in Tomatis’s reading, its external projection and the directing mechanism. A complementary question from Mr Baltz (p. 156) on the parallel re-education of ear and eye leads Tomatis to specify that “the left brain is also right-handed in depth”.

Laterality and lobectomy — Dr Deshayes (Orléans), p. 154-155

Dr Deshayes notes that in neurological pathology, when the zones of the left brain are affected, generally irreducible aphasias are observed, whereas the homologous right zones often allow for more complete recoveries. Tomatis replies with a rich clinical case: a child of 12 sent by Penfield, operated on by left lobectomy in Canada, brought to Paris in a state of motor instability and important aggressiveness, in whom re-education under Electronic Ear made it possible to tip the laterality gradually to the point of rebuilding an active and normal life.

Spiritual life, hierarchisation, periods of change — Prof. Tomatis, p. 157

Prof. Tomatis articulates the major function of the ear with the exploitation of subjacent consciousness. To cross the evolutional thresholds and change structure, the anxiety that accompanies every period of change can be restored and tamed under Electronic Ear. The hierarchisation of cerebral functions — a notion borrowed from Sarkissoff in his paper — sheds light on the progressive becoming aware of the whole by the highest degrees of intelligence.

Otospongiosis and Ménière’s vertigo — Mr Dardères, p. 158-160

On otospongiosis, Prof. Tomatis indicates that if one intervenes before ossification, at the time of an important tonico-vital process such as pregnancy, one can obtain a deep regulation of gestation and a modification of calcium metabolism. On Ménière’s vertigo, Tomatis presents the hypothesis of a triple syndrome — deafness, vertigo and tinnitus — in which the neuro-physiological overlap is such that the subject decompensates through the resistance he opposes to the labyrinthine alteration. Audio-vocal re-education, by restoring a tolerable auditory framework, can permit the subject to reinvest his environment without the initial refusal of vertigo.

From the Sphinx to Oedipus and Theseus — Prof. Tomatis, p. 160-162

Mr Dardères had put two questions in writing, one of which concerned the possible relations of audition with the Oedipus complex. Prof. Tomatis then introduces an extended mythological exegesis. He distinguishes several plateaus of language the child must cross as he grows up: vegetative babble (Oedipus-Sphinx, “the one with bound feet”), parental language, the language of the grown-ups (“Creon”). Liberation requires the killing of the first language, that is to say leaving the “palaeo-Celtic note” of infantile regression in order to reach symbolic language. This change is precisely the “death” of which we spoke just now. Tomatis then weaves the figures of Oedipus at Colonus, Creon, Antigone and Theseus to articulate individual and collective consciousness. Theseus, through the trials of the Minotaur, liberates the drive towards pure consciousness; he finds again, in Aegeus and the Minotaur, the same processes as in Oedipus.

Conclusion (p. 162, verbatim)

“One finds therefore, in Theseus, the same processes, the same approaches, the same trials as in Oedipus, and the encounter will be at the same level of integration, of comprehension.

Thus, this journey symbolises the path of language that will lead man towards pure consciousness; it is the path of existence, which is in sum but a long birthing. Out of the uterus, man engages, after the vaginal channel, in that of the family, then that of the school milieu, then that of the social environment, finally to attain the true birth that is death.”

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Source: Sarkissoff J., “L’appareil Tomatis et la psychanalyse” (followed by the discussion chaired by Prof. A. Tomatis), in Actes du II^e Congrès International d’Audio-Psycho-Phonologie, Paris, 11-14 May 1972, pp. 118-162. Document digitised from the personal archives of Alfred Tomatis. Methodological note: the present publication reproduces verbatim in quotation marks the passages perfectly legible in the stencil printing (opening p. 118-119; fundamental identity of the two treatments p. 138; opening of the debate p. 139; key punctual exchanges with Messrs. Dubard, Bonhomme, Spirig, Mapples, Baltz and others; mythological conclusion p. 162). Passages whose reading from the printing does not allow word-for-word fidelity are restored in explicit narrative synthesis form, in italics, without claim of literal citation.