On a case of autism

Lecture given by Madame Le Monnier (Centro Del Lenguaje, Madrid) at the 4th International Congress of Audio-Psycho-Phonology, Madrid, 1974*.*

On a case of autism — the story of José, aged six, the first case of grave autism received at the Centro Del Lenguaje of Madrid in January 1973. A clinical account of an audio-psycho-phonological intervention with filtered maternal voice and sonic birth: spectacular improvement after a few weeks, then dramatic regression linked to the decompensation of the family milieu. Beyond the case, a plea for a global approach — the child, the mother, the father and the context — without which the technique does not suffice.

The Centro Del Lenguaje of Madrid

It is within the framework of an experiment still very young — which I should like to present to you — that the observation of a clinical case made at the Centro Del Lenguaje of Madrid takes place. Beforehand, it would be agreeable to me to say a few words on this Centre, which opened its doors in January 1973, that is to say a little over a year ago.

A few statistics will give you first an overview of what we do and of the various types of patients we receive.

• Dyslexia and scholastic disorders come clearly in the lead, since we obtain a figure of 38.3% of cases. We have voluntarily set apart left-handedness, which nevertheless enters in large part into scholastic difficulties — and we have collected for it a percentage of 13.9%.

• A certain number of children reaches us for communication disorders of the autism, schizophrenia, language delay type, for which we obtain a figure of 13.9%.

• Deafness with a figure of 9.5% and global delays with 8.5%.

• We have classed under psychic disorder certain deficiencies of the type of nervous depressions, character disorders, and so on, for which we have collected a figure of 8.50%.

• Lastly, stammering, of which our psychologists has already spoken to you, accounts for 7.5% of our concerns.

As you can see, we have a sufficiently wide spectrum of cases to be able to draw some generalities on the results we obtain thanks to the techniques of audio-vocal education we use in our Centre. I should specify that we apply the method of Professor Tomatis, to which we devote ourselves entirely, to our great satisfaction moreover, as the results obtained attest.

The case of José

The case we have chosen is that of a child of six years presenting very important communication disorders, which we have not been able clearly to identify owing to the enormous variety of symptoms exposed. He was brought to us for autism. We shall say for the moment that he is a psychotic child whose story I shall try briefly to tell you, and whom we shall designate “the case of José”.

Anamnesis

José was born on 1 October 1966 in Madrid. He is the second son of a family of two children. The mother wished for a girl. She admits to having been disappointed when she was given into her arms a fragile little boy of 2.5 kg. Even today she does not hide her regret at not having had a girl in place of José. As for the father, the sex of his child did not matter to him. He was very happy to learn that it was a boy who, even then, resembled him greatly.

The mother’s pregnancy seems to have proceeded without notable incidents, other than a few nausea and vomiting during the first months. José was 15 days before term: premature rupture of the egg pouch and the absence of pains during about 24 hours decided the doctor to induce labour. It is noted in the child’s dossier that there was a haemorrhage at the rupture of the umbilical cord. The mother is unaware of whether the child cried at birth. Nothing abnormal was signalled to her at the maternity clinic.

The child’s ponderal evolution seems to have been satisfactory. José sat up at the normal age. He began to walk towards twelve months. There is no language delay, according to the mother. He babbled, spoke and structured his sentences normally. On the other hand, on the character plane, great difficulties are noted from early childhood — fits of anger, cries, instability, aggressiveness, especially towards other children whose presence he cannot tolerate. All these difficulties go on growing worse from the moment when walking begins.

José isolates himself, remains alone in a corner, refuses all communication. It is significant to note that he has a favourite game, which is always to pull the curtain cords — a reminiscence no doubt of his intra-uterine life. He is not affectionate, does not seem affectionate towards his brother who seems to ignore him — an elder brother who, for his part, is ashamed of him, who refuses him his affection, his protection, refusing to defend his brother whom, according to him, everyone calls an idiot, retarded and abnormal.

First audio-psycho-phonological assessment

The audio-psycho-phonological assessment carried out on the day of the first consultation reveals enormous disorders of self-control and very important relational problems. The mother indicates that her son hears well. In fact, on examination, listening difficulties are noted. José touches his ears continually; he likes to be spoken to loudly. He does not start when one cries into his ears. He needs a certain sonic energy to come into communication with the outside world. The study of the self-control circuits of language enables one to observe very numerous deficiencies. The child does not hear himself; he does not listen to himself. He does not control what he says, and his utterances are often incoherent.

The analysis of sounds is also defective in respect of the verbal frequencies that reach him. José does not understand what is said to him. He hears that he is being spoken to, which will provoke in him a reply, but the latter often has no relation to the question asked. Such an attitude makes the mother impatient and anxious. She herself becomes nervous, faced with the child who cannot manage to communicate with those around him. He realises that he is not understood, neither at home nor at school, which provokes in him an increased aggressiveness towards his interlocutors.

We cannot therefore speak in José of deafness, but of important listening and self-listening difficulties. As for language, beyond verbal stereotypy, the psittacism that frequently appears, a marked etymology, disorders of phonation are noted: the protected most. All attitudes translate vibration and phonation: most protected timbre and rhythm. The verbal flow is at times jerky, rapid, hasty. The child speaks loudly. His voice is at times deepened, strident especially when he cries. His utterances are incoherent.

After the study of the control circuits of audition and phonation, we approached that of laterality. José has no point of reference. He is ambidextrous. He knows how (a bit poorly) to use both his right hand and his left. His movements are often uncoordinated, abrupt, ill-commanded. He cannot situate himself in space, nor in time. He seems lost when one asks him questions about his tomorrow, yesterday, later.

On the affective plane, an important delay is also noted, with deep disorders. It is an infantile fixation with enuresis and onychophagia. The mother tells us that José bites his fingernails and toenails. In the sexual domain, intensive masturbation marking a strong maternal attachment.

The child’s behaviour denotes a very great instability, an aggressiveness towards the environment, a lack of affection in his surroundings. José takes no care of himself. He is dirty. His appearance is neglected. He likes to roll on the ground. His mother gives him no respect for himself or for others. The mother tells us that he likes to play with water, not to clean himself but for reasons we can easily imagine. In a swimming pool, she says, he is a true fish in water. He is happy; one feels he is at ease. The depths do not frighten him; he dives without fear and is in his element. As soon as he sees a river, a basin or a fountain, he seeks to plunge into it, fully clothed if need be. Like all schizophiles, José takes pleasure in finding again the aquatic conditions of his intra-uterine life. He would wish to return into his mother’s womb, from which, in truth, he has never come out.

Scholastic failure and psychiatric hospitalisation

Let us now broach the problem of schooling. At José’s age (he is 6) it will be compulsory. He was 4 when he first entered a communal school. From the first moments, it was for him a tragedy. What happened? What treatment did he receive? The parents are unaware. One thing only is certain. José’s state worsens. A father the master. He can no longer express himself because the parents say in the hospitals. A check-up visit one month later has him diagnosed as “mentally alienated”. The parents are desperate, distraught; they go from specialist to specialist, who speak of character disorders and end up directing the child to a hospital where José undergoes psychotherapy. But his state does not improve. On the contrary, his behaviour seems to worsen. When he is led to class, he is relegated to the back rows, with no one to extend a hand to him.

The following year, the teacher changes. A more human teacher, who seems to understand José’s problems. He encourages the parents, strives to reassure them, persuades them that José is like all other children and that one must win his trust. José can neither read nor write. He has never adapted to the school milieu. He shows at school an attitude of opposition to the teachers’ work. The enormous difficulties of an affective order which always threaten his anxiety do not make him at all available for learning to read and write. José has other concerns than to know what a U or an O is. He does not feel himself to exist. He cannot situate himself in his environment. He is lost in this world where he does not recognise himself, and he feels rejected. What does it matter to him to know how to read or write? His problem is not there, he feels confusedly, but the adults see nothing of it. Their only aim is to have him write signs which for him have no meaning. When do his parents come to comprehend all this?

Programming of the treatment

The father appears overwhelmed by events. The mother is very anxious; she doubts her child’s normality. She is disarmed in face of his fits of anger, his instability. She feels powerless. She becomes neurotic and believes that everyone is watching her, that she is being pointed at. She feels guilty. She mentions that her childhood was very difficult, but gives no details. We shall know more only later, on the occasion of a follow-up visit.

Here then summarised is the starting assessment we have been able to elaborate concerning this child. What solution to adopt before such a clinical picture? Our intervention will consist in allowing José to live peacefully with his environment. The first relation to re-establish is of course his relation with the mother. It is therefore a question of reconstructing the mother-child relation — that is to say of treating at the same time the two elements of the first couple, the harmony of which constitutes the very basis of the desire to communicate with the other, the alter-ego, springboard of the launch towards the adult state. We therefore propose to the mother a psycho-sensory approach under Electronic Ear for the child and for herself. She accepts to be treated at the same time as her son.

Filtered maternal voice and sonic birth

We then begin with sessions of filtered sounds to have José undertake a journey from the intra-uterine period. The mother’s voice is recorded and then filtered above 8,000 Hz in order to give the child the sensations of his foetal voice. A rhythm of 6 sessions a week (3 times 2 sessions) is fixed at the start of treatment. While her son is in session, the mother benefits from filtered music in a relaxation position.

Let us see now how the undertaken approach will unfold. During the first six sessions, José manifests violent opposition to the educator who looks after him. He insults her, hits her with his fists, spits in her face, throws his shoes at the stands, kicks her, utters shrill cries, spits in her face. He refuses to eat during a great part of the sessions. From the 10th, seeing that his comedy has no effect, and seeing that his comedy gives him no echo, he bursts into sobs and accepts to keep the headphones on throughout the session.

José’s behaviour improves from this moment. He is less aggressive; he hurls fewer insults; his desire to strike disappears. He becomes interested in games while listening to the filtered maternal voice. He does puzzles, climbs, communicates with the other children in the Centre. After 10 sessions of FMV (filtered maternal voice), José has changed greatly. He has become calmer, almost gentle. His language has become clearer, although it has remained incoherent.

First progress

His tics begin to disappear. He no longer bites his nails; there is almost no more enuresis. Sleep has become peaceful. The child shows a greater need to sleep. He has difficulty getting up in the morning. His appetite diminishes. José eats less than before. His vegetative life finally finds its balance, in a perspective of improvement.

On the whole a very satisfactory progression is noted; the child’s attitude has profoundly changed. We are no longer faced with a little monster but with a calm and reasonable little boy. On the other hand, the mother remains anxious. She would wish that everything went quickly, ever more quickly. She apprehends the holidays in the village where they usually stay. José is the village attraction. The other children incite him to mischief. They push him to undress and run naked in the streets. It is therefore in a state of deep disquiet that the mother envisages going on holiday with her child.

After a month’s stop corresponding to these holidays, José returns to Madrid. He is wholly transformed. The holidays went well, without incident. He was very calm. He has lost weight. His autistic symptoms have practically disappeared. He returns joyfully to the Centre, puts on his headphones himself and does his sessions in the greatest tranquillity. His relation with the other children has improved, although a certain timidity appears. He observes what goes on around him; one has the impression that he reflects. He speaks more, and his conversations become more sensible.

The return to class is also done in good conditions. José is still in the same class; the teacher has asked to follow him again this year; he notes a greater stability. José no longer disturbs the class; he is calmer, more obedient. At the start he was afraid of his progress; he is calmer, more obedient. At the start he was afraid of his progress, but he has now gained confidence. For the first time José manages to write following the lines. He also begins to learn the multiplication tables. His attitude in class has changed; José is more present, kinder with his schoolmates.

It is then that we undertake to make him enter the linguistic phase. After a few sessions of sonic birth, we have him hear nursery rhymes, Gregorian chants and a few small words which he begins to repeat scrupulously. He always comes to the Centre with pleasure. From time to time, he is heard humming. He becomes joyful, smiling, sociable. He seeks out the other children, while preserving a certain attitude of timidity. He is still afraid to go towards others, no doubt for fear of being rejected, his answer as he has sometimes been. Whatever it may be, José has progressed. His external appearance is more cared for. The child is cleaner, neater. Before leaving the Centre, he tidies up everything he has put into disorder, and is found calmer and more conquering, almost sure of himself. The desire to communicate is really set in motion. José gives the impression of wanting to live, to speak, to be like everyone else.

Favourable evolution of the mother

A favourable evolution is noted at the same time in the mother. She is more relaxed, happier. She seems less hunted; at the Centre she is more open, acknowledging that her son is better. She speaks more willingly; she finds herself more awake, more balanced. The maternal attitude has therefore been completely transformed. Her child is closer to her, more affectionate.

The regression — the family drama

We thus continue the programming in order to go further. However, from the 90th session, a certain disquiet manifests itself in José. He is again, one feels, nervous, preoccupied. He starts crying during the sessions again. The educator has difficulty in having him repeat the words he hears through the Electronic Ear. He no longer obeys; he quarrels with the other children; he becomes aggressive again. He starts playing with the light again, turning it on and off continually. His language deteriorates rapidly. The fixed, obsessional ideas return to the surface. The child unceasingly repeats a sentence whose meaning escapes us: “Don José y los del comedor aquí”, that is to say “Mister José and those of the dining room here”. We cannot manage to elucidate the mystery. The mother seems to know no more. What then are these characters in the dining room of whom José speaks and who seem to perturb him, to obsess him? What does he wish to express by repeating this sentence almost ceaselessly? What is the event that may have produced such an upheaval in this little boy who was beginning to blossom, to open to the outside world?

But we find ourselves incontestably before a phenomenon of regression which we cannot manage to explain. We ask the mother on several occasions whether she has noticed anything abnormal in her son’s daily life. She has noticed nothing. She nevertheless notes that the child is less well and that she herself is again beginning to be anxious, nervous and depressed. Her anxiety reappears; José is no longer the same, one would say. His physical appearance has again become neglected. His attire is disordered. His sexual problems reappear. He masturbates again, and enuresis reappears. He spends his time whistling at his father, as some autistic children do. His attentional capacities have disappeared. He is inattentive; he no longer participates in the life of his environment; he makes himself unhappy, enclosed in his universe of despair.

We are in full debacle. During a follow-up visit, at the 125th session, we find ourselves before a mother terribly anxious, nervous, despairing. José returns to his earlier state. She no longer knows what to do; she is distraught. Faced with such an attitude, we try to clarify the problem. We explain to her that this turnaround, this regression, this fall can only be due to an important event that has occurred in her son’s affective life. We seek in vain. The mother does not seem to have changed in anything; it is her husband’s absence for about a month.

The absent father

The father, being a military man, has received from his superiors the order to follow special training courses that will oblige him to live in residence at the Madrid barracks. He can come out only at the weekend.

So as not to remain alone at home, José’s mother has decided to have her parents come to live with her. As she has begun to work outside, she thinks they will be able to look after the children during her absence. It is well to note that José’s mother took the initiative of finding an activity outside the home in order to help with the upkeep of the household. Feeling less anxious, more tonic, as a result of the filtered music sessions from which she had benefited over the preceding weeks, she became conscious of her responsibilities and decided to share with the father the burdens of the household. This is an excellent move, which however does not seem to have received the agreement of the family entourage and in particular that of the maternal grandmother. The latter agrees to come and look after her daughter’s children but does not stop telling them that José is an abnormal child, that she is wasting her time wishing to have him treated, and so on. José’s mother gains confidence. In the course of a long interview we had with her, she makes us understand that her mother is very possessive and very authoritarian, which in part accounts for why she had told us at the start that her childhood had been very difficult. We notice that she does not dare to say more, but that great relational problems exist between her and her mother. This mother seems to keep her daughter under her sway. The fact of seeing her become an adult, of seeing her take important decisions, does not suit her. She thus strives to destroy her once again so as to recover her hold on her. José’s mother, who is not yet strong enough to be able to resist such a move, collapses and becomes once again a little girl under the yoke of the “Mama”. And it is the drama for José, who sees the image of the true mother — of the good mother who was beginning to be elaborated before him — vanish. All systems are once again destroyed, and the child, in full distress, having nothing left to cling to, finds again his schizoid universe that distances him from the outside world.

After this account, which brings us some clarification, we ask the mother, by gently explaining to her what has just taken place in the child’s experience, to remove her parents from the home and to take back her place as a mother. She seems to understand these arguments perfectly and promises to do what is necessary to re-establish balance in the house. At the same time, we resume clarifications as to the programming to be observed for José’s treatment. We resume sessions of filtered maternal voice and foetal audition in order to calm José, to bring him the soothing he needs after such a storm.

We notice that the child is sad, that his attire is neglected, that his language is full of insults, of vulgarities. He behaves a little like a brutal, revolted child. He shouts, he destroys, he strikes, he drools. The sessions under Electronic Ear are once again very agitated. José is very awake; his headphones no longer hold; he seems chained, and, at a stage of freeing himself, he howls his anguish and his distress.

The mother is also very nervous. She feels every day more anxious. Already she begins to shout at her son during the sessions; she panics, looks at the people around her, tries to give explanations. Rather than do filtered sessions, she prefers to remain in the waiting room, inhibited, prostrate. She no longer tolerates the filtered room either sitting or lying down. She does not stop saying that she is ill.

The collapse

It is true that she is ill, and that is the heart of the problem. José’s mother has just abdicated before a captivating, devastating maternal image. She has just destroyed what she represented for José of the secure, the harmonious, of strength, of comfort. She has just withdrawn from him all his supports, all the scaffolding that had been built to allow the child finally to reach a level of existence allowing him to become a little boy similar to those of his age.

Everything must be begun again — but will José’s mother have the courage? No! In face of this defeat, she bends the knee. She asks to interrupt the treatment for reasons of health. She no longer has the strength to fight; she prefers to take refuge in her illness, in depression. She is at the end of her strength; she gives up.

We try to help her and telephone her a few weeks later to ask for news and to propose a follow-up assessment in the presence of Professor Tomatis. She accepts as best she can, incapable of taking a decision, and presents herself at the consultation of 16 February. We then find ourselves before a woman in full distress. She trembles during our exchange, she speaks, she is desperate. The syndrome of great depression is manifest. The personality is annihilated. José’s mother is taken with panic; she cannot manage and can no longer get out of it. She feels unwell, she stumbles; the ground gives way under her. She has the impression that everyone is watching her. This surge of agoraphobia goes on growing and obliges her to stay more and more at home, where she no longer finds any security with those around her. She eats a great deal to soothe her anxiety, and as a result she has put on weight perceptibly. We learn moreover that her parents are still living with her; she has not yet wished to remove them from her home. She prefers the state of health of her father, who appears, it seems, to be very ill. She considers him as a poor disoriented being (and who is perhaps taking refuge in illness to escape the hold of his wife). She has lost the taste for living, for making efforts. She is tired, she is tired. She has lost the sense of struggle. She takes a few tranquilisers to try to calm her level of anxiety but says that this has no effect.

As for José, absent during this interview, the mother tells us that he has taken refuge in his initial state. All his autistic symptoms have reappeared. He is again cruel, unstable; he cries unceasingly; he is practically no longer able to express himself; his utterances are once again incoherent. The mother is incapable of taking a decision; she lets herself go, contents herself with pitying herself. She is a desperate woman to whom Doctor Mellado proposes a medical treatment, which she accepts.

A month later, José’s mother comes once again to visit us at the Centre, and as soon as she finds herself in our presence she bursts into sobs. She is moved to feel but not yet recovered. Relaxed and in confidence, she gives us an account of the things that have happened and of her maternal relation. She has resumed a professional activity that occupies her from 9 a.m. to 2:30 p.m. During these hours, her mind, occupied by her work, escapes; her problems fade and are relegated to the background.

On returning home, it is the return to reality; she feels again incapable of assuming her role of mistress of the house. Her mother is there; everything is organised in the house. Everything is decided in her place; the mother, who has never loved her, is the elder of two children. The younger sister has always had right of access to all the mother’s attentions; she was loved, cherished, adored. She is the most beautiful, the youngest. José’s mother suffered much from this; she had such need of affection. The war came and the situation scarcely improved. She was considered as one who could endure everything, bear everything, both physically and affectively. The years passed somehow, but rather badly than well; she hoped it was a role she was to assume some years later. A true struggle was waged between the two mothers-in-law. All means were employed to prevent this marriage: he was a boy unworthy of her, without quality, that one could have obtained a marriage, a true mismatch! Not for one moment were this boy’s numerous moral qualities mentioned. For the first time in her life, José’s mother could impose her will. It was the marriage, and now she is no longer capable; she has abdicated for a long time; she sees again an inferiority complex with regard to this authoritarian and uncompromising mother. As for the father, the only comment made about him was: “he is a good man”, which is alas a not very flattering compliment.

Conclusion — the necessity of a global approach

After these clarifications on this family ensemble, we proposed to José’s mother to arrange an interview with her own mother in order to make her understand the moral responsibilities. The daughter is afraid of her mother’s reactions but accepts our proposal in principle, while warning that her mother will behave in a negative — not to say insulting — manner towards the members of her family and the members of our Centre; she begs us not to take account of the comments that might be made.

Two days later, we have the surprise of a visit from José’s father. We find ourselves before a man profoundly touched, anxious, and conscious of the progress José had made, and astonished by his regression. He terribly accepts the interruption of his son’s treatment and now has only the desire to see his training period end so as to be able himself to bring his child back to the Centre. He is conscious of all the family problems. He knows the mother-in-law; he is content with a meaningful look that we understand by ourselves, since the latter is determined to come to the Centre to see for herself. José’s father is a passive man who avoids all discussion. Shouts and violence horrify him. He is a quiet man who accepts his fate. When he is at home, he devotes all his time to José; they go out a great deal and like to walk together. José is very relaxed in his company; he behaves almost normally. Wherever he goes, his father accompanies him. This position of the father often exasperates the mother, who would sometimes wish to go out alone with her son.

In the course of the interview that took place that very evening of the father’s visit, we could measure how tragic and dramatic the situation was. We found ourselves before an overflowing aggressiveness, an inexplicable pride limiting itself to being listened to — a woman knowing everything and having nothing to learn from anyone. She has only contempt for those around her. “I am a force of nature”, she says with pride. Without her, her daughter could never survive such a situation. Her son-in-law, a poor incompetent, a fool — he does not believe in the recovery of his son. “I have never seen the slightest improvement in my little grandson”; I would say even the contrary, that he is going from bad to worse; what you call progress is not the improvements we hope for. This child, during my absence, had lost weight. I alone know how to look after him. Under my eyes, I am the one who feeds him and I am the one who wants him for two women, so I am the one who takes care of everything."

No conversation was possible. It was a painful and distressing monologue that led nowhere. She left us saying: Certify and sign that you can cure José and I am ready for anything, but I am so certain that there is nothing to be done. José is an Autistic, as she would have said that José was Japanese or Bantu.

The abandonment — and its lesson

The story ends thus. We never saw José or his parents again. We can imagine the evolution of the situation. We are sorry not to be able to intervene with this family in distress.

The first results convinced us that we could have done something in so far as we had been in a position to treat thoroughly José’s mother with her own mother, and in so far as the maternal grandmother had agreed to let go the moorings that held her daughter prisoner.

It is here that we open the discussion and ask each of us to give us an opinion in the light of his own therapeutic experience with regard to children presenting disorders similar to those of José. It cannot be a question of removing from the sympathy of his own mother the family context which is at the very basis of the child’s illness. It is not José who is ill: it is the mother, who remains under the sway of her own mother; it is the grandmother who, despite her apparent absence, seems to have abdicated — the true mistress, a true wife; it is the maternal grandmother who did not know how to make of her daughter a true adult mother. The whole family environment must be called into question in the study of this dossier I am submitting to you, so that from your discussion light may spring.

What then is to be done in face of such a situation? We have thought that it would be well in the first place to remove the child from the family milieu that is the cause of his misery and to place him in a boarding school applying the same techniques. During this period of psychic re-equilibration of José, we could take the mother into treatment at the Centro Del Lenguaje of Madrid in order to try to settle her own inner problem. By taking her mother’s voice, we could have her undertake the necessary journey from her intra-uterine life to bring her to a true adult state allowing her to assume her role of mother and wife. For the moment, she has renounced this. She prefers to become again her mother’s little girl.

In the same way as on the moral plane one calls the wife of her husband and the mother of her children, her personality should be restored to her, to give her sufficient strength to live, sufficient tonus to work and struggle. It would also be well to see the father, to have a few interviews with him to make him conscious of his role of father and husband. Perhaps one might also — though that is much more doubtful as to the result — invite the maternal grandmother to come and do sessions of filtered music and musical sonic births in order to diminish her ego and her state of possession. As for the grandfather, we prefer to leave him in his armchair as a sick old man, for we should risk doing him more harm than good. He has taken refuge in illness; let him die in peace. But let us write the picture of the end, there is that of the beginning, the brilliance of this little Being who has the right to life, this little José whom we must try to save.

I now leave you to your reflections, and I thank you in advance for all the suggestions you would kindly make to us in trying to undo the knot that so preoccupies us. Thank you once more.

— Madame Le Monnier, Centro Del Lenguaje (Madrid). Lecture given at the 4th International Congress of Audio-Psycho-Phonology, Madrid, 1974.