The Problem of Access to Language

Communication presented at the 3^rd National Congress of the Association Française d’Audio-Psycho-Phonologie, Pau, May 1976*, by* Dr Jean Raynaud*, neuropsychiatrist, Toulouse Military Hospital.*

The problem of access to language through the semiological study and therapeutic evolution of a stammer and a psycho-neurosis under the Electronic Ear.

Introduction

A recent user of the Electronic Ear, I have chosen, in my most recent practice, to take two complex cases still in evolution. They seemed to me to allow the posing of the theoretical problems raised by the implementation of therapeutic techniques founded on the ideas and methods of Professor Tomatis.

In this theoretical perspective, I have wished to enlarge the approach to stammering to the less obvious and less differentiated language disorders that psycho-neuroses now represent for me. I have thus studied in parallel the evolution of a case of stammering and that of a psycho-neurosis, trying to show that the latter represents only a more discreet disorganisation of language — but one that is no less evident through the audio-psycho-phonological approach that the efficacy of the cure under the Electronic Ear makes possible.

From the book by Borel-Maisonny and Pichon I have retained the concept of lingui-speculative insufficiency, which would mean that in the stammerer “the passage from mental images issuing from sensory memories to figuration and expression by words would be deeply disturbed”. They also express this idea in this form: “Whatever the quality of their intelligence, they find it hard to formulate their thought to themselves in the world of language.” Therapy, according to these authors, would be a re-education of linguistic thought.

Through this idea of lingui-speculative insufficiency, through experimental facts and hypotheses of Professor Tomatis concerning language, I have tried to analyse semiologically, alongside the case of stammering, the problem of a psycho-neurosis that may thus be considered — to a lesser degree than stammering — as a lingui-speculative insufficiency; the therapy under the Electronic Ear here too being envisaged as a re-education of linguistic thought.

Observation 1 — M… Robert: stammering and family drama

Presentation

He is a young man of 19, unmarried, a voluntary enlistee in an engineering regiment, exercising the profession of mason, and who — after 9 months of service in the army — was hospitalised in our department for a first generalised epileptic seizure.

Of rather small stature, with a fairly common, unexpressive face, smooth and without revealing mimics, he smiles little, avoiding the gaze. Verbal communication is hindered to a major degree by a very pronounced stammer: his speech is only a succession of long periods of suspension of speech, with clonic repetition of any syllable in mid-word, until tonic blockage with multiple synkinesias. He moves his head, leans slightly forward, puffs out his cheeks and lips at each clonic emission, to finally — after the blockage — abruptly release his speech for the utterance of his sentence-end.

The speech, very syncopated then, is mostly made up of long silences filled by his tonic blockages. The expression is poor, with very short and very simple sentences, the interlocutor feeling reduced to soliciting only the shortest of replies.

Family history

The psychiatric examination brings to light the following facts: he only began to speak in his childhood at 4 or 5 years of age, being the elder of two siblings. He is said to be left-handed but writes with his right hand. He obtained his school-leaving certificate.

A catastrophic fact dominates the account of his life: when he was 16, his father killed his mother and his younger sister with a hammer, then strangled them with a rope. He does not know where his father is at present. He himself lives with his maternal grandparents, who have looked after him since the drama. He had begun an apprenticeship as a plumber with his father but, since the drama, had to turn to the trade of mason, then decided to enlist in the army — where he was beginning to feel ill at ease.

The neurological examination is normal. Classical investigations allow the identification, on EEG, of generalised degraded spike-wave discharges. A gas encephalography and a scintigraphy made it possible to eliminate any organic involvement. Level tests showed an IQ of 83, without significant deterioration.

The listening test performed on his entry into the department shows a significant bilateral hypoacusis beginning around 8,000 Hz, of perception, with total and bilateral impossibility of discriminating frequencies. The ENT examination concluded that the deafness was of congenital origin.

Evolution under the Electronic Ear

With his agreement, a course of treatment by the Electronic Ear was undertaken in mid-December. No very evident reaction was noted during the whole first phase of the treatment, where filtered music was administered at the rate of 3 hours per day — apart from some complaints, at times, of weariness. At the 50^th session, on his return from a short Christmas convalescence with his maternal grandparents, after a sleepless night, he presented a seizure during his music session.

At the 70^th session, we moved to the phase of sonic births. This phase allowed us to observe more precisely the new expression of an aggressiveness vis-à-vis his maternal grandparents, whom he reproached with restricting his freedoms, and against whom he had revolted at Christmas. He spoke from this time on of repetitive nightmares, always on the same theme, in which he saw himself in search of his father and being prevented by his grandparents.

In parallel, a clearer transference was established towards the female figures of the department, towards whom he turned to show them the newspaper article in his possession describing his father’s crime. He would ask one of the nurses to help him find his father. He even wanted to take up again the trade of plumber that his father had begun to teach him. Finally, it was to me that he turned, by bringing me and having me read the newspaper article relating his mother’s death.

From this time on, easier relations were established for him; his gaze was livelier and more alive, and he appeared much freer in his daily relations. The active sessions of vocal exercises and verbalisation were begun from the 185^th session, that is, in mid-February. He took to these sessions very well, putting into them conscientiousness and enthusiasm. He was rapidly lateralised on his right ear. Very quickly, he managed to reproduce wholly satisfactory vocal exercises, as well as the sibilants. He practically does not stammer under the Electronic Ear, although the exercises do include complex words and texts.

This period is marked by a certain enthusiasm to enter into relation with others: it was then that he began to go out with fellow patients, to play the trifecta (and to win), to go out to a nightclub with chance acquaintances.

Analysis

M… Robert appears to have delivered here a key situation of his psycho-motor development. In his journey towards language, divided between a mother bringing him back to mental images from before language, and a father wishing to impose by force and without nuances the semantics of which he was bearer, the neuronal conditionings implicated — vocal feedback systems — played in an antagonistic manner, due to the affective discordance of the parental couple.

His stammering expresses, in the act of speaking, only the dual stimulation arriving offset from one hemisphere relative to the other — the origin of the clono-tonic disorder. Although on the way, thanks to the therapy under the Electronic Ear, towards a more harmonious dominance of the left hemisphere (which commands semantics) over the right hemisphere (which itself integrates all mental imagery outside language), he still seems far from that ideal language issuing from a harmonious dominance of one hemisphere over the other.

The epileptic tendency, which still occasionally awakens, seems to us to be the sign that this reorganisation of a harmonious cerebral dominance is not easy.

The enormous affective demand expressed daily in all his approach finally suggests great difficulties in the relation to the mother: the nightmares have as their constantly repeated theme that of the impossible encounter with the father, because of the mother figured by the maternal grandparents.

The idea of a purely functional depression of listening, linked to a deeply disturbed maternal relation, seems to us to need to be evoked to explain his hypoacusis.

Observation 2 — G… Aimé: psycho-neurosis and the “left voice”

Presentation

G… Aimé is currently 46 years old. A retired non-commissioned officer after having exhausted his rights to long-term sick leave, he has received a pension since 1967, at 70% for severe and rebellious depressive syndrome, and at 40% for sequelae of amoebic colitis.

Coming from a united family of 2 boys, of whom he is the elder, he describes himself as closer to his father — a technical agent in the postal service (PTT) and deceased some years ago —, experienced as simple and good, more affectionate than a mother, kept at home, who would have lacked warmth, too preoccupied with the daily round, somewhat tyrannical, still alive. He uses the word “coarse” to qualify her globally — which seems to signify, for him: stupidly authoritarian. His psycho-motor development was normal; he is right-handed.

His career in the army is closely linked to the Indochina and Algeria campaigns. He is well rated and well adapted in all the various employments he has had. He is zealous, precise, meticulous, anxious for perfection and authoritarian — all qualities appreciated in his functions. For a long time, and especially in the overseas territories of operation and in an operational climate, he feels entirely at his ease.

From 1959 on, he becomes too preoccupied with his work, checks the details of it excessively, becomes anxious about it, gets up at night. He is hospitalised on several occasions for the amoebic colitis. On his return to the mainland, he is hospitalised in 1966, depressed, sad, emaciated. Since that time, authenticated in his neurosis by the obtaining of a pension, he oscillates between hospital, the treatments and the relations established with therapists and medical staff, and the closed world of his birthplace house where he lives withdrawn, inactive, with his widowed mother: belatedly reconstituted Oedipal couple, not without conflicts.

The face and the left voice

Of medium, rather small stature, he has attitudes marked by sobriety, restraint and mechanical repetition rhythmed by the imperatives of the hour. His face is hardly expressive, fixed, generally sad, never with a smile. His voice is toneless, badly timbred, monotone, rather low; the timbre is muffled. In the gestures of speech, the body is immobile.

He uses only his left hemiface to speak, his mask remaining fixed and toneless on the right; on the left, by contrast, the half-forehead, the corner of the mouth come alive almost exclusively during speech, and this very evidently, almost caricaturally. It may be affirmed that he speaks constantly with his left voice.

His speech is always situated on the same plane: in the mode of complaint, he describes with much precision, as though from a distance and from the observer’s standpoint, his symptoms. He never fails to affirm their permanence, their dramatically compelling character, as an ill that afflicts him, an incurable disease against which he can do nothing — which he endures in suffering, keeping vis-à-vis it his lucidity, his pseudo-objectivity.

He thus details all the doubts and verifications of a compelling character against which he can do nothing, and around which his life is organised: a whole world of obsessions bearing on taps, doors, the choice of shirts in shops (with which he is never satisfied, and which he tears up on arriving home), letters to send, administrative formalities. When he takes a train, he takes the ticket eight days in advance, finds it badly stamped, destroys it, buys another. His dental device in the carriage: “and what if he threw it into the lavatory?”

To this is added a very strong aggressiveness, which he describes as dangerous towards the people around him, and which is triggered by trifles: it is then a violent desire to strike, which he generally does not carry out, but which he mulls over on the night following the incident, remaining of course insomniac.

War nightmares

The relation will take, after two months of hospitalisation, a more spontaneous and affectively richer character, through the account of dramatic nightmares often recurring since 1966 and bringing back authentically experienced war facts. He says of himself: “I have the impression of destroying myself rather than defending myself against it.”

The scene relived is always the same: he had received the order to kill a prisoner; he designates a soldier volunteer for this; the soldier only wounds the prisoner; he himself finishes the wounded man with a pistol shot to the head — but he wakes up at the moment when the pistol shot rings out and the man, awaiting the shot, looks at him.

Evolution under the Electronic Ear

A course of treatment with the Electronic Ear is proposed to him; he accepts it. The sessions of filtered music rapidly prove effective. At the 7^th session, he feels, in a very anxious manner, a sensation of loss, of insensibility of his right half-body — which would then occur on the left also. To this is added a certain difficulty in speaking, tinglings on the right side of the mouth.

He also emphasises, spontaneously and to his great astonishment, that since the beginning of the cure, his intestinal transit has become regular: he no longer has diarrhoea or constipation. This fact is all the more remarkable in that, until then, he had been very exacting concerning the treatment of his colitis, dissatisfied with the various bismuth preparations prescribed and constantly complaining about it.

The discomfort at the level of the sense of his body will fade towards the 40^th session. Nothing further remarkable will occur until the active phase of verbalisation-vocalises of the treatment, which is introduced after 128 sessions of music and sonic birth. He will most often express an anxiety without theme, in crises, in the mode of reproach and nothing more. The phase of vocalises-verbalisation will further accentuate his anxiety, and he will experience considerable difficulties.

In view of his lack of cooperation and his lack of enthusiasm, the sibilant sessions are halted. He becomes very aggressive towards me at this time, accusing me of laying the failure of the treatment on him. Finally, the sessions are resumed and he admits that he had within him a kind of reluctance to do the exercises.

It is nonetheless noted at the present time — when his treatment is not yet finished — an improvement in his relations, noticed by other patients, a greater ease in communicating, the fact that he goes out into town more often (which he had abstained from completely until then). He himself admits that he sleeps a little better, is more relaxed. But if he is better, he affirms that it is because he feels “so very bad at certain moments”. If he goes out into town, he himself says that “it is against his will”.

Analysis

G…’s difficulties can be described, within the usual clinical framework, as psycho-neurotic disorders suggesting a severe obsessional neurosis, with paranoid character traits. The analytic perspective allows the underlining of the sado-masochistic traits of his conduct, implying a regression to the stage of sphincter conditionings.

For us, in the perspective of the hypotheses of Professor Tomatis and of the evolution of this case under the Electronic Ear, we interpret the case of G… Aimé as a first-of-all auditory dyslateralisation, and a complaisance — which we shall call functional, that is, inscribed in the neuronal circuits — to remain in a left audio-phonatory monitoring. This complaisance does not seem to us to be devoid of intentionality, and assumes a right hemispheric dominance.

It may thus be supposed that the language of G…, and his thought therefore — as depending directly on language — appear too strongly marked by the world of mental images, strongly imbued here with sado-masochism.

Thus, after the inaugural conditionings of childhood where the mother, by her voice, plays a determining role, G… left her in the aftermath of the conflictual upsurge of adolescence, having however elaborated his man’s language — for he accedes to a possibility of satisfactory speech in relation to our stammerer. In the army, doubtless, he wished to recover unconsciously this sado-masochistic world of his childhood, through the regulatory rigours and the situations of submission-domination permitted by the strict military hierarchy, especially in wartime.

In peacetime, the inadequacy of his inner language to less troubled times brings him to depressive decompensation, with deep anxiety and the resurgence of nightmares of traumatic appearance, bringing him back to a major sado-masochistic act, in an experience of great significance.

Comparative synthesis

By contrast with our stammerer, here the apparatus of language functions — but it produces a speech permanently submitted, warped by the libidinal world of the archaic representations of childhood, of regressions in the psychoanalytic sense, to the time when the mother was still all-powerful before true language by words. A true lingui-speculative distortion, where speech expresses indefinitely only an ill-mastered unconscious and which finally always calls forth in the other the same responses, as in the time of the poor conditioning of the first months of life. This underlines, were it needed, the importance of the mother and her way of loving — that is, of communicating — from, and perhaps before, birth, with her child.

Our stammerer, for his part, has remained in a kind of more absolute splitting between the world of words and that of representations — a splitting also inscribed neuronally, expressing itself through the syllabic doubling which makes, finally, of a hacked and syncopated speech, a kind of infra-language, a kind of permanent appeal to the solicitude of the other, ignoring the words. Is this not, very evidently, the mode of the inaugural communication between mother and child? — the drama here being to want to identify the other with the mother.

Towards a new semiological approach

These two cases pose, in our view, the problem of a new semiological approach to language and speech, through the clinical facts emerging from the cure under the Electronic Ear, through the discoveries and hypotheses of Professor Tomatis — which are in agreement with the recent studies on the specialisation of the hemispheres, the role of the corpus callosum, the problem of hemispheric dominances.

This approach should take into consideration:

1. The problem of listening, that is, the level of functioning attained by the ear and its modifications in the course of any cure whatsoever, very well analysed by the listening test.

2. The study of language in all its rhythmic, melodic, phonic, and finally semantic components.

Thus, it should be possible to review the whole semiology of language disorders — from stammering to schizophrenia — in an objective approach and in a more evolutionary perspective, taking into account the efficacy of the cure, as the two observations described suggest.

This entails the following consequences:

1. The need to consider every psychic or psycho-motor disorder as a disorder of communication — that is, a disintegration or a lingui-speculative distortion.

2. The need no longer to maintain a semiological viewpoint and a therapeutic viewpoint too often divergent in the classifying and nosographic attitudes of classical psychiatry. Evolution under the Electronic Ear appears indeed to be an indissociable whole, analytical and at the same time evolutionary.

But this assumes that one must define, as the aim of what is no longer only a therapy but a re-education, an ideal to be reached: that of communication under right self-control, an ideal potentiality to which every human being would be presumed able to attain.

One here abandons the notion of norm, of adaptation to reality — which is the more or less implicit reference of any therapeutic approach — to adopt that of an ideal in spoken communication, an ideal dimension of individual language.

Conclusion: healing as a path

This is a capital theoretical position, in our view physiologically grounded on the experimental facts brought to light by Professor Tomatis — thereby allowing a kind of passage from scientific, medical observation and from therapeutic preoccupation to the engagement of a journey towards an entity transcendent to humanity: language. A perspective which situates itself within an idealistic interpretation of human behaviour.

But finally, when one is implicated in the psychiatric undertaking, is one not the bearer — more or less implicitly or manifestly, in the way in which one addresses the psychiatric fact itself — of the ideology that one conveys, and which echoes more or less clearly upon the relation engaged in view of “healing”? This is a fundamental fact in the daily preoccupation of every medical psychiatrist. And the unbridled medicalisation of the problem in our system does not prevent the evolution of clinical cases from always being influenced by the theoretical and ideological foundations of the therapist. To wish to minimise the importance of this fact through pseudo-medical neutrality does not resolve the question.

Thus then, healing can no longer be defined as an aim to be acquired once and for all — but as a path opened towards something else… a dimension of consciousness increased, and to be increased, which at a given moment escapes from the medical field.

— Dr Jean Raynaud, neuropsychiatrist, Toulouse Military Hospital. Communication to the 3^rd National Congress of the AFAPP, Pau, May 1976.