Alfred Tomatis Heritage and archives

Approaches to a Care of Epileptic Phenomena through the Electronic Ear

Communication by Dr E. Derrien* (Montpellier, France), medical director of a Medico-Pedagogical Institute. Probably presented around 1976 within the framework of the works of the Association Française d’Audio-Psycho-Phonologie.*

How can the Electronic Ear accompany the care of epileptic phenomena? Presentation of a clinical research on ten cases, and psychosomatic hypotheses on the “sacred disease”.

Epilepsy, that neurological monument

To speak of epilepsy is very often a wager. So this account aims to be more a reflection than a partisan publication or a catalogue of various theories. In medicine, epilepsy is a clinical block which, ever and always, evolves, hooks, rejects. Be that as it may, this unshakable neurological monument is constantly a source of preoccupation. The epileptic is often the “sacred sufferer”, sometimes the divine voice, which troubles and which one must “put to sleep” — which our societies do not deprive themselves of doing.

It nevertheless seems, through the numerous and recent publications triggered by the study of this disease, that we are witnessing the bringing to light of new aspects. It is in particular the becoming aware of the psychiatric problems of the comitial patient which, at present, provokes the greatest stir.

It is thus that two schools take shape:

  • the neurologists in search, on the lookout, for an organic basis — and one cannot deny that this exists in cases whose proportions vary from 5 to 50% according to the statistics;

  • the psychiatrists who tend to study the often inseparable relations between the personality of the epileptic and his disease.

For the sake of clarity, we shall distinguish organic epilepsies — for which there exists a neurological, metabolic, vascular, traumatic or other focus — and the so-called “essential” epilepsies, for which a focus may possibly be found. This focus is then a grouping of normal neurons which, without anatomical irritative spine, see their electrogenesis disturbed. Let us specify that most often this focus is not identified by the supplementary examinations placed at our disposal.

But whatever the aetiology — or the absence of aetiology retained — it is little contested that the kindling of all or part of the brain triggering the seizure is influenced by exogenous or endogenous factors, or both. Emotional discharges, traumas, are sometimes the triggering factors of a perfectly organic seizure activity. It is, of course, essential epilepsy which will primarily hold our attention.

The epileptic in history

The lifelong condemnation of the comitial patient for being “the shameless ass” finds echoes even in a barrack-room song whose refrain says: “Idiots, lunatics, epileptics are reproaches beyond reply”. All those of our colleagues who have lived in the dens of hospital house-officers’ quarters undoubtedly know this refrain.

Let us note that the slaves of Ancient Egypt were submitted to an intermittent light stimulation, by means of a handmade stroboscope. Those in whom the trial triggered a seizure were pitilessly eliminated, sacrificed to the gods. Closer to us, Republican and Imperial Rome would cease to function if a person had a seizure in public. This mark of the gods’ disfavour brought about the adjournment of any assembly — in particular that of the comitia. Hence the term “comitiality”, often used as a euphemism.

These examples are here to tell us what asocial and magical charge the “senseless epileptics”, to use a term of the period, carried until the last century. The French psychiatrists who, in the 19th century, gave birth to the clinic — as Foucault would say — are the first to have given epilepsy a more psychological than neurological dimension. Their names are: Esquirol, Moreau de Tours, Delasiauve, Morel, Christian, and others still.

Psychic hypotheses on epilepsy

Madame Minkowska: “glischroidy”

A place apart must be made for the work of Madame Minkowska. Her remarkable analysis of the Rorschach of the epileptic has led the research of certain clinicians in a new direction. For her, all is conditioned by viscosity, which she calls glischroidy.

Freud: “Dostoyevsky and Parricide”

For the analysts — apart from Freud — the seizure is a guilt-laden aggressive discharge, or else a hallucinatory accomplishment of the drives.

Freud wrote a very beautiful text on epilepsy: “Dostoyevsky and Parricide”. For him, the epileptic is in the conjunction of a masochistic ego and a sadistic superego. The seizure is a suicide, an introjected crime. Allow me to yield to my desire to cite him in full:

“In epilepsy, as in suicide, we find at once the crime and the punishment: death by identification with the murdered father, that is, the accomplishment of his desire: murder and suicide. These death-seizures satisfy the masochistic tendencies of the ego and the sadistic tendencies of the superego, with the meaning of suicide as self-punishment.”

“It is therefore not surprising that it should be difficult to establish the unity of the clinical disease termed epilepsy. What is common to all these symptoms leads us to believe that these are essentially functional disorders; a mechanism of de-fusion of the drives seems to come into action according to the various circumstances, and this as much in the cerebral disorders deriving from very serious diseases as in the cases where the patient does not succeed in mastering the psychic mechanism which acts in crisis. We sense behind this dual aspect the identity of the mechanism of de-fusion of the drives.”

“It is certain that the epileptic reaction is at the service of the neurosis whose particularity is to rid itself somatically of the complexes of excitation from which it cannot otherwise liberate itself. The epileptic seizure then becomes a symptom of hysteria which adapts and transforms it more or less like the act of a normal sexual act.”

Tomatis: misunderstanding between the hemispheres

Another of our paths of research starts from a hypothesis of Professor Tomatis, who thinks that the comitial kindling is linked to a misunderstanding between the two cerebral hemispheres. I hope to be able next year to communicate to you experimental results concerning this study which is beginning.

To take up Covello’s just words, let us say with him: “One must underline the very close links between the structure of the patient and the isolated seizures.”

What to think of epilepsy?

  • Is it a disease? No. Current neuropsychiatrists have a marked tendency to reject this term which, condemning without helping, has truly been emptied of meaning.

  • Is it the symptom of a neurosis? Yes, often, doubtless, and this symptom — we have seen — will demand from us a quite particular listening.

  • Is it a behaviour? Yes, certainly. It is then that we may consider epilepsy as an anxious disturbance of the relation, bringing about an existential behavioural disorder.

This aspect, as you know, is readily approached by the Electronic Ear. On the other hand, we must consider as capital, in the evolution of the disease, the role of family psychogenesis, since this has conditioned the affective experience of the patient.

The DEATH of the epileptic is well accepted by the family — but it is still too soon, too soon, in our study, to affirm that the very aetiology of the disease is to be found in the death wish that the parents harbour. In the present state of things, what we can say is that one most often finds an overprotective or rejecting, abandoning mother, and an authoritarian or insipid father — which comes to the same thing.

The narcissistic wound is insupportable to the parents who, most often, do not hide their hostility, their desire for a distant placement so as to see him no more. Guilt and rationalisation flow from this. The death wish towards their child entails a fear-desire ambivalence which leads the child without delay to a pathological couple with his mother.

The true drama is that, in our classical therapies, the suppression of the seizure-symptom may reactivate the anxiety, and thereby lead the patient to psychosis, to the refusal of reality.

Clinical research on ten cases

The bases that have led us to undertake this research being defined, let us come to more practical data. To be sure, we still lack hindsight, and the observations are too few to be treated as statistics.

It is fortuitously that the disappearance of seizures has been observed in subjects under re-education with the Electronic Ear. But I hope that what I have just told you has convinced you that it could not be a question of fortuitous circumstances — and that the true face of epilepsy leads us to think that it falls fully within the field of action of the Electronic Ear, and thereby of Audio-Psycho-Phonology.

Protocol

  • Number of cases regularly followed: 10.

  • No exclusion for any clinical form.

  • The children are seen (with their parents if possible) at the surgery or at the Medico-Pedagogical Institute for which I am medically responsible.

We proceed as follows:

  • Classical assessment with electroencephalogram;

  • Placement under the Electronic Ear with allopathic treatment balancing the seizures;

  • Regular clinical and electroencephalographic monitoring;

  • After about three months — and if the state allows it, which has always been the case so far — reduction of doses until total suppression of all medication, within periods of 9 months or more depending on the case;

  • The mothers are, as far as possible, placed in sessions of Filtered Music under the Electronic Ear in a relaxation position.

The programming of the epileptic child differs little from the others in its main lines. It has however sometimes demanded more suppleness — with modulation at the level of listening at 8,000 Hz (period of filtered sounds in intra-uterine audition) — for instance the listening to an unfiltered Gregorian chant at the end of the session in order not to send away a sometimes irritable child.

The usual frequency has been two hours per week of Electronic Ear (that is, 2 times 2 half-hour sessions).

Global results

The results obtained allow us to affirm that there have been no failures, in the sense that all the cures undertaken and followed regularly have brought about a disappearance or a very sensible diminution of the seizures — this despite the more or less significant reduction, or disappearance, of the drug therapy. For three patients no longer presenting seizures, there has been no transition through another clinical form of critical episode. The possible reactivation, in the early stages of audio-psycho-phonological training, has not been noted.

Four clinical observations

Case no. 1 — P.A.G., typical temporal lobe epilepsy

Boy born on 4 July 1959. Poor academic results, stickiness, hazy thinking. The abundance of critical episodes (up to 8 or 10 per day) means that P.A.G. is on the verge of expulsion from the school where he is.

Placement under the Electronic Ear on 9 November 1974, with treatment by Alepsal and Orthenal (suppressing the seizures). Up to 19 June 1975, P.A.G. received 33 sessions of maternal voice in intra-uterine listening (33 VM) and 4 sessions of sonic births (4 AS).

Result: there are no longer any temporal lobe seizures. The academic results mark very clear progress; the general behaviour, both in society and in the family, is in constant improvement. There is no longer any drug treatment.

Case no. 2 — G.R., Lennox syndrome

Born on 6 August 1968. Presents a Lennox syndrome having begun at the age of two (diagnosis of the hospital service which usually follows the child). The latter has received very numerous treatments, including Synacthen. In June 1974, when we see him, he is receiving one capsule of Dopa-Inhibitor at 100 mg of Dopa for 25 mg of Decarboxylase Inhibitor, three half-tablets of Rivotril, 2 tablets of Gardenal 5 and 1 tablet of Valium 5.

At examination, apart from the epileptic symptomatology, the psycho-affective disorders are very pronounced and suggest an evolving infantile psychosis.

As soon as he is placed under the maternal voice with the Electronic Ear, G.R. enters a state of status epilepticus. The mother, for the first time, does not have him admitted to hospital; and after a few seizures, the child stops his convulsions himself. The previous treatment is suppressed by the parents, in an intemperate manner moreover. Since this period (July 1974), G.R. sees his seizures grow further apart; motor function improves very sensibly since the child can go up and down stairs alone. He is beginning to modulate sounds. His psychotic state unfortunately does not allow a listening test to be performed.

Result: the re-education is in progress, the child has only very sporadic seizures, the psychotic lines are regressing. There is no longer any drug treatment. G.R. has received in all, up to the present, 86 VM and 37 AS.

Case no. 3 — F.M., seizures and a syndrome of deficiency

Born on 23 October 1969. A child followed since August 1974 on two levels: first for widely spaced seizures of the comitial type; also for psycho-affective disorders bringing about a syndrome of deficiency with pseudo-debility. Very unstable behaviour, characteriological disorders.

Walking is achieved around the age of 25 months. The beginning of language is situated precisely at the moment when his young sister begins to babble — that is, when F.M. has reached the age of 3. F.M. reacts strongly to the presence of his sister. The family environment is disturbing. F.M. is not yet toilet-trained. There are found, in the course of evolution, episodes of desired regression where, for instance, he asks for the baby bottle.

Since the beginning of re-education under the Electronic Ear, this child of laden pathological past (premature, neonatal convulsions, otitis) has been making obvious and rapid progress. On the electroencephalographic and comitial plane, an improvement of the electrogenesis is noted with, concomitantly, considerable spacing of the seizures. F.M. has no continuous drug treatment, given the very wide spacing of his critical episodes. He has received 106 sessions of VM, 41 AS and 29 sessions of nursery rhymes. The rapid and favourable evolution allows the prospect of normalisation in the coming months.

Case no. 4 — Petit mal and psycho-affective disturbances

Boy born on 21 August 1963. Academic difficulties associated with serious psycho-affective disturbances. Placed in a convalescent home since 1969.

In March 1973, observation of absences of the petit mal type (eye-rolling); up to about 30 absences per day are reported. A treatment is established immediately with 100 drops of Depakine and two tablets of Epidione.

Placement under the Electronic Ear is carried out on 7 February 1975 with maternal voice. On 19 April, the EEG tracing shows a clear tendency towards normalisation. By 13 June, he has listened to 47 VM and 8 AS. There are no more absences upon hyperpnoea, the academic progress is exceptional, the child is stable. The treatment still remains at Depakine 80 drops, Epidione 1/2 tablet.

Advantages of the approach by Electronic Ear

I have therefore presented to you four cases among those I currently have in my care. It is evident that the advantages presented by an audio-psycho-phonological treatment with the help of the Electronic Ear are beyond comparison with other therapies. Let us note among others:

  • Reduction or suppression of medication. The patient is no longer put to sleep: he is no longer compelled to regular intakes which put him back into the situation of disease, even if the psycho-affective conditions are satisfactory — as is the case in certain psychotherapies of epileptics.

  • Suppression in certain cases of a sometimes mutilating intervention, in the domain of neurosurgery.

  • Action upon the very cause of the disease, and not only upon the clinical symptom.

I shall allow myself to note further that, in the example of neurosurgery or chemotherapy, one contents oneself with suppressing the seizures — thereby removing the possibility of a somatic expression of the affects, sending the patient back to his anxiety. Observations of very profound dissociative regression are frequently encountered after suppression of the seizures by a neurosurgical gesture, or even by a simple intake of medication.

However, let us not forget: epilepsy also knows curable organic causes. It is therefore well to know how to eliminate without any risk of error an organic genesis of the disease. One must above all be a meticulous and precise clinician before giving the disease an “essential” origin.

In purely organic epilepsies — by tumour for example — the Electronic Ear can intervene after suppression or treatment of the cause. There, we shall ask it for an eventual facilitation at the characteriological level by the resolution of the anxiety syndrome often observed, certainly related to the personality, but also to the diminution of capacities, and sometimes to the powerlessness always painfully experienced by the patient.

Conclusion

After these few observations, we can say that the Electronic Ear seems able to improve sensibly the clinical condition as well as the social status of the essential epileptic. It is evident that this study lacks hindsight and that the cases observed are too few for us to draw definitive conclusions. However, we have been able to see the importance of the mental and affective background of the epileptic. By modifying these data through treatment under the Electronic Ear, we doubtless have the possibility — the opportunity — to open some breaches in this clinical grouping which, since the distant times of history, has carried within itself all the maledictions of humanity, so much so that the epileptic patient builds for himself a system of defence. And it may even be that this disease is itself a defensive system against endogenous and exogenous aggressions.

In closing, I shall add that because this study — albeit promising — is in its infancy, because these few ideas have been set out too succinctly, and because we must still refine our working hypotheses, I wish a very broad debate.

— Dr E. Derrien, Montpellier.