"How to treat language disorders"

Fifth interview of the series Alain Gerber × Alfred Tomatis in SON Magazine. In no. 34, January 1973, Tomatis describes concretely the clinical protocol of the audio-psycho-phonological treatment for dyslexia, stammering, schizophrenia and language disorders. Five stages: sonic return, filtered sounds (from the recorded maternal voice), sonic birth, prelanguage, language. Dosage: three months for benign cases, one year for severe cases, sixty to ninety sessions for a mild dyslexic. Tomatis insists on the term “education” rather than “treatment”, details the pedagogy of the maternal voice filtered at 8,000 Hz, the progressive descent of the filtering for sonic birth, the prudent introduction of the paternal voice (perceived as “violation” and “the bear of legend”), and concludes on the necessity of involving the whole family — including the father, “a very difficult animal to approach” but often himself carrying a “left-handed voice” that must be treated in order to fix the progress of the children.

“SON” Magazine — no. 34 — January 1973
Audio-psycho-phonological education
Alfred A. TOMATIS: “How to treat language disorders”
Interview gathered by Alain Gerber

Presentation

Disorders of hearing, of phonation, of writing, of behaviour: so many accidents of trajectory that may handicap a child. To these imbalances, Professor Tomatis proposes a certain number of remedies that Alain Gerber sets out for you here.

The “ideal sonic path”

According to Alfred Tomatis, who has been able to observe that the hearing of a human being arrived at maturity was the fruit of an evolution in multiple stages, there exists an “ideal sonic path” on which depend closely not only our manner of hearing, but our manner of speaking and our manner of reading.

From the carnal communication of the foetus with the maternal womb to the most fertile verbal exchanges, the track is uninterrupted, but it is long and strewn with pitfalls. It is so arduous, in truth, that short of a miracle, one cannot follow it without being the victim of one or several accidents of trajectory. The idea of a perfect maturation, without hitches or blemishes, is precisely only an idea. In fact, things always happen otherwise.

The subject’s relation with the environment is at each period of his evolution, and almost at each instant of each of these periods, threatened with being troubled, or even cut outright. From before birth, for example, communication with the mother may be deficient. After birth, the risks are still greater. Education itself, which sets itself the opposite goal, contributes in large measure to multiplying them.

Whatever you do, Sigmund Freud said roughly to parents and educators, it is bad. Each case poses new problems for which one must, gropingly, invent new solutions. This for conscious conflicts alone, for there are also — there are above all — unconscious conflicts, all the more redoubtable in that, by definition, they do not allow themselves to be perceived except by specialists.

It is not appropriate, however, to be unduly pessimistic. For a majority of individuals, an equilibrium ends up establishing itself in spite of the worst difficulties. Moreover, with the progress made by medicine and psychology over a century, it is now possible to reduce certain disorders occasioned by defective relations of the subject with his entourage.

The field of action of Audio-Psycho-Phonology

Professor Tomatis, for his part, has tackled those that affect the circuit of hearing and phonation: certain types of deafness, certain language disorders (stammering among others) and of reading, since, according to him, dyslexia finds its origin in defective hearing (itself determined by deficient communication with the environment, the father in particular). All these accidents, of course, are essentially psychological, and that is what allows them to be remedied without any medicinal or surgical intervention.

Pedagogy rather than treatment

The treatment that Alfred Tomatis proposes consists in making the patient traverse the ideal path he should have followed since his conception. To this end he uses the Electronic Ear, which we presented in our issue no. 30. “I am reluctant about the term ’treatment’,” he specifies. “I prefer that one speak of pedagogy. It is indeed one, since it is a matter of coming to the aid of a subject prisoner of a certain immaturation and who, in a way, has remained stranded in his evolution. There is nothing to ‘cure’; one need only awaken a certain number of potentialities that have not yet been exploited. One cannot even speak of re-education: it is indeed of ’education’ that it is a question — insofar as one can consider existence as a permanent education. We help the individual to attain the level at which he can live to the maximum of his possibilities.”

The five stages of the method

The electronic apparatus at his disposal, as well as the numerous montages it permits, gives Doctor Tomatis the possibility of making his young clientele relive the ideal sonic evolution whose trajectory his work has allowed him to determine.

Briefly, the method consists, taking as its support the fact that a communication already exists between the foetus and the mother, in arousing in the subject the desire that this communication should continue after birth, with the mother first, then with the father, and finally with society as a whole. The itinerary begins in the “dialogue” of the embryo with the womb (a dialogue which, in fact, may itself be impoverished, obliging the practitioner to start over from scratch) and ends with the subject’s insertion into the social context (an insertion which, in its turn, is at the origin of an itinerary, much more personal that one).

The different stages that characterise it can be re-created in the laboratory, thanks to the Electronic Ear. One thus distinguishes five main stages in the method used by all the centres which, in France or abroad, claim affiliation with Tomatis. To facilitate his task, as well as that of his collaborators, he has given them names:

Sonic return
Filtered sounds
Sonic birth
Prelanguage
Language

But he takes care to underline that this terminology “has value only through the use the users of the Electronic Ear make of it”.

Dosage and organisation of sessions

According to the nature of the disorders, one insists more particularly on this or that episode of the audio-vocal education, but in every case, it is one and the same technique that serves as the basis of the approach. The latter, Tomatis specifies, “will extend over a quarter in benign cases, a year in severe cases. There remain, of course, individual cases that it is impossible to schedule precisely in time. However, the norms I have just stated prove valid in the great majority of cases. The most favourable solution is to provide for four sessions of half an hour every day, for a fortnight, then one or several impulses of 32 sessions (4 sessions of half an hour for 8 days) spaced 3 to 4 weeks apart.”

For children living far from the centre, it is preferable to consider staying on site for the duration of the education. Moreover, with regard to schools equipped with expression laboratories applying these techniques, the sessions are daily, with a stop of one or two days at the end of the week. Whichever solution is adopted, it is very important to ensure that the rhythm of the sessions is strictly observed.

Filtered sounds from the maternal voice

It has been said several times that, for Tomatis, the need to communicate is elaborated when the child is still in his mother’s womb. At that time, his listening is characterised by the fact that it operates in an aquatic milieu, since he himself is immersed in the amniotic fluid.

Now it is possible, by passing the sound through electronic filters, to reproduce artificially a hearing similar to that perceived in the amniotic fluid. The “filtered sounds” are a direct application of this principle. They place the subject hearing them in the conditions of his intra-uterine life and awaken in him the desire “for the most archaic relation, that with the mother”.

In general, these filtered sounds are produced from the maternal voice, which is one of the main “noises” perceived by the embryo. How does one proceed? One begins by asking the mother to read, for half an hour, a story that, in her view, is likely to please the subject. She is recorded under conditions which must allow, in view of the filtering, the conservation of the high frequencies. It is essential to carry out this operation on a good-quality apparatus, professional or semi-professional as far as possible, linear up to 15,000 hertz. Then, in the laboratory, the sounds of the maternal voice are filtered above 8,000 hertz, and a montage is made that will permit, the inventor of the system specifies, “the ear to be re-immersed in the conditions of a distant lived experience, the most ancient that it was given to it to perceive”.

The use of the voice of the child’s own mother in treatment is indispensable to its success. “However,” Tomatis notes, “in cases of adoption, which arouse, as is known, so many affective problems, we have on occasion recorded the adoptive voice and provoked intra-uterine sonic revival from this voice. We have often obtained surprising results which have allowed us largely to eliminate the tensions and blockages existing between the adoptive mother and the adopted child.”

What happens, however, when, following a divorce or a death, it is impossible to obtain the cooperation of the mother or of her stand-in? One then has recourse to filtered music, but this substitution raises a certain number of problems, for experience shows that not all musics entail the same reactions. Alfred A. Tomatis has noted, for example, that “musical themes are all the more effective in that they are rich in high frequencies and come close to the Mozartian rhythms or to Gregorian chants”, but he also recognises “that there is much to say and much to do about the choice of modulations to be filtered”: musicologists and psychologists are cordially invited to set to work.

From irritation to bliss

The number of sessions depends largely on the case treated. Sixty to ninety sessions of half an hour may suffice for a mild dyslexic. For a schizophrenic, on the other hand, one must envisage a series of 60 sessions, followed by several series of 30 sessions, spread over a year minimum.

The period of filtered sounds continues until the subject accepts communication with pleasure. During the sessions, the child is invited to play; he is offered drawings to make, puzzles to put together. Why encourage him in a ludic attitude? So that he should not offer resistance to this kind of de-conditioning from which he is benefiting without knowing it.

Certain subjects, at the outset, systematically refuse to listen to maternal sounds. They claim that this voice irritates them, or compare it to a bee always there beside their ear, ready to sting… Then comes the time of bliss: “the desire to listen manifests itself in the whole behaviour of the child, who awakens, stirs, wants to communicate, is taken with an immense desire to live and to externalise himself, as if this sensory memorisation allowed him to recover a past still virgin of all the conditionings of life, of all the troubles lived. Thus one might think that everything vanishes, as if there were an erasure of the blockages that had confined the child in the uncomfortable situation in which he had been ever since”.

Sonic birth

It is after a certain number of filtered-sound sessions that the operator carries out the “sonic birth” to which we have alluded on various occasions in our previous issues. It is, as is known, a matter of having the subject pass from hearing in an aquatic milieu to hearing in an aerial milieu. To this effect, during a session, the filtering of the maternal voice is brought down from 8,000 to 100 hertz.

This phase in particular makes it possible to rebalance “all those who have not been able to find, at the proper moment, at the other end of the communication, the voice of their mother”, certain premature children for example, or children who were hospitalised while still infants. Thanks to it, the subject will be able “to relive or to live in a few sessions this crucial moment of his human existence during which he should have been born into the world through his maternal relation”.

Prelanguage and the encounter with the father

So far, the child has remained passive. After sonic birth, the active phase will begin. This time, the disorder itself will gradually be tackled. In the case of a language disorder, an effort is made to arouse, then to excite, in the subject the desire to enter into verbal communication with the environment. “Abandoning the monologue passively absorbed under the conditions specified above,” writes Tomatis, “we direct the young aspirant to communication towards social life. The maternal relation, which seemed one-way since emanating from the mother alone, gives place in the child to the desire to elaborate dialogue.”

This dialogue, the child will seek above all to establish with the father who, for the child, is the other — “meaning,” Tomatis specifies, “the other than the mother”. For such is the rule: at the unconscious level, the child never quite distinguishes himself from the one who bore him in her womb and brought him into the world, whereas he immediately encounters the father as a third party, as the nearest of strangers. Alfred Tomatis has taken these lessons from the most current psychoanalysis and has tried to put them into practice.

At the outset, he had the subject hear the paternal voice directly, but this method provoked extremely marked negative reactions in his young patients. “One does not pass so easily from the language of the mother, which is a truly specific language, to the language of others. This penetration by the third party is felt as a veritable violation by the child. It is not too strong to say that the presentation of the father’s voice for certain children signifies the encounter with the bear or ogre of legend, with the undesirable, with the adversary. Hence the sessions of paternal voice may sometimes end badly. One witnesses very spectacular aggressive reactions; the child grows angry, begins to cry, the headphones flying to the other end of the room!”

“It is fascinating to see how much the injection of the paternal voice is one of the most extraordinarily explosive revealers. Its informational value is considerable. It reflects the image the child has of his father. It is particularly significant in the left-handed child who, by definition, is the one who refuses the right, the father, the Verb. Comfortably installed in his unique relation with the mother, the child deliberately rejects the father’s voice, that link with the environment, that launching pad towards the outside that should lead him towards a liberation he refuses.”

To avoid this kind of resistance to the treatment, this phase will begin with a certain number of sessions of filtered music which, by immersing the child in a sonic bath that washes away his anxieties, prepares him for a more serene acoustic encounter with the father.

Language and the encounter with self

The following phase allows the last stage of the ideal sonic path to be accomplished. At the previous stage, the subject was prepared to encounter the other (the social universe), the father. This time, it is a matter of bringing him to encounter himself, that is to say, to accept himself. By various means (including once again the listening to filtered music), the self-controls that guarantee a good adaptation of the individual to his own realities and to the conditions of existence imposed by the environment are reinforced.

As one might suspect, this last phase requires, even more than the previous one, an active participation of the child. The dyslexic, for example, will be asked to read aloud.

The results observed

When the programme ends, the disorders (of hearing, of phonation, of writing, of behaviour, etc.) have disappeared, or at least have been reduced in considerable proportions. Moreover, the general state improves noticeably, especially at the psychological level. The results obtained, notes Alfred Tomatis, “manifest themselves in particular through greater stability of behaviour, loss of aggressiveness, calmer, deeper sleep without nightmares, normalisation of appetite, the appearance of a hitherto unknown euphoria.”

“The child becomes joyful, glad to be alive. On the school plane, the organisation of work becomes easier. One notes a better overall yield through increase of attention, of the power of concentration, and through a broadening of memory.”

Among dyslexics in particular, but also in other types of children, “reading is more fluid, conducted in a tonic voice and supported by a good intelligibility of the text. Spelling mistakes disappear by successive leaps. On the plane of expression, one also notices a greater mastery of ideas which entails an improvement of composition. The recitation of texts, both prose and poetry, is done with ease. The school report reveals good marks in history, geography, natural sciences. The temporo-spatial notions, which install themselves in parallel with the crystallisation of right-handed laterality, explain the enormous progress made by the child in the domain of arithmetic and mathematics.”

Thereby, it is the entourage that derives by ricochet a benefit from this audio-vocal approach. In its turn, the family cell is made euphoric, its collective anxiety disappears and gives place to calm. “The storm,” writes Tomatis, “is henceforth averted, and while the child opens, blossoms, becomes talkative, takes an interest in what surrounds him, gives notice of his presence, of his existence, the family balance is re-established.”

The participation of the parents

Alfred Tomatis does not hide that he needs the parents — their understanding and even their direct collaboration — to carry out his educational enterprise. To begin with, he will ask them to show patience, not to try to hurry the child, not to measure his progress, as is often done in the families of dyslexics, only by the yardstick of school results. Then he seeks to involve them more actively.

During the filtered-sounds period, for example, the mother must not content herself with lending herself to the recording of her voice that is indispensable to the treatment. She must exercise, through her attitude towards the child, a function of regulation over his affectivity and behaviour. This phase of the treatment is indeed critical: for the duet of love that establishes or re-establishes itself between the subject and his mother is interrupted by scenes often violent, owing to the excessive reactions of the child, who at times shows himself overly affectionate and at others exaggeratedly vindictive, as if he wished “to liquidate a past for which he holds the mother alone responsible”.

From all this turmoil, however, serenity will emerge, if the mother has the intelligence and the strength to control her own reactions. “The attitude we recommend to her,” Tomatis specifies, “is to bear with a smile this somewhat disagreeable moment, without reacting to the repeated retorts and pestering of the child. Any too-brutal intervention would block, in large part, the child’s evolution by new withdrawals on his part, who finds himself made to feel guilty. Experience has shown us that all the affective discharges expressed during this period are released unconsciously. They are moreover often necessary to the good progress of the education undertaken. They seem, in their manifestations, on the scale of the importance the child has unconsciously attributed to the very causes of his blockages.”

“Next, the father will need to be summoned, in order to be informed of the relational problems and their repercussions in the family constellation.” He will also need to “be made aware of the considerable help he will be in a position to bring by accepting that linguistic bridge that is dialogue”. Indeed, “the encounter between the child and his father remains an essential element of social communication. It is difficult to achieve. It requires, on the father’s part, a very great availability, an openness, a broad understanding of the child’s psyche”.

When it is the family that resists

If Tomatis has reached these conclusions, it is because he needed to understand a certain number of events that occurred during the sessions. Thus he often recorded, on the part of the children treated, resistances that manifested themselves above all at the level of feeding behaviour: the subject refused to eat or devoured whatever presented itself. At first, he believed these were hostile reactions emanating from the child himself. But soon he realised that in fact, it was the family that resisted, and not the child.

Naturally, these resistances are most often unconscious, but they are not the less effective for that — quite the contrary! It is thus that the practitioner is led to see in consultation mothers who bring him their child, and who however, at their deepest, in their darkest, do not wish for him to be cured, because their unconscious finds an interest in the state their conscious deplores. In this case, one cannot arrive at a result except by treating the mother first or in parallel with the child.

“Moreover,” observes Alfred A. Tomatis, “we live phenomena of empathy. The anxious individual sows anxiety around him. A child cannot conquer his equilibrium if he lives with people who are not themselves perfectly balanced. On the other hand, I have been able to observe that the tensions born of these imbalances themselves form obstacles to communication: a child never speaks to an anxious adult. Look around you: at table in a family, when the father has serious worries, everyone would like someone to open their mouth, but nobody manages to speak. This is why it is not enough for us to meet the mothers: we also need the cooperation of the father.”

The father, “a very difficult animal to approach”

“The trouble is that he is not easily moved! The father is a very difficult animal to approach,” says Tomatis. Why? In the present case, because he confusedly knows, at the unconscious level once again, that he is implicated at the first stage in his child’s disorders, particularly if they are language disorders. “It is he,” Tomatis observes, “who is the bearer of Language. It is he who is invested with the Verb. He knows he is implicated, either because he did not wish to give language, or because he feels incapable of doing so, or — and this is the most common case — because he is obscurely jealous of his son and does not wish to give weapons to a rival by favouring the treatment of his shortcomings.”

To obtain the cooperation of the fathers, Tomatis and his collaborators resort to subterfuges: they make them understand that the moment has arrived when their collaboration has become absolutely indispensable. If this is not enough, they then have recourse to less noble but often more decisive arguments: they explain to them that without them, the treatment is going to last much longer, and that the bill will increase accordingly!

“I know few,” Tomatis observes with a smile, “who resist such arguments! To make their task easier, we have organised sessions on Saturday and Sunday. When they sincerely accept to collaborate with us, the desired goal is reached very quickly. The success of the enterprise is assured.”

The “model” family with four damaged children

“Sometimes, we notice that the disorders recorded in the children are a consequence of disorders from which the father suffers. The latter must therefore be persuaded to undergo treatment in his turn. Let me cite the very significant case of a family with four children. The couple formed by the parents was a veritable model: harmony, intelligence, etc. And yet, all four children were damaged. All were left-handed. One was afflicted with extraordinary stammering, another was blocked in such a way that he passed for retarded, and so on… All four presented serious disorders of language or behaviour; all four, moreover, were extremely gifted. It took me an enormous amount of time to get them out of trouble. I finally succeeded, after all sorts of vicissitudes, but every year I was obliged to give a global treatment to these children to fix the advantages obtained by the educational approach. And this until I took the father himself into treatment!”

“This man was remarkable: he had astonishing qualities. But at the same time, he had what I call a ’left-handed voice’, that is to say a poorly placed voice. Serving as a model to his progeny, he had ’left-handed’ everyone: hence the disorders presented by the family, since, as you know, to be in perfect physical and mental health, one must be right-handed… all the way to the left! Since I have followed him, my annual interventions have become unnecessary. This shows enough what responsibility the father can have, even a model father like this one, in certain deficiencies that affect his children.”

The individual is ill “with” and above all “through” others

This also shows that a great many people are secretly implicated in the illness of a single one. One must demand an account not only from father and mother, but from more distant relatives, from friends, from neighbours, from the school, from the State, from institutions in a general way. The environment, indeed, is all that, and it is the environment in its totality that one would have to treat to do the work properly. As soon as it is a question of psychology, one can no longer speak of individual illness. The individual is ill with and above all through others. In a certain way, one may say that he is ill of society. The therapist is therefore placed before an infinite task which, moreover, earns him the hostility of a collectivity not pressed to recognise its wrongs. Must he for all that succumb to discouragement?

Certainly not, and Alfred Tomatis’s adventure is there to testify. Little by little, he has prolonged his radius of action, extended his influence, ensured the penetration of his scalpel of new ideas into the social body. The day before yesterday, he was making mothers accept the off-putting idea that they were implicated in their children’s disorders; yesterday, it was the fathers’ turn; today, he is tackling doctors and teachers. The road is still long, since it has no end, “but,” he says, “I am in no hurry. If there is one thing this profession has taught me, it is patience. Patience and hope.”

Place of this interview in the series

This interview is the fifth of a series of fifteen published monthly by Alain Gerber in the journal SON Magazine from September 1972 to December 1977. For the complete contents and access to the other interviews, see the mother-article of the series.

Source: Alain Gerber, “Audio-psycho-phonological education — Alfred A. Tomatis: How to treat language disorders”, SON Magazine no. 34, Paris, January 1973. Digitisation: Christophe Besson, June 2010.