Opening Channels of Communication

By Clarice Moura Costa

Editorial note: This article has previously been published in Portuguese as a chapter in Clarice Moura Costa's book (1989), O Despertar para o Outro � Musicoterapia [The Awakening to the Other Music Therapy] pp. 79-88, São Paulo: Summus Editorial.

Psychosis, under a psychodynamic focus, is seen as an attempt to deny the enveloping reality which threatens the integrity of the individual, the alterations of the discourse being a defence against society. The subject remodels the linguistic symbols of the culture, using archaic forms of expression as a way to avoid contact with the other.

Watzlawick, Beavin & Jackson (1981), who study communication from the point of view of behaviour, believe that the schizophrenic tries to "not communicate", as if he were avoiding any commitment when facing the situation of "dual connection" in which he finds himself. Acording to the authors, the nonsense, the silence, the immobility, or any other form of denial are in itself communication, then the schizophrenic has the impossible task of denying what he/she is communicating and, at the same time, denying that his/her negation is a communication.

The first problem faced by the therapist who intends to treat a schizophrenic person is breaking the barrier of non-communication raised by the patients. The music therapist must accept their sound-music expression, however basic and destitute of creativity it maybe.

The nucleus around which the music therapy process turns is the action of making music, that is, to produce and organise sounds. At the beginning, this sound production may not have any intention of communicating, at least not at a conscious level, being directed merely to the sensorial pleasure of playing and listening . If the person is playing for himself and enjoying the music, the defence against the possibility of contact with the other drops, or at least diminishes substantially. What is at stake is the actual pleasure of playing and not the commitment to the act of communicating or not. One can see quite easily that many patients sing as they walk through the patios and wards of psychiatric hospitals, for the mere pleasure of singing. The comments made by patients in the first sessions of music therapy refer mostly to the sensorial pleasure of the action of making music, which indicates that this is the aspect which interests the subject.

Despite not having an explicit intention of communicating by the music produced, the act of playing reaches the hearing sense, leading everyone on the group to share a single sound space where those who remain apparently passive are in some way participating in the group event. Upon listening and being listened to, a rudimentary form of perception of the other begins, i.e., the perception of something or someone which belongs to the external space a musical instrument or a person. The isolated individual action becomes thus an action with, that is, a relationship is established with the other through music making.

Music mediation facilitates the establishment of interpersonal relationships by allowing an indirect contact with the social group from which the psychotic person struggles to defend himself. The subject is playing for himself, what does not cause great anxiety, but, although not intentionally, he gets in touch with the other. The acceptance of his musical production makes him little by little start to refer to the pleasure of playing with the other. Thus it is formed the music therapy binomial action/relationship.

It was observed over the years of clinical work and research that the patients, even those who were in very serious states of denial of reality, had an immense repertoire of music broadcasted by the media, singing the lyrics correctly to the music. Even catatonic patients, soon after extracting the first sound from whatever instrument, would start to sing and play with the group, even if on some occasions their participation was limited.

Playing brings the communication of drives or impulsions [1] through a psychomotor activity, which tends to organise itself spontaneously within the habitual rhythmic structures of Brazilian popular music. As musical language is by definition non-referential, the individual can express antagonistic drives without contradiction, without turning the music into something absurd or outrageous. The possibility of expressing their conflicts at a level of thing representation allows the transformation in word representation, that is to say it creates the opportunity to raise consciousness of the conflicts.

Songs fulfil an important role in this process. The choice of music is freely made by the patients, without any previous planning. They occur spontaneously, which means that they are connected to the psychic process at that moment in the mind of the patient. Music is a cultural language, which makes it possible for the therapist to understand what is being communicated by the patient, or at least offers the opportunity to try to clarify or interpret their communication. It should be noted that the word interpret is not being used here in the psychoanalytical sense, of transference interpretation, but in the common sense usual to speakers.

The use of a common language and the perception of the presence of the other already characterises a communicative intentionality. The music therapy process is thus configured as a trinomial action/relationship/communication which although intrinsically interlinked is perceived and made aware in a sequential process.

The music therapy process offers a significant similarity with the hypothesis proposed by Aulagnier (1979), on the evolution of the metabolization of information derived from reality which will culminate in the acquisition of language or the introduction of the infant into culture.

According to the author the psychic activity is constituted by the conjunction of three modes of functioning:

The originary process, in which "all existence is auto-engendered by the activity of the system which represents it";

The primary process, in which "all existence is an effect of the omnipotence of the desire of the other";

The secondary process, in which "all existence has an intelligible cause, made accessible by discourse"(p.30).

Each process, by its basic postulation, will metabolise the information received from the environment in an element coherent with its actual structure.

The author underlines the importance of that which is listened in order to support and sustain how each subsequent process can function, highlighting moreover the significant presence of audio hallucinations in the psychotic cases. The voice-object more frequently than any other can fulfil the function of the persecuting object, as the clinic shows. All those who work with psychotic patients can attest to the compulsion to think and to listen to the thought and mainly to the references made to the voices, which are nearly always making threats. We can ask ourselves about the reasons that give to the voice this strange privilege.

For Aulagnier (1979), the maternal voice has an important role for the entry of the individual in the semantic field. The importance of the mothers voice is also mentioned by Aberastury (n.d.). She says that the experiences with babies show that they recognise the voice of the mother since the first weeks of life and that this recognition has a special role when compared with other ways of recognising her. In her psychoanalytical clinic, she observed that the recognition of the mothers voice is a unique, precocious and total experience. "The mothers voice is not just the mother, but the mother inside the infans (per Aulagnier).The mothers voice also has the meaning of milk which enters through the ears and, when early experiences are relived, this is felt in a concrete, intense and physically gratifying manner" (p. 35).

The appropriation of the semantic field derives from the perception of sound and the maternal voice stands out from the other environmental sounds. The perception of sound passes through three phases, corresponding to each manner of functioning of the psychic system. The listened to possesses specific functions according to the finalities of each psychic process. The three phases are named by Aulagnier the pleasure of hearing, the desire to listen and the demand of meaning.

The pleasure of hearing is the way of metabolising the reality coherent with the original process. In this phase, the sounds deriving from the outside world are not noticed as external to the listener, neither do they carry any meaning. They are just sounds, which cause pleasure or displeasure, depending on the circumstances surrounding the newborn when he hears them a state of pleasure or discomfort and the actual quality of the sound being pleasant or unpleasant. In the words of Aulagnier, "it is therefore necessary to admit the presence of a pleasure of hearing, which does not have in this phase any kind of relationship with the qualitative meaning of the sounds emitted by the environment, referring merely to the sensory quality of the audible"(p.86)

The pleasure of hearing is the first investment of language, and without it, it would not be possible to reach the second mode of psychic functioning the primary process, and its form of perception of the listened to. It is this first pleasure that will transform pure sound into a sign which is the basis of the system of primary meanings.

As said before, the primary function postulates that "everything which exists is an effect of the omnipotence of the desire of the other" and not self-engendered by the omnipotence of its own desire, and thus sound becomes a sign of desire of the first object the breast. The primary process begins to operate as a consequence of the imposition on the psyche to recognise the existence of another space apart from its own. The sound then becomes an informative element for the baby of the presence or absence of another body the first object.

In this phase the body scheme is still not integrated. The body is perceived as a set of various erogenous zones, capaable of experiencing and even imposing pleasure or displeasure. The sensations experienced by these regions of the body, in not being any longer an object of its own desire will depend on the presence or absence of the breast, which possesses the same power of giving or not giving pleasure. In the primary process, it becomes a necessary condition to the investment of hearing the presence of the breast (the metonymic representation of the other) linked to the pleasure of hearing. If the voice of the mother brings pleasure, the baby will desire to hear it and will perceive that the presence of the breast is necessary to this hearing, and that this other body possesses the power of giving or denying pleasure.

From the pleasure of listening, the voice of the mother comes to be perceived as a sign, not only of the mothers presence but also of her desire. In relation to the listened to, the primary process metabolises the perception of sound elements as signs which inform the baby of the maternal desire in relation to himself. What he sees and listens to is translated as an intention of the other to give him pleasure or displeasure. And only in this way displeasure can have a sense. If it is not provoked by his own desire, it can only come about through the desire of the other. The presence of the voice will be invested or rejected, depending on whether the primary considers that its desire will result in pleasure or displeasure for him.

The nucleus through which the language would be developed is made up by these primary signs. In the first stage, a thing representation appears, and only afterwards, a word representation. According to Aulagniers vision, the image of thing and the image of word can merge only because the baby begins to see the listened to.

At the beginning, the primary cannot use the word representation, which only appears afterwards, giving way to mixed productions created by what she defines as primary-secondary. The author admits, therefore, the presence of the word representation, although in an incipient form, in the primary process. But this representation should be adequate to its way of metabolising reality, not possessing yet a meaning accepted by the secondary process later on.

In this primary-secondary phase, the secondary process enters the scene, having as its primary objective to make a discourse, which speaks of reality to the logic of the primary. It is in this moment that the transition from the primary sign to the linguistic sign begins, predicting the form of subsequent psychic activity, in which the entry in cultural language starts.

The listened to, in this transition phase, can only be a source of pleasure if it is transformed into a message of love from the Other. Only pleasure will allow the investment of language, the desire to understand/comprehend the enunciated sign which permits the blossoming of the secondary.

The recognition of a discourse which brings no arbitrary meanings is a demand of the secondary process, in which reality is no longer the fruit of the mothers desire, but a set of definitions about it formulated by the cultural discourse. The entrance in social speech, coincides with the conscience of the I. Although the illusion of the I is the acquisition of knowledge of the object itself, the finality of the Is work is to represent the world and to establish an order of causality between its various elements,which makes the actual existence of the world intelligible. With the loss or negation of symbols or words of the environment, the psychotic will represent the world in a particular and peculiar manner, in accordance with his psychological process.

The coincidence between the music therapy process and the phases of language acquisition, leading to the entry in the mode of functioning of the secondary process, was verified after a study [2] of the commentaries of patients in the music therapy sessions

In the initial period of treatment, it was seen that the patients only speak about their sensorial pleasure, using very limited language, without offering details about the action which motivated them. The patients do not offer signs of concern with the why of pleasure, neither do them demonstrate that they perceived that this pleasure could be due to stimuli coming from outside their own self, from the real world. This indicates a very narcissistic posture, with the relation of object in a very rudimentary state. Some examples of typical answers to the question: "What did you think of the session?"

Pleasant.

The hoity-toity was good.

It was good, I enjoyed it a lot.

I found it awesome, I loved it.

End of discussion. I found the session enjoyable.

Its... interesting... I liked it.

The main characteristic of this first moment is the fruition of sensory pleasure. Comments which reveal concrete thoughts, sometimes quite incoherent and ambivalent, are also made:

Its a pastime, entertainment, I got out of bed, I liked it.

I liked it but I want to leave.

A little sad but it was marvellous. Where there isnt order there isnt progress [3]

There is not, in these initial comments, anything which reveals in a clear manner the discrimination between the I and the other. The comments only refer to the actual subject, sometimes referring to himself in the third person.

I liked the music therapy, the individual becomes happier, at mealtime he has more appetite.

At the second moment, the first signs of distinction between I and not I and the perception of the necessity of the existence of something outside the I in order for pleasure appear. The fruition begins to be attributed to music, and thus, related to an object as in the following comments:

I thought all the music was great, I love music.

The sound is really groovy, I like it.

The playing of the instruments is really good today.

The sound was cool.

I thought the solo instruments were cool.

The piano was really good, I like the piano and the guitar the most.

Schizophrenic persons, according to Vetter(1968), only have experience of objects to which they can react in a concrete and immediate manner, often considering them as part of themselves, and not belonging to an outside and ordered world. The musical instrument can be experienced as an extension of the actual body. The sound can almost be perceived as if it were self-engendered and it relates to the pleasure of the subject, involving psycho-motricity as well as listening. However to make it sound, the subject real and voluntary action is necessary.

When the subject becomes able to recognise that pleasure comes from an object which exists outside himself (music and musical instruments), he comes to identify himself as an agent, as the subject of action. Musical expression becomes richer, and the individual seeks to explore the diverse possibilities of instrumental usage.

Im going to try all of the instruments.

I enjoyed having a good go with the conga drum, I stopped because my hand was hurting.

The session was really good and I liked the "boom boom". Today was really good, I liked the "boom boom", I sang it (samba-theme).

I thought it was good, I played the instruments, I tried the coco (Brazilian instrument). I preferred to come here (to the music).

The comments show a clear awareness of the desire to play, sing, and "make music". Note that the individual places himself as the subject of the action, and comes to be the agent of pleasure. The fruition does not come by itself, no longer being self-generated by omnipotent desire, but depends on a voluntary and conscious action of the subject.

This moment marks the emergence of rudiments of perception of the other, of the group, mediated by music and musical instruments. Rudiments of the attribution of meaning to the developed action also appear.

Sound space is interactive by its very nature, once sound is perceived by the actual subject and by the other. Sound space is therefore intrinsically shared and has a communicative property. Once the subject experiences the fruition of the stage previously described, in which he evolves from the pleasure of making to the making of pleasure, he starts to see music and the musical instruments as representatives or substitutes of the other.

The first references appear, although indirectly, to the other members of the group, sometimes involving and sometimes excluding the subject himself.

It was good, they sang "Máscara Negra"[4]

They sang "Bandeira Branca"[5]

They started with the "ai ai ai ai ai", in the middle of the music.

I thought it was good, very noisy, very much an international sound, its what we play here.

We mixed a bit of music and "pontos de macumba"[6], it was great.

By the comments one can be perceive unequivocally that music intermediates the relationship with the other, it fulfils the role of intermediary object in the group relationship in which the patient participates. This suggests a still precarious level of awareness of the interpersonal relationship that is occurring.

The importance of the music in this phase seems decisive, mediating, facilitating and creating favourable conditions for experiencing and becoming aware of the interpersonal relationships in the group.

This appears in the comments:

I stayed silent, but I participated.

I should have changed instruments.

Although silent the individual listens and enjoys the groups musical action, he feels like a member of the group. Through listening or playing instruments it is possible to get closer to the other.

When the individual recognises the music as representative of the relationship with the other, he begins to feel the need to harmonise the musical production, of making music with sense.

The instrument that I like the most is the tambourine, but I dont know how to play it strongly and softly. I play it in church like I clap my hand. Very good. (the session)

If you dont know the instrument it is difficult to play it.

Im beating it out of intuition, Im not used to playing this instrument.

The concern with performance shows the beginning of the attribution of meaning to the music. It is no longer any sound which gives pleasure. Sound has to be organised like language, both to make pleasure as well as to communicate with the other.

The first time it was more varied. Certain instruments stood out. It is important to make the sound uniform. It was lacking this music, communication, song.

It was good, it organised-it disorganised, it organised-it disorganised.

I thought it was good, if it were more organised it would be better.

The pleasant experiences in the first phases lead the patient to a subsequent moment, characterised by a clear reference to the existence of other people in the group. At this moment, the existence of the desire to listen to the other is evident, at first as an agent who makes music.

The examples that illustrate this:

This girl knows a lot of samba.

I liked the music that she sang. I liked E.s music. I liked what she sang.

I liked what they sang. I didnt sing.

I played for them to sing.

I thought the sound was dry, because everybody played for themselves and nobody for anybody else.

Afterwards, references to the inter-group relationships began to happen. The subject can now leave aside the intermediary object and can relate directly with and speak directly about the other people in the group.

Are you ill? Youre sad, Ive never seen you like this.

M.S. gave me strength.

You are an intelligent American.

I was sad because the girl went looking for J.

Are you coming to visit us? (referring to a patient who had been discharged).

E.s father is visiting her, thats why she hasnt come.

One can see the occurrence of a phenomenon analogous to that described by Aulagnier as demand of meaning that occurs in the secondary process. In this phase, the patient is already able to speak about himself, his feelings, his emotions, his interpersonal relationships within and outside the group. During the period as inpatients, we can usually observe only an incipient process of introspection, which leads to insights. In the outpatients who undergo a longer period of treatment, there happens, increasingly, a deepening in the sense of introspection, of self-awareness of the subjects condition and how the subject relates to people, to society and to the culture to which he belongs.

Examples of this phenomenon, spoken by inpatients:

You are ill and so am I.

It was less lively then it was the other day, I am tired. I think it was me who was less lively.

I take part, but only God knows how I am inside. Let me explain: I am laughing outside and crying inside, because I remember my children, I cant forget.

Me here I am tired of this hospital. Outside Im going to face difficulties. Obviously, more so here inside. One person takes their clothes off, she is given electric shock, there is dirt, Im horrified, how long it is Ive been here?

They are not here to teach us anything, it is to put things out. The music therapy helps to externalise our nerves, our issues. Music calms us.

She is sad, and Im also rather down.

It is possible to state that the music therapy process starts with the experience of the pleasure of making, merely sensorial, connected to hearing and psycho-motricity. There is thus a small modification, but very important, by revealing the beginning of a new meeting of the individual with his own identity. The patient begins to identify himself as an agent, as the subject of the action of making pleasure, although still only for himself. The acceptance of his musical production by the group leads him to be aware of the existence of the relationship with the other, and, afterwards, to the possibility of communicating explicitly, in verbal language, with the therapist and the group.

This process is not linear, there being stoppages, reversions, and even failures with some patients. However, in terms of the evolution of the group, one notes that the comments follow along the time, through phases described. The references to the making of music are always present, this being the core of the music therapy process, but the speech about the actual feelings, emotions, conflicts, become constant and more numerous in the more advanced stages of the therapy. The incoherencies of discourse disappear and the psychotic symptoms decrease considerably, coming to be considered as problems to be solved.

The music therapy process then appears as the opportunity to (re)experience very archaic phases in the constitution of the ego, but in a new manner. Sonority, in this new experience, is introjected as pleasure, leading to the possibility of a relationship with the other and of insertion in cultural discourse.

Notes

[1]Trieb, in German

[2]Moura Costa & et. al. (1988)

[3]Order and progress are words written on theBrazilian national flag

[4]Black Mask Zé Kéti and Pereira Matos

[5]White Banner Max Nunes and Laércio Alves

[6]Ritualistic Afro Brazilian music.

References

Aberastury, A. & Alvares de Toledo, L.G. (n. d.). La Musica y los instrumentos musicales [Music and Musical Instruments]. Revista de la Asociacion Psicanalítica Argentina, T. XII, n. 2

Aulagnier, P. (1979). A Violência da Interpretação (The violence of Interpretation). Rio de Janeiro: Imago

Moura Costa, C. (1989) O Despertar para o Outro Musicoterapia (The Awakening to the Other Music Therapy) São Paulo: Summus Ed.

Moura Costa, C., Negreiros, M. & Azevedo, L. (1988). Therapeutic Value of Music Therapy for Schizophrenia Research Report, unpublished.

Vetter, H. (Ed.) (1968). Language Behavior in Schizophrenia. Springfield, Illinois: Charles Thomas Publ.

Watzlawick. P., Beavin, J. H. & Jackson, D. D. (1981). Pragmática da Comunicação Humana: Um estudo dos padrões, patologias e paradoxos da Interação [Pragmatics of Human Communication: A study of Interactional Patterns, Pathologies and Paradoxes].