The Mute Patient

Louise, forty-one, high-school librarian for the last twenty years, sees me once a week, but she hardly says anything, at least that was true up until her fifth year in treatment. She would come, stare at me for a while. We would sit in silence, surprisingly with a sense of comfort with one another. I would ask her some open-ended questions, she would answer with a word. “How are you?” I would say, with enthusiasm that comes with looking forward to seeing her. “Fine,” she would answer, rather abruptly. Then, we would return to silence, broken by me speaking again by saying “it seems like you don’t feel like talking today,” to which she would nod in the affirmative. We would sit in silence again, until I started musing with her. “I am wondering about your work, your play time, your relationships,” all of which I knew little about. She would look at me, with no verbal response, but with an expression that made me think she was pleased that I was thinking about her. Eventually the sessions would end and I would say, “see you next week” and then she would politely get up and leave. I suspected that, as with many mute patients, both children and adults, that Louise had a lot to say, once she was comfortable saying it. Sure enough, one day, seemingly out of the blue, Louise started talking. She described a traumatic past of not knowing her father since he left when she was an infant. Her mother was “mean to the animals” she said, as a way of saying, if you can be mean to pets, imagine how mean you can be to your children. Over time, Louise went on to describe both physical and emotional abuse at the hands of her mother, although her younger sister was not victimized in the same way. For reasons which Louise is confused by, Louise was the target and focus of her mother’s rage. “So why do you think you were so quiet with me for all of these years?” I ask my long anticipated question. “I wanted to see if I could trust you. I could not trust my mom, so I had to check you out to make sure you were not like her,” she responds, as if she knew that question was on my mind. “So how did I pass the test?” I asked, having no idea of the answer. “Well, you were patient with my silence for such a long time, I figured that had to be a good sign,” Louise responded, surprising me that it was simply my tolerance and acceptance for where she was at, that made her feel that she could trust me with intimate details of her early life. In that moment, I felt such gratitude to so many of my teachers from medical school, psychiatric residency, child psychiatry fellowship and analytic training, who taught me that patients get comfortable in their time and not ours. So true.

 

See also…https://shirahvollmermd.wordpress.com/2012/02/10/mutism-the-meaning-of-silence/

Mutism: The Meaning of Silence

Alina, six years old, did not speak for her entire kindergarten year. She learned to talk in full sentences by three, and she was a very bright and articulate child, but she was “scared” she told me in kindergarten so she never said one word. Her mom reports that she was not too worried about that, since she felt that Alina would speak when she wanted to. The psychoanalytic saw is that children become mute when there is a family secret. The child is afraid to say the wrong thing, so to make sure that does not happen, the child does not speak at all. Alina came to my attention, not because she was mute in kindergarten, but because the mother was concerned that she was mean to her younger sister, age four. I was perplexed by her history of mutism. To be mute, especially for an extended period requires an amazing amount of tenacity. It is like the anorexic who does not eat, even though they are starving. The control suggests that the child might feel out of control and so not speaking might be one way to feel that life has some order. My guess is that this relates to her relationship with her sister. Alina’s unhappiness might first be manifested by her mutism and now is manifested by her aggression to her sister. I am excited to see how my relationship with Alina unfolds. I am optimistic that together, Alina and I can work through play an understanding of what is troubling her.