Article de : Julia-Flore Alibert
Psychanalyste SPP,pédopsychiatre Institut des jeunes Sourds de Bourg-la-Reine

Cet article a remporté le IPSO Writing Award Europe 2017 récompensant le meilleur article écrit dans la Zone Europe pour l’IPSO (International Psychoanalytical Studies Organization) et sera présenté au précongrès de l’IPSO lors du congrès de l’IPA à Buenos Aires en juillet 2017
Il sera publié en français « Voyage d’une psychanalyste au pays des sourds » dans la Revue Française de Psychanalyse 2017/3 (vol. 81) Sublimations et transitionnalité.

A psychoanalyst’s journey into the Deaf world

Publié le 19/06/17

I would never have thought that learning sign language would have such an impact on my psychoanalytic practice but little did I know...It might seem surprising for a psychoanalyst, whose main working tools are words and listening to words, to find an interest in deafness and in sign language. I started working recently as a child psychiatrist in a Deaf children's institute. This got me to learn and practice regularly French Sign Language (LFS). When starting this adventure, I could hardly imagine the broad impact it would have on both the clinical and theoretical aspects of my practice.

The journey into the deaf World: a necessary loss of identity

At the beginning, learning sign language were painstaking. The teacher was deaf. It was strictly forbidden to utter a single word for a whole week and this for six hours each day. It is no small feat to put aside all one’s vocabulary and rely only on gestures to express oneself after all those years of verbal communication and scientific studies. Among the deaf I was finding myself a new identity as a “hearing person” just as I had discovered myself a “White” in Africa, a “Latin” in English speaking countries, a “European” in America or a “Gadgi” among gypsies… I had to go as far as to forget my name, the time for deaf people to christen me and assign me a sign. That sign can be a distinctive physical feature, one related to one’s behavior or function but it has nothing to do with the original first or last names. This identity loss is transitory but necessary to the journey into the world of deaf people. One feels a loss of bearings and one feels exposed. Deaf people have this increased visual acuity that scrutinizes you in depth and makes you uncover parts of yourself you never had any inkling about, even after years spent talking on a couch…

At first shaken by all those unknowns, I was wondering if I wasn’t wasting my time with this learning of sign language. I had expected some classical foreign language teaching with conjugations, vocabulary lists and grammar. Forged by all my years of study, I expected I would be going home with homework, lists of words to learn and verbs to conjugate. So I was quite surprised to find that a smile, a blown out cheek, a blink of an eyelid or bulging eyes had as much value as a past participle or a modal verb! Grammar is read on the face, no grammar book is needed. My teacher would tell me later that in sign language, vocabulary, meaning words or signs, made only 20% of a conversation.
Hooked like all hearing people to my verbal language as to a life buoy in the affective tempest of human encounters, I had then wondered what the 80% remaining part was made of. How could one understand each other, exchange, talk or tell stories with so few words? French language has about 100000 words and in LSF dictionaries there are only around 3000 signs. I would learn that this language richness should absolutely not be measured by its lexical field, but by its wide iconicity enabling the expression of many concepts without resorting to the standard lexicon. In France, since the “deaf awakening” in the 70s, linguists like Christian Cuxac have studied and theorized the non-lexical structures of LSF, its visual and spatial grammar, they described its “high iconicity structures” and enabled its acknowledgement as a language in its own right in 2005.

Following the Milan congress in 1880, a purely oral education was advocated and LSF was forbidden in deaf institutes in France for more than 100 years. During most of the 20th century, many deaf children had their hands tied during school to keep them from signing. LSF survived but was affected by this. It carries the urgency, the power of expression and the tone of liberty and insubordination dating from its years of oppression. This reminds of the freedom of the jazz music invented by African American slaves in New-Orleans. It took me several days, drawing forms in space at length with my hands, circles, squares, triangles … then cubes, spheres, pyramids, imitating objects, miming situations, watch and be watched by other people, to reconnect with the little mute child hidden inside me and to lose myself to gestural communication. This is what the deaf needed us to rediscover before learning the alphabet, the colors, the days of the week. And it was a re-acquaintance more than a discovery. For we have all kept in a part of our memory this preverbal communication of the mute child we used to be. One just needs to look at toddlers. From nursery on, they are captivated by gestural nursery rhymes; they are able to mimic gestures long before uttering their first words. As they grow up the gestural ability gets lost a little, as is the ability to draw or play, except for those who remain connected to their inner child, artists, creator or those working with children. And maybe even psychoanalysts?
Back in the metro after these days filled with silence looks and gestures, the passengers’ silence suddenly seemed very loud to me. Their looks, their moving hands made me better perceive the 80% non-verbal communication the deaf had talked about, previously invisible to my eyes.

Listening with my eyes

Back in my consulting room, I started listening to patients differently.
I suddenly noticed on a young patient that I had been following for several years a grabbing hand on her throat whenever she would talk about her mother. We recaptured this gesture together and it was a key to the elaboration of her ambivalence towards her mother; opposing her was previously unimaginable.
Another patient would spend her sessions fidgeting with her ring, offered by her parents. Parents she was unable to untie from for she was caught up in an incestuous and alienating back and forth with them. This gesture during the session became louder than all her speeches filled with compulsive and repetitive ruminations and this also led to the elaboration of her impossible separation.
I picked out the gesture of this young man during our encounters. He would always start the session by politely “borrowing” several paper tissues, where he would pour his snot loudly and laboriously and then fiddle with those tissues during the whole session until finally shaking my hand with his own still damp from his nasal secretions. This gesture clearly marked his aggressiveness towards me. His desire to dirty me in contrast to his otherwise meticulously clean and polite ways. This gesture wasn’t part of his verbal speech, but unveiled his behavior way more than all his verbosity. The time is not ripe to act on this understanding, for the man is still very far away from his coprophilia. I will still need to wait a few years for his defenses to loosen.

A case of a supervision colleague came vividly in my mind: this man having a tendinitis on the third finger of his hand would spend his session the major erected towards his analyst while denying any hint of aggressiveness in himself. He was able to realize it only when the analyst pointed out that by this gesture he was clearly giving her the finger...

Interpreting with the hands

Meanwhile in my consulting room, there was a turning point in Aristide’s treatment. The passage to non-verbal and more specifically gestures had a particular importance in the dynamic of his therapeutic process. When I first met him, Aristide was the perfect little boy.  A toddler, neither his shoes nor his knee-length trousers were worn down unlike children his age. Though I could already perceive in his gaze a sort of inner wildness, Aristide stood still, very well-behaved, too well-behaved, and so clean he was unable to “pooh”. This was the reason his parents had brought him to a child psychiatrist following multiple medico-psychological exams. He would only defecate under the action of powerful mechanical enemas administrated into his rectum several times a week. His parents who were a lot like him except for those sphincteric symptoms were refractory to the idea of a psychotherapy. It was to be difficult to establish and maintain a framework along this cure, but Aristide’s defecation after each session would help his parents to accept and trust me.

Aside from his polite answers, Aristide didn’t play or talk to me. For more than a year I would use the “squiggle” technique with him. This would enable him to express a lot of his inner wildness in his drawings. Angry characters who shouted, killed, insulted and kicked, their mouth closed and their jaw clenching. Throughout the sessions, the big closed mouths with by big teeth would gradually open and spit their words as cartoon speech bubbles where he would dictate me what to write. At first blessing dear Winnicott and his squiggle, I started to curse him when after a year Aristide was still not playing and ritualizing his sessions around it. Aristide would come running to his session and always start with the simple same words “Let’s do like last time, you go first”. Those were generally the only words spoken during the whole session. He didn’t even sit on the chair and would remain standing, stiff in front of the table. I would then draw a line on the blank page, then him, then I and this would each time lead us to a different drawing. His last drawing will be the one of the “color war”. A kind of huge brown doodle this time I was not allowed to intrude and we ended in a pen battle. It provided an opportunity to move to figurine games. “You know we could also fight with animals” I told him. He was interested and at last we were able to play bloody animal fights and finally we were transformed in wild animals ourselves. He was “the tiger”, I could hear him on the stairs, arriving to his session rowing, which was not to his parents liking and it would be difficult for me to make them realize this was a progress.

Fortunately by that time Aristide was defecating. No more enema, his parents had to accept the growls. During several sessions, I was devoured by the tiger then by the shark, then we succeeded in uniting and hunt together, making up richer and richer stories, and staging ever more complex emotions. His knees were scabby, his shoes were wearing out faster. Aristide was moving, Aristide was playing.

A new ritual was getting initiated at the beginning of the session, the miming game. We would mime, taking turns, something the other had to guess. The parents ascertaining their child’s progress and his pleasure playing, pulled back, the end of the cure was near. During one of the latest session, boosted by the learning of sign language and tired by the slightly boring miming ritual preceding our fabulous animals’ stories, the idea came to me to mimic him. I therefore imitated Aristide when he came to my office, I played a model little boy, rigid, constipated, and then drawing standing up; I mimicked his angry monsters, the wide mouths closed with teeth, the cartoon bubbles, the pen war, then the tiger the shark and our recent adventures. First dumbstruck Aristide rapidly recognized himself and it made him burst into a beautiful laughter. He told me “do it again!” And I ended up redoing my sequence several times under his wide opened eyes. Then he mimicked me: the doctor with his computer, the doctor drawing, fighting with pens being devoured, the doctor shaking hands with his parents and taking their money… this made me laugh in return. At the last session Aristide took the toy doctor’s case and butchered me with the needle, he operated my stomach, my head, my heart and even made me “a graft with a dead person”. Was this the premises of a surgical vocation?
Much the same as an effective laxative his parents thanked me for my “action” and we parted. During this cure, the child’s difficulties to talk or draw forced me to develop the non-verbal dimensions of our interactions to the fullest. I was left wondering what happened during the final sequence of common imitation. Could this be attributed to a “gestural interpretation” on the analyst side? Indeed the intent in using mimicry was to extract latent meaning from the child’s behavior and communicate it to him. The fact that Aristide would recognize himself and laugh shows the message was heard despite the absence of words. In the light of dear Winnicot works, had I played, with my child impersonation, the mirror role of the mother, enabling in the end a game of cross identifications? Had I used a psycho-dramatic technic of role inversion enabling the patient to become aware of inner dimensions by seeing his role played by somebody else? It is probably the combination of these three references, helped by the gestural mimicry training conveyed by LSF learning that enabled me to invent what happened.

A common language: an illusion?

Most deaf children grow up with hearing families without having a common language with their parents and it strikes me that generally things are not too bad. Few parents of deaf children get to learn sign language. “But how do you communicate?” people often ask them at the institute. Most of them answer “we understand each other very well”... This is what is called gestural mimicry communication. Not that many words are needed to create a common language, a language where emotions can be conveyed.

I regularly discuss with my deaf psychologist colleague on the situation of the institute’s youth she reports. My sign language level is still quite poor, she lip reads and could talk intelligibly with a whispered voice but we prefer to “sign” using the 80% of non-verbal communication. I notice our exchanges are brief, but the essential goes. When she relates her clinical impressions on a young, I turn it into a visual thought, I emotionally feel the situation and I am not surprised when I meet him, he is exactly how she described him. The essential points are communicated, one doesn’t really know how but they are.

Sign language is not universal as people often believe. There is the French Sign Language, the American, the English, the Quebec one and many others. Yet when two deaf people meet, it is a lot easier for them than for hearing people to use those infamous 80% of non-verbal communication. They invent new signs or teach them to one another and can thus connect a lot more rapidly than two hearing people.

During international congresses, exchanges are always very rich and in multiple languages. Some polyglot colleagues work with three or even four different languages during the same day. At the end of those exhausting days switching from one language to another, their minds are full and confused between thousands of mixed words. And what remains them except the transference-countertransference relationship? This impression, this clinical sensation that ties them to the patient and that they almost feel in their bones, beyond words, beyond the language used.

We assume we speak a common language with our patients but is it really the case? Isn’t it an illusion, that makes us believe in an implicit understanding, but carries away its share of misunderstandings and resistance. The language community could pave the way for resistances by abolishing alterity in a connection of collusion. Shouldn’t the analyst be able to dismiss his own language in order to hear his patient’s unconscious beyond words in a form of preverbal emotional listening? Turn back with his patient into the mute child exposed to his parent’s foreign language.

Sign language a high road towards unconscious

A speech in sign language is like a movie in three even four dimensions. One first places the time on a horizontal axis going from past to future, then one sets the scene on an imaginary stage, one next places the characters and then the action. In order to describe each character, the “signer” points his finger at them and embodies them. He then becomes the one he designates and imitates his mimics and emotions just like an actor playing a character. The observer is is faced with a lively act that unfolds in front of him, featuring his interlocutor’s thoughts.

Sign language challenges metapsychology. In the nineties, a French group of psychoanalysts, including Benoit Virole (1990) wondered about the sign status in mental representation and about analogies between sign language and dream language.

LSF by its figurative dimension and its plasticity conveys mental images that have a closer tie with the object represented. It gives a more direct access to unconscious by removing the abstract symbols such as letters and words. Most signers use a process of metonymic or synecdochic representation. In other words, they manage to restitute the totality or the essence of an object through the representation of a part of it or of one of its prominent characteristic. The gestural signifier brings us closer to the primary symbolization, to the first mental representations, and to the archaic or primordial signifiers taking part in the genesis of thought. From a topical point of view, the sign is situated in between the object and the word representation. From an economical point of view, it is at a crossroads between primary and secondary processes.

The dream-thoughts and the dream-content present themselves as two descriptions of the same content in two different languages;(...) The dream-content is, as it were, presented in hieroglyphics, whose symbols must be translated, one by one, into the language of the dream-thoughts.” This is how Freud describes the dream work in the chapter 6 of the interpretation of Dreams.

Like dream and its symbolic figuration, LSF turns thought into pictures using its iconic and its and figurative grammar. It uses moving and condensation mechanisms to pass from one representation to the other letting the psychic energy flow more freely. The process of transformation of thoughts into sign language could be compared to the one from the dream that transforms body stimuli diurnal remnants and dream thoughts into manifest content. A speech in LSF is a pictorial speech that like a dream gives access to the unconscious, provided one knows how to decipher the signs. Thus the deaf world becomes an Eldorado for the psychoanalyst who like a gold hunter rejoices in advance of the treasures he will be able to explore…

Some signs have a message. By themselves they tell a whole story. The sign for “white” uses the image of the white ruff worn by men from the past, the sign for “confess” mimics the opening of curtains in confessionals. One sees what one is talking about and therefore is more deeply and more intimately connected to the thoughts of one’s interlocutor, sometimes even in a crude way. For example the sign for “gynecologist” reproduces a woman’s spread legs on stirrups. All signs from the sexual repertory directly reproduce the acts they are representing. No para-exitation, one dives directly straight to the action! Moreover signs are in three dimensions with sometimes a movement associated to the gesture. They have a dynamic dimension. The sign designing the concept of “Id”, the second Freudian topic, is made of the right fist banging into the left hand that is laying flat. This by itself is telling, the pulsional push is materialized by the fist moving up, the repression strength of the super-ego concretized as the flat hand against which it bumps. This by itself reveals a lot more than the “i” and the “d” put together. Some signs are the results of the concatenation of several signs and also tell of a story. The sign for “schizophrenia” is a combination of the sign for “division” and the one for “slave” that could be translated into “slave of one’s mental division”. The sign for “psychiatrist” is a mixture between “heal” and “soul” and could be translated into “the one who heals the soul” uncovering an open air etymology.

Journeying forward

At one point I asked myself if I was not wasting my time learning sign language, now am I daily amazed by the enrichment it brought me. I keep exploring this word and this fosters my clinical practice and makes me perceive more acutely all the nonverbal dimension of communication. This prevents me from a lot of mistakes and makes me get faster to the point and in the end save precious time. Above all I take real pleasure practicing this language and getting rid for a while of all the heavy words, only to find them again later and play with them better. Those back and forth create a joyful and fulfilling dynamic.

Julia-Flore Alibert, pédopsychiatre, psychanalyste SPP.
Il sera publié en français « Voyage d’une psychanalyste au pays des sourds » dans la Revue Française de Psychanalyse  2017/3 (vol. 81) Sublimations et transitionnalité

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