74 Chapter 4
Psychogenic Voice Disorders
Aronson (1990) lists several psychogenic voice disorders, including musculoskeletal tension
impairments, mutational falsetto, and childlike speech in adults. Musculoskeletal tension disor-
ders are a result of environmental stress. Patients may have a foreign body sensation in the throat,
difficulty swallowing, voice quality changes, and aphonia. Mutational falsetto, also known as
puberphonia, is the failure to change from the higher- pitched voice of the preadolescent to the
lower- pitched voice of the adult. “This high- pitched falsetto type is weak, thin, breathy, hoarse,
and monopitched, giving the overall impression of immaturity, effeminacy, and passiveness”
(Aronson, 1990, p. 136). Childlike speech and voice patterns in adults may result from psycho-
logical regression— the retreat to an earlier, more comfortable psychological state due to stress.
Childlike speech relieves the person of the responsibility of relating to others in an adult manner.
Hysterical aphonia and dysphonia are common psychogenic voice disorders. They are consid-
ered a result of a conversion reaction in which the person loses the voice because of psychic trauma
related to environmental stress or interpersonal conf licts. Some voice specialists have proposed
that the loss of voice symbolizes impaired, diminished, or absent communication with significant
others. Persons with hysterical aphonia or dysphonia may be involved in unsatisfying or dangerous
interpersonal relationships. Some of them seem to welcome the disorder and demonstrate indif-
ference or relief. In the psychiatric lit er a ture, this reaction is called la belle indifference (in French,
“the beautiful indifference”). Hysterical aphonia and dysphonia must be treated by a mental health
professional who is trained to deal with the patient’s under lying psychological and social dysfunc-
tions. According to Ramig and Verdolini (1998), clinical and experimental data support the effec-
tiveness of therapy for the treatment of psychogenic voice disorders.
Case Study 4-1: A 54-Year-Old Man With a Complete Laryngectomy
Tim survived the Vietnam War and retired from the military as a two- star general. He had
lived through many stressful nighttime aircraft carrier landings and had survived hundreds of
sorties and ground- to- air missile attacks. He had also survived a colossal mix-up in which, short
of fuel and f lying on fumes, he could not find the refueling air tanker. Tim had even weathered a
horrendous explosion of bombs and missiles on an aircraft carrier’s f light deck. But tragically, he
could not prevail over the damage caused by cigarettes. He succumbed to throat cancer after years
of battling the disease that took his voice and eventually his life.
Tim requested a voice evaluation from a private speech and hearing clinic after having a hoarse
voice for nearly 6 months. He also complained of a foreign body sensation in his throat. The initial
evaluation confirmed the hoarse voice quality, and as per standard protocol, he was told to seek
a medical examination; other wise, no voice therapy would be provided. This was particularly
impor tant in Tim’s case because he was over age 50 and a heavy smoker. He scheduled an appoint-
ment with a local otolaryngologist.
The otolaryngologist did a comprehensive laryngeal evaluation and, as was usual at that time,
conducted an indirect laryngoscopy. Tim sat in a chair with a light source behind him. The bright
light was directed over his shoulder onto an eye mirror on the doctor’s head. This mirror has a
small hole in it, allowing the doctor to direct the ref lected light to a dental mirror placed at the
back of Tim’s throat. The dental mirror ref lected the light source down the throat, revealing the