Voice and Resonance Disorders 79style, his days as a minister were numbered. Joseph and the clinician agreed that a compromise
was necessary.
The compromise involved the emphasis Joseph placed on sounds, syllables, and words dur-
ing his sermons. At one extreme, Joseph could continue to use his previous strong increases in
loudness and abrupt changes in pitch to dramatize his speech. This type of delivery would cause
chronic voice prob lems and possibly permanent damage to his voice. At the other extreme, Joseph
could deliver his sermons with monoloudness and monopitch, using softly spoken words and
phrases. That delivery was unacceptable to Joseph, who feared it would create boring and uninspir-
ing church ser vices. The compromise involved minimizing the vocally abusive be hav iors, using
the public address system, speaking with relaxed speech musculature, bathing the vocal cords in
plenty of liquids, and resting the voice before and immediately after the sermons. To achieve this
compromise, during several therapy sessions Joseph practiced his delivery to learn the strategies
of reducing the vocal abuse.
Although the compromise did not completely eliminate Joseph’s chronic voice disorder, it
reduced its frequency and severity. Joseph no longer required surgery, and his voice did not fade to
a whisper at the end of the ser vices. He continued the ministry and learned to deal with his voice
disorder and the propensity to develop vocal nodules. Joseph viewed the disorder as a test of his
faith and resolve as an evangelist.
Case Study 4-4: A 22- Year- Old Woman With
Psychogenic Aphonia
It seemed that Betsy had always been at odds with her mother. Both women were intelligent
and strong willed, and they frequently clashed. While growing up, Betsy had had a close relation-
ship with her father, but after her parents’ divorce, he moved to the West Coast. Betsy spent several
summers with him, but during the school year their relationship was limited to weekly telephone
calls. After graduating from high school, Betsy took several low- paying jobs that required her to
live at home. When she turned 21, she became a bartender at a tavern frequented by college stu-
dents. Shortly afterward, Betsy lost her voice.
Betsy could not identify the source of stress between her and her mother. In high school, their
clashes had occurred over her choice of boyfriends, driving the family car, tattoos, clothing, and
keeping her room clean. Betsy felt that she could not rationally discuss anything about her life with
her mother. Her mother would automatically react with anger and disapproval, refuse to allow her
to drive, take away her pitiful allowance, or give her the silent treatment. The war between them
lasted throughout high school. As a young woman, Betsy wanted to discuss her fears, hopes, disap-
pointments, and dreams, but her mother did not seem to have the time or the inclination. Betsy
knew that being a single mother, working full time, and having sleepless nights and hot f lashes
due to menopause were hard for her mother, but she was disappointed by her mother’s apparent
lack of interest and negative attitude. Betsy’s friends said that all mother– daughter relationships
were trying, but she suspected that the lack of meaningful communication between herself and
her mother was extreme.
At work, Betsy and a coworker began a relationship. As usual, her mother disapproved and
asked why she could not date someone with a better future. Betsy was amused by her mother’s idea
that young people still dated and that modern women considered men’s future earning power as
a factor in the mating equation. To Betsy, on those rare occasions when her mother broached an
impor tant subject like this relationship, she showed just how little she cared and how far removed
from young people’s lives she had become. To make matters worse, Betsy’s new relationship was
not going well and in fact was becoming dangerous. The man was very possessive and had become