80 Chapter 4
abusive. He had yet to harm her physically, but it was clear that he was not averse to controlling
her in that way. Sex was also becoming frightening; he was no longer gentle and considerate. Sex
was becoming another way of exercising control over her. Betsy ached to talk to someone about
the direction of her life.
Betsy tried talking to her father, but she could not bring herself to discuss impor tant life
issues by telephone; she also wondered if he would understand. She often tried to discuss the
relationship with her mother, but each time her mother automatically assumed the worst and
reminded Betsy that she had “told her so.” Their conversations were one- sided and unsatisfy-
ing. Her mother did not understand, and to Betsy, it seemed that she did not want to spend the
time and energy needed to understand. Betsy tried talking to her best friend, but since she had
recently married, their friendship had suffered. There was no one in Betsy’s life who seemed to
care enough or to take the time to talk to her. She felt completely alone and did not know how
to deal with her prob lem.
After an argument with her boyfriend, Betsy lost her voice. There was shouting and crying, and
he threatened to harm her if she continued to be friendly to customers. At some level, Betsy knew
that her loss of voice was not real and that she was capable of vibrating her vocal cords. However,
she refused to consciously acknowledge the psychogenic nature of her aphonia. In fact, she was
indifferent to the loss of her voice and somehow considered it a blessing. The aphonia had lasted
for nearly 2 weeks when her mother suggested that Betsy see a laryngologist. It was the first real
gesture of concern she had shown. The laryngologist completed an evaluation and referred Betsy
to a speech- language pathologist. Subconsciously, Betsy welcomed the attention.
The speech- language pathologist conducted several tests and examinations. Betsy was asked to
say sounds, syllables, words, and phrases. She was encouraged to produce a voice by simply trying
harder, saying sounds with her chin elevated, and speaking with a lot of air in her lungs. The clini-
cian also tried to get Betsy to laugh; several jokes were told, and she laughed freely. The clinician
asked Betsy to hum the tune “Row, Row, Row Your Boat,” and she complied without giving it a
second thought. Afterward, the clinician showed her how to prolong the sounds of the tune and
then to talk the same way. She merged humming into speech. It was like a miracle; Betsy could
vibrate her vocal cords during speech. During the remainder of the session, she hummed sounds,
words, and phrases. It was easy to turn humming into voiced speech, and by the end of the session
Betsy was talking normally. Then the speech- language pathologist said that Betsy should see a
psychiatrist. She was told that her loss of voice was a signal that all was not well in her life and that
her voice disorder might symbolize lack of communication.
Betsy told the clinician about her mother and her boyfriend. The clinician called the local
mental health clinic and arranged an appointment. The clinician was aware of Betsy’s financial
situation and knew that the clinic offered ser vices on a sliding- fee scale.
The meeting with the psychiatrist was short but helpful. The clinician prescribed an anti-
depressant for Betsy and arranged for counseling through the clinic. The antidepressant would
have to be taken for about 6 months, and longer if warranted. Individual and group therapy ses-
sions would last until Betsy felt they were no longer necessary. She learned that she was clinically
depressed and prob ably had been for many years. In therapy, Betsy discovered that she had an
immature relationship with her mother and was encouraged to get her own apartment, which
she did. She found roommates with positive lifestyles, jobs, and healthy relationships. She learned