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SILENCE THAT SPEAKS MORE THAN WORDS: A CASE OF ELECTIVE MUTISM

Autor: Ana Muntean
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p>Selective mutism is a psychiatric disorder associated with social anxiety disorder. A person who is normally capable of speech is unable to speak in specific situations or to specific persons. It is very seldom disorder among children with speech disorders. We are going to present here a case study of such a disorder. The case reflects the systemic principle based on which the manifested disorders of a child are the symptoms of family’s dysfunctions. The approach in the study case here is based on attachment and systemic theories which allow us to understand the complex causal relations involved in generating the selective mutism of the child. A comprehensive perspective comes with hopes and suggests the possibilities of interventions.

Introduction: why do children speak?

Elective mutism is a contradiction in itself: the child possesses the communication tools (he/she is not dumb), but they only work against certain people. Verbal communication is a product of symbolic thinking while implementing a person’s capacity to symbolize. In this sense, silence speaks as much, though perhaps less clear, as the words. The analysis of elective mutism sends us to the principles underlying the healthy development of the instrument of communication in children, primarily of the language. “The central element in this picture is the close relationship between the child and the significant adults around him/her. The child is closely involved in what parents do or say, enjoying their attention and rewards.” (Kiernan, Reid, Goldbart, 1987, p.16). The desire to be with them, to please them and to be like them, is the reason for him to have the appetite for communication. The first and most important way of learning in children, is imitation. Attentive to what the parents do and say, the child will try to imitate behaviours, including speech. Observing and imitating their parents, children learn the subtle functions of language and communication. Thus, they find out how to attract the attention of others, how to ask for certain things or actions, how to determine an adult to come to him/her and attend to his/her needs, how to show his/her displeasure and how reject, how to answer an adult’s question, how to get him/herself accepted, etc. Verbal and non-verbal language learned by children are just tools to meet those functions required for survival and development. The child acquires language and its functions simultaneously. (Clark, Clark, 1977).

Even at a very young age, children are surprisingly astute with others in terms of communication, knowing what they can expect from each person according to the adult’s behaviour and attention in their interactions. Imitation is one of the first forms of learning, and it is mandatory in learning language (Chomsky, Piaget, 1988). By imitation, the child develops complex communication skills through both verbal and non-verbal language. The child’s acquisitions are especially those rewarded by the parent through praise behaviours or simply by a satisfied smile or a hug. This was one of the two ways of structuring the child’s language, described by Vygotsky (1985) in his work Thought and Language. The child’s language acquisition, from semantic, syntactic and pragmatic perspective (Bloom, Lahey, 1978), takes place only in interaction with adults, whose presence represents for the child a strong motivation to improve ways to make himself/herself understood, to exchange messages, to communicate. Moments of shared attention between the child and the significant adults in his/her life, in the daily routine activities as J. Bruner (1993), describes them represent the cornerstone of the child’s language structure. At such times, the complex communion between the two, where the significant adult person (usually the mother) transmits to the child the cognitive and affective meaning of things, of situations and words, facilitates their integration by the child at a primary, subconscious level. This level makes it impossible for the child’s conscious control over them. If meanings prove dangerous, their processing will only be subject to psychotherapy, ulteriorly, when obstacles that occurred during the process of the child’s connection with others, in the social environments imposed by the child’s age, will make his/her integration into society impossible or dysfunctional. The way how the child’s communication will take place, his/her performance and the topics he/she will approach depend entirely on how the others, the adults around him/her receive the his/her messages. In other words, the pragmatic communication requires and depends on the extent to which “the environment [where the child grows] is oriented towards communication” (Kiernan & al., 1987). This quality of the environment will determine the development of the communication skills in children, and their efficiency. Empirical observations show that, when they grow near elderly people who speak less or generally, when they grow in environments where verbal exchanges are reduced, the children’s communication skills will be delayed.

In the former paragraphs, we have described the process of language acquisition and development from a cognitive point of view. The emotional substrate of the acquisition and use of language, however, is not emphasized sufficiently, does not attract enough attention, just as elective mutism may go unnoticed by those with whom the child communicates. The entire development of the child, including the cognitive development, is under the sign of his/her emotionality. Emotions, with their established expressions, some of them innate, are the first forms of communication and are, at the same time, the ones that remain throughout life as a more or less congruent shadow of the linguistic message. When congruence is thorough, the message is unitary, easily traceable and healthy. Nevertheless, when congruence is broken, verbal and non-verbal messages turn contradictory and give birth to so-called double messages, which are maddening (Jaccard, 1994).

In the first two years of the child’s life, the emotional system dominates his/her mental life. It is the period when the child’s attachment to the primary attachment figure and to the others around is built. The pattern of this first relationship with the attachment figure will impregnate relationships with others over a person’s entire life, in the absence of special experiences or interventions. It was John Bowlby, the father of attachment theory, who said this for the first time. Bowlby (1988) argued that attachment relationships, working through internalized model of the world that it structures, become the prototype for relationships later in life. For this model has high stability over life. The meaning and the way of communication with others are defined by the child’s attachment type. Peter Fonagy (1999) defines the attachment system as an open system, serving to regulate the child’s bio – social homeostasis. “A dyadic adjustment system that develops out of the signals the child gives every moment about the changes in his/her status and that are understood and answered by the person who cares for the child so that these statuses might be adjusted.” The child’s attachment, guiding his/her strategies and behaviour in situations where he/she needs the help of those who are caring for him, is a mirror of the people around the child, of their availability and their suitability in relation to the child’s needs.

At the end of the first year of life, the child’s behaviour has a goal, based on the expectations that he/she has, which had been structured and represented in his/her mind in relation to the attachment figure. Given the attachment strategies developed by the child in relationship to those who care for him, first of all with the primary attachment figure, given how the child has learned that he/she can rely on this person to remove the evil which he/she suffers from, and fears, the attachment relationships can be secure or insecure for the child. When the child’s early experiences are positive, he learns that no matter how intolerable his feelings would be, he/she can trust the attachment figure that she will be present and she will calm him/her down. Thus, the child will no longer be afraid of his/her own feelings and will gradually learn to control them him/herself. Progressive self-control of the securely attached children’s own emotions will allow them “to take possession of their experiences and understand themselves and others as beings endowed with intent, having behaviours determined by the mental states, thoughts, feelings, beliefs and desires”. (Fonagy, 1999). Research shows that children with secure attachment are more resilient, self-confident, socially oriented, empathetic with those who suffer, and able to build deep relationships (Stroufe & All, 2005). However, when a child develops insecure attachment, the existential development of these attributes is questionable. The secure attachment as well as the two forms of insecure attachment described in specialized literature (Killen, 2003) are behavioural strategies in relation to the attachment figure, the child use when in a stressful situation. Nevertheless, when the attachment figure is unpredictable or abusive or absent in dialogue with the child, the child will be unable to structure a strategy and his/her attachment shall be classified as disoriented / disorganized or unclassifiable. Many authors, including Zeanah’s team (Zeanah, Berlin, Boris, 2011), who conducted research in an orphanage in Romania, indicate the category of children whose attachment cannot be classified, since they show none of the qualities of behavioural strategies mentioned above. The behaviour of these children under stress situations, when the caregiver is available to secure them, is described as follows. “A minimum commitment with the person who cares for him/her or with a stranger, is not a sign or it is very weak evidence that the child would want proximity, avoidance or behaviour of resistance towards caregivers, minimal emotional responses to the departure or return of that person.» Carlson (1998) argues that disorganized attachment is also important in the long-term development of the child’s dissociative symptoms in childhood and adolescence. There is a significant correlation between the child’s distorted attachment and language delays, as well as in the development of stereotyped behaviours (Smyke, Dumitrescu, Zeanah, 2002). Attachment behaviour, as our entire mental life, has its foundation in our brain neurobiology.

In conclusion: why does the baby speak? Because it has appetite to communicate! He/she needs the attention of the others, their satisfaction and praise or their reward; he/she wants to be like them. For this purpose, he/she imitates them, thus learning to communicate.

 

The present study: questions and methods to find out answers

As announced by the title, we shall present a case study of elective mutism in a child aged 7 years. It is the case of a boy, the only child of the C family. Both parents come from families with many children in rural areas. The mother has fond memories of her childhood even though she was actually brought up by her grandmother that she loved very much and who now lives with the family. The father grew up with his biological parents, not the mother’s favourite child and, according to his wife, he was always sacrificed in the interests of his elder brother.

C family comes for a consultation concerning D, their child’s refusal to talk with people other than his mother, maternal grandmother and father. Their concern is even heightened by the fact that they intend to enrol their child to school in the autumn, when the child is almost 7 years old. At the time of the consultation, none of the parents was employed. Their daily living costs were covered by the money sent from Italy by the mother’s biological parents, and from the production they have in their household, in the village where they live.

Questions that immediately arose were “Does the child have a structured language?” (Doubting the parents’ statements) and if so, why does not he talk to anyone outside the family? These questions cannot find an answer only in the context of their relationships as members of the family and of the C family’s relationships with those outside the family, with the family’s environment.

As methods of working with the child and of assessment we used the Kohs block design test as well as the hand-eye coordination test Bender-Santucci. To assess impressive language we used images asking the child to identify the ones that we named. I asked the mother, who affirmed that the child speaks at home, to record one of their dialogue when the mother tells her child a story. We also assessed the child’s classification skills, of seriation, of conservation of the indiscreet amount, from genetic evidence. The aim in using these methods was to assess the child’s cognitive development as well as his linguistic performance. During the three meetings with the child and listening to a tape recorded by the mother, we excluded the diagnosis of mental retardation and elective mutism has been established definitively.

I followed the relationship of the three members of the family. During a meeting held according to systemic principles with all the three family members, I noted the child’s preference to interact with his father as well as mother’s moody, immature behaviour. Father talks to the child with patience and a certain degree of tenderness, while mother threatens him that “if he does not speak…”. Father has the same patience when faced with his wife’s criticism and her emotional outbursts. Both parents promise the child a visit to the toy store to purchase a toy which he has craved for. The child has a destructive behaviour towards toys, gets bored of a toy quickly and always asks for another. It is obvious that the child handles both father with his remarkably calm behaviour and mother with her jealousies and grievances.

The relationships with others, with the extended family are very conflicting. Although they are neighbours of father’s parents, mother forbade them to come into their house. Mother considers it is intolerable the fact that father talks to his parents and helps them from time to time. One of mother’s brothers is always with Family and father tolerates the situation very well, since he has a friendly relationship with ​​mother’s brother and with her family.

Administering the Test of Attachment Style Interview (ASI) (Bifulco, Thomas, 2012) to mother gave clear information on what constitutes Mrs C’s social support network, in fact, of family C. On the other hand, ASI has allowed us to identify the causes of the child’s elective mutism in the quality of the child relationship with his parents.

We shall further present the assessment with the ASI:

 

Summary of the interview

Mrs C is mother of D, a 7-year-old boy, with an elective mutism. Mother is 35 years old, while her husband is 42 years old. The nuclear family is living in a village, in the house of mother’s brother, although they own a house in another village. The parents are unemployed, they abandoned their workplace, and they no longer receive help from the state. They do not suffer from financial difficulties because they are helped by Mrs C.’s parents, but she has “put away her money,” of which her husband does not know. Their house is situated next to that of her in-laws (her husband’s parents) with whom she does not talk. Mrs C’s parents have been away in Italy, mother for seven years, and father for five. They meet once a year. They talk on the phone “even 10 times per day”. She feels closer to her dad ‘because he was on our mind’, in childhood. When they meet, they do not feel estranged, ‘we talk, we laugh, and we fight’. Mrs C. does not consider that the physical distance between her and her parents affects her. She claims that she does not miss them and explains this by the fact that they communicate a lot by mobile telephone and that since childhood she has been used to being separated from them. When they meet, she does not argue with her father, but the discussion is more general. She does not miss him, either. Sometimes, her mother makes her angry, the same now as she did in the past, because she was and she still is a nagging person. Even on the phone, they argue frequently, but then forgive each other immediately. Recently they had a fight on the phone for Mrs C. has been working on the house and got more help from her brother than from her husband. For already 8 years, Mrs C. and her mother have been constantly quarrelling because of Mrs C’s husband. “Yes, I do not give her permission to interfere in my life.” She does not argue with her father, she protects him, for he is sick. Mrs C. has two brothers, being the eldest sibling. One brother lives with them, being unmarried; he is 33 years old; he is the owner of the house where they all live. They help each other all the time. The other brother lives in the city, he is 26 years old, but they visit each other weekly. They communicate on the phone daily. The favourite brother is the one that lives with her. However, if he were away, she would not miss him. She grew up together with him at Grandma. The other brother grew up with their parents; being sick, he remained in hospital until the age of over one year. Mrs C argues with her brothers because of her husband, G., who does not go to work. G.’s job is a permanent cause of disagreement among members of her family, though less in the presence of G. Her husband does not react, and the two spouses do not argue because G. does not respond when it is attacked. He simply leaves the scene. Her whole family quarrels because G. is not employed. G. is a constant problem and a permanent tension. When she tells him something, he watches TV, does not care, and does not pay attention to her. Nor does he express any opinion, but he gives advice on certain family situations, and in general, he does as she says. She tells him, talk to him. He is calm, indifferent. She would like him to go to work, taking the bus, like everyone else. He wants to go to work by car, but she refuses to give it to him. G. gave her brother money on a loan for a few months and brother no longer gives him the money back. This is another problem of Mrs C’s, but it is not of her husband who is confident that he will get the money back. They have never time just for the two of them. She is angry of his indifference. G. does not like that she remembers and discusses all the details. She criticises him daily, while he very rarely. They do not become physically violent with each other. ‘I get angry up to a point and then, I do not know how but I go over it…” They have never been separated. She thinks she could manage without him, but the child loves him very much. The boy prefers his father’s company. When asked how they would cope if her husband would not be with her, she says ‘It is all the same to me’. She does not think that it would be hard for her without him “anyway, I have been carrying him on my back like a parasite ever since I knew him!”.  He does whatever she says, but has no initiative, does not solve any problem by himself. She makes him a list with what he has to do.

Mrs C. grew up in her grandmother’s house from the age of 2 weeks to school age, when she returned to her parents. The reason was that both parents were working in agriculture and were building the family house at the time, thus could not handle the kids. The grandmother (on the father’s side) who brought her up now lives with them and takes care of D. The grandmother was gentle and tolerant with her and the children. She did not impose rules. All her children were sleeping with her, she used to tell them stories, and show them filmstrips every night. Grandpa was mostly gone away.

The most important and beloved persons in Mrs C’s life are grandma and her dad. Grandma is the closest. It is the grandmother, not G, with whom she talks any matter over. (“Either I tell him or not, it’s indifferent”). She does not tell mother because she says she does not trust her. (“She disparages me  …”). Grandmother helps her daily in all tasks, including the child. Grandmother is 82 years old. Mrs C. is not telling quite everything to her grandma. She fears that she would worry her too much. She recounts in great, not all the details. She talks about all issues but not the ones related to her husband, to her health or her troubles. The reason is “She is old, I do not want to worry her; if I tell her something then she keeps thinking there all the time”. She tries to calm her down whenever she sees that she is too concerned about something. She had a recent discussion with her grandmother about G., complaining that he does not want to take a job. Grandmother advised her to send him to work herself, but to G., Grandma does not say anything. Now and then, Mrs C. argues with her grandmother. The latest argument happened a few days before and was due to grandmother’s ‘negligence’, who, although she felt a cable melted, did not do anything. Mrs C. quarrels with her grandmother about once a month, always due to grandmother’s negligence. However, Mrs C. thinks that she can rely on grandma. However, Mrs C. controls everything by phone when she is not present. With reference to the possibility of grandmother’s absence from her family life, Mrs C. says, “I could do without her, but it would be a bit hard!” If she were away, she would miss her. Grandma is used to do what she wants and she “does not like to do” physical labour. Nevertheless, she likes to play with the baby.

Her father is 62 years old, they communicate by phone daily, she trusts him, but her father is ill and he is treated in Italy. Her dad has a serious chronic disease and therefore the whole family, including Mrs C., protects him.

Mrs C. claims that she has a friend whom she trust to a certain extent, but she does not tell her too much about the events in her life. She claims that her life events are insignificant. The only serious problems that she faces are only those with her husband’s family, although these frictions do not affect her daily.

She communicates easily with G. She tells him everything that “crosses her mind”, with details, she makes plans. Only money is a limit to their collaboration. She feels that she cannot rely on him because he ruins all the money. When they need money, the husband says, ‘Ask money from your mother’.

When they lived alone in another village, where they have their home, they did not have these issues, then he went to work and they got along well together. Then, her mother-in-law, G’s mother, came to them daily, to take care of the child who was about three years old. Mrs C. mentions that, however, the mother-in-law would not come on her own initiative and ‘I think she used to come just because G told her” and felt obligated. At the time, both women were arguing so that “the whole street could hear me.” Her neighbours told Mrs C. that her mother-in-law did not even give D any food.

Her friend lives in the town where they also have a house. Mrs C. pays her a visit from time to time. When they meet, Mrs C. tells her details of her life, because they have similar problems. Their conversations, however, have certain limits. Such limits are about money, family, and the intimate relationship with G., of which Mrs C. does not speak. Her girlfriend does not give her advice nor is she worried about her. The last issue that she discussed with the girlfriend was about the latter’s teeth under repair because and Mrs C. too was interested to repair her teeth. One reason they do not speak about the other things is that they are never alone, but accompanied by their children. However, they tell stories together and laugh, they love to meet each other. Mrs C. has but a reproach to the friend, she believes that she is a “little liar”. Moreover, she even told her friend “she is a little misleading”. These two women do not argue, however; that is because “I see her how she is and I leave after her.” Nevertheless, she thinks that she can rely on her, that she can talk to her. Mrs C. also appreciates the fact that sometimes they go out together, in family. If she were not to see the friend, would easily do without her, she would not miss her. She feels good with her friend but she does not rely on her too much.

There are no other important people in Mrs C.’s life.

Trusting people seems to her the hardest thing, because “I have always met bad people”. When she meets someone, she has misgivings and they prove out later on. She wonders why those bad things that she senses happen and the answer that she gives is that the others are envious of how they get ahead, because they carry it off well … Overall, she trusts people in the family (this does not include the husband’s family). Her mistrust is directed especially to those outside the family. When friends of G. come along she serves them; But when she goes to them, “they take the pot off the table, hide tray with cakes.” “In [name of the village where their house is] there are very bad people! “. Grandma says the same: “People are like this by nature they think only about themselves, about their own good.” Although she is aware of this situation, it does not change her hospitable behaviour, although “I only declare that if I they come again, I shall do the same!” She finds it hard to have close relationships with others for they “think she is stupid”. With women, it is more difficult. “Because they are so evil and so …”. The explanation that she can find for this situation is that perhaps having only brothers, she knows better how to speak and act with the boys. When he has the opportunity to make a new acquaintance, she is talkative. When requested, she gives help, but she does not ask for help because “I prefer to do everything alone…” If she had a problem, she would address to her elder brother, to the other brother and possibly, in the end, to her friend. However, she would avoid some people at all costs in such situations, “her husband’s family, his brothers and his mother. Because they would not help, and they would tell tales about her to everyone. Perhaps, because of misunderstanding from the very beginning, I did not agree with the rules imposed by his mother …” She does not remember to have lived the experience of feeling betrayed during childhood and youth. When someone wants to tell her something, she enjoys the fact that the person trusts her. Nevertheless, when she tells someone something, it happens that she is going to regret ulteriorly, because “the entire street would found out” later. She felt hurt, rejected by people who ought to be close. Such experiences have made her recede into the background. She thinks she can deal with any problem alone, but she is not very sure … still she admits she needs the help of others, ‘without help, I don’t think’. She likes to have her independence (her money). “I think I’m rather lonely, I like to have everything, what’s mine should be mine.” She asks for advice when needed, but it is not sure she follows it, ‘Eventually I just do as I think fit.’ ‘I like to know the others’ opinions, whether they make me angry or I like them, but I do what I want. It is all the same to me, as to G., if the others’ views make me angry. Most decisions are taken only according to my mind.’ She disregards the opinion of G. or of the others. “I love it when I feel that I am right and I control things and I am right. I feel the need to go out somewhere, more people … not just the two of us. Although I am lonely, I like to be around people.” However, she also feels good when for some time she is in the company of only the child and G. She would like to meet with her friend more often and with other friends. Nevertheless, there were times with his family, when she believed that they met too often, especially with the sister-in-law. “I think it was because I could not stand them. That one used to come and told me straight I was stupid and then she asked me for help.”

Mrs C. declares, “I am a possessive person. I am jealous of my brother C. because he gets on better than we do.” She is not scared at the thought that G. should go somewhere, “if I know he is coming back.” If he did not come and did not announce she would feel scared. She does not like goodbyes; she finds it difficult to break away. She has never left the child overnight without her. If she cannot talk to G. she worries. If G left, he would miss him, especially during the night, this because she feels “weary” at night, but also because the child prefers him. She does not break relationships, but she often quarrels with others ‘if it does not suit me, I say it.’ It happens to cool relationships with others. She gives the example of the situation of the family that went to the seaside with them. “I did not argue with them because I was on the verge of beating them. We cooled our relationship … for my part … as for them, they keep trying … “.

She has nothing to blame her parents, and brothers, “Sometimes I am sick of C. he is pretentious with food. I say to him, laughing ‘I’m sick of you.’” Related to her childhood, she is satisfied with it; she does not think that is given the choice she would want it to be different from what it had been. She thinks people have not done enough for her. This complaint does not apply to her parents, too. “I have received even what I did not think about”. However, outside the family, she thinks that the others did not give her, they did not take her into account the same way as she took them. She thinks she knows how to make connections easily. Nevertheless, she admits, “there are times when I do not want to see anyone. I wish I was better with G., maybe I could be better with the baby … sometimes I think maybe with his kin [her husband’s family] I could have said something else, done things differently … I could have been nicer, Showing them out of the door without saying bad words.”   In connection with the child’s  manifestation of elective mutism she reflects “I have scolded the child a lot since he stopped speaking although I noticed that since I have started to scold him, it seemed that  he used to speak even with me with a shade of fear… now I try to let him go. “

The ASI assessment brings the following clarifications:

Mother’s ability to make and maintain relationships with others is somewhat present so can be rated 3.

This ability is shown in the following relationships:

a). relationship with the  partner (husband, Mr G.) with whom she has no major discrepancies, although the relationship is weak. Trust in the partner goes as far as the financial aspect of family life (3). She feels that she has active emotional support from her spouse (3) but is bothered by his good relationship with his biological family. Even if she defies, making contrary statements, their interactions have a good quality (4), although the negative aspects of the relationship (distrust about money, dissatisfaction with the fact that he is unemployed, the grudges that make her forbid him to use the car) are also present (3) in the relationship with the partner. Mrs C.’ attachment to her spouse is quite good (3) but the overall support from her husband, though without major discrepancies, is insufficient.

b). relationship with the paternal grandmother, probably Mrs C.’s attachment figure; she is the person who brought her up until it was time for her to go to school. Now they are living together. Grandma was chosen as the first significant person. Her confidence in grandmother is moderate (2) and Mrs. C. controls her continuously. Regarding the emotional support that she perceives from her grandmother, it is moderate (2), because there are many issues which she cannot share with her, especially about her worries with her husband’s unemployment. Positive aspects of interactions with Grandma are also moderate (2) being limited by distrust in grandmother, by tne limiting of the subjects that may be entrusted to grandmother and by the feeling that grandma is careless and does whatever she likes. If all these limits are regarded as such, they build a big enough share (3) of the negative aspects of interactions with Grandma. Attachment to the grandmother is also moderate (2) being undermined by mistrust and a sense of failure of the support received. On average, however, Mrs C. is receiving good support from grandmother and there are not too large discrepancies between them.

Distrust in relationships with others is at a remarkable level (1). She affirms that one cannot trust others and tells spicy aspects of her hospitality and the opposite answer of her acquaintances. In fact, there is no person in whom she has thorough confidence, or one who could convey the feeling that she could get help unconditionally and without hidden intentions.

Concerning closeness in relationships with the others, Mrs. C felt many constraints (moderate: 2) produced by her distrusting them as well as by the others’ envy and jealousy manifested for the welfare of her family.

Fear of being rejected is not too strong (moderate: 2), Mrs C. claiming that she is a lonely person concerned about the welfare of her family.

Self-confidence is also at a moderate level (2) which makes Mrs C. recognize that in a problematic situation she could not do without the others’ help, although there are people whom she would never ask for help.

Wish to have company is quite low (3) while recognizing that sometimes she spends time with other people or families. However, these moments are often an unfortunate outcome for Mrs C, which makes her claim that the presence of her child and of her husband is sufficient.

Surprised by the questions related to the fear of separation from significant people in her life, Mrs C. acknowledges some separation anxiety (3/4)., sometimes with detours and returns in the story.

The dominant characteristic of Mrs C’s accounts is but anger, frustration in dealing with others. This marked anger (1) impregnates her relationships with the loved ones (with D., her child, with G., her husband, with her grandmother, her attachment figure in childhood) and with the neutral ones (acquaintances who are not hospitable with her) or with people whom she perceives as enemies (her husband’s family).

 

Conclusion

The overall impression is one of a style that is dual, ambivalent, angry resigned and fearful at the same time, in relationships with others. It is a moderate insecure attachment style, that could mean a loss or trauma that has not been overcome yet.

Discussions and answer to the question: Why does not D. speak?

Around the age of 3, when D. had already good speech skills, his mother, who had found a job, was forced to leave him to stay at home during the day, with her mother-in-law. At the same time, mother detested her mother in-law with whom she had heated and endless noisy scandals; because of the mother –in – law, the couple was arguing in front of the child, too. What mother conveyed to D. was a strong and maddening double message: on the one hand was the hatred and aggression with which she abolished her mother-in-law, on the other hand she used to leave her precious child in her care. It is interesting to note how, in this message, one may find all the principles of double messages described by G. Bateson and his team at Palo Alto (1956). Being at an age when he needed the care of the grandmother that his mother hated, still, the child could not accept to communicate

with his grandmother because this would have been a betrayal, a lack of loyalty for the mother. Gradually, he ceased to talk to Grandma. In the first stage, caught in the ambivalent situation where she resorted to the help of the person whom she hated, mother did not pay attention that D. did not speak with his grandmother. Maybe sometimes, at the beginning of these manifestations, she even praised her child for his mutism towards grandmother. The child grew, with his mother’s consent, the symptom of this noisy and full of resentment relationship. The symptom is a message that “is communicated in a context and in a form in which the content and / or addressee are both affirmed and denied” (Bateson, 1972, p.28). This definition should be seen in the light of the double message theory.

The child, in refusing to talk to his grandmother, imitated the mother’s rejection of the mother in-law. The language created and acquired to facilitate human relationships and to connect people had become a weapon to destroy the other. For the mother, the weapon meant aggressive verbal outbursts and the quarrels in the ears of the entire street. Nevertheless, as the systemic approach records, there are three ways of response: total agreement (confirmation), disagreement with joint negotiations and search for meaning (rejection) and denial, ignoring the existence of the other. Actually, just ignoring, complete silence means the denial, the killing of the other. When I do not address you a word, for me you do not exist. D., in his desire to be loyal and to please his mother, he stepped on the platform of non-communication, in which the other does not exist. He managed to surpass his mother, who used to situate herself on the endless spiral of contradictions, conflicts and aggressive dialogues. For language does not reflect the world, but creates it. (Watzlawick,1978). Mother and son are in a revolutionary alliance against grandmother, creating together a world that is hostile to the grandmother. In fact, during the past two years, the mother imposed a ban to communicate with that grandmother even to her husband, G. However, the latter would violate the prohibition.

Unfortunately, mother is not only in conflicting relationships with her mother-in-law, but in a somewhat generalized state; her anger and frustration, based on insecure attachment, are directed against the whole world. D.’s mutism extended and his communication remained reserved within the family boundaries: mother, father, “good grandmother.”

 

Instead of conclusions

Caught in a world of conflict and confusion, between the unhappy mother who is at war with the world and his father, who is calm but somewhat apathetic and resigned, D. has already learned solid handling techniques. These, set against the background of the tendency to dominate, which is highlighted in in the different behaviours, could be blamed on an ambivalent insecure attachment. A systemic intervention could introduce extra information and therapeutic changes in the unhealthy family communication system. Maybe the child’s going to school could be such a change. Mother’s assessment brought a moment of reflection that can only be beneficial to the child and the family. Mother realized that she ‘could have been nicer’ with everyone, including the child whom she used to punish physically because he did not speak, but whose refusal to talk with his grandmother was well received. Mother had brought with her, from her own childhood, an insecure attachment, fearful and aggressive at the same time. The child and the whole family are in an unhealthy situation, generating symptoms. The intervention was too short in time (it comes down to three meetings) to bring profound changes. However, the extra information that the mother received with the ASI assessment could be a point of coagulation for changes. What she claims she had learned is the abandonment of physical punishments imposed to child in connection with his refusal to talk to neighbours, acquaintances, neighbourhood kids. She also understood that the school is for the child a chance to practice the language that has already acquired; in this sense, it is the parents’ responsibility to make school interesting for the child, to present it in the messages they transmit to the child that school is an interesting space, without conflicts.

What we have tried in this paper was to introduce elective mutism (a diagnosis, which we have not invested with too much confidence before coming across this case) from the perspective of attachment theory and of the systemic principles strongly congruent with of attachment theory; at the same time we wanted to pay due importance affective-cognitive combination of our behaviours.

 


  1. The assessment was performed with the written acceptance of the subject.
  2. In parentheses, we have the rates, which are set out from 1 to 4.
  3. 1. The two persons are engaged in a vital relationship; 2. A recurrent traumatic experience that includes fear of abandonment and definitive exclusion; 3. A primary verbal injunction; 4. A non-verbal injunction, as a rule a secondary one, contradicting the first injunction; 5. A third injunction, requiring conformation to both of the contradicting injunctions; 6. The victim has learned to perceive him/herself in the context of the double message where there is no way out.

 

 

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