The language of the body

What a voice can do (bonus Canada Day content)

Every so often a client will come to me with voice problems: dysphonia (aphonia means no voice). In grad school, I learned the anatomy and physiology of voice. There are some fascinating muscles, bones, and cartilage that allow us to have a voice. Put your hands on your neck and swallow. Do you feel something hard and smooth moving up and then down. That is the thyroid cartilage. It is a cup with the bottom missing. Some liken it to a shield. Inside this cup, across the middle of it, are two intricate flaps of muscles called the vocal folds. They are attached to the front of the cup and then to little swiveling cartilage-bones at the back. When they are relaxed they are an open V. Air flows through them to and from your lungs with ease. When they tighten, they come together (make a peace sign with your fingers and then close them up) and when air passes, they vibrate and make your voice.

This whole apparatus is called the larynx. It floats in a sling of muscles. At the bottom it attaches to your windpipe and at the top it attaches to a little horseshoe bone called the hyoid bone. This bone then attaches with muscles under your chin.

Swallow again. Feel your larynx move up and down. It also moves forward a bit. Say "ahhhh." Feel it vibrate. When things work well, there is an amazing coordination of events going on. Read the last sentence out loud. Notice how the voice is mostly on, but turns off for the /st/ in last, the /s/ sounds in sentence, and so on. It's all automatic. Not a conscious thought in sight. The accuracy of the timing is as fine as a string quartet. Add the complexity of language processing and it's as multi-layered as an orchestra.

Yesterday I saw a young woman with aphonia. It started with a bad cough in January and now she has blisters and callouses on her vocal folds because she's been coughing so violently for so long. When she coughs, she bends her head back and her whole body contracts and then after a long pause, explodes upwards. She's broken her ribs from the violence of it. She also clears her throat constantly and she loves to talk. She has no voice left so she needs to whisper very loudly. This is called a stage whisper and it really hurts the vocal folds. So does habitual throat clearing.

Once we sorted out all the physical stuff, I asked her about her stress.

I'm getting married in 5 weeks, she said, but I'm not really stressed.

I pause. I am skeptical about her claim of being stress-free, but I can't tell her how she feels (or should feel). This is exactly where my S-LP training falls short. What do we learn about counseling? Can I talk about how we lose touch with our body as we age so that we no longer recognize its language? Her body--her voice--is clearly telling her that she is stressed pretty much to the max (she can only sleep 4-6 hours a night), but she doesn't understand what it's saying. It's as if her physical body is a separate thing, like a car, and it needs to be fixed so she can get on with her life.

In the end I gave her some things to think about:
- voice rest: stop talking for 2-4 weeks, let those physical wounds heal
- find something else to do when you want to clear your throat, like swallowing forcefully or sipping water
- when you must speak, use the quietest whisper you can, get close so people can hear
- eat well and move (yoga would be great)
- read up on stress management (maybe she will make the connection and say "this IS me.")

When we meet next time, I'm going to ask her what she thinks she should do. We all need to learn that we have more power over our health than we think. But to do this we need to understand the language of our bodies.

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