1989 - Seeing Voices

by Oliver Sacks

  The mother—or father, or teacher, or indeed anyone who talks with the child—leads the infant step by step to higher levels of language; she leads him into language, and into the world picture it embodies (her world-picture, because it is her language; and beyond this, the world-picture of the culture she belongs to). The mother must always be a step ahead, in what Vygotsky calls the ‘zone of proximal development’; the infant cannot move into, or conceive of, the next stage ahead except through its being occupied and communicated to him by his mother.

  But the mother’s words, and the world behind them, would have no sense for the infant unless they corresponded to something in his own experience. He has an independent experience of the world given to him by his senses, and it is this which forms a correlation or confirmation of the mother’s language, and in turn, is given meaning by it. It is the mother’s language, internalized by the child, that allows it to move from sensation into ‘sense,’ to ascend from a perceptual into a conceptual world.

  Social and emotional intercourse, intellectual intercourse too, starts from the first day of life. 66

  66. The cognitive aspects of such preverbal intercourse have been especially studied by Jerome Bruner and his colleagues (see Bruner, 1983). Bruner sees in preverbal interactions and ‘conversations’ the general pattern and archetype of all the verbal interactions, the dialogues, that will occur in the future. If these preverbal dialogues fail to occur, or go awry, Bruner feels, the stage is set for serious problems in later verbal intercourse. This, of course, is exactly what may happen—and does happen, if precautionary measures are not taken—with deaf infants, who cannot hear their mothers and who cannot hear the sound of her earliest preverbal communications.

  David Wood, Heather Wood, Amanda Griffiths, and Ian Howarth, in their long-term study of deaf children, lay great emphasis on this (Wood et al., 1986). They write:

  Imagine a deaf baby with little or no awareness of sound…When he looks at an object or event, he receives none of the ‘mood music’ that accompanies the social experience of the hearing baby. Suppose he looks from an object of his attention to turn to an adult who is ‘sharing’ the experience with him and the adult talks about what he has just been looking at. Does the infant even realize that communication is taking place? To discover the relationships between a word and its referent, the deaf infant has to remember something he has just observed and relate this memory to another observation…The deaf baby has to do much more, ‘discovering’ the relationships between two very different visual experiences that are displaced in time.

  These and other major considerations, they feel, are liable to cause major communicative problems long before the development of language.

  The deaf children of deaf parents have a fair chance of being spared these interactional difficulties, for their parents know all too well from their own experience that all communication, all play, all games must be visual, and in particular, ‘baby talk’ must move into a visuo-gestural mode. Carol Erting and her colleagues have recently provided beautiful illustrations of the differences between deaf and hearing parents in this regard (Erting, Prezioso, and Hynes, 1989). In fact, an unusually visual, or hypervisual, orientation may be observed in deaf children almost from birth; and it is this, typically, which their parents, if deaf, recognize very early. Deaf children from the start show a different organization, and one which requires (as it demands) a different sort of response. Sensitive hearing parents may recognize this to some extent, and become quite skilled in visual interaction themselves. But there is a limit to what hearing parents, however loving, can provide; for they are, in their nature, auditory and not visual beings. A further, totally visual interaction is needed, if the deaf child is to develop his own special and unique identity—and this can only be conferred by another visual being, another deaf person.

  Vygotsky was greatly interested in these prelinguistic, pre-intellectual stages of life, but his especial interest was in language and thought and how they come together in the development of the child. Vygotsky never forgets that language is always, and at once, both social and intellectual in function, nor does he forget for a moment the relation of intellect and affect, of how all communication, all thought, is also emotional, reflecting ‘the personal needs and interests, the inclinations and impulses’ of the individual.

  The corollary to all this is that if communication goes awry, it will affect intellectual growth, social intercourse, language development, and emotional attitudes, all at once, simultaneously and inseparably. And this, of course, is what may happen, what does happen, all too frequently, when a child is born deaf. Thus Hilde Schlesinger and Kathryn Meadow say, as the first sentence of their book, Sound and Sign: 67

  Profound childhood deafness is more than a medical diagnosis; it is a cultural phenomenon in which social, emotional, linguistic, and intellectual patterns and problems are inextricably bound together.

  67. Schlesinger and Meadow, 1972. Very detailed studies have also been carried out by Wood et al. in England, who, like Schlesinger, see the mediating role of parents and teachers as crucial and bring out how often, and in what various and subtle ways, this may be defective when dealing with deaf children.

  It is to Schlesinger and her colleagues, over the last twenty years, that we owe the fullest and deepest observations on the problems that may beset the deaf from childhood to adult life, and how these are related to the earliest communications between mother and child (and later, between teacher and pupil)—communications all too often grossly defective or distorted. Schlesinger’s central concern is with how children and, in particular, deaf children—are ‘coaxed’ from a perceptual to a conceptual world, how crucially dependent this is upon such a dialogue. She has shown how the ‘dialectic leap’ that Vygotsky speaks of—the leap from sensation to thought—involves not just talking, but the right sort of talking, a dialogue rich in communicative intent, in mutuality, and in the right sort of questioning, if the child is to make this great leap successfully.

  Recording the conversational transactions of mother and child from earliest life, she has shown how often, and with what dire effects, this may go wrong when the child is deaf. Children, healthy children, are endlessly curious: they are constantly seeking cause and meaning, constantly asking ‘Why?’ ‘How?’ ‘What if?’ It was the absence of such questioning, and the very incomprehension of such question forms, that struck so ominous a note when I visited Braefield. Writing in more general terms about the all-too-common problems of the deaf, Schlesinger notes: 68

  68. Schlesinger, Hilde. ‘Buds of Development: Antecedents of Academic Achievement,’ work in progress.

  At eight years of age, many deaf youngsters show a delay in their understanding of questions, still continue to label, do not impose ‘central meanings’ to their answers. They have a poor sense of causation, and rarely introduce ideas about the future.

  Many, but not all. There tends, indeed, to be a rather sharp distinction between children who have these problems and those who do not, between those who are intellectually, linguistically, socially, and emotionally ‘normal’ and those who are not. This distinction, so different from the normal bell-curve distribution of abilities, shows that the dichotomy occurs after birth, that there must be early life experiences with a decisive power to determine the entire future. The origin of questioning, of an active and questing disposition in the mind, is not something that arises spontaneously, de novo, or directly from the impact of experience; it stems, it is stimulated, by communicative exchange—it requires dialogue, in particular the complex dialogue of mother and child. 69

  69. This interplay is a major concern of cognitive psychology. See especially L.S. Vygotsky, Thought and Language; A.R. Luria and F. la. Yudovich, Speech and the Development of Mental Processes in the Child; and Jerome Bruner, Child’s Talk. And, of course (and most especially with regard to the development of emotion, fantasy, creativity, and play) this is equally the concern of analytical psychology. See D.
W. Winnicott, The Maturational Process and the Facilitating Environment; M. Mahler, F. Pine, and A. Bergman, The Psychological Birth of the Human Infant; and Daniel N. Stern, The Interpersonal World of the Infant.

  It is here, Schlesinger finds, that the dichotomies start: 70

  70. Schlesinger, 1988, p. 262.

  Mothers talk with their children, do so very differently, and tend to be more often at one side or the other of a series of dichotomies. Some talk with their youngsters and participate primarily in dialogue; some primarily talk at their children. Some mainly support the actions of their offspring, and if not, provide reasons why not; others primarily control the actions of their children, and do not explain why. Some ask genuine questions…others constraint questions…Some are prompted by what the child says or does; others by their own inner needs and interests…Some describe a large world in which events happened in the past and will happen in the future; others comment only about the here and now…Some mothers mediate the environment by endowing stimuli with meaning [and others do not].

  A terrible power, it would seem, lies with the mother: to communicate with her child properly or not; to introduce probing questions such as ‘How?’ ‘Why?’ and ‘What if?’ or replace them with a mindless monologue of ‘What’s this?’ ‘Do that’; to communicate a sense of logic and causality, or to leave everything at the dumb level of unaccountability; to introduce a vivid sense of place or time, or to refer only to the here and now; to introduce a ‘generalized reflection of reality,’ a conceptual world that will give coherence and meaning to life, and challenge the mind and emotions of the child, or to leave everything at the level of the ungeneralized, the unquestioned, at something almost below the animal level of the perceptual. 71

  71. Eric Lenneberg feels that it is only in the verbal realm, after the age of three (say), that problems arise with the deaf; and in general, these are not severe in the preschool years (Lenneberg, 1967). Thus he writes:

  A healthy deaf child two years or older gets along famously despite his total inability to communicate verbally. These children become very clever in their pantomime and have well-developed techniques for communicating their desires, needs, and even their opinions…The almost complete absence of language in these children is no hindrance to the most imaginative and intelligent play appropriate for the age. They love make-believe games; they can build fantastic structures with blocks or out of boxes; they may set up electric trains and develop the necessary logic for setting switches and anticipating the behavior of the moving train around curves and over bridges. They love to look at pictures, and no degree of stylizing renders the pictorial representation incomprehensible for them, and their own drawings leave nothing to be desired when compared with those produced by their hearing contemporaries. Thus, cognitive development as revealed through play seems to be no different from that which occurs in the presence of language development.

  Lenneberg’s view, which seemed reasonable in 1967, is not one that is now held by close observers of deaf children, all of whom feel that there may be major communicative and cognitive difficulties, even in preschool days, unless language is introduced as early as possible. Unless special measures are taken, the average deaf child will have only fifty to sixty words at the age of five or six, whereas the average hearing child has three thousand. Whatever the enchantments of toy trains and make-believe games, a child must be deprived of some aspects of childhood if he has, in effect, no language before going to school; there must be some communication with the parents, with other people, some understanding of the world in general, that is cut off. At least one would suspect so: we need careful studies, including perhaps analytic reconstructions, to see how the first five years of life are altered if one fails to acquire language during this period.

  Children, it would seem, cannot choose the world they will live in—the mental and emotional, any more than the physical world; they are dependent, in the beginning, on what they are introduced to by their mothers.

  It is not just language, but thought, that must be introduced. Otherwise the child will remain helplessly trapped in a concrete and perceptual world—the situation with Joseph, Kaspar, and Ildefonso. This peril is much greater if the child is deaf—because (hearing) parents may not know how to address their child and, if they communicate at all, may use rudimentary forms of dialogue and language that do not advance the child’s mind and that, indeed, prevent its advance.

  Children seem to copy faithfully the cognitive world (and ‘style’) introduced to them by their mothers [Schlesinger writes]. Some mothers introduce a world that is populated by individual, static objects in the here-and-now labelled in identical ways for their children from toddlerhood through latency…Such mothers avoid language at a distance from the perceptual world…and in poignant attempts to share a world with their offspring join, and remain in, the perceptual world of their children…

  [Other mothers, in contrast], introduce a world wherein things that are seen, touched and heard are enthusiastically processed through language. The world they introduce is wider, more complex, and more interesting to the toddlers. They too label objects in the perceptual world of their children, but use correct labels for more sophisticated percepts, and add attributes to them via adjectives…They include people, and label the actions and feelings of individuals in the world, and characterize them via adverbs. They not only describe the perceptual world but help their children reorganize it and to reason about its multiple possibilities. 72

  72. Schlesinger, Hilde. ‘Buds of Development: Antecedents of Academic Achievement,’ work in progress.

  These mothers, then, encourage the formation of a conceptual world which, far from impoverishing, enhances the perceptual world, enriching it and elevating it continually to the level of symbol and meaning. Poor dialogue, communicative defeat, so Schlesinger feels, leads not only to intellectual constriction but to timidity and passivity; creative dialogue, a rich communicative interchange in childhood, awakens the imagination and mind, leads to a self-sufficiency, a boldness, a playfulness, a humor, that will be with the person for the rest of his life. 73

  73. It does not matter essentially, Schlesinger believes, whether the dialogue between mother and child is in speech or Sign; what matters is its communicative intent. This intent—which, like so many intents, is largely unconscious, may be in the direction of trying to control the child, or in the healthy direction of fostering its growth, its autonomy, and its expansion of mind. But the use of Sign, other things being equal, clearly makes communication easier in very early life, because the deaf infant spontaneously picks up Sign, but cannot as readily pick up speech.

  Schlesinger sees communicative intent as a function of ‘power’—whether the parents feel ‘powerful’ or ‘powerless’ in relation to their child. Powerful parents, in her formulation, feeling themselves autonomous and powerful, give autonomy and power to their children; powerless ones, feeling themselves passive and controlled, in turn exert an excessive control on their children, and monologue at them, instead of having a dialogue with them. Having a deaf child, of course, may give the parents a feeling of powerlessness: How can they communicate with the child? What can they do? What expectations can they, or the child, have for the future? What sort of world will be forced on them, or will they force on the child? What seems crucial is that there be a feeling, not of force, but of choice—that there be a desire for effective communication, whether it be speech, Sign, or both.

  Charlotte, a little girl of six, is also, like Joseph, congenitally deaf. But Charlotte is tremendously animated, playful, full of curiosity, turned vividly to the world. She is almost indistinguishable from any other six-year-old—totally different from poor, cut-off Joseph. What made the difference? As soon as Charlotte’s parents realized she was deaf—when she was a few months old—they decided to learn a signed language, knowing that she would not be able to pick up spoken language easily. They did this, as did several of their relatives and friends. As Charlo
tte’s mother, Sarah Elizabeth, wrote when Charlotte was four:

  Our daughter Charlotte was diagnosed profoundly deaf at ten months old. During these past three years we have experienced a range of emotions: disbelief, panic and anxiety, rage, depression and grief, and finally acceptance and appreciation. As our initial panic wore off it became clear that we needed to use sign language with our daughter while she was young. 74

  74. ‘For someone as deaf as Charlotte, lip-reading and intelligible speech can be achieved only after years of hard work, if at all,’ writes Sarah Elizabeth. This, at least, was her conclusion, after much study and discussion. But the parents of another profoundly deaf little girl, confronted with much the same situation, came to another conclusion, and felt they had another option.

  Alice was found to be profoundly deaf at the age of seventeen months (with a hearing loss of 120 db in one ear and 108 db in the other). One answer for her, her parents were persuaded, lay in Cued Speech, coupled with the use of the most powerful hearing aids. (Cued Speech, developed by Orin Cornett, makes use of simple hand positions about the mouth, which serve to clarify different sounds that look alike to the lip reader.) Alice has apparently done well with this, has acquired a large vocabulary and excellent grammar, and (at the age of five) has an expressive language level twenty months in advance of her age. She reads and writes well, enjoys reading and writing. She does well academically (she has a full-time Cued Speech interpreter at school). She is described by her parents as ‘very bright, well-adjusted, popular, outgoing,’ though with some fears, now, about finding herself ‘cut-off’ in school.