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It has long been recognized that the voice is a sensitive reflector of emotional states. Speech, as Hughlings Jackson said, is not always used solely for the communication of meanings—'propositional speech', as he called it—but may also constitute the expression of feelings, in which case it may have less propositional value. This fact is so universally recognized that there is danger of it being taken for granted and overlooked. The analyst may tend to concentrate his attention solely on what the voice is saying.
Disturbances of the voice and of voice production occur not infrequently as an outward manifestation of emotional conflict, in short, as a symptom of neurosis. Bunker recently discussed disturbances of the voice as symptoms of neurosis and psychosis and described a male patient who made a fetish of the female voice (1). Subtle changes in timbre, the inflections or monotony, the rate of speech, pitch and intensity or deviations in the use or grouping of words, may all be expressions of an underlying emotional conflict. Failure on the part of the psychiatrist to recognize consciously these deviations from the 'normal' can lead to delay or even to failure in understanding the unconscious conflicts depicted thereby. The purpose of this paper is the presentation and discussion of cases illustrating the use of the voice by the ego as a vector for symptoms and defense mechanisms. At no time are voice changes resulting from central lesions or structural alterations of the vocal apparatus referred to. All patients were adults free from the physiologic voice changes of puberty and all were neurologically normal.
Infants react with anxiety to certain tones of voice. Long before language is developed the child expresses pleasure and displeasure by the tone of the sounds it emits. As it grows