About the Silence

(*) Paper presented a round table during I Congresso Paulista de Neurologia e Psiquiatria Infantil — USP — São Paulo, Brazil, on March 3rd, 1993

Firstly, Abstract this short presentation demonstrates the autistic patient's communication barrier made u p of objects, things, play-words that "accidentally" – by means of a powerful affection that surpasses such barrier _ end by turning these activities into instruments that bring the patient closer and enable building up the autistic patient's language, consequently, facilitating communication with him. Secondly, by means of a psychodynamic comprehension of this process in the therapist-patient relationship, it aims at presenting psychopedagogical attitudes developed during the activities with the purpose of making the articulation of the autistic patient's language between the "outer" and "inner" world possible.


Key words: Language, silence, communication, activities.

To Wittgenstein, the meaning of life is transmitted by the language. Not only this language presents the experience, but it also gives meaning to it. However, the language only makes sense if it is able to reveal from the inner to the outer world. Consequently, the language can represent facts and express emotions.

According to this philosophic concept, both logic and ethics re connected with what can be "shown" but not "said". Therefore, the language is neither the counterpoint to silence nor an argument for it.

This philosopher who is rather for "pragmatic" and "psychological" currents states that as the painter creates an artistic representation, we also create a language.

This is a good area for those who phenomenological have to deal with a silent body. According to Green, it is "a live body as regards life, but dead to consciousness". It is a body that doesn't manifest affection. That is why we can not speak in terms of a "body that speaks". It is therefore an autistic body.

The individual who is born in this silence or who has it early very little is shown and very little is said. It is exactly in this autistic barrier that intervention is designed. It is therefore necessary to consider that the "barrier is basically on our side", that the accidental thing is a "break in the affective silence encouraged by a powerful affection".2It is a powerful affection that surpasses the opposing power of the barrier and shows by means of objectives, things, games or words that had built up the barrier.

This first movement is illustrated here by parts of occupational therapy sessions with two patients. The first one used a barrier made up of objects-things and the second one was made up of words that were ceaselessly said.

A therapist who was under my supervision showed me the case of a child who handled a ball in a strange way. The boy used to knead it, to roll over it, he used to passe it from one hand to another so fast that it was surprising not to see it fall. He never kicked or threw it. Sometimes, he would leave and make it fall. The therapist would then take it and call him persistently trying to throw it to the boy who would not eve look at it. When the ball was on the floor between his legs, he used to take it frantically and pass it from one hand to another.

This was not the only strange thing in this child. Everything was strange. But we decided to start to talk about the ball because the therapist thought that such attitude could probably give satisfaction to the patient.

At that moment, we started to see that way of using the ball as a very particular way of playing. We tried to check the possibility of making the therapist participate in this game. The therapist had to learn how to pass the ball from one hand to another. Later, the ball started to be handled by four hands.

One day while those four hands were playing, the two player fell on the floor. The boy fell on the therapist's lap and the ball was between the two bodies. The ball was exactly between the therapist's breast and the boy's mouth. The boy started to suck it, lying his head on the therapist's arm.

During most sessions, after playing with the ball, the boy wanted to lie on the therapist's. But something different occurred on that day . Sucking the ball comfortably and calmly he didn't defecate or urinate on the therapist's lap as he usually did.

The other boy used to speak a lot. He spoke ceaselessly scribbling on the blackboard and repeating: "We are teaching this". "The maid is a tramp". "the plane goes to the station and there is an accident with the train and the train with the plane". "On his birthday, if someone breaks the telephone he will be punished and the police will be called". "Do you want mom?" "Is he going to destroy the monster?" And so on…

I attended many lessons sometimes with his parents. Lessons that were given by that "irritant teacher" who irritated us for being persistent.

After having tried many times, I finally was able to draw a line on the blackboard dividing it and started to draw on it. While I was drawing a house, trees, boys, plays, etc., I told stories introducing my characters. At first, he used to erase my drawing eve before finishing them . Later, he would only erase them after I have finished telling the story.

Then I started to draw on sheets paper with color pencils putting them into a folder. The boy started to open the locker and take the drawing material. One day he found in the locker a doll made of cloth that had been made by a group of teenagers and who was called Alexandra.

He took the doll from the locker and as he hit her slightly, as if he was beating her, he asked: "Is she going to kill the monster?" "Is she bad?". Later, the doll started to draw "with us".

Since the doll was frequently handled it became loose. One day the boy moved it abruptly and the arm of the doll was detached from the body. The boy was extremely shocked and repeated: "Now it is all over, she is not coming any more". "She died". "It is over". I went to the locker, I took a thread and a needle and started to sew the arm and attach it to the doll. At that moment, he opened the locker, he took some color pencils and a sheet of paper and started to scribble saying: "Mrs. Jô knows, Mr. Paulo (it was presumably his name) doesn’t", and then "he is going to work too".

I believe that any therapist or person who wants to overcome the barrier the autistic creates, may have to face a break of the affective barrier to be able to find a way to establish a relation with the autistic.

However, seeing that we are dealing with occupational therapy, a technical project was previously designed by "doing".

This "doing" is determined by establishing a therapeutically area where three elements equally meaningful are present: the patient, the therapist and the activity.

A very particular dynamics is created in the comprehension and intervention of psychodynamic processes occurred in the relationship therapist-patient as well as in the doing, constructing, making, and creating dynamics. These area activities that not only communicate fanciful and projective movements but they are also objects that can be used in the outer reality.

There are two basic aspects in this therapeutically commitment – to comprehend the individual's psychodynamics and to create and apply psychopedagogical techniques so that activities are made. To make this possible, we must be able to "see" as the process of making activities evolves not only a body using a language but also a learning process.

When the boy was sucking the ball it gave him such a good feeling that it could replace another one – pure expulsion. The expansion of the sucking process occurred during the occupational therapy sessions when it was possible to establish the habit of being well fed. Preparing a meal and sharing it, these habits were added to the fact of eating appetizing things. These activities represented not only as a positive reinforcement to expand the use of the material available at the occupational therapy room, but they also enable a closer relationship between the therapist and the patient.

Alexandra – the ventricle boy's doll that wanted to learn to count – was able to do that by counting musical notes: do - re- mi... It is also because of the do scale that the boy learned to write his first letter on the blackboard.

If we want this to occur, there must be a silence in this occupational therapy program, that is, the therapist's silence. She must silence her own wishes, desires, her anxiety and anguish. This can be shown by avoiding saying many words and by making gestures that come out as and for answers.

This was seen on a video bought by the therapist under my supervision. It showed many sessions with an autistic patient and when the sound was omitted, the therapist's gestures were very effective in the sense that they could bring the patient closer. On the other hand, this same goal was reached by using words, short and clear sentences, repeated times after a long silence.

Concluding my presentation I would say that doing occupational therapy means above all doing. Everything that is seen and built within this context constitutes the informative arsenal. Information stored by the therapist is the main instrument that enables establishing a relationship, communication and language.

The same old question is: as far as psychodynamics is concerned – exhaustively examined by important experts on autism – to create in each clinical situation psychopedagogical techniques that enable establishing and maintaining the relation between the "inner" and "outer" as it is suggested by Winnicott

Adress for correspondence:
Maria José Benetton,
Occupational Therapist, Doctor in Mental Health, Coordinator at Centro de Estudos de Terapia Ocupacional
Rua Fradique Coutinho, 1945
São Paulo, SP
Email: cto_sp@terra.com.br