When Your Brain Steals Your Mic  

The Neuroscience behind Conversion Aphonia

What if the strongest way for your mind to protect you was by stealing your voice? Sounds terrifying, doesn’t it? Being robbed of your ability to voice yourself, because there is a profound difference between having nothing to say and being physically unable to speak. And this is a reality for people who experience conversion aphonia. Conversion (or functional) aphonia is a subtype within Functional Neurological Symptom Disorder (FNSD). It is characterised by a sudden loss of voice or the inability to produce voiced speech, despite the individual having no organic structural issues or damage in their vocal folds.

You may wonder: if there is no underlying neurological pathology, why can they not simply open their mouths and speak? Well, here is where the complexity unfolds. When an individual faces intense emotional or traumatic situations, the brain represses highly threatening emotions (such as profound rage, anxiety, grief, or terror) to protect us, preventing these emotions from entering conscious awareness, as bringing these emotions to light seems unsafe. This removes the person from having to verbally express their terrifying thoughts or feelings during stressful situations, preventing them from having a psychological breakdown. However, the emotional surge does not simply disappear- the outlet is its unconscious ‘conversion’ by the brain into physical, somatic symptoms that is the loss of one’s voice.

Here is where things get more complicated: on the rare occasion that conversion aphonia occurs, it may or may not be characterised by total voice loss; i.e., the non-verbal sounds of vegetative behaviour, like coughing, crying, yawning, sighing, etc., may still be preserved despite loss of vocalised speech. Sometimes, the individual may be able to speak, but the speech is strained and whispered. There was even an intriguing case in India, where an individual with conversion aphonia was asked to speak while wearing headphones playing loud masking noise, and he produced voiced speech, with an underlying application of the Lombard effect (in which people increase volume and vocal effort when speaking in a noisy environment). But when the noise stopped, and the client realised he was actually producing a voice, he immediately slipped back into his breathy, strained whisper.

While this may sound phoney, there is a modern neuroscientific explanation for the brain networks misfiring during conversion aphonia. Moving away from the Freudian concept of ‘repressed emotions’, fMRI shows that when an individual experiences overwhelming stress or trauma, the limbic system (the emotional processing centre) becomes hyperactive, flooding the prefrontal cortex and motor centres of the brain with inhibitory signals to manage the emotional overload and protect the system. With the brain’s emotional centre hijacking its physical controls, it is unable to send the command to move the vocal cords. So, the brain does its best to deal with the emotional overload, but its byproduct of this protection is the inability to speak. This presents a rare paradox: our brain robs us of our voice to protect us.

There is an interesting gender disparity seen in the occurrence of conversion aphonia, with its prevalence higher in females than males by a ratio of 8:1. The predominant reasons for the same are:

  • ‘Double Burden’ of Professional and Domestic Stress: Women experience high sociopsychological stress, where they are expected to perfectly balance their careers and domestic lives, which frequently puts them in high-stress situations. These can trigger somatic symptom defence mechanisms. The disparity is greatest in the age group of 30-50, because this is the period when women generally experience their highest levels of professional and domestic activity.
  • Familial and Societal Conditioning: Gender-specific upbringing and societal expectations that teach women to tolerate instead of speaking up for themselves can restrict emotional expression, which later manifests as somatic symptoms. In a case in Bangladesh, the youngest daughter, who was always shown unconditional love and overprotected since childhood, was unable to adaptively cope during a period of intense emotional conflict with her family, where their unconditional acceptance was disproved.
  • High-Vocal and Emotionally Demanding Occupations: Overpresentation is observed among women in jobs that require high vocal and emotional activity, especially homemakers and teachers.

Broader trends in trauma and anxiety disorders also show a higher prevalence in females compared to males, such as selective mutism and conversion disorder, to name a few.

Now, coming to the most important question- Is it possible to get your voice back in such a condition? The answer is a resounding ‘yes’! A multidisciplinary approach can be adopted for treating conversion aphonia, combining voice therapy, psychotherapy, and, at times, pharmacotherapy:

  • Voice and Sound therapy: Speech and language therapists build on the natural vegetative sounds (crying, yawning, sighing…) to show clients that they can close their vocal folds, which slowly transitions into voiced speech. Physical vocal exercises, such as humming, blowing, whistling, and more, are used to re-establish vocal control. The Lombard Effect is also used, in which auditory masking is achieved by having the client wear headphones that play loud masking noise. Because the client cannot hear themselves, they involuntarily produce voiced speech, and this is used to break through their mental block.
  • Psychotherapeutic interventions: Cognitive Behavioural Therapy (CBT) is often integrated with voice therapy to help clients restructure their negative and catastrophic thoughts, manage their stress and develop healthy behaviour patterns. Empathetic psychotherapy can help clients process their suppressed emotions, emotional conflicts or past traumas.
  • Occupational therapy and Environmental Modifications: Immediate modifications can be made to the client’s environment to reduce the stress factor driving the aphonia. Occupational therapy can help in cognitive retraining, social skills and reintegration into society by restoring confidence and psychosocial functioning.

This blog emphasises the importance of addressing our emotional conflicts, as our emotions need an outlet. Simply shutting the door on them at the moment does not make them disappear- they manifest elsewhere. UNSAD health specialises in the treatment of psychophysiological disorders, spreading awareness that not all physical impairments have structural or organic causes- they can be due to psychological stress too.




Author

I am Gaurika Sharma, an Honours-year B.A. Psychology student who is endlessly fascinated by what shapes a person’s plotline, especially the seemingly strange, complex, and sometimes counterproductive ways our brain tries to protect us. Currently interning at UNSAD Health, I aspire to be a Clinical Psychologist who is reliable, free of fluff and pretence, and who steadily walks alongside people until they reach their version of the finish line. When I’m not buried deep in novels and books or decoding human behaviour, I ground myself using a steady dose of dry sarcasm.

This article has been reviewed by Dr. Syeda Arifa Tasneem, Ph.D., Clinical Psychologist and Founder of UNSAD Health.

The author is currently completing an internship at UNSAD Health.