Scientific debates

The work of Alfred Tomatis occupies a singular position: widely disseminated and applied in many countries, it was never fully integrated into academic medicine, and the scientific scope of his work remains debated. To present this work requires setting out as well, without evading them, the reservations and criticisms it gave rise to — and the contemporary re-readings that reassess some of its intuitions.

A partial recognition, persistent reservations

From the 1950s onwards, Tomatis’s proposals met with both interest and hostility. The “Tomatis effect” — the dependence of vocal emission upon hearing — was confirmed experimentally and named at the National Academy of Medicine in 1957, in Raoul Husson’s communication (see the Archives). This validation, however, bears on a precise fact of audio-vocal physiology, not on the whole of the therapeutic method that would be derived from it.

For the rest, Tomatis’s relationship with institutional medicine remained tense throughout his career — a tension he himself dated to 1952, and which culminated in his resignation from the Order of Physicians in 1976. The clinical applications of audio-psycho-phonology, extended over time to learning, language and communication disorders, did not receive a recognition comparable to that of the initial physiological effect. The principal criticism is methodological in nature: the claimed clinical efficacy rests mainly on observations and case reports, and not on controlled trials meeting the requirements of evidence-based medicine.

This reservation was expressed in its most clear-cut form on 20 November 1989: in an opinion devoted to unproven medicines, the National Academy of Medicine held that the Tomatis method presented “no serious character from a scientific point of view” and that its results “have never been able to be tested precisely and remain strongly debatable.”

The contemporary assessment of the evidence

As the method came to be applied to vulnerable populations — notably children presenting developmental disorders —, it entered the field of the evaluation of care practices. Related auditory stimulation approaches (auditory training, the Tomatis method) were thus examined by evaluation bodies, which concluded that there was insufficient evidence of efficacy with respect to the criteria of evidence-based medicine.

In France, the recommendations of the Haute Autorité de santé devoted to autism and pervasive developmental disorders (March 2012) illustrate this position: they specify that “the so-called ‘auditory integration’ practices, including the Tomatis method, have proved to be without effect; they are not recommended.”

These reservations bear on the level of evidence, not necessarily on the absence of effect: they mean that therapeutic efficacy has not been established according to current methodological standards, and they call for caution in clinical indications.

A contemporary re-reading: the ear and the plasticity of the brain

While the assessment by evidence remains reserved, certain recent works in neuroscience have re-read Tomatis’s intuitions in a new light. The Canadian psychiatrist Norman Doidge, in The Brain That Changes Itself (2007) and then The Brain’s Way of Healing (2015), situates Tomatis’s approach within the framework of neuroplasticity — the capacity of the brain to remodel itself under the effect of stimulation.

Doidge ranks Tomatis among the “silent revolutionaries” of medicine and considers that his work suffered from not fitting the mechanistic model of the brain dominant in his time — that of a machine with specialized parts, irreparable once broken. He reports several cases drawn from the practice of the method (including that of Paul Madaule, who became a practitioner after having been its patient, and that of the Benedictine monks of En-Calcat — see the dedicated testimony) and argues that Tomatis’s central idea — the ear as a privileged gateway for stimulating and “recharging” the brain — finds an echo in the current understanding of the role of sensory stimulation. This re-reading does not amount to clinical demonstration, but it restores to the work a coherence and an interest that the controversy over evidence alone tends to obscure.

A work to be held in both hands

To do justice to Alfred Tomatis requires holding together two observations. On the one hand, a fruitful intuition about the link between listening, the voice and language, part of which — the audio-vocal effect — has been established, and the spirit of which today finds support again in the neuroscience of plasticity. On the other hand, a therapeutic edifice whose efficacy, for lack of controlled trials, has not received the validation that evidence-based medicine requires. It is in this gap — between a real influence and a missing proof — that the scientific debates around his work are located.

Sources: National Academy of Medicine, session of 20 November 1989; Haute Autorité de santé, recommendations on autism and PDD (March 2012); Norman Doidge, The Brain That Changes Itself (2007) and The Brain’s Way of Healing (2015).