- Abtract : A thirteen-year-old patient
is presented, to demonstrate how the active
analysis of nonverbal expressive behavior, in
this case yawning, was of value in understanding
and treating a youngster who, because he was so
withdrawn, would not otherwise have been
amenable to the standard one-to-one
psychotherapeutic approach. In discussing the
clinical material, the literature concerning
nonverbal expressive reactions, particularly in
respect to yawning, is reviewed. In the process
the psychogenetic, dynamic, structural, energic,
and adaptive aspects of yawning are described.
It is the author's opinion that only by focusing
on specific non verbal reaction such as yawning
can the unwieldy task of ,naking some meaningful
statement about a manifestation as protean as
the nonverbal in therapy occur.
-
- Whereas nonverbal communication may become
an issue in psychotherapy due to the patient's
own interest in certain specific nonverbal
reactions (Marcus, 1969), or because a nonverbal
response is particularly striking or interesting
to the therapist, there are instances when the
meaning of a patient's nonverbal behavior should
be explored even though neither the patient nor
the therapist finds the behavior to be
especially intriguing. This becomes imperative
when the nonverbal reaction is the sole response
the patient evidences, because its avoidance
would otherwise result in a therapeutic
stalemate. This is important when dealing with
the difficult child-patient who favors primitive
communications and who is often silent and
withdrawn during sessions.
-
- A noncommunicative thirteen-year-old will be
presented, whose incessant yawning constituted
his principal expressive response during a phase
of treatment lasting many months. The suggested
active approach to the nonverbal behavior, led
not only to an understanding of this patient's
nuclear pathology, but also provided an
opportunity to delineate the metapsychology and
therapeutic praxis of yawning. Only through the
restricted in-depth analysis of unitary
nonverbal reactions can the large and somewhat
unwieldy task of comprehending the psychological
significance of the nonverbal be reduced to
manageable proportions.
-
- CASE PRESENTATION
-
- The patient, whom I will call Ray, was
originally referred for psychotherapy at age 11
because of longstanding difficulty in learning
to read. He was also irritable and socially
isolated. Although his IQ placed him within the
high average range of intellectual functioning,
his academic performance was extremely poor.
Neurological examinations were negative. When
Ray was asked what the trouble was, he often
responded by saying that the reason he was "bad"
was that he was "too bored o be bothered with
anything."
-
- Ray's family background was highly
pathological. Ray's mother was a strongly
narcissistic lady who identified Ray with his
"crazy" father. The father was subject to
hypomanic episodes, at which times he was very
loud and flamboyant. The father repeatedly
disappointed the family by not being able to
sustain the grandiose life-style associated with
his elevated moods. Because of this, any natural
signs of emotional intensity or spontaneity on
Ray's part were looked upon with great suspicion
by the mother, and Ray therefore differentiated
himself by becoming, in certain apparent
respects, his father's opposite: that is, bland
to the point of being schizoid.
-
- Ray had already started therapy on the
occasion of his father's last and most
disastrous hypomanically inspired business
venture. The mother, once more faced with her
husband's failure, finally effected a
separation. Contact between Ray and his father
was now restricted to weekends, when the father
would not uncommonly take his son with him to
the race track, telling Ray that the boy's
presence was responsible for his wins or losses.
This may partly explain Ray's belief, which
emerged in therapy, that he could exercise
magical powers simply by passively
existing.
-
- After approximately two years of treatment,
the boy's initial therapist decided that given
Ray's rejecting mother and disturbed father,
nothing more could be done unless Ray were
removed from the parental home. As staff
psychiatrist at the Jewish Child Care
Association, which subsequently became
responsible for Ray's care, I started to see the
boy on a twice-a-week basis, six months after he
was placed at a small group residence.
-
- The new course of treatment following
placement did not begin auspiciously. Ray was
not happy about having to live apart from his
mother. Session after session, he sat silently
staring and yawning. Rather than agree with Ray
that nothing was worth talking about, and rather
than discuss reports of his continual failure in
many areas outside the therapy (something that
had been done by others, resulting in further
lowering of his already lowered selfesteem), I
simply described Ray's immediate nonverbal
behavior to him. In response to this, Ray,
somewhat annoyed, spoke of how he felt he was
always being unjustly criticized for everything
he did. I tried to point out that I was not
criticizing him but merely making
"observations." I only partially succeeded in
convincing Ray of my sincerity because, in
actuality, I had been mildly disconcerted by his
extreme passivity.
-
- At about this time I began to receive
information that outside therapy, Ray had begun
to improve in his ability to more actively enjoy
himself. Within the treatment, with continuing
feedback about his behavior, Ray now became
increasingly somnolent and withdrawn-making it
almost impossible for him to follow the simplest
conversation. Yawning during sessions became
more and more pronounced and, in keeping with a
decision to comment upon whatever the patient
brought to sessions, yawning at this point
became the major focus of the therapy.
-
- Ray at first insisted that yawning was in no
way significant. Although continuing to yawn, he
did perk up a bit when I evidenced real interest
in what he was doing. Ray then admitted to
feeling more relaxed when he yawned. He also
explained that yawning was a way of influencing
the person at whom the yawn was directed. The
infectious nature of the reflex was seen to be
an important aspect of its dynamic. This
formulation was an outgrowth of Ray's own
hesitant associations (increasingly verbal in
nature) about what he was doing.
-
- The patient said he was troubled since he
noted that I also yawned. He did not know
whether it was he who influenced me or vice
versa. Passive dependency was seen to be linked
with a concern about being controlled or
controlling others. Pursuing this theme, Ray
beamed when he announced that he would like to
dominate me, that is, put me to sleep; but felt
that he, of all people, could never influence
anyone. Because his social withdrawal and
boredom had always been experienced by others as
a psychological null factor, this
underlying
- fantasy of dominating other people had never
been made explicit. This clarification allowed
therapist and patient to understand how
passive-dependent states may screen very active
fantasies of omnipotent effectiveness. Further
analysis of yawning proved to be a rich source
of information about the complexity of his
passive-active strivings.
-
- Ray mentioned that he was puzzled by the
fact that he could not make any noise when he
yawned. I speculated that early in life, perhaps
when he was very young, he either did not want
to hear a certain sound or was severely
reprimanded for making noise. Following this
comment, the patient was amused to find that not
only could he vocalize when yawning, but that he
had become more verbal in his communications
outside the therapeutic setting as well. It
could not be verified whether the psychogenetic
reconstruction had been accurate; nonetheless,
Ray remembered that his mother had always been
impatient of any of the verbal demands he made.
It was easy to see why Ray was so taciturn. The
analysis of his yawning made his passivity more
understandable.
-
- The patient claimed at this time that his
therapist must be a mind-reader. Ray also
believed that he could read and control the
therapist's mind. He was convinced that he
yawned because I was thinking he would. He was
also convinced that by thinking sleepy thoughts,
he could force me to yawn. His preoccupation
with mind-reading, with thought and behavior
control, was clearly involved in his compulsive
yawning. The patient was encouraged to describe
all the nonverbal cues that initiated yawning,
and he gradually became aware that he had
generally made interpersonal exchanges more
magical than they really were. The magic
depended on the unconscious nature of Ray's
subliminal awareness of people's nonverbal
behavior. As long as this appreciation was
unconscious, the influence one person had on
another did not appear to be causably
explicable, except in some magical fashion. Of
course the unconscious of one person can
directly understand and be influenced by the
utterances of the unconscious of someone else
(Szalai, 1934), and when Ray had understood that
this was part of a rationally explicable
process, his belief in telepathy was greatly
diminished.
-
- The continued delineation of the extent to
which one can exercise conscious control over
simple reflex activity gave the patient a
greater sense of freedom and enabled him to
recognize in what manner he could choose to
influence or be influenced by others in respect
to the satisfaction of passive-dependent
drives.
-
- He became concomitantly capable of admitting
something of the aims and goals of his
behavior-aims and goals that formerly had been
repressed in the interest of mollifying a
superego demanding precocious
self-reliance.
-
- Having acknowledged that the threatening
controlling nature of his interpersonal,
nonverbal relationship with me was not that
"sinful," his yawning was now more and more
frequently accompanied by smiling. He no longer
had to punish himself as severely and began to
enjoy himself within the therapeutic
setting.
-
- Ray's understanding of telepathy made him
wonder about the fact that he was for many years
convinced that he had gone through a complicated
reincarnation. Ray described vague
recollections, either fantasied or real, of
pleasures experienced "in another life." It
became clear that the smiling cum yawning now in
evidence constituted a reenactment of an earlier
experience of pleasure. Meerloo (1955) has
reported that the act of yawning may itself
consist of an unconscious reminiscence. The
hypnoid state so often accompanying or induced
by compulsive yawning lent itself to producing a
disassociated state, which no doubt created
Ray's subjective impression of having lived
"another life." Just as the conscious awareness
of the importance of subliminally perceived and
emitted cues resulted in a decreasing belief in
telepathy, so a continuing analysis of Ray's
yawning resulted in a modification of his belief
in reincarnation. He now knew that he was
actually in mental possession of an earlier
pleasant identity, probably as a yawning,
contented infant. He understood that he had
never been an individual who had lived at some
entirely different historical period, but more
simply one who had isolated one part of his life
from the whole.
-
- Further details about this case reveal
little more about yawning per se.
-
- Although yawning within the therapeutic
setting persisted without abatement in the
modified "happy" form described above, yawning
and its associated lowered level of
consciousness as well as the boredom with which
Ray initially presented became a much more
peripheral aspect of Ray's life. Agency staff
dealing with Ray at the small group residence
noted that he was no longer withdrawn and
participated in group discussions and games with
his peers. Although he was still the
noncommunicative "pseudo-defective" at school,
his increasing assertiveness at the residence
led to a change in the attitudes of those around
him, particularly regarding his placement. Now
able more directly to articulate his wish to
return to his mother and being able to make this
demand on the basis of his increased maturity,
he succeeded in persuading both workers and
parents that he was ready to leave the
agency.
-
- By helping him to understand something about
the degree to which he had idiosyncratically
invested relatively miniscule "events" in his
passive state with values that these events did
not deserve, Ray was made to see that he really
had been doing nothing prior to placement. This
involved a certain therapeutic paradox. Ray
accepted the reality concerning the "nothingness
of his passivity" only when the passivity was
taken to have some value-that is, some small
adaptive feature that others had repeatedly
denied out of their frustration and fear of this
child's negativism. This value could only be
recognized by a therapist who through his
interpretations demonstrated his empathy, an
empathy that also encouraged Ray to trust others
more fully and to believe that others would
treat him more appropriately regardless of what
he did or did not do. With the renewed
confidence in himself and others, he was able to
allow himself to risk unleashing an active self
that had always been a part of his nature, but
that he had tied up in the passive defensive
maneuvers he employed. I believe there were two
reasons why he remained passive within the
therapy even though he changed outside of it.
First, in therapy his passivity was tolerated to
an extent not permissible elsewhere. Secondly,
the passivity that had not been worked through
more fully emerged whenever Ray was no
sufficiently engaged, as in school, or when he
was engaged to a degree he felt dangerous, as in
therapy.
-
- I did not actively involve myself in
implementing Ray's desire to return home, and
Ray found his relationship with me on these
grounds exceedingly boring. His energies were
now exclusively taken up with conferences
conducted by the agency social worker pursuant
to his living with his mother. Upon returning
home, Ray decided he did not wish to seek
further psychiatric help. Even though he was
bored and tired with me during the final phase
of treatment (since I had not involved myself in
pursuing his wish to go home) there is no doubt
that psychotherapy did allow this boy to move in
the direction of greater participation in
life.
-
- DISCUSSION
-
- Presentation of the foregoing patient
provides a springboard from which one might
plunge into a more elaborate discussion of the
psychological phenomenology of yawning. Some
fifty years ago a number of authors, (Dupart,
1921; Hauptman, 1920; Lewy, 1921) published
clinical studies dealing primarily with the
physiology of the reflex. However, Lewy stressed
the psychological nature of yawning and its not
infrequent association with psychiatric illness.
Goldie and Green (1961) reviews an even earlier
work by Charles Darwin, "The Expression of
Emotions in Man and Animals" published in London
in 1872, that also touches upon the
psychological or communicative aspect of the
reflex.
-
- Phylogenetically and neurologically, yawning
is probably a very primitive reaction.
Ontogenetically it may also be considered a very
basic response. Both Moore and Goldie comment
that yawning is present at birth. Joost Meerloo
(1955) writes that slow muscle contractions
around the mouth-something like yawning-have
been recorded from the fourth intrauterine
month. Could a postulated early psychogenetic
fixation point associated with yawning explain
why Ray was so preoccupied with a life before
life while yawning? Its archaic nature may have
played some part in this.
-
- Yawning is intimately associated with a
state of consciousness just preceding sleep. As
a stretch reflex bringing about reduced muscle
tension, yawning may be a prelude to sleep.
However, by initiating a Bainbridge reflex
(which increases cardiac output and thereby
increases cerebral blood flow), yawning may
decrease generalized neurological depression
making the individual more alert. Hence, by
yawning one may perhaps bring about a level of
consciousness somewhere between sleeping and
wakefulness. Familiarity with Ray's
psychodyanmics revealed that it was precisely
this intermediate state that he wished to
achieve. By compulsively yawning, Ray defended
himself both against falling asleep and against
anxious hyper-vigilance. This in turn is most
consonant with that view of mental
phenomenon-including nonverbal behavior-as
essentially overdetermined.
-
- Ray's object relations were also consistent
insofar as they were those of a person fixated
at the early or primitive stage we hypothesized
would be associated with compulsive yawning.
Scrutiny of the nature of yawning explains the
manner in which the unfolding of this reflex
provides a framework upon which Ray ultimately
elaborated more complex emotional and ideational
intrapsychic realizations of drive satisfaction
through the establishment of specific types of
object relations. For example, Ray's desire to
"be with his mother" went beyond a wish for mere
physical proximity. His associations made it
clear that he secretly desired to regress to a
point that he claimed to have vaguely
remembered-a time before his "reincarnation." He
wished to return to that phase of his existence
when he was unable to be consciously frustrated
by a rejecting mother because at that time he
was unable to clearly perceive any other person
as separate from himself. In his ongoing
behavior Ray attempted through yawning and the
attendant hypnoid state to deny momentarily the
fundamental differentiation of self and object.
He thereby happily merged with the love object.
His beatific expression during the soporific
state of yawning in the latter part of his
therapy, suggested that he had truly returned to
the "booming" satisfying confusion of infancy.
Yawning, and for that matter any primitive
reflex, may be viewed as a defense against
maturation favoring a return to an earlier type
of object relationship (Otto, 1935).
-
- Another adaptive aspect of Ray's yawning may
be perceived when one considers the quality of
the manner in which he related to others while
yawning. Because of the infectious nature of
primitive reflexes in general and of yawning in
particular, yawning favors unconscious imitation
as few other responses do. Through the strategy
of who-makes-whom-yawn, Ray was not only able to
more fully maintain the fiction of a desired
symbiosis but was, thereby, also able to model
himself after another person-becoming, as it
were, the parenting or caretaking individual
himself. He thereby resisted further regression
and avoided a more autistic adjustment. Through
this maneuver, Ray made himself less dependent
on the love object. Ego strength was always
sufficient to preclude a psychotic break.
Therapy consisted in further strengthening this
youngster's ego by providing it with insights
into the nature of nonverbal behavior formerly
ascribed to uncontrolled magic.
-
- Meerloo stresses in his discussion of
archaic reflexes that displaced aggression may
be expressed through incessant yawning. This too
seemed to have been operative in Ray's case. A
consideration of the phylogenesis of yawning
suggests an aggressive anlage for the reflex.
According to Darwin, baboons "yawn" when
threatening one another. As expressive behavior,
yawning must, nonetheless, be viewed as a rather
ritualized, covert form of aggression actually
guaranteeing inhibition of the more destructive
expression of the drive. It is, in this respect,
exactly analagous to smiling. Considering the
patient's remark about how pleased he was with
the idea of dominating the therapist by making
him sleepy, it is easy to see that Ray's yawning
probably was equivalent to an aggressive act. On
the other hand, by yawning the patient repressed
the more overtly angry thoughts that could not
be expressed lest he expose himself to
horrendous retaliation by someone outside
himself whom he intimated he had endowed with
great powers.
-
- At first, during the initial stage of
treatment, Ray handled the ongoing dilemma of
his relationship to me by working himself into a
bored state. The patient, fearing an
overwhelming loss of control due to the high
level of instinctual tension associated with
boredom (Fenichel, 1934), regressed to the less
dangerous condition of drowsy yawning. In this
instance one might speculate that Ray's yawning
(and yawning more generally) was not only a
defense against the more overt, less regressive
expression of aggression, but also a defense
against libidinal drives becoming manifest in
relationship to an overvalued parental figure.
In this context the yawning was consonant with a
state of a more inhibited libido as well as
aggression. Ray kept both friend and foe at a
distance, dulling the pangs of both anger and
separation.
-
- When Ray first began to yawn I found the
session spent with him very tiresome. I began
yawning myself. My reaction was not unusual.
Yawning, more than other nonverbal expressive
reactions, often provokes compulsive imitative
behavior. In contrast to smiling, however,
yawning is provoked by more diffuse stimuli and
is at the same time more concretely imitative.
For example, auditory cues such as other
people's auditorily perceived yawning may be
sufficient to induce large numbers of people to
yawn.
-
- In both crying and smiling, endogenous
factors as well as exogenous cues are important
in determining the response. This is also true
of yawning. Consideration of the relationship
between endogenous and automatic exogenous
smiling in early infancy has been well
researched by Emde (1970). Automatic endogenous
smiling is usually extinguished before the
flowering of social smiling at four months. Emde
postulated and proved that there would be a
developmental stage before the extinction of
primordial endogenous smiling and the full
flowering of automatic exogenously determined
behavior when a summation might be brought about
by satisfying the two sets of conditions
connected with both. Yawning is curiously like
both automatic or reflex smiling and the earlier
endogenous smiling of the drowsy infant. It too
is a neuromuscular reaction involving the mouth,
most often in evidence during drowsy states, and
making its appearance very early in life. The
association between yawning and drowsiness is
even more pronounced than that between smiling
and drowsiness, since it never disappears even
later in life. Yawning is unique because of all
the expressive reflexes it is the most clearly
associated with sleepiness, rather than with any
more complex emotional state. At the same time,
being the most concretely imitative in
nature-that is, the most automatically or
reflexly exogenous-it may be viewed as an
expressive reaction that never loses either its
primitive exogenous or endogenous
characteristics. It never becomes as fully
associated with autonomous ego functioning as do
both crying and smiling. This explains how
problems centering on those primitive processes
of identification-the diffusion of ego
boundaries and problems of symbiosis-may be
expressed through the inappropriate expression
of yawning. The delineation of Ray's problem
suggests the manner in which the control of
yawning may be one of the earliest aspects of
the definition of one's individuality. The
counter-transferential aspect of working with
Ray is also illustrative in this context.
-
- Reciprocal yawning became a problematic
aspect of the therapy. I was irritated when I
started to treat Ray, because I was excessively
frightened that I would be swept into an
overwhelming regression in imitation of my
patient. I felt the desire to manifest an active
resourceful response vis-à-vis the
patient's massive passivity. At the same time I
wished to allow the patient maximum freedom to
express whatever he deemed most appropriate. I
was aware that a classical analyst might
restrict himself to relative inactivity in
dealing with an analysand's silence, but the
patient's yawning was so seductively regressive
that I feared I would passively "give up" and
merge with the other person, just as Ray had
seemingly done. When I tried to arouse the
patient, calling his attention to his behavior,
Ray regressed to the sleepy yawning state as a
defense against the anxiety thereby generated. A
cycle was in the making whereby the therapist,
in attempting to rouse the patient and thereby
deny his own passive wishes, was provoking a
state of more irritable boredom in the
patient-precipitating further regression and
more and more compulsive yawning. A perpetuation
of the cycle was avoided when I began to trust
my ability to stay awake while relaxing with
Ray. When I told the patient that he was not
being criticized about his yawning, my statement
was not an entirely unconvincing intellectual
formulation because I had been willing to
discuss my own behavior which, of course,
included my own yawning.
-
- My supposition about the part the so-called
"noise-making" while yawning played in the
patient's original conflicts freed the patient
to talk more freely outside the therapy. This
amelioration of the patient's tendency to be
verbally undemonstrative and my knowledge about
the importance auditory cues played in
precipitating yawning suggests that yawning may
be involved in the development of speech. I
would not have thought of yawning as a precursor
of verbal communication had I not been able to
empathize with the patient about the adaptive
aspects of his behavior. Rather than criticizing
the patient for his "defense," it proved in this
instance more constructive to have him improve
upon what he was doing.
-
- Perhaps too much was made of the patient's
yawning. At some appropriate moment it might
have been reasonable to point out how tiresome
the whole matter had become. To some extent
voyeurism and covert exhibitionism had run away
with me. I had become gradually more and more
interested in developing a certain expertise
about yawning. Hence, I did not interest myself
in the patient's concern over going home and did
not involve myself more actively in planning for
his separation from the agency. I thereby
avoided recognizing the pain connected with the
loss of a patient with whom I partially
identified. In this way I may unconsciously have
dissuaded Ray from continuing treatment after
leaving placement. Improper involvement with
yawning resulted in a diminution of respect for
the patient's need to move in the direction of
greater individuation and constitutes one of the
dangers of the therapist's being less than
optimally attuned to the patient's nonverbal
behavior.
-
- CONCLUSION
-
- A thirteen-year-old patient is presented to
demonstrate the therapeutic efficacy of
analyzing nonverbal behavior in order to
understand more fully the specific phenomenology
of yawning. Yawning served a dynamic need to
regress. Object relations in this case were
obviated by a subjective sensation of merging
noted during the hypnoid state associated, and
perhaps brought about, by the patient's yawning.
In this manner the patient denied
separation
- from significant others. The automatic,
compulsive, imitative nature of his yawning also
favored the diffusion of ego boundaries,
allowing the patient both to control others
magically and to be controlled in turn. Through
the depression in his level of consciousness,
again associated with yawning, he escaped the
dictates of both instinct discharge and
conscience.
-
- Viewed from the standpoint of progression
rather than of regression, the imitative aspect
of yawning may have played a part in a primitive
internalization of the object through
identification. Yawning, through its controlled
reduction in the level of consciousness, might
have aided the patient in mastering an
unavoidable separation, thereby facilitating
differentiation from the object. Satisfying his
own passive strivings through yawning perhaps
made the patient independent of the real
presence of the need-satisfying object. In this
context, the capacity to yawn when appropriate
may be viewed as constituting a regression in
the service of the ego, facilitating a more
relaxed, more resourceful autonomous utilization
of passivity in the face of life's unalterable
vicissitudes.
-
- Nontherapeutic counter-transference may be
engendered by a patient fixated at a stage in
which a primitive expressive response such as
yawning predominates. The therapist is human. He
communicates nonverbally as well as verbally
and, hence, his own nonexpressive behavior
should also be understood, and it should
sometimes be a verbally articulated part of the
therapy as well.
-
- Hopefully, a detailed discussion of one
patient's yawning in conjunction with the review
of the literature has helped clarify rather than
obfuscate a subject that by its very nature may
not favor alert scrutiny.
-
- References
-
-
- 1. Barbizet, J. (1958), Yawning, Journal of
Neurology, Neurosurgery and Psychiatry, 21:
203-209.
-
- 2.Dickes, R. (l964),The defensive function
of an altered state-of consciousness, Journal of
the American Psychoanalytic Association 13;
356-403.
-
- 3. Dupart, V. (1921), Zur Kenntnis des
Wesens und der psychologischen Bedeutung des
Gähnens. Journal für Psychologie und
Neurologie, 27: 82.
- 4. Emde, R. N. (1970), Endogenous and
exogenous smiling in early infancy. Presented in
San Francisco at the 123rd Annual Meeting of the
American Psychiatric Association.
-
- 5. Fenichel, 0. (1934), On the Problem of
Boredom. Collected Papers, New York, Norton, 1:
292-303.
-
- 6. Goldie, L. and Green, J. M. (1961),
Yawning and epilepsy. Journal of Psychosomatic
Medicine, 5: 263-721.
-
- 7. Hauptman, A. (1920), Wie, wann und wozu
gaehnen wir? Neurologischer Zentralblatt, 39:
781.
-
- 8. Heusner, A. P. (1946), Yawning and
Associated Phenomena. Physiological Review, 26:
156-168.
-
- 9. Kris, E. (1939), Laughter as an
expressive process: Contributions to the
Psychoanalysis of Expressive Behavior.
Psychoanalytic Explorations in Art. New York:
International University Press, 1952.
-
- 10. Lewy, E. (1921), Ueber das Gaehnen,
Zeitschrft für Neurologie und Psychiatrie,
72: 161.
-
- 11. Marcus, N. (1969), A psychotherapeutic
corroboration of the meaning of the smiling
response. Psychoanalytic Review, 56:
387-401.
-
- 12 Meerloo, J. (1955) Archaïc behavior
communicative act: The meaning of stretching,
yawning, rocking and other fetal behavior in
therapy. Psychiatric Quarterly, 29: 60-73.
-
- 13. Otto, H. (1935), Von Recken, Strecken,
Gaehnen und Husten, Fortschritte der Medicin,
53: 304.
-
- 14. Schilkrret H. (1949), Psychogene
Sneezing and Yawning. Psychosomatic Medicine,
11:127
-
- 15. Spitz, R. A. (1965), The First Year of
Life, New York International Universities
Press.
-
- 16. Szalai, A. (1934), "Infectious"
parapraxis. International Journal of
Psycho-Analysis, 15: 187.
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