Seen and Heard at Living Table: Anita Kozan

Anita Kozan is a fairly new but particularly active member of Living Table. She shows up at workdays, sings in the choir, and always has something to contribute on Sundays. Outside of church, Anita is a speech and language pathologist, specializing in the voice. Over time, she has worked in medical and educational settings and also with private patients. In the 1980s and 90s, when she worked with hospitals, most of her patients came to her with injured voices. The clients she sees now are mostly transgender people, and some gender nonbinary people, who want their speaking and singing voice to match their true self.

Anita’s understanding of the vocal mechanism comes both from education and experience. Music has been a huge part of her life. She sings, writes music, and used to play Farfisa organ and alto sax in a group called Vitamin Q. Choir people at Living Table know that sometimes she helps Kevin explain how to make certain sounds or sound qualities. But she also has three academic degrees. She received the last one, a Ph.D. in Communication Science from the University of Minnesota, in 1995.

In 1987, when she started her degree, she founded the first voice laboratory in Minnesota, at United Hospital in St. Paul. Anita used video stroboscopy of the larynx to analyze the voice. A microphone against the person’s neck starts a strobe light when they talk or sing. The purpose is to measure the resulting vibrations of the two vocal folds (vocal cords). Since the folds’ vibrations are very fast (e.g., 256 Hz [i.e., 256 cycles] per second for singing middle C), the strobe light is used to make them appear to slow down so they can be seen by the naked eye for later review. The exam is recorded on video.

The video shows many things, such as whether the folds are symmetrical, close fully, and are the same or different in shape and movement. A trained reader can interpret these findings. The speaker may have some pathology in the cords or weakness or irritation, and there may be some interference in movement because of these. The effects of smoking can be seen. Anita used this information with her patients who had injured voices to help plan their voice rehabilitation goals.

In 2007, Anita left hospital work for educational work in the St. Paul Public Schools with teenagers whose communication difficulties were associated with the autism spectrum, developmental cognitive delay, or voice. She had already begun working with transgender people, in the 1980s in medical settings and in the 1990s privately. However, she concentrated on their care in her private practice, Kozan Clinic for Voice, Speech and Spirit, LLC, beginning in 2007. Her clients continue to come to her at any stage of the transition process, seeking to match their voice with their true gender.

The hormones given for transitioning change the body in various ways, but they have differing effects on the voice. What we tend to call vocal “cords” are really vocal “folds,” layers of flexible tissue folded or wrapped around muscles in the larynx (voice box). Testosterone, the male hormone, enlarges the vocal folds but doesn’t affect the size of the larynx, so the vocal folds don’t have as much space and can become irritated. This can lead to vocal fatigue or a weak voice, or the transmasculine person may push too much and injure the folds.

On the other hand, estrogen, the female hormone, doesn’t affect the vocal folds at all, leaving the transfeminine person with the same voice they had prior to its use. Anita teaches techniques and habits to make the voice better fit the person. For instance, she works with transfeminine people, the majority of her clients, to raise the pitch of the voice and to teach techniques that enhance the listener’s perception of femininity—using a wider pitch range, speaking from higher in the chest voice range or in the lower head voice range, blended in the mixed voice range, and giving the voice a breathier quality.

She also works with gender nonbinary people on their specific goals of finding voice qualities that suit their needs. Anita believes that it is the right of every person to change their speaking and/or singing voice or to leave it exactly as it is, as long as they are not injuring their voice by doing so.

Anita uses her understanding of the voice to make recommendations for exercises to bring about the desired result. For the last 25 years or so, with cisgender as well as transgender clients, she has tackled an extra difficulty—negative self-talk. In her current practice, she finds that often, the transgender person is afraid to try out the new voice publicly and is overly self-critical. So, Anita includes a recommendation that she uses herself.

She teaches people how to practice compassionate self-talk. Listen with compassion. Don’t criticize yourself, and don’t tell yourself that what you’re doing isn’t important or that you should be doing something else right now. Give yourself kind messages. And do it out loud whenever you can, because your self-messages are even more powerful when you hear them in your own voice.