July 31, 2012 Columns

Perspectives: Looking at—and Along—Communication Disorders

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In 1945 the British literary giant, C.S. Lewis, wrote a short article for The Coventry Evening Telegraph titled "Meditation in a Toolshed." In it, he described an experience he had when he entered a dark toolshed.

When he closed the door, a beam of light showed through a crack at the top of the door. He recounts looking at that beam of light and seeing the dust particles dancing in it. Then he moved and put his face and eye in the beam of light, looking along it. Lewis recounts seeing green leaves outside, the blue sky, and the sun. He used this experience to talk about two different ways of seeing something: looking at versus looking along.

For example, one can look at and along a communication disorder like aphasia. The speech-language pathologist can explain it by referring to brain damage, impaired neural processes, and the characteristics of language impairment. But, looking along it, the person with aphasia might relate the experience of being trapped inside oneself, feeling incompetent and "like a burden," and having a sense of darkness and gloom invading his or her life. We might say that the SLP has looked objectively at the experience of aphasia, but the person with aphasia has looked subjectively at it. Lewis comments:

The people who look at things have had it all their own way; the people who look along things have simply been brow-beaten. It has even come to be take for granted that the external account of a thing somehow refutes or "debunks" the account given from inside. "All these moral ideas which look so transcendental and beautiful from the inside," says the wiseacre, "are really only a mass of biological instincts and inherited taboos." And no one plays the game the other way around by replying, "If you will only step inside, the things that look to you like instincts and taboos will suddenly reveal their real and transcendental nature."

Step inside. That is not something I heard much about as I went about my graduate training to be an SLP. I attended a wonderful school for my master's work. It was small and intimate and the professors cared about us not only academically, but also personally. We were even strongly encouraged to call our professors by their first names, a heresy I've since heard in many other programs. I believe I was trained well to identify the characteristics of various communication disorders as well as to evaluate and treat patients. I felt confident when I left my graduate program and entered the hospital environment that I knew what I was doing. But a big surprise quickly came. That surprise was the subjective experience patients and their families were relating to me. Fear, loss, frustration, loneliness, desperation, depression, acceptance, shock, and anger—these were experiences my patients were telling me, and I was frankly unprepared to deal with them. I had been trained to look at, after all, not look along.

I understand that some who are reading this article will respond, "Suck it up...this is how we all learned!" But my question is, why is "looking at" acceptable in our training programs, but "looking along" is often left in the domain of "future practical experience"? Are we afraid of something? Are feelings too messy for us to deal with? Is there something we can do to take a whole-person perspective and train our undergraduates, graduates, and professionals to look at and also along? Can we teach them to "step inside" as Lewis urges?

I moved work settings about 13 years ago, leaving the hospital context and entering the world of academics. I vowed to teach my students well, to look both at and along their patients, but how? Was there a door I could identify that would allow students (and myself) into the subjective experience of our patients? Eventually, while working on my dissertation, I stumbled across a potential door—empathy. Merriam-Webster's Collegiate Dictionary defines empathy as:

The action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experiences of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner.

Margulies (1984) divided empathy into two domains. First, there is resonant empathy: The clinician listens attentively to the patient's expressions of emotion. Most professionals in our field are probably pretty good at this. In imaginative empathy, the clinician uses his or her imagination to step into the patient's shoes and construct what the patient's inner world might be like. To be effective SLPs, students and professionals must have not only resonant empathetic skills, but also knowledge about the possible emotions, struggles, and so forth a patient might have and effectively engage the patient in imaginative empathy. Margulies argues that imaginative empathy may be lacking in most communication disorders training programs; patients and caregivers, however, have reported that they want not only skillful clinicians, "but also an empathetic, supportive counselor" (Luterman & Kurtzer-White, 1999).

So, if imaginative empathy is the door to stepping inside and looking along, how do we come alongside students—and professionals—to open them to opportunities where that can develop? How do we hone this type of empathy?

One of my friends, Christopher Walker, told me about a book he used in one of his classes, Where Is the Mango Princess? A Journey Back from Brain Injury. The book recounts the story of the Crimmins family and their experience with the family's father, Alan, and his rehabilitation after a traumatic brain injury. What other media and experiences could I use with my students to get them to step inside and look along? Since this time, I have used primarily three things to build imaginative empathy in my students.

First, I've used biographies and autobiographies. In addition to The Mango Princess, I have also used Temple Grandin's Thinking in Pictures (autism), Donna Williams' Nobody Nowhere (autism), A. R. Luria's The Man With a Shattered World (traumatic brain injury), Oliver Sacks' The Man Who Mistook His Wife for a Hat (various neurological disorders), Jill Bolte Taylor's My Stroke of Insight (stroke), and Harrianne Mills' A Mind of My Own (aphasia).

Second, I have used movies. "Temple Grandin," starring Claire Danes, is a great film for helping students into the world of autism. "The King's Speech," with Colin Firth and Geoffrey Rush, is an obvious film for understanding the world of stuttering. One of my favorites is "The Diving Bell and the Butterfly," starring Mathieu Amalric, the story of Jean-Dominique Bauby and his struggle with locked-in syndrome. The director, Julian Schnable, makes the viewer feel he or she is inside Bauby, seeing the world the way he does (imaginative empathy!). My students are always greatly moved by the experience of watching clips of this film in class.

Third, I require students to interview a person with a disability. Through this exercise, they hear directly from people who have a speech, language, hearing, or other physical disability. They focus less on individual symptoms and more on fears, struggles, emotions, and successes. Students have reported that hearing about what life is like living with a disability is a meaningful experience.

Students are not the only ones who can benefit from experiences like these three. Because of large caseloads and hectic schedules, it is easy to get into "professional mode" and perform our professional practices without entering our patients' worlds. It would be impossible to do so with each of our patients, but we would benefit from using our imaginative empathy every so often and look along our patients and their experiences. Perhaps incorporating books and movies, along with deeper talks with patients, would go a long way in developing and deepening this form of empathy. I think this would make us better clinicians, fulfilling what Luterman and Kurtzer-White found our patients want: empathetic and supportive counselor-clinicians.

Matthew H. Rouse, SLPD, CCC-SLP, is associate professor and chair of the Department of Communication Sciences and Disorders at Biola University in La Mirada, California. He is an affiliate of Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders; 3, Voice and Voice Disorders; and 10, Issues in Higher Education. Contact him atmatt.rouse@biola.edu.

cite as: Rouse, M. H. (2012, July 31). Perspectives: Looking at—and Along—Communication Disorders. The ASHA Leader.


Canning, I., Sherman, E., Unwin, G. [producers], & Hooper T. [director]. (2010). "The King's Speech." London: UK Film Council.

Crimmins, C. (2000). Where is the mango princess? A journey back from brain injury. New York: Vintage Books.

Ferguson, S., Saines, E. G. [producers], & Jackson, M. (2010). "Temple Grandin." New York: HBO Films.

Grandin, T. (1995). Thinking in pictures and other reports from my life with autism. New York: Vintage Books.

Kennedy, K. [producer], & Schnabel, J. [director]. (2007). The Diving Bell And The Butterfly [motion picture]. France: Canal+.

Luria, A. R. (1972). The man with a shattered world: The history of a brain wound. Cambridge, MA: Harvard University Press.

Luterman, D., & Kurtzer-White, E. (1999). Identifying hearing loss: Parents' need. American Journal of Audiology, 8, 13-18.

Margulies, A. (1984). Toward empathy: The uses of wonder. The American Journal of Psychiatry, 141, 1025-1033.

Mills, H. (2004). A mind of my own: Memoir of recovery from aphasia. Bloomington, IN: AuthorHouse.

Sacks, O. (1985). The man who mistook his wife for hat and other clinical tales. New York: HarperPerennial.

Taylor, J. B. (2009). My stroke of insight: A brain scientist's personal journey. New York: Plume Publishing.

Williams, D. (1992). Nobody nowhere: The extraordinary autobiography of an autistic. New York: Times Books.


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