COVID-19 has changed interpersonal interactions – every person we meet is a possible vector of infection, and hence the new technology of ‘social distancing’, ‘facial coverings’ and PPE. But these precautions have their own consequences in altering interpersonal communication. Masks make our spoken language indistinct, and also obscure our facial expressions. Those who are deaf or hard of hearing are already missing the assistance of lip-reading. So perhaps we need to revisit communication skills with our physiotherapy students.
Illness narratives abound with stories of clinicians’ body language – its importance where language is not possible, and even its truth compared with wordy deceit.
Memoirs about and by people with aphasia and language problems show that aphasics seem to become more alive to body language and the meaning that lies behind facial expressions. John Hale was already an excellent actor and mimic before stroke abolished his language, but his wife Sheila observed how much more sensitive he became after his stroke to gesture and tone of voice. ‘Those with reduced comprehension of language are able to understand the gist of what is being said, and quickly become extremely sensitive to tone of voice and body language’ (Hale 2003 p.160). In John Hale’s case his inability to access language with others seemed to create a more direct form of emotional connection. ‘There is something about his eyes and voice and body language that seems to speak more directly to their hearts than all the words with which he charmed and taught throughout his speaking life’ (Hale 2003 p.220).
The temptation for those with language is to assume that those without have a severe cognitive disability. And that assumption is evident in tone of voice and body movements, as much as in the words we use. Douglas Ritchie tells of how enraged he was by a nurse who spoke to him in childish language. He also reports how the doctor examined him as he was about to leave the acute hospital: ‘he looked at me rather curiously and then with a nod, as benign as mine was fierce, said, ‘That’s right, that’s right.’ I refused to look at him any more, and the doctor, not noticing or, as I thought, assuming that I was as mad or as simple as he considered me to be, talked to my wife….’ (Ritchie 1974 p.49).
Jean-Dominique Bauby’s locked-in syndrome made communication with words very difficult. Many of his carers were unwilling to use his painstaking method of communication through eye-blinks and alphabet recitation. He makes some very caustic comments about lazy health professionals, such as the ophthalmologist who comes to tape one of his eyes: ‘I fired off a series of questioning signals with my working eye, but this man – who spent his days peering into people’s pupils – was apparently unable to interpret a simple look. He was the very model of the couldn’t-care-less doctor, arrogant, brusque, sarcastic…’ (Bauby 1997 p.61).
Mismatch between words and body language is the theme of Oliver Sack’s ‘The President’s Speech’, one of the vignettes in The Man Who Mistook His Wife for a Hat. The aphasic patients found the politician’s artificial body language and gestures laughable, although those not verbally challenged might not notice the mismatch, diverted as we are to the meaning of the words. Sacks went on to say “that one cannot lie to an aphasiac. He cannot grasp your words, and so cannot be deceived by them; but what he grasps he grasps with infallible precision, namely the expression that goes with the words, that total, spontaneous, involuntary expressiveness which can never be simulated or faked, as words alone can, all too easily.” (Sacks 1985)
Perhaps we should start miming classes for our students – essential clinical skills in the era of COVID-19.
References:
Bauby, Jean-Dominique (1997) The Diving-Bell and the Butterfly (translated by Jeremy Leggatt), London, Fourth Estate
Hale, Sheila (2003) The Man Who Lost His Language, London, Penguin
Ritchie, Douglas (first pub. 1960, 2nd ed. 1974) Stroke: A Diary of Recovery, London, Faber and Faber
Sacks, Oliver (1985) ‘The President’s Speech’ in The Man Who Mistook His Wife For A Hat, London, Picador
