A young man in a ward of a psychiatric hospital is talking to one of the nurses. Suddenly, he starts shouting and then storms off. He says to you “I don’t know what these nurses are talking about. They’re from the same place as me but it’s like they talk a different language. I don’t trust them. They are up to something. It’s like they are talking in some kind of code. What’s going on?”. As you speak to this young man you realise that his sentences don’t always make sense. Some of the words he is using are not even real words. You struggle to understand what he is meaning yet he looks at you are though you are the one with the problem.
What are your first thoughts? Paranoid? Psychotic?
An elderly man in a nursing home is tearful and withdrawn. You try to talk to him but he says to you “I just don’t understand. I’m so confused. I’m sorry. Please leave me alone.” When he does speak to staff the old man is difficult to understand. His speech is mumbled and he doesn’t always make sense so staff struggle to grasp his meaning and the old man just looks away.
What are your first thoughts? Dementia? Depressed?
Why are you drawn to thinking about these labels? How much of your judgement was based on the way they are talking and the things they are saying?
These men have something in common – they are both experiencing dysphasia. Dysphasia is a language disorder that impacts on your ability to understand and use spoken language. It can result from a stroke, a head injury and some people are even born and grow up with forms of dysphasia. What is different about them is our assumptions and expectations based on their age, circumstances, and the way they are reacting to the difficulties caused by their dysphasia.
Our communication ability, the environment we find ourselves in, and our personality all interact to influence our behaviour and within the context of adult mental health services that behaviour is often labelled with reference to a psychiatric diagnosis without due consideration of all the causative factors. Without a good understanding of a person’s language skills we need to be very cautious about interpreting and labelling their behaviour as a mental illness.