The Language of Mental Health

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An elderly man in a nursing home is tearful and withdrawn.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.

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Sorry Miss, My Life Ate My Homework

Today I was asked “What’s happened to your blog? I really enjoyed it”. Always one to respond well to flattery, it has given me the proverbial kick that I needed, but it has also made me think; what did happen?

Promoting the work I do and discussing my ideas through my blog is something I feel very passionately about and I certainly haven’t run out of ideas and topics. My last blog was exactly one month ago but it feels much, much longer than that because the last month has been a pretty busy one. With additional work commitments which, like buses, have all come at once, and in my own time a hectic rehearsal schedule for a forthcoming concert, even finding time to spend with my family has been a tall order. All in all, it has been an exhausting month, and no matter how often I thought about writing a new blog, life just kept getting in the way.

Reflecting on this has given me a new perspective on exactly what I am asking of people when I give them homework to do. We all have varying capacity in our lives to find the time to do that one extra thing. Sometimes, even when we know something is important and we really want to do it, our lives seem to conspire against us achieving it. It is easy to forget that whilst few of the people I work with have the traditional pressures of juggling work and family, they have many other things to cope with which will impact on their ability to achieve their goals; not least of all the demands of seeing a myriad of different professionals. Without a good overview of what else is going on in that person’s life at that moment in time it is impossible to determine how realistic it is for them to do that one little thing I am asking.

So I have decided to set myself a more realistic goal; to continue to write regularly but not add the pressure of making this a weekly blog, and also to seek to understand and give more consideration to how realistic the ‘homework’ I set for others actually is.

Little Things Make a Big Difference.

Surprised, curious, grateful and chuffed to bits. These are just a few words that describe my emotions when I received a letter from The Encephalitis Society this week informing me that I have been nominated for a Exceptional Service Award by the family of one of my clients.

According to the Society’s website, Exceptional Service Awards are given to individuals and organisations in health, education and social care services who have really made a difference to individuals or families who have been affected by Encephalitis. “What have I done to deserve that?” I asked myself. “All I have ever done is my job.”

Craig* is in his early 20s and developed Encephalitis when he was 6 years old.  The resulting damage to his brain has left him with a range of speech, language and interaction difficulties that have become increasingly problematic and intrusive as Craig has entered his adult life; impacting on his social inclusion, self-esteem and mental well-being.

So what have I done as a Speech and Language Therapist that has really made a difference to this young man and his family? What incredible intervention have I delivered? What have I done that is above and beyond the call of duty? Here is what the family say.

Susan…used to visit [Craig] at home, she always came to our house with a friendly smile and helped Craig with a speech he had to prepare…[we] would like to thank her for bringing her professionalism and cheery personality to our home and a listening ear.

What strikes me most about the family’s statement is that what they value the most is not the clinical outcomes but how I met their priorities.

Craig finds it difficult to attend appointments independently and his mother has 2 much younger children who she also needs to look after, so providing sessions at home rather than in a clinic was really important for this family.

Craig’s therapy focussed on addressing the social communication difficulties he experiences but what he really wanted to do was write and deliver a speech about his own experiences at an Encephalitis Society conference; so I supported him to do this.

It also appears that much of what made a difference wasn’t so much what I did as how I did it. A friendly smile and cheery personality are not clinical skills but they are valued by this family and that has made a difference too. It would appear that it is true what they say Little Things Make a Big Difference.

*Craig is a pseudonym to protect client confidentiality