From The Doctor's Tablet
The Blog of the Albert Einstein College of Medicine
By Noor Al Radi M.S., CCC-SLP
January 27, 2015
I vividly remember my high school English teacher, standing impossibly erect with her hair tightly wound, exclaiming, “If you can’t articulate it then you do not know it.”
This line has haunted me, and continues to do so in my profession as a speech-language pathologist at Albert Einstein College of Medicine’s Children’s Evaluation and Rehabilitation Center, a clinic for children and adults with developmental disabilities.
Is awareness contingent on a label? Does something not exist if you don’t have the word for it? Is language a necessary prerequisite to “knowing,” or is it more of a mediator?
Research, particularly in the realm of our capacity to infer the thoughts of others, has found that a richer repertoire of mental-state words (e.g., think, believe) is associated with a more mature theory of mind (Pyers & Senghas, 2009). Essentially, having more words to describe thought processes makes us better at assuming the perspectives of others.
So, where does emotion fit into this? Do we need a name to know what it is we are feeling? Or is the label more of a processing chip? Are our feelings shaped by the word we use to filter an experience?
This question came up when I met a young man with autism named Michael. Though a quiet presence, he was “excited” about everything, and per his stories the people in his life too were “excited” in all their daily doings: “The Notebook gets my Ma all excited like she even cries!” or “When people talk about my issues, it gets me all excited.”
Within that seven-letter word lay everything from joy to frustration to rage: “excited” was a catch-all term with little in the way of nuance. So began our year of building and exploring emotional vocabulary.
“I’ve Felt That Before!”
Michael’s understanding of emotional terms was set to context-bound perceptions, making his understanding superficial even for more-visceral feelings. For example, he described his frustration at not being able to express the urgency of feeling faint to his father; “I didn’t know what to say,” he explained. “I thought ‘sick’ was for like when you vomit, so I was like ‘I feel funny like my body’s all excited,’ and then I fell.”
For broader feelings this was even more difficult, defining calm as “when people say negative things and you’re all angry you gotta calm down.” Deconstructing these more rigid constructions and matching words to diverse experiences was a struggle peppered with small triumphs. Michael would exclaim with surprise, “I’ve felt that before!” A new word to quite literally redefine an experience.
Difficulty of course lies in the fact that emotions can be abstract and amorphous, contingent on an infinite set of contextual variables. Not only are you learning multiple words for an emotion, but those very words can be used in different contexts. This room for ambiguity and shape shifting is difficult for a concrete learner such as Michael and many with social communication deficits.
As emotions are often captured through figurative language, I was constantly caught in the literal, as we dug deeper into nuances (e.g., heartbroken—“Doctors can fix that with surgery, right?”). At one such moment Michael frustratingly asked why there weren’t clear words to “know emotions more easy.” In search of an answer I found myself a blinking cursor to the initial question: To “know” an emotion, is specificity of word needed?
Words, Context and Social Experiences
After a full year of work with Michael, he is now better able to label emotions based on physical cues as well as context, and subsequently predict the response of others. Across sessions we categorized the nuances of emotions as organized in the Zones of Regulation by Leah Kuypers and plotted ranges of intensity, as well as matched and then generated contexts in which he or another might feel that emotion.
Once his attention was drawn to external signs of emotion, he particularly excelled at identifying requisite facial features, tone and body postures. However, to Michael furrowed eyebrows were rigidly indicative of confusion only, loud voice strictly of anger and so forth. The bigger picture was often missed through the detailed lens, a characteristic of his autism.
Using Film to Notice and Use Context
Film has allowed him a supportive channel to zoom out and attend to context. Time has been spent dissecting film clips for context and signs of emotions, as well as highlighting antecedents and discussing consequences. Using video removes the burden of real time, allowing Michael to rewind, pause and slow sequences of events. This affords him time to process and organize the incoming information, with the added voyeuristic benefits of not having to consider his role or how he should react.
And this is what we are currently working on—attention and awareness. Language may help define the parameters of what we see, but if you’re not seeing the salient what use is a label? Emotions are adaptive and shift constantly by context—our capacity to adjust is contingent on noticing, interpreting and responding to external and internal cues.
Michael struggles to fully explain the sources of an emotional reaction. His capacity to decode social and situational information to create meaning is restricted, particularly when he is involved. To do so would require him to both read the context and simultaneously react in real time, a level of organization or executive functioning that is difficult for challenged social learners such as Michael.
The idea that he can impact how another feels and thus thinks was actually somewhat alarming for him, as he wondered whether placing himself in someone else’s shoes might lead to “catch[ing] a fungus.”
Why Language Can’t Stand Alone
If language is a prerequisite or a facilitator to understanding emotion, it cannot stand alone. It needs a foundation of social experiences and wherewithal to attach robustness to the lexicon, allowing the words a measure of flexibility per context—an aspect that is inherently difficult for many on the autism spectrum.
However, now that he can identify an array of emotions, Michael is better equipped for that next step. An emerging awareness has afforded him the successful ability to map out what tactic might improve his odds at playing video games when his mother is annoyed, tired or frustrated.
This has been his favorite triumph of late, as he asks with an earnest look, “Can I say that I’m excited about this?”
Noor Al Radi, M.S., CCC-SLP is a speech-language pathologist at the Children’s Evaluation and Rehabilitation Center of Albert Einstein College of Medicine.