Listening. The lack of it is one of the biggest problems people with brain injury face. Because of damage to Wernicke’s and/or Broca’s Areas, people are unable to comprehend speech in real time or at all. And they may be unable to produce speech easily. Compound that with loss of focus, easy distractibility, poor memory, missing working memory, significant loss of vocabulary access, and an inexplicable disconnect between the subconscious and conscious mind that is far, far greater than the norm, and you have circumlocutory language with a lot of swearing that seems to have no beginning and no end.
Three Problems
The problem with most therapy and medical appointments is threefold:
- The specialist interrupts. Every time they interrupt, they completely eradicate from the person’s mind what they were talking about, And memory may not return for hours. Definitely not, outside of random luck, within the appointment time.
- The specialist hears only rambling — not that the rambling is the expression of an injured brain trying to communicate a problem. When the specialist listens long enough without interrupting, they will hear the problem. That’s when the person will naturally stop speaking.
- Not everyone can speak what they’re trying to convey. Some can only write it. Unfortunately, most specialists focus on their own language needs and therapeutic methods instead of the person’s communication strengths. Yet they’re more likely to resolve issues and help the person successfully and quicker if they use the person’s strength.
Swearing
Judging swearing as bad behaviour shuts down listening. Telling the person to “clean up” their language makes them feel worthless and valueless. It puts them into an impossible situation since swearing arises out of their injury. Only effective treatment that restores vocabulary access and language production can reduce swearing. (And yes, some people grew up that way. Leave it be. People with brain injury should not be outcast for their language use. They’re dealing with bigger problems than using “fuck.”)
The Uses Of Swearing
Studies have shown that swear words are not stored nor accessed in the same way as regular vocabulary. Hence, a person can access swear words in real time in a way they can’t with even basic vocabulary. When the specialist listens with the idea that swear words are placeholders for regular words, then they can begin to hear what the person is really saying. They can also strip perception of anger from their listening. When swearing becomes a substitute for non-angry language that injury has rendered inaccessible then it no longer sounds like anger (though that can be true).
“As it turns out, there is a body of research on the neurobiology of swearing, and it largely supports the idea that the brain treats curse words as special. One source of evidence comes from Tourette’s syndrome (TS), a neurological condition characterized by involuntary behavioral tics. In some TS cases, these tics are manifested as involuntary outbursts of cursing or other inappropriate language. Another line of evidence is seen in aphasia, which is a specific loss of language caused by brain damage or dementia. Though people with aphasia may have severely impaired speech, they often produce curse words with greater fluency and regularity than other words.”
A Special Place in the Brain for Swearing. Jim Kloet. Feb 18, 2013
Swearing relieves pain. It releases frustration, grief, moral anger, feelings of injustice, despair — and physical pain.
“In a series of studies, Stephens and his colleagues illustrated how swearing can increase tolerance to pain. Students who repeated a curse word were able to keep their hand in a bucket of ice water longer than those who uttered a neutral word.
“As well as the pain tolerance change, participants also showed an increase in heart rate. When you swear your heart rate goes up even more, which suggests an emotional response to the swearing itself,” Stephens said. “This response is the stress fight or flight response and it works as an analgesic.””
The Surprising Benefits of Swearing. BBC Future. Tiffanie Wen / Images by Olivia Howitt, 3rd March 2016
By treating swearing as behavioural instead of a manifestation of injury, specialists disrespect the pain of the person who can’t access their vocabulary and whose broken brain tumbles swear words out of their mouth. They also end up focusing on the words instead of listening to the feelings, thoughts, and experiences.
A Twitter thread on therapists using swearing in session:
What’s everyone’s thoughts of swearing during therapy sessions?
— Adam Fare ? (@adamfare1996) March 26, 2021
I’ve often stopped myself even though I felt it the right thing to do at the time?
Therapists & patient views welcome 🙂
Solutions
Listening is key. With cognitive empathy and understanding of what brain injury does to communication skills only then can a specialist hear what a person is actually saying.
In Brief
- Patience.
- Believe.
- Never assume.
- Always ask so as to clarify and stimulate thoughts and feelings.
- Aid memory.
- Provide continuity from one session to the next.
- Use their preferred mode of communication.
To Aid Listening, To Make The Person Feel Heard
Wait until the person stops talking before speaking. In that way, specialists give the person the best chance for their subconscious to speak out loud.
Specialists can stimulate thinking and expression by asking questions based on what they’ve heard. Stay in line with what the person has been talking about instead of taking them onto another path.
Use neurostimulation such as three minutes of brain biofeedback of SMR at CZ in between talking or using audiovisual entrainment during can enable thinking and expression of feelings. This will make it easier for the specialist to listen and understand as well.
Ignore swearing. Period.
Instead of asking how a person is feeling in a general way, reflect to them observed emotions or affect. And if they disagree, believe them. Ask them to describe it. Active listening aids them in describing.
Believe what the person says. Don’t label their thoughts or feelings as “negative.” Instead, keep in mind that as bad as one thinks life with brain injury can be, it’s worse. What the specialist may consider negative is probably the person’s reality.
Summarize the previous session at the next session. In this way, the specialist both brings back into memory what happened last time, as well as telling the person that they were heard.
If the person cannot start the session because their mind has gone blank at the question of “What did you do last weekend?” (a common problem), ask them a question based on the most critical item from the last session.
Never assume. Always ask.
Be responsive to how the person communicates. After all, the goal is to make the person well, to direct their health care to best meet their needs. If they struggle with the method, change it. For example, if the person finds it easier to express themselves in writing, use a private messaging app like Signal with Disappearing Messages turned on to communicate during the session. Reading messages is listening.
Use virtual options such as secure messaging, encrypted email, or videoconferencing. Travelling to an appointment fatigues a person. And so being able to conserve energy results in better communication. Using the person’s preferred videoconferencing platforms lets them know that the specialist is listening. Some platforms cause headaches; others tire a person out easily or are not intuitive to use.
Understand that with slow processing, the person won’t be able to respond to any suggestions or observations for hours or days. When they do, the emotional response may overwhelm. And so provide them a way to communicate at that moment. Perhaps, they can message via Signal or email or leave a phone message. Then the specialist can discuss it at the next session. Result: the person will feel heard. And be heard.