Human Communication and Its Disorders

The ability to communicate is amazing. No other human ability is so complicated, so sophisticated, so important to civilization, and yet, so taken for granted. Communication allows people to work cooperatively to build families, legal and political systems, corporations, universities, libraries, space programs, religions, and the World Wide Web. Most importantly, it allows people to connect, to reduce loneliness and isolation, to comfort one another, and to counter the bleakness of existence that results from desolation. Mother Teresa of Calcutta observed: "Kind words can be short and easy to speak, but their echoes are truly endless." How tragic would life be without this marvelous ability to communicate?

Communication disorders have afflicted humans since the beginning of recorded history. As will be discussed later, there are references to them in the ancient Egyptian, Greek, and Roman societies. For some, communication and its disorders are God-given. In Exodus 4:10, there is a reference to the divine nature of communication and its disorders: "And Moses said unto the Lord, O my Lord, I am not eloquent, neither heretofore, nor since thou hast spoken unto thy servant; but I am slow of speech and slow of tongue. And the Lord said unto him, Who hath made man's mouth? Or who maketh the dumb, or deaf, or the seeing, or the blind? Have not I the Lord?" Whether communication disorders are the nuisance of a lisp or a mild stutter, the devastation of the loss of language from a stroke, or symptoms of the gradual onset of dementia, they affect the lives of millions of people. One in ten people in the United States has a communication disorder.

Communication sciences and disorders is an academic and clinical discipline whose mission is to understand communication and treat its disorders. It is a fledgling science and a newcomer to the sciences and therapeutic professions. It is a bit arrogant in assuming it can understand and explain the complexities of human communication, yet optimistically ambitious in tackling the treatment of its disorders.

This book is about communication sciences and disorders, and in some ways, it is a love story. It is a chronicle of my lifelong love affair with the marvelous human ability to communicate and my commitment to treating its disorders. In this book, you will read interesting examples, case studies, and observations about consciousness, language, acoustics, hearing, paralysis, disorientation, delusions, mental impairment, dementia, and the functions of the brain. They are but a few of the human abilities and maladies that are the subjects of this book.

This book is based on my experiences. I discuss only those topics with exceptional scientific and philosophical importance that often have implications about the human condition. You will read about the remarkable communication functions and fascinating disorders I have studied and observed. My goal is to give you an interesting read, and to share with you some of the amazing diseases, defects, disorders, and disabilities I have come across as a professor, scientist, and clinician.

I have been a professor of communication sciences and disorders for nearly 40 years and an enthusiastic student of communication all of my life. For most of my adult life, I have studied communication, speech-language pathology and audiology, and the speech and hearing sciences. I have owned a private speech and hearing clinic, served as an expert witness in legal cases involving communication sciences and disorders, and consulted with local, state, and federal agencies, as well as Native American Tribes of the Southwest. I have received several university, foundation, and federal grants. I have 14 books in print and list dozens of research articles and professional papers on my resume. I have published pamphlets, diagnostic tests, and treatment programs. I have been involved with the forensic aspects of voice prints, speaker profiling, and speaker recognition. I love what I do, and it occurred to me that I should share my experiences with you who may be considering majoring in this discipline, or who have a loved one with a communication disorder. This book may also be of interest to those of you who simply want to learn more about this human ability and the interesting disorders that can impair or destroy it.

From Farm to Campus

I was born on a large farm in Idaho. My family also owned a 2,000acre cattle and sheep ranch in southwestern Montana. Looking back on it, I suspect I was a hyperactive child. My family was fortunate there were hundreds of acres of farm and ranch land available for me to roam, run, explore, play, and exhaust my high levels of energy. On the negative side, current research shows exposure to chemicals often used on farms and ranches are a cause of attention deficit hyperactivity disorders (ADHD) and other conditions. One of the most vivid memories I have is of my father spraying the yard around our home with DDT to combat flies and mosquitoes. We grew potatoes, hay, and wheat. During the planting season, the seed potatoes were dipped in chemicals, and I would ride behind the planter to see that all of them were dropped into the ground. After each round, I remember wiping off the dried dirt and chemicals, including DDT, which had caked on my face. In addition, cattle are branded, dehorned, and given chemicals to prevent disease, stimulate growth, and to keep flies off them. Chemicals were and still are a big part of farming and ranching.

Today, a child with hyperactivity would likely be treated with medication. I am thankful medication was not prescribed to me for this disorder, if in fact I had it. ADHD is diagnosed far too frequently. I am certain there are children who suffer greatly from this disorder, and for them, medication is a godsend. I am equally certain that not every child who is active and full of energy, and who has problems attending in a stuffy classroom, is disordered. Today, Huck Finn and Tom Sawyer would likely have been diagnosed with ADHD, oppositional defiance disorder (ODD), antisocial personalities, and been promptly medicated.

When lecturing, I tell my students that rather than being disordered, perhaps I was simply a curious child with an intense enthusiasm for living. In the evenings and after supper, I would often still be wound-up. (My family called the evening meal "supper" and hyperactivity simply being "wound-up.") To rid me of excess evening energy, my parents required me to go outside and run around our house many times. It worked. After the exercise, I would retreat to my room exhausted and much calmer. Most of the time, I dutifully did my nightly therapy; however, several times I tried to fool my parents. Rather than do my exercise, I would pass the window from which they watched, turn around, sneak underneath it, and then pretend I had run completely around the house. Unfortunately, my timing was off, and my antics made it appear I was running around the house at superhuman speed. Despite my lame attempts to fool my down-to-earth parents, they treated hyperactivity with exercise. Today, there are studies showing the benefits of using this approach instead of medication.

My father did not complete high school, but managed to be a very successful farmer, rancher, and businessman. He was also a private pilot, and aviation was his passion. He had the kind of common sense, down-to-earth understanding of life I admired, respected, and tried to emulate. He was also fearless. It seems nothing frightened him, whether it was landing his blue, low-wing, tail-dragging airplane on a short landing strip or climbing high buildings, silos, and haystacks.

As a schoolgirl, my mother participated in an intelligence study. I heard from relatives that her tested IQ was 145, higher than 99% of the general population. She graduated from a small high school and desperately wanted to go to college. One of ten children, five boys and five girls, she lived through the Great Depression that left a lasting impression on her. Sadly, at that time, it was rare for women to get a higher education, and her parents encouraged only her brothers to go to college. Times certainly have changed, and now about 65% of college students are women.

I attended Idaho State University in Pocatello where I received a Bachelor of Science degree in Communications. In the 1960s, a degree in communications was similar to an interdisciplinary or liberal studies degree. Like most undergraduate students, I changed my major several times. For a while I studied philosophy, and the two best courses I took as an undergraduate were "logic" (inductive and deductive reasoning) and "epistemology" (the study of the acquisition of knowledge). As a professor, I have advocated for those two courses to be required of all college students. They taught me the fundamentals of how to think logically.

My Master's degree is in Speech Pathology and Audiology. One of my linguistics professors suggested I explore this major, and it immediately intrigued me. My advisor, Dr. Larry Sant, was a speech scientist who specialized in the anatomy and physiology of the speech mechanism. He was an excellent professor and died far too young from a congenital heart disorder.

During my second year of graduate school, I struggled to select a topic for my research project. I ended up writing it on interviewing and counseling mothers of children who stutter, and I learned a lot from it. However, before settling on that topic, I started a study on the effects of marijuana on psycholinguistic abilities.

One of the tests available to me was the Illinois Test of Psycholinguistic Abilities (ITPA). It is a complex test that assesses various so-called "psycholinguistic abilities." There are twelve subtests: auditory reception, visual reception, auditory association, visual association, verbal expression, manual expression, grammatic closure, visual closure, auditory sequential memory, visual sequential memory, auditory closure, and sound blending. The goal of my research proposal was to compare the ITPA scores of people under the influence of marijuana with a control group.

There was no shortage of volunteers to be subjects for the research; it was the early 1970s after all. After I submitted my prospectus to Dr. Sant, it was necessary for me to get the marijuana. We requested the drug from a state agency, and it took a year to be provided to us. Because of the time delay, I had to abandon the project. In fact, just before I left Pocatello to seek my doctorate, Dr. Sant received an ounce of the most potent marijuana available in Idaho. I remember him saying to me: "What am I supposed to do with this?" It was a frustrating and fruitless wait when I could have easily purchased the marijuana from hundreds of campus sellers. Perhaps the best lesson I learned from the experience was to be practical in research and to consider reasonable time objectives. When doing research, there are often factors you cannot control that will delay your project.

My doctorate is in Audiology and Speech Sciences from Michigan State University. At Michigan State, I had the honor of studying under Dr. Oscar I. Tosi. Dr. Tosi had a Ph.D. in Speech and Hearing Sciences and another doctorate in Physics. He was director of the Michigan State University Institute of Voice Identification which, at the time, was one of the world's preeminent voice print laboratories. Dr. Tosi served as an expert witness in many criminal cases and did voice analyses in the laboratory. Besides having superior academic and scientific qualifications, he spoke five languages fluently. During my first meeting with him, I wondered whether English was one of them due to his heavy Italian accent. Dr. Tosi was not only my mentor, but a good friend. We spent many hours discussing not only the speech sciences and acoustics, but the meaning of life. He was a brilliant and personable individual, and a true scientist and philosopher.

The Communication Chain in a Nutshell

The act of communication can be viewed as a chain of events. In this book, I will address each link in the chain as a normal process and also cover disorders that can disrupt, impair, delay, or eliminate each aspect of communication. While there can be communication through reading, writing, gestures, art, texting, and so forth, I concentrate on speech communication, which is the main way people communicate.

Communication begins as thoughts in the speaker's mind. Those thoughts are coded into a language for expression. At a small site in the left hemisphere of the brain, Broca's area, they are programmed into speech acts. The breath support necessary to utter the expression is created, and air is sent up the vocal tract. Most speech sounds are voiced at the level of the vocal cords and the acoustic energy is projected upward through the oral and nasal cavities. Some speech sounds have more nasal resonance than others, and this is produced by opening and closing the nasal chambers by using the soft palate. The articulators shape each of the 44 vowels and consonants of English primarily by the actions of the tongue. Also programmed by Broca's area is the cadence of speech, which gives utterances a smooth, melodic rhythm.

The production of speech sounds results in changes in atmospheric pressure, and the thoughts of the speaker are transmitted to the listener by a series of energy transformations. The listener picks up the acoustic energy by the eardrum, which is in contact with the atmosphere. The eardrum and bones of the middle ear transform the acoustic energy into mechanical energy. At the inner ear, the speech signal is further transformed into hydraulic energy and back again into neural electrochemical energy. The neural electrochemical energy carrying the meaning of the utterance then travels to a brain structure called the "thalamus," which is important for perception. From the thalamus, the message goes to an area of the brain called Wernicke's area, where it is partially decoded, and the listener understands the speaker's communication by making associations. Each link in the communication chain must be unbroken or the message will be disrupted, impaired, or lost. Speech communication is a series of energy transformations: neural electrochemical, acoustic, mechanical, hydraulic, and back again to neural electrochemical impulses in the listener.

When a speaker begins the act of communication, he or she first formulates the thoughts to be communicated. Obviously, thoughts are a product of the brain. Although much has been learned about brain functioning, there remains much to learn about it. Fundamental to understanding human consciousness is comprehending how the neural electrochemical impulses in the brain become thoughts. This is sometimes referred to as the "brain-mind leap." With regard to communication, the question becomes: How does the neural electrochemical energy in the brain become the meanings of utterances? Before addressing this link in the communication chain, I will address some interesting history, suppositions, theories, and facts about the brain.

History of the Study of Communication Sciences and Disorders

The human brain is often a topic of my lectures. It never ceases to amaze me how innately interested students are in the brain. Whether they are freshmen in an introduction course or graduate students studying neurogenic communication disorders, it is easy to captivate and intrigue them about the intricacies of the brain. But then, why shouldn't the brain be an interesting topic? The human brain is only about three pounds of organic tissue, yet it has the ability to create human thought in all its forms, to split the atom, and understand the creation of the universe. It cures illnesses, builds skyscrapers, nurtures babies, and permits jury deliberations. Internet social networks, brain scanning devices, digital photography, virtually all advances in civilization are products of this small organ. It is about 2% of a human's total body weight, enclosed in a bony skull, and sits atop a fragile neck. More than 100 billion neurons somehow work together, and through a series of neural electrochemical reactions, create human consciousness. Philosophically, this is all done by the brains in fragile human beings, who reside on a small planet revolving around an unremarkable sun, one of 200 billion stars in the Milky Way galaxy, which is but one of at least 100 billion galaxies of the known universe, and possibly one of an infinite number of universes. The human brain is truly a remarkable organ.