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Chapter 7: Disorders of Emotional Communication

EMOTIONAL COMMUNICATION

Disorders of emotional communication include problems expressing one's own feelings and misunderstanding the feelings of others. Emotion is communicated in facial expressions, body movements, body language, tone of one's voice, pace of words, and intensity. Emotion can also be communicated by the actual words used.

Emotional expressions signal our feelings to others and their feelings to us. The emotion "fear" can signal danger and warn us to leave a situation quickly.

Emotions can signal a pleasant situation. A friendly "Hi!" encourages us to smile and move forward to greet a friend.

As brain cells in the right hemisphere stop working properly, the person may become less able to express or under-stand feelings.

Difficulty Expressing Emotion
Being less able to express emotion interferes with communication. A person who is less able to express emotion may not show feeling in the face or voice. The face muscles may stay relaxed and the voice may stay even. The person may appear unconcerned and free of emotion. There may be no shifts in intensity in their facial expression or tone of voice. There may be no body gestures used with spoken words. The person may think they are expressing emotion but may be unable to show the true emotion to the listener.

Difficulty Understanding Emotion
The person may be unable to understand the emotional expression of others. This lack of understanding may result in miscommunication. For example, body behaviors such as raising an arm to threaten or putting hands on one's hips in anger may not be understood. Facial expressions such as a slight smile to show sarcasm, a frown to show disbelief, or a soft, quiet voice to show apology may also lose meaning. The message of the spoken word may be the only message that gets through. The feeling message may be lost, not understood at all.

Pace of Words
Sometimes the pace of words carries emotion. Fast speech may show anger or fatigue. Slow speech may mean boredom, relaxation, or fatigue. Sometimes a slow pace of speech is the result of changes in the frontal lobes and the basal ganglia.

Level of Intensity
Level of intensity carries emotion. Little intensity (very little effort, a more relaxed, neutral behavior) shows less feeling; this level of intensity may reflect acceptance, a good comfort level, or a lack of caring. A high level of intensity (a great deal of energy, loud voice, and strong gestures) shows a great deal of feeling; this level of intensity reflects strong feeling, either positive or negative. With some diseases, changes in the nervous system -especially in brain cells- may result in less ability to control intensity in communication. Thus, a person with Parkinson's disease may show little intensity with a low voice and little facial expression, but that person may feel very happy or angry.

Match or Mismatch: Words and Feelings
Sometimes a person's spoken words are the same as feelings expressed and sometimes they do not match. The spoken words may be opposite the feelings expressed. For example, an angry voice saying, "I am happy" will raise disbelief in most listeners. These listeners will search for the true message: happiness or anger or something else. However, the person with a disorder of emotional communication will listen and understand only the verbal message "I am happy." The anger of the voice goes unheard. The resulting inter-actions may lead to confusion, frustration, or a major conflict.

Sometimes people perceive those with disorders of emotional communication as being indifferent or uncaring. In relationships affection is often communicated in the feelings expressed on one's face, the tenderness in one's words, or through a general happy, positive attitude even when the actual words may be completely neutral. For example, the neutral, objective words "It is sunny outside" may be heard as an invitation to travel to the beach or an invitation to enjoy a soft drink together on the patio.

A person may ignore important messages without understanding the extra meaning of the feelings in tone or in the facial expression. The speaker may think the listener no longer cares about time together. Stress may build up in the relationship without any understanding of the steps leading to the stress.

STRATEGIES TO HELP IN DIS-ORDERS OF EMOTION

  1. Use more words to identify feelings. A friendly "Hello" will be better understood with the extra words, "Hello, I am happy to see you."
  2. Repeat the sentence with different, simple words that express the feeling. For example, say, "I am happy to see you" and next say, "I am glad to see you" and then say, "I enjoy seeing you."
  3. Ask the person with the disorder of emotion about the message just heard to check for understanding. You might ask, "How did my voice sound?" or "What do you think I am feeling?" It may help to be more specific, like "Do I sound nervous to you?" or "Do I sound confused to you?"
  4. Ask the person with the disorder of emotion for specific words about their emotional state during interactions. You could ask, "How are you feeling?" or "What feelings are going through you right now?" Or you could ask more directly some questions that push for a "Yes" or "No" answer. For example, you might ask, "Are you on edge?" or "Are you worried?" or "Are you excited?"

Strategies That Help if Words Are a Problem

  1. Ask the person with the disorder of emotion to choose a color in the room to describe their emotional state.
  2. Ask them to draw a picture to show their emotional state. Crayons or markers may help add feelings or depth of feelings to the picture.
  3. Have the person choose a picture from a page of different facial expressions to show their current feeling. The chart could show pictures of faces cut out of magazines or line drawings.
  4. Ask them to show on a scale how they feel. For example, a scale from 1 to 5 where 1 means a little happy, 3 means medium happy and 5 means super happy. Or, 1 could mean happy, 3 could mean no feeling / neutral, and 5 could mean sad or angry.

EMOTIONAL FEELING
Patients with dementia may have emotional changes as part of their disease or as a response to their disabilities. These emotional changes reflect feelings, responses from desires or experiences. The three types of emotions most often seen with dementia are depression, indifference, and anger. Occasionally a person will seem happier or sillier - perhaps laughing inappropriately - than their typical personality. This kind of change may result from the dementia. Emotions that result from desires or experiences will be discussed in CHAPTER TEN: MANAGING CHALLENGING BEHAVIORS.

CHAPTER SUMMARY
Disorders of emotional communication include problems expressing feelings and problems understanding the feelings of others. Sometimes people with disorders of emotional communication seem indifferent or uncaring. Over time this misunderstanding may build up a great deal of stress in a relationship.

Ways to help the disorder include using more words to identify feelings, repeating sentences with different simple words to get the emotional information across, checking with questions for understanding and asking for specific words to describe the emotional states during interactions.

When words are a problem, it may help to point to colors, to draw out a picture to show the emotion or to use a scale with numbers from 1 (meaning almost no feeling) to 5 (meaning much feeling).

The Next Chapter The next chapter contains a discussion of apraxia. Apraxia is decline or loss of the ability to perform skilled movements that use tools or objects. Also, there are suggested ways to help people with apraxia.

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Material taken from

"Helping People with Progressive Memory Disorders: A Guide For You And Your Family, 2nd ed." (University of Florida Health Science Center). Used with permission from the authors: K. M. Heilman, MD, L. Doty, PhD, J. T. Stewart, MD, D Bowers, PhD, & L. Gonzalez-Rothi, PhD. (1999).

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College of Public Health and Health Professions, University of Florida