The communicative and social value of affect may never be fully appreciated at a conscious
level until it is compromised. In fact, much of our communication is carried out not
through our words, but with the affective features that accompany those words: the
prosody of our speech, our facial expressions, and body postures. Consider, for example,
the disrespectful "tone of voice" that a teenager might use when speaking to a parent.
(In the T.V. sitcom Seinfield, Jerry's mother refers to this as "the tone" and warns
Jerry not to use it with her.) In the nonverbal domain, consider "the look" that some
mothers use to control their children's behavior. Indeed, we can communicate "volumes"
without speaking. In addition to our facial expressions, our body postures and the
way we "carry" ourselves can communicate internal mood states such as excitement,
defensiveness, and depression. For example, a quick look at a good friend may prompt
us to ask, "Are you all right?" In all of these examples, of course, the affective
communication is two-sided. One person is expressing a feeling or thought and the
other is perceiving and interpreting the intent of these expressions.
So-called "average" people are capable not only of displaying a range of affective,
mood, and thought states through their speech prosody, facial expressions, and body
"language," they also appreciate societal rules for the appropriateness of what may
be acceptably conveyed in particular situations. Tones of derision are not to be used
with one's teachers. Frustrated "eye-rolling" in response to friends' statements about
their religious beliefs would be unacceptable. Body language indicating impatience
during a traffic cop's warning speech about exceeding the speed limit is probably
a bad idea. Good communicators intuit or learn the "rules" of affective communication
and apply them.
Some people are above average in their ability to communicate affect. Actors are masters
of vocal, facial, and gestural nuances. "Con artists" and "stand-up" comedians succeed
by virtue of both what they say and how they say it. We all know people who are masters
of sarcasm in which the true message lies not in the face value of the words but in
the manner they are uttered. Other people may be clever at manipulating aspects of
their affective communication to hide profound inner feelings.
While there is admittedly a rather wide range of capacities for affective communication
and underlying affective states in the "normal" population, acquired and developmental
neurological disorders can cause noticeable impairment in these capacities. A well-recognized
example is seen in the patient with the flattened facial and vocal affect caused by
Parkinson's disease. Such patients may seem depressed or indifferent because of their
inability to manipulate the expressive muscles of their face and the prosodic aspects
of their speech. Patients with severe Parkinsonism may even appear demented because
of their blank looks, the monotone quality of their speech, and stooped posture. One
such patient of ours was labeled as "demented" by his doctor (admittedly he was difficult
to test because of his motor problems), but his wife told me that he liked to go to
the race track and was able to "handicap" the horses and riders and often picked winners.
In contrast, individuals with Alzheimer's disease (AD) who, indeed, are demented may
appear cognitively brighter than they are because of relatively preserved affective
communication. One of our AD patients who was very demented would respond to the question
"How are you today?" with a snappy, convincing (but automatic) response "Right as
rain!" Thus, we cannot base opinions regarding cognitive status entirely on the affective
communication of neurologically impaired patients. Another lesson to be learned is
that just because a patient with Parkinson's disease always "looks" depressed doesn't
mean that he or she isn't really depressed. This caveat also applies to individuals
who have had a right hemisphere stroke that affects their ability to demonstrate a
wide range of emotions. They may not have the skills to express their feelings or
they actually may feel quite indifferent to most things.
In contrast to patients who have difficulty with expression of affect, some patients
with neurologic disorders have poor control over their emotions, i.e., emotional lability.
This condition can be quite devastating, at the very least embarrassing. A patient
of ours who was a well-known physician before his strokes could not mention his family
members without becoming so tearful that he could not continue speaking. He was highly
distressed by his emotional lability which he understood and could call by name.
To remind us that affective communication is a two-way street, there are patients
(particularly those with right hemisphere strokes and closed head injury) who are
impaired in their ability to perceive and interpret affective communication. They
may not understand sarcasm, joking, and teasing, and this inability can be problematic
in their interpersonal exchanges of everyday life. We had a brain injured patient
who could not reintegrate with his buddies at the neighborhood sports bar because
he did not understand when he was being teased. Instead, he took comments at face
value and became defensive.
Finally, it is important to consider the developmental problems that can influence
individuals' ability to produce and interpret affective communication. Not uncommonly,
children with learning disabilities have difficulties in such domains and their difficulties
prevent successful socialization. Their use and interpretation of affective communication
may be reduced or inappropriate, such as the hyperprosodic, sing-song speech of some
developmentally disordered adolescents and teenagers. I once lived near a private
residential school for such individuals and I could tell when teenagers from that
school were present at the miniature-golf course by the tone and prosody of their
speech and not by the content, which, of course, had to do with miniature golf.
These few examples underscore the importance of affective communication for both those
with disorders in this realm and clinicians who must assess, diagnose, and treat these
disorders. To bring readers up to date in this area, I asked Colleen Karow to serve
as Guest Editor for an issue of Seminars in Speech and Language devoted to affective communication, its characteristics, disorders, and clinical
implications. Dr. Karow has a strong clinical and research interest in this area and
coauthored two excellent articles in this issue. At the same time, she recruited several
other clinical researchers to write articles addressing other aspects of affective
communication and its disorders. Together this team of authors has given us an issue
of Seminars in Speech and Language that contains information of vital importance to our readers.
