‘You’re going to have to repeat that’,

I tested a man who was blind in one eye and very deaf. I find it hard to test patients with sensory impairments to this extent, because it makes communication very stunted and awkward. I was basically shouting at him, and continually had to explain things in different ways or mime things to allow him to understand.

It’s frustrating because I didn’t want to treat him like a child – he was still there, it was just hard for me to get to him, and he to me.

He mentioned that he would often ‘work backwards’ to understand what was being said of him – if he missed some phonemes, he would retrospectively ‘fill them in’ afterwards, using the context of the rest of the words. I’ve come across the phonemic replacement effect before in cognitive psych, but I hadn’t come across it so clearly in a real world situation before.

It was startling at how much this man relied on ‘filling things in’ after the fact, and it got me thinking about how much of everyone’s perception is coloured by their perceived context. Everyone does this intuitively every day, but it isn’t an issue for most people, and mistakes are rarely made. Once your hearing begins to leave you however, it becomes much more important, crucial, to your understanding of the world.

It got me thinking about how deterioration of the senses plunges us unceremoniously into our inner worlds – perceptual biases, expectations, previous experiences have much more of an influence in our perception of the world. I was wondering as to whether the last roads of life are in fact vivid in their content – it’s just that the content is based on memories of the previous roads, rather than what is found in the present road.

I never want to patronise, I never want to coddle. I know there is still a full person in there, always – they’re just under the waves. Whereas the water used to be calm and clear, disruption of the senses creates waves, choppy and murky, and the light and the sound is filtered through the mess. My job is to be as clear and consistent as possible, so that my presence and intentions can be perceived as best as they are able.

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