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Invited Commentary
August 2018

“I’ll Have What He’s Having…” and Other Restrictions in Communicative Participation

Author Affiliations
  • 1Department of Rehabilitation Medicine, University of Washington, Seattle
JAMA Otolaryngol Head Neck Surg. 2018;144(8):693-695. doi:10.1001/jamaoto.2018.0677

Communication is about connecting with people. Whether for business, or leisure, or love, communication is about understanding and being understood. Communication disorders disrupt those connections in various ways. Vocal fold paralysis weakens your voice. Aphasia scrambles the meaning of words. Hearing loss leaves you grasping at fragments of conversations. On the surface, these examples represent disparate impairments of communication. However, careful listening to the lived experiences of people with different communication disorders reveals many shared stories.1,2 For example, with a communication disorder you cannot overpower loud and distracting background noise in restaurants to communicate with waitstaff. It is rare that you can order what you actually want—and to actually receive what you ordered. Thus, you shrug, point to the person sitting next to you, and say, “I’ll have what he’s having.” Telephones and intercoms at drive-through windows—daily conveniences for most people—pose insurmountable barriers when you have a communication disorder, so you drive on by without your latte or takeout pizza. Other people regard you with a look, or tone of voice, or comment that reveals their discriminating assumptions that because you cannot talk well, you must not be able to think well, or do anything else well. Hearing the same stories from people with different communication disorders leads to the realization that communication cannot be reduced to the mechanics of vocal fold vibration or speech articulation. Symptoms of various disorders interact with common barriers in the physical and social environments, leading to shared restrictions in communicative participation; that is, restricted involvement in and fulfillment of communication needs in daily life.

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