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Speechlessness and speech loss
Aphasia means "loss of language". Those affected can no longer really speak, but can hardly write, read or understand spoken language. The cause is always damage to the brain, for example as a result of a tumor, stroke or cerebral hemorrhage.
Mutism, on the other hand, means speechlessness that has psychological causes. Those affected are inhibited in their language development, they have massive cognitive problems and developmental disorders. Doctors suspect social fears and conflicts as the origin of this disorder.
Speechlessness also occurs with different mental disorders - especially as a result of a trauma. Traumatized people are often unable to talk about events related to the trauma - we then speak of emotional speech inability. But they also go through phases in which they do not speak at all and stare into the void.
Clinical depression, dissociative disorders, or borderline syndrome, along with periods in which those affected fall silent.
The pathological loss of language differs from the silence in social relationships. Partners and families who do not talk about conflicts then sit together at the table and remain silent. Here, however, there is no speechlessness in the organic sense, but a disturbance in communication. The many forms of speechlessness require different therapies.
Aphasia usually occurs after a stroke. But arterioslerosis and diabetes mellitus can also change the vessels so that the brain is no longer adequately supplied with blood. Children usually experience aphasia after traumatic brain injury.
There are different types of aphasia. With the global form, those affected can hardly communicate with words. They only eject fragments of individual words and hardly understand the words of others. Often they can only form a syllable, for example pa or ma.
In Broca aphasia, patients still speak, but their language faltered. They find it difficult to form words, there are no predicates or subjects in their sentences, and they string together short sentence modules. But they know what they want to express.
Wernicke's aphasia expresses something completely different. Those affected can hardly be stopped in their flow of speech. They constantly mix up words, turn letters back and forth, invent words that have no meaning for outsiders and make incomprehensible sounds. They don't even notice that their language is disturbed.
Amnestic aphasia is associated with memory loss. Those affected have no problems reading, writing and understanding other people's words. But they are missing many terms, mostly triggered by a brain-skull trauma. They know what they want to express, but have forgotten the right words. That is why they stop speaking, search for the right word and describe what they want to say like someone who learns a foreign language. It doesn't have to be complicated technical terms - they also forget everyday words like dog or sofa.
Aphasia occurs in various forms, and the therapies to cure it are just as varied. Those affected should be able to communicate linguistically again. In the first month, almost all therapies aim to stimulate the patient's speech.
Speech therapists and speech scientists are particularly in demand. Music and painting therapy also bring good results. Many sufferers can reactivate their language skills by singing songs. Because the brain stores melodies primarily in the "old centers", that is, in associative thinking, while the content of spoken and written sentences deals with analytical thinking.
Even people with severe speech disorders can form words when their right brain is intact. You can even learn new lyrics through rhythm and melody.
Painting therapy opens a creative outlet to alleviate the social consequences of global aphasia. Language is the engine of communication for people. Those who cannot speak only participate in social life to a very limited extent. When the patients paint, they find an alternative to express their thoughts and feelings. You use a non-verbal language.
A study by the University of Tor Vergata in Rome showed that patients who recovered from a stroke recovered significantly better when they were engaged in art, painting or theater. The treatment of speechlessness also includes occupational therapies, physiotherapy and physiotherapy.
The first treatments begin in the acute hospital. The doctors clarify the underlying illness and the speech and occupational therapy begins.
The rehabilitation clinics then offer a comprehensive program. This includes massage and baths as well as occupational therapy and neuropsychological training to restore brain performance. The treatment often takes years, and after discharge from the rehab clinic, outpatient treatment is often required.
Patients, relatives and doctors cannot expect short-term success. On the contrary: Improving aphasia requires patience. The loved ones and therapists have to listen attentively, they also have to verbally support those affected, help them and accept them with their problem.
Mustism comes from the Latin word "mutus" and that means dumb. However, sufferers of this disorder are not dumb in the organic sense. They can speak, but fall silent out of fear.
Mutimus is a language disorder that develops in childhood. The children “fall silent” in situations that are fraught with fear for them. They increasingly isolate themselves, and because they lack the exchange with their peers, they are left behind in social learning. Her social behavior develops little, her emotions often remain unreflected.
In puberty, those affected mostly become outsiders; they fail at school and at work and therefore suffer from depression. The risk of suicide is high.
Mutistic children differ from shy people in that they cannot make a conscious decision to remain silent. Shy children sometimes also can't open their mouths in the presence of strangers. However, if other people speak to them, they respond. Mutism patients cannot do this voluntarily.
Affected people suffer from excessive anxiety even as infants: they cling to their parents, cannot stand it without being the mother; they withdraw; they fall asleep badly; they are prone to tantrums and crying tears.
In kindergarten, when children usually play with their peers and discover the world outside, their fear of speaking is consolidated as an inability to speak. There is also a rigid posture, an empty look; they look away when others look them in the eye; they don't laugh out loud in public.
An anxiety disorder
Anxiety sufferers have a low stimulus threshold in the amygdala. This almond kernel sends out nerve impulses that signal danger. It was important from an evolutionary point of view, because this way we can quickly escape from a threatening situation, and the metabolism runs at full speed and sharpens the senses.
In over-anxious people, the almond kernel reacts more intensely than would be necessary for self-protection. The danger he indicates is not really there.
Children who suffer from selective mutism perceive social contacts as a danger: the brain's fear program runs in kindergarten, at school, with the teacher, caretaker or neighbors. It is not appropriate to make fun of it: the danger is not real, but the feelings of fear are.
So even if the child knows rationally that there is no danger, his palms will sweat, he wants to escape the situation, his heart is racing, and the language stops. The child becomes dumb to escape the fear associated with communicating through speech.
Mutism is considered a social anxiety disorder. The fear center in the brain overreacts. Mostly it is selective mutism: The language is cut out when the child has to talk to people who are not part of the closest family.
Most people with the disorder have a genetic predisposition to anxiety. They are afraid of strangers and situations.
Mutism is also associated with speech problems. Many children who suffer from this disorder also have general speech disorders.
Almost all people who suffer from selective mutism have at least one parent who is also socially isolated. 3 out of 4 parents even have an anxiety disorder. The question of the genetic basis, as is usually the case, cannot be clarified unequivocally: did the children develop their disorder because the parents taught them the fear behavior? Or did they inherit the behavior?
Very important: Even if there are overlaps in the symptoms, mutism has nothing to do with abuse or trauma. Unfortunately, parents who are looking for help are sometimes suspected of neglecting or even abusing their children.
Mutism is unfortunately unknown to many doctors. Linguists and child psychologists, on the other hand, mostly know the pattern. Psychiatry, psychology and speech therapy are the subjects that deal with mutism.
Mutism is recognized as a disorder and has serious social consequences if it is not recognized early. The children do not cause trouble, but they miss opportunities in life and enjoy their childhood little because they exclude themselves from social activities.
At school they become outsiders, do not participate orally and therefore receive poor grades, and psychological problems explode during puberty. Mutism is now growing into a complete social phobia, and speechlessness is associated with clinical depression.
Therapies should start in kindergarten, at school those affected need special therapy and school support for each level.
Various therapies lead to success for those affected. In the past, children with this disorder often went into analytical play therapy because professionals interpreted the disorder as a result of early childhood trauma. This diagnosis is considered wrong today.
Other doctors suspected family conflicts and worked through family dynamics on the relationship dynamics and projections of the parents. This therapy is also useful for genetic disposition. Since the fathers and mothers of those affected also suffer from similar problems, family dynamics certainly play a role in how the disorder develops.
However, speech therapy promises the best results. It does not rummage according to past patterns, but starts from the now state. Step by step, she rebuilds the language patterns of those affected and helps them to overcome language fears in social groups. For example, the therapist begins by letting the patient mimic sounds. Then they form syllables, later words and short sentences. Later on, those affected read the texts aloud and at the end they should speak freely.
In the last phase, it is "in the field". Those affected rehearse real situations: for example, they ask strangers about the time or shop at the bakery.
Speech therapy here turns into behavioral therapy, and behavioral therapy has also proven useful in controlling mutism. Behavioral therapists are also only interested in the causes of harmful behavior in the past. However, they assume that those affected have learned avoidance behavior and can therefore unlearn it.
Even more: Speechless people permanently increase their fears through their behavior. Language is always a system of relationships and changes the relationship dynamics. We cannot not communicate. Whoever closes himself, whether voluntarily or involuntarily, such as those suffering from mutism, signals to others: I don't want to talk to you. With the others, the message arrives: I set myself apart from you, which means that the others exclude those affected.
If you don't talk to your classmates or colleagues, especially when celebrating or going on a trip, the others no longer invite you to group events. At some point, those affected only look at social life from the outside. The relationships of others are becoming stranger to the speechless, and this makes it even more difficult to establish contacts.
Mutants suffering from this show the entire spectrum of closed-mindedness. They are speechless, the main means of our communication, but they also freeze their gestures and facial expressions. The others do not know what is going on in them, and this makes them look scary.
Behavioral therapy promotes the desired behavior through shaping. Those affected take simple steps in the direction of a different pattern of behavior, and the therapist encourages them to do so, for example by showing how this behavior has positive consequences.
In chaining, the behavior therapy in those affected links fragments of active communication that already exist. For example, a patient may be speechless when in a group, but hesitant to make eye contact. Then the therapist can train in a targeted manner to endure this eye contact, to lengthen it and to connect it with speech. For example, those affected can only nod or shake their heads at first and then answer quietly with yes or no later.
In prompting, the therapist specifically directs the attention of the person concerned to a certain behavior in order to prepare or accelerate a changed behavior. If the patient forms words with his lips without saying them, he could ask him: "Please say this out loud."
When the therapy starts, fading out begins. The therapist is now slowly but surely taking back the supports until the affected people also use their new behavior in everyday life.
Psychiatry and neurology focuses on the neurobiological and biochemical dimension of the disorder. If the anxiety center is hypersensitive, the serotonin level is low. Serotonin reuptake inhibitors increase serotonin in the brain metabolism.
Such remedies work against depression, anxiety disorders, compulsive disorders, Boderline syndrome and post-traumatic disorders and also against mutism. Drug treatment alone is dangerous in all of these diseases. Whether organically or not: Mental disorders have a huge social impact, and the learned avoidance behavior among speechless people cannot be changed by increasing serotonin levels.
Combined speech and behavioral therapy that supports medication is now considered the best way to treat mutism.
Many doctors are unfamiliar with the disease, and so are many parents. Mutism as a social disorder can be dealt with very well if it is recognized early. The child can then learn the social patterns in good time; it only becomes difficult when these solidify.
Parents and teachers should pay attention to the following symptoms:
1) Does a child fall silent in certain situations or towards certain people without a general speech disorder?
2) Does the child talk a lot (and at ease) to people he trusts but falls silent as soon as strangers arrive?
3) Does the child rarely take part in actions by peers, but does it always take center stage within the family?
4) Does the child shy away from testing their physical abilities, be it cycling, running or climbing?
Mutism and autism
Even autistic children often do not speak, incomprehensible, or they are closed to strangers. It is very difficult for laypersons to tell whether a child is suffering from mutism or an autistic spectrum disorder such as Autism or Asperger.
However, three characteristics distinguish autism from mutism patients considerably:
1) Autistic children always withdraw, they always avoid contacts and always ward off stimuli from their surroundings. In contrast to mutism patients, they build their own world, so they stimulate themselves. Mutists, on the other hand, remain silent towards classmates, teachers and strangers, but are extremely attached to their parents.
2) This also applies to feelings. Autistic people are "cold" as babies; they themselves have an abstract relationship with their parents and siblings. Mutists, on the other hand, are very emotional in the family when the fear center reports no danger.
3) Autistic people usually suffer from a language disorder at the neurolinguistic level. Your language differs massively from others when it comes to everyday communication; often they develop their own grammar and extraordinary language figures. They learn language as social communication like a telephone book without grasping the sensual content.
However, mutists do not have an organic disturbance to learn language, but inhibitions to use it. They are often very good at writing in school and thus compensate for their silence if they should contribute orally.
Instructions for teachers
Teachers who are unfamiliar with the disorder are overwhelmed with mutistic children. Unfortunately, they often behave completely wrong towards those affected. A child who does not speak is traditionally considered stubborn, even if the times when a "good spanking" was the number 1 means of forcing children to speak.
However, mutists are not school refusals who want to show teachers that they refuse to communicate - they cannot help but remain silent.
Keeping the disturbance secret is the wrong way to go. All adults who have contact with the child in school must know about the behavior pattern and not force the child to speak.
1. On the other hand, you should praise it when it speaks.
2. Teachers should pay attention to whether classmates bully or exclude the child.
3. The child should remain in the normal class association.
4. The teacher can offer the child equivalent tasks in which he does not have to speak: painting, writing, reading or playing.
5. Teachers can kindly support the child to play with other children, for example to paint with them.
6. The child can use computers to communicate, or symbols and gestures.
7. Group work can break down the limits of the language barrier.
8. The child can sit with children who are not very afraid of it and the work group should not change.
Help for the families
In order to overcome mutism, the family is the linchpin in the early years. Many parents get used to a behavior pattern that appears to protect the child, but worsens the disorder: they know about the fears that the child has in social relationships outside the family. Because it is so difficult for the child to speak to strangers, they speak for themselves - also to the doctor, therapist or teacher.
This leaves the child trapped in speechlessness. The parents, on the other hand, have to support the child to speak for themselves and, as difficult as it looks, to expose it step by step to situations in which it can cope with its fear.
You may not grant the "sensitive" child privileges at home either.
Conversely, the parents must not exert excessive pressure. If the child does not speak, it is not because they do not feel like it, but because they cannot speak because of their fear. If parental pressure builds up additional stress, it only aggravates the symptoms.
Above all, parents need to know that getting out of the snail shell is a long process in which success is very slow.
Speechlessness and trauma
Mutism is probably not due to traumatic experiences. But trauma can also lead to speechlessness.
Brain research today explains why this is so. The amygdala and hippocampus are the regions in the brain that are most important for the symptoms of traumatized people. The almond kernel processes reactions to experiences that were associated with strong affects and stores them. The hippocampus processes conscious memories and organizes them.
The hippocampus can no longer fully perform its function under stress, because an increased release of cortisol then suppresses its activity. This is probably the reason why people with post-traumatic stress syndrome suffer from distorted memories. The Brocasche center in the left half of the cortex controls the linguistic expression. During a traumatic event, it is inhibited just like the hippocampus. In the traumatic situation we therefore react speechless.
Since the traumatized situation in the brain repeats itself in traumatized people with appropriate triggers, they also lack the words.
In these phases, outsiders deal best with those affected if they give them the opportunity not to express their feelings verbally. This applies to therapists, but especially to traumatized people in court.
Depression and suicide
People suffering from clinical depression, bipolar people in a depressive phase and borderline patients also go through times when they are more or less speechless.
Depressed people report a wall between them and the outside world; they feel a wall between themselves and other people that they cannot break communicatively.
However, while they can hardly speak and often only eject snippets of sentences, stammer or remain silent, many of these patients compensate for their inability to speak by writing. This should definitely support a therapist.
Specific speechlessness is particularly important when it comes to the disorder. When people are asked about depression, they often stare up in the air, say nothing at all and cannot say anything.
Risk of suicide
In this phase, therapists should openly address those affected who may be at risk of suicide. Suicide often announces itself by withdrawing from communication and in particular by stopping speaking.
Living people report of a "different world" in which they were, in which they no longer really seem to communicate about everyday life, that is, real social relationships. A constant look that seems to be looking into the other world joins the speechlessness.
It is wrong to think that speaking about the danger only fuels suicidal intentions. Unconscious suicidal phases, breakdown of communication and loss of linguistic communication go hand in hand. Talking about the danger alone often builds the bridge for those affected to come back to "this world". (Dr. Utz Anhalt)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch
- Juebin Huang: Aphasia, MSD Manual, (accessed August 26, 2019), MSD
- Ercole Vellone et al .: Stroke survivors who like art have a better quality of life than those who do not, European Journal of Cardiovascular Nursing, (accessed 26.08.2019), Researchgate
- Bandelow, Borwin et al .: German S3 guideline for treatment of anxiety disorders, (accessed 26.08.2019), DGPPN
- Vadakkan C., Siddiqui W .: Claustrophobia, StatPearls Publishing, (accessed August 26, 2019), PubMed
ICD codes for this disease: R47.0, G31.0ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.