Susan ayers cambridge handbook of psychology he

C. Code
558
‘Psychosocial’ refers to the social context of emotional experience.
Most emotions are closely associated with our interactions with
others and this is what produces most of our happiness, sadness,
anxiety, etc. Psychosocial adjustment to aphasia entails coming to
terms with a unique constellation of life events. Because the aphasia
effects others too, it has implications for the individual’s whole
social network, especially the immediate family (Code & Muller,
1992; Code & Herrmann, 2003; Duchan & Byng, 2004). The disability
as experienced by the aphasic person, rather than the impairment
itself, is of particular importance. Studies investigating how psychosocial
adjustment to aphasia is perceived have concluded that
aphasic people and their families suffer from considerable stressful
changes resulting from professional, social and familial role
changes, reductions in social contact, depression, loneliness,
frustration and aggression. The value dimensions of psychosocial
factors in our lives, like health, sexuality, career, creativity, marriage,
intelligence, money, family, etc. are markedly affected for aphasic
peoples and their relatives (Herrmann & Wallesch, 1989).
There has been increased attention to direct emotional disorders
recently as interest in the cerebral representation of emotion and its
relationship to language impairment has grown (see Code, 1987;
Starkstein & Robinson, 1988, for reviews of issues). Post-stroke
depression correlates highly with anterior lesions but does not
appear to correlate with aphasia type (see also ‘Stroke’ ). However,
research also shows that as time elapses since onset there is an
increase in the interaction between extent of cognitive and physical
impairment and depression (Robinson et al., 1986).
But there has been little research that has sought to identify reactive
emotional states following brain damage and to separate them
from direct effects. Herrmann et al. (1993) found no differences in
overall depression between acute and chronic aphasic groups, but
acute speakers showed significantly higher ratings for physical signs
of depression and disturbances of cyclic functions (e.g. sleep), generally
considered direct effects, and an association between severity
of depression and anterior lesions close to the frontal pole. Further,
aphasic peoples with major depression (all acute) shared a common
subcortical lesion. This suggests that the symptoms of depression
in acute aphasi speakers may be caused more by the direct effects
of the damage. At later times post-onset it is a more reactive depression
which emerges.
One approach has been to view the depression accompanying
aphasia within the grief model (Tanner & Gerstenberger, 1988)
where individuals grieving for the loss of the ability to communicate
move through stages of denial, anger, bargaining, depression and
acceptance. The extent to which aphasic people work through the
stages of the model has not been investigated. The psychological
REFERENCES
Alexopoulos, M.P., Abrams, R.C.,
Young, R.C. & Shamoian, C.A. (1988).
Cornell scale for depression in dementia.
Biological Psychiatry, 23, 271–84.
Basso, A. (1992). Prognostic factors in
aphasia. Aphasiology, 6, 337–48.
Brumfitt, S. (1985). The use of repertory
grids with aphasic people. In N. Beail
(Ed.). Repertory grid techniques
and personal constructs. London: Croom
Helm.
Carlomagno, S. (1994). Pragmatic and
communication therapy in aphasia.
London: Whurr.
Chapey, R. (Ed.). (1987). Language
Intervention Strategies in Adult Aphasia
(2nd edn.). Baltimore: Williams & Wilkins.
Chapey, R. (Ed.). (1994). Language
Intervention Strategies in Adult Aphasia
(3rd edn.). Baltimore: Williams & Wilkins.
Code, C. (1987). Language aphasia and the
right hemisphere. Chichester: Wiley.
processing of denial, bargaining, acceptance, are less amenable to
more objective forms of measurement but have been investigated in
aphasic persons through interpretive assessments, such as personal
construct therapy techniques (PCT), by Brumfitt (1985, p. 93) who
argues that the impact of becoming aphasic is seen as an event
of such magnitude as to affect core-role construing and that the
grief the aphasic individual feels concerns loss of the essential
element of oneself as a speaker.
Studies of depression following brain damage have used factors
considered symptomatic of depression, like diminished sleep and
eating, restlessness and crying. These are the factors included
in depression questionnaires, although these symptoms may be
caused by physical illness and hospitalization directly unrelated
to mood state (Starkstein & Robinson, 1988) (see ‘Hospitalization
in adults’). While the most reliable method of gaining information
on the emotional state of people seems to be to ask them, language
plays a special role in the problem of identifying and measuring
mood for aphasic individuals. The intersection of language is further
problematic because mood manifests itself externally through facial
expression, voice quality, rate and amount of speech, gesture and
posture, as well as linguistic expression and comprehension, all of
which can be affected in impaired mood and all of which can
be affected by neurological damage.
Relatives and friends can assist to verify accuracy but determining
mood in an individual with aphasia presents many problems.
One approach to tapping inner feelings is to use the nonverbal
Visual Analogue Mood Scale (VAMS). Despite its simplicity the
VAMS has been shown to be reliable and valid (Folstein & Luria,
1973). The VAMS can be made more meaningful to severely aphasic
speakers by substituting schematic faces for words (Stern &
Bachman, 1991). Facial expression is the most direct method of
communicating emotion and an ability that should be preserved
in most aphasic individuals.
With an improved understanding of the social context of communication
and its importance to the reintegration of an aphasic
person to the community, approaches have developed that concentrate
on the communication, rather than the aphasic impairments,
and other speakers in the communicative exchange, like relatives,
healthcare professionals, shop keepers, policemen and publicans.
Research indicates that targeting these ‘conversational partners’
who have intact resources, rather than the aphasic person with
reduced resources, can make a significant contribution to improved
communication (Kagan et al., 2001; Togher et al., 2004).
(See also ‘Communication assessment’, ‘Neuropsychological
assessment’ and ‘Neuropsychological rehabilitation’.)
Code, C. (1994). The role of the right
hemisphere in the treatment of aphasia.
In R. Chapey (Ed.). Language Intervention
Strategies in Adult Aphasia (3rd edn.)
(pp.380–386). Baltimore: Williams & Wilkins.
Code, C. (2001). Multifactorial processes in
recovery from aphasia: developing the
foundations for a multilevelled framework.
Brain & Language, 77, 25–44.
Code, C. (2003). The quantity of life for
people with chronic aphasia.