Module 12: The Cultural Beliefs of Speech-Language Pathology

 

  • What underlying beliefs does the culture of speech-language pathology include?

  • After working with the material in this module, readers will be able to

    • Discuss the implications of a cultural assumption that normal exists and is preferred to abnormal

    • Discuss the implications of a cultural assumption that the speech, language, and social communication patterns of White monolingual speakers of the northern dialects of American English are normal, typical, and/or preferred

    • Discuss the implications of a cultural assumption that professionals exist and that clients exist

Thinking about our own cultures’ underlying assumptions or beliefs can be difficult, precisely because they are underlying and assumed. Let’s make the effort here, though, to name and discuss three of the key assumptions that haved shape our professional culture.

Underlying Assumption One: Normal Exists, Normal Serves as an Important Starting Point, and Normal is Preferred

Think back to the overall organizing structure of your master’s program, your graduate school classes, and even your textbooks. First you learned about normal anatomy, physiology, and neurology; the normal phonetic structure of English; and typical child language development. Then you learned about the departures from normal that our profession views as disorders (or conditions, or at least potential problems; see Module 11). Finally, you learned about applying that information in clinical assessment, treatment, or management. Why was your education organized that way?

The usual answers are that we cannot understand what is abnormal or atypical until we understand what is normal or typical, and that we cannot make appropriate decisions about management unless we understand the nature of the disorder.

But dig a little deeper underneath those answers.

Why do we say that students cannot understand atypical until they understand typical?

Why do we say that clinicians cannot understand treatment or management unless they understand the normal referent and the departures from normal that the client’s current abilities represent?

Notice, if we keep playing this game, that your explanations will probably devolve into restatements of the conclusion: “Students cannot understand what is atypical until they have learned what is typical because the typical serves as the base for learning about the atypical.”

These beliefs make sense to us, because we are fish in water.

But if can manage to get outside ourselves and think about our thinking, we realize that starting with normal is not strictly necessary in any objective sense; it is merely an underlying cultural assumption of our profession. It is part of the cultural belief system that we have inherited as members of our profession, and it directly reflects the interests of our original 25 professional ancestors. As Duchan and Hewitt (2023) recently catalogued in some detail, this tendency toward ableism (or perhaps “normalism,” an assumption of and preference for that which is perceived as “normal”) was clear in the earliest writings of the 25 founders of the 1925 association that became ASHA — and the same view has continued to shape our profession, not only as a belief but as the underlying structure of our entire educational system and our entire approach to what we describe as basic clinical practice.

This cultural centering of normalcy has also shaped how we describe our profession. In 1952, for example, multiple representatives of our profession worked together to develop a description of speech-language pathology to be used by the organizers of the MidCentury White House Conference on Children and Youth (ASHA Committee, 1952). In the ASHA Committee’s report to the Conference, children with speech disorders were described as one of the country’s “largest groups of seriously handicapped youngsters,” “urgently” in “need” of help. Persons with disabilities who “can speak normally” or at least “nearly so” were described as “tremendously different, as a rule... from [those] whose speech is gravely impaired,” and “the degree to which the family life may be carried on, in a normal fashion” was described as depending “very heavily upon whether the speech function of the handicapped individual is intact.” Even “relatively minor speech and voice defects” were described as disqualifying children from potential careers “such as teaching, [that] requir[e] good speech.”

Do you hear the underlying assumptions that are made explicit by these words? “Handicapped,” “impaired,” “normal,” “intact”; one of the more striking features of the ASHA MidCentury Report, to my reading as we approach the middle of the 21st century, is how casually and confidently the committee used such terminology. They seem to have been either utterly unaware of, or utterly convinced of, their underlying assumption that people who spoke or communicated in ways other than the ways that they assumed to be “normal” were “handicapped,” unable to participate “normally” in family life or in their chosen vocations, interfering with their entire families’ “normal” lives, and “urgently” in “need” of therapy designed to return them to an “intact” state.

Other examples of more or less explicit ableism or normalism are also obvious in our profession’s clinically-oriented journal articles or textbooks from different eras, including well after the 1950s. Our literature includes a continued emphasis throughout the decades on seeking “normal” speech and resonance for children who were born with cleft lip or cleft palate (e.g., Blakely & Brockman, 1995). And it’s not just history; well into the 21st century, our publications and textbooks continue to emphasize how exactly to elicit “correct” production of phonemes; the “need” to “suppress” and “eliminate” the use of “deviant” phonological patterns; and recommendations for the use of interventions that not only teach conversational skills but actually provide word-for-word scripts and specific goals for how an “appropriate” conversation must be structured, for clients we have diagnosed with social (pragmatic) communication disorder (see ASHA, n.d. and current as of this writing, about social communication disorder).

Why?

Why have we assumed that some residual hypernasality is a problem that must be fixed, rather than assuming and accepting that people are born with a range of facial anatomies that can reasonably be expected to lead to a range of nasality? Why would it even occur to us to literally script something as dynamic and unpredictable as a future conversation between two other human beings?

In these and many other examples, there is definitely some very clear evidence that our profession assumes that normal exists, that normal serves as a reasonable starting point, and that normal is preferred.

Has anyone ever questioned these assumptions? Yes, of course, and such questions also appear to be becoming more common in our professional culture, as you might have already been aware while reading this section.

As long ago as 1976, Clase drew on the constructs of stereotypes, social judgments, and continua that have shaped this website’s discussions as she asked “how different” speech must be to be considered “too different” and asked “To whom must it sound different?” (Clase, 1976, p. 51). She also questioned whether we “have the right” to make judgments about other people’s speech or to decide who needs treatment, given that such judgments can often be “subjective, arbitrary, and personal” (p. 51). She concluded by “questioning the ethics of... imposing our values on others and fostering a prescriptive position regarding acceptable speech behavior” (p. 55).

Later, similarly, in the first issue of the new American Journal of Speech-Language Pathology, Crais (1991) reviewed what had become by that time close to 10 years’ worth of work in the field of early intervention. Her article emphasized collaborating with parents and families, by which she meant supporting them as they seek to find the resources they want and develop the routines they find useful, given their reality as a starting point rather than given our values or our views about “normal” as a starting point.

Most recently, as the constructs of ableism and neurodiversity have become common in society and in our profession (see Diedrich, 2023; Duffy, 1981), many other authors in ASHA’s journals and elsewhere have begun to argue explicitly in favor of rejecting the notion that any “normal” exists or can be preferred. They write about resisting ableism, accepting neurodiversity, and embracing our “ethical duty” as professionals to “acknowledge, respect, and value disability as a culture” and as an identity (Saia, 2023, p. 795; see also the collection of papers edited by DeThorne & Gerlach-Houck, 2023, among other examples).

Some such conversations propose answers that fall too far along the relevant continua for my taste (in part because social models disability can forget to ask the individual what is bothering them, as we addressed at the end of Module 12). But it’s a good conversation, and it unquestionably reflects some thoughtful people attempting to understand the influence of, and the alternatives to, our profession’s founding and continuing underlying belief in “normal.”

Your Turn

As you think about normal, typical, normalism, or ableism in our professional culture, does it matter if we are discussing congenital, developmental, progressive, or suddenly-acquired characteristics, abilities, or conditions? Why or why not?

You might be familiar with the abbreviations WNL and WFL (within normal limits and within functional limits, respectively). If your work setting uses these abbreviations, how are they interpreted and applied? Do they represent an ableist assumption that “normal” exists, or do they represent an anti-ableist understanding that functional is a range that can be achieved in many ways? (If your answer was “recognition that functional is a range,” is it really? Does the “functional range” still basically center a presumed “normal”?) Where do our different interpretations of the same words or the same abbreviations come from?

If you use the abbreviation WFL to describe any client’s abilities as functional for them, do you think of yourself as being actively anti-ableist when you do so? Why or why not?

Underlying Assumption Two: The Speech, Language, and Social Communication Patterns of White Monolingual Speakers of the Northern Dialects of American English Are Normal, Typical, More Important, Preferred, and/or At the Very Least Necessary in Some Contexts

Did that heading bother you?

And is it true, overall, as a general underlying assumption that shapes our profession?

It certainly was true, at the beginning of our profession.

In 1936, the first article in Volume 1, Issue 1, of our new profession’s first journal, the Journal of Speech Disorders, was titled “Correcting the mechanism causing most foreign brogue.” It described the spoken English of people who had immigrated to the U.S. as “unsatisfactory”; provided extensive detail about coarticulation in English and about the transfer to later-learned languages of the phonological patterns, phonological constraints, and prosodic features of earlier-learned languages; and explained how to use this information to “overcome all trace of faulty accent” (Barker, 1936, p. 4). Similarly, the first edition of Van Riper’s (1939) classic and still influential textbook ended with six treatment chapters, one each for language delay, articulation, voice, stuttering, cleft palate, and “bilingualism and foreign dialect.” The “bilingualism and foreign dialect” chapter explicitly used the word “error” to refer to the speech patterns and the word “treatment” to describe the necessary actions by the speech therapist.

This assumption that “foreign” speech could be considered a disorder, on an equivalent footing with language delay or cleft palate, marked our profession for decades. Wise (1946, p. 330) referred to “the defects that result from environmental background such as foreign language dialect,” and Konigsberg and Windecker (1955) began their tutorial about speech correction in high schools by listing five types of disorders typically seen in that setting: “articulatory faults...voice problems...disturbance in fluency...speech problems related to hearing loss, and...foreign accent” (p. 247). The second (1947) and third (1954) editions of Van Riper’s book retained the foreign dialect treatment chapter. As late as 1978, MacKay (1978) explained that teaching English to speakers of other languages is “remediation,” requiring the same pedagogical or clinical techniques that are required in treating disorders for monolingual English speakers.

As was also true for the normalism or ableism that has marked our professional culture, of course, we can also find examples of other views. Wing (1972), for example, presented a relatively early example of the kind of information that is now emphasized in our field: that some articulatory or phonological patterns in children learning English are predictable based on their first language (or multiple earlier languages) and are not markers of disorders at all, while other patterns cannot be explained by a child’s language history and are more likely to represent disorders. Gandour (1980), similarly, in a response to McKay’s (1978) paper, explained that language learning and language transfer are not disorders and do not need therapy, and that teaching English to speakers of other languages must be differentiated, professionally, from providing speech therapy or remediation. [The prevailing view of the time was then clarified, however, by ASHA’s Clinical Certification Board (1980): Clinical work designed to teach pronunciation to English language learners was to be viewed as treatment.]

We also need to be blunt and clear, as we were in addressing raciolinguistics in Section Two, that this emphasis on treating accents as disorders did not extend to all accents.

Did your phonetics or language development classes include the opportunity to complete narrow transcriptions of any version of Scottish English or British English? They are distinctly different from American English, including in several characteristics of vowel use, realizing the grapheme “th” as the phoneme /f/, and the use of the velar fricative /x/. The differences extend well beyond accent, also, into language forms that characterize dialects. Many individual semantic items differ, from lifts and lorries to chips and biscuits. British English uses several prepositions differently from the way American English uses them (including to live “in” a street and to do things “at” the weekend). Speakers of British English use present perfect verb constructions (“I’ve lost my wallet,” “She’s brought some pencils”) where an American English speaker would probably describe the simple past as correct or necessary, and speakers of British English frequently add what American English considers an unnecessary (or even incorrect) verb in such phrases as “I might do” (for the American “I might” – although some Southern dialects of American English use the related “I might could”).

But would a White, monolingual English-speaking child from London be judged in need of speech or language therapy in the U.S. on the basis of these patterns?

No.

And is the reason astoundingly obvious, as you think about which accents and dialects have been judged to be problematic by our profession and which have not? Remember, as we discussed in earlier modules, that the reasoning behind many judgments about accents and dialects often has much less to do with the phonology or the language forms and much more to do with the (incorrect, stereotyped, and discriminatory) assumptions and judgments that a listener has already made about the speaker’s identities or background.

You are correct, therefore, if you are aware that the “foreign” or language-history-based accents deemed to be problematic within our profession have often been those accents produced by people who, as we have addressed, had already been judged by our White, English-speaking professional ancestors to be not White, not speaking the “appropriate” dialects of English with an “appropriate” accent, or both.  

We need to take several more steps into this uncomfortable territory, too, because our profession’s publications about “foreign” accents and dialects have overlapped considerably with our publications about cultural dialects of American English since approximately the mid 1960s. Moreover, the fact that this overlap did not emerge until the mid 1960s reveals another clear and uncomfortable truth about our profession’s culture, as we will address next.

Your Turn

This segment mentioned Volume 1 of our first journal, the Journal of Speech Disorders. Volume 2 included an article about bilingualism and stuttering that classified possible “speech defects” as

Box 13.1. History of Publications about African American English, Black English, and Similar Topics in ASHA Journals

In the Journal of Speech Disorders (1936 - 1947): None

In the Journal of Speech and Hearing Disorders (1948 - 1990):

Adler (1971): Dialectical differences: Professional and clinical implications “It is suggested that insteadof attempting to treat a supposed deficit speech pattern, the clinician considerteaching standard English to dialect speakers”

Seymour & Seymour (1977): A Therapeutic Model for Communicative Disorders Among Children Who Speak Black English Vernacular “black English vernacular is viewed as a normative referentfor a model of communication pathology for children who speak that vernacular”

Evard & Sabers (1979) Speech and Language Testing With Distinct Ethnic-Racial Groups: A Survey of Procedures for Improving Validity

Wiener et al. (1983): Measuring Language Competency in Speakers of Black American English “The study demonstrated the inappropriateness of using a test of Standard American English (SAE) as a test of language development for children whose primary language exposure is other than SAE.”

Box 13.2. History of Publications about the Influence of Culture in ASHA Journals

In the Journal of Speech Disorders (1936 - 1947): None

In the Journal of Speech and Hearing Disorders (1948 - 1990):

Multiple publications attempting to demonstrate that stuttering occurs or does not occur in different cultural groups (e.g., Aron, 1962; Leith & Mims, 1975)

Raph (1967) and

First, consider our profession’s publications about sociocultural dialects of American English and, especially, about the dialects of American English known through time as Black English, African American English, and by several other names. The Journal of Speech Disorders started in 1936, as we noted above. It was our profession’s first journal of clinical practice research, and it was published from 1936 through 1990 (renamed the Journal of Speech and Hearing Disorders, JSHD, in 1948). What was published in JSD/JSHD during its 54-year lifetime about helping people who spoke African American dialects or Black English, or more generally about the influence of culture or dialects on our work with speech, language, and hearing?

The answer, amazingly enough, is almost nothing.

In fact, there are so few relevant articles in JSD/JSHD that it is simple enough to summarize all of them in a few sentences. Explore Boxes 12.1 and 12.2. What underlying beliefs do these publication patterns represent or demonstrate?