Communicating With Your Partner When Speaking Is Difficult

 Recently, I was evaluating a patient with speech and voice changes from Progressive Supranuclear Palsy (PSP). During the history taking, his wife stated: "I wish he would communicate more." When I asked the patient to comment on his wife's statement, he said: "we've been married for twenty-five years, it's all been said." I saw sadness, or perhaps it was resentment, wash over his wife's face. Her choice of the word "communicate" made me think that she was looking for  more than just idle chatter. It appeared, from observing their interaction, that she was longing for her husband to communicate interest. Interest in life, his health, his safety, his friends, and, perhaps most of all, in her. She also seemed to need relief from a daily habit of instructing, mothering, and "nagging," to one of partnering and self-nurturing.

Ironically, in the same week I evaluated a younger, female patient with a diagnosis of Multiple Sclerosis (MS). Her husband sat in on the interview and expressed a similar desire for more communication. He verbalized frustration that his wife no longer spoke to him in complete sentences, but rather, abbreviated her thoughts and comments to short, telegraphic phrases. Noting her mildly slurred speech and reduced breath support, it occurred to me that her saying less was her way of conserving muscle energy and reducing fatigue. To her husband, however, her growing silence was viewed as as some rejection of him. He didn't seem to understand that the pause in her thinking was just that, and his rushing to finish her thought did not really help her.

Communication between couples is complex and certainly beyond the scope of this blog post. Communication between couples, when one has a communication impairment can be especially difficult. And, as you can see from my two examples above, does not seem to be gender specific. Sharing physical space with someone who, because of a physical or cognitive impairment can no longer communicate well, can introduce an emotional void into a relationship unless couples can discover other ways to be in communion with one another.

This might include non verbal activities like dancing, or painting, or listening to music together. Maintaining family connections and other social networks of course is also important. And,some days, perhaps just adopting the wisdom of various self-help programs which teach:

• One day at a time
• Go for being happy over being right
• Don't make mountains out of molehills
• and one that is particularly hard for me....ask for help when you feel in over your head