Ableism in Speech-Language Pathology: It is Not Just Autism
Ableism in this profession has been circling my brain for a while, but it is hard to communicate my frustration without becoming off-putting to an audience. So, I will start with this: You don’t mean harm in these ableist acts, just like I didn’t mean harm in the ableist acts I used to do (and, sometimes, still inadvertently do). But the ableism is rooted in our professors, our colleagues, our administators, ASHA…all communicating to us that we are the experts. But they don’t only communicate that—also, that we are so good. We are good people. But the reality is that you cannot be a “good person” or a “not good person,” as what constructs being “good” is layered and culturally determined. Still, most of us think we are good people. This combination of being assured we are the experts and are good people has resulted in an entitlement to judge….everybody. And that is what I am going to be discussing today.
Here’s a hypothetical situation:
It is a Sunday afternoon, and you are a speech-language pathologist having a lunch date with an SLP colleague-friend. The waiter comes by and asks you what drinks you would like to start out with. You politely order a coffee with cream and a water—then, once he leaves, you nudge your colleague asking if she heard the waiter’s lisp. It was so apparent, particularly on the /s/ in “start”! She nods and whisper-shouts that of course she heard it—how could she not??? You respond that you want to get in there and fix it! He is a waiter, talking to patrons all day, and he is talking like that? It is just so cringe. You say you feel bad for him because he must feel so self-conscious talking.
What if I say that the waiter has no problem with his lisp? What if I say that he does feel self-conscious about it because he went through 12 years of speech therapy with a constant focus on eliminating that lisp? What if I say that you don’t really care about his own perception of his speech?
Ableism is the belief that those with typical abilities are superior to those with disabilities, and it is rooted in Western views of societal worth—thus, it cannot be seperated from racism. Ableism is ingrained in our thought processes due to the very nature of the field of speech-language pathology.
Our profession is aimed at fixing people of their speech, language, voice, hearing, swallowing, feeding, cognitive, and pragmatic deficits. And that is based on research aimed at fixing people of their speech, language, voice, hearing, swallowing, feeding, cognitive, and pragmatic deficits. And that research measures success by however the researchers define “success”—not by how the clinical population they are serving define “success.” Research is, all too often, measuring the wrong thing. But what if research attempts to measure the “right” thing? That means longitudinal qualitative and quantitative studies and long-term funding. That means university faculty members who aren’t pressured to publish, publish, publish within their tenure-track position. To oversimplify it, the profession lives within a larger problem-ridden system that has created a medical model of disability nightmare where the communication expectation is an unobtainable level of communication perfection.
It is impossible to discuss ableism within every single aspect of speech-language pathology without this post being ultra long and overwhelming, so it is primarily focusing on the tendency for SLPs to make pitiful judgements about other people regarding things within our scope of practice. Do those other people care about their own “deficit/s”? That is irrelevant, both to the SLP and in this discussion. These judgements are cruel.
But I mean, I’ve done it. I may even still do it, occasionally, without even realizing I am. I am not immune to these systems of oppression so deeply ingrained in healthcare and educational fields.
When I was in graduate school, the clinical expertise and significant role of speech-language pathologists was strongly emphasized, as would be expected in any speech-language pathology graduate program. My cohort and I learned that speech-language pathologists are the experts on all things communication. This is a very powerful profession we have chosen—and with this power and knowledge, we have the ability to analyze others’ communication! And so we did. Very quickly, I noticed that cohort members were now discussing features of other cohort members’ communication that were “somewhat concerning.”
“She doesn’t even let other people talk—can she even be an SLP when her social skills suck?”
“Her vocal fry is so distracting! She is going to need to get that treated if she wants to be an SLP.”
“I can’t even follow what he is saying half of he time. He needs some language therapy, himself!”
Graduate students, quick to assert their knowledge of the field, demonstrated their competence by making superficial judgements about other cohort members.
And, like I said before, I did it too.
I think, for me, things started to change when I saw a Facebook post from an SLP colleague of mine about 1.5 years into my career. The post was about how she cringes whenever she hears her daughter’s boyfriend’s lisp, feeling secondhand embarrassment for him. And then her close SLP friends '“haha-ed” it and commented their similarly cringing reaction to hearing celebrities, former friends, and others lisp. They just want to fix it! Get their hands in there! I mean, lisps just sound so…yiiikes.
But I have a lisp—sometimes. But I am the only one who should have a say in my own lisp. Her daughter’s boyfriend is the only one who shoud have a say about his own lisp. This entire social media thread is so…messed up. It is fucked up.
You don’t need to look very far into speech therapy social media to find lisp or weak R sound jokes followed by~laughing crying emoji~.
You don’t need to talk to a speech therapist very long after a particularly long, tiring day of work before hearing some exasperated comments at the expense of clients and whatever disability they have.
“Did you hear her talk? She talks like a toddler!”
“No one is going to take him seriously if he keeps talking like that.”
“I just can’t with her open mouth breathing!”
And, even now, with a shift in thinking, I get an aspect of it. I understand that SLPs need to blow off some steam. It is natural for people in helping professions (who are all-too-often overworked and underpaid) to make exasperated comments about clients they see. But it doesn’t make it right.
SLPs, with our degree and clinical expertise, do not have a right to make pitiful judgements regarding items within our scope of practice for every single person. Not about people we know. Not about people we spot “in the wild.” Not about our own clients. I mean, for fuck’s sake, imagine if someone did that to you! Take the perspective of others. Take the perspective of the other person. Take the perspective of your client. For people who talk so much about perspective-taking (and fault those that can’t do it the “right way”), it seems that there is only one way to perspective-take—and that way is the disabled person taking the perspective of the abled person.
This is all wrong. We cannot and should not be bragging to our colleagues about how sick our families are of hearing us diagnose total strangers. We cannot and should not be the ones imposing our fears of bullying and osticization on our high school-aged clients who have articulation errors or varying levels of dysfluencies.
We should be listening to our clients and supporting them, not the ones judging them for their disability in the first place.
Back to the hypothetical.
Pointing out that waiter’s lisp couldn’t have been due to concern regarding his self-esteem or intelligibility—there were no indicators that he has poor self-esteem, and his speech was fully intelligible. So, really, pointing out that waiter’s lisp was a way to assert, in your mind, that you are the communication expert. You hear these things everywhere. You can spot incorrect grammar use, slushy /sh, ch, and j/, poor inferencing skills, dysfluent speech, etc. etc. within seconds. And you have the clinical knowledge to “get in there and fix it!” You would be saving him from the life that your mind imposes upon him—a life of self-consciousness, a life of not getting jobs and career advancements, a life of friends making fun of him. You would be his speech-language pathologist savior.
But he isn’t going to become your patient! Neither are any of the other people “in the wild” that have some sort of speech, language, voice, hearing, swallowing, feeding, cognitive, and pragmatic “deficits.”
This was never about him. This was never about his lisp. If you are an oralfacial myologist and are thinking about all the implications of the airway and facial growth—it was never about that either.
It was about making yourself feel good.
I usually end with some advice, some light at the end of the tunnel, some reassurance that it will all be ok, some ways to move forward. It is hard for me to do that right now. I can’t summarize anti-ableism in a few bullet points. And I only spoke to one common problem that is a result of the ableism in this profession. There are more, and I will speak to more.
I guess I hope that by being aware, SLPs can do some hard self-reflection about the responsibility that comes with being a “communication expert.”
