Coronavirus, Intellectual Disability and Language

The Limits of my Language are the Limits of my world”  Ludwig Wittgenstein. 

In a recent interview with Joe Rogan engineer Elon Musk speculated that within three years his neural nets will have rendered language obsolete as a mode of communication. Whatever the prospects of Musk’s wildly speculative views on the future of language as a mode of communication; at the present time language is a vital tool in coordinating our behaviour. In this blog-post I will discuss some of the challenges that face non-verbal people with intellectual disabilities, who are in full time care during the Covid-19 lockdown. My reflections will be to some degree region specific as I will be speaking about lockdown as it was implemented in Ireland. Obviously, however, the difficulties I speak of are ones that universally apply to the problem of maintaining social isolation for people who have extremely limited understanding of the reasons for the isolation. 

Language is a wonderous tool that enables us to achieve magical things. Using words we can refer to objects which are millions of miles away from us (the Sun), we can refer to objects that existed millions of years in the past (a T-Rex) and we can refer to non-existent objects (a Unicorn). Furthermore we can refer to unimaginably large objects (the Andromeda Galaxy), and unimaginably small objects ( a Quark). We can combine our words using grammatical rules that give us the ability to say an unlimited amount of things true or false about the objects we are referring to. We use language not only to speak about our shared world but to discuss possible worlds with various different properties. Not only do we use words to refer to objects in the external world but we also use words to refer to our own internal states. My headache or toothache may not be visible to you but if we speak the same language I can tell you I have a headache or a toothache. 

There are many different people who to varying different degrees lack the linguistic competence we take for granted. There are a dazzling array of different ways people can have difficulties with language. Some people can form sounds and repeat a few words they have heard but lack the capacity to attach concepts to the sounds they can form. Others can use a few words to refer to things in their environment but lack the grammatical capacity to combine words into sentences. Such people can say ‘Ball’ but cannot say ‘I want the Ball’, ‘Isn’t that a nice Ball’ etc. Some people can understand some language e.g. ‘Dinner time’, ‘Time for a Bus Drive’ etc, but are completely unable to produce any language of their own. 

Lacking the ability to use language doesn’t imply lacking the ability to think thoughts. Work in developmental psychology indicates that prior to learning language children have conceptual abilities about object permanence, agency, causation etc ( Carey 2006, Burge 2006, Spelke 1997). There are people who have never developed a language of their own who have thoughts and interests of their own. Nonetheless because such people lack a language their ability to communicate their needs is limited. 

Language and communication are not synonymous. It is possible to communicate one’s needs without being able to speak. Such communication typically involves establishing a joint frame of reference. A person can tell you they want something by pointing at it. Or if they lack the ability to use pointing as a tool they can bring you to the object they want. They can communicate that they don’t want food by handing it back. A person can indicate that they are happy by smiling and sad by frowning. 

But even a simple tool such as pointing isn’t a universal gesture. Few non-human animals can understand pointing at all. And while some non human primates can be trained to point their understanding of the pointing gesture is limited.  Typically developing children begin using pointing at the age of 1. Infants typically use pointing for three different purposes, (1) to request help, (2) to offer information, and (3) to express an attitude (excitement, fear)etc. (Tomasello 2019 p. 98). So when a non verbal person uses pointing to communicate, it takes more than just interpreting the pointing; it involves interpreting facial expressions and behavioural cues to understand the meaning of the pointing gesture. Furthermore, some people with developmental disorders such as autism will have trouble in using and understanding pointing. So they may only be able to tell you they want something by bringing you towards the object they desire. 

Having the ability to understand and use concepts and having preferred activities you like to engage in but lacking the ability to communicate what you want can be frustrating at the best of times. In the case of non-verbal people with intellectual disabilities they rely on their families and carers to help facilitate their needs and ensure that they get to engage in the activities they enjoy. Providing care in this sense involves getting to know them very closely and detailing what they like so you can narrow the search space when trying to interpret what it is they are looking to do during the day. 

Today with the Coronavirus governments have lock-downs in place to try to slow the spread of the virus. The reasons they want to slow the spread is to try and ensure that hospitals aren’t overwhelmed by infected people; as such if the hospitals are overrun they won’t be able to provide sufficient care and more people will die than would have died otherwise. Another reason to try to slow the spread of the infection is that it gives scientists time to try and develop effective treatments for the virus; and possibly even develop a vaccine. 

Understanding why there is a lockdown requires the peculiar features of language we discussed above. Understanding a word like ‘Virus’ even at the most rudimentary level involves being able to refer to something very small and to understand its behaviour by describing its properties. The concept of a  ‘lockdown’, involves an understanding of abstract things like ‘the rule of law’. While an understanding of ‘Social Distancing’ requires an understanding of units of measurement such as distance you stand near a person without being infected, time you can spend near a person and how this effects the probability of being infected. While understanding the possible outcomes if we don’t adhere to social distancing involves either reference to far away in space such as other countries who haven’t implemented social distancing; or far away in time people in the past who didn’t follow social distancing (the 1918 flu). A lot of our thinking about the coronavirus and how we should react to it involves thinking about possible worlds; if we don’t do this we will live in world x but if we do that we will live in world y. 

For the non-verbal person with an intellectual disability they have been thrown into a world where everything is different. As we discussed above they can think about their world, be anxious, scarred about the changes they are going through. They can communicate their immediate needs but without language it is difficult to convey their more complex wants. 

Some effects of the lockdown here in Ireland are that Day Activation Centres are closed, Schools are closed and visiting care homes and community houses are not allowed. So a lot of non verbal people with intellectual disabilities who either live in a residential home or in community housing suddenly find themselves not going to work or school anymore. They find themselves having limited access to their community; they can no longer go to the places they like e.g. they can’t go for a coffee or a walk in the park or to visit friends. Most worryingly they cannot be visited by their family anymore. It is a frightening thing to suddenly be cut off from your family, your community and your daily activities without having any understanding of why. 

While explaining to a non-verbal person with intellectual disability why there is a lock down, or even what a lock down is; is probably a non-starter, there are some practical things that can be done. With technology we have the capacity to engage in live chats with friends and family with apps like zoom or WhatsApp. Even if the non-verbal person cannot engage with the chat aspect, seeing their friends and family and hearing their voices will provide some comfort for them. It hopefully will let them know that their family is still out there and still cares about them.. Another useful tool to implement would be the use of a visual schedule indicating what daily activities are being used. The visual schedule could be mapped out further to take in the weeks and plans could be made for future activities that will become available as the various different stages of the lockdown are lifted. Obviously though the degree to which the use of long term plans based on visual schedules can be work will depend on the cognitive abilities of each different person. Primarily though what is needed is to provide a rich environment in their residence so that they can still enjoy multiple activities so that at least their lives are still rich and enjoyable even while restrictions are in place.

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