Читать книгу The Handbook of Language and Speech Disorders - Группа авторов - Страница 24

As professionals, we often operate within our sociocultural milieu without a critical analysis of our practices and the conceptualizations that underlie them. The problem with this, of course, is that we might become blind to our poorly justified practices, or we might ignore new or inconsistent data that could potentially undermine our assumptions about important processes like labeling and its impact on our practices. Since we are agents of our society and, as such, are defined by the same realities, practices, and assumptions as others, this is a natural tendency. Within our sociocultural milieu, however, we must also remember that we fulfill a role as agents of rehabilitation and scholarship. As Brantlinger (1997) has argued, this requires us to be more diligent in how we operate within our sociocultural and political contexts; our priority should not be the sociocultural or epistemological status quo. Rather, our priority should be as advocates and agents of positive change for our patients and clients.

There are at least three implications that should emerge from this realization of our role as advocates when dealing with the social complexity of labeling. First, we should acknowledge and strive to deal with labels as complex phenomena. Labels are not simple, direct, or objective. They are powerful sociocultural artifacts that transmit biases, assumptions, and facts. They are also catalysts in the construction of both positive and negative consequences. To effectively elicit the positive consequences and reduce the negatives ones, we must recognize the constructive nature of these labels and the fact that they are often context‐dependent, and at least partly context‐created. For example, a quantifiable impairment such as age‐related reduction in hearing (even within “age‐normal” limits) may constitute a career‐destroying handicap for the conductor of a symphony orchestra, but not for someone in a different walk of life. Consequently, as clinicians we should not simply reify labels and consider them as “absolute,” objective categories. Rather, we should carefully consider how important it is to properly identify actual difficulties, determine the severity and context‐dependence of the labeled difficulties, and avoid the tendency to label without addressing the complexity and obtaining definite and objective data to support a diagnosis.

Second, we should strive to avoid the most basic negative consequences of labeling that occur when relying solely on the label. Rather, we should strive to thoroughly describe the difficulties that underlie the label. This means not only carefully documenting actual behaviors and their impact on the context, but also determining how the context impacts the behaviors and whether there are other emergent factors that must be adequately described and addressed (Perkins, 2005). Rather than orienting to symptoms to determine labels, we should orient to the skills, abilities, and strategies that can determine functional adequacy within the relative communicative and learning contexts. Darley (1975) had this in mind when he suggested that, when diagnosing aphasia, we focus on ability not labels, and his chapter “Aphasia without adjectives” still offers relevant advice 45 years after its publication.

Finally, we must be circumspect with our current conceptualizations and practices. By employing a more sociocultural orientation when focusing on diagnosis and labeling, we can turn our analytic powers to the very contexts and assumptions that we often take for granted when working with labels, so that we can better serve the needs of our clients.

The focus of this chapter has been the process of labeling and how it is impacted by sociocultural processes and how, in turn, our practices are then impacted by the labels that we employ. There is of course much support in the professional literature for the process of labeling. Such support tends to focus on the positive consequences, while downplaying the negative ones. As competent professionals, however, we must consider the potential for both. Certainly, the practicing professional should strive to reduce the negative consequences of labeling whenever possible. As we discussed in an earlier publication (Damico et al., 2004), we need to be able to contextualize a diagnosis or label, and then we should strive to discover the reality behind the label and the individuality of each client’s condition. This will enhance our service delivery in the field of speech and language disorders.