When people think about “commu- nication,” many probably envision people talking to each other. After all, talking is the most common way by which humans communicate with one another. We use words and language, sometimes in complex and elaborate ways.

Using words to communicate is called verbal communication. But using words is just one means of communicating. Nonverbal communi- cation is also important, especially when some- one lacks the capacity to communicate verbally.

New parents become attuned to nonverbal communication when they are caring for infants who do not yet speak (the pre-language stage). Many parents can tell when their babies are hungry, tired, cranky, restless or afraid, just by observing the baby’s behaviors, some of which are obvious, such as a yawn and droopy eyes. Other behaviors are subtler. The baby doesn’t have to say in words, “I’m hungry!” or “I’m tired.” Parents may even develop somewhat of a “second sense” when it comes to their children’s needs and emotions. What may be happening is that they have become particularly effective at reading their children’s nonverbal cues.

Some researchers believe that humans are “hardwired” to read nonverbal cues because that ability has aided in the survival of the human species. They believe that before humans had the ability to communicate using language, they had to be attuned to each other’s nonverbal communication, such as whether a person was angry or afraid or some other emotion. We still possess that ability to “decode” nonverbal cues such as hand gestures, facial expressions, body language, posture and even how we use the space around us, although there may be communication or mental disorders that interfere with this ability.

Dementia-Related Communication

Dementia, such as Alzheimer’s disease, can interfere with a person’s ability to use verbal communication due to changes in how the brain works. Some of the verbal communication challenges include difficulties in finding the right word (anomia); the loss of ability to recognize familiar objects, people, smells, sounds and shapes (agnosia) and the loss of language ability (apha- sia). Adding to the communication difficulties may be an impaired ability to focus or concentrate (attention deficit); partial or total loss of memory (amnesia) and repetitive vocalizations (echolalia). If you are a caregiver to someone who is beyond the early stages of Alzheimer’s disease, you may recognize some of these problems.

Dementia is only one reason a person may have communication challenges. There are many others. People who have had a stroke, for example, may have to re-learn how to use language if the stroke affected a part of the brain that affects language ability. One older woman who was recovering from a stroke and re-learning how
to use language told me a story that she found quite amusing in retrospect.

She was at a restaurant with her husband, who was her caregiver as well as her constant companion. The woman was at a stage in her recovery where she was re-learning words, but sometimes got her words mixed up. She made her way up to the cashier at the restaurant and had intended to ask for a newspaper, but the words came out wrong and instead, she said, “Can I buy a husband?” to the startled cashier.

She could laugh about it later, but having difficulty communicating what you need or want is frustrating. As long as she was with her hus- band, he could help her find the words she was searching for and help her fill in the blanks.

I noticed that he didn’t automatically speak for her. He let her try to answer first, as best as she could, and then aided her when she was truly stumped. (I thought to myself, “No wonder she asked for a husband instead of a newspaper. She had a really good one!”) She said that in her mind, she knew what she wanted to say, but it didn’t always come out that way when she tried to say it.

With Alzheimer’s disease and other dementias, the changes in communication ability may vary from person to person, depending on what stage of the disease a person is in and on the particular way Alzheimer’s is affecting the per- son in question.

The Alzheimer’s Association website lists some of the changes in communication that a person with the disease may exhibit:

1) Using familiar words repeatedly;
2) Inventing new words to describe familiar objects;
3) Easily losing his or her train of thought;
4) Reverting back to a native language;
5) Having difficulty organizing words logically;
6) Speaking less often.

In more advanced stages, a person with Alzheimer’s disease may cease to communicate verbally altogether or only use a handful of words. However, even though a person no lon- ger uses words and language to communicate, they can still react — positively or negatively — to nonverbal communication.

Nonverbal Communication
Imagine yourself in a foreign country where you don’t understand the language. Someone comes up to you and begins speaking in words you do not understand. This person’s voice is loud and shrill, and his or her face looks angry, with glaring eyes and tight lines on the forehead. You don’t need to understand the language to know that the person is not saying something positive to you. You detect the person’s emo- tional state not from words, but from the tone of voice and body language. Oftentimes, you can tell whether a person likes you or doesn’t like you by their nonverbal communication. The sound of a person’s voice conveys a lot of mean- ing. A calm, friendly voice can be reassuring, regardless of what language is being spoken. But the “silent treatment” and the slamming of things — dishes, doors, etc. — also can be a form of communication, as feuding spouses know.

Our tone of voice and body language can convey much about our feelings and emotions. You can say the words, “Are you ready to go?” in a tone that is full of impatience and resentment (add to that an annoyed glance at the wrist watch), or you can say it in way that is simply asking a question. In the first example, the meaning is more along the lines of, “How much longer are you going to keep me waiting? Why aren’t you ready yet? Why do we have to go through this day after day?!”The same words can have different meanings depending on how we say them. We can change the meaning from unfriendly to friendly, or vice versa, without changing the words at all.

People who study nonverbal communication have come up with a variety of points to keep in mind when trying to improve interpersonal rela- tionships and mutual understanding. These can be especially useful when communicating with people who have communication difficulties due to disease, impairments or injuries.

Proxemics has to do with an individual’s perception and use of space. How close you sit or stand next to someone when talking to him or her is part of the study of proxemics. This can be tricky. What constitutes a “comfortable” distance between two people depends on a number of factors, including culture, context and the larger physical environment, as well as personal dif- ferences. Some people do not feel comfortable if someone they don’t know well stands or sits too close to them. There is no “right” distance between you and another person that applies universally to all people. But most people have what is called an “intimate space” — about a foot-and-a-half around the body — that should not be entered by those who are not intimate with the individual unless such physical close- ness is mutually desired.

Someone with advanced dementia may not recognize even close family members and friends – these people have essentially become strangers. So, approaching someone with de- mentia too quickly and entering his or her inti- mate space could scare that person. An effective reader of nonverbal cues should be able to detect whether a person has been made to feel uncom- fortable because his or her intimate space has been violated.

Beyond the intimate space is personal space, beginning around a foot-and-a-half away, which is often a comfortable distance to be away from someone with whom you are not intimate.

These distances should not be taken too literal- ly, of course, and do not require the use of a ruler or tape measure. The main idea is to remember that everyone needs some space and we should try to figure out together how much space is mu- tually comfortable in any given situation.

Haptic Communication
This has to do with physical touch and is another tricky one. Some people may appreciate a light touch to the shoulder or elbow as a physi- cal sign of support and connectedness, especial- ly if they lack this kind of closeness in their lives and desire it. Of course, in Hawai‘i’s local culture, there’s a lot of hugging and physical signs of affection. Still, there are those who do not like to be touched, especially by people they don’t know well. Moreover, dementia may change an individual’s personality such that they may no longer like or tolerate what they once did.

Keep in mind that certain cultures and reli- gions actually do not allow touching between members of the opposite sex unless there is already an acceptable intimate relationship (such as between husband and wife or mother and child). Culturally competent care requires that you avoid touching people if they don’t want to be touched, except in a clinical setting where touch is necessary for medical or nursing care. On the other hand, appropriate touch may be welcome and comforting for a family member or friend who is not able to communicate verbally.

The research on nonverbal communication is fascinating to read because some nonverbal behaviors are particular to certain cultures while others are more universal.

Japan presents an interesting case in point. In some contexts, it is OK for Japanese people to be physically close together, for example, on crowd- ed trains and subway cars. Passengers are often packed in like sardines and endure that level of physical closeness until they reach their desired destination.

However, it is well established that the Japa- nese engage in less public displays of affection than in the United States, although even in
the United States, it may depend on where you are living. Among Japanese adults,

you don’t see much hugging in public, or hand-holding, or arms around shoulders or even longing stares into each other’s eyes. Younger Japanese may engage in this kind of behavior, either because they are influenced by Western culture or are rebelling against Japanese norms, or both. Even the traditional Japanese greeting of bowing rather than shaking hands when meeting someone reveals a certain prefer- ence for less physical touching in public as compared to Italy, France or Argentina, for example.

In the past, Japanese immigrants to Hawai‘i may have consciously, or uncon- sciously, passed along their codes of public behavior to their children and grandchil- dren. Among the current generation of Japanese in Hawai‘i, however, it is becom- ing more difficult to generalize about pub- lic displays of affection.

In certain situations, appropriate and compassionate touch sends an important message that words may not be able to ad- equately convey. For example, holding the hand of someone who is in the active pro- cess of dying, can communicate volumes without many words being exchanged. Sitting silently and holding the hand of a loved one is an expression of devotion and compassion if the gesture is welcome.

“Distractions” and the Environment

The physical environment is important in establishing an effective communication rela- tionship. Eliminating distractions such as a noisy room or a busy hallway can aid in focusing on “soul-to-soul communication,” which is a kind of spiritual connection between two people, re- gardless of whether words are being exchanged. But, sometimes, distractions are not bad. Sitting outside in a park or in some other open setting and observing life going on around you and a friend or family member is almost like watching television, except you are watching real life. You can comment on what is going on. “Remember we used to have a dog that looked like that?” The right setting — the quiet of a private room, or the liveliness of the outdoors — depends on the goal is of being together.

Sometimes, people visiting older adults in institutional settings feel uncomfortable because they run out of things to say after the initial greetings and small talk. It’s perfectly fine to just sit and be together, especially if the older adult is not very communicative. They may just enjoy your company for a while. Or you can look at old photographs, magazine pictures, listen to music, draw, fold origami, sing songs from the past — whatever seems to interest the older per- son, even for a short while.

I remember visiting a psychiatric center where an older woman spent quite a bit of time sitting on the carpeted floor, folding towels. She folded the towels very neatly and put them in perfect stacks in a laundry basket. I asked a nurse about it and she said they found it to be an activity that this older woman actually seemed to enjoy, so they brought her lots of towels to fold. She could do that for hours and be satisfied.

This woman’s cognitive skills were severely diminished, but the caring staff members found an activity that fully engaged her and kept her active. Later, I thought that if I were to visit her in the future, we could just sit on the floor and fold towels together without exchanging too many words.

Some gestures are culture-specific and oth- ers have been found to be more universal. For example, hand gestures such as the “thumbs up” sign, “A-OK” sign or “peace sign” (index
finger and middle finger in a “V” position) may mean one thing in one culture and something very different in another culture. People need to be careful about using hand gestures in other cultures. The famous example is former Presi- dent George H.W. Bush’s “V” sign that he made with his hands when visiting Australia in 1992. He made the sign with his palm facing himself, which has the same connotation as sticking your middle finger out at someone in American culture, although the elder Bush apparently did not realize that at the time.

Other caveats in different cultures include not using the left hand to pass things to people, not patting people on the top of their head, and not thoughtlessly giving or receiving an object of importance with one hand. Japanese business people give and accept a business card with two hands and treat it respectfully, but this non- verbal behavior can also apply to anything of significance, such as a giving or receiving a gift or even when returning change after a purchase.

Other gestures are more universal. Many years of nonverbal communication research have shown that our facial expressions are pretty universal across cultures. People from differ-

ent cultures associate certain emotions with certain facial expressions. Regardless of what culture they belong to, they can identify facial expressions connected with happiness, sadness, fear, disgust and anger. Where culture comes into play is how some people choose to man- age, mask or conceal their real emotions more than those from other cultures. So, even though happiness may be demonstrated in facial expres- sions similarly in different cultures, people from some cultures may be more exuberant in show- ing happiness, while others may try to tone it down a bit, perhaps even covering their happy face with their hands.

Looking at a person’s face, along with other body language, may tell us how a person really feels, even if that person is not able to speak or says something that contradicts their nonverbal communication. For example, a person who does not talk may be showing signs of distress and pain by holding the side of her abdomen and looking very uncomfortable. Or a person who can speak may answer that he is “fine,” but his body language may reveal that he is actually unhappy. Being attuned to the nonverbal signs and cues sensitizes us to a reality that transcends words and language.

Reading the Signs
Whether we realize it or not, most of us are acutely attuned to nonverbal communication, both when interacting with our fellow humans and when interacting with our pets. People with pets learn to read the nonverbal signs demonstrated by their dogs, cats and other animal companions.

A dog’s tail and ears reveal a lot about his emotional state. A cat has her moods and preferences. A change in behavior from the normal routine — such as changes in eating, sleeping and bathroom patterns — signals that something may be wrong.

We can also sense when our human companions are not their normal selves. Chang- es in behavioral patterns — like staying in bed much longer than normal, or losing one’s appetite, or not wanting to do activities once enjoyed — may need to be closely monitored in case they are due to physical or mental illness.

Over the years, cross-cultural and intercultural researchers who have studied communication in Japan have written that, in general, the Japanese culture is a so-called “high-context” culture. In simple terms, this means that in a high-context culture, things are often not explicitly spelled out in direct terms. People in this culture have to rely on social con- text, nonverbal communication, cultural knowledge and the like. In a high-context culture, a person may not say “no” directly to a request, but will respond in a more indirect way. Direct communication may be considered too rough and unrefined in a high-context culture. Here is an example.

A neighbor in Japan asked a professional kimono dresser what she thought of a kimono that had recently been purchased for a young unmarried woman. The kimono dresser didn’t like the look of the kimono, but she did not say so directly. Instead, she said, “Oh! It’s so lively (nigiyaka), isn’t it?”That was her way of saying that she thought it was too “busy” in its color scheme and design. Both sides “saved face” because no one was embarrassed by a direct criticism of the kimono, but the kimono dresser told me that it was her way of communicating her displeasure. While the word nigiyaka is not considered to be negative in most contexts, it could be decoded that way when describing an article of clothing that is somewhat flashy. That is high-context communication. On the other hand, that is what drives people from a low-context culture crazy if they expect direct communication and have to deal with someone from a high-context culture whose comments and nonverbal communication often have to be carefully decoded. If you are incapable of decoding, you may think you are being complimented when, in reality, you are not.

We’re talking about broad generalizations, which means that there are going to be people in every culture who may deviate from their culture’s norms. But knowledge of the gen- eralizations can help when interacting with people from different cultures and trying to understand why they behave as they do. Some people from low-context cultures may come across as rude and insensitive because they just express what they think and feel, while those from high-context cultures may be seen as concealing how they really feel and think. But the reality has more to do with different communication styles, rather than which is better or worse.

The Smile
Regardless of age, culture or gender, a smiling face seems to have the most universal meaning, worldwide. If you see a person smiling at you, or if you smile at a person, or if you smile at each other at the same time, an expert isn’t needed to decode that nonverbal sign. When interacting with people who are no longer verbal or have few verbal skills, remember that they are probably still capable of feelings and emotions. They likely still can decode your nonverbal communication, and in that sense, you can still communicate with someone who no longer uses words or language. Use effective nonverbal communication such as sitting at a comfortable distance, facing the person, making good eye contact, using reassuring touch if appropriate, speaking in a calm and caring voice, showing the person respect and treating him or her with dignity. Effective nonverbal communication can be practiced and improved over time. A good place to begin is with a smile. HH

Kevin Kawamoto is a longtime contributor to the Herald. He teaches at the University of Hawai‘i at Mänoa.


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