The original source of US-based facilitated communication is the Australia-based Rosemary Crossley. In 1989, Douglas Biklen visited her clinic, and was so impressed by FC’s efficacy there that he took it back to upstate New York. It’s therefore not surprising to encounter in Crossley’s book Speechless: Facilitating Communication for People Without Voices, published in 1997, many of the justifications for FC that we continue to hear to this day.
Speechless recounts Crossley’s work facilitating the communication by typing of an assortment of individuals with minimal speaking skills, from victims of traumatic brain injury, encephalitis, and untreated PKU, to individuals with cerebral palsy, Down Syndrome, Rett Syndrome, and autism. While some of these people type via head pointers (pointing rods mounted on head bands), most use an extended index finger, and most require support at the wrist, forearm, elbow, shoulder or sleeve while typing.
Early on in Speechless, Crossley explains the various reasons why un-facilitated communication may in some cases not be possible:
- Deficient or unreliable speech
- An inability to point independently and reliably (ruling out independent typing
- Insufficient head control (ruling out typing by head pointing)
- Insufficient control over eye gaze (ruling out “eye typing”— selecting letters via eye tracker)
- Lack of sufficiently clear signals from muscles (ruling out communication devices of the sort used by Steven Hawking)
- Lack of sufficiently clear signals from the brain (ruling out communication via myelo-electric switches).
One question I had, going over this list, is whether—except in cases of extreme paralysis—there is anyone for whom all the above is true, and yet for whom language is still possible: someone who is still capable, that is, of engaging in the sort of propositional, subject-verb-object thinking that is the mental basis for linguistic communication. There is, after all, no a priori reason to think that all brains are intact enough to formulate such thoughts.
As for the arguments justifying physical intervention during typing, the following list emerges from Crossley’s case studies:
- The arm is too weak, or the muscle tone too low, to sustain typing without support
- Difficulty with finger isolation requires the hand to be molded and the non-pointing fingers held back
- A tremor in the arm or finger, or the trunk of a body, requires stabilization
- A tendency to perseverate, i.e. to get stuck on a certain letter or letter sequence, requires typing to be slowed or interrupted by physical resistance
- Difficulty with bodily awareness requires tactile feedback
- Difficulty maintaining focus requires physical prompts
- A need for moral support requires a hand on the thigh or shoulder
And (my personal favorite)
- A failure to look at the keyboard requires the facilitator to “make sure that the Communicator was in the right position in regard to [the client’s] hand.” (Crossley claims to have successfully weaned the girl in question off of this particular form of facilitation. One is left wondering, however, why the keyboard wasn’t stationary in the first place, and how, even if it is stationary, one could accurately hunt and peck without looking at it. In fact, later in the book, Crossley contradicts herself and says that such accuracy is in fact not possible).
Where autism is concerned, reasons 4-7 are reasons we continue to hear, even for more recent versions of FC like Rapid Prompting.
Other ways in which Crossley’s facilitatees of the 1980s and 1990s resemble those undergoing modern FC in 21st century America include: difficulty controlling bodily movements (“my muscles wouldn’t let me… open the door”; but raiding the sugar bowl is another matter); difficulty inhibiting persevative responses (“I want to stop talking”); inability or unwillingness to respond reliably to basic demands; inability to initiate actions; need for prompting; and speech, even when there’s no apraxia, that’s far less communicative, grammatically correct, and sophisticated than typing. Some are said to have word-retrieval difficulties when they speak, but not when they type (typing gives you more time to think, explains Crossley). One individual types the correct answer while pronouncing the wrong one. Some are said to have motor sequencing difficulties that prevent them, say, from cooking a meal, but not from typing the sequential letters of a sentence. Some only produce repetitive phrases when typing independently, but, when facilitated, type out sentences that are fully communicative. One, with someone’s hand on her leg, is “calm and focused, and her output made sense and was appropriate to the situation”; if that hand is removed “she became tense, her typing speeded up, and her output was like her speech—strings of recognizable words with no discernible meaning.”
Once again, as when reading Biklen, we wonder about simpler explanations for these phenomena: lack of comprehension and conceptual understanding of what one is supposed to do; expressive skills that are limited to echoic, perseverative or formulaic phrases; typed communications that are authored, not by the facilitatees, but by their facilitators.
But Crossley is certain that “most people, whatever their diagnosis, can use complex language,” and that her patients are the authors of the messages they type. Everyone else—the experts who question her, the hospital that dismisses her, the clients who stop coming after their children develop functional speech, and society in general—is blinded by long-standing stereotypes of disability into drastically underestimating people’s intellectual skills. This, despite the failure of two out of three of her clients, as she reports, to pass the “laboratory-style” message-passing tests administered by the Victoria’s Intellectual Disability Review Panel. (Three different clients, she claims, all passed a more naturalistic test; it’s unclear from Crossley’s description whether the facilitators were as blinded as they were in the first test).
Crossley reports that some of her clients have graduated to independent typing. As with the contributors to Biklen’s book, however, they still appear to do so by hunting and pecking. The slowness of such typing, Crossley explains, helps break the patterns of perseverative typing; it’s also much easier to cue, even without physical contact, than ten-finger touch typing, let alone handwriting.
In case we’re wondering how her facilitated clients, excluded as they generally were from regular education classes, learned how to spell printed words, Crossley explains that written language is a just another form of language, and that kids pick it up incidentally from the environment, just as they do with spoken language. In today’s world, Crossley explains, children are immersed in signs, magazines, newspapers, and, most importantly, advertisements and food packages that regularly combine words with pictures. Even a child with no interest in books, Crossley assures us, will “get a reading lesson” “every time she opens the refrigerator.” Crossley states that one of her clients learned the written word “through” from weekly church services in which he repeatedly opened his hymnbook to the 23rd Psalm and attended to the singing of “through Death’s dark vale”.
Reading scientists, however, are one a different page. They note that the written code, unlike oral language, is a recent invention: an artificial system for which brains have had not time to evolve. In fact, few kids master this code through incidental exposure alone: most require the kind of direct, systematic instruction that is hard to acquire outside of decent regular ed classrooms. (Indeed, if written language, or systematic instruction in it, were easier to acquire, we wouldn’t be having such a reading crisis.)
Only once does Crossley raise concerns about facilitator influence. She does this in the same chapter in which, unlike any other FC proponent I’ve encountered, she dares to mention Clever Hans—the horse who responded to subtle cues that told him when he’d stomped to the correct answer. She claims, however, that similarly subtle cues from a facilitator would be too “crude” to cue accurate letter selection unless the subject (a) already knows enough about spelling patterns and likely next words that she can guess which words she’s being cued to type, and (b) has actively decided to follow the facilitator’s cues.
Crossley proceeds to recount how precisely this happened with one of her clients: an autistic girl named Jill whose facilitators became reluctant to work with her when they sensed that she was reading their minds. Jill, it turned out, was responding to subtle changes in pressure from facilitators’ hands on her knee or shoulder and typing out private thoughts that they were unwittingly cueing. Why was she doing this? Eventually Jill explained it was for laughs—an explanation that also came through facilitated communication. Just because Jill sometimes responded to facilitator cues, Crossley assures us, doesn’t mean that she always does. Indeed, to make sure of this, Crossley and Jill’s mom conducted a impromptu message passing test (naturally, it was a naturalistic, as opposed to a laboratory, sort of test).
The anecdote about Jill leads Crossley to an explanation for the failure of message passing tests in laboratory settings. The testing environment makes subjects anxious; because they’re anxious, they lose confidence about getting the correct answers and therefore turn to their facilitator’s cues for guidance. Apparently that’s why, when they’re shown a picture of a key while the facilitator is shown a picture of a flower, they type “flower” rather than “key.” They somehow aren’t confident that they can correctly identify a key even though, according to Crossley, they must be quite literate–knowing enough about spelling regularities and word patterns to be able to interpret what Crossley claims must be “crude” cues and type “flower” instead.
These ruminations segue naturally into the most tantalizing chapter in the entire book. Entitled “On the Front Line”, it is Crossley’s response to the Frontline documentary Prisoners of Silence, an exposé of FC that made Crossley look like a charlatan. She opens this chapter with a number of hedges about FC—hedges we haven’t seen earlier. She calls FC a temporary remedy for some people; she says it either works or it doesn’t. She complains that it was embraced too uncritically and broadly in the US.—and no, this wasn’t Biklen’s fault, but the fault of a sensationalist, credulous society: one that, in contrast to the more private and less gullible Australians, is more eager to share personal miracle cure stories with the public. The upshot was an explosion of FC around the country and insufficient training for facilitators; large numbers of facilitators who didn’t realize the importance of making sure their charges are looking at the keyboard and, when they aren’t, of giving them feedback about which letters they’ve typed. Crossley cites one case she encounters where the boy is staring at the ceiling while typing “I want to thank you for discovering FC”. This, she says, is not FC, because the boy is clearly not the one communicating. But bogus instances of FC do not make FC bogus.
As for the message-passing tests showcased in the Frontline documentary that so damningly debunked FC, Crossley claims that the facilitators and facilitatees lacked the necessary years of practice, that the facilitators weren’t allowed give feedback by reading the letters out loud, and that the tests eliminated the “predictability and redundancy usual in human communication.”. Like Biklen and Savarese and other FC-proponents, she cites the Cardinal et al (1996) as a better, more naturalistic evaluation of FC.
At no point does Crossley explain why the facilitatees invariably typed “flower” when they were shown a key and their facilitator was shown a flower. Etc.
Nor, for that matter, does any other FC advocate I’ve ever encountered.