Fluency disorders and life quality: Subjective wellbeing vs. health-related quality of life
Introduction
Do people with verbal fluency disorders experience lower life quality because of their condition? It would seem to an observer that this must be so. The condition clearly creates difficulties in communication and therefore must be a burden. Curiously, however, the empirical literature is not clear-cut. The purpose of this chapter is to explore the reasons for this inconsistency and to suggest a way forward that might shed more determined light on the issue. First, however, I will begin with a description of the life quality construct and its measurement. Confusion at this basic level is to blame for the generally poor state of research on life quality in this and other applied areas.
The most important source of confusion arises from discipline-specific notions about how to represent the quality of life (QOL) construct. In particular, a schism has developed between medicine and the social sciences. Within the social sciences life quality is represented by the global construct of Subjective Wellbeing, which is essentially positive mood. Within medicine, on the other hand, Health-related quality of life (HRQOL) is defined as having multiple domains, most of which are negative constructs of health.
These are very different conceptions as to what constitutes life quality. Thus, understanding each perspective is essential to evaluate QOL studies pertaining to fluency disorders. So the first two sections of this paper will examine these two disciplinary views of life quality. Following this, the empirical literature pertaining to this area will be examined.
Section snippets
Subjective wellbeing
The term Subjective Wellbeing (SWB) has been adopted by the scientific community to avoid the word ‘happiness’. Like so many English words, the word is bothersome in having more than one meaning. To most people happiness means a fleeting emotion attached to a nice experience. Like a cup of tea on a hot day, or resting after a job well done. But SWB research concerns something different.
The form of happiness that accompanies SWB is a mood, rather than an emotion. Whereas emotions are fleeting,
Subjective wellbeing homeostasis
The theory of Subjective Wellbeing Homeostasis proposes that, in a manner analogous to the homeostatic maintenance of body temperature, SWB is actively controlled and maintained (Cummins, 1995, Cummins, 2010). This homeostatic process attempts to maintain a normal sense of wellbeing, which is manifest as a generalized, rather abstract and positive view of the self. This self-view is exemplified by responses to the classic question “How satisfied are you with your life as a whole?” Given the
Health-related quality of life
Health-related quality of life (HRQOL) is defined by the Food and Drug Administration (2006) as: “A multi-domain concept that represents the patient's overall perception of the impact of an illness and its treatment. A HRQOL measure captures, at a minimum, physical, psychological (including emotional and cognitive), and social functioning.” (p. 31).
The content of HRQOL instruments is generally true to this definition. This is because both the definition and the scale developers have been guided
Fluency disorders and wellbeing
Arguably, one of the most demanding and difficult aspects of life is effective communication between people who are unfamiliar with one another (Mulcahy, Hennessey, Beilby, & Byrnes, 2008). These interactions are not just exchanges about the topic under discussion but also a means for people to get to know one another through the subtly of inferred meaning and mutual sharing of values. Obviously, this process is disrupted when one of the pair has expressive language impairment. Moreover, the
The mechanism of harm
While there are many facets of the harm process, the most obvious is the reduced potential for sharing supportive communications (see Burleson, 2009 for a review) coupled with anxiety attendant to the verbal communication process. Despite some early doubts (Craig, 1994, Menzies et al., 1999, Miller and Watson, 1992, Miller and Watson, 1994), there is a now a general consensus that anxiety is one of the many predisposing, precipitating and persisting factors in stuttering and other fluency
Conclusions and recommendations
I have argued that there are serious problems in using HRQOL scales to assess the impact of fluency disorders. Certainly such instruments yield important information. The medical and psychological symptoms they measure are relevant and useful, but there are caveats. To re-cast symptoms of pathology as ‘life quality’ is to deny the nature of the construct as a potentially positive state. To combine symptoms to form a scale obscures the importance of each symptom, in its own right, as a measure
CONTINUING EDUCATION
Fluency disorders and life quality: Subjective wellbeing vs. health-related quality of life
QUESTIONS
Multiple choice questions
- 1.
The affective content of subjective wellbeing can be characterized as:
- a.
Emotional happiness
- b.
Emotional wellbeing
- c.
Mood happiness
- d.
Mental health
- a.
- 2.
Subjective wellbeing homeostasis implies that people with fluency disorders:
- a.
are likely to have depression
- b.
are likely to have low subjective wellbeing
- c.
are likely to have very low subjective wellbeing
- d.
are likely to have normal subjective
- a.
Acknowledgements
This study was part funded by the Australian Unity. I thank Ann-Marie James for her assistance in the preparation of this manuscript. I also acknowledge with gratitude the insightful comments made on drafts of this manuscript by Alison Gluskie, Wendy Kennedy, Anna Lau, Markus Lorburgs, and Kathy Martindale.
Robert A. Cummins has held a personal chair in Psychology at Deakin University since 1997. He has published widely on the topic of Quality of Life and is regarded as an international authority in this area. He is an editor of the Journal of Happiness Studies.
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Robert A. Cummins has held a personal chair in Psychology at Deakin University since 1997. He has published widely on the topic of Quality of Life and is regarded as an international authority in this area. He is an editor of the Journal of Happiness Studies.