"Nobody understands me!" Few losses are more profound than losing the ability to communicate. Negative feelings—such as frustration, anger, depression, anxiety, and low self-esteem—are common. And such feelings aren’t limited to those with severe speech and language problems. People with milder problems feel the pain as well. “Regardless of where you are on the severity continuum, it can be very distressing,” says Nina Simmons-Mackie, Ph.D., professor and scholar-in-residence at Southeastern Louisiana University. A study in the journal Stroke highlights this point. Researchers wanted to know which factors were related to emotional distress in men who had recently suffered a stroke. Problems with speaking turned out to be the one factor linked to distress both soon after the stroke and six months later. This supports other research showing that stroke survivors are more likely to be depressed if they have communication problems. Pulling Away from Others One reason speech loss is so upsetting is that it cuts you off from other people. Whether the loss is sudden or gradual, “friends tend to drift away,” says Dr. Simmons-Mackie. “You’re not able to do the things you used to do together, because you don’t have the communication to support it.” If your mobility is also impaired, that just adds to the challenge. At the same time, you may have lost some of the roles that once gave your life meaning and purpose. Perhaps you’ve had to quit your job, give up a hobby, or turn over household chores to someone else because you can’t communicate well enough to do these things anymore. Such life changes can be stressful and deeply discouraging. They make a difficult situation even harder to handle. When you do go out, you may be upset by the reactions you get. “People make all kinds of assumptions when you can’t talk,” Dr. Simmons-Mackie says. “They may think you have dementia or a mental illness.” Some people may treat you as if you’re a child or talk to others as if you aren’t there. Most of the time, this type of behavior is motivated by ignorance rather than meanness. But it still hurts—and it may make you feel even more like withdrawing into a shell. Reaching Out for Help Yet it’s important to fight the urge to pull away. Social support helps ward off loneliness and despair. In addition, socializing is one of the best ways to work on your speech and language skills. If you can’t communicate the way you used to, a speech-language pathologist (SLP) can help you find new ways to get your message across. For example, you might use pictures, gestures, or a speech generating device—an electronic device that speaks for you using either prerecorded messages or synthesized speech. A support group is a great place to meet other people who really understand what you’re going through. It also can be a safe, comfortable setting for trying out new communication skills. A patient organization—such as the National Stroke Association ( www.stroke.org), Brain Injury Association of America ( www.biausa.org), or National Aphasia Association ( www.aphasia.org) —may be able to suggest a group in your area. If you have tried these steps and are still feeling distressed, a counselor can offer advice on coping with your emotions. Your doctor, nurse, or SLP may be able to recommend a counselor who has experience helping people with the same communication challenges.