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clever Linda phenomenon
A form of involuntary and unconscious cuing. The term refers to a speech therapist (Linda Wouters) who responded to questions asked of Belgian Rom Houben by guiding Houben's finger to letters on a special touch-screen keyboard. At the time of the first public announcement of the clever Linda phenomenon in November 2009, Houben was 46-years-old and had been paralyzed for 23 years due to a brain injury suffered in a car crash. Houben had been diagnosed as being in a persistent vegetative state (PVT) until three years earlier, when Dr. Stephen Laureys, a Belgian neurologist, declared that new tests showed Houben was conscious and had locked-in syndrome. Usually, if a patient with locked-in syndrome can communicate, it is by blinking an eye (or, in Houben's case, moving a toe). [A press release from SKEPP, a Belgian skeptics organization, asserts that "all attempts to establish any form of communication with the patient by detecting and coding minute movements of the eyes or any other body part had failed."] The new diagnosis was the result of Rom's mother's belief that her son was conscious and her persistence in taking him to several clinics over the years for new testing.
Both Dr. Laureys and Linda maintain that she is responding to subtle pressure from Houben's fingers and that she "feels him objecting when she moves his hand toward an incorrect letter."* Video reports show, however, that Linda looks at the keyboard while Rom's eyes are closed, responds very quickly to questions, and moves from letter to letter at a speedy pace. Even a very clever person who had memorized the location of each letter on the board would have a hard time finding any given letter with his eyes closed since there would be no point of reference. Linda is engaging in a practice known as facilitated communication, which has been shown to be a cruel hoax. It should be emphasized that while facilitated communication has been shown to be without scientific merit, practitioners like Linda respond to unconscious cues and should not be accused of conscious fraud without compelling evidence. Self-deception, wishful thinking, communal reinforcement, and confirmation bias, rather than intentional deceit are most likely at work. One cannot help but be moved by the love, devotion, and persistence of Rom's mother.
Dr. Stephen Novella commented after watching a video of Linda and Rom:
We see Linda Wouters, Houben’s “facilitator”, looking intently at the screen and typing away, while Houben looks away with his eyes closed. No one can one-finger type without looking at the screen. Wouters claims to read the subtle cues from Houben’s intent – this despite the fact that clinical exams revealed his hand was completely paralyzed. The video also does not show what Wouters claims – following subtle muscle cues is very difficult, and would require (if at all possible) a gentle touch and some time to zero in on the intent, most likely with some overshooting . Again, what we see in the video is a woman typing very fast and precisely using Houben’s paralyzed hand.
Dr. Laureys claims that he has tested Linda and is confident that she is communicating Rom's thoughts and not her own. Rom's mother also testifies that Linda is really communicating her son's thoughts. [update: Dr. Laureys has since changed his mind. See below.]
Laureys' team showed Houben an object while his aide was taken outside, and when she came back in he was able to write it down correctly, said Prof. Audren Vandaudenhuyse, a colleague of Laureys.
"So all that has been checked and confirmed, so we are sure it is him who is talking," Vanhaudenhuyse said.
Houben's mother, Fina, told the AP her son has been communicating for three years and she believes no one is guiding him.
Dr. Laureys could have eliminated the charge of clever Linda phenomenon by doing a more rigorous test, one that eliminates the possibility of ideomotor action guiding her hand or providing her cues from subtle movements she unconsciously detects in others present. Even horses can pick up subtle cues from people when asked questions. Linda may have been inadvertently cued by those present at the test. Likewise, she may be inadvertently cued when responding to questions while Rom's mother is present.
Had Dr. Laureys wanted to eliminate ideomotor action from the equation rather than confirm his bias, he should have done a different test and at least made some effort to verify that Houben is sending subtle physical signals to Linda. One might think that blindfolding Linda would do the trick, but blindfolds don't always prevent one from seeing, especially if one looks down the sides of one's nose, which is what Linda would be doing. (He sits in a wheelchair while she stands behind and to his right.) Still, if a good method were used to prevent Linda from seeing while Rom guided her hand to letters on the keyboard, that would be a convincing test. Another test would be to put a divider between Rom and Linda, show pictures on each side of the divider, and ask Rom what he sees. If the clever Linda phenomenon is at work, the only time Rom would give a correct answer would be when both he and Linda were shown the same object. If Rom gives a correct answer every time, then Linda is really communicating his thoughts, not her own.
Another test was suggested to me by Conway Redding: put earphones on Houben and Wouters and ask them questions. If the only time Houben answers correctly is when both are asked the same question, then the clever Linda phenomenon would be supported. If Linda answers the question put to Houben rather than to her, then the clever Linda phenomenon would be falsified.
Most journalists and many physicians are not familiar with clever Linda phenomenon, the ideomotor effect, or facilitated communication. For example, the Belgian RTBF network showed Linda responding to a question asked of Rom: "Powerlessness. Utter powerlessness. At first I was angry, then I learned to live with it." A reporter for the Huffington Post wrote that "he" said these things, not Linda. The reporter, Raf Casert even described Rom as "punching the message into the screen during an interview." No mention was made of Linda. A BBC reporter swallowed whole the claim that his "helper" is just a helper. A CBS report stated:
Again, the journalists take it for granted that Houben, not Linda is doing the communicating. While there is no reason to doubt that Dr. Laureys is correct that a PET scan shows Rom's brain is functioning and he is not in a vegetative state, there is every reason to believe that the clever Linda phenomenon is at work in his alleged communication, as this video from CBS clearly shows. Rom appears to be sleeping while Linda types away at the special keyboard.
Here is what his facilitator typed and is being passed on to the unsuspecting world as coming from a brain that has been silent for over two decades:
I am called Rom. I am not dead. The nurses came, they patted me, they sometimes took my hand, and I heard them say "no hope." I meditated, I dreamed my life away--it was all I could do. I don't want to blame anyone--it wouldn't do any good. But I owe my life to my family. Everyone else gave up.
I studied what happened around me as if it were a tiny piece of world drama, the bizarre peculiarities of the other patients in the common room, the entry of the doctors into my room, the gossip of the nurses who were not embarrassed to speak about their boyfriends in front of "the extinct one." That made me an expert on relationships.
One can hardly blame journalists for not understanding clever Linda phenomenon when such luminaries in the medical world as Dr. Sanjay Gupta and Dr. Nancy Snyderman don't get it.
The Associated Press reports that Rom is writing a book "about his experiences."* I'm sure there will be few movies to follow. [update: further tests have revealed that indeed it was the clever Linda phenomenon that was at work in Rom's communicating.]
This Cruel Farce Has To Stop! by James Randi: This is yet another obvious example of abysmal, practiced, purposeful ignorance by medical personnel - including Dr. Snyderman and her staff who prepared this piece. I cannot understand how anyone, professional medical person or layman, can continue to believe that the farce known as "Facilitated Communication" [FC] represents anything other than a fantasy that was begun back in 1977, when an Australian woman named Rosemary Crossley came up with the idea that autistic persons could express their thoughts via a keyboard when their hand was "supported" by what she called a "facilitator."
Another contender for the worst medical reporting ever: "Coma man" by Orac. "Another thing I'm not sure of, having insufficient information to make an informed speculation, is whether Professor Laureys has let himself be duped or whether he's party to some sort of deception. I'm inclined to give him the benefit of the doubt and conclude the former. After all, as James Randi and others have shown time and time again, scientists are among the easiest to fool."
Man in Coma 23 Years – Is He Really Conscious? by Stephen Novella: This is a wonderful story for the media. But to this neurologist, and I would think to any critically-thinking journalist, some questions come to mind. The biggest problem with this case as presented is that the finger-typing of Mr. Houben looks suspiciously like facilitated communication.
The Coma Man Hoax: Rom Houben's "Communication" Is "Ideomotor" Ouija Board Effect by Michael Shermer: Dr. Sanjay Gupta missed it on CNN, Dr. Nancy Snyderman missed it on MSNBC. And neuroscientists untrained in skepticism and the history of facilitated communication all missed it.
Reborn Coma Man’s Words May Be Bogus by Brandon Keim: According to Randi, facilitated communication could only be considered credible if the facilitator didn’t look at the keyboard or screen while supporting Houben’s hand, and helped him type messages in response to questions she had not heard, thus ensuring that Houben’s responses are entirely his own.
Dr. Laureys Responds Regarding Man in Coma by Stephen Novella: The problem is that the communication shown on these videos is simply impossible.
books and articles
Beck, A.R. & Pirovano, C.M. 1996. “Facilitated Communicators’ Performance on a Task of Receptive Language.” Journal of Autism and Developmental Disorders, 26 (5), 497–512.
Eberlin, M., McConnachie, G., Ibel, S., & Volpe, L. 1993. “Facilitated Communication: A Failure to Replicate the Phenomenon.” Journal of Autism and Developmental Disorders, 23 (3), 507–530.
Gorman, Brian J. "Facilitated Communication in America: Eight Years and Counting," in Skeptic, vol. 6 no. 3, 1998.
Mostert, M.P. 2001. “Facilitated Communication Since 1995: A Review of Published Studies.” Journal of Autism and Developmental Disabilities, 31 (3), 287–313.
Regal, R.A., Rooney, J.R., & Wandas, T. 1994. “Facilitated Communication: An Experimental Approach.” Journal of Autism and Developmental Disorders, 24 (3), 345–355.
Simpson, R. L., & Myles, B. S. 1995. “Effectiveness of Facilitated Communication with Children and Youth with Autism.” The Journal of Special Education, 28 (4), 424–439.
An Experimental Analysis of Facilitated Communication by Barbara B. Montee, Raymond G. Miltenberger, and David Wittrock
Several months ago, a man in Belgium named Rom Houben was said to be writing a book more than 20 years after doctors concluded that a car crash had left him in a vegetative state.
Houben had gained international fame for supposedly revealing his innermost thoughts through a technique called facilitated communication.
Now, it looks like those initial reports were wrong.
Houben's neurologist, Dr. Steven Laureys, says a scientific test has shown that his patient cannot answer even simple questions....In the test, the man who was supposed to be writing a novel failed to identify an apple through facilitated communication.
Dr. Laureys Admits Facilitated Communication Failure Unfortunately, is appears that Laureys’ conversion to FC skeptic is not yet complete.