My previous post perhaps didn’t clarify my thoughts well, so I’ll make another attempt here.
Back in February, I (and probably millions of others) listened to a This American Life episode about the intersection of policing and race in the US. I was introduced to the concept of ‘unconscious bias’ or prejudice as being something separate from racism. As I see it, racism is an overt, direct belief in the inferiority of a race or many races (or similarly the superiority of a particular race). Unconscious bias is best illustrated by a quote from the episode attributed to Josh Corell:
For most of us, we would say things like, oh, you know, I like black people. I like black men. I don’t have anything against them. I don’t have any negativity toward them. That’s an explicit report of an attitude.
But it goes through an editing process. When I flash a picture up on a screen and ask you to respond in 630 milliseconds, you don’t have time to edit. It’s like everybody has this gut response that is, oh, black means threat.
You can test yourself on many biases at Project Implicit.
This ‘gut response’ is almost hardwired. Here’s a more relevant example: in class when we were discussing a recorded consultation with a cleft client, I referred to the male in the room as the doctor. I don’t think women can’t be doctors (at least explicitly). Yet my expectation was that the woman in the video couldn’t be the doctor – this was my built-in assumption. As soon as I said “the doctor”, I immediately corrected myself and said to my tutorial full of women “well, he could have been the speech pathologist.”
Unsurprisingly, my colleagues had also assumed that he was the doctor. Just because you belong to the ‘marked’ group (in this case women) does not mean you are free from unconscious bias. Women and men alike share these unconscious bias about what men and women are like, and what they are able to do.
And really, there’s little to be done about addressing this at the source. Instead, I think we should alert people to these unconscious thoughts through experiments (although the surgeon story could probably use a sequel), and make them acknowledge that they exist. The worst option is to pretend that we treat everyone equally, implying that discussions of race, gender or sexuality are off-limits, because “I know I’m not sexist/racist/homophobic”. Several responses to Adrian Bradley’s survey said the following regarding men in SP:
- “Not top priority for SLP, getting right candidate is more important”
- “Attracting the ‘right’ people is more important than their gender.”
These responses reminded me of the ‘women of merit’ argument for Tony Abbot’s male-dominated cabinet upon forming government in 2013. As the argument went, only the right candidates were chosen for cabinet, and it is coincidental that few of the women were the right candidates. Unconscious bias was not acknowledged: instead, we were told that everyone was being treated equally.
What is the right candidate? Could it be for the survey respondents that the qualities that are considered ‘right’ for SP are interwoven with ‘feminine’ qualities? Can you pretend to ignore a person’s race or gender when interviewing them? It is noteworthy that when American orchestras began auditioning musicians behind a screen (i.e. heard but not seen), the number of women in the ranks shot up. Yet I’m certain that any panel member would claim that they were free from gender bias, their unconscious bias may have played a part when they could see the candidate.
In summary, we cannot ignore gender – we must acknowledge it, and the biases that we all carry that come along with it.
The flip-side to unconscious bias is privilege, familiar to most Arts students from the essay ‘White Privilege: unpacking the invisible knapsack’ by Peggy McIntosh. Associate Professor Catriona Elder refers to privilege as “the unconscious, unearned and largely un-examined benefits of prejudice.”
I believe I have experienced privilege. For a case in point, once I left my wallet at a school in South Melbourne accidentally, before travelling to Bundoora by public transport (a long trip!). On the train to Reservoir, I was asked to see proof of my concession. Since I had been on placement, I was dressed in business attire and was reading on my iPad. I could not provide it, and said (rather lamely) that I had lost my wallet but still had my myki. The inspector looked at me for a moment, and walked away.
Of course, the plural of anecdote is not evidence, but I did wonder if I were a female international student from South-East Asia (a common target, as far as I can see) if I would have been simply let off without even a warning. Luckily, there is some evidence as this New York Times article summarises:
As they describe in two working papers, Redzo Mujcic and Paul Frijters, economists at the University of Queensland, trained and assigned 29 young adult testers (from both genders and different ethnic groups) to board public buses in Brisbane and insert an empty fare card into the bus scanner. After the scanner made a loud sound informing the driver that the card did not have enough value, the testers said, “I do not have any money, but I need to get to” a station about 1.2 miles away. (The station varied according to where the testers boarded.)
With more than 1,500 observations, the study uncovered substantial, statistically significant race discrimination. Bus drivers were twice as willing to let white testers ride free as black testers (72 percent versus 36 percent of the time). Bus drivers showed some relative favoritism toward testers who shared their own race, but even black drivers still favored white testers over black testers (allowing free rides 83 percent versus 68 percent of the time).
Male privilege is probably real in speech pathology, but probably only in areas where ‘male’ attributes are valued (e.g. perhaps in management issues concerning money, rather than ‘feminine’ rapport building skills with children). Anecdotally, more men work in adult populations, and are more likely to work in roles that could be construed as ‘technical’ roles rather than ‘care’ roles (I have never met a male speech pathologist who worked in disability, ASD being an important exception).
Once again, the way to combat privilege is to encourage those who benefit from it to acknowledge it, instead of pretending they got where they are solely and completely by their own personal merits.
I volunteered for my university’s open day, talking with prospective students. It was interesting to see almost ten young men approach the Speech Pathology stand to inquire about the course. I remember one prospective student asking me about the role of SPs, and the course content. I related to him a memorable interaction with a client from my acute hospital placement. He was well-informed, correctly inferring that her aphasia was non-fluent – better than your average Year 12 student! However, his mother asked me point-blank: “how many men are in the course?”. I couldn’t lie, out of ~100, there are three, and I am the only local (non-international) student (not that that’s a problem – but it’s an interesting statistic). Also, I am a postgraduate – when my colleagues were in first-year there were two men, one of whom has changed to Audiology. His mother was not impressed. I couldn’t blame her – men like to talk with men on some occasions, and most people would not like the enhanced attention that comes from being the only boy in the room. I tried to sell the positives: the lecturers would always know your name, you would be in high-demand, especially in pediatrics, and since society views men as more competent than women, your career would probably progress faster (this was tongue-in-cheek, but is perhaps true).
I performed a quick ABS search a few months ago, comparing the gender-split in SP to other professions, finding that, in Australia at least, Speech Pathology has perhaps the fifth highest proportion of women. However, when looking at the other side, there are far more professions that have a more extreme gender split favoured towards men (mainly in trades and engineering). It’s nothing new to state that professions that have been historically viewed as feminine (nursing, education, etc.) have large proportions of women, but it is the size of the split in SP that is intriguing.
Here’s a table to compare health practitioners (taken from AHPRA’s Annual Report):
Speech Pathologists aren’t registered with AHPRA, but they would have a similar proportion as the “Nurse and midwife” category.
This week the @wespeechies twitter handle was curated by Adrian Bradley, an Acute clinician from Ireland. He discussed the position of men in the profession, as well as strategies for addressing the gender split.
Is it a problem?
Obviously, there needs to be a benefit to having diversity before we commit to pursuing it. My opinion is that professions with low diversity can lack external credibility. SPs working in all environments face skepticism of their expertise and clinical skills from doctors, teachers, parents, policy-makers (for example see here). Diversity in a profession creates an image separate from the stereotypical associations outsiders may have (the GP as an older man, the nurse as a maternal woman, etc.). SP certainly has an image problem: upon telling a medical intern friend that I was commencing study in SP, he was surprised – his impression was of a lot of petite ladies with high-pitched voices. I have met SPs like this. But the majority that I have met have simply been women – from the country, the city, private schools and public schools. SPs of different ethnicities, some who have completed previous study in medical science, linguistics, psychology, science, education. Some who worked in business and marketing. Certainly beyond the stereotype!
Perhaps one of the issues with the stereotype is socialisation. Through our training, we take on the SP persona, in which our individuality is diminished somewhat. I have been in several settings where I have been told: “we can’t do that here because of X”. X usually involves Other People, who are not SPs (physios, doctors and headmasters are often the culprits here). By enforcing this professional boundary, we lessen diversity.
My ideal professional persona is more consultative than directive. I see myself as someone who has expert knowledge in language, speech, communication and feeding; and who is able to provide expert advice or therapies in consultation with people, their networks (families, friends, colleagues, etc.) in order to help them achieve their goals. To do this, I am more “Team Allied Health” or even “Team Health Care” than “Team Speech”.
Perhaps this comes from belonging to various other groups before entering Speech Pathology (musician, linguist, cooperative director, etc.).
During clinical placements, my gender is seldom mentioned. It was never mentioned on my acute hospital placement, and only once by a nurse on my sub-acute placement (“we’ve never had a male speechie before…”). However, on paediatric placements, whenever I seem to build good rapport with a male client, their parent always says, “it’s because you’re a man.” Perhaps it is, but I’d like to think its because of my skill!
I’ve been told on numerous occasions that clients will seek out a male SP, and that my career will progress faster – “you’ll go straight to management”. While I don’t envisage working solely in clinic for the rest of my career, I’d like to think that any progress I make during in my career would be due to my skill rather than my gender. But how would you know?
This has turned into a rambly sort of post, but these issues are complex and interwoven. The position of women, the position of the profession, and individual factors coalesce – there’s not a simple explanation for the observed phenomena.
The following papers have been referenced a lot in media stories about fry. However, as I show, none of them conclusively prove that fry is new, bad, good, or pathological. The gender difference in fry could be a result of sexual dimorphism (see discussion on Language Log). Given the probably vast speech corpora available, surely it wouldn’t be difficult to improve the state of the literature?
Perceptions of Fry 
This study, reported in a linguistics journal, compared perceptual/acoustic findings from 11 male and 12 female speakers of Californian English (students at UC Berkeley). It found American females using creaky voice twice as often as Japanese females or American males.
For the second part of the study, one voice recording from the first part was selected and presented to 175 college students at UC Berkeley and the University of Iowa, who were asked “what kind of impressions” they had of the woman who produced the voice. About four-fifths of listeners reported recognising the feature (interestingly, 90% in Iowa and 60% in California – the disparity is not discussed). The overwhelming impressions were “professional“, “upwardly mobile” and “urban“. No evidence is presented that vocal fry was the phenomenon the listeners associated with these impressions.
Conclusions: Female college students fry more than male college students. One speaker who uses vocal fry is thought of as sophisticatedly urban. It’s a stretch to say that fry is intrinsically urban or professional.
Prevalence in Young Adult Males & Females [2,3]
In this study, the authors worked from the position that fry is both a pathological sign and present in normal speakers – which renders its clinical utility as part of a perceptual profile a bit suspect, no? The goal of the study was to “quantify the prevalence of vocal fry in a population of young, female, SAE [Standard American English], college students” (p.e112 – my emphasis). The protocol involved sentence reading and vowel production.
That’s five modifiers, but we should add two more: firstly, that the students were all at Long Island University; and secondly, that they consented to appear in this study (volunteer bias). This doesn’t affect the validity of a narrow reading of the results, but often a broad reading is reported. Wolk (the lead author) was quoted as saying “Although it’s not exclusively used by young women, they seem to use verbal fry more frequently than young men or older individuals.” – which I suppose is more sexy than saying “Although it’s not exclusively used by young, female, SAE-speaking, Long Island-residing, college students who consented to be in the study…etc.”
The team found a prevalence of about two-thirds (n=34). In the Discussion they note that “knowledge of the extent of vocal fry usage in college students may have very important long-term consequences for vocal health”, citing Colton’s textbook Understanding Voice Disorders as a reference. While Colton is a fine author and clinician, no evidence is provided in this text for this assertion.
In a follow-up study, the team repeated the protocol with male, SAE-speaking, Long Island University-attending, 18-25 yr old students (n=34), but did not recruit further female students, instead choosing to use the old data. No proportion was reported (“vocal fry was rarely used”).
Conclusions: This doesn’t tell us a lot, other than confirming that female college students fry more than male college students. The judges seemed to have difficulty agreeing on fry (which is a fairly noteworthy feature as my previous post shows). Describing Kappas of 0.48 and 0.49 as “high agreement” seems stretched (The standard reference calls for at least .7 for a “reliable” instrument 
You won’t get a job with Fry 
The PLoS One article which received quite a bit of attention (see Part One of this series). It didn’t begin well, quoting many anecdotal sources as one might quote evidence in an Introduction. 14 speakers (7 male, 7 female) produced the phrase “thank you for considering me for this opportunity” in their “normal tone” and in vocal fry (“mimicking”). These recordings were then presented in random pairs to 800 internet-based listeners who answered questions like “who is more competent?”. The researchers found that the listeners, both male and female, preferred the “normal tones” to fry at a rate greater than chance. The researchers conclude that vocal-fry is perceived negatively, and may result in “negative labor market perceptions”. They also note its prevalence is increasing.
- The fry samples were not real fry but imitation
- The samples did not differ in just fry but also in
- duration of the sentence
- duration of individual words
- perceived vocal effort
- The “normal tone” examples had some fry as well!!! (you can listen to all the stimuli on the PLOS website)
To these I’ll add:
- Nobody would base the decision to hire solely on your voice (except perhaps this person).
- The judges did not work in recruitment.
Conclusions: This paper’s methodological flaws seem fatal to its conclusion. Perhaps we could say people imitating a vocal style they do not use do not sound trustworthy or convincing?
- Yuasa, I. P. (2010). Creaky Voice: A new feminine voice quality for young urban-oriented upwardly mobile American women? American Speech, 85(3), 315-337.
- Wolk, L., Abdelli-Beruh, N. B., & Slavin, D. (2012). Habitual use of vocal fry in young adult female speakers. Journal of Voice, 26(3), e111-e116.
- Abdelli-Beruh, N. B., Wolk, L. & Slavin, D. (2014) Prevalence of vocal fry in young adult male American speakers. Journal of Voice, 28(2), 185-190.
- Landis, J. R., Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics 33:159-174
- Anderson, R. C., Klofstad, C. A., Mayew, W. J., & Venkatachalam, M. (2014). Vocal fry may undermine the success of young women in the labor market. PLoS ONE, 9(5)
‘Vocal fry’ was trending again. This time I picked it up through SPA’s twitter feed:
I hear it every day. At a rough estimate, perhaps 20% of my colleagues at uni use it habitually, and many more at the end of sentences. I even hear myself do it. Here’s my housemate (mid 20s male) doing it:
Across the coverage, several things become apparent:
- It is a BAD thing: “annoying”, “vulgar”, “lazy”, “whiny”, “juvenile”, “shallow”, etc. Lexicon Valley (a supposedly reputable linguistics podcast) host Bob Garfield caused a stir by describing it as “obnoxious”, “repulsive” and “mindless”.
- It is pathological: However, the absence of hard clinical evidence often proves a barrier. So they resort to weasel words: “some doctors say there is a risk they could be doing permanent damage to their vocal chords.” When they do get experts, often they contradict the headlines. So the ENT interviewed by Portland TV network KATU talks (bizarrely enough) about chronic cough causing vocal fry, and the poor SLP interrogated by Channel 3000 can only offer a rephrasing of Titze and Verdolini’s impressive dictum that any vocal behaviour is damaging in excess, and no behaviour is damaging in small enough doses.
- It is socially hazardous: in addition to the paper above, none other than Claudio Milstein, one of the most esteemed voice clinicians in the States, seemed to suggest that fry is a habit that, along with fillers like “you know” and “like”, gives the impression of low intellect (!).
- It is occupationally risky. The study SPA linked to above noted “that young American females should avoid using vocal fry speech in order to maximize labor market opportunities.“
Here’s one of probably thousands comments on the articles mentioned above that illustrates the level of disgust people have for this ‘vocal tic’:
Simply put, it’s just another way to ignore the structural barriers women face to occupational success. People seem unwilling to admit that the barriers are cultural, historical and institutional, and instead seek to blame the women themselves. You didn’t get the job because you used uptalk. Because you used vocal fry. Because you made grammatical errors.
Luckily, there have been a few people to question this dominant narrative. Mark Liberman at Language Log has deconstructed many of the faulty assumptions that underly the above assertions (here’s a list). A voice training business wrote a stirring defense of women’s voices, and here is Amanda Hess’s response to Bob Garfield as referenced above.
(Cover Image by user Managementboy (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons)