True meanings

The total statement of nonverbal communication gives us the clues on whether a smile is unfriendly or full of merriment

May 1st, 1997

The total statement of nonverbal communication gives us the clues on whether a smile is unfriendly or full of merriment

Heidi Emmerling, RDH, BS

Chin up. Grit your teeth. Keep a stiff upper lip. Bare your teeth. These expressions describe behavioral and emotional states in terms of body language and nonverbal communication. These phrases express emotion, but they also express an action that symbolizes that emotion.

But the meanings of these actions are far from universal. Since, as a hygienist, you are in the smile biz, take something so seemingly simple as a smile. "We all smile in the same language," claim some. However, if you look closely, you realize that you smile at your patients, the dentist, the receptionist, the assistant, your spouse, your children, and your neighbors. And very few times do these smiles have real significance.

A smile becomes an `odd` message

Ray Birdwhistle, the world`s leading authority on kinesics (the study of the meaning of bodily gestures), writes that there is little consistency among those smiles. People from Ohio, Indiana, and Illinois smile more often than those from Massachusetts, New Hampshire, and Maine. The latter smile more than those in western New York. The highest incidence of smiling was in Atlanta, Louisville, Memphis, and Nashville. While it may be perfectly appropriate for a young woman to smile among strangers in Atlanta, such behavior would be highly inappropriate in Buffalo. In one part of the country, an unsmiling person would be asked, "What`s wrong?" In another, a smiling person would be asked, "What`s so funny?" Thus, smiling is not necessarily a natural gesture of expression.

Birdwhistle maintains that the presence of a smile in a particular context can mean pleasure; in another, humor; in others, ridicule; and in still others, friendliness or good manners. Smiles have been seen to indicate doubt, acceptance, equality, or subordination. Smiles occur in situations where insult is intended. In other situations, a smile is a denial of insult.

It is impossible to know what a smile (or any other nonverbal message) means until its context and variability is understood from society to society. You cannot separate the so-called message of the nonverbal code from where it is taking place. Just as spoken language alone will not give you the full meaning of what a person is saying, body language alone will not give you the full meaning.

In order for communication to take place, it must go through what is called a communication model. This model is composed of:

- The sender of the message (you, for example).

- The encoding process (how you present your message).

- The receiver (perhaps your patient).

- The decoding process (how the patient interprets the message).

- The channel (how the message is transmitted: your words, a brochure, a demonstration on a typodont, etc.).

- Feedback (the patient acknowledging to you that he got the message). Nonverbal cues that show your patient is listening to you and you are listening to him facilitates good communication. This often is shown through leaning forward, good eye contact, nodding heads, raising eyebrows, and smiling. However, if one of you leans back and crosses the arms or legs, this could be a signal of disagreement.

In the communication model above, there are two influences: the environment and the noise. The environment is where the communication takes place - usually the operatory, if we`re dealing with patients. This puts limits and constraints on you. Generally, there are certain messages that are and are not appropriate to send in the operatory, based on the unwritten rules of office decorum. For example, you probably wouldn`t raise your voice and yell at a patient.

Noise is anything that interferes with communication. It can be psychological noise (the patient tuning out), physical noise (a patient who is hard of hearing and you wearing a mask), or environmental noise (the handpiece operating in the background).

Nonverbal communication has certain characteristics. First, it exists without any formal education. It is learned through being a member of a certain culture. You don`t go to school, for example, to learn how to stand in an elevator or how close to stand to someone in the checkout line at the grocery store. You learn these rules through observation and, perhaps, by inadvertently breaking them, and then by systematically applying and bending them.

Another point is that you are never not communicating. How you act, what you look like, how you are built, where you are, your clothes, your hair-these are all sending messages and, others, right or wrong, are interpreting these messages.

Nonverbal codes are ambiguous. You always need to look at the context. An umpire raising his finger at a baseball game has a different meaning than someone raising a finger at an auction. Also, the "O" ring symbol in our culture means good or OK. If you do that in France you are telling someone they are worthless since the "O" means zero. In South India or Mexico, the same gesture is an obscenity since it signifies an orifice.

Depending on the context, a fist with a thumb sticking out can mean either thumbing a ride or get lost. The way you sit while you are cleaning the patient`s teeth in the operatory (legs spread, your face within inches of the patient`s) would have a totally different meaning to the patient were you to sit in exactly the same manner in the reception area.

Nonverbal codes are culture-bound. Every culture and subculture has its own codes. Notice the fads and fashions of the "in" crowd for your school-aged patients such as tattoos, piercings, and baggy clothes. In Anglo-American society, women adorn themselves with makeup and jewelry, while it is the men who adorn themselves in Africa. In America, married people wear wedding bands on the fourth finger of the left hand. In China, the middle finger sports the ring. Anglo Americans view staring as rude while the Native American culture sees it as a sign of respect.

When you, your patients, and your co-workers communicate nonverbally, you make use of body language, tone of voice, objects and artifacts, touch, space, time, and smell.

Shrug, tap, rub, slap - what do they mean?

Body language, also known as kinesics, includes posture, movements, and gestures. Some unconscious things people do include lifting an eyebrow in disbelief, rubbing the nose for puzzlement, clasping an arm to isolate and protect, shrugging the shoulders for indifference, winking one eye for intimacy, tapping fingers for impatience and slapping the forehead for forgetfulness.

A physiologic type of body language under the control of the autonomic nervous system is the dilation of the pupil in response to a stimulus perceived as being pleasant. Dr. Ed Hess has found that the pupil of a heterosexual man`s eye becomes twice the size when he sees the picture of a nude woman. Women`s eyes dilate when seeing pictures of nude men and mothers with babies.

Many literary legends tell us that the eyes are the windows of the soul. But, physiologically, they are mere organs of sight. The eyeball shows us nothing but its use. The use of the face around the eyeball is what gives it meaning: the length of the glance, the opening of the eyelids, squinting, etc.

Even without hearing words, gestures convey emotions to others. Dr. Norman Kagan of Michigan State University conducted a study among American deaf people. They were shown clips of people in various situations and asked to guess the emotional states based on the body-language clues and the context of the scene. They found that American people who talked while moving their hands appeared either nervous, embarrassed, or anxious. Eyes and face "coming down" was a sign of guilt. Jerky motions indicated frustration. A shrinking body showed depression. Snapping forward indicated a forceful emotion. Having the head tilted while the fingers doodled showed boredom. An intense gaze with a wrinkled forehead made them think the person was reflective. These perceptions turned out to be accurate.

Regardless of how much gestures can tell us, it is important to remember to look at everything in context. It is impossible to take an isolated body movement and try to extract an exact meaning from it.

Birdwhistle explains that examining gestures is similar to examining language, since gestures are similar to words. Gestures can be combined into simple or complex units, much like words, which then are combined into longer stretches of structured behavior, like sentences or paragraphs. Therefore, gestures are forms that are incapable of standing alone. For example, there is no word "cept" in the English language. You are taught to combine it with "pre," "ex," or "con" to make words. Similarly, gestures require suffixes and prefixes to achieve identity.

Another element of body language is posturing. Lessons in leadership show that most successful leaders are the ones who anticipate the desired action and lead people toward it. Make people do what they want to do. A good leader doesn`t say, "Let`s go shopping" when you are headed to the movies.

Although "rules" for posturing and effective nonverbal communication are too complex for one-sentence prescriptions and "how-to`s," an effective strategy might be to mirror the body movement or the posture of the person to whom you are speaking. Learning to be sensitive to these nonverbal cues that convey support will tend to facilitate communication. You want to gain cooperation from the patient and the patient is seated with her arms crossed? Try sittting down and crossing your arms. Lean in and make eye contact. Smile. She wants to know about the latest in electronic toothbrushes? Don`t go into a dissertation on flossing. Wait till later.

Pampering attractive patients?

Appearances fall under the category of body language. No one can do anything about whether they match society`s ideal of attractive or not. Researchers have found that attractive children get more attention in school and get better grades. Notice how you react to your patients. Are you more tolerant of an attractive person if he is late for appointments or lax with oral hygiene?

Body type and build are actually nonverbal codes. Height is directly correlated with salary in men. Research has shown that men who are 6`2" to 6`4" as a group make the highest salary. The person with the endomorphic body type (short, round) generally is perceived as lazy, greedy, and ignorant. Kids prefer having a handicapped friend over an endomorphic friend. The mesomorphic person (muscular, athletic) is perceived as competent and likable. The ectomorphic build (tall, thin, straight) is the most-favored type in our culture. Women actually prefer thinner builds for themselves than men. Ectomorphs are perceived as cool, serious, and aloof. All these judgments are just on appearance. The actual personality may be quite different. Do your perceptions match these? In order to fight your own or others` perceptions, it is necessary to first be aware that these perceptions exist.

He sounds like the chairman

A second type of nonverbal communication is vocalics or paralinguistics. This is the study of vocal characteristics which includes pitch, rate, inflection, quality, and pronunciation. According to D. W. Addington, author of "The Rela-tionship of Selected Vocal Characteristics to Personality Perceptions," a breathy voice is perceived as young and artistic in males, feminine, pretty, and shallow in females. For both males and females, a flat voice is perceived as sluggish, cold, and withdrawn. Again, for both males and females, a nasal voice conjures up the image of one who is short, lazy, unintelligent, fat, sickly, uninteresting - all socially undesirable traits.

Women who have a tense voice are perceived as being young, emotional, and high-strung, while men are perceived as being old and unyielding. A throaty voice in a male makes one think he is old, realistic, sophisticated, and well adjusted. But in a female, this trait is perceived as unintelligent, lazy, ugly, neurotic, uninteresting and apathetic. Again, compare these perceptions with your own. What is your voice saying? Does it match?

Adorned with status symbols?

Objects and artifacts are concerned with the study of body adornment and possessions. How do you perceive one who arrives at the office driving a red sports car vs. a blue station wagon vs. an oxidized pickup truck? How do you perceive one who wears wool, leather, silk, cotton, or fur vs. the person who wears polyester vs. one who wears clothing with writing on it? A Cartier watch vs. a Timex watch vs. a 20-function digital calculator watch? These artifacts communicate specific messages. Are they accurate?

Examine your own artifacts and clothing. These can be manipulated just like language. If you wear glasses, you may be perceived as serious or scholarly. If you wear white pants or matching scrubs you may be saying that you are one of the "doctor`s girls." If you wear business clothing similar to the dentist`s, you might be conveying a more independent and professional image. One study shows that physicians who dress casually are perceived as less competent than physicians who dress more formally.

A rare case of where touch is OK

Another type of nonverbal communication is haptics, the study of touch. This includes knowing the importance of touch, the message from a touch, and the gender differences in touch.

Kleinke conducted a study by arranging dimes to be placed on the shelves of phone booths in an airport. Men leaving the booths who had found the dime were approached by an experimenter (a female student) who asked if they had found the dime. The female students varied between gazing at the men and touching them. The experimenters found that only touching significantly affected whether men returned the dime.

According to Michael Argyle, author of "The Syntaxes of Bodily Communication," there is relatively little touching outside Anglo-American families except for greetings, farewells, and healthcare. Arabics and Hispanics touch more frequently while British people tend to touch less.

Thus, as a healthcare provider in Anglo-American society, you are in an unusual situation of being in a context where touch is acceptable and appropriate. See the related article for more information on gender differences in the use of touch.

Are you impatient or just greedy?

Chronemics, the study of time, is another category of nonverbal communication. Chronemics looks at the cultural difference in time structure. It also looks at the status and power in time use. Researchers Alexander Gonzalez and Philip Zimbardo have observed that different time perspectives account for much intercultural misunderstanding since different cultures often will value time orientations differently.

The future-oriented person is the patient who usually shows up early, makes appointments in advance, and has the mindset of working for tomorrow`s goals. Since you work on a tight time schedule, you might tend to value this type of person. You might get frustrated with the present-oriented person, the patient who doesn`t worry so much about time, is fatalistic, and who focuses on enjoying today. You might even think of them as being lazy and poorly motivated. On the other hand, these present-oriented people may view those with strong future orientations, perhaps dentists and hygienists, as obsessed with status and greed.

The use of time also can be a marker of status. Keeping others waiting puts one in a "one-up" position. Although they may not like it, many patients anticipate a wait when they arrive to see the dentist.

Marking your territory

The study of how space is used, termed proxemics, is another type of nonverbal communication. It covers territory and personal space. Once I begin a new job, one of the first things I like to do is decorate the operatory, to make it "mine." This is termed "marking" the territory. I place my children`s photos on the counter. I hang up my diplomas, licenses, and perhaps some pictures. I feel uneasy when I am not allowed to decorate.

All staff members in the office have their own "turf." Generally, break rooms, lounges, and sterilization areas are acceptable hangouts for the staff and tend to be off-limits for the doctor to loiter. The doctor probably has his or her private office where you usually do not encroach.

And notice how your dentist arranges the desk in the office. Is it like a throne, where the only possible place for visitors is on the opposite side of the desk? This arrangement reinforces the doctor`s sense of control. Another arrangement is having one side of the desk touching a wall. This allows for more informal and personal encounters. Sitting side-on to the door is another option. This arrangement allows for even more informality and ease of approach.

Although some manipulation of nonverbal communication and territorial use of space is iffy, it is interesting to experiment. For example, notice that at staff meetings, each person usually has claimed her or his "spot." If you have unspoken rules of where each person sits, just for fun, see what happens if you sit in someone else`s spot.

Want more interaction at staff meetings or encourage conversation in the reception area? Instead of having the chairs all lined up against the wall, try circling the chairs around a table. Another experiment to try: When having lunch with a friend, colleague, or employer, try arranging your placemat and tableware three-quarters of the way across the table. Mentally, people tend to share the table 50/50. If you encroach into the other person`s turf, she will more than likely become uncomfortable and squirm a little but not know why.

Drs. Edward T. Hall and Mildred Reed Hall, pioneers in the study of nonverbal communication, coined the term proxemics to describe these theories about zones of territory and how we use them. The four different zones are:

- The "intimate" zone ranges from actual physical contact to six to eight inches. This is the distance in which you generally operate with your patients. At this distance you and the patient are overwhelmed by sensory input - body heat, tactile stimulation, fragrance, even the sound of breathing. Even at the far phase, you still are within easy touching distance. In few other situations is this intimate distance in public acceptable.

- The second zone is the "personal distance." The close range is 11/2 to 21/2 feet. Couples usually stand at this distance in public. If another tries to move into this space, one or both of the members of the couple might become disturbed. The far distance is 21/2 to 4 feet. This is described as keeping someone at arm`s length and is the most common spacing used when conversing.

- The third zone is the "social distance," the general distance used during business transactions, such as the patient with the receptionist or, perhaps, you and the repair technicians. People who work together tend to use the closer distance of 4 to 7 feet.

You also use this distance for conversing at social gatherings. To stand at this distance from someone who is seated (employer to employee, hygienist to patient) has a dominating effect. The far phase of this zone is 7 to 12 feet. This distance lends a formal tone to business or social discourse. In the doctor`s private office, the desk serves to keep people at this distance.

- The fourth zone is the "public distance" and is used by teachers in classrooms or speakers at public gatherings. The farthest phase is 25 feet and beyond.

Pheromones fragrantly fill the air

The final category of nonverbal communication is the olfactory code, or the study of smells. Patients often complain about the smell of the dental office. Some claim just the smells alone in the dental office trigger a nervous reaction. For this reason some offices try to mask the smell with potpourri, hot cider, freshly-brewed coffee, or popcorn.

In animals, scent often serves to replace spoken language. It helps animals recognize mates, give alarm warnings, mark territory, and signal interest. However, personal odor is something people rarely talk about. Not only does the absence of consciously objectionable odors contribute to a person`s attractiveness, so do positive chemical messages of which you may be unaware. Odors that stem from poor personal cleanliness are considered unattractive in all cultures, even though ideas of what constitutes visual attractiveness differ considerably.

According to Dr. Peter Marsh, lecturer in psychology at Oxford Polytechnic and author of the book, Eye to Eye, throughout the world the only criteria common to notions of the physically attractive woman are lack of disease and a clean skin.

What is known about breath odors? An experiment conducted at the University of Pennsylvania showed that both male and female subjects could guess with 95 percent accuracy the gender of others from their breath, which was exhaled down a tube. Both genders found it easier to identify the breath of the opposite gender, and male odors were generally found to be more intense and unpleasant than those of females.

Undetectable scents called pheromones are released by apocrine glands when emotions are aroused, and, in turn, they affect the emotions of those you are with. If you look dangerous, the pheromones you release may heighten their fear. If you look attractive, pheromones may excite them. Experiments have suggested that women, without being able to explain why, are more attracted to men who have applied a pheromone chemical spray.

In one study, a seat in a dentist?s reception room was sprayed with pheromone, while others were left untouched. It was found that women were much more likely to sit on the sprayed seat even though it had previously been rather unpopular. Men, on the other hand, tended to avoid it completely. I?ll let you ponder the ethics of the study, but the results are, nevertheless, interesting.

As you have seen, one nonverbal cue can have many meanings. Conversely, a variety of nonverbal cues can have the same meaning. Thus, it is always important to interpret the meaning within the specific context. People who understand nonverbal communication and can relate them to emotional states of people can stay a step ahead. This requires careful observation. The body has rich and diverse expressive resources.

So, go ahead. Hold the glance of a stranger for a fraction longer than necessary and see what happens. Steal your colleague?s chair. Hog the table at lunch. You could either be in for a rude experience or have a terrific experience. Start playing the game of body language consciously. Bend a few rules and see what happens. You may be surprised, frightened, or amused. But never bored.

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