In this article, I investigate the case of a deaf woman, Silivia, who lived in western Uganda. Silivia did not use standardised sign language and was commonly considered to be ‘mad.’ However, some of her interlocutors disagreed, arguing that perceptions of madness arose because those around Silivia did not invest enough in attempting to communicate with her. I use experiential and analytical reflection on the methodological challenges of working with Silivia to explore what difficult moments tell us about how communication and everyday assessments of cognitive function are mutually implicated for deaf people in Uganda. Adopting a theoretical approach that understands languaging as a collective or distributed process, I argue that comprehensibility is not something that is determined by the qualities of a person’s expression, but rather something that happens to and through communication, mediated through social and environmental constraints. These include normative linguistic ideologies and frames of comprehensibility that may encode ableist expectations (for example, that ‘good’ communication is quick and efficient). In this context, I argue, interpretative difficulties that arise in the use of less conventionalised forms of visual languaging make some deaf people particularly subject to stigmatisation.