The Man Who List His Language tells the story of John Hale, art historian and Chairman of the Trustees of the National Gallery London, who suffered a stroke in 1992 which led to severe aphasia (loss of language). His wife, journalist and travel writer Sheila Hale, tells the story of his illness and partial recovery until his — peaceful — death in 1999.

The book is divided into three parts. The first part tells the story of Hale's stroke and the first experience with treatment of stroke patients in the National Health Service (of Britain). The second part reviews current knowledge on aphasia and the ways to treat aphasia patients. The third part relates the general outline of aphasia in the second part to the specific case of John Hale and his form of aphasia. The second edition contains a new postscript in which Sheila Hale looks at some recent developments in aphasia research and stroke treatment. A short section on 'Useful Addresses' provides contact information for therapy and recovery support groups.

The book (especially its second part) can be read as an introduction to aphasia. Aphasia is one of the well known brain afflictions. Many of us have heard of the Broca and Wernicke areas in the language centre(s) of the brain, discovered more than a century ago. There are, however, not only the variations of language disorders or afflictions that sometimes affect only sentence formation and sometimes only sentence understanding. Language disorders grouped under the title 'aphasia' are much more varied and the variations are fine-grained to an unbelievable degree (e.g. afflicting some word fields in contrast to others). 'It is notoriously difficult to diagnose, describe and treat aphasic symptoms. They change, sometimes from one day to the next' (141). Each patient's aphasia slightly differs.

This again is not only due to the modularized structure of the mind/brain, but also to individual hemispheric specializations for (parts of) language, since aphasia is usually result of a stroke and most strokes affect one of the two hemispheres of the brain. In most aphasics memory for language is retained and thus chances for recovery are real. As manifold as the varieties of aphasia are, however, also the approaches to therapy. They reach from recapturing lost knowledge by training to neurogenesis (growth of new neurons) to substitute for damaged tissue. The difficulty consists not only in our limited knowledge of the mechanisms of aphasia, but also in finding the specific therapy fitting a specific case of aphasia. 'There is no single metatheory of aphasia therapy, no evidence that one school works better than the others, and considerable disagreement about how far one theory or model can guide treatment' (152).

Foremost, however, the book is a personal account of a relative's struggle with the fate, treatment and recovery/therapy chances of a loved one suffering from aphasia.

John Hale's intelligence was not affected by his stroke. He could read books (at an astonishing rate), follow a conversation and travel. 'His semantic understanding of words and pictures was 100 per cent, as was his ability to read and copy upper-case as well as lower-case letters' (166). His loss of language concerned mainly loss of spoken language and writing. (Some additional problems concerned the recovery of wh-facts (who did what when and why to whom) from wh-questions after having read or heard a story.) By therapy and intensive work on composing sentences he partially recovered his writing after some years. His spoken repertoire, although being extended over the years by some eleven simple words like 'bus' and 'horse', consisted of sounds coming close to 'woah dawoah'. The strange element in his aphasia was that he did not realize that he was making senseless sounds. He thought he uttered meaningful sentences delivering his 'woah's in usual prosody and intonation, even accents. This special condition is called 'anosognosia' (meaning a disease related to one's knowledge of being ill). Somebody suffering from anosognosia is blind/deaf to his or her failure in performing usual tasks, like uttering sentences. John Hale by his use of prosody and gesture participated successfully in conversations, but he did not realize that nobody ever got the sentences he believed to have said. It seems that the modules of the mind/brain which are responsible to self-monitoring became decoupled from those responsible to control of voluntary speech, respectively speech recognition. Aphasia work — and especially cases like John Hale's — are thus also interesting to cognitive scientists concerned with the broader architecture of the mind/brain and its modularity. Individual failure of some faculty always indicates its encapsulated nature in connection to similar or related faculties. In John Hale's case evidence was also found that — as was the case with him — loss of 'inner voice' (accompanying or slightly preceding speech as monitoring process) might be responsible for loss of speech, although read or heard words could be understood by him, and he supposedly could conceptualize what he wanted to say. It seems 'intentionality … usually does remain intact in aphasics' (195). John Hale himself insisted that he still thought in language!

There are about two hundred thousand people suffering from aphasia in Britain and about a million in the United States. As people get older and medical techniques get more advanced more people suffer from strokes and live on with some aphasic disorder. Physicians will learn more about the multitude of disorders and (partial) recoveries from aphasia. The problem will increase in medical in political importance. And Sheila Hale's experiences with the British Health system are sobering. She comes to the conclusion 'I do not believe that any society that treats its old and helpless citizens the way they are treated in Britain deserves to call itself civilized' (236). Doctors — often because of being overburdened with work — do not care about stroke patients, even therapists tend to write their recovery chances off too early, it seems. For Britain — and the situation in the United States supposedly is worse — a lot depends on sheer luck with a hospital and personal connections. John Hale lived and partially recovered only because of intensive care by his wife and his friends — and a lot of luck.

The narrative of the individual case is, of course, highly personal. But it also drives forcefully home the message that each aphasia is different and how difficult it is to make generalizations here.

© 2007 Manuel Bremer

Manuel Bremer, Heinrich-Heine-Universität Düsseldorf, Germany

Categories: Psychology