June, Congress has proclaimed, is National Aphasia Awareness Month. We asked neurologist Joseph Safdieh, M.D., a member of our Medical Advisory Board, to explain what it must be like to have this condition—to be unable to turn your ideas into understandable language, or, even worse, to lose the ability both to understand what you hear or to express your thoughts. Dr. Safdieh likens this plight to the quandary of an English speaker in a foreign train station, trying vainly to communicate.—Ed.
Take a moment to imagine how you would feel if you suddenly found yourself standing at a newsstand in a busy Russian train station. Take in the sounds of the conversing commuters and the pictures and the headlines of the various Russian newspapers. What do the sounds and words mean to you? Probably nothing.
Now imagine you try to strike up a conversation in English with a group of passing Russian commuters. You notice the puzzled look on their faces; they know you are saying something, but what you say makes no sense to them because their brains are not adapted to understand English. As you look around and listen to all the Russian conversations happening at a rapid pace, looking at all the indecipherable headlines, you begin to feel somehow less human—you are fully intelligent but are no longer able to use your language skills to participate in society, even though you have no trouble speaking.
This is exactly how someone must feel who has aphasia. Aphasia is defined as a disorder of language caused by neurological problem, most commonly a stroke.
Language is the most recognizable feature that best distinguishes humans from other species. Language function encompasses so much more than just the ability to produce the spoken word. Language allows us to decode what we hear and read into it a meaningful concept—this is known as receptive language. Language also allows us to convert the mental representation of a concept into a word and to convert that word into the actual program that allows us to articulate it—this is known as expressive language.
Language seems pretty seamless to most of us, because the human brain is well adapted to language function. When we hear or read the word rose, the concept of a rose is immediately understood (receptive language) and we can then express what that concept brings to mind (expressive language). In fact, most of us take the ability to comprehend and speak for granted, a gift of nature that has been indispensable in the evolution of human society to what it is today.
At the Russian newsstand, you would be experiencing what a patient with receptive aphasia experiences. Patients with receptive aphasia speak their native language fluently, but their words make no sense and they have no ability to understand the written or spoken word. These patients are otherwise intelligent, but have no way of expressing their thoughts or ideas, nor can they understand what they are asked. I have seen many patients with this condition, and it can be quite frustrating for both the patient and the physician. What is fascinating is that, although the content of the language is meaningless, the prosody of their speech is normal—there are inflections that represent questions and surprise. It seems as if they are speaking sentences using English words, just not in any logical way. Others have used the term “word salad” to describe how this sounds.
The other type of aphasia is expressive aphasia. In this condition, the patient has lost her expressive language center, so she can no longer convert ideas into words, spoken or written. However, and what is very frustrating to the patient, is that she has the full ability to understand everything going on around her. She can decipher written and spoken words, but has no ability to express her thoughts. Unlike a patient with receptive aphasia, who is fluent yet nonsensical, the patient with expressive aphasia is non-fluent, often unable to state even a single word, sometimes even her own name. (Below, Harvey Alter, president of the International Aphasia Movement, reports movingly from the “Country of Aphasia.”)
The encouraging news is that when aphasia is caused by a stroke or a brain tumor, it often improves over time. Intensive speech therapy by a licensed speech therapist is critically important, as is significant patience by the patient and her caregivers. It is critical to remember that by definition, patients with aphasia have normal intelligence and should be included fully as members of the family structure. Just like a newborn learning a brand new language in a brand new world, patients with aphasia need to be retaught how to speak, and they can make remarkable strides with the appropriate resources.