What was going on? A roar of laughter from the aphasia ward, just as the President’s speech was starting, and the patients had all been so eager to hear the President speak.
There he was, the old charmer, the actor with his practiced rhetoric, his histrionics, his emotional appeal—and all the patients were convulsed with laughter. Well, not all: some looked bewildered, some looked outraged, one or two looked apprehensive, but most looked amused. The President is generally thought to be a moving speaker—but he was moving them, apparently, mainly to laughter. What could they be thinking? Were they failing to understand him? Or did they, perhaps, understand him all too well?
It was often said of these patients, who though intelligent had the severest receptive aphasia, rendering them incapable of understanding words as such, that they nonetheless understood most of what was said to them. Their friends, their relatives, the nurses who knew them well, could hardly believe, sometimes, that they were aphasic. This was because, when addressed naturally, they grasped some or most of the meaning. And one does speak “naturally,” naturally.
Thus to demonstrate their aphasia, one had to go to extraordinary lengths, as a neurologist, to speak and behave unnaturally, to remove all the extraverbal cues—tone of voice, intonation, suggestive emphasis or inflection, as well as all visual cues (one’s expressions, one’s gestures, one’s entire, largely unconscious, personal repertoire and posture). One had to remove all of this (which might involve total concealment of one’s person, and total depersonalization of one’s voice, even to use a computerized voice synthesizer) in order to reduce speech to pure words, speech totally devoid of what Frege called “tone-color” (Klangenfarben) or “evocation.” With the most sensitive patients, it was only with such a grossly artificial, mechanical speech, somewhat like that of the computers in Star Trek, that one could be wholly sure of their aphasia.
Why all this? Because speech—natural speech—does not consist of words alone, or (as the English neurologist Hughlings Jackson thought) of “propositions” alone. It consists of utterance—an uttering forth of one’s whole meaning with one’s whole being—the understanding of which involves infinitely more than mere word recognition. This was the clue to aphasiacs’ understanding, even when they might be wholly uncomprehending of words as such. For though the words, the verbal constructions, per se, might convey nothing, spoken language is normally suffused with “tone,” embedded in an expressiveness that transcends the verbal. It is precisely this expressiveness, so deep, so various, so complex, so subtle, that is perfectly preserved in aphasia, though understanding of words be destroyed. Preserved, and often more: preternaturally enhanced.
This too becomes clear, often in the most striking or comic or dramatic way, to all those who work or live closely with aphasiacs: their families or friends or nurses or doctors. At first, perhaps, we see nothing much the matter; and then we see that there has been a great change, almost an inversion, in their understanding of speech. Something has…
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copyright © 1985 Oliver Sacks.