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 gone, been devastated, it is true—but something has come in its stead, has been immensely enhanced, so that, at least with emotionally laden utterance, the meaning may be fully grasped even when every word is missed. This, in our species Homo loquens, seems almost an inversion of the usual order of things; an inversion, and perhaps a reversion too, to something more primitive and elemental. And this perhaps is why Hughlings Jackson compared aphasiacs to dogs (a comparison that might outrage both), though when he did this he was chiefly thinking of their linguistic incompetence, rather than their remarkable and almost infallible sensitivity to “tone” and feeling. Henry Head, more sensitive in this regard, speaks of “feeling-tone”* in his treatise Aphasia (1926), and stresses how it is preserved, and often enhanced, in aphasiacs.

Thus the feeling I sometimes have—which all of us who work closely with aphasiacs have—that one cannot lie to an aphasiac. He cannot grasp your words, and so cannot be deceived by them; but what he grasps he grasps with infallible precision, namely the expression that goes with the words, that total, spontaneous, involuntary expressiveness which can never be simulated or faked, as words alone can, all too easily.

We recognize this with dogs, and often use them for this purpose—to pick up falsehood, or malice, or equivocal intentions, to tell us who can be trusted, who is integral, who makes sense—when we, so susceptible to words, cannot trust our own instincts.

And what dogs can do here, aphasiacs do too, and at a human and immeasurably superior level. “One can lie with the mouth,” Nietzsche writes, “but with the accompanying grimace one nevertheless tells the truth.” To such a grimace, to any falsity or impropriety in bodily appearance or posture, aphasiacs are preternaturally sensitive. And if they cannot see one—this is especially true of our blind aphasiacs—they have an infallible ear for every vocal nuance, the tone, the rhythm, the cadences, the music, the subtlest modulations, inflections, intonations, which can give, or remove, verisimilitude from a man’s voice.


In this, then, lies their power of understanding—understanding, without words, what is authentic or inauthentic. Thus it was the grimaces, the histrionisms, the gestures—and, above all, the tones and cadences of the President’s voice—that rang false for these wordless but immensely sensitive patients. It was to these (for them) most glaring, even grotesque, incongruities and improprieties that my aphasiac patients responded, undeceived and undeceivable by words.

This is why they laughed at the President’s speech.

If one cannot lie to an aphasiac, in view of his special sensitivity to expression and “tone,” how is it, we might ask, with patients—if there are such—who lack any sense of expression and “tone,” while preserving, unchanged, their comprehension for words: patients of an exactly opposite kind? We have a number of such patients, also on the aphasia ward, although technically they do not have aphasia but, instead, a form of agnosia, in particular a so-called tonal agnosia. For such patients, typically, the expressive qualities of voices disappear—their tone, their timbre, their feeling, their entire character—while words (and grammatical constructions) are perfectly understood. Such tonal agnosias (or “atonias”) are associated with disorders of the right temporal lobe of the brain, whereas the aphasias go with disorders of the left temporal lobe.

Among the patients with tonal agnosia on our aphasia ward who also listened to the President’s speech was Edith D., with a glioma in her right temporal lobe. A former English teacher and poet of some repute, with an exceptional feeling for language, and strong powers of analysis and expression, Edith was able to articulate the opposite situation—how the President’s speech sounded to someone with tonal agnosia. Edith could no longer tell if a voice was angry, cheerful, sad—whatever. Since voices now lacked expression, she had to look at people’s faces, their postures and movements when they talked, and found herself doing so with a care, an intensity I had never seen her do before. But this, it so happened, was also limited, because she had a malignant glaucoma and was rapidly losing her sight too.

What she then found she had to do was to pay extreme attention to the exactness of words and word use, and to insist that those around her did just the same. She could less and less follow loose speech or slang—speech of an allusive or emotional kind—and more and more required of her interlocutors that they speak prose, “proper words in proper places.” Prose might, she found, compensate, in some degree, for lack of perceived tone or feeling.

In this way she was able to preserve, even enhance, the use of “expressive” speech (to use Frege’s distinction), in which meaning is largely given by the apt choice and reference of words, despite being more and more lost with “evocative” speech, where meaning is largely given in the use and sense of tone.

Edith also listened, stony-faced, to the President’s speech, bringing to it a strange mixture of enhanced and defective perceptions—precisely the opposite mixture from those of our aphasiacs. It did not move her—no speech now moved her—and all that was evocative, genuine or false, completely passed her by. Deprived of emotional reaction, was she then transported or taken in? By no means. “He is not cogent,” she said. “He does not speak good prose. His word use is improper. Either he is brain-damaged, or he has something to conceal.” Thus the President’s speech did not work for Edith either, owing to her enhanced sense of formal language use, propriety as prose, any more than it worked for our aphasiacs, with their word-deafness but enhanced sense of tone.

Here then was the paradoxical possibility raised by the President’s speech. That a good many normal people, aided, doubtless, by their wish to be fooled, were indeed well and truly fooled (“Populus vult decipi, ergo decipiatur“). And so cunningly was deceptive word use combined with deceptive tone, that it was the brain-damaged who remained undeceived.

copyright © 1985 Oliver Sacks.

This Issue

August 15, 1985