Free One Hundred Names for Love: A Memoir by Diane Ackerman Page B

need help. And a speech therapist.”
    Was it true? Did he understand anything I was saying? Could he talk to himself about it—did he still have an inner dialogue? I wasn’t sure.
    The brain usually toils seamlessly, above and below the pond scum of awareness, integrating millions of messages, calculations, appraisals, and updates. To its named owner, it speaks in streams of consciousness, image and back talk, a conversation that runs from birth to death, a voice that wells within us, as if a tailor-made talk show host took the stage each day and spoke only to us. That inner voice feels like an I , but also like an other , an observer. When they think no one is listening, people often narrate their doings in the third person, usually in the idiom of a sportscaster or TV interviewer. While The Tonight Show Starring Johnny Carson reigned, many people admitted to secretly fantasizing about being a guest on the show, silently staging the questions Johnny would ask them and their clever replies.
    And if the brain is scrambled like Paul’s, its bridges burned, its wires crossed, leaving decimated hillocks and gullies? How does a self reassemble itself from the rubble? Does it have to reconstitute its “inner voice”? How does it do that? By digging through the scorched earth for remembered voices? Maybe so, maybe in time they merge.
    With both Broca’s and Wernicke’s aphasia, he had little chance of following everything people said to him. People with Wernicke’s aphasia typically speak in long rambling sentences, or find their normal sentences invaded by lots of extra words, or mint neologisms, or utter gibberish. An example of this was Paul’s saying “You gad clottal to stir the nevis!!!” when he meant: “You’ve got to pay the electric bill.” They don’t understand simple instructions, yet their language may be grammatical, and fluent —strikingly natural in rhythm and tone—but jammed with jargon and gibberish.
    It made sense that Paul had abbreviated what he was feeling to “go home.” People with Broca’s aphasia tend to speak telegraphically in short halting phrases that may make sense but are staged with enormous effort because neurons in the Broca’s region of the brain are important in coordinating the muscles that move the lips, palate, tongue, and vocal cords. And Broca’s aphasia often leads to the frustration of knowing what you want to say without being able to say it. In Wernicke’s, the words tumble out in fits and starts, and sufferers often omit the small linking words “as,” “and,” or “the”; they may also omit parts of verbs. So when Paul said, “Go home,” he meant: “I want to go home.” He might also have meant: “I want you to go home,” or, depending on the context, “I’m losing my home.” If he were only suffering from Broca’s aphasia, he’d understand some of what people were saying to him—enough to know he had a speech problem and to feel horribly frustrated by it. In a way, Wernicke’s is more insidious; you don’t know you’re speaking gibberish.
    People like Paul, doubly stricken with global aphasia, have extensive damage to their language areas, and lose most of their ability to speak and understand language. So this meant that when I, the nurses, or the doctors talked, Paul had two problems: he couldn’t necessarily comprehend what we were saying, and he was unable to find words to respond. For people with such severe aphasia, everything verbal may suddenly vanish from their lives, leaving them only with gestures and facial expressions when they try to communicate. Paralysis of the right face and arm usually accompanies Broca’s aphasia (because the frontal lobe is also important for movement). So Paul’s numb hand, drooping face, and swollen arm were to be expected. And since the left hemisphere stores memories of how to perform skilled acts, I shouldn’t be surprised that he couldn’t remember how to comb his hair. Despite the brain’s