Authentic first person accounts of strokes that destroy access to language are very rare. Jill Bolte Taylor‘s memoir gives a retrospective impression of what it was like to exit and re-enter non-verbal and verbal worlds, although there is an element of reconstruction in this later version of the first hours after her bleed. The Man Who Lost His Language is the next best thing to a first-hand account. It is a description and analysis of dysphasia by a partner and closest carer, who observed The Man’s stroke and subsequent rehabilitation and years after the stroke. The man in this case is John Hale, an exceptional individual, blessed with a rich knowledge and experience of Renaissance art and civilisation, with a historian’s ability to read and master multiple data sources, and with strong abilities in the fields of communication, mime and acting. All of this is highly relevant for how he coped with his profound dysphasia.
Sheila Hale is a very intelligent commentator on her husband’s language problems, an acute observer and an author in her own right, able to summarise and critique the literature on aphasia, with pronounced opinions about the short-comings of current therapy, particularly with regard to funding, access, and its importance on the medical agenda.
John Hale had his stroke in July 1992, moving from the initial acute hospital to a N. London geriatric hospital in the September, and then to a rehabilitation home in November, staying there until April 1993. Speech therapy at home continued for a while, until Sheila found a specialist therapist in Cambridge who they travelled to see for regular sessions from Autumn 1993 until October 1996. John Hale died in August 1999. The book recounting all this relies in part on Sheila’s journals, but seems to have been a retrospective reconstruction, begun with John’s encouragement in 1998, and first published in 2002.
Hale’s profound aphasia left him unable to speak and initially unable to read. His experience as an actor however, enabled him to communicate using gesture and tone of voice. With intensive speech therapy, he rediscovered the ability to read, and even to utter a small vocabulary of useful words. The final chapters of the book give some examples of the few lines that he was able to prepare and write for postcards. One of the fascinating aspect of aphasia is the importance of the social aspects of communication, which means that there is often great uncertainty about how much is being understood through language alone. It would appear that Hale’s ability to participate in conversation masked some of his linguistic losses, which the therapists always rated as more profound than Sheila sometimes recognised.
There are fascinating vignettes focussing on particular aspects of linguistics, such as the role of verbs in sentences which John initially seemed incapable of grasping. With a great deal of effort and practice he appears to have reincorporated or re-found the concept, whereupon reading suddenly became possible again.
More immediate are the descriptions of Sheila’s frustration and even anger as she struggled to cope with the misunderstandings, and loss of closeness. The story of gradual changes and slow adjustment to a new routine – alongside efforts to change and improve – is beautifully and movingly told.
All clinicians should read the cautionary tale of John and Sheila’s treatment in the local acute hospital, immediately after his stroke, especially by the consultant in charge (chapter 4 ‘Hell’). The chapters on Aphasia, the nature of aphasia, its history, its assessment, and the different approaches to treatment are invaluable for those interested. In particular Chapter 6 ‘Vermeer’ describes John’s first attempts to write – the words that came, with such effort, were not common or garden words but the names of Renaissance artists. The chapter on John’s aphasia, and how he responded to therapy (chapter 13 ‘Cambridge’) is short but remarkable, and not to be missed. Chapter 14 (‘John’s Days’) is a lovely affectionate description of how John was able to cope with such language as he was able to access, in conjunction with his other communication skills, to conduct his everyday life and maintain a social life.
There is much in this book to enjoy, although slow readers may wish to concentrate on particular sections suggested above. As a loving narrative of how a person (and his closest friends) cope with the abrupt loss of language, it is unsurpassed.
Sheila Hale (2002) The Man Who Lost His Language, London, Allen Lane