I still confuse the verbs “read” and “write,” in part because they alternate between subject and object: the written page is what is read. Normally, the distinction is readily apparent, yet I seem to shift between subject and object frequently. Notice that this is appears [notice the verbal pleonasm — “is appears” — very frequent in my writing post-stroke] at first blush a semantic deficit, although most of the deficits I have noticed have been syntactic, not semantic. This is not isolated: interesting/interested differ from subject (a person is interested in some object) and object (an object is interesting), and I switched these, I believe, twice already within the first week of the stroke.

This post is an account of reading, starting at the first fifteen minutes of the stroke. As soon as I found I couldn’t type a reply to an e-mail — within the first five minutes of awaking from the nap which I count as the moment of the stroke — and I realized that I was more than just groggy from the nap, I went to the book I had been reading recently, Kirkham’s Theories of Truth, a somewhat dense and academic treatment of logic. I looked at exactly where I’d last finished:

“So the central questions in evaluating Dummett’s arguments are

1. Is it the case that one who knows the truth conditions for an undecidable would be able in every circimstance to ascertain its truth value….”

Albeit, this is less than transparent material, but it was no more difficult than the rest of his book, yet I could no longer apprehend a word.

This may have been the moment at which I recognized that I’d had a stroke, however, to be honest, I’m not sure when it had dawned. I had a suspicion when I couldn’t reply an e-mail, and this inability to read may have been the moment of confirmation. I had gone to look at the book in order to confirm that something seriously was amiss. Maybe already I grasped that it was a stroke, or maybe some sense more yet inchoate. The order of actions during the first fifteen minutes are mostly clear, but not absolutely perfectly clear to me. By constrast, the comedy of having to deal with the EMS medics, only about an hour later,  is perfectly clear.

Anyway, this passage from Kirkham became a touchstone for me over the next days. On the fourth day of the stroke, I still could not understand this sentence, but I was able to struggle with its structure and gain a little towards it. By the sixth day, I could comprehend, more or less, with difficulty. Now, two weeks later, I can understand it with the same difficulty as prior to the stroke.

At the hospital, I grabbed an available newspaper — I think it was the New York Daily News — looking at the first article I found. Right away I found it difficult, but I explained to myself that, a) the content must have been written for the familiar, but that it was unfamiliar to me, and, b) it was badly written and sketchily, and, c) difficult to understand simply because the matter itself was stupid.

I looked for another article. I have had the exact same impression. And, of course, I realized that the problem was not the article, but my comprehension.

This is instructive: the mental clarity suggests that there are no problems unless and until impenetrable obstacles are faced. When I first called my associate within the first ten minutes of the stroke, I didn’t understand why he was not responding appropriate. It took me a while before I realized that perhaps he was responding perfectly, intelligently and appropriately, only I couldn’t understand a damned word.

The second night of the stroke, at hospital, I tried to read an article that an ER resident had given me of a six-page Wikipedia print-out on conduction aphasia. I was able to understand a few sentences, but some were completely lost to me. On the second day, I was able to struggle through nearly all of the article. Some sentences puzzled me, for example:

“It has been shown that Broca’s and Wernicke’s aphasias are not due to damage specific to the areas described as Broca’s and Wernicke’s areas.”

At first the sentence seemed completely contradictory: that Broca’s and Wernicke’s were not Broca’s and Wernicke’s. After several minutes and repeats, I came to understand that the aphasias were no longer attributive to the areas themselves. If it weren’t a familair fact from the course I’d taught, I’m sure I would not have been able to made sense of this sentence.

On the fifth day or so, I tried to use reading to help jogging the kind of complex speech that I was accustomed to. Kirkham’s was too difficult and too narrow. I chose instead Thomas Babbington Macaulay and Oscar Wilde. The Wilde had sentences too long and complex, but the Macaulay was an easier target. I found it more than readable — beautiful writing, expressive, intelligent, clear. But it was a text that I had read once before decades ago. To try a new text, I read Lamb’s Dream-children, with understanding and appreciation for its piteousness.

While still struggling over reading, I tried to read my own writing, a complex historical piece on downtown New York. This was easy, because I knew these sentences well, almost by rote. Nevertheless, this was the most complex reading I’d had until that moment, and far beyond anything I’d been able to accomplish.

I also wrote read many e-mails and wrote and rewrite and edit my own replies. If practice helped recovery, I’d guess that e-mail was the most effective means — the attention to sentences focused on language better perhaps than talking, which is so fast and ephemeral. One learns from listening compensation methods — quickly catching up the idea without comprehending the details of grammar. But with e-mail, there is a focused, step-by-step walking through the details and complex agreement and dependencies.

However, it may be that the brain matter would have regenerated or recovery without any practice. I do feel that writing has improved most of all, and speech has not improved as much as I would like. Of all the capacities, grammatical speech seems the laggest, behind writing, listening and reading.

Finally, I found, following the stroke, that I wrote with much greater haste and less concern for perfection and accuracy. A I assume this was an effect of the mood elevation.

2 Responses to “reading”

  1. Dorothy Ross Says:

    Hi Rob, thanks so much for your blog. I was wondering, at this point, does your ability to think of words in your head seem to be normal? That is, can you formulate thoughts in your head normally, even if they don’t come out right when you speak or write? After working with many people with aphasia, I think that is the most important distinction in aphasia, even more important than fluent or nonfluent. Many people tell me that they can think of sentences perfectly in their mind, but when they try to talk it doesn’t come out, or it comes out sounding nonfluent. Others tell me that they have difficulty thinking of words, but once they remember the word, they can say it with no difficulty.

  2. rob Says:

    Fascinating question. I notice several problems: I begin with an idea or response, follow with the beginning of a sentence — maybe just the noun phrase or the subject and verb — but then realize that I am confused with the object or with the verb as related to the object or the subject.

    So I think that I have a prelinguistic whole idea or intention, but lack negotiating the grammatical relations. So, I think “ability to think of words in [my] head” is different from “formulating thoughts in [my] head.” I am not aware in my experience so far of any disconnection between thinking words and speaking words, but I am very much aware of a disconnection between intentions/thoughts and grammatical strings. I always seem to know what I intend to mean (as ideas, but not as words), but my sentences often get jumbled in the course of speaking.

    What kinds of deficits explain the types you have described? If someone has a clear notion of the sentence, but unable to speak it, that suggests a motor problem. But if the notion is not of sentences but a notion of ideas or intentions, then the deficit might be a grammaticality loss or a retrieval or even a memory problem.

    On the other hand, I’m puzzled by the other side you described: an unclear notion that becomes clear as words emerge in speech. It sounds almost like a kind of Wernicke’s aphasia, except with comprehension after the fluent speech flow.

    I have the least to say about speech production and comprehension, since it’s so much easier to look at writing at leisure, while the speech flow is so rapid and ephemeral. But I was about to take a first stab at it tomorrow on the blog!

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