Prior to uttering, I seem to have a clear intention, and usually the utterance begins well enough, often with the subject noun phrase or even as far as the verb, but things get tricky for a variety of grammatical complexities: tense, agreement, agent/patient either in the verb or the perspective from the noun phrases, conflated homonymies, compound tenses, syncopated words, switched part of speech category.
Once I begin recording my telephone conversations, I expect all these will be much clearer. Meanwhile, I’d like to offer a few of observations, following a comment on the previous post.
It seems to me that there are several slips between mind and mouth. At the beginning of the stroke, I experienced loss of grammatical comprehension. I understood a single word, “hello,” but I could not understand sentences. I also could not understand the sentences I uttered. This is a classic Wernicke’s syndrome: fluency without comprehension.
In addition, my thoughts were clear, so that I understood that I could not understand my own words. That is, I were was not confused by my utterances — I was quite clear that I plainly and unequivocally didn’t understand them, so plain, that I chose to stop uttering sentences altogether: I didn’t want to lose control of speech and state anything misleading.
Oddly, as I have recovered, the stubborn deficits remain in grammar, a classic Broca’s syndrome. With more time, I recognize the specific losses, and all of them are grammatical, with the single exception of frequent tip-of-the-tongue.
I take [it] that the mind can be confused in thought or intention; the resulting speech can reflect mental confusion, in which case this is not really linguistic aphasia, but a problem of cognitive or mental deficit. If the mental damage were repaired, presumably speech would resolve with no other problem or effort.
Or, the mind can be confused, but speech remains fluent, in which case there is a disconnect between the language faculty and the mind. In this case, if the mental confusion were repaired, the language problem would presumably remain. This is a classic Wernicke’s syndrome: regardless of the mental clarity, the speech is fluently irrelevant.
Wernicke’s is the oddball of aphasia. How can utterances be fluent and yet void of thought? How can you speak grammatically without any idea or intention? In my case, during the early moments of the stroke, I had intentions, but as I began to speak, not being able to comprehend the words I heard, the utterances seemed to take on a character of their own. In other words, it seemed to me that the problem was a simple issue of lack of language comprehension, including the words I heard. This implies that part of language ability is listening oneself.
To flesh out the implication in sequence: there is an intention in the mind which impells the beginning of a sentential utterance, the speaker monitors the utterance and then continues the utterance based on self-listening. In my case, the sentence was derailed as soon as I couldn’t monitor.
That doesn’t explain how fluency might continue beyond the first derailing. So this is not a complete explanation.
Another type: the mind is inchoate but, as the speaker begins to talk, ideas congeal along the words. I have trouble understanding this syndrome. How can the mouth direct mental intention? It seems not so much a chicken & egg problem as just no chicken. And yet, Wernicke’s aphasia bears a similarity: fluent speech but no ideas.
Yet another: the mind can be confused and the speech is also confused, but for independent causes.
Alternatively, the mind can be clear but speech is confused by loss of memory. That’s not strictly a language deficit, just a memory problem.
Or, the mind can be clear, but speech is confused by grammar loss. That’s me.
aphasic diary 
January 18, 2010 at 5:32 pm |
My best understanding of how sentences are constructed is inspired by the Japanese manufacturing strategy called “Just in time”. The concept is that instead of stockpiling an inventory of parts, the parts arrive “just in time” to be installed in the product. I think that sentence construction happens in a similar way. It begins in Broca’s area. Broca’s area selects a sentence or phrase form that will express the idea in mind. How the phrase form is selected is a whole other topic, but the pragmatic context and an individual’s customary way of speaking play a part. Once the phrase form is selected, the sentence begins. The substantive words arrive “just in time” as the sentence is being constructed. For example in the sentence, “I’ll pick up eggs after work”, the sentence form is “I’ll” + verb form + object + grammatical form of plural + preposition of time + event. (I’m not a linguist, so perhaps this is not stated exactly correctly, but just to give an idea.) As the sentence progresses, the substantive words arrive from Wernicke’s area and are inserted with their correct grammatical forms for the sentence. We can begin speaking as soon as the initial part of the sentence is formulated. This is how we can begin to speak a sentence, but in the middle of the sentence suddenly stop, because the word did not arrive when it was supposed to from Wernicke’s area, causing the whole “assembly line” to come to a halt. What I think happens in Wernicke’s aphasia is that the whole process is working correctly except that when the call goes to the Wernicke’s area for the correct word, an incorrect word is selected. So the speech is fluent, but has decreased meaning to the listener. Sometimes the process is only slightly off, so the error is close to the target word. Other times the error is so far off that the word that comes up is totally unrelated or even a neologism. So the speech is not actually “void of thought”. The thought is perfectly clear, it is just the execution that is flawed. Wernicke’s area does not seem to be available for self-monitoring. For example, normal speakers occasionally make a word choice that is incorrect and are not aware of it until it is pointed out by the listener. However, the final sentence output is available for self-monitoring when one chooses. I think you were monitoring more than most people would, because you are so aware of the implications. If a person is not aware that they have a problem, they might not be self-monitoring. Thus they could continue to speak even if it is not making sense. You could not keep speaking because you were self-monitoring. Kind of like an internal “delayed feedback” interfering with speech production. I am not sure about comprehension in Wernicke’s. The classic view is that comprehension is impaired in Wernicke’s. However, in the few people with Wernicke’s that I have seen, it seems that they do understand the intent of the other person, because the response is in the ball park. If the question is “What kind of work did you do?”, they will not try to tell you want they had for breakfast. They obviously are trying to say something about their work. I do not know how you could disentangle the internal comprehension from the errors in output. Retrieval of a word for speech production purposes could very well be a different process than retrieval of a word for comprehension purposes.
January 18, 2010 at 5:40 pm |
This is a separate reply for the Broca’s issues. It seems that initially the sentence would enter your ear and go through analysis into phonetic and phonemic units, and then would retrieve the correct word that was heard. However, when the sentence was sent over to Broca’s area for grammatical analysis, there was a break down somewhere. Whether ti was actually in Broca’s area or whether it was the transmission to Broca’s area is unclear. By any chance did you have an MRI? It would be a useful contribution to the literature to have your subjective insight combined with the external evidence of an MRI.
It seems that problem has decreased to a sentence assembly problem, e.g., inserting the correct grammatical forms into the final sentence “product”. I’m very happy for you that the language difficulty seems to be receding and that you are recovering quickly.
January 18, 2010 at 10:10 pm |
I did have an MRI, but I have not seen the test itself and won’t see the neurologist again until mid February. The MRI indicated that Wernicke’s was affected and a large expanse of the frontal cortex, which would have included Broca’s. The neurologist seemed to diagnose Wernicke’s aphasia, but she hadn’t had a chance to observe my speech first hand.