Hilda Reilly's Blog: The Writing of Guises of Desire - Posts Tagged "aphasia"

"Mrs Pappenheim stopped in the doorway. She saw Bertha’s features crease into fretful petulance, her finger pointing to the untouched breakfast tray lying beside the bed.
‘No voglio petit-déjeuner. Enleve. Tired. Voglio dormir. Ne dors pas noche. Je veux dormir adesso.’
Italian, French, English. Bertha knew all those languages. But why should she want to start speaking them now? And why jumble them all together like this? Mrs Pappenheim clenched her hands and stepped further into the room. ‘Bertha, what’s all this nonsense? Speak German, please.’
‘I am speaking German,’ Bertha said in English. She closed her eyes."
From Guises of Desire by Hilda Reilly

"For alongside of the development of the contractures there appeared a deep-going functional disorganization of her speech. It first became noticeable that she was at a loss to find words, and this difficulty gradually increased. Later she lost her command of grammar and syntax; she no longer conjugated verbs, and eventually she used only infinitives, for the most part incorrectly formed from weak past participles. And she omitted both the definite and indefinite article. In the process of time she became almost completely deprived of words. She put them together laboriously out of four or five languages and became almost unintelligible."
From Studies in Hysteria by Sigmund Freud and Josef Breuer

The disruption of Bertha's speech faculty was undoubtedly complex and it's perhaps not surprising that Breuer was at a loss to explain it in anything other than psychogenic terms. In addition to the difficulties described above, she went on to lose her command of German completely and for a while could speak only in English.
One of the obstacles to arriving at a neurological interpretation of Bertha's symptoms may have been the theory of retrograde amnesia formulated around the same time by French neurologist Theodule Ribot. According to this, any damage to memory areas of the brain would result in newer memories being affected before older ones. Extending this to the language function, it was therefore expected that languages learned later in life would be affected before earlier ones and that the mother tongue would be the last to suffer.
However, subsequent cases of multilingual patients affected by strokes and the like have not borne this out. American neuropsychologist Laurence Miller reports that the order in which languages are recovered in such cases is variable, and that individual patients can even exhibit different types of aphasic syndrome in their different languages. Research carried out by neurosurgeon George Ojemann while operating on bilingual patients indicated that, although some brain areas were common to both languages, there were also peripheral areas involving only one of the languages. This kind of anatomical distribution of language function makes it easier to see how language disruption could manifest itself in seemingly aberrant and arbitrary ways.
Perhaps the most fascinating writing on the subject is to be found in the reports of those who have had personal experience of language impairment as it gives insight into what the condition feels like.
In Stroke: A Diary of Recovery, Douglas Ritchie describes it thus:
"I could day-dream……. I could think, actively, without using words, and coming down to earth, I rehearsed speeches silently. But there was the blank wall. The minute I rehearsed speeches with my tongue, even though I kept silent, the words would not come……
It was like starting a motor car. The engine ticked over and speeded up, but the moment one sought to put the car into gear, something went wrong with the clutch, the gear crashed with an ugly sound the engine stopped."
In Auto-Observation of Aphasia by French doctor Jacques Lordat, written in the 19th century, Lordat describes being at times in a state of what he called paramnesia "a faulty use of known and remembered sounds. Thus when I wanted to ask for a book, I pronounced the word for handkerchief. However, immediately after having uttered this word, I retracted it, feeling that another was indicated."
Equally intriguing is The Man Who Lost His Language by Sheila Hale in which she writes of the aftermath of her husband's stroke. John Hale never recovered his power of speech, or at least as the term is generally understood, yet he managed a form of communication based on constant repetition of the syllables da woahs, modulated and infused with emotion as if in normal conversation, apparently believing that the sounds he was uttering were making perfect sense to his listeners.
Works such as these were of more help to me than the case history in getting to the raw feel of what Bertha's experience must have been like. The personal perspective is invaluable as a complement to the medical one.

"Hysterical a[phasia]…. is characterized by its completeness or, rather, by its absolute character. It is not that the patients are restricted to the use of individual words, but that they are completely speechless, indeed voiceless; not a sound, not a cry comes about."
Sigmund Freud, Aphasie 1888

In my post of 3 May I quoted Josef Breuer's description of Bertha Pappenheim's aphasia. It was of a complex nature and varied over the course of her illness, ranging from the typical telegrammatic speech of Broca's aphasia to the complete loss of her mother tongue, at which stage she could only express herself in other languages, mainly English. How then, in view of Freud's already published view about hysterical aphasia, could he and Breuer be subscribing to the idea that her aphasia was hysterically induced?
Freud was clearly enchanted by his own theories about hysteria, so much so that it seems almost to have constituted a default diagnosis for him. Once convinced that a patient suffered from hysteria nothing would budge him from that conclusion.
In the case of Frau Emmy von N (the second of the cases reported in Studies on Hysteria) the patient displayed, in addition to depression and insomnia, a set of symptoms which would nowadays be recognised as associated with Tourette's syndrome: random interjections and clacking sounds, agitated finger movements, convulsive facial tics and neck spasms. Freud, treating her with the cathartic method developed in discussion with Breuer, elicited from his patient a number of traumatic childhood memories, after which her vocal tics 'were strikingly improved' although they 'were not completely relieved'. This limited success turned out to be 'not a lasting one'. There is nothing surprising in this. Tourette's symptoms are well known to wax and wane, quite independently of any treatment.What is surprising is that Freud didn't even consider the possibility of a neurological cause here as he had known Gilles de Tourette while working with Charcot in Paris, at the very time when de la Tourette first published a paper on the disorder which was to bear his name.
A later, and much more serious, misdiagnosis was made in the case of a fourteen-year-old girl, known only as M-l, who suffered from abdominal pains. Freud diagnosed her as an 'unmistakable' case of hysteria, which he claimed cleared up 'quickly and radically' under his care. The girl died two months later of sarcoma of the abdominal glands.
Freud was still loath to relinquish the hysteria diagnosis. The girl had indeed been a hysteric, he maintained. The hysteria, instead of creating its own symptoms, had simply appropriated for itself the existing pains produced by the sarcoma.
This 'mixed aetiology' explanation has served on other occasions as a get-out clause in the history of hysteria. We see it too in the case of Frau Emmy von N. Finding that the neck spasms were continuing unabated Freud declared that they did not form part of the hysterical picture but were a form of migraine, therefore of organic origin and not susceptible to the cathartic treatment.
It's difficult to see how the mixed-aetiology explanation could be applied to solve the question I started this post with but given Freud's belief in his ability to wriggle Houdini-like out of any diagnostic bind he found himself in he would surely have come up with some rationale.