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The Aphasic Patient: Vulnerability and/or Exclusion

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Abstract

The aim of this article is to account for the vulnerability of the patient/subject affected by aphasia, the loss of acquired language in adults. In the case of a sudden onset of aphasia, the patient is often aware of his/her disorder from the very onset of the impairment. Vulnerability also affects patients suffering from progressive aphasia, mainly due to a collapse of the various components of memory. After describing the main types of aphasia in broad outline, the study focuses on the isolation and exclusion that they generate, starting from a brief study of the emotional impact of the impairment on the language-deprived subject. This will be related to the patient’s awareness of the disorder and the notion of awareness in structuring and using language, considered as the expression of thought. Finally, given that aphasia leads to the loss of employment, patients enter a phase of social vulnerability. Their speech is perceived as strange or even “foreign” by others in ordinary communicative contexts. What solutions can be proposed to overcome this state of vulnerability and exclusion, which is often felt to be insoluble by the patients themselves?

Abrégé résumé

Le propos est de rendre compte de la vulnérabilité du patient/sujet aphasique, souvent conscient de son trouble, dès les premières heures de l’atteinte, nous nous référerons aux aphasies d’installation brutale, perte du langage acquis de l’adulte, généralement, mais aussi aux aphasies dites progressives, essentiellement dues à un effondrement de la mémoire dans ses diverses composantes. Après un descriptif brossé à grand traits des types d’aphasies, nous rendrons compte de l’isolement qu’elles engendrent, à partir d’une brève étude de l’impact émotionnel de cette atteinte sur le sujet privé du langage, en relation avec sa conscience du trouble et la notion de conscience dans la structuration même et l’usage du langage, expression de la pensée. Enfin, sachant que l’aphasie engendre la perte de leur emploi, pour les patients encore en activité, ces derniers entrent dans une phase de vulnérabilité sociale; la parole devient partielle, entendue comme étrange, souvent «étrangère» par la communauté sociale, dans les contextes ordinaires de la communication. Quelles solutions pouvons-nous apporter pour palier un état de vulnérabilité et d’exclusion, souvent appréhendé comme insoluble par les patients eux-mêmes.

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Notes

  1. Anosognosia: unconsciousness of a disorder. The causes are varied and complex.

  2. Specific terms are defined in the text or in the endnotes.

  3. Aphasia is a disorder of the expression and/or comprehension of verbal signs, without any impairment of the peripheral organs of execution or reception, accompanied in most cases by intellectual difficulties, which can be either primary or secondary, depending on various authors. It corresponds to a localized brain injury; it entails the loss of relationships with the environment, which may often be increased by the simultaneous impairment of other perceptual-gestural means of communication that are closely related to language but not necessarily affected along with it. (All the translations from French are by the author).

  4. Dementia with Lewy bodies (DLB) is a neurodegenerative disease characterized by inclusions of the protein alpha-synuclein, called “Lewy bodies,” in neurons (Lewy described this disease in 1986). The cause of this disease remains unclear and it usually affects areas devoted to higher cognitive functions (especially memory) and motor skills.

  5. Institut national de la statistique et des études économiques (National Institute of Statistics and Economic Surveys). www.insee.fr.

  6. Broca (1863b), Remarques sur le siège, le diagnostic et la nature de l’aphémie, in Bulletin de la Société anatomique de Paris. Paris, imp. De Moquet, 16 p., in-8.

  7. Wernicke (1874), Der aphasische Symptomencomplex: ein psychologische Studie auf anatomischer Basis, Breslau, Cohn und Weigert, 72 p.

  8. Démonet and Puel, Aphasie et corrélats cérébraux des fonctions linguistiques, in Séron & Jeannerod (1994), Neuropsychologie humaine, p. 337–359 et sq.

  9. Hemiplegia: aphasia is accompanied by paralysis of the right side of the body in 80 % of cases.

  10. Hemianesthesia: aphasia is often accompanied by a loss of sensation in the right side of the body.

  11. These signs are reversed for the low percentage of patients whose language areas are located in the right hemisphere (≈7 %).

  12. Jacquet-Andrieu (2001), Cas d’aphasie mixte, p. 80.

  13. Sabouraud (1998), Le langage et ses maux, p. 92.

  14. Our emphasis.

  15. Alajouanine and Lhermitte (1964), Essais d’introspection de l’aphasie (l’aphasie vue par les aphasiques). Revue Neurologique, 110, 1964, pp. 609–621.

    I realized that when I wanted to talk, I could not find the words I needed […] The thought was ready, but the sounds which should have expressed it to my interlocutor were no longer available to me […] Do not think there was any change in the functions of the inner sense. I still felt the same inside. Mental isolation, sadness, embarrassment, a consequent feeling of stupidity made some people believe I had an intellectual impairment, an imperfection which caused grief for some, satisfaction for others. […] When I was alone, awake, I silently thought of the occupations of my life, of my studies. I felt no difficulty in exercising my mind… As soon as someone came to see me, I felt my disease by my inability to say even: Hello, how do you do?

  16. Alexander, Aphasia: the worm’s view of philosophic patient and the medical establishment, in Diogenes, 150, 1990.

  17. In the French text, de (of) should be replaced by dans (in).

  18. Jacquet-Andrieu (2001), op. cit., Ann. 12, pp. 112, sq & Correspondance.

  19. The author wrote * “jaisse,” a paraphasia repeated in another form of the verb “jaillir,” in Jacquet-Andrieu (2012a), langage de l’homme, pp. 351–359.

  20. Alexander, op. cit.

  21. Jacquet-Andrieu (2001), op. cit. p. 80.

  22. Damasio (1994), Descartes’ error: emotion, reason, and the human brain, p. 17.

  23. Hervé (2000), Éthique politique et santé, p. 7.

    Health is defined by the OMS as a state of complete physical, mental and social wellbeing. This is a paradigm, which many consider utopian. […] However, this definition has the advantage of reminding us that health does not apply only to physical wellbeing but also that mental and relational wellbeing are greatly involved in this state.

  24. A major breakthrough in linguistics was the recent discovery of more than 30,000 pages of F. de Saussure’s manuscripts, which are being carefully edited by specialists (Arrivé, 2007, 2008, 2012; Amacker 2011, etc.). As early as 1891, Saussure was already a remarkable cognitivist linguist (Jacquet-Andrieu 2012b).

  25. Our emphasis.

  26. Saussure (1916), Cours de linguistique générale, p. 39.

    The first expression of reality consists in saying that language (that is to say the speaker) neither recognizes the idea a, nor the form A, but only the relation a/A; this is only a rough approximation however. What the speaker really recognizes is only the relationship between the two links a/AHZ and abc/A, or b/ARS and blr/B, etc.

  27. Delacroix (1934), L’enfant et le langage, p. 10.

  28. Jacquet-Andrieu (2001), op. cit., pp. 57–60.

  29. Didactique: «l’art d’enseigner», Dict. Littré (1956–1958), t. 3, p. 39. Theories of learning: it relates to the theory of education: development, design, creation of methods and their application, regardless of the field considered.

  30. Logorrhée: a continuous and involuntary flow of incoherent speech.

  31. ITCE: Information Technology and Communication for Education.

  32. Van Eackhout (2001). Le langage blessé, pp. 23 et sq.

    […] if one focuses on the personality of these women and men who wish to rediscover language to find themselves, it is a whole world of adventure and passion that opens up before you. Adapting a therapy to someone is only possible after having met him/her. This means breaking into a unique story, to give the patient a new life project. A new story results from this second birth, new links for the person who finds her words again.

  33. Ibid.

  34. Hippocrates was born on the island of Cos and died in Larissa, 460–370 BC, approximately.

  35. Littré (1839–1861). Hippocratic oath (attributed to), extract:

    I will put my Professor of medicine on the same level as my parents. I will share my fortune with him. […] I will pass on the precepts, explanations and other aspects of his teaching to my children, my Professor’s followers, students and physicians who swore according the aoth of medicine […] As far as my strength and my knowledge permit, I will advise patients on the correct life style for their disorders and protect them anything that may be contrary or harmful to them.

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  1. Laboratoire d’éthique médicale et de médecine légale (EA 4569), Faculté de médecine, Université Paris Descartes, 45, rue des Saints Pères, 75006, Paris, France

    Armelle Jacquet-Andrieu

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Jacquet-Andrieu, A. The Aphasic Patient: Vulnerability and/or Exclusion. Cult Med Psychiatry 38, 60–76 (2014). https://doi.org/10.1007/s11013-014-9363-1

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