Aphasia – the damage to the language centers of the brain, and the beautiful memoir of Diane Ackerman ” One hundred names for love – a stroke, a marriage and the language of healing”

We take our bodies for granted, until an injury, a setback, makes us realize otherwise. This personality, this thing we call our articulate “self” is just the tip of the iceberg, sustained and nourished by an astonishingly intricate, delicately architected, tremendously resilient, and labyrinthine organic substratum – the human brain. Much of what happens in those serpentine and folded layers of grey mass of the brain happens incognito, without noise. We don’t even realize, under normal circumstances, that there are specific portions of the brain that trigger, scaffold and execute every word we speak, each thought we think, every emotion we feel, and every act we perform. We think the “I” uses the brain, but the opposite is true, it is the brain, the different parts of it creating a fuzzy whirlpool of neural activity that creates the “I”, and uses it as a facade to navigate the world. Damage to the brain can reveal the nature of the self, the cognitive gaps, and the extraordinary plasticity of the brain that kicks in to make up for the gaps in the self. Millions of years of evolution have ensured the goal of the human brain is to maintain a sense of a steady self, the homeostasis of an organism, that can then dynamically respond to external stimuli. But what capacities, what kind of self we project to the world, are dependent on which parts of the brain are intact, and which need to be compensated for.

I recently read Diane Ackerman’s wonderful 2011 memoir “One hundred names for love”, which is about the few years she spent rehabilitating her husband, Paul west, from a severe brain condition called aphasia. Mrs. Ackerman ( for those who may not know) is among the finest poets and prose writers of this generation. Books like “A natural history of the senses”, “a natural history of love”, and the widely popular novel, later made into a film “The zookeeper’s wife”, are works of deep study, imagination, and exuberant writing. Paul West, her husband, was an author of over fifty books, mostly novels and historical fiction, and was widely considered one of the most inventive and stylish writers in the English language. Unfortunately, not many of his books are readily in print or available, but you can find them occasionally on eBay or in second-hand bookstores. Paul was an Englishman, an Oxford student, and had a life-long love for the English language. He was twenty years older than Diane, when both met, as a professor and a student in a college, and the connection between them was immediate and deep. The binding force in Diane and Paul’s life was the beauty of words, their nuances, and the symbolic and metaphorical possibilities while using them. Both their lives were tethered to the wonder of words and the imaginative uses of language. In 2007, Paul had a stroke that led to brain damage, and in its aftermath, lost his capacity for words, a condition known as Aphasia. For a man who lived by the power and richness of words, this was the worst nightmare come true. Paul lost his capacity to understand words and his capacity to express himself. In a word-drenched companionship that existed between Diane and Paul, this sudden black hole in communication, was unimaginably painful for both of them. In her book, Diane beautifully captures the trauma the stroke caused, the brain damage that cut the chords of communication, followed the next few years of Paul’s rehabilitation and eventual recovery through ingenious verbal strategies and the use of those very words that were taken away from him by Aphasia. Diane and Paul christened their love for each other with a hundred names, each one arising spontaneously and without pretense, and it was through such verbal inventions that Paul resurrected back to his writing life from the verbal incapacitation caused by Aphasia.

So, what is this condition of Aphasia? Etymologically, this greek word means “loss of speech”, but in reality, this condition is much more than the loss of speech; it is a loss of language itself – both in its expression and comprehension. An Aphasic, depending on the severity of the condition, struggles or finds it impossible to comprehend what is being said, and/or cannot articulate what they wish to say. Depending on which sides of the brain are affected, a distinction is made between receptive and expressive Aphasia. In those rare cases where both sides are damaged, it is called Global Aphasia. It was Dr. Hughling Jackson, the 19th Century neurologist, who did pioneering work on this condition. He observed that patients with Aphasia lacked what he called “propositional” speech, or in other words, they lose the ability to construct syntactically proper statements. In English, a proposition is a word used, usually before a noun, to show direction, time, place, location, spatial relationships, or to introduce an object (words such as in, at, on, of, to, etc.), and aphasics simply cannot do that. They struggle to string together a coherent sentence and often get caught in single words or phrases, which they tend to repeat over and over again in response to any question. Nothing else will come out of them. In Paul’s case, for instance, in the first few months after the stroke, the only word he could speak was “Mem” and nothing else. Diane notes poignantly in her memoir “For now, the only remnant of language he (Paul) had was the one solitary syllable: “Mem, mem, mem”. He groaned it, he whispered it, he uttered it civilly as a greeting, he barked it in anger, he solicited help with it, and finally in frustration, when none of that worked, he sat upright in bed and spat it out as a curse”.

Aphasia is pretty common after a stroke. Science tells us that all it takes is a minute of lack of oxygen supply to the brain for it to lose about 1.9 million neurons, 12 billion synapses, and 7.5 miles of protective fibers. This is what happened to Paul on a grander scale. For a few minutes after the stroke, a blood clot in Paul’s brain prevented the flow of oxygen, and it resulted in severe damage to the innermost part of the brain where language and comprehension reside. Paul suffered from global aphasia – the most pervasive variety. Interestingly, studies have shown that a vast majority suffer from milder forms of Aphasia – difficulty finding words, using wrong words in the overall context, minor slips in speech, etc., but it is only in cases of specific damage to language areas of the brain (Broca and Wernicke areas), that Aphasia manifests in its fuller, debilitating dimensions and turns into a deficit that needs rehabilitation. The great English writer and creator of the first dictionary, Dr. Samuel Johnson, suffered a stroke when he was seventy-three, and lost his speech. Luckily, he still retained his powers of reception and continued to write for a few more years. But he never regained the same felicity of speech he was known for, and even his writing showed occasional lapses in language. Many Aphasiac patients, like Dr. Johnson, continue to live an active intellectual life, their inner voice intact, and their thinking remains fertile – what they have been deprived of is the ability to show visible signs of understanding or articulate their responses adequately.

In Paul west’s case, Aphasia deprived him of his very essence. After all, Paul’s entire life was about his dexterity with words and the inventive use of language. As Diane describes in her book, how their daily lives before the stroke were a verbal dance from the beginning of the day until the end, with each one playfully bouncing off words against each other creating new words and pet names on the fly, and exploring hidden nuances of language which then flowed into their writing and lectures to wide audiences across the country. Despite the differences in age between the two, the common thread that held them together was this constant renewal, replenishing, and exchange of language. And when the stroke took away that ability from Paul, it nearly took away the very ground they stood upon. There is a common myth that brain damages are irreversible. But that is not true, and Diane, fortunately, is a student of neuroscience and has written a book on the beauty of the human brain. She knew that Aphasia cannot be cured, but it was possible to reclaim some ground through rehabilitation. Her memoir beautifully recounts the regimen she instituted for Paul to bring back his verbal prowess. The process was painful, with many setbacks, but the only way Paul was going to regain his verbal understanding and expression was to force him to use words and coerce his brain to create new neural pathways. In her inimitable language, Diane evokes the process and deep sadness such an effort can bring to a relationship, the moral-ethical imperatives and the hard choices each one has to make, and above all, a test of one’s love and empathy.

There are many memoirs about people with brain damage and their recovery, but in the “hundred names for love”, Diane, a gifted writer, sketches the initial trauma and the long road it took to recover, with an eye of a poetess and the literary command of a novelist. In one striking sentence in the book, which will resonate long after the book is read, Diane writes “Aphasia is impersonal, but its manifestations are very personal”. Dr. Oliver Sacks, a renowned neurologist and arguably one of the finest observers of the human predicament caused by brain damage, wrote extensively on this specific point – that damage to the brain or the neural system affects each one uniquely, and each person attempts to compensate for the loss in their unique way. No two recovery paths are the same.

I read the one Hundred names for love in two sittings. It is an amazing book that fills one with optimism and possibilities. It is to Diane Ackerman’s literary credit that she was able to lift a sensitive and painful episode in her life and Paul’s into something deeper, educative, universal, and profound. Only a writer and literature of the highest order can achieve that.