“Ben” (BROCA'S DYSPHASIA): I met a patient called “Ben” who had Broca’s dysphasia. Broca’s dysphasia is the condition in which a person knows what they want to say, but can’t retrieve the words for it and/or express it in a coherent manner. This is typically due to a lesion (eg stroke) in the brain called Broca’s area, situated around the border of the frontal and temporal lobe in one hemisphere. That isn’t to say they necessarily have an intellectual disability, as many of them have preserved verbal and reading comprehension and cognition, especially if the lesion was purely isolated to Broca’s area. The condition can range from very severe (extremely little or no coherent expression) to a milder form which sounds “stilted” and/or “jerky” with circumlocution/substitution in the attempt to find the correct term.
I didn’t have a stroke and while I officially don’t have Broca’s dysphasia (*NB*), I could empathize for him in imagining it would be very frustrating and I automatically knew how to communicate to cater to his condition without having to ask anyone for assistance.
I asked numerous very direct questions so Ben only had to say “yes”, “no”, a number or a short phrase. It was very important to break the burden of what he wanted to say into smaller fragments, otherwise it would be too overwhelming for him. I also gave him extra time to try to express himself, and if I couldn’t fully get what he wanted to say, I then paraphrased it and asked him if that was what he meant. I also drew a few pictures and wrote some individual words on paper in the attempt to trigger his “correct” word.
It was very time consuming given the highly numerous very specific questions asked (instead of several broad questions) and patiently waiting for a reply and trying to clarify it, but I got most of my desired background info at the end.
When asked if he was very frustrated coz of this issue, he said “Of course!” and was shocked that such a phenomenon could occur. He wasn’t made upset or aggravated during the conversation, but appreciated the accommodations I made for him.
I felt very comfortable and relaxed speaking to him, partly because I could communicate in a way that benefitted both of us, but after the conversation a very disturbing epiphany hit me. It turned out that although he was one of the few patients I was intuitively very empathetic for, I was also comfortable in the sense that he wouldn’t be a threat to me verbally. I NEVER exploited or abused him and had his consent to speak to him and he said he wasn’t offended at all, but his condition in a sense was an “extrapolation “ of the expressive language difficulties faced by many people on the Autistic Spectrum, where they have trouble with verbal fluidity for complex things on the spot. This is one of the major factors that’d make them very vulnerable to being bullied, manipulated or framed by NTs (from my past experiences and experiences of other ASD adults) as they have difficulty immediately and eloquently arguing back in a coherent and emotionally pleasing manner (to the NTs) unless they have already memorized numerous sentences, studied advanced debating tactics in their spare time, or managed to incorporate the argument into a pre-designed algorithm in which they will give moderately programmed responses with some editing based on the context etc. IE A POWER IMBALANCE IN EXPRESSIVE FLUIDITY/VERBAL FLUENCY, WORDS ARE SO POTENT.
I felt guilty after this epiphany, because I thought I was gaining comfort from his newly acquired impairment, but later I decided not to feel guilty anymore as I had no malicious intentions, and would never take advantage of his vulnerable state. Other clinical staff shouldn’t feel guilty about Ben’s condition either, they’re all trying to help him with neurological investigations, treatments, monitoring and rehabilitation (including speech therapy). Likewise it would be excessive and unnecessary to feel guilty/remorseful for someone else’s condition that you didn’t cause and have absolutely no intention of maliciously exploiting even if you could technically detect a weakness, eg a patient having a broken leg, or a patient who has endured ototoxic side effects from certain medications. You can sympathize for what they’ve gone through, but to feel guilty about it is going too far imo.
NB: I also have difficulty explaining more complex thoughts on the spot in a smooth manner although it is much milder than the ones with the official diagnosis of Broca’s Dysphasia/Aphasia. This isn’t an anxiety issue, as it occurs to me even when I’m with people that I’m comfortable with. It’s like I have difficulty organizing the sentence structure, so I compensate by my very strong preference to speak in sequential blunter phrases so I’m less likely to “get lost in my words”. This may be a working memory/executive dysfunction issue. It was also comfortable as I had the innate preference for honesty anyway. Unfortunately during speech this can get interpreted by NTs as arrogance or rudeness, and could be deemed as being unempathetic to their ever so important emotional needs. An alternative is to laboriously/exhaustingly memorize the more verbose (yet “polite”) expressions by rote, as it is very unnatural for me to use these phrases.
Example: “If at any point in time you feel too tired or uncomfortable to continue, you are welcome to say stop.” ("polite")
INSTEAD OF
“If you want to stop talking, just say so any time.” ("rude")
The brute rote memorization still accomplishes the need to simulate verbal fluidity that sounds pleasing to them, even though it’s tiring. Fortunately this issue isn’t as obvious in writing and internet communications as there’s MUCH more time to form and edit what you want to say on the computer before submitting it, unlike speech where if you accidentally say something “rude” or have difficulty explaining things to patients in urgent situations, in which you’re screwed to some degree.
Very strangely Pubmed searches indicate rather few medical papers that discuss Broca’s area in relation to people with ASDs. It would be a major discovery if this is one of the several cortical areas implicated in the condition, which may contribute to noticeable verbal communication impairment in adults and teenagers who are more severe on the spectrum. I’d be extremely interested for more neurological investigations to be done on this area in ASD individuals so perhaps a treatment (if pathology was discovered) to address this specific issue may be developed.
