It would seem far simpler for her to rotate the plate than rotate herself. She agrees, and has tried this—or at least tried to try it. But it is oddly difficult, it does not come naturally, whereas whizzing round in her chair does, because her looking, her attention, her spontaneous movements and impulses, are all now exclusively and instinctively to the right.
Especially distressing to her was the derision which greeted her when she appeared only half made-up, the left side of her face absurdly void of lipstick and rouge. ‘I look in the mirror,’ she said, ‘and do all I see.’ Would it be possible, we wondered, for her to have a ‘mirror’ such that she would see the left side of her face on the right? That is, as someone else, facing her, would see her. We tried a video system, with camera and monitor facing her, and the results were startling, and bizarre. For now, using the video screen as a ‘mirror’, she did see the left side of her face to her right, an experience confounding even to a normal person (as anyone knows who has tried to shave using a video screen), and doubly confounding, uncanny, for her, because the left side of her face and body, which she now saw, had no feeling, no existence, for her, in consequence of her stroke. ‘Take it away!’ she cried, in distress and bewilderment, so we did not explore the matter further. This is a pity because, as R. L. Gregory also wonders, there might be much promise in such forms of video feedback for such patients with hemi-inattention and left hemi-field extinction. The matter is so physically, indeed metaphysically, confusing that only experiment can decide.
Computers and computer games (not available in 1976, when I saw Mrs S.) may also be invaluable to patients with unilateral neglect in monitoring the ‘missing’ half, or teaching them to do this themselves; I have recently (1986) made a short film of this. I could not make reference, in the original edition of this book, to a very important book which came out almost simultaneously: Principles of Behavioral Neurology (Philadelphia: 1985), edited by M. Marsel Mesulam. I cannot forbear quoting Mesulam’s eloquent formulation of ‘neglect’:
When the neglect is severe, the patient may behave almost as if one half of the universe had abruptly ceased to exist in any meaningful form. . . . Patients with unilateral neglect behave not only as if nothing were actually happening in the left hem-ispace, but also as if nothing of any importance could be expected to occur there.
9. The President’s Speech
What was going on? A roar of laughter from the aphasia ward, just as the President’s speech was coming on, and they had all been so eager to hear the President speaking . . .
There he was, the old Charmer, the Actor, with his practised rhetoric, his histrionisms, his emotional appeal—and all the patients were convulsed with laughter. Well, not alclass="underline" some looked bewildered, some looked outraged, one or two looked apprehensive, but most looked amused. The President was, as always, moving—but he was moving them, apparently, mainly to laughter. What could they be thinking? Were they failing to understand him? Or did they, perhaps, understand him all too well?
It was often said of these patients, who though intelligent had the severest receptive or global aphasia, rendering them incapable of understanding words as such, that they none the less understood most of what was said to them. Their friends, their relatives, the nurses who knew them well, could hardly believe, sometimes, that they were aphasic.
This was because, when addressed naturally, they grasped some or most of the meaning. And one does speak ‘naturally’, naturally.
Thus, to demonstrate their aphasia, one had to go to extraordinary lengths, as a neurologist, to speak and behave un-naturally, to remove all the extraverbal cues—tone of voice, intonation, suggestive emphasis or inflection, as well as all visual cues (one’s expressions, one’s gestures, one’s entire, largely unconscious, personal repertoire and posture): one had to remove all of this (which might involve total concealment of one’s person, and total deper-sonalisation of one’s voice, even to using a computerised voice synthesiser) in order to reduce speech to pure words, speech totally devoid of what Frege called ‘tone-colour’ (Klangenfarben) or ‘evocation’. With the most sensitive patients, it was only with such a grossly artificial, mechanical speech—somewhat like that of the computers in Star Trek—that one could be wholly sure of their aphasia.
Why all this? Because speech—natural speech—does not consist of words alone, nor (as Hughlings Jackson thought) ‘propositions’ alone. It consists of utterance—an uttering-forth of one’s whole meaning with one’s whole being—the understanding of which involves infinitely more than mere word-recognition. And this was the clue to aphasiacs’ understanding, even when they might be wholly uncomprehending of words as such. For though the words, the verbal constructions, per se, might convey nothing, spoken language is normally suffused with ‘tone’, embedded in an expressiveness which transcends the verbal—and it is precisely this expressiveness, so deep, so various, so complex, so subtle, which is perfectly preserved in aphasia, though understanding of words be destroyed. Preserved—and often more: preternaturally enhanced . . .
This too becomes clear—often in the most striking, or comic, or dramatic way—to all those who work or live closely with aphasiacs: their families or friends or nurses or doctors. At first, perhaps, we see nothing much the matter; and then we see that there has been a great change, almost an inversion, in their understanding of speech. Something has gone, has been devastated, it is true— but something has come, in its stead, has been immensely enhanced, so that—at least with emotionally-laden utterance—the meaning may be fully grasped even when every word is missed. This, in our species Homo loquens, seems almost an inversion of the usual order of things: an inversion, and perhaps a reversion too, to something more primitive and elemental. And this perhaps is why Hughlings Jackson compared aphasiacs to dogs (a comparison that might outrage both!) though when he did this he was chiefly thinking of their linguistic incompetences, rather than their remarkable, and almost infallible, sensitivity to ‘tone’ and feeling. Henry Head, more sensitive in this regard, speaks of ‘feeling-tone’ in his (1926) treatise on aphasia, and stresses how it is preserved, and often enhanced, in aphasiacs.[11]
Thus the feeling I sometimes have—which all of us who work closely with aphasiacs have—that one cannot lie to an aphasiac. He cannot grasp your words, and so cannot be deceived by them; but what he grasps he grasps with infallible precision, namely the expression that goes with the words, that total, spontaneous, involuntary expressiveness which can never be simulated or faked, as words alone can, all too easily . . .
We recognise this with dogs, and often use them for this purpose—to pick up falsehood, or malice, or equivocal intentions, to tell us who can be trusted, who is integral, who makes sense, when we—so susceptible to words—cannot trust our own instincts. And what dogs can do here, aphasiacs do too, and at a human and immeasurably superior level. ‘One can lie with the mouth,’ Nietzsche writes, ‘but with the accompanying grimace one nevertheless tells the truth.’ To such a grimace, to any falsity or impropriety in bodily appearance or posture, aphasiacs are preternaturally sensitive. And if they cannot see one—this is especially true of our blind aphasiacs—they have an infallible ear for every vocal nuance, the tone, the rhythm, the cadences, the music, the subtlest modulations, inflections, intonations, which can give—or remove—verisimilitude to or from a man’s voice.
11
‘Feeling-tone’ is a favourite term of Head’s, which he uses in regard not only to aphasia but to the affective quality of sensation, as it may be altered by thalmic or peripheral disorders. Our impression, indeed, is that Head is continually half-uncon-sciously drawn towards the exploration of ‘feeling-tone’—towards, so to speak, a neurology of feeling-tone, in contrast or complementarity to a classical neurology of proposition and process. It is, incidentally, a common term in the U.S.A., at least among blacks in the South: a common, earthy and indispensable term. ‘You see, there’s such a thing as a feeling tone . . . And if you don’t have this, baby, you’ve had it’ (cited by Studs Terkel as epigraph to his 1967 oral history Division Street: America).