Bush, Brain Damage, And State Of The Union

"One can lie with the mouth, but with the accompanying grimace, one nevertheless tells thetruth."

Nietzsche

President-Select George W. Bush delivered the yearly State of the Union address last night (January 28,2003). While members of congress appeared to be auditioning for a Ritalin commercial, bouncing up and down toapplaud and yell at the slightest provocation, Bush talked of "dramatically improving theenvironment" and the importance of "visiting prisoners."

"This Nation fights reluctantly," he told us. "We exercise power without conquest, andsacrifice for the liberty of strangers... Americans are a free people, who know that freedom is the right ofevery person and the future of every nation."

"We seek peace," he assured the folks who tuned in, before warning: "If war is forced uponus, we will fight in a just cause and by just means - sparing, in every way we can, the innocent. And if waris forced upon us, we will fight with the full force and might of the United States military - and we willprevail."

At this juncture, I was reminded of a chapter from Oliver Sacks' remarkable book, The Man Who MistookHis Wife for a Hat and Other Clinical Tales, in which Sacks detailed the reactions of people with aphasiaand agnosia as they viewed a televised speech by President Ronald Reagan. While the multiple language andspeech problems of aphasia can be caused by any disease or injury to the brain, the most common cause isstroke.

"The hallmark of aphasia," explains Dr. Antonio Damasio, a behavioral neurologist at theUniversity of Iowa, "is the use of words that are off-target, words that are related but not quitecorrect." Therefore, this condition can often be masked and difficult to diagnose. This can also be truewhen treating those with agnosia. Agnosia, while it can present an extremely broad range of symptoms,sometimes causes aphasia-like speech and language problems. Such a person with agnosia may suffer from tonalproblems and be unable to recognize the tone, timbre, feeling, or character of a voice, but can understand thewords and grammatical constructions perfectly.

Sacks, a noted neurologist, has been in the position to encounter many rare cases of agnosia. "Suchtonal agnosia (or 'atonias') are associated with disorders of the right temporal lobe of the brain," heexplains, "whereas the aphasiacs go with disorders of the left temporal lobes."

According to Sacks, people with atonia may sometimes be found in an aphasia ward. Therefore, as it is forpatients with aphasia, treating someone with aphasia can occasionally become more complex because manypatients will display a level of understanding that seemingly belies their condition. In addition, Dr. Sacksfound that some people with aphasia, when addressed "naturally," could grasp some or most of themeaning of one's words. Thus, he was compelled to utilize an unusual approach in his treatment. In order tosatisfactorily confirm their condition as aphasia, Dr. Sacks stated that he had to go to "extraordinarylengths, as a neurologist, to speak and behave un-naturally, to remove all the extra-verbal clues-tone ofvoice, intonation, suggestive emphasis or inflection, as well as all visual cues (one's gestures, one'sentirely unconscious, personal repertoire and posture)."

Such de-personalizing of voice renders speech devoid of tone or color. It is this machine-like way oftalking that will usually be unrecognizable to people with aphasia and quite possibly cause them to laugh atthe incomprehensible sounds being uttered. The words mean nothing, it is the way they are spoken that matters.Through such unusual treatment, Sacks was able to truly demonstrate his patients' aphasia. Quite unexpectedly,this peculiar method exposed a rather fascinating side-effect: political savvy. In the mid-eighties, Sacksstudied the reaction of people with aphasia as they watched a televised speech by theformer-actor-turned-president. Despite being unable to grasp the skillful politician's words, the patientswere convulsed in laughter.

"One cannot lie to an aphasiac," Dr. Sacks noted. "He cannot grasp your words, and so cannotbe deceived by them; but what he grasps, he grasps with infallible precision, namely the expression that goeswith the words, that total spontaneous, involuntary expressiveness which can never be simulated or faked, aswords alone can, all too easily."

So, why did those patients with aphasia cackle at Reagan's speech? "It was the grimaces, thehistrionics, the false gestures and, above all, the false tones and cadences of the voice which rang false forthese wordless but immensely sensitive patients," explained Sacks. Conversely, Sacks remarked on a womanwith tonal agnosia who was also watching the address -- stony-faced. Emily D., a former English teacher andpoet, was deprived of any emotional reaction to the speech but was able to judge it in the opposite way thepatients with aphasia did. Her response?

"He does not speak good prose," Emily D. told Sacks. "His word-use is improper. Either he isbrain-damaged or he has something to conceal."

"We normals," concluded Dr. Sacks, "aided, doubtless, by our wish to be fooled, were indeedwell and truly fooled. And so cunningly was deceptive word-use combined with deceptive tone, that only thebrain-damaged remained intact, undeceived." Those "well and truly fooled" lined up the next dayto demonstrate who remained intact.

A New York Times editorial declared, "No one watching the somber Mr. Bush's delivery coulddoubt his determination," Bush's "obvious sincerity."

Times reporter, Todd S. Purdum: "He spoke feelingly."

CNN.com stated Bush looked "determined and focused" as he presented a "powerful Stateof the Union address."

In Japan, Chief Cabinet Secretary Yasuo Fukuda called Bush's speech "a forceful, strong message,"while Sweden's Prime Minister Goeran Persson found the address to be "an important signal'

A Houston Chronicle editorial explained: "Bush is good at conveying confidence and strength,and certainly did last night," arguing "Few would quarrel with Bush's conclusion: 'We exercise powerwithout conquest, and sacrifice for the liberty of strangers.'"

The New York Post weighed in, declaring it "a remarkable speech" that Bush delivered"precisely, tactfully and with an occasional twinkle in the eye"

"Either he is brain-damaged or he has something to conceal." The words of Emily D. rang in myears, and I couldn't help wondering if, last night, there was laughter echoing down the corridors of thehospital where Dr. Oliver Sacks once worked.