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Bush, Brain Damage, And State Of The Union

I couldn't help wondering if, last night, there was laughter echoing down the corridors of the hospital where Dr. Oliver Sacks once worked.

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Bush, Brain Damage, And State Of The Union

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



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 to applaud and yell at the slightest provocation, Bush talked of "dramatically improving the environment" and the importance of "visiting prisoners."

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

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

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

"The hallmark of aphasia," explains Dr. Antonio Damasio, a behavioral neurologist at the University of Iowa, "is the use of words that are off-target, words that are related but not quite correct." Therefore, this condition can often be masked and difficult to diagnose. This can also be true when 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 tonal problems and be unable to recognize the tone, timbre, feeling, or character of a voice, but can understand the words and grammatical constructions perfectly.

Sacks, a noted neurologist, has been in the position to encounter many rare cases of agnosia. "Such tonal agnosia (or 'atonias') are associated with disorders of the right temporal lobe of the brain," he explains, "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 for patients with aphasia, treating someone with aphasia can occasionally become more complex because many patients will display a level of understanding that seemingly belies their condition. In addition, Dr. Sacks found that some people with aphasia, when addressed "naturally," could grasp some or most of the meaning of one's words. Thus, he was compelled to utilize an unusual approach in his treatment. In order to satisfactorily confirm their condition as aphasia, Dr. Sacks stated that he had to go to "extraordinary lengths, as a neurologist, to speak and behave un-naturally, to remove all the extra-verbal clues-tone of voice, intonation, suggestive emphasis or inflection, as well as all visual cues (one's gestures, one's entirely unconscious, personal repertoire and posture)."

Such de-personalizing of voice renders speech devoid of tone or color. It is this machine-like way of talking that will usually be unrecognizable to people with aphasia and quite possibly cause them to laugh at the 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, Sacks studied the reaction of people with aphasia as they watched a televised speech by the former-actor-turned-president. Despite being unable to grasp the skillful politician's words, the patients were convulsed in laughter.

"One cannot lie to an aphasiac," Dr. Sacks noted. "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."

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

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

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

A New York Times editorial declared, "No one watching the somber Mr. Bush's delivery could doubt 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 State of 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 power without 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 my ears, and I couldn't help wondering if, last night, there was laughter echoing down the corridors of the hospital where Dr. Oliver Sacks once worked.

Mickey Z. is the author of The Murdering of My Years: Artists and Activists Making Ends Meet  and an editor at Wide Angle. Courtesy: Znet .

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