Aphasia is a symptom, not a disease.
The usual causes of aphasia are wide-ranging, and a reminder that we don’t know what other people are experiencing.
The world recently learned that actor Bruce Willis has “aphasia.”
This news has been confusing to most people. That’s because, for the most part, aphasia is a symptom, not a diagnosis.
Aphasia is a word that describes the inability to express oneself through speech and/or the inability to comprehend speech. The causes are wide-ranging, and often difficult to pin down. So, saying that a person has aphasia, without any more information, is almost as imprecise as saying a person has dizziness. Dizziness is not a diagnosis unto itself; it’s a symptom in search of one.
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There are three major categories of aphasia that we tend to think of. But even these are descriptions of specific clusters of symptoms more than iron-clad diagnoses. Expressive aphasia (or “Broca’s aphasia”) is marked by the inability to produce speech. Some but not all people with expressive aphasia continue to understand speech. They just can’t generate it. Receptive aphasia (or “Wernicke’s aphasia”) is generally marked by the inability to understand speech, as well as difficulty producing coherent speech. Global aphasia is the merging of these two, where both comprehension and production of speech is lost.
Aphasia often occurs suddenly, as a result of a stroke, tumors, trauma, or even infections. Some forms of aphasia, including atypical variants of migraine headaches, are temporary and reversible. Aphasia can also develop slowly over time and is usually accompanied by other neurologic changes, many of which are indicative of dementia. In some instances, however, slowly progressive aphasia can truly be isolated, which points towards a condition called “Primary Progressive Aphasia" (PPA). In these unusual cases (and in which aphasia truly is a diagnosis, not just a symptom), the patient retains most of their other mental and cognitive abilities, at least at first. It may be that Willis has PPA. But compared to the other major causes of aphasia, this would be rather unusual.
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Willis’s family is under absolutely no obligation to tell any of us what the cause of his aphasia is and we should respect their privacy. They may not have even been given a specific diagnosis, or it may be that they have a diagnosis (like early onset dementia, or even PPA) but have chosen not to share it with the public.
I won’t join in on any speculation. But I will say that it’s now becoming public knowledge that Willis had apparently been slowly showing signs of difficulty for awhile. It occurs to me that over the years, some people may have seen his inability to remember lines on a movie set as a sign of unprofessionalism, or viewed his behaviors in some other negative light. In hindsight, however, those people might now feel a sense of guilt or even shame for having judged someone without knowing the details of their life. That’s perfectly understandable. How were they to know?
That said, this is a good reminder to us all. Many people in our midst are struggling silently, for any number of reasons. It’s always good to afford people the benefit of the doubt. Unless you’re a neurologist, you never really know what is going on inside of someone else’s brain. And even then, it’s not that easy.
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