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On expressive agrammatism
k Q,19 33, p_ Ii13), 1he word Agrummarismus was coined
77. Ever since, the term has been used to denote various ces. In order to avoid confusion, Isserlin (1922) d d~~r~i~at~ between e.~pressiverand irn~r~~~v~~ 737) that Agrammatismus should be Useful as they may be, these distineve not comgleteiy clarified the issue and it is desirable that the sharply demarcated and their respecof the present paper is to individualize one form of agramSy express&e agmmmutism and to uncover its neurolin -very hnguistic rmerance is a linear phenomenon, i.e., it is unfolded in time when it is being produced. ry stands in strong contrast to the simultaneity of the psychic utterance expresses. When I say “I areI hungry”, I am in Cabt evob-ing in time a complex sound pattern in order to make known an unserience, namely my knowledge of my being hungry. “In the electronic computers”, Osgood and Sebeok (1965, p. 132) write, t global impulses from the semantic unit feed into a timer which unreels the message.” ng of a psychic experience often requires that this exzed into parts that will be translated into words in a certain order. “ Es i.st zwischen dem Gedanken und seinem sprachlichen Ausdruck zu ~be~d~~‘, Lenz writes. * “Ais Gedanke ist das Urteil eine Einheit, ebenso wie re Perception &es in der Handlung begriffenen Subjekts; erst durch den rach~jche~ Ausdruck, der die Wahrnehmung mitteilen will, entsteht die Sysedes Urteils in seine Elemente.” The Into which the experience that is to be communicated is analyzed and the order in which these parts are worded, depend on the language
Y.~e~~ln et al., 0~ expressive agrammatism
127
being used. “Unc iangue est un tistrun,:nt dc communication selon lequei 1’~xp~ri~n~e humaine s’analyse, diffe’remment dans chaque commur ;iutC, ell unite’s dot&s d’un contenu se’mantique et d’une expression phonique .. . e articu~e [= sequences] B sa fac;on les signifiants.” ( from the wholeness of the psychic experience to the linearity of 3he utterance, w ch in normal speakers is effected smoothly and easily,
patients with a lesion
he frontal lobe of the cerebra1 partlc;ular kind of expressive
If at various levels: (1) There are patients who can hold an ordinary conversation but are at a loss as soon as they have to construct a story or ve a circumstantial account rts of the tale one after the of an event. Instead of mentioning the various ical order they tend to mix up the successive stages so that the r cannot make head or tail of their story. A French speakin p,tient of ours was once asked to tell the story of a film she had seen on television the previous day. Although she obviously had understood the plot and could remember what she had seen, she could only give a confused account of the happenings *: On a Patient: EtranglC la I une jeune fille Examiner: Elle est morte? Non monsieur Fatient: Examiner: Alors on ne l’a pas vraiment e’trangMe? Non Patient: Examiner: Et qui a voulu l’dtrangler? C’etait son Patient: L’ex enfin son-son Un bonhomrne qui di _ qui disait eel ‘in que c’e’tait lui qui Qui va ga - va garder Euh 11disait toujours que c’btait lui que par ici que - que comme Euh bonne ils sont deux vous savez b - le / un jour - journalier ? et euh Et un de’tec - ditective Qu’on disai t Et alors ils disaient / les deux vent Vent d’un ciite’ et de l’autre Et alors il paralt que dans le 11ssont dans un cham - dans l- une chambre un et dew mais * Her speech disorder seems to be due to a cerebral vascular disease. t Paraphrasia for joumaliste.
128
Y.LebtuPret al.. On expressiveagrammatism
Vous savez toute - toute proches Et alors le bonhomme Euh le bonhomme done Je n e sais pas - je ne sais pas le nom vous savez Le bonhomme qui disait que / hein attention j’ai Ctdma - j’ai e”td Euh J’dtais Je ne saurais pas le dire Non je ne saurais pas le dire Such patients may also find it difficult to break up the psychic experience which they should phrase. “This is much too broad, I don’t know what to choose”, a patient of Luria’s(1966, p. 382) exclaimed when he was requested to tell what he had been through the year before. Occasionally the patient tides over the difficulty by substituting a story he knows by heart for the story he should construct. Luria and Tsvetkova (1967) report t nat a patient of theirs once “tried to give an extended composition ‘The Nl)rth’, failed, and found ttle solution of the problem by reproduction of a well known verse, ‘The North’ by M. Lermontov.” The story this patient knew by heart was easier to produce because it was ready-made: routined neuronal circuits ensured that the various parts of th: story be timely phrased. His brain could work associately instead of integratiiely. Again, patients with expressive agranmatism often succeed in spinning a tale when they can lean on logically ordered series of pictures. “Each picture”, Luria (1966, p. 378) explains, “is an external aid to deveiopment and the patient does not have to construct his own internal scheme of narration.” (2) fn more severe cases, the patients find it hard to sequence the words that should make up their sentences. It is as if all the words would be formed simultaneously. ‘&Wordscollide on their way out”, a patient of ours once managed to explain. How can this difficulty in sequencing words be explained? Goldman-Eisler (1958) h.as shown that when subjects have to reconstruct an actual sentence by guessi,nge.%c?successiveword in the sentence, their task is not more difficult when .they start with the last word and reconstruct th2 sentence backwards than wlhen they begin with the first word and proceed’to the end of the sentence. This implies that the occurrence of a word i 1 a sentence depends as much on subsequent as on preceding words: “The forward course of speech production is affected by the probability structure of subsequent as well as preceding speech” (Goldman-Eisler 1968, p. 43). This finding accords with Aborn et al.‘s observation (1959) that, when subjects are requested to predict a word that has been omitted from a sentence, “a bilaterally distributed context irxerts greater constraint than a totally preceding or totally following context of the same length”.
i~ire~t~o~a~ ~nt~rde~ende~ce of words in a sentence indicates that the skewer who wants to produce an unrehearsed sentence, must decide on a sentence structure and, up to a certain oint, anticipate the words that will fit into this str~~t~re, before he be ins to utter the sentence. “It is as if the of partial excitation, held in check by the ical structure, but ready to activate the final comts SUCh as those described above fail to achieve a state of ~it~~i~~~ the neurons1 circuits hich correspond to the words of the sjr~ultaneously excited to the full; there ensues a jam in the final co usually such aphasir 6:~ find it less hard to talk when they can resort to a stock phrase because they sari then rely on a routinized neuronal circuit that insures the orderly product on of the phrase constituents. For the same reason these patients are usually able to recite such automatized series as the days of the week or the months of the year. * “Das ae J~ensprechen”* Kleist (I’EM, p. 909) observes, “bildet keir,e Bedingung des ~~tzs~re~~~ens, beide Leistongen sind ja such ihrem Wesen nach ganz versehieden. Dem Reihenspreehen liegt eine gedEchtnism&ige Verkniipfung bestimmter, einzelner, unmittelbar aufeinander folgender Worte zugrunde.” At this point too the patient occasionally resorts to a verse he knows by heart. “A scientist with a meningioma of the posterior part of the left frontal lobe”, Curia and Tsvetkova report (1967), “was given the word ‘thank’ and, in another experiment, the yvord ‘fly’ and was both times asked to construct a selltence including the given word. D&ring a long period of 5-7 minutes he tried to da so, repeating the given word, but was unable to construct a sentence, and then in the tirst experiment at once mentioned a well known part of a poem containing the word ‘thank’ or - in the second experiment a mmery rhyme containing the word ‘fly’.” Patients who find it dif’icult to unreel a sefitence in time can sometimes overcome the difficulty bq relying on a spatial sequence. If one arranges a series of identical cards or buttons in front of the ptient and if there are as many cards or buttons as there are words in The sentence the patient should speak, he will often be able to utter the sentence provided he points at each successive card or button while pronouncing the required words. -!(3) The difficulty of linearizing may also arise in connection with individu-
al words. The patient cannot prnnounce the word he wants because the word
* See patient Hoppo in Kleist (1934, pp. 888,909) and patient Dieck in lsserlin (1922). It is significant that Dieck could recite such series in the ordinary way, but not backwards, i.e. not in a non-automatized way. Hoppe could tell from 1 to 20 but not from 20 to 1. t See Luria and Tsvetkova(1967).
Y. Lebnm et al., On expressiveagrammatism
130
resists its being unreeled in time. It is as if the word would be uttered as a whole without beginning nor end. Compounds are most difficult to utter (Isserlin 1923; Mleist 1939, p. 908), obviously because their constituents need be properly sequenced. Because compounds are on the whole more difficult than non~~mposite words, patients find it usually easier to give lexical contraries (e than morphological contraries (e.g. polite/impolite, papist~a~~tip and He’caen1965). As a rule, such aphasiacs are more successful in re eating everyday than in repeating nonsense words (Dubois et al. 1967). This is due to the fact that when repeating an everyday word they can up to a certain point rely on a routinized cerebral pattern, whereas when repeating a nonsense wcrd they have to organize its pronunciation starting with the beginning of the word and consciously proceeldingto its end. When the patient does not succeed in speaking a usual word he can often be helped by prompting. * Indeed it sometimes suffices to show him the first articulatory movement (e.g. closing the lips as for /b/, /p/, or /ml): the patient imitates the examiner and this voluntary movement enables the cerebral programme which commands the pronunciation of the word to start and run out smoothly. It may also happen that when the patient wants to phrase a psychic experience cetera1 synonymous words or expressions come to his mind, sind he does not succeed in selecting one of the equivalents and in suppressing the others. “If J remember one [name] , all the rest immediately appear and I cannot choose the one I want”, a patient of Luria’s(1966, p. 363) complained. He further stated that he remembered words “in families”. As for the patient described by Cohen and He’caen(1965), he once said jumbe pied genou instead of pied. When synonyms enter the patient’s mind simultaneously they may occasionally give rise to a blend. When he was asked to write the name of the Russian town Go&ii, Luria’s patient “mixed up the two names - the present name of the city, Gor’kii, and its old name, Nizhnii Novgorod.” A patient with expressive agrammatism can thus be confronted with two difficulties: the crush of the constituents of his utterance (syntagnaaticsin& taneity) and the competition between synonyms (p~~~&~/rrn~icsirnultaneity
).
Words and sentences, however, are not all equally difficult: vocables that are used frequently can be more easily selected from the mass of conlpeting items, and sentence patterns that are repeatedly resorted to can be more readily implemented. Patients, therefore, tend to use but a limited number of words (Cohen and He’caen’s patient had an active vocabulary of about * SeepatientGBrard in Lebrun
(1967).
served
by GOodg!ass
and Mayer
( 1958),
they terld
c”“ 1 most habiting and simple sentence tion &onomiq?ie a un dbficit combinatoire” (Dubois et al. 1967) results in a ~aratactic discourse, i.e. “une succession de mOts Ou es trks rdduits e mots jUXtapos& sans liens syntaxiques” (Cohen and “a ~~~~~~ r~~~r~oir~
ered, however, whether t is paratactic speech, which is
nararoyriately, called telegraphic style, is not rather due to an rammatical knowledge, i.e. to th inability to remember actical rules. In other words, was leist (1934, p. 907) not t in maintaining that patients with expressive agrammatism have forgotten me dem Denken gemfssen grammatischen Abwandlungen, Verbindungen tzungen von einzelnen Worten ebenso wie die specifisch rammatischen Artikel, dewsrte und ‘Shnliches”? The following obse rcssive agrammatism can hardly be ascribed to a break-down in morphologrc;ll and/or syntactical competence: (a) As was abserved by Forster (I9 19) an by lsserlin ( 1922) in patient Dieck, aphasiacs with expressive a rammatism can detect the grammatical mistakes when they are shown incorrect sentences, although in most cases they arc unable to put the errors right. (b) Even if they have but to repeat sentences, agrammatic patients tend to convert the syntactical structure of the sentence to be repeated into one of their own habitual sentence structures (Goodglass and Mayer 1950 (c) One important feature of the speech disorder exhibited by Cohen and HBcaen’s patient was: “vision relativement Claire des morphkmes constitutifs d’un syntagme variable, mais impossibilite’ d’en re’aliser la synthese”. (d) As was emphasized by Isserlin (I 922), the speech of patients with expressive agrammatism is simplified, but not erroneous: they do not ccnfuse morphological form, they use but a limited number of them; they do not
Y.Lebrun et al., On expressive agrammatism
132
mix up syntactical rules, they ignore them. In short, their speech is “ein korrekter Telegrammstil”. On the other hand, the following excerpt from the recording on magnetic tape of an interview one of us has had with an agrammatic patient, shows clearly that the kernel of expressive agrammatism is actually the inability to sequence linguistic units, i.e. to effect the transition from thesimultaneity of thought to the lineari@ of language. The patient has been asked what he received for a dessert: Une tarte Patient: Mais jamais Ca fait que Examiner: Quoi ‘jamais’? Patient: Non Donne’ Examiner: Vous l’avez donnCe? Patient: Qui Examiner: Dites un peu ‘Je n’en mange jamais’ Oui c’est - c’est - c’est - c’est * Patient: Examiner: Dites-le ‘Je n’en mange jamais’ Patient: Ouic-c-c C’est bon mais moi La soupe pommes de terre euh le’gumeset viande et ** Suffisant The patient is then reminded that he has not repeated the sentence ‘Je n’en mange jamais’ yet: Patient: Oui-oui mais c’est - c d’accord seulement c - c - c Mais - mais *** None-c Examiner: Qu’est-ce qui vous empsche de la prononcer? Patient: Sais pas c - c - c The patient: is asked whether he can remember the sentence he is to repeat: Patient: Ah oui - ah oui $a - ah oui c - c - c docteur $a oui c - c mais - mais c’est - c’est Dire! The patier] t is asked whether he is saying that ha finds it difficult to sequence * Our patient’s speech disorder is due to a shot in the posterior part of the left frontal lobe.
is a “word heap”, to use Hughlings Jackson’s phrase. *** This is an instance of “abortive start with irrelevant opening words” (Goodglass and Mayer 958). **
This
Y. Lebrun et al, C&2expressive a~a~ilrnati~n e he should
133
repeat:
OUi’
nstein and T. Stertin~, 1959, Sources of contextual constraint upon ~.~~e~~ne~~ta~ Psychology 5 7, 17 1 - 180. , Remarques ~e~ro~~~~sti~:les sur un cas d’agrammade Psycl~ e iv~muk et ~~f~~o~o~~ue62, 273 -296. ldcaen, 1967, Description et classification des aphasics.
cads in ~~E~n~~~.Jou tisme. Joumd
h Wirnverletzung. MonarsF., 19511, Speech production
and the predictability
of words in context.
spontaneous speech. London, Academic Press. Goodffass, Pt. and J. Mayer, 1958, Agrammatism in aphasia. Journal of Speech and Hearing Disorders 23,99- 111. Iserlin, hf., 1922, Uber Agrammatismus, Zeitschrift fur die gesamte Neurologie und
Psycitkmie 75,332~410. Kleist, K., 1934, Gehirnpatkologie. Leipzig, Barth. Lashloy, K., 195 1, The problem of serial order in behavior. In: Cerebral mechanisms in behmior, edited by L. Jeffress, New York, Wiley, pp. 112- 136. Lcbrun, Y., 1967, Linguistic analysis of two cases of emissive aphasia. Journal of Neurological Sciences 4,271-277. Lutia, A., 1966, Human brain and psychological processes. New York, Harper and Row. Lurja, A. and L. Tsve &ova, 1967, Towards the mechanisms of “dynamic aphasia”. Acta neurologica et psychiatrica belgica 67, 104 5 - 1OS? . Mmtinet, A,, 1960, El&zents de linguistique gkekaie. Pxis, Colin. Osgood, C. and ‘I’. Sebeok, 1965, Psycholit~~uistic.~~.oomington, Indiana University Press. pick, A., 1913, Die a~ammatischen &k%Un$en.k3Crlh %JrhW.
77. Ever since, the term has been used to denote various ces. In order to avoid confusion, Isserlin (1922) d d~~r~i~at~ between e.~pressiverand irn~r~~~v~~ 737) that Agrammatismus should be Useful as they may be, these distineve not comgleteiy clarified the issue and it is desirable that the sharply demarcated and their respecof the present paper is to individualize one form of agramSy express&e agmmmutism and to uncover its neurolin -very hnguistic rmerance is a linear phenomenon, i.e., it is unfolded in time when it is being produced. ry stands in strong contrast to the simultaneity of the psychic utterance expresses. When I say “I areI hungry”, I am in Cabt evob-ing in time a complex sound pattern in order to make known an unserience, namely my knowledge of my being hungry. “In the electronic computers”, Osgood and Sebeok (1965, p. 132) write, t global impulses from the semantic unit feed into a timer which unreels the message.” ng of a psychic experience often requires that this exzed into parts that will be translated into words in a certain order. “ Es i.st zwischen dem Gedanken und seinem sprachlichen Ausdruck zu ~be~d~~‘, Lenz writes. * “Ais Gedanke ist das Urteil eine Einheit, ebenso wie re Perception &es in der Handlung begriffenen Subjekts; erst durch den rach~jche~ Ausdruck, der die Wahrnehmung mitteilen will, entsteht die Sysedes Urteils in seine Elemente.” The Into which the experience that is to be communicated is analyzed and the order in which these parts are worded, depend on the language
Y.~e~~ln et al., 0~ expressive agrammatism
127
being used. “Unc iangue est un tistrun,:nt dc communication selon lequei 1’~xp~ri~n~e humaine s’analyse, diffe’remment dans chaque commur ;iutC, ell unite’s dot&s d’un contenu se’mantique et d’une expression phonique .. . e articu~e [= sequences] B sa fac;on les signifiants.” ( from the wholeness of the psychic experience to the linearity of 3he utterance, w ch in normal speakers is effected smoothly and easily,
patients with a lesion
he frontal lobe of the cerebra1 partlc;ular kind of expressive
If at various levels: (1) There are patients who can hold an ordinary conversation but are at a loss as soon as they have to construct a story or ve a circumstantial account rts of the tale one after the of an event. Instead of mentioning the various ical order they tend to mix up the successive stages so that the r cannot make head or tail of their story. A French speakin p,tient of ours was once asked to tell the story of a film she had seen on television the previous day. Although she obviously had understood the plot and could remember what she had seen, she could only give a confused account of the happenings *: On a Patient: EtranglC la I une jeune fille Examiner: Elle est morte? Non monsieur Fatient: Examiner: Alors on ne l’a pas vraiment e’trangMe? Non Patient: Examiner: Et qui a voulu l’dtrangler? C’etait son Patient: L’ex enfin son-son Un bonhomrne qui di _ qui disait eel ‘in que c’e’tait lui qui Qui va ga - va garder Euh 11disait toujours que c’btait lui que par ici que - que comme Euh bonne ils sont deux vous savez b - le / un jour - journalier ? et euh Et un de’tec - ditective Qu’on disai t Et alors ils disaient / les deux vent Vent d’un ciite’ et de l’autre Et alors il paralt que dans le 11ssont dans un cham - dans l- une chambre un et dew mais * Her speech disorder seems to be due to a cerebral vascular disease. t Paraphrasia for joumaliste.
128
Y.LebtuPret al.. On expressiveagrammatism
Vous savez toute - toute proches Et alors le bonhomme Euh le bonhomme done Je n e sais pas - je ne sais pas le nom vous savez Le bonhomme qui disait que / hein attention j’ai Ctdma - j’ai e”td Euh J’dtais Je ne saurais pas le dire Non je ne saurais pas le dire Such patients may also find it difficult to break up the psychic experience which they should phrase. “This is much too broad, I don’t know what to choose”, a patient of Luria’s(1966, p. 382) exclaimed when he was requested to tell what he had been through the year before. Occasionally the patient tides over the difficulty by substituting a story he knows by heart for the story he should construct. Luria and Tsvetkova (1967) report t nat a patient of theirs once “tried to give an extended composition ‘The Nl)rth’, failed, and found ttle solution of the problem by reproduction of a well known verse, ‘The North’ by M. Lermontov.” The story this patient knew by heart was easier to produce because it was ready-made: routined neuronal circuits ensured that the various parts of th: story be timely phrased. His brain could work associately instead of integratiiely. Again, patients with expressive agranmatism often succeed in spinning a tale when they can lean on logically ordered series of pictures. “Each picture”, Luria (1966, p. 378) explains, “is an external aid to deveiopment and the patient does not have to construct his own internal scheme of narration.” (2) fn more severe cases, the patients find it hard to sequence the words that should make up their sentences. It is as if all the words would be formed simultaneously. ‘&Wordscollide on their way out”, a patient of ours once managed to explain. How can this difficulty in sequencing words be explained? Goldman-Eisler (1958) h.as shown that when subjects have to reconstruct an actual sentence by guessi,nge.%c?successiveword in the sentence, their task is not more difficult when .they start with the last word and reconstruct th2 sentence backwards than wlhen they begin with the first word and proceed’to the end of the sentence. This implies that the occurrence of a word i 1 a sentence depends as much on subsequent as on preceding words: “The forward course of speech production is affected by the probability structure of subsequent as well as preceding speech” (Goldman-Eisler 1968, p. 43). This finding accords with Aborn et al.‘s observation (1959) that, when subjects are requested to predict a word that has been omitted from a sentence, “a bilaterally distributed context irxerts greater constraint than a totally preceding or totally following context of the same length”.
i~ire~t~o~a~ ~nt~rde~ende~ce of words in a sentence indicates that the skewer who wants to produce an unrehearsed sentence, must decide on a sentence structure and, up to a certain oint, anticipate the words that will fit into this str~~t~re, before he be ins to utter the sentence. “It is as if the of partial excitation, held in check by the ical structure, but ready to activate the final comts SUCh as those described above fail to achieve a state of ~it~~i~~~ the neurons1 circuits hich correspond to the words of the sjr~ultaneously excited to the full; there ensues a jam in the final co usually such aphasir 6:~ find it less hard to talk when they can resort to a stock phrase because they sari then rely on a routinized neuronal circuit that insures the orderly product on of the phrase constituents. For the same reason these patients are usually able to recite such automatized series as the days of the week or the months of the year. * “Das ae J~ensprechen”* Kleist (I’EM, p. 909) observes, “bildet keir,e Bedingung des ~~tzs~re~~~ens, beide Leistongen sind ja such ihrem Wesen nach ganz versehieden. Dem Reihenspreehen liegt eine gedEchtnism&ige Verkniipfung bestimmter, einzelner, unmittelbar aufeinander folgender Worte zugrunde.” At this point too the patient occasionally resorts to a verse he knows by heart. “A scientist with a meningioma of the posterior part of the left frontal lobe”, Curia and Tsvetkova report (1967), “was given the word ‘thank’ and, in another experiment, the yvord ‘fly’ and was both times asked to construct a selltence including the given word. D&ring a long period of 5-7 minutes he tried to da so, repeating the given word, but was unable to construct a sentence, and then in the tirst experiment at once mentioned a well known part of a poem containing the word ‘thank’ or - in the second experiment a mmery rhyme containing the word ‘fly’.” Patients who find it dif’icult to unreel a sefitence in time can sometimes overcome the difficulty bq relying on a spatial sequence. If one arranges a series of identical cards or buttons in front of the ptient and if there are as many cards or buttons as there are words in The sentence the patient should speak, he will often be able to utter the sentence provided he points at each successive card or button while pronouncing the required words. -!(3) The difficulty of linearizing may also arise in connection with individu-
al words. The patient cannot prnnounce the word he wants because the word
* See patient Hoppo in Kleist (1934, pp. 888,909) and patient Dieck in lsserlin (1922). It is significant that Dieck could recite such series in the ordinary way, but not backwards, i.e. not in a non-automatized way. Hoppe could tell from 1 to 20 but not from 20 to 1. t See Luria and Tsvetkova(1967).
Y. Lebnm et al., On expressiveagrammatism
130
resists its being unreeled in time. It is as if the word would be uttered as a whole without beginning nor end. Compounds are most difficult to utter (Isserlin 1923; Mleist 1939, p. 908), obviously because their constituents need be properly sequenced. Because compounds are on the whole more difficult than non~~mposite words, patients find it usually easier to give lexical contraries (e than morphological contraries (e.g. polite/impolite, papist~a~~tip and He’caen1965). As a rule, such aphasiacs are more successful in re eating everyday than in repeating nonsense words (Dubois et al. 1967). This is due to the fact that when repeating an everyday word they can up to a certain point rely on a routinized cerebral pattern, whereas when repeating a nonsense wcrd they have to organize its pronunciation starting with the beginning of the word and consciously proceeldingto its end. When the patient does not succeed in speaking a usual word he can often be helped by prompting. * Indeed it sometimes suffices to show him the first articulatory movement (e.g. closing the lips as for /b/, /p/, or /ml): the patient imitates the examiner and this voluntary movement enables the cerebral programme which commands the pronunciation of the word to start and run out smoothly. It may also happen that when the patient wants to phrase a psychic experience cetera1 synonymous words or expressions come to his mind, sind he does not succeed in selecting one of the equivalents and in suppressing the others. “If J remember one [name] , all the rest immediately appear and I cannot choose the one I want”, a patient of Luria’s(1966, p. 363) complained. He further stated that he remembered words “in families”. As for the patient described by Cohen and He’caen(1965), he once said jumbe pied genou instead of pied. When synonyms enter the patient’s mind simultaneously they may occasionally give rise to a blend. When he was asked to write the name of the Russian town Go&ii, Luria’s patient “mixed up the two names - the present name of the city, Gor’kii, and its old name, Nizhnii Novgorod.” A patient with expressive agrammatism can thus be confronted with two difficulties: the crush of the constituents of his utterance (syntagnaaticsin& taneity) and the competition between synonyms (p~~~&~/rrn~icsirnultaneity
).
Words and sentences, however, are not all equally difficult: vocables that are used frequently can be more easily selected from the mass of conlpeting items, and sentence patterns that are repeatedly resorted to can be more readily implemented. Patients, therefore, tend to use but a limited number of words (Cohen and He’caen’s patient had an active vocabulary of about * SeepatientGBrard in Lebrun
(1967).
served
by GOodg!ass
and Mayer
( 1958),
they terld
c”“ 1 most habiting and simple sentence tion &onomiq?ie a un dbficit combinatoire” (Dubois et al. 1967) results in a ~aratactic discourse, i.e. “une succession de mOts Ou es trks rdduits e mots jUXtapos& sans liens syntaxiques” (Cohen and “a ~~~~~~ r~~~r~oir~
ered, however, whether t is paratactic speech, which is
nararoyriately, called telegraphic style, is not rather due to an rammatical knowledge, i.e. to th inability to remember actical rules. In other words, was leist (1934, p. 907) not t in maintaining that patients with expressive agrammatism have forgotten me dem Denken gemfssen grammatischen Abwandlungen, Verbindungen tzungen von einzelnen Worten ebenso wie die specifisch rammatischen Artikel, dewsrte und ‘Shnliches”? The following obse rcssive agrammatism can hardly be ascribed to a break-down in morphologrc;ll and/or syntactical competence: (a) As was abserved by Forster (I9 19) an by lsserlin ( 1922) in patient Dieck, aphasiacs with expressive a rammatism can detect the grammatical mistakes when they are shown incorrect sentences, although in most cases they arc unable to put the errors right. (b) Even if they have but to repeat sentences, agrammatic patients tend to convert the syntactical structure of the sentence to be repeated into one of their own habitual sentence structures (Goodglass and Mayer 1950 (c) One important feature of the speech disorder exhibited by Cohen and HBcaen’s patient was: “vision relativement Claire des morphkmes constitutifs d’un syntagme variable, mais impossibilite’ d’en re’aliser la synthese”. (d) As was emphasized by Isserlin (I 922), the speech of patients with expressive agrammatism is simplified, but not erroneous: they do not ccnfuse morphological form, they use but a limited number of them; they do not
Y.Lebrun et al., On expressive agrammatism
132
mix up syntactical rules, they ignore them. In short, their speech is “ein korrekter Telegrammstil”. On the other hand, the following excerpt from the recording on magnetic tape of an interview one of us has had with an agrammatic patient, shows clearly that the kernel of expressive agrammatism is actually the inability to sequence linguistic units, i.e. to effect the transition from thesimultaneity of thought to the lineari@ of language. The patient has been asked what he received for a dessert: Une tarte Patient: Mais jamais Ca fait que Examiner: Quoi ‘jamais’? Patient: Non Donne’ Examiner: Vous l’avez donnCe? Patient: Qui Examiner: Dites un peu ‘Je n’en mange jamais’ Oui c’est - c’est - c’est - c’est * Patient: Examiner: Dites-le ‘Je n’en mange jamais’ Patient: Ouic-c-c C’est bon mais moi La soupe pommes de terre euh le’gumeset viande et ** Suffisant The patient is then reminded that he has not repeated the sentence ‘Je n’en mange jamais’ yet: Patient: Oui-oui mais c’est - c d’accord seulement c - c - c Mais - mais *** None-c Examiner: Qu’est-ce qui vous empsche de la prononcer? Patient: Sais pas c - c - c The patient: is asked whether he can remember the sentence he is to repeat: Patient: Ah oui - ah oui $a - ah oui c - c - c docteur $a oui c - c mais - mais c’est - c’est Dire! The patier] t is asked whether he is saying that ha finds it difficult to sequence * Our patient’s speech disorder is due to a shot in the posterior part of the left frontal lobe.
is a “word heap”, to use Hughlings Jackson’s phrase. *** This is an instance of “abortive start with irrelevant opening words” (Goodglass and Mayer 958). **
This
Y. Lebrun et al, C&2expressive a~a~ilrnati~n e he should
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repeat:
OUi’
nstein and T. Stertin~, 1959, Sources of contextual constraint upon ~.~~e~~ne~~ta~ Psychology 5 7, 17 1 - 180. , Remarques ~e~ro~~~~sti~:les sur un cas d’agrammade Psycl~ e iv~muk et ~~f~~o~o~~ue62, 273 -296. ldcaen, 1967, Description et classification des aphasics.
cads in ~~E~n~~~.Jou tisme. Joumd
h Wirnverletzung. MonarsF., 19511, Speech production
and the predictability
of words in context.
spontaneous speech. London, Academic Press. Goodffass, Pt. and J. Mayer, 1958, Agrammatism in aphasia. Journal of Speech and Hearing Disorders 23,99- 111. Iserlin, hf., 1922, Uber Agrammatismus, Zeitschrift fur die gesamte Neurologie und
Psycitkmie 75,332~410. Kleist, K., 1934, Gehirnpatkologie. Leipzig, Barth. Lashloy, K., 195 1, The problem of serial order in behavior. In: Cerebral mechanisms in behmior, edited by L. Jeffress, New York, Wiley, pp. 112- 136. Lcbrun, Y., 1967, Linguistic analysis of two cases of emissive aphasia. Journal of Neurological Sciences 4,271-277. Lutia, A., 1966, Human brain and psychological processes. New York, Harper and Row. Lurja, A. and L. Tsve &ova, 1967, Towards the mechanisms of “dynamic aphasia”. Acta neurologica et psychiatrica belgica 67, 104 5 - 1OS? . Mmtinet, A,, 1960, El&zents de linguistique gkekaie. Pxis, Colin. Osgood, C. and ‘I’. Sebeok, 1965, Psycholit~~uistic.~~.oomington, Indiana University Press. pick, A., 1913, Die a~ammatischen &k%Un$en.k3Crlh %JrhW.