Bruce Willis Is Retiring From Acting Due to Aphasia. What Is Aphasia?

Recently, the family of the well-known actor Bruce Willis announced that he would be stepping away from acting due to a condition known as aphasia. Though aphasia is not uncommon, many do not know much about this communication disorder, which can affect spoken and written language abilities in a variety of ways.

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What is aphasia?

Aphasia is the result of damage to the parts of the brain involved in language processing, making communication difficult and often frustrating for both those affected and their loved ones. The most common cause of aphasia is a stroke, though traumatic injury, a brain tumor, infection, or other diseases can also cause it.

How exactly language is affected and whether both speech production and speech comprehension are impacted depends, in large part, on where the brain has been damaged and how severe the damage is. Much work in neurolinguistics focuses on how differences in the types of language deficits seen in aphasia patients can lead to a better understanding of the organization of language in the brain.

Types of aphasia

There are several different types of aphasia, each associated with different language deficits. The three most often discussed are Broca’s aphasia, Wernicke’s aphasia, and Global aphasia.

Broca’s aphasia

Identified in the 1860s by the French surgeon Paul Broca, who noticed several patients with similar types of speech disorders, Broca’s aphasia occurs when there is damage to the rear portion of the frontal lobe in an area thought to control the articulation of speech (known as Broca’s area). People with this form of aphasia are generally thought to be able to understand but not able to produce speech well.

This type of aphasia is often referred to as non-fluent or motor aphasia, as patients seem to struggle to get out what they want to say, despite seeming to know the thought they want to express. As a result, their speech is sometimes described as sounding like a telegram, without the ability to use function and connective words such as "the," "it’s," "to," or, "and," or grammatical endings like "-ing" or "-ed." For instance, they might say “John…house,” with a long laborious pause in between, for “John is going to the house."

Though difficulty producing sounds and correct sentence prosody (intonation) is very common, Broca’s patients also appear to suffer from a grammatical deficit, meaning it’s hard for those with this type of aphasia to come up with the words to fit together in the larger structure of a sentence. And, unlike some other forms of aphasia, those suffering from this condition are very aware of their deficit and find it difficult and frustrating to speak.

Language/brain organization is not that well understood.

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Wernicke’s aphasia

In contrast to Broca’s aphasia, those with damage to an area in the temporal lobe (the side portion of the brain) exhibit a condition known as Wernicke’s aphasia, named after the German physician who identified it in 1874. In this type of aphasia, the area of the brain that deals with monitoring production and semantics (or meaning) seems to be affected, though patients with this kind of aphasia are often not aware they have any problems.

In Wernicke’s, or fluent, aphasia, patients speak very smoothly and use function words and normal rhythm (prosody), but what they say does not make any sense. An example of a sentence that a Wernicke’s patient might produce would be something that sounds almost random, “You know, the smoothie is hitching like this to go,” or which might be somewhat less randomly constructed but not relate to what was said before, “That is her cat” to a query about the time.

Patients with Wernicke’s aphasia have difficulty comprehending what others say as well as producing sentences that are sensible to others. From the types of deficits found with this form of aphasia, it appears that this area of the brain—the temporal-parietal lobe—plays a big role in regulating semantic relationships and meaning. As a result, Wernicke’s is largely considered a condition affecting comprehension, which, in turn, limits a person’s ability to produce meaningful sentences.

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Global aphasia

There are also severe forms of aphasia, known as global aphasia, where all aspects of language, from speaking to comprehension to reading and writing are impaired. In such cases, patients are sometimes only able to utter automatic responses like "no" or idiomatic phrases like "how are you?" which may, unlike other language aspects, be housed in the right hemisphere of the brain. However, even with such severely impaired speech, global aphasics still often show normal function in other non-verbal domains, like picture matching.

How is aphasia treated?

Though aphasia might sound like a very frightening disorder, there is often hope for improvement as the brain heals and/or with treatment in the form of speech and occupational therapy. In many cases,, especially when caused by stroke or injury, patients will recover some of their language abilities and learn some compensatory strategies to help with what is not recovered. Similarly, those who spend a lot of time with someone who has aphasia can learn techniques like speaking slowly and using short sentences as well as relying on gestures, facial expressions, and eye gaze to help with better and less frustrating communication.

While the family has not released information on which kind of aphasia Willis has, or the root cause, there is good reason to hope that he will be able to find ways to communicate successfully and enjoy life, even if acting is no longer a part of it.