Multilingual Aphasia: A Personal Testimony
Experiencing a stroke and its effects on language and speech.
Posted Sep 09, 2019
A few years ago, I wrote two blog posts on multilingual aphasia, that is language and speech impairment in multilinguals due to brain damage. In the first (see here), I reported on a well-known case study of a man who suffered from aphasia after a stroke and whose first language to come back was not his native language but his third language. As a consequence, he could not speak to his wife directly as she did not know that language. In a second post (see here), I surveyed the various recovery patterns that one finds and the many factors that seem to account for them.
Dr. Valerie Lim, a speech-language therapist (see here), contacted me a few weeks ago to tell me that she had a multilingual aphasic patient, Isabelle K., in her late forties, who was willing to be interviewed. I was thrilled as a personal testimony can be of interest to others recovering from aphasia, their family members and friends, and the general public. It can also be motivating for the person herself who is struggling to recuperate her language(s). I am truly grateful to both Isabelle for her testimony, and to Dr. Lim who put us in touch with one another.
Isabelle, please tell us a bit about yourself and your multilingualism. First, which languages did you speak as a child, with your parents and grandparents?
My father was Japanese and my mother Swedish. Although I was born in Sweden, we lived in Japan until I was 11. English was the common language between my parents, and so it became the language at home. In my early years, my mother spoke English with me but then she started teaching me Swedish when I was seven. With my father, I spoke English and a bit of Japanese. As for my Japanese grandparents, my sister and I would communicate with them only in Japanese as they could not understand English.
What about the languages you used during your schooling?
At age 6, I went to an international school in Tokyo where my classes were all in English, except for Japanese classes. I learned French when I was 11 years old but only really improved it as an adult.
English got a definite boost when I went to boarding school in the UK between the ages of 11 to 18 and then to Oxford University for my undergraduate studies. I also went back to Japan over the summer all these years to see my grandparents.
For postgraduate studies from the ages of 23 to 26, I went to the Stockholm School of Economics to do a Masters degree in Economics and Finance. During those three years, my Swedish improved significantly.
Currently, which language(s) do you use with your husband and at work?
My husband is a French-speaking Belgian but we have always spoken in English together since we met in London and lived there for many years. We lived in Paris between 2010 to the end of 2012, so my French improved but I am not fluent in it by any means.
As for my work, English is my main language, although I am on disability leave currently. I used Japanese about once a year when I flew to Japan for my work.
Two years have gone by since your stroke. Can you first tell us what happened on the day that you had your accident?
On August 22, 2017 at 1.30pm—I remember the moment so well—I was working in my office in Singapore and I had a severe stroke. I had had the worse headache during the morning, and was sitting at my desk finishing a conference call when I fell to the floor and I could no longer speak. I remained calm but I needed an ambulance immediately.
I had suffered an ischemic stroke, that is an artery in the brain had become blocked. Almost the entire left side of the brain where the speech function is located was affected. The significant and rapid brain swelling led the doctors to perform a decompressive craniectomy—part of the skull was removed—which saved my life. After a few days I regained consciousness only to discover that the right side of my body was paralyzed (hemiplegia) and I could not utter a single sound.
How did you become aware that you had become aphasic? Which languages could you no longer speak?
I could not speak aloud any one of my languages when I woke up in the intensive care unit. I had completely lost the connection between my brain and my vocal cords. I could not utter a single sound! I was also suffering from speech apraxia (inability to coordinate speech muscles), and dysarthria (slurring of speech) given my paralysis on the right-hand side of my body, including my face and mouth.
My family was quite stressed but inside me, I thought to myself that my speech would definitely come back. My husband, after a lot of research, pushed the doctors to try out music therapy with me. And because of it, on the day of my birthday a few weeks later, my voice came back and I could sing happy birthday in English! The doctors could then make a diagnosis and confirm strong aphasia as well as apraxia.
How about speech comprehension of your different languages? Was it hindered too?
Aphasia affected my expressive functions significantly, but my comprehension was not as affected. Based on the conversations around me when I was in the hospital, I could understand English and 40% of French. Five weeks later, I realized I was able to comprehend conversational Swedish when I skyped my mother, and eight weeks later I was able to understand my Japanese neighbor when I came home from the hospital.
Comprehension often comes back first. What about language production apart from English which came back first?
I recovered Swedish about a year ago and Japanese about 8 months ago. I heard French every day, since my husband was speaking French with business colleagues and friends on the phone, and even though I now understand 60% of French, I can only say a few words in it.
And your ability to read and write? Did it suffer too?
Yes, it did. Initially, while I was still at hospital for my stroke, I was able to read in English but I did not write at all well. My writing in English has improved progressively since then—my therapy takes place in that language—but I still cannot write as I could pre-stroke. Swedish was the second language to come back, and I can now read at 90% and write at 60%. Japanese is only coming back slowly after 2 years, but it is far from the level I used to have pre-stroke.
Not being able to express oneself is extremely distressing. How did you live through this difficult time?
I was frustrated but I was not distressed. I have been quite lucky so far to have the strength to keep fighting every day without being too depressed. I guess it is also because I am so happy to be alive and every day is a gift. But it is indeed quite difficult to be one day a multilingual professional and the next day not being able to communicate properly with other people.
Were there moments when you felt that you were not making any further progress?
Many a time–I felt that my speech was not making any improvements, or only marginal improvements. It was about a year and a half ago, I confided in my husband that I was not making the progress I needed to and he comforted me by saying that my speech would come, slowly and surely. In the last three months, my speech has been more rapid, more accurate, and more diverse. It is a marathon and every day is another opportunity to make a little progress.
What are your remaining problems today?
Although I have improved, speaking English is still slow. When I am perky, I can now say 70-75% of what I want to say pre-stoke. This is already much better than 15 months ago, when I was only able to say 25-30% of what I wanted to. But when I am tired it slides down to about 50%. As they say, once you have completed 90% of the journey, there is still half of the way left!
All cases of aphasia are different from one another but would you have a few words of advice for aphasic patients who are just starting therapy, and for those who surround them and take care of them?
Start your speech therapy soon. Never give up—however long it takes. Your brain is making new connections every day, but it can take a long time in aphasic patients. Try new things, for example, read out loud, use music therapy which is excellent, and cognitive function therapy helps too.
Finally, those who are caring for us should keep having words of encouragement such as, "It is awfully hard to do what you are having to do after the stroke, but keep it up, and in a couple of years reap the benefits. Even if you cannot speak perfectly, well done!" Dr. Valerie Lim has been very encouraging. She has accompanied me from the beginning in my speech recovery journey and I want to thank her.