Explainer: what is aphasia?

After racking up more than 100 films over the span of four decades, Bruce Willis is closing out his stellar acting career. In a statement released by his family, his withdrawal from the spotlight has been attributed to a recent diagnosis with a condition called aphasia.

Never heard of aphasia before? You’re in good company. In a 2020 survey on aphasia awareness, 86.2% of participants had never heard of the condition. Of the few who did recognise the term, a third either had aphasia themselves or personally knew someone who did.

The disorder simply doesn’t have the broad recognition of Parkinson’s disease, cerebral palsy or multiple sclerosis.

And yet, aphasia is more common than any of these, affecting over a million Australians – and twice that number in the US.

So what is it?

Aphasia explained

Aphasia is an acquired communication disorder that impairs a person’s ability to process language – sufferers struggle to speak and to understand others, and often also experience difficulties with reading and writing.

But there’s no one-size-fits-all description of the disorder, and its severity can be wide ranging. In mild cases, aphasia may be barely noticeable. In more severe cases, communication can become near impossible.

Importantly, aphasia is not a disease, but rather a symptom of brain damage. This means that there’s no one single cause of the condition. Instead, aphasia may occur suddenly, often as a result of a stroke or head injury, or may creep up insidiously as a side effect of a brain tumour, infection or dementia.

The exact location of damage to the brain determines the nature and severity of the resulting language dysfunction. Generally, aphasia can be divided into three broad categories:

Broca aphasia: patients have damage to front portion of the language-dominant side of the brain. They may eliminate simple words, like “and” and “the”, from their speech, but can still construct meaningful – if abbreviated – sentences. The patient knows what they wish to say, but simply can’t find the words to say it.

Wernicke aphasia: patients have damage to the side portion of the language-dominant portion of the brain. They often speak in rambling, confusing sentences, adding unnecessary words or creating entirely new words of their own. The patient can hear spoken words without difficulty, or read words in print, but struggles to make sense of them.

Global aphasia: patients with this most severe presentation have more profound difficulties with all aspects of speaking or comprehending language.

Aphasia doesn’t indicate diminished intelligence

The aphasia awareness study offered another telling insight, beyond the lack of recognition of the disorder. Nearly half of all respondents strongly correlated intellectual capacity with speech ability, believing that “if a person has difficulties with speech, they also have intellectual deficiencies”.

While it’s easy to assume that the loss of speech correlates with the loss of an internal dialogue, and consequently of a thinking mind, this is absolutely not true of patients with aphasia – and it’s an assumption that can make interactions with aphasia patients unnecessarily challenging.

Provided the brain injury that caused the aphasia hasn’t impacted other areas of the brain, the damage wrought in the language centre of the brain doesn’t affect what patients remember, or how they think. They retain the same personality – the same bad jokes, strong opinions, and lifetime of stories are still present inside the mind, but now the patient struggles to make them manifest in the external world.

Treating aphasia

Aphasia isn’t necessarily a life-long diagnosis. The brain is a remarkably flexible and resilient organ, and many people with aphasia see dramatic improvements in their language abilities with dedicated treatment.

Research has shown that communication abilities can continue to improve for many years after traumatic injury and the onset of aphasia, though progress is largely determined by the extent of the injury. In slow-developing cases, such as those associated with the onset of dementia, recovery may not be possible – but targeted therapy may still assist in developing ways to build on remaining language abilities, incorporating alternative means of communication such as sign language or pictures.

Increasing aphasia awareness

The tragedy of aphasia lies in its shrouding silence – shut inside their own minds, sufferers struggle to convey the nature of their experience. As a result, despite its prevalence, aphasia is largely unknown in the general community.

This can make life incredibly challenging for aphasic patients and their carers, not only in their personal sphere, but in accessing social and medical services.

Increasing aphasia awareness is a vital step towards alleviating some of the difficulties that patients face. According to the awareness survey, among those who were aware of the condition, movies and television were one of the most commons means of introduction. Tragic though his diagnosis is, Willis’s publicly declared diagnosis with aphasia could make significant inroads in garnering the crucial awareness needed for this silent struggle. His acting career will be widely celebrated, but this may yet be his most vital contribution to the world.