One Hundred Names for Love: A Memoir

by Diane Ackerman

  Jaynes’s theory argues that these vividly distinct voices arose in the right hemisphere, in the convolutions that are counterparts to the left hemisphere’s language centers. After all the damage Paul had suffered to the left, in precisely those regions, could it be that his mind was compensating by unleashing the usually stifled voices in his right? To keep a continuous sense of self alive, perhaps? After all, someone had to call the shots, tell him what to do, even if his longstanding, carefully whittled “self” was temporarily fractured into several voices, not many compared to the mob reported by some folk.

  “I had been splintered into a million beings and objects,” Vladimir Nabokov wrote in an essay on sounds. “Today I am one; tomorrow I shall splinter again. . . . But I knew that all were notes of one and the same harmony.”

  “The head we inhabit is a haunted house,” philosopher William Gass once wryly observed, full of “the words which one burns like beacons against the darkness.” At heart lies “this secret, obsessive, often silly, nearly continuous voice . . . the silent murmur of us, our glad, our scrappy, rude, grand, small talk to ourselves, the unheard hum of our humanity.”

  Talk we must, we haven’t any choice. As babies we babble, and we keep right on babbling as grown-ups, too—but silently, to ourselves. The words in the haunted houses of our minds never stop, even inside the head of someone with aphasia. Not speaking to someone you barely know is considered a slight, and if you know them well it’s a blind arrow of anger or cruelty. Not talking to someone is regarded as passive violence, which is why we call it “cutting someone” or “cutting someone dead.” We remember who we are, what we did, how we felt in words, even if most of the time we-don’t-know-who is saying we-don’t-know-what to we-don’t-know-whom. We talk to ourselves all day, even while eating or making love, and at night we talk to ourselves in our sleep. We talk to cooperate and exchange ideas with others—it’s how our species survived—but also to commune with that compound ghost, our so-called “self,” and know how we feel, consider what we’re doing, analyze whether someone may be a killer, a rival, a mate.

  Some unlucky stroke patients are haunted, not with alien voices but with alien limbs, a rare neurological condition when a hand seems to have a will of its own, reaching out and grabbing things (or, most embarrassingly, body parts) unbidden, and needing to be wrestled down by the other hand. Sometimes called the “Dr. Strangelove syndrome” (after the Peter Sellers character in the movie of the same name, whose arm would suddenly shoot up in Heil Hitler! salutes), it makes the limb seem foreign to its owner, so beyond conscious control that patients usually give it a name, or refer to it as “It.” “It” may even try to strangle its owner. The cause remains a mystery, but seems to stem from multiple lesions in the brain that, in effect, separate it from itself in too many places, more than it can overlook and still feel whole. It made sense to me that lesser lesions in Paul’s brain might do something similar, not with limbs but with the speechifiers inside, the homely ghosts we talk to when we talk to our “selves.”

  “THREE DAYS OUT of seven, I can zoom,” Paul stage-whispered the next day, “the others no,” by which he meant speak, converse. His verbal ability also seemed affected by how much he’d slept, and even by the whims of weather and the time of day. True for all of us, as our brain cycles and rests. The best time of day for brainwork changes with age. A child’s internal clock naturally summons it to sleep at around 8 or 9 p.m. Teens tend to grow sleepy later, at around 11 p.m.; need nine hours of sleep, even if they rarely get it; and are notoriously hard to wake up. College students often report feeling brightest at night, and the elderly say they’re sharpest in the morning. Negative ions—molecules naturally produced at cascading waterfalls, beaches loud with heavy surf, or after a spring thunderstorm crackling with lightning—create more oxygen in the brain, which makes us feel exhilarated and more alert.

  It made sense that his “dictating” ability might vary from day to day, just as his speaking did. Also that it would provide invaluable speech therapy, if he continued to prod his brain to craft language until it wore itself out. And he’d be focused on what had always made him happiest: being immersed in a writing project, something creative and constructive which he was motivated to continue. I know now, as I sensed then, that it’s essential to tailor rehab to what impassions someone. The brain gradually learns by riveting its attention—through endless repetitions, alas.

  Right after breakfast, Paul felt most fluent, and that’s when he usually met me on the couch with a short list of notes on a small scrap of paper. Sometimes he sat down and studied his carefully prepared scribblings, unable to decipher his own craggy handwriting no matter how hard he tried. Other times even I could read the list, which might include a one-word cue such as “Morpurgo,” and sure enough, at some point during the hour, he would slip out a phrase like the “pitter-patter of Dr. Morpurgo’s feet.”

  The dictation was exhausting for both of us. For the hour or so I needed to concentrate hard on deciphering errant, often-wrong words, using my own language skills to do overtime, climb cliffs of possible meaning, looking for any toehold. After years of writing poetry, odd combos of words didn’t faze me, and I knew Paul’s habits of word and mind, so I could catch his dictated curve balls, but it became clear to me that I couldn’t be his secretary. It would sap all my writing energy, change our relationship, erase my creative self, bruise my own voice, reduce me to excavating when I needed to be freewheeling. And so I gently suggested that Liz be recruited to help transcribe his outpourings, and fortunately she agreed.

  Day after day, Paul continued dictating, sometimes with mountain-moving effort, and others sailing along at a good clip, freeing an account of what he’d gone through, what the inner world of aphasia felt and looked like. It was Paul’s chosen regimen, a struggle that helped him to organize his mind, which also impressed upon us all just how wounded his brain had been. Composing his narrative—and relating it to someone while doing so—was the best speech therapy anyone could have prescribed. For an hour of animated slogging every day, he stubbornly forced his brain to recruit cells, build new connections, find the right sounds to go with words, and piece together whole sentences. Painstakingly reviewing the text with him the next day helped Paul clarify his thoughts and gave him the opportunity to repair some of aphasia’s fingerprints in the prose. In those moments he transcended his brain injury, and was able to repossess himself, narrate and reorder his life. At times, what he said sounded nonsensical, but Liz and I were both punctilious about recording him exactly, whether he made sense or not.

  We already knew that when someone has aphasia, working out a seemingly simple, yet new, practice can be incredibly frustrating. Dictation was no exception. From the kitchen one day, I overheard Paul and Liz working through a typical roadblock.

  Paul requested a “new paragraph.”

  Liz presented him with the newly typed paragraph.

  Disappointed, he insisted, “No, new paragraph.”

  She stated emphatically, “It is a new paragraph.”

  He said, “No, new paragraph.”

  And round and round they went, both baffled and frustrated, until finally Liz figured out that Paul really meant “new chapter.”

  He made other irregular substitutions as well. “Period” for comma. “Full-stop” (British) for period. “Period” for question mark. The flags of punctuation are all symbols, and they defied him. For some bizarre reason known only to his gray matter, he didn’t make mistakes with the semicolon.

  To add to the general confusion, Paul was now the king of malaprops and a geyser of neologisms, at times substituting the wrong word or mispronouncing to the point of unintelligibility. For instance, trying to catch the word “cloud,” and pronouncing only the word “loud.” “Skeleton” became “skellington.” “Mold” came out as “mole.” He said “pillar” when he really meant “pillow.” He could only convey the id
ea of an umbrella if he referred to it as a “pagoda.” A simple word like “hurt” mutated into the more dire “hearse.” For “obsess” he’d say “abscess,” as if obsessing were a sort of boil in the brain. On the other hand, we were often surprised when we tried to puzzle out what we thought were nonsense words we’d faithfully written down phonetically—pallaisse, corybantic, halma, fatidic—only to discover they were real if obscure words, outside our vocabularies.

  What emerged in time was an aphasic’s journal yanked out of the brain attic, an account of stumbling around in his scary new mental landscape, searching for hidden light switches and keys to locked rooms, while dodging cobwebs of numbers, moth-eaten garlands of logic, dusty shoeboxes full of old photographs, newsreel memories, and, scattered everywhere, disintegrating sacks of word-shells collected over a lifetime—lightning whelks, owl limpets, heart cockles, alphabet cones, fighting conchs, pearly jingles, tiger cowries, saw-toothed pens, frilled dogwinkles, banded turbans, noble volutes, and thousands more—all knuckled together in quiet inclines that were threatening to spill. The book he christened The Shadow Factory, a unique chronicle of his first aphasic months, and he published it with Lumen Books, the avant-garde press in Santa Fe, known for its books on architecture and design, fiction and poetry, especially in translation.

  CHAPTER 25

  TO MY SURPRISE, PAUL HAD THE URGE TO CREATE EVERY single day. The habit of using language to express himself, despite the Sisyphian difficulties, still persisted. The language mill in Paul’s brain may have been blasted by the stroke, but apparently not the pied-à-terre of the muses. Where might those fickle ladies reside?

  By most accounts, the right side of the brain organizes creativity, but it’s a suspected whereabouts defined mainly by loss (people with right-hemisphere strokes typically lose their gift for poetry, music, or painting). Paul’s brain had always relished thinking in images, and he’d spent a lifetime being creative, in the process farming more of the neural landscape in his imaginative, intuitive right hemisphere. An ordinary feat. Every brain spirals and dovetails in unique ways, and propensity often leads to predilection—having a talent for something makes spending time at it pleasurable, which in turn shapes and fortifies the gray matter for it. Physical exercise develops muscles; mental exercise remodels the brain. Painters grow richer visual-association ranges; musicians auditory glens; writers language orchards.

  Paul’s lifetime as a wordsmith would have built dense language country, with more back roads between the hamlets, even if the major highways had crumbled, and more neural networks, wired as java joints and hopping to serve. My hunch was that his brain still had tillable hills and valleys, where a crop of words might yet flourish. This would help explain why he was speaking at all, given his CAT scan’s grim cameo. Creative brains nimbly scout both hemispheres for raw material—it’s a whole-brain enterprise. One needs the left hemisphere to inspect the results emerging from the right, and decide if the work is apt, original, and effective. So a well-built bridge between the hemispheres (the corpus callosum) must also play an essential role in creativity, and Paul’s would be built for heavy traffic, because he’d been bracing (even frescoing) it for decades.

  That seemed likely, especially since Paul had studied French, Latin, and Greek in school. Learning multiple tongues would have bolstered the language connections in his right hemisphere as well as in his left. We know from brain imaging done with bilingual speakers that most of us don’t take advantage of all the language room we inherit, which can be greatly enhanced. A person speaking one language shows activity in the classic left-hemisphere language areas. But as a bilingual speaker switches rapidly from one language to another, she increases the activity in both the right and left hemispheres, engaging more of what’s available for language, in time cultivating many more brain cells. Also, bilinguals, just like taxi drivers, jugglers, and symphony orchestra musicians, grow denser gray matter in areas related to their skills. The earlier the better, with the most changes in people who learn a second language before the age of five.

  A neuroscientist friend had told me about a visit from a Norwegian colleague who was surprised by the frequency of post-stroke aphasia in the United States compared to Norway. His colleague theorized that Norwegians fare better because they learn several foreign languages as children, giving them a distinct advantage in later years. Quite often, like the Czech-speaking violist, aphasics who lose access to their primary language can still remember a foreign tongue. Paul began studying French at ten, Latin and Greek at seventeen—late by some measures, but tilling spare gray matter nonetheless, because the temporal lobes (replete with regions that process language and emotions) are still efflorescing until around sixteen, when another round of pruning begins to sculpt the topiaries of the brain. And even then, honing new skills, or even new ways of thinking, can fertilize a bed of neurons, increasing its size.

  Ideally, post-stroke rehab should play to each patient’s strengths, the dense knots and networks of gray matter developed over a lifetime of use, one’s own private larder or offshore bank account. In college courses, a teacher often encounters the rubric of “all that must be learned,” but discovering how each student learns best is far more effective. It takes longer, and ideally the student and teacher will be a good “match.” The same is true with rebuilding after a stroke. Not just remodeling from scratch, but finding extra or out-of-the-way storehouses, and rewiring paths to them, bushwacking with unconventional tools if need be, uncovering lost or meandering trails, guiding by invisible and at times intuitive maps.

  Since Paul was naturally creative, a wild and woolly thinker, it wasn’t really surprising that he balked at conventional speech therapy, with its linear, fill-in-the-blank, right-or-wrong answers. Before his stroke, his brain hadn’t worked that way; that’s not where his strengths lay. In any case, everyone learns better through play—though, after a severe stroke, finding a playground may not be easy. It depends on what amused a loved one beforehand, and blazing paths, at a snail’s pace if need be, to that hidden reservoir. In Paul’s case, progress could only be made by pointing out the slime left by the snail, the calcium “love darts” that snails use during courtship, and any grotesque scenery along the way, since he loved weird metaphors.

  To build even such a slight metaphor, the brain hunts far and wide, across neural networks in both hemispheres, and connects seemingly unrelated tidbits that nonetheless have things in common. Different domains of knowledge are slammed together. It’s a pictorial kind of thinking, pre-rational and full of emotional intensity, a way of painting thoughts and feelings. When Lord Byron dubbed his wife-to-be “the Princess of Parallelograms,” he very effectively combined her rare gift for mathematics with her wealthy family, strict morals, elegant beauty, and cool demeanor.

  What we airily label creativity typically blends so many features: risk-taking, perseverance, problem-solving, openness to experience, the need to share one’s inner universe, empathy, detailed mastery of a craft, resourcefulness, disciplined spontaneity, a mind of large general knowledge and strength that can momentarily be drawn to a particular, ample joy when surprised, intense focus, the useful application of obsession, the innocent wonder of a child available to a learned adult, passion, a tenuous (or at least flexible) grasp on reality, mysticism (though not necessarily theology), a reaction against the status quo (and preference for unique creations), and usually the support of at least one person—among many other ingredients.

  In the throes of creativity, a lively brain tussles with a mass of memories and rich stores of knowledge, attacking them both sub rosa and with the mind wide open. Some it incubates offstage until a fully fledged insight wings into view. The rest it consciously rigs, rotates, kneads, and otherwise plays with until a novel solution emerges. Only by fumbling with countless bits of knowledge, and then ignoring most of it, does a creative mind craft something original. For that, far more than the language areas
are involved. Hand-me-down ideas won’t do. So conventions must be flouted, risks taken, possibilities freely spigoted, ideas elaborated, problems redefined, daydreaming encouraged, curiosity followed down zigzagging alleyways. Any sort of unconsidered trifle may be fair game. It’s child’s play. Literally. Not a gift given to an elect few, but a widespread, natural, human way of knowing the world. With the best intentions, our schools and society bash most of it out of us. Fortunately, it’s so strong in some of us that it endures. As neuroscientist Floyd Bloom observes:

  Schools place overwhelming emphasis on teaching children to solve problems correctly, not creatively. This skewed system dominates our first twenty years of life; tests, grades, college admission, degrees and job placements demand and reward targeted logical thinking, factual competence, and language and math skills—all purviews of the left brain. . . . [T]he brain is a creature of habit; using well-established neural pathways is more economical than elaborating new or unusual ones. Additionally, failure to train creative faculties allows those neural connections to wither.

  Creativity is an intellectual adventure into those jungles where the jaguars of sweet laughter croon, with a willingness to double back, ignore fences, or switch directions at the drop of a coconut.

  Why was Paul doing so well, all things considered? One small piece of the puzzle, strangely enough, may be that his earlier stroke—a small one, known as a TIA—probably worked in his favor. Swiss scientists Paciaroni, Arnold, van Melle, and Bogousslavsky reported, after studying over three thousand stroke patients, that “the occurrence of previous TIAs was significantly related to a better outcome.” They offered several explanations, among them that the slow blockage of an artery that leads to a TIA—like the narrowing of a hose—forced the brain to irrigate through other channels. After that, when the big stroke hit, there were backup routes for blood flow. Also, these patients were already on anticoagulants because of the TIA, a mixed blessing, preventing the use of tPA but still possibly protective.