Basic Problems of Neurolinguistics 9783110800159, 9789027932051

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JANUA LINGUARUM STUDIA M E M O R I A E NICOLAI VAN WIJK D E D I C A T A edenda curat

C. H. VAN S C H O O N E V E L D Indiana University

Series Maior

73

BASIC PROBLEMS OF NEUROLINGUISTICS

by

A. R. Luria

1976

MOUTON T H L H A G U E - PARIS

© Copyright 1976 Mouton & Co. B.V., Publishers, The Hague No part of this book may be translated or reproduced in any form, by print, photoprint, microfilm, or any other means, without written permission from the publishers.

Original Title Osnovnye problemy neirolingvistiki (Moskva, 1975) Translated from Russian by Basil Haigh

The publication of this work has been supported financially by the International Brain Research Organisation

ISBN 90 279 3205 0

Printed in Germany

FOREWORD

This book has a double aim. Firstly it has to review the observations on disturbances of language and speech associated with local brain lesions in relation to modern neurology, psychology and linguistics the author has made during the last few decades. Secondly it has to try to take the first steps towards a general scheme of a new branch of science - that of Neurolinguistics, using observations on disturbances of language and speech in patients with local brain lesions as a method for a better understanding of some c o m p o n e n t s of language itself. The author starts from the assumption that every local brain lesion results in a breakdown of one of the components of linguistic processes and thus can be used as an approach to an objective analysis of the structure of language as well. The book is divided into two parts. The first deals with the neuropsychological analysis of encoding and decoding of verbal communications and their disturbances in local brain lesions. The second discusses some problems of the revision of complex forms of aphasia in the light of modern neuropsychology. The author wants to express his most affectionate thanks to Dr. Basil Haigh for his excellent translation of the Russian text, and to Mouton Publishers and especially to Mr. Paul M. Waszink for the decision to publish the English version of this book. Last but not least, he expresses his gratitude to the International Brain Research Organisation, which supported its publication. Moscow May 1976

Λ. R. L.

TABLE OF CONTENTS

Foreword

V

Part I. NEUROPSYCHOLOGICAL ANALYSIS OF VERBAL COMMUNICATION I. The Problem of Verbal Communication 1. The Structure of Verbal Communication 2. Psychological Conditions of Verbal Communication 3. Neuropsychological Approach to the Process of Verbal Communication II. Neuropsychological Analysis of Encoding of Verbal Communication . A. Disturbances of the Syntagmatic Organization of Verbal Communication in Patients with Local Brain Lesions 1. Disturbances of Verbal Communication in Patients with Deep Lesions of the Brain 2. Disturbances of Verbal Communication in Patients with Frontal Lobe Lesions 3. Disturbances of Verbal Communication in Patients with a Syndrome of Dynamic Aphasia 4. Disturbances of Verbal Communication in Patients with "Telegraphic Style" 5. Disturbances of Verbal Communication in Patients with Complex Forms of "Efferent Motor Aphasia" B. Disturbances of the Paradigmatic Organization of Verbal Communication in Patients with Local Brain Lesions 1. Disturbances of the Articulatory Components of Verbal Communication in Patients with "Afferent Motor Aphasia" 2. Disturbances of the Acoustic Components of Verbal Communication in Patients with Sensory (Acoustic) Aphasia

3 4 29 42 48 52 55 57 64 73 83 95 99 106

VIII 3. Disturbances of the Encoding of Verbal Communication in Patients with Acoustico-Mnestic Aphasia 4. Disturbances of the Encoding of Verbal Communication in Patients with the "Fronto-Temporal Syndrome" 5. Disturbances of the Encoding of Verbal Communication in Patients with "Semantic" Aphasia C. Conclusion III.

Neuropsychological Analysis of the Decoding of Verbal Communication 1. The Psychological Process of Decoding of Verbal Communication a. Understanding of Word Meaning b. Understanding of Syntactic Constructions c. Understanding of Complex Verbal Communication (Text) 2. Methods of investigation of the Decoding of Verbal Communication. General Data of Neuropsychological Analysis 3. Disturbances of Understanding of Verbal Communication in Patients with Sensory Aphasia 4. Disturbances of Understanding of Verbal Communication in Patients with Semantic Aphasia 5. Disturbances of Understanding of Verbal Communication in Patients with Syndromes of Motor Aphasia a. Disturbances of Understanding of Verbal Communication in Patients with Afferent Motor Aphasia b. Disturbances of Understanding of Verbal Communication in Patients with Efferent Motor Aphasia 6. Disturbances of Understanding of Verbal Communication in Patients with Deep Brain Lesions and Syndromes of Memory Disorders 7. Disturbances of Understanding of Verbal Communication in Patients with Massive Lesions of the Frontal Lobes 8. Conclusion

115 122 127 136

143 143 144 152 . . 170

175 185 195 202 203 206

211 221 225

Part II. APHASIA RECONSIDERED I. A Re-Examination

of Complex Forms of Aphasia

233

II. A Re-Examination 1. The Problem

of "Conduction Aphasia"

239 239

IX 2. Disturbances of Repetitive Speech in Patients with AcousticoArticulatory Defects Patient Dmitr Patient Bich 3. Disturbances of Repetitive Speech in Patients with AcousticoMnestic Defects Patient Makar 4. Summary III. A Re-Examination of "Transcortical Motor Aphasia" 1. The Problem 2. The Hypothesis 3. "Transcortical Motor Aphasia" associated with Massive Disturbances of the Blood Supply to the Anterior Zones of the Speech Area Patient Grish Conclusion 4. "Transcortical Motor Aphasia" associated with a Massive Tumor of the Posterior Parts of the Frontal Lobes Patient Obukh 5. The Amnestic Form of "Transcortical Motor Aphasia" Patient Yush 6. Conclusion

247 248 261 273 275 283 286 286 287

292 292 324 325 325 341 341 351

IV. A Re-Examination of Amnestic (Nominal) Aphasia 355 1. Basic Principles 355 2. Psychological and Psycholinguistic Analysis of the Process of Naming of Objects 357 3. Psychological Conditions of the Process of Naming of Objects . . . 363 4. Psychophysiological Mechanisms of the Disturbances of Naming of Objects 365 Bibliography

369

Subjects index

391

Index of names

397

PART ONE NEUROPSYCHOLOGICAL ANALYSIS O F VERBAL COMMUNICATION

I THE PROBLEM OF VERBAL COMMUNICATION

Verbal communication, the process of human communication through the use of natural language, has been the subject of considerably study in various disciplines. In particular, linguistics has given a detailed description of the components of verbal communication and this has led to the creation of the theory of the phonemic structure of speech, the identification of the basic lexical units and grammatical structures of speech, and the description of the basic stages of the transition from "deep structures" to the "surface structures" of actual expression. The contribution of the theory of information has been to analyze the conditions of optimal audibility of the sounds of speech and the stochastic laws of perception of communication, connected on the one hand with the degree of meaningfulness of the text and, on the other hand, with its redundancy. The physics of acoustics and the physiology of speech have rendered considerable assistance by enabling a closer study to be made of the characteristics of acoustic speech that permit the formation and perception of communication. However, the data of these sciences cover only a part of the whole real complexity of the process of human verbal communication. Nor do the sciences themselves yet possess sufficiently exact and objective methods of desribing the real processes taking place in the brain of the speakers and listeners that together constitute the formation of communication and its perception, i.e., the assimilation of its content. Linguistics, for example, studies language mainly by the direct construction of functional models, usually without even pausing to consider the real processes on the basis of which man constructs and understands the expressions described by these models. Psychology (and psycholinguistics) is left with important problems that it can and must investigate: what are the real processes of formation of verbal communication and its comprehension, and what are the components of these processes and the conditions under which they take place. An important place in the analysis of these processes is occupied by a special branch of psychology known as neuropsychology, the data of which will be discussed later.

4 1. THE STRUCTURE Ol· VERBAL COMMUNICATION

The problems of how verbal communication is formed and how it is understood were first studied seriously in psychology during the first decades of the present century. Workers belonging to the Würzburg School and engaged on the study of thinking, notably Külpe, Ach and Bühler, understood the formation of verbal expression as the incarnation of thought into narrative speech and its understanding as the transition from narrative speech to thought. These propositions were summarized perhaps most clearly of all by Pick (1913), who described the formation of a verbal expression as the path "from thought to speech" and the process of understanding as the path "from speech to thought." The course of this path, running in two opposite directions, correctly outlines the essential sphere of investigation; however, it naturally still does not reveal the basic steps along this path or the means and mechanisms whereby these steps succeed each other so as eventually to lead either to the molding of a thought into the speaker's verbal expression or to the understanding of verbal communication received by the hearer. The original "thought" was understood by the members of the Würzburg School as an amorphous "intention," without any visual or verbal form, (imageless and speechless), but a purely "mental act," and its conversions into verbal communication was regarded discreetly as a process of fitting the ready-made (mental) "thought" into the equally ready-made clothing of grammatically constructed speech. Several decades had to pass before the development of science changes this initially apparently simple state of affairs and demonstrated the immeasurably greater complexity of the process of conversion of thought into speech or vice versa - the extraction of the basic content ("thought") from narrative verbal communication. The discovery of the true complexity of these two processes was a result of progress in psychological science, on the one hand, and progress in linguistics on the other hand. The main contribution of psychology to the analysis of the formation of verbal expression was made in the late 1920s and early 1930s and it is associated chiefly with the name of the outstanding Soviet psychologist L.S. Vygotskii. Important advances in the science of linguistics, aimed at discovering the concrete steps in the formation of communication and the discovery of the path from expressive speech to its inner meaning, were made at about the same time by a number of eminent linguists in various countries (F. de Saussure, Baudouin de Courtenay, Bloomfield etc.), but it did not attain its full development until the 1950s to the 1970s in the structural linguistics of

5 Ν. Chomsky and his school in America, the so-called generative semantics o f Fillmore, and in the work o f linguists and psychologists such as G. Miller, T.G. Bever, J . A . Fodor, H.H. Clark, J . J . Katz, R. Brown, and D. Slobin in the U.S.A., and I.A. Mel'chuk, A.K. Zholkovskii, Yu.D. Apresyan and A.A. Leont'ev and others in the Soviet Union, who have identified the important linguistic elements involved in the conversion o f the inner meaning (or thought) into expressive speech in all its richness. So was formed the branch o f knowledge with which we are now concerned and we must go on to examine the various stages o f its formation in turn. The work o f Vygotskii, summarized in his classical book "Thought and Speech" ( 1 9 3 4 ) , was perhaps the first and decisive step in the scientific psychological interpretation o f the conversion o f thought into expressive speech (or in other words, the formation o f verbal expression), on the one hand, and the conversion o f verbal expression into thought (or in other words, its understanding), on the other hand. Vygotskii set out from the classical definitions o f the process given by Bühler and his circle, but he immediately challenged the views o f these psychologists with totally different concepts. For the psychologists o f the Würzburg School, " t h o u g h t " was a mental act based neither on image nor on speech; it was postulated that before any expression the thought was ready prepared and was "incarnated" into speech in basically the same way as a ready-made body is fitted with a ready-made suit. Nothing like this process o f "fitting" thought into speech can be found in Vygotskii's propositions. His basic proposition is the denial that there is any such thing as a "ready-made thought," and instead he postulates its complex historical development, on the one hand, and its complex and dramatic conversion into expressive speech on the other hand. "Thought is not fitted into speech, but it is accomplished by speech," - said Vygotskii, and this was the basic proposition on which the whole o f his research was built. Least o f all did Vygotskü regard the actual " t h o u g h t " to be converted into speech as an elementary " m e n t a l " act incapable o f further subdivision. His basic proposition was that thought itself is a complex generalized reflection o f reality, activated by certain motives, a process formed during the historical development o f society on the basis o f the role played by language in the social history o f mankind. That is why thought, which at the dawn o f history was still a concrete expanded activity, and only later became converted into a condensed, internal process, cannot be regarded as an elementary " m e n t a l " act. Thought itself has its own (social) history, its own linguistic roots, and its active character in the growth o f knowledge. Considerations such as these compelled Vygotskii to seek the source o f each " t h o u g h t " in the motive evoking it, and in the complex structure which,

6 on a direct approach, might seem to be "imageless" and "speechless," but which in fact is incomparably more complex because "thought" itself cannot be regarded otherwise than as a psychological formation with a social origin. Vygotskii himself did not live to complete his study of the formation of thought, understood as a condensed, contracted action. In his work on the analysis of the origin of "thought" in ontogeny he showed that in the early stages of development of the child any difficulty, creating a "problem," induces the formation of external tests, incorporating external speech in an analytical and planning capacity (in his opinion, this function was performed by the "egocentric speech" described earlier by Piaget). In the next stages of the child's development this expanded external speech, incorporated into action and helping to solve the problem, is gradually converted into whispered speech, then contracted to become internal speech; this internal speech, after further contraction, forms the basis of the intimate process which, in its later and more complex forms, becomes "thought." Vygotskii's propositions upset the concepts that previously existed in psychology. "Thought," regarded as an elementary "mental" phenomenon in the past, now lost that character and began to be regarded as the product of complex and prolonged development, as a derivative of human psychological activity. Vygotskii himself was unable to develop his ideas of "thought" completely. By the end of his life he had merely outlined the basic propositions of the affective sources of thought which play a definite role in the selection of generalizations and in the conversion of socially formed "meanings" into individual "senses" corresponding to affective needs. While continuing to look upon "meaning" as the real system of generalizations represented by words and formed in the course of the social development of the language, unlike most students of linguistics he used the term "sense" to denote those affective relations toward the substance of the words that arise in the subject in the course of his individual development, and in which those aspects of the phenomena to be named that are of particular interest to the subject are reflected. Following Vygotskii, I shall use these two terms ["meaning" (znachenie) and "sense" (smysl)], distinguished strictly by psychologists but often used as synonyms in linguistics. The later development of the psychological theory of the meanings and senses of words and of the formation of thought, using the system of language, was associated with the work of Soviet psychologists (A.N. Leont'ev, 1959, P.Ya. Gal'perin, 1959, and others) who pointed out that any structure of psychological activity, as it develops, passes through a series of stages, starting from expanded forms of material action and ending with the formation of contracted "mental actions." This became the starting point for a fresh approach to the process that

7 concerns us directly now — the analysis of the conversion of a plan (or thought) into expanded verbal expressions and vice versa. I have already stated that the idea that a ready-made thought is fitted into equally ready-made "clothing" was unacceptable to Vygotskii from the very beginning. The concept I have just described, according to which the thought itself arose from gradually contracting and interiorized speech activity, suggests that the conversion of thought into expanded speech is also indirect in character and requires an additional intermediate stage, an essential mechanism for the accomplishment of Vygotskii's thesis that "thought is accomplished in speech." This intermediate stage that must be introduced between the original "thought" and the final external spoken expression, according to Vygotskii, is "internal speech." Internal speech, this essential stage in the conversion of thought into expanded verbal expression, was understood by Vygotskii as something quite different from "speaking to oneself' or from "speech minus sound," preserving all the grammatical forms of expanded external speech. The existence of such "speaking to oneself' would serve no psychological function; it would only duplicate the process of formation of external expanded speech and would not provide a way of explaining the origin of verbal expression. Internal speech, as Vygotskii understood it, has a totally different structure and quite definite functions that distinguish it both from thought and from external speech. A man with an intention which he wishes to express in expanded speech knows the subject (or the basic theme) of this expression; naturally, therefore, the subject of the expression does not require a special name. What does need a special name is what it is that must be expressed in words, what must be expressed about the original subject. It is this - the predicative content that must figure in internal speech, the main purpose of which is to convert the internal thought into an expanded verbal construction. That is why, as Vygotskii postulated, internal speech must be predicative in function. However, this feature is only one — a functional - property of internal speech. Its other feature — morphological - is its condensed, contracted character and its grammatical amorphousness. As I have said already, internal speech, which arises as the gradual condensation and internalization of external speech, in so doing loses its morphologically expanded, grammatical character. This can already be observed if we analyze the initial loud speech, followed by the whispering speech of a child as it solves some practical problem. These observations showed Vygotskii and his collaborators, as well as the numerous psychologists who have noted the evolution of "egocentric speech," that the morphological structure of expanded speech in this case becomes simplified, the expanded sentences

8 become contracted and fragmented, and often, even at the stage of whispered speech incorporated into the process of problem solving, it can be seen to be converted into grammatically amorphous fragments which retain their predicative function and their ability, if need be, to be re-expanded. This internal speech, amorphous in its structure and predicative in its function, may in Vygotskii's opinion play the role of the intermediate stage between thought, with no grammatical structure, and expanded verbal expression with its proper grammatical structure. However, one further characteristic of internal speech that enables it to perform this role must be mentioned. The "intention" (or "thought"), with which the process of expression formation begins, always undoubtedly reflects a certain reality; it generalizes the substance of what must be expressed as speech and it places the object of the expression in a certain category. Could anyone have done more than Vygotskii at that time to explain the structure of word meanings, without which the understanding of the material structure of thought would still be beyond our grasp. However, the thought to be expressed in words is always subjective - in other words it always reflects a combination of features picked out by the subject who is speaking in accordance with his motives, his plans and his needs. It is this subjective character of a thought to be expressed in words that Vygotskii defined by the term "meaning," as opposed to the term "sense," regarding "meaning" as the system of objective associations represented by the word and reflecting the real phenomena irrespective of the needs to which these associations correspond, whereas the "sense" as a subjective selection of the most important aspects of the information given and of its relation to the subject's motives. This approach sheds light on a new aspect both of internal speech itself and of its role in the conversion of the original thought into the external, expanded verbal expression. From this point of view internal speech is the mechanism that converts internal subjective "sense" into a system of external expanded verbal "meanings," and it is these psychological characteristics of the process, which Vygotskii formulated, that constitute the important final stage of his explanation of this process. In linguistics the two terms are often insufficiently distinguished, and in the recent psychological and psycholinguistic literature this aspect of the theory of the intermediate stage between thought and expanded speech has not been developed further. Vygotskii's theory, objectively one of the most important sources of modern psycholinguistics, has itself remained purely psychological. That is why the analysis of the semantic, lexical and morphological structure of internal speech, and more especially the description of the changes that internal speech may undergo during its conversion into expanded and grammatical external verbal expression, was not reflected in any great detail

9 in Vygotskii's writings. The development of this aspect of the formation of verbal expression continued for almost a generation through the efforts of many workers in the fields of linguistics and psychology, culminating only 30—40 years after Vygotskii's death in 1934 in the new and rapidly developing field of psycholingusitics. Let us now examine the contribution of linguistics and psycholinguistics to the study of the formation of verbal expression. At the time when Vygotskii was beginning to formulate his views on the psychological nature of the relationship between thought and speech, research was in progress in allied disciplines, notably lingusitics, with the object of approaching the same problems from the other side; these investigations led after several decades to the appearance of two new subdivisions — structural linguistics (the chief section of which at the present time is the theory of generative transformational grammar) and psycholinguistics. In the course of many decades linguistics has studied the lexical, morphological and syntactic composition of language and has described its basic units. In classical linguistics this problem was usually tackled by the comparative historical analysis of written languages, and possibly because of this for a long time linguistics remained a discipline widely separated from the study of the real processes of conversion of thought into speech and vice versa. It was not until the first quarter of the 20th century that a number of investigators first clearly saw that linguistics must cease to confine itself to the comparative historical study of written languages and that it must turn to the functional analysis of living speech, serving for generalization and communication, and that somehow or other it must begin to investigate how the speaker's thought is converted into his verbal expression and how the verbal expression received by the hearer is transformed back into thought. It was to this aspect of the problem that attention was drawn by linguists such as F. Brunot (1922) in France, who pointed out that one of the basic problems in linguistics is the study of the pathway from thought to the means of its expression, and E. Sapir (1934) in the USA, who directed attention to the role of language in the formation of perceptual psychological processes. However, the decisive change of interests in linguistics and its turning to the study of the incarnation of thought into verbal expression and to the analysis of the understanding of the sense of verbal communication is connected without any shadow of doubt with the names of two of the greatest of linguists: F. de Saussure (1916) and J.A. Baudouin de Courtenay (1913-1914). De Saussure, in his book "Course in General Linguistics," pointed out quite clearly that language, being a means of communication, is at the same

10 time a means of expression and shaping of thoughts, and that in addition to "external linguistics," which studies the basic forms of established languages and subjects them to comparative historical analysis, there must also exist an "internal linguistics," the purpose of which must be to study the theory of how the signs of language are created and used. It was de Saussure who was responsible for the clear differentiation between the concept of language (langue), as an objective system of sounds formed in the course of history, and the concept of speech (parole), by which he understood the process of transmission of information with the aid of the language system, on its first appearance on the pages of linguistic publications. As we shall see below, many of de Saussure's views, based on the fundamental distinction just mentioned (for example, the distinction between "paradigmatic" and "syntagmatic" relations), constitute some of the most important components of the problem of verbal communication and its mechanisms with which we are directly concerned. A no less important contribution to this problem also was made by the second of these major authorities, J.A. Baudouin de Courtenay. In his "Introduction to Linguistics" (1913—1914) he also stated the need for drawing a strict distinction between language and speech; he observed that, besides the "statics" of language, careful attention must also be paid to its "dynamics," the real process of formation of verbal expression on the one hand and the process of its perception on the other. The investigations of these two authorities initiated a whole series of studies which together formed the main branches of classical structural linguistics, the study of the basic laws governing any language. The study of the universal laws governing the structure of all languages was a step along the road to the analysis of the mechanisms of formation and understanding of any expression. Other members of this group of linguists were L. Bloomfield in the USA, L. Hjelmslev in Denmark, and N.S. Trubetzkoy and R.O. Jakobson in Russia and in Czechoslovakia. Bloomfield (1933) was one of the first linguists to undertake the task of developing a single constructive scheme of concepts suitable for describing any language; he made a decisive step toward the solution of this problem by attempting to distinguish the basic components common to any expression and describing their main classes. Similar tasks were undertaken by Hjelmslev (1936, 1954), who distinguished the external structure of language (the plan of expression) from its internal aspect (the plan of content) and studied the basic forms of relations (commutations) between them with the object of reducing the infinite richness of a language to a small number of "functions," the role of which in language could be understood deductively. Finally, the contribution of the Prague School (Trubetzkoy, 1939; Jakobson, 1942) was essentially to postulate that any language can be understood as a system of a

11 few types of basic comparisons, and that these basic comparisons, which can be studied in both the phonology and the morphology of any language, can be used as a basis for the study of its most general laws. These investigations, which were carried out in the 1930s and have become classical, laid the foundations of a new science — structural linguistics. Its development led to the creation of the theory of generative grammar, first proposed in the 1960s in the writings of N. Chomsky and others holding similar views (Bever et al., 1966; Bever, 1975, Fodor and Bever, 1966, Katz, 1966; Katz and Postal, 1964; Katz and Fodor, 1963; Clark, 1 9 6 9 , 1 9 7 5 , and others), it reached its peak in the researches of Soviet linguists (Zholkovskii and Mel'chuk, 1967, 1969; Mel'chuk, 1972, 1974; Apresyan, 1974), who worked on their "Sense - T e x t " model and it thereby filled the gap that still remained in Vygotskii's psychological studies with concrete linguistic material. 1 As I have already stated, the process of verbal communication was represented very schematically during the first decades of this century: the formation of verbal expression was taken as the direct, one-step incarnation of an immaterial thought into extended speech, whereas the understanding of communication was regarded as an equally direct process of transition from extended speech to thought. Even after Vygotskii, whose theory of internal speech first pointed to the important intermediate stage in the formation of verbal communication, the principal stages of this process remained uncertain and the subdivision of the phenomena of verbal intercourse into "language" and "speech" and recognition of the need to find general laws at the basis of the whole wide variety of language, as enunciated by the linguists I have just mentioned, still could not reveal the whole complexity of this process. The decisive step made by modern structural linguistics, with its theory of generative transformational grammar, opened up for the first time new paths toward the hitherto inaccessible scientific analysis of the stages of conversion of thought into extended speech. The basic proposition of the theory of generative grammar, as formulated by Chomsky (1957, 1965, 1968, 1972) so clearly, is in fact very simple. As a result of the very great homonymy and synonymy of words and grammatical structures in a language there is a virtually infinite number of possible alternatives. For example, since the Russian word "ruchka" can mean a small girl's hand, something with which to write, a doorknob, the arm of a chair, or the handle of an instrument, and the word "klyuch" can mean a key for opening a door, a spring of water, or an essential device for deciphering a manuscript, it will be easy to see that the use of these words in different situations and contexts may have different meanings and it may be very difficult to "master" the meanings of the words. Infinitely great variation also arises in the methods of expressing the

12 material for communication as a whole sentence. The same sentence may, in practice, have several meanings. For example, the phrase "Ivan prishel k Ol'ge s Petrom" (Ivan - came — to the house of — Ol'ga - with — Peter) may mean either that Ivan and Peter visited Ol'ga or that Ivan visited Ol'ga who lived with Peter. This variation in the forms of expression arises because any communication can be expressed in many different ways, involving different constructions, but without altering the sense of the communication. For instance, the sentence "only the large number of special terms in the text did not allow Smith to translate it" can be expressed either as "only because this text contains many special terms Smith cannot translate it" or "only because of the large number of special terms it is impossible for Smith to translate this text" and so on. According to calculations by linguists (Zholkovskii and Mel'chuk, 1967, page 180) the number of alternative sentences that can be used to express this communication could be as many as several thousands! That is why modern linguistics quite rightly states that the number of sentences that a man requires to form his extended speech is much greater than the number of seconds in his whole life. This inconceivable (virtually infinite) number of real alternatives of verbal expressions makes it extremely difficult to describe them scientifically and to discover the laws that could express this variation or, still more, predict it. However, the difficulties of attemtpting to explain how an unambiguous (invariant) thought is "incarnated" into unbelievably diverse expressions become more apparent still when the investigator considers the astonishing fact that a child between the ages of 1 lA and 2V£ years masters virtually all these alternative forms of expression in the course of a fantastically short time. This stage of affairs, according to Chomsky, can only be explained under one condition. The child, it must be accepted, does not master all the infinitely rich and variable forms of verbal expressions, but only the few rules on which all the infinitely rich verbal structures are based and modeled. This hypothesis led Chomsky to draw a distinction between at least two different levels of organization of verbal expression: the whole wealth and the whole diversity of the "surface grammatical structures of language," which we know under the name of ordinary extended speech, rest on the "deep grammatical structures of language"; from these deep structures the "surface grammatical structures" in all their diversity are formed by transformation. This hypothesis suggested that the child initially masters the "deep" semantic or grammatical (syntactic) structures, the construction of which is governed by only comparatively few rules, and that these "deep" syntactic structures of language" are an intermediate stage both for the transition from thought to speech and the formation of an extended verbal expression, and for the opposite process — the transition from extended speech to thought or, in other words, for the process of understanding of verbal communication.

13 It would be wrong to suppose that the "deep syntactic structure" preserves its identity — or even its similarity — with the "surface syntactic structure" of the sentence and that they differ only in the greater simplicity and generality of the former. The "deep structure" of the sentence differs radically from the superficial structure and, in fact, it occupies a middle position between the syntactic structure of natural language and the logical (or semantic) structure of expression. That is why the scheme (or "tree") which represents the deep structure of the sentence differs fundamentally from the scheme of the surface grammatical structure of the same sentence. On the one hand, it is more disjointed in character and reflects elements that do not necessarily figure in the surface structure; on the other hand, the logical components that form the basic model of grammatical expression are reflected in it as its main content. We have only to compare the surface grammatical structure of the sentence "Masha potrebovala ot Petyi, chtoby on ushel" (Masha ordered Peter to go away; literally "Masha demanded of Peter that he went away") with its deep structure to see how sharp these differences are. For example, its superficial and deep structures can be represented approximately as in Fig. 1. The deep structure of the same sentence is different in appearance: it has no auxiliary words but the generalized logical relations still remain the same. Sometimes the deep structure contains elements not represented in the surface structure. An example of this is the sentence "K Vase prishlo chelovek vosem' " (literally to Vasya came men eight; actual meaning "about eight men came to Vasya"), which expresses specifically only the approximate number of persons coming; the word "about" does not appear in the surface structure, yet it is an essential unit of the deep structure. 2 However, the most important difference between the deep and surface syntactic structure is to be found in the following two closely interconnected features. The deep syntactic structures of expression which are very close to logical structures are composed in accordance with very few rules. Sometimes the rules governing the composition of the deep structure of expression are not revealed in the surface structure, so that sentences that are apparently grammatically identical acquire different meanings. An example of such groupings (put between parentheses) is given by the sentence already mentioned above — Ivan came to Ol'ga with Peter — in its two different alternative forms: Ivan came to Ol'ga (with Peter). Ivan came to (Ol'ga with Peter).

14

on (he)

Petya Fig. 1

Scheme showing the surface- and deep-syntax

structure of a sentence

(after I. A. Mel'chuk)

This grouping of the sentence into direct components can be expressed either as a " t r e e " of hierarchical nodes and links and also in the form of a system of parentheses. Naturally these few rules, manifested equally in all languages and therefore "universal" in character (independent of the many different forms of living languages), reveal the most important way of learning real languages; it is this feature that makes the identification of the deep syntactic structures of a language the vital step for the discovery of methods whereby man masters real language. There is, however, another aspect of the description of these basic deep syntactic structures without which the whole significance of Chomsky's contribution to structural linguistics would remain incomplete. Besides the basic rules of composition of deep syntactic structures of language, Chomsky also described the basic laws and rules by which some structures are converted into others, or in other words, by which some grammatical structures can generate others, identical in content but differing in structure or differing in content but preserving the identical grammatical

15 structure. For example, the sentence "Ivan s Olei poshel ν kino (Ivan went with Olya to the movies)" can be converted with the aid of a few rules into the negative, the interrogative, or the partially negative form: Ivan s Olei ne poshel ν kino (Ivan did not go with Olya to the movies). Poshel Ivan s Olei ν kino? (Did Ivan go with Olya to the movies?) Ivan poshel ν kino ne s Olei (Ivan went to the movies not with Olya) Ivan s Olei poshel ne ν kino (Ivan went with Olya not to the movies), and so on. The description of the basic rules of rephrasing (or transformation) of sentences, as elaborated by Chomsky, laid the foundations of transformational grammar, led to the discovery of an objective, scientific way of expressing changes discernible in language, and thereby established a firm basis on which all possible forms of "surface-grammatical structures of language" could be derived from "deep-grammatical structures" or, in other words, paved the way for the creation of a scientifically based generative grammar. The close study of the "deep structures" of language brought forth an extensive literature that heralded not only great advances in linguistics, but also its reorientation toward the fundamental problems of the psychology of living communication and the analysis of the pathway from thought to expanded verbal expression and back again from expanded verbal communication to the understanding of the thought embodied in it. However, at the same time it aroused a lively discussion centered on the relations between the syntactic structure of verbal expression and the underlying thought. This problem has been widely studied (Fillmore et al., 1971; Lakoff, 1969, 1970, 1972; McCawley, 1968, 1970, 1972). Starting from the assumption that "deep structures of language" are close to the logical structure of expression and, unlike the "surface structures of language," they are not necessarily linear in character, they postulated that expression has in fact three and not two levels. In their view "deep-syntactic" and "deep-semantic" structures lie beneath the "surface-syntactic structure of language," whereas other investigators postulated that there are in general no deep-syntactic structures, that semantic and syntactic processing are in fact an indivisible entity, and that syntactic organization must be regarded as "a system of rules introducing limitations into semantic systems" (McCawley, 1972, page 384). The discussion which started after the appearance of Chomsky's basic research showed the great importance of seeking the deeper syntactic and semantic structures and indicated that the conversion of thought into extended speech is an immeasurably richer process than had been imagined by psychologists and linguists at the beginning of this century. Undoubtedly the least thought out portion of Chomsky's system was the

16 theory of the original semantic formations with which the conversion of thought into speech began and which, in the first stages of development of this branch of science, were described by Vygotskii under the general term of "internal speech." Whereas the propounders of the theory of transformational grammar paid most attention to the analysis of surface and deep syntactic structures, the semantic structure of the lexical units or words, of which all expressions are composed, attracted them much less, and Chomsky was able to analyze syntactic structures successfully by replacing their lexical components by conventional symbols for classes of words and word combinations. However, the real state of affairs turned out to be much more complex and the semantics of lexical elements is incomparably richer than is apparent from the formulae indicated above. I have already stated that many words denoting different objects are in fact homonyms; the word homonym denotes a whole group of possible objects, and a person who hears the word "ruchka" (see above), the word "plecho" (arm, shoulder, branch), "nozhka" (foot, leg, pedicle, jaw) and "klyuch" (see above) must of necessity choose one of the possible meanings of this word; everyone who pronounces the corresponding word must abstract from a large number of its possible meanings. Another no less well known fact is that in the successive stages of the development of language a word that continues to stand for the same object (which preserves its attribution to an object changes its semantic structure as it relates this object sometimes to the concrete situation, sometimes to an abstract category. That is why the word "lavka" (meaning a small shop) can signify to a small child something tasty, whereas for the schoolchild it may signify one particurlar shop where he can buy certain articles, and for the economist it implies one link in the system of commodity exchange. Naturally, therefore, the specification of the place occupied by the lexical unit in the syntactic structure by no means exhausts the whole richness of the associations for which this lexical unit stands. Vygotskii pointed these facts out very clearly many years ago, and I am not making any new discovery by recalling them. New and important aspects of the organization of the lexical system at the deepest (semantic) level of preparation for expression, indicating direct connections between this level and the deep syntactic structure, were discovered in a series of special linguistic investigations undertaken by the workers I have just mentioned, but pioneered by the Moscow school of linguistics. These investigations showed that individual lexical units not only incorporate the object they denote into a system of hierarchically constructed meanings, including lexical comparisons, but they also form paradigmatic systems, such as:

17 animal - (and not plant)

domestic animal - (and not wild animal)

dog - (and not cat)

dachshund - (and not terrier)

I

I

Lexical units can also evoke potential syntagmatic relationships, sometimes not requiring connections with other words, at other times requiring them of necessity. For instance, the word "moon" is an independent word, whereas the word "analysis" necessarily implies the answer to the question "of what?" and the word "conqueror" the answer to the question "of whom?" and so on. The need for a connection with other words is even more clearly apparent in the case of verbs: some in general do not require other words — they include impersonal verbs such as Latin "pluit" (it is raining) — others require one qualifying word, for example, "sleep" (who sleeps?), a third group require two additional words, i.e. "go" (who goes where?), three words, e.g. "give" (who gives what to whom?), or even four or more, e.g. "buy" (who buys what for whom and for how much?) and so on. These potential syntagmatic connections of words with other words are a basic feature of deep lexis, and if the attempt is made to reflect the deep syntactic structure sufficiently completely it is impossible to proceed without these deep syntactic valencies that constitute the basis of deep ("semantic") syntaxis. It would be a mistake, however, to suppose that the connections of deep lexis can be explained entirely by the unequal valency of the lexical units (the number of sites for linking with other words, distinguishing them from one another). Perhaps the most important fact is that the very large (practically infinite) number of semantic-syntactic connections with different meanings, in which individual lexical unites of both surface and deep syntaxis can take part one with another, can be reduced in practice to a few types of connections, each with definite characteristics of content. This problem has been studied by several linguists, who made a particularly important contribution. As their investigations have shown, the lexical units that constitute the semantic basis of speech can be easily joined into pairs to correspond to a

18 relatively few semantic functions, for which the term "lexical functions" has been proposed. Analysis has shown that the whole wide range of possible semantic connections between words can be reduced to 40 or 50 main types of lexical functions; they include functions such as Syn (synonymity: "philology" and "linguistics," "USSR" and "Soviet Union"), Conv2 j (conversion — changing the place of two or more local relationships: "boyat'sya", to be afraid of — "pugat'," to fear; "lyubit'," to love - "nravit'sya," to like), Incep (inception: "war" - "begins") and Fin (finality: "war" - "ends"), Caus (causation, action as a cause: "suit" - "sew," "hunger" — "induce"), Liqu (liquidation, termination: "sleep" - "awaken"), Func (function, take place: "wind" "blows"), Operj (to carry out the operation causing the result: "question" — "ask"), Labor] ? (accomplish : put to the test) and so on. The identification of groups of meaningful relationships, composed of lexical unites and capable of formalization in this way, is the basis of the syntactic network that determines real systems of connections between individual words and creates the basis both for deep syntaxis and for the even deeper level of preparation of verbal expression - the level of semantic sets. If to the description of these lexical functions we add the description of the basic (likewise not numerous) lexical and syntactic rules of the transformation of expressions it is clear that modern linguistics is beginning to acquire a system of methods that will enable it to describe the potential network of connections that can arise in every lexical unit: these connections, with a syntactic as well as a semantic content, are proving to be far richer than the ideas formulated earlier by Vygotskii in his theory of the generalizing function of words and word meanings. The contribution of modern linguistics to the study of the mechanisms of verbal communication is not, however, limited to the theory of lexical functions and of synonymic transformations I have just described. Classical linguistics set out to analyze language from the description of its separate sounds, words or phrases and this substantially limited the scope of this discipline. The workers I have cited, however, tackled the problem differently. They set out from the whole thought (sense) in order to be able to study how this thought is converted into an extended expression (text), or they set out from a whole text in order to be able to study the mechanisms of its understanding and how the text can be converted into a thought (sense) capable of being perceived by the listener (reader). Accordingly linguists describe their basic task as the creation of a "sense - text" model. Because (as has already been mentioned) one thought can be expressed in a virtually infinite number of possible alternative forms of extended text, Zholkovskii and Mel'chuk attempted to describe the levels at which the con-

19 version of thought into text and vice versa take place and its basic rules. They regard the incorporation of systems constructing all possible alternative verbal connections (generators) and systems responsible for the choice of alternatives most suitable in a given context (selectors) as an essential feature of these levels. By careful analysis these workers — like the spokesman of transformational linguistics mentioned previously — concluded that thought is represented at several consecutive levels in the process of its conversion into expressions. These levels are not only essential for the understanding of the whole "Sense — text" model but, more important still, they differ sharply from each other in both content and structure. The contribution of this "Sense — t e x t " model is that it has provided a closer approach than other models both to the differences in the formal structure of each level and to the description of the mechanisms incorporated in it. The deepest level, the first of the consecutive stages that convert a thought into extended speech, is the level of initial semantic sets. Semantic recording consists of individual potential sets denoted by elementary units of meaning (semae) or a system of simultaneous schemes representable by a "semantic graph." (Semantic recording is evidently a model of the semantic scheme embodied in the original thought). The next level of the "Sense - text" model, the level of deep syntactic structures, is a tree of dependent relationships the nodes of which contain not semae, but symbols of deep lexical units. (Presumably the transition from semantic sets to deep syntactic structures is effected with the aid of internal speech, which can pick out the most significant factor recorded by the deep syntactic structures). At the subsequent levels and the corresponding stages along the path from thought to word the deep syntactic structures are converted into s u r f a c e syntactic structures, and these may undergo further successive morphological, phonological and phonetic expansion. I have briefly summarized the whole complex path of expression formation and I must now return to its initial stages. The components of a future expression are not isolated terms representing individual objects, actions or qualities: they always presuppose various semantic connections, followed (at the level of deep syntactic structures) by various "lexical functions" (expressing the potential connections of a given semantic idea or lexical unit with other words). Accordingly the scheme of the systems of potential connections that arise at the early levels of formation of the verbal expression become incomparably more complex than that described by Vygotskii in his definition of "predicative internal speech." Let us imagine that a speaker wishes to express a thought such as: "Ivan shot a pellet into a partridge." It would be incorrect to suppose that this

20 thought has no potential figurative or verbal components; it would be also be wrong to suppose that it consists of ready-made isolated lexical units such as "Ivan," "shot," "pellet" and "partridge." The fact that this "thought" can be converted later into an extended verbal expression compels a different approach and a search in this initial, deepest level of semantic recording of thought for the components that, at this stage, already mark the potential connections and are already laying the foundations for the future extended expression. This task can be accomplished if the notions regarding potential semantic connections which I mentioned above are adopted. By the use of these concepts a given semantic set can be represented as follows. An approximate analysis reveals the subject "Ivan" (a man, adult, male, bearing this name), responsible for the theme of the thought (the onoma), and the complex predicate (the rhema), with the following components: "gun": the weapon, embodying the function of "causing" the shot or the liberation of potential energy for use in the task of "killing", i.e. ending life, and leading to the lexical function "pellet" that flies from the weapon to the bird; "the intention" of killing the bird, which leads Ivan to "cause" the shot; finally, "the partridge," which figures here not only as a bird — a woodland bird, a game bird, but also as an object intended to be killed, i.e., as an object into which the pellet is aimed from the gun; and so on. This type of semantic recording can be represented as a complex graph reflecting the connections I have mentioned above and having the appearance shown in Fig. 2. The semantic record of the expression "Vanya tverdo obeschchal Pete, chto vecherom on primet Mashu samym teplym obrazom" (Vanya faithfully promised Petya that he would receive Masha most cordially that evening) (Mel'chuk, 1972) is still more complex in character. Besides specifying Vanya (a single person, a man, with the name "Vanya"), this thought includes mention of Petya (also with the additional connection "to whom"), that later he would certainly (with great probability, approximately 100% ) receive (once, with the utmost friendliness, corresponding to Petya's concern) that evening (a period of time from 5 to 11 p.m., later than the time of the actual conversation but on the same day) Masha (a girl) and so on. The corresponding sense can also be represented by a complex graph (Fig. 3). Despite the apparent fragmentation, clumsiness and complexity of such a semantic set, it is an essential stage in the expansion of thought and its preparation for rendering in the form of expression. Its distinguishing feature is that it operates with semantic elements (including a system of relations designated by them) and not with words, so that it has no grammatical forms; it possesses "nodes" and "arcs," forming a directional graph; the apices of

21

time

t[

t o coincide

name

ο

A 1

Ο Ivan

ο this

ο

one

X

partridge

Ή Fig.

2

Semantic representation of a sentence (after I. A. Mel'chuk)

I ^ o

moment °r speech

name o.

Ο A Χ

D

ο

Ulis

Ο

Fig.

3

Semantic representation of a sentence (after I. A. Mel'chuk)

included

22 this graph are marked by symbols of semantic elements whereas the arcs are marked by symbols of semantic relationships that may exist between these semantic elements. Such a complex semantic graph must be adequate for subsequent conversion into the deep syntactic structure of expression. 3 However, its main difference from deep syntactic structures is that it incorporates a system of simultaneously evocable semantic connections, some of which are direct and actual while others form the background and are potential. The semantic graph is a dismembered diagram of the thought; however, at the same time, it is the starting point for the subsequent conversion of the thought into an extended expression. For this conversion to take place, the semantic set based on internal speech must be transferred to the level of the deep syntactic strucutre. This task naturally is associated with important structural changes in the semantic sets. As I mentioned above, the semantic set incorporates neither concrete lexical units nor concrete syntactic structures of the particular language. The change from the level of semantic representation to the level of deep-syntax structures thus requires a change to constructions in which relationships represented in the semantic graph would be selected and fitted into certain syntactic forms of expression, which still cannot be represented in simultaneous schemes of all semantic relationships, but which must be converted into systems of successive syntactic connections forming deep-syntax structures; these structures already bear the distinct character of speech, they have a logical-grammatical structure and they can be represented as a dependency "tree" of mutually subordinate verbal meanings. This is accomplished with the aid of "selectors" or "filters" on the one hand, and by the use of a few semantic rules, that convert the primary semantic graph into a deep-syntax tree, the nodes (or apices) of which are generalized lexemes of the particular language, while the branches are deep-syntax relations. The whole apparatus of the basic deep-syntax structures, as they are understood in the "Meaning - text" model, is the direct formula of internal speech; however, its characteristic feature is that its component elements retain the properties of semantic representations, although at the same time they are linguistic, verbal formations. The lexical units composing deepsyntax structures are generalized words, that possess the "lexical funtions" I discussed above. The deep-syntax relations embodied in these structures are limited to a very few predicative (or actant) relations which, according to the authors describing them do not exceed ten in number (four to six predicative relationships corresponding to the question who?/what?, whom?/what?, to whom?/to what?, of whom? and so on, one attributive, one coordinating and one appendant relationship). The essential formal difference between the deep-syntax structure and the semantic representation, as already stated, is

23 that at this level the record has already lost the character of a generalized simultaneous scheme or graph and has acquired the character of a successively branching tree, the nodes (or apices) of which are linked by known syntactic relations. This is the mechanism of the successive transition from one node to another. However, it must not be thought that deep-syntax structures reproduce the whole completeness and linear order of the "surface-syntax structures"; they preserve generalized semantic links and relations, and the logic of their construction is thus not the same as the logic of construction of surface synthesis of natural languages. That is why different sentences expressing the same sense (for example, "we know that the people are fighting fascism," "we know about the people's fight against fascism") can be represented by the same "deep-syntax structure" (Fig. 4).

narod (people) Fig. 4 Scheme of the basic deep-syntax

fashizm (fascism) structure

Sometimes (more often than not) the same words do not appear in the surface-syntax structure as in the deep-syntax structure; many words have acquired a generalized and transformed "conventional" character; many (implied) are repeated several times over, and the whole structure, while acquiring the features of a syntactic tree, continues to preserve some features (selected and "filtered") of the semantic graph. Following the footsteps of the authors cited above we can illustrate these distinctive features of deep syntactic structures by a single example (any of Chomsky's examples could be chosen just as appropriately). For instance, the surface-syntax structure of the Russian language: "On obychno ubezhdaet vsekh svoikh sotrudnikov ν torn, chto pitaet glubokii interes k matematike" (he usually assures all his colleagues that he has a deep interest in mathematics) (a structure permitting, as I have already mentioned, an enormous number of possible paraphrases), is reflected in its deep-syntax structure approximately as: "He is in the habit of causing all those who work with him to consider

24 that he is very interested in mathematics,' and this can be expressed as in Fig. 5 to be in the habit o f

to cause

Ο

to be interested in

^

magn

Ο

together

mathematics

o h he Fig. 5

Scheme of a complex basic deep-syntax structure ( a f t e r A . K . Z h o l k o v s k i i a n d I. Λ . M e f c h u k )

Clearly the deep syntactic structure simply displays by linguistic means the scheme embodied in the contracted, predicative "internal speech," that Vygotskii distinguished as the factor responsible for the conversion from thought to extended expression, and whose mechanisms are at last becoming much clearer. At the same time, it is equally easy to see that whereas the semantic graph inevitably reflects a large number o f potential semantic connections, from which only comparatively few are selected during the preparation o f the expression, for the formation o f the deep-syntax structure, later, as we shall have to discuss, this process o f limitation o f the necessary connections and choice o f the necessary syntactic structures continues, and it is this process o f selection o f connetions that is responsible for the clarity o f structure o f the verbal expression eventually formed. Let us examine this process in more detail. The "semantic sets" suggested by Soviet psychologists and linguists, like the deep-syntax structure described by Chomsky, is an intermediate stage to the surface-syntax structure or, in other words, to the external grammatical structures o f the extended expression. The changes arising during the transition from the deep-syntax structure to the surface-syntax structure or, in other words, to the level o f extended

25 expression, are perfectly clear. First, generalized logical syntactic formations of the deep-syntax structure, equally applicable to all languages, which obey only a few basic rules and are "universal" in character, are converted into diverse and infinitely variable syntactic structures of living "natural" languages. This happens because the nodes of these structures become concrete verbal (lexical) units, incorporating not only substantive and predicative words, but also all the auxiliary words characteristic of a given language. It also happens because the extended grammatical speech begins to be constructed in accordance with much more detailed basic rules, permitting paraphrasing and enabling one sentence expressing a certain sense to be replaced by many synonymous sentences. A decisive role in this process is evidently played by operations of exchanging the top of the tree for a lower node (adjunctive operations), splitting of nodes (replacing one node by two nodes), transposition of nodes at different levels of the tree, and transpositions of nodes that are arguments of the same predicate (conversive operations), which are evidently carried out at the deep-syntax level. The transition to surfacesyntax structures is achieved by mechanisms of selectors or filters that reject combinations unacceptable from the point of view of that particular language, thereby limiting the number of possible alternatives to relatively few. My description of the transition from thought to extended verbal communication mentioned only the first step of the whole process; it would be incomplete without a consideration of another very important aspect of this problem. As I have already stated, any thought set in train by a particular motive is subjective, in the sense that it picks up out from the situation under consideration one particular aspect essential to the subject, in which the subject is affectively interested. That was why Vygotskii distinguished between the concepts of meaning (the objective reflection of generalized connections and relationships of reality) and sense (the choice from the whole possible system of meanings of those aspects that correspond to the subject's needs, that are of special interest to him). Naturally in internal speech, with its contracted structure and predicative function, sense predominates over meaning, and the transition from thought and internal speech to external verbal communication is largely connected with the process of transition from subjective motives and senses to meanings that are extended, objective, and accessible for transmission as information. It is this process that is evidently accomplished by the system of deep-syntax structures we have discussed above, and by that complex system of rules to which the surface-grammatical structures of language are subordinated and which are adequate for the transmission of the basic objective content of the thought to the listener.

26 This is the principal factor concerned in the preparation of verbal communication; however, it is not the whole of the process. Besides the information on the objective content of the thought to be transmitted, the subjective or affective relationship to this content is also transmitted in verbal communication or, in other words, besides the transmission of meaning there is also the transmission of sense. How is this process of transmission of sense expressed and what are the mechanisms used? I have already stated that both a word and a combination of words can take part in all manner of possible connections, and that the subject must limit these connections each time and must choose those of them that appear most valuable to him; it is this that gives a verbal expression its particular sense. Some concepts introducted by modern linguistics enable us to analyze this process more clearly. I include the distinction drawn frequently in linguistics between what is already known to this speaker (the thema) that which is novel, that which has still to be communicated (the rhema). Selection of the rhema presupposes some limitation of the indefinite number of associations springing up in response to the use of the word, the choice of systems of connections that seem most essential in the context of the given expression, those that correspond to the intentions that the subject wishes to express. This limitation of the number of possible connections and choice of only a certain number of associations evoked by the word can take place in verbal communications consisting of either a single word or a complete sentence. It can be defined by the context of the communication and it can be expressed as intonations or as distributions of pauses between the individual components, and sometimes it may become understandable only from the "moral" of the expression. Clearly, if a lady wishing to boil water in a samovar says "Ugol' " (i.e., coal) and if the same word is uttered by a girl who has made a black mark on her new dress, these words, relating to the same thing and having objectively the same dictionary meaning, convey different senses: in one case the word expresses the meaning "where can I find coal for the samovar?" and in the other case it is an affective response to the spoiled new dress. Naturally the choice, from among all possible connections of a word, of only those that correspond to a particular motive and give this expression a completely definite subjective (affective) sense, will depend on the original motive of the expression. A similar influence of motive can be observed in the construction of the expression also. The semantic division of a sentence, as we know, does not always coincide with its grammatical division, but it is determined by the motive of the expression, its particular meaning in a certain situation, and also by the general context of the expression, and it can be reflected in its

27 prosodic structure - in the intonations and arrangement of the pauses. The same sentence (Ivan loves Masha) can mean either that it is Ivan who loves Masha or that Ivan loves Masha (and nobody else), or as a third possibility, it may mean that what Ivan feels for Masha is love (and not jealousy, envy, and so on). These changes in the sense of communication must be expressed in changes in the surface-syntax structure of the sentence; however, a change in intonation radically alters the relationship between the logical subject and the logical predicate or, to put it in other words, the " t h e m a " and "rhema" of the sentence. That is why the three variations of the sentence described above could be illustrated differently by marking the differences in the character of this communicative organization of the sentence: Ivan loves Masha a ± Ivan loves Masha 1 Ü Ivan loves Masha d' Χ H2 or these differences can be expressed by constructing the semantic graph in different ways in order to reflect the variations in the sense transmitted. How can we transmit these semantic differences in cases in which the semantic structure of the sentence remains unchanged? 1 have already stated that syntactic forms themselves possess only inadequate means for expressing the internal sense of the expression; however, this does not mean that there are no such facilities. To find them, all we have to do is to look beyond the formal methods of syntactics and turn to another aspect of organization of expression - to prosodies. Prosodic mechanisms (arrangement of the pauses, the accentuation of particular elements of the expression, the inclusion of the essential intonation) have only recently received particular attention from students of the theoretical relations between semantics and syntactics (Goldman-Kisler, 1961; McCawley, 1968, 1970; Lakoff, 1970, 1972; Fillmore, 1971, and above all, Chomsky, 1972). They have described examples that actually occur in a language and are manifested in the organization of all communication but which assume particularly marked forms in the organization of a literary text. These methods include pauses bringing some parts of the sentence closer together and spacing others wider apart, thereby distinguishing what some authorities (for example, Lakoff, 1972) call the "topic" and the "focus" of the sentence. Another of these methods is prosodic organization of the sentence, with the segregation of one of its elements by means of an accent. By this method

28 it becomes clear that the sentences " / walk to work," "I walk to work''' or "I walk to work" each transmit a completely different inner sense, despite their external identity, and they acquire a completely different connotation. Prosodic methods of organization of a "text" were well known in old church music, for besides the "black notes," denoting relationships of pitch and giving the melody, there were also "red notes," which organized the prosodies and gave the inner sense of the melody (this function has persisted only in the form of special remarks and it has largely been taken over by the conductor). The prosodic organization of the text, as Chomsky (1972) considers, shows that factors responsible for the semantic aspect of communication can thus be preserved in the surface-syntax structures, in which they continue to play an important role. However, the system of methods of semantic (prosodic) organization of communication, including nonverbal (mimico-gesticulatory) methods, has reached a much more advanced stage of development in the theory of theatrical art and, in particular, in the theory of the art of production (Stanislavskii, 1954; Knebel', 1964) than in linguistics, the process of mastering methods of expressing the inner meaning of a text, as developed by these workers, starting with work at the purely semantic level (impersonation of the character of the actor, of the possible forms of his actions in concrete situations), and converted only much later into a spoken text (which is thereby enriched with a semantic content), is thus an extremely important and by no means sufficiently comprehended test (see Knebel' and Luria, 1971). The methods just mentioned, which express the sense of communication, play a double role. First, they point to the successive stages involved in the transmission of the connotation that enable the sense of the communication (including its connotation and internal motives) to be conveyed most effectively to the listener; since the sense is transmitted step by step in this way, a well prepared theatrical presentation is perceived by the viewer directly, not only in its external form but also in its internal sense, and a literary text conveys its deep affective content just as successfully to the reader. Second, these methods enable the listener (or reader) to perceive the content of a communication at different depths. There is thus every reason to suppose that the "depth of reading a text," passing from surface syntax to deep syntax, and thereafter to the deepest levels of semantic representation, distinguishes individual people to a far greater degree than their understanding of lexis, syntactic connections, and the external content of communication. It will be clear from what has been said how complex is the structure of the path from thought to extended verbal communication or vice versa, and how complex is the character of those cases in which this path of the encoding or decoding of communication is disturbed as a result of damage to certain brain structures.

29 2. PSYCHOLOGICAL CONDITIONS OF VERBAL COMMUNICATION

I have dwelt in the most general terms on how some modern authors represent the linguistic mechanisms of expression. I must now describe, in equally general terms, the psychological conditions for the normal functioning of the mechanisms described above. Unfortunately it has to be admitted that whereas in the last decades structural linguistics has made an important contribution to the study of the nature of verbal expression at the different levels of its formation, the study of the psychological processes of the transition from one level to another and the psychological analysis of the operations that lead to the transformation of thought into extended verbal expression have so far been almost completely neglected. A close analysis shows that the theories of conversion of thought into speech have been dominated for many decades by associationist ideas, which were first propounded as long ago as the late 18th and early 19th centuries and have since continued, substantially unchanged, to influence all subsequent attempts to explain the process of conversion of thought into verbal expression. Representatives of the Würzberg school regarded thought as a formless and nonverbal mental phenomenon; for them, inevitably, the "incarnation of thought into word" was the association of the "mental act" with a conventional acoustic symbol. During the subsequent decades the view that the conversion of the original thought into its verbal expression is essentially associative in character continued unchanged. Perhaps the clearest example of this is given by attempts to understand the formation of verbal expression in accordance with the principle of "Markov chains," by which each preceding link (and only that link) determines the next link associatively, so that the whole verbal expression begins to be represented as a chain of separate, consecutively (associatively) connected links. This concept lay at the basis of the theories put forward by Osgood (1963, 1965) and his followers. It was later supplemented by a stochastic criterion according to which combinations of words found together most frequently arise with the greatest probability during the formation of expression; it was this idea that activated a series of attempts to verify the laws of formation of verbal expression by means of associative experiments (Deese, 1962, 1964; Clark, 1966, etc.; Howes and Osgood, 1956). Although these attempts took the form of the popular "probabilistic" theory of analysis of the phenomena, it is easy to see that their traditional associationist nature remained unchanged, and for that reason they aroused sharp criticism both from Chomsky (1957), who pointed out that the virtually immeasurable richness of possible alternative forms of verbal expressions

30 could hardly be explained from the standpoint of associative chains, and from Miller (1956, 1962, 1966) who demonstrated the futility of attempting to use the associative theory to explain the formation of expression. These associationist attempts to explain "word chains" were countered by other attempts to explain the production of expression and its deep structure (Chomsky, 1957, 1965). This was a fundamental and progressive move by comparison with attempts to explain the formation of verbal expression from associative chains, but even so it did not produce a sufficiently convincing psychological description of the events taking place. Most commonly the attempts were limited purely to references to the specific nature of shortterm "operative memory," which was necessary in order to maintain all the component parts of the complex syntactic structure in a state of operative readiness. All that was explained here was that the greater the number of components in the syntactic structure and the greater its depth, the greater the demand made on the capacity of this memory, and that in languages there are different ways of reducing " d e p t h " (Yngve, 1960, 1961). Attempts to explain the formation of expression on the psychological basis of human operative memory (the study of which, in turn, became the fashionable problem in the 1960s) are of considerable interest. However, there is no doubt that these attempts also were too general in character and rested too much on some general, nonspecific factor than on a real psychological explanation of the processes of conversion of thought into extended expression. This analysis of the attempts made to discover the psychological mechanisms of the conversion of thought into extended verbal communication and to describe in more detail the psychological process of formation of verbal expression gives the impression that since Vygotskii's time very little process has been made with this very difficult problem. The hypothesis that extended verbal expression is produced, not directly from "thought," but from the intermediate stage of "internal speech," with all its distinctive psychological features, still remains perhaps the only attempt from which further progress can be anticipated. This idea of "internal speech," with its predicative function and its contracted structure, has been enriched by the hypothesis of "deep-syntax and semantic structures" described above; it may well be that on this basis some definite, although slight, progress will be made in the psychological analysis of the conditions essential for the formation of verbal expression. Let us now examine some of these attempts in rather more detail. I stated in the first pages of this section that the starting point of every verbal expression is the presence of a motive or a set. I include among these motives those forms mentioned by Skinner and such as the desire to request something ( - m a n d = demand), to transmit something

31 (—tact = contact), or, finally, to understand or clarify something or classify it in a system of concepts (—cept = concept); if no such motives exist in a person, he will develop neither a thought nor any of the subsequent stages of conversion of thought into extended verbal expression. In these cases the position is limited either to affective exclamations (interjections) or to the echolalic repetition of expressions received; the understanding of audible speech will not go beyond the passive intake of individual words or phrases and it will be completely lacking in those active searches that are an essential condition for the decoding of communication. It is too early yet to assess the full importance of this factor but we must now move on to the basic theme, that is to the neuropsychological analysis of the process of verbal communication. I cannot say much about the psychological conditions essential for the appearance of thought, and in any case I cannot add significantly to what Vygotskii said about it 40 years ago. However, if we take account of attempts to characterize the process of formation of the semantic schemes, a process that stands on the borderline between thought and the semantic organization of internal speech, and about which I have spoken above, the task of discovering some of the essential psychological conditions for this process becomes much easier. I have already said that the semantic set according to its characteristics as given in modern linguistics cannot be regarded either as a linearly ordered chain or even as a hierarchically constructed tree. Instead, there is every reason to suppose that the semantic set is a multidimensional simultaneous structure, representable as a graph: a semantic graph. Both the semantic units that form the nodal points of the semantic graph and the semantic connections expressed as arcs joining these nodal points resemble least of all those simple dictionary definitions that are attached to the form of an object and constitute the solid lexical habits of vocabulary. As was shown earlier, the lexical units themselves introduce the content of the expression both into the system of paradigmatic relationships and into the system of syntagmatic connections. Let us examine these two systems separately. Every lexical unit (and, in particular, every word) fixes the place of the corresponding idea in the whole system of connections (for example, it relates the idea of "dog" to "animal," "domestic animal," "animal guarding the house," or "animal used in hunting," and the idea of "coal" to "organic substances," to "substances of a black color," "fuel substances" and so on). Meanwhile lexical units are linked together by particular relations with several other lexical units, which either possess common semantic features (they participate in a common situation, they belong to the same category), or are characterized by common phonetic features and are represented by similarly

32 sounding words. Lexical units also possess qualifying grammatical features ("number," "type," and so on) as well as formal grammatic features indicating the possibility of syntactic connection of one lexical unit with others. To express his thought in words, the speaker must break down the semantic graph into separate "pieces," each of which can be expressed by a separate lexical unit (word). However, since every word is joined by many connections with other words of the language and is incorporated into a network of multidimensional senses, for thinking to take place in an organized manner and for the formulation of expression, some choice from the many probable alternatives is necessary. The principal condition must be "filtration" of all the potential connections, the choice of those that correspond to the task in hand, and the rejection (inhibition) of those that are not relevant. In other words, the process of analysis of the semantic graph must assume an organized, selective character; this is the first condition for the successful formulation of thought and its subsequent conversion into extended expression. Under ordinary conditions this selective analysis of the semantic graph takes place automatically, so that the required word, stabilized in past experience, is recalled with greater probability than other words; it is this feature that makes the process of selection possible. Only if relatively rare words are sought is the required word not the one most likely to be recalled, the probability of recalling connections associated with the required word and several others, incorporating identical features, becomes equalized; the person attempting to find the necessary word then experiences considerable difficulty. The situation is the same when an insufficiently stabilized word is sought; this problem has recently been studied with great thoroughness by the American psycholinguists McNeill and Brown (1961), who have described it as the "tip of the tongue" phenomenon. If the word "microtome" is unfamiliar and inadequately fixed in the memory, the search for it may evoke a whole network of recalled words, some of which are evoked in accordance with the principle of a common root and a disyllabic structure ("micro-scope," "micro-graph), others by the principle of common meaning ("knife," "cutting"), and a third group by the principle of belonging to the same general category ("laboratory," "apparatus"), and the identification of the required word becomes much more complex. A similar situation may arise with surnames; in the attempt to recall the surname of the Georgian primitive artist Pirosmanishvili, other Georgian polysyllabic surnames of the type "Prangishvili" or place names of the type "Passanaurai" may b? recalled successively, and the search for the required name may be rendered more difficult by the uncontrollable recalling of words similar in general type, morphological structure, common sound, common meaning, and so on. The example of Chekhov's story "The Horsey Name"

33 (Loshadinaya Familya) is only one of the better known illustrations of this complex process. The multidimensional nature of the connections in which a word may take part can be clearly demonsteated in special series of experiments; I need describe only one such series for it illustrates the original fact clearly enough. If orienting reactions to all words are extinguished by frequent repetitions of some words (see: Luria and Vinogradova, 1959, 1971), and then one word (for example, " c a t " ) is made a test word, and if the patient is instructed to respond by a movement (pressing a key) to this word every time it is presented, or if this word is accompanied by a painful stimulus, the presentation of this word will evoke a vascular orienting reaction (constriction of the blood vessels of the hand and dilatation of the vessels of the head) or a specific conditioned nociceptive response (vasoconstriction in both hand and head). If, immediately after this, other words connected semantically with the test word (for example, "kitten," "mouse," "dog") or phonetically [for example, "koshka" (cat), "kryshka," "kruzhka," "okoshko"] are presented, a distinctive picture can be observed. In the normal adult subject (or the normal schoolchild) the presentation of words resembling the test word semantically will evoke a definite orienting vascular response (vasoconstriction in the hand, vasodilatation in the head); the presentation of words resembling the test word phonetically will not evoke any such response. In the mentally retarded child or a subject who is very tired or drowsy the pattern will be different: the presentation of words of similar meaning and also of words of similar sound, not evoking conditioned motor responses (pressing on a key with the hand), will continue to evoke an orienting vascular response; moreover, the more closely the word resembles the test word (in meaning or sound), the more intensive the response will be. In severe mental retardation this pathological feature is more marked: words resembling the test word in meaning will not evoke an orienting response of any sort, whereas words resembling the test word in sound will continue to evoke an orienting autonomic response. This stage of affairs will be clear from the fact that the preparation of a verbal expression at the level of semantic scheme and the movement from semantic associations (the semantic field) play the predominant role and inhibit the acoustic similarity, but under pathological conditions or in inhibitory states the primitive inhibitory (acoustic) associations are disinhibited and become equivalent to semantic associations. This stage of affairs will be clear from the fact that the preparation of a verbal expression at the level of semantic representation and the movement from plan and internal speech to expression are invariably in conflict with the need to choose the required word from a series of possible alternatives; the more complex (abnormal) the conditions under which the cortex functions and the greater the disturbances of the selected character of the normal

34 dynamics o f nervous processes, the more complex this process will become. The deepest level o f semantic schemes thus requires a complex process o f selective organization o f associations, a choice from many probable elements, and a process o f "decision making," to which much attention has recently been paid in psychological research, as the basic condition for the normal preparation o f verbal expression. However, the introduction o f the lexical unit into the system o f "paradigmatic relations" is only one o f the conditions o f expression formation. A second condition is the introduction o f the word into a system o f syntagmatic connections. As we have seen above, the semantic graph, the starting point for expansion o f the expression, consists not only o f semantic units, the nodal points o f the graph, but also o f arcs that join these nodal points o f the graph together. The appearance o f these arcs is completely determined by the fact that every word can be incorporated into a whole verbal expression because it possesses certain "valencies" and can command different combinations with other words. For instance, the word " b o u g h t " immediately evokes the question: who?, what?, from whom?, and requires possible connections such as: " a man bought ...," "bought bread ...," "bought for a high price"; the word " l e n t " has many valencies and evokes the questions: who?, what?, to whom?, and for how long? and it naturally also evokes expressions such as: " a man lent . . . " "lent to his friend," "lent a large sum o f money," or "lent for a short time." Every word included in an expression thus not only introduces the object or action it denotes into a system o f hierarchically (paradigmatically) organized concepts, but at the same time introduces it into a system o f expanded (syntagmatic) verbal expression. Investigations undertaken by many different psychologists have clearly shown that such syntagmatic connections appear very early. The present writer showed long ago that syntagmatic groups (such as "house burns," "dog barks") arise much earlier and take place much more easily than "associatively" organized paradigmatic connections:

inclusion in a common

category ( " s u n " — " m o o n " ) , subordination ( " d o g " — " a n i m a l " ) and so on (Luria, 1 9 2 7 ) . Clearly the presence o f these syntagmatic groups is just as important a condition for the production o f fluent expanded speech as the introduction o f a given lexical unit into a certain system o f hierarchically constructed paradigmatic relations and the significance o f these "syntagmatic groups" in the production o f expanded verbal expression derives from the fact that all speech, being a means o f communication, is a system o f syntagms (whole expressions) rather than a complex o f lexical units (words); it was this that led eminent thinkers such as Hughlings Jackson ( 1 8 6 6 ) to say that " t o speak is to propositionize," and A.A. Potebnya ( 1 8 8 2 , 1 8 8 8 ) to postulate that the

35 unit of speech is not so much the word as the real combination of words, the syntagm, the embryo of the proposition. It is these two factors — the "paradigmatic" relation between individual lexical meanings that forms the concept and is the act of "simultaneous synthesis" of individual elements of information, and the "syntagmatic" combination of single words into verbal expressions, manifested as the "serial organization of speech processes" (Lashley, 1951) - that are the two most general psychophysiological conditions essential for the conversion of thought into speech and for the expansion of verbal expression. The role of both these factors of verbal communications differs in different types of communication; in the first, which Svedelius (1897) at that time called "the communication of relationships" ("Socrates man," "birch tree"), the process of placing the object into a class or, in other words, the paradigmatic factor, arranging the elements of communication in hierarchically constructed simultaneous schemes, is predominant; in the second form "communication of events" ("house burns," "dog barks") there is a totally different psychological process and the syntagmatic connections, the units of coherent expression, are clearly predominant. While appreciating the wholly conventional nature of the subdivision used by Svedelius, I shall continue to use it in my description because it enables the two most important aspects of language and the two most important aspects of expression to be distinguished. What I have just said above is the basis for the general principles that govern the conversion of thought into expanded verbal communication. However, in order to add to the description of the psychological mechanisms of this transition that gives rise to the expression or converts in into thought, certain more concrete and special facts must be emphasized. The pathways from thought to speech and from speech to thought naturally incorporate the same stages: the motive and the basic thought of the expression, its semantic representation, internal speech converting this representation into the deep-syntax structure of expression, its surface-syntax structure and, finally, external speech itself. However, both the order and the psychological structure of these components differ, and this fact has been emphasized both by neurologists (Pick, 1913), who distinguished between "the path from thought to word" and "the path from word to thought," and linguists (Hockett, 1961), who proposed making a separate "grammar for the hearer" and "grammar for the speaker." Later I shall have to discuss these two pathways in detail; at this stage, however, I shal dwell only on their general psychological characteristics. The "path from thought to speech," included in the preparation of verbal expression, as I have already stated, starts with the motive or general notion (known to be the subject from the very beginning in its most general features), it passes through the stage of "internal speech," which is evidently based

36 on the scheme of the "semantic representation" with its potential connections, and this leads first to the formation of the deep-syntax structure, and then to expansion into the external spoken expression, based on the surfacesyntax structure. Nothing could be more mistaken than to assume that this process always takes place smoothly. In a person with a relatively inadequate verbal experience it invariably meets with many difficulties. The first difficulty is the formulation in words of the general thought or general scheme of expression, a process requiring the isolation of the most important connections and inhibition of the unimportant. This process clearly is connected with an act of choice from many possible alternatives and with "decision making," and the less the communication to be expressed in words corresponds to the most probable and best consolidated verbal stereotypes, the more complex this process will be. Naturally the verbal expression of a proposition that carries virtually no new information, such as "it is cold in winter," calls for far fewer special intermediate operations than the construction of the proposition "it was very hot this winter," which is not based on customary stereotypes. Equally naturally, the "communication of events" (such as "house burns") follows a much easier course than the "communication of relationships" (such as "Socrates man"). The construction of understanding of an expression using only simple grammatical structures, for example, predominantly at the level of "co-ordination" of the parts of the proposition (or "para-taxis") follows a much easier course than the constructional understanding of an expression that includes the complex forms of "sub-ordination" (hypo-taxis), using complex syntactic phenomena, i.e., the passive case or inversion (for example: Petya pobil Vaniu /Petya hig Vanya/ or Petyu pobil Vanya/Vanya hig Petya/) (in which the order of the words does not coincide with the order of events) and contains complex connections that are the instruments of this "hypo-taxis" or "inversion" (some relevant experimental facts were obtained by Wason, 1959; Gough, 1965, 1966; Smith, 1965; Slobin, 1966, and others). Finally, the construction of an expression including a complex hierarchy of co-ordinated components and, consequently, having a syntactic tree and great depth (see: Yngve, 1960, 1961), like the construction of expressions including distant structures, is much more difficult than the construction of expressions with limited depth and including only contactual structures. I shall be content here with these remarks, for in the subsequent chapters this problem will receive a more detailed analysis. The conditions outlined above have different roles to play in written and spoken speech. Whereas written speech, in which there is no interlocutor, is always monologic and cannot be supported by extralinguistic (sympractic) aids — knowledge of the situation, facial expression, gestures, - in spoken (especially dialogic) speech this limitation is absent: in this case information

37 can be transmitted by extralinguistic aids, and incomplete expansion, ellipsis, the participation o f intonation, and so on, can exist. The differences between spoken and written speech are o f considerable psychological interest yet, although they were clearly demonstrated by Vygotskii as long ago as in 1 9 3 4 , they have still not been properly investigated. As was stated above, the encoding o f verbal communication, involving the conversion o f thought into expanded speech, begins with the general scheme o f the expression as a whole, and this is then followed by the search for individual lexemes, in which support from syntagmatic aids (word orders, inflection, the use o f copulae or auxiliary particles) is very important. It is in this last stage that the valencies o f words, mentioned above, the lexical functions and the basic syntactic rules, which produce the syntactic units o f the whole expression and also act as the natural filters prohibiting unusable combinations and thereby greatly facilitating the choice o f the necessary syntactic forms, are used. All these preliminary schemes o f expanded verbal expression are based on the choice o f the necessary lexical units; this can be done both through the "paradigmatic" apparatus (finding a word through its isolation from a complete hierarchically organized system o f meanings) and through "syntagmatic" connections (the isolation o f the necessary word from turns o f conversational speech, such as, for example, finding the word " b a g " from the complex "school-bag" or the word " d a w n " from the expression "came the dawn." We shall see below how important these two methods are in the neurolinguistic analysis o f the forms o f speech disturbance met with in aphasia. The last elements in the stages o f formation o f the expression are processes taking place at the phonological and phonemic levels or, in other words, the expression o f a particular word in audible speech. The process o f decoding or comprehension o f a verbal expression or, in other words, the process o f change from expanded speech, as received, into its external meaning, and then to its inner sense, consists o f the stages listed above in the opposite order. Unlike the process o f formation o f expression I have just described, the process o f its comprehension begins with an expanded flow o f words that is dismembered by the hearer. As a result o f this dismemberment the hearer distinguishes the individual sound and words and perceives them; these elements then are fitted into a complete ordered structure, consisting o f lexical and syntactic groups. The communication perceived by the hearer incorporates both prosodic and also some nonlinguistic (mimic, sympractic) components. The hearer now has the task o f uniting these separate components, picking out from the flow o f words the meaningful units, and then — through the intermediary o f internal speech - recognizing the sense contained in this verbal communication. In this respect Chomsky states quite

38 rightly that the way of understanding verbal communication lies in its reconstruction at each successively deeper level and transforming its surface-syntax structure into a deep-syntax structure, and then into the original "semantic representation," that is the deepest level of verbal thinking (Chomsky, 1957, pp. 79, 102 etc.). Naturally the perception of the general intonational structure of the sentence and the understanding of the meaning of the words composing it are among the first conditions (in the order of arrival of the information) for the understanding of any verbal communication. However, this process is not simply one of placing the word meanings in their appropriate category, a phenomenon studied in detail by Vygotskii (1934). An essential role in the understanding of the meaning of a word included in the communication is played by its evaluation in the light of the position that it occupies in the sentence. As I have stated already, many words in any language are homonyms: the understanding of the precise meaning of the word "ruchka" depends on the context, which differs in the sentence "Ya derzhal ruchku devochki" (I held the girl's hand), "Ya pisal pis'mo ruchkoi" (I write a letter with a pen), or "Ya krepko derzhalsya za ruchku kresla" (I gripped the chair arm tightly). The importance of the context to the understanding of word meanings is seen similarly in the phenomenon of "infusions" of the sense of words, described by Vygotskii, according to whom each successive sentence must retain elements of the preceding sentence in its composition; this facilitates the unity of description, without which the coherent narration would be converted into a chain of isolated, unconnected sentences, so that the train of thought could not be maintained. This train of thought can be maintained by external links, as by correlative words such as "which," "as well as," or "as a result o f ' ; with the aid of these links, particularly important in dependent clauses, the language gives precision to the object of the narrative by linking the additional clause to the main clause and the next sentence to the one before. These external grammatical aids for the "infusion of sense" obtained an independent existence only in the relatively late stages of development of the language and a few centuries ago it was still necessary to use external verbal support, in the form of repeating the name of the object concerned, such as in the following sentences: "Goods are sold to the merchant, which merchant trades by the city wall." Only in the later stages of development of the language did these connecting words, serving as the means for "infusion of sense," begin to be used without any additional visual support, and in some cases they disappeared completely and the process of "infusion of sense" became internal or semantic in character. The need for this basic condition ensuring the "infusion of sense" and preserving the unity of narration is well illustrated by the anecdote in which the disappearance of this mechanism leads to interruption of the unity of the

39 sense in which each sentence, having become disconnected from its predecessor, can no longer serve to transmit the communication as a whole: "Ya tebe kotel dal?" - "Dal." "Ty ego vzyal!" "Gde zhe kotel?" - "Kakoi kotel?" "Ya zhe tebe ego dal?" - "Dal!" (Did I give you a kettle? - You did. Did you take it? - I did. Where is the kettle? - What kettle? Did I give you a kettle? - You did, and so on). The process of infusion of sense, an essential condition identifying the sense of a word, the mechanism of which is evidently closely bound up with the mechanisms of "short-term memory," still awaits detailed study; however, it is one of the important conditions necessary for the development of narration, and moreover it is a mechanism that functions only for short times during communication. The second, more general mechanism, is that of the effect of the general situation or program of description, which functions for longer periods during narration and is responsible both for preserving the basic direction of the account and for preventing all possible deviations from the path indicated. The role and the plan (or program) in the evolution of a complex action has been steadily studied in the last decade. Whereas previously a complex series of successive actions was interpreted as a chain, in which each succeeding link was evoked by mechanisms embodied only in the preceding link (as I have said above, this was the basis of attempts to describe the understanding of expressions in terms of Markov chains), more recently the understanding of the planned performance of programs has assumed a different and more complex character; investigators have begun to take as their basic assumption the view that there is some complex and permanent "monitoring device" which ensures that the program is carried out and corrections introduced whenever the action starts to deviate from the program. In physiology this concept of the performance of a complex program has been embodied in the ideas of "afferent feedback" or "self-regulating systems," including the mechanism of the "action acceptor" (Anokhin, 1955, etc.), a circle of communication and "secondary corrections" (Bernshtein, 1947, 1957, etc.), or Τ — O - T - E mechanisms (Miller, Pribram and Galanter, I960). In psycholonguistics and, in particular, in that section of it that deals with the decoding of communication and the psychology of the understanding of its sense, this "monitoring device" is manifested as a continuous search for the key parts of the account. Accents and pauses can be used as external supports to pick out these key components of the text in spoken speech, and paragraphs and italics in written speech. However, in the absence of these external aids, the distinguishing of these key elements of communication remains the task of semantic analysis, the internal comparison of the components of the communication and the constant return to parts analyzed previously, a mechanism highlighted so strongly by the study of the process

40 of understanding texts by recording the reader's eye movements (the literature on this problem is so extensive that I shall not even mention it). The next problem to be tackled in the decoding of verbal communication is naturally the search for "paradigmatic" and "syntagmatic" relations, which sometimes may be very complex in character, but without which the understanding of the communication could not be achieved. In some cases the understanding of "paradigmatic" relations may be particularly complex in character and call for a whole series of additional aids. Such cases include the understanding of "reversible" forms of "communication of relationship" (of the type "brat ottsa"/the father's brother/ and "otets brata"/the brother's father/; "solntse osveshchaetsya zemlei" /the sun is lit by the earth/ and "zemlya osveshchaetsya solntsem"/the earth is lit by the sun/), to which I have repeatedly drawn attention (Luria, 1946, 1947, 1962, etc.) and which I have specially studied in the course of an investigation of the decoding of communication. Cases of the understanding of constructions in which the word order does not coincide with the order of events (such as "I had my breakfast after reading the newspaper") or constructions embodying the same principle and including, for example, a double negative (of the type: "I am not in the habit of not obeying rules" equals "I am in the habit of obeying rules"), belong in the same category. The-group also includes all distant constructions in which part of the communication is separated from another part, closely linked semantically with it, by interposed phrases and digressions. Finally, this group of verbal constructions that cannot be directly understood includes all with a complex hierarchy of mutually dependent parts of the sentence, in which the distant elements have to be brought closer together, and this gives rise to particularly great difficulty for decoding. In all these cases (which I shall discuss again below) the understanding of the surface-syntax structures of the communication requires a certain amount of work on the text, with frequent reverting to stages already completed, comparison of widely distant parts of the communication, transformation of grammatical constructions (the change from passive to active, from inverted to direct, and so on), and without work of this sort the final understanding of the verbal communicatiom would be impossible. Naturally the capacity of the operative memory plays a vital role at this stage; if one fragment of the text exerts retroactive inhibition on the preceding part (under normal conditions this is abolished by Biihler's Law, according to which the semantic organization of the text abolishes such effects), it becomes much more difficult to understand a complex text. We shall see again below how this important condition is disturbed in pathological states of the brain. The process of decoding the communication does not end with the understanding of the external meaning of the sentence. It may be continued with the understanding of the internal sense of the sentence, on the one hand, and

41 the external sense of the whole text (or the understanding of the connotation), on the other hand. A sentence may have several sharply different sense and may be just as homonymous as a separate word. For instance, as already said, the sentence "Ivan prishel k Ol'ge s Petrom" (Ivan called on Olga with Peter) may mean that Ivan and Peter together visited Olga or that Ivan visited Olga who lives with Peter. The sentence "Muzhu izmenyat' nePzya" can mean equally that a wife must not change her husband and that a husband must not change his wife. In both cases semantic differences can be indicated by pauses - "Ivan prished k Ol'ge (s Petrom)" and "Ivan prishel (k Ol'ge s Petrom") or by a change of intonation (see above, page 12). The transition from the external meaning of the sentence to its internal sense is particularly remarkable in proverbs: "Strike while the iron is h o t " has nothing whatever to do with an episode in the life of a blacksmith, and "Cut your coat according to your cloth" has nothing to do with the work of a tailor. Even the decoding of an isolated sentence can thus go beyond the description of its external meaning and be converted into the examination of its internal meaning or connotation. The process is seen more clearly still in the understanding of a coherent text. Any coherent fragment of a text is not merely a sequence of sentences, but it incorporates a general thought, a conclusion drawn from the communication as a whole. That is why understanding the meaning of each separate sentence does not amount to understanding the sense of the whole text; in order to achieve this final result, the subject receiving the communication has to undertake work in order to analyze the text into its parts, to compare them, and to pick out the key components, and sometimes also to progress from separate "pieces" of information contained in the isolated sentences to the general idea of the communication and, finally, to its connotation or moral. This process takes places in any understanding of a text, but in its most expanded form it is observed during the understanding of fairy tales or stories with a moral. For instance, the story "The Jackdaw and the Pigeons" does not in the least refer to an incident in which a jackdaw, having heard that the pigeons had plenty of food, forgot himself and cried like a jackdaw, so that she was turned out of the pigeon house and left homeless; the moral of this story is the general notion that a person must not pretend that he is something else, and the understanding of this fragment in fact assumes going beyond the limits of the external theme of the communication into its "deep semantic structure." The complexity of the task of active discursive thinking required for the successful solution of this problem and its sharp difference from the direct

42 analysis of the "simple text," with no hidden internal sense, will be easy to see; it will be obvious what considerable differences exist between the "reading" of this fragment and the depth to which the hearer receiving it must penetrate. I am well aware that my description of the psychological conditions necessary for the conversion of thought into expanded verbal expression and from expanded verbal expression to thought by no means exhausts the whole real complexity of this process. The reason why the description of this process is so unsatisfactory is that the transition from some of its elements to others usually takes place unconsciously; that is why the psychological mechanisms of this process and its detailed description cannot readily be studied by linguistic or psychological methods. New ways of investigating these highly complex processes of encoding and decoding verbal communication must be sought - methods capable of distinguishing the component parts of this process and of describing their role in the formation and understanding of verbal expressions. Neuropsychology provides one such method.

3. NEUROPSYCHOLOGICAL APPROACH TO THE PROCESS OF VERBAL COMMUNICATION

I have already stated that neither linguistics nor psychology possesses sufficiently precise and objective methods of distinguishing the component parts of the encoding or decoding of verbal communication or of shedding light on the role of each component concerned in this complex process. In the initial period of its development, linguistics was limited to methods of formal analysis of natural languages. Structural linguistics and transformational grammar added a group of extremely important methods as a result of which models of language could be constructed, their general principles described, and their structural features studied with great accuracy. However, these branches of linguistics, which have greatly enriched the study of language with their distinction between the basic models of "deep" and "surface" lexical and syntactic structures, although capable of studying the formal laws of their transformation, are of very little help to us in the analysis of the real course of the process of transition from thought to expanded verbal communication and vice versa; that is why references to the possible psychological structure of this verbal activity which we find in the writings of such eminent supporters of transformational linguistics as Chomsky and his followers, are incomparably less accurate than their formal structural-linguistic analysis of the material they studied, and usually they do not go beyond the most general statements concerning the need to distinguish

43 between competence and performance, the hypothetical "recording o f the process in the nerve cells o f the brain," the presence o f "traces imprinted in the memory," and so on. It is easy to see that these references go no further than the description o f processes observed in the operation o f high-speed electronic computers and they are analogies rather than the discovery o f the real processes responsible for the formation and decoding o f expressions in the course o f verbal communication. Naturally, therefore, the thoughts o f specialists who wish to penetrate deeper into the structure o f these processes have turned to psychology and it is not surprising that fundamental investigations, such as those o f Bühler ( 1 9 3 4 ) and Vygotskii ( 1 9 3 4 ) , have begun to attract the attention o f investigators who consider that psychological analysis o f the act o f speech can yield the answers to the most important questions o f the relations between language and thought and material for the description o f the real processes o f formation (decoding) o f expressions. There is no doubt that the investigations cited above were absolutely essential for the further development o f this field o f science, and that the principles formulated by Vygotskii in his classical book "Thought and Language" are still mandatory for psycholinguistics. However, not even these investigations, subsequently continued by Miller ( 1 9 6 9 , 1970), McNeill ( 1 9 6 1 ) , R . Brown et al. ( 1 9 6 4 ) , Bever ( 1 9 7 1 ) , Fodor et al. ( 1 9 6 4 , 1 9 6 7 ) and others, could make decisive progress in the analysis o f the real process o f formation o f communication. The main reason for this was that these workers lacked an objective method that could give a detailed description o f each actual element successively incorporated into the expression or demonstrate the real role performed by each element in this process. There is reason to suppose that this problem can be solved in at least two ways. One, experimental genetic, aims at studying the development o f expression in the child or the formation o f ability to express thoughts as speech. This method was initiated by Piaget and Vygotskii. It has also been used by Miller, McNeill, Brown, Fodor, and Slobin in their ingenious psychological observations. I shall not discuss this matter further, more especially because I have already made a special study elsewhere o f some o f its results (see: Luria and Yudovich, 1 9 5 6 , 1 9 5 9 , 1972). Let us turn to the other method, which falls entirely within the scope o f the present book. This is the experimental pathological method, the analysis o f disturbances o f the process o f formation o f expression, made possible with the establishment o f the new scientific discipline o f neuropsychology. This science has developed entirely within the last two decades (see: Luria, 1 9 4 7 , 1 9 6 2 , 1 9 6 3 , etc.) and it evidently can provide wide opportunities for the investigation o f these problems. I propose to discuss some basic principles o f the neuropsychological

44 method o f investigation before attempting to use it to analyze the actual process o f communication. As I pointed out at the beginning o f this work every expression is constructed from a series o f consecutive elements, each o f which is an essential condition for this process. However, there are good grounds for supposing that every condition involved both in the complex process o f formation o f expression (the encoding o f thought) and in the no less complex process o f decoding (or understanding) o f communication is the result o f close collaboration between a series o f brain systems. Further, the evidence suggests that each o f these brain systems plays its own unique and special role in this complex process and makes it own special contribution to the construction o f the functional system on which it is based. I have argued the case for this principle in detail in my studies o f the neuropsychological organization o f many forms o f human behavior (Luria, 1 9 6 2 , 1966, 1 9 7 0 , 1973). We know that the human brain is a highly complex functional system that requires the constant participation o f at least three basic units in order to carry out its functions. One o f these units is responsible for the waking state o f the cortex and provide for prolonged selective forms o f activity; the sccond unit is that for the perception, processing and storage o f information, while the third unit is concerned with the programming, regulation and control o f activity while it is in progress (Luria, 1 9 7 0 , 1973a, c). Every act o f behavior -

every goal-directed, action, every process o f

perception, memorizing or thinking -

requires the combined operation o f

these basic functional brain units; each o f these units is responsible for its own particular aspect o f this process. These facts have become clear as the result o f the long and systematic analysis o f changes in psychological processes produced by local brain lesions arising as a result o f trauma, tumors, or localized hemorrhages. A lesion affecting the structures o f the first unit (the brain system, systems o f the medial cortex or limbic region) leads to a modality-nonspecific lowering o f cortical tone and it makes the selective course o f pscyhological activity impossible or very difficult. A lesion o f the structures o f the second unit (the secondary zone o f the left temporal or parieto-occipital region) substantially disturbs the conditions required for the reception and processing o f information; each lesion o f this unit leads to distinct modality-specific (visual, acoustic, spatio-kinesthetic) disturbances, whereas lesions o f these structures in the left (dominant) hemisphere radically limit the capacity for processing appropriate information with the aid o f language. Finally, a lesion o f the structures o f the third unit (the frontal zone),

45 although not changing cortical tone or affecting the basic conditions for the reception of information, substantially disturbs the process of active analysis of information, interferes with the formation of plans and programs of action and prevents the reliable and sustained monitoring and control of its course. Clearly each of these types of brain lesions abolishes one of the conditions necessary for the normal course of conscious activity and leads to the disintegration of the organized activity of functional systems. However, perhaps the most important fact is that each such lesion disturbs conscious activity in a specific manner; the disintegration of functional systems arising as a result of a lowering of cortical tone, as a result of a disturbance of modality-specific forms of reception, analysis and storage of information, or as a result of a disturbance of the programming, regulation and monitoring of activity all differ significantly from one another. I have used the neuropsychological method in order to study the components of several psychological processes: speech (Luria, 1947, 1970), writing (Luria, 1950), problem solving (Luria and Tsvetkova, 1966), constructive activity (Tsvetkova, 1966) and mnemonic processes (Luria, Konovalov and Podgornaya, 1970; Luria, 1974). All these investigations clearly showed that the neuropsychological analysis of changes taking place in the course of various types of activity as a result of local brain lesions provides objective data on their internal structure and on the role played by each component of the particular action during its course. It is this method that I propose to use in order to analyze the actual process of formation (encoding) of expression, on the one hand, and the process of its understanding (decoding), on the other. There is every reason to suppose that attempts to use the neuropsychological method to analyze the process of expression can yield important results. As I have already stated, every expression presupposes a certain motive or plan of converting a certain thought into speech. However, it is well known that in patients with local lesions of the frontal lobes it is precisely this process that is seriously impaired (Luria, 1962, 1969; Luria and Homskaya, 1966) and the active formation of a plan, the basis of programming of subsequent activity, is disturbed. In these cases substantial disturbance of the formation of active expression can be expected, despite the integrity of repetitive and dialogic speech, in which the creation of a stable plan and the active conversion of thought into speech are unnecessary. It is well known that there are local brain lesions (primarily lesions of the lower zones of the posterior frontal region of the left hemisphere and its connections with the temporal zones) that disturb the mechanisms of internal speech (Luria, 1962, 1969, 1970). It is therefore natural to expect that in such cases the important conditions for the preparation of expanded verbal expression will be absent and that, despite the integrity of repetitive and

46 nominative speech, the process of formation of fluent expanded expression will be disturbed. We also know of cases in which a lesion of certain parts of the brain (the secondary zones of the left temporal region) causes a disturbance of phonemic hearing, leading to "alienation of word meaning" and to inability to make a precise choice of the lexical elements of speech although the active search for these elements remained unchanged. It is therefore natural to expect that the disturbance of expression formation that arises in such cases will be completely different in character. Finally, lesions of the parieto-occipital zones of the left hemisphere are known to cause a disturbance of simultaneous (spatial) syntheses, which makes the grouping of individual elements of information into complex, organized systems extremely difficult and disturbs the formation of complex logical-grammatical relations (Luria, 1945, 1947, 1962, 1969). It may naturally be expected that such defects would lead to a disturbance of completely different components of the formation and decoding of expression and that the patients of this group would exhibit a disturbance of essentially different processes of verbal communication from those found in the cases described above. It must be clearly pointed out that the neuropsychological method, with its ability to analyze how the conversion of thought into expended verbal communication and the reverse process of decoding of this communication and its conversion back to thought are modified, is only one method of objective analysis of verbal expression. Also, the facts obtained by this method are complicated by certain conditions specific to the pathological state of the brain (pathological inhibitability of traces, loss of their selectivity, their pathological inertia), they have special features of their own, and they are by no means a simple copy of the normal course of these processes. However, for all these limitations the neurpsychological method is an important means of analytical investigation of the real processes of formation and decoding of verbal communication and it must be used whenever we wish to distinguish the real units of this process and to study the role of each unit in the complex process of verbal communication. The neuropsychological analysis of changes in the formation (encoding) and understanding (decoding) of communication in patients with local brain lesions clearly thus offers fresh opportunities for the study of this intricate process and it will be evident that the new field of research now called neurolinguistics can make a useful contribution to the solution of these difficult and not easily accessible problems. The neuropsychological analysis of speech processes is the main course I have followed in my own work and it has also been used by many other investigators (see: Whitaker, 1971; Benson, 1967; Geschwind, 1965, 1968,

47 1 9 7 4 , etc.; Green, 1 9 6 9 ; Lenneberg, 1967). In the following pages I shall make a detailed analysis o f these t w o fundamental processes o f verbal communication.

NOTES 1. In the present context I shall not dwell on the relations between the modelof language proposed by Chomsky and that developed by the Moscow linguists (Zholkovskii, Mel'chuk, etc.). This problem lies outside the scope of the present book. 2. In Russian if the number is put before the noun it qualifies it specifies an exact number, if the number follows the noun it specifies an approximate number. 3. Basic deep-syntax structures and deep-syntax structures derived from them are distinguished in the "Meaning - text" model. To simplify the description, I shall discuss only deep-syntax structures.

II NEUROPSYCHOLOGICAL A N A L Y S I S OF ENCODING OF V E R B A L COMMUNICATION

We have undertaken a linguistic and psychological analysis of the processes of verbal communication and the role of neuropsychology in the identifaction of the components of verbal expression. We must now make a closer examination of one of the main processes of verbal communication, namely its encoding, and we must scrutinize the facts that will enable us to distinguish its essential components with the aid of neuropsychological analysis. As I stated above, the encoding of verbal communication follows a complex path from thought to expanded expression. It begins with the appearance of the motive generating the demand to transmit something to another person; this demand is incarnated in the intention or thought, which is only the most general scheme of communication. With the aid of the mechanism of internal speech, the thought and its "semantic sets" are recoded into the deep-syntax structure of the future expression, which is then converted into the surface-syntax structure and, finally, into the sequential expanded expression. The question naturally arises: what is the role of these various stages in the formation of expression and what brain structures are concerned with the carrying out of each stage. As I have stated above, this question can be answered much more precisely with the aid of neuropsychological investigation. Can it be assumed that the motive, the formation of the general intention, its incarnation into the primary semantic sets, and later into the deep-syntax scheme, and its conversion into the expanded linear scheme of the sentence take place with the participation of a complex group of brain structures, some of which play the predominant role at each particular stage of the process? If so, many of the psychological processes lying at the basis of the encoding of communication would become much clearer. B y determining which stages of this pathway are directly linked with particular brain systems and by studying how the structure of speech activity is altered in patients with local brain lesions we can make a much closer

49 analysis of the encoding of communication. This will be the main purpose of the next section of this book. To detect the principal stages of the encoding of verbal communication it is necessary to use a whole series of methods in order to ensure the greatest possible completeness of the investigation. In order to tackle this problem I used the methods described below, which have proved their worth in the neuropsychological investigation of patients with local brain lesions. The collection of the necessary material begins with a clinical investigation of the patient's spontaneous speech, with which he expresses his requests and desires, his questions and, should these arise, his attempts to share certain communications with persons around him. These observations can reveal whether or not the patient possesses motives that correspond to what he has to say. The absence of such spontaneous speech may point either to a general lowering of the patient's active tone or to the absence or instability of his motivation. The nature of this phenomenon becomes much clearer in the second phase - the investigation of dialogic speech with the patient, during which he is asked questions to which he must supply the appropriate answers. In this case the examiner himself determines the patient's speech activity, and the character of its disturbances, if such are present, can be clearly seen. I have used two types of questions. In the first, the patient's verbal answer was already contained in the content of the question and it could consist of the affirmative repetition of the question or denial of its content ("Have you eaten to-day?" - "Yes, I have eaten to-day" or "No, I haven't eaten today") and no independent creation of expanded communication is called for. In the second type the question does not incorporate a ready-made answer and it is necessary for the patient to create his own new plan for the transmission of information, the closure of new connections, and the formulation of the required expression. ("What did you do this morning?" "This morning I ... saw the doctor ... went for a walk ..." and so on. "From what illnesses have you suffered?" - "I have had measles, scarlet fever" and so on). In this stage of the investigation no spontaneous motivation is required and the examiner can test to what extent the patient remains capable of giving an automatic verbal answer, on the one hand, and of creating a conceptual scheme of independent expression, on the other hand. The next, third phase of the investigation is the study of the patient's repetitive speech. In this stage the patient is instructed to repeat separate groups of sounds, including words, series of words and sentences. This system of tests shows the degree of preservation in the patient's simple, reproductive speech and shows whether his ability to repeat a verbal structure presented to

50 him is disturbed by the change from a single unit (a syllable, word or sentence) to a series (a chain of components, e.g. syllables or words). This test can demonstrate the presence of two conditions of great importance in the subsequent investigation of the whole process of encoding of communication. First, although the patient may easily repeat one verbal complex, he may have great difficutly when he tries to repeat a series of verbal units because he is unable to retain their proper order and because of the presence of mutual proactive and retroactive inhibition of the corresponding traces; in such cases it may be possible to discover a unique form of fragmentary repetition of only one part of the presented series (the first or the last part) or the order of repetition may be "inverted" so that the last is repeated first and vice versa, a result attributed to the predominance of repetition of recent traces (the "recency" factor), so that the further process of encoding of verbal communication is inevitably disturbed. Second, the patient may show signs of pathological inertia of existing traces, as a result of which he can successfully repeat a short series of acoustic or lexical units but cannot switch to different acoustic or lexical units or change their order. Clearly this pathological condition, not encountered normally, can easily disturb the process of encoding of communication. The fourth phase of the investigation is the study of to what extent the patient is still able to find the required lexical units (words) and whether he either has difficulty in doing so or replaces the necessary lexical unit by something irrelevant (paraphasia). The test of word recalling, very important for the investigation of encoding of verbal communication, incorporates two fundamentally different series of tests. In the first series the patient is instructed to name objects or actions shown to him (with the assistance of visual support — naming objects or pictures of objects shown to him, and in the absence of visual support — naming indicated parts of the body); both series test the ease with which the patient finds words in the course of coherent expression. The two series of tests differ in principle. In the first series the subject has to name a word and to distinguish it from a paradigmatic system (a system of hierarchical generalizations or classifications); in the second case he does this with the support of syntagmatic associations or, in other words, he reproduces words in the context of conversational speech. We have already seen the importance of the fact that the two tests I have just mentioned reveal difficulties in different cases; they thus point to different ways in which the required lexical units can be recalled. The fifth phase of collection of the material involves analysis of the patients' spontaneous monologic speech.

51 In the simplest forms of this test the need for the independent creation of an intention is excluded and the basic condition for success is ability to create a scheme of ready-made verbal expression and to convert it into expanded narrative speech. The methods used are repeating the theme of a story read to the patient or relating the content of thematic pictures. In the first method the whole content of the story is given in ready-made form and all that is required of the subject is that he decode it and reconvert it into expanded communication (I shall make a detailed analysis of the results thus obtained in a special section of this book). In the second case the task of analyzing the necessary information and picking out the significant elements is made more difficult and the examiner has greater opportunity of studying how the process of picking out the significant elements of the information received is tackled and to what extent the patient is able to convert this content into expanded verbal expression. Observations on the structure of spontaneous monologic speech conclude with the last (sixth) phase of these tests, in which the patient is instructed to give an expanded spoken discourse on a given theme (for example, on "The North")- In this case the problem simply names the general sphere of expression whereas the actual scheme of this expression has to be created by the patient himself, and he has also to convert the scheme into an expanded, independent verbal communication. The comparative analysis of the results obtained by all these various types of investigation of monologic speech can clearly reveal which components of the speech process (the independent creation of a plan, preservation of the active analysis of the material and identification of the original semantic scheme, the retention of the identified selective program or the creation of a basic verbal scheme or "deep grammar," lying at the basis of expanded verbal narration, remained unaffected and which of these components was disturbed. It is only by the use of such an extensive series of methods and by comparing their results that it is possible to decide which component of the mechanism responsible for the verbal encoding of thought is disturbed and whether the defect is manifested by absence or weakening of motive, by difficulty in creating or retaining an intention or thought, or of recoding this intention into the scheme of the future verbal expression, - or, finally, as a series of operational disturbances affecting the choice of the necessary words, the use of the appropriate logical-grammatical relationships, and so on. The system of methods described above must be used to analyze how the process of encoding of thought into verbal expression is altered and how the structure of verbal expression is disturbed in patients with lesions of deep zones of the brain (responsible for the energetic tone and state of wakefulness of the cortex), the frontal lobes (creating stable motives and programs of

52 behavior), the anterior portion of the speech areas of the brain (connected with internal speech and the creation of schemes of verbal expression), and the posterior (temporal and parietooccipital) zones of the speech areas (directly connected with the stability of the acoustic basis of speech, the identification of the essential elements of the visual form of an object and the conversion of serially organized information into simulaneous spatial (or quasi-spatial) schemes. It is only such a comparative analysis of lesions of zones whose role in the organization of behavior has been fully described by the writer elsewhere (see: Luria, 1962, 1966, 1969, 1972, 1973) that gives us the key to the complete neuropsychological analysis of processes of encoding of verbal communication.

A. DISTURBANCES OF THE SYNTAGMATIC ORGANIZATION OF VERBAL COMMUNICATION IN PATIENTS WITH LOCAL BRAIN LESIONS

I have already stated in the first section of this book that the encoding of verbal communication is based on two principal types of organization: the syntagmatic organization of coherent expression, on the one hand, and the paradigmatic organization of the phonemic, lexical, morphological, syntactic and semantic units, of which the language is composed, on the other hand. These two types of organization may appear to some extent independent of one another: whereas in the analysis of the basic units of language — the system of phonemes, systems of lexical and semantic units — we are concerned with a hierarchically organized (paradigmatic) system of comparisons, in our analysis of a living expression, starting with the motive and intention and ending with expanded speech, we can to some extent dispense with the system of codes (= linguistic units) that it uses and confine our attention to the syntagmatic organization of verbal communication. The question naturally arises: to what extent are these two basic forms or organization of language independent, and to what do they depend on the same or different brain mechanisms? The first person to ask this question was the eminent contemporary linguist Roman Jakobson; in a series of articles published by him between 1965 and 1966, and subsequently collected into a single volume (see: Jakobson, 1971) he postulated that all forms of speech disturbances arising in patients with local brain lesions can be subdivided into two major classes: disturbances of the coherent expression or syntagmatic organization of speech, and disturbances of systems of encoding of concepts into words, or the paradigmatic organization of language. The present writer in a number of articles has similarly shown that these two groups of disturbances are based on lesions in different parts of the brain; whereas lesions of the anterior zones of the "cortical speech areas" lead to a

53 disturbance of the coherence of expression, based on a disturbance of the internal speech that gives it its syntagmatic organization, lesions of the posterior zones of the cortical speech areas leave coherent verbal expression relatively intact but give rise to a group of fundamentally varied disturbances of verbal codes that causes disintegration of the articulatory and acoustic structure of the language and of its semantic organization, (Luria, 1947, 1964, 1967, 1970, 1973). However, all these hypotheses require very careful verification. We have to ask what forms of disturbance of verbal expression arise in patients with lesions of the anterior zones of the brain, to what extent they affect the patient's ability to master and utilize particular codes of the language, and if such disturbances take place, what forms they assume. In some of my other neurpsychological writings I rejected beforehand the idea of direct localization of complex forms of psychological activity in local areas of the brain. My basic assumption was that complex psychological processes are carried out by functional systems, based on certain component factors; being systems, these factors are not "localized" in circumscribed areas of the cortex but are distributed in the cortex (and subcortial formations); moreover, each area of the cortex (or subcortex) makes its own specific contribution to the organization of every complex functional system. The adoption of this approach clearly makes it equally impossible to accept either the "narrow localizationism," according to which a complex psychological process is a function of a localized group of cells, or the "antilocalizationism," which regards the brain as a single, undifferentiated entity (see: Luria, 1962, 1963, 1966, 1973, etc.). Naturally I must approach the question of the brain mechanisms of speech activity and the processes of encoding of verbal communication, with which we are concerned in this book, from the same positions. There is no difficulty in postulating that the construction of a syntagmatically organized expression is based on different psychological processes and different brain mechanisms from those at the basis of the mastering and utilization of phonemic, lexical and logical-grammatical codes of language. However, there are equally solid grounds for postulating that each of these functions is carried out by a single, strictly defined region of the cerebral cortex: for instance, a lesion of the anterior zones of the speech areas leads to an isolated disturbance of the syntagmatic organization of expression, leaving the process of utilization of phonemic, lexical and logical-grammatical codes of the language completely intact, whereas a lesion of the posterior zones of the speech areas leads to completely the opposite results. Local brain lesions always produce certain primary disorders that deprive the functional system of certain factors directly connected with these cortical zones; in turn, these primary disturbances evoke certain secondary disorders at the level of the functional systems themselves, because the corresponding

54

forms of activity now begin to take place under changed conditions, without the participation of the inactivated factors. We are therefore justified in asking what is the character of the disturbance of encoding of verbal expression found in each local brain lesion, which of the disturbances arising is primary and which is secondary in character, and how does the picture of the disturbance of encoding of verbal expression differ in lesions in different parts of the brain? The main purpose of the subsequent investigation will be to answer these questions. I shall begin with an analysis of forms of speech disorders in which the dominant feature is a disturbance of the syntagmatic organization of expression and I shall examine its various forms. I shall then turn to the analysis of changes in the encoding of verbal communication based predominantly on a disturbance of the mastering and utilization of paradigmatic codes of language. This is evidently the only way of drawing a sufficiently complete picture of speech disorders arising in local brain lesions and at the same time it permits suggestions to be made regarding the complex brain mechanisms of encoding of verbal expression. We saw in the first section of this book that the formation of expression begins with a certain motive and a certain intention and that these have to be embodied in verbal communication. It is only later, through the stage of internal speech and the "deep semantic and syntactic structures" connected with it that this intention is converted into expanded verbal expression. In my analysis of the pathology of verbal expression I shall follow this same course. I shall begin by analyzing disturbances of general human activity that lead to general disturbances of expression nonspecific for language. I shall then describe forms of brain lesions in which this inactivity assumes a more specifically verbal character, disturbs the general "linear scheme of expression" and prevents the "incarnation" of the original intention into a coherent, spontaneous verbal form. After describing this picture of "dynamic aphasia," in which the ability of converting thought into speech is disturbed but the grammatical structure of speech is still not affected, I shall turn to the analysis of a special type of disorder in which not only the "deep" but also the "surface" syntactic forms of expression are affected, their predicative components are severely disturbed, and their verbal expression, while retaining its nominative function, assumes the "telegraphic style." I shall conclude this section with an account of the form of speech disorders in which coherent expression becomes impossible because of the pathological inertia of established stereotypes. In this way I shall be able to show that the stages of formation of ex-

55 pression which I examined in the first section o f this book can be disturbed in relative isolation from each other, and that the description o f the resulting disturbances which I shall give covers the whole broad spectrum o f disorders o f coherent speech that belong to the first o f the classes o f speech defects I have defined.

1. Disturbances of Verbal Communication in Patients with Deep Lesions of the Brain Disturbances o f speech in patients with lesions o f the deep parts o f the brain, notably the basal ganglia, the diencephalon, hypothalamus, and limbic cortex, have so far received the least study. 1 However, these disturbances never assume the form o f specific disturbances o f speech as a complex symbolic activity, lying at the basis o f the encoding or decoding o f communication. I shall therefore not dwell on them in detail but shall simply mention them in the most general form. Speech disturbances observed in lesions o f deep brains structures may arise from two sources and, as a rough approximation, they can be divided into two categories. First, they may be the result o f a general lowering o f cortical tone manifested in all forms o f the patient's activity and capable in some cases o f giving rise to an oneiroid state; consequently, they are nonspecific in character. On the other hand, they may disturb the normal tonic and. phonic basis o f speech movements, and in these cases they assume the more specific forms o f speech dystonias, dysphasias, and dysphonias. Let us now examine both forms very briefly. Deep brain lesions (involving the diencephalon and hypothalamus) disturb what 1 have described elsewhere (Luria, 1 9 7 3 ) as the general modulator o f the tone o f the brain. In such cases the cortical tone naturally falls substantially, the patient's entire behavior acquires the features o f primary inactivity, and his verbal communication is severely disturbed. In patients with massive lesions this inactivity becomes so severe that the patient's speech is entirely disrupted and acquires the features o f organic mutism or it is limited to an inactive, monosyllabic, whispered speech, which soon gradually dies away and disappears. The general inactivity and the rapid fatigue o f the patients o f this group is manifested equally in all forms o f motor, verbal, and intellectual activity, and at all levels o f speech communication. The patients o f this group respond to an order by raising their hand slowly and lowering it equally slowly. Gradually these upward movements o f the hand become slower and slower, their latent period increases steadily, and eventually, after several test$. the movements cease completely. The same thing happens in speech activity - in repetitive speech, the eventually, after several tests, the movements cease completely.

56 The same thing happens in speech activity - in repetitive speech, the naming of objects, and dialogic speech. All these types of verbal activity run an equally slow course and after several repetitions of the test they begin to be carried out after progressively longer latent periods, speech becomes a whisper, and ultimately after a few tests it ceases altogether. The disturbance of encoding of thought into verbal expressions that is the principal subject of my analysis is not found in any of these patients. Both the original motives and the underlying thought, as well as the possibility of embodying it into the scheme of verbal expression and of using appropriate verbal mechanisms, still remain potentially intact in these cases and are simply blocked as a result of the inhibitory state of the cortex. In these cases, therefore, simply increasing the stimulation (increasing the intensity of the motive) or partially abolishing the inhibitory state of the cortex (for example, by administering stimulants), is sufficient to restore normal verbal expression; moverover, in these cases the normal structure of expression is preserved, and the only typical pathological features that remain in these cases are the characteristic disturbances of memory and of the selectivity and organized character of psychological processes that I have described elsewhere. This relatively intact speech structure may continue for a time until exhaustion of cortical activity returns the patient to a state of primary adynamia. I have devoted adequate space in my special monograph (see: Luria, "The Neuropsychology of Memory", Vols. 1 and 2, in Press) to the neuropsychological analysis of these states of reduced cortical tone and I shall not discuss them further in this book. A different and more specific pictures of speech disturbances has been described in patients with less extensive deep brain lesions limited to relatively local areas of the basal ganglia or individual thalamic nuclei. The latter were observed during stereotaxis operations and the disturbances of speech activity produced by such operations (or by stimulation of the thalamic nuclei through permanently implanted electrodes) have been described (Ojemann, Fedio and Van Buren, 1968; in the USSR by N.P. Bekhtereva, and by V.M. Smirnov and co-workers). As a rule these speech disturbances have the typical character of disorders of motor tone; they assume distinctive forms of verbal dystonia (which in Parkinsonism is indistinguishable from general motor disorders observable in this syndrome), and are manifested as slowness of speech and disturbances of Phonation; sometimes - as in lesions of the thalamic nuclei produced by permanently implanted electrodes — they are manifested as halting or stumbling of speech, sometimes as stimulation of the flow of words, its acceleration, or polylalia. Only in very strictly localized cases (lesions of the left thalamus) does a specific defect of modulation of verbal processes arise, so that the patient is unable to use selective systems of verbal processes and to block perseverations and extraneous associations. Such cases will be described elsewhere.

57 However, as I have pointed out above, all these disturbances are "peripheral" (motor-tonic) in character and they are not directly related to the conversion of thought into expression or the process of encoding of verbal communication with which we are now concerned. I shall therefore not discuss these forms of speech disorders in more detail.

2. Disturbances of Verbal Communication in Patients with Frontal Lobe Lesions A total different picture of disturbance of verbal communication is found in patients with massive lesions of the frontal lobes (especially if the focus lies in the left hemisphere and if the disturbance of function of this region of the brain is accompanied by a syndrome of increased intracranial pressure). The characteristic feature of these cases is a severe disturbance of the complex motives, intentions, and programs of behavior (see: Luria, 1966, 1969, 1970, 1973; Luria and Homskaya, 1966). This disturbance is inevitably reflected both in the patient's behavior and in his speech activity. As a rule such patients lie helplessly in bed, they exhibit no interest in their surroundings, make no requests and ask no questions. In the severest cases they have no spontaneous speech. Severe disturbances also are manifested in dialogic speech. If they are questioned they answer by echolalic repetition of the question: in the severest cases their verbal activity is limited to this; repetition of individual words or short phrases included in the question presents no difficulty to them. In patients with an extensive, but not quite so severe, lesion they will readily answer the first type of question, in which the shape of the answer is already included in the question, but they cannot answer questions of the second type for which all the verbal connections must be formed independently. If asked: "Vy uzhe obedali?" (Have you had lunch?) such patients give the echolalic answers "Obedali" (We have had lunch), but they are quite unable to answer a question such as "What did you have for lunch?" or "When did you become ill?", for which an active search for new verbal formulations is required. Only patients with a milder syndrome of "frontal inactivity" can answer this last type of question, but even so the patient's speech remains poor and contracted in character. Distinct changes also take place in repetitive speech and in the naming of objects. Although they have no difficulty in repeating simple words and short sentences, and when repeating series of syllables or words such patients may reveal no defects, in the severest cases we find that they will echolalically repeat only the last syllables or words of a series; soon, their repetition becomes slower and eventually it disappears completely. Sometimes these patients begin to exhibit pathological inertia of already evoked traces as a result of which they find it increasingly more and more

58 difficult to switch from repeating one series to repeating another, and instead they go on repeating the same inert stereotype. It is interesting to note that the repetition of a successive series of words may be particularly difficult in patients for whom the suggested series diverges from the well established "natural series" or is actually in conflict with it. In such cases (for example, in reply to the instruction to name the days of the week backwards), the patient starts to repeat the "conflicting" series but immediately slips into the firmly established "natural" series. Instead of "Monday - Sunday - Saturday" and so on, he gives the series as: "Monday - Sunday — Saturday — Sunday - Monday - Tuesday" and so on. Similar difficulties are found in tests of repetition of sentences, when the repetition of unusual or incorrect sentences is soon replaced by the repetition of more usual and correct versions (instead of "an airplane flies very slowly" he will say "an airplane flies very quickly,") but when repeating one sentence after another he may inertly repeat the first sentence. For instance, when asked how the two sentences differ from each other he may say: "Well, of course ... they differ in their meaning ... in their pronunciation," although in practice he continues to repeat the same sentence over and over again. Such patients show no particular defect in their naming of individual objects; however, as soon as they are asked to name pairs or groups of three objects shown to them in succession, they quickly slip into the repetition of inert stereotypes as described above. For example, when attempting to find the names "apple" and "cherry" the patient will say: "apple and ... little apples" or, when asked to name a "kettle" and a "lamp" he will say: "This is a kettle ... and this ... a sort of kettle that stays on the table" and so on. Clearly all these defects are disturbances of general programing activity, such as I have described often elsewhere, rather than primary speech defects. The monologic speech of such patients shows signs of being severely disturbed. Although the choice of words and syntactic structures required for complete expression remains intact, monologic speech requiring adherence to a rigid program remains as a rule impossible. When telling the story of a thematic picture, the patient therefore can only list the individual objects composing it or fragments of the situations depicted, and these frequently evoke an outpouring of stereotyped associations ("There is a castle ... a notice 'Danger' ... obviously something to do with the high voltage"). The same features are revealed during the repetition of a story just read to him, of which only individual fragments can be coherently given. The last and most active form of monologic speech, — a spoken discourse on a particular theme - naturally is completely beyond the ability of this group of patients. If such a task is given to them they cannot formulate a basic plan or, still more, a rigid program; despite the complete integrity of their speech, their performance of the task amounts to nothing more than a mingling of irrelevant impressions or inert stereotypes. I shall never forget a

59 patient with a massive " f r o n t a l s y n d r o m e " who began to write a letter t o the famous neurosurgeon, N.N. Burdenko, but who was unable to adhere to any form of program when writing; her letter began thus: "Dear Professor, I should like to tell you that I should like to tell you that I should like to tell you ..." and so on. The whole of this letter, occupying f o u r pages, never got beyond the repetition of the same sentence. Observations on patients with a syndrome of frontal inactivity show that the performance of this task is limited to the echolalic repetition of a given theme or of a given inert verbal stereotype. If a patient with a more severe syndrome of "de-inhibition" (typical of the basal-frontal syndrome) is studied, the verbal production is richer, but it likewise never assumes the form of a planned narration of the theme; the patient usually slips at once into a cycle of irrepressible irrelevant associations or inert stereotypes. A lesion of the frontal lobes (especially the prefrontal zones of the left hemisphere) thus leads to a distinctive pattern of disturbance of verbal communication, marked by gross impairment of the underlying motivation, inability to formulate an original plan or thought and inability to produce a rigid program which would control the speech process and result in precise and properly directed verbal communication. In sharp contrast to this, the whole of the operational side of verbal activity in such patients is intact; hence the paradoxical fact that a patient in possession of all his lexical and syntactic faculties is virtually unable to produce expanded verbal activity, I have described the severe disturbance of the pragmatic (regulatory) function of speech characteristic of such cases on many occasions (Luria, 1962, 1963, 1966, 1969) and I shall not therefore dwell on it here. I give below a few examples of a typical disturbance of the spcech of patients with massive frontal lesions. The first patient I shall describe had suffered a severe injury to both frontal lobes; the second patient had an equally large t u m o r of b o t h frontal lobes. Patient Kork, a 28-year-old male student, suffered a severe injury to both frontal lobes with a fracture of the base of the skull as the result of a railroad accident. I or three weeks he was unconscious, but then he gradually regained consciousness although initially it was unstable. His elementary speech was intact and free from phonetic or articulatory disturbances; he could easily repeat single words or short sentences and had no difficulty in naming isolated objects. However, his spontaneous speech was completely passive and even the simplest dialogic speech - answering very simple questions - was very quickly exhausted and replaced by the inert repetition of the same stereotypes. For instance, when asked his name he answered: "Vladimir Petrovich ..." And your father? "... father ... Vladimir Petrovich ..." And your mother'.' "Mother? ... y e s . . . Vladimir Petrovich ..." What year of your course have you reached? "The fifth year." What faculty was it! "The fifth faculty ..." And in what subject were you specializiitx'l "What subject ... the fifth subject." At what institute are you studying? "The Institute of Energetics ..." And when you finish, where will you work? "Where shall I work ... there, the Institute of Energetics ..." But surely you will have finished at the Institue of Energetics. Where will you work then? "Well, where else can I work? ..." and so on.

60 Despite the complete integrity of the phonetic, articulatory, lexical and grammatic levels of specch, the patient was unable to speak spontaneously and coherently and to subordinate his speech to the necessary program, so that it consisted instead of echolalic repetitions and inert stereotypes. The patient's repetitive speech and naming of objects showed similar disturbances. As I stated above, he could easily repeat isolated words and simple sentences; however, if instructed to repeat two pairs of words or two consecutive sentences his repetitive speech soon gave way to inert stereotypes. For instance, he could easily repeat a pair of words: "snow - needle," but when asked to repeat a sccond pair of words - "night - house" he repeated "night ... and needle ..." or later "snow - needle"; when asked to repeat "house - needle - pie" he did so, but he repeated the next group, "bell - bridge - cross" as "bell - needle - pie" or even as "house - needle - pie," without experiencing any obvious difficulty. He could easily repeat the sentence "Apple trees grow in the garden behind a high fence" followed by the sentence "A hunter killed a wolf on the edge of the forest; however, when asked to repeat the first sentence first he said: "Well now ... a hunter killed a wolf at the edge of the forest..." And what was the second sentence? "A hunter killed a wolf at the edge of the forest." Do you mean the sentences were the samel "No, not the same ..." Well then, what was the first sentence? "A hunter killed a wolf at the edge of the forest ..." And the second? "The second?! ... A hunter killed ... a wolf... at the edge of the forest." What is the difference? "The pronunciation isn't exactly the same ... the intonation is different." He was not clearly aware of the difference between the two sentences and when he tried to repeat them, as best he could only repeat the second as: "A hunter killed ... this ... hare ... at the edge of the forest." The inert stereotype completely replaced his attempt to switch to the second of the sentences given to him. The patient could easily name several objects shown to him separately; however, if after being shown two objects (for example "spectacles - apple") two other objects were shown to him (for example, "cupboard - overcoat"), he included an inert stereotype when naming them and said, "apple and overcoat"; a third pair of objects shown to him next ("sofa and telephone") he called "overcoat and telephone," and so on. Although he could easily name a pair of objects "apple and spectacles," the next pair (overcoat and sofa) he called "apple and sofa," the next pair (ball and tree) he called "apple and tree," the next (alarm clock and bucket) he called "apple and tree" and so on. Although the patient's ability to repeat isolated words or sentences immediately or to name isolated objects or pairs of objects remained intact, he was unable to repeat subsequent groups of words or sentences or to name other pairs of objects as a result of the gross pathological inertia of established stereotypes. All these disturbances of speech activity are obviously attributable to pathological inertia rather than to the disintegration o f the linguistic structure o f speech. The spontaneous narrative speech o f this patient was more severely disturbed still. As in the test described above, no special disturbances of the language system were present; however, the planned evolution o f narrative speech and its subordination to a rigid program were grossly disturbed and they very quickly gave way either to pathologically inert stereotypes or to irrepressible irrelevant associations, thus preventing fluent expanded narrative speech. I shall give only one example to illustrate this fact. The story "The Jackdaw and the Pigeons" was read to him and he remembered it well. He began to repeat it correctly, saying: "A jackdaw heard that the pigeons had plenty of food, and so she painted herself white and flew into the pigeon house ..." However, his

61 performance soon fell under the influence of inert stereotypes, and he continued his narrative as follows: "Well now ... the jackdaw flew into the pigeon house ... the pigeons decided to let her fly freely ... and so ... she flew a little where she was and then flew out ... then the jackdaw, having flown around her own home ... landed in her nest ... and then ... what could she do? This was not clear to the pigeons ... having flown a little around her own home ... the jackdaw ... landed ... or more correctly flew into her own nest ... and landed by it ... and so ... a short time passed ... for example, about 15 or 20 minutes ... a short time passed ... and the pigeons began to turn the jackdaw o u t . . . well ... a short time passed again - and the pigeons ... stopped her and asked her ... why she did not fly ... and now, a short time passed ... and the jackdaw, I can't say exactly ... about 15 or 20 minutes passed ... and the jackdaw's condition improved ... a short time passed ... and her condition became worse ..." and so on.

In this example the planned narration of the theme was disturbed by the perseveration of inert stereotypes. In other cases, — b o t h in this and in other patients of the group — this repetition of inert stereotypes was replaced by the equally irrepressible recalling of irrelevant associations, so that very soon the patient completely lost the theme of a story just read to him. l'or instance, having heard the story "The Hen and the Golden Fggs" he repeated it as follows: "A man had a hen which laid golden eggs. He wanted to get more gold immediately and so he killed the hen ... he killed and started to open ... and then to close ... during his search ... he saw ... that the door was sometimes closed and sometimes open ... and so he went to the door ... and what do you think there was? It must be the street? ... Yes ... this same street... there was the waiter from the restaurant ... he ordered himself a couple of beers, sat down and waited ... what did he wait for? ..." and so on.

Clearly both types of disturbances of coherent narration of a theme described above can be represented with the aid of two diagrams (Fig. 6), one of which (a) reflects the constant return to the same fragments of the communication (the meaning had long since been lost), whereas the other (b) reflects departure f r o m the theme into irrepressible irrelevant associations. It will be obvious that the phonetic, lexical, grammatical and syntactic systems of language remained completely intact in this patient. The basic disturbance of encoding of verbal expression was a severe disorder of programed verbal activity, the organizing of the separate elements of the verbal expression in accordance with a fixed program. This purposive activity, disturbed as a result of a massive lesion of the frontal lobes, was easily replaced by pathologically inert stereotypes and by irrepressible irrelevant associations; this inability to subordinate the verbal expression to the original intention and the original thought is the reason for this form of disturbance of the encoding of verbal communication. It must be particularly emphasized that this form of pathology is not specifically confined to speech: the disturbance of goal-directed activity was also manifested as disorders of o t h e r higher cortical functions (thinking, complex forms of praxis and gnosis). Rarely are the disturbances of the selective, goal-directed course of verbal

62

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Fig. 6 Scheme of the repetition of verbal communication in patients with a severe form of frontal lobe lesion (patient Kork.) activity so complete as in patients with extensive bilaterial lesions of the frontal lobes. In clinical neuropsychology this deviation of speech from the original plan is often in the form o f a compromise: the patient constantly deviates from the intended goal and then returns to it again. In such cases, usually patients with deep brain tumors located in the mid line and invading the frontal lobes only partially, there is no disintegration o f the lexical and grammatical mechanisms o f language and the deviations observed, as in the previous case, are attributable to disturbances of goaldirected activity, incomplete in character in these patients, rather than to disturbances o f language as a system o f specific codes. Let us consider one example, which will be sufficient to illustrate this state of affairs. Patient Avot, a man aged 34 years, a scientific worker, was admitted to the Burdenko Institute of Neurosurgery with a suspected deep brain tumor. Initially he showed no appreciable abnormality, but later his eyesight began to deteriorate, neurological manifestations appeared, the disorders of consciousness increased and after careful investigations a tumor was diagnosed and removed (it was a craniopharyngioma). However, through continued growth of the tumor the pathological features persisted and the patient began to develop symptons pointing to invasion of the basal zones of the frontal lobes (impairment of olfaction, restlessness and disinhibition, disturbance of memory). At this time the patient's speech was completely intact phonetically, lexically, and syntactically. He had no difficulty in repeating series of three (or even five) words or series of two disconnected sentences, and unlike the previous patient, he could easily repeat and even recall them. He could easily repeat and recall a story read to him 1 - 2 days previously. However, a special feature of this patient drew our attention under these circumstances: he began to repeat the story but was immediately distracted by irrepressible irrelevant associations,

63 returned again to the theme, and so on. The whole encoding of the theme of the story thus bore the character of a compromise between repeating the required theme and distraction by irrelevant associations. I give below an example of how he repeated a story. The story "The Hen and the Golden I'ggs" was read to him. He began as follows: "Once there was a man - a small proprietor - with private property-owning tendencies who had a hen - and you know how important poultry keeping is in farming; it often yields considerable profit and it is a good basis for farming. Well this hen laid remarkable, shining golden eggs. And you know that gold is of great importance in world trade - and you see now - the value of the dollar falls, but the value of gold remains high, and for that reason in all international markets gold is very valuable ... and so the man wanted to have as much gold as possible immediately - greed is always a feature of petty proprietors, and so he killed the hen - but killing of course is cruel, killing is forbidden, it is immoral..." and so on. The constant deviation o f the narrative into irrelevant associations and the equally constant return to the original theme clearly reflect a disturbance o f goal-directed speech activity despite the c o m p l e t e integrity o f all the mechanisms o f language, and it can be represented schematically as in Fig. 7. Text

R e p e t i t i o n by p a t i e n t

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Tig- 7 Scheme of disturbance of encoding of verbal communication in a patient with a craniopharyngioma (a deep brain tumor involving the frontal lobe; patient Avot.) These partial disturbances o f goal-directed s p e e c h activity can be seen in many brain lesions in w h i c h the apparatus responsible for controlling speech activity and inhibiting (filtering) irrepressible and irrelevant associations is distinctly disturbed; the patient c a n n o t limit the circle o f irrelevant associations, block those not corresponding to the program and the plan o f expression and pick out only those that d o correspond to it. I have seen such nonlingual d e f e c t s o f verbal activity many times in patients w i t h lesions o f the right cerebral hemisphere and with a s y n d r o m e o f "rationalization" (Luria, unpublished investigation), and I shall return their analysis later in a different c o n t e x t .

to

64 3. Disturbances of Verbal Communication in Patients with a Syndrome of Dynamic Aphasia The disturbances of encoding of expression described in the two previous sections are not specific disturbances of speech as a complex symbolic activity. Disturbances of a completely different character can be observed in patients with lesions of the anterior zones of the speech area in the left hemisphere. Such disturbances are specifically verbal and they affect primarily the deep levels of organization of speech processes, including the formation of internal speech, and spread to the level of the semantic recording or of deepsyntax structures. Disturbances of the encoding of verbal communication are manifested in such cases as the syndrome of dynamic aphasia (Luria, 1970; Luria and Tsvetkova, 1971; Ryabova, 1970; Akhutina, 1974). They are of such great interest to the neuropschological analysis of the encoding of verbal communication that I must dwell on them specially. In the patients discussed above the language system determining the encoding of the verbal communication remained intact and only organized goal-directed verbal activity was disturbed. In the patients of this group, on the other hand, with lesions of the anterior zones of the speech area in the left hemisphere, disturbances, of a specifically verbal character are observed. The general behavior of these patients remains unimpaired; they show no evidence of the loss of the original intention, no instability of the plan, and no replacement of goal-directed activity by pathologically inert stereotypes, such as I have described above. It is the speech disturbances that are specific for these patients: these disturbances are very distinctive in character and they differ sharply from those observed in other forms of aphasia. As a rule, the speech of these patients shows neither phonemic nor articulatory nor morphological defects. They easily repeat single sounds and words and they can name isolated objects or sometimes groups of two or three objects. They can easily understand what is said to them and they show none of that "alienation of word meaning" that I have described as a basic feature of sensory aphasia (see: Luria, 1947, 1969, 1970, 1973). They may even have no significant defect of the understanding of logical-grammatical relationships. Their writing, reading and calculation as a rule remain intact and their expanded speech activity does not lose its organized, goal-directed character. The central symptoms of this group of patients is a marked disturbance of spontaneous expanded speech, that dissociates it from all other aspects of the speech process which remain intact. As already said, the patients of this group can repeat single words and name single objects; often they show no pathological inertia in their verbal

65 activity and can switch relatively easily from one word to another. They start to have serious difficulties as soon as they attempt spontaneous narrative speech. As a rule, having easily repeated a series of words or having named a group of objects, these patients try painstakingly to express their thought, but they find that they cannot do so. They seek helplessly for the necessary words, they mix them up, they cannot construct a sentence, and for practical purposes they are unable to put together any form or independent expression, i.e., to use their speech as a means of communication. However, the most significant fact is that these disturbances of expanded narrative speech activity are manifested as gross disturbances of the dynamics of verbal expression. The patients have difficulty when they try to switch to dialogic speech from a simple (echolalic) response ("Have you eaten already?" - "Yes, I have eaten already"), or to a response requiring the introduction of new sentence constructions ("Where did you work before your illness?" or "Tell me what you ate for breakfast this morning"). This feature is also observed in patients with a massive frontal syndrome. However, unlike the latter, patients with dynamic aphasia still preserve a reasonable level of general activity and they attempt to find a way of giving the necessary reply; however, they show that they do not know how to start to reply, how to switch to the new sentence construction, how to give an expanded expression. Even greater difficulties arise when they attempt monologic, narrative speech. In that case the patient is completely helpless, both when repeating a story just read to him and when attempting to describe in his own words the theme of a picture. It is seen in a particularly severe form when the patient is required to produce expanded narrative speech in response to a request to describe some event from his past life or to give a spoken discourse on a particular subject. If they are asked to describe the history of their illness they can only mention a few of the principal events and cannot give an expanded narrative. It is the same when they repeat a story or describe the theme of a picture: they may be able to identify the basic theme and to pick out individual semantic elements, but they cannot produce coherent and fluent expanded speech and usually after a few attempts and after fragmentary reference to landmarks in the story ("Well now ... a man had a hen ... and golden eggs ... and he killed ... and so ...") they relapse into silence or abandon any further attempt at description ( " B u t . . . I c a n ' t . . . you see ... nothing ..."). This defect of spontaneous expanded speech is seen particularly clearly when the patient attempts to discourse on a chosen topic. In such cases, without any support for spontaneous expanded verbal communication, the patient either decisively abandons all attempts or he replaces the spontaneous description by some form of ready-made stereotype, which he utters easily

66 without any difficulty of finding the proper words and w i t h o u t any features of agrammatism. For instance, in response to the instruction to speak on the subject "The N o r t h " , one patient in this group at first refused to do so, saying: " N o ... I can't do it ... nothing will come into my head ..," but later, after a very long pause, he said: "In the wild north a pine tree stands alone on the bare hill t o p , " reproducing the words of a familiar poem. Another patient, when given the same task, said after a very long pause: "In the north there are bears ...," adding after another equally long pause the words: "... a fact that I would bring to y o u r a t t e n t i o n . " The most characteristic feature of this group of patients is that the defects described are not accompanied by any marked agrammatism (especially not by a "telegraphic style"); sometimes there is a tendency for the reduction of complex syntactic structures to more elementary constructions. The syntactic structure of expression remains within their grasp; this is reflected clearly in the fact that during rehabilitation and retraining recovery of their coherent speech does not pass through a stage of agrammatism. The impression is created that the basic disturbance in the formation of spontaneous expression is localized in these patients at the level of formation of the semantic scheme of expression and that it falls into the class of a defect of internal speech, the predicative structure of which prepares for the subsequent evolution of the expanded expression. Very probably the basic defect in these patients lies at the level of transition to deep-syntax structures; it is this disturbance that prevents them from switching from repetitive and nominative speech to expanded expression. These hypotheses are confirmed by tests in which, as a compensatory measure, the patient is given an external scheme for the syntactic structure of the sentence for support; observations show that sometimes the simple mentioning of a successive series of elements included in the sentence or, in other words, the creation of an external "linear scheme of the sentence," may have an adequate compensatory effect. This procedure compensates for the basic defect characteristic of these patients: essentially the inability to switch from a fragmented "semantic g r a p h " to a hierarchically organized syntactic " t r e e " of expression, and, as several investigators have shown (Tsvetkova, 1968, 1969, Luria and Tsvetkova, 1968, 1970; Ryabova, 1967, 1968), it can reorganize the structure of expression within certain limits and restore the patient's coherent speech. I give below one typical method used in this experiment and its results. A description of the test as used by Tsvetkova is as follows: the patient can repeat a series of words or a simple sentence but he cannot actively formulate a spontaneous expression, and can only try helplessly ("Well now - this ... you see ... how is it? ..."). He sits at a table and in front of him, a certain distance away, are placed three (and later four) blank cards. The examiner, having pointed to each of them consecutively, gives the patient a specimen sentence:

67 I

want

a drink

The patient repeats this sentence, and reproduces the appropriate gestures in their proper order. The patient is then instructed to use this m e t h o d with a sentence with a different meaning [usually having expressed in words the theme of a simple picture, such as "The yard-keeper sweeps the s t r e e t " or "The milkmaid milks the cow"]. Experience shows that these attempts first meet with some difficulty; later, however, the patient soon learns to find the necessary words of his expression unaided; at first accompanies the test by pointing consecutively to each picture of external gestures; gradually, however, this series of pointing gestures becomes unnecessary and the patient begins to express himself in words simply by looking at the series of cards. Finally, in the last stage of recovery, the linear scheme of the sentence becomes so firmly established that even the support of the external visual cues becomes unnecessary. Physiological analysis (recording the electromyogram of the tongue or lower lip) showed that whereas at the beginning of the experiment, before the external supports had been given to the patient, his helpless attempts to find the words for his expression in general did not activate the innervations of the speech apparatus; the offering of visual support, recreating the linear scheme of the sentence, as it were channeled the innervating impulses in the direction of the speech apparatus, whereas their removal once again led to disappearance of the corresponding electromyographic impulses (Fig. 8). The fact that the recovery of expression obtained by this method did not pass through a stage of agrammatism and was not confined to the simple naming of individual substantives (as in the "telegraphic style," of which I shall speak again below), but at once resulted in a poor but syntactically correct structure of the sentence (such as: "The dvornik - sweeps - the y a r d " or "The boy - hits - the dog"), clearly indicates that the basic defect in these cases lies in the deep-syntax structure of the future expression, which is essential for its communicative organization, rather than in its surfacesyntax structure, and that the type of this disturbance can be represented conventionally by the scheme given in Fig. 9. I shall give one example of this type of disturbance of the process of encoding of coherent, expanded verbal expression. Patient Buk, a male student aged 23 years, suffered a hemorrhage as a result of rupture of an aneurysm located in the bifurcation between the origin of the anterior cerebral artery and the anterior portion of the middle cerebral artery. For some time he was unconscious, and later he developed a syndrome of persistent right-sided hemiparcsis, more marked in the distal segments of the right upper limb, and gross speech disorders, manifested as motor aphasia with an intact understanding of speech. No disturbance of sensation was present. During the next six months the severe motor aphasia underwent regression, but

68

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Fig. 8

Electromyogram of lip movements during attempts to repeat a sentence by a patient with dynamic aphasia: a) background, b) attempts to repeat the sentence without support, c) attempts to repeat the sentence with external supports. In each case electromyograms of the lower lip are given, with different degrees of amplification.

69

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s

2

Scheme of the disturbance of generation of verbal communication in a patient with dynamic aphasia expanded spontaneous speech still remained impossible. At the time of testing, the patient was fully oriented in place and time, he understood what was said to him perfectly well and showed no evidence of alienation of word meaning. He easily repeated syllables and words (including difficult ones such as "korablekrushenie") and had no difficulty in repeating groups of two or three words or short sentences. Only when asked to repeat longer series of four words or more did he begin to rearrange them, but he was unaware of his mistake even after many repetitions; this defect was particularly conspicuous when he was instructed to repeat a given series after a pause of 1 5 - 2 0 seconds. The repetition of sentences, even if fairly long, was within this patient's grasp; however, even in this case, if asked to repeat the sentence after a pause, he often showed omission of less important elements of the sentence, particularly conjunctions, with subsidiary syntagmatic importance. Naming objects, whether single or in groups of two or three, was not too difficult; as already stated the understanding of direct word meanings remained intact and there was no evidence of "alienation of word meaning." The patient had particular difficulty with spontaneous expanded speech. His dialogic speech was very poor and his answers to questions were monosyllabic. Where do you live? "In Kazan'." Tell me about this city, what sort of a place is it? "I don't know." What sort of attractions are there in Kazan' - museums or theaters? "And shops ..." What eiset "A department store, a hotel..." Is there a river? "There is a river ..." Well tell me about it. "There is nothing to say." Is it deep? "It is deep" How does it flow? "Flow ... well ..." Not very fast? "Not very fast ..." What is the river bed like - rocky or what? "Rocky ... but ... sand ..." and so on. Do you have a school? "A middle school, on three storeys ..." What subjects did you likel "Mathematics, physics ..." And which teacher did you likel "The mathematics teacher." Tell me in what way was she nice? "Nice." What does nice mean? "I don't know ..." and so on. The patient's monologic speech was equally poor. Only very well fixed, habitual fragments could be spoken with any degree of fluency, and these he repeated many times. For example, when asked to say how be became ill, he said: "It was like this ... I went for a swim ... and ... at first I swam a long way ... then came back to the bank ... I began to feel ill ... I was in the water up to my waist ... suddenly I lost the use of my arm and leg ... then I fell unconscious ... Sashka pulled me out... they carried me home in the car and then to the hospital... to Kazan' hospital..." This short extract is sufficient to show that although the patient's ordinary speech showed no definite features of the telegraphic style and it was made up of normal short phrases, as a whole it was fragmented, broken up by pauses, and no longer fluent in character. Without much difficulty the patient could relate a coherent story (for example, "The Hen and the Golden Eggs" or "The Jackdaw and the Pigeons"); if, however, he had just

70 repeated a story read to him previously, iie found it very difficult to speak on his own initiative (for example, to draw a moral) and he usually answered in a few disconnected words. For example, when asked what the story "The Jackdaw and the Pigeons" tells us he could not answer, his assessment of the meaning of the story "The Ant and the Pigeon" was expressed by the one word "Friendship," and attempts to obtain a more expanded, coherent expression were unsuccessful. The patient found it more difficult still to tell the story of a thematic picture. As a rule his expression was of very poor quality and it very soon became apparent that his spontaneous narration was replaced by the frequent repetition of single simple fragments. For instance, the picture "The Letter from the Front" was described as follows: "A boy is reading a letter ..." (The patient is asked to describe the picture more fully). "A soldier is listening to him ... a girl is listening ... an old lady js listening ... a girl is listening ..." What has happened, tell me about the thing as a whole! "There is happiness on these faces ..." Well what has happened? "It is an interesting letter ..."And who do you think it is from? "From the front." To whom? "To the old lady ..." Now tell me about the whole picture in detail. "A boy is reading a letter, a soldier is listening to him, a girl is listening to him, an old lady is listening to him ... a girl is listening to him ... there is happiness on their faces." Further attempts to obtain a coherent narrative were unsuccessful and his description of the thematic picture remained nothing more than a series of stereotyped phrases: "A boy is reading a letter, everybody is listening, the soldier is listening, there is happiness on their faces." The fact that the patient did not create a semantic scheme of the expanded expression and that the structure of the expression, although not completely agrammatical, nevertheless showed evidence of simplification and reversion to the same fragments, was particularly noticeable in tests in which he was instructed to discourse on a given subject. I'or example, when asked to speak on the subject of "The North" after a long pause he said: "In the north it is very cold ..." After further insistent requests that he expand his narrative, he added: "The north is very cold ... there in the north ... there everyone goes out warmly dressed ... in the north it is very cold ..." Even prompting with the beginning of a suitable narrative was unsuccessful and he could only produce short fragments reflecting only one essential detail on the subject. Inability to develop an expression on a given theme spontaneously was thus a conspicuous feature of this patient. The problem became much easier if auxiliary words were given to the patient for use as supports for the development of his narrative. I-or instance, if auxiliary supporting words were given to him on the subject of "The North" (land - frost - summer - sun - horizon - night - day - tundra - permafrost, and so on), he used them to produce the following narrative: "In winter it is very frosty ... frost ... so ... the summer is very short ... the sun ... one hardly sees the sun ... the horizon ... the sun climbs above the horizon ... it is night for half the year ... six months of night and six months of day ... very ... the tundra ... it is very poor in the tundra ... they have permafrost ..." and so on. Clearly, therefore, the spontaneous development of expression can be compensated by direct support from auxiliary words given to the patient. Naturally the formation of a sentence from three given words did not present any particular difficulty to the patient. For instance, if he were asked to form a sentence from the three words "sneg" (snow) - ubirat' (to sweep) - dvornik (a yard porter)" without hesitation he said: "Sneg ubiral dvornik" (despite the order of the words, in Russian this means the dvornik swept the snow), and if given the words "bol'noi (patient) - sdelat' (to perform) - operatsiya (operation)" again without hesitation he formed the sentence "bol'nomy sdelali operatsiyu" (they performed an operation on the patient). Only if he were given a longer series of words from which to make a sentence simply by transposing the words and including additional connections did he start to have appreciable difficulty. For example, when instructed to form a single sentence from the words: "bol'noi (patient) - podrobno (in detail) - obsledovat' (to investigate) - naznachit' (to indicate) - operatsiya (operation)," he said: "bol'nomu podrobno issledovat' sdelat* operatsiya (to investigate the patient in detail ... to perform an operation) ... no ... sdelali operatsiyu (they performed an operation)..."

71 The patient could similarly be helped to organize an expanded expression in tests of telling stories from pictures. We have already seen that the spontaneous narration of a coherent story from a picture caused the patient great difficulty. However, if he were given a series of pictures, developing the theme consecutively, by supporting himself on each picture in turn he could produce a reasonably coherent story. For example, if he were given a scries of pictures showing a boy fishing, the boy falling into the river, his friend jumping into the water, and the same friend dragging the drowning boy to the bank, the patient was able to give a coherent narrative: "Gcna was fishing ... he stumbled somehow: he fell and started to drown ... he began to cry out ... he could not swim ... Vasya jumped into the water and ... Vasya began to pull him out... Vasya saved Gena ... Vasya was pleased about this ..." An important conclusion can be drawn from this material. The spontaneous development of the theme and the change from repetitive speech and the naming of objects to spontaneous expanded expression were very difficult for this patient. His defect could be compensated only by support from either auxiliary words or pictures. This method removed the necessity for a spontaneous change to expanded expression, and instead all that was required was the simple addition o f individual words (or pictures) to the disconnected sentences, and this the patient did not find too difficult. We can ask: what was the basis of the defect I have described? What stages of the transition from thought to expanded verbal expression were affected in this patient? To answer these questions, in a series o f tests the patient was given a number of sentences from which individual words were omitted and he was asked to fill in the gaps with a suitable word. The results showed that although the patient had no difficulty in supplying omitted substantives, he found it very difficult to replace omitted copulae or "intermediate words," which unite the components o f the sentence into a single entity, and sometimes it was virtually impossible. A few examples are given below. The following sentence was read to the patient: "Winter came and the streets were covered with deep ..." The patient at once said "snow." Tests using sentences in which a less probably substantive was omitted gave similar results, even if the word omitted was in the middle and not at the end of the sentence: "Now is the time to plant ..." "Apple trees." "We must build a ... for the hens." "Coop." He found it just as easy to replace an omitted verb: "I must ... this splinter from my finger" "Pull out" (one word - vytashchit' - in Russian). "The dvornik ... the snow with his shovel" "cleared." Only occasionally did replacing the omitted verb give rise to some difficulty and instead he introduced a substantive: "In spring the trees ... abundantly in the garden." "Mowers ... the apple trees flower ..." Tests in which the patient had to replace an omitted copula, placing the individual parts of the sentence into particular syntactic relationships with each other, gave results in sharp contrast to those just described. When confronted with these problems the patient lost confidence and often his answer was obviously incorrect: the necessary conjunction ("although," "in spite o f ' ) was either replaced by the simple copulative "and" or the less precise "because," and he was clearly unaware of the change thus brought about in the meaning of the sentence. I was late at the theater... I had hurried. "And I hurried ..." No, that is wrong. "I dashed to the theater... to which I hurried ..."

72 Can you say "because I hurried"? (The patient is silent). I was late at the theater ... I hurried. "I was late at the theater because I hurried ..." No, that is wrong. What should you have said? "I was late at the theater because I did not hurry." (A full explanation of the correct solution is given to the patient. He repeated the suggested conjunction "although"). The schoolboy received low marks ... he had studied hard. "Because he had not studied hard ..." (The reason why this solution was incorrect was explained to him). "The schoolboy received low marks ... he worked hard in the evening ..." (The mistake was again explained). "The schoolboy ... worked at his lessons next day ..." (The mistake was again explained). "The schoolboy received low marks and worked hard the day before ..." Further attempts failed to give the required result and the problem was solved only by giving the patient two words from which to choose: "because" and "although." Similar results were found when copulae were omitted from a long story. I shall give just one example that will suffice to illustrate the problem. The patient was asked to fill in the gaps in the story (the words supplied by the patient are given in parentheses). "One summer day the children went into the forest to gather mushrooms. They went deeper and deeper into the forest (but) their baskets grew fuller and fuller. Suddenly the children saw a squirrel (which) was jumping not far away from them from branch to branch. It seemed to the children (that) the squirrel was very close (and) they could catch it ... (1 minute 30 seconds, gives up) the two boys ran after the squirrel (25 seconds - but) having run a long way they suddenly realized (15 seconds — that) they were alone and (1 minute 20 seconds) that they did not know (55 seconds - how) to get home. On all sides the children were surrounded by thick forest (10 seconds - and) the boys (15 seconds - who) had run after the squirrel were afraid (45 seconds - that) now they could not find the way home. (But) Vasya knew (how) to get home (1 minute 45 seconds - and ... but... when ...) to find the way there." Clearly this task of filling in gaps in the text gave rise to considerable difficulty when the omitted elements were not nouns or verbs, but simply copulae (prepositions and conjunctions), whose function is to give unity to the coherent expression. The disturbance o f expanded spontaneous expression, which is the main sympton of the form o f dynamic aphasia I have described, is thus evidently based on a disturbance of the relationship between the "thema" and the "rhema" which gives expression its unity. This disturbance primarily affects the precise usage of those "intermediate words" (prepositions and conjunctions) that can justifiably be regarded as the basic components of syntagmatic structures. In patients with the form of brain lesions I have just described this defect occurred in the very first stages of the transition from the "semantic scheme" o f the original content to its formulation into a coherent expression. In the next type of speech disturbances this defect occurred at a much more special syntactic level of speech and the syntactic disorders produced by it were much more severe. I shall now turn to a description of this defect.

73 4. Disturbances of Verbal Communication "Telegraphic Style"

in Patients with

In the form of disturbances of expression I have just described, known as "disturbances of verbal initiative," the patients were unable to express a verbal communication in their own words and they frequently turned for support to well established verbal stereotypes. However, they could easily repeat short sentences and they showed no sign of disintegration of the grammatical structure of their speech. In another form of speech disorders, in which the grammatical structure of expression (in particular, its predicative, syntactic structure) is disturbed rather than its general program, the features observed are substantially different. As I have stated above, linguists (De Saussure, 1922; Jakobson, 1956, 1961, 1964, 1971) have for a long time distinguished between two fundamental classes of phenomena in language: the placing of words (and the things they denote) in a certain category (the paradigmatic structure of language) and the joining together of words into a coherent expression (the syntagmatic structure of language). Whereas the first class of linguistic phenomena has been the target of much research in morphology, lexics and semantics, the second class has attracted particular attention only very recently. That is why analysis of the form of disturbance of the syntagmatic encoding of expression found in certain patients with lesions of the anterior zones of the cortical speech area is particularly interesting; such cases were described many years ago by neurologists (Pick, 1913; Bonhoeffer, 1923; Isserlin, 1936) and the defect is usually known as the "telegraphic style." By contrast with the picture of disturbances observable in the patients of the previous group, in those I am now considering no defect of the semantic scheme of communication can be detected. However, the difficulties in such cases arise much nearer to the surface-syntax structure of expression, and the encoding of verbal communication begins to be distinctly impaired in its basic syntactic stages. The most characteristic feature of the patients of this group was that they could easily repeat single words and name single objects; however, when instructed to repeat elementary coherent sentences, they began to have appreciable difficulty: the predicative (verbal) part of the sentence either was omitted or was displaced by the nominative (substantive) part of the sentence; the latter took precedence and was repeated first of all. Frequently the form of both the verbal and the nominative components of the sentence to be repeated was distorted and the patient began to recite the words as from a dictionary, so that the repetitive speech lost its fluent character. For instance, when attempting to repeat the phrase "Mal'chik (the boy) udaril (hit) sobaku

74 (the dog)," these patients repeated it as: "Mal'chik ... sobaka (dog, nominative case)" or "Mal'chik ... sobaku (dog, accusative case) ... udarit' (to hit, infinite)." and the coherent sentence was broken up into a chain of isolated, syntactically disconnected words. This defect was even clearer in more complex types of verbal communication. For instance, when describing the history of his illness, or recalling the theme of a story read to him or a picture card shown to him, the patient's fluent narrative speech was replaced by a chain of isolated words, almost entirely nouns denoting objects, with only a very few verbs which, as a rule, were given in the infinitive form. For instance, when describing the story of how he was wounded, one such patient would say: "Well... f r o n t . . . soldiers ... campaign ... soldiers ... to shoot... well... head ... wound ... and hospital ... and so ...," or when repeating a story about looking for treasure in the wreck of a ship he would use the same "telegraphic style" of narration: "Well ... storm ... ship ... so ... to the bottom ... there ... gold ... money ... diver ..." and so on. The same sort of picture was seen in a "spoken composition" test. Unlike the patients of the previous group, these showed no evidence of "emptiness of thought" or inability to construct the semantic scheme of the narrative. Their defects were connected with the conversion of this semantic scheme into the scheme of expression, they had the character of disintegration of the executive verbal component, and they were manifested primarily as omission of the predicative forms of the verbal communication; as a result the expression lost its fluent, coherent character. In the severest cases this defect was manifested as the total disintegration of the "linear scheme of the sentence" with its incorporated predicative components: the patient was unable to form even a simple sentence, although the nominative function of his speech remained completely intact. This fragmentation of fluent speech gave rise to the distinctive syndrome of disturbance of encoding of expression found in cases of severe "dynamic aphasia," in which the syntactic scheme of the sentence disintegrates but the nominative function of speech is preserved. In patients with the severest lesions of the anterior speech zones (Broca's area) the picture which I have described elsewhere as "efferent motor aphasia" (Luria, 1947, 1970) arises. Such a patient cannot switch from one articuleme to another and he is unable to pronounce whole words (not to mention sentences). By contrast, in patients with speech disturbances of the type under consideration in this section the whole picture of the speech defects is quite different. As I have said above, this patient was unable to articulate single sounds, to switch from one sound to another, and to pronounce separate words. He could easily repeat words that are simple to pronounce and had difficulty

75 only when repeating more complex words (such as "korablekrushenie" or "arakhnoidendotelioma"), which are in effect series of separate syllables, so that the difficulty of switching from one syllable to another becomes particularly prominent, and also when repeating series of words, when pathological inertia was a serious obstacle to correct performance. He could equally easily name individual objects or choose the appropriate name from a series of alternatives, unlike patients with lesions of the parieto-temporo-occipital region and the syndrome of "amnestic aphasia." 2 The main defect observed in the patients of this group is essentially an unequal disturbance of the construction of word combinations and sentences: during the repetition of word groups, and more especially, in the structure of the whole expression the nominative function of speech (naming objects) remains intact whereas the predicative function (naming actions), giving the verbal expression its coherent character, is profoundly disturbed. This fundamental and unexpected dissociation between the two principal functions of the speech process shows conclusively that the nominative and predicative (and, as we shall see later, the paradigmatic and syntagmatic) functions of speech are carried out by different brain mechanisms and may be relatively independent of each other (see: Jakobson, 1971). As I have said, this phenomenon is manifested even at the level of repetitive speech. The patients of this group have no difficulty in repeating names (of objects). However, if required to repeat verbs (names of actions) they begin to experience appreciable difficulty, the latent period of the response rises sharply, and sometimes instead of a verb they repeat a substantive (instead of "uchit'sya" (to study), such a patient will repeat " u c h e n i k " (pupil) or "ucliitel' " (teacher) or " u r o k " (lesson). The repetition of simple sentences by these patients is more severely affected. Very o f t e n the verb of the sentence either is not repeated at all and only the nominative part is given, or it is replaced by a substantive, or finally, the verb is repeated in the infinitive mood. The sentence " D o m (the house) gorit (burns)" may be repeated by such a patient as: " D o m ... (and this ... well ... as it) ..." or as: "(There ... fire) ..." or finally, as: "(House ... and this ... here) ... goret' ( t o b u r n ) . " More complex sentences, involving subject predicate - and object (S Ρ Ο), such as "Mal'chik (the boy) udaril (hit) sobaku (the dog)" undergo the same fate. In the severest cases all words are used in their nominative (dictionary) form and the sentence is repeated as: "Mal'chik (the boy) ... (and then) ... sobaka (the dog, nominative case) ..." or "Mal'chik (the boy) ... palka (stick, nominative case) ... sobaka (dog, nominative case) ...," and it is thus no longer a complete syntactic structure. This phenomenon is more pronounced still in the patient's spontaneous expression. Investigations (Tsvetkova, Glozman, et al., 1974; Shokhor-Trotskaya,

76 1972; Ryabova, 1970) have shown that if these disturbances are severe the speech contains several times fewer verbs than normal speech, and there is a corresponding increase in the number of substantives. In precisely the same way the n u m b e r of nouns given in indirect cases falls sharply, and the number of nominative forms rises correspondingly (Ryabova and Shtern, 1968; Akhutina, 1974). This fact points to severe disintegration of certain syntactic structures as the basic defect of speech and it explains why the encoding of verbal expression, being restricted purely to the nominative function of speech, acquires the "telegraphic style" so familiar in the literature (for examples, see above). The facts I have described, and which I shall illustrate later with special examples, show that in certain brain lesions a very severely disturbed syntagmatic structure of speech may be accompanied by a relatively intact paradigmatic structure of the codes of language. Consequently, in these cases, in which the central feature is disintegration of the predicative function of speech, verbal activity is reduced to the nominative function only. This isolated disintegration of the syntagmatic structure of verbal expression, to which Jakobson drew attention in a series of publications (1964, 1968, 1971), is one of the most fundamental phenomena in neurolinguistics. We still know very little about the mechanisms lying at its basis. On the one hand, we can only conjecture that linguistically it is a disturbance of the deep and surfacc-syntax structure of expression with a decisive reduction of the predicative function of speech. On the other hand, the fact that this type of disturbance of the speech process is found in lesions of the anterior zones of the cortical speech area, which can themselves be regarded as part of the premotor systems, suggests that it is a special case of a disturbance of the integration of brain processes into serial systems (Lashley) or into "kinetic melodies." Whatever the case there is no doubt that we are concerned here with a specific disturbance of speech activity that can be expressed in terms of the concepts recently formulated by linguists who, on the basis of Vygotskii's hypothesis of the role of internal speech (the structure of which was described in the series of " d e e p - " and " s u r f a c e - " syntactic structures mentioned above) and its predicative function in the subsequent expansion of verbal expression, have studied the fundamental type of syntactic structures of expression. The scheme in Fig. 10, showing the radical differences between the picture observed here and that described in patients with "dynamic aphasia," can be regarded as an accurate reflection of the structure of the disturbances observed in these cases. Clearly b o t h the underlying motive and the general original thought of the expression, as well as its general scheme, remain potentially intact, but the

77 Repetition of text by patients with 'telegraphic style'

Text

Σ

s ]

S2

Σ S3

/\ A A

NP

VP NP

Disturbance

VP NP

of encoding

I

s4

VP NP

Si

A

VP

1 S2

s3

s4

Α Α Λ A

Fig. 10 of verbal communication style"

NP!

^ NP!

in patients

NP!

with the

NP!

"telegraphic

basic defect, which this time is purely verbal in character, can be reduced to disintegration of the predicative function of speech, leaving only the nominative components of the expression. At this stage I cannot do better than to give an example of this picture of the disturbance of speech activity. Patient Bogom, a man aged 24 years (Case No. 53825), an engraver educated up to middle-school standard. Two years before the investigation the patient began to develop progressive rightsided hemiparesis accompanied by speech disturbances: he could still understand the speech of others quite well but his own speech became poor in quality and soon he could utter only single words; the hemiparesis gradually regressed but the very severe speech disorders, assuming the form of the telegraphic style, remained unchanged. At the Institute of Neurosurgery, to which the patient was admitted in March 1971, the following picture was f o u n d : the patient was well oriented but slightly awkward; marked right-sided hemiparesis was present, with reflexes stronger on the right and pathological reflexes present on the right side. Angiography showed evidence of thrombosis of the left internal carotid artery directly above the bifurcation, with rccanalization. The patient could draw wonderfully and create pictures of high artistic quality but his speech defects remained substantially unchanged. The pattern of the speech disorders observed in this patient was essentially as follows: Active speech was completely absent. Fie was unable to express himself in words; he could not talk a b o u t his illness, a b o u t his previous jobs, or his family. In dialogic speech, he either did n o t answer questions although obviously he tried to do so, or he answered in monosyllables, or with words usually in the nominative f o r m . Examples of his answers to questions are given below. What was your previous jobl "Graver (engraver, nom.) ..." And what did you do? "Risovat' (to draw) ..." And how do you engrave? What do you do? What happens in the workshop? " I n s t r u m e n t (tool, nom.) ..." What do you do next? "Molotok (hammer, nom.) ..." And what nextn. "Gravchik (engraver, nom.) ..." And then? "... Gravira ..." No, tell me coherently so that I can understand! "..." Well, you took a hammer, and what did you do with it"1. "'... Korobka (box, nom.) ..." And next'.' "...." (Further a t t e m p t s to obtain a coherent expression were unsuccessful). How else did you spend your time? "Boks (boxing, n o m . ) . " Where did you do this'? "Kiev, Moscow." And what other games did you play? " H o c k e y , ... football ..." What was your trade when you were in the army? " C o m m a n d e r of a radio station." What was your job then? "Switch ..."And what else? "Svodka (report, nom.) ..." and so on. He could easily recite habitual scries of numbers in both increasing and diminishing order, he could give the names of the months in the correct order, but if he tried to recite the m o n t h s backwards he w as unable to do so and simply repeated a name with

78 which he was prompted, although he tried his utmost to find the next name. He had no difficulty in repeating isolated sounds and words. He could easily repeat simple words such as "slon," "portfel'," "sinitsa," and "zayats" and he had difficulty only with complicated words such as "korablekrushenie"; eventually, however, he succeedcd. Having once repeated the word, he retained it and could recall it without prompting after a pause of 1 - 2 minutes. He could repeat pairs of sounds (such as: r - n , s h - p , k - r ) ; however, sometimes mistakes arose as a result of perseveration of one element of the previous group (for example, after the pair " r - m " he repeated " p - k " as "p...r" or after the pair " i - a " he repeated " o - c " as " o - i " ) . Characteristically, replacing a sequence of two sounds by the same sequence in the reverse order caused evident difficulty; having repeated " r - k , " he could not repeat " k - r " but continued to repeat the first pair inertly. He had no disturbance of phonemic hearing and no mixing of oppositional phonemes was observed. He repeated pairs of words without difficulty and easily retained a pair in his memory once he had repeated it and could reproduce it after a pause of 1 - 2 minutes. Even such combinations as "shveinaya mashina" (sewing machine) and "skorostnoi samolet" (high-speed airplane) he repeated easily, whether at once of after a pause of 2 0 - 6 0 seconds. Repeating a series of three words caused this patient marked difficulty. He could repeat one series of words (for example, "noch" - igla - pirog"), but when given another series (for example, "sneg - ochki - krug") difficulties appeared: he either abandoned the attempt to reproduce the new series or repeated it with perseveration of one of the words (for example, "sneg - ochki ... sneg ..."), or he omitted the last word (for example, he repeated the series "sobaka - most - divan " as "sobaka, most ..."), or finally, he changcd the word order (for example, he repeated the series "dub skripka - pero" as "dub ... pero, skripka"). Sometimes in this series of tests the patient showed features of pathological inertia of words repeated previously (for example, after the series "sobaka - most - divan" he would repeat the series "pero - skripka - d u b " as "pero skripka - divan ..." Only after the suggestion that he repeat each word of the series separately could he repeat the complete series of three words at once; however, this was unstable and after a pause he was unable either to reproduce the series he had repeated previously or to recall its first word. This patient's limit of repetition was therefore a series of two words; he could not repeat a series of three words, evidently because of the difficulty of retaining this volume and also of the pathologically increased inertia of traces, preventing the switch to another series. Because of this last fact a series of tests was carried out to demonstrate the effect of pathological inertia on the repetition of word series. He could easily repeat isolated words and pairs of words. However, when tests involving the repetition of phonetically different words were followed by others in which he had to repeat phonetically similar words he met with insuperable difficulties. The same result was obtained in tests of repeating pairs of words with dissimilar and similar phonetic and articulatory structure. Appropriate examples are given below. 3 (A) Repetition of Dissimilar Words: slon koshka sinitsa portfel' slon (B)

koshka

sinitsa

portfel'

Repetition of Similar Words: polkovnik poklonnik poklonnits

polkovnik

polkovnik

(no) polkovnik

Mongoliya Mongoliya

... magnoliya

... polko...

and so on

79 Zabor

Sobor

Sobor

zabor

zabor

zabor

and so on

(A) Repetition of Pairs of Dissimilar Words: Chemodan - kaftan

ruchka - pidzhak

Chemodan - kaftan

ruchka - pidzhak

and so on

(B) Repetition of Pairs of Phonetically Similar Words: Skripka - skrepka

Skripka - skrepka

skripka - skripka

skripka - ... no!

Kroshka - kryshka

kroshka - kryshka

kroshka - kryshka

(1)... no,... (2) ..., no ...

Kroshka - kruzhka kroshka - kruzhka kroshka - kruzhka (1)..., no no (2)...,

Repetition Initially of Phonetically Dissimilar Words of the Same Semantic Group, Followed by Phonetically Similar Words of a Different Semantic Group·. solovei (nightingale) - vorona (crow)

lev (lion) - tigr (tiger)

solovei

lev

- vorona

- tigr

solovei - vorobei (sparrow)

vorobei - solovei

vorobei - solovei

solovei - vorobei

solo ... vorobei...

voro ... vorobei

muravei (ant) - vorobei

muravei - vorobei muravei - vorobei

muravei - vorobei ... (but)

vorobei - muravei vorobei - ... (no) ... This test clearly shows that whereas there is no difficulty in switching to phonetically and articulatorily dissimilar words, switching to phonetically similar words is very difficult; the repetition of word pairs, even incorporating words with similar endings (such as "vorobei - solovei" and "vorobei - muravei"), which the patient could repeat separately quite easily, was quite impossible. The repetition of sentences was even more difficult than the repetition of word pairs. He could repeat simple sentences consisting of object and predicate (S P), such as "sobaka laet" (the dog barks), "Ptitsa p o e t " (the bird sings), or "dom gorit" (the house burns), although he started to exhibit agrammatism, reflected in disagreement between the verb and the noun: instead of saying "devochka (girl, nom. sing.) prishla" (came, fem. sing.), he said "prishel ..." (masc. sing.) or "shla" (went), or instead of "ptitsa p o e t " he said "ptitsy (plural) p o e t " (sing.), or sometimes he perseverated the tense of the previous verb (after "sobaka gulyala" (the dog walked) he repeated the sentence "koskha tsarapaet" (the cat scratches) as "koshka tsarapala" (the cat scratched); sometimes the repetition of more difficult sentences of the S -*• Ρ -* Ο type (for example,

80 "Devochka p'et chai" (the girl drinks tea), "Mal'chik zabolcl kor'yu" (the boy had measles), or "Zhenshchina kupila korovu" (the woman bought a cow) gave rise to more severe difficulty exhibited as syntactic discordance: "Devochki (plural) pila (singular) chai" or "Zhenshchiny (fem. plural) kupil (masc. sing.) ... korovu" and so on. Immediately after attempting to repeat a complex sentence, changing to the next sentence gave rise to a group of disturbances, in which the disintegration of syntactic structures was combined with elements of perseveration: Zhenshchina kupila korovu

Zhenshchina prodala (sold) petukha (a cock)

Zhenshchiny ... kupil... korovu

1) ... de ... 2)... Zhenshchina 3) Zhenshchina kupil... 4) Zhenshchina ... ku ... (no) ... (1 can't!)

Repetition of more complex sentences still was quite impossible. The sentence "Soldaty shli s krasnymi znamenami" (the soldiers came with red banners) was repeated as: "Znamena ..." "Znamcname ..." "Soldaty ..." "Soldaty ... shli ... krasnye ..." "Soldaty ... poshli ... krasnye" and so on. This inability to repeat even relatively simple syntactic structures raised an important problem: was this defect a disturbance o f habitual automatized speech or was it deeper in character, and was it s h o w n even in attempts at the c o n s c i o u s analysis o f syntactic structures. T w o series o f tests were carried o u t t o answer this question. In the first series the patient was instructed to seek consciously for the necessary concordance b e t w e e n the words in the sentence, and in the s e c o n d series, apparently simpler, he was instructed t o repeat the words n o t in the nominative case, but in an oblique ( s y n t a c t i c ) form. The results pointed to the very deep character of the disturbance o f the syntagmatic structure o f speech. Let us e x a m i n e each test separately. Having repeated the sentence "Okhotnik zastrelil belky" (the hunter shot a squirrel) as "Okhotnik ... zastrelil ... belka (nominative case) ...," he was instructed to say whether he had given the right answer. He answered in the negative. What did the hunder shoot? "Belka ..." Is that correct? "No." What should you have said? "Belka ..." No, that is wrong'. "I don't know ..." He was asked to repeat the sentence: "Mal'chik ukololsya igolkoi" (the boy pricked himself - with a needle). He could not do so and could only repeat: "Mal'chik ..." What did he prick himself with? "Igolka (nominative case) ..." Is that right? "No ..." He was asked to complete the sentence: "Ya pisal karanda ..." (the sentence should read "Ya pisal karandashom" (I wrote with a pencil). He answered "Karandash." Is that correct? "No ..." U menya net karanda ... (prompting with the sentence "U menya net karandasha" (1 have no pencil) "Karandash ... karandashom ..." These records s h o w that the verb o f the sentence is usually o m i t t e d , but d e p e n d e n t n o u n s in the oblique case are usually given in the nominative case, and the "surface-syntax structure o f the s e n t e n c e " is p r o f o u n d l y disturbed through inability t o utilize oblique cases (syntactic forms). A n o t h e r characteristic fact was that the patient could even recognize that his use o f the nominative case was wrong but was unable t o correct his mistake.

81 These results lead to the next series o f control tests. Their purpose was to ascertain whether the patient had difficulty in repeating words given in the oblique (syntactic) form. Having easily r e p e a t e d n o u n s in the nominative case, the patient was instructed to repeat them in an oblique case. He at once began t o have great d i f f i c u l t y . A few examples are given below, Luna ( m o o n , n o m . sing.)

Lunoi (inst, sing.)

lunami (inst. pi.)

luna

lunoi

l u n n y e (nonsense)

Karandash ( n o m . sing.)

Karandashom (inst. sing.)

Karandashi ( n o m . pi.)

Karandash

Karandash ...

... ( n o ) ...

Ka - ran - da - shorn

Karandashom

What did I write with? Karan ...

Ka

Karandash ... (no)

Karan ... shorn ?

ran

da

shorn

Karanda ...

What have I not got? Karanda ... (correct answer Karandasha) Karandashom ...

... shorn Petukh ( n o m . sing.)

Petukha (gen. sing.)

pe - tu - kha

Pctukh

Petu... k h a

pe - tu - khi ( n o m . p i . ) . . . a n d so o n .

T h e same difficulty was f o u n d during repetition of verbs. Khodit' ( t o go)

khodil (he w e n t )

khodit'

khodil

Ukhodila (she went away)

u - k h o - di - la

kho ... (no)

u

kho

d i . . . la

Ukhodila ...(no)

Devochka prishla ( f e m . sing.)

devochka prishla

poshel (masc. sing.)

prishel ... poshel ... (camc ... went ...)

This last fact, on which I shall dwell only briefly here for it requires special investigation, is characteristic. Not only was the patient unable to repeat a sentence correctly, to find the proper syntactic structure, or even to repeat a word correctly in an oblique case, but he was by no means always able to recognize a syntactic mistake committed by the examiner when reading out a sentence. Although he could obtain guidance from the word order in the sentence and although he retained a full understanding of the meaning o f this word order, he was by no means always able to recognize a mistake of agreement, particularly if the mistake consisted o f the incorrect inflection of a noun used in an oblique case

82 or the gender o f a verb. T o test this phenomenon a series o f sentences with syntactically correct and syntactically incorrect structures was read to the patient and he was asked t o say whether the sentences were correct. He frequently could not do so. He easily appreciated mistakes in semantic or logical-grammatical relations between words, exclaiming that " s u m m e r b e f o r e spring" is wrong but that "spring b e f o r e s u m m e r " is right, that " w i n t e r a f t e r spring" is wrong, and that " t h e earth shines on the s u n " is wrong but " t h e sun shines on the e a r t h " is right. He could also understand distortions of the meaning of a sentence arising through incorrect arrangement of the words: for example, he stated that the sentence "Zayats zagryz lisitsu" (the hare devoured the fox) is incorrect. However, syntactic discordance between parts of the sentence in gender, time and case he found very difficult to evaluate and he often was mistaken in his answers. This will be clear from the following rccords: Stoyala (has become; f. sing.) ochen' (very) teplaya (warm; f. sing.) pogoda (weather; nom. sing.) "correct" Stoyal (m. sing.) ochen' teplyi (m. sing.) pogoda "incorrect" Stoyal ochen' teplaya pogoda "correct" Okhotnik (the hunter) ubil (killed, perfective form) zaitsa (the hare, accusativc) "correct" Okhotnik ubival (killed, imperfective form) zaitsa "corrcct" Zayats (the hare, nominative) ubil (killed) okhotnika (the hunter, accusative) "Ha ha! How absurd!" The difficulties in identifying syntactic relations were even more conspicuous in long sentences (the correct version is given first, followed by the versions given to the patient for identifying as correct or not, together with his answers). Koshka malen'kuyu devochkw potsarapato (the cat scratched the little girl) Koshka malen'kuyu devochka potsarapal_ " I don' know" Koshka malen' kaya devochku potsarapal "Correct" Koshka malen'kwyu devochkj potsarapal _ " I don* know" Koshka potsarapal_malen'k«ju devochkw " I don't know" Koshka potsarapal malen'kflya devochkw "Correct" Koshka potsarapala malen'kuyu devochkw "Incorrect" Malen'kuyu devochku koshka potsarapal_ "Corrcct" In this case the patient f o u n d it extremely difficult to decide whether the grammatical f o r m of the words contained in the syntactic structure was correct and perhaps all he could do was to " g u e s s " instead of carrying out the normal analysis o f the syntactic structure of the sentences. The laws lying at the basis of this disturbance o f encoding of verbal expression are by no means clear and there is a need f o r a special differential study o f verbal structures that still remain intact in the patients of this group and those that are disturbed; a close study is also required of the factors that lie at the basis o f the difficulties arising in these cases (the separation o f parts of the sentence

by intervening words, inversion, nominative and purely

83 syntactic constructions). Finally, a close study is also required of the psychological defects that lead to the development of the "telegraphic style." However, even at this stage it is clear that these disturbances are connected with the syntagmatic and not the paradigmatic organization of verbal expression, and it is this feature that distinguishes these cases as a special group of disturbances of the encoding of verbal communication.

5. Disturbances of Verbal Communication in Patients with Forms of "Efferent Motor Aphasia"

Complex

So far I have analyzed disturbances of the encoding of verbal expression in patients in whom a brain lesion has inactivated only one particular factor essential for verbal expression. I have considered defects of the encoding of verbal expression arising as a result, first, of disturbances of general activity and disintegration of motivation, planning, and control of actions not specifically restricted to language, and second, of disturbances of internal speech and of the syntactic scheme of the sentence or, in other words, cerebral disturbances of specific forms of speech activity. However, defects of the encoding of active verbal expression do not always bear the specific character that we saw in the last two forms I have described. It is much commoner in neuropsychological practice to find much more severe and complex disturbances of verbal expression, in which the factors described above (general inactivity and gross inertia of the nervous processes) are combined with specifically verbal disorders of the encoding of communication to produce a picture of severe motor aphasia, leading to the complex disintegration of verbal activity. Since such cases are found particularly commonly in patients with brain lesions (and especially patients with vascular disturbances), I shall now describe one such case in which a disturbance of the dynamics of the nervous processes in the nonverbal sphere led to the appearance of gross speech defects. Patient Grish, a man aged 52 years (Case No. 56492), the manager of a restaurant, was admitted to the Institue of Neurosurgery at the beginning of June, 1972, with the diagnosis of a suspected cerebrovascular disturbance in the anterior part of the territory supplied by the left middle cerebral artery. In February, 1970, the patient began to develop gradually increasing weakness in the right upper limb, progressing after one month into right-sided hemiparesis, which gradually regressed. A year later, in January 1971, weakness developed in the left upper limb and left-sided hemiparesis gradually developed; this also regressed. Finally, in October 1971, weakness reappeared in the right upper limb and his speech became disturbed. The electroencephalogram (EEG) revealed a focus in the posterior frontal and anterior temporal regions; carotid angiography revealed pathological tortuosity of the vessels arising from the left carotid artery and stenosis of the right internal carotid artery; an atheromatous plaque was found in the initial portion of the left internal

84 carotid artery. Clinical examination at this time showed mild right-sided hemiparesis with no disturbance of sensation and with increased reflexes on the right. Neuropsychological tests showed only mild and diffuse symptons; the patient's behavior was completely adequate, he exhibited traces of echopraxis, but with correction, and he did not use his right hand. His speech was intact apart from very slight disturbances of his audioverbal memory. On June 2, 1972 an operation was performed at which a plaque was removed from the region of the bifurcation of the left carotid artery. The operation was very difficult and was accompanied by considerable hemorrhage and spasm of the anterior branches of the left middle cerebral artery. Immediately after the operation a picture of gross right-sided hemiparesis developed, accompanicd by marked perseveration, severe motor aphasia, complete inactivity, and indifference of the patient to his disabilities. This syndrome pointed to marked pathological changes in the left front-temporal region, possibly spreading to the deep zones of the posterior frontal region. As a background to these changes the functions of the right hemisphere were not completely normal (stenosis was observed in the blood vessels supplying it), and for that reason the possibility of compensation of the defects was limited. Tests on this patient began ten days after the operation and continued for one month. The following picture was revealed. The patient was fully oriented, accessible for testing, but apathetic and his emotional attitude to his condition was inadequate. In his movements he showed definite echopraxis and perseveration. For instance, having once drawn a circle he was unable to stop and change to another figure, but continued to draw circles whether in response to a spoken instruction or copying a specimen; having once drawn a cross or a line, whatever instruction was given to him later or whatever sample was shown for copying, he continued to draw the same cross or the same line. The same perseveration occurred when writing numbers: having written the number "2," he would continue to write " 2 " whatever the number given in his instruction. This phenomenon continued unaltered during the first few weeks after the operation and although eventually it disappeared if he drew single figures, it still persisted if he had to draw pairs of figures. The patient's speech was severely disturbed throughout the period of observation. His spontaneous speech was completely absent; dialogic speech in the form of answers to questions was almost impossible, and consisted entirely of ccholalia and perseveration. Examples of conversations with the patient are given below. What is your complaint? "What is your complaint? ..." Are you good at conversation? "Conversation good ..." Or badl "Or conversation bad ..." What is your name? "Ivan Grishchuk." What is your /obi "Manager of a restaurant." Where is it, in which town: "In which town? ..." (Is silent for a long time). In what town, is it in Moscow? "No, not in Moscow." Where then? "I can't ... can't ... say" (gives up). How many people are there in your family? "Four people." Tell me who they are"1. "A son,... that is ... a son ... a daughter ... two sons ... that is ... this ... two sons ... tw'o sons ... that is ..." (In fact he had a son and a daughter). How many people altogehterl "Four." Tell me their names. "The son ... now the daughter... a son again ... and now a daughter ..." And have you a wife? "Yes, I have a wife also." How many people is that altogether? "Two ... that is two ... what is it?" Two sons? "No, son ..." One son? "One son, two son ..." What else? A daughter? How many daughters? "I have two daughters ... that is... this ..." A wife? "A wife ..." Anybody else? "No more." Now let us go through them all again ... one son? "One son." Two daughters'? "Two daughters." What else? "Two daughters ... that ... and two daughters ..." Once again. One son ... "One son ..." Goon. Two daughters'? "No, no ..." One daughter? "One daughter." And a wife? "I have a wife ..." What is your wife's name? "Valentina Vasil'evna."/int/.your son's name? "Son ... now ... Valentina ... that is ..." (He makes helpless attempts to switch from his wife's name to his son's name). Tell me what you did this morning? "This morning ... we did ... that is..." (Silence).

85 This record shows that despite the integrity of elementary syntactic constructions ("conversation good," "manager of a restaurant," and so on) spontaneous and dialogic speech were completely impossible; the encoding of a necessary expression was completely replaced by echolalia and perseveration. Ordinary everyday speech was completely intact. The patient could easily recite the natural order of numbers (one, two, three, and so on) and he could name the months (January, February, and so on), although occasionally he froze on the first members of the series, which he continued to repeat over and over again, sometimes mixing the elements of the word and making no further progress: "Voskresen'e (Sunday), ponedel'nik (Monday) ... voskresen'e, ponedel'nik ... voskresel'nik, ponedel'nik, voskresernik." He was quite unable to recite a series in the reverse order: instead of "ten, nine, eight..." he would say "ten, eleven, twelve," or instead of the series "December, November, October" he would inertly recite "December, January, February," and so on. He could repeat single sounds without difficulty and did not confuse similar phonemes. Repetition of pairs of sounds was very difficult for him. He either substituted a meaningful word for meaningless pairs of sounds, for example, instead of the pair of sounds " b - r " given to him he would repeat " b a - r a n " (sheep) ... no, not like that...," or having correctly repeated one or two pairs of sounds he would be unable to repeat any more because of perseveration: k-n

1-P

1-P

1-p

sh-k n - d

b-p

b-v

k-n

1-n

p...

p—1— s h - k n - d

p-d

p-d

g-d

t-d

r-k

n—m n - m

s-g

p-d

p-g

p-r

p-r

p...

p-r

Later, when he was tired, the same phenomenon began to appear even when he repeated single sounds: s

h

sh

k k

r r

r

p

r

m

m

r

ρ p-r p-r

r

k

p-r

r

n k

s

h

l

r-k r-n r-n

and so on

Although at first the patient could repeat a series of three sounds he very soon began to replace this by the repetition of a single inert stereotype. He could repeat single words, and if the words were sufficiently different in morphological structure or lexical meaning he did so easily; the repetition of morphologically complex words did not arouse any appreciable difficulty: stol (table) stol

baraban (drum) baraban

obez'yana (monkey) obez'yana

sneg (snow)

tigr (tiger)

sneg kooperativ (cooperative) kooperativ

korablekrushenie (shipwreck)

tigr

nebo (sky) nebo

prostranstvo (space) prostranstvo

and so on.

korablekurshenie Even the repetition of compound expressions was not difficult:

86 suiovaya zima (harsh winter)

zlaya sobaka (beware of the dog)

surovaya zima

zlaya sobaka

voskhodyashchee solntse (rising sun)

obshchestvennoe pitanie (communal feeding)

voshkodyashchec solntse

obshchestvennoe pitanie

proizvodstvennyi kooperativ (production combine) proizvodstvennyi kooperativ However, repetition of morphologically similar words immediately led to difficulty and he began to repeat one word inertly instead of the one required: stol

stul

stol

stol

stul

stol

stol

stol

stul

stol

stul

stul

stul

stul

koshka

kroshka

kroshka

kryshka

kryshka

koshka

ko...koshka

kroshka

kosh...(that is)

koshka

kryshka

kryshka

kruzhka

kruzhka

koshka

ko...

koshka...kryshka

kosh...

kosh... (that is)

kruzhka

koshka

kroshka

kroshka

kruzhka

koshka

kosh...koshka

koshka

os...

Although the basic phenomenon with this patient, inertia of a previous stereotype, did not prevent the switch from one word to another morphologically different word, it nevertheless prevented the switch to a morphologically similar word. The repetition of pairs of words was much more difficult. In the first the patient was able to repeat the first two or three pairs but very soon his performance began to be increasingly affected by the influence of the pathological inertia of previous words. As a result, although he could easily repeat the first word of the pair, he was unable to switch to the second; he either abandoned the attempt to repeat it or he substituted an inertly recalled word from the previous pair. Some typical examples are given below: dom - les

noch' - igla

dom - les

noch' — igla

kot - stol kot - stol

solntse - grebeshok solntse... (well) ... grebeshok ...

oblako - lampa

sobaka - ogon'

lisa - karandash

oblako... (no) ...

sobaka - ogon'...

lisa...(this)... sobaka - ogon'

lisa - karandash lisa ... These difficulties were increased considerably when, in a special test, two pairs of words were presented alternately. In this case the accumulation of pathological inertia prevented adequate repetition of the pairs much sooner:

87 volk - noga

lisa - khvost

volk - noga

volk - noga

lisa - khvost

volk - noga

lisa - khvost

volk...

volk - noga

vysa... (that is) ...

lisa - khvost vysa... (that is) ... dom - noch*

kot - igla

dorn - noch'

kot - igla

dom - noch*

kot - igla

dom - noch'

dom... (that is not like that)

The difficulty increased still more if the patient was instructed to repeat pairs of phonetically similar words. For reasons that will be clear, in such cases he was quite unable to carry out the test. koshka - kroshka

kruzhka - kryshka

kruzhka - kryshka

koshka - kroshka

kruzhka...(that is)...kruzhka

kruzhka - krushka... (no)

kroshka - kruzhka kryshka - kroshka koshka - okoshko kruzhka - kroshka kroshka - kroshka kruzhka... (and) kruzhka koshka - okoshko

First koshka, then okoshko

kruzhka (and) kroshka

koshka... (no)

koshka - okoshko

koshka - okoshko

krushka ... koshka ... (I mean) kruzhka... (no)

koshka... (no, it is difficult!)

Clearly the difficulty of repeating word pairs increased if the words were phonetically similar. Characteristically, the repetition of semantically similar but phonetically different words did not arouse anything like such difficulty. Examples of this were given in the previous extract from the records. Repetition of word pairs differing in their degree of phonetic similarity can be used as a test of the degree of their similarity as shown in the activity of the pathologically changed brain. The repetition of a series of three words, requiring a double switch, was completely impossible. dom - stol - kot

dom

stol

kot

(altogether): dom - stol - kot

dom... (well,,, no)

dom

stol

kot

stol... dom ...

noch' - igla - pirog

noch'

igla

pirog

noch'... gigla... pilo... pila

noch'

igla

pirog

(now altogether): noch' - igla - pirog igla... (and)... igla ... go on! ... igla, pila The very severe pathological inertia of previous traces disclosed in these tests reveals the cause of the patient's inability to produce spontaneous or dialogic expanded speech. It is significant that whereas difficulty in the direct repetition of words appeared only with a change to the repetition of word pairs (the repetition of single words being

88 perfectly possible), the repetition even of single words from memory was severely impaired. Pathological inertia was thus manifested in this case in "trace processes" even more clearly than in the direct sensomotor sphere. Repeat "dom": this is the first word

Repeat "kot": this is the second word

dom

kot

What was the first word? (First... no) First: "dom" dom

Second: "kot" kot

What was the

first?

And the second?

kon'

... (no)

First: "dom'

Second: "kot"

What was the first?

And the second?

dom

(I remembered)

k... (the word) kon'

...(no, I am afraid...)

This phenomenon was seen repeatedly in many tests. Clearly in these cases the inertia was manifested even at the level of traces of single words, when it led to contamination and to examples of artificial literal paraphasia. Such tests, using words differing in their morphological and semantic closeness, may be of considerable value for the linguistic assessment of the degree of similarity of morphological structures. The remarks I have made so far raise an interesting question: would these difficulties still remain if the patient had to repeat sentences or would the change to organized syntactic structures remove them within certain limits? The results of appropriate tests showed that since there was no primary defect of syntactic structures in this patient (which distinguished his condition from the previous type of disorder, manifested as the "telegraphic style"), the change to repetition of sentences could make the task easier; however, this applied only to repetition of simple sentences (of the S P) type) and it was relatively unstable; the repetition of more complex sentences (of the S -*• Ρ Ο type), although in principle still possible, led to increasing difficulties much sooner. Appropriate examples are given below. The patient was instructed to repeat short sentences, changing from one sentence to another each time. (the house burns) dom gorit

(the dog barks) sobaka laet

(the lime tree is in lipa tsvetet

dom gorit

sobaka laet

lipa tsvetet

flower)

(the cock crows) petukh krichit petukh kukarekaet

89 (the moon shines) luna svetit

(the girl cries) devochka plachit

(the boy is ill) mal'chik bol'noi

luna svetit

devochka plachit

mal'chik bol'noi

ma... mal'chik ... bo... (that is)...

devochka plachit

devochka plachit

mal'chik bol'noi

devochka plachit

de...dclo...reo...

vot (well)...vot ... (is silent)

devochka... plachit devochka plachit ... plachit... bol'noi

mal'chik bol'noi

mal'chik bol'noi

dom gorit

sobaka laet

ma...ba... (this)...

... (this)... (no)

dom gorit

sobaka laet

dom gorit

dom gorit

sobaka laet

dom gorit

... (this) ... (no)...

dom gorit

sobaka laet

sam... (no)

dom gorit

devochka plachit

and so on.

sam gorit... Clearly although the patient had n o difficulty in repeating short sentences, repeated switching from one o f a pair o f sentences t o the other quickly led t o the appearance o f contamination and to abandonment o f the test. The same p h e n o m e n o n was seen in a much more severe form during the repetition o f more difficult sentences (S

Ρ -*• Ο). In this case although the

patient could in fact still repeat a complex sentence, the difficulties I have described above were manifested in a more severe form. (the girl drinks tea)

(the boy hit the dog)

devochka p'et chai

mal'chik udaril sobaku

devochka p'et chai

devochka p'et chai

mal'chik udaril sobaku

(er)... (no)...

mal'chik udaril sobaku mal'chik ... ubil... (I mean) ... Mal'chik

udaril

sobaku

mal'chik udaril sobaku

Mal'chik

udaril

sobaku

mal'chik udaril sobaku

Devochka

p'et

chai

devochka p'et chai

Devochka

p'et

chai

devochka... udarila...

(the same test next day) Devochka p'et chai

devochka

p'et

chai

Devochka p'et... (confound it) ... devochka

p'et

chai

90 Mal'chik udaril sobaku

mal'chik

udaril

sobaku

Mal'chik u... u... (I mean) ... (no)

mal'chik

udaril

sobaku

Altogether:

mal'chik udaril sobaku

No, not like that:

mal'chik udaril sobaku

mal'chik ugnal sobaku

I know what you mean - it is this "ugnal" that is wrong)

Devochka p'et chai

devochka p'et moloko (the girl drinks milk)

Devochka p'et chai

devochka ... p'et... (well)...

Devochka

p'et

moloko

Devochka p'et moloko

Dcvochka

p'et

moloko

Devochka ... p'et... (oh, well...)

The record shows that although the repetition of a relatively complex syntactic structure aroused no difficulty (thereby distinguishing this patient from those with a "telegraphic style"), not only the change to a different complex sentence but even modification of the same sentence was sufficient to create obstacles connected with the pathological inertia of traces. Although the patient could repeat the isolated words contained in these structures he could not repeat the sentences as a whole. Similar results were observed in tests of naming objects. Unlike in patients in whom the encoding of verbal expression was impaired by the disintegration of the nominative function of speech (I shall discuss these below), the naming of objects and of pictures of objects still remained possible. However, the already familiar phenomena or pathological inertia of existing traces caused definite disturbances of this process: although this patient could name one object easily and then switch to another name, he began to have difficulty when naming the two objects a second time or switching to different objects. An extract from the rccord demonstrating this fact is given below. He was shown pictures of objects (shown in the numerator in parentheses) and he had to name them (the names he gave are shown in the denominator). (Pencil) (Slippers) (Karandash) (Tufli)

(Coffee-pot) (kofeinik)

(Is it a coffee-pot?)

karandash

(What are they...) tufli

(It is... fiddlesticks)

Yes

(Bear) (Mcdved')

(Is it a bear?)

(Duck) (Utka)

(Is it a duck?)

(It is .. what?)

(Yes)

(It is., what?)(Yes) (Medved')

Is it a bear?

(Utka)

(The same again... what?)

(Yes, a bear)

Utka

91 (Hare) (Zayats)

(Utka)

(Medved')

No, this is "medved'

Medved'.. (I mean)...

Utka

Zayats

Medved'

That's right! Now once again

(Medved*)

(It is ... what?)

Medved'?

(Zayats)

Medved'

(Cat) (Koshka)

(Cornflower) (Vasilek)

Vasilek?

(Koshka)

Koshka

(What is it?..)

Vasilek...

(What is it...)

Ko...

(Vasilek)

Vasi...

(Vasilek)

kot...

(It is something -lek else)

(What is it...)

Va... -silek Similar but more obvious results were obtained during the frequent repetition of alternate names of pictures, in which correct naming very quickly was superseded by inert stereotypes. (turkey) (indyuk)

(cherry) (vishnya)

(vishnya)

(indyuk)

"indyuk"

(It--.it...)

"vishnya"

(what...)

(indyuk)

No, it is " i n d y u k "

(vishnya)

"indyuk"

"indyuk"

"vishnya"

How can it be "indyuk"? It is "vishnya" "vishnya" What was the "indyuk"

first?

m...

'indyuk"

(vishnya) "vishnya"

(indyuk)

(vishnya)

(vishnya)

"indyuk"

"indyuk"

"indyuk"

And the second? 'indyuk"

and so on.

Again the results were similar in tests o f n a m i n g a c t i o n s . The patient was s h o w n a series o f picture cards and asked t o say what the p e o p l e represented o n t h e m were doing. Unlike patients w i t h a "telegraphic s t y l e " h e had n o d i f f i c u l t y in answering in a syntactically correct verbal f o r m ; h o w e v e r , very q u i c k l y ( e s p e c i a l l y if t w o pictures were alternated f r e q u e n t l y ) the correct answer disappeared and w a s replaced either b y inert s t e r e o t y p e s or b y c o n t a m i n a t i o n . The patient was given a picture of a girl drinking tea.

92 What is she doing?

That is correct, she is drinking tea.

"Drinking tea... that is..."

"That is what she is doing, drinking tea".

He was then shown a picture of a man digging the ground. He is digging the ground "Digging the ground" He was given the first picture again. What is she doing? "Drinking water" He is given the second picture. What is he doing?

Digging...

"He... it..."

"The ground"

And what is she doing?

"She is digging..."

"He is digging the ground..."

No, not like that, the girl is drinking...

"He is digging the ground..." Try once again

Once again: he is digging the ground!

"Water"

·

She is drinking water. Repeat it "She is digging... that is..."

No, she is drinking... "Drinking water"

In all the cases given above the defect, while extending equally to the naming of objects and actions, was attributable entirely to pathological inertia of verbal traces and not to any disturbance of visual forms: in a control test the patient could easily choose the three pictures shown to him from a set of fifteen; consequently, the pathological inertia in his case did not extend to the visual sphere. It is therefore perfectly natural that the patient would be totally unable to narrate coherently a story read to him. After being instructed to tell the story "The Hen and the Golden Eggs," he made a number of unsuccessful attempts which culminated in the helpless exclamation: "It is no use! ... what am I to do?" Tests in which the patient was instructed to give a coherent account of a thematic picture gave similar results. I stated above that the system of visual perception was much better preserved in this patient than his speech system. For that reason the analysis of his reading highlighted his speech defect particularly clearly. Reading is not simply a process of the decoding of communication pre-

93 sented in the written form; it also involves the conversion of visual (graphic) symbols into a spoken (articulatory) system. This accordingly suggests that reading must also include elements öf encoding (or recoding) of communication; consequently, by relying on the constant ability to utilize the still intact transmission of a communication (text) and not transferring the process to the level of traces, which were particularly disturbed in this patient (as shown by tests of repetition, which is always repetition from traces), we would be able to detect in a purer form the phenomena of pathological inertia and inability to suppress irrelevant associations, which could be observed only to a limited degree in other tests. The patient's reading remained virtually intact. He had no difficulty in reading single letters, words and complete sentences. However, if the scheme of the tests used previously when studying the repetition of words or naming objects was adopted again and the words to be read were alternated repeatedly, his reading exhibited the same phenomena of pathological inertia as before. Let us now examine the tests of reading words. He had no difficulty in reading single words ("koshka," "sobaka," "sneg," "luna,") or even more difficult words such as "kooperativ," " p o r t n o i " and so on. However, if two separate words were alternated many times in succession, so that the patient was compelled to read them in pairs, he showed the same phenomena of perseveration as we saw previously in his repetitive speech. An extract from the records clearly demonstrating this fact is given below. sneg "sneg" sobaka

luna

sneg

luna

"luna"

"sluna"

"luna"

koshka

sobaka

sneg "lu..no"

koshka

luna

sneg

"luna"

"slo."

sneg "luna... (no)..."

koshka

"sobaka" " k o s h k a " "sobaka" "sobaka" "sobaka"... (no), koshka" The phenomenon I have described was seen in a more marked form still if the patient has to read pairs of words, especially if similar in phonetic (morphological) structure. koshka-Mashka

koshka-kryshka

"koshka-Mashka"

"koshka-kroshka"

No, that is wrong, please read them again. koshka-Mashka "koshka-Mashka"

koshka-kryshka " k o s h k a - m y s h k a . . . no... m y s h k a - k r o s h k a "

To discover whether the patient's mistakes were based on perceptual or efferent defects the second word was written in capital letters. No change was found: the perseveration remained. In the next test only the letter distinguishing the words was written in capitals (krOshka-krYshka, and so on) and the patient had to read the words in pairs. The re-

94 suits were still the same and the patient continued to make mistakes and perseverate as before. krOshka

krYshka

krOshka

krYshka

krOshka

"kroshka"

"kryshka"

"kryshka"

"kryshka"

"kryshka"

krYshka "krysh..(no)"

The reading of sentences gave similar results. Although the patient could easily read single scntcnces he began to perseverate severely if two separate sentences were alternated repeatedly and he had to read the two sentences together. The examples of perseveration and contamination arising in this case arc most interesting. (Sobaka laet, ptitsa letaet: the dog barks, the bird flies) Sobaka laet, ptitsa letaet

Sobaka laet - ptitsa letaet

"Sobaka laet" - "ptitsa letaet"

"Sobaka letaet" - "ptitsa letaet"

Sobaka laet - ptitsa letaet "Sobaka letaet - ptitsa letaet" No, that is wrong! How can a dog fly! Read the words. Sobaka laet - ptitsa letaet "Ptitsa letaet i (and) sobaka le... sobaka letaet" No, not like that! Sobaka laet - ptitsa letaet

and so on.

"Sobaka letaet - ptitsa letaet" The same defects persisted if the second sentence was written in capital letters; this confirms that the perseveration in this case arose, not at the ' 'input," but at the "outp u t " - in the efferent side of reading.

I have given an example of the speech disturbances in one patient, who is representative of a large group, in whom a disturbance of speech arises as the result of extensive lesions of the speech areas of the brain, including Broca's area and the anterior temporal zones. By contrast with the cases described above, in which a brain lesion causes specific disturbances of particular components of the verbal encoding of expression (the "linear scheme of the sentence"or the predicative components of expression) the disturbances in this group of patients are nonspecific in character and affect the whole of the patient's neurodynamics, his movements as well as his speech. However, these cases are of special importance to neurolinguistics: they provide an opportunity for detailed study of two forms of verbal expression: those that are more stable and more resistant to the influence of pathological inertia and, on the other hand, those that submit to it more easily and disintegrate under the influence of pathological changes in the dynamics of

95 nervous processes. The interest in these cases can be summed up in the statement that they are not so much a general psychological process as a specific neurolinguistic process that requires investigation in each concrete case.

B. DISTURBANCES OF THE PARADIGMATIC ORGANIZATION OF V E R B A L COMMUNICATION IN PATIENTS WITH LOCAL BRAIN LESIONS

So far we have discussed the syntagmatic structure of expression and its disturbances. However, the description of all the stages of encoding of expression from its syntagmatic point of view and of the disturbance of this process constitutes only half of the problem with which we are concerned. The other half of the study of the organization of the codes of language themselves, their structure, and the disturbances observable in their use in patients with local brain lesions. The codes of language are constructed at different levels; they are organized into hierarchical systems of elements on the basis of certain cues (in other words, they have a definite paradigmatic structure). A disturbance of ability to acquire and use these codes may arise independently of disturbances of the syntagmatic organization of coherent expression and it is most frequently associated with lesions of the posterior cortical areas of the left hemisphere. Let us now turn to an examination of these forms of disturbance of the encoding of expression. The paradigmatic system of language, formed by oppositions of a more or less complex type, can be studied at the levels of its phonemic, lexical and semantic organization. The phonemic organization of language is based on a system of acoustic and articulatory oppositions, without which it would be impossible to use the codes of the language. In different languages the assortment of features on which these oppositions are based varies; some oppositions exist in all languages, others are used in only certain languages (Jakobson, 1941-1942). For instance, the vowel consonant contrast exists in all languages, whereas the opposition of nasal and nonnasal consonants or between long and short vowels is used in only some languages. However, the presence of a strict paradigmatic organization of the phonological level of linguistic codes is equally essential to all languages. The secondary zones of the sensory and sensomotor cortex play an essential role in the cerebral organization of this level and the syndrome of "phonemic disintegration," that arises in lesions of these zones, was well described in the French literature many years ago. The lexical or, more precisely, the morphological organization of language

96 is concerned with the meaning of its words and it forms the basis of the system of concepts which the language uses. In languages such as Russian, most words have a root and a system of additional components (prefixes, suffixes, and inflections); these components not only distinguish the essential features of an object or action described, but they also place it in a certain category; it is this function of speech that is essential for concept formation. The system of values represented by words is not formed at once; during the first eighteen months of the child's life the meanings of words are still very diffuse and amorphous, so that the same primitive group of sounds may signify equally an object and an action, a name and an order. The word " t p r u " may signify equally to a young child "a horse," "a whip," "go," or "stop," and' so on. It is only when a suffix is added to this amorphous word (for example, the word " t p r u " is converted in Russian into "tpru-n'ka") that it begins to denote some particular object (a horse) and ceases to apply to actions or qualities. This appearance of the first suffixes in the Russian language coincides with the sudden increase in wealth of the child's vocabulary, as is clear from the narrowing of the meanings that now begins to take place with every word, so that a considerable increase in the vocabulary becomes absolutely necessary. The process of word formation has been the subject of an extensive literature and I shall not dwell on it further (see: Ferguson and Slobin, 1973). Naturally this lexical-morphological organization of speech is based on a system of "paradigmatic" contrasts, which this time is concerned not with the phonemic (acoustico-articulatory), but with the semantic features of words. The word "chernil'nitsa" (inkstand) does not simply denote an object, but immediately places it into a whole system of comparisons. The root "chern-", denoting the color black, at once distinguishes one of the essential features of the object and includes this feature in a series of other possible names of colors (red, yellow, pale, dark), and thus forms one of the bases of words. The suffix " - i l - " points to a function of "instrumentality" and thereby includes the word in the whole category of objects possessing the same feature ("belila", white lead, "chernila", ink, "zubilo", chisel, and so on); the suffix " - n i t s " distinguishes yet another significant feature - that of a receptacle, and thus places the object described in another definite category ("sakharnitsa," sugar basin, "perechnitsa," pepper pot, "kofeinitsa," coffee box, "myl'nitsa," soap dish, and so on), thereby contrasting this object with others not possessing the particular feature. In the same way changes in the prefix in the verbs " p r i - k h o d i t ' " (to come), " u - k h o d i t ' " (to go away), " z a - k h o d i t ' " (to go visit often), " p o d khodit' " (to approach), as well as changes in words affecting features denoting number, time, or state form a highly complex system of codes en-

97 abling phenomena designated by the words to be organized, their essential features distinguished, and the phenomena placed into particular categories. Clearly in all these cases the lexico-morphological system of codes formed in the language in the course of tens of thousands of years does not simply permit particular objects and actions, qualities and relations, to be named but it automatically undertakes for us the highly complex task of picking out the necessary features, placing the objects or actions into certain categories, and contrasting the phenomenon named with others not possessing the particular feature or included in other categories. Such a semantic organization, which is incomparably more complex than the simple assigning of a word for a particular object, evidently leads to even more complex forms of cognitive activity that depend less on sensomotor processes and are perhaps effected by other cortical functional systems. We must now consider the last and, evidently, the most complex level of organization of the codes of language — the semantic level. Psychologists are well aware that words with the same lexico-morphological organization and denoting the same object (or, as is often said, having the same "object attribution") may have quite different meanings. The word "ugol' " (charcoal, carbon), by which the housewife understands the substance required for heating the stove, but which the charcoal burner uses to denote the material he makes, is placed by the chemist in a large and abstract category of substances designated by the letter C and including such widely different articles as charcoal, anthracite, or diamond. The word "lavka" (shop) or "magazin" (store) arouses in the small child the idea of something nice or tasty (sugar, candy, cookies, which can be bought there), the schoolboy conjures up a vision of a particular shop, but the economist regards it as one component of the public organization of exchange of goods. The phenomenon I have described has been called either the "meaning," or "semantic organization," or sometimes the "internal form of words." The discovery that at the different stages of the child's development a word not only possesses a range of associations that differs in its width, but also conceals different psychological processes, was made by L.S. Vygotskii more than forty years ago (see: Vygotskii, 1934) and it was one of the landmarks in modern psychology. It will be obvious that this level of semantic organization of language also uses a complex hierarchical system, or in other words, it has a complex paradigmatic structure; if it has been inadequately studied until recently the reason is that it is the least dependent on those external features, most amenable to objective analysis, that have always been the material of linguistics. I have enumerated the principal levels of paradigmatically organized codes of language that must of necessity be used whenever verbal communication is encoded. Clearly they differ radically in their structure and they are based on

98 completely different psychological processes. We now reach another most important but very little studied question: do all these systems o f codes rely on the same or on different brain mechanisms, and consequently, are the acquisition and use o f these codes disturbed in patients with lesions o f the same or o f different parts o f the brain? The fact that the process o f formation o f coherent expression (or the syntagmatic organization o f speech), on the one hand, and the acquisition o f the paradigmatic codes o f language, on the other hand, are based on different brain mechanisms and that the two systems may be disturbed independently o f each other, is widely known and has gained general acceptance in the literature. One o f the most eminent o f contemporary linguists, R. Jakobson, has drawn attention precisely to this fact and has published a whole series o f articles on it (see: Jakobson, 1971). It has also been confirmed by the discovery o f two sharply different forms o f aphasia, in one o f which (nonfluent aphasia) the fluent, coherent course o f expression is disturbed, whereas in the other (fluent aphasia) this feature remains unaffected. These two basic forms o f aphasia have been described by many authors (Goodglass, 1 9 6 8 ; Benson, 1 9 6 7 ; Kerschensteiner, Poeck and Brunner, 1972; Luria, 1973). The facts I have discussed above show that despite substantial disturbances o f fluent expression, patients with local lesions o f the anterior speech areas o f the left hemisphere may have no clear defects o f the use o f paradigmatically organized (phonemic, lexico-morphological, and semantic) linguistic codes. In lesions o f the posterior speech zones the opposite picture is observed. Here the use o f paradigmatically organized linguistic codes is primarily impaired, whereas in principle syntagmatic organization is preserved. However, the question arises: do lesions o f the posterior speech zones disturb equally the acquisition o f all the levels and systems o f linguistic codes enumerated above or are different systems o f linguistic codes disturbed differently by lesions in different parts o f the posterior zones o f the cortical speech area. In other words, do the acquisition and use o f each o f the systems o f linguistic codes require the participation o f different cortical structures? Although many conflicting views are held on this matter, my published observations (see: Luria, 1 9 4 7 , 1 9 6 2 , 1969, 1 9 7 0 , 1 9 7 3 ) provide a sufficiently unambiguous answer to this question). Since the acquisition and use o f different forms o f organization o f linguistic codes have totally different psychological mechanisms, we must seek the various cortical structures that participate in these processes. For instance, the acquisition and use o f phonemic linguistic codes requires the participation o f the secondary parts o f sensory and sensomotor subdivisions o f the speech areas, but this is quite unnecessary for the acquisition and use o f lexical and semantic codes. On the other hand, the acquisition and use o f lexico-morphological and semantic codes requires the participation o f the most complex, tertiary zones

99 of the cortex, adjacent to areas responsible for the reception, processing, and storage of visual and auditory information; these zones are concerned with the organization of complex forms of perceptual activity and have an absolutely essential role in the more elementary forms of external, acoustic speech. However, it is unlikely that such complex systems as the lexico-morphological and semantic codes could be "ascribed" to strictly localized areas of isolated cortical zones. Attempts to distinguish isolated forms of "verbal," "nominative," and "semantic" aphasia undertaken by Henry Head ( 1 9 2 6 ) , and more especially, attempts to correlate them with localized areas o f the cerebral cortex (Kleist, 1934), were conspicuously unsuccessful and led into an impasse. A much more likely hypothesis is that the acquisition and use of all these systems of codes may be disturbed in lesions of different parts of the posterior regions of the "speech zones," but that this disturbance differs in its course, each of these areas makes its own particular contribution to the

process of acquisition of these "paradigmatic" systems, and in every local lesion, besides primary defects it is also possible to distinguish secondary disturbances (disturbances of the system as a whole), that give rise to the varied picture of disorders found in patients with these lesions. Consequently, we must not only verify to what degree the disturbance of acquisition of paradigmatic codes of language may leave coherent (syntactically organized) verbal expression relatively intact, but we must also make a careful analysis of the character of disturbances in the acquisition of the various linguistic codes that can be observed in patients with lesions affecting different parts of the posterior regions of the cortical speech areas. Let us now examine the appropriate material.

1. Disturbances of the Articulatory Components of Verbal Communication in Patients with "Afferent Motor Aphasia" In the first section of this part I gave a general survey of the stages of encoding of verbal communication: I began by considering how the formation of verbal expression is affected by a disturbance of its original stage, the motive or intention, by the presence of general inactivity of thought and of its verbal forms and by a disturbance of the grammatical organization of the sentence.. I ended this survey with an analysis of cases in which the syntagmatic structure of expression is disturbed by phenomena not specifically related to language - global inertia of neurodynamic processes and their traces, - or in other words, when a disturbance of expression arises "at the output" - in its executive, motor component. In this section, when I analyze disturbances of the encoding of expression that affect chiefly the learning and use of the systems of language - its

100 phonological, morphological and semantic organization, - or in other words, when I turn to the analysis of disturbances of the paradigmatic structure of language, I shall proceed in the opposite way. I shall start with disturbances arising in the executive part of the speech act, during the organization of the articulatory scheme of verbal expression, and only after elucidating the disturbance at the phonemic level of the organization of speech shall I turn to the analysis of the more complex aspects of verbal expression. For verbal expression to be produced it must select the necessary verbal articulations or, in other words, it must use a system of articulemes within the framework of which the acoustic organization of the language is constructed. This system of articulations is built in accordance with the principle of oppositions, or in other words, it is paradigmatic in character, although this time it takes place at the articulatory-phonological level. The laws of these contrast, which every language uses, have been studied in modern linguistics in reasonable detail, and after the classical investigations of Troubezkoi (1939), Jakobson and Halle (1956) and many others, they are well enough known to require no further special mention. A more important fact for our purposes is that in certain definite brain lesions, notably lesions of the inferior zones of the left postcentral region, the kinesthetic afferentation necessary for the production of correct articulations is disturbed and the system of articulatory contrast on which articulated speech is based becomes inaccessible. It was this fact that lay at the basis of the syndrome described by French neurologists (Alajouanine, Ombredane, and Durand, 1939), as the "phonemic disintegration of speech" and which I have studied myself as part of the picture of afferent (kinesthetic) motor aphasia (Luria, 1947, 1962, 1966,1970; Vinarskaya, 1969, 1971). I shall turn now to the analysis of the disturbances of encoding of verbal expression that arise in patients with afferent motor aphasia. The direct result of lesions of the inferior zones of the postcentral region (operculum Rolandi) in the left hemisphere that give rise to "afferent motor aphasia" is a disturbance of ability to choose certain articulatory oppositions and thus to learn and use the articulatory codes of language. The pathological state of the postcentral (kinesthetic) cortical zones arising in such cases disturbs the physiological "rule of strength," as formulated originally by Pavlov, characteristic of the normal cortex, and an essential condition for the selectivity of psychological processes. Whereas in the normal postcentral cortex strong (or important) kinesthetic stimuli are dominant and weak (or unimportant) are inhibited and relegated to the background (so that it is possible to acquire the selective articulatory codes of the language), the situation is different in patients with a lesion of this region of the cortex. The kinesthetic cortex, in a pathological, "phasic" stage in such cases, no longer obeys the "rule of strength": strong and weak stimuli (or

101 traces) are equalized and begin to evoke equal responses; irrelevant and unnecessary articulemes are accordingly just as likely to arise as the essential articulemes, with which they may perhaps share one common feature, so that the precise (paradigmatic) system of articulatory contrasts is disturbed and the picture of "apraxic aphasia" is produced. In milder cases this picture is manifested only as the equally probable uttering of closely similar articulemes such as "1" - " d " - " n " or " m " - " b " - " p " (dentolinguals in the first case and labials in the second case), that differ acoustically but differ articulatorily in only one feature; for this reason the patient begins to confuse these articulemes easily and may pronounce "stol" as "slot" or "snot," and "khalat" as "khanat" or "khadat." In patients with more extensive lesions the system of contrasts is disturbed between less similar phonemes and the articulatory contrasts, which differ in their position and the method of their formation, begin to be revealed particularly clearly; the patients very easily confuse plosives, fricatives, the front, middle, and back Unguals, close, half-close, halfopen and open vowels, hard an soft consonants, and so on. In such cases phonemes that differ in their organization begin to be uttered with equal probability and properly articulated speech becomes impossible. The laws of these articulatory substitutions have been investigated by Vinarskaya (1969, 1971) who has shown, in particular, that whereas loud and sonorous consonants can still be pronounced by these patients relatively easily, the percentage of confusion during the contrasting of mute and sonorous consonants increases and the confusion of articulemes contrasting in position and method of organization becomes particularly marked. The results of an investigation of this fact in patients with relatively milder lesions and patients with the syndrome of afferent motor aphasia are shown graphically in Fig. 11. The immediate result of this primary disturbance is the disintegration of the whole system of encoding of verbal communication observed in such cases. The motive of expression and the scheme of the semantic content with these patients wish to transmit remain fully intact; the syntagmatic structure of expression also evidently is not primarily disturbed; however, access to it is difficult because the phonemic level of organization of the active speech process is grossly disturbed. The patients of this group try actively to say something, to find the necessary words, but all their attempts remain unsuccessful because the clear paradigmatic system of articulatory oppositions is no longer accessible to them. The patient either begins unsuccessfully to try to distinguish the articulation he needs from a group of similar ones but ends by choosing them all, or he cannot pronounce any particular single sound but remains the slave of a chaos of articulatory movements all of which take place with equal probability. This disturbance is the dominant factor of the picture of "apraxic" or "affarent motor aphasia." These disturbances are manifested equally in the spontaneous and re·

102 %of mistakes

% of mistakes I 40 -

°

I

Replacement

II

(II

of articulatory

IV

V

Fig. 11 and phonological oppositions with efferent motor aphasia (after F.. Ν. Vinarskaya)

of consonants

by

patients

petitive, the spoken and written speech of this group of patients. In every case they assume the form of total inability to speak, or of "literal paraphasia" (the replacement of one articulation by other, irrelevant articulations). The essential feature is that the "verbal paraphasia" (replacing the necessary word by another of similar meaning) typical (as we shall see) of patients with lesions of the temporal or parietooccipital region and a picture of sensory or "semantic" aphasia, is^isually not found in these cases. Another characteristic feature of this syndrome is that the disturbance of possession of the paradigmatic codes of language in such cases arises only at the phonemic (articulatory) level whereas other (lexico-morphological and semantic) levels remain relatively better preserved and the syntagmatic organization of coherent speech (access to which, as I have stated, can be relatively restricted because of the articulatory disorders) can be potentially preserved if not fully intact. This hypothesis is confirmed indirectly by some very important facts. Patients with the form of disorder with which we are now concerned can neither pronounce clearly nor repeat an isolated sound, syllable or word, but exhibit the articulatory substitutions described above when they try to do so; the more consciously they try to find the required articulation, the more the process needs their specially concentrated attention, the more difficult it is for them to find the articuleme desired. However, if the patient is distracted

103 from his task, sometimes he can easily pronounce whole sentences; no sign of a disturbance of the syntagmatic organization of fluent speech can be detected. This paradoxical phenomenon has often been described in the literature as a feature of "conduction aphasia," and cases in which the patient, when asked to repeat the word " n o , " says: "No, doctor, I just can't say the word 'no'," have found a firm place in textbooks of neurology. The psychophysiological mechanisms of this paradoxical phenomenon are still unknown and I have attempted to explain it in Chapter Five. At this point what is important is that inability to find the necessary articulation at one (conscious) level, coupled with integrity of the coherent, syntagmatically organized expression at another level, can be used as indirect evidence of the segregation of two independent systems - the syntagmatic and paradigmatic organization of verbal expression, that can be found easily in patients with such severe speech disorders. The data at our disposal are still too incomplete and inconclusive to decide to what extent other levels of encoding of verbal expression are affected in the patients of this group and, in particular, whether they still possess the lexico-morphological and semantic codes of language. The possibility cannot be ruled out that the use of these codes may be impaired in patients with a picture of "afferent motor aphasia"; however, the damage, if it exists, is secondary in character, at the level of the functional system: a patient whose entire efforts are directed toward finding a necessary articuleme, once he has chosen it from a whole series of articulations springing up with equal probability, can naturally lose the necessary structure of expression and simplify or deform it. The whole group of interconnected questions still requires further clarification. However, one thing remains clear: what I am saying now may be further indirect evidence that the disturbances observed in these cases are not uniformly severe and that the lexico-morphological and semantic codes of language are relatively independent of their phonemic (and articulatory) codes. Observations made over many years have shown that in the reeducation of patients with efferent motor aphasia (Broca's aphasia), whose main defect is the pathological inertia of established stereotypes, just as with patients with a disturbance of the predicative structure of expression, the main task is to overcome the pathological inertia and to restore the structure of the sentence. Patients with "afferent motor aphasia," with which we are now concerned, present a totally different problem. In patients of this group the main task of retraining is to restore ability to find the correct articulatory cues, to differentiate individual articulemes or to find the structural organizations of the sounds. If they start to do it these patients have no further difficulty, in principle, in restoring the morpho-

104 logical form o f words or finding the necessary names, or constructing whole sentences. Facts such as these, discussed elsewhere (see: Luria, 1948, 1970; Tsvetkova, 1972), may be further very important evidence of the independence o f the above-mentioned systems of the codes o f language and o f the specific character of their brain organization. Let us now examine a typical example of how the process of encoding of verbal expression is disturbed in a patient with a primary disorder of the articulatory level of speech organization associated with "afferent motor aphasia." I shall use the results o f tests on a patient in whom I am still particularly interested in connection with my reexamination of the problem of "conduction aphasia." Patient Dmit, (Case No. 54860), a woman aged 44, employed as a saleswoman, with a circulatory disturbance in the system of the middle cerebral artery in the left hemisphere and with a lesion chiefly on the lower postcentral zones. Her illness developed acutely in August, 1971 when she developed right-sided hcmiparesis with loss of sensation and definite speech disturbances. The hemiparesis quickly cleared up but the speech disturbances remained permanently. At the Institute of Neurosurgery, to which she was admitted in September, 1971, central paresis of the right facial nerve, a slight decrease in sensation on the right side, astercognosis on the right side, a slight loss of strength in the right upper limb, elements of oral apraxia, increased reflexes and a positive Rossolimo's sign on the right side, and marked disturbances of speech, predominantly of the afferent motor aphasia type, were found. The patient's personality was fully intact, she was well oriented and communicative, and she worked hard to overcome her disabilities. Her understanding of speech was primarily undisturbed and detailed tests revealed only very slight disorders. Her spontaneous speech was potentially intact, her intonations were expressive, and the syntactic structure of expression showed no primary defect and was disturbed only by word seeking. Characteristically the seeking for acoustic or articulatory components of words that occurred in repetitive speech were not found under these conditions. An example of her spontaneous speech is given below. Tell me how you became ill. "How I became ill? ... I went home on leave ... and before that I worked ... worked, do you understand? I was the head saleswoman ... that is to say I always gave up ... I handed over ... but this time I did not hand it over, do you understand? ... I went on leave ... I was there ... and something ... my head, and all the time I am thinking ... looked, and I say everything is all right with me ... I look quickly and can see that all my friends have come ... and my boss says that he must ... somewhere ... do you know where?" and so on. Her ability to recite series was quite intact. She had no difficulty in reciting the natural series of numbers, the familiar order of the days of the week and the months of the year, and she began to have difficulty only when reciting a familiar series in the reverse order. Her repetitive speech was in sharp contrast to this. She could not repeat individual sounds or pairs of sounds normally, but often substituted other articulemes with one similar feature: she would repeat " m " as "b", " p " as "1", "sh" as "ch", " p " as "t", " b - r " as " b - n " , " c h - s h " as "ch-1," and so on. She usually was aware of her defect but even her active attempts to find the required articuleme were unsuccessful. Similar defects appeared during the repetition of single words. For instance, she repeated the word "krest" (cross) as "kvo ... (no) ... ve ... (no) ... nf... kv ... kr ... kri... s ... no ...," the word "babochka" (butterfly) as "mamochka," (mother) the word

105 "gradusnik" (thermometer) as "gra... gra... gra... santi ("samtimetr" - centimeter) ... gradus ... no ...," the word " o k n o , " (window) as "an... antro... ono... onto... no, not a bit like that ...," and so on. Often she gave both literal and verbal paraphasias, introduced words like the habitual context, and substituted for the required word another close to it semantically. Among the mistakes of this group "plat'e" (dress) as "plashch" (cloak), the word "svin'ya" (pig) as "svinina" (pork), the word "lisa" (fox) as "zayats" (hare), and so on. She had similar difficulty when repeating sentences: in these cases the helpless searches for the required words for exact repetition of the sentence were easily replaced by verbal paraphasia. She repeated the sentence "Vchera bylo ochen' k h o l o d n o " (it was very cold yesterday) as "Vchera bylo khorosho... kho... (it was fine yesterday) ... k h o r . . . kholodno (cold)," the sentence "V sadu rastsvele tsvety" (the flowers were blooming in the garden) as "Vcsennei (in spring) ... no ... khoroshii (it is fine) ... no ... not so much ...," or the sentence "V etom godu khoroshii urozhai yablok" (this year the apple crop was good) as "Khoroshii (good)... v... segodnya (to-day) ... asi... ach... khoroshii vesenni dozdh' (the spring rains were good)... no, not khoroshii... arzh... arazhai." It is interesting to note that these attempts often showed preservation of the morphology of spcech despite a disturbance of its articulatory composition. This is clear from repetition of the sentence "Zhenshchina doit korovu" (the woman milks the cow) as "Zhenshchina molochit korovu" (the woman beats the cow - similarity between the word "molochi" and " m o l o k o " = milk), "Devochka ukrashaet elku" (the girl decorates the Christmas tree) as "Devochka pokushaet (pokupaet) elku (the girl eats (buys) the Christmas tree) ... (no) ... devochka delaet elku (the girl makes the Christmas tree) ..." and so on. Similar defects were found during the naming of objects. She could not find the exact word but gave "stakan" (tumbler) as "sta-ka-lon" and "etazherka" (whatnot) as "cherterka... ele... etoderka" (all nonsense), ... "trel'yazh" (trellis) as "pol... eret... srer... trishot..." and so on. Verbal paraphasia was frequent: she called a steamship an airplane, a sailor a hunter, a dress a skirt, a pig a cow, a dog - no, wolf ... no ... - or she replaced the word by an approximate description: "lily of the valley" - "it has a sweet smell..." "saucepan" - "this is to eat," " b o t t l e " - "bottle of milk..." " b r o o m , " - "it cleans ... it l i f t s . . . " or "cart" - "it goes" and so on. Characteristically all these defccts occurred in a much more masked form in spontaneous narrative speech, in which the syntagmatic structure of expression was preserved and opportunities for the free interchange of words with others of similar meaning were greater. The following are examples of this patient's dialogic speech. "What is there in your room at home?" "Well, in the evening when I lie down, so that I can read clearly ... so that it is light." Meanwhile direct repetition of the word " l a m p a " (lamp) led to a continuous series of literal paraphasias, such as: "lalcn ... no ... libar'... no ... svidionnyi ... svid ... no, not like that ..." It is interesting to note that words that the patient could not repeat directly were easily incorporated into her dialogic speech. When asked "What did you sell?" she answered: "1 have already told you: sausages, milk, sugar ... I forgot these ... what were they ... white and brown bread ... sauce, grapes, apples ... and I forgot what they call them ... melons ... no ..." and so on. This dissociation between the difficulty of directly finding the necessary articulemes and the integrity of the general meaning and syntagmatic structure of expression was manifested particularly clearly when the patient retold a story. For example, she repeated the story "The Hen and the Golden Eggs" as follows: "There was a hen ... and she had ... her master took her and cut her up ... and her eggs were very beautiful ... golden ... and when he ... when ... well ... he wanted ... to hide ... to hide it ... he was very frightened that this excellent hen of his... and he, I mean, recognized ... killed ... and there was nothing there." I do not propose at this stage to make a special examination of the differences between this patient's repetitive speech (which was particularly difficult) and other forms of speech (for example, naming objects, telling stories, and so on). This is done when I discuss the problem of the mechanisms of "conduction aphasia" later in the book.

106 I shall now summarize the results of tests carried out on the patients of this group. The most significant characteristic of these patients is the basic dissociation: despite a severe disturbance of the paradigmatic organization of verbal codes (at the phonemic-articulatory and lexical levels), the syntagmatic organization of their verbal expression remains largely intact. That is why the dominant feature of the speech of these patients is gross disintegration of the precise repetition of sounds, groups of sounds, and words, with frequent literal paraphasia and substitution of words of similar meaning (verbal paraphasia), whereas the elements of coherent syntagmatically organized expression remain basically unaffected.

2. Disturbances of the Acoustic Components of Verbal Communication in Patients with Sensory (Acoustic) Aphasia We have just analyzed the form of disturbance of expression that is connected with loss of the ability to operate with the phonemic codes of language as the result of a disturbance of the system of articulemes. We must now turn to another type of disturbance of the same phonemic level of verbal encoding and discuss patients in whom these disturbances are based on the disintegration of the acoustic basis of the phonemic organization of linguistic codes or, in other words, a disturbance of phonemic hearing. This disturbance arises in lesions of the superior zones of the left temporal region (Wernicke's area) with the attendant picture of sensory or acoustico-gnostic aphasia. In many respects the picture of the speech disorders in such patients is the antithesis of the picture in "afferent motor aphasia"; however, in both groups of speech disturbances the patient is unable to operate with the phonemic codes of language and the disorders observed take place primarily at the phonemic level of organization of speech processes. In cases of "afferent motor aphasia" accompanying lesions of the inferior postcentral zones of the left hemisphere (the operculum Rolandi) described above the disturbance of the phonemic organization of language arose from a disintegration of articulatory oppositions; in lesions of the posterior zones of the left superior temporal gyrus the disturbance is at the same level of the codes of language but it starts at the other end - with disintegration of the acoustic organization of the corresponding phonemic systems. In less severe cases of sensory (acoustico-gnostic) aphasia the contrast only of "oppositional" (or "correlative") phonemes is disturbed; in Russian these are phonemes that differ in the characteristics of voiced — unvoiced (b—p, d - t ) , hard - soft (1—1% t - t ' ) , and so on. Patients with this disturbance cannot correctly distinguish between the syllables " d a - t a " and "ta—da," "ba—pa"

107 and " p a - b a " and they pronounce them similarly as " d a - d a " or " b a - b a , " stating that there is some sort of difference between the parts of the pair but they cannot identify it clearly; the same phenomenon is observed when articulation is excluded (when the patient is asked to point to the corresponding letters or to raise his right hand in response to one sound of each pair and his left hand in response to the other). This shows that the primary disorder in such patients is sensory in nature. This is confirmed by the fact that the patients cannot understand the difference between words such as "bachka" and "pochka," "dochka" and "tochka", "zalo" and "salo," or "pyl' " and " p y l " "pil" and " p i l \ " 4 and they confuse them seriously when writing them. In patients with more severe disturbances of this type not even widely distant phonemes can be distinguished and the phenomenon known as "alienation of word meaning" arises. If the patient is instructed to point to the nos (nose) he helplessly repeats "nosh... nozh... noz... nosht..." and after many fruitless attempts to get the exact word he exclaims: "No, I don't know what the word means..." A natural result of this primary disorder is inability to repeat the corresponding words and to name objects shown: the mistakes that arise in such cases have the character of literal paraphasia and, unlike in cases of afferent motor aphasia, the substitutions are not articulatory but clearly acoustic in nature (substitutions of sounds with opposite phonemic characteristics). Only occasionally will a patient, after helplessly trying to find a required word, replace it by another of similar meaning (i.e., verbal paraphasia). Perhaps the most characteristic feature of these patients is that habitual expanded, syntagmatically and prosodically organized speech is relatively intact. Although the patient cannot find the required words, he still retains the general contour of the whole sentence and the inflected structure of the (phonemically distorted) words and its general pattern of intonation and melody remain intact. That is why someone listening to the speech of such a patient, in which the nominative components are either totally absent or are in a distorted form and only the interjections and interspersions, sometimes conjunctions or even verbs are preserved, can understand what he is saying mainly because of the completely intact syntagmatic, intonational and melodic structure of expression. When, therefore, the patient very expressively tells the story of how he was wounded, without a single substantive he may say: "And so you see ... to begin with ... you know ... it was all right, and there ... then it came ... and there they were, then suddenly — oh! - and then - nothing! ... but later oh dear, it was ... and then ... little by little ... and later... better and better ... and now you can see how it is to-day?" — the listener can easily recreate the pattern of gradual progress, with the explosion of the shell, the operation, and the gradual improvement. This relative integrity of syntagmatic speech, on the basis of which these speech disorders are grouped as "fluent aphasia," distinguishes them from the

108 other group of "nonfluent aphasia," which arises in lesions of the anterior speech zones. This is clear from the methods used by such patients in their attempts to find a word: when, after unsuccessful searches, they are forced to the conclusion that they cannot find the necessary phonemic structure, they try to compensate for their primary defect of word finding by ini.oducing the word they Seek into the content of a habitual whole expression: "Well it is something you eat with..." or "Well what can it be ... what is it? ... of course ... I stir my tea with it ... a spoon" - these are typical attempts made by such patients. The most important fact in the general pattern of encoding of verbal expression in the patients of this group is the dissociation between the intact syntagmatic and the disturbed paradigmatic structure of language. The acquisition and use of linguistic codes in such patients are disturbed primarily at the level of phonemic contrast; the semantic system is disturbed mainly at the level of isolated words and the disturbance is in the form of inability to understand the direct meaning of a particular word (or, more exactly, its relationship to a particular object), whereas the more complex levels of semantic organization such as the lexico-morphological level and, in particular, the level of whole expressions, may remain relatively intact. This is elegantly confirmed by the fact that in the patients of this group the "sense of the language," with the morphological structure of the suffixes ( " - n i t s a , " "—stvo" in Russian, " - r e s s , " " - n e s s " in English) and inflections remains intact and their language often consists of sentences with meaningless, artificial words but retaining their morphological structure and semantic form; these features were used originally by Shcherba, and later by Miller and Chomsky, to show that the syntactic structure of language is independent of the concrete meaning of the words composing it, that a correct sentence can be formed from artificial, meaningless words, and that syntactic structures have independent and stable laws. Another equally significant fact is that although these patients are completely unable to grasp the meanings of individual words, they can still understand the general meaning of a complex expression that they recreate from its individual morphological and intonational-syntactic components (I shall take up this point again in the next chapter). This dissociation between the syntagmatic structure of speech as a whole and the paradigmatic structure of individual words (mainly at their phonemic level), coupled with the whole series of disturbances of the encoding of verbal expression arising because of this complaint, is of the utmost interest to linguistics. My best plan at this stage will be to give an example that will show the picture observed in these cases. Patient Mark., an engineer aged 55 years with higher qualifications, right-handed, suffered from essential hypertension.

109 In May, 1971, he developed weakness in the left upper and lower limbs, from which he recovered; in August, 1972, weakness began to appear in the right upper and lower limbs; at the same time his speech began to be disturbed and marked sensory aphasia gradually developed. At this time neurological examination revealed loss of sensation and of muscular power on the left side, diminished reflexes, marked reflexes of oral automatism, and severe sensory aphasia. Neuropsychological investigation showed that the patient was fully oriented and his behavior adequate to the circumstances. Visual gnosis was intact, he had some difficulty in tests of postural praxis and spatial praxis, and difficulty in assessing and reproducing rhythms. His speech was severely disturbed as in sensory aphasia: phoncmic hearing and the understanding of spoken speech were particularly badly affected, the understanding of written speech less so; spontaneous reading and writing were impaired. Analysis of spoken speech (encoding of communication) gave the following picture. The patient's phonemic hearing was severely disturbed and, consequently, his ability to repeat phonemes was very limited; significantly, very often when attempting to repeat an isolated phoneme, the patient replaced it by a complete meaningful word (for instance, instead of " r " he repeated "raz" (once) and instead of " p " he repeated "pcrvyi" (the first) and so on). The repetition pf separate, meaningful words was better preserved than the repetition of phonemes, but here also some peculiarities were noted: if the patient repeated a word quickly or "automatically," he could do it quite well; if, however, he tried to concentrate on the phonetic analysis of the word he started to search unsuccessfully for the necessary phonemes and resorted to literal paraphasias (as in patients with afferent motor aphasia). Very often instead of repeating a given word he uttered words of similar meaning or belonging to the same class (verbal paraphasia); for instance, the patient repeated the word cat as dog, the word violin as maestro, the word concert as show, and so on. This tendency to replace the adequate repetition of a word by words belonging to the same semantic field was a feature common to all tests of word repetition with this patient. The repetition of sentences was easier than the repetition of isolated words, thus showing the relative integrity of the patient's fluent syntagmatic speech; even here, however, very often the sentence as given was replaced by a construction with a similar meaning but with different words, or reproducing a meaning falling within the same category. For instance, the sentence "Yesterday I went to a concert" was repeated by the patient as "Yesterday I went to a movie," and when it was pointed out to him that he should have said "concert" he replied: "Yes ... yes ... music ... maestro ..." and on repeating the test he said "Yesterday I went to a show! ..." He repeated the sentence "The trees in the orchard flowered in the spring" as "movie (perseveration) ... no, the park," and he repeated the sentence "It will be very hot in summer" as "After summer ... yesterday (perseveration) ... to-day (perseveration) ... we built ... hot weather ..." Hven the simple act of repeating verbal material was seriously disturbed. The patient could not repeat isolated phonemes; he repeated words and phrases more easily, but even then produced abundant verbal paraphasias, very close in meaning or in words to the test, or perseverating traces of the previous test. Similar disturbance occurred at a higher level of encoding of verbal communication the naming of objects. In such tests the patient either was completely unable to find the necessary lexical unit and helplessly stuck when faced with the choice of appropriate articulemes (as a result of the alienation of word meaning, which I shall discuss again below, prompting did not help him to find the name he sought), or he replaced the necessary word by another of similar sound or of similar meaning and gave verbal paraphasias. A few examples illustrating this defect are given below. Ulitka (snailj "Yu... this is the proble, ... yulitsa (contamination of "ulitsa" = street and "ulitka" = snail) ... no, not like that ... shlyutsa ... no ... ulitsa ... no ... yulitsa ... n o " Konvert (envelope) "No, ... I can't remember ..." Kon " N o . " Konve "No, I don't know, postman ...

110 no, it is difficult ..."I put a letter in it. "Inside ... postman ..." Borona (harrow) "Bo... ba... borozda (furrow)... no... boroda (beard)... bo... bo... no, I don't know..." Pero (featherj "Now ... what is it ... pti ... ptichka (bird) ... no ... pi... peritiko... no ..." Women have them in their hats... "I have forgotten ... pretty bird ... perlyshko... perlo... perno..." Pero... "Peri... perol'..." The patient thus had great difficulty in naming objects. Although names of every-day objects that normally spring up automatically (table, book, telephone, overcoat, knife, and so on) were sometimes found easily, attempts to find less habitual or less firmly consolidated names of objects cncountercd great difficulty and led to literal paraphasia and to the irrepressible springing up of alternative (similar in sound or meaning) words, which the patient himself realized were inappropriate but which he was unable to replace by the proper words. Characteristically neither prompting nor even introducing the required word into the context of customary expressions could help the patient, and the nominative function of his speech was thus severely disturbed. Further observations showed that naming actions was much easier for this patient than naming objects. This showed indirectly that the predicative function of his speech was better preserved than its nominative function and that the syntagmatic organization of expression was much less severely impaired than the paradigmatic system of code units. Tests showed that if the patient was shown a picture representing an action, he had much less difficulty in naming that action than in naming an object. A few examples illustrating this state of affairs are given below (the theme of the picture shown is given above the line in parentheses, the patient's verbal response is given below the line). (A boy drinks water from a tumbler) "He drank ... from a tumbler ... the boy drank from the tumbler ... but what I don't know." (A boy is running along the road) "A boy is running along the road." (A woman is sitting on a sofa) "A woman is sitting on a sofa." (A boy is catching a fish) "A boy caught (lovil) ... lovaku ... or ... neptyku (nonsense) ..." babochku (a butterfly)? "papochku ... a boy caught... no, ... what is it called?" (A mother is putting a shoe on her small son) "Here there is a girl with her son ... putting on a shoe ... stockings ..." (A woman is drying the clothes) "Here is a woman ... hanging ... long ... what is it that you hang the washing on ..."

Ill T h e s e results suggest t h a t t h e d i s t u r b a n c e s d i s c o v e r e d in this p a t i e n t ' s coherent

fluent

s p e e c h ( e n c o d i n g o f c o m m u n i c a t i o n ) are c o m p l e t e l y d i f f e r e n t in

c h a r a c t e r f r o m t h o s e f o u n d in p a t i e n t s w i t h l e s i o n s o f the p r e m o t o r o r f r o n t a l zones.

Moreover,

ponents,

was

coherent

contextual

speech, with

its p r e d i c a t i v e

m u c h b e t t e r preserved in this p a t i e n t t h a n t h e

com-

nominative

f u n c t i o n and i f it w a s i m p a i r e d , t h e d e f e c t w a s p r i m a r i l y in t h e n o m i n a t i v e c o m p o n e n t s o f the c o h e r e n t e x p r e s s i o n . T h i s c a n be s h o w n b y

a n a l y s i s o f the p a t i e n t ' s s p o n t a n e o u s

coherent

s p e e c h and b y analysis o f his p e r f o r m a n c e w h e n d e s c r i b i n g the t h e m e p i c t u r e s and in t h e m o s t d i f f i c u l t test o f all -

of

d i s c o u r s i n g o n a given t o p i c .

Spontaneous speech was fairly fluent, the syntactic constructions of expression remained basically intact, and the only disturbances were poverty of substantives and searches for the necessary names; the intonational-melodic aspect of speech was perfectly normal. A typical example of the patient's spontaneous speech is given below. Tell me how you became ill. "In general... it began ... my right side was paralyzed ... and after that ... they did what was the proper thing ... and I say - write to me at work. So they wrote - they sent a little message and I waited for a few days... but I still lay there ... in my room ... at home ... it is no longer clear." But now? " N o w it is much better ... although I cannot say anything, but to-day it is a little ... sometimes my wife speaks and I cannot understand ... she writes a sentence - and at that moment I can understand i t . . . " and so on. Narrating the story of a thematic picture showed similar features. The patient could analyze even complicated thematic pictures and could identify the essential features of the story, but his ability to narrate the story was limited by the defects in finding names. This is how the patient told the story of the picture "The Broken Window". "This is a schoolboy ... here are two others, they were playing with a ball and broke the window ... they were frightened, and the man went out to hit them, and he caught ... I mean a boy was playing with a snowball, he broke a window, and another boy evidently was passing and it was he whom the man saw ... He caught the one passing by but the other was hiding behind the door... behind the tree ..." Similar results were found when the patient told the theme of another picture "The Last Spring." " A young woman was ill... she lay ill... here there are evidently two sisters, who respected ... or who decided that it would be better for her frame of mind ..." Ukhazhivali za nei (Were they looking after her) ? " Y e s . . . ula ... uklazhivali... ukrashinali... uklazh... ukladyvali... they themselves ... ukladyvalis' ... (her sister was ill and) ukhazhivala... ukladyvala..." and so on. Similar features also were seen in the next test, in which the patient had to discourse on a given topic. Unlike patients with lesions of the anterior zones of the brain and a syndrome of "dynamic aphasia," who were unable to switch from repetitive speech to active expression, this patient had no difficulty at all in speaking about a given subject; his speech was just as fluent (being interrupted only by word seeking), new details of the evolving theme arose easily, and this most complex form of verbal expression aroused no fresh difficulties. An example is given below. The patient was instructed to speak on the subject "Sever" (The North). He said: "Sib (contamination of "Siberia" and "Sever" (North) ... sever ... se ... sever ... (well ... in the north they work on airplanes... they fly in any direction ... it is hard - they have to fly and to transport goods and provisions. In the north ... they move by reindeer and dogs ... in the north they have to work hard to ... keep the passage open ... the frost and ice, all movement has to stop ..." The patient discoursed similarly about other subjects, his own life history, and so on.

112 We can draw certain conclusions from the material I have described. In patients with the typical picture of moderately severe temporal aphasia (patients with a severe form of sensory aphasia are quite unable to understand speech addressed to them and instead of coherent expression they produce "word salad," in which only the intonational and melodic structure remains intact) the following typical disturbances of the encoding of verbal expression are found: coherent syntagmatic speech is preserved but difficulties are experienced in repetitive speech (in connection with the defect of phonemic hearing) and in the naming of objects. These difficulties are particularly conspicuous in the repetition of isolated words and the naming of objects, and they lead to obvious searching for the necessary phonemic structure of words (literal paraphasias) and replacement of the desired word by others of similar sound or meaning (verbal paraphasias). The defects described above are severest in the naming of objects and they are much less marked in the naming of actions, a fact that correlates clearly with the relative integrity of the predicative structure of expression. In both the cases analyzed in the last section, as I have already said, the basic defect is a disturbance of ability to operate with the system of the acoustic codes of language: at the level of articulations in one case and at the level of phonemic hearing the the other. It is thus possible to generalize the basic features of these two forms of disturbances and to represent them both by a single conventional scheme (Fig. 12). The first part of the scheme shows disturbances arising in the patient during the repetition of single sounds or words, the second part disturbances arising during attempts to repeat a whole expression. Two essential features here must be noted. First, the repetition of sounds or words, the naming of objects, or the repetition of a whole expression meets with difficulties connected with the disturbance of the system of articulemes (in the first case) or phonemes (in the second case); this leads to unsuccessful searches for the required articulatory-phonemic components (manifested as literal paraphasia) and the process is very soon diverted to another path - to the uttering of other words, connected by meaning, either as a result of active search or by inclusion in the context of a whole, habitual expression. Second, although verbal encoding of expression meets with the serious difficulties already mentioned above, the basic meaning of the expression is preserved. We have examined disturbances of encoding of expression in which the basic defects lead to disintegration of the acquisition and use of phonemic codes of language. Besides the essential differences between the two groups of disturbances I

113 a) R e p e t i t i o n o f separate sounds S e n s o r y and

Normal I

^

afferent

£ /

m o t o r aphasia

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Disturbance of the generation of verbal communication gnostic (sensory) aphasia

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in patients with acoustico-

Context

114 have described (in one the disintegration of spoken speech arises through a disturbance of the system of articulemes, in the other through a disturbance of the system of phonemes) the pathological process arising in both cases has two common features. First, in both cases the primary disturbances affect only the phonemic organization of spoken speech, whereas the lexico-morphological and semantic organization, if affected at all, are involved only secondarily. Second, by contrast with the forms of speech disturbances described earlier, the brain lesion in these patients disturbs their ability to grasp the paradigmatically organized system of the acoustic codes of language, whereas coherence, i.e., the syntagmatic organization of expression, is much less severely affected or, in some cases, may be perfectly normal. These facts show that the two aspects of speech activity — syntagmatic and paradigmatic - are based on different brain mechanisms and may be damaged separately in different brain lesions: some lesions lead to disturbance of the coherent, syntagmatically organized expression only, whereas others disturb only operations with the phonemic and articulatory codes of language, with a consequent impairment of ability to name objects, but without affecting the predicative and intonational-melodic structure of expression; these two components of the speech process can thus be separated. We do not yet know sufficiently precisely the neurophysiological basis of the cortical "dynamic mosaic" responsible for the separate existence of these components of the speech process and all we can do at this stage is to offer some initial thoughts on the possible explanation of this phenomenon. There is no doubt that a lesion of the anterior zones of the speech area disturbs that integration of the processes in time which, at the higher stages of its automation, is responsible for the creation of general kinetic schemes or motor skills and which, in speech activity, is essential for the appearance of expanded internal speech, with its predicative function. A different role is performed by the posterior, gnostic zones of the cortex, including the posterior zones of the speech area. Their functions are to analyze and synthesize speech sounds or articulemes and to use them to find the necessary names; in lesions of these zones the "operational" level of the paradigmatic organization of speech and ability to work with the corresponding codes of language are disturbed. So far we have considered forms of speech pathology that disturb this process at the more elementary articulatory-phonemic level. Let us now turn to the analysis of more complex forms of disturbance of the encoding of verbal expression, examining first those connected with special types of disturbance of audio-verbal memory, and later the even more complex forms in which the encoding of expression is disturbed as a result of the disintegration of simultaneous, quasi-spatial syntheses.

115

3. Disturbances of the Encoding of Verbal Communication in Patients with Acoustico-Mnestic Aphasia Our analysis of the disturbances that arise in patients with lesions of the temporal zones of the left hemisphere would be incomplete without some attempt to describe the obstacles to the process of encoding of expression that appear in patients with the form of speech disorder that is associated with lesions of the middle (nonacoustic) zones or the deep parts of the left temporal region and assumes the form of the so-called acoustico-mnestic aphasia. I have described acoustico-mnestic disturbances of speech in many publications (see: Luria, 1947, 1962, 1966, 1970, 1973). Without considering whether they are a special type of speech disorder or merely a less pronounced form of temporal (acoustico-gnostic) aphasia, I shall content myself with a brief description of these speech disturbances and mention only in the most general terms the difficulties that arise in the encoding of expression. A characteristic feature of patients with acoustico-mnestic aphasia is that, while the phonemic structure of language remains intact and alienation of word meaning is not a conspicuous feature, these patients cannot retain a series of audio-verbal traces sufficiently firmly, but they lose them easily after a pause or under the influence of interfering factors, and they thus are unable to form a stable series of consecutive audio-verbal chains. This disturbance is manifested in the patients of this group in tests of the repetition of verbal material. Although they can easily repeat single words, difficulties arise when they have to repeat series of words. In the most serious cases, such as I have described elsewhere (Luria, Sokolov and Klimkovskii, 1967, Luria, 1974), the repetition of a series of even two or three words was impossible. The patient first repeated the last word read to him (the "recency" factor), and then returned to the first word, or having repeated the last word he forgot the first. In less severe cases of acoustico-mnestic aphasia a similar phenomenon can be observed in tests of repetition of a relatively longer series of, say, 5—6 words. The patient then either repeats the first two or three words and declares he has forgotten the rest, or he repeats two or three of the last words and states that the first words of the series no longer remain in his memory. As observations by Tsvetkova and her collaborators have shown, sometimes the decrease in audioverbal memory may be connected, not with mutual inhibitability of auditory traces, but with another phenomenon known as "reduced span of audioverbal memory." In such cases the difficulties of repetition can be compensated to some extent if the series of syllables or words to be presented is broken up into successive groups, and each group is imprinted separately. By methods such as this, a patient with acoustico-mnestic aphasia was able to repeat a long series of words that was

116 completely impossible for him to repeat directly (Tsvetkova, 1968). The basic defect of encoding of verbal communication is also manifested in the patients of this group in tests of naming objects. Often, when naming objects (as also when recalling names), the patients of this group encounter the difficulties we have already met in a much more serious form when analyzing patients with sensory (acoustico-gnostic) aphasia. Being unable to find necessary words these patients very often substitute other words of the same semantic category (they say " p u t " instead of " f o u n d , " " b o y " instead of "adult," "looked" instead of "forgot" and so on); sometimes definite examples of the "etymologization" of words may be encountered: having forgotten a necessary word, the patient instead invents an "appropriate" word: he says "gvozdil'nik" (nail-driver) instead of "hammer" and so on. These patients find it very difficult to name series of objects shown to them. Besides the difficulties already mentioned, they also have others: as a rule they will name the last object shown to them first (the "recency" factor), and the first object last; often under these circumstances the difficulty is manifested simply as lengthening of the latent period or as a statement to the effect that the wanted word is "forgotten" or it is replaced by paraphasia. This phenomenon indicates that increased mutual inhibitability of audioverbal traces is evidently the basic pathophysiological mechanism of acoustico-mnestic aphasia. The most important aspect of this form of speech disorder, however, is that the syntactic structure of coherent speech remains intact in these patients and the difficulties of encoding of verbal expression are limited to acoustico-mnestic defects. This is clear from the fact that the repetition of short sentences is completely free from defects but, when an attempt is made to repeat long sentences, the familiar phenomena of changes in order arise: repetition of the end of the sentence first, followed by the beginning or, much more often, repetition of only part of the sentence and "forgetting" of the rest. This phenomenon is seen in perhaps its clearest form in the repetition of whole stories, when the patient as a rule retains the general meaning and preserves the relatively correct grammatical structure of individual fragments of the narrative, but is unable to repeat the story as a whole. Naturally such phenomena arise particularly clearly during spontaneous monologic speech, which retains an intact grammatical structure but is characterized by difficulty in recalling individual verbal fragments and by loss of coherence of expression: these difficulties are of a distinctly acousticomnestic character. The best way to illustrate the disturbance of verbal communication in acoustico-mnestic aphasia is by a concrete example.

117 Patient Dem., a woman aged 44 years (Case No. 53615), a constructional engineer, was admitted in February, 1970, to the Burdenko Institute of Neurosurgery with the diagnosis of a suspected intracerebral tumor of the left temporal lobe. She had complained of headache since March, 1969; in December of that year she developed severe defects of speech, writing and calculation. Neurological examination showed marked hemiparesis, hyperreflexia, and loss of optokinetic nystagmus, all on the right side. Roentgenograms of the skull showed displacement of the pineal gland to the right. Left-sided carotid angiography showed displacement of the anterior cerebral artery to the right and the left middle cerebral artery upward and medially. A network of pathological blood vessels of a tumor was found in the left posterior temporal zones. At operation a tumor was found in the left temporal region, at a depth of 1 . 2 - 2 cm, affecting the posterior temporal and parietal zones. After removal of the tumor the exposed bed measured 6 χ 7 χ 6 cm. The tumor was directly related to the wall of the posterior horn of the left lateral ventricle. Subsequently the patient underwent two further operations as a result of continued growth of the tumor. She was fully oriented, communicative, emotionally alert, and acutely aware of her illness. Her praxis and gnosis were intact and the main feature of the clinical picture was the severe disturbance of speech. The patient could understand speech addressed to her relatively well, her phonemic hearing was intact, and only if the material presented was considerable in volume (syllables, words, or complete sentences) was there some instability of the phonemes or difficulty in the direct understanding of speech, accompanied by very mild traces of alienation of the meaning of individual words, although this defect was easily compensated. The patient's spontaneous speech remained expanded and fluent, syntactically correct, and intonationally very rich and expressive. However, her basic defects, consisting of constant forgetting and unsuccessful seeking of words, paraphasia and, sometimes, ill-defined elements of perseveration, quickly came to light. An example of her spontaneous speech is given below. Tell me how you became ill. "I will tell you now ... I was not working ... no, I did not tell you properly ... I worked all the time and there ... I cannot tell you anything ... it was simply in my head ... it was in December ... no, I am mistaken! ... It was not in December ... and so you see - I have forgotten already, I have forgotten what it was ... anyhow, it was December, December 20 ... it was my birthday, and so ... I became ill. I went to work just the same, and they would not sign the sick-leave certificate ... I came - as if I had something wrong with my head ... when I arrived they did not discharge me as fit to work, and I simply did not sign on to work ... but really, you know, I am making all this up ... and so I came to the doctor, but they would not let me go. 'You are not ill ...' he said. Later, Mikhail Vasil'evich, my husband (paraphasia instead of "doctor"), you know, discharged me ... it was a working day ... the fourth in the month ... January 4 of the sixty-fourth year (paraphasia) ... that is right ... now I remember (paraphasia for "I forgot") it all... and so later I went to hospital, in Kuchino ... and then I came here ... I did not tell you properly, but it is all clear ... and that is all... and so I did not understand what had happened to me, where it had happened to my head ... I cannot remember anything ... didn't I tell you that? Well, in general that is all ... not ... I beg your pardon! Well, in general I simply feel that there is something ... I cannot quite tell you ... something is the matter with me, but what it is I don't understand ... Do you understand? ... Sometimes I have had a conversation with you ... You must understand what is the matter with me, but you do not understand that I am not telling the truth this time ... I ought to say something but I really say something else ... Do you understand? ... For that is everything!" The fluency of the patient's speech, on the basis of which the case is included in the group of "fluent aphasia," with difficulty in word seeking and numerous paraphasias, will be perfectly clear from this example. Categorial speech (reciting the natural series of numbers, days of the week, months

118 of the year) was not difficult, but the patient could not recite the series backward and instead always substituted the natural order; she was clearly aware of her difficulties and exclaimed "What a fool I am, that I cannot turn them round ..." The repetition of single sounds, words, and short sentences aroused no evident difficulty. Even pairs of oppositional phonemes were repeated correctly, evidence that her phonemic hearing was intact. She could repeat such difficult words as "korablekrushenie," (shipwreck) or expressions such as "stroitel'naya organizatsiya" (constructional organization) or "scrskokhozyaistvennyi kooperativ" (agricultural cooperative), or sentences such as "vypal glubokii sneg" (there was a heavy snowfall), "koshka poimala mysh' " (the cat caught a mouse) without the slightest difficulty. However, she began to have definite difficulty when, instead of repeating single elements or even pairs of syllables or words, she attempted to repeat longer series or to repeat verbal material from memory; the difficulty was increased still more when she attempted to find a necessary word or to name an object shown to her. In such cases she revealed instability of audioverbal traces, transposition of elements, and the easy forgetting of traces, accompanied by paraphasia. The simplest disturbance of the patient's audioverbal memory was the transposition of elements of an audioverbal series. She was asked to repeat the series of syllables: d a - r a - n a . She repeated: " n a - r a - n a ... no ... n a - r a - n a . . . no, not like that... when you ... recall me (in the sense of "tell" or "ask to recall") I recall something, you understand, not at once ... rather more slowly, step by step." Characteristically, if the same elements were given separately at first, and each one was repeated individually, followed by the series as a whole, the patient was able to repeat the complete system of syllables without difficulty. The same phenomenon was seen during repetition of a series of words. After easily repeating a pair of words she was quite unable to repeat a series of three unconnected words; she exhibited transposition of the words as well as literal and verbal paraphasia. In this case also, repetition of words separately enabled her to repeat the series as a whole later. Appropriate examples are given below. (Specimen)

igla (needle) - noch' (night) - pirog (pie)

(Repetition)

(1) igla - nog... piroch... (no ... I am telling a lie)... igla - nog - piroch ... popiro ... navrala... (2) igra (game) - nog (leg) - piroch... (no, not like that) and so on.

(Specimen)

sneg (snow) - les - (forest) - dym (smoke)

(Repetition)

(1) (I can't...) (2) les - sneg - dym... (3) les - sneg - dym

(Specimen)

sobaka (dog) - chainik (teapot) - zerkalo (mirror) (1) (I for... for... I can't...) (2) (I can't...) sobaka

chainik

zerkalo

sobaka

chainik

zerkalo

sobaka - chainik - zerkalo sobaka - chainik - zerkalo

119 Characteristically the repetition of a series of words " f r o m traces" was very difficult, especially if interfering activity of some sort was introduced between the immediate and delayed repetition. 5 An example illustrating this fact is given below. kot - igla - pirog

solntsc - ochki - papirosa

(1) kra... ( n o ) . . . krag... (no, not like that) (1) ochki - papirosa - solntse Repeat it in the proper order1. (2) klo... (I can't manage it) solntse - ochki - papirosa (3) klo... (no, that isn't the right word) kot

igla

pirog

kot

igla

pirog

kot - igla - pirog kot

igla

pirog!...

Repeat it once aRain (without further presentation of the specimen)

"Now, just a m o m e n t . . . no, I have said my piece (meaning "forgotten"), I am sorry ..."

(pause of 30 sec)

Repeat once morel klo... I know this is not right... you understand ... igla, pirog... and another word but I can't recall i t . . . slog, igla, pero... oh, I have forgotten

Solntse - ochki - papirosa Solntsc - ochki - papirosa Interference: What is 2 + 9? ... "2 ... add 3?..."

Now repeat the words I nave you "She turned me out into the street ... 1 did not speak like that ... I ought to have told you, but she turned me out ... Ulitsa (street), papirosa, ochki... something isn't quite right ... you must find it difficult with me!..." The instability of the audioverbal traces, so clearly apparent during the repetition of chains of separate syllables and words, also was a feature of the repetition of whole sentences; in this case, however, it was manifested only during repetition from traces, especially if the patient was tired. Appropriate examples are given below. Repeat: Mal'chik udaril sobaku (the boy hit the dog). "Mal'chik udaril sobaku ... (no, 1 should not have said t h a t . . . ) Mal'chik udaril sobaku..." Devochka p'et chai (the girl drinks tea). Devochka p'ct chai..." Once again· "Devochka p'et chai." Zimoi reka zamerzaet (in winter the river freezes). "Reko... rekoi... zim... zcmlya (the ground) zamerzaet (freezes) ..." Once again: Zimoi reka zemerzaet. "... Zimoi reka zamerzaet." (Pause). Repeat once again! "S... se... something is wrong somewhere ... I mean ... nachi... no, I can't find i t . . . Simoi... sim... sim... something is wrong somewhere ..." Zimoi reka zamerzaet. "Si... I can't do it properly today ... scgo ... sevoi... semoi... scgoi ... zemlya zamer zaetel... si... (I can't do it)..." Zimoi reka zamerzaet. "... (it doesn't seem right ... now, just a moment) ...sego...sigo... (1 can't do i t ) . . . "

120 Letom rastsvetayut derev'ya (in summer the trees are in blossom). "Letom rastsvetayut derev'ya." (Pause). Repeat it once again. "Ζ... I am doing this badly ... sigoi... si... I can't do it... what can it be, is it a?! ..." Letom rastsvetayut derev'ya. "Zivoi... scgodnya (today) ... letom zatsvetayut derev'ya (in summer the trees start to blossom)..." Repeat it once again! "Si... this must be some language ... only I don't understand how it goes ... s... I can't do anything ..." The same phenomenon occurred particularly clcarly if interference was introduced, by instructing the patient to recall the first of two sentences read to her: Letom rastsvetayut derev'ya. "Letom rastsvetayut derev'ya." Zimoi reka zamerzaet. "Rekoi... z... rekoi zemlya zamerzaet." What was the previous sentence? "It was something about ... summer ... we have ... you see what a fool I am ... I cannot tell you anything ..." Letom rastsvetayut derev'ya. "Letom ... you and I will see ... no, I am joking! Letom rastsvetayut derev'ya. "Letom rastsvetayut derev'ya ..." Zimoi reka zamerzaet. "Zi... here we are again ... when I start to deny, I cannot get what 1 need ..." Letom rastsvetayut derev'ya. "Letom rastsvetayut derev'ya." Zimoi reka zamerzaet. "Rekoi zemlya zamerzaet..." Repeat once again. "Le... lip... luk... no, not like that ... now ... lik... lunu... I can't do it ... if I had known what the other words had been I might have recalled it better ..." The facts show that whereas a sentence, as an organized entity, was repeated without any difficulty, attempts to repeat it "from traces" began to show definite signs o f replacement o f the necessary p h o n e m e s by oppositional phonemes (zima - "sim... sima..."), random acoustic and semantic associations ("sego... segodnya") or acoustic contamination (instead of "zimoi reka zamerzaet" - "Rekoi zemlya zamerzaet"), or, finally, semantic perseveration o f elements o f the previous sentence. These findings explain w h y the encoding o f an even more complex verbal expression - whether it be spontaneous speech or the narration of a complex text - was made extremely difficult b y the instability o f traces o f individual lexical elements and because, during attempts by the patient to relate the theme o f a text, any one o f a whole series o f random associations could spring up with equal probability. That is w h y such patients cannot produce a coherent narrative even though, by contrast with the cases o f "dynamic aphasia" or the "telegraphic style" described above, the syntagmatic structure o f coherent expression remains completely intact. Let us consider some examples. The story " T h e Hen and the Golden Eggs" was read to the patient and she was asked to repeat it. She said: "You see how I am ... now, doctor, look ... see what a fool I have become ... now I will tell you ... I tell a story badly ... well some eggs were found ... hens' eggs ... they thought that they were ordinary eggs ... well... now ... but he ... killed these eggs ... and it turned out that it was the same egg ... no, not like t h a t . . . " (The story is repeated). "Well now ... a man had a few eggs ... no, let me see ... they decided to find their own eggs and inside their egg ... they caught the eggs ... no, that isn't right, I can't do it."

121 (The story is again repeated). "Well now ... there were eggs... and they decidcd ... to take the eggs to pieces, so that all the eggs had ... no, that isn't right, it is difficult." What is the moral of the story? "Yes, of course! The moral must be that people ought to make sure that everything is in order, that nothing must ... of course I know what you want, but 1 can't give it." The disturbance of encoding of complex verbal communication was thus caused in this patient by the instability o f individual lexical traces; this phenomenon, so conspicuous during the repetition of series of words and syllables, was manifested particularly clearly during the "incarnation" of thought into coherent expression. Although the phenomena I have described were so persistent a feature when the patient was tested in the first stage of her illness, they disappeared almost completely after an operation to remove a deep intracerebral tumor of the middle zones of the left temporal region. Tests carried out three weeks after the operation showed that the patient could freely engage in conversation, repeat series of words directly or from traces, and repeat stories read to her: all that remained of the previous clinical picture was some instability of audioverbal traces (word seeking) and evidence of literal and verbal paraphasia, as a rule manifested only when she was tired. An extract from the records is given below for comparison with the picture described previously. Spontaneous Speech Tell me how your illness began. "I was working and I began to feel ill. The manager went away, I stayed - and suddenly I began to 'ramble,' as they say, excuse me. I no longer understood people. They brought me to hospital, I could not tell anything. 1 could speak only with my husband and son ... later they sent me from that hospital here - and it was here that N.S. and Professor F. looked after mc ... and now, after the operation, I have become a person again, now I can chat and talk to you, I can write ..." Repetition of series of three words was not difficult, and the order was maintained; she could recall the first scries of words after repeating a second series, and only occasionally exhibited paraphasia [zvon - igla - krest: "zvon - igla - krol' ... (no), krest ..." or sneg - noch' - shkaf: "sneg - nozh' - s h k a f ' l . A similar picture was revealed during the repetition of sentences. Having easily repeated the fiist sentence "Apple trees grew in the garden behind the high fence" she began to repeat another sentence " A hunter killed a wolf on the edge of the forest" as follows: "Behind the high ... I am telling a lie again ... dear me ... on the edge of the forest ... a hunter killed a bear ... no, it's wrong again ... on the edge of the fence ... a hunter killed a wolf! ..." Similar difficulties, but more severe, appeared during her attempt to recall the first sentence unaided, which she did as follows: "The first... now ... trees ... on the edge ... no ... I have confused it all, something wet, like a mouse ... on the edge of the for... no, that was the second one, I can remember that - this was a hunter, but the other ..." and so on. The narration of stories was considerably improved. For instance, she told the story "The Wolf and the Goat" as follows: "Now ... a wolf and this ... was it a sheep? or a what? Goat? Yes? The wolf and the sheep ... well the wolf saw the seheep ... no, not quite ... the wof saw the goat and noticed that she was well fed, and said: 'Why don't you come a little closer to this... to the water ... the grass is much better there to eat...'

122 I don't speak like that, do I? But she was wise and replied: 'Why should I go there? It is not so that I can eat, but because you want to eat me ...' " After the patient had successfully repeated another story "The Tortoise and the Eagle" without any prompting she easily repeated the first story. She was even able to recall the themes of stories read to her two or three days previously: she retained a complete understanding of the meaning and exhibited only a few features of instability of the traces of individual lexical elements.

I have described in some detail one typical case of a form of speech disorder that arises in patients with lesions of the middle zones of the left temporal region and with the condition that I describe as "acoustico-mnestic aphasia." As we have seen, the basic features of this form of encoding of verbal communication are the relative integrity of the phonemic level of the linguistic codes (similar phonemes are mixed only if the patient is tired), the complete integrity of the coherent, syntagmatically organized expression and, as the principal sympton - instability of audio-verbal traces, which is manifested particularly clearly during the repetition of series of words, long sentences, and complex semantic fragments. In the last case a double dissociation is clearly revealed: despite primary integrity of the syntagmatic organization of coherent verbal expression and ability to grasp and retain a general meaning, the patient exhibits gross instability of the traces of individual words and marked phenomena of literal and verbal paraphasia, the basic mechanism of which is equalization of the probability of recalling traces of similar acoustic or semantic content. Characteristically in speech disturbances of this type the instability of lexical traces is manifested equally in all parts of speech, just as frequently in the recalling of nouns as of verbs, and all these lexical defects occur despite the complete integrity of coherent speech. This dissociation between the intact syntagmatic organization of expression and the unstable lexical composition, which distinguishes this form of speech disorder from "dynamic aphasia" and the "telegraphic style," on the one hand, and from "afferent motor aphasia" and "acoustic, sensory aphasia" on the other hand, outlines the unique character of the "acousticomnestic" aphasias and it is undoubtedly of very great interest both to clinical neuropsychology and to linguistics. The complexity of this disorder is a considerable handicap to the construction of a fully adequate model of it; for that reason the scheme I give in Fig. 13 naturally is only a rough approximation and it is by no means perfect.

4. Disturbances of the Encoding of Verbal Communication in Patients with the "Fronto-TemporalSyndrome" In the course of my previous account I described two sharply different

123 b) Naming objects

a) Repetition of words

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Κ • d) Repetition of a whole expression Repetition

Specimen

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ι Fig. 13

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Disturbance of the generation of verbal communication mnestic aphasia

in patients with

acoustico-

pictures of the disturbance of encoding of verbal communication. In one type, such as is found in patients with lesions of the anterior speech zones and with massive lesions of the frontal lobes, the encoding of verbal expression was disturbed by pathological inertia of established verbal stereotypes, as a result of which the patient was unable to switch from one component (or structural element) of the expression to another; he continued to perseverate the first structural component (or in cases of "efferent motor aphasia" - a previous articulation) over and over again. In the second group of disturbances, typified by patients with lesions of the left temporal region and a picture of "acoustico-gnostic" (sensory) or "acoustico-mnestic" aphasia, the switching from one component (or structural element) to another was not particularly difficult, but the encoding of verbal communication was impaired either by a disturbance of the phonemic level of encoding of information or by instability of the audio-verbal traces of words, as a result of which different acoustic or lexical alternatives sprang up

124 w i t h equal p r o b a b i l i t y , t h u s resulting in literal and verbal paraphasia. T h e clinical picture o f t h e disturbances o f e n c o d i n g o f verbal e x p r e s s i o n w a s n o t , h o w e v e r , always so "pure". A m o n g these patients there is a n o t h e r group in w h o m b o t h s y s t e m s I have just discussed process.

frontal and temporal

-

are involved in the pathological

In such cases o f f r o n t o - t e m p o r a l l e s i o n s the t w o

corresponding

pictures are c o m b i n e d and the e x a m i n e r can see that the lexical e l e m e n t s s o o n begin t o be replaced b y o t h e r s and lose their selectivity: the c o m p o n e n t s ( o r structural e l e m e n t s ) that arise s i m u l t a n e o u s l y b e c o m e so inert that the patient is unable t o s w i t c h f r o m t h e m t o others; deprived o f their plasticity, t h e necessary c o m p o n e n t s o f the e x p r e s s i o n are replaced b y p a t h o l o g i c a l l y inert s t e r e o t y p e s . A special feature o f this picture, k n o w n in n e u r o p s y c h o l o g y as the " f r o n t o - t e m p o r a l s y n d r o m e , " is that because o f the instability o f t h e lexical values and the "alienation o f w o r d m e a n i n g , " the patient is unaware o f his mistakes and he therefore m a k e s n o a t t e m p t t o correct his paraphasia or his inert s t e r e o t y p e s . S u c h cases are relatively c o m m o n in patients w i t h brain t u m o r s or cerebrovascular disturbances. T o illustrate this " f r o n t o - t e m p o r a l s y n d r o m e " I shall give a typical example. Patient Neg., a man aged 46 years (Case No. 26143), a driver, was admitted to the Burdcnko Institute of Neurosurgery in February, 1959, in a serious condition with general adynamia and definite speech disorders. In November, 1958 he began to have headaches with nausea and vomiting and his eyesight and memory deteriorated; he began to forget the names of his close friends and relatives, he could not recall necessary words, and he gave up his job. In January, 1959, the following picture was found: he was apathetic and inhibited; slight paresis of the right facial nerve of central type was present; the reflexes were increased on the right side and pathological reflexes were present, also on the right. No disturbances of sensation were found. Examination of the optic fundus showed papilledema; the cerebrospinal fluid protein concentration was raised, pointing to the presence of a brain tumor. At the Institute of Neurosurgery, to which he was transferred, the patient was adynamic, tone was increased on the right side, and deep pathological reflexes were present. His speech was disturbed by defects of the understanding of spoken speech and by verbal perseveration; he was inadequately critical of his condition. The EEG showed a focus of pathological activity in the form of slow waves in the left fronto-temporal region. In February, 1959, at operation a large tumor with a cyst was found in the middle zones of the frontal lobe (anteriorly to the premotor area) at a depth of 4 cm; the cyst communicated with the cavity of the anterior horn of the left lateral ventricle and the tumor itself, growing from the subcortical area, occupied the superior, lateral, and part of the inferior wall of the cavity, reached to the base of the anterior zones of the left temporal region and spread toward the basal ganglia. The tumor (an angioreticuloma) was only partly removed; part of the tumor extending into the depth of the temporal region was left in situ. Neuropsychological tests carried out before the operation revealed the following picture. The patient was adynamic and insufficiently clearly oriented. He knew he was in hospital but could not say sufficiently clearly why he was there, what had happened, or what was his precise complaint.

125 He could not say when he was transferred to Moscow from Kishinev, but merely stated that he had been in Moscow "from the age of 18". Having stated that he was born in 1912, he went on to say that he was 35 years old, and then tried to add 36 and 16; he gave the date of the test incorrectly and exclaimed: "No ... I get so mixed up with everything ..." In his answers to questions he constantly exhibited perseveration: when, for example, after writing the word "window" in response to the examiner's instruction, he was asked from where he had come, he answered "from the window," completely unaware of his mistake. Investigation of the patient's speech gave the following results. Spontaneous speech was very sluggish and inactive. Spontaneous expanded expression was almost completely absent and all that could be obtained from him was dialogic speech, loaded with perseveration. His phonemic hearing was intact and he could easily repeat pairs of oppositional phonemes; however, he immediately slipped from the repetition of meaningless syllables to the repetition of meaningful words: he would repeat the syllables " p a - b a " as "palka" (stick) what is it? ..." The repetition of separate words caused him no difficulty and he could easily switch from one word to another. Significant difficulties arose during the repetition of series of words: having once made a mistake - for example, having altered the order of the words in the series, - he continued to repeat this mistake even though he was told about it. Similar pathological inertia was revealed when the patient, having repeated a series of words, was instructed to repeat a series of numbers: in so doing he often began to intermingle the words of the previous series and made no attempt at correction. An example of this sort is given below: Repetition of words : dom - stol - kot - les

Repetition of numbers : Repeat: 3 - 0 - 9 - 8 - 2

1) dom - kot - stol - les 2) dom - kot - stol - les

1) 2) 3) 4)

The order is wrong, pay attention 3) dom - stol - kot - les 4) dom - stol - kot - les , and so on.

3 3 3 9

-

9 9 9 2

- 0 - 9 - 9 - 9 -les - lebed' - stol... - lebed' - dom ... - 9 - lebed' - stol, and so on

The same phenomena of pathological inertia appeared in the patient when he repeated sentences; the paraphasia characteristic of the "temporal syndrome" was a feature of his repetition of sentences, but he was unaware of it and therefore made no attempt to correct his mistakes. Repeat:

Apple trees grew in the garden behind the high fence "Apple trees grew in the garden behind a high robot"

A hunter killed a wolf on the edge of the forest 1) Wolves ... at the edge of the forest ... no, once again please 2) An "okushik" (he means okhotnik) killed a wolf at the edge of the forest What is an "okushik'"]

"I'm afraid I don't know ..."

The lexical contaminations of "robot" (from "zabor" = fence and "rosli" = grew) or "okushik" (from "opuski" = edge and "okhotnik" = hunter), which the patient omitted with complete unconcern, and which he made no attempt to correct, are typical of the "fronto-temporal syndrome" and, as a rule, they are not found in patients with isolated lesions of either the frontal or the temporal zones of the brain.

126 The same phenomena of pathological inertia, accompanicd by "alienation of word meaning," also appeared during the naming of objects. The patient had no difficulty in naming isolated objects, during which he exhibited no trace of pathological inertia; however, when asked to name pairs of objects this pathological inertia was very conspicuous and the patient could make very little attempt to correct his mistakes. An extract from the relevant record is given below (the pictures shown are named above the line in parentheses; the patient's verbal reply is given below the line). Naming single objects : (tabic) (thermometer) "table"

"thermometer"

Naming pairs of objects ·. (beetle - goose) (zhuk - gus') "rak (crab) ... and raketa (rocket) ... and ... gus'ki (goslings) ..."

(tumbler)

(spade)

"tumbler"

"spade"

and so on.

(fork - cock) (vilka - petukh)

(poppy - clock) (mak - chasy)

"gus'ka (gosling) ... and vilka (fork)"

"chasy (clock) ... and ... raketa (rocket) .. that is chasy ... (clock)... and I am mixed up"

The same phenomenon was seen during drawing in response to dictated instructions. For instance, when he was told to draw a triangle (treugol'nik) he took the pencil and started to write; "Uvazhaemyi" (Dear - as at the beginning of a letter); when the instruction to draw a triangle was repeated he wrote: "Uvazhaemyi umyval'nik" (from "uvazhaemyi" and "treugol'nik"; literally, "dear washstand"). Further attempts to write words from dictation were disturbed by severe perseveration: having written the word "sobaka" (dog) as "sababova," when instructed to write the word "koshka" (cat) he began to write "sa..." and then "sobaka." The same defects appeared in other tests: when, after a test of writing, he was asked to draw a quadrilateral he write " 4 " and repeated the same number " 4 " when instructed to draw a "cross" and a "circle", without any attempt at correction. Because this pathological inertia was so severe, if after a writing test he was asked to copy shapes, he continued to write the same letters over and over again. Write "sobaka"

"koshka"

Draw a triangle

"sababova"

"sa..." "sobaka"

"Ivanaevsha

Reading tests gave similar results. At first the patient could easily read numbers but his correct reading quickly gave way to inert stereotypes, with the result that typical "paralexia of inertia" appeared; sometimes he perseverated actual symbols, sometimes he exhibited "inertia of systems." Examples of these tests are given below (the specimen given to him in writing is shown above the line and what he actually read is shown below the line). 24

64

108

" 2 4 " " 6 2 " (perseveration of"2"

219

" 4 0 1 " (perseveration of"4")

" 4 1 9 " (perseveration of"4")

214

noch' (night)

most (bridge)

okno (window)

kot (cap)

"214"

"401"

"400"

"four noughts"

"three noughts" and so on

127 These phenomena of pathological inertia still persisted even after the operation; six weeks after the operation the patient still produced inert stereotypes instead of correct answers. Having answered the question "What year is it? by saying "the 60th ..., no ... 51st year ..." he went on to answer the question "What time is it? by saying "the first year." Having correctly named a pair of picture cards "elephant and cup," when shown another pair of cards (a "cap"and "bucket") he still said: "this is an elephant and this a cup," unable to overcome the established inert stereotype. These disturbances continued for two months and regressed only very slightly.

This patient was discharged f r o m the Institute of Neurosurgery but was re-admitted one year later in a serious condition, very depressed, with marked inertia and more severe speech disturbances of the same type, so that communication with him was impossible. He died on 15 January, 1960. At autopsy a large brain t u m o r (an angioreticuloma with a cyst) was f o u n d t o occupy nearly the whole of the left temporal lobe, it spread to the frontal lobe and obliterated the anterior horn of the left lateral ventricle and occupied the caudate nucleus and the centrum semiovale. The pattern of speech disturbances observed in this case, including t w o clearly demarcated factors - instability of verbal traces and pathological inertia of established stereotypes - is sufficiently clear and requires n o special comment.

5. Disturbance of the Encoding of Verbal Communication in Patients with "Semantic"Aphasia So far we have examined disturbances of the encoding of expression in which the defect either was directly located at the level of the articulatory-phonemic organization of the speech process or was reflected secondarily at t h a t level. This was shown by the fact that in all the patients w h o m I have described in the last few sections of the book some degree of searching for the acoustic composition of a necessary word and the literal paraphasias accompanying this process were encountered. However, there are other forms of disturbance of encoding of expression in which the fluent syntagmatic organization of speech remains intact but n o searching for the acoustic composition of words takes place; consequently, the articulatory-phonemic level remains intact. Essential disturbances of encoding of expression this time are manifested as the forgetting of words ("amnestic aphasia"), on the one hand, and difficulties in the understanding and formulation of complex logical-grammatical relations ( " s e m a n t i c aphasia"), on the other hand. A characteristic feature of these cases, observable particularly clearly in patients with lesions of the tertiary parieto-occipital (or inferior parietal) zones of the cortex of the left hemisphere, is that disturbances of acquisition and use of linguistic codes are located at a different, higher level: at the semantic rather than the phonemic level.

128

It is well known that a word that denotes a particular object, or a system of words used to express the "communication of relations" (Svedelius, 1897), is not just a system of acoustic signals organized in accordance with the phonemic rules of language. A word, and still more a combination of words expressing a relationship, has a semantic aspect, the organization of which is even more complex than the organization of its acoustic aspect. I have already discussed this semantic organization of language in the first chapter and I shall therefore give only a very brief resume of its most important aspects here. As a rule words denote particular objects (features, actions, or relations) or, in other words, they have a particular object relationship. Consequently, a word must first be related to a certain form, or in other words it must have a certain sensory (visuo-tactile) basis. On the other hand, the semantic structure of a word is not limited to the relation of that word to a certain object or form; as I have already said, the word analyzes the object, places it in a particular system of relations, relates it to a certain category. For example, the word "clock" places the object it denotes in the category of objects for measuring time, and it applies to all objects possessing this function regardless of their type, shape, or size. The word "inkstand" not only stands for a particular thing, but it distinguishes its relation to objects of a certain color, used as instruments, and acting as containers (see page 146). Vygotskii (1934) called the whole of this complex organization the "meaning" of the word and studied the stages of its ontogenetic development. The semantic organization of a system of words or word-combinations and, in particular, of a word-combination expressing a relation, is more complex still. As well as the typical syntagmatic forms of organization of word-combinations expressing the "communication of events" (the house burns, the dog barks, the boy drinks tea) there is another group of combinations expressing the "communication of relations" (the father's brother, a cross under a circle), which are components of a paradigmatic system. Some of these forms of word-combinations have yet another important characteristic — they are syntactically reversible, but this reversibility alters their meaning. For example, "brat ottsa" (the father's brother) differs in meaning from "otets brata" (the brother's father), and "krest pod krugom" ( a cross under a circle) has a different meaning from "krug pod krestom" (a circle under a cross). The whole of this paradigmatic organization of the meaning of words and word-combinations (which I shall discuss again below) forms the complex semantic (or logical-grammatical) level of the system of linguistic codes. The acquisition and use of these structures of language naturally have their own psychological characteristics.

129 They assume the possibility to perceive clearly the object denoted by the word and to distinguish its essential features. Furthermore they assume the ability to relate this object and its features to other objects belonging to the same category. Finally, in the case of acquisition of whole word-combinations they assume the ability not only to analyze the meaning of each individual word (brother, father), but also to concentrate attention on the relations between the words or, t o express it differently, to convert the sequential units of information (words or forms) into a single, simultaneous system. If any one of these conditions is not observed, the acquisition and use of the semantic codes will be impaired. First, the person will be unable to distinguish the essential features of the object and this will create substantial difficulties in naming it, not f r o m the standpoint of the acoustic organization of the word, but from the standpoint of perceptual organization of the object. Second, the person will have considerable difficulty in recalling essential names or, in other words, his difficulties in this case will arise not so much through instability or excessive inhibitability of audio-verbal traces as through difficulty in distinguishing the essential systems of connections into which the word meaning fits. Finally, such a patient must have great difficulty in b o t h acquiring and using complex word-combinations expressing relations; although the syntagmatic organization of his expression remains intact, the operations with complex paradigmatically organized word-combinations will inevitable be impaired or, perhaps, totally impossible. I have described a syndrome of disturbance of the encoding of verbal expression that differs significantly f r o m all those described above. This syndrome arises in patients with lesions of the tertiary zones of the cortex of the left hemisphere and is usually known as "semantic aphasia." I have described it often elsewhere (Luria, 1947, 1962, 1966, 1970, 1972, 1973) and I shall therefore simply recall its basic mechanisms and state briefly the reasons why I associate it with a lesion of the parieto-occipital zones of the cortex. The tertiary, parieto-occipital zones of the cortex, intimately connected with the visual and tactile as well as the auditory cortex, particularly complex in structure and strongly developed only in man, provide not only for the synthesis of information arriving through the various sensory systems, but also for the conversion of successively received elements of information into simultaneous, quasi-spatial schemes. In the normal state of the cortex these particular features preserve the selective meaning of words, by distinguishing their important associations f r o m all the rest; in this way the subject can easily recall a name he has just heard, he can name an object himself and, finally, he can use the logicalgrammatical codes that express relations between the corresponding objects.

130 The situation is different in patients in whom these cortical zones are in a pathological state. In such patients as I have mentioned elsewhere, the basic law of cortical activity - the "law of strength" whereby powerful (or important) stimuli (or their traces) evoke a strong response, but weak (or unimportant) stimuli (or their traces) evoke a weak response, - is disturbed. Normal cortical activity is replaced by an inhibitory (or phasic) state in which strong stimuli (or their traces) start to evoke a response that is no stronger than that to weak stimuli, every trace begins to be recalled with the same probability, and for that reason the extremely high selectivity necessary for the normal functioning of the semantic level is disturbed. Unimportant features start to be recalled just as probably as important features; essential traces are no more likely to appear than irrelevant traces connected somehow with them, so that the process of naming objects or recalling necessary words is inevitably disturbed, but for quite different reasons this time from those responsible in "dynamic," "afferent m o t o r " or "sensory" aphasias. That is why the disturbance of the semantic level of speech organization, on account of which the syndrome arising in such cases has been called "semantic aphasia," leads at the same time to a disturbance of the naming of objects and the recalling of names or, in other words, to the picture known in clinical medicine as "amnestic aphasia," although the mechanisms in this case are quite different from those of the disturbance of naming objects and recalling names arising in patients with "efferent m o t o r " or "sensory" aphasia. Let us now analyze the disturbances of encoding of verbal communication found in patients with lesions of the parieto-occipital zones of the cortex of the left hemisphere. As I have already pointed out, lesions of these zones led to the appearance of two closely connected disturbances at the same time. First, lesions of these zones, directly adjoining the secondary zones of the occipital (visual) cortex, may disturb the complex process of analysis and synthesis of visual information, may interfere with the identification of its essential features and may prevent its precise distinction from other similar objects; mild symptons of optical agnosia are thus one component of the picture observed in such patients. Second, and this is particularly important, a lesion of the parieto-occipital zones of the cortex of the left hemisphere (the tertiary gnostic area) inevitably leads to a distinctive and very significant disorder; as Head (1926) pointed out originally, it is because of these lesions that the process converting consecutively received stimuli into simultaneously perceived syntheses is substantially disturbed so that the patient can no longer carry out this conversion, the basis for simultaneous spatial synthesis. As a result of this defect not only is orientation in space impossible, but all operations requiring

131 internal, quasi-spatial syntheses, and in particular, speech operations incorporating logical-grammatical relations, are disturbed. Inability to perceive immediately the significance of such "reversible" structures as "father's brother" or "brother's father," "square above circle" and "circle above square," a characteristic feature of these patients, is sufficiently well known; it will engage our attention again below when we consider disturbances of the decoding of verbal communications in patients with local brain lesions. The two phenomena I have just mentioned give rise, first, to massive disturbances of the understanding (decoding) of complex forms of verbal communication which I shall examine again below. At the same time, however, they also lead to serious difficulties in the encoding of expression. On the one hand, they cause definite disturbances of the nominative function of speech (the naming of objects); on the other hand, they give rise to equally clear disturbances of operations requiring the presence of simultaneously visualized structures and, in particular, of the operations with grammatical structures I have just mentioned. Both these disturbances interfere so seriously with the process of encoding of expression that I must make a special examination of them. I stated above that the naming of objects is by no means a simple association of an acoustic complex (word) with the form of the object to be named, but that the process requires, as an essential component, the recognition of the dominant feature of the object and its separation from all unimportant features. It is precisely this process that is disturbed in patients with lesions of the left parieto-occipital region of the cortex. As the work of Tsvetkova (1972), to which I have already drawn attention, showed these patients are very often unable to distinguish the dominant feature of an object, to complete a drawing they have begun by adding the characteristic features of the object, and to distinguish between stylized drawings of two similar objects, and so to place the object drawn into one of two categories. As a result of this defect the perceptual basis of naming an object is imperfect and imprecise, and this may prove a serious obstacle to the discovery of the exact name. On the other hand, the pathological state of the cortex in this region, which gives rise to the phenomena of "equalization of excitability" of different associations, creates an additional obstacle to the automatic evocation of the necessary names and induces the simultaneous appearance of many alternatives, all with equal probability. As a result of these factors (which are closely interconnected) patients with lesions of the parietooccipital zones of the cortex develop the syndrome of amnestic aphasia, the central feature of which is a disturbance of the process of searching for necessary names, or in other words, the characteristic phenomena of "nominative aphasia." These patients fully retain both the motives and the underlying semantic

132 scheme of expression; however, as soon as they try to embody this scheme in expanded speech they encounter insuperable obstacles, or they cannot immediately find the word they need to describe individual objects and they start to search helplessly among a vast number of alternatives. An essential feature of these attempts is that the syntagmatic organization of the speech process in these cases is better preserved than it was in the patients with temporal aphasia I described above; that is why patients in whom the paradigmatic system of language is disturbed very often try to get around these defects by resorting to habitual sentence constructions, using residual syntactic structures, and attempting to incorporate the word they seek into the necessary context by including it in their everyday speech, which still remains fluent. Such paraphrases as "Well no ... this... how shall I say ... for combing ... my hair ... no ... well now ... barber ... no" occupy the whole of their speech and make the fluent production of expression impossible. Unlike patients with lesions of the temporal system (or with sensory aphasia), or unlike patients with lesions of the inferior zones of the postcentral region (and with afferent, kinesthetic motor aphasia), the patients of this group either produce few or no acoustic substitutions (literal paraphasias), whereas semantic substitutions of desired words (verbal paraphasias) and attempts to find a wanted word by resorting to the context of a whole sentence ("... well ... how do I say ... I comb my hair ... aha! ... with a comb!") are very numerous. Characteristically, unlike in patients with lesions of the anterior speech zones and a disturbance of the predicative structure of speech, the use of words in the nominative case not only does not dominate the picture, but recedes into the background and words in indirect cases, part of the still intact syntactic construction, assume the dominant place. Finally, another characteristic feature that distinguishes these patients from those with sensory aphasia is that even gentle prompting with the first sound of the required word (which does not help at all a patient whose acoustic structure of words is disturbed) leads to the instant recalling of an apparently lost word. It distinguishes the required structure from others that are otherwise equally probable, makes the required word dominant, and thus creates the conditions for instant choice of the necessary word and for decision taking. The second factor disturbing the encoding of expression in the patients of this group is the disintegration of simultaneous syntheses, leading to considerable difficulty in operations with complex logical-grammatical relations. This aspect of the syndrome is so important that it deserves special discussion. As I have repeatedly stated above, workers in the field of psycholinguistics know well that all verbal constructions can be divided into two groups: in one group contextual (syntagmatic) constructions predominate; in the other group the process of incorporation of the object to be described into a system of relations (paradigmatic constructions) predominates. As was pointed out

133 some time ago by that eminent linguist Jakobson (1964, 1970, 1971), these two groups of verbal constructions can be affected separately by lesions in different parts of the brain. A lesion of the anterior speech zones upsets syntagmatic constructions and leads to severe disturbances of fluent speech whereas the paradigmatic constructions remain intact; conversely, a lesion of the posterior speech zones leaves fluent speech intact and disturbs complex paradigmatic constructions. This feature of local lesions provides as invaluable opportunity for separating the two basic factors in the encoding of expression and it leads to a unique syndrome in which this process is disturbed by a lesion of the parietooccipital zones of the cortex. As a rule, as I have already stated, all the contextual forms of fluent speech remain intact in these patients whereas complex logical-grammatical constructions, incorporating the "communication of relations" and resting on the integrity of logical-grammatical structures, with which these relations are expressed, are profoundly disturbed. This unique situation also has the result that although the patients of this group retain the general thought of communication, they have to resort with increasing frequency to primary and well-preserved contextual forms, and they begin to experience insuperable difficulties whenever they are forced to express a certain system of logical-grammatical relations in words. Because of this series of defects the repetition of words and short sentences by these patients remains relatively intact, whereas the repetition of complex sentences, incorporating intricate logical-grammatical relations may give rise to appreciable difficulties, so that the required logical-grammatical construction cannot be found and the grammatical structure of the sentence is of necessity simplified. These patients have great difficulty in naming objects and their performance is marked by many active searches and by verbal paraphasias. Instead of uttering a necessary word, the patients of this group are just as likely to utter irrelevant words related to it by some semantic feature, and their difficulties are considerable if they are instructed to name a given object or to recall a word. In such cases they will helplessly seek for the word they want and replace it by others of similar meaning, or by words that denote an object occurring in the same situation; alternatively, as already stated, they may resort to an intact contextual expression and incorporate the desired word into habitual fluent speech. On the other hand, the expanded speech of these patients clearly tends to avoid formulations expressing complex logical-grammatical relations and to replace them by simpler "para-tactic" (by contrast with "hypo-tactic") grammatical forms or well-consolidated phraseological formations of habitual speech. Perhaps one of the best examples is a patient with a wound of the left parietooccipital region whom I have studied for more than 25 years and

134 w h o m I described in my book (Luria, 1971), published in English as "The Man With a Shattered World" (Luria, 1973). This patient, suffering from a massive syndrome of amnestic and semantic aphasia, retained his contextual speech completely intact, but throughout the whole long period of my observation he was unable to operate directly with complex logical-grammatical relations. Although this very severe defect did not prevent him, during this 25 years o f observation, from writing his autobiography and the history of his illness, covering 3 , 0 0 0 pages of text, nevertheless, in the whole of these 3 , 0 0 0 pages, consisting o f a full and detailed description of events, not a single construction involving complex logical-grammatical relations can be found. T o illustrate these statements I give below the results of an investigation o f the difficulties experienced by this patient in the encoding of verbal expression. Patient Zas., a student at a higher technical institute, received a perforating splinter wound at the age of 23 years with the point of entry in the left parietooccipital region and of exit in the right parietooccipital region, which was subsequently complicated by inflammation. After a long period of unconsciousness he developed severe optical agnosia and alexia, with visuo-spatial disorders, disturbances of the body schema, and aphasia. Gradually these phenomena regressed and he was left with persistent semantic aphasia, with difficulty of word seeking and spatial disorders. This patient has been carefully studied for 28 years and has undergone several courses of rehabilitative training. The data given below relate-to observations made recently (1969-1972). The patient is completely rational, fully oriented in place and time, and emotionally stable; in recent years he has lived with his family, looks after himself, and is writing the story of his life, to which he devotes a considerable amount of time; his attitude to people around him is friendly and he has a realistic assessment of his own condition. He complains that words will not immediately come into his head, that he does not at once understand what is said to him, and that in general he does not understand certain grammatical structures incorporating complex relations and he is forced to resort to round-about methods. As previously, he still has difficulty in understanding spatial relations, he reads with difficulty, but his writing (including acoustic analysis and kinesthetics of writing) is fully intact. He has appreciable difficulty in calculating. His speech is suffuciently expressive and its prosodic and syntactic structure remains intact, although he is embarrassed by a constant search for necessary words. He relates the story of his wounding as follows: "We went into attack ... our company was separate ... that is ... what do they call them ... a light infantry detachment... we had to cross a stream ... I don't know how ... this comrade said ... now we went into attack ... I split them up into four groups of forty men each ... now they went, I mean ... over ... our ... my platoon ... and our ... over... there were the Germans ... then I saw ... the sun ... I must have fainted ... there was no more firing ... and then I remember ... I... I suddenly felt myself in the river ..." and so on. The repetition of sounds, syllables (even complex), and series of words and sentences presented no difficulty. Only when required to repeat long sentences he sometimes resorted to verbal substitutions (for instance, in the sentence "Apple trees grew in the garden behind the high fence," instead of "grew" he would sometimes say "flew" or "hung"). He found naming objects very difficult. Only rarely could he name an object or picture at once; usually he started to seek for the required word but would replace it by others of equivalent meaning or (less frequently) equivalent acoustic composition, or (most commonly of all) he would rcplace it by the name of an action or try to in-

135 elude it in some familiar syntactic context that remained intact. Prompting always helped the patient to find a word. A few examples are given below. (sofa: divan)

(strap: remen')

(fur coat: shuba)

It is ... a soft sofa

... well ... stitching to, tying t o , . . . there ... scissors (points to a buckle)

I can't remember this to-day ... i t . . . it isn't an overcoat ... sh... shuba!

(cherry: vishnya)

(cupboard: shkaf)

(book: kniga)

It grows in the garden ... I don't know what it is ...

They put overcoats in them ... and also underwear ... do you mean komod (chest of drawers)? Perhaps " k o m o d " , but this is not komod ... sideboard ... no, not sideboard ... table ... no, not table ...

Now this ... to study ... t e x t . . . a school exercise ... perhaps ... book

(vest: maika)

(skis: lyzhi)

(skipping rope: skakalka)

Well... like ... this ... shorts ... no ... not shirt... which ... it has no sleeves.

Well... this ... we go skiing ... these ... must be ... skis!

Well with they rope

this ... jumps ... these ... what are called ... skipping ...

Similar difficulties arose during the naming of pairs of objects (no fresh difficulties, however, were created by this test). (pero - pis'mo: pen - letter)

(yabloko - ogurets: apple -

cucumber)

This is ... school... and here ... I write and send ... and a pen ... no ... here ... no ... it is difficult

In a garden ... pear... no, apple ... and the other ... apple ... that is ... no ... yab ... no ... ogorod (kitchen garden)... no ...

The difficulty of naming objects in this case thus was based not on perseveration or difficulty of acoustic analysis, but on inability to find the necessary names, the equal likelihood of uttering any of several different alternatives and an overwhelming tendency to resort to contextual fragments (adjective + noun, name of an action, and so on). Only sometimes were examples of artificial etymologization found, with the formation of neologisms (in the example given above, he invented the word "poprigushka" for skipping rope instead of "skakalka," by utilizing a different verb meaning " t o j u m p " ) . Naturally the description of objects (permitting free incorporation of contextual, predicative expressions) was much easier for this patient than naming them. For example, he was shown a picture of a candle and asked to describe it. He did so as follows: "Of course ... a thing that is used for heating a room ... I mean for lighting a room ... it is made first ... there is a metal base above which ... I mean ... it is a thing that can be used to heat ... you light it with a match and it burns ... before this they had shavings, but then this was invented ... and later ... later a lamp ... but before now they used a candle ..." Statistically, some increase in the number of verbs and, in particular, the number of auxiliary words was found in this patient's speech (substantives 16%, verbs 10%, adject-

136 ives 1.5% , accessory and other undenominational words 72.5%; however, these statistics are not particulary demonstrative, for when the patient had difficulty in finding a desired substantive he readily replaced it by another equivalent substantive, which he uttered with equal probability. It is a much more instructive fact that although the patient required ten minutes to name 25 pictures of objects, he could name 25 actions in 2.5 minutes; when asked to name as many objects as possible that he could think of in a given time, his average for four tests was 13.5, whereas under the same conditions he could name 15 actions. Clearly, therefore, whenever he had to tell a story or describe a picture, this patient had great difficulty as a result of inability to find necessary words; his coherent speech hardly ever contained syntactic structures expressing complex (especially spatial and logical-grammatical) relations. We have already seen this in the patient's attempts to describe his wounding; it was also repeated in his description of pictures. l or example, when he was asked to tell the story represented by the picture "Bad Marks Again" he said: "Well ... evidently ... here there is ... this boy ... there ... his mother ... of course he was a pupil at this... evidently he has a school ... that do they call it ... this ... from i t . . . you know ... ex... no ... ex..." Do you mean satchel! "... satchel ... and evidently or he must have failed ... or because of ... his bad behavior ... or he ... not this ... what is it called ... not his bad behavior... he did not learn his lessons ... and so they gave him ... this ... what do you say ... these very low marks."

All this shows that the process of selection of necessary words, on the one hand, and the formulation of complex paradigmatic constructions, on the other hand, are the main obstacles preventing encoding of verbal communication in this case. The defects of encoding observed can be represented conventionally by the scheme given in Fig. 14.

C. CONCLUSION

We have completed our survey of the available material and can now draw the main conclusions. As we saw at the beginning of our analysis the process of encoding of verbal communication comprises two basic aspects. Verbal communication is always incorporated into a flow of coherent speech in which a person, having definite motives, embodies his thought. Speech has a definite syntagmatic structure; its formation goes through a series of stages starting from the original plan, continuing through the predicatively constructed "internal speech," and creating first, the semantic record, then the deep-syntax structure of expression and, finally, its surfacesyntax structure. Meanwhile there is another aspect of the formation and organization of expression, for they always use a certain system of linguistic code units, which has evolved in the course of history and which, in turn, has a complex paradigmatic structure. This paradigmatic structure of linguistic codes embraces a series of levels. The most significant fact is that these two chief aspects of the encoding

137 Repetitive speech Repetition of a series of words

Repetition of a word

1/

Naming objects

D-O-D

l? ι Jx / !• ν. < / ι \

'

ι

-I-

·>

\^

χ

: \

?

·>

Repetition of a whole expression

Λ -"Λ NP

VP

A

- - NP — 7

'

'I

VP

\\

A /rΛ

N P — VP

1

NP Fig. 14

Disturbance of the generation of verbal communication

NP

in patients with semantic aphasia

of expressing differ in their relation to different brain structures and may be disturbed separately by lesions of different parts of the brain. This statement does not in the least mean that we would wish to "localize" the complex structure of language in certain circumscribed areas of the brain or that we would adopt the ideas of "narrow localizationism." The very idea that the complex phenomena of language could be directly localized in circumscribed areas of the cerebral cortex is one that is deeply alien to us and, as history shows, one that can lead only into a blind alley. Our basic assumptions were that the encoding of verbal communication, connected with the acquisition and use of the codes of language, incorporates a series of psychophysiological factors (such as: "motives," original "schemes," the "serial organization of processes," the "conversion of successive information into simultaneous (quasi-spatial) visualized schemes" and so on), and that each of these factors operates with the aid of different, but corroborating systems of the cerebral cortex. That is why the removal of a particular zone of the cortex inactivates a particular factor and, as a result, affects the normal course of those forms of speech activity (or those forms of encoding of verbal communication) that depend to the greatest degree on the integrity of that factor.

138 The method o f n e u r o p s y c h o l o g y and of its i m p o r t a n t subdivision, neurolinguistics, is to analyze h o w the process of e n c o d i n g o f verbal communication is disturbed in patients with lesions of d i f f e r e n t parts o f the brain, and to determine the character of these disturbances and the aspects o f the formation o f expression that they a f f e c t . The results I have obtained by the use of this method alone, as applied to the analysis o f encoding o f verbal communication, have enabled me to distinguish t w o large groups o f speech disorders. In the first, connected with lesions of the anterior brain zones, the fluent, expanded, syntagmatically organized expression (in other words, the path from thought to fluent speech) is mainly affected, whether the ability to acquire and use the paradigmatic codes o f language remains relatively intact. In the second the opposite is the case: the ability to produce coherent, syntagmatically organized expression is potentially intact whereas the use o f paradigmatically organized linguistic codes (including the different levels) is disturbed. This happens in local lesions o f the posterior, modality-specific zones of the cerebral cortex (postcentral, temporal, and parieto-occipital zones o f the speech areas). By examining the different forms o f disturbances o f encoding o f verbal communication in lesions o f the anterior brain zones I was able to identify disturbances o f the different stages o f formation o f coherent expression. Massive lesions o f the prefrontal zones, accompanied by general inactivity o f the subject, disturb the system o f motives and make active expression impossible, although the whole speech apparatus o f expression (including the ability to produce "echolalic" repetitive speech and to create deep-syntax structures lying at the basis o f expression) remains potentially intact. By contrast, lesions o f the anterior speech zones (the posterior frontal and premotor zones o f the left hemisphere) lead t o completely different disturbances, affecting speech specifically. In some o f these cases coherent repetitive speech remains intact but, on account o f the disturbances o f "internal speech" and the formation o f "deepsyntax structures," the active creation o f what many authorities call the "linear scheme o f the sentence" becomes impossible and the patient is unable t o formulate expression spontaneously or to convert his thought into expanded speech. Such a disturbance leads to the picture o f dynamic aphasia, which I have described elsewhere. In other cases o f this group, evidently connected with lesions o f the inferior zones o f the premotor area, the disturbance o f encoding o f expression acquires a different and more specific character. The principal component affected in this case is the predicative structure o f expression, whereas its nominative c o m p o n e n t s remain intact. If the disturbance is severe it leads t o a "telegraphic style," in which the predicative structure o f coherent speech disintegrates and speech as a whole starts to consist o f nominative com-

139 ponents only. In less severe cases (or at certain stages of regression) the gross "telegraphic style" is replaced by a less marked form of agrammatism, in which the simplest forms of predicative organization of expression (simple structures of S - P or S—Ρ—Ο type) become possible, but more complex structures (for example, indefinitely personal sentences or complex subordinate clauses) and observation of the rules of government and concord are impaired. Finally, in the third group of cases we have the picture of efferent motor aphasia, with disturbance of the kinetic melody of words and pathological inertia. This last factor, in all probability connected with deep pathological foci in the anterior speech zones, is not itself a speech defect, but it aggravates the speech disturbance and leads to complete inability to produce coherent speech, which requires fluent switching from some elements of expression to others. These defects constitute the central feature of the form of motor aphasia usually known as Broca's aphasia. We do not yet fully understand the physiological mcchanisms that lead to all the disorders of coherent expression described above, but it is easy to see that the description of these forms is itself of great importance to the psychology of speech and, hence, to linguistics. Totally different forms of disturbance of the encoding of expression arise in patients with lesions of the posterior zones of the cortical speech area. In these cases the contextual, syntagmatic organization of fluent expression (which I have conventionally called the "path from thought to speech") remains primarily unaffected; however, the process of acquisition and use of paradigmatically constructed systems of linguistic codes, the second aspect just as necessary for the encoding of verbal expression, is significantly affected. The disturbance of ability to acquire and use the linguistic codes may be located at different levels and may assume different forms. In lesions of the inferior zones of the left postcentral cortex the system of kinesthetic afferentiation that lies at the basis of speech articulations is disturbed. The system of articulatory contrasts is thus disturbed, with the creation of a picture of afferent motor aphasia which, in the severest cases, prevents the patient from speaking at all (including repeating sounds and words and naming objects, which are affected to an equal degree), and in less severe cases is restricted to a disturbance of the system of contrasting of closely similar articulemes; this leads to replacement of articulemes with common features (for example, the labials " b " and " m " , the front-linguals " n " - " l " - " d " ) and differing from each other only in one particular aspect. In lesions of the posterior zones of the left superior temporal gyrus a different picture is seen: the primary disturbance in such cases is disintegration of complex "qualified hearing." The patients of this group are unable to distinguish the essential features of speech sounds or to differentiate between

140 phonemes - the basic units of spoken speech. In the severest cases of this sensory aphasia the differentiation of phonemes becomes totally impossible and the patient starts to perceive speech addressed to him as a flow of indistinguishable sounds; in milder cases the discrimination only of closely similar "oppositional" phonemes, differing in one differential feature, is disturbed (in Russian such a feature may be voicing and unvoicing, hardness and softness), and the patient start to confuse phonemes that were previously easy to differentiate. Despite all the differences between these two patterns of speech disturbances I have just described - one a disorder of motor speech, the other a disorder of sensory speech, they have two features in common. First, in both cases the primary disturbance of the ability to acquire and use the linguistic codes has a special, external character, it is located at the level of the phonemic (or, more precisely, the articulatory-phonemic) organization of spoken speech, and it is expressed as a large number of acoustic substitutions (literal paraphasias) in the speech of these patients. On the other hand, coherent contextual speech in both cases remains better preserved than the acquisition of the linguistic codes. This primary integrity of syntagmatically organized expression is masked in afferent motor aphasia by the breakdown of the articulatory " o u t p u t " of the speech process and is manifested only in the integrity of involuntary expressions and the patient's ability to acquire syntagmatically correctly constructed sentences quickly after being "presented" with the appropriate articulemes. In a patient with sensory aphasia this integrity of coherent, syntagmatically organized speech is seen more clearly and is manifested both as the integrity of the intonational-melodic structure of his speech (usually only distorted and fragmented words are available), and as a tendency to find necessary words by recourse to a habitual context, into which these words can be introduced ("Well this ... you see, you write with it" or "This ... how do you ... this spoon for pouring o u t " and so on). A special form of disturbance of the encoding of verbal expression is the so-called "acoustico-mnestic aphasia," arising in lesions of the middle zones of the left temporal region, which lead to instability of audio-verbal traces and to their ready inhibitability by interfering factors. The main defect arising in these cases is not specifically linguistic in character: it is connected with the instability of all auditory (including audioverbal) traces and the ease with which they are inhibited. However, this defect is sensitively reflected in the processes of encoding of verbal communication. The patients of this group can easily repeat single phonemes, words, and short sentences, they can easily name individual objects, but they start to have appreciable difficulty when they attempt to repeat series of words, for they transpose them or omit some. The same feature is seen during the repetition of long sentences and stories consisting of a series of components,

141 and it is reflected in the inability to repeat fully serially organized material, when these patients characteristically omit certain components. Naturally the same defect is also repeated in the spontaneous speech of this group of patients, which is marked by word-seeking, by verbal paraphasias, and by instability of the retention of individual components of complex expression with constant attempts to compensate for this defect by resorting to a habitual verbal context. Perhaps the most interesting disturbances of encoding of expression are those that arise in patients with lesions of the tertiary parieto-occipital cortical zones of the left hemisphere, with a picture of semantic aphasia. The articulatory-phonemic level of organization of spoken speech remains intact in these patients and all the disturbances are transferred to a higher semantic level of linguistic codes. A pathological state of these cortical zones may have two effects. First, because of the equalization of excitability of all (strong and weak, important and unimportant) impressions and traces, the diagnostic processes lose their selectivity, different associations are evoked with equal probability, and the process of finding a necessary name is substantially disturbed, resulting in a sympton of amnestic aphasia, but this time at a different (the semantic) level. The disturbance of the paradigmatic organization of word meanings is also manifested in these patients by the ease with which a desired word is replaced by other words having some semantic association with it (belonging to the same category, relating to the same situation), so that frequent verbal paraphasias (accompanied by relatively few literal paraphasias) are one of the commonest symptons of this type of speech disorder. Second, items of speech information reaching the subject successively are now no longer fitted into a simultaneously perceived, quasi-spatial scheme, as a result of which the paradigmatic organization of the system of meanings (requiring introducing the word into a certain network of categories) and systems of word-combinations expressing relations are significantly disturbed. The "reversible" constructions (such as "brat ottsa" - "otets brata": the father's brother - the brother's father) are particularly susceptible to this defect, and such patients are completely unable to use them. Characteristically these patients, who experience difficulties connected with the acquisition and use of paradigmatically organized semantic (logicalgrammatical systems, show a tendency to compensate for them by resorting to their intact syntagmatically organized contextual speech; these attempts to replace missing names of objects or disturbed operations expressing logicalgrammatical relations by introducing a word or word-combination into a habitual context ("Well, what is it ... this ... a sharp, table knife ..." or "What do they ... call ... this ... that dear old brother of my father ...") are typical examples of the circuitous methods used by these patients to overcome their difficulty with the paradigmatic organization of semantic codes.

142 I shall turn in more detail to all these phenomena in the next part of the book, where I deal with the neuropsychological analysis of the decoding of verbal communication, in which these phenomena occupy a central position. I have summarized the main facts discovered in the course of an analysis of the changes in the encoding of verbal expression that arise in patients with lesions of different parts of the brain. We have seen that this neurolinguistic method of analysis can provide much useful material for a closer study of the basic facts of the structure of speech activity. We have seen that lesions of different parts of the brain give rise to different disturbances of encoding of verbal communication; this provides psychology and linguistics with a new method of analysis of complex speech processes, a method that can break these processes down into their components and distinguish the factors that lie at the basis of speech activity. Analysis of the encoding of verbal communication, a process known in psychology as the conversion of expanded speech as received into thought, or as the understanding of speech. We have every reason to suppose that the neuropsychological analysis of this second aspect of verbal activity will also shed considerable light on the processes of speech understanding and that the results it will furnish will prove equally productive. Such an analysis will be the subject of the next section of this book.

NOTES 1. The latest research in this field was summarized in a special issue of Brain and Language, vol. 2, no. 1, 1975. 2. This syndrome is specially described in Part II, Chapter 3, "A Reexamination of Transcortical Motor Aphasia," and in Chapter 4 , "A Reexamination of Amnestic Aphasia." 3. The examples are given everywhere as fractions: the word presented is shown above the line and the word as repeated by the patient below the line. 4. These Russian words, differing only in the presence of a hard or soft consonant (1 or 1') or vowel (y or i) have a quite different meaning. 5. This phenomenon is fully described in the writer's book "The Neuropsychology of Memory". Vol. 1 (1973).

III NEUROPSYCHOLOGICAL ANALYSIS O F T H E DECODING O F V E R B A L COMMUNICATION

When we turn f r o m the analysis of formation (encoding) of expression to study the process of its understanding (decoding) we find a system of facts which in many respects is the opposite of that we have just examined in the previous section of the book. Whereas previously we traced the formation of communication f r o m thought to extended speech, we must now follow a path which leads from extended verbal communication to the understanding of its content, its general idea and, finally, the inner sense on which it is based.

1. THE PSYCHOLOGICAL PROCESS OF DECODING OF VERBAL COMMUNICATION

The understanding (decoding) of expression is possible under the three following conditions. First, the listener must receive and understand the separate words — the lexical units of speech. If the words are not received and understood the decoding of the expression is deprived of its basic material. The listener must then understand the structure of the whole sentence — the system composed of separate words; in other words, he must discover the meaning of the complete system of words by means of which a particular idea can be expressed. In the terms and concepts of modern linguistics the listener must discover the surface-syntax structure of the sentence and proceed f r o m it through the deep-syntax structure to the general meaning, or general semantic record of the sentence. Naturally if the listener understands the words included in a sentence but not their syntactic connections, his understanding of the communication will be incomplete and he will be forced to resort to guesses, not supported by the objective structure of the expression. Finally, after the separate sentences or elements of the whole expression have been understood, the process of decoding reaches its last stage - the understanding of the whole communication. Just as a sentence consists not only of separate words, but also the connections between them, i.e., it has its

144 own syntactic structure, the meaning of a whole expression will not be simply a combination of meanings of separate sentences; it will also include connections between individual sentences - components of the whole communication, and the listener will have to relate one sentence to another, to choose which of them is of key importance, to formulate the general idea of the expression, and sometimes to decipher the motive of the expression, ot its hidden meaning. The relationship between the "external" meaning of sentences in an expression and its underlying motivation or meaning, as we well know, is by no means always easy to find. For example, the question "What time is it?" may conceal the idea "It is already late, it is time to leave," and the sentence of Chatskii's, with which Griboedov ends his "Gore ot uma" (The Misfortune of Being Clever): "Bring me a carriage!" conceals the moral: "I am not fit for this society, I want to leave it, to abandon it." The change from the external meaning of the whole expression to its internal meaning and motivation is consequently very complex, and the "depth of reading" of the text, so familiar to students of literature and psychologists, may be very different. These are the stages of decoding of communication to which we must now turn and whose psychological analysis will be the subject of the subsequent pages. Whereas the first two stages — understanding the meaning of individual words and sentences - largely take place within the framework of linguistic rules - of phonetics and lexis, on the one hand, and of morphology and syntax, on the other hand, in our analysis of the understanding of the whole expression we go beyond the limits of linguistic problems and have to consider the psychology of verbal thinking or of conceptual activity as a whole. Let us now make a closer analysis of each of the above-mentioned stages of decoding of verbal communication, and deal successively with the psychological process of understanding the meaning of individual words, sentences, and the utterance as a whole. a. Understanding of Word Meaning At first glance it may seem that to perceive a word and understand its meaning all that is necessary is to have precise phonemic hearing (so that phonemes forming the word can be distinguished) and simple knowledge of the nominative values of the language. From this point of view inability to understand the meaning of a word can arise either if phonemic hearing is disturbed (ignorance of the phonemic system of the particular language) or in the absence of knowledge of the nominative values of the words received, being outside the subject's previous experience. However, such a representation is grossly inadequate. There are at least three considerations that can show the true complexity of what is apparently

145

such a simple process as the understanding of a single word. The concept of the homonymy (or multiple meaning) of perhaps every word of a language has long been held in linguistics. According to this view there are at least two principal types of differences between word meanings and, correspondingly, we must speak of two types of polysemy of words. First, there is the usual polysemy. The same word, as we know, may have several dictionary meanings. For instance, the Russian word "ruchka" may signify part of the body (a child's arm), a writing implement (a "pen"), or part of an object (the "arm" of a chair, the "handle" of a door) and so on. The same is true of many English words - for example, the word " g o " may mean in Russin "idti" (to go on foot), "ekhat' " (to go by transport), "nachinat' " (to begin), and so on. The first condition essential to the understanding of a communication is therefore identification of the concrete meaning of the word in the particular communication; this can be done only by taking into account the context in which the word is used (as has been done in a long series of recent studies in psycholinguistics). If the selection of the required word meaning from many possible alternatives does not take place, if one meaning of a word is too firmly fixed and can be replaced by another meaning only with great effort, the understanding of the communication will be seriously impeded. Perhaps the best example to illustrate this fact is the understanding of speech by the deaf and dumb. Investigations (see: Boskis, 1953, etc.) have shown that a deaf and dumb child, who learns to speak by being taught and not in the process of natural social contact, often learns one narrow meaning of a word without being aware of the many likely alternatives, whereby the meaning of a word varies with the context. For instance, the word "podnyat' " (raise, lift, pick up) may be firmly linked in such a person with the idea of "bending down and picking something up off the floor" (picking up a handkerchief, picking up a match); for that reason the expression "On podnyal ruku" (he raised his hand), in which the word "podnyat' " is used in a different sense, or still more the expression "u nego podnyalas' temperatura" (his temperature was raised - i.e., he had a fever), so obviously unlike this habitual idea, will often not be understood by the deaf and dumb person. The same is true of the word "ruchka," which the deaf and dumb child has been taught in its customary meaning of "a pen that you write with," but it will not be understood in the combination "ruchka devochki" (the little girl's hand), "ruchka kresla" (the arm of the chair), "ruchka dveri" (the door handle), and so on. Naturally, therefore, for a deaf and dumb person the task of learning a language is not simply learning a particular vocabulary, but rather learning a vocabulary made more difficult by the fact of polysemy and homonymy of words whose identification depends on the context.

146 Similar changes in the meaning of words or expressions, determined by context, or the "occasional" polysemy of words may be encountered in extended speech (see, for example, Chomsky, 1957, 1965; G. Miller, 1970; Garrett, 1972; Rubenstein, 1973, 1974, et al.), where such examples of ambiguity in the English language are given; for instance, the expression "flying planes" may be understood either as "piloting planes" or as "planes that are flying," and the expression "walking stick," usually understood as a stick to assist walking, may if introduced into the appropriate context, be understood as a stick which walks (Garrett, 1972). The second feature that distinguishes the polysemy of a word applies not to its direct designative function (its attachment to a particular object or, according to A.A. Potebnya, 1862, 1888, to the function of "pred - stavlenie" - = standing for standing before (replacing) an object), but to the general meaning represented by the word. This aspect of the semantic structure of words was studied in particular detail by Vygotskii in his classical book "Thought and Speech" (1934, English version 1962). According to Vygotskii, two aspects must be distinguished in a word: its "belonging to an object" (designative function of words) and the system of connections and generalizations represented by the word, for which Vygotskii proposed the term "znachenie" or connotation. Vygotskii's decisive contribution was to show that words belonging to the same object may have different connotations, and that this connotation of words develops in the successive stages of ontogeny. This is why indicating a particular object by no means exhausts the understanding of a word and when the speaker and listener relate a word to a certain object they may have in mind completely different systems of associations. The understanding of word meaning is therefore connected with a differential system of relations (or generalizations) represented by the word and the study of decoding of words which is not based on the analysis of the system of connotations evoked by the receiver will remain unproductive. Finally, there is a third factor without which the psychological analysis of word understanding would be incomplete; this aspect of semantic analysis of speech has been studied only in recent times, it forges a close link between the study of words and the study of syntax, and, at the same time, it constitutes a significant step forwards to the creation of a rational theory of semantics. Every word not merely stands for a particular object and for the characteristics of a particular system of associations. As I pointed out earlier in the first section of this book, a word has corresponding semantic-syntactic valencies or, to express it differently, it requires different forms of connections with other words. For instance, the word "tears" evokes only one connection: Who is shedding tears? the word "order" evokes at least three potential connections (Who orders whom to do what?); the verb " t o sleep"

147 must be combined with one other word (Who sleeps?), whereas the verb "to give" arouses the inevitable questions: "Who?", "what?", and "to whom?", and the verb "to lend" involves even more complex relations and evokes the following four connections: "Who?", "to whom?", "what?", and "for how long?". The reception of a word thus assumes not simply the perception of an object to which it refers (or its closest connotation) and the reflection of a system of semantic (concrete or abstract) connections concealed behind it; the reception of a word also assumes its reception as a unit of living speech and it is a process linked with excitation of its semantic-syntactic relations with other words. This last aspect of the problem, the dynamic aspect of word meaning, which brings us to the heart of the problem of syntax and, as we shall see below, is a vital component of the "language sense," has so far received very little study. Clearly, therefore, the understanding of words is not a simple process of recognizing their immediate meaning, but an active process of selection from many possible alternatives·, the process of selection takes place unequally at different levels of development of cognitive activity, it includes the potential connections of a given word with other words, and it thus leads directly to the problem of the internal laws of coherent, syntactically organized speech. Moverover, if a certain psychological condition essential for the complex activity that permits the understanding of the selective and labile meaning of words is disturbed, the process of word understanding will be substantially impaired and the impairment may arise in different components and may assume different forms. I have described the complex structure of word meaning. The most essential feature is that the semantic connections of a word, the product of long continued development, are complex and selective in character. It will be recalled (see page 32) that high selectivity of semantic connections of a word can be assured only if cortical activity is normal and properly differentiated, i.e., only if the dynamics of the nervous processes obeys the "law of strength." Perception of a word by a person in a normal state of consciousness first activates a system of selective semantic connections, whereas systems of irrelevant connections (for example, words of similar sound) are inhibited. This is one of the basic principles of operations with word meanings. It applies equally to the process of encoding of verbal communication and to its decoding. The word "skripka" (violin) will easily arouse in the mind of a normal subject the notion of similar musical instruments ('cello, guitar), but it is most unlikely to evoke the image corresponding to the similarly sounding word "skrepka" (bracket). This selective character of the organization of semantic connections is characteristic of the semantic structure of words in the normal, waking state. However, as I have already mentioned above, this selectivity of the system of

148 connections is easily disturbed in a state of drowsiness, during marked fatigue, and in pathological states of the cortex when the "law of strength" no longer applies and when stimuli (or their traces) of different strength evoke equal responses; in such cases, during the perception of a word the essential (organized into a semantic system) and unessential, irrelevant (for example, phonetic) connections are activated with equal probability and the selective character of the semantic connections is substantially disturbed. A normal waking state of the cerebral cortex is thus the basic condition for correct function of this complex, selective system of semantic connections associated with words. This waking, differentiated state of the cortex is formed only gradually during individual development and, as I have stated above, it is easily disturbed in pathological states of the brain. Because of its importance to the successful operation of the semantic system of verbal connections it is also a most important condition for the successful decoding of verbal communications and it will not therefore be surprising if, in the states that are the subject of neuropsychological investigation, the decoding of verbal communication will be upset by a disturbance of this basic psychophysiological condition. The facts just described compel us to make a special study of another aspect of the problem, namely the methods of studying this complexity of the semantic structure of words. Although the whole complexity of the psychological structure of the connections associated with words is gradually becoming clearer, psychology and psycholinguistics still lack objective methods by which the special features of the semantic structure of words can be identified sufficiently reliably to make the semantics of words a suitable subject for scientific investigation. The history of scientific psychology (and the short history of psycholinguistics) has seen the introduction of only relatively few methods capable of application to the study of experimental semantics of words. They have nevertheless proved their worth in the study of the development of word meaning in children and in the study of changes in word semantics arising in pathological states. I shall therefore briefly mention some of the basic methods before going on to make a special examination of forms of neuropsychological investigation that can take us an important stage further in the study of this complex problem. The earliest, and now classical method of study of word meanings was that of artificial words, suggested originally by N. Ach; its details were later developed by Vygotskii (1934), and it has subsequently been used by many investigators. The principles of this method are as follows: the subject is given a series

149 of artificial (meaningless) words and is asked to use them in order to classify geometrical shapes, by arranging them in groups each of which can be denoted by one of the artificial words. This method was used by Vygotskii and his collaborator, L.S. Sakharov, in their classical experiments. By this method they showed that at each stage of the child's mental development differently constructed groups of objects are designated by particular artificial words. These workers were thus able to study the changes in forms of generalization represented by these words (starting from diffuse, syncretic forms, proceeding through concrete, situational forms, and ending with abstract categories). This work was very significant, for it provided psychology (and neurolinguistics) with new opportunities for the experimental study of word semantics and its development in ontogeny. Two decades after Vygotskii's investigations, a similar experimental method of investigation was used to study the development of word meaning by the Soviet psychologist N.Kh. Shvachkin (1954; for an English version see: Ferguson and Slobin, 1973; Slobin, 1973) and others. A special word must be devoted to the investigation of development of word meaning in children undertaken by the Soviet worker Rozengart-Pupko (1947). The method used in these experiments was as follows: a small child was instructed to choose an object denoted by a certain word and take it into another room (for example: "bring the bird," "bring the teddy bear"). An essential feature of this experiment was that among the objects from which the child has to choose there was none that corresponded entirely to the given word; however, there were objects which had a certain feature possessed by the object denoted by the word. For example, when instructed to "bring the bird" the child could choose from the series of objects a ball with a pointed projection ("beak"); when instructed to "bring the teddy bear" the objects from which the child could choose included a fur glove (made of the same material as a teddy bear) and so on. The experiments showed that in these early stages the child soon learned to replace the choice of an object strictly corresponding to that named by a word by the choice of an object with one special feature in common with the word. Hence, in the early stages of the child's development words denote only syncretic features and the precise selective significance of words develops much later. Similar results were obtained in investigations conducted by Kol'tsova (1958) by other methods. A group of psychophysiological methods used by Riess (1940), Razran (1947), Shvarts (I960), and Luria and Vinogradova (1959, 1971), has been of considerable importance for the objective investigation of semantic word structure. These methods were as follows: a conditioned vascular, psychogalvanic, or pupillary reflex was formed in a subject in response to a certain word: for this purpose all responses to the structure of the word were repeated frequently,

150 but the presentation of one (test) word was reinforced by some unconditioned stimulus. After the formation of a conditioned reflex to one word (for example, "doktor"), the subject was given other words, some of them having no features in common with the test word, but others resembling it in sound ("diktor"), others similar in meaning ("lekar" or "vrach" = physician). Experiments of this type revealed words to which the subject responded by the same conditioned reflex as to the test word, i.e., they enabled the semantic generalization of word meaning to be studied. Tests on normal adults showed that words of similar meaning could give the same conditioned response as the test word, whereas words of similar sound did not give the same reflex. By slightly modifying this method, more detailed information could be obtained on the hierarchy of word associations and their dynamics in normal subjects and in pathological states. The writer has made a special investigation of this problem (Luria and Vinogradova, 1959, 1971); the results obtained will be described briefly below. To determine what connections are activated by each word or — to put it differently, to establish objectively its "semantic field," the following technique was used: different words were presented to the subject and the vascular (or psychogalvanic) component of the orienting reflex evoked by these words was recorded. After these orienting reflexes had been extinguished by prolonged and repeated repetition of the words, we proceeded to the main experiment. One particular "test" word whose connections we wished to study was picked out. In one series the subject was instructed to respond to this word (for example, the word "cat") by a movement (pressing a key with the hand); in another series presentation of the "test" word (for example, the word "violin") was accompanied by a painful stimulus. Naturally in both cases repeated presentation of these "test" words evoked active orienting reactions accompanied by their autonomic components (vasoconstriction of the hand with vasodilatation of the head, the appearance of a psychogalvanic reflex, and so on). Questions of cardinal importance now arise: which words will evoke similar autonomic components of the orienting reaction? Will it be words similar to the "test" word in sound or in meaning, and what will be the intensity of the autonomic responses to these words? The answers to these questions would provide an objective criterion on which to judge the bundles of connections evoked by the test word, and thus could provide a key to the objective investigation of the semantic fields of a particular word. The results obtained in the above tests clearly show into what different semantic fields the same words can be incorporated by different subjects under different conditions. In the normal adult subject when tested with the word "koshka" (cat),

151 an orienting reaction with similar features was evoked by words of similar meaning: "kotenok" (kitten), "mysh' " (mouse), and "sobaka" (dog), but not by the phonetically similar words "kroshka," "kryshka," or "kruzhka." Conversely, in mentally retarded children with a severe defect, words of similar meaning ("kotenok," "mysh' ", "sobaka") did not evoke similar responses, whereas phonetically similar words - "kroshka," "kruzhka," "kryshka," "okoshko" - evoked involuntary orienting reactions. This means that the "semantic fields" evoked by any word in a normal subject differ from the system of acoustic similarity which the same word evokes in the mentally retarded subject. The tests also showed that connections excited by a word can change with the subject's state. For instance, at the beginning of the working day, autonomic components of the orienting reaction similar to those evoked by the test word "koshka" (cat), continue to be evoked in the child with a mild degree of mental retardation by words of similar meaning ("kotenok," "mysh' ", and so on), whereas in a state of fatigue (after the fifth lesson) these words no longer evoke the corresponding autonomic orienting reactions, whereas phonetically similar words ("kroshka," "kryshka," and so on) now start to do so. Finally, the tests showed that semantic fields of a particular word may vary with the context; whereas in the case of a test word "violin," all words denoting musical instruments ("guitar," "piano," "flute," "pipe") under ordinary conditions evoked similar autonomic components of the orienting reaction, after the last word (the Russian word " t r u b a " = pipe or chimney) had been introduced into a context of words denoting parts of a building ("house," "wall," "stove," "chimney,") it altered its meaning and no longer evoked these components of the orienting reaction. The significance of these tests is that they formed the basis of an objective method of investigating semantic connections associated with a word and they revealed the high selectivity of those semantic connections associated with a word in the normal adult subject. However, perhaps the most important fact which they revealed is that in pathological states of the brain this high selectivity of the semantic systems may be disturbed and replaced by other, more diffuse connections. This is important enough to merit special attention: I shall need to return to it again later in the neuropsychological analysis of decoding of verbal communication. I have already stated that words included in communication may have many meanings and may activate different systems of connections. Semantically, every word generates many connections, only one of which has to be distinguished in order to understand a given communication, and all the others must be inhibited or blocked. For instance, the word "ruchka" (hand, arm, handle, pen) can evoke the associations "ruchka" (hand) - girl, as well

152 as the connections "ruchka" (arm) - chair, "ruchka" (handle) - door, "ruchka" (pen) — to write, and so on. In normal perception of a word standing in a known context, the process of distinguishing the significant meaning in a given context takes place instantaneously and almost automatically; however, if the communication is more complex in character, if it is formulated insufficiently clearly, irrelevant and alternative semantic connections may be activated and their inhibition may require special effort. In that case, when the psychological structure resembles the conditions of assessment of a blurred, "out of focus" figure, as was used by J.S. Bruner in his well-known experiments on complicated perception, the likelihood of activation of irrelevant connections increases and identification of the adequate word meaning begins to require choice from many alternatives and "decision making." Then the process of decoding becomes psychologically very complex. We find similar facts in the neuropsychological analysis of the decoding of lexical meanings incorporated in spoken communication.

b. Understanding of Syntactic

Constructions

I have examined the structure of the lexical elements of speech (words), their complex semantic structure, and the conditions necessary for their adequate understanding. The processes connected with the second stage of decoding of communication - the understanding of the syntactic structure of the sentence - are no less complex. For a long time it was considered that the understanding (decoding) of a sentence is a relatively simple process and that all that is needed for its successful accomplishment is knowledge of the meaning of words and of their morphological characteristics that determine their connection with neighboring words. As I have stated above, this view has gradually become unacceptable and has been replaced by the notions of modern structural linguistics, according to which it is necessary to distinguish a complex "surface-syntax structure" of the sentence, which differs in different languages and different terms of speech, from the "deep-syntax structure," which is common to different languages and reflects the fundamental logical structures lying behind the sentence. From this point of view the understanding (decoding) of a sentence is now represented as the transition from the sentence itself, first to its surfacesyntax structure, and then to its deep-syntax structure, thereby opening the way to the semantic record, i.e., to representation of the meaning of the sentence. From this point of view the understanding (decoding) of a sentence is now

153 represented as the transition from the sentence itself, first to its surfacesyntax structure, and then to its deep-syntax structure, thereby opening the way to the semantic record, i.e., to representation of the meaning of the sentence. How is this process of decoding the meaning of a sentence constructed and what are its essential conditions? At first glance it might appear that the understanding of simple sentences, not incorporating any complex system of mutually subordinate or successively subordinate parts, introductory clauses, or other constructions complicating the decoding process, would not present any appreciable difficulty. However, careful analysis shows that this is far from the truth, that sentences (even the simplest) are just as polysemic as individual words, and that a very complex procedure must be followed in order to understand them unambiguously. This fact of ambiguity, even of apparently the simplest sentences, has been studied in detail in modern linguistics (Chomsky, 1957, 1965, 1968, 1972; Miller, 1950; Bever, 1968, 1970, 1972; Fodor and Garrett, 1967; Garrett, 1972) and I shall not dwell on it in particular. Let us consider again the very simple and, at first glance, unambiguous sentence I used earlier (pages 13, 146). I stated above that the sentence (1) Ivan prishel k Ol'ge s Petrom (Ivan came to Olga with Peter) has at first glance only one (perfectly clear) meaning, although in reality, if the structure of the sentence is: (2) Ivan prishel (k Ol'ge s Petrom), it means that Ivan came to Olga who lives together with Peter, but if its structure is different, i.e.: (3) Ivan prishel (k Ol'ge) s Petrom, it means that Ivan and Peter together went to visit Olga. This example shows that by linking together the direct components in different ways, i.e., forming different surface-syntax structures, even such a simple sentence can be understood quite differently. An unambiguous understanding of more complex sentences, which can be understood variously because of the very nature of their syntactic construction, is an even more difficult problem. These include the grammatical constructions with nominalization so commonly found in English and repeatedly cited by Chomsky (1957).

154 An example is the sentence: (4) They are flying planes, which can be understood either as (5) They are flying (planes), i.e., they are piloting planes, or as (6) They are (flying planes), i.e., they are planes which are flying. Naturally, therefore, even such a simple sentence, with its two different syntactic structures, may be understood differently as a result of decoding. The same applies also to many constructions in Russian. For instance, the sentence (7) Priglashenie rabochikh Ivanova1,

brigad vyzvalo osuzhdenie

tovarischcha

composed by Yu. D. Apresyan (personal communication), may have up to 32 different meanings because the components of the sentence can be understood differently, for instance, rabochie brigady can be understood either as "brigades consisting of workers" or as "workers composing a brigade"; the expression tovarishcha Ivanova may mean either "of comrade Ivanov" or "comrades of a certain Ivanov"; the words priglashenie brigad may mean either "an invitation to the brigades by someone somewhere" or as "an invitation originating from the brigades"; and so on. The problem becomes more complex still if the sentence incorporates several parts inserted consecutively into one another, i.e., what is known as "double embedding." In these cases the difficulty of understanding a grammatical construction arises because the sentence is interrupted and a subordinate clause is inserted in it, separating its beginning and end. This happens in many distant constructions of the type: (8) The roof of the house standing on the top of the hill was covered with thick moss, in which the thick moss has to relate not to the hill, but to the house roof. To understand such a construction the listener must inhibit one of the possible (and semantically probable) connections between neighboring elements, i.e.,

155 must eliminate the interpretation (9) "... the top of the hill was covered with moss" and, having ascertained the true meaning of the construction, must choose a totaly different relationship, ignoring for the time being the sentence "embedded" in it (10) The roof of the house (standing on the hill top) was covered with moss. Bever (1968, 1972) and Fodor, Bever and Garrett (1968), after a careful analysis of constructions of this type, emphasize that elements both of a relatively simple sentence and of a construction with complex embedding, may form multiple relations with one another, as expressed by the schemes

(ID

Ν

(12)

Ν

Ν

Ν

Ν

V J

V

V

These schemes clearly show the complexity of the choice that must be made by a person receiving such constructions in order to obtain an adequate understanding of their meaning. Many of the possible relations expressed by such constructions can be understood only with great difficulty and the possible connections between the individual component parts can be analyzed only by means of a special intermediate transformation, in which the sentence is broken up into separate clauses so that the difficulty of understanding the sentence as a whole can be overcome. Bever quite rightly points out that it is this possibility of a double correlation between one component of the sentence and two other components that creates the fundamental difficulty, because the stimulus cannot be received simultaneously in two relationships or incorporated into the same perceptual scheme; moreover, this difficulty is quite indistinguishable from the difficulties that may arise in perception of what are called "impossible" figures" (Bever, 1972, pp. 10-12).

156 Having touched upon the problem of understanding sentences of complex construction, including the need for decoding the meaning of ambiguous structures involving double embedding, we have now reached the central problem which must engage our special attention - the psychology of the understanding of complex grammatical structures. In recent years the detailed psycholinguistic analysis of this problem has become a very frequent topic for psycholinguistic research, starting with the work of Miller ( 1 9 5 1 1970), Chomsky ( 1 9 5 6 - 1 9 7 2 ) , and many other psyhologists and linguists (some of their publications are included in the Bibliography at the end of this book). The process of understanding the constructions of language has been established in the course of the long history of society and many of the details of this dramatic process can be observed in the stages of successive development of children's speech (although, of course, this differs in principle f r o m the historical development of language). It is an important fact that in the early period of history language did not include all the constructions necessary to express a complex communication. Language itself was an inseparable part of practical activity, it had a relatively simple structure, and the adequate understanding of these relatively simple constructions requires the participation of a "synpractic c o n t e x t " ; for this reason, primitive languages could remain u n k n o w n without knowledge of the concrete situation in which a particular communication was used, of the gestures that accompanied it, of the intonation with which it was uttered, and so on. That is why, as the famous ethnologist Malinowski( 1930) pointed out, the expressions used by many peoples standing at a primitive level of social development can be understood only if the concrete situation is known and if their gestures are observed (hence the supposed difficulty of understanding their expressions in darkness). Only in the course of its long historical development has language gradually developed its own "synsemantic" forms of expression of relations, and so, as Bühler ( 1 9 3 4 ) stated, it has become " a system that includes in itself all the means of expressiveness." Thus the whole evolution of language can with full justification be represented as the path of liberation from dependence on the synpractic context and of gradual formulation of methods increasing the role of the linguistic (grammatically constructed) synsemantic context proper. Many traces of this complex process can still be seen in certain archaic forms of m o d e r n languages, which have not yet acquired all the necessary complex grammatical constructions, so that relatively simple forms of construction of expressions require corresponding qualifications, which the listener must carry out, in order to understand them. In primitive forms of modern languages relatively simple grammatical structures, enabling a simple and direct understanding of the decoded text,

157 predominated. For example, in the language of the Bible, just as in the language of old Russian manuscripts, there are hardly any complex hypotactic constructions, and it is relatively rare even to find sentences in which the order of the words disagrees with the sequence of events. Forms such as the attributive genitive case, in which quality or relationship can be expressed by an oblique form of the name - brat ottsa (the brother of the father), deti boyar (the children of the boyars), khozhyain sobaki (the master of the dog), - to understand which not only is it necessary to abstract from the substantiveness of the name, but to transpose the name mentally into the genitive case in the first place and to convert it into an adjective ("brat ottsa = otsovskii brat = — paternal brother") — appeared very late and was replaced in the language of the Bible, as in the language of manuscripts, by simple paratactic forms in which both names were left in the same case and were sometimes connected by the conjunction " a n d " (for example, in the Bible "King David and all his goodness" instead of "King David's goodness," in old German "Mit Leidschaft und Liebe" instead of "Mit Leidschaft der Liebe"), or in the old Russian manuscripts: "Sily i rati Akheitsev" = "the fighting men and the army of Achaia" instead of "the fighting men of the Achaian army" or "Boyare-deti" (boyar-children) instead of "deti boyar" (boyars' children). Other such late formations are constructions with the link "which," unaccompanied by any pronoun or repetition of the noun to facilitate the understanding of the meaning of the construction; in primitive forms of language the use of this relative pronoun as a rule is either accompanied by repetition of the substantive "dig the ditch, which ditch ..." or "obtained from a fisherman, from which fisherman ...", or it is replaced by a chain of simple clauses connected by the word "and" [compare: "for yonder 1 hear Sir Guy's horn blow and he, Sir Guy, (instead of " w h o " ) hath slain Robin Hood"]; in older records still the hierarchical system of subordination, using the relative pronoun "which", did not exist, in general and the complex hypotactic structure of sentences was replaced by a paratactic chain of simple, short constructions (compare the Bible: "and he went ... and he saw ... and he understood ..." and so on). Naturally the appearance of complex hypotactic constructions, using complex inflective forms and conjunctions ("which," "whereas," "although" and so on), endows a language with the ability to express any relationship unambiguously, by using the materials of language only. However, this ability inevitably introduces certain difficulties in the decoding of constructions, for which intermediate transformations are now required in order to overcome the difficulties connected with the need for dividing the sentence mentally into parts while at the same time surveying the whole complex structure and putting together its component parts into unambiguous combinations. From all the complex grammatical constructions in which modern expanded and, in particular, written speech is so rich, we can pick out some that

158 are particularly difficult to decode. These include, above all, complex constructions of government (or hypotactic constructions using inflections with prepositions, relative conjunctions, and so on); not all these mechanisms, a method of marking complex relationships, are capable of direct perception and, as a rule, their decoding requires special internal analysis. They also include "distant" and self-embedded constructions in which one part of the communication is separated from the other, directly connected with it in meaning, by long intermediate constructions or by accessory clauses (for example: the roof of the cottage which stood on the top of the wooded hill was covered in moss"); in such cases, when the individual components are simple,; the person must for a time disregard the introduced clause, so that he can join together in his mind the physically separated parts which are directly connected in meaning: the roof of the cottage (....) was covered in moss. The decoding of complex constructions in which the "distance" factor is complicated by a factor of embedding is more difficult still (such constructions have been studied in detail by psychologists, notably by Miller and coworkers (Miller, 1962; Miller and Selfridge, 1960; Miller and Isard, 1964). Variants of these constructions, including a series of mutually dependent components linked together by relative pronouns or conjunctions (such as "which"), differ both in the number of components of the complex sentence and in their arrangement. In some cases the "ladder" of mutually dependent parts is arranged in direct sequence (from left to right or right to left) and the difficulty in understanding them is due to the number of components which the listener has to retain in his operative memory (cf. Yngve, 1960). In other cases mutually dependent clauses are characterized by self-embedding, when the complex, hierarchically constructed sentence acquires a discrete type of structure and, in order to understand it, the listener must return to the first parts of the sentence so as to connect them with distant elements. In order to obtain a clear idea of the difficulties arising during the understanding of essential constructions, I give below a few sentences used by G. Miller, and consisting of equal numbers of words, starting with a linear arrangement of the elements forming a continuous series (reading from left to right), and I follow them with more complex, distant constructions. Some examples of these sentences are given below: (13) She liked the man who visited the jeweler that made the ring that won the prize that was given at the fair. Here we have a strictly successive arrangement of dependent clauses: A -*· Β

(14)The man that she liked visited the jeweler that made the ring that

159 won the prize that was given at the fair. The sequence of dependent clauses in this case is constructed somewhat differently and obeys the following scheme: A

->C^D->E->F Β

The next stage of increasing complexity of construction is reached by increasing the number of links concentrated in its initial part and increasing the gap (distance) between the components of the construction: (15) The jeweler that the man that she liked visited made the ring that won the prize that was given at the fair. The scheme of this construction indicates a marked lengthening of the gap between the two parts of the hierarchically arranged construction:

U

^ D + E + F

Β ^C

The following construction, in which the gap between the connected parts of the construction is increased by a few links more, is even more difficult to understand: (16) The ring that the jeweler that the man she liked visited made won the prize that was given at the fair. The scheme of this construction: A

-»· Ε Β

C

F

D

clearly shows the number of links separating the two mutually connected parts of the grammatical construction. Clearly it is much more difficult to understand this construction, which makes particularly great demands on the subject's operative memory. This factor of "distance" of a complex grammatical construction and of "self-embedding" thus significantly increases the difficulty of its understanding. We must now examine the last factor that adds to the difficulty of understanding grammatical constructions: "inversion" of the construction. Constructions with inversion can be divided into two subgroups. In the

160 first subgroup the difficulty is that the external order of the words is opposite to the order of events described by the grammatical construction. Examples are constructions of the type: (17) 1 had breakfast after I had read the newspaper; or I washed the car after I had swept the yard; where the order of events is opposite to the order of words in the sentence. Constructions of this type, the understanding of which has recently been studied (see, for example, Smith and McMahon, 1972), can be correctly understood only after the order of the words in the sentence has been harmonized with the order of events; the need for additional transformations to overcome the inversion inherent in the sentence is perfectly obvious. The other group of inverted constructions consists of those with semantic inversion, typical examples of which are constructions with a double negative, such as: (18) I am not in the habit of not obeying the rules; which can be understood only after the intermediate operation of removing the double negative (not in the habit of not obeying = in the habit of obeying). The processes essential to the understanding of such constructions have recently been studied by several workers (Bever, 1972; Wason, 1970) and I shall return later to their analysis. I have pointed to the difficulties that may arise during the decoding of a sentence which forms part of a communication on certain events, simply because it uses a series of constructions that cannot be understood at once without the performance of accessory operations, such as returning to earlier parts of the sentence, retention of the elements of the sentence in short-term memory, or the introduction of accessory transformations of the sentence in order to overcome the difficulties inherent in its construction. The difficulties that may arise are even greater if the sentence describes, not a concrete event, but a system of relations or, in other words, if it is a "communication of relations " (Svedelius, 1897). In these cases the subject receiving the communication has the task, not of reflecting concrete facts that are described, but of analyzing relations between the individual elements of the communication or, in other words, of performing an additional logical operation, without which the meaning of the logical-grammatical construction as a whole cannot be understood. Naturally this is essentially a different task and it introduces new and considerable difficulties in the way of decoding the communication.

161 A "communication of relations" can use various grammatical devices, including inflections of the substantive (for example, inflections of the genitive case, with attributive meaning), auxiliary words (such as the prepositions "under" and "over," "before" and "after"), rearrangement of the words in the sentence, and so on. The psychological features distinguishing some of these constructions expressing the "communication of relations" have been studied only during the last decades by a few psychologists and linguists (T. Bever, 1970, 1974; H.H. Clark, 1970, 1974). All that I can do is to mention some of the conditions that may add significantly to the difficulty of decoding these forms of communication, without implying at all that these are the only difficulties, and well aware that these conditions themselves require further careful investigation. Among the conditions that may make the understanding of such constructions significantly more difficult there are factors such as the presence or absence of a verb expressing the relation ("the man is afraid of the dog" is easier to understand than the shortened construction "fear of a dog"), the presence or absence of a relative character of the words included in the construction ["kusok khleba" (kusok, nom. sing., piece; khleba, gen. sing., of bread), in which both "piece" and "bread" have absolute values, are understood more easily than "brat ottsa" (brat, nom. sing., brother; ottsa, gen. sing., of father — i.e., father's brother), in which both "brother" and "father" have only relative values (somebody's brother, somebody's father)], the presence of reversibility (forms without reversibility such as "dog's collar," which has no opposite form "collar's dog" are understood more easily than forms with possible reversibility, such as "father's brother," with the alternative "brother's father" or "dog's master" with the possible reverse construction "master's dog." Finally, there are other factors which can significantly add to the difficulty of understanding and which are concerned with the unambiguity or ambiguity of the construction; ambiguity, requiring the listener to choose from several alternatives, naturally gives rise to much greater additional difficulty than unambiguity of construction, requiring no such choice for its understanding. Let us now turn to the analysis of the difficulties arising during the decoding of grammatical constructions such as those described above, for which the psychological process of decoding is particularly interesting. Let us take as examples some grammatical constructions whose decoding may present difficulty and which may be of special interest as material for neuropsychological analysis. As the first example let us take the "communication of relations" expressed with the aid of inflections which, in some languages (Russian, for example), are methods of transmission of case forms. Some forms of inflective relations, such as forms of the accusative case

162 in a construction of the type "Mal'chik uvidel kartinu" (the boy saw the picture), of the dative case, such as "Ya dal tetrad' drugu" (I gave the book to a friend), or the instrumental case, such as "Dom postroen Petrom" (the house was built by Peter), formulate a simple communication of an event; they have an unambiguous concrete subject matter and often they are irreversible in character (it would be impossoble to say: "the picture saw the boy" or "Peter was built by the house"); their decoding is naturally an easy task. The situation is different with inflective constructions formulating the "communication of relations," an extreme case of which is represented by constructions incorporating an applied genitive, or in particular, an attributive genitive ("father's brother" and "brother's father," "dog's master" or "master's dog"). The difficulties arising during the decoding of such a structure are complex in character. First, as I have already pointed out, this grammatical construction incorporates two names, each of relative value (somebody's "brother" and somebody's "father"), and this by itself gives rise to some psychological difficulty; second, the whole construction of the "father's brother" type does not strictly relate to any of the persons mentioned in the construction ("father's brother" - not a "brother" and not a "father," but an "uncle"). Furthermore, a word in the genitive case is more of an adjective in nature than a noun (father's = paternal), although it expresses this relative (or qualitative) meaning by means of a substantive (but in Russian it follows the noun it qualifies - brat ottsa — and does not procede it as with the adjectival form — otsovskii (paternal) brother. Finally, the whole construction is reversible and its meaning has to be contrasted with that of the opposite (but still possible) construction "otets brata" (brother's father). Consequently, the first condition essential for the understanding of this construction is abstraction from the immediate substantive value of the word and giving it the meaning of a word denoting a quality. Considerable additional operations can be assumed to be required for this purpose. In the Russian language an adjective, indicating the quality of an object, is placed before the noun it qualifies, just as in English ("krasivaya shlyapa" — pretty hat, "zlaya sobaka" — fierce dog). To understand the attributive meaning of a word placed in the genitive case more easily, it has to be transposed to precede the noun (this is often done in popular speech, when the form "ottsa brat" is used instead of "brat ottsa"), and sometimes an indicative pronoun as a special marker is added, to show to what the attribution relates ("etogo ottsa brat" — this father's brother", "etoi sobaki khozyain" - this dog's master). Perhaps it is only through these intermediate transformations that the conflict essentially arising between the attributive meaning of the noun placed in the genitive case and its position in the sentence can be resolved. Additional transform-

163 ations of this type, overcoming the difficulty of direct understanding of the construction, are used openly in popular speech, in which still more expanded forms often occur (such as "etogo ottsa ego brat" — literally of this father his brother - in Russian, or the Saxon genitive — "des Vaters sein Bruder" in German). The use of external markers, as a means of avoiding the duality of possible understanding of a construction and of eliminating the conflicts produced by it, thus points clearly to the real difficulties that arise during its decoding. An equally great obstacle to the direct understanding of such constructi o n s is their reversibility. The fact that, by keeping the same words but altering their case endings and arrangement, the whole construction can be given a different meaning (for example, "brat ottsa" (father's brother) and "otets brato" (brother's father); "khozyain sobak/" (the dog's master) and "sobaka khozyaina" (the master's dog) creates further difficulty in the way of its decoding. In such cases a person cannot resort to semantic cues for guidance to the meaning of the construction (as in the case of irreversible constructions of the type "the roof of the house," "the handle of the door," which have no opposite form, and the decoding of meaning purely from structure, based entirely on formal rules of inflection, naturally become much more difficult. This reversibility of constructions we are now discussing is one of the most important obstacles in the way of its understanding and it is the reason why the "attributive genitive" ("brat ottsa" when the opposite form, "otets brata," is possible) is much more difficult to understand than the irreversible construction of the "partitive genitive" ("kusok khleba" — piece of bread — when the opposite "bread of piece" is impossible). This explains why constructions using the same case may vary in the difficulty of their understanding; in order to assess fully the difficulties presented by a particular grammatical construction it is necessary to take into account not only its formal characteristics (for example, the case form), but also the presence of reversibility and the semantic characteristics. Careful analysis of case relations (something which has not yet been exhaustively carried out and which ought to be the subject of special investigation) thus provides us with the opportunity of directly studying the psychological difficulties that arise during the understanding of case constructions. The second method used for the "communication of relations" is the introduction of special auxiliary words - prepositions and conjunctions, which exist in a language to express spatial or temporal relations between two objects. Typical examples are prepositions such as "below" and "above," " i n " and " o u t , " "together," "as a result of," " a f t e r " and "in spite o f , " which can be used in constructions such as "a circle below a square" and "a square below a circle" or "spring before summer" and "summer before spring" and so on.

164 Many of these auxiliary words became distinguished in language as independent forms relatively late, and they still retain traces of their old substantive values (for example, "pod" - under, below — from the noun "pod" = hearth, the floor of an oven; "vmeste" — together — from "mesto" — a place; "nesmotrya" — in spite of — from "ne smotret, " — not to look, and so on; it must be pointed out that only comparatively recently the connection between many of these auxiliary words in Russian and their previous substantive meaning was reflected in their being written separately: "v meste (vmeste)," "v sledstvie (vsledstvie)," "po tomu (potomu)," and so on). It is also characteristic that many prepositions, such as "v" (in) and "iz" (from, out of), continue to have several different meanings, some of them concrete, others conventional or logical in character (for example: "tetrad' lezhit ν stole" — the book is lying on the table, and "ya veryu ν ego chestnot' " — I have faith in his honesty; "chelovek vyshel iz lesa" - the man came out of the forest, and "ya delayu vyvody iz ego rassuzhdeniya" — I draw conclusions from his argument; "on polozhil tetrad' na stol" — he put the book on the table, and "ya nadeyus' na pravil'noe reshenie zadachi" - I hope for a correct solution of the problem). Naturally all this creates special difficulties for the decoding of the meaning of these auxiliary words that cannot be ignored. Ambiguity of auxiliary words makes it necessary to choose the required meaning from a series of possible alternatives; clearly this process of overcoming ambiguity creates further difficulties which can only be overcome with assistance from the context in which the auxiliary words are introduced. Further considerable difficulty is created by the reversibility of these constructions, which is only minimally apparent in constructions in which the additional information determining the meaning of the communication is defined by its semantic characteristics (for example: "book on table" but not "table on book," or "carpet under bed" but not "bed under carpet"). Where this additional semantic marking is absent and the listener cannot obtain additional information (for example: "circle under square" and "square under circle") reversibility of construction is seen to its fullest extent and the only cue to the meaning of each construction is given by case inflections and word order. Where the case inflections are hononymous and do not help with the correct decoding — "on polozhil (he put) plat'e (the dress) pos veslo (under the oar)" or "on polozhil veslo pod plat'e" - and where the only cue to the correct meaning is word order, these difficulties of decoding constructions become more severe. Difficulty of understanding such constructions is particularly great in cases when the word order does not coincide with the order of the actions but is in conflict with it. Such a case arises, for example, with the instruction: (19) "Draw a cross below a circle."

165 In this case the subject receiving this instruction has a natural tendency to carry out the action in accordance with the word order and to draw a cross first, followed by a circle under it ( Q ); correct decoding of the construction involves suppressing the direct impression arising from the instruction and transforming the instruction ("cross below circle" = "circle first, cross below it"), and the fresh difficulty arising during the correct decoding of this construction will be clearly apparent. A similar situation arises with constructions of the type: (20) "I had breakfast after I had read the newspaper," in which the order of the words in the communication describing the sequence of two events suggests that they take place in that order. The actual time relationship of these events as described differs from the order of events as they happened, and to understand this the inversion included in the construction must be corrected. In all the cases mentioned above the process of understanding of this form of "communication of relations" is much more difficult psychologically than the process of understanding a simple "communication of events."' The recipient of these constructions must in every case inhibit the direct meaning of the nouns included in them ("cross," "circle") pick out the necessary meaning of the auxiliary word ("below," "above," etc.), compose a scheme of the relationship expressed in the construction, guided primarily by the formal cues (inflections, word order) and sometimes by them only, and finally, in certain cases, by introducing an auxiliary transformation of the grammatical construction so as to eliminate the difficulties as far as possible. We shall see later the importance of this complexity of the process of encoding of the types of "communication of relations" given above and the value of an analysis of the disturbances of this process arising in patients with local brain lesions. My description would be incomplete without discussing another group of constructions of "communication of relations" the understanding of which creates special difficulty. I refer to a group of constructions expressing relations of comparison. The psychological analysis of these constructions has been undertaken by many workers (Clark, 1965—1970, 1974; Flores d'Arcais, 1966, 1970; Huttenlocher, 1967, 1968; Lipmann, 1972; Bever, 1970, etc.; Garrett, 1970, and many others). Examples of such constructions in which the relations between two or three objects are expressed by adjectives in the comparative degree are as follows: (21a) An elephant is bigger than a fly or (21b) A fly is bigger than an elephant;

166 (22a) Peter is stronger than Vanya or (22b) Vanya is stronger than Peter. Finally, the most difficult construction, and one that has frequently been used in psychological tests of discursive operations, by C. Burt, for example, is as follows: (23) Olya svetlee Soni, no temnee Kati (Olya is fairer than Sonya but darker than Katya). The object of all these constructions, as is clear to see, is not a concrete action performed by the persons mentioned but their comparison in relation to a particular feature. This operation can be performed by comparing one word in the nominative case, which stands for the subject of the sentence, with another object, standing (in Russian) in the genitive case, denoting the object of comparison; in its expanded form the expression can be written as follows: (24) An elephant; it is bigger (in size) than a fly, or An elephant — it is bigger; but a fly — it is smaller. This operation of comparison thus requires that the adjective "bigger" applies to only one of the two objects named, and to understand what is said about the second object, one of the adjectives included in the sentence ("bigger") must be replaced by its opposite ("smaller"), thus creating the need for additional transformations which the listener reduces to a contracted "mental action." These examples of comparative constructions differ in their logical-grammatical structure and different operations are involved in their decoding. The first (reversible) construction can be decoded by the use of semantic cues (knowing that an elephant is large and a fly is very small), as a result of which the sentence can be understood even without grammatical markers ("an elephant is big" "A fly is very small!": the elephant must therefore be bigger than the fly). By contrast with this the second construction ("Peter is stronger than Vanya") is without any such semantic support; both names are neutral from the semantic point of view and they can be compared only on the basis of formal, grammatical inflections, requiring analysis of the word standing (in Russian) in the genitive case (Petya sil'nei Van/), as the word forming the object with which the comparison is made ("than Vanya"), and for that reason the additional transformation of the construction is more necessary in this case. Finally, in the third case ("Olya svetlee Soni, no temnee Kati") fresh

167 difficulties are introduced, because of the double comparison of the middle term ("Olya"): this member is placed in two opposite situations at the same time, as being fairer than one object and darker than the other. As in the case of "double embedding" this double relationship introduces considerable perceptual difficulties, which (as Bever, 1972, 1974, and others have pointed out) are analogous to those found during the examination of "impossible figures"; in these cases also, therefore, radical transformation of the situation is required in order to overcome the difficulties. The components of these intermediate transformations of this complex logical-grammatical construction have been carefully studied by psychologists and linguists (Clark, 1 9 6 5 - 1 9 7 2 ; 1974; Flores d'Arcais, 1966, 1972). As their analysis has shown, the understanding of structures such as "John is stronger than Peter" and, even more so, of more difficult structures such as the one used by Burt in his well-known test (No. 23) "Olya is fairer than Sonya but darker than Katya" presupposes a number of intermediate operations, the outcome of which is that the logical subject (the "theme"), on the one hand, can be distinguished from the logical predicate, expressing what is said about the subject (the "rheme") on the other hand. It also presupposes the formulation of a latent "null" or analogous link: John is strong or Olya is fair, followed by a second statement - the "theme": but John is not just strong, he is stronger than Peter, or but Olya is not just fair, she is fairer than Sonya; this again is followed by an auxiliary transformation (Olya is fairer than Sonya ... which means that Sonya is darker), and finally - the same operation with the last link [... but (she, Olya) is darker than Katya ... that means that Katya is fairer still). The whole of this cycle of operations, it is particularly important to stress, takes place within an inner (spatial) scheme, within which the corresponding components for comparison are manipulated (this last factor must engage our attention again below). Clearly these comparative constructions, even the simplest, cannot be directly understood and require special intermediate auxiliary transformations, which become particularly complicated when it is necessary to decode comparisons of three elements, one of which is simultaneously related to (contrasted with) the other two. I have thus described various forms that the communication of relations may take and have indicated the psychological complexities that make communication of this type incomparably more difficult to decode than the communication of events. We may naturally expect that the process of decoding of all these constructions will exhibit different levels of integrity during neuropsychological tests. However, before we turn to the neuropsychological analysis of these constructions, I will draw attention to the following fact. I described above difficulties of understanding (decoding) verbal communication that depend on the degree of complexity of syntactic structures. However, in order to

168 take all aspects of the process of decoding sentences into consideration, we must examine not only the special features of their formal grammatical structure, but also the content, the information which they carry. This difference in the content of sentences is necessarily reflected in differences in the process of their decoding. In some cases the content of a sentence includes nothing with which the subject was already familiar. In such cases the whole process of understanding the meaning of the sentence depends on a correct assessment of its grammatical structure, and if it is relatively complex the listener is forced to undertake certain work on the sentence, to assess its structure, to analyze the inflections of the various words, the meanings of the operative words, the order of the words in the sentence, and, on the basis of the results, t o deduce what information the expression contains. In some cases the person receiving the communication is even forced to carry out intermediate operations to transform the sentence and so indirectly to understand its meaning. This example of sentences of "neutral" meaning, such as I have given above (complex subordinate, distant, comparative constructions, e.g. "a circle under a square," "Peter is stronger than Vanya," "Olya is fairer than Sonya but darker than Katya") shows how a close analysis of the formal characteristics of the sentence must be carried out by the recipient of the communication in order to overcome its ambiguity and to make the information contained in the sentence finally clear. The situation is quite different when the content of the sentence is something already familiar from experience and when its meaning can be understood even without any special analysis of its grammatical structure. Let us compare the process of understanding two simple phrases, with identical constructions and expressing the "communication of an event," one of which does not contain something familiar from previous experience (24). (25) "I went out into the street to buy myself... (?) (26) "Winter came and deep lay the ... (?) In each of these constructions the last word is omitted and the person receiving the phrase has to fill in the gap; if this is done correctly, the full meaning of the sentence becomes clear. The psychological process of decoding the sentence will obviously be quite different in these two cases. The first sentence does not communicate to the listener information already known to him, and for that reason the meaning remains indeterminate. In this case the gap in the sentence can be filled by any one of a large number of words ("... to buy myself ... a newspaper? some bread? a hat? and so on). The second sentence, from the very beginning, has only one possible meaning, predicted by the first part of the expression (Winter came and deep

169 lay the ...): the sentence is ended unambigously by the addition of one word only - "snow." Definite psychological conclusions can be drawn from this difference in the meaning of the two sentences. The first sentence (25) can be interpreted only by analysis of the possible alternatives and the creation of an hypothesis, followed by "decision making"; the second sentence (26) requires no work on the analysis of alternatives or "decision making" and it can be completed simply by taking advantage of previous experience or, in other words, by "guessing" on the basis of the well-established and unambigous information given to the listener. The sentences I have given above are simple in their grammatical structure. However, similar differences in the psychological process of decoding the meaning of the sentence can be found in the case of grammatically more complex constructions. I shall give only two examples. Two sentences expressing spatial relationships: (27a) "A picture hangs above the bed" (27b) "A circle above a square" are absolutely identical in their grammatical structure. However, in the first of them the position of the picture is prompted by the listener's practical experience and the sentence has an unambiguous meaning which can be guessed without any special analysis of the formal construction (word order, meaning of the preposition, analysis of inflection); in the second case the spatial arrangement of the objects is not given by previous experience and decoding of the sentence as a whole depends on analysis of its grammatical construction. A similar state of affairs is found in comparative constructions, for the process of decoding the meaning of the two sentences: (28a) The elephant is bigger than the fly (28b) Olya is bigger than Katya follow different psychological courses. Whereas in the first construction (28a) the listener can obtain support from the meaning of the expression and the construction can be understood by guessing even without analysis of the grammatical markers, in the second construction (28b) the semantic support is absent and the meaning of the communication can be understood only as a result of special formal-grammatical analysis. We can conclude from the above facts that the psychological process of decoding the meaning of a sentence may follow different courses depending on whether the communication contains ready-made information or whether its meaning can be understood only on the basis of analysis of formal (grammatical) features of construction. In one case the process of understanding

170 is supported by a long and sometimes difficult analysis, accompanied by auxiliary transformations, but in the second case this grammatical analysis can be dispensed with and the meaning of the communication can be "understood" by simple guesswork or, more precisely, by simple reproduction of previous experience. We shall see below the importance of these differences in the process of decoding of grammatical structures for the neuropsychological analysis of its mechanisms.

c. Understanding of a Complex Verbal Communication

(Text)

A verbal communication is only rarely restricted to an isolated sentence. As a rule it consists of a series of consecutive sentences, forming an extended communication about a certain event; this series of sentences forms what is conventionally known as a text. It would be wrong to suppose that the meaning of a text is nothing more than the meaning of the separate sentences. The process of understanding the meaning of a whole "fragment" or "text" is incomparably more complex and has a totally different psychological structure, one going far beyond the bounds of linguistic rules. Analysis of the understanding of the meaning of a whole text can no more be deduced by the analysis of the sequence of a sentence constructed by the "Markov chain" principle than a sentence can be understood as a simple sequence of separate words. It is only in the relatively simple narrative texts of the type: "Spring came. The sun began to grow warmer. The days become longer. Trees began to flower in the garden" and so on - that the meaning of the text is a direct succession of meanings of isolated consecutive sentences. The meaning of more complex texts cannot be reduced to such a sequence and a combined process of analysis and synthesis is required, including the comparison of fragments sometimes separated considerably in time, the creation of hypotheses of the general meaning and, sometimes, departure outside the limits of the "external" text, to look for the "hidden meaning," incorporating the general meaning of the expression as a whole, and to evaluate the motives concealed behind this text. This highly complex semantic structure of a text is perhaps revealed to the best advantage in a fable (or parable), the understanding of which can be regarded as a model of the complex process of understanding a text. It was not by chance that, in one of his early papers, Vygotskii investigated the psychological structure of a fable. Let us consider one example which will show the complex structure of the process of decoding the meaning of such texts. One of Tolstoi's short stories - "The Jackdaw and the Pigeons" - is read

171 to the listener. (29) "A jackdaw heard that the pigeons had plenty to eat and so she painted herself white and flew to the pigeon house. The pigeons thought that she was a pigeon like them and took her in. However, she could not restrain herself and cried like a jackdaw. Then they saw that she was a jackdaw and they sent her away. She went back to her own kind, but they did not welcome her and sent her away also." The understanding of the meaning of this fragment is a very complex psychological process. The first part of this process is the semantic unification of the individual sentences, which Vygotskii at that time described as a process of "mingling of meanings." The meaning of each consecutive sentence includes an element of the meaning of the previous sentence, and this is an essential condition for the understanding of the meaning of the fragment as a whole. This is clear, first, from the fact that the later parts of the text must preserve a relationship to the object or event that was discussed previously and mentioned openly in the first sentence of the fragment. If this does not happen, the text as a whole must inevitably disintegrate into a series of isolated, disconnected sentences. This condition, concealed in the text, can be expressed by reading it as follows: (30) "A jackdaw heard that the pigeons had plenty to cat; she (the jackdaw) painted herself white and (she, the jackdaw) flew to the pigeon house. The pigeons thought that she (the jackdaw) also was a pigeon and (the pigeons) took her (the jackdaw) in. However, she (the jackdaw) could not restrain herself and cried like a jackdaw. Then the pigeons saw that she (the jackdaw) was a jackdaw and they sent her (the jackdaw) away. She (the jackdaw) returned to her own kind, but they (the jackdaws) did not welcome her (the jackdaw) and sent her (the jackdaw) away also." This exteriorization of the name of the object discussed, and not mentioned in the external text, indicates the first, but not the only, essential condition for the unity of understanding of the whole text. The second, and perhaps the most important, condition is evaluation of the inner, latent meaning, expressed by the communication. Decoding of the inner meaning can take place through the understanding of some relatively simple constructions (for example, metaphors) or of the

172 inner meaning of phraseologisms ( f o r example, proverbs). It is well known that the Russian expression "zolotoi chelovek" (literally, gold person) has the inner meaning of "a good and wise p e r s o n " (compare, in English, "good as gold"), the expression "zolotye ruki" (gold fingers; compare, in English, greenfingers) has the meaning of " e x p e r t , " and that "sinii chulok" (blue stocking) denotes certain features of the female character. It is equally well known that the meaning of the proverb "All that glitters is not gold" is not restricted to the bare meaning of the external fact, but there is also an inner meaning of " n o t judging things or people purely by their external appearance," and that its meaning is very similar to, although absolutely different in external form from, the proverb "Still waters run deep." In order to understand phraseologisms it is thus not enough to decode their external grammatical structure; the inner meaning or " m o r a l " must also be elucidated. This is even truer of the understanding of a whole text, especially the text of a fable or parable, an example of which I have just given above. In this case, (as Bühler, Bartlett and others have shown), a true understanding of the meaning of the text requires an interpretation initially of the hidden meaning of the individual fragment, and then of the general meaning of the text as a whole. Let us a t t e m p t to explain this basic psychological condition by a further examination of the text in which this inner meaning (or semantic kernel) is exteriorized. The text, under these conditions, assumes the following character: (the open, " e x t e r n a l " text is given above the line and the hidden meaning below the line). (31)

A jackdaw heard that the pigeons had plenty to eat. (She was envious of the pigeons) (She) painted herself white (She decided to make herself look like a pigeon so that they would not recognize her) And she flew to the pigeon house (So that she could eat as well as the pigeons) The pigeons thought that she also was a pigeon and (the pigeons) took her in. (Her plan succeeded, she was not recognized, the pigeons were deceived)

173 But she could n o t restrain herself and she cried like a jackdaw. (She was careless and gave herself away) The pigeons saw that she was a jackdaw and (the pigeons) sent her away. (The deception was found out and the painted jackdaw was chased away) She (the jackdaw) returned to her own kind (The jackdaw wanted to return to her previous life) But they (the jackdaws) did not welcome her and turned her away also. (The jackdaw's duplicity received its just reward and she was outcast). Perception ("reading") of each part of the fragment clearly includes not only understanding the " o p e n " text, b u t also drawing a parallel conclusion regarding the "inner meaning" (moral) of each part. Only by comparing all the component parts of this " m o r a l " can we deduce the general meaning of the whole text - the recognition of the jackdaw as deceitful and two-faced - and its " m o r a l " : " y o u must live honestly," " y o u must not pretend t o be someone else," " y o u must remain yourself," "deceit and duplicity are always punishe d " and so on. The whole psychological process of understanding a text thus goes far beyond the decoding of its individual grammatical structures; it requires abstraction from a special meaning, expressed by the individual elements of the text, about the communication which is transmitted by its external c o n t e n t ; the most important step in the understanding of the text becomes its internal semantic analysis, the psychological structure of which has so far remained almost completely unstudied. Naturally the work done by the subject when decoding a text must be kept within the bounds of the particular context becoming "a closed system" and all irrelevant associations that may arise in the course of its analysis must be constantly inhibited. In other words, the understanding of a text requires the same selectivity of psychological operations as the understanding of the meaning of individual words or grammatical constructions. If this condition is not observed, and if in the course of hearing (or reading) a text the subject gives way to irrelevant associations which he does not inhibit, the under-

174 standing of the text can n o longer be adequate and the whole process easily digresses from the text into irrelevant associations. We shall see below how important the observance of this basic condition is when we examine cases in which it is infringed. What I have just said is of great importance to the psychological assessment of what is generally called the "reading in d e p t h " of a text. There can be no d o u b t that reading a text in depth can vary very greatly; indeed it can probably vary f r o m one subject to another more than the analysis of the " e x t e r n a l " grammatically expressed meaning of sentences. Fragments can be read at different depths, and as tests by many workers who have analyzed the semantic understanding of texts have shown (Vygotskij, 1934; Morozova, 1947, 1953), in some cases it amounts merely to an understanding of the external subject, whereas in other cases it progresses to the analysis of its internal sense, to the recognition of the general meaning, and later to the motives concealed behind the action of the persons mentioned in the text. Investigations of the depth of "reading" a text and of the psychological processes connected with it might perhaps best be carried out not by professional psychologists, but by theatrical producers, whose main task is to explain to the actor the inner meaning of a text, the motives that lie at the basis of the actions of the person whose part they act. Only if this condition is satisfied can the actor play the part successfully and carry over to the audience not merely the external chain of events, but also the internal (ultimately emotional) individual meaning. The method used by the producer, attempting to reveal the inner meaning of a text, like the psychological characteristics of decoding this inner meaning or " m o r a l " might perhaps be best investigated by that genius among producers, K.S. Stanislavskii (1954), and his pupils (see: Knebel', 1964). As their investigations show, switching from the external text to its moral or general meaning is not achieved simply by explaining to the actor what the a u t h o r wished to say by a particular expression and what true meaning must lie behind the actor's words. This is a task of considerable length; it begins before the actor receives his script: he lias to learn to "mold h i m s e l f ' to the characteristic features of the person whose part he will play, to study the situations in which this person takes part, to act a series of scenes portraying this person in an imaginary situation, and then only after prolonged rehearsal with "real actions," giving an insight into the general motivation of the behavior of the person whose part is to be acted, is it possible to commence with the actual text of the play. An understanding of the inner sense of the expression is thus acquired only by prolonged general work on the character and situation, and it is the condensed result of this extensive activity. This long course of action as a whole still awaits detailed psychological

175 study, and I cannot dwell on it further here. 2 I shall say no more about the complex psychological process of decoding the general meaning of a text; as I have stated above, this problem has received very little study by psychologists (except, perhaps, in the classical work of Bühler (1908, 1909, 1934) and his followers; only in the last few years has it become a field of study for some (unfortunately, only a few) linguists; however, as their writings show, only the first steps have been made toward the semantic analysis of a whole text and much painstaking research is required. We have described this last stage - the decoding of a whole text - at length only because in the subsequent neuropsychological analysis of this problem the understanding of a whole text is just as important a matter for our purpose as the decoding of the meanings of individual words and syntactic structures, and also because, as we shall see below, analysis of the changes in the process of decoding a whole text found in patients with local brain lesions will be just as important for us as the analysis of changes in the understanding of single words and syntactic structures.

2. METHODS OF INVESTIGATION OF THE DECODING OF V E R B A L COMMUNICATION. G E N E R A L DATA OF NEUROPSYCHOLOGICAL ANALYSIS

The understanding (decoding) of verbal communication has not yet received sufficient study and neither linguists nor psychologists have adequate material for a detailed analysis of the processes involved. Methods of objective investigation of these processes are at an even lower level of development. After the work of Chomsky ( 1 9 5 7 , 1965), linguistics has begun to study the semantic structure of verbal communication seriously and has gradually placed this problem in the center of its interests; the focus of attention of psycholinguistics has also shifted largely toward the close analysis of the semantic structure of verbal communications. However, despite the involvement of such eminent linguists as Fillmore ( 1 9 7 0 , 1972), Lakoff ( 1 9 7 1 , 1972), Rommetveit (1968), Katz (1963 - 1 9 6 9 , 1972), McCawley (1968), 1972), Bierwisch ( 1 9 6 6 , 1972) and others, and in the Soviet Union, Zholkovskii, Leont'eva and Martem'yanov, 1961; Zholkovskii, Leont'eva, Shcheglov, e t a l . , 1964; Zholkovskii ( 1 9 6 7 , 1969), Mel'chuk ( 1 9 6 1 , 1972), Apresyan (1966), Katsnel'son ( 1 9 7 2 ) , and Brudnyi (1972), as well as of leading psychologists and psycholinguists such as G. Miller ( 1 9 5 1 - 1970), Bever ( 1 9 6 8 , 1970), Fodor (1965 - 1 9 6 7 ) , and Garrett ( 1 9 6 6 , 1970), who have studied this problem, the analysis of the understanding of verbal communication has not yet progressed beyond the stage of phenomenological description and the construction of hypothetical models, intended to reflect the basic features of

176 the semantic structure of verbal communication and its components. The absence of necessary scientific methods for the analysis of the real process of decoding of verbal communication is clearly apparent in the writings of Chomsky (1957, 1965, 1968, 1972), who distinguishes between knowledge of a language (competence) and the performance of speech operations, and who takes as his basic position the view that the chief method of understanding linguistic (grammatical) structures is their intuitive recognition, and that support on linguistic intuition must therefore be accepted as a basic method of linguistics. There is no doubt that the direct perception of linguistic structures, ability to distinguish between grammatically correct and incorrect constructions, the "sense of language" and "linguistic intuition" are important factors in the observation of linguistic phenomena. The construction of hypothetical models also plays a very important heuristic role. However, no one can rest assured that the schemes represented by such models in fact correspond to the real processes of decoding of human verbal communication and the testing of such models on computers tells us more about the logicalness of their design than about the real mechanisms involved in these processes. That is why progressive psycholinguists have become increasingly aware of the need to change over to objective (and, in particular, psychological) methods of studying the processes of verbal communication as a whole and the processes of its decoding in particular. Such methods must lead to the creation of models of the real processes 1 have discussed above. Clearly this psychological approach to the creation of models that adequately reflect psychological processes lying at the basis of verbal communication must differ significantly from linguistic models of language as regards the nature of their object: whereas in linguistics, it is the constructions of language that are modeled (usually quite separately from the psychological analysis of the real processes), in our case the main objects to be reproduced are the real psychological processes of encoding and decoding of verbal communication. Experimental psychological methods used to investigate the understanding (decoding) of verbal expression are still in their earliest stages of development, and are inadequate both in number and in depth. Many of the investigations have been devoted to a study of the rules and processes of decoding of separate sentences. I must refer here primarily to the long investigations undertaken by Miller (Miller, 1951, 1962; Miller and Chomsky, 1963; Miller and Selfridge, 1951; Miller and Isard, 1964; Miller and McKean, 1964), Morton (1964), Garrett et al. (1966, 1972), Bever (1968, 1970, 1972), Fodor et al. (1964, 1967, 1968), Katz (1963, 1964), and others.

177 These investigations fall into several groups. In some of them the m e t h o d used was one in which the subject was given grammatical constructions that gradually moved from incorrect (with random arrangement of the words) toward correct; the "coefficient of correctness" of the grammatical structures was calculated and the process of their understanding was examined (the approximation technique, suggested originally by G. Miller). In other investigations the presentation of a sentence was accompanied by clicks at various m o m e n t s and the subject had to decide at what point in the sentence he received the clicks (Miller et al., 1 9 6 4 - 1 9 6 9 ; Fodor and Bever, 1965); this method showed that subjects listening to a complex sentence are inclined to divide it up, not at random, but in accordance with " c h u n k s " of the sentence, which is what are directly perceived. In a special group of psychological investigations the latent period essential to the understanding of different grammatical structures was studied and the process of understanding sentences received against the background of interfering noise or of other sentences presented simultaneously to the right and left ear was analyzed; experiments of this type showed which of the sentences could be received more easily and which grammatical structures it is particularly important to receive in order to ensure their understanding. Special investigations have been aimed at obtaining detailed psychological descriptions of processes taking place during the understanding of grammatical structures of varied complexity, including ambiguous structures (Bever, 1968, 1970, 1972; F o d o r and Garrett, 1966; Garrett, 1972; Mehler, 1963, 1969). Finally, a whole series of investigations has been carried out to study the understanding of active and passive constructions (Wason, 1959; McMahon, 1972; Clark, 1966, 1972; Gaugh, 1966; Coleman, 1964), the understanding of inversion, especially of constructions changing the form of negation, including the double negative (Smith, 1965; Bever, 1970, 1972; Slobin, 1966; Bellugi, 1967), constructions expressing temporal sequence and including auxiliary words not requiring semantic inversion (of the "A before B" type) as well as constructions requiring such inversion (of the " A after B" t y p e ) (Bever, 1969, 1970, 1972; Clark, 1968, 1969, 1972; Smith and McMahon, 1972), and finally, the process of understanding of complex comparative constructions (Clark, 1968, 1969; Flores d'Arcais, 1966, 1972; Huttenlocher, 1968, 1969) and, something of particular interest, the study of the understanding of reversible and irreversible grammatical structure (Slobin, 1966, 1972). All these investigations provide essential information on the real difficulties that arise during the understanding of grammatical structures of different complexity and of the intermediate transformations used to understand them and they point the way to future psychological and psycholinguistic research.

178 Significantly fewer psychological studies have been made of the understanding of the semantic structure of sentences. These investigations have largely been limited to the study of the understanding of metaphors and proverbs, and they have been undertaken almost entirely on mentally retarded subjects or patients with various degrees of dementia (Zeigarnik, 1962, 1969, 1973). They have shown just how complex the process of abstraction from the direct meaning of the sentence or proverb and the change to the identification of the metaphorical meaning may be under those conditions. I must also refer again here to some investigations I mentioned earlier, which were aimed at studying differences observed in the understanding of the meaning of grammatical constructions by the deaf and dumb, whose speech has developed without any direct influence of verbal communication (Boskis, 1947, 1953; Morozova, 1947, 1953; Korovin, 1950; Shif, 1968). By contrast with the psychological and psycholinguistic study of the understanding of single sentences, the understanding of whole semantic texts and of their general and inner meaning is almost totally unrepresented in the literature. Classical studies were made by Bühler (1908, 1909, 1934) and Bartlett (1932), which I have already mentioned, and the work of other representatives of the Würzburg school, carried out in the first decade of this century, is also well known. These studies by members of the Würzburg school, including Bühler, were devoted directly to the analysis of the understanding of complex, abstract sentences and communications, and they established the fact that perception and memorizing of thoughts take place independently of the perception and memorizing of the separate component elements. Similar results also were obtained by other workers, who were supporters of the German Gestalt psychology. The well-known investigations of Bartlett (1932, etc.), who studied memorizing and reasoning, showed that the memorizing and recall of a whole semantic fragment are not just processes of direct imprinting and "reading" but rather processes of highly complex reconstruction - the identification of the basic semantic components, the analysis of their relationships with each other, and the restoration of the semantic schemes distinguished in the course of this reconstruction. Similar results were obtained by A.A. Smirnov (1948), who studied memorizing and analyzed the process of division of a text into "semantic chunks," fitted together by the subject when memorizing a text. Important research also was undertaken by A.N. Sokolov (1966), who gave the subject a complex text and studied which components are distinguished during the analysis of the text and the order in which they are recalled. Of all the investigations undertaken to study the decoding of complex communications, those carried out on patients with a pathological state (failure of development or disintegration) of their brain functions are particu-

179 larly interesting. It is in pathological states that the principles which, as Pavlov (1949, page 316) expresses it, taken together constitute the physiological normal, are obviously separated and dissociated; for that reason the study of disturbances of the process of "mingling of meanings," the identification of the important semantic elements of information, their synthesis into a single semantic entity and, in particular, the process of transition from the external meaning of a fragment to its internal meaning — begins to be seen particularly clearly when we study how patients with disturbances of brain activity understand semantic texts. Few such investigations have yet been undertaken and, as has already been stated, they are limited to psychological studies of the understanding of semantic texts in the deaf and dumb and in patients with organic dementia and schizophrenia. However, the investigation of the understanding (decoding) of texts by patients with local brain lesions or, in other words, the use of neuropsychological methods, such as were used to study the process of encoding of verbal communication, for the analysis of its decoding may be particularly important. As we saw above, lesions in different parts of the brain differ in their effects on the various components of verbal expression. Lesions of the secondary systems of the left temporal cortex lead primarily to the disturbance of phonemic hearing and to serious disruption of the lexical components of verbal expression. A lesion of the tertiary systems of the parieto-occipital region of the left hemisphere causes disintegration of spatial analysis and synthesis, impairs the conversion of successively received information into simultaneous schemes, and leads to a disturbance of operations with logical-grammatical relations. A lesion of the premotor zones of the left hemisphere leads to a disturbance of kinetic melodies and impairs the processes of fluent, extended, prosodic speech seriously. Finally, a lesion of the frontal lobes disturbs active goal-directed activity and leads to the disintegration of firmly retained programs and to their ready replacement by inert stereotypes, uncontrollable irrelevant associations, or contamination with direct impressions. I have already described the important information that the neuropsychological method can provide for the analysis of the formation of verbal communication. Analysis of how the process of decoding of verbal communication is disturbed in patients with various brain lesions can give no less important results. As we have seen, the decoding of verbal communication incorporates at least three basic components: the understanding of lexical units (the meaning of individual words), the understanding of syntactic structures and the transition from the surface — to deep-syntax structures and, finally, the

180 singling out of the inner (or general) meaning of the whole verbal expression with synthesis of its individual components and with the transition from the general "external" meaning of the text to its internal sense (moral or motivation). We have also seen that the decoding of verbal expression in some cases requires special work on the sentence or text: picking out the significant semantic components, comparing them with one another, the use of auxiliary transformations, the creation of an hypothesis regarding the meaning of the expression and, finally, taking a final decision regarding its general sense. The question naturally arises: at what stages is this complex process of decoding of verbal expression disturbed in patients with local lesions of different parts of the brain? Is a uniform disturbance of all three components of decoding of verbal communication found in patients with all such lesions or do lesions in different parts of the brain lead to a selective disturbance of individual components of the decoding of verbal communication. Is the decoding of verbal communication disturbed similarly in all such cases or do different forms of brain lesions lead to different disturbances of the decoding process and upset the normal relationship between the organized analysis of expression and those intellectual processes (guessing the meaning of the text, slipping into irrelevant associations) that can only interfere with the organized, selective decoding activity. If such dissociation takes place, the use of the neuropsychological method to analyze the decoding of verbal communication could prove decisively important to both psychology and linguistics and could make a new contribution to the development of neurolinguistics — this new branch of language science. A few examples will serve to answer these questions, to demonstrate that such a dissociation of the individual components of the decoding of verbal expression does in fact take place, and to show that the analysis of the way in which the understanding of verbal communication is disturbed in patients with lesions of different parts of the brain can indeed produce useful results. I shall now make a brief survey of the appropriate data and then turn to a more detailed examination. Observations show that a local lesion of the secondary zones of the left temporal cortex invariably leads to the disruption of phonemic hearing; however, perception of the intonational or melodic aspect of speech remains intact. For this reason, patients with such a lesion can no longer recognize individual words involving groups of phonemes (a phenomenon well known in neurology as "sensory aphasia" or "alienation of word meaning"), but they continue to grasp the intonational and melodic aspect of speech quite well, they assess correctly the tone in which the communication is given and its emotional content. Perhaps the most interesting fact is that a patient with a disturbance of phonemic hearing and disturbed understanding of the lexical

181

units of speech continues - within certain limits — to grasp general logicalgrammatical schemes (mutual dependence, restriction, affirmation and negation), at least to the extent to which they are based on the intonational and melodic components of speech. Often such a patient, still able to synthesize consecutive elements into simultaneous structures, can to some extent assess the general structural scheme of the sentence, despite the substantial impairment of his ability to assess individual lexical elements. The picture is different in patients with lesions of the inferior parietal and parieto-occipital zones of the left hemisphere. A lesion of these cortical zones, the "tertiary" (the latest to develop) zones of the posterior parts of the hemisphere, responsible for converting successively received information into simultaneously surveyable schemes, leads to totally different results. Such patients show no defects of phonemic hearing and they have a clear understanding of the meaning of individual lexical units (particularly, of concrete words). However, because of their inability to fit successive pieces of incoming information into simultaneous (especially spatial or quasi-spatial) schemes, these patients have difficulties of quite a different kind. As a rule their difficulties arise when, although easily understanding the meaning of individual words, they have to combine these words into precise semantic structures; for example, to understand the meaning of such an apparently elementary sentence as "na vetke (on the branch) dereva (of a tree) gnezdo (the nest) ptitsy (of a bird)" - i.e., there is a bird's nest on the branch of a tree. In such cases the meaning of each element of the communication (vetka - derevo - gnezdo - ptitsa) is preserved clearly enough, but the patient is quite unable to combine these individual elements into a single system built on the principle of grammatical subordination, and he will helplessly try to find the possible meaning of "vetka dereva" or "gnezdo ptitsy." The difficulties which such patients have when decoding logical-grammatical structures, in which complex inflective relations (for example, constructions with the attributive genitive - "otets brata" (the brother's father) or auxiliary words expressing spatial or temporal relations ("under" and "over", " t o the right" and " t o the left", " a f t e r " and "before"), — are so obvious that inability to distinguish between reversible syntactic constructions such as "a circle above a square" and "a square above a circle," or "father's brother" and "brother's father" have long been used as a reliable diagnostic test for these lesions. Clearly despite the preservation of one linguistic level of the decoding of communication (grasping the meanings of individual words), the patients of this group have great difficulty in operations at another level - the analysis and synthesis of logical-grammatical structures. A less evident but equally important fact is that, although they find it difficult or sometimes completely impossible to grasp the meaning of syntactic structures at once, such patients may be able to guess the general meaning of a communication which does not

182 require exact logical-grammatical analysis of particular syntactic combinations. This account shows the results of inactivation of the various factors included in the decoding of complex communication and it demonstrates how neuropsychological investigation of the syndromes observed in these two groups of patients can be applied to the neurolinguistic analysis of the decoding of communication. The scope of neuropsychological analysis is not confined to the two examples given above, in which the role of lexical assessment of the elements and the role of synthesis of logical-grammatical structures in the decoding of communication can be studied. By means of the neuropsychological method it is possible to identify the role played in the decoding of communication by short-term (operative) memory, on the one hand, and the plasticity of the neurodynamic processes, on the other hand; these are factors which have hitherto proved extremely difficult to study. I stated above that the decoding of communication is a sequential process, taking place over a period of time, and that it incorporates the retention of previous components, which is absolutely essential for that "mingling of meanings" whose importance we have already discussed. However, as became apparent, it is difficult to estimate the capacity of short-term (operative) memory and the concrete role of this condition in the decoding of a complex communication is purely a matter of conjecture. Neuropsychological investigations during recent years (Milner, 1958— 1970; Luria, 1974, 1976) have clearly shown that processes in short-term (operative) memory are functions of well-defined brain systems and that a lesion of the medial zones of the temporal region (the walls of the third ventricle, hippocampus, and structures forming the "circle of Papez") leads to a marked disturbance of short-term memory or, more precisely, to increased inhibitability of traces by interfering factors (Luria, 1971, 1974, 1976). If the lesion involves the medial (or deep) zones of the left temporal region, the defects of short-term (operative) verbal memory may be particularly severe, and although the patient can still remember the individual lexical components of a communication quite well and can still synthesize them into logicalgrammatical structures, he has appreciable difficulty in retaining the separate elements of the communication; for that reason difficulties arise in the normal process of "mingling of meanings" mentioned above. Observations on such patients show that, when trying to decode a long communication, before reaching the end of the communication they easily forget its beginning; when trying to repeat the communication they often lose the final elements; all this naturally interferes with their ability to retain both the surface- and deep-syntax structure as a single entity and to make it the subject of sequential analysis. A careful study of the process of understanding communications by these patients could help to reveal the role of short-term

183 (operative) memory in this process, an aspect beyond the reach of other methods of investigation. Neuropsychological investigation also provides a way of studying another factor in the understanding of communication, one which has been almost completely overlooked in the past and has never received special analysis. A complex communication involves repeated switching from one component (or fragment) to another, from one element to another and, consequently, considerable plasticity of the nervous processes. Under normal conditions the nervous processes are sufficiently plastic for the rapid change of content essential for the decoding of complex communication to take place unhindered and, consequently, it is something which is never investigated. The situation is quite different in pathological states of the brain. Normal plasticity of the nervous processes in such cases may be appreciably disturbed and the ensuing pathological inertia of existing excitations (or more precisely, existing stereotypes) interferes with the normal course of psychological processes. The influence of this pathological inertia has been studied closely by analyzing the motor processes in patients and, in particular, in those with deep lesions of the anterior brain zones, and by investigating disturbances of their expressive speech, writing, and arithmetical skill (Luria, 1963, 1966, 1969, 1970, 1973; Luria and Homskaya, 1966; Luria and Tsvetkova, 1966, 1967); however, there are no grounds for considering that this pathological inertia of nervous processes may not also be a substantial obstacle to the processes of understanding (decoding) of communication. Clearly individual fragments of a communication may evoke firmly established irrelevant associations which have to be inhibited for the communication to be properly understood. For example, in L.N. Tolstoi's story "The Ant and the Pigeon," the sentence: "Next day the hunter set a net in order to catch the pigeon ..." could easily evoke the stereotype "A fisherman set a net," and the correct understanding of the "fragment" requires inhibition of this initial stereotypes "net - fisherman - fish"; the meaning of the fragment can be decoded only when these irrelevant associations are blocked. If it is remembered that the decoding of verbal communication sometimes does not take place under conditions of freedom from interference, and that individual fragments of the communication may readily arouse a host of irrelevant associations and stereotypes, the difficulties facing the recipient of such communication will be clearly apparent. The need to block this flood of irrelevant associations in good time, which can only be done if the plasticity of the nervous processes is adequate, is a factor of the decoding of communication which has so far received very little study; it is evident that only painstaking research in the future can fill this gap·

184 We must now consider the last condition for the decoding of communication, and this again is a field almost completely lacking in objective study. To decode a complex communication demands certain activity from the recipient in order to discover the connections between the elements of the communication and to inhibit the flood of random associations, i.e., to make the process of decoding stable and selective in character. The simplest communications are decoded automatically and no special effort is required; the decoding of complex communications sometimes requires very considerable work, aimed at comparing individual fragments of the communication, analyzing their logical-grammatical relations, and penetrating into the basic thought of the communication. If no such active work were carried out the subject would run the risk of being held up at the stage of recording individual fragments of the communication, unable to penetrate into its inner meaning, to identify its basic thoughts, and sometimes to inhibit the flood of irrelevant associations. It is a familiar fact in neuropsychology that this type of activity, responsible for the selective performance of an assigned program and for constant control over the course of action, is the responsibility of totally different parts of the brain from those we have been considering and, in particular, of the prefrontal cortex; for that reason lesions of the frontal lobes, although they leave the elementary functions of gnosis and praxis intact, may produce a profound disturbance of selective goal-directed activity (Luria, 1962, 1963, 1966, 1969, 1973; Luria and Homskaya, 1966; Luria and Tsvetkova, 1966). Clearly all the disturbances of active selective activity mentioned above must affect the course of that work on a text which is required during the decoding of complex verbal communication. This process of decoding may therefore be disturbed by a massive lesion of the frontal lobes and in such cases the disturbance will be totally different in character. A person with a pathological process affecting the frontal lobes directly or indirectly is, as a rule, able to detect the meaning of individual lexical components of the communication and to understand simple logical-grammatical constructions, but he is unable to penetrate into the inner meaning of the communication, to pick out the essential elements of its moral or motivation, and, what is particularly important, to inhibit the uncontrollable flood of random associations. Clearly, therefore, the neuropsychological analysis of the disturbance of the process of decoding verbal communication in patients with lesions of different parts of the brain can serve as a useful additional method of studying the psychological structure of this process and it can shed much light on the basic problems of speech understanding that are of equal importance to psychology and linguistics. Let us now examine the appropriate material and consider how the process of decoding of verbal communication is disturbed in patients with local

185 lesions of the higher pane to-occipital, postcentral and premotor, deep and, finally, frontal zones of the brain respectively. The next sections of the book will be devoted to this purpose.

3. DISTURBANCES OF UNDERSTANDING OF VERBAL COMMUNICATION IN PATIENTS WITH SENSORY APHASIA

The principal fact that we encounter when studying the speech of patients with lesions of the postero-superior zones of the left temporal region, with a clinical picture of sensory (acoustico-gnostic) aphasia, is a disturbance of phonemic hearing and marked instability of the lexical units. Such patients have difficulty in understanding the meaning of individual words. Words seem incomprehensible and strange; characteristically, the word root is particularly severely affected whereas the system of affixes (which are fewer in number and more generalized in character) is relatively better preserved. That is why a patient with a massive lesion of the secondary zones of the left temporal region, who finds difficulty in differentiating closely similar phonemes, is quite unable to decode clearly the meaning of a word such as "golos" (hair); he hesitates and cannot make the necessary choice from a number of alternative meanings associated with words of similar sound: "kolos?" ... "kholost?" "kholst?" "kolkhoz?". Characteristically, placing a word in a certain category on the basis of the suffix that determines the category may paradoxically be preserved much better in such patients; despite a distinct feeling that a word with the ending "-stvo" ("prostranstvo" - space, "krest'yanstvo" - peasantry, and so on) has some sort of abstract or collective meaning, he is unable to decode its precise meaning. It is on this basis that the patients of this group exhibit their frequent paraphasia, which I have discussed in a previous section of the book: when attempting to recall the word "bol'nitsa" (hospital), they sometimes replace it with a word of similar acoustic composition (literal paraphasia) or with a word of alternative meaning with a common semantic feature ("... militsiya" - police station, "... shkola" - school, "krasnaya armiya" - Red Army), or sometimes they may replace the desired word by a descriptive expression ("... well now ... this is something I need to be in ..."). It is a well known fact that the verbal composition of speech (like the understanding of verbal forms) in these cases is much better preserved than the nominative (substantive) composition and it is familiar to neurologists that the nominative composition of the speech of such patients is poor but its verbal composition is much better preserved (although the mechanism of this well-established fact is still insufficiently clear). These phenomena have been adequately studied (Bein, 1947, 1957; Whitaker, 1972) and I shall not dwell on them further.

186 However, the most important feature from our point of view at this stage is not the many literal and verbal paraphasias affecting the active speech of patients with a lesion of the left temporal cortex and a picture of sensory aphasia, but the poor recognition of the meaning of individual words, the frequent occurrence of "alienation of word meaning" and some degree of "imprecision of meaning," as a result of which a well-marked "lexical paragnosia" forms the center of the speech disturbances in the patients of this group. I shall give a few examples showing the difficulties experienced by these patients in understanding words. For instance, when instructed to point to the nose (nos), the patients of this group may helplessly repeat "nozh ... noz... nozh... nozh..." and they may ultimately declare: "I don't understand what this 'nozh... noz...' is." When asked to point to the eye (glaz), the same thing happens and after several unsuccessful attempts to repeat the word ("glash... glas... glaz... gaz") they give up trying to understand it also. Having heard the word "golos" they repeat "golos... golosh... kolos... kolkhoz" and they are totally unable to distinguish between the words "golos," "kholost," "kolkhoz," "kolos" and so on. Difficulties of this type in the understanding of words, linked with diffuseness of their phonemic opposition, have often been described in the literature (Bein, 1947, 1957, 1967; Bein and Ovcharova, 1970; Luria, 1947, 1970) and they are the basic symptom in patients with acoustico-gnostic (sensory) aphasia. However, it is important to note that this disturbance of the understanding of the lexical composition of verbal communication observable in these patients does not extend equally to other aspects of the understanding of verbal communication. Although unable to clearly understand the lexical composition of speech, the patients of this group are still able to grasp the intonational and melodic aspect of speech and its significance; because of this, although they do not understand the correct meaning of individual words, they can still grasp the general construction of a verbal communication, "guess" its general sense, and thus circumvent the difficulties connected with their inability to grasp the meaning of individual lexical units. Characteristically, these patients also can still to some extent operate with the general syntactic structures of verbal communication. The syntactic "valencies" of verbs remain relatively intact. For instance, these patients realize that the word "prodat' " (to sell) implies certain syntactic connections and evokes the questions " t o whom? and what?" and that the word "kupit' " (to buy) has other syntactic connections and evokes the questions "what? and from whom?", even when the lexical significance of the words is obscure, and this is important. The same is true also of the meaning of names: ai-

187 though not clearly understanding the word "prostranstvo" (space), such patients retain a general impression of the abstractness of this word and the main classes of syntactic connection of words evidently remain much better preserved than their direct substantive meaning. All these factors lead to a very distinctive disturbance of the process of decoding of communication that can be observed only in the patients of the group I am describing: although they cannot decode the lexical composition of communication and, when repeating it, they replace the words in it by involuntary alternatives (paraphasia), the patients can still understand the general syntactic structure of the sentence (relying on inflections and on the intonational and melodic structure of speech) as well as the general sense of the communication, which they often recreate from its separate fragments and on the basis of the general contours of the text and its intonational structure. Characteristically their inability to grasp the lexical meanings of individual words is compensated in these patients by the general context, and their attempts to recreate the precise meaning of a communication from its individual components are compensated by guesses of its general meaning, a feature that is much more important in the understanding of communication by such a patient than by the normal subject. This radical change in the actual psychological structure of the process of understanding of verbal communication and the role that guessing begins to play in it results in incomprehension or misunderstanding of speech, the central phenomenon of sensory aphasia. This fact can easily be verified by very simple tests, in which an expression is given to the patient in its habitual context, giving rise to a guess, and the same communication is then given again, but in conflict with the habitual context, thus interfering with its adequate understanding. In the first case, the patient will apparently understand the verbal communication correctly, but in the second case he will not, and in fact he replaces the adequate understanding of the communication by a guess, which simply arouses firmlyrooted associations. For example, if a patient with marked sensory aphasia is instructed: "Close your eyes!" or "Open your mouth!", reproducing a habitual situation of a patient being examined by a doctor, he does so correctly. If, however, the instructions are reversed and given the rather unusual character - "Close your mouth!" or "Open your eyes!", such a patient as before will continue to open his mouth (responding to the word "Open!") and to close his eyes (responding to the word "Close!"). Clearly his response to the verbal communication is not a true decoding of the content of the sentence he hears, but simply a guess of its meaning based on one fragment only. With these observations in mind we can represent the pathology of the decoding of communication by the scheme I gave earlier (Fig. 2); there is

188 good reason to suppose that the whole structure of understanding of communication in this case is deeply modified and that direct decoding, starting with the direct deciphering of lexical components, is replaced by a process of guessing the semantic scheme of the communication, often on the basis of a very diffuse understanding of its lexical composition. Another essential fact is that the decoding of verbal communication is disturbed equally, whatever its grammatical structure: a "communication of events," not oncluding complex syntactic constructions, is just as difficult for the patients of this group to understand as the complex constructions in a "communication of relations." This fact shows once again that the source of the difficulty in these patients is not so much the decoding of complex syntactic constructions as inability to deduce the meaning of the verbal communication from its unstable and incomplete lexical composition. This is a matter for special and painstaking investigation, but the facts already available confirm the unequal disturbance of different aspects of verbal communication in these cases. We shall see below how this distinguishes patients with temporal (sensory) aphasia from patients with a lesion of the tertiary, parieto-occipital zones of the cortex, whom I shall analyze later. A scheme of the disturbance of the decoding of verbal communication in patients of this group is given in Fig. 15. This scheme demonstrates certain characteristic features of these disorders: the basic disturbance is now manifested in the nominative component (the NP element), which loses its precise, selective value and is easily replaced by semantic or acoustic equivalents (represented by the arrows going from the corresponding nominative component). The predicative component (VP) is much better preserved. Defects of the understanding of the general meaning of the fragment, resulting from the instability of misunderstanding of the meaning of individual words, are compensated by attempts to grasp the general meaning on the basis of guesses (represented in the lower part of the scheme, indicating attempts to restore the general meaning of the communication from the preserved (predicative) fragments. Examples of the difficulty experienced by the patients of this group when decoding verbal communication are given below. Patient Freid., a woman aged 6 2 years (hemorrhage into the left temporal region, syndrome of acoustico-lexical aphasia). The story "The Intelligent Crow" was read to her: (32) A crow wanted to drink. In the yard there was a jug with water. But the water only filled the bottom of the jug and the crow could not reach it. She began to throw stones into the jug and she threw so many that the water level in the jug rose and the crow could drink. She retold the story as follows (S.A. Soldatova's case): "A squirrel (belka, paraphasia instead of "galka," a crow) wanted to catch a small

189

Communication as presented

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