Subjective Experience of Word Production Difficulties in Aphasia: a Metaphor Analysis of Autobiographical Accounts

ABSTRACT

Background and aims

The subjective experience of neurological symptoms provides useful information for assessment, intervention and care. However, research in the subjective experience of aphasia is limited. Word production difficulties are universal to aphasia, and interdisciplinary research has produced sophisticated models of the multiple stages and processes involved. Critically, this word-production research does not incorporate the subjective experience of symptoms. We carried out a metaphor-led discourse analysis on autobiographical accounts written by people with aphasia, to determine whether subjective descriptions of word finding difficulties are consistent with the stages and processes of psycholinguistic models.

Method

Metaphor-led discourse analysis was used to identify, code and interpret metaphorical expressions describing word production difficulties in 12 English-language autobiographical accounts written by people with aphasia. These expressions were then analysed to determine the systematic metaphors (i.e., the related concepts which are used consistently to describe a particular topic). Two distinct types of systematic metaphor emerged in the analysis: conventional systematic metaphors frequently recurring throughout all or most of the accounts; novel systematic metaphors used in one or two extended passages in an overlapping subset of the accounts.

Results and discussion

4020 metaphorical expressions described word production, predominantly using conventional metaphors about communication and cognition. The conventional metaphor WORD-PRODUCTION AS MOVING OBJECTS OUT OF A CONTAINER was the most prevalent, with elaborations and variations allowing mapping of different symptoms. Other conventional metaphors included: WORD PRODUCTION AS A JOURNEY/HUNTING/HERDING THROUGH A LANDSCAPE, allowing description of effortful or partial retrieval, neuroplastic recovery, and internal strategies; APHASIA AS BODILY IMPAIRMENT, which described various symptoms in terms of different body parts, including self-monitoring difficulties; and APHASIA AS FRAGMENTATION AND PERSONIFICATION OF SELF and SELF AS MACHINE/COMPUTER to describe a disrupted sense of agency and attention. Novel systematic metaphors were used to describe certain symptoms: APHASIA AS SILENCE and APHASIA AS SPIRITUAL EXPERIENCE were used to describe a lack of ‘inner speech’, and APHASIA AS A DISMEMBERED TREE to describe problems making semantic associations.

Conclusions and implications

This research demonstrates the many consistencies of subjective descriptions of word production difficulties in aphasia with theoretical models, but also shows that some subjectively salient symptoms, in particular attentional and self-monitoring difficulties, and a lack of inner speech, are not captured by all theoretical models. Careful attention to the way that people with aphasia describe their symptoms can provide a valuable source of information to be integrated with objective measures.

KEYWORDS:

• metaphor analysis
• naming
• aphasia
• systematic metaphors
• autobiography

Acknowledgments

This work was supported by an ESRC South East Network for Social Sciences (SeNSS) Studentship Award to the first author. Thanks to Peggy Mercer, Jen Tyldesley and Emily John for assistance with collecting and coding data. Thanks to anonymous reviewers for Aphasiology for their valuable feedback, in particular on clarifying methodological rigour and theoretical implications. Thanks also to Sarah-Maria Thumbeck and Julianne Alexander for helpful comments on an earlier draft of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. The typographic convention of small caps is used to distinguish these abstracted systematic metaphors from the actually used vehicle terms that occur in the data.

Additional information

Funding

This work was supported by the Economic and Social Research Council.