Conversation and Brain Damage (review)

This volume deals with how people with brain damage communicate. The eleven chapters are arranged into four parts.

Part 1: ‘General perspectives’. Charles Goodwin (3–20) presents an introduction of conversation analysis (CA) and of the rest of the book. Emanuel A. Schegloff (21–55) shows the discourse/pragmatic competence of split-brain patients through a detailed analysis of video episodes of interaction between such patients and the therapist. CA research on conduct in interaction is claimed to produce promising results ‘at one of the more exciting growth points of human self-knowledge’ (47), if researchers treat people with communicative disorders as contributing participants of talk-in-interaction and integrate the study of ‘disordered talk’ with that of ‘ordinary talk by ordinary folks in ordinary (for them) settings’ (45).

Part 2: ‘Making meaning together’. Ray Wilkinson, Suzanne Beeke, and Jane Maxim (59–89) examine how speakers with fluent aphasia construct turns at talk using linguistic resources (e.g. lexical items, word order, fronting of noun phrases) that they might have used premorbidly. Charles Goodwin (90–116) focuses on a severely aphasic patient’s extensive use of gesture in a single extended sequence. He shows how gesture can be used to ‘build socially meaningful action’ and questions the validity of ‘assessments of competence based purely on the ability to produce language’ (110). Anu Klippi (117–43) examines meaning construction in aphasic group interactions involving collaborative efforts of both the aphasic patients and the therapists. Participants are found to resort to different linguistic resources, gestures, and situational contexts to achieve mutual understanding.

Part 3: ‘Repair’. Lisa Perkins (147–62) shows that in aphasic conversation quick repair is preferred and repair work is a socially sensitive event. The analysis of aphasic discourse ‘highlights the fundamentally collaborative nature of conversation’ and ‘provides the aphasia therapists with a tool to identify precisely how interlocutors are negotiating aphasia’ (160). Through an examination of collaborative construction of repair in conversations involving two Finnish speakers with Wernicke’s aphasia, Minna Laakso (163–88) finds that presence or lack of active coparticipation and shared knowledge directly affect the speed and success rate of repair. Jan Anward (189–210) presents a detailed comparison of two retellings of the same story by a Swedish woman with Wernicke’s aphasia. The second one is more successful than the first because the story becomes ‘tellable and meaningful in the current situation’ (208). Through an analysis of single and alternative guess sequences in aphasic conversation, Mary L. Oelschlaeger and Jack S. Damico (210–27) find that aphasic speakers and their conversational partners work together to resolve word searches. The collaborative coparticipation provides evidence for the social organization of aphasic conversations and for regarding communicative competence as interactional competence. It also reveals the need for a ‘more sociolinguistic perspective in aphasia treatment’ (223).

Part 4: ‘Interaction and assessment’. Claus Heeschen and Emanuel A. Schegloff (231–82) call for a paradigm shift from a medical (cognitive-experimental) approach to a sociolinguistic (conversational-analytic) approach to aphasia. They argue that testing with aphasics and other neurologically affected subjects should involve ‘naturally occurring conduct—including (perhaps preeminently) conduct in interaction’ (269) and should consider what they can do as well as what they can not do. Gail Ramsberger and Lise Menn (283–303) also argue for a social perspective to the assessment of communicative success in aphasia. They show that CA techniques may provide ‘an objective, ecologically valid measure of therapeutic outcome’ (301).

In sum, I agree with the editor that the papers in this volume might help to change ‘how people with aphasia are perceived and treated in society’, and thus go beyond their ‘theoretical contributions and therapeutic relevance’ (18).