Donald Trump has recently claimed that Hillary Clinton lacks the “mental and physical stamina” to be president. Just this week during an interview on MSNBC, Katrina Pierson, spokesperson for the Trump campaign, referred to Clinton’s “dysphasia” as evidence for this claim. Last week on Fox News, Sean Hannity asked Fox News medical correspondent, Dr. Marc Siegel, to comment on Clinton’s “weird pauses,” “coughing fits,” and “odd” facial expressions. In response, Dr. Seigel said, “…I’m wondering about a word called ‘aphasia’ where you’re searching for words, you suddenly lose those words, and that can be the sign, again, of some kind of traumatic brain injury or the after effects of a concussion.”
To be fair, in this and other interviews, Dr. Seigel admitted he can’t diagnose anything simply from a video clip. However, even after saying this, he openly speculated that Hannity’s observations of Clinton’s “weird pauses” are consistent with a diagnosis of aphasia. This speculation is irresponsible at best, and at worst fans the flames of Trump’s conspiracy theories.
For the moment, let’s ignore the incorrect assumption that someone with a language disorder or a brain injury is incompetent or unfit to hold political office. I’ll address that in a bit.
First, let’s clearly define the terminology used in these statements. The term “dysphasia” (that’s with an ‘s’, not a ‘g’) and “aphasia” are essentially synonymous. Although the literal definition of a-phasia is a total loss of language and dys-phasia is a partial loss of language, the term ‘aphasia’ is most commonly used to refer to either a complete or partial loss of language. A recently published article by Worrall and colleagues (2016) briefly reviews the history of these terms and calls for the elimination of the term “dysphasia.” They argue that using one term helps to avoid confusion (dyspha-sia is too similar to another term dyspha-gia, a swallowing disorder) and that “aphasia” is the preferred term in clinical, academic, and consumer publications and organizations. So if we are going to talk about it, let’s just agree to call it aphasia.
Now that we have our terminology straight, let’s address the next issue — are the “weird pauses” occasionally inserted into Hillary Clinton’s speech consistent with an aphasia diagnosis? The short answer is no, not even remotely. The fact is we all pause when we speak. Whether or not Clinton’s occasional pauses are “weird” seems to be a very subjective assessment, but regardless of what you might think, they are consistent with typical speech patterns of unimpaired adults. According to a 2014 review article in Science, as we age we “use more vague terms, have more frequent and more empty pauses . . . consistent with findings that older adults have more difficulty with word finding” (Shafto & Tyler, 2014). In other words, increased pausing and word finding difficulties are a part of normal ageing and occasionally forgetting a word is not the same thing as having a language disorder.
So now we’ve established that occasional pausing during speech does not equal aphasia. But you might ask, what about the fact that Hillary Clinton had a concussion? According to news sources, Clinton experienced a mild concussion in 2012 after a dehydration-related fainting episode. After a follow-up MRI, Clinton was diagnosed with cerebral venous sinus thrombosis, a blood clot that forms in the venous system of the brain. Does this condition have the potential to cause brain damage? Yes, but Clinton was treated right away for this condition, never experienced any symptoms, and her physician, Dr. Lisa Bardack, reported that she made a full recovery. It is very unlikely that almost four years later Clinton would be showing any significant residual effects from the concussion.
Finally, there is one issue that has not yet been part of this conversation, but I think is one of the most upsetting consequences of this situation. The false statements about Clinton contribute to the (incorrect) public perception that persons with aphasia are inherently incompetent. Aphasia is an acquired language disorder that affects about two million Americans.
Although all individuals with aphasia experience some level of difficulty with understanding and/or producing language, aphasia does not affect the person’s intellect and can only be diagnosed by a speech-language pathologist or neurologist.
In response to Katrina Pierson’s statement this week, the American Speech-Language-Hearing Association and the National Aphasia Association both published statements to emphasize this to the public. In other words (pun intended), persons with aphasia don’t have trouble thinking, they just have trouble with the words. We were recently reminded of the intellect, competency, and bravery of one individual with aphasia when Gabby Giffords spoke at the Democratic National Convention last month.
The horrific traumatic brain injury she suffered resulted in severe aphasia along with a myriad of other cognitive and physical challenges. Despite these significant challenges, Giffords has persevered through the recovery process and continues to fight to change policy. Giffords serves as a shining example of the abilities of persons with aphasia, showing that a loss of language doesn’t mean a loss of leadership.