Hard Talk: When Speech is Difficult

Jonathan Cole 

256 pps, MIT Press, May 2025

ISBN-10: ‎0262049562

ISBN-13: ‎978-0262049566

 

 

The effortless ability to comment, quip and contribute to a conversation is something we generally take for granted. Imagine if this were to become a struggle due to a poorly functioning voice, effortful articulation, or a difficulty understanding or using language. These are the challenges faced by the people Jonathan Cole writes about in his engaging and insightful book, Hard Talk: When Speech is Difficult.

Cole starts by discussing the purpose of speech and its primary importance as a means of social bonding, perhaps the human equivalent of primates grooming each other. Cole interviewed people living with impairments such as vocal fold palsy and spasmodic dysphonia; those whose difficulties are more with articulating speech, such as cleft lip and palate, cerebral palsy, and the much rarer Mobius Syndrome; and stroke survivors with acquired aphasia. The resulting book tells the stories of these individuals, not just describing their medical conditions, but exploring how these influence or restrict their lives (sometimes both socially and professionally), limit their ability to develop new relationships or maintain existing ones, and frequently affect their mental health.

Being afflicted with a rare and poorly recognised condition can add to the trauma. Cole describes how Jude woke up one morning feeling “as if someone had a hand around her throat”. She thought that her strange, strangled voice must be due to laryngitis and feared for her future when her voice did not improve. It was only when her nephew heard someone who sounded like her on television that she learned about spasmodic dysphonia and recognised this as her likely condition.

Many contributors talk of the fluency of their internal dialogue in contrast to the effort required to transform this into spoken ideas. Cole vividly illustrates the situation of Jeppe, a young man with cerebral palsy whose uncontrollable spasms oblige him to communicate via a personal assistant who recites the alphabet line by line with Jeppe indicating the intended letter by a tiny movement of his head. Cole describes the mental agility and effort required by Jeppe to hold a sentence in his head, while breaking it into words and letters for his PA to recognise and put together to communicate his thought. While society might tend to assume that a person who struggles to express themself is of lower intellect, Cole shows how Jeppe’s exacting means of communication reveals quite the opposite.

The impact on families is poignantly illustrated in the story of James who developed abulia following a stroke, robbing him of the ability to initiate an action or a conversation. Family members may need to find new ways of relating to a person whose personality may appear to be lost or changed by their altered ability to communicate.

Cole concludes that the greatest barrier for people with speech difficulties is often the lack of effort and patience on the part of the listener who may have no awareness of communication impairments. Cole asserts that the onus is on us: if someone finds speech difficult, it is up to us to listen harder.

 

Review is by Norma Fender who is a Speech and Language Therapist in South East London