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First-Person Case History

Some Thoughts About Thinking

Manguel, Alberto

Author Information
Cognitive and Behavioral Neurology: June 2015 - Volume 28 - Issue 2 - p 43-45
doi: 10.1097/WNN.0000000000000057
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Alberto Manguel is a translator, reviewer, editor, anthologist, essayist, novelist, playwright, librettist, and constant reader. Born in 1948 in Buenos Aires, Argentina, he grew up in Israel and Argentina. In the 1970s he lived and worked in France, England, Italy, and Tahiti before settling in Toronto, Canada, and becoming a Canadian citizen. He spent the past 15 years living in the French countryside, and recently moved to New York City. Mr Manguel has published in the Spanish and English languages. He has held a Guggenheim Fellowship for Creative Arts and received 4 honorary doctorates.

Mr Manguel provided this medical background about a stroke that he suffered at age 65 while living in a small town in France—the stroke that inspired his essay below.

Mr Manguel is right-handed. He has had hypertension and Type 2 diabetes since about age 56. Both conditions were being controlled with medication at the time of his stroke. He had never smoked and he did not have known heart disease.

When he was 60, a neuroendocrine cancer necessitated partial resection of his colon. Several months later, his spleen was removed and his liver biopsied; neither was shown to be involved. The cancer has not recurred.

One evening 5 years later, he suddenly had difficulty putting his thoughts into words. About an hour later, he was started on tissue plasminogen activator. Magnetic resonance imaging confirmed an ischemic stroke affecting his right hemisphere.

His aphasia did not worsen, and it resolved over the month after his stroke began. When he completed this essay, 16 months after the stroke, he felt fine and noticed only a residual stutter when he was tired.

In 2013, a week before Christmas, in the early evening, I sat down at my desk to answer a letter. But, just as I was about to write the first words, I felt as if they were escaping me, vanishing into air before reaching the paper. I was surprised but not concerned. I decided that I was very tired, and promised myself to stop work after finishing the note.

Trying to concentrate harder, I attempted to form in my mind the sentence I was supposed to write. However, while I knew the gist of what I wanted to say, the sentence would not take shape in my mind. The words rebelled, refused to do as I asked them; unlike Humpty Dumpty, who tells Alice that when using words, “The question is which is to be the master—that’s all” (Lewis Carroll, Through the Looking-Glass, 1872), I felt too weak to give the elusive words orders that they would be constrained to follow. At last, after much mental strain, I managed to scribble a line or 2. I was utterly exhausted.

I felt as if I had been groping in an alphabet soup for the words I needed but, as soon as I put in my spoon to grab a few, they would dissolve into meaningless fragments. I went back into the house (my office was across the yard) and tried to tell my partner that something was wrong. But I discovered that I was unable to mouth the words, except in a painfully protracted stutter. He called the ambulance and an hour later I was in the emergency room being treated for a stroke.

To prove to myself that I had not lost the capacity of remembering words, only that of expressing them out loud, I began to recite in my head bits of literature I knew by heart. Thankfully, the flow was easy: Poems by Saint John of the Cross and Edgar Allan Poe, chunks of Dante and Virgil, doggerel by Arturo Capdevila and Gustav Schwab echoed clearly in the darkness of my hospital room. The ability to read (both the books in my memory and those printed on paper) never left me and, a few hours later, I found that I was again able to write. However, whenever I tried to speak to the nurses, the incoherent stammer persisted. Only after 4 or 5 weeks of hesitant speech did the stammer gradually disappear.

The experience, while terrifying, made me reflect on the relationship between thought and language. If thought, as I believe, forms itself in our mind by means of words, then, in the first fraction of a second, when a thought is sparked, the words that instantaneously cluster around it, like barnacles, are not clearly distinguishable to the mind’s eye: They constitute the thought expressed in words only in potentia, a shape underwater, present but not fully detailed. When a thought is caused to emerge in the language of the speaker (and each language produces particular thoughts that can be only imperfectly translated into another language), the mind selects the most adequate words in that specific language to allow the thought to become intelligible, as if the words were select metal shavings gathering around the magnet of thought.

A blood clot in 1 of the arteries that feed my brain had blocked, for a few minutes, the passage of oxygen. As a consequence, some of my brain’s neural passages were cut off and died, presumably ones dedicated to transmitting electric impulses that turn words conceived into words spoken. Unable to go from the act of thinking to its verbal expression, I felt as if I were groping in the dark for something that crumbled at the touch, preventing my thought from forming itself in a sentence, as if its shape (to carry on with my image) had been demagnetized and were no longer capable of attracting the words supposed to define it.

This left me with a question. What is this thought that has not yet achieved its verbal state of maturity? This, I suppose, is what Dante meant when he wrote that “my mind was struck/by lightning bringing me what it wished” (The Divine Comedy: Paradiso, Canto XXXIII, verses 140-141; published 1321): the desired thought not yet expressed in words.

Under normal circumstances, the progress from the conception of a thought in the specific linguistic field of the thinker to its verbal constellation, and on to its expression in speech or writing, is instantaneous. We don’t perceive the stages of the process, except in half-dreams and hallucinatory states (I experienced this when, in my 20s, I experimented with LSD). After my stroke, this process was slowed down, became halting, uncertain, as if someone had turned off the lights in a familiar stairwell.

Faced with the inability to put my thoughts into words, I tried to find synonyms for what I knew I was trying to say. Again, a simile might help: It was as if, traveling down a stream, I had come to a dam that blocked my way and I sought to find a side canal to allow my passage. For instance, in the hospital, discovering that it was impossible to say, “My reflective functions are fine, but I find speaking difficult,” I managed to blurt out to the doctor, “Words, speak, hard.”

I experienced the expression of negatives as especially problematic. In my slowed-down mental process, if I wanted to say, in answer to the nurse’s question, “I don’t feel pain,” I found myself thinking “I feel pain” and adding “no” to the affirmative sentence. Accustomed to my normal rhythm of speech, I would try to answer at once, but the words would come out as “of course” or “yes” before I had time to construct my thought with the appropriate negative. It seems that, in my mind, the stage of affirmation precedes that of negation.

Perhaps, I said to myself afterward, this is how one’s literary style works: selectively finding the right waterway, not because of any blockage of the verbal expression (in the case of writing something) but because of a particular aesthetic sense that chooses not to take the commonplace main course (“the cat is on the mat”) but a particular side canal (“the cat slumbers on the mat”).

In the months following my stroke I became keenly conscious of these directional choices. I suppose this was to be expected: After you break a leg, you are more conscious of the act of walking. So it was, for me, with the act of thinking. The bridge that ordinarily led from my perceptions and consciousness of those perceptions, and from the abstract considerations and associations that these produced, to the practical realm of words that ordinarily would have attempted to express them, that bridge had collapsed, but on this side of the divide thoughts still gathered and multiplied and formed associations, and yet were unable to reach the other side.

In the 4th Century, Augustine compared the process to the recitation of a psalm. “Suppose that I am going to recite a psalm I know,” he suggests in the Confessions 278, Book 11, Section 28:

Before I begin, my faculty of expectation is engaged by the whole of it. But once I have begun, as much of the psalm as I have removed from the province of expectations and relegated to the past now engages my memory, and the scope of the action which I am performing is divided between the two faculties of memory and expectation, the one looking back to the part which I have already recited, the other looking forward to the part which I have still to recite. But my faculty of attention is present all the while, and through it passes what was the future in the process of becoming the past. As the process continues, the province of memory is extended in proportion as that of expectation is reduced, until the whole of my expectation is absorbed. This happens when I have finished my recitation and it has passed into the province of memory.

Trying to observe what was happening in my mind without the help of words, I noticed that whatever it was that was taking place did so outside time, as it were. Even allowing for the flow of quotations and visual memories, and vague imaginations about what would happen in the next few minutes, or hours, or days, the totality of complex processes of thought existed simultaneously, in a persistent here and now. Nothing disappeared or felt like a foreshadowing; everything was present even as it changed.

Medieval painters found ways of showing the evolution of a story in a single frame: In the same image, they depicted Saint Francis in the rich house of his parents, Francis undressing in front of his father to go naked into the world, Francis and his followers building his church, Francis preaching to the birds, and Francis receiving the stigmata. The sequence was temporal and the locations were various, but the material image of Francis’ life, the spectator’s vision of the story, was 1. In the same way, everything that was happening in my mind (even though, of course, I could not see more than a tiny part) was all there, all the time that I remained conscious of it. I don’t know what happened when I slept. The narrative of dreams is another story.

The realization that the expression of my thoughts into words would have required imposing on that single comprehensive vision a temporal and spatial sectioning and hierarchy, made me think (and this new thought appeared not as new and not as consequential) that our consciousness of ourselves and of the world is structured upon what I would call grammatical presumptions, which, in turn, are based on our notions of time and space. That is to say, the thoughts that our experience elicits are translated in our mind according to the rules of the language into which we translate it, and are fitted with the conventional forms that those rules demand. I’m told that in Estonian there is no future tense.

Therefore, the notion of temporal continuity that is an essential and intricate component of our consciousness would allot values of clarity and simplicity to the notions of past and present, explicit in their formulation, and of complexity and uncertainty to the future, expressed in circumlocutions. The scandal produced by the Mad Hatter’s affirmation to Alice that there’s “jam yesterday and jam tomorrow, but never jam today” (Lewis Carroll, Alice’s Adventures in Wonderland, 1865) stems from the implicit prestige of the present tense in the English language, where the notion of what happens now is equivalent to the notion of what is real and therefore true, and what is past and what still lies in the future do not benefit from the same degree of certainty.

Jorge Luis Borges, in “The Immortal,” a story published in 1949, has his narrator, a Roman soldier of the reign of Diocletian, imagine what the consciousness of a non-verbal being (a Troglodyte) might be. The Troglodyte (whom the narrator names Argos in memory of Odysseus’ faithful dog) and the narrator share the same perceptions but seem to participate (Borges says) in different universes: Not possessing speech, the Troglodyte combines these common perceptions “in another way” and makes “other objects with them” or, perhaps, there are no objects for him, “only a vertiginous and continuous play of extremely brief impressions.” And then the narrator says, “I thought of a world without memory, without time; I considered the possibility of a language without nouns, a language of impersonal verbs or indeclinable epithets.”

“A language without nouns, a language of impersonal verbs or indeclinable epithets”: This approximates the state of my mind in the hospital. After my stroke, I knew that I was thinking of an action without being able to label it, even impersonally, but somewhere in the background of my thoughts lay a verb that I knew to be “to drink” and a condition that I recognized as “thirsty.” I guessed the existence of these words even if I couldn’t bring them to my tongue. I thought of an afternoon in my adolescence when I was standing on the bank of a misty river, knowing that there were people and houses on the other side but not being able to make them out, and the recollection brought to mind a line of Virgil: “stretching their arms full of love towards the farther shore.” I say the line was brought to mind, but even though the Latin words emerged in my mental field of vision, I couldn’t have pronounced out loud, “I’m remembering a verse from the Aeneid.”

Lying in the hospital, allowing my brain to be scanned in coffin-like machines, I reflected on the fact that our age has allowed us that which medieval theologians believed impossible except for God: the observation of our observing, the ability to draw a chart of our thinking, the privilege to be both audience and performer of our intimate mental procedures, holding, as it were, our soul in our hands.


stroke; thinking; language; aphasia; dysgraphia

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