Communication Difficulties

Two swans in deep blue water with their backs to each other, one in profile to camera, other swimming away.

We communicate with each other via input and output. Output is easier than input. That is, talking and writing are cognitively easier than listening and reading.


We output what is already resident in our brain. The sticking point is communicating the internal to the external. For some people, that may be easier via writing and for others via talking. Since brain injury damages foundational cognitions like attention and memory, people cannot usually stay on track while talking. It happens, too, with writing. But with writing, you can go back to try and fix your verbos and edit down your circumlocution to what you meant to say — although that depends on the how extensive the damage is to reading, attention, and working memory. You can also show what you’re really feeling or wish you were feeling. With talking, there’s no fixing using the wrong words, rambling talk as you hunt for what you want to say, and ping-ponging between leaky eyes, no affect, and/or anger as opposed to expressing what you’re really feeling or think you’re feeling.

With brain injury, knowing what you want to say eludes you. It’s like some part of you has something to say but that part flits in and out of the conscious mind or isn’t even accessible to the conscious mind. It’s like something is bothering you, but you don’t know what. You need time to talk or write in a circumlocutory fashion until it pops out, and relief floods you — both in getting out the bothersome thought and in seeing what it is. You may forget in the next moment, but the person you’ve communicated it to — or your journal — will not.

If they’ve been listening or haven’t interrupted what seems like rambling to them.

Being interrupted from misunderstanding communication difficulties is the biggest issue: few have the patience to listen to what seems like nonsense or non-stop droning and hopscotching topics. They don’t realize it’s the expression of a brain whose communication circuits take the long way round to express what you’re thinking and/or feeling.

Illustration of brain with drawn black lines showing connection between Wernicke's area and Broca's area that are circled.
Illustration from Anatomy & Physiology, Connexions Web site., Jun 19, 2013.

The problems with communication lie in Wernicke’s Area and Broca’s Area. (Reading comprehension difficulties and the need to diagnose them properly and treat are a separate issue.)


The traditionally understood role of Wernicke’s area is to comprehend speech and written language. Before you can respond in a conversation, you must be able to comprehend speech. That comes out of Broca’s area.

Animation of left hemisphere of brain in transparent skull with Wernicke's area indicated in red.

Wernicke’s Area resides in your left temporal lobe, just above and behind your ear.

Animation of left hemisphere of brain in transparent skull with Broca's area indicated in red.

Broca’s area resides in the dominant hemisphere in the frontal lobe.

The dominant hemisphere would be on the left side if you’re right handed. The function of Broca’s area includes producing speech. Issues of non-responsiveness to conversation and instructions lie in damage to these areas, resulting in loss of the ability to comprehend and/or to produce speech.

Types of Communication Difficulties


Aphasia usually results from brain injury. It can vary from encompassing every form of communication to predominantly or only one, for example, talking but not listening or vice versa. Aphasia also affects reading and writing.

“Aphasia is a language problem that masks a person’s inherent competence, and most dramatically affects conversational interaction (talking and understanding), as well as the ability to read and write.”

The Aphasia Institute

The problem with aphasia is that we assume the way a person speaks reflects their intelligence. That’s false. Difficulty saying words doesn’t reflect difficulty in thinking. Because of slow processing and injuries to Wernicke’s area and/or Broca’s area, a person has thoughts but cannot move those thoughts into speech. See The Aphasia Institute’s FAQ on how to communicate with a person with aphasia — or any person with communication difficulty, really.


To confuse you, dysphasia has the same definition as aphasia. Usually resulting from brain injury, dysphasia “affects your ability to produce and understand spoken language. Dysphasia can also cause reading, writing, and gesturing impairments.” (Healthline)

“Dysphasia is a language disorder. It occurs when the areas of the brain responsible for turning thoughts into spoken language are damaged and can’t function properly. Consequently, people with dysphasia often have difficulty with verbal communication.”

Healthline, What is Dysphasia?

My dysphasia manifested itself as stuttering, slow response in conversations leading to eventual shut down as fatigue built up, and English turning to gibberish. That part was fun. Not! My speech-language pathologist told me to tell people to speak slower. Most interpreted that to mean shout. That hurt my ears. So I resorted to asking people to repeat themselves. (Reading difficulties I discuss on a separate page.)

Dysphasia and aphasia have the same causes and symptoms. Some sources suggest aphasia is more severe, and involves a complete loss of speech and comprehension abilities. Dysphasia, on the other hand, only involves moderate language impairments.

However, many health professionals and researchers use these terms interchangeably to refer to full and partial disruptions of language abilities. Aphasia is the preferred term in North America, while dysphasia may be more common in other parts of the world.

Healthline, What is Dysphasia?


People see swearing as bad behaviour or maybe a person acting out. So the common response by some brain injury organizations is to tell people that they will be expelled from groups if they don’t clean up their language. Show respect to others, they instruct, while never seeming to ask themselves why people with brain injury, including dementia, swear, especially when they hadn’t prior to injury.

“While conducting fieldwork in the late 1980s in Fargo, Diana Van Lancker Sidtis, a neurolinguist, encountered a striking phenomenon. A North Dakota farmer had been left unable to speak by a stroke — a condition called aphasia. And while he couldn’t discuss the weather or name the day of the week, he did manage to make political critiques of the president with the help of a special type of word.”

Your Cursing Cortex,, 10 July 2019

Researchers have learnt that swear words reside in a different part of the brain than vocabulary, and for some reason, remain accessible after injury. Swear words help dispel stress, and so these special words may be encoded in multiple areas like multiple backups of your most important documents.

“As it turns out, there is a body of research on the neurobiology of swearing, and it largely supports the idea that the brain treats curse words as special. One source of evidence comes from Tourette’s syndrome (TS), a neurological condition characterized by involuntary behavioral tics. In some TS cases, these tics are manifested as involuntary outbursts of cursing or other inappropriate language. Another line of evidence is seen in aphasia, which is a specific loss of language caused by brain damage or dementia. Though people with aphasia may have severely impaired speech, they often produce curse words with greater fluency and regularity than other words.

A Special Place in the Brain for Swearing, Helix, 18 February 2013

Specialists treating patients with aphasia have observed other aspects of swear words versus non-swearing vocabulary.

“Many aphasics retain the ability to produce automatic speech, which often consists of conversational placeholders like “um” and “er.” Aphasics’ automatic speech can include swear words — in some cases, patients can’t create words or sentences, but they can swear. Also, the ability to pronounce other words can change and evolve during recovery, while pronunciation and use of swearwords remains unchanged.”

How Swearing Works, Swearing and Brain Damage,

Researchers categorize swear words as emotion words and are trying to narrow down how the brain processes them and where (PubMed). And so by treating swearing as behavioural instead of manifestation of injury, people disrespect the pain of the person who can’t access their vocabulary and whose broken brain tumbles swear words out of their mouth.

What To Do To Heal It?

How do you resolve communication difficulties? By treating the brain injury. You can use one or several neurostimulation therapies, especially brain biofeedback to target attention difficulties. But also direct neurostimulation of Wernicke’s Area can rapidly improve conversation. The marked improvement in conversational ability reflects improvements in Wernicke’s and Broca’s and the restoration of speech and listening.

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