Hard Talk: When Speech Is Difficult

A moving, patient-centered portrait of the social importance of speech, from a medical expert known for his humanizing explorations of health.


Language comes to us through culture, environment, and family. Words embed over time, as we use our minds to comprehend them and then our mouths to say, mean, and own them. Without the ability to speak, or when talking becomes difficult, we face a challenge like few others, forced to reconnect with a world which assumes its communicators are eloquent vocally. In Hard Talk, Jonathan Cole takes a necessary look at the privilege of speech so we can better accommodate those for whom it presents problems.

Cole creates space for people with a variety of conditions, including cerebral palsy, vocal cord palsy, cleft palate, Parkinson’s, and post stroke dysphasia, to describe in their own words what the experience of difficult speech is like. No struggle is the same. Each develops along its own axis of factors—cognitive, social, and physical—that lead to unique vulnerabilities as well as extraordinary moments of adaptation and resilience. One person finds social chatter becoming more problematic than work speech. Another grows alarmed as changes in speech begin to constrain inner thoughts. Some lose the ability to find or make words though they retain awareness, while others lose self-awareness but maintain fluent speech bereft of meaning. One even loses the ability to speak with family while continuing to interact at work.

Hard Talk reacquaints us with the social power of speech while affirming the humane value of listening. Cole also reflects on the neuroscientific advances we’ve made in understanding barriers to speech and how we might reduce them.