One Hundred Names for Love: A Stroke, a Marriage, and the Language of Healing BY Diane Ackerman (W.W. Norton, 2011) From the Publisher: “One day Ackerman’s husband, Paul West, an exceptionally gifted wordsmith and intellectual, suffered a terrible stroke. When he regained awareness he was afflicted with aphasia — loss of language — and could utter only a single syllable: ‘mem.’ The standard therapies yielded little result but frustration. Diane soon found, however, that by harnessing their deep knowledge of each other and her scientific understanding of language and the brain she could guide Paul back to the world of words. This triumphant book is both a humane and revealing addition to the medical literature on stroke and aphasia and an exquisitely written love story: a magnificent addition to literature, period.”

To love – to marry – a partner older by many years contains, implicit within the commitment, two nearly inevitable provisos. The first: as the older partner’s body and mind begin to wear away, the younger’s most pressing role will become that of caregiver. The second: given the likelihood of outliving the elder, the younger spouse’s own old age may well be spent, in one important sense at least, alone. Consider the effect of aphasia on the lives of two brilliant and highly prolific wordsmiths whose collective breadth of work exhibited nothing less than a polymathic repository of shared knowledge. In 1970, as a “flower-child undergraduate,” the acclaimed poet and naturalist Diane Ackerman married the equally celebrated novelist Paul West, eighteen years her senior. She was only in her own thirties when West, aged fifty-five, developed heart arrhythmia and had to be fitted with a pacemaker. Twenty years later, while hospitalized for a kidney infection (when he became so bored that he composed an entire sonnet cycle), West experienced a massive stroke. With critical medication proscribed on account of his pre-existing heart trouble, severe damage to the neurological centers that govern language left him with a profoundly debilitating condition: global aphasia. Aphasics can understand some of what is spoken to them (although the ability to read, or recognize symbols, is highly compromised), and may believe they are communicating normally, but their actual speech is usually reduced to a single word or syllable. In West’s case, it was “mem.” Consider the effect of aphasia on the lives of two brilliant and highly prolific wordsmiths whose collective breadth of work exhibited nothing less than a polymathic repository of shared knowledge. Overnight, West loses access to his own genius, his control over some of his body and his ability to think or interact at even the most basic level of functionality. Ackerman’s independence, including time for her own writing or worry-free travel, suffers. They do not have children or relatives with whom the burden of caregiving can be shared by default. Most devastatingly: they are no longer equals. And gone is the private language unique to every couple, with its terms of endearments and play. Everything about day-to-day life changes: West must relearn how to swallow, how to speak on the telephone, and a catalogue of other prosaic things which, if done wrong, could result in terrible consequences. “Scrap by scrap, fragment by iota,” she writes, “life continued to evolve to accommodate his illness, which took on a life of its own, and became another inhabitant of the house, a central one, complete with special foods and routines.” One Hundred Names for Love is Ackerman’s poignant yet very charming memoir of the five years that followed West’s stroke. Gradually, with daily concentration and support, and tremendous reliance on his wife’s intuitive understanding of who he is and what he wants, West finds his way back to speaking, swimming, and even reading and writing. His functional vocabulary extends well beyond “mem,” and probably comes to exceed even that of most readers. Samuel Beckett and Charles Baudelaire (whose own aphasic pronouncement was French for “goddamn,” a tragicomical detail given that he was left in the care of a nunnery), among other authors, suffered aphasia near the end of their lives; neither had a partner like Diane Ackerman nor the scientific advances of today.

Crucially, Paul West’s near-recovery from global aphasia makes significant contributions as a neurological case study. One of the things they discover during his therapy sessions is that traditional exercises do not accommodate the particular curvature at which his mind, the creative mind, had always engaged with the world. Neither are most of the therapists he encounters equipped with the vocabulary he had at his disposal prior to the stroke, into which his mind continues to fish: words like “tesseract,” “tardigrade,” and “cherubim” are assumed — until Ackerman steps in — to be “nonsense words,” the ramblings of the brain-damaged.

Ackerman has spent vast amounts of her life in the acts of sheer marveling and deep enquiry…. what emerges is a memoir replete with facts, trivia, intimate yarns and – in a manner which few post-trauma memoirists engage in – delight.

Ackerman, who herself is a quintessential example of how the artistic mind never traffics merely in dictionary definitions or other limitations of usage, offers through her experience as West’s caregiver two notable observations relating to aphasia. The first is that while West gropes for a basic word like “table,” it easily conjures the obscure, like “templum” – suggesting that it is possible that sophisticated language, learnt after childhood, is stored and processed in a different part of the brain. The second is that men are more prone to speech-related ailments, and this may have some correlation with evidence that women use both of the brain’s hemispheres to converse, and do so with more alacrity, whereas men primarily use the left side.

Ackerman has spent vast amounts of her life in the acts of sheer marveling and deep enquiry. Her literary career – in particular excellent nonfiction treatises such as A Natural History of Love and A Natural History of the Senses – are testament to this. In One Hundred Names for Love, she turns this same spirit toward her husband’s illness and recovery. What emerges is a memoir replete with facts, trivia, intimate yarns and – in a manner which few post-trauma memoirists engage in – delight.

There is an abundance of good humor in these pages that belies what a less effulgent heart might regard purely as a medical tragedy. We are treated to West’s bons mots and bolts from the blue with the astonishment of a parent whose child has said or done a clever thing, yet free of the condescension that a caregiver’s role could have easily introduced into the dynamic. Ackerman allows only small glimpses of the fatigue, frustration and pain that she must no doubt have experienced; a case of aphasia in a “house made of words,” as she calls it, is no less than a partial widowing.

Toward the end of the book, when the author shows her husband’s brain scans to a specialist who gravely guesses that they must belong to a person in a vegetative state, to know that they in fact belong to an aphasic who authored three books within five years of an irreversible stroke seems less a miracle than proof of the triumph of human will – including, not least, the will to laugh.

“You are the hapax legomenon of my life,” he says to her one day, unexpectedly dislodging from deep in the recesses of his knowledge the Latin term for “a word that occurs only once in the entire written record of a language.” By the end of this sparkling ode to love and intelligence, Ackerman and West emerge as no less admirable a duo – or “duet,” to use her word – than they were prior to the aphasia. Before aphasia, they were one of modern literature’s most formidable partnerships; after it, theirs is also undeniably one of the great love stories of our time.