From heard to narrated: therapist-subject with aphasia interlocution in an activity with comic books

ABSTRACT

Purpose

To analyze the therapist-subject with aphasia interlocution in the process of interpretation and organization of comics.

Methods

Cross-sectional study of a qualitative nature. The data are from audio-recorded enunciative situations and presented descriptively by interlocution charts (A1-T1) and (A2-T2), registering activity with Comics, held at a meeting of the Interdisciplinary Group of Coexistence (GIC) in which subjects with and without aphasia participate. The interlocution between two therapists in training (T1 and T2) and two subjects with aphasia (A1 and A2) is analyzed. Results: The interlocutions between A1-T1 and A2-T2, which occurred during the process of organization of the comic, show different positions of the therapists regarding the ear and the narrated. A1 is recognized by T1 as a subject of language as the therapist promotes disjunction, that is, it directs A1 to the condition of speaker; the same does not occur with A2 and T2, because the former is not recognized as a subject of language, since T2 remains in conjunction, not giving A2 speaking space.

Conclusion

Benvenistian enunciation is configured as a theoretical and methodological resource for analysis and clinical intervention with subjects with aphasia; the context of group coexistence imposes itself as a locus of care and training for the different areas of attention to people with aphasia, articulating, interdisciplinary, aspects of enunciation to therapeutic practice.

Keywords:
Comics; Aphasia; Language studies; Enunciation; Specific Language Disorder

RESUMO

Objetivo

Analisar a interlocução terapeuta-sujeito com afasia no processo de interpretação e organização de história em quadrinhos.

Métodos

Estudo transversal, de natureza qualitativa. Os dados coletados foram de situações enunciativas audiogravadas e apresentadas descritivamente por quadros de interlocução (A1-T1) e (A2-T2), registrando atividade com Histórias em Quadrinhos (HQ), realizada em encontro do Grupo Interdisciplinar de Convivência da instituição, do qual participaram sujeitos com e sem afasia. Analisou-se a interlocução entre duas terapeutas em formação (T1 e T2) e dois sujeitos com afasia (A1 e A2).

Resultados

As interlocuções entre A1-T1 e A2-T2, ocorridas durante o processo de organização das HQ, evidenciaram posicionamentos diferentes das terapeutas, no que tange ao ouvido e ao narrado. A1 foi reconhecida por T1 como sujeito de linguagem, à medida que a terapeuta promoveu a disjunção, ou seja, encaminhou A1 à condição de locutor; o mesmo fato não ocorreu com A2 e T2, pois o primeiro não foi reconhecido como sujeito de linguagem, já que T2 manteve-se em conjunção, não conferindo lugar de fala a A2.

Conclusão

A enunciação benvenistiana configura-se como recurso teórico-metodológico para análise e intervenção clínica junto a sujeitos com afasia. O contexto de convivência grupal impõe-se como lócus de cuidado e formativo para as diferentes áreas de atenção às pessoas com afasia, articulando, interdisciplinarmente, aspectos da enunciação à prática terapêutica.

Palavras-chave:
História em quadrinhos; Afasia; Estudos de linguagem; Enunciação; Transtorno Específico de Linguagem

INTRODUCTION

This paper discusses the interlocution between subjects with aphasia and therapists (in training) during the performance of an activity in an Interdisciplinary Coexistence Group (ICG) held at the Federal University of Santa Maria (UFSM) and characterized as a space intended for promoting the health and comprehensive care of subjects with aphasia by speech therapy, letters, psychology, and occupational therapy professionals, among others⁽¹⁾, that also provides opportunities for educational activities of, with, and about language. Note here the ethical-political choice for using "subject with aphasia" instead of "aphasic subject".

It is worth highlighting that such a denomination, inspired by the propositions of the Convention on the Rights of Persons with Disabilities⁽²⁾ - which incorporates, at the basis of the definition of disabilities, the association of biological and sociocultural factures -, marks the fact that, before aphasic manifestations (stemming from biological impairments), there is a person that carries the history and culture of their time and themselves. Hence, we move away from the adjectivization of the subject (aphasic), an attitude specific to normative disciplinary knowledge, and highlight the condition of people with language in a condition of aphasia, emphasizing a conception of language and subject from the perspective of the enunciative linguistics of Benveniste⁽³⁾, especially regarding the universal-particular relationship.

Regarding the above, the pathological dimension of language must be addressed in the face of the singular organization of the subject that enunciates; hence, the motor and the sensory are related to the position the subject occupies in the language⁽⁴⁾. Such singularity is considered, through the Benvenistian postulate, that subjectivity is expressed through the transformation of the language into discourse⁽³⁾. This transformation, conditioned by the enunciative act and, therefore, the study of the therapist-subject with aphasia interlocution, is based on the recognition of the different and simultaneous processes performed in the enunciation that result in the dimension of the discourse. Listening must be situated as a fundamental mediating instance for sustaining the enunciation since subjectivity is conditioned by intersubjectivity⁽⁵⁾.

Having in sight the formal apparatus of enunciation as the foundation of the enunciative theory makes it possible to articulate different movements, such as those of conjunction and disjunction, which refer to enunciative reversibility and transcendence/subjectivity of the self, respectively. Such movements are anchored in the intersubjective condition of dialogue, in which there is no “I” without a “you” and enables the analysis according to the enunciative turns, that is, depending on which subject, in the dialogue, is exercising the function of speaker. It is possible to analyze, as well, how the speaker performs his function, whether enunciating, whether abstaining, or promoting the enunciative reversibility, among others.

It is based on the premise that the concept of enunciation is, at the same time, universal and particular^(4), that the research on the functioning of language in aphasia condition is potentiated, as the specifics of the individual use of language refer to the functioning of the formal enunciation apparatus, always situated in a time and space determined by the enunciative act itself, being possible, through the clipping of enunciative situations, to analyze the processes that are present in the dialogue between speaker and allocution - the narrated and the heard -, as well as the establishment of (inter)subjectivity.

With the theoretical support of the Benvenistian enunciative theory is that anchors the proposal of enunciative analysis of the situations experienced in the activity with Comics (HQs). In this activity, subjects with aphasia (A1 and A2) were proposed to organize, at their discretion, clippings of a comic, while they were assisted by therapists in training (T1 and T2). From this, the analysis of the interlocution between the enunciative pairs A1-T1 and A2-T2 was carried out from the enunciative turns of each speaker-allocutive, from the beginning of the organization of the clippings until its completion.

The bet for a Benvenistian interpretation in the contexts of so-called symptomatic speeches is motivated⁽⁴⁾, having the double dimension of this advance: in the first, of the epistemological order, everything that gives order to language is integrated into the linguistic investigation - including, thus, the problem of aphasia; and the second, of the methodological order, considers looking at the symptom as an opportunity to expand knowledge about the functioning of language in its range of expression. This potential provides new productive analytical devices in the process of evaluation and intervention when aimed at scenes made evident in the functioning of the ICG, in the presence of subjects with and without aphasia in full exercise of language⁽¹⁾.

It is worth clarifying that the ICG is an extension project under the name "Interdisciplinary Coexistence Group (ICG): transits of language, health education, and promotion of formative processes", aiming at the comprehensive care for adults and senior citizens with Acquired Brain Injury (ABI), especially subjects with aphasia, through weekly meetings. The ICG meetings aim to provide interdisciplinary follow-up to subjects with aphasia, promoting health education actions for the participants, besides expanding the knowledge about language in the training of professionals considering the diversity of areas involved, such as speech therapists (undergraduate and graduate students), occupational therapists, psychologists, and linguists.

Regarding the dynamics of the ICG, three moments stand out: 1) the news circle, when, seated in a circle, all participants share whatever is appropriate for them to report to the group, including personal events, local, national, and global news, and matters ranging from soccer to politics, for example; 2) snack time; 3) specific activities aimed at the productive use of language - verbal and non-verbal - and the other cognitive processes, always contextualizing the activities with the health needs and experiences of the group^(1). It is this third moment of the meeting that the object of this research is situated, when an activity with comic books was performed, a text genre that presents an established semiosis relationship between the verbal and the non-verbal, texts and drawings that must be related in order to construct the meaning⁽⁶⁾.

Hence, this research aimed to analyze the therapist-subject with aphasia interlocution in the process of comic book interpretation and organization.

METHODS

This study has a qualitative nature⁽⁷⁾ since it is concerned with addressing particular aspects of the enunciation to the detriment of generalizations about language, i.e., it analyzes intersubjective relationships that do not bear quantifications. It is cross-sectional research, as it analyzes clippings of the relationship between therapists in training and subjects with aphasia in a group context of a writing workshop, and was approved by the Human Research Ethics Committee (CEP) of the Federal University of Santa Maria (UFSM) under opinion No. 4.704.763 (CAAE: 46539421.8.0000.5346), with the Free and Informed Consent Form signed by the participants.

The data are presented descriptively considering what was heard and what was narrated by each enunciative partner (A1-T1 and vice versa; A2-T2 and vice versa). They were extracted from enunciative situations of an activity with comic books performed in an ICG meeting on May 22, 2022. The enunciative situation of the datum to be analyzed will be described first, followed by the therapist-subject-therapist verbal production and vice versa. In this presentation, it was sought to explain the enunciative turns of each speaker-allocutive, that is, the narrated and the heard of each enunciative partner before each lived interlocutory movement, from the separations of comics clippings, until the completion of its ordering. Both enunciative situations were arranged in separate charts (Chart 1 and Chart 2), each line representing a turn and the corresponding enunciative positioning of each enunciative partner (heard-narrated). Then, the images of the respective organizations of the HQ clippings performed by A1 and A2 were presented. As an analysis criterion, we consider the intersubjectivity in this exchange, categorizing the different enunciative movements: conjunction and disjunction⁽⁸⁾.

Chart 1
A1-T1 Interlocution

Lines	Situation 1: A1 is seated next to T1, who hands her the cutouts.
1	Heard by A1	Observes the cut-out panels and the comic book characteristics and immediately starts assembling her story.
2	Heard by T1	Welcomes A1’s initiative; does not interfere with her organization process.
3	Narrated by A1	Presents her organization
4	Narrated by T1	Asks for clarification about the criteria that motivated the organization presented.
5	Narrated by A1	States that she organized the comic book according to the images, considering that Cascão and Cebolinha have coexisted since they were babies, are growing up together, and always play ball when they wake up. Even as teenagers, they separate when they are dating but remain friends.
6	Heard by T1	Shows surprise and agreement.

• Source: Devised by the authors
• Subtitle: A1 = subject 1 with aphasia; T1 = therapist 1 in training

Chart 2
A2-T2 Interlocution

Lines	Situation 2: A2 is seated next to T2, who hands him the cutouts.
1	Heard by A2	Receives the cutouts and immediately begins organizing them.
2	Narrated by T2	Interferes with the organization process by reading aloud what is written in the speech balloons without A2 asking her to do so
3	Heard by A2	Continues his organization
4	Narrated by A2	Presents the final organization (see Figure 3)
5	Heard by T2	Shows discomfort with the organization presented
6	Narrated by T2	Asks if the sequence presented makes sense
7	Narrated by A2	States that it does. Does not change the sequence and reiterates, by pointing, that Cascão and Cebolinha dreamed about playing ball, which did not materialize because Cascão went on a date. Cebolinha gets upset and also seeks out his girlfriend. The mothers recall how they have coexisted since babies, having soccer as a common preference.

• Source: Devised by the authors
• Subtitle: A2 = subject 2 with aphasia; T2 = therapist 2 in training

Inspired by the Benvenistian enunciative perspective⁽⁸⁾, it explains the language acquisition process through conjunction and disjunction movements, thus being pertinent to the study of aphasia. According to the author, conjunction is marked by the reversibility/personal nature of the interlocutory relationship, forming a constitutive unit in the temporality of the discourse, whereas disjunction is characterized by the transcendence/subjectivity of the self, pointing to the separation of the subject-other in the discourse, which is subjectively inscribed in the language, a fact that allows taking responsibility for the constitution of oneself and the other in the enunciation⁽⁸⁾ .

We analyze data on the subjects with aphasia (A1 and A2) in interlocution with their respective therapists in training, named enunciative partners (T1, student in the 5th term of the Speech Therapy program, and T2, student in the 8th term of the Occupational Therapy program). The first has participated in the ICG since her first year in the program, and the second is a new participant. One may say there is a difference in the understanding of the nature of the aphasia and in the development of activities with subjects with aphasia due to the time interacting with them.

A1 is a woman who was 36 years old and single at the time and suffered a car accident ten years before that resulted in Traumatic Brain Injury in the temporoparietal and frontal region. At the time of the study, after a long rehabilitation period (with physical therapy, speech therapy, and occupational therapy), A1 had preserved mobility but did not go back to driving. She was independent in her everyday life and practical instrumental activities but did not return to work. Her oral production was fluent but slowed, with a tendency to short pauses, few repetitions, and some phonemic paraphasias. Her gesture expression was preserved and restricted. The oral understanding was more preserved. Regarding written language, she respected syntactic ordering, with some grammatical and orthographic deviations; she also wrote slowly after some latency to initiate a text.

At the time of the study, A2 was a married 58-year-old man, father of two children, and retired after an ischemic stroke in the temporoparietal region that occurred seven years earlier. He presented right hemiplegia with compromised mobility; he did not use support devices or drive. He did not return to work, although he was independent in everyday and practical instrumental activities. His oral production was non-fluent, with a tendency to phonoarticulatory perseverations, phonetic omissions and prolongations, repetitions, and many phonemic paraphasias. The oral understanding was more preserved. His gesture expression was compromised by the hemiplegia. He wrote little (presented dysgraphia), tending to content words.

The enunciative situations were audio-recorded during the activity of a Comic Book presented to the subjects in cutouts of disorganized panels for them to organize meaningfully (Figure 1). The activity coordinator advised on the dynamic of the day, explaining the shuffled cut-out panels, and instructing the participants to assemble a comic book that made sense to them.

Figure 1
Original comic book

RESULTS

Enunciative situations that occurred between A1-T1 and A2-T2 during the comic book organization process by the subjects with aphasia are presented next. It is worth clarifying that, after this moment, there was the exposure of the stories organized by the participants to the entire group. However, we emphasize here the moment of individual organization.

In the interlocution between A1-T1, the enunciative situation is presented from the initial moment of distribution of the clippings and starting the description from what was "heard" by A1, that is, the realized interpretation of the initial demand of the activity. Then, what was heard by T1, demarcating the posture in the intersubjective scenario of T1 (Chart 1).

From what was narrated by A1, that is, produced by A1 as an act of production of meaning, the chart follows with the interrogation act of T1 referring to the process of organization of the HQ performed by A1, who explained his method and was heard by T1 (Figure 2).

Figure 2
Comic book assembly by A1

In the dialogue between A2-T2, the chart is presented in the same way, separated into enunciative shifts that sought to explain the positions of speaker-allocutive (narrated-heard), starting with A2 meeting the demand of the proposed activity and starting its organization (Chart 2).

There was a different enunciative positioning of T1 and T2 in the various enunciative situations, since T2 began by placing itself in the function of speaker (line 2), interfering in the production of A2, without being demanded by the subject with aphasia, while T1 (Chart 1) refrained from speaking during the organizational process. The same difference was notable when T2 questioned whether "the sequence presented makes sense", while T1 asked for a "clarification about the criteria that motivated the organization presented". While T2 questioned the meaning presented, T1 asked A1 to explain its criteria, with a difference in the approach of the issue addressed and also in the ways in which these questions could be answered by A1 and A2.

Finally, A2 affirmed its choices and organization and narrated its explanation to T2, maintaining coherence with its initial interpretation of the proposed activity, which resulted in the organization exposed in Figure 3.

Figure 3
Comic book assembly by A2

It was noted that both A1 and A2 received the same instructions and the same clippings, which resulted in different ordinations and with different explanations about their signification processes. The actions of T1 and T2 were dissonant; while T1 refrained from pronouncing when not demanded, T2 positioned itself and demonstrated discomfort.

DISCUSSION

Reflecting on what was heard and what was narrated, made explicit in the data above, refers to the enunciation movements of conjunction and disjunction, given that the enunciation implies "putting into operation the language through an individual act of utilization"^(3:402), made possible through the intersubjectivity principle. Humans express their subjectivity as me in opposition to you. Benveniste⁽⁹⁾ stressed that every enunciation takes place in a specific space and time by an individual speech act. Therefore, one may say that the "self" reveals a position in the enunciation - particular and unrepeatable⁽⁹⁾.

Regarding the position in the enunciation, it is worth highlighting that there were differences between the A1-T1 and A2-T2 pairs. The enunciative structures made evident in the data analyzed herein refer to the statement about the process of acquisition and development of children's language⁽⁸⁾. From the Benvenistian body of work⁽³⁾, the "singularity of each speaker when they appropriate the language to enunciate"^(8:170) stands out, evincing structures that bear the presence of the speaker and the addressee. One may consider that, in the context of coexistence between subjects with and without aphasia, such a singularity cannot be recognized depending on the position of the subject without aphasia. If they consider the subject with aphasia as a subject of language, it is allowed to the latter the condition of holding themselves responsible for the constitution of the self and the other in the enunciation. In the case of A1 and T1, the recognition of such responsibility was immediately found (Chart 1 - Line 2). In turn, between A2 and T2, one may observe T2 denying the possibility of responsibilization of A2 when she occupies the position of the speaker in his stead (Chart 2 - Line 2).

The me-you positions are established in the enunciative act. In the words of Benveniste, "it is in a dialectic reality that encompasses the two terms [me-you] and defines them through the mutual relationship that the linguistic foundation of subjectivity is discovered"^(5:626). The dialogue condition is what makes the establishment of the discourse possible, given that a "me" will only be a "me" in the face of a "you". Hence, the subjectivity condition of language is intersubjectivity⁽⁵⁾. In this sense, it is convenient to consider the enunciation pairs A1-T1 and A2-T2 as a dialogic reality configured in the enunciation. Hence, if it is true that the disjunction movement, considered in a situation of language acquisition, refers the child to their subjective inscription in the language, conferring to the me/you separation a fundamental mobilization in the acquisition area⁽⁸⁾, the fact that, within the context of coexistence and/or therapeutic processes with people with aphasia, there is a need for 'space' guaranteed by the subject without aphasia (family members, friends, among others) and especially by the therapists is also true because it will be in the disjunction movement that there will be openness for the manifestation of subjectivity in the language.

In the face of the linguistic singularity, in both enunciation situations of this study, it is possible to notice marks of the subjectivity of A1 and A2 in the organization of the comic books; even if the interlocutors - A1-T1 and A2-T2 - are unaware of their linguistic activities and even if their linguistic work does not produce the effect they intended⁽¹⁰⁾, there is (inter)subjectivity.

In the enunciative situation of the A1-T1 pair, the initiative by A1 to interpret the demand of the activity proposer stands out, configuring the interpretative conjunction movement that calls A1 to enunciate. For understanding that there is intersubjectivity, T1 refrained from interfering in the comic book assembly process, which induced the second movement, that of disjunction, for providing A1 with the opening to organize it in her way without there being expressed interference of the norm about the signification process. In the case of A2-T2, A2 also interpreted the demand of the activity and initiated his organization. However, T2 remained in conjunction and interfered by reading aloud the content of the panels without being asked by A2, i.e., T2 superposed her interpretation, attempting to conduct A2’s signification process.

One may state that the position of the subjects with aphasia in the interlocution is relevant in the construction of what they enunciate, but so is the position of the therapists (what is heard and what is narrated), interfering collaboratively or not in the enunciative sequencing of the subjects with aphasia. In other words, in the first situation presented, the position of T1 is highlighted as the addressee of A1, manifesting, in line 2, her non-interference in the process of signification and, consequently, ordering of the comic book, allowing A1 to occupy the position of speaker (disjunction) and, with this, that of the subject in the language. In turn, in the second situation, T2 occupies the speaker position, remaining in conjunction, reading aloud, and asking if there is a sense in the comic book organization proposed by A2. T2 did not accept the proposal and insisted on the reorganization according to her viewpoint about the meaning; therefore, she did not provide an opportunity for A2’s autonomy (disjunction), not recognizing him as a subject of language.

From this Benvenistian enunciative conception and the datum presented in situation 2, it fits to understand that a therapist must resignify the role of the subject with aphasia, show that they are able to produce and interpret language (verbal and non-verbal), and demonstrate how they may place themselves in the interlocutions, thus favoring the intersubjective reconstruction of the subjects (with and without aphasia) in and with language. It is necessary to clarify that T2 had her first contact with subjects with aphasia and participation in the coexistence group on the day of this activity, i.e., the inexperience in the practice and therapeutic development regarding linguistic-cognitive aspects directly affected the understanding of her role as a therapist in the face of the demand of subjects with aphasia.

It is up to the therapist to listen to that which is not narrated, conferring space for the subject to appropriate the language and, as a subject of their language, to signify, i.e., to value the functioning of the language being enunciated. Hence, occupying a position of a subject and recognizing oneself as a subject is, at each instant, to transit between the movements of conjunction and disjunction. This combination is constructed in the enunciation and is always unrepeatable because each time the speaker appropriates the language, they promote a unique agency that causes a unique meaning to emerge⁽¹¹⁾.

CONCLUSION

It stands out from the analysis of the two enunciative situations and the position of the therapists and subjects with aphasia in the enunciative structures during the story organization process. We stress that, through conjunction and disjunction movements, therapists recognize (or not) the subjects with aphasia as subjects of language.

The appropriation of the concepts of conjunction and disjunction within the context of language in aphasia is confirmed, ratifying the enunciative contribution of Benveniste (1902-1976) in clarifying the work with and in language together with subjects with aphasia, founded on the intersubjectivity as a fundamental principle of enunciation, allowing to identify the different movements that occur in the enunciative situation and, with this, recognize the subjects with aphasia in their signification processes.

Thus, enunciation is emphasized as a theoretical-clinical resource in the comprehensive care for subjects with aphasia in a group coexistence context. Hence, the ICG is made evident as a formative space for the different areas of care for people with aphasia, interdisciplinarily articulating aspects of enunciation to the therapeutic practice.

• Study carried out at Programa de Pós-graduação em Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brasil.
• Funding: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Código de Financiamento 001.

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Publication Dates

• Publication in this collection
  16 Jan 2023
• Date of issue
  2023

History

• Received
  06 Sept 2022
• Accepted
  29 Nov 2022