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 that 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 aphasia, 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.
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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 that 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 aphasia, 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.
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Hard Talk: When Speech Is Difficult

Hard Talk: When Speech Is Difficult

by Jonathan Cole
Hard Talk: When Speech Is Difficult

Hard Talk: When Speech Is Difficult

by Jonathan Cole

Hardcover

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$32.95 
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Overview

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 that 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 aphasia, 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.

Product Details

ISBN-13: 9780262049566
Publisher: MIT Press
Publication date: 05/13/2025
Pages: 256
Product dimensions: 6.31(w) x 9.25(h) x 0.93(d)

About the Author

Jonathan Cole is a consultant in Clinical Neurophysiology at University Hospitals, Dorset, and Professor at Bournemouth University. He has written six narrative books, most recently Chekhov’s Sakhalin Journey: Doctor, Humanitarian, Writer.

Table of Contents

Introduction
1 No Zzzs: Acquired Vocal Cord Palsy
2 Words Unsaid: Congenital Vocal Cord Palsy
3 I Found Myself Boring: Vocal Cord Palsy
4 We Eat Eels Everyday: Spasmodic Dysphonia
5 Conversing with Myself: Spasmodic Dysphonia
6 Stuff Happens: Cleft
7 Full On: Mὄbius
8 Just Like My Elbows: Parkinson’s
8 In My Head, I Talk Slowly: Cerebral Palsy
10 How We Live: Cerebral Palsy
11 Acquiesce with Silence: Cerebral Palsy
12 Walks on the Wild Side: Non-fluent Aphasia
13 Uncontrollable Dog: Non-fluent Aphasia
14 Absence and Presence: Non-fluent Aphasia
15 Eloquent Rhymes of Nothing: Fluent Aphasia
16 Nothing in Mind: Abulia
17 Conclusions: Residing in Voice
Postscript: Inner Voices in Aphasia.
Notes
Index

What People are Saying About This

From the Publisher

“Cole helps us see the importance of something most of us take for granted—the ability to vocalize. He introduces us to the variety of conditions that disrupt this ability, not only explaining the physiological details but also, and brilliantly, giving voice to the people who live with such conditions.”
—Shaun Gallagher, Lillian and Morrie Moss Chair of Excellence in Philosophy, University of Memphis; author of The Self and Its Disorders

“Cole’s heartfelt way that he details the true impact of the disability is a fantastic demonstration of interest, patience, and empathy. He shows us a perspective that often eludes clinicians, family, and friends alike.
—Kate Heathcote, ENT Consultant, Centre for Airway, Voice and Swallow, University Hospitals Dorset; contributor to Atlas of Endoscopic Airway Surgery

“Cole’s Hard Talk gives a clear voice to so many who have significant communication difficulties. A must-read for anyone working in this field and a powerful reminder that communication is integral to humankind.”
—Tori Burnay, Clinical Lead Voice Specialist and Language Therapist, Guy’s and St. Thomas’ NHS Foundation Trust

“These are powerfully moving and insightful accounts of speakers and the surprisingly diverse impairments that shape their lives. I will never again take for granted my casual chitchat.”
—Michael Erard, author of Bye Bye I Love You

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