A comment on Wednesday's post reminded me of a delightful old case study by Andre Roch Lecours and Yves Joanette (1980) which seems to be largely unknown in the literature.
"Brother John" was a French monk who suffered severe, almost complete, aphasia (that is, incapacity with language) of both outer speech and, by his report, inner speech as well during epileptic episodes. Yet during these episodes he remained quite capable of rational thought and behavior. Here is Lecours and Joanette's description of one extended episode of severe global aphasia in Brother John:
While he was traveling by train from Italy to Switzerland, Brother John once found himself at the height of a paroxysmal dysphasia soon upon reaching the small town of his destination. He had never been in this town before but he probably had considered in his mind, before the spell began (or became severe), the fact he was to disembark at the next stop of the train. At all events, he recognized the fact he had arrived when the time came. He consequently gathered his suitcases and got off the train and out of the railway station, the latter after properly presenting his transportation titles to an attending agent. He then looked for and identified a hotel, mostly or entirely on non-linguistic clues since alexia was still severe, entered and recognized the registration desk, showed the attendant his medic-alert bracelet only to be dismayed and dismissed by a gesture meaning "no-room" and a facial mimic that perhaps meant "I-do-not-want-trouble-in-my-establishment." Brother John repeated the operation in search of a second hotel, found one and its registration desk, showed his bracelet again, and, relieved at recognizing through nods and gestures that there were both room and sympathy this time, he gave the receptionist (a "fat lady") his passport, indicating the page where she was to find the information necessary for completing his entry file. He then reacted affirmatively to her "do-you-want-to-rest-in-bed-now" mimical question. He was led to his room and given his key; he probably tipped as expected and went to bed. He did not rest long, however: feeling miserable ["It helps to sleep but sometimes I cannot because I am too nervous and jittery" (free translation)], then hungry, he went down to the hotel's lobby and found the restaurant by himself. He sat at the table and, when presented with the menu, he pointed at a line he could not read but expected to be out of the hors-d'oeuvres and desserts sections. He hoped he had chosen something he liked and felt sorry when the waiter came back with a dish of fish, that is, something he particularly dislikes. He nonetheless ate a bit ("potatoes and other vegetables"), drank a bottle of "mineral water," then went back by himself to his room, properly used his key to unlock his bedroom door, lay down, and slept his aphasia away. He woke up hours later, okay speechwise but feeling "foolish" and apologetic. He went to see the fat lady and explained in detail; apparently, she was compassionate (p. 13-14).If Lecours and Joanette's understanding of Brother John is correct, there was no, or almost no, inner or outer speech production or recognition through the entire episode. Brother John was presumbably not "thinking in words" -- or if he was, "thinking in words" must mean something very different from what I'd have thought it to mean.
Of course we shouldn't put much weight on a single anecdote transmitted second-hand....