100 Chapter 5
You say, “Helen, please fill in the blank: ‘The United States of.. .’ ” She smiles and clearly
says, “Amer i ca.” You reward her with the thumbs-up gesture and the comment “ Great job.”
Clearly pleased with herself, Helen awaits the next sentence. “Red, white, and.. .” Helen again
smiles and says, “Amer i ca.” Then, as if stung by her verbal impotence, she winces and tries
to self- correct. “Amer i ca, no, Amer i ca, I mean... A... merica.” Again she smiles and says,
“Am... am... blue?” You quickly comment, “ Great job; keep it up.” The next sentence is pro-
vided: “Knife, fork, and.. .” Helen quickly says, “Amer i ca.” Then in frustration she says, “No,
no, no!” The majority of the session is filled with the frustration of naming errors compounded
by perseveration.
Knowing that these frustrating exercises can cause anxiety and possibly a panic attack, sev-
eral times during the session you stop the exercises and engage in chitchat. Verbal impotence
can be very threatening to a patient’s self- esteem. To lessen the stress, you show pictures and
have Helen discuss them with no pressure to produce correct responses. One picture shows
dancers apparently doing the Charleston, the rage of the 1920s and 1930s. Helen points to the
picture and says, “Flapper.”
Aware that neurogenic communication disorders can evolve into dif fer ent types, at first you
suspect that she has uttered a made-up word, a neologism. Perhaps f lap approximates tap, as
in tap dance, and er, as in dancer. But Helen’s response is inconsistent with her predominantly
expressive aphasia because she had not displayed any form of jargon in the past. Again Helen
says, “Flapper” and, even more curiously, points to herself, apparently proud of the statement.
During the remaining sentence completion exercises, Helen continues to improve in naming
and overcoming the perseveration. Several times, however, f lapper is perseverately inserted
into the drills.
With some free time before the next session, you decide to search the World Wide Web for
“f lapper” in an attempt to understand Helen’s curious symptoms. Perhaps you are simply not
aware of the meaning of the term. To your surprise, there are several references to the word and
descriptions of wild women who danced the Charleston with clothing and jewelry f lapping.
During the roaring ‘20s and ‘30s, f lappers danced at speakeasies where illegal beer f lowed and
good times were had during the Prohibition era. Chicago’s gangster- run South Side was home
to many speakeasies, f lappers, and profitable rum- running businesses. Apparently, fortunes
were made during Prohibition, and you recall the rumors of Helen’s vast wealth and ponder
this in ter est ing woman’s past.