April 15, 2015

Image Credit: Bruna Schenkel, Creative Commons

It is all over the news – Hodor has been diagnosed with expressive aphasia. If you belong to what seems to be a small minority of people who haven’t been watching HBO’s Game of Thrones then you probably haven’t heard of Hodor, so here is how The Conversation describes him:

Hodor is the brawny, simple-minded stableboy of the Stark family in Winterfell. His defining characteristic, of course, is that he only speaks a single word: “Hodor.”

No matter what the situation is, what is asked of him, or what is being said to him, it’s always – hodor, hodor, hodor. Which is how he got his aphasia diagnosis:

Those who read the A Song of Ice and Fire book series by George R R Martin may know something that the TV fans don’t: his name isn’t actually Hodor. According to his great-grandmother Old Nan, his real name is Walder. “No one knew where ‘Hodor’ had come from,” she says, “but when he started saying it, they started calling him by it. It was the only word he had.”

Whether he intended it or not, Martin created a character who is a textbook example of someone with a neurological condition called expressive aphasia.

Diagnosing with aphasia a popular character from a widely watched TV show (its 5th season premiere drew 8 million viewers) makes for a fun read and it is also a great way to spread awareness about this neurological disorder. Most people have never heard of aphasia despite that it is a fairly common condition that affects about a third of all stroke patients. Aphasia results from brain injury that damages areas that control speech and language. Such damage is most commonly caused by stroke or head trauma but it could also result from tissue degeneration.

Media attention that boosts aphasia awareness is welcome but there is a caveat. Many of the articles that diagnosed Hodor’s language peculiarity as aphasia introduced him as “simple-minded“. Other online depictions of Hodor also characterize him as “slow of wits“. This kind of allusions leave the impression that Hodor has intellectual deficits.

The articles about Hodor make for fascinating read about aphasia and the history of its discovery. But given the context, it would have been great if they emphasized that aphasia is a disorder that affects speech and language only. It does not affect people’s intellectual capabilities.

Inability to express oneself, speaking with grammatically incorrect sentences, inserting words that make no logical sense, and difficulty understanding what is being said are all characteristics of various forms of aphasia. Unfortunately, they are also associated with intellectual deficits. This is a problem with which many persons with aphasia struggle because people who are unfamiliar with the disorder assume that patients with aphasia have intellectual deficits as well. Which is why it is important to make the distinction clear.