mr tan to see the presentation

February 8, 2013

The man who couldn t speak and how he revolutionized psychology

By Maria Konnikova

This article was published in Scientific American’s former blog network and reflects the views of the author, not necessarily those of Scientific American

When he was 30 years old, Louis Victor Leborgne lost the ability to speak—or speak in any matter that made any sort of sense. Upon being admitted to Bicêtre, a suburban Paris hospital that specialized in mental illness, he could utter only a single syllable: Tan. That syllable came with expressive hand gestures and varying pitch and inflection, to be sure. But it was the only syllable Leborgne could pronounce. By the time he arrived at the hospital, he had been unable to speak properly for some two to three months. And even though his family thought the condition might be temporary—he had, after all, been dealing with epilepsy successfully for many years—he would remain there until his death, 21 years later.

Apart from his inability to speak, Louis Victor did not appear to exhibit any signs of physical or cognitive trauma. His intelligence seemed unaffected, his mental and physical faculties, intact and responsive. He appeared to grasp everything he was asked and did his best to respond in a meaningful fashion. Though tan —usually, spoken twice, tan tan —remained the only thing he could say, he never stopped trying to communicate.

Within ten years, however, Leborgne began to manifest other signs of distress. First, his right arm became paralyzed. Soon, his right leg followed suit. His vision deteriorated. His mental faculties, as well. It got to the point where patient Tan, as he came to be called, refused to get out of bed—and he remained that way for over seven years.

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In April, 1861, Leborgne developed gangrene. His entire right side had become inflamed and he could hardly move. On April 11, 1861, he was admitted to surgery. And there, he met for the first time a certain French physician: Pierre Paul Broca.

Broca specialized in the study of language. Leborgne intrigued him. Gangrene aside, he decided to test the patient’s faculties to see if he couldn’t determine the extent of his condition. It was a tricky business: Leborgne was right-handed. Not only could he not speak, but he couldn’t write. Communication would prove difficult. Leborgne could, however, gesture with his left hand—and while many of the gestures were incomprehensible, when it came to numbers he retained a surprising amount of control. He could tell the time on a watch to the second. He knew precisely how long he had been at Bicêtre. His faculties had indeed degraded, but in some ways he remained as sharp as ever.

When it came to speech, however—Broca’s main area of interest—Leborgne was hopelessly lost. As Broca would later describe his condition,

He could no longer produce but a single syllable, which he usually repeated twice in succession; regardless of the question asked him, he always responded: tan, tan, combined with varied expressive gestures. This is why, throughout the hospital, he is known only by the name Tan.

Broca termed the deficit aphémie, or aphimia, the loss of articulated speech. Today, it is known as Broca’s aphasia.

On April 17, at approximately 11am, Louis Victor Leborgne died. He was 51 years old. A biopsy of his brain revealed a large lesion in the frontal area—specifically, in the posterior inferior frontal gyrus, a section that corresponds roughly to Brodmann’s areas 44 and 45. Today, we remember Leborgne as Patient Tan, one of the most famous patients in the history of psychology. And we remember his brain as the brain that was ground zero for Broca’s Area, one of the most widely studied language regions in cognitive psychology.

Just a few months after Leborgne’s death, Broca met Lazare Lelong, an 84-year-old grounds worker who was being treated at Bicêtre for dementia. A year earlier, Lelong had, like Leborgne, largely lost the ability to speak. In contrast to Leborgne’s ever-present tan , however, he retained the ability to say a few words that held real meaning. Five, to be exact: oui (yes), non (no), tois (from trois, or three; Lelong used it to mean any number whatsoever), toujours (always), and Lelo (his attempt to say his own name).

When Lelong died, his brain, too, was autopsied. What Broca found—a lesion that encompassed much the same area as had been affected in Leborgne’s brain—confirmed a suspicion that had been growing ever-stronger in his mind: our speech function was localized. A specific area governed our ability to produce meaningful sounds—and when it was affected, we could lose our ability to communicate. What would remain intact, however, was the rest of our intelligence and language comprehension. Not only was speech function localized, but it could be dissociated into specific areas: comprehension, production, formation. An injury to one part did not necessitate an injury to others.

The phrenologists who had preached localization of function may have been more off-base than not, but in one way, they had gotten it right. We did have parts of the brain that were specialized for certain functions. Injure the responsible part, and the function would suffer along with it.

Broca was far from the first to study the disturbance of speech in the brain. As early as 1770, the German physician and medical writer Johann Gesner published a treatise on a topic he called speech amnesia, Die Sprachamnesie , where he described the same type of fluent aphasia that the neurologist Carl Wernicke would make famous over a hundred years later, where patients produced a string of fluent words—that were, alas, gibberish. Not only did Gesner describe the case of KD, along with five later cases, in terms remarkably similar to our current understanding of aphasia, but he made a logical leap that was far beyond the medical knowledge of the day: he realized that this so-called speech amnesia was largely separate from other types of idea generation – and so, the responsible brain injury could well be selective in its impact.

In 1824, the French physician Jean-Baptiste Bouillard took Gesner’s ideas a step further. Bouillard proposed a remarkable notion: brain function may well be lateralized. In other words, our two hemispheres are not created equal. An injury to the left part of the frontal lobe, say, did not necessarily produce the same type of impediment as a mirror injury on the right. In fact, Bouillard argued, show me someone who suffered a speech impairment while alive, and I will show you someone whose brain, upon autopsy, will have damage in the left frontal lobe. In 1848 , he went as far as to offer 500 francs to any person who could produce a brain of someone who had suffered a speech impairment that did not contain damage to the left frontal lobe. As far as we know, his challenge went unanswered.*

Bouillard’s ideas met with widespread opposition. His notion of such specific functional localization appeared to validate some of the claims of the discredited phrenologists—and that was not a direction the medical establishment wanted to go in. Beginning in 1852, however, Bouillard’s son-in-law, Ernest Auburtin, came to the aid of his cause. He even went as far as to present a demonstration of his father-in-law’s theories in a living patient – as high a proof as they come. The patient in question had attempted to commit suicide by shooting himself in the head. He had only been partially successful and had managed to shoot away the frontal bone—but the lobes underneath had remained intact, and were now exposed.

The patient was admitted to Hôpital St. Louis. His intelligence and speech were intact, and he survived for several (what I imagine as incredibly painful) hours, during which he was subject to an extraordinary experiment. As the patient spoke, a physician applied the flat surface of a spatula to different parts of his exposed brain. With gentle pressure to the frontal lobes, his speech came to a halt. When the pressure was removed, speech returned. Other functions and consciousness were not affected.

Remarkably, Auburtin’s demonstration went largely unnoticed, and it was not until Broca’s 1861 case that the full implications of his and Bouillard’s work became apparent.

Leborgne’s brain presented an opportunity to test and refine Bouillard and Auburtin’s theories. But it wasn’t until 1865, a full four years after the famed Tan autopsy, that Broca was finally ready to assert that speech production was localized in a specific part of the left frontal lobe, the region that now bears his name. By that time, he had described the brains of 25 additional patients who had suffered from aphémie and had come to conclude that speech articulation was indeed controlled by the left frontal lobe, just as Bouillard and Auburtin had suspected.

That wasn’t, however, the whole story.

Brain function wasn’t entirely fixed, Broca wrote. With time—and therapy—individuals could improve. Most aphasiacs, he noted, would within weeks begin to regain some of their abilities, or become better able to function even with their loss – especially if they were given the opportunity to practice. Could it not be, Broca wondered, that the right hemisphere was taking over some of the functions of the left? In this question, Broca went a step beyond anyone who had come before him. He anticipated our current understanding of adult brain plasticity, the ability of the brain to learn new ways of function when old ways were no longer an option.

Broca may have been, in many ways, prescient. But he was also not altogether correct. As early as 1906, Pierre Marie—at one time a student of Broca’s—noted that Broca’s aphasia could be caused by much broader lesions that the ones identified by Broca himself. Injury to the insula and basal ganglia, for instance, could result in many of the same symptoms. In the 1970s and 1980s, researchers determined that the damage could be broader still. The surrounding frontal cortex and underlying white matter, the insula, basal ganglia, parts of the anterior temporal gyrus: all of these seemed to be somehow involved in speech production.

Even Leborgne’s original lesion, when scanned with modern fMRI technology, was shown to extend beyond the areas originally identified by Broca. In 2007, a team of researchers led by Nina Dronkers, at the University of California, Davis, decided to reexamine the brains that he had carefully preserved. This would mark the third time that Leborgne’s brain was scanned, and the first time ever that researchers would revisit the brain of Lelong.

To examine the extent of both the cortical and subcortical lesions of each brain, Dronkers’s team used high resolution volumetric MRI. What they saw was damage that went far further than Broca had suspected. In both cases, the lesions extended to the superior longitudinal fasciculus, a network of fibers that connects posterior and anterior language regions and had gone unobserved by Broca (he had made the decision to preserve the brain intact rather that slice it open). And while Broca’s Area was indeed affected, it was likely not the only culprit in the severity of the observed aphasia. Indeed, the researchers argued, if the damage had been contained to Broca’s Area, the speech disruptions would have likely been milder and less pervasive. Broca was correct in localizing speech production. He was slightly less so in his understanding of how extensive that localization may be.

Still, the extent of Broca’s contribution to psychology and neuroscience can’t be underestimated. His work set the stage for much of what we now term cognitive neuroscience and neuropsychology. Two major principles that now govern how we think about the brain—the localization and lateralization of function and the notion that an impairment in one area of cognition (i.e., language) as a result of brain damage does not necessarily signify a general impairment in intellect—are in large part a result of Broca’s pioneering work. (Wilder Penfield’s maze-dazed mice, for one, owe their increasingly severe brain damage in large part to Broca’s research and conclusions.) Without Broca, our understanding of language would not have likely evolved as quickly as it did—or have had as great an impact on the study of other cognitive processes.

But perhaps his greatest legacy is one we don’t often consider, so engrained has it become in the study of psychology and cognition: the habit of learning from the diseased brain. It is by looking at the moments when the brain goes very wrong that we begin to understand how it manages to go right so much of the time. When we see lesions, we can trace the resulting injury to the underlying function. When we see recovery, we can trace the neural reorganization that made it possible.

We’ve come a long way from the days of phrenology. And much of it is thanks to the man who couldn’t speak—and the doctor who understood just how meaningful that loss would be for the future of science.

* Psychologist Christian Jarrett has been kind enough to point out that the challenge was , in fact, answered, albeit many years later. Read his post at Psychology Today: http://www.psychologytoday.com/blog/brain-myths/201205/500-francs-says-language-is-housed-in-the-frontal-lobes

Broca, Paul (1861). Perte de la Parole, ramollissement chronique et destruction partielle du lobe antérieur gauche du cerveau. Bulletin de la Société Anthropologique, 2, 235-238

Lazar, R., & Mohr, J. (2011). Revisiting the Contributions of Paul Broca to the Study of Aphasia Neuropsychology Review, 21 (3), 236-239 DOI: 10.1007/s11065-011-9176-8

Dronkers NF, Plaisant O, Iba-Zizen MT, & Cabanis EA (2007). Paul Broca's historic cases: high resolution MR imaging of the brains of Leborgne and Lelong. Brain : a journal of neurology, 130 (Pt 5), 1432-41 PMID: 17405763

Domanski CW (2013). Mysterious "Monsieur Leborgne": The Mystery of the Famous Patient in the History of Neuropsychology is Explained. Journal of the history of the neurosciences, 22 (1), 47-52 PMID: 23323531

Lorch M (2011). Re-examining Paul Broca's initial presentation of M. Leborgne: understanding the impetus for brain and language research. Cortex; a journal devoted to the study of the nervous system and behavior, 47 (10), 1228-35 PMID: 21831369

STOOKEY B (1963). Jean-Baptiste Bouillaud and Ernest AUBURTIN. Early studies on cerebral localization and the speech center. JAMA : the journal of the American Medical Association, 184, 1024-9 PMID: 13984405

Speech by SNOC President Mr Tan Chuan-Jin at the IOC Awards Presentation

SPEECH BY MR TAN CHUAN-JIN, GUEST OF HONOUR, MINISTER FOR SOCIAL AND FAMILY DEVELOPMENT AND PRESIDENT OF THE SINGAPORE NATIONAL OLYMPIC COUNCIL AT THE IOC AWARDS PRESENTATION ON TUESDAY 8 MARCH 2016 AT 7.20PM AT FABER PEAK SINGAPORE

Mr Ng Ser Miang, IOC Member

Mr Tan Howe Liang and our Olympians

Fellow SNOC and NSA colleagues

Ladies and gentlemen

Good evening.

Firstly, I would like to extend my gratitude to the IOC and Ser Miang for this special occasion. Thank you for holding our Singaporean sportsmen and administrators in such high regard. Tonight is certainly a celebratory milestone for all of us in the sport fraternity.

Many successful roles in sport require passion, dedication and largely, a spirit of volunteerism and willingness to do something good for the community. A culture of appreciation and recognition is important to express our gratitude to these unsung heroes and to acknowledge the value of such deeds. Deeds which go beyond the normal call of duty, deeds which include sacrifice and exemplary work and services, deeds which serve the community and were conducted without expectations of rewards. The lives of Mr Tan Howe Liang, Dr Tan Eng Liang and Mr Chris Chan espoused deeds which have served our community and created a meaningful impact to the Olympic movement.

In 1960, during the tumultuous times of Singapore’s pre-independence, Mr Tan Howe Liang boldly pursued an ambition of winning an Olympic medal – a feat never accomplished before by any Singaporean. His achievement was realised without the support of external help, it was purely out of interest and a desire to do well. He remains as one of the few athletes in Singapore who have won medals at the Olympic, Commonwealth, Asian and South-east Asian Games. He continued to coach and mentor younger athletes after his competitive days and spent later part of his years serving the then-Singapore Sports Council.

Many of you would be familiar with Dr Tan Eng Liang. Just last year at the 28th SEA Games, Eng Liang led Team Singapore to a record-breaking medal haul in his 12th outing as Chef de Mission. He also led Team Singapore to a silver medal at the 2008 Olympic Games. Besides the back-breaking work of a Chef de Mission, he chairs SNOC’s Special Training Assistance Committee, a committee that engages the National Sports Associations to ensure that training and preparation of major Games are on track. As Singapore Sports Council’s former chairman, he selflessly poured 16 years of his life strategising and implementing the blueprint for sports in Singapore. If I continue further with Eng Liang’s involvement in sports, we would be here all night. Eng Liang, to many of us, epitomises the values of a true sportsman and Olympian.

Secretary-General, Mr Chris Chan, has served the SNOC since 2002. Under his stewardship, the SNOC, with a small staff strength of five, scarce resources and support from partner agencies, has organised successful editions of the prestigious IOC session, Youth Olympic Games and the IOC Athletes’ Forum. He also played a major role in “Project 0812”, a national initiative to medal at the Olympic Games. Chris’ involvement in sport extends beyond Singapore. He represents us at the SEA Games Federation, Commonwealth Games Federation and Olympic Council of Asia and has ensured that our region’s interest at these forums are constantly protected and promoted positively.

Often, we seek inspiration from figures in sport from people whose hearts are in sport not for expedient reasons or for personal benefit, but for all the priceless values that sport upholds. Howe Liang, Eng Liang and Chris have demonstrated these values through their commitment to sports. My heartiest congratulations goes out to them for this special recognition from the IOC.

There are many others in Singapore who have given many years – even decades – of their lives to sport. ¬ Many of you here are serving sport in a voluntary capacity. I wish your work in sport continues to bring meaning to your lives and make a positive impact to our community and Singapore.

My final word of appreciation is reserved for the families of our sports personalities and volunteers, I thank and commend them for their patience and understanding in tolerating the time and effort we invest in sports – a common space we share and embrace in good times and bad.

Thank you and enjoy your evening.

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Speech by 2M Tan See Leng at the Singapore Prestige Brand Award (SPBA) Award Presentation Ceremony and Gala Dinner

Mr Kurt Wee, President, Association of Small & Medium Enterprises Ms Lee Huay Leng, Editor in Chief, Chinese Media Group, SPH Media Trust Distinguished guests, ladies and gentlemen Preamble 1. Good evening. It is my pleasure to attend tonight’s award presentation ceremony organised by the Association of Small & Medium Enterprises (ASME) in partnership with Lianhe Zaobao, and to present the awards to the 2020 and 2021 Singapore Prestige Brand Award winners. It is good to finally see everyone in person. 2. Tonight, we recognise and celebrate the achievements of many of our Small and Medium Enterprises (SMEs). The past 2 years have been particularly challenging for businesses. Besides the border restrictions, supply chain disruptions and prolonged COVID-19 pandemic, businesses have been dealing with the impact of the war in Ukraine and heightened geo-political tensions. 3. This challenging backdrop makes the hard work of our local enterprises over the last 2 years, to press on, pivot and transform, all the more remarkable. I want to applaud this. Our enterprises have shown tremendous resilience amidst the challenging and constantly evolving environment. Many of them have even successfully entered new markets, created new products and solutions, and transformed the crisis into an opportunity of a generation. Companies have done well to persevere and transform despite a crisis and tough external business environment 4. I am pleased to note that the Singapore Prestige Brand Award will be awarded to 38 local brands tonight, with 31 being first-time winners. These brands are setting the pace for innovation and transformation. They have dug deep to strengthen their core capabilities and evolved their service and product offerings. Let me briefly highlight three examples. 5. Many associate Singapore enterprises with the brand of trust, quality and integrity, and this will resonate especially well with heritage brands like Econ Healthcare . They have worked hard to build and maintain their reputation over the past 35 years, and this has also proven instrumental in their overseas expansion efforts in China and Malaysia. We have also seen established businesses like City Gas be deliberate to evolve their branding alongside their changing business and priorities – having recently rebranded to City Energy to reflect their commitment towards using more sustainable and pollution-free energy sources. In the food services sector, elemen has continued to reinvent themselves and develop new and exciting recipes that push the boundaries of meat-free dining. These are three examples, and I know that all 38 brands represented tonight have their own unique and inspiring story. We must build and sustain a vibrant ecosystem of Singapore enterprises that are future-ready and can compete globally 6. The Government will partner enterprises like Econ Healthcare, City Energy, and elemen to chart the next bound of our economic development. At the MTI Committee of Supply earlier this year, I shared about our Enterprise 2030 vision, to build and sustain a vibrant ecosystem of Singapore enterprises that are future-ready and possess deep capabilities to compete globally. Under the Enterprise 2030 strategy, the government has committed a suite of measures to support the growth of high potential companies to become global champions and to strengthen the core capabilities of the broad base of local enterprises in key areas such as capability development, digitalisation, internationalisation and innovation. 7. We are committed to accelerating the growth of high potential local enterprises which are home-grown, provide leading innovative and globally competitive products and solutions to the world and have strong international presence and networks. I look forward to many of you working with Enterprise Singapore to realise your future growth ambitions to become a Singapore Global Enterprise. The Government will continue to work closely with TACs to support businesses amid an uncertain business landscape 8. Besides working with individual enterprises, the Government will also deepen efforts to work with our Trade Associations & Chambers (TACs). TACs play an important role as multipliers to drive industry transformation, and MTI will support TACs’ efforts to uplift their capabilities, especially in digital adoption and leadership development, to serve their members better. For example, we recently announced the new Digi-TAC programme by SBF and SGTech to help TACs digitalise, and the upcoming SBF TAC Fellowship Programme to enable TACs to grow their leadership pipeline. 9. At this juncture, I would like to take this opportunity to thank ASME for your efforts to support local businesses. ASME, through their SME Centre, has served as a key touchpoint for local enterprises, and has supported more than 7,000 companies in their transformation efforts over the past two years. One such example is AOX (pronounced “A-O-X”), a homegrown manufacturing company that designs and supplies alkaline water dispensers. With the help of business advisors at SMEC@ASME, the company was able to integrate their backend processes seamlessly through the adoption of suitable solutions. This has enhanced their productivity, allowing them to expand their business lines. I thank ASME for your good work “for entrepreneurs, by entrepreneurs”. Concluding remarks 10. Let me conclude. Singapore has come a long way in our fight against COVID-19. Despite the challenges, the last two years have also brought new opportunities and growth. It is time to set our sights further, plan for the longer-term as we put in place building blocks now to ride the economic recovery in the post-COVID world. In this effort, I look forward to a continued close partnership between our businesses, trade associations, and the Government, to position ourselves well for the long-term. Let us embrace continuous innovation, think outside the box, and transcend our constraints to seize emerging opportunities. 11. My heartiest congratulations to all the Winners this year, who have exemplified this fighting spirit and gumption. Thank you.

Speech by Minister Gan Kim Yong at the Firefly Symposium 2022

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Antoine  Dole,  alias  Mr  Tan,  est  né  en  1981.  Créateur et  scénariste  de la série  Mortelle Adèle  (10 millions d’exemplaires écoulés), il est aussi romancier  aux  éditions  Actes  Sud et Robert Laffont.  Ses voyages au Japon  ont  donné  naissance  à  différents  ouvrages  questionnant  la  société  japonaise  ou  explorant ses codes, dont le roman  Ueno Park  (Actes Sud, 2018), l’album  Les  Jours  Heureux   (Nobi  Nobi,  2019),  le  manga   4LIFE   (Glénat  Manga,  2019)  ou  le  recueil  de  photographies   Nendo  Stories   (Glénat  Editions,  2 019). Il rencontre Mato à Tokyo en  2019 et déroule  avec  elle  l’histoire  de  Jizo,  poussant  plus  loin  son  exploration  du  folklore  japonais  et  de  ses  croyances. Ils se retrouvent une nouvelle fois pour Ningyo , un conte sensible onirique. Primés à plusieurs reprises, les  ouvrages  d'Antoine  Dole  sont  traduits  dans  différents  pays,  dont  la  Chine,  la  Corée,  l'Espagne,  l'Italie,  la  Pologne, l'Ukraine, la Russie, l'Arménie ou encore les Pays-Bas. 

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What It Takes to Give a Great Presentation

• Carmine Gallo

Five tips to set yourself apart.

Never underestimate the power of great communication. It can help you land the job of your dreams, attract investors to back your idea, or elevate your stature within your organization. But while there are plenty of good speakers in the world, you can set yourself apart out by being the person who can deliver something great over and over. Here are a few tips for business professionals who want to move from being good speakers to great ones: be concise (the fewer words, the better); never use bullet points (photos and images paired together are more memorable); don’t underestimate the power of your voice (raise and lower it for emphasis); give your audience something extra (unexpected moments will grab their attention); rehearse (the best speakers are the best because they practice — a lot).

I was sitting across the table from a Silicon Valley CEO who had pioneered a technology that touches many of our lives — the flash memory that stores data on smartphones, digital cameras, and computers. He was a frequent guest on CNBC and had been delivering business presentations for at least 20 years before we met. And yet, the CEO wanted to sharpen his public speaking skills.

• Carmine Gallo is a Harvard University instructor, keynote speaker, and author of 10 books translated into 40 languages. Gallo is the author of The Bezos Blueprint: Communication Secrets of the World’s Greatest Salesman  (St. Martin’s Press).

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