Understanding Sen. John Fetterman’s struggle to understand

Note to readers: The New York Times reported February 16 that Sen. John Fetterman checked himself into a hospital the week before for treatment of his clinical depression, which has worsened as he adjusted to the rigors of US Senate work after suffering a life-threatening stroke last year.

Pennsylvania Sen. John Fetterman isn’t deaf, exactly, but he might as well be.

A stroke that laid him low last year apparently left remnants of neurological damage that rendered him, at least temporarily, unable to consistently understand speech and to unhesitatingly speak.

Although the reason he doesn’t “hear” may be auditory pathways in the brain injured in his stroke rather than weak sound-processing hairs in the inner-ear cochlea—the usual cause of common deafness—the net result is the same: spoken language is now hugely challenging for him to process and express.

As someone with a very significant hearing loss myself—“moderate to profound,” they say—I totally empathize with Sen. Fetterman’s current struggles as he tries to acclimate to a brand-new environment (the U.S. Senate) where, at minimum, processing and expressing complex speech is critical to success.

But he can’t do that fluently at the moment as he very slowly recovers—ultimately how much is now unknown—from the currently debilitating effects of his stroke.

Fetterman’s stroke was triggered by atrial fibrillation, an irregular heart rhythm that can cause blood to pool in heart chambers and clots to form. In the senator’s case, a clot migrated from his heart and lodged in his brain, temporarily starving neurons of oxygen before surgeons “retrieved” it, according to an October 2022 article in The New Yorker. Doctors then implanted a pacemaker and defibrillator in Fetterman’s chest to mitigate any future heart flutters and protect against heart failure.

Dhruv Khullar, the New Yorker article’s author, wrote:

Fetterman spent nine days in the hospital and three months off the campaign trail. Since returning, his speech is less fluent; at times, he has difficulty finding the right word, or pronouncing it once he’s found it. He struggles with auditory processing, or reliably comprehending spoken language, and has used closed-captioning for interviews and campaign events. “I sometimes will hear things in a way that’s not perfectly clear,” Fetterman told Dasha Burns, of NBC News. … Fetterman’s ability to read and respond to written language also suggests that his cognitive capacities haven’t been meaningfully compromised.

Beyond Fetterman’s lingering verbal expression issues, his is the practical profile of people with ordinary garden-variety hearing loss that is severe enough to drastically compromise their ability to smoothly navigate the spoken realm: They are cognitively fine. They can fully understand written language. But they struggle to hear words clearly enough to fluidly understand and thus cogently process and respond to them (it’s more about clarity than loudness).

So Fetterman has done what hearing-impaired people everywhere do, whatever the primary cause. They seek out aids. Since his current disability is not inner-ear related, traditional “hearing aids” aren’t helpful. But being able to translate speech into text is—and he has employed a phalanx of speech recognition and closed captioning solutions that suggest protypes for future standard mitigators of hearing loss.

Fetterman’s new job site, the U.S. Senate, recently received a digital upgrade to help the senator succeed, with the installation of infrastructure to accommodate state-of-the-art assistive devices. It could have far-ranging effects. Wrote Minnie Racker in a February Time magazine article:

“In securing the devices that are helping him begin a new job during a very public recovery process, advocates say Fetterman is forging a path for people with disabilities and health challenges to make it in public office.”

But also for people not in public office.

READ: 50 years ago, depression ended a campaign. That’s changed, politicians say.

To compensate for his speech-comprehension issues, Fetterman mainly used portable closed-captioning equipment during his Senate campaign and continues to use such devices now. They translate speech into text in real time, like when your iPhone “notes” or email software render your spoken words into text on your screen as you speak them. It also works for transcribing a podcast episode or what the Post Office clerk is saying to you when you mail a package.

Closed captioning is now ubiquitous on television, with most shows providing captioning, which, even if it’s sometimes laggy and spotty, is far, far better than nothing if you have hearing issues. And with captioning devices provided by the local movie theater in our small, Midwestern city, I can enjoy captioning for many films so configured.

Assistive devices for the hearing impaired certainly are getting better and more available, yet, as I’m sure Sen. Fetterman now knows, communicating on the fly in public, even with assistive devices, is to wade through a maelstrom of undecipherable noise attended by constant confusion. Understanding spoken words in these noisy environments is next to impossible.

Even cutting-edge hearing aids are abysmally ill-equipped to handle speech in, say, a pub during the Super Bowl (yay, Chiefs!). Still, hearing aid manufacturers tout aids that supposedly provide excellent speech recognition in noisy environments. I’ve met no one who actually wears a hearing aid that can vouch for that claim. I certainly can’t.

[A]s I’m sure Sen. Fetterman now knows, communicating on the fly in public, even with assistive devices, is to wade through a maelstrom of undecipherable noise attended by constant confusion. Understanding spoken words in these noisy environments is next to impossible.

So I understand somewhat the acute comprehension struggle that John Fetterman is going through but not the enormous added stress he must also endure, simultaneously, in shouldering one of the nation’s most demanding, consequential and unforgiving jobs.

Let’s hope that his unique ability to corral high-tech voice-recognition and captioning devices to help smooth his own legislative path will also spark a surge of new, effective assistive devices for all Americans with speech-processing challenges.