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For the most part, though, I was struck not by the verbal felicity and invention of my patients and those around them but by their inability to express themselves with anything like facility: and this after 11 years of compulsory education, or (more accurately) attendance at school.
With a very limited vocabulary, it is impossible to make, or at least to express, important distinctions and to examine any question with conceptual care. My patients often had no words to describe what they were feeling, except in the crudest possible way, with expostulations, exclamations, and physical displays of emotion. Often, by guesswork and my experience of other patients, I could put things into words for them, words that they grasped at eagerly. Everything was on the tip of their tongue, rarely or never reaching the stage of expression out loud. They struggled even to describe in a consecutive and logical fashion what had happened to them, at least without a great deal of prompting. Complex narrative and most abstractions were closed to them.

In their dealings with authority, they were at a huge disadvantage—a disaster, since so many of them depended upon various public bureaucracies for so many of their needs, from their housing and health care to their income and the education of their children. I would find myself dealing on their behalf with those bureaucracies, which were often simultaneously bullying and incompetent; and what officialdom had claimed for months or even years to be impossible suddenly, on my intervention, became possible within a week. Of course, it was not my mastery of language alone that produced this result; rather, my mastery of language signaled my capacity to make serious trouble for the bureaucrats if they did not do as I asked. I do not think it is a coincidence that the offices of all those bureaucracies were increasingly installing security barriers against the physical attacks on the staff by enraged but inarticulate dependents.

From a recent Theodore Dalrymple article.