Speech Strategies in the Discourse of Psychotic Patients

Linguistic studies in the field of psychiatry are few
and mainly concentrate on aphasic speech and
what some call “mind disorders”. It is true that the
possibility offered by psychiatric institutions to
work on a ward is very often difficult to get and
many patients are, for the least, not very cooperative or unable to take part in a scientific research
program.
However, in the last few years, things have become easier and the use of quantitative linguistics
has proved beneficial and begins to be part of the
evaluation of patients on admission. This is the
case, for example, in L’Hôpital Sainte Anne, in
Paris.
This paper aims at showing that some linguistic
markers are valuable indications both for the diagnosis, the understanding of the illness, and the
prevention of possible relapses.
Very often, the work on “psychotic speech” concentrates on the different semantic fields the patient deals with. Our hypothesis is that knowing
that a certain person claims he/she is Jesus or the
Virgin Mary is of no real avail to the analysis. This
is why we decided to concentrate on markers like
determinants, negations, repetitions, phatic forms
and so on, to get a deeper understanding of the
specificity of this kind of discourse.
The corpus used is an oral one which includes
alltogether some 300 000 words. The patients who
cooperated and volunteered in this study were
either schizophrenic patients or manic-depressive
ones, both depressive and elated. I also had a
control group including “normal” people, who had
no past or present psychiatric history, which I tried
to pair with my two other groups for age, sex,
education, and social background. The interviews
of the patients were standardised, all recorded and
transcribed by myself, then fed to the computer,
using a very limited coding of some categories to
avoid ambiguity. For example, “her dress” was
left as such, whereas “I can see her” was fed to the
computer in the form “I can see “*her”, to make
it easier when sorting out the different grammatical categories I wanted to study. Concordances
were then obtained thanks to the software “The
Concorder”, by David Rand (Montreal University).
Choosing to put aside, at least at this stage, what
is actually said to concentrate on the way it is said,
allowed me to point out that linguistic markers,
which most of the time escape the conscious use
of the speaker (especially in oral speech) was
deliberate. I assumed that the way patients expressed their ideas or delusions would be more meaningful, in some ways, than what they expressed.
The main categories I chose to select are as follows:
– the determinants, which are markers which can
show how the patient both sees the world he lives
in, and the way he is able to share is with another
speaker. For a finer analysis, I had to split this
large category in sub-classes, like “constrained”
determinants, which are included in a fixed form
like “Once aupon a time” and escape the conscious
of the speaker between for exempts a and the or
this.
I discovered this grammatical category was, in
most cases, a very good index of communication
as some patients very cleverly distort what seems
a communicative process by using determinants
without giving the hearer the least possibility to
find out which substantives are possible referents.
– personal pronouns because, here again, they are
a good index of the coherence of the speach in a
situation of communication between two persons.
Here again, the presence of an obvious referent is
the sign that the speaker includes his/her hearer in
the relationship and gives him/her clues to identifyi people, things or places he/she is talking about.
– phatic forms, which are meant to maintain a
contact with one’s hearer, and a way of letting him
know that the communicative process is still consciously going on. Together with these phatic
forms, I included the study of the systematic repetition of words, and the presence of unfinished
sentences, because the close study of the concordances led me to discover that these different
forms usually occur in the same speech sequence.
A detailed study of these sequences, including this
time the semantic value of the words, led us to
discover these clusters of phatic forms, repetitions
and unfinished sentences occurr when the patient
is about to speak of a very personal experience,
probably yet too painful to be uttered in a more
structured and understandable form. These
“knots” of dis-structured sequences are of prime
importance to try and have a hint of the problems
the patient is still unable to face and discuss.
Finally, an extensive study of the negative forms
was performed both on a grammatical and semantic level. Here again, a number of sub-groups was
designed to separate the negations or negative
statements applying to the world of the speaker or
to the outside world and people. In another paper,
I showed that the use of negative forms is very
often an indication of depressive features, even
though this depression is not felt and expressed by
the patient, or even visible to the nursing staff. My
personal opinion, shared by others, is that schizophrenic patients are very often deeply depressed, though this feature is rarely taken into account
because the other symptoms of the illness are too
overwelming.
On the whole, it apppears that concentrating on
what is not said rather than on the semantic message itself is a more pregnant approach, as far as
the condition of a psychotic patient can be evaluated on admisssion and during the course of the
treatment. Unable not to communicate psychotic
patients use the tricks of language to give an
illusion of communication while avoiding the topics their inner self can’t face at this stage of the
illness.
Surprisingly enough, language is nevertheless the
only outlet left to them to express their suffering
and ask for help, even though their dilema is that
they can’t put it into a straightforward meaningful
form for the hearer. They both crave for a true
communication and fear it more than anything
else.
This kind of studies reveals to be a valuable indication for the doctors, who can then control more
accurately the swing of moods of the manic patients, and the depressive features both of the
schizophrenic and manic patients.