Language in psychiatry
Some time ago I came across references to an article on linguistic comparison of auditory hallucinations. As I looked at the article, I thought it was time to write a bit on psychiatric analyses of language.
My first encounter with ‘psychiatric linguistics’ was when I found a book called Language in psychiatry. As you might imagine, I was very keen to lay my hands on the book. Is this what linguistics could offer psychiatry? What I hoped I would find was that people with certain experiences tell stories in a particular way and listening to those stories might be helpful in clinical settings. Unfortunately, the book’s aim was much more ambitious and, I feel, doomed.
For the author tried to reverse the order. He was trying to say that the way a person talks could be diagnostic. In other words, if you talk ‘oddly’ and ‘ungrammatically’, you might have psychotic experiences. If you talk quietly and slowly, yes, you guessed it, here comes depression. Still, the book was written by a linguist and the linguistics of the book was sound.
After reading the book, I discovered that there are a number of attempts by psychiatrists to define for example “schizophrenic language”, each attempt more problematic than the other. All underpinned by assumptions that we, healthy people, speak in beautifully formed sentences, in perfect grammar, while those ‘schizophrenic people’ make all sorts of grammatical mistakes, which, needless to say, just tells that they are ill and so completely different from us. To be honest, such assumptions are so stupid that I shall not dignify them with a comment. Nor will I give references to the texts I am referring to. I have mercy.
Let me just add that according to such research most poets should be sectioned immediately, as poetry’s linguistic acrobatics are surely the clearest sign of severe mental illness.
And here comes the article (which is not in the same league as the research I have just referred to) I came across in my Twitter timeline. The article suggests that “AVH of psychotic patients showed lower syntactic complexity and higher levels of repetition and abuses than AVH of nonpsychotic individuals”. And it is probably true what the authors say in the sense that the analyses of their data are sound, and yet, I have some problems with what they are attempting to do. I want to raise two issues. The first refers to some conceptual chaos in the article, second to the complete absence of the social dimension in the article. So, let’s start with the former.
The authors use the concept of ‘utterance’ in their analyses and that’s quite a problem, actually. Does it mean that they take everything a person said, from the first clearing of the throat to silence? Or are they interested only in the ‘verbatim AVH’? It is only seemingly easy, as the informant might actually frame the ‘verbatim’ bit by what precedes it. It is highly unlikely that the person simply sits down and starts ‘verbatimming’. Also, what is the standard the authors applied to ‘grammatical utterances’ (a concept which, to be honest, makes no sense)? After all, there is no one, universal and wonderful grammatical standard. And while you might be tempted to say ‘ain’t’ over a pint, you are unlikely to during your inaugural lecture. Which standard (or register) did the researchers adopt? Furthermore, we linguists know very well that written language differs from spoken language and it makes little sense to apply written language standards to spoken language (for those interested, here a link to Per Linell’s book on written language bias)
So, as I suspect that ‘ungrammatical’ in the article means: “said in a way I, the researcher, have a problem with”, which is not exactly very scientific. I could add: what about stylistic effects of playing with grammar? And then the authors write:
Linguistic complexity was examined by scoring the following characteristics: total words produced, type-token ratio, mean length of utterance, proportion of grammatical utterances, mean number of embeddings, verb complexity, noun-verb ratio, open -closed class ratio, and proportion of negations.
And what I see is the time-honoured disciplinary instruments of linguistics. If words are too close to each other, you failed, if you speak in ‘simple sentences’ you’re a simpleton, if you don’t match verb and noun, you are moron. The only other thing you should add is speaking in ‘complete sentences’. To be honest, if children spoke the way they’re asked to speak at school, they would easily sound ‘odd’.
Before I discuss the social bit, let me offer a story. Most psychiatric interviews I sat in on, included a psychiatrist’s request that the patient repeat a series of numbers (or words) as a means to test their memory. Inevitably, the patient could do it and I could not. No matter how hard I tried, I never could remember the remaining third of the numbers, while the patients recited them. I always wondered whether the doctor actually remembered themselves….
So, as I failed to repeat a simple series of numbers or words ‘verbatim’, what are the chances I could repeat my hallucinations ‘verbatim’? And so, has the ability of ‘verbatimness’ been tested? Or have we simply assumed that patients could do it? In other words, how do we know that what the informants said was the ‘verbatim’ rendering of their hallucinations? Moreover, I must admit that the task of rendering them with “the same intonation, loudness, and pronunciation as the voice they perceive” would scare me as I might not have any acting skills, and my children keep telling me that my attempts to emulate pronunciation always fail miserably. But, hey, what wouldn’t I do for science?!
And here comes the social bit. What really annoys me in such analyses is complete disregard for the way people speak. As the article apparently offers us insight into whether they people ‘were psychotic’ or not, what about their social class, age, level of education? They all are likely to have impact on how we speak. What about their speaking practices? For example, if I normally don’t swear, how likely am I to repeat the ‘swear words’? Incidentally, when you read psychology or psychiatry, you must think that all their research participants never stop, repair, hesitate, swear…. You have those highly sanitised excerpts that only psych people believe are possible.
And finally, has anyone wondered whether the way patients speak is a result of what psychiatrists expect them to say? Quite a number of psychiatric patients told me that their doctors never want to hear what they have to say. You either have suicidal ideation or not and there is no in-between, no hesitations, no maybes, no moaning. If you’re in-between, you lack insight and you are not cooperative. Yes, this is exactly what psychiatrists interviewed by Justyna Ziolkowska told her. Patients learn very quickly to say what their shrinks expect them to say.
But the research I am criticising here ignores completely such contexts. The researcher seems to have a special device (like in the film “Men in black”) with which they zap the person out of who and where they are and they simply repeat hallucinations verbatim. After all it’s all about the right hemisphere….
I so wish psychiatrists would occasionally talk to linguists.