AUTHOR: DERYN FISHMAN
Various disorders can affect language production and efficiency, a prominent one being schizophrenia. This disorder makes it difficult for those affected to speak properly and fluently, making it troublesome for others to comprehend the message they are trying to convey. Various aspects of their language are affected, inclusive to both its format and content. The organizational structure, attentiveness, executive functioning, and semantic and lexical properties are all dysfunctional in consequence. Although claims have been made that refute these findings, their abundant and thorough nature creates persuasive evidence regarding the influence schizophrenia has on language, amongst other facets.
This chronic disorder affects the thoughts, behaviors, and feelings of those suffering with it (National Institute of Mental Health, 2016). One overwhelming feature in people with the disorder is having a disassociation from reality (National Institute of Mental Health, 2016), a result of a combination of symptoms. Although symptoms typically appear between the ages of 16 and 30, there have been cases where they are shown during childhood (National Institute of Mental Health, 2016).
These symptoms are divided into three different categories: negative, cognitive, and positive. Language deficits form as consequences of each of these categories. Positive symptoms produce psychotic features, such as hallucinations, movement disorder, and delusions, which is what makes patients appear to have lost touch with reality (National Institute of Mental Health, 2016); although, the symptom that leads to language deficits is thought disorder. This dysfunction makes schizophrenics think in unusual ways (National Institute of Mental Health, 2016). Because their thoughts are dysfunctional, their pragmatics are the same way. Think about it: you can’t speak properly and convey messages well if your thoughts aren’t formed properly.
As for negative symptoms, these manifestations promote abnormal behavior and emotions. The concept of “flat affect” in patients relates to inability to create facial expressions or change the voice of tone to show their emotions (National Institute of Mental Health, 2016). In addition, people with schizophrenia do not experience as much pleasure from their everyday lives and have a hard time initiating oneself in new activities as well as maintaining them; but, most importantly, they show a reduction in speech production (National Institute of Mental Health, 2016).
Lastly, the cognitive symptoms tend to be more subtle than the others but results in changes in their memory or thought processes. This consists of deficient executive functioning, an inability to understand information and apply it to situations (National Institute of Mental Health, 2016). This makes it more challenging for schizophrenics to make decisions and leads to language impairment (Marini et al., 2008). Other cognitive deficiencies include trouble with working memory and paying attention, which also are related to issues with language (Marini et al., 2008).
Much research has been conducted to advance our knowledge on exactly what processing and functional abilities are altered by the disorder to alter such language capabilities. In 2008, Andrea Marini and her colleagues produced a study looking to determine the relationship between micro and macro-linguistic skills in schizophrenic patients. The term “micro-abilities” refers to lexical and syntactic abilities. Lexical skills are needed in language comprehension and production because they work in retrieving information within a person’s mind. Syntactic skills involve understanding how to organize phrases, sentences, and word order to create comprehensive speech. As for “macro-abilities”, this term refers to pragmatic level processing, as in social language skills used for communicating thoughts, ideas, and feelings (Marini, 2016). Their findings showed that there is only a minimal impairment in syntactic and lexical skills in schizophrenics, but that this impairment is affected by pragmatic level processing. So, producing speech with poor organization and word order is not as significant as the difficulty people with schizophrenia face when trying to communicate thoughts, ideas, and feelings in a social environment; but, when organizational issues are present, they are paired with issues with pragmatic processing.
Although impairments in lexical abilities are somewhat rare in patients, it has been found that the presence of such can result in the use of neologisms, or “made-up words” (Bellani, Brambilla, Perlini, 2009). This is another feature of schizophrenics that shows a difficulty in producing language. It has also been determined that deficits in patients’ semantic knowledge leads to neologisms, as well as stilted speech (Bellani, 2009). Stilted speech is defined as the use of legalistic, overly-formal, and unnatural speech in an inappropriate manner (Bellani, 2009); so, picture a person who is not a lawyer but using such language to describe a situation even though he or she is not equipped with the knowledge to do so.
Another attribute found in patients is having poor attention and executive functioning. It has been found that these two features actually predict language impairments (Marini et al., 2008), where executive functioning refers to the skills used in working memory and our ability to carry out plans, abide by social rules, adapt to new circumstances, solve problems, and conduct tasks simultaneously (Orellana & Slachevsky, 2013). Without these abilities, people with schizophrenia not only suffer with their language but with carrying out daily activities as well. In addition, patients are known to create erratic, derailed sentences containing irrelevant information due to reduced attention and executive functioning (Marini et al., 2008). For example, they may start speaking about how they like oranges, but then include irrelevant words and, in the end, finish the sentence off with something unrelated to oranges. This makes it incredibly challenging for them to convey their thoughts and feelings, and it makes it hard for others to understand them. They can become easily distracted, which is why they often go on tangents that do not have to do with the topic of their sentence. But, deficits in executive functioning lead to challenges in conveying messages as well (Kuperberg, 2010).
Studies have shown that executive dysfunction, a common feature in schizophrenics, produces poverty of speech in addition to derailment and disorganization (Covington et al., 2005). Poverty of speech just means short and limiting speech or responses to speech are made, and derailment is when speech does not make sense because it is not consistent with one idea (Covington et al., 2005). People with schizophrenia will often talk about one idea then spontaneously change to another unrelated idea, changing the sentence’s frame of reference. This aspect of language makes it challenging for others to follow and understand what message he or she is trying to convey. This idea of “poverty of speech” is the consequence of patients not producing ideas as much as the average person (Hinzen & Rossello, 2015). This frequent characteristic in schizophrenics is also existent because their speech variability is lower than the average person’s (Hinzen & Rossello, 2015). These two elements combined make it troublesome for people with this disorder to speak fluently because they are lacking in the creation of ideas and do not have as many words to pick from their memory.
Yet, their failure in communicating isn’t just due to derailment or lack of speech; people suffering from this disorder sometimes hold different meanings of words than the conventional definition (Wrobel, 1989). Our language is full of customs that allow us to carry on conversations while manipulating the same words in various ways. Those with schizophrenia lack this ability; they only utilize the most basic, primary meaning of words (Wrobel, 1989). They almost take on the attitude of a child who has no linguistic flexibility or pragmatics. Words have one meaning and one meaning only, independent of the context they appear in. Inevitably, because they have such a simplistic take on language, they are unable to make strong, appropriate references in their speech (Rutter, 1985). Speech is hard to follow and understand if the speaker is not utilizing correct referent networks.
Although these studies bring to light important and detrimental aspects of schizophrenia’s influence on language, other articles have criticized such findings. Til Wykes claims that these speech errors are not unique to societal members with the disorder, but that they are committed by all speakers (Wykes, 1980). Wykes also says there are methodological flaws within these studies; they do not consider socio-economic factors between groups, if it is comorbid with other disorders or symptoms, drug administration levels, and they do not clearly discriminate between “thought-disordered” schizophrenics and those with schizophasia (Wykes, 1980). Thought-disordered patients typically struggle in maintaining a plan, where those with schizophasia indulge in neologism, random utterances, and clanging (Covington et al., 2005).
Similar in most disorders, there are various routes for treatment for schizophrenia. Antipsychotics are used to reduce the positive and negative symptoms, while psychosocial treatments are used to address coping skills to lead to the pursuit of a normal life consisting of healthy relationships and goals (National Institute of Mental Health, 2016). In addition to these forms of treatment, speech and language therapy has recently developed to address the specific issues caused by speech deficits. Studies have shown that this intervention is successful in expanding verbal communication and developing better, more suitable communication skills in social settings (Clegg et al., 2007).
Altogether, schizophrenia creates a wide variety of impairments for those suffering. Its extensive consequences on language are undeniable, between the skill and content-based dysfunctions, despite regards to criticism in the findings. Although it poses as an obstacle for communication, speech and language therapy brings hope to decreasing such adverse aspects in patients.
References
Allen, H. A. (1983). Do positive symptom and negative symptom subtypes of schizophrenia show qualitative differences in language production? Psychological Medicine, 13(04), 787. doi:10.1017/s0033291700051497
Bellani, M. (2009). Language disturbances in schizophrenia. Retrieved December 13, 2017, from https://www.cambridge.org/core/services/aop-cambridge- core/content/view/033E4514B6FDDAB366035786296AAF68/S1121189X00000270a.pd f/div-class-title-language-disturbances-in-schizophrenia-div.pdf
Clegg, J., Brumfitt, S., Parks, R. W., & Woodruff, P. W. (2007). Speech and language therapy intervention in schizophrenia: a case study. International Journal of Language and Communication Disorders, 42(S1), 81-101. doi:10.1080/13682820601171472
Covington, M. A., He, C., Brown, C., Naci, L., McClain, J. T., Fjordbak, B. S., . . . Brown, J. (2005). Schizophrenia and the structure of language: The linguist’s view. Schizophrenia Research, 77, 85-98. doi:10.1016/j.schres.2005.01.016
Hinzen W, Rosselló J. The linguistics of schizophrenia: thought disturbance as language pathology across positive symptoms. Front Psychol (2015) 6:971.10.3389/fpsyg.2015.00971
Kuperberg, G. R. (2010, August 01). Language in Schizophrenia Part 1: An Introduction, Language & Linguistics Compass. Retrieved December 13, 2017, from https://www.deepdyve.com/lp/wiley/language-in-schizophrenia-part-1-an-introduction- M007ETNxk9
Marini, A., Spoletini, I., Rubino, I. A., Ciuffa, M., Bria, P., Martinotti, G., . . . Spalletta, G. (2008). The language of schizophrenia: An analysis of micro and macrolinguistic abilities and their neuropsychological correlates. Schizophrenia Research, 105(1-3), 144-155. doi:10.1016/j.schres.2008.07.011
National Institute of Mental Health. (2016, February). Schizophrenia. Retrieved December 11, 2017.
Orellana G, Slachevsky A. Executive functioning in schizophrenia. Front Psychiatry 2013;4:35 doi:10.3389/fpsyt.2013.00035
Rutter, D. R. (1985, April). Language in schizophrenia. The structure of monologues and conversations. Retrieved December 13, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/4016443
Wrobel, J. (1990). Language and schizophrenia. Amsterdam: J. Benjamins.
Wykes, T. (1980). Language and Schizophrenia. Institute of Psychiatry, Psychology & Neuroscience, 10(3), 403-406. doi:DOI: 10.1017/S0033291700047279
