Impaired Pragmaticsas an Diagnostic Tool for Schizophrenia August Van PattenNorthern ArizonaUniversity AbstractThis paper synthesizes information from previously publishedscholarly articles in hopes of providing the reader with further insight of howpragmatics is essential to understanding schizophrenia, especially the speechpatterns of schizophrenics. Schizophrenia is a complex disorder and studies arestill developing with hopes of researchers gaining understanding for the causesand exact symptoms of the disease.
Formal Though Disorder (FTD) is defined as”the disruption of normal thought” and is a common symptom of schizophrenia. Thearticles range from 1999 to 2016 and aim at providing the reader with an acuteunderstanding of pragmatics in relation to schizophrenia and exemplify howlinguistics can be applied to other areas of study. The readings provided suggest that pragmaticsare both a diagnostic and therapeutic tool for those with schizophrenia, andthat linguistics and neuroscience are closely related.
In this paper, I willfirst provide an explanation of how schizophrenia and pragmatics are related. Iwill then discuss how second language acquisition might be a tool forschizophrenics to limit the symptoms of schizophrenia. Finally, I will concludewith an overview of how psychology and linguistics are closely related, and thevalue linguistics can have on other areas of study. Keywords: pragmatics, schizophrenia, formalthought disorder, second language acquisition Impaired Pragmaticsas an Diagnostic Tool for Schizophrenia Schizophreniais a complex brain disorder in which individuals primarily suffer from auditoryand visual hallucinations, amongst many other symptoms. While the exact causeof schizophrenia is uncertain, scientists and psychologists do know that thedisease affects how people think and perceive and interact with theirsurroundings. Essentially, schizophrenia can be viewed as a disease in whichlinguistic factors are significantly impaired. Pragmatics specifically relatesto how one interprets and reacts to their surroundings, is highly contextual,and relies on the individuals participating in a conversation to read socialcues and respond in an appropriate manner. Literature on the subject widelyconcludes that many pragmatic competencies suffer as a result of schizophrenia,which creates a correlation between the study of psychology and the study oflinguistics (see Meilijson et al.
,2004). It is important to note that becauselanguage use is unique to each person, and every person whom has schizophreniais impaired differently, it is difficult to provide an overview, and, whateverinformation is provided is a generalization and may differ depending on theindividual. The conclusions drawn are very broad and encourage further researchand continued interpretation from future studies. Most of the linguistic studies onschizophrenia focus on specific ways that schizophrenic’s language use differsfrom a “normal” native speaker. Formal thought disorder (FTD) is a commonsymptom of schizophrenia, and often the focus of studies.
Formal thoughtdisorder is essentially a “disturbance in speech comprehension and coherence”and is used to describe the odd way schizophrenics sometimes speak (Salavera etal.,2014). It is important to understand that although it is called “thoughtdisorder” it relates directly to speech production and comprehension. Langdon et al. (2002) describes FTD as thebasic thinking processes being disrupted. Most important about FTD is how itaffects speech patterns and is used often to diagnose schizophrenia (seeLangdon et al., 2002; Covington et al., 2005; Radanovic et al.
, 2013; Salaveraet al., 2014). Both previous mentioned articles alsodiscuss a correlation between FTD and pragmatics, which proves that the moreprevalent FTD is in a patient, the more their semantic and pragmaticcapabilities falter. The presence of FTD in each individual of course varies,however, based on research it is safe to say that there is an absolutecorrelation between the presence of FTD in an individual and their semantic andpragmatic aptitude.Langdon et al. (2002) delvesfurther into how pragmatics specifically are affected in individuals withschizophrenia. Based on their research, they have found that pragmaticcomprehension is significantly impaired in these individuals which, in additionto FTD, makes it extremely difficult for them to carry on conversations.Mind-reading skills are basically non-existent and reading social cues andunderstanding the illocutionary force of a speaker’s utterance (Langdon et al.
,2002). Metaphors, irony, proverbs, indirect hints, and essentially any spokenspeech which is not literal becomes hard for schizophrenics to understand andrespond to in a socially “correct” manner (see Langdon et al., 2002; Colle etal., 2013). Although this study was conducted in 2002, there are not anydirectly contradicting studies which prove otherwise.
Rather, many contemporarystudies support the conclusion that pragmatics are greatly impaired inschizophrenics and pose a challenge for them in conversational comprehension andproduction.The fact that schizophrenics havedifficulty understanding non-literal language is fascinating, and in theirstudy, Schnell et al. (2016) used fMRIs to directly look at how the brain ofschizophrenics reacts and processes irony. They first relate the lack ofunderstanding of irony to the Theory of Mind (ToM), which is atypical in manyschizophrenics. According to Schnell et al. (2016) this most likely”contributes to their deficit in pragmatic competence”. Theory of Mind is anessential part of language development in general and is essentially one’srecognition that they have opinions, beliefs, etc. and that another person alsohas those things, which might differ from their own perspective (Dronjiclecture; Spring 2017).
ToM allows conversational partners to understand thecontext necessary for proper pragmatic cues to occur in conversations, so itwould be understandable that if the ToM is atypical in schizophrenics, thentheir pragmatic capabilities would also not be up to par. Furthering theirexplanation of how key pragmatic factors are compromised in schizophrenics,Schnell et al. (2016) states that Grice’s Maxims are also consistently violatedin the speech of those with the disease, which makes their speech even moredifficult for others to understand. An example of how a person withschizophrenia might violate the maxims is by providing the listener way toomuch or not enough information.
Understanding how ToM and Grice’s Maximscorrespond to the study of language by schizophrenics is important tocomprehending the large role that pragmatics has in everyday life, and thedifficulty that arises when pragmatic competencies are lacking.Ultimately, after explaining theimportance of pragmatics and how it relates to schizophrenia, Schnell et al.(2016) explains the results of the fMRIs and patient’s responses to irony basedactivities while undergoing a brain-mapping process.
Not only do the resultsfrom the social context task conclude that schizophrenics are less able tocomprehend irony, it also shows that different areas of the brain of the personwith schizophrenia lit up on the fMRI compared to the control group (Schnell etal., 2016). Whereas the brain scans of the individuals without schizophreniawere more targeted to specific regions needed to comprehend the irony andcontext (see figure 1), the brain scan of the schizophrenic was more widespread(see figure 2).
This result is extremely significant because it shows that howschizophrenics process information is completely different from the controlgroup, and might further inspire others to do similar studies using fMRIs (orother new technology) as a tool to understand language processing inindividuals with mental health issues. Figure 1: Control group response to Figure 2: Patient response to social contextsocial context of irony task of irony task (Both images from Schnell et al., 2016 article) Implementingthe use of new technologies in the study of linguistics and mental health wouldgreatly improve the research which has been done. Most of the articlesdiscussed in this essay acknowledge that past studies pertaining toschizophrenia are not entirely accurate due to how the information wascollected and organized. For example, many studies during the 80s and 90s wererecorded through some kind of audio recording device and then transcribed intoscript. However, the methods of transcribing at the time were so wildlydifferent that many of the transcriptions could be viewed as inaccurate now.
Another problem mentioned by M. Joyal et al. (2016) is that studies are completed,and conclusions are drawn, but individuals who participated in the studies arenot reevaluated at all after the study to see if the conclusion is accurate.
Asmental health is explored more, especially in correlation with linguistics, itwould be wise for future researchers to learn from past mistakes and try tofill the knowledge gap as much as possible. By just implementing newtechnologies available and understanding where past researchers might havefailed, modern research can strengthen the information known aboutschizophrenia in particular and its relation to neurolinguistics. One conclusion that manyresearchers have come to is that second language acquisition might bebeneficial to those with schizophrenia, and is in fact quite possible. Many wouldassume that schizophrenics would not be able to learn a second language,however, language acquisition is mostly grammar and vocab based, so it iscompletely possible for people whom have schizophrenia to learn a new language.According to research completed by James Dugan of Northern Arizona University(2014), “individuals with psychosis who speak more than one language commonlyhave an uneven expression of symptoms across languages, leading somepatients to appear healthier in one language than another” (308). Thisconclusion is shocking considering the difficulty many schizophrenics havespeaking in their native language, and suggests that second languageacquisition might constitute a useful tool which they can utilize in order toachieve clear, understandable speech and understanding. Symptoms ofschizophrenia exemplified in spoken language (e.
g. use of neologisms,incoherent/disorganized speech, inability to provide/receive pragmatic cues,etc.) might appear less often in a person who is using their L2 (Dugan, 2014:310). The apparent lessening of symptoms might be due to the L2 beingexplicitly planned and thought out by speakers, therefore leaving less room forhallucinations to occur (Paradis 2004 per Dugan 2014). Other researchers likeBersudsky (2005) have suggested that there is little to no difference in how aperson with or without schizophrenia acquires language (See Dugan, 2014;Smirnova et al., 2015).
However, asDugan points out, it is extremely hard to make inferences when it comes tolanguage use, especially by schizophrenics, because of how individualizedlanguage is and each person’s own unique characteristics. Context is also essential,and it is difficult to judge factors that influenced people in multiple studiesto acquire a second language (i.e.
motivation and/or necessity for L2). The absolute necessity for an immigrant to learnthe language of the country he or she had moved to might provide enough need thatdespite mental health, he or she is able to accurately learn a second language andbecome bilingual. Context is important for understanding the information provided,and without the contextual factors explicitly conveyed, interpretations of dataor success might be exaggerated.In their research, Smirnova et al.(2015) looked at how bilingual speakers affected by schizophrenia differ inspeech between their L1 and L2, specifically in relation to pragmatic discoursemarkers and code-switching. Their study looked at 10 Russian immigrants who hadbeen diagnosed with schizophrenia for at least two years, and acquired a Hebrewlanguage upon relocating to Israel. Data was elicited through two interviews,the first being in the language the individual chose, and the shortly followingsecond interview in the other language. Contrary to the information presentedin Dugan (2014), Smirnova et al.
(2015) found that “clinical markers wereimpaired relatively the same in both languages, linguistic markers were moreimpaired in L2 than in L1, and fluency markers were more prevalent in L1than inL2.” These findings suggest that L2 acquisition has little to no chance ofproviding schizophrenics with a tool in which they can speak without schizophrenicmarkers happening. Of course, this is not the case for everyone, and thevarying results between Dugan (2014) and Smirnova et al.
(2015) show howinconsistent findings are in neurolinguistics. The researchers do emphasize,however, that the pragmatic discourse markers and codeswitching were usedexceptionally well by the participants (in both L1 and L2), which does indicatethat schizophrenic speakers are more skilled in social discourse than one mightat first expect. However, both came to different conclusions on what thefindings might implicate. While the possibility of L2acquisition to potentially provide people with schizophrenia a possible tool bywhich they can communicate clearer, the research on the topic is too divided tocome to a possible conclusion as to whether it is worth the endeavor. Thereare, however, other methods which can help people suffering from schizophrenia.Researchers in Canada conducted study on which methods might work best andfound that out of 12 studies in which individuals were explicitly taught pragmaticand discourse skills, 11 of them were successful in the schizophrenicindividuals retaining the information taught (M.
Joyal et al., 2016). Therapy(both group and individual) is another option discussed by M. Joyal et al.(2016), however, it either worked for patients or did not. None of the methodswere found to significantly help individual’s semantic fluency, only thepragmatic competency. The other methods reviewed in the article were notconclusive, as there was not enough information nor follow up provided to allowresearchers to conclude their benefit. This study was conducted recently, andemphasizes the need for further research in understanding and helping thosewith schizophrenia.
The research on schizophrenia andits correlation to linguistics can be both over and underwhelming. While thereis a lot of research on the topic, it is all so diversified that drawingconclusions becomes difficult. It is a disease of the brain and neurologistsand psychologists (amongst many others) are still working hard to completelyunderstand the brain and all of its processes. Linguistics is a helpful tool bywhich scientists can categorize information and explain the symptoms thatoccur, but there is still a tremendous amount of research that needs to bedone. Language is unique to each individual and so is their brain, so combiningthe two, trying to understand how one influences the other, is difficult to saythe least. Schizophrenia, though, is a great example of how neurolinguisticsand psycholinguistics are continuing to grow as a field and have a wide arrayof applications.
Even smaller components of the study of linguistics, likepragmatics, are important diagnostic tools. As researchers and scientists alikebegin to recognize the value of linguistics in other areas of research,hopefully a bigger picture will begin to form, and information will synthesizeacross disciplines.In conclusion, individuals whomsuffer from schizophrenia also suffer from poor pragmatic skills, which in additionwith FTD, poses a difficult obstacle in their conversational skills. Secondlanguage acquisition has been explored as a possible way in whichschizophrenics might be able to express themselves without such difficulty.However, the literature on L2 acquisition is conflicting and there is no realconclusion to be made as to whether schizophrenic symptoms occur less in an L2than a L1.
The fact that people with schizophrenia can learn a second languageis important though because it contradicts assumptions that schizophrenics areunable to further their education once the onset of the disease. There are somany different ways in which schizophrenia presents itself that can be relatedto the study of linguistics, and even more specifically, pragmatics, so it isdifficult to narrow it down to a few specific instances. However, byunderstanding even a fraction of the role that pragmatics plays inschizophrenia, one can understand how important the field of linguistics is andits applications. ReferencesColle, Livia, Angeleri, Romina, Vallana, Marianna, Sacco,Katiuscia, Bara, Bruno G., & Bosco, Francesca M. (2013). Understandingthe Communicative Impairments in Schizophrenia: A Preliminary Study. Journal of Communication Disorders, 46(3),294-308.
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