Impaired Pragmatics
as an Diagnostic Tool for Schizophrenia

August Van Patten

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This paper synthesizes information from previously published
scholarly articles in hopes of providing the reader with further insight of how
pragmatics is essential to understanding schizophrenia, especially the speech
patterns of schizophrenics. Schizophrenia is a complex disorder and studies are
still developing with hopes of researchers gaining understanding for the causes
and exact symptoms of the disease. Formal Though Disorder (FTD) is defined as
“the disruption of normal thought” and is a common symptom of schizophrenia. The
articles range from 1999 to 2016 and aim at providing the reader with an acute
understanding of pragmatics in relation to schizophrenia and exemplify how
linguistics can be applied to other areas of study.  The readings provided suggest that pragmatics
are both a diagnostic and therapeutic tool for those with schizophrenia, and
that linguistics and neuroscience are closely related. In this paper, I will
first provide an explanation of how schizophrenia and pragmatics are related. I
will then discuss how second language acquisition might be a tool for
schizophrenics to limit the symptoms of schizophrenia. Finally, I will conclude
with an overview of how psychology and linguistics are closely related, and the
value linguistics can have on other areas of study.

            Keywords: pragmatics, schizophrenia, formal
thought disorder, second language acquisition


Impaired Pragmatics
as an Diagnostic Tool for Schizophrenia

is a complex brain disorder in which individuals primarily suffer from auditory
and visual hallucinations, amongst many other symptoms. While the exact cause
of schizophrenia is uncertain, scientists and psychologists do know that the
disease affects how people think and perceive and interact with their
surroundings. Essentially, schizophrenia can be viewed as a disease in which
linguistic factors are significantly impaired. Pragmatics specifically relates
to how one interprets and reacts to their surroundings, is highly contextual,
and relies on the individuals participating in a conversation to read social
cues and respond in an appropriate manner. Literature on the subject widely
concludes that many pragmatic competencies suffer as a result of schizophrenia,
which creates a correlation between the study of psychology and the study of
linguistics (see Meilijson et al.,2004). It is important to note that because
language use is unique to each person, and every person whom has schizophrenia
is impaired differently, it is difficult to provide an overview, and, whatever
information is provided is a generalization and may differ depending on the
individual. The conclusions drawn are very broad and encourage further research
and continued interpretation from future studies.

Most of the linguistic studies on
schizophrenia focus on specific ways that schizophrenic’s language use differs
from a “normal” native speaker. Formal thought disorder (FTD) is a common
symptom of schizophrenia, and often the focus of studies. Formal thought
disorder is essentially a “disturbance in speech comprehension and coherence”
and is used to describe the odd way schizophrenics sometimes speak (Salavera et
al.,2014). It is important to understand that although it is called “thought
disorder” it relates directly to speech production and comprehension.  Langdon et al. (2002) describes FTD as the
basic thinking processes being disrupted. Most important about FTD is how it
affects speech patterns and is used often to diagnose schizophrenia (see
Langdon et al., 2002; Covington et al., 2005; Radanovic et al., 2013; Salavera
et al., 2014). Both previous mentioned articles also
discuss a correlation between FTD and pragmatics, which proves that the more
prevalent FTD is in a patient, the more their semantic and pragmatic
capabilities falter. The presence of FTD in each individual of course varies,
however, based on research it is safe to say that there is an absolute
correlation between the presence of FTD in an individual and their semantic and
pragmatic aptitude.

Langdon et al. (2002) delves
further into how pragmatics specifically are affected in individuals with
schizophrenia. Based on their research, they have found that pragmatic
comprehension is significantly impaired in these individuals which, in addition
to FTD, makes it extremely difficult for them to carry on conversations.
Mind-reading skills are basically non-existent and reading social cues and
understanding the illocutionary force of a speaker’s utterance (Langdon et al.,
2002). Metaphors, irony, proverbs, indirect hints, and essentially any spoken
speech which is not literal becomes hard for schizophrenics to understand and
respond to in a socially “correct” manner (see Langdon et al., 2002; Colle et
al., 2013). Although this study was conducted in 2002, there are not any
directly contradicting studies which prove otherwise. Rather, many contemporary
studies support the conclusion that pragmatics are greatly impaired in
schizophrenics and pose a challenge for them in conversational comprehension and

The fact that schizophrenics have
difficulty understanding non-literal language is fascinating, and in their
study, Schnell et al. (2016) used fMRIs to directly look at how the brain of
schizophrenics reacts and processes irony. They first relate the lack of
understanding of irony to the Theory of Mind (ToM), which is atypical in many
schizophrenics. According to Schnell et al. (2016) this most likely
“contributes to their deficit in pragmatic competence”. Theory of Mind is an
essential part of language development in general and is essentially one’s
recognition that they have opinions, beliefs, etc. and that another person also
has those things, which might differ from their own perspective (Dronjic
lecture; Spring 2017). ToM allows conversational partners to understand the
context necessary for proper pragmatic cues to occur in conversations, so it
would be understandable that if the ToM is atypical in schizophrenics, then
their pragmatic capabilities would also not be up to par. Furthering their
explanation of how key pragmatic factors are compromised in schizophrenics,
Schnell et al. (2016) states that Grice’s Maxims are also consistently violated
in the speech of those with the disease, which makes their speech even more
difficult for others to understand. An example of how a person with
schizophrenia might violate the maxims is by providing the listener way too
much or not enough information. Understanding how ToM and Grice’s Maxims
correspond to the study of language by schizophrenics is important to
comprehending the large role that pragmatics has in everyday life, and the
difficulty that arises when pragmatic competencies are lacking.

Ultimately, after explaining the
importance of pragmatics and how it relates to schizophrenia, Schnell et al.
(2016) explains the results of the fMRIs and patient’s responses to irony based
activities while undergoing a brain-mapping process. Not only do the results
from the social context task conclude that schizophrenics are less able to
comprehend irony, it also shows that different areas of the brain of the person
with schizophrenia lit up on the fMRI compared to the control group (Schnell et
al., 2016). Whereas the brain scans of the individuals without schizophrenia
were more targeted to specific regions needed to comprehend the irony and
context (see figure 1), the brain scan of the schizophrenic was more widespread
(see figure 2). This result is extremely significant because it shows that how
schizophrenics process information is completely different from the control
group, and might further inspire others to do similar studies using fMRIs (or
other new technology) as a tool to understand language processing in
individuals with mental health issues.



Figure 1: Control group response to                 
Figure 2: Patient response to social context

social context of irony task                                of irony task


(Both images from Schnell et al., 2016 article)


the use of new technologies in the study of linguistics and mental health would
greatly improve the research which has been done. Most of the articles
discussed in this essay acknowledge that past studies pertaining to
schizophrenia are not entirely accurate due to how the information was
collected and organized. For example, many studies during the 80s and 90s were
recorded through some kind of audio recording device and then transcribed into
script. However, the methods of transcribing at the time were so wildly
different 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 are
not reevaluated at all after the study to see if the conclusion is accurate. As
mental health is explored more, especially in correlation with linguistics, it
would be wise for future researchers to learn from past mistakes and try to
fill the knowledge gap as much as possible. By just implementing new
technologies available and understanding where past researchers might have
failed, modern research can strengthen the information known about
schizophrenia in particular and its relation to neurolinguistics.

One conclusion that many
researchers have come to is that second language acquisition might be
beneficial to those with schizophrenia, and is in fact quite possible. Many would
assume that schizophrenics would not be able to learn a second language,
however, language acquisition is mostly grammar and vocab based, so it is
completely 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 commonly
have an uneven expression of symptoms across languages, leading some
patients to appear healthier in one language than another” (308). This
conclusion is shocking considering the difficulty many schizophrenics have
speaking in their native language, and suggests that second language
acquisition might constitute a useful tool which they can utilize in order to
achieve clear, understandable speech and understanding. Symptoms of
schizophrenia 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 being
explicitly planned and thought out by speakers, therefore leaving less room for
hallucinations to occur (Paradis 2004 per Dugan 2014). Other researchers like
Bersudsky (2005) have suggested that there is little to no difference in how a
person with or without schizophrenia acquires language (See Dugan, 2014;
Smirnova et al., 2015). However, as
Dugan points out, it is extremely hard to make inferences when it comes to
language use, especially by schizophrenics, because of how individualized
language is and each person’s own unique characteristics. Context is also essential,
and it is difficult to judge factors that influenced people in multiple studies
to acquire a second language (i.e. motivation and/or necessity for L2).  The absolute necessity for an immigrant to learn
the language of the country he or she had moved to might provide enough need that
despite mental health, he or she is able to accurately learn a second language and
become bilingual. Context is important for understanding the information provided,
and without the contextual factors explicitly conveyed, interpretations of data
or success might be exaggerated.

In their research, Smirnova et al.
(2015) looked at how bilingual speakers affected by schizophrenia differ in
speech between their L1 and L2, specifically in relation to pragmatic discourse
markers and code-switching. Their study looked at 10 Russian immigrants who had
been diagnosed with schizophrenia for at least two years, and acquired a Hebrew
language upon relocating to Israel. Data was elicited through two interviews,
the first being in the language the individual chose, and the shortly following
second interview in the other language. Contrary to the information presented
in Dugan (2014), Smirnova et al. (2015) found that “clinical markers were
impaired relatively the same in both languages, linguistic markers were more
impaired in L2 than in L1, and fluency markers were more prevalent in L1than in
L2.” These findings suggest that L2 acquisition has little to no chance of
providing schizophrenics with a tool in which they can speak without schizophrenic
markers happening. Of course, this is not the case for everyone, and the
varying results between Dugan (2014) and Smirnova et al. (2015) show how
inconsistent findings are in neurolinguistics. The researchers do emphasize,
however, that the pragmatic discourse markers and codeswitching were used
exceptionally well by the participants (in both L1 and L2), which does indicate
that schizophrenic speakers are more skilled in social discourse than one might
at first expect. However, both came to different conclusions on what the
findings might implicate.

While the possibility of L2
acquisition to potentially provide people with schizophrenia a possible tool by
which they can communicate clearer, the research on the topic is too divided to
come to a possible conclusion as to whether it is worth the endeavor. There
are, however, other methods which can help people suffering from schizophrenia.
Researchers in Canada conducted study on which methods might work best and
found that out of 12 studies in which individuals were explicitly taught pragmatic
and discourse skills, 11 of them were successful in the schizophrenic
individuals 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 methods
were found to significantly help individual’s semantic fluency, only the
pragmatic competency. The other methods reviewed in the article were not
conclusive, as there was not enough information nor follow up provided to allow
researchers to conclude their benefit. This study was conducted recently, and
emphasizes the need for further research in understanding and helping those
with schizophrenia.

The research on schizophrenia and
its correlation to linguistics can be both over and underwhelming. While there
is a lot of research on the topic, it is all so diversified that drawing
conclusions becomes difficult. It is a disease of the brain and neurologists
and psychologists (amongst many others) are still working hard to completely
understand the brain and all of its processes. Linguistics is a helpful tool by
which scientists can categorize information and explain the symptoms that
occur, but there is still a tremendous amount of research that needs to be
done. Language is unique to each individual and so is their brain, so combining
the two, trying to understand how one influences the other, is difficult to say
the least. Schizophrenia, though, is a great example of how neurolinguistics
and psycholinguistics are continuing to grow as a field and have a wide array
of applications. Even smaller components of the study of linguistics, like
pragmatics, are important diagnostic tools. As researchers and scientists alike
begin to recognize the value of linguistics in other areas of research,
hopefully a bigger picture will begin to form, and information will synthesize
across disciplines.

In conclusion, individuals whom
suffer from schizophrenia also suffer from poor pragmatic skills, which in addition
with FTD, poses a difficult obstacle in their conversational skills. Second
language acquisition has been explored as a possible way in which
schizophrenics might be able to express themselves without such difficulty.
However, the literature on L2 acquisition is conflicting and there is no real
conclusion to be made as to whether schizophrenic symptoms occur less in an L2
than a L1. The fact that people with schizophrenia can learn a second language
is important though because it contradicts assumptions that schizophrenics are
unable to further their education once the onset of the disease. There are so
many different ways in which schizophrenia presents itself that can be related
to the study of linguistics, and even more specifically, pragmatics, so it is
difficult to narrow it down to a few specific instances. However, by
understanding even a fraction of the role that pragmatics plays in
schizophrenia, one can understand how important the field of linguistics is and
its applications.




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