Mind & mouth: thought disorder & speech patterns
Thought disorder is defined by “improper use of semantic and relational aspects of language and is experienced by the listener as disorganized speech” (Goldberg et al, 1998: 1671). However Hotchkiss & Harvey (1986) believe the term could be a misnomer “because the clinician or research is typically studying language directly and is only inferring thought process” (155).
As the connection between thought and speech cannot be tied down scientifically, there is leeway for the writer when deciding what thoughts and feelings prompt specific types of speech.
Fiction writing can’t afford to copy speech disorder symptoms religiously because there would be no actual book to read. Felman (2003: 104) explains that when we integrate the speech patterns of psychosis into fiction it “raises the question of how the unreadable can as such be read: how and why does nonsense produce sense”. Keitel (1989: 3) agrees, asking “how can a literary text overcome certain specific limits of verbalisation, while at the same time allowing for a psychotic experience to be communicated?”
As Oyebode (2004: 142) explains, “for a story to work it has to be coherent and plausible”. He states any psychosis “has to be comprehensible within the total structure of the narrative” – and that even an account of fractured mind needs to have some form of structure.
For Oyebode, for example, the construction of Spider in McGrath’s 1990 novel is not completely believable – but he is ‘believable enough’. “Authorial coherence authenticates the narrative and makes Spider’s account believable. It is true that Spider’s world is never entirely explicable but none the less it has the compelling force of reality” (Oyebode, 2004: 141).
We choose to believe the voice of the first-person narrator in such novels because, as Lodge (2002: 87) points out, in a world where there is so much uncertainty, “the single human voice, telling its own story, can seem the only authentic way of rendering consciousness [which] creates an illusion of reality”.
The toolkit of ‘speech symptoms’ initially developed by Andreasen in 1979 in The Clinical Assessment of Thought, Language and Communication Disorders (cited in Bentall, 2004: 384-5), is a constructive way of reviewing the language used in personal, autobiographical and fictional accounts.
Although some terms described have fallen out of favour, others – such as derailment and clanging – are not only still referred to in diagnoses today, but are useful tools for the fiction writer.
It is important to note a sufferer doesn’t display all variants of speech symptoms all of the time, that many diagnoses made regarding the language patterns are only applicable “to certain cases at certain moments” (Leader, 2011: 103), and that many sufferers have periods where they don’t display any speech symptoms at all.
Keitel (1989: 2-3) explains there is “no formal schema displayed by all psychopathographies exists” and that “there is no established formula for processing psychotic experience in literary discourse”. He explains each individual “must confront and react in its own idiosyncratic way to the problem of exactly how to tell [their] story” (ibid: 81) – and this is true in fiction as well as in real life cases.
The admission notes for Lori Schiller are a case in point – they state “She appeared to have no formal thought disorder, flight of ideas or circumstantiality” (Schiller, 1994: 74) – and yet she was given a diagnosis of schizophrenia.
Thankfully, for fiction writers, “disturbance of language functioning occurs in most individuals with mental illness and it crosses diagnostic boundaries” (Roche et al, 2016: 29) – so a character can show a mix of speech symptoms without it hampering the credibility of any diagnosis. A fictional character experiencing psychosis needs to be “approached on his own terms, through the verbal, dramatic, and narrative symbols that convey the unconscious processes he portrays and reveals” (Feder, 1980: 9).
Jumping thoughts: distractible speech & derailment
Distractible speech is where talking either stops or tangents abruptly because of internal or external stimuli – referred to as “disrupted attentional processes” by Hotchkiss & Harvey (1986: 172). If the stimuli are internal, the sufferer is “distracted by the sound or meaning of his own words” or “because fragments of ideas are connected in an illogical way to create a new idea” (Covington et al, 2005: 93, and Bentall, 2003: 379, respectively.)
Galloway uses italics in her 1989 novel The Trick is to Keep Breathing to mark Joy’s past from her present. There are examples of distractible speech in both. From her past, there is the moment on holiday when she first realises there is something wrong – the minutes that unfold before she realises her lover is dead. From her present, there is the arrival of the post, which cuts into her thoughts, then the contents of the letter, the words of which swarm before her eyes so she is unable to concentrate on them.
“Something catches my eye. A red beachball. Men slicking back wet hair. There are men at the side of the pool. They stand in a rough O near the water, looking down. I am aware of staring and try hard to smile in case people are looking at me, then I swivel my head the length of the water and back, searching. A red beachball. Children sit on the rim of tile. But there is something inevitable about the centre, the hollow of the ragged O. I turn to face it. The water is very bright” (Galloway, 1989: 16-17, italics in original).
“Upstairs there is blood on the pillow, glass on the… The flap of paper on concrete, receding footfalls. Three pieces of mail lie flat in the porch. The blue is airmail from America. The white is from Norma’s lawyer. The manilla is typewritten, giving nothing away […] I open it slowly […] I try to read it again while the words fold and slither on the paper” (Galloway, 1989: 101).
Also known as ‘looseness of association’ and ‘flight of ideas’, derailment can also manifest itself as tangents, but the reason behind the manifestation is different.
Derailment is “a disturbance of thinking shown by speech in which ideas shift from one unrelated […] subject to another” (Shives, 2008: 112). Kuperberg (2010: 3) describes it as “a pattern of spontaneous speech that tends to slip off track and in which the ideas expressed are either obliquely related or completely unrelated”; while Hotchkiss & Harvey (1986: 156) describe it as “incoherence and abrupt or unexplained shifts in topic […] attributed to the intrusion of irrelevant associates in thoughts”.
One disturbingly beautiful example of derailment is in Elyn Saks’ autobiography: “‘I don’t know if you’re having the same experience of words jumping around the pages as I am,’ I say. ‘I think someone’s infiltrated my copies of the cases. We’ve got to case the joint. I don’t believe in joints. But they hold your body together.’” (2007: 137).
In The Trick is to Keep Breathing, Galloway uses her pockets of italics to show Joy’s derailment after the death of her lover: “It’s all right now. It’s all right. And something starts. Starts. I look down and his mouth is a red O. White water runs through his hair. His mouth is a red O, eyes wide to the sky” (1989: 40, italics in original). Her thoughts converge on the idea of the ‘O’ whether a ‘rough O of men’ or ‘red O of mouth’ – it is the perfect forewarning of her descent into psychosis.
Finding the words: poverty of speech & blocking
Poverty of speech is what Kuperberg (2010: 3) refers to as a ‘negative thought disorder’, stating it tends to occur “in patients with other non-linguistic negative symptoms”. Keitel (1989: 2) refers to it as ‘psychotic personality fragmentation’ – the “experience of being suspended at the verge of non-existence, which cannot be communicated in its full range of content and emotion”.
In her autobiography, Elyn Saks describes how, as her thoughts disintegrated, so did her ability to speak: “Daily, my thoughts grew more disorganised. I’d start a sentence, then be unable to remember where I was going with it. I began to stammer severely, to the point were I could barely finish a thought” (2007: 65).
In her personal account, Deegan is not able to find words. She describes her sense of despair as “a wound with no mouth, a wound so deep that no cry can emanate from it” (1994: 153). Deegan’s account is the perfect example of negative symptoms being caused by what Kaysen (1993: 77) calls the ‘faster speed’ of madness, and what Longden (2012) describes as the ‘paradox’ of negative symptoms – “we are not devoid of emotions, we are overwhelmed and crushed by them” (184).
Poverty of speech – like loss of interaction – needs someone other than the sufferer to narrate. In The Other Side of You (Vickers, 2006), it is Elizabeth’s psychiatrist who describes her lack of speech, and how the first time she speaks to him brews ‘excitement’ in him. “One day, when the weather was particularly violent, after staring a while at the tree outside, she volunteered, ‘It could be blown down in that wind.’ ‘Yes, it might,’ I agreed, trying to conceal any off-putting excitement. She made no follow-up to this, so after a decent pause I hazarded, ‘Do you feel you might blow down too?’ The grey eyes grazed mine and looked away […] she made a gesture as if shrugging the invisible protective mantle closer round her” (Vickers, 2006: 17).
Blocking can be described as “a sudden stoppage in the spontaneous flow or stream of thinking or speaking for no apparent external or environmental reason” (Shives, 2008: 111) – although this is only the external view of the symptom. As Shives goes on to explain, it may also “be due to preoccupation, delusional thoughts, or hallucinations” (ibid: 111).
This was certainly the case for Susannah Cahalan, who explains in her autobiography “Sometimes I would trail off midsentence, staring off into space for several minutes before continuing my conversation. During these moments the paranoid aggression receded into a childlike state. These times were the most unnerving for everyone” (2012: 58-59).
Galloway (1989) and Filer (2013) both have the same rather elegant solution for showing blocking – using the page as a print of the mind, and showing the words as broken-up sentences. Although their characters’ thought processes could be broken up by ellipses, the gaps on the page have a bigger impact on the reader as the layout disrupts the normal reading pattern.
Cacophony of sounds: word salad & clanging
The name ‘word salad’ gives a clear image of words being tossed up together in a bowl – and that is very much what the symptom sounds like to anyone listening. Kuperberg (2010: 4) describes it as “unintelligible speech in which neither the individual words nor the sentences being strung together seem to correspond to any discernable overall meaning”.
From the perspective of the sufferer, Covington et al (2005: 89) state it is caused by ‘semantic dysfunction’, which “affects the ability to map thoughts onto language and pursue a communicative goal” – the result being speech which “contains a mixture of words and phrases that lack comprehensive meaning or logical coherence” (Shives, 2008: 112).
In her 2007 autobiography, Elyn Saks gives an example of her speech – “Me: ‘They’re messing with foetuses. They think it’s us whereas the truth is God. Voices went, tabernacle, out to the edge of time. Time. Time is too low. Lower the Boom.’” (2007: 91). The section is within speechmarks, but it is not clear is if this has been taken from her memory, the memory of a third party, or a recording of her speech at the time.
In her autobiography, instead of giving an example of her incoherent speech, Susannah Cahalan chooses to explain what felt like: “My tongue twisted when I spoke […] I spoke in garbled sentences […] I also stopped speaking in full sentences, moving from unintelligible ramblings to monosyllables and sometimes just grunts.” (2012: 106).
Cahalan does retell the story of calling for her boyfriend Stephen – witnessed by her friend Hannah (although, as with Saks, it is not clear if this account is taken from memory or recording): “‘Tlantyoiforslen,’ I said. ‘Tlantyoiforslen! Tlantyoiforslen!’ I began repeating over and over, my face reddening. ‘You’re welcome,’ Hannah said, uncertainly. I shook my head violently. ‘No, no, no! Tlantyoiforslen!!!’ I yelled. Hannah bent down closer to my face, but proximity only made me more unintelligible. I began pointing emphatically at the door. ‘Slefeen, Slefeen!’ Finally, Hannah understood. She called Stephen in, and when I saw him, I instantly calmed” (ibid: 125).
Fiction’s need to be ‘coherent and plausible’ and its requirement to ‘communicate the psychotic experience’ (Oyebode, 2004: 142, and Keitel, 1989: 3, respectively) mean that word salad is not the most useful tool for first-person narrative. Speech with unusual patterns – such as clanging – is more effective at sharing the mind’s disintegration into psychosis as it shows a mind working differently from the norm – which is far more terrifying than one not working at all.
Clanging is “a type of thinking in which the sound of a word (e.g. punning or rhyming),
substitutes for logic during communication” (Shives, 2008: 111). The result for the listener is the “chaining together similar sounding words as if [the sufferer is] distracted by them” (Covington et al, 2005: 86).
Another section of speech-marked text in Elyn Saks’ autobiography gives an example of clanging: “‘They’re killing me! I’ve got to try. Die. Lie. Cry.’” (Saks, 2007: 129). There is a more extreme version in Lori Schiller’s autobiography, where she becomes distracted in a lecture and writes clanging phrases such as “Row, row, row your boat. Don’t be cutthroat. Cut your throat. Get your goat. Go out and vote” (Schiller, 1994: 183).
While in Spider, McGrath hints at clanging with the repetition of the same word to show how distressed Spider is: “Here! Here! Here here here here here! It echoed as I turned, stumbling, toward the source, a bearded figure in a cap and raincoat on the other side of the fence. Here! Here! Here here here here here!” (McGrath, 1990: 49).
Galloway also uses repetition to reflect Joy’s distress at moment of her lover’s death.
Disturbed speech, dissociated voice
Many fiction writers have chosen to ‘sprinkle’ elements of disturbed speech on top of their work, as if to add a touch of psychotic flavouring to the voice of their characters. Medicine and academia are not able to ‘prove’ connections between thought and speech, so many first-person fictional accounts are able to focus on what a character thinks and says – rather than the words they use to think or say it.
This light handedness of speech symptoms not only increases readability, but helps ensure writers do not break the relationship between the reader and the character by using language that forces the reader to reread passages for sense purposes.