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Using Language in Psychiatry Jonathan Fine, PhD1 | ||
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Much of the diagnosis and definition of psychiatric disorders depends on language behaviour. Both the lay and clinical communities recognize that some atypical language behaviour helps to the identify psychiatric disorders. A functional approach to language provides the means to classify the atypicalities in meaning and in wordings that are associated with psychiatric disorders. Culture levels, register, genre, context, vocabulary-grammar, and sound must all be taken into account in considering language atypicalities. Language simultaneously conveys 3 kinds of meaning—ideational, interpersonal and textual. Individually or combined, these 3 kinds of meaning can be used to describe the atypical language behaviour associated with psychiatric disorders. (Can J Psychiatry 2001;46:916–922) Key Words: language, speech, interaction, clinical listening, diagnosis, functional linguistics |
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Interviewer: did someone bring you [here]? Patient: did someone bring me . . . no nobody brought me . . . I flew in my very own plane . . . I wouldn’t trust anybody down at the airport to bring me anywhere. Interviewer: why not? Patient: why not . . . why not . . . for the very simple fact that I don’t think that they can really handle a plane . . . unless they are going to lay me down as a little rose and put me back in the box and they can fly me around because there’s a million people out there that can meet the same world . . . it’s just world after world after a world right Interviewer: yeah Patient: and there’s no need to be worried about that and if you want them you can go down and get them and if you figure you need plastic ones or other ones if they figure they need those things and they want those things it’s entirely up to them —(Courtesy Dr G Bartolucci and Dr J Pelletier, St Joseph’s Hospital, Hamilton, Ontario) The above passage was uttered by a patient diagnosed with schizophrenia. What gives us the clues that this language is atypical and is likely to be from a patient with schizophrenia, rather than from a patient with some other disorder?
Manuscript received July 2001 and accepted October 2001. |
A careful study of language can contribute to psychiatry’s efforts to answer such questions. The daily clinical work in psychiatry depends heavily on language for impressions, diagnosis, and some forms of treatment. In fact, crucial aspects of psychiatric syndromes are diagnosed and defined by language. This paper aims to place the language of psychiatric disorders in a theoretical linguistic framework that will guide listening to patients. To be effective clinically, language theory must deal with a wide range of linguistic phenomena and must consider language use in context, rather than as an entity standing on its own. Section 1 of this paper presents the background to the use of language in psychiatry: language is presented as a broad phenomenon that originates in culture and as a functional system for interacting with other people. Section 2 presents the functional features of language as a guide to the atypicalities that may be heard. These functional features are divided into 3 major groups: how language talks about the world, how language is used to influence others, and how language fits into its context. Section 3 then uses this framework to connect language features to the features of psychiatric disorders—to indicate what should be listened for clinically. Using Language in Psychiatry: Background, Purposes, Goals Language is a signalling system used in social groups to achieve social purposes defined by the groups.
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