8 CHAPTER II
REVIEW OF RELATED LITERATURE
2.1 Theoretical Background
2.1.1 Language and Brain
The ability of human to communicate with others through language cannot
be separated from the role of the brain. As Steinberg (2001: 309-310) said that we
have minds and in our minds we have the means for producing and
comprehending speech.
Human brain is divided into two halves, a left hemisphere and a right
hemisphere. Stainberg (2001: 309-310) stated that the general structure of the
brain is that of a whole which is divided into vertical halves which seem to be a
mirror images of one another. He also added that each half of the brain is called a
hemisphere. There is a left hemisphere and a right hemisphere.
The brain controls the body by a division of labour, so to speak. The left
hemisphere controls the right side of the body, including the right hand, the right
arm, and the right side of the face, while the right hemisphere controls the left side
of body (Steinberg, 2001: 313).
For most people, the language area is in the left hemisphere. However,
recent evidence indicates that the right hemisphere too is involved in language
9 single lexical items and the semantic relation between them, while it is the left
hemisphere that combines syntactic, semantic, and pragmatic information into a
conceptual representation of a sentence (Faust, 1998 cited in Steinberg, 2001:
324).
The complexity underlying speech first reveled itself in patient who were
suffering various communication problems. The ancient Greeks noticed that the
brain damage could cause loss of the ability to speak (a condition known as
aphasia). In 1861, Pierre Paul Broca described a patient who could utter only
single word – ‘tan’. When this patient died, Broca examined his brain and
observed significant damage to the left frontal cortex, which has since become
known anatomically as ‘Broca’s area’. The result of his finding is patients with
damage to the Broca’s area can understand language, but they generally are
unable to produce speech because words are not formed properly, this language
disorder called Broca’s aphasia.
Other researcher who did research relates to language problems due to
damage to the brain is Carl Wernicke. In 1876, he discovered that language
problems also could result from damage to another section of the brain. This area,
later termed as ‘wernicke’s area’, located in the posterior part of the temporal
lobe. Damage to the Wernicke’s area can result in a loss of the ability to
understand language or Wernicke’s aphasia. Thus, patient with damage in this
area can continue to speak, but words are put together in such a way that they
10 Peoples with Wernicke’s aphasia speech appear superficially similar to
patient with schizophrenia. Kuperberg and Caplan (2003:446) said that the speech
of some schizophrenic patients appears, at least superficially, similar to
Wernicke’s aphasia. Lecours and Vanier Clement (1976) claim that Aphasia-like
symptoms are “episodically observed in only a small portion of subjects
considered to be schizophrenics”, whereas the aphasia produced by stroke or brain
injury is in most cases constantly present. And patients with aphasia have normal
thoughts and express them with difficulty; those with schizophrenia have unusual
thoughts (or disorganized discourse plans) and express them with comparative
ease (Covington et al., 2005: 87).
2.1.2 Psycholinguistics
The research on schizophrenia is traditionally seen as something belonging
to psychology, while study of language belongs to linguistics. So, this study of
language disorder in schizophrenia belongs to both psychology and linguistics or
psycholinguistics.
Linguistics is the study of human language. The primary object is human
language signifying that language is human specific and human species. It is only
human that uses language as a means of communication. In its development,
linguistics consists of two branches; micro linguistics and macro linguistics. The
former, micro linguistics, focuses on the structure of language e.g., phonology,
morphology, syntax, semantic, and pragmatic. The later, macro linguistics,
11 neurology, etc. From this combination of studies some new inter-discipliners are
appeared, such as sociolinguistics; studies the relation between language and
society i.e. how social factors influence the structure and use of language,
Neuroliguistics is the study of language processing and language representation in
the brain, and psycholinguistics, or the psychology of language. It is a branch of
linguistics which concerns with discovering the psychology process by which
human acquire and use language.
Psycholinguists focus on three aspects of language competence;
acquisition, comprehension, and production. Language acquisition is the process
by which human acquire the capacity to perceive and comprehend language, as
well as to produce and use words and sentences to communicate. The term
language acquisition also refers to language learning, in the babyhood or later.
Language comprehension is the ability to extract intended meanings from
language. Language production is the ability to speak or write fluently.
Scovel (1998: 4) defined psycholinguistics as the study of the normal and
abnormal use of language and speech to gain a better understanding of how
human mind functions. In his book psycholinguistics (1998) he examined research
questions on psycholinguistics in four sub-fields: (1) how are language and speech
acquired? (2) How are language and speech produced? (3) How are language and
speech comprehended? And finally, (4) how are language and speech lost?
Chaer (2009: 6) said that practically psycholinguistics tries to applied
12 and language learning, early reading and advance reading learning, bilingual and
multilingual, language and speech disorder such as aphasia, stuttering, etc; as well
as other social problems which related to language, such as language and
education and developing nations.
From some definitions above, it can be concluded that psycholinguistics is
a relatively new subject of linguistics due to the fact that it involves not only
language study but pscychological aspects as well. Study of the mental processes
involved in the comprehension, production, and acquisition of language.
Traditional areas of research include language production, language
comprehension, language acquisition, and language disorders.
2.2 Description and Classification of Language Disorders
Simanjuntak (2009: 248) stated that the term language disorder used as a
large and common term to name certain abnormal verbal behavior, and other
behavior deficits acquired by a child which is abnormal or different from another
child in the same age with him/her. He then said that observed behaviors which is
considered as abnormal behavior are various, including less speak or cannot speak
at all, cannot understand the topic or given instruction, the use of vague words and
phrases, grammatical errors which may interrupt the communication processes,
queer pronunciation or voice, and etc. And at the end he also added that the term
language disorder can be used to refer disruption in language acquisition and
13 Paul, (2007: 8) said that a variety of names have been given to the problem
relates to language abnormalities, including language impairment, language
disability, language disorder, language delay, language deviance, and childhood
or congenital aphasia or dysphasia. At certain points in the history of language
pathology, some terms have predominated, whereas others were used less
commonly. From this statement, it can be concluded that the term language
disorder may refers to any language impairment in mother tongue.
2.2.1 Developmental and Acquired Language Disorder
Based on its origin, the language disorder can be classified into two
groups; developmental and acquired language disorder. The former,
Developmental language disorder is a disordered of language due to abnormalities
acquired from the time of birth. Developmental language disorder currently has no
known cause. It is first observed when a child is learning to talk and is much more
common than the acquired form of the disorder. Children with this type of
language disorder begin speaking late and progress more slowly than others
normal children.
Second, acquired language disorder is a language disorder which occurs
after a period of normal development as a result of a neurological or other general
medical condition such as brain damage due to stroke, traumatic brain injury, and
disease such as schizophrenia and dementia. Peach & Saphiro (2012: 203) said
that acquired language disorder including; aphasia, dementia, and schizophrenic –
14 to language deficits that results from neural trauma (stroke, traumatic brain injury)
or neurological disease (e.g., Alzheimer, Parkinson, schizophrenia), all of which
result in some degree of language impairment.
2.2.2 Medical and Environmental language Disorder
According to Chaer (2009: 148) language disorder divided into two major
divisions; (1) language disorder due to medical factor and (2) language disorder
due to social factor. The language disorder results from medical factor including
abnormalities in brain functions and speech organs. And the social factor
including unnatural environment, such as separated or isolated from normal social
life.
Language disorder due to medical factors differentiated into three groups.
Sidharta (1984) in Chaer (2009: 148) said that medically, language disorder can
be divided to three groups: Speech disorder, Language disorder, and Thought
disorder.
2.2.2.1 Language Disorder
Human use language to communicate and interact with others. Language
is human specific-species (Gleason & Ratner, 1998). It means that only human
that has the ability to acquire and use complex system of communication.
In other view point, language can be defined as a symbolic, rule governed
system used to convey a message. The symbols can be words, either spoken or
15 understanding language, it includes using words to built-up conversation and
understanding and making sense of what people say. When this ability to speaking
and understanding language is impaired due to several factors, such as damage to
the portion of the brain which is responsible to language, in the left hemisphere of
the brain for most right-handed people (Steinberg, 2001: 319), or due to
disorganized thought in schizophrenia patients – since language and thought
cannot be separated and thought reflects in language, this condition is called
language disorder.
The American Speech-Language-Hearing Association (ASHA) has
defined language disorder as an impairment in “comprehension and/or use of
spoken, written, and/or other symbol system. The disorder may involve (1) the
form of language (phonologic, morphologic, and syntactic system, (2) the content
of language (semantic system), and/or (3) the function of language in
communication (pragmatic system), in any combination” (American
Speech-Language-Hearing Association, 1993: 40) (Paul, 2007: 3).
From the definitions above, it may be said that language disorder is a
specific impairment in understanding and sharing thoughts and ideas, i.e., a
disorder that involves the processing of linguistic information. Language disorder
often use as general term refers to abnormalities in mother tongue or native
16 2.2.2.2 Speech Disorder
The term speech refers to three things; they are articulation/phonological
skills, fluency, and voice quality. In other words, speech related to saying sounds
accurately, speaking fluently without hesitating, or prolonging or repeating words
or sounds, and speaking with expression and a clear voice, using pitch, volume
and intonation to support meaning. It involves the physical motor ability to speak.
ASHA (American Speech-Language-Hearing Association) defined a
speech disorder is an impairment of the articulation of speech sounds, fluency,
and/or voice and in general, speech disorder include voice disorders, fluency
disorders, and disorders of articulation and phonology.
Speech disorder is characterized by difficulty in articulation of words.
Examples include stuttering or problems producing particular sounds. Articulation
refers to the sounds, syllables, and phonology produced by the individual. Voice,
however, may refer to the characteristics of the sounds produced—specifically,
the pitch, quality, and intensity of the sound. Often, fluency will also be
considered a category under speech, encompassing the characteristics of rhythm,
rate, and emphasis of the sound produced.
Language and speech disorders are similar in that they cause
communication problems, but there is a distinction between the two conditions.
The difference between language and speech disorders is that language deals with
meaning and the speech deals with sounds. A person with a language disorder has
17 person with a speech disorder has trouble producing or pronouncing sounds in the
correct or fluent manner. So, when a person is unable to produce speech sounds
correctly or fluently, or has problems with his or her voice, then he or she has a
speech disorder. Difficulties pronouncing sounds, or articulation disorders, and
stuttering are examples of speech disorders
2.2.2.3 Thought Disorder
Thought disorders are conditions that affect the way a person thinks,
creating disturbance in the way a person puts together a logical consequence of
ideas. It is commonly recognized by incoherent or disorganized thinking. An
individual suffering from a thought disorder may speak quickly and incessantly,
skip from one idea to the next, suffer from paranoia, delusions or hallucinations
(http://www.Mentalhealthcenter.org).
Maher (1972) proposed a model that attempted to demonstrate the link
between thinking and the behaviour of speech in language. The model might be
likened to a typist copying from a script before her. Her copy may appear to be
distorted because the script is distorted although the communication channel of
the typist’s eye and hand are functioning correctly. Alternatively, the original
script may be perfect, but the typist may be unskilled, making typing errors in the
copy and thus distorting it. Finally, it is possible for an inefficient typist to add
errors to an already incoherent script. Unfortunately, the psychopathologist can
observe only the copy (language utterances): he cannot examine the script (the
18 accepted the first of the three alternatives, namely that a good typist is transcribing
a deviant script. The patient is correctly reporting a set of disordered thoughts. As
Critchley put it: ‘Any considerable aberration of thought or personality will be
mirrored in the various levels of articulate speech – phonetic, phonemic, semantic,
syntactic and pragmatic’. The language is a mirror of the thought (Oyebode, 2008:
175).
The script is likened to thought and the typist to language. Most clinicians
have taken the view that language closely mirrors thought and see the primary
abnormality as the thinking disorder (Beveridge, 1985). Disordered language is
then seen as merely a reflection of this underlying disturbance, with diagnosis of
thought disorder only possible on the basis of what the patient says.
Chaer (2009: 160) said that most of people represent their personality
through the language they used. Verbal expression is a representation of thought.
Therefore, language is a representation of one’s thought. And he concluded that
impaired verbal expression as a result of an impaired thought. Language disorder
due to thought disorder can be found in dementia, schizophrenia and depressive.
1) Dementia
Cummings (2014: 60) said that the dementias are a large and varied group
of neuropathologies that lead eventually to the loss of cognitive and physical
functions in affected individuals. People with dementia may experience mild
cognitive impairment initially which develops over time into mutism,
19 Dementias can be caused by infections (e.g. HIV infection), excessive alcohol
consumption over an extended period of time (e.g. Korsakoff’s syndrome),
cerebrovascular disease (e.g. vascular dementia) and age-related degenerative
changes in the brain (e.g. Alzheimer’s disease).
Kaplan & Sadock, (2007: 329) defined dementia as a progressive
impairment of cognitive functions occurring in clear consciousness (i.e., in the
absence of delirium). Dementia consists of a variety of symptoms that suggest
chronic and widespread dysfunction. Global impairment of intellect is the
essential feature, manifested as difficulty with memory, attention, thinking, and
comprehension. Other mental functions can often be affected, including mood,
personality, judgment, and social behavior. Although specific diagnostic criteria
are found for various dementias, such as Alzheimer's disease or vascular
dementia, all dementias have certain common elements that result in significant
impairment in social or occupational functioning and cause a significant decline
from a previous level of functioning.
Dr. Martina Wiwie S. Masun said that dementia is a deteriorating of
degradation of memory function or ability to remember and other cognitive
ability. This cognitive disturbance in dementia include impaired short-term
memory, inability to recognized place, people, and time as well as impaired in
language fluency (Chaer, 2009: 159).
Dementia can be occurs due to a great number of damage to the function
20 individual with dementia was characterized by inability to find appropriate words.
They also often utter same sentence for several times. Conversation often
disrupted because they forget the topic. It makes their speech incoherent (Chaer,
2009: 159).
From definition and explanation above it can be said that language
disorder in dementia is an acquired language impairment due to degradation of
cognitive and memory function because the factors of aging. The characteristic of
language in dementia are influent speech, repetition, and incoherent topic.
2) Depressive
People with depression can be recognized through their language use. It is
because a depressed people often project their depression through their language
style and language content. They often speak with very slow sound and the
fluency of their speech often disrupted for a long interval. However, their thoughts
are not impaired. Their speech often disrupted when they take a breath. The
characteristics of depressive speech are the topic often consist of sorrow, they
often curse themselves, loss of interest in live and doing activities, unable to enjoy
their life, and they tend to end their live by doing suicide (Chaer, 2009: 161).
3) Schizophrenia
Schizophrenia is one of the most serious and common psychotic disorders.
Its name derives from the Greek meaning “split Mind” (William, 2014: 2). Kaplan
21 but profoundly disruptive, psychopathology that involves cognition, emotion,
perception, and other aspects of behavior.
The cause of schizophrenia remains unknown (Kaplan & Sadock, 1998). It
was suggested that several factors could play a role in the etiology of
schizophrenia. Among these are genetic, biological, and environmental factors
(Williams, 2006: 1).
The first signs of schizophrenia usually occur during adolescence and
early adulthood. Often the effects of the disease are confusing and upsetting
family and friends. People with schizophrenia have difficulty in articulating
thoughts. This condition leads them to have hallucinations, delusions, disjointed
thoughts and behaviors, and unusual speech (William, 2012: 2). Because of these
symptoms, people suffering from this disease have serious difficulty interacting
with others and tend to isolate themselves from the outside world.
In order to simplify diagnosis of schizophrenia, schizophrenia symptoms
were classified into two categories, known as positive and negative symptoms.
According to Kuperberg (2010: 577) positive symptoms of schizophrenia are
characterized by an excess or distortion of normal function. They include
hallucination (most often, verbal auditory hallucination), delusion (fixed false
beliefs, out of keeping with cultural norms, and held against all evidence to the
contrary), and positive thought disorder (disorganized language output). Negative
symptoms describe the absence of characteristics that normally appear on healthy
22 apathy, flat or inappropriate affect, and negative thought disorder (poverty of
speech and language).
Kuperberg (2010: 576) said that symptoms of schizophrenia reflect
abnormalities in multiple aspects of human thought, language and
communication. Delusion and hallucination in schizophrenia make people with
schizophrenia may hear voices other people don’t hear, or see things that other
don’t see. They also may believe other people ore reading their minds, controlling
their thoughts, or plotting to harm them. People with schizophrenia may sit for
hours without moving or talking.
Kuperberg and Caplan (2003: 444) stated that abnormalities in language
are the central of psychosis, particularly the schizophrenic syndrome. Many,
though not all, patients diagnosed with schizophrenia display abnormalities of
language. These abnormalities are highly variable and often hard to characterize.
It is often unclear whether they reflect deficits in language itself or in related
cognitive processes such as planning, execution, and memory (Covington et al.,
2005: 86). Chaer (2009: 160) called language disorder in schizophrenia as
“sisofrenik”. He said that sisofrenik is language disorder due to thought disorder.
2.3 Schizophrenia Speech
Many of the general signs of psychiatric problems can be observed in
speech. In fact, oral language is a particularly sensitive manifestation of thought
processes and brain dysfunction. Andreasen (1979 : 1318- 1321) proposed 18
23 poverty of speech, poverty of content of speech, pressure of speech, distractible
speech, tangentiality, derailment, incoherence, illogicality, clanging, neologism,
word approximations, circumstantiality, loss of goal, perseveration, echolalia,
blocking, stilted speech, and self-reference.
1) Poverty of speech (poverty of thought, laconic speech)
Poverty of speech is a restriction in the amount of spontaneous speech, so
that replies to questions tend to be brief, concrete and unelaborated. Unprompted
additional information is rarely provided. Replies may be monosyllabic, and some
questions may be left unanswered altogether. When confronted with this speech
pattern, the interviewer may find him/herself frequently prompting the patient to
encourage elaboration of replies.
Example from Andreasen (1979: 1318):
Interviewer: “ Do you think there’s a lot of corruption in government?” Patient: “Yeah, seem to be”.
Interviewer: Do you think Haldeman and Ehrlichman and Mitchell have been fairly treated?”
Patient: “I don’t know”.
Interviewer: “Were you working at all before you came to the hospital?” Patient: “No”.
Interviewer: “What kind of jobs have you had in the past? Patient: “Oh, some Janitor jobs, painting”.
Interviewer: “What kind of work do you do?”
Patient: “I don’t. I don’t like any kind of work. That’s silly.” Interviewer: “How far did you go in school?”
24 2) Poverty of content of speech (poverty of thought, empty speech,
alogia, verbigeration)
In poverty of content of speech, although replies are long enough so that
speech is adequate in amount, it conveys little information. Language tends to be
vague, often over-abstract or over-concrete, repetitive and stereotyped. This
interviewer may recognize this finding by observing that the patient has spoken at
some length, but has not given adequate information to answer the question.
Alternatively, the patient may provide enough information to answer the question,
but require many words to do so, so that a lengthy reply can be summarized in a
sentence or two. Sometime the interviewer may characterize the speech as ‘empty
philosophizing’. Poverty of content of speech differs from circumstantiality in that
the circumstantial patient tends to provide a wealth detail.
Example:
Example from Andreasen (1979: 1318):
25 3) Pressure of speech
Pressure of speech is an increase in the amount of spontaneous speech as
compared with what is considered ordinary or socially customary. The patient
talks rapidly and is difficult to interrupt. Some sentences may be left uncompleted
because of eagerness to get on to a new idea. Simple questions that could be
answered in only a few words or sentences will be answered at great length, so
that the answer takes minutes rather than seconds, and indeed may not stop at all
if the speaker is not interrupted. Even when interrupted, the speaker often
continues to talk. Speech tends to be loud and emphatic. Sometimes speaker with
severe pressure will talk without any social stimulation, and talk even though no
one is listening. If a quantitative measure is applied to the rate of speech, then a
rate greater that 150 words per minute is usually considered rapid or pressured.
4) Distractible speech
In distractible speech, during the course of a discussion or interview, the
patient repeatedly stops talking in the middle of a sentence or idea and changes
the subject in response to a nearby stimulus, such as an object in a desk, the
interviewer’s clothing or appearance, etc.
Example from Andreasen (1979: 1318):
26 5) Tangentiality
In tangentiality, patient replies a question in an oblique, tangential or even
irrelevant manner. The reply may be related to the question in some distant way.
Or the reply may be unrelated and seem totally irrelevant. In the past, tangentiality
has been used as roughly equivalent to loose associations or derailment. The
concept of tangentiality has been partially redefined so that it refers only to
questions and not to transition in spontaneous speech.
Example from Andreasen (1979: 1319):
Interviewer: “What city are you from?”
Patient: “Well that’s a hard question to answer because my parents. . . I was born in Lowa, but I know that I’m white instead of black so apparently I came from North somewhere and I don’t know where, you know, I really don’t know where my ancestors came from. So I don’t know whether I’m Irish or French or Scandinavia or I don’t I don’t believe I’m Polish but I think I’m I think I might be German or Welsh. I’m not but that’s all speculation and that’s one thing that I would like to know and is my ancestors you know where where did I originate. But I just never took the time to find out the answer to that question.”
6) Derailment (loose association, flight of ideas)
Derailment is a pattern of spontaneous speech in which the ideas slip off
the track on to another one that is clearly but obliquely related, or on to one that is
completely unrelated. Things may by said in juxtaposition that lack a meaningful
relationship, or the patient may shift idiosyncratically from one frame of reference
to another. At times there may be a vague connection between the ideas; at others,
none will be apparent. Perhaps, the commonest manifestation of this disorder is a
slow, steady slippage, with no single derailment being particularly severe, so that
27 showing any awareness that his reply no longer has any connection with the
question that was asked.
Derailment differs from circumstantiality in that each new subject is only
obliquely related or even unrelated to the previous one and is not a further
illustration or amplification of the same idea or subject. It may lead to loss of
goal, but the speaker may also realize that he has gotten off the track and return to
his original subject, and this should also be considered derailment.
Example from Andreasen (1979: 1319):
Interviewer: What did you think of the whole Watergate affair?”
Patient: “You know I didn’t tune in on that, I felt so bad about it. I said, boy, I’m not going to know what’s going on in this. But it seemed to get so murky, and everybody’s reports were so negative. Huh, I thought, I don’t want any part of this, and I was I don’t care who was in on it, and all I could figure out was Artie had something to do with it. Artie was trying to flush the bathroom toilet of the White House or something. She was trying to do something fairly simple. The tour guests stuck or something. She got blamed because of the water overflowed, went down in the basement, down, to the kitchen. They had a, they were going to have to repaint and restore the White House room, the enormous living room. And then it was at this reunion they were having. And it’s just such a mess and I just thought, well, I’m just going to pretend like I don’t even know what’s going on. So I came downstairs and ‘cause I pretended like I didn’t know what was going on, I slipped on the floor of the kitchen, cracking my toe, when I was teaching some kids how to do some double dives.”
7) Incoherence (word salad, schizophasia, paragrammatism)
Incoherence or also called word salad, schizophasia, and paragrammatism
are a pattern of speech that is essentially incomprehensible at times. The
incoherence is due to several different mechanisms, which may sometimes all
occur simultaneously. Sometimes the rule of grammar and syntax are ignored, and
28 Sometimes portions of coherent sentences may be observed in the midst of a
sentence that is incoherent as a whole. Sometimes the disturbance appears to be at
semantic level, so that words are substituted in a phrase on sentence so that the
meaning seems to be distorted or destroyed. Sometimes “cementing words”
(conjunctions such as ‘and’ and ‘although’ and adjectival pronouns such as ‘the’,
‘a’ and ‘an’) are deleted (in English grammar).
This type of language disorder is relatively rare. When it occurs, it tends to
be severe or extreme, and mild forms are quite uncommon. It may sound quite
similar to a Wernicke’s aphasia or jargon aphasia; in these cases, the disorder
should only be called incoherence (thereby implying a psychiatric disorder as
opposed to a neurological disorder) when history and laboratory data exclude the
possibility of a known organic etiology and formal testing for aphasia gives
negative results.
Incoherence often is accompanied by derailment. It differs from
derailment in that the abnormality occurs at the level of sentence, within which
words or phrases are joined incoherently. The abnormality in derailment involves
unclear or confusing connections between larger units, such as sentence or ideas.
Example fron Andreasen (1979: 1319):
Interviewer: Why do you think people believe in God?
29 Interviewer: “What do you think about current political issues like the energy crisis?”
Patient: “They’re destroying too many cattle and oil just to make soap. If we need soap when you can jump into a pool of water, and then when you go to buy your gasoline, my folks always thought they should get pop, but the best thing to get is motor oil, and money. May may as well go there and trade in some pop caps and, uh, tires, and tractors to car garages, so they can pull cars away from wrecks, is what I believed in”.
8) Illogicality
Illogicality is a pattern of speech in which conclusions are reached that do
not follow logically. This may take the form of non sequiturs (i.e., it does not
follow), in which the patient makes a logical inference between two clauses that is
unwarranted or illogical. It may take the form of faulty inductive inferences. It
may also take the form or reaching conclusions based on faulty premises without
any actual delusional thinking. Illogicality may either lead to or result from
delusional beliefs.
Example from Andrease (1979: 1320):
Patient may say: “parents are the people that raise you. Any thing that raises you can be a parent. Parents can be anything, material, vegetable, or mineral, that has taught you something. Parents would be the world of things that are alive, that are there. Rocks, a person can look at a rock and learn something from it, so that would be a parent.”
9) Clanging
Clanging is a pattern of speech in which sounds rather that meaningful
relationships appear to govern word choice, so that the intelligibility of the speech
is impaired and redundant words are introduced. In addition to rhyming
relationships, this pattern of speech may also include punning associations, so that
30 “I’m not trying to make noise. I’m trying to make sense. If you can make sense
out of nonsense, well, have fun. I’m trying to make sense out of sense. I’m not
making sense (cents) anymore. I have to make dollars.”
10) Neologisms
Neologisms are new word formations. A neologism is defined here as a
completely new word or phrase whose derivation cannot be understood.
Sometimes the term ‘neologism’ has also been used to mean a word that has been
incorrectly built up but with origins that are understandable as due to a misuse of
the accepted methods of word formation. For purposes of clarity, these should he
referred to as word approximations.
Example from Andreasen (1979: 1320):
Patient may say: “I got so angry I picked up a dish and threw it at the gashinker”. “So I sort of bawked the whole thing up”.
11) Word approximations (paraphasia, metonyms)
Word approximations are old words that are used in a new and
unconventional way, or new words that are developed by conventional rules of
word formation. Often the meaning will be evident even though the usage seems
peculiar or bizarre (i.e., gloves referred to as ‘handshoes’, a ballpoint pen referred
to a ‘paperskate’, etc). Sometimes the word approximation may be based on the
use of stock words, so that the patient uses one or several words repeatedly in
ways that give them a new meaning (i.e., a watch may be called a ‘time vessel’,
31 Example from Andreasen (1979: 1320):
Patient may say: “Southeast Asia, well, that’s like Middle Asia now”. “His boss was a seeover”.
12) Circumstantiality
Circumstantiality is a pattern of speech that is very indirect and delayed in
reaching its goal idea. In the process of explaining something, the speaker brings
in many tedious details and sometimes makes parenthetical remarks.
Circumstantial replies or statements may last for many minutes if the speaker is
not interrupted and urged to get to the point. Interviewers will often recognize
circumstantiality on the basis of needing to interrupt the speaker to complete the
process of history taking within an allotted time.
Although it may coexist with instances of poverty of content of speech or
loss of goal, it differs from poverty of content of speech in containing excessive
amplifying or illustrative detail and from loss of goal in that the goal is eventually
reached if the person is allowed to talk long enough. It differs from derailment in
that the details presented are closely related to some particular idea or goal and in
that the particular goal or idea must by definition eventually be reached.
An example of circumstantiality is that when patient asked about the age
of his mother at death, the speaker responds by talking at length about accidents
and how too many people die in accidents, then eventually says how the mother’s
32 13) Loss of goal
Loss of goal refers to failure to follow a chain of thought through to its
natural conclusion. This is usually manifested in speech that is begins with a
particular subject wanders away from the subject and never returns to it. The
patient may or may not be aware that he has lost his goal. This often occurs in
association with derailment.
14) Perseveration
Perseveration refers to persistent repetition of words, ideas or subjects, so
that once a patient begins a particular subject or uses a particular word, he
continually returns to it in the process of speaking (McKenna, 2005: 24). This
may also involve repeatedly giving the same answer to different questions.
Example from Andreasen (1979: 1320):
Interviewer: “Tell me what you are like, what kind of person you are.” Patient: “I’m from Marshalltown, lowa. That’s 60 miles northwest, northeast of Des Moines, lowa. And I’m married at the present time. I’m 36 years old. My wife is 35. She lives in Garwin, lowa. That’s 15 miles southeast of Marshalltown, lowa. I’m getting a divorce at the present time. And I am at presently in a mental institution in lowa City, lowa, which is a hundred miles southeast of Marshalltown, lowa”.
15) Echolalia
Echolalia is a pattern of speech in which the patient echoes words or
phrases of the interviewer. Typical echolalia tends to be repetitive and persistent.
The echo is often uttered with a mocking, mumbling or staccato intonation.
33 Example from Andreasen (1979: 1321):
Doctor say to the patient: “I’d like to talk with you for a few minutes”. The patient may responds with a staccato intonation: “Talk with you for a few minutes”.
16) Blocking
Blocking refers to interruption of a train of speech before a thought or idea
has been completed. After a period of silence lasting from a few seconds to
minutes, the person indicates that he cannot recall what he had been saying or
meant to say. Blocking should only be judge to be present if a person voluntarily
describes losing his thought or if on questioning by the interviewer he indicates
that that was his reason for pausing.
17) Stilted speech
Stilted speech refers to speech that has an excessively formal quality. It
may seem rather quaint or outdated, or may appear pompous, distant or over
polite. The stilted quality is usually achieved through use of particular word
choices (multisyllabic when monosyllabic alternatives are available and equally
appropriate), extremely polite phraseology (‘Excuse me madam, may I request a
conference in your office at your convenience’). Or stiff and formal syntax
(‘whereas the attorney comported himself indecorously, the physician behaved as
is customary for a born gentleman’).
Example from Andreasen (1979: 1321):
34 18) Self-reference
Self-reference refers to a disorder in which the patient repeatedly refers the
subject under discussion back to himself when someone else is talking and also
refers apparently neutral subjects himself when he himself is talking.
Example from Andreasen (1979: 1321):
Interviewer: “What’s the time?”
Patient: “It’s 7 o’clock. That’s my problem. I never know time it is. Maybe I should try to keep better track of the time”.
2.4 Related Researches
Some researchers also have been made some researches related to
language disorder in schizophrenic patient. One of the research about language
disorder in schizophrenic patient have been made by Ni Ketut Alit Ida
Setianingsih, I Made Netra, I Gst. Ngurah Prathama (2009) from University of
Udayana in their journal Kajian Psikolinguistik Bahasa Skizofrenik: Studi Kasus
Pada Rumah Sakit Jiwa Bangli published in scientific journal of language and
literature in University of North Sumatera.
Their research concerns on language production and comprehension in
schizophrenia patient. To analyze language production and comprehension
produced by the schizophrenic patient the writers used some psycholinguistic
theories and applied direct observed conversation method. The samples of the
research are three schizophrenia patients; an emergency patient, a
35 The result of the analysis showed that (1) a) such stages of language
production as conceptualization, formulation, articulation, and self-monitoring
were differently used by the patients. The emergency patient failed to use those
stages of language production. The semi-emergency patients were able to make
use of those stages of language production inconsistently. Meanwhile, the quite
patient was able to use those stages of language production relatively consistently;
b) the schizophrenic language was comprehended through phonetic and
phonological, morphological, syntactic, and text units. The emergency patient
failed in using those units of language comprehension. Therefore, the utterances
produced were not properly structured and coherent. The semi-emergency patient
used those units of language comprehension inconsistently through out the whole
conversation. The quiet patient used those units of language comprehension
relatively more consistently (2) generally, schizophrenic behavior included
association obstacles resulting in sudden change and unclear concepts.
Schizophrenic behavior was actually that of the self expression of which language
was in a high linguistic level, semantics and pragmatics. Schizophrenic behavior
was unique, eccentric, full of metaphor, and neologism.
Other research related to language disorder in schizophrenia patient is an
analysis by Isra Az-Zahra, Gangguan Berbicara Pada Penderita Skizofrenia
Pasien Rumah Sakit Jiwa Tampan Pekanbaru. This analysis focuses on language
characteristic produced by paranoid schizophrenia patient. In doing this analysis,
the researcher use theory of schizophrenia by Kaplan and applying a qualitative
36 As the result of the analysis, the writer found that pressure of speech,
unintelligible speech, poverty of speech, voice disorder, disprosody, poverty of
content of speech, stuttering and inability to answer spontaneously are common in
patient with paranoid schizophrenia.
Other related research is a journal by Rizkhi Nurul Azizah, Kemampuan
Verbal Penderita Skizofrenia: Sebuah Studi Kasus. This research uses cooperative
pragmatic theory by Grice and focuses on pragmatic impairment in language used
by schizophrenia patient. Based on this research, the researcher found that verbal
expression of schizophrenia patient follows Grice’s maxims.
Other related research is A Psycholinguistic Study on Comprehension
Disorder of the Main Character in A Beautiful Mind Movie (2010) written by
Sumitro Agung Nugroho. This study focuses on analyzing comprehension
disorder of the schizophrenic character in A Beautiful Mind movie. This study
uses descriptive qualitative method and the data are utterances of John Nash, the
main character of A beautiful mind movie.
The aim of the study is to get the understanding and detailed explanation
about comprehension disorder found in the schizophrenic character of A Beautiful
Mind movie. And the result of the study shows that the schizophrenic character of
A Beautiful Mind movie, John Nash, has a comprehension disorder which
occurred due to his delusion and hallucination. There are nine types of
37 movie, including derailment, flight of ideas, incoherence, irrelevant answer,
blocking, retardation, perseveration, pressure of speech, and circumstantiality.
Other related research is a Thesis entitled Schizophrenic Language (a case
study of Toni Blank) (2014) written by Wahyu Wiji Nugroho from Gadjah Mada
University. It is a descriptive qualitative research which attempts to explain about
language phenomenon occurred in schizophrenic or people with mental disorder,
especially Toni blank. The aims of this study are (1) to describe the characteristics
of language in schizophrenic, especially Toni Blank, (2) to describe about
violation of cooperative principle and degree of relevance when Toni Blank speak
to other (3) to describe cohesion and coherence of schizophrenic, especially Toni
Blank.
The data of the research is taken from Toni Blank Shows and live
interview between the researcher and Toni Blank. Toni Blank Shows is a video
made by X-Code Yogyakarta Film, consists of dialogue between Toni Blank and
the interviewer which is uploaded in youtube. And the data of this research are
utterances and answers from Toni Blank.
The result of the study are (1) the characteristics of language of Toni
Blank including: incoherence, Neologism, Blocking, repetition, code-mixing,
dieksis, and pragmatic deficit, (2) Toni Blank tends to violate all of the
cooperative principle and have a very low degree of relevance, (3) Toni Blank still
38 All of those related researches give a lot contribution to writer in
understanding language disorder in schizophrenia as well as it helps writer in
writing and organized this analysis. The method used in the journal Kajian
Psikolinguistik Bahasa Skizofrenik: Studi Kasus Pada Rumah Sakit Jiwa Bangli
written by Ni Ketut Alit Ida Setianingsih, I Made Netra, I Gst. Ngurah Prathama
inspires the writer in collecting the data of A Psycholinguistic Analysis of
Language Disorder in Schizophrenia: A Case Study in which the data will be
collected by using direct observed conversation by doing involved interview with
some schizophrenia patients.
There are some differences between this analysis and others related
researches which only focus on language comprehension disorder in
schizophrenia. This Analysis of Psycholinguistic analysis of language disorder in
schizophrenia: a case study use Andreasen’s theory in analyze the subtypes of
language disorder found in schizophrenia paranoid patients. And this analysis is a
field research which will be done by using case study method, therefore, the result
