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Language and
Schizophrenia

Schizophrenia is one of the most enigmatic mental disorders, and language is one
of its most essential and distinctive traits. Language and Schizophrenia provides a
complete overview of schizophrenic language, utilising both psychological and
philosophical perspectives to explore the unique way language impacts on this
mental disorder.
Language and Schizophrenia investigates specific features of schizophrenic lan-
guage using cognitive psychology alongside the opposing field of phenomeno-
logical psychiatry, concluding that neither of these approaches fully succeeds in
explaining the linguistic features unique to schizophrenia. Cardella’s innovative
approach of combining psychological perspectives with philosophy offers a direct
alternative to traditional cognitive perspectives, emphasising the fundamental
role that language plays in the disorder.
This book provides a thorough analysis of the deep link between language
and schizophrenia and will be of great value to researchers and postgraduates
studying schizophrenia, phenomenology, neuropsychology and philosophy of
language.

Valentina Cardella is Associate Professor of Philosophy of Language at the

University of Messina, Italy.
Language and
Schizophrenia
Perspectives from Psychology
and Philosophy

Valentina Cardella
First published 2018
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2018 Valentina Cardella
The right of Valentina Cardella to be identified as author of this work
has been asserted by her in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced
or utilised in any form or by any electronic, mechanical, or other
means, now known or hereafter invented, including photocopying and
recording, or in any information storage or retrieval system, without
permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identification and
explanation without intent to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record for this book has been requested

ISBN: 978-1-138-56590-6 (hbk)

ISBN: 978-1-138-56591-3 (pbk)
ISBN: 978-1-315-12323-3 (ebk)
Typeset in Bembo
by codeMantra
This book is dedicated to Gabriele and Emma.
CONTENTS

Acknowledgments ix

Introduction 1

1 The enigma of schizophrenia 5

Schizophrenia in history 5
Patients with neither desires nor fear 9
Different portraits, one disease 12

2 Language in schizophrenia 18
Grammar and syntax 18
Semantics 22
Speech disorganisation 26
Pragmatics 31
Non-literal use of language 34

3 The cognitive perspective on schizophrenic language 39

The cognitive approach 39
Explaining schizophrenic language—attempt one:
semantic memory 41
Attempt two: working memory and other
executive functions 46
Attempt three: Crow and the deictic frame 50
Attempt four: the theory of mind 53
viii Contents

4 The philosophical perspective on

schizophrenic language 64
Having schizophrenia or being schizophrenic? 64
Delusions and language: a world full of meaning 68
Language and forms of life 71

5 An alternative view: schizophrenia as a

disease of language 77
What’s wrong with schizophrenic language, then? 77
Language in schizophrenia: a natural fuel 80
Conclusion: can we imagine schizophrenia without language? 84

References 89
Index 105
Acknowledgments

I would like to express my gratitude to the many colleagues and friends who have
helped me along.
Thanks to Antonino Pennisi, my mentor, who introduced me to the intrigu-
ing world of psychopathology of language. Special thanks to Alessandra Falzone,
Amelia Gangemi, and Francesco Paolo Tocco for their priceless support, and
most of all for their precious friendship. Thanks also to Franco Lo Piparo, with-
out whom I would never have developed a passion for the philosophy of lan-
guage. I am also grateful to all the colleagues of the Department of Cognitive
Sciences, who make my job at the University of Messina a very pleasant one.
Special thanks to Ceri McLardy for her interest in my book, and to Anna
Cuthbert, Hannah Kingerlee, and the crew at Routledge. Two anonymous ref-
erees made helpful comments on my proposal and have been supportive of the
project; I am grateful to them.
Last and most important: thanks to my husband, my parents, and my brother
for their constant support and encouragement in any aspect of my life.
Introduction

This book is an enquiry about language and schizophrenia and aims to show how
language contributes to the unique features of this mental disorder. In order to
investigate the specific features of schizophrenic language, I compare two differ-
ent approaches: cognitive psychology, on one hand, and phenomenological psy-
chiatry, on the other. My opinion is that, even if these theories can account for
some specific features of this kind of language, they are not able to identify single
impairments that can explain the entire schizophrenic language. Moreover, the
two approaches, admittedly very different, agree in considering schizophrenic
language as something that is not important per se, but as a simple reflection
of what happens to other levels (the broader cognitive one for the cognitive
­approach, or the Lebensform for the philosophical one).
Yet, when we give voice to schizophrenic patients, they have a completely
­d ifferent opinion of the role of language in their mental disorder. They seem to be
perfectly aware that language is a sort of natural fuel for their disease. Adam, for
example, is a paranoid schizophrenic who tells his story in the First Person ­section
of the American journal, Schizophrenia Bulletin. According to him, in order to un-
derstand what it is like to be a schizophrenic, the reference to W­ ittgenstein’s no-
tion of a linguistic game can be useful (Wittgenstein, 1953). This notion means
very different things: for example, telling a joke, asking, begging, promising,
and so on are different linguistic games because they are distinct ways to use a
proposition. Teaching the meaning of a term by the ostensive definition is a kind
of linguistic game too: while saying a word, I point at the c­ orresponding object,
so that the person listening to me can understand the reference of that term.
Wittgenstein remarks that linguistic games can only have sense in the context
of a common life form. In other words, to speak one language implies someone
to talk to (a social net) and also implies a background of shared actions, activ-
ities, and habits; this background is essential for every linguistic game and for
2 Introduction

the whole language. The specific Wittgensteinian ­example Adam refers to is an

imaginary linguistic game where a builder points at specific building ­m aterials
(stones, bricks, etc.), showing them to his assistant and saying the corresponding
word at the same time, and little by little the assistant learns to hand out the re-
quested material. Wittgenstein uses this example to show how linguistic games
can allow us, among other things, to institute the meaning of words of one
language. Adam, after quoting this example, finds some remarkable similarities
with his personal experience and states that ‘my paranoia consisted of the idea
that everyone was playing language games and that the object that people were
referring to for certain words was me’ (Timlett, 2011: 1099). I will report here
his words to clarify what he means when he talks of language games.

What I found was that my perception of how people conversed became

r­ educed to the simple rules of a language game, and I was an ­unwilling
­participant in this game. The problem was that these games were not
­harmless communication but used as a way of persecuting me. One reason
that I may have had the perception that this was happening was that at some
point I began to feel that what people meant could not be accounted for in
the usual sense. So I resorted to analyzing people’s conversations in terms
of a language game. It is possible that my emotional fear of being singled
out is what caused me to no longer understand things in their normal way.
(Timlett, 2011: 1099)

What we have here is a peculiar characteristic of schizophrenia that we will describe

ahead (see Chapter 4 p. 68), the so-called suspension of meaning; without going
into a detailed description of this phenomenon, which certainly deserves more
space, I can point out in the meantime that this suspension specifically concerns
the meaning of the words that cannot be interpreted ‘in their normal way’. Thus,
given that Adam feels that something is hiding behind the words, he starts to think
that people around him are playing a linguistic game he needs to decode in order
to understand what they really mean. An activity of interpretation (which is well
known by anyone who deals with paranoids) thus begins, a chain of associations
that ensures that whatever is said by others has a personal reference. For example, if
someone said ‘America’ to Adam, this was interpreted as ‘Am Erika’ or as a coded
reference to someone who is actually a woman; through the analysis of gestures,
smiles, and nods used by people involved in this conversation, Adam persuaded
himself that he was the intended reference and reacted in a certain way (e.g., by
staring at a man). He then took it that this staring was accepted as his response, and
then another series of linguistic games began. In other words, as Adam states,

I found myself an unwilling participant in a language game, and soon

­became immersed in a world of language games that I could not resist par-
ticipating in, despite the anger that I would feel at being given these names
and referred to in this way.
(Timlett, 2011: 1099)
 Introduction 3

It seems an efficient portrayal of the famous pragmatic paradox according to

which it is impossible to not communicate (Watzlawick et al., 1967); as it is well
known, each behaviour communicates something, even when the intention is to
communicate nothing. So, Adam finds himself involved in linguistic games he
cannot avoid because each of his reactions can be interpreted as a message. He
thus starts becoming obsessed with language.

It seems to me that what paranoia does is tap in to this reservoir of p­ otential

meaning and interpretation, with potentially devastating results. Given
that I was an adult with a decent vocabulary, and a reasonable sensitiv-
ity to metaphor, the possibility of people playing language games opened
up a whole vista of experience and interpretation that I seemed to find
­irresistible. Effectively, I became addicted to thinking about how words
could be used to make coded references. I became obsessed with playing
language games instead of using language primarily as it is normally used.
(Timlett, 2011: 1099)

Adam is like a child discovering language for the first time: a whole world of
potential meanings opens up, but since he is an adult already full of language,
this opening has dangerous effects, because everything can be seen as a coded
message once the conversations are examined in terms of linguistic games.
­Moreover, in this case, language really hurts: it is through the conversations
that Adam’s persecution is committed. Language is what makes him feel alone,
derided, humiliated, and unhappy.
I want to report here another passage of Adam’s story that I think is ­particularly
important.

I have tended to respond quickly to the medication, and therefore s­ everal

times I have had the experience of staying on a mental ward while my
senses were relatively intact. During these times, I have been able to
observe and converse with my fellow patients, and I have come to the
­conclusion that the overwhelming majority of the patients are also lost in a
world of language games.
(Timlett 2011: 1099)

Thanks to his experience and to what he learned talking with other people
­suffering from mental illness, Adam comes to the conclusion that being obsessed
with language is a common problem. People that are mentally ill are all lost in a
world of language games, as if they were locked up by language, together fasci-
nated and paralyzed by its infinite possibilities of signification (see the idea of the
limitless noetic field in Pennisi, 1998).
This book is in line with Adam’s thesis. The basic idea is that language plays a
fundamental role in the schizophrenic Lebensform. The analysis of schizophrenic
language cannot reduce to a simple description of how language changes in this
mental disorder, but implies questioning the deep link between language and
4 Introduction

existence, and the inseparable connection between language and human ­sociality.
The specific features of schizophrenic language have been highlighted for their
oddity since the first descriptions of schizophrenia as a separate ­syndrome, and
they keep on challenging psychiatrists and psychologists. Even if schizophrenic
speech is so peculiar that it can be considered the grounds for that early feeling
that allows also non-experts to perceive schizophrenia (Rümke, 1941), the actual
nature of the impairment underlying schizophrenic language has not been dis-
covered yet. The hypotheses, as we will see throughout the book, are varied and
single out very different capacities, like semantic memory, mentalising abilities,
and executive functions. But, the results of this kind of research appear to be
absolutely unsatisfactory; none of these theories seem able to identify the core
deficit that explains all the peculiarities of schizophrenic language.
Yet, language is one of the most important fields to understand s­ chizophrenia.
We cannot explain this complex and enigmatic mental disorder by ­putting
aside the peculiar way it affects and modifies language. People who, despite be-
ing schizophrenic, preserve the clarity of mind to analyse the disease from the
­inside—people like Adam—testify to the linguistic nature of schizophrenia.
This is the reason why, even if the schizophrenic semantics and pragmatics’ core
is still unclear, it is still worth trying to explore this issue.
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