‘There is a necessary relationship between language and psychiatric disorders’, and with this every psychiatrist would surely agree. Language in Psychiatry has some chapters explaining how linguistics can be used to clarify psychiatric symptomatology and others examining the language of individual disorders. It expresses its credentials in the first sentence by advocating ‘listening in psychiatry’. The author introduces the psychiatrist to a new ‘language’, satisfactorily explained – clinical history strategies, lexicogrammar, the speech community, information space, theme and rheme – and states that language is disorder, not just a sign of disorder.
The psychiatrist's assessment of atypicality of speech becomes more refined when the distinction is made between ‘observed’ and ‘expected’ on linguistic principles, rather than reporting that the patient speaks oddly. The primary phenomenon in language disorder is atypicality of meaning: ‘odd meanings and odd wordings of meanings’; how can we structure what is odd about language? The three major categories of meaning (experience of the external world, the relationship to the listener and fitting the language into context) may be compromised in psychiatric disorders. Genre – that is how language is organised to achieve processes in context – is important for mental illness.
This book is unashamedly didactic, which is just as well as most Anglo-American psychiatrists were never formally taught English grammar. It takes what the patient says seriously, worthy of detailed analysis. One can attempt to link specific disturbance of language and the organisation of language to particular conditions, by ‘the mapping of language onto disorders’. ‘The close study of language contributes to understanding the phenomenology’.
Unfortunately, Language in Psychiatry is less successful when it deals with some disorders. It covers pervasive developmental disorders, attention-deficit hyperactivity disorder, psychotic disorders, mood disorders and personality disorders. One wonders why the personality disorder chapter is there – how does their language differ from normal? Schizophrenia is particularly disappointing with nothing explanatory on neologism, stock words and phrases, and so on. There is also the surprising omission of organic disorders such as dementia and delirium, with perseveration mentioned only in the context of schizophrenia. Whereas the linguistics is soundly based, psychiatry is linked to the rather sparse descriptions of DSM–IV rather than to a more general psychiatric text; this is a limitation but it offers the psychiatrist an opportunity to put clinical flesh on these nosological bones. Psychiatrists could better help their patients by adding linguistic analysis, which is well introduced here, to listening to their patients.
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