William Tucker
New York, New York, United States

Understanding the odd speech of people with schizophrenia has generally been considered, by psychiatrists and the public alike, both futile and pointless. Often enigmatic and sometimes threatening, it has long been assumed that such speech results from disordered thinking that responds only to anti-psychotic medications. Consequently, psychiatric training has devoted scant attention to understanding it. One figure stands out against this general practice, however: America’s premier interpreter of schizophrenic speech, Harold Searles, a psychiatrist and psychoanalyst who spent most of his career listening carefully to such patients and teaching generations of residents to do likewise.

Here are seven actual examples of such speech:

• A salesman says he is capable of “talking the customers deaf, dumb, and blind.”
• A woman experiences herself as a “watcher-machine.”
• “A person could take a bug and turn it into a person, and then they’d have something to call their own.”
• “Is that my body you have? Back when I had a healthy body, they could make rubies out of my blood and amethysts out of my saliva.”
• “I don’t like John Costello [his given name]. He was a selfish stinker. The name sticks in my throat.”
• “You see, my mother was my mind, and when I lost her, I lost my mind.”
• “When you talk to me like that, I feel I’m going to be led to the edge of the world, and the people are going to decide whether I’d have to jump off or not.”

Each of these examples sounds odd. More importantly, each speaker sounds tormented, full of anguish, fear, and despair. The language sounds almost metaphorical, but something says that the words are meant literally. That is why they seem odd. In ordinary discourse, a speaker may reach for metaphor deliberately to convey a feeling more graphically. But there is nothing deliberate about the words here: each speaker is compelled to put the feeling just this way and no other. It’s as if they’ve found themselves cast into another, eerie world and are trying to reach across to our familiar one to convey their intense needs and feelings, but the way they do so leaves us confused. Such speech tends to push us away.

These examples are taken from Searles’ book Collected Papers on Schizophrenia and Related Subjects.¹ His method was to pay close attention to how patients’ speech made him feel, rather than to the words themselves. Though he had no scientific way to prove that his interpretations were accurate, his patients consistently responded by becoming less tormented and more engaged in their interactions with him.

Periodically, he put on a demonstration of his approach. Once, he interviewed a man who described how his powerfully built father had grown weaker as he lay dying of a brain tumor. Toward the end of his life, the father asked his son to kiss his forehead, which both repelled and attracted his son. “And I bet you’d like to kiss my forehead, right now,” Searles abruptly said to the man. The audience froze, anticipating a calamitous, even violent, response. But the patient only relaxed and spoke more freely, as if he felt—perhaps, for the first time—understood.

Another psychiatrist and psychoanalyst, Laurence Kubie, MD, wrote in Neurotic Distortion of the Creative Process (1981)² about how mental illness distorts the creative process by injecting conflict into it—that is, by making it compulsory, not chosen. He reports a case of a brilliant architect with schizophrenia who exclaimed, “I must create a space which will be different in space and dimensions from any space where I have been before, different from the space which I ultimately came from.” This speech sounds like that of Searles’ patients. Those who incorporated his teaching could easily supply many examples from their own practices.

Searles speculated that the basis of such speech was the loss, largely from genetic causes, of the ability to perform the brain’s most complex function; namely, reading and interpreting the social environment. Such speculation is easy enough to test empirically: people with schizophrenia are baffled by such a question as, “How are you feeling today?” because they are unsure how the questioner expects them to respond. However, when asked how they think the nurses caring for them would rate their behavior, they have no difficulty responding, though not necessarily accurately. A decade ago, some indirect support for such speculation appeared in a study that found a statistically significant difference between the incidence of odd speech by adolescents with a high genetic loading for schizophrenia (frequently) and by accomplished poets (only when essential).³                                      

Poetic speech is odd, too, but in a very different way from that found in schizophrenia. In poetry, the emotion is nuanced, even when it expresses anguish. The images found in it result from choice, rather than from compulsion. They develop into a story that comes alive and progresses, unlike the “stuck,” repetitive language of schizophrenia.

Here is a famous poem by Emily Dickinson:⁴

“Hope” is the thing with feathers
That perches in the soul –
And sings the tune without the words –
And never stops – at all –

And sweetest – in the Gale – is heard –
And sore must be the storm –
That could abash the little Bird

That kept so many warm – 

I’ve heard it in the chillest land –
And on the strangest Sea –
Yet – never – in Extremity,
It asked a crumb – of me.

The poem starts with the image of hope as a bird. It sounds like an invitation on Dickinson’s part to join her in her relationship with it. She develops the image to arrive at the real message of the poem, which is to express the one-sided nature of the giving process. That message recalls Nietzsche’s definition of inspiration, namely, that it is a process of receiving without asking who has given.⁵

The late literary critic Helen Vendler in Dickinson: Selected Poems and Commentaries (2010),⁴ puts this poem’s message more elegantly, saying that the poet “sketches its [i.e., the little Bird’s] sublime offer to exempt her from conventional reciprocity: it remains under her roof [note how naturally Vendler extends Dickinson’s metaphor], whether or not she ever repays it for its sustenance [i.e., of her]. Even ‘in Extremity’—when she asks the most of it—it never asks anything back, not even a crumb.”⁶

Looking at the two kinds of odd speech side-by-side shows how differently each of them has arisen and thus, how each can be understood. The clinician can examine the feelings that schizophrenic speech evokes, taken as a whole, rather than trying to follow each repetition of the same image. In contrast, since the poet has developed a progressive story with the image(s), it is worth reading a poem through to the end several times and follow the progression. Then it is possible to see where the poem is heading and to put the message into one’s own words.

Demystifying the odd speech typical of schizophrenia may provide a practical skill for busy medical practitioners. Fortunately, the need to confront an acutely agitated person who is speaking oddly comes up only rarely, even for most psychiatrists. If a medical practitioner assumes that behind the odd language is the need to communicate something vitally important, it may be possible to figure out what that is—even getting close is good enough—and thus avoid the reflexive response of ordering physical restraints and sedating medications. Searles has not been alone in demonstrating how to deescalate tense confrontations. Successful, enduring, community treatment programs that incorporate something like this approach include OnTrack⁷ and Pathways to Housing⁸ in the US; The Adamant⁹ in France; and One of Us¹⁰ in Denmark.

Demystifying the odd speech typical of poetry offers a different kind of benefit. It allows greater engagement with the pleasurable world of art and the exciting world of science that sustain these same practitioners outside the consulting room, involving them in the larger range of human experiences. The first step toward understanding poetic speech is one they have probably taken already: acquiring familiarity with a range of poems, some of which they respond to, even if others remain mysterious. The next step is to engage with those words and images the poet has provided—in effect, to play with them, looking for new connections, until they can make their own translation of the poem. There is no single or “correct” one, because each poem can evoke the whole world of the reader. The poet Wallace Stevens provided his own description of how to confront a poem: “A poem must resist the intelligence / Almost successfully.”¹¹

The same process applies to engagement with other art forms (painting, photography, sculpture, dance, and music) and to discoveries in science. The photographer Ansel Adams said of photographic art that it “may be likened to the art of the juggler in keeping many balls in the air at one time!”¹² As an example of engagement with painting, here is Colm Toibin—a noted writer but not a formal art critic—responding to a lithograph by Josef Albers (see picture):¹³

At first glance, they seem all surface and edge. It is only when you stand in front of one of them and give yourself time, when you stop thinking and start looking carefully, that a strange, tentative energy is released. It is clear that there was exact planning, but then, in the creation of the squares, in the placing of colours around each other, there are actual raw signs of how the work was made, there are signs of someone striving.¹⁴

Ultimately, understanding each of these forms of odd speech begins with close listening, reading, or looking, which is a skill that anyone can learn and improve on with practice. Perhaps it is the poet Robert Lowell who put the contrast between these two forms of odd speech most clearly and succinctly. In his foreword to Sylvia Plath’s last book of poems, he describes her poetry as showing “controlled hallucination.”¹⁵ The distinction between this form and the uncontrolled form, which is a symptom of schizophrenia, says it all.

References

1. Searles H. Collected Papers on Schizophrenia and Related Subjects (International University Press, New York, 1965).
2. Kubie L. Neurotic Distortion of the Creative Process (The Noonday Press, New York, 1961).
3. Bedi G, Carrillo F, Cecchi GA, et. al. Automated analysis of free speech predicts psychosis onset in high-risk youth. NPJ Schizophr, 2015 Aug26
4. Emily Dickinson. Collected Poems (Little, Brown, Boston, 1960; this poem was written in 1861).
5. Nietzsche F. Thus Spake Zarathustra (Ernst Schmeitzner, Chemnitz, 1885).
6. Vendler H. Dickinson: Selected Poems and Commentaries (Belknap Press, Cambridge, 2010)
7. OnTrackNY: early-intervention program for first-episode psychosis developed in 2013 by Lisa Dixon, MD, PhD.
8. Pathways to Housing: community housing-and-treatment program, developed in 1992 by Sam Tsemberis, PhD.
9. The Adamant: community mental health clinic in Paris, subject of documentary film in 2022 by Nicholas Philibert.
10. One of Us: anti-stigma program of the Danish government, 2011.
11. Wallace Stevens, in poem “Man Carrying Thing” (1943).
12. Ansel Adams. The Negative (Little, Brown, Boston, 1981).
13. Josef Albers. JHM-II (1973).
14. Colm Toibin. (personal communication, February 2, 2020).
15. Robert Lowell. In Ariel: Poems by Sylvia Plath (Harper & Row, New York, 1961).