THE LANGUAGE OF SCHIZOPHRENIA ANDTHE WORLD OF DELUSION

MICHAEL ROBBINS Amherst Ma

The bizarre language of schizophrenics is nowadays generally believed to be themeaningless breakdown product of a neurobiological disorder The psychologicalsigni cance of hallucinations and delusions also remains mysterious Verbatimvignettes are presented from an advanced stage of a psychoanalytically informedtreatment to illustrate that schizophrenics speak a meaningful language that issyntactically and morphologically similar to ordinary language but is qualitativelydifferent in terms of semantics and pragmatics From a semantic perspective theordinary distinctions between words things body states and actions are absentcreating words and sentences that are not representationalor symbolic It is a languageof equivalence immediacy and action as contrasted with a language of self-awarenessthoughtfulness re ection and communication From a pragmatic standpoint becausethe language of schizophrenia makes no distinction between mind and world it enablesand supports delusional thinking In order for the psychoanalyst to comprehend whatthe patient means and couch interpretations in such a way as to convey the meaningheshe intends analyst and patient must become aware of their inability to comprehendone anotherrsquos languagesand nd a way to bridge the communication barrier

Background

When Freud dubbed psychoanalysis his rsquo talk-ing curersquo he signi ed his awareness that lan-guage is an essential constituent of everyhuman relationship Language is both a pro-duct and a determinant of the way we per-ceive think about and understand the worldThe language of schizophrenics is doubtlessthe strangest of the tongues that analysts en-counter Psychoanalytic study of schizophren-ic language dates back to Freudrsquos (1900)preface to The Interpretation of Dreams Thiswork includes a historical survey of observa-tions about the similarity between dreams andpsychosis that goes back as far as Kant in themid-eighteenth century Notable among themis Griesinger (1882) whose belief that bothdreaming and psychosis are forms of wish-ful lment presaged Freud Freud concluded

that dreaming and schizophrenic languageare analogous processes and in his later years(1933) he refers to dreaming as a form of psy-chosis Unfortunately he never had the oppor-tunity to apply his insights about dreamingto an elucidation of the meaningfulness ofschizophrenic language

Schizophrenic disorders of speech andthought attracted the interest of psychiatristsat the Burgholzli sanatorium at the turn of thecentury these included Kraepelin (1896)Jung (1906) Stransky (1905 1905a) andBleuler (1911) Beginning with Klein (1930)a handful of analysts among them Katan(1939 1960) Segal (1950 1956 1957) Bion(1955 1967) Searles (1965) Arieti (1973)and others whose work is inaccessible to anon-German- or non-French-speaking reader(Schilder 1914 Storch 1922 1923 1930Gerson 1928 Bobon 1962) have used the

Int J Psychoanal (2002) 83 383

analytic setting as an opportunity to studyschizophrenic language About four decadesago the neuroscienti c view of schizophreniaas an organic illness the mental manifesta-tions of which including speech and writingare meaningless by-products gained ascen-dancy and psychoanalytic interest in thesubject correspondingly waned

The mid-twentieth century psychoanalyticdebate about the meaningfulness of schizo-phrenic language centred on whether sym-bolic capability is missing entirely orwhether symbolism is arcane idiosyncraticand opaque Both the concrete and the arcanesymbolic theoretical positions rest on theassumption that ordinary language andschizophrenic language are qualitatively simi-lar differing only with regard to symboliccapability Harry Stack Sullivan (1962) isrepresentative of those who hold the opinionthat schizophrenic and ordinary language arequalitatively similar in all respects includingsymbolic capability but that what makesschizophrenic language seem different is itsunusual use of symbols

The more substantial body of opinionamong psychiatrists psychoanalysts andpsychologists as early as White (1925) isthat what separates the two languages is aspeci c defect in symbolic capability Ana-lysts including Katan (1939) Segal (19501956 1957) Burnham (1955) Searles(1965) and Arieti (1974) as well as psycholo-gists including Werner (1940) Goldstein(1944) and Cameron (1944 1963) believethat schizophrenics are stimulus-bound andconcrete and that they cannot abstractgeneralise or form concepts and categoriesBuilding on Freudrsquos (1900) concept of con-densation the psychologist Von Domarus(1944) coined the phrase rsquo predicate identityrsquowith reference to the concretising process in

schizophrenics Klein (1930) noted schizo-phrenic dif culty in symbol formation andsubsequently (1946) described primitive so-matopsychic projective identi cation in herelucidation of what she believed to be thepsychotic phase of the rst year of lifeSegal (1950) elaborated the dif culty insymbolising and subsequently (1957) calledschizophrenic concreteness rsquo symbolic equa-tionrsquo Segal comments on her patientrsquosrsquo failure to distinguish between that whichwas thought of and that which wasrsquo (1950p 269)

There has been little exploration of theproblems linguistic concreteness poses forpsychoanalytic treatment Reports in theliterature suggest that even analysts such asSegal who contributed so much to thehypothesis that schizophrenic language isconcrete have tended to approach patientsclinically with the rsquo unusual symbolismrsquo hy-pothesis and the related assumption thatschizophrenic and normal language are moresimilar than different so that an astuteanalyst functioning as cryptographer candecode unconscious meaning and interpret itin a manner that will be comprehensible tothe patient (Burnham 1955)

The nature of schizophrenic delusions hasalso remained relatively opaque to our under-standing although a review of this complexsubject is beyond the scope of the paper I hadan extraordinary opportunity to study schizo-phrenic language and its relationship to delu-sions during the twelfth year of a four timesweekly psychoanalytically informed1 therapyAlthough I have had intensive and extensivepsychoanalytically informed treatment ex-periences with numerous schizophrenic per-sons (Robbins 1993) language had neverbefore become the focus of investigation Inthis instance my attention was called to it

1By rsquo psychoanalytically informedrsquo I mean that my technique was informed by concepts of transferenceunconscious meaning in the primary if not the dynamic sense of the concept and lack of psychic integrationas well as goals of enhancing mental representation and of converting fragmented unconscious elements intoconscious con ict

384 MICHAEL ROBBINS

quite by accident during an impasse intreatment with my patient Caroline We cameto recognise the peculiar nature of herlanguage that we named schizophrenese andto study it together While one may questionthe validity of generalisations drawn from asingle case my experience with Caroline wassuf ciently similar to my experience withothers of my schizophrenic patients as to leadme to believe her language problem reason-ably representative

Schizophrenese language andthought

Before presenting clinical illustrations Ishould like to consider two related questionsFirst is it appropriate to think of schizophre-nese as a language And second what is therelationship between schizophrenese andthought Although it is still a matter ofcontroversy (see Harrow et al 1986) thepreponderance of opinion among psychia-trists and psychologists dating back as far asStransky (1905 1905a) and including such gures as Bleuler (1911) and Nolan Lewis(1944) is that schizophrenese is not a lan-guage The dictionary includes communica-tion as an essential element of language andschizophrenese is often incomprehensibleThe schizophrenic seems to inhabit a solipsis-tic universe and to have little interest incommunicating Pavy states rsquo It is frequentlyobserved that though schizophrenics useproper words and produce reasonably well-formed sentences one is unable after havingheard a series of such sentences to compre-hend what has been saidrsquo (1968 p 175)Surprisingly not all linguists adhere to thedictionary de nition of language Some de- ne language in terms of formal structureand believe that communication is a separateentity (Akmajian et al 1984) In order tosimplify matters I will refer to schizophren-ese as a language while keeping in mind thatit is necessary to consider both its structureand the communicative intent of its users

The relationship between language andthought is also a matter of controversy Inorder to understand this it is useful toremember that linguists usually divide lan-guage into parts syntax which refers togrammar and sentence structure morphologyhow words are formed semantics the studyof meaning and pragmatics the uses towhich language is put Two categories ofhypothesis have been proposed with regard tothe relationship between language andthought unitary and disjunctive The termunitary signi es that they are two aspectsof a single entity or at least that languagebears resemblance or analogy to underlyingthought whereas the term disjunctive meansthat language and underlying thought areunrelated entities Each category in turn isdivided into two sub-hypotheses

Counter-intuitive though it may seemthere is by no means general agreement thatlanguage and thought are aspects of a unitaryprocess Supporters of the disjunctive hypoth-esis (French amp Fromm 1964 Seeman 1970Chaika 1974 1990 and Chaika amp Lambe1985) note how dif cult it can be to nd theright words to express our thoughts andargue that because particular thoughts andexperiences can be cast in many linguisticforms there is no necessary correspondencebetween the two Those who hypothesise thatlanguage and thought are disjunctive are inturn divided according to which functionmdashlanguage or thoughtmdashthey believe is intactand which is deranged in schizophrenia Theintact language hypothesis (Brown 19581973 Harrow Himmelhoch et al 1972Harrow Tucker et al 1972 Fromkin 1975LeCours amp Vanier-Clement 1976 Gerson etal 1977 Cohen 1978 and Harrow et al1986) equates meaning and function withthought and restricts language to syntaxFrom this de nition it is concluded thatschizophrenia is a disorder of thought butthat language is intact and serves successfullyto communicate the disturbance One mayobject to such a restrictive de nition oflanguage but it is based on an established

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 385

though not always apparent fact Despite itsevident bizarreness schizophrenese appearsto be more or less normal in its syntactic andmorphologic aspects (Andreasen et al 1985Matthysse 1987) Caroline read me thefollowing inscription that she had written inthe front of one of her books rsquo C C (herinitials) For a friend having a start at a pearlynew larger place To a larger print Whatrsquos acrop Slow reader from Carolina who pearlsnot Ultimately she had a problem A rsquorsquo no Jrsquorsquoproblem Last chance world knits A for afriend what L from a friend C C O T Vpromisersquo

To my amazement when I initially tran-scribed this with my computer my word-processing programme which mercilesslycritiques what I would like to believe areperfectly acceptable sentences had nothingto say Equating language with syntax andmorphology however reduces it to an intrin-sically meaningless mechanical processWerner and Kaplan remark rsquo One cannotconclude from the fact that the schizophrenicmay exploit conventional linguistic forms inhis utterances that he actually uses or regardslanguage in the same way as does the normalrsquo(1963 p 257)

The second disjunctive hypothesis thatschizophrenic language is defective but thatschizophrenics think the same way as othersis known as the schizaphasic hypothesis(Fish 1957 Chapman 1966 Chapman ampChapman 1973 Chaika 1974 1990 Chaikaamp Lambe 1985 Harrod 1986) The schizo-phrenic is believed to be trying to articulatean ordinary thought but failing because he orshe is trapped within the con nes of adefective expressive linguistic apparatusThis hypothesis is typically illustrated withbrief concrete interchanges in which theschizophrenic has dif culty conveying whaton the surface seem commonplace ideas andobservations Since aphasic persons canusually write their thoughts this hypothesisimplicitly limits the de nition of language tospoken language I will present data thatindicate both schizophrenic written and re-

ceptive language are abnormal Moreover itis dif cult to imagine how anyone who hasclose contact with schizophrenic persons andthe signi cant disturbances they manifest inevery area of life could seriously subscribeto the idea that their problems are socircumscribed

Notable proponents of a unitary hypothesisinclude Vygotsky (1934 1962) Lewis(1944) and Lanin-Kettering amp Harrow(1985) Both psychoanalytic and neuroscien-ti c hypotheses are unitary but they arediametrically opposed with regard to thequestion of meaningfulness

Introducing my co-investigator

At the time this material was gatheredCaroline was an unmarried woman almost 40years of age She lived alone and althoughshe held an entry-level job she was predomi-nantly supported by a family trust At onetime or another she satis ed all the DSMcriteria for the diagnosis of schizophrenia

Caroline was the youngest child of amother whose inherited wealth enabled her tospend much of her life either in bed watchingtelevision and reading trashy novels or play-ing tennis and drinking cocktails at the localcountry club Mother gave over the care ofthe household and her daughter to hired helpIt was my impression from several meetingswith her as well as that of the social workerwho worked with her that she was ratherinfantile and super cial and committed todenial of problems of any kind Father whoby the time I met Caroline had died in anaccident caused by his own carelessness wasapparently equally irresponsible and pro i-gate He had failed in business and judgingfrom Carolinersquos description gradually devel-oped a manic psychosis complicated byalcoholism Parents were openly hostile toone another and they eventually divorcedwhen Caroline was in her teens

It was many years before Caroline in-formed me that she had spent much of her

386 MICHAEL ROBBINS

pre-pubescent life in bed with her mother inwhat proved to be the paradigm for hersubsequent relationships particularly withmen Father slept in another room She andmother cuddled stroked one another engagedin mutual daydreaming and lived vicariouslythrough characters on the TV soaps andmovies they watched together Mother seem-ingly had no conception of process andencouraged Caroline to believe in magicaltransformation as though she was a fairy-story heroine who need not make any effortin life for a Prince Charming would comealong to take care of her so that she wouldlive happily ever after Father was also quiteseductive toward her at night when inebri-ated though there was never overt sexualactivity between them Carolinersquos behaviourwith boys became sexual in a way that wentbeyond the casual bodily exploration play ofyoung children around the time she startedschool

When Caroline reached puberty mothershowed reluctance to continue to bed downwith her Her parentsrsquo relationship deterio-rated and on one occasion father took a gunand threatened to shoot her mother In ade ning moment of her life Caroline stoodparalysed in front of a mirror for hoursholding a knife to her throat after which shemore or less gave up any efforts to beresponsible and to learn and reverted to thepattern of precociously sexual sadomasochis-tic behaviour she had originally manifested inher earliest school years Despite her increas-ing dif culties she became skilled at charm-ing others into taking care of her and makingspecial allowances for her ineptitude andwith the help of her rst of many therapistsand a school willing to offer many specialconcessions she managed to complete col-legemdashprobably the major achievement of herlife

After graduation Caroline went to a fastfood restaurant where she became catatonicrequiring the rst of numerous hospitalisa-tions Many years later she told me she hadbeen waiting for Prince Charming to come

and take care of her as mother had promisedThis incident seems to have been her realrsquo graduationrsquo into a career as disabled mentalpatient In the hospital she was catatonic andshe hallucinated She had literally to becarried to the toilet bathed and tube fed asshe would not move of her own volition Sheclamped her teeth on her tongue almostbiting it off before her jaws could be priedapart Many years later she was able toexplain to me that it was because she did notwant to speak to her parents but hers was notordinary causal logicmdashthat the absence ofher tongue would render it impossible for herto do so It was an action-rendition of theaphorism rsquo I bit my tonguersquo mdashthat not talkingis literally not having a tongue

Two courses of electro-convulsive therapywere followed by numerous medications andpsychotherapy by an analyst She spent thenext decade in the mental hospital and inhalfway houses of a major teaching institu-tion Her delusional sense of identity wasbased on the belief she was special friendlover or potential bride of the idealiseddoctors and other mental health personnelwho took care of her even as she would notor could not recognise her disabled state andassume rudimentary responsibility for herown care Eventually the staff concluded thatthey had nothing more to offer her andtransferred her to the hospital where I mether When we were introduced Carolinersquosattractive and cheerful demeanour belied thedescription of the referring analyst in histransfer note as rsquo a pathetic young womanrsquo but to my dismay I gradually came to realisethat his expression of defeat and despair wasa tting response to the identity Carolinesoon began to enact in her new surroundings

Soon after her admission Caroline brokeinto the locked medication room on the wardand consumed a large quantity of drugs Sheremained comatose and near death for severaldays Many years later she explained to methat she had been unable to tolerate the ideathat she was like the other psychotic dilapi-dated patients who inhabited the ward so she

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 387

decided to get in with the nurses and doctorsrsquo So I broke in to the med room I was goingto get in maybe like the nurses to theirpowerrsquo It reminded her of how she wasunable to get in with her parents as a childbecause they were so out of it She had feltsimilarly outcast at college The terms gettinginto and being out of had become identical tobodily action on her environment that sheendowed with the power to alter reality Aswe shall see this dynamic so apparentlyconsistent with Kleinrsquos formulationsmdashdid notbecome apparent until we both understoodthat we spoke different languages and shebecame able to couch her mental states inordinary language

Twelve years of analytic therapy the rsttwo of which were spent in the hospitalensued prior to the vignettes I shall describeAfter extensive clinical trials on numerouspsychoactive medications both alone and incombination Trilafon proved the only drugthat made a difference By the time of thevignettes the daily dose had been consider-ably tapered to 8 mg Carolinersquos seductiveineptitude made hospital staff feel needed andspecial Her days were spent describing inminute detail to any staff member who wouldlisten everything she was doing conveyingthe impression she could not make up hermind about anything and that this person wasthe special guru who alone could tell her whatto think and do In fact Caroline was usingthese contacts as opportunities to evacuatethe contents of her mind and she paid littleattention to any of the extensive advice shewas given although she made it all intoslogans that she took with her so that sheseemed at times like an encyclopaedia ofbanal bumper stickers Her seemingly naiacuteveshow of interest and idealisation effectivelyconcealed what I gradually came to realisewas hostility and arrogant disdain towards thehelper of the moment She went from oneperson to another enlisting the sympathies ofeach by implying that his or her predecessorhad somehow failed or harmed her and evenas she mouthed idealisations of me I came to

feel like one of many anonymous persons towhom she attempted to give over responsi-bility for her failed life She had dif cultydistinguishing words from concrete actionsrsquo sticks and stonesrsquo from rsquo namesrsquo In factwhen I said something she did not wish tohear she believed and told staff that I hadliterally struck her

At rst I mistook Carolinersquos repetitiousstatements that nothing good would everhappen for expressions of despair and hope-lessness But as she repeatedly destroyedevery opportunity to be constructive abouther life I began to realise that her litany wasa statement of intent and that concealedbeneath her sweet incompetent facade wasenormous ragemdasha drive to despoil whateverwas given her Staff members believed thatthe more anxious confused scattered andupset Caroline appeared the more of theircaretaking she needed The squeaking wheelgot lots of grease but paradoxically it movedslower and slower In concurrent sessionswith a social worker Carolinersquos vacuousmother seemed unaware of the seriousness ofher daughterrsquos problems and denied that therehad ever been any dif culties in their rela-tionship Indeed the fact that there had neverbeen overt con ict between the two wasprobably part of the problem When shevisited Caroline there was no discussion ofsubstantive issues and she spoke to herdaughter in platitudes such as rsquo Just get wellrsquoCaroline became increasingly frantic disor-ganised out of control and suicidal andeventually after all else had failed electro-shock treatment was once again contem-plated In retrospect I believe that the staffand I were as reluctant to face the truth aboutCarolinersquos unwillingness to assume any re-sponsibility for her mind as she was insteadwe assimilated her subtle cues and held oneanother to blame

Despite the destructive system of mutualblaming in which we were entangled Caro-line was eventually mobilised to leave thehospital and surprisingly she never returnedAlthough her inclination and capacity for

388 MICHAEL ROBBINS

independent living and for work remainedmarginal it progressively improved Alongthe way she created every kind of problemimaginable and came near to suicide seriousaccidents troubles with the law destitutionand starvation After years of treatment weuncovered her unconscious envy of homelessstreet-corner mendicants for to her theyrepresented her motherrsquos success in trickingothers to take care of her thereby absolvingher of the necessity of taking responsibilityfor herself

Our sessions typically consisted of Caro-linersquos pressured and detailed recitations anddemonstrations of all the events of her lifesince we had last met along with descriptionsof the problems she had got herself into rsquo Justone more thingrsquo was a favourite responsewhen I would attempt to get a word in of myown and when she was not able to avoid mycomments about her responsibility she wasfull of plans and pledges to do bettermdashnoneof which ever came to fruition In the courseof these recitations she regularly forgot thecentral point and changed the subject andbecause she could not grasp that there wereconsequences to her actions no learningresulted from our discussions Instead sherelentlessly held accountable those of us whoremained devoted to her referring to us withrage as rsquo criminals who got off the hookrsquo Shegradually re-directed her sexual promiscuityand made intensive efforts to seduce me intoparticipating in a mind-losing sexual orgy inwhich she could imagine our identitiesmerged so that by deluding herself she wasme and I her she would get what she imaginedI had My efforts to contain and to help her tofocus were for the most part either ignoredor greeted with rage and blaming When Iresisted her blandishments she would becomeseriously abusive and hint to others includingher family not only that I was an irrespon-sible and ineffective therapist but also thatshe was an innocent victim of my seductionsboth mental and physical

As years went by this grim picture wasgradually mitigated as Caroline took small

steps toward personal autonomy There wereminuscule increments of insight and even anoccasional sense of productively workingtogether but these were regularly undone anddestroyed Increasingly I came to feel thetreatment was stalemated Shortly prior to theevents I will describe she appeared to regressand behave like a typical chronic schizophren-ic with attened affect wooden facial ex-pression a gross tremor and such paralyticambivalence that at times she could hardlymove and sat rocking back and forth Herfamily became concerned and at their urgingI sought a psychopharmacological consulta-tion In place of Trilafon several of the neweranti-psychotic medications were tried bothalone and in combination but her conditiononly seemed to worsen Eventually Trilafontherapy was resumed her condition restabi-lised and our struggles continued I experi-enced overwhelming lethargy during oursessions I tried to believe and to tell Caro-line that she was offering me a lethal dose ofthe kinds of emotion that had overwhelmedher in the course of her futile childhoodefforts to reach her mother in the hope that Iwould not be destroyed by it as she had beenbut would offer her a model for dealing withit but my interpretations had no substantiveeffect on either of us

Although there had always been noticeablepeculiarities in her language I had notfocused attention on them hitherto other thanto tell her on occasion that I did not under-stand and to ask her to clarify One day in apoorly concealed moment of exasperationand without much thought I remarked thatshe was speaking schizophrenese a languageI did not comprehend She was taken abackand informed me that as I was the therapistand she was the schizophrenic it was my jobto understand her After unproductive discus-sions that spanned several sessions I suddenlyhad the liberating thought that whether or notshe chose to learn from me I was not trappedin a hopeless situation I could terminate withher or learn from her and I told her that Iwould choose the latter course and she would

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 389

henceforth educate me about schizophreneseIn situations where hitherto I would have felthopeless angry and bored I pulled out padand pen and took the verbatim notes thatyears later she gave her permission for me touse as data for this paper I questioned her indetail as though I were a student asking theprofessor to explain the lecture To mysurprise my self-serving action nally gotCarolinersquos attention when what I thought hadbeen my efforts to care about her had not Shewas shocked fascinated and amused

In retrospect I believe my decision to learnrather than be driven crazy or to reject herwas a model for what Caroline had beenunable to do as a child Because I nally feltthat I was getting something out of therelationship I felt less immediately investedin whether Caroline did rsquo therapyrsquo and in turnCarolinersquos curiosity was piqued She began toalert me to get out my notebook when shesensed an urge to speak schizophrenese andshe decided to keep a journal When I onceasked her in response to her having justalerted me to get pen and notebook how shewas able to determine that she was about tospeak schizophrenese she replied rsquo Itrsquos whenI put things together in strange ways that no-one else would understandrsquo adding rsquo I take agiant leaprsquo The ensuing discussion willclarify what she meant

Vignette 1

Caroline had gone to play pool after takingher car to be repaired It had been damageddue to irresponsible actions on her part aboutwhich we had talked at length

P I had time to kill Rack it up and pocketrsquo em Sock it and rock rsquo em Clear the tableThe only table that had monkey business to it

A What do you meanP E [a staff member in the hospital whom

Caroline idealised] and I used to play poolA What do you meanP Judgement Day Irsquo ve got so many balls

and I have to put them in the pocket Get theeight-ball in and yoursquo re out Irsquo ve got to shoot

straight from the hip and keep both feet onthe ground Just straight shots coming fromthe heart People have things racked upagainst you but you keep on shooting and ifyou make a racket like me it gives them moreammunition

A What do you meanP Now you really think Irsquo m crazy I racked

rsquo em up and then I bought a root beer The guysaid rsquo You canrsquo t drink that herersquo and then wetalked about getting 50 off lodging in [adistant resort] I said that late September isthe best time to go there [laughs]

A What are you laughing aboutP Well itrsquos not a short walk to get there

and I have $16 in my wallet They donrsquo t wantunethical behaviour in the bar So I thinkabout going there I build up in my mindplaces to go I start out thinking Irsquo m going toclean the apartment Then I do these otherthings Then I start thinking when I donrsquo t thatitrsquos the fault of the landlord and others Then Iran out of time and I had to go to work I waslate again

A What about the resortP Itrsquos a Closetland place [a reference to a

movie about a woman who turned to fantasyin order to endure torture] no problems thereeverything is ne

Analysis

Caroline begins by trying to tell me some-thing in rsquo purersquo schizophrenese After shemakes the observation that I will think she iscrazy she begins to try to explain her thoughtprocess by using more schizophrenese Gra-dually she shifts into ordinary language andattempts to re-cast her thoughts The ordinarylanguage moves the discourse from the con-crete level of things and actions to the realmof subjective thought and feeling symbol andmetaphor An ordinary language renditionderived from what she told me and from thebroader context of our relationship at thattime might be rsquo The Day of Judgement hascome for me Irsquo m in a rage at myself for allmy monkey businessmdashdamaging my car not

390 MICHAEL ROBBINS

being nancially responsible not cleaningmy apartment or being on time for myappointments and treating life like a game Igive others ammunition to use against meIrsquove really got myself behind the eight-balland Irsquove got to get my feet back on theground But Irsquo m in a rage at having to beresponsible I just want to kill more timeblame others wipe the table clean of all myproblems and imagine Irsquom at a resort on aperpetual vacationrsquo

This version of her thoughts requires alanguage of re ection metaphor and symbo-lism In schizophrenese by contrast insteadof a subjective self the thoughts and feelingsabout the situation she has got herself intoshe describes an animated literalmdashnotmetaphoricalmdashpool table microcosm ofwhich she is omnipotent master as shecombines words body actions and things Itis Judgement Day and she literally believesshe is ridding herself of her problems Killingtime involves rage- lled destructive action Italso re ects the absence of comparativeconcepts that would serve to make her awareof the passage of time and its implicationssuch as process work patience and perspec-tive What might appear to be low-grademetaphors or similesmdashcliches such as rsquo shootstraightrsquo rsquo shoot from the hiprsquo rsquo rack rsquo em uprsquo rsquo rock rsquo em and sock rsquo emrsquo being rsquo behind theeight-ballrsquo rsquo killing timersquo mdashare in fact actioncondensations of words body movementsand things based on assonance

Vignette 2

This is a sample of Carolinersquos writtenlanguage She brought in for discussion aletter entitled rsquo The Class Actrsquo which sheproposed to send to twenty- ve or so of herformer caretakers as accompaniment to aValentine card It begins with the salutationrsquo To a Quarter of Caring Peoplersquo

rsquoAlthough I have loving feelings for thepeople who have held me in their thoughts ofcare this card is an expression of appreciationand care not love I am on an excavation of

dignity (dig-knit-tea) The month of nancialFebruary is for my initial dig The month ofMarch my birthday always and forever hold-ing is for my knit The month of April is for apoem once learned as in college

T T TSee these threeHear their chimeThings take time for thought taxes andteaHer letter concludes with a paragraph of

plans for each of the months of May andJune In response to my request that sheexplain this to me in ordinary language shesays

P Itrsquos how overwhelmed I am about thecoming months In the 6th grade a teacher Irespected took her class on an archaeologicaldig That means rsquo dig inrsquo rsquo Dignityrsquo has threeparts dig-knit-tea You have to dig in and knitthings and then drinking tea calms you down

A But why do you say it this way and notsomething like rsquo Irsquo m overwhelmed about howIrsquo m going to manage my life in a digni edway during the coming months I need to nda way to calm down and to use my 6th gradeteacher as a model for digging in workinghard and pulling my life togetherrsquo

P The way I said it is brilliant Besides itkeeps me at a distance from people puts mein a separate space where they wonrsquo t knowwhat Irsquom talking about I donrsquo t want people toknow how much distress Irsquo m in

A So yoursquo re writing a letter of informationabout yourself with all sorts of details aboutyour life to people you supposedly careaboutmdashbut you want to conceal your realdistress from them

P The time is so overwhelming I had tocompartmentalise it into months so I couldmanage my mess Then I send it to respon-sible people and they will take care of it Irsquom lling up their mailbox adding to theirconcern So I gave it to my landlord to readand he said rsquo Take carersquo I got furious He wassupposed to take care of it Irsquo m getting amisery out of it getting to sit in some low-down place and not move out of it Some

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 391

people try to intimidate people I intimatepeople

A What do you meanP Relationships are too dif cult so I word

my way into a relationship with letters Irsquodlike to work my way into your hearts withoutworking my way in and without mentioningthings that would work my way out of yourhearts

Analysis

Caroline is gradually able to re-present thethought behind her letter in an ordinarylanguage statement but even at the conclu-sion of the discussion she is still partlyspeaking schizophrenese If she were able tospeak ordinary language she might saysomething like rsquo I would like to fool myselfand the others in my life that this is really aValentine about loving and feeling close tothem and a resolution not to be such a low-down person but to identify myself withconstructive responsible people and to workhard to dig myself out from the mess Irsquovemade But really this card expresses my wishto avoid the pain of my situation and to sendall my problems away and force them insideothers to take care ofrsquo

What sets the schizophrenese apart fromthe ordinary language version is that she isnot expressing wishes nor is she usingphrases like rsquo digging inrsquo being rsquo low downrsquo rsquo keep me in your heartrsquo rsquo I give you myheartrsquo or rsquo knitting together the strands of herlifersquo metaphorically Instead of workingwhich involves effort patience thoughtfulre ection and bearing of distress she engagesin wording an action discharge that is itsantithesis An ordinary person might work atsolving her problems while singing such songlyrics as rsquo Pack up your troubles in your oldkit bagrsquo or rsquo Pack up your troubles and sendthem all to mersquo When Caroline says rsquo I send it(rsquorsquo my messrsquorsquo ) to responsible people Irsquom lling up their mailbox I word my wayinto a relationship with lettersrsquo she literallybelieves she is digging out and packaging her

word-self into the Valentine card and puttingit in the mailbox-hearts of people who willhold and care for her emotionally distressedself in a way that she cannot or will not doThere is nothing left for her to think about tofeel or to work on Insofar as her actionssucceed in burdening others with her worriesand problems her wishful belief in a sensecomes true Fooling others so that she getsno realistic feedback is necessary in order tocontinue to fool herself The words dignityand intimate are neologismsmdashhomophoniccompounds that combine word action andthing

The interaction with her landlord illustratestwo points Nancy Andreasen et al (1985)believe that while schizophrenics are defec-tive in expressive language receptive lan-guage remains normal It is clear in thisinstance however that Caroline hears whather landlord says in schizophrenese as wellFrom a psychoanalytic perspective it is evi-dent that the underlying thought processresembles the phantasies Klein writes aboutand lends itself to an interpretation of projec-tive identi cation but in order to know this itis rst necessary to re-present the thoughtThe miscommunication that can ensue frommaking a psychoanalytic interpretation basedon the belief the patient is speaking andlistening in ordinary language is illustratedby Carolinersquos interchange with her landlordHe believes she is speaking ordinary lan-guage and he responds to her Valentine bytelling her to rsquo take carersquo She receives hisordinary language statement as though hewere speaking schizophrenese Her construc-tion of it as a rejection throws her into a ragewhich she in turn conceals because sheimagines it will evoke his anger

Vignette 3

P I walked around the lake with mymother when my affair with my collegeprofessor was going on [perhaps 15 yearspreviously] and told her about it So the lastfew days I found three lakes and walked

392 MICHAEL ROBBINS

around them Three guys were on one dockThings reminded me of the professor Birdson an island in the rst lake remind me of aman who didnrsquo t disclose that he was probablyhaving other relationshipsmdashprobably screw-ing other women all those birdsmdashbut it washard to keep my mind together walkingaround the big lake because it was so big toobig a place to keep my mind Then these guysstarted irting playing with my mind Allthree of those lakes make a penis the end themiddle the part you play with

A Why did you do thisP I did it so I could focus on a destructive

relationship I was trying to feel the feeling Ionce had with my mother after the affair Butthe lakes are such a big temptation to fall in itagain Walking around the smaller lake Icould get more in touch with the feeling ofloss and hurt some of the feeling but itwasnrsquo t satisfying The bigger lakes were over-whelming and I didnrsquo t know why I was thereany more I was trying to get into troubleThe birds on the big lake felt threatening allthe people he screwed the things I didnrsquo t seeI was foolish I start to realise it but theninstead it becomes my mother fooled me notwhat I did My mother goes to [her wintervacation home] and spends time watching thebirds I feel betrayed I went to the dock andsaw two birds in a caged area I felt caged Iwondered if those women were prostitutesand ended in jail

A What do you meanP Irsquom trying to deal with what happened

in my twenties with the professor Around thelake my mother and I walked and I told her[Her mother had blamed the professor andtold Caroline not to worry about what she haddone] The lie was talking to my mother aboutit and my motherrsquos lies My interest in thelake is a re-creation of the crime when some-thing equals nothing and nothing equalssomething The lively pond is a metaphor formy mind and my dif culty containing limitsand boundaries staying in bounds and notdestroying everything attending to a straightline of thought The kids represent how easily

Irsquo m distracted and take my mind off The lakeis a reference to my mind and the tree is myinterest in life The tree and the birds are ablaming thing People donrsquo t tell others abouttheir affairs but they communicate insidethemselves about it My mind is the pond thetree Claustrophobia is how rsquo in the darkrsquo apart of me is My thoughts versus my actionsI say one thing make my pledges then I godo another Destructive Irsquo m terri ed of thetemptation to blow everything to bits My treeis empty and alone others have things in theirbranches I canrsquo t walk a straight line I veeroff so I try another planet Itrsquos painful I knowif I canrsquo t stay on line in this little pond thenIrsquo ll never get anywhere in the bigger issues inlife I can look at trees that seem moreinteresting but I have to be able to deal withwhatrsquos here

A Now you are speaking in metaphor whydonrsquo t you always

P Metaphors take more responsibilitythey are more connecting

Analysis

Caroline begins speaking about her trip inliteral schizophrenese but by the conclusionof our discussion the physical elements of hersurroundings have become incorporated inmetaphors A more elaborate translation thatsupplements her efforts with other informa-tion in my possession but preserves her ownwords and phrases might be something likethis rsquo Irsquo ve been thinking about my affair withthe professor trying to return so to speak tothe scene of the crime and nd a differentway in my mind to handle what I couldnrsquo tdeal with then but I keep falling into thesame old patterns of thinking I fell intosexual temptation and I lost my mind I wasrsquorsquo out of my treersquorsquo Did he fool me or did I foolmyself Afterwards my mother and I took awalk I was struggling over whether to facemy feelings of hurt responsibility and guiltor stay in the dark about what I had done anddeny that I was a fool But I couldnrsquo t contain

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 393

myself I canrsquo t seem to rsquorsquo go straightrsquorsquo I fellinto it again and spilled everything out to mymother I deserved to be punished but insteadof making me feel like a jailbird or aprostitute she blamed him and she made likeit was nothing she vacated her mind andlooked for other birds to blamersquo

In this ordinary-language version thereemerges a thoughtful emotional re ectiveself replete with the symbolism and meta-phor that is missing in a language that fuseswords things and actions Caroline describesher schizophrenese much as Bion (1967)described attacks on linkingmdashas a process ofacting rather than thinking and blowing hermind to bits As she observes makingmetaphors takes too much energy When shetalks about getting in touch with feelings sheis not referring to metaphorical touching butto literal sensory-motor activities She can-not separate words from actions and things sothat she might be able to think about thedestructive relationship and the overwhelm-ing temptation Instead she walks around alake that she has rendered equivalent to (notwhich symbolises) the container of her mindher mind itself the loss of her mind thetempting three-part male genital the threeguys playing with her mind and her playingwith the penis Her mind is also literallyindistinguishable from the tree or the cageand the birds caged or in trees are concreteenactments of internalised or projected res-ponsibility and blame Of the three vignettesthis re ects the most mental maturity in so faras Caroline is trying to think and feel in anordinary way at the very same time sheexperiences the omnipotent capacity to elimi-nate what needs to be thought about Bothefforts fail

Discussion

Schizophrenics speak a meaningful lan-guage that differs from ordinary language inits essence not simply with regard to sym-bolism This language has a determina-

tive relationship to delusional thinkingBecause Freudrsquos linguistic analysis ofdreaming as a delusional and hallucinatorywish-ful lmentmdashan encapsulated nocturnalpsychosismdashis of considerable relevancesummarising some of the parallels betweendreaming and schizophrenia will be a usefulpoint of entry Schizophrenia presents itselfon a continuum in varying degrees of regres-sion or compensation In its most regressedform catatonia it resembles a waking dreamstate characterised by absence of wakefulattentiveness and sensory-perceptual domi-nance in the form of hallucinations Verbaland motor action are also absent as in thestate of sensory-perceptual identity to whichFreud made reference in his discussion of theprimary process in dreams (1900) and in hispaper on hallucinatory wish ful lment in theabsence of the object (1911) At the other endof the continuummdashthe state of maximalcompensationmdashthe balance is shifted towardspsycho-motor identity the language ofschizophrenia is one of action and actualisa-tion rather than thought and it resembles thesensorimotor stage of infancy

Discussion of language is usually dividedinto syntax morphology semantics and prag-matics As noted earlier syntax here is moreor less intact With regard to morphologyalthough some of the words used by theschizophrenic may be idiosyncratic the rulesor processes by which they are formed (suchas the use of af xes compounding onomato-poeia proper noun transformation clippingand blending) seem identical to those used inordinary language Therefore the ensuingdiscussion will focus on semantic and prag-matic considerations

Ordinary language is an aspect of re ectivethought that is uniquely situated betweenimpulse and action and enables adaptation toconsensual reality by means of exchangingthoughts and feelings with others and con-templating them oneself Language is neverentirely divorced from the sensorimotorphase in the sense that action in the form ofgestures and bodily expressions as well as

394 MICHAEL ROBBINS

somatic sensations remains an inextricablepart of it but in the course of developmentspeech and writing become relatively autono-mous The more sophisticated the subject themore exible the language becomes in mov-ing between concrete sensory somatic andfunctional considerations on the one handand more abstract re ective and comparativeoperations in which one element stands forabbreviates or enriches one or more otherson the other Individual language developsfrom simple denotationmdashthat is learningculturally determined signi ersmdashto abstractdevelopment of symbols metaphors andsimiles both those shared by a given cultureand those that re ect unique personal experi-ence The capacity for simultaneous parallelor multi-track processing enables language todisguise and conceal as well as to re ectclarify and communicate and to have at anygiven time more than one meaning It is thismulti-dimensional complexity that makespsychoanalysis possible

Because we have no choice but to useordinary language as both a means and areference point for analysing schizophreniclanguage it is natural to assume the latter tobe qualitatively continuous with ordinarylanguage and that linear translation of one tothe other is possiblemdashas in Freudrsquos well-known comparison of dream imagery toEgyptian hieroglyphics We tend to assumethat schizophrenese is a kind of encryptedcode cover or disguise that can be decodedinto its unconscious rsquo realrsquo ordinary languagemeaning Thus it would seem natural to askof a schizophrenic utterance rsquo What does itmeanrsquo mdasha question which I raise repeatedlyin the paper and which I often addressed toCaroline But schizophrenese is not a variantof ordinary language It is unique and intrin-sically different hence such a reduction is notpossible It may eventually be possible how-ever for the schizophrenic to acquire thecapacity to re-state or re-present the thoughtsthat he or she was couching in schizophrenesein ordinary language so that the two lan-guages can be compared and contrasted and

this is what Caroline gradually acquired thecapability to do

From a semantic perspective schizophre-nese is characterised by an absence of theordinary distinctions between word thingbodily process and action The word is usedas though it were identical to the thing towhich it would ordinarily refer as well as toactionsmdashpast present or prospectivemdashon orin relation to the thing and to the mediatingsomatic processes Words lack their ordinaryconnotation as representations and refer-ences they have become happenings orevents Caroline once referred to this processas rsquo combination thinkingrsquo mdasha term nearlyidentical to the concept rsquo combinative think-ingrsquo proposed by McClain Johnston andPhilip Holzman (1985) In ordinary discoursespeaker and listener recognise the symbolicimport of a concrete-sounding statement suchas rsquo I have a special pipeline to the bossrsquo orrsquo Letrsquos smoke a peace-pipersquo The metaphorserves as emphasis or highlighting of a keyidea that is being talked about In contrastCaroline once literally handed me a sectionof plumberrsquos pipemdasha gesture so pregnantwith meaning yet impregnable to my inter-pretive skills that it would have been easy toconclude that the pipe was an arcane symbolWhen I questioned her about it however shewas able to tell me that she was making aconnection with me In other words the pipewas just a pipe An ordinary speaker mightmetaphorically and passionately declare loveby saying rsquo I give you my heartrsquo or sing aboutempathic sharing in the folk lyric rsquo Pack upyour troubles in your old kit bag and smilersquo but in discussing the thought process involvedin mailing her Valentine card with a largeheart on it to a large number of casual andformer acquaintances Caroline told me shewas packaging and mailing her word-self toothers she looked upon as more willing toassume responsibility for her than she was forherself While it is tempting to use terms likecollapse implosion explosion fusion orboundary loss to describe the creation ofthese concrete linguistic identities such

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 395

terms convey the incorrect impression thatschizophrenese is a regressive degradation ofordinary language Rather schizophrenese isa language of equivalence immediacy andaction in contrast to ordinary languagewhich supports representational thinkingMoreover there is no evidence that theschizophrenic ever rsquo spokersquo differently

Schizophrenese then is an immediatelanguage of the body and its function in theworld of things particularly motor (throwinghitting) respiratory (breathing talking andblowing as in the felicitous expression rsquo mindblowingrsquo ) gastrointestinal (vomiting and de-fecating) and orgasmic (rsquo fucking onersquos brainsoutrsquo ) Caroline describes printmaking as fol-lows rsquo I was pounding it down oozing out myblack insides on paperrsquo She described one ofher long walks as follows rsquo I want to run andrun and run away from the painful feelings Ifeel like I can split off disintegrate and getaway from them This is what schizophreneseis aboutrsquo She said rsquo I give people the breath-ing they need I make a case to take care ofme I respire them With every breath I givethem responsibilityrsquo

rsquo Respirersquo is a neologism made by theordinary morphological processes of clippingand condensation of the physical process ofrespiration and the work-related concept ofresponsibility but it is a thing and not areference She said rsquo Irsquom mad today I had toput in limits and boundaries and not spill myguts There are lots of snakes inside me and Iwant you to eat them for mersquo In reference toan episode of vomiting during a meal withher family when they questioned her aboutinstances of her irresponsible behaviour shecomments rsquo I couldnrsquo t bear the feeling ofhaving taken all those courses wastingmoney scattering my time and I had to getrid of them I was throwing up the feelingrsquo

It follows from the nature of their languagethat schizophrenics lack patience self-controland restraint have dif culty conceptualisingprocess and sequence distinguishing pastfrom present and here from there and seeingthe consequences of their actions and thereby

learning from experience Carolinersquos Valen-tine mailing was an example of how sheregularly bombarded with letters persons withwhom she had no current contact often fromthe distant past She called these bizarremass-mailings rsquo Trail Newsrsquo and she believedshe was relieving herself into these others ofher otherwise troubling mental contents Shesaid rsquo If your arm was controlled by maturethought then you could wait Itrsquos the entangle-ment quality instead of being able to stop andthinkrsquo

Despite its sometimes strange and colour-ful character the language of schizophreniais neither a language of conscious awareness(re ection) nor of unconscious concealment(repression) It does not support mentalrepresentation symbolisation and re ectionFailure to appreciate this may be what led ageneration of analysts including such semi-nal gures as Frieda Fromm-Reichmann toidealise schizophrenic persons as havingspecial psychic acuity and access to theirunconscious mental life that ordinary personsdo not A neurotic patient might refer to herhabitual and inappropriate tendency to con- de personal affairs to others using theunconscious symbolism of a phrase such asrsquo spilling my gutsrsquo If questioned she wouldhave the sense that she had said somethingworth re ecting on thinking about andanalysing the symbolic meaning of WhenCaroline used the expression as noted earliershe not only believed there were snakes in herintestines that she needed to give to me(although she could reality-test the idea ifpressed to do so) but she referred to anearlier occasion when she had vomited to ridherself of unwanted feelings In an ordinaryanalysis the analyst might suggest that thepatientrsquos behaviour and associations indicatethat she viewed her problems as a mess shebelieved she could dump on to or into theanalyst and the patient might respond to theinterpretation with associations to oral or analfantasies and memories When Caroline saysrsquo I send it [rsquorsquo my messrsquorsquo ] to responsible people Irsquom lling up their mailbox I word my

396 MICHAEL ROBBINS

way into a relationship with lettersrsquo she isdoing something and not speaking metaphori-cally or thinking Whereas an ordinary personmight be aware of the underlying fantasiesand con icts Caroline literally believes thatshe is excreting her self which is identical toher words into others It might be moreaccurate to say that she is expressing phan-tasy in the Kleinian sense but if so even atthis level of discourse when she makes anattempt to interpret the original schizophren-ese account of her mass mailings in alanguage more comprehensible to me she isstill speaking in a language of closure andenactment devoid of interpretable symbo-lism and unconscious meaning

While schizophrenia is a state of self-centredness or egocentricity in the solipsisticsense of the term schizophrenese paradoxi-cally is a language without a centred subjectexcept in the most rudimentary sense ofobserver and actor of a drama The subjectiversquo Irsquo denoting the presence of conscious re ec-tion and thought about beliefs fantasiesemotions and con icts is largely missing andin its stead Caroline describes a microcosm inwhich she is participant consisting of suchthings as a pool table with its sticks and ballsher sewing box with its bobbins and yarns orthe terrain bordering the three lakes she haswalked around with its birds trees andpeople In ordinary discourse one might shareonersquos subjective thoughts and feelings aboutonersquos mother by saying rsquo Irsquo m always behindthe eight-ball with herrsquo or rsquo I was cluelesswhen it came to my mother itrsquos the oldproblem of the irresistible force and theimmovable objectrsquo Caroline by contrastdescribed to me a game of pool she hadplayed in which her mother was the cue balland she had been able to pocket the otherballs without moving the cue-ball or hittingthe eight-ball Her affect was one of triumphfor she literally believed she had solved theproblem of dealing with her mother

This example will serve to segue from thesemantic to the pragmatic aspects of schizo-phrenese which is closely related to delusion

reversal and undoing and deceptionmdashpro-cesses that enable the user to avoid thoughtand awareness of feelings Ordinary languageserves to adapt the waking user to anrsquo externalrsquo world as subjectively perceivedwithin broad consensual outlines The worldof the schizophrenic by contrast is internalthough unrecognised as such and consists ofidiosyncratic microcosms that combine whatmore maturely we look upon as psyche withwhat is sensed and perceived Subjectivelyby manipulating mental contents the schizo-phrenic experiences control over the worldThe language is felt by its user to possess thepower to undo reverse and eliminate intoler-able reality both past and present It is alanguage of psychic alchemy or delusionalomnipotence (Burnham 1955 Frosch 1967Glass 1981) Caroline told me rsquo I fool myselfinto thinking it didnrsquo t happenrsquo Speakingordinary language she referred to schizo-phrenese as rsquo the language of wish and desirersquo With her knitting a game of pool a walkaround the lake or detailed letters to othersshe creates a universe that she can describeand act upon with the conviction that she isaltering events problems and associated feel-ings both present and past Ordinary lan-guage also employs reversal but in anentirely different way and for an oppositepurpose By its stark contrast with the sharedand implicitly acknowledged context such areversal in ordinary language serves to high-light or accentuate the feeling the speakerwishes to conveymdashfor instance in the remarkrsquo Hersquos a ne one to be saying thatrsquo Thedelusional reversal of schizophrenia by con-trast eliminates the necessity to differentiatemind from reality to bear painful feelingsand to adapt to a consensually validatedworld An ordinary person faced with apainful situation might transiently nd solaceby constructing heroic fantasies and becom-ing in imagination someone able to surmountany dif culty invulnerable to pain and hurtSchizophrenic language by contrast lacksthe rsquo as if rsquo capacity inherent in the use ofmetaphor that is required to construct such a

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 397

fantasy Instead of an unconscious fantasyand a language capable of contemplation theschizophrenic experiences a delusional senseof actualisation rsquo isrsquo has replaced rsquo as if rsquo

The qualitative difference between schizo-phrenese and ordinary language helps toaccount for the fact that delusions are xedbeliefs refractory to clinical analysis In themind of their creator they are actualitiesrather than fantasies so that there is nothingto be thought about Some time after thevignettes that I have presented when Carolinehad become more uent in ordinary languageand more uid in moving back and forthbetween the two she commenced an hour byobserving my new shoes and commenting rsquo Itmakes me angry that you always have neatshoes and I donrsquo trsquo I observed aloud that herown feet were beginning to move Sheresponded rsquo Our feet move togetherrsquo andadded that she would like me to hug her Iinquired what that was about and she said rsquo Iwant to be in your shoesrsquo She was then ableto express in ordinary language her aware-ness that she was not expressing a fantasy orsymbolising a wish to be more like me butwas verging on speaking the thoughtlesslanguage of schizophrenese which in the pastwould have achieved a sense of actualisationand closure (in this case the delusion she hadexchanged identities with me) rather thanallowing the opportunity for re ectivethought about painful feelings and issuesrelated to being her own separate person

Paradoxically it is this very failure ofschizophrenic language to distinguishthoughts from events that may disguise itsbizarreness and conceal the delusional think-ing it supports because utterances may seemto patient and analyst to be nothing more thandescriptions or observations of happeningsIn telling me about the degrading affair withher college professor and her subsequentconversation about it with her mother Caro-line believed she was doing it over differentlynot simply wishing she might

No discussion of schizophrenic languagewould be complete without a comment about

neologisms which incidentally are notnearly so speci c to schizophrenia as gener-ally believed They appear to be constructedaccording to ordinary morphological princi-ples and it is primarily in their semantic andpragmatic aspects that they are remarkableOne day Caroline said rsquo Irsquove got it set up atwork so no-one can refrain from authoritingme They tell me what to do It pisses me offrsquoWhen I inquired if she believed authoritingwas a legitimate word she said she supposednot I then asked why she did not say whatshe meant in acceptable English She repliedthat it would compel her to face feelings ofshame at loss of dignity and control over herown life By not accepting the existence of anordinary language word to express her feelingstate she managed to repudiate the reality ofthe issue and to avoid the feelings about itThis is another example of the identity ofwords things and actions If the word is thereal thing and she can substitute a neologismthen she can delude herself that the thing orthe problem no longer exists It is easy for theanalyst who is struggling to understand thepatient to gloss over the idiosyncratic aspectof the word in favour of what appears to bethe underlying meaning as one might do withsome of the peculiarities of speech of some-one not uent in onersquos native tonguemdashin thisinstance to assume that Caroline rsquo reallyrsquomeans rsquo acting like an authority withrsquo In thisway the patientrsquos delusion combines with theanalystrsquos illusion to form collusion

Schizophrenic patients do not want to beunderstood for it threatens them with un-wanted knowledge about themselves Schizo-phrenese not only lacks communicativeintent it is a language of deception In orderto function as a vehicle of communicationcontextual elements and related linguisticassumptionsmdashpersonal social and culturalmdashmust be suf ciently concordant in speakerand listenermdashthe rsquo musicrsquo so to speak thataccompanies the words In the case of schizo-phrenese not only are these assumptionsidiosyncratic to the speaker or writer but alsothe speaker or writer is unwilling to elucidate

398 MICHAEL ROBBINS

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

analytic setting as an opportunity to studyschizophrenic language About four decadesago the neuroscienti c view of schizophreniaas an organic illness the mental manifesta-tions of which including speech and writingare meaningless by-products gained ascen-dancy and psychoanalytic interest in thesubject correspondingly waned

The mid-twentieth century psychoanalyticdebate about the meaningfulness of schizo-phrenic language centred on whether sym-bolic capability is missing entirely orwhether symbolism is arcane idiosyncraticand opaque Both the concrete and the arcanesymbolic theoretical positions rest on theassumption that ordinary language andschizophrenic language are qualitatively simi-lar differing only with regard to symboliccapability Harry Stack Sullivan (1962) isrepresentative of those who hold the opinionthat schizophrenic and ordinary language arequalitatively similar in all respects includingsymbolic capability but that what makesschizophrenic language seem different is itsunusual use of symbols

The more substantial body of opinionamong psychiatrists psychoanalysts andpsychologists as early as White (1925) isthat what separates the two languages is aspeci c defect in symbolic capability Ana-lysts including Katan (1939) Segal (19501956 1957) Burnham (1955) Searles(1965) and Arieti (1974) as well as psycholo-gists including Werner (1940) Goldstein(1944) and Cameron (1944 1963) believethat schizophrenics are stimulus-bound andconcrete and that they cannot abstractgeneralise or form concepts and categoriesBuilding on Freudrsquos (1900) concept of con-densation the psychologist Von Domarus(1944) coined the phrase rsquo predicate identityrsquowith reference to the concretising process in

schizophrenics Klein (1930) noted schizo-phrenic dif culty in symbol formation andsubsequently (1946) described primitive so-matopsychic projective identi cation in herelucidation of what she believed to be thepsychotic phase of the rst year of lifeSegal (1950) elaborated the dif culty insymbolising and subsequently (1957) calledschizophrenic concreteness rsquo symbolic equa-tionrsquo Segal comments on her patientrsquosrsquo failure to distinguish between that whichwas thought of and that which wasrsquo (1950p 269)

There has been little exploration of theproblems linguistic concreteness poses forpsychoanalytic treatment Reports in theliterature suggest that even analysts such asSegal who contributed so much to thehypothesis that schizophrenic language isconcrete have tended to approach patientsclinically with the rsquo unusual symbolismrsquo hy-pothesis and the related assumption thatschizophrenic and normal language are moresimilar than different so that an astuteanalyst functioning as cryptographer candecode unconscious meaning and interpret itin a manner that will be comprehensible tothe patient (Burnham 1955)

The nature of schizophrenic delusions hasalso remained relatively opaque to our under-standing although a review of this complexsubject is beyond the scope of the paper I hadan extraordinary opportunity to study schizo-phrenic language and its relationship to delu-sions during the twelfth year of a four timesweekly psychoanalytically informed1 therapyAlthough I have had intensive and extensivepsychoanalytically informed treatment ex-periences with numerous schizophrenic per-sons (Robbins 1993) language had neverbefore become the focus of investigation Inthis instance my attention was called to it

1By rsquo psychoanalytically informedrsquo I mean that my technique was informed by concepts of transferenceunconscious meaning in the primary if not the dynamic sense of the concept and lack of psychic integrationas well as goals of enhancing mental representation and of converting fragmented unconscious elements intoconscious con ict

384 MICHAEL ROBBINS

quite by accident during an impasse intreatment with my patient Caroline We cameto recognise the peculiar nature of herlanguage that we named schizophrenese andto study it together While one may questionthe validity of generalisations drawn from asingle case my experience with Caroline wassuf ciently similar to my experience withothers of my schizophrenic patients as to leadme to believe her language problem reason-ably representative

Schizophrenese language andthought

Before presenting clinical illustrations Ishould like to consider two related questionsFirst is it appropriate to think of schizophre-nese as a language And second what is therelationship between schizophrenese andthought Although it is still a matter ofcontroversy (see Harrow et al 1986) thepreponderance of opinion among psychia-trists and psychologists dating back as far asStransky (1905 1905a) and including such gures as Bleuler (1911) and Nolan Lewis(1944) is that schizophrenese is not a lan-guage The dictionary includes communica-tion as an essential element of language andschizophrenese is often incomprehensibleThe schizophrenic seems to inhabit a solipsis-tic universe and to have little interest incommunicating Pavy states rsquo It is frequentlyobserved that though schizophrenics useproper words and produce reasonably well-formed sentences one is unable after havingheard a series of such sentences to compre-hend what has been saidrsquo (1968 p 175)Surprisingly not all linguists adhere to thedictionary de nition of language Some de- ne language in terms of formal structureand believe that communication is a separateentity (Akmajian et al 1984) In order tosimplify matters I will refer to schizophren-ese as a language while keeping in mind thatit is necessary to consider both its structureand the communicative intent of its users

The relationship between language andthought is also a matter of controversy Inorder to understand this it is useful toremember that linguists usually divide lan-guage into parts syntax which refers togrammar and sentence structure morphologyhow words are formed semantics the studyof meaning and pragmatics the uses towhich language is put Two categories ofhypothesis have been proposed with regard tothe relationship between language andthought unitary and disjunctive The termunitary signi es that they are two aspectsof a single entity or at least that languagebears resemblance or analogy to underlyingthought whereas the term disjunctive meansthat language and underlying thought areunrelated entities Each category in turn isdivided into two sub-hypotheses

Counter-intuitive though it may seemthere is by no means general agreement thatlanguage and thought are aspects of a unitaryprocess Supporters of the disjunctive hypoth-esis (French amp Fromm 1964 Seeman 1970Chaika 1974 1990 and Chaika amp Lambe1985) note how dif cult it can be to nd theright words to express our thoughts andargue that because particular thoughts andexperiences can be cast in many linguisticforms there is no necessary correspondencebetween the two Those who hypothesise thatlanguage and thought are disjunctive are inturn divided according to which functionmdashlanguage or thoughtmdashthey believe is intactand which is deranged in schizophrenia Theintact language hypothesis (Brown 19581973 Harrow Himmelhoch et al 1972Harrow Tucker et al 1972 Fromkin 1975LeCours amp Vanier-Clement 1976 Gerson etal 1977 Cohen 1978 and Harrow et al1986) equates meaning and function withthought and restricts language to syntaxFrom this de nition it is concluded thatschizophrenia is a disorder of thought butthat language is intact and serves successfullyto communicate the disturbance One mayobject to such a restrictive de nition oflanguage but it is based on an established

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 385

though not always apparent fact Despite itsevident bizarreness schizophrenese appearsto be more or less normal in its syntactic andmorphologic aspects (Andreasen et al 1985Matthysse 1987) Caroline read me thefollowing inscription that she had written inthe front of one of her books rsquo C C (herinitials) For a friend having a start at a pearlynew larger place To a larger print Whatrsquos acrop Slow reader from Carolina who pearlsnot Ultimately she had a problem A rsquorsquo no Jrsquorsquoproblem Last chance world knits A for afriend what L from a friend C C O T Vpromisersquo

To my amazement when I initially tran-scribed this with my computer my word-processing programme which mercilesslycritiques what I would like to believe areperfectly acceptable sentences had nothingto say Equating language with syntax andmorphology however reduces it to an intrin-sically meaningless mechanical processWerner and Kaplan remark rsquo One cannotconclude from the fact that the schizophrenicmay exploit conventional linguistic forms inhis utterances that he actually uses or regardslanguage in the same way as does the normalrsquo(1963 p 257)

The second disjunctive hypothesis thatschizophrenic language is defective but thatschizophrenics think the same way as othersis known as the schizaphasic hypothesis(Fish 1957 Chapman 1966 Chapman ampChapman 1973 Chaika 1974 1990 Chaikaamp Lambe 1985 Harrod 1986) The schizo-phrenic is believed to be trying to articulatean ordinary thought but failing because he orshe is trapped within the con nes of adefective expressive linguistic apparatusThis hypothesis is typically illustrated withbrief concrete interchanges in which theschizophrenic has dif culty conveying whaton the surface seem commonplace ideas andobservations Since aphasic persons canusually write their thoughts this hypothesisimplicitly limits the de nition of language tospoken language I will present data thatindicate both schizophrenic written and re-

ceptive language are abnormal Moreover itis dif cult to imagine how anyone who hasclose contact with schizophrenic persons andthe signi cant disturbances they manifest inevery area of life could seriously subscribeto the idea that their problems are socircumscribed

Notable proponents of a unitary hypothesisinclude Vygotsky (1934 1962) Lewis(1944) and Lanin-Kettering amp Harrow(1985) Both psychoanalytic and neuroscien-ti c hypotheses are unitary but they arediametrically opposed with regard to thequestion of meaningfulness

Introducing my co-investigator

At the time this material was gatheredCaroline was an unmarried woman almost 40years of age She lived alone and althoughshe held an entry-level job she was predomi-nantly supported by a family trust At onetime or another she satis ed all the DSMcriteria for the diagnosis of schizophrenia

Caroline was the youngest child of amother whose inherited wealth enabled her tospend much of her life either in bed watchingtelevision and reading trashy novels or play-ing tennis and drinking cocktails at the localcountry club Mother gave over the care ofthe household and her daughter to hired helpIt was my impression from several meetingswith her as well as that of the social workerwho worked with her that she was ratherinfantile and super cial and committed todenial of problems of any kind Father whoby the time I met Caroline had died in anaccident caused by his own carelessness wasapparently equally irresponsible and pro i-gate He had failed in business and judgingfrom Carolinersquos description gradually devel-oped a manic psychosis complicated byalcoholism Parents were openly hostile toone another and they eventually divorcedwhen Caroline was in her teens

It was many years before Caroline in-formed me that she had spent much of her

386 MICHAEL ROBBINS

pre-pubescent life in bed with her mother inwhat proved to be the paradigm for hersubsequent relationships particularly withmen Father slept in another room She andmother cuddled stroked one another engagedin mutual daydreaming and lived vicariouslythrough characters on the TV soaps andmovies they watched together Mother seem-ingly had no conception of process andencouraged Caroline to believe in magicaltransformation as though she was a fairy-story heroine who need not make any effortin life for a Prince Charming would comealong to take care of her so that she wouldlive happily ever after Father was also quiteseductive toward her at night when inebri-ated though there was never overt sexualactivity between them Carolinersquos behaviourwith boys became sexual in a way that wentbeyond the casual bodily exploration play ofyoung children around the time she startedschool

When Caroline reached puberty mothershowed reluctance to continue to bed downwith her Her parentsrsquo relationship deterio-rated and on one occasion father took a gunand threatened to shoot her mother In ade ning moment of her life Caroline stoodparalysed in front of a mirror for hoursholding a knife to her throat after which shemore or less gave up any efforts to beresponsible and to learn and reverted to thepattern of precociously sexual sadomasochis-tic behaviour she had originally manifested inher earliest school years Despite her increas-ing dif culties she became skilled at charm-ing others into taking care of her and makingspecial allowances for her ineptitude andwith the help of her rst of many therapistsand a school willing to offer many specialconcessions she managed to complete col-legemdashprobably the major achievement of herlife

After graduation Caroline went to a fastfood restaurant where she became catatonicrequiring the rst of numerous hospitalisa-tions Many years later she told me she hadbeen waiting for Prince Charming to come

and take care of her as mother had promisedThis incident seems to have been her realrsquo graduationrsquo into a career as disabled mentalpatient In the hospital she was catatonic andshe hallucinated She had literally to becarried to the toilet bathed and tube fed asshe would not move of her own volition Sheclamped her teeth on her tongue almostbiting it off before her jaws could be priedapart Many years later she was able toexplain to me that it was because she did notwant to speak to her parents but hers was notordinary causal logicmdashthat the absence ofher tongue would render it impossible for herto do so It was an action-rendition of theaphorism rsquo I bit my tonguersquo mdashthat not talkingis literally not having a tongue

Two courses of electro-convulsive therapywere followed by numerous medications andpsychotherapy by an analyst She spent thenext decade in the mental hospital and inhalfway houses of a major teaching institu-tion Her delusional sense of identity wasbased on the belief she was special friendlover or potential bride of the idealiseddoctors and other mental health personnelwho took care of her even as she would notor could not recognise her disabled state andassume rudimentary responsibility for herown care Eventually the staff concluded thatthey had nothing more to offer her andtransferred her to the hospital where I mether When we were introduced Carolinersquosattractive and cheerful demeanour belied thedescription of the referring analyst in histransfer note as rsquo a pathetic young womanrsquo but to my dismay I gradually came to realisethat his expression of defeat and despair wasa tting response to the identity Carolinesoon began to enact in her new surroundings

Soon after her admission Caroline brokeinto the locked medication room on the wardand consumed a large quantity of drugs Sheremained comatose and near death for severaldays Many years later she explained to methat she had been unable to tolerate the ideathat she was like the other psychotic dilapi-dated patients who inhabited the ward so she

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 387

decided to get in with the nurses and doctorsrsquo So I broke in to the med room I was goingto get in maybe like the nurses to theirpowerrsquo It reminded her of how she wasunable to get in with her parents as a childbecause they were so out of it She had feltsimilarly outcast at college The terms gettinginto and being out of had become identical tobodily action on her environment that sheendowed with the power to alter reality Aswe shall see this dynamic so apparentlyconsistent with Kleinrsquos formulationsmdashdid notbecome apparent until we both understoodthat we spoke different languages and shebecame able to couch her mental states inordinary language

Twelve years of analytic therapy the rsttwo of which were spent in the hospitalensued prior to the vignettes I shall describeAfter extensive clinical trials on numerouspsychoactive medications both alone and incombination Trilafon proved the only drugthat made a difference By the time of thevignettes the daily dose had been consider-ably tapered to 8 mg Carolinersquos seductiveineptitude made hospital staff feel needed andspecial Her days were spent describing inminute detail to any staff member who wouldlisten everything she was doing conveyingthe impression she could not make up hermind about anything and that this person wasthe special guru who alone could tell her whatto think and do In fact Caroline was usingthese contacts as opportunities to evacuatethe contents of her mind and she paid littleattention to any of the extensive advice shewas given although she made it all intoslogans that she took with her so that sheseemed at times like an encyclopaedia ofbanal bumper stickers Her seemingly naiacuteveshow of interest and idealisation effectivelyconcealed what I gradually came to realisewas hostility and arrogant disdain towards thehelper of the moment She went from oneperson to another enlisting the sympathies ofeach by implying that his or her predecessorhad somehow failed or harmed her and evenas she mouthed idealisations of me I came to

feel like one of many anonymous persons towhom she attempted to give over responsi-bility for her failed life She had dif cultydistinguishing words from concrete actionsrsquo sticks and stonesrsquo from rsquo namesrsquo In factwhen I said something she did not wish tohear she believed and told staff that I hadliterally struck her

At rst I mistook Carolinersquos repetitiousstatements that nothing good would everhappen for expressions of despair and hope-lessness But as she repeatedly destroyedevery opportunity to be constructive abouther life I began to realise that her litany wasa statement of intent and that concealedbeneath her sweet incompetent facade wasenormous ragemdasha drive to despoil whateverwas given her Staff members believed thatthe more anxious confused scattered andupset Caroline appeared the more of theircaretaking she needed The squeaking wheelgot lots of grease but paradoxically it movedslower and slower In concurrent sessionswith a social worker Carolinersquos vacuousmother seemed unaware of the seriousness ofher daughterrsquos problems and denied that therehad ever been any dif culties in their rela-tionship Indeed the fact that there had neverbeen overt con ict between the two wasprobably part of the problem When shevisited Caroline there was no discussion ofsubstantive issues and she spoke to herdaughter in platitudes such as rsquo Just get wellrsquoCaroline became increasingly frantic disor-ganised out of control and suicidal andeventually after all else had failed electro-shock treatment was once again contem-plated In retrospect I believe that the staffand I were as reluctant to face the truth aboutCarolinersquos unwillingness to assume any re-sponsibility for her mind as she was insteadwe assimilated her subtle cues and held oneanother to blame

Despite the destructive system of mutualblaming in which we were entangled Caro-line was eventually mobilised to leave thehospital and surprisingly she never returnedAlthough her inclination and capacity for

388 MICHAEL ROBBINS

independent living and for work remainedmarginal it progressively improved Alongthe way she created every kind of problemimaginable and came near to suicide seriousaccidents troubles with the law destitutionand starvation After years of treatment weuncovered her unconscious envy of homelessstreet-corner mendicants for to her theyrepresented her motherrsquos success in trickingothers to take care of her thereby absolvingher of the necessity of taking responsibilityfor herself

Our sessions typically consisted of Caro-linersquos pressured and detailed recitations anddemonstrations of all the events of her lifesince we had last met along with descriptionsof the problems she had got herself into rsquo Justone more thingrsquo was a favourite responsewhen I would attempt to get a word in of myown and when she was not able to avoid mycomments about her responsibility she wasfull of plans and pledges to do bettermdashnoneof which ever came to fruition In the courseof these recitations she regularly forgot thecentral point and changed the subject andbecause she could not grasp that there wereconsequences to her actions no learningresulted from our discussions Instead sherelentlessly held accountable those of us whoremained devoted to her referring to us withrage as rsquo criminals who got off the hookrsquo Shegradually re-directed her sexual promiscuityand made intensive efforts to seduce me intoparticipating in a mind-losing sexual orgy inwhich she could imagine our identitiesmerged so that by deluding herself she wasme and I her she would get what she imaginedI had My efforts to contain and to help her tofocus were for the most part either ignoredor greeted with rage and blaming When Iresisted her blandishments she would becomeseriously abusive and hint to others includingher family not only that I was an irrespon-sible and ineffective therapist but also thatshe was an innocent victim of my seductionsboth mental and physical

As years went by this grim picture wasgradually mitigated as Caroline took small

steps toward personal autonomy There wereminuscule increments of insight and even anoccasional sense of productively workingtogether but these were regularly undone anddestroyed Increasingly I came to feel thetreatment was stalemated Shortly prior to theevents I will describe she appeared to regressand behave like a typical chronic schizophren-ic with attened affect wooden facial ex-pression a gross tremor and such paralyticambivalence that at times she could hardlymove and sat rocking back and forth Herfamily became concerned and at their urgingI sought a psychopharmacological consulta-tion In place of Trilafon several of the neweranti-psychotic medications were tried bothalone and in combination but her conditiononly seemed to worsen Eventually Trilafontherapy was resumed her condition restabi-lised and our struggles continued I experi-enced overwhelming lethargy during oursessions I tried to believe and to tell Caro-line that she was offering me a lethal dose ofthe kinds of emotion that had overwhelmedher in the course of her futile childhoodefforts to reach her mother in the hope that Iwould not be destroyed by it as she had beenbut would offer her a model for dealing withit but my interpretations had no substantiveeffect on either of us

Although there had always been noticeablepeculiarities in her language I had notfocused attention on them hitherto other thanto tell her on occasion that I did not under-stand and to ask her to clarify One day in apoorly concealed moment of exasperationand without much thought I remarked thatshe was speaking schizophrenese a languageI did not comprehend She was taken abackand informed me that as I was the therapistand she was the schizophrenic it was my jobto understand her After unproductive discus-sions that spanned several sessions I suddenlyhad the liberating thought that whether or notshe chose to learn from me I was not trappedin a hopeless situation I could terminate withher or learn from her and I told her that Iwould choose the latter course and she would

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 389

henceforth educate me about schizophreneseIn situations where hitherto I would have felthopeless angry and bored I pulled out padand pen and took the verbatim notes thatyears later she gave her permission for me touse as data for this paper I questioned her indetail as though I were a student asking theprofessor to explain the lecture To mysurprise my self-serving action nally gotCarolinersquos attention when what I thought hadbeen my efforts to care about her had not Shewas shocked fascinated and amused

In retrospect I believe my decision to learnrather than be driven crazy or to reject herwas a model for what Caroline had beenunable to do as a child Because I nally feltthat I was getting something out of therelationship I felt less immediately investedin whether Caroline did rsquo therapyrsquo and in turnCarolinersquos curiosity was piqued She began toalert me to get out my notebook when shesensed an urge to speak schizophrenese andshe decided to keep a journal When I onceasked her in response to her having justalerted me to get pen and notebook how shewas able to determine that she was about tospeak schizophrenese she replied rsquo Itrsquos whenI put things together in strange ways that no-one else would understandrsquo adding rsquo I take agiant leaprsquo The ensuing discussion willclarify what she meant

Vignette 1

Caroline had gone to play pool after takingher car to be repaired It had been damageddue to irresponsible actions on her part aboutwhich we had talked at length

P I had time to kill Rack it up and pocketrsquo em Sock it and rock rsquo em Clear the tableThe only table that had monkey business to it

A What do you meanP E [a staff member in the hospital whom

Caroline idealised] and I used to play poolA What do you meanP Judgement Day Irsquo ve got so many balls

and I have to put them in the pocket Get theeight-ball in and yoursquo re out Irsquo ve got to shoot

straight from the hip and keep both feet onthe ground Just straight shots coming fromthe heart People have things racked upagainst you but you keep on shooting and ifyou make a racket like me it gives them moreammunition

A What do you meanP Now you really think Irsquo m crazy I racked

rsquo em up and then I bought a root beer The guysaid rsquo You canrsquo t drink that herersquo and then wetalked about getting 50 off lodging in [adistant resort] I said that late September isthe best time to go there [laughs]

A What are you laughing aboutP Well itrsquos not a short walk to get there

and I have $16 in my wallet They donrsquo t wantunethical behaviour in the bar So I thinkabout going there I build up in my mindplaces to go I start out thinking Irsquo m going toclean the apartment Then I do these otherthings Then I start thinking when I donrsquo t thatitrsquos the fault of the landlord and others Then Iran out of time and I had to go to work I waslate again

A What about the resortP Itrsquos a Closetland place [a reference to a

movie about a woman who turned to fantasyin order to endure torture] no problems thereeverything is ne

Analysis

Caroline begins by trying to tell me some-thing in rsquo purersquo schizophrenese After shemakes the observation that I will think she iscrazy she begins to try to explain her thoughtprocess by using more schizophrenese Gra-dually she shifts into ordinary language andattempts to re-cast her thoughts The ordinarylanguage moves the discourse from the con-crete level of things and actions to the realmof subjective thought and feeling symbol andmetaphor An ordinary language renditionderived from what she told me and from thebroader context of our relationship at thattime might be rsquo The Day of Judgement hascome for me Irsquo m in a rage at myself for allmy monkey businessmdashdamaging my car not

390 MICHAEL ROBBINS

being nancially responsible not cleaningmy apartment or being on time for myappointments and treating life like a game Igive others ammunition to use against meIrsquove really got myself behind the eight-balland Irsquove got to get my feet back on theground But Irsquo m in a rage at having to beresponsible I just want to kill more timeblame others wipe the table clean of all myproblems and imagine Irsquom at a resort on aperpetual vacationrsquo

This version of her thoughts requires alanguage of re ection metaphor and symbo-lism In schizophrenese by contrast insteadof a subjective self the thoughts and feelingsabout the situation she has got herself intoshe describes an animated literalmdashnotmetaphoricalmdashpool table microcosm ofwhich she is omnipotent master as shecombines words body actions and things Itis Judgement Day and she literally believesshe is ridding herself of her problems Killingtime involves rage- lled destructive action Italso re ects the absence of comparativeconcepts that would serve to make her awareof the passage of time and its implicationssuch as process work patience and perspec-tive What might appear to be low-grademetaphors or similesmdashcliches such as rsquo shootstraightrsquo rsquo shoot from the hiprsquo rsquo rack rsquo em uprsquo rsquo rock rsquo em and sock rsquo emrsquo being rsquo behind theeight-ballrsquo rsquo killing timersquo mdashare in fact actioncondensations of words body movementsand things based on assonance

Vignette 2

This is a sample of Carolinersquos writtenlanguage She brought in for discussion aletter entitled rsquo The Class Actrsquo which sheproposed to send to twenty- ve or so of herformer caretakers as accompaniment to aValentine card It begins with the salutationrsquo To a Quarter of Caring Peoplersquo

rsquoAlthough I have loving feelings for thepeople who have held me in their thoughts ofcare this card is an expression of appreciationand care not love I am on an excavation of

dignity (dig-knit-tea) The month of nancialFebruary is for my initial dig The month ofMarch my birthday always and forever hold-ing is for my knit The month of April is for apoem once learned as in college

T T TSee these threeHear their chimeThings take time for thought taxes andteaHer letter concludes with a paragraph of

plans for each of the months of May andJune In response to my request that sheexplain this to me in ordinary language shesays

P Itrsquos how overwhelmed I am about thecoming months In the 6th grade a teacher Irespected took her class on an archaeologicaldig That means rsquo dig inrsquo rsquo Dignityrsquo has threeparts dig-knit-tea You have to dig in and knitthings and then drinking tea calms you down

A But why do you say it this way and notsomething like rsquo Irsquo m overwhelmed about howIrsquo m going to manage my life in a digni edway during the coming months I need to nda way to calm down and to use my 6th gradeteacher as a model for digging in workinghard and pulling my life togetherrsquo

P The way I said it is brilliant Besides itkeeps me at a distance from people puts mein a separate space where they wonrsquo t knowwhat Irsquom talking about I donrsquo t want people toknow how much distress Irsquo m in

A So yoursquo re writing a letter of informationabout yourself with all sorts of details aboutyour life to people you supposedly careaboutmdashbut you want to conceal your realdistress from them

P The time is so overwhelming I had tocompartmentalise it into months so I couldmanage my mess Then I send it to respon-sible people and they will take care of it Irsquom lling up their mailbox adding to theirconcern So I gave it to my landlord to readand he said rsquo Take carersquo I got furious He wassupposed to take care of it Irsquo m getting amisery out of it getting to sit in some low-down place and not move out of it Some

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 391

people try to intimidate people I intimatepeople

A What do you meanP Relationships are too dif cult so I word

my way into a relationship with letters Irsquodlike to work my way into your hearts withoutworking my way in and without mentioningthings that would work my way out of yourhearts

Analysis

Caroline is gradually able to re-present thethought behind her letter in an ordinarylanguage statement but even at the conclu-sion of the discussion she is still partlyspeaking schizophrenese If she were able tospeak ordinary language she might saysomething like rsquo I would like to fool myselfand the others in my life that this is really aValentine about loving and feeling close tothem and a resolution not to be such a low-down person but to identify myself withconstructive responsible people and to workhard to dig myself out from the mess Irsquovemade But really this card expresses my wishto avoid the pain of my situation and to sendall my problems away and force them insideothers to take care ofrsquo

What sets the schizophrenese apart fromthe ordinary language version is that she isnot expressing wishes nor is she usingphrases like rsquo digging inrsquo being rsquo low downrsquo rsquo keep me in your heartrsquo rsquo I give you myheartrsquo or rsquo knitting together the strands of herlifersquo metaphorically Instead of workingwhich involves effort patience thoughtfulre ection and bearing of distress she engagesin wording an action discharge that is itsantithesis An ordinary person might work atsolving her problems while singing such songlyrics as rsquo Pack up your troubles in your oldkit bagrsquo or rsquo Pack up your troubles and sendthem all to mersquo When Caroline says rsquo I send it(rsquorsquo my messrsquorsquo ) to responsible people Irsquom lling up their mailbox I word my wayinto a relationship with lettersrsquo she literallybelieves she is digging out and packaging her

word-self into the Valentine card and puttingit in the mailbox-hearts of people who willhold and care for her emotionally distressedself in a way that she cannot or will not doThere is nothing left for her to think about tofeel or to work on Insofar as her actionssucceed in burdening others with her worriesand problems her wishful belief in a sensecomes true Fooling others so that she getsno realistic feedback is necessary in order tocontinue to fool herself The words dignityand intimate are neologismsmdashhomophoniccompounds that combine word action andthing

The interaction with her landlord illustratestwo points Nancy Andreasen et al (1985)believe that while schizophrenics are defec-tive in expressive language receptive lan-guage remains normal It is clear in thisinstance however that Caroline hears whather landlord says in schizophrenese as wellFrom a psychoanalytic perspective it is evi-dent that the underlying thought processresembles the phantasies Klein writes aboutand lends itself to an interpretation of projec-tive identi cation but in order to know this itis rst necessary to re-present the thoughtThe miscommunication that can ensue frommaking a psychoanalytic interpretation basedon the belief the patient is speaking andlistening in ordinary language is illustratedby Carolinersquos interchange with her landlordHe believes she is speaking ordinary lan-guage and he responds to her Valentine bytelling her to rsquo take carersquo She receives hisordinary language statement as though hewere speaking schizophrenese Her construc-tion of it as a rejection throws her into a ragewhich she in turn conceals because sheimagines it will evoke his anger

Vignette 3

P I walked around the lake with mymother when my affair with my collegeprofessor was going on [perhaps 15 yearspreviously] and told her about it So the lastfew days I found three lakes and walked

392 MICHAEL ROBBINS

around them Three guys were on one dockThings reminded me of the professor Birdson an island in the rst lake remind me of aman who didnrsquo t disclose that he was probablyhaving other relationshipsmdashprobably screw-ing other women all those birdsmdashbut it washard to keep my mind together walkingaround the big lake because it was so big toobig a place to keep my mind Then these guysstarted irting playing with my mind Allthree of those lakes make a penis the end themiddle the part you play with

A Why did you do thisP I did it so I could focus on a destructive

relationship I was trying to feel the feeling Ionce had with my mother after the affair Butthe lakes are such a big temptation to fall in itagain Walking around the smaller lake Icould get more in touch with the feeling ofloss and hurt some of the feeling but itwasnrsquo t satisfying The bigger lakes were over-whelming and I didnrsquo t know why I was thereany more I was trying to get into troubleThe birds on the big lake felt threatening allthe people he screwed the things I didnrsquo t seeI was foolish I start to realise it but theninstead it becomes my mother fooled me notwhat I did My mother goes to [her wintervacation home] and spends time watching thebirds I feel betrayed I went to the dock andsaw two birds in a caged area I felt caged Iwondered if those women were prostitutesand ended in jail

A What do you meanP Irsquom trying to deal with what happened

in my twenties with the professor Around thelake my mother and I walked and I told her[Her mother had blamed the professor andtold Caroline not to worry about what she haddone] The lie was talking to my mother aboutit and my motherrsquos lies My interest in thelake is a re-creation of the crime when some-thing equals nothing and nothing equalssomething The lively pond is a metaphor formy mind and my dif culty containing limitsand boundaries staying in bounds and notdestroying everything attending to a straightline of thought The kids represent how easily

Irsquo m distracted and take my mind off The lakeis a reference to my mind and the tree is myinterest in life The tree and the birds are ablaming thing People donrsquo t tell others abouttheir affairs but they communicate insidethemselves about it My mind is the pond thetree Claustrophobia is how rsquo in the darkrsquo apart of me is My thoughts versus my actionsI say one thing make my pledges then I godo another Destructive Irsquo m terri ed of thetemptation to blow everything to bits My treeis empty and alone others have things in theirbranches I canrsquo t walk a straight line I veeroff so I try another planet Itrsquos painful I knowif I canrsquo t stay on line in this little pond thenIrsquo ll never get anywhere in the bigger issues inlife I can look at trees that seem moreinteresting but I have to be able to deal withwhatrsquos here

A Now you are speaking in metaphor whydonrsquo t you always

P Metaphors take more responsibilitythey are more connecting

Analysis

Caroline begins speaking about her trip inliteral schizophrenese but by the conclusionof our discussion the physical elements of hersurroundings have become incorporated inmetaphors A more elaborate translation thatsupplements her efforts with other informa-tion in my possession but preserves her ownwords and phrases might be something likethis rsquo Irsquo ve been thinking about my affair withthe professor trying to return so to speak tothe scene of the crime and nd a differentway in my mind to handle what I couldnrsquo tdeal with then but I keep falling into thesame old patterns of thinking I fell intosexual temptation and I lost my mind I wasrsquorsquo out of my treersquorsquo Did he fool me or did I foolmyself Afterwards my mother and I took awalk I was struggling over whether to facemy feelings of hurt responsibility and guiltor stay in the dark about what I had done anddeny that I was a fool But I couldnrsquo t contain

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 393

myself I canrsquo t seem to rsquorsquo go straightrsquorsquo I fellinto it again and spilled everything out to mymother I deserved to be punished but insteadof making me feel like a jailbird or aprostitute she blamed him and she made likeit was nothing she vacated her mind andlooked for other birds to blamersquo

In this ordinary-language version thereemerges a thoughtful emotional re ectiveself replete with the symbolism and meta-phor that is missing in a language that fuseswords things and actions Caroline describesher schizophrenese much as Bion (1967)described attacks on linkingmdashas a process ofacting rather than thinking and blowing hermind to bits As she observes makingmetaphors takes too much energy When shetalks about getting in touch with feelings sheis not referring to metaphorical touching butto literal sensory-motor activities She can-not separate words from actions and things sothat she might be able to think about thedestructive relationship and the overwhelm-ing temptation Instead she walks around alake that she has rendered equivalent to (notwhich symbolises) the container of her mindher mind itself the loss of her mind thetempting three-part male genital the threeguys playing with her mind and her playingwith the penis Her mind is also literallyindistinguishable from the tree or the cageand the birds caged or in trees are concreteenactments of internalised or projected res-ponsibility and blame Of the three vignettesthis re ects the most mental maturity in so faras Caroline is trying to think and feel in anordinary way at the very same time sheexperiences the omnipotent capacity to elimi-nate what needs to be thought about Bothefforts fail

Discussion

Schizophrenics speak a meaningful lan-guage that differs from ordinary language inits essence not simply with regard to sym-bolism This language has a determina-

tive relationship to delusional thinkingBecause Freudrsquos linguistic analysis ofdreaming as a delusional and hallucinatorywish-ful lmentmdashan encapsulated nocturnalpsychosismdashis of considerable relevancesummarising some of the parallels betweendreaming and schizophrenia will be a usefulpoint of entry Schizophrenia presents itselfon a continuum in varying degrees of regres-sion or compensation In its most regressedform catatonia it resembles a waking dreamstate characterised by absence of wakefulattentiveness and sensory-perceptual domi-nance in the form of hallucinations Verbaland motor action are also absent as in thestate of sensory-perceptual identity to whichFreud made reference in his discussion of theprimary process in dreams (1900) and in hispaper on hallucinatory wish ful lment in theabsence of the object (1911) At the other endof the continuummdashthe state of maximalcompensationmdashthe balance is shifted towardspsycho-motor identity the language ofschizophrenia is one of action and actualisa-tion rather than thought and it resembles thesensorimotor stage of infancy

Discussion of language is usually dividedinto syntax morphology semantics and prag-matics As noted earlier syntax here is moreor less intact With regard to morphologyalthough some of the words used by theschizophrenic may be idiosyncratic the rulesor processes by which they are formed (suchas the use of af xes compounding onomato-poeia proper noun transformation clippingand blending) seem identical to those used inordinary language Therefore the ensuingdiscussion will focus on semantic and prag-matic considerations

Ordinary language is an aspect of re ectivethought that is uniquely situated betweenimpulse and action and enables adaptation toconsensual reality by means of exchangingthoughts and feelings with others and con-templating them oneself Language is neverentirely divorced from the sensorimotorphase in the sense that action in the form ofgestures and bodily expressions as well as

394 MICHAEL ROBBINS

somatic sensations remains an inextricablepart of it but in the course of developmentspeech and writing become relatively autono-mous The more sophisticated the subject themore exible the language becomes in mov-ing between concrete sensory somatic andfunctional considerations on the one handand more abstract re ective and comparativeoperations in which one element stands forabbreviates or enriches one or more otherson the other Individual language developsfrom simple denotationmdashthat is learningculturally determined signi ersmdashto abstractdevelopment of symbols metaphors andsimiles both those shared by a given cultureand those that re ect unique personal experi-ence The capacity for simultaneous parallelor multi-track processing enables language todisguise and conceal as well as to re ectclarify and communicate and to have at anygiven time more than one meaning It is thismulti-dimensional complexity that makespsychoanalysis possible

Because we have no choice but to useordinary language as both a means and areference point for analysing schizophreniclanguage it is natural to assume the latter tobe qualitatively continuous with ordinarylanguage and that linear translation of one tothe other is possiblemdashas in Freudrsquos well-known comparison of dream imagery toEgyptian hieroglyphics We tend to assumethat schizophrenese is a kind of encryptedcode cover or disguise that can be decodedinto its unconscious rsquo realrsquo ordinary languagemeaning Thus it would seem natural to askof a schizophrenic utterance rsquo What does itmeanrsquo mdasha question which I raise repeatedlyin the paper and which I often addressed toCaroline But schizophrenese is not a variantof ordinary language It is unique and intrin-sically different hence such a reduction is notpossible It may eventually be possible how-ever for the schizophrenic to acquire thecapacity to re-state or re-present the thoughtsthat he or she was couching in schizophrenesein ordinary language so that the two lan-guages can be compared and contrasted and

this is what Caroline gradually acquired thecapability to do

From a semantic perspective schizophre-nese is characterised by an absence of theordinary distinctions between word thingbodily process and action The word is usedas though it were identical to the thing towhich it would ordinarily refer as well as toactionsmdashpast present or prospectivemdashon orin relation to the thing and to the mediatingsomatic processes Words lack their ordinaryconnotation as representations and refer-ences they have become happenings orevents Caroline once referred to this processas rsquo combination thinkingrsquo mdasha term nearlyidentical to the concept rsquo combinative think-ingrsquo proposed by McClain Johnston andPhilip Holzman (1985) In ordinary discoursespeaker and listener recognise the symbolicimport of a concrete-sounding statement suchas rsquo I have a special pipeline to the bossrsquo orrsquo Letrsquos smoke a peace-pipersquo The metaphorserves as emphasis or highlighting of a keyidea that is being talked about In contrastCaroline once literally handed me a sectionof plumberrsquos pipemdasha gesture so pregnantwith meaning yet impregnable to my inter-pretive skills that it would have been easy toconclude that the pipe was an arcane symbolWhen I questioned her about it however shewas able to tell me that she was making aconnection with me In other words the pipewas just a pipe An ordinary speaker mightmetaphorically and passionately declare loveby saying rsquo I give you my heartrsquo or sing aboutempathic sharing in the folk lyric rsquo Pack upyour troubles in your old kit bag and smilersquo but in discussing the thought process involvedin mailing her Valentine card with a largeheart on it to a large number of casual andformer acquaintances Caroline told me shewas packaging and mailing her word-self toothers she looked upon as more willing toassume responsibility for her than she was forherself While it is tempting to use terms likecollapse implosion explosion fusion orboundary loss to describe the creation ofthese concrete linguistic identities such

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 395

terms convey the incorrect impression thatschizophrenese is a regressive degradation ofordinary language Rather schizophrenese isa language of equivalence immediacy andaction in contrast to ordinary languagewhich supports representational thinkingMoreover there is no evidence that theschizophrenic ever rsquo spokersquo differently

Schizophrenese then is an immediatelanguage of the body and its function in theworld of things particularly motor (throwinghitting) respiratory (breathing talking andblowing as in the felicitous expression rsquo mindblowingrsquo ) gastrointestinal (vomiting and de-fecating) and orgasmic (rsquo fucking onersquos brainsoutrsquo ) Caroline describes printmaking as fol-lows rsquo I was pounding it down oozing out myblack insides on paperrsquo She described one ofher long walks as follows rsquo I want to run andrun and run away from the painful feelings Ifeel like I can split off disintegrate and getaway from them This is what schizophreneseis aboutrsquo She said rsquo I give people the breath-ing they need I make a case to take care ofme I respire them With every breath I givethem responsibilityrsquo

rsquo Respirersquo is a neologism made by theordinary morphological processes of clippingand condensation of the physical process ofrespiration and the work-related concept ofresponsibility but it is a thing and not areference She said rsquo Irsquom mad today I had toput in limits and boundaries and not spill myguts There are lots of snakes inside me and Iwant you to eat them for mersquo In reference toan episode of vomiting during a meal withher family when they questioned her aboutinstances of her irresponsible behaviour shecomments rsquo I couldnrsquo t bear the feeling ofhaving taken all those courses wastingmoney scattering my time and I had to getrid of them I was throwing up the feelingrsquo

It follows from the nature of their languagethat schizophrenics lack patience self-controland restraint have dif culty conceptualisingprocess and sequence distinguishing pastfrom present and here from there and seeingthe consequences of their actions and thereby

learning from experience Carolinersquos Valen-tine mailing was an example of how sheregularly bombarded with letters persons withwhom she had no current contact often fromthe distant past She called these bizarremass-mailings rsquo Trail Newsrsquo and she believedshe was relieving herself into these others ofher otherwise troubling mental contents Shesaid rsquo If your arm was controlled by maturethought then you could wait Itrsquos the entangle-ment quality instead of being able to stop andthinkrsquo

Despite its sometimes strange and colour-ful character the language of schizophreniais neither a language of conscious awareness(re ection) nor of unconscious concealment(repression) It does not support mentalrepresentation symbolisation and re ectionFailure to appreciate this may be what led ageneration of analysts including such semi-nal gures as Frieda Fromm-Reichmann toidealise schizophrenic persons as havingspecial psychic acuity and access to theirunconscious mental life that ordinary personsdo not A neurotic patient might refer to herhabitual and inappropriate tendency to con- de personal affairs to others using theunconscious symbolism of a phrase such asrsquo spilling my gutsrsquo If questioned she wouldhave the sense that she had said somethingworth re ecting on thinking about andanalysing the symbolic meaning of WhenCaroline used the expression as noted earliershe not only believed there were snakes in herintestines that she needed to give to me(although she could reality-test the idea ifpressed to do so) but she referred to anearlier occasion when she had vomited to ridherself of unwanted feelings In an ordinaryanalysis the analyst might suggest that thepatientrsquos behaviour and associations indicatethat she viewed her problems as a mess shebelieved she could dump on to or into theanalyst and the patient might respond to theinterpretation with associations to oral or analfantasies and memories When Caroline saysrsquo I send it [rsquorsquo my messrsquorsquo ] to responsible people Irsquom lling up their mailbox I word my

396 MICHAEL ROBBINS

way into a relationship with lettersrsquo she isdoing something and not speaking metaphori-cally or thinking Whereas an ordinary personmight be aware of the underlying fantasiesand con icts Caroline literally believes thatshe is excreting her self which is identical toher words into others It might be moreaccurate to say that she is expressing phan-tasy in the Kleinian sense but if so even atthis level of discourse when she makes anattempt to interpret the original schizophren-ese account of her mass mailings in alanguage more comprehensible to me she isstill speaking in a language of closure andenactment devoid of interpretable symbo-lism and unconscious meaning

While schizophrenia is a state of self-centredness or egocentricity in the solipsisticsense of the term schizophrenese paradoxi-cally is a language without a centred subjectexcept in the most rudimentary sense ofobserver and actor of a drama The subjectiversquo Irsquo denoting the presence of conscious re ec-tion and thought about beliefs fantasiesemotions and con icts is largely missing andin its stead Caroline describes a microcosm inwhich she is participant consisting of suchthings as a pool table with its sticks and ballsher sewing box with its bobbins and yarns orthe terrain bordering the three lakes she haswalked around with its birds trees andpeople In ordinary discourse one might shareonersquos subjective thoughts and feelings aboutonersquos mother by saying rsquo Irsquo m always behindthe eight-ball with herrsquo or rsquo I was cluelesswhen it came to my mother itrsquos the oldproblem of the irresistible force and theimmovable objectrsquo Caroline by contrastdescribed to me a game of pool she hadplayed in which her mother was the cue balland she had been able to pocket the otherballs without moving the cue-ball or hittingthe eight-ball Her affect was one of triumphfor she literally believed she had solved theproblem of dealing with her mother

This example will serve to segue from thesemantic to the pragmatic aspects of schizo-phrenese which is closely related to delusion

reversal and undoing and deceptionmdashpro-cesses that enable the user to avoid thoughtand awareness of feelings Ordinary languageserves to adapt the waking user to anrsquo externalrsquo world as subjectively perceivedwithin broad consensual outlines The worldof the schizophrenic by contrast is internalthough unrecognised as such and consists ofidiosyncratic microcosms that combine whatmore maturely we look upon as psyche withwhat is sensed and perceived Subjectivelyby manipulating mental contents the schizo-phrenic experiences control over the worldThe language is felt by its user to possess thepower to undo reverse and eliminate intoler-able reality both past and present It is alanguage of psychic alchemy or delusionalomnipotence (Burnham 1955 Frosch 1967Glass 1981) Caroline told me rsquo I fool myselfinto thinking it didnrsquo t happenrsquo Speakingordinary language she referred to schizo-phrenese as rsquo the language of wish and desirersquo With her knitting a game of pool a walkaround the lake or detailed letters to othersshe creates a universe that she can describeand act upon with the conviction that she isaltering events problems and associated feel-ings both present and past Ordinary lan-guage also employs reversal but in anentirely different way and for an oppositepurpose By its stark contrast with the sharedand implicitly acknowledged context such areversal in ordinary language serves to high-light or accentuate the feeling the speakerwishes to conveymdashfor instance in the remarkrsquo Hersquos a ne one to be saying thatrsquo Thedelusional reversal of schizophrenia by con-trast eliminates the necessity to differentiatemind from reality to bear painful feelingsand to adapt to a consensually validatedworld An ordinary person faced with apainful situation might transiently nd solaceby constructing heroic fantasies and becom-ing in imagination someone able to surmountany dif culty invulnerable to pain and hurtSchizophrenic language by contrast lacksthe rsquo as if rsquo capacity inherent in the use ofmetaphor that is required to construct such a

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 397

fantasy Instead of an unconscious fantasyand a language capable of contemplation theschizophrenic experiences a delusional senseof actualisation rsquo isrsquo has replaced rsquo as if rsquo

The qualitative difference between schizo-phrenese and ordinary language helps toaccount for the fact that delusions are xedbeliefs refractory to clinical analysis In themind of their creator they are actualitiesrather than fantasies so that there is nothingto be thought about Some time after thevignettes that I have presented when Carolinehad become more uent in ordinary languageand more uid in moving back and forthbetween the two she commenced an hour byobserving my new shoes and commenting rsquo Itmakes me angry that you always have neatshoes and I donrsquo trsquo I observed aloud that herown feet were beginning to move Sheresponded rsquo Our feet move togetherrsquo andadded that she would like me to hug her Iinquired what that was about and she said rsquo Iwant to be in your shoesrsquo She was then ableto express in ordinary language her aware-ness that she was not expressing a fantasy orsymbolising a wish to be more like me butwas verging on speaking the thoughtlesslanguage of schizophrenese which in the pastwould have achieved a sense of actualisationand closure (in this case the delusion she hadexchanged identities with me) rather thanallowing the opportunity for re ectivethought about painful feelings and issuesrelated to being her own separate person

Paradoxically it is this very failure ofschizophrenic language to distinguishthoughts from events that may disguise itsbizarreness and conceal the delusional think-ing it supports because utterances may seemto patient and analyst to be nothing more thandescriptions or observations of happeningsIn telling me about the degrading affair withher college professor and her subsequentconversation about it with her mother Caro-line believed she was doing it over differentlynot simply wishing she might

No discussion of schizophrenic languagewould be complete without a comment about

neologisms which incidentally are notnearly so speci c to schizophrenia as gener-ally believed They appear to be constructedaccording to ordinary morphological princi-ples and it is primarily in their semantic andpragmatic aspects that they are remarkableOne day Caroline said rsquo Irsquove got it set up atwork so no-one can refrain from authoritingme They tell me what to do It pisses me offrsquoWhen I inquired if she believed authoritingwas a legitimate word she said she supposednot I then asked why she did not say whatshe meant in acceptable English She repliedthat it would compel her to face feelings ofshame at loss of dignity and control over herown life By not accepting the existence of anordinary language word to express her feelingstate she managed to repudiate the reality ofthe issue and to avoid the feelings about itThis is another example of the identity ofwords things and actions If the word is thereal thing and she can substitute a neologismthen she can delude herself that the thing orthe problem no longer exists It is easy for theanalyst who is struggling to understand thepatient to gloss over the idiosyncratic aspectof the word in favour of what appears to bethe underlying meaning as one might do withsome of the peculiarities of speech of some-one not uent in onersquos native tonguemdashin thisinstance to assume that Caroline rsquo reallyrsquomeans rsquo acting like an authority withrsquo In thisway the patientrsquos delusion combines with theanalystrsquos illusion to form collusion

Schizophrenic patients do not want to beunderstood for it threatens them with un-wanted knowledge about themselves Schizo-phrenese not only lacks communicativeintent it is a language of deception In orderto function as a vehicle of communicationcontextual elements and related linguisticassumptionsmdashpersonal social and culturalmdashmust be suf ciently concordant in speakerand listenermdashthe rsquo musicrsquo so to speak thataccompanies the words In the case of schizo-phrenese not only are these assumptionsidiosyncratic to the speaker or writer but alsothe speaker or writer is unwilling to elucidate

398 MICHAEL ROBBINS

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

quite by accident during an impasse intreatment with my patient Caroline We cameto recognise the peculiar nature of herlanguage that we named schizophrenese andto study it together While one may questionthe validity of generalisations drawn from asingle case my experience with Caroline wassuf ciently similar to my experience withothers of my schizophrenic patients as to leadme to believe her language problem reason-ably representative

Schizophrenese language andthought

Before presenting clinical illustrations Ishould like to consider two related questionsFirst is it appropriate to think of schizophre-nese as a language And second what is therelationship between schizophrenese andthought Although it is still a matter ofcontroversy (see Harrow et al 1986) thepreponderance of opinion among psychia-trists and psychologists dating back as far asStransky (1905 1905a) and including such gures as Bleuler (1911) and Nolan Lewis(1944) is that schizophrenese is not a lan-guage The dictionary includes communica-tion as an essential element of language andschizophrenese is often incomprehensibleThe schizophrenic seems to inhabit a solipsis-tic universe and to have little interest incommunicating Pavy states rsquo It is frequentlyobserved that though schizophrenics useproper words and produce reasonably well-formed sentences one is unable after havingheard a series of such sentences to compre-hend what has been saidrsquo (1968 p 175)Surprisingly not all linguists adhere to thedictionary de nition of language Some de- ne language in terms of formal structureand believe that communication is a separateentity (Akmajian et al 1984) In order tosimplify matters I will refer to schizophren-ese as a language while keeping in mind thatit is necessary to consider both its structureand the communicative intent of its users

The relationship between language andthought is also a matter of controversy Inorder to understand this it is useful toremember that linguists usually divide lan-guage into parts syntax which refers togrammar and sentence structure morphologyhow words are formed semantics the studyof meaning and pragmatics the uses towhich language is put Two categories ofhypothesis have been proposed with regard tothe relationship between language andthought unitary and disjunctive The termunitary signi es that they are two aspectsof a single entity or at least that languagebears resemblance or analogy to underlyingthought whereas the term disjunctive meansthat language and underlying thought areunrelated entities Each category in turn isdivided into two sub-hypotheses

Counter-intuitive though it may seemthere is by no means general agreement thatlanguage and thought are aspects of a unitaryprocess Supporters of the disjunctive hypoth-esis (French amp Fromm 1964 Seeman 1970Chaika 1974 1990 and Chaika amp Lambe1985) note how dif cult it can be to nd theright words to express our thoughts andargue that because particular thoughts andexperiences can be cast in many linguisticforms there is no necessary correspondencebetween the two Those who hypothesise thatlanguage and thought are disjunctive are inturn divided according to which functionmdashlanguage or thoughtmdashthey believe is intactand which is deranged in schizophrenia Theintact language hypothesis (Brown 19581973 Harrow Himmelhoch et al 1972Harrow Tucker et al 1972 Fromkin 1975LeCours amp Vanier-Clement 1976 Gerson etal 1977 Cohen 1978 and Harrow et al1986) equates meaning and function withthought and restricts language to syntaxFrom this de nition it is concluded thatschizophrenia is a disorder of thought butthat language is intact and serves successfullyto communicate the disturbance One mayobject to such a restrictive de nition oflanguage but it is based on an established

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 385

though not always apparent fact Despite itsevident bizarreness schizophrenese appearsto be more or less normal in its syntactic andmorphologic aspects (Andreasen et al 1985Matthysse 1987) Caroline read me thefollowing inscription that she had written inthe front of one of her books rsquo C C (herinitials) For a friend having a start at a pearlynew larger place To a larger print Whatrsquos acrop Slow reader from Carolina who pearlsnot Ultimately she had a problem A rsquorsquo no Jrsquorsquoproblem Last chance world knits A for afriend what L from a friend C C O T Vpromisersquo

To my amazement when I initially tran-scribed this with my computer my word-processing programme which mercilesslycritiques what I would like to believe areperfectly acceptable sentences had nothingto say Equating language with syntax andmorphology however reduces it to an intrin-sically meaningless mechanical processWerner and Kaplan remark rsquo One cannotconclude from the fact that the schizophrenicmay exploit conventional linguistic forms inhis utterances that he actually uses or regardslanguage in the same way as does the normalrsquo(1963 p 257)

The second disjunctive hypothesis thatschizophrenic language is defective but thatschizophrenics think the same way as othersis known as the schizaphasic hypothesis(Fish 1957 Chapman 1966 Chapman ampChapman 1973 Chaika 1974 1990 Chaikaamp Lambe 1985 Harrod 1986) The schizo-phrenic is believed to be trying to articulatean ordinary thought but failing because he orshe is trapped within the con nes of adefective expressive linguistic apparatusThis hypothesis is typically illustrated withbrief concrete interchanges in which theschizophrenic has dif culty conveying whaton the surface seem commonplace ideas andobservations Since aphasic persons canusually write their thoughts this hypothesisimplicitly limits the de nition of language tospoken language I will present data thatindicate both schizophrenic written and re-

ceptive language are abnormal Moreover itis dif cult to imagine how anyone who hasclose contact with schizophrenic persons andthe signi cant disturbances they manifest inevery area of life could seriously subscribeto the idea that their problems are socircumscribed

Notable proponents of a unitary hypothesisinclude Vygotsky (1934 1962) Lewis(1944) and Lanin-Kettering amp Harrow(1985) Both psychoanalytic and neuroscien-ti c hypotheses are unitary but they arediametrically opposed with regard to thequestion of meaningfulness

Introducing my co-investigator

At the time this material was gatheredCaroline was an unmarried woman almost 40years of age She lived alone and althoughshe held an entry-level job she was predomi-nantly supported by a family trust At onetime or another she satis ed all the DSMcriteria for the diagnosis of schizophrenia

Caroline was the youngest child of amother whose inherited wealth enabled her tospend much of her life either in bed watchingtelevision and reading trashy novels or play-ing tennis and drinking cocktails at the localcountry club Mother gave over the care ofthe household and her daughter to hired helpIt was my impression from several meetingswith her as well as that of the social workerwho worked with her that she was ratherinfantile and super cial and committed todenial of problems of any kind Father whoby the time I met Caroline had died in anaccident caused by his own carelessness wasapparently equally irresponsible and pro i-gate He had failed in business and judgingfrom Carolinersquos description gradually devel-oped a manic psychosis complicated byalcoholism Parents were openly hostile toone another and they eventually divorcedwhen Caroline was in her teens

It was many years before Caroline in-formed me that she had spent much of her

386 MICHAEL ROBBINS

pre-pubescent life in bed with her mother inwhat proved to be the paradigm for hersubsequent relationships particularly withmen Father slept in another room She andmother cuddled stroked one another engagedin mutual daydreaming and lived vicariouslythrough characters on the TV soaps andmovies they watched together Mother seem-ingly had no conception of process andencouraged Caroline to believe in magicaltransformation as though she was a fairy-story heroine who need not make any effortin life for a Prince Charming would comealong to take care of her so that she wouldlive happily ever after Father was also quiteseductive toward her at night when inebri-ated though there was never overt sexualactivity between them Carolinersquos behaviourwith boys became sexual in a way that wentbeyond the casual bodily exploration play ofyoung children around the time she startedschool

When Caroline reached puberty mothershowed reluctance to continue to bed downwith her Her parentsrsquo relationship deterio-rated and on one occasion father took a gunand threatened to shoot her mother In ade ning moment of her life Caroline stoodparalysed in front of a mirror for hoursholding a knife to her throat after which shemore or less gave up any efforts to beresponsible and to learn and reverted to thepattern of precociously sexual sadomasochis-tic behaviour she had originally manifested inher earliest school years Despite her increas-ing dif culties she became skilled at charm-ing others into taking care of her and makingspecial allowances for her ineptitude andwith the help of her rst of many therapistsand a school willing to offer many specialconcessions she managed to complete col-legemdashprobably the major achievement of herlife

After graduation Caroline went to a fastfood restaurant where she became catatonicrequiring the rst of numerous hospitalisa-tions Many years later she told me she hadbeen waiting for Prince Charming to come

and take care of her as mother had promisedThis incident seems to have been her realrsquo graduationrsquo into a career as disabled mentalpatient In the hospital she was catatonic andshe hallucinated She had literally to becarried to the toilet bathed and tube fed asshe would not move of her own volition Sheclamped her teeth on her tongue almostbiting it off before her jaws could be priedapart Many years later she was able toexplain to me that it was because she did notwant to speak to her parents but hers was notordinary causal logicmdashthat the absence ofher tongue would render it impossible for herto do so It was an action-rendition of theaphorism rsquo I bit my tonguersquo mdashthat not talkingis literally not having a tongue

Two courses of electro-convulsive therapywere followed by numerous medications andpsychotherapy by an analyst She spent thenext decade in the mental hospital and inhalfway houses of a major teaching institu-tion Her delusional sense of identity wasbased on the belief she was special friendlover or potential bride of the idealiseddoctors and other mental health personnelwho took care of her even as she would notor could not recognise her disabled state andassume rudimentary responsibility for herown care Eventually the staff concluded thatthey had nothing more to offer her andtransferred her to the hospital where I mether When we were introduced Carolinersquosattractive and cheerful demeanour belied thedescription of the referring analyst in histransfer note as rsquo a pathetic young womanrsquo but to my dismay I gradually came to realisethat his expression of defeat and despair wasa tting response to the identity Carolinesoon began to enact in her new surroundings

Soon after her admission Caroline brokeinto the locked medication room on the wardand consumed a large quantity of drugs Sheremained comatose and near death for severaldays Many years later she explained to methat she had been unable to tolerate the ideathat she was like the other psychotic dilapi-dated patients who inhabited the ward so she

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 387

decided to get in with the nurses and doctorsrsquo So I broke in to the med room I was goingto get in maybe like the nurses to theirpowerrsquo It reminded her of how she wasunable to get in with her parents as a childbecause they were so out of it She had feltsimilarly outcast at college The terms gettinginto and being out of had become identical tobodily action on her environment that sheendowed with the power to alter reality Aswe shall see this dynamic so apparentlyconsistent with Kleinrsquos formulationsmdashdid notbecome apparent until we both understoodthat we spoke different languages and shebecame able to couch her mental states inordinary language

Twelve years of analytic therapy the rsttwo of which were spent in the hospitalensued prior to the vignettes I shall describeAfter extensive clinical trials on numerouspsychoactive medications both alone and incombination Trilafon proved the only drugthat made a difference By the time of thevignettes the daily dose had been consider-ably tapered to 8 mg Carolinersquos seductiveineptitude made hospital staff feel needed andspecial Her days were spent describing inminute detail to any staff member who wouldlisten everything she was doing conveyingthe impression she could not make up hermind about anything and that this person wasthe special guru who alone could tell her whatto think and do In fact Caroline was usingthese contacts as opportunities to evacuatethe contents of her mind and she paid littleattention to any of the extensive advice shewas given although she made it all intoslogans that she took with her so that sheseemed at times like an encyclopaedia ofbanal bumper stickers Her seemingly naiacuteveshow of interest and idealisation effectivelyconcealed what I gradually came to realisewas hostility and arrogant disdain towards thehelper of the moment She went from oneperson to another enlisting the sympathies ofeach by implying that his or her predecessorhad somehow failed or harmed her and evenas she mouthed idealisations of me I came to

feel like one of many anonymous persons towhom she attempted to give over responsi-bility for her failed life She had dif cultydistinguishing words from concrete actionsrsquo sticks and stonesrsquo from rsquo namesrsquo In factwhen I said something she did not wish tohear she believed and told staff that I hadliterally struck her

At rst I mistook Carolinersquos repetitiousstatements that nothing good would everhappen for expressions of despair and hope-lessness But as she repeatedly destroyedevery opportunity to be constructive abouther life I began to realise that her litany wasa statement of intent and that concealedbeneath her sweet incompetent facade wasenormous ragemdasha drive to despoil whateverwas given her Staff members believed thatthe more anxious confused scattered andupset Caroline appeared the more of theircaretaking she needed The squeaking wheelgot lots of grease but paradoxically it movedslower and slower In concurrent sessionswith a social worker Carolinersquos vacuousmother seemed unaware of the seriousness ofher daughterrsquos problems and denied that therehad ever been any dif culties in their rela-tionship Indeed the fact that there had neverbeen overt con ict between the two wasprobably part of the problem When shevisited Caroline there was no discussion ofsubstantive issues and she spoke to herdaughter in platitudes such as rsquo Just get wellrsquoCaroline became increasingly frantic disor-ganised out of control and suicidal andeventually after all else had failed electro-shock treatment was once again contem-plated In retrospect I believe that the staffand I were as reluctant to face the truth aboutCarolinersquos unwillingness to assume any re-sponsibility for her mind as she was insteadwe assimilated her subtle cues and held oneanother to blame

Despite the destructive system of mutualblaming in which we were entangled Caro-line was eventually mobilised to leave thehospital and surprisingly she never returnedAlthough her inclination and capacity for

388 MICHAEL ROBBINS

independent living and for work remainedmarginal it progressively improved Alongthe way she created every kind of problemimaginable and came near to suicide seriousaccidents troubles with the law destitutionand starvation After years of treatment weuncovered her unconscious envy of homelessstreet-corner mendicants for to her theyrepresented her motherrsquos success in trickingothers to take care of her thereby absolvingher of the necessity of taking responsibilityfor herself

Our sessions typically consisted of Caro-linersquos pressured and detailed recitations anddemonstrations of all the events of her lifesince we had last met along with descriptionsof the problems she had got herself into rsquo Justone more thingrsquo was a favourite responsewhen I would attempt to get a word in of myown and when she was not able to avoid mycomments about her responsibility she wasfull of plans and pledges to do bettermdashnoneof which ever came to fruition In the courseof these recitations she regularly forgot thecentral point and changed the subject andbecause she could not grasp that there wereconsequences to her actions no learningresulted from our discussions Instead sherelentlessly held accountable those of us whoremained devoted to her referring to us withrage as rsquo criminals who got off the hookrsquo Shegradually re-directed her sexual promiscuityand made intensive efforts to seduce me intoparticipating in a mind-losing sexual orgy inwhich she could imagine our identitiesmerged so that by deluding herself she wasme and I her she would get what she imaginedI had My efforts to contain and to help her tofocus were for the most part either ignoredor greeted with rage and blaming When Iresisted her blandishments she would becomeseriously abusive and hint to others includingher family not only that I was an irrespon-sible and ineffective therapist but also thatshe was an innocent victim of my seductionsboth mental and physical

As years went by this grim picture wasgradually mitigated as Caroline took small

steps toward personal autonomy There wereminuscule increments of insight and even anoccasional sense of productively workingtogether but these were regularly undone anddestroyed Increasingly I came to feel thetreatment was stalemated Shortly prior to theevents I will describe she appeared to regressand behave like a typical chronic schizophren-ic with attened affect wooden facial ex-pression a gross tremor and such paralyticambivalence that at times she could hardlymove and sat rocking back and forth Herfamily became concerned and at their urgingI sought a psychopharmacological consulta-tion In place of Trilafon several of the neweranti-psychotic medications were tried bothalone and in combination but her conditiononly seemed to worsen Eventually Trilafontherapy was resumed her condition restabi-lised and our struggles continued I experi-enced overwhelming lethargy during oursessions I tried to believe and to tell Caro-line that she was offering me a lethal dose ofthe kinds of emotion that had overwhelmedher in the course of her futile childhoodefforts to reach her mother in the hope that Iwould not be destroyed by it as she had beenbut would offer her a model for dealing withit but my interpretations had no substantiveeffect on either of us

Although there had always been noticeablepeculiarities in her language I had notfocused attention on them hitherto other thanto tell her on occasion that I did not under-stand and to ask her to clarify One day in apoorly concealed moment of exasperationand without much thought I remarked thatshe was speaking schizophrenese a languageI did not comprehend She was taken abackand informed me that as I was the therapistand she was the schizophrenic it was my jobto understand her After unproductive discus-sions that spanned several sessions I suddenlyhad the liberating thought that whether or notshe chose to learn from me I was not trappedin a hopeless situation I could terminate withher or learn from her and I told her that Iwould choose the latter course and she would

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 389

henceforth educate me about schizophreneseIn situations where hitherto I would have felthopeless angry and bored I pulled out padand pen and took the verbatim notes thatyears later she gave her permission for me touse as data for this paper I questioned her indetail as though I were a student asking theprofessor to explain the lecture To mysurprise my self-serving action nally gotCarolinersquos attention when what I thought hadbeen my efforts to care about her had not Shewas shocked fascinated and amused

In retrospect I believe my decision to learnrather than be driven crazy or to reject herwas a model for what Caroline had beenunable to do as a child Because I nally feltthat I was getting something out of therelationship I felt less immediately investedin whether Caroline did rsquo therapyrsquo and in turnCarolinersquos curiosity was piqued She began toalert me to get out my notebook when shesensed an urge to speak schizophrenese andshe decided to keep a journal When I onceasked her in response to her having justalerted me to get pen and notebook how shewas able to determine that she was about tospeak schizophrenese she replied rsquo Itrsquos whenI put things together in strange ways that no-one else would understandrsquo adding rsquo I take agiant leaprsquo The ensuing discussion willclarify what she meant

Vignette 1

Caroline had gone to play pool after takingher car to be repaired It had been damageddue to irresponsible actions on her part aboutwhich we had talked at length

P I had time to kill Rack it up and pocketrsquo em Sock it and rock rsquo em Clear the tableThe only table that had monkey business to it

A What do you meanP E [a staff member in the hospital whom

Caroline idealised] and I used to play poolA What do you meanP Judgement Day Irsquo ve got so many balls

and I have to put them in the pocket Get theeight-ball in and yoursquo re out Irsquo ve got to shoot

straight from the hip and keep both feet onthe ground Just straight shots coming fromthe heart People have things racked upagainst you but you keep on shooting and ifyou make a racket like me it gives them moreammunition

A What do you meanP Now you really think Irsquo m crazy I racked

rsquo em up and then I bought a root beer The guysaid rsquo You canrsquo t drink that herersquo and then wetalked about getting 50 off lodging in [adistant resort] I said that late September isthe best time to go there [laughs]

A What are you laughing aboutP Well itrsquos not a short walk to get there

and I have $16 in my wallet They donrsquo t wantunethical behaviour in the bar So I thinkabout going there I build up in my mindplaces to go I start out thinking Irsquo m going toclean the apartment Then I do these otherthings Then I start thinking when I donrsquo t thatitrsquos the fault of the landlord and others Then Iran out of time and I had to go to work I waslate again

A What about the resortP Itrsquos a Closetland place [a reference to a

movie about a woman who turned to fantasyin order to endure torture] no problems thereeverything is ne

Analysis

Caroline begins by trying to tell me some-thing in rsquo purersquo schizophrenese After shemakes the observation that I will think she iscrazy she begins to try to explain her thoughtprocess by using more schizophrenese Gra-dually she shifts into ordinary language andattempts to re-cast her thoughts The ordinarylanguage moves the discourse from the con-crete level of things and actions to the realmof subjective thought and feeling symbol andmetaphor An ordinary language renditionderived from what she told me and from thebroader context of our relationship at thattime might be rsquo The Day of Judgement hascome for me Irsquo m in a rage at myself for allmy monkey businessmdashdamaging my car not

390 MICHAEL ROBBINS

being nancially responsible not cleaningmy apartment or being on time for myappointments and treating life like a game Igive others ammunition to use against meIrsquove really got myself behind the eight-balland Irsquove got to get my feet back on theground But Irsquo m in a rage at having to beresponsible I just want to kill more timeblame others wipe the table clean of all myproblems and imagine Irsquom at a resort on aperpetual vacationrsquo

This version of her thoughts requires alanguage of re ection metaphor and symbo-lism In schizophrenese by contrast insteadof a subjective self the thoughts and feelingsabout the situation she has got herself intoshe describes an animated literalmdashnotmetaphoricalmdashpool table microcosm ofwhich she is omnipotent master as shecombines words body actions and things Itis Judgement Day and she literally believesshe is ridding herself of her problems Killingtime involves rage- lled destructive action Italso re ects the absence of comparativeconcepts that would serve to make her awareof the passage of time and its implicationssuch as process work patience and perspec-tive What might appear to be low-grademetaphors or similesmdashcliches such as rsquo shootstraightrsquo rsquo shoot from the hiprsquo rsquo rack rsquo em uprsquo rsquo rock rsquo em and sock rsquo emrsquo being rsquo behind theeight-ballrsquo rsquo killing timersquo mdashare in fact actioncondensations of words body movementsand things based on assonance

Vignette 2

This is a sample of Carolinersquos writtenlanguage She brought in for discussion aletter entitled rsquo The Class Actrsquo which sheproposed to send to twenty- ve or so of herformer caretakers as accompaniment to aValentine card It begins with the salutationrsquo To a Quarter of Caring Peoplersquo

rsquoAlthough I have loving feelings for thepeople who have held me in their thoughts ofcare this card is an expression of appreciationand care not love I am on an excavation of

dignity (dig-knit-tea) The month of nancialFebruary is for my initial dig The month ofMarch my birthday always and forever hold-ing is for my knit The month of April is for apoem once learned as in college

T T TSee these threeHear their chimeThings take time for thought taxes andteaHer letter concludes with a paragraph of

plans for each of the months of May andJune In response to my request that sheexplain this to me in ordinary language shesays

P Itrsquos how overwhelmed I am about thecoming months In the 6th grade a teacher Irespected took her class on an archaeologicaldig That means rsquo dig inrsquo rsquo Dignityrsquo has threeparts dig-knit-tea You have to dig in and knitthings and then drinking tea calms you down

A But why do you say it this way and notsomething like rsquo Irsquo m overwhelmed about howIrsquo m going to manage my life in a digni edway during the coming months I need to nda way to calm down and to use my 6th gradeteacher as a model for digging in workinghard and pulling my life togetherrsquo

P The way I said it is brilliant Besides itkeeps me at a distance from people puts mein a separate space where they wonrsquo t knowwhat Irsquom talking about I donrsquo t want people toknow how much distress Irsquo m in

A So yoursquo re writing a letter of informationabout yourself with all sorts of details aboutyour life to people you supposedly careaboutmdashbut you want to conceal your realdistress from them

P The time is so overwhelming I had tocompartmentalise it into months so I couldmanage my mess Then I send it to respon-sible people and they will take care of it Irsquom lling up their mailbox adding to theirconcern So I gave it to my landlord to readand he said rsquo Take carersquo I got furious He wassupposed to take care of it Irsquo m getting amisery out of it getting to sit in some low-down place and not move out of it Some

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 391

people try to intimidate people I intimatepeople

A What do you meanP Relationships are too dif cult so I word

my way into a relationship with letters Irsquodlike to work my way into your hearts withoutworking my way in and without mentioningthings that would work my way out of yourhearts

Analysis

Caroline is gradually able to re-present thethought behind her letter in an ordinarylanguage statement but even at the conclu-sion of the discussion she is still partlyspeaking schizophrenese If she were able tospeak ordinary language she might saysomething like rsquo I would like to fool myselfand the others in my life that this is really aValentine about loving and feeling close tothem and a resolution not to be such a low-down person but to identify myself withconstructive responsible people and to workhard to dig myself out from the mess Irsquovemade But really this card expresses my wishto avoid the pain of my situation and to sendall my problems away and force them insideothers to take care ofrsquo

What sets the schizophrenese apart fromthe ordinary language version is that she isnot expressing wishes nor is she usingphrases like rsquo digging inrsquo being rsquo low downrsquo rsquo keep me in your heartrsquo rsquo I give you myheartrsquo or rsquo knitting together the strands of herlifersquo metaphorically Instead of workingwhich involves effort patience thoughtfulre ection and bearing of distress she engagesin wording an action discharge that is itsantithesis An ordinary person might work atsolving her problems while singing such songlyrics as rsquo Pack up your troubles in your oldkit bagrsquo or rsquo Pack up your troubles and sendthem all to mersquo When Caroline says rsquo I send it(rsquorsquo my messrsquorsquo ) to responsible people Irsquom lling up their mailbox I word my wayinto a relationship with lettersrsquo she literallybelieves she is digging out and packaging her

word-self into the Valentine card and puttingit in the mailbox-hearts of people who willhold and care for her emotionally distressedself in a way that she cannot or will not doThere is nothing left for her to think about tofeel or to work on Insofar as her actionssucceed in burdening others with her worriesand problems her wishful belief in a sensecomes true Fooling others so that she getsno realistic feedback is necessary in order tocontinue to fool herself The words dignityand intimate are neologismsmdashhomophoniccompounds that combine word action andthing

The interaction with her landlord illustratestwo points Nancy Andreasen et al (1985)believe that while schizophrenics are defec-tive in expressive language receptive lan-guage remains normal It is clear in thisinstance however that Caroline hears whather landlord says in schizophrenese as wellFrom a psychoanalytic perspective it is evi-dent that the underlying thought processresembles the phantasies Klein writes aboutand lends itself to an interpretation of projec-tive identi cation but in order to know this itis rst necessary to re-present the thoughtThe miscommunication that can ensue frommaking a psychoanalytic interpretation basedon the belief the patient is speaking andlistening in ordinary language is illustratedby Carolinersquos interchange with her landlordHe believes she is speaking ordinary lan-guage and he responds to her Valentine bytelling her to rsquo take carersquo She receives hisordinary language statement as though hewere speaking schizophrenese Her construc-tion of it as a rejection throws her into a ragewhich she in turn conceals because sheimagines it will evoke his anger

Vignette 3

P I walked around the lake with mymother when my affair with my collegeprofessor was going on [perhaps 15 yearspreviously] and told her about it So the lastfew days I found three lakes and walked

392 MICHAEL ROBBINS

around them Three guys were on one dockThings reminded me of the professor Birdson an island in the rst lake remind me of aman who didnrsquo t disclose that he was probablyhaving other relationshipsmdashprobably screw-ing other women all those birdsmdashbut it washard to keep my mind together walkingaround the big lake because it was so big toobig a place to keep my mind Then these guysstarted irting playing with my mind Allthree of those lakes make a penis the end themiddle the part you play with

A Why did you do thisP I did it so I could focus on a destructive

relationship I was trying to feel the feeling Ionce had with my mother after the affair Butthe lakes are such a big temptation to fall in itagain Walking around the smaller lake Icould get more in touch with the feeling ofloss and hurt some of the feeling but itwasnrsquo t satisfying The bigger lakes were over-whelming and I didnrsquo t know why I was thereany more I was trying to get into troubleThe birds on the big lake felt threatening allthe people he screwed the things I didnrsquo t seeI was foolish I start to realise it but theninstead it becomes my mother fooled me notwhat I did My mother goes to [her wintervacation home] and spends time watching thebirds I feel betrayed I went to the dock andsaw two birds in a caged area I felt caged Iwondered if those women were prostitutesand ended in jail

A What do you meanP Irsquom trying to deal with what happened

in my twenties with the professor Around thelake my mother and I walked and I told her[Her mother had blamed the professor andtold Caroline not to worry about what she haddone] The lie was talking to my mother aboutit and my motherrsquos lies My interest in thelake is a re-creation of the crime when some-thing equals nothing and nothing equalssomething The lively pond is a metaphor formy mind and my dif culty containing limitsand boundaries staying in bounds and notdestroying everything attending to a straightline of thought The kids represent how easily

Irsquo m distracted and take my mind off The lakeis a reference to my mind and the tree is myinterest in life The tree and the birds are ablaming thing People donrsquo t tell others abouttheir affairs but they communicate insidethemselves about it My mind is the pond thetree Claustrophobia is how rsquo in the darkrsquo apart of me is My thoughts versus my actionsI say one thing make my pledges then I godo another Destructive Irsquo m terri ed of thetemptation to blow everything to bits My treeis empty and alone others have things in theirbranches I canrsquo t walk a straight line I veeroff so I try another planet Itrsquos painful I knowif I canrsquo t stay on line in this little pond thenIrsquo ll never get anywhere in the bigger issues inlife I can look at trees that seem moreinteresting but I have to be able to deal withwhatrsquos here

A Now you are speaking in metaphor whydonrsquo t you always

P Metaphors take more responsibilitythey are more connecting

Analysis

Caroline begins speaking about her trip inliteral schizophrenese but by the conclusionof our discussion the physical elements of hersurroundings have become incorporated inmetaphors A more elaborate translation thatsupplements her efforts with other informa-tion in my possession but preserves her ownwords and phrases might be something likethis rsquo Irsquo ve been thinking about my affair withthe professor trying to return so to speak tothe scene of the crime and nd a differentway in my mind to handle what I couldnrsquo tdeal with then but I keep falling into thesame old patterns of thinking I fell intosexual temptation and I lost my mind I wasrsquorsquo out of my treersquorsquo Did he fool me or did I foolmyself Afterwards my mother and I took awalk I was struggling over whether to facemy feelings of hurt responsibility and guiltor stay in the dark about what I had done anddeny that I was a fool But I couldnrsquo t contain

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 393

myself I canrsquo t seem to rsquorsquo go straightrsquorsquo I fellinto it again and spilled everything out to mymother I deserved to be punished but insteadof making me feel like a jailbird or aprostitute she blamed him and she made likeit was nothing she vacated her mind andlooked for other birds to blamersquo

In this ordinary-language version thereemerges a thoughtful emotional re ectiveself replete with the symbolism and meta-phor that is missing in a language that fuseswords things and actions Caroline describesher schizophrenese much as Bion (1967)described attacks on linkingmdashas a process ofacting rather than thinking and blowing hermind to bits As she observes makingmetaphors takes too much energy When shetalks about getting in touch with feelings sheis not referring to metaphorical touching butto literal sensory-motor activities She can-not separate words from actions and things sothat she might be able to think about thedestructive relationship and the overwhelm-ing temptation Instead she walks around alake that she has rendered equivalent to (notwhich symbolises) the container of her mindher mind itself the loss of her mind thetempting three-part male genital the threeguys playing with her mind and her playingwith the penis Her mind is also literallyindistinguishable from the tree or the cageand the birds caged or in trees are concreteenactments of internalised or projected res-ponsibility and blame Of the three vignettesthis re ects the most mental maturity in so faras Caroline is trying to think and feel in anordinary way at the very same time sheexperiences the omnipotent capacity to elimi-nate what needs to be thought about Bothefforts fail

Discussion

Schizophrenics speak a meaningful lan-guage that differs from ordinary language inits essence not simply with regard to sym-bolism This language has a determina-

tive relationship to delusional thinkingBecause Freudrsquos linguistic analysis ofdreaming as a delusional and hallucinatorywish-ful lmentmdashan encapsulated nocturnalpsychosismdashis of considerable relevancesummarising some of the parallels betweendreaming and schizophrenia will be a usefulpoint of entry Schizophrenia presents itselfon a continuum in varying degrees of regres-sion or compensation In its most regressedform catatonia it resembles a waking dreamstate characterised by absence of wakefulattentiveness and sensory-perceptual domi-nance in the form of hallucinations Verbaland motor action are also absent as in thestate of sensory-perceptual identity to whichFreud made reference in his discussion of theprimary process in dreams (1900) and in hispaper on hallucinatory wish ful lment in theabsence of the object (1911) At the other endof the continuummdashthe state of maximalcompensationmdashthe balance is shifted towardspsycho-motor identity the language ofschizophrenia is one of action and actualisa-tion rather than thought and it resembles thesensorimotor stage of infancy

Discussion of language is usually dividedinto syntax morphology semantics and prag-matics As noted earlier syntax here is moreor less intact With regard to morphologyalthough some of the words used by theschizophrenic may be idiosyncratic the rulesor processes by which they are formed (suchas the use of af xes compounding onomato-poeia proper noun transformation clippingand blending) seem identical to those used inordinary language Therefore the ensuingdiscussion will focus on semantic and prag-matic considerations

Ordinary language is an aspect of re ectivethought that is uniquely situated betweenimpulse and action and enables adaptation toconsensual reality by means of exchangingthoughts and feelings with others and con-templating them oneself Language is neverentirely divorced from the sensorimotorphase in the sense that action in the form ofgestures and bodily expressions as well as

394 MICHAEL ROBBINS

somatic sensations remains an inextricablepart of it but in the course of developmentspeech and writing become relatively autono-mous The more sophisticated the subject themore exible the language becomes in mov-ing between concrete sensory somatic andfunctional considerations on the one handand more abstract re ective and comparativeoperations in which one element stands forabbreviates or enriches one or more otherson the other Individual language developsfrom simple denotationmdashthat is learningculturally determined signi ersmdashto abstractdevelopment of symbols metaphors andsimiles both those shared by a given cultureand those that re ect unique personal experi-ence The capacity for simultaneous parallelor multi-track processing enables language todisguise and conceal as well as to re ectclarify and communicate and to have at anygiven time more than one meaning It is thismulti-dimensional complexity that makespsychoanalysis possible

Because we have no choice but to useordinary language as both a means and areference point for analysing schizophreniclanguage it is natural to assume the latter tobe qualitatively continuous with ordinarylanguage and that linear translation of one tothe other is possiblemdashas in Freudrsquos well-known comparison of dream imagery toEgyptian hieroglyphics We tend to assumethat schizophrenese is a kind of encryptedcode cover or disguise that can be decodedinto its unconscious rsquo realrsquo ordinary languagemeaning Thus it would seem natural to askof a schizophrenic utterance rsquo What does itmeanrsquo mdasha question which I raise repeatedlyin the paper and which I often addressed toCaroline But schizophrenese is not a variantof ordinary language It is unique and intrin-sically different hence such a reduction is notpossible It may eventually be possible how-ever for the schizophrenic to acquire thecapacity to re-state or re-present the thoughtsthat he or she was couching in schizophrenesein ordinary language so that the two lan-guages can be compared and contrasted and

this is what Caroline gradually acquired thecapability to do

From a semantic perspective schizophre-nese is characterised by an absence of theordinary distinctions between word thingbodily process and action The word is usedas though it were identical to the thing towhich it would ordinarily refer as well as toactionsmdashpast present or prospectivemdashon orin relation to the thing and to the mediatingsomatic processes Words lack their ordinaryconnotation as representations and refer-ences they have become happenings orevents Caroline once referred to this processas rsquo combination thinkingrsquo mdasha term nearlyidentical to the concept rsquo combinative think-ingrsquo proposed by McClain Johnston andPhilip Holzman (1985) In ordinary discoursespeaker and listener recognise the symbolicimport of a concrete-sounding statement suchas rsquo I have a special pipeline to the bossrsquo orrsquo Letrsquos smoke a peace-pipersquo The metaphorserves as emphasis or highlighting of a keyidea that is being talked about In contrastCaroline once literally handed me a sectionof plumberrsquos pipemdasha gesture so pregnantwith meaning yet impregnable to my inter-pretive skills that it would have been easy toconclude that the pipe was an arcane symbolWhen I questioned her about it however shewas able to tell me that she was making aconnection with me In other words the pipewas just a pipe An ordinary speaker mightmetaphorically and passionately declare loveby saying rsquo I give you my heartrsquo or sing aboutempathic sharing in the folk lyric rsquo Pack upyour troubles in your old kit bag and smilersquo but in discussing the thought process involvedin mailing her Valentine card with a largeheart on it to a large number of casual andformer acquaintances Caroline told me shewas packaging and mailing her word-self toothers she looked upon as more willing toassume responsibility for her than she was forherself While it is tempting to use terms likecollapse implosion explosion fusion orboundary loss to describe the creation ofthese concrete linguistic identities such

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 395

terms convey the incorrect impression thatschizophrenese is a regressive degradation ofordinary language Rather schizophrenese isa language of equivalence immediacy andaction in contrast to ordinary languagewhich supports representational thinkingMoreover there is no evidence that theschizophrenic ever rsquo spokersquo differently

Schizophrenese then is an immediatelanguage of the body and its function in theworld of things particularly motor (throwinghitting) respiratory (breathing talking andblowing as in the felicitous expression rsquo mindblowingrsquo ) gastrointestinal (vomiting and de-fecating) and orgasmic (rsquo fucking onersquos brainsoutrsquo ) Caroline describes printmaking as fol-lows rsquo I was pounding it down oozing out myblack insides on paperrsquo She described one ofher long walks as follows rsquo I want to run andrun and run away from the painful feelings Ifeel like I can split off disintegrate and getaway from them This is what schizophreneseis aboutrsquo She said rsquo I give people the breath-ing they need I make a case to take care ofme I respire them With every breath I givethem responsibilityrsquo

rsquo Respirersquo is a neologism made by theordinary morphological processes of clippingand condensation of the physical process ofrespiration and the work-related concept ofresponsibility but it is a thing and not areference She said rsquo Irsquom mad today I had toput in limits and boundaries and not spill myguts There are lots of snakes inside me and Iwant you to eat them for mersquo In reference toan episode of vomiting during a meal withher family when they questioned her aboutinstances of her irresponsible behaviour shecomments rsquo I couldnrsquo t bear the feeling ofhaving taken all those courses wastingmoney scattering my time and I had to getrid of them I was throwing up the feelingrsquo

It follows from the nature of their languagethat schizophrenics lack patience self-controland restraint have dif culty conceptualisingprocess and sequence distinguishing pastfrom present and here from there and seeingthe consequences of their actions and thereby

learning from experience Carolinersquos Valen-tine mailing was an example of how sheregularly bombarded with letters persons withwhom she had no current contact often fromthe distant past She called these bizarremass-mailings rsquo Trail Newsrsquo and she believedshe was relieving herself into these others ofher otherwise troubling mental contents Shesaid rsquo If your arm was controlled by maturethought then you could wait Itrsquos the entangle-ment quality instead of being able to stop andthinkrsquo

Despite its sometimes strange and colour-ful character the language of schizophreniais neither a language of conscious awareness(re ection) nor of unconscious concealment(repression) It does not support mentalrepresentation symbolisation and re ectionFailure to appreciate this may be what led ageneration of analysts including such semi-nal gures as Frieda Fromm-Reichmann toidealise schizophrenic persons as havingspecial psychic acuity and access to theirunconscious mental life that ordinary personsdo not A neurotic patient might refer to herhabitual and inappropriate tendency to con- de personal affairs to others using theunconscious symbolism of a phrase such asrsquo spilling my gutsrsquo If questioned she wouldhave the sense that she had said somethingworth re ecting on thinking about andanalysing the symbolic meaning of WhenCaroline used the expression as noted earliershe not only believed there were snakes in herintestines that she needed to give to me(although she could reality-test the idea ifpressed to do so) but she referred to anearlier occasion when she had vomited to ridherself of unwanted feelings In an ordinaryanalysis the analyst might suggest that thepatientrsquos behaviour and associations indicatethat she viewed her problems as a mess shebelieved she could dump on to or into theanalyst and the patient might respond to theinterpretation with associations to oral or analfantasies and memories When Caroline saysrsquo I send it [rsquorsquo my messrsquorsquo ] to responsible people Irsquom lling up their mailbox I word my

396 MICHAEL ROBBINS

way into a relationship with lettersrsquo she isdoing something and not speaking metaphori-cally or thinking Whereas an ordinary personmight be aware of the underlying fantasiesand con icts Caroline literally believes thatshe is excreting her self which is identical toher words into others It might be moreaccurate to say that she is expressing phan-tasy in the Kleinian sense but if so even atthis level of discourse when she makes anattempt to interpret the original schizophren-ese account of her mass mailings in alanguage more comprehensible to me she isstill speaking in a language of closure andenactment devoid of interpretable symbo-lism and unconscious meaning

While schizophrenia is a state of self-centredness or egocentricity in the solipsisticsense of the term schizophrenese paradoxi-cally is a language without a centred subjectexcept in the most rudimentary sense ofobserver and actor of a drama The subjectiversquo Irsquo denoting the presence of conscious re ec-tion and thought about beliefs fantasiesemotions and con icts is largely missing andin its stead Caroline describes a microcosm inwhich she is participant consisting of suchthings as a pool table with its sticks and ballsher sewing box with its bobbins and yarns orthe terrain bordering the three lakes she haswalked around with its birds trees andpeople In ordinary discourse one might shareonersquos subjective thoughts and feelings aboutonersquos mother by saying rsquo Irsquo m always behindthe eight-ball with herrsquo or rsquo I was cluelesswhen it came to my mother itrsquos the oldproblem of the irresistible force and theimmovable objectrsquo Caroline by contrastdescribed to me a game of pool she hadplayed in which her mother was the cue balland she had been able to pocket the otherballs without moving the cue-ball or hittingthe eight-ball Her affect was one of triumphfor she literally believed she had solved theproblem of dealing with her mother

This example will serve to segue from thesemantic to the pragmatic aspects of schizo-phrenese which is closely related to delusion

reversal and undoing and deceptionmdashpro-cesses that enable the user to avoid thoughtand awareness of feelings Ordinary languageserves to adapt the waking user to anrsquo externalrsquo world as subjectively perceivedwithin broad consensual outlines The worldof the schizophrenic by contrast is internalthough unrecognised as such and consists ofidiosyncratic microcosms that combine whatmore maturely we look upon as psyche withwhat is sensed and perceived Subjectivelyby manipulating mental contents the schizo-phrenic experiences control over the worldThe language is felt by its user to possess thepower to undo reverse and eliminate intoler-able reality both past and present It is alanguage of psychic alchemy or delusionalomnipotence (Burnham 1955 Frosch 1967Glass 1981) Caroline told me rsquo I fool myselfinto thinking it didnrsquo t happenrsquo Speakingordinary language she referred to schizo-phrenese as rsquo the language of wish and desirersquo With her knitting a game of pool a walkaround the lake or detailed letters to othersshe creates a universe that she can describeand act upon with the conviction that she isaltering events problems and associated feel-ings both present and past Ordinary lan-guage also employs reversal but in anentirely different way and for an oppositepurpose By its stark contrast with the sharedand implicitly acknowledged context such areversal in ordinary language serves to high-light or accentuate the feeling the speakerwishes to conveymdashfor instance in the remarkrsquo Hersquos a ne one to be saying thatrsquo Thedelusional reversal of schizophrenia by con-trast eliminates the necessity to differentiatemind from reality to bear painful feelingsand to adapt to a consensually validatedworld An ordinary person faced with apainful situation might transiently nd solaceby constructing heroic fantasies and becom-ing in imagination someone able to surmountany dif culty invulnerable to pain and hurtSchizophrenic language by contrast lacksthe rsquo as if rsquo capacity inherent in the use ofmetaphor that is required to construct such a

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 397

fantasy Instead of an unconscious fantasyand a language capable of contemplation theschizophrenic experiences a delusional senseof actualisation rsquo isrsquo has replaced rsquo as if rsquo

The qualitative difference between schizo-phrenese and ordinary language helps toaccount for the fact that delusions are xedbeliefs refractory to clinical analysis In themind of their creator they are actualitiesrather than fantasies so that there is nothingto be thought about Some time after thevignettes that I have presented when Carolinehad become more uent in ordinary languageand more uid in moving back and forthbetween the two she commenced an hour byobserving my new shoes and commenting rsquo Itmakes me angry that you always have neatshoes and I donrsquo trsquo I observed aloud that herown feet were beginning to move Sheresponded rsquo Our feet move togetherrsquo andadded that she would like me to hug her Iinquired what that was about and she said rsquo Iwant to be in your shoesrsquo She was then ableto express in ordinary language her aware-ness that she was not expressing a fantasy orsymbolising a wish to be more like me butwas verging on speaking the thoughtlesslanguage of schizophrenese which in the pastwould have achieved a sense of actualisationand closure (in this case the delusion she hadexchanged identities with me) rather thanallowing the opportunity for re ectivethought about painful feelings and issuesrelated to being her own separate person

Paradoxically it is this very failure ofschizophrenic language to distinguishthoughts from events that may disguise itsbizarreness and conceal the delusional think-ing it supports because utterances may seemto patient and analyst to be nothing more thandescriptions or observations of happeningsIn telling me about the degrading affair withher college professor and her subsequentconversation about it with her mother Caro-line believed she was doing it over differentlynot simply wishing she might

No discussion of schizophrenic languagewould be complete without a comment about

neologisms which incidentally are notnearly so speci c to schizophrenia as gener-ally believed They appear to be constructedaccording to ordinary morphological princi-ples and it is primarily in their semantic andpragmatic aspects that they are remarkableOne day Caroline said rsquo Irsquove got it set up atwork so no-one can refrain from authoritingme They tell me what to do It pisses me offrsquoWhen I inquired if she believed authoritingwas a legitimate word she said she supposednot I then asked why she did not say whatshe meant in acceptable English She repliedthat it would compel her to face feelings ofshame at loss of dignity and control over herown life By not accepting the existence of anordinary language word to express her feelingstate she managed to repudiate the reality ofthe issue and to avoid the feelings about itThis is another example of the identity ofwords things and actions If the word is thereal thing and she can substitute a neologismthen she can delude herself that the thing orthe problem no longer exists It is easy for theanalyst who is struggling to understand thepatient to gloss over the idiosyncratic aspectof the word in favour of what appears to bethe underlying meaning as one might do withsome of the peculiarities of speech of some-one not uent in onersquos native tonguemdashin thisinstance to assume that Caroline rsquo reallyrsquomeans rsquo acting like an authority withrsquo In thisway the patientrsquos delusion combines with theanalystrsquos illusion to form collusion

Schizophrenic patients do not want to beunderstood for it threatens them with un-wanted knowledge about themselves Schizo-phrenese not only lacks communicativeintent it is a language of deception In orderto function as a vehicle of communicationcontextual elements and related linguisticassumptionsmdashpersonal social and culturalmdashmust be suf ciently concordant in speakerand listenermdashthe rsquo musicrsquo so to speak thataccompanies the words In the case of schizo-phrenese not only are these assumptionsidiosyncratic to the speaker or writer but alsothe speaker or writer is unwilling to elucidate

398 MICHAEL ROBBINS

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

though not always apparent fact Despite itsevident bizarreness schizophrenese appearsto be more or less normal in its syntactic andmorphologic aspects (Andreasen et al 1985Matthysse 1987) Caroline read me thefollowing inscription that she had written inthe front of one of her books rsquo C C (herinitials) For a friend having a start at a pearlynew larger place To a larger print Whatrsquos acrop Slow reader from Carolina who pearlsnot Ultimately she had a problem A rsquorsquo no Jrsquorsquoproblem Last chance world knits A for afriend what L from a friend C C O T Vpromisersquo

To my amazement when I initially tran-scribed this with my computer my word-processing programme which mercilesslycritiques what I would like to believe areperfectly acceptable sentences had nothingto say Equating language with syntax andmorphology however reduces it to an intrin-sically meaningless mechanical processWerner and Kaplan remark rsquo One cannotconclude from the fact that the schizophrenicmay exploit conventional linguistic forms inhis utterances that he actually uses or regardslanguage in the same way as does the normalrsquo(1963 p 257)

The second disjunctive hypothesis thatschizophrenic language is defective but thatschizophrenics think the same way as othersis known as the schizaphasic hypothesis(Fish 1957 Chapman 1966 Chapman ampChapman 1973 Chaika 1974 1990 Chaikaamp Lambe 1985 Harrod 1986) The schizo-phrenic is believed to be trying to articulatean ordinary thought but failing because he orshe is trapped within the con nes of adefective expressive linguistic apparatusThis hypothesis is typically illustrated withbrief concrete interchanges in which theschizophrenic has dif culty conveying whaton the surface seem commonplace ideas andobservations Since aphasic persons canusually write their thoughts this hypothesisimplicitly limits the de nition of language tospoken language I will present data thatindicate both schizophrenic written and re-

ceptive language are abnormal Moreover itis dif cult to imagine how anyone who hasclose contact with schizophrenic persons andthe signi cant disturbances they manifest inevery area of life could seriously subscribeto the idea that their problems are socircumscribed

Notable proponents of a unitary hypothesisinclude Vygotsky (1934 1962) Lewis(1944) and Lanin-Kettering amp Harrow(1985) Both psychoanalytic and neuroscien-ti c hypotheses are unitary but they arediametrically opposed with regard to thequestion of meaningfulness

Introducing my co-investigator

At the time this material was gatheredCaroline was an unmarried woman almost 40years of age She lived alone and althoughshe held an entry-level job she was predomi-nantly supported by a family trust At onetime or another she satis ed all the DSMcriteria for the diagnosis of schizophrenia

Caroline was the youngest child of amother whose inherited wealth enabled her tospend much of her life either in bed watchingtelevision and reading trashy novels or play-ing tennis and drinking cocktails at the localcountry club Mother gave over the care ofthe household and her daughter to hired helpIt was my impression from several meetingswith her as well as that of the social workerwho worked with her that she was ratherinfantile and super cial and committed todenial of problems of any kind Father whoby the time I met Caroline had died in anaccident caused by his own carelessness wasapparently equally irresponsible and pro i-gate He had failed in business and judgingfrom Carolinersquos description gradually devel-oped a manic psychosis complicated byalcoholism Parents were openly hostile toone another and they eventually divorcedwhen Caroline was in her teens

It was many years before Caroline in-formed me that she had spent much of her

386 MICHAEL ROBBINS

pre-pubescent life in bed with her mother inwhat proved to be the paradigm for hersubsequent relationships particularly withmen Father slept in another room She andmother cuddled stroked one another engagedin mutual daydreaming and lived vicariouslythrough characters on the TV soaps andmovies they watched together Mother seem-ingly had no conception of process andencouraged Caroline to believe in magicaltransformation as though she was a fairy-story heroine who need not make any effortin life for a Prince Charming would comealong to take care of her so that she wouldlive happily ever after Father was also quiteseductive toward her at night when inebri-ated though there was never overt sexualactivity between them Carolinersquos behaviourwith boys became sexual in a way that wentbeyond the casual bodily exploration play ofyoung children around the time she startedschool

When Caroline reached puberty mothershowed reluctance to continue to bed downwith her Her parentsrsquo relationship deterio-rated and on one occasion father took a gunand threatened to shoot her mother In ade ning moment of her life Caroline stoodparalysed in front of a mirror for hoursholding a knife to her throat after which shemore or less gave up any efforts to beresponsible and to learn and reverted to thepattern of precociously sexual sadomasochis-tic behaviour she had originally manifested inher earliest school years Despite her increas-ing dif culties she became skilled at charm-ing others into taking care of her and makingspecial allowances for her ineptitude andwith the help of her rst of many therapistsand a school willing to offer many specialconcessions she managed to complete col-legemdashprobably the major achievement of herlife

After graduation Caroline went to a fastfood restaurant where she became catatonicrequiring the rst of numerous hospitalisa-tions Many years later she told me she hadbeen waiting for Prince Charming to come

and take care of her as mother had promisedThis incident seems to have been her realrsquo graduationrsquo into a career as disabled mentalpatient In the hospital she was catatonic andshe hallucinated She had literally to becarried to the toilet bathed and tube fed asshe would not move of her own volition Sheclamped her teeth on her tongue almostbiting it off before her jaws could be priedapart Many years later she was able toexplain to me that it was because she did notwant to speak to her parents but hers was notordinary causal logicmdashthat the absence ofher tongue would render it impossible for herto do so It was an action-rendition of theaphorism rsquo I bit my tonguersquo mdashthat not talkingis literally not having a tongue

Two courses of electro-convulsive therapywere followed by numerous medications andpsychotherapy by an analyst She spent thenext decade in the mental hospital and inhalfway houses of a major teaching institu-tion Her delusional sense of identity wasbased on the belief she was special friendlover or potential bride of the idealiseddoctors and other mental health personnelwho took care of her even as she would notor could not recognise her disabled state andassume rudimentary responsibility for herown care Eventually the staff concluded thatthey had nothing more to offer her andtransferred her to the hospital where I mether When we were introduced Carolinersquosattractive and cheerful demeanour belied thedescription of the referring analyst in histransfer note as rsquo a pathetic young womanrsquo but to my dismay I gradually came to realisethat his expression of defeat and despair wasa tting response to the identity Carolinesoon began to enact in her new surroundings

Soon after her admission Caroline brokeinto the locked medication room on the wardand consumed a large quantity of drugs Sheremained comatose and near death for severaldays Many years later she explained to methat she had been unable to tolerate the ideathat she was like the other psychotic dilapi-dated patients who inhabited the ward so she

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 387

decided to get in with the nurses and doctorsrsquo So I broke in to the med room I was goingto get in maybe like the nurses to theirpowerrsquo It reminded her of how she wasunable to get in with her parents as a childbecause they were so out of it She had feltsimilarly outcast at college The terms gettinginto and being out of had become identical tobodily action on her environment that sheendowed with the power to alter reality Aswe shall see this dynamic so apparentlyconsistent with Kleinrsquos formulationsmdashdid notbecome apparent until we both understoodthat we spoke different languages and shebecame able to couch her mental states inordinary language

Twelve years of analytic therapy the rsttwo of which were spent in the hospitalensued prior to the vignettes I shall describeAfter extensive clinical trials on numerouspsychoactive medications both alone and incombination Trilafon proved the only drugthat made a difference By the time of thevignettes the daily dose had been consider-ably tapered to 8 mg Carolinersquos seductiveineptitude made hospital staff feel needed andspecial Her days were spent describing inminute detail to any staff member who wouldlisten everything she was doing conveyingthe impression she could not make up hermind about anything and that this person wasthe special guru who alone could tell her whatto think and do In fact Caroline was usingthese contacts as opportunities to evacuatethe contents of her mind and she paid littleattention to any of the extensive advice shewas given although she made it all intoslogans that she took with her so that sheseemed at times like an encyclopaedia ofbanal bumper stickers Her seemingly naiacuteveshow of interest and idealisation effectivelyconcealed what I gradually came to realisewas hostility and arrogant disdain towards thehelper of the moment She went from oneperson to another enlisting the sympathies ofeach by implying that his or her predecessorhad somehow failed or harmed her and evenas she mouthed idealisations of me I came to

feel like one of many anonymous persons towhom she attempted to give over responsi-bility for her failed life She had dif cultydistinguishing words from concrete actionsrsquo sticks and stonesrsquo from rsquo namesrsquo In factwhen I said something she did not wish tohear she believed and told staff that I hadliterally struck her

At rst I mistook Carolinersquos repetitiousstatements that nothing good would everhappen for expressions of despair and hope-lessness But as she repeatedly destroyedevery opportunity to be constructive abouther life I began to realise that her litany wasa statement of intent and that concealedbeneath her sweet incompetent facade wasenormous ragemdasha drive to despoil whateverwas given her Staff members believed thatthe more anxious confused scattered andupset Caroline appeared the more of theircaretaking she needed The squeaking wheelgot lots of grease but paradoxically it movedslower and slower In concurrent sessionswith a social worker Carolinersquos vacuousmother seemed unaware of the seriousness ofher daughterrsquos problems and denied that therehad ever been any dif culties in their rela-tionship Indeed the fact that there had neverbeen overt con ict between the two wasprobably part of the problem When shevisited Caroline there was no discussion ofsubstantive issues and she spoke to herdaughter in platitudes such as rsquo Just get wellrsquoCaroline became increasingly frantic disor-ganised out of control and suicidal andeventually after all else had failed electro-shock treatment was once again contem-plated In retrospect I believe that the staffand I were as reluctant to face the truth aboutCarolinersquos unwillingness to assume any re-sponsibility for her mind as she was insteadwe assimilated her subtle cues and held oneanother to blame

Despite the destructive system of mutualblaming in which we were entangled Caro-line was eventually mobilised to leave thehospital and surprisingly she never returnedAlthough her inclination and capacity for

388 MICHAEL ROBBINS

independent living and for work remainedmarginal it progressively improved Alongthe way she created every kind of problemimaginable and came near to suicide seriousaccidents troubles with the law destitutionand starvation After years of treatment weuncovered her unconscious envy of homelessstreet-corner mendicants for to her theyrepresented her motherrsquos success in trickingothers to take care of her thereby absolvingher of the necessity of taking responsibilityfor herself

Our sessions typically consisted of Caro-linersquos pressured and detailed recitations anddemonstrations of all the events of her lifesince we had last met along with descriptionsof the problems she had got herself into rsquo Justone more thingrsquo was a favourite responsewhen I would attempt to get a word in of myown and when she was not able to avoid mycomments about her responsibility she wasfull of plans and pledges to do bettermdashnoneof which ever came to fruition In the courseof these recitations she regularly forgot thecentral point and changed the subject andbecause she could not grasp that there wereconsequences to her actions no learningresulted from our discussions Instead sherelentlessly held accountable those of us whoremained devoted to her referring to us withrage as rsquo criminals who got off the hookrsquo Shegradually re-directed her sexual promiscuityand made intensive efforts to seduce me intoparticipating in a mind-losing sexual orgy inwhich she could imagine our identitiesmerged so that by deluding herself she wasme and I her she would get what she imaginedI had My efforts to contain and to help her tofocus were for the most part either ignoredor greeted with rage and blaming When Iresisted her blandishments she would becomeseriously abusive and hint to others includingher family not only that I was an irrespon-sible and ineffective therapist but also thatshe was an innocent victim of my seductionsboth mental and physical

As years went by this grim picture wasgradually mitigated as Caroline took small

steps toward personal autonomy There wereminuscule increments of insight and even anoccasional sense of productively workingtogether but these were regularly undone anddestroyed Increasingly I came to feel thetreatment was stalemated Shortly prior to theevents I will describe she appeared to regressand behave like a typical chronic schizophren-ic with attened affect wooden facial ex-pression a gross tremor and such paralyticambivalence that at times she could hardlymove and sat rocking back and forth Herfamily became concerned and at their urgingI sought a psychopharmacological consulta-tion In place of Trilafon several of the neweranti-psychotic medications were tried bothalone and in combination but her conditiononly seemed to worsen Eventually Trilafontherapy was resumed her condition restabi-lised and our struggles continued I experi-enced overwhelming lethargy during oursessions I tried to believe and to tell Caro-line that she was offering me a lethal dose ofthe kinds of emotion that had overwhelmedher in the course of her futile childhoodefforts to reach her mother in the hope that Iwould not be destroyed by it as she had beenbut would offer her a model for dealing withit but my interpretations had no substantiveeffect on either of us

Although there had always been noticeablepeculiarities in her language I had notfocused attention on them hitherto other thanto tell her on occasion that I did not under-stand and to ask her to clarify One day in apoorly concealed moment of exasperationand without much thought I remarked thatshe was speaking schizophrenese a languageI did not comprehend She was taken abackand informed me that as I was the therapistand she was the schizophrenic it was my jobto understand her After unproductive discus-sions that spanned several sessions I suddenlyhad the liberating thought that whether or notshe chose to learn from me I was not trappedin a hopeless situation I could terminate withher or learn from her and I told her that Iwould choose the latter course and she would

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 389

henceforth educate me about schizophreneseIn situations where hitherto I would have felthopeless angry and bored I pulled out padand pen and took the verbatim notes thatyears later she gave her permission for me touse as data for this paper I questioned her indetail as though I were a student asking theprofessor to explain the lecture To mysurprise my self-serving action nally gotCarolinersquos attention when what I thought hadbeen my efforts to care about her had not Shewas shocked fascinated and amused

In retrospect I believe my decision to learnrather than be driven crazy or to reject herwas a model for what Caroline had beenunable to do as a child Because I nally feltthat I was getting something out of therelationship I felt less immediately investedin whether Caroline did rsquo therapyrsquo and in turnCarolinersquos curiosity was piqued She began toalert me to get out my notebook when shesensed an urge to speak schizophrenese andshe decided to keep a journal When I onceasked her in response to her having justalerted me to get pen and notebook how shewas able to determine that she was about tospeak schizophrenese she replied rsquo Itrsquos whenI put things together in strange ways that no-one else would understandrsquo adding rsquo I take agiant leaprsquo The ensuing discussion willclarify what she meant

Vignette 1

Caroline had gone to play pool after takingher car to be repaired It had been damageddue to irresponsible actions on her part aboutwhich we had talked at length

P I had time to kill Rack it up and pocketrsquo em Sock it and rock rsquo em Clear the tableThe only table that had monkey business to it

A What do you meanP E [a staff member in the hospital whom

Caroline idealised] and I used to play poolA What do you meanP Judgement Day Irsquo ve got so many balls

and I have to put them in the pocket Get theeight-ball in and yoursquo re out Irsquo ve got to shoot

straight from the hip and keep both feet onthe ground Just straight shots coming fromthe heart People have things racked upagainst you but you keep on shooting and ifyou make a racket like me it gives them moreammunition

A What do you meanP Now you really think Irsquo m crazy I racked

rsquo em up and then I bought a root beer The guysaid rsquo You canrsquo t drink that herersquo and then wetalked about getting 50 off lodging in [adistant resort] I said that late September isthe best time to go there [laughs]

A What are you laughing aboutP Well itrsquos not a short walk to get there

and I have $16 in my wallet They donrsquo t wantunethical behaviour in the bar So I thinkabout going there I build up in my mindplaces to go I start out thinking Irsquo m going toclean the apartment Then I do these otherthings Then I start thinking when I donrsquo t thatitrsquos the fault of the landlord and others Then Iran out of time and I had to go to work I waslate again

A What about the resortP Itrsquos a Closetland place [a reference to a

movie about a woman who turned to fantasyin order to endure torture] no problems thereeverything is ne

Analysis

Caroline begins by trying to tell me some-thing in rsquo purersquo schizophrenese After shemakes the observation that I will think she iscrazy she begins to try to explain her thoughtprocess by using more schizophrenese Gra-dually she shifts into ordinary language andattempts to re-cast her thoughts The ordinarylanguage moves the discourse from the con-crete level of things and actions to the realmof subjective thought and feeling symbol andmetaphor An ordinary language renditionderived from what she told me and from thebroader context of our relationship at thattime might be rsquo The Day of Judgement hascome for me Irsquo m in a rage at myself for allmy monkey businessmdashdamaging my car not

390 MICHAEL ROBBINS

being nancially responsible not cleaningmy apartment or being on time for myappointments and treating life like a game Igive others ammunition to use against meIrsquove really got myself behind the eight-balland Irsquove got to get my feet back on theground But Irsquo m in a rage at having to beresponsible I just want to kill more timeblame others wipe the table clean of all myproblems and imagine Irsquom at a resort on aperpetual vacationrsquo

This version of her thoughts requires alanguage of re ection metaphor and symbo-lism In schizophrenese by contrast insteadof a subjective self the thoughts and feelingsabout the situation she has got herself intoshe describes an animated literalmdashnotmetaphoricalmdashpool table microcosm ofwhich she is omnipotent master as shecombines words body actions and things Itis Judgement Day and she literally believesshe is ridding herself of her problems Killingtime involves rage- lled destructive action Italso re ects the absence of comparativeconcepts that would serve to make her awareof the passage of time and its implicationssuch as process work patience and perspec-tive What might appear to be low-grademetaphors or similesmdashcliches such as rsquo shootstraightrsquo rsquo shoot from the hiprsquo rsquo rack rsquo em uprsquo rsquo rock rsquo em and sock rsquo emrsquo being rsquo behind theeight-ballrsquo rsquo killing timersquo mdashare in fact actioncondensations of words body movementsand things based on assonance

Vignette 2

This is a sample of Carolinersquos writtenlanguage She brought in for discussion aletter entitled rsquo The Class Actrsquo which sheproposed to send to twenty- ve or so of herformer caretakers as accompaniment to aValentine card It begins with the salutationrsquo To a Quarter of Caring Peoplersquo

rsquoAlthough I have loving feelings for thepeople who have held me in their thoughts ofcare this card is an expression of appreciationand care not love I am on an excavation of

dignity (dig-knit-tea) The month of nancialFebruary is for my initial dig The month ofMarch my birthday always and forever hold-ing is for my knit The month of April is for apoem once learned as in college

T T TSee these threeHear their chimeThings take time for thought taxes andteaHer letter concludes with a paragraph of

plans for each of the months of May andJune In response to my request that sheexplain this to me in ordinary language shesays

P Itrsquos how overwhelmed I am about thecoming months In the 6th grade a teacher Irespected took her class on an archaeologicaldig That means rsquo dig inrsquo rsquo Dignityrsquo has threeparts dig-knit-tea You have to dig in and knitthings and then drinking tea calms you down

A But why do you say it this way and notsomething like rsquo Irsquo m overwhelmed about howIrsquo m going to manage my life in a digni edway during the coming months I need to nda way to calm down and to use my 6th gradeteacher as a model for digging in workinghard and pulling my life togetherrsquo

P The way I said it is brilliant Besides itkeeps me at a distance from people puts mein a separate space where they wonrsquo t knowwhat Irsquom talking about I donrsquo t want people toknow how much distress Irsquo m in

A So yoursquo re writing a letter of informationabout yourself with all sorts of details aboutyour life to people you supposedly careaboutmdashbut you want to conceal your realdistress from them

P The time is so overwhelming I had tocompartmentalise it into months so I couldmanage my mess Then I send it to respon-sible people and they will take care of it Irsquom lling up their mailbox adding to theirconcern So I gave it to my landlord to readand he said rsquo Take carersquo I got furious He wassupposed to take care of it Irsquo m getting amisery out of it getting to sit in some low-down place and not move out of it Some

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 391

people try to intimidate people I intimatepeople

A What do you meanP Relationships are too dif cult so I word

my way into a relationship with letters Irsquodlike to work my way into your hearts withoutworking my way in and without mentioningthings that would work my way out of yourhearts

Analysis

Caroline is gradually able to re-present thethought behind her letter in an ordinarylanguage statement but even at the conclu-sion of the discussion she is still partlyspeaking schizophrenese If she were able tospeak ordinary language she might saysomething like rsquo I would like to fool myselfand the others in my life that this is really aValentine about loving and feeling close tothem and a resolution not to be such a low-down person but to identify myself withconstructive responsible people and to workhard to dig myself out from the mess Irsquovemade But really this card expresses my wishto avoid the pain of my situation and to sendall my problems away and force them insideothers to take care ofrsquo

What sets the schizophrenese apart fromthe ordinary language version is that she isnot expressing wishes nor is she usingphrases like rsquo digging inrsquo being rsquo low downrsquo rsquo keep me in your heartrsquo rsquo I give you myheartrsquo or rsquo knitting together the strands of herlifersquo metaphorically Instead of workingwhich involves effort patience thoughtfulre ection and bearing of distress she engagesin wording an action discharge that is itsantithesis An ordinary person might work atsolving her problems while singing such songlyrics as rsquo Pack up your troubles in your oldkit bagrsquo or rsquo Pack up your troubles and sendthem all to mersquo When Caroline says rsquo I send it(rsquorsquo my messrsquorsquo ) to responsible people Irsquom lling up their mailbox I word my wayinto a relationship with lettersrsquo she literallybelieves she is digging out and packaging her

word-self into the Valentine card and puttingit in the mailbox-hearts of people who willhold and care for her emotionally distressedself in a way that she cannot or will not doThere is nothing left for her to think about tofeel or to work on Insofar as her actionssucceed in burdening others with her worriesand problems her wishful belief in a sensecomes true Fooling others so that she getsno realistic feedback is necessary in order tocontinue to fool herself The words dignityand intimate are neologismsmdashhomophoniccompounds that combine word action andthing

The interaction with her landlord illustratestwo points Nancy Andreasen et al (1985)believe that while schizophrenics are defec-tive in expressive language receptive lan-guage remains normal It is clear in thisinstance however that Caroline hears whather landlord says in schizophrenese as wellFrom a psychoanalytic perspective it is evi-dent that the underlying thought processresembles the phantasies Klein writes aboutand lends itself to an interpretation of projec-tive identi cation but in order to know this itis rst necessary to re-present the thoughtThe miscommunication that can ensue frommaking a psychoanalytic interpretation basedon the belief the patient is speaking andlistening in ordinary language is illustratedby Carolinersquos interchange with her landlordHe believes she is speaking ordinary lan-guage and he responds to her Valentine bytelling her to rsquo take carersquo She receives hisordinary language statement as though hewere speaking schizophrenese Her construc-tion of it as a rejection throws her into a ragewhich she in turn conceals because sheimagines it will evoke his anger

Vignette 3

P I walked around the lake with mymother when my affair with my collegeprofessor was going on [perhaps 15 yearspreviously] and told her about it So the lastfew days I found three lakes and walked

392 MICHAEL ROBBINS

around them Three guys were on one dockThings reminded me of the professor Birdson an island in the rst lake remind me of aman who didnrsquo t disclose that he was probablyhaving other relationshipsmdashprobably screw-ing other women all those birdsmdashbut it washard to keep my mind together walkingaround the big lake because it was so big toobig a place to keep my mind Then these guysstarted irting playing with my mind Allthree of those lakes make a penis the end themiddle the part you play with

A Why did you do thisP I did it so I could focus on a destructive

relationship I was trying to feel the feeling Ionce had with my mother after the affair Butthe lakes are such a big temptation to fall in itagain Walking around the smaller lake Icould get more in touch with the feeling ofloss and hurt some of the feeling but itwasnrsquo t satisfying The bigger lakes were over-whelming and I didnrsquo t know why I was thereany more I was trying to get into troubleThe birds on the big lake felt threatening allthe people he screwed the things I didnrsquo t seeI was foolish I start to realise it but theninstead it becomes my mother fooled me notwhat I did My mother goes to [her wintervacation home] and spends time watching thebirds I feel betrayed I went to the dock andsaw two birds in a caged area I felt caged Iwondered if those women were prostitutesand ended in jail

A What do you meanP Irsquom trying to deal with what happened

in my twenties with the professor Around thelake my mother and I walked and I told her[Her mother had blamed the professor andtold Caroline not to worry about what she haddone] The lie was talking to my mother aboutit and my motherrsquos lies My interest in thelake is a re-creation of the crime when some-thing equals nothing and nothing equalssomething The lively pond is a metaphor formy mind and my dif culty containing limitsand boundaries staying in bounds and notdestroying everything attending to a straightline of thought The kids represent how easily

Irsquo m distracted and take my mind off The lakeis a reference to my mind and the tree is myinterest in life The tree and the birds are ablaming thing People donrsquo t tell others abouttheir affairs but they communicate insidethemselves about it My mind is the pond thetree Claustrophobia is how rsquo in the darkrsquo apart of me is My thoughts versus my actionsI say one thing make my pledges then I godo another Destructive Irsquo m terri ed of thetemptation to blow everything to bits My treeis empty and alone others have things in theirbranches I canrsquo t walk a straight line I veeroff so I try another planet Itrsquos painful I knowif I canrsquo t stay on line in this little pond thenIrsquo ll never get anywhere in the bigger issues inlife I can look at trees that seem moreinteresting but I have to be able to deal withwhatrsquos here

A Now you are speaking in metaphor whydonrsquo t you always

P Metaphors take more responsibilitythey are more connecting

Analysis

Caroline begins speaking about her trip inliteral schizophrenese but by the conclusionof our discussion the physical elements of hersurroundings have become incorporated inmetaphors A more elaborate translation thatsupplements her efforts with other informa-tion in my possession but preserves her ownwords and phrases might be something likethis rsquo Irsquo ve been thinking about my affair withthe professor trying to return so to speak tothe scene of the crime and nd a differentway in my mind to handle what I couldnrsquo tdeal with then but I keep falling into thesame old patterns of thinking I fell intosexual temptation and I lost my mind I wasrsquorsquo out of my treersquorsquo Did he fool me or did I foolmyself Afterwards my mother and I took awalk I was struggling over whether to facemy feelings of hurt responsibility and guiltor stay in the dark about what I had done anddeny that I was a fool But I couldnrsquo t contain

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 393

myself I canrsquo t seem to rsquorsquo go straightrsquorsquo I fellinto it again and spilled everything out to mymother I deserved to be punished but insteadof making me feel like a jailbird or aprostitute she blamed him and she made likeit was nothing she vacated her mind andlooked for other birds to blamersquo

In this ordinary-language version thereemerges a thoughtful emotional re ectiveself replete with the symbolism and meta-phor that is missing in a language that fuseswords things and actions Caroline describesher schizophrenese much as Bion (1967)described attacks on linkingmdashas a process ofacting rather than thinking and blowing hermind to bits As she observes makingmetaphors takes too much energy When shetalks about getting in touch with feelings sheis not referring to metaphorical touching butto literal sensory-motor activities She can-not separate words from actions and things sothat she might be able to think about thedestructive relationship and the overwhelm-ing temptation Instead she walks around alake that she has rendered equivalent to (notwhich symbolises) the container of her mindher mind itself the loss of her mind thetempting three-part male genital the threeguys playing with her mind and her playingwith the penis Her mind is also literallyindistinguishable from the tree or the cageand the birds caged or in trees are concreteenactments of internalised or projected res-ponsibility and blame Of the three vignettesthis re ects the most mental maturity in so faras Caroline is trying to think and feel in anordinary way at the very same time sheexperiences the omnipotent capacity to elimi-nate what needs to be thought about Bothefforts fail

Discussion

Schizophrenics speak a meaningful lan-guage that differs from ordinary language inits essence not simply with regard to sym-bolism This language has a determina-

tive relationship to delusional thinkingBecause Freudrsquos linguistic analysis ofdreaming as a delusional and hallucinatorywish-ful lmentmdashan encapsulated nocturnalpsychosismdashis of considerable relevancesummarising some of the parallels betweendreaming and schizophrenia will be a usefulpoint of entry Schizophrenia presents itselfon a continuum in varying degrees of regres-sion or compensation In its most regressedform catatonia it resembles a waking dreamstate characterised by absence of wakefulattentiveness and sensory-perceptual domi-nance in the form of hallucinations Verbaland motor action are also absent as in thestate of sensory-perceptual identity to whichFreud made reference in his discussion of theprimary process in dreams (1900) and in hispaper on hallucinatory wish ful lment in theabsence of the object (1911) At the other endof the continuummdashthe state of maximalcompensationmdashthe balance is shifted towardspsycho-motor identity the language ofschizophrenia is one of action and actualisa-tion rather than thought and it resembles thesensorimotor stage of infancy

Discussion of language is usually dividedinto syntax morphology semantics and prag-matics As noted earlier syntax here is moreor less intact With regard to morphologyalthough some of the words used by theschizophrenic may be idiosyncratic the rulesor processes by which they are formed (suchas the use of af xes compounding onomato-poeia proper noun transformation clippingand blending) seem identical to those used inordinary language Therefore the ensuingdiscussion will focus on semantic and prag-matic considerations

Ordinary language is an aspect of re ectivethought that is uniquely situated betweenimpulse and action and enables adaptation toconsensual reality by means of exchangingthoughts and feelings with others and con-templating them oneself Language is neverentirely divorced from the sensorimotorphase in the sense that action in the form ofgestures and bodily expressions as well as

394 MICHAEL ROBBINS

somatic sensations remains an inextricablepart of it but in the course of developmentspeech and writing become relatively autono-mous The more sophisticated the subject themore exible the language becomes in mov-ing between concrete sensory somatic andfunctional considerations on the one handand more abstract re ective and comparativeoperations in which one element stands forabbreviates or enriches one or more otherson the other Individual language developsfrom simple denotationmdashthat is learningculturally determined signi ersmdashto abstractdevelopment of symbols metaphors andsimiles both those shared by a given cultureand those that re ect unique personal experi-ence The capacity for simultaneous parallelor multi-track processing enables language todisguise and conceal as well as to re ectclarify and communicate and to have at anygiven time more than one meaning It is thismulti-dimensional complexity that makespsychoanalysis possible

Because we have no choice but to useordinary language as both a means and areference point for analysing schizophreniclanguage it is natural to assume the latter tobe qualitatively continuous with ordinarylanguage and that linear translation of one tothe other is possiblemdashas in Freudrsquos well-known comparison of dream imagery toEgyptian hieroglyphics We tend to assumethat schizophrenese is a kind of encryptedcode cover or disguise that can be decodedinto its unconscious rsquo realrsquo ordinary languagemeaning Thus it would seem natural to askof a schizophrenic utterance rsquo What does itmeanrsquo mdasha question which I raise repeatedlyin the paper and which I often addressed toCaroline But schizophrenese is not a variantof ordinary language It is unique and intrin-sically different hence such a reduction is notpossible It may eventually be possible how-ever for the schizophrenic to acquire thecapacity to re-state or re-present the thoughtsthat he or she was couching in schizophrenesein ordinary language so that the two lan-guages can be compared and contrasted and

this is what Caroline gradually acquired thecapability to do

From a semantic perspective schizophre-nese is characterised by an absence of theordinary distinctions between word thingbodily process and action The word is usedas though it were identical to the thing towhich it would ordinarily refer as well as toactionsmdashpast present or prospectivemdashon orin relation to the thing and to the mediatingsomatic processes Words lack their ordinaryconnotation as representations and refer-ences they have become happenings orevents Caroline once referred to this processas rsquo combination thinkingrsquo mdasha term nearlyidentical to the concept rsquo combinative think-ingrsquo proposed by McClain Johnston andPhilip Holzman (1985) In ordinary discoursespeaker and listener recognise the symbolicimport of a concrete-sounding statement suchas rsquo I have a special pipeline to the bossrsquo orrsquo Letrsquos smoke a peace-pipersquo The metaphorserves as emphasis or highlighting of a keyidea that is being talked about In contrastCaroline once literally handed me a sectionof plumberrsquos pipemdasha gesture so pregnantwith meaning yet impregnable to my inter-pretive skills that it would have been easy toconclude that the pipe was an arcane symbolWhen I questioned her about it however shewas able to tell me that she was making aconnection with me In other words the pipewas just a pipe An ordinary speaker mightmetaphorically and passionately declare loveby saying rsquo I give you my heartrsquo or sing aboutempathic sharing in the folk lyric rsquo Pack upyour troubles in your old kit bag and smilersquo but in discussing the thought process involvedin mailing her Valentine card with a largeheart on it to a large number of casual andformer acquaintances Caroline told me shewas packaging and mailing her word-self toothers she looked upon as more willing toassume responsibility for her than she was forherself While it is tempting to use terms likecollapse implosion explosion fusion orboundary loss to describe the creation ofthese concrete linguistic identities such

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 395

terms convey the incorrect impression thatschizophrenese is a regressive degradation ofordinary language Rather schizophrenese isa language of equivalence immediacy andaction in contrast to ordinary languagewhich supports representational thinkingMoreover there is no evidence that theschizophrenic ever rsquo spokersquo differently

Schizophrenese then is an immediatelanguage of the body and its function in theworld of things particularly motor (throwinghitting) respiratory (breathing talking andblowing as in the felicitous expression rsquo mindblowingrsquo ) gastrointestinal (vomiting and de-fecating) and orgasmic (rsquo fucking onersquos brainsoutrsquo ) Caroline describes printmaking as fol-lows rsquo I was pounding it down oozing out myblack insides on paperrsquo She described one ofher long walks as follows rsquo I want to run andrun and run away from the painful feelings Ifeel like I can split off disintegrate and getaway from them This is what schizophreneseis aboutrsquo She said rsquo I give people the breath-ing they need I make a case to take care ofme I respire them With every breath I givethem responsibilityrsquo

rsquo Respirersquo is a neologism made by theordinary morphological processes of clippingand condensation of the physical process ofrespiration and the work-related concept ofresponsibility but it is a thing and not areference She said rsquo Irsquom mad today I had toput in limits and boundaries and not spill myguts There are lots of snakes inside me and Iwant you to eat them for mersquo In reference toan episode of vomiting during a meal withher family when they questioned her aboutinstances of her irresponsible behaviour shecomments rsquo I couldnrsquo t bear the feeling ofhaving taken all those courses wastingmoney scattering my time and I had to getrid of them I was throwing up the feelingrsquo

It follows from the nature of their languagethat schizophrenics lack patience self-controland restraint have dif culty conceptualisingprocess and sequence distinguishing pastfrom present and here from there and seeingthe consequences of their actions and thereby

learning from experience Carolinersquos Valen-tine mailing was an example of how sheregularly bombarded with letters persons withwhom she had no current contact often fromthe distant past She called these bizarremass-mailings rsquo Trail Newsrsquo and she believedshe was relieving herself into these others ofher otherwise troubling mental contents Shesaid rsquo If your arm was controlled by maturethought then you could wait Itrsquos the entangle-ment quality instead of being able to stop andthinkrsquo

Despite its sometimes strange and colour-ful character the language of schizophreniais neither a language of conscious awareness(re ection) nor of unconscious concealment(repression) It does not support mentalrepresentation symbolisation and re ectionFailure to appreciate this may be what led ageneration of analysts including such semi-nal gures as Frieda Fromm-Reichmann toidealise schizophrenic persons as havingspecial psychic acuity and access to theirunconscious mental life that ordinary personsdo not A neurotic patient might refer to herhabitual and inappropriate tendency to con- de personal affairs to others using theunconscious symbolism of a phrase such asrsquo spilling my gutsrsquo If questioned she wouldhave the sense that she had said somethingworth re ecting on thinking about andanalysing the symbolic meaning of WhenCaroline used the expression as noted earliershe not only believed there were snakes in herintestines that she needed to give to me(although she could reality-test the idea ifpressed to do so) but she referred to anearlier occasion when she had vomited to ridherself of unwanted feelings In an ordinaryanalysis the analyst might suggest that thepatientrsquos behaviour and associations indicatethat she viewed her problems as a mess shebelieved she could dump on to or into theanalyst and the patient might respond to theinterpretation with associations to oral or analfantasies and memories When Caroline saysrsquo I send it [rsquorsquo my messrsquorsquo ] to responsible people Irsquom lling up their mailbox I word my

396 MICHAEL ROBBINS

way into a relationship with lettersrsquo she isdoing something and not speaking metaphori-cally or thinking Whereas an ordinary personmight be aware of the underlying fantasiesand con icts Caroline literally believes thatshe is excreting her self which is identical toher words into others It might be moreaccurate to say that she is expressing phan-tasy in the Kleinian sense but if so even atthis level of discourse when she makes anattempt to interpret the original schizophren-ese account of her mass mailings in alanguage more comprehensible to me she isstill speaking in a language of closure andenactment devoid of interpretable symbo-lism and unconscious meaning

While schizophrenia is a state of self-centredness or egocentricity in the solipsisticsense of the term schizophrenese paradoxi-cally is a language without a centred subjectexcept in the most rudimentary sense ofobserver and actor of a drama The subjectiversquo Irsquo denoting the presence of conscious re ec-tion and thought about beliefs fantasiesemotions and con icts is largely missing andin its stead Caroline describes a microcosm inwhich she is participant consisting of suchthings as a pool table with its sticks and ballsher sewing box with its bobbins and yarns orthe terrain bordering the three lakes she haswalked around with its birds trees andpeople In ordinary discourse one might shareonersquos subjective thoughts and feelings aboutonersquos mother by saying rsquo Irsquo m always behindthe eight-ball with herrsquo or rsquo I was cluelesswhen it came to my mother itrsquos the oldproblem of the irresistible force and theimmovable objectrsquo Caroline by contrastdescribed to me a game of pool she hadplayed in which her mother was the cue balland she had been able to pocket the otherballs without moving the cue-ball or hittingthe eight-ball Her affect was one of triumphfor she literally believed she had solved theproblem of dealing with her mother

This example will serve to segue from thesemantic to the pragmatic aspects of schizo-phrenese which is closely related to delusion

reversal and undoing and deceptionmdashpro-cesses that enable the user to avoid thoughtand awareness of feelings Ordinary languageserves to adapt the waking user to anrsquo externalrsquo world as subjectively perceivedwithin broad consensual outlines The worldof the schizophrenic by contrast is internalthough unrecognised as such and consists ofidiosyncratic microcosms that combine whatmore maturely we look upon as psyche withwhat is sensed and perceived Subjectivelyby manipulating mental contents the schizo-phrenic experiences control over the worldThe language is felt by its user to possess thepower to undo reverse and eliminate intoler-able reality both past and present It is alanguage of psychic alchemy or delusionalomnipotence (Burnham 1955 Frosch 1967Glass 1981) Caroline told me rsquo I fool myselfinto thinking it didnrsquo t happenrsquo Speakingordinary language she referred to schizo-phrenese as rsquo the language of wish and desirersquo With her knitting a game of pool a walkaround the lake or detailed letters to othersshe creates a universe that she can describeand act upon with the conviction that she isaltering events problems and associated feel-ings both present and past Ordinary lan-guage also employs reversal but in anentirely different way and for an oppositepurpose By its stark contrast with the sharedand implicitly acknowledged context such areversal in ordinary language serves to high-light or accentuate the feeling the speakerwishes to conveymdashfor instance in the remarkrsquo Hersquos a ne one to be saying thatrsquo Thedelusional reversal of schizophrenia by con-trast eliminates the necessity to differentiatemind from reality to bear painful feelingsand to adapt to a consensually validatedworld An ordinary person faced with apainful situation might transiently nd solaceby constructing heroic fantasies and becom-ing in imagination someone able to surmountany dif culty invulnerable to pain and hurtSchizophrenic language by contrast lacksthe rsquo as if rsquo capacity inherent in the use ofmetaphor that is required to construct such a

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 397

fantasy Instead of an unconscious fantasyand a language capable of contemplation theschizophrenic experiences a delusional senseof actualisation rsquo isrsquo has replaced rsquo as if rsquo

The qualitative difference between schizo-phrenese and ordinary language helps toaccount for the fact that delusions are xedbeliefs refractory to clinical analysis In themind of their creator they are actualitiesrather than fantasies so that there is nothingto be thought about Some time after thevignettes that I have presented when Carolinehad become more uent in ordinary languageand more uid in moving back and forthbetween the two she commenced an hour byobserving my new shoes and commenting rsquo Itmakes me angry that you always have neatshoes and I donrsquo trsquo I observed aloud that herown feet were beginning to move Sheresponded rsquo Our feet move togetherrsquo andadded that she would like me to hug her Iinquired what that was about and she said rsquo Iwant to be in your shoesrsquo She was then ableto express in ordinary language her aware-ness that she was not expressing a fantasy orsymbolising a wish to be more like me butwas verging on speaking the thoughtlesslanguage of schizophrenese which in the pastwould have achieved a sense of actualisationand closure (in this case the delusion she hadexchanged identities with me) rather thanallowing the opportunity for re ectivethought about painful feelings and issuesrelated to being her own separate person

Paradoxically it is this very failure ofschizophrenic language to distinguishthoughts from events that may disguise itsbizarreness and conceal the delusional think-ing it supports because utterances may seemto patient and analyst to be nothing more thandescriptions or observations of happeningsIn telling me about the degrading affair withher college professor and her subsequentconversation about it with her mother Caro-line believed she was doing it over differentlynot simply wishing she might

No discussion of schizophrenic languagewould be complete without a comment about

neologisms which incidentally are notnearly so speci c to schizophrenia as gener-ally believed They appear to be constructedaccording to ordinary morphological princi-ples and it is primarily in their semantic andpragmatic aspects that they are remarkableOne day Caroline said rsquo Irsquove got it set up atwork so no-one can refrain from authoritingme They tell me what to do It pisses me offrsquoWhen I inquired if she believed authoritingwas a legitimate word she said she supposednot I then asked why she did not say whatshe meant in acceptable English She repliedthat it would compel her to face feelings ofshame at loss of dignity and control over herown life By not accepting the existence of anordinary language word to express her feelingstate she managed to repudiate the reality ofthe issue and to avoid the feelings about itThis is another example of the identity ofwords things and actions If the word is thereal thing and she can substitute a neologismthen she can delude herself that the thing orthe problem no longer exists It is easy for theanalyst who is struggling to understand thepatient to gloss over the idiosyncratic aspectof the word in favour of what appears to bethe underlying meaning as one might do withsome of the peculiarities of speech of some-one not uent in onersquos native tonguemdashin thisinstance to assume that Caroline rsquo reallyrsquomeans rsquo acting like an authority withrsquo In thisway the patientrsquos delusion combines with theanalystrsquos illusion to form collusion

Schizophrenic patients do not want to beunderstood for it threatens them with un-wanted knowledge about themselves Schizo-phrenese not only lacks communicativeintent it is a language of deception In orderto function as a vehicle of communicationcontextual elements and related linguisticassumptionsmdashpersonal social and culturalmdashmust be suf ciently concordant in speakerand listenermdashthe rsquo musicrsquo so to speak thataccompanies the words In the case of schizo-phrenese not only are these assumptionsidiosyncratic to the speaker or writer but alsothe speaker or writer is unwilling to elucidate

398 MICHAEL ROBBINS

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

pre-pubescent life in bed with her mother inwhat proved to be the paradigm for hersubsequent relationships particularly withmen Father slept in another room She andmother cuddled stroked one another engagedin mutual daydreaming and lived vicariouslythrough characters on the TV soaps andmovies they watched together Mother seem-ingly had no conception of process andencouraged Caroline to believe in magicaltransformation as though she was a fairy-story heroine who need not make any effortin life for a Prince Charming would comealong to take care of her so that she wouldlive happily ever after Father was also quiteseductive toward her at night when inebri-ated though there was never overt sexualactivity between them Carolinersquos behaviourwith boys became sexual in a way that wentbeyond the casual bodily exploration play ofyoung children around the time she startedschool

When Caroline reached puberty mothershowed reluctance to continue to bed downwith her Her parentsrsquo relationship deterio-rated and on one occasion father took a gunand threatened to shoot her mother In ade ning moment of her life Caroline stoodparalysed in front of a mirror for hoursholding a knife to her throat after which shemore or less gave up any efforts to beresponsible and to learn and reverted to thepattern of precociously sexual sadomasochis-tic behaviour she had originally manifested inher earliest school years Despite her increas-ing dif culties she became skilled at charm-ing others into taking care of her and makingspecial allowances for her ineptitude andwith the help of her rst of many therapistsand a school willing to offer many specialconcessions she managed to complete col-legemdashprobably the major achievement of herlife

After graduation Caroline went to a fastfood restaurant where she became catatonicrequiring the rst of numerous hospitalisa-tions Many years later she told me she hadbeen waiting for Prince Charming to come

and take care of her as mother had promisedThis incident seems to have been her realrsquo graduationrsquo into a career as disabled mentalpatient In the hospital she was catatonic andshe hallucinated She had literally to becarried to the toilet bathed and tube fed asshe would not move of her own volition Sheclamped her teeth on her tongue almostbiting it off before her jaws could be priedapart Many years later she was able toexplain to me that it was because she did notwant to speak to her parents but hers was notordinary causal logicmdashthat the absence ofher tongue would render it impossible for herto do so It was an action-rendition of theaphorism rsquo I bit my tonguersquo mdashthat not talkingis literally not having a tongue

Two courses of electro-convulsive therapywere followed by numerous medications andpsychotherapy by an analyst She spent thenext decade in the mental hospital and inhalfway houses of a major teaching institu-tion Her delusional sense of identity wasbased on the belief she was special friendlover or potential bride of the idealiseddoctors and other mental health personnelwho took care of her even as she would notor could not recognise her disabled state andassume rudimentary responsibility for herown care Eventually the staff concluded thatthey had nothing more to offer her andtransferred her to the hospital where I mether When we were introduced Carolinersquosattractive and cheerful demeanour belied thedescription of the referring analyst in histransfer note as rsquo a pathetic young womanrsquo but to my dismay I gradually came to realisethat his expression of defeat and despair wasa tting response to the identity Carolinesoon began to enact in her new surroundings

Soon after her admission Caroline brokeinto the locked medication room on the wardand consumed a large quantity of drugs Sheremained comatose and near death for severaldays Many years later she explained to methat she had been unable to tolerate the ideathat she was like the other psychotic dilapi-dated patients who inhabited the ward so she

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 387

decided to get in with the nurses and doctorsrsquo So I broke in to the med room I was goingto get in maybe like the nurses to theirpowerrsquo It reminded her of how she wasunable to get in with her parents as a childbecause they were so out of it She had feltsimilarly outcast at college The terms gettinginto and being out of had become identical tobodily action on her environment that sheendowed with the power to alter reality Aswe shall see this dynamic so apparentlyconsistent with Kleinrsquos formulationsmdashdid notbecome apparent until we both understoodthat we spoke different languages and shebecame able to couch her mental states inordinary language

Twelve years of analytic therapy the rsttwo of which were spent in the hospitalensued prior to the vignettes I shall describeAfter extensive clinical trials on numerouspsychoactive medications both alone and incombination Trilafon proved the only drugthat made a difference By the time of thevignettes the daily dose had been consider-ably tapered to 8 mg Carolinersquos seductiveineptitude made hospital staff feel needed andspecial Her days were spent describing inminute detail to any staff member who wouldlisten everything she was doing conveyingthe impression she could not make up hermind about anything and that this person wasthe special guru who alone could tell her whatto think and do In fact Caroline was usingthese contacts as opportunities to evacuatethe contents of her mind and she paid littleattention to any of the extensive advice shewas given although she made it all intoslogans that she took with her so that sheseemed at times like an encyclopaedia ofbanal bumper stickers Her seemingly naiacuteveshow of interest and idealisation effectivelyconcealed what I gradually came to realisewas hostility and arrogant disdain towards thehelper of the moment She went from oneperson to another enlisting the sympathies ofeach by implying that his or her predecessorhad somehow failed or harmed her and evenas she mouthed idealisations of me I came to

feel like one of many anonymous persons towhom she attempted to give over responsi-bility for her failed life She had dif cultydistinguishing words from concrete actionsrsquo sticks and stonesrsquo from rsquo namesrsquo In factwhen I said something she did not wish tohear she believed and told staff that I hadliterally struck her

At rst I mistook Carolinersquos repetitiousstatements that nothing good would everhappen for expressions of despair and hope-lessness But as she repeatedly destroyedevery opportunity to be constructive abouther life I began to realise that her litany wasa statement of intent and that concealedbeneath her sweet incompetent facade wasenormous ragemdasha drive to despoil whateverwas given her Staff members believed thatthe more anxious confused scattered andupset Caroline appeared the more of theircaretaking she needed The squeaking wheelgot lots of grease but paradoxically it movedslower and slower In concurrent sessionswith a social worker Carolinersquos vacuousmother seemed unaware of the seriousness ofher daughterrsquos problems and denied that therehad ever been any dif culties in their rela-tionship Indeed the fact that there had neverbeen overt con ict between the two wasprobably part of the problem When shevisited Caroline there was no discussion ofsubstantive issues and she spoke to herdaughter in platitudes such as rsquo Just get wellrsquoCaroline became increasingly frantic disor-ganised out of control and suicidal andeventually after all else had failed electro-shock treatment was once again contem-plated In retrospect I believe that the staffand I were as reluctant to face the truth aboutCarolinersquos unwillingness to assume any re-sponsibility for her mind as she was insteadwe assimilated her subtle cues and held oneanother to blame

Despite the destructive system of mutualblaming in which we were entangled Caro-line was eventually mobilised to leave thehospital and surprisingly she never returnedAlthough her inclination and capacity for

388 MICHAEL ROBBINS

independent living and for work remainedmarginal it progressively improved Alongthe way she created every kind of problemimaginable and came near to suicide seriousaccidents troubles with the law destitutionand starvation After years of treatment weuncovered her unconscious envy of homelessstreet-corner mendicants for to her theyrepresented her motherrsquos success in trickingothers to take care of her thereby absolvingher of the necessity of taking responsibilityfor herself

Our sessions typically consisted of Caro-linersquos pressured and detailed recitations anddemonstrations of all the events of her lifesince we had last met along with descriptionsof the problems she had got herself into rsquo Justone more thingrsquo was a favourite responsewhen I would attempt to get a word in of myown and when she was not able to avoid mycomments about her responsibility she wasfull of plans and pledges to do bettermdashnoneof which ever came to fruition In the courseof these recitations she regularly forgot thecentral point and changed the subject andbecause she could not grasp that there wereconsequences to her actions no learningresulted from our discussions Instead sherelentlessly held accountable those of us whoremained devoted to her referring to us withrage as rsquo criminals who got off the hookrsquo Shegradually re-directed her sexual promiscuityand made intensive efforts to seduce me intoparticipating in a mind-losing sexual orgy inwhich she could imagine our identitiesmerged so that by deluding herself she wasme and I her she would get what she imaginedI had My efforts to contain and to help her tofocus were for the most part either ignoredor greeted with rage and blaming When Iresisted her blandishments she would becomeseriously abusive and hint to others includingher family not only that I was an irrespon-sible and ineffective therapist but also thatshe was an innocent victim of my seductionsboth mental and physical

As years went by this grim picture wasgradually mitigated as Caroline took small

steps toward personal autonomy There wereminuscule increments of insight and even anoccasional sense of productively workingtogether but these were regularly undone anddestroyed Increasingly I came to feel thetreatment was stalemated Shortly prior to theevents I will describe she appeared to regressand behave like a typical chronic schizophren-ic with attened affect wooden facial ex-pression a gross tremor and such paralyticambivalence that at times she could hardlymove and sat rocking back and forth Herfamily became concerned and at their urgingI sought a psychopharmacological consulta-tion In place of Trilafon several of the neweranti-psychotic medications were tried bothalone and in combination but her conditiononly seemed to worsen Eventually Trilafontherapy was resumed her condition restabi-lised and our struggles continued I experi-enced overwhelming lethargy during oursessions I tried to believe and to tell Caro-line that she was offering me a lethal dose ofthe kinds of emotion that had overwhelmedher in the course of her futile childhoodefforts to reach her mother in the hope that Iwould not be destroyed by it as she had beenbut would offer her a model for dealing withit but my interpretations had no substantiveeffect on either of us

Although there had always been noticeablepeculiarities in her language I had notfocused attention on them hitherto other thanto tell her on occasion that I did not under-stand and to ask her to clarify One day in apoorly concealed moment of exasperationand without much thought I remarked thatshe was speaking schizophrenese a languageI did not comprehend She was taken abackand informed me that as I was the therapistand she was the schizophrenic it was my jobto understand her After unproductive discus-sions that spanned several sessions I suddenlyhad the liberating thought that whether or notshe chose to learn from me I was not trappedin a hopeless situation I could terminate withher or learn from her and I told her that Iwould choose the latter course and she would

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 389

henceforth educate me about schizophreneseIn situations where hitherto I would have felthopeless angry and bored I pulled out padand pen and took the verbatim notes thatyears later she gave her permission for me touse as data for this paper I questioned her indetail as though I were a student asking theprofessor to explain the lecture To mysurprise my self-serving action nally gotCarolinersquos attention when what I thought hadbeen my efforts to care about her had not Shewas shocked fascinated and amused

In retrospect I believe my decision to learnrather than be driven crazy or to reject herwas a model for what Caroline had beenunable to do as a child Because I nally feltthat I was getting something out of therelationship I felt less immediately investedin whether Caroline did rsquo therapyrsquo and in turnCarolinersquos curiosity was piqued She began toalert me to get out my notebook when shesensed an urge to speak schizophrenese andshe decided to keep a journal When I onceasked her in response to her having justalerted me to get pen and notebook how shewas able to determine that she was about tospeak schizophrenese she replied rsquo Itrsquos whenI put things together in strange ways that no-one else would understandrsquo adding rsquo I take agiant leaprsquo The ensuing discussion willclarify what she meant

Vignette 1

Caroline had gone to play pool after takingher car to be repaired It had been damageddue to irresponsible actions on her part aboutwhich we had talked at length

P I had time to kill Rack it up and pocketrsquo em Sock it and rock rsquo em Clear the tableThe only table that had monkey business to it

A What do you meanP E [a staff member in the hospital whom

Caroline idealised] and I used to play poolA What do you meanP Judgement Day Irsquo ve got so many balls

and I have to put them in the pocket Get theeight-ball in and yoursquo re out Irsquo ve got to shoot

straight from the hip and keep both feet onthe ground Just straight shots coming fromthe heart People have things racked upagainst you but you keep on shooting and ifyou make a racket like me it gives them moreammunition

A What do you meanP Now you really think Irsquo m crazy I racked

rsquo em up and then I bought a root beer The guysaid rsquo You canrsquo t drink that herersquo and then wetalked about getting 50 off lodging in [adistant resort] I said that late September isthe best time to go there [laughs]

A What are you laughing aboutP Well itrsquos not a short walk to get there

and I have $16 in my wallet They donrsquo t wantunethical behaviour in the bar So I thinkabout going there I build up in my mindplaces to go I start out thinking Irsquo m going toclean the apartment Then I do these otherthings Then I start thinking when I donrsquo t thatitrsquos the fault of the landlord and others Then Iran out of time and I had to go to work I waslate again

A What about the resortP Itrsquos a Closetland place [a reference to a

movie about a woman who turned to fantasyin order to endure torture] no problems thereeverything is ne

Analysis

Caroline begins by trying to tell me some-thing in rsquo purersquo schizophrenese After shemakes the observation that I will think she iscrazy she begins to try to explain her thoughtprocess by using more schizophrenese Gra-dually she shifts into ordinary language andattempts to re-cast her thoughts The ordinarylanguage moves the discourse from the con-crete level of things and actions to the realmof subjective thought and feeling symbol andmetaphor An ordinary language renditionderived from what she told me and from thebroader context of our relationship at thattime might be rsquo The Day of Judgement hascome for me Irsquo m in a rage at myself for allmy monkey businessmdashdamaging my car not

390 MICHAEL ROBBINS

being nancially responsible not cleaningmy apartment or being on time for myappointments and treating life like a game Igive others ammunition to use against meIrsquove really got myself behind the eight-balland Irsquove got to get my feet back on theground But Irsquo m in a rage at having to beresponsible I just want to kill more timeblame others wipe the table clean of all myproblems and imagine Irsquom at a resort on aperpetual vacationrsquo

This version of her thoughts requires alanguage of re ection metaphor and symbo-lism In schizophrenese by contrast insteadof a subjective self the thoughts and feelingsabout the situation she has got herself intoshe describes an animated literalmdashnotmetaphoricalmdashpool table microcosm ofwhich she is omnipotent master as shecombines words body actions and things Itis Judgement Day and she literally believesshe is ridding herself of her problems Killingtime involves rage- lled destructive action Italso re ects the absence of comparativeconcepts that would serve to make her awareof the passage of time and its implicationssuch as process work patience and perspec-tive What might appear to be low-grademetaphors or similesmdashcliches such as rsquo shootstraightrsquo rsquo shoot from the hiprsquo rsquo rack rsquo em uprsquo rsquo rock rsquo em and sock rsquo emrsquo being rsquo behind theeight-ballrsquo rsquo killing timersquo mdashare in fact actioncondensations of words body movementsand things based on assonance

Vignette 2

This is a sample of Carolinersquos writtenlanguage She brought in for discussion aletter entitled rsquo The Class Actrsquo which sheproposed to send to twenty- ve or so of herformer caretakers as accompaniment to aValentine card It begins with the salutationrsquo To a Quarter of Caring Peoplersquo

rsquoAlthough I have loving feelings for thepeople who have held me in their thoughts ofcare this card is an expression of appreciationand care not love I am on an excavation of

dignity (dig-knit-tea) The month of nancialFebruary is for my initial dig The month ofMarch my birthday always and forever hold-ing is for my knit The month of April is for apoem once learned as in college

T T TSee these threeHear their chimeThings take time for thought taxes andteaHer letter concludes with a paragraph of

plans for each of the months of May andJune In response to my request that sheexplain this to me in ordinary language shesays

P Itrsquos how overwhelmed I am about thecoming months In the 6th grade a teacher Irespected took her class on an archaeologicaldig That means rsquo dig inrsquo rsquo Dignityrsquo has threeparts dig-knit-tea You have to dig in and knitthings and then drinking tea calms you down

A But why do you say it this way and notsomething like rsquo Irsquo m overwhelmed about howIrsquo m going to manage my life in a digni edway during the coming months I need to nda way to calm down and to use my 6th gradeteacher as a model for digging in workinghard and pulling my life togetherrsquo

P The way I said it is brilliant Besides itkeeps me at a distance from people puts mein a separate space where they wonrsquo t knowwhat Irsquom talking about I donrsquo t want people toknow how much distress Irsquo m in

A So yoursquo re writing a letter of informationabout yourself with all sorts of details aboutyour life to people you supposedly careaboutmdashbut you want to conceal your realdistress from them

P The time is so overwhelming I had tocompartmentalise it into months so I couldmanage my mess Then I send it to respon-sible people and they will take care of it Irsquom lling up their mailbox adding to theirconcern So I gave it to my landlord to readand he said rsquo Take carersquo I got furious He wassupposed to take care of it Irsquo m getting amisery out of it getting to sit in some low-down place and not move out of it Some

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 391

people try to intimidate people I intimatepeople

A What do you meanP Relationships are too dif cult so I word

my way into a relationship with letters Irsquodlike to work my way into your hearts withoutworking my way in and without mentioningthings that would work my way out of yourhearts

Analysis

Caroline is gradually able to re-present thethought behind her letter in an ordinarylanguage statement but even at the conclu-sion of the discussion she is still partlyspeaking schizophrenese If she were able tospeak ordinary language she might saysomething like rsquo I would like to fool myselfand the others in my life that this is really aValentine about loving and feeling close tothem and a resolution not to be such a low-down person but to identify myself withconstructive responsible people and to workhard to dig myself out from the mess Irsquovemade But really this card expresses my wishto avoid the pain of my situation and to sendall my problems away and force them insideothers to take care ofrsquo

What sets the schizophrenese apart fromthe ordinary language version is that she isnot expressing wishes nor is she usingphrases like rsquo digging inrsquo being rsquo low downrsquo rsquo keep me in your heartrsquo rsquo I give you myheartrsquo or rsquo knitting together the strands of herlifersquo metaphorically Instead of workingwhich involves effort patience thoughtfulre ection and bearing of distress she engagesin wording an action discharge that is itsantithesis An ordinary person might work atsolving her problems while singing such songlyrics as rsquo Pack up your troubles in your oldkit bagrsquo or rsquo Pack up your troubles and sendthem all to mersquo When Caroline says rsquo I send it(rsquorsquo my messrsquorsquo ) to responsible people Irsquom lling up their mailbox I word my wayinto a relationship with lettersrsquo she literallybelieves she is digging out and packaging her

word-self into the Valentine card and puttingit in the mailbox-hearts of people who willhold and care for her emotionally distressedself in a way that she cannot or will not doThere is nothing left for her to think about tofeel or to work on Insofar as her actionssucceed in burdening others with her worriesand problems her wishful belief in a sensecomes true Fooling others so that she getsno realistic feedback is necessary in order tocontinue to fool herself The words dignityand intimate are neologismsmdashhomophoniccompounds that combine word action andthing

The interaction with her landlord illustratestwo points Nancy Andreasen et al (1985)believe that while schizophrenics are defec-tive in expressive language receptive lan-guage remains normal It is clear in thisinstance however that Caroline hears whather landlord says in schizophrenese as wellFrom a psychoanalytic perspective it is evi-dent that the underlying thought processresembles the phantasies Klein writes aboutand lends itself to an interpretation of projec-tive identi cation but in order to know this itis rst necessary to re-present the thoughtThe miscommunication that can ensue frommaking a psychoanalytic interpretation basedon the belief the patient is speaking andlistening in ordinary language is illustratedby Carolinersquos interchange with her landlordHe believes she is speaking ordinary lan-guage and he responds to her Valentine bytelling her to rsquo take carersquo She receives hisordinary language statement as though hewere speaking schizophrenese Her construc-tion of it as a rejection throws her into a ragewhich she in turn conceals because sheimagines it will evoke his anger

Vignette 3

P I walked around the lake with mymother when my affair with my collegeprofessor was going on [perhaps 15 yearspreviously] and told her about it So the lastfew days I found three lakes and walked

392 MICHAEL ROBBINS

around them Three guys were on one dockThings reminded me of the professor Birdson an island in the rst lake remind me of aman who didnrsquo t disclose that he was probablyhaving other relationshipsmdashprobably screw-ing other women all those birdsmdashbut it washard to keep my mind together walkingaround the big lake because it was so big toobig a place to keep my mind Then these guysstarted irting playing with my mind Allthree of those lakes make a penis the end themiddle the part you play with

A Why did you do thisP I did it so I could focus on a destructive

relationship I was trying to feel the feeling Ionce had with my mother after the affair Butthe lakes are such a big temptation to fall in itagain Walking around the smaller lake Icould get more in touch with the feeling ofloss and hurt some of the feeling but itwasnrsquo t satisfying The bigger lakes were over-whelming and I didnrsquo t know why I was thereany more I was trying to get into troubleThe birds on the big lake felt threatening allthe people he screwed the things I didnrsquo t seeI was foolish I start to realise it but theninstead it becomes my mother fooled me notwhat I did My mother goes to [her wintervacation home] and spends time watching thebirds I feel betrayed I went to the dock andsaw two birds in a caged area I felt caged Iwondered if those women were prostitutesand ended in jail

A What do you meanP Irsquom trying to deal with what happened

in my twenties with the professor Around thelake my mother and I walked and I told her[Her mother had blamed the professor andtold Caroline not to worry about what she haddone] The lie was talking to my mother aboutit and my motherrsquos lies My interest in thelake is a re-creation of the crime when some-thing equals nothing and nothing equalssomething The lively pond is a metaphor formy mind and my dif culty containing limitsand boundaries staying in bounds and notdestroying everything attending to a straightline of thought The kids represent how easily

Irsquo m distracted and take my mind off The lakeis a reference to my mind and the tree is myinterest in life The tree and the birds are ablaming thing People donrsquo t tell others abouttheir affairs but they communicate insidethemselves about it My mind is the pond thetree Claustrophobia is how rsquo in the darkrsquo apart of me is My thoughts versus my actionsI say one thing make my pledges then I godo another Destructive Irsquo m terri ed of thetemptation to blow everything to bits My treeis empty and alone others have things in theirbranches I canrsquo t walk a straight line I veeroff so I try another planet Itrsquos painful I knowif I canrsquo t stay on line in this little pond thenIrsquo ll never get anywhere in the bigger issues inlife I can look at trees that seem moreinteresting but I have to be able to deal withwhatrsquos here

A Now you are speaking in metaphor whydonrsquo t you always

P Metaphors take more responsibilitythey are more connecting

Analysis

Caroline begins speaking about her trip inliteral schizophrenese but by the conclusionof our discussion the physical elements of hersurroundings have become incorporated inmetaphors A more elaborate translation thatsupplements her efforts with other informa-tion in my possession but preserves her ownwords and phrases might be something likethis rsquo Irsquo ve been thinking about my affair withthe professor trying to return so to speak tothe scene of the crime and nd a differentway in my mind to handle what I couldnrsquo tdeal with then but I keep falling into thesame old patterns of thinking I fell intosexual temptation and I lost my mind I wasrsquorsquo out of my treersquorsquo Did he fool me or did I foolmyself Afterwards my mother and I took awalk I was struggling over whether to facemy feelings of hurt responsibility and guiltor stay in the dark about what I had done anddeny that I was a fool But I couldnrsquo t contain

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 393

myself I canrsquo t seem to rsquorsquo go straightrsquorsquo I fellinto it again and spilled everything out to mymother I deserved to be punished but insteadof making me feel like a jailbird or aprostitute she blamed him and she made likeit was nothing she vacated her mind andlooked for other birds to blamersquo

In this ordinary-language version thereemerges a thoughtful emotional re ectiveself replete with the symbolism and meta-phor that is missing in a language that fuseswords things and actions Caroline describesher schizophrenese much as Bion (1967)described attacks on linkingmdashas a process ofacting rather than thinking and blowing hermind to bits As she observes makingmetaphors takes too much energy When shetalks about getting in touch with feelings sheis not referring to metaphorical touching butto literal sensory-motor activities She can-not separate words from actions and things sothat she might be able to think about thedestructive relationship and the overwhelm-ing temptation Instead she walks around alake that she has rendered equivalent to (notwhich symbolises) the container of her mindher mind itself the loss of her mind thetempting three-part male genital the threeguys playing with her mind and her playingwith the penis Her mind is also literallyindistinguishable from the tree or the cageand the birds caged or in trees are concreteenactments of internalised or projected res-ponsibility and blame Of the three vignettesthis re ects the most mental maturity in so faras Caroline is trying to think and feel in anordinary way at the very same time sheexperiences the omnipotent capacity to elimi-nate what needs to be thought about Bothefforts fail

Discussion

Schizophrenics speak a meaningful lan-guage that differs from ordinary language inits essence not simply with regard to sym-bolism This language has a determina-

tive relationship to delusional thinkingBecause Freudrsquos linguistic analysis ofdreaming as a delusional and hallucinatorywish-ful lmentmdashan encapsulated nocturnalpsychosismdashis of considerable relevancesummarising some of the parallels betweendreaming and schizophrenia will be a usefulpoint of entry Schizophrenia presents itselfon a continuum in varying degrees of regres-sion or compensation In its most regressedform catatonia it resembles a waking dreamstate characterised by absence of wakefulattentiveness and sensory-perceptual domi-nance in the form of hallucinations Verbaland motor action are also absent as in thestate of sensory-perceptual identity to whichFreud made reference in his discussion of theprimary process in dreams (1900) and in hispaper on hallucinatory wish ful lment in theabsence of the object (1911) At the other endof the continuummdashthe state of maximalcompensationmdashthe balance is shifted towardspsycho-motor identity the language ofschizophrenia is one of action and actualisa-tion rather than thought and it resembles thesensorimotor stage of infancy

Discussion of language is usually dividedinto syntax morphology semantics and prag-matics As noted earlier syntax here is moreor less intact With regard to morphologyalthough some of the words used by theschizophrenic may be idiosyncratic the rulesor processes by which they are formed (suchas the use of af xes compounding onomato-poeia proper noun transformation clippingand blending) seem identical to those used inordinary language Therefore the ensuingdiscussion will focus on semantic and prag-matic considerations

Ordinary language is an aspect of re ectivethought that is uniquely situated betweenimpulse and action and enables adaptation toconsensual reality by means of exchangingthoughts and feelings with others and con-templating them oneself Language is neverentirely divorced from the sensorimotorphase in the sense that action in the form ofgestures and bodily expressions as well as

394 MICHAEL ROBBINS

somatic sensations remains an inextricablepart of it but in the course of developmentspeech and writing become relatively autono-mous The more sophisticated the subject themore exible the language becomes in mov-ing between concrete sensory somatic andfunctional considerations on the one handand more abstract re ective and comparativeoperations in which one element stands forabbreviates or enriches one or more otherson the other Individual language developsfrom simple denotationmdashthat is learningculturally determined signi ersmdashto abstractdevelopment of symbols metaphors andsimiles both those shared by a given cultureand those that re ect unique personal experi-ence The capacity for simultaneous parallelor multi-track processing enables language todisguise and conceal as well as to re ectclarify and communicate and to have at anygiven time more than one meaning It is thismulti-dimensional complexity that makespsychoanalysis possible

Because we have no choice but to useordinary language as both a means and areference point for analysing schizophreniclanguage it is natural to assume the latter tobe qualitatively continuous with ordinarylanguage and that linear translation of one tothe other is possiblemdashas in Freudrsquos well-known comparison of dream imagery toEgyptian hieroglyphics We tend to assumethat schizophrenese is a kind of encryptedcode cover or disguise that can be decodedinto its unconscious rsquo realrsquo ordinary languagemeaning Thus it would seem natural to askof a schizophrenic utterance rsquo What does itmeanrsquo mdasha question which I raise repeatedlyin the paper and which I often addressed toCaroline But schizophrenese is not a variantof ordinary language It is unique and intrin-sically different hence such a reduction is notpossible It may eventually be possible how-ever for the schizophrenic to acquire thecapacity to re-state or re-present the thoughtsthat he or she was couching in schizophrenesein ordinary language so that the two lan-guages can be compared and contrasted and

this is what Caroline gradually acquired thecapability to do

From a semantic perspective schizophre-nese is characterised by an absence of theordinary distinctions between word thingbodily process and action The word is usedas though it were identical to the thing towhich it would ordinarily refer as well as toactionsmdashpast present or prospectivemdashon orin relation to the thing and to the mediatingsomatic processes Words lack their ordinaryconnotation as representations and refer-ences they have become happenings orevents Caroline once referred to this processas rsquo combination thinkingrsquo mdasha term nearlyidentical to the concept rsquo combinative think-ingrsquo proposed by McClain Johnston andPhilip Holzman (1985) In ordinary discoursespeaker and listener recognise the symbolicimport of a concrete-sounding statement suchas rsquo I have a special pipeline to the bossrsquo orrsquo Letrsquos smoke a peace-pipersquo The metaphorserves as emphasis or highlighting of a keyidea that is being talked about In contrastCaroline once literally handed me a sectionof plumberrsquos pipemdasha gesture so pregnantwith meaning yet impregnable to my inter-pretive skills that it would have been easy toconclude that the pipe was an arcane symbolWhen I questioned her about it however shewas able to tell me that she was making aconnection with me In other words the pipewas just a pipe An ordinary speaker mightmetaphorically and passionately declare loveby saying rsquo I give you my heartrsquo or sing aboutempathic sharing in the folk lyric rsquo Pack upyour troubles in your old kit bag and smilersquo but in discussing the thought process involvedin mailing her Valentine card with a largeheart on it to a large number of casual andformer acquaintances Caroline told me shewas packaging and mailing her word-self toothers she looked upon as more willing toassume responsibility for her than she was forherself While it is tempting to use terms likecollapse implosion explosion fusion orboundary loss to describe the creation ofthese concrete linguistic identities such

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 395

terms convey the incorrect impression thatschizophrenese is a regressive degradation ofordinary language Rather schizophrenese isa language of equivalence immediacy andaction in contrast to ordinary languagewhich supports representational thinkingMoreover there is no evidence that theschizophrenic ever rsquo spokersquo differently

Schizophrenese then is an immediatelanguage of the body and its function in theworld of things particularly motor (throwinghitting) respiratory (breathing talking andblowing as in the felicitous expression rsquo mindblowingrsquo ) gastrointestinal (vomiting and de-fecating) and orgasmic (rsquo fucking onersquos brainsoutrsquo ) Caroline describes printmaking as fol-lows rsquo I was pounding it down oozing out myblack insides on paperrsquo She described one ofher long walks as follows rsquo I want to run andrun and run away from the painful feelings Ifeel like I can split off disintegrate and getaway from them This is what schizophreneseis aboutrsquo She said rsquo I give people the breath-ing they need I make a case to take care ofme I respire them With every breath I givethem responsibilityrsquo

rsquo Respirersquo is a neologism made by theordinary morphological processes of clippingand condensation of the physical process ofrespiration and the work-related concept ofresponsibility but it is a thing and not areference She said rsquo Irsquom mad today I had toput in limits and boundaries and not spill myguts There are lots of snakes inside me and Iwant you to eat them for mersquo In reference toan episode of vomiting during a meal withher family when they questioned her aboutinstances of her irresponsible behaviour shecomments rsquo I couldnrsquo t bear the feeling ofhaving taken all those courses wastingmoney scattering my time and I had to getrid of them I was throwing up the feelingrsquo

It follows from the nature of their languagethat schizophrenics lack patience self-controland restraint have dif culty conceptualisingprocess and sequence distinguishing pastfrom present and here from there and seeingthe consequences of their actions and thereby

learning from experience Carolinersquos Valen-tine mailing was an example of how sheregularly bombarded with letters persons withwhom she had no current contact often fromthe distant past She called these bizarremass-mailings rsquo Trail Newsrsquo and she believedshe was relieving herself into these others ofher otherwise troubling mental contents Shesaid rsquo If your arm was controlled by maturethought then you could wait Itrsquos the entangle-ment quality instead of being able to stop andthinkrsquo

Despite its sometimes strange and colour-ful character the language of schizophreniais neither a language of conscious awareness(re ection) nor of unconscious concealment(repression) It does not support mentalrepresentation symbolisation and re ectionFailure to appreciate this may be what led ageneration of analysts including such semi-nal gures as Frieda Fromm-Reichmann toidealise schizophrenic persons as havingspecial psychic acuity and access to theirunconscious mental life that ordinary personsdo not A neurotic patient might refer to herhabitual and inappropriate tendency to con- de personal affairs to others using theunconscious symbolism of a phrase such asrsquo spilling my gutsrsquo If questioned she wouldhave the sense that she had said somethingworth re ecting on thinking about andanalysing the symbolic meaning of WhenCaroline used the expression as noted earliershe not only believed there were snakes in herintestines that she needed to give to me(although she could reality-test the idea ifpressed to do so) but she referred to anearlier occasion when she had vomited to ridherself of unwanted feelings In an ordinaryanalysis the analyst might suggest that thepatientrsquos behaviour and associations indicatethat she viewed her problems as a mess shebelieved she could dump on to or into theanalyst and the patient might respond to theinterpretation with associations to oral or analfantasies and memories When Caroline saysrsquo I send it [rsquorsquo my messrsquorsquo ] to responsible people Irsquom lling up their mailbox I word my

396 MICHAEL ROBBINS

way into a relationship with lettersrsquo she isdoing something and not speaking metaphori-cally or thinking Whereas an ordinary personmight be aware of the underlying fantasiesand con icts Caroline literally believes thatshe is excreting her self which is identical toher words into others It might be moreaccurate to say that she is expressing phan-tasy in the Kleinian sense but if so even atthis level of discourse when she makes anattempt to interpret the original schizophren-ese account of her mass mailings in alanguage more comprehensible to me she isstill speaking in a language of closure andenactment devoid of interpretable symbo-lism and unconscious meaning

While schizophrenia is a state of self-centredness or egocentricity in the solipsisticsense of the term schizophrenese paradoxi-cally is a language without a centred subjectexcept in the most rudimentary sense ofobserver and actor of a drama The subjectiversquo Irsquo denoting the presence of conscious re ec-tion and thought about beliefs fantasiesemotions and con icts is largely missing andin its stead Caroline describes a microcosm inwhich she is participant consisting of suchthings as a pool table with its sticks and ballsher sewing box with its bobbins and yarns orthe terrain bordering the three lakes she haswalked around with its birds trees andpeople In ordinary discourse one might shareonersquos subjective thoughts and feelings aboutonersquos mother by saying rsquo Irsquo m always behindthe eight-ball with herrsquo or rsquo I was cluelesswhen it came to my mother itrsquos the oldproblem of the irresistible force and theimmovable objectrsquo Caroline by contrastdescribed to me a game of pool she hadplayed in which her mother was the cue balland she had been able to pocket the otherballs without moving the cue-ball or hittingthe eight-ball Her affect was one of triumphfor she literally believed she had solved theproblem of dealing with her mother

This example will serve to segue from thesemantic to the pragmatic aspects of schizo-phrenese which is closely related to delusion

reversal and undoing and deceptionmdashpro-cesses that enable the user to avoid thoughtand awareness of feelings Ordinary languageserves to adapt the waking user to anrsquo externalrsquo world as subjectively perceivedwithin broad consensual outlines The worldof the schizophrenic by contrast is internalthough unrecognised as such and consists ofidiosyncratic microcosms that combine whatmore maturely we look upon as psyche withwhat is sensed and perceived Subjectivelyby manipulating mental contents the schizo-phrenic experiences control over the worldThe language is felt by its user to possess thepower to undo reverse and eliminate intoler-able reality both past and present It is alanguage of psychic alchemy or delusionalomnipotence (Burnham 1955 Frosch 1967Glass 1981) Caroline told me rsquo I fool myselfinto thinking it didnrsquo t happenrsquo Speakingordinary language she referred to schizo-phrenese as rsquo the language of wish and desirersquo With her knitting a game of pool a walkaround the lake or detailed letters to othersshe creates a universe that she can describeand act upon with the conviction that she isaltering events problems and associated feel-ings both present and past Ordinary lan-guage also employs reversal but in anentirely different way and for an oppositepurpose By its stark contrast with the sharedand implicitly acknowledged context such areversal in ordinary language serves to high-light or accentuate the feeling the speakerwishes to conveymdashfor instance in the remarkrsquo Hersquos a ne one to be saying thatrsquo Thedelusional reversal of schizophrenia by con-trast eliminates the necessity to differentiatemind from reality to bear painful feelingsand to adapt to a consensually validatedworld An ordinary person faced with apainful situation might transiently nd solaceby constructing heroic fantasies and becom-ing in imagination someone able to surmountany dif culty invulnerable to pain and hurtSchizophrenic language by contrast lacksthe rsquo as if rsquo capacity inherent in the use ofmetaphor that is required to construct such a

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 397

fantasy Instead of an unconscious fantasyand a language capable of contemplation theschizophrenic experiences a delusional senseof actualisation rsquo isrsquo has replaced rsquo as if rsquo

The qualitative difference between schizo-phrenese and ordinary language helps toaccount for the fact that delusions are xedbeliefs refractory to clinical analysis In themind of their creator they are actualitiesrather than fantasies so that there is nothingto be thought about Some time after thevignettes that I have presented when Carolinehad become more uent in ordinary languageand more uid in moving back and forthbetween the two she commenced an hour byobserving my new shoes and commenting rsquo Itmakes me angry that you always have neatshoes and I donrsquo trsquo I observed aloud that herown feet were beginning to move Sheresponded rsquo Our feet move togetherrsquo andadded that she would like me to hug her Iinquired what that was about and she said rsquo Iwant to be in your shoesrsquo She was then ableto express in ordinary language her aware-ness that she was not expressing a fantasy orsymbolising a wish to be more like me butwas verging on speaking the thoughtlesslanguage of schizophrenese which in the pastwould have achieved a sense of actualisationand closure (in this case the delusion she hadexchanged identities with me) rather thanallowing the opportunity for re ectivethought about painful feelings and issuesrelated to being her own separate person

Paradoxically it is this very failure ofschizophrenic language to distinguishthoughts from events that may disguise itsbizarreness and conceal the delusional think-ing it supports because utterances may seemto patient and analyst to be nothing more thandescriptions or observations of happeningsIn telling me about the degrading affair withher college professor and her subsequentconversation about it with her mother Caro-line believed she was doing it over differentlynot simply wishing she might

No discussion of schizophrenic languagewould be complete without a comment about

neologisms which incidentally are notnearly so speci c to schizophrenia as gener-ally believed They appear to be constructedaccording to ordinary morphological princi-ples and it is primarily in their semantic andpragmatic aspects that they are remarkableOne day Caroline said rsquo Irsquove got it set up atwork so no-one can refrain from authoritingme They tell me what to do It pisses me offrsquoWhen I inquired if she believed authoritingwas a legitimate word she said she supposednot I then asked why she did not say whatshe meant in acceptable English She repliedthat it would compel her to face feelings ofshame at loss of dignity and control over herown life By not accepting the existence of anordinary language word to express her feelingstate she managed to repudiate the reality ofthe issue and to avoid the feelings about itThis is another example of the identity ofwords things and actions If the word is thereal thing and she can substitute a neologismthen she can delude herself that the thing orthe problem no longer exists It is easy for theanalyst who is struggling to understand thepatient to gloss over the idiosyncratic aspectof the word in favour of what appears to bethe underlying meaning as one might do withsome of the peculiarities of speech of some-one not uent in onersquos native tonguemdashin thisinstance to assume that Caroline rsquo reallyrsquomeans rsquo acting like an authority withrsquo In thisway the patientrsquos delusion combines with theanalystrsquos illusion to form collusion

Schizophrenic patients do not want to beunderstood for it threatens them with un-wanted knowledge about themselves Schizo-phrenese not only lacks communicativeintent it is a language of deception In orderto function as a vehicle of communicationcontextual elements and related linguisticassumptionsmdashpersonal social and culturalmdashmust be suf ciently concordant in speakerand listenermdashthe rsquo musicrsquo so to speak thataccompanies the words In the case of schizo-phrenese not only are these assumptionsidiosyncratic to the speaker or writer but alsothe speaker or writer is unwilling to elucidate

398 MICHAEL ROBBINS

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

decided to get in with the nurses and doctorsrsquo So I broke in to the med room I was goingto get in maybe like the nurses to theirpowerrsquo It reminded her of how she wasunable to get in with her parents as a childbecause they were so out of it She had feltsimilarly outcast at college The terms gettinginto and being out of had become identical tobodily action on her environment that sheendowed with the power to alter reality Aswe shall see this dynamic so apparentlyconsistent with Kleinrsquos formulationsmdashdid notbecome apparent until we both understoodthat we spoke different languages and shebecame able to couch her mental states inordinary language

Twelve years of analytic therapy the rsttwo of which were spent in the hospitalensued prior to the vignettes I shall describeAfter extensive clinical trials on numerouspsychoactive medications both alone and incombination Trilafon proved the only drugthat made a difference By the time of thevignettes the daily dose had been consider-ably tapered to 8 mg Carolinersquos seductiveineptitude made hospital staff feel needed andspecial Her days were spent describing inminute detail to any staff member who wouldlisten everything she was doing conveyingthe impression she could not make up hermind about anything and that this person wasthe special guru who alone could tell her whatto think and do In fact Caroline was usingthese contacts as opportunities to evacuatethe contents of her mind and she paid littleattention to any of the extensive advice shewas given although she made it all intoslogans that she took with her so that sheseemed at times like an encyclopaedia ofbanal bumper stickers Her seemingly naiacuteveshow of interest and idealisation effectivelyconcealed what I gradually came to realisewas hostility and arrogant disdain towards thehelper of the moment She went from oneperson to another enlisting the sympathies ofeach by implying that his or her predecessorhad somehow failed or harmed her and evenas she mouthed idealisations of me I came to

feel like one of many anonymous persons towhom she attempted to give over responsi-bility for her failed life She had dif cultydistinguishing words from concrete actionsrsquo sticks and stonesrsquo from rsquo namesrsquo In factwhen I said something she did not wish tohear she believed and told staff that I hadliterally struck her

At rst I mistook Carolinersquos repetitiousstatements that nothing good would everhappen for expressions of despair and hope-lessness But as she repeatedly destroyedevery opportunity to be constructive abouther life I began to realise that her litany wasa statement of intent and that concealedbeneath her sweet incompetent facade wasenormous ragemdasha drive to despoil whateverwas given her Staff members believed thatthe more anxious confused scattered andupset Caroline appeared the more of theircaretaking she needed The squeaking wheelgot lots of grease but paradoxically it movedslower and slower In concurrent sessionswith a social worker Carolinersquos vacuousmother seemed unaware of the seriousness ofher daughterrsquos problems and denied that therehad ever been any dif culties in their rela-tionship Indeed the fact that there had neverbeen overt con ict between the two wasprobably part of the problem When shevisited Caroline there was no discussion ofsubstantive issues and she spoke to herdaughter in platitudes such as rsquo Just get wellrsquoCaroline became increasingly frantic disor-ganised out of control and suicidal andeventually after all else had failed electro-shock treatment was once again contem-plated In retrospect I believe that the staffand I were as reluctant to face the truth aboutCarolinersquos unwillingness to assume any re-sponsibility for her mind as she was insteadwe assimilated her subtle cues and held oneanother to blame

Despite the destructive system of mutualblaming in which we were entangled Caro-line was eventually mobilised to leave thehospital and surprisingly she never returnedAlthough her inclination and capacity for

388 MICHAEL ROBBINS

independent living and for work remainedmarginal it progressively improved Alongthe way she created every kind of problemimaginable and came near to suicide seriousaccidents troubles with the law destitutionand starvation After years of treatment weuncovered her unconscious envy of homelessstreet-corner mendicants for to her theyrepresented her motherrsquos success in trickingothers to take care of her thereby absolvingher of the necessity of taking responsibilityfor herself

Our sessions typically consisted of Caro-linersquos pressured and detailed recitations anddemonstrations of all the events of her lifesince we had last met along with descriptionsof the problems she had got herself into rsquo Justone more thingrsquo was a favourite responsewhen I would attempt to get a word in of myown and when she was not able to avoid mycomments about her responsibility she wasfull of plans and pledges to do bettermdashnoneof which ever came to fruition In the courseof these recitations she regularly forgot thecentral point and changed the subject andbecause she could not grasp that there wereconsequences to her actions no learningresulted from our discussions Instead sherelentlessly held accountable those of us whoremained devoted to her referring to us withrage as rsquo criminals who got off the hookrsquo Shegradually re-directed her sexual promiscuityand made intensive efforts to seduce me intoparticipating in a mind-losing sexual orgy inwhich she could imagine our identitiesmerged so that by deluding herself she wasme and I her she would get what she imaginedI had My efforts to contain and to help her tofocus were for the most part either ignoredor greeted with rage and blaming When Iresisted her blandishments she would becomeseriously abusive and hint to others includingher family not only that I was an irrespon-sible and ineffective therapist but also thatshe was an innocent victim of my seductionsboth mental and physical

As years went by this grim picture wasgradually mitigated as Caroline took small

steps toward personal autonomy There wereminuscule increments of insight and even anoccasional sense of productively workingtogether but these were regularly undone anddestroyed Increasingly I came to feel thetreatment was stalemated Shortly prior to theevents I will describe she appeared to regressand behave like a typical chronic schizophren-ic with attened affect wooden facial ex-pression a gross tremor and such paralyticambivalence that at times she could hardlymove and sat rocking back and forth Herfamily became concerned and at their urgingI sought a psychopharmacological consulta-tion In place of Trilafon several of the neweranti-psychotic medications were tried bothalone and in combination but her conditiononly seemed to worsen Eventually Trilafontherapy was resumed her condition restabi-lised and our struggles continued I experi-enced overwhelming lethargy during oursessions I tried to believe and to tell Caro-line that she was offering me a lethal dose ofthe kinds of emotion that had overwhelmedher in the course of her futile childhoodefforts to reach her mother in the hope that Iwould not be destroyed by it as she had beenbut would offer her a model for dealing withit but my interpretations had no substantiveeffect on either of us

Although there had always been noticeablepeculiarities in her language I had notfocused attention on them hitherto other thanto tell her on occasion that I did not under-stand and to ask her to clarify One day in apoorly concealed moment of exasperationand without much thought I remarked thatshe was speaking schizophrenese a languageI did not comprehend She was taken abackand informed me that as I was the therapistand she was the schizophrenic it was my jobto understand her After unproductive discus-sions that spanned several sessions I suddenlyhad the liberating thought that whether or notshe chose to learn from me I was not trappedin a hopeless situation I could terminate withher or learn from her and I told her that Iwould choose the latter course and she would

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 389

henceforth educate me about schizophreneseIn situations where hitherto I would have felthopeless angry and bored I pulled out padand pen and took the verbatim notes thatyears later she gave her permission for me touse as data for this paper I questioned her indetail as though I were a student asking theprofessor to explain the lecture To mysurprise my self-serving action nally gotCarolinersquos attention when what I thought hadbeen my efforts to care about her had not Shewas shocked fascinated and amused

In retrospect I believe my decision to learnrather than be driven crazy or to reject herwas a model for what Caroline had beenunable to do as a child Because I nally feltthat I was getting something out of therelationship I felt less immediately investedin whether Caroline did rsquo therapyrsquo and in turnCarolinersquos curiosity was piqued She began toalert me to get out my notebook when shesensed an urge to speak schizophrenese andshe decided to keep a journal When I onceasked her in response to her having justalerted me to get pen and notebook how shewas able to determine that she was about tospeak schizophrenese she replied rsquo Itrsquos whenI put things together in strange ways that no-one else would understandrsquo adding rsquo I take agiant leaprsquo The ensuing discussion willclarify what she meant

Vignette 1

Caroline had gone to play pool after takingher car to be repaired It had been damageddue to irresponsible actions on her part aboutwhich we had talked at length

P I had time to kill Rack it up and pocketrsquo em Sock it and rock rsquo em Clear the tableThe only table that had monkey business to it

A What do you meanP E [a staff member in the hospital whom

Caroline idealised] and I used to play poolA What do you meanP Judgement Day Irsquo ve got so many balls

and I have to put them in the pocket Get theeight-ball in and yoursquo re out Irsquo ve got to shoot

straight from the hip and keep both feet onthe ground Just straight shots coming fromthe heart People have things racked upagainst you but you keep on shooting and ifyou make a racket like me it gives them moreammunition

A What do you meanP Now you really think Irsquo m crazy I racked

rsquo em up and then I bought a root beer The guysaid rsquo You canrsquo t drink that herersquo and then wetalked about getting 50 off lodging in [adistant resort] I said that late September isthe best time to go there [laughs]

A What are you laughing aboutP Well itrsquos not a short walk to get there

and I have $16 in my wallet They donrsquo t wantunethical behaviour in the bar So I thinkabout going there I build up in my mindplaces to go I start out thinking Irsquo m going toclean the apartment Then I do these otherthings Then I start thinking when I donrsquo t thatitrsquos the fault of the landlord and others Then Iran out of time and I had to go to work I waslate again

A What about the resortP Itrsquos a Closetland place [a reference to a

movie about a woman who turned to fantasyin order to endure torture] no problems thereeverything is ne

Analysis

Caroline begins by trying to tell me some-thing in rsquo purersquo schizophrenese After shemakes the observation that I will think she iscrazy she begins to try to explain her thoughtprocess by using more schizophrenese Gra-dually she shifts into ordinary language andattempts to re-cast her thoughts The ordinarylanguage moves the discourse from the con-crete level of things and actions to the realmof subjective thought and feeling symbol andmetaphor An ordinary language renditionderived from what she told me and from thebroader context of our relationship at thattime might be rsquo The Day of Judgement hascome for me Irsquo m in a rage at myself for allmy monkey businessmdashdamaging my car not

390 MICHAEL ROBBINS

being nancially responsible not cleaningmy apartment or being on time for myappointments and treating life like a game Igive others ammunition to use against meIrsquove really got myself behind the eight-balland Irsquove got to get my feet back on theground But Irsquo m in a rage at having to beresponsible I just want to kill more timeblame others wipe the table clean of all myproblems and imagine Irsquom at a resort on aperpetual vacationrsquo

This version of her thoughts requires alanguage of re ection metaphor and symbo-lism In schizophrenese by contrast insteadof a subjective self the thoughts and feelingsabout the situation she has got herself intoshe describes an animated literalmdashnotmetaphoricalmdashpool table microcosm ofwhich she is omnipotent master as shecombines words body actions and things Itis Judgement Day and she literally believesshe is ridding herself of her problems Killingtime involves rage- lled destructive action Italso re ects the absence of comparativeconcepts that would serve to make her awareof the passage of time and its implicationssuch as process work patience and perspec-tive What might appear to be low-grademetaphors or similesmdashcliches such as rsquo shootstraightrsquo rsquo shoot from the hiprsquo rsquo rack rsquo em uprsquo rsquo rock rsquo em and sock rsquo emrsquo being rsquo behind theeight-ballrsquo rsquo killing timersquo mdashare in fact actioncondensations of words body movementsand things based on assonance

Vignette 2

This is a sample of Carolinersquos writtenlanguage She brought in for discussion aletter entitled rsquo The Class Actrsquo which sheproposed to send to twenty- ve or so of herformer caretakers as accompaniment to aValentine card It begins with the salutationrsquo To a Quarter of Caring Peoplersquo

rsquoAlthough I have loving feelings for thepeople who have held me in their thoughts ofcare this card is an expression of appreciationand care not love I am on an excavation of

dignity (dig-knit-tea) The month of nancialFebruary is for my initial dig The month ofMarch my birthday always and forever hold-ing is for my knit The month of April is for apoem once learned as in college

T T TSee these threeHear their chimeThings take time for thought taxes andteaHer letter concludes with a paragraph of

plans for each of the months of May andJune In response to my request that sheexplain this to me in ordinary language shesays

P Itrsquos how overwhelmed I am about thecoming months In the 6th grade a teacher Irespected took her class on an archaeologicaldig That means rsquo dig inrsquo rsquo Dignityrsquo has threeparts dig-knit-tea You have to dig in and knitthings and then drinking tea calms you down

A But why do you say it this way and notsomething like rsquo Irsquo m overwhelmed about howIrsquo m going to manage my life in a digni edway during the coming months I need to nda way to calm down and to use my 6th gradeteacher as a model for digging in workinghard and pulling my life togetherrsquo

P The way I said it is brilliant Besides itkeeps me at a distance from people puts mein a separate space where they wonrsquo t knowwhat Irsquom talking about I donrsquo t want people toknow how much distress Irsquo m in

A So yoursquo re writing a letter of informationabout yourself with all sorts of details aboutyour life to people you supposedly careaboutmdashbut you want to conceal your realdistress from them

P The time is so overwhelming I had tocompartmentalise it into months so I couldmanage my mess Then I send it to respon-sible people and they will take care of it Irsquom lling up their mailbox adding to theirconcern So I gave it to my landlord to readand he said rsquo Take carersquo I got furious He wassupposed to take care of it Irsquo m getting amisery out of it getting to sit in some low-down place and not move out of it Some

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 391

people try to intimidate people I intimatepeople

A What do you meanP Relationships are too dif cult so I word

my way into a relationship with letters Irsquodlike to work my way into your hearts withoutworking my way in and without mentioningthings that would work my way out of yourhearts

Analysis

Caroline is gradually able to re-present thethought behind her letter in an ordinarylanguage statement but even at the conclu-sion of the discussion she is still partlyspeaking schizophrenese If she were able tospeak ordinary language she might saysomething like rsquo I would like to fool myselfand the others in my life that this is really aValentine about loving and feeling close tothem and a resolution not to be such a low-down person but to identify myself withconstructive responsible people and to workhard to dig myself out from the mess Irsquovemade But really this card expresses my wishto avoid the pain of my situation and to sendall my problems away and force them insideothers to take care ofrsquo

What sets the schizophrenese apart fromthe ordinary language version is that she isnot expressing wishes nor is she usingphrases like rsquo digging inrsquo being rsquo low downrsquo rsquo keep me in your heartrsquo rsquo I give you myheartrsquo or rsquo knitting together the strands of herlifersquo metaphorically Instead of workingwhich involves effort patience thoughtfulre ection and bearing of distress she engagesin wording an action discharge that is itsantithesis An ordinary person might work atsolving her problems while singing such songlyrics as rsquo Pack up your troubles in your oldkit bagrsquo or rsquo Pack up your troubles and sendthem all to mersquo When Caroline says rsquo I send it(rsquorsquo my messrsquorsquo ) to responsible people Irsquom lling up their mailbox I word my wayinto a relationship with lettersrsquo she literallybelieves she is digging out and packaging her

word-self into the Valentine card and puttingit in the mailbox-hearts of people who willhold and care for her emotionally distressedself in a way that she cannot or will not doThere is nothing left for her to think about tofeel or to work on Insofar as her actionssucceed in burdening others with her worriesand problems her wishful belief in a sensecomes true Fooling others so that she getsno realistic feedback is necessary in order tocontinue to fool herself The words dignityand intimate are neologismsmdashhomophoniccompounds that combine word action andthing

The interaction with her landlord illustratestwo points Nancy Andreasen et al (1985)believe that while schizophrenics are defec-tive in expressive language receptive lan-guage remains normal It is clear in thisinstance however that Caroline hears whather landlord says in schizophrenese as wellFrom a psychoanalytic perspective it is evi-dent that the underlying thought processresembles the phantasies Klein writes aboutand lends itself to an interpretation of projec-tive identi cation but in order to know this itis rst necessary to re-present the thoughtThe miscommunication that can ensue frommaking a psychoanalytic interpretation basedon the belief the patient is speaking andlistening in ordinary language is illustratedby Carolinersquos interchange with her landlordHe believes she is speaking ordinary lan-guage and he responds to her Valentine bytelling her to rsquo take carersquo She receives hisordinary language statement as though hewere speaking schizophrenese Her construc-tion of it as a rejection throws her into a ragewhich she in turn conceals because sheimagines it will evoke his anger

Vignette 3

P I walked around the lake with mymother when my affair with my collegeprofessor was going on [perhaps 15 yearspreviously] and told her about it So the lastfew days I found three lakes and walked

392 MICHAEL ROBBINS

around them Three guys were on one dockThings reminded me of the professor Birdson an island in the rst lake remind me of aman who didnrsquo t disclose that he was probablyhaving other relationshipsmdashprobably screw-ing other women all those birdsmdashbut it washard to keep my mind together walkingaround the big lake because it was so big toobig a place to keep my mind Then these guysstarted irting playing with my mind Allthree of those lakes make a penis the end themiddle the part you play with

A Why did you do thisP I did it so I could focus on a destructive

relationship I was trying to feel the feeling Ionce had with my mother after the affair Butthe lakes are such a big temptation to fall in itagain Walking around the smaller lake Icould get more in touch with the feeling ofloss and hurt some of the feeling but itwasnrsquo t satisfying The bigger lakes were over-whelming and I didnrsquo t know why I was thereany more I was trying to get into troubleThe birds on the big lake felt threatening allthe people he screwed the things I didnrsquo t seeI was foolish I start to realise it but theninstead it becomes my mother fooled me notwhat I did My mother goes to [her wintervacation home] and spends time watching thebirds I feel betrayed I went to the dock andsaw two birds in a caged area I felt caged Iwondered if those women were prostitutesand ended in jail

A What do you meanP Irsquom trying to deal with what happened

in my twenties with the professor Around thelake my mother and I walked and I told her[Her mother had blamed the professor andtold Caroline not to worry about what she haddone] The lie was talking to my mother aboutit and my motherrsquos lies My interest in thelake is a re-creation of the crime when some-thing equals nothing and nothing equalssomething The lively pond is a metaphor formy mind and my dif culty containing limitsand boundaries staying in bounds and notdestroying everything attending to a straightline of thought The kids represent how easily

Irsquo m distracted and take my mind off The lakeis a reference to my mind and the tree is myinterest in life The tree and the birds are ablaming thing People donrsquo t tell others abouttheir affairs but they communicate insidethemselves about it My mind is the pond thetree Claustrophobia is how rsquo in the darkrsquo apart of me is My thoughts versus my actionsI say one thing make my pledges then I godo another Destructive Irsquo m terri ed of thetemptation to blow everything to bits My treeis empty and alone others have things in theirbranches I canrsquo t walk a straight line I veeroff so I try another planet Itrsquos painful I knowif I canrsquo t stay on line in this little pond thenIrsquo ll never get anywhere in the bigger issues inlife I can look at trees that seem moreinteresting but I have to be able to deal withwhatrsquos here

A Now you are speaking in metaphor whydonrsquo t you always

P Metaphors take more responsibilitythey are more connecting

Analysis

Caroline begins speaking about her trip inliteral schizophrenese but by the conclusionof our discussion the physical elements of hersurroundings have become incorporated inmetaphors A more elaborate translation thatsupplements her efforts with other informa-tion in my possession but preserves her ownwords and phrases might be something likethis rsquo Irsquo ve been thinking about my affair withthe professor trying to return so to speak tothe scene of the crime and nd a differentway in my mind to handle what I couldnrsquo tdeal with then but I keep falling into thesame old patterns of thinking I fell intosexual temptation and I lost my mind I wasrsquorsquo out of my treersquorsquo Did he fool me or did I foolmyself Afterwards my mother and I took awalk I was struggling over whether to facemy feelings of hurt responsibility and guiltor stay in the dark about what I had done anddeny that I was a fool But I couldnrsquo t contain

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 393

myself I canrsquo t seem to rsquorsquo go straightrsquorsquo I fellinto it again and spilled everything out to mymother I deserved to be punished but insteadof making me feel like a jailbird or aprostitute she blamed him and she made likeit was nothing she vacated her mind andlooked for other birds to blamersquo

In this ordinary-language version thereemerges a thoughtful emotional re ectiveself replete with the symbolism and meta-phor that is missing in a language that fuseswords things and actions Caroline describesher schizophrenese much as Bion (1967)described attacks on linkingmdashas a process ofacting rather than thinking and blowing hermind to bits As she observes makingmetaphors takes too much energy When shetalks about getting in touch with feelings sheis not referring to metaphorical touching butto literal sensory-motor activities She can-not separate words from actions and things sothat she might be able to think about thedestructive relationship and the overwhelm-ing temptation Instead she walks around alake that she has rendered equivalent to (notwhich symbolises) the container of her mindher mind itself the loss of her mind thetempting three-part male genital the threeguys playing with her mind and her playingwith the penis Her mind is also literallyindistinguishable from the tree or the cageand the birds caged or in trees are concreteenactments of internalised or projected res-ponsibility and blame Of the three vignettesthis re ects the most mental maturity in so faras Caroline is trying to think and feel in anordinary way at the very same time sheexperiences the omnipotent capacity to elimi-nate what needs to be thought about Bothefforts fail

Discussion

Schizophrenics speak a meaningful lan-guage that differs from ordinary language inits essence not simply with regard to sym-bolism This language has a determina-

tive relationship to delusional thinkingBecause Freudrsquos linguistic analysis ofdreaming as a delusional and hallucinatorywish-ful lmentmdashan encapsulated nocturnalpsychosismdashis of considerable relevancesummarising some of the parallels betweendreaming and schizophrenia will be a usefulpoint of entry Schizophrenia presents itselfon a continuum in varying degrees of regres-sion or compensation In its most regressedform catatonia it resembles a waking dreamstate characterised by absence of wakefulattentiveness and sensory-perceptual domi-nance in the form of hallucinations Verbaland motor action are also absent as in thestate of sensory-perceptual identity to whichFreud made reference in his discussion of theprimary process in dreams (1900) and in hispaper on hallucinatory wish ful lment in theabsence of the object (1911) At the other endof the continuummdashthe state of maximalcompensationmdashthe balance is shifted towardspsycho-motor identity the language ofschizophrenia is one of action and actualisa-tion rather than thought and it resembles thesensorimotor stage of infancy

Discussion of language is usually dividedinto syntax morphology semantics and prag-matics As noted earlier syntax here is moreor less intact With regard to morphologyalthough some of the words used by theschizophrenic may be idiosyncratic the rulesor processes by which they are formed (suchas the use of af xes compounding onomato-poeia proper noun transformation clippingand blending) seem identical to those used inordinary language Therefore the ensuingdiscussion will focus on semantic and prag-matic considerations

Ordinary language is an aspect of re ectivethought that is uniquely situated betweenimpulse and action and enables adaptation toconsensual reality by means of exchangingthoughts and feelings with others and con-templating them oneself Language is neverentirely divorced from the sensorimotorphase in the sense that action in the form ofgestures and bodily expressions as well as

394 MICHAEL ROBBINS

somatic sensations remains an inextricablepart of it but in the course of developmentspeech and writing become relatively autono-mous The more sophisticated the subject themore exible the language becomes in mov-ing between concrete sensory somatic andfunctional considerations on the one handand more abstract re ective and comparativeoperations in which one element stands forabbreviates or enriches one or more otherson the other Individual language developsfrom simple denotationmdashthat is learningculturally determined signi ersmdashto abstractdevelopment of symbols metaphors andsimiles both those shared by a given cultureand those that re ect unique personal experi-ence The capacity for simultaneous parallelor multi-track processing enables language todisguise and conceal as well as to re ectclarify and communicate and to have at anygiven time more than one meaning It is thismulti-dimensional complexity that makespsychoanalysis possible

Because we have no choice but to useordinary language as both a means and areference point for analysing schizophreniclanguage it is natural to assume the latter tobe qualitatively continuous with ordinarylanguage and that linear translation of one tothe other is possiblemdashas in Freudrsquos well-known comparison of dream imagery toEgyptian hieroglyphics We tend to assumethat schizophrenese is a kind of encryptedcode cover or disguise that can be decodedinto its unconscious rsquo realrsquo ordinary languagemeaning Thus it would seem natural to askof a schizophrenic utterance rsquo What does itmeanrsquo mdasha question which I raise repeatedlyin the paper and which I often addressed toCaroline But schizophrenese is not a variantof ordinary language It is unique and intrin-sically different hence such a reduction is notpossible It may eventually be possible how-ever for the schizophrenic to acquire thecapacity to re-state or re-present the thoughtsthat he or she was couching in schizophrenesein ordinary language so that the two lan-guages can be compared and contrasted and

this is what Caroline gradually acquired thecapability to do

From a semantic perspective schizophre-nese is characterised by an absence of theordinary distinctions between word thingbodily process and action The word is usedas though it were identical to the thing towhich it would ordinarily refer as well as toactionsmdashpast present or prospectivemdashon orin relation to the thing and to the mediatingsomatic processes Words lack their ordinaryconnotation as representations and refer-ences they have become happenings orevents Caroline once referred to this processas rsquo combination thinkingrsquo mdasha term nearlyidentical to the concept rsquo combinative think-ingrsquo proposed by McClain Johnston andPhilip Holzman (1985) In ordinary discoursespeaker and listener recognise the symbolicimport of a concrete-sounding statement suchas rsquo I have a special pipeline to the bossrsquo orrsquo Letrsquos smoke a peace-pipersquo The metaphorserves as emphasis or highlighting of a keyidea that is being talked about In contrastCaroline once literally handed me a sectionof plumberrsquos pipemdasha gesture so pregnantwith meaning yet impregnable to my inter-pretive skills that it would have been easy toconclude that the pipe was an arcane symbolWhen I questioned her about it however shewas able to tell me that she was making aconnection with me In other words the pipewas just a pipe An ordinary speaker mightmetaphorically and passionately declare loveby saying rsquo I give you my heartrsquo or sing aboutempathic sharing in the folk lyric rsquo Pack upyour troubles in your old kit bag and smilersquo but in discussing the thought process involvedin mailing her Valentine card with a largeheart on it to a large number of casual andformer acquaintances Caroline told me shewas packaging and mailing her word-self toothers she looked upon as more willing toassume responsibility for her than she was forherself While it is tempting to use terms likecollapse implosion explosion fusion orboundary loss to describe the creation ofthese concrete linguistic identities such

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 395

terms convey the incorrect impression thatschizophrenese is a regressive degradation ofordinary language Rather schizophrenese isa language of equivalence immediacy andaction in contrast to ordinary languagewhich supports representational thinkingMoreover there is no evidence that theschizophrenic ever rsquo spokersquo differently

Schizophrenese then is an immediatelanguage of the body and its function in theworld of things particularly motor (throwinghitting) respiratory (breathing talking andblowing as in the felicitous expression rsquo mindblowingrsquo ) gastrointestinal (vomiting and de-fecating) and orgasmic (rsquo fucking onersquos brainsoutrsquo ) Caroline describes printmaking as fol-lows rsquo I was pounding it down oozing out myblack insides on paperrsquo She described one ofher long walks as follows rsquo I want to run andrun and run away from the painful feelings Ifeel like I can split off disintegrate and getaway from them This is what schizophreneseis aboutrsquo She said rsquo I give people the breath-ing they need I make a case to take care ofme I respire them With every breath I givethem responsibilityrsquo

rsquo Respirersquo is a neologism made by theordinary morphological processes of clippingand condensation of the physical process ofrespiration and the work-related concept ofresponsibility but it is a thing and not areference She said rsquo Irsquom mad today I had toput in limits and boundaries and not spill myguts There are lots of snakes inside me and Iwant you to eat them for mersquo In reference toan episode of vomiting during a meal withher family when they questioned her aboutinstances of her irresponsible behaviour shecomments rsquo I couldnrsquo t bear the feeling ofhaving taken all those courses wastingmoney scattering my time and I had to getrid of them I was throwing up the feelingrsquo

It follows from the nature of their languagethat schizophrenics lack patience self-controland restraint have dif culty conceptualisingprocess and sequence distinguishing pastfrom present and here from there and seeingthe consequences of their actions and thereby

learning from experience Carolinersquos Valen-tine mailing was an example of how sheregularly bombarded with letters persons withwhom she had no current contact often fromthe distant past She called these bizarremass-mailings rsquo Trail Newsrsquo and she believedshe was relieving herself into these others ofher otherwise troubling mental contents Shesaid rsquo If your arm was controlled by maturethought then you could wait Itrsquos the entangle-ment quality instead of being able to stop andthinkrsquo

Despite its sometimes strange and colour-ful character the language of schizophreniais neither a language of conscious awareness(re ection) nor of unconscious concealment(repression) It does not support mentalrepresentation symbolisation and re ectionFailure to appreciate this may be what led ageneration of analysts including such semi-nal gures as Frieda Fromm-Reichmann toidealise schizophrenic persons as havingspecial psychic acuity and access to theirunconscious mental life that ordinary personsdo not A neurotic patient might refer to herhabitual and inappropriate tendency to con- de personal affairs to others using theunconscious symbolism of a phrase such asrsquo spilling my gutsrsquo If questioned she wouldhave the sense that she had said somethingworth re ecting on thinking about andanalysing the symbolic meaning of WhenCaroline used the expression as noted earliershe not only believed there were snakes in herintestines that she needed to give to me(although she could reality-test the idea ifpressed to do so) but she referred to anearlier occasion when she had vomited to ridherself of unwanted feelings In an ordinaryanalysis the analyst might suggest that thepatientrsquos behaviour and associations indicatethat she viewed her problems as a mess shebelieved she could dump on to or into theanalyst and the patient might respond to theinterpretation with associations to oral or analfantasies and memories When Caroline saysrsquo I send it [rsquorsquo my messrsquorsquo ] to responsible people Irsquom lling up their mailbox I word my

396 MICHAEL ROBBINS

way into a relationship with lettersrsquo she isdoing something and not speaking metaphori-cally or thinking Whereas an ordinary personmight be aware of the underlying fantasiesand con icts Caroline literally believes thatshe is excreting her self which is identical toher words into others It might be moreaccurate to say that she is expressing phan-tasy in the Kleinian sense but if so even atthis level of discourse when she makes anattempt to interpret the original schizophren-ese account of her mass mailings in alanguage more comprehensible to me she isstill speaking in a language of closure andenactment devoid of interpretable symbo-lism and unconscious meaning

While schizophrenia is a state of self-centredness or egocentricity in the solipsisticsense of the term schizophrenese paradoxi-cally is a language without a centred subjectexcept in the most rudimentary sense ofobserver and actor of a drama The subjectiversquo Irsquo denoting the presence of conscious re ec-tion and thought about beliefs fantasiesemotions and con icts is largely missing andin its stead Caroline describes a microcosm inwhich she is participant consisting of suchthings as a pool table with its sticks and ballsher sewing box with its bobbins and yarns orthe terrain bordering the three lakes she haswalked around with its birds trees andpeople In ordinary discourse one might shareonersquos subjective thoughts and feelings aboutonersquos mother by saying rsquo Irsquo m always behindthe eight-ball with herrsquo or rsquo I was cluelesswhen it came to my mother itrsquos the oldproblem of the irresistible force and theimmovable objectrsquo Caroline by contrastdescribed to me a game of pool she hadplayed in which her mother was the cue balland she had been able to pocket the otherballs without moving the cue-ball or hittingthe eight-ball Her affect was one of triumphfor she literally believed she had solved theproblem of dealing with her mother

This example will serve to segue from thesemantic to the pragmatic aspects of schizo-phrenese which is closely related to delusion

reversal and undoing and deceptionmdashpro-cesses that enable the user to avoid thoughtand awareness of feelings Ordinary languageserves to adapt the waking user to anrsquo externalrsquo world as subjectively perceivedwithin broad consensual outlines The worldof the schizophrenic by contrast is internalthough unrecognised as such and consists ofidiosyncratic microcosms that combine whatmore maturely we look upon as psyche withwhat is sensed and perceived Subjectivelyby manipulating mental contents the schizo-phrenic experiences control over the worldThe language is felt by its user to possess thepower to undo reverse and eliminate intoler-able reality both past and present It is alanguage of psychic alchemy or delusionalomnipotence (Burnham 1955 Frosch 1967Glass 1981) Caroline told me rsquo I fool myselfinto thinking it didnrsquo t happenrsquo Speakingordinary language she referred to schizo-phrenese as rsquo the language of wish and desirersquo With her knitting a game of pool a walkaround the lake or detailed letters to othersshe creates a universe that she can describeand act upon with the conviction that she isaltering events problems and associated feel-ings both present and past Ordinary lan-guage also employs reversal but in anentirely different way and for an oppositepurpose By its stark contrast with the sharedand implicitly acknowledged context such areversal in ordinary language serves to high-light or accentuate the feeling the speakerwishes to conveymdashfor instance in the remarkrsquo Hersquos a ne one to be saying thatrsquo Thedelusional reversal of schizophrenia by con-trast eliminates the necessity to differentiatemind from reality to bear painful feelingsand to adapt to a consensually validatedworld An ordinary person faced with apainful situation might transiently nd solaceby constructing heroic fantasies and becom-ing in imagination someone able to surmountany dif culty invulnerable to pain and hurtSchizophrenic language by contrast lacksthe rsquo as if rsquo capacity inherent in the use ofmetaphor that is required to construct such a

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 397

fantasy Instead of an unconscious fantasyand a language capable of contemplation theschizophrenic experiences a delusional senseof actualisation rsquo isrsquo has replaced rsquo as if rsquo

The qualitative difference between schizo-phrenese and ordinary language helps toaccount for the fact that delusions are xedbeliefs refractory to clinical analysis In themind of their creator they are actualitiesrather than fantasies so that there is nothingto be thought about Some time after thevignettes that I have presented when Carolinehad become more uent in ordinary languageand more uid in moving back and forthbetween the two she commenced an hour byobserving my new shoes and commenting rsquo Itmakes me angry that you always have neatshoes and I donrsquo trsquo I observed aloud that herown feet were beginning to move Sheresponded rsquo Our feet move togetherrsquo andadded that she would like me to hug her Iinquired what that was about and she said rsquo Iwant to be in your shoesrsquo She was then ableto express in ordinary language her aware-ness that she was not expressing a fantasy orsymbolising a wish to be more like me butwas verging on speaking the thoughtlesslanguage of schizophrenese which in the pastwould have achieved a sense of actualisationand closure (in this case the delusion she hadexchanged identities with me) rather thanallowing the opportunity for re ectivethought about painful feelings and issuesrelated to being her own separate person

Paradoxically it is this very failure ofschizophrenic language to distinguishthoughts from events that may disguise itsbizarreness and conceal the delusional think-ing it supports because utterances may seemto patient and analyst to be nothing more thandescriptions or observations of happeningsIn telling me about the degrading affair withher college professor and her subsequentconversation about it with her mother Caro-line believed she was doing it over differentlynot simply wishing she might

No discussion of schizophrenic languagewould be complete without a comment about

neologisms which incidentally are notnearly so speci c to schizophrenia as gener-ally believed They appear to be constructedaccording to ordinary morphological princi-ples and it is primarily in their semantic andpragmatic aspects that they are remarkableOne day Caroline said rsquo Irsquove got it set up atwork so no-one can refrain from authoritingme They tell me what to do It pisses me offrsquoWhen I inquired if she believed authoritingwas a legitimate word she said she supposednot I then asked why she did not say whatshe meant in acceptable English She repliedthat it would compel her to face feelings ofshame at loss of dignity and control over herown life By not accepting the existence of anordinary language word to express her feelingstate she managed to repudiate the reality ofthe issue and to avoid the feelings about itThis is another example of the identity ofwords things and actions If the word is thereal thing and she can substitute a neologismthen she can delude herself that the thing orthe problem no longer exists It is easy for theanalyst who is struggling to understand thepatient to gloss over the idiosyncratic aspectof the word in favour of what appears to bethe underlying meaning as one might do withsome of the peculiarities of speech of some-one not uent in onersquos native tonguemdashin thisinstance to assume that Caroline rsquo reallyrsquomeans rsquo acting like an authority withrsquo In thisway the patientrsquos delusion combines with theanalystrsquos illusion to form collusion

Schizophrenic patients do not want to beunderstood for it threatens them with un-wanted knowledge about themselves Schizo-phrenese not only lacks communicativeintent it is a language of deception In orderto function as a vehicle of communicationcontextual elements and related linguisticassumptionsmdashpersonal social and culturalmdashmust be suf ciently concordant in speakerand listenermdashthe rsquo musicrsquo so to speak thataccompanies the words In the case of schizo-phrenese not only are these assumptionsidiosyncratic to the speaker or writer but alsothe speaker or writer is unwilling to elucidate

398 MICHAEL ROBBINS

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

independent living and for work remainedmarginal it progressively improved Alongthe way she created every kind of problemimaginable and came near to suicide seriousaccidents troubles with the law destitutionand starvation After years of treatment weuncovered her unconscious envy of homelessstreet-corner mendicants for to her theyrepresented her motherrsquos success in trickingothers to take care of her thereby absolvingher of the necessity of taking responsibilityfor herself

Our sessions typically consisted of Caro-linersquos pressured and detailed recitations anddemonstrations of all the events of her lifesince we had last met along with descriptionsof the problems she had got herself into rsquo Justone more thingrsquo was a favourite responsewhen I would attempt to get a word in of myown and when she was not able to avoid mycomments about her responsibility she wasfull of plans and pledges to do bettermdashnoneof which ever came to fruition In the courseof these recitations she regularly forgot thecentral point and changed the subject andbecause she could not grasp that there wereconsequences to her actions no learningresulted from our discussions Instead sherelentlessly held accountable those of us whoremained devoted to her referring to us withrage as rsquo criminals who got off the hookrsquo Shegradually re-directed her sexual promiscuityand made intensive efforts to seduce me intoparticipating in a mind-losing sexual orgy inwhich she could imagine our identitiesmerged so that by deluding herself she wasme and I her she would get what she imaginedI had My efforts to contain and to help her tofocus were for the most part either ignoredor greeted with rage and blaming When Iresisted her blandishments she would becomeseriously abusive and hint to others includingher family not only that I was an irrespon-sible and ineffective therapist but also thatshe was an innocent victim of my seductionsboth mental and physical

As years went by this grim picture wasgradually mitigated as Caroline took small

steps toward personal autonomy There wereminuscule increments of insight and even anoccasional sense of productively workingtogether but these were regularly undone anddestroyed Increasingly I came to feel thetreatment was stalemated Shortly prior to theevents I will describe she appeared to regressand behave like a typical chronic schizophren-ic with attened affect wooden facial ex-pression a gross tremor and such paralyticambivalence that at times she could hardlymove and sat rocking back and forth Herfamily became concerned and at their urgingI sought a psychopharmacological consulta-tion In place of Trilafon several of the neweranti-psychotic medications were tried bothalone and in combination but her conditiononly seemed to worsen Eventually Trilafontherapy was resumed her condition restabi-lised and our struggles continued I experi-enced overwhelming lethargy during oursessions I tried to believe and to tell Caro-line that she was offering me a lethal dose ofthe kinds of emotion that had overwhelmedher in the course of her futile childhoodefforts to reach her mother in the hope that Iwould not be destroyed by it as she had beenbut would offer her a model for dealing withit but my interpretations had no substantiveeffect on either of us

Although there had always been noticeablepeculiarities in her language I had notfocused attention on them hitherto other thanto tell her on occasion that I did not under-stand and to ask her to clarify One day in apoorly concealed moment of exasperationand without much thought I remarked thatshe was speaking schizophrenese a languageI did not comprehend She was taken abackand informed me that as I was the therapistand she was the schizophrenic it was my jobto understand her After unproductive discus-sions that spanned several sessions I suddenlyhad the liberating thought that whether or notshe chose to learn from me I was not trappedin a hopeless situation I could terminate withher or learn from her and I told her that Iwould choose the latter course and she would

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 389

henceforth educate me about schizophreneseIn situations where hitherto I would have felthopeless angry and bored I pulled out padand pen and took the verbatim notes thatyears later she gave her permission for me touse as data for this paper I questioned her indetail as though I were a student asking theprofessor to explain the lecture To mysurprise my self-serving action nally gotCarolinersquos attention when what I thought hadbeen my efforts to care about her had not Shewas shocked fascinated and amused

In retrospect I believe my decision to learnrather than be driven crazy or to reject herwas a model for what Caroline had beenunable to do as a child Because I nally feltthat I was getting something out of therelationship I felt less immediately investedin whether Caroline did rsquo therapyrsquo and in turnCarolinersquos curiosity was piqued She began toalert me to get out my notebook when shesensed an urge to speak schizophrenese andshe decided to keep a journal When I onceasked her in response to her having justalerted me to get pen and notebook how shewas able to determine that she was about tospeak schizophrenese she replied rsquo Itrsquos whenI put things together in strange ways that no-one else would understandrsquo adding rsquo I take agiant leaprsquo The ensuing discussion willclarify what she meant

Vignette 1

Caroline had gone to play pool after takingher car to be repaired It had been damageddue to irresponsible actions on her part aboutwhich we had talked at length

P I had time to kill Rack it up and pocketrsquo em Sock it and rock rsquo em Clear the tableThe only table that had monkey business to it

A What do you meanP E [a staff member in the hospital whom

Caroline idealised] and I used to play poolA What do you meanP Judgement Day Irsquo ve got so many balls

and I have to put them in the pocket Get theeight-ball in and yoursquo re out Irsquo ve got to shoot

straight from the hip and keep both feet onthe ground Just straight shots coming fromthe heart People have things racked upagainst you but you keep on shooting and ifyou make a racket like me it gives them moreammunition

A What do you meanP Now you really think Irsquo m crazy I racked

rsquo em up and then I bought a root beer The guysaid rsquo You canrsquo t drink that herersquo and then wetalked about getting 50 off lodging in [adistant resort] I said that late September isthe best time to go there [laughs]

A What are you laughing aboutP Well itrsquos not a short walk to get there

and I have $16 in my wallet They donrsquo t wantunethical behaviour in the bar So I thinkabout going there I build up in my mindplaces to go I start out thinking Irsquo m going toclean the apartment Then I do these otherthings Then I start thinking when I donrsquo t thatitrsquos the fault of the landlord and others Then Iran out of time and I had to go to work I waslate again

A What about the resortP Itrsquos a Closetland place [a reference to a

movie about a woman who turned to fantasyin order to endure torture] no problems thereeverything is ne

Analysis

Caroline begins by trying to tell me some-thing in rsquo purersquo schizophrenese After shemakes the observation that I will think she iscrazy she begins to try to explain her thoughtprocess by using more schizophrenese Gra-dually she shifts into ordinary language andattempts to re-cast her thoughts The ordinarylanguage moves the discourse from the con-crete level of things and actions to the realmof subjective thought and feeling symbol andmetaphor An ordinary language renditionderived from what she told me and from thebroader context of our relationship at thattime might be rsquo The Day of Judgement hascome for me Irsquo m in a rage at myself for allmy monkey businessmdashdamaging my car not

390 MICHAEL ROBBINS

being nancially responsible not cleaningmy apartment or being on time for myappointments and treating life like a game Igive others ammunition to use against meIrsquove really got myself behind the eight-balland Irsquove got to get my feet back on theground But Irsquo m in a rage at having to beresponsible I just want to kill more timeblame others wipe the table clean of all myproblems and imagine Irsquom at a resort on aperpetual vacationrsquo

This version of her thoughts requires alanguage of re ection metaphor and symbo-lism In schizophrenese by contrast insteadof a subjective self the thoughts and feelingsabout the situation she has got herself intoshe describes an animated literalmdashnotmetaphoricalmdashpool table microcosm ofwhich she is omnipotent master as shecombines words body actions and things Itis Judgement Day and she literally believesshe is ridding herself of her problems Killingtime involves rage- lled destructive action Italso re ects the absence of comparativeconcepts that would serve to make her awareof the passage of time and its implicationssuch as process work patience and perspec-tive What might appear to be low-grademetaphors or similesmdashcliches such as rsquo shootstraightrsquo rsquo shoot from the hiprsquo rsquo rack rsquo em uprsquo rsquo rock rsquo em and sock rsquo emrsquo being rsquo behind theeight-ballrsquo rsquo killing timersquo mdashare in fact actioncondensations of words body movementsand things based on assonance

Vignette 2

This is a sample of Carolinersquos writtenlanguage She brought in for discussion aletter entitled rsquo The Class Actrsquo which sheproposed to send to twenty- ve or so of herformer caretakers as accompaniment to aValentine card It begins with the salutationrsquo To a Quarter of Caring Peoplersquo

rsquoAlthough I have loving feelings for thepeople who have held me in their thoughts ofcare this card is an expression of appreciationand care not love I am on an excavation of

dignity (dig-knit-tea) The month of nancialFebruary is for my initial dig The month ofMarch my birthday always and forever hold-ing is for my knit The month of April is for apoem once learned as in college

T T TSee these threeHear their chimeThings take time for thought taxes andteaHer letter concludes with a paragraph of

plans for each of the months of May andJune In response to my request that sheexplain this to me in ordinary language shesays

P Itrsquos how overwhelmed I am about thecoming months In the 6th grade a teacher Irespected took her class on an archaeologicaldig That means rsquo dig inrsquo rsquo Dignityrsquo has threeparts dig-knit-tea You have to dig in and knitthings and then drinking tea calms you down

A But why do you say it this way and notsomething like rsquo Irsquo m overwhelmed about howIrsquo m going to manage my life in a digni edway during the coming months I need to nda way to calm down and to use my 6th gradeteacher as a model for digging in workinghard and pulling my life togetherrsquo

P The way I said it is brilliant Besides itkeeps me at a distance from people puts mein a separate space where they wonrsquo t knowwhat Irsquom talking about I donrsquo t want people toknow how much distress Irsquo m in

A So yoursquo re writing a letter of informationabout yourself with all sorts of details aboutyour life to people you supposedly careaboutmdashbut you want to conceal your realdistress from them

P The time is so overwhelming I had tocompartmentalise it into months so I couldmanage my mess Then I send it to respon-sible people and they will take care of it Irsquom lling up their mailbox adding to theirconcern So I gave it to my landlord to readand he said rsquo Take carersquo I got furious He wassupposed to take care of it Irsquo m getting amisery out of it getting to sit in some low-down place and not move out of it Some

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 391

people try to intimidate people I intimatepeople

A What do you meanP Relationships are too dif cult so I word

my way into a relationship with letters Irsquodlike to work my way into your hearts withoutworking my way in and without mentioningthings that would work my way out of yourhearts

Analysis

Caroline is gradually able to re-present thethought behind her letter in an ordinarylanguage statement but even at the conclu-sion of the discussion she is still partlyspeaking schizophrenese If she were able tospeak ordinary language she might saysomething like rsquo I would like to fool myselfand the others in my life that this is really aValentine about loving and feeling close tothem and a resolution not to be such a low-down person but to identify myself withconstructive responsible people and to workhard to dig myself out from the mess Irsquovemade But really this card expresses my wishto avoid the pain of my situation and to sendall my problems away and force them insideothers to take care ofrsquo

What sets the schizophrenese apart fromthe ordinary language version is that she isnot expressing wishes nor is she usingphrases like rsquo digging inrsquo being rsquo low downrsquo rsquo keep me in your heartrsquo rsquo I give you myheartrsquo or rsquo knitting together the strands of herlifersquo metaphorically Instead of workingwhich involves effort patience thoughtfulre ection and bearing of distress she engagesin wording an action discharge that is itsantithesis An ordinary person might work atsolving her problems while singing such songlyrics as rsquo Pack up your troubles in your oldkit bagrsquo or rsquo Pack up your troubles and sendthem all to mersquo When Caroline says rsquo I send it(rsquorsquo my messrsquorsquo ) to responsible people Irsquom lling up their mailbox I word my wayinto a relationship with lettersrsquo she literallybelieves she is digging out and packaging her

word-self into the Valentine card and puttingit in the mailbox-hearts of people who willhold and care for her emotionally distressedself in a way that she cannot or will not doThere is nothing left for her to think about tofeel or to work on Insofar as her actionssucceed in burdening others with her worriesand problems her wishful belief in a sensecomes true Fooling others so that she getsno realistic feedback is necessary in order tocontinue to fool herself The words dignityand intimate are neologismsmdashhomophoniccompounds that combine word action andthing

The interaction with her landlord illustratestwo points Nancy Andreasen et al (1985)believe that while schizophrenics are defec-tive in expressive language receptive lan-guage remains normal It is clear in thisinstance however that Caroline hears whather landlord says in schizophrenese as wellFrom a psychoanalytic perspective it is evi-dent that the underlying thought processresembles the phantasies Klein writes aboutand lends itself to an interpretation of projec-tive identi cation but in order to know this itis rst necessary to re-present the thoughtThe miscommunication that can ensue frommaking a psychoanalytic interpretation basedon the belief the patient is speaking andlistening in ordinary language is illustratedby Carolinersquos interchange with her landlordHe believes she is speaking ordinary lan-guage and he responds to her Valentine bytelling her to rsquo take carersquo She receives hisordinary language statement as though hewere speaking schizophrenese Her construc-tion of it as a rejection throws her into a ragewhich she in turn conceals because sheimagines it will evoke his anger

Vignette 3

P I walked around the lake with mymother when my affair with my collegeprofessor was going on [perhaps 15 yearspreviously] and told her about it So the lastfew days I found three lakes and walked

392 MICHAEL ROBBINS

around them Three guys were on one dockThings reminded me of the professor Birdson an island in the rst lake remind me of aman who didnrsquo t disclose that he was probablyhaving other relationshipsmdashprobably screw-ing other women all those birdsmdashbut it washard to keep my mind together walkingaround the big lake because it was so big toobig a place to keep my mind Then these guysstarted irting playing with my mind Allthree of those lakes make a penis the end themiddle the part you play with

A Why did you do thisP I did it so I could focus on a destructive

relationship I was trying to feel the feeling Ionce had with my mother after the affair Butthe lakes are such a big temptation to fall in itagain Walking around the smaller lake Icould get more in touch with the feeling ofloss and hurt some of the feeling but itwasnrsquo t satisfying The bigger lakes were over-whelming and I didnrsquo t know why I was thereany more I was trying to get into troubleThe birds on the big lake felt threatening allthe people he screwed the things I didnrsquo t seeI was foolish I start to realise it but theninstead it becomes my mother fooled me notwhat I did My mother goes to [her wintervacation home] and spends time watching thebirds I feel betrayed I went to the dock andsaw two birds in a caged area I felt caged Iwondered if those women were prostitutesand ended in jail

A What do you meanP Irsquom trying to deal with what happened

in my twenties with the professor Around thelake my mother and I walked and I told her[Her mother had blamed the professor andtold Caroline not to worry about what she haddone] The lie was talking to my mother aboutit and my motherrsquos lies My interest in thelake is a re-creation of the crime when some-thing equals nothing and nothing equalssomething The lively pond is a metaphor formy mind and my dif culty containing limitsand boundaries staying in bounds and notdestroying everything attending to a straightline of thought The kids represent how easily

Irsquo m distracted and take my mind off The lakeis a reference to my mind and the tree is myinterest in life The tree and the birds are ablaming thing People donrsquo t tell others abouttheir affairs but they communicate insidethemselves about it My mind is the pond thetree Claustrophobia is how rsquo in the darkrsquo apart of me is My thoughts versus my actionsI say one thing make my pledges then I godo another Destructive Irsquo m terri ed of thetemptation to blow everything to bits My treeis empty and alone others have things in theirbranches I canrsquo t walk a straight line I veeroff so I try another planet Itrsquos painful I knowif I canrsquo t stay on line in this little pond thenIrsquo ll never get anywhere in the bigger issues inlife I can look at trees that seem moreinteresting but I have to be able to deal withwhatrsquos here

A Now you are speaking in metaphor whydonrsquo t you always

P Metaphors take more responsibilitythey are more connecting

Analysis

Caroline begins speaking about her trip inliteral schizophrenese but by the conclusionof our discussion the physical elements of hersurroundings have become incorporated inmetaphors A more elaborate translation thatsupplements her efforts with other informa-tion in my possession but preserves her ownwords and phrases might be something likethis rsquo Irsquo ve been thinking about my affair withthe professor trying to return so to speak tothe scene of the crime and nd a differentway in my mind to handle what I couldnrsquo tdeal with then but I keep falling into thesame old patterns of thinking I fell intosexual temptation and I lost my mind I wasrsquorsquo out of my treersquorsquo Did he fool me or did I foolmyself Afterwards my mother and I took awalk I was struggling over whether to facemy feelings of hurt responsibility and guiltor stay in the dark about what I had done anddeny that I was a fool But I couldnrsquo t contain

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 393

myself I canrsquo t seem to rsquorsquo go straightrsquorsquo I fellinto it again and spilled everything out to mymother I deserved to be punished but insteadof making me feel like a jailbird or aprostitute she blamed him and she made likeit was nothing she vacated her mind andlooked for other birds to blamersquo

In this ordinary-language version thereemerges a thoughtful emotional re ectiveself replete with the symbolism and meta-phor that is missing in a language that fuseswords things and actions Caroline describesher schizophrenese much as Bion (1967)described attacks on linkingmdashas a process ofacting rather than thinking and blowing hermind to bits As she observes makingmetaphors takes too much energy When shetalks about getting in touch with feelings sheis not referring to metaphorical touching butto literal sensory-motor activities She can-not separate words from actions and things sothat she might be able to think about thedestructive relationship and the overwhelm-ing temptation Instead she walks around alake that she has rendered equivalent to (notwhich symbolises) the container of her mindher mind itself the loss of her mind thetempting three-part male genital the threeguys playing with her mind and her playingwith the penis Her mind is also literallyindistinguishable from the tree or the cageand the birds caged or in trees are concreteenactments of internalised or projected res-ponsibility and blame Of the three vignettesthis re ects the most mental maturity in so faras Caroline is trying to think and feel in anordinary way at the very same time sheexperiences the omnipotent capacity to elimi-nate what needs to be thought about Bothefforts fail

Discussion

Schizophrenics speak a meaningful lan-guage that differs from ordinary language inits essence not simply with regard to sym-bolism This language has a determina-

tive relationship to delusional thinkingBecause Freudrsquos linguistic analysis ofdreaming as a delusional and hallucinatorywish-ful lmentmdashan encapsulated nocturnalpsychosismdashis of considerable relevancesummarising some of the parallels betweendreaming and schizophrenia will be a usefulpoint of entry Schizophrenia presents itselfon a continuum in varying degrees of regres-sion or compensation In its most regressedform catatonia it resembles a waking dreamstate characterised by absence of wakefulattentiveness and sensory-perceptual domi-nance in the form of hallucinations Verbaland motor action are also absent as in thestate of sensory-perceptual identity to whichFreud made reference in his discussion of theprimary process in dreams (1900) and in hispaper on hallucinatory wish ful lment in theabsence of the object (1911) At the other endof the continuummdashthe state of maximalcompensationmdashthe balance is shifted towardspsycho-motor identity the language ofschizophrenia is one of action and actualisa-tion rather than thought and it resembles thesensorimotor stage of infancy

Discussion of language is usually dividedinto syntax morphology semantics and prag-matics As noted earlier syntax here is moreor less intact With regard to morphologyalthough some of the words used by theschizophrenic may be idiosyncratic the rulesor processes by which they are formed (suchas the use of af xes compounding onomato-poeia proper noun transformation clippingand blending) seem identical to those used inordinary language Therefore the ensuingdiscussion will focus on semantic and prag-matic considerations

Ordinary language is an aspect of re ectivethought that is uniquely situated betweenimpulse and action and enables adaptation toconsensual reality by means of exchangingthoughts and feelings with others and con-templating them oneself Language is neverentirely divorced from the sensorimotorphase in the sense that action in the form ofgestures and bodily expressions as well as

394 MICHAEL ROBBINS

somatic sensations remains an inextricablepart of it but in the course of developmentspeech and writing become relatively autono-mous The more sophisticated the subject themore exible the language becomes in mov-ing between concrete sensory somatic andfunctional considerations on the one handand more abstract re ective and comparativeoperations in which one element stands forabbreviates or enriches one or more otherson the other Individual language developsfrom simple denotationmdashthat is learningculturally determined signi ersmdashto abstractdevelopment of symbols metaphors andsimiles both those shared by a given cultureand those that re ect unique personal experi-ence The capacity for simultaneous parallelor multi-track processing enables language todisguise and conceal as well as to re ectclarify and communicate and to have at anygiven time more than one meaning It is thismulti-dimensional complexity that makespsychoanalysis possible

Because we have no choice but to useordinary language as both a means and areference point for analysing schizophreniclanguage it is natural to assume the latter tobe qualitatively continuous with ordinarylanguage and that linear translation of one tothe other is possiblemdashas in Freudrsquos well-known comparison of dream imagery toEgyptian hieroglyphics We tend to assumethat schizophrenese is a kind of encryptedcode cover or disguise that can be decodedinto its unconscious rsquo realrsquo ordinary languagemeaning Thus it would seem natural to askof a schizophrenic utterance rsquo What does itmeanrsquo mdasha question which I raise repeatedlyin the paper and which I often addressed toCaroline But schizophrenese is not a variantof ordinary language It is unique and intrin-sically different hence such a reduction is notpossible It may eventually be possible how-ever for the schizophrenic to acquire thecapacity to re-state or re-present the thoughtsthat he or she was couching in schizophrenesein ordinary language so that the two lan-guages can be compared and contrasted and

this is what Caroline gradually acquired thecapability to do

From a semantic perspective schizophre-nese is characterised by an absence of theordinary distinctions between word thingbodily process and action The word is usedas though it were identical to the thing towhich it would ordinarily refer as well as toactionsmdashpast present or prospectivemdashon orin relation to the thing and to the mediatingsomatic processes Words lack their ordinaryconnotation as representations and refer-ences they have become happenings orevents Caroline once referred to this processas rsquo combination thinkingrsquo mdasha term nearlyidentical to the concept rsquo combinative think-ingrsquo proposed by McClain Johnston andPhilip Holzman (1985) In ordinary discoursespeaker and listener recognise the symbolicimport of a concrete-sounding statement suchas rsquo I have a special pipeline to the bossrsquo orrsquo Letrsquos smoke a peace-pipersquo The metaphorserves as emphasis or highlighting of a keyidea that is being talked about In contrastCaroline once literally handed me a sectionof plumberrsquos pipemdasha gesture so pregnantwith meaning yet impregnable to my inter-pretive skills that it would have been easy toconclude that the pipe was an arcane symbolWhen I questioned her about it however shewas able to tell me that she was making aconnection with me In other words the pipewas just a pipe An ordinary speaker mightmetaphorically and passionately declare loveby saying rsquo I give you my heartrsquo or sing aboutempathic sharing in the folk lyric rsquo Pack upyour troubles in your old kit bag and smilersquo but in discussing the thought process involvedin mailing her Valentine card with a largeheart on it to a large number of casual andformer acquaintances Caroline told me shewas packaging and mailing her word-self toothers she looked upon as more willing toassume responsibility for her than she was forherself While it is tempting to use terms likecollapse implosion explosion fusion orboundary loss to describe the creation ofthese concrete linguistic identities such

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 395

terms convey the incorrect impression thatschizophrenese is a regressive degradation ofordinary language Rather schizophrenese isa language of equivalence immediacy andaction in contrast to ordinary languagewhich supports representational thinkingMoreover there is no evidence that theschizophrenic ever rsquo spokersquo differently

Schizophrenese then is an immediatelanguage of the body and its function in theworld of things particularly motor (throwinghitting) respiratory (breathing talking andblowing as in the felicitous expression rsquo mindblowingrsquo ) gastrointestinal (vomiting and de-fecating) and orgasmic (rsquo fucking onersquos brainsoutrsquo ) Caroline describes printmaking as fol-lows rsquo I was pounding it down oozing out myblack insides on paperrsquo She described one ofher long walks as follows rsquo I want to run andrun and run away from the painful feelings Ifeel like I can split off disintegrate and getaway from them This is what schizophreneseis aboutrsquo She said rsquo I give people the breath-ing they need I make a case to take care ofme I respire them With every breath I givethem responsibilityrsquo

rsquo Respirersquo is a neologism made by theordinary morphological processes of clippingand condensation of the physical process ofrespiration and the work-related concept ofresponsibility but it is a thing and not areference She said rsquo Irsquom mad today I had toput in limits and boundaries and not spill myguts There are lots of snakes inside me and Iwant you to eat them for mersquo In reference toan episode of vomiting during a meal withher family when they questioned her aboutinstances of her irresponsible behaviour shecomments rsquo I couldnrsquo t bear the feeling ofhaving taken all those courses wastingmoney scattering my time and I had to getrid of them I was throwing up the feelingrsquo

It follows from the nature of their languagethat schizophrenics lack patience self-controland restraint have dif culty conceptualisingprocess and sequence distinguishing pastfrom present and here from there and seeingthe consequences of their actions and thereby

learning from experience Carolinersquos Valen-tine mailing was an example of how sheregularly bombarded with letters persons withwhom she had no current contact often fromthe distant past She called these bizarremass-mailings rsquo Trail Newsrsquo and she believedshe was relieving herself into these others ofher otherwise troubling mental contents Shesaid rsquo If your arm was controlled by maturethought then you could wait Itrsquos the entangle-ment quality instead of being able to stop andthinkrsquo

Despite its sometimes strange and colour-ful character the language of schizophreniais neither a language of conscious awareness(re ection) nor of unconscious concealment(repression) It does not support mentalrepresentation symbolisation and re ectionFailure to appreciate this may be what led ageneration of analysts including such semi-nal gures as Frieda Fromm-Reichmann toidealise schizophrenic persons as havingspecial psychic acuity and access to theirunconscious mental life that ordinary personsdo not A neurotic patient might refer to herhabitual and inappropriate tendency to con- de personal affairs to others using theunconscious symbolism of a phrase such asrsquo spilling my gutsrsquo If questioned she wouldhave the sense that she had said somethingworth re ecting on thinking about andanalysing the symbolic meaning of WhenCaroline used the expression as noted earliershe not only believed there were snakes in herintestines that she needed to give to me(although she could reality-test the idea ifpressed to do so) but she referred to anearlier occasion when she had vomited to ridherself of unwanted feelings In an ordinaryanalysis the analyst might suggest that thepatientrsquos behaviour and associations indicatethat she viewed her problems as a mess shebelieved she could dump on to or into theanalyst and the patient might respond to theinterpretation with associations to oral or analfantasies and memories When Caroline saysrsquo I send it [rsquorsquo my messrsquorsquo ] to responsible people Irsquom lling up their mailbox I word my

396 MICHAEL ROBBINS

way into a relationship with lettersrsquo she isdoing something and not speaking metaphori-cally or thinking Whereas an ordinary personmight be aware of the underlying fantasiesand con icts Caroline literally believes thatshe is excreting her self which is identical toher words into others It might be moreaccurate to say that she is expressing phan-tasy in the Kleinian sense but if so even atthis level of discourse when she makes anattempt to interpret the original schizophren-ese account of her mass mailings in alanguage more comprehensible to me she isstill speaking in a language of closure andenactment devoid of interpretable symbo-lism and unconscious meaning

While schizophrenia is a state of self-centredness or egocentricity in the solipsisticsense of the term schizophrenese paradoxi-cally is a language without a centred subjectexcept in the most rudimentary sense ofobserver and actor of a drama The subjectiversquo Irsquo denoting the presence of conscious re ec-tion and thought about beliefs fantasiesemotions and con icts is largely missing andin its stead Caroline describes a microcosm inwhich she is participant consisting of suchthings as a pool table with its sticks and ballsher sewing box with its bobbins and yarns orthe terrain bordering the three lakes she haswalked around with its birds trees andpeople In ordinary discourse one might shareonersquos subjective thoughts and feelings aboutonersquos mother by saying rsquo Irsquo m always behindthe eight-ball with herrsquo or rsquo I was cluelesswhen it came to my mother itrsquos the oldproblem of the irresistible force and theimmovable objectrsquo Caroline by contrastdescribed to me a game of pool she hadplayed in which her mother was the cue balland she had been able to pocket the otherballs without moving the cue-ball or hittingthe eight-ball Her affect was one of triumphfor she literally believed she had solved theproblem of dealing with her mother

This example will serve to segue from thesemantic to the pragmatic aspects of schizo-phrenese which is closely related to delusion

reversal and undoing and deceptionmdashpro-cesses that enable the user to avoid thoughtand awareness of feelings Ordinary languageserves to adapt the waking user to anrsquo externalrsquo world as subjectively perceivedwithin broad consensual outlines The worldof the schizophrenic by contrast is internalthough unrecognised as such and consists ofidiosyncratic microcosms that combine whatmore maturely we look upon as psyche withwhat is sensed and perceived Subjectivelyby manipulating mental contents the schizo-phrenic experiences control over the worldThe language is felt by its user to possess thepower to undo reverse and eliminate intoler-able reality both past and present It is alanguage of psychic alchemy or delusionalomnipotence (Burnham 1955 Frosch 1967Glass 1981) Caroline told me rsquo I fool myselfinto thinking it didnrsquo t happenrsquo Speakingordinary language she referred to schizo-phrenese as rsquo the language of wish and desirersquo With her knitting a game of pool a walkaround the lake or detailed letters to othersshe creates a universe that she can describeand act upon with the conviction that she isaltering events problems and associated feel-ings both present and past Ordinary lan-guage also employs reversal but in anentirely different way and for an oppositepurpose By its stark contrast with the sharedand implicitly acknowledged context such areversal in ordinary language serves to high-light or accentuate the feeling the speakerwishes to conveymdashfor instance in the remarkrsquo Hersquos a ne one to be saying thatrsquo Thedelusional reversal of schizophrenia by con-trast eliminates the necessity to differentiatemind from reality to bear painful feelingsand to adapt to a consensually validatedworld An ordinary person faced with apainful situation might transiently nd solaceby constructing heroic fantasies and becom-ing in imagination someone able to surmountany dif culty invulnerable to pain and hurtSchizophrenic language by contrast lacksthe rsquo as if rsquo capacity inherent in the use ofmetaphor that is required to construct such a

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 397

fantasy Instead of an unconscious fantasyand a language capable of contemplation theschizophrenic experiences a delusional senseof actualisation rsquo isrsquo has replaced rsquo as if rsquo

The qualitative difference between schizo-phrenese and ordinary language helps toaccount for the fact that delusions are xedbeliefs refractory to clinical analysis In themind of their creator they are actualitiesrather than fantasies so that there is nothingto be thought about Some time after thevignettes that I have presented when Carolinehad become more uent in ordinary languageand more uid in moving back and forthbetween the two she commenced an hour byobserving my new shoes and commenting rsquo Itmakes me angry that you always have neatshoes and I donrsquo trsquo I observed aloud that herown feet were beginning to move Sheresponded rsquo Our feet move togetherrsquo andadded that she would like me to hug her Iinquired what that was about and she said rsquo Iwant to be in your shoesrsquo She was then ableto express in ordinary language her aware-ness that she was not expressing a fantasy orsymbolising a wish to be more like me butwas verging on speaking the thoughtlesslanguage of schizophrenese which in the pastwould have achieved a sense of actualisationand closure (in this case the delusion she hadexchanged identities with me) rather thanallowing the opportunity for re ectivethought about painful feelings and issuesrelated to being her own separate person

Paradoxically it is this very failure ofschizophrenic language to distinguishthoughts from events that may disguise itsbizarreness and conceal the delusional think-ing it supports because utterances may seemto patient and analyst to be nothing more thandescriptions or observations of happeningsIn telling me about the degrading affair withher college professor and her subsequentconversation about it with her mother Caro-line believed she was doing it over differentlynot simply wishing she might

No discussion of schizophrenic languagewould be complete without a comment about

neologisms which incidentally are notnearly so speci c to schizophrenia as gener-ally believed They appear to be constructedaccording to ordinary morphological princi-ples and it is primarily in their semantic andpragmatic aspects that they are remarkableOne day Caroline said rsquo Irsquove got it set up atwork so no-one can refrain from authoritingme They tell me what to do It pisses me offrsquoWhen I inquired if she believed authoritingwas a legitimate word she said she supposednot I then asked why she did not say whatshe meant in acceptable English She repliedthat it would compel her to face feelings ofshame at loss of dignity and control over herown life By not accepting the existence of anordinary language word to express her feelingstate she managed to repudiate the reality ofthe issue and to avoid the feelings about itThis is another example of the identity ofwords things and actions If the word is thereal thing and she can substitute a neologismthen she can delude herself that the thing orthe problem no longer exists It is easy for theanalyst who is struggling to understand thepatient to gloss over the idiosyncratic aspectof the word in favour of what appears to bethe underlying meaning as one might do withsome of the peculiarities of speech of some-one not uent in onersquos native tonguemdashin thisinstance to assume that Caroline rsquo reallyrsquomeans rsquo acting like an authority withrsquo In thisway the patientrsquos delusion combines with theanalystrsquos illusion to form collusion

Schizophrenic patients do not want to beunderstood for it threatens them with un-wanted knowledge about themselves Schizo-phrenese not only lacks communicativeintent it is a language of deception In orderto function as a vehicle of communicationcontextual elements and related linguisticassumptionsmdashpersonal social and culturalmdashmust be suf ciently concordant in speakerand listenermdashthe rsquo musicrsquo so to speak thataccompanies the words In the case of schizo-phrenese not only are these assumptionsidiosyncratic to the speaker or writer but alsothe speaker or writer is unwilling to elucidate

398 MICHAEL ROBBINS

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

henceforth educate me about schizophreneseIn situations where hitherto I would have felthopeless angry and bored I pulled out padand pen and took the verbatim notes thatyears later she gave her permission for me touse as data for this paper I questioned her indetail as though I were a student asking theprofessor to explain the lecture To mysurprise my self-serving action nally gotCarolinersquos attention when what I thought hadbeen my efforts to care about her had not Shewas shocked fascinated and amused

In retrospect I believe my decision to learnrather than be driven crazy or to reject herwas a model for what Caroline had beenunable to do as a child Because I nally feltthat I was getting something out of therelationship I felt less immediately investedin whether Caroline did rsquo therapyrsquo and in turnCarolinersquos curiosity was piqued She began toalert me to get out my notebook when shesensed an urge to speak schizophrenese andshe decided to keep a journal When I onceasked her in response to her having justalerted me to get pen and notebook how shewas able to determine that she was about tospeak schizophrenese she replied rsquo Itrsquos whenI put things together in strange ways that no-one else would understandrsquo adding rsquo I take agiant leaprsquo The ensuing discussion willclarify what she meant

Vignette 1

Caroline had gone to play pool after takingher car to be repaired It had been damageddue to irresponsible actions on her part aboutwhich we had talked at length

P I had time to kill Rack it up and pocketrsquo em Sock it and rock rsquo em Clear the tableThe only table that had monkey business to it

A What do you meanP E [a staff member in the hospital whom

Caroline idealised] and I used to play poolA What do you meanP Judgement Day Irsquo ve got so many balls

and I have to put them in the pocket Get theeight-ball in and yoursquo re out Irsquo ve got to shoot

straight from the hip and keep both feet onthe ground Just straight shots coming fromthe heart People have things racked upagainst you but you keep on shooting and ifyou make a racket like me it gives them moreammunition

A What do you meanP Now you really think Irsquo m crazy I racked

rsquo em up and then I bought a root beer The guysaid rsquo You canrsquo t drink that herersquo and then wetalked about getting 50 off lodging in [adistant resort] I said that late September isthe best time to go there [laughs]

A What are you laughing aboutP Well itrsquos not a short walk to get there

and I have $16 in my wallet They donrsquo t wantunethical behaviour in the bar So I thinkabout going there I build up in my mindplaces to go I start out thinking Irsquo m going toclean the apartment Then I do these otherthings Then I start thinking when I donrsquo t thatitrsquos the fault of the landlord and others Then Iran out of time and I had to go to work I waslate again

A What about the resortP Itrsquos a Closetland place [a reference to a

movie about a woman who turned to fantasyin order to endure torture] no problems thereeverything is ne

Analysis

Caroline begins by trying to tell me some-thing in rsquo purersquo schizophrenese After shemakes the observation that I will think she iscrazy she begins to try to explain her thoughtprocess by using more schizophrenese Gra-dually she shifts into ordinary language andattempts to re-cast her thoughts The ordinarylanguage moves the discourse from the con-crete level of things and actions to the realmof subjective thought and feeling symbol andmetaphor An ordinary language renditionderived from what she told me and from thebroader context of our relationship at thattime might be rsquo The Day of Judgement hascome for me Irsquo m in a rage at myself for allmy monkey businessmdashdamaging my car not

390 MICHAEL ROBBINS

being nancially responsible not cleaningmy apartment or being on time for myappointments and treating life like a game Igive others ammunition to use against meIrsquove really got myself behind the eight-balland Irsquove got to get my feet back on theground But Irsquo m in a rage at having to beresponsible I just want to kill more timeblame others wipe the table clean of all myproblems and imagine Irsquom at a resort on aperpetual vacationrsquo

This version of her thoughts requires alanguage of re ection metaphor and symbo-lism In schizophrenese by contrast insteadof a subjective self the thoughts and feelingsabout the situation she has got herself intoshe describes an animated literalmdashnotmetaphoricalmdashpool table microcosm ofwhich she is omnipotent master as shecombines words body actions and things Itis Judgement Day and she literally believesshe is ridding herself of her problems Killingtime involves rage- lled destructive action Italso re ects the absence of comparativeconcepts that would serve to make her awareof the passage of time and its implicationssuch as process work patience and perspec-tive What might appear to be low-grademetaphors or similesmdashcliches such as rsquo shootstraightrsquo rsquo shoot from the hiprsquo rsquo rack rsquo em uprsquo rsquo rock rsquo em and sock rsquo emrsquo being rsquo behind theeight-ballrsquo rsquo killing timersquo mdashare in fact actioncondensations of words body movementsand things based on assonance

Vignette 2

This is a sample of Carolinersquos writtenlanguage She brought in for discussion aletter entitled rsquo The Class Actrsquo which sheproposed to send to twenty- ve or so of herformer caretakers as accompaniment to aValentine card It begins with the salutationrsquo To a Quarter of Caring Peoplersquo

rsquoAlthough I have loving feelings for thepeople who have held me in their thoughts ofcare this card is an expression of appreciationand care not love I am on an excavation of

dignity (dig-knit-tea) The month of nancialFebruary is for my initial dig The month ofMarch my birthday always and forever hold-ing is for my knit The month of April is for apoem once learned as in college

T T TSee these threeHear their chimeThings take time for thought taxes andteaHer letter concludes with a paragraph of

plans for each of the months of May andJune In response to my request that sheexplain this to me in ordinary language shesays

P Itrsquos how overwhelmed I am about thecoming months In the 6th grade a teacher Irespected took her class on an archaeologicaldig That means rsquo dig inrsquo rsquo Dignityrsquo has threeparts dig-knit-tea You have to dig in and knitthings and then drinking tea calms you down

A But why do you say it this way and notsomething like rsquo Irsquo m overwhelmed about howIrsquo m going to manage my life in a digni edway during the coming months I need to nda way to calm down and to use my 6th gradeteacher as a model for digging in workinghard and pulling my life togetherrsquo

P The way I said it is brilliant Besides itkeeps me at a distance from people puts mein a separate space where they wonrsquo t knowwhat Irsquom talking about I donrsquo t want people toknow how much distress Irsquo m in

A So yoursquo re writing a letter of informationabout yourself with all sorts of details aboutyour life to people you supposedly careaboutmdashbut you want to conceal your realdistress from them

P The time is so overwhelming I had tocompartmentalise it into months so I couldmanage my mess Then I send it to respon-sible people and they will take care of it Irsquom lling up their mailbox adding to theirconcern So I gave it to my landlord to readand he said rsquo Take carersquo I got furious He wassupposed to take care of it Irsquo m getting amisery out of it getting to sit in some low-down place and not move out of it Some

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 391

people try to intimidate people I intimatepeople

A What do you meanP Relationships are too dif cult so I word

my way into a relationship with letters Irsquodlike to work my way into your hearts withoutworking my way in and without mentioningthings that would work my way out of yourhearts

Analysis

Caroline is gradually able to re-present thethought behind her letter in an ordinarylanguage statement but even at the conclu-sion of the discussion she is still partlyspeaking schizophrenese If she were able tospeak ordinary language she might saysomething like rsquo I would like to fool myselfand the others in my life that this is really aValentine about loving and feeling close tothem and a resolution not to be such a low-down person but to identify myself withconstructive responsible people and to workhard to dig myself out from the mess Irsquovemade But really this card expresses my wishto avoid the pain of my situation and to sendall my problems away and force them insideothers to take care ofrsquo

What sets the schizophrenese apart fromthe ordinary language version is that she isnot expressing wishes nor is she usingphrases like rsquo digging inrsquo being rsquo low downrsquo rsquo keep me in your heartrsquo rsquo I give you myheartrsquo or rsquo knitting together the strands of herlifersquo metaphorically Instead of workingwhich involves effort patience thoughtfulre ection and bearing of distress she engagesin wording an action discharge that is itsantithesis An ordinary person might work atsolving her problems while singing such songlyrics as rsquo Pack up your troubles in your oldkit bagrsquo or rsquo Pack up your troubles and sendthem all to mersquo When Caroline says rsquo I send it(rsquorsquo my messrsquorsquo ) to responsible people Irsquom lling up their mailbox I word my wayinto a relationship with lettersrsquo she literallybelieves she is digging out and packaging her

word-self into the Valentine card and puttingit in the mailbox-hearts of people who willhold and care for her emotionally distressedself in a way that she cannot or will not doThere is nothing left for her to think about tofeel or to work on Insofar as her actionssucceed in burdening others with her worriesand problems her wishful belief in a sensecomes true Fooling others so that she getsno realistic feedback is necessary in order tocontinue to fool herself The words dignityand intimate are neologismsmdashhomophoniccompounds that combine word action andthing

The interaction with her landlord illustratestwo points Nancy Andreasen et al (1985)believe that while schizophrenics are defec-tive in expressive language receptive lan-guage remains normal It is clear in thisinstance however that Caroline hears whather landlord says in schizophrenese as wellFrom a psychoanalytic perspective it is evi-dent that the underlying thought processresembles the phantasies Klein writes aboutand lends itself to an interpretation of projec-tive identi cation but in order to know this itis rst necessary to re-present the thoughtThe miscommunication that can ensue frommaking a psychoanalytic interpretation basedon the belief the patient is speaking andlistening in ordinary language is illustratedby Carolinersquos interchange with her landlordHe believes she is speaking ordinary lan-guage and he responds to her Valentine bytelling her to rsquo take carersquo She receives hisordinary language statement as though hewere speaking schizophrenese Her construc-tion of it as a rejection throws her into a ragewhich she in turn conceals because sheimagines it will evoke his anger

Vignette 3

P I walked around the lake with mymother when my affair with my collegeprofessor was going on [perhaps 15 yearspreviously] and told her about it So the lastfew days I found three lakes and walked

392 MICHAEL ROBBINS

around them Three guys were on one dockThings reminded me of the professor Birdson an island in the rst lake remind me of aman who didnrsquo t disclose that he was probablyhaving other relationshipsmdashprobably screw-ing other women all those birdsmdashbut it washard to keep my mind together walkingaround the big lake because it was so big toobig a place to keep my mind Then these guysstarted irting playing with my mind Allthree of those lakes make a penis the end themiddle the part you play with

A Why did you do thisP I did it so I could focus on a destructive

relationship I was trying to feel the feeling Ionce had with my mother after the affair Butthe lakes are such a big temptation to fall in itagain Walking around the smaller lake Icould get more in touch with the feeling ofloss and hurt some of the feeling but itwasnrsquo t satisfying The bigger lakes were over-whelming and I didnrsquo t know why I was thereany more I was trying to get into troubleThe birds on the big lake felt threatening allthe people he screwed the things I didnrsquo t seeI was foolish I start to realise it but theninstead it becomes my mother fooled me notwhat I did My mother goes to [her wintervacation home] and spends time watching thebirds I feel betrayed I went to the dock andsaw two birds in a caged area I felt caged Iwondered if those women were prostitutesand ended in jail

A What do you meanP Irsquom trying to deal with what happened

in my twenties with the professor Around thelake my mother and I walked and I told her[Her mother had blamed the professor andtold Caroline not to worry about what she haddone] The lie was talking to my mother aboutit and my motherrsquos lies My interest in thelake is a re-creation of the crime when some-thing equals nothing and nothing equalssomething The lively pond is a metaphor formy mind and my dif culty containing limitsand boundaries staying in bounds and notdestroying everything attending to a straightline of thought The kids represent how easily

Irsquo m distracted and take my mind off The lakeis a reference to my mind and the tree is myinterest in life The tree and the birds are ablaming thing People donrsquo t tell others abouttheir affairs but they communicate insidethemselves about it My mind is the pond thetree Claustrophobia is how rsquo in the darkrsquo apart of me is My thoughts versus my actionsI say one thing make my pledges then I godo another Destructive Irsquo m terri ed of thetemptation to blow everything to bits My treeis empty and alone others have things in theirbranches I canrsquo t walk a straight line I veeroff so I try another planet Itrsquos painful I knowif I canrsquo t stay on line in this little pond thenIrsquo ll never get anywhere in the bigger issues inlife I can look at trees that seem moreinteresting but I have to be able to deal withwhatrsquos here

A Now you are speaking in metaphor whydonrsquo t you always

P Metaphors take more responsibilitythey are more connecting

Analysis

Caroline begins speaking about her trip inliteral schizophrenese but by the conclusionof our discussion the physical elements of hersurroundings have become incorporated inmetaphors A more elaborate translation thatsupplements her efforts with other informa-tion in my possession but preserves her ownwords and phrases might be something likethis rsquo Irsquo ve been thinking about my affair withthe professor trying to return so to speak tothe scene of the crime and nd a differentway in my mind to handle what I couldnrsquo tdeal with then but I keep falling into thesame old patterns of thinking I fell intosexual temptation and I lost my mind I wasrsquorsquo out of my treersquorsquo Did he fool me or did I foolmyself Afterwards my mother and I took awalk I was struggling over whether to facemy feelings of hurt responsibility and guiltor stay in the dark about what I had done anddeny that I was a fool But I couldnrsquo t contain

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 393

myself I canrsquo t seem to rsquorsquo go straightrsquorsquo I fellinto it again and spilled everything out to mymother I deserved to be punished but insteadof making me feel like a jailbird or aprostitute she blamed him and she made likeit was nothing she vacated her mind andlooked for other birds to blamersquo

In this ordinary-language version thereemerges a thoughtful emotional re ectiveself replete with the symbolism and meta-phor that is missing in a language that fuseswords things and actions Caroline describesher schizophrenese much as Bion (1967)described attacks on linkingmdashas a process ofacting rather than thinking and blowing hermind to bits As she observes makingmetaphors takes too much energy When shetalks about getting in touch with feelings sheis not referring to metaphorical touching butto literal sensory-motor activities She can-not separate words from actions and things sothat she might be able to think about thedestructive relationship and the overwhelm-ing temptation Instead she walks around alake that she has rendered equivalent to (notwhich symbolises) the container of her mindher mind itself the loss of her mind thetempting three-part male genital the threeguys playing with her mind and her playingwith the penis Her mind is also literallyindistinguishable from the tree or the cageand the birds caged or in trees are concreteenactments of internalised or projected res-ponsibility and blame Of the three vignettesthis re ects the most mental maturity in so faras Caroline is trying to think and feel in anordinary way at the very same time sheexperiences the omnipotent capacity to elimi-nate what needs to be thought about Bothefforts fail

Discussion

Schizophrenics speak a meaningful lan-guage that differs from ordinary language inits essence not simply with regard to sym-bolism This language has a determina-

tive relationship to delusional thinkingBecause Freudrsquos linguistic analysis ofdreaming as a delusional and hallucinatorywish-ful lmentmdashan encapsulated nocturnalpsychosismdashis of considerable relevancesummarising some of the parallels betweendreaming and schizophrenia will be a usefulpoint of entry Schizophrenia presents itselfon a continuum in varying degrees of regres-sion or compensation In its most regressedform catatonia it resembles a waking dreamstate characterised by absence of wakefulattentiveness and sensory-perceptual domi-nance in the form of hallucinations Verbaland motor action are also absent as in thestate of sensory-perceptual identity to whichFreud made reference in his discussion of theprimary process in dreams (1900) and in hispaper on hallucinatory wish ful lment in theabsence of the object (1911) At the other endof the continuummdashthe state of maximalcompensationmdashthe balance is shifted towardspsycho-motor identity the language ofschizophrenia is one of action and actualisa-tion rather than thought and it resembles thesensorimotor stage of infancy

Discussion of language is usually dividedinto syntax morphology semantics and prag-matics As noted earlier syntax here is moreor less intact With regard to morphologyalthough some of the words used by theschizophrenic may be idiosyncratic the rulesor processes by which they are formed (suchas the use of af xes compounding onomato-poeia proper noun transformation clippingand blending) seem identical to those used inordinary language Therefore the ensuingdiscussion will focus on semantic and prag-matic considerations

Ordinary language is an aspect of re ectivethought that is uniquely situated betweenimpulse and action and enables adaptation toconsensual reality by means of exchangingthoughts and feelings with others and con-templating them oneself Language is neverentirely divorced from the sensorimotorphase in the sense that action in the form ofgestures and bodily expressions as well as

394 MICHAEL ROBBINS

somatic sensations remains an inextricablepart of it but in the course of developmentspeech and writing become relatively autono-mous The more sophisticated the subject themore exible the language becomes in mov-ing between concrete sensory somatic andfunctional considerations on the one handand more abstract re ective and comparativeoperations in which one element stands forabbreviates or enriches one or more otherson the other Individual language developsfrom simple denotationmdashthat is learningculturally determined signi ersmdashto abstractdevelopment of symbols metaphors andsimiles both those shared by a given cultureand those that re ect unique personal experi-ence The capacity for simultaneous parallelor multi-track processing enables language todisguise and conceal as well as to re ectclarify and communicate and to have at anygiven time more than one meaning It is thismulti-dimensional complexity that makespsychoanalysis possible

Because we have no choice but to useordinary language as both a means and areference point for analysing schizophreniclanguage it is natural to assume the latter tobe qualitatively continuous with ordinarylanguage and that linear translation of one tothe other is possiblemdashas in Freudrsquos well-known comparison of dream imagery toEgyptian hieroglyphics We tend to assumethat schizophrenese is a kind of encryptedcode cover or disguise that can be decodedinto its unconscious rsquo realrsquo ordinary languagemeaning Thus it would seem natural to askof a schizophrenic utterance rsquo What does itmeanrsquo mdasha question which I raise repeatedlyin the paper and which I often addressed toCaroline But schizophrenese is not a variantof ordinary language It is unique and intrin-sically different hence such a reduction is notpossible It may eventually be possible how-ever for the schizophrenic to acquire thecapacity to re-state or re-present the thoughtsthat he or she was couching in schizophrenesein ordinary language so that the two lan-guages can be compared and contrasted and

this is what Caroline gradually acquired thecapability to do

From a semantic perspective schizophre-nese is characterised by an absence of theordinary distinctions between word thingbodily process and action The word is usedas though it were identical to the thing towhich it would ordinarily refer as well as toactionsmdashpast present or prospectivemdashon orin relation to the thing and to the mediatingsomatic processes Words lack their ordinaryconnotation as representations and refer-ences they have become happenings orevents Caroline once referred to this processas rsquo combination thinkingrsquo mdasha term nearlyidentical to the concept rsquo combinative think-ingrsquo proposed by McClain Johnston andPhilip Holzman (1985) In ordinary discoursespeaker and listener recognise the symbolicimport of a concrete-sounding statement suchas rsquo I have a special pipeline to the bossrsquo orrsquo Letrsquos smoke a peace-pipersquo The metaphorserves as emphasis or highlighting of a keyidea that is being talked about In contrastCaroline once literally handed me a sectionof plumberrsquos pipemdasha gesture so pregnantwith meaning yet impregnable to my inter-pretive skills that it would have been easy toconclude that the pipe was an arcane symbolWhen I questioned her about it however shewas able to tell me that she was making aconnection with me In other words the pipewas just a pipe An ordinary speaker mightmetaphorically and passionately declare loveby saying rsquo I give you my heartrsquo or sing aboutempathic sharing in the folk lyric rsquo Pack upyour troubles in your old kit bag and smilersquo but in discussing the thought process involvedin mailing her Valentine card with a largeheart on it to a large number of casual andformer acquaintances Caroline told me shewas packaging and mailing her word-self toothers she looked upon as more willing toassume responsibility for her than she was forherself While it is tempting to use terms likecollapse implosion explosion fusion orboundary loss to describe the creation ofthese concrete linguistic identities such

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 395

terms convey the incorrect impression thatschizophrenese is a regressive degradation ofordinary language Rather schizophrenese isa language of equivalence immediacy andaction in contrast to ordinary languagewhich supports representational thinkingMoreover there is no evidence that theschizophrenic ever rsquo spokersquo differently

Schizophrenese then is an immediatelanguage of the body and its function in theworld of things particularly motor (throwinghitting) respiratory (breathing talking andblowing as in the felicitous expression rsquo mindblowingrsquo ) gastrointestinal (vomiting and de-fecating) and orgasmic (rsquo fucking onersquos brainsoutrsquo ) Caroline describes printmaking as fol-lows rsquo I was pounding it down oozing out myblack insides on paperrsquo She described one ofher long walks as follows rsquo I want to run andrun and run away from the painful feelings Ifeel like I can split off disintegrate and getaway from them This is what schizophreneseis aboutrsquo She said rsquo I give people the breath-ing they need I make a case to take care ofme I respire them With every breath I givethem responsibilityrsquo

rsquo Respirersquo is a neologism made by theordinary morphological processes of clippingand condensation of the physical process ofrespiration and the work-related concept ofresponsibility but it is a thing and not areference She said rsquo Irsquom mad today I had toput in limits and boundaries and not spill myguts There are lots of snakes inside me and Iwant you to eat them for mersquo In reference toan episode of vomiting during a meal withher family when they questioned her aboutinstances of her irresponsible behaviour shecomments rsquo I couldnrsquo t bear the feeling ofhaving taken all those courses wastingmoney scattering my time and I had to getrid of them I was throwing up the feelingrsquo

It follows from the nature of their languagethat schizophrenics lack patience self-controland restraint have dif culty conceptualisingprocess and sequence distinguishing pastfrom present and here from there and seeingthe consequences of their actions and thereby

learning from experience Carolinersquos Valen-tine mailing was an example of how sheregularly bombarded with letters persons withwhom she had no current contact often fromthe distant past She called these bizarremass-mailings rsquo Trail Newsrsquo and she believedshe was relieving herself into these others ofher otherwise troubling mental contents Shesaid rsquo If your arm was controlled by maturethought then you could wait Itrsquos the entangle-ment quality instead of being able to stop andthinkrsquo

Despite its sometimes strange and colour-ful character the language of schizophreniais neither a language of conscious awareness(re ection) nor of unconscious concealment(repression) It does not support mentalrepresentation symbolisation and re ectionFailure to appreciate this may be what led ageneration of analysts including such semi-nal gures as Frieda Fromm-Reichmann toidealise schizophrenic persons as havingspecial psychic acuity and access to theirunconscious mental life that ordinary personsdo not A neurotic patient might refer to herhabitual and inappropriate tendency to con- de personal affairs to others using theunconscious symbolism of a phrase such asrsquo spilling my gutsrsquo If questioned she wouldhave the sense that she had said somethingworth re ecting on thinking about andanalysing the symbolic meaning of WhenCaroline used the expression as noted earliershe not only believed there were snakes in herintestines that she needed to give to me(although she could reality-test the idea ifpressed to do so) but she referred to anearlier occasion when she had vomited to ridherself of unwanted feelings In an ordinaryanalysis the analyst might suggest that thepatientrsquos behaviour and associations indicatethat she viewed her problems as a mess shebelieved she could dump on to or into theanalyst and the patient might respond to theinterpretation with associations to oral or analfantasies and memories When Caroline saysrsquo I send it [rsquorsquo my messrsquorsquo ] to responsible people Irsquom lling up their mailbox I word my

396 MICHAEL ROBBINS

way into a relationship with lettersrsquo she isdoing something and not speaking metaphori-cally or thinking Whereas an ordinary personmight be aware of the underlying fantasiesand con icts Caroline literally believes thatshe is excreting her self which is identical toher words into others It might be moreaccurate to say that she is expressing phan-tasy in the Kleinian sense but if so even atthis level of discourse when she makes anattempt to interpret the original schizophren-ese account of her mass mailings in alanguage more comprehensible to me she isstill speaking in a language of closure andenactment devoid of interpretable symbo-lism and unconscious meaning

While schizophrenia is a state of self-centredness or egocentricity in the solipsisticsense of the term schizophrenese paradoxi-cally is a language without a centred subjectexcept in the most rudimentary sense ofobserver and actor of a drama The subjectiversquo Irsquo denoting the presence of conscious re ec-tion and thought about beliefs fantasiesemotions and con icts is largely missing andin its stead Caroline describes a microcosm inwhich she is participant consisting of suchthings as a pool table with its sticks and ballsher sewing box with its bobbins and yarns orthe terrain bordering the three lakes she haswalked around with its birds trees andpeople In ordinary discourse one might shareonersquos subjective thoughts and feelings aboutonersquos mother by saying rsquo Irsquo m always behindthe eight-ball with herrsquo or rsquo I was cluelesswhen it came to my mother itrsquos the oldproblem of the irresistible force and theimmovable objectrsquo Caroline by contrastdescribed to me a game of pool she hadplayed in which her mother was the cue balland she had been able to pocket the otherballs without moving the cue-ball or hittingthe eight-ball Her affect was one of triumphfor she literally believed she had solved theproblem of dealing with her mother

This example will serve to segue from thesemantic to the pragmatic aspects of schizo-phrenese which is closely related to delusion

reversal and undoing and deceptionmdashpro-cesses that enable the user to avoid thoughtand awareness of feelings Ordinary languageserves to adapt the waking user to anrsquo externalrsquo world as subjectively perceivedwithin broad consensual outlines The worldof the schizophrenic by contrast is internalthough unrecognised as such and consists ofidiosyncratic microcosms that combine whatmore maturely we look upon as psyche withwhat is sensed and perceived Subjectivelyby manipulating mental contents the schizo-phrenic experiences control over the worldThe language is felt by its user to possess thepower to undo reverse and eliminate intoler-able reality both past and present It is alanguage of psychic alchemy or delusionalomnipotence (Burnham 1955 Frosch 1967Glass 1981) Caroline told me rsquo I fool myselfinto thinking it didnrsquo t happenrsquo Speakingordinary language she referred to schizo-phrenese as rsquo the language of wish and desirersquo With her knitting a game of pool a walkaround the lake or detailed letters to othersshe creates a universe that she can describeand act upon with the conviction that she isaltering events problems and associated feel-ings both present and past Ordinary lan-guage also employs reversal but in anentirely different way and for an oppositepurpose By its stark contrast with the sharedand implicitly acknowledged context such areversal in ordinary language serves to high-light or accentuate the feeling the speakerwishes to conveymdashfor instance in the remarkrsquo Hersquos a ne one to be saying thatrsquo Thedelusional reversal of schizophrenia by con-trast eliminates the necessity to differentiatemind from reality to bear painful feelingsand to adapt to a consensually validatedworld An ordinary person faced with apainful situation might transiently nd solaceby constructing heroic fantasies and becom-ing in imagination someone able to surmountany dif culty invulnerable to pain and hurtSchizophrenic language by contrast lacksthe rsquo as if rsquo capacity inherent in the use ofmetaphor that is required to construct such a

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 397

fantasy Instead of an unconscious fantasyand a language capable of contemplation theschizophrenic experiences a delusional senseof actualisation rsquo isrsquo has replaced rsquo as if rsquo

The qualitative difference between schizo-phrenese and ordinary language helps toaccount for the fact that delusions are xedbeliefs refractory to clinical analysis In themind of their creator they are actualitiesrather than fantasies so that there is nothingto be thought about Some time after thevignettes that I have presented when Carolinehad become more uent in ordinary languageand more uid in moving back and forthbetween the two she commenced an hour byobserving my new shoes and commenting rsquo Itmakes me angry that you always have neatshoes and I donrsquo trsquo I observed aloud that herown feet were beginning to move Sheresponded rsquo Our feet move togetherrsquo andadded that she would like me to hug her Iinquired what that was about and she said rsquo Iwant to be in your shoesrsquo She was then ableto express in ordinary language her aware-ness that she was not expressing a fantasy orsymbolising a wish to be more like me butwas verging on speaking the thoughtlesslanguage of schizophrenese which in the pastwould have achieved a sense of actualisationand closure (in this case the delusion she hadexchanged identities with me) rather thanallowing the opportunity for re ectivethought about painful feelings and issuesrelated to being her own separate person

Paradoxically it is this very failure ofschizophrenic language to distinguishthoughts from events that may disguise itsbizarreness and conceal the delusional think-ing it supports because utterances may seemto patient and analyst to be nothing more thandescriptions or observations of happeningsIn telling me about the degrading affair withher college professor and her subsequentconversation about it with her mother Caro-line believed she was doing it over differentlynot simply wishing she might

No discussion of schizophrenic languagewould be complete without a comment about

neologisms which incidentally are notnearly so speci c to schizophrenia as gener-ally believed They appear to be constructedaccording to ordinary morphological princi-ples and it is primarily in their semantic andpragmatic aspects that they are remarkableOne day Caroline said rsquo Irsquove got it set up atwork so no-one can refrain from authoritingme They tell me what to do It pisses me offrsquoWhen I inquired if she believed authoritingwas a legitimate word she said she supposednot I then asked why she did not say whatshe meant in acceptable English She repliedthat it would compel her to face feelings ofshame at loss of dignity and control over herown life By not accepting the existence of anordinary language word to express her feelingstate she managed to repudiate the reality ofthe issue and to avoid the feelings about itThis is another example of the identity ofwords things and actions If the word is thereal thing and she can substitute a neologismthen she can delude herself that the thing orthe problem no longer exists It is easy for theanalyst who is struggling to understand thepatient to gloss over the idiosyncratic aspectof the word in favour of what appears to bethe underlying meaning as one might do withsome of the peculiarities of speech of some-one not uent in onersquos native tonguemdashin thisinstance to assume that Caroline rsquo reallyrsquomeans rsquo acting like an authority withrsquo In thisway the patientrsquos delusion combines with theanalystrsquos illusion to form collusion

Schizophrenic patients do not want to beunderstood for it threatens them with un-wanted knowledge about themselves Schizo-phrenese not only lacks communicativeintent it is a language of deception In orderto function as a vehicle of communicationcontextual elements and related linguisticassumptionsmdashpersonal social and culturalmdashmust be suf ciently concordant in speakerand listenermdashthe rsquo musicrsquo so to speak thataccompanies the words In the case of schizo-phrenese not only are these assumptionsidiosyncratic to the speaker or writer but alsothe speaker or writer is unwilling to elucidate

398 MICHAEL ROBBINS

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

being nancially responsible not cleaningmy apartment or being on time for myappointments and treating life like a game Igive others ammunition to use against meIrsquove really got myself behind the eight-balland Irsquove got to get my feet back on theground But Irsquo m in a rage at having to beresponsible I just want to kill more timeblame others wipe the table clean of all myproblems and imagine Irsquom at a resort on aperpetual vacationrsquo

This version of her thoughts requires alanguage of re ection metaphor and symbo-lism In schizophrenese by contrast insteadof a subjective self the thoughts and feelingsabout the situation she has got herself intoshe describes an animated literalmdashnotmetaphoricalmdashpool table microcosm ofwhich she is omnipotent master as shecombines words body actions and things Itis Judgement Day and she literally believesshe is ridding herself of her problems Killingtime involves rage- lled destructive action Italso re ects the absence of comparativeconcepts that would serve to make her awareof the passage of time and its implicationssuch as process work patience and perspec-tive What might appear to be low-grademetaphors or similesmdashcliches such as rsquo shootstraightrsquo rsquo shoot from the hiprsquo rsquo rack rsquo em uprsquo rsquo rock rsquo em and sock rsquo emrsquo being rsquo behind theeight-ballrsquo rsquo killing timersquo mdashare in fact actioncondensations of words body movementsand things based on assonance

Vignette 2

This is a sample of Carolinersquos writtenlanguage She brought in for discussion aletter entitled rsquo The Class Actrsquo which sheproposed to send to twenty- ve or so of herformer caretakers as accompaniment to aValentine card It begins with the salutationrsquo To a Quarter of Caring Peoplersquo

rsquoAlthough I have loving feelings for thepeople who have held me in their thoughts ofcare this card is an expression of appreciationand care not love I am on an excavation of

dignity (dig-knit-tea) The month of nancialFebruary is for my initial dig The month ofMarch my birthday always and forever hold-ing is for my knit The month of April is for apoem once learned as in college

T T TSee these threeHear their chimeThings take time for thought taxes andteaHer letter concludes with a paragraph of

plans for each of the months of May andJune In response to my request that sheexplain this to me in ordinary language shesays

P Itrsquos how overwhelmed I am about thecoming months In the 6th grade a teacher Irespected took her class on an archaeologicaldig That means rsquo dig inrsquo rsquo Dignityrsquo has threeparts dig-knit-tea You have to dig in and knitthings and then drinking tea calms you down

A But why do you say it this way and notsomething like rsquo Irsquo m overwhelmed about howIrsquo m going to manage my life in a digni edway during the coming months I need to nda way to calm down and to use my 6th gradeteacher as a model for digging in workinghard and pulling my life togetherrsquo

P The way I said it is brilliant Besides itkeeps me at a distance from people puts mein a separate space where they wonrsquo t knowwhat Irsquom talking about I donrsquo t want people toknow how much distress Irsquo m in

A So yoursquo re writing a letter of informationabout yourself with all sorts of details aboutyour life to people you supposedly careaboutmdashbut you want to conceal your realdistress from them

P The time is so overwhelming I had tocompartmentalise it into months so I couldmanage my mess Then I send it to respon-sible people and they will take care of it Irsquom lling up their mailbox adding to theirconcern So I gave it to my landlord to readand he said rsquo Take carersquo I got furious He wassupposed to take care of it Irsquo m getting amisery out of it getting to sit in some low-down place and not move out of it Some

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 391

people try to intimidate people I intimatepeople

A What do you meanP Relationships are too dif cult so I word

my way into a relationship with letters Irsquodlike to work my way into your hearts withoutworking my way in and without mentioningthings that would work my way out of yourhearts

Analysis

Caroline is gradually able to re-present thethought behind her letter in an ordinarylanguage statement but even at the conclu-sion of the discussion she is still partlyspeaking schizophrenese If she were able tospeak ordinary language she might saysomething like rsquo I would like to fool myselfand the others in my life that this is really aValentine about loving and feeling close tothem and a resolution not to be such a low-down person but to identify myself withconstructive responsible people and to workhard to dig myself out from the mess Irsquovemade But really this card expresses my wishto avoid the pain of my situation and to sendall my problems away and force them insideothers to take care ofrsquo

What sets the schizophrenese apart fromthe ordinary language version is that she isnot expressing wishes nor is she usingphrases like rsquo digging inrsquo being rsquo low downrsquo rsquo keep me in your heartrsquo rsquo I give you myheartrsquo or rsquo knitting together the strands of herlifersquo metaphorically Instead of workingwhich involves effort patience thoughtfulre ection and bearing of distress she engagesin wording an action discharge that is itsantithesis An ordinary person might work atsolving her problems while singing such songlyrics as rsquo Pack up your troubles in your oldkit bagrsquo or rsquo Pack up your troubles and sendthem all to mersquo When Caroline says rsquo I send it(rsquorsquo my messrsquorsquo ) to responsible people Irsquom lling up their mailbox I word my wayinto a relationship with lettersrsquo she literallybelieves she is digging out and packaging her

word-self into the Valentine card and puttingit in the mailbox-hearts of people who willhold and care for her emotionally distressedself in a way that she cannot or will not doThere is nothing left for her to think about tofeel or to work on Insofar as her actionssucceed in burdening others with her worriesand problems her wishful belief in a sensecomes true Fooling others so that she getsno realistic feedback is necessary in order tocontinue to fool herself The words dignityand intimate are neologismsmdashhomophoniccompounds that combine word action andthing

The interaction with her landlord illustratestwo points Nancy Andreasen et al (1985)believe that while schizophrenics are defec-tive in expressive language receptive lan-guage remains normal It is clear in thisinstance however that Caroline hears whather landlord says in schizophrenese as wellFrom a psychoanalytic perspective it is evi-dent that the underlying thought processresembles the phantasies Klein writes aboutand lends itself to an interpretation of projec-tive identi cation but in order to know this itis rst necessary to re-present the thoughtThe miscommunication that can ensue frommaking a psychoanalytic interpretation basedon the belief the patient is speaking andlistening in ordinary language is illustratedby Carolinersquos interchange with her landlordHe believes she is speaking ordinary lan-guage and he responds to her Valentine bytelling her to rsquo take carersquo She receives hisordinary language statement as though hewere speaking schizophrenese Her construc-tion of it as a rejection throws her into a ragewhich she in turn conceals because sheimagines it will evoke his anger

Vignette 3

P I walked around the lake with mymother when my affair with my collegeprofessor was going on [perhaps 15 yearspreviously] and told her about it So the lastfew days I found three lakes and walked

392 MICHAEL ROBBINS

around them Three guys were on one dockThings reminded me of the professor Birdson an island in the rst lake remind me of aman who didnrsquo t disclose that he was probablyhaving other relationshipsmdashprobably screw-ing other women all those birdsmdashbut it washard to keep my mind together walkingaround the big lake because it was so big toobig a place to keep my mind Then these guysstarted irting playing with my mind Allthree of those lakes make a penis the end themiddle the part you play with

A Why did you do thisP I did it so I could focus on a destructive

relationship I was trying to feel the feeling Ionce had with my mother after the affair Butthe lakes are such a big temptation to fall in itagain Walking around the smaller lake Icould get more in touch with the feeling ofloss and hurt some of the feeling but itwasnrsquo t satisfying The bigger lakes were over-whelming and I didnrsquo t know why I was thereany more I was trying to get into troubleThe birds on the big lake felt threatening allthe people he screwed the things I didnrsquo t seeI was foolish I start to realise it but theninstead it becomes my mother fooled me notwhat I did My mother goes to [her wintervacation home] and spends time watching thebirds I feel betrayed I went to the dock andsaw two birds in a caged area I felt caged Iwondered if those women were prostitutesand ended in jail

A What do you meanP Irsquom trying to deal with what happened

in my twenties with the professor Around thelake my mother and I walked and I told her[Her mother had blamed the professor andtold Caroline not to worry about what she haddone] The lie was talking to my mother aboutit and my motherrsquos lies My interest in thelake is a re-creation of the crime when some-thing equals nothing and nothing equalssomething The lively pond is a metaphor formy mind and my dif culty containing limitsand boundaries staying in bounds and notdestroying everything attending to a straightline of thought The kids represent how easily

Irsquo m distracted and take my mind off The lakeis a reference to my mind and the tree is myinterest in life The tree and the birds are ablaming thing People donrsquo t tell others abouttheir affairs but they communicate insidethemselves about it My mind is the pond thetree Claustrophobia is how rsquo in the darkrsquo apart of me is My thoughts versus my actionsI say one thing make my pledges then I godo another Destructive Irsquo m terri ed of thetemptation to blow everything to bits My treeis empty and alone others have things in theirbranches I canrsquo t walk a straight line I veeroff so I try another planet Itrsquos painful I knowif I canrsquo t stay on line in this little pond thenIrsquo ll never get anywhere in the bigger issues inlife I can look at trees that seem moreinteresting but I have to be able to deal withwhatrsquos here

A Now you are speaking in metaphor whydonrsquo t you always

P Metaphors take more responsibilitythey are more connecting

Analysis

Caroline begins speaking about her trip inliteral schizophrenese but by the conclusionof our discussion the physical elements of hersurroundings have become incorporated inmetaphors A more elaborate translation thatsupplements her efforts with other informa-tion in my possession but preserves her ownwords and phrases might be something likethis rsquo Irsquo ve been thinking about my affair withthe professor trying to return so to speak tothe scene of the crime and nd a differentway in my mind to handle what I couldnrsquo tdeal with then but I keep falling into thesame old patterns of thinking I fell intosexual temptation and I lost my mind I wasrsquorsquo out of my treersquorsquo Did he fool me or did I foolmyself Afterwards my mother and I took awalk I was struggling over whether to facemy feelings of hurt responsibility and guiltor stay in the dark about what I had done anddeny that I was a fool But I couldnrsquo t contain

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 393

myself I canrsquo t seem to rsquorsquo go straightrsquorsquo I fellinto it again and spilled everything out to mymother I deserved to be punished but insteadof making me feel like a jailbird or aprostitute she blamed him and she made likeit was nothing she vacated her mind andlooked for other birds to blamersquo

In this ordinary-language version thereemerges a thoughtful emotional re ectiveself replete with the symbolism and meta-phor that is missing in a language that fuseswords things and actions Caroline describesher schizophrenese much as Bion (1967)described attacks on linkingmdashas a process ofacting rather than thinking and blowing hermind to bits As she observes makingmetaphors takes too much energy When shetalks about getting in touch with feelings sheis not referring to metaphorical touching butto literal sensory-motor activities She can-not separate words from actions and things sothat she might be able to think about thedestructive relationship and the overwhelm-ing temptation Instead she walks around alake that she has rendered equivalent to (notwhich symbolises) the container of her mindher mind itself the loss of her mind thetempting three-part male genital the threeguys playing with her mind and her playingwith the penis Her mind is also literallyindistinguishable from the tree or the cageand the birds caged or in trees are concreteenactments of internalised or projected res-ponsibility and blame Of the three vignettesthis re ects the most mental maturity in so faras Caroline is trying to think and feel in anordinary way at the very same time sheexperiences the omnipotent capacity to elimi-nate what needs to be thought about Bothefforts fail

Discussion

Schizophrenics speak a meaningful lan-guage that differs from ordinary language inits essence not simply with regard to sym-bolism This language has a determina-

tive relationship to delusional thinkingBecause Freudrsquos linguistic analysis ofdreaming as a delusional and hallucinatorywish-ful lmentmdashan encapsulated nocturnalpsychosismdashis of considerable relevancesummarising some of the parallels betweendreaming and schizophrenia will be a usefulpoint of entry Schizophrenia presents itselfon a continuum in varying degrees of regres-sion or compensation In its most regressedform catatonia it resembles a waking dreamstate characterised by absence of wakefulattentiveness and sensory-perceptual domi-nance in the form of hallucinations Verbaland motor action are also absent as in thestate of sensory-perceptual identity to whichFreud made reference in his discussion of theprimary process in dreams (1900) and in hispaper on hallucinatory wish ful lment in theabsence of the object (1911) At the other endof the continuummdashthe state of maximalcompensationmdashthe balance is shifted towardspsycho-motor identity the language ofschizophrenia is one of action and actualisa-tion rather than thought and it resembles thesensorimotor stage of infancy

Discussion of language is usually dividedinto syntax morphology semantics and prag-matics As noted earlier syntax here is moreor less intact With regard to morphologyalthough some of the words used by theschizophrenic may be idiosyncratic the rulesor processes by which they are formed (suchas the use of af xes compounding onomato-poeia proper noun transformation clippingand blending) seem identical to those used inordinary language Therefore the ensuingdiscussion will focus on semantic and prag-matic considerations

Ordinary language is an aspect of re ectivethought that is uniquely situated betweenimpulse and action and enables adaptation toconsensual reality by means of exchangingthoughts and feelings with others and con-templating them oneself Language is neverentirely divorced from the sensorimotorphase in the sense that action in the form ofgestures and bodily expressions as well as

394 MICHAEL ROBBINS

somatic sensations remains an inextricablepart of it but in the course of developmentspeech and writing become relatively autono-mous The more sophisticated the subject themore exible the language becomes in mov-ing between concrete sensory somatic andfunctional considerations on the one handand more abstract re ective and comparativeoperations in which one element stands forabbreviates or enriches one or more otherson the other Individual language developsfrom simple denotationmdashthat is learningculturally determined signi ersmdashto abstractdevelopment of symbols metaphors andsimiles both those shared by a given cultureand those that re ect unique personal experi-ence The capacity for simultaneous parallelor multi-track processing enables language todisguise and conceal as well as to re ectclarify and communicate and to have at anygiven time more than one meaning It is thismulti-dimensional complexity that makespsychoanalysis possible

Because we have no choice but to useordinary language as both a means and areference point for analysing schizophreniclanguage it is natural to assume the latter tobe qualitatively continuous with ordinarylanguage and that linear translation of one tothe other is possiblemdashas in Freudrsquos well-known comparison of dream imagery toEgyptian hieroglyphics We tend to assumethat schizophrenese is a kind of encryptedcode cover or disguise that can be decodedinto its unconscious rsquo realrsquo ordinary languagemeaning Thus it would seem natural to askof a schizophrenic utterance rsquo What does itmeanrsquo mdasha question which I raise repeatedlyin the paper and which I often addressed toCaroline But schizophrenese is not a variantof ordinary language It is unique and intrin-sically different hence such a reduction is notpossible It may eventually be possible how-ever for the schizophrenic to acquire thecapacity to re-state or re-present the thoughtsthat he or she was couching in schizophrenesein ordinary language so that the two lan-guages can be compared and contrasted and

this is what Caroline gradually acquired thecapability to do

From a semantic perspective schizophre-nese is characterised by an absence of theordinary distinctions between word thingbodily process and action The word is usedas though it were identical to the thing towhich it would ordinarily refer as well as toactionsmdashpast present or prospectivemdashon orin relation to the thing and to the mediatingsomatic processes Words lack their ordinaryconnotation as representations and refer-ences they have become happenings orevents Caroline once referred to this processas rsquo combination thinkingrsquo mdasha term nearlyidentical to the concept rsquo combinative think-ingrsquo proposed by McClain Johnston andPhilip Holzman (1985) In ordinary discoursespeaker and listener recognise the symbolicimport of a concrete-sounding statement suchas rsquo I have a special pipeline to the bossrsquo orrsquo Letrsquos smoke a peace-pipersquo The metaphorserves as emphasis or highlighting of a keyidea that is being talked about In contrastCaroline once literally handed me a sectionof plumberrsquos pipemdasha gesture so pregnantwith meaning yet impregnable to my inter-pretive skills that it would have been easy toconclude that the pipe was an arcane symbolWhen I questioned her about it however shewas able to tell me that she was making aconnection with me In other words the pipewas just a pipe An ordinary speaker mightmetaphorically and passionately declare loveby saying rsquo I give you my heartrsquo or sing aboutempathic sharing in the folk lyric rsquo Pack upyour troubles in your old kit bag and smilersquo but in discussing the thought process involvedin mailing her Valentine card with a largeheart on it to a large number of casual andformer acquaintances Caroline told me shewas packaging and mailing her word-self toothers she looked upon as more willing toassume responsibility for her than she was forherself While it is tempting to use terms likecollapse implosion explosion fusion orboundary loss to describe the creation ofthese concrete linguistic identities such

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 395

terms convey the incorrect impression thatschizophrenese is a regressive degradation ofordinary language Rather schizophrenese isa language of equivalence immediacy andaction in contrast to ordinary languagewhich supports representational thinkingMoreover there is no evidence that theschizophrenic ever rsquo spokersquo differently

Schizophrenese then is an immediatelanguage of the body and its function in theworld of things particularly motor (throwinghitting) respiratory (breathing talking andblowing as in the felicitous expression rsquo mindblowingrsquo ) gastrointestinal (vomiting and de-fecating) and orgasmic (rsquo fucking onersquos brainsoutrsquo ) Caroline describes printmaking as fol-lows rsquo I was pounding it down oozing out myblack insides on paperrsquo She described one ofher long walks as follows rsquo I want to run andrun and run away from the painful feelings Ifeel like I can split off disintegrate and getaway from them This is what schizophreneseis aboutrsquo She said rsquo I give people the breath-ing they need I make a case to take care ofme I respire them With every breath I givethem responsibilityrsquo

rsquo Respirersquo is a neologism made by theordinary morphological processes of clippingand condensation of the physical process ofrespiration and the work-related concept ofresponsibility but it is a thing and not areference She said rsquo Irsquom mad today I had toput in limits and boundaries and not spill myguts There are lots of snakes inside me and Iwant you to eat them for mersquo In reference toan episode of vomiting during a meal withher family when they questioned her aboutinstances of her irresponsible behaviour shecomments rsquo I couldnrsquo t bear the feeling ofhaving taken all those courses wastingmoney scattering my time and I had to getrid of them I was throwing up the feelingrsquo

It follows from the nature of their languagethat schizophrenics lack patience self-controland restraint have dif culty conceptualisingprocess and sequence distinguishing pastfrom present and here from there and seeingthe consequences of their actions and thereby

learning from experience Carolinersquos Valen-tine mailing was an example of how sheregularly bombarded with letters persons withwhom she had no current contact often fromthe distant past She called these bizarremass-mailings rsquo Trail Newsrsquo and she believedshe was relieving herself into these others ofher otherwise troubling mental contents Shesaid rsquo If your arm was controlled by maturethought then you could wait Itrsquos the entangle-ment quality instead of being able to stop andthinkrsquo

Despite its sometimes strange and colour-ful character the language of schizophreniais neither a language of conscious awareness(re ection) nor of unconscious concealment(repression) It does not support mentalrepresentation symbolisation and re ectionFailure to appreciate this may be what led ageneration of analysts including such semi-nal gures as Frieda Fromm-Reichmann toidealise schizophrenic persons as havingspecial psychic acuity and access to theirunconscious mental life that ordinary personsdo not A neurotic patient might refer to herhabitual and inappropriate tendency to con- de personal affairs to others using theunconscious symbolism of a phrase such asrsquo spilling my gutsrsquo If questioned she wouldhave the sense that she had said somethingworth re ecting on thinking about andanalysing the symbolic meaning of WhenCaroline used the expression as noted earliershe not only believed there were snakes in herintestines that she needed to give to me(although she could reality-test the idea ifpressed to do so) but she referred to anearlier occasion when she had vomited to ridherself of unwanted feelings In an ordinaryanalysis the analyst might suggest that thepatientrsquos behaviour and associations indicatethat she viewed her problems as a mess shebelieved she could dump on to or into theanalyst and the patient might respond to theinterpretation with associations to oral or analfantasies and memories When Caroline saysrsquo I send it [rsquorsquo my messrsquorsquo ] to responsible people Irsquom lling up their mailbox I word my

396 MICHAEL ROBBINS

way into a relationship with lettersrsquo she isdoing something and not speaking metaphori-cally or thinking Whereas an ordinary personmight be aware of the underlying fantasiesand con icts Caroline literally believes thatshe is excreting her self which is identical toher words into others It might be moreaccurate to say that she is expressing phan-tasy in the Kleinian sense but if so even atthis level of discourse when she makes anattempt to interpret the original schizophren-ese account of her mass mailings in alanguage more comprehensible to me she isstill speaking in a language of closure andenactment devoid of interpretable symbo-lism and unconscious meaning

While schizophrenia is a state of self-centredness or egocentricity in the solipsisticsense of the term schizophrenese paradoxi-cally is a language without a centred subjectexcept in the most rudimentary sense ofobserver and actor of a drama The subjectiversquo Irsquo denoting the presence of conscious re ec-tion and thought about beliefs fantasiesemotions and con icts is largely missing andin its stead Caroline describes a microcosm inwhich she is participant consisting of suchthings as a pool table with its sticks and ballsher sewing box with its bobbins and yarns orthe terrain bordering the three lakes she haswalked around with its birds trees andpeople In ordinary discourse one might shareonersquos subjective thoughts and feelings aboutonersquos mother by saying rsquo Irsquo m always behindthe eight-ball with herrsquo or rsquo I was cluelesswhen it came to my mother itrsquos the oldproblem of the irresistible force and theimmovable objectrsquo Caroline by contrastdescribed to me a game of pool she hadplayed in which her mother was the cue balland she had been able to pocket the otherballs without moving the cue-ball or hittingthe eight-ball Her affect was one of triumphfor she literally believed she had solved theproblem of dealing with her mother

This example will serve to segue from thesemantic to the pragmatic aspects of schizo-phrenese which is closely related to delusion

reversal and undoing and deceptionmdashpro-cesses that enable the user to avoid thoughtand awareness of feelings Ordinary languageserves to adapt the waking user to anrsquo externalrsquo world as subjectively perceivedwithin broad consensual outlines The worldof the schizophrenic by contrast is internalthough unrecognised as such and consists ofidiosyncratic microcosms that combine whatmore maturely we look upon as psyche withwhat is sensed and perceived Subjectivelyby manipulating mental contents the schizo-phrenic experiences control over the worldThe language is felt by its user to possess thepower to undo reverse and eliminate intoler-able reality both past and present It is alanguage of psychic alchemy or delusionalomnipotence (Burnham 1955 Frosch 1967Glass 1981) Caroline told me rsquo I fool myselfinto thinking it didnrsquo t happenrsquo Speakingordinary language she referred to schizo-phrenese as rsquo the language of wish and desirersquo With her knitting a game of pool a walkaround the lake or detailed letters to othersshe creates a universe that she can describeand act upon with the conviction that she isaltering events problems and associated feel-ings both present and past Ordinary lan-guage also employs reversal but in anentirely different way and for an oppositepurpose By its stark contrast with the sharedand implicitly acknowledged context such areversal in ordinary language serves to high-light or accentuate the feeling the speakerwishes to conveymdashfor instance in the remarkrsquo Hersquos a ne one to be saying thatrsquo Thedelusional reversal of schizophrenia by con-trast eliminates the necessity to differentiatemind from reality to bear painful feelingsand to adapt to a consensually validatedworld An ordinary person faced with apainful situation might transiently nd solaceby constructing heroic fantasies and becom-ing in imagination someone able to surmountany dif culty invulnerable to pain and hurtSchizophrenic language by contrast lacksthe rsquo as if rsquo capacity inherent in the use ofmetaphor that is required to construct such a

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 397

fantasy Instead of an unconscious fantasyand a language capable of contemplation theschizophrenic experiences a delusional senseof actualisation rsquo isrsquo has replaced rsquo as if rsquo

The qualitative difference between schizo-phrenese and ordinary language helps toaccount for the fact that delusions are xedbeliefs refractory to clinical analysis In themind of their creator they are actualitiesrather than fantasies so that there is nothingto be thought about Some time after thevignettes that I have presented when Carolinehad become more uent in ordinary languageand more uid in moving back and forthbetween the two she commenced an hour byobserving my new shoes and commenting rsquo Itmakes me angry that you always have neatshoes and I donrsquo trsquo I observed aloud that herown feet were beginning to move Sheresponded rsquo Our feet move togetherrsquo andadded that she would like me to hug her Iinquired what that was about and she said rsquo Iwant to be in your shoesrsquo She was then ableto express in ordinary language her aware-ness that she was not expressing a fantasy orsymbolising a wish to be more like me butwas verging on speaking the thoughtlesslanguage of schizophrenese which in the pastwould have achieved a sense of actualisationand closure (in this case the delusion she hadexchanged identities with me) rather thanallowing the opportunity for re ectivethought about painful feelings and issuesrelated to being her own separate person

Paradoxically it is this very failure ofschizophrenic language to distinguishthoughts from events that may disguise itsbizarreness and conceal the delusional think-ing it supports because utterances may seemto patient and analyst to be nothing more thandescriptions or observations of happeningsIn telling me about the degrading affair withher college professor and her subsequentconversation about it with her mother Caro-line believed she was doing it over differentlynot simply wishing she might

No discussion of schizophrenic languagewould be complete without a comment about

neologisms which incidentally are notnearly so speci c to schizophrenia as gener-ally believed They appear to be constructedaccording to ordinary morphological princi-ples and it is primarily in their semantic andpragmatic aspects that they are remarkableOne day Caroline said rsquo Irsquove got it set up atwork so no-one can refrain from authoritingme They tell me what to do It pisses me offrsquoWhen I inquired if she believed authoritingwas a legitimate word she said she supposednot I then asked why she did not say whatshe meant in acceptable English She repliedthat it would compel her to face feelings ofshame at loss of dignity and control over herown life By not accepting the existence of anordinary language word to express her feelingstate she managed to repudiate the reality ofthe issue and to avoid the feelings about itThis is another example of the identity ofwords things and actions If the word is thereal thing and she can substitute a neologismthen she can delude herself that the thing orthe problem no longer exists It is easy for theanalyst who is struggling to understand thepatient to gloss over the idiosyncratic aspectof the word in favour of what appears to bethe underlying meaning as one might do withsome of the peculiarities of speech of some-one not uent in onersquos native tonguemdashin thisinstance to assume that Caroline rsquo reallyrsquomeans rsquo acting like an authority withrsquo In thisway the patientrsquos delusion combines with theanalystrsquos illusion to form collusion

Schizophrenic patients do not want to beunderstood for it threatens them with un-wanted knowledge about themselves Schizo-phrenese not only lacks communicativeintent it is a language of deception In orderto function as a vehicle of communicationcontextual elements and related linguisticassumptionsmdashpersonal social and culturalmdashmust be suf ciently concordant in speakerand listenermdashthe rsquo musicrsquo so to speak thataccompanies the words In the case of schizo-phrenese not only are these assumptionsidiosyncratic to the speaker or writer but alsothe speaker or writer is unwilling to elucidate

398 MICHAEL ROBBINS

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

people try to intimidate people I intimatepeople

A What do you meanP Relationships are too dif cult so I word

my way into a relationship with letters Irsquodlike to work my way into your hearts withoutworking my way in and without mentioningthings that would work my way out of yourhearts

Analysis

Caroline is gradually able to re-present thethought behind her letter in an ordinarylanguage statement but even at the conclu-sion of the discussion she is still partlyspeaking schizophrenese If she were able tospeak ordinary language she might saysomething like rsquo I would like to fool myselfand the others in my life that this is really aValentine about loving and feeling close tothem and a resolution not to be such a low-down person but to identify myself withconstructive responsible people and to workhard to dig myself out from the mess Irsquovemade But really this card expresses my wishto avoid the pain of my situation and to sendall my problems away and force them insideothers to take care ofrsquo

What sets the schizophrenese apart fromthe ordinary language version is that she isnot expressing wishes nor is she usingphrases like rsquo digging inrsquo being rsquo low downrsquo rsquo keep me in your heartrsquo rsquo I give you myheartrsquo or rsquo knitting together the strands of herlifersquo metaphorically Instead of workingwhich involves effort patience thoughtfulre ection and bearing of distress she engagesin wording an action discharge that is itsantithesis An ordinary person might work atsolving her problems while singing such songlyrics as rsquo Pack up your troubles in your oldkit bagrsquo or rsquo Pack up your troubles and sendthem all to mersquo When Caroline says rsquo I send it(rsquorsquo my messrsquorsquo ) to responsible people Irsquom lling up their mailbox I word my wayinto a relationship with lettersrsquo she literallybelieves she is digging out and packaging her

word-self into the Valentine card and puttingit in the mailbox-hearts of people who willhold and care for her emotionally distressedself in a way that she cannot or will not doThere is nothing left for her to think about tofeel or to work on Insofar as her actionssucceed in burdening others with her worriesand problems her wishful belief in a sensecomes true Fooling others so that she getsno realistic feedback is necessary in order tocontinue to fool herself The words dignityand intimate are neologismsmdashhomophoniccompounds that combine word action andthing

The interaction with her landlord illustratestwo points Nancy Andreasen et al (1985)believe that while schizophrenics are defec-tive in expressive language receptive lan-guage remains normal It is clear in thisinstance however that Caroline hears whather landlord says in schizophrenese as wellFrom a psychoanalytic perspective it is evi-dent that the underlying thought processresembles the phantasies Klein writes aboutand lends itself to an interpretation of projec-tive identi cation but in order to know this itis rst necessary to re-present the thoughtThe miscommunication that can ensue frommaking a psychoanalytic interpretation basedon the belief the patient is speaking andlistening in ordinary language is illustratedby Carolinersquos interchange with her landlordHe believes she is speaking ordinary lan-guage and he responds to her Valentine bytelling her to rsquo take carersquo She receives hisordinary language statement as though hewere speaking schizophrenese Her construc-tion of it as a rejection throws her into a ragewhich she in turn conceals because sheimagines it will evoke his anger

Vignette 3

P I walked around the lake with mymother when my affair with my collegeprofessor was going on [perhaps 15 yearspreviously] and told her about it So the lastfew days I found three lakes and walked

392 MICHAEL ROBBINS

around them Three guys were on one dockThings reminded me of the professor Birdson an island in the rst lake remind me of aman who didnrsquo t disclose that he was probablyhaving other relationshipsmdashprobably screw-ing other women all those birdsmdashbut it washard to keep my mind together walkingaround the big lake because it was so big toobig a place to keep my mind Then these guysstarted irting playing with my mind Allthree of those lakes make a penis the end themiddle the part you play with

A Why did you do thisP I did it so I could focus on a destructive

relationship I was trying to feel the feeling Ionce had with my mother after the affair Butthe lakes are such a big temptation to fall in itagain Walking around the smaller lake Icould get more in touch with the feeling ofloss and hurt some of the feeling but itwasnrsquo t satisfying The bigger lakes were over-whelming and I didnrsquo t know why I was thereany more I was trying to get into troubleThe birds on the big lake felt threatening allthe people he screwed the things I didnrsquo t seeI was foolish I start to realise it but theninstead it becomes my mother fooled me notwhat I did My mother goes to [her wintervacation home] and spends time watching thebirds I feel betrayed I went to the dock andsaw two birds in a caged area I felt caged Iwondered if those women were prostitutesand ended in jail

A What do you meanP Irsquom trying to deal with what happened

in my twenties with the professor Around thelake my mother and I walked and I told her[Her mother had blamed the professor andtold Caroline not to worry about what she haddone] The lie was talking to my mother aboutit and my motherrsquos lies My interest in thelake is a re-creation of the crime when some-thing equals nothing and nothing equalssomething The lively pond is a metaphor formy mind and my dif culty containing limitsand boundaries staying in bounds and notdestroying everything attending to a straightline of thought The kids represent how easily

Irsquo m distracted and take my mind off The lakeis a reference to my mind and the tree is myinterest in life The tree and the birds are ablaming thing People donrsquo t tell others abouttheir affairs but they communicate insidethemselves about it My mind is the pond thetree Claustrophobia is how rsquo in the darkrsquo apart of me is My thoughts versus my actionsI say one thing make my pledges then I godo another Destructive Irsquo m terri ed of thetemptation to blow everything to bits My treeis empty and alone others have things in theirbranches I canrsquo t walk a straight line I veeroff so I try another planet Itrsquos painful I knowif I canrsquo t stay on line in this little pond thenIrsquo ll never get anywhere in the bigger issues inlife I can look at trees that seem moreinteresting but I have to be able to deal withwhatrsquos here

A Now you are speaking in metaphor whydonrsquo t you always

P Metaphors take more responsibilitythey are more connecting

Analysis

Caroline begins speaking about her trip inliteral schizophrenese but by the conclusionof our discussion the physical elements of hersurroundings have become incorporated inmetaphors A more elaborate translation thatsupplements her efforts with other informa-tion in my possession but preserves her ownwords and phrases might be something likethis rsquo Irsquo ve been thinking about my affair withthe professor trying to return so to speak tothe scene of the crime and nd a differentway in my mind to handle what I couldnrsquo tdeal with then but I keep falling into thesame old patterns of thinking I fell intosexual temptation and I lost my mind I wasrsquorsquo out of my treersquorsquo Did he fool me or did I foolmyself Afterwards my mother and I took awalk I was struggling over whether to facemy feelings of hurt responsibility and guiltor stay in the dark about what I had done anddeny that I was a fool But I couldnrsquo t contain

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 393

myself I canrsquo t seem to rsquorsquo go straightrsquorsquo I fellinto it again and spilled everything out to mymother I deserved to be punished but insteadof making me feel like a jailbird or aprostitute she blamed him and she made likeit was nothing she vacated her mind andlooked for other birds to blamersquo

In this ordinary-language version thereemerges a thoughtful emotional re ectiveself replete with the symbolism and meta-phor that is missing in a language that fuseswords things and actions Caroline describesher schizophrenese much as Bion (1967)described attacks on linkingmdashas a process ofacting rather than thinking and blowing hermind to bits As she observes makingmetaphors takes too much energy When shetalks about getting in touch with feelings sheis not referring to metaphorical touching butto literal sensory-motor activities She can-not separate words from actions and things sothat she might be able to think about thedestructive relationship and the overwhelm-ing temptation Instead she walks around alake that she has rendered equivalent to (notwhich symbolises) the container of her mindher mind itself the loss of her mind thetempting three-part male genital the threeguys playing with her mind and her playingwith the penis Her mind is also literallyindistinguishable from the tree or the cageand the birds caged or in trees are concreteenactments of internalised or projected res-ponsibility and blame Of the three vignettesthis re ects the most mental maturity in so faras Caroline is trying to think and feel in anordinary way at the very same time sheexperiences the omnipotent capacity to elimi-nate what needs to be thought about Bothefforts fail

Discussion

Schizophrenics speak a meaningful lan-guage that differs from ordinary language inits essence not simply with regard to sym-bolism This language has a determina-

tive relationship to delusional thinkingBecause Freudrsquos linguistic analysis ofdreaming as a delusional and hallucinatorywish-ful lmentmdashan encapsulated nocturnalpsychosismdashis of considerable relevancesummarising some of the parallels betweendreaming and schizophrenia will be a usefulpoint of entry Schizophrenia presents itselfon a continuum in varying degrees of regres-sion or compensation In its most regressedform catatonia it resembles a waking dreamstate characterised by absence of wakefulattentiveness and sensory-perceptual domi-nance in the form of hallucinations Verbaland motor action are also absent as in thestate of sensory-perceptual identity to whichFreud made reference in his discussion of theprimary process in dreams (1900) and in hispaper on hallucinatory wish ful lment in theabsence of the object (1911) At the other endof the continuummdashthe state of maximalcompensationmdashthe balance is shifted towardspsycho-motor identity the language ofschizophrenia is one of action and actualisa-tion rather than thought and it resembles thesensorimotor stage of infancy

Discussion of language is usually dividedinto syntax morphology semantics and prag-matics As noted earlier syntax here is moreor less intact With regard to morphologyalthough some of the words used by theschizophrenic may be idiosyncratic the rulesor processes by which they are formed (suchas the use of af xes compounding onomato-poeia proper noun transformation clippingand blending) seem identical to those used inordinary language Therefore the ensuingdiscussion will focus on semantic and prag-matic considerations

Ordinary language is an aspect of re ectivethought that is uniquely situated betweenimpulse and action and enables adaptation toconsensual reality by means of exchangingthoughts and feelings with others and con-templating them oneself Language is neverentirely divorced from the sensorimotorphase in the sense that action in the form ofgestures and bodily expressions as well as

394 MICHAEL ROBBINS

somatic sensations remains an inextricablepart of it but in the course of developmentspeech and writing become relatively autono-mous The more sophisticated the subject themore exible the language becomes in mov-ing between concrete sensory somatic andfunctional considerations on the one handand more abstract re ective and comparativeoperations in which one element stands forabbreviates or enriches one or more otherson the other Individual language developsfrom simple denotationmdashthat is learningculturally determined signi ersmdashto abstractdevelopment of symbols metaphors andsimiles both those shared by a given cultureand those that re ect unique personal experi-ence The capacity for simultaneous parallelor multi-track processing enables language todisguise and conceal as well as to re ectclarify and communicate and to have at anygiven time more than one meaning It is thismulti-dimensional complexity that makespsychoanalysis possible

Because we have no choice but to useordinary language as both a means and areference point for analysing schizophreniclanguage it is natural to assume the latter tobe qualitatively continuous with ordinarylanguage and that linear translation of one tothe other is possiblemdashas in Freudrsquos well-known comparison of dream imagery toEgyptian hieroglyphics We tend to assumethat schizophrenese is a kind of encryptedcode cover or disguise that can be decodedinto its unconscious rsquo realrsquo ordinary languagemeaning Thus it would seem natural to askof a schizophrenic utterance rsquo What does itmeanrsquo mdasha question which I raise repeatedlyin the paper and which I often addressed toCaroline But schizophrenese is not a variantof ordinary language It is unique and intrin-sically different hence such a reduction is notpossible It may eventually be possible how-ever for the schizophrenic to acquire thecapacity to re-state or re-present the thoughtsthat he or she was couching in schizophrenesein ordinary language so that the two lan-guages can be compared and contrasted and

this is what Caroline gradually acquired thecapability to do

From a semantic perspective schizophre-nese is characterised by an absence of theordinary distinctions between word thingbodily process and action The word is usedas though it were identical to the thing towhich it would ordinarily refer as well as toactionsmdashpast present or prospectivemdashon orin relation to the thing and to the mediatingsomatic processes Words lack their ordinaryconnotation as representations and refer-ences they have become happenings orevents Caroline once referred to this processas rsquo combination thinkingrsquo mdasha term nearlyidentical to the concept rsquo combinative think-ingrsquo proposed by McClain Johnston andPhilip Holzman (1985) In ordinary discoursespeaker and listener recognise the symbolicimport of a concrete-sounding statement suchas rsquo I have a special pipeline to the bossrsquo orrsquo Letrsquos smoke a peace-pipersquo The metaphorserves as emphasis or highlighting of a keyidea that is being talked about In contrastCaroline once literally handed me a sectionof plumberrsquos pipemdasha gesture so pregnantwith meaning yet impregnable to my inter-pretive skills that it would have been easy toconclude that the pipe was an arcane symbolWhen I questioned her about it however shewas able to tell me that she was making aconnection with me In other words the pipewas just a pipe An ordinary speaker mightmetaphorically and passionately declare loveby saying rsquo I give you my heartrsquo or sing aboutempathic sharing in the folk lyric rsquo Pack upyour troubles in your old kit bag and smilersquo but in discussing the thought process involvedin mailing her Valentine card with a largeheart on it to a large number of casual andformer acquaintances Caroline told me shewas packaging and mailing her word-self toothers she looked upon as more willing toassume responsibility for her than she was forherself While it is tempting to use terms likecollapse implosion explosion fusion orboundary loss to describe the creation ofthese concrete linguistic identities such

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 395

terms convey the incorrect impression thatschizophrenese is a regressive degradation ofordinary language Rather schizophrenese isa language of equivalence immediacy andaction in contrast to ordinary languagewhich supports representational thinkingMoreover there is no evidence that theschizophrenic ever rsquo spokersquo differently

Schizophrenese then is an immediatelanguage of the body and its function in theworld of things particularly motor (throwinghitting) respiratory (breathing talking andblowing as in the felicitous expression rsquo mindblowingrsquo ) gastrointestinal (vomiting and de-fecating) and orgasmic (rsquo fucking onersquos brainsoutrsquo ) Caroline describes printmaking as fol-lows rsquo I was pounding it down oozing out myblack insides on paperrsquo She described one ofher long walks as follows rsquo I want to run andrun and run away from the painful feelings Ifeel like I can split off disintegrate and getaway from them This is what schizophreneseis aboutrsquo She said rsquo I give people the breath-ing they need I make a case to take care ofme I respire them With every breath I givethem responsibilityrsquo

rsquo Respirersquo is a neologism made by theordinary morphological processes of clippingand condensation of the physical process ofrespiration and the work-related concept ofresponsibility but it is a thing and not areference She said rsquo Irsquom mad today I had toput in limits and boundaries and not spill myguts There are lots of snakes inside me and Iwant you to eat them for mersquo In reference toan episode of vomiting during a meal withher family when they questioned her aboutinstances of her irresponsible behaviour shecomments rsquo I couldnrsquo t bear the feeling ofhaving taken all those courses wastingmoney scattering my time and I had to getrid of them I was throwing up the feelingrsquo

It follows from the nature of their languagethat schizophrenics lack patience self-controland restraint have dif culty conceptualisingprocess and sequence distinguishing pastfrom present and here from there and seeingthe consequences of their actions and thereby

learning from experience Carolinersquos Valen-tine mailing was an example of how sheregularly bombarded with letters persons withwhom she had no current contact often fromthe distant past She called these bizarremass-mailings rsquo Trail Newsrsquo and she believedshe was relieving herself into these others ofher otherwise troubling mental contents Shesaid rsquo If your arm was controlled by maturethought then you could wait Itrsquos the entangle-ment quality instead of being able to stop andthinkrsquo

Despite its sometimes strange and colour-ful character the language of schizophreniais neither a language of conscious awareness(re ection) nor of unconscious concealment(repression) It does not support mentalrepresentation symbolisation and re ectionFailure to appreciate this may be what led ageneration of analysts including such semi-nal gures as Frieda Fromm-Reichmann toidealise schizophrenic persons as havingspecial psychic acuity and access to theirunconscious mental life that ordinary personsdo not A neurotic patient might refer to herhabitual and inappropriate tendency to con- de personal affairs to others using theunconscious symbolism of a phrase such asrsquo spilling my gutsrsquo If questioned she wouldhave the sense that she had said somethingworth re ecting on thinking about andanalysing the symbolic meaning of WhenCaroline used the expression as noted earliershe not only believed there were snakes in herintestines that she needed to give to me(although she could reality-test the idea ifpressed to do so) but she referred to anearlier occasion when she had vomited to ridherself of unwanted feelings In an ordinaryanalysis the analyst might suggest that thepatientrsquos behaviour and associations indicatethat she viewed her problems as a mess shebelieved she could dump on to or into theanalyst and the patient might respond to theinterpretation with associations to oral or analfantasies and memories When Caroline saysrsquo I send it [rsquorsquo my messrsquorsquo ] to responsible people Irsquom lling up their mailbox I word my

396 MICHAEL ROBBINS

way into a relationship with lettersrsquo she isdoing something and not speaking metaphori-cally or thinking Whereas an ordinary personmight be aware of the underlying fantasiesand con icts Caroline literally believes thatshe is excreting her self which is identical toher words into others It might be moreaccurate to say that she is expressing phan-tasy in the Kleinian sense but if so even atthis level of discourse when she makes anattempt to interpret the original schizophren-ese account of her mass mailings in alanguage more comprehensible to me she isstill speaking in a language of closure andenactment devoid of interpretable symbo-lism and unconscious meaning

While schizophrenia is a state of self-centredness or egocentricity in the solipsisticsense of the term schizophrenese paradoxi-cally is a language without a centred subjectexcept in the most rudimentary sense ofobserver and actor of a drama The subjectiversquo Irsquo denoting the presence of conscious re ec-tion and thought about beliefs fantasiesemotions and con icts is largely missing andin its stead Caroline describes a microcosm inwhich she is participant consisting of suchthings as a pool table with its sticks and ballsher sewing box with its bobbins and yarns orthe terrain bordering the three lakes she haswalked around with its birds trees andpeople In ordinary discourse one might shareonersquos subjective thoughts and feelings aboutonersquos mother by saying rsquo Irsquo m always behindthe eight-ball with herrsquo or rsquo I was cluelesswhen it came to my mother itrsquos the oldproblem of the irresistible force and theimmovable objectrsquo Caroline by contrastdescribed to me a game of pool she hadplayed in which her mother was the cue balland she had been able to pocket the otherballs without moving the cue-ball or hittingthe eight-ball Her affect was one of triumphfor she literally believed she had solved theproblem of dealing with her mother

This example will serve to segue from thesemantic to the pragmatic aspects of schizo-phrenese which is closely related to delusion

reversal and undoing and deceptionmdashpro-cesses that enable the user to avoid thoughtand awareness of feelings Ordinary languageserves to adapt the waking user to anrsquo externalrsquo world as subjectively perceivedwithin broad consensual outlines The worldof the schizophrenic by contrast is internalthough unrecognised as such and consists ofidiosyncratic microcosms that combine whatmore maturely we look upon as psyche withwhat is sensed and perceived Subjectivelyby manipulating mental contents the schizo-phrenic experiences control over the worldThe language is felt by its user to possess thepower to undo reverse and eliminate intoler-able reality both past and present It is alanguage of psychic alchemy or delusionalomnipotence (Burnham 1955 Frosch 1967Glass 1981) Caroline told me rsquo I fool myselfinto thinking it didnrsquo t happenrsquo Speakingordinary language she referred to schizo-phrenese as rsquo the language of wish and desirersquo With her knitting a game of pool a walkaround the lake or detailed letters to othersshe creates a universe that she can describeand act upon with the conviction that she isaltering events problems and associated feel-ings both present and past Ordinary lan-guage also employs reversal but in anentirely different way and for an oppositepurpose By its stark contrast with the sharedand implicitly acknowledged context such areversal in ordinary language serves to high-light or accentuate the feeling the speakerwishes to conveymdashfor instance in the remarkrsquo Hersquos a ne one to be saying thatrsquo Thedelusional reversal of schizophrenia by con-trast eliminates the necessity to differentiatemind from reality to bear painful feelingsand to adapt to a consensually validatedworld An ordinary person faced with apainful situation might transiently nd solaceby constructing heroic fantasies and becom-ing in imagination someone able to surmountany dif culty invulnerable to pain and hurtSchizophrenic language by contrast lacksthe rsquo as if rsquo capacity inherent in the use ofmetaphor that is required to construct such a

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 397

fantasy Instead of an unconscious fantasyand a language capable of contemplation theschizophrenic experiences a delusional senseof actualisation rsquo isrsquo has replaced rsquo as if rsquo

The qualitative difference between schizo-phrenese and ordinary language helps toaccount for the fact that delusions are xedbeliefs refractory to clinical analysis In themind of their creator they are actualitiesrather than fantasies so that there is nothingto be thought about Some time after thevignettes that I have presented when Carolinehad become more uent in ordinary languageand more uid in moving back and forthbetween the two she commenced an hour byobserving my new shoes and commenting rsquo Itmakes me angry that you always have neatshoes and I donrsquo trsquo I observed aloud that herown feet were beginning to move Sheresponded rsquo Our feet move togetherrsquo andadded that she would like me to hug her Iinquired what that was about and she said rsquo Iwant to be in your shoesrsquo She was then ableto express in ordinary language her aware-ness that she was not expressing a fantasy orsymbolising a wish to be more like me butwas verging on speaking the thoughtlesslanguage of schizophrenese which in the pastwould have achieved a sense of actualisationand closure (in this case the delusion she hadexchanged identities with me) rather thanallowing the opportunity for re ectivethought about painful feelings and issuesrelated to being her own separate person

Paradoxically it is this very failure ofschizophrenic language to distinguishthoughts from events that may disguise itsbizarreness and conceal the delusional think-ing it supports because utterances may seemto patient and analyst to be nothing more thandescriptions or observations of happeningsIn telling me about the degrading affair withher college professor and her subsequentconversation about it with her mother Caro-line believed she was doing it over differentlynot simply wishing she might

No discussion of schizophrenic languagewould be complete without a comment about

neologisms which incidentally are notnearly so speci c to schizophrenia as gener-ally believed They appear to be constructedaccording to ordinary morphological princi-ples and it is primarily in their semantic andpragmatic aspects that they are remarkableOne day Caroline said rsquo Irsquove got it set up atwork so no-one can refrain from authoritingme They tell me what to do It pisses me offrsquoWhen I inquired if she believed authoritingwas a legitimate word she said she supposednot I then asked why she did not say whatshe meant in acceptable English She repliedthat it would compel her to face feelings ofshame at loss of dignity and control over herown life By not accepting the existence of anordinary language word to express her feelingstate she managed to repudiate the reality ofthe issue and to avoid the feelings about itThis is another example of the identity ofwords things and actions If the word is thereal thing and she can substitute a neologismthen she can delude herself that the thing orthe problem no longer exists It is easy for theanalyst who is struggling to understand thepatient to gloss over the idiosyncratic aspectof the word in favour of what appears to bethe underlying meaning as one might do withsome of the peculiarities of speech of some-one not uent in onersquos native tonguemdashin thisinstance to assume that Caroline rsquo reallyrsquomeans rsquo acting like an authority withrsquo In thisway the patientrsquos delusion combines with theanalystrsquos illusion to form collusion

Schizophrenic patients do not want to beunderstood for it threatens them with un-wanted knowledge about themselves Schizo-phrenese not only lacks communicativeintent it is a language of deception In orderto function as a vehicle of communicationcontextual elements and related linguisticassumptionsmdashpersonal social and culturalmdashmust be suf ciently concordant in speakerand listenermdashthe rsquo musicrsquo so to speak thataccompanies the words In the case of schizo-phrenese not only are these assumptionsidiosyncratic to the speaker or writer but alsothe speaker or writer is unwilling to elucidate

398 MICHAEL ROBBINS

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

around them Three guys were on one dockThings reminded me of the professor Birdson an island in the rst lake remind me of aman who didnrsquo t disclose that he was probablyhaving other relationshipsmdashprobably screw-ing other women all those birdsmdashbut it washard to keep my mind together walkingaround the big lake because it was so big toobig a place to keep my mind Then these guysstarted irting playing with my mind Allthree of those lakes make a penis the end themiddle the part you play with

A Why did you do thisP I did it so I could focus on a destructive

relationship I was trying to feel the feeling Ionce had with my mother after the affair Butthe lakes are such a big temptation to fall in itagain Walking around the smaller lake Icould get more in touch with the feeling ofloss and hurt some of the feeling but itwasnrsquo t satisfying The bigger lakes were over-whelming and I didnrsquo t know why I was thereany more I was trying to get into troubleThe birds on the big lake felt threatening allthe people he screwed the things I didnrsquo t seeI was foolish I start to realise it but theninstead it becomes my mother fooled me notwhat I did My mother goes to [her wintervacation home] and spends time watching thebirds I feel betrayed I went to the dock andsaw two birds in a caged area I felt caged Iwondered if those women were prostitutesand ended in jail

A What do you meanP Irsquom trying to deal with what happened

in my twenties with the professor Around thelake my mother and I walked and I told her[Her mother had blamed the professor andtold Caroline not to worry about what she haddone] The lie was talking to my mother aboutit and my motherrsquos lies My interest in thelake is a re-creation of the crime when some-thing equals nothing and nothing equalssomething The lively pond is a metaphor formy mind and my dif culty containing limitsand boundaries staying in bounds and notdestroying everything attending to a straightline of thought The kids represent how easily

Irsquo m distracted and take my mind off The lakeis a reference to my mind and the tree is myinterest in life The tree and the birds are ablaming thing People donrsquo t tell others abouttheir affairs but they communicate insidethemselves about it My mind is the pond thetree Claustrophobia is how rsquo in the darkrsquo apart of me is My thoughts versus my actionsI say one thing make my pledges then I godo another Destructive Irsquo m terri ed of thetemptation to blow everything to bits My treeis empty and alone others have things in theirbranches I canrsquo t walk a straight line I veeroff so I try another planet Itrsquos painful I knowif I canrsquo t stay on line in this little pond thenIrsquo ll never get anywhere in the bigger issues inlife I can look at trees that seem moreinteresting but I have to be able to deal withwhatrsquos here

A Now you are speaking in metaphor whydonrsquo t you always

P Metaphors take more responsibilitythey are more connecting

Analysis

Caroline begins speaking about her trip inliteral schizophrenese but by the conclusionof our discussion the physical elements of hersurroundings have become incorporated inmetaphors A more elaborate translation thatsupplements her efforts with other informa-tion in my possession but preserves her ownwords and phrases might be something likethis rsquo Irsquo ve been thinking about my affair withthe professor trying to return so to speak tothe scene of the crime and nd a differentway in my mind to handle what I couldnrsquo tdeal with then but I keep falling into thesame old patterns of thinking I fell intosexual temptation and I lost my mind I wasrsquorsquo out of my treersquorsquo Did he fool me or did I foolmyself Afterwards my mother and I took awalk I was struggling over whether to facemy feelings of hurt responsibility and guiltor stay in the dark about what I had done anddeny that I was a fool But I couldnrsquo t contain

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 393

myself I canrsquo t seem to rsquorsquo go straightrsquorsquo I fellinto it again and spilled everything out to mymother I deserved to be punished but insteadof making me feel like a jailbird or aprostitute she blamed him and she made likeit was nothing she vacated her mind andlooked for other birds to blamersquo

In this ordinary-language version thereemerges a thoughtful emotional re ectiveself replete with the symbolism and meta-phor that is missing in a language that fuseswords things and actions Caroline describesher schizophrenese much as Bion (1967)described attacks on linkingmdashas a process ofacting rather than thinking and blowing hermind to bits As she observes makingmetaphors takes too much energy When shetalks about getting in touch with feelings sheis not referring to metaphorical touching butto literal sensory-motor activities She can-not separate words from actions and things sothat she might be able to think about thedestructive relationship and the overwhelm-ing temptation Instead she walks around alake that she has rendered equivalent to (notwhich symbolises) the container of her mindher mind itself the loss of her mind thetempting three-part male genital the threeguys playing with her mind and her playingwith the penis Her mind is also literallyindistinguishable from the tree or the cageand the birds caged or in trees are concreteenactments of internalised or projected res-ponsibility and blame Of the three vignettesthis re ects the most mental maturity in so faras Caroline is trying to think and feel in anordinary way at the very same time sheexperiences the omnipotent capacity to elimi-nate what needs to be thought about Bothefforts fail

Discussion

Schizophrenics speak a meaningful lan-guage that differs from ordinary language inits essence not simply with regard to sym-bolism This language has a determina-

tive relationship to delusional thinkingBecause Freudrsquos linguistic analysis ofdreaming as a delusional and hallucinatorywish-ful lmentmdashan encapsulated nocturnalpsychosismdashis of considerable relevancesummarising some of the parallels betweendreaming and schizophrenia will be a usefulpoint of entry Schizophrenia presents itselfon a continuum in varying degrees of regres-sion or compensation In its most regressedform catatonia it resembles a waking dreamstate characterised by absence of wakefulattentiveness and sensory-perceptual domi-nance in the form of hallucinations Verbaland motor action are also absent as in thestate of sensory-perceptual identity to whichFreud made reference in his discussion of theprimary process in dreams (1900) and in hispaper on hallucinatory wish ful lment in theabsence of the object (1911) At the other endof the continuummdashthe state of maximalcompensationmdashthe balance is shifted towardspsycho-motor identity the language ofschizophrenia is one of action and actualisa-tion rather than thought and it resembles thesensorimotor stage of infancy

Discussion of language is usually dividedinto syntax morphology semantics and prag-matics As noted earlier syntax here is moreor less intact With regard to morphologyalthough some of the words used by theschizophrenic may be idiosyncratic the rulesor processes by which they are formed (suchas the use of af xes compounding onomato-poeia proper noun transformation clippingand blending) seem identical to those used inordinary language Therefore the ensuingdiscussion will focus on semantic and prag-matic considerations

Ordinary language is an aspect of re ectivethought that is uniquely situated betweenimpulse and action and enables adaptation toconsensual reality by means of exchangingthoughts and feelings with others and con-templating them oneself Language is neverentirely divorced from the sensorimotorphase in the sense that action in the form ofgestures and bodily expressions as well as

394 MICHAEL ROBBINS

somatic sensations remains an inextricablepart of it but in the course of developmentspeech and writing become relatively autono-mous The more sophisticated the subject themore exible the language becomes in mov-ing between concrete sensory somatic andfunctional considerations on the one handand more abstract re ective and comparativeoperations in which one element stands forabbreviates or enriches one or more otherson the other Individual language developsfrom simple denotationmdashthat is learningculturally determined signi ersmdashto abstractdevelopment of symbols metaphors andsimiles both those shared by a given cultureand those that re ect unique personal experi-ence The capacity for simultaneous parallelor multi-track processing enables language todisguise and conceal as well as to re ectclarify and communicate and to have at anygiven time more than one meaning It is thismulti-dimensional complexity that makespsychoanalysis possible

Because we have no choice but to useordinary language as both a means and areference point for analysing schizophreniclanguage it is natural to assume the latter tobe qualitatively continuous with ordinarylanguage and that linear translation of one tothe other is possiblemdashas in Freudrsquos well-known comparison of dream imagery toEgyptian hieroglyphics We tend to assumethat schizophrenese is a kind of encryptedcode cover or disguise that can be decodedinto its unconscious rsquo realrsquo ordinary languagemeaning Thus it would seem natural to askof a schizophrenic utterance rsquo What does itmeanrsquo mdasha question which I raise repeatedlyin the paper and which I often addressed toCaroline But schizophrenese is not a variantof ordinary language It is unique and intrin-sically different hence such a reduction is notpossible It may eventually be possible how-ever for the schizophrenic to acquire thecapacity to re-state or re-present the thoughtsthat he or she was couching in schizophrenesein ordinary language so that the two lan-guages can be compared and contrasted and

this is what Caroline gradually acquired thecapability to do

From a semantic perspective schizophre-nese is characterised by an absence of theordinary distinctions between word thingbodily process and action The word is usedas though it were identical to the thing towhich it would ordinarily refer as well as toactionsmdashpast present or prospectivemdashon orin relation to the thing and to the mediatingsomatic processes Words lack their ordinaryconnotation as representations and refer-ences they have become happenings orevents Caroline once referred to this processas rsquo combination thinkingrsquo mdasha term nearlyidentical to the concept rsquo combinative think-ingrsquo proposed by McClain Johnston andPhilip Holzman (1985) In ordinary discoursespeaker and listener recognise the symbolicimport of a concrete-sounding statement suchas rsquo I have a special pipeline to the bossrsquo orrsquo Letrsquos smoke a peace-pipersquo The metaphorserves as emphasis or highlighting of a keyidea that is being talked about In contrastCaroline once literally handed me a sectionof plumberrsquos pipemdasha gesture so pregnantwith meaning yet impregnable to my inter-pretive skills that it would have been easy toconclude that the pipe was an arcane symbolWhen I questioned her about it however shewas able to tell me that she was making aconnection with me In other words the pipewas just a pipe An ordinary speaker mightmetaphorically and passionately declare loveby saying rsquo I give you my heartrsquo or sing aboutempathic sharing in the folk lyric rsquo Pack upyour troubles in your old kit bag and smilersquo but in discussing the thought process involvedin mailing her Valentine card with a largeheart on it to a large number of casual andformer acquaintances Caroline told me shewas packaging and mailing her word-self toothers she looked upon as more willing toassume responsibility for her than she was forherself While it is tempting to use terms likecollapse implosion explosion fusion orboundary loss to describe the creation ofthese concrete linguistic identities such

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 395

terms convey the incorrect impression thatschizophrenese is a regressive degradation ofordinary language Rather schizophrenese isa language of equivalence immediacy andaction in contrast to ordinary languagewhich supports representational thinkingMoreover there is no evidence that theschizophrenic ever rsquo spokersquo differently

Schizophrenese then is an immediatelanguage of the body and its function in theworld of things particularly motor (throwinghitting) respiratory (breathing talking andblowing as in the felicitous expression rsquo mindblowingrsquo ) gastrointestinal (vomiting and de-fecating) and orgasmic (rsquo fucking onersquos brainsoutrsquo ) Caroline describes printmaking as fol-lows rsquo I was pounding it down oozing out myblack insides on paperrsquo She described one ofher long walks as follows rsquo I want to run andrun and run away from the painful feelings Ifeel like I can split off disintegrate and getaway from them This is what schizophreneseis aboutrsquo She said rsquo I give people the breath-ing they need I make a case to take care ofme I respire them With every breath I givethem responsibilityrsquo

rsquo Respirersquo is a neologism made by theordinary morphological processes of clippingand condensation of the physical process ofrespiration and the work-related concept ofresponsibility but it is a thing and not areference She said rsquo Irsquom mad today I had toput in limits and boundaries and not spill myguts There are lots of snakes inside me and Iwant you to eat them for mersquo In reference toan episode of vomiting during a meal withher family when they questioned her aboutinstances of her irresponsible behaviour shecomments rsquo I couldnrsquo t bear the feeling ofhaving taken all those courses wastingmoney scattering my time and I had to getrid of them I was throwing up the feelingrsquo

It follows from the nature of their languagethat schizophrenics lack patience self-controland restraint have dif culty conceptualisingprocess and sequence distinguishing pastfrom present and here from there and seeingthe consequences of their actions and thereby

learning from experience Carolinersquos Valen-tine mailing was an example of how sheregularly bombarded with letters persons withwhom she had no current contact often fromthe distant past She called these bizarremass-mailings rsquo Trail Newsrsquo and she believedshe was relieving herself into these others ofher otherwise troubling mental contents Shesaid rsquo If your arm was controlled by maturethought then you could wait Itrsquos the entangle-ment quality instead of being able to stop andthinkrsquo

Despite its sometimes strange and colour-ful character the language of schizophreniais neither a language of conscious awareness(re ection) nor of unconscious concealment(repression) It does not support mentalrepresentation symbolisation and re ectionFailure to appreciate this may be what led ageneration of analysts including such semi-nal gures as Frieda Fromm-Reichmann toidealise schizophrenic persons as havingspecial psychic acuity and access to theirunconscious mental life that ordinary personsdo not A neurotic patient might refer to herhabitual and inappropriate tendency to con- de personal affairs to others using theunconscious symbolism of a phrase such asrsquo spilling my gutsrsquo If questioned she wouldhave the sense that she had said somethingworth re ecting on thinking about andanalysing the symbolic meaning of WhenCaroline used the expression as noted earliershe not only believed there were snakes in herintestines that she needed to give to me(although she could reality-test the idea ifpressed to do so) but she referred to anearlier occasion when she had vomited to ridherself of unwanted feelings In an ordinaryanalysis the analyst might suggest that thepatientrsquos behaviour and associations indicatethat she viewed her problems as a mess shebelieved she could dump on to or into theanalyst and the patient might respond to theinterpretation with associations to oral or analfantasies and memories When Caroline saysrsquo I send it [rsquorsquo my messrsquorsquo ] to responsible people Irsquom lling up their mailbox I word my

396 MICHAEL ROBBINS

way into a relationship with lettersrsquo she isdoing something and not speaking metaphori-cally or thinking Whereas an ordinary personmight be aware of the underlying fantasiesand con icts Caroline literally believes thatshe is excreting her self which is identical toher words into others It might be moreaccurate to say that she is expressing phan-tasy in the Kleinian sense but if so even atthis level of discourse when she makes anattempt to interpret the original schizophren-ese account of her mass mailings in alanguage more comprehensible to me she isstill speaking in a language of closure andenactment devoid of interpretable symbo-lism and unconscious meaning

While schizophrenia is a state of self-centredness or egocentricity in the solipsisticsense of the term schizophrenese paradoxi-cally is a language without a centred subjectexcept in the most rudimentary sense ofobserver and actor of a drama The subjectiversquo Irsquo denoting the presence of conscious re ec-tion and thought about beliefs fantasiesemotions and con icts is largely missing andin its stead Caroline describes a microcosm inwhich she is participant consisting of suchthings as a pool table with its sticks and ballsher sewing box with its bobbins and yarns orthe terrain bordering the three lakes she haswalked around with its birds trees andpeople In ordinary discourse one might shareonersquos subjective thoughts and feelings aboutonersquos mother by saying rsquo Irsquo m always behindthe eight-ball with herrsquo or rsquo I was cluelesswhen it came to my mother itrsquos the oldproblem of the irresistible force and theimmovable objectrsquo Caroline by contrastdescribed to me a game of pool she hadplayed in which her mother was the cue balland she had been able to pocket the otherballs without moving the cue-ball or hittingthe eight-ball Her affect was one of triumphfor she literally believed she had solved theproblem of dealing with her mother

This example will serve to segue from thesemantic to the pragmatic aspects of schizo-phrenese which is closely related to delusion

reversal and undoing and deceptionmdashpro-cesses that enable the user to avoid thoughtand awareness of feelings Ordinary languageserves to adapt the waking user to anrsquo externalrsquo world as subjectively perceivedwithin broad consensual outlines The worldof the schizophrenic by contrast is internalthough unrecognised as such and consists ofidiosyncratic microcosms that combine whatmore maturely we look upon as psyche withwhat is sensed and perceived Subjectivelyby manipulating mental contents the schizo-phrenic experiences control over the worldThe language is felt by its user to possess thepower to undo reverse and eliminate intoler-able reality both past and present It is alanguage of psychic alchemy or delusionalomnipotence (Burnham 1955 Frosch 1967Glass 1981) Caroline told me rsquo I fool myselfinto thinking it didnrsquo t happenrsquo Speakingordinary language she referred to schizo-phrenese as rsquo the language of wish and desirersquo With her knitting a game of pool a walkaround the lake or detailed letters to othersshe creates a universe that she can describeand act upon with the conviction that she isaltering events problems and associated feel-ings both present and past Ordinary lan-guage also employs reversal but in anentirely different way and for an oppositepurpose By its stark contrast with the sharedand implicitly acknowledged context such areversal in ordinary language serves to high-light or accentuate the feeling the speakerwishes to conveymdashfor instance in the remarkrsquo Hersquos a ne one to be saying thatrsquo Thedelusional reversal of schizophrenia by con-trast eliminates the necessity to differentiatemind from reality to bear painful feelingsand to adapt to a consensually validatedworld An ordinary person faced with apainful situation might transiently nd solaceby constructing heroic fantasies and becom-ing in imagination someone able to surmountany dif culty invulnerable to pain and hurtSchizophrenic language by contrast lacksthe rsquo as if rsquo capacity inherent in the use ofmetaphor that is required to construct such a

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 397

fantasy Instead of an unconscious fantasyand a language capable of contemplation theschizophrenic experiences a delusional senseof actualisation rsquo isrsquo has replaced rsquo as if rsquo

The qualitative difference between schizo-phrenese and ordinary language helps toaccount for the fact that delusions are xedbeliefs refractory to clinical analysis In themind of their creator they are actualitiesrather than fantasies so that there is nothingto be thought about Some time after thevignettes that I have presented when Carolinehad become more uent in ordinary languageand more uid in moving back and forthbetween the two she commenced an hour byobserving my new shoes and commenting rsquo Itmakes me angry that you always have neatshoes and I donrsquo trsquo I observed aloud that herown feet were beginning to move Sheresponded rsquo Our feet move togetherrsquo andadded that she would like me to hug her Iinquired what that was about and she said rsquo Iwant to be in your shoesrsquo She was then ableto express in ordinary language her aware-ness that she was not expressing a fantasy orsymbolising a wish to be more like me butwas verging on speaking the thoughtlesslanguage of schizophrenese which in the pastwould have achieved a sense of actualisationand closure (in this case the delusion she hadexchanged identities with me) rather thanallowing the opportunity for re ectivethought about painful feelings and issuesrelated to being her own separate person

Paradoxically it is this very failure ofschizophrenic language to distinguishthoughts from events that may disguise itsbizarreness and conceal the delusional think-ing it supports because utterances may seemto patient and analyst to be nothing more thandescriptions or observations of happeningsIn telling me about the degrading affair withher college professor and her subsequentconversation about it with her mother Caro-line believed she was doing it over differentlynot simply wishing she might

No discussion of schizophrenic languagewould be complete without a comment about

neologisms which incidentally are notnearly so speci c to schizophrenia as gener-ally believed They appear to be constructedaccording to ordinary morphological princi-ples and it is primarily in their semantic andpragmatic aspects that they are remarkableOne day Caroline said rsquo Irsquove got it set up atwork so no-one can refrain from authoritingme They tell me what to do It pisses me offrsquoWhen I inquired if she believed authoritingwas a legitimate word she said she supposednot I then asked why she did not say whatshe meant in acceptable English She repliedthat it would compel her to face feelings ofshame at loss of dignity and control over herown life By not accepting the existence of anordinary language word to express her feelingstate she managed to repudiate the reality ofthe issue and to avoid the feelings about itThis is another example of the identity ofwords things and actions If the word is thereal thing and she can substitute a neologismthen she can delude herself that the thing orthe problem no longer exists It is easy for theanalyst who is struggling to understand thepatient to gloss over the idiosyncratic aspectof the word in favour of what appears to bethe underlying meaning as one might do withsome of the peculiarities of speech of some-one not uent in onersquos native tonguemdashin thisinstance to assume that Caroline rsquo reallyrsquomeans rsquo acting like an authority withrsquo In thisway the patientrsquos delusion combines with theanalystrsquos illusion to form collusion

Schizophrenic patients do not want to beunderstood for it threatens them with un-wanted knowledge about themselves Schizo-phrenese not only lacks communicativeintent it is a language of deception In orderto function as a vehicle of communicationcontextual elements and related linguisticassumptionsmdashpersonal social and culturalmdashmust be suf ciently concordant in speakerand listenermdashthe rsquo musicrsquo so to speak thataccompanies the words In the case of schizo-phrenese not only are these assumptionsidiosyncratic to the speaker or writer but alsothe speaker or writer is unwilling to elucidate

398 MICHAEL ROBBINS

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

myself I canrsquo t seem to rsquorsquo go straightrsquorsquo I fellinto it again and spilled everything out to mymother I deserved to be punished but insteadof making me feel like a jailbird or aprostitute she blamed him and she made likeit was nothing she vacated her mind andlooked for other birds to blamersquo

In this ordinary-language version thereemerges a thoughtful emotional re ectiveself replete with the symbolism and meta-phor that is missing in a language that fuseswords things and actions Caroline describesher schizophrenese much as Bion (1967)described attacks on linkingmdashas a process ofacting rather than thinking and blowing hermind to bits As she observes makingmetaphors takes too much energy When shetalks about getting in touch with feelings sheis not referring to metaphorical touching butto literal sensory-motor activities She can-not separate words from actions and things sothat she might be able to think about thedestructive relationship and the overwhelm-ing temptation Instead she walks around alake that she has rendered equivalent to (notwhich symbolises) the container of her mindher mind itself the loss of her mind thetempting three-part male genital the threeguys playing with her mind and her playingwith the penis Her mind is also literallyindistinguishable from the tree or the cageand the birds caged or in trees are concreteenactments of internalised or projected res-ponsibility and blame Of the three vignettesthis re ects the most mental maturity in so faras Caroline is trying to think and feel in anordinary way at the very same time sheexperiences the omnipotent capacity to elimi-nate what needs to be thought about Bothefforts fail

Discussion

Schizophrenics speak a meaningful lan-guage that differs from ordinary language inits essence not simply with regard to sym-bolism This language has a determina-

tive relationship to delusional thinkingBecause Freudrsquos linguistic analysis ofdreaming as a delusional and hallucinatorywish-ful lmentmdashan encapsulated nocturnalpsychosismdashis of considerable relevancesummarising some of the parallels betweendreaming and schizophrenia will be a usefulpoint of entry Schizophrenia presents itselfon a continuum in varying degrees of regres-sion or compensation In its most regressedform catatonia it resembles a waking dreamstate characterised by absence of wakefulattentiveness and sensory-perceptual domi-nance in the form of hallucinations Verbaland motor action are also absent as in thestate of sensory-perceptual identity to whichFreud made reference in his discussion of theprimary process in dreams (1900) and in hispaper on hallucinatory wish ful lment in theabsence of the object (1911) At the other endof the continuummdashthe state of maximalcompensationmdashthe balance is shifted towardspsycho-motor identity the language ofschizophrenia is one of action and actualisa-tion rather than thought and it resembles thesensorimotor stage of infancy

Discussion of language is usually dividedinto syntax morphology semantics and prag-matics As noted earlier syntax here is moreor less intact With regard to morphologyalthough some of the words used by theschizophrenic may be idiosyncratic the rulesor processes by which they are formed (suchas the use of af xes compounding onomato-poeia proper noun transformation clippingand blending) seem identical to those used inordinary language Therefore the ensuingdiscussion will focus on semantic and prag-matic considerations

Ordinary language is an aspect of re ectivethought that is uniquely situated betweenimpulse and action and enables adaptation toconsensual reality by means of exchangingthoughts and feelings with others and con-templating them oneself Language is neverentirely divorced from the sensorimotorphase in the sense that action in the form ofgestures and bodily expressions as well as

394 MICHAEL ROBBINS

somatic sensations remains an inextricablepart of it but in the course of developmentspeech and writing become relatively autono-mous The more sophisticated the subject themore exible the language becomes in mov-ing between concrete sensory somatic andfunctional considerations on the one handand more abstract re ective and comparativeoperations in which one element stands forabbreviates or enriches one or more otherson the other Individual language developsfrom simple denotationmdashthat is learningculturally determined signi ersmdashto abstractdevelopment of symbols metaphors andsimiles both those shared by a given cultureand those that re ect unique personal experi-ence The capacity for simultaneous parallelor multi-track processing enables language todisguise and conceal as well as to re ectclarify and communicate and to have at anygiven time more than one meaning It is thismulti-dimensional complexity that makespsychoanalysis possible

Because we have no choice but to useordinary language as both a means and areference point for analysing schizophreniclanguage it is natural to assume the latter tobe qualitatively continuous with ordinarylanguage and that linear translation of one tothe other is possiblemdashas in Freudrsquos well-known comparison of dream imagery toEgyptian hieroglyphics We tend to assumethat schizophrenese is a kind of encryptedcode cover or disguise that can be decodedinto its unconscious rsquo realrsquo ordinary languagemeaning Thus it would seem natural to askof a schizophrenic utterance rsquo What does itmeanrsquo mdasha question which I raise repeatedlyin the paper and which I often addressed toCaroline But schizophrenese is not a variantof ordinary language It is unique and intrin-sically different hence such a reduction is notpossible It may eventually be possible how-ever for the schizophrenic to acquire thecapacity to re-state or re-present the thoughtsthat he or she was couching in schizophrenesein ordinary language so that the two lan-guages can be compared and contrasted and

this is what Caroline gradually acquired thecapability to do

From a semantic perspective schizophre-nese is characterised by an absence of theordinary distinctions between word thingbodily process and action The word is usedas though it were identical to the thing towhich it would ordinarily refer as well as toactionsmdashpast present or prospectivemdashon orin relation to the thing and to the mediatingsomatic processes Words lack their ordinaryconnotation as representations and refer-ences they have become happenings orevents Caroline once referred to this processas rsquo combination thinkingrsquo mdasha term nearlyidentical to the concept rsquo combinative think-ingrsquo proposed by McClain Johnston andPhilip Holzman (1985) In ordinary discoursespeaker and listener recognise the symbolicimport of a concrete-sounding statement suchas rsquo I have a special pipeline to the bossrsquo orrsquo Letrsquos smoke a peace-pipersquo The metaphorserves as emphasis or highlighting of a keyidea that is being talked about In contrastCaroline once literally handed me a sectionof plumberrsquos pipemdasha gesture so pregnantwith meaning yet impregnable to my inter-pretive skills that it would have been easy toconclude that the pipe was an arcane symbolWhen I questioned her about it however shewas able to tell me that she was making aconnection with me In other words the pipewas just a pipe An ordinary speaker mightmetaphorically and passionately declare loveby saying rsquo I give you my heartrsquo or sing aboutempathic sharing in the folk lyric rsquo Pack upyour troubles in your old kit bag and smilersquo but in discussing the thought process involvedin mailing her Valentine card with a largeheart on it to a large number of casual andformer acquaintances Caroline told me shewas packaging and mailing her word-self toothers she looked upon as more willing toassume responsibility for her than she was forherself While it is tempting to use terms likecollapse implosion explosion fusion orboundary loss to describe the creation ofthese concrete linguistic identities such

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 395

terms convey the incorrect impression thatschizophrenese is a regressive degradation ofordinary language Rather schizophrenese isa language of equivalence immediacy andaction in contrast to ordinary languagewhich supports representational thinkingMoreover there is no evidence that theschizophrenic ever rsquo spokersquo differently

Schizophrenese then is an immediatelanguage of the body and its function in theworld of things particularly motor (throwinghitting) respiratory (breathing talking andblowing as in the felicitous expression rsquo mindblowingrsquo ) gastrointestinal (vomiting and de-fecating) and orgasmic (rsquo fucking onersquos brainsoutrsquo ) Caroline describes printmaking as fol-lows rsquo I was pounding it down oozing out myblack insides on paperrsquo She described one ofher long walks as follows rsquo I want to run andrun and run away from the painful feelings Ifeel like I can split off disintegrate and getaway from them This is what schizophreneseis aboutrsquo She said rsquo I give people the breath-ing they need I make a case to take care ofme I respire them With every breath I givethem responsibilityrsquo

rsquo Respirersquo is a neologism made by theordinary morphological processes of clippingand condensation of the physical process ofrespiration and the work-related concept ofresponsibility but it is a thing and not areference She said rsquo Irsquom mad today I had toput in limits and boundaries and not spill myguts There are lots of snakes inside me and Iwant you to eat them for mersquo In reference toan episode of vomiting during a meal withher family when they questioned her aboutinstances of her irresponsible behaviour shecomments rsquo I couldnrsquo t bear the feeling ofhaving taken all those courses wastingmoney scattering my time and I had to getrid of them I was throwing up the feelingrsquo

It follows from the nature of their languagethat schizophrenics lack patience self-controland restraint have dif culty conceptualisingprocess and sequence distinguishing pastfrom present and here from there and seeingthe consequences of their actions and thereby

learning from experience Carolinersquos Valen-tine mailing was an example of how sheregularly bombarded with letters persons withwhom she had no current contact often fromthe distant past She called these bizarremass-mailings rsquo Trail Newsrsquo and she believedshe was relieving herself into these others ofher otherwise troubling mental contents Shesaid rsquo If your arm was controlled by maturethought then you could wait Itrsquos the entangle-ment quality instead of being able to stop andthinkrsquo

Despite its sometimes strange and colour-ful character the language of schizophreniais neither a language of conscious awareness(re ection) nor of unconscious concealment(repression) It does not support mentalrepresentation symbolisation and re ectionFailure to appreciate this may be what led ageneration of analysts including such semi-nal gures as Frieda Fromm-Reichmann toidealise schizophrenic persons as havingspecial psychic acuity and access to theirunconscious mental life that ordinary personsdo not A neurotic patient might refer to herhabitual and inappropriate tendency to con- de personal affairs to others using theunconscious symbolism of a phrase such asrsquo spilling my gutsrsquo If questioned she wouldhave the sense that she had said somethingworth re ecting on thinking about andanalysing the symbolic meaning of WhenCaroline used the expression as noted earliershe not only believed there were snakes in herintestines that she needed to give to me(although she could reality-test the idea ifpressed to do so) but she referred to anearlier occasion when she had vomited to ridherself of unwanted feelings In an ordinaryanalysis the analyst might suggest that thepatientrsquos behaviour and associations indicatethat she viewed her problems as a mess shebelieved she could dump on to or into theanalyst and the patient might respond to theinterpretation with associations to oral or analfantasies and memories When Caroline saysrsquo I send it [rsquorsquo my messrsquorsquo ] to responsible people Irsquom lling up their mailbox I word my

396 MICHAEL ROBBINS

way into a relationship with lettersrsquo she isdoing something and not speaking metaphori-cally or thinking Whereas an ordinary personmight be aware of the underlying fantasiesand con icts Caroline literally believes thatshe is excreting her self which is identical toher words into others It might be moreaccurate to say that she is expressing phan-tasy in the Kleinian sense but if so even atthis level of discourse when she makes anattempt to interpret the original schizophren-ese account of her mass mailings in alanguage more comprehensible to me she isstill speaking in a language of closure andenactment devoid of interpretable symbo-lism and unconscious meaning

While schizophrenia is a state of self-centredness or egocentricity in the solipsisticsense of the term schizophrenese paradoxi-cally is a language without a centred subjectexcept in the most rudimentary sense ofobserver and actor of a drama The subjectiversquo Irsquo denoting the presence of conscious re ec-tion and thought about beliefs fantasiesemotions and con icts is largely missing andin its stead Caroline describes a microcosm inwhich she is participant consisting of suchthings as a pool table with its sticks and ballsher sewing box with its bobbins and yarns orthe terrain bordering the three lakes she haswalked around with its birds trees andpeople In ordinary discourse one might shareonersquos subjective thoughts and feelings aboutonersquos mother by saying rsquo Irsquo m always behindthe eight-ball with herrsquo or rsquo I was cluelesswhen it came to my mother itrsquos the oldproblem of the irresistible force and theimmovable objectrsquo Caroline by contrastdescribed to me a game of pool she hadplayed in which her mother was the cue balland she had been able to pocket the otherballs without moving the cue-ball or hittingthe eight-ball Her affect was one of triumphfor she literally believed she had solved theproblem of dealing with her mother

This example will serve to segue from thesemantic to the pragmatic aspects of schizo-phrenese which is closely related to delusion

reversal and undoing and deceptionmdashpro-cesses that enable the user to avoid thoughtand awareness of feelings Ordinary languageserves to adapt the waking user to anrsquo externalrsquo world as subjectively perceivedwithin broad consensual outlines The worldof the schizophrenic by contrast is internalthough unrecognised as such and consists ofidiosyncratic microcosms that combine whatmore maturely we look upon as psyche withwhat is sensed and perceived Subjectivelyby manipulating mental contents the schizo-phrenic experiences control over the worldThe language is felt by its user to possess thepower to undo reverse and eliminate intoler-able reality both past and present It is alanguage of psychic alchemy or delusionalomnipotence (Burnham 1955 Frosch 1967Glass 1981) Caroline told me rsquo I fool myselfinto thinking it didnrsquo t happenrsquo Speakingordinary language she referred to schizo-phrenese as rsquo the language of wish and desirersquo With her knitting a game of pool a walkaround the lake or detailed letters to othersshe creates a universe that she can describeand act upon with the conviction that she isaltering events problems and associated feel-ings both present and past Ordinary lan-guage also employs reversal but in anentirely different way and for an oppositepurpose By its stark contrast with the sharedand implicitly acknowledged context such areversal in ordinary language serves to high-light or accentuate the feeling the speakerwishes to conveymdashfor instance in the remarkrsquo Hersquos a ne one to be saying thatrsquo Thedelusional reversal of schizophrenia by con-trast eliminates the necessity to differentiatemind from reality to bear painful feelingsand to adapt to a consensually validatedworld An ordinary person faced with apainful situation might transiently nd solaceby constructing heroic fantasies and becom-ing in imagination someone able to surmountany dif culty invulnerable to pain and hurtSchizophrenic language by contrast lacksthe rsquo as if rsquo capacity inherent in the use ofmetaphor that is required to construct such a

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 397

fantasy Instead of an unconscious fantasyand a language capable of contemplation theschizophrenic experiences a delusional senseof actualisation rsquo isrsquo has replaced rsquo as if rsquo

The qualitative difference between schizo-phrenese and ordinary language helps toaccount for the fact that delusions are xedbeliefs refractory to clinical analysis In themind of their creator they are actualitiesrather than fantasies so that there is nothingto be thought about Some time after thevignettes that I have presented when Carolinehad become more uent in ordinary languageand more uid in moving back and forthbetween the two she commenced an hour byobserving my new shoes and commenting rsquo Itmakes me angry that you always have neatshoes and I donrsquo trsquo I observed aloud that herown feet were beginning to move Sheresponded rsquo Our feet move togetherrsquo andadded that she would like me to hug her Iinquired what that was about and she said rsquo Iwant to be in your shoesrsquo She was then ableto express in ordinary language her aware-ness that she was not expressing a fantasy orsymbolising a wish to be more like me butwas verging on speaking the thoughtlesslanguage of schizophrenese which in the pastwould have achieved a sense of actualisationand closure (in this case the delusion she hadexchanged identities with me) rather thanallowing the opportunity for re ectivethought about painful feelings and issuesrelated to being her own separate person

Paradoxically it is this very failure ofschizophrenic language to distinguishthoughts from events that may disguise itsbizarreness and conceal the delusional think-ing it supports because utterances may seemto patient and analyst to be nothing more thandescriptions or observations of happeningsIn telling me about the degrading affair withher college professor and her subsequentconversation about it with her mother Caro-line believed she was doing it over differentlynot simply wishing she might

No discussion of schizophrenic languagewould be complete without a comment about

neologisms which incidentally are notnearly so speci c to schizophrenia as gener-ally believed They appear to be constructedaccording to ordinary morphological princi-ples and it is primarily in their semantic andpragmatic aspects that they are remarkableOne day Caroline said rsquo Irsquove got it set up atwork so no-one can refrain from authoritingme They tell me what to do It pisses me offrsquoWhen I inquired if she believed authoritingwas a legitimate word she said she supposednot I then asked why she did not say whatshe meant in acceptable English She repliedthat it would compel her to face feelings ofshame at loss of dignity and control over herown life By not accepting the existence of anordinary language word to express her feelingstate she managed to repudiate the reality ofthe issue and to avoid the feelings about itThis is another example of the identity ofwords things and actions If the word is thereal thing and she can substitute a neologismthen she can delude herself that the thing orthe problem no longer exists It is easy for theanalyst who is struggling to understand thepatient to gloss over the idiosyncratic aspectof the word in favour of what appears to bethe underlying meaning as one might do withsome of the peculiarities of speech of some-one not uent in onersquos native tonguemdashin thisinstance to assume that Caroline rsquo reallyrsquomeans rsquo acting like an authority withrsquo In thisway the patientrsquos delusion combines with theanalystrsquos illusion to form collusion

Schizophrenic patients do not want to beunderstood for it threatens them with un-wanted knowledge about themselves Schizo-phrenese not only lacks communicativeintent it is a language of deception In orderto function as a vehicle of communicationcontextual elements and related linguisticassumptionsmdashpersonal social and culturalmdashmust be suf ciently concordant in speakerand listenermdashthe rsquo musicrsquo so to speak thataccompanies the words In the case of schizo-phrenese not only are these assumptionsidiosyncratic to the speaker or writer but alsothe speaker or writer is unwilling to elucidate

398 MICHAEL ROBBINS

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

somatic sensations remains an inextricablepart of it but in the course of developmentspeech and writing become relatively autono-mous The more sophisticated the subject themore exible the language becomes in mov-ing between concrete sensory somatic andfunctional considerations on the one handand more abstract re ective and comparativeoperations in which one element stands forabbreviates or enriches one or more otherson the other Individual language developsfrom simple denotationmdashthat is learningculturally determined signi ersmdashto abstractdevelopment of symbols metaphors andsimiles both those shared by a given cultureand those that re ect unique personal experi-ence The capacity for simultaneous parallelor multi-track processing enables language todisguise and conceal as well as to re ectclarify and communicate and to have at anygiven time more than one meaning It is thismulti-dimensional complexity that makespsychoanalysis possible

Because we have no choice but to useordinary language as both a means and areference point for analysing schizophreniclanguage it is natural to assume the latter tobe qualitatively continuous with ordinarylanguage and that linear translation of one tothe other is possiblemdashas in Freudrsquos well-known comparison of dream imagery toEgyptian hieroglyphics We tend to assumethat schizophrenese is a kind of encryptedcode cover or disguise that can be decodedinto its unconscious rsquo realrsquo ordinary languagemeaning Thus it would seem natural to askof a schizophrenic utterance rsquo What does itmeanrsquo mdasha question which I raise repeatedlyin the paper and which I often addressed toCaroline But schizophrenese is not a variantof ordinary language It is unique and intrin-sically different hence such a reduction is notpossible It may eventually be possible how-ever for the schizophrenic to acquire thecapacity to re-state or re-present the thoughtsthat he or she was couching in schizophrenesein ordinary language so that the two lan-guages can be compared and contrasted and

this is what Caroline gradually acquired thecapability to do

From a semantic perspective schizophre-nese is characterised by an absence of theordinary distinctions between word thingbodily process and action The word is usedas though it were identical to the thing towhich it would ordinarily refer as well as toactionsmdashpast present or prospectivemdashon orin relation to the thing and to the mediatingsomatic processes Words lack their ordinaryconnotation as representations and refer-ences they have become happenings orevents Caroline once referred to this processas rsquo combination thinkingrsquo mdasha term nearlyidentical to the concept rsquo combinative think-ingrsquo proposed by McClain Johnston andPhilip Holzman (1985) In ordinary discoursespeaker and listener recognise the symbolicimport of a concrete-sounding statement suchas rsquo I have a special pipeline to the bossrsquo orrsquo Letrsquos smoke a peace-pipersquo The metaphorserves as emphasis or highlighting of a keyidea that is being talked about In contrastCaroline once literally handed me a sectionof plumberrsquos pipemdasha gesture so pregnantwith meaning yet impregnable to my inter-pretive skills that it would have been easy toconclude that the pipe was an arcane symbolWhen I questioned her about it however shewas able to tell me that she was making aconnection with me In other words the pipewas just a pipe An ordinary speaker mightmetaphorically and passionately declare loveby saying rsquo I give you my heartrsquo or sing aboutempathic sharing in the folk lyric rsquo Pack upyour troubles in your old kit bag and smilersquo but in discussing the thought process involvedin mailing her Valentine card with a largeheart on it to a large number of casual andformer acquaintances Caroline told me shewas packaging and mailing her word-self toothers she looked upon as more willing toassume responsibility for her than she was forherself While it is tempting to use terms likecollapse implosion explosion fusion orboundary loss to describe the creation ofthese concrete linguistic identities such

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 395

terms convey the incorrect impression thatschizophrenese is a regressive degradation ofordinary language Rather schizophrenese isa language of equivalence immediacy andaction in contrast to ordinary languagewhich supports representational thinkingMoreover there is no evidence that theschizophrenic ever rsquo spokersquo differently

Schizophrenese then is an immediatelanguage of the body and its function in theworld of things particularly motor (throwinghitting) respiratory (breathing talking andblowing as in the felicitous expression rsquo mindblowingrsquo ) gastrointestinal (vomiting and de-fecating) and orgasmic (rsquo fucking onersquos brainsoutrsquo ) Caroline describes printmaking as fol-lows rsquo I was pounding it down oozing out myblack insides on paperrsquo She described one ofher long walks as follows rsquo I want to run andrun and run away from the painful feelings Ifeel like I can split off disintegrate and getaway from them This is what schizophreneseis aboutrsquo She said rsquo I give people the breath-ing they need I make a case to take care ofme I respire them With every breath I givethem responsibilityrsquo

rsquo Respirersquo is a neologism made by theordinary morphological processes of clippingand condensation of the physical process ofrespiration and the work-related concept ofresponsibility but it is a thing and not areference She said rsquo Irsquom mad today I had toput in limits and boundaries and not spill myguts There are lots of snakes inside me and Iwant you to eat them for mersquo In reference toan episode of vomiting during a meal withher family when they questioned her aboutinstances of her irresponsible behaviour shecomments rsquo I couldnrsquo t bear the feeling ofhaving taken all those courses wastingmoney scattering my time and I had to getrid of them I was throwing up the feelingrsquo

It follows from the nature of their languagethat schizophrenics lack patience self-controland restraint have dif culty conceptualisingprocess and sequence distinguishing pastfrom present and here from there and seeingthe consequences of their actions and thereby

learning from experience Carolinersquos Valen-tine mailing was an example of how sheregularly bombarded with letters persons withwhom she had no current contact often fromthe distant past She called these bizarremass-mailings rsquo Trail Newsrsquo and she believedshe was relieving herself into these others ofher otherwise troubling mental contents Shesaid rsquo If your arm was controlled by maturethought then you could wait Itrsquos the entangle-ment quality instead of being able to stop andthinkrsquo

Despite its sometimes strange and colour-ful character the language of schizophreniais neither a language of conscious awareness(re ection) nor of unconscious concealment(repression) It does not support mentalrepresentation symbolisation and re ectionFailure to appreciate this may be what led ageneration of analysts including such semi-nal gures as Frieda Fromm-Reichmann toidealise schizophrenic persons as havingspecial psychic acuity and access to theirunconscious mental life that ordinary personsdo not A neurotic patient might refer to herhabitual and inappropriate tendency to con- de personal affairs to others using theunconscious symbolism of a phrase such asrsquo spilling my gutsrsquo If questioned she wouldhave the sense that she had said somethingworth re ecting on thinking about andanalysing the symbolic meaning of WhenCaroline used the expression as noted earliershe not only believed there were snakes in herintestines that she needed to give to me(although she could reality-test the idea ifpressed to do so) but she referred to anearlier occasion when she had vomited to ridherself of unwanted feelings In an ordinaryanalysis the analyst might suggest that thepatientrsquos behaviour and associations indicatethat she viewed her problems as a mess shebelieved she could dump on to or into theanalyst and the patient might respond to theinterpretation with associations to oral or analfantasies and memories When Caroline saysrsquo I send it [rsquorsquo my messrsquorsquo ] to responsible people Irsquom lling up their mailbox I word my

396 MICHAEL ROBBINS

way into a relationship with lettersrsquo she isdoing something and not speaking metaphori-cally or thinking Whereas an ordinary personmight be aware of the underlying fantasiesand con icts Caroline literally believes thatshe is excreting her self which is identical toher words into others It might be moreaccurate to say that she is expressing phan-tasy in the Kleinian sense but if so even atthis level of discourse when she makes anattempt to interpret the original schizophren-ese account of her mass mailings in alanguage more comprehensible to me she isstill speaking in a language of closure andenactment devoid of interpretable symbo-lism and unconscious meaning

While schizophrenia is a state of self-centredness or egocentricity in the solipsisticsense of the term schizophrenese paradoxi-cally is a language without a centred subjectexcept in the most rudimentary sense ofobserver and actor of a drama The subjectiversquo Irsquo denoting the presence of conscious re ec-tion and thought about beliefs fantasiesemotions and con icts is largely missing andin its stead Caroline describes a microcosm inwhich she is participant consisting of suchthings as a pool table with its sticks and ballsher sewing box with its bobbins and yarns orthe terrain bordering the three lakes she haswalked around with its birds trees andpeople In ordinary discourse one might shareonersquos subjective thoughts and feelings aboutonersquos mother by saying rsquo Irsquo m always behindthe eight-ball with herrsquo or rsquo I was cluelesswhen it came to my mother itrsquos the oldproblem of the irresistible force and theimmovable objectrsquo Caroline by contrastdescribed to me a game of pool she hadplayed in which her mother was the cue balland she had been able to pocket the otherballs without moving the cue-ball or hittingthe eight-ball Her affect was one of triumphfor she literally believed she had solved theproblem of dealing with her mother

This example will serve to segue from thesemantic to the pragmatic aspects of schizo-phrenese which is closely related to delusion

reversal and undoing and deceptionmdashpro-cesses that enable the user to avoid thoughtand awareness of feelings Ordinary languageserves to adapt the waking user to anrsquo externalrsquo world as subjectively perceivedwithin broad consensual outlines The worldof the schizophrenic by contrast is internalthough unrecognised as such and consists ofidiosyncratic microcosms that combine whatmore maturely we look upon as psyche withwhat is sensed and perceived Subjectivelyby manipulating mental contents the schizo-phrenic experiences control over the worldThe language is felt by its user to possess thepower to undo reverse and eliminate intoler-able reality both past and present It is alanguage of psychic alchemy or delusionalomnipotence (Burnham 1955 Frosch 1967Glass 1981) Caroline told me rsquo I fool myselfinto thinking it didnrsquo t happenrsquo Speakingordinary language she referred to schizo-phrenese as rsquo the language of wish and desirersquo With her knitting a game of pool a walkaround the lake or detailed letters to othersshe creates a universe that she can describeand act upon with the conviction that she isaltering events problems and associated feel-ings both present and past Ordinary lan-guage also employs reversal but in anentirely different way and for an oppositepurpose By its stark contrast with the sharedand implicitly acknowledged context such areversal in ordinary language serves to high-light or accentuate the feeling the speakerwishes to conveymdashfor instance in the remarkrsquo Hersquos a ne one to be saying thatrsquo Thedelusional reversal of schizophrenia by con-trast eliminates the necessity to differentiatemind from reality to bear painful feelingsand to adapt to a consensually validatedworld An ordinary person faced with apainful situation might transiently nd solaceby constructing heroic fantasies and becom-ing in imagination someone able to surmountany dif culty invulnerable to pain and hurtSchizophrenic language by contrast lacksthe rsquo as if rsquo capacity inherent in the use ofmetaphor that is required to construct such a

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 397

fantasy Instead of an unconscious fantasyand a language capable of contemplation theschizophrenic experiences a delusional senseof actualisation rsquo isrsquo has replaced rsquo as if rsquo

The qualitative difference between schizo-phrenese and ordinary language helps toaccount for the fact that delusions are xedbeliefs refractory to clinical analysis In themind of their creator they are actualitiesrather than fantasies so that there is nothingto be thought about Some time after thevignettes that I have presented when Carolinehad become more uent in ordinary languageand more uid in moving back and forthbetween the two she commenced an hour byobserving my new shoes and commenting rsquo Itmakes me angry that you always have neatshoes and I donrsquo trsquo I observed aloud that herown feet were beginning to move Sheresponded rsquo Our feet move togetherrsquo andadded that she would like me to hug her Iinquired what that was about and she said rsquo Iwant to be in your shoesrsquo She was then ableto express in ordinary language her aware-ness that she was not expressing a fantasy orsymbolising a wish to be more like me butwas verging on speaking the thoughtlesslanguage of schizophrenese which in the pastwould have achieved a sense of actualisationand closure (in this case the delusion she hadexchanged identities with me) rather thanallowing the opportunity for re ectivethought about painful feelings and issuesrelated to being her own separate person

Paradoxically it is this very failure ofschizophrenic language to distinguishthoughts from events that may disguise itsbizarreness and conceal the delusional think-ing it supports because utterances may seemto patient and analyst to be nothing more thandescriptions or observations of happeningsIn telling me about the degrading affair withher college professor and her subsequentconversation about it with her mother Caro-line believed she was doing it over differentlynot simply wishing she might

No discussion of schizophrenic languagewould be complete without a comment about

neologisms which incidentally are notnearly so speci c to schizophrenia as gener-ally believed They appear to be constructedaccording to ordinary morphological princi-ples and it is primarily in their semantic andpragmatic aspects that they are remarkableOne day Caroline said rsquo Irsquove got it set up atwork so no-one can refrain from authoritingme They tell me what to do It pisses me offrsquoWhen I inquired if she believed authoritingwas a legitimate word she said she supposednot I then asked why she did not say whatshe meant in acceptable English She repliedthat it would compel her to face feelings ofshame at loss of dignity and control over herown life By not accepting the existence of anordinary language word to express her feelingstate she managed to repudiate the reality ofthe issue and to avoid the feelings about itThis is another example of the identity ofwords things and actions If the word is thereal thing and she can substitute a neologismthen she can delude herself that the thing orthe problem no longer exists It is easy for theanalyst who is struggling to understand thepatient to gloss over the idiosyncratic aspectof the word in favour of what appears to bethe underlying meaning as one might do withsome of the peculiarities of speech of some-one not uent in onersquos native tonguemdashin thisinstance to assume that Caroline rsquo reallyrsquomeans rsquo acting like an authority withrsquo In thisway the patientrsquos delusion combines with theanalystrsquos illusion to form collusion

Schizophrenic patients do not want to beunderstood for it threatens them with un-wanted knowledge about themselves Schizo-phrenese not only lacks communicativeintent it is a language of deception In orderto function as a vehicle of communicationcontextual elements and related linguisticassumptionsmdashpersonal social and culturalmdashmust be suf ciently concordant in speakerand listenermdashthe rsquo musicrsquo so to speak thataccompanies the words In the case of schizo-phrenese not only are these assumptionsidiosyncratic to the speaker or writer but alsothe speaker or writer is unwilling to elucidate

398 MICHAEL ROBBINS

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

terms convey the incorrect impression thatschizophrenese is a regressive degradation ofordinary language Rather schizophrenese isa language of equivalence immediacy andaction in contrast to ordinary languagewhich supports representational thinkingMoreover there is no evidence that theschizophrenic ever rsquo spokersquo differently

Schizophrenese then is an immediatelanguage of the body and its function in theworld of things particularly motor (throwinghitting) respiratory (breathing talking andblowing as in the felicitous expression rsquo mindblowingrsquo ) gastrointestinal (vomiting and de-fecating) and orgasmic (rsquo fucking onersquos brainsoutrsquo ) Caroline describes printmaking as fol-lows rsquo I was pounding it down oozing out myblack insides on paperrsquo She described one ofher long walks as follows rsquo I want to run andrun and run away from the painful feelings Ifeel like I can split off disintegrate and getaway from them This is what schizophreneseis aboutrsquo She said rsquo I give people the breath-ing they need I make a case to take care ofme I respire them With every breath I givethem responsibilityrsquo

rsquo Respirersquo is a neologism made by theordinary morphological processes of clippingand condensation of the physical process ofrespiration and the work-related concept ofresponsibility but it is a thing and not areference She said rsquo Irsquom mad today I had toput in limits and boundaries and not spill myguts There are lots of snakes inside me and Iwant you to eat them for mersquo In reference toan episode of vomiting during a meal withher family when they questioned her aboutinstances of her irresponsible behaviour shecomments rsquo I couldnrsquo t bear the feeling ofhaving taken all those courses wastingmoney scattering my time and I had to getrid of them I was throwing up the feelingrsquo

It follows from the nature of their languagethat schizophrenics lack patience self-controland restraint have dif culty conceptualisingprocess and sequence distinguishing pastfrom present and here from there and seeingthe consequences of their actions and thereby

learning from experience Carolinersquos Valen-tine mailing was an example of how sheregularly bombarded with letters persons withwhom she had no current contact often fromthe distant past She called these bizarremass-mailings rsquo Trail Newsrsquo and she believedshe was relieving herself into these others ofher otherwise troubling mental contents Shesaid rsquo If your arm was controlled by maturethought then you could wait Itrsquos the entangle-ment quality instead of being able to stop andthinkrsquo

Despite its sometimes strange and colour-ful character the language of schizophreniais neither a language of conscious awareness(re ection) nor of unconscious concealment(repression) It does not support mentalrepresentation symbolisation and re ectionFailure to appreciate this may be what led ageneration of analysts including such semi-nal gures as Frieda Fromm-Reichmann toidealise schizophrenic persons as havingspecial psychic acuity and access to theirunconscious mental life that ordinary personsdo not A neurotic patient might refer to herhabitual and inappropriate tendency to con- de personal affairs to others using theunconscious symbolism of a phrase such asrsquo spilling my gutsrsquo If questioned she wouldhave the sense that she had said somethingworth re ecting on thinking about andanalysing the symbolic meaning of WhenCaroline used the expression as noted earliershe not only believed there were snakes in herintestines that she needed to give to me(although she could reality-test the idea ifpressed to do so) but she referred to anearlier occasion when she had vomited to ridherself of unwanted feelings In an ordinaryanalysis the analyst might suggest that thepatientrsquos behaviour and associations indicatethat she viewed her problems as a mess shebelieved she could dump on to or into theanalyst and the patient might respond to theinterpretation with associations to oral or analfantasies and memories When Caroline saysrsquo I send it [rsquorsquo my messrsquorsquo ] to responsible people Irsquom lling up their mailbox I word my

396 MICHAEL ROBBINS

way into a relationship with lettersrsquo she isdoing something and not speaking metaphori-cally or thinking Whereas an ordinary personmight be aware of the underlying fantasiesand con icts Caroline literally believes thatshe is excreting her self which is identical toher words into others It might be moreaccurate to say that she is expressing phan-tasy in the Kleinian sense but if so even atthis level of discourse when she makes anattempt to interpret the original schizophren-ese account of her mass mailings in alanguage more comprehensible to me she isstill speaking in a language of closure andenactment devoid of interpretable symbo-lism and unconscious meaning

While schizophrenia is a state of self-centredness or egocentricity in the solipsisticsense of the term schizophrenese paradoxi-cally is a language without a centred subjectexcept in the most rudimentary sense ofobserver and actor of a drama The subjectiversquo Irsquo denoting the presence of conscious re ec-tion and thought about beliefs fantasiesemotions and con icts is largely missing andin its stead Caroline describes a microcosm inwhich she is participant consisting of suchthings as a pool table with its sticks and ballsher sewing box with its bobbins and yarns orthe terrain bordering the three lakes she haswalked around with its birds trees andpeople In ordinary discourse one might shareonersquos subjective thoughts and feelings aboutonersquos mother by saying rsquo Irsquo m always behindthe eight-ball with herrsquo or rsquo I was cluelesswhen it came to my mother itrsquos the oldproblem of the irresistible force and theimmovable objectrsquo Caroline by contrastdescribed to me a game of pool she hadplayed in which her mother was the cue balland she had been able to pocket the otherballs without moving the cue-ball or hittingthe eight-ball Her affect was one of triumphfor she literally believed she had solved theproblem of dealing with her mother

This example will serve to segue from thesemantic to the pragmatic aspects of schizo-phrenese which is closely related to delusion

reversal and undoing and deceptionmdashpro-cesses that enable the user to avoid thoughtand awareness of feelings Ordinary languageserves to adapt the waking user to anrsquo externalrsquo world as subjectively perceivedwithin broad consensual outlines The worldof the schizophrenic by contrast is internalthough unrecognised as such and consists ofidiosyncratic microcosms that combine whatmore maturely we look upon as psyche withwhat is sensed and perceived Subjectivelyby manipulating mental contents the schizo-phrenic experiences control over the worldThe language is felt by its user to possess thepower to undo reverse and eliminate intoler-able reality both past and present It is alanguage of psychic alchemy or delusionalomnipotence (Burnham 1955 Frosch 1967Glass 1981) Caroline told me rsquo I fool myselfinto thinking it didnrsquo t happenrsquo Speakingordinary language she referred to schizo-phrenese as rsquo the language of wish and desirersquo With her knitting a game of pool a walkaround the lake or detailed letters to othersshe creates a universe that she can describeand act upon with the conviction that she isaltering events problems and associated feel-ings both present and past Ordinary lan-guage also employs reversal but in anentirely different way and for an oppositepurpose By its stark contrast with the sharedand implicitly acknowledged context such areversal in ordinary language serves to high-light or accentuate the feeling the speakerwishes to conveymdashfor instance in the remarkrsquo Hersquos a ne one to be saying thatrsquo Thedelusional reversal of schizophrenia by con-trast eliminates the necessity to differentiatemind from reality to bear painful feelingsand to adapt to a consensually validatedworld An ordinary person faced with apainful situation might transiently nd solaceby constructing heroic fantasies and becom-ing in imagination someone able to surmountany dif culty invulnerable to pain and hurtSchizophrenic language by contrast lacksthe rsquo as if rsquo capacity inherent in the use ofmetaphor that is required to construct such a

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 397

fantasy Instead of an unconscious fantasyand a language capable of contemplation theschizophrenic experiences a delusional senseof actualisation rsquo isrsquo has replaced rsquo as if rsquo

The qualitative difference between schizo-phrenese and ordinary language helps toaccount for the fact that delusions are xedbeliefs refractory to clinical analysis In themind of their creator they are actualitiesrather than fantasies so that there is nothingto be thought about Some time after thevignettes that I have presented when Carolinehad become more uent in ordinary languageand more uid in moving back and forthbetween the two she commenced an hour byobserving my new shoes and commenting rsquo Itmakes me angry that you always have neatshoes and I donrsquo trsquo I observed aloud that herown feet were beginning to move Sheresponded rsquo Our feet move togetherrsquo andadded that she would like me to hug her Iinquired what that was about and she said rsquo Iwant to be in your shoesrsquo She was then ableto express in ordinary language her aware-ness that she was not expressing a fantasy orsymbolising a wish to be more like me butwas verging on speaking the thoughtlesslanguage of schizophrenese which in the pastwould have achieved a sense of actualisationand closure (in this case the delusion she hadexchanged identities with me) rather thanallowing the opportunity for re ectivethought about painful feelings and issuesrelated to being her own separate person

Paradoxically it is this very failure ofschizophrenic language to distinguishthoughts from events that may disguise itsbizarreness and conceal the delusional think-ing it supports because utterances may seemto patient and analyst to be nothing more thandescriptions or observations of happeningsIn telling me about the degrading affair withher college professor and her subsequentconversation about it with her mother Caro-line believed she was doing it over differentlynot simply wishing she might

No discussion of schizophrenic languagewould be complete without a comment about

neologisms which incidentally are notnearly so speci c to schizophrenia as gener-ally believed They appear to be constructedaccording to ordinary morphological princi-ples and it is primarily in their semantic andpragmatic aspects that they are remarkableOne day Caroline said rsquo Irsquove got it set up atwork so no-one can refrain from authoritingme They tell me what to do It pisses me offrsquoWhen I inquired if she believed authoritingwas a legitimate word she said she supposednot I then asked why she did not say whatshe meant in acceptable English She repliedthat it would compel her to face feelings ofshame at loss of dignity and control over herown life By not accepting the existence of anordinary language word to express her feelingstate she managed to repudiate the reality ofthe issue and to avoid the feelings about itThis is another example of the identity ofwords things and actions If the word is thereal thing and she can substitute a neologismthen she can delude herself that the thing orthe problem no longer exists It is easy for theanalyst who is struggling to understand thepatient to gloss over the idiosyncratic aspectof the word in favour of what appears to bethe underlying meaning as one might do withsome of the peculiarities of speech of some-one not uent in onersquos native tonguemdashin thisinstance to assume that Caroline rsquo reallyrsquomeans rsquo acting like an authority withrsquo In thisway the patientrsquos delusion combines with theanalystrsquos illusion to form collusion

Schizophrenic patients do not want to beunderstood for it threatens them with un-wanted knowledge about themselves Schizo-phrenese not only lacks communicativeintent it is a language of deception In orderto function as a vehicle of communicationcontextual elements and related linguisticassumptionsmdashpersonal social and culturalmdashmust be suf ciently concordant in speakerand listenermdashthe rsquo musicrsquo so to speak thataccompanies the words In the case of schizo-phrenese not only are these assumptionsidiosyncratic to the speaker or writer but alsothe speaker or writer is unwilling to elucidate

398 MICHAEL ROBBINS

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

way into a relationship with lettersrsquo she isdoing something and not speaking metaphori-cally or thinking Whereas an ordinary personmight be aware of the underlying fantasiesand con icts Caroline literally believes thatshe is excreting her self which is identical toher words into others It might be moreaccurate to say that she is expressing phan-tasy in the Kleinian sense but if so even atthis level of discourse when she makes anattempt to interpret the original schizophren-ese account of her mass mailings in alanguage more comprehensible to me she isstill speaking in a language of closure andenactment devoid of interpretable symbo-lism and unconscious meaning

While schizophrenia is a state of self-centredness or egocentricity in the solipsisticsense of the term schizophrenese paradoxi-cally is a language without a centred subjectexcept in the most rudimentary sense ofobserver and actor of a drama The subjectiversquo Irsquo denoting the presence of conscious re ec-tion and thought about beliefs fantasiesemotions and con icts is largely missing andin its stead Caroline describes a microcosm inwhich she is participant consisting of suchthings as a pool table with its sticks and ballsher sewing box with its bobbins and yarns orthe terrain bordering the three lakes she haswalked around with its birds trees andpeople In ordinary discourse one might shareonersquos subjective thoughts and feelings aboutonersquos mother by saying rsquo Irsquo m always behindthe eight-ball with herrsquo or rsquo I was cluelesswhen it came to my mother itrsquos the oldproblem of the irresistible force and theimmovable objectrsquo Caroline by contrastdescribed to me a game of pool she hadplayed in which her mother was the cue balland she had been able to pocket the otherballs without moving the cue-ball or hittingthe eight-ball Her affect was one of triumphfor she literally believed she had solved theproblem of dealing with her mother

This example will serve to segue from thesemantic to the pragmatic aspects of schizo-phrenese which is closely related to delusion

reversal and undoing and deceptionmdashpro-cesses that enable the user to avoid thoughtand awareness of feelings Ordinary languageserves to adapt the waking user to anrsquo externalrsquo world as subjectively perceivedwithin broad consensual outlines The worldof the schizophrenic by contrast is internalthough unrecognised as such and consists ofidiosyncratic microcosms that combine whatmore maturely we look upon as psyche withwhat is sensed and perceived Subjectivelyby manipulating mental contents the schizo-phrenic experiences control over the worldThe language is felt by its user to possess thepower to undo reverse and eliminate intoler-able reality both past and present It is alanguage of psychic alchemy or delusionalomnipotence (Burnham 1955 Frosch 1967Glass 1981) Caroline told me rsquo I fool myselfinto thinking it didnrsquo t happenrsquo Speakingordinary language she referred to schizo-phrenese as rsquo the language of wish and desirersquo With her knitting a game of pool a walkaround the lake or detailed letters to othersshe creates a universe that she can describeand act upon with the conviction that she isaltering events problems and associated feel-ings both present and past Ordinary lan-guage also employs reversal but in anentirely different way and for an oppositepurpose By its stark contrast with the sharedand implicitly acknowledged context such areversal in ordinary language serves to high-light or accentuate the feeling the speakerwishes to conveymdashfor instance in the remarkrsquo Hersquos a ne one to be saying thatrsquo Thedelusional reversal of schizophrenia by con-trast eliminates the necessity to differentiatemind from reality to bear painful feelingsand to adapt to a consensually validatedworld An ordinary person faced with apainful situation might transiently nd solaceby constructing heroic fantasies and becom-ing in imagination someone able to surmountany dif culty invulnerable to pain and hurtSchizophrenic language by contrast lacksthe rsquo as if rsquo capacity inherent in the use ofmetaphor that is required to construct such a

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 397

fantasy Instead of an unconscious fantasyand a language capable of contemplation theschizophrenic experiences a delusional senseof actualisation rsquo isrsquo has replaced rsquo as if rsquo

The qualitative difference between schizo-phrenese and ordinary language helps toaccount for the fact that delusions are xedbeliefs refractory to clinical analysis In themind of their creator they are actualitiesrather than fantasies so that there is nothingto be thought about Some time after thevignettes that I have presented when Carolinehad become more uent in ordinary languageand more uid in moving back and forthbetween the two she commenced an hour byobserving my new shoes and commenting rsquo Itmakes me angry that you always have neatshoes and I donrsquo trsquo I observed aloud that herown feet were beginning to move Sheresponded rsquo Our feet move togetherrsquo andadded that she would like me to hug her Iinquired what that was about and she said rsquo Iwant to be in your shoesrsquo She was then ableto express in ordinary language her aware-ness that she was not expressing a fantasy orsymbolising a wish to be more like me butwas verging on speaking the thoughtlesslanguage of schizophrenese which in the pastwould have achieved a sense of actualisationand closure (in this case the delusion she hadexchanged identities with me) rather thanallowing the opportunity for re ectivethought about painful feelings and issuesrelated to being her own separate person

Paradoxically it is this very failure ofschizophrenic language to distinguishthoughts from events that may disguise itsbizarreness and conceal the delusional think-ing it supports because utterances may seemto patient and analyst to be nothing more thandescriptions or observations of happeningsIn telling me about the degrading affair withher college professor and her subsequentconversation about it with her mother Caro-line believed she was doing it over differentlynot simply wishing she might

No discussion of schizophrenic languagewould be complete without a comment about

neologisms which incidentally are notnearly so speci c to schizophrenia as gener-ally believed They appear to be constructedaccording to ordinary morphological princi-ples and it is primarily in their semantic andpragmatic aspects that they are remarkableOne day Caroline said rsquo Irsquove got it set up atwork so no-one can refrain from authoritingme They tell me what to do It pisses me offrsquoWhen I inquired if she believed authoritingwas a legitimate word she said she supposednot I then asked why she did not say whatshe meant in acceptable English She repliedthat it would compel her to face feelings ofshame at loss of dignity and control over herown life By not accepting the existence of anordinary language word to express her feelingstate she managed to repudiate the reality ofthe issue and to avoid the feelings about itThis is another example of the identity ofwords things and actions If the word is thereal thing and she can substitute a neologismthen she can delude herself that the thing orthe problem no longer exists It is easy for theanalyst who is struggling to understand thepatient to gloss over the idiosyncratic aspectof the word in favour of what appears to bethe underlying meaning as one might do withsome of the peculiarities of speech of some-one not uent in onersquos native tonguemdashin thisinstance to assume that Caroline rsquo reallyrsquomeans rsquo acting like an authority withrsquo In thisway the patientrsquos delusion combines with theanalystrsquos illusion to form collusion

Schizophrenic patients do not want to beunderstood for it threatens them with un-wanted knowledge about themselves Schizo-phrenese not only lacks communicativeintent it is a language of deception In orderto function as a vehicle of communicationcontextual elements and related linguisticassumptionsmdashpersonal social and culturalmdashmust be suf ciently concordant in speakerand listenermdashthe rsquo musicrsquo so to speak thataccompanies the words In the case of schizo-phrenese not only are these assumptionsidiosyncratic to the speaker or writer but alsothe speaker or writer is unwilling to elucidate

398 MICHAEL ROBBINS

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

fantasy Instead of an unconscious fantasyand a language capable of contemplation theschizophrenic experiences a delusional senseof actualisation rsquo isrsquo has replaced rsquo as if rsquo

The qualitative difference between schizo-phrenese and ordinary language helps toaccount for the fact that delusions are xedbeliefs refractory to clinical analysis In themind of their creator they are actualitiesrather than fantasies so that there is nothingto be thought about Some time after thevignettes that I have presented when Carolinehad become more uent in ordinary languageand more uid in moving back and forthbetween the two she commenced an hour byobserving my new shoes and commenting rsquo Itmakes me angry that you always have neatshoes and I donrsquo trsquo I observed aloud that herown feet were beginning to move Sheresponded rsquo Our feet move togetherrsquo andadded that she would like me to hug her Iinquired what that was about and she said rsquo Iwant to be in your shoesrsquo She was then ableto express in ordinary language her aware-ness that she was not expressing a fantasy orsymbolising a wish to be more like me butwas verging on speaking the thoughtlesslanguage of schizophrenese which in the pastwould have achieved a sense of actualisationand closure (in this case the delusion she hadexchanged identities with me) rather thanallowing the opportunity for re ectivethought about painful feelings and issuesrelated to being her own separate person

Paradoxically it is this very failure ofschizophrenic language to distinguishthoughts from events that may disguise itsbizarreness and conceal the delusional think-ing it supports because utterances may seemto patient and analyst to be nothing more thandescriptions or observations of happeningsIn telling me about the degrading affair withher college professor and her subsequentconversation about it with her mother Caro-line believed she was doing it over differentlynot simply wishing she might

No discussion of schizophrenic languagewould be complete without a comment about

neologisms which incidentally are notnearly so speci c to schizophrenia as gener-ally believed They appear to be constructedaccording to ordinary morphological princi-ples and it is primarily in their semantic andpragmatic aspects that they are remarkableOne day Caroline said rsquo Irsquove got it set up atwork so no-one can refrain from authoritingme They tell me what to do It pisses me offrsquoWhen I inquired if she believed authoritingwas a legitimate word she said she supposednot I then asked why she did not say whatshe meant in acceptable English She repliedthat it would compel her to face feelings ofshame at loss of dignity and control over herown life By not accepting the existence of anordinary language word to express her feelingstate she managed to repudiate the reality ofthe issue and to avoid the feelings about itThis is another example of the identity ofwords things and actions If the word is thereal thing and she can substitute a neologismthen she can delude herself that the thing orthe problem no longer exists It is easy for theanalyst who is struggling to understand thepatient to gloss over the idiosyncratic aspectof the word in favour of what appears to bethe underlying meaning as one might do withsome of the peculiarities of speech of some-one not uent in onersquos native tonguemdashin thisinstance to assume that Caroline rsquo reallyrsquomeans rsquo acting like an authority withrsquo In thisway the patientrsquos delusion combines with theanalystrsquos illusion to form collusion

Schizophrenic patients do not want to beunderstood for it threatens them with un-wanted knowledge about themselves Schizo-phrenese not only lacks communicativeintent it is a language of deception In orderto function as a vehicle of communicationcontextual elements and related linguisticassumptionsmdashpersonal social and culturalmdashmust be suf ciently concordant in speakerand listenermdashthe rsquo musicrsquo so to speak thataccompanies the words In the case of schizo-phrenese not only are these assumptionsidiosyncratic to the speaker or writer but alsothe speaker or writer is unwilling to elucidate

398 MICHAEL ROBBINS

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

them to the listener Here is what Carolinesays about it rsquo I get away to a place where myown words are real but other people arenrsquo t Icanrsquo t be touched by them I guess Irsquo m ndinga closet land a private place where I escapeto my own words to avoid other peoplersquostouch that threatens mersquo

In the context of an apparently idealisingletter to one of her former doctors whom shesurmised was Jewish Caroline wrote that hewas a rsquo kitersquo He dismissed the letter as he didmuch of her writing to him as another sadexample of her insanity Little did he know asshe eventually rephrased it to me in ordinarylanguage that he had once secretly enragedher by telling her she was rsquo higher than a kitersquo or that her father had often referred to Jews asrsquo kikesrsquo She invented an epithet that con-densed what he had called her with her ragein such a way that she could throw it back athim without his having any idea what she wasdoing and hence without consequence to her

From a pragmatic point of view whereasthe primary purpose of ordinary language isto heighten awareness of onersquos thoughts andfeelings and to selectively communicate themto others schizophrenese functions to helpthe subject avoid such awareness and thecommunication that might serve to enhanceit Searles (1965) remarks that emotionalawareness is related to the development ofsymbolic thought Remember that Carolinesaid she did not use metaphor becausersquo metaphors take more responsibility they aremore connectingrsquo It is well known that affectin schizophrenia is either contextually inap-propriate or absent Schizophrenese short-circuits the necessity to know think and feelWhat presses to be known as my mentor inschizophrenia Elvin Semrad was wont to sayis extensive intolerable mentally unrepre-sented pain consequent to early interpersonalexperience ampli ed by subsequent destruc-tion of life opportunities Were the feelingsrepresented rage would probably be para-mount but hopelessness and despair terrorshame and guilt are also frequently involvedCaroline said rsquo I want to run and run and run

away from the painful feelings I feel like Ican split off disintegrate and get away fromthe painful feelingrsquo She concluded rsquo This iswhat schizophrenese is aboutrsquo

Schizophrenics have an inordinate reluc-tance to do the mental work involved inbearing and processing emotional reality andinstead operate according to the pleasureprinciple (Freud 1900 Katan 1960 Frosch1967) Elsewhere (1993) I referred to this asmental nihilism and concluded that schizo-phrenics are able to attain a pain-free statewithout the use of narcotics Painful as aschizophrenic episode may be to watch thesubject does not thoughtfully experience theemotional distress that the empathically at-tuned observer infers and repels the attentionthat might make him or her aware of the realpain related to the life situation that broughtit about

Theory of psychosis

Kleinian theory of the paranoid-schizoidposition and its evolution (Klein 1930 19351946 Segal 1950 1956 1957 Bion 1967and other authors too numerous to mention)has more or less become the default theory ofpsychosis as Freudrsquos contribution is to neu-rosis The normal mind at the earliest stage ofmental development which the theory articu-lates is somato-psychic It is undifferentiatedfrom sensations perceptions actions andother persons (projective identi cation) aswell as unintegrated (splitting) and it isfuelled for the most part by rage Representa-tional constancy and the related capacities tosymbolise to think and re ect and to experi-ence con ict and ambivalence that character-ise the depressive position have yet to beachieved The mental product of this phase isphantasy a system qualitatively differentfrom fantasy which is a product of maturethought and language Maternal containmentassists the infant to metabolise projected betaprecursors into the alpha elements that even-tually comprise symbolic thought As Mahler

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 399

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

(1975) observed the good-enough motherempathically rsquo readsrsquo the infantrsquos mind andassists the otherwise helpless infant to satisfyneeds of which it is unaware so that it rstexperiences its word-thing-body expressionunits as omnipotent a state similar to beingdelusional except for the connotation ofnormality or pathology The mentation of theparanoid-schizoid position is in many re-spects consistent with the hypotheses I havepresented about the nature of schizophreniclanguage although the connections havenot been elaborated much beyond Kleinrsquosand Segalrsquos observations about failure tosymbolise

Kleinian theory holds that rage is the primemover of development normal and pathologi-cal and that a state like psychosis or schizo-phrenia is a transient stage of normaldevelopment that may be xated upon andmalignantly ampli ed if rage is excessive andmaternal containment de cient It is notnecessary to accept either of these proposi-tions however in order to appreciate therelevance of the distinction between the mindof the paranoid-schizoid and depressive posi-tions to an understanding of the distinctionbetween normal and schizophrenic languageSchizophrenic language and the normal lan-guage of infancy may be similar if notidentical in their semantic and syntacticaspects and yet differ in their functional andpragmatic aspects consistent with the differ-ent circumstances in which they appear Itmay be that different conditions and stages ofdevelopment share for reasons unique toeach and because of basic limitations andparameters of the neural apparatus a com-mon language template

One reason that the important linguisticimplications of Kleinian theory have not beendeveloped may be that the theory is couchedin a kind of schizophrenesemdashthe animisticsomatic concrete magical language of whatis presumed to be schizophrenic and infantilesubjectivitymdashrather than in ordinary lan-guage that conceptualises integration differ-entiation and mental representation This

blurs the distinction between the language ofthe analyst and that of the patient A relatedblurring seems to occur in the clinical situa-tion where analysts seem relatively unawareof the implications of the differences betweenthe paranoid-schizoid and depressive posi-tions for the nature of language and tend toconduct treatment based on the assumptionthat they and their patients speak the samelanguage of relative maturity more or lessThis assumption is implicit in the practice ofinterpreting unconscious signi cance tophantasy as though it were fantasy (that issymbolic) even in the absence of collabora-tion and corroboration from the patientHanna Segal for example who has made themost salient observations since Klein aboutschizophrenic concreteness and inability tosymbolise says in her discussion of a clinicalvignette rsquo From the start [of the analysis of aschizophrenic man] however some of hisdelusions could be recognised as phantasiesfamiliar to every analyst But I found therewas no point interpreting them out of con-textrsquo (1950 p 270) At the same time shebelieves that the salient distinction is con-textual rather than linguistic she also remarksthat her patient consistently rejected herinterpretations of his phantasies and herefforts to raise what she felt was repressedunconscious material to consciousness Sheapparently construed this as a resistancerather than a fundamental linguistic differ-ence between the two of them While sheclaims to have dealt with his inability to formsymbols by interpreting that as well shedoes not provide particular data about howshe went about this

Language and treatment

I do not mean to imply in the foregoingremarks that analytically informed treatmentof schizophrenia is impossible without recog-nition and resolution of language differencesas this would y in the face of a substantialbody of clinical experience No doubt most

400 MICHAEL ROBBINS

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

schizophrenic individuals who are maintainedin a state of relative compensation and en-gaged in an active rehabilitative environmentlearn from contact with those who care aboutthem and although communication may notbe speci cally geared towards recognition oflanguage differences most likely the personwill develop some ordinary language capabil-ity In any case ordinary language andthought capacity seems to develop by anindependent pathway ultimately bringing thepatient into con ict between what Bion(1967) called the psychotic and non-psycho-tic parts of the personality

For the most part however psychoanalystsand their schizophrenic patients speak to andhear one another in completely differentlanguages Ordinary language of re ectionand thought is utterly at odds with the senseof actualisation and delusional omnipotentcertainty that characterises schizophreneseInterpretations made without rst bridgingthe language barrier may serve to protect thetherapist from facing the sense of helpless-ness attendant upon the realisation of howlittle impact he or she has on the patient Inthat sense they are analogous to the patientrsquosuse of delusional thinking to protect him orherself against experiencing feelings of help-lessness hopelessness and rage The combi-nation of the patientrsquos delusional languageand the analystrsquos illusions about his or hercapacity to understand may lead to a state ofcollusion and to chronic treatment stalemates

Therefore before it can be possible tobegin the ordinary therapeutic task of psycho-dynamic clari cation interpretation andanalysis with a schizophrenic person it isnecessary rst to be able to identify andresolve delusional omnipotence and to devel-op a shared language that acknowledges onersquoslimited power to alter reality the need toadapt and the need to think and to feel Thisis a dif cult task because of the paradoxinherent in the fact that the treatment must beconducted for the most part in ordinarylanguage and because in the language ofdelusional actualisation there is no latent

unconscious omnipotent fantasy or wish thatthe analyst can uncover and subject to mutualre ection and interpretation The formationof an emotionally dependent relationshipwhich is dif cult to achieve with a schizo-phrenic is necessary before the patient canbegin to learn that the analyst is a separateperson not under his or her controlmdashsomeonewhose understanding he or she wishes toobtain but who speaks a different languageFrom this position the two may begin torecast schizophrenese into mutually compre-hensible ordinary language If this task suc-ceeds then gradually in the place ofomnipotent delusion there may be wishfulfantasy that can be communicated throughordinary language and that may be suscepti-ble to interpretation

It is of critical importance to note that onlyafter the contents of mind can be expressed inordinary language is it possible to identifyand begin to work on the particular psycho-dynamic issues unique to each schizophrenicindividual It is not until this later stage oftreatment that interpretation Kleinian orotherwise becomes a valuable tool Theprojective identi cation inherent in CarolinersquosValentine card for instance would not havebeen apparent to even the most astute analystprior to collaborative discussions that led toher re-presenting the underlying mental pro-cess in ordinary language Even if I hadsuspected it Caroline did not possess thereceptive language capability to assimilate aninterpretation couched in the language ofsymbolism and unconscious fantasy and Ilacked the capacity to intentionally speak toher in schizophrenese How could anyoneunderstand that her landlordrsquos unwittingrsquo Take carersquo would be receivedmdashin schizo-phrenesemdashas a challenge to Carolinersquos delu-sional conviction that she had literally givenhim her troubled heart and that in acceptingher Valentine he had agreed to take care of itThe offhand comment brought to the surfaceCarolinersquos unconscious rage In so doing itwas actually a powerful and potentially muta-tive interpretation but it was therapeutically

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 401

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

useless because neither party could thinkabout what was really happening

In closing I should like to review therelationship between schizophrenese and con-sciousness The unawareness inherent inschizophrenese should not be interpreted tomean that it is a language pregnant withunconscious signi cance There is no uncon-scious symbolically encoded fantasy inherentin Carolinersquos Valentine card waiting to beassociatively analysed Since it is a languageof delusional actualisation schizophrenesedoes not support consciousness in the normalsense in which we use the term either It is alanguage of primary unconsciousness but notin the ordinary developmental sense It is analternative language structure that circum-vents the necessity to represent elements ofmind and to be thoughtful

Acknowledgements I would like to thankBarbara Artson PhD David Gar eld MDBonnie Litowitz PhD and Eduardo Pradode Oliveira MD for their helpful comments

Translations of summary

De nos jours on pense generalement que lelangage bizarre des schizophreniques est le produitdrsquo une rupture sans sens drsquo un trouble neurobiologi-que La signi cation des illusions et hallucinationdemeure aussi mysterieuse Lrsquo auteur presente desvignettes textuelles provenant drsquo un stade avance drsquo untraitement a base psychanalytique pour illustrer queles schizophreniques parlent un langage qui a du senset est syntactiquement et morphologiquement iden-tique au langage ordinaire mais dont la semantiqueet la pragmatique different de facon qualitative Drsquo unpoint de vue semantique les distinctions ordinairesentre les mots les choses les etats du corps et lesactions sont absentes creant des mots et des phrasesqui ne sont pas representationnels ou symboliquesCrsquo est un langage drsquo equivalence drsquo immediatete etdrsquo action par contraste a un langage de conscience desoi de re exion et de communication Drsquo un point devue pragmatique le langage de la schizophreniepermet la pensee illusionnelle et lui sert de supportdu fait qursquo il ne distingue pas lrsquo esprit du monde A nque le psychanalyste comprenne ce que le patientveut dire et formule des interpretations qui vehicu-lent ce qursquo ilelle veut dire lrsquo analyste et le patientdoivent avoir conscience de leur incapacite a com-

prendre le langage de lrsquo autre et trouver un moyen decombler le fosse qui les empeche de communiquer

Die bizarre Sprache von Schizophrenen wirdheutzutage als das bedeutungslose Produkt einesZusammenbruchs in einer neurobiologischenKrank-heit gesehen Die psychologische Bedeutung derHalluzinationen und Wahnvorstellugen bleibt auchmysterios Wortliche Vignetten einer psychoanaly-cisch informierten Behandlung in einem fortgeschrit-tenen Stadium werden vorgestellt um zu illustrierendass Schizophrene eine bedeutungsvolle Sprachesprechen die syntaktisch und morphologisch derAlltagssprache ahnlich aber bezuglich der Semantikund Pragmatik qualitativ anders ist Aus der seman-tischen Perspektive fehlen die ublichen Unterschei-dungen zwischen Worten Dingen Korperzustandenund Handlungen und schaffen so Worte und Satzedie nicht reprasentativ oder symbolisch sind Es isteine Sprache der GleichstellungUnmittelbarkeit undAktion im Gegensatz zu einer Sprache der Selbst-wahrnehmung Nachdenklichkeit Re ektion undKommunikation Aus einem pragmatischen Blick-winkel da die Sprache der Schizophrenie keineUnterscheidungzwischen Gedanken und Welt machtermoglicht und unterstutzt es wahnhaftes DenkenDamit der Psychoanalytiker versteht was der Patientmeint und seine Interpretationen in so einer Art undWeise fasst dass er die Bedeutung die er beabsich-tigt hat vermitteln kann mussen sich Analytiker undPatient ihrer Unfahigkeit die Sprache des anderen zuverstehen bewusst werden und einen Weg ndendiese Kommunikationsbarriere zu uberbrucken

Hoy diacutea se cree en general que el extrano lenguajede los esquizofrenicos es el productomdashfruto delderrumbemdashde un desorden neurobiologico y quecarece de sentido El signi cado psicologico de lasalucinaciones y pensamientos ilusivos tambien siguesiendo misterioso Se presentan verbatim algunasvinetas de la etapa avanzada de un tratamiento debase psicoanaliacutetica para ilustrar que los esquizofre-nicos hablan un lenguaje que tiene sentido consintaxis y morfologiacutea parecidas a las del lenguajecomun pero un lenguaje cualitativamente diferenteen cuanto a la semantica y la pragmatica Del puntode vista semantico no estan presentes las distin-ciones comunes entre las palabras las cosas losestados corporales y las acciones y se crean palabrasy frases que no son representativas ni simbolicas Esun lenguaje de equivalencia inmediatez y accion adiferencia de un lenguaje de conciencia de siacute mismoponderacion re exion y comunicacion De un puntode vista pragmatico porque el lenguaje esquizofreni-co no distingue entre mente y mundo facilita y le daasidero al pensamiento ilusivo Para que el psicoana-lista comprenda lo que el paciente quiere decir ypueda asir las interpretaciones de tal modo que

402 MICHAEL ROBBINS

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

transmitan el signi cado propuesto analista y pa-ciente deben hacerse concientes de la incapacidad de

entender el lenguaje del otro y encontrar el modo defranquear la barrera de comunicacion

R eferences

Akmajian A et al (1984) Linguistics AnIntroduction to Language and Communi-cation Cambridge MA MIT Press

Andreasen N et al (1985) Languageabnormalities in schizophrenia In NewPerspectives in Schizophrenia ed MMednick amp M Seeman New York Mac-millan pp 97ndash120

Arieti S (1974) Interpretation of Schizo-phrenia New York Basic Books 2ndedition

Bion W R (1955) Language and theschizophrenic patient In New Directionsin Psycho-Analysis ed M Klein P Hei-mann amp R Money-Kyrle London Tavi-stock Publications pp 220ndash39

mdashmdash (1959) Attacks on linking Int JPsychoanal 40 308ndash15

mdashmdash (1967) Second Thoughts LondonWilliam Heinemann Medical Books

Bleuler E (1911) Dementia Praecox orThe Group of Schizophrenias Trans JZinkin New York Int Univ Press 1950

Bobon J (1962) Psychopathologie de lrsquo ex-pression Paris Masson

Brown R (1958) Words and Things NewYork Free Press

mdashmdash (1973) Schizophrenia language andreality Amer Psychologist 28 395ndash403

Burnham D (1955) Some problems incommunication with schizophrenic pa-tients J Amer Psychoanal Assn 367ndash81

Cameron N (1944) Experimental analysisof schizophrenic thinking In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 50ndash64

mdashmdash (1963) Personality Development andPsychopathology Boston Houghton Mif- in

Chaika E (1974) A linguist looks atrsquo schizophrenicrsquo language Brain amp Lan-guage 1 257ndash76

mdashmdash (1990) Understanding Psychotic

Speech Spring eld IL Charles CThomas

mdashmdash amp Lambe R (1985) The locus ofdysfunction in schizophrenic speech Schi-zophrenia Bulln 11 8ndash15

Chapman J (1966) The early symptoms ofschizophrenia British J Psychiat 122225ndash51

Chapman L amp Chapman J (1973) Dis-ordered Thought in Schizophrenia Engle-wood Cliffs N J Prentice Hall

Cohen B (1978) Referent communicationdisturbances in schizophrenia In Lan-guage and Cognition in Schizophrenia edS Schwartz New York Erlbaum

Fish F (1957) The classi cation of schizo-phrenia the views of Kleist and his co-workers J Mental Science 103 443ndash63

French T amp Fromm E (1964) DreamInterpretation New York Basic Books

Freud S (1900) The Interpretation ofDreams SE 4ndash5

mdashmdash (1911) Formulations on the two prin-ciples of mental functioning SE 12pp 213ndash26

mdashmdash (1933) New Introductory Lectures onPsychoanalysis SE 22 pp 3ndash248

Fromkin V (1975) A linguist looks at rsquoAlinguist looks at schizophrenic languageBrain amp Language 2 498ndash503

Frosch J (1967) Delusional xity sense ofconviction and the psychotic con ict IntJ Psychonal 48 475ndash95

Gerson S et al (1977) Diagnosis schizo-phrenia versus posterior aphasia Amer JPsychiat 134 966ndash9

Gerson W (1928) Schizophrene Sprach-neubildung und schizophrenes Denken ZGes Neurol Psychiat 113 159ndash76

Glass J (1981) Facts and meaning fromthe perspective of schizophrenic internal-ity Contemp Psychoanal 17 118ndash35

Goldstein K (1944) Methodological ap-proach to the study of schizophrenicthought disorder In Thought and

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 403

Language in Schizophrenia ed J SKasanin New York W W Norton pp17ndash40

Griesinger W (1882) Mental Pathologyand Therapeutics Trans C Robertson ampJ Rutherford New York William Wood ampCompany

Harrod J (1986) Schizophrenia as a semi-otic disorder Schizophrenia Bulln 1212ndash13

Harrow M Himmelhoch J et al(1972) Overinclusive thinking in acuteschizophrenic patients J Abnorm Psy-chol 79 161ndash8

Harrow M Tucker G et al (1972)Concrete and idiosyncratic thinking inacute schizophrenic patients Archiv GenPsychiat 26 433ndash39

Harrow M et al (1986) Is schizophrenia asemiotic disorder Replies to HarrodSchizophrenia Bulln 12 14ndash19

Johnston M amp Holzman P (1979)Assessing Schizophrenic Thinking A Clin-ical and Research Instrument for Measur-ing Thought Disorder San FranciscoJossey-Bass

Jung C G (1906) The Psychology ofDementia Praecox New YorkWashing-ton Nervous and Mental Disease PubCo 1936

Katan M (1939) A contribution to theunderstanding of schizophrenic speechInt J Psychoanal 20 353ndash62

mdashmdash (1960) Dream and psychosis theirrelationship to hallucinatory processesInt J Psychoanal 41 341ndash50

Klein M (1930) On the importance ofsymbol formation in the development ofthe ego In Love Guilt and ReparationLondon Hogarth Press and the Institute ofPsycho-Analysis 1975 pp 219ndash32

mdashmdash (1935) A contribution to the psycho-genesis of manic-depressive states InLove Guilt and Reparation LondonHogarth Press and the Institute of Psycho-Analysis 1975 pp 262ndash89

mdashmdash (1946) Notes on some schizoid me-chanisms In Envy and Gratitude LondonHogarth Press and the Institute of Psycho-Analysis 1975 pp 1ndash24

Kraepelin E (1896) Dementia Praecoxand Paraphrenia Trans RM Barclay

Edinburgh E amp S Livingstone 1919Lanin-Kettering I amp Harrow M

(1985) The thought behind the words aview of schizophrenic speech and thinkingdisorders Schizophrenia Bulln 11 1ndash7

LeCours A amp Vanier-Clement M(1976) Schizophasia and jargonaphasia acomparative description with commentson Chaikarsquos and Fromkinrsquos respectivelooks at rsquo schizophrenicrsquo language Brain ampLanguage 3 516ndash65

Lewis N (1944) Preface to Thought andLanguage in Schizophrenia ed J SKasanin New York W W Norton ppvndashxii

Mahler M S Pine F amp Bergmann A(1975) The Psychological Birth of theHuman Infant New York Basic Books

Matthysse S (1987) Schizophrenicthought disorder a model-theoretic per-spective Schizophrenia Bulln13 173ndash84

Pavy D (1968) Verbal behavior in schizo-phrenia a review of recent studies Phy-siol Bulln 70 164ndash78

Robbins M (1993) Experiences of Schizo-phrenia New York Guilford

Schilder P (1914) Wahn und ErkenntnisMono Ges Geb Neurol Psychiat BerlinSpringer

Searles H (1962) The differentiation be-tween concrete and metaphorical thinkingin the recovering schizophrenic patient InCollected Papers on Schizophrenia andRelated Subjects New York Int UnivPress 1965 pp 560ndash83

mdashmdash (1965) Collected Papers on Schizo-phrenia and Related Subjects New YorkInt Univ Press

Seeman M (1970) Analysis of psychoticlanguage a review Diseases Nerv System31 92ndash99

Segal H (1950) Some aspects of the analy-sis of a schizophrenic Int J Psychoanal31 268ndash78

mdashmdash (1956) Depression in the schizophre-nic Int J Psychoanal 37 339ndash43

mdashmdash (1957) Notes on symbol formation IntJ Psychoanal 38 39ndash45

Storch A (1922) Das archaisch-primitiveErlebnis und Denken der SchizophrenenMonogr Ges Geb Neurol Psychiat 321ndash89

404 MICHAEL ROBBINS

mdashmdash (1923) Bewusstseinsebenen und Wirk-lichkeitsbereiche in der Schizophrenie ZGes Neurol Psychiatr 82 331ndash42

mdashmdash (1930) Die Welt der beginnendenSchizophrenie und die archaische Welt ZGes Neurol Psychiatr 127 779ndash810

Stransky E (1905) On Dementia PraecoxVienna Vienna Medical Press

mdashmdash (1905a) Uber Sprachverwirrheit HalleMarhold

Sullivan H S (1962) Schizophrenia as aHuman Process New York W W Norton

Vygotsky L S (1934) Thought in schizo-phrenia Archiv Neuro amp Psychiat 311063ndash77

mdashmdash (1962) Thought and Language TransE Hanfmann amp G Vaska New York

John Wiley amp SonsVon Domarus E (1944) The speci c laws

of logic in schizophrenia In Languageand Thought in Schizophrenia ed J SKasanin New York W W Nortonpp 104ndash14

Werner H (1940) Comparative Psychol-ogy of Mental Development New YorkInt Univ Press

mdashmdash amp Kaplan B (1963) Symbol For-mation An Organismic-DevelopmentalApproach to Language and the Expressionof Thought New York John Wiley ampSons

White WA (1925) Schizophrenia (De-mentia Praecox) New York Paul BHoeber

MICHAEL ROBBINS MD Copyright Institute of Psychoanalysis London 200256 Kestrel LaneAmherst MA 01002mdrobbinsmdattbicom

THE LANGUAGE OF SCHIZOPHRENIA AND THE WORLD OF DELUSION 405