Linguistic Analysis
of in Affective Disorders Nancy J. C. Andreasen, MD, PhD,
Bruce Pfohl
\s=b\ Various aspects of speech and language were compared, using psycholinguistic techniques, in a group of 15 depressed patients and 16 manic patients: lexical diversity, syntactical complexity, syntactical elements, and content analysis. Contrary to anticipation, the manic patients did not show more varied word choice or complexity of sentence structure than the depressives. In particular, they did not differ significantly in type-token ratio. The greatest difference was in syntactical elements, with manics using more action verbs, adjectives, and concrete nouns, while the depressed patients used more state of being verbs, modifying adverbs, first-person pronouns, and personal pronouns. When compared by content analysis, the manics used more words reflecting a concern with power and achievement. These results imply that depressive speech tends to be more vague and qualified and to show considerable self-preoccupation, while manic speech tends to be colorful and concrete and to show more concern with things than with people. (Arch Gen Psychiatry 33:1361-1367, 1976)
patients' thought, or thought that our only way of learning disorder. Too often we about a patient's thoughts is through his speech and language, either spoken or written. Spoken or written language may not be an accurate or reliable index of thought, even when it is supposed to approximate it closely as in free association, but is the only index we have available. Given this fact, it is something of an oddity that so much has been written by psychologists and psychia¬ trists about thought and so little about language. Linguistics is a relatively new field, of course, and psycholinguistics is even newer. Nevertheless, a number of investigators have attempted to apply linguistic techniques to a variety of psychiatric disorders. Basically, frequently speak Psychiatrists thought, forget content of
Accepted
about their
stream of
for publication Dec 19, 1975. From the Department of Psychiatry, University of Iowa College of Medicine, Iowa City. Reprint requests to Department of Psychiatry, University of Iowa Hospitals and Clinic, 500 Newton Rd, Iowa City, IA 52242 (Dr
Andreasen).
Speech
these investigations are of two types: those that attempt to examine formal elements of speech and writing such as grammar and syntax, and those that attempt to examine aspects of content such as vocabulary word choice. Analyses of form have grown increasingly sophisticated. Newman and Mather1 made an early effort to examine speech in patients suffering from mania or depression by studying such variables as pitch, tempo, syntax, and latency of response. Their results are largely descriptive, however, and provide no quantitative data. Lorenz and Cobb have compared the speech of manies to that of normals by using more rigorous quantitative methods such as determining the distributions of parts of speech or the number of words spoken per minute.- Manies were found to have significantly different speech patterns. Lorenz and Cobb have also examined speech in neurotic patients.'·' Determination of the verb-adjective (V-A) ratio was developed in an effort to find a quantitative method of relating grammatical forms to psychopathology. Originally developed by Busemann,'' it was considered to be an "action quotient" or an index of emotional instability. Although the measure was developed for use in children, a variety of investigators have applied it to psychiatric patients. Fair¬ banks" and Mann7 have found schizophrenics to have a higher V-A quotient than normals, while Lorenz and Cobbhave found manies and hysterics to have a higher quotient than normals. Benton et al8 obtained a higher quotient in people with high anxiety as compared to low anxiety, while Balken and Masserman" found anxiety states to have a higher quotient in comparison with conversion hysterics. Very few studies have been able to replicate the actual figures of the others, however; for example, the quotient in normals has been variously reported as 1.07, 1.98, and 3.43. Such variability is probably due to differences in definition of terms and in sample collection. Spreen and Wachal have attempted to refine methodol¬ ogy in syntactical analysis still further by describing a precise method of collecting and transcribing speech samples and developing sophisticated statistical methods
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for data analysis.'"'- Their techniques, developed for use in aphasies (perhaps the most difficult group for linguistic
analysis), are too new to be widely replicated as yet. Other investigators have attacked the problem of de¬ scribing and differentiating speech patterns by examining aspects of content rather than form. Perhaps the oldest and simplest technique is the type-token ratio (TTR), originally developed by Wendell Johnson as a way of describing vocabulary size of "lexical diversity."'1'4 This measure is determined by dividing the total number of
words (or tokens) into the total number of different words (or types). This variable has been examined most often in schizophrenia, with some indications that schizophrenics may have a lower TTR than normals. The range of values has differed widely from study to study, however, with a low of .26 and a high of .74."'7·'3 As Wachal and Spreen have pointed out, the TTR tends to be highly dependent on sample length and whether the sample is spoken or writ¬
have been developed and applied over the years, with somewhat varied results. With the possible exception of Weintraub, no one has succeeded in developing a method that can be consistently repeated in a range of psychiatric patients, and no one has as yet attempted to replicate Weintraub's data. Yet enough has been done to suggest that psycholinguistic studies are a potentially rich method for exploring language and ultimately thought in
writing
psychiatric patients. The present investigation was undertaken as a pilot study. The overall plan was to examine a number of linguistic variables. Based on the research just reviewed, four different areas were selected for investigation: lexical diversity, syntactical complexity, frequency of types of syntactical elements, and content analysis. In order to increase precision, only variables that could be analyzed quantitatively were selected. METHOD
ten.
methods
Other investigators have attempted to develop that focus more closely on aspects of content that may give a better index of actual cognitive style. Weintraub and Aronson""1 have developed a method of using word choice and phrase choice as an index of various psychological defense mechanisms. This method identifies a variety of factors considered to be of psychological significance in psychiatric disorders: qualifying phrases and words, nega¬ tors, retractors, expressions of feeling, value judgments, etc. Using these techniques, Weintraub and Aronson have
found differences between normal controls and patients from a wide range of psychiatric disorders: delusional behavior, impulsive behavior, compulsive behav¬ ior, and depression. Gottschalk and associates--"1 have attempted to examine interpersonal and emotional aspects of content by developing an elaborate weighted scoring system designed to evaluate anxiety, social alienation, uncertainty, and feelings of being controlled. They have developed this primarily as a method of defining and
suffering
differentiating schizophrenic thought.
The methods of Weintraub and Gottschalk and col¬ leagues require individual scoring of phrases and clauses in transcribed samples of speech. Thus they are necessarily time-consuming and, to some extent, dependent on the subjective judgment of the scorer. Other experiments in content analysis have developed as a way of surmounting these problems. Several investigators have attempted to analyze content by developing "dictionaries" or sets of word categories that group together words considered to share a similar psychological significance.-4 For example, all words dealing with the concept of failure would be enumerated under this category. After a series of these dictionaries have been developed and their reliability and validity determined, they can be used to analyze vocabu¬ lary content through more accurate and efficient comput¬ erized methods. Such computerized content analysis has been used to analyze a wide variety of speech samples, ranging from the political pronouncements of foreign statesmen to
spontaneous productions by schizophrenics.
Its application to psychiatric populations has, however, been quite limited to date. Thus, a variety of methods for analyzing speech and
Within three to five days after admission, speech samples were obtained from 16 inpatients suffering from mania and 15 inpatients suffering from depression. Although some patients were receiving medication at the time of testing, all were fully sympto¬ matic. Consecutive admissions were used, but only patients who met previously defined diagnostic criteria (the Research Diag¬ nostic Criteria) were included.-'' These criteria for mania and depression are as follows: For manic disorder, A through E are required for the episode of illness being considered: A. One or more distinct periods with a predominantly elevated or irritable mood. The elevated or irritable mood must be a prominent part of the illness and relatively persistent, although it may alternate with depressive mood. If the manic symptom only occurs during periods of alcohol or drug intake or withdrawal from them, it should not be considered here. B. If mood is elevated, at least three of the following symptom categories must be definitely present to a significant degree (four if mood is only irritable) (for past episodes, because of memory difficulty, one less symptom is required): 1. More active than usual—either socially, at work, sexually—or physically restless 2. More talkative than usual or felt a pressure to keep talking 3. Flight of ideas or subjective experience that thoughts are
racing 4. Inflated self-esteem (grandiosity, which may be delusional) 5. Decreased need for sleep 6. Distractability, ie, attention is too easily drawn to unimpor¬ tant or irrelevant external stimuli 7. Excessive involvement in activities without recognizing the high potential for painful consequences, eg, buying sprees, sexual indiscretions, foolish business investments, reckless driving C. Overall disturbance is so severe that at least one of the following is present: 1. Meaningful conversation is impossible 2. Serious impairment socially, with family, at home, or at
work 3. In the absence of No. 1 or 2, hospitalization D. Duration of manic features at least one week (or any duration if hospitalized). E. None of the following, which suggest schizophrenia is pres¬ ent: 1. Delusions of
being controlled or of thought broadcasting, withdrawal 2. Hallucinations of any type throughout the day for several days or intermittently throughout a one-week period, unless all of insertion,
or
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the content is clearly related to depression or elation 3. Auditory hallucinations in which either a voice keeps up a running commentary on the patient's behavior as it occurs, or two or more voices converse with each other 4. At some time during the period of illness had delusions or hallucinations for more than one week in the absence of prominent
affective
(depressed
or
manic) symptoms
5. At some time during the period of illness had more than one week when he exhibited no prominent manic symptoms but had several instances of formal thought disorder For major depressive disorder, A through E are required for the episode of illness being considered: A. Dysphoric mood characterized by symptoms such as the following: depressed, sad, blue, hopeless, low, down in the dumps, "don't care anymore," irritable, worried. The mood disturbance must be prominent and relatively persistent but not necessarily the most dominant symptom. It does not include momentary shifts from one dysphoric mood to another dysphoric mood, eg, anxiety to depression to anger, such as are seen in states of acute psychotic turmoil. B. At least five of the following symptoms are required to have appeared as part of the episode for definite and four for probable (for past episodes, because of memory difficulty, one less symptom is required): 1. Poor appetite or weight loss or increased appetite or weight gain (change of 0.5 kg a week over several weeks or 4.5 kg a year when not dieting) 2. Sleep difficulty or sleeping too much 3. Loss of energy, fatigability, or tiredness 4. Psychomotor agitation or retardation (but not mere subjec¬ tive feeling of restlessness or being slowed down) 5. Loss of interest or pleasure in usual activities, including social contact or sex (do not include if limited to a period when delusional or hallucinating) 6. Feelings of self-reproach or excessive or inappropriate guilt (either may be delusional) 7. Complaints or evidence of diminished ability to think or concentrate, such as slow thinking, or indecisiveness (do not include if associated with obvious formal thought disorder) 8. Recurrent thoughts of death or suicide, or any suicidal behavior C. Dysphoric features of illness lasting at least one week. Definite if lasted more than two weeks, probable if one to two weeks. D. Sought or was referred for help from someone during the dysphoric period or had impaired functioning socially, with family, at home, or at work. E. None of the following, which suggest schizophrenia is pres¬
thought disorder Using these criteria, kappa coefficients of interrater reliability have been calculated at .90 for manic disorder and .85 for major depressive disorder. The manies and depressives did differ slightly in age or educational background. The manies ranged in age from 16 to 64 years, with a mean of 33, and they had a mean of 12.6 years of schooling. The depressives had 10.7 years of schooling, and they ranged from 16 to 76 years old, with a mean of 41. Nine of the manic patients were female, while 13 of the depressed group were 6. Definite instances of formal
female. The speech
samples consisted of a mixture of responses to proverb interpretation and spontaneous free speech in response to questions such as "What are you like?" or "Tell me about your family." The proverbs were taken from a standard list in the Mental Examiner's Handbook.-" The first 80 words of proverb interpretation and the first 320 words of spontaneous speech were used for analysis. All speech samples were tape-recorded and later transcribed. After transcription, each word in the sample was coded with a designation for part of speech and each sentence was coded for sentence type, using a method worked out by one of the investi¬ gators (N.J.C.A.) and available on request. Verbs were, for exam¬ ple, classified into either action or state-of-being verbs and also bytense into past, present, and future. Nouns were divided into abstract (qualities such as beauty, truth) and concerte (objects such as book, street). Pronouns were divided into six classes: three classes of personal pronouns (first, second, third person), and also relative (who, which, etc), demonstrative (this, that, etc), and indefinite (any, both, etc) pronouns. Adjectives were divided into three types according to degree (positive, comparative, and superlative), and a fourth group was designated as indefinite adjectives (a, the, this). Adverbs were divided into four groups:
descriptive (forcefully, fast, etc), interrogative (how, when, etc), modifying (rather, very, etc), and indicators of time and place (now, again, here, etc). Conjunctions were divided into coordinat¬
ent: 1. Delusions of
ing (and, or, etc), subordinating (because, if, etc), and transitional (accordingly, moreover, etc). Prepositions were not divided into subclasses. Thus, grammatical elements were divided into seven major classes, which were further subdivided into 26 subclasses. In an effort to examine possible differences in sentence structure, each sentence was also coded to indicate sentence type: simple, compound, complex, compound-complex, and fragment. This method of coding also permitted an examination of sentence length. Several speech samples were coded independently by each of the investigators. Since codings differed on only 1.5% of the words, this was considered to represent suitable interrater reliability. Thereafter coding was divided between the two investigators, with each taking half the manic sample and half the depressed sample in order to randomize any systematic error that might
insertion,
occur.
being controlled or of thought broadcasting, withdrawal 2. Hallucinations of any type throughout the day for several days or intermittently throughout a one-week period, unless all of the content is clearly related to depression or elation 3. Auditory hallucinations in which either a voice keeps up a running commentary on the patient's behaviors or thoughts as they occur, or two or more voices converse with each other. 4. At some time during the period of illness had delusions or hallucinations for more than one month in the absence of promi¬ nent affective (manic or depressive) symptoms (although typical depressive delusions, such as delusions of guilt, sin, poverty, nihilism, or self-deprecation or hallucinations of similar content are
or
permitted)
5. Preoccupation with a delusion or hallucination to the relative exclusion of other symptoms or concerns (other than delusions or
guilt, sin, poverty, nihilism, with similar content)
or
self-deprecation
or
hallucinations
Other methods were used to examine aspects of speech content, such as vocabulary and word choice, as opposed to the above syntactical aspects. At the simplest level, richness or convention¬ ality of vocabulary was examined by determining what percentage of words used by the patients were among the 1,000 most commonly used words as determined by the Lorge-Thorndike Dictionary. Which particular words were used most frequently by each subject was also determined. In addition, the lexical diversity of each subject was determined by calculating the type-token ratio. The number of negators (no, not, never, etc) and the number of qualifiers (perhaps, if, maybe, etc) were also determined for each subject, using a standard predetermined list. In an attempt to achieve a more sophisticated approach to vocabulary and word choice, techniques of content analysis were also used. The most recent revision of the Harvard Psychosociological Dictionary, the Harvard IV-3, was obtained from Phillip
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Table 1.—Lexical
Diversity in Depressives and Manies
Depressives (
Manies (
15)
=
16)
—
Lexical Diversity No. of 1,000 most common words
SD
Mean
SD
15.07
330.88
11.37
Mean 338.13
Type-token ratio
.4098
Table
.0333
.4280
2.—Syntactical Complexity in Depressives and Depressives (
.0259
NS
Manies
Manies (
15)
NS 2.63
=
16)
—
Mean
SD
Mean
SD
Simple Compound Complex Compound-complex No. of fragments
13.27
8.00
13.31
8.44
0.02
NS
280
1.90
1.15
1.16
NS
9.53
3.19
NS
3.20
3.44 1.37
2.13 8.19
4.20
No. of sentences in 400-word sample
33.00
No. of sentences
Stone and his associates. This dictionary divides 8,700 words or word senses into 170 content categories. Since using all 8,700 word senses and 170 content categories was thought to be too large an undertaking for a pilot study of this type, 28 categories were selected as being of possible relevance to affective disturbance. These categories contained words that tend to denote or connote such ideas or feelings as achievement, failure, abandonment,
2.23
2.48
3.81 3.69
1.09 0.88
2.68
0.53
NS
9.54
31.13
10.62
0.50
NS
NS
d. Personalization: It was predicted that manies would show preoccupation with themselves, as reflected in increased use
more
of
first-person
Lorge-Thorndike Dictionary and the 28 categories for content analysis. The various frequency counts of word choice, and syntac¬ tical elements, and vocabulary were all determined by computer¬ ized analysis, using either stock programs locally available or programs written by one of the investigators. (B.P.) These data were used to test a number of hypotheses concerning several variables in structure and content of speech in affective
pronouns. Time orientation: It was predicted that depressives would be more preoccupied with the past, as reflected by the use of more past-tense verbs and more adverbs referring to time and place. /. Concrete vs abstract usage: It was predicted that manies would be more concrete and depressives more abstract, as reflected by manies using more concrete nouns referring to places and things and depressives using more abstract nouns referring to qualities or ideas. g. Verb-adjective ratio: This can be calculated as a verbadjective, verb-noun, or verb-noun plus adjective ratio. If a higher ratio is associated with greater emotional instability, one would expect a higher ratio in manic patients. h. State of being-Action Verb Ratio: It was predicted that depressives would have a higher ratio, which would serve as an index of anergy. 4. Content analysis: It was predicted that manies would use more words from the groups dealing with concepts such as strength or achievement, while depressives would choose words reflecting a concern with weakness or failure.
disorder. 1. Lexical diversity: It was predicted that manies would have greater lexical diversity as reflected in higher type-token ratios and more words not occurring in the Lorge-Thorndike. 2. Syntactical complexity: It was predicted that manies would tend to use longer sentences and employ more complicated syntax as reflected in more compound, complex, and compound-complex sentences and fewer simple sentences. It was also anticipated that they would use more fragments. 3. Frequency of syntactical elements: These were subdivided into several groups that might reflect similar aspects of speech. a. Vagueness: It was predicted that depressives would show more vagueness as reflected by an increase in such syntactical elements as indefinite adjectives, state of being verbs, and relative, demonstrative, and indefinite pronouns. 6. Colorfulness of speech: It was predicted that manies would have more colorful or emotional speech, as reflected in more adverbs, adjectives, nouns, and action verbs. c. Use of qualifiers: It was predicted that depressives would tend to qualify their statements more often, as reflected by the use of more modifying adverbs.
The results of data analysis illustrate quite well how difficult it is to predict language behavior on the basis of clinical experience. Subjective impressions were not always supported by objective information, and a considerable number of the hypotheses were not proved. As shown in Table 1, the depressives and manies did not differ in lexical diversity. Although the manies did have a slightly higher type-token ratio, suggesting a wider range of word choice, this was not statistically significant. Like¬ wise, the manies used slightly fewer "commonly used" words, as represented by the Lorge-Thorndike Dictionary, but the difference was not statistically significant. As Table 2 demonstrates, the manies also did not show a significant difference in syntactical complexity. Both manies and depressives used similar numbers of simple sentences, and this tended to be the most common sentence type in both groups. They also did not differ significantly
hostility, submission, strength, weakness, virtue, vice, disorder, or negation. Each of these categories contained from 10 to 37 words. The specific 28 categories used were: INCR, IMPLNEG, HOST, FEEL, ABANDON, EXPRS, EXERT, EVAL, EMOT, DISORDR, DECR, CAUSAL, CHANGE, ACTV 3, ACH, FALL, WEAK 3, VIRTUE, VICE, UNDRST, SUBM, STRNG 3, SOLVE, QUALIF, POWER, OVRST, NGTV 3, INDEF. Speech samples were transferred to computer cards, as were the
e.
RESULTS
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Table 3.—Frequency of
Syntactical Elements in Manies and Depressives Depressives (
Vagueness Indefinite adjectives Relative demonstrative and indefinite pronouns State of being verbs
=
15)
Manies ( =16)
Mean
SD
Mean
SD
15.13 25.60
4.56
18.38
5.54
1.72
6.63
24.38
5.73
0.53
NS
61.13
13.35
49.44
9.45
2.74
.02 .02
NS
Colorfulness Adverbs Action verbs
46.60
8.25
39.44
7.19
2.50
45.93
16.20
57.63
8.17
2.48
02
Adjectives
40.40
11.27
48.44
8.27
2.20
.05
31.20
7.35
43.94
11.73
6.18
13.59
42.93
7.01
57.44
6.99 9.99
3.48 0.72
.01
11.73
4.60
.001
30.87
8.92
21.56
5.19
3.46
.01
Concreteness Concrete nouns Abstract
nouns
Nouns
NS
Qualifiers
Modifying
adverb
Personalization 38.87
7.08
31.69
5.31
3.10
.01
Personal pronouns Time orientation
69.93
9.17
61.50
11.06
2.25
.05
Past-tense verbs
24.53
14.35
17.81
14.43
1.26
NS
Adverb Indicating time
10.40
4.29
13.81
1.82
NS
First-person
pronouns
in the numbers of
complex
sentences
compound, compound-complex,
used, and both used nearly the
or
same
number of fragments. Depressives tended to use slightly shorter sentences, but again the difference was not signif¬ icant. Table 3 shows the frequency of syntactical elements in the two patient groups, and in this area the manies and depressives were often different, although not always in the direction predicted. As hypothesized, depressed patients tended to show more vagueness, although only on one index. They did not use significantly more indefinite adjectives or relative, demonstrative, and indefinite pronouns, but they did use significantly more state-ofbeing verbs at the .02 level. Manies, on the other hand, did tend to have more colorful language. Their use of action verbs and adjectives was greater at the .05 and .02 levels, respectively, but the depressed patients did use more adverbs with a difference significant at the .02 level. The issue of concrete vs abstract usage is somewhat obscure. The manic patients tended to use considerably more nouns, and they therefore used both more concrete nouns and more abstract nouns than the depressed patients. The difference in abstract nouns is not statisti¬ cally significant, however, while the differences in nouns generally and in concrete nouns are significant at the .001 and .01 levels, respectively. The manies, therefore, were
definitely more concrete. As predicted, the depressed patients tended
to
qualify
often, as reflected in their use of more qualifying adverbs, with the difference significant at the .01 level. On the other hand, the hypotheses concerning their statements
more
personalization and time reference were not supported by the data. The depressed patients, rather than the manies, tended to show a greater preoccupation with themselves, as reflected in their greater use of the first person pronoun, with the difference significant at the .01 level. They also tended to use more personal pronouns generally, with the
difference significant at the .05 level. They used more pasttense verbs and therefore showed some preoccupation with the past, but the results did not reach statistical signifi¬ cance, and they did not use significantly more adverbs referring to time and place. Table 4 contains a series of ratios that were calculated to permit comparison of our data with those of other studies. Each of these ratios is statistically significant, although slightly less so than if the various syntactical elements are compared singly. Contrary to prediction, the depressives have a higher verb-adjective ratio than the manies. They also have a higher verb-noun and verb-noun plus adjective ratios. These differences are significant at the .05, .02, and .02 levels, respectively. If a ratio of state of being-action verbs is constructed, then the depressed patients also are higher at the .05 level. This index is probably relevant because it indicates that the verb-adjective ratio cannot truly be considered an action quotient, since it does not reflect a high use of action verbs among the depressed
patients.
Table 5 reports the results of content analysis, which statistically significant. As expected, manies tended to choose words that reflected concern with power and achievement, but somewhat surprisingly the depressives were higher in the overstatement category. Since the total number of dictionaries examined was 28 and since only three were found to differentiate the two groups signifi¬ cantly, the differentiation may be purely on the basis of chance. Table 6 compares the results of our analysis of manic and depressive speech expressed in percentages with that of Lorenz and Cobb. Since they reported their data in percentages and did not report means and standard devia¬ tions, statistical comparison is not possible, but the results for manic patients are strikingly similar and suggest that data of this type can be replicated. Their patient sample size was smaller (ten) and their word sample size larger were
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Table
4.—Syntactical Ratios ¡n Manies and Depressives
Depressives ( =15) Ratio
Mean 2.88
Verb-adjective Verb-noun Verb-noun +
State of
SD
being-action verb
Overstatement (19) Achievement (37)
2.18
.05
0.44
2.47
1.33
1.04
3.18
.02 .02
1.72
1.35
0.89
0.20 0.26
2.36
.05
Manies
SD
Mean
SD
2.67
13.19
3.86
5.48 2.75
12.00
4.83
3.17 2.88
.02
17.53 7.53
10.19
3.15
2.42
.05
.02
'Numbers in parentheses are the number of words In the category.
Table 6.—Syntactical Elements in Two Studies of Speech in Affective Disorders % of Words Lorenz & Cobb2
Andreasen & Pfohl
(Current Study) Nouns
Normals
Manies
16.7
14.9
Manies 13.3
Depressives 9.9
Adjectives
12.2
9.6
7.0
5.9
Adverbs
12.5
9.1
10.8
Verbs
16 8
11.7 22 3
24.8
Pronouns
13.8 10.4
18.2
19.9
24.8 22.1
8.9
8.3 7.5
5.6 8 1
5.9 8.9
6.4
5.9
5.5
3.5
Prepositions Conjunctions Articles
SD
1.93
9.26
Mean
Power (18*)
16)
0.56 0.30
(N = 16)
=
=
0.51
Table 5—Content Analysis Depressives (N 15)
(
Mean 2.29
0.92
2.57
adjective
Manies
(1,000 words), but nevertheless none of the categories differ by more than 3%. Oddly, our depressed patients tend to differ from Lorenz and Cobb's normal subjects in a more extreme way than the manies, suggesting that "normality" is not necessarily a mean between mania and depression. COMMENT
Because it is a pilot study, this investigation deals with a large number of linguistic variables. A considerable number, thought to be potentially promising, were not of any value in discriminating between the two groups statis¬ tically. In particular, measures of lexical diversity such as the type-token ratio have been of considerable value in other linguistic studies of psychiatric populations. The content analysis dictionaries have been described as a very interesting method for examining the emotional tones expressed in samples of language. The negative results obtained with these two linguistic tools were particularly disappointing. In addition, greater differences in syntac¬ tical complexity were also anticipated. However, these negative results may have been due to an error in experimental design, which should be remedied in subsequent studies. The use of 80 words of proverb inter-
pretation and the relatively short length of the sponta¬ neous speech samples may well have produced an artifactual homogeneity in word choice and sentence type. Subse¬ quent investigations in this area should probably be limited to "spontaneous speech" only and increase the word sample to at least 500 words per patient and possibly 1,000 words. Most of the content analysis dictionaries consist of 20 to 30 words, and a 400-word sample is probably not long enough to assess the use of this relatively small number of words. Further, subsequent studies should probably control for verbal intelligence quotient rather than using consecu¬ tive admissions, since vocabulary size and intelligence may well play a significant role in syntactical complexity and lexical diversity. The higher educational level of the manies may have distorted results in some way, although neither group is of a very high educational level. Nevertheless, manic and depressed patients did differ from
substantial number of variables analysis of syntac¬ tical elements was particularly useful in distinguishing between the two groups, and several working hypotheses were validated. The speech of the depressives was charac¬ terized by the use of more state of being verbs, adverbs, modifying adverbs, first-person pronouns, and personal pronouns, while the manies used significantly more action verbs, adjectives, concrete nouns, and nouns generally. Although the characteristics of speech that these syntac¬ tical elements are assumed to represent are somewhat arbitrary and theoretical, these results imply that depres¬ sive speech tends to be more vague, qualified, and person¬ alized, while manic speech is more colorful and concrete. If one wishes to reject the descriptive categories altogether as too arbitrary, one nevertheless is left with the clear implication that depressed patients tend to qualify more, to talk more in terms of a "state of being," and to talk more both about themselves and other people. Manies, on the other hand, tend to talk more about things than about people, to discuss them in terms of action, and to use more adjectives to describe them. Because our data on manies are so similar to those of Lorenz and Cobb, it seems likely that these positive findings can be replicated in future studies. The results of one familiar linguistic variable, the verbone
another
on a
probably not related
adjective ratio,
to education. The
were
particularly surprising. Originally
described as an "action quotient" or an index of instability, it has been consistently higher among psychiatric groups than normals. If it were indeed either an action quotient or an index of instability, one would anticipate that it would be higher in manies than depressed patients, but the reverse was true. Other aspects of the data analysis suggest that one must consider not only the quantity of
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verbs used but also the types of verbs used in order to assess the meaning of the verb-adjective ratio. If the quotient is composed of all verbs, including both auxiliary and main verbs and a mixture of action and state of being verbs, as appears to be the case in most of the quotients calculated, then the varying quantity of those components can certainly affect the meaning of the quotient. In this study the quotient is loaded with a substantial quantity of state of being verbs in the depressives and action verbs in the manies, with the overall average number of verbs being similar in the two groups. Manies, however, use many more adjectives. This gives the manies a relatively lower quotient than the depressives, although their speech contains more syntactical elements suggestive of action and color. Thus a high verb-adjective quotient in this study appears to be an index of a rather drab colorless inactive style of speaking. This dissecting out of the elements that actually produce a particular quotient appears to be illumi¬ nating and is recommended for future studies. Thus, this pilot study has led to some positive results and suggested some methods for future improvement. It has not drawn heavily on transformational or generative grammar, since conventional grammar appeared to lend itself more readily to data analysis, but it has used other
relatively sophisticated psycholinguistic techniques such as content analysis and measures of lexical diversity. Oddly enough, at this point, analyzing grammar in conventional descriptive terms has been the most useful tool. Further studies using larger samples are needed to determine definitively the usefulness of the other techniques. References 1. Newman S, Mather VG: Analysis of spoken language of patients with affective disorders. Am J Psychiatry 94:913-942, 1938. 2. Lorenz M, Cobb S: Language behavior in manic patients. Arch Neurol Psychiatry 69:763-770, 1952. 3. Lorenz M, Cobb S: Language behavior in psychoneurotic patients. Arch Neurol Psychiatry 69:684-694, 1953. 4. Lorenz M: Language as expressive behavior. Arch Neurol Psychiatry 70:277-285, 1953. 5. Busemann A: Die Sprache der Jugend als Ausdruck der Entwicklungsrhythmik. Jena, Germany, Fisher Verlag, 1925.
6. Fairbanks H: The quantitative differentiation of samples of spoken language. Psychol Monogr 56:19-38, 1944. 7. Mann MB: The quantitative differentiation of samples of written language. Psychol Monogr 56:41-74, 1944. 8. Benton AL, Hartman CH, Sarason IG: Some relations between speech behavior and anxiety level. J Abnorm Soc Psychol 5:295-297, 1955. 9. Balken ER, Masserman JH: The language of the phantasies of patients with conversion hysteria, anxiety state, and obsessive compulsive neuroses. J Psychol 10:75-86, 1940. 10. Gosse A, Wachal RS, Spreen 0: Linguistic Analysis of Free Speech Samples: Manual of Instructions for Transcription, Pre-editing, and Coding. Victoria, British Columbia, Neuropsychology Laboratory, Department of Psychology, University of Victoria, 1974. 11. Spreen 0, Wachal RS: Psycholinguistic analysis of aphasic language: Theoretical formulations and procedures. Lang Speech 16:130-146, 1973. 12. Wachal RS, Spreen 0: Some measures of lexical diversity in aphasic and normal language performance. Lang Speech 16:169-181, 1973. 13. Johnson W: Studies in language behavior. Psychol Monogr 56:1-15,
1944.
14. Chotlos JW: A statistical and comparative analysis of individual written language samples. Psychol Monogr 56:77-111, 1944. 15. Maher B: The language of schizophrenia: A review and interpretation. Br J Psychiatry 120:3-17, 1972. 16. Weintraub W, Aronson H: The application of verbal behavior analysis to the study of psychological defense mechanisms: Methodology and preliminary report. J Nerv Ment Dis 134:169-181, 1962. 17. Weintraub W, Aronson H: The application of verbal behavior analysis to the study of psychological defense mechanisms: II. Speech pattern associated with impulsive behavior. J Nerv Ment Dis 139:75-82, 1964. 18. Weintraub W, Aronson H: The application of verbal behavior analysis to the study of psychological defense mechanisms: III. Speech associated with delusional behavior. J Nerv Ment-Dis 141:172-179, 1965. 19. Weintraub W, Aronson H: The application of verbal behavior analysis to the study of psychological defense mechanisms: IV. Speech pattern associated with depressive behavior. J Nerv Ment Dis 144:22-28, 1967. 20. Weintraub W, Aronson H: Application of verbal behavior analysis to the study of psychological defense mechanisms: V. Speech pattern associated with overeating. Arch Gen Psychiatry 21:739-744, 1969. 21. Weintraub W, Aronson H: Verbal behavior analysis and psychological defense mechanisms: VI. Speech pattern associated with compulsive behavior. Arch Gen Psychiatry 30:297-300, 1974. 22. Gottschalk LA, Glesner GC, Magliocco EB, et al: Further studies on the speech patterns of schizophrenic patients. J Nerv Ment Dis 132:101-113, 1961. 23. Gottschalk LA, Glesner GC, Daniels RS, et al: The speech patterns of schizophrenic patients: A method of assessing relative degree of personal disorganization and social alienation. J Nerv Ment Dis 127:153-166, 1958. 24. Stone PJ, Dunphy DC, Smith MS, et al: The General Inquirer: A Computer Approach to Content Analysis. Cambridge, Massachusetts Institute of Technology Press, 1966. 25. Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders. New York, Biometrics Research, New York State Psychiatric Institute, 1975. 26. Wells FL, Ruesch J: Mental Examiner's Handbook. New York, Psychological Corp, 1945.
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of in Affective Disorders Nancy J. C. Andreasen, MD, PhD,
Bruce Pfohl
\s=b\ Various aspects of speech and language were compared, using psycholinguistic techniques, in a group of 15 depressed patients and 16 manic patients: lexical diversity, syntactical complexity, syntactical elements, and content analysis. Contrary to anticipation, the manic patients did not show more varied word choice or complexity of sentence structure than the depressives. In particular, they did not differ significantly in type-token ratio. The greatest difference was in syntactical elements, with manics using more action verbs, adjectives, and concrete nouns, while the depressed patients used more state of being verbs, modifying adverbs, first-person pronouns, and personal pronouns. When compared by content analysis, the manics used more words reflecting a concern with power and achievement. These results imply that depressive speech tends to be more vague and qualified and to show considerable self-preoccupation, while manic speech tends to be colorful and concrete and to show more concern with things than with people. (Arch Gen Psychiatry 33:1361-1367, 1976)
patients' thought, or thought that our only way of learning disorder. Too often we about a patient's thoughts is through his speech and language, either spoken or written. Spoken or written language may not be an accurate or reliable index of thought, even when it is supposed to approximate it closely as in free association, but is the only index we have available. Given this fact, it is something of an oddity that so much has been written by psychologists and psychia¬ trists about thought and so little about language. Linguistics is a relatively new field, of course, and psycholinguistics is even newer. Nevertheless, a number of investigators have attempted to apply linguistic techniques to a variety of psychiatric disorders. Basically, frequently speak Psychiatrists thought, forget content of
Accepted
about their
stream of
for publication Dec 19, 1975. From the Department of Psychiatry, University of Iowa College of Medicine, Iowa City. Reprint requests to Department of Psychiatry, University of Iowa Hospitals and Clinic, 500 Newton Rd, Iowa City, IA 52242 (Dr
Andreasen).
Speech
these investigations are of two types: those that attempt to examine formal elements of speech and writing such as grammar and syntax, and those that attempt to examine aspects of content such as vocabulary word choice. Analyses of form have grown increasingly sophisticated. Newman and Mather1 made an early effort to examine speech in patients suffering from mania or depression by studying such variables as pitch, tempo, syntax, and latency of response. Their results are largely descriptive, however, and provide no quantitative data. Lorenz and Cobb have compared the speech of manies to that of normals by using more rigorous quantitative methods such as determining the distributions of parts of speech or the number of words spoken per minute.- Manies were found to have significantly different speech patterns. Lorenz and Cobb have also examined speech in neurotic patients.'·' Determination of the verb-adjective (V-A) ratio was developed in an effort to find a quantitative method of relating grammatical forms to psychopathology. Originally developed by Busemann,'' it was considered to be an "action quotient" or an index of emotional instability. Although the measure was developed for use in children, a variety of investigators have applied it to psychiatric patients. Fair¬ banks" and Mann7 have found schizophrenics to have a higher V-A quotient than normals, while Lorenz and Cobbhave found manies and hysterics to have a higher quotient than normals. Benton et al8 obtained a higher quotient in people with high anxiety as compared to low anxiety, while Balken and Masserman" found anxiety states to have a higher quotient in comparison with conversion hysterics. Very few studies have been able to replicate the actual figures of the others, however; for example, the quotient in normals has been variously reported as 1.07, 1.98, and 3.43. Such variability is probably due to differences in definition of terms and in sample collection. Spreen and Wachal have attempted to refine methodol¬ ogy in syntactical analysis still further by describing a precise method of collecting and transcribing speech samples and developing sophisticated statistical methods
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for data analysis.'"'- Their techniques, developed for use in aphasies (perhaps the most difficult group for linguistic
analysis), are too new to be widely replicated as yet. Other investigators have attacked the problem of de¬ scribing and differentiating speech patterns by examining aspects of content rather than form. Perhaps the oldest and simplest technique is the type-token ratio (TTR), originally developed by Wendell Johnson as a way of describing vocabulary size of "lexical diversity."'1'4 This measure is determined by dividing the total number of
words (or tokens) into the total number of different words (or types). This variable has been examined most often in schizophrenia, with some indications that schizophrenics may have a lower TTR than normals. The range of values has differed widely from study to study, however, with a low of .26 and a high of .74."'7·'3 As Wachal and Spreen have pointed out, the TTR tends to be highly dependent on sample length and whether the sample is spoken or writ¬
have been developed and applied over the years, with somewhat varied results. With the possible exception of Weintraub, no one has succeeded in developing a method that can be consistently repeated in a range of psychiatric patients, and no one has as yet attempted to replicate Weintraub's data. Yet enough has been done to suggest that psycholinguistic studies are a potentially rich method for exploring language and ultimately thought in
writing
psychiatric patients. The present investigation was undertaken as a pilot study. The overall plan was to examine a number of linguistic variables. Based on the research just reviewed, four different areas were selected for investigation: lexical diversity, syntactical complexity, frequency of types of syntactical elements, and content analysis. In order to increase precision, only variables that could be analyzed quantitatively were selected. METHOD
ten.
methods
Other investigators have attempted to develop that focus more closely on aspects of content that may give a better index of actual cognitive style. Weintraub and Aronson""1 have developed a method of using word choice and phrase choice as an index of various psychological defense mechanisms. This method identifies a variety of factors considered to be of psychological significance in psychiatric disorders: qualifying phrases and words, nega¬ tors, retractors, expressions of feeling, value judgments, etc. Using these techniques, Weintraub and Aronson have
found differences between normal controls and patients from a wide range of psychiatric disorders: delusional behavior, impulsive behavior, compulsive behav¬ ior, and depression. Gottschalk and associates--"1 have attempted to examine interpersonal and emotional aspects of content by developing an elaborate weighted scoring system designed to evaluate anxiety, social alienation, uncertainty, and feelings of being controlled. They have developed this primarily as a method of defining and
suffering
differentiating schizophrenic thought.
The methods of Weintraub and Gottschalk and col¬ leagues require individual scoring of phrases and clauses in transcribed samples of speech. Thus they are necessarily time-consuming and, to some extent, dependent on the subjective judgment of the scorer. Other experiments in content analysis have developed as a way of surmounting these problems. Several investigators have attempted to analyze content by developing "dictionaries" or sets of word categories that group together words considered to share a similar psychological significance.-4 For example, all words dealing with the concept of failure would be enumerated under this category. After a series of these dictionaries have been developed and their reliability and validity determined, they can be used to analyze vocabu¬ lary content through more accurate and efficient comput¬ erized methods. Such computerized content analysis has been used to analyze a wide variety of speech samples, ranging from the political pronouncements of foreign statesmen to
spontaneous productions by schizophrenics.
Its application to psychiatric populations has, however, been quite limited to date. Thus, a variety of methods for analyzing speech and
Within three to five days after admission, speech samples were obtained from 16 inpatients suffering from mania and 15 inpatients suffering from depression. Although some patients were receiving medication at the time of testing, all were fully sympto¬ matic. Consecutive admissions were used, but only patients who met previously defined diagnostic criteria (the Research Diag¬ nostic Criteria) were included.-'' These criteria for mania and depression are as follows: For manic disorder, A through E are required for the episode of illness being considered: A. One or more distinct periods with a predominantly elevated or irritable mood. The elevated or irritable mood must be a prominent part of the illness and relatively persistent, although it may alternate with depressive mood. If the manic symptom only occurs during periods of alcohol or drug intake or withdrawal from them, it should not be considered here. B. If mood is elevated, at least three of the following symptom categories must be definitely present to a significant degree (four if mood is only irritable) (for past episodes, because of memory difficulty, one less symptom is required): 1. More active than usual—either socially, at work, sexually—or physically restless 2. More talkative than usual or felt a pressure to keep talking 3. Flight of ideas or subjective experience that thoughts are
racing 4. Inflated self-esteem (grandiosity, which may be delusional) 5. Decreased need for sleep 6. Distractability, ie, attention is too easily drawn to unimpor¬ tant or irrelevant external stimuli 7. Excessive involvement in activities without recognizing the high potential for painful consequences, eg, buying sprees, sexual indiscretions, foolish business investments, reckless driving C. Overall disturbance is so severe that at least one of the following is present: 1. Meaningful conversation is impossible 2. Serious impairment socially, with family, at home, or at
work 3. In the absence of No. 1 or 2, hospitalization D. Duration of manic features at least one week (or any duration if hospitalized). E. None of the following, which suggest schizophrenia is pres¬ ent: 1. Delusions of
being controlled or of thought broadcasting, withdrawal 2. Hallucinations of any type throughout the day for several days or intermittently throughout a one-week period, unless all of insertion,
or
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the content is clearly related to depression or elation 3. Auditory hallucinations in which either a voice keeps up a running commentary on the patient's behavior as it occurs, or two or more voices converse with each other 4. At some time during the period of illness had delusions or hallucinations for more than one week in the absence of prominent
affective
(depressed
or
manic) symptoms
5. At some time during the period of illness had more than one week when he exhibited no prominent manic symptoms but had several instances of formal thought disorder For major depressive disorder, A through E are required for the episode of illness being considered: A. Dysphoric mood characterized by symptoms such as the following: depressed, sad, blue, hopeless, low, down in the dumps, "don't care anymore," irritable, worried. The mood disturbance must be prominent and relatively persistent but not necessarily the most dominant symptom. It does not include momentary shifts from one dysphoric mood to another dysphoric mood, eg, anxiety to depression to anger, such as are seen in states of acute psychotic turmoil. B. At least five of the following symptoms are required to have appeared as part of the episode for definite and four for probable (for past episodes, because of memory difficulty, one less symptom is required): 1. Poor appetite or weight loss or increased appetite or weight gain (change of 0.5 kg a week over several weeks or 4.5 kg a year when not dieting) 2. Sleep difficulty or sleeping too much 3. Loss of energy, fatigability, or tiredness 4. Psychomotor agitation or retardation (but not mere subjec¬ tive feeling of restlessness or being slowed down) 5. Loss of interest or pleasure in usual activities, including social contact or sex (do not include if limited to a period when delusional or hallucinating) 6. Feelings of self-reproach or excessive or inappropriate guilt (either may be delusional) 7. Complaints or evidence of diminished ability to think or concentrate, such as slow thinking, or indecisiveness (do not include if associated with obvious formal thought disorder) 8. Recurrent thoughts of death or suicide, or any suicidal behavior C. Dysphoric features of illness lasting at least one week. Definite if lasted more than two weeks, probable if one to two weeks. D. Sought or was referred for help from someone during the dysphoric period or had impaired functioning socially, with family, at home, or at work. E. None of the following, which suggest schizophrenia is pres¬
thought disorder Using these criteria, kappa coefficients of interrater reliability have been calculated at .90 for manic disorder and .85 for major depressive disorder. The manies and depressives did differ slightly in age or educational background. The manies ranged in age from 16 to 64 years, with a mean of 33, and they had a mean of 12.6 years of schooling. The depressives had 10.7 years of schooling, and they ranged from 16 to 76 years old, with a mean of 41. Nine of the manic patients were female, while 13 of the depressed group were 6. Definite instances of formal
female. The speech
samples consisted of a mixture of responses to proverb interpretation and spontaneous free speech in response to questions such as "What are you like?" or "Tell me about your family." The proverbs were taken from a standard list in the Mental Examiner's Handbook.-" The first 80 words of proverb interpretation and the first 320 words of spontaneous speech were used for analysis. All speech samples were tape-recorded and later transcribed. After transcription, each word in the sample was coded with a designation for part of speech and each sentence was coded for sentence type, using a method worked out by one of the investi¬ gators (N.J.C.A.) and available on request. Verbs were, for exam¬ ple, classified into either action or state-of-being verbs and also bytense into past, present, and future. Nouns were divided into abstract (qualities such as beauty, truth) and concerte (objects such as book, street). Pronouns were divided into six classes: three classes of personal pronouns (first, second, third person), and also relative (who, which, etc), demonstrative (this, that, etc), and indefinite (any, both, etc) pronouns. Adjectives were divided into three types according to degree (positive, comparative, and superlative), and a fourth group was designated as indefinite adjectives (a, the, this). Adverbs were divided into four groups:
descriptive (forcefully, fast, etc), interrogative (how, when, etc), modifying (rather, very, etc), and indicators of time and place (now, again, here, etc). Conjunctions were divided into coordinat¬
ent: 1. Delusions of
ing (and, or, etc), subordinating (because, if, etc), and transitional (accordingly, moreover, etc). Prepositions were not divided into subclasses. Thus, grammatical elements were divided into seven major classes, which were further subdivided into 26 subclasses. In an effort to examine possible differences in sentence structure, each sentence was also coded to indicate sentence type: simple, compound, complex, compound-complex, and fragment. This method of coding also permitted an examination of sentence length. Several speech samples were coded independently by each of the investigators. Since codings differed on only 1.5% of the words, this was considered to represent suitable interrater reliability. Thereafter coding was divided between the two investigators, with each taking half the manic sample and half the depressed sample in order to randomize any systematic error that might
insertion,
occur.
being controlled or of thought broadcasting, withdrawal 2. Hallucinations of any type throughout the day for several days or intermittently throughout a one-week period, unless all of the content is clearly related to depression or elation 3. Auditory hallucinations in which either a voice keeps up a running commentary on the patient's behaviors or thoughts as they occur, or two or more voices converse with each other. 4. At some time during the period of illness had delusions or hallucinations for more than one month in the absence of promi¬ nent affective (manic or depressive) symptoms (although typical depressive delusions, such as delusions of guilt, sin, poverty, nihilism, or self-deprecation or hallucinations of similar content are
or
permitted)
5. Preoccupation with a delusion or hallucination to the relative exclusion of other symptoms or concerns (other than delusions or
guilt, sin, poverty, nihilism, with similar content)
or
self-deprecation
or
hallucinations
Other methods were used to examine aspects of speech content, such as vocabulary and word choice, as opposed to the above syntactical aspects. At the simplest level, richness or convention¬ ality of vocabulary was examined by determining what percentage of words used by the patients were among the 1,000 most commonly used words as determined by the Lorge-Thorndike Dictionary. Which particular words were used most frequently by each subject was also determined. In addition, the lexical diversity of each subject was determined by calculating the type-token ratio. The number of negators (no, not, never, etc) and the number of qualifiers (perhaps, if, maybe, etc) were also determined for each subject, using a standard predetermined list. In an attempt to achieve a more sophisticated approach to vocabulary and word choice, techniques of content analysis were also used. The most recent revision of the Harvard Psychosociological Dictionary, the Harvard IV-3, was obtained from Phillip
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Table 1.—Lexical
Diversity in Depressives and Manies
Depressives (
Manies (
15)
=
16)
—
Lexical Diversity No. of 1,000 most common words
SD
Mean
SD
15.07
330.88
11.37
Mean 338.13
Type-token ratio
.4098
Table
.0333
.4280
2.—Syntactical Complexity in Depressives and Depressives (
.0259
NS
Manies
Manies (
15)
NS 2.63
=
16)
—
Mean
SD
Mean
SD
Simple Compound Complex Compound-complex No. of fragments
13.27
8.00
13.31
8.44
0.02
NS
280
1.90
1.15
1.16
NS
9.53
3.19
NS
3.20
3.44 1.37
2.13 8.19
4.20
No. of sentences in 400-word sample
33.00
No. of sentences
Stone and his associates. This dictionary divides 8,700 words or word senses into 170 content categories. Since using all 8,700 word senses and 170 content categories was thought to be too large an undertaking for a pilot study of this type, 28 categories were selected as being of possible relevance to affective disturbance. These categories contained words that tend to denote or connote such ideas or feelings as achievement, failure, abandonment,
2.23
2.48
3.81 3.69
1.09 0.88
2.68
0.53
NS
9.54
31.13
10.62
0.50
NS
NS
d. Personalization: It was predicted that manies would show preoccupation with themselves, as reflected in increased use
more
of
first-person
Lorge-Thorndike Dictionary and the 28 categories for content analysis. The various frequency counts of word choice, and syntac¬ tical elements, and vocabulary were all determined by computer¬ ized analysis, using either stock programs locally available or programs written by one of the investigators. (B.P.) These data were used to test a number of hypotheses concerning several variables in structure and content of speech in affective
pronouns. Time orientation: It was predicted that depressives would be more preoccupied with the past, as reflected by the use of more past-tense verbs and more adverbs referring to time and place. /. Concrete vs abstract usage: It was predicted that manies would be more concrete and depressives more abstract, as reflected by manies using more concrete nouns referring to places and things and depressives using more abstract nouns referring to qualities or ideas. g. Verb-adjective ratio: This can be calculated as a verbadjective, verb-noun, or verb-noun plus adjective ratio. If a higher ratio is associated with greater emotional instability, one would expect a higher ratio in manic patients. h. State of being-Action Verb Ratio: It was predicted that depressives would have a higher ratio, which would serve as an index of anergy. 4. Content analysis: It was predicted that manies would use more words from the groups dealing with concepts such as strength or achievement, while depressives would choose words reflecting a concern with weakness or failure.
disorder. 1. Lexical diversity: It was predicted that manies would have greater lexical diversity as reflected in higher type-token ratios and more words not occurring in the Lorge-Thorndike. 2. Syntactical complexity: It was predicted that manies would tend to use longer sentences and employ more complicated syntax as reflected in more compound, complex, and compound-complex sentences and fewer simple sentences. It was also anticipated that they would use more fragments. 3. Frequency of syntactical elements: These were subdivided into several groups that might reflect similar aspects of speech. a. Vagueness: It was predicted that depressives would show more vagueness as reflected by an increase in such syntactical elements as indefinite adjectives, state of being verbs, and relative, demonstrative, and indefinite pronouns. 6. Colorfulness of speech: It was predicted that manies would have more colorful or emotional speech, as reflected in more adverbs, adjectives, nouns, and action verbs. c. Use of qualifiers: It was predicted that depressives would tend to qualify their statements more often, as reflected by the use of more modifying adverbs.
The results of data analysis illustrate quite well how difficult it is to predict language behavior on the basis of clinical experience. Subjective impressions were not always supported by objective information, and a considerable number of the hypotheses were not proved. As shown in Table 1, the depressives and manies did not differ in lexical diversity. Although the manies did have a slightly higher type-token ratio, suggesting a wider range of word choice, this was not statistically significant. Like¬ wise, the manies used slightly fewer "commonly used" words, as represented by the Lorge-Thorndike Dictionary, but the difference was not statistically significant. As Table 2 demonstrates, the manies also did not show a significant difference in syntactical complexity. Both manies and depressives used similar numbers of simple sentences, and this tended to be the most common sentence type in both groups. They also did not differ significantly
hostility, submission, strength, weakness, virtue, vice, disorder, or negation. Each of these categories contained from 10 to 37 words. The specific 28 categories used were: INCR, IMPLNEG, HOST, FEEL, ABANDON, EXPRS, EXERT, EVAL, EMOT, DISORDR, DECR, CAUSAL, CHANGE, ACTV 3, ACH, FALL, WEAK 3, VIRTUE, VICE, UNDRST, SUBM, STRNG 3, SOLVE, QUALIF, POWER, OVRST, NGTV 3, INDEF. Speech samples were transferred to computer cards, as were the
e.
RESULTS
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Table 3.—Frequency of
Syntactical Elements in Manies and Depressives Depressives (
Vagueness Indefinite adjectives Relative demonstrative and indefinite pronouns State of being verbs
=
15)
Manies ( =16)
Mean
SD
Mean
SD
15.13 25.60
4.56
18.38
5.54
1.72
6.63
24.38
5.73
0.53
NS
61.13
13.35
49.44
9.45
2.74
.02 .02
NS
Colorfulness Adverbs Action verbs
46.60
8.25
39.44
7.19
2.50
45.93
16.20
57.63
8.17
2.48
02
Adjectives
40.40
11.27
48.44
8.27
2.20
.05
31.20
7.35
43.94
11.73
6.18
13.59
42.93
7.01
57.44
6.99 9.99
3.48 0.72
.01
11.73
4.60
.001
30.87
8.92
21.56
5.19
3.46
.01
Concreteness Concrete nouns Abstract
nouns
Nouns
NS
Qualifiers
Modifying
adverb
Personalization 38.87
7.08
31.69
5.31
3.10
.01
Personal pronouns Time orientation
69.93
9.17
61.50
11.06
2.25
.05
Past-tense verbs
24.53
14.35
17.81
14.43
1.26
NS
Adverb Indicating time
10.40
4.29
13.81
1.82
NS
First-person
pronouns
in the numbers of
complex
sentences
compound, compound-complex,
used, and both used nearly the
or
same
number of fragments. Depressives tended to use slightly shorter sentences, but again the difference was not signif¬ icant. Table 3 shows the frequency of syntactical elements in the two patient groups, and in this area the manies and depressives were often different, although not always in the direction predicted. As hypothesized, depressed patients tended to show more vagueness, although only on one index. They did not use significantly more indefinite adjectives or relative, demonstrative, and indefinite pronouns, but they did use significantly more state-ofbeing verbs at the .02 level. Manies, on the other hand, did tend to have more colorful language. Their use of action verbs and adjectives was greater at the .05 and .02 levels, respectively, but the depressed patients did use more adverbs with a difference significant at the .02 level. The issue of concrete vs abstract usage is somewhat obscure. The manic patients tended to use considerably more nouns, and they therefore used both more concrete nouns and more abstract nouns than the depressed patients. The difference in abstract nouns is not statisti¬ cally significant, however, while the differences in nouns generally and in concrete nouns are significant at the .001 and .01 levels, respectively. The manies, therefore, were
definitely more concrete. As predicted, the depressed patients tended
to
qualify
often, as reflected in their use of more qualifying adverbs, with the difference significant at the .01 level. On the other hand, the hypotheses concerning their statements
more
personalization and time reference were not supported by the data. The depressed patients, rather than the manies, tended to show a greater preoccupation with themselves, as reflected in their greater use of the first person pronoun, with the difference significant at the .01 level. They also tended to use more personal pronouns generally, with the
difference significant at the .05 level. They used more pasttense verbs and therefore showed some preoccupation with the past, but the results did not reach statistical signifi¬ cance, and they did not use significantly more adverbs referring to time and place. Table 4 contains a series of ratios that were calculated to permit comparison of our data with those of other studies. Each of these ratios is statistically significant, although slightly less so than if the various syntactical elements are compared singly. Contrary to prediction, the depressives have a higher verb-adjective ratio than the manies. They also have a higher verb-noun and verb-noun plus adjective ratios. These differences are significant at the .05, .02, and .02 levels, respectively. If a ratio of state of being-action verbs is constructed, then the depressed patients also are higher at the .05 level. This index is probably relevant because it indicates that the verb-adjective ratio cannot truly be considered an action quotient, since it does not reflect a high use of action verbs among the depressed
patients.
Table 5 reports the results of content analysis, which statistically significant. As expected, manies tended to choose words that reflected concern with power and achievement, but somewhat surprisingly the depressives were higher in the overstatement category. Since the total number of dictionaries examined was 28 and since only three were found to differentiate the two groups signifi¬ cantly, the differentiation may be purely on the basis of chance. Table 6 compares the results of our analysis of manic and depressive speech expressed in percentages with that of Lorenz and Cobb. Since they reported their data in percentages and did not report means and standard devia¬ tions, statistical comparison is not possible, but the results for manic patients are strikingly similar and suggest that data of this type can be replicated. Their patient sample size was smaller (ten) and their word sample size larger were
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Table
4.—Syntactical Ratios ¡n Manies and Depressives
Depressives ( =15) Ratio
Mean 2.88
Verb-adjective Verb-noun Verb-noun +
State of
SD
being-action verb
Overstatement (19) Achievement (37)
2.18
.05
0.44
2.47
1.33
1.04
3.18
.02 .02
1.72
1.35
0.89
0.20 0.26
2.36
.05
Manies
SD
Mean
SD
2.67
13.19
3.86
5.48 2.75
12.00
4.83
3.17 2.88
.02
17.53 7.53
10.19
3.15
2.42
.05
.02
'Numbers in parentheses are the number of words In the category.
Table 6.—Syntactical Elements in Two Studies of Speech in Affective Disorders % of Words Lorenz & Cobb2
Andreasen & Pfohl
(Current Study) Nouns
Normals
Manies
16.7
14.9
Manies 13.3
Depressives 9.9
Adjectives
12.2
9.6
7.0
5.9
Adverbs
12.5
9.1
10.8
Verbs
16 8
11.7 22 3
24.8
Pronouns
13.8 10.4
18.2
19.9
24.8 22.1
8.9
8.3 7.5
5.6 8 1
5.9 8.9
6.4
5.9
5.5
3.5
Prepositions Conjunctions Articles
SD
1.93
9.26
Mean
Power (18*)
16)
0.56 0.30
(N = 16)
=
=
0.51
Table 5—Content Analysis Depressives (N 15)
(
Mean 2.29
0.92
2.57
adjective
Manies
(1,000 words), but nevertheless none of the categories differ by more than 3%. Oddly, our depressed patients tend to differ from Lorenz and Cobb's normal subjects in a more extreme way than the manies, suggesting that "normality" is not necessarily a mean between mania and depression. COMMENT
Because it is a pilot study, this investigation deals with a large number of linguistic variables. A considerable number, thought to be potentially promising, were not of any value in discriminating between the two groups statis¬ tically. In particular, measures of lexical diversity such as the type-token ratio have been of considerable value in other linguistic studies of psychiatric populations. The content analysis dictionaries have been described as a very interesting method for examining the emotional tones expressed in samples of language. The negative results obtained with these two linguistic tools were particularly disappointing. In addition, greater differences in syntac¬ tical complexity were also anticipated. However, these negative results may have been due to an error in experimental design, which should be remedied in subsequent studies. The use of 80 words of proverb inter-
pretation and the relatively short length of the sponta¬ neous speech samples may well have produced an artifactual homogeneity in word choice and sentence type. Subse¬ quent investigations in this area should probably be limited to "spontaneous speech" only and increase the word sample to at least 500 words per patient and possibly 1,000 words. Most of the content analysis dictionaries consist of 20 to 30 words, and a 400-word sample is probably not long enough to assess the use of this relatively small number of words. Further, subsequent studies should probably control for verbal intelligence quotient rather than using consecu¬ tive admissions, since vocabulary size and intelligence may well play a significant role in syntactical complexity and lexical diversity. The higher educational level of the manies may have distorted results in some way, although neither group is of a very high educational level. Nevertheless, manic and depressed patients did differ from
substantial number of variables analysis of syntac¬ tical elements was particularly useful in distinguishing between the two groups, and several working hypotheses were validated. The speech of the depressives was charac¬ terized by the use of more state of being verbs, adverbs, modifying adverbs, first-person pronouns, and personal pronouns, while the manies used significantly more action verbs, adjectives, concrete nouns, and nouns generally. Although the characteristics of speech that these syntac¬ tical elements are assumed to represent are somewhat arbitrary and theoretical, these results imply that depres¬ sive speech tends to be more vague, qualified, and person¬ alized, while manic speech is more colorful and concrete. If one wishes to reject the descriptive categories altogether as too arbitrary, one nevertheless is left with the clear implication that depressed patients tend to qualify more, to talk more in terms of a "state of being," and to talk more both about themselves and other people. Manies, on the other hand, tend to talk more about things than about people, to discuss them in terms of action, and to use more adjectives to describe them. Because our data on manies are so similar to those of Lorenz and Cobb, it seems likely that these positive findings can be replicated in future studies. The results of one familiar linguistic variable, the verbone
another
on a
probably not related
adjective ratio,
to education. The
were
particularly surprising. Originally
described as an "action quotient" or an index of instability, it has been consistently higher among psychiatric groups than normals. If it were indeed either an action quotient or an index of instability, one would anticipate that it would be higher in manies than depressed patients, but the reverse was true. Other aspects of the data analysis suggest that one must consider not only the quantity of
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verbs used but also the types of verbs used in order to assess the meaning of the verb-adjective ratio. If the quotient is composed of all verbs, including both auxiliary and main verbs and a mixture of action and state of being verbs, as appears to be the case in most of the quotients calculated, then the varying quantity of those components can certainly affect the meaning of the quotient. In this study the quotient is loaded with a substantial quantity of state of being verbs in the depressives and action verbs in the manies, with the overall average number of verbs being similar in the two groups. Manies, however, use many more adjectives. This gives the manies a relatively lower quotient than the depressives, although their speech contains more syntactical elements suggestive of action and color. Thus a high verb-adjective quotient in this study appears to be an index of a rather drab colorless inactive style of speaking. This dissecting out of the elements that actually produce a particular quotient appears to be illumi¬ nating and is recommended for future studies. Thus, this pilot study has led to some positive results and suggested some methods for future improvement. It has not drawn heavily on transformational or generative grammar, since conventional grammar appeared to lend itself more readily to data analysis, but it has used other
relatively sophisticated psycholinguistic techniques such as content analysis and measures of lexical diversity. Oddly enough, at this point, analyzing grammar in conventional descriptive terms has been the most useful tool. Further studies using larger samples are needed to determine definitively the usefulness of the other techniques. References 1. Newman S, Mather VG: Analysis of spoken language of patients with affective disorders. Am J Psychiatry 94:913-942, 1938. 2. Lorenz M, Cobb S: Language behavior in manic patients. Arch Neurol Psychiatry 69:763-770, 1952. 3. Lorenz M, Cobb S: Language behavior in psychoneurotic patients. Arch Neurol Psychiatry 69:684-694, 1953. 4. Lorenz M: Language as expressive behavior. Arch Neurol Psychiatry 70:277-285, 1953. 5. Busemann A: Die Sprache der Jugend als Ausdruck der Entwicklungsrhythmik. Jena, Germany, Fisher Verlag, 1925.
6. Fairbanks H: The quantitative differentiation of samples of spoken language. Psychol Monogr 56:19-38, 1944. 7. Mann MB: The quantitative differentiation of samples of written language. Psychol Monogr 56:41-74, 1944. 8. Benton AL, Hartman CH, Sarason IG: Some relations between speech behavior and anxiety level. J Abnorm Soc Psychol 5:295-297, 1955. 9. Balken ER, Masserman JH: The language of the phantasies of patients with conversion hysteria, anxiety state, and obsessive compulsive neuroses. J Psychol 10:75-86, 1940. 10. Gosse A, Wachal RS, Spreen 0: Linguistic Analysis of Free Speech Samples: Manual of Instructions for Transcription, Pre-editing, and Coding. Victoria, British Columbia, Neuropsychology Laboratory, Department of Psychology, University of Victoria, 1974. 11. Spreen 0, Wachal RS: Psycholinguistic analysis of aphasic language: Theoretical formulations and procedures. Lang Speech 16:130-146, 1973. 12. Wachal RS, Spreen 0: Some measures of lexical diversity in aphasic and normal language performance. Lang Speech 16:169-181, 1973. 13. Johnson W: Studies in language behavior. Psychol Monogr 56:1-15,
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14. Chotlos JW: A statistical and comparative analysis of individual written language samples. Psychol Monogr 56:77-111, 1944. 15. Maher B: The language of schizophrenia: A review and interpretation. Br J Psychiatry 120:3-17, 1972. 16. Weintraub W, Aronson H: The application of verbal behavior analysis to the study of psychological defense mechanisms: Methodology and preliminary report. J Nerv Ment Dis 134:169-181, 1962. 17. Weintraub W, Aronson H: The application of verbal behavior analysis to the study of psychological defense mechanisms: II. Speech pattern associated with impulsive behavior. J Nerv Ment Dis 139:75-82, 1964. 18. Weintraub W, Aronson H: The application of verbal behavior analysis to the study of psychological defense mechanisms: III. Speech associated with delusional behavior. J Nerv Ment-Dis 141:172-179, 1965. 19. Weintraub W, Aronson H: The application of verbal behavior analysis to the study of psychological defense mechanisms: IV. Speech pattern associated with depressive behavior. J Nerv Ment Dis 144:22-28, 1967. 20. Weintraub W, Aronson H: Application of verbal behavior analysis to the study of psychological defense mechanisms: V. Speech pattern associated with overeating. Arch Gen Psychiatry 21:739-744, 1969. 21. Weintraub W, Aronson H: Verbal behavior analysis and psychological defense mechanisms: VI. Speech pattern associated with compulsive behavior. Arch Gen Psychiatry 30:297-300, 1974. 22. Gottschalk LA, Glesner GC, Magliocco EB, et al: Further studies on the speech patterns of schizophrenic patients. J Nerv Ment Dis 132:101-113, 1961. 23. Gottschalk LA, Glesner GC, Daniels RS, et al: The speech patterns of schizophrenic patients: A method of assessing relative degree of personal disorganization and social alienation. J Nerv Ment Dis 127:153-166, 1958. 24. Stone PJ, Dunphy DC, Smith MS, et al: The General Inquirer: A Computer Approach to Content Analysis. Cambridge, Massachusetts Institute of Technology Press, 1966. 25. Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders. New York, Biometrics Research, New York State Psychiatric Institute, 1975. 26. Wells FL, Ruesch J: Mental Examiner's Handbook. New York, Psychological Corp, 1945.
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