Folia Psychiatrica et Neurologica Japonica, Vol. 31, No. 4, 1977
The Context Theory of Schizophrenia (Part 2) Ken Ohira, M.D. Department of Psychiatry, Medical Center at Koishikawa, University of Tokyo, Tokyo
INTRODUCTION This article is a supplement to a previous article on schizophrenic speech.’ Schizophrenic comprehension of speech will be explained patholinguistically in this article while the previous one dealt with schizophrenic expression. The schizophrenic’s interpersonal relationship can then be examined since the linguistic forms of both schizophrenic expression and comprehension will now be available. The basic method applied here is the same as that used in the previous article: a method based on abnormal speech instead of that based on normal speech. DEFINITION OF KEY WORDS Some key words should first be defined to clarify the subsequent argument. Verbal Context In the previous article, context was defined as follows: context is the relation between symbol and what-is-symbolized and is also the relation between thought and word. Conversely stated, these two pairs of elements are two different levels of a single relation, namely context. Such a definition is adequate for discussion focused on schizophrenic thinking and speaking activities. It should be noted at this point that the discussion in the previous article limited itself to a condition in which the schizophrenic alone was considered; we observed 1.
Received for publication Mar. 16, 1977.
him speaking and thinking, but not interacting with others. In this article, a situation of dialogue will be considered. In this situation, expression and comprehension will be the theme as two persons are exchanging words. Context is then defined as consisting of two forms: context of expression and context of comprehension. Context of expression is a context by means of which one speaks coherently. This is identical to the context in external speech discussed in the previous article. Context of comprehension is a context by means of which one comprehends another’s speech. This is precisely the process through which we learn by context. Let us consider the situation of dialogue. One is a speaker and the other a listener. Their roles are interchangeable and do actually interchange. In reaction to the speaker’s speech, a thought is formed within the listener. At the same time, the listener checks if his thought, thus formed, is consistent with the words of the other’s speech. If it is, it can be said that he is comprehending the speech. This can be paraphrased as follows. When this individual listens to the other, he accepts the other’s words into his thought through the action of comprehension. At the same time, he is verifying his own thought by comparing it with the other’s words through the action of confirmation. This relation between the thought of self and the words of the other is defined as the context of comprehension. The action of Comprehension is
K. Ohira
55 4
the turning of words into thought, while the action of confirmation is the reverse. These are illustrated in Fig. 1. Incidentally, a listener understands the meaning of a speaker's words in his own way. At the same time the listener checks, consciously and unconsciously, if his understanding of the words is consistent with that of the speaker. To paraphrase, the self relates the symbol used by the other to his concept of what-is-symbolized. At the same time he relates this what-is-symbolized to the symbol used by the other. This mutual relation between the what-is-symbolized of the self and the symbol of the other is also defined as the context of comprehension. This is illustrated in Fig. 2. To summarize, the context of comprehension is defined as follows: context of comprehension is the relation between the thought of self and the words of the other and is also the relation between the symbol of the other and what-is-symbolized of self. Conversely stated, these two pairs of elements are two different levels of a single relation, namely the context of comprehension.
2.
Substitute
It may seem more in line with reality to take the degree into consideration for the pathological relation between either one of the two pairs of elements defined in section one of this chapter, but such a consideration, in fact, has no effect other than to introduce ambiguity of the one examining the relation into the discussion. In the previous article, the presence or absence of a complete relation was first examined. The cases in which the degree came into question were included in the group without a complete relation. As a second step, a substitute action (e.g. hallucination of hearing) was then introduced with regard to this group. The substitute action was introduced in the place of the action proper (e.g. inner speech) merely to explain the existence of an incomplete relation. An element-substitute was introduced as the effect of each action-substitute. Next, the presence or absence of this element-substitute was checked. The cases without element-substitute were discarded in this check to leave all phenomena involving degrees in the substitute category. This concept of substitute also holds true in this article.
confirmation
CONTEXT CESSATION
I
thought ( s e l f )
L
word ( t h e o t h e r )
I
comprehension
Fig. 1
what-is-
0 Fig. 2
1. Case Presentation A 16-year-old senior high school student was brought to my clinic. His complaint was inability to attend school. It was learned that he had developed an olfactory hallucination that a bad odor emanated from his anus during junior high school years. He, however, managed to graduate and entered a senior high school which he became unable to attend in the middle of his first year. At the clinic, this patient received phenothiazine tranquilizing medication and regular psychotherapy. His chief problem was discovered to be
Context Theory of Schizophrenia inability to go out of his house. He gave the following reasons for this condition: “They make a fool of me outside” and “I also end up making fools of them.” He also mentioned another pathologic experience which occurred both at home and outside: “They say queer things. T don’t understand why they say things like that.” He also had hallucination of hearing (inner speech-substitute): “T hear them talking about me while T am listening to records on a headset.” No blocking of words (external speech cessation) was observed during interviews. On the other hand, blocking of thought occurred often when he was trying to answer questions put to him. He would explain, “Oh . . . my thought has just stopped.” (inner speech cessation) One day he said, “Sometimes I can’t understand what others are talking about.” (“You can’t understand?”) “No, T suddenly miss words.” (“You don’t hear?”) “Yes, I hear them OK . . . but that’s all. Their meanings don’t come across to me.” His mother brought a letter from him addressed to me on one occasion when his fear of going outside was strong enough to prevent him from coming to the clinic. The letter contained the following part. “When I listen to others, T hear (for example) the word ‘mama’ when it is really ‘mugo’ (Japanese: grandchild) . . . sometimes I also hear a different word when it does not even sound similar to the actual word.” (Parentheses are added by the author.)
2.
Discussion The above patient explains that “I hear them OK’ but “their meanings don’t come across to me.” He is aware that “others are talking” but he would admit that “1 suddenly miss words.” We can deduce from this explanation that he hears the sounds of the words of others but he does not always grasp their meanings, and that he notices that words are uttered but he cannot always accept them into his thought stream. To paraphrase, the
555
normal relations between thought and word and between symbol and what-is-symbolized are not maintained here, which is to say the context of comprehension ceases in this patient. Context cessation will be examined at the two levels of context of comprehension in the following discussion. At the level of thought and word, the cessation of context refers to that of comprehension and of confirmation (Fig. 1). As for cessation of comprehension, two opposite phenomena are found to occur from the case presented above: One is to “miss words” (incomprehension), while the other is to “hear a different word” (misapprehension). The former is only a cessation of comprehension. In contrast, the latter can be called a comprehension-substitute since it occurs as a substitute of comprehension. The logical basis of this substitute concept is described in the chapter on definition. As for the cessation of confirmation, two opposite phenomena are again found to occur from the above case: One is that in which the patient is not aware of his incomprehension or misapprehension, while the other is that in which he is aware of it. The former is manifested in the patient’s speech: “They say queer things. T don’t understand why they say things like that.” The latter is manifested in his letter in which he himself describes an example of misapprehension. As above, the former is called cessation of confirmation and the latter confirmation-substitute. When comprehension-substitute is the case, pathologic phenomena do take place at the level of symbol and what-is-symbolized as shown in the patient’s letter. Assonance (“mama” and “mago”) and collapsed concept (“a different word”) are found to occur. INTERPERSONAL RELATION IN DIALOGUE
The linguistic forms of schizophrenic ex-
556
pression were described in the previous article. Those of schizophrenic comprehension have been presented in this article. Now that all phenomena concerning schizophrenic verbal exchange have been systematically formulated, a discussion on dialogue involving the schizophrenic becomes feasible. Form of Relation First, the interpersonal relation of dialogue between two normal individuals will be considered. One expresses himself according to the context of expression and comprehends the other according to the context of comprehension. The relation of self with the other can thus be represented as in Fig. 3. It should be noted at this point that the participants in this relation are interchangeable and do interchange in dialogue. Let us assume this relation to be normal for the time being. Then how does this differ from the form of relation involving a schizophrenic? Suppose this normal relation ceased to be, which would be the only conceivable situation in an abnormal relation. Both contexts would also have ceased to exist (see “context cessation” in the previous chapter). If some kind of dialogue, though pathologic, is to be feasible between a schizophrenic and the other under this condition, the schizophrenic must have new contexts which enable him to express himself and to comprehend the other. These new contexts are pathologic and are substitutes for the original contexts. The new relation thus formed by the context-substitutes is a pathologic one. The logical basis of the substitute conCopt is explained in the chapter on definition. The above discussion centers on a schizophrenic, which is to say a schizophrenic is placed at the “self” position in Fig. 3. This form of relation, therefore, reflects the subiective position of a schizophrenic in a dialogue relation. On the other hand, a similar argument holds true when a normal person is the “self” and a schizophrenic “the other” in 1.
K. Ohira
Fig. 3. The new relation formed by the context-substitutes is again pathologic although the person of “self” is normal. This form of relation reflects this person’s subjective position in a dialogue relation with a schizophrenic, which is expressed by such reactions as: “What nonsense he is talking!” and ‘‘I also find myself talking such nonsense to him.”
context of expression
n
self
I
JI
the other
I
Fig. 3
2.
Delusion : Patient’s Position in Relation Again, the context-substitutes are the only contexts that enable a patient to maintain the self-other relation. This self-other relation is pathologic. We can find examples of a patient’s position in the self-other relation in the case presented earlier: “They make a fool of me outside,” and ‘‘I also end up making fools of them.” The former shows, as far as he comprehends, that the others are making a fool of him, while the latter shows that he feels his expressions are making fools of others. Here, we understand that the substitute for context of comprehension is acting in the former instance and the substitute for context of expression in the latter. Both these context-substitutes are acting as delusional contexts that relate others to self. It should be noted at this point that the same linguistic form of delusional context, namely the context-substitute, is arrived at through a different approach in the previous article.
Context Theory OE Schizophrenia CONCLUSION As a sequel to the previous article on schizophrenic thinking and speaking, patholinguistic analysis was first performed on schizophrenic comprehension and then on the schizophrenic interpersonal relation in dialogue. A development of the theory toward psychotherapy is now in order, since
557
it is within the dialogue situation that we usually encounter the schizophrenic for psychotherapeutic purpose. REFERENCE Ohira, K.:The Context Theory of Schizophrenia: A New Approach, Folia Psychiat Neurol Jap, 31: 139-147, 1977.
The Context Theory of Schizophrenia (Part 2) Ken Ohira, M.D. Department of Psychiatry, Medical Center at Koishikawa, University of Tokyo, Tokyo
INTRODUCTION This article is a supplement to a previous article on schizophrenic speech.’ Schizophrenic comprehension of speech will be explained patholinguistically in this article while the previous one dealt with schizophrenic expression. The schizophrenic’s interpersonal relationship can then be examined since the linguistic forms of both schizophrenic expression and comprehension will now be available. The basic method applied here is the same as that used in the previous article: a method based on abnormal speech instead of that based on normal speech. DEFINITION OF KEY WORDS Some key words should first be defined to clarify the subsequent argument. Verbal Context In the previous article, context was defined as follows: context is the relation between symbol and what-is-symbolized and is also the relation between thought and word. Conversely stated, these two pairs of elements are two different levels of a single relation, namely context. Such a definition is adequate for discussion focused on schizophrenic thinking and speaking activities. It should be noted at this point that the discussion in the previous article limited itself to a condition in which the schizophrenic alone was considered; we observed 1.
Received for publication Mar. 16, 1977.
him speaking and thinking, but not interacting with others. In this article, a situation of dialogue will be considered. In this situation, expression and comprehension will be the theme as two persons are exchanging words. Context is then defined as consisting of two forms: context of expression and context of comprehension. Context of expression is a context by means of which one speaks coherently. This is identical to the context in external speech discussed in the previous article. Context of comprehension is a context by means of which one comprehends another’s speech. This is precisely the process through which we learn by context. Let us consider the situation of dialogue. One is a speaker and the other a listener. Their roles are interchangeable and do actually interchange. In reaction to the speaker’s speech, a thought is formed within the listener. At the same time, the listener checks if his thought, thus formed, is consistent with the words of the other’s speech. If it is, it can be said that he is comprehending the speech. This can be paraphrased as follows. When this individual listens to the other, he accepts the other’s words into his thought through the action of comprehension. At the same time, he is verifying his own thought by comparing it with the other’s words through the action of confirmation. This relation between the thought of self and the words of the other is defined as the context of comprehension. The action of Comprehension is
K. Ohira
55 4
the turning of words into thought, while the action of confirmation is the reverse. These are illustrated in Fig. 1. Incidentally, a listener understands the meaning of a speaker's words in his own way. At the same time the listener checks, consciously and unconsciously, if his understanding of the words is consistent with that of the speaker. To paraphrase, the self relates the symbol used by the other to his concept of what-is-symbolized. At the same time he relates this what-is-symbolized to the symbol used by the other. This mutual relation between the what-is-symbolized of the self and the symbol of the other is also defined as the context of comprehension. This is illustrated in Fig. 2. To summarize, the context of comprehension is defined as follows: context of comprehension is the relation between the thought of self and the words of the other and is also the relation between the symbol of the other and what-is-symbolized of self. Conversely stated, these two pairs of elements are two different levels of a single relation, namely the context of comprehension.
2.
Substitute
It may seem more in line with reality to take the degree into consideration for the pathological relation between either one of the two pairs of elements defined in section one of this chapter, but such a consideration, in fact, has no effect other than to introduce ambiguity of the one examining the relation into the discussion. In the previous article, the presence or absence of a complete relation was first examined. The cases in which the degree came into question were included in the group without a complete relation. As a second step, a substitute action (e.g. hallucination of hearing) was then introduced with regard to this group. The substitute action was introduced in the place of the action proper (e.g. inner speech) merely to explain the existence of an incomplete relation. An element-substitute was introduced as the effect of each action-substitute. Next, the presence or absence of this element-substitute was checked. The cases without element-substitute were discarded in this check to leave all phenomena involving degrees in the substitute category. This concept of substitute also holds true in this article.
confirmation
CONTEXT CESSATION
I
thought ( s e l f )
L
word ( t h e o t h e r )
I
comprehension
Fig. 1
what-is-
0 Fig. 2
1. Case Presentation A 16-year-old senior high school student was brought to my clinic. His complaint was inability to attend school. It was learned that he had developed an olfactory hallucination that a bad odor emanated from his anus during junior high school years. He, however, managed to graduate and entered a senior high school which he became unable to attend in the middle of his first year. At the clinic, this patient received phenothiazine tranquilizing medication and regular psychotherapy. His chief problem was discovered to be
Context Theory of Schizophrenia inability to go out of his house. He gave the following reasons for this condition: “They make a fool of me outside” and “I also end up making fools of them.” He also mentioned another pathologic experience which occurred both at home and outside: “They say queer things. T don’t understand why they say things like that.” He also had hallucination of hearing (inner speech-substitute): “T hear them talking about me while T am listening to records on a headset.” No blocking of words (external speech cessation) was observed during interviews. On the other hand, blocking of thought occurred often when he was trying to answer questions put to him. He would explain, “Oh . . . my thought has just stopped.” (inner speech cessation) One day he said, “Sometimes I can’t understand what others are talking about.” (“You can’t understand?”) “No, T suddenly miss words.” (“You don’t hear?”) “Yes, I hear them OK . . . but that’s all. Their meanings don’t come across to me.” His mother brought a letter from him addressed to me on one occasion when his fear of going outside was strong enough to prevent him from coming to the clinic. The letter contained the following part. “When I listen to others, T hear (for example) the word ‘mama’ when it is really ‘mugo’ (Japanese: grandchild) . . . sometimes I also hear a different word when it does not even sound similar to the actual word.” (Parentheses are added by the author.)
2.
Discussion The above patient explains that “I hear them OK’ but “their meanings don’t come across to me.” He is aware that “others are talking” but he would admit that “1 suddenly miss words.” We can deduce from this explanation that he hears the sounds of the words of others but he does not always grasp their meanings, and that he notices that words are uttered but he cannot always accept them into his thought stream. To paraphrase, the
555
normal relations between thought and word and between symbol and what-is-symbolized are not maintained here, which is to say the context of comprehension ceases in this patient. Context cessation will be examined at the two levels of context of comprehension in the following discussion. At the level of thought and word, the cessation of context refers to that of comprehension and of confirmation (Fig. 1). As for cessation of comprehension, two opposite phenomena are found to occur from the case presented above: One is to “miss words” (incomprehension), while the other is to “hear a different word” (misapprehension). The former is only a cessation of comprehension. In contrast, the latter can be called a comprehension-substitute since it occurs as a substitute of comprehension. The logical basis of this substitute concept is described in the chapter on definition. As for the cessation of confirmation, two opposite phenomena are again found to occur from the above case: One is that in which the patient is not aware of his incomprehension or misapprehension, while the other is that in which he is aware of it. The former is manifested in the patient’s speech: “They say queer things. T don’t understand why they say things like that.” The latter is manifested in his letter in which he himself describes an example of misapprehension. As above, the former is called cessation of confirmation and the latter confirmation-substitute. When comprehension-substitute is the case, pathologic phenomena do take place at the level of symbol and what-is-symbolized as shown in the patient’s letter. Assonance (“mama” and “mago”) and collapsed concept (“a different word”) are found to occur. INTERPERSONAL RELATION IN DIALOGUE
The linguistic forms of schizophrenic ex-
556
pression were described in the previous article. Those of schizophrenic comprehension have been presented in this article. Now that all phenomena concerning schizophrenic verbal exchange have been systematically formulated, a discussion on dialogue involving the schizophrenic becomes feasible. Form of Relation First, the interpersonal relation of dialogue between two normal individuals will be considered. One expresses himself according to the context of expression and comprehends the other according to the context of comprehension. The relation of self with the other can thus be represented as in Fig. 3. It should be noted at this point that the participants in this relation are interchangeable and do interchange in dialogue. Let us assume this relation to be normal for the time being. Then how does this differ from the form of relation involving a schizophrenic? Suppose this normal relation ceased to be, which would be the only conceivable situation in an abnormal relation. Both contexts would also have ceased to exist (see “context cessation” in the previous chapter). If some kind of dialogue, though pathologic, is to be feasible between a schizophrenic and the other under this condition, the schizophrenic must have new contexts which enable him to express himself and to comprehend the other. These new contexts are pathologic and are substitutes for the original contexts. The new relation thus formed by the context-substitutes is a pathologic one. The logical basis of the substitute conCopt is explained in the chapter on definition. The above discussion centers on a schizophrenic, which is to say a schizophrenic is placed at the “self” position in Fig. 3. This form of relation, therefore, reflects the subiective position of a schizophrenic in a dialogue relation. On the other hand, a similar argument holds true when a normal person is the “self” and a schizophrenic “the other” in 1.
K. Ohira
Fig. 3. The new relation formed by the context-substitutes is again pathologic although the person of “self” is normal. This form of relation reflects this person’s subjective position in a dialogue relation with a schizophrenic, which is expressed by such reactions as: “What nonsense he is talking!” and ‘‘I also find myself talking such nonsense to him.”
context of expression
n
self
I
JI
the other
I
Fig. 3
2.
Delusion : Patient’s Position in Relation Again, the context-substitutes are the only contexts that enable a patient to maintain the self-other relation. This self-other relation is pathologic. We can find examples of a patient’s position in the self-other relation in the case presented earlier: “They make a fool of me outside,” and ‘‘I also end up making fools of them.” The former shows, as far as he comprehends, that the others are making a fool of him, while the latter shows that he feels his expressions are making fools of others. Here, we understand that the substitute for context of comprehension is acting in the former instance and the substitute for context of expression in the latter. Both these context-substitutes are acting as delusional contexts that relate others to self. It should be noted at this point that the same linguistic form of delusional context, namely the context-substitute, is arrived at through a different approach in the previous article.
Context Theory OE Schizophrenia CONCLUSION As a sequel to the previous article on schizophrenic thinking and speaking, patholinguistic analysis was first performed on schizophrenic comprehension and then on the schizophrenic interpersonal relation in dialogue. A development of the theory toward psychotherapy is now in order, since
557
it is within the dialogue situation that we usually encounter the schizophrenic for psychotherapeutic purpose. REFERENCE Ohira, K.:The Context Theory of Schizophrenia: A New Approach, Folia Psychiat Neurol Jap, 31: 139-147, 1977.
