The opening of dialog and meaning: a pragmatic perspective on intersubjective rationality in the potential initial prodromal stage and early stages of schizophrenia

Abstract

A propensity to refer to facts in a fictional context (for example, with a first-person reference: “I think they are getting ready to sleep”) was found among patients in early stages of schizophrenia. Facts in fiction are, however, not immediately relevant since the narrator is usually transparent and the story “tells itself” (e.g., “they are getting ready to sleep”). A control group’s narratives were conventional in this sense. The aim here is to discuss the patient’s references to facts from a pragmatic perspective; as verbal activity types related to the conversational maxims, and especially as related to the discursive problematization of the usually presupposed basic validity conditions of speech. This method of using activity types as a perspective limits the extremely broad concept of “context” which might otherwise have introduced an abundance of inseparable, extrinsic, and always potential aspects of contextual influence. It is concluded that the patients occasionally hyper-comply with the conversational maxims, and recurrently problematize the validity conditions. Basically, the patients’ references to facts open the dialog with the researcher or open the interpretive meaning of the story, and, to a minor degree, the patients sometimes “close” the interpretive meaning by adding supportive argumentative evidence.

Keywords:

• Prodromal schizophrenia
• first-admission schizophrenia
• discourse analysis
• conversational maxims
• narratives
• contextual inappropriateness
• first episode psychosis

Notes on contributor

Charlotte Petersen is currently a postdoc researcher at Roskilde University in Denmark. She earned her PhD degree in linguistics at Roskilde University collaborating with a research project on early identification and intervention in schizophrenia. Her current research is also interdisciplinary targeted: a theoretical analysis of context as well as an empirical evaluation of facts in fiction in the potential initial prodrome and early stages of schizophrenia. The author works with the continental-phenomenologically oriented psychiatry as well as functional linguistics, grammar, and in particular pragmatics and discourse analysis.

Acknowledgments

The examples from patients in this article are based on narratives collected in Denmark at Psychiatric Center Glostrup; Dr. med. Bent Rosenbaum has kindly given access to patients in connection with a research and treatment project about early intervention in potential initial prodromal patients and first-admission patients. In addition, Prof. Tor K. Larsen at the University Hospital in Stavanger has given access to narratives from patients with the same diagnosis.

Notes

¹ Data excerpts are coded by a letter indicating the potential initial prodrome and early stages of schizophrenia (P for prodromal, F for first episode, first admission, and L for longer duration). DK indicates the Danish corpus (my own) and K indicates data obtained from my control group.

² All participants, including the control group (n = 24), were tested at psychiatric hospitals. The prodromal patients (also called “at risk-mental states”) had symptoms which may precede a later development into schizophrenia. They were included if they were scored positive on the SIPS-criteria (McGlashan et al. 2001), or if showing a 30% reduction in social functioning as measured by the Global Assessment of Functioning Scale (Endicott et al. 1976), or in case of known genetic predisposition or schizotypal disorder. The other patient groups had a diagnosis of schizophrenia (ICD-10, WHO 1994). The control group (n = 24) had no history of psychiatric illness. Diagnosis and collection of narratives in Norway was undertaken by the research group at the University Hospital in Stavanger and the material, 81 narratives, was kindly lent to the Danish project. Diagnostics in Denmark were conducted as part of the research project “FOKUS-projektet” at the Psychiatric Center Glostrup with research leader Dr. med. Bent Rosenbaum. Collection of narratives in Denmark was undertaken by the author of this article at the Psychiatric Center Glostrup.

³ References to events before the first picture were either lexical (e.g., “the day before”) or shifts in grammatical tense (e.g., “once there was a boy, who had found a frog”), and correspondingly for events after the last picture (e.g., “the boy went home and would come again the next day”). The Danish project was initially corpus based, as data collection methods and participating groups were defined in advance, but the analysis of the narratives was corpus driven because the method of analysis changed according to the results – facts in fiction. The results were primarily tendencies, but a statistically significant correlation between proper names and direct speech was found; therefore, more “fictive” elements were analysed (e.g., anticipation and retrospection of events before the first picture and after the last). This tendency was not statistically significant.

⁴ Habermas relates rightfulness, truthfulness, and truth to regulative, expressive, and constative speech acts, respectively, and we can add to this that the narrative text presupposes these speech acts (Austin 1962).

⁵ There is no direct English equivalent to the class of Danish dialogical particles, which often makes it difficult to translate utterances that contain particles like vist (example 9). In some cases, a rendering through an English sentence adverbial is possible (nok in example 11 or dog in example 32).

⁶ There is some debate in argumentation theory about whether a claim constitutes argumentative evidence or whether it is “only” an additional description. However, because one claim in the examples can be causally related to another claim, I have used the term “argumentative evidence”.