A prominent feature of schizophrenia is disorganized speech, also known as loose association. In psychotically disorganized speech, words are not linked together based on the normal rules of language, but are strung together based on sounds, rhyme, puns, or free associations. Although everyone makes speech errors, especially when they’re tired or stressed, psychotically disorganized speech is obviously abnormal, and is difficult or impossible to understand.
Here is a verbatim transcript of a portion of the report of a schizophrenic patient. It's from Albert Rothenberg's book, Creativity and Madness:
"I've never been confused as much as I have been recently. Confusion was nothing to me. It was fun. I loved art. I loved to have my hands in every single thing I could get them in. And when I'm here I don't have the facilities to dig in the garden . . .
. . . and put my feet in the mud and I just can't stand that . . . feeling. I, I need to be free like most of us do, because I feel like a bird when I'm skiing, I feel like I could fly if I really tried but I wouldn't try because -- hee, hee -- it's beyond my power. Maybe someday they'll perfect it so that a person can fly without . . . walking. But they better hurry up! Because there's too many guys on the road right now."
The disorganized speech of the schizophrenic reflects the patient's inability to comprehend abstractions. The schizophrenic's inability to comprehend abstract ideas is also seen in the patient's use of concrete thinking.
Concrete thinking is a problem associated with various psychiatric disorders such as schizophrenia. It is defined as the inability to think in abstract terms. Abstractions and symbols are interpreted superficially without fact, finesse or any awareness of nuance. The person is unable to free himself from what the words literally mean. In the process, the patient's thinking excludes more abstract ideas.
In Creativity: The Magic Synthesis, the late Silvano Arieti, M.D., an expert in schizophrenia and creativity studies, wrote: "One patient had the delusion that his wife put poison in his food. He actually used to think that his wife "poisoned" his life. The abstract poisoning then became a concrete and specific one; a concept was transformed into an object, a chemical poison. In this respect the schizophrenic is similar to the dreamer, the fine artist, and the poet, all of whom transform abstract concepts into perceptual images. It is not implied that in the fine artist, the dreamer, or even the schizophrenic, the capacity to think abstractly is lost. The schizophrenic uses the concrete representation as a psychological defense, the creative person . . . uses it for aesthetic or scientific purposes."
Even an experienced mental health professional can misdiagnose a creative person's word usage with that of the schizophrenic. The psychoanalyst Carl Jung, for example, was convinced, after reading Ulysses, that James Joyce had schizophrenia. In Ulysses, Joyce employs stream of consciousness, parody, jokes, and virtually every other established literary technique to present his characters.
Joyce's method of stream of consciousness, literary allusions and free dream associations was pushed to the limit in Finnegans Wake, which abandoned all conventions of plot and character construction and is written in a peculiar and obscure language, based mainly on complex multi-level puns. This approach is similar to, but far more extensive than that used by Lewis Carroll in Jabberwocky. This has led many readers and critics to apply Joyce's oft-quoted description in the Wake of Ulysses as his "usylessly unreadable Blue Book of Eccles" to the Wake itself. However, readers have been able to reach a consensus about the central cast of characters and general plot.
The ability to navigate the potential clang and confusion posed by abstract concepts and perceptual images is also seen in the psychoanalyst who attributes a tentative meaning to the puns and word associations communicated in the patient's psychoanalytic narrative.
A French patient in analysis (who no doubt spoke more than four words of French) reported the following dream: "My father and I are in a garden. I pick some flowers and offer him a bouquet of six roses." The analyst, in an attempt to bring out the patient's ambivalent feelings toward his father, tried to combine the positive connotations of the gift with the negative feelings he may have had about the fact that the father had died of alcoholism. He took advantage of the phonetic similarity between the six roses of the dream and the father's fatal illness--cirrhosis of the liver (the similarity in sound connecting six roses and cirrhosis is particularly evident in French)--and made the following reply: "Six roses or cirrhosis?"
At a superficial level the analyst's observation is indistinguishable from the schizophrenic's use of (and mis-interpretation of other people's apparent use of) word play as well as his inability to appreciate abstract ideas. In reality, the analyst's observation reflects his sophisticated appreciation of the use of word play by the patient to evade the censorship of forbidden thoughts. The analyst's interpretation is not a product of cognitive impairment, but rather an expression of his highly-developed cognitive skills repertoire. In addition, the analyst's attribution of a tentative meaning to the patient's narrative does not reflect cognitive impairment; rather, it is a product of the analyst's ability to defer judgment, a cognitive skill lacking in the schizophrenic.