Background:
Formal thought disorder is an important although not pathognomonic clinical feature of schizophrenia. The clinical and neurocognitive literature on thought disorder, although vast, is limited to the extent that it draws on a model of thought that can be traced to the English Enlightenment and Locke's theory of ideas and their associations, itself based on his clinical experience and the influence of Newton's physics of atoms and forces. We propose an alternative model that draws on recent work in linguistics. By giving greater emphasis to the interactional aspects of language, it enables a sharper focus on thought disorder as an emergent property of conversation.
Methods:
Conversational interaction between patients with identified thought disorder and psychiatrist is analyzed. The analysis focuses on agency as it manifests in the management ofturn taking (drawing on conversational analytic techniques) and in transitivity structures within clauses (drawing on systemic functional grammar).
Results:
Patients are accomplished agents in the management of their part of turn taking. However, in representing themselves as agents in language, they transfer their agency onto other phenomena in their lived world, including inanimate objects and objects that are coined through neologisms.
Conclusions:
This novel method of investigating thought disorder as fraught conversational interaction provides for the possibility of sharpening the definition of thought disorder as a construct, with attendant benefits both for clinical detection and for neurobiological research.
