Disorganized, Rapid Speech Is Not Necessarily Mental Illness

 Disorganized, Rapid Speech Is Not Necessarily Mental Illness

 Psychiatrists and other mental health professionals tend to think that if a person speaks rapidly then they have manic speech. They think that if their speech is tangential, then they must be psychotic. They tend to judge people by their speech, and then tell them that they have a thought disorder,and so they tried to get them to take a neuroleptic. Some even want you to take Risperdal. That's what it was like for me as a Dyslexic, Dyspraxic, ADHD person. They didn't know that my rapid, tangential speech was cluttering. They never stopped to consider that at all. They told me that I had some "slight thought disorder" and wanted me to take a neuroleptic. When I came back to mental hospital for depression, they made me take Risperdal because of my speech irregularities. These psychiatrists never asked if I had a history of speech therapy nor special education. I had intensive speech therapy in special education for my Dyslexia, Dyspraxia. It's very important that psychiatrists differentiate cluttering speech from speech stemming from mental illness like schizophrenia, bipolar. This type of speech runs in families, my mother told me that my father had speech problems that including stammering and stuttering. I read that they were the same, and so I asked my mother if my father cluttered. My mother told me "No", but I read my mother about the symptoms of cluttering, and my mom said that's what he did. My father was a clutterer like me, and he was diagnosed paranoid schizophrenic by prison psychiatrists. From what my mom told me, he was a neurodivergent. Understanding cluttering speech is very important. Many nonprofessionals can even misjudge clutterers too, and look at them like they are clueless and/or crazy because they are ignorant about this type of speaking.

page 59 of DSM-IV-TR Diagnostic Statistical Manual of Mental Disorders

The most common associated feature of Expressive Language Disorder in younger children is Phonological Disorder. There may also be a disturbance in fluency and language formulation involving an abnormally rapid rate and erratic rhythm of speech and disturbances in language structure (cluttering). When Expressive Language Disorder is acquired, additional speech difficulties are also common and may include motor articulation problems, phonological errors, slow speech, syllable repetitions, and monotonous intonation and stress patterns. Among school-age children, school and learning problems (e.g., writing to dictation, copying sentences, and spelling) that sometimes meet criteria for Learning Disorders are often associated with Expressive Language Disorder. There may be also be some mild impairment in receptive language skills, but when this is significant, a diagnosis of Mixed Receptive Language should be made.   A history of delay in reaching some motor milestones, Developmental Coordination Disorder, and Enuressis are not uncommon. Social withdrawal and some mental disorders such as Attention Deficit/Hyperactivity Disorder are also commonly associated. 

Expressive Language Disorder may be accompanied by EEG abnormalities, abnormal findings on neuroimaging, dysarthric or apraxic behaviors, or other neurological signs.

What is cluttering?

 Information compiled by Kathleen Scaler Scott, Florence Myers, Peter Kissagizlis

International Cluttering Association (ICA)

Cluttering is a communication disorder that affects one’s ability to convey messages to others in a clear and/or concise manner. Individuals with cluttered speech often report that their listeners have difficulty understanding them, and attribute this to factors such as their rate of speech, the clarity of their speech, and/or the organization or relevance of their message. Some who clutter have said they’ve often received such feedback as, “Slow down!”, “Don’t mumble” or “Where did that comment come from?”. 

 An interesting thing about cluttering is that unlike stuttering, many who clutter are unaware of their difficulties with communication. This is one reason many are not diagnosed with the disorder until adulthood. Another reason for the delay in diagnosis relates to the fact that cluttering is misunderstood among the public and professionals alike, and therefore those who clutter may be misdiagnosed as stutterers or “anxious speakers.” Adults who clutter have reported that in growing up, others have commented to them about “improving their communication,” but such comments tended to be vague, so the individual could never put his/her finger on what was causing this type of response. Cluttering can often co-exist with stuttering. 

It is important to understand that the definition of cluttering is a work in progress, and will likely be refined as we gain more information about this communication disorder. In the meantime, researchers gain a good deal of their information about cluttering from adults who are experiencing it. Some of the symptoms commonly observed by researchers and/or reported by adults who clutter are:  

Racing thoughts

Rapid and/or irregular rate of speech

Leaving off the ends of words

Omitting or distorting sounds or syllables (e.g., “elephant” becomes “elphant”; “orange” becomes “orng”)

Words sound as if they are “running into each other”

Lots of starts and stops in speaking

Excessive use of disfluencies such as “um”, “uh”, repeating or revising phrases, or repeating words; unlike stuttering, these disfluencies are not accompanied by struggle behaviors or muscular tension

Difficulty organizing thoughts and/or getting to the point

Limited awareness of how one’s speech sounds to others

Difficulties slowing down even when asked to do so

Tendency to interrupt conversational partner

Words or ideas come out differently than intended 

There are other difficulties which have been identified by those who clutter. Research is currently in progress to determine whether these symptoms are a part of the disorder of cluttering, or simply other disorders that tend to co-occur with cluttering in some individuals. This is difficult to separate because everyone’s experience of cluttering is not the same. Some of these symptoms are: 

Difficulties with handwriting, i.e. legibility decreases with time

Difficulties sustaining attention for such activities as reading and/or small talk

Always “on the go”

Difficulties with typing words accurately, such as having to do excessive editing of email messages

Speech is often at its best in a structured situation in which the person is actively monitoring it, such as when being videotaped. Speech is often at its worst when the person is more relaxed. 

If you have some of the symptoms listed in this document, you may be experiencing cluttering. However, a definitive diagnosis of cluttering can only be made by a speech-language pathologist who has experience and expertise with this communication disorder. Cluttering may also co-occur with stuttering. Because cluttering and stuttering are closely related fluency disorders, a speech-language pathologist with expertise in the area of fluency disorders is often the ideal professional to diagnosis and/or treat a cluttering disorder. See our “Resources” section for further information on locating a specialist in your area.

 http://associations.missouristate.edu/ICA/

 page 47 to 49 from A SOLUTION TO THE RIDDLE OF DYSLEXIA(The DISCOVERY OF CEREBELLAR-VESTIBULAR SYNDROMES by Harold N. Levinson, MD

Occasionally, dyslexics manifested a "loose" and telescopic quality to their associative speech or thinking styles, and as a result tended to be rapid,wordy, and rambling in their spontaneous descriptions. This interesting speech pattern appeared independent of anxiety factors, and tended to resemble a schizophrenic's "loose associations" and tangential thinking. However, these dyslexic children were not psychotic, and lacked autistic preoccupation and projective thinking mechanisms. They merely seemed to forget momentarily the direction of their thought sequences and/or the thoughts and words themselves.  

Occasionally, the temporal spacing between words and sentences was shorter than normal and even dysmetric. 

Later studes noted nonpsychotic "absentminded" adult dyslexics to manifest similar loose,wordy, and rambling speech patterns ----clearly demonstrating the need to qualitatively and diagnostically distinguish dyslexic speech patterns from schizophrenic patterns (Kasaninin, 1964). Upon analysis, this loose, absent-minded dyslexic thinking style prone to slips was found to be due to the very same underlying memory, directional, and temporal spatial dyscoordination mechanisms characterizing dyslexic reading, writing, and spelling. 

Not infrequently these so-called absent-minded individuals intend to do say or do one thing and wind up saying or doing another, even the opposite of what was originally intended. Forgetting is commonplace. As a result, the dyslexic's speech and action patterns may often exhibit a disoriented and disjointed, even comical, quality, which many clinicians fallaciously consider due to primary psychogenic determinants. However, upon analysis, the dyscoordination or slip between intention and speech or motor response was most often found lacking a primary emotional causation, and appeared qualitatively consistent with the dyslexic symptomatology. In retrospect, these slips invariably provoked secondary emotional attempts at compensation; and the unsuspecting psychiatrist and psychologist will unwittingly mistake secondary defensive reaction with primary causation. For example, some dyslexics become embarassed, blush, and retreat socially as a result of their slips, while others attempt to joke and rationalize them away.

What Is Pressured Speech?

By Marcia Purse, About.com Guide  What Is Pressured Speech?

Answer: Pressured speech is a hallmark symptom of mania or hypomania in bipolar disorder (manic depression). In the American Psychiatric Association's Diagnostic and Statistical Manual IV (DSM-IV), pressured speech is used in combination with several other symptoms to confirm a diagnosis of bipolar disorder. In his glossary, Dr. Jacob L. Driesen defines pressured speech as "rapid, virtually nonstop, often loud and emphatic, seemingly driven, and usually hard to interrupt. It typically occurs in mania and in some drug-induced states and in severe anxiety states." In her book Bipolar Disorders, Mitzi Waltz uses the phrase "motormouth" to describe pressured speech. Pressured speech occurs in bipolar children as well as adults. Examples of Pressured Speech  "Pressured Speech" is just a fancy psychiatrist's term for a manicky person's tendency to talk really really fast. I've been told that I just have so many thoughts going through my head so fast and I am trying to fit them all into the words that I am saying at the same time that it doesn't work and that is why my speech comes out at a speed that is unintelligible to most people Joy Inside view: the ideas and associations are arriving thick and fast and if you're expressing them by talking to someone, the speech tends to be faster than usual, the idea content more dense, the apparent digressions more abundant and noticeable.  

http://bipolar.about.com/cs/faqs/f/faq_presspeech.htm

Flight of Ideas

By Marcia Purse, About.com Guide

Definition: Flight of ideas is one of the symptoms of bipolar mania as well as schizophrenia and ADHD. Some web definitions include:  a nearly continuous flow of rapid speech that jumps from topic to topic, usually based on discernible associations, distractions, or plays on words, but in severe cases so rapid as to be disorganized and incoherent. It is most commonly seen in manic episodes but may also occur in other mental disorders such as in manic phases of schizophrenia. 

Merck Source A nearly continuous flow or accelerated speech with abrupt changes from topic to topic, usually based on understandable associations, distracting stimuli, or plays on words. University of Michigan Medical Center. 

A continuous change of subject and thought content with little apparent connection among the topics and little external stimulation for the change. This may be one manifestation of attention-deficit/hyperactivity disorder (ADHD). Children With Challenges

 http://bipolar.about.com/od/maniahypomani1/g/gl_flightofidea.htm

 

The following is disorganized speech in schizophrenia from:

What are the Symptoms of Schizophrenia? 

 From Catherine Harrison, PhD, former About.com Guide

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. 

 http://schizophrenia.about.com/od/whatisschizophrenia/f/schiz_symptoms.htm