Can’t Talk Won’t Talk

It’s a familiar scenario to those of us working with people diagnosed with schizophrenia.  The person whose conversations are becoming characterised by short question and answer sessions.  Who seems unable to give more than the most basic information.  Who is increasingly uncomfortable in social situations and appears to want to get out of conversations as quickly as possible.  But do we really know the reasons why, and does having a diagnosis of schizophrenia affect how the person’s communication difficulties are perceived and interpreted by mental health professionals?

How likely are we to attribute poor conversational skills to poor motivation because it is considered one of the negative symptoms of schizophrenia? And how many of us regularly accept these communication difficulties as part of the condition and therefore not seek ways to address them?

The language difficulties experienced by people with schizophrenia have been well documented, and the descriptive label “schizophasia” has been used by some; drawing parallels between the language features of schizophrenia and the language disorder aphasia most commonly associated with stroke or head injury. Individuals with schizophrenia can experience a wide range of communication difficulties which impact on their verbal expression and comprehension skills, and if we put ourselves in their shoes we can begin to understand the complexity of the can’t talk vs won’t talk issue.

How would your interaction patterns change if you started to lose the ability to easily form sentences?  If you constantly experienced that “it’s on the tip of my tongue” sensation?  If you had to use all your concentration just to process one sentence?  How motivated would you be to engage in conversation?

Speech and Language Therapy has a valuable role to play in assessing and describing the communication difficulties an individual is experiencing, as well as providing intervention or advising on strategies which can support the person to communicate more effectively and this has benefits for us all.  As one of my clients explained “If I hadn’t started coming to see the Speech Therapist I reckon I’d just have stayed the same or worse…it makes it easier to talk to others [and] it’s made it easier to communicate with the other professionals I see”.


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