What do we mean when we refer to a thought disorder? What does a thought disorder look or sound like and what is the significance of a thought disorder?
The L.A. Times has the video that led to Jared Loughner's suspension from Pima Community College last September. It's worth watching because it presents strong evidence of a thought disorder.
Incoherent, incomprehensible speech and writing frequently accompany psychotic disorders. These language disorders are assumed to be the outward manifestations of underlying disordered thinking. My first thought when I heard about the violence in Tucson was that it might be the work of a political enemy, a fired employee or a spurned suitor. As soon as I saw the Youtube videos, all of that changed.
In the most recently released video, his paranoid-ish references to mind-control, his idiosyncratic preoccupations with the relationship between currency and illegal war, his references to torture and the loss of free speech (somehow caused by a passerby) are thoughts that a psychotic person could have had 10 years ago, 20 years ago or 50 years ago. The reference to torture wasn't even about recent political discussions of torture. It refers to what is happening at Pima Community College.
The significance of Mr. Loughner's presentation was readily apparent to psychiatrists and psychologists who saw the Youtube videos last week. For example, check out the reader comment posted at 5:47 pm amid Andrew Sullivan's live blogging of speculation about the meaning of the rampage:
I'm a licensed psychologist with 20 years experience. I've watched the Jared Loughner Youtube videos. They show evidence of delusions of persecution. Loughner's less than coherent language also suggests a thought disorder. While Loughner can't be diagnosed without a full exam conducted in person, there are significant indications in the videos that he suffers from a psychotic disorder. I would not rule out drugs as a factor, but he is within the age range that psychotic patients often suffer their first psychotic break. If I had to guess, I'd go with paranoid schizophrenia. If that's the case, his politics are irrelevant. He may not even be fit to stand trial unless and until his psychotic thinking is brought under control with medication.
And also last Saturday afternoon, Jeff Kaye, at FireDogLake:
I am a licensed psychologist and from afar, and am not in the position to diagnose Mr. Loughner. However, one can make some initial impressionistic comments based upon the video content he posted on YouTube. The autistic, in the sense of highly encapsulated and personal, nature of his thought processes, his emphasis on coercion from without [see his discussion about being taught letters of the alphabet], the strange nature of his logic and language, the paranoid attitude toward the world in general, are consistent with known cases of schizophrenia, paranoid type… This is not the rambling of a right-wing crackpot, which some have claimed Loughner to be, but gibberish. This doesn’t take away from the possibility Loughner reacted to right-wing propaganda, but quite likely out of madness, not political motivation, such as we understand such motivation.
And last Sunday from a psychiatrist, 1 Boring Old Man:
Loughner’s ramblings follow a private logic and focus on ideas of influence - mind control, brain-washing, grammar control. In the early days when Schizophrenia was being defined, there were a number of criteria suggested for the diagnosis. Eugene Bleuler proposed "the four As" as primary symptoms - Autism [Private Logic], Associations [Tangential flow of thought], Affect [an Inappropriate Affect], and Ambivalence. Kurt Schneider introduced the "first rank" symptoms including certain kinds of hallucinations and ideas of influence or outside manipulation of thought. Victor Tausk wrote of the Influence Machine, the schizophrenic’s notion of how thoughts might be influenced from the outside. Loughner’s ramblings fit all of these criteria in a variety of ways.
You get the idea.
A list of some the signs and symptoms of thought disorder, lifted from Wikipedia, follow. As you read, you will notice that you hear some of these signs of thought disorder in Jared Loughner's speech.
Blocking - Interruption of train of speech before completion. e.g. "Am I early?", "No, you're just about on-" This is commonly seen when a joke is being told and the speaker forgets the punchline. At an extreme degree, after blocking occurs, the speaker does not recall the topic he or she was discussing. True blocking is a common sign of schizophrenia.
Circumstantiality - Speech that is highly detailed and very delayed at reaching its goal. Speaking about many concepts related to the point of the conversation before eventually returning to the point and concluding the thought. Excessive long-windedness. e.g. "What is your name?" "Well, sometimes when people ask me that I have to think about whether or not I will answer because some people think it's an odd name even though I don't really because my mom gave it to me and I think my dad helped but it's as good a name as any in my opinion, I think it's a little weird to have the same name as two of my other names, but the fact that I like it, is a good thing... but yeah, it's Tom."
Clanging - Sounds, rather than meaningful relationships, appear to govern words or topics. Excessive rhyming. e.g. "I'm not trying to make noise. I'm trying to make sense. If you can't make sense out of nonsense, well, have fun." "I heard the bell. Well, hell, I heard the bell."
Derailment (also Loose Association and Knight's Move thinking) - Ideas slip off the topic's track on to another which is obliquely related or unrelated. e.g. "The next day when I'd be going out you know, I took control, like uh, I put bleach on my hair in California."
Distractible speech - During mid speech, the subject is changed in response to a stimulus. e.g. "Then I left San Francisco and moved to... where did you get that tie?"
Echolalia - Echoing of one's or other people's speech that may only be committed once, or may be continuous in repetition. This may involve repeating only the last few words or last word of the examiner's sentences. This can be a symptom of Tourette's Syndrome. e.g. "What would you like for dinner?", "That's a good question. That's a good question. That's a good question. That's a good question."
Evasive Interaction - Attempts to annunciate ideas and/or feelings about another individual comes out as evasive or in a diluted form, e.g.: "I... er ah... you are uh... I think you have... uh-- acceptable erm... uh... hair."
Flight of Ideas - A sequence of loose associations or extreme tangentiality where the speaker goes quickly from one idea to another seemingly unrelated idea. To the listener, the ideas seem unrelated and do not seem to repeat. Often pressured speech is also present. e.g. "I own five cigars. I've been to Havana. She rose out of the water, in a bikini."
Illogicality - Conclusions are reached that do not follow logically (non-sequiturs or faulty inferences). e.g. "Do you think this will fit in the box?" draws a reply like "Well duh; it's brown isn't it?"
Incoherence (word salad) - Speech that is unintelligible because, though the individual words are real words, the manner in which they are strung together results in incoherent gibberish, e.g. the question "Why do people comb their hair?" elicits a response like "Because it makes a twirl in life, my box is broken help me blue elephant. Isn't lettuce brave? I like electrons. Hello, beautiful."
Loss of goal - Failure to show a train of thought to a natural conclusion. e.g. "Why does my computer keep crashing?", "Well, you live in a stucco house, so the pair of scissors needs to be in another drawer."
Neologisms - New word formations. These may also involve elisions of two words that are similar in meaning or in sound. e.g. "I got so angry I picked up a dish and threw it at the geshinker."
Perseveration - Persistent repetition of words or ideas. e.g. "It's great to be here in Nevada, Nevada, Nevada, Nevada, Nevada." This may also involve repeatedly giving the same answer to different questions. e.g. "Is your name Mary?" "Yes." "Are you in the hospital?" "Yes." "Are you a table?" "Yes."
Phonemic paraphasia - Mispronunciation; syllables out of sequence. e.g. "I slipped on the lice and broke my arm."
Pressure of speech - An increase in the amount of spontaneous speech compared to what is considered customary. This may also include an increase in the rate of speech. Alternatively it may be difficult to interrupt the speaker; the speaker may continue speaking even when a direct question is asked.
Self-reference - Patient repeatedly and inappropriately refers back to self. e.g. "What's the time?", "It's 7 o'clock. That's my problem."
Semantic paraphasia - Substitution of inappropriate word. e.g. "I slipped on the coat, on the ice I mean, and broke my book."
Stilted speech - Speech excessively stilted and formal. e.g. "The attorney comported himself indecorously."
Tangentiality - Replying to questions in an oblique, tangential or irrelevant manner. e.g.:
Q: "What city are you from?"
A: "Well, that's a hard question. I'm from Iowa. I really don't know where my relatives came from, so I don't know if I'm Irish or French.