THE LANGUAGE OF PSYCHOTHERAPY: METAPHOR, AMBIGUITY, WHOLENESS

ABSTRACT Psychoanalysis is approached from the perspective of linguistics. It is argued that analysis is concerned with a type of communication different in nature and logic from that of the natural sciences. The characteristics of analytic language are illustrated by comparing poetry and psychoanalysis. Transference is discussed as a special type of metaphor; ambiguity is seen as an intrinsic aspect of aesthetic language; wholeness is held to be a goal of both therapy and the arts. The relevance of this view to recent findings in neurophysiology and ethology is discussed.     

Multilingual healthcare communication: Stumbling blocks,solutions, recommendations

ObjectiveTo provide guidance on multilingual and language discordant healthcare communication.DiscussionWe provide a critical reflection on common stumbling blocks to securing (professional) language support, as well as on the currently available solutions to language discordance in healthcare. We discuss issues pertaining to i) the assessment of the patient and healthcare professional’s language proficiency, ii) the decision making on whether to seek language support, iii) the currently available options of language support and the development of skills that ensure their effective use, iv) the inclusion of professional interpreters in the interprofessional healthcare team, and v) the transition from single- to integrated language support solutions that allow for a more comprehensive approach to multilingual healthcare communication. We present a set of recommendations for good practice.ConclusionUnderstanding the needs, capabilities and shortcoming of the available language- support solutions and the implications arising from them can enable decision makers to make informed decisions that ensure the quality of communication and care. The integrated use of language-support solutions at different stages of care can create the conditions for effective communication, while promoting patient and family participation in the decision making process. Evidence-based interventions that can inform the implementation of solutions are required.     

A Comparison of Receptive-Expressive Language Profiles between Toddlers with Autism Spectrum Disorder and Developmental Language Delay

Purpose

It is well known that expressive language impairment is commonly less severe than receptive language impairment in children with autism spectrum disorder (ASD). However, this result is based on experiments in Western countries with Western language scales. This study tries to find whether the result above is applicable for toddlers in a non-Western country; more specifically, in Korea with non-Western language scales.

Materials and Methods

The participants were 166 toddlers aged between 20 months and 50 months who visited the clinic from December 2010 to January 2013. The number of toddlers diagnosed as ASD and developmental language delay (DLD) was 103 and 63, respectively. Language development level was assessed using Sequenced Language Scale for Infants (SELSI), a Korean language scale. Using SELSI, each group was divided into 3 sub-groups. Moreover, the group difference by age was observed by dividing them into three age groups. Chi-square test and linear-by-linear association was used for analysis.

Results

Receptive language ability of the DLD group was superior to that of the ASD group in all age groups. However, expressive language ability in both groups showed no difference in all age groups. A greater proportion of expressive dominant type was found in ASD. The 20-29 months group in ASD showed the largest proportion of expressive language dominant type in the three age groups, suggesting that the younger the ASD toddler is, the more severe the receptive language impairment is.

Conclusion

These findings suggest that receptive-expressive language characteristics in ASD at earlier age could be useful in the early detection of ASD.     

Language, gesture, and the developing brain

Do language abilities develop in isolation? Are they mediated by a unique neural substrate, a “mental organ” devoted exclusively to language? Or is language built upon more general abilities, shared with other cognitive domains, and mediated by common neural systems? Here, we review results suggesting that language and gesture are “close family”, then turn to evidence that raises questions about how real those “family resemblances” are, summarizing dissociations from our developmental studies of several different child populations. We then examine both these veins of evidence in light of some new findings from the adult neuroimaging literature and suggest a possible reinterpretation of these dissociations as well as new directions for research with both children and adults. © 2002 Wiley Periodicals, Inc. Dev Psychobiol 40: 293–310, 2002. DOI 10.1002/dev.10034     

William preyer (1841–1897) and his neuropsychology of language acquisition

In his 1882/1889 book, The Mind of the Child, William Preyer proposed a neuropsychological model of language acquisition that described the gains and losses involved in the normal development of language and that diagramed the functional brain centers likely to mediate developmental language change. The book analyzed language development in terms of the incremental growth of neural associations like those in the wiring diagrams late‐nineteenth century aphasiologists used to express the relationships among adult aphasic symptoms; discussed language acquisition as the mirror image of adult aphasic language dissolution; and described detailed longitudinal observations on the language of Preyer's son, Axel, in the first 3 years of life. For those aspects of child language that seemed to be incrementally acquired, Preyer plausibly suggested real or hypothetical fiber tracts that might mediate immature language by virtue of being incompletely developed. But Preyer also stressed the fact that child language involved a series of active transformations of linguistic input, making it qualitatively as well as quantitatively different from that of the adult. He did not attempt to relate these developmentally distinct and changing features of child language to the heuristic neurology of adult aphasia. Preyer's work bears reexamination because no modern neuropsychological model of language development has yet solved the problem posed by his work: how to characterize the changing neural basis of a volatile language acquisition system.     

The mirror brain, concepts, and language: The price of anthropogenesis

This article presents a review of cognitive evolution and the question of the origin of language and consciousness. Questions of the genetic history of Homo sapiens are considered, along with basic concepts and their relationship to sensory experience. The questions of the location of higher functions and the organization of metarepresentations in health and pathology are discussed. __________ Translated from Rossiiskii Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 92, No. 1, pp. 84–99, January, 2006.     

Discourse connectedness in manic and schizophrenic patients: associations with derailment and other clinical thought disorders

The language performance of hospitalised manic ( n = 12) and schizophrenic (n=15) patients was compared in order to test hypotheses based on previous models of communication disorder in these patient groups. It was hypothesised that the derailments of manic and schizophrenic patients were discriminable by virtue of differences in the level of connectedness of the speech during this type of language disorder. Previous hypotheses have suggested that manics derail because they discuss multiple concurrent topics and schizophrenics derail as a pattern of general vagueness and poorly interconnected speech. These hypotheses were supported by the finding that manic patients manifested a higher level of overall discourse connectedness during derailments, even when the overall increased amount of speech was accounted for. Manics were not simply more competent overall, because they failed to differ from schizophrenics in their discourse connectedness during nondisordered segments. These results are discussed in terms of their implications for clinical and linguistic differentiation of the language of psychotic patients.     

Discourse Connectedness in Manic and Schizophrenic Patients: Associations with Derailment and Other Clinical Thought Disorders

The language performance of hospitalised manic (n = 12) and schizophrenic (n=15) patients was compared in order to test hypotheses based on previous models of communication disorder in these patient groups. It was hypothesised that the derailments of manic and schizophrenic patients were discriminable by virtue of differences in the level of connectedness of the speech during this type of language disorder. Previous hypotheses have suggested that manics derail because they discuss multiple concurrent topics and schizophrenics derail as a pattern of general vagueness and poorly interconnected speech. These hypotheses were supported by the finding that manic patients manifested a higher level of overall discourse connectedness during derailments, even when the overall increased amount of speech was accounted for. M anics were not simply more competent overall, because they failed to differ from schizophrenics in their discourse connectedness during nondisordered segments. These results are discussed in terms of their implications for clinical and linguistic differentiation of the language of psychotic patients.     

Language processing from the perspective of electrical stimulation mapping

ABSTRACT

Electrical Stimulation (ES) is a neurostimulation technique that is used to localize language functions in the brain of people with intractable epilepsy and/or brain tumors. We reviewed 25 ES articles published between 1984 and 2018 and interpreted them from a cognitive neuropsychological perspective. Our aim was to highlight ES as a tool to further our understanding of cognitive models of language. We focused on associations and dissociations between cognitive functions within the framework of two non-neuroanatomically specified models of language. Also, we discussed parallels between the ES and the stroke literatures and showed how ES data can help us to generate hypotheses regarding how language is processed. A good understanding of cognitive models of language is essential to motivate task selection and to tailor surgical procedures, for example, by avoiding testing the same cognitive functions and understanding which functions may be more or less relevant to be tested during surgery.     

Navigating Language Games Around Psychosis

Psychoanalytic work can help people meaningfully engage with aspects of psychotic experience which feel overwhelming. However, such contact is only possible if we offer a practice that is acceptable to both potential patients, and the family, team and social groups they exist within. As a psychoanalytic community we are failing to do this, partly because of the political terrain, but also due to our perceived unapproachability. I argue that the type of tentative, humble positions advocated by approaches such as ‘open dialogue’ allows psychoanalytic techniques to be more palatable to those experiencing psychosis. This is especially important given how language functions in psychosis, and the histories of intrusion and oppression that language interacts with. Clinical material from work with a female patient suffering from paralysing visual hallucinations is discussed, with a particular emphasis on how contact was only possible once certain discourse knots were deconstructed. Such work requires giving up some traditional ideas around technique in the interest of serving one of the most disenfranchised client groups.     

Defining the broader phenotype of autism: genetic,brain, and behavioral perspectives

Achieving progress in understanding the cause, nature, and treatment of autism requires an integration of concepts, approaches, and empirical findings from genetic, cognitive neuroscience, animal, and clinical studies. The need for such integration has been a fundamental tenet of the discipline of developmental psychopathology from its inception. It is likely that the discovery of autism susceptibility genes will depend on the development of dimensional measures of broader phenotype autism traits. It is argued that knowledge of the cognitive neuroscience of social and language behavior will provide a useful framework for defining such measures. In this article, the current state of knowledge of the cognitive neuroscience of social and language impairments in autism is reviewed. Following from this, six candidate broader phenotype autism traits are proposed: (a) face processing, including structural encoding of facial features and face movements, such as eye gaze; (b) social affiliation or sensitivity to social reward, pertaining to the social motivational impairments found in autism; (c) motor imitation ability, particularly imitation of body actions; (d) memory, specifically those aspects of memory mediated by the medial temporal lobe-prefrontal circuits; (e) executive function, especially planning and flexibility; and (f) Language ability, particularly those aspects of language that overlap with specific language impairment, namely, phonological processing.     

Infant-mother attachment security,contextual risk,and early development: a moderational analysis

In light of evidence that the effects of attachment security on subsequent development may be contingent on the social context in which the child continues to develop, we examined the effect of attachment security at age 15 months, cumulative contextual risk from 1 to 36 months, and the interaction of attachment and cumulative risk to predict socioemotional and cognitive linguistic functioning at age 3 years, using data from the National Institute of Child Health and Human Development Study of Early Child Care. Results indicated that early attachment predicts both socioemotional development and language skills, but not cognitive functioning as indexed by a measure of school readiness, and that the effect of attachment on socioemotional development and expressive language varied as a function of social-contextual risk. Insecure-avoidant infants proved most vulnerable to contextual risk, not children classified as secure or insecure more generally, although in one instance security did prove protective with respect to the adverse effects of cumulative contextual risk. Findings are discussed in terms of risk and resilience and in light of the probabilistic nature of the relation between early attachment and later development.     

Preadolescent girls with attention-deficit/hyperactivity disorder: I. Background characteristics,comorbidity, cognitive and social functioning,and parenting practices

This study investigated a diverse sample of girls (6-12 years of age) with attention-deficit/hyperactivity disorder (ADHD), combined type (n = 93) and inattentive type (n = 47), plus age- and ethnicity-matched comparison girls (n = 88), who participated in research summer programs. Speech and language problems, grade retention, and adoption characterized the ADHD sample; documented abuse characterized the combined type. Girls with ADHD showed dysfunction in terms of externalizing and internalizing behaviors and comorbidities, cognitive and academic performance, authoritarian parenting, and peer status. The inattentive type was more socially isolated but less rejected by peers than the combined type. ADHD-related impairment was independent of age and disruptive comorbidity. Further examination of processes related to psychopathology and competencies in girls with ADHD is needed.     

An examination of the language construct in NIMH's research domain criteria: Time for reconceptualization!

The National Institute of Mental Health's Research Domain Criteria (RDoC) Initiative “calls for the development of new ways of classifying psychopathology based on dimensions of observable behavior.” As a result of this ambitious initiative, language has been identified as an independent construct in the RDoC matrix. In this article, we frame language within an evolutionary and neuropsychological context and discuss some of the limitations to the current measurements of language. Findings from genomics and the neuroimaging of performance during language tasks are discussed in relation to serious mental illness and within the context of caveats regarding measuring language. Indeed, the data collection and analysis methods employed to assay language have been both aided and constrained by the available technologies, methodologies, and conceptual definitions. Consequently, different fields of language research show inconsistent definitions of language that have become increasingly broad over time. Individually, they have also shown significant improvements in conceptual resolution, as well as in experimental and analytic techniques. More recently, language research has embraced collaborations across disciplines, notably neuroscience, cognitive science, and computational linguistics and has ultimately re‐defined classical ideas of language. As we move forward, the new models of language with their remarkably multifaceted constructs force a re‐examination of the NIMH RDoC conceptualization of language and thus the neuroscience and genetics underlying this concept. © 2016 The Authors. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published by Wiley Periodicals, Inc.

     

Language learning impairments: integrating basic science, technology, and remediation

One of the fundamental goals of the modern field of neuroscience is to understand how neuronal activity gives rise to higher cortical function. However, to bridge the gap between neurobiology and behavior, we must understand higher cortical functions at the behavioral level at least as well as we have come to understand neurobiological processes at the cellular and molecular levels. This is certainly the case in the study of speech processing, where critical studies of behavioral dysfunction have provided key insights into the basic neurobiological mechanisms relevant to speech perception and production. Much of this progress derives from a detailed analysis of the sensory, perceptual, cognitive, and motor abilities of children who fail to acquire speech, language, and reading skills normally within the context of otherwise normal development. Current research now shows that a dysfunction in normal phonological processing, which is critical to the development of oral and written language, may derive, at least in part, from difficulties in perceiving and producing basic sensory-motor information in rapid succession – within tens of ms (see Tallal et al. 1993a for a review). There is now substantial evidence supporting the hypothesis that basic temporal integration processes play a fundamental role in establishing neural representations for the units of speech (phonemes), which must be segmented from the (continuous) speech stream and combined to form words, in order for the normal development of oral and written language to proceed. Results from magnetic resonance imaging (MRI) and positron emission tomography (PET) studies, as well as studies of behavioral performance in normal and language impaired children and adults, will be reviewed to support the view that the integration of rapidly changing successive acoustic events plays a primary role in phonological development and disorders. Finally, remediation studies based on this research, coupled with neuroplasticity research, will be presented.     

Speech,language, and feeding phenotypes of SATB2-associated syndrome

SATB2-associated syndrome (SAS) is a recently identified disorder characterized by neurodevelopmental deficits and craniofacial anomalies. Assessments of speech, language, and feeding-related issues were conducted among 61 individuals with SAS (median age = 86 months, range = 26 months to 29 years of age). Individuals with SAS were mostly non-verbal communicators (72.1%) with severe deficits in both language comprehension and expression. The majority of individuals had receptive vocabulary skills of a child younger than 3 years of age. Based on parent report, the average spoken lexicon was 28.6 (SD = 84.6, n = 55) with a range of 0 to 500 (median = 5 words). All of the individuals with SAS with enough verbal ability either showed signs of childhood apraxia of speech or already had a diagnosis (n = 40) and 73.3% exhibited problems with reliable communication with unfamiliar partners. Hypernasal resonance (17.8%) due to velopharyngeal insufficiency secondary to a history of cleft palate and/or apraxic palatal movement (60.0% of hypernasal patients with no history of cleft palate), problems with chewing (68.2%), overstuffing the mouth with solids (64.9%), pharyngeal phase dysphagia (60.8%), and sialorrhea (63.3%) were common in this population. Mutation type was not predictive of receptive or expressive language abilities. We developed language and communication treatment recommendations based on these findings.     

Clinical phenomenology, somatic symptoms, and distress in Hispanic/Latino and European American youths with anxiety disorders.

This study compared clinic-anxious Hispanic/Latino and European American youths (ages 6 to 17 years old) along sociodemographic and clinical variables. Groups were relatively similar, although significant differences emerged as a function of ethnocultural and language choice (English, Spanish) used during the assessment. Within the English language choice group, Cuban American (CA) youths reported somatic symptoms as less distressing than non-Cuban American Hispanic/Latino (non-CA/HL) youths. Conversely, within the Spanish language choice group, CA youths reported somatic symptoms as more distressing than non-CA/HL youths. Also, parents in the European American and CA groups reported their youths as having less somatic symptoms than parents in the non-CA/HL group. Implications of findings are discussed, particularly regarding possible cultural significance of somatic symptoms.     

Bilingualism, brain injury, and recovery: implications for understanding the bilingual and for therapy

Psychologists and other therapists are seeing an increasingly large number of bilingual individuals. Such clients are a special challenge when there has been some type of brain injury or disease because of the seemingly unpredictable effect such disorders may have on language skills, impacting either or both of the client's languages and interfering with internal speech that plays a role in higher cognitive functions such as insight and awareness. While there are many clinical assumptions about which language will show the least impairment or recover the best, such suppositions based on clinical lore are often contradictory. A review of the literature finds that the outcome of brain injury may be influenced by factors such as cerebral representation of a secondary language, method of language acquisition, age of acquisition, premorbid language proficiency, and style of learning in an individual. Neuropsychological concepts that can explain these findings are examined, along with their implications for therapy, and rehabilitation.     

High‐level language competencies and Theory of Mind in a group of children with Klinefelter syndrome

Klinefelter syndrome (KS) is a genetic anomaly involving the presence of one or more supernumerary X chromosomes in male individuals. In the cognitive profile of these individuals, strengths are found in nonverbal abilities, whereas weaknesses are observed in executive function, language, and academic performance. Our study is based on a comparison between eight children diagnosed with KS (47,XXY) (age range: 9–13 years; IQ range: 80–123), with no delay in language development, and eight typically developing (TD) controls. We explored a range of high‐level language competencies and Theory of Mind (ToM) in addition to basic language competency. High‐level language competencies were assessed by a battery that measures pragmatic language skills and a metaphor comprehension test (MCT). To assess ToM, we administered the corresponding subtest of the NEPSY II. Basic language competence was assessed by the NEPSY II Comprehension of Instructions subtest. Although basic language performance did not differentiate the individuals with KS from the TD controls, relevant differences appeared in some of the high‐level language competencies as well as in the ToM task. All tasks in which the individuals with KS performed less well were characterized by complex inferential processes. Some possible clinical and educational implications are discussed.