Descriptive Psychopathology: The Signs and Symptoms of ...

235 Chapter 9: Disturbances in speech and language“Yes, I was dumb and numb then but not deaf, I know Mrs. Ida Teff, she is dead, probably anappendicitis; I don’t know whether she lost her sight, sightless Hesse, His Highness of Hesse,sister Louisa, His Highness of Baden, buried and dead on September the 20th 1907, when I getback, red–gold–red ...”. 17Looseness-of-association is another term linked to the diagnosis of schizophrenia.Bleuler defined it as associations which lose their continuity and areincorrect, bizarre, and utterly unpredictable: Often thinking stops in the middle of a thought ...(blocking) instead of continuing the thought, new ideas crop up which neither the patient northe observer can bring into any connection with the previous stream of thought. 18Bleuler considered associational looseness a fundamental feature of schizophrenia,but his descriptions are also consistent with flight-of-ideas:Clang-associations receive unusual significance as do indirect associations ... the tendency tostereotypy produces an inclination to cling to one idea ...blocking ...echopraxia ...pressureof thoughts ... increased flow of ideas 19 ... “pressure of thoughts” can continue for years ...many patients complain that they think too much, that their ideas chase each other in theirheads. They themselves speak of “thought-overflow” ... because too much comes to mind atone time. 20Bleuler attempted to distinguish flight-of-ideas from looseness of associationsby claiming that the associational leaps in flight-of-ideas can usually be understoodwhile in looseness of associations the steps are unintelligible or appearso “bizarre that they would never have entered his [the examiner’s] mind.” 21He offers the examples of a patient referring to Brutus as an Italian rather thana Roman, and a patient who in response to the query “Are your thoughts heavy?”said “Yes, iron is heavy.” 22 Thus, if the examiner understands the associationalleaps the speech is flight-of-ideas, whereas if the examiner cannot understand theleaps, the speech is looseness of associations. This reliance on examiner idiosyncraticabilities, however, insures poor reliability. For example, Bleuler considersthe phrase “Blossom time of Horticulture” from a patient as incomprehensibleand thus looseness of associations and the patient to be schizophrenic. 23 From anaphasiologist’s perspective, however, the phrase can be understood as meaning“springtime” and an out-of-class paraphasia or private word usage (see formalthought disorder below) and has several diagnostic implications.Bleuler offers the following letter from a patient to his mother as a classicillustration of what he means by looseness of associations. But it best illustratesflight-of-ideas.Dear Mother: Today I am feeling better than yesterday. I really don’t feel much like writing. ButI love to write to you. After all, I can tackle it twice. Yesterday, Sunday, I would have been sohappy if you and Louise and I could have gone to the park. One has such a lovely view from