Bipolar 2 From Inside and Out

What Speech Reveals

What you say says a lot about you. How you say it matters too. You can take a simple sentence and change its meaning just by how you pitch your voice and what words you emphasize.

Try it: Say the sentence, “I want you to love me.” Emphasize the “I” and you’re saying, “I, as opposed to anyone else.” Emphasize “want” and you mean “I want it, even if you don’t believe it.” If you come down hard on “love,” you mean “I want love, not friendship.” An emphasis on “me” translates to “I want you to love me, not that other person.” It works for nearly any sentence: “Please close the door.” “You have my attention.” “Why don’t you care about me?” We translate these meanings naturally and internally, without really thinking about them.

Changes in language can certainly be revealing. In fact, there are several different kinds of speech that have a role in mental illness. They can be indicative of a certain kind of mental illness or of the way that a person is feeling. They can be used in diagnosis. They can be a way to better understand what a friend or loved one is going through.

Pressured speech

Pressured speech means that words seem to just tumble out, without much thought as to what is being said. The words come quickly, packed together like little freight trains of meaning that will zoom by if you don’t pay attention. Listening to pressured speech can be both confusing and overwhelming, difficult to understand.

Pressured speech is common in bipolar disorder, especially in manic episodes. People who are experiencing mania feel a compelling, urgent need to share thoughts, ideas, comments, or emotions. They don’t wait for replies, as one would in a normal conversation. They can also speak inappropriately loudly or at inappropriate times, such as in church or during a lecture or concert. Pressured speech can last for an hour at a time or even longer.

Because they are speaking so fast, people with pressured speech may even have difficulty expressing their own thoughts. There can be a lack of a clear thought process in what the manic person is saying, as they may talk about many things that don’t connect to each other. Their speech may include jokes or rhymes, song lyrics, and such.

It does no good to ask a person with pressured speech to slow down or stop talking. They may feel like they must keep talking, as if they can’t stop.

While pressured speech is most often associated with the mania or hypomania of bipolar disorder, it can also happen with schizoaffective disorder, autism, psychosis, ADHD, or an anxiety disorder.

Flat affect/emotional blunting

Flat affect means that you’re not demonstrating much of an emotional reaction to a situation. Inside, you may feel happy, for example, but it doesn’t show on your face or in your speech. The inside and the outside don’t match.

Emotional blunting is a little different from flat affect, though. With emotional blunting, you don’t feel an emotion internally at all. You might not feel at all interested in a book or a movie that once gave you pleasure or laughter, for example. This results in flat, unemotional, dull speech patterns.

Flat affect and emotional blunting are in some ways the opposite of pressured speech. They may occur when a person is depressed, in shock, or suffering from PTSD or other conditions. It’s a symptom of some illnesses, but not an illness in itself.

Word salad

“Word salad,” also called “schizophasia,” means a confused mixture of seemingly random words and phrases. It happens as a result of a neurological disorder like dementia or a stroke, or a psychiatric condition like schizophrenia. The words can be grammatically correct or not, but they make no sense. One example of word salad would be a person saying, “That clock has a headache.” It’s a real sentence, but it has no meaning that a listener can discern. The person producing word salad may not be aware that they are not speaking coherently.

There are several ways that schizophasia can be expressed. “Graphorrhea” is word salad in writing. “Logorrhea” means excessive talking, but without the attempt at clarity of pressured speech. A “clanging” speech pattern uses rhymes or other sound associations rather than trying to construct meaning in the usual way.

As for me, a person with bipolar disorder, I have experienced emotional blunting often and pressured speech a couple of times. My hypomania tends to have other manifestations such as reckless spending. My husband can tell when I’m nearing or in a depressive episode when I speak mostly in a monotone, with single-syllable responses to most questions. But my lifelong fascination with language has made me aware of the psychological and psychiatric implications of speech. And my lifelong experience with bipolar disorder has made me keenly conscious of the way in which speech interacts with mental illness.

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