Approaches to semiotics: Cultural anthropology, education, linguistics, psychiatry, psychology ; transactions of the Indiana University Conference on Paralinguistics and Kinesics [2. printing. Reprint 2015 ed.] 9783111349022, 9783110995138

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APPROACHES TO SEMIOTICS

JANUA LINGUARUM STUDIA MEMORIAE N I C O L A I VAN WIJK D E D I C A T A edenda curat

C O R N E L I S H. VAN S C H O O N E V E L D INDIANA UNIVERSITY

SERIES

MAIOR

XV

1972

M O U T O N & CO. THÉ HAGUE

· PARIS

APPROACHES TO SEMIOTICS CULTURAL ANTHROPOLOGY·

EDUCATION

LINGUISTICS · PSYCHIATRY PSYCHOLOGY

Transactions of the Indiana University Conference on Paralinguistics and Kinesics Edited by T H O M A S A. SEBEOK ALFRED S. HAYES · MARY CATHERINE BATESON

Second printing

1972 M O U T O N & CO. THE H A G U E · PARIS

© Copyright 1964 Mouton & Co., Publishers, The Hague, The Netherlands. No part of this book may be translated or reproduced in any form, by print, photoprint, microfilm, or any other means, without written permission from the publishers.

This text w a s developed pursuant to a contract between the U n i t e d States Office o f Education and Indiana University, and is published with the permission o f the U n i t e d States Office o f Education.

First printing

1964

Printed in The Netherlands by Mouton «S Co., Printers, The Hague.

PREFACE

The term semiotic, confined in earlier usage to the medical theory of symptoms, seems to have been introduced into philosophical discourse at the end of the 17th century by John Locke to cover one of the three branches of science, namely, the doctrine of signs, "the business whereof is to consider the nature of signs, the mind makes use of for the understanding of things, or conveying its knowledge to others". The real founder and first systematic investigator of the field, however, was the subtle and profound American philosopher, Charles Sanders Pierce; as he himself observed: " . . . I am, as far as I know, a pioneer, or rather a backwoodsman, in the work of clearing and opening up what I call semiotic, that is, the doctrine of the essential nature and fundamental varieties of possible semiosis ; and I find the field too vast, the labour too great, for a first-comer." The unique place of semiotic among the sciences - not merely one among the others, "but an organon or instrument of all the sciences" - was stressed by Charles Morris who, in 1938, proposed to absorb logic, mathematics, as well as linguistics entirely within semiotic. "The whole science of language", Rudolf Carnap then reaffirmed in 1942, "is called semiotic", and, in 1946, Morris introduced further refinements when he distinguished among pure semiotic, which elaborates a language to talk about signs; descriptive semiotic, which studies actual signs; and applied semiotic, which utilizes knowledge about signs for the accomplishment of various purposes. In the final moments of the conference the transactions of which are set forth in the following pages, the well-known linguistic process Hanns Oertel called "analogic creation" was perhaps at work when Margaret Mead proposed semiotics - a plural noun possibly in pseudo-proportional analogy with "semantics" - as a term which might aptly cover "patterned communications in all modalities". Implying the identification of a single body of subject matter, this summative word was incorporated, overburdened as it is, and not without remonstrations from several quarters, into the main title of our work. By choosing it for the title, we intend to stress the interactional and communicational context of the human use of signs and the way in which these are organized in transactional systems involving sight, hearing, touch, smell, taste. The selection of some single term seemed a persuasive device to advance unified research. On the one hand, by reckoning linguistics as a branch of semiotics, we meant to imply that coding in all modalities takes place within a cultural context as

6

PREFACE

learned behavior at various levels of consciousness, and to underscore the relevance of the linguist's model to the study of other semiotic codes. On the other hand, the methodological integrity of linguistics is preserved, for we also recognized that not all semiotic codes are identical and that, in most cases, they have been and will remain most amenable to study by non-linguists. Sponsored by the Indiana University Research Center in Anthropology, Folklore, and Linguistics, the conference, the immediate results of which are embodied in this book, was held in Bloomington, on May 17-19, 1962, with the generous support of the United States Office of Education (contract # S A E 9490). The meeting was attended by some sixty scholars (see pp. 289-294),who gathered for a discussion designed to focus primarily on paralinguistics and kinesics. While inquiry and debate not infrequently widened to comprehend other areas of nonverbal communication, there was also a tendency to view these problems with constant reference to language which is, as Edward Stankiewicz reminded us, "the most pervasive, versatile and organizing instrument of communication", and a growing awareness that there must be similarities of structure in communication in all modalities. Five "state of the art" papers were prepared and distributed in advance to all the participants in the original conference.1 Each paper, written by a specialist in one of the five principal disciplines represented (cultural anthropology, education, linguistics, psychiatry, and psychology), was the center of debate during a four-hour session, where it was reviewed and examined in an interdisciplinary context. This book follows the same pattern: each paper is reproduced with a minimum of after-thoughts and is then succeeded by an edited version of the actual transcript of the ensuing discussion. Slightly less than one half of the transcript was retained and is rendered here after considerable reorganization and stylistic revision, in the first instance by each individual to whom a remark was attributed and, in final form, by the editors. Pure, descriptive, and applied approaches to semiotics are all displayed by the contributors of papers and comments, the variations in emphasis reflecting differences in specialty, professional interest, and personal preferences. Margaret Mead, instead of being asked to prepare a working paper, was invited to 1 The following seven papers, most of which have been published elsewhere, were also circulated, as background material, to all participants : Kramer, E., "Personality stereotypes in voice: a reconsideration of the data", J. Soc. Psychol, (in press). , "The judgment of personal characteristics and emotions from nonverbal properties of speech", Psychol. Bull., 60 (1963), pp. 408-420. Kroeber, A. L., "Sign language inquiry", Int. J. Amer. Ling. 24 (1958), pp. 1-19. Moses, P. J., "Modern trends in singing", Paper presented at the 1st Int. Congress of Audiology and Phoniatrics (Mexico City, August. 1961). Sebeok, Τ. Α., "Coding in the evolution of signalling behavior", Behavioral Science, 7 (1962), pp. 430-442. Trager, G. L., "Paralanguage: a first approximation", Studies in Ling., 13 (1958), pp. 1-12. Voegelin, C. F., "Sign language analysis, on one level or two?", Int. J. Amer. Ling. 24 (1958), pp. 71-77.

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PREFACE

present a lecture on the second night of the conference which would relate to its purposes but would also be intelligible to a larger audience, as part of the Indiana University Horizons of Knowledge Lecture Series. Her lecture drew on materials which are being published elsewhere,2 and also on unpublished materials on which she and Rhoda Metraux, with Ray L. Birdwhistell as an active consultant, are working in a project, Studies in Allopsychic Orientation. Her paper which concludes this book was written subsequent to the reorganization of the conference proceedings and thus takes into account the continuity provided for by that rearrangement and by the discussions of future plans at the close of the conference. The continuing work of Thomas A. Sebeok in the "Linguistic evaluation of nonverbal communication" is supported by the United States Public Health Service (MH 07488-01). The paper of Alfred S. Hayes was completed pursuant to a separate contract with the Office of Education, under which he is preparing a manuscript dealing with research relevant to foreign language teaching. Each of the five "state of the art" papers has a separate bibliography at the end save that of Weston La Barre who chose to integrate his extensive references with the body of his text. While insuring that all references were consistent with the requirements of the author's particular scholarly tradition, the editors strove to make them fully accessible to readers from each of the other disciplines involved. Beyond that, however, we avoided interfering with any bibliographic apparatus. The editors particularly regret their inability to convey in this book not only an accurate multimodal representation of the formal proceedings of the conference, such as by sound recording or motion pictures, but also the rich informal verbal interaction among the participants which punctuates all events of this nature. Although specific guide lines for future programs of research and more exact theoretical formulations in semiotics have not been included here, the conferees concluded their deliberations with concrete plans for a symposium in which representatives of different sciences might bring their tools to bear cooperatively on a unified corpus of tape and film. The assistance of Alexandra Ramsay in preparing the manuscript for press and reading proofs is gratefully recorded. January, 1964

THOMAS

A.

SEBEOK

ALFRED S. HAYES MARY CATHERINE BATESON

2

Mead, M., Continuities in cultural evolution, (New Haven and London, 1964).

TABLE OF C O N T E N T S

Preface

5

PETER F . OSTWALD

How the Patient Communicates about Disease with the Doctor Discussion Session on Psychiatry Chairman: John I. Nürnberger

11 35

GEORGE F . M A H L AND GENE SCHULZE

Psychological Research in the Extralinguistic Area Discussion Session on Psychology Chairman: Roger W. Russell

51 125

ALFRED S. HAYES

Paralinguistics and Kinesics: Pedagogical Perspectives Discussion Session on Language Teaching Chairman: William R. Parker

145 173

WESTON LA BARRE

Paralinguistics, Kinesics, and Cultural Anthropology Discussion Session on Cultural Anthropology Chairman: C. F. Voegelin

191 221

EDWARD STANKIEWICZ

Problems of Emotive Language Discussion Session on Linguistics Chairman: Thomas A. Sebeok

239 265

MARGARET MEAD

Vicissitudes of the Study of the Total Communication Process List of Participants

277 289

HOW THE PATIENT COMMUNICATES ABOUT DISEASE WITH THE DOCTOR by P E T E R F. OSTWALD

A medical doctor is concerned with total human functioning - the way the body works, how patients think, what they feel, and their activities in family and social situations. He must always emphasize the detection and correction of malfunction, and part of this primary task is to interpret a patient's sign-making behavior correctly, be it linguistic, paralinguistic, or kinesic. The doctor listens to the patient's words in terms of symptoms that point to disease; he looks for physical signs in order to recognize underlying bodily malfunction; he postulates diagnoses as a guide for subsequent management of the problem presented by the patient; and he administers the appropriate treatment to reverse tangible pathology and prevent further disability. Medical history-taking, examination, diagnosis, and treatment all involve communication between two persons whose individual roles are usually quite clear and whose tasks are also well-defined. This is why clinical problems offer such interesting possibilities for investigation in terms of current theories about processes of information exchange. The purpose of this paper is to highlight but one aspect of the sign-making behavior of sick persons as perceived by physicians: communication without words.

THE PATIENT-DOCTOR RELATIONSHIP An old physician has said : For him who has eyes to see and ears to hear no mortal can hide his secret; he whose lips are silent chatters with his fingertips and betrays himself through all his pores. (45) Physicians traditionally function in two-person relationships with their patients, and the assumptions of this clinical dyad must be understood if one uses it as a model for research in communication (27). From the beginning of his interaction with a patient, the physician alerts himself to visible, audible, palpable, and smellable signs that nonsymbolically transmit information about pathology. He is allowed to behave in such a way as to facilitate direct body contact with the patient, touching naked skin, listening to inner noises, and inspecting private openings so as to learn things which may be unknown to the sender. During the course of their interaction the patient

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PETER F. OSTWALD

(sender) also speaks to the doctor (receiver), using conventional verbal symbols for communication, yet neither sender nor receiver knows in advance what code is going to carry the significant information about disease. In one instance an immobile lump of the breast discloses cancer; another time this information cannot be obtained without surgical exploration and microscopic analysis of suspicious tissue. A highly charged emotional relationship may arise within this ambiguous communicational setting: the patient tends to relate anaclitically ; he bares himself, trusts, and confides. The doctor on the other hand is expected to understand, to heal, and to protect the patient. Outsiders looking through a screen at what goes on, or listening to tape-recordings of what has happened, are likely to miss the very basic ingredient of clinical communication - the sense of intimacy, fear, hope, and other strong emotions shared by the two participants (75). Nor can this essential element in patient-doctor communication be artificially produced for experimental investigation (20). Hence post hoc description and anecdotal case presentation are generally used for teaching and research in this field. Lately linguistic transcription of verbal material (77), acoustic measurement of sounds (64), analysis of gestures and postures (16), and physiologic studies (44), have been applied in order to make more rigorously scientific investigation possible.

THE LANGUAGE OF THE BODY

The autopsy table was medicine's greatest lesson to Man, a lesson in honesty and humility. It is medicine's great spiritual contribution to human culture.(Lawrence Kubie, 42) The term "language" is used very loosely in medicine, and not within the specialized framework familiar to linguists. It can refer to any informative, expressive, or communicative activity of the patient - conscious or unconscious - and may even apply to something happening within part of the patient's body, such as his skin, heart, or gastro-intestinal tract. Much of this has been documented, and for any student of body language there are three invaluable dictionaries: French's Index of differential diagnosis (18), Dunbar's Emotions and bodily changes (19), and Grinstein's Index of psychoanalytic writings (34). From this vast material I shall review only what seems directly pertinent to the work of investigators outside the field of clinical medicine. The body as a whole Sizing-up a person is done in a split-second, but often these first impressions outlast later ones. Of particular interest to physicians are striking abnormalities of body size or shape. These usually have physical causes : dwarfism, for example, results from lack of pituitary or thyroid hormone, achondroplasia, vitamin deficiencies, and other metabolic diseases (38). Gigantism is usually due to a tumor of the pituitary gland.

HOW THE PATIENT COMMUNICATES ABOUT DISEASE WITH THE DOCTOR

13

But total appearance is also influenced by the patient's feeding-behavior and exercise patterns, both of which can be upset through emotional conflicts. For example, obesity is often a sign that oral demands for love and attention are unfulfilled or unfulfillable; and cachexia can result from self-imposed starvation routines designed to achieve delusional goals (13). Relationships between physique and personality have been described in the work by Kretschmer (40) and Sheldon (84). Less well-known to the nonmedical world are studies of internalized concepts of the body and the effects of these "body images" on appearance and behavior (25, 79). Reactions to another person depend in important ways upon how one perceives, evaluates, and uses his own body and its component parts (17). The surface of the body The enveloping skin is a kind of advertising bill-board that broadcasts to the world what goes on under its surface. Fevers, infections, neoplasms, allergies, ageing, and circulatory defects are some of the organic processes which become manifest through dermal change (4). By means of pilo-erection, vasomotor change, pigmentation, exudation, and other signs, the skin also transmits information about the bearer's emotions (60). Fear gives him goosepimples and pallor, anger produces flushing and mottling, itching annoys the victim and also the onlooker. Scanning the skin, a trained eye picks up significant pimples, scratches, scars, moles, tattoos, birthmarks, and self-induced lesions which stand out from the smooth homogeneous surface. The primary emotional appeal of that surface is probably related to the infant's instinctive search for its mother; in dreams her breast is not infrequently symbolized as a "blank" screen (47). Various skin shades and colors also are associated with highly individualized ideas that stem from preverbal thoughts (39). For example, a Negro patient who had a dark-skinned father and a light-skinned mother alternately denigrated and whitewashed her own brown-ness. Depending on which phase of her ambivalence predominated, she would tan herself - to feel sweatier, warm, and more attractive - or despise the darker shades as dirty, masculine, and dangerous. The hair of the head is an especially important preoccupation for the dermatologist, who finds that it turns white or falls out under stress. Psychopathology includes hairfetishism, tearing-out-of-hair, and bizarre dyeing and dressing. Emotional reactions to baldness, haircuts, and visits to the beauty parlor tend to be surprisingly profound. For example, a college-graduate mother-of-three spent 24 hours in near panic after she sent her 9-year-old daughter out for her first permanent wave. This event apparently symbolized many of her own struggles over sexual identity and maturity. Paucity of body hair has forced the human animal to cover himself with feathers, furs,

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PETER F. OSTWALD

cloth, plastic, and other clothing. Flügel has discussed this in psychological terms, pointing out that the body surface is covered not only for protection but also as a sign of modesty and for decorative purposes (26). The face Hippocrates described the "sharp nose, sunken temples, cold ears, hollow, vacant eyes, open mouth, loose, blanched lips, and livid, muddy color" of imminent death (92). For the living also, the expression of the face is of primary importance in communicating what is wrong. Acromegaly, myxedema, hemiplegia, 7th nerve paralysis, psychoses, wasting, alcoholism, and many other diseases produce characteristic "facies". Thorek has collected these in a book worth perusing, if for no other reason than to see how unsettling it is to view familiar forms in unfamiliar guises (92). According to Rangell, facial communication of emotion takes place primarily via the snout, a peri-oral "porthole [which is] the focus of greatest concentration of effector response to emotions, at least in relation to the external world... Within these relatively few inches of body surface, the tone, position in space, and direction of the skin and facial musculature denote how a person is at the moment" (72). Eyes declare the presence of jaundice (yellow sclerae), hyperthyroidism (bilateral exophthalmos), and neurological disorders (pupillary and oculomotor imbalances). Psychiatrists also gauge the sense of interpersonal relatedness by means of eye expression; schizophrenics tend to stare in an immobile, vacant fashion; hysterics may use their eyes to meltingly caress the surface of the doctor's body; suspicious paranoid persons try to focus their eyes inside your head, as though this might enable them to read thoughts directly; the psychopath may shift his gaze watchfully, try to seduce, or give you the "evil eye" (22). Various forms of pathologic weeping have been described (32). Expressive automatisms called tics or spasm disorders may affect the facial muscles as well as other parts of the body. Included here are blinks, squints, sudden scanning movements with the eyes, and contortions of one or another part of the face. Their etiology ranges from epileptic foci of brain irritation (90) to psychoneurotic conflicts (7). Unless of organic origin, abrupt facial contortions usually indicate frightreactions; they are signs of overwhelming fear produced by an external shock or by the undigested memory of a traumatic event in the past. Occasionally it is possible to pinpoint specific maladaptive processes which have produced and perpetuated a spasm disorder (23). For example, a young man entered the hospital for treatment of paroxysmal jerking movements of his head, neck, shoulders, and pelvis which were accompanied by sudden harsh snorting noises. Psychotherapy disclosed that in early childhood he became convinced another person had "entered" his body, and the paroxysms now occur whenever he becomes uncomfortably aware of this inside outsider and tries to shake him out. Spastic torticollis is an expressive automatism characterized by stereotyped turning

HOW THE PATIENT COMMUNICATES ABOUT DISEASE WITH THE DOCTOR

15

of the head to one side. Not infrequently precipitated while being shaved or during military inspections, this disorder may be a symbolic expression of the patient's need to look away from threatening hostile-aggressive impulses which have been unduly stimulated or which cannot be controlled in socially-acceptable ways (57). Posture, gait, and movement of the body Posture, gait, and body movements are controlled by the integrated activity of at least three nervous systems: the pyramidal system (for volitional control of movement), the extrapyramidal and cerebellar system (for involuntary aspects of muscle tone, balance, and motility), and the reticular-activating system (for attentiveness, alertness, and overall coordination) (53). Inputs from the external environment directly influence at least two of these - the pyramidal and the reticular-activating systems. Thus social stimuli play a major role in the initiation, reinforcement, and prohibition of various body movements. Furthermore, the patterns of posture, gait, and movement are altered by diseases of muscles, bones, and joints. Since body movement has such a large number of determinants, no one particular pattern can have much semantic specificity (73). The patient's postures and movements communicate at best something generally about tension and tension-release. Without additional information, one could make no clear distinction therefore between, say, stiffness due to brain tumor, military training, rheumatism, hostility, meningitis, etc. The neurologist deals specifically with such diagnostic tasks. Reflex tests, motorstrength studies, electroencephalograms, and other techniques for getting at underlying neuro-muscular relationships must be used (55). It is important for the nonmedical reader to keep this in mind while studying texts about the symbolic (22) and the semiotic (77) significance of the various posture, gait, and motility abnormalities. The hands Free to move in space and richly represented in the cerebral cortex, the human hand can attain extraordinary importance in communication. Some rudimentary gestures may already be seen in infancy: for example, the newborn presents the palm for grasping, clenches the hands together for balance, and protrudes the thumb in touching the mouth. More elaborate analogues of this infantile hand behavior are later found in saluting, prayer, and the hitch-hiking sign. But only under acoustically unfavorable conditions, such as deafness or continuously intense noise, are hand languages ever systematically developed (58). Hand and fingers are terminal peninsulas of the human body and as such particularly susceptible to ageing, arthritis, arteriosclerosis, and other organic disease processes. Thus it seems extremely doubtful that diagnostic procedures based solely on the hand, for example in terms of its morphology (96), would be accurate beyond the point of the manual stereotypes taught by drama teachers (87). Sometimes in psychotherapeutic work it is possible to obtain insight into the

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personal meaningfulness of tremors, fidgets, thrusts, and other noticeable hand behavior (24). For example, an obsessive-compulsive writer, blocked in his efforts to produce a novel, folded his hands and propped them against his mouth during long intervals of silence in the therapy hour. Later he explained this as an expression of deep humiliation and suffering. Another patient stroked the carpet in the office at times when she felt an intense need to be affectionately fondled. Of further diagnostic importance are the products of manual activity. Sounds produced by hand range from simple mechanical noises to complex musical patterns (68): finger-snaps may be used to indicate the "a-hah!" feeling of sudden understanding. Scratching, finger-tapping, and knuckle-cracking also are used to express emotional states. Among visible products of the hand, writing has been most extensively studied from a psychopathologic point of view. Repetitiousness, clumsiness, fragmentation, ornamentation, and other handwriting characteristics tend to match the expression disturbances of speech and gesture (74). Sketching and tracing (7), smearing and modelling (54), and painting (83) are also used for psychodiagnosis and therapy. Contrary to the artist whose ego integrates a variety of elements into new symbolic forms, a mentally ill person tends to elaborate raw id material through crude, stereotyped visual symbols (41). The feet In ordinary social affairs one keeps his feet on the ground, encased, out of sight, and refrains from kicking. Not so in medicine where the patient's horizontal posture elevates his feet to a position of equality with the head and the heart. The Babinsky reflex (elevation of the big toe and spreading of the little toes) is one of neurology's most important signs. Part of a mass withdrawal response, this primitive reflex suggests the treeclimbing behavior of monkeys (94). Newborns have it: they engage in rough, pseudo-climbing thrusts and pedalling movements of the lower extremities. Once cortical control has taken over, primitive lower-limb reflexes tend to occur only under conditions of strong emotion or when the pyramidal tract is damaged. During arguments, for instance, the feet tense up; rage produces kicking and stomping; inhibition of aggression may result in hysterical paralysis of the legs. The lowly foot is also subject to circulatory drought and stasis. Arteriosclerosis, varicose veins, elephantiasis, diabetes, and other conditions affecting its nutrient supply tend to create most unpleasant pedal symptoms. Smell Doctors must be able to differentiate the stink of uremia, diabetes, alcoholism, lung abscess, and other serious illnesses. Even psychiatric diagnosis may be aided by a good nose, since the sweat of chronically schizophrenic patients carries a peculiar odor that rats and perfume experts are able to detect (86).

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The human smell brain lies buried beneath structures subserving "higher" intellectual processes, yet is closely connected to both the cortex and the hypothalamic emotion centers (50). Its exact function in human communication is not known. Some psychosomatic facts about the nose have been presented by Holmes (37), and a delightful naturalistic book about the sense of smell is available (5). That social inhibition may be a factor in reducing nasal sensitivity is suggested by the fact that close to one billion dollars is spent in the United States each year on perfumes, cosmetics, deodorizers, and other toiletries (93). Olfactory sensitivity increases during pregnancy, in certain epileptic auras, and with some brain lesions. But cultural interests in synesthetic phenomena can account for heightened olfactory sensibility; take for example Des Esseintes in Huysmans' " A Rebours" who doused himself with various perfumes. Pathologic oral fixations can also lead to nasal hypersensitivity. An obese, childish, postpartum depressive patient preoccupied herself with the smell of flowers in my office; a lonely young man dreamt that his mother forbade him to eat canapes with a delicious, pungent smell.

HUMAN SOUNDS Language is a poor thing. You fill your lungs with wind and shake a little slit in your throat, and make mouths, and that shakes the air; and the air shakes a pair of little drums in my head - a very complicated arrangement, with lots of bones behind - and my brain seizes your meaning in the rough. What a roundabout way, and what a waste of time. (Du Maurier, "Peter Ibbetson", 95) From the welter of primarily nonacoustic signs described in the preceding section, no physician could get more than a fragmented and self-contradictory impression of what is wrong with his patient. To learn more he has to listen closely to the sounds the patient makes, and this involves attention on both verbal and nonverbal levels (63). First the doctor "takes a history", hoping thus to illuminate the sequential pattern of pathologic developments. He asks questions, receives answers, and - if he is a psychiatrist - encourages the active verbalization of fantasies and wishes. During all of this, the doctor attends closely to paralinguistic acoustic cues, for example variously intoned forms of " o h " and the nuances which support or belie overt meanings of words. A few noises and musical patterns have already been mentioned in connection with the language of hands and feet; I have discussed these in greater detail elsewhere (62). Other body sounds are systematically elicited from the patient during the physical examination. These range all the way from byproducts of the examination, for instance " a a h " uttered during visualization of the posterior pharynx, to characteristic diagnostic sounds like the systolic murmur of aortic stenosis. While primarily

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informative about bodily events per se, many of these acoustic cues also have something to say about a patient's mental condition, particularly when these sounds are used in place of words (81). A short vocabulary of body sounds Acoustic study of human sounds began only recently (69), and the following remarks should be taken as tentative hypotheses rather than as definitive or conclusive statements about the nonverbal soundmaking of patients. Rhythmic beats. - To come to another person's awareness, the rhythmic beating sounds of the heart need amplification; this is done in the clinic by means of the stethoscope. Only in rare cases of syphilitic aortitis may cardiac pulsations become sufficiently visible for communication, through the patient's rhythmic head-nodding (De Musset's sign). Under conditions of physical contiguity - between mother and child, lover and beloved - the pulse can also be directly transmitted. This fosters a feeling of intimacy and is said to be a factor in the organization of rhythmicity during intra uterine and early nursery development (55). Breath sounds. - Acoustic signals transmitted by air generally play a more important role in communication than do those transmitted by contact. It is possible of course to breathe softly, in which case respiratory sounds are barely audible and have, at most, a mildly hypnotic effect. But due to the larynx, the practice one gets in childhood of stirring others to action with cries, and the amplification afforded by numerous resonating chambers, the respiratory tract is probably man's best instrument for acoustic communication. Vocalization for speech comes off well in the expiratory phase of respiration. So do sighs, whispers, moans, hums (66), whistles (61), screams, and exclamations. Inspiratory sounds, in particular wheezing and snoring, tend to produce annoyance and alarm. Rasping noises. - While any sound can be noise in the sense of being unwanted (10), some sounds more than others are especially annoying. These include tooth-gnashing, fingernail-scratching, grinding friction between solid objects, and other noises with a nonharmonic pattern. So far as medical diagnosis is concerned, sounds of this type almost invariably indicate pathology. Rough heart sounds, peritoneal friction rubs, and crepitation in the joints generally point to inflammation, decay, breakage, or new growth which impedes the smooth frictionless gliding of one surface over another. Due to defective phonation or articulation, grating and rasping sounds may also get into the voice and communicate varying degrees of annoyance and unpleasantness. To a certain extent the reactions of listeners to nonharmonic acoustic patterns are further conditioned by the acoustic preference of their community (21). Spasms. - Spasmodic contractions in the gastrointestinal, respiratory, and urogenital tracts at times produce characteristic brief sounds : coughs, gasps, sneezes, retching, cramping, gurgling, and flatulence. These are basically sounds of reflex origin and indicate the body's efforts to eject painful or useless irritants. Under certain

HOW THE PATIENT. COMMUNICATES ABOUT DISEASE WITH THE DOCTOR

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circumstances spasm sounds come to be used in communication, however. How this may happen can best be seen through the analysis of a single sound, for example, the cough. The biography of a cough The cough is part of an unlearned, reflex ejection-spasm triggered when there is irritation in the patient's respiratory passageway (3). Acoustically it is an intense, sudden, explosive, noise that can be heard at some distance. Should this noise fall on trained ears - any listener is at least partly trained since he too has coughed at some time in his life - it is then intuitively perceived in terms of something irritating. The listener may himself feel some irritation in the throat. More often however, he finds himself merely sympathetically in tune with the cougher, in the sense that a tacit agreement, "cough means irritation and riddance spasm", leads to some mutuality. Now the listener may respond to his own reflex impulses to clear the throat, to reduce irritation, even to silence the cougher or escape from the unpleasant situation. Or he may inhibit these impulses and turn to the cougher in helpful ways. If he is a physician, then the listener uses his own sense of irritation to gauge that of the coughing patient. He may further search for the etiology of the cough, treat the patient, and try to prevent recurrence. These responses may all have the desired effects upon the patient and his cough. But something else can happen too: the patient may recognize that his coughing manages to arouse interest and help from the environment. Should he have difficulty in obtaining these reactions in other ways, he may then be tempted to put more and more vigor into his coughing, which thereby loses its instinctive spontaneity and becomes a pathologic symptom, like a tic. He may even learn to imitate a cough at times when it is not actually the respiratory tract but some other body part that feels irritated. If these counterfeit coughs succeed in eliciting the desired help and attention, then the patient obtains more than the usual amount of control over his environment through coughing. One could call such a non-reflex cough a sort of "verbal" operant (85). However, it seems more correct to think of this kind of sound-making as contrary if not inimical to communication with words. Like other pathologic forms of acoustic behavior used to gratify dependent, passive, infantile strivings, provocative coughing often tends to shut off the possibility of more complex linguistic communication (56). Laughter and crying Repetitive, uncontrolled, spasmodic chains of sound that accompany the release of accumulated tensions are man's purest sounds for emotional expression. Laughter tends to be composed of shorter, more staccato, more high-pitched and more rapidlyrepeated tonal elements than crying. For example, the tinkly giggle contrasts easily with the mournful moan as extreme examples of laughing vs. crying. But towards the center of the laugh-cry continuum, it is difficult to make the distinction acoustically; at this point visual cues, such as the square mouth of sadness described by Darwin (14), become helpful.

20

PETER F. OSTWALD

Psychiatrists pay a good deal of attention to the conditions that precede emotional sound-making, for instance the tension build-ups before laughter a n d the feelings of loss which precipitate crying. Laughter can also be produced by a sudden sense of incongruity (55). For example, in the joke-telling situation, the joker subdues the laugher by coaxing him into having evermore discrete fantasies. As soon as the laugher reaches a certain pitch of tense expectation, the joker "punch-lines" him with information that either is entirely unexpected or might only have been tangentially inferred from ambiguous hints contained in the build-up. Of interest here is the necessary inequality between joketeller and listener: to get a joke to work, the joker must emit verbal symbols continuously (words, puns, metaphors, etc.) while the laugher can emit only non-verbal signs (silent attentiveness, eyes lighting-up with anticipation, outburst of noise after the punch-line). Variations on this theme are found in actedout jokes and comedy. Crying is usually a symptom of depression resulting f r o m real or fantasied experiences of loss (29). As in the evaluation of laughter, the psychiatrist must consider not only a patient's background and physical condition, but also social rules t o the extent that these selectively prohibit or encourage certain forms of emotional expression. Also, as with other sounds, crying can be used to arouse sympathy, declare one's helplessness, or express anger. Often the best way to distinguish genuine from counterfeit emotional behavior is for the clinican to allow himself to respond instinctively to his patient and then to introspectively evaluate the depth of these intuitive reactions (78). Acoustic signalling and the origins of communication The science of bioacoustics is barely 5 years old (91). Yet with an eye towards the next section of this paper which deals with stunted and abnormal speech, one must venture a formulation about the ontogeny of normal human acoustic-communication: Meaningful sound-making originates in the nuclear child-mother relationship. It is here that reflexly produced acoustic patterns first jell into a repertory of signs and then symbols for information exchange. First there is the cry, which is life-saving in any culture that allows a mother to leave her child alone. This sound enables the otherwise completely helpless baby simultaneously to summon assistance and to indicate how uncomfortable it is. A t first no mother can tell with certainty precisely what physiologic tensions are rising and which of the baby's vital needs demand satisfaction. Only gradually does the acoustic behavior of the infant become morphologically distinctive enough to enable the mother to discern cries of hunger f r o m shrieks of pain, whines of soiled diapers f r o m plaints for attention, delighted yelps from overexcited yells (49). To learn this "language" of her newborn, the mother proceeds much like any person who tries to communicate in a strange tongue: she touches, inspects, smells, and lives with the foreign visitor to acquaint herself with his behavior and to decipher the relationships between this behavior and the sounds he makes. At the same time she expects the stranger to do likewise. Babies make numerous sounds beside cries : smacking, cooing, hiccupping, humm-

HOW THE PATIENT COMMUNICATES ABOUT DISEASE WITH THE DOCTOR

21

ing, gurgling, whining, burping, coughing, sneezing, flatus, shrieking, spitting, and more {43). How mothers seize upon these behavioral cues for information about infants depends in large measure upon their native interest in sounds and their enthusiasm for playing the acoustic detective game. This in turn is probably a function of a mother's personal experience as a child with her own parents and may also reflect the acoustic habits of her particular culture. For example, a mother may decide that there is no hunger-cry simply by listening for and acting upon the infantile lip-smacking noises which precede crying. This actually occurs, and more general inverse relationships between mothering and crying have also been documented (11). One occasionally sees this going too far: I recently learned of a mother who so rarely let her baby out of eye-range that the latter reduced its acoustic output to an occasional mewling whimper. Clearly then, acoustic communication is historically associated in every person with the helplessness, immaturity, and absolute dependency of his own infancy. The transition from this life period into childhood is characterized by the use of "familylanguages" that contain acoustic elements derived from both infantile sound-making and parental speech (52). The final step into adulthood requires that the growing person wean himself from the pidgin-languages of his family circle and communicate with symbols useful to the community-at-large. Failure to accomplish this leads to all kinds of disturbances in communication (76), some of which will now be discussed. SPEECH AND ITS ABERRATIONS1 ... Does not the eternal sorrow of life consist in the fact that human beings cannot understand one another, that one person cannot enter into the internal state of another? (I. P. Pavlov [70J P· 50). Verbal communication is a relatively late accomplishment, both in the history of the individual and the history of living things (36). It is not surprising therefore that aberrations of the speech functions are so frequently encountered in medical practice. Those due to developmental anomalies, for instance cleft-palate, or organic disease processes like laryngitis will not concern us here (48). Neither will I be able to cover the field of neurologic disturbance and its effects on memory, language, and speech (57). Rather the focus is on relationships between personality disorders and those aspects of behavior which lead to meaningful verbalization. Nonhuman languages There are patients who "speak" like dogs, cats, chickens, billy-goats, monkeys, and other animals. Sometimes this is due to a degree of mental deficiency plus social 1

Investigations reported in this section werefinanced,in part, by grant T-59-144 from the Foundations' Fund for Research in Psychiatry.

22

PETER F. OSTWALD TABLE 1

The " Vocabulary" of a Mentally Defective Patient =H3 3 9 3 3 9

3 3

j j n r

π

» 3 3 3 3 a

\

Κ = Φ 3 =

\ * — * — « * i

• ι —• s. 3 0

ρ==Ρίΐ

, r-) » ϊ 4 Α 0 0 3

-

-

J

ΠΓ

as

η

s

3E.

i — ι — f D ^

Il"

ha FS—*

» ' - J

isolation which in effect keeps the sick person from learning any human language. Cases have been reported of children reared by animals (12); also in the hospitals for chronic mental disease one finds patients who have no trace of recognizable speech.2 Table I displays this kind of acoustic behavior; it shows the output of a woman who has been in a State Hospital for 40 of her 45 years. She uses bleats and grunts - accompanied by several stereotyped gestures - to communicate with the staff in a rudimentary way about her feelings and needs. Another patient in the same hospital communicates only by humming; she emits simple song-like tunes as well as repetitious monotonal hums (see Table II). 2

Leonti Thompson, M. D., recorded the two patients demonstrated here.

HOW THE PATIENT COMMUNICATES ABOUT DISEASE WITH THE DOCTOR

23

T A B L E II

A Mentally Defective Patient who Hums Song-like tunes:

-ί

Γ Ί

-

J

Simple hums :

m =3± 1

1

Γ > Γ >

i

Other mentally ill patients know how to speak, but produce the sounds of animals at times when they feel themselves to be nonhuman. These are usually schizophrenics who, apparently due to deprivation of security and love early in childhood, turned to nonhuman objects for basic affection and contact (82). Omissions, repetitions, and errors Even patients who use a human tongue without difficulty are likely to make slips. Their omissions, repetitions, and errors tend to occur during moments of anxiety (51) and often stem from the inability to resolve some intrapsychic conflict under the stress of having to speak (28). For example :

24

PETER F. OSTWALD

A patient spoke of seeing the movie "To Have and Have Not" on TV. She had previously seen this film during her adolescence, and on the basis of a common appellation (Slim) had closely identified with the female lead, Lauren Bacali. In discussing the movie the patient for a while said nothing about the male lead. This was the first symptom of her speech disturbance: omission of an essential part of the topic. The second symptom, a syllablerepetition, soon followed; when she finally ventured to name the male lead, it came out "Hum-Humphrey Bogart". The patient denied any awareness of the stutter until I mentioned it to her; and then she reconstructed her thinking in such a way that her speech symptoms became plausible: "Hum" called to her mind "humping", a slang expression for sexual intercourse which she had guiltily and mischievously used as a teenager. Two other determinants for the development of some hesitancy in pronouncing Humphrey Bogart emerged through our discussion: 1) For the past few days she periodically had the fantasy that her husband, a swarthy man who resembles Bogart, might be killed in an auto-accident. This fantasy led to an obsessional idea: "You're not supposed to think about having intercourse with a dead man." 2) The preceding day she had told me about certain of her ideas regarding pregnancy, but only now remembered how proud of her abdomen she was while pregnant. "It resembled the hump of an oriental male god."

TABLE III

Some Examples of Speech Errors Level of Disturbance

Type of Error

The Intended Sound

The Actual Sound

Single Sounds :

omission addition substitution transposition

front remnant affect Yale Journal

font ->· remenant affuct Jail Yournal

Syllables:

omission addition substitution transposition condensation

salivary Marietta taken Beruf suchen apprenticeship

salary Marionetta -*• taking -»· Besuch rufen -* apprentiship

Words:

omission addition substitution transposition condensation fragmentation

you bastard stop working feet of film bowel movement reminder

you -> please stop -» mother -+ film of feet -*• boom -*• rema...

HOW THE PATIENT COMMUNICATES ABOUT DISEASE WITH THE DOCTOR

25

Table III offers further examples of speech errors collected from a number of different patients and speakers. It is likely that linguistic rules for the formation and decay of language symbols are involved in the production of these disturbances (97). Therefore a combined approach by linguistics and psychiatry to these interesting symptoms seems called for. Stress, intonation, and pause anomalies In clinical work one usually studies clusters of symptoms called "syndromes", not single isolated symptoms. Also in the analysis of verbal behavior, disturbance of a single phonetic variable may have little relevance, since several symptomatic disturbances usually occur within the same speech fragment (46). The unbalanced stress pattern demonstrated by the following patient, for example, occurred in the context of sloppy articulation, repetitiousness, and verbosity. A middle-aged lawyer, whose fortune and professional reputation had crumbled as the result of personal and economic failures, overstressed certain words and word groupings. Most notable were exaggerated or even incorrect stresses in word couples like "párty pólitics, pólice protection, possible pártnerships". From other information obtained about this man, it became apparent that he had failed to develop emotionally much further than the sexually ambivalent orientation of early childhood. For instance, in the face of extremely vengeful feelings towards women he quite generally directed his dependency strivings towards men. An analysis of the stress anomaly in his speech showed that the explosive overemphasis was a veiled calling out for his father, whose early death had robbed him of the emotional support needed to cope with a crippled mother and two elderly psychotic sisters. The patient had never given up the infantile babbled form of paternal address, pá-pá, in favor of more adult versions: pápa, papá, father, etc. Now in his unhappy depressed state, energetic mouthing of the aforementioned word couples gave him an illusory way to magically call out for a father. His associations to the overstressed words (e.g. police, partnership) also revealed fantasies in which an omnipotent agent, usually masculine, was to rescue him from distress. A number of pathognomonic intonation patterns have been noted in the speech of psychiatric patients. Excitable and histrionic persons often exaggerate the normal pitch pattern of the language. When matched by an equally theatrical use of gesture, clothing, makeup, and perfume, these hyperinflections usually indicate a hysterical process (2). The patient seems to use dramatization as a kind of noise to impede the verbal communication of troublesome personal matters. Depressed patients often restrict the range of pitch variation in the voice. This symptom usually parallels a reduction of vocal intensity and speed. Words are uttered in a lusterless, monotonous way that communicates apathy and resignation. Anomalous use of pitch cues is noted among patients with schizophrenic illnesses, particularly children and adolescents whose autism also manifests itself through grammar confusion, neologisms, and disconnected word fragments (9). Verbal interaction with these patients is extremely difficult since one often cannot extract meaning from what the patient says.

26

PETER F. OSTWALD

TABLE IV Samples of Schizophrenic "Speech" Sample 1:

patient:

t=5t=á

th

εΑ 3wa

ΛΠ3Ζ

Sample 2:

patient:

doctor:

3hé nor

t h lt s .

h a n d i ten.

A/ h

patient:

5h5? 5

Art 5i.

doctor:

ón dir

tén.

?ów.

Sample 1 shows a verbal utterance that lends itself to 72 ambiguous interpretations. Sample 2 shows a fragment of confused conversation in response to the doctor's question "Do you have any little brothers or sisters?" Take for example the 14-year old boy, samples of whose speech are shown in Table IV.S during an acute excitement he produced what psychiatrists call a "word salad" - he was incoherent, babbling, constantly switching between a high and squeaky voice and a low droning one. Sample 1 is a characteristic spontaneous production which, if one tries to impose meaning upon it, can be interpreted in 72 different ways as follows: (D o»-,>

don·. ,e.,

}

g „ ¡

* This and subsequent linguistic transcriptions were done by William Shipley, Ph. D., Associate Professor of Linguistics, University of California (Berkeley).

HOW THE PATIENT COMMUNICATES ABOUT DISEASE WITH THE DOCTOR

27

Sample 2 of Table IV shows what happened when one tried to converse with this confused patient. The doctor asks, "Do you have any little brothers or sisters?" Instead of a "yes" or "no" reply, the patient produces an ambiguous sound (line 1) which the doctor tries to translate into "hundred ten?" (line 2). The patient then makes some more of the same ambiguous sound (line 3) upon which the doctor now imposes the less absurd meaning "under ten" (line 4). Pause anomalies are best observed among stutterers. Fixated at pre-genital levels of psychosexual development, these patients get into a jam when they can neither express their anger through shouts nor inhibit it by keeping still (30). Unlike the overt psychotic who may lose control at this point, the stutterer immobilizes himself and frustrates the listener by emitting a sequence of repetitions, embolophrasias, clichés, or say-nothings.

TABLE V

48 Abnormal Pause Forms from 5 Minutes of Speech by a Stutterer áy a a t t t . . . δό ?3 ?3 (sigh) öo ?3 kkk... 6é... ?3... pppîyiy a kkk... 3>nH α hwén II 3 sst... ôér 3 Ôér s ppp... aend 3 3 3 Siy... öaet 3 3p... kânat 3 ôéynj... àydinôw ?3 || áy... (long pause) àyôîkd méybiy... öiy 3 θίηζ... in 3 II öisiz... ¿èkSiliy 3 gèt áp... â n d 3 II sêy àym... sêy àym 3 ttt... tûwèy ?3 grúwp... kin 3 II sst sstûwdint 3 gávsmint... wél ?3... bât 3 ôéy...

w3z a ákSiliy... tùw ?3 séy... ôêy jist 3 lúk... álsów 3 túw 3 ?3 ?3... àyôik3 öaet β... nät 3 nät 3 évriy... aekäliy 3 ?a...lukiq rayt 3 3 3 ¿käliy 3 . . . wâyày 3 lûk 3 élshwêr... aend 3 ôêy léft... mîkst 3 grúwp... lûk 3 lûkôwvir... hawévir ?3 ow ?3... hédêy s . . . gîv 3 t t t . . . âkSliy 3 ?3 kóvird... dównt 3 dównt 3 . . . Gîrjkày 3 || wél... âkSliy 3 p p p . . . ôiyâpizit 3 séks... in 3 y lâyk in sspówrts... êniy 3 tràini... wiö 3 wárdz âkâliy... ékSliy s 3 h á v n t . . .

28

PETER F. OSTWALD

For example, a 21-year old college student complained of difficulty "tttttalking". He tried to "chchchchchchchchchange" his "pppprogram" for school. He also complained of trouble "pppeeing" and found it "tttttough" going with girls. Table V shows consecutive pause anomalies in 5 minutes of a tape-recorded interview with this stutterer. Abnormalities in vocal intensity, register, and utterance rate Illness also takes its toll on the paralinguistic system (#). Like pianists who press different pedals to emphazise important themes, patients selectively vary their vocal intensity, switch register, and change speed while talking. Voice intensity can be measured by means of acoustic devices (89).

TABLE VI

Loudness Levels of a Blind Patient's Voice during Two Interviews Vocal Loudness4

Patient tries to:

He says:

energetically convey compliance

"Yes, o yes, oh, yes, eh yes sir!"

86 phons

indignantly deny responsibility

"He didn't say who he was."

84 phons

tensely explain

"It's a little bit different; I don't know just how to explain it, but..."

82 phons

criticise

"...an overstaffed office"

80 phons

humbly convey embarrassment

"I guess maybe I don't use it enough, huh, huh"

78 phons

sadly contemplate his condition

"these treatments have done me quite a lot of good because..."

72 phons

painfully discuss his symptoms

"next to a woman I have the strong urge..."

68 phons

sadly acknowledge defeat

"I don't think she cares anymore."

60 phons

* Converted from decibels re 0.0002 microbar to phons using the method of S. S. Stevens (/. Acoust. Soc. Am., 28, 1956, 807-832).

HOW THE PATIENT COMMUNICATES ABOUT DISEASE WITH THE DOCTOR

29

For example, Table VI shows acoustic measurements of the voice of a blind patient. Like many persons without vision, this man compensated for his communication defect by resourceful use of acoustic cues (80). He selected vocal loudnesses over a range of 26 phons in order to convey shades of emotion aind to over- or under-score the verbal content of his utterances. Register shifts have been described clinically (59) and can be demonstrated by means of acoustic filters that cut out part of the speech signal (88) or selectively measure the individual components of an intact signal (65). During experimental stress or acute emotional illness, acoustic energy fluctuates particularly in bands centered at 500 cycles per second (67). Table VII shows half-octave band analyses carried out during the opening (A) and the closing (Z) phases of 11 interviews with a 26-year old salesman who applied for psychiatric treatment following the breakup of his marriage. At that time, he was in a state of acute restlessness, trying to keep a more chronic sense of sadness and unworthiness from undermining his social adjustment. He was the younger of two sons and had usually gotten along pretty well by being a charming, boyish, friendly person and keeping away from intellectual or occupational competition. When on the spot, for example during "dressing downs" from superiors, he tended to become anxious and behave in an arrogant, provocative manner. This would get him into trouble, which he then tried to escape through passive resignation and submissiveness. The rapid alternation between provocativeness and submissiveness evident in this patient's social behavior also appeared in his paralinguistic behavior (Table VII). Strident, querulous, effeminate soprano voices (upper curves) would alternate with flabby, resigned baritones (lower curves). These register shifts often took place within sentences, as for example in interview 1 (3-2-60), segment A: His high voice says "putting conversations and things into a negative"; this is cut short by an embolophrasia "b...uh"; the low voice then continues with "course of viewpoint". The end (Z) of the first interview shows this same intra-sentence instability, but now each voice carries more energy than before. Compare Interview 1 just described with Interview 2 (3-7-60), which shows more acoustic stability both within sentences and within the hour. Now look at Interview 4 (3-9-60), which shows a little fluctuation at the beginning (segment A) but none at the end of the interview which has the voicefixedin a persistent high register (segment Z). A persistently high voice was generally associated in this patient with defensive negative attitudes; for example, after Interview 4 the patient broke two consecutive appointments with his doctor. Later phases of the therapy showed more intrasentence stability than did earlier interviews. Some most bizarre register shifts can be heard during schizophrenic excitements. For instance, the patient whose productions are given in Table IV dramatized his preferential use of certain vocal registers by emitting the high squeaky voice from the left side of his mouth and the low one from the right side. Disturbance in the rate of speech provides another criterion for the analysis of behavior; utterance rates can be objectively measured and are found to be influenced by personal and social variables (89). Particularly gross disturbances of speech rate accompany the cyclic mental disease called manic-depressive psychosis (6). During the manic phase the patient is under tremendous pressure and his speech speed-up is

30

PETER F. OSTWALD TABLE VII

Intrasentence Variations in the Acoustic Behavior of a Patient during Psychotherapy

PATIENT ·

a. M

5-2-60 TO 4 - 4 - 6 0 • A= SEGINNING OF INTERVIEW • Z.= END OF INTERVIEW

F R E Q U E N C Y IN CYCLES PER SECOND

Half-octave band analyses of 11 interviews are shown here. Solid graphs denote the voice at the beginning of sentences, and broken graphs at the end of sentences.

part of the general psycho-motor excitement. In the depression, speech is remarkably retarded, approaches inaudibility, and may cease altogether. Defensiveness during psychotherapy is another frequent cause of utterance-rate

HOW THE PATIENT COMMUNICATES ABOUT DISEASE WITH THE DOCTOR

31

change. Transient speed-ups or slow-downs may betray the emergence into consciousness of unacceptable ideas and unpleasant feelings. F o r example: a self-supporting spinster in her early thirties spoke with extreme rapidity whenever she experienced erotic desires. A rigidly hypermoralistic attitude towards sex m a d e the open recognition of such feelings absolutely unacceptable. H e r feverish verbalizations also h a d the effect of minimizing any questions and explanations the therapist might offer in challenging her repressive attitudes. T o be interrupted and talked to was a threat to her fantasy of being a n independent asexual person. She recalled that rapid speech used to annoy her mother who complained of inability to understand what was being said. Over the years the patient h a d thus learned to use loquacity also as a way to keep other people at a distance.

SUMMARY A N D CONCLUSION

This paper deals with the perceivable manifestations of disease processes which doctors are trained to recognize as symptoms and use as diagnostic cues. Some physical signs point directly to specific bodily malfunctions; others communicate in more general ways about emotional disturbance. Acoustic signals may do this also; but in addition, patients deliberately emit sounds for the purpose of verbal communication. Insofar as illness affects the voice and speech, specific abnormalities of communication with words are discussed, and detailed clinical examples are given. Both the normal and the aberrant usage of spoken language seem related to man's peculiar cerebral organization, his orality, and the problems posed by his social living. The rift between sound and sense which heralds many human illnesses is a practical consideration for the clinician. But within a wider context one may ask whether these vexing disruptions between acoustic and semantic behavior do not betray a basic flaw in the way man applies soundmaking to the problems he must solve. How can communication about basic human needs and urgent human dilemmas be improved? An optimistic guess might be that we are on the verge of casting off outmoded ways of discourse in an effort to evolve more universal forms of communication. Perhaps the scientific study of paralinguistic and kinesic phenomena can here make its greatest contribution to the general weal.

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PETER F. OSTWALD

7. Bender, L., A visual motor gestalt test and its clinical use (New York, 1938). 8. Birdwhistell, R. L., "Paralanguage - 25 years after Sapir", in H. Brosin (ed.), Lectures on experimental psychiatry (Pittsburgh, 1961). 9. Boatman, M. J., and S. A. Szurek, "A clinical study of childhood schizophrenia", in D. Jackson (ed.), The etiology of schizophrenia (New York, 1960), pp. 389-440. 10. Broadbent, D. E., "Effects of noise on behavior", in C. M. Harris (ed.), Handbook of noise control (New York, 1957). 11. Brody, S., Patterns of mothering (New York, 1956). 12. Brown, R., Words and things (Glencoe, 111., 1958). 13. Bruch, H., "Conceptual confusion in eating disorders", J. Nerv, and Ment. Dis., 133 (1961), 46-54. 14. Darwin, C., The expression of the emotions in man and animals (New York, 1955). 15. Davis, H., and S. R. Silverman (eds.), Hearing and deafness (New York, 1960). 16. Deutsch, F., "Analytic posturology", Psychoan. Quart., 21 (1952), 196-214. 17. Diethelm, O., Treatment in psychiatry, third edition (Springfield, 111., 1955). 18. Douthwaite, A. H. (ed.), French's index of differential diagnosis, seventh edition (Baltimore, 1954). 19. Dunbar, F., Emotions and bodily changes, fourth edition (New York, 1954). 20. Erikson, E. H., "The nature of clinical evidence", in D. Levner (ed.), Evidence and inference (Glencoe, 111., 1959), pp. 73-95. 21. Farnsworth, P. R., The social psychology of music (New York, 1958). 22. Feldman, S. S., Mannerisms of speech and gestures in everyday life (New York, 1959). 23. Fenichel, O., The psychoanalytic theory of neurosis (New York, 1945). 24. Ferenczi, S., "Embarrassed hands", in Further contributions to the theory and practice ofpsychoanalysis (London, 1950), pp. 315-316. 25. Fisher, S., and S. E. Cleveland, Body image and personality (Princeton, 1958). 26. Flügel, J., The psychology of clothes (London, 1950). 27. Frank, J. D., Persuasion and healing (Baltimore, 1961). 28. Freud, S., The psychopathology of everyday life, Vol. 6 of The complete psychological works of Sigmund Freud (London, 1960). 29. , "Mourning and melancholia", in Collectedpapers of Sigmund Freud, Vol 4 (1925), pp. 152170. 30. Glauber, I. P., "The psychoanalysis of stuttering", in J. Eisenson (ed.), Stuttering - a symposium (New York, 1958), pp. 71-119. 31. Goldstein, K., Language and language disturbance (New York, 1948). 32. Greenacre, P., "Pathological weeping", in Trauma, growth, and personality (New York, 1952), pp. 120-131. 33. Grinker, R. R., P. C. Buey, and A. L. Sahs, Neurology (Springfield, 111., 1960). 34. Grinstein, Α., The index of psychoanalytic writings, 5 vols. (New York, 1956). 35. Grotjahn, M., Beyond laughter (New York, 1957). 36. Hockett, C. F., "The origin of speech", Sci. Amer., 203 (1960), pp. 89-96. 37. Holmes, T. H., The nose (Springfield, 111., 1950). 38. Hurxthal, L. M., and N. Musulin, Clinical endocrinology, 2 vols. (Philadelphia, 1953). 39. Knapp, P. H., "Sensory impressions in dreams", Psychoan. Quart., 25 (1956), pp. 325-347. 40. Kretschmer, E., Physique and character (New York, 1925). 41. Kris, E., Psychoanalytic explorations in art (New York, 1952). 42. Kubie, L. S., "The eagle and the ostrich", Arch. Gen. Psychiatry, 5 (1961), 109-119. 43. Kurtz, J. H., Tape-recording of the sounds of an infant during the first 24 hours of life. Langley Porter Neuropsychiatrie Institute, (Aug. 1961). 44. Lacey, J. I., "Psychophysiological approaches to the evaluation of psychotherapeutic progress and outcome", in E. A. Rubinstein and M. B. Parloff (eds.), Research in psychotherapy (Washington, D.C., 1959), pp. 160-208. 45. Lasswell, H., Psychopathology and politics (Chicago, 1930). Quotation from Preface. 46. Lehiste, I., R. S. Tikofsky, and R. P. Tikofsky, "An acoustic description of dysarthric speech", J. Acoust. Soc. Am., 33 (1961), 1677. 47. Lewin, Β. D., "Sleep, the mouth, and the dream screen", Psychoan. Quart., 15 (1946), 419-435. 48. Luchsinger, R., and G. E. Arnold, Lehrbuch der Stimm- und Sprachheilkunde, second edition (Wien, 1959).

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49. Lynip, A. W., "The use of magnetic devices in the collection and analysis of the preverbal utterances of an infant", Genet. Psychol. Monogr., 44 (1951), 221-262. 50. MacLean, P. D., "Psychosomatic disease and the visceral brain", Psychosom. Med., 11 (1949), 338-353. 51. Mahl, G., "Disturbances and silences in the patient's speech during psychotherapy", J. Abn. andSoc. Psychol., 53 (1956), 1-15. 52. McCarthy, D., "Language development in children", in L. Carmichael (ed.), Manual of child psychology (New York, 1954), pp. 492-630. 53. McDowell, F. (ed.), Handbook of neurologic diagnostic methods (Baltimore, 1960). 54. Meares, Α., Shapes of sanity (Springfield, 111., 1960). 55. Meerloo, J., "Rhythm in babies and adults", Arch. Gen. Psychiatry, 5 (1961), 169-175. 56. , "Psychoanalysis as an experiment in communication", Psychoan. andPsychoan. Rev., 46 (1959), 2-16. 57. Mitscherlich, M., "Psychologie und Therapie des Torticollis Spasticus", in Proceedings of the 3rd World Congress of Psychiatry (Montreal, 1961). 58. Moser, H. M., et. al., Hand signals: finger-spelling ( = Technical Note No. 49, Contract No. AF 19 (604)-1577) (Air Force Cambridge Research Center, 1958). 59. Moses, P., The voice of neurosis (New York, 1954). 60. Obermayer, M. E., Psychocutaneous medicine (Springfield, 111., 1955). 61. Ostwald, P. F., "When people whistle", Lang, and Speech, 2 (1959), 137-145. 62. , "Human Sounds", in D. Barbara (ed.), Psychological and psychiatric aspects of speech and hearing (Springfield, 111., 1960), pp. 110-137. 63. , "The sounds of human behavior - a survey of the literature", Logos, 3 (1960), 13-24. 64. , "A method for the objective denotation of the sound of the human voice", J. Psychosom. Res., 4 (1960), 301-305. 65. , "Visual denotation of human sounds - a preliminary report of an acoustic method", Arch. Gen. Psychiatry, 3 (1960), 117-121. 66. , "Humming: sound and symbol", J. Aud. Res., 3 (1961), 224-232. 67. , "The sounds of emotional disturbance", Arch. Gen. Psychiatry, 5 (1961), 587-592. 68. , "Sound, music, and human behavior", in E. Schneider (ed.), Music therapy I960 (Kansas, 1960), pp. 107-125. 69. , Soundmaking - the acoustic communication of emotion (Springfield, 111., 1963). 70. Pavlov, I. P., Lectures on conditioned reflexes, Vol. I (New York, 1928). 71. Pittenger, R. E., C. F. Hockett, and J. J. Danehy, The first five minutes (Ithaca, 1960). 72. Rangell, L., "The psychology of poise - with a special elaboration on the psychic significance of the snout or peri-oral region", Int. J. Psychoan., 35 (1954), 313-332. 73. Rioch, D. McK., "Dimensions of human behavior", in H. Brosin (ed.), Lectures on experimental psychiatry (1961), pp. 341-361. 74. Roman, K. G., "Handwriting and speech", Logos, 2 (1959), 29-39. 75. Roose, L. J., "The influence of psychosomatic research on the psychoanalytic process", J. Am. Psychoan. Assn., 8 (1960), 317-334. 76. Ruesch, J., Disturbed communication (New York, 1957). 77. , and W. Kees, Nonverbal communication (Berkeley, 1956). 78. Riimke, H. C., "Problems of nosology and nomenclature in the mental disorders", in J. Zubin (ed.), Field studies in the mental disorders (New York, 1961), pp. 73-84. 79. Schilder, P., The image and appearance of the human body (New York, 1950). 80. Schumann, H. J., Träume der Blinden (Basel, 1959). 81. Scott, W. C. M., "Noise, speech, and technique", Int. J. Psychoan., 39 (1958), 1-4. 82. Searles, H. F., The nonhuman environment (New York, 1960). 83. Shaw, R. F., Finger painting (Boston, 1938). 84. Sheldon, W. H., The varieties of human physique (New York, 1940). 85. Skinner, B. F., VerbaI behavior (New York, 1957). 86. Smith, K., and J. O. Sines, "Demonstration of a peculiar odor in the sweat of schizophrenic patients", Arch. Gen. Psychiatry, 2 (1960), 184-188. 87. Stanislavski, C., Building a character (New York, 1949).

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88. Starkweather, J. Α., "Vocal communication of personality and human feelings", J. of Communication, 11 (1961), 63-72. 89. Steer, M. D., and T. D. Hanley, "Instruments of diagnosis, therapy, and research", in L. Travis (ed.), Handbook of speech pathology (New York, 1957). 90. Strauss, H., "Epileptic disorders", in S. Arieti (ed.), American handbook of psychiatry (New York, 1959), pp. 1109-1143. 91. Tembrock, G., Tierstimmen - Eine Enfiihrung in die Bioakustik (Wittenberg Lutherstadt, 1959). 92. Thorek, M., The face in health and disease (Philadelphia, 1946). 93. U.S. Bureau of the Census, Statistical abstract of the United States: 1959 (Washington D.C., 1959). 94. Wartenberg, R., "The Babinsky reflex after fifty years", J. Am. Med. Assoc., 135 (1947), 763-767. 95. West, R., The pathology of speech and the rationale of its rehabilitation, quotation from G. DuMaurier, "Peter Ibbetson", (New York, 1957). 96. Wolff, C., The hand in psychological diagnosis (New York, 1952). 97. Zipf, G. K., Human behavior and the principle of least effort (Cambridge, Mass., 1959).

DISCUSSION SESSION ON PSYCHIATRY

Chairman: Dr. Nürnberger Rapporteur: Dr. Ostwald

OSTWALD : In the recording which demonstrates loudness levels in a blind patient's voice, shown in Table VI, I am introducing the matter of acoustical measurements applied to the soundmaking of a psychiatric patient. This is a subject on which I would very much appreciate some discussion. My own attitude is that acoustical instruments are extremely helpful in disclosing very small differences in such factors as loudness or, objectively speaking, intensity levels of sound, and we are beginning now to use acoustical measurements also to determine pitch levels or frequency characteristics of the soundmaking of psychiatric patients. In this example (Table VI) the degree of loudness ranges from sixty to eighty-six phons, 1 an unusually large range. This seems to be related to the fact that this patient is blind, and uses soundmaking as a very active instrument for manipulating the environment and also for orienting himself. Also, he is constantly responding to the effects of his sounds in lieu of vision. DISCUSSANT: Will you tell us what is a "normal" range of phons? OSTWALD: Well, in the studies that we have, we normally get a range between about sixty-five and seventy-five. Let me tell you how I recorded and measured these sounds and that will perhaps clarify the situation. The patient is in an anechoic corner of the office and the microphone is ten inches from his or her mouth. The sounds are directly recorded on tape and measured by means of a half-octave band analyzer. The reason I chose this method is that it eliminates the extraneous noises around the clinic and also permits one to pick up more detail of the articulation pattern. Acoustical studies of conversational speech of persons who are not psychiatric patients generally show intensity levels of around sixty-five decibels; such measurements have usually been taken in anechoic chambers or other acoustically-controlled situations roughly similar to the setup I have just described. MEAD: Have these been two-person situations? OSTWALD: Not all the time. Some of these studies in the acoustical literature are done from reading or reciting prepared material, and I think that would be considered a one-person situation. 1

The phon is a unit of loudness level, equivalent to decibels at 1,000 cps.

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FREEDMAN: Most psychiatric interviews take place in rooms which are soundproofed to maintain privacy but into which street and other extraneous noises may intrude. This may mean that the sound level in which a "typical" patient-psychiatrist interview takes place is higher than the measured decibel level of a patient-doctor interaction in an acoustically-controlled environment designed for research. When I have recorded therapeutic interviews and have listened to the tapes about six months later, I have often been astounded at the amount of extraneous noise that I had not "heard" at the time of the treatment session - ambulance sirens, automobile horns, and so on. This is quite aside from the specific patient communications to which I did not respond. Without realizing it, I blocked out, as I suspect the patient did, outside noises of very high intensity. I assume that we both must have raised the level of our own verbal communications to compensate for them. BIRDWHISTELL: They are discovering at Columbia that when you cut the noise level below a given point you observe distorted behavior in your subjects. Several "quiet" laboratories that were built at great expense are now being torn out and being turned "live" again. Y o u get systematically different behavior in too quiet a room. With psychiatrists and patients, one of the things we must do, if we want to do decent comparative work, is to make sure that surrounding sound is not reduced too low. MEAD: We have been neglecting Dr. Ostwald's actual suggestion that precise acoustical measurements can give us valuable data. His actual illustration of the blind patient was exceedingly interesting. We didn't get very clear from him initially-which is one reason we weren't sufficiently appreciative - that he was comparing the blind person with other patients in a controlled environment, where the doctor's behavior and the shape of the room were constant, and the blind patient showed a different range of variation from the others. Now if recording at this level can be significant without being raised to other levels of analysis, this is very important for us to know. Every time we can use the simplest measure, we are lucky not to have to raise it to a more complex measure. The possibility of using acoustical data diagnostically should go on record. BIRDWHISTELL: The context and recording technique must be defined so that you know where your data come from, and can measure and evaluate your results. That is, "kinesic" or "paralinguistic" data are subject to a given kind of methodology, subject to a given kind of discipline. In a sense, Dr. Ostwald has offered us a hillside full of data, full of gold and silver and coal, but the fact that we can find minerals there does not make our efforts minerology. Minerology comes when you use certain techniques of a very specific nature to identify, to check, to test, and to allow other people to run similar tests and checks. The fact that we have a vast array of material does not make it kinesics or paralinguistics. The real question is : How do we know? What is the situation, the context from which the data are derived? We must measure significance in terms of the situation of the patient. Otherwise, how can we provide a profile which makes it possible to separate abnormal, pathological, inappropriate

DISCUSSION

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behavior from behavior which is totally expectable in a normal human being within a given context? N o w , if we may turn to the figures in Table VII, we must ask you, Dr. Ostwald, what you think, from your studies, the variation in these lines, the systematic irregularity of pattern that you see there, is about? From your theoretical position, why do these lines tend to take this particular shape? What is the nature of such shapes? D o you think that the fact that these are similar has a reference to illness, a reference to humanness or is this a patternment of communication? Is this the way in which human beings interact with each other by the pattern method? OSTWALD: I think the question of meaningfulness and of the relationship between verbal measures and other statements about patients should be deferred until we have had a chance to hear Dr. Mahl's paper, which focuses on some of these very questions. KRAMER: The underlying similarity that is measured by a good many of these figures in Table VII is the voice of one person. The differences, I think, are significant. The similarities you could pretty much expect, since you have the person's characteristic tone of voice recorded. The strength of each frequency, the relative intensity of certain parts of the sound spectrum is an important constituent of the tone of voice. Y o u simply have somebody whose voice you would recognize if you met again at a later interview. MEAD: Dr. Kramer, the real issue here is: Would you recognize him in this context? Are we dealing here with the distinctive idiosyncratic characteristics of this individual or are these characteristics of the communications situation he is in? NÜRNBERGER: I would like to ask how much of the type of pattern which is demonstrated in Table VII is culturally determined, rather than individually determined. If, for example, you were plotting the intensity and frequency of communication, the beginning and end of sentences or of interviews, with an Indian in Calcutta or Bombay, would you be able to isolate anything idiosyncratic, or would the contrast with this man who derives from a different culture be in terms of the particular type of communications situation? It seems to me you would be highly suspicious that variations in the beginning and ending of sentences, for example, which I think the curve in Table VII demonstrates, would include a strong cultural factor. GOFFMAN: The problem is that we can't fall back on saying: " I ' m just dealing with what I've got here." It's our j o b to try to make explicit what it is we might be having here : American vs. Indian ; ill person vs. well ; a patient, medical or psychiatric, vs. a healthy person; a two-person interaction vs. a multi-person interaction; subordinate-superordinate vs. equalitarian interaction. There is a whole nest of rolesin-context to which we might impute any difference we find. STANKIEWICZ: I would like to reconsider what we call here, rather vaguely, "communication". On the one hand, we have phenomena which are fairly constant under various circumstances, and which are not easily controlled by the patient. These are the olfactory or tactile phenomena, which are of a physical nature, as well

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as the various types of sounds you describe, not all of them produced by the oral orifice. These phenomena may be regarded as symptoms. If they communicate, it is by virtue of the fact that they can be given a diagnosis or tell us something about a physical state or disease. In the same sense, every physical phenomenon conveys information, so long as there are interpreters intent on explaining it. St. Augustine stated the problem clearly when he said that the Sight of birds communicates, but it communicates differently to the seer, hunter, or birdwatcher. In other words, everything can be interpreted with reference to a given context or in terms of some private code. This type of communication has to be separated from that conveyed by signs which are part of a communal code. I think that if we draw this distinction at the very beginning, we may be able to discuss the various modes of communication in terms of signs which have a fixed, coded value, as opposed to physical phenomena which allow for variable, socially or contextually determined interpretations. BIRDWHISTELL : I wonder whether it might be profitable to divide our discussion between those things which are descriptions of expression within one body as contrasted to these things which are communicational, interpersonal. OSTWALD : I don't think that we tend to make much formal distinction between expression and communication in clinical medicine. This is a question that I think the other physicians on the panel will have something to say about. KANFER: At the beginning of the paper my reaction was, as expressed before, that we are shifting from a description of pathology, which is in the structure of the organism, one which we observe and which gives us some diagnosis, to a description of functional relationships to someone else. At first, these two seemed to me to be differentiable but, on second thought, I would like to raise the question of underlying assumption here. Would you think, for example, of a skin disorder as being a communication in the sense that it is functional also, or would you differentiate it at some point as being only a structural property? 2 OSTWALD : I certainly am impressed by the literature in psychosomatic medicine which attempts to define the multiple relationships between different emotional states — for example intractable tension associated with anger - and physical structural changes in the body - for instance renal pathology associated with hypertension. This is a very important area for medical research and I think no one has the final answer to it. 3 Two different approaches seem to be called for: 1) we must know on the one hand what processes are involved when an individual translates the symbolic messages that he perceives coming from the external environment into neurophysiological signals and patterns of reaction; 2) we must also consider what the internal makeup of a person may be which controls how he translates his internal neurophysiological patterns into the kind of expressive behavior which can be communicated to outside observers. To begin with, it will be important to differens

Grinker, R. R., and F. P. Robbins, Psychosomatic case book (New York, 1954). Reiser, M. F., "Reflections on interpretation of psychophysiologic experiments", Psychosomatic Medicine, 23 (1961), 430-439. 8

DISCUSSION

39

tiate transient physiological changes, such as blushing of the skin or labile hypertension, from more permanent or semi-permanent bodily changes, such as chronic scarring of the skin or fixed hypertension. We know that psychotherapy, which is an attempt to influence the body's internal state through external symbolic forces, can make psychosomatic patients feel subjectively better and even at times reduce the degree of abnormal bodily responsiveness. But once an intractable state of bodily dysfunction has been attained, psychotherapy seldom if ever can do more than help the patient accept his disability and reduce the secondary turmoil associated with being ill. BIRDWHISTELL: Would you say that blushing and blanching, for instance, to go back to this transitory response, are merely physiological conditions, capillary conditions, or do you feel that blushing and blanching are cultural and learned phenomena? OSTWALD : I don't see why they can't be both. MARKEL: If we accept the fact that all these things are cultural and leave it to anthropology to describe them in an extrasomatic sense, then there is no problem. MEAD: I do not speak of culture as extrasomatic; if you stated it like that, of course you would have a lovely time. But our general conception of culture is of a system of learned behavior embodied by the people who live in it, and their bodies grow in it all through their lives. MARKEL: The term doesn't make any difference. Certainly the culture is always expressed by individuals, but there are cultural systems which exist over and above any individual. I think the question you are raising is answered if we assume that all behavior is culturally determined; the psychologists and psychiatrists study how the individual uses the system. MEAD: If you go back to Darwin's The expression of the emotions in man and animalsthe one thing that Darwin was not dealing with that we deal with now is communication. He was discussing what makes the dog bare his teeth when he is angry : the dog perceives something and bares his teeth because of what he perceives, not to tell the other dog what he is going to do. I think this is the sort of dilemma that was presented by Dr. Ostwald's paper, because it ran the full gamut. It started with things which are physiological, and may be identified in any culture, for instance worms that are picked up by eating certain foods and invade the liver and may produce jaundice. This is a geographic and not a cultural trait, so that any time that you pick up this worm you'll get a state in the liver which could be identified by a physician whether or not the patient knew, whether or not the patient wanted to tell the doctor. If the doctor knew the phenomenon, he could read this sign from the patient. OSTWALD: The doctor has to have the patient in a situation where the patient will allow himself to be examined in certain ways. MEAD : Then the paper went on to complex relationships such as the individual 4

Darwin, Ch., The expression of the emotions in man and animals (New York, 1955).

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learning to use regressive, infantile behavior as communication, which may interfere with higher communicative behavior. I think the reason we are arguing is because Dr. Ostwald has covered the whole range within the clinical picture. BIRDWHISTELL : Dr. Ostwald, would you be prepared to say, as a clinical physician, that a symptom arises from a particular trauma or that a symptom is learned? That is, do you learn how to express where you hurt in a given culture and does the organism have to develop a method of sending a message to the external world in order to be taken care of? Or is the symptom located as an intrinsic element within the illness? If you can tell me that, I will know where you stand in your paper. I also have another question: Is the symptomatology we have been talking about a device to get special attention? This would include what are called successful symptoms. Generally speaking, we have only studied successful symptoms. That is, we have only recorded those which have gotten through to us. It takes a brilliant young internist to catch the patients who send the wrong signals! It may be only the man who is successful that we see. NÜRNBERGER: Would you discriminate between a symptom and a sign? A sign is something that the physician uses, such as a heart murmur. A symptom would be something that a patient would complain about one way or the other. He might not complain about a murmur, but a physician would hear it. BIRDWHISTELL: I can see the distinction, so I'll back up and re-ask the question, with specific reference to such things as coughing, limping, gasping, differentiation in breath rate or heart rate - not murmurs, which we can isolate - , and such things as, for example, the drying up of mucus or an increase in the amount of mucus. Are these things essentially within and immanent in the trauma or are they learned organization? Or would you say this was a matter of degree? PITTENGER : There is one other comment that seems to me important in terms of the paper. You speak of a cough as being, in a sense, unlearned. Very quickly or almost immediately one hears a cough, he hears it in context and he hears a particular kind of cough. It is one of my beliefs that there is almost no such thing as a spontaneous unlearned act within an event because we have learned the action in a context and we elaborate and extend it, or we contract it, or inhibit it, because of cultural learning about the context and about the meaning of this act in the place where we learned it. The child is dependent and helpless, but he is very quickly learning and being taught and trained for a whole set of contexts and reactions. I think that we underestimate the intensity and the volume of learning, and the immediacy of the learning that is taking place in these events. OSTWALD: Well, I will give you an example which I learned recently from discussion of this subject.5 These are observations taken on the battlefield where a person may suffer a very considerable bodily trauma, loss of a limb or something equally serious, and not develop a symptom, a complaint, until he reaches a certain •

David McK. Rioch, M. D., in a lecture at Langley Porter Neuropsychiatrie Institute, 1962.

DISCUSSION

41

level of the structure of the army organization, say the battalion aid station where there are people available who are either trained to respond to what has happened or able to respond in some intuitively helpful way. So I think both factors are involved: the physical trauma and the learning experience, the knowledge that the sufferer has of the appropriate place and time and person for complaining about the symptom. PITTENGER : What a person does with what has happened to him is determined by his audience. OSTWALD : Yes, I think that is important. However, a person can also be his own audience. SCOTT: We should be specific about a person being his own audience, because discussing the result of the habit formed when people become their own audience would lead to something which hasn't been mentioned here yet. On the one hand, we must ask whether the person is conscious of what he himself is doing which may be seen or heard. Is the actor auditing or monitoring, or, on the other hand, is it the person watching or listening who is auditing, or are both? We should talk about the size of the field of consciousness in those in the world around about (the audience) and the size of the field of consciousness in what we call the person, the self, being observed. Both are continually varying. We must find ways of measuring the variation. The degree of self auditing, as well as the reaction to audience auditing, seems to have much to do with learning to change. STANKIEWICZ: I would like to address myself to the same question. Could we speak, perhaps, of some kind of a grading scale? If a person is lame, he might emphasize or attenuate his lameness for the sake of an audience, but if he is lame because a part of his leg is cut off, he could hardly conceal this defect. If somebody coughs, he may have a case of TB, for TB patients are known to cough. Do they do this for an audience or is coughing a symptom of the disease? Can coughs and lameness be imitated? And if so, do they serve a communicative function? Culture may control and modify the appearance of symptoms, but these are basically physical phenomena. FREEDMAN: A scaled gradient between audience-determined or culture-conditioned symptom communications and the purely physical signs would probably, paradoxically, have to vary idiosyncratically with individual patients or subjects, and with special sub-cultures or environments. For example, flatus or farting is considered many things but rarely a means of voluntary communication in our culture. Yet, on one of the wards of tuberculosis patients with which I was acquainted, farting contests were a principal means of prestige attainment, competition, and communication. The fellow whose volume and frequency were the highest had a considerable gain in status over the others! None of them considered this at all extraordinary - but they were aware of sub-cultural differences. When I commented on this, they acknowledged that "a gentleman" wouldn't understand; a gentleman, they said, "sneaksthem out". MOSES: In Bavaria, where everyone uses caraway seeds in bread, people love flatus. The way they dance the Schuhplattler shows that this part of the body [il-

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lustrating by slapping the buttocks] plays a tremendous part. Is this satisfaction for them, or is it in any way communication? Certainly they start the day with flatus and they end with it because they have caraway seed in their bread four or five times a day. I wouldn't know what this is. To me, it does not go under the term communication. FREEDMAN : We do find a difference in somatization of psychiatric symptomatology as a form of communication in different socio-economic levels. For example, in one of our studies® we were able to differentiate people who were in some diagnostic or treatment relationship with psychiatrists on the basis of increasing somatization and involvement of the total body as we went down the class-level scale. Now please don't misunderstand me. 1 am not saying that we now know that this distinction necessarily holds for the differing social classes in all contexts; my observation concerns individuals who come in contact with psychiatrists. If you define your socio-economic levels by education, occupation, and residence, so that Class I is the highest and Class V the lowest, you discover significant differences in how the body is used as a psychiatric communicating system. When you come to Class IV, you have a high percentage of people who have bodily symptoms; when you get to Class V, again you have a much higher incidence of people who have serious behavioral difficulties with society. So you find increasing paralinguistic and kinesic symptomatology of psychiatric patients as you go down the scale. BIRDWHISTELL: With regard to lameness, 1 think that even random observation around a rehabilitation center will show that there is a great difference between those individuals who are sending the signal, "I'm lame", and those individuals who are working to cover their lameness. The way in which lameness is used at various times will vary. Now certainly if you don't give the patient a prosthetic limb and he falls over every time he tries to walk, of course it is true that the cause is physical. But if you put on a prosthetic limb, it is perfectly clear from studying "rehab" situations that there are those who relatively easily learn not to send the signal, "I am lame", and there are people who constantly send the signal, "I am lame". This is probably not just an idiosyncratic matter; there is a pattern to it. Take the cough, for instance. The Kutenai Indian could tell the difference between a Kutenai cough and a Shuswap cough. It was a different type of cough and they coughed in a certain way. The Kutenai Indians coughed up their nose. This is part of being a decent Kutenai and not to have done so would mean being taken for a damned Shuswap! STANKIEWICZ : Sneezing is probably a physical phenomenon. BIRDWHISTELL: Breathing is a physical phenomenon. MEAD: I think it is very important that we don't talk about cultural influences only on the level of whether you speak to the captain or the private about a wound, or cover your nose with a handkerchief, but that we should realize from the very • Freedman, L. Z., and A. B. Hollingshead, "Neurosis and social class", Am. J. ofPsychiat., (1957).

113, 9

DISCUSSION

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start that all of this behavior is patterned from the moment of birth and probably although the evidence is not conclusive - from the moment of conception, and that we are dealing with the fact that, from the moment something occurs once and there is a response to it or a non-response to it, it is changed. One cannot speak of simple spontaneous events that occur more than once. We have to keep this whole pattern of systematic types of behavior characteristic of different cultures very clearly in context. Now when a Manus baby is born, for a proper Manus birth, there are three women in attendance. One of these women is there to deal with the baby and, from the moment the baby is born, she starts to cry in unison with the birth cry, so that a Manus baby never has the experience of crying and waiting to see what will happen, because he knows at once! This develops later into a lullaby in which the way you put a child to sleep is to cry in tune with the child but louder, which would not put children to sleep in many other societies. Now, it seemed to me, as you were speaking, that the disappearance of croup is a useful example of this kind of thing. I don't know exactly what has happened in this country, but it is reported reliably in England that croup has disappeared. 7 A generation ago, babies got croup and they choked and the whole family went into fits, and all families kept a tent which they put over the baby's bed and the mother sat up all night and the baby nearly died! Now how does the baby know that croup is out of style? OSTWALD: Perhaps babies somehow have come to sense that now they are allowed to have colic! MEAD: The parents don't have fits any more. The kind of panic that used to be aroused by that name "croup" was aroused in the adults and not the baby. I am assuming the adult had charge of this! MOSES: May I mention first that we are talking here about a type of croup which is of an entirely psychosomatic nature. There is another one, not discussed here, which is of dangerous organic nature, similar to diphtheria. I think that croup occurs in children who first tried breathholding, which later conditions them to croup. In former years we often observed children who had first breathholding, later croup and eventually ended up with asthma: they did croup successfully enough to create interest in them on the part of the family and for this reason went on to asthma. This pattern has become very rare. The way a mother takes care of her child is quite different now. The child no longer has to press the button to get attention from mother. I think that breathholding is handled differently and therefore we have less croup. I remember very well that no child got croup during broad daylight. It was a typical symptom of the dark. One had to "analyze" the voice of the mother to find out how serious the attack was. At that time we did not know yet that croup was a psychosomatic 7 Soddy, K., Proceedings of the meeting of the scientific committee, Health, 1962. [Unpublished.]

World Federation for Mental

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symptom, but I learned from my notes that it always happened in children who did breathholding first. SCOTT: Can we not go further? Is croup not related to the problem of vomiting? Vomiting, frequent as it is as a symptom now, used to be much more frequent. Culturally we have developed an intolerance of vomiting. Hysterical fecal vomiting disappeared just before World War I. Years ago, psychiatrists were interested in patients who vomited so much that they vomited their feces. The last recorded case was in 1911. I think we lack the explanation of why our culture has become less tolerant of vomiting as we have become more tolerant of yelling. OSTWALD: During my life span, there has been a great change in tolerance towards noise. There is much more radio and telephone used, and now it's television. Possibly this is a problem for an anthropologist to come to grips with: why does there seem to be such a change? M E A D : About noise, I think there is less tolerance, not more, just as is the case with smell. In the United States, nobody has been willing to smell another human being, if they could help it, for the last fifty years. We have covered everybody over with every possible kind of a scent so that, from their tooth paste and their shaving cream, everybody smells like a drug store and nobody smells like a person! This was necessary, I think, because of the intolerance of different groups coming together and having to smell people who ate differently and slept differently and so forth. This is now happening with sound. We are finding now that the major comment that people make on the neighborhood they have to move into, the other people that move into it, and the reason they move out, is that people don't make the right kind of noise. It is this wrong kind of noise that intrudes into your yard. You want to live in a group of people who all make the same kind of noise, which will bar out the inevitable smaller noises that are different. The acoustic level has changed. OSTWALD: The amount of noise has been rising and recently I heard Professor Vern O. Knudson, an acoustical engineer from Los Angeles, talk about this. If the noise level keeps rising at the rate it has been up to now, apparently within ten or fifteen years the noise levels will be so intense as to produce deafness by physical damage to the ear. I was interested in your saying "noise" and "smell". There are certain verbal qualifiers that are coming in. For instance, just as "stink" is a derogatory way of talking about smell, "noise" is often used as a derogatory term for sound, even by acoustical engineers, who speak of noise as "unwanted sound". M E A D : They are the two invaders. After all, they are the two modalities that can invade the rest of the world. You sit still and other peoples' noise and other peoples' smell come and get you and enter into your system. You can close your eyes, you can refuse to eat and you can refuse to touch. But noise and smell are invasions from a distance; that's the feature that links these two. BIRDWHISTELL : 1 certainly agree about the business of odor. It is very odd that in the early pioneer reports, the men who moved always complained about the odor

DISCUSSION

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of other men's fires. They moved not only because they could see someone on that other hill that offended them because they were getting too close; they could also smell his cooking over two or three miles away, carried by the wind. The neighbors were "stinking the place up"! And from here we get into the whole business of the amount of body movement that becomes offensive. MOSES: Allow me to go back to the recordings which Dr. Ostwald demonstrated, which are of great importance, because what we heard was really a catalogue of vocal expression. The question we have all been asking is: To what extent can such things be communication? To what extent are they not communication? I have the feeling that we have to focus on this in terms of a specific concept. Unfortunately, Dr. Bühler is not here today. He actually invented the term "appeal". 8 He gave us the key. What is communication? He said part of it is "appeal", and I am analyzing all these problems by this criterion : is the sound designed to reach somebody or is it not? As long as it is an autistic expression and interests only the speaker but not the hearer, how can we analyze it? I have developed a list of what we can call "acoustical dimensions" which include this item of appeal. For instance, in this animal sound, augh-augh-augh [illustrating], we have rhythmic communication, in which the melodious factor is eliminated. The melody is out and the rhythm is in. This is not communication, this is not directed to any audience. In schizophrenic communication (Dr. Ostwald doesn't want me to use the term "schizophrenic" ; I use it anyway because I am a throat doctor! I can afford it!), we often find that the melody is decreased in favor of the rhythm. More rhythm does not mean better rhythm, it simply means hyper-rhythm. The voice of Adolph Hitler was high in rhythm, and anti-melodious. Goebbels, the right hand of Hitler, gave his speeches first in a rhetorical, then in an operatic manner. He gave the facts and then added the emotions in something like an aria. In other words, this man was so fantastically controlled that he could first give the dry facts in a very balanced rhythm, in rhetoric - in opera we would call it "recitativo" ; then came the "aria", where all of a sudden the emotional factor appeared, carried by a tremendous hyper-melody, which embraced his listeners emotionally. This was a rhetorical trick which he used in a very successful way, unfortunately, - which means that he convinced millions of people that he was right. Now, what have we heard today? We have mainly heard voices which are not directed at another person. We heard patients who sounded as if they were talking to themselves. There is something else, a factor which has not been mentioned, the factor of resonance. I am referring particularly to nasality. When you have a child with a cleft palate, or a person with a paralyzed soft palate, or when you have a high-school girl in the United States right now, going out during the week with flat heels, with a 8

Bühler, Κ., Sprachtheorie (Jena, 1934).

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shuffling gait, not moving the soft palate, so that she speaks with a nasal voice - this is all open nasality, due to dysfunction of the soft palate. And then, on Friday and Saturday night, she goes out on a date wearing high heels and all of a sudden she moves the soft palate and she has a completely different type of voice - no more dysfunction, but normal function of the soft palate. What we heard in two of the recorded voices was a touch of what we call open rhinolalia where the soft palate did not move at all. This is one type of nasal resonance, but a fairly unimportant one. The type of nasal resonance which serves as a gesture like an outstretched hand is something entirely different. T. H. Holmes' book, The nose,9 gives us the key to the swellings and shrinkings of nasal mucous membranes under different affects, which are used to express the emotions in love and hatred. Accompanying sexual impulses there is a swelling of the nasal membranes which gives to the voice a completely different aspect, and we have to say that the nasal turbinates are much more easily influenced than the swellbodies of the sex organs. We have to keep in mind that we can see how mucous membranes shrink and swell under different emotional conditions. If there is the slightest appeal in this voice, if the patient gives what I call the outstretched hand through the touch of nasality - which is cross-cultural probably, if I may say so; this is not conditioned - he is making some effort to make contact. In other words, we have two types of expression. We have one which is entirely oral, which needs distance and expresses distance, and which goes entirely through the mouth. In contrast, love has a nasal touch. There is a slight nasal touch which every decent Hamlet actually experiences on the stage when he is in love ; it is not faked. In Peter Ostwald's excellent demonstrations of voices today, all of these voices were one hundred percent oral, there was not a touch of outstretched hand, from the mentally retarded to the blind boy. I made the following experiment: Gregory Bateson interviewed several schizophrenic patients, without telling me anything about the setup, and sent me the tapes. All these tapes sounded the following way: Bateson talks to the patient, but the patient's voice passed right by him. All of these patients had qualities in their voice which showed this was unsuccessful communication or disturbed communication. Every word was audible, but it was not directed toward the interviewer. This is not communication! This is disturbed. The proportion between melody and rhythm, and also nasal resonance, are all important to us in measuring appeal. I have introduced something else which the psychiatrists probably don't like: the word "pathos". 1 0 Pathos is an expression of personal dignity, in the street-cleaner or the emperor. This expression of personal dignity, pathos, occurs in any type of voice as long as the individual is not a psychotic. In all psychotic patients, it is gone completely. If there is no appeal, there is no expression of pathos, of personal dignity. • 10

Holmes, T. H., H. Goodell, S. Wolf, H. Wolff, The nose (Springfield, 111., 1950). Moses, P., The voice of neurosis (New York, 1954).

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So with these concepts I can make a dichotomy: Is communication intended or not? Is communication possible or not possible? There is something else I would like to say. We have in our psychotic type of vocal expression something which is a most important part of the kinesics of the vocal cords, and in the different papers which we received on kinesics, I missed the kinesics which take place completely within the vocal cords. Vocal cords are by no means just bands which produce voice. I want to remind you that, if we accept the theories of the French physiologist Husson, we have to change our ideas completely. Perhaps every individual vibration is brain-born and by no means respiration-born, which changes many things. But besides, the vocal cords are not uniform structures : a vocal cord has inside fibers and outside fibers, and the inside fibers produce the head register, the outside fibers produce the chest register. Dr. Mead asked me at lunch whether mutation, the change of voice which starts with the beginning of pubescence, is automatic in girls as it is in boys. Puberty affects the voice of both sexes because the larynx is a secondary sex organ. All sexual development is accompanied by modifications in our voice. The change in boys' voices is more dramatic than the change in girls' voices, because the boy's larynx grows about one centimeter, forming the Adam's apple, while the girl's cords grow three or four millimeters. Boys' voices drop about one octave, girls' voices about one third of an octave. Does this occur in all boys? No. Is this constant in all emotional situations? No. In one of the records we heard this morning, the voice all of a sudden sounded as if it had become high. This illustrates my theory that the schizophrenic is entitled to what I call "schizophonia", which means that he separates his vocal registers.11 This divergence of registers makes it possible that he use either head- or chestregister. The same thing happens then that you hear in the "Henry Aldrich-Complex" : in one single tone you can hear a high phase produced by the inner fibers of the vocal cords as well as the low phase produced by outer fibers. I have developed a theory that, with the degree of blending of these registers, we can almost measure the identity of a young man. If he is not identified, if he is unable to identify himself, he will go on breaking his voice for months or even years. Very, very many have this falsetto voice [illustrating], which can often be cured mechanically in one single treatment by applying light pressure on the thyroid cartilage from above. The patient will then lower his voice automatically. The patient will often protest at the new low voice: "That sounds horrible!" It takes a certain time to get him used to it. Now, my psychiatrist friends object: "This is a therapeutic crime, because he needs this high voice!" Since I follow up this first victorious step with psychotherapy the treatment is usually successful. There are typical girls' voices in Catholic schools, as characteristic as the stylish handwriting of young girls educated in Sacre Coeur convents. Whispering plays a 11 Moses, P., "Vocal elements of disturbed communication", Practica Oto-rhmo-laryngologica, 19, No. 4 (1957).

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great part in Catholic schools. In whispering, you close the anterior and middle third of the vocal cords, keep open the posterior third. If you do this for a certain time, you feel the strain, which they tolerate because they are not allowed to talk loudly. This gives a certain uniform voice which one learns to recognize immediately. The same items which appear in handwriting come out in voices. Now these are, to me, interesting communications in voice. Let me say one more word. A schizophrenic very often talks in a high voice, meaning with isolated head register, for minutes, hours or months and years, using this type of falsetto [illustrating] all the time. Or he may talk in a very low voice for minutes, days or years. What this means is up to the interpretation of the psychiatrist ; I only know that he talks with the two isolated registers. "Since the schizophrenic seems to speak in two voices, schizophrenia brings to mind ventriloquism where 'the other personality' is externalized almost in the flesh and sits on the obsessed's arm or lap to contradict him, fight him, warn him; in short, to do everything that voices tell the schizophrenic. In former centuries divine oracles were proclaimed through ventriloquism and until the beginning of modern times a supernatural origin was believed."12 There is a split, the other part of the ventriloquist is externalized. You have never seen a peaceful discussion between a dummy and a ventriloquist. They all fight. There is a special technique. MEAD: Could they make love? MOSES: NO - or this would have to be a narcissistic self-love between two parts of the personality. Before I finish I want to mention the way emotion affects the breathing function. 13 Increased inspiration expresses pleasure, increased exhalation displeasure. The pronunciation of the letter / includes inspiration and the touching of mucous membranes, plus production of saliva. Interest in sex that the law forbids is expressed in words beginning with an inspiratory /: lewd, lascivious, libidinous. Good food is called by words with the sucking /, as in delicious, delightful, delectable. Inspiratory voice is used to express pleasureful sensations; in "je t'haime" you really love! OSTWALD: I would like to mention the difficulty of studying such nonverbal phenomena as whistling and humming. For example, there are many different forms of humming. Some of the humming behavior that I have seen among psychiatric patients has to do with impeding communication rather than promoting it. For example, there are certain children and certain regressed adults who will hum in order to prevent the perception of words. These are steady, pure tones of humming or intermittent tones of relatively long duration, and this kind of humming is quite different from certain verbal hummings, which are interactional cues and can mean such things as "yes", "go on", or "stop", and so forth. 12 This brief quotation from Dr. Moses' own book, The voice of neurosis (op. cit.), was added for clarification. Edd. ia Moses, P., "Psychosomatic aspects of inspiratory voice", A.M.A. Archives of Otolaryngology, Vol. 67 (April, 1958).

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STANKIEWICZ : I want to take up the modes of communication which are in their essence physiological, even if they may become conventionalized or even ritualized, and distinguish them as clearly as possible from signs which communicate because they are a part of a code. Concerning Dr. Ostwald's paper, I don't quite understand why he considers body actions a part of a culture. Would you consider the body actions of a dog a part of culture, or would you draw a distinction between bodies that have a soul and those that don't have a soul? MEAD: A dog embodies to the best of the dog's ability the culture in which he lives. An example is that after the recent trouble in Hungary when we had distributed throughout this country for quite a long time Hungarians who were living as guests in America, ä great many dogs learned Hungarian. Not to speak it, you understand! STANKIEWICZ: The questions which seem to me relevant are: what kind of physical phenomena are modified by culture? For example, under what circumstances can one not laugh? And do cultural prohibitions necessarily serve a communicative purpose? Phenomena which are modified or controlled by culture are not equivalent to phenomena which are purely cultural, such as verbal behavior. The next question is: to what extent can physical phenomena become a means of communication? Take the example given by Dr. Freedman of the farting contest. You can also choose coughing, sneezing, or simulated lameness as communicative signals. But if they do acquire a communicative function, it is only on the basis of some private agreement, as a kind of private language, which is restricted to some situations and to small groups of individuals. FREEDMAN : We are ending up with the conclusion that what is needed is a more precise experimental or observational delineation of the interactional relationship of the biological and cultural factors.

PSYCHOLOGICAL RESEARCH IN THE EXTRALINGUISTIC AREA by GEORGE F. MAHL A N D GENE SCHULZE

INTRODUCTION Definition of the area Before describing and discussing "the state of the art" it is necessary to present a working definition of the "art" we are considering in this paper. When an individual speaks he engages in a special class of behavior — linguistic behavior. The essence of it is the production, via the speech apparatus, of institutionalized sounds organized into institutionalized patterns. The immediate purpose of this behavior is to communicate with another individual, to interact by means of messages. From the strictly linguistic standpoint, speaking behavior is determined by two things: (1) the code itself and (2) the intention to communicate a particular message in that code. These linguistic factors, however, do not fully determine the behavior of the speaker. One important qualification is that the code does not completely mold or restrict the content of the behavior. There may be variations both within the linguistic behavior itself and in accompanying non-institutionalized behavior. Linguistic variations include the choice of the language (French or English, for example, in cases of polyglot participants), variation in dialect, the use of simple or complex sentences, active or passive voice, present or past tense, extensive or restricted vocabulary, etc. From the linguistic standpoint we may say, loosely, that the same message can be communicated regardless of the alternatives used. Permissible, non-linguistic variations are greater. They include such things, in English at least, as variations in rate of speech, general loudness, general pitch level, throat clearing, belching, a wide variety of body movements, etc. Another important qualification to the strictly linguistic determination of speaking behavior is that, beyond the immediate communicative intention, other psychological states or processes are simultaneously operative. Of necessity, or adventitiously, or both, they enter into the determination of both linguistic and non-linguistic behavior. For example, a self-confident person may speak in relatively simple sentences with well controlled pitch and volume, and with few sighs or nervous coughs. An insecure person, on the other hand, may speak in complex, involved or even unfinished sentences, with poor pitch and volume control, and with frequent nervous mannerisms.

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The case for the listener is similar to that of the speaker. He hears and reacts to the institutionalized sounds, but his behavior is not fully determined by strictly linguistic factors. The permissible variations in the linguistics of the message and the non-linguistic behavior of the speaker are stimuli for the listener, arousing in him psychological states and processes beyond the strictly linguistic ones of receiving and decoding the message. Sentence length may vary considerably, for example, within the limits of acceptable English and convey the same explicit message to a listener. Yet increasing sentence length may cause a variety of listener reactions to the content or to the speaker: interest, boredom, annoyance, etc. Similar statements could be made about such things as the general rate of uttering the message, as well as the overall pitch and volume level used by the speaker. The preceding remarks, which deal very briefly with highly complex matters, point to the behavioral phenomena this paper considers. We will call the area "extralinguistic",1 It encompasses extralinguisticphenomena in the speaker's overt behavior. These Include both the permissible variations in the strictly linguistic (institutionalized) behavior and the non-linguistic (non-institutionalized) behavioral phenomena. Thus, extralinguistic phenomena subsume Trager's paralinguistic phenomena. The extralinguistic area also includes, however, the functional relationships between the extralinguistic phenomena and the non-linguistic states and processes in the speaker and listener interacting in the communication situation. Speaker's covert states and processes include: a. immediate intention to communicate, allied linguistic factors.

Speaker's overt behavior includes: ->· a. linguistic

Listener's covert states and processes include: a. linguistic

S

b. non-linguistic states b. non-linguistic b. non-linguistic and processes. (Extralinguistic phenomena include permissible linguistic variations and all non-linguistic behavior. Extralinguistic relationships defined by solid arrows.) Fig. 1.

The solid, completed arrows in Figure 1 outline the extralinguistic area this paper reviews. Psycholinguistics includes the extralinguistic area. Plan of the paper The plan is to review the state of extralinguistic research by looking at it from several viewpoints. First, we will classify and describe those extralinguistic phenomena which psychologists have investigated. This includes methods of study and 1

Although our introductory remarks deal with oral behavior, we believe that analogous statements would apply to writing and gestural language. Thus there would be an analogous extrakinesic area.

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measurement. Second, we will present a survey of the existing, systematic investigations of the extralinguistic relationships. This will include a tabular summary and a discussion of factors highlighted by the summary. The first two parts of the paper can serve the reader as an annotated index to the scattered literature in the area. Third, we will present in some detail that research which deals with a specific area, the extralinguistics of concurrent anxiety. This part of the paper will illustrate problems in the field. Fourth, we will discuss some more general issues.

SECTION ONE. E X T R A L I N G U I S T I C P H E N O M E N A CLASSIFICATION

Several systems for classifying extralinguistic phenomena have been proposed: Sapir (221), Newman (196), Sanford (220), Sebeok, Walker, and Greenberg (231), Pittenger and Smith (211), Trager (252), and Pittenger (210). The classification in Table I stems from the systems presented in the papers cited above. It combines the logical and the methodological. For example, the two main divisions are methodological ones: Behavioral-Paralinguistic methods of analysis. We believe that the main subcategories under Behavioral Analysis are logical ones though they may be incomplete. The further subdivisions of these main subcategories refer to both logical and methodological distinctions. The major distinction between Behavioral and Paralinguistic Analysis seems artificial. The extralinguistic area, as we have defined it, includes the Paralinguistic categories of Trager. Only a relatively small portion of the research investigations of extralinguistic phenomena have used the research methods and classification system developed by Smith, Hall, Pittenger, and Trager in recent years. Our distinction between Behavioral and Paralinguistic methods of analyzing extralinguistic phenomena does not imply that we think different classes of phenomena or different levels of discourse are involved. The basis for making a distinction between Paralinguistic and Behavioral methods seems to us largely a matter of emphasis. Those investigators who use Behavioral methods are less concerned with interpreting every instance of the phenomena they are studying; they tend to focus on a few specific phenomena; and they usually employ statistical tests to evaluate relations between certain theoretically-suggested assemblages of extralinguistic phenomena and other behavioral phenomena. Those investigators who use Paralinguistic methods of analysis usually are more concerned with individual - that is, discretely identified - instances of certain features of utterances, including deviations from characteristic patterns. Usually an exhaustive analysis is made, in which scorers attempt to identify all instances of all phenomena included in the entire classification system of Paralanguage.

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TABLE I

Classification of Extralinguistic Vocal Dimensions I. Behavioral Methods of Analysis A. Language style 1. Verb/adjective ratios 2. Parts of speech 3. Verb tense 4. Other B. Vocabulary Selection and Diversity 1. Type-Token Ratio 2. Rank-frequency 3. Other C. Pronunciation and dialect D. Voice Dynamics 1. Voice quality and rhetorical features 2. Rhythm 3. Continuity a. Silent pauses b. Non-fluencies c. Intrusions, intruding speech mannerisms 4. Speech Rate 5. Other temporal phenomena a. Duration of utterances b. Interaction rates c. Latency 6. Verbal output, productivity II. Paralinguistic Methods of Analysis 1. Voice qualities 2. Vocalizations

DESCRIPTION OF THE CLASSES OF EXTRA-LINGUISTIC PHENOMENA; DEFINITION OF MEASURES

I. Behavioral Analysis A. Language style Verb-adjective ratios (also known as verb-adjective quotients, adjective-verb quotients, and action quotients), are calculated as a rule simply by dividing the number of verbs in a sample by the number of adjectives. In some cases either the Verb or the Adjective category has been restricted or defined more psychologically, for ex-

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ample "qualifiers" instead of "adjectives". Also, the sum of two categories may appear in the denominator. Abbreviations: Avq, V-Aq, VAQ, AVQ, V/A ratio, A/adj, A/A+AD, V/V+Tq. [Investigators: Busemann (29, 30), Boder (20), Balken and Masserman (6), Sanford (critical review, 219), Spencer (240), Mann (177), Hays, Gellerman and Sloan (115), Mowrer (192, p. 509), Lorenz and Cobb (156), Wolf (265), Goldman-Eisler (87), Gottschalk and Hambidge (100), Back, et al. (5), Gottschalk, Gleser and Hambidge (101), King and Cofer (138), Krause (143), Krause and Pilisuk (145).] Relative frequencies of various parts of speech, other than the V/A Ratio, have been studied. The various measures have been too numerous and varied for a complete listing. [Investigators: Fairbanks (70), Mann (177) Chotlos (47), Lorenz (153, 154), Lorenz and Cobb (755, 156), Gottschalk, Gleser, and Hambidge (101), Hambidge and Gottschalk (106), Bergman (14).] Verb tense analysis. Measures of past, present, and future verb tense usually take the form of percentages of the total number of verbs in the sample which are of a given tense. [Investigators: Sanford (219, 220), Fairbanks (70), Seeman (232), Zimmerman and Langdon (270), Grumman (104), Mowrer (192, p. 528), Lorenz (154), Jaffe (125).] Other (e.g. Active-Passive Voice). Sanford (220) outlined other possible measures of language style which have been used sporadically. B. Vocabulary selection and diversity Type-Token ratios. Johnson (129) defined the TTR as "the ratio of different words (types) to total words (tokens) in a given language sample". Over-all TTR is computed from a total sample, and Johnson found this to be related to the size of the sample. Johnson described the Mean Segmental TTR as follows: "TTR's for samples of different magnitude can be made comparable by dividing each sample into like-sized segments of, say, 100 words each, computing the TTR for each sample." Feldstein and Jaffe (75) have found 25 word samples comparable to 100 word samples, and easier to computej'[Investigators : Spencer (240), Johnson (129), Fairbanks (70) Mann (177), Chotlos (47), Grumman (104), Mowrer (192), Roshal (217), Page (205) Back, et al. (5), Lerea (750), Jaffe (123, 124, 125), E. Moses (186), Jaffe, Fink and Kahn (128), Fink, Jaffe, and Kahn (79), Bergman (14), Gottschalk (99), DiMascio (57), Feldstein and Jaffe (75, 76).] Rank-frequency curves. Zipf (271, 273) developed a technique for ranking words according to their frequency of occurrence in a language sample. He found striking regularities in the rank-frequency curves. [Investigators : Zipf (271, 272, 273), Whitehorn and Zipf (261), Mowrer (192).] Other. Carroll (37) and Skinner (235) did work with prototypes of the TTR as an extension of their interests in regularities in Rank-Frequency data. These measures, along with Zipf's Interval Frequency and Yule's Coefficient Κ are based on the same principle as the TTR. [Other investigators : Aaronson (7).]

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C. Pronunciation and Dialect Variations in language usage by polyglots, and in dialect, have been determined by gross clinical observations and by more detailed phonetic and phonemic analysis. In comparisons of dialect usage, pre-selected key words may facilitate quantitative analysis. [Investigators: Buxbaum (32), Greenson (102), Krapf (142), Bender and Mahl (12), Leight (149), Shah (233).] D. Voice Dynamics To avoid duplication, we are omitting mention of most of the research reviewed by Zucker (speech melody [27-/]), by Licklider and Miller (perception of speech [752]),11 by Van Riper (speech defects, articulation problems, stuttering, [255]). We shall also omit research investigations of speech disorders of neurological origin such as aphasie and cerebral palsy speech. The following have investigated voice dynamics at the molar level, by naturalistic or clinical observation and categorization, descriptive techniques, and study of perception of voice dynamics: Henry (117), Wyatt (268), P. Moses (187, 188, 189, 190, 191), Wolff (266), Glauber (85), Ruesch and Prestwood (218), Mueller (193), Soskin (237), Kauffman (136), Barbara (9), Skinner (236), Grigg (103), Oken (199), Butler, et. al. (31), Soskin and Kauifman (239), Luft (159), Borke and Fiske (25), Starkweather (241, 242), Davitz and Davitz (51, 52). Voice quality and rhetorical features. [Investigators : Travis (253), Lundeen (160), Mysak (194), Drexler (60), Ostwald (203, 204), Hargreaves and Starkweather (110), Barnard, Zimbardo, and Sarason (10). a. Non-phonemic PITCH. Fairbanks and Pronovost (68, 69), Curry (48), Bonner (22), Duffy (67). b. Non-phonemic LOUDNESS. c. Non-phonemic TIMBRE. Licklider and Miller (152), Bowler (26), Diehl, White and Burk (56).] Rhythm, non-phonemic stresses, accents. [Investigator: Pierce (209)]. Interruptions of continuity: silent pauses. Lounsbury (158, p. 98) has proposed several criteria for distinguishing Hesitation Pauses from standard linguistic boundaries, called Junctures. In addition to Hesitation Pauses, Goldman-Eisler (89, 90, 92) has identified and studied Breathing Pauses. She calls the rate at which these Breathing Pauses occur the Respiration Rate (RR); it is calculated by dividing the number of inspirations in the sample (counts usually obtained from tape recordings by an observer) by the number of time units in the sample. The RR can also be used in calculating the Ventilation Index, which is the RR divided by the output of speech * Kramer (141) has recently reconsidered the literature dealing with the judgment of personality characteristics from speech perception. Kramer agrees with others that the major conclusion to be drawn from studies so far is that judges react to speech with shared stereotypes which do not accord with the actual characteristics of the speakers. Kramer offers some interesting ideas as to the meaning of this conclusion.

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(number of syllables) per breath (ER). Krause (143) also studied Breathing Pauses and an approximation of the Ventilation Index. Maclay and Osgood (161) identified four types of hesitation phenomena. Of these, the Unfilled Pauses (UP) can be classed as one type of Silent Pause; the rest can be included in the Non-Fluency category (see below). Mahl (165) devised an index which is a gross measure of the proportion of the time available to an interviewee during which he is silent: the Silence Quotient. Pauses of approximately 0.5 sec. and longer are summated with this technique. Tindall and Robinson (250), Baker (7) and Weisman (257) distinguished between Hesitation (Unfilled) Pauses and Prolonged Silences. [Other Investigators: Chappie (40), Carnes and Robinson (36), Fliess (80), Meerloo (180), Toman (251), Lorenz and Cobb (157), Gillespie (83), Mahl (172), Goldman-Eisler (95, 96).] Interruptions of continuity: non-fluencies. Meringer and Mayer (181) identified and described a number of common, usually unnoticed, speech and reading errors: interchanges of words, syllables, and sounds, anticipations, post-positions, contaminations, substitutions, omissions, stutters, etc. Freud (82) explored the psychodynamics of such phenomena and found that psychological conflict was an important condition for their occurrence. He also hypothesized that non-fluencies of normal speech reflected in part the work of the "inner critic". Sanford (219, 220) identified several "normal roughnesses of speech": repetitions, rephrasing, hesitating sounds, etc. It was Sanford's impression that speakers who had a high frequency of one type of "roughness" in their speech tended also to show high frequencies of the other types. Baker (7, 8) identified a large number of "extralinguistic" phenomena which he proposed to include with the better known paraphasias. He mentioned "repetitions, tautology, grammatical slips which involve illogicalities, ... use of pretentious or out-of-character words, uncompleted sentences, contradictions, and hesitatory formulas such as Ί don't know' ..." Later Baker added "hesitatory inteijections... 'er, 'ah', 'ha', and ' u m ' . . . brief laughs; yawns; borborygmus; belches; coughs and clearing of the throat; swallowing; heavily marked inhalation and exhalation; sighs; sniffs ... hiccups." (We would class many of these as Intrusions - see below - rather than Non-Fluencies.) Mahl (163-174) classified "speech disturbances" he observed into the following categories: "Ah" and its variants, Sentence Change, Repetitions, Stutters, Omission, Sentence Incompletion, Tongue Slips, and Intruding Incoherent Sounds. He developed ratio scores to measure the rate at which these disturbances occur, dividing the number of disturbances by either the number of words or the time duration of the sample. Mahl (164,169,170) divided the General Speech Disturbance Ratio (SDR) into the Ah Ratio and Non-ah Ratio because of evidence that "Ah" and "Non-ah" frequencies were influenced by different factors. Recently there has been evidence that "Ah's" and the other Non-Fluencies may vary together under some conditions. Panek and Martin (206) found that Ah and Repetition rates were similarly related to GSR dips in psychotherapy interviews. Also, Maclay and Osgood (161) concluded from their study of spontaneous speech in a symposium discussion that Repeats

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GEORGE F. MAHL AND GENE SCHULZE

(comparable to Mahl's Repetition plus Stutter categories) "tend to occur in the same locations as pauses" ( Unfilled plus Filled Pauses, the latter equivalent to the Ah Variants category) "and presumably serve the same function — providing time for selection among diverse lexical alternatives". However, Goldman-Eisler (96), studying impromptu and rehearsed explanations of cartoons, concluded that Unfilled Pauses are related to cognitive factors such as degree of abstraction or difficulty of selection from language alternatives, whereas Filled Pauses reflect an emotional factor. Dibner (53, 54) included the following Non-Fluencies in his Cue Scale I: Breaking in with a new thought, Unfinished sentence, "I don't know", Interrupted sentence, Repeating words or phrases, and Stuttering. Cue Scale I and the Non-Ah SDR are roughly comparable, and were found to be highly correlated by Krause (143). Krause and Pilisuk (145) regrouped the Mahl and Dibner Non-Fluency components as follows: " . . . we adopted Dibner's 'break', Mahl's 'correction', their common 'unfinished' or 'incomplete' (Fragment), and pooled their 'repetition' and 'stutter' categories. Mahl's 'tongue slip' and 'omission' and Dibner's 'omission' (part of his 'stutter' category) we combined into 'distortion', Dibner's Ί don't know', 'sigh', 'laugh', and 'question', as well as Mahl's 'intruding incoherent sound', were pooled in our 'intrusion' category. The Mahl 'Ah' category we expanded as 'procrastination' (Italics ours. They indicate names of Krause and Pilisuk's categories.) Boomer (23) regrouped Mahl's SDRs according to linguistic and syntactical differences among the disturbances. He classed stutter, tongue-slip, and incoherent sound as Articulation Errors, omission, sentence change, and incompletion as Editorial Correction", ah and repetition as Filled Pause. Maclay and Osgood (161) mentioned the following overlaps between their categories and Mahl's: "'ah' is equivalent to our Filled Pause·, sentence correction equates with our Retraced False Start·, repetition plus stutter corresponds to our Repeat" (Italics ours). Gottschalk, Gleser, and Hambidge (101) named their Ah Variants category Fills. They also studied Repetitions, Incomplete words, and Aposiopesis. Heltman (116), Williams and Kent (262), and Boehmler (21) have provided evidence suggesting that the difference between "stuttering" and normal non-fluencies is a matter of social judgement, determined largely by the frequency of non-fluencies, but also to a lesser degree by the type of non-fluency. [Other investigators of Non-Fluency: Steer and Johnson (246), Davis (50), Travis (254), Hill (review of stuttering and physiology, 120), Bloodstein (review of stutteringreduction and suppression, 18), Cameron and Magaret (33, 34), Hassol, Cameron, and Magaret (113), Moore, Soderberg and Powell (185), Berlinsky (15), Van Riper (review with annotated bibliography on stuttering, 255), Sheehan and Voas (234), Sullivan (249, p. 75), Cherry and Sayers (46), Lerea (750), Kasl and Mahl (135), Kline (140), Feldman (72, p. 107), Moore (184), Needles (795), Schulze, Mahl and Holzberg (227), Schulze, Mahl, and Murray (228), Mandler, et al. (176), Shah (233), Schulze (226), Gottschalk (99), DiMascio (57), Boomer and Goodrich (24), Miller,

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et al. (183), Cazavelan (59), Blumenthal (79), Feldstein (73), Feldstein and Jaffe (76, 77), Pope and Siegman (273).] Interruptions of continuity: intrusions, intruding speech mannerisms. Feldman (71, 72) described many intruding speech habits of his psychotherapy patients. These included: "but", "sort of", "wait a minute", "may I ask you", "I don't know", "you know", and the like. While these intrusions border on the Content Analysis area of subject matter, the manner in which they occur appears ritualized and repetitive, and distinguishes them from utterances which are more essential and appropriate to the main stream of communication. Baker (7) identified a large number of these intrusions, which he called "hesitatory formulas". Among them were "I mean", "Well", and others also mentioned by Feldman. Baker (8) also called attention to the following non-verbal Intrusions : "brief laughs", "yawns", "belches", "coughs", "throat-clearing", "swallowing", "sighs", "sniffs", and "hiccups". Dibner's (53, 54) Cue Scale II included Laughing, Voice Change, and Sighing. Gottschalk, Gleser and Hambidge (101) included a Non- Verbal Expressives (NVE) category among the interruptions in continuity which they studied. Krause and Pilisuk (145) included Intruding Incoherent Sounds, "I don't know", laughs, and sighs in their Intrusion measure. Mahl (174) studied fluctuations in the rate of utterance of two characteristic intruding mannerisms of a patient in an investigative interview, by forming a ratio of the sums of "I can't..." and "I don't know..." type utterances divided by number of words in each 1-minute sample. Scott (229) has discussed the significance of intruding vocalisms, such as snoring, sniffing, snorting, yawning, blathering, coughing, and burping, in psychotherapy. Speech rate, speed, articulation rate. Henze (118), following out the implications of an observation of Keilhacker (137), noted : " . . . it is of great importance to see the difference between the 'total time' and the 'absolute time'. Contrary to the 'total time', which includes the intervals between words, the 'absolute time' measures the drawl of the pronounced syllables" (p. 243). Henze (118) and Goldman-Eisler (91) have shown that under a variety of conditions, fluctuations in Speech Rate are largely determined by variation in duration and/or frequency of pauses, with the actual rate at which syllables are spoken, the Articulation Rate, varying within much narrower limits. [Other investigators: Stetson and Hudgins (247), Hawthorne (114), Lasswell (147, 148), Olson and Koetzle (200), Fairbanks and Hoaglin (67), Black (17), Goldman-Eisler (88, 91, 92, 97), Benton, Hartman, and Sarason (13), Hutton (122), Sauer and Marcuse (224), Gottschalk, Gleser and Hambidge (101), Kanfer (130, 131, 132, 133), Maclay and Osgood (161) Drexler (60), Miller, et al. (183), Hargreaves and Starkweather (111), Bergman (14), Blumenthal (79), and Krause (143).] Other temporal phenomena: duration of utterances. Several research investigators have studied frequency distributions of utterance durations. Starkweather (243) described how utterance duration is defined: "By definition of the utterance is meant the decision of whether the same utterance is about to continue or whether a new

60

GEORGE F. MAHL AND GENE SCHULZE

one is beginning. This decision was built into the apparatus in terms of an arbitrary pause time, and in the present instance, a pause of one-second or more re-set the apparatus to begin timing a new duration, while a pause of less than one-second was ignored" (p. 148). [Other investigators: Fairbanks and Hoaglin (67), GoldmanEisler (87, 88), Starkweather (243), Hargreaves (108), 109), Hargreaves and Starkweather (111).] Other temporal phenomena: interaction rates. There have been a large number of studies of temporal characteristics of human interactions based upon a method for timing interaction units developed by Chappie, with Arensberg (43). Chappie (41, 42) has substantially refined the technique with the addition of a standardized interview and the automation of the operations whereby several composite variables are derived from the basic recording of temporal interaction units (speech acts and communicative gestures). According to Saslow and Matarazzo (222): " . . . 14 variables ... are objectively recorded by an observer who activates a series of electrically controlled counters which are connected to two keys, one for the interviewer, the other for the subject. Each key is depressed by the observer whenever the designated individual is talking, nodding, gesturing, or in other ways communicating (interacting) with the second person" (p. 127). The standardized interview consists of three non-directive phases alternating with two stress phases. The first stress phase consists of the interviewer's delaying his responses to the interviewee's acts so that periods of silence occur; the second consists of the interviewer's frequently interrupting the interviewee. Saslow and Matarazzo (222) have written an excellent review of research findings which were obtained with the Interaction Chronograph technique up to 1959. In order to avoid extensive duplication we refer the reader to that review, its bibliography, and to the discussions of it which appear in the same book (pp. 209-234). We also refer the reader to a recent critical assessment of research in this area (Jaffe, Feldstein, and Cassotta, 127). Several modifications of Interaction Chronograph-type devices have been developed for various research purposes. Verzeano and Finesinger (256) designed a speech analyzer that eliminated the need of the observer under certain conditions and yielded automatically much of the data made available by Chappie's method. Kasl and Mahl (134) developed a simple apparatus for cumulating the amount of time each interview participant is talking or silent, and the number of "acts" by each. Starkweather (244) described a duration tabulator which allows the operator to obtain frequency distributions of utterances according to their temporal duration. Cassotta, Feldstein, and Jaffe (38) have developed an electronic system for coding on IBM cards information about speech acts directly from microphones worn by each interview participant. They are now working on a modification of that apparatus system which will record volume and pitch in coded form. [Other investigators: Chappie and Harding (45), Matarazzo, et al. (178, 179), Guze and Mensh (105), Chappie, et al. (44), Hess, Matarazzo and Saslow (119), Hare, et al. (107), Phillips, et al. (207, 208), Wood, et al. (267), Saslow et al. (223).]

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Other temporal phenomena: latency. This is the time intervening between the end of a question, instructions, or stimulus and the beginning of the subject's verbal response. [Investigators: Hess, Matarazzo, and Saslow (119), Krause (143, 133), and Cazavelan (59).] Verbal output, productivity. Verbal output is usually measured by word-counts, but occasionally by length of time used in responding. In either case, it is a measure of the quantity of a subject's response in an open-ended situation, where the subject is relatively free to determine how much he will produce to answer a question, comply with task instructions, or meet the implicit conditions of interaction. [Investigators: Hawthorne (114), Olson and Koetzle (200), Osburn (201), Moore, Soderberg, and Powell (185), West (258), Hirshman (121), Benton, Hartman, and Sarason (13), Lerea (150), Davids and Eriksen (49), Sauer and Marcuse (224), Hambidge and Gottschalk (106), Winitz (263, 264 : summary of 9 previous investigations of language skills in children), Schulze, Mahl and Holzberg (227), Levin, et al. (151), Blumenthal (19), Krause (143, 144), Feldstein (73, 74), Pope and Siegman (213).] II. Paralinguistic Analysis The main categories of classification Trager (252) proposed are : A. Voice qualities: pitch range, resonance, tempo, articulation control, etc. B. Vocalizations 1. Vocal characterizers : laughing, crying, sighing, yawning, etc. 2. Vocal qualifiers: intensity (overloud, oversoft), pitch height (overhigh, overlow), extent (drawl, clipping). 3. Vocal segregates: "uh" and variants, silent pauses (beyond junctures), intruding sounds, 'hm', trills, 'tsk' (clicks), etc. Newman and Mather (197), Pittenger and Smith (211), and Pittenger (210) proposed similar classifications of Paralanguage. Pittenger, Hockett, and Danehy (212) demonstrated the coding and illustrated the clinical interpretation of paralinguistic phenomena in a microscopic analysis of five minutes of a psychotherapy interview. Sebeok, Walker, and Greenberg (231, p. 75) pointed out that these phenomena are discretely scored and, as a rule, are interpreted discretely rather than in terms of rates or frequencies. This practice is not necessary, of course, as shown by Eldred and Price (64). [Other investigators: Alkon (3, historical), Goldfarb, Braunstein, and Lorge (86), McQuown (162), Shah (233) Dittmanand Wynne (58), Bateson et al. (11).] SECTION TWO. GENERAL SURVEY OF SYSTEMATIC STUDIES OF EXTRALINGUISTIC PHENOMENA In this section we will survey, and take stock of, empirical investigations of the classes of extralinguistic phenomena we described in the preceding section.

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EXPLANATORY REMARKS ABOUT THE SURVEY

The survey, presented in the accompanying tables, is organized as follows: 1. First, it is organized by class of extralinguistic phenomena. Thus there is a separate table for V/A Ratio, Type-Token Ratio, etc. 2. Secondly, within each table we have stated for each study: (a) the nature of the language behavior involved, the materials·, (b) the situational variables manipulated by the investigator; (c) the organism variables (in the speaker) which were either measured, or controlled by subject selection. Our tables originally included (d) response of the listener as a function of the various extralinguistic phenomena. Since there were no entries for this item, we have omitted it from the tables. 3. The survey includes only studies that have attempted to determine systematically the functional relationships between the particular class of extralinguistic phenomena, on the one hand, and situational or organism variables, on the other hand. This criterion excludes purely naturalistic studies, such as those by Meringer and Mayer, Freud, and Baker on Non-Fluencies and those by Pittenger and Smith, and by Pittenger, Hockett and Danehy on Paralinguistic phenomena, etc. The exclusion of such studies is not intended to minimize their significance. We consider them to be essential in laying the foundation for systematic research aimed at the discovery of lawful relations among the phenomena in these areas, and the discovery of their determinants. Reference to Figure 1 in the Introduction, with the above outline in mind, will show that this survey deals with : the types of speaking behavior investigated (materials); the types of psychological states and processes investigated in relation to the various extralinguistic phenomena (directly in case of organism variables, indirectly in case of situational variables) ; and the functional relationships between any particular class of extralinguistic phenomena and other classes (included under organism variables). The following more specific notes about the tables will make them more intelligible : 1. "Materials" include "spoken" samples, unless specified as "written". 2. "Situational Variables" includes an item only if the investigator determined the relationship between it and the extralinguistic phenomenon by correlational techniques, comparisons of means, etc. 3. "Organism Variables" includes items that have been (a) controlled by subject selection - e.g. diagnostic status, or (b) directly measured anxiety. Often the investigator has explicitly manipulated a Situational Variable in order to manipulate an Organism Variable, as in the case of manipulating stimuli or interaction to vary experimentally the anxiety intensity in the speaker. In such instances, an item is entered under Organism Variables only if the study included the actual assessment of the Organism Variable. Many entries under "Organism Variables" refer to measures of extralinguistic phenomena. These entries mean, of course, that these measures have been related

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to the phenomena for which the table was constructed. The latter phenomena will not be mentioned in the body of the table itself.

Verbi Adjective Ratio (incl. Authors (year)

Materials

variants)

Situational Variables

Organism Variables

Busemann (25)

Children's stories

Emotional stability (teacher ratings) Age

Balken and Masserman (40)

TAT stories

Diagnostic status: anxiety states, conversion hysteria, obsessivecompulsive neurosis

Boder (27, 40)

Personal written documents

Subject matter of text

Mann (44)

Written autobiographical statements

Diagnostic status: schizophrenics - college freshmen

Hays et al. (51)

TAT stories

Rorschach M/C Ratio, Age, Intelligence. Diagnostic status: institutionalized - noninstitutionalized

Goldman-Eisler (54a)

Psychiatric interviews

Individual differences

Back et al. (55)

Psychiatric interviews

TTR, Speech disturbances. Anxiety (observer ratings)

Gottschalk and Hambidge (55)

TAT stories Verbal response to standard open end question

Visual-verbal elicitation of speech sample

Thematic content: threat of bodily injury Diagnostic status: hospitalized psychiatric patients - normals

Lerea (56)

Speeches by students in public speaking course

First-last days of course

Fear (self-report)

Krause (61)

Psychotherapy interviews

Krause and Pilisuk (61)

Descriptions of probable reactions to situations

Non-fluencies Disastrous-neutral situations. High-Low degree of empathie participation in the descriptions

Anxiety (self-report) Non-fluencies

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GEORGE F. MAHL AND GENE SCHULZE

Other Parts of Speech Authors (year)

Materials

Situational Variables

Organism Variables

Sanford (42b)

Thematic stories Variety of impromptu verbalizations Written autobiographical statements

Character structure (inferred from variety of clinical data)

Chotlos (44)

Written language samples

Age, IQ

Fairbanks (44)

Interpretations of proverbs

Diagnostic status: schizophrenics - college freshmen.

Mann (44)

Written autobiographical statements

Diagnostic status: schizophrenics - college freshmen.

Lorenz and Cobb (53a)

Interview samples TAT stories

Diagnostic status: neurotics, manies, normals

Gottschalk et al. (57)

TAT stories Response to standard question

Diagnostic status: hospitalized psychiatric patients - normals

Verb Tense Authors (year)

Materials

Situational Variables

Organism Variables

Fairbanks (44)

Interpretation of proverbs

Diagnostic status: schizophrenics - college freshmen

Seeman (49)

Psychotherapy interviews

Participation in psychotherapy

Zimmerman and Langdon (49)

Psychotherapy interviews

Participation in psychotherapy

Grumman (50)

Psychotherapy interviews

Participation in psychotherapy

Jaffe (61)

Psychotherapy interviews

TTR (dyadic)

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Type Token Ratio Authors (year)

Situational Variables

Materials

Organism Variables

Sanford (42b)

Thematic stories Variety of impromptu verbalizations Written autobiographical statements

Character structure (inferred from variety of clinical data)

Chotlos (44)

Impromptu writing

Age, Intelligence Sex, Geographical locality

Fairbanks (44)

Interpretation proverbs

Diagnostic status: schizophrenics - college freshmen

Mann (44)

Written autobiographical statements

Diagnostic status: schizophrenics - college freshmen

Grumman (50)

Psychotherapy terviews

in-

Participation in therapy Therapeutic "success" ratings

Roshal (53)

Psychotherapy interviews

Participation in therapy Therapeutic "success" ratings Adjustment ratings

Back et al. (55)

Psychiatric interviews

V/A ratio, speech disturbances Anxiety (observer ratings)

Lerea (56)

Speeches by students in public speaking course

First-last days of course

Fear (self-report)

E. Moses (59)

Impromptu writing and speaking

Talking - writing Narration of pleasant - unpleasant experiences

Sex

Jaffe et al. (60)

Psychological, unstructured interviews

Convulsive - subconvulsive electroshock

Delta activity in EEG Syntactic language patterns in independent structured interviews

Di Mascio (61)

Psychotherapy interviews

Fink et al. (61)

Investigative interviews

of

Heart rate, skin temperature Activating - tranquilizing drugs

66

GEORGE F. MAHL AND GENE SCHULZE Authors (year)

Materials

Gottschalk et ai. (61)

Psychotherapy interviews

Jaffe (61)

Psychotherapy interviews

Feldstein and Jaffe (62)

Thematic stories

Situational Variables

Organism Variables Speech disturbances Anxiety verbal content, "Schizophrenic" disorganization of speech

Dyadic interaction

Verb tense

Speech disturbances Diagnostic status: schizophrenic - non-psychiatric patients

Voice Dynamics-Nonspecific Authors (year)

Materials

Situational Variables

Organism Variables

Starkweather (56a)

Filtered, contentfree speech of "Army-McCarthy" congressional hearing

Emotional expression: amount expressed, aggressiveness, challenging quality, indignation, matter-of-factness, pleasantness (observer ratings)

Starkweather (56b)

Filtered, contentfree speech of stressful role-playing

Emotional state: pleasantness aggressiveness (observer rating) Character structure (based on blood pressure and "hypertensive personality" traits)

Davitz and Davitz (59a)

Reciting alphabet

Instructions to com- Emotional expression: anger, municate different fear, happiness, jealousy, love, feelings nervousness, pride, sadness, satisfaction, sympathy (observer judgments)

Davitz and Davitz (59b)

Reciting alphabet

Instructions to com- Characteristics of feeling states: municate 50 differ- their identity, strength - weakent feelings ness, active - passive, good - bad (observer ratings)

See also reviews by Licklider and Miller (152) and Zucker (274).

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Pitch Authors (year)

Materials

Situational Variables

Organism Variables

Travis (27)

Uttering sustained Threats and physound sical punishmentRepeating sentences relaxation

Fairbanks and Pronovost (38, 39)

Reading standard passage

Bonner (43)

Uttering sustained Fear induction: no fear, simulated fear, sound Repetition of stand- mike fright and assorted "unknown" ard sentence stimuli

Emotional tension (self report)

Hargreaves and Starkweather (61a)

Psychotherapy interviews

Electronic identification of 2 "characteristic voices" of patient from pitch and loudness profile

Diagnostic status: stutterers nonstutterers

Instructions to simulate anger, contempt, fear, grief, indifference

See also Eldred and Price (58) in "Paralinguistic" table.

loudness See Hargreaves and Starkweather (61a) above, and Eldred and Price (58) in "Paralinguistic" table.

Pauses Authors (year)

Materials

Situational Variables

Organism Variables

Fairbanks and Hoaglin (41)

Reading of standard Instructions to sipassage mulate fear, anger, contempt, grief, indifference

Tindall and Robinson (47)

Psychotherapy interviews

Mental reorganization, indecision, soliciting information

Lorenz and Cobb (52)

Spontaneous speech

Diagnostic status: manies - normals

Gillespie (53)

Psychotherapy interviews

Resistance to treatment

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GEORGE F. MAHL AND GENE SCHULZE

Authors (year)

Situational Variables

Materials

Organism Variables

Goldman-Eisler (SS)

Psychological interviews Normal conversation

Individual differences

Goldman-Eisler (56b)

Psychological interviews

Interrelations within subjects: respiration rate, speech rate, articulation rate

Mahl (56)

Psychotherapy interviews

Therapist interaction implicitly considered

Anxiety and conflict (judged clinically)

Goldman-Eisler (58b)

Reading previously uttered sentences from which words were deleted, and to be supplied by subject

Words deleted at points of: high-low transitional probability, high-low fluency

Correctness of words supplied by subject

Maclay and Osgood (59)

Spontaneous speech by work conference participants

Schulze (59)

Thematic stories

Exposure to eroticnon-erotic pictures

Diagnostic status: acute, chronic schizophrenics, orthopedic patients

Schulze et al. (59)

Thematic stories

Exposure to eroticnon-erotic pictures

Speech disturbances

Linguistic distribution Speech rate

Filled pauses ("ah") Goldman-Eisler (61a, Verbal response to Cartoon contents 61b) questions about car- Degree of abstrac- Individual differences tion : describe- sumtoons marize and explain Hargreaves and Starkweather (61 b)

Reading of standard Dosage level of sodium pentabarbital passage

Non-Fluencies Authors (year)

Materials

Situational Variables

Organism Variables

Davis (40)

Spontaneous speech in nursing school

Language maturity

Back et al. (55)

Psychotherapy interviews

V/A, TTR

PSYCHOLOGICAL RESEARCH IN THE EXTRALINGUISTIC AREA

Authors (year)

Materials

Situational Variables

69

Organism Variables

Mahl (55)

Psychiatric interviews

Dibner (56, 58)

Psychotherapy interviews

Ambiguity - struc- Anxiety (self-report and rated by ture of interviewer's observers) behavior Skin conductance

Mahl (56a)

Psychotherapy interviews

Patient-therapist in- Anxiety and conflict (judged cliteraction implicitly nically) considered

Mahl (56b, 59)

Psychiatric interviews

Anxiety (rated by observers) Hostility (rated by observers) Rate of speech, education, sex, interrelations of nonfluencies

Gottschalk et al. (57)

TAT stories Verbal response to standard open-end question

Diagnostic status: psychiatric patients-normals

Mahl (57)

Psychiatric interviews

Manifest verbal content: Discomfort - Relief Quotient

Eldred and Price (58)

Psychotherapy interviews

Affective states: anger, depression, anxiety (clinically judged) Suppressed - overt affective states (clinically judged)

Kasl and Mahl (58)

Psychological, investigative interviews

"Normal" conver- Palmar perspiration sation - probing for Anxiety (Taylor Manifest Anxpersonal informa- iety Scale), interrelations of nontion fluencies articulation rate.

Mahl (58) Mahl and Kasl (58)

Psychological investigative interviews

Face-face vs. "telephone type" situation

Maclay and Osgood (59)

Spontaneous speech by work conference participants

Rate of speech, linguistic distribution, interrelations of nonfluencies

Panek and Martin 59)

Psychotherapy interviews

Galvanic skin response

Schulze (59) Schulze et al. (59)

Thematic stories

Linguistic distribution Interrelations of nonfluencies

Exposure to eroticnon-erotic pictures

Age of weaning and speech onset, character traits

Diagnostic status : acute, chronic schizophrenics, orthopedic patients. Interrelations of nonfluencies

70

GEORGE F. MAHL AND GENE SCHULZE Authors (year)

Materials

Situational Variables Variation in audience: a single, known adult - 6 strange adults

Organism Variables Character traits: exhibitionism selfconsciousness

Levin et al. (60)

Impromptu speech of children

Mahl (60)

Psychological investigative interview

Schulze et al. (60)

Psychotherapy interviews

Mild probings approvals by therapist

Manifest verbal content: referring to drives, frustration, conflict

Blumenthal (61)

Investigative, psychological interviews of chronic schizophrenics

Nature of interpersonal relation in interview: neutral - stressful, understanding - nonunderstanding

Verbal productivity Premorbid adjustment Current mental status: regressed - partially remitted

Boomer and Goodrich (61)

Psychotherapy interviews

Cazavelan (61)

Thematic stories

Di Mascio (61)

Psychotherapy interviews

Feldstein (61) Feldstein and Jaffe (61)

Thematic stories

Gottschalk et al. (61)

Psychotherapy interviews

TTR, Verbal content "Schizophrenic" disorganization of speech

Krause (61)

Psychotherapy interviews

Speech rate, V/A ratio, verbal productivity, response latency, frequency of references to interviewer, interrelations amongnonfluencies

Krause and Pilisuk (61)

Descriptions of pro- Disastrous-neutral bable reactions to situations High-low degree of situations empathie participation in the descriptions

Anxiety (self-report) Interrelations of nonfluencies, V/A Ratios

Recognition of noxious olfactory stimulus Idiosyncratic verbal expressions in content

Anxiety and conflict (judged clinically) Pictures selected for varying degrees of "relevance" for hostility Skin temperature, heart rate Affective - nonaffective pictures Close - remote interpersonal situation

Diagnostic status: schizophrenic - nonpsychiatric patients Interrelations of nonfluencies TTR

PSYCHOLOGICAL RESEARCH IN THE EXTRALINGUISTIC AREA Authors (year)

Situational Variables

Materials

71

Organism Variables

Mahl (61)

Psychotherapy terviews

in-

Spontaneous variation in therapeutic interaction

Miller et al. (61)

Speech by students in public speaking course

Giving - withholding approval for performances

Schulze (61)

Psychotherapy interviews

Interrelations of measures

Boomer (62)

Psychotherapy interviews

Body movements

Feldstein and Jafle (62c)

Psychological, investigative interview

Anger arousal Sequence of directdisplaced expression

Anger (self report)

Pope and Siegman (62)

Psychotherapy interviews

Specificity of therapist response

Verbal productivity

Anxiety content score of Gottschalk et al.

Intruding Speech Mannerisms Authors (year)

Materials

Situational Variables

Organism Variables

Gottschalk et al. (57)

TAT stories Verbal response to standard open end question

Diagnostic status: psychiatric patients - normals

Dibner (56, 58)

Psychotherapy interviews

Ambiguity - structure of interviewer's behavior

Anxiety (self-report and rated by observers) Skin conductance

Krause and Pilisuk (61)

Descriptions of probable reactions to situations

Disastrous - neutral situations High-low degree of empathie participation in the descriptions

Anxiety (self report) Non-fluencies, V/A Ratios

Mahl (61)

Psychological investigative interview

Non-fluencies

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GEORGE F. MAHL AND GENE SCHULZE

Speech Rate Authors (year)

Materials

Situational Variables

Organism Variables

Hawthorne (34)

Responses to standard questions Reading, naming objects

Diagnostic status: stutterers non-stutterers

Lasswell (35)

Free association interviews

Skin conductance

Fairbanks and Hoaglin (41)

Reading of standard passage

Henze (S3)

Verbalizations during: film descriptions, TAT stories, role-playing, descriptions of emotional experiences, problem solving

Emotional themes Intelligence, word association reaction times, motor coordination and tempo Pauses

Goldman-Eisler (54a)

Psychiatric interviews

Individual differences Self references Action time

Goldman-Eisler (54b)

Spontaneous speech For normals, the of normals in inter- identity of interlocutor action Psychological interviews of psychiatric patients

Diagnostic status: normals patients Individual differences Duration of utterances

Benton et al. (55)

TAT stories

Anxiety (Taylor Manifest Anxiety Scale Scores)

Goldman-Eisler (55)

"Normal" conver- Interviewing mesations thod: non-directive Psychiatric inter- active views Psychological investigative interviews

Individual differences Breathing pauses, syllables per expiration Tension and affect (inferred from respiration)

Goldman-Eisler (56a)

Psychological interviews

Free expression - restricted expression of affect as measured by manifest verbal content Interrelations with respiration rate and syllables per respiration cycle

Instructions to simulate anger, contempt, fear, grief, indifference

-

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Materials

Situational Variables

73

Organism Variables

Goldman-Eisler (56b)

Psychological interviews

Interrelations within subjects: respiration rate, pauses, articulation rate

Goldman-Eisler (56c)

Psychological interviews

Muscle potentials Degree of "catharsis" - inferred from verbal content, temporal phase of interview, and muscle potentials

Gottschalk et al. (57)

TAT stories Response to standard question

Diagnostic status: hospitalized psychiatric patients - normals

Sauer and Marcuse (57)

TAT stories

Kanfer (58a, b)

Spontaneous, serial Conditions of stiutterance of indimulation: fear convidual words ditioning stimulation - control stimulation

Heart rate

Kasl and Mahl (58)

Psychological, investigative interviews

"Normal" conversation-probing for personal information

Palmar perspiration Anxiety (Taylor Manifest Anxiety Scale) interrelations of non-fluencies

Kanfer (59)

Psychological, investigative interviews

Topics raised in interviews

Adjustment in topic areas (rated from manifest verbal content) Individual differences

Maclay and Osgood (59)

Spontaneous speech by work conference participants

Schulze (59)

Thematic stories

Exposure to erotic - Diagnostic status: acute, chronic non-erotic pictures schizophrenics and orthopedic patients

Kanfer (60)

Psychological investigative interviews

Topics raised in interviews

Recording situation : overt - covert

Anxiety level (Taylor Manifest Anxiety Scale)

Pause frequency Non-fluencies

Diagnostic status: acute schizophrenics, paranoid schizophrenics, neurotic patients. Anxiety (Taylor Manifest Anxiety Scale) MMPI, Cornell Index Eyeblink rate

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GEORGE F. MAHL AND GENE SCHULZE

Authors (year)

Materials

Situational Variables Nature of interpersonal relation in interview: neutral - stressful, understanding - nonunderstanding

Organism Variables

Blumenthal (61)

Investigative, psychological interviews of chronic schizophrenics

Premorbid adjustment Current mental status: regressed - partially remitted

Goldman-Eisler (61c)

Verbalization about Degree of abstrac- Individual differences cartoons tion: describe summarize and explain Spontaneous - practiced responses

Hargreaves and Starkweather (61b)

Reading of standard Dosage level of sopassage dium pentabarbital

Miller et al. (61)

Speeches by students in public speaking course

Giving - withholding verbal approval for performance

Duration of Utterances Authors (year)

Materials

Situational Variables

Organism Variables

Fairbanks and Hoaglin (41)

Reading of standard Instructions to sipassage mulate emotional states: anger, contempt, fear, grief, indifference

Goldman-Eisler (54b)

Spontaneous speech Interlocutor in interof normals in inter- action of "normals" action Psychological interviews of psychiatric patients

Diagnostic status: psychiatric patients - normals Individual differences Speech rate

Hargreaves (59)

Speech in various situations

Individual differences

Starkweather (59)

Speech during stressful role-playing

Spontaneous interaction of subjects while studying, while in argument, and during psychological interview

See also "Temporal Characteristics of Interaction".

Individual differences

PSYCHOLOGICAL RESEARCH IN THE EXTRALINGUISTIC AREA Temporal Characteristics Authors (year)

of

Interaction

Situational Variables

Materials

75

Organism Variables

Chappie and Harding (40)

Interaction during conversation between pairs of subjects

Components of EEG record

Chappie and Lindemann (42)

Interaction during Chappie's standard interview

Diagnostic status: controls, psychoneurotic, psychosomatic, psychotic patients

Matarazzo et al. (57)

Interaction during Chappie's standard interview

Diagnostic status : chronic, acute, mixed schizophrenics, outpatients, and normals

Saslow and Matarazzo (59)

Interaction during Chappie's standard interview

Chappie et at. (60)

Interaction during Chappie's standard interview

Diagnostic status: schizophrenics, normals

Hare et al. (60)

Initial psychiatric interviews

Bales interaction categories

Phillips et al (61)

Interaction during Chappie's standard interview

Manifest content categories

Wood et al. (61)

Interaction during Chappie's standard interview

Absence of interviewer response contrasted with interruption by interviewer

Administration of phenothiazines to schizophrenic patients

See review by Saslow and Matarazzo (222).

Verbal Authors (year) Hawthorne (34)

Materials Responses to standard questions Reading, naming objects

Productivity Situational Variables

Organism Variables Diagnostic status: stutterers, non stutterers

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GEORGE F. MAHL AND GENE SCHULZE Authors (year)

Materials

Situational Variables

Organism Variables

Olson and Koetzle (36)

Spontaneous speech of children during play

Age level: nursery school kindergarten

Eichler (SI)

Verbalizations during Rorschach

Threat of electric shock

Moore et al. (52)

Responses to standard questions

Topics of questions : Diagnostic status: duration of parents, hopes, mis- stuttering deeds, fears, associates, good times

Hirschman (S3)

Written description

Interpersonal inDiagnostic status: schizophrenic volvement with in- - nonpsychiatric patients vestigator

West (53)

TAT stories

Recording situation: overt-covert

Westrope (53)

Verbalization during Rorschach testing

Wharton (53)

Verbalization during Rorschach testing

Benton et al. (55)

TAT stories

Lerea (56)

Speeches by students in public speaking course

First-last days of course

Fear (self report)

Sauer and Marcuse (57)

TAT stories

Recording situation: overt-covert

Anxiety (Tayler Manifest Anxiety Scale)

Schulze (59)

Thematic stories

Exposure to erotic - nonerotic pictures

Diagnostic status: acute, chronic schizophrenics, and orthopedic patients

Winitz (59)

Children's Apperceptive Test (CAT) stories

Levin et al. (60)

Impromptu stories by children

Discomfort (self report) Anxiety (Taylor Manifest Anxiety Scale Scores)

Threat of physical punishment - electric shock Anxiety (Taylor Manifest Anxiety Scale Scores)

Sex, IQ, socioeconomic status Language maturity

Nature of audience: Personality traits: exhibitionism a single, known - selfconsciousness adult - six strange adults

PSYCHOLOGICAL RESEARCH IN THE EXTRALINGUISTIC AREA Authors (year)

Materials

Situational Variables

77

Organism Variables

Blumenthal (61)

Investigative psychological interview of chronic schizophrenics

Nature of interpersonal relation in interview: neutral - stressful, understanding - nonunderstanding

Feldstein (62)

Thematic stories

Interpersonal situa- Speech disturbances tion : remote - close Diagnostic status: schizophrenAffective - nonaffec- ics - nonschizophrenics tive content of pictures

Pope and Siegman (62)

Psychotherapy interviews

Degree of specificity Speech disturbances of therapist responses

"Paralinguistic" Authors (year)

Materials

Speech disturbances Premorbid adjustment Current mental status: regressed - partially remitted

Phenomena

Situational Variables

Organism Variables

Newman and Mather (38)

Investigative interviews Reading samples

Diagnostic states: depressive, manic, "dissatisfied, gloomy, and self-pitying" patients

Goldfarb et al. (56)

Spontaneous conversation, reading, answering questions, imitating

Diagnostic status: children with schizophrenic and reactive behavior disorders

Eldred and Price (58)

Psychotherapy interviews

Affective states: anger, depression, anxiety (clinically judged) Suppressed - overt affective states (clinically judged)

TAKING STOCK: SOME IMPLICATIONS OF THE SURVEY A n y conclusions w e draw f r o m this survey o f systematic studies will be limited by its adequacy.

W e believe the survey is at least representative, and that it is fairly

complete for the English literature. General

Quantitative

Impressions.

The tables contain 110 references, about three-

fourths dating since 1950. W e believe this is a rather small number of references, considering that the earliest studies in which these p h e n o m e n a were identified date back t o the turn o f the century and considering the numerous references to 'how'

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the patient talks in the clinical literature. The systematic investigation of relationships in the extralinguistic area is largely a development which got under way in the last decade and has been the object of an accelerated increase of research efforts in the last two years. The tables indicate that the majority of the studies are due to the impact of a relatively small number of people, often working in isolation from the influence of each other's ideas and methods. Our Voice Dynamics classes of phenomena have the most references. In fact, we did not even make a table for Pronunciation and Dialect for it would have included only one reference. These differences in emphasis may reflect the interest in purely "expressive" and behavioral aspects of language on the part of psychologists and psychiatrists who work out of clinical settings and make up the majority of the investigators cited in the tables. The relative ease of reliable quantification for some of the Voice Dynamics classes (speech rate, other temporal phenomena, and productivity) may also contribute to this state of affairs. There are relatively few studies of pitch, volume, etc. listed in our tabular summary. This is partly due to our exclusion of the old voice perception literature from this review. But it is probably also due to a large extent to the fact that it is more difficult to judge by ear, or measure instrumentally, the purely audible dimensions of speech than it is to count words, parts of speech, etc. The important point is that the relative emphasis on the various classes is not rational. Methodological innovations, such as the Type-Token Ratio, the Interaction Chronograph method, and the Speech Disturbance Measures, have had clearly discernible impacts on the research trends. The clarity of such effects reveals the undeveloped state of the field, as well as the extent of the latent interest in it. Substantive Impressions. One of the most striking revelations of the survey is the absence of systematic study of how the extralinguistic phenomena affect the listener's spontaneous, communicative behavior or his underlying psychological states and processes. Jaffe's (124, 125) emphasis on analyzing the interaction of the dyad and his use of dyadic measures of the TTR, provide the clearest recognition of the problem, but this method does not distinguish between speaker and listener. Some investigators, Ruesch and Prestwood (218) for example, examined the influence of the extralinguistic phenomena on diagnostic, judgmental impressions of expert observers. These are indirect, tangential studies of the problem. The neglect of direct study of the relationships under consideration is part of a more general neglect of the social, interpersonal aspects of the phenomena, a point that will be reflected in several of the remaining comments of this section. Inspection of the tables shows that a good many of the studies have used monologue materials. We are referring here to the use of autobiographical statements, thematic stories, speeches, etc., in contrast to spontaneous conversations, interviews, conference discussion, etc. Most of the dialogues have consisted of the psychiatric interview, a rather special situation as far as roles, role relations, as well as goals and needs of the

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79

participants are concerned. Since much of the monologue material was produced for an ultimate audience of psychologists and psychiatrists, it too probably shares some of the special qualities of interviews. Although the materials have been weighted in these ways, they have not been limited in total variety. The net effect, however, is that our capacity to generalize from one speaking situation to another is unknown and questionable at best. Soskin and John (238), Maclay and Osgood (161), and Starkweather (241) are among the few who have investigated "everyday life" situations. Most of the studies have involved adults, relatively few have investigated children. And, of course, there has been virtually no longitudinal research on the developmental aspects of the extralinguistic phenomena. Turning now to the Organism Variables, the survey shows several things. Directly or indirectly, nearly all the studies demonstrate individual differences. If we ask what kind of variables have been investigated that might account for individual differences, we find the following. A relatively large number of the studies have used "diagnostic status" as the basis for comparisons. ' Even when reliably made, this use of diagnostic categories provides only an extremely crude screening device, for the categories do not represent homogeneous groups of people. It would seem to be advantageous at this stage to shift to a finer method for studying individual differences, one involving the use of personality traits organized into meaningful patterns. Only a few studies at this level appear in the tables. Together with the comparative, "diagnostic status" investigations, studies of the functional relationships between transitory emotional states and the extralinguistic phenomena make up the bulk of the tables. Moreover, most of these have focussed on the negative, disruptive states of stress, tension, or anxiety. There is also an occasional reference to anger and depression. The variation in the extralinguistic phenomena with pleasure-states, positive affects of all sorts, has been virtually unexplored. Examination of the tables reveals that a wide variety of methods have been used in the studies of transitory emotional states. These have included the use of spontaneous emotional behavior, the experimental manipulation of interpersonal interaction, of discrete physical stimulation, and of the physiological state, and the use of the simulation method. When there has been independent assessment of the emotional states, it has been done variously by means of self-reports, of global or systematic ratings by observers, and by the use of physiological indices. There has been great variety in what from an over-all view is a relatively small body of research. Only a few studies have been directly concerned with biological states, especially states of the central nervous system, as independent variables. This is analogous to the underemphasis on the social aspects of the extralinguistic phenomena. Most of the studies deal with isolated classes of extralinguistic phenomena in relation to single or isolated situation or organism variables. This probably reflects the embryonic stage of the area. The time when we will investigate organized patterns

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of phenomena - within and between extralinguistic, organismic, and situational seems to be a long way off.

SECTION THREE. EXTRALINGUISTIC PHENOMENA AND CONCURRENT ANXIETY Another way of indicating the "state of the art" is to examine in detail the nature of systematic research and the findings for some particular extralinguistic relationship. This will give some idea of the substantive yield to be expected in the future and should illustrate the kinds of problems stemming from some of the factors that havejust been summarized. We have chosen to review research dealing with the functional relationship between extralinguistic phenomena and concurrent anxiety in the speaker. We will organize the material in accordance with the outline introduced earlier. There will be gaps, since not every extralinguistic class has been theoretically or empirically related to concurrent anxiety. The lower-case roman numerals at the beginning of each subsection refer to the following plan of organization: (i) Theoretical rationale for relating the phenomenon and its measures to anxiety. (ii) Relationships of the measure with other extralinguistic phenomona. (iii) Relationships between the measure and non-vocal expressive responses such as gestures, facial expressions, and the like. (We shall call these Kinesic if they are commonly understood, and Extra-Kinesic if they are idiosyncratic or rarely communicative.) (iv) Relationships between the measure and Content Analysis Measures related to anxiety. (v) Relationships between the measure and global, clinical, or naturalistic ratings of anxiety. (vi) Relationships between the measure and self-ratings of anxiety obtained from subjects. (vii) Relationships between the measure and physiological measures, or physiological manipulations, conceivably related to anxiety. (viii) Effects of variation in stimulus conditions upon the measure.

I. BEHAVIORAL METHODS O F ANALYSIS

A. Language Style 1. Verb-Adjective Ratios (i) Theoretical Rationale: Balken and Masserman (6) hypothesized that "High values connote restless, forceful, dramatic action in the phantasies, expressing libidinal tensions and anxiety in the subject" (p. 79). Back et al. (S) proposed as a working

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81

hypothesis that the V/A Ratio varies directly with anxiety intensity. Gottschalk and Hambidge (100) reported that their use of the A/adj Index "was based on the observation that when we estimated that the diffuse drive to action was increased there was an increased number per unit time of verbs denoting neuro-muscular action (A) and a decrease in the number per unit time of qualifying words, specifically adjectives". Investigators who have studied V/A Ratios as a function of anxiety generally agree in predicting that these ratios would be positively related to concurrent anxiety intensity. (ii) V/A Ratios and other Extralinguistic Measures: Back, et al. (5) hypothesized that the V/A Ratio would be inversely related with segmental TTRs, assuming that each of these measures reflected the disturbance of communicativeness by anxiety. They found negative correlations between V/A Ratios and segmental TTRs in 32 out of 39 psychiatric outpatients, using speech samples collected during intake interviews. The mean of these intra-subject correlations was -.37. Back, et al. also predicted a direct relation between V/A Ratios and General SDRs as a function of anxiety. They found a low positive correlation between those measures in 92 samples from psychotherapy interviews in one patient (r = .29, ρ