Linguistic Analysisof Speech
in Affective Disorders
Nancy J. C. Andreasen, MD, PhD, Bruce Pfohl
\s=b\ Various aspects of speech and language were compared,
using psycholinguistic techniques, in a group of 15 depressed
patients and 16 manic patients: lexical diversity, syntactical
complexity, syntactical elements, and content analysis. Contrary
to anticipation, the manic patients did not show more varied
word choice or complexity of sentence structure than the depres-
sives. In particular, they did not differ significantly in type-token
ratio. The greatest difference was in syntactical elements, with
manics using more action verbs, adjectives, and concrete nouns,
while the depressed patients used more state of being verbs,
modifying adverbs, first-person pronouns, and personal
pronouns. When compared by content analysis, the manics used
more words reflecting a concern with power and achievement.
These results imply that depressive speech tends to be more
vague and qualified and to show considerable self-preoccupa-
tion, while manic speech tends to be colorful and concrete and to
show more concern with things than with people.
(Arch Gen Psychiatry 33:1361-1367, 1976)
patients'
Psychiatrists thought,
content of
frequently speak
disorder. Too often we
forget
stream of
about their
thought, or thought
that our only way of learning
about a patient's thoughts is through his speech and
language, either spoken or written. Spoken or written
language may not be an accurate or reliable index of
thought, even when it is supposed to approximate it closely
as in free association, but is the only index we have
available. Given this fact, it is something of an oddity that
so much has been written by psychologists and psychia¬
trists about thought and so little about language.
Linguistics is a relatively new field, of course, and
psycholinguistics is even newer. Nevertheless, a number of
investigators have attempted to apply linguistic
techniques to a variety of psychiatric disorders. Basically,
Accepted for publication Dec 19, 1975.
From the Department of Psychiatry, University of Iowa College of
Medicine, Iowa City.
Reprint requests to Department of Psychiatry, University of Iowa
Hospitals and Clinic, 500 Newton Rd, Iowa City, IA 52242 (Dr
Andreasen).
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these investigations are of two types: those that attempt to
examine formal elements of speech and writing such as
grammar and syntax, and those that attempt to examine
aspects of content such as vocabulary word choice.
Analyses of form have grown increasingly sophisticated.
Newman and Mather1 made an early effort to examine
speech in patients suffering from mania or depression by
studying such variables as pitch, tempo, syntax, and
latency of response. Their results are largely descriptive,
however, and provide no quantitative data. Lorenz and
Cobb have compared the speech of manies to that of
normals by using more rigorous quantitative methods such
as determining the distributions of parts of speech or the
number of words spoken per minute.- Manies were found to
have significantly different speech patterns. Lorenz and
Cobb have also examined speech in neurotic patients.'·'
Determination of the verb-adjective (V-A) ratio was
developed in an effort to find a quantitative method of
relating grammatical forms to psychopathology. Originally
developed by Busemann,'' it was considered to be an "action
quotient" or an index of emotional instability. Although
the measure was developed for use in children, a variety of
investigators have applied it to psychiatric patients. Fair¬
banks" and Mann7 have found schizophrenics to have a
higher V-A quotient than normals, while Lorenz and Cobb-
have found manies and hysterics to have a higher quotient
than normals. Benton et al8 obtained a higher quotient in
people with high anxiety as compared to low anxiety, while
Balken and Masserman" found anxiety states to have a
higher quotient in comparison with conversion hysterics.
Very few studies have been able to replicate the actual
figures of the others, however; for example, the quotient in
normals has been variously reported as 1.07, 1.98, and 3.43.
Such variability is probably due to differences in definition
of terms and in sample collection.
Spreen and Wachal have attempted to refine methodol¬
ogy in syntactical analysis still further by describing a
precise method of collecting and transcribing speech
samples and developing sophisticated statistical methods
 for data analysis.'"'- Their techniques, developed for use in
aphasies (perhaps the most difficult group for linguistic
analysis), are too new to be widely replicated as yet.
Other investigators have attacked the problem of de¬
scribing and differentiating speech patterns by examining
aspects of content rather than form. Perhaps the oldest
and simplest technique is the type-token ratio (TTR),
originally developed by Wendell Johnson as a way of
describing vocabulary size of "lexical diversity."'1'4 This
measure is determined by dividing the total number of
words (or tokens) into the total number of different words
(or types). This variable has been examined most often in
schizophrenia, with some indications that schizophrenics
may have a lower TTR than normals. The range of values
has differed widely from study to study, however, with a
low of .26 and a high of .74."'7·'3 As Wachal and Spreen have
pointed out, the TTR tends to be highly dependent on
sample length and whether the sample is spoken or writ¬
ten.
Other investigators have attempted to develop methods
that focus more closely on aspects of content that may give
a better index of actual cognitive style. Weintraub and
Aronson""1 have developed a method of using word choice
and phrase choice as an index of various psychological
defense mechanisms. This method identifies a variety of
factors considered to be of psychological significance in
psychiatric disorders: qualifying phrases and words, nega¬
tors, retractors, expressions of feeling, value judgments,
etc. Using these techniques, Weintraub and Aronson have
found differences between normal controls and patients
suffering from a wide range of psychiatric disorders:
delusional behavior, impulsive behavior, compulsive behav¬
ior, and depression. Gottschalk and associates--"1 have
attempted to examine interpersonal and emotional aspects
of content by developing an elaborate weighted scoring
system designed to evaluate anxiety, social alienation,
uncertainty, and feelings of being controlled. They have
developed this primarily as a method of defining and
differentiating schizophrenic thought.
The methods of Weintraub and Gottschalk and col¬
leagues require individual scoring of phrases and clauses in
transcribed samples of speech. Thus they are necessarily
time-consuming and, to some extent, dependent on the
subjective judgment of the scorer. Other experiments in
content analysis have developed as a way of surmounting
these problems. Several investigators have attempted to
analyze content by developing "dictionaries" or sets of
word categories that group together words considered to
share a similar psychological significance.-4 For example,
all words dealing with the concept of failure would be
enumerated under this category. After a series of these
dictionaries have been developed and their reliability and
validity determined, they can be used to analyze vocabu¬
lary content through more accurate and efficient comput¬
erized methods. Such computerized content analysis has
been used to analyze a wide variety of speech samples,
ranging from the political pronouncements of foreign
statesmen to spontaneous productions by schizophrenics.
Its application to psychiatric populations has, however,
been quite limited to date.
Thus, a variety of methods for analyzing speech and
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writing have been developed and applied over the years,
with somewhat varied results. With the possible exception
of Weintraub, no one has succeeded in developing a method
that can be consistently repeated in a range of psychiatric
patients, and no one has as yet attempted to replicate
Weintraub's data. Yet enough has been done to suggest
that psycholinguistic studies are a potentially rich method
for exploring language and ultimately thought in
psychiatric patients.
The present investigation was undertaken as a pilot
study. The overall plan was to examine a number of
linguistic variables. Based on the research just reviewed,
four different areas were selected for investigation: lexical
diversity, syntactical complexity, frequency of types of
syntactical elements, and content analysis. In order to
increase precision, only variables that could be analyzed
quantitatively were selected.
METHOD
Within three to five days after admission, speech samples were
obtained from 16 inpatients suffering from mania and 15 inpa-
tients suffering from depression. Although some patients were
receiving medication at the time of testing, all were fully sympto¬
matic. Consecutive admissions were used, but only patients who
met previously defined diagnostic criteria (the Research Diag¬
nostic Criteria) were included.-'' These criteria for mania and
depression are as follows:
For manic disorder, A through E are required for the episode of
illness being considered:
A. One or more distinct periods with a predominantly elevated
or irritable mood. The elevated or irritable mood must be a
prominent part of the illness and relatively persistent, although it
may alternate with depressive mood. If the manic symptom only
occurs during periods of alcohol or drug intake or withdrawal from
them, it should not be considered here.
B. If mood is elevated, at least three of the following symptom
categories must be definitely present to a significant degree (four
if mood is only irritable) (for past episodes, because of memory
difficulty, one less symptom is required):
1. More active than usual—either socially, at work, sexually—or
physically restless
2. More talkative than usual or felt a pressure to keep talking
3. Flight of ideas or subjective experience that thoughts are
racing
4. Inflated self-esteem (grandiosity, which may be delusional)
5. Decreased need for sleep
6. Distractability, ie, attention is too easily drawn to unimpor¬
tant or irrelevant external stimuli
7. Excessive involvement in activities without recognizing the
high potential for painful consequences, eg, buying sprees, sexual
indiscretions, foolish business investments, reckless driving
C. Overall disturbance is so severe that at least one of the
following is present:
1. Meaningful conversation is impossible
2. Serious impairment socially, with family, at home, or at
work
3. In the absence of No. 1 or 2, hospitalization
D. Duration of manic features at least one week (or any
duration if hospitalized).
E. None of the following, which suggest schizophrenia is pres¬
ent:
1. Delusions of being controlled or of thought broadcasting,
insertion, withdrawal
or
2. Hallucinations of any type throughout the day for several
days or intermittently throughout a one-week period, unless all of
 the content is clearly related to depression or elation
3. Auditory hallucinations in which either a voice keeps up a
running commentary on the patient's behavior as it occurs, or two
or more voices converse with each other
4. At some time during the period of illness had delusions or
hallucinations for more than one week in the absence of prominent
affective (depressed or manic) symptoms
5. At some time during the period of illness had more than one
week when he exhibited no prominent manic symptoms but had
several instances of formal thought disorder
For major depressive disorder, A through E are required for the
episode of illness being considered:
A. Dysphoric mood characterized by symptoms such as the
following: depressed, sad, blue, hopeless, low, down in the dumps,
"don't care anymore," irritable, worried. The mood disturbance
must be prominent and relatively persistent but not necessarily
the most dominant symptom. It does not include momentary shifts
from one dysphoric mood to another dysphoric mood, eg, anxiety
to depression to anger, such as are seen in states of acute psychotic
turmoil.
B. At least five of the following symptoms are required to have
appeared as part of the episode for definite and four for probable
(for past episodes, because of memory difficulty, one less symptom
is required):
1. Poor appetite or weight loss or increased appetite or weight
gain (change of 0.5 kg a week over several weeks or 4.5 kg a year
when not dieting)
2. Sleep difficulty or sleeping too much
3. Loss of energy, fatigability, or tiredness
4. Psychomotor agitation or retardation (but not mere subjec¬
tive feeling of restlessness or being slowed down)
5. Loss of interest or pleasure in usual activities, including
social contact or sex (do not include if limited to a period when
delusional or hallucinating)
6. Feelings of self-reproach or excessive or inappropriate guilt
(either may be delusional)
7. Complaints or evidence of diminished ability to think or
concentrate, such as slow thinking, or indecisiveness (do not
include if associated with obvious formal thought disorder)
8. Recurrent thoughts of death or suicide, or any suicidal
behavior
C. Dysphoric features of illness lasting at least one week.
Definite if lasted more than two weeks, probable if one to two
weeks.
D. Sought or was referred for help from someone during the
dysphoric period or had impaired functioning socially, with family,
at home, or at work.
E. None of the following, which suggest schizophrenia is pres¬
ent:
1. Delusions of being controlled or of thought broadcasting,
insertion, withdrawal
or
2. Hallucinations of any type throughout the day for several
days or intermittently throughout a one-week period, unless all of
the content is clearly related to depression or elation
3. Auditory hallucinations in which either a voice keeps up a
running commentary on the patient's behaviors or thoughts as
they occur, or two or more voices converse with each other.
4. At some time during the period of illness had delusions or
hallucinations for more than one month in the absence of promi¬
nent affective (manic or depressive) symptoms (although typical
depressive delusions, such as delusions of guilt, sin, poverty,
nihilism, or self-deprecation or hallucinations of similar content
are permitted)
5. Preoccupation with a delusion or hallucination to the relative
exclusion of other symptoms or concerns (other than delusions or
guilt, sin, poverty, nihilism, or self-deprecation or hallucinations
with similar content)
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6. Definite instances of formal thought disorder
Using these criteria, kappa coefficients of interrater reliability
have been calculated at .90 for manic disorder and .85 for major
depressive disorder. The manies and depressives did differ slightly
in age or educational background. The manies ranged in age from
16 to 64 years, with a mean of 33, and they had a mean of 12.6 years
of schooling. The depressives had 10.7 years of schooling, and they
ranged from 16 to 76 years old, with a mean of 41. Nine of the
manic patients were female, while 13 of the depressed group were
female.
The speech samples consisted of a mixture of responses to
proverb interpretation and spontaneous free speech in response to
questions such as "What are you like?" or "Tell me about your
family." The proverbs were taken from a standard list in the
Mental Examiner's Handbook.-" The first 80 words of proverb
interpretation and the first 320 words of spontaneous speech were
used for analysis. All speech samples were tape-recorded and later
transcribed.
After transcription, each word in the sample was coded with a
designation for part of speech and each sentence was coded for
sentence type, using a method worked out by one of the investi¬
gators (N.J.C.A.) and available on request. Verbs were, for exam¬
ple, classified into either action or state-of-being verbs and also by-
tense into past, present, and future. Nouns were divided into
abstract (qualities such as beauty, truth) and concerte (objects
such as book, street). Pronouns were divided into six classes: three
classes of personal pronouns (first, second, third person), and also
relative (who, which, etc), demonstrative (this, that, etc), and
indefinite (any, both, etc) pronouns. Adjectives were divided into
three types according to degree (positive, comparative, and
superlative), and a fourth group was designated as indefinite
adjectives (a, the, this). Adverbs were divided into four groups:
descriptive (forcefully, fast, etc), interrogative (how, when, etc),
modifying (rather, very, etc), and indicators of time and place
(now, again, here, etc). Conjunctions were divided into coordinat¬
ing (and, or, etc), subordinating (because, if, etc), and transitional
(accordingly, moreover, etc). Prepositions were not divided into
subclasses. Thus, grammatical elements were divided into seven
major classes, which were further subdivided into 26 subclasses. In
an effort to examine possible differences in sentence structure,
each sentence was also coded to indicate sentence type: simple,
compound, complex, compound-complex, and fragment. This
method of coding also permitted an examination of sentence
length.
Several speech samples were coded independently by each of the
investigators. Since codings differed on only 1.5% of the words,
this was considered to represent suitable interrater reliability.
Thereafter coding was divided between the two investigators,
with each taking half the manic sample and half the depressed
sample in order to randomize any systematic error that might
occur.
Other methods were used to examine aspects of speech content,
such as vocabulary and word choice, as opposed to the above
syntactical aspects. At the simplest level, richness or convention¬
ality of vocabulary was examined by determining what
percentage of words used by the patients were among the 1,000
most commonly used words as determined by the Lorge-Thorndike
Dictionary. Which particular words were used most frequently by
each subject was also determined. In addition, the lexical diversity
of each subject was determined by calculating the type-token
ratio. The number of negators (no, not, never, etc) and the number
of qualifiers (perhaps, if, maybe, etc) were also determined for
each subject, using a standard predetermined list.
In an attempt to achieve a more sophisticated approach to
vocabulary and word choice, techniques of content analysis were
also used. The most recent revision of the Harvard Psychosociolog-
ical Dictionary, the Harvard IV-3, was obtained from Phillip
 Table 1.—Lexical Diversity in Depressives and Manies

Depressives ( 15) Manies ( =

16)
—

Lexical Diversity Mean SD Mean SD

No. of 1,000 most common words 338.13 15.07 330.88 11.37 NS
Type-token ratio .4098 .0333 .4280 .0259 2.63 NS

Table 2.—Syntactical Complexity in Depressives and Manies

Depressives ( 15) Manies ( =

16)
—

Mean SD Mean SD
No. of sentences
Simple 13.27 8.00 13.31 8.44 0.02 NS
Compound 280 1.90 2.13 1.15 1.16 NS
Complex 9.53 3.44 8.19 3.19 1.09 NS
Compound-complex 3.20 1.37 3.81 2.23 0.88 NS
No. of fragments 4.20 2.48 3.69 2.68 0.53 NS
No. of sentences in 400-word sample 33.00 9.54 31.13 10.62 0.50 NS

Stone and his associates. This dictionary divides 8,700 words or
word senses into 170 content categories. Since using all 8,700 word
senses and 170 content categories was thought to be too large an
undertaking for a pilot study of this type, 28 categories were
selected as being of possible relevance to affective disturbance.
These categories contained words that tend to denote or connote
such ideas or feelings as achievement, failure, abandonment,
hostility, submission, strength, weakness, virtue, vice, disorder, or
negation. Each of these categories contained from 10 to 37 words.
The specific 28 categories used were: INCR, IMPLNEG, HOST,
FEEL, ABANDON, EXPRS, EXERT, EVAL, EMOT, DISORDR,
DECR, CAUSAL, CHANGE, ACTV 3, ACH, FALL, WEAK 3,
VIRTUE, VICE, UNDRST, SUBM, STRNG 3, SOLVE, QUALIF,
POWER, OVRST, NGTV 3, INDEF.
Speech samples were transferred to computer cards, as were the
Lorge-Thorndike Dictionary and the 28 categories for content
analysis. The various frequency counts of word choice, and syntac¬
tical elements, and vocabulary were all determined by computer¬
ized analysis, using either stock programs locally available or
programs written by one of the investigators. (B.P.)
These data were used to test a number of hypotheses concerning
several variables in structure and content of speech in affective
disorder.
1. Lexical diversity: It was predicted that manies would have
greater lexical diversity as reflected in higher type-token ratios
and more words not occurring in the Lorge-Thorndike.
2. Syntactical complexity: It was predicted that manies would
tend to use longer sentences and employ more complicated syntax
as reflected in more compound, complex, and compound-complex
sentences and fewer simple sentences. It was also anticipated that
they would use more fragments.
3. Frequency of syntactical elements: These were subdivided
into several groups that might reflect similar aspects of speech.
a. Vagueness: It was predicted that depressives would show
more vagueness as reflected by an increase in such syntactical
elements as indefinite adjectives, state of being verbs, and
relative, demonstrative, and indefinite pronouns.
6. Colorfulness of speech: It was predicted that manies would
have more colorful or emotional speech, as reflected in more
adverbs, adjectives, nouns, and action verbs.
c. Use of qualifiers: It was predicted that depressives would
tend to qualify their statements more often, as reflected by the
use of more modifying adverbs.
d. Personalization: It was predicted that manies would show
more preoccupation with themselves, as reflected in increased use
of first-person
pronouns.
Time orientation: It was predicted that depressives would be
e.
more preoccupied with the past, as reflected by the use of more
past-tense verbs and more adverbs referring to time and place.
/. Concrete vs abstract usage: It was predicted that manies
would be more concrete and depressives more abstract, as
reflected by manies using more concrete nouns referring to places
and things and depressives using more abstract nouns referring to
qualities or ideas.
g. Verb-adjective ratio: This can be calculated as a verb-
adjective, verb-noun, or verb-noun plus adjective ratio. If a higher
ratio is associated with greater emotional instability, one would
expect a higher ratio in manic patients.
h. State of being-Action Verb Ratio: It was predicted that
depressives would have a higher ratio, which would serve as an
index of anergy.
4. Content analysis: It was predicted that manies would use
more words from the groups dealing with concepts such as
strength or achievement, while depressives would choose words
reflecting a concern with weakness or failure.
RESULTS
The results of data analysis illustrate quite well how
difficult it is to predict language behavior on the basis of
clinical experience. Subjective impressions were not always
supported by objective information, and a considerable
number of the hypotheses were not proved.
As shown in Table 1, the depressives and manies did not
differ in lexical diversity. Although the manies did have a
slightly higher type-token ratio, suggesting a wider range
of word choice, this was not statistically significant. Like¬
wise, the manies used slightly fewer "commonly used"
words, as represented by the Lorge-Thorndike Dictionary,
but the difference was not statistically significant.
As Table 2 demonstrates, the manies also did not show a
significant difference in syntactical complexity. Both
manies and depressives used similar numbers of simple
sentences, and this tended to be the most common sentence
type in both groups. They also did not differ significantly

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 Table 3.—Frequency of Syntactical Elements in Manies and Depressives
Depressives ( = 15) Manies ( =16)

Mean SD Mean SD
Vagueness
Indefinite adjectives 15.13 4.56 18.38 5.54 1.72 NS
Relative demonstrative and indefinite pronouns 25.60 6.63 24.38 5.73 0.53 NS
State of being verbs 61.13 13.35 49.44 9.45 2.74 .02
Colorfulness
Adverbs 46.60 8.25 39.44 7.19 2.50 .02
Action verbs 45.93 16.20 57.63 8.17 2.48 02
Adjectives 40.40 11.27 48.44 8.27 2.20 .05
Concreteness
Concrete nouns 31.20 7.35 43.94 11.73 3.48 .01
Abstract nouns 11.73 6.18 13.59 6.99 0.72 NS
Nouns 42.93 7.01 57.44 9.99 4.60 .001
Qualifiers
Modifying adverb 30.87 8.92 21.56 5.19 3.46 .01
Personalization
First-person pronouns 38.87 7.08 31.69 5.31 3.10 .01
Personal pronouns 69.93 9.17 61.50 11.06 2.25 .05
Time orientation
Past-tense verbs 24.53 14.35 17.81 14.43 1.26 NS
Adverb Indicating time 10.40 4.29 13.81 1.82 NS

in the numbers of compound, compound-complex,
complex sentences used, and both used nearly the
number of fragments. Depressives tended to use slightly
shorter sentences, but again the difference was not signif¬
icant.
Table 3 shows the frequency of syntactical elements in
the two patient groups, and in this area the manies and
depressives were often different, although not always in
the direction predicted. As hypothesized, depressed
patients tended to show more vagueness, although only on
one index. They did not use significantly more indefinite
adjectives or relative, demonstrative, and indefinite
pronouns, but they did use significantly more state-of-
being verbs at the .02 level. Manies, on the other hand, did
tend to have more colorful language. Their use of action
verbs and adjectives was greater at the .05 and .02 levels,
respectively, but the depressed patients did use more
adverbs with a difference significant at the .02 level.
The issue of concrete vs abstract usage is somewhat
obscure. The manic patients tended to use considerably
more nouns, and they therefore used both more concrete
nouns and more abstract nouns than the depressed
patients. The difference in abstract nouns is not statisti¬
cally significant, however, while the differences in nouns
generally and in concrete nouns are significant at the .001
and .01 levels, respectively. The manies, therefore, were
definitely more concrete.
As predicted, the depressed patients tended to
their statements often, as reflected in their use of
more
more qualifying adverbs, with the difference significant at
the .01 level. On the other hand, the hypotheses concerning
personalization and time reference were not supported by
the data. The depressed patients, rather than the manies,
tended to show a greater preoccupation with themselves, as
reflected in their greater use of the first person pronoun,
with the difference significant at the .01 level. They also
tended to use more personal pronouns generally, with the
or difference significant at the .05 level. They used more past-
same tense verbs and therefore showed some preoccupation with
the past, but the results did not reach statistical signifi¬
cance, and they did not use significantly more adverbs
referring to time and place.
Table 4 contains a series of ratios that were calculated to
permit comparison of our data with those of other studies.
Each of these ratios is statistically significant, although
slightly less so than if the various syntactical elements are
compared singly. Contrary to prediction, the depressives
have a higher verb-adjective ratio than the manies. They
also have a higher verb-noun and verb-noun plus adjective
ratios. These differences are significant at the .05, .02, and
.02 levels, respectively. If a ratio of state of being-action
verbs is constructed, then the depressed patients also are
higher at the .05 level. This index is probably relevant
because it indicates that the verb-adjective ratio cannot
truly be considered an action quotient, since it does not
reflect a high use of action verbs among the depressed
patients.
Table 5 reports the results of content analysis, which
were statistically significant. As expected, manies tended
to choose words that reflected concern with power and
achievement, but somewhat surprisingly the depressives
were higher in the overstatement category. Since the total
number of dictionaries examined was 28 and since only
three were found to differentiate the two groups signifi¬
qualify cantly, the differentiation may be purely on the basis of
chance.
Table 6 compares the results of our analysis of manic and
depressive speech expressed in percentages with that of
Lorenz and Cobb. Since they reported their data in
percentages and did not report means and standard devia¬
tions, statistical comparison is not possible, but the results
for manic patients are strikingly similar and suggest that
data of this type can be replicated. Their patient sample
size was smaller (ten) and their word sample size larger

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 Table 4.—Syntactical Ratios ¡n Manies and Depressives
Depressives ( =15) Manies ( =
16)
Ratio Mean SD Mean SD
Verb-adjective 2.88 0.92 2.29 0.51 2.18 .05
Verb-noun 2.57 0.56 1.93 0.44 2.47 .02
Verb-noun + adjective 1.33 0.30 1.04 0.20 3.18 .02
State of being-action verb 1.72 1.35 0.89 0.26 2.36 .05

Table 5—Content Analysis pretation and the relatively short length of the sponta¬
neous speech samples may well have produced an artifac-
Depressives Manies tual homogeneity in word choice and sentence type. Subse¬
(N 15)
=
(N = 16)
quent investigations in this area should probably be
Mean SD Mean SD limited to "spontaneous speech" only and increase the word
Power (18*) 9.26 2.67 13.19 3.86 3.17 .02 sample to at least 500 words per patient and possibly 1,000
Overstatement (19) 17.53 5.48 12.00 4.83 2.88 .02 words. Most of the content analysis dictionaries consist of
Achievement (37) 7.53 2.75 10.19 3.15 2.42 .05 20 to 30 words, and a 400-word sample is probably not long
'Numbers in parentheses are the number of words In the category.
enough to assess the use of this relatively small number of
words. Further, subsequent studies should probably control
for verbal intelligence quotient rather than using consecu¬
Table 6.—Syntactical Elements in tive admissions, since vocabulary size and intelligence may
Two Studies of Speech in Affective Disorders well play a significant role in syntactical complexity and
lexical diversity. The higher educational level of the manies
% of Words
may have distorted results in some way, although neither
Lorenz & Cobb2 Andreasen & Pfohl group is of a very high educational level.
(Current Study)
Nevertheless, manic and depressed patients did differ
Normals Manies Manies Depressives from one another substantial number of variables
on a
Nouns 16.7 14.9 13.3 9.9 probably not related to education. The
analysis of syntac¬
Adjectives 12.2 9.6 7.0 5.9 tical elements was particularly useful in distinguishing
Adverbs 12.5 11.7 9.1 10.8 between the two groups, and several working hypotheses
Verbs 16 8 22 3 24.8 24.8 were validated. The speech of the depressives was charac¬
Pronouns 13.8 18.2 19.9 22.1 terized by the use of more state of being verbs, adverbs,
Prepositions 10.4 8.3 5.6 5.9 modifying adverbs, first-person pronouns, and personal
Conjunctions 8.9 7.5 8 1 8.9 pronouns, while the manies used significantly more action
Articles 6.4 5.9 5.5 3.5 verbs, adjectives, concrete nouns, and nouns generally.
Although the characteristics of speech that these syntac¬
tical elements are assumed to represent are somewhat
(1,000 words), but nevertheless none of the categories arbitrary and theoretical, these results imply that depres¬
differ by more than 3%. Oddly, our depressed patients tend sive speech tends to be more vague, qualified, and person¬
to differ from Lorenz and Cobb's normal subjects in a more alized, while manic speech is more colorful and concrete. If
extreme way than the manies, suggesting that "normality" one wishes to reject the descriptive categories altogether
is not necessarily a mean between mania and depression. as too arbitrary, one nevertheless is left with the clear

COMMENT
Because it is a pilot study, this investigation deals with a
large number of linguistic variables. A considerable
number, thought to be potentially promising, were not of
any value in discriminating between the two groups statis¬
tically. In particular, measures of lexical diversity such as
the type-token ratio have been of considerable value in
other linguistic studies of psychiatric populations. The
content analysis dictionaries have been described as a very
interesting method for examining the emotional tones
expressed in samples of language. The negative results
obtained with these two linguistic tools were particularly
disappointing. In addition, greater differences in syntac¬
tical complexity were also anticipated.
However, these negative results may have been due to an
error in experimental design, which should be remedied in
subsequent studies. The use of 80 words of proverb inter-
implication that depressed patients tend to qualify more,
to talk more in terms of a "state of being," and to talk more
both about themselves and other people. Manies, on the
other hand, tend to talk more about things than about
people, to discuss them in terms of action, and to use more
adjectives to describe them. Because our data on manies
are so similar to those of Lorenz and Cobb, it seems likely
that these positive findings can be replicated in future
studies.
The results of one familiar linguistic variable, the verb-
adjective ratio, were particularly surprising. Originally
described as an "action quotient" or an index of instability,
it has been consistently higher among psychiatric groups
than normals. If it were indeed either an action quotient or
an index of instability, one would anticipate that it would
be higher in manies than depressed patients, but the
reverse was true. Other aspects of the data analysis
suggest that one must consider not only the quantity of

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 verbs used but also the types of verbs used in order to
assess the meaning of the verb-adjective ratio. If the
quotient is composed of all verbs, including both auxiliary
and main verbs and a mixture of action and state of being
verbs, as appears to be the case in most of the quotients
calculated, then the varying quantity of those components
can certainly affect the meaning of the quotient. In this
study the quotient is loaded with a substantial quantity of
state of being verbs in the depressives and action verbs in
the manies, with the overall average number of verbs being
similar in the two groups. Manies, however, use many more
adjectives. This gives the manies a relatively lower
quotient than the depressives, although their speech
contains more syntactical elements suggestive of action
and color. Thus a high verb-adjective quotient in this study
appears to be an index of a rather drab colorless inactive
style of speaking. This dissecting out of the elements that
actually produce a particular quotient appears to be illumi¬
nating and is recommended for future studies.
Thus, this pilot study has led to some positive results and
suggested some methods for future improvement. It has
not drawn heavily on transformational or generative
grammar, since conventional grammar appeared to lend
itself more readily to data analysis, but it has used other
relatively sophisticated psycholinguistic techniques such as
content analysis and measures of lexical diversity. Oddly
enough, at this point, analyzing grammar in conventional
descriptive terms has been the most useful tool. Further
studies using larger samples are needed to determine
definitively the usefulness of the other techniques.
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