Über die Autorin bzw. den Autor

Martin J. Ball is Hawthorne Endowed Professor and Head of the Department of Communicative Disorders at the University of Louisiana at Lafayette.

Michael R. Perkins is Professor of Clinical Linguistics in the Department of Human Communication Sciences at the University of Sheffield, England.

Nicole Müller is Hawthorne-BoRSF Endowed Professor in the Department of Communicative Disorders at the University of Louisiana at Lafayette.

Sara Howard is Senior Lecturer in Clinical Phonetics in the Department of Human Communication Sciences at the University of Sheffield.

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The Handbook of Clinical Linguistics brings together an international team of contributors to produce an original and in-depth survey of this multi-faceted field. It fills a gap in the existing literature as the first non-encyclopedic volume to provide comprehensive, up to date coverage of this ever-expanding area of linguistics.

Relevant chapters include a range of pathologies, with each section exploring multilingual and cross-linguistics aspects of the field, as well as analytical methods and assessment. In those chapters examining a specific area of linguistics, a section has been included which outlines how mainstream theories and descriptions of language have been influenced, if at all, by clinical research. The result is an essential resource for students and practitioners of speech-language pathology, linguistics, psychology, and education.

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The Handbook of Clinical Linguistics

John Wiley & Sons

Chapter One

NICOLE MÜLLER, JACQUELINE A. GUENDOUZI, AND BRENT WILSON

1.1 Introduction: Definitions and Conceptualizations of Discourse

1.1.1 What is discourse?

The applied clinical disciplines have a long history of borrowing theoretical constructs and methods of inquiry from, for example, theoretical linguistics, psycholinguistics, the philosophy of language, sociology, anthropology, and others. This means on the one hand that there is an impressive array of methodological resources and complementary (and sometimes contradictory) theoretical viewpoints that can inform our understanding of all manner of speech and language data. On the other hand, there is a danger of conceptual and terminological confusion, if the theoretical and philosophical heritage of terminologies is overlooked (see Guendouzi & Müller, 2006; Perkins, 2007, for more detailed discussion).

The terms discourse and discourse analysis are used in many different ways by different people, not only in clinical linguistics (or, more broadly, clinical communication studies) and speech-language pathology, but also in nonclinical domains. The Latin word discursus, which became 'discourse' in English (Onions, 1966, p. 272), means 'running to and fro', from which derived the medieval Latin meaning 'argument'. Thus, within disciplines that deal with human language, speech and communication, 'discourse' can be understood, in the widest sense, as both the process of running to and fro, an exchange, between a human being and his or her environment, and the products arising from such exchanges.

Because of space limitations, we do not attempt to give a comprehensive overview of explicit and implicit definitions of the terms discourse and discourse analysis as they have been used in the non-clinical literature. Readers may find such overviews in the opening chapter of Jaworski and Coupland (1999) or Schiffrin (1994, ch. 2), and in the introduction to Schiffrin, Tannen, and Hamilton (2001). The latter volume groups the multitude of discourse-analytic approaches into three major strands: "(1) anything beyond the sentence, (2) language use, and (3) a broader range of social practice that includes nonlinguistic and nonspecific instances of language" (p. 1). The conceptualization of discourse adopted, whether explicitly defined or left implicit to emerge from the data gathered and analyzed, depends of course on the research question asked, which in turn is constrained by the theoretical or analytical framework within which a researcher works.

Schiffrin (1994) distinguishes between formalist and functionalist traditions in discourse analysis. Formalist approaches aim at the discovery of structural properties pertaining between elements of discourse, (1) as defined in Schiffrin, Tannen, and Hamilton (2001). It would appear to follow that such approaches also implicitly focus on discourse as product, rather than as a process. In other words, while there are "producers and receivers of sentences, or extended texts, ... the analysis concentrates solely on the product, that is, the words-on-the-page" (Brown & Yule, 1983, p. 23). Functionalist views of discourse, on the other hand, aim to capture patterns of language use, including the use of linguistic form (and other communicative devices) for interactive and communicative purposes, thus discourses (2) and (3). Brown and Yule, taking a process stance towards discourse, describe a discourse analyst as someone who is "interested in the function or purpose of a piece of linguistic data and also in how that data is processed, both by the producer and the receiver" (1983, p. 25), and who treats "data as the record (text) of a dynamic process in which language was used as an instrument of communication in a context by a speaker/writer to express meanings and achieve intentions (discourse)" (p. 26). Discourse (3) is the object of analysis in critical approaches, which examine language and its use within the context of social practices, and society and identities as constructed through discursive (linguistic and non-linguistic) practices. (Guendouzi & Mller, 2006, ch. 1, on which this section draws substantially, presents a more detailed overview of definitions and approaches to discourse, and additional references, with specific application to dementia studies.)

In reality, the distinction between discourse as process and discourse as product, and indeed between formalist and functionalist approaches, turns out to be less than straightforward to maintain. First of all, it has to be stressed that all analysis of discourse is an analysis of a product (with the possible exception of real-time neuroimaging studies; but even there we can argue that what is analyzed is an artifact of an analytical procedure, i.e. a pattern, or image). That is to say, the starting point of an analysis is always going to be a "piece of linguistic data", in Brown and Yule's phrase, or a text. In general, researchers in clinical contexts are primarily concerned with the mechanisms that underlie the processing of discourse and the production of text. However, definitions of discourse in work that does not draw on the methods of conversation analysis (see Wilkinson, chapter 6 in this volume), particularly in experimental research, tend to fall squarely into Schiffrin, Tannen, and Hamilton's (2001) category (1), as for example Joanette, Goulet, and Hannequin's statement (1990, p. 163) that discourse "refers to a groups of sentences such as in a conversation or a story", or Cherney, Shadden, and Coelho's definition of discourse (1998, p. 2) as "continuous stretches of language or a series of connected sentences or related linguistic units that convey a message".

Research and assessment in clinical discourse analysis frequently targets specific discourse types, or genres. Table 1.1 summarizes a widely used taxonomy (based on Cherney, Shadden, & Coelho, 1998).

The distinction between discourse types and their characteristics is of course an oversimplification. A speaker's main purpose in telling a story may be instructional (a 'cautionary tale'), by way of entertainment. A business negotiation may have a conversational structure overall, but is likely to contain elements of expository and persuasive discourse, and possibly even narrative material (by way of illustrating elements of either expository or persuasive discourse). However, in terms of clinical applications the simplification inherent in the categorization is deliberate, since it limits the variables of analysis that have to be taken into account, and thus makes comparisons and generalizations easier. This is also the reason why in assessment or research contexts, 'naturalness' tends to be sacrificed for the sake of standardization in terms of the tasks and stimuli used. For example, one of the frequently used picture stimuli to elicit descriptive discourse is the well-known "Cookie Theft Picture" from the Boston Diagnostic Aphasia Examination (Goodglass & Kaplan, 1983). Narrative discourse is often elicited using action pictures, or picture sequences (see some of the references in sections 1.2 and 1.3 below. Thus a balance is attempted between achieving generalizability and, if not necessarily a discourse context that is entirely personally relevant and natural to the participant, one that is engaging enough to produce data that reflect the best of the participant's ability.

1.1.2 Analyses of discourses in clinical domains, and the role and impact of disorder

We believe it is safe to say that there is, in clinical domains, a common thread among the multiplicity of approaches to the analysis of discourse, namely the quest for mechanisms that permit humans the creation of meaning in context. The chief instrument for meaning creation is of course language use. Within clinical linguistics and interaction studies, a focus of interaction is impairments that impede communicative language use. The object of analysis is always a text, and the properties of the said text may be formulated in a multitude of different ways; however, clinical discourse analysis in the end will always aim at a clinical purpose. The purpose may be the search for generalizable features, patterns or symptoms that characterize either disorders or populations with certain impairments, for strategies by which the impact of impairment is alleviated, or for the mechanisms by which societies construct images of impairment or disorder. Whatever the research question, the analysis of discourse in clinical domains is essentially functional, even though the measures employed may be borrowed from so-called formal approaches to discourse analysis.

As regards the enabling (or, depending on one's perspective, disabling) mechanisms in the creation of meaning in context, we can, at a minimum, distinguish the following:

1 Intra-individual or -personal: the cognitive, linguistic, but also organic (including neural) mechanisms that can be linked to the achievement of discourse. Michael Perkins (chapter 5 in this volume) lists a number of semiotic, cognitive and sensorimotor elements of pragmatics, which can be included here as part of the intra-individual discourse potential.

2 Inter-individual, or interactional: the mechanisms at work in an interaction that contribute to meaning creation. These mechanisms could be further subdivided into characteristics of interactants (which makes reference back to point 1), of an unfolding interaction, and of the context in which an interaction takes place.

3 Social: the mechanisms in the socio-cultural context beyond any given communicative situation that contribute to meaning creation.

This tripartite distinction is of course somewhat of a simplification: It is too gross-grained in that within each category, multiplicities of mechanisms and processes could be distinguished; and it is too rigid because meaning creation between communicating participants cannot happen without all three types of mechanisms. However, it may serve us as a simple structure to which to anchor some distinctions concerning the various approaches to clinical discourse analysis, and the presence and nature of disorder.

To say what it means for a skill, an anatomical or neurological mechanism, an interaction, or even a person (to name only a few possibilities) to be 'disordered' is not a trivial endeavor in clinical studies. The perspective on this question will determine how a researcher or clinician defines and approaches a research question or therapeutic activity. Our tripartite classification of contributing mechanisms, then, offers three different perspectives on the nature of texts, and on the role of disorder. We can look at texts as windows on cultural and social processes, and socially negotiated meanings of 'order' and 'disorder' (making reference to point 3). Another perspective is an interactional-emergent view of disorder that makes reference to point 2 above, and that looks at a text as a record of the joint, interactional negotiation of meaning. Furthermore, we can use texts, and in particular texts in which meaning construction is disrupted in some fashion, as reflections of certain configurations of impairments that are properties of a person (point 1).

Wilkinson (chapter 6 in this volume) discusses the application of conversation analysis (CA) to clinical data. Among the major methodological tenets of CA and clinical approaches based on CA is the principle that one's data must be approached with as few preconceptions as possible as to how mutual understanding (the joint negotiation of meaning within the interactional context) is or is not achieved. Further, the analyst's role is to discover, by way of detailed description of the 'local' (i.e. turn-by-turn, in conversational data) organization of a text (e.g. a transcript of a conversation), the mechanisms that interactants use to jointly negotiate meaning. Thus, there is no a priori 'ill-formed' or 'well-formed' structure; rather, what is or is not successful emerges out of the unfolding interaction (see also Atkinson & Heritage, 1984). Thus the search is for joint interactional mechanisms (including, for example, compensatory strategies, or even non-conventional uses of interactional tools; see also Perkins, chapter 5 in this volume), rather than primarily for indicators of communicative impairment.

In contrast to what could thus be termed a bottom-up approach to discourse as defined above, many investigators apply a top-down set of tools to the analysis of data from clinical contexts. These tools are then employed in the search for characteristics of discourse that can be considered typical for certain types of disorder; that is, discourse characteristics are analyzed as reflections of impairment. This perspective within clinical discourse analysis typically employs an experimental or quasi-experimental-reductionist approach to research, in which attempts are made to control for factors that may influence the production of texts and cloud the perspective on individual impairment. Top-down approaches to discourse typically employ, either implicitly or explicitly, a notion of well-formedness. In other words, as well as applying a set of descriptive-analytic categories to a text, such approaches bring a set of assumptions as to appropriate or inappropriate realizations of categories.

Our presentation of approaches to the analysis of discourse is necessarily selective. In sections 1.2 and 1.3 below, we discuss perspectives on discourse that originated in research on language processing, namely the notion of micro-and macrostructures (1.2) and analyses of narrative, specifically story grammars (1.3). Section 1.4 deals with a perspective borrowed from the philosophy of language, speech act theory. While these perspectives emerge from very different scientific and philosophical traditions, they have provided researchers in the clinical disciplines with analytical and descriptive frameworks that have been widely used (and at times widely criticized). Other influential work in the realm of clinical discourse analyses is discussed elsewhere in this volume: for example, cohesion analyses grounded in Systemic Functional Linguistics (Ferguson & Thomson, chapter 8 in this volume), and conversation analysis (Wilkinson, chapter 6 in this volume). Section 1.5 moves the discussion to the social construction of self and personhood in the presence of disorder, specifically dementia.

1.2 Perspectives from Discourse Processing: Micro- and Macrostructures

Theories that attempt to explain the processing of discourse, developed chiefly in the 1970s and 1980s, have had a considerable impact on the clinical domain. The research underlying the clinical application was deliberately and programmatically interdisciplinary, spanning psychology, linguistics, sociology and cognitive science (see e.g. Gordon, 1993; Kintsch, 1977; Mandler, 1984; Schank & Abelson, 1977; Van Dijk, 1977; Van Dijk & Kintsch, 1978, 1983). Attempts to model cognitive structures and processes underlying the comprehension (and by implication production) of discourse were motivated by the view that "actual language use in social contexts" rather than "abstract or ideal language systems should be the empirical object of linguistic theories" (de Beaugrande, 1991, p. 265, excerpting from Van Dijk & Kintsch, 1983). This view is influenced by the traditions of European structuralism, literary scholarship and rhetoric, and sociolinguistics, and can also be seen in part as a reaction against the preoccupation of mainstream linguistics (in essence dominated by the transformational generative paradigm) and psycholinguistics with the syntax and semantics of isolated sentences. A central tenet of what Duchan (1994, pp. 2–3) briefly summarizes as the "thought behind the discourse" approach is that the comprehension and production of discourse involves a language user's establishing and subsequently drawing on mental representations (knowledge structures or schemas). Further, it is assumed that it is possible to formally model such representations. In the clinical literature, further assumptions that emerge are that such models can be used to describe and isolate deficits in processing (both linguistic and cognitive) associated with various diagnostic categories, such as aphasia, right-brain damage, and others, and that, in turn, the deficits associated with these diagnostic categories can shed light on normal, non-disordered language processing.

(Continues...)

Excerpted from The Handbook of Clinical Linguisticsby Martin J. Ball Michael R. Perkins Nicole Müller Sara Howard Copyright © 2008 by John Wiley & Sons, Ltd. Excerpted by permission of John Wiley & Sons. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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