Do Patients With Depression Prefer Literal or Metaphorical Expressions for Internal States? Evidence From Sentence Completion and Elicited Production

Abstract

In everyday communication metaphoric expressions are frequently used to refer to abstract concepts, such as feelings or mental states. Patients with depression are said to prefer literal over figurative language, i.e. they may show a concreteness bias. Given that both emotional functioning and the processing of figurative language may be altered in this clinical population, our study aims at investigating whether and how these dysfunctions are reflected in the understanding and production of metaphorical expressions for internal states. We used two behavioral approaches: a sentence completion task and elicited speech production. In the first experiment, patients with ICD 10 depression (n = 26) and healthy controls (n = 32) were asked to complete sentences by selecting an appropriate word out of four alternatives (metaphorical expression, literal expression, concrete distractor, abstract distractor). All participants–irrespective of the presence of depression–chose more literal (60%) than metaphorical (40%) expressions. In the second experiment, patients with depression (n = 44) and healthy controls (n = 36) described pictures showing emotive events. The descriptions were transcribed and coded for type of expression (non-figurative words for internal states vs. metaphorical expressions, valence, type of metaphor, source and target domain of metaphor). In addition, the Thought and Language Index was applied to assess formal thought disorder. When talking about internal states, both groups used more literal than metaphorical expressions. The groups did not differ with respect to the composition of internal state language, but patients with depression tended to verbalize positive content to a lesser extent. Correlation analyses within the patients' group revealed that signs of disorganization in their speech were related to a higher use of internal state expressions, whereas a negative correlation was found with dysregulation phenomena. Taken together, results indicate that people with and without depression prefer literal means in order to verbalize internal states, but they additionally make use of figurative language. Since patients with depression were able to understand and produce metaphors for internal states similar to controls, the concreteness bias cannot be confirmed by the present study. The results contribute to existing research by demonstrating associations between symptoms of formal thought disorder and internal state language.

Metaphors of Depression. Studying First Person Accounts of Life with Depression Published in Blogs

“…These last studies did not deal precisely with metaphor types for depression, but with the metaphorical capacity of people diagnosed with depression. In this sense, the recent study by Kauschke, Mueller, Kircher, and Nagels (2018) reveals that the understanding and production of metaphorical expressions is completely preserved in patients with depression, with no significant differences from the healthy control group.…”

The Interplay of Syntactic and Lexical Salience and its Effect on Default Figurative Responses

“…The basic claim here is that the competence in figurative language comprehension relies on inferencing skills and the ability to integrate information from various sources (Gibbs, 1992;MacKey & Shaw, 2006;Rundblad & Annaz, 2010). Other factors and mechanisms might also play a role in figurative language processing, such as the type of embodiment pattern activated (Barsalou, 2008;Bergen, 2012); the state of mind and inner states or mood (Charteris-Black, 2012;Kauschke et al, 2018), and probability and heuristic factors (Tversky & Kahneman, 1974;Ritchie, 2013;Hetmański, 2015). Holistic assessment of these factors is still a challenge, although it is obvious that the interplay of various factors and mechanisms can shed light on the process of inferencing.…”

Assessing Pragmatic Language Skills in Adults with Major Depressive Disorder: An Exploratory Study

“…Moreover, when looking at metaphoric and figurative language, research has shown among MDD patients significant impairments in the production of metaphors, that is, a lesser tendency to verbalize positive contents [75], and a “concreteness bias” when providing verbal descriptions of a picture [77]. Nevertheless, if concretism has been widely observed in schizophrenia, it is currently unclear whether or not, and to what extent, metaphorical processing is affected in patients with depression [75].…”

“…Moreover, when looking at metaphoric and figurative language, research has shown among MDD patients significant impairments in the production of metaphors, that is, a lesser tendency to verbalize positive contents [75], and a “concreteness bias” when providing verbal descriptions of a picture [77]. Nevertheless, if concretism has been widely observed in schizophrenia, it is currently unclear whether or not, and to what extent, metaphorical processing is affected in patients with depression [75]. Indeed, some studies have highlighted the presence of difficulties among MDD patients in processing figurative language and in interpreting metaphors [71, 73, 74, 76], while other studies, comparing metaphorical interpretation among subjects with depression and controls, did not observe difficulties with metaphorical processing per se and emphasized strong interpretational negativism, that is, selection and overrepresentation of negative content [86].…”

“…In the same direction, several studies underlined, in MDD patients, the presence of concretism (i.e., difficulties in the comprehension of figurative sentences), among other impaired formal thought disorders, such as poverty of speech, slowed thinking, and avolition [76, 87]. Moreover, formal thought disorder symptoms of dysregulated speech (i.e., perseveration and distractibility) were found to negatively correlate with the number of metaphors produced by depressive patients [75].…”