Pragmatics and Language Pathology

Abstract

Pragmatic concepts are often poorly understood and characterized by the clinicians and researchers who use them. To be clear from the outset on the nature and extent of pragmatic behaviours, this chapter examines a range of pragmatic and discourse concepts which will be addressed throughout the book: speech act, implicature, presupposition, deixis, non-literal language, context, cohesion, and coherence. Numerous examples, including those taken from clinical subjects, will be used to demonstrate these concepts. The chapter also examines the ‘pragmatic turn’ in the study of language disorders. This turn has served to reshape every aspect of the clinical management of language disordered clients, and not just those with pragmatic disorders. The implications of this turn for how these disorders are diagnosed, assessed and treated are considered. In an era of budgetary constraints and evidence-based health care, clinicians who treat clients with communication disorders are increasingly being required to demonstrate the effectiveness of speech and language therapy (SLT). Many of the functional communication measures which are used for this purpose have their origins in pragmatics. The chapter concludes with a discussion of how pragmatics has shaped the measures that are now used to demonstrate the effectiveness of SLT interventions.

Notes

• 1. For Grice, ‘what is said’ is a technical notion which equates to the truth-conditional content of an utterance, or the proposition which is expressed by the utterance of a sentence on a particular occasion. See Huang (2010) and Wharton (2010b) for further discussion.

• 2. Milestones in the historical development of the discipline and profession of speech-language pathology include the following. The predecessor of the American Speech-Language-Hearing Association (ASHA)—known as the American Academy of Speech Correction—was established in 1925. The first issue of the Journal of Speech Disorders was published in March 1936. In the UK, the College of Speech Therapists—predecessor of the Royal College of Speech and Language Therapists (RCSLT)—was established in January 1945. Newcastle was the first university in the UK to award a degree in speech and language therapy in 1959.

• 3. The reader is referred to Duchan (2011) for an account of this revolution as it relates to speech-language pathology. Duchan (1984) describes the impact of the pragmatics revolution on language assessment. She urged a ‘hot version’ of the pragmatics movement: ‘The hot version of the pragmatics movement is forwarded by the movement’s revolutionaries, who opt for overthrowing our previous conceptions that language is what we are assessing, and propose that we move toward a new conceptualization which examines communication and context, and, if called for, the language within it. The hot view is the one that must be embraced if we are to take seriously what the literature in pragmatics has to tell us’ (Duchan 1984, p. 178).

• 4. This is how two authors from the period characterized what they believed would be the impact of this new pragmatics on the assessment of children with language disorders: ‘We predict that this pragmatics approach will not be just another addition to our evaluation techniques but that it will shake the very foundations of how we have been approaching children with language problems. Our notion that we can examine children’s language by presenting them with controlled stimuli, such as sentences to imitate or formal tests, will come into question. Our idea that language in the clinic is the same as language outside the clinic will be suspect. Our hope that we can measure a child’s language ability in one context in a two-hour diagnostic session will be demolished as results from the research in pragmatics become known to us’ (Lund and Duchan 1983, p. 6).

• 5. The emphasis has to be on pragmatic therapies complementing more traditional language interventions, rather than replacing these interventions. As Holland (1991, p. 198) forcefully remarks, ‘I am […] aware that an overwhelming fascination with pragmatic issues, to the exclusion of concern about comprehension and production of words, phrases and sentences, as well as reading and writing, fails adequately to serve aphasic clients. Indeed, one of the most pervasive misperceptions about pragmatic treatment is that it precludes rigorous work on other aspects of language. If a patient with marginal comprehension for somewhat complex utterances can signal “yes” and “no” in some rudimentary way, let us fervently hope that he does NOT find himself under the care of a “pragmatically oriented” clinician who will term him “a functional communicator”. This is not the case. Such a patient could hardly be a less functional communicator.’

• 6. I emphasize ‘gradually’ because it is clear that not all aphasiologists were equally quick to embrace new pragmatic therapies. In this way, Elman (2005, p. 41) describes how many clinicians continued to use traditional approaches to aphasia intervention long after the time when Sarno and Holland first began to advocate pragmatic and social approaches: ‘Pioneers such as Sarno and Holland were early and vocal advocates of real life and functional assessments as well as the psychosocial impact of aphasia. However, the majority of clinicians and researchers continued to concentrate on impairment-level linguistic treatment tasks. Little consideration was given to real-life activities or life participation issues, and aphasia treatment remained focused on stimulus-response linguistic tasks. Therapy was typically provided in a nondescript therapy room within a medical setting. Given the office setting, individuals with aphasia rarely had the opportunity to meet others who were dealing with similar challenges, and important psychosocial issues related to coping with aphasia were unlikely to be addressed’.

• 7. Like functional communication, communication effectiveness subsumes a range of pragmatic behaviours: ‘to be communicatively effective, of course, requires the appropriate use of several pragmatic skills’ (Wright and Newhoff 2005, p. 242).