Speaking Under Suspicion: What People With Schizophrenia Do Well

One observation that struck me throughout my PhD was that much of schizophrenia research is concerned with deficits.

Even in 2026, researchers continue to publish studies showing that people with schizophrenia perform worse than healthy comparison participants on almost every measure imaginable: cognitive flexibility, semantic fluency, spatial reasoning, executive functioning, and many others.

My Google Scholar feed provides a regular reminder of this.

What receives far less attention is how these studies are designed. Most involve extensive battery testing: perhaps a full-scale IQ assessment followed by three to five experimental tasks, each lasting between ten and thirty minutes. Compensation is often modest. Participants may spend several hours completing cognitively demanding assessments in exchange for a £10 voucher that arrives months later after navigating university finance systems.

This raises an obvious question.

People with schizophrenia often experience symptoms such as anhedonia (reduced ability to experience pleasure), alogia (reduced speech output), and avolition (reduced motivation). Experimental testing is tiring even for healthy participants. Is it surprising that people experiencing these symptoms frequently perform worse on lengthy, repetitive tasks?

The problem is not simply that performance differs. It is that poorer performance may reflect multiple factors simultaneously: executive functioning difficulties, fatigue, disengagement, boredom, frustration, or a combination of all four. Separating these influences is rarely straightforward.

Psycholinguistic research faces a similar challenge.

One common method involves asking participants to describe a picture. While convenient for researchers, picture-description tasks bear little resemblance to ordinary conversation. Humans do not generally gather together to describe static images. Yet findings from such tasks are often used to make claims about natural speech and communication.

This longstanding focus on impairment was one of the motivations behind my PhD.

Rather than asking only what people with schizophrenia struggle with, I wanted to understand whether there were areas of preserved or enhanced functioning. In particular, I was interested in linguistic creativity and whether it was related to formal thought disorder (FTD), sometimes called disorganised speech.

The answer turned out to be more nuanced than I expected.

In affective psychoses, particularly mania and bipolar disorder, there does appear to be a relationship between thought disorder and creativity. Mood seems to play an important role. In schizophrenia, however, the relationship is much weaker. The negative symptoms commonly associated with schizophrenia often work against the motivational and affective processes that support creative expression.

This also reinforced another conclusion from my research: the thought disorder seen in schizophrenia is not identical to the thought disorder seen in mania, bipolar disorder, or autism. Similar labels are often applied across conditions, but the linguistic patterns differ considerably.

Much of my thesis therefore focused on what goes wrong with language in schizophrenia because that is where the literature has traditionally directed its attention.

After completing the PhD, however, I became interested in a different question.

What were participants doing well?

To explore this, I revisited my interview corpus using a large language model. Rather than searching for errors, I instructed the model to identify moments where participants were doing linguistically interesting or meaningful things. The model was explicitly instructed not to alter the transcripts, infer information that was not present, or move beyond the data itself.

The results were encouraging.

Throughout the interviews, participants demonstrated humour, recognised irony, played creatively with questions, and occasionally challenged the assumptions built into the interview itself. They displayed many of the same communicative strengths that are rarely discussed within the schizophrenia literature.

One theme appeared repeatedly.

Participants often seemed cautious.

Many appeared reluctant to commit fully to what they were saying. They qualified statements, hesitated, or carefully managed how they presented themselves. My interpretation was not that this reflected pathology alone. Rather, it reflected an awareness of context.

People with schizophrenia often exist in environments where their words are interpreted through assumptions of illness, incompetence, impaired judgement, or diminished capacity. In such circumstances, speaking carries risks. What is said may be analysed, scrutinised, or attributed to symptoms in ways that other people rarely experience.

Viewed from that perspective, caution becomes understandable.

The most important finding from this post-PhD analysis was therefore not that people with schizophrenia possess hidden creative abilities. It was that they retain many ordinary communicative abilities that deficit-focused research rarely acknowledges.

Humour, irony, creativity, self-awareness, and strategic communication were present throughout the corpus. They were simply not the phenomena most researchers were looking for.

The full results of this analysis are available on my ResearchGate profile and in my book How Language Holds: Schizophrenia Beyond Structure.