The Mind Distorted: Disorganized Speech (Part 5)

Disorganized Speech: When Thought Loses Its Structure

Disorganized speech is one of the more striking features of psychosis. To the listener, it often sounds rambling, illogical, or incoherent. However, while it often presents in a random manner, it reflects a deeper disturbance in the individual's ability to think, structure, and organize their thoughts.

In earlier articles, we discussed thought disorder as the foundational disruption underlying psychosis. Disorganized speech represents one of the most direct ways that this disturbance manifests. It is the outward expression of a mind that cannot reliably organize, sequence, or contain its own thoughts.

From Thought to Speech: What Breaks Down

Under normal circumstances, thought and speech are guided by a set of internal mental boundaries. These boundaries help us stay on topic, suppress irrelevant associations, track what has already been said, and anticipate what needs to come next. They allow thoughts to remain compartmentalized and goal-directed.

In psychosis, these boundaries weaken. Thoughts begin to bleed into one another, associations form without logical constraint, and the mind struggles to filter what is relevant from what is not. Speech reflects this breakdown and illustrates the loss of internal architecture that keeps thinking coherent. In other words, it reveals the inherent chaos of psychotic thinking.

For those who do not work closely with psychotic individuals, disorganized thinking can be difficult to grasp. However, most people, even when mentally healthy, have experienced fleeting moments of disorganization. One common example is hypnagogia, the transitional state between wakefulness and sleep. During this phase, it is not unusual for thoughts to become surreal, fragmented, or nonsensical. A person might find their internal thoughts drifting into disconnected images unrestricted by logical associations.

Similarly, dreams can be somewhat disorganized. Most people have had dreams where people, places, and time suddenly shift, oftentimes without any clear rationale or logical continuity. When this happens, you may wake up and try to recount the dream, only to find that it feels like trying to remember a very fragmented memory from an alternate reality. While it was coherent in the moment, it becomes incredibly disjointed upon reflection.

While these states are benign and transient in healthy individuals, they offer a useful analogy for the experience of psychotic disorganization. It may also help in appreciating the inherent loss of control frequently experienced by those who remain disorganized for significant periods of time, even when conscious.

Common Forms of Disorganized Speech

Disorganization exists on a spectrum. It can range from language that is odd and personalized, to fragmentation and incoherence that render communication effectively impossible.

Common forms of disorganization include:

Tangentiality

The individual responds to questions with irrelevant and digressive information that is unrelated to the question or topic.

Example: "I was there, but then it started raining more, which always happens when things are being adjusted. You can tell because the air feels heavier, so I stopped just to see if it would calm things down.”

Loose Associations (Derailment)

Ideas shift from one to another with little or no logical connection. The listener may recognize fragments of meaning, but the overall message is lost.

Clang Associations

Speech is driven by sound rather than meaning. Words are chosen because they rhyme or share phonetic qualities.

Example: “The clock talks in blocks and locks the fox.”

Word Salad

The most severe form of disorganization. Speech becomes so fragmented that it is essentially unintelligible, lacking grammatical structure or conceptual continuity.

Example: “The house went thinking sideways because the numbers don’t sleep, and the calendar opened my lungs with permission.”

Neologisms

The creation of new words that hold meaning only for the speaker.

Example: “My thoughts are getting too mindspliced lately.”

Each of these reflects a failure of mental boundaries that normally constrain and organize thought.

Disorganized speech rarely presents as a single, isolated feature. Rather, it often presents as a convergence of multiple forms of disorganization. In these cases, the underlying narrative becomes increasingly fragmented, nonsensical, and incoherent. For example, the following is a response a defendant gave me when I asked about his diagnostic history:  

It's a disorder of social studies, I think is how it was explained to me. And then you panic when you get in the other lane. A schizophrenia. Even if you make a decision, if it works for you to get out of this situation, and the next situation that you’re living excites you or brings you to think bad thoughts, moo‑loo style, a Sharon, do‑ma‑lagano turns into a cartoon feature for a little while and you’re in trouble.

In this response, we see overlapping features of tangentiality, neologisms, and associative conclusions when no such connection or relationship is apparent. The narrative as a whole lacks coherence, is fragmented, and is inherently nonsensical.

Mental Boundaries and the Loss of Cognitive Containment

A useful way to understand disorganized speech is through the concept of mental boundaries. In healthy cognition, boundaries help maintain:

• Topic continuity

• Temporal sequencing

• Conceptual categories

• Distinction between internal and external experience

In psychosis, these boundaries erode. Thoughts that would normally remain background noise contaminate into conscious awareness. Associations that would ordinarily not be formed are expressed freely. Speech becomes a running stream of unfiltered cognition.

Effects on Orientation, Memory, and Attention

Disorganization does not affect speech alone. It often coincides with broader disruptions in attention, working memory, and orientation.

Highly disorganized individuals may:

• Struggle to maintain attention long enough to complete a thought

• Lose track of time, place, or sequence

• Have difficulty recalling conversations or events that occurred during periods of severe disorganization

Many individuals describe their memory of disorganized periods as fragmented or incomplete. (Think of the example above about trying to remember a bizarre dream). Events may be remembered in isolated snapshots without a coherent timeline. This is particularly relevant in forensic contexts, where individuals may genuinely be unable to recount their actions or reasoning during an offense. This may be due, in part, to an inability to even form memories during such a disorganized period.

Additionally, disorganization often exists in conjunction with delusional beliefs and hallucinations. This leads to recollections that are not only incomplete, but are also contaminated with other psychotic thoughts that make reality-based reconstruction almost impossible.