Content warning: This article is primarily about mental illnesses and one specific effect they can have on language use.

Depression, schizophrenia, childhood trauma, generalized and social anxiety disorders.

A (non-definitive) list of conditions that share many features in the changes that manifest in those affected, relating to language use. One feature that is viewed with more empathy than other features – possibly due to being more common – is alogia. Alogia refers to poor ability to speak, usually inferred to result from poor ability to think, stemming from psychological causes. However, this is distinct from aphasia, in which physical deformities or damage to the brain result in issues with communication. Another feature common with such conditions is muteness – referring to an absence of speech from a perceived unwillingness to speak, which can be either complete muteness or selective mutism, such as a child only able to speak to a loved one, or a person only being able to speak in small groups.

It is easy enough to picture countless cases of such a thing, though they are never pleasant images. A victim of child abuse or a person struggling to speak and get thoughts out, even outside their abusive setting. A severely depressed patient, a person scared to get up and make a meal for the first time in days for fear of attempting suicide, unable to muster the motivation to open their mouth when directly asked a question. A psychotic schizophrenic, someone genuinely completely convinced of a delusion that everyone in the world is trying to kill them, feeling confused and betrayed and depressed at how their loved ones could do such a thing, hearing their voices in an empty room telling them to end their life, too deceived by their condition to consider talking to another. A socially anxious teen, a person too afraid to go to a concert for a band they love for fear of breaking down from the suffocating claustrophobia in a crowd of people.

All of these people are just that – people. People who are not defined by their condition but deserving of empathy and kindness when they need it the most, when battling with a condition they did not choose. And for that reason, it is an easy thing to give empathy for; it is easy to understand that a person who is hurting would struggle to speak.

In the case of alogia, this may manifest as one of two forms. The first type involves normal speech that is vague, empty, and repetitive, known as “poverty of content”. The second is named as a counterpart to this as “poverty of speech” or uniquely as “laconic speech”, in which a speaker will lack in their production of unprompted content that is typical of normal speech. This presents as a lack of spontaneous speech, no response, or limited responses to anything barring an explicit question. It is worth clarifying that this is an entirely unconscious issue that one cannot overcome with any amount of willpower, since it reflects psychological issues with internal thought processes.

This is contrasted to mutism, a term reserved in psychiatry for an unwillingness to talk. This means mutism isn’t an unconscious process, although it doesn’t make it easier to overcome. This doesn’t decrease the anxiety surrounding speech, it doesn’t make communication any more bearable.

But – like almost everything to do with humanity – there isn’t simply a binary of “normal” and “strange”, or of “speaking normally” and “not able to speak”. This falls upon a continuum or spectrum or much wider map of human experience, just like emotion, sexuality, or politicism. Just as one may struggle with producing speech as a result of psychiatric conditions, one may struggle with being unable to stop producing speech under the same conditions. This is clinically referred to as pressured speech and can feel just as inhibiting and frustrating as the opposite side of the spectrum. Medical professionals significantly under-identify it, and incredibly few non-professionals have ever heard of such a thing.

Pressured speech is characteristically difficult to clinically identify and is often overlooked by professionals due to being easy to dismiss as someone being especially and unusually chatty, nervous, or stubborn. Even when recognized by the layperson, it’s often accompanied with comments of “But why does that matter?” and “Since when is it a bad thing to be more willing to talk?”, but it can be just as distressing as its counterpart on the other side of the speech spectrum, if not more so at times.

Trying to express the distress of pressured speech is as difficult a feat as trying to explain an emotion to someone that has never heard of it, but it is still worth an attempt. The internal narrative of describing the experience of pressured speech goes a bit like this:

I’m panicking and scrambling to talk, and I can’t stop. It’s like trying to rush through giving a talk, realizing I have 20 minutes of things left to say but only 5 minutes left to get it all out. I need to keep talking, and I can’t stop. I can tell people are waiting and giving me cues that they want a turn in this conversation, but I can’t give it to them, because the panic means I can’t stop. I have nothing left to say but I need to say something, I need to keep talking, I can’t stop, I’ll over explain and repeat and go on tangents if I have to, but I can’t stop. Words are pouring out of me, but I am empty; I don’t even know what I’m thinking but I know that I can’t stop. I can’t stop. I need to talk, as if I’m being threatened or compelled to keep speaking, but nothing is going on, but I can’t stop.

As mentioned in the internal monologue, a person with pressured speech feels compelled to keep speaking seemingly unendingly. One is aware of the nature of social interaction and turn-taking and adjacency pairs in the structure of human conversation and yet cannot conform to them because one cannot stop talking. This makes such a person very difficult to stop or interrupt, but one is painfully aware of the fact that they are disrupting the ordinary structure of communication. This likely creates a large amount of guilt, feeling as if they are forcing themselves upon others in conversation and silencing others, and yet they cannot stop themselves.

Pressured speech is equally associated with several psychiatric conditions as its counterpart. Alogia and mutism are linked very strongly to severe depression, anxiety disorders, autism spectrum disorder, PTSD, psychosis, and schizophrenia (a non-comprehensive list). Pressured speech is strongly linked to bipolar disorder and schizoaffective disorder but also is predisposed to come up more in people with ADHD, anxiety disorders, autism spectrum disorder, psychosis, schizophrenia (an equally non-comprehensive list).

Given so many conditions coming up in both lists, it is easy to see an overlap between the two groups listed. This has led to further research, suggesting that perhaps alogia and pressured speech are not simply on opposing ends of a continuum and may be results of essentially different processes and brain structures, even if their occurrence is mutually exclusive. Regardless, it is of note that the conditions listed are plentiful, such that the rate of occurrence is common – at least in terms of medical symptoms not caused by the common cold.

The likelihood of meeting a person with pressured speech at some point or other is incredibly high, and thus I write this article to ask if such a person be given the same empathy and patience for their increased verbal output as someone with reduced verbal output. The latter is well known, and many are willing to offer kindness for the distress that such a person must be feeling, but the former is almost entirely unknown, despite being accompanied with the same level of distress.

And so, I write to ask for your understanding if talking to a person who seems to present with pressured speech, especially if it is uncharacteristic for such a person, and that they still be treated as a person – neither a point of envy nor annoyance but simply as a person. I write to ask that you be kind to them, that you be kind to someone like me.