- Email: [email protected]
Clinical Pragmatics
Journal of Pragmatics 42 (2010) 2609–2611
Contents lists available at ScienceDirect
Journal of Pragmatics journal homepage: www.elsevier.com/locate/pragma
Book review Clinical Pragmatics Louise Cummings, Cambridge University Press, Cambridge, 2009, 305 pp., $115 Clinical Pragmatics is an invaluable contribution to the research field of language pathology, invaluable because Cummings provides a long awaited trait d’union between pragmatic theories and cognitive theories that account for pragmatic impairments in language disordered subjects. In the Preface the author articulately lays out the aims of the book as follows (p. x): ‘‘to provide a survey, through critical evaluation, of the current state of knowledge of developmental and acquired pragmatic disorders and to reflect on findings of the existing researches’’ and ‘‘to examine the nature of the existing interdisciplinary exchanges and to highlight the areas in which more exchanges are needed so as to improve our knowledge of the subject’’. Cummings commences in a critical tone, cogently arguing that research on pragmatic disorders – usually conducted by investigators from the field of cognitive sciences or psychology – needs to be challenged from the perspective of pragmatics. Although, as already stated, the aim of the book is to discuss pragmatic disorders, the author goes far beyond that, questioning the tenets of some cognitive theories from a pragmatic point of view and critically reviewing pragmatic theories in the light of the most recent discoveries in the fields of neurobiology and cognitive neurosciences. With this critique she does not aspire to put forward her own theory, but to highlight the fact that both cognitive scientists and pragmatics researchers could benefit from a deeper knowledge of the inner-workings of the other’s approach in order to arrive at a pragmatically plausible cognitive theory (cf. p. 158). The book is divided into seven chapters. The first three establish a base of knowledge about pragmatic language impairments which enables the reader to follow the critical discussions of the last four chapters wherein the author provides a thorough analysis of theories regarding cognitive substrates, assessment and treatment of both developmental and acquired pragmatic disorders. In Chapter 1, the author provides a working definition of the field of clinical pragmatics and reviews some basic pragmatic notions such as speech acts, implicatures, presuppositions, deixis, context, non-literal language, conversation and discourse in the light of the contribution they have made or can make to future studies in clinical pragmatics. According to Cummings, clinical pragmatics and the investigators working in this area lack a ‘‘strong theoretical rationale’’ (p. 13); this is mainly due to the fact that pragmatics is somehow regarded as a minor discipline within linguistics. Pragmatic skills are thought to be part of our linguistic performance rather than competence, and as such, it is, or at least it has been until recently, believed that pragmatics can not have any relationship with cognitive sciences; consequently, it can not be considered a domain of scientific enquiry. This is the view of pragmatics that Cummings seeks to challenge – not only in Chapter 1 but throughout the book – through well-argued and insightful critiques of theories and researchers that misinterpret the definition and the scope of pragmatics. In particular, following Searle (1974), she proposes ‘‘the integration of pragmatics within our linguistic competence’’ and that ‘‘pragmatics is about the knowledge that allows the speaker to employ a linguistic utterance to achieve a certain communicative effect’’ (p. 7). Moreover, she criticizes pragmatists for not having been able to define the domain of pragmatics, to establish boundaries between phenomena which pertain to the field and those which do not. The chapter closes with a brief discussion of the relation between cognition and pragmatics, pivotal to the entire book and for any theory of pragmatics. The aim of Chapter 2 is to survey developmental pragmatic disorders. Cummings sets out with a crucial reflection on the lack of a theoretical framework for the acquisition of pragmatic skills in typically developing individuals, a lack that renders the task of studying developmental pragmatic disorders particularly challenging. Notwithstanding this difficulty, the author painstakingly discusses the pragmatic deficits of subjects with diverse developmental disorders. She provides a critical analysis and original review of a large number of findings from investigations on children with specific language impairment, autistic spectrum disorder subjects, emotionally and behaviorally disordered children and mentally retarded children. Chapter 3 is dedicated to acquired pragmatic disorders. Cummings examines the pragmatic deficits of people with lefthemisphere damage, right-hemisphere damage, schizophrenia, traumatic brain injury and neurodegenerative disorders. Bearing in mind the pivotal role that cognitive theory findings play in pragmatic impairment investigation, the author mentions the possible cognitive substrates of these deficits and the cognitive theories that account for them, most
0378-2166/$ – see front matter ß 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.pragma.2010.03.002
2610
Book review
prominently the Theory of Mind (ToM). This theory (Baron-Cohen et al., 1985, among others) illustrates the ability to attribute mental states to one’s own mind and, crucially, to the minds of others, an ability that, as Cummings points out, ‘‘is a key cognitive skill in all forms of pragmatic interpretation’’ (p. 52). For example, in order for the cooperative principle – one of the most basic pragmatic principles – to function, the interlocutors must assume that the other is willing to cooperate, or is in a collaborative mood. In assuming such a thing, interlocutors attribute to each other a mental state. This example explains Cummings’ constant reference to ToM when discussing pragmatic deficits and why, despite the fact that the relationship of ToM with language skills still needs further investigation, she states that ‘‘the central role of ToM skills [. . .] in utterance interpretation means that this is an investigation that workers in pragmatics can ill afford to neglect’’ (p. 53). Chapter 4 deals with the main cognitive theories of autism, i.e. ToM, Weak Central Coherence (WCC) Theory and Executive Function Theory, which have been developed by cognitive scientists and psychologists, and purport to account for the pragmatic language impairments of autistic subjects. As such, Cummings points out, they have to be critically examined from a linguistic, and more specifically pragmatic, perspective. The aim of the chapter is to provide criteria for the pragmatic adequacy of these theories. A pragmatically adequate cognitive theory of autism must meet, according to Cummings, two criteria (p. 127): first, ‘‘explain the inferential process by means of which a speaker’s communicative intentions are established’’ and, second, ‘‘account for the global nature of that process’’. Adopting these two criteria the author challenges each of the three theories and demonstrates that none of them satisfies both and that, consequently, none of them is, at present, a pragmatically adequate theory of autism. According to the proponents of ToM, autism is caused by the inability of the affected subjects to attribute mental states to themselves and, more importantly, to others. It is this inability that prevents autistic subjects from assuming that the interlocutor has a communicative intention and is, therefore, held to be the cause of their pragmatic impairments. ToM thus takes into consideration only the first criterion – something that already renders this theory pragmatically not fully adequate. Besides, as Cummings convincingly demonstrates, ToM experiments that test pragmatic impairments in autistic subjects misinterpret the real sense of what pragmatic phenomena are and what they involve. The same flaw is also to be found in the experiments conducted by investigators working within the framework of WCC. This second theory (Frith et al., 1991) accounts for pragmatic impairments by appealing to the way that autistic subjects process information, which is characterized by a preference for parts over wholes and which leads them to neglect context in sentence interpretation. This failure to take into account the global or local context of a communicative exchange is then held responsible for the subjects’ difficulties with pragmatic skills such as drawing inferences, understanding implicit meaning or establishing the force of a speech act. WCC, however, does not appear to be pragmatically adequate because it only satisfies the second criterion. Moreover, as Cummings emphasizes, the notion of context that this theory employs is a distorted one. The context involved in the process of utterance interpretation and understanding is a dynamic construction created by the interlocutors; therefore, it is not possible to put boundaries to it and to manipulate it in an experimental task so as to have only one possible interpretation of an exchange. Again, investigators are shown to have misinterpreted the pragmatic notions they examined. As for the Executive Function theory, the behavioral symptoms as well as the ToM deficit of autistic subjects are held to arise from a deficit in executive function abilities (e.g. planning, mental flexibility, working memory). Since this theory is based on the neurobiology of autism, it is difficult to challenge it from a pragmatic perspective because of the lack of knowledge on the neurobiology of pragmatics. In this case, the criteria of pragmatic adequacy are not applicable, but the question remains open to future investigation. Chapter 5, aimed at providing a tool for researchers to help them identify a ‘‘clinically valid’’ (p. 142) pragmatic theory and a pragmatically plausible cognitive theory, examines the cognitive basis of acquired pragmatic disorders in adults. The chapter opens with a critical remark about current theories that adopt a developmental model of inquiry for the study of acquired pragmatic disorders; this, however, is theoretically misleading, given that the language of children and adults differ. Moreover, adults with pragmatic disorders had intact pragmatic skills before the injury, while children probably never developed those skills. This theoretical mistake is mainly due to the lack of pragmatic theories that account for acquired pragmatic impairments. Cummings, however, analyzes some pragmatic and cognitive theoretical frameworks and discusses their explanatory usefulness for acquired pragmatic disorders in adults. Chapter 6 describes the main tools currently available to assess pragmatic language impairments (Pragmatic Profile, Pragmatic Protocol, Children’s Communication Checklist, Test of Pragmatic Language, analysis of both conversation and discourse of disordered subjects) and the main approaches employed in the treatment of pragmatic disorders (e.g. teaching conversation skills, social communication and theory of mind). Throughout the chapter, Cummings underscores the ‘‘lack of consensus amongst clinicians and researchers on the question of how pragmatic disorders should be treated’’ (p. 196), a fact partly due to the absence of a theoretical rationale in pragmatics upon which language therapists might rely. Chapter 7 is entirely devoted to the discussion of the main errors committed by investigators when assessing and treating pragmatic disorders. The first critique is intended for all the investigators, who, oblivious of the central role of language in pragmatics, make the crucial error of considering pragmatics to include non-verbal behavior – a mistake arising from the erroneous identification of pragmatics with communication. Other common errors identified by the author derive from the ‘‘loose understanding’’ (p. 221) of some key pragmatic concepts; this results, for example, in the forced attribution of communicative intentions where actually there are none (see Baron-Cohen et al., 1999), the complete missing of the pragmatic point of an exchange (Surian et al., 1996) or the distortion of the notion of context (Jolliffe and Baron-Cohen, 1999). Treatments, too, reveal this misunderstanding of pragmatic phenomena; teaching rules of conversation, for example, does not mean teaching all of the more subtle skills involved in communicative exchanges. The chapter, and with it
Book review
2611
the book, closes with Cummings’ proposal of four regulatory criteria to define the scope of pragmatics and so be a guide for future investigations, i.e. centrality of language, integration of reasoning into pragmatics, principle of charity, centrality of communicative intention. This is indeed a needed and invaluable contribution for the field of pragmatics which will surely bear fruitful consequences for clinical pragmatics as well. In conclusion, Clinical Pragmatics is an inspiring book, an essential tool for every investigator interested in pragmatic disorders, both developmental and acquired, and their assessment and treatment. Cummings brilliantly filled a gap that had long been overlooked. Few linguists have dealt with this topic in such an insightful and thorough way as she does with this book, which surely stands out as a significant contribution to ‘‘the emergence of a new, mature phase in the development of clinical pragmatics’’ (p. 250). References Baron-Cohen, Simon, et al., 1985. Does the autistic child have a ‘‘theory of mind’’? Cognition 21 (1), 37–46. Baron-Cohen, Simon, et al., 1999. Recognition of faux pas by normally developing children and children with Asperger syndrome or high-functioning autism. Journal of Autism and Developmental Disorders 29 (5), 407–418. Frith, Uta, et al., 1991. The cognitive basis of a biological disorder: autism. Trends in Neuroscience 14, 433–438. Jolliffe, Therese, Baron-Cohen, Simon, 1999. A test of central coherence theory: linguistic processing in high-functioning adults with autism or Asperger syndrome: is local coherence impaired? Cognition 71 (2), 149–185. Searle, John R., 1974. Chomsky’s revolution in linguistics. In: Harman, G. (Ed.), On Noam Chomsky: Critical Essays. Anchor Press/Doubleday, New York, pp. 2–33. Surian, Luca, et al., 1996. Are children with autism deaf to gricean maxims? Cognitive Neuropsychiatry 1 (1), 55–71. Yhara Formisano is a PhD candidate in linguistics at the University of Perugia, Italy. Her PhD dissertation is about pragmatic deficits of autistic subjects. She has a master degree in linguistics and has also conducted research in the field of second language acquisition.
Yhara Formisano Department of Ancient, Modern and Comparative Languages and Literatures, University of Perugia, Perugia, Italy E-mail address: [email protected]
Contents lists available at ScienceDirect
Journal of Pragmatics journal homepage: www.elsevier.com/locate/pragma
Book review Clinical Pragmatics Louise Cummings, Cambridge University Press, Cambridge, 2009, 305 pp., $115 Clinical Pragmatics is an invaluable contribution to the research field of language pathology, invaluable because Cummings provides a long awaited trait d’union between pragmatic theories and cognitive theories that account for pragmatic impairments in language disordered subjects. In the Preface the author articulately lays out the aims of the book as follows (p. x): ‘‘to provide a survey, through critical evaluation, of the current state of knowledge of developmental and acquired pragmatic disorders and to reflect on findings of the existing researches’’ and ‘‘to examine the nature of the existing interdisciplinary exchanges and to highlight the areas in which more exchanges are needed so as to improve our knowledge of the subject’’. Cummings commences in a critical tone, cogently arguing that research on pragmatic disorders – usually conducted by investigators from the field of cognitive sciences or psychology – needs to be challenged from the perspective of pragmatics. Although, as already stated, the aim of the book is to discuss pragmatic disorders, the author goes far beyond that, questioning the tenets of some cognitive theories from a pragmatic point of view and critically reviewing pragmatic theories in the light of the most recent discoveries in the fields of neurobiology and cognitive neurosciences. With this critique she does not aspire to put forward her own theory, but to highlight the fact that both cognitive scientists and pragmatics researchers could benefit from a deeper knowledge of the inner-workings of the other’s approach in order to arrive at a pragmatically plausible cognitive theory (cf. p. 158). The book is divided into seven chapters. The first three establish a base of knowledge about pragmatic language impairments which enables the reader to follow the critical discussions of the last four chapters wherein the author provides a thorough analysis of theories regarding cognitive substrates, assessment and treatment of both developmental and acquired pragmatic disorders. In Chapter 1, the author provides a working definition of the field of clinical pragmatics and reviews some basic pragmatic notions such as speech acts, implicatures, presuppositions, deixis, context, non-literal language, conversation and discourse in the light of the contribution they have made or can make to future studies in clinical pragmatics. According to Cummings, clinical pragmatics and the investigators working in this area lack a ‘‘strong theoretical rationale’’ (p. 13); this is mainly due to the fact that pragmatics is somehow regarded as a minor discipline within linguistics. Pragmatic skills are thought to be part of our linguistic performance rather than competence, and as such, it is, or at least it has been until recently, believed that pragmatics can not have any relationship with cognitive sciences; consequently, it can not be considered a domain of scientific enquiry. This is the view of pragmatics that Cummings seeks to challenge – not only in Chapter 1 but throughout the book – through well-argued and insightful critiques of theories and researchers that misinterpret the definition and the scope of pragmatics. In particular, following Searle (1974), she proposes ‘‘the integration of pragmatics within our linguistic competence’’ and that ‘‘pragmatics is about the knowledge that allows the speaker to employ a linguistic utterance to achieve a certain communicative effect’’ (p. 7). Moreover, she criticizes pragmatists for not having been able to define the domain of pragmatics, to establish boundaries between phenomena which pertain to the field and those which do not. The chapter closes with a brief discussion of the relation between cognition and pragmatics, pivotal to the entire book and for any theory of pragmatics. The aim of Chapter 2 is to survey developmental pragmatic disorders. Cummings sets out with a crucial reflection on the lack of a theoretical framework for the acquisition of pragmatic skills in typically developing individuals, a lack that renders the task of studying developmental pragmatic disorders particularly challenging. Notwithstanding this difficulty, the author painstakingly discusses the pragmatic deficits of subjects with diverse developmental disorders. She provides a critical analysis and original review of a large number of findings from investigations on children with specific language impairment, autistic spectrum disorder subjects, emotionally and behaviorally disordered children and mentally retarded children. Chapter 3 is dedicated to acquired pragmatic disorders. Cummings examines the pragmatic deficits of people with lefthemisphere damage, right-hemisphere damage, schizophrenia, traumatic brain injury and neurodegenerative disorders. Bearing in mind the pivotal role that cognitive theory findings play in pragmatic impairment investigation, the author mentions the possible cognitive substrates of these deficits and the cognitive theories that account for them, most
0378-2166/$ – see front matter ß 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.pragma.2010.03.002
2610
Book review
prominently the Theory of Mind (ToM). This theory (Baron-Cohen et al., 1985, among others) illustrates the ability to attribute mental states to one’s own mind and, crucially, to the minds of others, an ability that, as Cummings points out, ‘‘is a key cognitive skill in all forms of pragmatic interpretation’’ (p. 52). For example, in order for the cooperative principle – one of the most basic pragmatic principles – to function, the interlocutors must assume that the other is willing to cooperate, or is in a collaborative mood. In assuming such a thing, interlocutors attribute to each other a mental state. This example explains Cummings’ constant reference to ToM when discussing pragmatic deficits and why, despite the fact that the relationship of ToM with language skills still needs further investigation, she states that ‘‘the central role of ToM skills [. . .] in utterance interpretation means that this is an investigation that workers in pragmatics can ill afford to neglect’’ (p. 53). Chapter 4 deals with the main cognitive theories of autism, i.e. ToM, Weak Central Coherence (WCC) Theory and Executive Function Theory, which have been developed by cognitive scientists and psychologists, and purport to account for the pragmatic language impairments of autistic subjects. As such, Cummings points out, they have to be critically examined from a linguistic, and more specifically pragmatic, perspective. The aim of the chapter is to provide criteria for the pragmatic adequacy of these theories. A pragmatically adequate cognitive theory of autism must meet, according to Cummings, two criteria (p. 127): first, ‘‘explain the inferential process by means of which a speaker’s communicative intentions are established’’ and, second, ‘‘account for the global nature of that process’’. Adopting these two criteria the author challenges each of the three theories and demonstrates that none of them satisfies both and that, consequently, none of them is, at present, a pragmatically adequate theory of autism. According to the proponents of ToM, autism is caused by the inability of the affected subjects to attribute mental states to themselves and, more importantly, to others. It is this inability that prevents autistic subjects from assuming that the interlocutor has a communicative intention and is, therefore, held to be the cause of their pragmatic impairments. ToM thus takes into consideration only the first criterion – something that already renders this theory pragmatically not fully adequate. Besides, as Cummings convincingly demonstrates, ToM experiments that test pragmatic impairments in autistic subjects misinterpret the real sense of what pragmatic phenomena are and what they involve. The same flaw is also to be found in the experiments conducted by investigators working within the framework of WCC. This second theory (Frith et al., 1991) accounts for pragmatic impairments by appealing to the way that autistic subjects process information, which is characterized by a preference for parts over wholes and which leads them to neglect context in sentence interpretation. This failure to take into account the global or local context of a communicative exchange is then held responsible for the subjects’ difficulties with pragmatic skills such as drawing inferences, understanding implicit meaning or establishing the force of a speech act. WCC, however, does not appear to be pragmatically adequate because it only satisfies the second criterion. Moreover, as Cummings emphasizes, the notion of context that this theory employs is a distorted one. The context involved in the process of utterance interpretation and understanding is a dynamic construction created by the interlocutors; therefore, it is not possible to put boundaries to it and to manipulate it in an experimental task so as to have only one possible interpretation of an exchange. Again, investigators are shown to have misinterpreted the pragmatic notions they examined. As for the Executive Function theory, the behavioral symptoms as well as the ToM deficit of autistic subjects are held to arise from a deficit in executive function abilities (e.g. planning, mental flexibility, working memory). Since this theory is based on the neurobiology of autism, it is difficult to challenge it from a pragmatic perspective because of the lack of knowledge on the neurobiology of pragmatics. In this case, the criteria of pragmatic adequacy are not applicable, but the question remains open to future investigation. Chapter 5, aimed at providing a tool for researchers to help them identify a ‘‘clinically valid’’ (p. 142) pragmatic theory and a pragmatically plausible cognitive theory, examines the cognitive basis of acquired pragmatic disorders in adults. The chapter opens with a critical remark about current theories that adopt a developmental model of inquiry for the study of acquired pragmatic disorders; this, however, is theoretically misleading, given that the language of children and adults differ. Moreover, adults with pragmatic disorders had intact pragmatic skills before the injury, while children probably never developed those skills. This theoretical mistake is mainly due to the lack of pragmatic theories that account for acquired pragmatic impairments. Cummings, however, analyzes some pragmatic and cognitive theoretical frameworks and discusses their explanatory usefulness for acquired pragmatic disorders in adults. Chapter 6 describes the main tools currently available to assess pragmatic language impairments (Pragmatic Profile, Pragmatic Protocol, Children’s Communication Checklist, Test of Pragmatic Language, analysis of both conversation and discourse of disordered subjects) and the main approaches employed in the treatment of pragmatic disorders (e.g. teaching conversation skills, social communication and theory of mind). Throughout the chapter, Cummings underscores the ‘‘lack of consensus amongst clinicians and researchers on the question of how pragmatic disorders should be treated’’ (p. 196), a fact partly due to the absence of a theoretical rationale in pragmatics upon which language therapists might rely. Chapter 7 is entirely devoted to the discussion of the main errors committed by investigators when assessing and treating pragmatic disorders. The first critique is intended for all the investigators, who, oblivious of the central role of language in pragmatics, make the crucial error of considering pragmatics to include non-verbal behavior – a mistake arising from the erroneous identification of pragmatics with communication. Other common errors identified by the author derive from the ‘‘loose understanding’’ (p. 221) of some key pragmatic concepts; this results, for example, in the forced attribution of communicative intentions where actually there are none (see Baron-Cohen et al., 1999), the complete missing of the pragmatic point of an exchange (Surian et al., 1996) or the distortion of the notion of context (Jolliffe and Baron-Cohen, 1999). Treatments, too, reveal this misunderstanding of pragmatic phenomena; teaching rules of conversation, for example, does not mean teaching all of the more subtle skills involved in communicative exchanges. The chapter, and with it
Book review
2611
the book, closes with Cummings’ proposal of four regulatory criteria to define the scope of pragmatics and so be a guide for future investigations, i.e. centrality of language, integration of reasoning into pragmatics, principle of charity, centrality of communicative intention. This is indeed a needed and invaluable contribution for the field of pragmatics which will surely bear fruitful consequences for clinical pragmatics as well. In conclusion, Clinical Pragmatics is an inspiring book, an essential tool for every investigator interested in pragmatic disorders, both developmental and acquired, and their assessment and treatment. Cummings brilliantly filled a gap that had long been overlooked. Few linguists have dealt with this topic in such an insightful and thorough way as she does with this book, which surely stands out as a significant contribution to ‘‘the emergence of a new, mature phase in the development of clinical pragmatics’’ (p. 250). References Baron-Cohen, Simon, et al., 1985. Does the autistic child have a ‘‘theory of mind’’? Cognition 21 (1), 37–46. Baron-Cohen, Simon, et al., 1999. Recognition of faux pas by normally developing children and children with Asperger syndrome or high-functioning autism. Journal of Autism and Developmental Disorders 29 (5), 407–418. Frith, Uta, et al., 1991. The cognitive basis of a biological disorder: autism. Trends in Neuroscience 14, 433–438. Jolliffe, Therese, Baron-Cohen, Simon, 1999. A test of central coherence theory: linguistic processing in high-functioning adults with autism or Asperger syndrome: is local coherence impaired? Cognition 71 (2), 149–185. Searle, John R., 1974. Chomsky’s revolution in linguistics. In: Harman, G. (Ed.), On Noam Chomsky: Critical Essays. Anchor Press/Doubleday, New York, pp. 2–33. Surian, Luca, et al., 1996. Are children with autism deaf to gricean maxims? Cognitive Neuropsychiatry 1 (1), 55–71. Yhara Formisano is a PhD candidate in linguistics at the University of Perugia, Italy. Her PhD dissertation is about pragmatic deficits of autistic subjects. She has a master degree in linguistics and has also conducted research in the field of second language acquisition.
Yhara Formisano Department of Ancient, Modern and Comparative Languages and Literatures, University of Perugia, Perugia, Italy E-mail address: [email protected]