UH as a pragmatic marker in dementia discourse

Journal of Pragmatics xxx (xxxx) xxx

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UH as a pragmatic marker in dementia discourse Boyd H. Davis a, Margaret A. Maclagan b, * a b

University of North Carolina-Charlotte, Charlotte, USA University of Canterbury, Christchurch NZ, New Zealand

a r t i c l e i n f o

a b s t r a c t

Article history: Available online xxx

In this paper we draw from variationist analysis and ethnographic and sociopragmatic approaches to examine conversations with Maureen Littlejohn who moved from mild into moderate Alzheimer's disease over the six years of the study. As dementia increases, people often find it difficult to use pragmatic particles such as well, so or you know. We explore how Ms Littlejohn used UH, often dismissed by researchers as only marking hesitations, as a pragmatic particle in conversations with students and with the first author. In our analysis
lez (2004) in her exploration of the pragmatic force of we adopt categories used by Gonza markers such as well, so, then, and anyway in both English and Catalan. We demonstrate that, even in her last conversations, Ms Littlejohn was able to use UH in a variety of pragmatically meaningful ways to express many of the categories identified by Gonz
alez. © 2018 Elsevier B.V. All rights reserved.

Keywords: Pragmatic marker UH Dementia discourse Discourse particle Discourse marker Pragmatic particle

1. Introduction Pragmatic or discourse markers retain multiple functions in the speech of persons who are cognitively impaired by dementia. Indeed, they continue to be used to manage turn-taking, to establish common ground with the (typically unimpaired) conversational partner, to signal confusion, disagreement, or a momentary loss of focus or to maintain the conversational  us floor while searching for a word, a phrase, or even the gist of the interaction (Clark and Fox Tree, 2002; Davis, 2008; Ben et al., 2011; Gayraud et al., 2011; Pakhomov et al., 2011). In the present study, we examine the uses and functions of UH in the conversations of one speaker with moderate dementia, a white American woman in her mid-eighties living in a memory care residence in the upper south of the United States. We track changes in her use of UH over time and across conversations with different conversational partners and demonstrate that its use is by no means random. We focus on UH rather than um in this analysis because whereas “Maureen Littlejohn” used UH frequently, she very rarely used um. Although Ms Littlejohn was moving into moderate Alzheimer's disease, she continued to be a willing and interesting conversationalist. She allowed herself to be recorded on more than 60 occasions over the course of six years, talking to students who were taking introductory university-level gerontology courses (Hancock et al., 2009) and to the first author. The use of UH as a hesitation marker is a part of the interactional skills retained even as the disease progresses. However, like pauses, filled pauses such as um, interjections, and other discourse markers, those skills are often used to substitute for some feature of conversational production that is no longer accessible to the speaker (Davis and Maclagan, 2009, 2013; Davis et al.,2011). Such skills are often examined by work in clinical pragmatics (e.g. Cummings, 2017; Kindell et al., 2017; Davis and Maclagan, 2018). UH is more than a hesitation marker: it may be considered as an interjection under a wide variety of terminological umbrellas (reviewed in Norrick, 2011:243) and concomitantly as one of the discourse markers used “for the scaffolding of interactional meaning in conversation” (Romero-Trillo, 2001:529). Romero-Trillo calls it an “acategorical item” since it has no * Corresponding author. Department of Communications Disorders, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand. E-mail addresses: [email protected] (B.H. Davis), [email protected] (M.A. Maclagan). https://doi.org/10.1016/j.pragma.2018.12.005 0378-2166/© 2018 Elsevier B.V. All rights reserved.

Please cite this article as: Davis, B.H., Maclagan, M.A., UH as a pragmatic marker in dementia discourse, Journal of Pragmatics, https://doi.org/10.1016/j.pragma.2018.12.005

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“original grammatical ascription” (Romero-Trillo, 2017:256). It is often called a pragmatic marker as it “guides” the listener's interpretation (Aijmer and Simon-Vandenbergen, 2006:2). Tottie (2011) notes that both UH and um can serve sociolinguistic purposes, differentiating among registers. Norrick considers it a primary interjection (2011:262) “serving mainly to pass or hold the turn and to fill pauses”. Norrick notes (2011:247), summarizing Goffman (1978:109), that, even when UH is seen primarily as a disfluency marker, it “counts” as a response cry to “‘facilitate tracking’ of the speaker's inner word search.” In this discussion, we first briefly review how UH is often classified as a hesitation marker. When seen as a hesitation marker, UH typically elicits one of two interpretations explained by either the signal hypothesis e where the UH signals something to the hearer e or the symptom hypothesis, where UH is “symptomatic of some sort of cognitive process on the part of the speaker” (De Leeuw, 2007:86; cf. Wieling et al., 2016). We then highlight recent examinations of hesitation markers and pragmatic markers in dementia discourse. Using ethnographic, variationist (Cameron and Schwenter, 2013), and sociopragmatic or sociolinguistic approaches to analyze the speech of people with dementia may give us additional insights into “the decline, preservation or improvement of abilities in old age” (Davis and Maclagan, 2016:221, drawing on Hamilton, 1999). In particular, such approaches may highlight how persons retain language competencies, which competencies they maintain, how they maintain their discoursal repertoires of identities, and the extent to which they still desire to communicate with others. Our research question asks if and to what extent, the use of UH in dementia discourse can move beyond being considered
lez (2004) for as disfluency to be seen as potentially having specific kinds of pragmatic force in the sense discussed by Gonza markers such as well, so, then, I mean, you know and anyway. 2. Background̩ 2.1. Hesitation markers in the speech of unimpaired speakers Early descriptivist, structuralist and generative opinions on pause, silence, and hesitation in the speech of unimpaired persons can be represented by Maclay and Osgood (1959). They cite early work by Goldman-Eisler and Zellig Harris, who, like Bloomfield (1933), find that pause represents juncture. They begin by explaining the difference they find between hesitations and pauses: hesitations, as we define them, refer to events that are relatively gross and easily observable, while the juncture-pauses of linguistic theory are quite short in duration and much harder to observe and record. In addition, hesitations often interrupt the flow of speech while juncture pauses do not. (1959:20) Maclay and Osgood (1959) find the studies of the Yale psychologist George Mahl particularly interesting in that, like Freud, Mahl finds a link between what he calls “speech disturbances” and anxiety or stress in a patient. Mahl's first category, ah, is what Maclay and Osgood consider a “filled pause” (1959:21) and define as [3, æ, r̩, ə, m̩ ], of which the schwa [ə] is the most frequently used (p. 22). Ultimately, they find that the ah-pauses often occur at junctures where the speaker wishes to “keep control” (p. 41) and suggest further study of features such as “status differences between speaker and listener”, planning and conversational stress (p. 43). Fluency has remained a prominent concern in attempting to define discourse or pragmatic particles. For example, discussions on the Language Log blog in 2005 reported that “at a given age, men are more disfluent than women (or at least they use uh more than women)”.1 Schegloff (2010:166) reminds readers that UH can suggest that “a dispreferred sequence is being launched”, adding (p. 171) that the frequently cited study of UH and um by Clark and Fox Tree (2002) is “limited in its scope.” Fox Tree's 2010 discussion updates the research on discourse markers, including “inserts” such as UH (2010:271), which both  us et al. (2011) and Pakhomov et al. (2011) use in their studies of temporal accommodation and the “patterns of alterBen nations between hesitant and fluent speech (i.e., temporal cycles) and cognitive decline associated with aging and dementia” (Pakhomov et al., 2011:619). By contrast, Braun and Rosin (2015:733) find the patterns of hesitation markers signal “speaker €tz (2013:39) points out that “discourse markers can also contribute to a native speaker's identity” and are speaker-specific. Go fluency … they increase the general degree of naturalness in speech substantially”. Crible (2018:96) finds that, when the discourse markers sort of and kind of occur in clause-medial position in English, they can sometimes [be] classified as hedges or mitigators”. She states (2018:2) that “so-called disfluencies are not systematically problematic (as opposed to what a writing-based standard of fluency would argue) but can actually create coherent and efficient discourse-”. 2.2. Hesitation markers in the speech of people with dementia In terms of speakers with dementia, findings are mixed. Wilson (2007) conducted a study using conversation analysis of discourse markers oh, so, you know, and and but in a series of 4 spontaneous conversations with a woman aged 59 diagnosed with early onset Alzheimer's disease (AD). They found that their use increased with familiar (as opposed to unfamiliar) interlocutors (2007:212). Gayraud and colleagues found no statistical differences for the presentation of filled pauses (2011:206) between AD patients and unimpaired controls in spontaneous speech about topics such as “the best/worst day in their life” (p. 202). Sajjadi et al. (2012) compared performance on picture description and semi-structured interviews by persons with no linguistic/

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http://itre.cis.upenn.edu/~myl/languagelog/archives/002632.html accessed 27 March 2018. See also Bortfeld et al. 2001 and Rayson et al. 1997.

Please cite this article as: Davis, B.H., Maclagan, M.A., UH as a pragmatic marker in dementia discourse, Journal of Pragmatics, https://doi.org/10.1016/j.pragma.2018.12.005

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cognitive impairments, persons with semantic dementia, and persons with AD. They found greater use of hesitation markers by the AD group in both speech situations, and an increase of both hesitation markers and discourse markers in both patient groups in the interviews (2012:856). Using the Linguistic Data Consortium at University of Pennsylvania (www.ldc.upenn.edu) for definitions, they identified discourse markers as “structuring units” such as you know, you see, well and hesitation markers as utterances that indicate the speakers' effort to maintain the flow of speech while performing a mental search to retrieve a word or piece of information during conversation (e.g., uh, um, and emm) (2012:852). These findings suggest that no matter which items are called hesitation markers, such markers continue to be seen either as a symptom or a signal in the speech of both impaired and unimpaired speakers. The focus on symptom and signal seems to us to be part of the focus on a deficit paradigm, which, as Georgakopoulou and Charalambidou (2011:33) note, is “characterized by a developmental outlook on age that posits the two endpoints of youth and old age as aberrations from norms”. This outlook positions the latter as “progressive, inevitable and unwanted decline” (p.34) and studies it primarily under experimental conditions. In this discussion we will demonstrate that, rather than being merely signals or symptoms, hesitation markers can also have pragmatic force for a speaker with AD. 2.3. Discourse markers as compensatory strategies Discourse markers such as oh, well and you know have been seen for over twenty years as furthering communication in aphasia rehabilitation. In an ethnographic analysis of compensatory strategies used by persons with aphasia, SimmonsMackie and Damico find these markers regulate conversation flow and “provide cues to a participant's frame of reference and attitude” (1996:37). Indeed, Simmons-Mackie and Damico (1997:769) add that compensatory strategies are “flexible in their patterns of occurrence…context sensitive…[and] specific to the participant.” Aphasia and dementia are two very different conditions, particularly since the former can often be rehabilitated whereas the latter continues to worsen. Nevertheless, it should not be surprising that persons with dementia can also seek to use compensatory strategies, using formulaic language, discourse markers, and pragmatic markers such as UH. 2.4. Pragmatic markers and discourse structures Gonz
alez compares the pragmatics of nine English and eleven out of twenty-three Catalan markers that are used to establish and mark coherence in oral narrative, both in a monograph (2004) and in a summative article (2005). She begins with an extended discussion of Schiffrin's five planes of talk (1987: information state, participation framework, and ideational, action and exchange structures), finding that neither exchange nor action structures “actively operate in narratives” (2004:56). This leads her to work more closely with Redeker's (1991:1167-68) revision of Schiffrin to three structures found in
lez, 2004: 59). To these three, she adds an informal narrative: Ideational, Rhetorical, and Sequential structures (Gonza Inferential component that allows her to incorporate not only the models of Grosz and Sidner (1986) and of Roulet (1984), but also a “relevance-based approach” (p. 74) which supports attitudes and participation. Each of the markers she examines is lexical. While we do not, of course, claim that UH is a lexical item, and nor do we examine its use only in oral narrative, we find Gonz
alez's tabulation (see Table 1 in section 3) to be highly useful in classifying the various pragmatic functions UH plays in Ms Littlejohn's oral conversations and conversational narratives. We have shortened the (largely self-explanatory) names for the categories for the functions of the markers identified by Gonz
alez (see her “Appendix, Key to pragmatic functions coding” in 2005:83e34 for fuller definitions) and added two that are characteristic of dementia discourse. 2.5. Pragmatic markers and variation Aijmer and Simon-Vandenbergen (2006) provide a fine overview of terminology for markers, as well as their range of features and their multifunctionality in discourse structuring and attitudinal expression. Sociolinguistic aspects of the items being discussed (pp. 237e238) are reviewed as typically contrastive in nature (cross-gender and other features of social background) and keyed to speaker variables. Rather than contrasting different markers, different speakers or different groups of speakers, we are here looking at the potential variation in pragmatic discourse functions of one particular marker across time and across conversational partner (CP), in the speech of a single older woman with dementia. In that sense, we are drawing on an ethnographic perspective (Hymes, 1974; Guendouzi and Mueller, 2006:49) of Ms Littlejohn's speech within the culture of dementia, since all of her conversation partners know she has the condition and that is why they have come to converse. Accordingly, using Hymes' mnemonic for identifying communicative units in an interaction, S P E A K I N G, we see commonalities for Setting (Ms Littlejohn's room and courtyard at the memory care center); Ends - the goal of the partners is to initiate and maintain informal conversation with Ms Littlejohn in a pleasant, non-clinical Key using oral speech as Instrumentality; and as Norms and Genre, allowing the older woman to choose the topic within casual chat. What will vary in this analysis is the conversation-partner Participants and some aspects of the Act sequence, in that Ms Littlejohn will hold the floor and use UH for a variety of pragmatic functions apparently keyed to what she sees as the amount of commonality or rapport she holds with her audience. Please cite this article as: Davis, B.H., Maclagan, M.A., UH as a pragmatic marker in dementia discourse, Journal of Pragmatics, https://doi.org/10.1016/j.pragma.2018.12.005

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3. Methods The 62 conversations with Ms Littlejohn were recorded over six years. The conversations were recorded in accordance with IRB (Institutional Review Board) ethics regulations at the first author's university, and Ms Littlejohn assented to each conversation. They were transcribed by HIPAA-compliant transcribers, either students who had taken training in ethics or professional medical transcribers. The second author, a specialist in phonetic transcription, checked all the transcripts against the recordings to ensure that all ums, UHs, ers, and the like were included, as it is often difficult for transcribers to remember to incorporate them or to incorporate them in the appropriate place in the transcript. Eighteen recordings and transcripts across the six years were chosen for this analysis, to represent male and female students of different ages and a researcher, the first author, an older female who identified social network connections with Ms Littlejohn during the conversations. The conversations vary in length because they were unscripted and the students varied in their ability to sustain the interactional flow. The students, who were all taking an introductory gerontology course with a service-learning component, were given a minimum of an hour's training, with video clips and PowerPoint, role-play and/or handouts, on conversing with older persons, particularly those who had dementia. They were also guided to write reflections before and after their conversations (Hancock et al., 2009). As instructed, they were largely able to turn control of time and topic over to Ms Littlejohn. Both time and topic were usually keyed to whether Ms Littlejohn said she was tired, would prefer to be outside in the residence's tiny garden, was interested in the details of the students' lives, or had stories she wished to share. Transcript utterances were divided by speaker and then by prosody. Each usage of UH spoken by Ms Littlejohn was coded and reviewed by each researcher for (a) what followed its production (that is, silence or type of propositional content; this material is not discussed in this chapter) and (b) which one or, on occasion, two categories of pragmatic functions seemed to typify its usage,
lez (2004) and set out in Table 1. In addition to Gonza
lez's 23 categories, we used the categories as identified previously by Gonza word-finding (WFD) and way finding (WYF). Word-FinDing is a term used in clinical linguistics to describe the situations when someone cannot immediately find the word they want to use. Everyone experiences instances of word-finding problems, but they can be acute in some forms of aphasia and become increasingly problematic as dementia progresses (see, for example, Rohrer et al., 2008). WaY Finding is a term we have coined to describe instances where people with dementia seem to lose track of where they are in a conversation or a story. WaY Finding problems usually become more apparent as dementia increases. The transcripts were randomly assigned to either author for initial coding. All coding was carried out in tandem by the two authors, one author conducted the initial analysis and the other reviewed the coding. Any disagreements were resolved between them. All uses of UH as well as of the more conventional discourse markers well, so and you know were counted and
lez's categories of functions are clear, and Littlejohn's prosody is normalized per 1000 words. There were few problems: Gonza usually unambiguous. In context it was usually obvious which pragmatic function Ms Littlejohn was intending with her UHs. The first author had talked with her on 20 occasions across 4 years, and the second author had listened to the audio recordings and watched all the video-recorded conversations. Both authors were therefore very familiar with Ms Littlejohn's interaction style and it was rare that we disagreed about what she intended to say. Table 1 Pragmatic functions of markers used in oral narrative; adapted from Gonz
alez (2004: Appendix II, 379e80). Ideational [logicoesemantic relations] CON resultative CONsequence REF REFormulate previous, usually with paraphrase SEQ SEQuence introducer

Sequential DSP FRA FRC INI

introduce Direct SPeech initiate FRAme narrative segment FRame Closer e closes narrative segment INItiates action

Rhetorical [illocutionary intentions] ADD ADDitional info CLA CLArification CLU conCLUding COM COMment, evaluative DEL DELay, staller EMP EMPhasizer EVA EVAluator EVI EVIdential REC RECovers topic TOP TOPic shifter

Inferential CTX JUS MIT PRE PRO SIT

ConTeXt narrower JUStification MITigator PREsupposition PROximity sets up SITuation

4. Findings Ms Littlejohn used 1077 instances of UH in the 18 conversations we analyze here. She only used 57 instances of um in the conversations and we do not analyze them. Twenty-three of the 57 uses of um were in the last conversation with the researcher, BD, when Ms Littlejohn was very ill, and most of these (18) occurred with long pauses after them as she tried to breathe. Not all
lez (2004, 2005) were identified in the Littlejohn transcripts, but Ms Littlejohn did use pragmatic functions classified by Gonza categories from each of the four groups, ideational, rhetorical, sequential and inferential. We present first the results for UH variation according to the different conversational partners, followed by UH variation across time and across audience.

Please cite this article as: Davis, B.H., Maclagan, M.A., UH as a pragmatic marker in dementia discourse, Journal of Pragmatics, https://doi.org/10.1016/j.pragma.2018.12.005

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4.1. Variation across conversational partners 4.1.1. Variation across individual partners The student conversations can be divided into three types (see Table 2). The first group of students (A) responded to Ms Littlejohn's questions and talked mainly about themselves. She was apparently happy to let them do this, never cutting them short or interrupting them. In these conversations she used relatively few UHs (between 7 and 20 per 1000 words). These interviews were all by male students, and it is clear by her frequent laughter and cheery, up-glided intonation that Ms Littlejohn thoroughly enjoyed talking to them. Her frequency of UH usage does not increase markedly in the 2013 conversations compared with those in 2009. The second type of interview is exemplified by W (see B in Table 2), a mature student, who recorded Ms Littlejohn five times and encouraged her to talk. Ms Littlejohn told W many rehearsed stories. In 2010 Ms Littlejohn was using between 20 and 36 UHs per 1000 words in order to maintain her fluency, a rate of usage that is higher than she used with the male students in group A and also somewhat higher than that used when talking to the researcher, (see C in Table 2). Slightly lower usage (between 12 and 23 UHs per 1000 words) was observed within the conversations with BD, the researcher to whom she also told rehearsed stories, but with whom she identified common experiences. With both the researcher and student W, flurries of UHs surrounded Littlejohn's efforts to explain something that seemed negative or uncomplimentary to events or surroundings, and this raised the totals per 1000 words. All the students knew Ms Littlejohn had dementia, but most treated her simply as someone to talk to. Some were nervous and asked a lot of questions, and others, like W, were much more relaxed. Student M (see D in Table 2) was different. From her research notes, she clearly did not expect Ms Littlejohn to be able to remember anything e she was surprised when Ms Littlejohn remembered her former occupation as a radiology technician and knew what the word gerontology meant. M conversed with Ms Littlejohn five times but from the third conversation it was clear that Ms Littlejohn was not happy talking with her and in the last conversation she asked M not to visit her again. Ms Littlejohn's number of UH tokens per 1000 words increased in the last two interviews when she used politeness strategies to discourage M from visiting her again (Davis et al., 2016:51e2). (We do note that the number of UH per 1000 words in the fourth conversation with M is less reliable because the conversation was very short.) Table 2 UH usage by Maureen Littlejohn with students and the researcher. Conversational Partnera

Year

# words

# uh

uh/1000 words

A)

A-C 1 A-C 2 P L

2009 2009 2113 2113

2668 2158 1835 1914

49 14 36 20

18.37 6.49 19.62 10.45

B)

W W W W W

2010 2010 2010 2010 2010

5980 3986 3468 3250 2028

182 103 113 72 42

30.43 25.84 32.58 22.15 20.71

C)

BD BD BD BD

2010 2011 2012 2014

3954 1722 5189 4579

80 21 120 44

20.23 12.20 23.14 9.63

D)

M M M M M

2010 2010 2010 2010 2010

2083 1997 2240 282 1034

73 44 69 16 36

35.05 22.03 30.80 56.74 34.82

a

A-C, P, L, W and M are graduate students; BD is the first author.

4.1.2. Variation across discourse communities The combination of variationist and what Rampton calls ethnographically-based interactional sociolinguistics (Rampton, 2017) supports the pragmatic exploration of “how social meaning is conveyed and inferred in particular interactions” (Holmes, 2013: 179). Ms Littlejohn's UHs give us insight into identifying “the social categories that have significance to ‘participants’ or members of a given community” (Ehrlich and Meyerhoff, 2014:11). Ms Littlejohn participates in several such communities. First, the official residential site in which she lives is called a community by its administrators. It is a memory care building separate from the main residential site for aging retirees and as a genre in caregiving, has its own cultural rules about who is admitted to live there, when one eats, when one gets dressed, with whom one can talk and share activities and the like, although Ms Littlejohn seldom conforms to any of them except for meals. She is a member of a larger ‘community’ of old women receiving care in an institutionalized setting; she is a family member as an aged and beloved aunt of the person who “pays the bills”; and she is one of a growing community of persons with dementia, a condition which tends to have both clinical and social norms and expectations for behaviors (Sabat, 2017). Her UHs often offer clues as to which community genre is impacting her choice of speech and her selection of topics. For example, she talks about what it is like to live in the memory care residence almost exclusively to the researcher, because their interpersonal relationship (and hence, their interpersonal Please cite this article as: Davis, B.H., Maclagan, M.A., UH as a pragmatic marker in dementia discourse, Journal of Pragmatics, https://doi.org/10.1016/j.pragma.2018.12.005

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pragmatics: see Locher and Graham, 2010; Haugh et al., 2013) differs from that with the student visitors. With them, she is free to entertain with anecdotes of her own youth; with the researcher, she can share her thoughts and opinions as well as her reminiscences. The interpersonal pragmatics displayed between Ms Littlejohn and her conversation partners (CP) in excerpts (i) and (ii) show the participant-keyed changes in what she apparently perceives as the appropriate topic and ways of talking in the situation as she sees it. Locher (2013: 146) would explain this as Ms Littlejohn's concern for her “face needs, i.e. the projected image they [interactants] wish to portray in an interaction” which could involve, for example, the social distance she wishes to signal between herself and her conversation partners. Notice, for example, in excerpt (ii) the increased pausing used with the researcher with whom she shares rapport. She apparently feels she can afford to speak slowly with her and to pause as compared with the way she speaks quickly if not necessarily coherently with the student. In excerpt (i) from a conversation in 2010, Ms Littlejohn talks factually about meals with student W, a student with whom she was at ease. In excerpt (ii) from the last conversation in 2014 she talks with the researcher about her niece (a longer excerpt including this section can be seen in excerpt (viii)). In this excerpt the shared laughter indicates the rapport between Ms Littlejohn and the researcher. In these excerpts, dots indicate very brief pauses, numbers in square brackets indicate longer pauses, material in square brackets [2 syll] indicates unclear speech and comments are in parentheses {}.

(i)

CP: ML:

CP: ML: (ii)

so do you get to select what food you want to eat every day? no . well I guess to some degree you know you do UH but UH If there's something you really really don't like or what have you or if there's something you really don't like of course they'll always fix you a cheese sandwich . hmmm. so UH we don't go hungry for sure Pam. bless her heart [.663] she has UH [.652] all the [1.252] grandkids and [.368] her father and me and [.484] she's just one of these people that just [.726] goes with the flow, doesn't really get too fussed or upset or [.515] what have you . she just takes charge and [.505] that's it [2 syll] [.915] my bills are paid I . reckon . ‘cos she just {both laugh} they haven't evicted me or talked about evict~ [iɪk] evicting me yet so .

4.2. Variation across time 4.2.1. Variation in canonical discourse markers across time In this section, we look more closely at the distribution of form and function of UH across time, seen here in the succession of conversation partners across the timespan of six years, as well as across Ms Littlejohn's slowly-changing situation (i.e., her gradual increase in dementia as reported by her niece, a nurse). In Pichler's discussion defining discourse-pragmatic features (2013: 3e20), she examined three multifunctional variables well, so, and you know. We are working with a fourth, UH, a variable which is normally removed from discussions of propositional content (see Kjellmer, 2003:170), and frequently dismissed as a marker of disfluency alone. Like other discourse-pragmatic features, we find that UH can concomitantly “function to encode pragmatic and procedural meanings which are not easy to specify in lexical terms” (Pichler, 2013:6). We start by comparing Ms Littlejohn's use of the canonical discourse-pragmatic markers well, so, and you know with her use of UH. Fig. 1 displays their normalized frequencies (as tokens per 1000 words) in comparison with UH. It is immediately clear from Fig. 1 that, although Ms Littlejohn does use the discourse-pragmatic markers well, so, and you know, she uses them rarely compared with her use of UH. Linear trendlines have been added for her use of well and UH. The trendline for well is flat, indicating that her usage of well does not change over time. By contrast, the trendline for UH declines slightly indicating a slight decrease in her usage of UH over time. Trendlines for her use of so or you know are flat, like the trend for well. We did not add them to the graph because she rarely uses so and you know and because the graph would become unreadable. Full details of Ms Littlejohn's usage of well, so and you know are given in Appendix A. 4.2.2. Pragmatic variation across time and partner Table 3 summarizes Ms Littlejohn's pragmatic usage of UH across time and across speakers, keyed to the functions
lez (2004). In this table, we present her UH usage according to Gonz
identified by Gonza alez's major categories of Ideational, Rhetorical, Sequential and Inferential together with the combined categories of word-finding and way-finding. Appendix B presents the full details of UH usage for each of the subcategories within the major categories. The numbers in Table 3 are the actual numbers of times Ms Littlejohn used UH in each of the conversations. However, since these are largely spontaneous conversations with occasional semi-scripted questions, both duration and word length vary. This means that a direct comparison of numbers of UH in the different categories across time is not meaningful. For each conversation, we calculated the proportion of Ms Littlejohn's UH usage that fell within each of the categories. This enabled us to compare the relative frequency of Ms Littlejohn's use of the major categories of Ideational, Rhetorical, Sequential and Inferential over time. This data is presented graphically in Fig. 2. We do not include word finding or wayfinding in Figs. 2 and 3 because the proportions are too low to be seen. Fig. 2 shows that Ms Please cite this article as: Davis, B.H., Maclagan, M.A., UH as a pragmatic marker in dementia discourse, Journal of Pragmatics, https://doi.org/10.1016/j.pragma.2018.12.005

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Fig. 1. Normalized frequencies of pragmatic markers UH, well, so and you know used by Ms Littlejohn expressed as the number of occurrences per 1000 words.

Table 3 UH usage by Ms Littlejohn over time with different conversational partners. Interviewer

A-C

A-C

Date

Nov09

Nov09

W

24Feb10 CP gender mx2 mx2 f CP status st st st # words 2668 2158 5980 length m:sec 15:13 11:30 35:56 UH/1000 18.4 6.5 35.1 words IDEATIONAL 6 0 27 RHETORICAL 30 9 141 SEQUENTIAL 10 0 7 INFERENTIAL 4 5 22 WYF/WFD 0 0 13

M

M

M

W

W

W

W

M

M

BD

BD

BD

P

LA

BD

25Feb10 f st 2083 13:47 37.9

4Mar10 f st 1997 12:52 22.0

11Mar10 f st 2240 14:31 42.0

18Mar10 f st 3986 26:20 28.1

19Mar10 f st 3468 21:26 37.8

19Mar10 f st 3250 21:31 26.8

22Mar10 f st 2028 12:47 25.6

23Mar10 f st 282 1:31 67.4

25Mar10 f st 1034 6:08 34.8

18Oct10 f r 3954 22:31 23.5

20Oct11 f r 1722 10:05 13.4

1Feb12 f r 5189 27:25 23.1

20Nov13 m st 1835 10:00 21.3

23Apr13 m st 1914 11:00 10.5

20Oct14 f r 4567 30:31 12.9

11 51 3 3 11

5 33 2 4 0

15 63 4 1 11

13 77 3 17 2

12 108 1 10 0

5 71 5 6 0

5 42 0 5 0

0 17 1 0 1

16 14 0 5 1

3 73 3 4 10

1 19 0 1 2

8 100 5 1 6

9 24 0 4 2

1 16 1 2 0

3 52 0 2 2

CP ¼ conversational partner; st ¼ student; r ¼ researcher; UH/1000 words ¼ number of UH per 1000 words.

Littlejohn used UH most often in a rhetorical sense in all conversations except for the one with M on 25 March 2010 when Ms Littlejohn was displaying heavy politeness in trying to persuade M not to visit again. The subcategories included under the category of Rhetorical include adding extra information or clarifying what has been said, providing evidence or emphasis for a statement, changing topic or delaying. Ms Littlejohn used all these subcategories in the various conversations. She used all 10 subcategories in the last conversation with the Researcher in 2014 (for details see Appendix B). Her use of the Ideational categories peaked in the last interview with student M. The subcategories of this category include reformulating material and introducing consequences of a previous proposition. Since Ms Littlejohn was here spelling out precisely - and more than once - the consequences she desired, viz., that student M would visit someone else, it is not surprising that this interview contains the highest proportion of Ideational uses of UH. A linear trendline for Ms Littlejohn's use of UH in the Rhetorical categories has been added to Fig. 2. The trend line in Fig. 1 showed that Ms Littlejohn's usage of UH per 1000 words had declined slightly over time. The trend line on Fig. 2 shows that, even as her overall use of UH decreased over time, her relative use of the Rhetorical functions of UH increased.

Please cite this article as: Davis, B.H., Maclagan, M.A., UH as a pragmatic marker in dementia discourse, Journal of Pragmatics, https://doi.org/10.1016/j.pragma.2018.12.005

8

B.H. Davis, M.A. Maclagan / Journal of Pragmatics xxx (xxxx) xxx

1.00 0.90

ProporƟon of UH

0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 23-Mar-10

25-Mar-10

18-Oct-10

20-Oct-11

1-Feb-12

20-Nov-13

23-Apr-13

20-Oct-14

M

22-Mar-10

11-Mar-10

M

19-Mar-10

4-Mar-10

M

19-Mar-10

25-Feb-10

W

18-Mar-10

Nov-09

A-C A-C

Nov-09

24-Feb-10

0.00

W

W

W

W

M

M

BD

BD

BD

P

LA

BD

ConversaƟonal partner and date IDEATIONAL

RHETORICAL

SEQUENTIAL

INFERENTIAL

WYF/WFD

Linear (RHETORICAL)

Fig. 2. Proportion of UH use by Ms Littlejohn in each of the major categories. A linear trend line has been added to her use of the rhetorical categories.

Ms Littlejohn continued to use most of the categories in the Ideational and Rhetorical sections of Table 3 throughout the six years of the conversations. However, her use of the Sequential and Inferential categories seemed to lessen over time. We do not display trendlines for the Ideational, Sequential or Inferential functions because they make Fig. 2 too crowded to read. The Ideational trend line does not change over time, confirming that Ms Littlejohn retained her ability to keep her place in the conversations, but both the Inferential and Sequential trend lines decline noticeably. Unimpaired speakers use pragmatic

Fig. 3. Proportion of UH by Ms Littlejohn in each of the major categories calculated across the total number of words in each conversation. A linear trend line has been added to her use of the rhetorical categories.

Please cite this article as: Davis, B.H., Maclagan, M.A., UH as a pragmatic marker in dementia discourse, Journal of Pragmatics, https://doi.org/10.1016/j.pragma.2018.12.005

B.H. Davis, M.A. Maclagan / Journal of Pragmatics xxx (xxxx) xxx

9

markers from the Inferential and Sequential categories to help situate their listeners in the flow of the conversation. Over time, Ms Littlejohn's listeners needed to carry out more of the conversational work to ensure that they were all talking about the same thing. The students usually managed this by talking about their own lives. The researcher was much closer in age to Ms Littlejohn than were the students. She chatted freely with Ms Littlejohn and, rather than trying to control the situation, followed Ms Littlejohn's lead, even when the topic shifts were not well signaled. Fig. 3 presents Ms Littlejohn's usage of UH as a proportion of the total number of words in the individual conversations. Because the number of words included in this analysis is much greater than those included in the analysis presented in Fig. 2, UH constitutes a very small proportion of the total number of words. The scales on the y-axes of Figs. 2 and 3 are therefore different so that the data presented in Fig. 3 can actually be seen. When presented in this way, Ms Littlejohn's UH usage in the last two interviews with student M stand out differently. In the second last interview on 23 March 2010 she shows the greatest proportion of Rhetorical uses of UH. This peak is present in Fig. 2 but it does not stand out as dramatically. The interview on 23 March 2010 was very short and Ms Littlejohn was trying hard to be polite to student M. This explains why UH constitutes such a high proportion of the total number of words.

4.3. Different uses of UH as a pragmatic marker In the next sections we examine specific uses of UH as a pragmatic marker. First, we provide examples of the way in which Ms Littlejohn's use of UH indicates the different social roles she can still play. We then consider its use as a pragmatic boundary marker and finally the way in which Ms Littlejohn can use it to signal more than one pragmatic function at a time. Our discussion in the following sections is illustrated with examples from various conversations with Ms Littlejohn. 4.3.1. Example of UH as pragmatic marker signaling social roles In excerpt (iii) from a 2009 conversation Ms Littlejohn is speaking first in the role of a person being visited in her institutional setting by two young male students with whom she, in the present, enjoys bantering. At times she even initiates the bantering. The rainy weather and a conversation partner's (CP) comment leads her to reminisce briefly about the Labrador dogs she owned before she moved into the memory care unit and how they loved water. She uses a colloquialism, “good old dog,” similar to the folksy “good old boy” but clearly used in a positive sense signaling a shared background keyed to perceived regional accents and the fact that her conversational partners are dog owners. She then speaks from a more detached position as a knowledgeable, life-long dog owner about the advantages of big dogs in general and Labs in particular. There are no dogs where she currently lives. This is the only example in the conversations we have recorded where Ms Littlejohn uses the inferential category PREsupposition, where she assumes shared knowledge between herself and the student dog owner. In this and other excerpts, CP ¼ Conversation Partner, < > indicates brief interrupting speech, ~ indicates a truncated word, longer pauses (in seconds) are shown in square brackets and brief pauses are shown by dots (.); in this selection, three dots signal ellipsis. (iii)

Interaction excerpt CP: At least it's nice and wet for Labs outside in this weath~ ML: We lived not too far from the river . and I promise you we could get within a quarter of a mile of the river and they'd start running…and man they and they would stay as long as I'd stay with them. they never came out on their own. [1.7 sec] And [.6 sec] a Lab's just a UH good old dog anyway . They're good natured . UH kids love them because they're so big . they can rough house with them . but I always had a dog . a big dog .

Pragmatic Function of UH

UH gives ADDitional information of EVALuative nature, from two different stances. The first PREsupposes shared information about dogs

4.3.2. Examples of UH as pragmatic marker signaling pragmatic boundaries  us et al. (2011:3003), call UH-tokens conversation fillers (CFs), and claim that people “tend to use CFs to signal Ben pragmatic, discourse, or syntactic boundaries.” Ms Littlejohn had the ability to combine pragmatic functions for UH-tokens and manipulate them to start and stop discourse sequences, often where another speaker might have used a discourse marker such as well or so to signal discourse boundaries. For example, in 2009, two male students (A-C) asked her about several framed pictures that were leaning against the wall on the floor of her room, putting them in the context that she could have found them in yard sales. In excerpt (iv), the first and third uses of UH have a double function. Its first use serves as a DELay as Ms Littlejohn prepares to REFormulate biographic details she has already shared. The third UH serves both as a DELay for Please cite this article as: Davis, B.H., Maclagan, M.A., UH as a pragmatic marker in dementia discourse, Journal of Pragmatics, https://doi.org/10.1016/j.pragma.2018.12.005

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B.H. Davis, M.A. Maclagan / Journal of Pragmatics xxx (xxxx) xxx

word finding and a FRAme for the following narrative sequence. Commentary is italicized, CP ¼ Conversation Partner, brief pauses are shown by dots (.), a dash e indicates a longer pause and ~ indicates that Ms Littlejohn reformulated a word without an obvious hesitation.

(iv)

Interaction excerpt CP: ML:

CP: ML:

Pragmatic Function of UH so you used to go to a lot of yard sales or well not so much . UH . I was never a real yard sale person but just I'd like to go to antique stores or something like that . UH used to have some real pretty nice stuff but once you get in here but yeah . those those go in the corner there . you couldn't put up three pictures there or something without looking overdone or something so I just don't like that they still have a lot of those kind of stores in the mountains Oh yeah . oh golly . and there's so many UH . people that have lived there in their home for you know 40 . 50 years and now it's time when then someone now one of them dies and then the other one has to go into a nursing home . and just some wonder~ wonderful little old antiques . not just so little price wise but that doesn't seem to go down but you can pick up . in yard sales . it's just amazing what you can find in them . so

UH serves as a DELay and precedes REFormulation of biographical details; UH FRAmes sequence of independent clauses in a jumbled narrative to explain why she didn't hang the pictures

UH precedes a probable DELay for word-finding and FRAmes narrative sequence of independent clauses about where mountain antiques can be found

In excerpt (v), from a conversation with student M in 2010, the UHs hold her turn so that Ms Littlejohn can reformulate an earlier topic for a sequence of clauses about her mother's Sunday dinners, continue to add new information, tell how the few leftovers would be carried off, bring the sequence to a close, and combine final-particle but with UH to finish the topic. (v)

Interaction excerpt ML: yeah . well always loved t'be there on Sunday because she'd UH even after my father died and we were all away. she'd still cook . UH we didn't live too far we were pretty close she'd still get up and cook us a Sunday dinner and then she'd have all these quote leftovers but you'd have them all covered up . and UH everybody lift up . UH there's a big chicken leg left or what have you so we'd UH it didn't last long around us but UH .

Pragmatic Function of UH [sequence] ADDitional details ADDitional details

ADDitional details ADDitional details ConCLUdes sequence TOPic-closer

In her 2013 conversation with P, Ms Littlejohn was eager to share stories from her youth and to explain something about her family. She sometimes piled up the frames setting up her stories, occasionally using UM rather than UH to do so, as in excerpt (vi) where UH frames one story about her family farm to which she will return later, and one of her rare uses of UM frames another about her family's education. The CP's encouragement is shown in angle brackets < >, brief pauses are shown by dots (.) and slightly longer pauses (less than 1 s) are shown by dashes (e). In this excerpt, three dots (…) indicate that Ms Littlejohn seems to have lost the gist of what she is saying (rather than ellipsis).

(vi)

Interaction excerpt You know . you just . UH I grew up on a farm and . UM . my mother and father both had a big . old one-room schoolhouse e teachers . they'd paid as I probably told you . mother's way to go e go to college and e e but she paid her brother's way to go to college . and he wouldn't go… e

Pragmatic Function of UH FRAme 1 [small story (Georgakopoulou 2007)] FRAme 2

Please cite this article as: Davis, B.H., Maclagan, M.A., UH as a pragmatic marker in dementia discourse, Journal of Pragmatics, https://doi.org/10.1016/j.pragma.2018.12.005

B.H. Davis, M.A. Maclagan / Journal of Pragmatics xxx (xxxx) xxx

11

Ms Littlejohn often emphasized details in the stories she shared with students. In excerpt (vii) from her 2009 conversation with A-C about giving the Archbishop of Canterbury one of her hand-woven egg baskets, she EMPhasizes her EVIdence. Angle brackets < > enclose the CP's response. Brief pauses are shown by dots (.); three dots again (…) indicate that Ms Littlejohn seems to have lost the gist of what she is saying (rather than ellipsis). (vii)

Interaction excerpt I'd I'd look back and laugh at all these country fresh eggs that they had been saving up for a week . [laughter] but eggs really evidently have a real long life to them . UH longer than you'd think UH…

Pragmatic Function of UH

EMPhasis EVAluate

4.3.3. Examples of UH used to signal more than one pragmatic function UH-usages that had at least two simultaneous functions frequently involved UHs being used to delay or stall while retaining the speaker's turn. They were often followed by a multi-clausal narrative sequence or account and/or a topic shift, suggesting how UH was used to FRAme the next part of the conversation. Table 4 uses five speakers to illustrate Ms Littlejohn's use of UH to serve more than one pragmatic function across time. The conversations include both the first in the
lez's (2004) categories are in column 1. The other columns indicate the catseries (with A-C) and the last (with BD). Gonza egories Ms Littlejohn combined with the category in the first column. When talking with A-C, for example, Ms Littlejohn used UH to indicate a CONsequence together with a CLArification and when she was talking to BD in both 2011 and 2014 she used UH to signal ADDitional information as well as a DELay. Where there is more than one category in a cell, Ms Littlejohn combined the category in the first column with each of these categories separately. For example, in her conversation with P in 2013, she combined SEQ with REF and SEQ with FRA. The conversation with BD in 2014 was the last time we talked with Ms Littlejohn. At this time, she was very unwell. In this conversation she was using DELays more often as she gathered her
lez's (2004) pragmatic thoughts. But even in this last conversation, she was still able to use UH to signal most of Gonza categories (see Table 3 and Appendix B) and UH rarely served solely as a hesitation marker. Table 4
lez (2004); the columns for each Examples of double usage of UH by Ms Littlejohn across time. The left column contains the categories from Gonza conversational partner (CP) indicate the categories that Ms Littlejohn combined with the leftmost category. Duration indicates the length of the conversation in minutes: seconds. CP

A-C

M

BD

P

BD

Date CP gender Duration # words UH/1000 words Ideational CON REF SEQ Rhetorical ADD CLA CLU

2009 M x2 15:13 2668 18.37

2010 F 12:52 1997 22.03

2011 F 10:05 1722 13.36

2013 M 10:00 1835 21.25

2014 F 30:31 4567 12.82

þCLA þFRA

þCLU þADD þDEL

þSEQ þ REF; þFRA

þDEL þDEL

COM DEL

þFRA þREF þCOM

þREF þFRA þDEL

þDEL

þTOP þCON

þ DEL

þEVA þDEL

þCLU þSEQ þADD

þREC þTOP þ CLU

þTOP þMIT þSIT þCLU

EMP EVA

þEVA þEMP

þTOP þREC þCOM þEMP

EVI REC TOP

þEVA þFRA

þTOP þREC þCOM þEMP

Sequential FRA FRC Inferential SIT

þCLU

þDEL þDEL þDEL þEVA þDEL þADD þREF þCLU þCOM þSEQ þCLA þCLU

þDEL þDEL

þSEQ þTOP þDEL

Please cite this article as: Davis, B.H., Maclagan, M.A., UH as a pragmatic marker in dementia discourse, Journal of Pragmatics, https://doi.org/10.1016/j.pragma.2018.12.005

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B.H. Davis, M.A. Maclagan / Journal of Pragmatics xxx (xxxx) xxx

Excerpt (viii) is taken from the last conversation between the researcher and Ms Littlejohn in 2014. Because of her illness Ms Littlejohn paused more often and for longer stretches of time, often to catch her breath. In this excerpt we see two examples of UH being used with a double pragmatic function. In the first instance Ms Littlejohn uses UH as a DELay marker while she adds extra information about her niece and in the second example, UH is used as a DELay marker while she REFormulates what she is saying. In this excerpt pauses in seconds are indicated in square brackets, a dot (.) indicates a very brief pause, ¼ indicates that Ms Littlejohn responded immediately to her conversational partner's question, [2 syll] indicates unintelligible speech and ~ indicates that she reformulated her word without an obvious pause.

(viii)

Interaction excerpt CP: how is Pam and her husband doing?¼ ML: ¼so far as I know, they're doing OK . Pam . bless her heart [.663] she has UH [.652] all the [1.252] grandkids and [.368] her father and me and [.484] she's just one of these people that just [.726] goes with the flow . doesn't really get too fussed or upset or [.515] what have you . she just takes charge and [.505] that's it [2 syll] [.915] my bills are paid I reckon . ’cos she just {both laugh} they haven't evicted me or talked about evict~ evicting me yet . so CP: and they'd tell you [.778] ML: oh they would . if they didn't get their re~ UH money UH [.673] You wouldn't last long around here . that's for sure [.494] You know [.473] she's a good kid [.642]

Pragmatic Function of UH

DELay, ADDition

DELay, REFormulate EMPhasize

5. Discussion As her dementia slowly increased, Ms Littlejohn continued to use UH in a variety of ways, including marking im/politeness. Her use of UH varied according to her audience and her pleasure or displeasure with the topic and quality of their interaction. For example, in conversations with students, she used fewer instances of the particle in conversations where she was happy for her conversational partner to guide the interaction (up to 20 per 1000 words of conversation, see A in Table 1). She used a greater number of UH tokens when she wanted to take a more active part and share more of her stories with her partner (between 20 and 36 UH per 1000 words of conversation, see B and C in Table 2). She used the greatest concentration of UH with a conversational partner she found difficult to interact with (between 20 and 35 UH per 1000 words of conversation, see D rows 1e3 in Table 2). She used even more when she was trying to persuade this partner that she should not visit her again (35e60 UH per 1000 words of conversation, see D rows 4 and 5 in Table 2). This interaction is shown in excerpt (ix) where brief pauses are shown by dots (.), longer pauses by dashes (-) and three dots in this excerpt (…) indicate that Ms Littlejohn seems to have lost the gist of what she is saying.

(ix)

Interaction excerpt CP: is she the niece that is the nurse? ML: yes she UH she UH e [a] nurse . CP: you told me about her ML: yeah yeah . but UH ask them maybe to assign you to someone else that UH . that really and assistance and so on and UH needs your kind attention and I do appreciate but I'm just UH . I'm just as comfortable and happy here I'm not lonesome or anything (laughs). so I just . UH … but UH… CP: well that's understandable

Pragmatic function of UH We suggest that these are the kind of throat-clearing ums and uhs when a person is stalling for time, keeping the turn, and casting about for how to suggest independence (Scollon et al. 2012) without being overtly rude.

but UH is used as a compound closing particle

Under ordinary circumstances, as Van der Wouden and Foolen explain (2015:243), a final conjunction such as but, followed by a hesitation signal e in this case, UH and a pause e can serve as a “fade-out” and an offer for the conversational partner to take a turn. It is probably a signal of politeness. In this instance, rather than offering the student a further turn, Ms Littlejohn is doing her best to employ surface politeness while encouraging M's departure. Similar clusters or uses of UH as a hesitation marker without additional pragmatic force surround statements suggesting embarrassment as in excerpt (x) from a conversation with student L or the avoidance of saying something negative as in Please cite this article as: Davis, B.H., Maclagan, M.A., UH as a pragmatic marker in dementia discourse, Journal of Pragmatics, https://doi.org/10.1016/j.pragma.2018.12.005

B.H. Davis, M.A. Maclagan / Journal of Pragmatics xxx (xxxx) xxx

13

excerpt (xi) from a conversation with student W. Comments from L and W are in angle brackets < >, brief pauses are indicated by dots (.) and slightly longer pauses by dashes (-). The three dots at the end of excerpt (x) indicate that Ms Littlejohn has lost what she was going to say. (x)

ML:

CP: ML: (xi)

and . then . on the very back end . is that porch that we can go out . . and . sit . which is nice once in a while . particularly. whenever . UH . one of them brings one of their dogs . . and . then . we can go out there and throw frisbees and what have you . yeah . yeah . now, you don't have any, do you have any of your dogs anymore? no . they're all . UH … [Rather than concluding her comment, Ms Littlejohn turns and points out the dogs in their photos on her wall.] well we don't go on trips that much here . . UH UH I think there is a little bus that somewhere that once in a while e it's been a long time since it UH we went out on a little trip but it's not . not very often


lez’ framework (2004; 2005), were rhetorical. What Most of Ms Littlejohn's pragmatic uses for UH, as codified by Gonza is not used across all 18 conversations, or is used very seldom, is as interesting, and potentially as important for diagnostic or intervention purposes as what is frequently used. For example, in Ms Littlejohn's 18 conversations, UH is not used to preface phrases or clauses introducing or facilitating certain inferences such as presupposition or proximity, particularly since, as Gonz
alez comments (2004:126), a marker of proximity e such as you know e suggests that background knowledge is “mutual” and the narrator seeks understanding. The only time she shares presuppositions about dogs with the student conversation partners, she does not preface this with a pragmatic marker. While Ms Littlejohn does occasionally use UH you know, she is almost always attempting to relocate or reformulate the thread of her discourse, while she is hoping her conversation partner understands something of what she is trying to say and will not stop the conversation. The knowledge cannot be seen as mutual. In excerpt (xii), W has just complimented Ms Littlejohn on how nice her room appears. Ms Littlejohn acknowledges that her room is ‘comfortable’ and then reformulates the interaction to talk about books she has handy.

(xii)

It's comfortable UH you know being and so on and so I was . was reading and I keep a good supply of books around to read .

As time passes and dementia increases, other markings of inferentiality using UH, such as for JUStification or MITigation, are reduced in frequency, as are suggestions of its use as a RESultative consequence or SEQuence introducer which typically mark ideation and connectivity. The Linguistic Data Consortium at the University of Pennsylvania (www.ldc.upenn.edu) defines discourse markers as “structuring units” and hesitation markers “as utterances that indicate the speaker's effort to maintain the flow of speech” (2012:852) while they try to find a word or something they want to day. We see UH functioning in both these ways in Ms Littlejohn's conversations. She uses UH to FRAme what she wants to say (as in excerpts (iv) and (vi) above) and but UH often indicates that she has finished all she wants to say on this topic (see excerpt (v)). As her dementia increased, Ms Littlejohn used UH more frequently as a DELay while she tried to find a word (see, e.g., excerpt (viii) above). Ms Littlejohn used UH to control the conversation (see Maclay and Osgood, 1959), using it more frequently when she wanted to share more of her stories and less frequently when she was happy to let her conversational partner do most of the talking. Increasingly, UH indicated that she had lost the gist of what she had been saying (see excerpts (vi) and (vii) above) and was happy for her conversational partner to take over. In the conversations with Ms Littlejohn that we have analyzed here, it is clear the UH goes beyond being used solely as a hesitation marker and moves towards functioning as a full discourse marker, albeit a discourse marker without linguistic content. 6. Conclusion UH is a variable which is normally removed from any discussions of propositional content. It is frequently dismissed as a marker of disfluency alone, either as a signal of the disfluency or a symptom of it. Many analyses of spoken language that focus exclusively on content simply throw it away. Such disposal may be detrimental, given the pragmatic usefulness of UH in signaling various aspects of content and structure to the conversational partner. In this paper we have analyzed the use of UH over time by a woman whose language is increasingly impaired by dementia. As her dementia increased Ms Littlejohn continued to converse willingly with students and the first author. However, as time went on, she became less able to use more conventional pragmatic markers such as well, so and you know to guide and structure the conversation. As her use of these traditional discourse markers decreased, her use of the pragmatic particle UH increased. Without a detailed analysis, it might have seemed that Ms Littlejohn's conversation was simply becoming more hesitant with the
lez (2004) increase in her dementia. A detailed analysis of her use of UH using pragmatic categories proposed by Gonza shows that, right up to her death, Ms Littlejohn was able to use UH with almost all the types of pragmatic functions shown by more conventional markers. The categories she did not use were as interesting as the ones she continued to use. Once the condition began to progress more rapidly, which was apparently shortly after the conversations in early 2009, she did not use UH to signal inferences such as presupposition or proximity, functions that presuppose shared background knowledge between the speakers and Ms Littlejohn. Although Ms Littlejohn shared common experiences and even family Please cite this article as: Davis, B.H., Maclagan, M.A., UH as a pragmatic marker in dementia discourse, Journal of Pragmatics, https://doi.org/10.1016/j.pragma.2018.12.005

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B.H. Davis, M.A. Maclagan / Journal of Pragmatics xxx (xxxx) xxx

friends from her youth with the researcher who talked to her, even in these conversations she did not use UH to signal presupposition or proximity. Instead, her UH and her increasing pauses allowed her to keep the floor, retaining the status of “preferred talker” d after all, she was the person whom others came to visit d and allowing her to plan the next part of her story, utterance, or evaluatory sniff. Our research question asked if and to what extent, the use of UH in dementia discourse could go beyond being considered as disfluency so that it could be considered as potentially having specific kinds of pragmatic force in the sense
lez (2004) for markers such as well, so, then, I mean, you know and anyway. Detailed analysis of the use discussed by Gonza of UH by Ms Littlejohn confirms that UH is used with pragmatic force and is not simply a marker of disfluency in her speech. If this is the case for Ms Littlejohn, we assume that other speakers with dementia will be able to use UH or a similar pragmatic marker as one of their compensatory strategies (Ripich et al., 2000) when their ability to use more conventional markers declines. In sum, we find that further exploration of pragmatic uses of particles such as UH may allow researchers to discriminate between cognitively impaired and unimpaired speakers by investigating how the particles do more than mark the temporal cycles of fluent and hesitant spontaneous speech for each group of speakers. Such exploration also identifies retained interactional skills that may support the development of conversational interventions for persons with dementia.

Conflicts of interest The authors report no conflict of interest.

Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi.org/10.1016/j.pragma.2018.12.005. Appendix A. Discourse marker comparison. Number of instances of discourse markers UH, well, so and you know per 1000 words. Duration is in minutes:seconds. CP ¼ conversation partner

CP

Date

CP gender

CP status

Duration

# words

# UH

# UH/1000 words

# well

# well/1000 words

# so

# so/1000 words

# you know

# you know /1000 words

A-C A-C W M M M W W W W M M BD BD BD P L BD

2009 2009 24-Feb-10 25-Feb-10 4-Mar-10 11-Mar-10 18-Mar-10 19-Mar-10 19-Mar-10 22-Mar-10 23-Mar-10 25-Mar-10 18-Oct-10 20-Oct-11 1-Feb-12 20-Nov-13 23-Apr-13 20-Oct-14

M x2 M x2 F F F F F F F F F F F F F M M F

St St St St St St St St St St St St Res Res Res St St Res

15:13 11.30 35:56 13:47 12:52 14:31 26:20 21:26 21:31 12:47 1:31 6:08 22:31 10:05 27:25 10:00 11:00 30:31

2668 2158 5980 2083 1997 2240 3986 3468 3250 2028 282 1034 3954 1722 5189 1835 1914 4567

49 14 182 73 44 69 103 113 72 42 16 36 80 21 120 36 20 44

18.37 6.49 30.43 35.05 22.03 30.80 25.84 32.58 22.15 20.71 56.74 34.82 20.23 12.20 23.13 19.62 10.45 9.63

9 13 28 31 21 18 37 33 50 20 5 10 26 16 39 6 18 34

3.37 6.02 4.68 14.88 10.52 8.04 9.28 9.52 15.38 9.86 17.73 9.67 9.29 7.52 3.27 3.27 9.40 7.44

8 4 22 12 11 13 28 24 20 13 3 7 10 4 8 11 7 17

3.00 1.85 3.68 5.76 5.51 5.80 7.02 6.92 6.15 6.41 10.64 6.77 2.53 2.32 1.54 5.99 3.66 3.72

14 7 27 1 3 6 7 21 12 8 1 1 14 5 21 6 3 15

5.25 3.24 4.52 0.48 1.50 2.68 1.76 6.06 3.69 3.94 3.55 0.97 3.54 2.90 4.05 3.27 1.57 3.28

Please cite this article as: Davis, B.H., Maclagan, M.A., UH as a pragmatic marker in dementia discourse, Journal of Pragmatics, https://doi.org/10.1016/j.pragma.2018.12.005

B.H. Davis, M.A. Maclagan / Journal of Pragmatics xxx (xxxx) xxx

15

Appendix B. Number of instances of pragmatic functions for which Maureen Littlejohn used UH across time and with different conversation partners. CP ¼ Conversation partner; St ¼ Student; Res ¼ Researcher; Duration is in minutes:seconds; UH/1000 ¼ number of UH per 1000 words

CP

A-C

A-C

W

M

M

M

W

W

W

Date

Nov 2009

Nov 2009

Feb 24 2010

M x2 St 11:30 2158 6.49

F St 35:56 5980 30.43

Mar 11 2010 F St 14:31 2240 30.80

Mar 18 2010 F St 26:20 3986 25.84

Mar 19 2010

M x2 St 15:13 2668 18.37

Mar 4 2010 F St 12:52 1997 22.03

Mar 19 2010

CP gender CP status Duration # words UH/1000 Ideational CON REF SEQ Rhetorical ADD CLA CLU COM DEL EMP EVA EVI REC TOP Sequential DSP FRA FRC INI Inferential CTX JUS MIT PRE PRO SIT WYF WFD TOTAL

Feb 25 2010 F St 13:47 2083 35.05

F St 21:26 3468 32.58

F St 21:31 3250 22.15

2 25

3 8

3 2

1 10 4

13

12

4 1

30 18 24 4 20 2 18 7 6 12

13 6 12 3 3 1 7 4

8 2 5 3 8 3 3

9 2 12 1 27 1 3 1 3 4

13 10 5 3 20 4 10 6 1 5

12 12 18 8 34 5 11 1 4 3

6 10 9 5 18 1 14 4 3 1

7

2 1

3 1

1 2

1

3 2

1

1 6 10

4 5

6

8 3 94

1 1 112

3 2 1 2 7 1 1 8 1 4

1 2 4 2

2 4

6 4

1 2

1 4

1 2

3 11 6

1 1

2 7 6 210

1 9 2 79

2

2

1

50

14

2

1

44

131

87

CP

W

M

M

BD

BD

BD

P

L

BD

Date

Mar 22 2010 F St 12:47 2028 20.71

Mar 23 2010

Mar 25 2010 F St 6:08 1034 34.82

Oct18 2010 F Res 22:31 3954 20.23

Oct20 2011 F Res 10:05 1722 12.20

Feb1 2012 F Res 27:25 5189 23.14

Nov20 2013 M St 10:00 1835 19.62

Apr23 2013 M St 11:00 1914 10.45

Oct20 2014 F Res 30:31 4567 9.63

16

2 1

8

1 4 4

1

2 1

CP gender CP status Duration # words UH/1000 Ideational CON REF SEQ Rhetorical ADD CLA CLU COM DEL EMP EVA EVI REC TOP

F St 1:31 282 67.38

5

2 4 11 5 18 1

1 1 5

6

8

6

1 1 1 2

12 11 4 1 14 3 9 1 11 7

1 4 3 3 3 3 3

13 9 3 6 23 8 11 1 16 10

6 2 5 4 1 1 2 3

3 2 3 2 3 3

10 6 9 4 8 2 8 1 2 2

(continued on next page)

Please cite this article as: Davis, B.H., Maclagan, M.A., UH as a pragmatic marker in dementia discourse, Journal of Pragmatics, https://doi.org/10.1016/j.pragma.2018.12.005

16

B.H. Davis, M.A. Maclagan / Journal of Pragmatics xxx (xxxx) xxx

(continued ) CP Sequential DSP FRA FRC INI Inferential CTX JUS MIT PRE PRO SIT WYF WFD TOTAL

W

M

M

1

BD

BD

1 2

BD

P

3 2

L

BD

1

1 1 4

52

2 3

1 3

1

1

2 2

1

1

10

2

6

2

19

36

93

23

120

39

1

1 1

20

1 1 59

Note: Ideational includes: CONsequential, REFormulative, SEQuential. Rhetorical includes: ADDitive, CLArification, conCLUding, COMment, DELay, EMPhasizer, EVAluator, EVIdential, RECover topic, TOPic shift. Sequential includes: DSP Direct SPeech, FRAme marker opening. FRC frame marker closing, INI initiates action. Inferential includes: CTX contextual, JUStification, MITigator, PREsupposition. PRO proximity (monitors shared background), SITuation of narrative world (see Gonz
alez, 2004: 379e380, Appendix 2). WYF is way-finding. WFD is word-finding.

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Simmons-Mackie, Nina, Damico, Jack, 1997. Reformulating the definition of compensatory strategies in aphasia. Aphasiology 11, 761e781. Tottie, Gunnel, 2011. Uh and Um as sociolinguistic markers in British English. Int. J. Corpus Linguist. 16 (2), 173e197. Wieling, Martijn, Grieve, Jack, Bouma, Gosse, Fruehwald, Josef, Coleman, John, Liberman, Mark, 2016. Variation and change in the use of hesitation markers in Germanic languages. Lang. Dynam. Change 6, 199e234. Wilson, Brent, 2007. A Functional Exploration of Discourse Markers by an Individual with Dementia of the Alzheimer's Type: a Conversation Analytic Perspective. Unpublished PhD dissertation, University of Louisiana-Lafayette, USA. Van der Wouden, Ton, Foolen, Ad, 2015. Dutch particles in the right periphery. In: Hancil, S., Haselow, A., Post, M. (Eds.), Final Particles. De Gruyter Mouton, Berlin, pp. 221e247. Boyd Davis, PhD, is Cone Professor and Professor of Applied Linguistics, University of North CarolinaeCharlotte. Her research emphasizes sociohistorical approaches to narrative, pragmatics and stance, especially in medical discourse and Alzheimer's speech, and digital corpora. She is co-PI of the Carolinas Conversation Collection, an NIH-supported web portal to several hundred conversational interviews with impaired/unimpaired older persons. Her most recent publications include Pragmatics in Dementia Discourse (Cambridge Scholars, with J. Guendouzi, 2013), and discussions co-authored with Maclagan in Dialogue and Dementia (2014); Routledge Handbook of Language and Health Communication (2014); Multilingual Interaction and Dementia (2017) and the Journal of Pragmatics (2018). Margaret Maclagan, PhD is a retired Professor in Communication Disorders, University of Canterbury, New Zealand, where she specializes in sound change over time in M aori, change in New Zealand English, and discourse in Alzheimer's Disease. Her most recent book, New Zealand English (with J. Hay and E. Gordon) was published by Edinburgh University Press, 2008; her most recent discussions of language in dementia are published in The Routledge Handbook of Language and Health Communication (2014), Dialogue and Dementia: Cognitive and Communicative Resources for Engagement (2014) and the Journal of Pragmatics (2018).

Please cite this article as: Davis, B.H., Maclagan, M.A., UH as a pragmatic marker in dementia discourse, Journal of Pragmatics, https://doi.org/10.1016/j.pragma.2018.12.005