When reviewing a person's history and their symptoms, a psychiatrist not only listens to the words a person is saying as they tell their story, but also to how they are saying those words.
This is a common part of a psychiatric evaluation because the way a person speaks often reflects their thoughts and their mood. Carefully noting different descriptive aspects of a person's speech provides important data that contributes to the patient's assessment.
In particular, a psychiatrist notes:
how many words a person is saying
how fluently they are speaking (i.e., are they having difficulty finding words)
how quickly they are speaking,
whether there are any notable rhythms to their speech (i.e., slurring, hesitations, )
how loudly they are speaking
the tone of their speech (i.e., child-like, low, whispered)
the prosody of their speech
Of the above, I find that prosody often tends to be the new concept for people, and that's why I wanted to cover it today.
The key idea is that a person typically has a predictable melody to their speech, which is a unique combination of the innate qualities of their voice and also reflects the language they are speaking. One can think of prosody as the net combination of rhythm and pitch, much like a song is a unique combination of particular notes combined with particular rhythms.
For example, when speaking English we can tell a lot about what a person is saying by how their voice is pitched throughout their sentences. Questions tend to end with a slightly higher pitch. Excitement leads to more rapid speech and perhaps speaking in a slightly higher pitch. Exhaustion can be accompanied by a bit of a mumble and overall slower speech.
A psychiatrist will make note of the rate and rhythm of a person's speech, but they will also listen for this overall melody, the prosody of their speech, with a few questions in mind:
Is there a change in the prosody of their voice from their last appointment?
Is their prosody on interview similar to prosodies typical of particular illnesses? For instance, severe depression can often lead to a person speaking with a typical rhythm but without the typical pitch changes as they move through their sentences. Often people describe this prosody type as flat.
Is the person aware that their prosody is unexpected or changed?
Over several appointments, psychiatrists will track the various characteristics of a person's speech as a way to monitor their mood and thought patterns. This data will be used to evaluate their treatment plan, and whether changes might need to be made moving forward.