Circumstantiality
Circumstantiality is a style of thinking and speech in which the person eventually reaches the point of what they are trying to say, but only after travelling through a great many unnecessary and trivial details along the way. The overall goal of the thought is never lost, unlike in more disorganised patterns of thinking; it simply takes a long, winding route to get there.
This has traditionally been distinguished precisely by the fact that the goal is retained throughout, however indirect the path — the thinking is thorough and over-inclusive rather than genuinely directionless.
Recognition features
- The eventual answer to a question does arrive, but only after a long, detailed, and often tangential account
- Excessive, unnecessary detail is included at every step
- The overall goal of the conversation or train of thought is retained throughout, unlike in flight of ideas
- Attempts to redirect the person back to the point are often only briefly successful before the digression resumes
Eliciting it at interview
- Ask a simple, specific question and note whether the answer, when it eventually arrives, is preceded by an unusually long and detailed account of surrounding, tangential material
- Gently attempt to redirect the person and observe whether they can return to the point, however briefly, which helps distinguish this from more severely disorganised thinking
- Consider premorbid personality style and any history of epilepsy or learning disability, both of which have been associated with this pattern
Distinguishing features
- Differs from flight of ideas, in which the connections between ideas are driven by chance and the overall goal of the thought is lost entirely, rather than merely delayed
- Differs from tangentiality (in which the point is never reached at all), since in circumstantiality the person does eventually arrive at the answer
- The retained goal-directedness, however inefficient, is the key feature separating this from more disorganised forms of thought disturbance
Common misconceptions
- That circumstantiality is simply a personality trait of being talkative; it can also occur as part of the psychopathology of psychotic or organic conditions and is worth documenting as a formal finding
- That circumstantiality and flight of ideas are the same phenomenon just described differently; the two are separated by whether the underlying goal of the thought is preserved
Related phenomena
Practice this
Asked a simple question about when his symptoms began, a man gives a long, detailed, meandering account full of unnecessary tangents, and each time you try to redirect him he briefly returns to the point before digressing again. Eventually, several minutes later, he does answer the original question. What is this? · Asked a simple question, a patient produces a rapid stream of associated ideas — one word or image suggesting the next through rhyme, chance resemblance, or passing distraction — and after several minutes has still not addressed, or seemingly even registered, the original question at all. Before revealing the answer: is this circumstantiality? · A patient's speech takes a long, roundabout path before reaching a point. Before revealing the answer, decide what distinguishes circumstantiality from flight of ideas. · A patient takes a long, winding route through many side-topics before finishing their answer. Before revealing the answer, decide what would tell flight of ideas apart from circumstantiality. · You want to assess whether a patient's speech pattern is circumstantiality. Before revealing the answer, decide what you would specifically observe. · Explain why retained goal-directedness, despite the inefficiency, is what actually defines circumstantiality rather than simply talking at length.
Illustration
Asked simply whether he has been taking his medication, a 61-year-old man launches into a five-minute account of the pharmacy's opening hours, an unrelated disagreement with a neighbour about parking, and the make of his late father's car, before eventually confirming, almost as an aside, that yes, he has been taking the tablets every morning.
References
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 4, 'Disorders of Thought and Speech'.