This paper offers a biosemiotic account of the poetic aspects of gesture and speech in schizophrenia. The argument is that speech and gesture are not the mere expression of pre-verbal thoughts. Instead, meaning is enacted by the temporal and semantic coordination of speech and gesture. The bodily basis of language is highlighted by the fact that, failing to create language that is organized around topics, individuals with schizophrenia often rely on poetic associations in directing their utterances. Accordingly, the analysis of (...) schizophrenic speech and gesture based on McNeill’s Growth Point theory is enriched with reference to both Cowley’s (2007b) views on language as distributed social coordination, and Alexander’s (Biosemiotics 2(1):77–100, 2009) description of formal causes in nature. Schizophrenic language can be seen as a hypertrophied manifestation of the discourse-scaffolding function of poetic associations in speech and gesture. The analysis of schizophrenic language shows that language behavior need not be built on pre-verbal thoughts and important aspects of schizophrenic language, such as metalinguistic awareness and semiotic agency, can be clarified by applying concepts from biosemiotics. (shrink)