This paper aims to show how clinical pragmatics (the study of pragmatic deficits) can fruitfully inform the classical theoretical models proposed by philosophical pragmatics. In the first part of the paper I argue that theories proposed in the domain of philosophical pragmatics, as those elaborated by Austin and Grice, are not plausible from a cognitive point of view and that for this reason they cannot be useful to understand pragmatic deficits. In the second part, I show that Relevance Theory overcomes this limitation (being consistent with the data about actual mind’s functioning), but I also argue that it offers a restricted view of human communication which has to be integrated with a model of language use that takes into account a central pragmatic property: coherence of discourse.