The Science of the Voices in your Head – with Charles Fernyhough

last time I was here there was also a TV crew there's a also camera crew is a TV camera crew and they were filming an episode of Impractical Jokers the comedy program and it involved this comedian having to stand up here before my talk and give an impromptu could totally improvised utterly spoof lecture on memory my talk was quite good in comparison so I'm hoping the same sort of hoping the same effect will all happen tonight it's very appropriate that we are starting with comedy because my story starts with Mel Gibson playing a character called Nick Marshall and advertising executive who after a freak accident involving a bathtub a hairdryer and copious quantities of red wine comes to with an uncanny ability to read people's minds to listen in to their thoughts and the reason I mention this rather silly example was somebody dealing with other people's thoughts is that when Mel listens into people's thoughts he really does overhear them he hears what people are saying to themselves thinking in this depiction of it is a conversation it is something that a person is saying to herself as she's going about her business so in this clip here Mel is listening listening in to what his boss Darcy is saying to herself in some particular situation at work so the reason I mention it is to try to illustrate the fact that thinking for many of us is a verbal process it involves language involves some kind of speech and in fact when you ask people to reflect on their own experience this is very much what people say lots of people say there are there are words in the head there's other stuff of course there as well there is music there are images there's all sorts of things that make up what William James at the end of the 19th century memory memorably called the stream of consciousness but verbal qualities seem to be particularly important and many many people will say that their thoughts have something of the linguistic about them and you get this if you ask people more formally to reflect on their own experience if you ask them to fill in questionnaires and so on so I'm interested in where this comes from so I want to explore that phenomenon tonight I want to ask where do these words in the head come from what are they doing there and what are they like I came to this topic as a developmental psychologist I'm interested in I was interested in Italy as a psychologist in the development of children and babies and I became particularly focused on one particular aspect of babies of children's developing experience how they come to use language in their thinking so my interest is a development of psychologist is in where does this language come from what is it doing there and what is it like to use the technical term what is its phenomenology and for me the most useful the most powerful the most profound views on this come from the Russian psychologists lived the ghost of a goat Sookie who flourished in the 20s and 30s in the early Soviet Union so I'm going to say a bit about vygotsky's ideas but I'm going to illustrate them first of all with the case of a small child those of you who came to my Royal Institution talking way back in 2010 will recognize my little unpaid research assistant my daughter Athena who here is about 2 and a quarter she's now 16 and nearly 6 foot tall and she really doesn't mind I still haven't paid her but she doesn't mind me doing this and what I'm going to do is show you a little clip of Athena playing with her toys and I should say that her speech like the speech of many toddlers is rather indistinct so what I've done is I've translated it for you so I've sort of spelt out what she's saying just in case you can't make it out okay it doesn't ask a simple question who is Athena talking to any suggestions I'm hearing quite a lot of herself and I agree okay I think you get a really strong impression from watching this the Athena isn't engaged in a private monologue dialogue she's talking to herself not all the way through so right at the beginning she says I'm gonna make a train track I didn't put the daddy up there but right at beginning she does mention my name she says I'm gonna make a train track daddy and when we're coding children's language in this way we would count that as social speech because it uses my name it's addressed to me but that's right at the beginning and then for the rest of the clip I could have got on a spaceship and flown to Mars for all she cared it wouldn't have made any difference to her she was talking to herself it's a curious finding that children do more of this kind of speech she's completely normal by the way this is what children do children between the ages of 2 & 8 roughly do this all the time and if you if you've got access to a small child and a chance to listen to them playing you'll hear this kind of thing going on okay she's so she's completely normal and it seems to be a completely typical aspect of children's experience that they talk to themselves whilst they're playing they seem to do more of it when they're other people around but they're nevertheless focusing the words on themselves and this is where Vygotsky comes in because if akatsuki had a lovely clear simple theory of how all this works he argues that children are born into a social world they don't have to become social they don't have to learn to be social they are born social they're engaging with other people from the very first days of life as language develops that becomes a linguistic process of communication so they're engaged in social dialogue from almost as soon as they've got language and then they go through a stage of what Vygotsky called internalization when that conversation that the child is having with another person becomes taken on into the self and she starts to do it for herself she conducts the entire dialogue for herself but she's still doing it out loud this is the stage known as a private speech and you just saw an illustration of private speech in that clip from Athena so it's talking to yourself out loud but talking to yourself then according to the Gonski there's a bit more internalization and all that that stuff that was going on externally becomes totally internalized so it's just going on in the head and that is your inner speech that is the words in your head that you hear when you're walking to work when you're lying in the bath when you're preparing dinner in the kitchen that internal conversation started out developmentally as an external conversation so it's a pretty simple idea it's slightly more complicated than that because because you thought that as language is internalized it changes and in particular it becomes abbreviated it becomes shortened so for example Athena says to herself I need some cars and she answers herself to cars she doesn't say I need two cars I need two cars for my train track she says two cars so the sentence the utterance is squashed up compressed condensed like a telegraphic form of what might be said in an external conversation note also something interesting about Athena's language in that little extract I need some cars two cars she's talking to herself in the form of a dial out of a dialogue she's saying to herself at one point she says what am i doing I'm gonna build a train track she's asking herself a question and then answering it so she's doing that whole dialogue for herself that initially according to Vygotsky would have been done between two people then becomes conducted outloud for the self and then ultimately is done entirely internally entirely silently that is your inner speech now I found this as a PhD student in the 1990s found ly interesting idea and I thought it suggested all sorts of lines of research that I couldn't see being explored a couple of the things that I focused on are the implication that our inner speech should have a dialogic quality when we talk to ourselves it should be like a dialogue and as we'll see that's pretty important for what follows another implication is that there should be different kinds of inner speech remember what I said about these processes of transformation of abbreviation that happen when speech is internalized well that should mean that our inner speech takes different forms and I focused in particular on two kinds one that I call expanded in a speech and one that I call condensed in a speech expanded in a speech is when you're having a conversation with yourself and it really is a full-blown conversation you're saying yes a full sentence to yourself and then you're answering it and a full sentence and the words are fully expanded and and stretched out condensed in a speech is probably more like what we're doing most of the time condensed in a speech is that note form version it's the two cars it's the stripped-down abbreviated version of in a speech and that we should end the implication that I'm interested in is that we should be able to move but we should be able to do all these different kinds of in a speech and move between them as we as not just as we grow up but as adults as well so another show of hands hands up if you if you ever talk to yourself out loud okay thank you thank you for being honest it's a wonderful honest audience here I said a lots of people think it's a bit weird to say to admit that you talk to yourself out loud I do it the whole time and I don't see why people have a hang-up about it and in fact it's exactly what you'd predict from vygotsky's theory this is my modification of that diagram I showed you earlier so remember we had this diagram with a couple of slides ago and I've just flipped it around so we start off at the bottom with social speech we move up to private speech and then we've got two kinds of in a speech we've got the expanded form where you're really having a conversation with yourself and you're putting a point of view forward and then you're answering it and you're saying all the objections to it and then you're putting in a counter punch in and so on you're really going to town you're really having that full-blown internal conversation that's your expanded in a speech and then you've got your condensed in a speech which is much more stripped-down telegraphic it's like you're sending telegrams to yourself it's like you're thinking to yourself in note form you can move between all these levels is you don't just have one or the other you're moving between all these levels all the time including moving from inner speech back to private speech adults do it as well Vygotsky seem to think that for the outloud private speech goes away as children develop but it doesn't keep adults do it the whole time okay that's the basic sort of structure of my modification of the Garcias scheme and as we'll see that's that suggests all sorts of interesting research ideas which I'll touch on in what's to come a more important question before we go any further though is how the hell in a speech is by definition private in a speech is something that only you know about if you were Mel Gibson you could peer into the mind of the person next to you but we're not Mel Gibson at what I didn't mention of course was the the really dodgy thing about this movie which is that Mel can read people's minds but he can only read women's minds so he can he can work out what women are thinking which is of course extremely important in his life so it was pointed out to me that a much more politically sound example of somebody doing this kind of thing is Sookie Stackhouse from True Blood seek he also listens in to people's thoughts she's telepathic she can hear what people are thinking and when she does she hears people speaking thinking is a kind of speaking so I'm neither male nor Sookie I've got to use more more mortal kind of ways of of studying of stuff there are things I can do I can look at individual differences so I can look at differences in the in the extent which one person uses in a speech compared to another and I can see whether that correlates with their performance on psychological tests I can do what psychologists call a dual task paradigm and that simply means if you think that using in a speech is important for a particular task then make the person do that task while at the same time trying to knock out there in a speech stopping them from using language making them do the task if in a speech is important for that task then stopping them using in a speech should mess up their performance so you give them two tasks at the same time one is the task that you're interested in one is designed to knock out your ability to do it to use any language including in a speech and that's a pretty useful way of studying this stuff we can do phenomenological studies and here I could in mind simply asking people giving them a questionnaire and saying do you do a lot of inner speech once you're in a speech light we can do that that's fine we can do more in-depth experience sampling and I'm going to give you an example of that in a second and we can look at the brain so there are various things we can do I'm going to show you some fMRI dates here in a second we can also use neuro stimulation artificially changing the activity of the brain for brief periods of time to see what effect it has on people's performance on tasks and we can look at neuro psychology this has been around for well over 100 years the idea that studying naturally-occurring brain damage can tell you something about what BOTS what parts of the brain are involved so as that PhD student in the 1990s people were looking at me and shaking their heads and saying no you can't you can't study in a speech but actually things have changed a lot so when you scientists asked me to review this a couple of years ago for this cover feature there was plenty to talk about there was plenty of research out there and my colleague Ben Alderson day and I reviewed the literature just last year for Psychological bulletin and there's something like two hundred and fifty references in that paper there's a lot of published research that we could point to that was relevant to this so plenty of examples of this kind of research coming up I'll start with one example of what I call phenomenological studies and here we're simply using a smartphone app so this thing called inner life we designed you open it up you choose a time period in which you want to be alerted a slot within your day when you feel you want to answer these questions and then when the alert goes off that your phone beeps or whatever you get some questions to answer so you get a quick little questionnaire about what your thinking was like at that particular moment and we found some quite interesting results or using this app with a sample of students we found that it kind of correlated with what people were saying in ordinary questionnaires and we think it's a useful way of studying this stuff going forward one problem though is that asking people about their inner experience is problematic and the reason for that is that people tend to have very strong preconceptions about their experience if I asked you individually now whether you taught yourself quite a few of you would probably say yes I'm doing it all the time I never stopped talking to myself and that's fine it's a very strong impression that people have but it's probably false I used to think that I talk to myself all the time but I don't I don't now I think I've probably talked to myself quite a lot and when I do it's very salient it's very noticeable but I think a lot of the time I'm not actually doing it I'll give you some reasons for that in a second but it makes us worry about questionnaires it makes us worry about apps because we think all you're really doing if you're asking people what their inner experience is like is you're asking about their preconceptions what do you think your inner experience is like rather than what does it actually like so we've been using a method a kind of experience sampling known as descriptive experience sampling which I'll describe to you now it was developed it has been developed over a period of 40 years or so by the psychologist Russell Hurlburt at the University of nob Nevada Las Vegas and it involves some rather low tech equipment it evolved this thing the thing he calls a beeper which clips to your belt very much like this microphone thing that I'm wearing and it has an earpiece that goes into your ear a bit like this thing I've got on my head and you wear this thing for a few hours in a particular day and every so often randomly the thing will be a beep will sound in your ear and then you've got an important task to do what you have to do at that moment is think about what was going on just before the beep beep and you had to make quick notes for yourself about what you were thinking about what was in your experience and then the next day you come into the lab and we grill you on those moments of experience so we sit down for an hour or so and we take you through each of the six or so beeps you might have collected the day before we can spend 20 minutes half an hour talking about one tiny moment of experience it's completely fascinating it's very hard to do for the participants and the crucial thing is you have to you're no good at it when you start you have to keep doing it you have to do it over a few days so that you can get better at it and it's fascinating to see how people's ability to do this thing changes over the course of a few days so it's not something that you just come in and do as a one-off thing it's something that you have to learn to do over the course of a few days and that's crucial for what I'm about to describe to you which is a study that we did in Berlin at the Max Planck Institute what we wanted to do is for the first time ever combine this very detailed method of getting at people's inner experience with the power of neuroimaging and in order to do that we had to have quite a complicated study design this is that study design all I want you to take from this slide is wow it's complicated now actually I want you to take a slightly more from that this is how people moved through the study they started here they did a week's work of a week's worth of work with us came back to the second week's worth of work and finished here the first week they were doing beeping they were wearing the beeper they were going about their everyday lives they were riding the u-bahn they were going to college they were going to work they were doing whatever they do in Berlin and they were wearing this thing every so often it was beeping and they were taking notes and they were coming into the lab and we were talking about that we were training them up in doing this method okay so by the end of it they were crack des crack experience samplers they really knew what they were doing they were very good at it then we did it all over again but this time we did it in the MRI scanner so we were asking them to wear the beeper to listen to the beep to take notes we rigged it up so they could be lying in the scanner and their right hand was three other writing hands-free and they could write notes to themselves we give them 25 minutes in the scanner we take them out of the scanner take them across the corridor we'd sit them down and we'd interview them about the beeps they'd had in the scanner then we'd stick them back into the scanner to cook for another 25 minutes and they did that day after day they did that for like four or five days by the end of it we'd gathered gathered a huge amount of neuroimaging data we knew what the brain was doing through all of this time and we knew what the brain was doing at the moment that the beeps went off and the other main thing I want you to take from this diagram is this bit here it reads tasks elicited experience what people have always done when they've studied in a speech in the scanner if they put people in there in the brain scanner and they said right now do some inner speech so they might give them a sentence to say to themselves silently they give them a cue they say right do that bit of in a speech right now they scan their brains and they find certain things happen and they say right now we understand what's going on in the brain when people do in a speech when people talk to themselves we wanted to do that and we wanted to compare it with what happens when people do in a speech naturally when in a speech when people talk to themselves not because they've been told to do it by an experimenter but because they just naturally happened spontaneously to want to do some in a speech at that moment and because we collected all these beeps in the scanner we were able to look at all these beeps and say right worse some in the speech where is the inner speech happening where are people talking to themselves and then we could compare the kind of the activations when people were doing in a speech because they had to as we told them to with when they were doing it because they naturally spontaneously were doing it and this is what I'm going to show you now we focused on two particular parts of the brain we focused on this area called colloquially known as Broca's area it's sort of here in the brain it's the left inferior frontal gyrus and it's very very strongly implicated in language production if you have damage to this area you're going to have a failure you can have a problem in producing language and it always lights up when people do in a speech studies in the scanner they say this part of the brain always lights up we looked at a second area which is known as Heschl's gyrus and we picked this area because it's not meant to be involved in speech production it's meant to be put in volved in hearing stuff in processing speech and other sounds it wasn't meant to be a big speech production area so we didn't expect it to activate when people were doing in a speech and indeed all those studies that have been done previously find that it doesn't activate so I'm going to show you the activations that we had first of all in the elicited condition so remember this is where we asking people to do in a speech and they're doing it because we told them to and what you find is exactly as you predict when people are doing in a speech because they're told to Broca's area lights up and this area is not doing anything it's deactivating so it's exactly the pattern that you find from all these other studies that have been done but then remember we were able to look at the cases when people were naturally spontaneously producing this stuff when they were thinking because they wanted to they were thinking's naturally and spontaneously and we found the opposite pattern of findings don't worry about the red bars we're just looking at the the blue bars for now so this is the spontaneous in a speech when people are doing in a speech naturally there's nothing in broker there's no activation or tiny amount but there's a huge activation in this part of the brain which isn't supposed to be involved in speech you get completely the opposite pattern of findings depending on whether you ask people to do in a speech compared to when they do it naturally and spontaneously and we think the implications of this are pretty profound not least for all the studies that have gone about thinking that you can study this stuff simply by telling people to do it so I'm going to change tack slightly now and I'm gonna talk about an experience that I having having spoken about something that I think most people in this room will relate to I'm going to talk about an experience that many people probably wouldn't admit to probably wouldn't relate to I'm going to talk about the experience of hearing voices hearing voices when there is no one there hearing voices in the absence of any speaker usually associated with severe mental illness a diagnosis such as schizophrenia indeed if you have a diagnosis of schizophrenia around about 70% of people with that diagnosis will hear voices in medical terms it's known as auditory verbal hallucinations and it's often assumed that hearing voices just is schizophrenia the two things are the same but nothing could be further from the truth many many other psychiatric disorders have voice hearing associated with them so people hear voices in eating disorders post-traumatic stress disorder bipolar disorder the list goes on and on there is also a significant number of people who hear voices pretty regularly and they do not meet the criteria for mental illness because they're not mentally ill they hear voices they have this experience but that it doesn't bother them it doesn't distress them it doesn't mess up their lives they don't seek psychiatric help they don't get a psychiatric diagnosis instand and quite right - we think roughly 1% of people are in that bracket about as many people who have schizophrenia there's a lot of people who hear voices who are not mentally ill and then there's a much larger group of people somewhere between 5 to 15% of the population who will have fleeting one-off or very uncommon voice hearing experiences you can go even further and you you can say that among if we are incorporating if we're encompassing experiences that happen on the Verge's of sleep when at the moment of falling asleep or at the moment of waking up the proportion of people who have hallucinatory experiences there rises to about 80% in our studies so most people have hallucinations in that state so voice hearing happens to a whole lot of different people it seems to be a an aspect of human experience that is not indicative of mental illness necessarily it can be understood in all sorts of different ways and in fact it has been understood in very different ways particularly in the last 25 years or so with the growth of the International hearing voices movement people used to think that hearing voices just meant a severe mental illness like schizophrenia they don't anymore and people who hear voices get together they meet they talk about their experiences in groups they support each other they understand the resonances across the centuries and across cultures and so on and they've become an incredibly powerful force in the mental health world things are changing in terms of the awful stigma that's associated with hearing voices Arisa not changing fast enough a recent study in America showed that around about 50% of news reports about hearing voices associated it with violence which is a terribly skewed distorted view of this experience and in our project hearing the voice during with one of the things that we're trying to do is change public perceptions help people to understand that hearing voices is a natural part of human experience but why am I even talking about hearing voices surely I'm talking about something that's very deviant that's very unusual very strange that's very not part of everyone's experience well it actually seems to have a lot in common with the thing I've been talking about up to now the experience of in a speech and in particular there's quite a meet theory that accounts for hearing voices or tries to account for hearing voices in terms of in a speech and there's all sorts of psychological evidence from psychological tests and there's neuro scientific evidence as well so when you look at what's happening in the brain there's evidence to support this model the theory is very simple people who hear voices according to the theory hear a voice when they're actually just producing some inner speech they are just talking to themselves but for some reason they don't recognize it as something that they themselves have done so you might hear a voice saying go and get the milk and it seems to be coming from over here and it's strange and it's frightening and all the rest of it according to this theory all that's really happening there is you're thinking in inner speech go and get the milk but you're not recognizing it as your own utter ins for some reason you don't see it as your own work and this has quite a nice foundation in the brain remember I talked about this part of the front of the brain on the left Broca's area or the left inferior frontal gyrus which we know is important in inner speech generation and there are some parts of the brain of a further back ones an area known as Veronica's area which is an extremely important in speech perception and the idea of totally simple simply fiying here by the way but the basic idea is that what normally happens is that when you produce them in a speech you're thinking to yourself going at the milk it's almost like a signal is soon sent within your brain from that speech generation part of the brain to the speech perception area saying don't worry too much about this thing you're about to hear because you said it that's effectively the idea the the system the auditory system is is suppressed because it's getting a signal saying it was you that did that so don't you know they don't treat it as if it were an external utterance don't process it in that way just switch off don't worry about it and that seems to be what happens in the typical case so when we're talking to ourselves usually that message is getting through and we're not we're not perceiving our inner speech as external but for some reason the theory goes when people are hear voices that signal doesn't get through it's degraded it's delayed it doesn't happen at all something goes wrong with that signal and so this the message saying don't listen to this it's just you doesn't get through and so people produce them in a speech and they perceive it they experience it as an external voice so I'm simplifying hugely here there is a lot of support for this view it's a pretty good theory it's had a lot of support from lots of different areas there's a lots wrong with it we'll come to some ways in which it's problematic in a second but first I just want to suggest that there's no better way of tackling a topic that it is at the cutting edge of neuro scientific research then stepping back 600 years in time and looking at a medieval manuscript let's have another show of hands who's heard of Margery Kemp I'm not going to pick on volunteers there's a few hands gone up great thank you I think many more people should should have heard of Margery Kemp not least because she was an extraordinary larger-than-life character she lived at the end of the 14th and the beginning of the 15th century she was based in the town of Lynn in Norfolk nan and his King's Lynn she was married to John and and born him 14 children she'd failed in business twice and she heard voices and she saw things and she had mystical experiences which she wrote about in her famous book she believes she was hearing the voice of God and of other biblical actors of other characters from from Scripture and she wrote about them in this extraordinary book she herself couldn't write so she dictated it to ascribe and this is the book of Marjorie Kemp this is it Edie there is one of them this is the manuscript and this is a photograph I took of the book when I went to visit her at the British Library of which more later it is unique this is the book of Marjorie Kemp but it was written down in about 1440 and the reason more of you should know about Marjorie Kemp is that this book is also the first autobiography in the English language nobody man or woman had ever written about their life before in English so Marjorie Kemp should be a she is a literary Colossus but she should be known more widely as such why am i interested in her well for all sorts of reasons not least because she writes about her voice hearing she writes about her experiences of hearing voices and she shows us that this experience is a very diverse one it comes in all sorts of shapes and sizes and I'm going to give you a few little examples with the English with the middle Englishman and little modern English translation for you sometimes she hears a voice that is clear external speech so in this one of her earliest experiences she she hears Jesus speaking to her saying daughter why have you why have you forsaken me when I never forsook you sometimes she hears a voice she hears something that is auditory but nonverbal so she hears a sound but it's not words so in this case she's hearing the voice of the Holy there's the the sound of the Holy Ghost as if it had been a pair of bellows blowing in her ear okay so the sound that she the communication the things she's hearing sounds like a pair of bellows for pumping up a fire sometimes she hears a voice that is auditory but not even human and then our Lord turned that sound into the voice of a dove so she hears the voice of God but it's the voice of a dove and another bit later on in the same passage she talks about it being turned into the voice of a robin redbreast she also has experiences that are multi-sensory she doesn't just hear Jesus in that first example she sees him clad in a mantle of purple silk sitting on her bedside and we've argued that these experiences resonate very neatly with the experiences of voice hearers today when you ask people as we did in this survey published last year in The Lancet Psychiatry when you ask people who hear voices what their experience is like they give you this incredible range of phenomena they tell you about things that a clear external speech and other things that are much more obscure and hard to pin down they talk about other bodily sensations so about two thirds of the people who answer wrote in response to our survey said they had certain bubbly feelings that went with their voice hearing like a feeling of prickling or burning on the skin for example lots of people said their voices were often a mixture between voices and the thoughts so it's not the case that voices are always these really clear externally located experiences the highly diverse and think about Marjorie came and working in this interdisciplinary project hearing the voice at Durham which is supported by welcome has brought me into contact with people who are studying this phenomenon from very different perspectives such as the medieval scholar Koren Saunders and working with Koren on Marjorie Kemp's writings has made me think differently about my science has made me think differently about how I approach in a speech and I wanted to try and flesh a bit of that out to be some of the research that we've done that fits with that and in particular I want to focus on this idea of an inner dialogue you're talking silently in your head but you're talking to yourself it's a two and a fro is a give-and-take it's two sides it's a dialogue and I was thinking about how how does that work psychologically it doesn't fit with any of the previous theories of in a speech because nobody had ever thought about in a speech as a dialogue before they'd always thought of it as a monologue so I started to think how can we how could construct a theory that makes sense of that so I thought well what you could have in an inner dialogue is you could have me speaking you could have a some way of representing what I'm saying this is the process of in a speech generation but then you've also got a represent that other point of view that other perspective in the dialogue with which I'm having a to and fro so let's call it the me as interlocutor or the person that I'm speaking to and this is the sort of basic psychological structure of the dialogue crucially that me is interlocutor is occupying what I call the open tslot I can have a conversation with myself but I can have a conversation with other people as well I can have an internal conversation with my mum for example my dear sister Claire is here in the audience as well and I thought about including some photos of her from the 1980s I think she'll thank me she'll thank me later for not doing so so I can talk to my mom or my sister in my head quite happily if I Marjorie I can talk to God in my head I can have an internal conversation with anyone because of that dialogic structure that has been established through the process of how I developed as a child because I was having conversations with other people that I was then internalizing I've got this internal dialogic structure that enables me to have conversations internally with all sorts of other other individuals one person told me recently that she has a very frequent internal dialogues with with other people but people who are no longer with us she has conversations with with dead people who she know you know people who have passed away from her from her life to me that makes perfect sense that's what inner dialogue is for you can talk to yourself but you can talk to other people and you can talk to God and the angels and whoever you want to talk to back to the book of Marjorie Kemp I mentioned that Marjorie lived in Lynn or King's Lynn in Norfolk and if he turns this page of Marjorie's book you see this interesting reference in the margin which says Dame Julianne and this is a reference to Julian of Norwich hands up if you've heard of Julian of Norwich thank you slightly more slightly more people have heard of Julian of Norwich than Marjorie she should also be more famous than she is because Julian wrote a book called revelations of divine love she's got a man's name is a bit weird isn't it she's called Julian because she's associated she was an anchor at an anchorite in other words she was a nun a holy person who lived in a Cell attached to a church and the church she was attached he wasn't Julian's Church in in Norwich so she's known as Julian of Norwich we don't actually know what she was what her name was what her real name was but she's known as Julian of Norwich so despite the the blokes name she's very much she and she wrote the first book in English known to have been written by a woman she was the first female writer in English which is a pretty massive claim to fame and she's unjustly neglected the reason I'm interested in in Julian because she also heard voices and saw things and had unusual experiences and this reference in Marjorie's book is where Margery is hearing a voice instructing her to go to Norwich and to seek out Julian and to talk to her about her experiences because Julian has wisdom in these matters and Julian will help you to understand if the voices you're hearing of the true voice of God so that's what this passage in Marjorie's book is saying go to Norwich talk to this this Julian woman so the two women met they met almost exactly 600 years ago we think round about the year 1415 in Norwich they spent a few days together according to Marjorie and they talked about the voices I like to think of it as an early hearing voices group Julian is a very very different character utterly fascinating brilliant writer great theologian she also heard voices and she also had very diverse experiences so in this example she's hearing the voice she's just had a vision of the devil and she's saying I heard a bodily jangling a kind of commotion as if it had been of two bodies and both to my thinking were jangling at the same time as if they've been holding a parliament or a meeting with a great business and all was soft muttering and as I understood nothing of what they said and all this was to stir me to despair so she's describing an experience which is quite common for people who hear voices that of overhearing an obscured conversation a conversation that you can only hear indistinctly so you know some people are talking but you can't work out what they're saying and it can be quite distressing it can be quiet anxiety provoking and this is Judy and writing about it at six hundred years ago so as part of the work that I've been doing with hearing the voice part the work I've been doing with welcome an opportunity arose to do something to indulge this fascination with these two incredibly important women writers and as welcome we're planning their latest exhibition this is a voice which is on now and will run until the end of July they wanted to include something on hearing voices so I helped them to put their exhibit together and I was very keen in particular that we should at least have a go at getting the manuscripts remember there is only one version of Marjorie's manuscript it's held in the British Library there are few versions of Julian's manuscript but they're all so utterly unique and we thought we'd have a go borrowing them and thankfully we were able to persuade them that around these two manuscripts we could create a really powerful exhibit and that's what we we did we secured the loan didn't realize it at the time but it was the first time the two manuscripts had ever been displayed together which i think isn't amazing but given that these two women met the two manuscripts hadn't been shown together ever and this is how it was covered in The Guardian a few weeks ago and if you go to the exhibition which is a welcome collection on opposite Houston it's a free exhibition you will see these two manuscripts you will see the book of Marjorie Kemp it's not usually on display at the British library's but it's on display now this is what you'll see on the left is Marjorie's book you'll see the page of Marjorie this is exactly the page of Marjorie's but you'll see when you go to the exhibition and on the right is Julian's book unions book you know in a later edition it's it's a it's probably copied around 1625 there is an earlier version of Julian but we couldn't secure a loan of that because the British tribe we didn't want to leave too utterly priceless you know they're obviously priceless but utterly unique manuscripts out of the building at the same time so we had one of the slightly later versions of Julian when you see the Marjorie's book it's quite small it's quite hard to read unless you're a medieval English scholar so I'm gonna help you out a bit here you see this page on little on the left you noticed by the way the love heart in the margin the monks who looked after this book after it was written down were big fans of marginalia as we've already seen and I like to think that this monk just was just making indicating that he really liked this passage I really like it I'm gonna zoom in on it it's kind of up here I'm zooming in and you can see the original text of three bits that I've just mentioned to you as if it had been a pair of bellows blowing in her ear and then later on she talks about the voice of a dove and then a little bird that is called a red breast at the bottom there so that's the page that you will see of Marjorie's text if we look at Julian's text now this is a famous passage where Julian has had an experience one of her first is her first revelation in fact and she's looking down at the palm of her own hand and she sees a tiny little thing about the size of a hazelnut in her hand and she thinks to herself she in an inner speech she says to herself what could it be and she hears a voice saying it is all that is made so she hears the voice of God saying that little thing you see in your hand about the size of a house on that is the entirety of my creation it is everything that I made and this script is much much clearer and in this she showed me a little thing the quantity in other words the size of a hazelnut lying in the palm of my hand and she says what made that what made us be and it was answer generally thus it is all that is made so that's the bit that you'll see of Julian's text in the light in the Welcome exhibition so we thought by putting these two texts together the incredibly rich description of hearing voices that they give us the word the way they resonate across the centuries even better would be if we could get some young people who hear voices to make something to go into the exhibition and so we an artist worked with a group of young people who hear voices and they created this artwork it's called everyday objects belonging to a voice hero and on one side of the panel you can see the accurate everyday objects belong to a voice hero on the other you can see everyday objects belonging to an envoy Sarah and the point is I don't know how clearly you can see it but if you can if you look at it you know in the flesh as it were in the exhibition you'll see there's no there's no difference you can't tell which belongs to the voice here and which belongs to the non voice here and that's the whole point so do get it do go along and have a look at the exhibition if you can I think it's a really powerful and hopefully quite well-balanced account of hearing voices I'm going to go back to a little bit of science to finish off and I want to zoom in again on this issue of internal dialogue this is a pretty scary diagram from that article that I mentioned Ben Alderson day and I published last year which was our big review on in a speech and all this is doing really is showing that a particular part of the cognitive system this thing here if any of you studied psychology you'll know about working memory the working memory system and the working memory system is the bit of a bit of a bit of the mind that allows us to rehearse information keep information in mind if you think about how if you're walking around the supermarket and you're reciting to yourself the last few items on your shopping list you're using working memory you're talking to yourself for a particular purpose to keep things in memory and that's all that scary bit there is and then there's a scary bit up here which is really just showing you the aspect that I've already mentioned of how you have to keep another person's perspective in mind and it is called theory of mind or social cognition you may well have come across these terms theory of mind is your ability to think about the minds of others and we argued that to do internal dialogue because you've got to represent these different points of view you must be doing some theory of mind so we're interested in how the language system interacts with the theory of mind system so it's really the same diagram as I showed you earlier on but just with a bit more psychological flesh on it and we thought well if it's true that some inner speech is dialogic has a quality of a dialogue if it's recruiting theory of mind if it's using bits of the brain that do theory of mind we should see they're happening in the scanner so we did the first study that try to get people doing in a speech that was more like the kind of inner speech that I think we do spontaneously in other words a dialogue in internal dialogue so we ask people to go into the scanner this is in the university scanner in Middlesbrough and in the scanner they were asked to generate some in a speech and in two conditions they were either doing it in the condition of a monologue or they were doing it as a dialogue and they were given a scenarios they were asked to imagine going back to their old school and conducting it in a speech either a monologue giving a speech to the student or a dialog having a conversation with an old head teacher and we had a sequence of these scenarios and we looked at what was going on in the brain when people were doing this stuff and here are some blobs for you we were able to work out what was special about the dialogic in a speech by comparing the activations when people were doing dialogic in a speech and subtracting away the activations when people were doing more logic in a speech so the blue bits here represent the dialogic over on mana logic comparison in other words it's what's going on that's special in the brain when you're doing dialogue the yellow bits represent your theory of mind system so we've got people doing theory of mind tasks and scan them as they were thinking about other people's minds the crucial thing then the thing we were really interested in it was is there a conjunction are there any bits of the brain that are activated in both and that's that's the kind of thing that neuroscientists get excited about when you see an overlap between regions and we thought we had found such an overlap in the right hemisphere in an area roughly around the temporoparietal junction which is quite a big area from lots of previous studies in the theory of mind so we we were quite excited about this because we thought we've got an interaction between a language system and a theory of mine system just as we predicted this is how its illustrated in my book in some in a lovely diagram prepared by Mary Robson who did all the diagrams in the book this is our left hemisphere language system is our in a speech Network and this is our right hemisphere theory of mind system and the idea we argue that our findings support an interaction a conversation between these two different parts of the brain one involved in language one involved in thinking about other minds if you put the two things together you've got in a dialogue some other research that we've been doing recently suggests that more general aspects of brain development might play a role so we had access to a sample of brain scans from some patients with schizophrenia in Australia and working jane garrison who led the study at Cambridge had developed expertise in being able to measure a particular part of the brain known as the para cingulate sulcus and it's a little fold that's kind of deep down inside your brain towards the front and the interesting thing about the PCs is that it varies in length here's a picture of somebody with a long PCs can you see the red thing here and here's a picture of somebody with a short piece yes when you you probably all you won't all have a pcs most of you will have one and it will vary in length hugely between between you and some previous research that the team at Cambridge had been doing suggested that this particular fold in the brain correlated with how good people were distinguishing between stuff that happened internally things that they'd imagined versus things that happened externally and so we predict that this might play a role in whether people were likely to hallucinate the idea is that if you hallucinate what's going on is that you're producing something internally like some in a speech but you're not recognizing it as your own so you're mistaking it for something that happened externally that's why we were interested in this part of the brain and we found quite a meat correlation we found there's no difference actually between healthy control subjects without a diagnosis and the schizophrenia patients who didn't hallucinate so we had information on whether the patients had hallucinations or not healthy controls were no different I mean there's a slight difference but it's not statistically significant healthy controls were no different to schizophrenia patients who didn't hallucinate in the length of this fold but they were significantly different to the schizophrenia patients who did hallucinate so among people with schizophrenia the length of this fold predicted how likely they were to have hallucinations and we found that for every one centimeter that this particular fold reduced in length these patients likelihood of having hallucinations increased by 20% this work was covered by Jonathan in fact for BBC News and he did a really good job of it we were really delighted with the way he covered it and not least because most of the other study most of the other reports on this would have said something that frontal brain link wrinkle frontal brain wrinkle linked to schizophrenia and of course that isn't what we showed but this wasn't about saying this is what a schizophrenic brain looks like it was about saying among a bunch of people with schizophrenia there is this interesting different so it we linked it to her as nations not to schizophrenia okay I'm just going to end with a few outstanding questions for research some of the things that we're interested in going forward some of the things that were where I think the big the big the important breakthroughs will happen in the future so one interesting issue is about the extent to which voices are communicative this is a picture of Joe Atkinson who's a psychologist UCL whose focuses on deaf cognition so she herself has been deaf since childhood and she's done some amazing work on people with who are deaf including deaf people who hear voices and you might think this is completely paradoxical does sound a bit strange that's somebody who in some cases people who have been who have never heard anything who who have always been Deaf will hear voices but they do and if you ask them they produce exactly the right appropriate signs for hearing voices you say to them you can't be hearing voices your death they say I'm hearing voices so Joe's work is profoundly important to us and we're collaborating with her because we're interested in something it tells us about this experience of hearing voices it's not about an auditory phenomenon it's not about sound it's about something else and in particular we think hearing voices is about at least some of them at least part of the experience is about sensing that someone is trying to communicate with you so we're working with Gerry on that topic more generally we're interested in the social quality of voices and the extent to which theory can account for the fact that voices involve a kind of social interaction a lot of voices don't seem to fit with the inner speech model so someone like Ellen or Longdon who we collaborate with in her very highly a very popular TED talk has written about the role of trauma in hearing voices and so we think there are different kinds of voice hearing experience and they need to be understood differently we need to know how these experiences develop and we need to unpack the implications for therapy if there are these different kinds of voices that have different underpinnings what does that mean for the way that we try and deal with them in terms of trying to help people who who are seeking help so there's a lot of interesting research still to be done I hope I've given you a flavor of how varied the ordinary voice is in our head ah but also of how varied the more unusual experience of voice hearing is showing you some of the connections between the two and giving you some food for thought I guess this is the book and this is it in its lovely US Edition which is coming up soon and finally a few acknowledgments thank you people use in a speech for all sorts of emotional and motivational purposes we talk to ourselves to G ourselves up to tell ourselves off to encourage ourselves and so on so I think there's a whole range of different functions I think inner speech has as many functions as ordinary language out loud it does

Channel: The Royal Institution

Views: 270,826

Rating: 4.7348585 out of 5

Keywords: Ri, Royal Institution, psychology, charles fernyhough, voices, hearing voices, inner voice, psychiatry

Id: 95otBlepVHc

Length: 60min 25sec (3625 seconds)

Published: Wed Sep 14 2016

Reddit Comments

[u/WiggleBooks]

I thought that the Bicameral Mind theory of consciousness was debunked or at least not the opinion of scientists anymore

[u/edessahines]

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