Hearing Voices

“Stupid, stupid!” says the silent imagined voice as a glass pitcher crashes to the floor—while for others, inner voices sound real; some even shout with paranoid suspicions and dangerous commands. New research is using AI assistance to help decode the inner speech of people with ALS and other health conditions that impair the ability to speak. But it’s also creating fears about eavesdropping on secret thoughts.

Basic questions persist, meanwhile, about whether unspoken thoughts even exist in a language-based form, according to The New York Times. Some argue there is no such thing as inner speech, while others say they hear their thoughts as an inner voice and “use language to perform the very act of thinking.”

“We don’t need language to think,” M.I.T. cognitive neuroscientist Evelina Fedorenko told the Times. That’s based on brain scans that map the production of language. While Fedorenko hears an inner voice, *she says “her husband does not,” and that “many people have no idea what you’re talking about when you say you have an inner voice.”

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As for inner voices that can command people diagnosed with schizophrenia, therapists have actively conversed with those voices to discover childhood trauma and help relieve symptoms. In her TED talk titled “The voices in my head,” English psychologist Eleanor Longden traces her recovery from schizophrenia to therapists willing to converse with her most disturbing inner voices.

“There’s nothing inside of anyone that can hurt if they’re not afraid of it,” Harvard psychologist Richard Schwartz told a Psychotherapy Networker Symposium in DC. Around 10% of people may have experienced hearing voices at least once in their lifetime, but these rarely persist or disrupt daily life. In a survey of 450 people by the Hearing Voices Network—comprised of some 200 groups worldwide—one-third said they had no trouble with their voices.

From Chopin’s tinkling piano music to animal calls, the phenomenon of auditory verbal hallucinations (AVH) covers a wide range of imagined sounds, including voices. Hearing imagined music often occurs in the presence of running water and motors, especially old air-conditioners: called Musical Ear Syndrome, it’s a form of pareidolia, which usually refers to visual hallucinations such as seeing animals in clouds. Explains neuroscience writer Philip Jaekl in Nautilus, pareidolia results from the human tendency to perceive “patterns in randomness where none exist.”

Alternatively, the absence of an inner voice is called aphantasia. As one subject explained in a Frontiers in Psychology overview titled “The Silent Mind,” “I silently think and silently read (with no auditory ‘voice’).” While aphantasia usually refers to the inability to form mental pictures, 2% to 5% of all people report a complete absence of auditory imagery.

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Silencing of the spoken voice, by contrast, occurs in mental health conditions such as selective mutism and what used to be called hysterical mutism, both often related to trauma. Psychiatric treatment of mutism to help solve a murder has featured in recent mystery novels like Alex Michaelides’s The Silent Patient—though, due to complicating factors such as suggested and false memories, psychotherapy has not proved useful in real-life cases.

Different inner voice experiences—from AVH that produce actual sound to imagined voices—emerge from the constellation of regions in the brain that produce language, according to The New York Times. In the typical brain, explains Stanford neuroscience research Erin Kunz, “The language network… issues commands” to the muscles to create speech or sign language or text.

An AI-assisted computer successfully predicted with 97.5% accuracy specific words that had been imagined by subjects in the Stanford research. For patients with ALS, whose weakened vocal muscles made speaking difficult, the computer generated vocalizations based on early recordings of their voices. One study participant used this brain-machine interface to hold conversations with family and friends.

“We wanted to investigate if there was a risk of the system decoding words that weren’t meant to be said aloud,” Kunz said. When patients were asked to silently count the green squares in a large diagram, the computer reproduced numbers as the subjects counted them in their head. That is, the machine could “hear” *them counting, indicating that language is involved in some forms of thought, but also “some cause for concern” about eavesdropping.

For schizophrenic patients, encouraging them to act in response to their inner voice commands dates back to work by Scottish psychiatrist and author R.D. Laing. Today, Schwartz explained at the Networker symposium, practitioners of a therapy called “internal family systems” begin with the belief that we all have multiple personalities and inner voices—and that childhood trauma has caused some of these voices to become dysfunctional.

*The “uncanny valley” shared by many who hear audible inner voices is a sensation of realness accompanied by a lingering unease, according to Jaekl.

My “Stupid, stupid” voice, imagined but not actually heard, is only one auditory experience I’m trying to change — in this case, with substitutes such as “Oh dear,” or even “Brilliant!” I’m also working to allay mild misophonia—distracting irritation at repetitive noises that include dripping faucets, throat-clearing and snoring. But the auditory experience I most wish to change is a dramatic “startle” response at sudden unexpected noises, such as in movie theaters, that cause me to scream loudly and often with great embarrassment.