Edinburgh International Book Festival: Charles Fernyhough: Voices in Our Heads

‘Our experience is full of words; we are talking, we are listening’

When Andy Murray was losing against Novak Djokovic, he went into the locker room, looked at himself in the mirror and said: ‘You are not losing this match’. ‘I was surprised,’ he said later, ‘ by my response.’

I can’t imagine that anyone who was hanging around in that locker room thought Murray was mad – but for those of us who are not the No 2 tennis player in the world, the reaction can be very different. Indeed, the invention of smart phones has been a great boon to anyone who likes to chat away as they walk down the street; now everyone thinks there’s someone else in our one-sided conversations – and according to Professor Charles Fernyhough, there is.

Fernyhough was talking with Richard Holloway (himself no stranger to this experience…) at the Edinburgh International Book Festival. The Durham University psychologist is co-director of Hearing the Voice, an interdisciplinary research project looking at the experience of hearing voices in the absence of any external stimuli; he’s also a best selling author whose latest book is The Voices Within: The History and Science of How We Talk to Ourselves. Talking to ourselves – which is generally seen as only mildly weird (even Einstein did it when he was trying to solve a problem) – may, Fernyhough suggests, be the key to understanding why some people hear voices – a phenomenon which, at least until recently, has been seen as very far from ‘normal’. 

To have an internal dialogue, you have to represent the mind of the other person you’re talking to (even though that person is yourself). Small children, says Fernyhough, do it all the time and much more vocally than the average adult – he cites a conversation he overheard his own daughter (about whose development he wrote The Baby in the Mirror [Granta, 2008]) having with herself, ‘I want cars’, ‘Two cars’ – the question in between those two statements had been internalised. How do we know that the ‘other’ voice is coming from ourselves? One theory is that one part of our brain, the ‘inner speech generator’, communicates with another part, the ‘speech perceptor’. If that communication breaks down, we no longer realise that both voices are our own; instead we start to’ hear voices’.

The experience of hearing voices when we are alone tends to be stigmatised and seen as a sign of severe mental illness. No-one really knows why it happens – for many years the most popular theory was that it resulted from childhood trauma, with the voices being the externalised version of something so bad that the hearers don’t want it to be a part of them. Although those living with schizophrenia have a 70% chance of hearing voices, they’re certainly not alone. Post-traumatic stress disorder, dementia, eating disorders and Parkinson’s disease are all possible causes, and voices have been heard by many people with no mental illness at all. It’s particularly common ‘on the edges of sleep’ – when we are waking up or just dropping off.

‘Voice hearing is a highly varied experience.’

Voice hearing is also a very frightening experience for many people, but things are changing. Although medication has been the standard way to deal with ‘hallucinations’, it often doesn’t work. There’s still very little help available for sufferers, but other ways of making sense of voice hearing are emerging; the Hearing Voices Network, which began in the Netherlands and has spread throughout the UK and the US, has enabled sufferers to take a positive role in managing ‘their’ voices, to take back ownership of their experiences.

So how, asks Richard Holloway, do you study inner voices? When Fernyhough began his work, people thought such research impossible – how could you tell what other people were thinking? Now methodologies have changed – not only can psychologists use neuro-imaging to see what is going on in our brains, they can also harness computer software (those smartphones again…) to get us to record our thoughts and experiences – Fernyhough’s project has its own custom-designed Inner Life app. Intervoice, an international hearing voices network, asks voice hearers to identify research questions which are relevant and valuable for them, then asks its committee of invited academics (some of whom are also ‘experts by experience’) to select themes and issues from this data and transform them to operational research questions. Its coordinator Eleanor Longden has said that becoming able to forgive the worst of her voices has been a turning point in her life.

Fernyhough himself does not take part in Hearing Voices groups; with fellow psychologist Guy Dodgson he is developing a new manual of Cognitive Behavioural Therapy, a well established talking treatment now beginning to be used in psychosis. Dodgson is also working with writers who hear voices, and with people who hear them in a spiritual context. Holloway points out that voice hearing lies at the heart of many religious traditions; Fernyhough agrees – he’s very interested in Joan of Arc, Julian of Norwich and Marjery Kempe, three very different women, all voice hearers. Kempe wrote the first autobiography in the English language, and describes the rich experience of hearing the voice of God, sometimes so loudly that she ‘would not have heard another speaker had they been in the same room’. Kempe actually met Julian of Norwich, a known expert in voices and visions. In his book Fernyhough dramatises this meeting, which fascinates him; ‘I have thought differently about my model of inner voices because of Marjery Kempe.’ Holloway himself went through a phase of ‘speaking in tongues’, when he believed he was speaking Mandarin –  ‘It was fun while it lasted’ (though a Chinese girl with whom he tried to converse at Waverley station apparently found it somewhat less amusing.)

Holloway wonders whether animals talk to themselves? It’s not something that Fernyhough has studied, but it does, he says, raise interesting points, not least whether language is needed for thought, or is merely a tool of thought. What about people who are deaf, or have asphasia (a condition that affects the brain and leads to problems using language correctly)? Do they hear voices? Do they talk to themselves? At University College London, Dr Jo Atkinson has carried out groundbreaking work on schizophrenia, psychosis and voice-hallucinations in deaf people, and has found that they do indeed hear voices, although she points out that ‘Deaf people who had never heard did not experience true auditory hallucinations; for this group, communication came via the mind’s eye: visual hallucinations of moving lips, or disembodied hands and arms making sign language movements.’ Atkinson’s research has led scientists to think of voices not as auditory phenomena but as a sense of ‘being communicated with.’  Meanwhile Dr Jill Bolte Taylor, a Harvard neuroanatomist who experienced a severe stroke at the age of just 37, has said that when she lost her language (now recovered) she also lost her inner speech – and her sense of who she was. Dr Bolte Taylor’s subsequent presentation at a TED Conference in Monterey has become the second most viewed TED Talk of all time.

Is there a link between tinnitus and voice hearing? Tinnitus, says Fernyhough, is understood as a ‘tuning in’ to something that’s always been there, and some voice hearers perceive their experiences in similar terms – ‘the voices haven’t suddenly started speaking, it’s just that you’ve only just started listening.’

Writers are often asked where their ideas come from – do they hear the voices of their characters in their heads? Two years ago Fernyhough, a novelist himself, sent questionnaires to writers coming to the Book Festival – he found that most of them not only heard their characters, they also saw them and smelled them – and although the majority described the experience as a kind of eavesdropping, 40% actually entered into dialogues with them. In a Guardian survey, one in seven readers said they heard characters’ voices as clearly as if they were physically present. Holloway asks about the mechanics of reading – do we sound out the words in our head? Yes, says Fernyhough, it takes us longer to read a word that takes longer to say; writers are ‘colonising our inner speech, making us sound out the words they want us to hear.’

‘Contrary to conventional messages of pessimism and pathology, we believe voice hearing is a normal human variation which needs acknowledgment.’ (Intervoice)

Charles Fernyhough is at the forefront of the interdisciplinary challenge to these pessimistic messages (though he’s well aware that not all hearers see their voices in a positive light); he’s also gifted with the ability to explain his research in terms that the rest of us can understand. Holloway invites him to come back to EIBF with further updates on this intriguing research, and the enthusiasm of today’s audience suggests that future sessions will sell out even more quickly than this one.

The Voices Within: The History and Science of How We Talk to Ourselves by Charles Fernyhough is published by Profile Books/Wellcome Collection.