Many of us talk to ourselves in our minds–rehearsing conversations, reflecting on our day, or even just narrating life as it unfolds. This internal monologue is known as inner speech, and it’s a normal part of human thought. But in schizophrenia, something is different. For some people, this internal monologue can take on a life of its own – experienced not as self-generated, but as intrusive voices coming from outside. These are called auditory-verbal hallucinations.
A time to reflect
On World Schizophrenia Day, it’s important to reflect not just on the challenges of living with schizophrenia, but also on the growing science helping us understand it. One leading theory suggests that hallucinated voices may actually be a form of misattributed inner speech – internal thoughts that the brain fails to recognise as self-generated.
Understanding brain activity
Research using brain imaging and EEG shows that when people experience auditory-verbal hallucinations, similar brain areas activate as when they hear real voices. But unlike typical inner speech, these experiences often carry a sense of agency – as if someone else is doing the talking.
Why does this happen? Some researchers believe it’s a breakdown in the brain’s ability to predict and monitor its own actions–a kind of self-monitoring error where the brain loses track of its own inner voice. When these systems fail, the brain might not recognise that a thought came from itself, leading to the distressing experience of a foreign voice inside the mind.
Could the past speak or voice trauma
Many people with schizophrenia report that these voices are critical, hostile, or commanding, and frequently commenting on the person’s actions, appearance, or worth in a negative way. There’s also growing evidence that these voices echo phrases or tones reminiscent of past abuse or neglect. In this sense, auditory-verbal hallucinations might not just be a perceptual glitch, but a deeply emotional, memory-linked phenomenon, where the past quite literally speaks.
Distinguishing between self-generated and hallucinated thought
Emerging therapies are exploring whether people can learn to better distinguish self-generated thoughts from hallucinated ones. Techniques like real-time neurofeedback or cognitive training are being tested to improve source monitoring – the brain’s ability to tell who ‘said’ what. Early findings are promising, suggesting that the brain-based interventions may one day complement traditional treatments like medication and psychotherapy.
Understanding the link between inner speech and auditory-verbal hallucinations not only advances our understanding of schizophrenia’s biological underpinnings. It may also provide a potential window into the neural mechanisms behind the condition, and a possible biomarker to guide future treatment. Just as importantly, it can also reduce stigma. People who hear voices aren’t “making it up” or “losing touch with reality” in the way popular culture sometimes suggests. Instead, their experiences reflect complex changes in how the brain processes and attributes thoughts.
For people who hear voices, one of the hardest parts can be explaining the experience to others. The voices may sound as real as someone speaking next to them, or they might be quieter and more ambiguous. They might be continuous, intermittent, or triggered by certain situations. This variability can make it hard for friends, family, and clinicians to fully grasp what the person is going through – and underscores the need for empathy and open-ended listening.
This World Schizophrenia Day, let’s listen with empathy, promote understanding, challenge stigma, and support the science that helps us understand – and honour – the inner lives of those living with schizophrenia.
https://www.healthline.com/health/schizophrenia/schizophrenia-awareness_