Can this be true?

Posted on January 23, 2004 by acb
“It is now quite firmly established that the voice the schizophrenic ‘hears’ is his own; he is talking to himself silently without realising it. As simple an obstacle as having the patient hold his mouth wide open is sufficient to stop the voices (Rich and Kinsbourne, 1987).”
This is a footnote from Consciousness Explained (page 250 of my paperback). It seems far too important a discovery to be buried there: a simple and effective way to cut off auditory hallucinations.
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3 Responses to Can this be true?

  1. qB says:
    January 25, 2004 at 11:15 am

    Seems extremely unlikely to me… I’m yomping through my book on schizophrenia to find out more.

  2. qB says:
    January 25, 2004 at 6:18 pm

    The proposed answer in “Schizophrenia A Very Short Introduction” by Christopher Frith & Eve Johnstone (http://www.oup.co.uk/isbn/0-19-280221-6) would seem to be “yes and no”.

    After talking about a couple of cases in which patients are audibly producing their “hallucinatory” voices the authors write:

    “These are extreme cases in which the patient’s subvocal speech is sufficiently overt that it can be amplified and transcribed. However, we all use inner speech when trying to remember a telephone number or doing mental aarithmetic, and this inner speech need not be accompanied by any overt whispering or mouth movements. It is possible that hallucinations could be accompanied by such covert inner speech even though there were no detyectable signs that the patient was speaking or muttering during the hallucinations. The problem is how to study inner speech when it cannot be observed directly.

    “Inner speech has been intensively studied since Alan Baddeley and Graham Hitch first proposed the idea of an articulatory loop. The articulatory loop is a mechanism for maintaining words in memory for a short period. In order to keep a phone number in mind for the time it takes to get to the phone, we typically repeat the number to ourselves using the articulatory loop. Two components are involved: we articulate the number subvocally (the mind’s voice), and we maintain the sound of this articulation for a short time (the mind’s ear). However, we have to repeat the process if the material is to be kept in mind for more than a few seconds. This repetition creates the articulatory loop. This verbal working memory system is used in many tasks other than remembering phone numbers. For example, you will use it if you think about the sounds of the words you are reading at this moment.

    “It is easy to interfere with the functioning of the articulatory loop by asking people to articulate (for example, to say ‘la la la la’ while trying to remember words. If hallucinations are really inner speech, then such procedures should also interfere with hallucinations. There is some evidence that procedures like humming or subvocal counting can indeed reduce the severity of hallucinations, but not all patients find this helpful and the effects tend to be short-lived.”

    So yes, the auditory hallucinations appear to be “self generated” (there’s brain imaging evidence that indicates similar activity to a non-schizophrenic person imagining they are listening to someone talking to them) but no, walking round with an open mouth isn’t an effective way to stop them.

    Fascinating stuff.

  3. dave heasman says:
    January 26, 2004 at 12:56 pm

    “The problem is how to study inner speech when it cannot be observed directly.”

    In the case of a schizophrenic the problem is to stop the inner speech. From close anecdotal experience, the physical “takeover” of the speech instruments is worth a try.

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