The dark side of language
Valentina Cardella and Alessandra Falzone
Language is one of the most remarkable features of human species. Nothing can compare its infinite possibilities of meaning, its combinatory potential, its capacity to invest and shape all other human activities. It allowed Homo sapiens to spread worldwide, to create tools, to use symbols and rituals, it made cumulative transmission possible, transformed our specific sociality, made us one of the most adaptive species in the history of evolution. Philosophers, linguists, psychologists, experts in artificial intelligence, ethologists, all have explored different aspects of human language, showing how the most complex system of communication dramatically contributes to the distinctiveness of the human species. But language is not a simple tool for communication. It has some distinctive and amazing power. Since the dawn of Western philosophy, language has been viewed as a sort of magic device: “speech is a powerful lord that with the smallest and most invisible body accomplishes most godlike works. It can banish fear and remove grief and instil pleasure and enhance pity”, stated Gorgias more than 2000 years ago (1982: H8). Language is invisible, has no material body, but it can do miracles. And we experience its magic in our everyday life. Words make us laugh, cry, fall in love, move, scare, shake, they unite people and split them apart, build barriers and cancel them, create worlds and stories and make us believe them; in sum, language is one of the most powerful capacities mastered by the human brain.
But what would happen if language was affected by some sort of virus? A virus that doesn’t damage the language’s biological bases, like linguistic articulation (as in those syndromes resulting from brain damages), but a much higher level, more difficult to detect, which lies at the intersection of semantic and pragmatics capacities? In this case, language would not only be the host of the virus, but also be some sort of trigger for the spreading of the virus itself. The question could be regarded as bizarre, or specious. But here’s an example of this strange kind of virus:
- • How are you?
- • To relate to people about new-found talk about statistical ideology'. Er, I find that it’s like starting in respect of ideology, ideals change, and ideals present ideology and new entertainments new, new attainments. And the more one talks about like, ideal totalitananism, or hotelatarianism, it’s like you want new ideas to be formulated, so that everyone can benefit in mankind, so we can all live in our ideal heaven. Presumably that’s what we still want, and with these ideas it can be brought about. I find the it’s like a rose garden.
- (McKenna and Oh, 2005: 43)
What happened to language in this example? We are not facing any alteration which affects the articulatory capacity, or the rules of grammar, or lexical and syntactical abilities. What is profoundly disturbed here, is the flow of speech, its coherence, its cohesion, and its meaning. And we can identify the virus that makes people talk this way: its name is schizophrenia.
In our chapter, we’ll examine the impact that language has on this mental disorder. We claim that schizophrenia is, in a strong sense, a linguistic experience. Language plays a crucial role in this psychosis. It is directly involved, in that disorganized language is one of the most important features of schizophrenia, but it is also indirectly involved in the other distinctive schizophrenic symptoms: delusions and hallucinations. What we will try to show is that, in schizophrenia, language can short-circuit, and, in doing so, contribute to maintaining the mental disorder itself. In some sense, thus, schizophrenia can be viewed as a language’s virus that shows the dark side of this remarkable feature of mankind.
2 Schizophrenic language
Schizophrenia is one of the most severe forms of mental disorder that involves a large series of symptoms affecting attention, language, perception, volition, affect, and behaviour. According to the DSM-V (АРА, 2013), the common signs of schizophrenia are delusions, hallucinations, disorganized language, negative symptoms, and disorganized behaviour. Delusions are false beliefs, usually bizarre, which are not amenable of change in the light of conflicting evidence. Persecutory delusions are the most common. In some cases, delusions involve extraordinarily bizarre beliefs, e.g., having a completely see-through mind, with telepathically accessible thoughts, or having a microchip in the brain by which alien entities control what the subject says or does. From a linguistic point of view, delusions are particularly important; therefore, we will come back to this topic later in this chapter (see Section 4). The hallucinations are more common in the auditory form, and they are one of the most distressing symptoms of schizophrenia (patients can hear voices almost constantly). For their linguistic nature, hallucinations can reveal the importance of language in schizophrenia: this will be the topic of the last paragraphs.
The term ‘disorganization’ refers to a group of various symptoms that comprise disorganized speech and bizarre behaviour. In most cases, schizophrenic patients look clearly ‘strange’, because they behave in a bizarre, unusual, affected, unnatural way. They can display inappropriate affect (for example, laughing in sad circumstances), show unfitting social conduct (such as indecent exposure), put too many clothes on, not follow basic hygienic rules, be extremely agitated in unpredictable ways, or exhibit negative symptoms. Those symptoms involve a withdrawal of some functions or traits, as in anhedonia - the inability to experience pleasure; catatonia - motor immobility, and abulia - impaired ability to perform voluntary actions.
In disorganized speech, language changes in one of the most bizarre and peculiar way. Schizophrenia exhibits a specific cluster of linguistic features, including derailment, tangentiality, and incoherence, which represent the different ways schizophrenic people can lose track of conversations. Here’s an example of disorganization:
They’re destroying too many cattle and oil just to make soap. If we need soap when you can jump into a pool of water, and then when you go to buy your gasoline, my folks always thought they should get pop, but the best thing to get is motor oil, and money. May totalitarianism as well go there and trade in some pop caps and, uh, tires, and tractors to car garages, so they can pull cars away from wrecks, is what I believed in.
(Andreasen, 1979: 1319-1320)
The first observations on the peculiar way schizophrenic patients speak date back to Krapelin and Bleuler; the former, who is in every respect the father of the modern concept of schizophrenia, noted that in this disorder ‘the train of thought does not progress at all in any one direction, but only wanders with numerous and bewildering digressions in the same general paths’ (Kraepelin, 1913: 40), while the latter talked of a ‘loosening of associations’, which, by the way, he considered the basic disturbance of schizophrenia (Bleuler, 1950). Derailment, tangentiality, and loss of goal are the core expressions of disorganized speech: the links among the parts of discourse get weaker and weaker, the replies of the patient touch the topic for only a second, and then go on following unpredicted directions, the conversation drifts slowly away from the initial thread, and the subject seems completely unaware that she’s going off the track (Cardella, 2017). Here’s another example of this peculiar language:
P: My mummy is very upset, yes. [laughs]
T: Nothing to laugh about.
P: No, yes, it’s sad [laughs], it’s sad the owl said, and it looked at his young and it was an owl itself.
T: I didn’t get that.
P: It’s sad the owl said, and it looked at his young and it was an owl itself. Don’t you understand? I don’t either anymore and I won’t say it again, you know, I’m going to eat my apple to store vitamins for telling stories, otherwise I’ll crumble to pieces.
(De Decker and Van de Craen, 1987: 252)
The most severe form of this disorganization is incoherence, where speech becomes almost incomprehensible, like in the following examples:
Lukewarm is real free, hot or cold-warm is false.
Lukewarm is false?
Lukewarm is real in a manhood. Hot isn’t in a man, a woman uses cold. One, the Bible says, Revelation says, ‘you’re neither hot or cold, lukewarm’. That’s the rewritten-wrote down all that suffer stuff an’all the plagues. I know who it was - Michael.
Well, this friend of mine. He calls himself the arcmain. I call him the arc-main. He didn’t know who he was. Didn’t keep reminding himself. He fell. Jim James took over. He’s more, ah, we call adequaa. He knows Jesse James.
(Carpenter, 1982: 562)
Moreover, there are other typical features which contribute to make the schizophrenic speech so bizarre and difficult to understand, that is, neologisms and paralogisms. Schizophrenics use the terms of their language with wide freedom: they can create new words (neologisms), and they can use existing words in an inappropriate way (paralogisms). Neologisms are usually created to express concepts linked to delusional or hallucinatory experiences: these are subjective events that patients need to convey through the invention of designated words. The neologism’s use is therefore quite stable in schizophrenia, with the new word acquiring a permanent place in the patient’s vocabulary. For example, Bleuler (1950) wrote of a patient who claimed that voices were brought to her by an ‘aero-telephone’; Cummings and Mega (2003) reported a schizophrenic who used the word ‘seisometer’ to indicate a device behind his right eye that received and transmitted information; one patient analysed by Carpenter (1982) termed the voices emanating from his body heart-voices; another one called trafusion (tra-fusione in the original) the torture she suffered by hands of her relatives (Cardella, 2013). Paralogisms, on their hand, are due to unusual use of words; for instance, a patient used the term ‘hill’ to indicate a letter, another one called ‘cuttlefish’, a means of transport and ‘fishing’ his personal assets, and one more used ‘suggestive’ to mean caused by suggestion (Cardella, 2017). Words are employed privately, and there is no doubt that this kind of language, with this strange employ of words and the often bizarre neologisms, clearly affects the possibility to understand schizophrenic people, and contributes to creating a sense of extra-neity between us, ‘normal people’, and ‘them’.
We are beginning to see that language is an important part of schizophrenic disorder. But, of course, there are other disorders which involve language (brain disorders, degenerative illnesses, and so on), and this doesn’t mean that language plays a peculiar role in them: it is only a secondary effect of the disease, that would remain more or less the same, independently from the linguistic side. But is this the case of schizophrenia? Is schizophrenia a disorder that has in language one of its striking aspects, nothing more?
To answer this question, we’ll start considering the peculiar attitude schizophrenic patients have towards language. Their words seem to unveil that there is in language a powerful, almost magic dimension, which can yet turn into a dark side.
3 A hyper-reflexive attitude towards language
What about a cougar? What would you associate a ‘gar’ with? What is a ‘gar?’ See this is what I’m telling you about these letters coming together. I separate them out. They indicate people s desires.
(Oltmanns, 1984: case n.3)
Many authors noted that schizophrenic patients seem to show a hyper-reflexive attitude towards language, as if they were considering it an object of study, rather than a tool for communication (Goss, 2011). Tanzi (1905) was one of the first researchers who highlighted the cult that schizophrenics have for words and their special power; basing on this kind of ‘from the outside’ language’s observation, individuals with schizophrenia begin to show idolatry for words, that are regarded as something sacred and enigmatic. Schizophrenic patients manipulate language, divide it into its different elements (‘I separate them’, like in the foregoing quotation), and can also adapt their behaviour to what the ‘words’ tells them. A famous example of this sort of ‘linguistic oracle’ is that of Lola Voss (Binswanger, 1957), a girl who was ‘controlled’ by language, since she used the unbundling of words (performed between two languages, Spanish and English) and the interpretation of the consequent message as a guide for action. For instance, when she was worried, watching someone putting his hand on his face had a relaxing effect on her, because face in Spanish is cara, that sounds like care, the second syllable of the Spanish word ntano (hand in Spanish) is no, so the final result was no care, don’t worry. Thus, the words guided her behaviour, building up a different reality.
By virtue of this peculiar attitude towards language, schizophrenic patients deconstruct it, manipulate it, find new ways to interpret it. As noted by Phillips, “the schizophrenic . . . becomes acutely aware of his or her own words or gestures as words or gestures, they suddenly reveal their nature as signs - or semiotic things” (2000: 19). This deep linguistic awareness leads to a paradoxical result: trapped in the language’s world, fascinated by language games, schizophrenics lose the possibility to communicate something, in that the linguistic level detaches from reality and lives a life of its own, as in the following examples:
What is contentment? Well, uh, contentment, well the word contentment, having a book perhaps, perhaps your having a subject, perhaps you have a chapter of reading, but when you come to the word “men” you wonder if you should be content with men in your life and then you get to the letter T and you wonder if you should be content having tea by yourself or be content with having it with a group and so forth.
(Lorenz, 1961: 604)
I don’t like television, I would like the tele but not the vision, more the sion than the vi, because the vi reminds me of the letter V that is in the TV that means television and I don’t like it.
(Piro, 1992: 44)
The so-called clanging is one of the aspects involved; schizophrenic patients can rhyme, rather than talk, paying more attention to sound associations than to the meaning they want to convey:
My mother’s name was Bill, [pause] . . . and coo? St. Valentine’s Day is the official startin’ of the breedin’ season of the birds. All buzzards can coo. I like to see it pronounced buzzards rightly. They work hard.
(Chaika, 1974: 260)
I’m not trying to make noise. I’m trying to make sense. If you can make sense out of nonsense, well, have fun. I’m trying to make sense out of sense. I’m not making sense (cents) anymore. I have to make dollars.
(Andreasen, 1979: 478)
Does water saunter? As to protein, might one tote-it-in? Is it a hydro-car-boat or a carbohydrate? As to any vitamin, might one invi- te-them-in? Is the dinner-all there with mineral? Is the bulk cellulose or the hulk swell-you-host? Might the medicine have met-us-some? Is it a platypus or adipose? Is the seasoning pleasing? Is food reserved to be preserved? Is one glad-to-give an additive?
(McKenna and Oh, 2005: 49)
Today is the day that I say March, April, and May without delay, if I may say. High-powered transmitters permitters me to know no way. Yesterday was a rain delay - a damp, lamp.
(Sacks, 2005: uww.unc.edu/~sacksm/Schizhan.html)
The parallel with poetic language must not be misleading: schizophrenics don’t choose to talk this way. As noted by Chaika:
Preoccupation with definition, abnormal rhyming, and inappropriate word associating have long been recognized as features of schizophrenic speech. In fact, typically they are the concern of poets. Of course, poets make these their concern by especially focusing on them. In their usual conversations, poets, like most people, ignore such features, or at least they do not allow them to interfere with the topic at hand in their surface utterances. The schizophrenic, however, does not seem to be able to suppress his notice of the features of words.
(Chaika, 1974: 269)
In other words, in schizophrenia, differently from poetry, there is an inability to get beyond the signifier:
only the symbol remains, but, because of the absence of its relation to the signified, it loses its true value as a signifier, a symbol. It is no longer anymore than an image taken for reality. The imaginary has become the real.
(Lemaire, 1970: 233)
These observations accord to Freud’s intuition that the strangeness of the symptom in schizophrenia is due to “the predominance of the word-relation over that of the thing” (Freud, 1915: 147)
The connection between schizophrenia and language is thus much narrower than one could think. Language in schizophrenia goes around in circles, devours itself, gets stuck preventing any possibility to mean something: a virus, then, that lies in language (and that it’s impossible to imagine without language), and that doesn’t infect language only, but the whole schizophrenic existence.
4 Nothing is exactly what it seems: the world of delusion
As already remarked, one of the main features of schizophrenia is delusion, that is, a false belief not amenable to change even in the light of conflicting evidence. For their bizarreness, and the peculiar obstinacy they are defended with, delusions have drawn the attention of all researchers since the origin of modern psychiatry. A wide range of literature focused on the most spectacular aspect of delusion, that is, the possibility to believe in impossible things, and the apparent lack of rationality that make delusional subjects hold their beliefs despite any contrary evidence. But there is another side of the delusion which often passes unnoticed: its linguistic side. In delusions too, language plays a crucial role, since words always tell something more, something different.
To clarify this point, we have to step backwards for a moment, to the early stages of delusions. Schizophrenic patients, before ‘officially’ entering the domain of delusion, often begin to perceive the world differently. External reality suddenly seems to have lost its familiarity, and objects, places, even people start looking unreal, creepy, frightening, enigmatic. More precisely, patients don’t claim that things and people have changed from the perceptual point of view, rather than, whilst staying the same, all have changed in meaning. The pre-delusional atmosphere (the so-called Whanstimmung, cf. Jaspers, 1913) is primarily an overwhelming loss of meaning. Patients testify these early stages of delusion’s linguistic side: they declare that the terms of language can’t be read with their usual meaning, and that behind the words lie a hidden sense. They feel that the words’ meaning has changed, but they don’t know how to replace it. Someone even begins to think that people around him are speaking in code, rather than speaking the normal language (Tim-lett, 2011; Cardella, 2017), while other patients don’t seem to recognize the usual references of the words, like this schizophrenic girl who complained that, when she saw a chair, or a pot, she didn’t recognize their function, she didn’t saw a chair to sit on, or a pot to hold water, “they had lost their name, their meaning, their function, they had become things” (Sechehaye, 1950: 55). This sense of unreality seems to be due to the pragmatics, semantic and affective components connected to the objects recognition. The meaning is suspended, and things, lacking a recognizable function, become mysterious and strange; patients attend to this event with unspeakable angst.
This loss of meaning regards people, too, who look like mannequins, automatons, or robots. The schizophrenic girl we just quoted reported to be frightened by her roommate because she looked inhuman (ivi: 165), like some sort of android, another one noted that, when she saw the face of someone, the face started to look weird, and she failed to find meaning in it (Kaysen, 1996: 43). This loss of meaning, which involves both things and people, and is often interpreted as if something terrible is going to happen, is thus perceived as extremely scary and threatening.
But when the world becomes unfamiliar and seems to gradually lose its meaning, where is it possible to recover what we are losing? The answer is easy: in the inner world. It comes as no surprise, then, that schizophrenic patients manage to get out from this insufferable state of suspension only when the delusional idea rises. The delusion comes when the loss of meaning is at its peak, and it reverses the condition, producing an overload of meaning. The delusional idea fixes the situation, and fills in everything with meaning: before, it was impossible to interpret anything, and now, everything becomes interpretable; before, every possibility to understand was suspended, and now, one understands everything. This world suffused with meaning is clearly described by this patient:
Schizophrenia is a disease of information. And undergoing a psychotic break was like turning on a faucet to a torrent of details, which overwhelmed my life. In psychosis, nothing is what it seems. Everything exists to be understood beneath the surface. A bench remained a bench but who sat there became critical. Like irony, the casual exchange of words between a stranger or a friend meant something more than was being said. The movies, TV, and newspapers were alive with information for those who knew how to read. Without warning my world became suffused with meaning like light. In response, I felt as if I had been only half conscious before, as ignorant of reality as a small child. Although my sense of perception remained unaffected, everything I saw and heard took on a halo of meaning that had to be interpreted before I knew how to act. An advertising banner revealed a secret message only I could read. The layout of a store display conveyed a clue. A leaf fell and in its falling spoke: nothing was too small to act as a courier of meaning.
(Weiner, 2003: 877)
As one could see, the condition is turned upside down, and the schizophrenic subject is suddenly overwhelmed by the meaning’s dimension. Speeches mean more than what they literally say. Each conversation, even among strangers, is a clue to something, or refers to the subject.
Additionally, I had begun to see hidden meanings in everything, from graffiti to architecture and to everyday speech. People in Ann Arbor were so intellectual that they used symbolic speech! This was a great discovery for me, and I henceforth began an attempt to discern what people actually were talking about behind their banal conversations. Initially, thinking this way was beneficial to me in my architecture classes, where one analyzed every little detail, but it soon led to great distortions when I began applying it to everyday life.
(Reina, 2010: 4)
Eventually, each word seems to get a special meaning:
When I half-heard a conversation in the distance or the honking of a car, I would think it held special significance for me. I would randomly open a dictionary and find a word (‘die’, ‘liar’, ‘evil’) and interpret how the word had special meaning for me.
(Chapman, 2002: 547)
We can look to this phenomenon differently: the delusion prevents things to happen by chance, in that everything is connected. Delusional subjects spend the vast majority of their time decoding and interpreting every single gesture, every single word. The delusional belief is so powerful that it will enter all of the schizophrenics’ conversations, it will dominate their thoughts and speeches with overwhelming strength. Thus, when asked to explain the idiomatic expression ‘a drowning man will clutch at a straw’, one patient, dominated from mystic delusions, answered: “Duh. Help! Is anyone going to save him. I could say I’m a drowning man right now. Anyone who asks for help. Ask and you shall receive. Seek and you shall find it. It all has to do with Christ” (McKenna and Oh, 2005: 14). A schizophrenic girl, who believed in magic, and was convinced that some of her college’s teachers were witches, one day, sitting on the lobby of her college, saw a poster displaying students and saying “At the University of Michigan I learned of worlds that I had never known to exist”, and immediately thought that “this was clear proof that magic, ie, the other worlds, existed” (Reina, 2010: 4). In the realm of delusion, the subject is overwhelmed from a flood of information, all concerning the subject’s delusional idea, and all having the same importance. All speak, to whom who knows how to listen. Once again, it’s hard to overrate the relevance of language; every single word, in delusions, is full of meaning, and each conversation, even the most trivial, has to be systematically over-interpreted. One way or another, the words pronounced by the others confirm to the patient the delusion’s truth, confirm his belief to be persecuted, to be cheated, to be special, and there’s no way out from this confirmatory cycle.
The delusion fills up with meaning the same reality which had become obscure and unfamiliar in the stages preceding the delusion. It is a private belief, impossible to share, but its massive capacity to signify fascinates the people who hold it. As reported by this patient:
A note about becoming ‘sane’: medicine did not cause sanity; it only made it possible. Sanity came through a minute-by-minute choice of outer reality, which was often without meaning, over inside reality, which was full of meaning. Sanity meant choosing reality that was not real and having faith that someday the choice would be worth the fear involved and that it would someday hold meaning.
(Anon., 1992: 335)
Thus, schizophrenia has strongly to do with language. The latter is specifically affected and transformed, and schizophrenic subjects show a peculiar attitude towards it: they manipulate it, play with it, and can also get trapped in a world of rhymes, associations, and linguistic games. In delusion, schizophrenic people usually overinterpret language, and each conversation, each word become full of meaning. It’s time to show how language occurs in another important symptom of schizophrenia, that is, auditory hallucinations. We will focus on this feature in the next sections.
5 The language within: the phenomenon of inner speech
In the previous sections, we have discussed the role of language in the characterization of schizophrenia: schizophrenic language is disorganized, derailed, and, above all, is the cognitive trigger that the linguistic experience of the schizophrenic is built on. The reports and linguistic testimonies of schizophrenic experiences clearly express the power and fascination that language exerts on cognition and representation of the world. This relationship is evident in a very common aspect of the linguistic experience - inner speech, or internal dialogue. First, we will discuss this phenomenon, its characteristics, and its pervasiveness in everyday experience. Then we will illustrate the close connection between inner speech and one of the most obvious symptoms of schizophrenia: auditory verbal hallucinations (Rosen et al., 2018). Our aim is not to go fully into the debate on the mechanisms and functioning of inner speech, but to argue that inner speech is a genuine linguistic experience, which demonstrates the power of language over other cognitive processes. In this perspective, schizophrenia is the testing ground for the power of language.
Inner speech can be considered one of the most intimate and natural linguistic experiences. Each one of us has experiences of internal dialogue, although not always explicitly. At different times of the day, we find ourselves talking to ourselves in our minds. Some people experience inner speech while they are doing sports, or a cognitive task, meeting a friend, planning their day, or remembering an episode. Inner dialogue can also occur while resting (mind-wandering: Perrone-Bertolotti et al., 2014; see Irving and Glasser, 2020 for a philosophical approach) as a form of flow of thoughts not necessarily associated with external stimuli or other cognitive processes.
Basically, “human beings talk to themselves every moment of the waking day” (Baars, 2003: 7).
In both scientific and philosophical literature, it is often referred to as internal dialogue, inner language, inner speaking, self-talk, internal monologue (Morin et al., 2011). In general, inner speech can be defined as the ability of the subject to speak to himself in a silent manner (Geva and Warburton, 2018), in his/her own mind, in the absence of linguistic articulation (Alderson-Day and Fernyhough, 2015).
According to many authors, it is a central cognitive phenomenon, ubiquitous but poorly examined by classical cognitive psychology and cognitive neuroscience for two main reasons. First, it has complex relationships with other cognitive functions such as planning, reasoning, and problem-solving (Baldo et al., 2015); self-regulation and memory (Morin et al., 2011); self-motivation (Geva and Ferny-hough, 2019); self-awareness (Morin, 2009, 2012); creativity (Smallwood and Schooler, 2014); consciousness and self-reflection (Alderson-Day and Fernyhough, 2015), to name but a few. Secondly, there are some methodological issues (Morin and Uttl, 2013; Fernyhough, 2008), mainly concerning the ecological validity of the quanti-qualitative tools for its evaluation (Hurlburt, 2011).
An interesting approach is proposed by Hurlburt and colleagues stating that inner speech “naturally occurs in natural situations” and it is a “pristine” phenomenon, i.e., “it naturally occurs before a specific attempt to alter it” (Hurlburt et al., 2013: 1480). For this reason, they proposed a qualitative method to describe pristine inner speech based on randomly sampled inner experience (Descriptive Experience Sampling) which does not include the manipulation by experimental procedures (Heavey and Hurlburt, 2008). According to Hurlburt et al. (2013), some aspects of the methodological issue on inner speech arise because of its ubiquity and importance and its several manifestations. In their study, sampling health college students, they reported five types of inner experience (inner speech, feelings, mental imagery, sensory awareness, and unsymbolized thinking). Some objections have been raised about this method, because it is not so clear if the methodology grasps the real nature of inner speech (Alderson-Day and Fernyhough, 2014), i.e., if this method assesses events that involve non-inner speech occurrences (Morin et al., 2011).
Nevertheless, researchers have identified the fundamental characteristics of inner speech, drawing on the phenomenology of this pervasive phenomenon. Inner speech is covert speech, i.e., it doesn’t involve the voice but it can vary in pitch, frequency, type of voice, vividness (Wilkinson and Alderson-Day, 2016; Vil-haurer, 2017) just like the overt, but the way phonological/lexical characteristics emerge during inner speech varies from that of overt speech (see Oppenheim and Dell, 2008, but in contrast Corley et al., 2011). The quality of the inner voice can vary depending on the external context, the task in which the subject is involved, emotions, and direct or indirect reporting (Yao et al., 2015). Typically self-reported inner speech focuses on the speaker or people close to them (Morin et al., 2011) and the inner voice is attributed to the speaker her/himself (Rosen et al., 2018) as the agent of the internal speech attributed to the subjects that “produce” the voice (Gallagher, 2007).
Neuroscientists have investigated inner speech to describe its function with respect to overt speech and other cognitive processes. Inner speech neural processing involves overlapping areas in respect to those activated during overt speech (classical linguistic regions, i.e., Broca’s and Wernicke’s areas, inferior parietal lobule in the specialized left hemisphere), but inner speech and overt speech are not the same neural process. While overt speech elicits a greater activation of motor and premotor cerebral regions as compared to inner speech, covert speech involves other specific areas (left precentral gyrus, left middle frontal gyrus, left or right middle temporal gyrus, left superior frontal gyrus, right cingulate gyrus, left or right inferior parietal lobe, left dorsal frontal cortex, left parahippocampal gyrus, right cerebellum - see Perrone-Bertolotti et al., 2014 for a review).
Perrone-Bertolotti et al. (2014) reviewed neuroscientific studies comparing brain activations during overt speech and covert/inner speech conditions, observing that “inner speech seems to recruit some cerebral regions that are not recruited in overt speech. Some of these activations can be attributed to inhibition of overt responses or response conflict” (2014: 230). In fact, despite the first studies that seemed to incline towards a description of inner speech as overt speech without a motor component, the main research about the relationship between overt/covert speech rejects this impoverished view.
The most plausible proposal is that these areas involved exclusively in inner speech are part of an inhibition system (Wilkinson and Fernyhough, 2018) that allows control of internal functions by eliciting agency (see Corollary Discharge model, Frith, 2019; Subramanian et al., 2019). In a recent article, using electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS), Stephan and colleagues (2020) have demonstrated that the brain prepares overt and inner speech differently: their results are consistent with the hypothesis that a cerebral inhibitory mechanism works during inner speech.
The variability in the phenomenology' of inner speech leads many authors to propose multi-component models to describe this process. Following Vygotskij’s theory' of functional language stages that consist of progressive processes of inte-riorization of language from open dialogue (infants), through private speech (verbalized dialogue with themselves as toddlers) to asymbolized and inaudible inner speech (adolescents) (Vygotskij, 1934-1987), Fernyhough (1996, 2008, 2009) has proposed a four-level model in which inner speech is the result of a progressive internalization process of dialogue. There is the first level (external dialogue) starting from the first sounds and consisting of overt dialogues with caregivers, a second level (private dialogue) during which children conduct an overt inner dialogue with themselves, gradually subvocalizing it, a third level (expanded inner speech) in which inner speech is completely internalized keeping its dialogical structure, and a fourth level (condensed inner speech), in which inner speech is characterized by the syntactic and semantic abbreviation in respect to overt or covert dialogic structure.
Inner speech is not simply a stage of our language development but a modality through which we construct our inner life and consequently our experience (Loevenbruck, 2018).
How is inner speech linked to experience? Several scholars, philosophers as well as psychologists have questioned the nature of inner speech. As we have seen previously, inner speech has several characteristics, the main one being that in the vast majority of cases, it has a content, that is, it refers to a part of the experience. Although there is much debate on the intentional or unintended nature of our inner speech (see Irving and Glasser, 2020), several authors agree with the idea that inner speech is about an experience of the world. Whether in its condensed or extended form, the ‘interior monologue’ refers to some form of experience in the world (abstract or concrete, lived or future). In essence, inner speech “is something that we do, and which we have an experience of” (Wilkinson and Fernyhough, 2018: 2).
In this way, inner speech is a cognitive tool through which we experience our (internal and external) ‘world knowledge’ (Hagoort et al., 2014; Falzone, 2016). Inner speech, therefore, is considered a form of eminently linguistic experience, not in the sense of verbal content (we are not referring to how “mental sentences” are constructed or the accuracy with which the utterances of inner speech are expressed), but in the sense of linguistic-representational content. Although inner and overt speech are not super-imposable processes, many studies show that inner speech is an eminently linguistic process. But the sense of this characterization is not so immediate.
The experience level which we refer to is not simply that of motor practice or motor simulation, but the representational level. For instance, Netsell and Bakker (2017) showed that the inner speech in people who stutter is reported as fluent even though their vocalized speech presents many word-order and word-onset errors. Researchers have investigated inner speech in non-hearing subjects to comprehend if they have inner speech and the possible form it has. Wilson and Emmorey (1998) have shown that Sign Language is processed on the basis of its articulatory properties rather than its visual-gestural modality, supporting a multimodal characterization of inner speech in the deaf. Other studies conducted with neuroscientific methods have argued for similarity in circuits underpinning inner speech in hearing and non-hearing subjects (McGuire et al., 1997). According to Wilkinson and Fernyhough (2018), an experience of inner speech represents an interior linguistic act and it concerns the mental state expressed by that linguistic act and, consequently, it concerns the individual possessor of that mental state, that is, the speaker: thus when one asserts something in inner speech, the conscious experience of that represents their belief in what they have asserted, and, somewhat trivially, represents it as belonging to them. This much can also be said about hearing someone (oneself or someone else) sincerely assert something in outer speech (Wilkinson and Fernyhough, 2018).
Another example of the linguistic nature in the sense of linguistic cognition is represented by the experience of voices in the reports of profoundly deaf people: the profoundly deaf, even the congenitally deaf, report hearing voices in their heads. Such voices can comment positively, they can be reassuring, or they can constitute a negative experience. Hallucinations are also present in the deaf population, as demonstrated by numerous studies. What researchers have questioned is whether the voice reported by the profoundly deaf with hallucinations is a type of experience similar to that experienced by people who are not deaf. Some scholars argue that these are non-auditory experiences and that the representation of these hallucinations is actually not auditory, but multimodal: when the deaf hallucinate voices, they actually hallucinate multimodal experiences.
Yet, in numerous detailed reports, deaf signing people with hallucinations describe having clearly audible hallucinatory experiences, although they declared themselves to be (and were) completely deaf (du Feu and McKenna, 1999). According to Atkinson (2006), in reality these are not voices but messages without a defined agent. It is still unclear whether hallucinatory voices experienced by deaf people are the result of motor mechanisms’ activation (given the iconic-visual nature of sign language gestures). What appears evident from the reports is that hallucinations are experienced as linguistic information that conditions the subject’s experience and describes it.
This data enables us to formulate two observations: the first, inner speech is a cognitive phenomenon that must be investigated by adopting a method that takes into account the first-person perspective (Fernyhough, 2016). The reports of people who hear voices have provided essential information both for the structuring of experimental protocols and for the formulation of theoretical models relating to the functioning of inner speech and the cognitive abilities with which it is connected. The second, the essential phenomenological aspect that characterizes inner speech is the voices. This phenomenon, as we have described previously, can be both positive and negative. The voices in one’s head can play a fundamental role in daily experience, just as they can prove to be a danger when such voices are not recognized as being owned by the person who experienced them. And this is the case with some psychopathologies, schizophrenia in particular.
6 The power of language: schizophrenia and inner speech
The voice we hear in our head is our voice. It can have different verbal characteristics and vary in tone, it can be expressed in the form of a syntactically correct utterance and be explained in its entirety or it can be condensed, elliptical. It may rehearse the voice of someone we know, but in any case this voice is perceived as originating from ourselves. Numerous studies have tried to understand why the vast majority of healthy people hear voices in their heads. A proposed distinction concerns the difference between the experience of speaking to oneself (as selfspeaker) and the experience of listening to a voice in one’s head (as self-listener). There is no agreement on how the two processes are connected (which may also involve partially different neural systems), or if in reality it is a single process (inner speech) modulated through different perceptual pathways. What the studies converge on is the perception of the voice’s agency: whether it is a sort of one’s own ‘dematerialized’ and condensed voice, or whether it is a form of memory, not necessarily faithful, to a heard voice, but the voice is considered to belong to the subject who perceives it. In some cases, this attribution is not so obvious, as in auditory verbal hallucinations (AVHs). An increasing number of studies demonstrate that this phenomenon can be interpreted as a form of modification of the normal process of attributing inner speech to oneself. As we have described in the previous sections, AVHs are a telltale symptom of psychosis, particularly schizophrenia. As Fernyhough (2014: 1090) stated “if schizophrenia is, as in Thomas Szasz’s coinage, the ‘sacred symbol of psychiatry’, then this [AVH] is the sacred symbol of the sacred symbol”. AVHs are the main clinical feature of schizophrenia, manifesting in hearing a voice (or voices) that judges the patient’s behaviour, encourages him to carry out actions, or offends him. AVHs are sometimes so upsetting and pervasive for the patient’s existence that the patient feels ‘lived by another’ (Fernyhough, 2016).
AVHs have characterized schizophrenic disorder since its first definitions (Bleuler, 1950) and reveal a very high diagnostic value (Cardella, 2017). There are various hypotheses about the cause of this symptom. One of the most accredited assigns these AVHs in schizophrenics to a deficit in monitoring their own actions. According to Frith (2019), the AVHs are a consequence of the modification of the functioning of the cognitive system that controls self-produced actions. This system monitors whether the actions are produced by the subject or if they come from outside, preventing the subject from perceiving his actions as performed by others (see Blakemore et al., 2000). Self-talk, that is the language produced and directed to oneself, also falls within this system. When we produce inner speech, the areas of language involved in the process of producing language aloud are activated and send an efference copy to the part of the auditory cortex responsible for decoding language. This message alerts the areas that decode the linguistic message that respond with a lower intensity of activation than that required for the understanding of external verbal productions.
It is as if this efference copy ‘attenuated’ the decoding activity of linguistic areas (Ford and Mathalon, 2004; Whitford et al., 2011). In this way, the monitoring of one’s inner speech activity would be achieved: the inhibitory message sent from the Broca area (responsible for linguistic coding) through the arched file would immediately reach the Wernicke area (responsible for linguistic decoding) therefore inhibiting its activation. Thus, our brain processes the voice produced by the Broca area as an internal voice.
According to this hypothesis, AHVs in schizophrenic subjects are produced by a change in the inner speech control system. It seems that schizophrenic patients have unusual patterns of connectivity between the frontal regions (in which the Broca area is located) and the temporal regions (in which the Wernicke area is located). Such patterns modify the communication from the frontal to the temporal lobe, so the schizophrenic subject perceives the internal voices as produced by someone else, or in any case as not belonging to himself (for a discussion, see Parlikar et al., 2019). Several objections have been raised to this model, most of which derive from the nature of the control system (mainly motor or in any case connected to the action). Other scholars, for example, argue that inner speech is the product of functional connectivity activated during the resting state (default mode network). In patients with schizophrenia, the normal DMN is hyperactivated in respect to controls both in speech perception and in verbal thought generation (Rapin et al., 2012; Perrone-Bertolotti et al., 2014).
Also, in this case, various objections have been raised regarding the methodologies used to investigate the mind-wandering state. To date, not enough evidence has been collected to support one of these hypotheses exclusively, but in the last 30 years, research in psychiatry has considered inner speech as a raw material for auditory verbal hallucinations. Let us consider two elements: AVHs can also occur in non-psychotic subjects (Laroi, 2012). In this case, the experience is equally upsetting, but typically the subject considers that experience to be an alteration, an experience that is not part of everyday life and is linked to contingent situations (such as substance abuse). Furthermore, in the phenomenological field, there is a copious amount of literature in which healthy persons report hearing voices, often comforting or encouraging, as in the case of those who practice sports that require constant concentration but motor activity only at certain times or in writers (in literature these subjects are identified with the term voice-hearer, see Fernyhough, 2016).
If we look at the experiential level, several elements suggest that the experience of voices is not only associated with moments of psychotic alteration, prompting researchers to describe the experiences of voices as a continuum: schizophrenia is placed at an extreme where interior linguistic experiences are experienced as belonging to another rather than oneself.
In this perspective, internal voices constitute the testing ground of the cognitive power of language. The studies we have discussed previously assign the role of raw material for AVHs to internal language. In the perspective we have offered, inner speech is an essential phenomenon for the construction of the self, connected with many other cognitive processes. Carruthers (2002, 2018) argues that language, and in particular inner speech, is a process that holds together domains of cognition that would otherwise be separate.
Reflecting on the role of language in human cognition and in relation to other cognitive processes, Carruthers formulates an idea of inner language “as a mental lingua franca: a medium for representing items of information drawn from distinct domain-specific modules in the brain” (Nelson, 2002: 694). Without this process, the outputs of cognitive activities will remain autonomous, separated, “disconnected”, and “fragmentary”. Accordingly, Wilkinson and Fernyhough (2018) stated that inner speech is a fundamental process for self-knowledge, the way everyone reflects on (and constructs) her/himself. Inner speech, therefore, is a constructor of ipseity, which, in the schizophrenic subject, is modified, different, other (Sass and Parnas, 2003).
The voices in the heads of schizophrenics communicate with each other using the same mechanisms of vocal speech, generating a sense of external agency that in healthy persons corresponds to themselves. Often schizophrenic subjects listen to the speech of their own voices and analyse them in content, pragmatic adequacy and in relation to their own self. This analysis does not concern the formal and syntactic correctness of the utterances of the internal voices, but their very presence. Schizophrenics hear internal voices as third entities that invade their mental life, although they are often aware that such voices can only be a product of their own mind. Adam, one of the voice-hearers of the “Hearing the Voice” project (Fernyhough, 2014), when interviewed about the difference between his ordinary thoughts and his voices, he answered:
It becomes so confusing when you have it for so long. You’re talking to yourself, but you’re getting a response. You’re talking to yourself, but you’re getting asked questions. Which can be very difficult, because say if you think of something, you aren’t sure if it’s you who’s thinking it. ... I have another person living inside my head. ... It isn’t me, but it is me.
(Fernyhough, 2016: 270)
The disorientation that the experience of voices causes in the existence of schizophrenics is often connected with a consequent detachment from reality that leads the subjects to question themselves about what is more natural, what a healthy subject usually takes for granted: who is thinking what it’s on my mind? Is it me or is it someone else? This tendency is called hyper-reflexivity, i.e., a form of exaggerated awareness of “oneself that would normally remain in the background of awareness” (Sass, 2014: 369; Stephensen and Parnas, 2018; see also the chapter by Pennisi and Gallagher in this book). Sass (2014) outlines how the schizophrenic usually observes his own inner world from the outside, and his own language as an object of alien reflection (see also Goss, 2011). This determines the break with the world and the belief that others cannot understand what is inside their lived life.
It could then be hypothesized that the schizophrenic’s internal linguistic life consists only of voices. But is the inner speech of schizophrenics made up exclusively of voices? Several studies have shown that patients can distinguish their own voice from that produced by others and their thoughts. Thus, patients know that hallucinated voices, however similar they may be to those produced by themselves (inner speech) or heard externally during a conversation, are something else (Leu-dar and Thomas, 2000).
Voices are perceived as real as people, but the subject is aware that they do not have a body, they are voices that live within their soul (Fernyhough, 2016). Schizophrenics may have a clear perception that voices inhabit their body, they are not external voices of someone who utters them. The awareness of this third party of hallucinated voices has prompted researchers to wonder why, once such awareness is achieved, the voices are still retained. Often, in the experience of the schizophrenic, even after therapy, the voices remain present, continue to talk to each other, and the schizophrenic chooses not to feed them. Some reports also indicate a certain ability to control the situations and topics on which the voices intervene. For example, Garrett and Silva report the case of a patient who hears the voice of a child in a 2003 study. They describe this patient during a clinical assessment who claimed that the child’s voice was real only when the patient was in a condition of emotional need; “she hesitated to say the baby was real because she said she would then have to worry about its need for care. They quoted the patient as saying “she’s like my imaginary baby. She’s real to me in some senses. I love her” (Garrett and Silva, 2003: 450). She “calls” the baby real only when this served her emotional needs.
Patients try to experiment on their own if the voices they hear are real. They question them and test them, thus confirming their real existence and their importance within the patient’s cognitive life. Experiences such as those described previously show that the schizophrenic subject’s inner speech is one of the elements in maintaining the voices themselves. The different way of constructing one’s inner speech for schizophrenics is as painful and tiring as it is powerful. According to the analysis of phenomenological psychiatry, schizophrenics idolize words, they consider them something sacred (Pfersdorff, 1935). If we consider inner speech as a proof that language is a cognitive tool that allows one to build their inner life and organize it thoroughly, then schizophrenic voices are the proof of this exponential power.
We started this chapter stating the importance of language for the human species. It allows us to communicate in very sophisticated ways, but its power is terrific, since language is much more than just a tool for communication. Schizophrenia turns the power of language into its dark side. The metalinguistic function, one of the most brilliant and exclusive features of human language, where the language is used to talk about language itself, in schizophrenia is pushed to extreme consequences, in that the linguistic level detaches from reality and lives a life of its own. Thanks to language, we can convey meaning. But, in schizophrenia, the process of interpreting becomes potentially infinite, with devastating effects. Each word, each piece of conversation, as trivial as it may be, gets full of meaning, and means always something more. In delusion, this over-interpreting activity is directed to only one direction: the delusional belief. Finally, language accompanies us in all our activities, with an inner dialogue that helps us to plan our activities, solve problems, and build our self-image. In schizophrenia, the inner speech becomes something external, that the subject doesn’t recognize anymore, and it starts haunting the patient, harassing her with endless voices.
And maybe this is the way to describe the linguistic experience of this mental disorder: schizophrenic patients, in different ways, are haunted by language, and show us its dark, dangerous, and even frightful side.
For the specific constraints of the Italian Academy, we specify that Valentina Cardella wrote Sections 1, 2, 3, 4, and 8; Alessandra Falzone wrote Sections 5, 6, 7 and 8.
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