With books in mind

Professor Charles Fernyhough (Durham University) and neurologist Dr Suzanne O'Sullivan both made an appearance at London's Libreria in April to discuss their new books with BBC Click technology journalist Bill Thompson. Fernyhough began with a passage from his book, The Voices Within, which explores different experiences of heard-voices, from the regular conversations we hold with ourselves to the hallucinations experienced by people with mental health problems.

Thompson asked Fernyhough about his own research into hearing voices and people's internal speech, and about the challenges of doing research around an 'ineffable' topic. Over the past 20 years, Fernyhough explained, scientific methods had improved, making this topic more available to research.

He explained the use of descriptive experience sampling (DES) in his participants – where people are trained to recall their experiences in great depth when a beep randomly sounds. He explained his findings: 'In the old days if you were studying this you'd stick someone in a scanner and ask them to "do some inner speech" and look at their brain activation. In this case you get activation in Broca's area, which is involved in language production. So the standard view is inner speech is out-loud speech but without speaking aloud. But when we've trained people in DES we're gathering moments of experience in the scanner. We looked at the activation that looked like inner speech and it looked different. When you ask people to do inner speech you have Broca area activation and barely any in Wernicke's area, but in our method we found it was the other way around. In an area associated with hearing we saw activation but not in speech areas. The implications are pretty massive for everything we do in neuroscience – if we think we can put people in the scanner and just say "have a memory, have some mental imagery" they'll do something, but it won't necessarily have anything to do with the thing we're interested in.'

Thompson then moved on to voice hearing experienced by people with a wide range of mental health problems and asked whether this was due to a person generating inner speech but without the realisation it was inner speech. Fernyhough said there was evidence to suggest that when people hear voices they're generating inner speech and while there's normally a mechanism that tells you what you're doing so you know the voice is internal, that mechanism doesn't work properly for some. He added: 'There is a possible link between inner speech and hearing voices – usually associated with schizophrenia. But it also happens in people from a number of other psychiatric categories – it's very significant in eating disorders. It also happens to lots of people who aren't mentally ill, and they can find the voices guiding, constructive or sometimes banal.' Fernyhough said he was starting to explore the clinical implications of people's different voice-hearing experiences.

O'Sullivan's book It's All in Your Head, which recently won the Wellcome Book Prize, explores so-called psychosomatic illnesses, the severity of some of these conditions and the stigma surrounding patients with problems without a biological cause. She said in her first consultant neurologist post she looked after many people suffering from seizures, and in her first year 70 per cent of those admitted to hospital with seizures had no brain disease or injury. She explained: 'All their tests were normal, even during the seizures, even when they were unconscious and convulsing – there's only one time that can happen, when a seizure has a psychological or behavioural cause.'

She soon became very interested in physical symptoms with no organic cause, including people who were blind while every parameter of measurement said they could see, people in wheelchairs and those with memory loss – every type of condition you can imagine but with apparently healthy brains by the measures used. She added: 'It's difficult to look after people with these disabilities as they don't obey any of the laws of neurological disease – I would see people with profound paralysis of their legs, but in distracted moments you will turn around and see they've moved their legs. When you're not familiar with this type of disorder it leads to misunderstandings in which doctors and members of the public think there's nothing wrong with them. If people can take the journey I took through my book, they might come to the same understanding I did – that these are extremely distressing disorders and they get no attention when it comes to research resources.'

Thompson asked about the effects of psychosomatic illnesses on patients. 'Some patients are upset at the diagnosis and you can see why: if you had a colleague who was in a wheelchair and you thought it was because of MS but find out it's because of a psychological problem, if people are being honest with themselves they'd see that person differently, but if you're the person in the wheelchair your experience of the disability isn't equal. If you have a hysterical seizure, or epileptic seizure, you're having a seizure either way. One will get more respect, is more likely to be covered by insurance or personal independence payments. If someone changes your diagnosis it's difficult for practical reasons,' O'Sullivan said.

She added that over the decades these problems, previously known as 'hysterical' conditions, have waxed and waned in popularity depending on what they were called and how they were viewed. 'When Charcot thought hysteria was an organic illness it was OK in Paris to say you had hysteria, then it became a very popularly made diagnosis. Then the psychological paradigm came back and it was shameful again. Patients have gone in and out of the shadows based on how much we view their illness. All we do is change the name and no one's done much research on it,' she added.