Every day on my way to lab, I pass a bulletin board tacked with 4-by-6 photos of a petite brunette with twinkling eyes and a broad smile. In one, she’s celebrating her successful qualifying exam. In another, she’s en pointe, arms arched gracefully above her head. It was in this spot just over 2 years ago that I last spoke to Maria, who was standing in the hallway eating her lunch. “Why don’t you go sit down in the break room to eat?” I laughed as I passed by. “If I sit down, I’ll fall asleep,” she answered. I walked on, concerned but telling myself she must have been tired from working long hours, as she always did.
A few weeks later, Maria passed away suddenly from a mysterious autoimmune disease. It was as though the life went out of our department. Maria had been a near-constant, vivid presence, and a bright light of welcome to everyone who entered the building. The hallways felt empty without the echo of her laughter. Her death was especially shocking because I, like many in the department, didn’t even know she’d been sick.
Maria was by all accounts the model student: She had received a prestigious fellowship, was about to publish two high-profile research articles, and was deeply involved in serving the community. It was only after her death that I learned Maria had spent the last weeks of her life searching for answers to unexplained symptoms.
As I weighed her public accomplishments against her private hospitalizations and struggle to find a diagnosis, I felt like a hypocrite. For me, hiding the effects of my connective tissue disorder—my chronic pain, crushing fatigue, and skeletal deformities—was an art form. Summer of 2013, the classes taken during my recovery from major surgery to hide my summer “off.”
Summer of 2016, another major surgery and the pain of sitting through a short course too soon after having my rib cage pieced together like a jigsaw puzzle. Fall of 2016, weeks of 7 a.m. physical therapy scheduled to avoid missing classes. Summer of 2017, sleeping through my flight to a conference. Perhaps worse than any of the physical symptoms was my sense of alienation from my classmates, who seemed to know more about backpacking across the country and pulling all-nighters in the lab than appealing denied health insurance claims or juggling doctor’s appointments. I wondered whether there was a place for me in academic science.
Maria’s sudden death was a wake-up call. … I was only alone to the extent that I stayed silent.
- Anna Moyer, Johns Hopkins University School of Medicine
Maria’s sudden death was a wake-up call. I began to reach out to fellow students, disability services, and the diversity office to discuss how to better support trainees with disabilities, chronic illnesses, and mental health conditions. We started a seminar series featuring senior scientists and clinicians with these conditions and held social events for trainees to connect over our shared experiences. Along the way, I met a classmate with a similar condition just down the hallway. As we compared notes on physical therapy techniques and whether our insurance covers compounded medications, I began to regret that I’d wasted 4 years in solitude. I was only alone to the extent that I stayed silent. I’d been so blinded by my fear of being vulnerable that I couldn’t imagine the immense relief I would feel when I finally let go.
I’ve now talked to countless students with a range of conditions and experiences. Ironically, the one feeling we all share is a deep sense of isolation. It can seem a privilege to be able to pass as nondisabled and avoid the potential consequences of disclosure, but it is also a curse when we choose to suffer in silence.
In 4 more years, the graduate students in our department will know Maria only as a name on a plaque. But the community can honor Maria’s legacy by taking steps to ease the burdens of those with chronic illnesses and disabilities. Include us in diversity initiatives. Simplify access to health care and insurance. Promote a climate that prioritizes health above productivity. Foster a sense of community where we feel safe to disclose our conditions. Show us that we belong in science and don’t let us fall through the cracks.
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Being caught talking to yourself, especially if using your own name in the conversation, is beyond embarrassing. And it’s no wonder – it makes you look like you are hallucinating. Clearly, this is because the entire purpose of talking aloud is to communicate with others. But given that so many of us do talk to ourselves, could it be normal after all – or perhaps even healthy?
We actually talk to ourselves silently all the time. I don’t just mean the odd “where are my keys?” comment – we actually often engage in deep, transcendental conversations at 3am with nobody else but our own thoughts to answer back. This inner talk is very healthy indeed, having a special role in keeping our minds fit. It helps us organise our thoughts, plan actions, consolidate memory and modulate emotions. In other words, it helps us control ourselves.
Talking out loud can be an extension of this silent inner talk, caused when a certain motor command is triggered involuntarily. The Swiss psychologist Jean Piaget observed that toddlers begin to control their actions as soon as they start developing language. When approaching a hot surface, the toddler will typically say “hot, hot” out loud and move away. This kind of behaviour can continue into adulthood.
Non-human primates obviously don’t talk to themselves but have been found to control their actions by activating goals in a type of memory that is specific to the task. If the task is visual, such as matching bananas, a monkey activates a different area of the prefrontal cortex than when matching voices in an auditory task. But when humans are tested in a similar manner, they seem to activate the same areas regardless of the type of task.
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Macaque matching bananas. José Reynaldo da Fonseca/wikipediaIn a fascinating study, researchers found that our brains can operate much like those of monkeys if we just stop talking to ourselves – whether it is silently or out loud. In the experiment, the researchers asked participants to repeat meaningless sounds out loud [“blah-blah-blah”] while performing visual and sound tasks. Because we cannot say two things at the same time, muttering these sounds made participants unable to tell themselves what to do in each task. Under these circumstances, humans behaved like monkeys do, activating separate visual and sound areas of the brain for each task.
This study elegantly showed that talking to ourselves is probably not the only way to control our behaviour, but it is the one that we prefer and use by default. But this doesn’t mean that we can always control what we say. Indeed, there are many situations in which our inner talk can become problematic. When talking to ourselves at 3am, we typically really try to stop thinking so we can go back to sleep. But telling yourself not to think only sends your mind wandering, activating all kinds of thoughts – including inner talk – in an almost random way.
This kind of mental activation is very difficult to control, but seems to be suppressed when we focus on something with a purpose. Reading a book, for example, should be able to suppress inner talk in a quite efficient way, making it a favourite activity to relax our minds before falling asleep.
But researchers have found that patients suffering from anxiety or depression activate these “random” thoughts even when they are trying to perform some unrelated task. Our mental health seems to depend on both our ability to activate thoughts relevant to the current task and to suppress the irrelevant ones – mental noise. Not surprisingly, several clinical techniques, such as mindfulness, aim to declutter the mind and reduce stress. When mind wandering becomes completely out of control, we enter a dreamlike state displaying incoherent and context-inappropriate talk that could be described as mental illness.
Loud vs silent chat
So your inner talk helps to organise your thoughts and flexibly adapt them to changing demands, but is there anything special about talking out loud? Why not just keep it to yourself, if there is nobody else to hear your words?
In a recent experiment in our laboratory at Bangor University, Alexander Kirkham and I demonstrated that talking out loud actually improves control over a task, above and beyond what is achieved by inner speech. We gave 28 participants a set of written instructions, and asked to read them either silently or out loud. We measured participants’ concentration and performance on the tasks, and both were improved when task instructions had been read aloud.
Much of this benefit appears to come from simply hearing oneself, as auditory commands seem to be better controllers of behaviour than written ones. Our results demonstrated that, even if we talk to ourselves to gain control during challenging tasks, performance substantially improves when we do it out loud.
This can probably help explain why so many sports professionals, such as tennis players, frequently talk to themselves during competitions, often at crucial points in a game, saying things like “Come on!” to help them stay focused. Our ability to generate explicit self instructions is actually one of the best tools we have for cognitive control, and it simply works better when said aloud.
So there you have it. Talking out loud, when the mind is not wandering, could actually be a sign of high cognitive functioning. Rather than being mentally ill, it can make you intellectually more competent. The stereotype of the mad scientist talking to themselves, lost in their own inner world, might reflect the reality of a genius who uses all the means at their disposal to increase their brain power.
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