Inner speech and the neurobiology of psychosis
bioRxiv Preprint Server August 22, 2025 Jeremy I Skipper, Daniel R Lametti, David W Green preprint
Psychotic symptoms such as hearing voices or feeling that thoughts are inserted may arise from failures in the brain's prediction and self-monitoring systems. Normally, when people talk internally, the brain sends copies of motor commands to auditory regions and suppresses them, helping distinguish self-generated from external input. When this suppression malfunctions, predicted inner speech can become perceptually salient and misattributed as external. Neuroimaging meta-analyses showed that psychosis-spectrum participants had increased activity in motor-related regions for inner speech and decreased grey matter in auditory cortices and anterior cingulate cortex. These regions form inversely coupled networks, supporting a hierarchical predictive-processing account where disruption distorts self-awareness.