About 14% of study subjects experienced a state of self awareness, during which they were unaware of their external environment, but aware of their inner selves. For some subjects this was a simple awareness of how they felt and their inner world. For example, one man remembered the experience as being black and dark but without pain. Others remembered the experience as being white.
Other subjects experienced more. For example, one subject dreamt while being resuscitated, and was surprised to wake up to see the resuscitation team at the foot of his bed. He asked them what they were doing there.
It is common for us to have the ability to communicate with ourselves. That ability persisted for some subjects. Often they were aware they might die and were afraid. One man said, "The only thing I remember was trying to come back. That was a struggle. I started talking to myself. It was uncomfortable and frightening."
Currently our understanding of how this inner dialogue is generated remains incomplete. We know from studies of lucid dreaming (Godwin, 1994) that this is another situation when this ability manifests itself. When some people are dreaming they are also aware that they are dreaming . It is this alternate awareness that is still active in these subjects and some unconscious patients. The exact mechanism for how this occurs is unknown.
More recently there has been considerable research in understanding inner dialogue. It is also referred to as verbal thinking, inner speaking, covert self-talk, internal monologue, and inner speech. It has been found people often talk to themselves for various reasons, including self-regulation, problem solving, and decision making.
It has been difficult to identify precise operational definitions of inner dialogue. Research is difficult even in imaging studies. Participants can have considerable variation in how they carry out inner dialogue (Lidstone, et al, 2011). Researchers are developing tools to use in questionnaires about inner dialogue such as the Self-Verbalization Questionnaire, the Self- Talk Scale, the Inner Speech Questionnaire, the Self-Talk Inventory, and the Rumination-Reflection Questionnaire. The results showed that self-reports of inner speech are reliable but have only limited validity (Alderson-Day & Fernyhough, 2015).
To date, there is no clear description how an unconscious patient can have an inner dialogue and not be aware of the external environment. Research in the area of the neurobiology of inner dialogue continues to be ongoing..
Alderson-Day, B. & Fernyhough, C. (2015). Inner Speech: Development, Cognitive Functions, Phenomenology, and Neurobiology. Psychological Bulletin. 141(5), 931–965.
Lidstone J., Meins E., & Fernyhough C. (2011). Individual differences in children’s private speech: Consistency across tasks, timepoints, and contexts. Cognitive Development, 26, 203–213. 10.1016/j.cogdev.2011.02.002.
Some patients in an
unconscious state are not aware of their external environment
but can have an inner dialogue and possibly dream.