When children talk to themselves out loud, their classmates commonly tease them by saying this is the first sign of madness. It is a cruel taunt but also an inaccurate one. Talking to yourself is normal at all age¹—and so is talking to trees and other inanimate objects. To emphasise this point, a psychiatrist even appeared on television in Germany earlier this year to ask people not to overwhelm his profession with concerns about talking to flowers and walls when under quarantine, and he advised them only to call if the flowers or walls started to talk back.² Talking to yourself can in fact be beneficial in certain circumstances, such as enhancing performance in sport,³ finding objects that have been mislaid⁴ and developing problem-solving skills.⁵ Personally, I have never believed that it is mad to talk to yourself, but I have often said to medical colleagues and trainees, half in jest, that the opposite is certainly true: the first sign of madness is when you stop talking to yourself. In this case, I am not necessarily referring to speaking your thoughts aloud—although that can sometimes be helpful too. I am trying to encourage what is called inner speech or internal dialogue, as part of reflective practice.

Reflection in the literal sense means looking at yourself in a mirror. Much discussion of reflective practice uses language related to vision, like ‘self-observation’, rather than referring to the capacity to speak and listen to yourself. In …