As someone who writes I would have a very hard time imagining writing without the ability to have a mental monologue. I do know Alan Moore said in an interview that he would talk to himself in the mirror. Maybe he's an instance of a writer who doesn't think in words.
I would not think of a blue elephant as the word 'blue elephant' it would be the mental image of one. However, when it comes to thinking about a multiple choice question on a practice test or a quote I've recently read I can recall the words on the page of paper and the words mentally "read out".