Too much or too little? Disorders of agency on a spectrum

Disorders of agency could be described as cases where people encounter difficulties in assessing their own degree of responsibility or involvement with respect to a relevant action or event. These disturbances in one’s sense of agency appear to be meaningfully connected with some mental disorders and with some symptoms in particular—i.e. auditory verbal hallucinations, thought insertion, pathological guilt. A deeper understanding of these experiences may thus contribute to better identification and possibly treatment of people affected by such disorders. In this paper I explore disorders of agency to flesh out their phenomenology in more detail as well as to introduce some theoretical distinctions between them. Specifically, I argue that we may better understand disorders of agency by characterizing them as dimensional. In §1 I explore the cases of Auditory Verbal Hallucinations (AVH) and pathological guilt and I show that they lie at opposite ends of the agency spectrum (i.e. hypoagency versus hyperagency). In §2 I focus on two intermediate cases of hypo- and hyper- agency. These are situations that, despite being very similar to pathological ones, may be successfully distinguished from them in virtue of quantitative factors (e.g. duration, frequency, intensity). I first explore the phenomenon of mind wandering as an example of hypoagency, and I then discuss the phenomenon of false confessions as an example of hyperagency. While cases of hypoagency exemplify situations where people experience their own thoughts, bodies, or actions as something beyond their control, experiences of hyperagency provide an illusory sense of control over actions or events.

Voice of God, Sound of Self

Humans are biologically evolved to identify sources of their own conscious experience and to distinguish between private inner speech and speech acts of external agents. So how are we to explain exceptions to our success in this capacity? How, in particular, can we account for hallucination of the voice of God? The chapter explores the question in detail. It distinguishes between hallucinations that result from religiously undomesticated breakdowns of source monitoring, in, say, schizophrenia, and those that are parts of culturally standard religious rituals and practices. The chapter identifies a range of cognitive systems that are connected with source monitoring and active in hallucination. These include, among others, theory of mind and linguistic processing systems. The chapter compares and contrasts hallucination of God’s voice with self-attribution of God’s thought in a delusion of thought insertion.

Cotard syndrome, self-awareness, and I-concepts

Various psychopathologies of self-awareness, such as somatoparaphrenia and thought insertion in schizophrenia, might seem to threaten the viability of the higher-order thought (HOT) theory of consciousness since it requires a HOT about one’s own mental state to accompany every conscious state. The HOT theory of consciousness says that what makes a mental state a conscious mental state is that there is a HOT to the effect that “I am in mental state M.” I have argued in previous work that a HOT theorist can adequately respond to this concern with respect to somatoparaphrenia and thought insertion. There is also Cotard syndrome which is a rare neuropsychiatric disorder in which people hold the delusional belief that they are dead, do not exist, or have lost their blood or internal organs. In this paper, I argue that HOT theory has nothing to fear from it either and can consistently account for what happens in such unusual cases. I analyze Cotard syndrome in light of my previous discussion of somatoparaphrenia and thought insertion, and argue that HOT theory can provide a somewhat analogous account without the worry of inconsistency. It is crucial to recognize that there are multiple “self-concepts” and levels of HOTs which can help to provide a more nuanced explanation. With regard to the connection between consciousness and self-consciousness, it is proposed that Cotard patients are indeed capable of having some “I-thoughts” about their bodies and mental states.

Mad identity II: Unity and continuity of self

Chapter 8, “Mad identity II: Unity and continuity of self,” examines two objections to Mad activism. Certain mental health phenomena are considered to undermine unity and continuity of self and hence to undermine two requirements for identity formation. This chapter explores the nature and extent of these problems, and whether or not they are fatal to the claim that madness can be grounds for identity. With regard to disunity of self, the chapter investigates passivity phenomena with a focus on thought insertion. It uncovers the cultural psychological basis of judgments of disunity, and offers a more complex appraisal of passivity phenomena. With regard to discontinuity of self, the chapter investigates patterns of discontinuity in spirit possession, dissociative identity disorder, schizophrenia, and bipolar disorder. It notes similarities and differences in these patterns, and ways of overcoming discontinuity. In pursuing this, the chapter engages with key arguments by Jennifer Radden and Christine Korsgaard.

Hypnotic Clever Hands: Agency and Automatic Responding

The Clever Hands task (Wegner, Fuller, & Sparrow, 2003) is a behavioral illusion in which participants make responses to a trivia quiz for which they have no sense of agency. Sixty high hypnotizable participants completed two versions of the Clever Hands task. Quiz one was a replication of the original study. Quiz two was a hypnotic adaptation using three suggestions that were based on clinical disruptions to the sense of agency. The suggestions were for: Random Responding, Thought Insertion, and Alien Control. These suggestions led to differences in accuracy (action production) and estimates of accuracy (action projection). Specifically, whereas the Random Responding suggestion had little effect, the two clinically based suggestions had opposite impacts on action production: the Thought Insertion suggestion led to an increase in the rate of correct responses (although participants still believed they were responding randomly); while the Alien Control suggestion led to a reduction in the rate of correct answers and a pattern of results that more closely approximated randomness. Contrary to theoretical accounts that claim that hypnosis affects executive monitoring rather than executive control, this result indicates that specific hypnotic suggestions can also influence the implicit processes involved in action production.