Agency is the sense of ownership, i.e. the personal experience of being the originator of one's thoughts and actions (Walter, 2001). Disorders of agency are prominent in schizophrenia and may also be part of several other neuropsychiatric disorders and syndromes, e.g. alien-hand syndrome, drug-induced psychoses or anosognosia. In recent years, cognitive neuroscience has made considerable progress in understanding the neural basis of agency. In this chapter, current neurocognitive theories of agency are reviewed which are based on the assumption that an internal monitoring deficit lies at the core of disorders of agency in schizophrenia. It is demonstrated how they fail to explain several features of disturbed agency. A complementary theory is proposed which takes into account the experiences of reference and insertion of personal relatedness as well as the acknowledged role of dopamine for schizophrenia and its role as a neuromodulator regulating signal-to-noise ratio.
The psychopathology of agency in schizophrenia
Schizophrenic patients often report the immediate experience of someone else controlling their thoughts and actions. In addition, sometimes they feel they are in control of external events or are convinced they know what other people think. They think that things or events are related to themselves in a special way, have a personal significance or are made especially for them. The German psychiatrist Kurt Schneider emphasized these types of ideation as criteria for the diagnosis of schizophrenia, and because of their relative homogeneity and recognizability, they are frequently referred to as Schneiderian first-rank symptoms.
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