The Routledge Handbook of Consciousness

Rocco J. Gennaro

of subjectivity,” and the feeling of causing my mental state the “sense of agency.” They urge that
these two can come apart in unusual cases, so that thought insertion involves the sense of sub-
jectivity without the sense of agency, which also accounts for the curious “passivity experience”
of schizophrenics. So attributing thoughts to someone else makes sense because it still must be
caused by something or someone.
Gallagher (2000) makes the similar distinction between a “sense of ownership” and a “sense
of agency,” but, in contrast to Stephens and Graham’s (2000) “top-down” approach, argues
instead that the primary deficit regarding thought insertion is more of a “bottom-up” problem
with the first-person experience itself rather than a self-monitoring abnormality. What happens
at the introspective level is not erroneous but rather a correct report of what the schizophrenic
actually experiences, that is, thoughts that feel different and externally caused. Gallagher also
points to some preliminary neurological evidence which indicates abnormalities in the right
inferior parietal cortex for delusions of control.^7

2 Disorders of Outer Perception

Of course, many psychopathologies of consciousness involve abnormally experiencing the outer
world via outer perception. Agnosia, for example, is the loss of ability to recognize objects, per-
sons, sounds, shapes, or smells while the specific sense itself is not necessarily defective and there
is no significant memory loss. Focusing on visual agnosia, it is known to come in two types:
apperceptive visual agnosia, cases where “recognition of an object fails because of an impairment
in visual perception,” and associative visual agnosia, cases “in which perception seems adequate
to allow recognition, and yet recognition cannot take place” (Farah 2004: 4). The latter is far
more interesting to philosophers since it appears to be an instance of having a “normal percept
stripped of its meaning” (Teuber 1968). So, for example, a patient will be unable to name or rec-
ognize a bicycle. Associative agnosics are not blind and do not have damage to the relevant areas
of the visual cortex. In addition, associative agnosics tend to have difficulty in naming tasks and
with grouping objects together. Unlike in apperceptive agnosia, there seems to be intact basic
visual perception; for example, patients can copy objects or drawings that they cannot recognize,
albeit very slowly. But the deficit in associative agnosics is more cognitive than in patients with
apperceptive agnosia. Patients will also often see the details of an object but not the whole of the
object at a glance. The main point is that the very phenomenal experience of associative agnosics
has changed in a way that corresponds to a lack of conceptual deployment. It is, however, impor-
tant to recognize that associative agnosics still do possess the relevant correct concept because
they can apply it via other modalities. For example, a patient might easily identify a whistle by
sound instead of sight. Like other disorders, the lack of unity in consciousness is striking for
those who suffer from agnosia.
There are other similar psychopathologies resulting in devastating effects on consciousness.
Prosopagnosia (also known as “faceblindness” and “facial agnosia”) occurs when patients cannot
consciously recognize very familiar faces, sometimes even including their own. They do not
have a sense of familiarity when looking at another’s face but can sometimes make inferences
via auditory or other visual cues (e.g. clothes, hair) to compensate. However, skin conduct-
ance responses show that there is some kind of emotional arousal when in the presence of a
known person. Akinetopsia is the loss of motion perception or visual animation, sometimes
called “motion blindness.” The visual world seems to come to a standstill or appears more like a
sequence of frozen snapshots, such that objects don’t really move but appear to “jump” from one
place to another. One’s visual consciousness is distorted both with respect to temporal sequence
and the unity of consciousness. Simultanagnosia occurs when patients can recognize objects