Spence / Alien Control: From Phenomenology to Cognitive Neurobiology ■ 163

Alien Control:
From Phenomenology
to Cognitive
Neurobiology
Sean A. Spence

ABSTRACT: People experiencing alien control re- tions, and emotions. The external influence re-
port that their thoughts, movements, actions, ported does not occur through “normal” means,
and emotions have been replaced by those of an such as empathy, intimidation, or coercion. What
“other.” The latter is commonly a perceived per-
patients describe is a marked disturbance of their
secutor of the patient. Here I describe the clinical
phenomenology of alien control, mechanistic subjectivity so that their most intimate thoughts
models that have been used to explain it, prob- are “interfered with” directly, their physical move-
lems inherent in these models, the brain deficits ments “belong to” another, and their moods are
and functional abnormalities associated with this “put into them” from outside. The explanations
symptom, and the means by which disordered offered may invoke the technology of the day
agency may be examined in this perplexing con- (e.g., satellites or computers) or spiritual entities.
dition. Our current state of knowledge impli-
These experiences have been regarded as “un-
cates potentially reversible dysfunction in certain
key brain regions (especially the right parietal understandable” to the “normal” interviewer.
cortex), which is temporally related to the pres- Yet they are so characteristic and are found so
ence of symptoms. Alien control is quintessen- widely across the populations studied that they
tially a disorder of agency. have remained central to contemporary theories
KEYWORDS: alien control, delusion, psychosis, motor
of schizophrenia (e.g., Crow 1998).
control, action, agency, parietal lobe, internal-moni- A problem for the schizophrenia researcher is
toring that these symptoms are not confined to this dis-
order. They are found in a range of other condi-
Introduction tions, such as psychotic depression and some forms
of epilepsy. Thus in the present context, it is prag-
matic to consider the neural mechanisms under-
pinning the symptoms of alien control specifical-

A
LIEN CONTROL COMPRISES a group of symp- ly, rather than to address the broader syndrome
toms united by the common feature that of schizophrenia, a condition that may well com-
a person’s subjective sense of agency is prise multiple patho-physiological processes.
replaced (or directly interfered with) by that of In addition, when considering psychopatholo-
another. It may affect thoughts, movements, ac- gy (abnormalities of mind), it is important to

© 2002 by The Johns Hopkins University Press

acknowledge that the brain functions at the level possessed and doing these things to him. At one
of integrated systems, rather than isolated foci of point, he storms out of the room. Two or three
neural tissue. Hence, an apparent dysfunction minutes later, he is back to apologize. He has
within a given system may be attributable to a concluded that God is in the interviewer as well.
“lesion” or defect in any one of a number of On the same ward, there is a young woman who
component parts within that system (Masterman has schizophrenia and whose symptoms are cen-
and Cummings 1997). In addition, dysfunction tered on eyes. She stares closely at people but asks
may be consequent upon a variety of pathologi- that they do not look back at her. If they do, she
cal mechanisms, e.g., the modulation of activity seems to hear “voices” in the perceived movements
by a psychotropic substance (a drug) or the chance of their eyes, or to experience others’ thoughts as
localization of a lesion. Hence, both the site and entering her head. She asks repeatedly what this
the cause of a dysfunction may vary between means. She is constantly looking for reassurance:
subjects, although their phenomenology (their “Can this kind of thing really happen?”
symptom) may “look” similar. These two vignettes illustrate some of the day-
In this paper, I will examine the following: to-day phenomenology of schizophrenia. In the
first case, the male patient experiences interfer-
(1) The clinical phenomenology of alien control as
described by patients ence with his movements, particularly those in-
(2) The mechanistic explanations that have been of- volved in speech. We can see that the phenome-
fered by clinicians and scientists nology changes rapidly over a relatively short
(3) The problems with one very influential psycho- period. In addition, the phenomenology impli-
logical theory of symptom-generation cates the immediate social environment: It is not
(4) The subtle neuropsychological deficits associated just that this man’s movements are being inter-
with alien control
fered with, it is that those surrounding him may
(5) The neural correlates of the sense of agency
(6) The evidence for disturbance within these neural be implicated (although, ultimately, it is God and
systems coinciding with alien control the Devil with whom he is concerned). He is
unusual in that we do not normally see grossly
We begin with the phenomenology. abnormal movements in those with alien con-
trol. Although they experience their movements
Clinical Phenomenology as abnormal, these movements do not usually
On a psychiatric ward in an inner city, a man appear objectively unusual.
who elicits fear in those around him sits at the Turning to the female patient, we can see that
center of a ward round. He has been in prison she has “thought insertion” on occasions, which
and secure units in the past. His speech is loud. is secondary to the movement of other peoples’
He is preoccupied with God and the Devil. He eyes. Other people’s thoughts seem to enter her
believes at times that he is God but at other head. However, this symptom also changes rap-
times, he believes that God is inside him. He idly, and by its very nature, it implicates a rela-
usually avoids social contact, tending to stay in tionship between the subject and those whom
his room. He is unable to cope with money and she observes.
cannot function in the community. In addition, These cases were taken from a single day’s
he has tardive dyskinesia: involuntary movements practice and comprise the two cases of alien
affecting his face and tongue. control seen that day but are not chosen accord-
At one point, this man can hardly speak and ing to any other criteria. They serve to emphasize
his protruding tongue seems to trip him up as his the rapidly changing nature of an acute psychot-
words falter. The interviewer makes a remark ic episode. To this author they also highlight the
about the difficulty that he is having. The patient “organicity” of schizophrenia. These patients
answers that the Devil is trying to prevent him seem to be assailed by rapid, yet quite specific,
from speaking. Over the course of some minutes, changes in subjectivity, relating to the move-
he is unsure whether the interviewer might be ments of speech and the perception of eye move-
 Spence / Alien Control: From Phenomenology to Cognitive Neurobiology ■ 165

Table 1. Patient reports of alien control of movement (from Spence et al. 1997)

Verbatim report

“I felt like an automaton, guided by a female spirit who had entered me during it [an arm movement].”

“I thought you [the experimenter] were varying the movements with your thoughts.”

“I could feel God guiding me [during an arm movement].”

ment, respectively. These may be rapid and dis- delusional “misidentification”) has made two er-
tressing, but they are not chaotic: They affect rors. He has erroneously identified his wife, but
specific domains. Importantly, these changes also he has also failed to identify his nurse. In the
implicate inter-subjectivity, implied between the Hughlings-Jackson conceptualization of psycho-
patients and those “others” whose agency they sis, the false identification (of his wife) is a “pos-
seem to experience. They do not simply lose itive” phenomenon, whereas the failure to iden-
awareness of their own agency or sense of voli- tify his nurse constitutes a “negative” phenomenon,
tion. They are implicated in a relationship with i.e., a function that should be present but is
those around them (the interviewer, staff, and “missing” (see Berrios 1996).
other patients) or believed to be at a distance We can follow the same dichotomy through
(God or the Devil). other theories of psychosis. Angyal, writing in
The phenomena of alien control, by their very the 1930s, proposed that the positive symptoms of
nature, implicate “others”: those (allegedly) ex- schizophrenia were due to a lack of proprioception
erting control. We have also seen this in our own (joint position sense), leaving the patient unaware
experimental subjects. In a functional neuroim- of his own movements. Because of this lack of
aging study of alien control, using positron emis- awareness, the patient falsely attributes his move-
sion tomography (PET), we specifically studied ments to external agents. Angyal (1936) provides
people (with schizophrenia) who experienced their a long and detailed account of one such patient:
limb movements as being controlled by outside
Some of the thoughts he has are not his thoughts,
forces (Spence et al. 1997). In this way, we hoped “somebody gives them [to him] silently; they put them
to constrain the neural systems studied (to those into [his] head.” It seems to him also as if someone
involved in limb movement). Some examples of else thinks in him, “as if I had two or three people
the phenomenology recounted are given in Table with me.” “[W]hen I am chewing it seems that anoth-
1. Again, it is the agency of an “other” that is er tongue comes and takes the food.” When the pa-
common to these accounts, an agency variously tient intends to do one thing, “they try to make me do
something different,” he feels like a “mechanical man.”
attributed to a “female spirit,” the experimenter
“It is hard to control the tongue, they just drop some
(i.e., me), or God. words on your tongue” (Angyal 1936, 1036).

Interpreting Alien Control Notice how similar these symptoms are to those
of our contemporary patients (above).
Many theories of psychotic symptoms have The notion that a normal awareness of inner
highlighted two features: an absence of one nor- functioning is lost in the psychotic process also
mal mental function and an abnormal or exces- forms the basis for Feinberg’s (1978) contribu-
sive elaboration of another, giving rise to the tion. In his “corollary discharge” model, Fein-
florid symptoms of psychosis (e.g., hearing voic- berg postulates that thoughts and movements
es or being controlled). Thus, in the oft-quoted involve a “feed forward” component, such that
example from Hughlings-Jackson (1931), a man their initiation gives rise to a re-afference signal.
who mistakenly identifies his nurse as his wife (a This signal essentially labels the thought or move-
166 ■ PPP / VOL. 8, NO. 2–3 / JUNE–SEPTEMBER 2001

ment as being “internally generated” (“belong- Psychotic symptoms arise because patients are
ing to me”). Such a theory has its antecedents in unaware of key processes taking place in their
the writings of many previous authors (e.g., Helm- brains (minds). Un-awareness of these processes
holtz, James, Janet, Anokhin, Bernstein and oth- gives rise to abnormal experiences and false be-
ers reviewed by Berthoz 2000). Feinberg hypoth- liefs, which attempt to account for these experi-
esizes that if there were a breakdown in this ences. A central problem for both Feinberg and
feed-forward mechanism, then it might give rise Frith is how the absence of a function can ex-
to psychotic phenomena. A thought or move- plain a “positive” symptom. For instance, if the
ment might appear to be initiated de novo, with- man in Hughlings-Jackson’s example cannot rec-
out the subject experiencing agency. However a ognize his nurse, why does he see his wife? If
problem for this theory is the prerequisite that Angyal’s patient (above) cannot feel his tongue,
“normal” thoughts be labeled as “internally gen- why does he think that it is controlled by anoth-
erated” (“mine”). Campbell and others have ar- er? Perhaps the emergence of action is the key.
gued cogently that there is no necessity for Frith’s solution was to propose that the symp-
thoughts to be labeled in this way, as we do not toms of schizophrenia could be understood in
normally expect thoughts to arise from anywhere terms of “action” (Frith 1987). Positive symp-
else except our own minds (for reviews, see Camp- toms (like alien control) were hypothesized to be
bell 1999; Spence 2000). due to the patient’s inability to monitor his own
Another aspect of the Feinberg model is the intentions (to act), while negative symptoms (such
requirement that thinking be associated with a as poverty of speech and apathy) were due to a
sense of “effort,” which provides the subjective failure to generate action. This is an elegant and
sense of agency. This seems to lack face validity: highly influential theory.
Much of the time we do not have any sense of Frith defines actions in the same way as Mac-
effort regarding our own thinking. This may murray (1991). They are movements that are
certainly apply in specific situations, such as at- chosen by the agent. When Frith uses “inten-
tempting mental arithmetic or trying to remem- tion,” he is specifying “prior” intentions in the
ber a name, but it cannot be generalized to most sense used by Searle (1983); he is specific that
of our thinking. This same problem recurs in a they precede action. There are two forms of
highly influential contemporary theory of alien intention: those that are “willed” (and conscious)
control, which again stresses the effort of think- and those that are “stimulus-dependent” (which
ing (Frith 1987). It is postulated that if the sense are probably unconscious). See Spence (2000,
of effort is missing for some reason, then a thought 131–143) for a full critique of Frith’s apparent
may be attributed to an external force. This has meaning.
also been questioned, most recently by Campbell Frith proposes that there is an internal moni-
(1999). See Spence (2000, 129–143) for a con- toring system, which monitors three things: stim-
sideration of the predictions that would follow ulus intentions, willed intentions, and the action
from such a theory. that has been selected. It monitors the latter via
In the following section, I address Frith’s “ac- the corollary discharge (a form of feedback). It
tion” theories of schizophrenia in some detail, as can detect mismatches between intentions and
they have provided the theoretical underpinning their consequent actions at a very early stage,
for many recent psychological and functional thus permitting rapid error correction. Because it
neuroimaging studies of schizophrenia. maintains the distinction between willed (con-
scious) intentions and stimulus (automatic, un-
The Paradox in Frith’s Action conscious) intentions, it can provide information
about the type of error occurring and thus facili-
Theories tate correction (Frith 1987, 635).
Frith’s theories may be understood as an itera- With respect to positive symptoms such as
tive attempt to build on Feinberg’s central thesis: alien control, Frith proposes that there is a fail-
 Spence / Alien Control: From Phenomenology to Cognitive Neurobiology ■ 167

ure to monitor willed intentions: “The classic . . . retain its explanatory power (a conscious inten-
symptom of a “made” volitional act [alien con- tion, which is unconscious), yet the paradox can-
trol] corresponds particularly closely to an in- not explain how an “alien” intention is experi-
ability to monitor the intention to act . . . [T]he enced as “alien” (because it is out of awareness
experience of thoughts being initiated without and hence is not “experienced”). An abnormal
any apparent intention to have them would be experience (of alien agency) is not then explained
described by the patient as thought insertion” by an absence of experience (of agency). To re-
(Frith 1987, 639). turn to Hughlings-Jackson, we may deduce that
This model contains a number of problems, the “positive” component of alien control (ab-
not least of which is the proposal that the subject normal awareness) is not reducible to its “nega-
(experiencing alien control) may be performing tive” component (an absence of awareness of
“actions,” which are preceded by “intentions to one’s own agency). The psychopathology resist-
act” of which he or she is unaware. Using Frith’s ing explication must reside within agency itself.
own definition of action as necessitating prior
intention, a paradox is revealed: The Neuropsychological
These schizophrenic acts are volitional “acts” Deficit in Alien Control
because they are preceded by (conscious) willed
intentions. These intentions are conscious. Yet, Despite the problems characterizing the “in-
the patient is (hypothesized to be) unaware of tention” component of his theory, Frith and oth-
this (conscious) intention to act. This line of ers have demonstrated empirically that there are
argument suggests that “somewhere” in the af- indeed problems in the “monitoring” of motor
fected brain there is a conscious “intention to activity in people with schizophrenia. In one study,
act,” but despite its being conscious the patient is Frith and Done (1989) demonstrated that those
unaware of it. experiencing alien control were relatively im-
It is important to emphasize that Frith is not paired on tasks requiring them to rely on “inter-
suggesting that there is simply an absence of a nal monitoring” of their movements, as opposed
willed intention. Such an absence (or lack) of to direct visual feedback. In these studies, pa-
intention forms the basis of the second part to tients had to rely on their own proprioception to
his theory, pertaining to negative or deficit symp- guide the behaviors. Their performance was worse
toms (such as poverty of speech). For positive than others with schizophrenia or affective psy-
symptoms, he is quite specific that there is an choses (who were not experiencing alien con-
intention (associated with alien control), but it is trol). They seemed “not [to know] what response
not being monitored. they had just made” (Frith and Done 1989). In a
Hence, although it is frequently invoked with- subsequent study by Mlakar et al. (1994), the
out further comment, Frith’s (1987) theory of investigators studied patients concurrently expe-
the defective internal monitor, failing to monitor riencing the “first rank symptoms” of schizo-
willed intentions, is problematic. Its construc- phrenia (including, but not exclusively, those of
tion commits the investigator to a view of con- alien control). They conducted two experiments
sciousness that is obscure, namely, (in the “alien- involving the generation of visual designs with
controlled” patient) intentions are simultaneously varying degrees of visual feedback. The patients
conscious (in the brain) and unconscious (to the who were currently experiencing first-rank symp-
patient). This apparent paradox might be re- toms exhibited increasing deficit as the necessity
solved if the patient were said to be conscious of for reliance on internal monitoring increased.
his intention as one that is “alien,” but then the This deficit was apparent in both the (unguided)
patient would no longer be unaware of this in- copying of an experimenter’s visual design and in
tention, and so his “unawareness” of it could no the recognition of their own (the patient’s self-
longer form the basis of its “alien-ness.” Put generated) design. These deficits were relative to
simply, Frith’s model “requires” a paradox to control groups, one of which comprised patients
168 ■ PPP / VOL. 8, NO. 2–3 / JUNE–SEPTEMBER 2001

who had previously experienced such symptoms. trol at the time they were tested. In addition,
Therefore, the current presence of these symp- subjects who experienced alien control comprised
toms was temporally related to an impairment of only part of the index subject group, the majori-
sensory awareness. ty of whom did not experience this symptom but
Thus, in two similar studies (and a third by suffered from auditory verbal hallucinations
Stirling et al. 1998), patients with alien control (“voices”) instead. Hence, we need to clarify
have been shown to be impaired on the perfor- whether one form of pathophysiology is com-
mance of motor tasks (necessitating “self moni- mon to those experiencing alien control and au-
toring”). Mlakar et al. (1994, 563) suggest that ditory hallucinations. Similarly, Stirling et al.
“in certain phases of their illness, [these] patients (1998), above, combined similar patient groups
are lacking a clear, distinct and solid representa- and summarized their data as referring to “alien
tion of internally initiated mental activity” (con- control,” when the more robust findings were
gruent findings have also been reported by Dap- those specific to auditory hallucinations. Indeed,
rati et al. 1997; Franck et al. 2001). when IQ and cognitive performance were con-
It is notable that there is an overlap between trolled for, most of the results relating specifical-
these formulations of cognitive impairment dur- ly to alien control symptoms lacked statistical
ing alien control and that offered by Angyal significance.
(1936), relating to a lack of proprioception. In A subtle difference in the later Frith study
terms of their phenomenology, people who expe- (Blakemore et al. 2000), is the move away from
rience alien control fail to experience (or to re- the alien control of action (affecting the hand
tain a memory of) their motor acts, an abnor- “doing the tickling”) towards the sensory aware-
mality temporally related to the presence of these ness of the area tickled (elsewhere on the body).
symptoms. Thus, the forward model no longer refers to the
In a further study, Frith and colleagues control of a movement (through feedback), but
(Blakemore et al. 2000) have shown that those its anticipated (distal) consequences on other body
who experience alien control have different ex- areas.
periences of self-tickling, compared to healthy Since we are primarily interested in why ac-
controls and other patients with schizophrenic tions are perceived as being under the control of
or affective disorders. The point here is that other agents, we will now consider the neural
people with these symptoms experience no atten- correlates of agency.
uation in sensory stimulation when they tickle
themselves, in contrast to the “normal” state in The Neural Correlates of
which tickling oneself is experienced as being Agency
less pleasant than being tickled by someone else.
One possible explanation for such findings (in In the context of this paper, “agency” refers to
patients) is the lack of a “forward model” emerg- the sense of ownership of action experienced by
ing for the act of tickling: In essence, a failure (by a subject. Hence, the term is being used to refer
the brain) to anticipate auto-stimulation leads to to a subjective experience, rather than an observ-
a relatively enhanced response by the relevant er’s attribution of agency to the subject. From
sensory cortex to (self-induced) peripheral stim- the neurological literature, it is clear that a loss
ulation. Hence, a motor mechanism breaking of the ability to move, or even to control a limb,
down during movement (“forward modeling”) does not necessarily lead to a loss of agency.
may have consequences for the subsequent sen- Patients who have suffered strokes, leaving them
sory awareness of that movement, and altered unable to move their limbs, do not frequently
sensations may then be attributed to alien sources. report these limbs as belonging to others.
Several details require clarification. First, in While the movements of the limb under alien
the Blakemore et al. (2000) study the subjects control may appear grossly normal, there is a
were not reported to be experiencing alien con- syndrome in which a limb appears objectively as
 Spence / Alien Control: From Phenomenology to Cognitive Neurobiology ■ 169

if it is out of control: the alien or anarchic limb compelling account of the deficits in self-recogni-
syndrome (phenomenology described in detail in tion, or “me-ness,” which accompany right hemi-
Spence 1996). However, in this case the hand sphere lesions. It seems that the right hemisphere
that cannot be controlled is still mostly recog- may be particularly involved in recognition of
nized as being part of the subject’s own body and the “self” and, hence by extrapolation, in recog-
subject to their “ownership” (Spence and Frith nition of that self’s agency. One intriguing find-
1999). Two forms of alien hand are seen in ing that has been well replicated is that patients
which a limb is disinhibited following lesions of with somatoparaphrenia may exhibit temporary
either the medial premotor cortex or the corpus remissions in response to vestibular caloric stim-
callosum. In these cases, subjects admit to diffi- ulation (where cold water is inserted into the left
culty controlling the affected limb (which seems outer ear). During such stimulation, a patient
to perform pseudo-purposeful movements, grasp- may again experience the left limb as “their own,”
ing objects in the environment), but they do not but afterwards return to believing that it belongs
generally attribute control of that limb to another. to another (see Bisiach et al. 1991).
However, when the alien limb is seen in the
context of a right-sided parietal lesion, the phe- The Functional Anatomy of
nomenology may be rather different. Hence, the Alien Control
following report by Leiguarda et al. (1993) of a
woman with a right-sided parietal lesion, giving In the alien control of movement, “made move-
rise to epileptic activity associated with intermit- ments” are attributed to an external agent, the
tent, abnormal movements of the left arm: agency being ceded to the “other” (Table 1). In
our study using PET, we found such movements
She said: “suddenly I had a strange feeling on my left to be associated with hyperactivity in the right
side; later I could not recognize the left arm as my inferior parietal cortex and other related areas
own; I felt it belonged to someone else and wanted to
(Spence et al. 1997). This hyperactivation was
hurt me because it moved towards me . . . .”
relative to other acutely deluded patients, nor-
In this case, both the intentions and the identi- mal controls, and the index group themselves as
ty of the alien limb are disturbed. The limb is not they recovered (four to six weeks later). This
only beyond the control of the subject (as it same brain region was hyperactivated whether
might be in the other forms of alien limb) but is patients performed freely chosen or stereotypic
also perceived to be under the control of anoth- movements (relative to the resting state).
er: “it belonged to someone else.” The limb is The right inferior parietal region is an area of
also credited with a (conscious) intention (to heteromodal association cortex implicated in
act): “it . . . wanted to hurt me.” many cognitive functions involved in sensorimo-
This disturbance of ownership (and hence, tor integration and attention (to egocentric space:
agency) of a limb (in the context of a right pari- Eidelberg and Galaburda 1984; Binkofskiet al.
etal lesion) was also described by Critchley (1953) 1998; Mattingley et al. 1998; Banati et al. 2000).
and first by Gerstmann (1942). In reviewing the It is an area where activity is modulated by calor-
literature at that time, Critchley describes “so- ic stimulation (see above and Bottini et al. 2001).
matoparaphrenia,” cases where limbs are said The parietal cortices are also known to be in-
to “belong to someone else,” where patients de- volved in the programming of (unconscious) in-
velop erotic feelings for their limbs (which they tentions (those aspects of motor behavior of which
perceive as those of others), and cases where we are unaware, e.g., the individual muscle trans-
family members are mistakenly identified as the formations necessary to pick up a cup: Snyder et
owners of these affected limbs. A similar case has al. 1997; Jeannerod 1997). Data acquired from
been described by Nightingale (1982), again as- non-human primates and human patients sug-
sociated with right-sided parietal involvement. gest that these regions engage in the program-
In addition, Brugger (in press) has provided a ming of reaching and grasping and adjusting
170 ■ PPP / VOL. 8, NO. 2–3 / JUNE–SEPTEMBER 2001

limb responses outside normal human aware- in alien control (and schizophrenia generally)
ness. Only after brain lesions may the expression deserves further study. Interestingly, a recent study
of such “intentions” become manifest—as the has shown that patients with alien control exhib-
disinhibited grasping of an “alien hand” follow- it abnormalities in the timing of imagined move-
ing a medial frontal lesion (above) or the failure ments: They fail to obey Fitts’s law (see Maruff
of an apraxic hand to grasp an object after a and Currie, in press).
parietal lesion. In the former, the (non-conscious) The neuropsychological data obtained
parietal intention is thought to be “released” by Frith and others (Frith and Done 1989; Mlakar
from the normal inhibition of the frontal lobe; in et al. 1994; Stirling et al. 1998) and our own PET
the latter, the intention is itself disrupted due to data (Spence et al. 1997) support the hypothesis
parietal lobe damage; the hand fails to grasp (for that the cognitive neurobiological substrate of
review, see Spence and Frith 1999). alien control is itself dynamic over time. In other
These data prompt a question with respect to words, both the failure to “monitor” movements
alien control: and the hyperactivation of right parietal cortex
Might the latter be a special case of “inten- accompanying movement appear to come and
tions” becoming conscious that should other- go. We need to establish the determinants of such
wise have remained beyond conscious awareness? intermittent cerebral dysfunction.
Rather than comprising solely a failure to Finally, there is an incongruity between the
monitor conscious intentions (as in Frith’s theo- neurological literature cited above and that per-
ry), does alien control actually involve an in- taining to people with schizophrenia. Although
creased awareness of unconscious intentions, au- right-sided parietal lesions precipitate symptoms
tomatic programs that should remain outside on the left side of the body, the symptoms of
awareness? Are these the “intentions” attributed alien control described in schizophrenia are not
to the “other?” This would provide a feasible so well lateralized. Our patients in the PET study
explanation of the alien agency attributed to the moved their right arms and experienced alien
alien limb in Leiguarda’s case (above). Since that control of these movements (Table 1). However,
limb moved, we may postulate that motor-pro- the complex functioning of the right parietal
gramming “intentions” (after Searle [1983] and cortex may be such that it monitors more than
Jeannerod [1997]) were active during that move- just the left (contralateral) side of the body. It is
ment. Yet, the patient experienced no sense of clearly engaged in programming right-sided move-
agency herself. She thought that the agency was ments (Spence et al. 1997). This issue requires
that of another. Parietal cortex dysfunction in further investigation. A number of authors have
alien control may disturb the sense of agency reported an increased prevalence of left-sided
associated with voluntary movement. How “agen- somatic (bodily) symptoms in people with schizo-
cy” is cognitively specified remains unclear, al- phrenia, a finding that might also implicate right
though some recent imaging studies are shedding parietal dysfunction (e.g., Cutting 1989).
light on this complex area (e.g., Ruby and De-
cety 2001). Conclusion
A number of questions remain unanswered. In
a previous paper, I suggested that alien control Alien control symptoms are those in which
might involve the misperception of the timing of the patient’s sense of agency is replaced by that
motor acts (Spence 1996): The relationship be- of another. Theoretical accounts have had diffi-
tween unconscious programming and subsequent culty explaining the emergence of an alien agen-
conscious awareness of action might be disturbed. cy within the mind-brain. Empirical findings point
In this regard, it is intriguing that the right inferi- to subtle deficits in bodily awareness, and aware-
or parietal cortex is also one of the cortical ness of action, in people with alien control while
regions involved in subjective perception of time they are maximally symptomatic. The neurology
(Harrington et al. 1998). The perception of time of alien control currently implicates the right
 Spence / Alien Control: From Phenomenology to Cognitive Neurobiology ■ 171

parietal lobe, although it is likely that more dis- Bottini, G., H-O. Karnath, G. Vallar, et al. 2001.
tributed systems are also involved (a subject not Cerebral representations for egocentric space: Func-
addressed here). It is chastening to reflect that tional-anatomical evidence from caloric vestibular
stimulation and neck vibration. Brain 124:1182–96.
Angyal (1936) predicted that alien control phe-
Brugger, P. in press. From haunted brain to haunted
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Acknowledgments Crow, T. J. 1998. Nuclear schizophrenic symptoms as
The author wishes to thank Ms. J. Woodhead a window on the relationship between thought and
for help in the preparation of this manuscript. At speech. British Journal of Psychiatry 173:303–309.
Cutting, J. 1989. Body image disorders: Comparison
the time of conducting the PET study of alien
between unilateral hemisphere damage and schizo-
control, the author was supported by the Medi- phrenia. Behavioural Neurology 2:201–10.
cal Research Council (UK) and the Charing Cross Daprati, E., N. Franck, N. Georgieff, et al. 1997.
Hospital Special Research Trustees. We thank all Looking for the agent: An investigation into con-
those who contributed to these studies. The clin- sciousness of action and self-consciousness in
ical case vignettes were taken from an earlier schizophrenic patients. Cognition 65:71–86.
unpublished essay and awarded the 1997 Royal Eidelberg, D., and A. M. Galaburda. 1984. Inferior
Society of Medicine Essay Prize in Psychiatry. parietal lobule: Divergent architectonic asymme-
tries in the human brain. Archives of Neurology
41:843–52.
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