Other faces in the mirror: a perspective on schizophrenia

A patient with schizophrenia may generate an action (whether manual or verbal), but not attribute the generation of that action to himself. We distinguish self-monitoring and attribution of agency, relating only the former to forward models and the mirror system. We suggest that alien hand experiences occur when an action progresses through hand control pathways with no record of disinhibition having been kept and is then seen but dismissed as external. Analogously, auditory pathways are active during verbal hallucinations and produce a subvocal verbal process, but since no record is kept of the words being created, they are treated as external. The subject then proceeds to confabulate, to provide an account for the agency.