Beyond consciousness of external reality: a "who" system for consciousness of action and self-consciousness

This paper offers a framework for consciousness of internal reality. Recent PET experiments are reviewed, showing partial overlap of cortical activation during self-produced actions and actions observed from other people. This overlap suggests that representations for actions may be shared by several individuals, a situation which creates a potential problem for correctly attributing an action to its agent. The neural conditions for correct agency judgments are thus assigned a key role in self/other distinction and self-consciousness. A series of behavioral experiments that demonstrate, in normal subjects, the poor monitoring of action-related signals and the difficulty in recognizing self-produced actions are described. In patients presenting delusions, this difficulty dramatically increases and actions become systematically misattributed. These results point to schizophrenia and related disorders as a paradigmatic alteration of a "Who?" system for self-consciousness.