Part I of the dissertation examines the cognitive aspects of autonomy. The central question concerns what kind of cognitive capacity autonomy is. It will be argued that the concept of autonomy is best understood in terms of a metacognitive capacity of the individual. It is argued that metacognition has two components: procedural reflexivity and metarepresentation. Metarepresentation in turn can be divided into inferential reflexivity and other-attributiveness. These two components are essential for autonomy. Particular emphasis is put on procedural reflexivity. Further, (...) since the essential function of metacognition is control, it is argued that the concept of autonomy, understood as a metacognitive capacity, can be interpreted in terms of control. Issues arising from empirical data from neuroscience on functional, as well as impaired, metacognition, and on undermined autonomy, are dealt with. It is argued that autonomy cannot be determined with respect to subjective conditions. Neurological impairments, like Anton’s Syndrome, dementia, and thought insertion in schizophrenia, are put forward in support of this claim. To determine autonomy we require external conditions. In order to determine whether an individual is autonomous, both the metacognitive status of the individual and the external setting must be considered, since they are in interplay and consequently influence each other. In Part II, the analysis put forward in Part I is applied to Swedish healthcare. It is argued that the distinction between autonomy as a right and as a capacity must be explicit in order to understand what autonomy means and to deal with it effectively in healthcare practice. A discussion about whether or not the patient’s right to autonomy sometimes tends to be over-emphasized in healthcare is put forward. Special emphasis is placed on psychitaric issues such as deinstitutionalization and participation. Following the closure of the mental hospitals, deinstitutionalization and community-based care have become central topics in psychiatry. At the same time, the implementation of such care can be demanding for patients suffering from a persistent mental disorder. In part II it is also suggested that the metacognitive account of the concept of autonomy might help clarify the criteria governing coercive care. Finally, some suggestions concerning developments and improvements in Swedish healthcare, especially in psychiatry, where the concept of autonomy is important but problematic, are put forward. (shrink)

Experience of agency in patients with schizophrenia involves an interesting dissociation; these patients demonstrate that one can have a thought or perform an action consciously without being conscious of thinking or acting as the motivated agent, author of that thought or of that action. This chapter examines several interesting accounts of this dissociation, and aims at showing how they can be generalized to thought insertion phenomena. It is argued that control theory allows such a generalization; three different comparators need to (...) be distinguished: the sense of subjectivity relies on a comparator in which motivation and emotion play a structuring role. The sense of agency emerges in a system that delivers a rough categorization of self-generated – versus other- generated – actions and mental activities. A third system specializes in the social evaluation of the effects of an action, intention or other thought process, given certain goals in self or in others. (shrink)

While the term “metacognition” is sometimes used to refer to any form of thinking about thinking, in cognitive psychology, it is typically reserved for thinking about one’s own thinking, as opposed to thinking about others’ thinking. How metacognition in this more specific sense relates to other-directed mindreading is one of the main theoretical issues debated in the literature. This article considers the idea that we make use of the same or a largely similar package of resources in conceptually interpreting our (...) own mind as we do in interpreting others’. I assume that a capacity for other-directed mindreading is minimally shared with our great-ape relatives, but I argue that the architecture of this system had to be substantially modified before it could efficiently and adaptively be turned inwards on one’s own mind. I contend that an important piece of the overall evolutionary explanation here likely concerns selection pressures arising from the domain of conversational interaction. Specifically, drawing on work carried out in the human interaction studies tradition (e.g., conversation analysis), I argue that the smooth to-and-fro of conversational interaction can be seen to heavily depend on metacommunicative capacities, which, in turn, are underpinned by metacognitive capacities. I conclude with a thumbnail sketch of an evolutionary account of the emergence of these metacognitive capacities in the human line. Their appearance and spread – whether via genes, cultural learning, or more likely, some combination of the two – helps to explain the transition from great-ape communication to human conversation. (shrink)