Anosognosia for hemiplegia is the denial of neurologically-caused paralysis, and it often co-occurs with a number of distortions of belief and emotion such as somatoparaphrenia and an exaggeration of negative affect towards minor health complaints. The salience of these latter symptoms led early investigators to propose explanations of AHP which construed it as a process of motivated self-deception against the overwhelming anxiety and depression that knowledge of deficit would otherwise cause, and which was observed in hemiplegic patients without the anosognosia. (...) Since some influential critiques of this approach, however, theories of this kind have largely been rejected on the grounds that they are inappropriately “psychogenic.” What has replaced them are a class of theories which explain the lack of awareness in terms of neurocognitive deficit, with the deficit in question variously described by researchers as involving spatial awareness, motor control, and other capacities. In this paper I argue – contra claims in the literature – that the patterns of explanation which are characteristic of the psychodynamic theory are not incompatible in principle with the notion that the illness involves neurocognitive deficit. That means that these patterns of explanation can be preserved where they make good sense of the obscure attitudinal and emotional symptoms that occur in AHP – symptoms that are otherwise difficult to explain. I suggest some ways in which this fact could be accommodated by deficit theories of the illness which are based on motor deficit. (shrink)

The impact of our desires and preferences upon our ordinary, everyday beliefs is well-documented [Gilovich, T. . How we know what isn’t so: The fallibility of human reason in everyday life. New York: The Free Press.]. The influence of such motivational factors on delusions, which are instances of pathological misbelief, has tended however to be neglected by certain prevailing models of delusion formation and maintenance. This paper explores a distinction between two general classes of theoretical explanation for delusions; the motivational (...) and the deficit. Motivational approaches view delusions as extreme instances of self-deception; as defensive attempts to relieve pain and distress. Deficit approaches, in contrast, view delusions as the consequence of defects in the normal functioning of belief mechanisms, underpinned by neuroanatomical or neurophysiological abnormalities. It is argued that although there are good reasons to be sceptical of motivational theories , recent experiments confirm that motives are important causal forces where delusions are concerned. It is therefore concluded that the most comprehensive account of delusions will involve a theoretical unification of both motivational and deficit approaches. (shrink)