Review of Philosophy and Psychology

, Volume 8, Issue 2, pp 337–353 | Cite as

Can Anosognosia for Hemiplegia be Explained as Motivated Self-Deception?

  • Andrew C. SimsEmail author


Anosognosia for hemiplegia (AHP) 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.


Prior Belief Predictive Processing Belief Formation Cortical Blindness Anosognosia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Adams, R. A., Stephan, K. E., Brown, H. R., Frith, C. D., & Friston, K. J. 2013. The computational anatomy of psychosis. Frontiers in Psychiatry, 4(47).Google Scholar
  2. Aimola Davies, A.M., and M. Davies. 2009. Explaining pathologies of belief. In Psychiatry as Cognitive Neuroscience: Philosophical Perspectives, eds. M.R. Broome, and L. Bortolotti, 285–323. Oxford: Oxford University Press.Google Scholar
  3. Aimola Davies, A.M., M. Davies, J.A. Ogden, M. Smithson, and R.C. White. 2009. Cognitive and motivational factors in anosognosia. In Delusion and self-deception: affective and motivational influences on belief formation, eds. T. Bayne, and J. Ferdández, 187–225. New York: Psychology Press.Google Scholar
  4. Babinski, J. 1900. Diagnostic differential de l’hémiplégie organique et de l’hémiplégie hystérique. Gazette Hospitaux 73: 533–537.Google Scholar
  5. Besharati, S., S.J. Forkel, M. Kopelman, M. Solms, P.M. Jenkinson, and A. Fotopoulou. 2014. The affective modulation of motor awareness in anosognosia for hemiplegia: behavioural and lesion evidence. Cortex 61: 127–140.CrossRefGoogle Scholar
  6. Bisiach, E., and G. Geminiani. 1991. Anosognosia related to hemiplegia and hemianopia. In Awareness of deficit after brain injury: clinical and theoretical issues, eds. G.P. Priganato, and D.L. Schachter, 17–39. Oxford: Oxford University Press.Google Scholar
  7. Bisiach, E., G. Vallar, D. Perani, C. Papagno, and A. Berti. 1986. Unawareness of disease following lesions of the right hemisphere: anosognosia for hemiplegia and anosognosia for hemianopia. Neuropsychologia 24: 471–482.CrossRefGoogle Scholar
  8. Bortolotti, L. 2008. Delusions and other irrational beliefs. Oxford: Oxford University Press.Google Scholar
  9. Bortolotti, L. 2015. The epistemic innocence of motivated delusions. Consciousness and Cognition 33: 490–499.CrossRefGoogle Scholar
  10. Bortolotti, L., and M. Mameli. 2012. Self-deception, delusion, and the boundaries of folk psychology. Humana Mente 20: 203–221.Google Scholar
  11. Breuer, J., and S. Freud. 1893. On the psychical mechanism of hysterical phenomena: preliminary communication from Studies on Hysteria. In The standard edition of the complete psychological works of Sigmund Freud, volume 2, ed. J. Strachey, 1–17. London: The Hogarth Press and the Institute of Psychoanalysis.Google Scholar
  12. Cappa, S., R. Sterzi, G. Vallar, and E. Bisiach. 1987. Remission of hemineglect and anosognosia during vestibular stimulation. Neuropsychologia 25: 775–782.CrossRefGoogle Scholar
  13. Carhart-Harris, R.L., and K.J. Friston. 2010. The default-mode, ego-functions and free-energy: a neurobiological account of Freudian ideas. Brain 133: 1265–1283.CrossRefGoogle Scholar
  14. Clark, A. 2016. Surfing uncertainty: prediction, action, and the embodied mind. Oxford: Oxford University Press.CrossRefGoogle Scholar
  15. Cocchini, G., N. Beschin, A. Cameron, A. Fotopoulou, and S. Della Sala. 2009. Anosognosia for motor impairment following left brain damage. Neuropsychology 23: 223–230.CrossRefGoogle Scholar
  16. Critchley, M. 1974. Misoplegia, or hatred of hemiplegia. Mt. Sinai Journal of Medicine 41: 82–87.Google Scholar
  17. Cutting, J. 1978. Study of anosognosia. Journal of Neurology, Neurosurgery, and Psychiatry 41: 548–555.CrossRefGoogle Scholar
  18. Davidson, D. 2006 [1982]. Paradoxes of irrationality. In The essential Davidson (pp. 138–152). Oxford: Oxford University Press.Google Scholar
  19. Davies, M., and A. Egan. 2013. Delusion: cognitive approaches – Bayesian inference and compartmentalisation. In The Oxford handbook of philosophy and psychiatry, eds. K.W.M. Fulford, M. Davies, R.G.T. Gipps, G. Graham, J.Z. Sadler, G. Stanghellini, and T. Thornton, 689–727. Oxford: Oxford University Press.Google Scholar
  20. Davies, M., A. Aimola Davies, and M. Coltheart. 2005. Anosognosia and the two-factor theory of delusions. Mind & Language 20: 209–236.CrossRefGoogle Scholar
  21. Ditto, P. 2009. Passion, reason, and necessity: a quantity-of-processing view of motivated reasoning. In Delusion and self-deception: affective and motivational influences on belief formation, eds. T. Bayne, and J. Fernández, 23–53. New York: Psychology Press.Google Scholar
  22. Feinberg, T.E., A. Venneri, A.M. Simone, Y. Fan, and G. Northoff. 2010. The neuroanatomy of asomatognosia and somatoparaphrenia. Journal of Neurology, Neurosurgery & Psychiatry 81: 276–281.CrossRefGoogle Scholar
  23. Ferenczi, S. 1952. Stages in the development of the sense of reality. In First contributions to psycho-analysis (pp. 213–239). London: The Hogarth Press and the Institute of Psychoanalysis.Google Scholar
  24. Fotopoulou, A. 2012. Illusions and delusions in anosognosia for hemiplegia: from motor predictions to prior beliefs. Brain 135: 1344–1347.CrossRefGoogle Scholar
  25. Fotopoulou, A. 2013. Time to get rid of the ‘modular’ in neuropsychology: a unified theory of anosognosia as aberrant predictive coding. Journal of Neuropsychology 8: 1–19.CrossRefGoogle Scholar
  26. Fotopoulou, A., and M.A. Conway. 2004. Confabulation pleasant and unpleasant. Neuropsychoanalysis 6: 26–33.CrossRefGoogle Scholar
  27. Fotopoulou, A., S. Pernigo, R. Maeda, A. Rudd, and M.A. Kopelman. 2010. Implicit awareness in anosognosia for hemiplegia: unconscious interference without conscious re-representation. Brain 133: 3564–3577.CrossRefGoogle Scholar
  28. Freud, S. 1900. The interpretation of dreams. In The standard edition of the complete psychological works of Sigmund Freud, vol 4–5, ed. J. Strachey. London: The Hogarth Press and the Institute of Psychoanalysis.Google Scholar
  29. Friston, K. 2005. A theory of cortical responses. Philosophical Transactions of the Royal Society: Biology 360: 815–836.CrossRefGoogle Scholar
  30. Frith, C.D., S.J. Blakemore, and D.M. Wolpert. 2000. Abnormalities in the awareness and control of action. Philosophical Transactions: Biological Sciences 355: 1771–1788.CrossRefGoogle Scholar
  31. Gardner, S. 1993. Irrationality and the philosophy of psychoanalysis. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  32. Gerrans, P. 2002. A one-stage explanation of the Cotard delusion. Philosophy, Psychiatry, & Psychology 9: 47–53.CrossRefGoogle Scholar
  33. Gershmann, S.J., and N.D. Daw. 2012. Perception, action, and utility: the tangled skein. In Principles of brain dynamics: global state interactions, eds. M.I. Rabinovich, K.J. Friston, and P. Varona, 293–312. Cambridge: MIT Press.Google Scholar
  34. Hobson, J.A., and K.J. Friston. 2012. Waking and dreaming consciousness: neurobiological and functional considerations. Progress in Neurobiology 98: 82–98.Google Scholar
  35. Hohwy, J. 2014. The predictive mind. Oxford: Oxford University Press.Google Scholar
  36. Hopkins, J. 1982. Introduction: philosophy and psychoanalysis. In Philosophical essays on Freud, eds. R. Wollheim, and J. Hopkins, vii–xlv. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  37. Hopkins, J. 2012. Psychoanalysis, representation, and neuroscience: From the Freudian unconscious to the Bayesian brain. In From the couch to the lab: trends in psychodynamic neuroscience, eds. A. Fotopoulou, M.A. Conway, and D. Pfaff, 230–265. Oxford: Oxford University Press.CrossRefGoogle Scholar
  38. Jehkonen, M., Ahonen, J-P., Dastidar, P., Laippala, P., and J. Vilkki. 2000. Unawareness of deficits after right hemisphere stroke: double-dissociations of anosognosias. Acta Neurological Scandavica 102: 378–384.Google Scholar
  39. Kaplan-Solms, K., and M. Solms. 2002. Clinical studies in neuro-psychoanalysis: introduction to a depth neuropsychology, Second edn. New York: Other Press.Google Scholar
  40. Langer, K.G. 2009. Babinski’s anosognosia for hemiplegia in early twentieth-century French neurology. Journal of the History of the Neurosciences 18: 387–405.CrossRefGoogle Scholar
  41. Mathys, C. 2013. The delicate balance between accuracy and complexity: Psychopathology as the breakdown of free-energy minimization. Paper presented at Free Energy Principle: Unifying theory of brain function, Berlin School of Mind and Brain.Google Scholar
  42. Miall, R.C., and D.M. Wolpert. 1996. Forward models for physiological motor control. Neural Networks 9: 1265–1279.CrossRefGoogle Scholar
  43. Mograbi,. D.C., and R.G. Morris. 2013. Implicit awareness in anosognosia: clinical observations, experimental evidence, and theoretical implications. Cognitive Neuroscience 4: 181–197.Google Scholar
  44. Orfei, M.D., R.G. Robinson, G.P. Prigatano, S. Starkstein, N. Rüsch, P. Bria, C. Caltagirone, and G. Spalletta. 2007. Anosognosia for hemiplegia after stroke is a multifaceted phenomenon: a systematic review of the literature. Brain 130: 3075–3090.CrossRefGoogle Scholar
  45. Prigatano, G.P., J. Matthes, S.W. Hill, T.R. Wolf, and J.E. Heiserman. 2011. Anosognosia for hemiplegia with preserved awareness of complete cortical blindness following intercranial haemorrhage. Cortex 47: 1219–1227.CrossRefGoogle Scholar
  46. Ramachandran, V.S. 1995. Anosognosia in parietal lobe syndrome. Consciousness and Cognition 4: 22–51.CrossRefGoogle Scholar
  47. Ramachandran, V.S. 1996. The evolutionary biology of self-deception, laughter, dreaming and depression: Some clues from anosognosia. Medical Hypotheses 47: 347–362.CrossRefGoogle Scholar
  48. Rao, R.P.N., and D.H. Ballard. 1999. Predictive coding in the visual cortex: A functional interpretation of some extra-classical fields effects. Nature Neuroscience 2: 79–87.CrossRefGoogle Scholar
  49. Turnbull, O.H., K. Jones, and J. Reed-Screen. 2002. Implicit awareness of deficit in anosognosia? An emotion-based account of denial of deficit. Neuropsychoanalysis 4: 69–86.CrossRefGoogle Scholar
  50. Turnbull, O.H., C.E.Y. Evans, and V. Owen. 2005. Negative emotions and anosognosia. Cortex 41: 67–75.CrossRefGoogle Scholar
  51. Turnbull, O.H., A. Fotopoulou, and M. Solms. 2014. Anosognosia as motivated unawareness: the ‘defense’ hypothesis revisited. Cortex 61: 18–29.CrossRefGoogle Scholar
  52. Weinstein, E.A., and R.L. Kahn. 1950. The syndrome of anosognosia. AMA Archive of Neurology and Psychiatry 64: 772–791.Google Scholar
  53. Weinstein, E.A., and R.L. Kahn. 1953. Personality factors in denial of illness. AMA Archive of Neurology and Psychiatry 69: 355–367.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  1. 1.Deakin UniversityBurwoodAustralia

Personalised recommendations