It is hypothesised that there is a need for a holistic representation of different processes that might be used to monitor a person's progress within the environment. Our success in performing a task depends on some integration of different senses and motor skills. If we are sawing a piece of wood and see that we have sawn the piece inaccurately then the integrated conscious experience of sawing the wood allows some feedback to improve such action in the future. As a species that has a dominant visual process our conscious experience tends to be visual, but for a rat, for example, it may well be largely olfactory. This idea that there is a need for integration of different processes is encouraged by the knowledge that some parts of our conscious experience are processed faster than others, for example, our motor reactions and monochrome vision take place faster than colour vision. If there was no integration of these different processes it might be hard to determine how one process might affect the other in real time. We might be left with the thought: "well I know that my sawing the work-bench in half was an error, but I have no visual version that coincided with the feeling of the action that might inform me more on how this happened and how it might be improved".

Of course, this sophisticated interface comes at a price. Consciousness requires the combined processing in a number of different brain areas and is consequently correspondingly slow. Such a lumbering process is less useful if you are being attacked or are having to kill a moving moose. In such cases the conscious representation has to play catch-up, occurring after the required movements have been completed.

This is a question that requires the understanding that our private conscious representations may not be shared. Heated arguments may occur between partners about colours of rooms because they are either seeing different colours e.g. green turquoise and certain blues or because they have attached the labels to these colours differently according to their own experience. Concepts of high levels of depression or anxiety may alter according to a person's own conceptions and experience. Special difficulties occur when there is a request for a person's emotional disposition and reports on past behaviour, if the patient has memory problems or finds it difficult to monitor their own behaviour. In such cases there is an advantage to getting the patient's partner, carer or friend to fill in the questionnaire although such third person reports have their own difficulties. For example, neurotic persons describe their partner as being more neurotic. A third party may also have little evidence of the areas being questioned or may have a personal reason for accentuating some problems over others. However, both these types of response remain a valuable testament to subjectively perceived difficulties that may require management, counselling and a focus for rehabilitation.

Large differences between the patients' self assessment and the assessment by a significant other may be a signal that the patient's memory should be assessed or that the patient lacks insight into their own difficulties and some of the executive dysfunction tests might be used to assess an ability to monitor their own behaviour e.g. the 6 elements test. These problems may be separately diagnosed according to testing. Differentiation between poor memory and poor self-monitoring may be difficult, but may have a consequence for the patients' unrealistic judgements on their own abilities and their premature readiness to return to work.

The patient may be given an assessment which tests their perception of the world and therefore tests their primary consciousness. For example, a test of unilateral neglect e.g. bisecting a line, asesses the patient awareness for information in their visual space. A rough and ready assessment of their primary consciousness may also be obtained by bedside testing. You might test their ability to perceive objects just by asking them to identify an object e.g. a cup, to test for agnosia. Or move two fingers one each side of the patient to test neglect.

Evaluative consciousness might be assessed by comparing the patient's self-evaluation with that of a carer or therapist. But within an interview one might ask them questions such as: "Do you think you have any memory problems?". A number of areas might be assessed in this way. The interviewer has a good idea that the patient has profound memory impairment or behavioural problems with outbursts of anger, but how does the patient see themselves? Do they have accurate self-evaluations?

It seems likely that there are common areas that contribute to consciousness which are likely to include such proceses of attention, for example. These are shared by different functions and some of these common sub-functions are contributed to by parieto-frontal areas. Later in this chapter there is a more refined description of areas.

However, there are also areas that contribute in a more specific way to consciousness of a particular function. For example, consciousness of visual perception, according to Dehaene's and others' theory, suggests that the visual cortex is an important prerequisite for visual consciousness. Also the finding that there are disorders that show impairment of consciousness may be specific to one area e.g. memory in WKS patients provides evidence of the specificity of consciousness.

Conscious realisation of a stimulus requires analysis involving a large brain area and therefore takes predictably longer to process than subliminal and preconscious processing. Subliminal processing involves a sub-set of preconscious processing which is in turn a sub-set of conscious processing. This answer could be elaborated with examples and a more in-depth description of these three levels of consciousness.

The parallel with working memory is clear. Information that is well-learned is easier to assimilate into long-term-memory store; it is also easier to retain and less vulnerable to decay. Such information may be retrieved back into consciousness from a preconscious state with an increased delay prior to retrieval compared to material less easily learned. It is heartening to find these links between areas of theory and this supports the view of an economic brain.

There is evidence that the terms of primary and evaluative consciousness may be too broad when dealing with research topics that show a dissociation between different types of evaluative consciousness e.g. Metcalfe's work. On what evidence should we consider expanding our terminology?

Sometimes different types of consciousness may be discovered serendipitously in the clinic or as a result of research. Different terms may be developed for the purposes of research, but one would hope that such terms would not be maintained unless some scientific evidence found them to be distinctive. Metcalfe found differences in schizophrenic patients in terms of judgements of self-agency and their accuracy of judgements, the former being impaired but the latter being intact. There is evidence reviewed in the chapter on emotion that argued that patients with ventromedial damage were poor at evaluating their own socially inappropriate behaviour until they saw such past behaviour on video or viewed their past behaviour while answering a questionnaire. Seeing behaviour on video involves primary consciousness. Is monitoring your own behaviour as it occurs a primary conscious experience? I would think so according to our definition. Therefore this research suggests that there is emerging evidence for two types of primary consciousness. One type involves the perceptual information of others (including self-videoed material) and the other relates to self-observed information in real time. It might be expected that differences would be found in terms of self and other evaluations. These differences within a category are further discussed later in this chapter.

Most frequently evaluative consciousness is determined by the information and experience of primary consciousnesss over time. However, on occasions either primary or evaluative consciousness may be impaired and the patient has to deduce that one or the other is providing misinformation. In the case of quadrantanopia a patient may realise through their primary consciousness that they are missing out on visual information when they see cars coming at them from some unknown source. In such a case their evaluative consciousness is updated with this information. In the case of phantom limb the patient knows that their primary consciousness is providing misinformation, e.g. feeling a limb is present when it has been amputated. They know this by using primary consciousness from an alternative modality (visual information — my limb is missing) and their evaluative consciousness also has access to intact knowledge concerning past surgery.

The patient with agnosia fails to realise the primary consciousness is not allowing top-down primary consciousness and so when their lack of knowledge is brought to their attention their evaluation consciousness is suddenly and unexpectedly apprised of the situation. However, their damaged consolidation system means they are unlikely to retain this information concerning their own impaired perception. This is an untested interpretation. These are some of the examples that might be given illustrating the inter-play between these two types of consciousness.

Both mentalism and ToM are overlapping terms, but mentalism makes fewer assumptions about the nature of the cognitive process. ToM is made up from a number of arguably different processes which include thinking about others. ToM is conceptually inclusive of the notion of understanding what others are thinking about and their motivations, also, recognising the emotional disposition of others. These are complex cognitions that involve a number of different brain areas, whereas mentalism is a comparatively simple term describing the involvement of thoughts concerning self or others.

The reader will understand that the paper by Shurz (2014) is worth reading to get an idea of the heterogeneity of tasks and the corresponding variability of activated regions depending on these different ToM tasks. The temporal parietal junction especially in the right hemisphere and the medial/ventromedial areas are seen as core areas for ToM tasks. The TPJ area can be further divided into sub-areas. Most noted are the dorsal posterior area and the ventral anterior of the TPJ. The dorsal posterior area of the TPJ has connectivity with the medial PFC including the ventromedial PFC and is associated with an understanding of covert mental states such as subjective mental perspectives and emotional ToM e.g. false belief tasks (see Box 2). This area of the TPJ is seen as important for understanding belief and desire and not overt actions. The anterior ventral part of the TPJ has connections with the inferior frontal gyrus (IFG) and is associated with the analysis of overt mental states. This includes the reading of emotional expressions and actions, and is referred to as teleological ToM which aims to read a person's intentions. The connections between the avTPJ are with the inferior frontal gyrus (IFG), which is understood to contain mirror neurons. The IFG are seen to simulate expressions that would be seen and allow some understanding of the emotional feelings. It would depend on the task, but it would be a conclusion from this survey of past studies that both pathways would be required for emotional ToM and more specifically for feelings of empathy. In addition to these core areas there other structures such as the AM which are also clearly indicated for the analysis of emotional expression.

The IFG is clearly implicated in feelings of empathy given that lesions in this area are associated with reduced empathy. But this area is also active for non-emotional judgements while the ventromedial prefrontal (with its connection to the dpTPJ) is only active for emotional ToM. From this and other evidence the vmPFC is seen to play a key integrating role for the emotional requirements of empathy. Reduced empathy is also a feature of patients who have damage in this vmPFC area e.g. patients with temporal-parietal dementia.

A failure of metacognition would mean that the patient would not be able to judge the accuracy of their own perfomance and a failure to self-introspect is a failure to reflect on a person's own behaviour. The most obvious distinction would be a failure of a feeling of knowing which is a failure to feel that you are near to knowing something versus judgement made on the acuracy of your performance. A feeling of knowing is a form of metamemory, but this may be distinguished from retrospective or secondary metamemory judgements that are made reflecting the accuracy of past performance e.g. my recognition memory is very acccurate.

For example, a person may profess to be ignorant of knowing whether they are capable of knowing some information (no feeling of knowing (FOK) — no self-introspection): "Do you know the capital of Outer Mongolia?"; "No, I have no idea". But then when given the options in a recognition test a) Chu-song, b) Ulaanbaatar, c)Trimaarnar, they might choose b) (the correct answer) and the person may then say they were "Very confident that b) was the correct answer". Normally, the FOK would predict the confidence of knowing that the answer is correct. In the above example, the person would be more likely to say: "I think b) but I am not sure". In other words the level of FOK usually related to the secondary metamemory concerning confidence regarding the response. Therefore to find a difference following brain damage to a particular area is suggestive of different mechanisms supportung the two judgements.

Schizophrenia patients may have an accurate metacognition on a computerised tracking test (knowing how well they are doing on a tracking task) but then fail to introspect or monitor the agency "given the delayed feedback on the tracking task, was it me or the computer that was in control of the tracking?". These examples are arguments for the distinction between the consciousness of one's own performance versus the judgements on the same performance. The aspect of consciousness of one's own performance, self-introspection and actual judgements on performance may be dissociated. It is understood that the medial PFC are important for judgements that require consciousness or predictive judgements of FOK and judgements of self-agency, while the actual performance and immediate judgements on that performance involve more lateral aspects of the PFC such as the dorsolateral PFC (see review by Fleming and Dolan, 2012).

This is not a comprehensive answer to the question but may help the reader to find a framework depending on the argument they wish to take. There is  evidence for the separation and a degree of independence between the preparation for movement and the intentions to move as follows:

1. A separation occurs when the brain is artificially stimulated. Patients may report following stimulation in some areas of the parietal cortex that they have moved, when they have not. Alternatively when directly stimulated in areas of the motor cortex the patient may observe their limb moving, but feel no intention to move. They report feeling as if the movement has been drawn out of them. This evidence is from the neurosurgical studies from researchers such as Desmurget and Penfield.
2. There is credible evidence that the preparation for the movement is specific to the movement and occurs prior to the conscious intention to move. The more recent studies have shown the imaged and electrical signature that is directly related to the movement to the left or right response, rather than a general readiness to act. This occurs prior to the registered and reported intention to move, even when the demands of reporting are reduced.
3. There are a number of phenomena that show some metaphorical attempt by the brain to bind the movement to the conscious intention to move, through the artificial binding of conscious perception to the movement e.g. examples of tickling and other binding mechanisms.  

This evidence converges on the view that intentions to move do occur prior to the conscious intention to move and that they are processed with comparative independence. However, it may be unlikely that these two processes are completely independent since they appear from an fMRI study that there is activation in PFC areas even before the preparation for movement and intention to move. There is activity in expected areas of the PFC associated with planning and monitoring e.g. area 10. Further research is required, but these PFC areas have a more correlative relationship with the preparation of movement and intention to move respectively that is greater than that which exists between these areas.
In other words a hypothesis has been set up that the preparation of movement and the intention to move are both initiated by a third rostral PFC area and that the processing for each of these sub-functions occurs independently in parallel. This, of course, means that we have unconscious free will, but the decision to move actually takes place before it is available to conscious deliberation.
Further, evidence to support this proposal might be to manipulate the type of preparation required for the movement while keeping the movement requirements constant.

Finally, it is likely that there are more controlled movements e.g. threading a needle, defusing a bomb in which there is a feedback between consciousness of the movement, the consciousness of the initiation of a movement and the sub-conscious processes of prepartion of movements in a process that is dramatically slowed and co-operative in its co-interactions.

The brain areas that are required for the default mode do not necessarily overlap with other tasks and so cannot be subtracted from another task in an effort to deduce the crucial areas required of that other task. It is sensible to evaluate the default mode as a condition that is worth investigating in its own right. This might be argued more elaborately from examples and the traditions of measurement of the default mode.

The default mode is common to some experiences that require self-introspection e.g. retrieving information from autobiographical memory. This suggests that the default has a core that is representative of internal conscious states that can be contrasted with states that require attention and consciousness to external stimuli.

There are a small number of patients who show signs of a vegetative state but that apparently do respond to questions provided by an examiner and show some understanding of these questions through changes in brain activity. This is despite being unable to visibly acknowledge and respond to such questions. Therefore it has been recorded that such patients continue to have some external consciousness for these examiner questions. Of course, internal consciousness might also exist in such patients without external consciousness. Therefore when a patient is asked to think of a tennis game as a way of saying yes, this is a way of testing internal consciousness but testing without instruction (without external consciousness) may be difficult to demonstrate unless we reached the stage of accurately indentifying imaged thought without external instruction.

A disrupted sense of self is an impaired feeling that one owns a part of your body (Factor 2). This may be in the case of disowning a limb as is the case for anosgnosia for hemiplegia. Alternatively in the case of phantom limb a feeling that one owns a part of your body that does not exist. This is more than a sensory disconnection or aberrant neural connection that would impact on the physical feeling (Factor1), but is rather a cortically-driven sense that a part of your body is owned or not owned.

Most dramatically, this has been researched using TMS by disrupting the brain areas that give rise to a feeling of altered body awareness. For this question there might also be a mention of the rubber hand experiment and how this might be used to compare anosgnosia patients with normal persons.

These are important distinctions that can be easily described from the text.

The answer to this question should reveal a multifactorial explanation for the AVH.

1. There is less self-voice supression reducing the differentiation between self and other voices possibly increasing the volume of self-subvocal speech and thought processes, which might then increase the perception that they are from an external source.
2. There is activation of the parahippocampal and SMA areas just prior to the hallucination that may explain top-down interpretation of the hallucination and the inadvertent translation into speech production respectively.
3. Disruption of the left and right temporal parietal junction with TMS which has resulted in unusual sense of self in normals has also resulted in, presumably, temporary therapeutic effects. In a single Sz case they found reduced auditory hallucinations following left TPJ stimulation and normalisation of feelings of self-agency following repetitive right TPJ stimulation.
4. Studies investigating auditory rivalry (auditory equivalent of binocular rivalry) show that there is a tendency for the left hemisphere to inhibit the right hemisphere when a decision is required during a verbal dichotic presentation. There is evidence that the structures that might allow this kind of inter-hemispheric inhibition e.g. corpus calossum are less efficient in Sz patients and the degree of this impairment in inter-hemispheric communication is related to the level or degree of hallucination severity. Sz patients show indications of less lateralised language to the left hemisphere with less inhibition of the right hemisphere according to verbal dichotic tasks. Leading from these findings is the speculation that language process would not be inhibited in the right hemisphere, also that verbal analysis by the right hemisphere might be received by the left hemisphere as being from another source.
5. It has been found that when making a judgement on own versus other speech there is a tendency for the medial rostral area of the PFC e.g. area 10 to be less active in Sz participants. This is an area that is important to monitoring self. Abnormalities in this area and the TPJ would mean that both self-monitoring and external attention are undermined respectively. In this way there would be impaired monitoring of both self and whether external stimuli are present as a source of speech.

Some of these explanations of AVH are less sound or convincing than others. Also, there may be more than one contribution to AVH in Sz, a condition that has been found to have a number of different brain area abnormalities each of which might contribute to their symptoms in some way.