Abstract

The anterior cingulate cortex (ACC)has been identified as part of a supervisoryattentional network for selecting alternativemotor programs in response to top-down corticalprocessing, particularly in situationsinvolving conflicting cognitive tasks.Bilateral lesions to the ACC may be causallyassociated with akinetic mutism, where patientsare unable to voluntarily initiate responses.The clinical and neuroanatomical evidence forthis presumed causal association is examined atlength. However, given the many reciprocalprojections between cerebral, motor, limbic andparalimbic structures within the executivesupervisory network, the association ofvoluntary behavior with a particular structure(the ACC) is highly controversial and thereforepremature at this time. Also considered is theclaim that our subjective sense of voluntarycontrol and free will is simply due toour not having conscious access to theunderlying neural computations that precede our decisions and actions. On thecontrary, the distinction between voluntary and involuntary thoughts and actions mayrather be a matter of temporal and directionallag between parallel computations in differentneural areas. Finally, with reference toDennett, there is an extended discussion ofwhether patients with akinetic mutism are (i) conscious automata, (ii) non-intentional systems, and (iii) in azombie-like state. The relevance of (i)–(iii) for the cognitive neuroscientificliterature is then briefly addressed.