The case report by Ay et al 1 of alien hand syndrome and review of the literature neglected the intriguing issue of why in every case so far reported the patient seems to be terrified of the alien limb. Not believing that you are any more in control of a limb is not likely to be a pleasant experience.

Those with alien hand syndrome seem to jump to extremely negative conclusions concerning the intent of the limb. Typically, as in the report of Ay et al, the common belief is that the limb has deeply malevolent intentions towards the victim.

It is this aspect of alien hand syndrome that I suggest also needs incorporating into its neurological explanations, and which provides a clue as to why our everyday experience of being in charge of our bodies, and so initiating all personal action, itself has a neurological basis. In other words, while the brain is the seat of all our actions and experiences, there is also a part of our nervous system which is responsible for our belief that we have free will over our behaviour. Patients with alien hand syndrome think that they are no longer in control of a limb because the part of the brain that gives us the sensation of control over our bodies has been damaged. When that happens, our limbs seem to act independently of us.

Research2 conducted in the 1980s has found that the same electrical brain wave changes that characteristically precede all limb movements, occur several 100 ms before we seem to consciously decide to move a limb. If our conscious decision to act is preceded by brain changes that anticipate action, then our “decision” to choose how to behave or “freedom”, as in free will, is in fact illusory. Our …