Todd Feinberg is an accomplished writer who manages to convey a lot of information in a relatively short compass. Laudably, he illustrates his points with transcripts of interviews with patients, particularly in the first half of the book.

From the clinical material he draws on, Feinberg has a great interest in what he terms ‘neuropathologies of the self’ – anosognosia, asomatognosia and delusional misidentification, including Capgras and Fregoli syndromes. In the first half of the book, Feinberg's topic is one that those interested in psychosis and the philosophy of delusions are familiar with: how to give an account of delusions, and how, if at all, delusions are distinguished from other irrational beliefs and confabulations. Although the terminology is not employed, Feinberg works within the Maherian paradigm (a delusion being an explanation of an anomalous experience) and, like many contemporary researchers and theoreticians, adds in a second stage (traditionally, this second stage is a reasoning bias or neuropsychological deficit), which in combination with the odd experience leads to the delusion or unusual belief. For Feinberg, the main thesis is that damage to the brain (in the right frontal region particularly) engenders in people a reversion to utilising more primitive psychodynamic defence mechanisms, such as delusional projection. It seems the idea is that there is a genuine paralysis, for example, resultant on brain damage and this too can give rise to denial of disability (anosognosia) or projection (thinking the limb an imaginary friend or persecutor) via the reactivation of these primitive mechanisms.

The second half of the book seems largely independent of the first and is more ambitious. The author moves away from clinical concerns to notions of self, identity and consciousness and proposes the ‘neural hierarchy theory of consciousness’. Here, Feinberg introduces the notion of ‘nested hierarchy’.

The book as a whole is easy to read and of interest. However, as a stand-alone text, I felt it was not fully convincing in terms of the arguments offered and the data used. Feinberg has very compelling ideas which, if correct, are very important and I look forward to reading their exposition in future publications.