Self-illness ambiguity is a difficulty to distinguish the ‘self’ or ‘who one is’ from one's mental disorder or diagnosis. Although self-illness ambiguity in a psychiatric context is often deemed to be a negative phenomenon, it may occasionally have a positive role too. This paper investigates whether and in what sense self-illness ambiguity could have a positive role in the process of recovery and self-development in some psychiatric contexts by focusing (...) on a specific case of mental disorder – anorexia nervosa. (shrink)

Self-illness ambiguity involves difficulty distinguishing between patterns of thought, feeling, and action that are the ‘products’ of one's illness and those that are genuinely one's own. Bortolan maintains that the values, cares, and preferences that define someone’s personal identity are rooted in intentional emotions and non-intentional affects (i.e., existential feelings and moods). The uncertainty that comprises self-illness ambiguity results from the experience of moods or existential feelings that are in tension with ones that (...) the patient experienced prior to the onset of illness. Building on these ideas, I examine how the notion of ‘affordance’ can shed further light on the dynamics and phenomenology of self-illness ambiguity. In my view, such ambiguity results from a lack of diachronic continuity and stability in a subject’s field of affordances. (shrink)

Psychiatric patients sometimes ask where to draw the line between who they are – their selves – and their mental illness. This problem is referred to as the self-illness ambiguity in the literature; it has been argued that solving said ambiguity is a crucial part of psychiatric treatment. I distinguish a Realist Solution from a Constructivist one. The former requires finding a supposedly pre-existing border, in the psychiatric patient’s mental life, between that which belongs to (...) the self and that which belongs to the mental illness. I argue that no such border exists, and that attempts to find it might even render the felt ambiguity worse. Instead, any solution must be constructivist; the patient (and others) should deliberate and discuss what to identify with or not. I further argue that psychiatric patients need not see their mental illness as wholly distinct from themselves to avoid ‘identifying with their diagnoses' in a problematic way. Finally, we can excuse problematic behaviour by mentally ill people – in fact, we can do so in a more nuanced and constructive way – while rejecting the view that the mental illness is wholly distinct from the patient’s self. (shrink)

Although the concept of self-illness ambiguity is relatively new, the phenomenon is not. It seems likely that people have struggled with the oftentimes ambiguous relation between themselves and the...

The article investigates the concept of self-illness ambiguity (SIA), which was recently re-introduced in the philosophy of psychiatry literature. SIA refers to situations in which patients are uncertain about whether features (symptoms, signs) of their illness should be attributed to their illness or to their ‘selves’. Identification of these features belongs to a more encompassing process of self- definition and -interpretation. The paper introduces a distinction between the notions of self-relatedness, self-referentiality (or: (...) implicit self-signification), self-awareness and self-interpretation. Each of these notions offers a different perspective on SIA, but these perspectives do not exclude one another. A further distinction will be developed between primary, secondary and tertiary forms of self-referentiality. The practical and conceptual relevance of these distinctions will be illustrated with case vignettes. Throughout the paper our findings will placed in the context of other philosophical work on the self, especially in the field of narrative theory (Ricoeur), phenomenology (Ratcliffe) and philosophy of mind. The article closes with a brief discussion about the appropriateness of the term ambiguity and the potential of SIA as concept in the context of clinical psychiatry. Directions for future work will be indicated. (shrink)

We thank Sanneke de Haan for her thoughtful response. We agree with what she says and consider it as a further specification of our intentions. We particularly endorse the two main points she raises, that is, that dealing with self-illness ambiguity requires a relational perspective; and that relying on reflection solely is problematic since it plays an only modest role in the resolution of self-illness ambiguity. We discuss both points in reverse order.With respect to (...) the role of reflection, we have, as a matter of fact, been very explicit: “we should not overemphasize the importance of reflection”; and “self-ambiguity is more likely to be a diachronic process”, with a “back and forth between narrative... (shrink)

The article provides a conceptualization of self(-illness) ambiguity and investigates to what extent self(-illness) ambiguity is ‘special’. First, we draw on empirical findings to argue that self-ambiguity is a ubiquitous phenomenon. We suggest that these findings are best explained by a multidimensional account, according to which selves consist of various dimensions that mutually affect each other. On such an account, any change to any particular self-aspect may change other self-aspects and (...) thereby alter the overall structural pattern of self-aspects, potentially leading to self-ambiguity. Second, we propose that self-ambiguity comes in degrees and should be understood as a spectrum (as opposed to there being qualitative differences among instances of self-ambiguity). Third, we argue that complexity is the most useful dimension to organize cases of self-ambiguity, with mundane instances of self-ambiguity on the one end and self-illness ambiguity on the other end of the spectrum. Fourth, we address the promises and perils of narrativity with regard to self-ambiguity. Finally, we link our deflationary account of self(-illness) ambiguity to pattern theories of self. (shrink)

The article provides a conceptualization of self(-illness) ambiguity and investigates to what extent self(-illness) ambiguity is ‘special’. First, we draw on empirical findings to argue that self-ambiguity is a ubiquitous phenomenon. We suggest that these findings are best explained by a multidimensional account, according to which selves consist of various dimensions that mutually affect each other. On such an account, any change to any particular self-aspect may change other self-aspects and (...) thereby alter the overall structural pattern of self-aspects, potentially leading to self-ambiguity. Second, we propose that self-ambiguity comes in degrees and should be understood as a spectrum (as opposed to there being qualitative differences among instances of self-ambiguity). Third, we argue that complexity is the most useful dimension to organize cases of self-ambiguity, with mundane instances of self-ambiguity on the one end and self-illness ambiguity on the other end of the spectrum. Fourth, we address the promises and perils of narrativity with regard to self-ambiguity. Finally, we link our deflationary account of self(-illness) ambiguity to pattern theories of self. (shrink)

In their target article, Moore and colleagues offer a valuable overview of the various ambivalence-related phenomena that may impede swift clinical decision-making. They argue that patients...

Volume 26, Issue 1, March 2023, Page 86-90.

ABSTRACT This paper investigates from a phenomenological perspective the origins of self-illness ambiguity. Drawing on phenomenological theories of affectivity and selfhood, I argue that, as a phenomenon which concerns primarily the ‘personal self’, self-illness ambiguity is dependent on distinct alterations of affective background orientations. I start by illustrating how personhood is anchored in the experience of a specific set of non-intentional affects – i.e. moods or existential feelings – alterations of which are often (...) present in mental ill-health. Also through the exploration of the phenomenology of acute and long-term anxiety, I suggest that self-illness ambiguity originates in the presence of moods or existential feelings that are in tension with the ones that structure the person’s experience prior to the onset of the illness or when its symptoms are not experienced. More specifically, I claim that due to their ability to ‘block’ or ‘suspend’ some of the person’s affective and cognitive responses, such affective orientations may unsettle one’s self-defining evaluative perspective, leading to uncertainty and doubting about one’s personal self. (shrink)

Deep brain stimulation (DBS) uses electrodes implanted in the brain to modulate dysregulated brain activity related to a variety of neurological and psychiatric conditions. A number of people who use DBS have reported changes that affect their sense of self. In the neuroethics literature, there has been significant debate over the exact nature of these changes. More recently, there have been suggestions that this debate is overblown and detracts from clinically-relevant ways of understanding these effects of DBS. In this (...) paper, we offer an alternative approach to understanding the effects of DBS on the self, drawing on John Sadler’s work on self-illness ambiguity. We argue that self-illness ambiguity is a complex concept, with at least three different aspects, and that each of the three aspects we identify also characterizes one kind of DBS-related change. Our analysis also suggests ways of helping patients to adjust to life as a DBS user. (shrink)

Deep brain stimulation (DBS) uses electrodes implanted in the brain to modulate dysregulated brain activity related to a variety of neurological and psychiatric conditions. A number of people who use DBS have reported changes that affect their sense of self. In the neuroethics literature, there has been significant debate over the exact nature of these changes. More recently, there have been suggestions that this debate is overblown and detracts from clinically-relevant ways of understanding these effects of DBS. In this (...) paper, we offer an alternative approach to understanding the effects of DBS on the self, drawing on John Sadler’s work on self-illness ambiguity. We argue that self-illness ambiguity is a complex concept, with at least three different aspects, and that each of the three aspects we identify also characterizes one kind of DBS-related change. Our analysis also suggests ways of helping patients to adjust to life as a DBS user. (shrink)

In a compelling and provocative paper, ‘Solving the Self-Illness Ambiguity: The Case for Construction Over Discovery,’ Sofia M.I. Jeppsson distinguishes two ways of addressing the self-illness ambiguty problem. The first is the Realist Solution, which postulates a pre-existing border between the self and the illness and frames the goal of treatment in psychiatry as helping the patient ‘discover’ this boundary. Addressing the shortcomings of the Realist Solution, both in terms of its feasibility and (...) possible outcomes, Jeppsson proposes and defends the Constructivist Solution, according to which the patient, through self-reflection and deliberation with others, including the clinicians, decides, which parts of her experiences they identify with themselves and which parts they attribute to their illness. This paper critically evaluates Jeppson’s arguments and addresses some of the shortcomings of Jeppsson’s positive argument, i.e. the Constructivist Solution. (shrink)

ABSTRACT‘Self-ambiguity’, we suggest, is best understood as an uncertainty about how strongly a given feature reflects who one truly is. When this understanding of self-ambiguity is applied to a view of the self as having both essential and shapable components, self-ambiguity can be seen to have two aspects: (1) uncertainty about one's essential or relatively unchangeable characteristics, e.g. one's sexuality, and (2) uncertainty about how to shape oneself, e.g. which values to commit to, (...) actions to pursue, or essential features to identify with. We explain how a narrative account of agency can accommodate these forms of self-ambiguity and argue that such an account also reveals another kind of self-ambiguity, namely, (3) uncertainty about whether one's established self-narrative represents who one really is. We illustrate this third form of self-ambiguity in the context of addiction where people's established addiction self-narratives make it difficult to identify with recovery. We argue that recovery will require embracing, especially, our third form of self-ambiguity as a chance for positive self-transformation. Treatment for addiction should, therefore, support people in going through and ultimately narratively resolving the inevitable self-ambiguities of the recovery process. (shrink)

From a twenty-first century partnership between bioethics and neuroscience, the modern field of neuroethics is emerging, and technologies enabling functional neuroimaging with unprecedented sensitivity have brought new ethical, social and legal issues to the forefront. Some issues, akin to those surrounding modern genetics, raise critical questions regarding prediction of disease, privacy and identity. However, with new and still-evolving insights into our neurobiology and previously unquantifiable features of profoundly personal behaviors such as social attitude, value and moral agency, the difficulty of (...) carefully and properly interpreting the relationship between brain findings and our own self-concept is unprecedented. Therefore, while the ethics of genetics provides a legitimate starting point - even a backbone - for tackling ethical issues in neuroimaging, they do not suffice. Drawing on recent neuroimaging findings and their plausible real-world applications, we argue that interpretation of neuroimaging data is a key epistemological and ethical challenge. This challenge is two-fold. First, at the scientific level, the sheer complexity of neuroscience research poses challenges for integration of knowledge and meaningful interpretation of data. Second, at the social and cultural level, we find that interpretations of imaging studies are bound by cultural and anthropological frameworks. In particular, the introduction of concepts of self and personhood in neuroimaging illustrates the interaction of interpretation levels and is a major reason why ethical reflection on genetics will only partially help settle neuroethical issues. Indeed, ethical interpretation of such findings will necessitate not only traditional bioethical input but also a wider perspective on the construction of scientific knowledge. (shrink)

Neuroethics, in its modern form, investigates the impact of brain science in four basic dimensions: the self, social policy, practice and discourse. In this study, we analyzed a set of 461 peer-reviewed articles with neuroethics content, published by authors from 32 countries. We analyzed the data for: (1) trends in the development of international neuroethics over time, and (2) how challenges at the intersection of ethics and neuroscience are viewed in countries that are considered developed by International Monetary Fund (...) (IMF) standards, and in those that are developing. Our results demonstrate a steady increase in global participation in neuroethics from 1989 to 2005, characterized by an increase in numbers of articles published specifically on neuroethics, journals publishing these articles, and countries contributing to the literature. The focus from all countries was on the practice of brain science and the amelioration of neurological disease. Indicators of technology creation and diffusion in developing countries were specifically correlated with increases in publications concerning policy implications of brain science. Neuroethics is an international endeavor and, as such, should be sensitive to the impact that context has on acceptance and use of technological innovation. (shrink)

The discussions about subject and validation in our late modernity tend to oscillate between the "weak" self of postmodernity ("empty" or "rhetorical") and neo-Cartesian versions trying, as they do, to recover a discredited foundation. Correspondingly, the solutions advanced range from calls for a "New Enlightenment" (in the face of the resurgence of myth and "the irrational") to attempts to "re-enchant the world" (in the face of the growing threat of an impersonal instrumental Reason).The present study seeks to respond theologically (...) to such a situation from the perspective of God's action in and towards the world by engaging two prominent philosophical/theological figures who continue to inform such discussions today, namely, Georg Friedrich Hegel and Paul Ricoeur. The upshot of this response points to a view of rationality that follows the drama of God's engagement with the world, thus involving both dying and resurrection, ascesis and abundance, suffering witness and eucharistic communion. (shrink)

Neuroethics, in its modern form, investigates the impact of brain science in four basic dimensions: the self, social policy, practice and discourse. In this study, we analyzed a set of 461 peer‐reviewed articles with neuroethics content, published by authors from 32 countries. We analyzed the data for: (1) trends in the development of international neuroethics over time, and (2) how challenges at the intersection of ethics and neuroscience are viewed in countries that are considered developed by International Monetary Fund (...) (IMF) standards, and in those that are developing. Our results demonstrate a steady increase in global participation in neuroethics from 1989 to 2005, characterized by an increase in numbers of articles published specifically on neuroethics, journals publishing these articles, and countries contributing to the literature. The focus from all countries was on the practice of brain science and the amelioration of neurological disease. Indicators of technology creation and diffusion in developing countries were specifically correlated with increases in publications concerning policy implications of brain science. Neuroethics is an international endeavor and, as such, should be sensitive to the impact that context has on acceptance and use of technological innovation. (shrink)

While new generations of implantable brain computer interface devices are being developed, evidence in the literature about their impact on the patient experience is lagging. In this article, we address this knowledge gap by analysing data from the first-in-human clinical trial to study patients with implanted BCI advisory devices. We explored perceptions of self-change across six patients who volunteered to be implanted with artificially intelligent BCI devices. We used qualitative methodological tools grounded in phenomenology to conduct in-depth, semi-structured interviews. (...) Results show that, on the one hand, BCIs can positively increase a sense of the self and control; on the other hand, they can induce radical distress, feelings of loss of control, and a rupture of patient identity. We conclude by offering suggestions for the proactive creation of preparedness protocols specific to intelligent—predictive and advisory—BCI technologies essential to prevent potential iatrogenic harms. (shrink)

The recent discussion in scientific psychiatry has paid increasing attention to the role of concepts of the person in psychiatric discourse. What are the uses of concepts of the person, such as self or person, in psychiatric discourse? Does describing these uses clarify the significance of conceptual and empirical elements in conceptions of mental illness? I try to answer these questions in a philosophically informed textual analysis of one representative psychiatric article. I conclude that concepts of the person (...) are used largely interchangeably in their various relevant meanings. The interplay between different uses of the concepts of the person allows us to conceptualize psychopathology and to conceive possibilities of overcoming this vague usage. My results underline the importance of a sensitivity to the ways concepts of the person are used in psychiatry and manifest the embeddedness of the language of psychopathology in everyday "person discourse.". (shrink)

This paper addresses an important yet neglected existential issue sometimes faced by persons with bipolar disorder (BD): confusion about the extent to which what one is like is influenced by BD. Although such confusion is common in psychiatric illnesses, BD raises idiosyncratic difficulties due to its intricate interactions with personality, cognition and behavior. The fluctuating mood phases of BD can generate inconsistency in one's self-experience and sense of self. One way to resolve this confusion would be to coherently (...) account for BD within one's overall self-concept. To facilitate this task, this paper introduces a heuristic taxonomy of different relationships wherein BD can be viewed in light of self-related beliefs. The relationships are as follows: (1) BD contributes to the self, (2) BD scaffolds the self, (3) BD gradually becomes part of the self and (4) BD is not part of the ‘real self’. As the individual presentation of BD varies extensively, the type of relationship one feels holds true depends on one's personal experience of managing and living with the disorder. These relationships act as an organizing framework for one's self-related beliefs about how to account for the effects of BD on personality, behavior, cognitive patterns and other self-expressions. (shrink)

ABSTRACT‘If I experience X, is it because of the illness, the medication, or is it ‘just me’?’ (Karp 2009) [Is it me or my Meds? Living with Antidepressants. Harvard University Press]. This issue is known as self-illness ambiguity (SIA) (Sadler 2007) ["The Psychiatric Significance of the Personal Self." Psychiatry: Interpersonal and Biological Processes 70 (2): 113–129]. In her paper Know Thyself: Bipolar Disorder and Self-concept, Carls-Diamante (2022) [“Know Thyself: Bipolar Disorder and Self-Concept.” Philosophical (...) Explorations, 1–17] offers a taxonomy of different ways in which Bipolar Disorder can be related to one’s self and self-concept. In contrast to the essentialist model of mental disorders she seems to adopt, I propose a different outlook on SIA, following an enactive approach to psychiatric disorders as disorders of sense-making. One’s way of making sense of the world and/or oneself can become stuck in a rigid pattern that is stronger than oneself and at odds with how one would want to be. I argue that it is helpful to distinguish between the experiential SIA of specific experiences (Am I over/underreacting?) and the long term concerns of existential SIA (How to live my life in accordance with what matters to me despite/while having certain vulnerabilities?). I conclude that knowing oneself is not an intra-individual matter, nor primarily a matter of reflection: it is rather a relational and material practice of trying to live your life in accordance with what matters to you. (shrink)

The promotion of the self‐managing capacities of people has become a marker of contemporary mental health practice, yet self‐management remains a largely uncontested construct in mental health settings. This discourse analysis based upon the work of Foucault investigates self‐management practices for bipolar disorder and their action upon how a person with bipolar disorder comes to think of who they are and how they should live. Using Foucault's framework for exploring the ethical self and transcripts of interviews (...) with people living with bipolar disorder, this discourse analysis finds that the discursive practices of self‐management for bipolar disorder are prescribing a restricted regime for living based upon the quintessential neo‐liberal subject using practices that are focused upon managing an unreliable and problematic self. The article concludes with the proposition that the problem of bipolar disorder (for which self‐management is an answer) is less about the object itself and more about how we construct the nature of the self. A Māori indigenous ontology is used here as an example of an alternative discursive resource through which people make sense of the self and which allows ways of thinking about self‐management that engage with ambivalence and ambiguity rather than restriction and regulation. (shrink)

Psychiatric disorders involve changes in how you feel, think, perceive, and/or act—and the same goes for psychotropic medication. How then do you know whether certain thoughts or feelings are genuine expressions of yourself, or whether they are colored by your psychiatric illness, or by the medication you take? Or, as Karp nicely sums up the problem: “if I experience X, is it because of the illness, the medication, or is it “just me’?” Such “self-illness ambiguity” (...) seems to be quite an ubiquitous problem in psychiatry. It is a very unsettling problem, moreover, and not easy to resolve.In their... (shrink)

In this thesis I develop an account of how processes of social understanding are implicated in experiences of mental disorder, critiquing the lack of examination of this phenomena along the way. First, I demonstrate how disorder concepts, as developed and deployed by psychiatric institutions, have the effect of shaping the cognition of individuals with psychopathology through setting expectations. Such expectation-setting can be harmful in some cases, I argue, and can perpetuate epistemic injustices. Having developed this view, I criticise enactive accounts (...) of mental disorder for failing to consider how such terms like ‘dysfunction’ are open to interpretation and can come embedded with normative expectations. Enactive accounts consequently run the risk of perpetuating injustices in their account of the sociality of mental disorder. Similar concerns arise when we consider the attachment of enactivism to the medical model, I argue. But by adapting enactivism to consider other experiences of disorder, such as those described as ‘madness’, enactive psychiatry may genuinely provide ethical groundwork for a better conception of disordered experience. Then, I consider a further concern with a distinctly medicalised conception of mental disorder from the perspective of self-illness ambiguity, arguing that self-illness ambiguities appear to form a special class of ambiguities due to their proximity to disorder concepts which mark them as appropriate targets for therapeutic treatment. However, I argue further that we should be critical of the idea that self-illness ambiguities necessitate disambiguation, as, in cases where self and illness are demarcated, individuals may still experience distress because simply having a mental disorder can be socially alienating. The medicalised focus in self-illness ambiguity, and the explicit need from the medical perspective to disambiguate it, might then exacerbate the distress someone experiences in mental disorder. Moreover, drawing on Mad Studies, I suggest that one might not need a coherent self-narrative to live well. Because of this, one may not need to adopt a medicalised view of the self in the case of selfillness ambiguity. In order to support this analysis, I provide a phenomenological account of language and argue that the very thoughts implicated in mental disorder shape the individual’s perception of the world due to the way that language foregrounds particular aspects of our world. This demands a critical examination of the language adopted and used by both clinicians and disordered individuals. I thus conclude with some thoughts on how to approach research and developing understanding of mental disorder given that we, as people, are always implicated in this process and therefore socialisation of some kind will always be taking place. (shrink)

Connecting research and production, art research represents a breaking of the barrier between creation and academia. However, there is also a contradiction contained in this kind of research deriving from its methods, since the process of art-based practice must, by its very nature, involve the subjectivity of the artist. I use my own studies as the research object to discuss this issue, and this article presents the problems I encountered during my artistic practice and research of ambiguous roles. This paper (...) has two main points of focus. First, I explore how the fallacy of self-referentiality is presented in paintings and films, and, second, I draw on my short film practice during my master’s study period to explain how the shots present a continuum in relation to the “absent one” and produce interface effects. However, the second point is not necessarily the result of the first one. This kind of connection and contradiction between practice and cognition in the process of art research is that I will analyse and discuss here. (shrink)

In his reflections on action in Being and Nothingness, Sartre goes to the heart of what it is to be human. Our free actions are not the consequence of ouridentity, they are its foundation. As human beings we go beyond who we are towards a freely chosen future self. Human identity is ambiguous because consciousness simultaneously accepts and sees beyond the identity it discovers; there is an internal disintegration which distances us from ourselves. The intentionality of consciousness means that (...) we are constituted not by an objective presence but by a “presence to” our identity. Personhood is established only when we select certain values and allow them to shape our identity and guide our actions. As “being-for-itself” we go beyond the present and project ourselves towards an identity that does not yet exist, thus creating ourselves through our freedom, through our concrete choices. This article pays careful attention to Sartre’s understanding of consciousness, selfconsciousness, and “selfness,” before drawing some conclusions about the role of human freedom in the construction of identity. (shrink)

Merleau-ponty's thesis of the ambiguity of time is used to criticize husserl's and hume's views of the self. the thesis states that 1) the experience of present and past time depend on one another for intelligibility, and 2) the "objective" is past experience frozen in time; the "subjective" is present experience. adequate accounts of the self (and, generally, adequate philosophical explanation) will respect the ambiguity of time and discuss the interaction between subjective and objective facets of (...) experience. (shrink)

This paper raises a slightly uncomfortable question: are some delusional subjects responsible for their delusions? This question is uncomfortable because we typically think that the answer is pretty clearly just ‘no’. However, we also accept that self-deception is paradigmatically intentional behavior for which the self-deceiver is prima facie blameworthy. Thus, if there is overlap between self-deception and delusion, this will put pressure on our initial answer. This paper argues that there is indeed such overlap by offering a (...) novel philosophical account of self-deception. The account offered is independently plausible and avoids the main problems that plague other views. It also yields the result that some delusional subjects are self-deceived. The conclusion is not, however, that those subjects are blameworthy. Rather, a distinction is made between blameworthiness and ‘attributability’. States or actions can be significantly attributable to a subject—in the sense that they are expressions of their wills—without it being the case that the subject is blameworthy, if the subject has an appropriate excuse. Understanding delusions within this framework of responsibility and excuses not only illuminates the ways in which the processes of delusional belief formation and maintenance are continuous with ‘ordinary’ processes of belief formation and maintenance, it also provides a way of understanding the innocence of the delusional subject that does not involve the denial of agency. (shrink)

Self-knowledge has always played a role in healthcare since a person needs to be able to accurately assess her body or behaviour in order to determine whether to seek medical help. But more recently it has come to play a larger role, as healthcare has moved from a more paternalistic model to one where patients are expected to take charge of their health; as we realise that early detection, and hence self-examination, can play a crucial role in outcomes; (...) as medical science improves and makes more terminal illnesses into chronic conditions requiring self-management; as genetic testing makes it possible to have more information about our futures; and with the advent of personal electronic devices that make it easy for a person to gather accurate real-time information about her body. It can be hard to get good information about oneself, and even harder to know what to do it. Sometimes self-knowledge is needed for a good outcome, but sometimes it is useless, or worse. For instance, breast self-examination can lead to over-treatment, learning that one has a predisposing gene can create a detrimental illusion of knowing more about the future than one does, and data about one’s vital signs can be meaningless if taken out of a context of interpretation. This collection explores how these and other issues play out in a variety of medical specialities. (shrink)

While distinguishing between the actions and physical boundaries of self and other (non-self) is usually straightforward there are contexts in which such differentiation is challenging. For example, self-other ambiguity may occur when actions of others are similar or complementary to those of the self. Even in the absence of such situational challenges, individuals experiencing hallucinations have difficulties with this distinction, often experiencing thoughts or actions of self as belonging to other agents. This paper explores (...) the role of ambiguity in self-other differentiation, drawing from developmental, psychodynamic and neurocognitive perspectives. A key proposal is that engagement in contexts that make distinctions between self and other challenging yet necessary allow reality-testing skills related to agency to develop. Attunement in typical caregiver-infant interactions is framed as a safe but inherently ambiguous environment that provides optimal condition for the infant to develop a coherent self-other sense. Vulnerability to psychosis may be related to limited access to such an environment in early development. However, the perceptual, cognitive and social skills that contribution to attribution are likely to be malleable following infancy and improve though opportunities for boundary play in similarly ambiguous settings. Using music-making to illustrate, we postulate that engagement in intricate joint-actions that blurs agentic boundaries can contribute to the continued development of an adaptive sense of self and other essential to healthy social functioning. Increased insight into the self-other ambiguity may enhance our understanding of mechanisms underlying ‘self-disorders’ such as schizophrenia and eventually extend the range of social and arts-based therapeutic possibilities. (shrink)

Self-control is integral to successful human agency. Without it we cannot extend our agency across time and secure central social, moral, and personal goods. But self-control is not a unitary capacity. In the first part of this paper we provide a taxonomy of self-control and trace its connections to agency and the self. In part two, we turn our attention to the external conditions that support successful agency and the exercise of self-control. We argue that (...) what we call moral security is a critical foundation for agency. Parts three and four explore what happens to agency when moral security is lacking, as in the case of those subject to racism, and those living in poverty. The disadvantages suffered by those who are poor, in a racial minority or other oppressed group, or suffering mental illness or addiction, are often attributed to a lack of individual self-control or personal responsibility. In particular, members of these groups are often seen as irresponsibly focused on short-term pleasures over long-term good, a view underwritten by particular psychological theories of self-control. We explore how narratives about racism and poverty undermine moral security, and limit and distort the possibility of synchronic and diachronic self-control. Where moral security is undermined, the connection between self-control and diachronic goods often fails to obtain and agency contracts accordingly. We close with some preliminary reflections on the implications for responsibility. (shrink)

Self-reported data are regarded by medical researchers as invalid and less reliable than data produced by experts in clinical settings, yet individuals can increasingly contribute personal information to medical research through a variety of online platforms. In this article we examine this ‘participatory turn’ in healthcare research, which claims to challenge conventional delineations of what is valid and reliable for medical practice, by using aggregated self-reported experiences from patients and ‘pre-patients’ via the internet. We focus on 23andMe, a (...) genetic testing company that collects genetic material and self-reported information about disease from its customers. Integral to this research method are relations of trust embedded in the information exchange: trust in customers’ data; trust between researchers/company and research subjects; trust in genetics; trust in the machine. We examine the performative dimension of these trust relations, drawing on Shapin and Schaffer’s discussion of how material, literary and social technologies are used in research in order to establish trust. Our scepticism of the company’s motives for building trust with the self-reporting consumer forces us to consider our own motives. How does the use of customer data for research purposes by 23andMe differ from the research practices of social scientists, especially those who also study digital traces? By interrogating the use of self-reported data in the genetic testing context, we examine our ethical responsibilities in studying the digital selves of others using internet methods. How researchers trust data, how participants trust researchers, and how technologies are trusted are all important considerations in studying the social life of digital data. (shrink)

Self‐management is often presented as a panacea for chronic disease care. It plays an important role at the policy level and increasingly guides the delivery of health care services. Self‐management approaches to care are founded on traditional individualistic views of autonomy in which the patient is understood as being independent, rational, self‐interested, and self‐governing. This conceptualization of autonomy has been challenged, particularly by feminist scholars. In this paper I review predominant critiques of self‐management and the (...) traditional individualistic view of autonomy. I propose that a relational approach to autonomy, which is premised on social embeddedness and attends to social, political, and material conditions, is a more sound conception of autonomy capable of taking into consideration the complexities of illness experiences. I suggest that integrating a relational perspective of autonomy into self‐management will be valuable in guiding its progression and elaborate ways in which self‐management research and practice could benefit from incorporating a relational approach to autonomy. (shrink)

When a terminally ill patient kills herself, using a drug prescribed by a physician for this purpose, in bioethical literature this would be described as a case of physician-assisted suicide. This would also be a case of suicide according to the standard account of suicide in the philosophical literature. However, in recent years, some authors have argued that terminally ill self-killing in fact should not be considered suicide. In this paper, we don’t try to address the philosophical merits of (...) such arguments. Instead, we ask whether these considerations align with the way non-philosophers think about suicide. We present empirical evidence from four studies that address different concerns raised about terminally ill self-killing being a suicide. We conclude that the raised concerns cannot be supported by the folk understanding of suicide. (shrink)

The distribution of scarce healthcare resources is an increasingly important issue due to factors such as expensive ‘high tech’ medicine, longer life expectancies and the rising prevalence of chronic illness. Furthermore, in the current healthcare context lifestyle-related factors such as high blood pressure, tobacco use and obesity are believed to contribute significantly to the global burden of disease. As such, this paper focuses on an ongoing debate in the academic literature regarding the role of responsibility for illness in (...) healthcare resource allocation: should patients with self-caused illness receive lower priority in access to healthcare resources? This paper critically describes the lower priority debate's 12 key arguments and maps out their relationships. This analysis reveals that most arguments have been refuted and that the debate has stalled and remains unresolved. In conclusion, we suggest progression could be achieved by inviting multidisciplinary input from a range of stakeholders for the development of evidence-based critical evaluations of existing arguments and the development of novel arguments, including the outstanding rebuttals. (shrink)

When behaviours or character traits match sociocultural expectation, heteronomy is a natural suspicion. A further natural suspicion is that the behaviours or character traits are unhealthy for the agent or for objectives of social justice and liberation. Second Wave feminism therefore includes a robust narrative of unease about female self-sexualisation. Third Wave feminism has more upbeat narratives of the latter, in terms of confidence and empowerment. The preceding tension is refracted through cases such as Ronda Rousey and ‘derby girls’, (...) as well as those of many less ostentatious women. It is argued that such self-sexualisation can be autonomous as opposed to heteronomous. It is argued, furthermore, that it is not a priori unhealthy for the agent and that autonomous female self-sexualisation admits of degrees of self-consciousness and articulacy. At the same time, such self-sexualisation takes place within gendered social structures, with consequences that legitimate the reinvocation of Second Wave motifs such as the commodification of female sexuality and the privileging of precise images of female sexuality. (shrink)

When behaviours or character traits match sociocultural expectation, heteronomy is a natural suspicion. A further natural suspicion is that the behaviours or character traits are unhealthy for the agent or for objectives of social justice and liberation. Second Wave feminism therefore includes a robust narrative of unease about female self-sexualisation. Third Wave feminism has more upbeat narratives of the latter, in terms of confidence and empowerment. The preceding tension is refracted through cases such as Ronda Rousey and ‘derby girls’, (...) as well as those of many less ostentatious women. It is argued that such self-sexualisation can be autonomous as opposed to heteronomous. It is argued, furthermore, that it is not a priori unhealthy for the agent and that autonomous female self-sexualisation admits of degrees of self-consciousness and articulacy. At the same time, such self-sexualisation takes place within gendered social structures, with consequences that legitimate the reinvocation of Second Wave motifs such as the commodification of female sexuality and the privileging of precise images of female sexuality. (shrink)

We argue that cognitive empathy and other instances of mental state attribution are a byproduct of self-awareness. Evidence is brought to bear on this proposition from comparative psychology, early child development, neuropsychology, and abnormal behavior.