The meaning we attach to our concept and experience of ‘self’ differs across sociocultural boundaries. For instance, Marcel Mauss famously documented societies in Central America in which individuals assumed the identity of a deceased ancestor – thus the purpose of ‘the self’ was to perpetuate a ‘role’ determined by society. Equally, debates on the category of the ‘self’ as either a continuously emerging or a predetermined entity have dominated much of western philosophy and anthropology. Increasingly, the nature of self-experience is being explored in cognitive neuroscience and psychiatry in relation to psychosis. This post I will explore the theoretical arguments of Tim Ingold and Jean-Paul Sartre and suggest why such ideas may be relevant to how we think about rehabilitation.
The emerging self
During the 2014 Huxley Memorial Lecture, Tim Ingold introduced his theory of social life as ‘a life of lines’. Using the analogy of ‘knots and lines’ which are constantly becoming more entangled he argued that social life (and what we experience) is one of ‘correspondence and fluidity’:
“Minds and lives are not closed in entities that can be enumerated and added up; they are open ended processes, who’s most outstanding characteristic is that they carry on and in carrying on they wrap around each other like the strands of a braid” (Ingold, 2014)
Ingold was fascinated by the literal presence of ‘the line’ throughout history – whether it be in our conception of time, the boundaries we draw between physical and abstract categories (i.e. linguistically) or the material culture that we create. Social life and our connectedness to one another, he argues, is like a bundle of knots which are formed by the knotting of single, continuous lines. Where some have argued that social life is a ‘network’ of lines between points, he describes it as a ‘meshwork’ that is sustained by continuously branching out.
Significantly, he argued that these lines are individual persons rather than the space between them, whose identities are ‘open ended processes’, constantly growing through experience and action. At the heart of correspondence is “habit (rather than volition), ‘agencing’ (rather than agency), and attentionality (rather than intentionality)” (Ingold, 2016, 9). In his conception of the self, the ‘I’ is not a predetermined entity to be realised throughout one’s life, but emerges through being in the midst of experience; in the meeting of minds - in acting. This is the fundamental principal of knotting – that who ‘I’ am emergences from the binding of my actions in the world, rather than my actions being a result of an inherent ‘nature’ or ‘persona’.
Of course, Ingold is not suggesting that the ‘I’ develops in isolation from social history or the influences of our childhood – he acknowledges that we are born into a part of life’s meshwork, but the important factor is that we can radically unearth the most seemingly fundamental elements of who ‘I’ am, if we chose to.
These ideas have clear connections to existential philosophy – most notably to Jean-Paul Sartre’s famous notion that “existence precedes essence”. According to Sartre your ‘existence’ – your acting, engaging, experiencing, choosing – is what is causing ‘the self’ to be recognised retrospectively, and revealing what is experienced as ‘essence’ (what one thinks of as their ‘nature’). In opposition to theories underlying early psychoanalysis, which state that the ‘true self’ is within the subconscious, Sartre’s conception of self-identity argues that what is at stake at each point of ‘existence’ is the ‘essence’ because, of course, we can choose to radically change our ‘self’ in a way that changes, fundamentally, who the ‘I’ that carries out/refrains from acting, takes on/gives up a belief is.
Again, we have certain unchangeable, factual elements about ourselves (our date of birth, the inability to relive the past, eye colour) but these unchangeable features do not define (or rather, do not cause) the choices we make, though we may be influenced. Conversely, the choices we make/ our actions no more reveal ‘true identity’ than those we refrain from making.
Reflecting on these ideas led me to think about the loss of ‘a sense of self’ or ‘identity’ experienced by some patients during psychosis. What is striking is the fact that these questions (often touched upon but consigned to the domain of philosophy) have a profound impact on the way we think about the purpose of rehabilitation.
The notion that ‘the self’ is a contained, determined entity can lead to the assumption that illness “separates the individual from their pre-psychosis self” (Gergel, 2017) and, therefore, recovery is an attempt to restore (‘to recover’) the ‘true identity’, as if psychosis marks a period of suspension.
But how can this be when it is the same person who holds the memory of the pre-psychosis self and the self during psychosis?
This is the point at which I think philosophy is a critical guide: patients do not ‘take on’ illness but become ill – therefore, it is a gradual, experiential process. For instance, if we consider the formation of delusions in some patients with psychosis, it can be a gradual (if punctuated) process through which they arrive at such a disordered idea.
The experience of existing, acting, being is how a belief or conception of self is arrived at. Yet, often when we read about the loss of self in psychosis it is described as the experience of being under ‘alien control’ – which seems to support the idea of the ‘true self’ being shattered or reduced to something or someone that is ‘other’.
The question then is whether we think altered self-perception in psychosis is a continuation of the process of entanglement - a new knot in self recreation - or a temporary disruption to the true nature of the self?
What is at the heart of Sartre’s (and I believe Ingold’s) idea’s is the idea that in going forward (existing, projecting our life’s lines) we are free to choose the person we will be (at any given moment), with the backdrop of our past.
We all undergo changes that alter our self-perception, but I think that our attention to and memory of the choices we make along the way means this process is experienced as a ‘smooth’ transition, so that even with radical life changes (i.e. giving up/ taking on a religious faith) we can integrate our experiences, our actions and choices which have led up to a defining point (‘do I believe that ‘X’ is true?’) as ‘mine’. What is significant is that at any given point of choice, because of this freedom, who ‘I’ am can constantly be recreated.
It seems to me that what is important is not so much the fracturing (or temporary suspension) of a true self in psychosis but, rather, a disordering of the ability to experience the freedom to make the types of choices which would be consistent with the previous self, as a result of biological disturbances (the disease pathway). Unlike the ‘smooth transition’ described above, during a disturbance of the experience of freedom, what is contributing to a sense of loss of self is the inability to integrate the unchangeable, factual self/ ‘the essence’ (i.e. one’s particular history irrespective of psychological state) with the continuity of ‘existence’ (one’s actions and choices preceding and during an episode). I think that without this integration what is negated is, unsurprisingly, ownership of these memories. Just as, for instance, in periods of intense stress we may carry out decisions/ actions that later we may feel are irreconcilable with who I ‘am’. I think what is really meant is ‘who I use to be’ – the ‘I’ that I was before would not have made these choices, therefore I was not ‘myself’.
To bring this back to the question of the purposes of rehabilitation, supposing that the existence/essence view of self is closer to truth that an unchanging self, we have to ask ourselves: what it is that treatment is trying to rehabilitate? Whilst anti-psychotics have immense use in reducing symptoms, they do not enable patients to ‘rehabilitate’ a sense of self or return to ‘who’ they were previously.
It is now easier to see that without a clear theoretical perspective on what constitutes a self, even beginning to answer this question in terms of therapeutic approaches becomes difficult. I think that if what has been compromised is an individual’s ability to experience freedom of choice, then a novel approach would seek to enable individuals to enter into a mental state where they are able to integrate pre/post psychosis experiences within self-conception.
The idea that one has lost themselves to an illness (which is out of their control) is immensely debilitating and can serve to compound depression/ feelings of discouragement because what is desired by an individual is a return to ‘the normal’. I think that Sartre and Ingold’s ideas are incredibly liberating because they shift the perception of the patient as a fractured self to a changed and changing self.
J. P. Sartre - Being and Nothingness
“The continuing allure of existentialism: Jean-Paul Sartre's understanding of freedom” - a lecture by Fr Stephen Wang at the Philosophy Society, New College of the Humanities