Russell Jodie Louise
Institute for Mental Health, University of Birmingham, Birmingham, UK.
Synthese. 2025;206(2):64. doi: 10.1007/s11229-025-05147-8. Epub 2025 Jul 17.
Recent work on the phenomenon of self-illness ambiguity has sought to not only understand how tensions arise between one's experience of self and one's disorder experiences, but also how best to resolve said ambiguities to relieve the suffering of the person in question (Sadler, Psychiatry: Interpersonal and Biological Processes, 70(2), 113-129, 2007; Dings & Glas, Philosophy, Psychiatry, & Psychology, 27(4), 333-347, 2020; Dings & de Bruin, American Journal of Bioethics, 22(6), 58-60, 2022; Jeppsson, Philosophical Explorations, 25(3), 294-313, 2022). While the involvement of other people has been emphasised as important in regulating the self and thus will play a part in self-illness ambiguity, the impact of this social dimension has not been sufficiently explored. The goal of this paper is to provide an account of how social norms may be implicated in the enactment of the 'self' and experiences of self-illness ambiguity. To do this, I will provide a plausible account of what it means to have a coherent or understandable self, drawing on the mind-shaping view of social cognition (McGeer, Folk Psychology Re-Assessed, 137-156, 2007; Mameli, Biology & Philosophy, 16(5), 595-626, 2001; Zawidzki, Philosophical Explorations, 11(3), 193-210, 2008; Zawidzki, Mindshaping: A new framework for understanding human social cognition. Cambridge, MA: MIT Press, 2013; Zawidzki, Mindshaping and self-interpretation. In J. Kiverstein (Ed.), The Routledge Handbook of Philosophy of the Social Mind, 495-513. London & New York: Routledge, 2016). Mind-shaping suggests that we are successful in social coordination tasks because we are able to negotiate and follow shared norms that facilitate understanding. These norms indicate and shape what kinds of people we understand ourselves to be, as well as how others understand us, which we might refer to as the 'self'. Given that disorder experiences can be transformative, fundamentally changing how the world is meaningful for someone, we may therefore expect that disorder experiences can transform norms of the self that may undermine seamless social coordination. Following this, I argue that individuals with self-illness ambiguity face unique challenges when it comes to navigating social problems that other individuals with disorder experiences may not face. This is because, as I argue, some discourses around mental disorder are deemed more or less strategies for conceptualising the relationship between self and disorder. Since self-illness ambiguity doesn't 'fit' into these discourses, individuals with self-illness ambiguity may feel isolated not just from their wider community but also from mental disorder communities themselves. I suggest, then, that individuals with self-illness ambiguity might experience an acute form of alienation that is yet to be discussed in the literature.
最近关于自我疾病模糊性现象的研究不仅试图理解一个人的自我体验与疾病体验之间是如何产生紧张关系的，还试图理解如何最好地解决上述模糊性，以减轻相关人员的痛苦（萨德勒，《精神病学：人际与生物过程》，第70卷第2期，第113 - 129页，2007年；丁斯和格拉斯，《哲学、精神病学与心理学》，第27卷第4期，第333 - 347页，2020年；丁斯和德布鲁因，《美国生物伦理学杂志》，第22卷第6期，第58 - 60页，2022年；耶普松，《哲学探索》，第25卷第3期，第294 - 313页，2022年）。虽然他人的参与在调节自我方面的重要性已得到强调，因此会在自我疾病模糊性中发挥作用，但这一社会维度的影响尚未得到充分探讨。本文的目的是阐述社会规范可能如何与“自我”的形成以及自我疾病模糊性的体验相关联。为此，我将借鉴社会认知的塑造心灵观点（麦吉尔，《民间心理学再评估》，第137 - 156页，2007年；马梅利，《生物学与哲学》，第16卷第5期，第595 - 626页，2001年；扎维茨基，《哲学探索》，第11卷第3期，第193 - 210页，2008年；扎维茨基，《塑造心灵：理解人类社会认知的新框架》。马萨诸塞州剑桥：麻省理工学院出版社，2013年；扎维茨基，《塑造心灵与自我诠释》。载于J. 基弗斯坦（编），《社会心灵哲学劳特利奇手册》，第495 - 513页。伦敦和纽约：劳特利奇出版社，2016年），对拥有连贯或可理解的自我意味着什么给出一个合理的解释。塑造心灵观点表明，我们在社会协调任务中取得成功是因为我们能够协商并遵循有助于理解的共享规范。这些规范指明并塑造了我们认为自己是什么样的人，以及他人如何看待我们，我们可将其称为“自我”。鉴于疾病体验可能具有变革性，从根本上改变世界对某人的意义方式，因此我们可能预期疾病体验会改变自我规范，而这可能会破坏无缝的社会协调。在此基础上，我认为患有自我疾病模糊性的个体在应对社会问题时面临着其他有疾病体验的个体可能不会面临的独特挑战。这是因为，如我所论证的，一些围绕精神疾病的话语或多或少是用于概念化自我与疾病之间关系的策略。由于自我疾病模糊性并不“符合”这些话语，患有自我疾病模糊性的个体可能不仅会感到与更广泛的社区隔绝，还会感到与精神疾病社区本身隔绝。那么，我认为患有自我疾病模糊性的个体可能会经历一种在文献中尚未被讨论过的急性疏离形式。
