My article “Solving the self-illness ambiguity: the case for construction over discovery” has been accepted for publication in the journal Philosophical Explorations, for a special issue on the topic of self-illness ambiguity. It will be published with comments by Serife Tekin.

EDIT: It’s out online now, and can be read Open Access here:

”The self-illness ambiguity” refers to the uncertainty that psychiatric patients can feel about what’s them, what belongs to their personalities, their character traits, and so on, and what is merely mental illness symptoms. It’s considered important for recovery to disentangle this issue. However, I point out in the article that there are two ways to solve this problem: On the one hand, I might make a choice and decide what to identify with, what to see as part of myself, and what to regard as ego-alien symptoms. On the other, I might gaze inwards and analyze my own mental life until I discover where the border lies – a solution which presupposes that a border already exists in my mind, independently of what I decide to identify with.

In the article, I argue against the latter kind of solution. There’s no such border to discover. What you should consider part of yourself and your personality vs what you should regard as mental illness symptoms isn’t a question about independent facts, it’s a choice to be made. This doesn’t necessarily mean that all choices are equal – they might be, for instance, more or less destructive/constructive, more or less conducive to recovery. There may also be rules of thumb for which choices tend to work best in different diagnoses. But rules of thumb are nothing more than that, and clinicians should be open to the idea that one patient’s mental illness symptoms could be another patient’s personality traits.

Here’s the abstract:

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.