Prescriptive 'selves' and self-illness ambiguity

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 valuable 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.