On being yourself
‘I was always the life and soul of the party, flirting with everyone’, wrote Lucille Howe, in ‘Fabulous Magazine’, (22 July 2012), ‘but I wanted John to fall in love with the real, quieter me’. In the same article, Charlotte Ruhle notes how her psychotherapy helped her to recover from a broken relationship. ‘[My] friends started saying I….seemed more like my old self.‘
The media, and indeed our ordinary conversations, are awash with this sort of language. Not only are we conscious – having a sense that there is an ‘I’ that is in some sort of continuity with the ‘I’ that existed yesterday, will hopefully exist tomorrow, and to whom things happen – but we have firm convictions about the nature of the ‘I’. When it is not allowed to express itself – to ‘be itself’, we complain. Depending on our education, we say that we’re ‘out of sorts’, ‘not myself’, or ‘ontologically vertiginous’.
The notion of a core self with defined characteristics pervades our ethics and our law. Someone can be compulsorily treated for psychiatric illness if he’s not in his ‘right mind’ (not a legal expression, but a fair gloss). The patient with anorexia nervosa, discussed here, is being force-fed, despite her expressed wish to die, because, in the court’s view, it’s not really ‘her’ who seeks death. A surgeon might be persuaded to lop off the limbs of a patient with Body Image Dysphoria until the patient’s body represents the view she has of ‘himself’. Advance Directives and the notion of substituted judgment grope clumsily towards the fulfilment of the wishes of a notional ‘I’.
Pervasive though this notion is, it is rarely (although it is increasingly ) identified and discussed. We tend simply to say: ‘Autonomy’s the guiding principle’. While of course respect for autonomy is an essential ingredient of decent ethical and legal decision-making, often the injunction ‘Respect autonomy’ will be hopelessly question-begging. We all agree that there are some situations in which autonomy should not be respected. Usually this is where the exercise of X’s autonomy will cause harm to Y. Often, of course, X and Y occupy different bodies. But often they don’t. And where they don’t, we have to ask some unavoidably metaphysical (yes, I know it’s an obscene word in modern philosophy) questions along the lines of: ‘Which is the authentic self? Whose autonomy interests should prevail?’
Once we’re alive to this issue, we’ll see it everywhere. Not because we’re philosophically hallucinating, but because it really is everywhere. Whenever anyone invokes the idea of autonomy, our reflex should be: ‘Whose autonomy? Which is the authentic self whose interests should be protected?’
The second part of this question is most obviously pertinent when the competing factions share a skin and a brain. But they’re not restricted to that situation. We’re all inevitably, and by definition, relational beings. We can only be defined in terms of the nexus of relationships in which we exist and of which, to a large extent, we consist. Hence the authentic ‘I’ whose autonomy interests should trump the autonomy interests of the co-habiting ‘false I’, might well give its primary address as ‘Society’, or ‘Family’, or a particular religion. Sometimes the competition will be felt by the person herself. She has to decide whether to live or die, but who has the casting vote? The her that is a doting mother, for whom seeing her children for an extra day is everything? The her that is a tired patient, at the end of her tether? The her that is a religious Jew, nervous of usurping a divine prerogative? Where the person can feel and sufficiently appreciate the fact and nature of the competition, she (of course) is best placed to adjudicate on the submissions made by the various voices. But sometimes such introspection and self-adjudication will be impossible. That may be because cognition is medically or temperamentally impossible, or because the issues are simply too complex (and aren’t they usually?). What’s to be done then? Well then, obviously, a discussion begins. With her, if she can join in. And, if she cannot, with all the other people conventionally involved in discussions about decisions made on behalf of a third party. But conventionally left off the agenda of those discussions, and of discussions involving capacitous patients, are centrally important issues relating to the real identity of the person by or on whose behalf a decision is made.
 For recent examples, see Levy N, 2011, Enhancing authenticity. Journal of Applied Philosophy 28(3): 308-318, and Erler A, One man’s authenticity is another man’s betrayal: A reply to Levy, Journal of Applied Philosophy, Online First.
Many thanks to Mikey Dunn for helpful discussion.