Dimensions of self-illness ambiguity – a clinical and conceptual approach

ABSTRACT

The article investigates the concept of self-illness ambiguity (SIA), which was recently re-introduced in the philosophy of psychiatry literature. SIA refers to situations in which patients are uncertain about whether features (symptoms, signs) of their illness should be attributed to their illness or to their ‘selves’. Identification of these features belongs to a more encompassing process of self- definition and -interpretation. The paper introduces a distinction between the notions of self-relatedness, self-referentiality (or: implicit self-signification), self-awareness and self-interpretation. Each of these notions offers a different perspective on SIA, but these perspectives do not exclude one another. A further distinction will be developed between primary, secondary and tertiary forms of self-referentiality. The practical and conceptual relevance of these distinctions will be illustrated with case vignettes. Throughout the paper our findings will placed in the context of other philosophical work on the self, especially in the field of narrative theory (Ricoeur), phenomenology (Ratcliffe) and philosophy of mind. The article closes with a brief discussion about the appropriateness of the term ambiguity and the potential of SIA as concept in the context of clinical psychiatry. Directions for future work will be indicated.

KEYWORDS:

• Self
• self-illness ambiguity
• illness experience
• self-relatedness
• self-referentiality
• self-awareness

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Gerrit Glas

Gerrit Glas is philosopher and psychiatrist. He is currently emeritus professor of philosophy of neuroscience (Amsterdam University Medical Center), holder of the Dooyeweerd chair (Department of Philosophy, Faculty of Humanities, Vrije Universiteit, Amsterdam) and director of residency training in GGzE (Eindhoven, the Netherlands).