Anorexia Nervosa (AN) is a complex disorder characterised by self-starvation, an act of self-destruction. It is often described as a disorder marked by paradoxes and, despite extensive research attention, is still not well understood. Much AN research focuses upon the distorted body image that individuals with AN supposedly experience. However, based upon reports from individuals describing their own experience of AN, I argue that their bodily experience is much more complex than this focus might lead us to believe. Such research (...) often presents an overly cognitive understanding of bodily experience in AN, underplaying the affective, felt experience of individuals with AN, as well as descriptions of empowerment, strength and control reported in the early stages of AN. This paper seeks to enrich our understanding of bodily experience in AN as it progresses throughout the various stages of the disorder. I show how the classical phenomenological distinction between the body-as-subject and the body-as-object, as well as Leder’s conception of the visceral body, can inform our understanding of bodily experience in AN. I suggest that the project of self-starvation is an attempt to overcome the noisy demands of the visceral body, which are experienced as threatening the body-as-subject, through a process of objectifying the body-as-object. By cashing out AN as a project of radical bodily control that, tragically, comes to control the individual, we can capture important aspects of the bodily experience of AN and the temporal progression of the disorder. -/- . (shrink)

The article provides a conceptualization of self(-illness) ambiguity and investigates to what extent self(-illness) ambiguity is ‘special’. First, we draw on empirical findings to argue that self-ambiguity is a ubiquitous phenomenon. We suggest that these findings are best explained by a multidimensional account, according to which selves consist of various dimensions that mutually affect each other. On such an account, any change to any particular self-aspect may change other self-aspects and thereby alter the overall structural pattern of self-aspects, potentially leading (...) to self-ambiguity. Second, we propose that self-ambiguity comes in degrees and should be understood as a spectrum (as opposed to there being qualitative differences among instances of self-ambiguity). Third, we argue that complexity is the most useful dimension to organize cases of self-ambiguity, with mundane instances of self-ambiguity on the one end and self-illness ambiguity on the other end of the spectrum. Fourth, we address the promises and perils of narrativity with regard to self-ambiguity. Finally, we link our deflationary account of self(-illness) ambiguity to pattern theories of self. (shrink)

Authenticity has recently emerged as an important issue in discussions of mental disorder. We show, on the basis of personal accounts and empirical studies, that many people with psychological disorders are preoccupied with questions of authenticity. Most of the data considered in this paper are from studies of people with bipolar disorder and anorexia nervosa. We distinguish the various ways in which these people view the relationship between the disorder and their sense of their authentic self. We discuss the principal (...) modern ac-counts of authenticity within the analytic philosophical tradition. We argue that accounts based on autonomous, or wholehearted, endorsement of personal characteris-tics fail to provide an adequate analysis of authenticity in the context of mental disorder. Significant elements of true self accounts of authenticity are required. The concept of authenticity is a basic one that can be of particular value, in the context of self-development, to people with mental disorder and to others experiencing substantial inner conflict. (shrink)

Despite widespread agreement that ambivalence precludes agency “at its best,” in this paper I argue that ambivalence as such is no threat to one’s agency. In particular, against “unificationists” like Harry Frankfurt I argue that failing to be fully integrated as an agent, lacking purity of heart, or being less than wholehearted in one’s choices, tells us nothing about whether an agent’s will is properly functioning. Moreover, it will turn out that in many common circumstances, wholeheartedness with respect to some (...) motive or course of action is itself a defect in an agent’s will. (shrink)

Various traditions in mental health care, such as phenomenological, and existential and cognitive-behavioral psychotherapy, implicitly or explicitly acknowledge that a disruption of the self, or the person, or the agent is among the common denominators of different mental disorders. They often emphasize the importance of understanding patients as reasonsresponsive, in their full mental health relevant complexity, if their mental disorder is to be treated successfully. The centrality of the concept of the self is not mirrored in the mainstream scientific approaches (...) in psychiatry however; the self has rarely been considered as the object of scientific research, the empirical investigation of which might yield successful explanations of and interventions in mental disorders. Thus, even though self-related phenomena are clinically relevant in so far as they give important information about a mental disorder to the clinician and help the development of effective interventions, they are not considered among the scientifically relevant properties of mental disorders. Leaving the self-related phenomena out of the scientific research on mental disorders can be attributed to the presupposition that the self is not empirically tractable and its use will hinder psychiatry’s goal to be scientific. In this paper, taking issue with this, I argue the self is empirically tractable, and its use as a target of research will not hinder psychiatry’s scientific commitments. (shrink)

ABSTRACT‘Self-ambiguity’, we suggest, is best understood as an uncertainty about how strongly a given feature reflects who one truly is. When this understanding of self-ambiguity is applied to a view of the self as having both essential and shapable components, self-ambiguity can be seen to have two aspects: (1) uncertainty about one's essential or relatively unchangeable characteristics, e.g. one's sexuality, and (2) uncertainty about how to shape oneself, e.g. which values to commit to, actions to pursue, or essential features to (...) identify with. We explain how a narrative account of agency can accommodate these forms of self-ambiguity and argue that such an account also reveals another kind of self-ambiguity, namely, (3) uncertainty about whether one's established self-narrative represents who one really is. We illustrate this third form of self-ambiguity in the context of addiction where people's established addiction self-narratives make it difficult to identify with recovery. We argue that recovery will require embracing, especially, our third form of self-ambiguity as a chance for positive self-transformation. Treatment for addiction should, therefore, support people in going through and ultimately narratively resolving the inevitable self-ambiguities of the recovery process. (shrink)

In this paper, I argue against certain dogmas about ambivalence and alienation. Authors such as Harry Frankfurt and Christine Korsgaard demand a unity of persons that excludes ambivalence. Other philosophers such as David Velleman have criticized this demand as overblown, yet these critics, too, demand a personal unity that excludes an extreme form of ambivalence (“radical ambivalence”). I defend radical ambivalence by arguing that, to be true to oneself, one sometimes needs to be radically ambivalent. Certain dogmas about alienation are (...) even more entrenched. Allen Wood’s entry on “alienation” in the Oxford Companion to Philosophy begins as follows: “A psychological or social evil, characterized by one or another type of harmful separation, disruption or fragmentation, which sunders things that belong together.” I think that it is not true that self-alienation is necessarily “harmful.” I argue that radical ambivalence is a form of self-alienation. Thus, because faithfulness to oneself sometimes requires radical ambivalence, to be true to oneself, one sometimes needs to be alienated from oneself. (shrink)

Lucy Osler's piece, "Controlling the noise: A phenomenological account of Anorexia Nervosa and the threatening body," lays out an important new interpretation of anorexia. Anorexia Nervosa is no longer viewed as primarily a perceptual distortion of body-image, an obsession with thinness, or an attempt to dematerialize—to free the subject from its inert thing-like body. Rather, the body itself, and the visceral body in particular, takes on a "voice" which the anorexic experiences as demanding and threatening. Anorexic monitoring and self-starvation beckons (...) as a way to regain power over this renegade viscerality. Unfortunately, this strategy of self-empowerment is doomed to backfire; hunger, illness, and body/food... (shrink)

It feels like there’s two of you inside—like there’s another half of you, which is my anorexia, and then there’s the real K [own name], the real me, the logic part of me, and it’s a constant battle between the two. The anorexia almost does become part of you, and so in order to get it out of you I think you do have to kind of hurt you in the process. I think it’s almost inevitable. We came to the (...) concept of authenticity belatedly, one might say. We had been talking to people who had a diagnosis of anorexia nervosa about their experiences of living with their condition, and though we had not raised issues of authenticity or identity ourselves, they often did. They struggled with questions of .. (shrink)

The article provides a conceptualization of self(-illness) ambiguity and investigates to what extent self(-illness) ambiguity is ‘special’. First, we draw on empirical findings to argue that self-ambiguity is a ubiquitous phenomenon. We suggest that these findings are best explained by a multidimensional account, according to which selves consist of various dimensions that mutually affect each other. On such an account, any change to any particular self-aspect may change other self-aspects and thereby alter the overall structural pattern of self-aspects, potentially leading (...) to self-ambiguity. Second, we propose that self-ambiguity comes in degrees and should be understood as a spectrum (as opposed to there being qualitative differences among instances of self-ambiguity). Third, we argue that complexity is the most useful dimension to organize cases of self-ambiguity, with mundane instances of self-ambiguity on the one end and self-illness ambiguity on the other end of the spectrum. Fourth, we address the promises and perils of narrativity with regard to self-ambiguity. Finally, we link our deflationary account of self(-illness) ambiguity to pattern theories of self. (shrink)

In their target article, Moore and colleagues offer a valuable overview of the various ambivalence-related phenomena that may impede swift clinical decision-making. They argue that patients...

The article proposes a theoretical model to account for changes in self due to Deep Brain Stimulation. First, we argue that most existing models postulate a very narrow conception of self, and thus fail to capture the full range of potentially relevant DBS-induced changes. Second, building on previous work by Shaun Gallagher, we propose a modified ‘pattern-theory of self’, which provides a richer picture of the possible consequences of DBS treatment.

The article proposes a theoretical model to account for changes in self due to Deep Brain Stimulation. First, we argue that most existing models postulate a very narrow conception of self, and thus fail to capture the full range of potentially relevant DBS-induced changes. Second, building on previous work by Shaun Gallagher, we propose a modified ‘pattern-theory of self’, which provides a richer picture of the possible consequences of DBS treatment.

Psychiatric disorders involve changes in how you feel, think, perceive, and/or act—and the same goes for psychotropic medication. How then do you know whether certain thoughts or feelings are genuine expressions of yourself, or whether they are colored by your psychiatric illness, or by the medication you take? Or, as Karp nicely sums up the problem: “if I experience X, is it because of the illness, the medication, or is it “just me’?” Such “self-illness ambiguity” seems to be quite an (...) ubiquitous problem in psychiatry. It is a very unsettling problem, moreover, and not easy to resolve.In their... (shrink)