Today's post is by Jodie Russell (University of Birmingham) who is addressing self-illness ambiguity.
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| Jodie Russell |
In a recent paper titled “Prescriptive ‘selves’ and self-illness ambiguity” (Synthese 2025), I explain the phenomenon of self-illness ambiguity and argue that individuals who experience these ambiguities might feel a particular form of social isolation. Self-illness ambiguities occur when people struggle to determine whether a thought, feeling, or behaviour is due to their illness (specifically, a mental disorder) or due to who they are as a person (i.e. stemming from their self). For example, someone with depression might find it difficult to tell whether their sadness after being let down by a friend is a symptom of their depression or a response rooted in their personal history of being let down by others.
As Sadler (2004) describes, mental disorder can saturate or transform a person’s relationship to the world, and this transformation can be valuable in itself. For instance, someone might find the voices they hear to be comforting and reassuring. This is one way in which the boundary between self and mental disorder can become blurred. Such blurred boundaries can be difficult for others - especially those without self-illness ambiguities or any experience of mental disorder - to understand. This lack of understanding can lead to blame, stigma, and vilification (Sadler 2004).
The goal of my paper is to explore how social understanding is applied to people with disorder experiences, particularly those with self-illness ambiguities. I begin with the assumption that social understanding is a form of mind-shaping: the idea that we understand one another by guiding each other to conform to shared norms and rules. This is best understood in context.
For example, if I own a bookshop, I understand that my customers wish to buy books not because I can read their minds (excuse the pun), but because they perform book-buying behaviours that follow certain rules. They bring their chosen books to the till and exchange money. If a customer were to walk out of the shop without following these rules and took a book with them, new rules would come into play to explain their behaviour, namely, the rules of stealing.
There are countless rules we follow in everyday conversations, some of which we may be more or less aware of. For instance, we may follow rules about gender which are reflected in how we dress, or rules about politeness when taking turns in conversation. I argue that there are also rules governing the ‘self’ we present to others and how we talk about illness.
To perform certain actions in a social situation, we need an idea of who we are first. I need to take on the role of the customer in order to perform the action of buying books (if I don’t know I’m the customer, I’d only be buying things by accident). This idea of who we are becomes more specific when we interact regularly with the same people, e.g. our family, friends, and colleagues. To my friends, I’m not just a book-buying customer; I’m also a coffee lover, videogame player, and dungeon master. These categories help others make sense of my behaviour. When I act contrary to these roles, I might appear ‘not myself’ or simply incomprehensible to others.
Specific disorder experiences, as I describe them, can be transformative - they can change your outlook on life and give things new meanings. This can conflict with the ‘self’ others expect you to perform. For instance, if I develop anxiety, my experience of socialising in coffee shops may be radically transformed, such that I no longer wish to take part in that activity. My friends, who are used to doing this with me, might see this as a radical departure from my usual behaviour. Some might explain it as a result of my anxiety, but others might struggle to understand the change.
It’s these moments of misunderstanding that my paper is concerned with. I argue that self-illness ambiguities are situations where individuals are especially likely to be misunderstood. This is because we have accepted ways of talking about and understanding illness, but not about illness ambiguities specifically.
In the anxiety example, my friends might recognise anxious behaviour and apply the concept of ‘anxiety’ to explain my actions. But if my behaviour is ambiguous to both myself and my friends, it’s unclear what rules are in play or which concepts apply. If I push myself to go to the coffee shop despite my feelings of anxiety and I seem more withdrawn than usual, it may be unclear whether my withdrawal is due to my anxiety or another aspect of my personality (perhaps I just dislike that particular coffee shop). Without a clear answer as to whether my behaviour stems from my disorder or my ‘self’, I might not know how to interact with my friends, and they might not know how to interact with me (e.g. should they draw me into conversation, leave me be, or suggest a different coffee shop?).
It’s important to note that not everyone finds self-illness ambiguity problematic. Not knowing whether an experience stems from the ‘self’ or a disorder may not cause practical issues or distress. However, I argue that people with self-illness ambiguities may be socially alienated because they don’t fit into mainstream ways of talking about mental disorder.
This can exacerbate difficulties for some, such as hermeneutic injustices (see Fricker 2007), where individuals are overburdened with the expectation to explain themselves in ways others understand, without having access to the necessary conceptual tools to do so. This can make self-illness ambiguity a deeply isolating experience.