Recovering One's Self from Psychosis: A Philosophical Analysis

Recovering One's Self from PsychosisA Philosophical Analysis The author reports no conflicts of interest. Rosanna Wannberg (2024) has given us a dense but helpful introduction to certain philosophical questions raised by the fact that many patients recovering from psychotic illnesses describe their recovery in terms of gaining or regaining a 'sense of self' and a 'sense of agency,' which often involves acceptance of the 'fact' of being mentally ill, for example, of 'having schizophrenia.' She raises two important questions: How should we understand what is going on in these accounts? and What are the implications of these reports for our understanding of what it is to have a 'sense of self' or a 'sense of agency'—of 'subjectivity' generally—which might have, both, clinical and nonclinical implications? What does it mean to have a self or a sense of having one, agency or a sense of having it? One might think these are the possession or experience of something 'inner' such as feelings of confidence or assurance, perhaps having a kind of inner structure or a set of deeply held ideas which give us coherence, motivate us and justify our actions, and which we can know by 'looking inward,' in an introspective act which provides direct, privileged acquaintance. Yet Wittgenstein called this a dangerously misleading 'picture' which 'held us captive,' and needed always to be 'gotten rid of' (Wittgenstein, 1958). One way of seeing the problem is to consider that no inner 'object,' no thing inside us, can be, or give us a sense of having, a self or agency, because no mere thing (whether an experience of confidence, or having an inner structure) can have any meaning or provide any explanation. A thing (like a word on a page) is just a thing—inert, dead— and must be interpreted, that is used, before it can play a role in our 'forms of life' (Wittgenstein, 1958) including explaining our sense of self or agency. Semantic externalists (Burge, 1979; Putnam, 1975), have argued that even what is internal to our minds—like thoughts—have contents which are determined by experiences in the 'outside' world in which we have lived and learned: if our experiences in the world, they have shown, were different, then so, also, would be the contents of our thoughts. It has even been argued that internal mental experiences which appear to be purely phenomenological (such as an image or a thought-token, so-called narrow content) can only End Page 67 be identified and thought about using concepts having references in the external world: there is, so it is claimed, no narrow content (Yli-Vakkuri and Hawthorne, 2018); or, if there is, it is of no explanatory use in psychology (Fodor, 1994). If this is the philosophical background from which Wannberg confronts first-person accounts of recovery from psychosis which include (re)gaining a sense of self or agency, and if this philosophy is right, what becomes of the accounts? How are they to be understood? To meet this challenge, Wannberg invokes an alternative account of self-possession and firstperson authority provided by Richard Moran (2001). Moran's position is that we find or possess ourselves when we find or hold beliefs about the world which we do not merely believe but endorse or avow, where to endorse or avow a belief about the world is to find and endorse reasons in the world, which support that belief. Thus, I can avow that it's raining if I can look outside and see that it is raining. This Moran calls the transparency condition. Endorsing or avowing both a belief and the external reasons for it gives the self what Moran refers to as authenticity and which also might be said to provide cohesion, consistency and intelligibility—plausibly, a 'sense of self.' The transparency condition also applies to beliefs that justify actions. We act intentionally when we can give good reasons for what we do (Anscombe, 1957; Moran, 2001) and we can give good reasons for what we do when we can identify facts in the world that support those reasons. Thus, the transparency condition can explain both a sense of self and a sense...