As features of the good life, agency and identity are in mutual support. Awareness of one’s own agency is an important part of having a sense of self, and psychiatric conditions disrupting one often disrupt the other. In this chapter psychiatric disruptions will be used briefly to indicate some contours of the sense of self. People care about feeling at home in their own body, “being comfortable in their own skin.” They need recognition by others to create a secure awareness of being the person they are. Without this, efforts to create an identity may be shallow and self-defeating. People can also care about their moral identity, wanting to shape the kind of person they are.
Bodily shape may not fit a person’s idea of the shape they should be. It may not fit the person they feel they are. The feeling of such conflict in gender identity disorder has been succinctly expressed by Jan Morris: “But it all seemed plain enough to me. I was born with the wrong body, being feminine by gender but male by sex, and I could achieve completeness only when the one was adjusted to the other.”1
There is a something similar in body integrity identity disorder. People with this disorder feel that some bit of their body is not part of them, and so want it amputated. This can involve great distress, suicidal feelings, and even attempts at self-amputation.2 They may feel it when the offending arm or a leg is touched, but the appendage does not become part of their body image.3
Evidence links this to poor functioning of mechanisms in the right parietal lobe that map actual bodily boundaries on to the person’s body-image. One response might be that it is the body image, rather than the body, that needs adjusting. But we have no means of adjusting the body image, so it is amputation or nothing. Obviously, help offered should reflect the facts of each person’s case. But refusing an informed and considered request for amputation would need reasons strong enough to outweigh the distress of the felt mismatch: “BIID seems weird and alien at first, but it is a very real condition that affects a lot of people. I have needed to be paraplegic as far back as I can remember … ‘First do no harm.’ But the surgeons’ refusal to help us is actually what is doing harm. You cannot begin to understand the amount of anguish and emotional pain we live with. Day after day. Refusing us surgery, the only thing that actually helps with BIID symptoms, is condemning us to a life of utter misery.”4
I’m horrible, I told the man at the other end of the phone. I hate myself. I’m crazy. It would really surprise him that once upon a time I used to be somebody, I used to accomplish things.
—Rachel Reiland, Get Me Out of Here: My Recovery from Borderline Personality Disorder
Some of the men interviewed in Broadmoor wanted recognition and had been denied it. As children they felt hardly noticed—not picked up from school, or for years not visited in the hospital. They would have been pleased just to be seen, wanted, accepted, and loved for who they were. These are likely foundations of the deeper sense of self: the secure and untroubled awareness of the distinct person you are.
One conjecture put forward earlier about the Broadmoor patients was that denial of recognition aroused in them a hunger for it. Some of them tried to satisfy this hunger in shallow ways—wanting to impress other people, and themselves, that they were really “somebody.” This shallow way of being “somebody” evades the deeper sense of self. Gwen Adshead’s comment that some of the Broadmoor patients were “not very real to themselves” touched on this. Having not been recognized or not been respected themselves, they might not have learned through the usual reciprocity to recognize and respect others. If this is right, they may have a weak sense both of other people and of themselves.
There are other causes of the failure to develop a deep sense of self. Gunilla Gerland has described her autism partly in terms of a sense of personal emptiness. This also was linked to lack of recognition. She was different from nonautistic people. She felt that their mental maps had no space for the person she was: “I was trying to be someone, but I didn’t seem to exist among all the possibilities available, so it had to be someone else.” This left her feeling she had no character of her own: “I felt I was empty. I had peeled away the unafraid person, those individual characteristics, the special tastes I had as a child. I hardly knew what I liked at all now. I didn’t know if I was hungry or satisfied. I didn’t know what kind of music I liked, or whether I liked music at all. I didn’t know whether I liked the books I was reading or whether I just read them anyway. I didn’t know if I preferred doing one thing or another.”
Having lost her own individuality, she borrowed from other people, but this left her with no sense of any self of her own: “People asked me what I wanted, what I thought. I took features from people I met and added them to me. I often took features from people who seemed very self-confident. I did this immensely skilfully. I became a chameleon—if I adopted Karin’s way of sighing as she spoke, I could use it with everyone except Karin, and if I adopted Maria’s taste in music, then I didn’t talk about music with Maria. I was an empty jar that could be filled with anything. People’s behavior simply fell into the jar and I used it to try to feel myself someone, like a real person. I developed this strategy in order to be able to relate to people. If you were no one, you couldn’t relate—you had to be someone.”
But this borrowing to relate actually hollowed out relationships: “I sensed that Dirk liked the features I had adopted from other people. He didn’t know he was having a relationship not with me but with a woman I had invented. It couldn’t work. How could it have done? The invented woman wasn’t real. She was empty, and I who was playing her was not real either. No one, not even I myself, had ever seen me as I really was. Things got worse when more intimacy was called for. Imitation couldn’t rise to it—I didn’t know who I should be. I started screening myself off … Dirk was annoyed when, as he put it, I disappeared into the wall. I just wasn’t present, he said.”5 Helping people escape this emptiness raises difficult questions about what makes characteristics, tastes, and desires authentically one’s own.
As well as caring about being “somebody,” people care about the kind of somebody they are. Many—though perhaps not all—care about the pattern that emerges, wanting their life to add up to something. This can be reflected in what they contribute to the world or to a few people close to them. Or it can be about achievements that may not reverberate into the lives of others. (One obituary of an Oxford academic, with the fine discrimination examiners show between alpha and alpha minus, said he was a great, perhaps even a very great, collector of books.) It can be a sense of moral identity, to care about the kind of person you are—wanting to be a person whose life is shaped by these values, not those. Moral identity also can be damaged in ways that call for help.