Are You Thinking About the Self?

Drawing by Sydney Cash 1972

“Self” is the consummate même for our time.  From the moment we acquire language and first utter the word”I”, we are haunted by the private, insidious question, “Who am I.”Psychologists have been delimiting the meaning of self since that field of endeavor announced itself, a hundred and thirty years ago. In 1890 William James, one of the first self-designated psychologists, published “The Principles of Psychology.” He opens with this statement: “The Empirical Self of each of us is all that he is tempted to call by the name of me.”In my first contact with schizophrenia, as a medical student, I discovered how slippery that sense of self could be. I learned to identify such slipperiness as depersonalization or identity diffusion. Interesting as academic concepts, but to those suffering that instability of self is like being on a ship tossing furiously in an unremitting storm.Almost my first day on the “psych” ward I encountered a man about fifty seeming to be hiding in a back stairwell. I was taking a shortcut down to the floor below not realizing that that exit door was locked.The man turned away from me, clasping his arms around himself as if to block interaction. I knew he was not supposed to be off his ward so I thought I should engage with him and help him return.Without responding to my gaze he, his face averted. freely answered my first question: “Can I help you?”He said, in a cooly robotic voice, “He’s not available.” I then identified myself as a medical student and asked, “when might you be available?”His answer: “When his time comes.” And he fell silent, unresponsive to further inquiry.  Later I learned that this man had been a surgeon whose psychosis had overtaken him some decades past. He was known to “hide” in the stairwell as if it were his place of refuge.I took to visiting him there every day. I would tell him a little about my life, explain who I was. His response was uniformly: “He will get back to you when the time comes.” He never looked at me and always kept his face at least partly hidden, as if, I thought, in fear of discovering a lost self.And he would never disclose or acknowledge his actual identity. When I gently asked if he was T. K. or Doctor K, his one-time curious answer was “Why not ask him?”.

"Many of the mental conditions regarded in the past as emotional disturbances have proven to be brain-based."

.Some patients would be terrified by the loss of their sense of self or the often concomitant feeling that nothing was real, that reality shifted about as if they were different persons at different times or that locations altered sometimes hellishly.Loss of a stable sense of self is probably far worse than lack of sight or hearing, because without a self one is lost to madness. An incomprehensible world is anyone’s worst nightmare.What about defects in the "normal" self, defects mostly invisible, unrecognizable to oneself? These would be defects experienced as difficulties in life, in relationships, in careers, in mood and self-esteem. Accodrding to theories and treatment strategies developed by the International Masterson Institute, disorders of the self, also called personality disorders, arise out of distortions in the organization of the self system, the intrapsychic structure all of us sustain. There are three recognized such systemic aberrations: the borderline, the narcissistic and the schizoid personalities. Each of these are thought to have evolved out perceived conditions for love and acceptance by parental figures. The borderline struggles between opposing positions of dependence/infantilism and impulsive assertion; the narcissist inhabits a bubble of perfection subject to piercings that can bring on collapse or rage; and the schizoid appears aloof and wholly self-reliant yet secretly yearns for a fearful other.Psychotherapy has evolved over the past century and a half as a tool for self repair. Many of the mental conditions regarded in the past as emotional disturbances have proven to be brain-based. These include schizophrenia, depression, the bipolar condition of mania alternating with depression, extreme obsessive-compulsive behaviors, panic attacks, anorexia, and—most egregiously perhaps—autism. Not that psychotherapy has no role in treating these conditions; suffering from any one of these damages self-esteem as well as social and vocational function.We in the 'West' live in a world increasingly focused on the individual and we demand and seek high levels of achievement and recognition. We emphasize individual qualities that promote various forms of success. And our societies worship the very highest success. We adore and emulate and nearly deify those who rise to the top. Our celebrities become aligned like gods or even demons.That pressure on the self exposes the possible fault lines that form just from growing up in a world radically modified by civilization. Family and social life have been shaped and re-shaped for eons. That progression has raced far ahead of the slow process of physical evolution. We enjoy comforts and commodities unavailable even as recent as a hundred years ago. We are living life on continually changing planes.Our sense of self, our identity, the realization of self, pays no small price.