Book Review

A Simple Theory of the Self

N Engl J Med 1994; 331:1318-1319November 10, 1994

Article

A Simple Theory of the Self
By David W. Mann. 176 pp. New York, W.W. Norton, 1994. $25. ISBN: 0-393-70172-7

Medicine is far more than an empirical activity, and physicians are not mere technocrats. The underlying philosophies of how we regard nature and ourselves determine the very character of medicine. Thus, the vast differences between medicines in China and the West may be traced to their differing views of the world. One of the quandaries in Western thought and Western medicine is the Cartesian mind-body duality. Various philosophical responses to this problem have given rise to different psychologies of the self. In medicine, our understanding of selfhood -- what it means to be an individual -- has implications for everything from psychiatric practice to doctor-patient relationships. Theories of the self therefore affect matters well beyond esoteric discussions among philosophers.

The thesis of A Simple Theory of the Self is that the self has three dimensions: time, body (space, loosely viewed), and relation. The first two categories are self-explanatory -- we each have a personal history and an awareness of our embodiment. But what is “relation”? Mann has incorporated a dominant 20th-century philosophical concern with the so-called self-other relation that includes not only our relationship with other persons and our environment (both social and natural) but also our relationship with ourselves. Mann uses the term “reflexivity” to indicate self-awareness, a psychological dimension in which we recognize that there is a self. By focusing on self-consciousness, which is the innermost part of our identity, Mann builds a psychology that uses self-identification as a means of opening our psyche. By explicitly isolating the reflexive component of our consciousness, Mann hopes to develop new categories of psychiatric dysfunction and improve our understanding of normal behavior.

There is the germ of a powerful psychology in the reflexive self, but I do not believe Mann has developed the potential of its intriguing narrative power. I regard his thesis as a prelude or perhaps an allusion to a rich intellectual history that will reveal a highly nuanced and complex theory. Rather than offer a detailed critique, I will only indicate the origins of Mann's proposal and the general direction in which he and others of similar thought may be headed. That this particular book seems to me an inadequate foundation for a new psychology based on reflexivity hardly condemns the general effort.

A Simple Theory of the Self originates in a complex history of the philosophy of personal identity. Hegel and his 19th-century followers changed the self from an entity to a process. Their view was that the self neither is given nor emerges in some final form but can be constituted only in relation to its object -- whether that is the exterior world or some inner sense of identity. Kierkegaard wrote that the self is “a relation which relates itself to its own self, and in relating itself to its own self relates itself to another.” This definition was expanded by 20th-century phenomenologists, who focused on how relations defined, or authenticated, the self. And later theorists, often referred to as postmodernists, deconstructed the self as completely dependent on a particular cultural and historical design.

Mann's thesis is a confused mixture of these two views. On the one hand seemingly unaware of the rich history of his central idea in philosophy, he affirms that “the self is quintessentially reflexive,” yet, on the other hand, he fails to draw the fundamental lesson from that characterization: the self as an entity dissolves. Mann correctly perceives that there is a problem, which he characterizes as the self's indeterminacy. This he finds to be a natural consequence of Heisenberg's uncertainty principle, in which, in quantum mechanics, the simultaneous determination of both the momentum and the position of a particle is impossible. How, or for that matter, why, relations found in elementary particle physics resemble human relationships is never explained. I do not believe that the problem of defining the self can be explained by the metaphysics of quarks.

Most contemporary philosophers regard the self problem as one of several types of imbroglios imposed by the limitations of our language. One view, in keeping with Mann's own orientation, is that the self is neither subject nor object but reflexivity (in philosophical terms, a dialectic). Only verbs capture such action, and we do not readily collapse verbs from their divided subject-predicate status to a union, yet this is what is required. Mann's self is lost in a grammar yet to be articulated. He still refers to the psychiatric patient as a subject, a multidimensional entity that he cannot adequately describe. His description falters because in my opinion he is simply and ironically still locked into a pre-Hegelian psychology. Mann, who persists in regarding the self as an entity, only vaguely perceives the philosophical conundrum.

If we seek a new psychology, it is unlikely to emerge from the version described in this book. A psychology based on a reflexive function must develop a grammar that places ourselves in our world, neither as subjects nor objects, but as integrated “subject-less verbs” of experience. This is the project begun by William James, and one that remains incomplete. To so situate the self is a most ambitious philosophical task, perhaps impossible. Many are hailing the end of philosophy, not because the classic problems have been solved, but because there is growing anxiety that philosophical analysis cannot resolve such issues as the self. Nevertheless, even flawed, derivative efforts such as Mann's remind us that the problem remains and seeks responses.

Alfred I. Tauber, M.D.
Boston University, Boston, MA 02215