Editor’s Preface: Consider the Self

Who am I To stand and wonder, to wait While the wheels of fate Slowly grind my life away. Who am I?

Country Joe and the FishElectric Music for the Mind and Body¹

In this issue of Literature and Medicine, we consider the self—a difficult, contentious little construct that has driven a good many poor souls to drink and worse—so we tread lightly here as we think a bit about the nature of this remarkably resilient and slippery concept that has deviled psychologists, philosophers, sociologists, medical practitioners, novelists, poets, cultural critics, theologians, and even, perhaps especially, song writers.

“Who am I?” was probably the first question the first human being asked as she wiped the primordial ooze off her sandals and began the endless work of creating what we now think of as civilization, creating in the process the collective other against and by which her descendants forever after have measured and defined them-selves, a collective other that has always and continues to complicate not only what the self might be, but the question of whether in fact there is any such thing as a self at all. Perhaps, some argue, the self is no more and no less than the sum of civilization’s or culture’s or hegemony’s footprints in the ooze of our always already compromised existence in this place. Others retort that the self is the center of being, the essence of who we are, the soul, if you will, of the matter of our lives. Still others hold that the notion of the self is no more or less than an anomaly in the use of language. In the introduction to an article titled “The Self,” analytic philosopher Galen Straw-son summarizes and responds to this argument in the following way:

The substantival phrase ‘the self’ is very unnatural in most speech contexts in most languages, and some conclude from this that it’s an illusion to think that there is such a thing as the self, an illusion that arises from nothing more than an improper use of language. This, however, is implausible. People are not that stupid. The problem of the self doesn’t arise from an unnatural use of language which arises from nowhere. On the contrary: use of a phrase like ‘the self’ arises from a prior and independent sense that there is such a thing as the self. The phrase may be unusual in ordinary speech; it may have no obvious direct translation in many languages. Nevertheless all languages have words which lend themselves naturally to playing the role that ‘the self’ plays in English, however murky that role may be. The phrase certainly means something to most people. It has a natural use in religious, philosophical, and psychological contexts, which are very natural contexts of discussion for human beings.²

We are all familiar with Descartes’ summation of the self—Cogito ergo sum: I think, therefore I am—a remarkably powerful enthymeme, a jingle writer’s holy grail sound bite that proved capable not only of lodging itself in the minds of generation after generation, but of splitting consciousness into radically disparate halves and wreaking philosophical, scientific, and cultural havoc that seems never to reach its end. And this, I think, is where it makes sense to focus on the intersection at which discussions of the self meet the practices of literature and medicine.

Descended from and empowered by Descartes’ memorable enthymeme, medicine has long struggled to account for the body as mechanical and chemical mystery and the equally crucial but less experimentally “interesting” illness aspects affecting the lives and spirits of those upon whom medicine works. Over its history, and often for very good reasons and to good ends, medicine has chosen to attend to disease and to leave the illness out. This focus has produced remarkable progress, enabling physicians to discover and refine cures for some of the most devastating scourges in all of human history, including polio, syphilis, tuberculosis, and pneumonia, to name only a few. At the same time, patients, as persons, have found themselves increasingly removed...