 reply to this question could appeal to the way in which, as Nietzsche saw, we at least partly create ourselves. Nietzsche’s version of self-creation was a highly self-conscious one, making people like architects or landscape gardeners of their own character and personality. He was right that many of us do care about the sort of person we are, and do to some extent try to grow in one direction rather than another. But for most people self-creation is less dramatic than in Nietzsche’s picture: more a matter of trying to be the sort of person who answers letters, or who gives up a job in public relations because you don’t want to be the kind of person you see you are becoming. And less dramatic still is the often completely unconscious self-creation that comes about when repeated actions become character-shaping habits.
Aristotle took the view that our character is something we are responsible for, because it results from our own freely chosen actions. Pointing out that we punish people who, through carelessness, are ignorant of things they should know, he says that we assume that they have the power to take care. He then considers the objection that someone may be a careless kind of person. He replies that becoming such a person is their own fault: “they are themselves by their slack lives responsible for becoming men of that kind, and men make themselves responsible for being unjust or self-indulgent, in the one case by cheating and in the other by spending their time in drinking-bouts and the like; for it is activities exercised on particular objects that make the corresponding character.” He accepts that, once we have a certain character, we may be unable to change it at will, but says that it was still pour own fault that we acquired it. (3.)
This robustly “common sense” Aristotelian view is broadly presupposed by most legal systems and by the everyday morality of praise and blame. There is the presumption that actions are voluntary unless there is some special reason to think that they are not, together with the view that our character is also our responsibility because it is the residue left by past actions. This also applies to the character changes resulting from some voluntarily chosen major upheaval in life. The nun’s new piety and the immigrant’s new patriotism both stem from free choices they have made.
But the stubbornness of the person with dementia contrasts sharply with this. We do not do things that predictably bring on dementia. This disaster, despite being inside the body, comes on us “from outside” in the sense that it is not under our present, or even past, control. The response that the new personality is not the real person but a product of the illness seems justified.
This response also fits with our concern about being one sort of person rather than another. There has been a good deal of debate about living wills and euthanasia, in which those who think it right to respect someone’s advance directive not to be kept alive in certain states appeal to the interest people have in the pattern of their lives. The demented person I become in twenty years’ time may seem quite content and show no wish to die. But if I now hope to die earlier rather than include a few extra vacant years of dementia in the pattern of my life, this seems something to take into account. Leaving aside whether it is enough to justify acting on the advance directive, this interest in the kind of person I am over a lifetime gives me reason to hope that people will see the grumpy surliness as reflecting the dementia rather than reflecting me.
B. The Case of Schizophrenia.
Dementia mainly (though not always) comes on at a relatively late stage of life. This makes it easier to see the demented period as a coda: something after the main part of then person’s life rather than part of it. But this option is less readily available in some other character-distorting conditions. Schizophrenia, for instance, usually comes on relatively young and also often brings about radical changes of character and personality.
A person with schizophreni