stion, “is it him or is it his illness?” would largely disappear. The decision to withhold the more critical reactive responses would seem to have been right. The person’s self-creative project would have been temporarily disrupted by an illness. The hostility or aggression they displayed should be put aside as not reflecting their real self.
Now imagine a scenario, more like the actual one for many people with schizophrenia, in which the original personality is not restored. Should we treat the current, schizophrenic, personality as not reflecting the person’s real self, but as merely the product of the illness? The case for this approach is that it is the one we would adopt if there were a cure. It seems puzzling that the schizophrenic personality should have a completely different status depending on whether we are making the decision before or after scientists have developed a cure.
On the other hand, where there is no cure, there is a case for accepting the schizophrenic personality as now being the person’s real self. This is not some brief coda at the end of life. His real self, if not reflected in the schizophrenic personality, is something hidden for decades. Can the real self of the forty year-old man really be that of the teenage boy before the onset of schizophrenia, a real self unlikely ever to be seen again? Would it not be more realistic to accept how he is now as his real self?
People confronted with this issue tend to be pulled both ways. The phrase “the real self” is of course vague and indeterminate, which makes it unlikely that the issue is one where the “right” answer can simply be read off from the evidence about the condition. Any answer seems at least as much a matter of decision as of discovery. And the reasons point in conflicting directions.
There is the desire not to give up on the possibility of a cure, a kind of keeping faith with the original person. This is given a degree of support by some of the cases in Oliver Sacks’s book Awakenings, in which he describes how people who had suffered from a severely Parkinsonian condition since the 1920s responded in the 1960s to L-Dopa. In some cases there was an extraordinary restoration of the original personality, which had been totally submerged for decades. It was not always possible to maintain the revived personality, but the fact that it could be revived at all supports the idea that, in these long-term conditions that distort character and personality, the original version of the person may not be totally lost. On the analogy of a television where the picture has been replace by visual chaos, there is the hope that if only could get the neurological or neurochemical tuning right the original picture might be restored.
There is also the thought that, as with dementia, the new personality is obviously caused by the disorder, and that it was not the product of the person’s own previous decisions or self-creative project. It seems unfair that their personality has been distorted by something outside their control, and refusal to see the new personality as really them is a kind of recognition of this.
On the other hand, the refusal to recognize the new personality as reflecting anything other than illness seems to leave the person as they are now in a kind of limbo, possibly for the rest of their lives. It is possible to have a character and personality shaped by a medical condition and still to identify with it. One autistic person protested against parents who wished his autism could be cured, by saying that their real wish was that he had not been born and that they had had a different child instead. The arguments pull both ways.
3. THE MISSHAPEN REAL SELF.
Schizophrenia typically comes on at a much earlier stage in life than dementia. But even schizophrenia’s onset comes on after there has been time for quite a bit of development of the person’s “original” character and personality. Because of this, we can contrast the person and the illness, and may see the latter as eroding or distorting the person’s previous character, But there are conditio