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 schizophrenia may go through periods of crisis, where it is hard to see any coherent personality at all. There may be a torrent of words that do not make much sense, or which reflect some delusional state. Moods may oscillate between shallow, excited optimism and a sunken, withdrawn despair. Attitudes to people he or she knows may move, apparently randomly, from warmth and love to suspicious hostility expressed by a menacing stare.
But, as a result of medication or as a new phase of the condition, there can be long periods of stability. In these periods, the person may seem much as before the illness. But often there is a transformation of personality. Someone friendly, alert and with wide interests may have moved into a negative, strangely unreachable phase: slow, sullen, perhaps aggressive, usually uninterested in others, saying little and doing little beyond half-watching television. In these periods, friends and family may say, “it is like talking to a different person”.
For some people, the oscillation between periods of crisis and these negative phases may last a lifetime. Friends and family may have conflicting responses to the aggression they are sometimes shown. Should they react with exasperation or with detachment? Is it him or is it his illness?
There is a case for refusing to see the schizophrenic personality as the person’s real self. There is usually little doubt that the strangeness and the narrowing passivity are products of the illness. As a thought experiment, imagine that a treatment is developed that can restore permanently someone from this negative state to their original state before the onset of the illness. In the absence of other residual problems, this would be a cure for schizophrenia. It would then be natural to see the second personality as a product of the illness, and not as what the person is really like. This would be supported by the fact that many aspects of the second personality appear on lists of the “negative symptoms of schizophrenia”. In retrospect, difficulties in answering the que