At the intersection of self and not-self: finding the locus of 'self in autoimmunity

摘要

Individuals with chronic autoimmune disease experience a sense of vulnerability. In part, this relates to the struggle for finding the meaning of the illness. The consequent existential distress may manifest in an unseated sense of personhood. Insight into the mechanism of this state of powerlessness and of perceived loss of agency is central to establishing a supportive clinician-patient relationship. This present exposition underscores the concept of autoimmunity as one that represents a demarcation in the psyche: one that is not just a threat to our sense of self-hood but also to our humanity. Autoimmunity exposes the challenge imposed on the relating of the self to one's own self and hence is an ontological challenge. The breach of the boundary between self and not-self that is caused by the autoimmune process culminates in feelings of alienation. Autoimmune diseases (sometimes called connective tissue diseases) refer to a collection of chronic illnesses wherein normal tissues are misidentified by the endogenous immune system as 'foreign'. In these conditions, organ damage may occur as a consequence of the body 'attacking itself. Famous examples of autoimmune diseases include rheumatoid arthritis, systemic lupus erythema-tosus and type I diabetes mellitus. Because there is no cure for these types of diseases, chronic pain and debility may ensue. Independent functioning may be threatened. This essay analyses an underappreciated aspect to the psychological despair that may accompany the lived experience of autoimmunity.