Authenticity has recently emerged as an important issue in discussions of mental disorder. We show, on the basis of personal accounts and empirical studies, that many people with psychological disorders are preoccupied with questions of authenticity. Most of the data considered in this paper are from studies of people with bipolar disorder and anorexia nervosa. We distinguish the various ways in which these people view the relationship between the disorder and their sense of their authentic self. We discuss the principal modern ac- counts of authenticity within the analytic philosophical tradition. We argue that accounts based on autonomous, or wholehearted, endorsement of personal characteris- tics fail to provide an adequate analysis of authenticity in the context of mental disorder. Signiﬁcant elements of true self accounts of authenticity are required. The concept of authenticity is a basic one that can be of particular value, in the context of self-development, to people with mental disorder and to others experiencing substantial inner conﬂict.Erler argues
Authenticity has recently emerged as an issue in bioethics principally in two settings: discussions around enhancement and with reference to mental disorder. One issue that is being much debated is whether some methods of enhancement, for example, using drugs, result in the person becoming inauthentic and are for that reason morally problematic (e.g., see Elliott 1998; DeGrazia 2000). In the setting of mental disorder, people with a disorder, and those around them, may seek to distinguish between the authentic and inauthentic characteristics of the person. Some parents of children with attention deﬁcit hyperactivity disorder (ADHD) are concerned with the issue of when medication helps to ‘reveal’ and when it obscures their child’s authentic character (Singh 2005, 2007). Some people with anorexia nervosa come to see aspects of their personality associated with the anorexia as inauthentic (Hope et al. 2011). Karp reports that many people with bipolar disorder ask themselves: “If I experience X, is it because of the illness, the medication, or is it ‘just me’?” (Karp 2006, 119). In both settings, the relevant authenticity is of human psychological characteristics that, in some contexts, refers to the self as a whole and in others to speciﬁc aspects of the self, such as decisions, desires, emotions, and behavior. We use the term ‘authenticity’ to apply to any or all such phenomena, depending on context.
In this paper, we argue, on the basis of personal accounts and empirical studies, that many people with mental disorder ﬁnd the issue of authenticity signiﬁcant particularly in the context of self-development. We distinguish the various ways in which people with mental disorder view the relationships between the disorder and their sense of their authentic self. We go on to discuss why the experience of mental disorder gives rise to questions about authenticity. We then outline the three principal modern accounts of authenticity within the analytic tradition. We consider how these accounts relate to the uses made of the concept of authenticity in the cases we discuss. We argue that only those accounts that give prominence to the idea that there is a ‘true self’ to be discovered provide an adequate analysis of the majority of ways in which those with mental disorder use the concept of authenticity. We argue that the concerns about authenticity are distinct from concerns about best interests and autonomy. Finally, we consider the normative implications of considerations of authenticity in the context of mental disorder (and further contexts). Although the concept of authenticity in the context of mental disorder is mainly of value for prudential reasons, it can also have moral implications.