ABSTRACT

This chapter proposes a concept of the self which offers dignity and respect to all patients in primary health care. It begins with the coherent and engaged self, persons with the capacity to lead our own lives and find meaning in our engagement with the world around us. This concept helps us to make sense of the experience of depression and is widely useful, particularly in relation to patients with long term conditions, as a basis for shared decision-making and self-management. However not all patients have agency, the capacity to lead their own lives, or fit formal definitions of the person, for example those with advanced dementia. Making distinctions between the person and the self, and then between self-experience and self-essence, I argue that all humans have self-experience, with continuity of consciousness and perhaps intentional entity. I then consider varieties of self-essence, including minimal embodied self, multiple selves, social or distributed self and no self. I conclude that the concept of the coherent and engaged self is valuable, with self-experience and sociality as its elemental forms. It offers a basis for medical encounters with patients with reduced capacity, and for understanding how disease is enacted.