"Delusions" of Identity

After reading an NYT article earlier this month about identity disorders,I've become interested in explanations for how the "self" comes to be a self, and amazed at how that sense of self can be disrupted. I recommend a new book by Todd E. Feinberg called From Axons to Identity about the different type of identity problems, and explores what these teach us about normal identity.

The more I think about these things, the more I am fascinated by what the brain and the mind do. But also, I confront the basic awareness that identity cannot really be explained or even defined. What we think of as ourselves is it is really just an idea based on familiarity, habit, and what we learn from those around us. The fact that my "identity" can think about this is even stranger. (This is why I put "delusion" in quotes in the title - since healthy identity is itself a delusion, as we can say about these disorders are that they stray from common wisdom, and probably cause challenges in interacting with the world around us.

A good example is a recent news story (discussed, in brief, here and here) about a man with body integrity identity disorder - he believed that his foot was a foreign object. No one would amputate it for him, so he stuck it in dry ice until it was so damaged that they had to cut it off. Now, he reports to be very pleased. His wife reports that their relationship has improved.

This story makes us consider what it would be like to believe that a limb attached to us is not ours. In what essential way is this different from believing that our hair can be cut, or that an artificial limb that performs the same functions as a leg is not a part of our body? Thinking broadly, this raises the question of what it mean to think that we are our bodies, and we end where our bodies end.

Thinking clinically (this is supposed to be about social work, after all), I could not help wondering what I would do if I was working with this family or individual as a therapist, pre- or post-operation, besides refer him to a neurologist. Could it have helped to explore his psychic history, or is this simply an issue of neuronal malfunction?

He is very happy that his alien limb is gone, and appears to have no psychiatric symptoms. Is there any reason to discuss the leg or to challenge him about it? What does his wife think about all of this? How do we explain it to their children?

I don't know, but my simple, basic conclusion (which summarizes a lot of what I see in the world) is: People are strange and amazing.