of individual nurses. This perspective reinforces and privileges the ‘interiority’ perspective of Leibing. But what about the culture of the care setting, the team behaviours and practices, the style of management and leadership in operation, the resources available to do the job, and many other elements of organisations that influence our individual effectiveness? To truly be a person‐centred accountable person, we also need to operate in cultures that pay attention to these values – more on this in Chapters 3 and 4.
Self and selfhood
In thinking about how we connect with personhood, Sabat (2002) suggests that personhood is connected with different understandings of ‘self’. Rejecting the idea of the ‘loss of self’ that is dominant in dementia discourse and that implies not just a flattening of personhood but its loss, with the consequence of being labelled as a ‘non‐person’, Sabat (2002, p. 27) argues that we have three forms of self – Self 1, Self 2 and Self 3.
Self 1 is ‘the self of personal identity’ evidenced through our use of personal pronouns: ‘I’, ‘me’, ‘mine’, ‘myself’, ‘ours’ (meaning mine and yours). This self relates to our individual and unique view of the world. It expresses how we relate to our being in the world and the words we use to describe this being. It is autobiographical in nature and forms the narrative of our lives. Through Self 1, we tell the stories of our lives, and often how we tell those stories gives some indication of what is important to us. Sabat argues that a loss of words and language (such as happens with people living with dementia) does not mean a loss of self; rather, this Self 1 remains intact but the challenge is how we can enable such persons to voice their stories. Identical diagnosis and apparent severity of dementia, or other conditions, does not mean we can understand all persons in the same way.
Self 2 comprises our physical, mental and emotional attributes past and present – eye colour, height, weight, beliefs, religion, happiness, love, sadness, achievements, hobbies and so forth are all examples of Self 2. Again, these remain relatively intact with the threat of disease and illness. However, Self 2 becomes a problem when others focus on deficits and decline rather than abilities and potentials. Whilst the symptoms of a disease might impact on our physical, mental or emotional attributes, the attributes themselves do not change – what changes is how others engage with this aspect of our self.
Self 3 comprises the different social personas that we construct in different situations in which we live our lives. In different situations and contexts, a person may display very different behaviours – a highly dedicated and professional healthcare person by day and a hard party‐goer by night; a focused, targeted and ‘hard‐nosed’ manager versus a loving, sensitive and intimate partner.
Sabat argues that Self 3, the social persona, is most vulnerable when threatened by disease and illness, as it is dependent on a connection with at least one other person in our social world. Whilst this threat is obvious in a person living with dementia, we can also see the potential for loss of Self 3 in all kinds of illness situations where the autobiographical self is not considered; that is, we are concerned with treatment and cure and not with the social construction of that illness and how it threatens our personhood – something central to the argument made for a person‐centred approach to practice in many of the chapters in this book. Self 3 fits most closely with Kitwood’s ideas on personhood as social status bestowed by others (Dewing 2018).
Of course, these constructions of self can also be challenged and debated as there are a variety of ways in which Self 1–3 can change and/or be altered, and indeed the question needs to be asked, ‘are we limited to three kinds of self?’. However, Sabat's ideas demonstrate how interiority (Leibing 2008) links with Smith's (2003) ideas of culture as an important basis for understanding how our behaviours can impact on the personhood of others. Paying attention to Self 1 and 2 is therefore critical for the protection of personhood in situations where a person is vulnerable and in need of care. Sabat's expression of self resonates with Merleau‐Ponty's argument about the primacy of a ‘perceiving body’ in the world (Dewing 2012). Merleau‐Ponty argues against any idea of a mind–body split or that we are passive recipients of our history. Instead, he suggests that our knowing is always subjective as we carry through the movement in our bodies, our prehistories that we take up, inherit and transform through our being in the world. Therefore, Self 1 is ever‐present, even in the absence of rational thought.
So we could summarise by suggesting that ‘persons are persons because of their personhood’ and that this is what distinguishes human persons from non‐human persons. We are more than our body parts held together by connective tissue – we are interacting persons, guided by whilst also shaping and reshaping our being in the world through our interior and exterior conditions. Yes, persons are complex!
Activity
In our discussion of personhood, a focus on ‘values’ has been dominant. Consider your core values and what these say about you as a person.
What values did you identify as being important to you? Can you see a connection between your stated values and any of the elements of your collage (self‐portrait)? It might be that this is implicit; for example, the place you identified as important might reflect values such as family or relationships. A key learning experience might have influenced your desire to be a healthcare worker. Can you see any connections?
Persons, personhood and person‐centred practice
Having some core understandings of persons and personhood is important as you develop your healthcare practice. Knowing who you are as a person, what is important to you, what core values you hold and how these are shaped and developed through different cultures are key considerations as you develop your person‐centred practice. As you move through this book and in your day‐to‐day work, you will read about and hear different ways of understanding how persons and personhood are articulated by you and others, such as person‐centred care, family‐centred care, woman‐centred care, person‐centred practice, person‐centred culture – to name a few! The ways in which these terms are used reflect different understandings of or engagement with personhood.
Think about ‘person‐centred care’, for example – what does that term say about personhood? Does it reflect a particular set of beliefs and values? We would argue that person‐centred care privileges the personhood of the patient/service user over that of the practitioner, i.e. the focus is on ensuring that ‘what matters’ to the patient is of primary importance. What might the implications of that be for a nurse or physiotherapist, for example? If the nurse or physiotherapist were in a care situation where their values were compromised, does that matter? We would argue that a focus on person‐centred culture in healthcare, for example, ensures that the personhood of all persons is equally valued and paid attention to. Drawing on Smith's analysis, different cultural contexts shape how personhood is realised. The Person‐centred Practice Framework pays attention to these cultural issues and places something like ‘person‐centred care’ in a broader social context. This focus will be demonstrated in other chapters and in the different ways in which the framework is applied in contrasting contexts.
Conclusion
In this chapter, we have introduced you to the ideas of person and personhood. We have challenged views of persons that privilege cognitive and physical attributes as key characteristics of persons. If you are new to this debate then we realise that this can be challenging to engage with. However, as you consider your own personhood, you will see how you pay attention to other aspects of you as a person and even take these physical and cognitive perspectives for granted – they form the background to your life. As active agents in the world, we constantly evolve, change and grow and through this evolution we influence and are influenced by our interior and exterior qualities, traits and circumstances. Thus being a person is a dynamic state.