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At the intersection of self and not-self: finding the locus of ‘self’ in autoimmunity
  1. James David Katz
  1. Correspondence to Dr James David Katz, NIAMS, National Institutes of Health Clinical Center, Bethesda, MD 20814, Maryland, USA; james.katz{at}


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.

  • immunology
  • psychology
  • philosophy of medicine/health care
  • rheumatology

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  • Contributors JDK is the sole contributor.

  • Funding This study was supported in part by the Intramural Research Program of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.