I've got pretty bad akrasia. I want to do things, but then I do other things. Intuitively, I feel like I'm me, and I'm in control.

Rationally, not so much. Rationally speaking the answer to "Am I in control?" depends a lot on how broad you define "I". Is my rational mind in control? No way. Is my brain as a whole in control? Yeah, mostly.

Do excuses automatically pop up when I avoid work? Definitely. "I wanted to relax." "I got distracted." "I hate working." Having some rationality allows me to see through them though, which I presume puts me in the "someone more qualified than a random patient" category you mention.

I'm not sure if this is exactly what Yvain is referring to, I just want to shine a light on the matter from a different angle.