What kind of “management” is self-management? A two-dimensional approach to self-management in mental health care

Abstract

In this article, we propose a two-dimensional analysis of self-management in mental health care. The first dimension pertains to the object of self-manage-ment. Some conditions to be managed directly affect a person’s agential capacities and sense of self. Such conditions are “proximal-to-self.” Other conditions, by contrast, are more “distal-to-self” in that they do not directly affect a person’s sense of self. The second dimension represents the process of self-management. Here we will distinguish between management as “control over” versus management as “facilitation of” health promoting conditions or behavior. We argue for a division of labor between management-as-control and management-as-facilitation in the self-management of (mental) illness. The two-dimensional analysis of self-management that we will propose is intended as an antidote against the naïve common-sense view of self-management as “taking conscious control over one’s health conditions.” This is a one-sided and unrealistic representation of what it means to cope with (mental) illness. The proposed analysis distinguishes four types of self-management intervention, which can be combined in diverse ways. Hence, we argue, it can serve as a tool for determining realistic, person-specific and context-sensitive self-management interventions. Thus, it may also help to reduce (self-) stigmatization and foster a realistic understanding of empowerment.