Self-Management as Socially Embedded Endeavor

When we first anticipated the research project concluded with this special issue, about eight years ago, it seemed timely and appropriate to investigate the opportunities and the challenges of self-management in mental health care. At the time self-management was well on the rise in general health care, offering both empowerment to patients and efficiency and cost-effectiveness to the health care system. It seemed a most promising approach in an era that celebrates individualistic self-reliance. And we were sure about our insight that self-management in mental health care would deserve comprehensive investigation because ‘the self’ that was supposed to do the management would itself be the core problem in psychiatric and psychosomatic conditions. Now that the project is over and done with some changes seemed to have happened in the general appreciation of individualism and of the dominant kind of management. As we are writing this during the COVID-19 crisis – locked up at home obeying the instruction to keep physical distance – these changes seem to accelerate. We cannot do it alone. And we shouldn’t think of self-regulation in terms of decisive control. Solidarity and entrustment markedly strike home. It may be that we have picked up the Zeitgeist in our research or have played a role ourselves in bringing about these changes. Either way, the results discussed in this issue certainly resonate with a transformation that might be in progress. In this concluding paper we want to highlight two novel features of our understanding of self-management as it turned out to find articulation in our investigations. One feature concerns a shift in our understanding of management, a shift away from decisive control towards an embedded facilitation. We can follow this shift along three lines of analysis, which concern different scaffolding resources: environmental cues, language and caregivers. The other feature concerns the acknowledgement of a potentially persistent ambiguity of the self as an element of self-management. The preceding papers display the conceptualization of this ambiguity along five different dimensions of ‘the self’: responsible agency, experiential subjectivity, personal integrity, narrative authority and existential concern