Self-management as management of the self Future directions for healthcare and the promotion of mental health

In lieu of an abstract, here is a brief excerpt of the content: In a recent attempt to update the 1948 World Health Organization definition of health as a state of complete well-being and absence of disease, it has now been proposed to change its emphasis to the ability to adapt and self manage in the face of social, physical and emotional challenges (Huber et al., 2011). The question how we should conceptualize such self-management, however, is rarely raised and its theoretical foundations remain largely unexplained. Still, to an increasing extent, scholars, health professionals, researchers, caretakers and policy makers emphasize the great potential of self-management strategies in somatic as well as mental healthcare. Patients, so the argument runs, should not be treated merely as objects of diagnosis and treatment, but as "expert clients", actively involved in the management of their own care. The advantages of this approach are considered twofold: it holds the prospect of more efficient and (cost)effective preventive and care strategies to promote mental health and well-being, and converges with recent research findings which acknowledge that incorporating the patients' subjective perspectives is beneficial to treatment progress. At the same time, it is clear that self-management in the context of mental healthcare poses profoundly challenging problems (Van Geelen, 2013; Van Geelen, 2014), as we need to take into account that it is often "the self" that is part and parcel of the problem in psychiatric and psychosomatic conditions (Kyrios et al., 2015; Santhouse, 2008; Sadler, 2007). In the context of mental healthcare, then, self-management confronts us with fundamental questions: what is our understanding of this self in psychosomatic and psychiatric settings, and how does that understanding, directly or indirectly, affect diagnoses, treatment plans and nosology in the fields of psychopathology and psychosomatic medicine? Answering such questions will also be of vital importance to a theoretically sound and practically relevant, implementable notion of self-management. Given the complexity of this subject matter, addressing such [End Page 179] problems requires an interdisciplinary approach, as we have argued in the introduction (Van Geelen & Franssen, 2017). A conceptual framework for self-management should integrate insights from a variety of disciplines, as it needs to acknowledge the multifaceted character of self-experience – with all its embodied, affective, cognitive, moral and social complexities. It is imperative, in other words, that insights in the structure and characteristics of self and self-experience as developed in humanities traditions – i.e., phenomenology, philosophy of mind and action, ethics, narrative theory – are brought into a dialogue with results obtained in psychiatric and psychosomatic research and practice.