- Self-Management as Socially Embedded Endeavor
When we first anticipated the research project concluded with this special issue, about 8 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 coronavirus disease-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 should not 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 article 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 articles display the conceptualization of this ambiguity along five different dimensions of “the self”: responsible agency, experiential subjectivity, personal integrity, narrative authority and existential concern.
The Shift Toward Embedded Facilitation
Strijbos and Slors (2020) make an interesting distinction between management-as-control and management-as-facilitation. They use the etymology of the verb “to manage”—derived from the Italian verb “maneggiare,” which means the capacity to direct or exercise a horse—to point out an interesting difference between driving a [End Page 425] car and driving a herd of cattle. The behavior of a herd is, as they emphasize, “dynamically complex, responsive to several external and internal factors …, and therefore heavily context-dependent.” (Strijbos & Slors, 2020, p. 361). To manage a herd, to drive it through a terrain is therefore not simply a matter of directly and explicitly controlling the herd’s behavior. It is rather a matter of using one’s knowledge of the terrain and one’s knowledge of how the herd responds to salient features of the terrain to drive the herd by manipulating the saliency of those features. This is much more indirect than driving a car. To drive a car you need to be in the driver’s seat from where you can push and pull the wheel and the pedals which will mechanically bring it about that the car will go wherever you want it to go. The design of the car will allow you to use the linear causality of the car’s mechanism to control its movements. But such straightforward causal control of the herd’s behavior is not available. To manage a herd, Strijbos and Slors argue, requires a different kind of management. They call it management-by-facilitation, because the kind of activity you can undertake to manage a herd, to drive it in the direction you want it to go, is a matter of facilitating the herd to respond appropriately to the environmental cues you manipulate.
Self-management can take both forms. It can be a matter of control, a matter of being in the driver’s seat, as in the case of...