Self-Management in Psychiatry and Psychomatic Medicine—Part 2 Marc Slors (bio) and Derek Strijbos (bio) This special issue is a follow-up on a previous issue in this journal on self-management in psychiatry and psychosomatic medicine (Van Geelen & Franssen, 2017). It is the concluding chapter of a research project that sought to unpack and develop the implications of an understanding of self-management in psychiatry and psychosomatic medicine as “management of the self.” Over the last, 20 years, self-management has gained a central place in treatment programs across various medical disciplines. It positions patients as “expert-clients,” who share knowledge, responsibilities and expertise with health professionals, and it actively involves them in the management of their own care (Crawford, Lee, May, & Active Self-Care Therapies for Pain (PACT) Working Group 2014; Kemp, 2011; Siantz & Aranda, 2017). Such an approach has been argued to have great advantages: self-management strategies promise to increase the autonomy and well-being of patients, to stimulate shared decision making, and to make healthcare delivery more efficient and more cost-effective (Greenhalgh, 2008; Newman, Steed, & Mulligan, 2004; Siantz & Aranda, 2014). Nevertheless, in psychiatry and psychosomatic medicine, the notion of self-management is somewhat paradoxical. Whereas self-management in somatic medicine is traditionally understood as “disease-management by patients” (Lorig & Holman, 2003), the same model can only be applied to mental health care if we flagrantly fail to acknowledge that problems in self-experience, autonomy, identity, and agency are often core aspects of psychiatric and psychosomatic illness. Under what conditions can these patients constructively relate to and take responsibility for their illness (Redman, 2007)? The problem is that psychiatric and psychosomatic pathologies directly pertain to the self of the persons suffering from them (Kyrios, Nelson, Ahern, Fuchs, & Parnas, 2015; Sadler, 2007; Santhouse, 2008). Hence, as argued by Van Geelen and Franssen (2017), self-management cannot simply be disease-management by the self. It should just as much consist of management of the self. But that notion—management of the self—stands in need of further development. What, exactly, is meant by “a self” in this context, and what are its features? And what kinds of interventions, for that matter, can properly be referred to with the term “management”? These are difficult questions, but a number of features are salient. Starting with the notion of “self,” one thing to note is that selves can often be seriously underdetermined; making sense of [End Page 329] oneself can be a major issue for people suffering from psychiatric and psychosomatic disorders. Selves are also dynamic; they develop and evolve. Furthermore, selves are inextricably intertwined with their sociocultural context. We understand ourselves in part by learning how others understand themselves. Societal expectations and narrative templates play an important role here. And so do attitudes of others, especially the attitudes of care givers. We should also recognize that pathologies of the self, mental illnesses, are normative notions that have complex and sometimes diffuse repercussions on attributions of responsibility—which again emphasizes the crucial role that attitudes of others play in establishing, maintaining and developing a self and hence in management of the self. As to the notion of “management,” one issue to take notice of is the growing evidence against the efficacy of conscious short-term intentions (see Strijbos & Slors). This makes it harder to simply think of management in terms of direct conscious control, that is, as “taking one’s life in one’s own hands.” Perhaps self-management should involve forms of “self-nudging,” more than self-control. To demystify the idea of management of the self, that is, to undo the paradoxical air of self-management in the context of psychiatry and psychosomatic medicine, these features of the notions of “self” and “management” should be taken into account. This, we propose, is an endeavor in which the humanities, in particular philosophy and literary studies, can be of help. The articles in this issue are all written from this perspective. They address aspects of the notions of “self” and “management” that need to be elucidated for the development of a non-paradoxical notion of self-management in mental health care to become possible. In the first article...