Reprinted from "Self-Management" issue of Visions Journal, 2003, 1 (18), p. 26-27
Self-management programs are based on a comprehensive knowledge about one’s condition, its treatment and medication, and based on developing ways to get and keep well in the long run in the face of life’s everyday challenges. They are an attempt to counter philosophies such as that of Elizabeth Miller’s psychiatrist who told her upon discharge from the hospital: “You will not know when you are ill; only I will be able to tell you that. You won’t know what you are feeling; only I will know.”
This article reviews the work of several authors who realized the value of a consumer-driven approach to recovery, starting with an approach developed by Miller herself. This approach stems from the premise that people should gain control over their illness by managing it responsibly.
There are four crucial components to Miller’s approach. First of all, the person needs information and a peer support network. Secondly, the individual needs to learn to recognize the warning signs and triggers of the illness, both generic and individual in character, then needs to develop a plan for the onset of symptoms in cooperation with health professionals. Finally, there is the task of maintaining good mental health overall through monitoring of one’s mood swings and symptoms, getting feedback from friends and relatives, having a healthy diet and exercise regime, as well as maintaining proper sleep patterns. As Miller says, “Not everyone wants to take responsibility for their illness, but just about everyone benefits from more information.” Willpower and perseverance help people learn more and apply the knowledge for their own benefit. For more, see www.primhe.org/downloads/ journal/vol_001 and2/miller.pdf
Manic Depression Fellowship
The Self-Management program of the Manic Depression Fellowship (in the UK) is a sixweek program of three-hour sessions led by people with bipolar disorder. In the first two weeks, participants learn to recognize the nature of their illness and what impact it has on their lives. Half way through the course, the sessions centre on learning about triggers and warning signs by keeping a mood diary. Other topics addressed at this stage include self-medication, building support networks, and making action plans. The last two week address developing a lifestyle that promotes good mental health. This involves developing personal awareness and maintaining a daily routine — just to name a few of the topics discussed. Active participation in the sessions is encouraged, and the program is accompanied by exercises that are done on an individual or group basis. Positive outcomes achieved with this approach include reduction of participants’ negative attitudes towards the past, as well as reduction of suicidal thoughts and difficulty with concentration. Participants in the program also tend to feel more in control of their illness as well as more involved in the treatment offered to them by their clinicians. For more, see www.mdf.org.uk/services/smt.html
Wellness Recovery Action Plan
Mary Copeland’s book Living without depression and manic depression is a practical workbook that shows that it is possible to live with this disorder through information, acceptance and conscious change. By gaining confidence in one’s knowledge of the disorder, and about what treatments and medications work best, the individual is able to prepare not only for a relapse situation, but also for long-term management of the illness within the person’s social networks. The workbook offers practical examples of questions to ask the doctor and things to know about conditions that might look like bipolar disorder. It also deals with issues such as the value of receiving and giving peer support, the advantages of developing a lifestyle that enhances wellness, coming to terms with the past, and getting the most out of counseling. Numerous charts offer suggestions of how to track one’s moods, how to change negative thoughts into positive ones, or what actions to take to avert a relapse.
Copeland’s concept of WRAP (Wellness Recovery Action Plan) provides a simple system for monitoring and managing emotional and psychiatric symptoms, as well as avoiding unhealthy habits or behaviour patterns. In order to arrest symptoms and hasten remission and recovery, people both learn and share personal strategies for dealing with each level of relapse. For more, see www.mentalhealthrecovery.com
All of the programs listed have a common underlying message: that it is possible to break away from the inevitability of the illness, take charge of the course of life, and to work on getting oneself out of the trenches and back into the social networks that are so valuable for the people who live with this illness.
Miller, E. (1999). “Self-management in manic depression.” Journal of Primary Care Mental Health,2
Harris, A. (2000). “Self-managing manic depression.” Mental Health Care, 31(8), 274-5.
Copeland, M.E. (1994). Living without depression and manic Depression. Oakland, CA: New Harbinger Publications.