Paper short abstract:

We analyze interviews with individuals who completed a Self-Management (SM) course. SM as a mentality of governance evokes specific forms of choice that normalize subjects, elicit self-regulation with respect to managing chronic disease, and produce culpability in those who are non-conforming.

Paper long abstract:

The management of chronic disease has emerged as a priority for Western states in strategies to address increasing life expectancies and diseases that are often associated with lifestyle. Self-management (SM) programs tend to focus on the provision of information and skills to manage various conditions. This represents a potentially efficient form of health governance, with the development of individuals who control their disease through self-regulating measures that target unhealthy lifestyle (e.g., diet). Where health-related behaviours are intricately connected to the social determinants of health, and health inequities, SM policies and practices can be understood as repositioning responsibility for health from the state onto the individual.

Drawing from Foucauldian perspectives on 'governmentality' we analyze findings from interviews (N=14) with individuals living with one or many chronic disease(s) who, voluntarily, completed a SM course that focused on managing their condition. Our analysis explores how discourses relating to SM become internalized and invoke specific effects in subjects. We present three interconnected themes that relate to people's experiences of SM training around their condition: 1) The technique of confession and disclosure of risk and individual limits; 2) The "responsibilization" of the individual for self-care and health; and 3) The role of relationality within a group setting. We argue that SM as a mentality of governance evokes specific forms of desire and choice within subjects that relate to these themes. Together these techniques work to normalize subjects, elicit self-regulation with respect to the management of chronic disease, and produce culpability in those who are non-conforming.