The (Un)managed Self: Paradoxical Forms of Agency in Self-Management of Bipolar Disorder

  • Talia WeinerEmail author


Self-management of mental illness is a therapeutic paradigm that draws on a distinctly biomedical conceptualization of the isolability of personhood from pathology. This discourse posits a stable and rational patient/consumer who can observe, anticipate, and preside over his disease through a set of learned practices. But in the case of bipolar disorder, where the rationality of the patient is called into question, the managing self is elusive, and the disease that is managed coincides with the self. While humanist critiques of the biomedical model as applied to mental illness have argued that its logic fatalistically denies patients intentionality and effectiveness (Luhrmann, Of Two Minds: The Growing Disorder in American Psychiatry, 2000), biomedical proponents claim that psychiatry’s way of envisioning the body as under the control of the intentional mind actually returns agency to the patient/consumer. Rose (The Psychiatric Gaze, 1999) remarks that biomedical models have the potential to “[open] that which was considered natural to a form of choice” (p. 37), and that techniques of medical self-control help constitute the free embodied liberal subject who is obliged to calculate and choose. Through an examination of clinical literature as well as the practices and narratives of members of a bipolar support group, this paper explores ethnographically the possibilities for subjectivity and agency that are conditioned or foreclosed by the self-management paradigm, which seems to simultaneously confer and deny rational selfhood to bipolar patients. To express their expertise as rational self-managers, patients/consumers must, paradoxically, articulate constant suspicion toward their present thoughts and emotions, and distrust of an imagined future self. I argue that through their self-management practices, bipolar support group members model provisional and distributed forms of agency based on an elusive, discontinuous, and only partially knowable or controllable self—revealing, perhaps, the limits of the contemporary reification and medicalization of both selfhood and disease.


Self-management Bipolar disorder Agency Subjectivity 



I am grateful to my brilliant advisors—Jennifer Cole, Judy Farquhar, and Eugene Raikhel—for their ongoing encouragement, support, and insight. I have also been fortunate to have many conversations about this project with Professors E. Summerson Carr, Susan Gal, Don Kulick, Bert Cohler, and Rick Shweder, who all raised challenging questions that pushed my analysis in productive directions. In addition to these University of Chicago faculty members, I would like to thank Professors Emily Martin, Nikolas Rose, Bob Desjarlais, Angela Garcia, and Barry Saunders for their generosity in taking the time to discuss my work and offer their invaluable perspectives. Furthermore, I am indebted to my wonderful colleagues in the Clinical Ethnography and Medicine, Body, and Practice Workshops, my anonymous peer reviewers, and to the members of my writing group, who patiently offered feedback on so many drafts of this article that they probably have committed portions of it to memory by now. Finally, I thank my informants for sharing their lives and teaching me so much.


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© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Comparative Human DevelopmentThe University of ChicagoChicagoUSA

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