This isn’t necessarily an approach I pursue and I sometimes even flagrantly disregard it, but I do find it very interesting. A chronic illness, physical or mental, is commonly thought of as something that requires management. It can’t be cured, so you have to deal with it permanently, and you want to optimise the way you deal with it in order to optimise your quality of life. This is the basic idea as I understand it. That involves different kinds of decisions. For example, in the case of OCD, over the medium term, you might need to decide to pursue a specific treatment plan which combines medication and psychotherapy. Over the long term, you might decide to pursue a career that is minimally stressful. On a day to day basis, you might consciously choose to pace yourself so you don’t become so tired that your symptoms flare up, if your symptoms flare up when you’re tired. As everyone is different, everyone’s management plan will be different. Someone who values their stressful career highly may need to manage their condition through stricter day-to-day management. Someone who doesn’t wish to take medication may need to pursue psychotherapy over a longer period.
Logical though it sounds, in practice it can be tricky. Managing physical pain is something you do quite instinctively. If your arm hurts when you move it a certain way, you avoid moving it that way and you avoid participating in activities that might call for that arm movement. Mental illnesses, and plenty of physical illnesses, don’t give you that kind of instant feedback to guide your management plan. You have to learn by trial and error what works and what doesn’t and with infinite factors affecting you at any one time, establishing what’s what and achieving that optimal management can take a lifetime or more. You learn gradually how much work you can take on without it leading to a crisis. You learn gradually what signs indicate that a crisis is brewing and alter your how daily management strategies when they arise to avoid reaching that crisis point.
In some ways, the idea of managing a chronic mental illness provokes a bad reaction in me. I have learnt to make last minute decisions according to which way the wind blows and to have faith that what is meant to be will be. I like to live my life that way, even if it often doesn’t work out well. This seems quite incompatible with a sensible management strategy. I also disagree with the idea of accepting that mental illness imposes limitations. I don’t want to mark mental illness out as something special in that sense, because it isn’t. Everybody has limitations of their own and decisions to make with regards to that. However, in the case of non-mental illness, I think many would recognise there is a lot to be said for refusing to accept limitations. On the other hand, perhaps because of OCD, I like the idea of adopting a management strategy as part of my ritualistic ways and so on some level the idea of management also appeals. It promises the kind of routine and protocol that I enjoy working within. If I could adopt management of my condition as a ritualistic thing in a healthy way, that could be quite powerful.
There should be a conclusion to this but I’m not sure what it is, because I have an internal conflict. The side that is winning out right now is probably the side that thinks management is silly. As I’m feeling reckless, I would rather go with the flow and take the repercussions than be sensible.
