The Chronic, Part Two....

Sue Bergeson Health Guide
  • While I was tempted to use the title of this blog to talk about marijuana and mood disorders (Wasn't that the reason behind the title of Dr. Dre's classic 1992 album of the same name?), I actually have more to say about Kate Lorig's self-management-of-chronic-conditions model. (That said, there's a really interesting article about marijuana use and increased psychosis on USA Today's website.  Since a significant number of people living with mood disorders self-medicate with alcohol and illegal substances, that article may be of interest to some.)


    I've been thinking a lot about Kate Lorig, RN, DrPH, and her book Living a Healthy Life With Chronic Conditions, and it struck me ... what she has been saying for years about how best to manage chronic conditions like cancer, diabetes, etc., is so similar to what many leaders these days are saying about managing mental illnesses with strengths-based recovery and person-centered planning.

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    I don't know about you, but when I see my doctor, he scribbles out a treatment plan that I haven't ever had the chance to see. I work aggressively with my talk therapists as well, but we have only occasionally developed a clear plan that defines what we're working on and working toward. I bet, though, if I look at my medication treatment plan, it would say something about what I want to avoid-my symptoms-and not what I want to create: a full life in the community.


    A true person-centered approach says, "Let's build a treatment plan based on what's important to the consumer. And let's build that plan with the consumer-not for the consumer." This plan should focus on what the consumer does well-not on what is wrong-and on what the consumer wants to create in his or her life. Likewise, Lorig says that those of us with chronic illnesses must become active self-managers and that our self-management needs to focus on what we want to accomplish.


    Again, I personally find it so interesting, and so refreshing, that I share this struggle with millions of other people who have completely different illnesses. It refocuses my treatment on what I want to create, not on what holds me back.


    We have a long, long, long way to go in mental health before person-centered planning is adopted, or even understood, by most health care professionals and consumers. It's not uncommon to hear tales of clinics where treatment plans are already filled out, leaving the name blank for the next new patient who walks in the door. And the goals listed on the pre-filled-out forms? "Attend all doctors' appointments" and "take all medications." Can you think of two goals that are less person-centered, less based on what we want to create in our lives? Taking all my meds may be a strategy to get me to a person-centered, recovery-oriented goal like having a meaningful job or taking my first real vacation. But no one can reasonably expect that a goal like taking my medication would ever motivate me to move forward to recovery. It begs the question about what's considered reasonable for treatment-as-usual in mental health.


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    It may be that we need to look at how cancer, diabetes and heart disease are managed to find new models of care to help us transform the mental health system ... or at least help us individually to manage our own illnesses.


    What person-centered, recovery-oriented goals would you like to establish with your doctor (e.g., maintaining a job, developing a network of friends, continuing education, etc.)?


    For more information on the Lorig model, visit:


    For more information on person-centered planning in mental health, visit:

Published On: September 12, 2007