Selbstsorge: Ausgangspunkt eines Konzepts leiborientierter Gesundheitsförderung für Erwachsene mit einer seelischen Erkrankung/Behinderung in sozialpsychiatrischen Settings – eine explorative Untersuchung

Over the past decades health has become a central factor in the social political discourse. Not only for that reason has the subject health gained in significance in social-psychiatric contexts where the question of health promotion is playing an ever increasing role. The present study examines under which theoretical prerequisites and references a body orientated concept of individual related health promotion for adults with a mental illness or disability can be formulated in social-psychiatric settings. A suitable point of departure for this undertaking is provided by personal care of the self. The main focus of attention is to answer the question how health promotion of a category of persons which has already been “defined” by the therapeutic paradigm can be backed up from a theoretical standpoint. Initially, with regard to a systematic basis of health promotional pedagogical work various theories of corporeality (“Leiblichkeit”) will be illustrated. According to these, the living body is regarded as an existential and also a fundamental provider of meaning for human beings. Further, a meaning orientated position from an anthropological perspective will be considered. Then, concepts of mental illness will be presented which question, on the one hand, a reductive bio-chemical model of illness and, on the other, place the pathological process in a larger context. This is done with recourse to, for example, phenomenological-anthropological psychiatry or by way of selected psychoanalytical approaches. Complementing this, theoretical views of health will be developed which categorically renounce the polarization of illness and health, i.e. a definition of health as the mere absence of disease. For instance, historical concepts of health as well as approaches by the recovery movement will be outlined. Thereupon, the study takes a closer look at the subject areas self and self-care. With regard to a conceptualization of self-care appropriate to the addressees, first of all, considerations follow with respect to which of these terms from antiquity or contemporary times can be drawn upon. In this context also supplementary points of view will be inquired into. This is achieved inter alia by finding a definition of self-care which is not accentuated in a one dimensional rational manner. Furthermore, models of the self will be analyzed with a view to their suitability for an understanding of self-care in the case of mental illness. Paramount in this regard are conceptualizations which see the self as a fundamentally in the (living) body based structure, or which demonstrate a health orientated approach. Hereafter, the study shifts its focus towards empirical research. Three casuistic studies underlying findings obtained from different documents are presented with the intention of illustrating the options for self-care in the case of a mental illness. Thereby, of primary consideration in the case analyses will be to weigh up the validity of resource orientated against pathological orientated interpretations. Finally, after a résumé of the main theoretical lines of argumentation the key results will be expounded. For example, general dimensions of self-care and approaches to self-care with respect to mental illness will be presented in detail. In addition, critical aspects, innovative content and benefits of the study will be discussed.