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Individual and collective initiatives in disablement.

After setting a historical background for health care activities this paper relates the development of self-care to changes that have taken place. Relatively recent technological possibilities in medicine have altered the tensions in regard to self-care, highlighting demands for greater knowledge and the search for means of coming to terms with the existential challenge of chronic illness or disablement. The characteristics of self-help groups are discussed briefly, and problems are noted in relation to condition-specific orientation and the emphasis on personal identity and personal responsibility. Various contradictions in attitudes to self-help are also reviewed, notably those associated with the almost opposing traditions of mutual aid and individual self-sufficiency, in moral as well as economic dimensions. The ambiguous liberation provided by self-care and self-help has to be set against political attempts to promote the notion that we can all look after ourselves. Among other things, this rhetoric serves to conceal the real challenges for improvements in community care.