I used to lead a six-week self-management program for people with chronic conditions at a Kaiser Permanente hospital. Iris was 60 years old when she came to one of these classes. She was a short woman with straight black hair and glasses, who walked slowly with a cane in her left hand. Iris had high blood pressure and Type 2 diabetes, and two and a half years before, she had had a stroke. Since then, she had mostly been moping around, not doing much of anything.