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Abstract This paper puts forward the proposition that modern self-help organizations are the progeny of an uneasy relationship between two ideologies: individualism and collectivism. Within this relationship individualism is the dominant partner. Using a case-study I examine the way in which these ideological influences can be seen to take concrete form in the history and activities of the National Ankylosing Spondylitis Society. I argue that certain characteristics of ankylosing spondylitis itself make it particularly amenable to self-help, but that under pressure from various social and cultural forces this tends to take the form of an emphasis on individual self-reliance rather than mutual aid. This tendency makes it difficult for the Society to respond in a meaningful way to social aspects of disablement. Although these interpretations are necessarily provisional, the paper concludes by suggesting that the tensions and equivocations revealed by the analysis have more general relevance to self-help groups, particularly those which are condition-specific and rely, to some extent, on the patronage of doctors and other health professionals.