Managed care is taking control of mental health and is creating demands upon psychology's world of ideas. Psychological ideas are being gagged and tied by the emerging romance between professionally minded psychologists and their courtiers, the profit oriented managed care industry. In an effort to control costs, managed care is controlling the way therapy is practiced, emphasizing inexpensive and simple approaches to the psyche. As psychologists struggle to establish professional status in a competitive field, they are willingly agreeing to align their ideas and therapeutic techniques with the employment criteria of managed care. As a result, the job of the psychologist has become doing the public relations work of maintaining managed care's personas of scientific objectivity and therapeutic effectiveness, and in exchange they receive a slice of upper class pie.
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Managed Care has moved in and is making decisions as to what is science and what is quackery in the field of mental health. The "science" of effectiveness has become an afterthought, a rhetorical technique to justify the profession of healing being governed by managed care's want for profit. A parallel to this occurs in the medical profession. Ten years ago the art of chiropractic was continually criticized by the medical profession as being unscientific and ineffectual. Now, however, under the umbrella of managed care chiropractors have a new life as their services are seen as inexpensive alternatives to costly surgical solutions to chronic back problems. An even more extreme example of this occurs with acupuncture which until very recently was considered a voodoo practice from old-world China. Kaiser Permamente, however, in reaction to the competitive cost cutting atmosphere of the medical industry, has recently begun employing such practitioners and is aggressively exploring "alternative" medical approaches.
The point here is that it is irrelevant whether acupuncture and chiropractic are effective. What is relevant is how these treatments effect the finances of the governing economic bodies. When doctors were in control of the medical profession, they stood to lose money if the populous viewed these practices as anything but quackery. Yet, now, as the economic dominus has shifted to insurance companies, the once ruling doctor is a costly expense, making a demand for less expensive and less professional options. Techniques of psychotherapy have traditionally been chosen by psychoanalysts and similar practitioners who had a vested interest in job securing, long term therapies. Today, however, managed care is taking control of mental health and their investment is in inexpensive, short term therapies.
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Marx writes that the ruling class, the class that controls resources and capital, also controls ideas. His belief is that even though people may think ideas to be the result of science, intuition, common sense, or revelation, ideas can actually be traced to historical and cultural currents which serve to reinforce and continue class structures. This old and simple analyses of the world of ideas is very visible today in the politics of managed care and their psychologist. The psychologist's job is to produce and maintain ideas which are congruent with the mental health political apparatus. The shadow here is that there is nothing scientific nor original in the origin of the professional's ideas. The ideas themselves are mere puppets pulled by the capital controlling class, serving their self protecting needs.
For Marx, however, there is nothing new about managed care's control of ideas. Academia has well served this need since its inception. Money to the professional, professionalism to the educated, education to those with money. The only change is that managed care is now in direct charge of psychological ideas. The academic middleman is no longer the primary controller of ideas. Academia still has a role as an upper class filtration device, keeping the controlling class's population down, but the world of ideas is no longer theirs. Marx would have us believe that academia and science have never been in control. Capital interests have always led the way. With managed care, the psychologist is confronted with the reality of who is in charge of the ideas of their profession. Ultimately the psychologist must choose between the control of their own ideas and professionalism.
As an elder in the field of psychology, Nicholas Cummings does a fine job of educating the psychologist, aspiring for success, of the revolutionary changes that are occurring in the field of mental health. He, however, is dry of any other fantasy of the psychologist's role beside that of the technical P. R. man for managed care. Where is the calling to science with its mythic methodology for discerning truth in the world? Where is the alchemical doctor's fantasy of transforming that which is ill into that which is well? Vacant is the psychotherapist's dream of helping his fellow woman. Omitted is the valuation of healing. Cummings suggest's that the psychologist fall asleep in her pursuit of professional status and let herself be carried away in the arms of insurance companies and their plans for profit.
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