Jung At Heart

...Ramblings About Psychotherapy and Whatever Else Comes to Mind...

Man the barricades?

There is a steady undercurrent in articles here and there about what is being lost in the field of psychotherapy. People like me talk about problems with the DSM IV, with managed care, with the medicalization of mental health but we don't do much of anything.

I have long thought that the reason managed care has been able to gut psychotherapy so easily and effectively is because we do not speak with one voice. Each profession is so busy defending its turf that hardly anyone sees that the patch of ground we stand on is being made smaller and smaller. And because we have become so afraid that we will lose income if we stand against these encroachments, most of us choose instead to meekly go along. I saw it years ago when I worked in community mental health and I see it now with so many talented psychotherapists believing that their only option of they do not play the game as directed by managed care is to leave the field, to become a coach or something similar.

A recent issue of  Psychotherapy Networker underlines my concern in  Michael Ventura's article about the "Evolution of Psychotherapy" conference, sponsored by the Milton Erickson Foundation, which brought a remarkable 8,500 therapists to Anaheim, most of whom were drawn by a faculty that featured many of the profession's revered elders. He notes that the most radical ideas at the conference were presented not by young and ambitious thinkers but by old familiar ones like Thomas Szasz, James Hillman, Sal Minuchin, Jean Houston -- all of whom have been around for many years.

Think about this:

Szasz went even further. He said that therapists who submit to the protocols of managed care "are acting like government agents" because "it's the government that controls this." He accused "the entire mental health industry" of collusion with the essentially government-instigated idea of who fits in and who doesn't. In this sense, he said, "America is built on the idea of mental illness," and "there's no opposition that's visible." Then he threw out an enormous yet elegantly simple (not simplistic) question: "If you take what I've said seriously, what happens?"

Obviously what happens is, as the title of their talk stated, a "larger mission": the therapist as subverter of societal demands, the therapist as organizer, the therapist as revolutionary. Szasz and Madanes were calling on therapists to stand against pharmacology and managed care, stand against government regulation, and risk their livelihoods to achieve what Glasser had termed "a mentally healthy society...

But the audience didn't rise to its feet and cheer. It didn't vow to storm the barricades. Instead, the audience listened attentively but a bit sullenly, perhaps thinking: "That's easy for you old guys to say! Your reputations are secure. You're no longer out in the trenches earning your livelihoods." Yet no one rose up to argue with Madanes and Szasz's premises, either.

The message put forth by Madanes and Szasz was elegantly simple: submit or rebel. If you're not rebelling, you're submitting. If you're submitting, you're a collaborator in a terrible a system that endangers the mental health of your patients and your society—and you're doing it just for money. It seemed to me that, at this session's end, most listeners were only too happy to slip into the anonymity of the crowded hallways, where no one would demand of them a moral choice that they were unprepared to face.

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