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In his article, “Jihad, McWorld and Enactment in the Postmodern Mental Health World,” Dr. Plakun adds an overall theoretical framework that is useful to us as mental health practioneers. As dynamic psychiatrists and psychoanalysts, we tend to practice in the “Jihad,” as opposed to the “McWorld.” Our tendency to focus on the world of one, to help that individual understand the inner and outer worlds that shape the patient's existence, forces us to respect and cherish that practice. We all must understand the inner and outer experience of all our patients and as individuals must have a firm grasp of what is “happening” in the world around us.
This article has special significance, especially after the tragedy of September 11, 2001. It gives a framework for us as therapists and for our patients. We all share that experience. The world we live in has changed. The theoretical discussion of a changing world affords us insights that could help us understand our patients and ourselves.
However, the case discussion used to support his thesis, that if we become angry and hostile to managed care we compromise our treatment with our patients, is misguided. The case presentation is of a man who was seen three times a week for years. This was funded by his insurance company. This is not managed care as we know it.
As a member of the American Psychiatric Association's Managed Care Committee for the past five years, and as Chairman of the Connecticut Psychiatric Society's Managed Care Committee, I have seen a different managed care, one that is directly responsible for the deaths of multiple patients. Mortality should not be an outcome of utilization review (Bozzuto, 2002).
This patient, as presented by Plakun, was highly functional and received generous insurance benefits. To equate this form of “managed care” with the usual and customary is a mistake. The managed care I am familiar with is associated with the following:
A contract, is obtained with a local HMO that denies all patient