On Becoming Managed: Managed Care Enters a Psychoanalytic Treatment

Ralph Nader's study group on the baby food industry wrote in their report (cited in Miller [1994]):

Originally, baby food jars contained the meat, fruit or vegetable described on the label. As the cost of these real ingredients increased, some of the nutritious ingredients were replaced by less expensive starches and sugars. Salt and monosodium glutamate were added to make the food more appealing to mothers, who tested the taste for their babies. Then it was discovered that if some of the baby's saliva was transferred by the spoon to the contents of the baby food jar, the saliva digested the starch and turned it to water. The baby food company solved this problem by using a starch that could not be digested by saliva, even though some experts pointed out that a baby's digestive system was not capable of fully digesting the new starch. The result was a product that was called food and looked and tasted like food [pp. 15-16].

We could ask, “But was it?” Dr. Miller goes on to make the comparison with what managed care has done with outpatient mental health. In this paper, I shall describe the impact of managed care intrusions on an analytic treatment and ask the reader to judge whether what