I have been fighting for patient choice, privacy, and control and organizing against managed care (MC) for eight years now. I have had the joy of meeting many wonderful, passionate people and of knowing that our work has had an impact. Early on, though, when I began saying that MC was a system of corporate dictatorships, many of our colleagues called me a lot of names. I was called a “radical,” a “loose cannon,” and a “crazy woman” because others couldn't yet see the dangers that I foresaw. It was only later that people began asking me “How did you know?” Also, these past eight years required a great deal of personal sacrifice. Thus, the American's recognition is so very meaningful and appreciated.
Psychoanalysis is alive, but it should be flourishing. And it would be, were it not for MC. In 1992, a training analyst told me of a chilling meeting he had had with a former student who was now involved in building the MC industry. When the analyst expressed concern for the future of psychoanalysis under MC, his former student told him straight out “we will kill psychoanalysis.”
Also a danger to psychoanalysis and psychodynamic therapy are the rigid empiricists, for they make more sense to bureaucrats, lawmakers, policymakers, and employers than we do.
How bad could it get? I have seen single-payer proposals that specifically exclude psychoanalysis and psychodynamic therapy because they are not among the “empirically validated” therapies. One well-known and potentially influential scientist-practitioner recently wrote me saying that it should be considered malpractice to use psychoanalysis for disorders shown to improve with brief treatment.
“We all need to help solve the MC problem — not just for our practices, but for our families, our communities, and our nation. We need to build a new system based on the ethics of patients and caring professionals. The goal of a [U.S.] health care system should be to ensure that the United States is a mentally and physically healthy nation. An industrial, authoritarian model cannot achieve this.”
MC must be brought to an end and replaced. We must stop our training programs from “training students for the marketplace” and have them return to training students to meet the real and complex needs of the real and complex people who will seek their help. And we must prevail over the scientists in our professional communities whose focus is too narrow to measure that which makes us truly human.
We all need to help solve the MC problem — not just for our practices, but for our families, our communities, and our nation. We need to build a new system based on the ethics of patients and caring professionals. The goal of a [U.S.] health care system should be to ensure that the United States is a mentally and physically healthy nation. An industrial, authoritarian model cannot achieve this.
Regulation of MC is not enough, for MC is run by bullies. You cannot simply regulate bullies and let them stay in power, hoping they will act honorably. Bullying is in their character, and they will always tend toward bullying whenever they think they can get away with it. I hope you will help the National Coalition and the American remove the bullies from power. You count, and you are very needed as part of the solution.
My sincere thanks to you and to the American for awarding me with honorary membership. It is a long way to have come from the days when people were calling me names for saying such things as I said here today. I thank you very, very much.