I am not sure how much interest others will have in this topic, so I will
try to keep it brief at this point. The recent accounts of how pervasive
and accepted surveillance is in our time brings to mind an area of
particular concern to me. I am a psychologist who practices psychotherapy,
and the burgeoning of managed care has had a tremendous impact on how
psychotherapists deliver their services. Reading Discipline and Punish, it
seemed obvious to me how managed care, especially in the arena of mental
health, functions as a disciplinary apparatus. Quite simply, managed care
makes a case of each psychotherapist who contracts with the managed care
company; data is collected on the all work delivered by that therapist,
through telephonic and written reports; and this information is stored in
computer data bases. This information provides a basis to examine each
therapist to insure that they are functioning within the predetermined norm
(e.g., prevalence of certain diagnoses, theoretical orientation, number of
sessions per case, fees, etc.), and further education can be suggested, if a
therapist is seen as falling outside of what is expected. Behavioral
managed care can be thought of as the industrialization of psychotherapy
into a nationwide service delivery system in which a single uniform product
is to be provided. (MacTherapy anyone?)
What I find interesting and ironic in all this is how the very disciplinary
processes that the human sciences grew up with are now being turned upon
these fields, themselves (the disciplining of the mental health
disciplines). I think this may have something to do with the curious
ambivalence and uncertainty within the professions as to how to respond to
managed care. On some level, it seems all to familiar; thus, it is spoken
of as if it is inevitable or perhaps something to be further regulated in
its turn (supervisors perpetually supervised). I'll leave it at this for
now. I could certainly go into more detail, but I would prefer to respond to
someone's particular interest before doing so.
John Sproule
Knoxville, TN
try to keep it brief at this point. The recent accounts of how pervasive
and accepted surveillance is in our time brings to mind an area of
particular concern to me. I am a psychologist who practices psychotherapy,
and the burgeoning of managed care has had a tremendous impact on how
psychotherapists deliver their services. Reading Discipline and Punish, it
seemed obvious to me how managed care, especially in the arena of mental
health, functions as a disciplinary apparatus. Quite simply, managed care
makes a case of each psychotherapist who contracts with the managed care
company; data is collected on the all work delivered by that therapist,
through telephonic and written reports; and this information is stored in
computer data bases. This information provides a basis to examine each
therapist to insure that they are functioning within the predetermined norm
(e.g., prevalence of certain diagnoses, theoretical orientation, number of
sessions per case, fees, etc.), and further education can be suggested, if a
therapist is seen as falling outside of what is expected. Behavioral
managed care can be thought of as the industrialization of psychotherapy
into a nationwide service delivery system in which a single uniform product
is to be provided. (MacTherapy anyone?)
What I find interesting and ironic in all this is how the very disciplinary
processes that the human sciences grew up with are now being turned upon
these fields, themselves (the disciplining of the mental health
disciplines). I think this may have something to do with the curious
ambivalence and uncertainty within the professions as to how to respond to
managed care. On some level, it seems all to familiar; thus, it is spoken
of as if it is inevitable or perhaps something to be further regulated in
its turn (supervisors perpetually supervised). I'll leave it at this for
now. I could certainly go into more detail, but I would prefer to respond to
someone's particular interest before doing so.
John Sproule
Knoxville, TN