Four Assumptive Worlds of Psychopathy V: The World of Mental Illness
We see here one of the most important reasons why the fourth assumptive world has won the day in most societies. There is money to be made in defining psychopathology as an “illness.” Psychiatrists, psychologists and even primary care providers are willing to live with the strictures of DSM and the heavy use of psychopharmacological treatment plans if their services are being full compensated. I would suggest that there is something even more powerful operating: when money is involved there is a strong tendency to try restriction of trade.
Much as American physicians in the early 20th Century were able to significantly increase their own income by reducing the number of men and women (especially woman) providing medical services, so it is now tempting to restrict the number of “mental health” providers who can receive third party compensation for their services. We find the extensive use of “panels” in North American mental health plans: only certain mental health providers are eligible to be reimbursed for their services. In other countries, the government agencies providing compensation or direct services sets up strict standards regarding who can and cannot be compensated or even provide services.
The restrictions imposed in early 20th Century America resulted in the homogenization of American medicine—through the death of most nontraditional (homeopathic) medical training centers and the termination of most nontraditional medical practices. Medical schools that admitted women or racial minorities were also put out of business. As a result, American medicine was provided exclusively by white men who were trained in traditional, allopathic medicine. Only a scattering of nontraditional medical practices (such as chiropractic) were allowed to remain in business.
The same homogenization is now occurring in the treatment of psychopathology. DSM reigns supreme: a we will not in greater detail in our fifth essay, mental health providers must frame their description and diagnosis of psychopathy in DSM categories if they want to be reimbursed or (in some countries) want to stay in business. Similar, there are strict limits set on the number of psychotherapeutic sessions that can be reimbursed. This leads to the almost exclusive use of brief therapy strategies (such as cognitive-behavioral therapy: CBT) and reliance of many psychiatrists on the exclusive use of (prescribing of) psychopharmacological agents. At best, the two strategies are combined with the psychotherapist using CBT and psychiatrist using a specific medication.
This money-driven homogenization also is built on a credential restriction: mental health practitioners must be graduates of fully accredited programs (that primarily offer traditional, fourth assumptive world perspectives on psychopathy). The “outliers” and advocates of new paradigmatic perspectives might be able to practice their “witchcraft” (after all we are an “open-minded” mental health community): but they certainly should not be reimbursed by any reputable organization for this “craft.” As noted in a publication of the American Psychological Association, the world of mental health has moved from “seance to science.” Our understanding of mental health issues has progressed with the application of solid scientific findings. We are now governed by “evidence-based” mental health perspectives.