Abstract

The discourse of managed mental health care, in the form of training manuals, treatment guidelines, professional commentary and administrative, business and policy publications produced in response to or reaction against the emergence of managed mental health care were studied hermeneutically in order to understand the ideological assumptions, rhetorical strategies and treatment practices commonly used in managed mental health care settings. The practices and effects of managed care regulations on the self were interpreted by studying how the patient, the therapist, and the therapeutic relationship were conceptualized in managed care settings. The ideology of accountability, and specific value-based assumptions that underlie it, such as efficiency, objectivity, standardization, and calculability, were found to contribute to the emergence of a configuration of self that is psychologically uncomplicated and more rational than in earlier descriptions. Moreover, it was found that this configuration of self embodied values and moral understandings accorded greater importance in conntemporary American society. Healing practices in managed mental health care settings emphasized short-term treatments, rapid assessment of patient difficulty, symptom amelioration, neurobiological intervention, and understandings of psychological problems that were inherently reductive. Patient problems were thought to be resolved by the identification and attainment of clearly stated, behavioral goals for treatment. Consequently, the configuration of self brought to light through these practices was thought to be less emotional and conflicted, more rational, efficient, autonomous, and cognitively masterful than in prior configurations. Psychological problems of a moral nature---such as those pertaining to character, personal identity, meaning, mortality, and personal striving were not thought to be constitutive of psychological illness as defined by managed care. ;This study concludes that in a fast-paced society where time is at an ever-increasing premium on account of technological change and economic competition, the healing practices utilized by managed systems of care reflect and thus reproduce elements of contemporary life that are in part constitutive of many forms of psychological distress. Therefore, these practices and the cultural values that underlie them cannot function as the means to their cure.