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On Being Called a Provider |
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Classic Reprints |
Karen Shore |
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It has been six years since I began speaking out against managed care (MC). From the beginning, I have focused on the industry’s use of power, and how mental health services, education, and training would be destroyed. I knew because I am a woman and a Jew, and because of my awareness as a woman and a Jew, I have always been very sensitive to the ways in which power has been and can be used, and how a determined force can overpower and even destroy anyone in its way. Jerry Rubin, one of the “Chicago Seven” charged with “instigating a riot” outside the Democratic National Convention in 1968 to protest the war in Vietnam, once said: “The power to define the situation is the ultimate power.” The managed care industry is now defining mental health care, and the education and training of new psychologists are following the industry’s definition. As a psychologist in the V.A., I interview applicants for psychology internships. They are increasingly focused on “techniques,” research, neuropsychology, and on “being marketable.” Few speak of psychodynamics, of understanding their patient, or of forming therapeutic alliances with patients. Several of our interns now come from graduate school never having spent more than 12 or 15 sessions with any one patient, and they haven’t the faintest idea what to do beyond that. Graduate schools are changing their programs and faculty to “prepare students for the marketplace,” rather than for the real needs of the real people who will seek psychological care in the future. Our work and our training are being defined by the MC industry. A recent discussion on a professional e-mail list focused on the question of whether or not it matters that the managed care industry refers to clinicians as “providers.” After all, one psychologist wondered, isn’t a rose still a rose? And doesn’t it smell as sweet regardless of what it is called? In reality, a rose will smell as sweet regardless of what it is called because the rose is not affected by whatever name people choose to call it. The rose doesn’t hear, doesn’t know the meaning of the words, and doesn’t change its fragrance depending on what we choose to call it. Its self-concept, so to speak, does not change. We know all too well, though, that language and words greatly affect how people think about self and others. Words can so easily lead us to objectify others and hurt them. When Hitler popularized the notion of “the Jewish Problem,” he removed the subjectivity of Jews as sensate human beings, making it easier to see the Jewish people objectively as an economic “Problem” that required a “Solution.” The language of MC represents the dominance of the impersonal industrial culture in health care, a culture that has begun to eradicate the humanitarian culture to which we held. It is no accident that the MC industry uses the term “behavioral health care” rather than “mental health care,” and focuses on “functioning” rather than on the totality of a person’s behaviors, thoughts, feelings, dreams, memories, attitudes, capacity for relatedness, fears, hopes, and potentials for satisfaction and happiness. It is also no accident that the MC industry calls us and our colleagues from other disciplines “providers” rather than “clinicians,” “practitioners,” “professionals,” or “caretakers”. I feel a deep demoralization each time I hear one of us use the word “provider” because I know this means that that person’s mind has begun to be influenced by a dominating culture; that person has begun to accept the dominance of MC and its culture, even if he/she hates MC. And I know that his/her perceptions of self and others has, without awareness, begun to change. So, as Shakespeare asked, “What’s in a name?” First, at the very least, the word “provider” is a sterile word that does not even imply that one is a human being. After all, hospitals, laboratories, and clinics - and even the insurance and MC companies - are also now called “providers.” For that matter, AT&T is my “long distance provider,” and the manufacturers of appliances I buy tell me to contact my “service provider” if it breaks. The old words “professional,” “clinician,” “practitioner,” and “caregiver” all have a respectful and descriptive meaning that makes it clear that we are speaking of a human -- a person -- who gives care to another person. The word “provider” is used to blur the distinction between people and things, to rub away individuality, humanity, and professional identity and integrity from the minds of patients, lawmakers, and employers, as well as the minds of clinicians, themselves. Second, the use of the word “provider” leads others to see all those who give care as “interchangeable parts.” It becomes easier to think that any “provider” can deliver any “product” or perform any “service.” Consumers may become less apt in the future to ask for a social worker, a psychologist, a psychiatrist. One will ask for a “provider” and will be assigned a “provider,” with the covert implication that each “provider” is equivalent to and interchangeable with every other “provider.” Still, some may not yet understand why there should be any great protest. After all, clinicians do “provide” health care, so why not call them “providers?” Well, flutists, clarinetists, harpists, Yo Yo Ma, Yitzhak Perlman, members of the Boston Symphony Orchestra all “provide” music. Why not call them “music providers?” Together, actors, singers, musicians, painters, sculptors, ballerinas, could all be called “art providers!” Could you imagine their protest! The de-humanizing and de-professionalizing nature of the label would be so crystal clear, and we would all support their protest. So why aren’t you protesting your new name? MC industry leaders want us to forget our origins, too. But do you want to forget that you are “psychologists” and “psychotherapists?” Do you want to call yourselves “providers” and deliver a “product” to “customers?” Do you want to “partner” with the very people who have hurt your patients and who have oppressed you, demeaned you, destroyed your independence, and who are removing the intimacy and the personal meaning from your work? No, a rose isn’t just a rose regardless of what it is called if the rose is capable of being affected by what it is called. Language influences attitude and behavior toward self and others, and it can be used purposefully and manipulatively. Re-naming a class of people has to do with power. MC has re-named us. We must take this as a warning, and as a further indication of who they are characterologically and what they have in mind for us. We must rebel and overthrow the control of the industrialists and their corporate, bureaucratic culture. Further, we must do more than rebel. We must work to create alternative systems of insurance so that we can replace managed care. Clarence Darrow once said: “As long as the world shall last there will be wrongs, and if no man objected and no man rebelled, those wrongs would last forever.” You must rebel and encourage the development of alternatives to MC so we can replace it with a more pro-patient, pro-quality system. Along the way to replacing managed care, I implore you to raise the consciousness of anyone who uses the, word “provider.” The names “psychologist,” “psychotherapist,” “psychoanalyst,” “practitioner,” “clinician,” and “caregiver” are perfectly good words - descriptive, inclusive, and they have meaning. These are the only words I accept for my professional self. These words connote that I am a person, and not a company, a facility, or an organization. The words connote that I provide a human service to other human beings and that I have been specially trained in and by a profession I love. Let us all stand together and defeat MC so we can take back the power to define psychology. |
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