Magazine article The Public Interest

Religion's Challenge to Psychology

Magazine article The Public Interest

Religion's Challenge to Psychology

Article excerpt

America's therapy industry - by which I mean not only the licensed counselors in all mental-health specialties but also the psychiatric hospitals where many work and the graduate schools that train them - is currently in the throes of what is undoubtedly its single greatest economic upheaval since the beginnings of professional psychology just over 100 years ago.

Government agencies and insurance companies that once offered generous coverage for psychotherapy and related mental-health procedures are suddenly becoming tightfisted. Meanwhile, the traditional therapy hierarchy that puts the nation's 45,000 psychiatrists with M.D.s at the top of the pyramid - followed by the 144,000 psychologists with Ph.D.s, then the 484,000 masters-level social workers, the 154,000 school counselors, and, finally, the 189,000 "human-service workers" (including marriage and family counselors, employee-assistance professionals, and geriatric aides) - is collapsing with the advent of new treatment structures. At the same time, the institutional domination of mental-health services by America's 1,237 psychiatric hospitals, 1,674 general hospitals with psychiatric units, and 2,232 outpatient clinics is being seriously challenged for the first time by none other than organized religion.

Although some journalists have hinted at aspects of this transformation, there is reason to believe that the cultural impact of what is happening to the economies of therapy will go beyond anything imagined by the popular press. Developments within the field of psychology have always had significant spill-over effects. The first behaviorists had a disproportionate influence on the philanthropic funding of psychological research in the early 1920s, ultimately shaping the humanities curriculum of every college and university in America. By dominating the therapeutic training of doctors, Freudians led an entire nation to focus on childhood sexuality. The success in the 1960s of social scientists in attracting federal dollars to subsidize the growth of their departments accelerated the development of Great Society programs. It is likely that current changes within the psychotherapy business will also have an impact on our culture beyond the simple material well-being of individual counselors and their affiliated institutions.

Economic downturn

To clearly understand the current plight of today's therapy industry, as well as its implications for the future of American intellectual life, we must first examine the spiraling medical costs of recent years. The majority of Americans receive their medical care under some kind of insurance policy. Since the policy's price tag represents simply the average cost of all illnesses covered, most people mistakenly assume that the sharp rise in premiums over the last decade reflects an inflationary trend that has been uniformly steep in all areas of medicine.

But what insurance companies and self-insuring corporations, who actually pay the bills rendered by therapy providers, began to notice in the late 1980s was that mental-health and related services were accounting for a disproportionately large percentage of their payables - up to 10 percent by 1990, according to the U.S. Department of Health and Human Services. Between 1987 and 1991, the cost per employee of the average company's mental-health bill actually doubled, according to the benefits consulting firm of Foster Higgins.

So dramatic were these increases that, by the middle of 1990, Texas Attorney General Dan Morales initiated the first of many state investigations across the country. These revealed a widespread pattern of abuse among the nation's therapists and mental-health hospitals - all aimed at milking insurance policies for the maximum possible payoff. The predominant thrust of this activity, according to the testimony of Ralph Roath, formerly Patient Intake Director at Twin Lakes Hospital in Denton, Texas, was "to put the head in the bed and keep it there. …

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