It is not the judicious prescribing of medication in a particular instance that is at issue in this section. Psychotropic medication is a resource to be drawn upon in certain instances for certain people. What is at issue is the domination by economic and political forces of a field that traditionally has been, and by nature must continue to be, shaped in response to the needs of the people seeking its services.
The care of people's emotional needs in this country has traditionally been the charge of religious and social service organizations, the majority of which have been nonprofit or government-sponsored organizations. The people drawn to work with people's emotional difficulties have traditionally seen their work as something of a calling—a kind of central principle in their lives, orienting them toward bettering the lives of others. Because of the values in the larger culture, those people have always understood that their financial remuneration for this work would be modest. * This has been acceptable to these people because their bottom line is not the dollar, as in business, but rather the opportunity to perform acts for the betterment of others. In fact, it is this spirit of involvement with others—the therapeutic relationship—that is the only element of psychotherapy that quantitative research findings repeatedly correlate with successful outcomes.
What we are taking issue with, then, is the blurring of the boundary between healing and commerce. The managed-care industry, as an arm of the insurance business, has purely commercial roots. While maintaining its commercial status and its responsibility to its stockholders, it has now laid claim to territory traditionally reserved for the healing arts: decisions about who will receive care and what kind of care that will be. The production of pharmaceutical substances, on the other hand, is part of the healing tradition. Marcello Pakman, in his chapter, tells us that until the seven
*Even though psychiatrists usually receive more than moderate remuneration, their economic status among physicians is the lowest.