I read in the newspapers how employers are desperate and are increasing wages and amenities to attract workers to return.
I read in the newspapers how employers are desperate and are contacting previous workers to come back: all is forgiven, shalom bayit.
Nary a one of these approaches are apparent in the psychotherapeutic industrial complex.
I have been to several interviews for hospitals interested in hiring psychologists for their behavioral health units. These are well-known hospitals who have cut back on their staff for the past 40 years (decimation by attrition) and increased the surviving staffs' caseloads. They have turned into procrustean bed palaces (you will remember that the Procrustean bed is one size fits all--if your feet stick out--cut them off. If the body is too small, stretch it to fit the bed). These psychotherapy nut huts are dark Procrustean mills.
I am always shocked to discover that the hours have increased. Shifts are inflexible. Wages are stagnant. Caseloads are large. I am told that I must practice CBT, even before I assess the patient. Salaries are well below the median of licensed psychologists in NYS. Benefits--in name only. Fewer amenities than ever. Maintenance still relying on low budgets and dirty water mops.
I tell them, "First of all, I am opposed to large caseloads. I believe we should go back to the future. Forty years ago, before Reagan, these hospitals had three times the staff and one third the patients. Regardless of income, patients received (for better or worse) similar treatment as they would have in a private practice. Now, everyone is processed. People are provided for (not treated). Quality has deteriorated, due to the attrition policies. I have worked extensively with these economically marginalized. They are physically unhealthy. They need to be offered programs that are holistic--and these programs need to be offered to the community--they used to--before Guiliani, hospitals offered all sorts of social, educational, and recreational programs to everyone in the catchment areas. Then, under Guiliani, it had to be insurance reimbursable. So they disappeared overnight. These old hospitals used to be complete communities--hair salons, printing presses, pools, gyms. These are still there, somewhere. Plus, many hospitals used to offer restaurants and cafes run by and staffed by outpatients--sort of a jobs skills and social skills training fora."
Now our urban poor are discriminated against. They are segregated to public hospitals only. They face extensive delays between registration and evaluation (not just in behavioral health--every department). They are more likely to give birth on a gurney in a hallway. They are more likely to die while waiting in the ER. All hospitals may have turned into bedlams. But the urban poor suffer disproportionately so because of attrition.
They look at me, probably mentally shredding my resume. They say, "I admire your passion, Dr. Kahn." Which means they don't admire my passion. And they probably think I have borderline pathology. Passion, unless you are singing the "FLASHDANCE" theme song, is not admired in the mental health community. Somewhere, somehow, we are supposed to talk like Roth's stereotyped Wasp leaders--in hushed mumbles. Well, I didn't get that memo. No one has studied psychoanalysis like me. European analysts did not speak in hushed tones. Look at that video of Fritz Perls exhibiting his approach. His accent renders his words unintelligible. But there is nothing hushed about Perls. And of course, there is the famous transcript of Kohut calling a patient, "an idiot."
Freud, of course, is famous for noting that for the poor, the only cure is the "King's gold." And there is an American psychoanalyst who noted, "If a patient breaks out in hives every time they eat a lobster, and, only when they eat a lobster, it would be better for him to refrain from eating lobsters than to consult a psychoanalyst." The old psychoanalysts displayed a certain amount of wisdom lacking from our current hospital administrators. Despite all the suffering caused by attrition and authoritarian approaches to staff, they just want to continue doing the same thing over again and expect a different result. And that, my dear reader, is the definition of insanity.