The "thinly" veiled contempt that Ferenczi wrote of, from psychoanalyst to patient, has now become the norm of all medical practice in the United States. Think of it--the poor get a tenth rate, diluted version of both psychotherapy and of medicine. The poor who have Medicaid attend clinics where polypharmaceutical treatment is the norm. They have a 10 minute appointment with a psychiatrist, in a scarcely clean office, where the seats are old and ripped, the floor tile scratched, with decades of grime settled in. The psychiatrist is never from their socio-economic class or their country of origin. The psychiatrist presents at case conferences where the patients (now referred to delicately as LIEM--lower income, economically marginalized) as Triple P (Piss-poor-protoplasm). The psychiatrist barely looks at them, so intent on tapping notes into the Ipad (and often the notes have little to do with the actual session--but they document that things were said). The psychiatrist neither listens nor talks to them. If the patient protests, the psychiatrist's authority is compromised and they immediately show the patient out, with prescriptions for half a dozen medications (symptom based practice rules). The psychiatrist doesn't care if they smoke pot (which compromises every known psychiatric drug and causes mania) The patient later sees "counselors" (psychologists rarely work in clinic settings anymore) who are happy to "manage" their caseload (again, 1/2 once in a while) They say they practice DBT or CBT or RET or any random alphabet soup acronym), but it is unlikely they even know what they are doing--DBT, CBT, or RET require more preparation and more feedback than the occasional session. Patients feel the contempt of the clinic--they are not worth decent furniture, clean rooms, or patient, knowledgeable clinicians--and so they are called "noncompliant," as they don't take their meds (side effects, synergistic effects) or prefer marijuana/cocaine/alcohol/methamphetamine. Or they come in and ask for stimulant meds or benzo's and the doctor actually balks at doling it out. So they find other clinics with even less scrupulous practitioners--after all, they are Triple P and no one actually expects them to improve.
Even worse, some patients take advantage of the practitioners scorn. They come in "I can't work." When you drop out of 10th grade, don't expect fulfilling work. Every job you have when you are in school sucks. Fast food has had a turnover rate of over 300%/year since the 1980's. They are dead end jobs. Don't expect to be plucked from the ranks and sent to Hamburger U or management training. That was the 1970's. Reagan destroyed this country. Every single unskilled job sucks. Restaurants pay the same $2/hr they did when I was a waitress in the 1990's. The cost of living has risen so that one cannot support oneself on a waitress pay. Restaurant owners are not like Mel's Diner in ALICE. Even fewer allow the hope that an unknown actor can be discovered (as in A TREE GROWS IN BROOKLYN--singing waiters, etc). So if you do not continue your education, if you do not learn a trade, yes, work sucks. Bosses are abusive, colleagues will rat you out if they think they can advance through it). The answer is not disability, but education.
So, in a way, it is Ferenczi's mutual analysis. The practitioners want the census, which can only be maintained if patients receive disability. So they reinforce the patient's disability narrative--yes, you can't possibly complete a working day doing simple work. It's the dysfunctional mutual analysis of supercapitalism. The practitioners have nothing but contempt for the patients; and it's mutual--both are only offering the minimum necessary to keep the patient enrolled.
Because what is the alternative. Psychotherapy brings in no reimbursement. The testing is not reimbursed by insurance. If they refer to a higher level of treatment, they have to discharge the patient (bye bye money). Clinics will not put out money to do more than the minimum needed to meet inspection standards.
What do they need. A healthy life. Clinics need to offer access to gyms, swimming pools, swim lessons. They need to offer safe places to learn crafts. They need to offer budgeting, shopping, and cooking skills. They need to teach life skills. They need to offer trips to museums and interesting sites. But insurance doesn't reimburse for such.
It's a vicious circle.
That's why I say--restorative justice. Theranos fine should be going to this. Epstein's money.
Instead--you have people sending millions to casual murderers, men who kill others men with a calm, bored, almost sleepy expression on their face. And not one cent to preventing the victims from having nothing but their illness to keep them company.