The following reflections were inspired by a Facebook thread, responding to this article. The article gushes that, according to some corporate consultants, mental health services in Australia could be delivered for $9.70 annually, saving on the inefficiency of training psychologists for face-to-face clinical work. People suffering with problems could anonymously read fact sheets, and undertake generic courses in CBT.
This approach is the logical conclusion of the prevailing paradigms in both economics and psychology. On the one hand, the selling point of this policy is cheapness and efficiency, above all else. On the other hand, the underlying assumptions are that ‘rapport’ is reducible to information exchange; ‘treatment’ is reducible to the administration of standardised techniques; and that the patients themselves are fungible units, that my depression is the same as yours, that my particular cure is applicable in general. Never mind that the long-term benefits of CBT are poor, and when delivered online, they are even worse. What matters is that you have a ‘beautiful set of numbers’, to quote Australia’s first neoliberal treasurer.
It is difficult to escape the conclusion that psychology itself – or more specifically, its academics and bureaucrats – have dug a grave for the profession. They have relentlessly prioritised the quantitative over the qualitative, given primacy to the general (and generic) over the singular, and emphasised cheesy ‘techniques’ over transferential relationships. In helping psychology win a race to the bottom, they have reduced clinicians to technocratic functionaries, problem-solvers without lack, micromanaged by internalised standardisation and protocols. This internalisation is then inflicted on ‘clients’, who undertake self-surveillance through the internet, ‘homework’ and data-driven apps. The ideal psychologist in this paradigm would resemble something rather like a drone. This is what happens when an entire profession considers its ethics to be reducible to a couple of prohibitions against financial and sexual impropriety, and when two-and-a-half millenia of Western thought on psychology is compressed into this:
In psychoanalytic terms, all this betrays the degradation of the symbolic order to fiduciary concerns, but further, also debases the imaginary, since the affects being manipulated in this model are presumed to be homogenous, and are ‘treated’ separably from any encounter between speaking bodies.
The implementation of cheap, standardised online services will be a boon to the corporations who receive the tender, and of benefit to the self-protection of the government departments in question, since they will be able to demonstrate ‘on paper’ (so to speak) that they have enhanced efficiency in service-dellivery. We can reasonably predict, however, that the mental health of the suffering will further deteriorate, and that a profession in crisis will continue its slide into irrelevance. After all, why spend several years training as a chef only in order to flip burgers at a fast-food joint? Moreover, the political implications of this tendency remain to be grasped. Psychologists in the UK (and elsewhere) face the prospect of their services being cut. In Australia, mental health is being gradually hollowed out from the inside, and not only by conservatives. When the austerity cuts eventually arrive, there may be little remaining for practitioners to fight to preserve.
On the other hand, since standardised measures will not do much to address what is lacking, these arrangements driven by numerical efficiency will make psychoanalysis all the more relevant, since an analysis will be one of the few remaining means of obtaining a non-bureaucratic treatment of any sort. The choice for the suffering will be one of online anonymity or subjective implication. The choice for psy-practitioners is one of being ‘scientist-practitioners’ (i.e. the burger-flippers of administered mental health) or subjects of transference, that is, subjects supposed to know.
Archives of a Divided Subject 