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PubMed1990

Integrating political-societal concerns in psychotherapy.

Despite growing publicity and public concern about the serious nature of the nuclear, societal, and environmental problems in our increasingly globally conscious world, and despite the fact that a majority of psychotherapists share this concern, most psychotherapists state that their patients never mention such matters in psychotherapy. Some possible reasons for this scarcity of discussion in psychotherapy are offered. These include the often unstated understanding that political-societal matters are not to be discussed by patients in therapy, therapists not hearing such content or hearing it only as a way of talking about early, intrapsychic fears, therapists' concerns about influencing their patients, the fear of talking about "ordinary death" much less the death of all life now and in the future via nuclear or environmental disaster, and the impact of modern Western civilization's overemphasis of individualism on much of psychotherapy theory and practice. An approach in which questions about political-societal concerns are raised early in treatment is described and discussed. The results of this approach include an increased dialogue about death, the meaning of life, and connectedness to the world of others.

Attitude↗
PubMed1983

Freud's ego ideals: a study of admired modern historical and political personages.

It is appropriate to conclude this study with a statement that characterizes Freud and his search for particular models, and this is: "A genius chooses his family from among heroes." His historical heroes were Cromwell, Napoleon, Masséna, Garibaldi, Bismarck, Adler, Lasalle, Lasker, and Wilson. Of course, toward many of these figures, Freud was also ambivalent. Yet these leaders have certain common denominators. In various degrees, they may be characterized as progressive, secular, and anti-Catholic. Moreover, they all had spectacular careers, stood up against great odds, and in many instances had serious conflicts with their fathers or men in authority. These leaders had a special significance for Freud, and their selection is representative not only of his own personal dynamics, but also of his historical milieu. His ego ideals demonstrate that Freud was ambitious and had partisan political feelings and concerns. In some cases the choice of the ego ideals stemmed from his ambivalent feelings toward his father and his particular resolution of the oedipal situation. Also very significant is the fact of Freud's Jewish heritage and the anti-Semitism he experienced as a citizen of the Hapsburg Empire. Moreover, Freud was always sensitive about the power and the influence of the Catholic church. Still another reason for his selection of widely scattered figures with whom to identify is the broadening influence of his classical education. In addition, being gifted linguistically, he was able to transcend a parochial environment. In general then, Freud's ego ideals reveal that he was informed politically and historically and that he regarded these men as promoting policies that were liberating.

Austria↗
PubMed1987

Psychological concepts useful in the building of political foundations between nations: Track II diplomacy.

There are two phases in the process of negotiating for peace with antagonistic national groups. The leader (or leaders) of one such group will not negotiate with his opposite number until political foundations to support such negotiation are laid down, and obstacles to peace identified and dealt with; at least some measure of success is anticipated by both sides. Accordingly, the first phase requires the building of bridges between those representing opposing nations. The activities in this preliminary phase are sometimes called Track II diplomacy; they differ from those of official or Track I diplomacy. I suggest two kinds of concepts that may be useful in Track II diplomacy, and present them in the hope of initiating further discussion, and exploration of metapsychological underpinnings of each concept. As Mitscherlich (1971) suggested, the psychology of international politics may be better understood if psychoanalysts are willing to engage in interdisciplinary work with others engaged in such endeavors.

Ceremonial Behavior↗
PubMed1992

Politics and mental health I.

The origins and evolution of psychiatry as a medical discipline since the end of the 18th century have been influenced by society's beliefs about the 'nature of man', the dominant forms of social organisation, and the level of technology which could be mobilised to modify human behaviour. These are also the themes from which politics develop. Throughout the past two centuries and up to the present day, two distinct streams can be traced in the political history of psychiatry: first, psychiatry as social control of deviance; and secondly, psychiatry as advocacy of the 'right to be different'. The 'third psychiatric revolution' which is now in progress in many parts of the world has been inspired by the second set of beliefs. It has already produced positive effects on the quality of life of many patients but is also experiencing certain setbacks. The extent to which the new approach to mental health care delivery will benefit patients and society depends not so much on psychiatry as a discipline as on the perceptions and actions of politicians.

Cross-Cultural Comparison↗
PubMed2005

What's in a grade? Academic success and political orientation.

Expanding the literature on person-environment fit, the authors argue that political orientation is an important factor in shaping academic success in college. Based on social dominance theory, it was expected that academic disciplines that are more likely to provide students with future access to social and economic power tend to favor individuals who hold attitudes that strengthen the existing societal order. In a longitudinal sample of undergraduate students at a major American university (n=3,890), the authors demonstrated that student grades in these disciplines, but not in other disciplines, are positively related to a precollege measure of conservatism. This association between conservatism is consistent over time and subgroups, thus implicating higher education in the reproduction of social hierarchy. The discussion examines the causal processes underlying the relationship between political orientation and academic success in college.

Achievement↗
PubMed2005

Democracy justifies the means: political group structure moderates the perceived legitimacy of intergroup aggression.

The present research tested the hypothesis that the political structure of conflicting groups moderates perceived legitimacy of intergroup aggression. In two experiments, participants read scenarios of fictitious summer camps in which members of one group aggressed members of another group. The political structure of both the perpetrator and the victim groups was described as either egalitarian (defined with democratic decision-making procedures) or hierarchical (authoritarian decision-making procedures). Results of both experiments showed that aggressions perpetrated by members of egalitarian groups at the expense of members of hierarchical groups were evaluated as less illegitimate than aggressions committed in the three remaining conditions. This effect is discussed as a function of the higher social value attributed to democratic groups.

Adolescent↗
PubMed1992

Rights of animals, perceptions of science, and political activism: profile of American animal rights activities.

This article reports original research examining characteristics of the active followers of the American animal rights movement. Typical respondents were Caucasian, highly educated urban professional women approximately thirty years old with a median income of $33,000 (1989). Most activists think of themselves as Democrats or as Independents, and have moderate to liberal political views. They were often suspicious of science and made no distinction between basic and applied science, or public versus private animal-based research. The research suggests that animal rights activism is part of a symbolic manifestation of egalitarian social and political views concerning scientific and technological change.

Animal Rights↗
PubMed2003

Lay experts and the politics of breast implants.

This paper discusses the controversy around breast implants in the United States and Europe. It focuses on the emergence of consumer and support groups for women and offers an analysis of the role they have played in recent policy developments in UK and Europe. The politics of breast implants is seen as a politics of knowledge in which scientific expertise has consistently been deployed in ways that minimize the credibility and legitimacy of women's accounts of their bodies and illness experiences. These women have been doubly disadvantaged in a policy debate that turns on scientific controversy and uncertainty. This implies a gendered dynamic to the changing relations of knowledge and expertise. The paper contributes to an understanding of the relations between regulators, manufacturers, users, and clinicians in the global medical device industry and to wider debates around the public understanding of science.

Breast Implants↗
PubMed1989

The political and economic context of mental health care in the United States.

Since the mid-1970s, the mental health treatment system in the U.S. has faced budgetary famine. This is in stark contrast to the growing cornucopia of fiscal resources enjoyed by the overall health care system. This paper explores the complex reasons for this disproportionate allocation in health spending. On the one hand, mental health may suffer from the perception that its diagnoses are largely "subjective" and its treatments do not fit the traditional "medical model" that can be defined precisely and paid for by third-party insurers. But more importantly, the death of mental health resources can be attributed to the peculiar nature and characteristics inherent in American politics. This paper describes the American political environment, from both a historical and a contemporary perspective, to give some insight into the development of policies affecting the mental health system in the U.S. Given the current climate of fiscal conservatism in this country toward any increases in social spending, it is likely that the profound mismatch in need and spending for mental health programs will continue indefinitely.

Civil Rights↗
PubMed1990

American political culture and the search for lessons from abroad.

The American health care system appears to suffer from higher costs and less access than the health care systems of other industrialized nations. This perception has set social scientists searching for "lessons from abroad." This paper places the dialogue about health system lessons within the context of American political culture. It sketches out some of the distinctive dynamics in the American policymaking process. Those dynamics help explain the problems we face, the programs we have pursued, and the alternatives we have foregone. The same political process which shaped past policies is likely to frame any lessons we try to import from abroad.

Costs and Cost Analysis↗
PubMed1990

Political and economic determinants of insurance regulation in mental health.

This article studies determinants of two important sets of laws regulating insurance coverage for mental health care: mandated inclusion of minimum coverage for psychotherapy, and mandated coverage for psychologist services, the so-called freedom of choice (FOC) laws. Political market models are developed and estimated to examine the passage of mandates and FOC laws among all fifty states from 1968 through 1983. Findings indicate that a number of groups influence whether these laws are passed, including psychologists and the state, which acts both in its own interests as a direct provider of services and to protect the public's interest. A state's political system and socioeconomic environment also influence the likelihood of passage of these regulations. Our findings run counter to the assumption often made by policymakers and researchers that regulations exclusively serve the interests of providers.

Community Mental Health Centers↗
PubMed1990

Health care and the homeless: a political parable for our time.

The growth in the number of homeless persons is perhaps the most visible indicator of social disintegration in the 1980s, although health and health care are not the central issues of homelessness. This paper, which draws on the author's experience as chairman of the Committee on Health Care for Homeless People of the Institute of Medicine (IOM), describes what is known about the characteristics of homeless persons and the causes of homelessness, and about the health status of homeless persons, which is often not very good (but not significantly worse, it would appear, than that of other low-income persons). The contemporary history of health services targeted to homeless persons begins with the joint initiative of the Robert Wood Johnson Foundation and the Pew Charitable Trusts in 1985, which became the model for federal support through the Stewart B. McKinney Act of 1987. The McKinney Act, like the IOM report, demonstrates how, in contemporary American politics, there can be widespread political consensus not only about a problem but about solutions, while the resulting policy actions are largely symbolic.

Decision Making↗
PubMed1993

Analysis, advice, and congressional leadership: the Physician Payment Review Commission and the politics of Medicare.

In 1985, Congress established the Physician Payment Review Commission (PPRC) to help formulate changes in the system used by Medicare to pay for physician services. The recommendations of the PPRC and subsequent legislative action led to fundamental reform. As a new type of advisory body, the PPRC enabled Congress to establish an agenda for physician payment reform and set it into law despite initial resistance from the executive branch. Four key factors contributed to the influence of the commission: (1) an institutional design that enhanced and integrated congressional policy formulation; (2) the quality of the information generated for legislative deliberation; (3) the open, consensual process the commission used to translate that information into policy recommendations; and (4) the strategic packaging of the proposals for reform. In the process leading to enactment of the new payment system, the commission skillfully bridged the traditionally segmented roles of neutral analyst and political advisor for legislators pursuing Medicare reform. Implementation of physician payment reform has been largely an administrative responsibility, in which the PPRC has played a minimal role. The complexity and ambiguity of some of the legislative provisions have left room for administrative officials and interest groups to maneuver according to their priorities. Thus, despite congressional efforts to design a tightly controlled system, a considerable amount of work remains to assure its technical and political success.

Decision Making, Organizational↗
PubMed1978

Community mental health centers: politics and therapy.

This paper traces the development of theory and public awareness of mental health from 1900 to 1960, with particular stress on the rise of social psychiatric models and the impact of events in and around World War Two. The federal legislative history of the Community Mental Health Center (CMHC) program through 1976 is then outlined with regard to particular social problems (e.g., alcoholism) and to domestic politics as they influenced the program's regulations and mandates. A brief critique of the CMHC program from both viewpoints follows, with emphasis on poor administration, lack of community control, and poor evaluation and accountability. This is the basis of an argument for a more egalitarian, explicitly political viewpoint and methodology as a start toward solving problems that chronically afflict the mental health system.

Community Mental Health Services↗
PubMed1978

The politics of health care regulation: the case of the National Health Planning and Resources Development Act.

This paper examines the political and bureautic dynamics of health regulation under the National Health Planning and Resources Development Act and, to a lesser extent, the Carter Cost Proposal now before Congress. A number of underlying issues that affect the day-to-day exercise of health planning are considered, including the contest between state and local and federal government for program control, jurisdictional conflict between state and local planning agencies, and the unsettled roles to be played by professional planners, consumers, and providers. When we assess regulatory policy in health, these complicating factors must be added to the long list of handicaps that already exist. One important finding is that local planning agencies have embraced the task of health regulation somewhat more fully than had generally been expected. A number of explanations for this are offered. In short, the controlling factors in health planning are political, not technical, and there is more occurring at the state and local levels than many had predicted, although any impact is not likely to be dramatic.

Costs and Cost Analysis↗
PubMed2000

What prompts health care policy change? On political power contests and reform of health care systems (the case of Canada and Israel).

This article attempts to shed light on the complexity inherent in health care reform policies in the context of political power contests that trigger the changes imposed on the health care system. Rather than being solely a response to financial circumstances, as it is often claimed, we argue that these political contests lead to many of the changes in the systems. Furthermore, changes do not necessarily occur when worrying symptoms appear in the system, but rather when the contest reaches a peak and when neither side involved can emerge from the contest as winner or loser and as defender of the public interest. While in both cases fiscal problems in the health systems are usually brought up in order to justify reform, the trigger for change in Israel has been the power contest between the two main parties--the Labor Party and the Likud Party--with the Likud attempting to impair the financial basis of the former. In Canada, the power contests are between the provinces and the federal government.

Canada↗
PubMed2003

Between welfare medicine and mainstream entitlement: Medicaid at the political crossroads.

As the new century begins, the Medicaid program is arguably at a political crossroads. Over the 1980s and 1990s, policy makers enacted major expansions in Medicaid coverage, offering significant new health benefits to poor women and children and other constituencies. In elite rhetoric and political framing, Medicaid was increasingly cast as a broad-based social welfare entitlement of value to all Americans, including middle-class citizens. Some health care advocates began viewing Medicaid expansions as a potential path to achieving universal coverage in the United States. Yet Medicaid remains a means-tested program that has been repeatedly threatened with policy retrenchment. In this essay, we scrutinize Medicaid's current status and future possibilities from a historical-institutional perspective by tracing its complex evolution since its enactment in the Social Security Amendments of 1965. Our core claim is that decisions made at the time of Medicaid's original adoption have fundamentally set the matrix for struggles over the program's unfolding development. We demonstrate that key ambiguities embedded in the 1965 act created largely unintended opportunities for policy entrepreneurs to broaden Medicaid's scale and scope as well as foreseeable vulnerabilities that must be overcome if Medicaid is to realize its full potential.

Aged↗
PubMed2004

States and the politics of incrementalism: health policy in Wisconsin during the 1990s.

Wisconsin officials during the 1990s seemed poised to enact innovative and comprehensive health care reform. During that era, an ambitious, popular, and reform-minded governor led the state. The state had an unusually professional legislature. The state's economy was strong. Even with these advantages, however, the report card on the state's efforts is mixed. The state enacted a fairly modest set of reforms that were financed largely by the federal government and subject to extensive federal oversight. The Wisconsin story thus seems to be about the politics of incrementalism. But while critics of incrementalist politics point out that the number of uninsured continues to grow, the catalytic federalism witnessed in Wisconsin in the 1990s may well be the best model for implementing health care reform.

Child↗