Manufacturing depression by Gary Greenberg

Author:Gary Greenberg
Language: fr
Format: mobi, epub
ISBN: 9781416569794
Publisher: Simon & Schuster
Published: 2010-01-14T23:00:00+00:00

CHAPTER 11

DIAGNOSING FOR DOLLARS

Sometime during my first session with a new patient, usually toward the end, the touchiest subject in therapy comes up. Which is not what you might think it is. People will pour out, sometimes unbidden and in more detail than you may want, their illicit romps, their most ignoble or kinky wishes, their peccadilloes and deceptions, and other carnal secrets long dammed by shame and other family traditions. But ask these same people how much money they earn or have in the bank and they will seize up like a frozen pipe. Sometimes they even tell me that it’s none of my business, and, as a rule, the more affluent they are, the more likely they are to feel that way. It is as if they are putting me on notice that there is a nakedness that even I’m not allowed to see.

So when the m-word arises in that first session, it’s not because I’m asking. I’ve learned that much in twenty-five years. It’s because despite the intimacy of the encounter—which, by the way, is real; nothing draws people closer than simple, honest talk—we are doing business. I’m renting myself out by the hour, so as the clock ticks down, just as they might wonder if a first date will end with a handshake or a kiss or a wave good-bye, patients find themselves thinking about the transaction that will bring our time to a close. And more often than not, the way they let me know this is to say, “Do you take my insurance?”

This often ends up being a much more interesting conversation than patients bargain on. I tell them that I would be glad to submit the paperwork to their insurance company so that they can get reimbursed for what they have paid me. If they can convince me that their cash flow can’t handle that approach, I’ll even wait for the insurance company to pay up, although, I remind them, the responsibility to pay me is ultimately theirs, and they need to bear in mind that insurance companies make their profits by paying for as little health care as the law and, occasionally, common decency will allow. And then I tell them what I must do to have a chance of opening up the insurance coffers. “I’ll have to tell your insurance company that you have a mental illness.”

You wouldn’t think that would be a big surprise; they don’t call it medical insurance for nothing. But very often it is. In general, the people who come to see me for therapy don’t think that they are mentally ill. Mostly, they think they are worried or unhappy or reeling from setbacks. So they are often nonplussed when I point out the obvious—that they will soon be officially sick in the head, that this fact will be part of their permanent medical record, that should they seek life insurance or a security clearance or high political office, should the nosy manager in the human resources office happen to get a look at their file, they might come to regret having received that diagnosis.

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