Corporatised,Scientistic and Authoritarian: A 2020 Vision of a Psychiatric Oligarch

This decision is based on the recommendations of the Casemix Allocation of Funding Committee of Australia (CAFCA). In an internationally televised address carried by all seventeen of TechnoMac's satellite education channels, the chairperson CAFCA, Professor Narcissco Meinleadre explained the findings of a study conducted by a respected consultancy firm, Hobbit Psychological Consultants, which numbers among its directors senior academics and officials of the Australasian and South Pacific Medical College. This college is the product of the amalgamation of all medical colleges which occurred in 2010 to facilitate government coordination of medical care.

Hobbit Psychological Consultants have recently completed a detailed review of the current 12-month mental health training course for generic welfare-worker aides. The Hobbit review had concluded that the current course was unnecessarily long and technical.

Indeed, research in Professor Meinleadre's department has shown such training could be rationalised and operationalised by means of a computerised protocol, EPOCH, that would substantially increase the efficiency of the workforce, provide standardised, uniform training and hasten the transit time of consumers through the program, thereby resulting in substantial costsavings and reductions in hospital bed utilisation.

Meinleadre assured consumers that only evidence-based protocols using the EPOCH model had been approved and that a government-sponsored hot-line would be set up advising consumers not to attend any psychiatrist in the corporatised health networks who did not use the EPOCH model.

The professor denied there was any similarity between this decision and the infamous Compulsory Cartelisation decree enacted in Germany in July 1933 or similar legislation in Italy in 1932 and in Japan in 1931. The professor said that such nonsensical claims reflected the dangers of exposing people, especially young, impressionable generic mental health workers, to the study of history, as a result of which that subject had been deleted from the curriculum at TechnoMac University, resulting in a saving of almost a million dollars annually.

Furthermore, Meinleadre reminded his audience of the highly successful hospital construction programme begun by the government of Victoria in the mid-1990s. It consisted of the government awarding tenders for the building of new hospitals to private companies while concurrently reducing the money for the maintenance and upgrading of public hospitals in the same geographical region as the new, privately-built hospitals. The dissemination of the EPOCH model by similar methods of government support was entirely justified, Meinleadre asserted.

The professor claimed that the continuing opposition to the government's programme reflected the elitist, self-serving, unscientific views of those few octogenarian psychiatrists who still clung to the antiquated notion that psychiatry was a medical specialty based on a relationship between the doctor and the patient which served as a secure emotional base for the patient.

He said that the government was sick and tired of such soft-headed, special pleading by interest groups who put their needs ahead of the greater good of the community. He pointed to the success of content-free management, competitive tendering, outsourcing and consumer-sensitive best-practice which had enabled the government to integrate and then to corporatise education in the first decade of the 21st century in the face of opposition from school teachers and university academics.

Many of these were subsequently replaced by generic teacher aides which had resulted in cost savings of millions of dollars.

The professor also reminded his audience of the government's decision in the 1990s to remove engineers from senior executive positions when Australia's and New Zealand's public utilities, such as gas, electricity and water supplies, were privatised. The engineers had been replaced by managers who, initially, had been unfairly criticised for their lack of understanding of the organisations they were running, an understanding that was said to develop only through years spent immersed in the day-to-day problems that occur in such enterprises. Such claims, the professor said, had merely been another example of special pleading by professionals wishing to protect their professional turf.

The new system of performance-linked bonuses and efficiency guidelines implemented by the government-appointed administrators conformed to the international standards of best practice which the administrators had themselves designed. While the occasional gas crisis, sewerage breakdown or power failure which crippled entire cities were disturbing, they were the unavoidable teething problems of making these industries more competitive. ‘You can't make an omelette without breaking eggs’, Meinleadre reminded his listeners, ‘and their learning curve is getting steeper by the day’.

Close consultation by TechnoMac with consumer association representatives would protect health consumers, Meinleadre promised. In fact, the president and vice-president of the consumers' association had joined TechnoMac's board of directors and were currently on an educational tour of TechnoMac's facilities in Aspen, Colorado, and Paris, France.

The claim that policies affecting care of ‘patients’ (i.e. clients) should include the views of psychiatrists who have had extensive training and supervision in clinical practice was just another form of grandstanding by old-fashioned doctors, the professor argued. He himself was a living example of how a psychiatrist could be an influential researcher and government adviser on health matters without having on-going clinical contact with patients over the years. ‘I haven't sought supervision of my clinical work since I was a registrar’, Meinleadre boasted. ‘You can't expect busy academics and programme managers to waste their time mulling over the minutiae of clinical interactions with a handful of patients when they have to attend many important meetings, both locally and overseas’, he protested.

The management of clients was best done by non-medical, generic mental health workers under the supervision of psychologists or social workers the professor said. A psychiatrist's role was to ensure that the treatment guidelines described in the standardised protocols were adhered to. Loud applause from the audience, led by the one hundred adjunct professors of managerial psychiatry Meinleadre had personally appointed to his staff, greeted these comments.

The main obstacle to realising the government's aim had been the mischief perpetrated by disaffected psychiatrists through their constant invocation of the concept of the doctor-patient relationship, Meinleadre declared.

He claimed to have learned about the doctor-patient relationship while researching his monumental book ‘Saving Psychiatry: The struggle against unscientific ideas in the 20th century’ (TechnoMac Publications, 2018). In that book he describes how a new breed of academic-clinician-managers emerged from the dark, selfish, unscientific days of psychiatry in the late 1980s. By a mixture of clinical brilliance and administrative daring they solved the problem of the doctor-patient relationship by re-naming it the ‘liaison-consumerknowledge-and-strategic-providers-of-intensive-throughput-tastask-linked-enterprise (LICK-SPITTLE)’.

In collaboration with the World Health Association of Technical and Scientific Health Administrators and Managers (WHAT A SHAM), and the Hobbit Consultancy on Cost-benefit Casemix Underwriters Society (HOCUS POCUS), Professor Narcissco Meinleadre had designed a scientific questionnaire which was distributed to five thousand chronically depressed or chronically anxious people, all of whom asserted that they had never experienced unconscious guilt or unconscious fear of their own anger. The professor said that this finding was the final nail in the coffin of the nonsensical notion of the interpersonal or trans-generational transmission of grief, developmental trauma or perverse identifications as factors in the causation of suicide, recurrent psychosis, chronic depression, chronic anxiety states, child abuse and neglect, marital breakdown or bottomless despair.

Speaking from his private jet, Meinleadre said that new treatment protocols based on the results of this questionnaire would ensure that scarce and precious funds would no longer be squandered training service providers to learn how to explore such non-existent phenomena with consumers. This would result in considerable cost savings for the corporatised health networks at a time when the government was preparing for their complete privatisation.

Professor Meinleadre, who is in Australia to receive the Ferdinand Marcos Memorial Golden Heart Award from CAFCA, is returning tonight to Geneva, where he is the vice-president of TechnoMac's academic studies division. He has pioneered a multi-centre demonstration proposal of the feasibility of introducing Lithifiz into the water supply of rural towns and cities in China, Brazil and Australia as a way of reducing their ever-growing national suicide rates. Lithifiz is manufactured by TechnoMac, but Meinleadre has consistently claimed that his research is entirely objective and evidence-based.

Sentimental notions about failed empathy and unreliable attachments in childhood, the breakdown of family life, the loss of shared community values, the demoralising effects of chronic unemployment and a dearth of men and women of integrity to serve as role models to the younger generation in the face of the effects of global market forces are no substitute for hard science when it comes to treating the scourges of suicide and serious mental illness, the professor explained.

Nor, the professor noted, could the global free market in which TechnoMac was a key player afford to have its workforce burdened by anxiety or guilt. ‘High productivity demands high self-esteem’, he said. This subject is addressed in one of TechnoMac's many protocols.

Free copies of this protocol will be distributed to general practitioners who complete the ARISTOTLE module as part of TechnoMac's Doctorate of Psychological Science programme. This is a three-week (part-time) computerised course in which medical practitioners are taught how to deal with clients' experiences of grief, self-doubt, intimacy, despair, guilt, loyalty, revenge, envy, rage, gender-identity, bodily-integrity and other troubling human experiences. Particular attention is given to teaching the shareholder-doctors to deal with accusations that evidence-based programmes were a disguise for under-treatment.

The professor explained that the ARISTOTLE module was named after a Greek philosopher whose writings were deleted from the curriculum at TechnoMac University when it was found that they made students uneasy about the epistemological assumptions and ethics of the health reform strategy. Such unease interfered with the students' productive output.

The professor recalled that in the 1990s, before the corporatisation of the health industry, a number of psychiatrists had criticised the reform process. Some of these critics had been indoctrinated by the writings of a long-discredited Viennese charlatan called Freud and his successors.

Professor Meinleadre said that Freud's writings too had been deleted from the curriculum at TechnoMac. In future offending psychiatrists in TechnoMac's health networks would be sent on re-education courses in the Kimberley Ranges and the Gobi Desert.

There they would learn the wisdom of multi-disciplinary, collective thinking, the importance of consumer relations and respect for evidence-based, protocol-structured management practices. They would discard outmoded ideas such as that a treatment should be tailored to the individual patient in accordance with his/her state of mind, physical health, developmental experiences and current contexts.

Such ideas implied fidelity to the traditional model of clinical medicine wherein a psychiatrist is trained to make a clinical assessment and to prescribe a course of treatment on the basis of his/her own clinical judgement, and that this judgement often changes over time as the psychiatrist gets to know the patient better, monitors the feedback from the original intervention and as the patient feels trusting enough to disclose personal anxieties, traumas and family secrets.

This, said Meinleadre, was a recipe for chaos and anarchy. ‘How can we control what everybody is thinking and doing if we leave it to professional training and the shared wisdom of peers? These psychiatrists are a threat to the rational, uniform, costsensitive, corporatised management of health care! Their ideas must be discredited and expunged from the awareness of health service providers! It is fortunate for our beloved country that a few of us have been courageous and far-sighted enough to do it’, said Meinleadre, ‘and it is entirely appropriate that a grateful government should reward us for our altruistic, selfless toil in the name of science and on behalf of suffering humanity’.

Seen in this light the deletion of psychiatry as a medical specialty was a necessary step in the rationalisation of health services and in the elimination of potential troublemakers among the mental health workforce. It would also serve as a deterrent to doctors in other areas of medicine who might want to challenge the government's health policies.

In closing, Professor Meinleadre's hitherto exuberant manner became more subdued when he admitted that, regrettably, some of his one hundred adjunct professors of managerial psychiatry would lose their jobs in the restructuring of the mental health workforce. ‘However’, he reminded them, ‘history proves that every change is an opportunity for those who are alert enough and strong enough to harness and exploit the forces of evolution. Adversity makes us strong, life is constant competition, only the best survive, boldness and determination make us win not whinge!’, the professor declared.

Those adjunct professors of managerial psychiatry who are under thirty-five years old will be offered positions as administrators of the government's integrated Tropical Rain Forests and Fun-Park Development Project (itself a triumph of content-free management). Some of the older administrator-clinicians will be offered short-term (month-long) contracts with TechnoMac's California Academy of Counselling Training or with its re-education programmes in the Kimberley or the Gobi Desert. As for the rest, their loyalty to TechnoMac will not go unrewarded; as part of their retirement package they will each be given, absolutely free, five years' supply of personal packs of Lithifiz, as well as a ten-year supply of the newly developed paediatric form of Lithifiz, Lithikid, currently undergoing field trials in Somalia.