Abstract
Mental health treatment providers today are subject to insurance company regulation. Using grounded theory to analyze 33 interviews of treatment providers, I portray this regulation as a form of surveillance that operates through discourse, and ask how treatment providers communicate with and through this system. My findings reveal that mental health treatment providers are required to deliver information to insurers within a rationalized medical discourse that is supposed to represent treatment, but is inadequate for the task. I argue this bureaucratic system demands that providers communicate with insurers in a distorted way. These findings are theorized in dialogue with Habermas’ communication typology and his theory of lifeworld colonization. I argue that the case of managed mental health care presents an arena of communication and colonization which is best suited by building from the Habermasian framework. Colonization occurs, yet on within a specific channel of communication, despite pretensions of thoroughgoing colonization. Systematically generated communicative distortions occur, but often without necessarily involving self-deceptions or strategic private agendas. This paper contributes to Habermasian theory by suggesting it could be further elaborated upon to account in for forms of colonization and distorted communication that occur in varied social contexts.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adorno, T.W. (1973) Negative Dialectics. New York: Continuum.
Bevir, M. (1999) Foucault, power, and institutions. Political Studies 47(2): 345–359.
Boxenbaum, E. and Jonsson, S. (2008) Isomorphism, diffusion and decoupling. The SAGE Handbook of Organizational Institutionalism (pp. 78–98). Thousand Oaks: Sage.
Charmaz, K. and Bryant, A. (2007) The coding process and its challenges. The SAGE Handbook of Grounded Theory. London: Sage.
Collinson, D. (2014) Dichotomies, dialectics and dilemmas: New directions for critical leadership studies? Leadership 10(1): 36–55.
Deleuze, G. (1992) Postscript on the societies of control. October 59: 3–7.
Derrida, J. (1978) Writing and Difference. Chicago: University of Chicago Press.
Derrida, J. (1982) Margins of Philosophy. Chicago: University of Chicago Press.
Field, M.J. and Gray, B.H. (1989) Controlling Costs and Changing Patient Care? The Role of Utilization Management. Washington, DC: National Academy Press.
Foucault, M. (1977) Discipline and Punish: The Birth of the Prison. New York: Pantheon.
Freidson, E. (1988) Profession of Medicine: A Study of the Sociology of Applied Knowledge. Chicago: University of Chicago Press.
Goffman, E. (1959) The Presentation of Self in Everyday Life. Garden City, NY: Anchor.
Habermas, J. (1970) On systematically distorted communication. Inquiry 13, 205–218.
Habermas, J. (1984) The Theory of Communicative Action: Reason and the Rationalization of Society (Vol. 1). Boston: Beacon.
Habermas, J. (1985) The Theory of Communicative Action: Lifeworld and System: A Critique of Functionalist Reason (Vol. 2). Boston: Beacon.
Hansen, H.K. and Flyverbom, M. (2015) The politics of transparency and the calibration of knowledge in the digital age. Organization 22(6): 872–889.
Iedema, R. and Rhodes, C. (2010) The undecided space of ethics in organizational surveillance. Organization Studies 31(2): 199–217.
Lyon, D. (2007) Surveillance Studies: An Overview. Cambridge: Polity Press.
Lyotard, J.F. (1988) The Differend: Phrases in Dispute. Minneapolis: University of Minnesota Press.
McCarthy, T. (1981) The Critical Theory of Jürgen Habermas. Boston: MIT.
McKinlay, J.B. and Stoeckle, J.D. (1988) Corporatization and the social transformation of doctoring. International Journal of Health Services 18(2): 191–205.
Meyer, J.W. and Rowan, B. (1977) Institutionalized organizations: Formal structure as myth and ceremony. American Journal of Sociology 83, 340–363.
Morse, J.M. (2010) Sampling in grounded theory. The SAGE Handbook of Grounded Theory (pp. 229–244). London: Sage.
Orton, J.D. and Weick, K. (1990) Loosely coupled systems: A reconceptualization. Academy of Management Review 15(2): 203–223.
Ritzer, G. and Walczak, D. (1988) Rationalization and the deprofessionalization of physicians. Social Forces 67(1): 1–22.
Sahlin, K. and Wedlin, L. (2008) Circulating ideas: Imitation, translation and editing. The SAGE Handbook of Organizational Institutionalism (pp. 218–242). Thousand Oaks: Sage.
Scheid, T.L. (2003) Managed care and the rationalization of mental health services. Journal of Health and Social Behavior 44(2): 142–161.
Schlesinger, M.J., Gray, B.H. and Perreira, K.M. (1997) Medical professionalism under managed care: The pros and cons of utilization review. Health Affairs 16(1): 106–124.
Scott, W.R., Ruef, M., Mendel, P.J. and Caronna, C.A. (2000) Institutional Change and Healthcare Organizations: From Professional Dominance to Managed Care. Chicago: University of Chicago Press.
Timmermans, S. and Kolker, E.S. (2004) Evidence-based medicine and the reconfiguration of medical knowledge. Journal of Health and Social Behavior 45(Extra Issue): 177–193.
Timmons, S. (2003) A failed panopticon: Surveillance of nursing practice via new technology. New Technology, Work and Employment 18(2): 143–153.
Ware, N.C., Lachicotte, W.S., Kirschner, S.R., Cortes, D.E. and Good, B.J. (2000) Clinician experiences of managed mental health care: A rereading of the threat. Medical Anthropology Quarterly 14(1): 3–27.
Weick, K.E. (1976) Educational organizations as loosely coupled systems. Administrative Science Quarterly 21(1): 1–19.
Whooley, O. (2010) Diagnostic ambivalence: Psychiatric workarounds and the diagnostic and statistical manual of mental disorders. Sociology of Health & Illness 32(3): 452–469.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Morelock, J.C. Bureaucratically distorted communication: The case of managed mental health care. Soc Theory Health 14, 436–457 (2016). https://doi.org/10.1057/s41285-016-0015-0
Published:
Issue Date:
DOI: https://doi.org/10.1057/s41285-016-0015-0