Bureaucratically Distorted Communication: The Case of Managed Mental Health Care

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 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 for forms of colonization and distorted communication that occur in varied social contexts.

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