Good Mental Health Care: What It Is, What It Is Not & What It Could Be

There is a good deal of quantitative and qualitative data about the treatment out-comes of particular kinds of therapy, and much reportage about their practices, to suggest they are.10 And yet we also find regular accounts in the me- dia and in the rapidly expanding genre of patient and family member narratives that raise serious questions about just how good, in general, the quality of care for p. [...] It reduces care to its sup- ply and demand and product-centered characteristics; it is simply an inadequate way of framing caregiving.31 It offers only a small space to acknowledge and af- firm the pain and suffering of patients, the fear and uncertainty of family mem- bers, and the emotional and moral responses of practitioners. [...] Out of that human care comes the presence (or absence of presence) of the protagonists in the hospital’s healing dramas and the reciprocity that elicits and sustains care in families and communities.32 Care itself is about the work of caregiving through acts like supporting, assisting, being there, accompanying. [...] 10 See the work of Jonathan Shedler for an overview of the state of clinical evidence for psychotherapy and an important perspective on the interpretation of various types of evidence with regard to psychotherapy, as well as the complexities inherent in the ob- jective study of subjective states and common misrepresentations of evidence and out- comes in psychiatric and psychological publications. [...] These observations have taken many shapes, from the various models of the unconscious in psychodynamic theory and practices (for a thorough review of the influences on and the evolution of the original formula- tions of a dynamic unconscious, see Henri Ellenberger, The Discovery of the Unconscious [New York: Basic Books, 1981; 1970]), to the growing understanding of dissociation and “split-off” ex.