Public Policy, Mental Health, Poverty, and Behavioral Economics

“Years ago, during an earlier stage of my career as a clinical psychologist, I was working as a therapist with a young family, whose adolescent son told me he wanted a computer. Over the next several weeks, we developed a plan for acquiring the computer that included writing a brief resume, reviewing the classified ads to learn what jobs might be available, and talking about the families in his neighborhood that might need (paid) help with
grounds-keeping and other projects.

“As we moved from plan-development into plan-implementation (i.e., he had obtained a good job but had not begun work), he did not come in to see me for two consecutive appointments. When our paths crossed on the third week, I asked him about the missed appointments. He smiled and said he had been at home “playing with my new computer.” He told me his social worker had gotten some grant money to pay much of the price for the computer, and she had obtained some money from her church to pay the balance. Oh, by the way, he had changed his mind about taking the job. I spoke with his social worker about my misgivings, and she seemed indifferent to any suggestion that her intervention might be anything other than helpful and praiseworthy.

“In the practice of medicine, we have the concept of iatrogenic illness, which is an illness
or injury that is caused by the physician. The word comes from the Greek iatros for physician and genic for cause or origin. The original concept of iatrogenic illness was originally reserved for the sponge or clamp that was left in the surgery patient or the mix-up in which the wrong leg is amputated or the hip replacement patient awakes from surgery to find that he has donated a kidney. It happens.

My years of clinical practice have led me to conclude that professional helpers (e.g., psychologists, social workers, and counselors) also make iatrogenic errors and do so with all the best of intentions – as when a social worker derails an adolescent’s industrious plan for work and the expenditure of earned money.

“If my story were an isolated incident, perhaps it would not be so troublesome. My colleague’s iatrogenic intervention would have given only one adolescent the message, “Talk about what you want in front of the correct people, and, with any luck at all, the thing you want will materialize.”

“I believe that well-intentioned but misguided people, spending other people’s money, often help from the moral high ground, in ways that do not help in the long run, and this is the focus of my new blog: hammocks2catapults.

“Arguably, the aggressive identification of potential recipients for some of this money and/or the enabling of passive-dependent behavior on the part of those who would “game the system,” have sapped our country of its vitality and borrowed our unsuspecting children into a black hole of debt, from which there may be no recovery that will not involve major pain for them.

“Sometimes, this style of helping is a response to the demands of a class of dependent people with a mindset of victimization, whose members, like the adolescent above, have been derailed from any thoughts of earning and saving money, at buying the necessary and the optional things that are associated with “work credits” (i.e., money), and the deferral of gratification. Add to this pattern the fact that this group of assistance-recipients becomes a powerful voting block — the influence of which can result in iatrogenics on a grand scale.

“I’m not talking about the mentally retarded, the mentally ill, or quadriplegics; I am talking about the man who helped me unload a pickup truck full of firewood, who laughed and said he was late for his doctor’s appointment to supplement his application for disability benefits for what he described as a “bad back.” Between chuckles, and with a twinkle in his eye, he told me, “I’m lining up some checks for my retirement.”

“I am excited to launch this new blog to share some thoughts regarding mental health, public policy, poverty, and the emerging field of behavioral economics. Some of these postings will be original, some will involve links to articles on related issues, and some will be invited contributions.

“Should you choose to subscribe, I hope you find the thoughts helpful, and they will prompt you to work toward a paradigm shift in our culture away from the cynical exploitation of the generosity and industry of others, with an ascendance of increase in the personal industry, privacy, courage, and self-reliance that made our country great.

I look forward to hearing from you.”

— Andrew J. Billups

About ajb

I am clinical psychologist and academic coach with more than twenty years of psychotherapy, academic coaching, and training experience. I operate from my base camp in the Chesapeake Bay Country of Tidewater Virginia. I have a long-term interest in the relationship among public policy, education, mental health, poverty, and change language.
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