23 mars 2010
The successful passage of health insurance reform legislation in the United States moves me to wonder about the extent to which scholars have looked into the role of health insurance in mental health care. About ten years ago, a number of us historians examined the impact of mental illness on social insurance in Germany around the years 1880-1930. Perhaps not surprisingly, the rise of shellshock in World War I and the killing of 200,000 psychiatric patients by the Nazis under their T-4 program provided the backdrop and inspiration for much of this research. In my own study of disability within early German social insurance (Making Security Social), I found that providing health care benefits to those suffering from work-related nervous illnesses prompted a vocal, organized, and persistent backlash from those who contended that the system was only rewarding malingering. The fact that some claimants contended that their nervous symptoms were caused, not by a factory accident, but rather by the torturous process of applying for a pension itself only seemed to confirm the view that social insurance and mental illness did not mix well. In fact by the 1920s and 1930s, "pension neuroses" – as they were called – were publicly pilloried by conservatives, liberals, and the Nazis as emblematic of a social insurance system that bred whining and undermined productivity and masculinity. Interestingly enough, however, the Nazis found it politically impossible to dismantle the social insurance system, despite the fact that many reformers in their party wished to do so. So, there is certainly historical evidence indicating that, indeed, insurance systems do create new constituencies that provide powerful support for the system's continuation.
So, I have some questions for others. Are there good historical studies out there (articles or monographs) which examine insurance's impact on mental illness and mental health and vice versa? What role has health insurance played in reinforcing or undermining professional, institutional, and social trends and practices? For instance, to what extent was social insurance responsible for the post-World War II boom in psychotherapeutic professionals and services? What role have pharmaceutical companies played in health insurance systems affecting mental health across the globe? What effects did health insurance schemes have on the process widely known as deinstitutionalization? Please post any responses on the blog.
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