The Processual Ordering of Mental Health Care: The Dramaturgical Styles of Contending Political Factions

Abstract

The processual ordering branch of symbolic interaction has long recognized the importance of rhetoric and power to the social constitution of reality. However, little systematic effort has been devoted to probing their intertwined effects in the public policy arena. The purpose of this paper is to employ the processual ordering perspective to examine the dramaturgical styles used in shaping public policy-expressed in terms of the "public administration" and "realpolitik" forms of rhetoric-among contending political factions as they negotiate mental health public policy. A latent content analysis of the minutes of key U.S. Congressional debates, augmented with secondary archival material from the press is employed. It is concluded that both forms of rhetoric play a role in shaping public mental health policy and that both factions modify their rhetorical form as the debate progresses. Those modifications strengthen the position of one faction while weakening that of the other. Theoretical implications are discussed. Affordability and accessibility, in my view, are the two important words. Forget all the others-affordability; accessibility. .. I do not want to be misunderstood. In the Republican minority's proposal] you will not find the National Health Board. You will not find price controls. You will not find mandates and you will not find new taxes. You will not find these because our bill is not based on the principle we have to get more government. I think it is based on the principle that the American people know best. (Senator Robert Dole, Rep., Kansas, *S11012) Health care reform plans designed to make health care more accessible and affordable would continue the discrimination prevalent in private health insurance today. Many plans allow 365 days for in-patient physical care, but only 45 days of in-patient psychiatric care; provide unlimited coverage of office visits for physical care, but only 20 visits for psychiatric care; and provide up to $1 million in lifetime coverage for physical care, but only $50,000 lifetime coverage for mental health care. These are discriminations that we cannot let continue, especially if we reform the health care programs, more particularly if we reform the insurance programs of our Nation.