The perversion of care: Psychological therapies in a time of IAPT

Abstract

In this article, I argue that sweeping changes brought in by the government's Improving Access to Psychological Therapies (IAPT) programme have resulted in a perversion of care where National Health Service (NHS) mental health services now disavow the realities of suffering, dependence and vulnerability and turn away from the complexities of managing those in psychological distress. Drawing on work by Freud [1927. Fetishism. In SE Vol XX1: The future of an illusion, civilization and its discontents and other works (pp. 147–158).], Steiner (1993. Psychic retreats. London: Routledge.) Chasseguet-Smirgel (1981. Loss of reality in perversions – With special reference to fetishism. Journal of the American Psychoanalytic Association, 29, 511–534.) and others, I argue that the NHS ‘market for care’ turns a blind eye to the emotional realities of suffering, instead constructing what has been identified as a ‘virtual reality’ where attention to targets, outcomes, protocols and policies is privileged over attention to the patient's psychological needs. Drawing on an organisational case example, I propose this virtual reality is part and parcel of a more general fetishisation of governance systems within the NHS, which is used to mask unbearable feelings of helplessness in the face of our limitations when trying to help those in psychological distress.