Accreditation as a social defense

Healthcare management struggles to be both a scholarly discipline and a legitimate practice. Legitimacy is often equated with being “business like”. As such, healthcare management scholars and practitioners have made “professionalization” a priority in an effort to legitimize the field (Gerard, 2019; 2021). Accreditation is at the center of this effort.

Accreditation of healthcare management programs (along with clinics, behavioral health programs, and hospitals) makes sense on the surface, but it is also a way that faculty and students (and clinicians, managers, and executives), unconsciously, protect themselves from having to confront the field’s complicity with questionable managerial techniques that at best reinforce existing health (and healthcare) inequities and, at worst, exacerbate social injustices.

Working in healthcare settings, as managers and as clinicians, requires awareness of self and other experiences in the face of acute fear, anxiety, loss of hope, and even death – while holding hope for recovery, health, and life. Yet, in today’s healthcare environments, managers and clinical staff avoid these emotional complexities with technical models, data-driven interventions, and pretentions to rigorous science. The psychoanalytic question here: what do these efforts represent unconsciously, and what do they attempt to cover over or deny?

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The psychodynamics of bearing witness

We all see “bad stuff” that is toxic and traumatic in nature and harmful to others, animals, economies, and the environment. Those that bear witness are fundamentally injured in ways that are individualized and deeply personal. The fantastic nature of the witnessed event(s), such as the recent footage from Ukraine, is accentuated by unconscious dynamics such as fantasies, selective retention and recall, and mediated by rationalization and denial, transforming the moral injury to make it tolerable. What happened is manipulated in mind to minimize the stress of the witnessing and the anxiety about having “helplessly” observed. Bearing witness suggests that writing and speaking about the “knee on the neck” also helps to “process” what was witnessed.