Perverting the course of therapy: the fetishisation of governance in public sector mental health services

Abstract

In this paper, I draw on Freudian and Lacanian psychoanalytic theory to consider the notion of perversion and fetishisation within the context of contemporary UK public mental health services which have been subject to New Public Management restructuring. Offering an organisational case example based on clinical experience within an expanded NHS mental health service, I explore how services that are subject to neo-liberal regulatory and performance management systems sponsor a perverse organisational solution to the anxieties and difficulties of dealing with psychologically distressed patients. I conclude that theorising the unconscious dynamics of perversion and fetishism may provide an opportunity to rethink governmentality, offering a potentially fruitful means of addressing recent political concerns about the negative impact of a ‘target culture’ on public sector health services.

Keywords::

• fetishisation
• IAPT
• Lacan
• mental health
• NHS
• NPM
• organisational dynamics
• perversion
• psychoanalysis