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'The Christmas Carol' and the Newtown peril

January 10, 2013
by H. Steven Moffic, MD
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Whew! My timing was sure off on my last blog. Soon after writing about laughter being the best gift, we had the tragedy of the killings, mainly of young children, in Newtown, Connecticut. I, and the nation, were in tears. As we search for solutions, I was comforted and challenged by a play.

Even though I'm Jewish, I've always enjoyed seeing the Christmas Carol over the Christmas Holidays. but this year my wife and I saw it several times. At first, I didn't know why, but it gradually became apparent.

Recall the story. In the English Victorian times of the author Charles Dickens, Christmas was arriving. All seemed to be celebrating with family and generosity, except for Ebeniezer Scrooge. Instead, he is busy counting his money and will only loan money, not give it away, for a good cause. Even then, he will only loan with prohibitive interest. "Bah, Humbug!", is his response.

Then he is visited by the ghost of his prior business partner, Jacob Morley. Morley warns him of a horrible afterlife in chains like himself, unless Scrooge changes. He is to be visited by the spirits of Christmas Past, Christmas Present, and Christmas Future.

As it turned out this time around, these spirits, taken all together as one, reminded me of the best of psychotherapy. They review his isolated childhood, his failed attempt of being in love, and turning instead to the security and control of money. At his future death, everyone cheers and his home is robbed. Quite a eulogy! His poor employee's lame son, Tiny Tim, has also died for lack of adequate healthcare.

Scrooge obtains insight from the spirits and changes his ways. He is happy, and Tiny Tim survives with the best of healthcare. Gloom lifts and laughter reigns.

In our time, the children who were killed in Newtown were about the age of Tiny Tim. My professional organization, the American Psychiatric Association, expressed regret and called for more gun control and improved mental healthcare access and the kind of treatment which might have prevented the mass murders of so many, by people who seemed to have untreated - or minimally treated - mental illness.

But, who is the Scrooge here? It may not be just one person, or even a person.

One candidate is a system. That system is for-profit managed healthcare run by insurance conglomerates. In the past, as I depicted in The Ethical Way: Challenges and Solutions for Managed Behavioral Healthcare (Jossey-Bass, 1997), these companies put business ethics and making money ahead of healthcare ethics and patient care.

The present is now an increasingly managed care system, with inadequate access to resources for quality care, worse even in behavioral healthcare than the rest of medicare care.

The future, even as President Obama's healthcare reform continues to roll out, may not be much better, given no  public option and more lives covered by these for-profit insurance companies, even with some new controls. Another candidate for Scrooge could be the politicians who are currently fighting, Scrooge-like, over the money, called the "fiscal cliff."



H. Steven Moffic

H. Steven Moffic

H. Steven Moffic, M.D. retired from the clinical practice of psychiatry and his tenured...

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