Reason and Rationality in Health and Human Services Delivery

Science and Western medicine have customarily focused on the pursuit of reason and rationality in the never-ending quest to cure diseases and prevent illness. In fact, anything less than complete, value-free objectivity and neutrality is considered antithetical to the goals of medicine and pure science. For the most part, this objective remains the gold standard for medical practice, medical research, and medical care delivery. Consequently, consumers' subjective experiences of illness and use of services has been largely ignored.

Recently the principles of reason and rationality have begun to pervade all of the human services, and the behavioral health field in particular. The principles and goals of managed behavioral health care mirror the aims of reason and rationality in traditional medicine and science. Clearly, without some preparation and planning, the system would produce utter chaos. But is the relentless pursuit of complete objectivity guided strictly by reason and rationality appropriate for the rapidly changing, postmodern world of health and human service delivery? Even if the answer is an unequivocal yes, some skepticism and criticism are still warranted. For that reason alone, this book is a breath of fresh air.

The book is a provocative collection of scholarly articles examining the current state of a health and human service delivery system steeped in the principles of reason and rationality. It is timely and relevant, especially as managed care continues to exert force within and outside the behavioral health care system. The editors and contributors are experts in the fields of medical sociology, social science epistemology, social policy, epidemiology, and human service delivery.

Throughout the book's comprehensive introduction and seven chapters, the authors attempt to critically assess the forceful role of reason and rationality in such areas as management information systems, epidemiology, health care delivery, health care decision making, and health policy. Although a specific audience for the book is not identified, it would be appropriate supplemental reading for students and professionals interested in the epistemology of health and human service delivery, primary care medicine, human services management, epidemiology, public health, gerontology, managed care, health policy, and behavioral health care.

Readers of Psychiatric Services will find the book relevant to direct practice, program design and evaluation, policy formulation and analysis, and especially consumer empowerment. For many consumers and their families, empowerment is empty rhetoric. The authors hope to change that dynamic by uncovering a health and human service delivery system that largely ignores the complex social lives and cultural context of its clients.

Although the contributors do not entirely discount the need for reason and rationality, they recommend a good-faith attempt to acknowledge and account for the life-world of citizens and consumers. For some social workers and psychiatrists, their plea will be familiar. But for others in the field, the authors' perspective will be new, bold, and compelling. One hopes that the authors' views and recommendations will be disseminated and will help modify the current service delivery system. Only then will the editors' true, albeit implicit, objectives be met.

In the end, if reason and rationality are so superior to subjective interpretations of health and human service practice and policy, why are 43 million people uninsured? Why are more women and children expected to become impoverished under current federal and state welfare reform laws? And why does the U.S. government spend more money on interdiction against illicit drugs than on funding for substance abuse treatment programs? Politics aside, these questions might not have to be asked if policy makers and program planners consulted the life-world of citizens before developing one-size-fits-all social policies couched in criteria based solely on reason and rationality.

Mr. Provost is affiliated with Concord-Assabet Family and Adolescent Services, Inc., in Acton, Massachusetts.