Aging & Wisdom Quote by Albert Ellis

Ellis isn’t lamenting a bygone golden age of patient openness; he’s pointing at the plumbing of American mental health care and naming it as the real gatekeeper. The bluntness is the tell. “In the old days” sounds nostalgic, but he immediately undercuts sentimentality with a transactional metric: referrals. The unit of meaning here isn’t healing, it’s access. Therapy happens, or doesn’t, based on how a third party chooses to reimburse it.

The subtext is a quiet indictment of managed care’s power to shape clinical reality. HMOs aren’t just insurers; they’re informal editors of what counts as legitimate treatment, which clinicians are “in network,” and how many sessions a person is allowed to need. Ellis frames affiliation as the bottleneck: the issue isn’t demand for therapy, it’s the shrinking set of sanctioned relationships. In that word, “affiliated,” you can hear the soft coercion - clinicians adapting their practice, paperwork, and pricing to fit institutional requirements, or losing patients.

Context matters: Ellis built his career on making therapy more direct, more efficient, and more broadly usable. Yet even for someone committed to pragmatic treatment, the HMO era reads as a downgrade - not because it demands efficiency, but because it rations choice under the language of coordination. The quote works because it drags an economic story into a space we prefer to moralize: if fewer people are getting help, it may be less about stigma than about networks, contracts, and who gets to be “covered.”