Psychoanalysis evolved at a time when tradition in Europe was breaking down, when individualism was on the rise. Psychoanalysis took tradition and made it into an internal force, an internalized superego. Conflict between the individual's self-interested desires and the requirements of tradition became an internal conflict that could be mediated and resolved through the rational offices of the ego. Just as living in a time of rapid unpredictable change gives rise for longings for stability, the destabilizing elements of psychoanalysis are profoundly out of synch with the current cultural desire for stability and predictability. The core message of psychoanalysis is that people do not know what they want. Consumer capitalism takes advantage of this uncertainty, and the unease it engenders, to try to convince that the desires can be defined, and then met with products. Public health falls within the province of public funding, so accountability in terms of cost effectiveness is an especially crucial issue in the public sector.