A Case-Study in the Functioning of Social Systems as a Defence against Anxiety: A Report on a Study of the Nursing Service of a General Hospital Isabel E. P. MenziesFirst Published May 1, 1960 Research Article https://doi.org/10.1177/001872676001300201 Article informationA Case-Study in the Functioning of Social Systems as a Defence against Anxiety: A Report on a Study of the Nursing Service of a General Hospital – Isabel E. P. Menzies, 1960
Isabel Menzies LythIsabel Menzies Lyth – Melanie Klein Trust
Isabel Menzies Lyth
Isabel Menzies Lyth was born in Fife in 1917, the fourth child of a minister of the Church of Scotland. She took a double first in economics and experimental psychology from St Andrews, where she lectured for some years. Her tutor was Eric Trist, who was to become a leading figure in the field of organisational development. It was through Trist that during the war she was able to spend her vacations from her teaching at St Andrews working with the War Office Selection Board and, later, the Civil Resettlement Headquarters of the British Army. At the end of the war she moved to London and was the only woman in a group of psychiatrists, psychologists, psychoanalysts and social scientists who founded the Tavistock Institute of Human Relations, which offered research and consultation to organisations. Among this group were Wilfred Bion, John Bowlby, John Rickman, Jock Sutherland and Elliott Jaques. In this post-war period the influence of Melanie Klein, and then also Donald Winnicott, imbued the atmosphere of the Tavistock Institute.
In addition to her social research, Menzies began psychoanalytic training in London. Bion was her second analyst. It was an analysis which she said she undertook for herself, rather than the analysis required as part of her psychoanalytic training. Bion had a great influence upon her. In 1957 she qualified as a child analyst, and in 1960 became a training analyst of the British Psychoanalytical Society. Throughout her time at the Tavistock, she would see her patients in the morning and carry out social research in the afternoon (Dartington, 2008).
She had a significant role as a group-relations consultant, particularly at the Tavistock Institute’s international ‘Leicester’ conferences on the dynamics of authority and leadership.
Contribution to understanding organisational life
Menzie’s classic paper on the structure of a hospital nursing service, ‘A case-study in the functioning of social systems as a defence against anxiety. A report on a study of the nursing service of a general hospital’ (1960), has almost iconic status within the field of organisation theory and organisational consultancy. It is required reading for all who were interested in what is now termed the ‘system psychodynamic’ approach to organisations (Gould, J., Stapley, L. and Stein, M., 2001). In the paper Menzies made the original proposition that work in health care and social care organisations entail significant anxieties for staff and that defences against this anxiety are part of organisational life. In the introduction to the paper she describes how a hospital,
“…sought help in developing new methods of carrying out a task in nursing organisation. The research data were, therefore, collected within a socio-therapeutic relationship in which the aim was to facilitate desired social change.”From, ‘A case-study in the functioning of social systems as a defence against anxiety. A report on a study of the nursing service of a general hospital’ (1960), p.95.
The hospital had been finding it increasingly difficult to reconcile staffing needs and training needs. The senior staff felt that that there was a danger of complete breakdown in the system of allocating student nurses to practical front line work with patients, while also trying to train them effectively.
Menzies states that she took a position of considering the overt problem as the ‘presenting symptom’ and to reserving judgement on the real nature of the difficulties until she had completed the ‘diagnostic’ work. She set up a programme of data-gathering consisting of intensive interviewing, observational studies of operational units, and informal contacts with nurses and other staff. In an interesting footnote she refers to this as a ‘therapeutic study’ and writes of how the work in later stages shifted from diagnosis to therapy. She states that “presentation and interpretation of data, and work done on resistances to their acceptance, facilitate the growth of insight into the nature of the problem”.
She notes that as the research proceeded she “came to attach increasing importance to understanding the nature of the anxiety and the reasons for its intensity” (p97). For Menzies, the anxiety is connected to primitive anxieties aroused in the nurse by contact with seriously ill patients. She uses the description of infantile psychic life as elaborated by Freud, and more particularly by Melanie Klein (1959), as a conceptual framework. Above all, she draws on Klein’s view that the internal phantasy world of the infant “is characterised by a violence and intensity of feeling quite foreign to the emotional life of the normal adult”, seeing infantile-type primitive anxieties aroused for the nurses through intimate contact with patients. She describes how she sees these anxieties mobilised in the nurse around love, hate, aggression and suggests that the main psychological mechanism in use is projection. The nurse projects her own infantile phantasy situation into the workplace, experiencing the work as a deeply painful mixture of objective reality and phantasy.
Alongside anxiety is another crucial theoretical concept, the relationship between emotion and its ‘containment’; that is, the ways in which emotion is experienced or avoided, managed or denied, kept in or passed on, so that its effects are either mitigated or amplified. The capacity to think, on the part of individuals or groups, is related to the capacity for containment of anxiety (Bion, 1959) Going one step further, Menzies then suggests that this to-be-expected anxiety is amplified by the techniques used to contain and modify this anxiety.
The main message of her paper is the elaboration of how these defensive techniques are played out in the organisation of the nursing service. They are:
- Splitting up the nurse-patient relationship
- Depersonalisation, categorisation, and denial of the significance of the individual
- Detachment and denial of feelings
- The attempt to eliminate decisions by ritual task-performance
- Reducing the weight of responsibility in decision-making by checks and counter checks
- Collusive social redistribution of responsibility and irresponsibility
- Purposeful obscurity in the formal distribution of responsibility
- The reduction of the impact of responsibility by delegation to superiors
- Idealisation and underestimation of personal development possibilities
- Avoidance of change
Her conclusions give a powerful picture of dynamic processes at work within an institutionally defensive system.
Although people rely on social defences to contain their anxiety, they also desire to restore their experience of psychological wholeness and repair the real or imagined damage they have done in devaluing others. This desire for repair helps to limit the level of social irrationality in any group setting and provides a strong basis for moments of group development.
Perhaps the particular emphases of Menzies’ nursing paper militate against its being remembered and taken seriously. The paper illustrates the complex defence system used by the nursing system but does not address adequately what to do about it. This is a point that Menzies continued to feel strongly about. In an interview with Liz Webb and David Lawlor (2009) she asserted that the paper had been misunderstood and had led people to believe that providing support groups for staff was the answer to anxiety-provoking work. She was firmly opposed to this idea. She thought that the issue of anxiety was over-emphasised, in relation to the other side of the process – containment. She felt that the organisation needed to be designed in a way that offered staff effective containment of their anxieties.
Dr David Lawlor, 2016
1960 Menzies Lyth, I. ‘A case-study in the functioning of social systems as a defence against anxiety. A report on a study of the nursing service of a general hospital’, Human Relations. 13(2): 95-121.
Bion, W. R. 1959. ‘Attacks on linking’, International Journal of Psycho-Analysis. 40: 308-315, and also in Second Thoughts, London: Heinemann.
Dartington, T. 2008. ‘Isabel Menzies Lyth’ (obituary), The Guardian. [online] Available at: https://www.theguardian.com/science/2008/feb/20/1
Gould, J., Stapley, L. and Stein, M. (eds.) 2001. The Systems Psychodynamics of Organisations. Karnac: London.
Klein, M. 1959. ‘Our adult world and its roots in infancy’. In The Writings of Melanie Klein Vol 3, Routledge, 1975.
Lawlor, D. and Webb, L. 2009. ‘An interview with Isabel Menzies Lyth, with a conceptual commentary’, Organizational & Social Dynamics. 9(1): 93-137.
Lawlor, D. 2009. ‘Test of time: a case study in the functioning of social systems as a defence against anxiety: rereading 50 years on’, Clinical Child Psychology and Psychiatry. 14(4): 523-30.
Menzies Lyth, I. 1988. Containing Anxiety in Institutions, Vol. 1. London: Free Association Books.
Menzies Lyth, I. 1989. The Dynamics of the Social Selected Essays, Vol. 2. London: Free Association Books.
Thanks to the Archives of the British Psychoanalytical Society who have granted us kind permission to reproduce the photograph above of Isabel Menzies Lyth.