So, to recall our last post, how did Tom Main understand the basic reversal of the changes that he and others had made, not so long ago, at the Cassel Hospital? Now, though espousing a 'liberal, progressive' policy of encouraging weekend leave for the patients (the content) this had now become as rigid and staff lead policy as the old one - of banning weekend leave.
Well, if this was thought of as a 'symptom' then we, following our model, must call it a defence so.....against what was it defending?
Remember here that defences are at rock bottom, defences against pain - in institutions that will be deep emotional and existential pain.
An institution will always develop defences against the anxieties inherent in the type of work with which it is engaged and the defences of its staff members will have to be broadly congruent with those institutional defences which will lead to stress and more observable symptoms such as high staff turnover, a culture of complaint/grievance, high sickness rate etc.
In the field of mental (ill)health this will revolve around the fear of mental ill-health, of one's own ability to remain mentally robust and have a coherent sense of self: In the UK of the 1950s remember, the societal defence against the fear of breakdown, madness etc was to shut those who had crossed that line (from 'sane' to 'mad') away - almost literally beyond the pale into asylums, which were themselves almost always 'outside the city walls' and behind their own physical and institutional wall.
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In the psychoanalytic model this is known as splitting - splitting into good/bad, right/wrong, sane/mad etc and it is a way of managing primitive anxieties (fears) by expelling/renouncing them in oneself and instead locating them outside the self into 'the other', where they can then, of course, be safely observed and attacked.
Staff at the Cassel Hospital would of course have already been attuned to this defensive position before working there and then been further indoctrinated into its component parts by the hierarchical and split nature of the institution.
In his seminal paper Knowledge, Learning and Freedom from Thought' (1967.1990, Tom Main described how he thought that:
'What had begun as a free-ego choice had grown into a fixed discipline. It was no longer that a particular choice could be relevant, characteristic, singular, useful or interesting; it had become either good or bad, a matter for conformance and not thought, an affair of the Nurse's super-ego and not her ego'. p.7
In other words, the nurse was simply enacting which was true of the whole organisation i.e., something that had, in one generation, been thought through via the organisation's ego (thoughtful, open to change but grounded in reality) had now, in the next generation, been lodged, upwards and backwards into the organisation's superego. That is to say, into the part which 'aims for perfection and prohibits the expression of drives, fantasies, feelings and actions' - the part that substitutes the word should for the word maybe.
So far in this Blog we have looked at the Psychoanalytic aspect of the Tavistock Model of Organisational Consultancy but it is in fact made up of two interconnected models, the second being one being called Open Systems Theory and this may be a good time to slightly prematurely, introduce this aspect.
An organisational consultant using this model, will be broadly interested in both of the attributes of these two, sub-models: An example of using the psychoanalytic model might be, you first visit a setting into which you have been invited but when you get there for your first visit, you cannot find the door and when you do, nobody answers the door-bell and when they eventually do, the staff member has no idea who you are! How do you feel? This is the counter-transference and of course, part of the analytic component.
In terms of the open-systems aspect (into which we will go in much more detail later) this is much more about what is physically apparent, - the closed door, how people communicate with each other, who can communicate with whom and how do tangible systems encourage this?
How did this manifest in the Cassel Hospital? Well, after months, then years, of patients being encouraged to go on weekend leave, slowly it became the institutional norm, too, for staff to go on weekend leave i.e. to have weekends off and they rather liked this.
So, the anxiety of the work remained, of course exactly the same (see above) but the institution had altered it's overt stance (open systems - what you see/hear/know) but bowed to the unconscious - the staff were still in charge (superego) and instructed the patients to do as they were told - just as before.
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