In our last Post, we looked at the theoretical background to the respective, Paranoid-Schizoid (P-S) and Depressive (D) Positions, planning in this Post to look at its practical relevance to Institutional Dynamics.
So, let's look first at the characteristics of each position:
Paranoid Schizoid Position functioning is characterised by:
Splitting - them/us, good/bad.
Blame - the bad is outside the team or outside the agency
Persecutor anxiety - fear of punishment and/or retaliation
Primitive defences such as manic denial, obsessional defences, idealisation/denigration (denial of reality).
Depressive Position functioning is characterised by:
The capacity to reflect thoughtfully about difficulties and staying in touch with reality.
Tolerating having ambivalent (mixed) feelings towards others.
Tolerating the reality of one's limitations without feeling too persecuted by a sense of failure for which one will be blamed/punished or.......having to resort to blaming others,
Blame comes from within ourselves (guilt and remorse) rather than being perceived as coming primarily from others.
Effective problem-solving requires depressive position functioning. To stay in or to regain the depressive position we need adequate containment. If an individual or a Team is excessively blamed or feels punished (e.g by cuts) or when containment decreases (e.g. a lack of supervision, constant restructuring) this is likely to stimulate persecutory anxiety and a retreat to the P-S position.
So, let's introduce some other factors that need to be considered in all of this organisational analysis:
All staff members (people) work within specialities - child and adolescence, addictions, psychoanalytic psychotherapy etc etc - you may be there out of 'coincidence' but if you stay and specialise in this field then this area of Mental (ill) Health must resonate with a core part of yourself.
As part and parcel of the above, there will be a pull (a valency) towards the staff team's and its members' pathology beginning to mirror the pathology of the patient group and especially when in the P-S Position.
So, a Child and Adolescent (C&A) team which is constantly criticised for not admitting enough patients, for not keeping-up with new changes to recording information and/or for a spike in incidents of self harm or suicide will be prone to retreat into the P-S Position and like any other team blame, in their case, outside managers, Social Services, education depts. etc for their 'failings'.
This is a classic symptom of P-S functioning but it may manifest in a particular way in this team i.e., in a kind of mirroring of the C&A defensive pathology e.g., taking up a child position of blaming 'adults' - acting-out in an aggressive and sabotaging way, not complying, 'dumb insolence', passive aggression etc.
Again, as with adolescents the team may be suffering from a lack of containment - a lack of a containing and enabling parental couple.............so we might think here too, of Winnicott's ideas about 'male' and 'female functioning i.e. doing to and being with and the need for these to be balanced and tempered to the situation.
In our next Post we will look further at particular areas of Health both physical and mental and the particular anxieties that they engender.
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