In our last Post we looked at the spectrum between the P-S and D positions of functioning and as to how 'effective problem solving requires Depressive Position functioning' and that for this to function, we/teams need adequate containment.
First there are conscious anxieties which might be valid across all health specialities:
Performance anxiety - am I doing well enough?
Personal/interpersonal anxiety - am I liked or appreciated?
Business anxiety - are we financially viable?
Anxiety about an uncertain future - restructuring, redundancies etc.
Clinical anxiety - will my patient kill themselves. Can i cope with my case load?
Then there are the unconscious anxieties and for these I will just chose a couple of specialities within health care.
Physical Health: U/Cs anxiety - Guilt etc about feelings of disgust or attraction towards patients.
Many years ago, when I was working as a General Nurse in a large District General Hospital, I, like all nursing staff had to collect, clean up, dispose of etc pretty much all human waste, fluids, solids etc that one can imagine - this was part of the job and few nurses would baulk or complain about this although, interestingly cleaners would baulk at this and indeed have contracts saying that they did not do this.
However, I noticed that there was one bodily product that was an exception to this rule and that was - SPUTUM! Nurses were 'allowed' to say that of all such tasks, the one that revolted them - 'it makes me cockle' - was sputum-specimen collection, as if cleaning up,say, loose faeces/diarrhoea was enjoyable or even simply 'par for the course....barely noticeable....'
We might speculate that this (Sputum!) served somewhat as the 'canary in the coalmine' alerting us to an underlying and more pervasive and indeed, inherent sense of disgust that was part of the relationship between nurse and patient but which had to be defended against. (See earlier post - Isabel Menzies-Lyth).
2. Mental Health - Fear of the mad parts of oneself and one's mad habits and/ or anxiety
about fragmenting thought processes.
I was conduction a long-term, group-analytic psychotherapy group where one of the members had some years ago, started his mental nurse training but was then himself admitted to an acute admissions ward in a psychiatric hospital - a ward in which he had once, not so long ago, had a placement.
He decided that he wanted to make himself a cup of tea and went into the kitchen to do this when an irate staff member rebuked him and ordered him out of the kitchen - these were staff cups and he was not allowed in there!
He had been humiliated and this sense was still palpable when he told this story, in the group and years later: So, in terms of our model, how could this be understood?
In the P-S position the most common defence is splitting and projection - so the staff member was in tune with this organisational defence i.e., that madness/badness lay within the patient group. Sanity, health, goodness etc lay within the staff group and if any of the former leaked into the latter then it must be immediately rejected and ejected.
Remember this was an acute admission ward and there could be no rational understanding as to why staff and patient cups should be separate but it was if, unconsciously, the 'disease' of mental illness might contaminate staff through the cups.
In teams where there is a more contained and hence open and self-aware regime, these splits could be repaired/ameliorated and so the team might move from the P-S position to the D position where staff and patients could problem-solve together with a much more satisfying and fruitful engagement which would benefit the Team's primary task.
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