In our last Post we looked at anxieties about the work in Institutions and in particular, as so often in these Posts, about conscious and unconscious anxieties in the fields on Mental and Physical Health settings.
So in this Post we can look at some of the psychological defences which staff/teams use to defend against these anxieties. We might pause too, to reflect that anxieties cause pain and that the anxieties which we are thinking about today, are those connected to holding one self-image (and Team image) while experiencing feelings which are contrary, incongruent and conflicting with those self images.
Human beings try to avoid pain and this leads us back to the defences which defend against that pain.
Examples of institutional/team/personal - they all merge as one - defences against the anxieties of the work.
Splitting - this takes us back to Isabel Menzies Lyth where the nursing staff were understood to be split=off from all relational/emotional contact with the patients by means of 'task orientated nursing'.
Manic Denial: Behaving as if one is able to achieve far more than is realistically possible.
An example might be Team/ward that takes on ever more patients e.g. community nurses with caseloads far too large to manage: Think back to Open Systems Theory wherein a system can only survive by exchanging materials from the environment but if it is too 'Open' then it will become swamped and slowly malfunction to the eventual point of becoming dysfunctional.
Obsessional Routines: These can give an illusion of being in control and can also put a distance between Health-Worker and Patient.
Some years ago, when training as a general nurse I was working in a post-natal ward where the patients were, of course, new mothers: with their just-born infants - in psychoanalytic terms, a time of existential anxiety for both and where a sense of being in control was always precarious, a panicky feeling against which it was 'essential' to defend.
The ward sister, a competent, omnipresent but 'highly strung' nurse did have an 'obsession' and that was located within the realm of recording 'observations' on the ubiquitous' chart, i.e. temperature, respirations and pulse. Each one had to be in a different and specified colour and had to be marked with a ruler, not by hand and if there was any deviation from this, she became upset and indeed quite angry.
Well, this did indeed help her to manage her anxiety which may have reflected her conscious anxiety of 'getting things wrong' being blamed, falling-short etc. It may have reflected more unconscious anxieties concerning anger towards stressful mothers and babies, envy towards successful parenting....one could speculate but these are human feelings but often at existential odds with nurses and others' self image as selfless deliverers of care.
Lastly, we must add that these core anxieties stir-up and reverberate with our own personal, unresolved and largely unconscious anxieties - the more so as people are often drawn to a particular field of work out of an unconscious drive to 'repair' or resolve their own internal conflicts.
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