Isabel Menzies Lyth's 1959 paper 'The functioning of social systems as a defence
against anxiety: A report on a study of the nursing service of a general hospital' is
one of the classic applications of psychoanalytic ideas to institutional processes. It
has become a basic text on the social application of psychoanalytic ideas, and in the
education of psychoanalytic consultants. Its argument has however been subject, in
the half century since its publication, to rather little critical scrutiny or empirical
extension. Menzies Lyth believed that her research had exercised little influence on
hospital systems, although she may well have underestimated the lasting influence
of her ideas.
We believe that the theory of unconscious defences against anxiety remains a
powerful one. But its relevance to research and practice needs to be examined and
demonstrated, if it is to gain the place it deserves in applied psychoanalytical and
psycho-social research. These ideas needs to be reconsidered in relation to hospital
and other institutional settings, which may manifest their own characteristic forms
of anxiety and defence. Note also needs to be taken of larger changes in the
environment since the original thesis was put forward. Workers may feel
persecuted not only by the projected sufferings of those for whom they care, but
also by pervasive economic insecurities, and by methods of regulation which
augment rather than diminish anxieties. Further, the theory of 'borderline states',
advanced by psychoanalysts such as John Steiner and Ron Britton, has also been
shown to illuminate the particular form of defence known as 'not-knowing' or
'turning a blind eye', which has been implicated in a number of recent catastrophic
failures in systems of care involving children.
David Armstrong and Michael Rustin will explore in their talk ways in which
these ideas can be renewed and further developed.
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