legend, myth and idea: on the fate of a great paper

LEGEND, MYTH AND IDEA: ON THE FATE OFA GREAT PAPERbjp_1176 219..227

Andrew Cooper

abstract Isabel Menzies Lyth’s seminal paper on social systems as a defenceagainst anxiety is so well known and frequently cited that it risks acquiring mythicor legendary status. But what explains its phenomenal influence? In this contribu-tion I suggest that it is a model example of the psychoanalytic case study, derivingits power from a deep engagement with organizational particularities as a basis forgeneral theorizing. Its continued influence depends upon the way in which it isused to conceptualize new organizational experiences. An example from an insti-tutional observation undertaken as part of an advanced social work training at theTavistock illustrates this. Institutional observation is one of a range of non-clinicalpsychoanalytically informed methods of training at the Tavistock, and in the finalpart of the paper I discuss new applications of Menzies Lyth’s work that aim toilluminate the irrational forces shaping modern social policy. Death and anxietiesabout death emerge as a subtext of the present paper, perhaps reflecting the factthat it was prepared as part of a memorial conference to Menzies Lyth herself, andalso that the paper taught us to think better about death as an aspect of organiza-tional experience.

Key words: Isabel Menzies Lyth, case studies, death, the Quakers, social policy

In the anniversary year of its publication how many of us can name any-thing Charles Darwin wrote other than The Origin of Species? How manyof us have read The Origin of Species? Among our students and col-leagues, how many could name more than one paper written by IsabelMenzies Lyth, and how many can provide the title of that one paper fullyand accurately? That paper. It’s a bit like The Communist Manifesto.Within our admittedly rather small and esoteric community, it is so famousthat it is in danger of acquiring modern celebrity status – that is, of beingfamous for being famous, while being properly read by a declining groupof people. What a terrible fate.

Why has it acquired such status? Psychoanalysis is built upon a foundationof individual case studies – The Wolf Man, Little Hans, Richard and so on. Ibelieve that, when the single case study works, it does so because it captures

andrew cooper ba mphil cqsw dip app soc studies mbap is Professor of SocialWork at the Tavistock Clinic and University of East London. He has a long-standinginterest in the application of psychoanalytic thinking and experience to the analysisof social life including the evolution of the British welfare state. With Julian Lousadahe co-authored Borderline Welfare: Feeling and Fear of Feeling in Modern Welfare(Karnac, 2005). Address for correspondence: The Tavistock Clinic, 120 Belsize Lane,London NW3 5BA. [[email protected]]

© The authorJournal compilation © 2010 BAP and Blackwell Publishing Ltd, 9600 Garsington Road,Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA. 219

the deep particularity of that case, and simultaneously shows us how itnecessarily partakes of the universal, general or invariant principles of whichthe case is an unique instance. In this way the good case study embodies aparadox. Great case studies work in the same way as great novels or poems.If a case study achieves this kind of stature, then time, social change, newtheoretical developments and so on do not invalidate its core of validity,despite the fact that it will come to seem dated. ‘A case-study in the func-tioning of social systems as a defence against anxiety: A report on a study ofthe nursing service of a general hospital’ (Menzies, 1960) does seem datednow, and I believe this is partly because the nature of organizations in oursociety has changed sufficiently since 1960 for us to need to stand back andask: ‘Do we need to revise the theoretical precepts that inform this greatpaper, and which it also generated?’ (Cooper & Dartington, 2004).

As I thought about the various ways in which I wanted to explore thisquestion to which the answer is both ‘yes’ and ‘no’, I found that most ofwhat I wanted to say was about death. Perhaps that is apposite in a wholenumber of ways, just one of which is that the paper was prepared for amemorial conference to commemorate the life and work of Isabel MenziesLyth. Perhaps people, or at least some people, die differently now fromhow they did in 1960. But, as Ludwig Wittgenstein (1972, p. 72) onceobserved: ‘Death is not an event in life: we do not live to experiencedeath’. I suspect that, however we die, dead is dead and always was andalways will be.

So, firstly, the particularity of the case study; students who undertakeinstitutional observations within the Tavistock tradition do so in the benignshadow of Menzies Lyth’s paper, and will always do so, I suspect. Anxietyand defences against anxiety are one key idea you want the student to gethold of through observation, and to get hold of through experience. If astudent does not have the opportunity to undertake a personal analysis ortherapy as part of a course or training, the Tavistock tradition has devised allsorts of pretty good substitutes – group relations events, infant observation,experiential groups and institutional observations. A post-qualifying socialwork student decided to undertake his institutional observation by attend-ing Sunday morning meetings at his local Quaker meeting house. In thesilence of the meeting he describes how often his thoughts turned to death.He wonders why this should be and then at one point, reflecting partly onthe age of the majority of those attending, he asks himself whether thisnon-proselytizing religious institution might harbour unconscious anxietiesabout its own capacity to survive.

During my observations individuals felt moved to share poems or lines fromthe Bible:

He read aloud the poem ‘This was The Summer Day’ by Mary Oliver whichended with the line ‘Tell me, what is it you plan to do with your one wild and

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precious life’ . . . I felt suddenly wonderfully positive and wanted to clap. No onesaid anything or moved and David sat back down and closed his eyes. I thought‘Yes, what am I do with my one precious life?’ Any thoughts of death or dyingsuddenly left me. (Week 4)

This felt to me to be an attempt to challenge the ‘deadliness’ which existed inthe group, an attempt to bring life back into the organization. The Quakershave a long and proud tradition of pacifism and non-intervention, they areagainst wars, but does this become a form of death in itself? I felt myselfanxious on behalf of these gentle people who seemed unable to ‘save their ownlives’; I became worried about whether they could save their organization.Hopes for the future focused in my mind on a young boy who attended thegroup with his mother:

The 4 year-old boy I had noticed before sat next to his mother. He looked aroundthe group, fidgeted on his seat and whispered to his mother. He then silentlystarted counting by pointing at everyone as he went round the circle. I smiledbecause this is often what I did – without pointing. (Week 9)

The 4 year-old stood up and took his mother’s hand. They both left to go toanother room next door. I felt sad as they left as all life seemed to leave the room.(Week 9)

It seemed significant in my mind that the young boy could not stand the‘deadly’ silence for long periods and left after only 10 or 15 minutes of thegroup meeting to play next door. He being the youngest member, it also felt tome as if life was leaving the room as he left.

The endings of the meetings were almost as enigmatic to me as the start orthe content. As I entered the room the group were already in silence, nobodyever said:‘Right we are all silent now, so say nothing’. For all I knew as I enteredit felt as if they could have been sitting in the meeting room all night. It wasalmost as if the sudden ending was like a death itself, a sudden inexplicablechange in the group:

Suddenly a woman in her early 60s, who looked like an ex-head-teacher stood upand everyone moved. I was taken aback at the sudden movement, which seemedout of keeping from the previous hour’s silence. (Week 1)

(Jordan, 2008)

Psychoanalytic psychotherapy is largely in my view the practice of helpingpeople think thoughts that have hitherto been too painful or difficult tobear. To do this the therapist must first be able to bear the unbearablethoughts and feelings in that field of experience we call the countertrans-ference. I think Isabel Menzies Lyth taught us that institutions are asked toperform a similar kind of work on behalf of society and that, like thera-pists, or anybody, they sometimes do it well and sometimes not so well, andsometimes they need help with the difficulty of the task. The thought thatyou may be dying as an institution after some hundreds of years may justnot be thinkable.

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This student did not know until I told him that there is more than acoincidental connection between the practices of Quaker meetings, and theteaching and learning methods of the Tavistock Clinic. In his paper on thistheme, ‘The Quaker connection in the Tavistock Clinic’s development’,Sebastian Kraemer says:

When I arrived at the Tavistock Clinic as a psychiatric registrar over thirtyyears ago I remember thinking that the reflective practice of seminars, includ-ing the arrangement of chairs in a circle, might be something like a Quakermeeting, though I had never (and still have not) been to one. Only recently didit occur to me that there may actually be a connection. It turned out there wasmore than I expected. (2007, p. 1)

He later quotes from a lecture by John Rickman, one of the analysts whoinfluenced those who shaped Tavistock methods, about the Quakers:

There is an element of mutual admiration and a tendency to undue exaltationof the performances of the members or of the group as a whole, but there isanother and more valuable process at work as well: the production of anatmosphere of tolerance towards the expression of any idea irrespective of theeffect that the idea may have on the individual or on society. I do not want tominimize the dangers of this atmosphere. (Rickman, 2003, p. 287)

The ‘dangers of this atmosphere’, when applied to the study of institutions,are equally not to be minimized, and I have known observers (not just 4year-old children) find it impossible for one reason or another to see throughthe task of simply sitting and bearing their emotional experience in anorganization for one hour. But whatever is learned about an organization’sanxieties and methods of defending itself against anxiety via this method, Iwant to stress that what it gives access to is the very particular nature of theparticular organization under study. We cannot jump to the conclusion that,for example, it is a function of all organized religious institutions to contain ormanage anxieties about dying on behalf of the wider society, although, as Ishall explore a little later, this may not be a completely silly hypothesis.

I said that maybe the model of organizations implied by Menzies Lyth’spaper might stand in need of revision. I briefly want to explore why. I amindebted to my colleague, Tony McCaffrey, for the following succinct andoriginal way of telling the changing story of anxiety in human service organ-izations over the last 20 or 30 years.

The story begins with the familiar idea for which we are indebted toMenzies Lyth – the organization as container of professional anxiety arisingfrom the nature of the primary task. Strong systems for the provision ofreflective supervision to front line staff might be part of this picture. But at acertain juncture, in the 1980s perhaps, new forms of anxiety begin to beardown on institutions. ‘Rationing anxiety’ arises as we lose faith in the infinitecapacity of the state to fund health and social welfare in this country – people


are living longer, the proportionate tax base to fund pensions and the eco-nomically inactive is shrinking,medical technologies are proving expensive aswell as effective – and in recognition of these developments, or perhapsemphasizing them at the expense of seeking state-funded solutions to them,new ideologies of welfare and health provision make their appearance. Thetension that begins to appear is well illustrated in a story told by TonyMcCaffrey (personal communication). He was consulting to a group ofmanagers in a north London hospital, struggling with the impact of costsavings, so that acute bed spaces were full to overflowing.There was a seriousroad accident on a nearby busy highway, and a patient was flown into thehospital by air ambulance.The A&E manager arrived late to the consultancygroup as a result, related this story and added: ‘But, fortunately, the patientwas dead on arrival’.

Markets or quasi-markets make their appearance and in their wake comesthe whole panoply of performance management systems, audit regimes andregulatory practices with which we are all familiar. New forms of survivalanxiety appear – less directly associated with money, more with quality andthe measurement of quality. For short, we call this ‘performance anxiety’. Asthe imperative towards a mixed economy of care evolves in tandem with thenew commissioner–provider split, compulsory competitive tendering and‘contestability’, traditional boundaries between different sectors of provi-sion – public, private, independent – become blurred. Services are deliveredvia partnerships, networks and multi-agency systems and frequently no oneseems to have single overall control or authority within these systems. Thepeculiarly named phenomenon of ‘governance’ appears in an effort toprovide some form of order in the face of the potential chaos of these newsystems, many of which operate at arms length from the state. ‘Partnership’or ‘governance anxiety’ is added to the gallery.

Increasingly, a fracture appears within organizations; senior and middlemanagers face ‘outwards’ in their effort to manage the demands of cost,competition, performance and partnership, leaving front-line staff isolated intheir struggle with the face-to-face task, which in truth may not havechanged that much. Most first line and middle managers to whom I haveshown the diagram (see Fig. 1) seem to recognize the picture – more thanone has said something like ‘I walk along that jagged line every day’.

My question is: in the face of this story, does the traditional psychoanalyticstory of organizational anxiety and defences against anxiety need somemodification? I believe it does. Or maybe it always did present a rather tooneat and simple account of how anxieties are generated and contained (ornot) in organizations. Maybe the emotional life of organizations always wasrather more politically and socially inflected than we recognized? But onceagain, maybe the great and illuminating case study works precisely becauseit does edit out complexity, or ‘noise’, leaving us with a kind of ideal type or‘pure culture’ of something.

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Whatever, I seem to be proposing that we cannot any more usefully modelthe nature of the emotional life of organizations without attention to theimpact of the policy and political environment. So can Isabel Menzies Lythhelp us with this re-modelling? I think she can.Another great strength of thecentral idea about task, anxiety and social systems as a defence againstanxiety is how widely, not to say wildly, generally applicable it seems to be.Anything, one suddenly realizes, that looks remotely like a social system orsocial process might actually be functioning as a defence against anxiety.

Now this has given rise to some wonderfully exciting and I believe impor-tant ideas, even if they are ideas that are very difficult to evidence in asystematic way. In his chapter on ‘Social Anxieties in Public Sector Organiza-tions’,Anton Obholzer (1994) wrote the following, now quite famous, words:

In the unconscious, there is no such concept as ‘health’. There is, however, aconcept of ‘death’, and in our constant attempt to keep this anxiety repressed,we use various unconscious defensive mechanisms, including the creation ofsocial systems to serve the defensive function. Indeed our health service mightmore accurately be called a keep-death-at-bay-service. (p. 171)

* This diagram is reproduced with the kind permission of Tony McCaffrey.

Anxiety in Organizations – a history

Professional Anxiety

Rationing Anxiety

Performance Anxiety

The organization as container of anxiety

Coal FaceSenior Management

Partnership

Anxiety

Fig. 1: The evolution of public sector anxieties*


If this is the case, can we in any way explain what sometimes seems to bea determined effort to ruin our health service via the imposition of efficiencysavings, targets, audit, performance management regimes and so on? Is thecollective unconscious somehow sabotaging itself? Maybe so, and I willconclude with a few thoughts on this.

But first let me give some personal, observational evidence for Obholzer’sthesis. It was my recent misfortune to be admitted to hospital with a nastyinfection that had got out of control. Looking back I think I was prettyanxious about the whole experience. I spent a lot of time closely observingthe institutional processes around me, and sometimes being inflicted uponme – presumably, this is a case of the functioning of institutional observationas a defence against anxiety. It did seem to me that the many, many systemsthat go to make up the total life of the hospital ward were hopelessly illco-ordinated. Nursing, catering, cleaning, pharmaceutical, infection controland medical systems seemed to intersect terribly poorly, and within them-selves to effect very poor handovers between shifts. I observed a patientbeing admitted to our ward late at night, and later his relative asking him thewhereabouts of his hearing aid.After his relative had gone, a nurse appearedand began to ask him questions.After a while I did intervene and say:‘I thinkthis man wears a hearing aid’, and she thanked me. But next morning thisinformation seemed to have been lost. I gave up trying to solve all thesystemic problems around me and settled for trying to be a patient, thoughclearly, as my fellow patient answered yes or no to questions from doctorsthat I thought he could not hear, this loss of information in the system waspotentially dangerous to him.

Death made its appearance in the following way: another man was trans-ferred into our little six-bed ward space late one night as I was trying tosleep. Then I heard his wife come beetling down the corridor, saying: ‘Areyou alright now? I’ll see you in the morning. ’ ‘Is there any chance of a dropof water?’ said the man. ‘No, no, you’re in the hospital now, you can’t haveany water,’ said his wife. ‘Ah, well,’ came the reply, ‘a man could feckin’ diein here then.’

My colleague Liz Webb and I have been teaching psychoanalyticallyinformed social policy to our social work students here at the Tavistock forthe last few years. In truth, given there is not much of a tradition of suchwork (but see Cooper, 2009), we and the students have largely been makingit up as we go along. Isabel Menzies Lyth has, for better or worse, been ourconstant companion on this voyage. Modern social work is deeply impactedby what seem, intuitively, to be anxious social and political responses toevidence of risk, failure, and damage in our society. Interrogated from thiskind of perspective many of the all too familiar instruments of modern socialpolicy – regimes of audit, inspection, regulation, procedure, risk manage-ment and so on – themselves turn out (on closer inspection as it were) tohave something to do with an effort to ward off death, or the fear of death,

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or the fear of being blamed for death. ‘We must ensure this is never allowedto happen again’ is the common political response to the emergence intopublic awareness of a new tragedy. ‘And to ensure this never happens again,my civil servants will write some new procedures’ is what usually ensues. Ithink most of this superstructure of inspection and checking is actually aform of ritual, and that those who administer it are priests of the variouschurches that have grown up to help us manage our anxieties about death ina secular age.

It might be a surprising thought that the contradictions of modern socialpolicy can be partly explained by their ‘excess rationality’ which in turnmight derive from contemporary misconceptions about the nature of(social) science, society itself, and their relationship to faith, including reli-gious faith. But if so then so much the better, for we need a world full ofsurprises.The philosopher and literary critic,Terry Eagleton, has given voiceto some of what I’m hinting at here:

A society of packaged fulfilment, administered desire, managerialized politics,and consumerist economics is unlikely to cut to the kind of depth wheretheological questions can even be properly raised, just as it rules out politicaland moral questions of a certain profundity. (Eagleton, 2009, p. 39)

So, here is a little meta-theoretical support for a grand, if so far ratherloosely elaborated thesis about modern social and political formations, theirrelationship to primitive anxieties and to our unconscious fear of death.Whether you buy it or not, I think it is a pretty interesting idea. It is an ideathat could not in my view ever have been born without the great andimportant ideas forged from the close study of particular organizationalexperience contained in the Menzies Lyth paper, that is part of her legacyto us.

References

Cooper, A. (2009) ‘Be quiet and listen’: Emotion, public policy and social totality. In:D. Jones et al. (eds), Emotion: New Psychosocial Perspectives, pp. 169–82. London:Routledge.

Cooper, A. & Dartington, T. (2004) The vanishing organization: Organizationalcontainment in a networked world. In: C. Huffington et al., Working Below theSurface: The Emotional Life of Contemporary Organisations, pp. 127–50. London:Karnac.

Eagleton, T. (2009) Reason, Faith and Revolution: Reflections on the God Debate.London: Yale University Press.

Jordan, S. (2008) Unpublished institutional observation paper, The Tavistock Clinicand University of East London.

Kraemer, S. (2007) The Quaker connection in the Tavistock Clinic’s development.Unpublished paper.

Menzies, I.E.P. (1960) A case-study in the functioning of social systems as a defenceagainst anxiety: A report on a study of the nursing service of a general hospital.


Human Relations 13: 95–121. [(1988) Reprinted in I. Menzies Lyth, ContainingAnxiety in Institutions. Selected Essays, Vol. 1. London: Free Association Books.]

Obholzer, A (1994) Social anxieties in public sector organizations. In: A. Obholzerand V.Z. Roberts, The Unconscious at Work, pp. 169–78. London: Routledge.

Rickman, J. (2003) A study of Quaker beliefs. In: P. King (ed.), No Ordinary Psy-choanalyst: The Exceptional Contributions of John Rickman, pp. 269–93. London:Karnac.

Wittgenstein, L. (1972) Tractatus Logico-Philosophicus. London: Routledge &Kegan Paul.

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legend, myth and idea: on the fate of a great paper

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