Arabella Kurtz reviews Armstrong and Rustin’s important and fascinating edited book on the relevance of the social defence model to the NHS today (oh and neoliberalism and the small matter of the global market economy)
My review of David Armstrong and Michael Rustin’s much recommended book ‘Social Defences Against Anxiety: Explorations in a Paradigm’ (Karnac Books, 2014) for Psychoanalytic Psychotherapy has just been published online. In it I draw on my experience of teaching Menzies Lyth’s ideas to clinical psychology trainees on the Leicester course. I also welcome the book’s emphasis on the integration of social and psychoanalytic perspectives in understanding experiences of our rapidly changing world.
An extract from the review appears below:
We are reminded by the editors that Elliott Jacques, who first coined the term ‘social defence system’, had a primarily psychological understanding of the concept. He saw it as the sum of the defensive needs of the individuals within it. However, Menzies Lyth introduced two important social aspects in her formulation of this type of group defence as a response to anxieties generated by the working task of the organisation, which is then expressed through a variety of social structures and procedures. There are a number of papers in this book, which aim to further extend the concept of the social defence to embrace a variety of social and cultural influences.
One of the most persuasive of these is Marcus Evans’ response to the Francis Report of 2013, which is based on years of clinical experience and psychoanalytic reflection. He poignantly describes the current demoralised state of the nursing profession in the light of the internal market economy and obsessively target-driven culture of today’s NHS. In his account ground-level staff now face anxieties from two distinct sources. As in Menzies Lyth’s day, there is considerable task-related anxiety in the form of the challenge of caring for the frail and vulnerable. But institutional anxieties about survival now exert a new and independent force. These are passed down, or in Evans’ words ‘pushed’, by managers into front-line staff. He packs quite a punch when he writes:
Far from the system containing front-line staff, there is a tendency for management to push their anxieties into them via shards of survival anxiety.
Arabella Kurtz, June 2016