The sense that professionals behave as they do because of the influence of the organisation in which they worked was not a new discovery. The seminal text was Isabel Menzies’ analysis of the behaviour of nurses in a hospital and how much of this was driven by the unconscious emotional underpinning of hospital life – the anxiety about death. Interestingly enough, we faced one symptom of this organisational life in the Bereavement Society in Milton Keynes when we tried to publicise the service to families of people who would die in hospital or after a stay in hospital. The idea that we would put up posters which alluded to the fact that people die was thought to be disturbing to the well being of patients and their families (as if this thought would not have occurred to them without our posters). This is however treating the defensive anxiety of the hospital as if it were just a problem to be overcome – the point about defences is that they are both dysfunctional and functional. They allow people to achieve things, care, be effective as well as get in the way of positive outcomes.
In the hospital, the way in which nurses’ tasks were allocated, as Menzies describes them, had a real purpose – all kinds of practical tasks had to be done and they would not be efficiently completed if staff were persistently distressed about sick patients for whom they were caring. Dividing jobs up into specialisms had the benefit of preventing nurses from getting too emotionally close to any particular patient. Whilst the hospice movement crystallised the possibility of handling things differently, the distress of staff about patients dying still has to be managed.