Isabel Menzies
Anxiety and stress is a natural and perhaps unavoidable part of organizational life. Pressures to conform to organizational norms are ever-present, even when members find them tolerable. For professions where the risks of failure are great, such as the loss of life, the potential for high anxiety can be equally great. At one level, individual members must develop ways of dealing with such anxiety, otherwise they may depart the organization.
Today’s reading is about how social defenses may emerge that collectively create conditions whereby members are protected against anxiety, perhaps even to the detriment of the individual. It is an article by Isabel Menzies titled “A Case-Study in the Functioning of Social Systems as a Defence Against Anxiety: A Report on a Study of the Nursing Service of a General Hospital,” published in Human Relations in 1960. Interestingly, Isabel did not set out to study anxiety – her research team from the Tavistock Institute was called upon to examine a structural problem at a teaching hospital. The professors needed their students to perform field work commensurate with the curriculum, but this was not matched by the needs of the patients coming to the hospital for treatment. It was during the interviews that Isabel uncovered a greater, more nagging problem that was driving nursing students to quit in the middle of the program.
The problem was that nursing students entered into the school to follow a calling to care for their human beings. What they witnessed was how the hospital environment, with its attendant procedures and rules, discouraged that same sense of calling. The reason was because of the potentially crippling effects of anxiety. A nurse who became too attached to a patient or the patient’s situation risked strong negative emotions should that patient pass away or the condition significantly worsen. The effects of that anxiety could lead to depression or otherwise harm the nurse’s performance. Thus, within the hospital emerged a series of odd procedures that served to prevent or preclude such close ties from occurring – continuous rotations of duties and patients served, lack of clarity in decision making, and constant last-minute changes. Nurses were also encouraged to limit their emotional contact or commitment to patients, their families, and other nurses. It was this realization that drove many good nursing students out.
In a move that might be more unusual in modern scholarship, Menzies contextualized anxiety within the psychological literature of the time, showing why anxiety is a natural emotion and why humans must develop ways to cope. However, the study shows how this can become, at least to an observer, dysfunctional.
Many of the sources of anxiety align well with today’s environment. The character and sources may change, but the nature of anxiety and how it affects us remain.
Part 1. The story of a teaching hospital and its students (released 12 April 2022)
Part 2. Modern sources of anxiety and collective ways of mitigating them (released 19 April 2022)
Read with us:
Menzies, I. E. P. (1960). A case-study in the functioning of social systems as a defence against anxiety: A report on a study of the nursing service of a general hospital. Human Relations, 13(2), 95-121.
To Learn More:
Lawlor, D. (2009). Test of time: a case study in the functioning of social systems as a defence against anxiety: rereading 50 years on. Clinical child psychology and psychiatry, 14(4), 523-530.
Other Talking About Organizations Podcast episodes referenced:
Episode 34. Sociotechnical Systems — Trist and Bamforth
Episode 35. The Managed Heart — Arlie Hochschild
Episode 38. Socialization and Occupational Communities — Van Maanen
Episode 67. Professions & Professionalism — Andrew Abbott
Title Image Credit: Jonathan Borba via Unsplash.com
I really enjoyed this episode and it’s a great paper. I am a psychiatrist at a teaching hospital in the US, and I read this paper with psychiatry residents in an organizational seminar that I run. The anxiety and organizational responses encountered by Menzies’ nursing students resonate very well with the experience of psychiatry trainees, and they often appreciate finding that in the paper. Catherine’s reflection on these defence mechanisms enduring into 2022 is right on. Thank you for another great discussion, it deepened and expanded my appreciation of the topic, and I will bring that back to the young doctors that I teach.
Thank you so much, Marshall, for your kind comments. I’m glad that our conversation was useful — we have wanted to cover Isabel Menzies-Lyth’s work for some time as it resonates not just within the medical community but professionals in many other high-risk or high-intensity fields. Cheers, and all the best. –Tom Galvin
Thanks for your response to my post, Tom. The second part of your Menzies episode was great, and I wished I could have jumped into your group conversation. It echoed the conversations physicians and leadership are having at my work about the struggles of my department to deliver proper patient care in the face of logics not based on actual patient care. The result has been a failure to control anxiety and the departure of staff, further undermining the task of patient care. This is starting to become a death spiral, and is occurring at a Harvard Med. School teaching hospital, where providers hoped there would be enlightened enough leadership to manage this dilemma.
On another note, I have been listening to your podcast for a few years, and I have learned so much, and it has prompted me towards other learning and reading about organizations. I hope you get regular positive feedback about how valuable your podcast is. I draw on your group’s insights as I ponder organizational issues and recommend episodes to my colleagues. Thanks for all the education. Marshall
Dear Marshall. First of all, thanks for listening and sharing your comments. It is a bit disheartening to hear about these struggles still happening today. But alas, it shows that the challenges related to organization and management are enduring (so still much to be studied and tried). What you describe also seems to touch on the clashing of professional and managerial systems or the erosion of professional standards in organizations. We are hoping to cover this theme in a future episode. For now, I wanted to flag some of the episodes related to high-reliability in complex settings, as Tom mentioned, like episode 11. Such an approach represents a model that mainstream leadership and management could learn from. By the way, suggestions for topics/readings are always welcomed.
We do not receive many messages from our listeners, so it is great to read that you find the podcast useful. It gives us the motivation and energy to continue =)
Dear Pedro. Thanks for your reply. Yes, the challenges related to organizations and management are enduring. I think they are part of the human condition, especially when we come together in groups, and papers like Menzie’s won’t offer many easy, concrete solutions, but can help us move with and survive the dilemmas. I’m involved with a regular group of physicians struggling to navigate conflicting professional and managerial imperatives, and its an exhausting effort, with the definition of “professional” seeming to shift to what management wants it to be. I am revisiting episode 11, and your current one (89) looks interesting, too. I have a couple of thoughts about potential topics for your group to cover, but I don’t know if either would really fit. One is the current work of Gianpiero Petriglieri, a psychiatrist and professor of management at INSEAD, who comes from a perspective similar to Menzies and is very humanizing in his approach to management education. Secondly, I think it would be fascinating to hear you discuss Karl Marx ‘s theory of alienation and how it applies to modern dilemmas of work. I see his underlying perspective recycled in many examples of how people just can’t stand their work anymore.
Dear Marshall, thanks for all these reflections and suggestions. The issue of professionals and managers; and the extent organizations allow for professionals to carry out their work according to their standards is indeed a threat across management research and practice. Seems like it would make a good topic for a dedicated episode as well.
I find the podcast extremely relevant to what is going on today in my own place of work. I am also a psychiatrist at a teaching hospital in the US, becoming a very sad witness to how many high-quality psychiatrists left due to feeling demoralized, burnout, and disgusted with a system that has become highly dysfunctional. The systemic causes are complex and beyond this comment but having administrators (professionals who don’t see patients and are more or less clueless about the nature of the work) as leaders of a clinical and teaching department only compounds the problem.
Dear Claudio, thanks for your message. This problem seems to be a systemic one. There is also evidence of a similar trend in other industries. It appears that management is increasingly detached from the task and purpose of an organization. The much-debated crash of the Boeing 747 has raised questions if the issue has arrived even in industries known for their emphasis on professional expertise. As I responded to Marshall above, I think it is time to start taking the lessons from high-reliability seriously—a theme we hope to touch on in a future episode. Do let us know if you have suggestions for topics/readings. Thanks for reaching out!